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Cost-effectiveness of a Community-based Rehabilitation Programme in Nepal

Vaughan, Kelsey
Thapa, Aradhana
2016

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Purpose: This study aimed to estimate the cost-effectiveness of a community- based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology to estimate the programme’s achievements and cost-effectiveness.

 

Methods: Financial records were reviewed to determine total expenditure during the period August 2011 - December 2013. Programme records which documented the physical, mental and social status of children and adults with a disability qualitatively before, during and after the intervention were used to determine a starting disability weight and improvement score, which was then converted into a change in disability weight. The disability weight and expected remaining lifespan of each person were used to estimate disability-adjusted life years (DALYs) averted by the intervention. The cost per DALY averted was estimated by dividing the total programme expenditure by the sum of DALYs averted over that same period.

 

Results: I2C cost 204,823 Euros to implement over the period August 2011- December 2013. In total, an estimated 1,065 DALYs were averted from the treatment and rehabilitation components. The cost per DALY averted was 192.34 Euros.

 

Conclusions and Implications: The methodology devised for the study was able to successfully estimate the cost-effectiveness of the I2C programme. Using WHO benchmarks, this programme can be considered highly cost-effective. Other organisations can assess the cost-effectiveness of their programmes by using the assessment improvement score and subsequent conversion to DALYs averted. However, while mental, physical and social gains have been captured, other benefits from I2C cannot be captured in the cost per DALY averted statistic. Further research is needed to develop methods for incorporating these harder-to- measure gains in cost-effectiveness studies with a single outcome measure like the DALY.

Human Rights

www.macao-tz.org
December 2014

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Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania.  Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods.  In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.

A feeling of belonging : an example of a community mental health project in Rwanda

FINEL, Elodie
PEGON, Guillaume
Eds
November 2012

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This video documentary and accompanying booklet present Handicap International’s approaches taken since January 2007 to restore the Rwandan population’s psychological well-being and its social cohesion after the genocide. Knowledge about setting up and implementing a community mental health project is shared for the information of Handicap International team members, partners and the public. General guidelines are offered to share expertise and technical perspectives in the field of mental health and psychological support

Is doing good "good" : professional motives vs. community needs

POLLARD, Nick
SAKELLARIOU, Dikaios
2009

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"This paper offers a critical discussion of the goodness of fit between professional motives and community needs in the field of community-based rehabilitation (CBR). Data were drawn from the authors’ involvement in a survey of occupational therapists involved in CBR and a search of CINAHL, PsychInfo and Medline online databases for related descriptive and analytical articles. Due to cultural differences and time constraints CBR professionals often are, and remain, ‘outsiders’ to the community they are working with. The focus of CBR is sometimes uncertain. Professional motives do not always meet community needs and good intentions do not necessarily transpire into sustainable, culturally appropriate action. The involvement of the community in all stages of programme development and implementation is important both to ensure relevancy and build alliances with the community. CBR needs to be approached and evaluated as a unique area of professional practice"

 

Asia Pacific Disability Development Journal, Vol 20, No 2

Tools together now : 100 participatory tools to mobilise communities for HIV/AIDS

INTERNATIONAL HIV/AIDS ALLIANCE
May 2006

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This publication provides a comprehensive selection of participatory learning and action tools and interactive exercises to enable communities, organisations and groups to work together and effectively in the design, implementation and evaluation of HIV and AIDS programmes. It was specifically designed to use alongside "All Together Now! Community Mobilisation for HIV/AIDS". The what, why and how of each tool is clearly described, and comments and suggestions for facilitators are also included. Each activity is accompanied by a chart, diagram or illustration that can be replicated or adapted in workshops and group activities. Tools are arranged in sections, including mapping tools, time analysis tools, linkages and relationship tools, experiential tools, prioritisation and quantification tools, action planning tools and PLA training tools. Examples of tools presented include: body mapping, community mapping, story with a gap, negotiation card game, picture story, chapati diagram, impact matrix and trust game

Capitalisation on network strengthening, community-based approach and partnership in mine risk education project : Lessons learned from experience in Angola

SAVI, Gabrielle
2006

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This report highlights three components of Handicap International's Mine Risk Education project in Angola. The first involves networking in the Angolan context and the associated lessons, constraints and the strengths. The second, is a discussion on the evolution of the community-based approach in Angola. Lastly, this report discusses the strengths and weaknesses of partnerships made with local NGOs

Inside voices : CBR workers stories

OKUNE, Joan
Ed
2006

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This book is an output from three CBR writing workshops held in Kenya, Tanzania and Malawi with the aim to facilitate the capacity of CBR workers to communicate their experiences thus increasing documentation of CBR practices in Africa. The book contains articles based on participants’ experience of CBR and is useful to anyone interested in CBR experiences in Kenya, Tanzania and Malawi

Mobilising the church : a PILLARS guide

CARTER, Isabel
2004

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Churches are often at the forefront in helping the poor and supporting communities, playing a role that goes beyond biblical teaching and spiritual support. This guide provides church members with material for discussion, designed to help churches to successfully manage their interventions, understand their role in the community, develop facilitation skills, increase confidence in their ability to carry out practical work and activities, improve relationships with other organisations and encourage openness and sharing of differing views. Drawing on key passages of the Bible, this guide consists of a brief introduction to each topic, accompanied by a set of questions designed to encourage group discussion

Report of the second meeting of the Global Alliance to eliminate lymphatic filariasis

GLOBAL ALLIANCE TO ELIMINATE LYMPHATIC FILARIASIS
2002

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This meeting was an opportunity for Global Alliance members to take stock of activities related to lymphatic filariasis (LF) elimination programmes at country, regional and global levels. This report aims to capture the basic elements of the discussion at the meeting. The aim was to enable the Alliance to build on progress to date and scale up coverage to ensure that by 2020 LF is eliminated. It is a useful resource for health managers

Guide to WHO documents concerning adolescent health and development

WORLD HEALTH ORGANIZATION (WHO). Department of Child and Adolescent Health and Development
2002

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Bibliography of WHO documents relating to adolescent health and development. It is divided into four sections which follow the logical programming steps: building political commitment, assessing priorities for action, maintaining implementation, and monitoring and evaluation

Human rights and disability : the current use and future potential of United Nations human rights instruments in the context of disability

DEGENER, Theresia
QUINN, Gerard
2002

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This study reviews the current use of the United Nations human rights instruments and how they can be developed further. It addresses the shift from a charity based and medical approach towards a human rights, advocacy and empowerment based approach of disabled people's organisations.The study examines different human rights conventions and how they can be applied to people with disabilities and offers national case studies.The study is aimed at people with disabilities, policy makers and organisations working with disabled people

Understanding community approaches to handicap in development (CAHD)

KREFTING, Douglas
March 2001

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This document, part of the Handicap and Development Collection, introduces an expanded concept of community-based rehabilitation (CBR) called CAHD (community approaches to handicap in development). It is aimed at CBR planners, policy-makers and managers. CAHD aims to develop two-way relationships within communities to change attitudes so that community practices will include disabled persons and provide them with services and assistance

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