Community-based Rehabilitation Projects Research Articles

Ethics and Community-Based Rehabilitation: Eight Ethical Questions from a Review of the Literature.

Purpose: This article reviews the literature regarding ethics and community-based rehabilitation (CBR) with the goal of identifying and analyzing ethical considerations associated with this approach. Method: We conducted a critical interpretive review of the academic literature related to CBR in low- and middle-income countries and to indigenous communities in high-income countries. Using an inductive analysis of the collected articles, we identified five key topic areas related to ethical considerations. We then critically appraised this literature and developed eight questions that reflect areas of ethical tension, uncertainty, or debate. Results: The five key topic areas are partnerships among stakeholders, respect for culture and local experience, empowerment, accountability, and fairness in programme design. The eight ethical questions are linked to these topics and associated with how CBR practices reflect commitments to equity, respect, inclusion, participation, and social justice. Conclusion: Continued engagement with ethical considerations associated with CBR can help to strengthen the foundations of this important and influential approach. It is crucial that all those involved in CBR projects, including physiotherapists, pay careful attention to the development of partnerships that, despite asymmetries among stakeholders, are respectful and effective.

Teaching Children with Learning Difficulties via Community-Based Rehabilitation Projects in rural Sri Lanka

Teachers in rural Sri Lanka find it challenging to support students with Learning Difficulties (LD) in regular classrooms. As a result, students with LD often quit school early. Community-Based Rehabilitation (CBR) projects located in rural areas sometimes provide learning opportunities for students who are school dropouts. Purpose: The research focussed on identifying an effective teaching approach that Developmental Assistants (DAs) can employ when teaching students with LD. Methods: An action research methodology with two action cycles was selected for this purpose. Each cycle consisted of four stages: analysing, reflecting, planning, and implementing, and monitoring. Data collection involved semi-structured interviews and real-time observations. A combination of qualitative and quantitative methods was adopted for data analysis. Research participants included 11 students aged 8-14 years, their parents and two DAs. Results: Outcomes suggest that students with LD actively engage in learning when an integrated approach that uses thematic units which reflect the students’ world, is in force. They also benefit when some elements of the behavioural approach to teaching-learning: explicit direct instruction, modelling, scheduled practice, reinforcement and feedback, are combined with certain components of the constructivist approach: independent work, group discussions and reflection. Conclusions: The study demonstrates that students with LD can succeed when the teaching-learning process is modified to suit their needs. Hence, CBR project workers ought to be trained to plan and design lessons that meet the needs of students with LD. It further validates the role CBR projects can play in diminishing negative views on disability and in creating inclusive societies. Limitations: The study’s illuminative design was appropriate within a limited sample of students. However, this sample is not wholly representative of the multicultural and multi-religious student population with LD in hard-to-reach areas of Sri Lanka.

Protecting Children with Disabilities from Violence in CBR Projects: Why we need to work with a different form of child protection policy for children with disabilities

Children with disabilities encounter more violence in their lives than their peers without disability. Organisations involved in Community Based Rehabilitation (CBR) come across many cases of violence against the children they work with. Many organisations have no policy on child protection since it is not within the scope of their expertise. Others work with child protection policies that are hard to apply in the realities they deal with. Through research done in Ethiopia, with a recent update, the author attempts to show that there is a need for policies in CBR, that follow a community approach rather than an individual approach to child protection.

Prevailing Practice and Perception on Managerial Aspects of Community Based Rehabilitation Projects in India

Prevailing Practice and Perception on Managerial Aspects of Community Based Rehabilitation Projects in India

Reflections on Community-based Rehabilitation

Community-based rehabilitation (CBR) has grown and evolved over the last three decades, from being a service delivery approach for persons with disabilities living in rural areas in developing countries, to a world-wide accepted strategy and movement, based on inclusive community development principles. This article traces the origins and current understanding of CBR, goes on to discuss some of debates around the concept of CBR, and introduces the WHO CBR Guidelines. The Guidelines provide a structure for CBR planners and practitioners, based on a synthesis of CBR experiences from different regions of the world, and are an attempt to build on existing field level practice. The Guidelines demonstrate how CBR can be a useful strategy to achieve the goal of inclusive development for persons with disabilities. The Guidelines also provide a much needed framework for monitoring and evaluating CBR projects, with the increasing calls from around the world for strengthening the evidence base for CBR.

SIG 17 Perspectives Vol. 1, No. 1, May 2011

SIG 17 Perspectives Vol. 1, No. 1, May 2011

Meeting the Needs of Women in Mental Health Rehabilitation Services

A service evaluation investigated the gender sensitivity of a London mental health rehabilitation service, including interventions to increase participation in women-only groups and activities. Method: A total of 40 female service users and 13 staff teams from 13 inpatient and community-based rehabilitation projects completed questionnaires regarding the service's gender sensitivity. Results: Most projects provided women-only space and the majority of female service users had a female keyworker, but there was limited provision and uptake of women-only groups and activities. Conclusion: A focus on collaboration with female service users to identify and establish, where lacking, groups and activities that appeal to women service users is needed to increase meaningful occupation.

Living with spinal deformities: the Indian experience

India has the largest number of cases of spinal deformities in the world. The major causes of such deformities are malnutrition, water impurities, post-polio complications, calcium deficiency, congenital conditions, social violence and accidents. In India, there are very few medical centers which can perform corrective surgery and even fewer capable of rehabilitation. Community based rehabilitation projects also lack the infra-structure and expertise to deal with spinal deformity cases. Individuals with spinal deformities are marginalized, stigmatized and discriminated in the society. Folklores and religious scripture reinforce the prejudices against individuals with a hunchback or crooked spine. Some charitable and religious institutions do cater to the basic needs of these individuals; however, their meaningful participation in social life and in proper employment remain distant goals.

Success indicators for integrating mental health interventions with community-based rehabilitation projects

Community interventions for people with physical disabilities and for people with mental illness have evolved following similar trajectories, although at different periods of time. This study develops and tests indicators for successful integration of community-based rehabilitation (CBR)-mental health and development (MHD) services. An in-depth study was conducted of two organizations in Sri Lanka and India that successfully integrated CBR and MHD services as well as two organizations in Nepal and Bangladesh, which were planning integration. Interviews and focus groups were used to gather nonconfidential information. The study suggests many benefits of integration and several indicators of readiness: willingness to work with mentally ill people, a basic understanding of the mental health concept and mental illness problems, a match of context and strategy between current CBR activities and proposed MHD activities, stability of basic resources and infrastructure in the organization. A second set of indicators determined the long-term viability of an integrated CBR-MHD approach: ability to strategize and plan a mental health programme, ability to network with stakeholders effectively, ability to make use of resources efficiently. A major finding of the study was the need for training in the practical aspects of integration of mental health interventions with CBR. Tool sets are available that can be used by donors and by local organizations for assessing needs and readiness as well as developing viable strategies for the integration of community-based mental health interventions into existing CBR work.

Systematic synthesis of community-based rehabilitation (CBR) project evaluation reports for evidence-based policy: a proof-of-concept study

BackgroundThis paper presents the methodology and findings from a proof-of-concept study undertaken to explore the viability of conducting a systematic, largely qualitative synthesis of evaluation reports emanating from Community Based Rehabilitation (CBR) projects in developing countries.MethodsComputer assisted thematic qualitative analysis was conducted on recommendation sections from 37 evaluation reports, arising from 36 disability and development projects in 22 countries. Quantitative overviews and qualitative summaries of the data were developed.ResultsThe methodology was found to be feasible and productive. Fifty-one themes were identified and the most important ones of these are presented to illustrate the significance of the method. The relative priorities of these themes indicated that "management" issues were the primary areas in which recommendations were made. Further analysis of themes reflected the emphasis evaluators placed on the need for enhanced management, organisational, personnel and administrative infrastructure in CBR projects. Evaluators consistently recommended that CBR projects should be more connected and collaborative at governmental, organisational, political and community levels. The synthesis also noted that evaluators questioned the emphasis in CBR on project expansion and income generation.ConclusionThe application of the synthesis methodology utilised in this proof-of-concept study was found to be potentially very beneficial for future research in CBR, and indeed in any area within health services or international development in which evaluation reports rather than formal "research evidence" is the primary source material. The proof-of-concept study identified a number of limitations which are outlined. Based on the conclusions of 37 evaluation reports, future policy frameworks and implementation strategies in CBR should include a stronger emphasis on technical, organisational, administrative and personnel aspects of management and strategic leadership.

Operationalizing community participation in community-based rehabilitation: Exploring the factors

Purpose. The purpose of this article is to critically discuss issues that pertain to the operationalization of community participation in community-based rehabilitation (CBR).Method. Data were drawn from an international, questionnaire-based survey of occupational therapists involved in CBR conducted through the World Federation of Occupational Therapists. A search of CINAHL. PsychInfo and Medline databases for articles on CBR was performed and both descriptive articles and analytical ones were included.Results. Although there are guidelines on the nature of CBR these do not always match its application in practice. Active involvement of local communities in CBR projects is often limited, threatening the sustainability of CBR programmes. Furthermore, the failure to acknowledge the sociopolitical underpinnings and the cultural nature of disability is likely to compromise the nature of disabled people's involvement in CBR.Conclusions. There is confusion and lack of clarity about the nature of CBR. Educational modules on CBR should be made available to professionals. These should consider the importance of community involvement and context-specific and culture-sensitive programmes in practice.

The evidence base for community-based rehabilitation: a literature review

Literature on community-based rehabilitation (CBR) published between 1978 and 2002 is reviewed to assess the evidence base for CBR. There were 128 articles found that met the criteria set by the authors. The articles have been classified according to the methodology used and the key aspects studied. The review showed an ever-increasing number of publications on CBR. Theory papers and descriptive studies are the most common types of papers in CBR literature. Intervention studies and case reports are relatively rare. No systematic review has yet been carried out although reviews on specific aspects of CBR have become available. The key aspects of 'implementation' and 'stakeholders' are relatively well presented but the numbers of articles on 'participation' and 'use of local resources' are noticeably low. This study reveals that there is no real focus of research in CBR and therefore the evidence base for CBR is fragmented and incoherent on almost all aspects of CBR. It is recommended that comprehensive review studies should be carried out on key aspects of CBR projects. This should be supported by systematic research in CBR projects in order to establish evidence-based practices.

Rehabilitation services for visually impaired persons in West Africa, the challenges of integration

The World Health Organisation estimates that not more than 2% of the disabled people have access to any form of rehabilitation services in the developing world. The emergence of community-based rehabilitation (CBR) as a community development strategy for increasing coverage of rehabilitation services to disabled people generally with the involvement of communities and families in the delivery processes seem to be catching on fast with many donors and implementing agencies in almost every country in West Africa. Target beneficiaries in our CBR programmes are predominantly irreversibly visually impaired persons, their families and the local communities as primary stakeholders. Low vision services for both adults and children are yet to go beyond the provision of affordable glasses. Programmes are managed within a comprehensive eye service set up. Local governments and mainstream service providers currently participate in the rehabilitation process as secondary stakeholders. The main frontline personnel are trained and resourced volunteers, while core technical staff co-ordinate service delivery that range from psychological, social and economic services. In response to key recommendations of a recent evaluation of the CBR projects in the Gambia and Ghana, Sight Savers is embarking on a review process that will shift greater participatory roles to visually impaired people, their organisations and local governments as key stakeholders in the design, implementation, monitoring and evaluation of CBR from a programme structure and perspective.

A community of citizens: disability rehabilitation in the Palestinian transition to statehood

Purpose : It has been widely argued that community based programmes offer considerable advantages to the classical institutional forms of health and rehabilitation services delivery. With about 10 years of experience in operating community based rehabilitation projects (CBR) for the disabled, the Palestinian experience points to potentially serious problems relating to the conception and operationalization of such programmes in real life situations. Issues : Of importance is the issue of the impact of communal care on the already burdened lives of women, especially when such care is expected to be voluntary in nature. Caretaking in the Palestinian context, especially of the disabled, elderly and the sick, is a pre-defined sex linked role dictated by a patriarchal society and system of policy making that excludes women from economic and social life. The voluntary care aspect entailed in the CBR conception and practice, can and does contribute further to the exclusion of women not only from the labour force, but from most other aspects of life as well. This represents an apparent contradiction between the needs of two excluded groups, the disabled and women. The other problematic entailed in the communal model of caring for the disabled is the strategic and operational bias focusing on community, to the exclusion of the notion of social rights of all citizens, and the role and duty of state structures in the fulfilment of the disabled basic needs. Such an approach can only relegate the disabled rights back to their original place as charity. On the other hand, when CBR projects are operated holistically, in the context of social movements existing within power relation and with a broader democratic agenda engaging different groups - including a disability movement - as is currently taking place in Palestine, CBR projects can also turn into a mobilizing force for the social rights of all excluded groups. Conclusion : Thus the question is not merely one of governmental involvement as opposed to the involvement of nongovernmental organizations and charitable societies in community based projects. Rather, it is a question of the right to a decent life for all, in dignity and security, that citizenship and statehood promise, but have yet to deliver in many developing countries, especially in Palestine.

Appreciation of community-based rehabilitation by caregivers of children with a disability.

Evaluations of community-based rehabilitation (CBR) programmes generally focus on quantitative data. To gain insight into the determinants of the outcomes, process-oriented data are needed. From the literature six variables have been identified that possibly correlate with the evaluation of CBR by caregivers of children with a disability. These variables are: (1) traditional beliefs, (2) impact of a child with a disability on the caregiver, (3) community involvement, (4) perceived ability to teach the child, (5) attitude towards various health services, and (6) expectations for the future of a disabled child. The study was done in the CBR projects in Zimbabwe. Seventy-five caregivers were interviewed. Background, perceived abilities to teach and expectations of the caregivers were very different. This study revealed a significant correlation between the appreciation of CBR and the attitude towards various health services, and between the perceived ability to teach and the expectations for the future of the child.

Disability and special educational provision for children with disabilities in low income countries

ABSTRACT Causes of disability are investigated and linked to the state of the health care infrastructure in low income countries. The health education component in both Primary Health Care and Community Based Rehabilitation is discussed with reference to the prevention of impairment, disability and handicap. The existence of educational provision for children with different categories of disability and Community Based Rehabilitation projects in each low income country has been tabulated. Details of strategies to improve and increase educational services for these children are given in the framework of information exchange, organization, training and resourcing. The inequality between high and low income countries in financial resources is an issue that runs throughout the paper.