Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya District, in India

Abstract

Purpose: In this paper, we measure the effectiveness of Community-Based Rehabilitation (CBR) programmes in promoting the well-being of people with disabilities and removing the barriers to their participation in family and community decision-making processes. Method: To evaluate the impact of the CBR programme, we use data from a large-scale control study in Karnataka, India. Propensity score matching is used to evaluate the impacts on disabled persons after 2, 4 and 7 years of entering the CBR. The theoretical framework for the analysis is based on the CBR guidelines, which are combined with the International Classification of Functionings (ICF), the United Nations Convention on the Rights of People with Disabilities (UN CRPD) and Amartya Sen’s capability approach. Results: CBR has a positive impact on the well-being of persons with disabilities participating in the programme and particularly on their participation within the family and the society at large. Conclusions: CBR programmes have a multidimensional and positive impact on individual and collective capabilities; on individual, agency and social empowerment.

Implications for Rehabilitation

• Community-Based Rehabilitation (CBR) can make a lasting difference in the life of persons with disabilities.

• CBR improves participation and inclusion of persons with disabilities in the family and in the community.

• Community-based rehabilitation
• impact evaluation
• participation

Acknowledgements

We are grateful to Parul Bakhshi and Ramesh Giriyappa for their research support and to Hannah Kuper and Fabrizia Mealli for their suggestions. We also wish to thank the persons and organisations that participated in the initial definition of S-PARK/CBR research protocol, especially Alana Officer and Chapal Khasnabis from WHO/DAR and the members of Scientific Advisory Group and their organisations and institutions: K. Devapitchai, M. V. Jose, Mary Kutty, Leela, M. Mahesh, K. Nagamma, M. Natrajan, K. R. Rajendra, H. Rao, K. Srinivasan, T. V. Srinivasan, R. Vardhani, M. Vaz and J. C. Victor. We also thank the staff of the two CBR projects under MOB and SRMAB, the survey participants, members of RCG and the research facilitators and AIFO India office for their support without which this research would not have been possible. Finally, we are especially grateful to the people of Mandya and Ramanagaram districts who participated in the survey with patience and courtesy.

Notes

¹In general, research on rehabilitation has several characteristics that distinguish it from biomedical research, resulting in different caveats: small sample size, ethical issues with controlled trials if services are denied for control groups [43, pp. 119–120].

²For details on the characteristics of these three approaches, see [36].

³The nine types of disabilities (as in Table 1 later) are from the WHO CBR Manual (Training in the community for people with disabilities, Helander E et al., WHO, Geneva, 1989) because the CBR programme uses these same categories in the field. The questions were formulated keeping in mind the types of disabilities in the WHO CBR manual and the recommendations of the Washington group.

⁴The participation scale was developed initially by WHO to measure effect of stigma on persons with mental illness. Van Brakel et al. [39] used this scale in different countries to measure effect of stigma on participation of leprosy affected persons in different aspects of community life. In our research the Participation scale version 5 developed by the “Participation scale development team” under Wim Von Brakel was taken and rearranged during the field testing.

⁵The CBR programme did not have a common starting date across villages. This [effectively?] means that some villages covered by the programme are considered “control” villages prior to joining the programme. For example, villages where the programme started in 2002 can be compared, some years later, with villages where the programme started in 2004, 2005, 2006.