Impact of CBR: Community-Based Rehabilitation Programme in Mandya District (Karnataka, India)

A wide variety of very different and complementary approaches are taken in developing countries, such as India, to adequately respond to the needs of persons with disabilities. CBR programmes are considered fundamental for improving the well-being of persons with disabilities, and for fostering their participation in the community and society at large (Cornielje, 2009; Sharma, 2007). CBR programmes are also considered, in theory, to be the most cost effective approach to improving the well-being of persons with disabilities, in comparison with care in hospitals or rehabilitation centres (Mitchell, 1999). The original CBR strategy was to promote the use of effective locally developed technologies to prevent disability, and transfer knowledge and skills about disability and rehabilitation to persons with disabilities, their families and the community at large (WHO, 1976). However, more than three decades later, there is little literature providing evaluations of the impact of CBR programmes on the well-being of persons with disabilities. This can partially be explained by a tendency to concentrate resources on the implementation of CBR rather than on research and evaluation. Within the CBR literature which does exist, there are many identified gaps that pertain to the substantive issues this research seeks to address. Firstly, there are still no universally agreed criteria for the evaluation of CBR programmes (Cornielje, Velema, and Finkenfugel, 2008). Secondly, there is little research available on the effective participation of persons with disabilities, families and communities in CBR. There is therefore little evidence to address the criticism that many CBR programmes are managed using a “top-down” approach, and do not effectively engage with persons with disabilities or their organizations. Our research project aims to contribute towards filling this gap, using an original methodology — capabilities based on a potential outcomes framework — based on different measurement tools which explore various facets of the programmes’ impact. This project is timely as the WHO is collecting information about CBR in order to test their new version of the Community Based Rehabilitation manual (published at the end of 2010). This information will also address the need for more knowledge about how to effectively ensure equal opportunities for persons with disabilities, as emphasized by the UN Convention of the Rights of Persons with Disabilities (2006). In particular, our research assesses the impact of the CBR approach on the lives of persons with disabilities and their communities in two CBR projects covering the Mandya district and neighbouring areas of Ramanagaram district in South Karnataka State in India. The overall Research Initiative called S-PARK/CBR (Samagama Participatory Action Research and Knowledge in Community Based Rehabilitation) is organized in three main phases, which are partly consecutive and partly parallel: Phase 1: Quantitative research based on a large-scale survey of persons with disabilities and some key stakeholders in the areas covered by CBR and in control areas. The present volume reports on this phase of research. Phase 2: Emancipatory research focusing on the mapping of different barriers faced by persons with disabilities in the communities, their strategies for overcoming these barriers and the part played by the CBR programme. This research is conducted by representatives of persons with disabilities from Mandya district with support from a scientific advisory group. Phase 3: Participatory research for in-depth understanding of key issues emerging from the first two phases of the research through the introduction of emancipatory research approach in routine CBR activities of the two projects. During the large-scale survey and their main conclusions. The research obtained relevant results for the literature, and these are detailed in the following chapters of this volume. Firstly, the research aimed to understand and measure the overall role and impact of CBR in improving the quality of life of persons with different types of impairments, as well as different demographic, social and economic backgrounds. Quality of life is determined in the capability approach framework by the freedom of people to do and to be what they value (Sen, 1999). Therefore, we investigated the effectiveness of CBR programmes in improving the control that persons with disabilities have over their daily lives, participating in different aspects of community life (i.e. combating stigma and prejudice), and accessing various services, over the five domains of the CBR matrix (health, education, livelihood, social and empowerment). Furthermore, we examined to what extent persons with disabilities involved in the CBR programmes are improving their socio-economic conditions, and therefore escaping from multidimensional poverty (Sen, 1992). We found that the CBR programmes have rather a positive impact on the well-being of persons with disabilities in the examined district in most areas of intervention: health, education, livelihoods (including opportunity for employment), disability rights, and social participation. It is also relevant to notice that the findings show that participation in CBR has an impact in terms of changing mentalities and fighting prejudice and exclusion. Secondly, we investigated the factors which constitute barriers to access CBR activities and support. The research should highlight whether the CBR programmes are completely inclusive of all groups of individuals with disabilities. The results on the CBR coverage are very relevant since they disentangle the question of inclusion and access to CBR activities. Almost 60% of persons with disability are part of CBR. Furthermore the persons who are not part of CBR are less poor, have more mild disabilities and are older. Thirdly we tried to capture spillover effects of CBR – i.e. if in the area of CBR activities there is an effect on the well-being of other persons from the community, such as the caregivers, and on the community social environment through the heads of villages, social workers and teachers. We found evidence of spillover effects in the community of the area of CBR both at village level and for individuals such as the caregivers. Health Cooperation Papers Volume 18 - 2012, This research is part of a Joint Plan of Work between the Disability and Rehabilitation team of World Health Organisation (WHO/DAR) and the Italian Association Amici di Raoul Follereau (AIFO).