Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review

Abstract

BackgroundCommunity-Based Rehabilitation (CBR) has evolved over the last 30 years and now focuses on empowering persons with disabilities to access and benefit from a wide range of services. The evidence for CBR is frequently cited in the literature as being scanty and of poor quality.PurposeWe sought to determine how CBR is conceptualised and understood in the literature from Southern Africa. Our interest centred on to what extent the literature could inform policy makers and practitioners in the region.MethodsA systematic review of the literature from countries in Southern Africa guided by Population, Intervention/Phenomenon of Interest, Context and Outcome of Interest to the reviewer (PICO) was employed. This involved an extensive, internally valid and systematic search of electronic databases using specific keywords/subject heading combinations. Journal articles reporting on a description or objectives of CBR, published after 2006, and journal articles written in English of all types of studies were included. Data were charted according to the emergent themes. Two independent raters coded the emergent themes.ResultsNine from a possible 257 published articles were reviewed; four of these were programme evaluations. Themes describing CBR converged on community development and poverty reduction. Only one article referred to human rights. Training and supervision of CBR workers and education of the community about disability were frequently reported activities.ConclusionIn isolated cases, the literature is aligned to components of the CBR matrix. However, consistent with previous criticism of CBR, the literature is meagre, as is the evidence to inform policy makers and practitioners in southern Africa.

Training Needs of Community-based Rehabilitation Workers for the Effective Implementation of CBR Programmes

“…Government leadership and support is also important in establishing credible and sustainable training programmes to ensure both national and international commitment to pursue inclusive development through CBR (Lehmann, 2008;Hartley et al, 2009;Kuipers and Cornielje, 2012;Lewis Gargett et al, 2016;M'kumbuzi and Myezwa, 2016). Since governments are responsible for developing and implementing policies as well as for the coordination and provision of resources (M'kumbuzi and Myezwa, 2016), CBR programmes need to maintain effective collaboration with governmental bodies when developing comprehensive policies on training and the role of mid-level CBR workers (Chappell and Johannsmeier, 2009).…”

“…A number of articles emphasise the need for more rigorous evaluation of the content, methods, and impact of training on service provision; however, the same studies provide limited information on their methods of evaluation or how further evaluation should be conducted (Rule et al, 2006;Finkenflügel and Rule, 2008;Narayan and Reddy, 2008;Shamrock, 2009;Rule, 2013;Raj and Thomas, 2015). Several other reviews on the conceptualisation, characteristics, and impact of CBR consistently report concerns with the methodological quality of evaluation in CBR (Cleaver & Nixon, 2014;Iemmi et al, 2016;M'kumbuzi and Myezwa, 2016). However, the complexity and diversity of CBR creates challenges in monitoring and evaluation of training, including cost, limited capacity and time, and multiple methodological approaches (Cornielje et al, 2008;Lukersmith et al, 2013;Weber et al, 2016).…”

Part 1: A review of using photovoice as a disability research method: Implications for eliciting the experiences of persons with disabilities on the Community Based Rehabilitation programme in Namibia

“…Community Based Rehabilitation is recommended as one of the best strategies for promoting access to services for persons with disabilities in developing countries (Helander 2007 ). Further, it has been adopted as a response, in both developed and developing countries, and as a strategy to make available sufficient and appropriate rehabilitation services to a greater number of persons with disabilities (M’kumbuzi & Myezwa 2016 ). Over the past three decades, CBR has been an effective way of providing care at a local level with integration into primary health care (PHC) for persons with disabilities, particularly those living in remote rural areas.…”

“…At community level, the family plays an important role in providing support and rehabilitation to the person with disability. The intermediate level has professionals linked to government providing support, specialised interventions, training and technical supervision to the community (M’kumbuzi & Myezwa 2016 ). The government offers the overall planning, coordination and evaluation role to CBR at the national level (Helander 2007 ).…”

Part 2: The feasibility of utilising photovoice method and the World Health Organization Quality of Life instrument in evaluating the Community-Based Rehabilitation programme in Namibia: A pilot study

“…Furthermore, the CBR Guidelines (WHO et al 2010 ) added a new rights-based approach with an emphasis on inclusion and active participation of persons with disabilities. As a result of the evolving concept of CBR, it has been implemented in various contexts thus affecting the global scope on CBR evaluations (M’kumbuzi & Myezwa 2016 ).…”