Development of indicators for monitoring Community-Based Rehabilitation

Abstract

BackgroundCommunity-Based Rehabilitation (CBR) is a multi-sectoral approach working to equalize opportunities and include people with disability in all aspects of community life. Reliable and internationally comparable data needed to monitor and evaluate CBR are scarce, partially due to the absence of standardized indicators. The objective of this manuscript is to describe the collaborative development process which led to the World Health Organization's (WHO) recently launched set of standardized CBR outcome indicators.MethodsThe WHO's CBR Guidelines recognize CBR as a comprehensive and multi-sectoral strategy, and were therefore used as the starting point for the development of the indicators, in a consensus process involving WHO and International Disability and Development Consortium. Pilot implementations in Guatemala, Egypt and China using a specifically developed mobile phone application to collect data, and an online expert survey were completed to assess validity and feasibility of the indicators and their corresponding questions.ResultsThe indicator set includes 13 Base Indicators which are broad enough to capture the situation of people with disability in settings where CBR is carried out, independently of the specific CBR activities carried out in a community; and 27 Supplementary Indicators that provide more specific coverage and can be selected based on the specific goals of a CBR program.ConclusionThe indicators were suitable to assess differences in health, education, social life, livelihood and empowerment between people with disability and other community members. This comparability provides valuable information to CBR managers, donors and government agencies, to guide decision making, support advocacy and improve accountability. The CBR indicators will support WHO and its member states in their efforts towards strengthening CBR, by generating evidence on its effectiveness.

Using Concept Mapping to Develop a Human Rights Based Indicator Framework to Assess Country Efforts to Strengthen Rehabilitation Provision and Policy: The Rehabilitation System Diagnosis and Dialogue (RESYST) Framework

“…While many of the results of this project reinforce those from previous studies suggesting indicators to monitor important aspects of rehabilitation services and policy such as admission and discharge barriers to medical rehabilitation [76], multi-level barriers in access to community based rehabilitation [77], patient satisfaction [78,79], rehabilitation workforce density [80] etc., there were several new findings. Human rights indicators capturing the legal and regulatory landscape of rehabilitation services, which ranked highly in both importance and feasibility, were not mentioned in previous studies, except with reference to the ratification of human right treaties [13,81] and the recognition of disabled people's right to health in national constitutions [82].…”

Perspectiva ética de la rehabilitación basada en la comunidad en el contexto chileno.

“…La rendición de cuentas es una preocupación importante en los programas de RBC, esta promueve la legitimidad de las iniciativas e incluso facilita los procesos de empoderamiento en la comunidad (6,30). El accountability 2 " se refiere a la necesidad de controlar el poder público por medio de mecanismos que obligan a los funcionarios a informar y justificar sus acciones" (31).…”

“…Se plantea desde dos aristas, la primera se relaciona con la inversión del recurso público en la política estatal, ejemplo de ello son las plataformas Chile indica y Chile transparente de acuerdo a los principios de gobernanza (32). La segunda, se relaciona con los resultados y el desarrollo de indicadores que den cuenta de la implementación de RBC (6,30), aspecto a mejorar según lo señalado en el plan de acción global sobre discapacidad (30,33) que evidencie la brecha existente entre persona sin discapacidad y personas con discapacidad respecto a la igualdad de oportunidades (6).…”

“…Esta desigualdad constituye un imperativo ético donde debiese existir una inversión social que equipare oportunidades para toda la población, considerando la diversidad existente (30).…”

Implementation Research in Community Based Rehabilitation

“…CBR has gained the recognition of the WHO and governmental and non-governmental organisations due to its inclusive participation of all members and parties of a community, especially in countries of low-middle income (Darawsheh, 2017;Velema et al, 2010;WHO, United Nations Educational, Scientific (Darawsheh, 2017;Finkenflügel, Wolffers, & Huijsman, 2005;Velema et al, 2010;Mason, Weber, Atasoy, Sabariego, & Cieza, 2017).…”