Community Participation in Community-based Rehabilitation Programmes

Central to the community-based rehabilitation (CBR) approach is the concept of community participation. While many projects are based on the CBR approach, it is not evident how many CBR projects indeed use and measure community participation. The purpose of this study was to qualitatively analyse the extent of evaluation of community participation in CBR studies evaluated over the last thirty years. A total of 22 evaluations of CBR projects were carried out. Three studies each from Australia, India, Zimbabwe and two studies each from England, Philippines, Vietnam and one each from Finland, Guyana, Jamaica, Japan, Pakistan, Papua New Guinea, Thailand, and the United States were included in the analysis. From the 22 studies that evaluated CBR, only six evaluated community participation. In the six evaluations that measured community participation, it was found that four documented positive effects of participation, while two showed that community participation did not work, or was inadequate in the project. Community participation as a construct has not been adequately measured by CBR programmes. There is need to measure all dimensions of participation including measurement of the number of people with disabilities reached and quantity and quality of resources generated as a result of community participation. Valid and reliable measures of community participation need to be developed. INTRODUCTION Three decades have elapsed since the World Health Organisation (WHO) introduced the community-based rehabilitation (CBR) strategy as part of its goal to accomplish “Health for All by the year 2000”(1). A training manual was produced in 1980 (2) which was revised in 1989 (3) and has now been translated in several languages for use at the village level. In