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Improving Accessibility to Medical Services for Persons with Disabilities in Thailand

NUALNETR, N
SAKHORNKHAN, A
2012

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Purpose: This action research aimed at developing an action plan to improve the accessibility to home health care and assistive devices for persons with disabilities in a rural community, and to evaluate changes in the numbers of such persons who received appropriate home health care and assistive devices after a three-month implementation of the action plan.

 

Method: The study was conducted at a sub-district of Maha Sarakham Province, Thailand. The main beneficiaries were 99 persons with disabilities (mean age 55.4±18.7 years). Group meetings were organised for persons with disabilities, caregivers, and various community members. An action plan for improving the accessibility of persons with disabilities to home health care and assistive devices was collaboratively formulated and implemented for three months.

 

Results: The main strategy for improving accessibility was to increase the competency of village health volunteers in providing home health care and assistive devices to persons with disabilities. After the three-month action plan implementation, the number of persons with disabilities who received appropriate home health care, i.e. at least once a month, significantly increased from 33.3% to 72.2% (Chi-square test, P<0.01, 95% CI 18.5 to 59.3). The number of persons who received assistive devices suited to their disabilities also significantly increased from 33.3% to 58.3% (Chi-square test, P=0.03, 95% CI 3.5 to 46.5).

 

Conclusions: Under the supervision of physical therapists and/or other allied health professionals, the village health volunteer is likely to be a key person for improving the accessibility to home health care and assistive devices for personswith disabilities in a rural community.

 

Limitations: The study was limited to only one sub-district. No comparable areas were studied. Further, since the study recruited persons with disabilities from a rural community, applicability of the findings to persons with disabilities in an urban community should be considered judiciously.

Lady Health Workers (LHWs) as Flag Bearers for Children with Disabilities in Pakistan

LASI, S Z
QAYYUM, A
RAFIQUE, G
2012

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Purpose: This study explores the perceptions, knowledge and attitudes of LHWs towards children with disabilities in Pakistan. It considers the feasibility of utilising the LHWs for prevention, early identification and management of disabilities for these children in the community.

 

Methods: Two Focus Group Discussions (FGDs) were conducted with 15 Lady Health Workers (LHWs), and two In Depth Interviews (IDIs) with LHWs of both a semi-urban and a rural community of Pakistan.

 

Results: LHWs were found to have major concerns and strong emotions regarding children with disabilities. They also revealed the insensitive attitude of community members towards these children. While they understood the major types and magnitude of disabilities better than lay persons, they lacked the knowledge to manage these disabilities. Consanguineous marriages were identified as the main cause of disabilities. LHWs reported that education and health facilities were lacking in semi-urban and rural areas, and demanded that the government provide these facilities for the children. They also expressed their willingness to work for these children, provided they had the approval of higher authorities and were given proper training.

 

Conclusions: This qualitative exploratory study recommends that the existing primary health system be reviewed, and the possibility of introducing community based rehabilitation services, utilising LHWs’ services for children with disabilities, be examined. In this regard, it is imperative to assess the existing training modules of LHWs and to introduce modules on prevention, early identification, and management of children with disabilities. It is also necessary to employ mass media to spread awareness about persons with disabilities.

A Low-intensity Approach for Early Intervention and Detection of Childhood Disability in Central Java: Long-term Findings and Implications for “Inclusive Development”

KUIPERS, P
MARATMO, J
2012

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Purpose: This paper describes a qualitative follow-up study, conducted eight years after completion of a low-intensity early intervention and detection of childhood disability project in Central Java, Indonesia. The original project sought to increase the level of skills and engagement of existing community health volunteers, for the support of children with disabilities. This follow- up study explored long-term outcomes and implications for the inclusive development approach.

 

Method: Semi-structured interviews were conducted with 18 of the original volunteers. Interview notes were translated and thematically categorised.

 

Results: While the study was qualitative and descriptive, results indicate that despite the low intensity of the project, some early detection and prevention activities were still going on eight years later.

 

Conclusions: The study suggests that a low-intensity initiative such as this, which is closely aligned with the goals of a government department, may indeed achieve some ongoing change by extending the focus of the department towardsdisability-related concerns.

 

Implications: Implications are drawn for the emerging area of “inclusive development”, which similarly seeks to promote change in mainstream services for the benefit of people with disabilities.

Mental Health and Quality of Life of Caregivers of Individuals with Cerebral Palsy in a Community Based Rehabilitation Programme in Rural Karnataka

DEEPTHI, N
KRISHANMURTHY, A
2012

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Background: Cerebral palsy is a type of non-progressive central nervous system disorder with multiple impairments. As there are sensory, communicatory and intellectual impairments, providing care at home may be stressful and affect to the physical and mental health of the caregivers. This in turn could interfere with rehabilitation of persons with cerebral palsy.

 

Purpose: This study assesses the mental health status and quality of life of caregivers of persons with disabilities. The study group consisted of caregivers of 23 children with cerebral palsy and intellectual disability.

 

Method: The needs of the children with disabilities were assessed using a pre- tested interview schedule, while caregivers were administered GHQ-28 and WHO-QOL.

 

Results: Thirteen (56.52%) of the primary caregivers tested positive for GHQ. The psychological and environmental domains of QOL were found to be most affected, while the physical and social domains were relatively better.

 

Conclusion: There was a significant (p<0.05) correlation between the GHQ scores and quality of life.

The Community Based Rehabilitation Programme of the University of the Philippines Manila, College of Allied Medical Professions

MAGALLONA, M L M
DATANGEL, J P
2012

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Purpose: This paper reports the process of development of a CBR programme by UP Manila College of Allied Medical Professions, and its impact on the stakeholders: persons with disabilities, students and alumni, CBR workers, local leaders and the agencies involved in the programme.

 

Method: The impact of the programme was assessed through interviews, questionnaires, focus group discussions and review of secondary data and records.

 

Results: The programme results show that the condition of persons with disabilities has improved and there has been a remarkable change in their knowledge, attitudes and skills. The positive attitudes, skills and values of students were enhanced, and the CBR programme was a “character builder” for them as rehabilitation professionals. The CBR workers who participated in the programme learnt to appreciate the potential of persons with disabilities and to accept their limitations. Another key result was the pledge by local leaders to sustain CBR in their own villages.

 

Conclusions: The students and alumni reported that the CBR programme should be replicated for nation-building. The different stakeholders reported that it helped improve the quality of life of people with disabilities and contributed to community development.

Impact of CBR : impact of community-based rehabilitation programme in Karnataka India

BIGGERI, Mario
et al
2012

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"The main goal of the research was 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. We therefore investigated the effectiveness of CBR programmes in improving the control that persons with disabilities have over their daily lives, their participation in different aspects of community life (i.e. combating stigma and prejudice) and their access to various services over the five domains of the CBR matrix (health, education, livelihood, social and empowerment)"

Promoting empowerment|Emancipatory research in community-based rehabilitation programmes : a guide for CBR programmes managers

DEEPAK, Sunil
2012

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This practical guide is written for organizations and persons involved in CBR projects. It is also targeted at DPOs, especially those working at community and peripheral levels. The information provides a straight forward guide for people working in CBR programmes to carry out simple emancipatory research (ER). Examples are provided from successful ER projects. This resource is useful to anyone interested in ER in community-based rehabilitation programmes

Inclusion through community based rehabilitation : lessons learned in Burkina Faso, Ethiopia & Mozambique 2009 - 2011

LIGHT FOR THE WORLD
2012

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"The LIGHT FOR THE WORLD Community Based Rehabilitation (CBR) Framework brought together 14 CBR projects in Ethiopia, Burkina Faso and Mozambique between 2009 and 2011 to share experiences and learning. This report reflects the experiences of the projects during this period and the lessons learned that can provide invaluable learning for other CBR projects. It also provides a useful record of the projects’ activities and outcomes, and enables future planning"

CBR guidelines as a tool for community-based inclusive development

INTERNATIONAL DISABILITY AND DEVELOPMENT CONSORTIUM (IDDC)
Ed
2012

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This document presents the CBR Guidelines as a tool for community-based inclusive development. It provides an introduction to CBR, community based inclusive development, and the CBR guidelines. It then highlights partnerships between stakeholders in CBR and the CBR guidelines as a framework for monitoring and evaluation using an example from Cambodia

Community based rehabilitation and the convention on the rights of persons with disabilities

INTERNATIONAL DISABILITY AND DEVELOPMENT CONSORTIUM (IDDC)
Ed
2012

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This document explores the linkages between community based rehabilitation (CBR) and the convention on the rights of persons with disabilities (CRPD). It presents introductory information about the CRPD, CBR and the linkages. It then details CBR as a strategy for implementing the CRPD by highlighting experiences and principles

Community-based rehabilitation (CBR) guidelines and promoting inclusion of persons with disabilities in international development cooperation|Working paper : article 32 of the UNCRPD and the CBR guidelines

DEEPAK, Sunil
October 2011

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"The working paper aims to provide basic information about the Community-based Rehabilitation (CBR) Guidelines as well some specific examples on how these guidelines can be used (to) promote an inclusive approach in International Development Cooperation, so that persons with disabilities can access the benefits of all interventions in the same way as all other citizens"

Promoting Prosocial Beliefs and Behavior Toward People with Disabilities in Nepal through a Children’s Entertainment-Education Program

STRONG, D A
BROWN, W J
2011

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Purpose: This quasi-experimental field study examines the prosocial influences of a children’s entertainment-education television programme, Khushi Ko Sansar, on children’s beliefs and intended behaviour towards people with disabilities in Nepal.

 

Method: Pre-test and post-test survey data were gathered from 357 Nepali children from nine communities that took part in the study. The children were shown two television episodes in which the star of the programmes, a dog named Khush, befriends and visits people with disabilities.

 

Results: Post-test results show that children developed strong identification with Khush and adopted his prosocial beliefs and behaviour towards people with disabilities.

 

Conclusions: The authors conclude that the entertainment-education television programme, Khushi Ko Sansar, provided a positive role model for children who encounter people with disabilities. Implications of these findings suggest that entertainment- education media can improve the treatment of people with disabilities and can promote beneficial health beliefs and practices.

Insight plus : perspectives on social inclusion

SIGHTSAVERS
June 2011

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This newsletter presents information about social inclusion and how working together with disabled people, their families and local communities can break down barriers and ensure that disabled people are able to participate fully in society, receive an education, gain employment and be part of local decision-making processes. Featured case studies include joint efforts towards an accessible electoral process in Cameroon, new ways of working towards social inclusion in Uganda, and campaigning for accessible banking systems in India
Insight Plus, Issue 3

Sustainability Criteria for CBR Programmes – Two Case studies of Provincial Programmes in Vietnam

MIJNARENDS, Donja M
PHAM, D
SWAANS, Kees
VAN BRAKEL, W H
WRIGHT, Pamela
2011

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Purpose: This paper aims to explore the conditions needed for sustainable community based rehabilitation (CBR) programmes for persons with disabilities in Vietnam, and to identify the conditions and opportunities missing at present for the implementation of such programmes.

 

Method: Two CBR programmes in Vietnam, one medical based and one comprehensive (medical, educational, livelihood, social and empowerment), were evaluated for requirements and the current situation. Four factors were taken into account - human resources, organisational setting, social and political environment, and financing. Data were collected through interviews with programme managers and focus groups with stakeholders from provincial, district and communal levels, and with persons with disabilities. Persons with disabilities also completed a questionnaire to evaluate their satisfaction with the programme and their involvement in it.

 

Results: The conditions needed for a sustainable CBR programme were identified: availability of human resources, training, monitoring and evaluation, collaboration, commitment and financing. The conditions missing at present were: a stable pool of human resources (in both programmes), collaboration between sectors and with local authorities (in the medical programme), and knowledge about how to maintain financing (in both programmes). Persons with disabilities were more satisfied with their involvement in the comprehensive programme than in the medical programme. Stakeholders proposed opportunities to increase sustainability; highest priority was given to a collaboration plan (comprehensive CBR programme) and to involvement of other sectors in the CBR Steering Committee (medical CBR programme).

 

Conclusions: Few differences were found in conditions needed for sustainability of the medical and comprehensive programmes. The existence of disabled persons’ organisations (DPOs) seemed to be associated with the level of satisfaction persons with disabilities felt with their involvement in the programme.

 

Limitations: The People’s Committee was not involved in this research, although their input was perceived to be important. Generalisation of the results of this study should be done with caution because health system structures and organisational levels of CBR differ.

CBR matrix and perceived training needs of CBR workers: a multi-country study

DEEPAK, Sunil
2011

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CBR Matrix, proposed in the CBR Guidelines, provides a systematic framework for organising and analysing CBR activities. A sample of experienced CBR workers, active at community level in 7 countries , were asked for information about different activities they actually carry out, so as to understand the applicability of CBR Matrix framework in the field. The CBR workers were also asked to identify their most pressing learning needs in different areas of CBR Matrix.

This study shows that CBR Matrix can be a useful framework to understand field-level activities in CBR projects. The study has identified a number of priority learning needs, in terms of different domains of CBR Matrix, and in terms of different disabilities. It also shows that globally, areas related to advocacy, lobbying, legal protection and rights-based approach, are the most important learning needs identified by CBR workers.

Availability and accessibility of treatment for persons with mental illness through a community mental health programme

NAVANEETHAM, Janardhana
RAGHUNANDAN, Shravya
NAIDU, D M
HAMPANNA, H
2011

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This article describes experiences in implementing a community mental health and development project in a rural district in southern India, including the position of persons with mental illness when the project was initiated, the challenges the faced and the strategies that were developed to overcome these challenges. The authors conclude that when services are locally available, persons with mental illness can be treated and rehabilitated within their own community. They can live with dignity and their rights are respected. There is a great need for inclusion of persons with mental illness in the existing developmental activities and in disabled persons’ organizations.

 

 

Disability, CBR and Inclusive Development, Vol 22, No 2

Regional framework on community-based rehabilitation : pilot version

WORLD HEALTH ORGANIZATION (WHO), Regional Office or the Eastern Mediterranean (EMRO)
2011

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This regional framework was developed from an inter-country initiative by national authorities and independent experts within the WHO Eastern Mediterranean Region to develop a community-based rehabilitation strategy to put into effect the provisions of the of the United Nations Standard Rules on the Equalization of Opportunities for People with Disabilities (1993) and Convention on the Rights of Persons with Disabilities (2006). It details the CBR strategic objectives, key approaches to achieving them and indicators of success

Guidelines to reduce stigma : guide 1|What is health-related stigma?

VAN BRAKEL, Wim
et al
2011

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"This guide is part of a series of four Guides to reduce stigma. The guides are for all managers, health and social workers and service staff who have to deal with stigma in leprosy and other health conditions. These Guides provide evidence-based and best-practice information from different disciplines, and recommendations for field workers on how to reduce stigma against and among affected persons and in the community. This first Guide provides basic information on stigma, its causes, manifestations, and effects"

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