A Literature Review on CBR Evaluation
Along with the development of CBR, its evaluation has been explored to some extent. Over the past decade, a range of monitoring and evaluation approaches and methods has gradually been developed. These approaches and methods are useful to development workers, including those at community level.
The earliest study on the impact of CBR was published by Mendis and Nelson (1982). The authors visited and followed up the results in five countries, namely: Botswana, India, Mexico, Pakistan and Sri Lanka. The study was an early indication of the effectiveness of the practice. O'Toole (1988) presented an evaluation of a CBR project he initiated in Guyana. O'Toole used a multiple-baseline design and evaluated the outcome of the project using several different techniques, with measurements before and six months after the end of the programme. Its purpose was to scientifically evaluate a small scale experiment to genuinely determine the validity and potential of CBR approach". Arnold (1988) made a description of a successful project carried out in Nepal. Mendis (1988) gave a very detailed account of CBR programme in Vietnam in 1988, which included the objectives of the project, management, results, coverage, effectiveness of functional training, schooling, economic productivity, the use of WHO manual "Training in the Community for People with Disabilities", intermediate level support, and costs. Saunders and Zinkin (1990) reported an outside evaluation of a CBR programme carried out on a representative sample. The report contained no statistical data but a large number of observations. Lagerkvist (1992) undertook a scientific outsider evaluation of two CBR programmes: one in the Philippines and one in Zimbabwe. The results obtained by assessment history, testing of ability in activities in daily living (ADL) and communication and family discussion. Brar (1992) published the paper "Research and Evaluation in Community-Based Rehabilitation - Some Views Derived from UNICEF Experiences". It focuses on the processes and purposes of documentation, evaluation and research into CBR. CBR Project in Bacolod, Philippines, initiated in 1981, expanded the coverage of its service to over 3000 disabled persons in 112 villages by the end of 1992. Kwok (1991) reported "An Evaluative Research Design for Urban Community-Based Rehabilitation Programme-A care study from Hong Kong in 1991. The paper presented a quasi-experimental evaluative research design in assessing the impact of CBR in Hong Kong. Rajendre et al. (1994) published a paper, "The Sourabha CBR Project - An Evaluation Study". The methodology used in this study is simple enough to do an evaluation of a fairly large sized project engaged in rehabilitation and to elicit reliable and valid answers. The main aim of the evaluation study was to evaluate the extent to which the CBR project had achieved its objectives in the various sector of rehabilitation and to see whether the existing organizational system had adequately helped in the implementation of the programmes. The study also tried to identify the kind of changes. Three questionnaire were adapted from the draft UNDP Guide on Evaluation of Rehabilitation Programmes for Disabled People. Korpela et al. (1993) presented an evaluation of rehabilitation services. They used a follow-up method to evaluate the extent of use of technical aids for disabled children. Mitchell et al. (1993) reported an evaluation of CBR about attitudes towards people with disabilities changed in the city of Guangzhou, China. The measurement of attitudes towards the disabled was made using "the Attitude Towards Disabled People (ATDP) Scale" developed by Yuker, Blick and Campbell. They claimed that "the scale has reasonably good" content validity.
According to WHO (1981), evaluation is a systematic way of learning from experience and using the lessons learnt to improve current activities and promote better planning by careful selection of alternatives for future action. This involves an analysis of different phases of a programme, its relevance, its formulation, its efficiency, effectiveness and its acceptance by all parties concerned. A working definition of evaluation from Krefting (1994): systematic collection, analysis, and interpretation of information about the activities and outcomes of CBR Programs in order for interested people to make judgements about what the program is doing and how it can be improved. In fact evaluation is one of the most important kinds of research in social change programs.
Helander (1993) reviewed the evaluation and experience applied to CBR programs in his book entitled "Prejudice and Dignity-An Introduction to Community-Based Rehabilitation". He dealt with the principles of evaluation, with a review of some representative case studies which report the outcome of CBR. He pointed out five factors to consider in the evaluation of CBR, namely: relevance, effectiveness, efficiency, sustainability and impact. The joint position paper -- Community-Based rehabilitation, CBR for and with people with disabilities by ILO, UNESCO and WHO (ILO et al., 1994) attempts to clarify the objective of CBR and methods for implementation. Aimed at policy-makers and programme managers, it addresses the issues of sustainability, disability policies and integration into the community. It presents the essential elements of CBR: "CBR is strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disabilities" (ILO et al., 1994, page 3), "CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" (ILO et al., 1994, page 3). This position paper points out the responsibility of government, non-governmental organizations, community, people with disabilities and their organizations.
The Standard Rules on the Equalization of Opportunities for Persons with Disabilities were adopted by the United Nations General Assembly at its 48th Season on 20, December 1993. Rule 20 states: "the evaluation of various programmes in the disability field should be built in at the planning stage. So that the over all efficacy in fulfilling their policy objectives can be evaluated. (UN, 1994, page 37)
Lele (1995) pointed out six problems in the area of CBR programs evaluation at the meeting in Bangkok in June 1995, to review the progress of the Asian and Pacific Decade of Disabled Persons, 1993-2002, which involves information sharing, methodologies of evaluation adopted, the evaluation question of the role of the communities, evaluation on the costs of CBR programme, evaluation technology and key issues in evaluation.
From above discussions, we can see a big step has been learned from the first wave of CBR porgrammes, with its focus on delivering technology. However, CBR is still in its adolescent stage, and it would be too early to conclude the frontiers of CBR have been fully covered. Indeed, much more work has yet to be done in establishing criteria and methods for evaluating CBR experiences and programme.
Evaluating Community Based Rehabilitation :
Guidelines for Accountable Practice
By Dr. Tizun Zhao, Joseph K.F. Kwok Ph.D, J.P.