Dear Editor,

NEED FOR MORE COMPREHENSIVE EVALUATION REPORTS OF CBR PROGRAMMES

I would like to make some comments on the mid-term project evaluation reports of Wayanad Sarva Seva Mandal (WSSM) CBR project and Coimbatore Rural Development Association, published in Actionaid Disability News. Volume 7, No.2, 1996.

While both project reports stressed the need for CBR Programme managers to undertake periodic evaluation of project activities, the really big questions in CBR were given short shrift in the evaluation reports, as detailed below. Project effectiveness: Both reports did not indicate how the results of the evaluation compared with the objectives of that were set in the planning phase. One commonly mentioned advantage of CBR over the institutional model, is increased coverage. It would have been helpful if the evaluation reports included the total number of persons with disabilities provided with services out of the estimated number of persons with disabilities in the project areas since commencement of the projects. Obviously, the sample sizes used in the evaluation were rather small. Therefore, any general conclusion made on the basis of such small sample sizes may be misleading..

Project expenditure: Proponents of CBR present it to the public as rehabilitation services delivery system which relies heavily on low and medium level manpower and low cost technology. This view of CBR suggests that CBR is more cost-effective than the traditional institution-based rehabilitation model which, it is argued, depends on high technology delivered by expensive professionals. The unmistakable message from the proponents of CBR is that CBR is relatively cheap and communities can eventually take over its funding and management, with only necessary inputs from governments and NG0s. Is CBR really a cheap alternative to institution-based rehabilitation? Can communities take over CBR projects? Can national or local governments run CBR projects without financial assistance from foreign NG0s? Answers to such questions are needed to cut the ground off the feet of opponents of CBR.

Unfortunately, both project evaluation reports did not make any remarks about the over all project expenditure or the average unit cost per person with a disability who was served.

The WSSM and CRDA projects adopted the comprehensive model of CBR. This means they offered medical, vocational, economic and educational rehabilitation services. Amongst their clients with medical/orthopaedic problems, what proportion was successfully managed at the community/family level by CBR workers, and what proportion was referred for more specialised care? Again, opponents of CBR are quick to point out that CBR workers offer inferior quality services much to the detriment of persons with disabilities. It would have been very helpful if the WSSM's and CRDA's reports contained the successes and failures of their CBR workers in managing medical/orthopaedic problems at the village and family levels. Without filling these knowledge gaps by reporting the results of the intervention carried out by CBR workers, it may be difficult to initiate or sustain government interest in CBR.

After more than a decade of existence, CBR still lacks deep community and national government support in many countries. In order for CBR to move from its status of a subject for seminars organised by government officials, to a realistic alternative to the high cost, low coverage institutional rehabilitation, existing CBR projects must provide answers to the big questions beclouding CBR.

Title:
ASIA PACIFIC DISABILITY REHABILITATION JOURNAL Vol. 10 @ No. 1 @ 2000

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