INTRODUCTION
People with disabilities are estimated to form 7-10% of the population in any country, and around 2% would need some form of rehabilitation services. Yet only 0.01% to 0.02% of the population in developing countries actually get such services. There are presently about 200 million moderately and severely disabled people in developing countries, where disabilities are mostly poverty related. The incidence of disability has always been on the increasing trend, and about 60% of disabilities could have been prevented (WHO Expert Committee, 1981; Murthy, 1992).
In bringing about positive impact on the situation of people with disabilities, at least three approaches have been practiced, namely: Institutional Based Rehabilitation, Extension of Institutional Based Rehabilitation, and Community Based Rehabilitation (CBR). While the rehabilitation gap cannot be closed in any quick or easy way, CBR is considered one of the most practical and efficient rehabilitation approaches (Handojo, 1991; Helander, 1988).
CBR is defined as "a system which envisages using existing resources of manpower and material within the community to promote integration of disabled people in all spheres of life and activity" (Thomas, 1990, page 3). "The Community-Based Rehabilitation strategy is an effort to design a system for change---for improving service delivery in order to reach all in need, for providing more equal opportunities and for promoting and protecting the human rights of disabled people" (Helander, 1993, page 5).
In 1976, member countries of the World Health Organization (WHO) decided to include rehabilitation in the goal "Health for all by the year 2000" (Helander, 1980). Recognizing that people with disabilities in developing countries have a large need for rehabilitation and have very limited access to rehabilitation facilities, WHO has developed community-based rehabilitation program designed to integrate with programs for primary health care. Since then CBR as a tool for government and non-government intervention has been expanding very rapidly all over the world. People with disabilities, their families, and their communities have benefited from CBR. CBR practices in countries with vast differences in race, culture, language, socio-economic-political development, and religious belief have provided a collection of diversified and rich experiences.
In 1979, a manual published by WHO proposed a simple demystified set of technologies for the community and family levels (Helander, 1980). In 1989, a revised version of the manual entitled 'Training in the community for people with disabilities" appeared. There has been much practice and discussion about the concept, objective, methodology research of CBR during these years.
In 1992, a discussion forum was hosted by the United Nations Development Program in Geneva. Helander presented his latest definition of CBR at the Geneva forum. "Community- based rehabilitation is a strategy for improving service delivery, for providing more equitable opportunities and for promoting and protecting the human rights of disabled people" (UNDP, 1993, page 1). It calls for the full and co-ordinated involvement of all levels of society.
In 1993, "Prejudice and Dignity-An Introduction to Community-Based Rehabilitation" was published by Helander (1993), UNDP. It discussed and analysed background, definitions, principles, technology management, system of CBR, reviewed evaluation techniques, and described a plan of action for CBR in the future.
Since the early days of CBR experimentation, the Asia and Pacific Region has been at the forefront in the field of CBR and made significant contributions to the world. The Asia and Pacific Region with over 50 countries and territories, is the home of 57% of the world's population. Most people with disabilities live in the region's developing countries. Not surprisingly, CBR has been looked upon as a solution to achieving practical and efficient rehabilitation approaches.
In order to further promote the development of CBR in coordination with the social and economic development of this region, there is a need to develop a set of comprehensive guidelines for CBR evaluation. Such guidelines should be scientific, practical, easy to use, and should cover various aspects and stages of the practice.
In 1993, during "the Seoul Conference on Rehabilitation Manpower Development and Networking in the Asia and Pacific Decade of Disabled Persons 1993-2002", the Rehabilitation Action Network for Asia and the Pacific Executive Committee submitted a proposal entitled "The Research Project-Guidelines for CBR Evaluation", and received finding support from the Hong Kong based RI Regional Secretariat for Asia and the Pacific and the Japan based Regional NGO Network for the Asia and Pacific Decade of Disabled Person 1993-2002.
In December 1993 a research team was established on the design and implementation of the project, which consisted of members from Malaysia, Hong Kong, Korea, Singapore, Japan, Indonesia and China. The members of the research project have extensive involvement in CBR and rehabilitation services. A plan of the research project was drafted, which consisted of several aspects including the sponsor, research member, aim, objectives, methodology, outcome and procedure. In order to invite more suggestions and comments, copies of the plan had been sent to people who have been involved in CBR or rehabilitation services from inside and outside the region. Collection and analysis of literature relating to subject is an essential and basic work in any research project. The researchers have paid special attention to the replenish of literature, so as to have a better grasp of the latest reference materials. So far, more than 30 pieces of information on the evaluation of CBR have been collected and reviewed. In August 1994, ILO, UNESCO and WHO drafted a joint position paper "Community-Based Rehabilitation For And With Disabilities" (ILO et al., 1994). It made a statement on the concept, objective, methods, sustainable, interagency collaboration on CBR. The present guidelines for evaluation of CBR has taken note of the views from the joint position paper.
The researchers consulted with members of the research team, as well as experts who are from WHO, UNICEF, UNDP, RI, RNN, etc. In September 1995, a seminar on OMAR (OMAR IN REHABILITATION. A Guide on Operations Monitoring and Analysis of Results (draft for field testing)) was held in Wuhan, China. It provided a good opportunity for the researchers to get access to updated knowledge. A useful exchange of ideas on evaluation of CBR was carried with Ture Jonsson, Senior Program Officer, UNDP Inter-Regional Program for Disabled People (IRPDPP) (Jonsson, 1994).
This research project has been launched to meet a specific need of CBR development, and has practical significance. Due to the support received from various sectors and efforts of the members of the project team, the first working edition of the Guidelines was able to be published to greet the mid-point review of the Asia and the Pacific Decade of Disabled Persons, 1993-2002. The researchers wish that the Guidelines would be a useful reference tool for evaluation in CBR practice. Any shortcomings or errors found in the Guidelines will be the sole responsibility of the researchers.
Evaluating Community Based Rehabilitation :
Guidelines for Accountable Practice
By Dr. Tizun Zhao, Joseph K.F. Kwok Ph.D, J.P.