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Community-Based Rehabilitation (CBR) Evaluation Framework

Community-Based Rehabilitation (CBR) Evaluation Framework. Manjula Marella. Co-authors: Ecosse Lamoureux and Jill Keeffe Centre for Eye Research Australia University of Melbourne. Community-based rehabilitation (CBR).

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Community-Based Rehabilitation (CBR) Evaluation Framework

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  1. Community-Based Rehabilitation (CBR) Evaluation Framework Manjula Marella Co-authors: Ecosse Lamoureux and Jill Keeffe Centre for Eye Research Australia University of Melbourne

  2. Community-based rehabilitation (CBR) • The World Report on Disability identifies CBR as an important component of health systems • Rehabilitation within one’s own community using local resources • TheWorld Health Organization (WHO) guidelines promote a comprehensive system addressing Health, Education, Livelihood, Social participation and Empowerment of people with disabilities

  3. Effectiveness of CBR services • Evaluations published on CBR programs lack evidence-based research • Published evaluations are mainly descriptions of services • Different methodologies and indicators used for evaluations • Common indicators and a systematic framework for evaluation that are valid for different settings of CBR are essential

  4. Evaluation framework • To address the gap in the literature related to effectiveness of CBR programs, the Centre for Eye Research Australia (CERA)-CBR Framework (CCF) has been developed • The CCF includes indicators to comprehensively evaluate CBR programs

  5. CERA – CBR Framework (CCF) Components Key Areas ManjulaMarella, CERA November 2010

  6. Key area Themes/Questions Indicators Eligibility to enrol Client demographics Enrolments Average number of clients enrolled per year Waiting time Waiting list Utilisation of services Number of clients on waiting list Number of clients who discontinue annually Dropouts Socio-demographic profile of dropouts Gender ratio of dropouts Reasons for dropouts

  7. Developing questionnaires • Questions for each indicator • Data collection methods and sources • Key informant questionnaires • CBR staff • Clients and Family members • Government (Health and Social Welfare) • Eye care practitioners • Disabled People Organisations (DPOs) • Non-government organisations (NGOs)

  8. Face validity of the CCF • Reviewed by an expert panel (n=7) • CBR • Evaluation methods • To assess the appropriateness of the content and structure of the CCF • The CCF was modified based on the feedback from the panel • Modified version of the CCF included 230 indicators

  9. Field-validation of the CCF • Fiji Society for the Blind (FSB) • Cambodian Development Mission for Disability (CDMD)

  10. Field-validation of the CCF

  11. Analysis • Collated responses from various stakeholders • NVivo 8 • Qualitative analysis • Strengths and limitations of the CBR programs • Usefulness of indicators • Applicable (relevant to the context of services) • Measurable (feasible to obtain data) • Triangulation – information obtained from different sources and compared

  12. 1. Service delivery system

  13. 2. Program planning

  14. 3. Networking

  15. 4. Outcomes

  16. Usefulness of the CCF Overall 230 indicators in the framework

  17. Discussion • The CCF is comprehensive and useful to evaluate the effectiveness of CBR programs • First study to compare two models of CBR • Comprehensive model of CBR is feasible and more effectively meets the needs of the clients • Recommendations provided based on the findings using the CCF helped the organisations to plan new services and strategies • Training of staff • Plans for financial sustainability

  18. Application of the CCF • 144 (63%) indicators were derived from the literature where they were not proposed for any specific disability • The majority (197, 85%) indicators were applicable to two different settings • The framework is likely to be applicable to different programs irrespective of model and type of disability

  19. Limitations and recommendations for future research • The component ‘outcomes’ needs further validation • Only two case-studies in this study • Does not include economic analysis • Application in other settings including developed countries

  20. Summary • The CCF has been developed to evaluate the effectiveness of vision-related CBR programs • Field-tested in two different CBR settings in Fiji and Cambodia • Practical and useful to investigate the strengths and limitations of the two CBR programs

  21. Acknowledgements • Supervisors: A/Prof EcosseLamoureux and Prof Jill Keeffe • Fiji Society Blind and Cambodian Development Mission for Disability • Vision Cooperative Research Centre (CRC) • University of Melbourne

  22. Thank you

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