The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial

• Published in: Journal of epidemiology and community health (1979) 2014-11, Vol.68 (11), p.1102-1108
• Main Authors: Mauro, Vincenzo, Biggeri, Mario, Deepak, Sunil, Trani, Jean-Francois
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Community; Community associations; Community health; Community Health Services - methods; Community Health Services - standards; Control groups; Disabilities; Disability; Disabled Persons - education; Disabled Persons - psychology; Disabled Persons - rehabilitation; Employment - economics; Employment - psychology; Employment - statistics & numerical data; Empowerment; Evidence-based public health policy and practice; General aspects; Health outcomes; Health Services Accessibility; Household appliances; Humans; India; Interviews as Topic; Medical sciences; Miscellaneous; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Participation; Pension plans; People with disabilities; Poverty; Power (Psychology); Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomized Controlled Trials as Topic; Rehabilitation; Rehabilitation, Vocational - economics; Rehabilitation, Vocational - methods; Rehabilitation, Vocational - statistics & numerical data; Social Environment; Therapeutic communities; Villages; Wellbeing
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech-2013-203728

Background Community-based rehabilitation (CBR) programmes have been described as highly effective means of promoting the rights and opportunities of persons with disabilities (PwD). Although CBR is often the main way in which PwD in low-income and middle-income countries access rehabilitation services, there is little literature providing rigorous evaluation of their impact on people's well-being. Methods Data were collected in the Mandya and Ramanagar districts (Karnataka state, India), between December 2009 and May 2010. In total 2540 PwD were interviewed using stratified random sampling: 1919 CBR beneficiaries (who joined the programme between 1997 and 2009) and 621 persons who were living in villages not covered by the programme. We controlled for the systematic differences between people joining and not joining the programme using the propensity score matching method controlling for covariates at individual and village level. We evaluated the impact of the programme on the subgroups of PwD who are disadvantaged on the dimensions of interest: access to pensions, use of aid appliances, access to paid jobs and improvement in personal-practical autonomy after 4 and 7 years of joining the CBR. Results We observed a positive and significant impact of the programme on access to services, rights and opportunities of PwD. The results indicate that compared with the control group access to pensions and allowances, aid appliances, access to paid jobs and personal-practical autonomy increased by 29.7%, 9.4%, 12.3% and 36.2%, respectively, after 7 years. Conclusions The CBR programme analysed has a positive impact on access to services and the well-being of PwD who are particularly deprived on outcomes of interest.