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Services for people with communication disabilities in Uganda: supporting a new speech and language therapy professional

MARSHALL, Julie
WICKENDEN, Mary
2018

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Services for people with communication disability (PWCD), including speech and language therapists (SLTs), are scarce in countries of the global South. A SLT degree programme was established at Makerere University, Uganda, in 2008. In 2011, an innovative project was set up to provide in-service training and mentoring for graduates and staff of the programme. This paper describes the project and its evaluation over three years. Three types of input: direct training, face-to-face individual and group meetings, and remote mentoring, were provided to 26 participants and evaluated using written and verbal methods. The first two types of input were evaluated mainly positively, while remote mentoring received more mixed evaluations. Less positive evaluations were linked to factors including resourcing, cultural perceptions about professional roles and services, work patterns, power/status, engagement, perceptions of help-seeking, community recognition of the needs for services for PWCD. Findings suggest that participatory approaches, flexibility, reflexivity and open discussion with participants around support and work challenges, are important. Power gradients between white Northern ‘experts’ and relatively inexperienced East African SLTs, contributed to some challenges. Structural issues about degree programme structures and statutory bodies, provide lessons about the development of new services and professions in low-income settings. 

 

Disability and the Global South, 2018 Vol.5, No. 1

Disability & the Global South (DGS), 2017, Vol. 4 No. 1 - Special issue: Disability in the Sustainable Development Goals: Critical Reflections

2017

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Articles include:

  • Editorial: Disability and the SDGs: is the battle over?
  • Entering the SDG era: What do Fijians prioritise as indicators of disability-inclusive education?
  • SDGs, Inclusive Health and the path to Universal Health Coverage
  • No One Left Behind: A review of social protection and disability at the World Bank
  • The capacity of community-based participatory research in relation to disability and the SDGs
  • Measuring Disability and Inclusion in relation to the 2030 Agenda on Sustainable Development

An Online Survey on Identification of Evaluation Capacity, Needs and Current Practice of Programme Evaluation in Community-based Rehabilitation

WEBER, Joerg
POLACK, Sarah
HARTLEY, Sally
2016

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Purpose: Evaluation of Community-based Rehabilitation (CBR) is important for developing good practice and providing a foundation for evidence of efficacy of practice. Since not much is known about the extent to which monitoring and evaluation (M&E) are carried out within CBR programmes, this study aimed to enhance knowledge by focussing on current M&E activities, the need and capacity of programmes to conduct evaluations and the challenges experienced. 

 

Method: An online survey of 15 questions was developed, field-tested and sent out to 236 CBR managers in Africa, Asia and Latin America.  

 

Results: The majority (86%) of the respondents indicated that their programmes had been evaluated in the past.While this was mainly done by international donors (87%), only around half of the respondents reported programme participants as the main audience. Just over half of the programmes (54%) included people with disabilities, their families and community members in evaluation processes. Insufficient financial resources were considered the most important challenge to conduct evaluation, particularly in the African region and among smaller programmes. The complexity of CBR was also indicated as an important barrier to evaluation.

 

Conclusions and Recommendations:  Although evaluations have been widely implemented in CBR programmes, many of them are not locally owned, and people with disabilities and their families are often not included in evaluation processes. The issues of limited financial resources and CBR complexity reflect current discussions in other areas of mainstream development. It is therefore recommended that models for evaluation in CBR should learn from, and be embedded in, ongoing developments in mainstream evaluation in international developm

OPERA framework

July 2016

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"A guiding lens for CESR's national enforcement work, the OPERA framework allows an assessment that triangulates outcomes, policies and resources to provide a much fuller picture of what a state is doing to promote the realization of specific rights. Importantly, it traces economic and social deprivations and disparities back to the actions or omissions of the state, to make the case that they constitute an injustice and a violation of human rights."

How are service users instructed to measure home furniture for provision of minor assistive devices?

ATWAL, Anita
MCINTYRE, Anne
SPILIOTOPOULOU, Georgia
MONEY, Arthur
PARASKEVOPULOS, Ioannis
2016

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Purpose: Measurements play a vital role in providing devices that meet the individual needs of users. There is increasing evidence of devices being abandoned. The reasons for this are complex but one key factor that plays a role in non-use of equipment is the lack of fit between the device, environment and person. In addition, the abandonment of devices can be seen as a waste of public money. The aim of this paper is to examine the type, the readability, and the content of existing guidance in relation to measuring home furniture.

 

Method: An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated.

 

Results: From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9–11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths.

 

Conclusion: There is a need to standardize guidance to ensure that measurements are reliable.

Cross-cutting Capacity Building Learning Review

LIPSON, Brenda
GARBUTT, Anne
March 2016

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This short report is based on an analysis of the individual case studies on capacity building in Cambodia and Bangladesh. The purpose of this cross-case report is to present the views of the two consultants with regard to the following:

  • Points arising from the experiences in the two countries which shed light on the ADD approach and working model of capacity building.
  • Recommendations for ADD to reflect upon in its work to strengthen the capacity building model and the overall monitoring, evaluation and learning on this work.

Participatory Monitoring of Community-Based Rehabilitation and other Disability- Inclusive Development Programmes: the Development of a Manual and Menu

Madden, Rosamond H
et al
2016

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Purpose: This paper describes a three-year research project leading to the development of the CBR Monitoring Manual and Menu (MM&M). The MM&M is a practical toolkit that meets the needs of CBR managers and stakeholders, and is consistent with the philosophy of CBR and community- based disability-inclusive development. It is designed to produce meaningful and locally useful information and data, based on international data standards where possible, to enable aggregation at regional, national and international levels.

 

Methods: Five complementary workstreams of research were carried out from 2011 to 2014: 1) literature review and analysis; 2) participatory action research with CBR stakeholders; 3) analysis and refinement of validity of concepts andstructures; 4) consultation and review; and 5) synthesis of results. This article documents the method and key results of each of the five workstreams, and the lessons learned along the way.

 

Results: The MM&M is now freely available on-line at thttp://sydney.edu. au/health-sciences/cdrp/projects/cbr-monitoring.shtml. Collaboration among members of the development team continues, chiefly via an on-line group to which new members have been welcomed.

 

Conclusion and Implications: At the time of writing, the MM&M is the only international monitoring product, known to the authors, that consciously sets out to reflect both a ‘bottom- up’ and ‘top-down’ perspective of monitoring information and data.To achieve this for a complex programme such as CBR, and to align with its principles, it was essential to use a multi-component and multi-stage strategy for tool development, involving a diverse multidisciplinary team including collaboration with CBR stakeholders.

NGO self-assessment through a SWOT exercise

NETWORKLEARNING.ORG
January 2016

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This short guide aims to guide non-governmental organisations (NGOs) through a four-step analysis of capacity. Known as a SWOT exercise, this tool has been found to be useful in many NGOs and stands for the "Strengths" and "Weaknesses" within your organisation; plus factors outside your organisation that offer "Opportunities" or pose "Threats."  The guide enables NGOs to lead themselves through the SWOT exercise and make, implement, evaluate and monitor the resulting strategic action plan

Towards a ‘mind map’ for evaluative thinking in Community Based Rehabilitation: reflections and learning

WEBER, Joerg
GRECH, Shaun
POLACK, Sarah
2016

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Calls for evaluations in Community Based Rehabilitation (CBR), in particular those of a participatory nature have stepped up in recent years. Much of this shifting discourse has emerged in response to the fact that evaluations overall remain scarce. Furthermore, very little is known about the impacts of CBR in practice and if/how it benefits persons with disabilities and their families on the ground. Nevertheless, and despite the calls for participatory approaches, the few existing efforts are too often targeted at creating standardised evaluations frequently at the expense of voice, participation and flexibility. This paper reports on a series of critical workshops held in Jamaica with CBR workers and other stakeholders, the objectives of which included discussions and reflections on emerging issues in localised, locally driven and responsive participatory evaluation frameworks. The findings highlight how participants favoured a flexible, adaptive and iterative approach that was not rigid, structured or per-determined by outsiders. Instead, they favoured an approach that created a safe space for sharing and learning, prioritised their narratives, and that was directly linked to and that fed directly into action on the ground. The paper concludes with the call for critical, engaged and bottom-up approaches that move away from control-oriented approaches in CBR towards more experimental and adaptive problem and process-oriented approaches, that embrace complexity and that are consistently responsive to an ever changing context.

 

Disability & the Global South (DGS), 2016, Vol. 3 No. 2

Community based rehabilitation for people with disabilities in low and middle income countries : a systematic review

IEMMI, Valentina
et al
September 2015

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This Campbell Collaboration systematic review assesses the effectiveness and cost-effectiveness of community-based rehabilitation (CBR) for people with physical and mental disabilities in low- and middle-income countries, and/or their family, their carers, and their community. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). The authors conclude that the evidence on the effectiveness of CBR for people with disabilities in low- and middle-income countries suggests that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer and recommend future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations

Campbell Systematic Reviews 2015:15

Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities : a study protocol

SKEMPES, Dimitrios
BICKENBACH, Jerome
September 2015

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This paper seeks to develop a study protocol that can assess and improve the provision of rehabilitation services for people with disabilities across the world. The research targets a knowledge gap that exists whereby there are no indicators to reliable identify the performance of rehabilitation systems and monitoring technologies. The paper provides a detailed analysis of the issue before outlining and justifying a choice of methods for data collection and analysis, and the likely impact and use of the study results

BMC International Health and Human Rights, 15:25

Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

VISAGIE, Lisa
LOXTON, Helene
SILVERMAN, Wendy K
2015

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Background: Childhood anxiety presents a serious mental health problem, and it is one of the most common forms of psychological distress reported by youth worldwide. The prevalence of anxiety symptoms amongst South African youth is reported to be significantly higher than in other parts of the world. These high prevalence rates become even more significant when viewed in terms of children with visual impairments, as it is suggested that children with physical disabilities may be more prone, than their non-disabled peers, for the development of psychological difficulties. 

 

Objectives: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments.

 

Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9–13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- postand follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants’ symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale.

 

Conclusion: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African) anxiety intervention programmes can be built.

 

Impact evaluation : a guide for commissioners and managers

STERN, Elliot
May 2015

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A guide on the processes involved in implementing and designing instruments to measure the impact evaluation of development projects for commissioners and managers. This guide takes a multifaceted approach, considers the perspective of all possible stakeholders, and highlights best practice

Mental health recommendations included in Sendai framework for disaster risk reduction

UNITED NATIONS UNIVERSITY
March 2015

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“The expert group was formed to address this challenge, bringing together UN experts to review evidence on mental well-being and disability related to disasters, share lessons learned and best practices, and develop recommendations for mainstreaming these issues in Disaster Risk Education.” This UN University report illustrates how disability and mental health should be highlighted as a priority in disaster risk reduction planning and execution. In addition, the group responsible for the report suggest that disability and mental health be integrated into any future discussions related to security and human rights. Finally, the group recommended that a United Nations working group be established to explore the ways in which policies and action effect or how these individuals can affect policy within the United Nations. 

Children with disabilities and disaster risk reduction : a review

RONOH, Steve
GAILLARD, JC
MARLOWE, Jay
March 2015

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Children with disabilities are often excluded from disaster risk reduction (DRR) initiatives and, as a result, can experience amplified physical, psychological, and educational vulnerabilities. Research on children with disabilities during disasters is lacking, and their potential value in helping shape inclusive policies in DRR planning has been largely overlooked by both researchers and policymakers. This article highlights the existing research and knowledge gap. The review includes literature from two areas of scholarship in relation to disasters—children, and people with disabilities—and provides a critique of the prevailing medical, economic, and social discourses that conceptualize disability and associated implications for DRR. The article analyzes the different models in which disability has been conceptualized, and the role this has played in the inclusion or exclusion of children with disabilities in DRR activities and in determining access to necessary resources in the face of disaster. Finally, the study explores possible pathways to studying the contribution and involvement of children with disabilities in DRR.

 

International Journal of Disaster Risk Science, Volume 6 Issue 1

Capturing the difference we make : community-based rehabilitation indicators manual

WORLD HEALTH ORGANIZATION (WHO)
2015

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This manual presents indicators that "capture the difference (Community-Based Rehabilitation) CBR makes in the lives of people with disabilities in the communities where it is implemented. This manual presents these (base and supplementary) indicators and provides simple guidance on collecting the data needed to inform them. The indicators have been developed to show the difference between people living with a disability and their families and those without disabilities in relation to the information reported in the indicators. This comparability provides valuable information to CBR managers, donors and government agencies alike, which can be used to guide decision-making, support advocacy and improve accountability. Further, the ability of the indicators to provide a comparison of the populations of persons with disability to persons without disability aligns with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which states that persons with disability have equal rights to those without disabilities...this manual serves to standardize the monitoring of differences made by in the lives of people with disabilities and their families, making it possible to compare the difference CBR makes across areas and countries. This manual aligns with the WHO Global Disability Action Plan 2014–2021, and may also be used to monitor other development plans in an easy and efficient way”

Operationalizing the 2030 agenda : ways forward to improve monitoring and evaluation of disability inclusion

UNITED NATIONS DEPARTMENT OF ECONOMIC AND SOCIAL AFFIARS (UNDESA)
2015

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This note concerns monitoring and evaluation of disability and inclusion in light of the sustainable development goals. The note identifies steps which can be taken by individual countries and the international community as a whole to address the gaps in data disaggregation and collection concerning people with disabilities. The note concludes with a discussion of possible ways forward for better monitoring and evaluation for disability inclusion in the 2030 Agenda for Sustainable Development

Global status report on disability and development prototype 2015

UNITED NATIONS DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS (DESA)
2015

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This report situates disability and inclusion within the broader context of sustainable development, with a particular focus on the Sustainable Development Goals (SDGs). The paper provides background on the historical role of the UN in promoting inclusion and outlines the current trends and challenges facing people with disabilities globally. The following section presents these challenges within the context of the SDGs, showing that disability needs to be tackled if the SDGs are to be achieved. It concludes with a number of recommendations for a disability-inclusive 2030 agenda for sustainable development

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