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Training of Mid-Level Rehabilitation Workers for Community-Based Rehabilitation Programmes
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Purpose: There is a lack of trained rehabilitation professionals, especially in the small towns and rural areas of low and middle income countries. In India, a cadre of mid-level rehabilitation workers, the Rehabilitation Therapy Assistants (RTAs), are being trained by Mobility India, a Non-Governmental Organisation (NGO). This paper aims to assess impact of their training and experiences after the training.
Method: Data were collected from 3 different initiatives connected with the trained RTAs: an impact assessment of their training; interviews with RTAs during an evaluation; and a survey of 188 RTAs trained between 2002 and 2019.
Results: RTAs were shown to have good skills to provide rehabilitation interventions in the field and are appreciated by clients and other stakeholders. Most of the RTAs work for NGOs in CBR programmes, and in private hospitals and clinics. There does not seem to be a role for them in government services in most countries. The number of trained RTAs remains small in spite of the large needs. This may be due to lack of an accreditation system for RTAs and the low priority given to rehabilitation services in general in some countries.
Conclusions: The results provide useful information to strengthen RTA training courses. Training RTAs to provide rehabilitation services in smaller towns and rural areas of low and middle income countries can have a good impact through CBR programmes. However, this impact remains circumscribed to small areas where NGOs are active. Changes are needed in health systems for the inclusion of mid-level rehabilitation workers in primary health care services.
Individualised Funding: A Realist Analysis to Identify the Causal Factors That Facilitate Positive Outcomes
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There is growing interest, internationally, in empowering people with disabilities, and the United Nations have identified individualised funding as one way in which empowerment might be achieved. ‘Individualised funding’ is an umbrella term for various publicly funded support structures that provide personalised and individualised support services for people with a disability. These aim to facilitate self-direction, empowerment, independence, and self-determination. The findings of a recent mixed-methods systematic review of studies undertaken during an approximate 25-year period suggest positive effects with respect to quality of life, client satisfaction, and safety, as well as very few adverse effects, although the evidence on cost-effectiveness was inconclusive. This paper involved a re-examination of the qualitative findings of that review by employing a realist framework to explore the interplay between key contexts and mechanisms, and how these facilitate or inhibit positive outcomes associated with individualised funding and its underlying programme theory.
Increasingly consulted, but not yet participating: IDA global survey report on participation of Organisations of Persons with Disabilities
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This new report presents the findings of the first-ever global survey led by OPDs on their participation in decision making processes of governments, the UN system and funding agencies.
The IDA Global Survey is part of a strategy to hold decision-makers accountable for their commitments under Articles 4.3 and 32 of the UN Convention on the Rights of Persons with Disabilities (CRPD). Based on testimonies collected from OPDs in 165 counties, the report assesses the quality, depth, scope and relevance of the OPDs participation in programmes and policies, and offers recommendations for governments, the UN system and funding agencies.
Excluded from the Excluded: People with Intellectual Disabilities in (and out of) Official Development Assistance
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This report from Inclusion International analyzes data available through the Organization for Economic Cooperation and Development (OECD) Development Assistance Committee (DAC)’s Creditor Reporting System (CRS), which reveals that mainstream development projects fail to include people with intellectual disabilities, and in many cases use project methodologies that promote segregation and other human rights violations.
Analysis of ODA data from 2014 to 2018 found that 99.98% of ODA funding did not include people with intellectual disabilities, that 36% of the ODA projects that did include people with intellectual disabilities were not CRPD-compliant, and that only 2% of aid relevant to people with intellectual disabilities and their families was delivered through OPDs.
This report urges action from donors to ensure that the commitment to disability-inclusive development under Article 32 of the CRPD is also fulfilled for people with intellectual disabilities, and sets out recommendations for funders to ensure CRPD-compliance and inclusion in the projects they support.
Funding ≠ Inclusion: Segregation and CRPD Non-Compliance in Official Development Assistance
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This two-page summary resource compiles key data on the CRPD-compliance of Official Development Assistance (ODA)-funded programmes. This analysis was originally published in Inclusion International's 2020 report, Excluded from the Excluded, which revealed that 36% of projects that included people with intellectual disabilities in 2018 used methodologies that promoted segregation.
This summary resource profiles key data on the CRPD compliance of ODA-funded programme methodologies by thematic area - including livelihoods, education, emergency response, and service provision programmes. The summary resource also shares key recommendations for organizations implementing programmes to ensure CRPD-compliance.
No one left behind? Exclusion of People with Intellectual Disabilities in Official Development Assistance
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This one-page factsheet presents key data from Inclusion International's 2020 report "Excluded from the Excluded," which revealed that people with intellectual disabilities are excluded from 99.98% of Official Development Assistance (ODA)-funded programmes. The factsheet also shares key recommendations for funders to ensure that no one is left behind by ODA funding.
Differentiation and individualisation in inclusive education: a systematic review and narrative synthesis
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This study integrates research about differentiation and individualisation in inclusive education since the UN Convention on the Rights of Persons with Disabilities in 2006 (United Nations, 2006). The concept of inclusive education for all learners increases the requirement for teachers to create educational spaces that encourage stimulating teaching and learning processes. Accordingly, a methodological shift from the traditional ‘one-size-fits-all’ model to individualised teaching and learning offers a starting point for educational equity. The aim of this paper is to investigate the progress of differentiated and individualised teaching practices in inclusive classroom settings considering collaboration and teamwork, instructional practices, organisational practices and social/emotional/behavioural practices (see Finkelstein, Sharma, & Furlonger, 2019. “The Inclusive Practices of Classroom Teachers: A Scoping Review and Thematic Analysis.” International Journal of Inclusive Education, 1–28). Results of a criteria-based review considering papers from 2008 to December 2018 encompass 17 articles that were included in the narrative synthesis. Results indicated that the following aspects are characteristic of inclusive education: collaboration and co-teaching, grouping, modification (of assessment, content, extent, instruction, learning environment, material, process, product and time frame), individual motivation and feedback, and personnel support of students. Implications of the findings and gaps in the research have been outlined.
Uganda's disability data landscape and the economic inclusion of persons with disabilities
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This report looks at the landscape of data on disability in Uganda – summarising what data on persons with disabilities is available, who produces and uses it, and how – as well as what this means for the economic inclusion of persons with disabilities.
For persons with disabilities to benefit from and contribute to society and the economy there needs to be effective policies, programmes and services that support their inclusion, particularly in employment. Reliable information and data on persons with disabilities, known as ‘disability data’, is essential to planning and for decision-making. When it is of high quality, accessible and used effectively, disability data can help organisations of persons with disabilities (OPDs), civil society, government and businesses better understand and prioritise interventions that are vital for supporting persons with disabilities and ensuring their inclusion.
OPDs, civil society and the government have an important role to play in strengthening the landscape of disability data. Developed as part of Development Initiatives’ work on data to support disability inclusion, in consultation with Uganda’s disability rights movement, this report presents an analysis of Uganda’s landscape of disability data. It highlights important data sources, challenges and recommendations, providing a valuable evidence base to inform efforts aimed at strengthening the enabling environment for disability inclusion.
Research for all: making research inclusive of people with disabilities
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Developing programs to be inclusive of people with disabilities ensures that all people benefit. Acknowledging and understanding the lived experiences of people with disabilities is essential in changing the paradigm that development programs ‘do to’ or ‘do for’ a specific vulnerable and marginalised portion of the community. It addresses issues of equity and of development effectiveness.
This guidance provides tools and resources for practitioners, researchers and policymakers for any and all forms of research, or evaluation with human participants, to ensure best-practice. This guide is for ensuring that all people with disabilities within the population or community are not excluded (either purposefully or accidentally, through poor planning or inexperience) in doing development research or evaluation. The guide is not specifically designed for those doing research or projects solely focusing on people with disabilities.
This guide is divided into three sections for addressing and implementing good practice in development research.
Section One sets out the fundamental principles and ethical considerations of disability-inclusive development (DID) research. This includes an overview of the rights-based approach to disability, and its guidance in shaping development.
Section Two discusses the ethical considerations for designing inclusive research questions and methods, including when working with children with disabilities. This involves enabling and obtaining informed consent.
Section Three details the key steps and processes for ethically involving people with disabilities throughout the four main phases of the research process: planning, design, implementation, and dissemination.
Labour Market Assessment - Inclusion Works Bangladesh
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This rapid labour market assessment was undertaken in the intervention areas of Dhaka, Gazipur, Tangail, Chattogram and Khulna. The objectives were to analyse current scenario of the labour market, identify job opportunities for persons with disabilities, skills requirement for those jobs, risks and barriers of getting those jobs, etc. This report explains the facts and findings of the assessment and provides recommendations to make Inclusion Works more effective in their interventions. The assessment consists of two parts – secondary literature review and qualitative study.
The opinions expressed are those of the authors and do not necessarily reflect the views or policies of the UK government or members of the Inclusion Works consortium.
Labour Market Assessment - Inclusion Works Uganda
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This labour market assessment (LMA) has been conducted to collect a baseline to inform the implementation of the Inclusion works project. The LMA evaluated the economic trends and patterns and identified growth sectors and subsectors with a high propensity for job creation. Using value chain analysis, the LMA identified the kind of jobs available in the selected subsectors and the type of skills and educational qualifications required to fill them. The study also analysed the flows and stocks of education that the workforce possess to match the demand in the selected subsectors. Furthermore, the LMA assessed functionality of labour market coordination system and how existing policies and structures influence the labour market.
The opinions expressed are those of the authors and do not necessarily reflect the views or policies of the UK government or members of the Inclusion Works consortium.
Labour Market Assessment - Inclusion Works Nigeria
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This labour market assessment (LMA) was important to ensure the Inclusion Works programme interventions are strategic and provide the most optimal way to address unemployment challenges facing persons with disabilities. This LMA was designed to answer key questions associated with perspectives on: policy; coordination systems; employer; training and recruitment service providers; and job seekers. To address the questions, the assessment attempted to identify; the growing sectors and job opportunities in Lagos, Abuja and Jigawa States, the demand and supply of skills for enabling persons with disabilities to compete for current and future job opportunities, and understanding barriers for employers and persons with disabilities with regards to disability inclusive formal employment while focusing on both current and future opportunities in formal and informal sectors.
The opinions expressed are those of the authors and do not necessarily reflect the views or policies of the UK government or members of the Inclusion Works consortium.
Labour Market Assessment - Inclusion Works Kenya
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This is a rapid assessment of the Kenyan labour market which was commissioned to understand how the labour market functions in Kenya within the context of disability. This assessment provided opportunity to validate existing data on employment of persons with disabilities thus generating a solid baseline on which to anchor the programme’s targets and assumptions.
The opinions expressed are those of the authors and do not necessarily reflect the views or policies of the UK government or members of the Inclusion Works consortium.
Disability and disaster risk reduction as an incongruent matrix: Lessons from rural Zimbabwe
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This research paper focuses on two key topics in the disaster science field: pre-disaster risk reduction planning and post-disaster emergency response activities. It is based on experiences from disaster risk reduction projects in Bulilima and Mangwe districts in southern Zimbabwe between 2006 and 2014. A qualitative research methodology was employed, and data were collected using in-depth personal interviews, observations and focus group discussions. Both able-bodied people and people living with disabilities (PWDs) were part of the study.
Jamba. (Journal of disaster risk studies) 2019; 11(1): 648.
doi: 10.4102/jamba.v11i1.648
Maintaining professional integrity: experiences of case workers performing the assessments that determine children’s access to personal assistance
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This qualitative study explores Swedish case workers experiences of decision making regarding disabled children's right to obtain assistance in their everyday life whereby they can live independently in the community. Data collection included seven focus-group interviews and 11 complementary individual interviews with case workers from different agencies responsible for decisions regardig access to personal assistance. Grounded theory methodology was used. Compromised professional integrity under shifting conditions emerged as a main concern and maintaing professional integrity was used as an approach to resolve it. The case workers are maintaining professional integrity by applying different strategies; struggling with division of responsibility, bureaucratizig, and justifying and protecting. The results indicate that present application of assessment criteria in combination with the utilization of precedent rulings has made it difficult for the case workers to make decisions that provide children access to assistance. Current practice raises questions about the case workers perspectives of professionalism.
I Am EmployAble
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I am EmployAble walks the reader through the process of vocational training – from enrolment to training to employment – and provides tips based on experience, anecdotes and tools to inspire and support those working with and for disability inclusive technical and vocational training institutes.
The specific aim of this programme was to contribute to quality vocational training for young people with disabilities in Kenya, Rwanda and Ethiopia and create lasting linkages between technical and vocational training institutes and the labour market, thus facilitating decent and sustainable wage or selfemployment for young people with disabilities. This meant not just targeting the young people with disabilities themselves but also local training institutes and private sector actors, in order to work for systemic change.
Community Action Research in Disability (CARD): An inclusive research programme in Uganda
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The ideology of Emancipatory Disability Research (EDR) reflected in the phrase ‘Nothing about us without us’, was first put forward in the 1990s. Although it aimed to place research control in the hands of the ‘researched’, i.e., people with disability, this rarely happens even today, 25 years later.
The Community Action Research on Disability (CARD) programme in Uganda embraced and modified the EDR approach, recognising the need for including people with disability in the research process from concept to outcome, and nurturing participation and collaboration between all the stakeholders in achieving action-based research. The research teams always included people with disability and staff from Disability People’s Organisations (DPOs) as well as academics and service providers. It endeavoured to generate and carry out research around issues that mattered to people with disability and their families. Leadership roles were assigned by team members. The objectives of the CARD programme were: (1) to fund teams to carry out action-based research on disability in Uganda; (2) to develop research and administrative capacity to manage the initiative within the academic registrar’s office at Kyambogo University; (3) to incorporate new knowledge generated from the studies into the ongoing local community-based rehabilitation and special education courses; and, (4) to ensure wide dissemination of research findings to all stakeholder groups.
CARD ran for 5 years, commissioning 21 action research studies in the field of disability and community-based services. This paper describes the process, presents the 12 completed studies, examines the extent to which the objectives were achieved and evaluates the experiences of the participating research teams, particularly in relation to the inclusion of its members with disability. It concludes with recommendations for future initiatives designed to promote validity, good value and inclusive approaches in disability research.
The capacity of community-based participatory research in relation to disability and the SDGs
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The 2030 Agenda pledges to foster shared responsibility, recognizes all as crucial enablers of sustainable development, and calls for the mobilization of all available resources. It also commits to multi-stakeholder partnerships and pledges to be open, inclusive, participatory and transparent in its follow-up and review. Community-based participatory research (CBPR) equitably involves community members, organizational representatives and researchers, enabling them to share power and resources through drawing on the unique strengths that each partner brings. It aims to integrate any increased knowledge and understanding into action, policy and social change to improve the health and quality of life of community members. CBPR involves recruiting community or peer researchers, involving them in planning and offering them training to undertake interviews and observations in their context. They are also part of the analysis and dissemination process, and continue to work with local partners on advocacy plans and events after projects and research have finished. People with disabilities are actively part of the research process throughout. Drawing on relevant literature and current CBPR disability research in East and West Africa, this paper puts forward CBPR as a methodology that can enable community members to identify key barriers to achieving the SDGs, and inform how policy and programmes can be altered to best meet the needs of people with disabilities. It demonstrates CBPR in practice and discusses the successes and complexities of implementing this approach in relation to the SDGs. The paper also highlights findings such as the high level of support needed for community research teams as they collect data and formally disseminate it, the honest raw data from peer to peer interaction, a deep level of local ownership at advocacy level, emerging issues surrounding meaningfully involving community researchers in analysis, and power differentials. A key conclusion is that to join partners with diverse expertise requires much planning, diplomacy, and critical, reflexive thought, while emphasising the necessity of generating local ownership of findings and the translation of knowledge into a catalyst for disability-related policy change.
Disability & the Global South (DGS), 2017, Vol. 4 No. 1
Community-Based Rehabilitation Services in Low and Middle-Income Countries in the Asia-Pacific Region: Successes and Challenges in the Implementation of the CBR Matrix
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Purpose: This literature review aims to explore the importance of physical therapy services and the increasing awareness of CBR, specifically related to challenges in its implementation in low and middle-income countries in the Asia-Pacific region.
Method: A literature review of multiple databases was conducted to locate relevant articles written within the past five years. The databases used for the search were Google Scholar, Cochrane Library, CINAHL, and PubMed.
Results: Thirteen articles about CBR were included in the literature review. These consist of studies on the quality of life, access to healthcare services, and barriers to CBR, as well as about the impact of CBR to LMICs and stakeholders. The articles demonstrate the vast potential of CBR, especially in LMICs in the Asia-Pacific region, with a significant positive impact on the lives of people with disabilities.
Conclusion: CBR has improved the quality of life, access to medical services, functional independence, autonomy, community inclusion, and empowerment of people with disabilities in LMICs in the Asia-Pacific region. However, challenges in the implementation of CBR remain. These include lack of awareness and understanding of CBR, and physical, environmental, socio-economical and personal barriers.
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