Analysis of CBID/CBR Training Needs in Egypt

1. An Evidence-based Analysis of Community-Based Inclusive Development (CBID)/Community-Based Rehabilitation (CBR) Training Needs in Egypt: A study of 4 selected communities CAN 5th Conference “CBR Guidelines: A Bridge to Inclusive Society beyond the 2015 Development Framework”, 1-5th June 2015 Study Team: Gamal Ezz Elarab, Magrabi Foundation / Egypt Yana Zayed, CBM / EMRO Acknowledgement: All participants, local NGOs, DPO Federation in Asyout, Magrabi team and field facilitator, CEOSS, SETI, Egypt CBR Network, Sign Interpreters, data entry & analysis staff

2. Why is a TNA relevant now? • CBR has become part of a bigger goal – inclusive development • Paradigm shift from medical model, ‘client’ approach to rights-based model, ‘person-first’ focus • New approaches and techniques • New international legislation and frameworks

3. Objectives of the Study • To determine the unaddressed training needs and prioritiesof people with disability, community workers and other related stakeholders in Egypt • To assist in developing and planning training and learning activities for better inclusive community development at local and national levels More specifically, to: • Create an evidence–based understanding of CBR capacity building needs to contribute to the goal of CBID in Egypt • Map recent CBR training courses and opportunities • Make recommendations that would support strengthening the growth of CBR/CBID capacities and complement the existing efforts

4. Key questions explored The study aimed to look beyond ‘traditional’ CBR programmes to analyse the capacity needs for inclusive community development • What role are DPOs / people with disability playing in the development, implementation and evaluation of CBR programmes and other initiatives in their communities? How can their capacity be built? • What are the significant KSA gaps amongst community workers with regard to their contribution to CBID? • What CBR/CBID training or learning opportunities are there? How well are these opportunities accessed by the various CBR stakeholders? • What would be the most effective means for building capacity in CBID/CBR? (E.g. peer-to-peer learning, e-learning, short vs. long courses) • How are CBR programmes connected to other CBID interest groups such as gender, older people, other marginalised groups, etc.?

5. Scope As the first study of its kind in Egypt, a lot of evidence needed to be collected however the resources available to EICO were limited, so study scope was determined in discussion with the Egypt CBR Network, based on agreed priorities. Study focused on: • Key informants from the community level as well as those deemed to have a strong insight to the CBR/inclusive community development sector in Egypt. • In depth analysis of 4 selected villages from the Delta, Greater Cairo, Upper Egypt regions, as well as an additional remote location with very limited resources. Out of scope: Key informants from national/district level government, UN agencies, international and national mainstream NGOs would be approached later on.

6. Egypt Map with Study Locations 1 2 3 4 5 1. Kafr Elbatekh (Domyat) 2. Ezbet Khayeralla (Cairo) 3. Kotta (Fayoum) 4. Geziret Beba (Beni Suef) 5. Manabad (Asyout)

7. Methodology • The methodology was finalised in December 2014 following a consultation with the Egypt CBR Network. • In-depth community analysis was conducted in 4 communitiesfrom different governorates across the country (3 villages and 1 inner urban slum) using the same approach to allow for comparative analysis. • One additional community remote from service provision was selected. Scarce infrastructure in that fifth community did not allow for applying the full methodology and information was gathered only from home visits and observations. • Additional focus groups held with 2 DPO umbrella networks and 1 CBR training team. • Validation will run with the Egypt CBR Network in the future.

8. Data Collection The fieldwork was conducted during January and February 2015 and the data was processed between March to April 2015.

9. Tools’ Design Questionnaires • 4 different forms tailored to different target groups. Each form covered sections on personal data, needs & access to disability specific and other general services, perceptions of disability, community involvement and training received & needs. • Forms were produced in Arabic & Braille, and coded. • Assistance provided to people requiring support to fill in the forms (e.g. high illiteracy rate in rural areas). • STATA software was used for data analysis. Focus groups • Conducted with accessibility in mind, facilitated by study team and persons with disability in some locations. Sign language interpreters participated. Interviews • Conducted in person by study team using structured but open questions. Observations • Home visits conducted to get more in depth understanding of reality allowing people to talk freely. Oral Permissions obtained from families prior to home visits. • A walk around the community to get a sense of environment.

10. Description of sample population 1. Questionnaires - a total of 137 surveys questionnaires were completed including: 46 - people with disability 43 - family members of people with disability 28 - CBR workers 20 - community workers who do not identify themselves as CBR workers 68% of respondents completed the questionnaires on their own 2. Focus group discussions - 71 - persons with disability (22 female) 40 - families of persons with disability (37 female) 41 - community workers (40 female) 3. Key informant interviews - 5 CBR programme managers/trainers, 3 Village Mayors, 4 Head Nurses of Village Health Unit, 3 Head Teachers of Village Primary School, 4 staff of local Ministry of Social Solidarity Rehabilitation Office 4. Informal/observations / visits - 6 homes of adults with disability, 8 homes of children with disability.

11. Profile of questionnaire respondents In total, 54 persons with disability responded (39% of respondents) of whom 26 were members of DPOs / Elected committees

12. None of the respondents who received training on rights reflected the rights-based model in their definition • The majority of people with disability and their families had never heard of the CBR guidelines; even those who were aware of the UN CRPD and national legislation.

13. Overall lack of knowledge, in particular the majority of people with disability and their families had never heard of the CBR guidelines

16. Training received • Of the 137 respondents, 75 people noted that they had received training of some kind • Of the 48 respondents who noted they were in a DPO, 38 people noted that they had received training of some kind • 81 different training topics were noted by the respondents • The most comment topic noted by people in DPOs was 'Lobbying & Advocacy' • The most comment topic noted by people not aligned to DPOs was 'Speech Therapy‘ There was a strong correlation noted between proficiency levels and those who received training

18. Other key findings on knowledge, skills and attitudes Despite working towards the same goals, there is very little collaboration between local DPOs/Elected Committees and CBR programmes based on misconception of respective roles. In 3 of the 4 communities, people with disability and families noted at least 7 areas within the CBR matrix where no services or activities were available in their community whereas the community/CBR workers noted that they offer services in those areas. Confusion exists among all groups - including government staff – regarding the Egyptian welfare/social protection system. Several incidences of misdiagnosis and/or poor medical advice observed – knowledge gaps in basic interventions outside of a medical facility (especially autism and physiotherapy). 18 out of 19 community workers strongly agreed with the statement that they would welcome the opportunity to build their capacity to be more inclusive of people with disability.

19. Learning approaches • 87% of respondents noted that for training to be useful they needed to attend a new course every few months • 70% expressed that they would need to improve their computer skills before taking part in a computer-based training course

20. Conclusions • People with disability have very limited knowledge of CBR principles and DPOs do not align closely enough with CBR programmes. • Community workers need to shift their approach and understanding of disability as rights and person based.

21. Lessons Learned • The questionnaires were very detailed and proved too complex for many of the respondents to fill in without guidance. • The study was not designed as a participatory study however, some people with disability from a neighboring DPO volunteered to support with the data collection and this had many positive outcomes.

22. Way Forward • Findings will contribute to Egypt CBR Network strategic planning workshop scheduled for year 2015. • EICO to develop relevant training programmes based on findings and need – working with other national stakeholders. • This study should be followed up with a more comprehensive national study that can be used to influence decision-makers in order to raise the status of CBID/CBR in Egypt. • It is hoped that the findings will support CBR and community development practitioners, as well as DPOs, wishing to develop an evidence-based understanding of CBR and CBID capacity gaps within their communities.

23. Thank you! Any questions? Dr Gamal Ezz Elarab - Magrabi Foundation, Egypt gamal@magrabi.org