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1. Disability and Community-Based Rehabilitation (CBR) in Africa Page de garde présentation Page de garde présentation
2. Introduction Around 250 millions disabled persons live today in developing countries It is estimated that about 250 millions DPs live today in developing countries
In 2035, this number will probably reach 500 millions
However, a very small proportion of that mass of DPs from developing countries has access to an acceptable level of rehabilitation
22 sec
It is estimated that about 250 millions DPs live today in developing countries
In 2035, this number will probably reach 500 millions
However, a very small proportion of that mass of DPs from developing countries has access to an acceptable level of rehabilitation
22 sec
3. Why this situation ? Rich Countries: rehabilitation model based on specialized institutions and professionals
« Institution-Based » system effective but costly
Not suitable for developing countries
Too poor:
To create enough institutions
To train and pay the necessary specialised staff
For the population to pay for care and services Why this situation ?
Rich countries could develop a rehabilitation model based on the action of many specialized institutions
This « institution based » model is effective but has the great default of being very costly
Therefore it is not adapted to developing countries
That are too poor:
To create enough institutions
To train and to pay the necessary specialized staff
And simply for the people to afford the cost of care and services
37 secWhy this situation ?
Rich countries could develop a rehabilitation model based on the action of many specialized institutions
This « institution based » model is effective but has the great default of being very costly
Therefore it is not adapted to developing countries
That are too poor:
To create enough institutions
To train and to pay the necessary specialized staff
And simply for the people to afford the cost of care and services
37 sec
4. What can be done ? Increase the number of institutions ?
Not realistic
The financial means of DCs are weak
The needs of DPs are not a priority in DCs Therefore what can be done ?
Create more rehabilitation institutions in developing countries ?
Seems not realistic because:
The financial means of developing countries are weak and it is likely that it will stay weak in the next decades
Considering the huge uncovered needs of the global population, The needs of DPs are not a priority for DCs authorities .
Therefore we need to imagine another rehabilitation model :
That would be better adapted to the economical, social and cultural context of developing countries
That could give an acceptable answer to the rehabilitation needs of a majority of DPs.
42 secTherefore what can be done ?
Create more rehabilitation institutions in developing countries ?
Seems not realistic because:
The financial means of developing countries are weak and it is likely that it will stay weak in the next decades
Considering the huge uncovered needs of the global population, The needs of DPs are not a priority for DCs authorities .
Therefore we need to imagine another rehabilitation model :
That would be better adapted to the economical, social and cultural context of developing countries
That could give an acceptable answer to the rehabilitation needs of a majority of DPs.
42 sec
5. Major principles of this alternative rehab model Not only be based on the action of specialized institutions
To build as much as possible on:
action
resources
knowledge
Of the family , neighbouring and all human community where the DP lives What should be the major principles of this new rehabilitation model :
Not only be based on the work of rehabilitation institutions and professionals
On the opposite, it should Build as much as possible on the :
- action
- resources
- knowledge
Of the family, neighboring, and all human community where the disabled person lives. 25 sec
What should be the major principles of this new rehabilitation model :
Not only be based on the work of rehabilitation institutions and professionals
On the opposite, it should Build as much as possible on the :
- action
- resources
- knowledge
Of the family, neighboring, and all human community where the disabled person lives. 25 sec
6. Where do we stand now ? For 25 years WHO promotes the « Community Based Rehabilitation » Strategy (CBR)
CBR was experimented on a small scale in many DCs with very uneven results
There is a debate about CBR. Other models were experimented
Problem: serious published evaluations about CBR are very rare
Consequence: we miss data to improve our knowledge of CBR implementation and management Where are we now?
For the past 25 years WHO and United Nations promotes the development of a strategy called « Community Based Rehabilitation »
This strategy was experimented on a small scale in many developing countries with very uneven results
The CBR model proposed by WHO faces criticisms. Other models were proposed and experimented
The main problem is that serious published evaluations about CBR experiences are extremely rare
The consequence is that we miss clear data to improve our knowledge of the CBR strategy, which, up to now, never passed the stage of small scale projects.
48 sec
Where are we now?
For the past 25 years WHO and United Nations promotes the development of a strategy called « Community Based Rehabilitation »
This strategy was experimented on a small scale in many developing countries with very uneven results
The CBR model proposed by WHO faces criticisms. Other models were proposed and experimented
The main problem is that serious published evaluations about CBR experiences are extremely rare
The consequence is that we miss clear data to improve our knowledge of the CBR strategy, which, up to now, never passed the stage of small scale projects.
48 sec
7. Purpose of this presentation Synthesis Research As a contribution to help answering this issue, the presentation is divided into two parts
A synthesis on basic principles, functioning, problems and challenges linked to the community approach of rehabilitation
A research part based on a detailed assessment of two WHO CBR experiences in West Africa.
26 sec
As a contribution to help answering this issue, the presentation is divided into two parts
A synthesis on basic principles, functioning, problems and challenges linked to the community approach of rehabilitation
A research part based on a detailed assessment of two WHO CBR experiences in West Africa.
26 sec
8. Part 1 - Synthesis
3 sec
3 sec
9. Basic principles of Community Rehabilitation approach CBR
= What are the basic principles of the community approach of rehabilitation ?
CBR is basically a community development process.
Which main purpose is to improve services for disabled persons.
12 sec
What are the basic principles of the community approach of rehabilitation ?
CBR is basically a community development process.
Which main purpose is to improve services for disabled persons.
12 sec
10. Community Development ? 1. A group of People organize themselves at community level in order to reach a common goal they consider important What is, however, the meaning of the term « Community Development »
One will speak of community development when a group of people from civil society organize themselves at community level and act to reach a common goal they consider important.
To reach this goal they must however be supported by professionals of what will be called intermediary level for technical acts that they cannot perform alone
Then, at national level, the authorities must support and encourage the community initiative.
A strong coordination between these three levels of the society is the basic rule for the management of any community development process.
42 sec What is, however, the meaning of the term « Community Development »
One will speak of community development when a group of people from civil society organize themselves at community level and act to reach a common goal they consider important.
To reach this goal they must however be supported by professionals of what will be called intermediary level for technical acts that they cannot perform alone
Then, at national level, the authorities must support and encourage the community initiative.
A strong coordination between these three levels of the society is the basic rule for the management of any community development process.
42 sec
11. Three basic « tools » WHO CBR model I already told you that there are several models of community rehabilitation
This work mainly evaluates the WHO CBR model
WHO CBR works with three basic « tools » :
A Specific CBR rehabilitation technique
A specific service delivery system , which means the way CBR techniques reach the DPs on the ground
And finally a decentralized way to manage the CBR system
35 secI already told you that there are several models of community rehabilitation
This work mainly evaluates the WHO CBR model
WHO CBR works with three basic « tools » :
A Specific CBR rehabilitation technique
A specific service delivery system , which means the way CBR techniques reach the DPs on the ground
And finally a decentralized way to manage the CBR system
35 sec
12. WHO CBR Technique What does WHO CBR technique look like ?
First of all, in order to be as universal as possible, the CBR technique is very standardized. Its elements are gathered in a manual of several hundred pages which you see here the French version cover page. Here is the title of the English version
What are its main principles ?
12 sec What does WHO CBR technique look like ?
First of all, in order to be as universal as possible, the CBR technique is very standardized. Its elements are gathered in a manual of several hundred pages which you see here the French version cover page. Here is the title of the English version
What are its main principles ?
12 sec
13. It is in fact a very pragmatic, non medical approach that mainly aims at searching practical solutions to the daily problems faced by both Disabled Persons and their families.
It can easily be understood when reading the titles of the separate booklets of the manual
25 sec It is in fact a very pragmatic, non medical approach that mainly aims at searching practical solutions to the daily problems faced by both Disabled Persons and their families.
It can easily be understood when reading the titles of the separate booklets of the manual
25 sec
14. Disabled persons and their families did however not wait CBR to try solving their problems.
CBR technique is therefore much inspired of spontaneous rehabilitation behaviors that could be observed all around the world and that are gathered and standardized in the manual.
As an example we have this very simple sign languages for people with speaking difficulties. It must of course have been invented thousands of times in many ways before being printed in the WHO CBR manual.
Another example is this simple method to identify coins and banknotes for people with seeing difficulties.
30 sec Disabled persons and their families did however not wait CBR to try solving their problems.
CBR technique is therefore much inspired of spontaneous rehabilitation behaviors that could be observed all around the world and that are gathered and standardized in the manual.
As an example we have this very simple sign languages for people with speaking difficulties. It must of course have been invented thousands of times in many ways before being printed in the WHO CBR manual.
Another example is this simple method to identify coins and banknotes for people with seeing difficulties.
30 sec
15. To be accessible to people , CBR techniques build as much as possible on what is locally available
For instance we have a simple foot anti falling device, made of tissue and rubber band, for feet that are crippled after anti malaria injections
Or this helmet made with rags, to prevent head injuries for people suffering from severe fits crisis.
18 sec To be accessible to people , CBR techniques build as much as possible on what is locally available
For instance we have a simple foot anti falling device, made of tissue and rubber band, for feet that are crippled after anti malaria injections
Or this helmet made with rags, to prevent head injuries for people suffering from severe fits crisis.
18 sec
16. Finally, following the same logic, CBR techniques build the rehabilitation process as much as possible on informal means, which means, whenever possible, out of institutions and services formally designed for disabled persons
The « physical therapy » part of rehabilitation will be as much as possible completed at home with the help of a family member, generally the mother.
29 sec Finally, following the same logic, CBR techniques build the rehabilitation process as much as possible on informal means, which means, whenever possible, out of institutions and services formally designed for disabled persons
The « physical therapy » part of rehabilitation will be as much as possible completed at home with the help of a family member, generally the mother.
29 sec
17. In the same way, training to daily life activities will mainly be made inside the family
As for this multi disabled girl trained to personal care, this girl with a mental delay or this other young girl with Down syndrome who were trained to participate to home activities
21 secIn the same way, training to daily life activities will mainly be made inside the family
As for this multi disabled girl trained to personal care, this girl with a mental delay or this other young girl with Down syndrome who were trained to participate to home activities
21 sec
18. Always in the same logic , the educational aspects of rehabilitation will mainly take place in normal schools
As for this young girl with two legs crippled by poliomyelitis or this boy with Down Syndrome who were included with non disabled children in normal classes.
20 sec
Always in the same logic , the educational aspects of rehabilitation will mainly take place in normal schools
As for this young girl with two legs crippled by poliomyelitis or this boy with Down Syndrome who were included with non disabled children in normal classes.
20 sec
19. Vocational training will mostly be achieved in the same apprenticeship networks attended by non disabled persons
We have the example of a young girl with two crippled legs who learns hairdressing with non disabled apprentices
Or a boy with the same disability who learns to paint shop signs in a calligraphy workshop
22 sec Vocational training will mostly be achieved in the same apprenticeship networks attended by non disabled persons
We have the example of a young girl with two crippled legs who learns hairdressing with non disabled apprentices
Or a boy with the same disability who learns to paint shop signs in a calligraphy workshop
22 sec
20. At last, access to income generating activities will mostly be achieved through informal economy as for the majority of non disabled persons in developing countries.
We have here the example of a polio paraplegic boy who had a three wheeled Vespa scooter made with a 300 liters gas tank. With this special vehicle, his professional activity consist of smuggling gas between Nigeria and Benin.
Another example is this blind women who works in a group of women who created a small ambulant laundry business.
As a matter of interest, I get back for a while on these paraplegic gas smugglers who are many in Benin
As you can see they are always helped by a non disabled who sits on their back. It is rather remarkable if we consider that , in this particular case, it is the disabled person who provides a job to a non disabled.
30 sec At last, access to income generating activities will mostly be achieved through informal economy as for the majority of non disabled persons in developing countries.
We have here the example of a polio paraplegic boy who had a three wheeled Vespa scooter made with a 300 liters gas tank. With this special vehicle, his professional activity consist of smuggling gas between Nigeria and Benin.
Another example is this blind women who works in a group of women who created a small ambulant laundry business.
As a matter of interest, I get back for a while on these paraplegic gas smugglers who are many in Benin
As you can see they are always helped by a non disabled who sits on their back. It is rather remarkable if we consider that , in this particular case, it is the disabled person who provides a job to a non disabled.
30 sec
21. Principles of WHO CBR Techniques 1. « Solving Problem » approach
2. Based on people’s experience
3. Use locally available resources
4. Based on informal training systems A very important thing that must be learned from the CBR techniques is that they naturally integrate rehabilitation acts to the daily life of non disabled people
As a result, they progressively tend to decrease the discrimination and negative attitudes disabled persons are victims of
It helps therefore the disabled persons getting their essential human rights
28 sec A very important thing that must be learned from the CBR techniques is that they naturally integrate rehabilitation acts to the daily life of non disabled people
As a result, they progressively tend to decrease the discrimination and negative attitudes disabled persons are victims of
It helps therefore the disabled persons getting their essential human rights
28 sec
22. CBR service delivery system Let us now see how CBR makes its techniques « reach » the disabled persons
It is in fact a multilevel service delivery system
The disabled person gets a daily training from a « family trainer » who is generally the mother.
The Family trainer is himself trained and advised by a « Local Facilitator ». It is a volunteer from the village or from the area who accepts to spend a part of his time for some disabled persons of his community
Several Local Facilitators are trained and regularly framed by a CBR professional who is called the « Intermediary Level Supervisor »
In addition to his training role for community rehabilitation workers, the Intermediary Level Supervisor plays the very important role of a link between community level of action and the level of reference institutions when the Disabled Person must leave her community for specialized technical acts that cannot be performed at community level and later comes back to her community, in order to carry on her rehabilitation process.
75 secLet us now see how CBR makes its techniques « reach » the disabled persons
It is in fact a multilevel service delivery system
The disabled person gets a daily training from a « family trainer » who is generally the mother.
The Family trainer is himself trained and advised by a « Local Facilitator ». It is a volunteer from the village or from the area who accepts to spend a part of his time for some disabled persons of his community
Several Local Facilitators are trained and regularly framed by a CBR professional who is called the « Intermediary Level Supervisor »
In addition to his training role for community rehabilitation workers, the Intermediary Level Supervisor plays the very important role of a link between community level of action and the level of reference institutions when the Disabled Person must leave her community for specialized technical acts that cannot be performed at community level and later comes back to her community, in order to carry on her rehabilitation process.
75 sec
23. CBR Management Then, the management of the CBR strategy is naturally based on community development principles
At community level
The basic unit of CBR strategy is called « CBR district ». It is a geographic entity with a population between 50.000 and 100.000 inhabitants.
The CBR district is managed by a CBR committee, made of people living there who want to do something to improve the life of disabled persons of their community.
At intermediary level
The Intermediary level supervisor and the reference institutions technically support the community rehabilitation work
Then at regional and National Level, the authorities support intermediary and community levels with subventions, trainings of intermediary and community staff, wages, assessments, planning, …
60 secThen, the management of the CBR strategy is naturally based on community development principles
At community level
The basic unit of CBR strategy is called « CBR district ». It is a geographic entity with a population between 50.000 and 100.000 inhabitants.
The CBR district is managed by a CBR committee, made of people living there who want to do something to improve the life of disabled persons of their community.
At intermediary level
The Intermediary level supervisor and the reference institutions technically support the community rehabilitation work
Then at regional and National Level, the authorities support intermediary and community levels with subventions, trainings of intermediary and community staff, wages, assessments, planning, …
60 sec
24. Voici donc brièvement comment , en théorie, le modèle de RBC de l'OMS est sensé fonctionner.
Je vous ai cependant dit qu'à ce jour , les expériences de RBC lancées à travers le monde n'ont guère dépassé le stade de quelques centaines voire quelques milliers de PH concernées.
Or, il est urgent de passer à beaucoup plus grande une échelle. Pourquoi ?
Si nous considérons l'évolution probable du nombre de personnes handicapées dans le monde
Nous voyons que les pays développés vont connaître d'ici trente ans une croissance modérée du nombre de PH.
Mais Cette croissance sera dramatiquement plus importante dans les PVD
Or, face à leur démographie, les PVD auront milles autres priorités que la réadaptation des PH
Il n'auront donc pas les moyens de mettre en place un modèle institutionnel suffisant
Faute d'alternatives, la stratégie RBC semble donc incontournable .
Il est donc urgent de l'évaluer pour mieux la connaître, mieux l'appliquer et lui donner une chance de se répandre.
60 sec Voici donc brièvement comment , en théorie, le modèle de RBC de l'OMS est sensé fonctionner.
Je vous ai cependant dit qu'à ce jour , les expériences de RBC lancées à travers le monde n'ont guère dépassé le stade de quelques centaines voire quelques milliers de PH concernées.
Or, il est urgent de passer à beaucoup plus grande une échelle. Pourquoi ?
Si nous considérons l'évolution probable du nombre de personnes handicapées dans le monde
Nous voyons que les pays développés vont connaître d'ici trente ans une croissance modérée du nombre de PH.
Mais Cette croissance sera dramatiquement plus importante dans les PVD
Or, face à leur démographie, les PVD auront milles autres priorités que la réadaptation des PH
Il n'auront donc pas les moyens de mettre en place un modèle institutionnel suffisant
Faute d'alternatives, la stratégie RBC semble donc incontournable .
Il est donc urgent de l'évaluer pour mieux la connaître, mieux l'appliquer et lui donner une chance de se répandre.
60 sec
25. Part 2
Ghana and Benin’s CBR programs Let us now go over to the second part of this work, the assessment of Ghana and Benin’s CBR experiences
9 sec Let us now go over to the second part of this work, the assessment of Ghana and Benin’s CBR experiences
9 sec
26. 238.533 km2.
Pop: 20 millions Geographical data Ghana and Benin are two Countries of west Africa, facing the Gulf of Benin. They are nearly neighbors, only separated by the small Togo.
Ghana has 238.000 km2 with 20 millions inhabitants
Benin is two times smaller and three times less crowded
23 sec Ghana and Benin are two Countries of west Africa, facing the Gulf of Benin. They are nearly neighbors, only separated by the small Togo.
Ghana has 238.000 km2 with 20 millions inhabitants
Benin is two times smaller and three times less crowded
23 sec
27. Origins of the two CBR experiences WHO CBR approach At the beginning of the nineties, Ghana and Benin’s Ministries of social welfare decided to experiment CBR in some of their localities
In both countries the programs were WHO CBR models
Launched with technical support of United Nations
And with financial support of European NGOs.
21 sec At the beginning of the nineties, Ghana and Benin’s Ministries of social welfare decided to experiment CBR in some of their localities
In both countries the programs were WHO CBR models
Launched with technical support of United Nations
And with financial support of European NGOs.
21 sec
28. Main Objectives of the research Evaluation of the two CBR programs The research objectives were to evaluate in depth the two CBR programs
In order to learn as much as possible for the implementation of other CBR programs
14 sec The research objectives were to evaluate in depth the two CBR programs
In order to learn as much as possible for the implementation of other CBR programs
14 sec
29. Method 1. Implementation and management of the 2 CBR programs
Available documents and interviews of CBR actors
2. Results with the DPs participating to the program
Enquiry on a sample of 624 DPs aged from 0 to 32 years The evaluation method is divided in two parts:
The first part was a comparative study. It consisted in
• comparing implementation and management of the 2 CBR programs from available documents and from interviews with CBR actors
• Comparing results obtained with Disabled Persons. This was achieved through an enquiry made on 624 disabled persons from 0 to 32 years old who participated to the CBR program,.
The second part was an analysis.
Highlighting factors significantly linked with progress made by disabled persons
This was achieved using multivariate statistical analysis methods.
44 sec The evaluation method is divided in two parts:
The first part was a comparative study. It consisted in
• comparing implementation and management of the 2 CBR programs from available documents and from interviews with CBR actors
• Comparing results obtained with Disabled Persons. This was achieved through an enquiry made on 624 disabled persons from 0 to 32 years old who participated to the CBR program,.
The second part was an analysis.
Highlighting factors significantly linked with progress made by disabled persons
This was achieved using multivariate statistical analysis methods.
44 sec
30. 1.1 Setting up strategies of the CBR districts We start with this comparative part of the research work
It concerns at first the comparison between implementation and management of the two programs
Beginning by examining how the two programs established their CBR districts.
12 secWe start with this comparative part of the research work
It concerns at first the comparison between implementation and management of the two programs
Beginning by examining how the two programs established their CBR districts.
12 sec
31. In Benin: the 15 first CBR districts were established only in the south part of the country:
7 districts, represented by stars, were set up between 1990 and 1992 ,
8 districts, represented by circles, were set up in 1998
Among them (in blue) 6 districts were established in urban areas
While 9 districts (in green) were established in Rural areas
The enquiry concerned a sample of 330 Disabled persons sampled out of the 7 first established districts.
45 sec
In Benin: the 15 first CBR districts were established only in the south part of the country:
7 districts, represented by stars, were set up between 1990 and 1992 ,
8 districts, represented by circles, were set up in 1998
Among them (in blue) 6 districts were established in urban areas
While 9 districts (in green) were established in Rural areas
The enquiry concerned a sample of 330 Disabled persons sampled out of the 7 first established districts.
45 sec
32. In Ghana, contrary to Benin, CBR districts were established from the South to the North of the country
A first wave of 10 districts was set up in 1992
A second wave of ten districts followed in 1995
There was only one urban district in the Capital Accra.
An 19 districts in rural areas.
The enquiry concerned a sample of 294 DPs from 0 to 32 years old sampled out of 8 of the ten first CBR districts
45 sec In Ghana, contrary to Benin, CBR districts were established from the South to the North of the country
A first wave of 10 districts was set up in 1992
A second wave of ten districts followed in 1995
There was only one urban district in the Capital Accra.
An 19 districts in rural areas.
The enquiry concerned a sample of 294 DPs from 0 to 32 years old sampled out of 8 of the ten first CBR districts
45 sec
33. But there was another big difference between the two programs
In 1997 Benin had 15 CBR districts with a global population of 1 million people
On the other side Ghana had 20 CBR districts with a population of only 250.000 people
It can be explained by the fact that Benin had 6 very crowded urban districts
While Ghana had only one
But the main reason is that the two programs had very different setting up strategies in rural areas
In Benin the rural CBR district is established in an administrative district , with a head town and some peripheral localities. The CBR district covers all this geographical entity.
It represent big target communities with an average size of 70.000 people, the CBR district being managed by only one CBR committee.
In Ghana the situation is the same , but the difference is that the CBR district only covers some of the localities of the administrative district where it is established. It concerns therefore much smaller target communities of 4 x 2000 people in average. Each locality having its own CBR committee.
77 sec But there was another big difference between the two programs
In 1997 Benin had 15 CBR districts with a global population of 1 million people
On the other side Ghana had 20 CBR districts with a population of only 250.000 people
It can be explained by the fact that Benin had 6 very crowded urban districts
While Ghana had only one
But the main reason is that the two programs had very different setting up strategies in rural areas
In Benin the rural CBR district is established in an administrative district , with a head town and some peripheral localities. The CBR district covers all this geographical entity.
It represent big target communities with an average size of 70.000 people, the CBR district being managed by only one CBR committee.
In Ghana the situation is the same , but the difference is that the CBR district only covers some of the localities of the administrative district where it is established. It concerns therefore much smaller target communities of 4 x 2000 people in average. Each locality having its own CBR committee.
77 sec
34. To have a better idea, you can see here a view taken in a slum of the urban CBR district of Cotonou 2 – Akpkapa situated in the suburbs of Cotonou , the economic capital of Benin.
12 sec To have a better idea, you can see here a view taken in a slum of the urban CBR district of Cotonou 2 – Akpkapa situated in the suburbs of Cotonou , the economic capital of Benin.
12 sec
35. Still in Benin this is a picture made in a village of the Misserete rural CBR district.
10 secStill in Benin this is a picture made in a village of the Misserete rural CBR district.
10 sec
36. In Accra, Capital of Ghana, this is a view of the James Town area, the only urban district of the Ghanaian CBR program.
10 sec In Accra, Capital of Ghana, this is a view of the James Town area, the only urban district of the Ghanaian CBR program.
10 sec
37. And here you see one of the 4 target localities of Techiman rural CBR district, and a second target locality of the same district
12 sec And here you see one of the 4 target localities of Techiman rural CBR district, and a second target locality of the same district
12 sec
38. Consequences of these different implementation strategies Benin
Average of 70.000 inhab./district This difference in implementation strategies induced important consequences
In Benin each District has an average of 70.000 inhabitant
While in Ghana the average population of a Rural district does not exceed 8.000 people
The literature generally says that the average prevalence of disability in developing countries is around 4 %
Considering this figure, there should approximately be 2.000 Disabled persons in each Beninese CBR district but no more than 320 DPs in Ghanaian CBR districts
However, it appeared in the two countries that each CBR district was able to follow a maximum of 150 DPs simultaneously
Due to this limiting factor there was a important selection of the DPs enrolled in Benin’s CBR district
while the selection was much less important in Ghana.
This difference in selection of DPs induced other consequences
60 sec
This difference in implementation strategies induced important consequences
In Benin each District has an average of 70.000 inhabitant
While in Ghana the average population of a Rural district does not exceed 8.000 people
The literature generally says that the average prevalence of disability in developing countries is around 4 %
Considering this figure, there should approximately be 2.000 Disabled persons in each Beninese CBR district but no more than 320 DPs in Ghanaian CBR districts
However, it appeared in the two countries that each CBR district was able to follow a maximum of 150 DPs simultaneously
Due to this limiting factor there was a important selection of the DPs enrolled in Benin’s CBR district
while the selection was much less important in Ghana.
This difference in selection of DPs induced other consequences
60 sec
39. DP’s age distribution First of all, on the age of the DPs enrolled in each program
In appeared that DPs from Ghanaian program (in red) were regularly distributed between the different ages categories
While DPs from Beninese program (in green) were clearly younger
The average age was 15 years in Ghana and more than 30 years in Ghana.
23 sec First of all, on the age of the DPs enrolled in each program
In appeared that DPs from Ghanaian program (in red) were regularly distributed between the different ages categories
While DPs from Beninese program (in green) were clearly younger
The average age was 15 years in Ghana and more than 30 years in Ghana.
23 sec
40. Types of disabilities Moreover, considering types of disabilities, it appeared that the Beninese CBR program (in green) enrolled more persons with motor disabilities, while Ghana (in red) enrolled more persons with sensory disabilities
Then , considering gravity of disabilities , Benin selected more severely disabled persons than Ghana.
25 sec Moreover, considering types of disabilities, it appeared that the Beninese CBR program (in green) enrolled more persons with motor disabilities, while Ghana (in red) enrolled more persons with sensory disabilities
Then , considering gravity of disabilities , Benin selected more severely disabled persons than Ghana.
25 sec
41. Social level of the DP’s families At last, let us consider the social level of the families were the DPs lived:
We see that the distribution was more or less normal in Benin between, very poor, poor, middle class or rich families
While in Ghana the big majority of the families were included in the « poor » category
Which means that they get at least the daily food but have many difficulties to satisfy all their other basic needs (health , education, housing)
The reason being that the Ghanaian program was mostly implemented in rural areas
33 sec At last, let us consider the social level of the families were the DPs lived:
We see that the distribution was more or less normal in Benin between, very poor, poor, middle class or rich families
While in Ghana the big majority of the families were included in the « poor » category
Which means that they get at least the daily food but have many difficulties to satisfy all their other basic needs (health , education, housing)
The reason being that the Ghanaian program was mostly implemented in rural areas
33 sec
42. 1.1 Setting up strategies of the CBR districts After their setting-up strategies
Lets us briefly see what was the cost of the two programs
12 secAfter their setting-up strategies
Lets us briefly see what was the cost of the two programs
12 sec
43. Ghana spent an average of 227.000 US dollars per year from 1992 to 1995
While Benin spent an average of 61.000 dollars per year from 1992 to 1995.
Compared to the number of concerned disabled persons , it represents a yearly cost of 118 Dollars per Disabled person in Ghana for 1910 concerned disabled persons and 94 dollars per disabled person in Benin for 650 concerned disabled persons.
The big difference stays however in the origin of the funds;
In Ghana all the funds spent for the program were provided by the Government and foreign NGOs. There was no community participation to finance the program
In Benin, between 1994 and 1997, CBR committees managed to provide by themselves an average of 25 % of the global amount spent each year for the CBR program Ghana spent an average of 227.000 US dollars per year from 1992 to 1995
While Benin spent an average of 61.000 dollars per year from 1992 to 1995.
Compared to the number of concerned disabled persons , it represents a yearly cost of 118 Dollars per Disabled person in Ghana for 1910 concerned disabled persons and 94 dollars per disabled person in Benin for 650 concerned disabled persons.
The big difference stays however in the origin of the funds;
In Ghana all the funds spent for the program were provided by the Government and foreign NGOs. There was no community participation to finance the program
In Benin, between 1994 and 1997, CBR committees managed to provide by themselves an average of 25 % of the global amount spent each year for the CBR program
44. Expenditures of the 2 CBR programs It is interesting to see how the money provided by foreign NGOs and the two Governments was spent:
In Ghana (in red) the national coordination of the program spent for itself 42 % of the total budget, against only 11 % in Benin.
On the opposite we see that the same Ghanaian National Coordination never provided any direct financial support to the CBR committees, while Benin devoted about 25 % of its budget for it.
Finally we see that the budget for vehicles and bikes maintenance and fuel is very weak in Ghana. The main consequence is that the 20 Ghanaian Intermediary level supervisors missed most of the time the money necessary to have their duty bikes ride. They had therefore many difficulties to travel around their CBR districts so that the framing of local facilitators was very irregular.
To illustrate this, you can see here the supervisor of Akastsi CBR District in Ghana, himself disabled. When the enquiry took place in 1999, his tricycle bike was already broken since two years.
The situation can then be summarized as follows:
The Beninese national coordination maintained a good balance of the expenditures between the three levels of its CBR program , and there was a significant community participation to the program financing
In Ghana the budget was “eaten” by the national level at the expense of the other levels and there was no community participation to the financing of the program
85 sec It is interesting to see how the money provided by foreign NGOs and the two Governments was spent:
In Ghana (in red) the national coordination of the program spent for itself 42 % of the total budget, against only 11 % in Benin.
On the opposite we see that the same Ghanaian National Coordination never provided any direct financial support to the CBR committees, while Benin devoted about 25 % of its budget for it.
Finally we see that the budget for vehicles and bikes maintenance and fuel is very weak in Ghana. The main consequence is that the 20 Ghanaian Intermediary level supervisors missed most of the time the money necessary to have their duty bikes ride. They had therefore many difficulties to travel around their CBR districts so that the framing of local facilitators was very irregular.
To illustrate this, you can see here the supervisor of Akastsi CBR District in Ghana, himself disabled. When the enquiry took place in 1999, his tricycle bike was already broken since two years.
The situation can then be summarized as follows:
The Beninese national coordination maintained a good balance of the expenditures between the three levels of its CBR program , and there was a significant community participation to the program financing
In Ghana the budget was “eaten” by the national level at the expense of the other levels and there was no community participation to the financing of the program
85 sec
45. 1.1 Setting up strategies of the CBR districts After we studied the setting up strategies of CBR districts and the costs of the two CBR programs, a third important point was to evaluate to which extend the disabled persons had access to reference institutions for technical interventions that cannot be performed at community level.
12 secAfter we studied the setting up strategies of CBR districts and the costs of the two CBR programs, a third important point was to evaluate to which extend the disabled persons had access to reference institutions for technical interventions that cannot be performed at community level.
12 sec
46. To illustrate this , let us quickly see what are the most frequently used reference institutions
In the two samples, the major part of disabled persons had motor disabilities. As a consequence orthopedic appliances workshops were one of the most often used institutions, mostly for polio sequels, amputation and orthopedic deformities.
25 sec
To illustrate this , let us quickly see what are the most frequently used reference institutions
In the two samples, the major part of disabled persons had motor disabilities. As a consequence orthopedic appliances workshops were one of the most often used institutions, mostly for polio sequels, amputation and orthopedic deformities.
25 sec
47. Before the orthopedic appliance can be used, orthopedic deformities must often be corrected through gypsotomy (correction with plaster) or through orthopedic surgery for the most difficult cases.
15 sec Before the orthopedic appliance can be used, orthopedic deformities must often be corrected through gypsotomy (correction with plaster) or through orthopedic surgery for the most difficult cases.
15 sec
48. Even though the physical rehabilitation acts are mostly done at home, for some cases it is useful to make some physiotherapy sessions in a specialized unit, in order to explain to the disabled person, his family and the local facilitator what are the basic exercises that must be repeated at home.
As, for instance, in the case of that stroke patient suffering from hemiplegia, coming to the hospital with his son who learns how to practice exercises with his father.
25 sec Even though the physical rehabilitation acts are mostly done at home, for some cases it is useful to make some physiotherapy sessions in a specialized unit, in order to explain to the disabled person, his family and the local facilitator what are the basic exercises that must be repeated at home.
As, for instance, in the case of that stroke patient suffering from hemiplegia, coming to the hospital with his son who learns how to practice exercises with his father.
25 sec
49. Other medical units are often necessary, as consultation and care in ophthalmology or with the ENT specialist.
10 sec Other medical units are often necessary, as consultation and care in ophthalmology or with the ENT specialist.
10 sec
50. Among frequently used reference institutions let us also mention specialized schools for hearing and speaking impaired children.
10 sec Among frequently used reference institutions let us also mention specialized schools for hearing and speaking impaired children.
10 sec
51. Or specialized schools for blind and seeing impaired children
6 sec Or specialized schools for blind and seeing impaired children
6 sec
52. 1. Quantitative needs for referrals What are precisely the needs for referrals ?
First , The enquiry searched what was the proportion of Disabled Persons of the two samples who needed to pass through a specialized institution
At the time the enquiry took place, It appeared that about 80 % of the sampled DPs did pass or still had to pass in a reference institution for some rehabilitation intervention that could not be performed at community level.
Then, the enquiry checked the proportion of DPs who had already been referred when it was necessary.
although the quantitative needs were similar in the two countries, It appeared that the proportion of referred Disabled persons were not the same. The Disabled persons from Ghana sample were clearly under referred , compared to their needs.
57 sec What are precisely the needs for referrals ?
First , The enquiry searched what was the proportion of Disabled Persons of the two samples who needed to pass through a specialized institution
At the time the enquiry took place, It appeared that about 80 % of the sampled DPs did pass or still had to pass in a reference institution for some rehabilitation intervention that could not be performed at community level.
Then, the enquiry checked the proportion of DPs who had already been referred when it was necessary.
although the quantitative needs were similar in the two countries, It appeared that the proportion of referred Disabled persons were not the same. The Disabled persons from Ghana sample were clearly under referred , compared to their needs.
57 sec
53. Let us see now what were the types of specialized institutions the sampled disabled persons needed .
We see that the needs for referrals were better distributed in Ghana (in red) than in Benin (in green). The fact remains that in the two countries the most frequent needs concerned orthopedic interventions (surgery, gypsotomie, orthopedic appliances)
What is interesting is that between all these needs for referrals, there are two different categories
The first one for which the competent specialized institutions did not exist or were not geographically accessible, which fortunately represented only 20 % of the needs.
The second one, where competent institutions existed and were geographically accessible to the sampled DP’s, which represented 80 % of the global needs for referrals.
55 sec Let us see now what were the types of specialized institutions the sampled disabled persons needed .
We see that the needs for referrals were better distributed in Ghana (in red) than in Benin (in green). The fact remains that in the two countries the most frequent needs concerned orthopedic interventions (surgery, gypsotomie, orthopedic appliances)
What is interesting is that between all these needs for referrals, there are two different categories
The first one for which the competent specialized institutions did not exist or were not geographically accessible, which fortunately represented only 20 % of the needs.
The second one, where competent institutions existed and were geographically accessible to the sampled DP’s, which represented 80 % of the global needs for referrals.
55 sec
54. Pourquoi les PH de l'échantillon ghanéen sont-elles si peu référées par rapport à leurs besoins, alors que nous venons de voir que, pour la majorité des besoins, les services compétents sont disponibles ?
En interrogeant les parents des PH qui avaient déjà été référées, il apparaît que les deux programmes n'appuient pas de la même façon les familles pour faciliter l'accès des PH au service spécialisé dont elles ont besoin.
On voit que dans une majorité des cas, le programme RBC béninois aide financièrement les familles à accéder aux services de référence ou accompagne la PH jusque dans le service. Au Ghana l'aide se limite le plus souvent à des conseils à la famille.
Cette politique d'aide à la référence explique en grande partie pourquoi les PH béninoises sont plus souvent référées par rapport aux PH de l'échantillon ghanéen.
60 sec
Pourquoi les PH de l'échantillon ghanéen sont-elles si peu référées par rapport à leurs besoins, alors que nous venons de voir que, pour la majorité des besoins, les services compétents sont disponibles ?
En interrogeant les parents des PH qui avaient déjà été référées, il apparaît que les deux programmes n'appuient pas de la même façon les familles pour faciliter l'accès des PH au service spécialisé dont elles ont besoin.
On voit que dans une majorité des cas, le programme RBC béninois aide financièrement les familles à accéder aux services de référence ou accompagne la PH jusque dans le service. Au Ghana l'aide se limite le plus souvent à des conseils à la famille.
Cette politique d'aide à la référence explique en grande partie pourquoi les PH béninoises sont plus souvent référées par rapport aux PH de l'échantillon ghanéen.
60 sec
55. 1.1 Setting up strategies of the CBR districts We reach now the second part of the comparative study
Which assesses and compares the results of the
two programs
12 secWe reach now the second part of the comparative study
Which assesses and compares the results of the
two programs
12 sec
56. From the initial sample of 624 DPs, the enquiry could be totally completed for 525 DPs
In Ghana 236 DPs from 0 to 32 years .
In Benin 289 PH of the same age category
The assessment criteria were the progress made by the DPs since they entered the CBR program and this in 5 different fields of the rehabilitation process
30 sec From the initial sample of 624 DPs, the enquiry could be totally completed for 525 DPs
In Ghana 236 DPs from 0 to 32 years .
In Benin 289 PH of the same age category
The assessment criteria were the progress made by the DPs since they entered the CBR program and this in 5 different fields of the rehabilitation process
30 sec
57. These 5 fields being:
Improvement of the deficiency in itself
Improvement in the ability to perform daily life activities
Educational process
Access to vocational training
Access to income generating activities These 5 fields being:
Improvement of the deficiency in itself
Improvement in the ability to perform daily life activities
Educational process
Access to vocational training
Access to income generating activities
58. For these 5 fields , the Local Facilitators Volunteers and the parents of DPs were separately questioned :
The enquirers asked them:
To describe the situation of the DP when she entered the program
To describe the DP’s evolution since she entered the program and her present situation
After analysis of the answers it was stated:
Whether an intervention in one or several fields of the rehab process was necessary or not
If the necessary interventions did really occur
The result of the intervention described by parents and by local facilitators was then estimated on a 0 to 5 scale
We had then:
On one side the answers of local facilitators
On the other side the answers of DP’s parents
At the centre of this figure: we had the corroborating answers that were divided into two categories
The LFs and the parents both agreed to estimate that the DP did significantly progress (from 3 to 5 on 5)
The LFs and the parents both agreed to estimate that the DP did not significantly progress (from 0 to 2 on 5)
80 sec For these 5 fields , the Local Facilitators Volunteers and the parents of DPs were separately questioned :
The enquirers asked them:
To describe the situation of the DP when she entered the program
To describe the DP’s evolution since she entered the program and her present situation
After analysis of the answers it was stated:
Whether an intervention in one or several fields of the rehab process was necessary or not
If the necessary interventions did really occur
The result of the intervention described by parents and by local facilitators was then estimated on a 0 to 5 scale
We had then:
On one side the answers of local facilitators
On the other side the answers of DP’s parents
At the centre of this figure: we had the corroborating answers that were divided into two categories
The LFs and the parents both agreed to estimate that the DP did significantly progress (from 3 to 5 on 5)
The LFs and the parents both agreed to estimate that the DP did not significantly progress (from 0 to 2 on 5)
80 sec
59. What were the results
Taking into account all disabilities, we obtained for the two samples and for each field of the rehabilitation process the proportion of DPs whom LFs and parents described a situation that justified a rehabilitation intervention
We see that the needs for rehab interventions on the impairment are very frequent in the two countries. They are less frequent for vocational training and access to income generating activities, specially in Benin where the DPs were younger and less often at the age of professional life.
Compared to these needs, we have then the percentages of satisfaction
It appears that the Beninese DPs systematically progress more than the DPs from the Ghana sample with a rate of satisfaction for rehabilitation needs situated between 50 and 60 %.
These differences are most of the time significant with a very important gap on vocational training and access to income generating activities where the Beninese CBR program appears far more performing than Ghana’s CBR program.
The Next slides show that these global results are confirmed when we split the two samples into different categories of DPs
85 sec What were the results
Taking into account all disabilities, we obtained for the two samples and for each field of the rehabilitation process the proportion of DPs whom LFs and parents described a situation that justified a rehabilitation intervention
We see that the needs for rehab interventions on the impairment are very frequent in the two countries. They are less frequent for vocational training and access to income generating activities, specially in Benin where the DPs were younger and less often at the age of professional life.
Compared to these needs, we have then the percentages of satisfaction
It appears that the Beninese DPs systematically progress more than the DPs from the Ghana sample with a rate of satisfaction for rehabilitation needs situated between 50 and 60 %.
These differences are most of the time significant with a very important gap on vocational training and access to income generating activities where the Beninese CBR program appears far more performing than Ghana’s CBR program.
The Next slides show that these global results are confirmed when we split the two samples into different categories of DPs
85 sec
60. When to consider only the persons with severe disabilities, we obtained a similar graph with significant differences on the last three aspects of the rehabilitation process.
20 secWhen to consider only the persons with severe disabilities, we obtained a similar graph with significant differences on the last three aspects of the rehabilitation process.
20 sec
61. The appearance of the graph does not change much when to consider only the group of moderately disabled persons. Here again we got significant differences in three fields of the rehabilitation process.
20 sec The appearance of the graph does not change much when to consider only the group of moderately disabled persons. Here again we got significant differences in three fields of the rehabilitation process.
20 sec
62. Regarding the group of people with motor disabilities only, the differences of performance between Ghana and Benin were smaller, except once again for what concerns vocational training and access to Income generating activities.
15 sec
Regarding the group of people with motor disabilities only, the differences of performance between Ghana and Benin were smaller, except once again for what concerns vocational training and access to Income generating activities.
15 sec
63. For DPs victims of multiple disabilities, seeing impairments or hearing and speaking impairments , the observed differences are generally not significant, mostly because there were not enough DPs in each category.
20 sec For DPs victims of multiple disabilities, seeing impairments or hearing and speaking impairments , the observed differences are generally not significant, mostly because there were not enough DPs in each category.
20 sec
64. Synthesis of comparative study Benin It is now time to make a quick synthesis of this comparative part of the research
Benin chose to balance urban and rural districts
It opted for big target communities, which implied an important selection on ages and types of disabilities
We also noticed:
A good support from National level to intermediary level supervisors and to target communities
A unified community management with only one CBR committee per CBR district
A significant community involvement
An organized support to facilitate DPs access to available reference institutions.
Ghana opted for CBR districts essentially set up in rural areas
It opted also for small target communities
Which does not oblige to select the enrolled DPs
We noticed however
that there was a wrong support from national level to Intermediary supervisors and communities
That the community management was fragmented with several CBR committees per district
That the community involvement was weak
and that there was no organized measures to facilitate DPs access to reference institutions
In view of these differences it appears that DPs from Benin’s sample have globally a better rehabilitation process than those of the Ghana sample
100 secIt is now time to make a quick synthesis of this comparative part of the research
Benin chose to balance urban and rural districts
It opted for big target communities, which implied an important selection on ages and types of disabilities
We also noticed:
A good support from National level to intermediary level supervisors and to target communities
A unified community management with only one CBR committee per CBR district
A significant community involvement
An organized support to facilitate DPs access to available reference institutions.
Ghana opted for CBR districts essentially set up in rural areas
It opted also for small target communities
Which does not oblige to select the enrolled DPs
We noticed however
that there was a wrong support from national level to Intermediary supervisors and communities
That the community management was fragmented with several CBR committees per district
That the community involvement was weak
and that there was no organized measures to facilitate DPs access to reference institutions
In view of these differences it appears that DPs from Benin’s sample have globally a better rehabilitation process than those of the Ghana sample
100 sec
65. 1.1 Setting up strategies of the CBR districts We move on now to the analytic part of the research work
Which purpose was to isolate factors that, in the two CBR experiences, promoted the good achievement of the DPs rehabilitation process.
12 secWe move on now to the analytic part of the research work
Which purpose was to isolate factors that, in the two CBR experiences, promoted the good achievement of the DPs rehabilitation process.
12 sec
66. In the previous part we assessed DPs progress in 5 fields of the rehabilitation process.
After gathering all DPs together in the same sample, we obtained for each field the proportion of DPs who made or did not make significant progress
The question is: why did some DPs improved while others did not improve significantly ?
The enquiry allowed us to identify some variables that could possibly influence progress of DPs. But how can we be sure of what influences what ?
It is at this point that multivariate statistical analysis will allow us to measure the strength of the influence between the progress made by the DPs, which we will call dependant variables, and the other factors that we will call independent variables.
In practical terms, all independent variables were simultaneously crossed with one of the dependant variables. The calculation power of the computer allowed then to eliminate one by one the variables which, combined with the others, did not appear to be significantly linked to the progress of the DPs.
At the end of the operation some variables stayed that were significantly linked with DP’s progress. For each of them we got an influence coefficient , so that we had a sort of mathematic model giving the probability for a DP to make more or less progress in that particular field of the rehabilitation process.
The model was finally assessed by the computer with an adequacy test that verified its capacity to reflect the reality.
The same operation was repeated with the other dependant variables.
120 secIn the previous part we assessed DPs progress in 5 fields of the rehabilitation process.
After gathering all DPs together in the same sample, we obtained for each field the proportion of DPs who made or did not make significant progress
The question is: why did some DPs improved while others did not improve significantly ?
The enquiry allowed us to identify some variables that could possibly influence progress of DPs. But how can we be sure of what influences what ?
It is at this point that multivariate statistical analysis will allow us to measure the strength of the influence between the progress made by the DPs, which we will call dependant variables, and the other factors that we will call independent variables.
In practical terms, all independent variables were simultaneously crossed with one of the dependant variables. The calculation power of the computer allowed then to eliminate one by one the variables which, combined with the others, did not appear to be significantly linked to the progress of the DPs.
At the end of the operation some variables stayed that were significantly linked with DP’s progress. For each of them we got an influence coefficient , so that we had a sort of mathematic model giving the probability for a DP to make more or less progress in that particular field of the rehabilitation process.
The model was finally assessed by the computer with an adequacy test that verified its capacity to reflect the reality.
The same operation was repeated with the other dependant variables.
120 sec
67. Let us see now the results of the analysis.
A first group of three factors seems to be strongly linked to the progress of the DP. Each of them influencing indeed three aspects of the rehabilitation process
DPS that could be referred to a specialized institution , DPs with slight or moderate disabilities and DPs from Benin made more progress than others.
A second group of four factors has an influence on two aspects of the rehabilitation process. Younger DPs, DPs with motor disabilities, those who must not be referred anymore and those whose local facilitator says that the family participates well to the rehabilitation work made more progress than others.
At last , we had a third group of five factors, each of them influencing only one aspect of the rehabilitation process. The male DPs , those whose family thinks that the origin of disability is natural, those who are in the program for more than four years, those whose head of family went at least to primary school and those living in large families of more than 10 persons made more progress than others.
We must notice that the probability for a DP to make medical progress on the impairment seems to depend on many factors. Among them, the fact that the DP could be referred to a specialized institution when necessary is logically a key factor with a very big influence coefficient.
While access to income generating activities is only influenced by two factors. Among them the country where the DP lives, which reflects the internal organization of each CBR program, had a very strong influence coefficient.
Let us also notice that DPs with motor disabilities seem to have more probability than others to have a good educational process.
Finally it is encouraging enough to see that in this sample taken out of a very patriarchal society, the sex of the DP seems to influence only
one aspect of the rehabilitation process, which is the access to vocational training. Male DPs getting more frequently a vocational training than female DPs.
120 sec Let us see now the results of the analysis.
A first group of three factors seems to be strongly linked to the progress of the DP. Each of them influencing indeed three aspects of the rehabilitation process
DPS that could be referred to a specialized institution , DPs with slight or moderate disabilities and DPs from Benin made more progress than others.
A second group of four factors has an influence on two aspects of the rehabilitation process. Younger DPs, DPs with motor disabilities, those who must not be referred anymore and those whose local facilitator says that the family participates well to the rehabilitation work made more progress than others.
At last , we had a third group of five factors, each of them influencing only one aspect of the rehabilitation process. The male DPs , those whose family thinks that the origin of disability is natural, those who are in the program for more than four years, those whose head of family went at least to primary school and those living in large families of more than 10 persons made more progress than others.
We must notice that the probability for a DP to make medical progress on the impairment seems to depend on many factors. Among them, the fact that the DP could be referred to a specialized institution when necessary is logically a key factor with a very big influence coefficient.
While access to income generating activities is only influenced by two factors. Among them the country where the DP lives, which reflects the internal organization of each CBR program, had a very strong influence coefficient.
Let us also notice that DPs with motor disabilities seem to have more probability than others to have a good educational process.
Finally it is encouraging enough to see that in this sample taken out of a very patriarchal society, the sex of the DP seems to influence only
one aspect of the rehabilitation process, which is the access to vocational training. Male DPs getting more frequently a vocational training than female DPs.
120 sec
68. Conclusions Which conclusions can be made at the end of this research work, Which conclusions can be made at the end of this research work,
69. Very different implementation Strategies
Ghana: small target communities
Benin: big target communities The comparative part showed us that the two countries chose very different implementation strategies , one of the main differences being that Ghana opted for small target communities while Benin worked with big target communities.
The complementarities between national, intermediary and community levels of action appeared to be quite well respected in Benin but almost ignored in Ghana
The Beninese program seemed to get better results than the Ghana program
The analytic part allowed then to highlight some factors linked to the good achievement of the Rehabilitation process of the sampled DPs.
Among these factors, the age of the DP, the type of disability, the severity of disability , the country where the DP lives and the fact that the DP could be referred to a specialized institution when necessary seemed to be very important.
We notice that, in the present case, the distribution of the first three factors closely depends on the way the two programs were implemented; Implementation ways that produced different selection of DPs.
While the two other factors seem to be more dependent on the respect of basic principles of any community development process.
In every case, It seems that these 5 factors had a strong influence on the effectiveness of both CBR programs.
On the other side the respect of community development basic principles could let us predict in theory that the Beninese CBR program would be more viable than the Ghanaian one. The theory was indeed confirmed since the Ghana program in its 20 districts was closed in 1998.
Finally, it is very interesting to notice that among the factors taken into account, some apparently do not have any influence on the quality of DPs rehabilitation process.
These factors are:
the rural or urban living condition of the DP
and the social level of the family where the DP lives.
150 sec The comparative part showed us that the two countries chose very different implementation strategies , one of the main differences being that Ghana opted for small target communities while Benin worked with big target communities.
The complementarities between national, intermediary and community levels of action appeared to be quite well respected in Benin but almost ignored in Ghana
The Beninese program seemed to get better results than the Ghana program
The analytic part allowed then to highlight some factors linked to the good achievement of the Rehabilitation process of the sampled DPs.
Among these factors, the age of the DP, the type of disability, the severity of disability , the country where the DP lives and the fact that the DP could be referred to a specialized institution when necessary seemed to be very important.
We notice that, in the present case, the distribution of the first three factors closely depends on the way the two programs were implemented; Implementation ways that produced different selection of DPs.
While the two other factors seem to be more dependent on the respect of basic principles of any community development process.
In every case, It seems that these 5 factors had a strong influence on the effectiveness of both CBR programs.
On the other side the respect of community development basic principles could let us predict in theory that the Beninese CBR program would be more viable than the Ghanaian one. The theory was indeed confirmed since the Ghana program in its 20 districts was closed in 1998.
Finally, it is very interesting to notice that among the factors taken into account, some apparently do not have any influence on the quality of DPs rehabilitation process.
These factors are:
the rural or urban living condition of the DP
and the social level of the family where the DP lives.
150 sec
70. Through this research work, some elements were highlighted that could usefully be considered by those who would be involved in other CBR experiences somewhere else in the world
Through this research work, some elements were highlighted that could usefully be considered by those who would be involved in other CBR experiences somewhere else in the world
71. First of all Ghana and Benin’s examples confirm that the respect of complementarities between National, intermediary and community levels is an essential element of any CBR program’s viability and that all aspects of the program implementation must refer to this basic principle. First of all Ghana and Benin’s examples confirm that the respect of complementarities between National, intermediary and community levels is an essential element of any CBR program’s viability and that all aspects of the program implementation must refer to this basic principle.
72. In that perspective, a special attention must be paid to DPs access to reference institutions they need to go to. It is a very important factor for the good achievement of the rehabilitation process and it must be facilitated by specific measures.
In that perspective, a special attention must be paid to DPs access to reference institutions they need to go to. It is a very important factor for the good achievement of the rehabilitation process and it must be facilitated by specific measures.
73. The analysis also showed that the two programs got better results with younger DPs and with motor disabilities.
This reality must be carefully considered when a new CBR program starts, when it has to polish its procedures and demonstrates its capacities.
If CBR wants to expand, it will have indeed to convince the population , convince the rehabilitation professionals and convince the authorities. It is therefore better to start with easier things in order to convince quicker and give the CBR program more opportunities to settle.
The analysis also showed that the two programs got better results with younger DPs and with motor disabilities.
This reality must be carefully considered when a new CBR program starts, when it has to polish its procedures and demonstrates its capacities.
If CBR wants to expand, it will have indeed to convince the population , convince the rehabilitation professionals and convince the authorities. It is therefore better to start with easier things in order to convince quicker and give the CBR program more opportunities to settle.
74. Finally it is quite encouraging to notice that in this study, poor disabled persons and those who live in rural areas are not more « handicapped » than the others because of their poverty or their rural condition.
If this could be confirmed in other CBR program assessments it would be an extremely positive confirmation of the social justice dimension the CBR strategy is claiming for.
. 14 sec Finally it is quite encouraging to notice that in this study, poor disabled persons and those who live in rural areas are not more « handicapped » than the others because of their poverty or their rural condition.
If this could be confirmed in other CBR program assessments it would be an extremely positive confirmation of the social justice dimension the CBR strategy is claiming for.
. 14 sec
75. Justice ? This is indeed the word that this young polio paraplegic man I showed you on the introduction slide, spontaneously chose, as his shop sign
Thanks to a loan given by the CBR committee, he could open this small stall that enables him to meet his needs and therefore to live independently, with dignity and fully integrated inside his community.
Thank you for your attention.
30 secJustice ? This is indeed the word that this young polio paraplegic man I showed you on the introduction slide, spontaneously chose, as his shop sign
Thanks to a loan given by the CBR committee, he could open this small stall that enables him to meet his needs and therefore to live independently, with dignity and fully integrated inside his community.
Thank you for your attention.
30 sec
