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Publication

Perceived impact of a CBR programme: Impact evaluation of a CBR programme with the most significant change technique.

Abstract

Background: CBR is a strategy for rehabilitation, poverty reduction, equalization of opportunities and the social inclusion of people with disabilities. Programmes that use this strategy should have a positive impact on the lives of people with disabilities. In the literature it is shown that CBR is an effective low cost intervention to meet the needs of the target group; although there is less evidence about how this positive impact is achieved. Moreover, there is a need for effective methods to evaluate the complex concept of CBR. Currently, a comprehensive CBR programme is constructed in Kailali in western Nepal. On the basis of a pilot programme in three sub districts (VDCs), lessons are learned about how to construct a programme that meets the needs of people with disabilities in the whole district. One method to evaluate a development programme that aims at social change, and to foster learning about effectiveness, is the ‘Most Significant Change technique’. This technique uses participants’ stories of change as input to deliberation meetings about the value of change.

Objective: To provide insight in the changes in the lives of the participants of the 3 VDC-project to deterimine the successes and challenges in constructing a comprehensive CBR-programme in Kailali-district.

Methods: To determine the changes and impact of the 3 VDC-project, the ‘Most Significant Change’ technique has been applied in three communities. In each VDC, 15 stories of change have been collected using semi-structured interviews. Participants were sampled on the basis of different disabilities, sex and age. In all VDCs a selection meeting with participants of the programme was held to dertermine what participants value as the most significant change in their lives since the programme started. The results of the interviews and the meetings have been analysed to determine the output, outcome and impact of the programme.

Results: The stories and deliberations revealed a positive personal, social and financial impact in the lives of people with disabilities in all three communities. The output of the programme is an increased knowledge, an improvement of social contacts, awareness in the community and increased livelhood oppertunities. This resulted in two outcomes: a sense of unity among people with disabilities and a perspective of income growth. A selection of participants did not perceive any change or impact, because of inablity or unwillingness to participate in activities, or because they had different expectation of the programme. The participants recommended strengthening the programme by investing in activities aiming at financial securiy, community awareness, education, treatment of disease, and the programme structure. Differences in change between the communties because of their different geographical location and ethinicicy were difficult to determine, because of the study design and the complex nature of these concepts.

Conclusion: The CBR programme in the 3 VDCs has a positive impact in the lives of the participants included in this study. Activies which are highly valued are, firsly, knowledge and awareness creating activities regarding the rights and dignity of people with disabilties. Secondly, skills training, which provides the perspective of reduction of poverty and, simultaneously, an example of the abilities of people with disabilities. The challanges are to involve more people with disabilities in the accessible activities and create a network of partner organizations to enhance the financial and knowledge input of the programme.

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Thesis