South African stakeholders' knowledge of community-based rehabilitation.

BACKGROUND: Community-based rehabilitation (CBR) is a complex concept and strategy that has been implemented in diverse ways globally and in South Africa. Internationally, some stakeholders have described CBR as confusing, and this may influence implementation. A southern African study reports that there is insufficient evidence of the understanding of CBR in the region to influence training, policy and practice. OBJECTIVES: The aim of this study was to investigate South African stakeholders' knowledge of CBR. METHOD: This article reports on an electronic survey that was part of a larger mixed methods study. Based on the sample of 86 respondents, descriptive statistics were used to analyse the quantitative data and thematic analysis for the qualitative data. RESULTS: The majority of respondents had had exposure to CBR, but almost a quarter had no knowledge of the CBR guidelines and matrix. The results revealed varying knowledge concerning the key concepts of CBR, its beneficiaries and its funders. Respondents identified persons with disabilities as having a central role in the implementation of CBR. Problems with the visibility of CBR programmes were noted, as well as misunderstandings by many therapists. CONCLUSION: The implementation of CBR, and its goal of ensuring the rights of persons with disabilities, is negatively affected by the confusion attached to the understanding of what CBR is. The misunderstandings about, and lack of visibility of, CBR in South Africa may hinder its growing implementation in the country in line with new government policies.

Integrating community-based rehabilitation and leprosy rehabilitation services into an inclusive development approach.

Community-based rehabilitation (CBR) has been described as a strategy for leprosy rehabilitation. Developments in CBR and leprosy rehabilitation services, including Socio-economic rehabilitation (SER) show that both approaches aim to become part of a community development process. The basic assumption is that people with disabilities will benefit most from being included in mainstream programmes implemented in their own community, e.g. programmes aiming to improve livelihood. These developments have a decisive impact on the roles of all people involved in the rehabilitation process. Where the emphasis in the rehabilitation process shifts to the community and becomes part of community development, the rehabilitation workers need different competencies than were required in vertical disability programmes. This article focuses on the changing roles of mid-level rehabilitation workers and trainers and therapists. In many programmes a mid-level cadre was introduced to work with people with disabilities and their families. Consequently, trainers and therapists have moved away from direct, hands-on interventions and focussed on training this mid-level cadre and offering specialised referral services. This system was primarily developed to provide treatment at all levels, including community level. However, when rehabilitation becomes part of a community development process there is a need for 'change agents' and a structure that supports them. The success of integrating disability specific programmes like CBR and SER, into inclusive development programmes will depend largely on the extent to which rehabilitation workers are able to reinvent themselves as 'change agents' and redefine their roles, positions, and competencies.