Evaluation of the CBR program in Palestine – from the perspective of persons with disabilities themselves.

Background

Evaluation by Norwegian Association of Disabled (NAD).

Further to Local partners: ). The CBR program is the main component of the RP. NAD's sister organization, the General Union of Disabled Palestinians (GUDP), is one of our RP partners.

Since 1990, the Community Based Rehabilitation program (CBRP) in Palestine has been part of a long-term strategy aimed at strengthening the rehabilitation sector as a whole in order to address the needs of disabled people. The Norwegian Association of Disabled (NAD), in partnership with Swedish Diakonia, has since 1994 provided financial and technical support to 17 non-governmental organization (NGO) partners that implement the CBRP with the aim of promoting social inclusion of Palestinian children and adults with disability. CBR has since been adopted as a national strategy.

The CBRP is active in more than 200 localities, covers 50% of the population of the West Bank and Gaza, and has reached more than 35,000 disabled persons and their families since its inception. The program's network of NGO partners have organized themselves into five Regional Committees that have responsibility for planning and implementing the CBR program, and for coordinating the work at both the community and regional levels.

A number of studies and program reviews carried out by external consultants have described the CBRP's accomplishments and documented that it has had a major impact on the rehabilitation sector in Palestine. While the studies mentioned above have considered the effectiveness of the CBRP from a number of different aspects, none of them have focused solely on the 'user perspective'. Therefore, this evaluation has been conducted to investigate the impact of the program from the perspective of disabled people and their families.

Purpose/objective

The main objectives of the evaluation were to:
? Ascertain to what extent the CBRP has contributed to improving the quality of life of disabled people.
? Assess the degree of involvement of persons with disabilities and their families in the CBRP.
? Identify the program's strengths and weaknesses as perceived by disabled people.
? Suggest ways in which the program can more effectively meet the needs of disabled people

Methodology

The study was carried out by two external consultants, one Swedish and one Palestinian. It involved a review of existing evaluation and other reports and a field trip carried out in October/November 2005. Qualitative data was generated through semi-structured interviews with 25 individuals with disabilities; 15 focus group discussions (each with 5-7 people); interviews with local Disabled People's Organizations, as well as the Deaf Club in Hebron and the Organisation of Persons Injured by the Intifada in Gaza; and through observations during visits to homes, communities and schools.

The responses of persons interviewed have been analyzed and categorised according to the 8 Quality of Life domains (as defined by the IASSID Consensus Document). Findings were also analyzed in relation to gender, age and type of disability. Possible variations between regions and implementing organisations were also considered.

Key findings

Despite the unfavourable political conditions the CBR program has managed to achieve a great deal. The program has empowered individuals and parents, improved basic daily living skills and coping mechanisms, reduced stigma and isolation and increased social inclusion. People with disabilities are more respected in their families and have become more visible and more vocal. Many have also been able to access education and rehabilitation services.

In regard to the program's impact on the different aspects of quality of life, it has had an exceptional impact on emotional well being and self esteem. It has also had a substantial but uneven impact on interpersonal relations, social inclusion and personal development.

It has had some impact on physical well being (access to medical treatment, rehabilitation services and assistive devices), especially in Gaza and Central Region.

However, the CBR program has had limited impact on self determination and influence, material well being and rights. The evaluation shows that the least impact has been made on the quality of life of persons with hearing impairments and severe intellectual disability.

The strategies that were most successful to achieve the positive changes were: the moral support, getting the family to understand and deal with the disability, breaking the isolation and helping to change the attitudes in schools and communities. Children also praised the inclusive summer camps.

Recommendations

The report provides a detailed and critical description of program achievements and areas for further improvement as perceived by the disabled people themselves. Proposals made by the interviewees covered areas such as income generation, practical assistance (transport to and from school, technical aids), day care and special education classes for children with intellectual disabilities, youth clubs etc. Voices were also raised for increased coverage by the CBR program. It is presently reaching approximately 50 % of the target population.

The report concludes with a number of recommendations to improve the impact of the program. The recommendations are classified into three groups: program-related recommendations, advocacy and policy recommendations and management and organization recommendations. The report finally suggests that it is time for the CBR program to review its objectives, structures, strategies and working methods. A workshop is proposed to be organised early 2006 to review the program and formulate a plan for the coming 5 years. Both CBR workers and representatives of the service users should be part of such a planning exercise.

Comments from the organisation

As this summary is being submitted one year after completion of the final evaluation report summarized above, NAD can report that recommendations made in the report have been seriously considered in both short and long-term CBRP planning. In particular, a new long-term strategy was developed in early 2006 by key CBR actors. This strategy, which incorporates many of the recommendations of the user perspective evaluation, is the basis for Atlas Alliance's funding application to Norad for the 3-year period from 2007-2009.