Evaluation of the Community Based Rehabilitation Program in Uganda

Background

Community Based Rehabilitation (CBR) was introduced by the Government of Uganda (GoU) in 1992, with financial assistance from the Norwegian Association of Disabled (NAD), as the official government strategy for addressing disability issues. The initial pilot program involving three districts was eventually expanded to another seven districts. Between 1993 and 2000, three external evaluations were carried out on the CBR program. The most recent of these, conducted in 2000, recommended consolidation of the program through a clear, strategic plan that would improve program coverage and quality of services provided to disabled people. As a result, the National CBR Steering Committee together with NAD decided to implement CBR in a model district which, if successful, could eventually be replicated to other districts in Uganda. In 2002, preparations were made to implement CBR in Tororo District, and the program was introduced in the district in late 2002.

Purpose/objective

The main objectives of the review were to:
1. Determine to what extent the programme is accomplishing the programme objectives since its inception in 2002.
2. Assess to what extent the programme has addressed the recommendations of the 2000 external evaluation.
3. Identify the programme's strengths and weaknesses with particular emphasis on a review of the programme's management and financial arrangements.
4. Make recommendations for strengthening the CBR programme.
5. Consider the CBR programme in Tororo District as a model for expansion to other districts in Uganda.

Methodology

Combination of qualitative and quantitative analyses with field visits and in-depth interviews with disabled, families of disabled, volunteers at parish level and employees from national to local level. The findings of an extensive internal evaluation undertaken in August 2004 provided valuable inputs to this external evaluation and many of the internal evaluation's findings were confirmed in this evaluation. The evaluation included a two week mission in Uganda in February 2005 of which one week was spent in Tororo District and included visits to four sub-counties.

Key findings

1. The Tororo CBR model has shown encouraging results considering the fact that it has only been under implementation since 2002/2003. The approach taken in the current CBR program has proven that a true community based approach is possible and gives significantly higher outreach in terms of numbers of communities and families reached if compared to the previous national level and supply driven model. It has also proven to be a more cost efficient model compared to the previous model. The reasons for these successes are primarily attributed to:
a. The mobilisation of communities, including dedicated volunteers at parish level guided and supported by community based workers at the sub-county-level.
b. Significantly more financial resources are allocated to sub-county level.
c. The participation of DPOs and other stakeholders in planning, sensitisation and monitoring at all levels.
d. Disabled people and communities identify themselves as partners in the mobilisation of assistance, not only as receivers of services.
e. More mainstreaming of services from health clinics, assistive aid workshops, integration of more disabled in schools, and disabled persons benefiting form agricultural extension service programmes.
2. Wider awareness efforts have resulted in identification and assessment of a much larger number of disabled and a significantly higher number of referrals since the new model has been established.
3. The program has acquired more information from the target group due to introduction of a computerized management information system (MIS).
4. Changes in the budget and planning process have contributed to increased assurance, accountability and ownership of funds allocated to the programme and also a significantly higher share of GoU contribution to the programme.
5. The Tororo model can be replicated to other districts following some adjustments.
6. The main challenge to the program is associated with resource allocation and the current demands made on the programme, which are beyond its initial scope.

Recommendations

o A gradual expansion into 3-5 new districts to ensure that experience is gained from other district environments before considering scaling up CBR to all districts.
o Allocate a substantially higher share of resources to sub-counties which will enable more volunteers per parish and more resources to strengthen their capacity.
o Identify more disabled people living in urban and hard to reach areas.
o Capacity building of DPOs at district level is beyond the scope of the program and should be funded from other sources.
o Include referral service providers/stakeholders in the planning stage so they can prepare to meet the increased demand resulting from the CBR programme.
o Consider the special needs of persons who are visually impaired and deaf.
o Planning and indicators need to be changed to focus on results for disabled people.
o Allocation of funds to sub-county should be according to population rather than a flat contribution.
o The MIS needs to be simplified and focus on basic data and models for analysing data introduced.
o Address the delay in CBR program funds reaching the district level.
o Semi-annual audits should be based on existing GoU financial statements and should include the sub-county level.