Development and evaluation of a community-based rehabilitation programme for pre-school disabled children in Guyana
There are millions of disabled persons in the world. An
Institutionally-Based model of rehabilitation alone cannot meet
the challenge. The World Health Organisation (WHO) have offered
Community-Based Rehabilitation(CBR) as an alternative approach.
CBR advocates a simplified form of rehabilitation , mobilising
resources that exist within the community.
This project examines the relevance and effectiveness of a CBR
project implemented in two rural areas of Guyana over a two
The programme is facilitated by a Local Supervisor (LS) who
works in the child's home alongside a family member. Two
groups of LSs were recruited, one comprised 26 volunteers from
the community and the other constituted 25 nursery teachers.
Disabled children were identified by surveys and by referrals
by parents and professionals.
A Multiple-Baseline Design was adopted to assess the child's
progress. The children were assessed fortnightly on the
Portage Checklist and pre, post and at a 6 month follow-up on
the Griffiths Test of Mental Development. The quantitative
gains were balanced with a qualitative analysis of
questionnaire and interview data.
The majority of parents participated actively in the programme,
however for others the role was too demanding.An analysis of Portage scores revealed a gain of .67 items per
month per subtest under baseline conditions, 1.95 items under
treatment conditions and 1.02 items under control! follow-up
conditions.The Griffiths results were significant at post-test
and 6 month follow-up test (p= .01 for both groups of
children.) The mothers observed changes in themselves feeling
more relaxed and confident, and less depressed. The changes
were however more characteristic of the 'volunteer' mothers
than the 'nursery' mothers. 4/26 volunteers and 12/25 nursery
teachers were not involved in the programme.
Progress was seen in the physically and mentally handicapped
children, others with severe speech and hearing problems may
need more intensive help than that offered by this approach.
A local committee created a resource unit for the disabled
children of their area. The cost of the programme, excluding
the cost of referral services, was £27 per child, per year.
The thesis analyses; key features of introducing an innovation;
ways in which the WHO approach was modified; limitations of the
CBR model, and suggestions for further study.