Development of indicators for monitoring Community-Based Rehabilitation

BACKGROUND: Community-Based Rehabilitation (CBR) is a multi-sectoral approach working to equalize opportunities and include people with disability in all aspects of community life. Reliable and internationally comparable data needed to monitor and evaluate CBR are scarce, partially due to the absence of standardized indicators. The objective of this manuscript is to describe the collaborative development process which led to the World Health Organization's (WHO) recently launched set of standardized CBR outcome indicators. METHODS: The WHO's CBR Guidelines recognize CBR as a comprehensive and multi-sectoral strategy, and were therefore used as the starting point for the development of the indicators, in a consensus process involving WHO and International Disability and Development Consortium. Pilot implementations in Guatemala, Egypt and China using a specifically developed mobile phone application to collect data, and an online expert survey were completed to assess validity and feasibility of the indicators and their corresponding questions. RESULTS: The indicator set includes 13 Base Indicators which are broad enough to capture the situation of people with disability in settings where CBR is carried out, independently of the specific CBR activities carried out in a community; and 27 Supplementary Indicators that provide more specific coverage and can be selected based on the specific goals of a CBR program. CONCLUSION: The indicators were suitable to assess differences in health, education, social life, livelihood and empowerment between people with disability and other community members. This comparability provides valuable information to CBR managers, donors and government agencies, to guide decision making, support advocacy and improve accountability. The CBR indicators will support WHO and its member states in their efforts towards strengthening CBR, by generating evidence on its effectiveness.