Rehabilitation of Afghans with disabilities impact evaluation

INTERVENTION: The researchers did not randomize the participants in the CBR. They only carried out cluster randomization of the controls. This is why it is a quasi‐experiment and not an RCT. The inclusion criteria for the intervention group is the identification between January 2013 and December 2013 by 137 CBR workers of an individual with disabilities based on information from key informants in each mahal and word of mouth between residents. A person is categorized as disabled using a locally developed questionnaire based on the World Health Organization “Training in the community for people with disabilities: Guide for Local Supervisors” (World Health Organisation 1989). Each CBR worker assessed participant’s willingness to enrol in the CBR program and consent to participate in the study. Each CBR worker averages two new participants per month. 1680 individuals were enrolled in 169 villages or urban areas called Mahals. They are catchment areas of a given CBR worker. The size of each mahal depends on the number of persons with disabilities living in the area and enrolled in the program that one given CBR worker is able to serve. New participants above age three were interviewed using the capability tool within a month of commencing services with a CBR worker. The Community Based Rehabilitation program includes five components: 1. Social integration of people with disabilities 2. Employment support and vocational training 3. Special and inclusive education 4. Physiotherapy and orthopedic services 5. Institutional capacity development The CBR program is implemented in 13 provinces and 48 districts of northern and eastern Afghanistan. The CONDITION: Rehabilitation, education, employment and social participation of persons with disabilities ; Not Applicable SECONDARY OUTCOME: Employment measured using a question about paid activity in the last week at baseline (entrance in the program between July 1st 2012 and December 31st 2013), midline (after one year in the program between 1st July 2013 and 31st December 2014) and endline (after two years in the program between 1st July 2014 and 31st December 2015) PRIMARY OUTCOME: ; Measured at baseline (entrance in the program between 01/07/2012 and 31/12/2013), midline (after 1 year in the program between 01/07/2013 and 31/12/2014) and endline (after 2 years in the program between 01/07/ 2014 and 31/12/2015):; 1. Mobility measured using a mobility index composed of five activities with response choices limited to a Likert scale composed of three choices (I can always, I can with help, I cannot at all): Can you sit (asked to respondents above 1 year old); Can you stand (above 1 year old); Can you move inside the home (above 1 year old); Can you move outside the home (above 2 years old); Can you walk at least ten steps (above 2 years old).; 2. Activity of daily living outcome measured using an index composed of four activities with the same three response choices: Are you able to eat on your own (asked above 4 years old); Are you able to bathe (above 8 years old); Are you able to use the latrine (above 3 years old); Can you dress and undress (above 4 years old).; 3. Communication measured by an index focused on the four following functions with the same three response choices: Can you speak (above 2 years old); Can you understand simple instructions (above 2 years old); Can you express needs (above 2 years old); Do you feel confident learning new things (above 4 years old).; 4. Social participation measured using an index comprised a first item below with three response choices (I can without difficulty, I can with some difficulties, no, I cannot at all) and four following items with three different choices (I can always, I can sometimes, no never): Can you make friends outside the family; Are you consulted in family decisions (above 15 years old); Can you join in community activities and ceremonies; Do you feel respected in the community (above 5 years old); Do you feel respected in your family.; 5. Emotional well‐being measured using an index was composed of five items with three response choices (never, sometimes, always): Do you feel sad (above 5 years old); Do you feel angry (above 5 years old); Do you feel worried or distressed (above 5 years old); Do you have nightmares or bad sleep (above 5 years old); Do you have headaches, stomach‐aches or nausea (above 5 years old); INCLUSION CRITERIA: 1. Screened as having a disability using a locally developed, tested and validated questionnaire based on World Health Organization guidelines for grass root disability program to account for contextual factors 2. Joining the CBR program between July 2012 and December 2013 3. Living in one of the 169 villages or urban areas called mahals of the catchment area of the program 4. Willingness of the person with disabilities and the family members to participate in the CBR programs 5. Readiness of a family member to be trained by ‐ and implement ‐ the activities set up by the CBR worker in order for such activities to be ongoing daily, while the CBR worker would check progress made on a weekly or sometimes bi‐weekly basis 6. Absence in the mahal of a similar intervention by any other organization 7. Intervention is welcomed by the overall