IJPPHS International Journal of Preventive and Public Health Sciences 2454-9223 Smile Nation - Lets Smile Together India IJPPHS-2-5 10.17354/ijpphs/2016/26 Original Article Effectiveness of Community-based Rehabilitation Program for Persons with Special Needs in Plateau State Amwe Racheal Asibi Aliu Charity Ukwo Longpoe Patricia Kwalzoom Lecturer II, Department of Special Education and Rehabilitation Sciences, Faculty of Education, University of Jos, Nigeria CORRESPONDING AUTHOR: Racheal Asibi Amwe, Department of Special Education and Rehabilitation Sciences, Faculty of Education, University of Jos, Nigeria. Phone: +91-8038662096. E-mail: amweracheal44@gmail.com Jul–Aug 2016 08 2016 2 2 5 10 052016 062016 072016 Copyright: © International Journal of Preventive and Public Health Sciences 2016

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Background:

The purpose of this study was to examine the effectiveness of community-based rehabilitation (CBR) program for persons with visual impairment in Jos, Plateau State.

Materials and Methods:

The descriptive survey design was adopted for the study. The target sample comprised 16 persons with visual impairment in Jos North LGA of Plateau State. The instrument used for data collection for the study was a structured questionnaire which consists of 20 items is designed along a 3-point Likert-type scale.

Results:

Among the major findings of the study areas follows, the study revealed that CBR services provided by community workers are generally inadequate. In addition, the study also revealed the need for collaboration between the community, persons with special needs, NGO’s and CBR workers/managers in the provision of CBR services. It was, however, recommended that communities, parents and/or families of the persons with visual impairment as well as other stakeholders should be actively involved in CBR programs.

Conclusion:

CBR services provided by community workers are generally inadequate and will require the involvement of persons with special needs and community members and facilities within the communities to improve its effectiveness.

Community-based rehabilitation Community workers Visual impairment
INTRODUCTION

Recent studies have shown that a great number of visually impaired persons require qualitative rehabilitation services to enable them become self-reliant, independent and compete with the labor market for jobs. These services are grossly inadequate as the government cannot fund the establishment of rehabilitation centers alone, therefore, posing a need for non-governmental organizations (NGOs) to complement government effort. These organizations have taken up the task of providing appropriate skills and therapies to visually impaired persons in Nigeria. These services include impairment prevention, school support, community participation, advocacy, self-help schemes, and public awareness which by provided by trained community-based rehabilitation (CBR) workers.

Stakeholders in education, health, rehabilitation as well as CBR workers are almost certain to give different explanations of what CBR is. This implies that CBR means different things for different people (persons with special needs, rehabilitation workers, health workers, special educators, etc.). The World Health Organization (WHO), International Labor Organization (ILO), and the United Nations Educational Scientific and Cultural Organization (UNESCO) in a joint position paper on CBR states that it is a strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disability … implemented through the combined efforts of people with disabilities themselves, their families communities and also the appropriate health, education, vocational and social services.1-6

Obviously, this approach to CBR is very broad, specific, and all encompassing. A logical result of this broad approach is that, today, there are many people working in the field of CBR with little or no experience or expertise relevant to the rehabilitation of people with impairments. The United Nations emphasizes that CBR is for all people with disability. Similarly, many practitioners also interpret this to mean that individual CBR project with all categories of impairments.7 Traditionally, CBR implies direct service for people with impairment, which provides the skills and training they need to maintain, increase and improve their capacities to move and function in dependently. CBRs’ focus in rehabilitation is to promote change in the way persons with special needs can manage and conduct their lives, function at home, and participate actively in the community. CBR is also about providing the appropriate therapies and skills to about these desired changes.8-13

Beyond satisfying the basic needs of food, clothing, shelter and health, the visually impaired persons also aspire to higher ideals of political, social and economic well-being. Persons with visual impairment need to enjoy their fundamental human rights, equal opportunities and justice to live a fulfilling, meaningful and independent life.4 To achieve this aim, the community has to be involved in the rehabilitation process so as to enable persons with visual impairment become fully integrated and contribute the growth and development of these communities.

It is based on the above premise that the researcher seeks to add to the evidence base of CBR through research studies on the effectiveness of CBR programs on persons with visual impairment in Jos, Plateau State.7,13,14

Purpose of the Study

For clarity of purpose, this study seeks to investigate effectiveness of CBR program for persons with visual impairment in Plateau State. Specifically, the purpose of the study includes the following:

To identify CBR services rendered to persons with visual impairment in Plateau State.

To ascertain if the services provided in rehabilitating persons with visual impairment are appropriate and adequate.

To determine the effects of CBR services on the beneficiaries.

To find out the challenges encountered by community workers in providing CBR services.

To proffer solutions to some of the challenges, community workers encounter in the provision of services.

Research Questions

The following research questions are formulated to guide the study;

What are the CBR services rendered to persons with visual impairment?

To what extent are the services in rehabilitating persons with visual impairment appropriate and adequate?

What are the effects of the CBR services on the visually impaired beneficiaries?

What are the challenges encountered by community workers in providing CBR services?

How would the challenges encountered by community workers be overcome?

Review of Relevant Literature

The concept and operation of CBR are considered differently by various schools of thought. This is evident in a wide diversity of definitions currently attached to the term. However, CBR is a community development program where disabled persons and their families are actively involved in all issues that concern to them. Community participation is thus a central and essential tenet of CBR.12 Therefore, in this scenario, the community owns the program, implements and sustains it with the involvement, active role and full participation of persons with special needs themselves in the rehabilitation process.

Similarly, CBR refers to the provision of rehabilitation services for children and adults with special needs usually through home-based programs.14 Community workers with basic rehabilitative training work with persons with special needs through physical and perceptual activities with the aim of improving the functioning levels of persons with special needs.

More so, the development for international development rates that CBR is an approach which has grown out of debate between the so-called medical and model of disability. Its supporters believe that it can meet basic rehabilitation needs of four out of five people with disability.5 Therefore, CBR attempts to combine physical rehabilitation through the participation of both the process of rehabilitation.

CBR is claimed to be the approach to inclusion and social integration as well as an effective means of making the best use of scarce resources through the five principles of CBR which includes participation, inclusion, sustainability and self-advocacy, empowerment. More so, empowerment is a core principle of CBR and involves employing strategies for ensuring economic empowerment of persons with special needs include the provision of employment, educational opportunities, and opportunities for financial resources.13

However, the pitfalls to achieving the goals of CBR include lack of financial, human and material capacity and technical support. Others include lack of formal training of CBR workers, poor participation of communities, and inadequate funding as well as the under-utilization of community resources.10

MATERIAS AND METHODS Research Design

The descriptive survey design was adopted in carrying out this study. The premise of this design undertakes the study of a large population by describing it through a close study of the representative sample that has been selected from a target population at a particular time. The design was considered appropriate for this study because the data collected from the representative sample are analyzed, and the findings are generalized on the properties of the target population.8

Population and Sample of the Study

The population of the study comprised all persons with visual impairment in the Zawan Rehabilitation Centre for the Visually Impaired Jos, Plateau State. The target sample comprised 16 persons with visual impairment in the center.

Sampling Technique

The purposive sampling technique was used to select the sample for the study. The purposive sampling is a non-probability sampling technique that is aimed at selecting the sample that appears to the researcher as a representative of the population under study as defined by the research problem.2. This design is a more appropriate to the study due to the few number of respondents available and who are benefiting from CBR services at the time of carrying out the study.

Instrument for Data Collection

A structured questionnaire which was personally constructed by the researchers was used to elicit relevant information from respondents for the study. The questionnaire consists of 20 items and it was made up of two parts: Section A was designed to elicit responses on the respondents’ background. These include demographic data, e.g., age, marital, status, state of origin, and the level of visual loss (degree of vision loss). Similarly, Section B formed the main part of the questionnaire designed along a 3-point Likert-type scale; ranging from Agree (A), Undecided (U), and Disagree (D). Respondents are required to tick the option (A, U or D). The questions were meant to elicit responses on the effects of CBR on persons with visual impairment in Zawan Rehabilitation Centre for the Visually Impaired Jos, Plateau State. However, anonymity in response was ensured to encourage honesty, and frankness and subjects have a right to insist that their individual identities should not be made salient aspects of the research.3

Method of Data Analysis

Data gathered through the questionnaire were tabulated and analyzed accordingly. The total frequency of responses was calculated and results used to further find simple percentages for the purpose of establishing result of the study. In other words, simple percentage (%) was employed as the statistical tool for the study.

RESULTS Research Question 1

What are the CBR services rendered the persons with visual impairment in the center?

In Table 1, responses to the statement 1 indicated that 14 representing 87.5% of the respondents agreed that “Orientation and mobility are parts of the CBR services, rendered to the visually impaired;” while 2 representing 12.5% of them were undecided. Responding to statement 2, 13 representing 81.2% of the visually impaired respondents affirmed that “Handicraft is one of the economic integration services provided for the visually impaired;” 1 representing 6.3% was undecided; while 2 representing 12.5% of them disagreed.

CBR services to visually impaired persons in the center

Furthermore, responding to statement 3, 15 representing 93.7% of the respondents agreed that “animal rearing is included in the CBR services for the visually impaired” whereas 1 representing 6.3% of them were undecided. Responses to statement 4 indicate that 12 representing 75% of the respondents affirmed that petty trading is another economic integration program of CBR services for the visually impaired.” However, 2 representing 12.5% of them were undecided and disagreed to that statement, respectively.

Research Question 2

To what extent are the services appropriate in rehabilitating persons with visual impairment?

In Table 2, responses to statements indicated that all (16) representing 100% of all respondents agreed that the CBR services are beneficial though inadequate.” Responding to 6, 13 representing 82.3% of the respondents affirmed that CBR Services in the center are aimed at achieving the goals and vision of rehabilitation;” while 3 representing 18.7% of them disagreed.

Appropriateness of the services in rehabilitating persons with visual impairment

Moreover, responses to statement 7 indicated that 14 representing 87.5% agreed that “the CBR program is very appropriate for the rehabilitation of the visually impaired persons in the center, while 2 representing 12.5% were undecided. Responding to statement 8, 3 representing 18.7% indicated that they are currently clients on CBR program while the majority (13) representing 81.3% of them have disagreed.

Research Question 3

What are the effects of the CBR services on the visually impaired beneficiaries?

Table 3 indicated that 13 representing 81.3% of the respondents agreed to statement 9, which stated that “The CBR services have helped you to acquire vocational skills,” while 3 representing 18.7% of them were undecided. Responding to statement 10, 12 representing 75% of the respondents indicated that “They have become independent through CBR services,” while 3 representing 18.7% were undecided. 1 representing 6.3% of them, however, disagreed to the statement.

Effects of the CBR services on the visually impaired beneficiaries

Responses to statement 2 indicate that 8 representing 50% of the respondents affirmed that they have secured paid employment through CBR services. While 3 representing 18.7% were undecided; 5 representing 31.3% of them disagreed. Responding to statement 12, 13 representing 81.3% agreed that CBR services have enabled them to integrate economically in the society, while 3 representing 18.7% were undecided. Finally, responses to statement 13 indicated that 14 representing 87.5% of the respondent agreed that their orientation and mobility skills have been improved through the CBR services, while 2 representing 12.5% of them were undecided.

Research Question 4

What problems do community workers encounter in providing the CBR services?

In Table 4, responses to statement 14 indicate that 13 representing 81.3% of the respondents agreed that lack of support from families of the visually impaired (VI) persons poses a problem to community workers in providing CBR services. While 1 representing 6.3% were undecided; 2 representing 12.5% of them disagreed to that statement. Furthermore, responses to statement 15 showed that 12 representing 75% of the respondents agreed that lack of active community participation in CBR program possess a challenge in CBR service provision while 3 representing 18.7% were undecided. 1 representing 6.3% of them disagreed.

Problems encountered in providing the CBR services

Responses to statement 16 indicated that 14 representing 87.5% of the respondent affirmed that lack of accommodation for the increasing number of visually impaired persons in Plateau State is a problem to CBR services provision, while 2 representing 12.5% of them were undecided. Finally, responses to statement 17 showed all (16) representing 100% of the respondents affirmed that the CBR services do no cover the whole State.

Research Question 5

How would the problems community workers encounter be overcome?

As indicated in Table 5, responses statement 18 indicate that 14 representing 87.5% of the respondents agreed that active participation of the community is a necessity in overcoming the problems rehabilitation centers encounter in the provision of CBR services. However, 2 representing 12.5% were undecided.

How problems community workers encounter in providing CBR services can be overcome

Similarly, response to statement 19 indicates that 16 representing 100% of respondents affirmed that parents and/or families of the persons with visual impairment should complement rehabilitation centers effort in rehabilitating their wards through active involvement. This will go a long way in overcoming the problems rehabilitation centers face in the provision of CBR services in the Plateau state. Finally, responses to statement 20 indicate that 15 representing 93.6% of the respondent agreed that other rehabilitation services should complement the CBR services provided by rehabilitation centers in the Plateau state.

DISCUSSION

The discussion of the results of this study is done in line with various research questions 1 revealed that orientation and mobility are parts of the CBR services rendered the visually impaired, handicap is one of the economic integration services CBM provides for the visually impaired and petty trading is another economic integration program of the empowerment. This implies that CBR programs are aimed at empowering individuals to acquire vocational and technical skills that will enable them become self-reliant. A review reveals that CBR provides Socio-economic integration for visually impaired persons.11. These programs are aimed at providing training for teachers in braille and other techniques, handcrafts, and wood-work. They are also taught income-generating activities which are carried out sometimes in collaboration with non-disabled persons.

The analysis of responses to research question 2 revealed that CBR services are beneficial though inadequate and that CBR is achieving the goals and vision of rehabilitation. Similarly, respondents agreed that the CBR program is very appropriate for the visually impaired in the center some respondents are currently clients and benefiting from the CBR program.

More so, the study revealed that there is a significant effect of CBR services on the visually impaired beneficiaries and has acquires relevant vocational skills. Quite a number of the respondents have become independent through CBR services. Similarly, respondents attested to have secured paid employment through CBR services, and CBR services have enabled them integrate economically in the society. Nevertheless, their opinions are in line with the objectives and contents of CBR programs which include the provision of employment support with skills training, apprenticeships, and revolving loans as support to set up businesses or other income generating activities.9

The analysis of responses to research question 4 on the problems encountered in providing the CBR services revealed that there is a lack of support from families of the respondents asserted that the lack of active community participation in CBR program in the c is one of the problems encountered in the provision of CBR activities. This pitfalls and obstacles to CBR programs are in line with the WHO, ILO, and UNESCO joint position paper, which states that CBR program has involved communities at one point or another but have not made them participate fully. This has led to lack of ownership of the CBR program by communities.6

Similarly, there is a lack of accommodation for the increasing number of visually impaired persons in the center and CBR services do not cover the whole State. These major problems, barriers and challenges as stated by the joint position paper of the WHO, ILO, and UNESCO have been lingering and are mostly attributed to lack of financial, human and material capacity/support, on one hand, and technical support on the other.6 However, the analysis of responses on research question 5 providing responses on the measures taken to overcome the problems community workers encounters in the provision of CBR services. Respondents agree that active community participation is a necessity and parents, or families of the visually impaired should complement governments’ effort in rehabilitating their wards through active involvement. Similarly, respondents are not of the opinion that other rehabilitation services should complement the services offered by community workers. However, a preliminary analysis of CBR programs in Africa revealed that most of the NGO programs can be found in West Africa including Nigeria where communities are not actively involved and do not provide adequate support in service provision.1

CONCLUSION

The following conclusions and recommendations are proffered:

NGOs can make significant contributions to the development of CBR and the provision of services to visually impaired persons in the Plateau State.

The provision of services in the center is wholly inadequate but beneficial to usually impaired persons in the state.

Empowering visually impaired persons through the provision of vocational training by in the rehabilitation center is beneficial to integrate persons with visual impairment in the state.

There is need to expand CBR to rural communities that have very limited access of CBR services. This is because an increasing number of visual impaired persons are found in rural areas.

The investment in the training of CBR workers/program managers will help to strengthen the services within the various sectors that contribute to CBR service provision.

Other voluntary organization should collaborate in partner with the government-owned rehabilitation centers in the provision of ideals framework in continuing the shift for center-based care to community-based care.

Several organizations should be committed to the formation of a CBR national network in Nigeria to improve the provision of services to visually impaired persons.

There is need for material and moral support of local authorities for the activities of CBR programs in the center.

Communities should be encouraged to embrace CBR programs and also become actively involved in the provision of CBR services.

There is need for the commitment and availability of stakeholders who work to achieve better living conditions for persons with disabilities especially visually impaired persons. This can be attained through the involvement of community heads/leaders, district heads, persons with special needs, families, religious organizational and their leaders, community schools, community health centers, health care providers, volunteers, disability peoples groups, etc.

Networking with other countries through membership of CBR African Network is necessary in implementing, sustaining and evaluating CBR programs in Nigeria.

Finally, there is need to gather and provide evidence-based research and information on the process of including persons with visual impairment in CBR programs as well as other categories of persons with special needs.

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