WORLD HEALTH ORGANIZATION
CONCEPT NOTE
WHO Manual on Participatory Monitoring and Evaluation of
Community Based Rehabilitation
June 2014
MANDATE
A new World Health Assembly Resolution 67/16 Disability: WHO global disability action plan
2014–2021: Better health for all people with disability adopted in May 2014 requests the
World Health Organization (WHO) to support Member States to strengthen community-based
rehabilitation programmes; notably through support for monitoring and evaluation in addition
to training and network development.
Most of the world’s population with disabilities lives in low- and middle-income countries,
facing stigma, discrimination, barriers to equal participation, and lack of appropriate services.
Community-based rehabilitation (CBR), developed by WHO in the 1970s, has evolved over the
years to address the wider needs of persons with disabilities, to maximize their participation
and inclusion in society and to enhance their quality of life. CBR is currently implemented in
over 100 countries around the World.
CBR aims to provide rehabilitation, reduce poverty, equalize opportunities and promote the
inclusion of persons with disabilities in their communities and does this through a
comprehensive and multi-sectoral approach that is aligned with the Convention on the rights
of persons with disabilities(CRPD).
Guidelines on Community-based rehabilitation (WHO 2010) developed by WHO , in
partnership with the International Labour Organization (ILO), the United National
Educational, Scientific and Cultural Organization (UNESCO), and the International
Disability and Development Consortium (IDDC) provide support to national, regional and
global efforts to promote community-based rehabilitation programmes for persons with
disabilities and their families.
The CBR guidelines target programme managers and stakeholders to strengthen CBR
programmes to meet the basic needs of people with disabilities using a participatory
approach. They offer practical suggestions on how to build links with and strengthen the
capacity of mainstream services and facilitate access to specific services to empower
people with disabilities and their families to access the benefits of the health, education,
livelihood and social sectors and improve their quality of life (see Figure 1 for the CBR
Matrix).
World Health Organization
WHY IS THIS WORK NECESSARY?
A significant challenge to promoting and advocating for implementation of CBR is the ability to
demonstrate results. While significant anecdotal evidence exists on the success of CBR,
baseline data are scarce and there is no agreement on indicators. The CBR Guidelines contain
a chapter about the management of CBR programmes which includes a brief introduction to
monitoring and evaluation, but the information provided is limited and there are currently no
universal/internationally comparable indicators or measurement tool/s in line with the
guidelines to support CBR programmes in their efforts to undertake monitoring and
evaluation.
In conjunction with the first CBR World Congress in Agra, India, WHO convened a global
meeting of experts to discuss needs in this area. The group proposed that a manual on CBR
monitoring and evaluation, accompanied by standardized indicators, would benefit programme
managers and advocates alike to better monitor the impact of CBR and make a case for its
implementation. Some work has been done to identify indicators. There are also four
international research projects that are exploring different, but complementary, aspects of
CBR M&E on which this work can be built. WHO seeks an organization or individual(s) to
coordinate the refining of indicators and the development of a manual on CBR monitoring and
evaluation.
OBJECTIVES
The purpose of developing a set of core and extended CBR indicators is to facilitate
measurement of results that is objective and internationally comparable, covering the many
facets of CBR. Outcome indicators will be prioritized, with guidance provided on selection of
input/process and output indicators. The indicators and guidance on their measurement and
use may be published as part of the Manual on Participatory Monitoring and Evaluation of
CBR or as a stand-alone product.
The Manual on Participatory Monitoring and Evaluation of CBR is intended to provide practical
guidance for planning and executing monitoring and evaluation of CBR programmes using a
participatory approach. The manual will be grounded in the CBR Guidelines and CBR Matrix.
It will provide guidance on selecting various types of indicators, including both outcome and
process indicators, choosing and implementing monitoring and evaluation methodology,
involving stakeholders in the process, collecting baseline data and disseminating and acting
on the results. A key challenge of the manual will be to guide users in working with
standardized procedures, tools and indicators within a participatory monitoring and
evaluation approach.
DESCRIPTION OF THE TARGET AUDIENCE
The manual will be targeted at CBR programme managers. It will also be relevant to disabled
peoples’ organizations, government officials involved in disability programmes (in particular,
local officials), staff of development organizations and nongovernmental organizations,
researchers and academics, and people with disabilities.
DEFINITIONS
Disability / difficulties in functioning
-2-
World Health Organization
To ensure consistency in concepts and language across professions, stakeholders and
countries, the Manual and indicators will be consistent with the International Classification of
Functioning (ICF) (WHO, 2001) and the Convention on the rights of persons with disabilities.
The ICF understands functioning, and disability, as a dynamic interaction between health
conditions and contextual factors, both personal and environmental. In the ICF, problems in
functioning are categorized in three interconnected areas: impairments, activity limitations
and participation restrictions. Disability refers to difficulties encountered in any or all three of
these areas. The ICF emphasizes environmental factors in creating disability.
The CRPD states that disability is an evolving concept and “results from the interaction
between persons with impairments and attitudinal and environmental barriers that hinders
their full and effective participation in society on an equal basis with others”.
Community-based rehabilitation
The ILO/UNESCO/WHO Joint Position Paper defines CBR as a “strategy within general
community development for the rehabilitation, poverty reduction, equalization of
opportunities and social inclusion of all people with disabilities” (ILO/UNESCO/WHO, 2004).
The CBR Matrix provides a framework for CBR programmes. The matrix consists of five key
components – the health, education, livelihood, social and empowerment components. The
matrix has been designed to allow programmes to select options which best meet their local
needs, priorities and resources.
Participatory monitoring and evaluation
Since participation and empowerment lay at the core of CBR, it is optimal if monitoring and
evaluation of CBR programmes takes a participatory approach. The World Bank defines
participatory monitoring and evaluation (PM&E) as “a process through which stakeholders at
various levels engage in monitoring or evaluating a particular project, program or policy,
share control over the content, the process and the results of the M&E activity and engage in
taking or identifying corrective actions.” PM&E not only measures the effectiveness of a
programme or project, it also builds ownership, has an empowering effect on beneficiaries,
and strengthens accountability and transparency.
MANAGEMENT OF INDICATORS AND MANUAL DEVELOPMENT
In addition to a broad range of contributors including researchers and writers with
experience and expertise in programme evaluation and CBR, the following groups will guide
the development and quality of the manual and indicators.
WHO Steering Group
The WHO Steering Group will provide advice on the scope of the manual; advise on selection
and definition of indicators; identify suitable researchers and writers; ensure
recommendations are consistent with WHO policy and will review and comment on relevant
chapters of the manual.
CBR M&E Reference Group
The CBR M&E Reference Group is responsible for advising on the content of the manual.
Their specific roles include: advising on the scope and priority questions; advising on the
approach to evidence collection and assessment; assessment and interpretation of the
evidence; advising on selection and definition of indicators; and formulation of
recommendations. This group has already met once and discussed possible indicators.
Peer Review
The draft indicators and manual will be extensively peer-reviewed by experts and end-users
at WHO headquarters and regional offices, the World Bank, and also external stakeholders
-3-
World Health Organization
including Disabled Peoples Organizations, CBR programme managers, and decision and
policy makers and service providers.
INDICATIVE TIMELINE
September 30, 2014
Prepare detailed table of contents for manual.
November 30, 2014
Refine draft indicators and achieve consensus
December 15, 2015
Finalize indicators and manual at meeting of CBR M&E
Reference Group.
February 27, 2015
Finalise Drafting of manual.
May 30, 2015
Final, peer-reviewed draft of manual complete.
June 30, 2015
Production and publishing.
-4-