Community-based rehabilitation in Fiji : evaluation of the competency, assessment, and local solutions (CAL) programme

Abstract

Background: Approximately 12 000 people with a disability live in the developing country of Fiji, yet only 0.2% of those requiring services have access to them. The competency based training, assessment and consultancy, and local/community participation activities (CAL) programme is a 3 year programme aiming to address the needs of children with disabilities in Fiji. It supports immediate health solutions, skill development for community rehabilitation assistants (CRAs), health workers, parents and teachers, and culminating in sustainability. Objectives: To evaluate the first 2 years of the CAL programme regarding efficiency, quality and effectiveness and to make recommendations for ongoing sustainability and improved implementation. Design: A multiple stakeholder case study design was utilised, allowing evaluation of the programme in its real world setting. Participants/Setting: Stakeholders including families, CRAs, teachers, health workers and representatives of external stakeholder organisations. Materials/Methods: A multi-faceted mixed method data collection approach was utilised. Quantitative and qualitative data was collected using semi-structured questionnaires (n = 53), interviews (n = 4), focus groups (n = 3 with 41 participants), record reviews and field observations. Quantitative data was collated with descriptive statistics and qualitative data transcribed and thematically coded. Results: Efficiency – CRAs (13 i.e. 100% completion), teachers and health care workers have been trained through the programme and are now implementing assessments, detailed individualised rehabilitation goals and plans, and interventions. Quality – High program satisfaction rates were reported by all stakeholders (75% to 94%), with identified program strengths including knowledge gain, service provision, sustainability, community approach and expertise of facilitators. Contextual factors identified that may influence ongoing success of the programme included policy, legislative, political, access and financial issues. Parents report feeling more confident and informed. Stakeholders commonly recommended that further outcome improvement could be achieved by training more people. Effectiveness – 77% of participants felt that community perception of disability had changed for the better as a result of the programme. 100% of CRAs reported skill transfer to children with disabilities and their families, and 100%of children assessed are now provided with a detailed action plan including functional goals. Participants reported greater confidence, communication skills, assessment skills and skills in developing and actioning appropriate plans for their clients. Conclusions/Clinical Implications: The CAL programme is producing positive outcomes. Recommendations include: continuation and extension of the programme; increasing number of CRAs trained; ongoing communication with stakeholders to raise awareness of the programme; inclusion of outcome measures to evaluate effectiveness; and a focus during the third year on future sustainability of the programme