Sustainable Community Based Rehabilitation at local and national levels Presented by Professor Gwynnyth Llewellyn (University of Sydney) and Darryl Barrett (World Health Organization)

Alternative governance mechanisms CBR governance varies worldwide Government ministry/ ministries Health, Labour and Social Welfare, Education NGOs Funded by and accountable to government ministry, INGOs, international donor government agencies DPOs

Government/ Donor funding Government – dependent on budget allocation annually particularly if project based rather than integrated in ongoing Ministry program Donor funded - application based (annual or bi-annual) without certainty of continuity Accountability primarily focused on localities served and number of participants Outcomes accountability may be quite under-developed

Alternative governance approaches CBR is a community-based inclusive development strategy One ministry may take the lead however cross ministry governance is needed for disability inclusion – health, education, labour, social-cultural UN Agencies and donors – health, education, labour DPOs are integral in informing about the barriers to disability inclusion and in working with government and NGOs to reduce the barriers

Accountability mechanisms: why? To determine impact For individuals with disabilities and their families For the local community For the society What type of impact Empowering people with disability to contribute actively to their community Including people with disabilities in social and economic development Reducing need for family members to provide all needed support

Critical question for accountability, monitoring and evaluation What would disability inclusion look like in this context? this community? this regional area? this country? CRPD provides guidance Incheon Strategy 2010-2020 provides regional plan with goals and targets WHO Better health for all. Global Disability Action Plan 2014-2021 provides direction and objectives What disability inclusions looks like in a specific context requires genuine and ongoing discussion by all stakeholders

Monitoring and Evaluation Critical to governance and accountability is that there is data to monitor and evaluate the process and outcome of CBR-CBID Requires genuine and ongoing discussion about what inclusion of people with disabilities looks like to know what data needs to be collected Number of local areas served and people in a program is not enough to measure disability inclusion

Measuring progress towards disability inclusion Measuring for example changes in societal attitudes towards people with disabilities reduced barriers which exclude people with disabilities services becoming accessible and inclusive people with disabilities going to school, becoming and staying healthy, getting and keeping a job, raising a family, serving the community

Critical components Monitoring and evaluating the contribution of CBR as CBID strategy requires: Involving people with disabilities in determining the measures of progress and indicators of disability inclusion success Choosing measures and indicators that are meaningful and useful to decision-makers who have the power to influence change Presenting the data in ways that convince decision makers to create and/ or sustain ongoing CBR and disability inclusion

Governance It’s about understanding how decisions are made, who makes them, why they make the decisions they make and what can be done to influence those decisions Involves both formal and informal processes Who are the actors involved in the formal and informal processes and what are their relationships For CBR it could include government (various levels), disabled peoples organisations, service providers (various sectors), people with disability and their families, UN agencies, bilateral donors, international development agencies, international and local NGO

Regardless of the level (local, provincial or national), appreciating governance mechanisms requires us to understand the roles that various stakeholders take in decision making and influencing decision making What constitutes ‘good governance’ include concepts of Participation Consensus Accountability Transparency Responsiveness Effectiveness and Efficiency Equity and Inclusion Rule of law

Understanding governance with political economy analysis How can we better understand the governance around our CBR programs, so success can be achieved? One way is through a political economy analysis, as a tool for development effectiveness Focus is on power and resources, and how they operate in a particular context, especially the distribution of that power and those resources Disability is often about power and power imbalance

Considerations for a political economy analysis Consider what is involved in a situational analysis as a starting point Political economy analysis looks at the characteristics of and between stakeholders, drawing on history, power distribution, economic drivers, social movements, laws and policies, government systems and informal rules about how things get done

What is the problem that we are trying to solve? Know who the various stakeholders are and how they interact with each other (what governance arrangements are in place)? What are the influences on the political economy, drawing on characteristics of the stakeholders involved, their relationships with each other, their history, the social forces (social movements) and trends in the particular society/community Action for next steps

Thank you Any questions? Presented by Professor Gwynnyth Llewellyn(gwynnyth.llewellyn@sydney.edu.au) Professor Family and Disability Studies Director, Centre for Disability Research and Policy  Head, WHO Collaborating Centre for Health Workforce Development in Rehabilitation and Long Term Care Darryl Barrett (dbarrett@who.int) Technical Lead Disabilities and Rehabilitation World Health Organization Western Pacific Regional Office