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

2. 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

3. 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

4. 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

5. 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

6. 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 provides regional plan with goals and targets
WHO Better health for all. Global Disability Action Plan provides direction and objectives
What disability inclusions looks like in a specific context requires genuine and ongoing discussion by all stakeholders

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Thank you Any questions?
Presented by
Professor Gwynnyth
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
Technical Lead Disabilities and Rehabilitation
World Health Organization
Western Pacific Regional Office