Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review

BACKGROUND: Community-Based Rehabilitation (CBR) has evolved over the last 30 years and now focuses on empowering persons with disabilities to access and benefit from a wide range of services. The evidence for CBR is frequently cited in the literature as being scanty and of poor quality. PURPOSE: We sought to determine how CBR is conceptualised and understood in the literature from Southern Africa. Our interest centred on to what extent the literature could inform policy makers and practitioners in the region. METHODS: A systematic review of the literature from countries in Southern Africa guided by Population, Intervention/Phenomenon of Interest, Context and Outcome of Interest to the reviewer (PICO) was employed. This involved an extensive, internally valid and systematic search of electronic databases using specific keywords/subject heading combinations. Journal articles reporting on a description or objectives of CBR, published after 2006, and journal articles written in English of all types of studies were included. Data were charted according to the emergent themes. Two independent raters coded the emergent themes. RESULTS: Nine from a possible 257 published articles were reviewed; four of these were programme evaluations. Themes describing CBR converged on community development and poverty reduction. Only one article referred to human rights. Training and supervision of CBR workers and education of the community about disability were frequently reported activities. CONCLUSION: In isolated cases, the literature is aligned to components of the CBR matrix. However, consistent with previous criticism of CBR, the literature is meagre, as is the evidence to inform policy makers and practitioners in southern Africa.