IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v19y2022i10p6341-d822103.html
   My bibliography  Save this article

Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?

Author

Listed:
  • Jean-Francois Trani

    (Brown School, Washington University, St. Louis, MO 63130, USA)

  • Kyle A. Pitzer

    (School of Medicine, Washington University, St. Louis, MO 63130, USA)

  • Juanita Vasquez Escallon

    (UNICEF—United Nations Children’s Fund, New York, NY 10017, USA)

  • Parul Bakhshi

    (Occupational Therapy Program, School of Medicine, Washington University, St. Louis, MO 63108, USA)

Abstract

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified in 2006, states that the achievement of equal rights, empowerment, and social inclusion of people with disabilities requires comprehensive rehabilitation services involving educational, social, economic, and medical interventions, all dimensions of the World Health Organization Community based rehabilitation (CBR) matrix. CBR programs aim at achieving those goals. In the present study, we investigated whether a large scale CBR program is improving access to multiple services (namely physical therapy, assistive technology, education, employment, advocacy, and community awareness) and providing satisfactions (by measuring the reduction in unmet needs) of Afghans with disabilities. We enrolled in the study 1861 newly recruited CBR participants with disabilities from 169 villages between July 2012 and December 2013, and 1132 controls screened with disabilities randomly selected with a two-stage process within 6000 households from 100 villages in the same provinces as the CBR but outside its catchment area. Using propensity score matching (PSM) and difference in difference analysis, we estimated the differences in accessing services. There were statistically significant differences between participants and controls on the access of available services between the baseline and endline. Using PSM we also found that needs were more often met among CBR participants compared to the controls. Our study indicates that a CBR program may be an effective way to provide services for persons with disabilities even in a conflict context such as Afghanistan. It contributes to addressing the longstanding question whether CBR can actually improve the rehabilitation of persons with disabilities.

Suggested Citation

  • Jean-Francois Trani & Kyle A. Pitzer & Juanita Vasquez Escallon & Parul Bakhshi, 2022. "Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?," IJERPH, MDPI, vol. 19(10), pages 1-26, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:10:p:6341-:d:822103
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/19/10/6341/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/19/10/6341/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
    2. Jean-Francois Trani & Jill Kuhlberg & Timothy Cannings & Dilbal Chakkal, 2016. "Multidimensional poverty in Afghanistan: who are the poorest of the poor?," Oxford Development Studies, Taylor & Francis Journals, vol. 44(2), pages 220-245, April.
    3. Josephine E. Prynn & Hannah Kuper, 2019. "Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia," IJERPH, MDPI, vol. 16(18), pages 1-11, September.
    4. Jean-Francois Trani & Parul Bakhshi & C�cile Rolland, 2011. "Capabilities, Perception of Well-being and Development Effort: Some Evidence from Afghanistan," Oxford Development Studies, Taylor & Francis Journals, vol. 39(4), pages 403-426, December.
    5. Jean-Francois Trani & Parul Bakhshi & Sarah Myers Tlapek & Dominique Lopez & Fiona Gall, 2015. "Disability and Poverty in Morocco and Tunisia: A Multidimensional Approach," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 16(4), pages 518-548, November.
    6. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    7. Trani, Jean-Francois & Bakhshi, Parul & Brown, Derek & Lopez, Dominique & Gall, Fiona, 2018. "Disability as deprivation of capabilities: Estimation using a large-scale survey in Morocco and Tunisia and an instrumental variable approach," Social Science & Medicine, Elsevier, vol. 211(C), pages 48-60.
    8. Ashrita Saran & Howard White & Hannah Kuper, 2020. "Evidence and gap map of studies assessing the effectiveness of interventions for people with disabilities in low‐and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(1), March.
    9. Mauro, Vincenzo & Biggeri, Mario & Grilli, Leonardo, 2015. "Does Community-Based Rehabilitation Enhance the Multidimensional Well-Being of Deprived Persons With Disabilities? A Multilevel Impact Evaluation," World Development, Elsevier, vol. 76(C), pages 190-202.
    10. Janice Tripney & Alan Roulstone & Carol Vigurs & Nina Hogrebe & Elena Schmidt & Ruth Stewart, 2015. "Interventions to Improve the Labour Market Situation of Adults with Physical and/or Sensory Disabilities in Low‐ and Middle‐Income Countries: A Systematic Review," Campbell Systematic Reviews, John Wiley & Sons, vol. 11(1), pages 1-127.
    11. Valentina Iemmi & Karl Blanchet & Lorna J. Gibson & K. Suresh Kumar & Santosh Rath & Sally Hartley & Gudlavalleti V. S. Murthy & Vikram Patel & Joerg Weber & Hannah Kuper, 2016. "Community-based rehabilitation for people with physical and mental disabilities in low- and middle-income countries: a systematic review and meta-analysis," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 8(3), pages 368-387, July.
    12. James J. Heckman & Hidehiko Ichimura & Petra E. Todd, 1997. "Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 605-654.
    13. Arne H Eide & Hasheem Mannan & Mustafa Khogali & Gert van Rooy & Leslie Swartz & Alister Munthali & Karl-Gerhard Hem & Malcolm MacLachlan & Karin Dyrstad, 2015. "Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    14. Lena Morgon Banks & Hannah Kuper & Sarah Polack, 2017. "Poverty and disability in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-19, December.
    15. Parul Bakhshi & Ganesh M. Babulal & Jean-Francois Trani, 2021. "Disability, Poverty, and Schooling in Post-civil War in Sierra Leone," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 33(3), pages 482-501, June.
    16. Mizunoya, Suguru & Mitra, Sophie & Yamasaki, Izumi, 2018. "Disability and school attendance in 15 low- and middle-income countries," World Development, Elsevier, vol. 104(C), pages 388-403.
    17. Mitra, Sophie & Posarac, Aleksandra & Vick, Brandon, 2013. "Disability and Poverty in Developing Countries: A Multidimensional Study," World Development, Elsevier, vol. 41(C), pages 1-18.
    18. Trani, Jean-Francois & Ballard, Ellis & Peña, Juan B., 2016. "Stigma of persons with disabilities in Afghanistan: Examining the pathways from stereotyping to mental distress," Social Science & Medicine, Elsevier, vol. 153(C), pages 258-265.
    19. Nora Groce & Maria Kett & Raymond Lang & Jean-Francois Trani, 2011. "Disability and Poverty: the need for a more nuanced understanding of implications for development policy and practice," Third World Quarterly, Taylor & Francis Journals, vol. 32(8), pages 1493-1513.
    20. Jean-François Trani & Ganesh Muneshwar Babulal & Parul Bakhshi, 2015. "Development and Validation of the 34-Item Disability Screening Questionnaire (DSQ-34) for Use in Low and Middle Income Countries Epidemiological and Development Surveys," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-14, December.
    21. Janice Tripney & Alan Roulstone & Carol Vigurs & Nina Hogrebe & Elena Schmidt & Ruth Stewart, 2015. "Interventions to Improve the Labour Market Situation of Adults with Physical and/or Sensory Disabilities in Low‐ and Middle‐Income Countries: A Systematic Review," Campbell Systematic Reviews, John Wiley & Sons, vol. 11(1), pages 1-127.
    22. Stanislav Kolenikov & Gustavo Angeles, 2009. "Socioeconomic Status Measurement With Discrete Proxy Variables: Is Principal Component Analysis A Reliable Answer?," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 55(1), pages 128-165, March.
    23. Green, Sara E., 2003. ""What do you mean 'what's wrong with her?'": stigma and the lives of families of children with disabilities," Social Science & Medicine, Elsevier, vol. 57(8), pages 1361-1374, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Trani, Jean-Francois & Moodley, Jacqueline & Anand, Paul & Graham, Lauren & Thu Maw, May Thu, 2020. "Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem," Social Science & Medicine, Elsevier, vol. 265(C).
    2. Takasaki, Yoshito, 2020. "Impacts of disability on poverty: Quasi-experimental evidence from landmine amputees in Cambodia," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 85-107.
    3. Trani, Jean-Francois & Bakhshi, Parul & Brown, Derek & Lopez, Dominique & Gall, Fiona, 2018. "Disability as deprivation of capabilities: Estimation using a large-scale survey in Morocco and Tunisia and an instrumental variable approach," Social Science & Medicine, Elsevier, vol. 211(C), pages 48-60.
    4. Ute Rink & Theresa Rollwage, 2022. "Household disability and time preferences: Evidence from incentivized experiments in Vietnam," TVSEP Working Papers wp-027, Leibniz Universitaet Hannover, Institute of Development and Agricultural Economics, Project TVSEP.
    5. Derek Asuman & Charles Godfred Ackah & Frank Agyire-Tettey, 2021. "Disability and Household Welfare in Ghana: Costs and Correlates," Journal of Family and Economic Issues, Springer, vol. 42(4), pages 633-649, December.
    6. Mónica Pinilla-Roncancio, 2023. "Multidimensional Measures and the Extra Costs of Disability: How Are They Related?," IJERPH, MDPI, vol. 20(3), pages 1-15, February.
    7. Pierre DeBeaudrap & Charles Mouté & Estelle Pasquier & Muriel Mac-Seing & Pulchérie U. Mukangwije & Gervais Beninguisse, 2019. "Disability and Access to Sexual and Reproductive Health Services in Cameroon: A Mediation Analysis of the Role of Socioeconomic Factors," IJERPH, MDPI, vol. 16(3), pages 1-14, February.
    8. Xanthe Hunt & Ashrita Saran & Lena Morgon Banks & Howard White & Hannah Kuper, 2022. "Effectiveness of interventions for improving livelihood outcomes for people with disabilities in low‐ and middle‐income countries: A systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(3), September.
    9. Jan Fałkowski & Maciej Jakubowski & Paweł Strawiński, 2014. "Returns from income strategies in rural Poland," The Economics of Transition, The European Bank for Reconstruction and Development, vol. 22(1), pages 139-178, January.
    10. Marco Caliendo & Stefan Tübbicke, 2020. "New evidence on long-term effects of start-up subsidies: matching estimates and their robustness," Empirical Economics, Springer, vol. 59(4), pages 1605-1631, October.
    11. Christian Volpe Martincus & Jerónimo Carballo, 2010. "Is Export Promotion Effective in Developing Countries? Firm-Level Evidence on the Intensive and Extensive Margins of Exports," IDB Publications (Working Papers) 36763, Inter-American Development Bank.
    12. Cadot, Olivier & Fernandes, Ana M. & Gourdon, Julien & Mattoo, Aaditya, 2015. "Are the benefits of export support durable? Evidence from Tunisia," Journal of International Economics, Elsevier, vol. 97(2), pages 310-324.
    13. Marco Caliendo & Reinhard Hujer, 2006. "The microeconometric estimation of treatment effects—An overview," AStA Advances in Statistical Analysis, Springer;German Statistical Society, vol. 90(1), pages 199-215, March.
    14. Raymond Lang & Marguerite Schneider & Maria Kett & Ellie Cole & Nora Groce, 2019. "Policy development: An analysis of disability inclusion in a selection of African Union policies," Development Policy Review, Overseas Development Institute, vol. 37(2), pages 155-175, March.
    15. Volpe Martincus, Christian & Carballo, Jerónimo, 2010. "Beyond the average effects: The distributional impacts of export promotion programs in developing countries," Journal of Development Economics, Elsevier, vol. 92(2), pages 201-214, July.
    16. Ashrita Saran & Howard White & Hannah Kuper, 2020. "Evidence and gap map of studies assessing the effectiveness of interventions for people with disabilities in low‐and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(1), March.
    17. Gudibande, Rohan Ravindra & Jacob, Arun, 2020. "Minimum wages for domestic workers: impact evaluation of the Indian experience," World Development, Elsevier, vol. 130(C).
    18. Michele Cincera & Gilles Eric Fombasso Toyem, 2018. "The impact of EUREKA projects on the economic performance of R&D SMEs," Working Papers TIMES² 2018-027, ULB -- Universite Libre de Bruxelles.
    19. Christian Volpe Martincus & Jerónimo Carballo, 2010. "Entering new country and product markets: does export promotion help?," Review of World Economics (Weltwirtschaftliches Archiv), Springer;Institut für Weltwirtschaft (Kiel Institute for the World Economy), vol. 146(3), pages 437-467, September.
    20. Jane Wilbur & Tess Bright & Thérèse Mahon & Shaffa Hameed & Belen Torondel & Wakisa Mulwafu & Hannah Kuper & Sarah Polack, 2018. "Developing Behaviour Change Interventions for Improving Access to Health and Hygiene for People with Disabilities: Two Case Studies from Nepal and Malawi," IJERPH, MDPI, vol. 15(12), pages 1-21, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:19:y:2022:i:10:p:6341-:d:822103. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.