The impact of a Community Based Rehabilitation Program in Afghanistan: A longitudinal analysis using propensity score matching and difference in difference analysis

Abstract Background. The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components. Methods. We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment.Results. There were statistically significant differences between participants and controls on all outcomes between baseline and end-line, with impacts ranging from the highest on emotional wellbeing (1.02, 95%CI 0.04-2.00) and the lowest on activities of daily living (0.08, CI 0.03-0.13).Conclusion. Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered. Trial registration. ISRCTN, ISRCTN50214054. Registered August 5th 2020 - retrospectively registered, http://www.isrctn.com/ISRCTN50214054