Applying Freirian Model for Development and Evaluation of Community-based Rehabilitation Programmes

Published in the Asia Pacific Disability Rehabilitation Journal, this 8-page article explores the potential application of Paulo Freire's model of adult education to the development and evaluation of community-based rehabilitation (CBR) programmes in developing countries. As author Manoj Sharma explains, Freire's model has been used in community organisation, health education, alcohol and substance abuse prevention, development work in agrarian cultures, and coalition building. However, the effectiveness of this model has generally been measured qualitatively. In order to quantitatively transcribe this model, Sharma identified 5 distinct constructs: dialogue, conscientisation, praxis, transformation, and critical consciousness. Specific directions for quantitative applications for developing and evaluating CBR programmes using these constructs are presented in this paper.

Sharma begins by explaining the motivation behind, and the process of, CBR, which was developed by World Health Organisation (WHO) as part of its goal to accomplish "Health for all by the year 2000." Having estimated that 90% of persons with disabilities were totally neglected in developing countries, WHO created a CBR training manual, which has (since its original publication in 1980) been revised and translated in several languages for use at the village level. The 5 basic principles of CBR strategy include:

1. Utilisation of available resources in the community to provide primary care and rehabilitative assistance to persons with disabilities;
2. Transfer of knowledge about disabilities and skills in rehabilitation to people with disabilities, families, and communities;
3. Community involvement in planning, decision making, and evaluation;
4. Utilisation and strengthening of referral services at district, provincial, and national levels; and
5. Utilisation of a co-ordinated, multisectoral approach.

Sharma then outlines Freire's paedagogical, process-centred approach, which includes 3 phases. In the first phase (the "naming" phase or the "listening" stage), one asks the question, "What is the problem?" or "What is the question under discussion?" This phase is conducted in equal partnership with the community members to identify problems and determine priorities. Next, in the "reflection" or "dialogue" phase, one poses the question, "Why is this the case?" or "How do we explain this situation?" To structure dialogue, a "code" - or physical representation of an identified community issue in the form of a role play, story, slide, photograph, song, etc. - is created so that participants can express their emotional and social responses to the problem. (In some training programmes, facilitators help in this reflection process by using a 5-step questioning strategy, which is outlined here). The third phase, the "action" phase, is characterised by the question, "What can be done to change this situation?" or "What options do we have?"

Next, the author explores the constructs of the Freirian model, and applies them to CBR. Here is a summary of Sharma's key points:

• The first construct is dialogue, the authentic exchange between (in the case of CBR) educators/providers and the persons with disabilities or their families on real, concrete awareness on the root causes of their situation - from the perspective of those living it. Sharma explains that dialogue supports the following WHO strategies: transfer of knowledge about disabilities and skills in rehabilitation; community involvement in planning, decision making, and evaluation; and utilisation of a coordinated, multisectoral approach. In evaluation of CBR programmes to measure the construct of dialogue, some of the dimensions that can be measured are the extent of 2-way communication, the extent of problem posing, and the extent of joint discovery of the "social reality".
• The second construct is conscientisation, or efforts to identify and address the underlying systemic forces of oppression. Sharma claims that this process is vital in implementation of the WHO strategy of transfer of knowledge about disabilities and skills in rehabilitation. Opportunities for evaluation of CBR programmes that are aligned with this construct relate to the extent of identification of oppressive sources, the extent of people working together as change agents, and the extent of the key issue influencing each person at a personal level.
• The third construct is praxis, or reflection on, and linking of, theory and practice. Sharma argues that, in CBR, this construct can be applied by providing a group of persons with disabilities or their family members with a joint project to plan, implement, and evaluate collectively. Some of the researchable aspects along the lines of praxis in CBR include: extent of participation in project planning, extent of reflection in project planning, extent of participation and reflection in project implementation and evaluation, and extent of perceived utility of the project.
• The fourth construct is transformation, which Freire describes as the process of changing "objects" (who have a naive consciousness of reality) into "subjects" (who see the theory behind the reality). It connotes independence, status, and integrity. Sharma indicates that this idea can be applied in CBR by providing opportunity to the participants for self-reflection. Evaluators of CBR can measure the extent of focus on the issue from the perspective of the people negatively affected by disability, the extent of integration of persons with disabilities within the community, and the extent of unison on a collective viewpoint.
• The fifth construct is critical consciousness, which refers to the political organisation of those adversely affected. Sharma contends that this concept can be
  applied in CBR by building cooperation between educators and persons with disabilities, fostering unity on issues, developing effective communication, and augmenting the process of political organisation to change policies and legislation.

Sharma concludes by detailing several limitations of the Freirian model, but nonetheless concludes that this approach has potential in developing and evaluating CBR programmes.