Training Needs of Community-based Rehabilitation Workers for the Effective Implementation of CBR Programmes

Julia Mary Jansen-van Vuuren, Heather Michelle Aldersey


Purpose: This review investigates the training needs of Community-Based Rehabilitation (CBR) workers that would enable them to effectively facilitate CBR programmes. Emphasis was placed on identifying: (a) the skills that CBR workers require (b) the training currently available for them, and (c) the gaps in current training.

Method: A scoping review was conducted using on-line database searches (Medline, Embase, Cinahl, PsycInfo, Global Health) for English articles from 2006 onwards. A combination of keywords related to CBR, personnel, and training were applied. Hand searches of reference lists and the DCID journal were also conducted. Grey literature related to training, from the World Health Organisation (WHO), CBR Regional Networks and organisations affiliated with CBR were included as secondary data. Thirty-three articles and thirty-five sources from the grey literature were included. Data was organised under the three objectives outlined above – i.e., required skills, available training and training gaps.

Results: CBR workers represent a diverse group requiring a broad range of skills. A new cadre of mid-level workers is also necessary to effectively implement the CBR guidelines. There is currently no standardised training for CBR workers and training varies widely, depending on context. CBR workers require further training in various clinical, social, management, communication, and cultural competence skills across the spectrum of the CBR Matrix, and specifically in empowering persons with disabilities and facilitating community development. They also need to develop critical reasoning, creativity, and compassion.

Conclusion: A standardised approach to training CBR workers would be beneficial to ensure basic standards and quality services, to allow meaningful comparison and evaluation across contexts, to recognise the role of mid-level CBR workers, and to strengthen the workforce. Further research is required to determine minimal competencies, define the roles of various CBR workers, and evaluate the effectiveness of training.


Training; education; skills; competencies; CBR workers

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Arksey H, O'Malley L (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology; 8 (1): 19-32.

Beshir MA, Woreta SA, Kebede M (2017). Evidence-based practice among health professionals in hospitals of Northwest Ethiopia: A cross-sectional study. International Journal of Evidence-Based Healthcare; 15(4): 161-170.

Brandsma JW, Harijan T, Wagle P, Baxter KA (2008). Partnership for rehabilitation: looking beyond impairments. Indian Journal of Leprosy; 80(1): 19-29. PMid:19295118

CBR Community Development and Training Centre (2010). Finding out about CBR training materials for community-based rehabilitation workers. Solo, Indonesia: Community Based Rehabilitation Development and Training Centre (CBRDTC). Available at: [Accessed Feb 2018].

Chappell P, Johannsmeier C (2009). The impact of community based rehabilitation as implemented by community rehabilitation facilitators on people with disabilities, their families and communities within South Africa. Disability and Rehabilitation; 31(1): 7-13. PMid:19194807

Chipps JA, Simpson B, Brysiewicz P (2008). The effectiveness of cultural-competence training for health professionals in community-based rehabilitation: a systematic review of literature. Worldviews on Evidence-Based Nursing; 5(2): 85-94. PMid:18559021

Cleaver S, Nixon S (2014). A scoping review of 10 years of published literature on community-based rehabilitation. Disability and Rehabilitation; 36(17): 1385-94. PMid:24151820

Como E, Batdulam T (2012). The role of community health workers in the Mongolian CBR programme. Disability, CBR and Inclusive Development; 23(1): 14-33.

Cornielje H, Velema JP, Finkenflügel H (2008). Community based rehabilitation programmes: Monitoring and evaluation in order to measure results. Leprosy Review; 79(1): 36-49. PMid:18540236

Dagys K, Popat A, Aldersey H (2015). The applicability of e-learning in community-based rehabilitation. Societies; 5(4): 831-854.

Dawad S, Jobson G (2011). Community-based rehabilitation programme as a model for task-shifting. Disability and Rehabilitation; 33(21-22): 1997-2005. PMid:21291340

Deepak S (2011). CBR Matrix and perceived training needs of CBR workers: A multi-country study. Disability, CBR and Inclusive Development; 22 (1): 85-98.

Deepak S (2012). Promoting empowerment: Emancipatory research in community-based rehabilitation programmes: A guide for CBR programmes managers. Italy: AIFO. Available at: [Accessed Feb 2018].

Dunleavy K (2007). Physical therapy education and provision in Cambodia: A framework for choice of systems for development projects. Disability and Rehabilitation; 29(11-12): 903-920. PMid:17577725

Enablement (n.d.). Enablement diploma courses[Online]. Netherlands. Available at: [Accessed Feb 2018].

Ferrante M (2014). Empowering communities through knowledge transfer: training guide for community based rehabilitation. Italy: OVCI. Available at: [Accessed Feb 2018].

Finkenflügel H (2006). Who is in... and for what? An analysis of stakeholders' influences in CBR. Asia Pacific Disability Rehabilitation Journal; 17(1): 12-34.

Finkenflügel H, Rule S (2008). Integrating community-based rehabilitation and leprosy rehabilitation services into an inclusive development approach. Leprosy Review; 79(1): 83-91. PMid:18540239

Gilmore B, Maclachlan M, Mcveigh J, Mcclean C, Carr S, Duttine A, Mannan H, Mcauliffe E, Mji G, Eide AH, Hem KG, Gupta N (2017). A study of human resource competencies required to implement community rehabilitation in less resourced settings. Human Resources for Health; 15(1): 70. PMid:28938909 PMCid:PMC5610467

Grandisson M, Hébert M, Thibeault R (2014). A systematic review on how to conduct evaluations in community-based rehabilitation. Disability and Rehabilitation; 36(4): 265-275. PMid:23614357. PMCid:PMC3913006

Grandisson M, Hébert M, Thibeault R (2017). Practice guidelines for program evaluation in community-based rehabilitation. Disability and Rehabilitation; 39(12): 1243-1251. PMid:27347694

Grech S (2015). Community Based Rehabilitation (CBR): Critical perspectives from Latin America. CBM International. Available at: [Accessed Feb 2018].

Hartley S, Finkenflügel H, Kuipers P, Thomas M (2009). Community-based rehabilitation: opportunity and challenge. The Lancet; 374(9704): 1803-1804.

Heinicke-Motsch K (2010). CBR Policy Paper. CBM International. Available at: [Accessed Feb 2018].

Iemmi V, Gibson L, Blanchet K, Kumar KS, Santosh R, Hartley S, Murthy GVS, Vikram P, Weber J, Kuper H (2016). Community-based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review. Campbell Systematic Reviews; 11(15): 368-387.

International Labour Office (ILO), United Nations Educational, Scientific and Cultural Organisation (UNESCO), World Health Organisation (WHO) (2004). CBR: A strategy for rehabilitation, equalisation of opportunities, poverty reduction and social inclusion of people with disabilities: joint position paper. Geneva, Switzerland: World Health Organisation. Available at: [Accessed 5 December 2017].

International Labour Office (ILO) (2008). Skills development through community- based rehabilitation (CBR): a good practice guide. Geneva, Switzerland: ILO. Available at: [Accessed Feb 2018].

Karthikeyan P, Ramalingam K (2014). Physiotherapy training to enhance community-based rehabilitation services in Papua New Guinea: an educational perspective. Disability, CBR and Inclusive Development; 25(1): 82-94.

Kendall E, Muenchberger H, Catalano T, Amsters D, Dorsett P, Cox R (2011). Developing core interprofessional competencies for community rehabilitation practitioners: findings from an Australian study. Journal of Interprofessional Care; 25(2): 145-151. PMid:21182441

Kotbungkair W (2009). Training needs of vocational rehabilitation practitioners in Thailand: An exploratory study. PhD Michigan State University. Available at:

Kuipers P, Cornielje H (2012). Alternative responses to the human resource challenge for CBR. Disability, CBR and Inclusive Development; 23(4): 17-23.

Kyamboga University (n.d.). Faculty of special needs and rehabilitation [Online]. Available at: [Accessed Feb 2018].

Lehmann U (2008). Mid-level health workers: The state of the evidence on programmes, activities, costs and impact on health outcomes: A literature review. Geneva, Switzerland: World Health Organisation. Available at: [Accessed 2 March 2018].

Lehmann U, Sanders D (2007). Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva, Switzerland: World Health Organisation. Available at: [Accessed 2 March 2018].

Lewis Gargett A, Llewellyn G, Short S, Kleinitz P (2016). Identifying Rehabilitation Workforce Strengths, Concerns and Needs: A case study from the Pacific Islands. Disability, CBR and Inclusive Development; 27(2): 19-36.

Lorenzo T, Van Pletzen E, Booyens M (2015). Determining the competences of community based workers for disability-inclusive development in rural areas of South Africa, Botswana and Malawi. Rural and Remote Health; 15(2): 2919. PMid:26048267

Loveday M (2006). The HELP guide for community based rehabilitation workers: a training manual. Seattle, USA: Global HELP. Available at: [Accessed Feb 2018].

Lukersmith S, Hartley S, Kuipers P, Madden R, Llewellyn G, Dune T (2013). Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disability and Rehabilitation; 35(23): 1941-1953. PMid:23574396

MacLachlan M, Mannan H, Mcauliffe E (2011). Staff skills not staff types for community-based rehabilitation. The Lancet; 377(9782): 1988-1989.

Madden RH, Lukersmith S, Millington MJ, Scarf DC, Fortune N, Hartley S, Llewellyn G (2015). Participatory monitoring of community-based rehabilitation and other disability-inclusive development programmes: the development of a manual and menu. Disability, CBR and Inclusive Development; 26(4): 26-52.

Magallona MLM, Datangel JPB (2011). The community based rehabilitation programme of the University of the Philippines Manila, college of allied medical professions. CBR, Disability and Inclusive Development Journal; 22(3): 39-61.

Mannan H, MacLachlan M (2010). Human resources for health: focusing on people with disabilities. The Lancet; 375(9712): 375.

Mannan H, Boostrom C, MacLachlan M, Mcauliffe E, Khasnabis C, Gupta N (2012a). A systematic review of the effectiveness of alternative cadres in community based rehabilitation. Human Resources for Health; 10(20).

Mannan H, MacLachlan M, Mcauliffe E (2012b). The human resources challenge to community based rehabilitation: The need for a scientific, systematic and coordinated global response. Disability, CBR and Inclusive Development; 23(4): 6-16.

McGlade B, Mendoza V (2009). Philippine CBR manual: an inclusive development strategy. Philippines: CBM South East Asia & Pacific Regional Office (SEAPRO). Available at: [Accessed Feb 2018].

M'kumbuzi VRP, Myezwa H (2016). Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review. South African Journal of Physiotherapy; 72(1): 1-8. PMid:30135885. PMCid:PMC6093098

Moran A, Nancarrow SA, Enderby P (2015). Mechanisms to enhance the effectiveness of allied health and social care assistants in community-based rehabilitation services: a qualitative study. Health and Social Care in the Community; 23(4): 389-398. PMid:25475506

Mullan F, Frehywot S (2007). Non-physician clinicians in 47 sub-Saharan African countries. Lancet; 370(9605): 2158-2163.

Naidoo D, Van Wyk J, Joubert RW (2016). Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders. African journal of primary health care & family medicine; 8(1): 1139. PMid:27608672 PMCid:PMC5016716

Narayan J, Reddy PS (2008). Training of Trainers (TOT) programme on intellectual disability for CBR workers. Asia Pacific Disability Rehabilitation Journal; 19(1): 122-130.

O'Dowd J, MacLachlan M, Khasnabis C, Geiser P (2015). Towards a core set of clinical skills for health-related community based rehabilitation in low- and middle- income countries. Disability, CBR and Inclusive Development; 26(3): 5-43.

Okune J (2006). Inside voices: CBR workers' stories. Uganda: CBR Africa Network (CAN). Available at: [Accessed Feb 2018].

Pfaller JS, Tu WM, Morrison B, Chan F, Owens L, Anderson CA, Fitzgerald S, Brooks J, Menz FE (2016). Social-cognitive predictors of readiness to use evidence-based practice: A survey of community-based rehabilitation practitioners. Rehabilitation Counselling Bulletin; 60(1): 7-15.

Pollard N, Sakellario D (2008). Operationalising community participation in community-based rehabilitation: exploring the factors. Disability and Rehabilitation; 30(1): 62-70. PMid:17852288

Raj VSV, Thomas M (2015). Effectiveness of training community-based rehabilitation workers on multiple disabilities: a pilot study. International Journal of Health and Allied Sciences; 4(4): 259-262.

Raja S, Boyce WF, Ramani S, Underhill C (2008). Success indicators for integrating mental health interventions with community-based rehabilitation projects. International Journal of Rehabilitation Research; 31(4): 284-292. PMid:19008676

Rule S (2013). Training CBR personnel in South Africa to contribute to the empowerment of persons with disabilities. Disability, CBR and Inclusive Development; 24(2): 6-21.

Rule S, Kahonde C, Lorenzo T (2015). "When I grow up I would like to be ...": Factors affecting career choice of community disability workers in Southern Africa. International Journal of Disability, Development and Education; 62(5): 486-500.

Rule S, Lorenzo T, Wolmarans M (2006). Community-based rehabilitation: New challenges. In: Watermeyer B (Ed.) Disability and social change: A South African agenda. Cape Town, South Africa: HSRC Press: 273-290.

Shamrock J (2009). Evaluation of a pilot community based rehabilitation training programme in East Timor. Asia Pacific Disability Rehabilitation Journal; 20(2): 17-31.

Sharma M (2007a). Community participation in community-based rehabilitation programmes. Asia Pacific Disability Rehabilitation Journal; 18(2): 146-157.

Sharma M (2007b). Evaluation in community based rehabilitation programmes: a strengths, weaknesses, opportunities and threats analysis. Asia Pacific Disability Rehabilitation Journal; 18(1): 46-62.

Taylor-Ritzler T, Balcazar F, Dimpfl S, Suarez-Balcazar Y, Willis C, Schiff R (2008). Cultural competence training with organisations serving people with disabilities from diverse cultural backgrounds. Journal of Vocational Rehabilitation; 29(2): 77-91.

Van Pletzen E, Booyens M, Lorenzo T (2014). An exploratory analysis of community-based disability workers' potential to alleviate poverty and promote social inclusion of people with disabilities in three Southern African countries. Disability and Society; 29(10): 1524-1539.

Weber J, Polack S, Hartley S (2016). An online survey on identification of evaluation capacity, needs and current practice of programme evaluation in community-based rehabilitation. Disability, CBR and Inclusive Development; 27(2): 5-18.

WCPT (n.d.). World Confederation for Physical Therapy. WCPT. Available at: [Accessed March 6 2018].

WFOT (n.d.). World Federation of Occupational Therapists. WFOT. Available at: [Accessed March 6 2018].

World Health Organisation (n.d.). Community-based rehabilitation (CBR)[Online]. Available at: [Accessed Feb 2018].

World Health Organisation (n.d.). INCLUDE: A Community-based rehabilitation (CBR) learning community [Online]. Available at: [Accessed Feb 2018].

World Health Organisation (2010). Community-based rehabilitation: CBR guidelines. Geneva, Switzerland. [Accessed Feb 2018].

World Health Organisation (2011). World report on disability. Geneva, Switzerland. [Accessed Feb 2018].

Yeap CE, Ibrahim H, Vandort S, Ahmad K, Yasin MS (2017). CBR workers' training needs for people with communication disability. Disability, CBR and Inclusive Development; 27(4): 37-54.

Yeung E, Balogh R, Cole D, Jakovic D, Landry MD (2011). Internet use among community-based rehabilitation workers in Bosnia and Herzegovina: A cross-sectional survey. Physiotherapy Canada; 63(4): 445-452.


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