Contributions in Early Intervention Programs: The Case of Vision Community-Based Rehabilitation Association in Ambo, Ethiopia

Abstract

The purpose of this study was to explore the contributions of the vision community-based rehabilitation association (VCBRA) in early intervention programs in Ambo, Ethiopia. In this case study, a total of 18 respondents, consisting of the VCBRAs’ staff, such as the program director, the manager, social workers, beneficiaries, and participants from partners’ institutions, such as Ambo branch organizations of persons with disabilities, Ambo University, Ambo town social affairs office, were participated in the study as sources of data. Data were collected through document analysis, interview, and close-ended questionnaire. The quantitative data were analyzed using descriptive statistics, such as frequency, percentage, and mean. In addition, data from document analysis and interviews were analyzed thematically and supplemented by narrative descriptions and verbatim quotations. The effectiveness of VCBRA intervention programs were assessed using a CBR matrix, and the finding uncovered that VCBRA intervention programs were found to be effective in general. Specifically, VCBRA seems to be more effective in the three intervention areas, such as health, education, and livelihood components, while empowerment and social components of rehabilitation programs were less focused. In addition, children and youths with different disabilities, parents of children with disabilities, and poor families were beneficiaries of VCBRA intervention programs. Further, lack of trained and diversified staff, lack of financial resources, low parent involvements, and the negative impact of COVID-19 were identified as the main challenges hindering the implementation of early intervention programs provided by the VCBRA.

1. Introduction

The World Disability Report estimates that there are over one billion people with disabilities in the world, of which 110–190 million experience very significant difficulties, and amongst them 80% of persons with disabilities live in low- and middle-income countries [1]. In Ethiopia, it is estimated that 17.6% of the Ethiopian population has a disability [1].

Ethiopia has ratified and adopted almost all of the relevant initiatives and international legal documents on the rights of persons with disabilities, including the UN Convention on the Rights of Persons with Disabilities [2]. The Convention in its article 26 states that comprehensive rehabilitation services, including health, employment, education, and social services are needed “to enable people with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.” ([2] article 26).

Accordingly, supporting children with disabilities at an early age is paramount. Early intervention is a range of all necessary interventions social, medical, psychological, and educational targeted toward children and their families, to meet the special needs of children who show or risk some degree of delay in development (Karanth et al., n.d.). Evidence indicates that two-thirds of the young children who need early intervention programs are yet marginalized and underserved.

The responsibility for improving the situation of children with disabilities lies not only on the government but also requires the engagement of civil society, including the private sector and the general public [3]. In relation to this, different governmental and non-governmental organizations have been working to ameliorate the situation of PWDs in Ethiopia [4]. Specifically, non-governmental organizations (NGOs) play a critical role, along with the government, in the design of early intervention programs that create a foundation for providing support for children, their caregivers, and the community.

In the Ethiopian context, plan international and save the children were amongst the organizations that are widely involved in early intervention programs (Belay H. and Belay T., 2016). But, most of the interventions made in developing countries, such as Ethiopia, are uncoordinated and do not adequately involve the community in rehabilitation activities [4]. Besides, it was reported that children with disabilities are excluded from education, health, employment, and other aspects of society, and that this can potentially lead to or exacerbate poverty and there is a need for stronger evidence base on the efficacy and effectiveness of CBR programs [1].

Likewise, studies in Ethiopia reported that the majority of the children with disabilities have not yet been reached by rehabilitation service providers and their access to basic services remains limited and concentrated in urban areas [3] and mostly located in the capital city, Addis Ababa, at Paulos specialized hospital, and in a number of major towns, such as Mekele, Hawassa, Arba Minch, Dire Dawa, and Jimma [4]. Therefore, these centers cannot serve children with disabilities who live far away from the service deliverers.

As a result, among millions of children with various degrees of disabilities in Ethiopia, only a few are beneficiaries of intervention services and the traditional approach has been predominantly applied in delivering rehabilitation services in Ethiopia [4].

Thus, there is still a great need to work for the full inclusion of children with disabilities in all aspects of society [3]. The lack of comprehensive research-based data on the access, practice, and challenges at the national level in Ethiopia makes it impossible to understand to what extent CBR is an effective strategy [4]. Hence, the engagements of civic society in the provision of early intervention programs need to be investigated in Ethiopia [5]. To this end, this study was aimed at assessing the effectiveness of on-going early intervention programs by VCBRA under operation in Ambo, Ethiopia.

Many organizations and stakeholders have been involved in early intervention programs and practices in Ethiopia [5]. However, the practice, strengths, and opportunities of early intervention programs functioning, particularly found in the community have not been explored sufficiently in Ethiopia [5]. As a result, there is a lack of reliable data and statistics about disability and intervention practices in the country [3].

VCBRA is one of the disability service providing NGOs in Ethiopia. It is responsible for providing technical guidance, delivery of services, and support for PWD in collaboration with the government and organizations of persons with disabilities (OPDs) [3]. Recognizing the challenges people with disabilities are facing in west Shewa Zone in Ethiopia, the vision community-based rehabilitation association (VCBRA) was established in 2006, and licensed to provide rehabilitation services for people with disabilities (PWDs). VCBRA used community-based rehabilitation (CBR) as the main strategy to address the needs of people with disabilities. The association provides early intervention programs for children below 15 years of age and works by mainly focusing on the four components of CBR: health, education, livelihood, and social, to offer comprehensive rehabilitation services. VCBRA has been operating in Oromia regional state and provided a wide range of rehabilitation services to people with disabilities in Ambo and the surrounding areas.

However, the VCBRA’s current practices, status, success scenario, and challenges in implementing early intervention programs need to be researched and communicated to the scientific community. Accordingly, this study aimed at investigating the ongoing early intervention programs provided by VCBRA in Ethiopia.

The following basic research questions guided the investigation:

• To what extent are the VCBRA’s intervention programs effective?

• What are the challenges in VCBRA’s intervention programs?

This study has both theoretical and practical contributions for intervention programs in Ethiopia and other similar contexts. It attempts at filling the literature and research gap in the current practice, components, and challenges of intervention programs, as well as contribute to the enrichment of the body of knowledge in the area. In addition, this study is significant to solve current problems related to the early intervention by assessing VCBRA’s strengths and challenges and suggesting some practicable recommendations for improving the intervention quality of the association.

2. Methods

The study area, Ambo, is located in the Oromia regional state in Ethiopia, 110 km west of Addis Ababa (Finfinne), the capital city. The town has a latitude and longitude of 8°59′N 37°51′E and an elevation of 2101 meters. Ambo is a center for institutions, such as the Ethiopian Institute of Agricultural Research, Ambo University, Rift Valley University, Ambo Mineral Water, and several NGOs, including VCBRA. VCBRA was established in Ambo town and provides intervention services to the surrounding areas, such as Guder, Woliso Tiulubollo, Dillella, and Goro towns.

To assess the nature of VCBRA’s early intervention programs, a case study design was employed, to investigate the institution-bounded issue (VCBRA), through detailed data collection that involved multiple sources of information (e.g., questionnaires, interviews, and documents). Quantitative and qualitative data were collected simultaneously to analyze, merge and use the results of both. A basic rationale for this design was that one data collection form supplies strengths to offset the weaknesses of the other form and that a more complete understanding of a research problem results from collecting both quantitative and qualitative data [6].

This study attempted to assess the early intervention programs being delivered by VCBRA in Ambo and the surrounding areas. A total of 18 participants were selected purposively based on their collaborations and experiences with VCBRA early intervention programs in Ambo town. More specifically, seven (39%) participants were VCBRA staff members, including executive director and founder, program manager, two field workers, a workshop worker, and two supervisors. On the other hand, about 11 (61 %) of the respondents were recruited from partner institutions currently working with VCBRA, such as two beneficiaries, one Ambo town labor and social affairs office expert, two experts from Ambo town education office, two leaders and one teacher from primary schools, one representative of Ambo branch organization of persons with disabilities (OPD), and two staff of Ambo University.

Besides, from the total participants, seven(39%) were female, 11 (61%) were male, and the majority of the respondents have work experience ranging from 6 to 26 years. Further, regarding participants’ educational background, nine(50%) of them were second-degree holders, while five(27.8%), three(16.7%), and one(5.6%) were first-degree, diploma, and primary school certificate holders, respectively.

A questionnaire, document analysis, and interview were employed to collect data. All sample participants filled a closed-ended questionnaire in which four items were designed to collect participants’ background data, 25 closed-ended items were prepared with three points rating scale: 3-agree, 2-not sure, and 1-disagree, and employed to collect data on the type and effectiveness of VCBRA’s early intervention programs. In addition, documents, such as VCBRA plans and reports, internal and external evaluation reports from 2019/20 to 2021/22, and photo gallery methods. Finally, interviews conducted with the VCBRA director, program manager, and beneficiaries were used as data sources.

The study used both quantitative and qualitative methods of data analysis based on the CBR matrix developed by ILO, UNESCO & WHO [7]. The quantitative data were analyzed with descriptive statistics, such as frequencies, percentages, and means. In addition, data from document analysis and interviews were analyzed thematically and supplemented by narrative description and verbatim.

The CBR matrix provides a structured overview of thematic areas (health and education), life conditions (livelihood and social), and political strategies to improve the situation (empowerment). The CBR guidelines aim to connect the different areas and to show the direction toward inclusive development [4]. The CBR matrix (Table 1) provides a basic framework for CBR programs. It highlights the need to target intervention in different aspects of life, including the five key components: health, education, livelihood, social, and empowerment. Each component includes five elements where the different activities are listed. A CBR program is formed by one or more activities in one or more of the five components. Thus, a CBR program is not expected to implement every component of the CBR matrix, and not all people with disabilities require assistance in each component of the matrix [9].

Health	Education	Livelihood	Social	Empowerment
Promotion	Early childhood	Skills development	Personnel assistance	Advocacy and communication
Prevention	Primary	Self-employment	Relationships, marriage, and family	Community mobilization
Medical care	Secondary and higher	Wage employment	Culture and arts	Political participation
Rehabilitation	Non-formal	Financial support	Recreation, leisure, and sports	Self-help groups
Assistive devices	Lifelong learning	Social protection	Justice	Disabled people’s organization

Table 1.

CBR matrix.

Note: From [8].

The five components of CBR matrix are: health, education, livelihood, social, and empowerment. Table 1 shows the components of the matrix along with its element:

The way in which CBR might work varies depending on the targets of specific components included in the program are: health, education, livelihood, social, and empowerment.

Therefore, VCBRA’s intervention programs were assessed by using the CBR matrix depicted inFigure 1 [9] as a conceptual framework. The overall approach includes a focus on including people with disabilities in existing services, as well as creating new interventions, specifically considering people with disabilities and their families.

Figure 1.

Conceptual framework of CBR programs for PWDs. Adapted from ([7], Figure 3, p. 4).

Respondents agreed to participate in the study with a clear understanding of the purpose of the study, the type of information required, and their roles and rights in the study process. In addition, an agreement was made with the study participants not to misuse the results of the study and to provide them with access to the research findings.

3. Results and discussion

In this section, the results and discussion sections are combined “for not separating the finding from its interpreted meaning” within this research context ([10], p. 169). Results from the quantitative strand are presented first followed by the data from document analysis and interview. Respondents’ views of disagreement are compiled together to reveal the low performance of VCBRA in early intervention program provision. On the other hand, respondents’ views of the agreement are compiled together to indicate VCBRA’s high level of performance in the provision of an early intervention program. The analyses are arranged under four themes: background of VCBRA, intervention type and beneficiaries (health, education, social, empowerment, and livelihood), the effectiveness of intervention programs, and challenges faced.

3.1 Background of VCBRA

The data obtained from document analysis indicated that VCBRA is a non-profit, non-partisan association that was initiated in 2005 and registered by the Federal Democratic Republic of Ethiopia Charities and Societies Agency under law No 0263. It was established in 2006 and licensed for three years as an Ethiopian Resident Charity (indigenous) NGO in accordance with Charities and Societies Proclamation No 621/2009. It was re-registered as the Ethiopian Resident Charity Organization in 2009 to help persons with different disabilities. VCBRA was established by a person without disability (current executive director) based on his commitment to improve the lives of persons with disabilities.

VCBRA has the vision to see disadvantaged people free from experiencing major life challenges and the mission to prevent disability and ensure meaningful involvement of people with disabilities in the development endeavors of the country.

VCBRA operates in Oromia regional state, west and south west Shewa Zones, Ethiopia. It has two branches; the main branch is located at Ambo town and the sub-branch is located at Woliso town. The association has different offices with full equipment, indoor and outdoor therapy centers, and a mini-workshop that produces assistive devices for people with disabilities. Further, it has internet, transportation, and health insurance services for all its staff members.

From interviews conducted with the manager it was noted that the association runs different activities in Ambo, Guder, Waliso towns, and adjacent areas of Ambo town. In addition, the manager explained that VCBRA has different permanent and contract staff members, including physiotherapists, nurses, and social workers. In addition, data from the document review depicts that some of the VCBRA staff members have an educational background in such fields of study as psychology, development study, business administration, management, and ICT. By reviewing VCBRA’s staff profile it was ascertained that the association did not have workers with special needs and inclusive education background. However, the director of the association during the interview revealed that some of the employees have taken training in special needs and inclusive education organized by the Ministry of Education, CBR Network Ethiopia, and Ethiopian Center for Disability and Development (ECDD). The major donors for VCBRA are Light for the World, Rehabilitation International, and Cittadinanza Onlus of Italy.

3.2 Intervention types and beneficiaries of VCBRA

The UNCRPWDs state that comprehensive rehabilitation services for PWDs should include health, employment, education, and social services to enable PWD to maintain maximum independence, full physical, mental, social, vocational ability, and full inclusion participation in all aspects of life [2]. Accordingly, the intervention programs carried out by VCBRA in the west and south west Shoa Zone of the Oromia region are presented based on the CBR matrix, as follows: health, education, social, empowerment, and livelihood.

3.3 Health

The health component of the matrix aims for people with disabilities to achieve their highest attainable standard of health. It includes health promotion, prevention of impairment or illness, medical care provision, rehabilitation, and provision of assistive devices [8]. This is in line with the United Nations Convention on the Rights of Persons with Disabilities (CRPD) Article 25 which addresses the right to health for people with disabilities [2].

Participants of the study were requested to assess the extent to which VCBRA’s health intervention programs are effective. The observed mean score for “health intervention” was found to be 2.4, which becomes greater than the expected mean of two, which indicates VCBRA’s health intervention programs are effective (Table 2).

In delivering health intervention, VCBRA’	N	Mean
Collaboration with health services providers	18	2.28
Educating the local community on nutrition, sanitation, eye health, disability prevention	18	2.06
Referring clients to health services	18	2.67
Provision of training to clients in its rehabilitation center	18	2.5
Provision assistive devices for children with disabilities	18	2.56
Grand Mean		2.414

Table 2.

Health component.

Early Identification and Referral Services: Identification and admission of children with disability are the primary activities of the schools to realize their education. Regarding this idea, the Ethiopian Ministry of Education ensures that screening and assessment tools are prepared at the national level and used to identify children with disability in the schools [11].

In relation to the health component, VCBRA has been working to meet the health needs of PWDs.

The annual report of the VCBRA, (2019/20 and 2021/22) shows that in 2019/20, 425 and 2021/22, 584 children with disabilities were identified and benefited from rehabilitation services under the VCBRA project catchment area.

The same report reveals that VCBRA has established effective referral systems with general and specialized medical care services at governmental and non-governmental hospitals. In 2019/2020, more than 547 and in 2021, 199 children, youths, and adults with disabilities were referred to St. Luke, Cure, and Ambo hospitals and to other similar rehabilitation centers to get access to a wide range of rehabilitation services such as medical treatment, corrective surgery, and provision of assistive devices (VCBRA Annual Report, 2019/20 and 2021/22).

One of the VCBRA management members confirmed during an interview that “in the provision of referral services … VCBRA covers the coast of general and specialized medical care services for people with disabilities in collaboration with governmental and non-governmental hospitals while in some hospitals they are served free of charge and/or half payment.” This indicates great achievement attained by VCBRA in providing referral services for children with disabilities. VCBRA conducted a disability-specific baseline survey to determine the status of disability in Ambo town, Woliso town, and surrounding areas. Accordingly, 3,686 persons with disabilities were identified to have various rehabilitation services (Annual report, 2021/22).

Regarding the referral service, the director took as an example ten years old boy, with a club foot on his left leg, who was treated through the referral system and brought to normalcy. The director mentioned that, currently, the child is attending primary school (Figure 2).

Figure 2.

Boy with clubfoot before and after the intervention. (a) before getting intervention, and (b) after getting intervention under referral by VCBRA.

Home Based Rehabilitation: According to the annual reports of the VCBRA (2019/20), 361 and (2021/22) 294 children with disabilities were benefited from home-based rehabilitation services. The report reveals that various exercises and therapies for the hand, leg, and head; daily living activities for children with intellectual disability, mobility training and orientation for blind children basic sign language and Braille literacy skills, psycho-social support, medical follow-up, and awareness-raising programs are among the major activities performed through the home-based rehabilitation programs to improve the children’s functionality to join the school. This is in line with the recommendation by UNCRPD, which states that comprehensive rehabilitation services may be preferred to isolated interventions for persons with disabilities [2].

Data from interviewed parent-beneficiary revealed that “VCBRA’s field workers make a follow-up program once in two months to check the children’s situation and provide technical support for families as needed”. Similarly, the manager disclosed that “The duration of home-to-home intervention may take from 4 months to 4 years and VCBRA’s field workers visit 1-4 times in a week depending on the nature and intensity of the child problem.”

VCBRA Rehabilitation Center: VCBRA rehabilitation center is located in Ambo town to provide medical and rehabilitation services to children with cerebral palsy, developmental delay, and clubfeet, people who have a stroke and spinal cord injury, and people with a wide range of disabilities (VCBRA Annual Report, 2021/22) (Figure 3).

Figure 3.

(a) VCBRA’s institution based physiotherapy out of the room, and (b) VCBRA’s institution based physiotherapy in the room.

Awareness raising activities: In order to create awareness on disability, VCBRA used multiple strategies, such as community sensitization programs on disability during coffee ceremony, organizing disability awareness clubs at schools, child-to-child programs, such as telling oral traditions on disabilities, and song, community conversation programs at the community meeting and at Idir, and celebration of international day of PwDs with the office of social affairs and Ambo University (VCBRA annual report, 2021/22). Further, the annual report of the association (2019/20) showed that training has been conducted for 13 CBR workers on assisting children with disabilities at home-based and center-based rehabilitation services.

The International Disability Day was celebrated with the aim of increasing awareness of disability and promoting an inclusive environment. The International Day of Persons with Disabilities was celebrated in Woliso and Ambo towns as the Oromia region is celebrating the day for the 20th time (VCBRA annual report, 2021/22) (Figure 4).

Figure 4.

Awareness raising workshop on Disability: VCBRA in collaboration with Ambo University.

According to the VCBRA report, 150 awareness-raising sessions were conducted in the community. In reference to the report, in 2019/20, around 11283 individuals (4198 male and 7085 female) and in (2021/22) 8981 persons (3697 male and 5284 female) were benefited from these sessions. Similarly, the manager reported that the awareness-raising sessions were organized within families of children with disability, at schools, at health centers, and other places where there are public gatherings mainly focusing on the topics chosen by the community members.

VCBRA also conducted awareness-raising activities on the prevention of COVID-19 and adhere to health measures to stop the pandemic’s spread. Proper use of mask, hand washing, use of hand sanitizer, and maintaining social distancing was among the topics communicated (VCBRA Annual Report, 2021/22). The interview with director indicates as VCBRA is working by giving priority to promoting both center-based and community-based rehabilitation services, inclusive education, and social inclusion interventions for PWD in Oromia region, Ethiopia.

Further, parents of children with disabilities are key rehabilitation actors to bring change to the disability situations of their children with disability. In relation to this, the manager stated that “Though parent’s role is significant, there is a high knowledge gap on rehabilitation skills, particularly with those who have a child with severe disabilities.” To fill this gap VCBRA has organized training for 60 parents of children with disabilities on disability management and rehabilitation skill (Annual Report of VCBRA, 2019/20). A manager reported that “At this time some parents are supporting their children with disability and they are taking part in the rehabilitation process of their kids.”

3.4 Education

The education component of the matrix has a goal to provide access to education and lifelong for people with disabilities, leading to the fulfillment of their potential, a sense of dignity and self-worth, and effective participation in society. It includes formal and non-formal education as well as life-long learning [12].

Participants were requested to assess the extent to which VCBRA’s education intervention programs are effective. The observed mean score for “education intervention” was found to be 2.4 that is greater than the expected mean of 2. This indicates that VCBRA’s education intervention programs are effective in the study area (Table 3).

In delivering intervention for education, VCBRA	N	Mean
provision of training for caregivers on early childhood intervention	18	1.94
advocating the children’s rights to education	18	2.78
delivering awareness-raising training on inclusive education	18	2.72
provision of home-based learning to children	18	2.56
motivate adults to continue learning through sharing information	18	1.78
Grand Mean		2.356

Table 3.

Education component.

VCBRA as an association, is dealing with children and youth with disabilities following CBR as a strategy and promote educational opportunities for children with disabilities. Educational materials supported were to children with disabilities, including exercise books, pen and pencil, facemask, sanitizer, and school uniforms Ambo Awaro, and Addisketema schools. One of the association management noted that “The education materials provided by VCBRA helped the students with disabilities to remain in the school and continue their education.”

Similarly, VCBRA’s director and program manager indicated that the main strategy to bring children with disability to school is through home-to-home visitation. They also explained that the coffee ceremony and community meetings have helped them to get an opportunity to discuss with the community and to create awareness about the causes of disability and the right to education for all (Figure 4).

Figure 5.

(a) Boy writing by leg, and (b) Self–feed by the leg.

Further, the manager mentioned, “Following the awareness raising program, the association starts to give educational support at home, center and school level according to the degree and type of disabilities.”

As displayed in the Figure 5a and b below, these boys have amputations in both hands. During the interview, the program manager indicates (Figure 6):

Figure 6.

A special class organized for children with intellectual disabilities by VCBRA.

Because of VCBRA interventions of training and physiotherapy, two boys are able to write, dress themselves, eat and drink using their toes. These children joined the surrounding primary schools and started to learn along with their peers. In addition, VCBRA provided a special chair prepared in its workshop so that they can use adapted chairs at home and in the classroom.

Intellectual disability: According to the data obtained from the manager during the interview, “children with intellectual disability were identified by VCBRA and a special classroom was organized for children with intellectual disabilities in Awaro primary school in collaboration with Ambo town education officers.”

Figure 6 illustrates the educational intervention provided for the boy in the early intervention program.

Capacity Development: According to VCBRA’s annual report document (2021/22), the training has been given to several participants, such as VCBRA staff, teachers in primary and secondary school, social workers, and community members on different topics: disability, child rights, and inclusive education; sign language, and rehabilitation skills. Specifically, the annual report, (2019/20) indicates the training organized at different times on the topic of inclusive education for 30 primary school teachers. Further, one of the parent beneficiaries reported that “the association provides training and appropriate devices for their children with disabilities before bringing their children to school.”

Inclusive Resource Center: Establishing an inclusive resource center is a key to enhance the education of children with disabilities in schools. Ministry of Education of Ethiopia stated in its ESDP VI to “strengthen and expand inclusive education resource centers.” ([13], p. 89). In line with this, the VCBRA report (2019/20) showed that various materials and equipment have been purchased to the strengthened inclusive resource center and support of children with disability in selected primary schools of Ambo town. The center is equipped with the materials like computers, television, sign language books, audio, play, practical, pictorial, and other educational materials (VCBRA Annual Report, 2019/20) (Figure 7).

Figure 7.

Disability resource center established by VCBRA.

Accessibility of the School Environment: The data obtained from the interview noted that VCBRA worked a lot to make educational environments accessible to children with disabilities. The participant notified as an example, “the dormitory, playground, ramps and toilets were adapted by VCBRA for students with disabilities in Ambo University.” Similarly, figure taken from a photo gallery showed that walkways were built in some primary schools so that wheelchair users and other people with disabilities can move around in the school compound (Figure 8).

Figure 8.

Ramps were built in primary schools.

Thus, based on the presented data above, this result is supporting the Ethiopian building proclamation no 624/2009, Article 36 that states the design and construction of public buildings should be accessible for people with disability [14].

Provision of Assistive Materials: Data from the document review annual report (2019/20) revealed that different assistive materials are purchased (Figure 9a) or were prepared in VCBRA’s mini workshop (Figure 9b) and provided to children with disabilities. The same document reported that in collaborations with other rehabilitation centers, VCBRA has purchased materials like treatment beds, therapy materials, various exercise tools, small therapy machines, stimulation, and play equipment that are important for establishing a rehabilitation center at Ambo town.

Figure 9.

(a) The adapted chair produced in the VCBRA workshop, and (b) VCBRA purchased a special wheelchair for a child.

In addition, VCBRA provided different supportive devices, such as optic glasses (spectacles), hearing aids, orthopedic shoes, crutches, wheelchairs, special chairs, artificial legs, walking frames, toilet chairs, guide canes, hand blocks and to children with disabilities in the community (VCBRA Annual Report, 2019/20). Similarly, the selected photos from the collection showed that several materials have been produced in VCBRA mini workshop and provided to the local community to support children with physical disabilities. For instance, children with physical disabilities who have moving difficulty access assistive chairs from VCBRA (Figure 9a).

Further, VCBRA has been providing educational material support to integrate children with disabilities in schools. For instance, school uniform, Braille paper, slate, stylus, sign language books, and voice recorder have been provided to special classes found in Woliso Liban, Ambo Awaro, and Addis Ketema primary schools (Annual Report, 2021/22).

The data gained from document analyzes showed that VCBRA distributed more than 30,000 washable and reusable face masks for nearly 14,500 students with disabilities in five regions of the country, such as Addis Ababa, Oromia, Amhara, and Sidama in order to protect the expansion of COVID-19 (Annual Report of 2021/22).

3.5 Livelihood

Livelihood is one of the five vital components of the CBR strategy in which people with disabilities can earn enough income to lead dignified lives and contribute economically to their families and communities that include skills development, self-employment, wage employment, financial services, and social protection [15].

In relation to this study, participants were requested to assess the extent VCBRA’s livelihood intervention programs are effective. The observed mean score for “livelihood intervention” was found to be 2.4 that is greater than the expected mean 2. This indicates that VCBRA’s livelihood intervention programs are effective in the study area (Table 4).

In the Livelihood intervention delivery, VCBRA	N	Mean
facilitation of vocational skills training for marginalized groups	18	2.56
supporting marginalized groups to start up their business	18	2.67
linking marginalized groups to micro business to get a loan for their business	18	2.5
advocating for employers to give job opportunities for PWD	18	1.61
advocating to improve the lives of children with disabilities	18	2.67
Grand Mean		2.402

Table 4.

Livelihood component.

In the livelihood domain, the CBR services provided in VCBRA focus on providing financial services, skill development, and self-empowerment services by establishing micro-finance enterprises. Specifically, for purpose of economic empowerment of PWDs, VCBRA recruited and established a group of children with disabilities and their families who have an interest in being a member of the saving and lending association in their local areas (Annual Report, 2021/22).

In relation to this, the VCBRA manager noted through his interview that PWD was trained in different activities to improve their livelihoods. He said, “VCBRA facilitate vocational training for the individual with a disability in Ambo technical and vocational training centers to help them get training on wood and metal works, salon, shopping, tailoring, decoration, and ICT skills.” After the training, VCBRA provided PWD with the starting capital or seed money for PWD to organize into groups to help them start up their business. Further, VCBRA link PWD with existing microfinance institutions to make them active in the system and as a result more than 16 parents of CWDs and 61 children with disabilities benefited from the services (Annual Report of VCBRA, 2021/22).

On the hand, VCBRA in collaboration with Ambo University, provides economic support for children with physical disabilities. The university donated a cow of foreign Creole with a calf. This cow gives about 15 liters per day. The boy got enough milk to drink and rent the excess. His family earns money from milk rent and improved economically. These are the livelihood and social components that endeavored for this boy, said the program manager and one of the social workers of VCBRA (Figure 10). This boy is now happy and said that “Thanks to God and to those who saw me and treated me well, my legs serve me both as legs and hands” (Figure 5).

Figure 10.

The gift to the boy by Ambo University President in collaboration with VCBRA.

3.6 Empowerment

The empowerment component of the matrix is a cross-cutting theme of the CBR program with the goal to allow people with disabilities to make their own decisions and take responsibility for changing their lives. It includes advocacy, political participation, establishing self-help groups and organizations for peoples with disabilities, and claiming their right to equity, justice, and inclusion in society [16].

To this end, the study participants were requested to assess the extent to which VCBRA’s empowerment intervention programs are effective. The observed mean score for “empowerment intervention” was found to be 2 that is equal to the expected mean 2. This indicates that participants were not sure about the effectiveness of VCBRA’s empowerment intervention programs (Table 5).

In delivering empowerment intervention, VCBRA …	N	Mean
deliver counseling services for PWD	18	1.78
giving training to family members on how to support PWD	18	2.17
encouraging PWD to participate in social activities	18	2.33
organizing inclusive sports activities	18	2
supporting PWD to access legal assistance service	18	1.83
Grand Mean		2.022

Table 5.

Empowerment component.

On the other hand, VCBRA establishes networking between disability organizations and governmental bureaus, such as health bureau, social affairs bureau, and women and children issue bureau, in Ambo town (Annual Report, 2021/22). In addition, the VCBRA’s annual report document (2021/22) the most effective way to change community attitudes toward people with disabilities, should focus on the training and empowerment of PWD. Similarly, the report indicates that VCBRA organized the training for 27 PWD selected from the organization of persons with disabilities (Annual Report, 2019/20).

3.7 Social

The social component aims for people with disabilities to have meaningful social roles and responsibilities in their families and communities, and be treated as equal members of society. Hence, children with disabilities have a right to participate in the community’s culture, religion, art, sport, recreation, and access to justice [17].

Accordingly, the study participants were requested to assess the extent to which VCBRA’s social intervention programs are effective. The observed mean score for ‘Social intervention’ was found to be 2.4 that is greater than the expected mean 2. This indicates that VCBRA’s social intervention programs seem to be effective (Table 6).

In delivering the social intervention, VCBRA …	N	Mean
provide training on communication skills for PWDs	18	2.28
encourage PWD to participate in the social issue	18	2.22
provide training to develop self-help skills for needy group	18	2.72
mobilize resources to empower PWDs	18	2.28
build the capacity of district disabled people’s organizations (DPOs)	18	2.56
Grand Mean		2.412

Table 6.

Social component.

This finding is similar to the findings from the picture collection. Accordingly, VCBRA worked only on inclusive sports (Source: photo collection of VCBRA) (Figure 11).

Figure 11.

Inclusive sport.

This depicts the inclusive sport in which boys with physical disabilities play football with children without physical disabilities. From this figure, it is possible to observe that VCBRA is working to improve the situation of children with disabilities to have meaningful social participation in sports activities in the community.

3.8 Challenges of VCBRA’s intervention programs

By reviewing relevant documents of VCBRA and data gained from the interview, the major challenges encountered during the VCBRA’s early intervention programs were identified and presented as follows. Some of the major challenges include:

Lack of coordination among stakeholders: There was weak partner institutional among different stakeholders, which resulted in program postponements and delays (Annual Report, 2021/22). The manager highlighted in his interview that coordination amongst stakeholders presented one of the critical challenges for early intervention programs. Governmental offices of the concerned body are not supportive as expected and some of them are reluctant to work for effective early intervention. On the other hand, literature depicted that organizations of person with disability have the roles in promoting the education of children with disability, for example, by “encouraging parents to send their children to school and become involved in their children’s education, providing role models, and campaigning for inclusive education.” ([1], p. 125)

Lack of professional staff: Staff noted that one of the biggest challenges faced in the early intervention program had been the absence of trained and professionally diversified staff (Annual Report, 2021/22). The manager reported the low capacity of parents, teachers, and school staff to screen children with disabilities and implement early intervention programs were also identified as the major challenges.

Budget constraints: The annual report stated that due to the lack of budget constraints, VCBRA was not able to address the needs of a large number of children with disabilities migrating from rural areas to the towns. For example, assistive devices are a major unfilled gap in Ethiopia (Annual Report, 2019/21). This finding is consistent with the research report indicating that the intervention program was highly dependent on external funds [18].

Low involvements of parents: The duration of the intervention depends on the type, intensity of the problem, and parents’ involvement level. The manager notified that some parents are reluctant to play their role and make the intervention program ineffective. This is one of the challenges field workers encountered and forced to stop intervention. He contended that “parents … rather than playing their role as they sign agreement with VCBRA to deal with intervention programs, some parents wait for payable money from VCBRA in order to provide support service for their own children.” This finding is not similar to the roles of parents identified by the World Report on Disability (2011) [1] serving as the first source of information for a child and creating educational opportunities for their children at home.

COVID-19 as a challenge: Finally, the various challenges and restrictions resulting from the COVID-19 pandemic negatively impacted and reduced the VCBRA’s intervention program activities (said the Director).

In relation to this, all the above, identified challenges were consistent with the challenges of intervention programs reported by MOLSA [3], such as limited number of community-based rehabilitation programs, inadequate or nonexistent specialized medical rehabilitation services, and lack of availability of affordable assistive aids and devices.

4. Conclusion

The effectiveness of VCBRA intervention programs was assessed using the CBR matrix. It is possible to conclude that VCBRA worked mainly on three components of CBR: health, education, and livelihood components of rehabilitation services intervention programs for children with disability. The health, education, and livelihood components gained high emphasis from VCBRA, while empowerment and social components of rehabilitation programs were less focused. In addition, children and youths with different disabilities, parents of children with disabilities, poor families, employees of the association, and the community at large are beneficiaries of VCBRA intervention programs.

VCBRA has faced challenges, such as lack of trained and diversified staff, lack of financial resources, low parent involvement, and the negative impact of COVID-19, were identified as the main challenges hindering the implementation of early intervention programs provided by the association.

5. Implications

Early intervention is essential, cost-effective, and more successful if it is done at the early years for children with disabilities. In the early intervention program it is better to focus on the child’s abilities (what he/she can) rather than the child’s disabilities (what he/she can’t). The interventions by VCBRA were focusing on emphasizing the child’s ability than disability. For more achievements, VCBRA shall work to employ skilled and professionally diverse staff to provide comprehensive services. There should be a strategy to increase the involvement and collaborations with parents and other stakeholders, search for more financial resources, and strengthen the identification and support centers for children with various disabilities. Moreover, VCBRA should work more on its coverage and expansion of the rehabilitation services throughout the region and at the national level in order to address a large number of marginalized children in the community through early intervention programs. Finally, there is a need to improve, expand and standardize the CBR services [3].