Community-Based Rehabilitation in Developing Regions: Access, Effectiveness, and a Capability-Centred Agenda for Inclusive Practice

Abstract

Community-based rehabilitation (CBR) remains the principal strategy through which low- and middle-income countries attempt to close the gap between the scale of rehabilitation need and the reach of formal health systems. Yet more than four decades after its introduction, the evidence on what CBR achieves, for whom, and under what conditions is still uneven, and much of the debate proceeds without a clear normative account of what rehabilitation is ultimately for. This paper offers an interdisciplinary synthesis. Drawing on published evaluations, systematic reviews, and recent programme reports from sub-Saharan Africa, South Asia, and Latin America, we examine patterns of access, documented effectiveness, and recurring barriers to CBR in developing regions. We then propose an integrated analytical framework that joins a sociological reading of structural exclusion with the capability approach as a normative anchor, and we outline a simple composite measure, a capability-adjusted rehabilitation access index, together with a modelling strategy that programmes could adopt with routinely collected data. Three findings stand out. First, unmet need is very large and socially patterned: poverty, rurality, gender, and stigma compound one another. Second, where CBR has been evaluated with credible designs it shows meaningful effects on independence, social inclusion, and livelihoods, but evaluation practice remains weak overall. Third, emerging digital and data-driven tools could strengthen CBR monitoring, provided that questions of equity, consent, and algorithmic bias are addressed from the outset. We close with recommendations for programme design, measurement, and policy that follow from treating people with disabilities as agents whose real freedoms are the proper measure of success.