Paper short abstract:

The objective of this paper is to provide a contribution to equity analysis literature by assessing, from a capability approach perspective, the impact of a Community-Based Rehabilitation (CBR) program in India on health and non-health outcomes of children and youth with disabilities.

Paper long abstract:

Equity analysis is taken into account to evaluate and guide health programs and policies as it allows a more flexible and effective response to health inequities especially in lower- and middle-income countries (LMICs) (Sen, 2002; Briggs and Nugent, 2016; Griffiths et al., 2016). The notion that the intersection of multiple identities matters for accessing opportunities is increasingly recognized allowing policymakers to identify better interventions to improve equity and reduce chronic outcomes’ disadvantages (Sen et al., 2009; Sen and Iyer, 2012; Deepak et al. 2013; Larson, et al. 2016). Several authors identify the capability approach as a suitable theoretical frame for this type of multidimensional analyses (Sen, 2002; Coast et al., 2008b; Lorgelly et al., 2010; Greco et al., 2016).

The objective of this paper is to provide a contribution to equity analysis literature by assessing, from a capability approach perspective, the impact of a Community-Based Rehabilitation (CBR) program in India on health and non-health outcomes of children and youth with disabilities.

Overall, in India CBR programs have been promoted as the most practical and viable solution for improving the well-being of persons with disabilities (O'Keefe, 2009). The CBR program in the districts of Mandya and Ramanagaram in Karnataka (India) constitutes our illustrative case study. This CBR program began in 1997 and by 2010, it had reached 2,045 villages in the 2 districts of involving around 22,000 persons with disabilities.

The impact analysis - after 4 and 7 years the CBR started - is based on a large-scale survey and a quasi-randomised trial design and is assessed across 7 dimensions of well-being via multilevel logit regressions. Equity analysis is performed by intersecting personal characteristics, or identities, in order to simulate estimates for 8 profiles based on gender, caste, and severity of disability. Qualitative data were collected to triangulate quantitative findings.

While caste membership does not significantly affect the magnitude of any improvement, the severity of disability and gender status play a determinant role. Overall, evidence suggests that the CBR program should strive to improve services for persons with severe disability, considering some complex social and cultural factors such as those related to gender roles.