Navigating Complexity: A Systematic Review of the Challenges in Community-Based Rehabilitation (CBR) Implementation

Authors

  • Farhana Yaakub Faculty of Administrative Science and Policy Studies, Universiti Teknologi MARA
  • Asiyah Kassim Faculty of Administrative Science and Policy Studies, Universiti Teknologi MARA
  • Makmor Tumin Faculty of Business and Economics, Universiti Malaya

DOI:

https://doi.org/10.24191/jas.v22i2.8448

Keywords:

Community-Based Rehabilitation (CBR), Challenges , Person with Disabilities (PWDs), Systematic Literature Review

Abstract

Community-Based Rehabilitation (CBR) Program is a global effort proposed by the World Health Organization (WHO) to cater the needs of people with disabilities (PWDs). As the number of registered PWDs increases annually, the demand for accessible rehabilitation services becomes more urgent to foster their social inclusion. While the government and community are focusing on providing better and reachable rehabilitation services based on the local capacities and resources, they face multiple challenges in the program implementation. This study aims to systematically review and synthesize the challenges of CBR implementation. Following the PRISMA guidelines, 13 eligible studies were selected and critically appraised by using CASP Checklist and then analysed using thematic analysis to identify recurring themes. From the analysis, five main themes are highlighted: 1. lack of skilled workforce and training deficiencies; 2. insufficient resources; 3. poor integration and coordination; 4. attitudinal and cultural barriers; 5. barriers to accessing CBR services. To reap its great potential in empowering PWDs, CBR must be backed by strong and coordinated policies, well trained manpower, sustainable funding, and social support.

Author Biographies

Asiyah Kassim, Faculty of Administrative Science and Policy Studies, Universiti Teknologi MARA

Head of Graduate Studies (Recruitment & Admission)

INSTITUTE OF POSTGRADUATE STUDIES (IPSis)

Makmor Tumin, Faculty of Business and Economics, Universiti Malaya

Department of Political Science, Public Administration and Development Studies Faculty of Business and Economics

References

Abiddin, N. Z., Ibrahim, I., & Abdul Aziz, S. A. (2022). Non-governmental organisations (NGOs) and their part towards sustainable community development. Sustainability, 14(8), 4386. https://doi.org/10.3390/su14084386

Abouzeid, O. N., Hasan, A. S. G., Abuelela, I. S., & Manar D. Mohammed. (2024). Satisfaction and barriers regarding community-based rehabilitation services among caregivers of children with cerebral palsy in Minia Governorate. Tanta Scientific Nursing Journal (Vol. 34, Issue 3). 10.21608/tsnj.2024.384587

Adenan, N. D., Abdullah, N., Mohamad Said, N. S., Abdul Manaf, S. M., Mohd Zahari, A. S., (2023). Community-based rehabilitation: an overview of organisational practices. In the International Journal of Academic Research in Business and Social Sciences (Issue 11, pp. 2758–2760). https://doi.org/10.6007/IJARBSS/v13-i11/19749

Aldersey, H. M., Xu, X., Balakrishna, V., Sserunkuma, M. C., Sebeh, A., Olmedo, Z., Nuri, R. P., & Ahmed, A. N. (2023). The role of community-based rehabilitation and community-based inclusive development in facilitating access to justice for persons with disabilities globally. International Journal of Disability and Social Justice, 3(3). https://doi.org/10.13169/intljofdissocjus.3.3.0004

Amrutha P. & K.Sathyamurthi (2024). Empowering individuals with disabilities through community-based rehabilitation: an experience of the buds approach in Kerala. Juni Khyat (Vol-14, Issue-4, No.01, April: 2024. https://www.researchgate.net/publication/379661926_EMPOWERING_INDIVIDUALS_WITH_DISABILITIES_THROUGH_COMMUNITY-BASED_REHABILITATION_AN_EXPERIENCE_OF_THE_BUDS_APPROACH_IN_KERALA

An, Z., Li, K., Yang, X. et al. (2024). Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience. BMC Public Health 24, 740, 2024. https://doi.org/10.1186/s12889-024-18218-1

Asalal, N., Sidek, S., & Wahab, H. A. (2023b). Keperluan golongan profesional terlatih mengendalikan golongan orang kurang upaya di Malaysia. Asian People Journal (APJ), 6(1), 143–155. https://doi.org/10.37231/apj.2023.6.1.444

Ayalew, A. T., Adane, D. T., Obolla, S. S., Ludago, T. B., Sona, B. D., & Biewer, G. (2020). From community-based rehabilitation (CBR) services to inclusive development. a study on practice, challenges, and future prospects of CBR in Gedeo Zone (Southern Ethiopia). Frontiers in Education, 5. https://doi.org/10.3389/feduc.2020.506050

Barbareschi G, Carew MT, Johnson EA, Kopi N, and Holloway C. (2021). "When they see a wheelchair, they've not even seen me"-factors shaping the experience of disability stigma and discrimination in Kenya. International Journal Environment Research and Public Health. 2021 Apr 17;18(8):4272. https://doi.org/10.3390/ijerph18084272

Blose, S., Chetty, V., Cobbing, S., & Chemane, N. (2024). Managers’ perceptions on the implementation of community-based rehabilitation in KwaZulu-Natal. South African Journal of Physiotherapy, 80(1). https://doi.org/10.4102/sajp.v80i1.1965

Blose, S., Cobbing, S., & Chetty, V. (2021). community-based rehabilitation implementation for people with disabilities in South Africa: a protocol for a scoping review. Systematic Reviews, 10(1). https://doi.org/10.1186/s13643-021-01839-7

Cayetano RDA, Elkins J. (2016) Community-based rehabilitation services in low and middle-income countries in the Asia-Pacific region: Successes and challenges in the implementation of the CBR matrix. Disabil CBR Incl Dev. 2016;27(2):112–127. DOI:10.5463/dcid.v27i2.542

Çaynak S, Özer Z, Keser İ. (2022). Stigma for disabled individuals and their family: A systematic review. Perspect Psychiatr Care. 2022 Jul;58(3):1190-1199. https://doi.org/10.1111/ppc.12893

Cui, J. (2023). The impacts of stigma on people with disabilities: a systematic review. In BCP Social Sciences & Humanities ASSSD (Vol. 21, pp. 108–109).

Department of Social Welfare, Malaysia (2023). Community-based rehabilitation. http://pdk.jkm.gov.my/en_US/community-based-rehabilitation-program- cbr/#1501833085404-f938d3c3-9bad

Duyan, V. (2007). The community effects of disabled sports. Amputee sports for victims of terrorism. Amsterdam: IOS Press, 70–77. https://ebooks.iospress.nl/volumearticle/24227

Garidzirai, R. (2020). Covid-19 and its economic impact on the South African Economy. Agricagrowth Agenda 17, 10–12. Available online at: https://hdl.handle.net/10520/ejc-afgrow_v1_i1_a1

Gautam, K. (2022). Community based rehabilitation: provide barrier free environment and developmental opportunities for disabled people. International Journal of Advanced Research, 10(02), 382–386. https://doi.org/10.21474/ijar01/14214

Govender P, Naidoo D, Bricknell K, Ayob Z, Message H, Njoko S. (2019). ‘No one prepared me to go home’: Cerebrovascular accident survivors’ experiences of community reintegration in a peri-urban context. The African Journal of Primary Health & Family Medicine. 2019;11(1):1–8. https://doi.org/10.4102/phcfm.v11i1.1806

Hasan, H., & Aljunid, S. M. (2019). Job satisfaction among Community-Based Rehabilitation (CBR) workers in caring for disabled persons in the east coast region of Peninsular Malaysia. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-6520-z

Helander, E. (2000). 25 years of community-based rehabilitation. Asia Pacific Disability Rehabilitation Journal, 11(1). https://www.dinf.ne.jp/doc/english/asia/resource/apdrj/z13jo0500/z13jo0503.html

Khairul AY, Kannan TC and Erna FP (2024). The strain among caregivers of children with disabilities at the community-based rehabilitation centres in Kudat division of Sabah, Malaysia. Medical Journal Malaysia. 2024 Mar;79 (Suppl 1):59-66. PMID: 38555887. https://www.e-mjm.org/2024/v79s1/children-with-disabilities.pdf

Khamis, M., Prinz, D., Newhouse, D., Palacious-Lopez, A., Pape, U., and Weber, M. (2021). The early labour market impacts of covid-19 in developing countries: evidence from high frequency phone surveys. Policy Research Working Paper 9510. World Bank Group. doi: 10.1596/1813-9450-9510

Khanjani M S, Fallahi Bookani N, Abdi K. (2022). The experience of involved individuals from the implementing challenges of community-based rehabilitation in Iran: a qualitative study. Iranian Rehabilitation Journal 2022; 20 (4) :469-480. http://irj.uswr.ac.ir/article-1-1643-en.html

Koly, K.N., Abdullah, R., Shammi, F.A. et al. (2022) Mental health and community-based rehabilitation: a qualitative description of the experiences and perspectives of service users and carers in Bangladesh. Community Mental Health Journal 58, 52–66. https://doi-org.uitm.idm.oclc.org/10.1007/s10597-021-00790-0

Lemmi, V., Blanchet, K., Gibson, L. J., Kumar, K. S., Rath, S., Hartley, S., … Kuper, H. (2016). Community-based rehabilitation for people with physical and mental disabilities in low- and middle-income countries: a systematic review and meta-analysis. Journal of Development Effectiveness, 8 (3), 368–387. https://doi.org/10.1080/19439342.2016.1157623

Madsen, L. S., Handberg, C., Jensen, C. M., & Nielsen, C. V. (2020). Community-based rehabilitation approaches in outdoor settings: a systematic review of people with disabilities’ and professionals’ experiences and perceptions. Disability & Society, 36(7), 1073–1098. https://doi.org/10.1080/09687599.2020.1783206

Magnusson, L., Kebbie, I. & Jerwanska, V. (2022). Access to health and rehabilitation services for persons with disabilities in Sierra Leone – Focus Group Discussions with Stakeholders. BMC Health Serv Res 22, 1003 (2022). https://doi-org.uitm.idm.oclc.org/10.1186/s12913-022-08366-8

Mikeladze, A. (2021). Financial management role for NGOs. European Journal of Economics and Business Studies. January - June 2021 Volume 7, Issue 1. https://revistia.com/files/articles/ejes_v7_i1_21/Mikeladze.pdf

Mitchell-Gillespie, B., Hashim, H., Griffin, M. et al. (2020) Sustainable support solutions for community-based rehabilitation workers in refugee camps: piloting telehealth acceptability and implementation. Global Health 16, 82 (2020). https://doi.org/10.1186/s12992-020-00614-y

Msomi, N. L., & Ross, A. J. (2024). Social accountability challenges and recommendations by community service rehabilitation therapists. South African Family Practice, 66(1). https://doi.org/10.4102/safp.v66i1.5936

Pasara, M. T. (2022). Impact of community-based rehabilitation on attainment of sustainable development goals: the case of selected districts in Zimbabwe. Frontiers in Communication, 7. https://doi.org/10.3389/fcomm.2022.935097

Senate of Malaysia. (2025, March 19). Dewan negara parlimen kelima belas penggal keempat mesyuarat pertama, 19 march 2025 [Parliamentary debate transcript]. Parliament of Malaysia. https://www.parlimen.gov.my/files/hindex/pdf/DN-19032025.pdf

Shang, J. (2021). Investigation on the operation status of community-based rehabilitation station in a District of Chongqing. Journal of Healthcare Engineering, 2021, 1–4. https://doi.org/10.1155/2021/6044923

The World Health Organization (2018). The need to scale up rehabilitation. rehabilitation 2030: a call for action. https://www.who.int/docs/default-source/documents/health-topics/rehabilitation/call-for-action/need-to-scale-up-rehab-july2018.pdf?sfvrsn=f627c34c_5

Tofani, M., Esposito, G., Berardi, A., Galeoto, G., Iorio, S., and Marceca, M. (2021). Community-based rehabilitation indicators: validation and preliminary evidence for disability in Italy. International Journal Environment Research and Public Health 18, 11256. doi: 10.3390/ijerph182111256

UNICEF (2007). Promoting the rights of children with disabilities, Innocent Digest, no. 13. Florence: UNICEF Innocenti Research Centre. https://www.unicef.org/media/126526/file/Digest13-Disability.pdf

Vuuren J, & Aldersey HM. (2020). Stigma, acceptance and belonging for people with IDD across cultures. Current Developmental Disorders Reports. 2020;7(3):163-172. doi: 10.1007/s40474-020-00206-w

Wolderufael, W. (2022). Assessing practice and challenges of university of gondar community based rehabilitation program to provide services for persons with disabilities. European Online Journal of Natural and Social Sciences, 11(3), pp. 743-759. https://european-science.com/eojnss/article/view/6524

World Health Organization, International Labour Office, & United Nations Educational, Scientific and Cultural Organization. (2004). CBR A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities. https://www.ilo.org/media/316271/download

World Health Organization. (1978, September 12). Report of the International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 [report]. 1978. https://www.who.int/publications/i/item/9241800011

World Health Organization. (2010). CBR Guidelines. https://iris.who.int/bitstream/handle/10665/44405/9789241548052_supplement_eng.pdf?sequence=1

World Health Organization. (2023, March 7). Disability. https://www.who.int/news-room/fact-sheets/detail/disability-and-health

Xin, W., Xu, D., Dou, Z., Jacques, A., Umbella, J., & Hill, A. (2024). Effectiveness of community-based rehabilitation (CBR) centers for improving physical fitness for community-dwelling older adults: a systematic review and meta-analysis. Annals of Rehabilitation Medicine, 48(1), 5–21. https://doi.org/10.5535/arm.23148

Zaliha Mustafa, D. (2024, December 17). Speech at the Majlis Penyerahan Sumbangan PPKWP kepada PPDK Wilayah Persekutuan [Speech transcript]. Ministry of the Prime Minister’s Department (Federal Territories), Malaysia. https://www.jwp.gov.my/storage/media/17122024_MAJLIS-PENYERAHAN-SUMBANGAN-PPKWP-KEPADA-PPDK-WILAYAH-PERSEKUTUAN.pdf

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Published

2025-10-30

How to Cite

Yaakub, F., Kassim, A., & Tumin, M. (2025). Navigating Complexity: A Systematic Review of the Challenges in Community-Based Rehabilitation (CBR) Implementation. Journal of Administrative Science, 22(2), 126–160. https://doi.org/10.24191/jas.v22i2.8448