Persons with physical disabilities in rural African contexts face significant barriers to social inclusion. Community-based rehabilitation (CBR) is a key strategy promoted to address these barriers, yet longitudinal evidence of its sustained impact in post-conflict settings remains limited. This study assessed the long-term impact of CBR programmes on the social inclusion of persons with physical disabilities in a rural, post-conflict district. It aimed to identify the mechanisms through which CBR influences inclusion and the persistent structural challenges. A sequential explanatory mixed methods design was employed. A cross-sectional survey of 150 participants with physical disabilities was conducted, followed by 25 in-depth interviews and 4 focus group discussions with beneficiaries, family members, and CBR workers to contextualise the quantitative data. Quantitatively, CBR engagement was significantly associated with higher self-reported social inclusion scores. Approximately 65% of long-term participants reported sustained improvements in community participation. Qualitatively, three key themes emerged: CBR as a catalyst for changed community perceptions, the critical role of peer networks, and enduring economic exclusion as a primary barrier. CBR programmes have contributed positively to dimensions of social inclusion, particularly in shifting attitudes and fostering supportive networks. However, their ability to generate transformative inclusion is constrained by entrenched poverty and limited livelihood opportunities. Policymakers and practitioners should integrate targeted livelihood support within CBR frameworks. Future programmes must advocate for systemic changes to improve physical accessibility and anti-discrimination legislation to address structural barriers. community-based rehabilitation, social inclusion, physical disability, mixed methods, Rwanda, Africa This paper provides novel longitudinal evidence on the sustained, yet economically limited, impact of CBR in a post-conflict African context, introducing a refined model linking programme mechanisms to specific inclusion outcomes.
Jean de Dieu Uwimana (Thu,) studied this question.
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