The Community-Based Rehabilitation (CBR) project in Manikganj, Bangladesh, was launched in 2013 by the Disability Rehabilitation and Research Association (DRRA) in partnership with the Dutch organization Niketan to address the needs of children with complex and multiple disabilities. Despite global concerns over the sustainability and evidence base of CBR programs, this initiative has built a strong network of partners and parent organizations. However, challenges such as limited access to quality assistive devices, professional physiotherapy, and financial sustainability persist. The program remains vital to its beneficiaries and offers valuable insights into community-based care, particularly in rural areas where access to institutional rehabilitation services is limited.
The CBR model in Manikganj emphasizes rehabilitation close to home, integrating medical, social, and rights-based approaches. Rooted in community participation, it empowers local volunteers and families to provide support using existing community networks. The program’s approach evolved from focusing solely on medical treatment to fostering inclusion, awareness, and empowerment within the broader community, ensuring sustainability and a sense of ownership among local participants.
Manikganj district, comprising seven sub-districts and 1,643 villages, faces geographic and infrastructural barriers that make access to centralized services difficult. The partnership between DRRA and Niketan initially began with day-care centers for children with disabilities, but these proved difficult to scale. In response, the CBR pilot introduced low-cost “veranda schools,” organized on the verandas of community members’ homes. These centers brought educational and rehabilitation services closer to families, reducing expenses while fostering local responsibility for maintaining the program.
Situated between two major rivers, the Ghior and Daulatpur sub-districts experience frequent natural disasters and poverty, making life especially challenging for families with children with disabilities. Many existing disability projects in Bangladesh focus on less complex conditions, leaving children with neurodevelopmental disorders excluded. The CBR project recognized this gap and developed an inclusive model involving parents and local volunteers to deliver personalized, home-based rehabilitation for children with severe and multiple disabilities.
The program has achieved remarkable social transformation. Communities that once hid children with disabilities now host veranda schools, providing inclusive spaces for education and therapy. Parents have organized forums to share knowledge, advocate for disability rights, and access government support. Youth volunteers, trained as “buddies,” play with children, assist with learning, and promote positive social attitudes. Together, these efforts have made disabilities more visible, increased awareness, and fostered a culture of inclusion.
The initiative has also empowered families economically. Parents received vocational training and participated in income-generating activities such as livestock rearing and compost production. Youth with disabilities gained employment or started small businesses, contributing to their independence. Collaboration with local authorities, NGOs, and private partners enhanced the project’s sustainability, resource sharing, and recognition. It even gained official permission to conduct disability-inclusive education activities in local government schools.
The external evaluation conducted in 2023 used the Participatory Inclusion Evaluation (PIE) toolkit to assess impact through participatory methods, interviews, and focus group discussions. It found that parent platforms and local disability organizations became strong advocates, raising awareness, facilitating access to government allowances, and lobbying for inclusive policies. Early intervention through veranda schools significantly improved children’s development, enabling some to transition into mainstream schools.
Despite notable successes, ongoing challenges include outdated physiotherapy methods, insufficient assistive devices, and limited career prospects for young adults with disabilities. Evaluators recommend updating rehabilitation curricula, emphasizing functional therapy, and training caregivers to lead home-based practices. They also highlight the need for greater government involvement to ensure long-term sustainability and integration of early detection and rehabilitation services into public health programs.
The Manikganj CBR project stands as a model of community-driven inclusion and rehabilitation. Its success demonstrates how low-cost, participatory approaches can create lasting change when supported by committed communities, effective networks, and cross-sector collaboration. However, sustained impact requires government ownership, continued evidence building, and stronger advocacy to secure long-term funding and policy support for community-based rehabilitation nationwide.
