This is the original research work done for the purpose to develop and modify the course content in local language for the caregivers in low and lower middle income countries. For the rehabilitation of patients with incontinence of bladder and bowel, the caregivers become more confident and competent if they get the proper course content with knowledge and skill as they engage in the health care process. The target audience are the educators and the council responsible for formulating the course curriculum for the caregivers. In this study we tried to include and modify the course curriculum regarding knowledge and skill in bowel and bladder care, transfer activities, propelling wheel chair, avoid developing pressure sours and exercise, important for those spinal cord injury patients who can lead a better life.

Increased globalization and robust modernization has brought about problems of disaster related to spinal cord injuries having bladder and bowel incontinence, paucity of trained medical & health professionals, and lack of experienced qualified staff in low and lower middle income countries. In view of these phenomena to meet the challenge for the need of proper skilled caregiving, the concept of caregiving and creation of a cadre of care givers is the need of the time and community. An appropriate course content is needed to support the competency development. The availability of trained caregivers and operationalizing the program in care giving will fulfill the needs of the persons with disability increasing at an alarming rate. To prepare a cadre of trained caregivers to provide quality care in various areas of disabilities ranging from infancy to old age, we identified the following points to be taken care of:
1.	Immense need for the appropriate course content and curriculum.
2.	Appropriate trained rehabilitation personal is the key to meeting the need.
3.	Training program and centers are called upon for teaching appropriate practical oriented service.
4.	To modify the course or program to integrate the practical need oriented content according to international guidelines.
5.	The developed resource can be used to advocate for appropriate education and training on caregiver’s course.
6.	Inside the institutions the courses will be modified or added.
7.	Outside the institutions like in councils, clinicians and professional organizations, the course to be introduced.
We prepared four different groups to initiate and support the project.
1.	The community Participatory Action Research Working Group will use the steps of continually seek feedback from all Working Groups on the status and progress. To facilitate maximum accountability and transparency and to keep the project aligned with the subject of concern by the course. By definition, Community‐based participatory research is a collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well‐being through taking action, including social change.
2.	The Advocacy Working Group will collect resources and develop content that will provide educators with guidance for navigating challenges that are often faced when integrating or modifying caregiver course contents specifically for the rehabilitation of the person having complication of ADL in spinal cord injury patient in the university program or training center curricula, such as a lack of awareness of the need for rehabilitation and overcome activities of daily living specially for the person facing this incontinence.  
3.	The Integration and Improvement Working Group will collect resources and develop content that will provide educators with guidance on options for evaluating student competence, efficacy of course pedagogic approaches and the course itself, as well as continuous course improvement processes.
4.	The Pilot Site Working Group will create a structured approach for piloting the developed content and evaluate the pilots as a means of refining the content for its launch version.

Successfully raise awareness on the requirement of appropriately trained personnel in the service and able to respond to the needs of the population and the inclusion of newly developed course content in the curricula of caregiver courses.
A successful advocacy was done in two groups: (a). Within the institution (educator, administrator, course in charge)   (b). Outside the institution (council, secretary, association and support group).
After an extensive advocacy we can be able to include some of the content which will be helpful for the competent workforce to integrate the changes in the course curricula in training institution for the patients suffering from bladder and bowel incontinence.

Successfully we can integrate and put this agenda for the next expert committee meeting for the council. The institution where the caregiver course are being run and appreciated, and forward this move to the council to integrate. So our advocacy group developed awareness among the local sector Service providers and the patients concern organizations.

Person having incontinence of bladder and bowel wright to get the appropriate products and services with dignity, safe and easy ADL, enabling them to access education, employment and health care and to participate in their social events. 
This paper helps to serve as a global resource in advocacy, education, standards, evidence-based practice, innovation and a platform for information exchange in the course curriculum of caregiver.  
We tried our best to develop the content in local languages for easy adaptation and communication with the patients and give them a best care.  
The purpose of the paper fulfils its mission to guide the integration of education into professional rehabilitation academic programs and regional training centers. The target audience are the educators in these programs from high-, medium- and low-income settings, with and without experience in service and delivery for the support to those patients having incontinence of bladder and bowel.