Stroke rehabilitation in low-income and middle-income countries: a call to action

There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries.We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework.The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility.This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services. 

/pdf/prioritizing-rehabilitation-in-low-and-middle-income-country-20x5s1wy.pdf

Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework

A comprehensive, accurate description of workforce capacity is important for health service planning, to ensure that health services meet local needs. In many low- to middle-income countries, the government's service planning ability is barred by the lack of accurate and/or comprehensively-described workforce data. In these low-resource settings, lack of appropriate planning leads to limited or no access to rehabilitation services. Variability in the definitions and scope of rehabilitation professionals further complicates the understanding of rehabilitation services and how it should be planned and delivered. Another challenge to describing the primary rehabilitation workforce capacity, is the lack of standardised and agreed-upon global metrics. These inconsistencies highlight the need for a comprehensive understanding of current practices, which can offer guidance to countries wishing to describe their rehabilitation workforce. This study aimed to scope the range of descriptors and metrics used to describe the rehabilitation workforce and to compare the workforce across countries that used similar descriptors in published reports.A scoping review was conducted according to the five-step framework first developed by Arksey and O'Malley. The review included a broad search of literature regarding the rehabilitation workforce and how countries quantify and describe the rehabilitation workforce.Nineteen studies on rehabilitation workforce capacity were identified. All but one (a cross-sectional study) were database reviews. The main descriptors and indicators used to describe the rehabilitation workforce capacity were profession type, age, gender, distributions between urban/rural, level of care, and private/public sectors, absolute count totals, and population-adjusted ratios.This scoping review provided an overview of descriptors and indicators used to describe the rehabilitation workforce capacity internationally. The study is a first step towards developing standardised descriptors and metrics to quantify the rehabilitation workforce capacity, that will allow for comparison between different settings.This scoping review protocol has been registered with the Open Science Framework (http://osf.10/7h6xz). 

/pdf/rehabilitation-workforce-descriptors-a-scoping-review-1zk2ulzc.pdf

Rehabilitation workforce descriptors: a scoping review

This study investigates and ranks the critical capacity building challenges (CBC) impacting the Tanzanian public–private partnerships (PPPs) projects. The strength of interactions between CBC is es...

Identification of critical capacity building challenges in public-private partnerships (PPPs) projects: The case of Tanzania

There is a strong consensus among humanitarian response authorities for a need for global action by professional organizations to work toward developing a structured approach to provide a coordinated international response during sudden-onset disasters. The aim of this report was to develop a Disaster Rehabilitation Response Plan to enable International Society of Physical and Rehabilitation Medicine to provide leadership and governance role in liaison/coordination with the WHO emergency medical team initiative and other relevant stakeholders to provide rehabilitation input during sudden-onset disasters. The proposed plan uses a "three-tier approach": tier 1, immediate disaster response at a national/international level; tier 2, organization and deployment of rehabilitation personnel; and tier 3, rehabilitation management of disaster survivors and community reintegration. The International Society of Physical and Rehabilitation Medicine (and its subcommittee, the Disaster Rehabilitation Committee), categorized in the tier 2, could provide central leadership role working for the rehabilitation subcluster within the WHO emergency medical team initiative (tier 1) and support in coordination, preparation, and management of rehabilitation teams and/or members for deployment to sudden-onset disasters. The Disaster Rehabilitation Committee could also contribute to advocacy, training, and accreditation processes for rehabilitation professionals. The challenge ahead is commitment of countries worldwide to develop comprehensive rehabilitation-inclusive approach to ensure effective delivery of services to communities at risk.

Disaster Rehabilitation Response Plan: Now or Never.

OBJECTIVE Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals' perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity. METHODS A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia) of health professionals' working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF). RESULTS Respondents (n = 532) from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52.8%), nurses (8.8%), speech (5.3%) and occupational therapists (8.5%), rehabilitation physicians (3.8%), other doctors (5.5%) and prosthetist/orthotists (1.5%). The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities/participation and personal factors. CONCLUSION The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.

/pdf/capacity-building-in-clinical-skills-of-rehabilitation-uqgiq21djo.pdf

Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries.

Facilitators and Barriers to the Rehabilitation Workforce Capacity Building in Low- to Middle-Income Countries.

Concept Changes and Standardizing Tools in Community-Based Rehabilitation.

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Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries.

Facilitators and Barriers to the Rehabilitation Workforce Capacity Building in Low- to Middle-Income Countries.

Concept Changes and Standardizing Tools in Community-Based Rehabilitation.