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Rehabilitation 2030:
Workforce strategies to address unmet needs for
rehabilitation services in low and middle income
countries
Dr Cliona O’Sullivan
University College Dublin
Ireland
@mycliona [email protected]
‘Global trends in health and aging require a major scaling up
of rehabilitation services in countries around the world and in
low- and middle-income countries in particular’,
WHO 2017
80% 20%
Rehabilitation 2030
THE IMPACT
OF DISABILITY
Worse education
outcomes
Reduced livelihood
opportunities
Greater healthcare
spend
Stigma and
discrimination
Social isolation
Carer stress
Limited access to
rehabilitation and social
services
Poverty
References:
WHO World Disability Report
O’Sullivan and McLachlan, (2007)
Crosbie et al, (2014)
BESTMINIMAL
BUSINESS IDEA
July 5th 2015
Munich
‘A set of measures that assist individuals who experience or who are likely to experience disability to achieve and maintain optimum functioning in interaction with their environment’
Definition of Rehabilitation , (WHO 2011)
Physiotherapist/Occupational Therapists/
Prosthetists Orthotists/ Physical medicine physicians
.
Ministries for health
Community Based RehabilitationWorkers/ PT-OT assistants/
Exercise professionals
Family members& care givers
.
Human Resources for Physical RehabilitationWho are the workforce ?
LACK OF REHABILITATION WORKERS
FINANCIAL RESOURCES
INTEGRATION INTO HEALTH SYSTEMS
EDUCATION AND TRAINING
GOVERNANCE
Challenges in Physical Rehabilitation
Workforce Planning
Evidence informed practice in physical rehabilitation in low and middle income settings….
……… ‘Reverse evidence’“A child with mild CP who has never had rehab with contractures, no independent function and not going to school, a patient with stroke discharged after 2 days in
hospital that spends the next 6 months in bed deteriorating when they could have been up and mobile, an amputee with contractures and pain and no chance of a prosthesis”.
…Rehabilitation for children with Cerebral Palsy(Mullins et al, 2017, paper in preparation)
Participants
(n)
Pre-
intervention
GMAE score
(%)
Post-
intervention
GMAE score
(%)
Mean
difference
Improvement
(%)
p-value
Total 67 29.49 ± 15.50 34.36 ± 14.97 4.87 ± 5.80 *0.00000002
Male 34 33.54 ± 16.35 36.97 ± 16.89 3.43 ± 5.34 *0.000395
Female 33 25.32 ± 13.56 31.67 ± 12.39 6.35 ± 5.96 *0.000014
GMFCS Level 2 4 51.30 ± 11.74 56.05 ± 11.22 4.75 ± 2.48 0.068
GMFCS Level 3 9 39.09 ± 17.52 42.75 ± 18.75 3.66 ± 4.65 *0.028
GMFCS Level 4 17 37.12 ± 6.46 41.47 ± 9.58 4.35 ± 7.07 *0.015
GMFCS Level 5 37 21.29 ± 13.01 26.71 ± 11.30 5.42 ± 5.77 *0.000013
Rural 29 31.71 ± 13.41 35.13 ± 13.70 3.42 ± 5.64 *0.002
Urban 38 27.79 ± 16.89 33.77 ± 16.03 5.98 ± 5.75 *0.000001
BESTMINIMAL
BUSINESS IDEA
July 5th 2015
Munich
Rehabilitation post spinal cord injury..
…A case example
“The blind spot of
contemporary science is
experience, if we only use the
past as our guide, it is
impossible to envision and
create a better future”.
Francisco Varela
(1946 – 2001)
The way forward
Strengthen education and training
• GOVERNMENT COMMITMENT
• STANDARDS AND COMPETENCIES
• PARTNERSHIPS
Policy
Governance
Different cadres of rehabilitation workers
Strengthen rehabilitation research
within health systems research
Integration into existing health services
1
4
Mr Jean Damascene Gasherebuka, Physiotherapist, Rwanda
Mr Joseph Capo-Chichi, Physiotherapist, Benin
Dr Seini Baro, Physiotherapist, Niger
Mr Herman Kazibwe, Physiotherapist, Uganda
Ms Cornelia Barth, ICRC, Switzerland
Ms Uta Prehl, Handicap International, Burkina Faso
Mr Pete Skelton, Handicap International, UK
Dr Mike Landry, Duke University, US
Dr Emma Stokes, President, World Confederation for Physical Therapy
Acknowledgements
Referencesintellectual disabilities in Western Ghana'. Physical Therapy Reviews, 19 (1).
• Crosbie S, O'Sullivan C (2014) 'Attitudes and beliefs of parents/carers of children with physical and intellectual disabilities in Western Ghana'. Physical Therapy Reviews, 19 (1).
• Jesus T, landry M, Dussault G, Fronteira I (2017) ‘Human Resources for Health 9and rehabilitation): Six Rehab-Workforce Challenges for the Century’. Human Resources for Health. 15:8
• Lindley RI, Anderson CS, Forster A, et al. (2017) ‘Family led rehabilitation after stroke in India (ATTEND): a randomised controlled trial’, 390:588-99
• O’ Dowd J, MacLachlan M, Khasnabis C, Geiser P. (2015) ‘Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries, Disability, CBR and Inclusive Development. 26 (3)
• O’Sullivan C, M. MacLachlan, (2009) 'Childhood Disability In Burkina Faso and Sierra Leone: An Exploratory Analysis' In: M. MacLachlan, Swartz L; (eds). Disability and Development: Towards Inclusive Global Health. New York: Springer. pp.161-181
• O’Sullivan C, Kazibwe H, Whitehouse Z, Blake C, (2017), ‘Constructing a global learning partnership in Physiotherapy: An Ireland Uganda Initiative’, Frontiers in Public Health, June 2017
• WHO. Global strategy for human resources for health: Workforce 2030. Geneva. World Health Organisation 2016 [
• WHO. World Report on Disability. Geneva. World Health Organisation. 2011
• WHO. Rehabilitation in Health Systems. Geneva. World Health Organisation. 2017
• WHO. Community Based Rehabilitation. CBR Guidelines. Geneva. World Health Organisation. 2010
• World Confederation for Physical Therapy (2012). WCPT guideline for physical therapist professional entry level education 2012 [cited 2016 4thDecember] Available from: ttp://www.wcpt.org/guidelines/entry-level-education