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Htwe O, Yuliawiratman BS, Tannor AY, Nor Asikin MZ, Soh E, DE Groote W, Naicker MS, Naicker AS. Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review. Eur J Phys Rehabil Med 2024; 60:514-522. [PMID: 38551518 PMCID: PMC11258907 DOI: 10.23736/s1973-9087.24.08154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. EVIDENCE ACQUISITION In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. EVIDENCE SYNTHESIS Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. CONCLUSIONS Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.
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Affiliation(s)
- Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia -
| | | | - Abena Y Tannor
- Department of Health Promotion and Disability, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Muhamad Z Nor Asikin
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elaine Soh
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wouter DE Groote
- Department of Rehabilitation Medicine, AZ Rivierenland, Bornem, Belgium
| | | | - Amaramalar S Naicker
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Domingues CDA, Laplane ALF. Assistive technology in public policies: trends in the international debate and implications for Brazil. Disabil Rehabil Assist Technol 2024:1-13. [PMID: 38372271 DOI: 10.1080/17483107.2024.2316896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The objectives of this study(1) were threefold: to identify the main topics related to the international debate on Assistive Technology (AT) public policies, to analyze the Brazilian case in light of these topics, and to extract lessons that could be applied in Brazil and other countries to advance progress in the field. METHODOLOGY A qualitative study was conducted through a critical literature review, involving the search for, selection, and analysis of articles indexed in two information source portals and four databases from 2007 to 2023. International and Brazilian laws, reports, and other publications specifically related to AT policies were also included. RESULTS The analysis of 186 articles and Brazilian documents facilitated the examination of four themes: AT policies from a human rights perspective, public procurement, service delivery systems, and national plans. A subset of 107 publications was then selected for detailed analysis. DISCUSSION Initiatives such as implementing a national plan, establishing an AT research center, and creating a product catalog are considered virtuous. Enhancing the freedom of choice for products and developing public procurement mechanisms are identified as additional strategies to reinforce protections of human rights in Brazil. CONCLUSIONS Policy dynamics and national and international experiences suggest the potential for expanding initiatives and creating new solutions in Brazil. Universities and other scientific institutions emerge as promising loci for generating new knowledge to support the formulation of AT policies and facilitate their debate and further development.
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Blose S, Chetty V, Cobbing S, Chemane N. Managers' perceptions on the implementation of community-based rehabilitation in KwaZulu-Natal. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1965. [PMID: 38322651 PMCID: PMC10839209 DOI: 10.4102/sajp.v80i1.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 02/08/2024] Open
Abstract
Background Community-based rehabilitation (CBR) is a World Health Organization (WHO) strategy for social inclusion, equalisation of opportunities and provision of essential services for people with disabilities (PWDs). Community-based rehabilitation is a multi-sectoral strategy that requires all stakeholders to participate equally in its implementation. KwaZulu-Natal has implemented CBR for over two decades, with various stakeholders at the forefront of implementation. However, the status of stakeholder engagement, collaboration and coordination is unknown. Objective The objective of our study was to understand how CBR is implemented in KwaZulu-Natal and the roles of each stakeholder in its implementation, with a focus, on managers from government and non-governmental organisations. Method A descriptive explorative approach using semi-structured interviews was used to collect data from 20 managers from various stakeholders involved in implementing CBR in KwaZulu-Natal. Data were transcribed and analysed using thematic analysis. Results The findings revealed five dominant themes: (1) the understanding of concepts, (2) missed opportunities for implementing CBR, (3) barriers to implementing CBR, (4) benefits to implementing CBR and (5) recommendations for future implementation. Conclusion A formal management structure with clear roles and responsibilities was fundamental for implementation. Collaboration, coordination and planning were believed to be the critical roles of managers in the implementation of CBR. Training, awareness and sharing of resources among stakeholders were also identified as important factors in implementing CBR in KwaZulu-Natal. Clinical implications Our study will assist managers and clinicians to improve their planning and implementation of CBR.
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Affiliation(s)
- Sithembiso Blose
- Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Verusia Chetty
- Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saul Cobbing
- Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Physiotherapy, Faculty of Health Sciences, University of Toronto, Toronto, Canada
| | - Nomzamo Chemane
- Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Grigorovich A, Xi M, Lam N, Pakosh M, Chan BCF. A systematic review of economic analyses of home-based telerehabilitation. Disabil Rehabil 2022; 44:8188-8200. [PMID: 34965827 DOI: 10.1080/09638288.2021.2019327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions. MATERIALS AND METHODS Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist. RESULTS Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear. CONCLUSIONS More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.
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Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Natascha Lam
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Brian C F Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Shirazikhah M, Roshanfekr P, Takian A, Alizadeh Zarei M, Shirazikhah A, Joghataei MT. Availability of Physical Rehabilitation Facilities for People with Disabilities in Iran: A Comparative Study on Universal Health Coverage. ARCHIVES OF IRANIAN MEDICINE 2022; 25:698-705. [PMID: 37542402 PMCID: PMC10685876 DOI: 10.34172/aim.2022.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/04/2021] [Indexed: 08/06/2023]
Abstract
BACKGROUND Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels. METHODS This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016. RESULTS On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher. CONCLUSION According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.
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Affiliation(s)
- Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amirhossein Takian
- Director, Department of Global Health & Public Policy, Tehran University of Medical Sciences, Tehran, Iran
- Vice Dean, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Chief of Research, Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Alizadeh Zarei
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Adeleh Shirazikhah
- Office of the Minister’s Adviser on Rehabilitation, Ministry of Health and Medical Education, Tehran, Iran
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Barth CA, Wladis A, Blake C, Bhandarkar P, Aebischer Perone S, O'Sullivan C. Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries. BMJ Open 2021; 11:e049533. [PMID: 34853101 PMCID: PMC8638157 DOI: 10.1136/bmjopen-2021-049533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Limb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries. DESIGN A retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations. SETTING Five countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment. PARTICIPANTS All PwA newly attending rehabilitation. RESULTS Data for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001). CONCLUSIONS Young age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.
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Affiliation(s)
- Cornelia Anne Barth
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Andreas Wladis
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Prashant Bhandarkar
- BARC Hospital, WHO collaborating centre for research in surgical needs in LMICs, Mumbai, India
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, India
| | - Sigirya Aebischer Perone
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
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Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
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Jesus TS, Arango-Lasprilla JC, Kumar Kamalakannan S, Landry MD. Growing physical rehabilitation needs in resource-poor world regions: secondary, cross-regional analysis with data from the global burden of disease 2017. Disabil Rehabil 2021; 44:5429-5439. [PMID: 34086516 DOI: 10.1080/09638288.2021.1933619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. MATERIALS AND METHODS This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990-2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. RESULTS All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990-2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. CONCLUSIONS An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions.IMPLICATIONS FOR REHABILITATIONAsia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa.The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data.The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level.
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Affiliation(s)
- Tiago S Jesus
- Global Healthand Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Suresh Kumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health - Hyderabad (IIPH-H), Hyderabad, India
| | - Michel D Landry
- School of Medicine, Duke University, Durham, NC, USA.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Ahmadzadeh N, Ebadi Fard Azar F, Baradaran HR, Roghani RS, Shirazikhah M, Taghi Joghataei M, Zanjari N, Moradi-Lakeh M, Saneh S, Bahrampouri S. A Framework for National Rehabilitation Policy and Strategies in Iran: A Scoping Review of Experiences in Other Countries. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1597-1610. [PMID: 33643933 PMCID: PMC7898089 DOI: 10.18502/ijph.v49i9.4072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran. Methods In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran. Results In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation. Conclusion To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.
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Affiliation(s)
- Nahal Ahmadzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salman Roghani
- Physical Medicine & Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Anatomy and Neuroscience, Cellular and Molecular Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nasibeh Zanjari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sadaf Saneh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saiedeh Bahrampouri
- Health in Emergency and Disaster Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
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Nuri RP, Aldersey HM, Ghahari S, Huque AS. Experience of families in accessing government-led support for children with disabilities in Bangladesh. Disabil Rehabil 2020; 44:1354-1366. [DOI: 10.1080/09638288.2020.1804000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Louw Q, Twizeyemariya A, Grimmer K, Leibbrandt D. Estimating the costs and benefits of stroke rehabilitation in South Africa. J Eval Clin Pract 2020; 26:1181-1187. [PMID: 31503395 DOI: 10.1111/jep.13287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation. DESIGN We report an economic modelling approach using a worked cost-effectiveness to validate the argument for the cost-saving benefits of stroke rehabilitation. SETTING South African health care, employing analysis of available secondary data from South African research and government reports. PARTICIPANTS In line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return-to-work as the desired rehabilitation outcome. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return-to-work rates, intervention costs, and the cost of rehabilitation services to estimate cost-savings as a result of an individualized workplace intervention. RESULTS The cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return-to-work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%). CONCLUSION The value of rehabilitation should not be considered in terms of cost-effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.
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Affiliation(s)
- Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Asterie Twizeyemariya
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Karen Grimmer
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Dominique Leibbrandt
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Garg A, Skempes D, Bickenbach J. Legal and Regulatory Approaches to Rehabilitation Planning: A Concise Overview of Current Laws and Policies Addressing Access to Rehabilitation in Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4363. [PMID: 32570746 PMCID: PMC7346088 DOI: 10.3390/ijerph17124363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rising prevalence of disability due to noncommunicable diseases and the aging process in tandem with under-prioritization and underdevelopment of rehabilitation services remains a significant concern for European public health. Over recent years, health system responses to population health needs, including rehabilitation needs, have been increasingly acknowledging the power of law and formal written policies as strategic governance tools to improve population health outcomes. However, the contents and scope of enacted legislation and adopted policies concerning rehabilitation services in Europe has not been synthesized. This paper presents a concise overview of laws and policies addressing rehabilitation in five European countries. METHODS Publicly available laws, policies, and national action plans addressing rehabilitation issues of Sweden, Italy, Germany, the Netherlands and the United Kingdom were reviewed and descriptive documents analyzed. Actions found in national health policies were also evaluated for compliance with the key recommendations specified in the World Health Organization's Rehabilitation 2030: Call for Action. Results: Across countries, legal and policy approaches to rehabilitation planning varied in scope and reach. While all countries entitle citizens to rehabilitation services, comprehensiveness of coverage varied. Health legislation of Germany and Netherlands recognizes access to rehabilitation as a human right for persons with disabilities, while Sweden and the United Kingdom acknowledge its importance in disability laws for achieving substantive equality for persons with disabilities. Regarding policies, in all countries but Italy, targeted universalism remains the predominant strategy governing rehabilitation services, as demonstrated by the lack of comprehensive, national action plans for rehabilitation addressing the general population. Nevertheless, references found in disease specific policies indicate a solid consensus that rehabilitation remains an integral component of the care continuum for those experiencing disability. CONCLUSION Although a universal approach to rehabilitation coverage is institutionalized in national legislation of the countries examined, this approach is not expressed in formal policies. Targeted strategies aiming to ensure access to subpopulation groups with higher perceived needs for rehabilitation prevail, indicating a strong political will towards the reduction of health inequalities and the promotion of human rights of people experiencing disability. Results obtained from conducting this descriptive review provide the basis for future appraisals of the situation regarding rehabilitation service and policy development in Europe.
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Affiliation(s)
- Aditi Garg
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland; (D.S.); (J.B.)
| | - Dimitrios Skempes
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland; (D.S.); (J.B.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Jerome Bickenbach
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland; (D.S.); (J.B.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
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White RM, Bornman J, Johnson E, Tewson K, van Niekerk J. Transformative equality: Court accommodations for South African citizens with severe communication disabilities. Afr J Disabil 2020; 9:651. [PMID: 32391248 PMCID: PMC7203191 DOI: 10.4102/ajod.v9i0.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 01/20/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Persons with disabilities are generally at greater risk of experiencing violence than their peers without a disability. Within the sphere of disability, individuals with severe communication disabilities are particularly vulnerable and have an increased risk of being a victim of abuse or violence and typically turn to their country's criminal justice system to seek justice. Unfortunately, victims with disabilities are often denied fair and equal treatment before the court. Transformative equality should be pursued when identifying accommodations in court for persons with communication disabilities, as the aim should be to enable such individuals to participate equally in court, without barriers and discrimination. OBJECTIVES This research aimed to identify court accommodations recommended by legal experts, which could assist individuals with severe communication disabilities in the South African court. METHOD A qualitative design was used to conduct a discussion with a panel of legal experts. RESULTS Using Article 13 (Access to Justice) of the Convention on the Rights of Persons with Disabilities (CRPD) as a human rights framework, four themes were identified: equality, accommodations, participation and training of professionals. CONCLUSION Foreign and national law clearly prohibits discrimination against persons with communication disabilities because of their disability and state that they should be given fair and equal access to the court system. For transformative equality to be achieved, certain rules and laws need to be changed to include specific accommodations for persons with communication disabilities so that they may be enabled to participate effectively in court in the criminal justice system.
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Affiliation(s)
- Robyn M White
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Karen Tewson
- National Prosecuting Authority, Pretoria, South Africa
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Jesus TS, Landry MD, Dussault G, Fronteira I. Classifying and Measuring Human Resources for Health and Rehabilitation: Concept Design of a Practices- and Competency-Based International Classification. Phys Ther 2019; 99:396-405. [PMID: 30561749 DOI: 10.1093/ptj/pzy154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/28/2018] [Indexed: 02/09/2023]
Abstract
The burden of physical impairments and disabilities is growing across high-, middle-, and low-income countries, but populations across the globe continue to lack access to basic physical rehabilitation. Global shortages, uneven distributions, and insufficient skill mix of human resources for health and rehabilitation (HRH&R) contribute to such inequitable access. However, there are no international standards to classify HRH&R and to promote their global monitoring and development. In this article, we conceptually develop an international classification of HRH&R based on the concept of monitoring HRH&R through their stock of practices and competencies, and not simply counting rehabilitation professionals such as physical or occupational therapists. This concept accounts for the varying HRH&R configurations as well as the different training, competencies, or practice regulations across locations, even within the same profession. Our perspective specifically develops the concept of a proposed classification, its structure, and possible applications. Among the benefits, stakeholders using the classification would be able to: (1) collect locally valid and internationally comparable data on HRH&R; (2) account for the rehabilitation practices and competencies among nonspecialized rehabilitation workers (eg, in less resourced/specialized contexts); (3) track competency upgrades or practice extensions over time; (4) implement competency-based human resources management practices, such as linking remuneration to competency levels rather than to professional categories; and (5) inform the development of (inter-)professional education, practice regulation, or even task-shifting processes for the whole of HRH&R. The proposed classification standard, still in a concept-development stage, could help drive policies to achieve the "right" stock of HRH&R, in terms of practices and competencies.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira 100, Lisbon 1349-008, Portugal
| | - Michel D Landry
- Duke Doctor of Physical Therapy Division, Duke University Medical Center, and Duke Global Health Institute, Duke University, Durham, North Carolina, United States
| | - Gilles Dussault
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon
| | - Inês Fronteira
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon
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Skempes D, Melvin J, von Groote P, Stucki G, Bickenbach J. Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST). Global Health 2018; 14:96. [PMID: 30285888 PMCID: PMC6167891 DOI: 10.1186/s12992-018-0410-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments' efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities. METHODS A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators' organizing framework which was verified and interpreted by a select number of participants. RESULTS A concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two-tiered priority set of indicators. CONCLUSION Concept mapping was successful in generating a shared model that enables a system's view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems.
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Affiliation(s)
- Dimitrios Skempes
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
| | - John Melvin
- Department of Rehabilitation Medicine, Thomas Jefferson University, 25 S. Ninth Street, Philadelphia, PA 19107 USA
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
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Smith ER, van de Water BJ, Martin A, Barton SJ, Seider J, Fitzgibbon C, Bility MM, Ekeji N, Vissoci JRN, Haglund MM, Bettger JP. Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda. BMC Health Serv Res 2018; 18:727. [PMID: 30236098 PMCID: PMC6149201 DOI: 10.1186/s12913-018-3510-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/29/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Community services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need. METHODS This study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services. RESULTS Of 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions. CONCLUSIONS Our study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.
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Affiliation(s)
- Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97313, Waco, TX 76798 USA
| | | | - Anna Martin
- Duke University, Sanford School of Public Policy, Durham, NC USA
| | - Sarah Jean Barton
- Physical Therapy and Occupational Therapy, Duke University Medical Center, Durham, NC USA
- Duke University Divinity School, Durham, NC USA
| | - Jasmine Seider
- Department of Orthopedic Surgery, Division of Physical Therapy, Duke University, School of Medicine, Durham, NC USA
| | - Christopher Fitzgibbon
- Mechanical Engineering and Materials Science, Duke University, Durham, NC USA
- Triangle Insights Group, Durham, NC USA
| | | | - Nelia Ekeji
- Duke University, Trinity College, Durham, NC USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Surgery, Division of Emergency Medicine, Duke University, School of Medicine, Durham, NC USA
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC USA
| | - Michael M. Haglund
- Duke Global Health Institute, Duke University, Durham, NC USA
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC USA
- Department of Neurosurgery, Duke University, Durham, NC USA
| | - Janet Prvu Bettger
- Duke Global Health Institute, Duke University, Durham, NC USA
- Duke University, Sanford School of Public Policy, Durham, NC USA
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Pryor W, Newar P, Retis C, Urseau I. Compliance with standards of practice for health-related rehabilitation in low and middle-income settings: development and implementation of a novel scoring method. Disabil Rehabil 2018; 41:2264-2271. [DOI: 10.1080/09638288.2018.1462409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Wesley Pryor
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Pushpak Newar
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
| | - Chiara Retis
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
| | - Isabelle Urseau
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
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18
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Rehabilitation in momentum of Norwegian coordination reform: From practices of discipline to disciplinary practices. ALTER 2017. [DOI: 10.1016/j.alter.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alary Gauvreau C, Kairy D, Mazer B, Guindon A, Le Dorze G. Rehabilitation strategies enhancing participation in shopping malls for persons living with a disability. Disabil Rehabil 2017; 40:917-925. [DOI: 10.1080/09638288.2017.1280093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christine Alary Gauvreau
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
- Centre intégré de santé et de services sociaux (CISSS) de Laval, Jewish Rehabilitation Hospital, Laval, Québec, Canada
| | - Dahlia Kairy
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Barbara Mazer
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre intégré de santé et de services sociaux (CISSS) de Laval, Jewish Rehabilitation Hospital, Laval, Québec, Canada
- School of Physical & Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Andréanne Guindon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
| | - Guylaine Le Dorze
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
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Jesus TS, Landry MD, Dussault G, Fronteira I. Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century. HUMAN RESOURCES FOR HEALTH 2017; 15:8. [PMID: 28114960 PMCID: PMC5259954 DOI: 10.1186/s12960-017-0182-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/12/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce. METHODS The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome. RESULTS The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas. DISCUSSION Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world. CONCLUSIONS Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.
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Affiliation(s)
- Tiago S. Jesus
- Portuguese Ministry of Education, Aggregation of Schools of Escariz, 4540-320 Escariz, Portugal
| | - Michel D. Landry
- Doctor of Physical Therapy Division, Duke University Medical Center, Duke University, Box 104002, 27710 Durham, NC United States of America
- Duke Global Health Institute, Duke University, Durham, NC United States of America
| | - Gilles Dussault
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Inês Fronteira
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
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Solvang PK, Hanisch H, Reinhardt JD. The rehabilitation research matrix: producing knowledge at micro, meso, and macro levels. Disabil Rehabil 2016; 39:1983-1989. [PMID: 27645805 DOI: 10.1080/09638288.2016.1212115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE EU policy documents and health scholars point out that in order to understand the complexity of modern health systems, as well as to devise appropriate policy responses, considering micro, meso, and macro levels is indispensable. This article aims to develop an analytical framework for how rehabilitation as an interdisciplinary field can be framed in such a three-level framework. METHODS This is a conceptual paper based on recent contributions to the development of a theory of rehabilitation. The paper applies sociological theory to build an analytical framework for a holistic understanding of rehabilitation. RESULTS Three groups of agents in the field of rehabilitation are identified: individuals with disabilities, professionals, and governmental authorities. The paper systematizes how these agents are positioned and act at micro, meso, and macro levels. In the intersection between the three levels of society and the three groups of actors, a nine-cell table emerges. In the cells of the table, key examples of important social processes to study in the field of disability and rehabilitation are identified. At the micro level, individuals experience a daily life relevant to rehabilitation, professionals ask what works in therapy, and policy authorities promote a strong work ethic. At the meso level, individuals with disabilities act as service user groups, professionals develop organizational designs and the policy authorities ask for cost-effective services. At the macro level, organizations representing people with disabilities lobby, professionals negotiate authorization issues, and the policymaking authorities must identify what can count as just distribution of services. The nine cells of the table are elaborated on by presenting relevant current studies exemplifying each cell. CONCLUSION To systematize societal levels and agents involved is to enhance the understanding of rehabilitation as an interdisciplinary field of research. Implications for rehabilitation Rehabilitation practice and research must relate to different levels of society and identify different social agents. Service users are not only individuals receiving therapy, but also organized agents influencing the organization of rehabilitation services as well as priorities made at the level of policy development. Both the results produced by health professionals doing a clinical trial and political scientists studying rehabilitation policy disputes will improve when placed in a wide frame of knowledge production.
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Affiliation(s)
- Per Koren Solvang
- a Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences , Oslo , Norway.,b Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Halvor Hanisch
- b Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine , University of Oslo , Oslo , Norway.,c Work Research Institute (AFI) , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Jan D Reinhardt
- d Swiss Paraplegic Research , Nottwil , Switzerland.,e Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland.,f Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University , Sichuan , People's Republic of China
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McVeigh J, MacLachlan M, Gilmore B, McClean C, Eide AH, Mannan H, Geiser P, Duttine A, Mji G, McAuliffe E, Sprunt B, Amin M, Normand C. Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis. Global Health 2016; 12:49. [PMID: 27558240 PMCID: PMC4997679 DOI: 10.1186/s12992-016-0182-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022] Open
Abstract
Background Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation. Methods An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Results Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Conclusions Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
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Affiliation(s)
- Joanne McVeigh
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.,School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland. .,School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland. .,Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Brynne Gilmore
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Chiedza McClean
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Arne H Eide
- Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.,SINTEF Technology and Society, P.O. Box 124 Blindern, NO-0314, Oslo, Norway.,Department of Health Science, Norwegian University of Science and Technology, Tungasletta 2, 7047 Trondheim, Norway
| | - Hasheem Mannan
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Priscille Geiser
- Handicap International Fédération, 138, avenue des Frères Lumière, 69008, Lyon, France
| | - Antony Duttine
- Handicap International, 8757 Georgia Avenue, Suite 420, Silver Spring, MD 20910, USA
| | - Gubela Mji
- Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Beth Sprunt
- Nossal Institute for Global Health, Level 4, Alan Gilbert Building, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Mutamad Amin
- Ahfad University for Women, P.O. Box 167, Omdurman, Sudan
| | - Charles Normand
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.,Health Policy & Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
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Berghs M, Atkin K, Graham H, Hatton C, Thomas C. Implications for public health research of models and theories of disability: a scoping study and evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04080] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundPublic health interventions that are effective in the general population are often assumed to apply to people with impairments. However, the evidence to support this is limited and hence there is a need for public health research to take a more explicit account of disability and the perspectives of people with impairments.Objectives(1) To examine the literature on theories and models of disability; (2) to assess whether or not, and how, intervention studies of effectiveness could incorporate more inclusive approaches that are consistent with these theories and models; and (3) to use the findings to draw out implications for improving evaluative study designs and evidence-based practice.Review methodsThe project is a scoping review of the literature. The first stage examines theories and models of disability and reflects on possible connections between theories of disability and public health paradigms. This discussion is used to develop an ethical–empirical decision aid/checklist, informed by a human rights approach to disability and ecological approaches to public health. We apply this decision aid in the second stage of the review to evaluate the extent to which the 30 generic public health reviews of interventions and the 30 disability-specific public health interventions include the diverse experiences of disability. Five deliberation panels were also organised to further refine the decision aid: one with health-care professionals and four with politically and socially active disabled people.ResultsThe evidence from the review indicated that there has been limited public health engagement with theories and models of disability. Outcome measures were often insensitive to the experiences of disability. Even when disabled people were included, studies rarely engaged with their experiences in any meaningful way. More inclusive research should reflect how people live and ‘flourish’ with disability.LimitationsThe scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.ConclusionsOur ethical–empirical decision aid offers a critical framework with which to evaluate current research practice. It also offers a resource for promoting more ethical and evidence-based public health research that is methodologically robust while being sensitive to the experiences of disability.Future workDeveloping more inclusive research and interventions that avoid conceptualising disability as either a ‘burden’ or ‘problem’ is an important starting point. This includes exploring ways of refining and validating current common outcome measures to ensure that they capture a diverse range of disabling experiences, as well as generating evidence on meaningful ways of engaging a broad range of disabled children and adults in the research process.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Maria Berghs
- Department of Health Sciences, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Carol Thomas
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Ståhl C. Placing people in the same room is not enough: An interprofessional education intervention to improve collaborative knowledge of people with disabilities. J Interprof Care 2016; 30:331-7. [DOI: 10.3109/13561820.2016.1147022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Serv Res 2016; 16:26. [PMID: 26801984 PMCID: PMC4722611 DOI: 10.1186/s12913-016-1268-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/12/2016] [Indexed: 11/28/2022] Open
Abstract
Background For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. Methods This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. Results 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019). Conclusions Wheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.
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Affiliation(s)
- Maria L Toro
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Programa de Ingenieria Biomedica, Escuela de Ingeniería de Antioquia y Universidad CES, Envigado, Antioquia, Colombia
| | - Chika Eke
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jonathan Pearlman
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. .,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
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Vaughan C, Zayas J, Devine A, Gill-Atkinson L, Marella M, Garcia J, Bisda K, Salgado J, Sobritchea C, Edmonds T, Baker S, Marco MJ. W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines. BMC Public Health 2015; 15:984. [PMID: 26419646 PMCID: PMC4588263 DOI: 10.1186/s12889-015-2308-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines. DESIGN W-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research. DISCUSSION This three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.
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Affiliation(s)
- Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Jerome Zayas
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
| | - Alexandra Devine
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Liz Gill-Atkinson
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Manjula Marella
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Joy Garcia
- WOWLEAP, 73 Edelweiss St., ESLA Urban Homes, Bgy. Sto. Domingo, Cainta, 1900, Rizal, Philippines.
| | - Krissy Bisda
- PARE, CAPWD, Bgy. Calamba EcoCenter, Calamba, 6000, Cebu City, Philippines.
| | - Joy Salgado
- Likhaan Center for Women's Health, 27 St., Ofelia Subdivision, Ofelia, Project 8, Quezon City, 1106, Metro Manila, Philippines.
| | - Carolyn Sobritchea
- University of the Philippines Center for Women's Studies Foundation, Magsaysay Ave., corner Ylanan St., Diliman, 1101, Quezon City, Philippines.
| | - Tanya Edmonds
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Sally Baker
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Ma Jesusa Marco
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
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Skempes D, Bickenbach J. Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities: a study protocol. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:25. [PMID: 26404637 PMCID: PMC4582732 DOI: 10.1186/s12914-015-0063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rehabilitation care is fundamental to health and human dignity and a human right enshrined in the United Nations Convention on the Rights of Persons with Disabilities. The provision of rehabilitation is important for reducing the need for formal support and enabling persons with disabilities to lead an independent life. Increasingly scholars and advocacy groups voice concerns over the significant barriers facing people with disabilities in accessing appropriate and quality rehabilitation. A growing body of research highlights a "respond-need" gap in the provision of rehabilitation and assistive technologies and underscore the lack of indicators for assessing performance of rehabilitation systems and monitoring States compliance with human rights standards in rehabilitation service planning and programming. While research on human rights and health monitoring has increased exponentially over the last decade far too little attention has been paid to rehabilitation services. The proposed research aims to reduce this knowledge gap by developing a human rights based monitoring framework with indicators to support human rights accountability and performance assessment in rehabilitation. METHODS/DESIGN Concept mapping, a stakeholder-driven approach will be used as the core method to identify rights based indicators and develop the rehabilitation services monitoring framework. Concept mapping requires participants from various stakeholders groups to generate a list of the potential indicators through on line brainstorming, sort the indicators for conceptual similarity into clusters and rate them against predefined criteria. Multidimensional scaling and hierarchical cluster data analysis will be performed to develop the monitoring framework while bridging analysis will provide useful insights about patterns of agreement or disagreement among participants views on indicators. DISCUSSION This study has the potential to influence future practices on data collection and measurement of compliance with human rights standards in rehabilitation service delivery and organization. The development of a valid and universally applicable set of indicators will have a profound impact on the design and implementation of evidence informed disability policies and programs as it can support countries in strengthening performance measurement through documentation of comparative information on rehabilitation care systems. Most importantly, the resulting indicators can be used by disabled people's organizations as well as national and international institutions to define a minimal standard for monitoring and reporting progress on the implementation of the Convention on the Rights of Persons with Disabilities in the area of rehabilitation.
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Affiliation(s)
- Dimitrios Skempes
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Guido A. Zaech Institute (GZI), CH-6207, Nottwil, Switzerland.
- Human Rights in Patients Care Program, Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Guido A. Zaech Institute (GZI), CH-6207, Nottwil, Switzerland.
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