The Role of Rehabilitation Within Low Resource Settings

Original Editor - Robin Tacchetti based on the course by Cornelia Barth
Top Contributors - Robin Tacchetti, Robin Leigh Tacchetti, Wanda van Niekerk, Tarina van der Stockt, Kim Jackson, Jess Bell and Stacy Schiurring

Introduction

"Physiotherapists in low-resource settings cannot simply be physiotherapists. They need a whole array of skills and understanding in order to fulfil the many roles their profession requires in [low resource] settings." -Cornelia Barth, Physiotherapist

Recent estimates by the World Health Organization state that over 2.4 billion people need rehabilitation services. 80% of these individuals are from low- and middle-income countries. Poverty breeds disability, and disability breeds poverty - the two are inherently linked. Malnutrition, non-potable water, unsanitary conditions and inadequate shelter compound the impact of poverty. Attaining healthcare services can be even more challenging in areas that are also grappling with political uncertainty, corruption, volatile security, lack of professional healthcare training, dysfunctional and/or overwhelmed health systems and insufficient roads to access services.

Purple=Advanced Blue=In Transit Orange=Less Developed Red= Least Developed

Health Inequalities in Low Resource Settings

"The problem rehabilitation currently has in low-resource settings is that very often, it is actually not part of the health system. Rehabilitation is often married to disability in the minds of policymakers. And fair enough, persons with disabilities do need rehabilitation, but that excludes the sector from being an equal component within health systems, from being presented within health ministries, rather than ministries of social affairs or other ministries, having a place on the table and access to health resources, access to certain research funding, to education models and all that within the network of health professions." -Cornelia Barth, Physiotherapist

Migration in Low Resource Setting

Poor people living in low-income settings tend to be the least healthy and benefit the most from healthcare. Social determinants of health, such as education, income level, gender, ethnicity, place of residence and employment status, directly correlate with the rate of illness, with lower-income countries bearing a higher burden of disease or illness.

Access to Care

Accessibility of healthcare services is a crucial problem. When discussing access to care, we must consider if the services are available, affordable and well-accepted.  

Availability

If healthcare services are provided within these settings, it is often of poor quality. Substandard or ineffective care tends to lead to mistrust in healthcare and a decrease in demand for these services. This, in turn, impacts whether or not individuals seek future care and generates mistrust of providers.

Affordability

When healthcare services are obtainable, are they affordable? 

Acceptability

People living in low-resource settings may have educational and cultural differences that may prevent them from pursuing healthcare services and/or they may not appreciate the potential health benefits of available services.

Rehabilitation Specific

The need for rehabilitation services is high and increasing in low-resource settings. However, there are low resources and low supply (in terms of quantity and quality). These countries have less than ten skilled rehabilitation providers per 1 million population.

"... it helps to understand that rehabilitation is the same everywhere. In the last years, we have seen huge developments in terms of definition of rehabilitation, of competencies, of education frameworks. Developed for a global world and not only high-resource settings. So rehabilitation, its core, its purpose, its concept is the same everywhere. It's the implementation that may vary greatly from one context to the other." -Cornelia Barth, Physiotherapist

The demand for rehabilitation services continues to increase as the world manages global warming, droughts, floods, natural disasters, war and conflict, epidemics and migration and displacement. This video by the World Health Organization explains why rehabilitation services are so important in low-income countries.

Future Course for Rehabilitation Professionals

"There's a huge diversity and complexity and the situation is very challenging. Then why does it matter? Because there's high needs that are met with low supply, human resources, infrastructure, and with low demand and low awareness and understandings, it's like a vicious circle. How do you make it work? Teamwork and partnerships. Different conditions but same purpose, learn from each other and strengthen each other." -Cornelia Barth, Physiotherapist

Knowledge

When working in low-income settings, rehabilitation professionals must investigate the region's local political, economic, cultural and social circumstances. Interventions from high-income countries should be adapted to the cultural norms of local settings. Additionally, when donating equipment and medication, it is necessary to consider the needs of the community to which they are being sent. Learning about the culture will prevent the misuse of donations, as in the real-life examples below:

1. Hip prosthesis provisions were distributed to a country where people were used to squatting  
2. Lice shampoo was dispensed to people who could not read and who viewed shampoo as a luxury that should be shared with others

Advocate

In low-resource settings, there is minimal recognition of rehabilitation services. This prevents the rehabilitation sector from gaining an equal footing in local health systems. Advocating for rehabilitation services to become a division within the Ministries of Health would allow rehabilitation professionals to access education models, health resources and research funding. Rehabilitation professionals should promote their services to health policymakers, local health authorities, and the people living within these areas.

Listen

Utilising high-income country interventions, even when they are evidence-based, may not be applicable in low-resource settings. Services must be determined by the people living in the region and reflect the situation of these diverse settings. The most effective way to initiate care is to listen to experts on the ground. These experts can identify available resources within that particular setting and any cultural beliefs that must be considered.

Partnerships

Rehabilitation professionals from higher-resource settings can assist low-resource healthcare professionals via education and professional development. Non-governmental organisations should move from short-term to long-term partnerships with local authorities to improve health care over time.

Resources

• World Health Organization: Rehabilitation 2030
• WHO: The need to scale up rehabilitation
• Role of Physiotherapists in Global Health
• Global Health
• Determinants of Health
• Rehabilitation Contexts
• Introduction to Rehabilitation