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

Recent estimates by the World Health Organization state that over 1 billion people in the world need rehabilitation services, 80% being from low and middle-income countries.  Poverty breeds disability and disability breeds poverty as they are inherently linked.  Compounding poverty in these settings is malnutrition, non-potable water, unsanitary conditions and inadequate shelter. Attaining healthcare services in these poor areas is particularly challenging as many of them are also grappling with political uncertainty, corruption, volatile security, lack of professional healthcare training, dysfunctional and/or overwhelmed health system and insufficient roads to access services.

Health Inequalities in Low Resource Settings

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 have a direct correlation on the rate of illness with lower income-countries bearing a higher burden of disease or illness..

Access to Care

Accessibility to healthcare services is a crucial problem.  When discussing access to care, one needs to consider if the services are available, affordable and well accepted.  

• Availability

If healthcare services are provided within these settings, oftentimes it is found to be of poor quality.  Substandard care or non- effective care lends itself to mistrust in healthcare and a decrease in demand for these services.  This in turn will hinder beliefs in seeking future care and breed mistrust in providers.

• Affordability

When healthcare services are obtainable, are they affordable?  

• Acceptability

People living within these 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.

Rehabilitation Specific

Within low resource settings, the needs for rehabilitation services are high, however, there are low resources and low supply (meaning both quantity and quality). These countries have less than ten skilled rehabilitation providers per 1 million population.   The demand for these services continues to increase as the world manages global warming, droughts, floods, natural disasters, war and conflict, epidemics and migration and displacement.

Migration in Low Resource Setting

Future Course

Knowledge

Working in low-income settings requires investigating the local political, economical, cultural and social circumstances within that region.  High-income country interventions should be adapted to the cultural norms of local settings.  Additionally, donations of equipment and medication should bear in mind the needs of the location to which they are being sent.Learning about the culture will prevent a misuse of donations as in the real life examples below:

1. hip prosthesis provisions distributed to a country where people were used to squatting.  
2. dispensing of lice shampoo to illiterate people who view shampoo as a luxury and like to share with others

Advocate

In low resource settings there is minimal recognition of rehabilitation services preventing this sector from having equal footing within the local health systems. Advocating rehabilitation services to be a division within the Ministries of Health would allow professionals to access education models, health resources and research funding.  Rehabilitation professional should promote their services to health policymakers, local health authorities and to the people living within these areas.

Listen

Utilizing high-income country interventions, even evidence-based research, is not applicable for these settings.  Provided services will need to be determined by the people living there and the situation within these diverse settings.  the most effective way to initiate care is to listen to experts on the ground. These experts can identify resources that are available within that particular setting and any cultural belief.

Partnerships

Western professionals can assist low resource healthcare professionals via education and professional development.  NGOs should move from short-term to long-term partnerships with local authorities to improve health care over time. 

Resources

• https://www.who.int/initiatives/rehabilitation-2030
• https://www.who.int/disabilities/care/Need-to-scale-up-rehab-July2018.pdf
• Role of Physiotherapists in Global Health
• Global Health
• Determinants of Health
• Rehabilitation Contexts
• Introduction to Rehabilitation