The Role of Rehabilitation Within Low Resource Settings
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Top Contributors - Robin Tacchetti, Robin Leigh Tacchetti, Wanda van Niekerk, Tarina van der Stockt, Kim Jackson, Jess Bell and Stacy Schiurring
Introduction[edit | edit source]
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.[1] Compounding poverty in these settings is malnutrition, non potable water, unsanitary conditions and inadequate shelter.[2] 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.[3]
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Health Inequalities[edit | edit source]
Poor people living in low income settings tend to be the least healthy and benefit the most from healthcare. Social factors 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 have a higher burden[4].
Access to Care[edit | edit source]
It is well understood that in low income countries accessibility to healthcare services is the major problem. Accessibility or availability encompasses acceptability and affordability.
- 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. If these services effectiveness is low, there is less opportunity for them to see benefits of receiving care. This in turn does not breed trust among the providers or treatments. [5]
- 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.
- Affordability
When healthcare services are obtainable, are they affordable?
Rehabilitation Specific[edit | edit source]
Within low resource settings, the needs for rehabilitation services are high. With this high demand however, there are low resources and low supply (meaning both quantity and quality). In low income countries, there are less than ten skilled rehabilitation providers per 1 million population. [6] The demand for these services is growing as the world deals with global warming, droughts, floods, natural disasters, war and conflict, epidemics and migration and displacement.(CB) [7]
How to change[edit | edit source]
- Knowledge
Working in low income settings requires investigating the local political, economical, cultural and social circumstances within that region. High income country interventions may need to be adapted differently in these settings based on their cultural norms. Utilizing donations of equipment and medication should bear in mind the needs of the location to which they are being sent.[8] Understanding their culture can prevent misutilization of donated goods such as these two examples:
- hip prosthesis provisions were distributed in a country where people were used to squatting.
- dispensing of lice shampoo to illiterate people who view shampoo as a luxury to be shared with others[8]
2. Advocate
Advocating for rehabilitation services in low resource settings must be done with people living there, local health authorities and health policy makers. Because of insignificant recognition of rehabilitation, this sector is not on equal footing within the health systems. Becoming a division within the Ministries of Health would allow the rehabilitation professionals to access education models, health resources and research funding. (CB)
3. Listen
Utilizing high income country interventions (even evidence based research) is not applicable for these settings. Services provided will need to be determined by the people living there and the situation within these diverse settings. Effective strategies for interventions are to start by listening to experts on the ground who can make suggestions on identify resources that are available within that particular setting. (CB)
4. 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. [8]
5. Fiscal
Money can be utilized in many ways for these low resource settings including the following:
- can focus on prevention
- Improve local services
- Support for patients who cannot pay
- Supplies for hospitals, clinics [8]
Resources[edit | edit source]
- https://www.who.int/initiatives/rehabilitation-2030
- https://www.who.int/disabilities/care/Need-to-scale-up-rehab-July2018.pdf
- https://members.physio-pedia.com/?p=58368&preview=1&_ppp=8924e7926c
- https://www.physiospot.com/2019/07/03/rehabilitation-2030-the-second-meeting/
- https://members.physio-pedia.com/?p=58368&preview=1&_ppp=8924e7926c
- Global Health
- Rehabilitation Contexts
- Introduction to Rehabilitation
References[edit | edit source]
- ↑ Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. International journal of environmental research and public health. 2018 Oct;15(10):2165.
- ↑ Orach D, Garimoi C. Health equity: challenges in low income countries. African health sciences. 2009 Oct 1;9(s2):S49-51.
- ↑ Barth CA. Meeting the needs of people with physical disabilities in crisis settings. Bulletin of the World Health Organization. 2019 Dec 1;97(12):790.
- ↑ https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
- ↑ Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Hafizur Rahman M. Poverty and access to health care in developing countries. Annals of the new York Academy of Sciences. 2008 Jun;1136(1):161-71.
- ↑ Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. International journal of environmental research and public health. 2018 Oct;15(10):2165.
- ↑ Jesus TS, Landry MD, Hoenig H. Global need for physical rehabilitation: systematic analysis from the Global Burden of Disease Study 2017. International journal of environmental research and public health. 2019 Jan;16(6):980.
- ↑ 8.0 8.1 8.2 8.3 Bauer I. More harm than good? The questionable ethics of medical volunteering and international student placements. Tropical diseases, travel medicine and vaccines. 2017 Dec;3(1):1-2.
