Rehabilitation 2030:

Workforce strategies to address unmet needs for

rehabilitation services in low and middle income

countries

Dr Cliona O’Sullivan

University College Dublin

Ireland

@mycliona cliona.osullivan@ucd.ie

‘Global trends in health and aging require a major scaling up

of rehabilitation services in countries around the world and in

low- and middle-income countries in particular’,

WHO 2017

80% 20%

Rehabilitation 2030

THE IMPACT

OF DISABILITY

Worse education

outcomes

Reduced livelihood

opportunities

Greater healthcare

spend

Stigma and

discrimination

Social isolation

Carer stress

Limited access to

rehabilitation and social

services

Poverty

References:

WHO World Disability Report

O’Sullivan and McLachlan, (2007)

Crosbie et al, (2014)

BESTMINIMAL

BUSINESS IDEA

July 5th 2015

Munich

‘A set of measures that assist individuals who experience or who are likely to experience disability to achieve and maintain optimum functioning in interaction with their environment’

Definition of Rehabilitation , (WHO 2011)

Physiotherapist/Occupational Therapists/

Prosthetists Orthotists/ Physical medicine physicians

.

Ministries for health

Community Based RehabilitationWorkers/ PT-OT assistants/

Exercise professionals

Family members& care givers

.

Human Resources for Physical RehabilitationWho are the workforce ?

LACK OF REHABILITATION WORKERS

FINANCIAL RESOURCES

INTEGRATION INTO HEALTH SYSTEMS

EDUCATION AND TRAINING

GOVERNANCE

Challenges in Physical Rehabilitation

Workforce Planning

Evidence informed practice in physical rehabilitation in low and middle income settings….

……… ‘Reverse evidence’“A child with mild CP who has never had rehab with contractures, no independent function and not going to school, a patient with stroke discharged after 2 days in

hospital that spends the next 6 months in bed deteriorating when they could have been up and mobile, an amputee with contractures and pain and no chance of a prosthesis”.

…Rehabilitation for children with Cerebral Palsy(Mullins et al, 2017, paper in preparation)

Participants

(n)

Pre-

intervention

GMAE score

(%)

Post-

intervention

GMAE score

(%)

Mean

difference

Improvement

(%)

p-value

Total 67 29.49 ± 15.50 34.36 ± 14.97 4.87 ± 5.80 *0.00000002

Male 34 33.54 ± 16.35 36.97 ± 16.89 3.43 ± 5.34 *0.000395

Female 33 25.32 ± 13.56 31.67 ± 12.39 6.35 ± 5.96 *0.000014

GMFCS Level 2 4 51.30 ± 11.74 56.05 ± 11.22 4.75 ± 2.48 0.068

GMFCS Level 3 9 39.09 ± 17.52 42.75 ± 18.75 3.66 ± 4.65 *0.028

GMFCS Level 4 17 37.12 ± 6.46 41.47 ± 9.58 4.35 ± 7.07 *0.015

GMFCS Level 5 37 21.29 ± 13.01 26.71 ± 11.30 5.42 ± 5.77 *0.000013

Rural 29 31.71 ± 13.41 35.13 ± 13.70 3.42 ± 5.64 *0.002

Urban 38 27.79 ± 16.89 33.77 ± 16.03 5.98 ± 5.75 *0.000001

BESTMINIMAL

BUSINESS IDEA

July 5th 2015

Munich

Rehabilitation post spinal cord injury..

…A case example

“The blind spot of

contemporary science is

experience, if we only use the

past as our guide, it is

impossible to envision and

create a better future”.

Francisco Varela

(1946 – 2001)

The way forward

Strengthen education and training

• GOVERNMENT COMMITMENT

• STANDARDS AND COMPETENCIES

• PARTNERSHIPS

Policy

Governance

Different cadres of rehabilitation workers

Strengthen rehabilitation research

within health systems research

Integration into existing health services

THANK YOUQUESTIONS?

1

4

Mr Jean Damascene Gasherebuka, Physiotherapist, Rwanda

Mr Joseph Capo-Chichi, Physiotherapist, Benin

Dr Seini Baro, Physiotherapist, Niger

Mr Herman Kazibwe, Physiotherapist, Uganda

Ms Cornelia Barth, ICRC, Switzerland

Ms Uta Prehl, Handicap International, Burkina Faso

Mr Pete Skelton, Handicap International, UK

Dr Mike Landry, Duke University, US

Dr Emma Stokes, President, World Confederation for Physical Therapy

Acknowledgements

Referencesintellectual disabilities in Western Ghana'. Physical Therapy Reviews, 19 (1).

• Crosbie S, O'Sullivan C (2014) 'Attitudes and beliefs of parents/carers of children with physical and intellectual disabilities in Western Ghana'. Physical Therapy Reviews, 19 (1).

• Jesus T, landry M, Dussault G, Fronteira I (2017) ‘Human Resources for Health 9and rehabilitation): Six Rehab-Workforce Challenges for the Century’. Human Resources for Health. 15:8

• Lindley RI, Anderson CS, Forster A, et al. (2017) ‘Family led rehabilitation after stroke in India (ATTEND): a randomised controlled trial’, 390:588-99

• O’ Dowd J, MacLachlan M, Khasnabis C, Geiser P. (2015) ‘Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries, Disability, CBR and Inclusive Development. 26 (3)

• O’Sullivan C, M. MacLachlan, (2009) 'Childhood Disability In Burkina Faso and Sierra Leone: An Exploratory Analysis' In: M. MacLachlan, Swartz L; (eds). Disability and Development: Towards Inclusive Global Health. New York: Springer. pp.161-181

• O’Sullivan C, Kazibwe H, Whitehouse Z, Blake C, (2017), ‘Constructing a global learning partnership in Physiotherapy: An Ireland Uganda Initiative’, Frontiers in Public Health, June 2017

• WHO. Global strategy for human resources for health: Workforce 2030. Geneva. World Health Organisation 2016 [

• WHO. World Report on Disability. Geneva. World Health Organisation. 2011

• WHO. Rehabilitation in Health Systems. Geneva. World Health Organisation. 2017

• WHO. Community Based Rehabilitation. CBR Guidelines. Geneva. World Health Organisation. 2010

• World Confederation for Physical Therapy (2012). WCPT guideline for physical therapist professional entry level education 2012 [cited 2016 4thDecember] Available from: ttp://www.wcpt.org/guidelines/entry-level-education