A rehabilitation training partnership in Madagascar (original) (raw)
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Evaluating a global health partnership rehabilitation training programme in Madagascar
Journal of Rehabilitation Medicine
Rehabilitation services play an important role in helping people with disabilities to participate fully in everyday life. In Madagascar, a training programme in rehabilitation medicine was run jointly by partners in Madagascar and the UK from 2011 to 2013. This led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme. Trainees gained new knowledge and practical skills, leading to significant lasting improvements to rehabilitation services. A national association of rehabilitation professionals was formed. UK volunteers also benefited from the experience, gaining skills relevant to their current professional roles. A clear vision and strong working partnerships between the 2 countries was crucial to this success. Rehabilitation is increasingly recognized as an important focus for international development. Successful rehabilitation training programmes can be achieved at low cost with global health partnerships, as described here. These learning points are applicable to other contexts. Objective: Rehabilitation services play an important role in optimizing functional ability and societal integration for people with disabilities. The Madagascar Rehabilitation Programme (2011-2013) resulted from a global training partnership and led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme methods, results and learning points. Methods: A combination of qualitative methods was used for the evaluation, based on a Theory of Change model, with informants from Madagascar and the UK. Results: Malagasy trainees and UK volunteers gained new theoretical knowledge and practical skills. For Madagascar, it led to changes in working practice and the formation of a national rehabilitation association. Key to its success was the strong collaboration between Malagasy and UK professionals, with support from the University and Ministry of Health in Madagascar, and the UK partners. Having a clear common vision ensured the programme met the needs of the Malagasy clinicians. Conclusion: Rehabilitation is increasingly recognized as an important focus for international development. Successful rehabilitation training programmes can be achieved at modest costs with global health partnerships. The combination of factors that enabled this programme to be a success is reproducible in other contexts.
Journal of rehabilitation medicine, 2015
To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach...
Disability and Rehabilitation, 2013
Purpose: The aim of this manuscript is to describe recent changes in rehabilitation medicine education in Croatia, and to highlight the effort that was made at University of Split School of Medicine, as well as at University Hospital Split in order to improve training in rehabilitation medicine. Method: Critical collection and study of pertinent data on evolvement and present state of physical and rehabilitation medicine (PRM) education in Croatia. Results: Education in physical medicine and rehabilitation in Croatia was mainly focused on rheumatology rather than rehabilitation. In order to satisfy the new standards set for quality of rehabilitation medicine national curriculum reform was made for medical students, specialist and physiotherapists and new rehabilitation medicine training centers were established throughout the country. Conclusions: Academic setting such as PRM training center Split enables education for different health professionals at the same place and time, which provides opportunities for learning about competencies of other team members and development of future collaboration. Also, a uniform approach to education in rehabilitation medicine is provided for all health professionals. All of this sets a solid foundation for education of integrated rehabilitation team and achieving excellence in contemporary Croatian PRM.
Disability & Rehabilitation, 2009
Introduction: the medical specialty of physical and rehabilitation medicine has had a proven impact on people with disabilities and on healthcare systems. Documents such as the White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, in some regions the practice has not been well defined. Objective: to explore the practice of physical and rehabilitation medicine in Sub-Saharan africa and antarctica. Methods: Medline searches, membership data searches, fax survey of medical schools, internet searches, and interviews with experts. Results: the continents are dissimilar in terms of climate and government. However, both Antarctica and Sub-Saharan africa have no physical and rehabilitation medicine training programs, no professional organizations, no specialty board requirements, and no practising physicians in the field. Since there are no known disabled children on Antarctica and adults are air-lifted to world-class healthcare, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of Sub-Saharan Africa, including approximately 78 million people with disabilities, are left unserved. Conclusion: Antarctica is doing fine, but Africa is in a crisis. Local medical schools, hospitals doctors, and people with disabilities, along with foreign volunteers, aid groups, and policy makers can have an impact on the crisis. However, governments, specifically national ministries of health, are ultimately responsible for the health and well-being of their citizens.
Journal of Rehabilitation Medicine, 2009
Introduction: the medical specialty of physical and rehabilitation medicine has had a proven impact on people with disabilities and on healthcare systems. Documents such as the White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, in some regions the practice has not been well defined. Objective: to explore the practice of physical and rehabilitation medicine in Sub-Saharan africa and antarctica. Methods: Medline searches, membership data searches, fax survey of medical schools, internet searches, and interviews with experts. Results: the continents are dissimilar in terms of climate and government. However, both Antarctica and Sub-Saharan africa have no physical and rehabilitation medicine training programs, no professional organizations, no specialty board requirements, and no practising physicians in the field. Since there are no known disabled children on Antarctica and adults are air-lifted to world-class healthcare, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of Sub-Saharan Africa, including approximately 78 million people with disabilities, are left unserved. Conclusion: Antarctica is doing fine, but Africa is in a crisis. Local medical schools, hospitals doctors, and people with disabilities, along with foreign volunteers, aid groups, and policy makers can have an impact on the crisis. However, governments, specifically national ministries of health, are ultimately responsible for the health and well-being of their citizens.
Neurological disorders affect one billion people worldwide and have significant disability-burden with longer-term functional and psychosocial issues that need comprehensive management, including rehabilitation. The prevalence of disability due to neurological conditions is escalating worldwide. These add to the economic burden for healthcare systems (particularly in low-resourced countries), where despite improved acute health care systems, health policies have not extended to include rehabilitation. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring collaborative coordinated effort of diverse sectors, professions, patients and community. This article provides a narrative overview of literature on neurorehabilitation in developing countries and highlights some of the challenges in implementation of the World Health Organization's Global Disability Action Plan (DAP), focusing on rehabilitation (Objective 2) within the context of neurological conditions. Several issues related to neurorehabilitation are discussed for a systematic approach to build horizontal health care systems that are sustainable and responsive; involvement of bilateral agencies using multi-sectorial approach, new partnerships, strategic collaboration; provision of technical assistance, research and development; and capacity-building for a strong interdisciplinary workforce. Other factors that need to be addressed include governance for strengthening health care systems through logistics, surveillance and service delivery; and adequate scaling. The DAP provides comprehensive summary actions to tackle global disability, including neurological disorder-related disability, and offers governments, policy-makers and other relevant stakeholders a blueprint for implementing recommendations of the World Disability Report and the Convention on the Rights of Persons with Disabilities, and facilitate social inclusion of persons with neurological conditions, in countries at all stages of development.
Teaching disability and rehabilitation medicine at the Medical School in Split, Croatia
Croat Med J, 2004
We describe the unsatisfactory situation of teaching disability and rehabilitation to medical students, focusing on countries of Central/Eastern Europe (CEE), sourcing a selection of relevant literature and reports of competent colleagues from these countries. Further, we present a model of teaching disability and rehabilitation medicine as it is now taught at the Medical School in Split, after the program for teaching Physical Medicine and Rehabilitation to the 5th year medical undergraduates was reformed in the academic year 2001/2002 to make it a satisfying educational experience that focuses on rehabilitation medicine, allowing acquisition of the competence necessary for managing persons with disability in the community. In an anonymous evaluation questionnaire, 96% of students thought that the new program was very good, that it contributed significantly to their general medical education, and was useful for their future work as general practitioners. We belive that the new program, which is broad in scope and content, well received by students, and attains its objectives, deserves to be introduced to a wider medical community.
Towards a conceptual description of Physical and Rehabilitation Medicine
Journal of Rehabilitation Medicine, 2011
physical and Rehabilitation Medicine (pRM) is an independent medical specialty focusing on the improvement of functioning. a shared understanding of concepts is of vital importance for integrated action in this field. The aim of the present paper is to provide a conceptual model of pRM, to give background on its development and adoptions, and to explain the choice of terms, phrases, and concepts. it is based on the terms and concepts of the international classification of Functioning, Disability and Health (ICF) that provides a widely accepted conceptual model and taxonomy of human functioning. Based on the White Book on physical and Rehabilitation Medicine in Europe of 2006 a first proposal for a conceptual description of rehabilitation has been published in 2007. this proposal has been subjected to comments for modifications and amendments. E.g. it was underlined that pRM can apply both a health condition perspective including curative approaches and measures aiming at body functions and structures and a multi-dimensional and multi-professional team approach aiming to optimize functioning from a comprehensive functioning and disability perspective. the interaction between the pRM specialist and the person should be characterized as a partnership. pRM specialists work across all areas of health services and across all age groups. in summary, the specialty of pRM is characterized as the medicine of functioning.
Frontiers in Public Health
The increase in life expectancy is linked, among other factors such as genetic factors, environmental factors, factors of medical conditions, socio-demographic factors, self-management, and access to care, to an increase in non-communicable diseases (NCDs) (1), which puts huge pressure on the health care systems. Cardiovascular diseases are, by far, the most common NCD in low-to middle-income countries (LMICs) (2); among these diseases, stroke is the most frequent (3). To face the huge public health challenge of NCDs and to lower their associated burden for patients and their families and caregivers, rehabilitation services are an essential part of management of these diseases (4). Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Rehabilitation can be provided in many different settings, from the conventional inpatient or outpatient hospital setting to private clinics or in community settings, such as an individual's home. The rehabilitation workforce is made up of different health workers, including but not limited to physiotherapists, occupational therapists, speech/language therapists, audiologists, orthotists, and prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses (5). Evidence-based practice (EBP) in rehabilitation has been defined by Novak et al. as "the cornerstone of care to maximize client outcomes through the application of best available interventions" (6).
Journal of Rehabilitation Medicine, 2012
physical & Rehabilitation Medicine (pRM) programmes in post-acute settings cover interventions for the rehabilitation of people with a variety of disabling health conditions. the setting of the intervention is more important than the timing and these programmes can be carried out in a variety of facilities. this paper describes the role of pRM services and of pRM specialists in delivering rehabilitation programmes to people, who have initially been admitted to hospital. the emphasis is on improving patients' activities and addressing participation issues. pRM programmes in post-acute settings provide a range of treatments and have a major influence in the long-term on the pace and extent of return of function and recovery from ill-health. This paper will define the meaning of post-acute settings and will describe the patient's journey through the post-acute setting. in particular, it addresses the standards of care across europe that patients should expect. this paper also examines the general principles of funding such programmes within the context of different health care systems across europe. coordinated care improves outcomes and economic profiles for both payers and providers of services. this paper describes the value of pRM interventions and pRM specialist-led teams in promoting better outcomes for people with disabilities with complex needs.