S. Suwal1, C. Retis2, G. Mareschal3, M. Bikram Shah4
1Handicap International (HI), Physical Rehabilitation Activity Program, Kathmandu, Nepal, 2Handicap International (HI), Technical Resources Division, Lyon, France, 3Handicap International, Physical Rehabilitation Activity Program, Kathmandu, Nepal, 4Handicap International (HI), Health System Strengthening, Kathmandu, Nepal

In many low and middle income countries rehabilitation is underdeveloped yet the need for rehabilitation is increasing globally. In Nepal, physiotherapy services have been integrated into basic package of health care and should be available at all levels of care, towards universal health coverage.  However, availability of physiotherapists is poor in the country with a limited capacity to deploy professionals out of city areas, to the rural areas. One strategy to address this gap is to train primary health care (PHC) workers based in primary health facilities on basic physiotherapy skills.

Purpose: To test basic physiotherapy skills to PHC workers and to integrate training curriculum into the Ministry of Health and Population’s (MOHP) existing curriculum of primary health care workers.

Methods: A technical working group (TWG) under MOHP was set up which comprised of Nepal physiotherapy association, government physiotherapists, public health experts and policy makers. 5-day training on basic physiotherapy skills was designed by the TWG with reference to available international literature and taking into account the local needs and priorities- a set of skills such as body re positioning, mobility training, stretching, strengthening, range of motion exercises, breathing exercises, safe transfer were selected for priority conditions. 143 PHC workers were trained by 10 trainer physiotherapists in rotation basis. Trainees knowledge and skills improvement were assessed by comparing pre-and post-training tests and pre and post skill transfer tests respectively. Likewise, experience of developing and conducting the training was formally evaluated and shared with MoHP.

Results: The training curriculum transferred knowledge on basic physiotherapy interventions on selected health conditions (Pre-test average knowledge score of the trainees was 50%, whereas the average knowledge score was 87% in post-test indicating increase in knowledge level of trainees from the training). Before the training, 88% of total trainees were having limited rehabilitation skills while 12% showed good rehabilitation skills. Meanwhile, 80% of trained trainees showed good rehabilitation skills while 20% showed limited rehabilitation skills. Likewise, consultation with policy makers and trainees recommended to integrate basic physiotherapy skills in the selected health conditions into MOHP’s existing curriculum of PHC workers which will ensure comprehensive care at the primary level health facilities.  

Conclusion(s): As a result of the training, both knowledge and skills of the primary health care workers on provision of basic physiotherapy interventions increased. The curriculum and training conducted by physiotherapists to PHC workers shows promising results in imparting knowledge and skills on basic physiotherapy. Hence, the finding of this study highlights the possibility of integrating basic physiotherapy skill into PHC workers practice. However, further evaluation on effectiveness of training needs to be conducted to understand the long term effect of the training, especially by measuring functional outcomes on patients receiving treatment by the trained PHC workers.

Implications: The training curriculum should be rolled out and scaled up including refresher training for PHC workers. However, the training curriculum needs to be adapted and get aligned with global Essential package of rehabilitation interventions being developed by WHO for primary health care level.  

Funding, acknowledgements: DFID through the “Study on basic physiotherapy skill transfer implemented by Handicap International, Nepal” project.

Keywords: Primary health care, Skill transfer, Physiotherapy

Topic: Globalisation: health systems, policies & strategies

Did this work require ethics approval? No
Institution: Handicap International
Committee: Handicap International
Reason: Not required as no patients were involved in data collection and analysis.

All authors, affiliations and abstracts have been published as submitted.

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