CONTINUING ESSENTIAL PHYSICAL REHABILITATION SERVICES DURING COVID-19: AN EXPERIENCE FROM FIVE PHYSICAL REHABILITATION CENTERS (PRCS) OF NEPAL

J.K. Singh¹, S. Suwal¹, G. Mareschal¹, Y.R. Niraula¹

Background: Strict COVID related lockdown (67,804 COVID cases reported on 9/23/2020) imposed in Nepal for more than 3 months disrupted dramatically the provision of essential services including rehabilitation. In Nepal, there was no guidance on measures to be taken by rehabilitation services, both private and government to protect health workers and beneficiaries while ensuring continuum of care.

Purpose: To support private and public rehabilitation actors to provide essential rehabilitation services during lockdown while ensuring the safety of rehabilitation professionals and clients.

Methods: Handicap International (HI) worked in close coordination with professional associations, disability networks and relevant actors under the leadership of Ministry of Health and Population (MOHP) to develop essential disability-inclusive Health and Rehabilitation Guidelines. Based on the guidelines, HI oriented 5 PRCs teams; while supporting them to receive Personal Protective Equipment (PPEs) and to operationalize MOHP guidance, especially for home visit, telerehabilitation, essential medical items provision, assistive devices repair & replacement and safety measures at center level.
Financial support was provided for ensuring implementation of activities at PRCs. Monitoring and reporting tools were developed and technical follow up rolled out by HI.  Data and reports collected from 5 PRCs were analyzed for monitoring impact of intervention.

Results: The five PRCs reached 514 beneficiaries through telerehabilitation,7 clients through home visits, 223 clients for essential medical items and health products, 38 clients for assistive devices provision and 33 clients for repair and replacement services. Center -based care and home visits to clients were very challenging due to local restriction from authorities, no transport facilities, risk of transmission in the community, lack of awareness to local authorities on the need of delivering rehabilitation services. Telerehabilitation proved to be new and safest way to reach out clients although challenges were faced due to weak internet or mobile phone network, limited client’s skills on digital technology and limited compliance with service delivery through technology.
Several challenges and mitigations such as adapting the infrastructures for safe services delivery, training the staffs on risk reduction, maintaining supply of PPEs, disinfectants and appropriate consumables for assistive devices were also identified when essential rehabilitation services partially resumed.

Conclusion(s): Telerehabilitation seems to be a  good strategy for ensuring access to rehabilitation services but there is a need to identify technology and protocols of use that are adapted to Nepal context. Providing information to local authorities and central MOHP on the importance of rehabilitation and guidance for home visit and center-based care is key to improve access to essential rehabilitation services in future pandemic with lockdown situation.

Implications: Future health system preparedness program targeting new potential pandemic must include rehabilitation. Local authorities should engage with local services to ensure that rehabilitation needs are met, providing safe services through home visit and center-based care during lockdown. Investment of MOHP to develop telerehabilitation protocols and the identification of appropriate technology is highly recommended to increase access to rehabilitation services in remote areas which is one of the main challenges in Nepal.

Funding, acknowledgements: USAID

Keywords: Essential Rehabilitation, COVID-19, Telerehabilitation

Topic: COVID-19

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: Ethics approval was not required as it was an adapted program related to COVID related lockdown situation.