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Chakraborty R1, Hasan R2, Jalal F3, Marella M4, Smith F4, Pryor W4
1Handicap International - Humanity & Inclusion, Technical Unit, Dhaka, Bangladesh, 2National Disabled Development Foundation, Planning, Dhaka, Bangladesh, 3Handicap International - Humanity & Inclusion, Programme, Dhaka, Bangladesh, 4University of Melbourne, Nossal Institute for Global Health, Melbourne, Australia
Background: Access to rehabilitation services is essential to reach universal health coverage and to ensure healthy lives and promote well-being for all. In Bangladesh, rehabilitation is often provided as a parallel system to health care by non-government organizations and through a network called Integrated Disability Service Centres (IDSCs), which are part of social services. IDSCs mostly provide physical therapy to both adults and children. Delays in attending rehabilitation are common and the coordination between IDSCs, health and other social services has been challenging. Separation of health and rehabilitation may limit the effectiveness and the uptake of existing services.
Purpose: As part of efforts to strengthen access to rehabilitation and to develop new strategies to optimise coordination of care, a research project investigated stakeholder perspectives on factors influencing the timely access to, and continuity of rehabilitation services.
Methods: A qualitative exploratory study was undertaken in three districts of Bangladesh: Kurigram, Narsingdi and Tangail. Existing frameworks were used as a theoretical basis to design semi-structured question guides. Nineteen representatives of health, rehabilitation and social services, and disabled people's organisations were interviewed. Thematic analysis was conducted using an inductive approach to generate codes and themes from the data using Nvivo software.
Results: For many people seeking rehabilitation, religious healers or advisers are the first information point; some service users access rehabilitation directly through word of mouth. Referral to rehabilitation from medical services is uncommon with an estimated delay of first access to rehabilitation of 6-12 months or more. Withdrawal or non-uptake is common at time of first medical care, first rehabilitation care and in long term rehabilitation phase. Service-related factors affecting timely uptake of rehabilitation services and continuity of care were poor knowledge or negative attitudes towards rehabilitation by medical professionals, especially at the primary level for first referral; indirect costs to access services over time and their limited availability; gaps in workforce and professional skills of staff. Individual-related factors were poor awareness, negative attitudes towards disability and negative beliefs in the community; unrealistic expectations on rehabilitation services, poor motivation among family members to accompany and to provide continuous support, and socio-economic status.
Conclusion(s): Coordination between health & medical services and rehabilitation is poor, which may cause delayed or inappropriate referrals of people who might benefit from rehabilitation and physical therapy. Poor awareness about rehabilitation services was a major factor both at the individual and systems levels. Stakeholders' recommendations to improve coordination included strengthening referral and information systems to enhance inter-sector collaboration, integrating rehabilitation and physical therapy into general health care system to increase coverage of acute and inpatient care, engaging communities and traditional healers.
Implications: Physical therapists and their professional organizations, along with many other stakeholders, have an essential role in strengthening rehabilitation, including through collaboration with health and social services. To address barriers to coordination, efforts to raise awareness of rehabilitation are needed. Working with policy makers, primary health care workers and traditional healers for timely identification, referral and continuous support of people in need of rehabilitation might address some of the observed issues.
Keywords: Coordination of care, Rehabilitation, Bangladesh
Funding acknowledgements: The European Union, through “Towards Global Health”, implemented by Handicap International-Humanity & Inclusion Bangladesh, with Nossal Institute for Global Health.
Purpose: As part of efforts to strengthen access to rehabilitation and to develop new strategies to optimise coordination of care, a research project investigated stakeholder perspectives on factors influencing the timely access to, and continuity of rehabilitation services.
Methods: A qualitative exploratory study was undertaken in three districts of Bangladesh: Kurigram, Narsingdi and Tangail. Existing frameworks were used as a theoretical basis to design semi-structured question guides. Nineteen representatives of health, rehabilitation and social services, and disabled people's organisations were interviewed. Thematic analysis was conducted using an inductive approach to generate codes and themes from the data using Nvivo software.
Results: For many people seeking rehabilitation, religious healers or advisers are the first information point; some service users access rehabilitation directly through word of mouth. Referral to rehabilitation from medical services is uncommon with an estimated delay of first access to rehabilitation of 6-12 months or more. Withdrawal or non-uptake is common at time of first medical care, first rehabilitation care and in long term rehabilitation phase. Service-related factors affecting timely uptake of rehabilitation services and continuity of care were poor knowledge or negative attitudes towards rehabilitation by medical professionals, especially at the primary level for first referral; indirect costs to access services over time and their limited availability; gaps in workforce and professional skills of staff. Individual-related factors were poor awareness, negative attitudes towards disability and negative beliefs in the community; unrealistic expectations on rehabilitation services, poor motivation among family members to accompany and to provide continuous support, and socio-economic status.
Conclusion(s): Coordination between health & medical services and rehabilitation is poor, which may cause delayed or inappropriate referrals of people who might benefit from rehabilitation and physical therapy. Poor awareness about rehabilitation services was a major factor both at the individual and systems levels. Stakeholders' recommendations to improve coordination included strengthening referral and information systems to enhance inter-sector collaboration, integrating rehabilitation and physical therapy into general health care system to increase coverage of acute and inpatient care, engaging communities and traditional healers.
Implications: Physical therapists and their professional organizations, along with many other stakeholders, have an essential role in strengthening rehabilitation, including through collaboration with health and social services. To address barriers to coordination, efforts to raise awareness of rehabilitation are needed. Working with policy makers, primary health care workers and traditional healers for timely identification, referral and continuous support of people in need of rehabilitation might address some of the observed issues.
Keywords: Coordination of care, Rehabilitation, Bangladesh
Funding acknowledgements: The European Union, through “Towards Global Health”, implemented by Handicap International-Humanity & Inclusion Bangladesh, with Nossal Institute for Global Health.
Topic: Service delivery/emerging roles
Ethics approval required: Yes
Institution: Nossal Institute for Global Health, University of Melbourne, Australia.
Ethics committee: Dentistry & Health Sciences Human Ethics Standing Committee
Ethics number: 1750328.1
All authors, affiliations and abstracts have been published as submitted.
