Does Gender affect Access to Rehabilitation for People with Amputation in Ethiopia? Perspectives of Health Workers

This study aimed to explore healthcare workers' perspectives on the factors impacting access to and participation in rehabilitation services for people with amputation in Ethiopia, with a specific focus on gender aspects.

A community-based participatory research approach was employed from October 2022 to January 2023. Consultative workshops with experts and community engagement through local research advisory committees were integral to the study. Data were collected via semi-structured one-to-one interviews with 4 female and 18 male healthcare workers from hospitals and a rehabilitation center. Interviews were recorded, transcribed, translated and analysed using reflective thematic analysis. Themes and sub-themes were identified and agreed upon by the research team, using mind-maps to highlight interconnectivity.

Five main themes with interconnecting sub-themes were identified:

1. Barriers to Access Rehabilitation Services: knowledge and awareness, fear and violence, cultural beliefs, long distances, transportation challenges, financial constraints, physical environment, and acceptability/utilization of prostheses.
2. Resources: quality of materials and physical infrastructure, workforce shortages.
3. Rehabilitation System: need for comprehensive rehabilitation to support independent living, user engagement strategies, and service design improvements.
4. Perceptions of Patients' Experiences: psychological/emotional impacts, relationship and coping challenges, and physical impairments.
5. Health Outcomes: pain, wound healing, and prosthetic discomfort.

Healthcare workers' insights reveal complex and multifaceted struggles faced by women with amputation, which compromise their rights to equal rehabilitation services. The study highlights the need for gender-inclusive programmes addressing financial constraints, cultural barriers, limited decision-making capacity, and transportation issues. Community-based programmes, cultural adaptations, and innovative prosthetic designs are crucial for empowering women. Furthermore, specific policies and campaigns are necessary to promote greater gender diversity among healthcare professionals.

The study's findings emphasize the necessity for policy changes to ensure gender-inclusive rehabilitation services. This includes addressing financial and logistical barriers, enhancing community-based programs, and promoting cultural sensitivity. Increasing the workforce involved in rehabilitation, with a focus on gender diversity, is essential. Future research should continue exploring gender-specific barriers and the impact of healthcare workers' gender on service utilization. Implementing community awareness programs and fostering multi-stakeholder collaborations are vital for sustaining engagement and driving innovation in rehabilitation services.