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K. Dunleavy1, R. Dizazzo-Miller2, F. Pociask3
1University of Florida, Physical Therapy, Gainesville, United States, 2Wayne State University, Occupational Therapy, Detroit, MI, United States, 3Wayne State University, Physical Therapy, Detroit, MI, United States
Background: Sustainability of projects aiming to address the major rehabilitation needs in lower resource countries is considered one of the most important outcomes of initiatives. While some information on is available from public health and medical projects on promoting sustainability, there is less evidence on facilitators and barriers for sustainability of global rehabilitation development projects.
Purpose: The purpose of this study was to determine expert opinions of factors that promote and hinder sustainability in global rehabilitation projects.
Methods: Eleven medical and rehabilitation professionals with extensive experience and expertise in providing global rehabilitation development projects were recruited through a peer nomination process. Participants were included if they had >8 years of experience in global rehabilitation projects in > 3 countries Participants provided their opinions of factors contributing to the degree of sustainability (facilitators) and those considered barriers in telephonic interviews. Data-driven inductive coding of interview transcripts was conducted by 3 researchers with thematic analysis followed by discussion until agreement. Themes were confirmed by participants using a follow-up survey for triangulation.
Results: Participants were experienced academic educators, administrators or advisors for non-profit organizations involved in ongoing projects ranging from 2-30 years in 42 countries. All participants were English speaking (n=11) and some fluent in French, Spanish, Korean and Portuguese with most from the United States (n=9). The four factors that were identified as either facilitators and barriers for sustainability were related to the presence or lack of: 1) established processes and procedures, 2) government, health ministry and health organization support, 3) availability of trained local personnel and knowledge, and 4) long term funding, resources and equipment. Presence of established professional standards was a distinctive facilitator and disruptions from natural disasters and war were a distinctive barrier. An important element of planning was involvement of key local leaders and individuals in all phases of projects.
Conclusion(s): Factors impacting long term success of global rehabilitation programs were illustrated on a continuum. Established processes and procedures, support from government, health ministry and health organizations, availability of trained local personnel, and options for continued long term funding, resources and equipment are important to consider in planning and implementation. The presence of established professional standards was a distinctive facilitator while disruptions from natural disasters and war were obviously expected major barriers. An important element was involvement of key local leaders and individuals in all phases of projects. Findings are consistent with the WHO global disability action plan and Rehabilitation 2030 plan recommendations. Limitations of the study include primarily English speaking participants. Perspectives from host countries would be important for future studies.
Implications: Themes identified as both facilitators and barriers are important for needs assessment, planning and evaluation of global rehabilitation projects. Some of the barriers can be addressed in longer term projects, while long term funding and external systems such as government and health ministry support are more difficult to address. Key recommendations are identification and involvement of key individuals with the capacity to facilitate change.
Funding, acknowledgements: Funding was provided by the Wayne State University College of Pharmacy and Health Sciences
Keywords: Global rehabilitation, Sustainability, Development projects
Topic: Service delivery/emerging roles
Did this work require ethics approval? No
Institution: Wayne State University
Committee: Institutional Review Board
Reason: Exempt - IRB107514B3F
All authors, affiliations and abstracts have been published as submitted.
