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Mann M.1, Bachani A.1, Basoita G.2, Kobusingye O.3
1Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, 2Mulago National Referral Hospital, Physiotherapy, Kampala, Uganda, 3Makerere University, School of Public Health, Kampala, Uganda
Background: Currently, eighty percent of people with disabilities (PWD) live in low resource countries and the majority of them have limited access to rehabilitation services. The burden of disability is growing in these regions secondary to a demographic shift resulting in both an aging population worldwide, as well as an increase in injuries and chronic diseases. Numerous studies have demonstrated that lack of rehabilitative care by PWD can result in a limited ability to perform activities of daily living, participation restrictions, and a diminished quality of life. As in many low resource countries, rehabilitation services in Uganda do not meet the needs of PWDs.
Purpose: The aim of this study is to offer an overview of the current state of physiotherapy in Uganda as well as highlight opportunities for enhancing rehabilitative care and improving the quality of life for Ugandan PWD.
Methods: The study is based on seventeen qualitative semi-structured interviews with key informants and four clinical observations in public and private physical therapy departments in Uganda. Interviews were analyzed for recurring themes related to strengths, weaknesses, and gaps in physiotherapy practice and education.
Results: Strengths in physiotherapy included the presence of an established physiotherapy association, improvements in professional education, and ample job opportunities. Weaknesses included poor documentation including unfamiliarity with outcome measures, decreased clinical decision making skills, and an uncertain future for community-based rehabilitation (CBR). Among gaps reported was a lack of clinical specialists, minimal continuing professional development (CPD) opportunities, substandard educational programs, and a shortage of physiotherapists in rural regions of the country.
Conclusion(s): Uganda is currently experiencing multiple changes in the field of physiotherapy some of which have the potential to positively impact the quality of life of PWD while others present possible challenges to be overcome. Interventions are suggested at the societal, health system, and professional education levels in order to increase the quantity and quality of physiotherapy services. These include transitioning all physiotherapy professional education programs to a Bachelors level, initiating a transitional bridging Bachelors program for practicing physiotherapists, increasing affordable CPD options, expanding CBR programs, staffing hospitals with an adequate number of physiotherapists, improving transportation options for PWD, and carrying out publicity campaigns about the profession. Future work is needed to help bring these interventions to fruition.
Implications: The information gleaned from this research can be used to improve policies, practice, and education in the field of physiotherapy including the effort to improve professional education and access to rehabilitative care throughout the country. This should lead to increased utilization of rehabilitative care in order to increase the quality of life of PWD. Additionally, this research presents a replicable qualitative model for assessing physiotherapy in low-resource settings and uncovers challenges that are also experienced in other countries where profession of physiotherapy is in the early stages of development.
Funding acknowledgements: This work was supported by the grant #5D43TW009284 from the Fogarty International Center of the U.S. National Institutes of Health.
Topic: Professional issues
Ethics approval: The Johns Hopkins School of Public Health Institutional Review Board determined this study was exempt, and approval was not required.
All authors, affiliations and abstracts have been published as submitted.
