PILOT FOR COMPREHENSIVE FACILITY-LEVEL ASSESSMENT OF NEUROLOGY AND NEUROSURGERY CARE CAPACITY IN UGANDA: REHABILITATION SERVICE FINDINGS IN SOUTHWEST REGION

K. Bullock¹, F. Nanyunja², R. Kasiita³, P. Njeru¹, A. Whithaus¹, M. Haglund¹, D. Koltai¹, T. Fuller¹

¹Duke University, Duke Global Neurosurgery & Neurology, Durham, United States, ²Mbarara University of Science and Technology, Physiotherapy, Mbarara, Uganda, ³Mulago National Referral Hospital, Physiotherapy, Kampala, Uganda

Background: Neurological disorders are leading causes of hospitalization and disability in Uganda. National registries reveal a collective ratio of only 0.9 physiotherapists (PT) and occupational therapists (OT) per 100,000 people. Rehabilitation is imperative to promote functional recovery, manage disability, and prevent readmission. National-level data is needed to support expansion of Uganda’s public rehabilitation sector.

Purpose: To evaluate overall care capacity, resource distribution, and referral patterns of neurologic rehabilitation services at three care continuum points (entry, in-patient, and outpatient) in Ugandan public facilities.

Methods: A cross-sectional survey adapted from The World Health Organization’s Template for Rehabilitation Information Collection, the Systematic Assessment of Rehabilitation Situation data collection tool, was conducted between July to August 2022. For adaption, two reviewers identified facility-level questions, with a Kappa value of 0.71. A third reviewer resolved discrepancies. Pre-dissemination patient public involvement clarified wording and comprehension. PT, OT and orthopedic technology (OTT) services were examined across domains of human resources, service delivery, infrastructure, equipment, and informatics. Public national, regional, and general hospitals in the Southwest Region were included. As allocation of public rehabilitation services is limited to hospital-level, Health Centers were excluded. Data was collected through in-person contact of facility administrators and subsequent identified departmental rehabilitation services leaders. Descriptive statistical analyses were performed.

Results: 14 facilities were surveyed, with 100% completion by facility administrators identifying 31 separate PT, OT, and OTT services. Of these, 29 (93.5%) departmental leaders completed their respective section, representing 10 (71.4%) PT, 7 (50%) OT, and 12 (85.7%) OTT services. Ten (71.4%) facilities had more than one rehabilitation service, and 5 (35.7%) had all three services. Workforces totaled 17 PTs, 11 OTs, and 19 OTTs in all facilities. Stroke was the neurologic condition with the most available rehabilitation treatment [PT: 8(80%), OT: 6 (85.7%), OTT: 7 (58.3%)]; while Neuro-Oncology was the least available across services [PT: 4 (40%), OT: 2 (28.6%,), OTT: 2 (16.7%)]. Acute, outpatient, and community practice settings identified PT in 6 (42.9%), 9 (64.2%), and 3(21.4%); OT in 6 (42.9%), 6 (42.9%), and 4 (28.6%), and OTT in 9 (64.2%), 12 (85.7%), and 4 (28.6%) facilities respectively. Facilities utilizing specialized clinic days for at least one service were 7(50%). One (7.1%) facility reported access to in-patient rehabilitation gym space, 8 (80%) PT and 3 (42.9%) OT services reported dedicated outpatient space, but no facility had specialized neurologic rehabilitation units. Mbarara Regional Referral Hospital received the most reported referrals from all services [9 (31.1%)].

Conclusions: Neurologic rehabilitation services are present but limited in Uganda’s Southwest Region public facilities, with low human resources and infrastructure, and few facilities providing treatment for all major neurologic conditions. Implementation displayed ability to capture detailed, facility-level information. Scaling to include all regions and all rehabilitation services is needed to elucidate national-level capacity.

Implications: This study informs current gaps in Uganda’s public health system to manage neurological disease/injury burden along the care continuum. Future countrywide data will aid policy development, strategic planning for capacity strengthening, and comparisons of prevalence and incidence to service availability, even beyond neurologic rehabilitation.

Funding acknowledgements: Funding provided by Duke Global Neurosurgery and Neurology, The Josiah Charles Trent Memorial Foundation Endowment Fund, and Duke Bass Connections

Keywords:
Neurologic Rehabilitation
Care Capacity
Care Continuum

Topics:
Neurology
Service delivery/emerging roles
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: Uganda National Council of Science and Technology

Committee: Uganda National Council of Science and Technology

Ethics number: Protocol HS2344ES