QUALITY OF PHYSIOTHERAPY CARE IN BURUNDI: NATIONWIDE ASSESSMENT IN PHYSIOTHERAPY CENTERS AND DEPARTMENTS

E. Havyarimana¹, E. Mpundu², A.P. Ishimwe¹, C. Sèbiyo Batcho³

¹National Reference Center for Physiotherapy and Rehabilitation Medicine, Bujumbura, Burundi, ²Ministry of Health, Bujumbura, Burundi, ³University Laval, Department of Rehabilitation, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada

Background: Assessing the quality of care is a fundamental approach to improve health system. In Burundi, the Ministry of health has implemented a system to evaluate the quality of physiotherapy care provided across the country. The most recent evaluation was conducted from September 2021 to October 2022.

Purpose: This work reports on the quality of care in physiotherapy centers in Burundi and the analysis of indicators likely to influence that quality of care.

Methods: A questionnaire was developed and validated by stakeholders for the 3 main levels of the Burundian health pyramid. Evaluation criteria were based on the quality of the infrastructures, availability of human resources and equipment, reception of patients, initial and final evaluations of patients, quality of treatment and the general organization of services. Trained investigators conducted assessments in physiotherapy centers across the country. The overall maximum score of the assessment grid was 200 points where higher score indicates an excellent quality of care.
For data analysis, Wilcoxon-Mann-Whitney testwas used to compare results across centers. In addition, Spearman's and Pearson’s coefficients were calculated to determine the indicators that influence the overall score obtained.

Results: Twenty- eight (28) physiotherapy departments and centers were evaluated. Scores ranged from 59.1 to 170.7 out of 200 with a mean of 115.8 ± 31.59. Results showed that in more than 60.7 % of physiotherapy centers the infrastructure and equipment did not meet the standard requirements. Human resources were not sufficient in 71.42 % of cases, and public and private centers had fewer qualified staff than those managed by confessional organizations (p< 0.001). The majority of patients were assessed by physicians and physiotherapists on admission, whereas in 60.7 % of the centers physiotherapists did not systematically conduct final assessments of patients before discharge. The rating for reception and general organization of the services was quite good (ranging from 62 % to 83.6 %) in most of the services evaluated.
The type of managers (r = 0.499; p = 0.006), availability of human resources (r = 0.49; p < 0.001) and general organization of services (r = 0.49; p = 0.008) showed a considerable correlation with overall score obtained. The quality-of-care score was also related to the quality of the physician's (r = 0.43; p = 0.022) and physiotherapists' (r = 0.44; p = 0.01) assessments as well as to the treatment performed by the physiotherapists (r = 0.46; p = 0.01).

Conclusions: The quality of care offered in physiotherapy departments and centers in Burundi is not yet satisfactory. Improvements still need to be made regarding infrastructures and equipment’s, recruitment of qualified personnel in public departments, and in the quality of assessments performed by physiotherapists. Recommendations were formulated during this evaluation and will allow for progress in the coming years.

Implications: The results of this evaluation facilitate internal self-evaluation of the physiotherapy departments and centers as well as the planning of health services management in the country. The methodology and tools used could serve as an example to start this activity in other countries.

Funding acknowledgements: This work was initiated by the Ministry of Health of Burundi with COPED and this project was funded by APEFE.

Keywords:
Quality of care
Physiotherapy
Burundi

Topics:
Globalisation: health systems, policies & strategies

Did this work require ethics approval? No

Reason: The ethics approal was not requered because the data collection for this study was not conducted directly on humans or animals. It is an investigation undertaken by the Ministry of Health in Burundi among the centers and services of physiotherapy.