Assessment of Rehabilitation Capacity in Ghana
Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana.
Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author.
Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence-based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities.
Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts.
Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.
Abdullah F, Choo S, Hesse A, Abantanga F, Sory E, Osen H, Ng J, McCord C, Cherian M, Fleischer-Djoleto C, Perry H (2011). Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews. The Journal of Surgical Research; 171(2): 461-466.
Africa Health Workforce Observatory (2010). Human resources for health country profile. Available from: http://www.hrh-observatory.afro.who.int/en/hrh-country-profiles/profile-by-country.html [Accessed on 11 February 2014]
Agyepong I, Adjei S (2008). Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy and Planning; 23(2): 150-160.
Anderson C, Mhurchu C, Rubenach S, Clark M, Spencer C, Winsor A (2000). Home or hospital for stroke Rehabilitation? Results of a randomised controlled trial: II: Cost minimisation analysis at 6 months. Stroke: A Journal of Cerebral Circulation; 31(5):1032-1037.
http://dx.doi.org/10.1161/01.STR.31.5.1024. http://dx.doi.org/10.1161/01.STR.31.5.1032. PMid:10797162
Briffa T, Eckermann S, Griffiths A, Harris P, Heath M, Freedman S, Donaldson L, Briffa N, Keech A (2005). Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. The Medical Journal of Australia; 183(9): 450-455. PMid:16274344
Cadilhac D, Ibrahim J, Pearce D, Ogden K, McNeill J, Davis S, Donnan G (2004). Multicentre comparison of processes of care between Stroke Units and conventional care wards in Australia. Stroke: A Journal of Cerebral Circulation; 35(5): 1035-1040. http://dx.doi.org/10.1161/01.STR.0000125709.17337.5d. PMid:15060326
Cardenas D, Haselkorn J, McElligott J, Gnatz S (2001). A bibliography of cost-effectiveness practices in physical medicine and rehabilitation: AAPM&R white paper. Archives of Physical Medicine and Rehabilitation; 82(5): 711-719. http://dx.doi.org/10.1053/apmr.2001.24814. PMid:11346857
Chan D, Cordato D, O'Rourke F, Chan D, Pollack M, Middleton S, Levi C (2013). Comprehensive stroke units: A review of comparative evidence and experience. International Journal of Stroke: Official Journal of the International Stroke Society; 8(4): 260-264.
Choo S, Perry H, Hesse A, Abantanga F, Sory E, Osen H, Fleischer-Djoleto C, Moresky R, McCord C, Cherian M, Abdullah F (2010). Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Tropical Medicine & International Health; 15(9): 1109-1115. http://dx.doi.org/10.1111/j.1365-3156.2010.02589.x
Christian A, González-Fernández M, Mayer R, Haig A (2011). Rehabilitation needs of persons discharged from an African trauma centre. The Pan African Medical Journal; 10: 32. PMid:22187614 PMCid:PMC3240926
Connor M, Walker R, Modi G, Warlow C (2007). Burden of stroke in black populations in sub-Saharan Africa. The Lancet: Neurology; 6(3): 269-278. http://dx.doi.org/10.1016/S1474-4422(07)70002-9
Dunleavy K (2007). Physical therapy education and provision in Cambodia: A framework for choice of systems for development projects. Disability and Rehabilitation: An International, Multidisciplinary Journal; 29(11-12): 903-920.
Frye BA (1993). Review of the World Health Organisation's report on disability prevention and rehabilitation. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses; 18(1): 43-44. http://dx.doi.org/10.1002/j.2048-7940.1993.tb01287.x. PMid:8430265
Ghana Ministry of Health (2007).National Health Policy: Creating wealth through health. Accra'. Available from: http://www.moh-ghana.org/UploadFiles/Publications/NATIONAL%20HEALTH%20POLICY_22APR2012.pdf [Accessed on 11 February 2014]
Ghana Physiotherapy Association (2013). Established and scaling up physiotherapy education in University of Ghana. Available from: http://www.journal.physioghana.org/index.php/ScientificCongress/article/view/10 [Accessed on 11 February 2014]
Gupta N, Castillo-Laborde C, Landry M (2011). Health-related rehabilitation services: assessing the global supply of and need for human resource. BMC Health Services Research; 11: 276. http://dx.doi.org/10.1186/1472-6963-11-276. PMid:22004560 PMCid:PMC3207892
Haig A, Im J, Adewole D, Nelson V, Krabak B (2009). The practice of physical and rehabilitation medicine in sub-Saharan Africa and Antarctica: a white paper or a black mark? Journal of Rehabilitation Medicine; 41(6): 401-405. http://dx.doi.org/10.2340/16501977-0367. PMid:19479150
Joshipura M, Mock C, Goosen J, Peden M (2004). Essential trauma care: Strengthening trauma systems round the world. Injury; 35(9): 841-845. http://dx.doi.org/10.1016/j.injury.2003.08.005
Kengne A, Anderson C (2006).The neglected burden of stroke in Sub-Saharan Africa. International Journal of Stroke: Official Journal of the International Stroke Society; 1(4): 180-190. http://dx.doi.org/10.1111/j.1747-4949.2006.00064.x. PMid:18706015
Ko K, Sheppard L (2006). The contribution of a comprehensive stroke unit to the outcome of Chinese stroke patients. Singapore Medical Journal; 47(3): 208-212. PMid:16518555
Koton S, Schwammenthal Y, Merzeliak O, Philips T, Tsabari R, Bruk B, Orion D, Rotstein Z, Chapman J, Tanne D (2005). Effectiveness of establishing a dedicated acute stroke unit in routine clinical practice in Israel. The Israel Medical Association Journal; 7(11): 688-693. PMid:16308989
Lemogoum D, Degaute J, Bovet P (2005). Stroke prevention, treatment, and rehabilitation in sub-Saharan Africa. American Journal of Preventive Medicine; 29(5) Suppl 1: 95-101. http://dx.doi.org/10.1016/j.amepre.2005.07.025. PMid:16389133
Mock C, Arreola-Risa C, Quansah R (2003). Strengthening care for injured persons in less developed countries: a case study of Ghana and Mexico. Injury Control and Safety Promotion. 10(1-2): 45-51. http://dx.doi.org/10.1076/icsp.10.1.45.14114. PMid:12772485
Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M (2006). Evaluation of trauma care capabilities in four countries using the WHO-IATSIC Guidelines for Essential Trauma Care. World Journal of Surgery; 30(6): 946-956. http://dx.doi.org/10.1007/s00268-005-0768-4. PMid:16736320
Moodie M, Cadilhac D, Pearce D, Mihalopoulos C, Carter R, Davis S, Donnan G (2006). Economic evaluation of Australian stroke services: a prospective, multicentre study comparing dedicated stroke units with other care modalities. Stroke: A Journal of Cerebral Circulation; 37(11): 2790-2795. http://dx.doi.org/10.1161/01.STR.0000245083.97460.e1. PMid:17008615
Osen H, Chang D, Choo S, Perry H, Hesse A, Abantanga F, McCord C, Chrouser K, Abdullah, F (2011). Validation of the World Health Organisation tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World Journal of Surgery; 35(3): 500-504. http://dx.doi.org/10.1007/s00268-010-0918-1. PMid:21190114 PMCid:PMC3032911
Sagui E (2007). Stroke in sub-Saharan Africa. Médecine Tropicale: Revue Du Corps De Santé Colonial; 67(6): 596-600.
Saxena S, Thornicroft G, Knapp M, Whiteford H (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet (London, England); 370(9590): 878-889. http://dx.doi.org/10.1016/S0140-6736(07)61239-2
Saxena S, Lora A, Morris J, Berrino A, Esparza P, Barrett T, van Ommeren M, Saraceno B (2011). Mental health services in 42 low and middle-income countries: A WHO-AIMS cross-national analysis. Psychiatric Services; 62(2): 123-125. http://dx.doi.org/10.1176/ps.62.2.pss6202_0123. PMid:21285088
Tinney M, Chiodo A, Haig A, Wiredu E (2007). Medical rehabilitation in Ghana. Disability and Rehabilitation: An International, Multidisciplinary Journal; 29(11-12): 921-927.
Walsh T, Cotter S, Boland M, Greally T, O'Riordan R, Lyons D (2006). Stroke unit care is superior to general rehabilitation unit care. Irish Medical Journal; 99(10): 300-302. PMid:17274172
World Bank (2014a). Sub-Saharan Africa. Available from: http://data.worldbank.org/region/SSA [Accessed on 11 February 2014]
World Bank (2014b). Health expenditure, total (% of GDP). Available from: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS [Accessed on 13 February 2014]
World Federation of Occupational Therapists (WFOT, 2011). Occupational therapy human resources project 2010. World Federation of Occupational Therapists Bulletin; 63(1): 9-15.
World Health Organisation (2002). Global burden of disease. Geneva: WHO. Available from: http://www.who.int/healthinfo/global_burden_disease/estimates_regional_2002/en/ [Accessed on 13 February 2014]
World Health Organisation (2004a). Global burden of disease. Geneva: WHO. Available from: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/ [Accessed on 13 February 2014]
World Health Organisation (2004b). World report on road traffic injury prevention. Geneva: WHO. Available from: http://apps.who.int/iris/bitstream/10665/42871/1/9241562609.pdf [Accessed on 13 February 2014]
World Health Organisation (2006). World health report. Geneva: WHO. Available from: http://www.who.int/whr/2006/whr06_en.pdf [Accessed on 13 February 2014]
World Health Organisation (2008). Global atlas of the health workforce. Geneva: WHO. Available from: http://apps.who.int/globalatlas/default.asp [Accessed on 13 February 2014]
World Health Organisation (2009). Integrated management for emergency & essential surgical care (IMEESC) toolkit. Geneva: WHO Available from: http://www.who.int/surgery/publications/imeesc/en/ [Accessed on 13 February 2014]
World Health Organisation (2011). World report on disability. Geneva: WHO. Available from: http://www.who.int/disabilities/world_report/2011/report.pdf [Accessed on 13 February 2014]
- There are currently no refbacks.
Copyright (c) 2016 Asare Christian, Jacob Bentley, Richmond Aryeetey, Dzifa Ackuaku, R. Samuel Mayer, Stephen Wegener
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© Disability, CBR & Inclusive Development