Journal of Rehabilitation Medicine 51-11 | Page 33

J Rehabil Med 2019; 51: 847–853 SPECIAL REPORT EVALUATING A GLOBAL HEALTH PARTNERSHIP REHABILITATION TRAINING PROGRAMME IN MADAGASCAR Helen N. LOCKE, MBChB, MRCP 1,2 , Simone DOCTORS, MD 3 , Irene RANDRIAMAMPIANINA, MBBS 4 , M. Anne CHAMBERLAIN, DSC (hons) 1 and Rory J. O’CONNOR, MD, FRCP 1,2,5 From the 1 Academic Department of Rehabilitation Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, 2 National Demonstration Centre in Rehabilitation, Leeds Teaching Hospitals NHS Trust, 3 Independent International Development, Education and Human Resources Consultant, Leeds, UK, 4 Centre d’Appareillage de Madagascar, Befelatanana, 101 Antananarivo, Madagascar and 5 NIHR Devices for Dignity MedTech Co-operative, Royal Hallamshire Hospital, Sheffield, UK Objective: Rehabilitation services play an important role in optimizing functional ability and societal in- tegration for people with disabilities. The Madagas- car Rehabilitation Programme (2011–2013) resulted from a global training partnership and led to 8 doc- tors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme methods, results and learning points. Methods: A combination of qualitative methods was used for the evaluation, based on a Theory of Change model, with informants from Madagascar and the UK. Results: Malagasy trainees and UK volunteers gai- ned new theoretical knowledge and practical skills. For Madagascar, it led to changes in working prac- tice and the formation of a national rehabilitation association. Key to its success was the strong col- laboration between Malagasy and UK professionals, with support from the University and Ministry of Health in Madagascar, and the UK partners. Having a clear common vision ensured the programme met the needs of the Malagasy clinicians. Conclusion: Rehabilitation is increasingly recogni- zed as an important focus for international develop- ment. Successful rehabilitation training programmes can be achieved at modest costs with global health partnerships. The combination of factors that enab- led this programme to be a success is reproducible in other contexts. Key words: global health; rehabilitation; teaching; health services; development; partnership. Accepted Oct 22, 2019; Epub ahead of print Oct 28, 2019 J Rehabil Med 2019; 51: 847–853 Correspondence address: Helen N. Locke, Academic Department of Rehabilitation Medicine, D Floor, Martin Wing, Leeds General Infirmary, Leeds LS1 3EX, UK. E-mail: [email protected] A pproximately 15% of the world’s population live with a disability and this number continues to in- crease (1). Persons with disabilities are over-represented in low- and middle-income countries (LMICs). The Uni- ted Nations (UN) estimate that two-thirds of people with moderate or severe disabilities live in poverty worldwide (2, 3). The World Health Organization’s (WHO’s) World Report on Disability 2011 and Global Disability Action LAY ABSTRACT Rehabilitation services play an important role in helping people with disabilities to participate fully in everyday life. In Madagascar, a training programme in rehabilitation medicine was run jointly by partners in Madagascar and the UK from 2011 to 2013. This led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme. Trainees gained new knowledge and practical skills, leading to sig- nificant lasting improvements to rehabilitation services. A national association of rehabilitation professionals was formed. UK volunteers also benefited from the expe- rience, gaining skills relevant to their current professional roles. A clear vision and strong working partnerships bet- ween the 2 countries was crucial to this success. Rehabi- litation is increasingly recognized as an important focus for international development. Successful rehabilitation training programmes can be achieved at low cost with global health partnerships, as described here. These lear- ning points are applicable to other contexts. Plan 2014–2021 highlight disability as a truly global public health priority (1, 4). Rehabilitation services are an important actor in optimizing functional ability and societal integration for people with disabilities. Effec- tive rehabilitation encourages participation in society, reducing care costs and supporting people to return to education and employment, contributing to tax revenue and national development (5). However, a considerable gap remains between the need for rehabilitation and the services available. This is particularly true in LMICs such as Madagascar, where training for rehabilitation physicians and associated health professionals is often limited or non-existent (6). It is estimated that there are fewer than 0.5 rehabilitation professionals per 10,000 citizens in many sub-Saharan countries (7). Madagascar is the fifth poorest country in the world: an estimated 78% of its population of nearly 27 mil- lion live on less than US$1.90 per day (8). Political instability and lack of foreign aid have contributed to an enduring social and economic crisis, with a lack of stable public services, high rates of unemployment, food insecurity and diminishing educational level. An estimated 2.8% of the population of Madagascar live with a physical impairment, although the actual This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2621