Journal of Rehabilitation Medicine 51-11 | Page 35

Table II. Objectives of the evaluation
1. To evaluate the successes and failures of the 2011–2013 training
programme.
2. To provide an impact assessment of the training programme and related
activities.
3. To guide future developments in Madagascar with a view to ensuring
sustainability of the programme.
4. To identify how the programme might be used as a model for other low-
income countries.
Table III. Malagasy informants for semi-structured interviews
• All doctors and all available physiotherapists who had undertaken the
training.
• Other health professionals within the same departments.
• Hospital managers and directors.
• Representatives from the University of Antananarivo’s Faculty of
Medicine.
• Regional government representatives.
• Representatives from appropriate non-governmental organizations within
the rehabilitation sector.
• Civil society groups.
• Patients and their families.
sustainable change (18–20). The evaluation was overseen by
a reference group comprised of representatives of Opt In and
UK clinician and academic volunteers, the Malagasy Faculty of
Medicine and MoH, and the doctors and physiotherapists who
had undertaken the training.
Data collection
Sixty semi-structured interviews were carried out (Table III)
in Madagascar. Eight focus groups were also conducted; the
50 participants included rehabilitation doctors, physiothera-
pists and prosthetic/orthotic technicians from 6 rehabilitation
centres (Fig. 2).
Rehabilitation training in Madagascar
849
Visits were made to 4 rehabilitation units across the country,
each of which had at least one doctor and one physiotherapist
trained by the programme, for workplace observations and
review of workplace records. The 4 units (Hôpital Joseph
Ravoahangy Andrianavalona (HRJA) Antananarivo, Centre
d’Appareillage de Madagascar (CAM) Antananarivo, Service
d’Appareillage et Réeducation (SAR) Mahajanga, SAR Toama-
sina) were chosen to represent the geographical and sociological
diversity of Madagascar.
In the UK, 13 semi-structured interviews were carried out
with informants, including volunteers who had participated
in delivering the training, members and trustees of Opt In and
representatives of the teaching hospitals.
Relevant documentation was reviewed as secondary evidence
including: planning documents and volunteer reports from Opt
In; the MoU between LTHT, Opt In and the Malagasy partners;
plans and reports from the rehabilitation units; and reports from
doctors having undertaken the DU.
A literature review was carried out to place the evaluation
in context within the current available literature, specifically
national and international rehabilitation policy, international de-
velopment, skills transmission and medical education in LMICs.
RESULTS
Achievement of programme objectives
All 8 doctors completed the training and passed the
required assessments, including written papers and
Objective Structured Clinical Examinations (OSCEs)
(21). Seven of the 10 physiotherapists completed the
training, some of which was specific to physiotherapy
although the course was not specifically designed for
physiotherapists.
The feedback from the doctors who undertook the
DU was unanimously positive and everyone reported
that they had gained extensive knowledge and practical
skills: “The programme is very objective and recog-
nizes the realities of our country”. Its emphasis on
the practical application of rehabilitation techniques
alongside theoretical knowledge was highlighted as
one of the main benefits of the course. “The training
did not only focus on medical conditions but also on
how the doctor can improve their day-to-day clinical
practice”. The physiotherapists also enjoyed the course
and gained skills. However, there was some discontent
expressed with regards to the lack of certification or
direct career benefit for the physiotherapists.
Impact
Fig. 2. Location of rehabilitation centres in Madagascar included in the
evaluation (17).
Prior to the DU course, there was no specialist clini-
cal training for doctors in rehabilitation medicine in
Madagascar. Doctors were seconded from general
practice into rehabilitation and there was no continuing
professional development. The course provided them
with a sound body of relevant clinical knowledge and
practical skills. Several doctors went on to undertake
managerial responsibilities within their units. Partici-
J Rehabil Med 51, 2019