Journal of Rehabilitation Medicine 51-11 | Page 37

Rehabilitation training in Madagascar
tunities and Madagascar has now joined AFSCIN as an
active member, with a representative on the executive
board, and plans for the national congress in 2020 to
have spinal cord injury rehabilitation as its main topic.
An outcome of considerable national importance
was the development of a specialist rehabilitation
team for acute spinal cord injuries in HJRA (29). The
team, led by Dr Renaud Rakotonirainy, consists of
a rehabilitation physician, 2 specialist nurses and a
physiotherapist. This service has shown great success
in reducing complications such as pressure ulcers and
urinary tract infections (29, 30). Dr Rakotonirainy is
now supporting the development of a second service
in Fianarantsoa, which is due to start in 2019.
The treatment of clubfoot, a common, disabling, but
treatable, childhood condition, has been transformed
in Madagascar since the introduction of the Ponseti
method. Crucial to this success was a joint study with
Malagasy and UK partners into problems faced by
parents in accessing this treatment. This not only led
to service changes, but helped to secure funding to
facilitate uptake of this method (11).
As part of efforts to build the multidisciplinary team,
an orthotist from Madagascar was supported to attend
training at the Tanzania Training Center for Ortho-
paedic Technologists (TATCOT), a training school
recognized by the International Society for Prosthetics
and Orthotics (ISPO) in 2018 (31).
DISCUSSION
This paper has described the evaluation of a specific
teaching and professional development programme
co-designed by Malagasy and UK rehabilitation pro-
fessionals, based on a robust needs analysis. It led to
a series of enduring improvements in rehabilitation
services in Madagascar.
Key factors for success
The evaluation identified a number of key factors that led
to the successes (Table V), as presented briefly below.
Clearly-focussed aim. The programme had clear, locally
determined aims from the outset, with a focus on skills
Table V. Key factors for success of a global training partnership
• Clear, focussed aim
• Strong, collaborative leadership within both countries
• Co-operative approach
• Demand-driven, based on local needs
• Commitment and motivation from trainees
• Skilled and motivated trainers
• Support from Ministry of Health and Faculty of Medicine
• Strategic vision and integration into national policy
• Sustainability
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transfer. This is in line with Larkan’s framework for
global health partnerships, which states that having a
clear focus with common goals is the first step in ac-
hieving a successful partnership (32). It was understood
from the beginning that it would not tackle wider issues,
such as requests for equipment or material help. This
was important, given the limitations of budget and time.
Strong collaborative leadership. Much of the pro­
gramme’s success can be attributed to the collaborative
leadership from Malagasy and UK individuals. Dr So-
nia Adrianabela from the Malagasy MoH was a crucial
figure with the drive and experience to make change
possible. Her clear vision and political astuteness
were pivotal in the programme’s success. In the UK,
Professor Anne Chamberlain was the driving force be-
hind the development of the DU. She provided strong
leadership based on her experiences of developing
rehabilitation services over 3 decades in the UK. The
8 “Principles of Partnership” outlined by the Tropical
Health and Education Trust (THET), which focus on
building sustainable partnerships, place emphasis
not only on the role of each organization, but also of
individuals committed to effecting change (33–35).
Cooperative approach. The 2 countries adopted a
cooperative approach throughout the development of
the programme, with common goals and motivations.
This mutual support and commitment to joint learning
was highlighted by the evaluation and has led to the
development of a lasting reciprocal relationship. This
is reflected in John et al.’s 2016 article, whose main
resulting theme for success of a global research part-
nership was “mutual respect and benefit” (36).
Demand driven, based on local needs. Importantly, the
training programme was developed with a ground-up
approach; the teaching methods and topics were di-
rectly related to the needs of the Malagasy clinicians
and their patients.
Commitment and motivation from trainees. One of the
key factors in this success was the Malagasy trainees,
who were receptive to the teaching and had a clear vision
of what they wanted to achieve, allowing them to surpass
the expected outcomes of the programme and achieve
wider change. Involving trainees in the development of
programmes and empowering them to make change can
help to build and maintain motivation and commitment.
Skilled and motivated trainers. The volunteers who gave
their time to teach had the relevant clinical skills and
the necessary attitudes and personal attributes to work
effectively in a challenging, low-resource environment.
They received pre-departure training and support whilst
in-country. The benefits of volunteering abroad are well-
recognized and are discussed in a UK parliamentary
J Rehabil Med 51, 2019