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The World Report on Disability ( WRD ) ( WHO and the World Bank ) indicates an escalating prevalence of disability , due to global population ageing , a rise in chronic conditions ( including non-communicable diseases ; NCDs ) and an upsurge in natural / man-made disasters ( 1 , 4 ).
The WRD supports implementation of the CRPD with special emphasis on PM & R ( 1 ), and highlights inadequacies in resources and access for PwD , especially in LMICs ( 5 – 7 ). In 2005 , only 3 % of individuals who needed rehabilitation globally received the service and a third of countries did not allocate specific budgets for PM & R services ( 1 ). Further , a 2006 global survey of government action ( n = 114 countries ) for implementation of UN Standard Rules on Equalization of Opportunities for PwD reported that rehabilitation policies were not adopted in 48 countries ( 42 %), legislation on rehabilitation for PwD not passed in half ( 50 %) member states , and rehabilitation programmes were not established in 46 countries ( 40 %) ( 8 ). It is estimated that people needing prostheses or orthotic-related services represent 0.5 % of the population in developing countries , whilst 30 million people in Africa , Asia , and Latin America require over 180,000 PM & R professionals to cater for the needs of PwD ( 9 , 10 ). Ethnic minorities , elderly citizens , women , children , refugees and the displaced are more vulnerable amongst the PwD ( 11 ). The burden of disease and subsequent disability in Sub-Saharan Africa ( including Nigeria ) is colossal . The region is one of the least developed in the world in terms of rehabilitation opportunities ( 12 , 13 ). In 2008 , there were only 6 trained rehabilitation physicians listed in the region , all located in South Africa ( 12 , 13 ).
The WHO “ Global Disability Action Plan 2014 – 2021 ( GDAP ): Better Health for All People with Disability ” ( 14 ), provides a list of specific actions and metrics of success to achieve 3 main objectives : remove barriers to health services ; strengthen / extend rehabilitation , assistive-technology , support services , and community-based rehabilitation ; and collection of disability data . The GDAP framework is a step forward in provision of PM & R services for PwD , and integrates PM & R into national and international policy development . However , it can be challenging for many LMICs and for the PM & R community , as it sets high standards requiring evidence-based rehabilitative care ( 15 ). The potential for successful implementation of GDAP is not clear , especially in LMICs , where provision of rehabilitations to PwD remains a challenge ( 7 , 16 – 18 ). Our earlier reports highlight significant challenges in this area specifically in Madagascar ( 17 ), Mongolia ( 16 ) and Pakistan ( 18 ). These reports were based on the data collected during organized workshop-programmes in these countries to document challenges and strengths within the existing healthcare systems , corresponding with the established objectives listed in the GDAP . Although , these countries varied in terms of healthcare systems , nature and status of disability , healthcare work force and provision of PM & R services , there were many commonalities in terms of barriers / challenges in caring for PwD and the views of local healthcare professionals as to how to overcome these challenges ( 16 ).
This aim of this study was to identify potential barriers and facilitators for implementation of GDAP objectives in Nigeria and to compare the findings with those from other LMICs : Madagascar , Mongolia and Pakistan .
METHODS
The authors ( FK , MG ), as a part of the Rehabilitation Flying Faculty from the Royal Melbourne Hospital ( RMH ) team , were invited as independent experts to run an organized 3-day intensive educational workshop programme by the College of Medicine , University of Ibadan and Blossom Neurorehabilitation Centre , Ibadan , Nigeria ( affiliated with the World Federation for Neurorehabilitation ) ( March 2017 )). The team previously conducted similar workshops in Madagascar , Mongolia and Pakistan ( 16 – 18 ). Within the Nigerian programme , a 1-day exercise concentrated solely on utilizing the GDAP framework to educate participants , build workforce capacity , develop PM & R standards and operational set-up for PM & R services within the country . This exercise was approved by the local institution and the Royal Melbourne Hospital .
Participants and procedure
The training programme at the Ibadan University was attended by 196 healthcare professionals from various hospitals , community and academic rehabilitation centres across Nigeria . These included : 21 neurologists , 98 physiotherapists ( PT ), 23 nurses , psychologists and social workers , 11 occupational therapists ( OT ) and prosthetists and orthotists ( P & O ), 7 speech pathologists and 31 resident medical doctors , research officers and students . The participants were from various PM & R facilities across the country ( including rural areas , private sector ).
Details of participants and methodology for the GDAP exercises in Madagascar , Mongolia and Pakistan have been described in previous reports ( 16 – 18 ).
Over the training period , the authors ( FK , MG ) assumed a facilitator role in conducting an intensive teaching programme and 1-day consensus meeting based on the objectives of the GDAP . Prior to the detailed workshops , the authors summarized the GDAP , evidence in the www . medicaljournals . se / jrm