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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