On 6 July ReLAB-HS partner Humanity & Inclusion hosted an event to discuss the importance of rehabilitation for achieving SDG 3. A side event to the United Nations (UN) High Level Political Forum, the session focussed on both learning from the COVID-19 crisis and looking beyond it, to the crucial role rehabilitation will play in the achievement of SDG 3. Zoe Duckworth and Hayley Stewart report back.
It is estimated that 2.4 billion people globally have a health condition that would benefit from rehabilitation. Of these 2.4 billion people, greater consideration is generally given to those with chronic conditions. COVID-19, however, has showed how rehabilitation can be essential to addressing the effects of infectious diseases. Over the duration of the pandemic, we have seen that rehabilitation is fundamental in addressing acute needs, for example respiratory needs in intensive care, but also the short and long-term consequences of COVID-19.
Dr Alarcos Cieza, who oversees WHO’s work on prevention of deafness and blindness, disability and rehabilitation, says rehabilitation is underprioritized, under resourced and completely undervalued, stating that, for years, rehabilitation has been put in a small box, believed only to benefit those with long-term disabilities. But this is not the case.
Janet Bettger, an Associate Professor and health services researcher at Duke University, summarised global research that commenced a month into the pandemic. Her team worked with twelve low-, middle-, and high-income countries to describe the impact of COVID-19 on rehabilitation services, using the Rehabilitation 2030 framework. The stories that emerged showed significant negative impact. Rehabilitation beds were converted to increase capacity for acute COVID-19 patients. This delayed in-patient rehabilitation admissions, shortened the length of in-patient stay, led to early discharge, and most patients were discharged with minimal training, impacting families and caregivers.
Outpatient rehabilitation was largely suspended in all countries or offered at a reduced capacity. Community-delivered and home-based rehabilitation was limited to critical services. The cessation or reduction of rehabilitation services during the pandemic compromised the health and functioning outcomes of rehabilitation users, and increased mortality.
However, telehealth was recognized as a service which could help increase access to rehabilitation. These services were adopted in countries such as Tanzania, where technology had played no role in rehabilitation until that point. The Tanzanian Ministry of Health supported the development of a text and telephone-based rehabilitation strategy in Northern Tanzania for physicians and therapists to address their second leading cause of disease burden – musculoskeletal pain, particularly in the lower back.
Smitha Sadasivan, an advocate for persons with disabilities, spoke about how rehabilitation is unavailable or unaffordable for large swathes of the population – who live in poverty, in rural areas, and in particular in low- and middle-income countries. In many of these countries there are only ten rehabilitation professionals per million people. Experiences of persons with disabilities show that for certain groups intersecting identities can make barriers more difficult to overcome – for example access can be more challenging for women and girls, in many contexts.
ReLAB-HS works to improve the integration of rehabilitation within health systems. Where this integration is successful, access to services improves. Ariane Mangar, Director of Rehabilitation Services at the Ministry of Health in Guyana told how two weeks after lockdown was implemented, telerehabilitation began to be utilised in Guyana, with professionals using WhatsApp and phone calls to communicate with patients. By August 2020, a specialist hospital was developed to treat COVID-19 patients and free up resources. 85% of rehabilitation staff have been vaccinated, more physiotherapists and occupational therapists have been hired, and additional services rolled out to rural areas. Such community-based, accessible rehabilitation can be a powerful tool to aid in the attainment of SDG3. With adequate political will, resources can be mobilized, the rehabilitation workforce can be strengthened, and more persons in need of rehabilitation can improve their functioning and participation.
Deputy General Director of Humanity & Inclusion Florence Daunis said her organization saw health systems, especially those in already fragile contexts, were not able to continue responding to other health needs while managing the pandemic emergency. NGOs that deliver rehabilitation services and/or accompany governments to make this happen had to significantly adapt their operations, to continue responding to the most pressing needs in critical times. In recent months, Humanity & Inclusion have announced the deployment of telerehabilitation in countries including Bolivia, Cambodia, Colombia, Nepal and Rwanda, to prevent complications and maximize functionality for persons who face a high risk of developing co-morbidities if they do not receive rehabilitation services.
This valuable event once more highlighted the importance of a multi-stakeholder approach to tackling rehabilitation delivery, and of integrating these services into the larger health system. Innovations such as telerehabilitation, utilized alongside a people-centred approach will help reach more of those in need of these vital services. SDG 3 cannot be achieved without accessible, quality rehabilitation services for all, which in turn will play a key role in delivering many of the other Sustainable Development Goals.
Photo credit: “Eye hospital waiting area during COVID-19 pandemic” by Community Eye Health is licensed under CC BY-NC 2.0