By Fred Echeku and Gilliane McShane for ReLAB-HS
Rose Tibitondwa, a 74-year-old living in the Mayuge town council in Mayuge district, faced severe functional limitations. After surviving a heart attack in March 2024, during which she collapsed and fractured her leg, her recovery required her leg to be in a cast for two months.
Prior to her fall, Rose was fairly active, fetching water for her household, tending the garden, and working as a tradesperson in the community, among other tasks. While recuperating, however, she was unable to do most activities independently, including routine self-care, such as bathing or using the toilet. Though she had two homemade walking sticks to offer some assistance, she relied heavily on her family to support her in carrying out various activities, which became burdensome for everyone.
Before being discharged from the hospital, Rose learned from a health worker how physiotherapy services could assist in her recovery. Given the high cost of rehabilitation services and products, pursuing them did not seem like a feasible option for her.
Until recently in Uganda, rehabilitation and assistive technology (AT) services have only been available at higher-level facilities, such as hospitals or specialized facilities, often located far from small communities and unaffordable for many. To enhance community access to rehabilitation services, Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) has been supporting district-level stakeholders to integrate quality and affordable rehabilitation and AT services into the local health systems of select districts, including Mayuge. As a result of advocacy efforts, the Mayuge District Local Government recognized the growing need for these services and invested local resources to establish rehabilitation services at primary care facilities. This included:
During a follow-up home visit, a community health worker informed Rose that fully subsidized physiotherapy services were available and issued her a referral, encouraging her to seek care. Learning that the service fees were covered by the government and available at a local facility, she was more willing to go.
In May 2024, with the assistance of her grandson, she started attending rehabilitation services every Wednesday at Mayuge Health Centre IV, the primary care facility providing subsidized rehabilitation services. There, she learned how to do muscle-strengthening exercises to improve her functional mobility.
After just seven appointments, Rose’s functional abilities greatly improved. She became more independent, no longer needing the walking sticks to walk. She can now go to the garden to collect food. Regaining her muscle strength supported her to be independent, reducing her reliance on her family members for activities of daily living.
“With time, I want to resume attending community events,” she declared.
In addition to the part-time physiotherapists delivering services, ReLAB-HS and local stakeholders successfully advocated for the transfer of an orthopedic officer to Mayuge Health Center IV, expanding the range of services available to the community.
The investment of local resources to integrate rehabilitation and AT services at the primary care level has eliminated financial and logistical barriers for individuals like Rose, who would otherwise have limited options to restore their functioning. She expressed her appreciation for these services, stating, “I am very grateful to the health workers for the exercises at no cost.”
By financing these services on a small scale and prioritizing workforce development at the primary care level, the Mayuge District Local Government is demonstrating the feasibility of improving both geographical and financial access to essential health services needed by individuals like Rose.