By Sarah Magoba for ReLAB-HS

The need for rehabilitation and assistive technology (AT) services in Uganda is high—according to 2019 estimates by the World Health Organization (WHO)one in six people could benefit from rehabilitationThe Systematic Assessment of Rehabilitation Situation (STARS) completed earlier this year in Uganda found that, among other factors, the delivery of quality rehabilitation and AT services is hindered by an insufficient workforce and the scarcity of available services, particularly at the primary care level.  

To address this gap, Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS), in collaboration with the WHO, trained non-rehabilitation providers (medical doctors, clinical officers, and nurses) to deliver basic rehabilitation services at the primary care level. The training was conducted using the Basic Rehabilitation Package Clinical Resource (BRP-CR), a newly developed WHO resource. With this training, ReLAB-HS aims to expand the skill sets of primary care providers to improve the availability of and access to rehabilitation services in Uganda.  

Expanding skill sets and strengthening integration  

The WHO developed the Basic Rehabilitation Package Clinical Resource (BRP-CR) for primary health care providers. The resource is designed to support the delivery of “low-cost, high-impact, evidence-based interventions for rehabilitation.” 

In August 2023, ReLAB-HS, with the support of WHO rehabilitation experts, trained primary care providers from the districts of Gulu, Lira, Iganga, and Mayuge on the BRP-CR, focusing on mobility, pain, and self-care. These were selected based on the needs identified in the districts ReLAB-HS is working in. The training covered the three steps in the provision of basic rehabilitation (assess, deliver care, and monitor). The providers learned the following skills:   

  • Conducting an assessment to determine the rehabilitation need 
  • Determining the appropriate rehabilitation intervention and need for referral 
  • Setting rehabilitation goals with the client based on the client’s priorities  
  • Teaching the client exercises appropriate for the rehabilitation need and the client’s priorities 
  • Creating a monitoring plan to review client progress 

The training also included rehabilitation professionals. This provided an opportunity to engage the rehabilitation professionals during the training, to build strong links between the primary care providers and rehabilitation professionals, and to promote continuous mentorship. In total, 77 health workers were trained—60 primary care providers and 17 rehabilitation professionals (mentors). 

Based on the concept of task-sharing, the BRP-CR is intended for use by the existing health workforce at the primary health care facilities in low-resource settings. These are called Health Centers III and IV in the Ugandan health system. At this level, the number of rehabilitation workers is limited or unavailable. The BRP-CR is designed to guide the clinical decision-making of the primary care providers, enabling them to identify rehabilitation needs and provide basic rehabilitation for adults, such as simple exercises, transfers, and training on how to execute activities of daily living. The BRP-CR expands providers’ skill sets and supports the integration of rehabilitation services into existing primary care services, improving access to rehabilitation services and bringing quality services closer to the community.  

The trained primary care providers reflected on the value of the BRP-CR in enhancing their clinical practice. Dr. Okabo Denis, a medical officer of Abala Health Center III, said, “The training is very important, it will help us to identify, assess and manage patients with rehabilitation needs. I have learnt the basic steps to rehabilitation, how to deliver assessment, delivery of care, and monitoring.”  

Dr. Daniel Kyabayinze, Director Public Health at the Ministry of Health and the chief guest at the training, said in his closing remarks, “The government is now upgrading all Health Centre IIIs to Health Centre IVs. As the Government changes its approach to service delivery, we shall ensure integration of rehabilitation and AT services, which [are] key at all levels of care.”  

Expanding access to rehabilitation services  

By training primary health care providers on the BRP-CR, ReLAB-HS has advanced efforts to strengthen Uganda’s health system. The training has equipped these providers with specialized skills that will allow them to provide basic rehabilitation services to individuals in their respective communities who might otherwise not be able to access services. 

To further these efforts, ReLAB-HS will continue to strengthen rehabilitation service delivery by facilitating increased collaboration between primary care providers and rehabilitation professionals in the target districts, working toward improved coordination of rehabilitation services and quality of care.