The urgent and growing need for accessible rehabilitation and assistive technology (AT) services in Uganda is clear despite limited available data to guide health policy. The country’s health system includes rehabilitation and AT services; however, these services are largely provided at tertiary levels of care, such as national and regional hospitals located far from remote communities, presenting access barriers to many.
Rehabilitation and AT services are important for people who experience disability, as well as for people experiencing or likely to experience limitations in everyday functioning due to aging or health conditions, including chronic diseases or disorders, injuries, or trauma. Uganda, like other low- and middle-income countries, is experiencing an epidemiological transition characterized by an increasing burden of noncommunicable diseases, including cancer, diabetes, and cardiovascular diseases, and injuries, especially road traffic injuries, as well as effects associated with an aging population.
The increasing double burden of communicable and noncommunicable diseases in Uganda has increased the number of persons with functional difficulties. The World Health Organization (WHO) estimates that nearly 6.8 million people—or approximately one in six people—in Uganda could benefit from rehabilitation services. According to the Uganda National Population and Housing Census 2014, the overall disability prevalence rate for the population ages two years and older stands at 12.4%.
Launched in Uganda February 2021, Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) is working to address the unmet need for rehabilitation and AT services in Uganda by strengthening its health systems to improve service provision and to integrate these critical services at the community level to close the gap between current availability and future demands.
In Uganda, starting at the district level, we are implementing a comprehensive approach to support, expand, and sustain the delivery of high-quality care at community and primary care levels to meet the growing need for rehabilitation. ReLAB-HS’s activities are dedicated to improving coordination between facilities and providers, supporting processes to improve the quality of services, building the capacity of health system leaders and the rehabilitation workforce, and facilitating the development and implementation of a national strategy for rehabilitation and AT.
Working with public and private partners in selected districts, we are strengthening service delivery of rehabilitation and AT services by supporting coordination between health care facilities at the community and primary care levels and the regional level to reliably connect patients to appropriate services and assistive products. To improve availability and access, we are working with local stakeholders to integrate rehabilitation and AT services into existing services at primary care facilities. This will be achieved through increasing health care workers’ knowledge and skills for:
Working with district stakeholders, ReLAB-HS is supporting the integration of AT services into primary health care by improving procurement processes to increase the provision of simple assistive products, such as walking aids and toilet and shower chairs, that have the potential to dramatically improve functioning and quality of life.
ReLAB-HS is strengthening health system capacity by developing the skills of health system leaders and the health workforce to enhance access to rehabilitation services in order to improve population health and well-being.
Through our Global Rehabilitation Leadership Institute, we are developing health system and rehabilitation leaders’ competencies in understanding rehabilitation and health systems, developing a shared vision for rehabilitation, formulating a strategy for integrating rehabilitation within health systems, and collaborating with multi-sectoral and multi-disciplinary partners. Using this course, ReLAB-HS has strengthened leadership skills among key rehabilitation and health system actors, while also forging connections that will amplify efforts to effectively integrate rehabilitation and AT services into the Ugandan health system.
We are strengthening workforce capacity in Uganda by training rehabilitation and non-rehabilitation providers, such as doctors, nurses, and community health workers, to identify rehabilitation and AT needs, provide basic treatment, and initiate timely referral of patients to specialized services as needed. Training will focus on the treatment of priority conditions, such as clubfoot in children, and the provision of basic AT services, such as selecting appropriate AT to meet users’ needs, fitting products to users, and training them on how to use and care for products at home. This training will strengthen providers’ skills and build their confidence in the delivery of high-quality care.
In addition to clinical training for providers, ReLAB-HS is focusing on broad workforce development initiatives that will strengthen the educational environment. Working with rehabilitation professional associations, we are delivering continuing professional development according to the needs expressed by rehabilitation professionals. Additionally, we are supporting professional associations to identify gaps and take steps to strengthen professional regulation and institutional education for rehabilitation professions.
To promote the inclusion of rehabilitation and AT as part of essential health services, ReLAB-HS is strengthening strategic planning in Uganda through several initiatives. In collaboration with the WHO, we are supporting the Ministry of Health to carry out assessments that determine the country’s capacity to effectively deliver rehabilitation and AT services. These assessments identify gaps or weaknesses in the health system (such as rehabilitation services being unavailable at primary care facilities), informing what actions the government should prioritize. In tandem, ReLAB-HS is assessing current financing for rehabilitation to determine where government investments will be most valuable.
Using findings from these assessments, we are assisting the Ministry of Health to develop and implement Uganda’s National Rehabilitation and AT Strategic Plan, which will guide efforts by the government and relevant stakeholders to strengthen Uganda’s health system.
To support ongoing strategic planning, ReLAB-HS is working with the Ministry of Health to update Uganda’s health management and information systems to collect rehabilitation-related information. This improvement will enable collection of current and reliable data that will support performance improvement among providers and facilities, as well as inform the Ministry of Health where attention is needed.
ReLAB-HS has made important progress toward strengthening rehabilitation and AT in Uganda’s health system:
Johns Hopkins International Injury Research Unit (JH-IIRU). JH-IIRU, within the Johns Hopkins Bloomberg School of Public Health, leads the ReLAB-HS consortium. The Research Unit identifies effective solutions to the growing burden of injuries in low- and middle-income populations, influences public policy and practice, and advances the field of injury prevention throughout the world. Since its creation in 2008, JH-IIRU has led cutting-edge research in global injury prevention and control. JH-IIRU is active in over 30 countries around the globe, implementing a coordinated strategy involving research, education and practice. In recognition of its growing role as a leader in injury prevention, the Unit was designated as a World Health Organization (WHO) Collaborating Center for Injuries, Violence and Accident Prevention.
Momentum Wheels for Humanity will lead implementation in Uganda drawing on more than 25 years of experience increasing access to mobility and developing rehabilitation services inclusive of assistive technology. As a first activity Momentum will ensure alignment with national and global rehabilitation and Assistive Technology (assistive technology) priorities and actors including the World Health Organization, the Clinton Health Access Initiative, GATE, AT Scale, and R4D as well as other donor-funded initiatives to strengthen the provision of rehabilitation services, including assistive technologies.
Physiopedia is working with rehabilitation organisations in multiple countries in Africa, including Uganda, to support workforce development activities. In Uganda, Physiopedia will continue to collaborate with universities and professional organisations to develop training resources that support workforce capacity development.