Equity and the distribution of rehabilitation personnel in one health district in the Western Cape

This paper describes a situation analysis of the rehabilitation personnel, employed by the state and non-governmental organisations, and the services available for people with disabilities in one health district in Cape Town. The recurrent cost of employing the rehabilitation personnel is analysed to determine how funding is allocated within the district. The results indicate that most expenditure on personnel is at two state institutions in the district, with 76% of the expenditure at the regional psychiatric hospital and its residential facility for people with a profound intellectual disability. The balance - 24% of expenditure - is the cost of employing rehabilitation personnel who provide a district level service. Seventy percent of this district level expenditure is at one special school that accepts 6% of children with disabilities in the district. A high percentage of intellectually disabled children and adults, with or without physical disabilities, do not have access to rehabilitation. There is minimal expenditure on employing rehabilitation personnel at the community heath centre. The only expenditure on community based rehabilitation is provided by the non-governmental organisation. The study demonstrates the inequitable distribution of funding for rehabilitation services within one relatively well-resourced health district and makes recommendations to facilitate change.

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“We can’t handle things we don’t know about”: perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors

BMC Pediatrics ◽

10.1186/s12887-020-02405-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Alexandra Boubour ◽

Sebastian Mboma ◽

Tracy Võ ◽

Gretchen L. Birbeck ◽

Karl B. Seydel ◽

...

Keyword(s):

Cerebral Malaria ◽

Data Gathering ◽

Group Discussions ◽

Community Based ◽

Community Based Rehabilitation ◽

Exploratory Approach ◽

Holistic Understanding ◽

Multiple Regions ◽

Trained Staff ◽

Rehabilitation Personnel

Abstract Background We sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methods An exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs). Results FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable. Conclusions There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.

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“We Can’t Handle Things We don’t Know About”: Perceived Neurorehabilitation Needs and Challenges for Malawian Paediatric Cerebral Malaria Survivors

10.21203/rs.3.rs-35488/v1 ◽

2020 ◽

Author(s):

Alexandra Boubour ◽

Sebastian Mboma ◽

Tracy Võ ◽

Gretchen L. Birbeck ◽

Karl B. Seydel ◽

...

Keyword(s):

Cerebral Malaria ◽

Data Gathering ◽

Group Discussions ◽

Community Based ◽

Community Based Rehabilitation ◽

Exploratory Approach ◽

Holistic Understanding ◽

Multiple Regions ◽

Trained Staff ◽

Rehabilitation Personnel

Abstract Background: We sought to identify perceptions of neurorehabilitation needs and challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methods: An exploratory approach was used to qualitatively investigate current available neurorehabilitation services; investigate the needs of caregivers, CM survivors, providers, and the community; and identify challenges and methods to accessing neurorehabilitation services. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs).Results: Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs). FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.Conclusions: There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.

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“We can’t handle things we don’t know about”: Perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors

10.21203/rs.3.rs-35488/v2 ◽

2020 ◽

Author(s):

Alexandra Boubour ◽

Sebastian Mboma ◽

Tracy Võ ◽

Gretchen L. Birbeck ◽

Karl B. Seydel ◽

...

Keyword(s):

Cerebral Malaria ◽

Data Gathering ◽

Group Discussions ◽

Community Based ◽

Community Based Rehabilitation ◽

Exploratory Approach ◽

Holistic Understanding ◽

Multiple Regions ◽

Trained Staff ◽

Rehabilitation Personnel

Abstract Background: We sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.Methods: An exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs).Results: FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.Conclusions: There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.

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Neighbourhood support to families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme

Child Care Health and Development ◽

10.1046/j.1365-2214.1996.816816.x ◽

1996 ◽

Vol 22 (6) ◽

pp. 397-410 ◽

Cited By ~ 1

Author(s):

R Bischoff ◽

M J Thorburn ◽

P Reitmaier

Keyword(s):

Coping Strategy ◽

Rehabilitation Programme ◽

Community Based ◽

Community Based Rehabilitation

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Exploration-Stage Implementation Variation

Zeitschrift für Psychologie ◽

10.1027/2151-2604/a000164 ◽

2014 ◽

Vol 222 (1) ◽

pp. 37-48 ◽

Cited By ~ 12

Author(s):

Stephanie Romney ◽

Nathaniel Israel ◽

Danijela Zlatevski

Keyword(s):

Parent Training ◽

Average Cost ◽

Cost Savings ◽

Training Group ◽

Group Differences ◽

Triple P ◽

Community Based ◽

Parent Training Program ◽

A Site ◽

The Cost

The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

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Community-Based Rehabilitation of Children with Disabilities and Its Contribution to the Protection of Children

PsycEXTRA Dataset ◽

10.1037/e500792015-318 ◽

2014 ◽

Author(s):

Jose Campang ◽

Emma Estrada

Keyword(s):

Children With Disabilities ◽

Community Based ◽

Community Based Rehabilitation

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CAPACITY BUILDING PENGURUS REHABILITASI BERBASIS MASYARAKAT DALAM PELAYANAN TERHADAP PENYANDANG DISABILITAS DI KELURAHAN BABAKAN CIPARAY KECAMATAN BABAKAN CIPARAY KOTA BANDUNG

Pekerjaan Sosial ◽

10.31595/peksos.v18i1.159 ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Arif Setiadi

Keyword(s):

Action Research ◽

Capacity Building ◽

Community Based ◽

Persons With Disabilities ◽

Community Based Rehabilitation ◽

Building Community

Capacity Building adalah proses peningkatan kemampuan pengurus Rehabilitasi Berbasis Masyarakat (RBM) dalam memberikan pelayanan kepada penyandang disabilitas, sehingga penyandang disabilitas dapat mengakses pelayanan yang dibutuhkan. Tujuan penelitian ini adalah untuk mengkaji tentang Capacity Building Pengurus Rehabilitasi Berbasis Masyarakat dalam Pelayanan terhadap Penyandang Disabilitas di Kelurahan Babakan Ciparay Kecamatan Babakan Ciparay Kota Bandung. Metode penelitian yang digunakan adalah kualitatif dengan design action research. Sumber yang digunakan adalah sumber data primer dan sumber data sekunder. Adapun teknik pengumpulan data yang digunakan adalah wawancara mendalam, observasi partisipatif, studi dokumentasi, dan Penilaian Kapasitas. Teknik pemeriksaan data yang digunakan yaitu uji kepercayaan, uji keteralihan, uji ketergantungan dan uji kepastian. Selanjutnya hasil penelitian ini di analisis menggunakan teknik analisis kualitatif. Hasil penelitian ini menunjukkan bahwa capacity building terhadap pengurus RBM Kelurahan Babakan Ciparay membawa perubahan dalam memberikan pelayanan kepada penyandang disabilitas. Capacity Building pengurus RBM tersebut berdampak pada pelayanan terhadap penyandang disabilitas menjadi lebih komprehensif dan berbasis metode serta teknik pekerjaan sosial. Keywords: Capacity Building, Community-Based Rehabilitation, Persons With Disabilities

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Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20982773 ◽

2021 ◽

pp. 1357633X2098277

Author(s):

Molly Jacobs ◽

Patrick M Briley ◽

Heather Harris Wright ◽

Charles Ellis

Keyword(s):

Cost Effectiveness ◽

Economies Of Scale ◽

Reference Group ◽

Unit Cost ◽

Community Based ◽

Face To Face ◽

Conduction Aphasia ◽

Aphasia Treatment ◽

The Cost ◽

The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

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Economic burden of childhood diarrhea in Burundi

Global Health Research and Policy ◽

10.1186/s41256-021-00194-3 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Fulgence Niyibitegeka ◽

Arthorn Riewpaiboon ◽

Sitaporn Youngkong ◽

Montarat Thavorncharoensap

Keyword(s):

Economic Burden ◽

Cost Model ◽

Primary Treatment ◽

Management Program ◽

Community Based ◽

Factors Affecting ◽

Hospitalization Costs ◽

Illness Study ◽

The Cost ◽

Substantial Economic Burden

Abstract Background In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. Methods The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients’ caregivers and review of patients’ medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. Results One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. Conclusion Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.

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