Assessment of Rehabilitation Capacity in Ghana

Asare B. Christian. MD, MPH.

Clinical Associate, Penn Medicine PM&R, Philadelphia, PA, USA

Outpatient Medical Director, Good Shepherd Rehabilitation Hospital, Allentown, PA, USA

4/27/2018

Disclosures

I have received payment from Ipsen pharmaceuticals for consultative work.

I will not be discussing any Ipsen product.

Learning Objectives

1. Appreciate the need for Global Rehabilitation Medicine

2. Medical Rehabilitation Capacity in Ghana

3. Current State of Rehabilitation-Training of the Ghana doctor in Rehab Medicine

Background

• Rehabilitation Medicine

• Function, quality of life, improve health systems

• 1 billion disable around the world

• 80% live in low resource countries

• Sub-Saharan Africa

• 156 million

• Disease and Disability burden

• 24% disease burden, 3% health workers, 1% healthcare expenditure

Background

• Limited data on Rehab Capacity

• Infrastructure, human, interventions

• Quality of service, education

• A forsaken Global Health issue

• Trauma related disability, cardiovascular, cerebrovascular disease

• Global Rehab capacity

• limited, fragmented, inconsistencies

Background

• 2011 World Report on Disability(WDR)

• Policy Change; CBR to Medical Rehabilitation

• Govt. to expand comprehensive rehabilitation

• Multidisciplinary Rehabilitation care

• For this to be implemented

• A Need assessment to inform policy makers

Background

• Sub-Saharan Rehab workforce

• 6 physiatrist

• 4169 Occupational therapist

• 0.1 per 100, 000 Physical therapist in Ghana, 6.7 per 100,000 in South Africa

• Other Allied health

• 0.04 per 100,000 Social workers

• 0.04-0.06 per 100,000 Rehab psychologist

Objective-Assessment

of Rehab Capacity in

Ghana

• Pilot an assessment tool for capacity of Rehabilitation care in Ghana • Infrastructure, human resources,

interventions provided

• Create a standardize tool for assessing rehabilitation care in resource constraints areas

• Accurate assessment of met and unmet rehabilitation needs

Background

• Ghana: Black star of Africa

• 24.97 million people

• GDP of $39 billion,4.8 of GDP on Healthcare

• Estimated 3.75 million persons with disability

• No medical rehabilitation, PT only, no inpatients

• Rehabilitation Capacity

• Rehabilitation planning

Methods:

•Across the country, easily accessible by transport

•Record keeping

Sampling Selection

•9 Physiotherapist centers in Ghana

•Tema General Hospital (Greater Accra Region)

•Ashanti Mampong Municipal Hospital (Ashanti Region)

•Sunyani Regional Hospital (Brong Ahafo region)

•Koforidua Regional Hospital, Teteh-Quashi Memorial Hospital, and Begoro Rehabilitation Center (Eastern Region)

•Effia Nkwanta Regional Hospital (Western Region)

•Cape Coast Regional Hospital (Central Region)

•Tamale Teaching Hospital (Northern Region).

Settings

Methods

• Interview Process

• A modified Situational Analysis Tool for Assessment of Essential Comprehensive Rehabilitation Care(ECRC) was developed

• 11 Page Questionnaire

• Infrastructure, human resource, interventions

• To be completed by those of in charge of the PT centers

• Lesson from the surgical world

Results

• Infrastructure • 5 out of 9 centers were Regional

Hospital • 1 inpatient rehabilitation

center/Pediatric rehab • Begoro Salvation Army

• Funded by Ghana Ministry of Health

• Centers were built by Enfra Nonius Dutch grant

Results

• Infrastructure •1 center to serve 735,545 person •Pt seen/yr 400-295000 •2 have aquatic therapy •Travel distance to centers 63Km(20-200Km)

•42 physiotherapy centers •22 in Ashanti and Accra

Results

Human Resources

• no PM&R doctors, rehab psychologists, recreational therapist, in country

• 1 OT, no SLP in our sample

• 1 rehab nurse, 1 prosthetics in our sample

• 7 lack a social worker

39 PT’s identified in our study to serve 6.6million people

Results

• Intervention

• Stroke Rehab: 100%

• Spinal cord injury: 90%

• TBI Rehab: 50%

• MSK: 70%

• Pediatric Rehab: 80%

• Medical Rehab: 60%

• Amputations: 90%

Discussion

• Summary

• First study proposing the need to create a standardize tool for comprehensive rehabilitation in Africa

• First study looking at capacity of a nation to provide ECR

• Human resources

• Significant deficiencies in infrastructure, humans resources, and ability to provide comprehensive rehabilitation

• Use of assessment tool feasible in local environment

Study Weakness

• Small sample size (9 out of 42 centers)

• But represent 26% of Ghana Population

• Bigger centers (Accra and Kumasi) not survey

• 5 Regional hospital

• No post-analysis of ease of answering survey

• Some questions might not be appropriate in the environment

• Some questions were not responded to

• The tool proposed has not be validated

• We don’t have one yet

Recommendations

• Essential Comprehensive Rehabilitation is cost-effective and safes lives

• Need most is places where resources are limited

• Implications of its absence are colossal

• Ghana Ministry of Health and external bodies should invest in comprehensive rehabilitation

• WHO should support this initiative to make Rehabilitation needs a Global Health priority

Current Rehabilitation State

•The creation of Physical Medicine and Rehabilitation program in Ghana

•Policy and Proposal

•Rehabilitation Medicine at KATH

Rehabilitation Fellowship in

Ghana

• Name of program?

• Dr. Abena Tanor and Dr. Tesfaye

• A two year curriculum approve by the Ghana Medical board

• Fellowship

• Local leadership and ownership

• Clinical experience

• Blue jeans platform

Fellowship training con’t

Musculoskeletal medicine

Stroke rehabilitation

Traumatic brain Injury rehabilitation

Trauma rehabilitation

Spinal cord injury rehabilitation

Vocational rehabilitation

Pediatric rehabilitation

Amputee care

Pain management

Fellowship

• In and out training

• Ghana, US, Europe, Asia, Ethiopia

• KATH, Nsawam, others……….

• Ghana Rehab Mission visit to KATH

• Clinical management

• Workship

• Policy and advocacy management

• WHO and global presence and advocacy

• Dr. Abena Tannor visit to Good Shepherd Rehab

• Inpatient rehabilitation training

• Outpatient clinic

• w/c clinic and technology ad

Ghana Rehab Mission • Clinic with team

• Inpatient workshop and nurses training

• Policy and advocacy

• Medical rehabilitation proposal

Ghana rehab mission

Fellowship barriers

• Value of Physical medicine and rehabilitation

• Human behavior and culture

Local support and priority

• No funding, volunteer based

• International Rehab Forum

• Ghana Rehab Mission

Outside support

Conclusion

Conclusion

•A comprehensive rehabilitation program is needed in Ghana

•Effort to support such initiatives are needed

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Thank You

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