Have you ever experienced a sprained ankle while working out? Or maybe you took a wrong step and ended up staying in bed for two to three weeks? Physical injury, no matter how small it may be, can cause a lot of inconvenience to a healthy person. There would be times when a person might need physical rehabilitation at some stage in our lives – following a disease, illness, injury or as we get older.
Dr Zaib Taj volunteers as a medical officer in Disable Welfare Association. Due to a gunshot from a police mobile, she was rendered disabled after the injury which damaged her spinal cord and left her paralysed. It came as a shock to a qualified independent doctor who suddenly got divorced after her injury as she became a completely dependent person. Dr Zaib went through a long phase of depression, low self-confidence and isolation at home for seven years. Despite her low morale, she managed to get back up and became a role model for other such women, “Challenges for women with disabilities start from home where the family overprotects them and doesn’t allow them to go out, hence making them insecure and unconfident. Those who dare to venture out, come across new challenges whether it’s public transport or road infrastructure for the differently-abled. Besides an integrated health system, there is an overall need of rehauling the entire infrastructure at every level,” shares Dr Zaib.
Rehabilitation is not a luxury but sadly it is not accessible to all. It’s an essential health service. And yet, it is often overlooked, leaving many vulnerable people in low- and middle-income class, especially those affected by conflict, unable to receive vital rehabilitation services. It is estimated that one in three people – around 2.4 billion – are living with a health condition that would benefit from rehabilitation.
With a population of more than 220 million, Pakistan’s health system is overburdened and faces many challenges in meeting the needs of health for all. With very few facilities at primary healthcare centres like Basic Health Units and Rural Health Centres, the tertiary care hospitals take the excess burden of patients, thus further compromising the quality of healthcare.
Service delivery in Pakistan is divided into preventive, promotive, curative, and rehabilitative services. Most curative and rehabilitative services are provided in secondary and tertiary care health facilities. Preventive and promotive services are primarily delivered through a variety of national programmes such as Lady Health Workers, or primary health care institutions, and through outreach initiatives. However, shortage of a skilled workforce and a fragmented health system leave gaps in rehabilitation and Assistive Technology (AT) services, especially when it comes to differently able people including women.
In response to these conditions, the government of Pakistan has been working towards providing rehabilitation and AT programmes at national and provincial levels. Pakistan has developed comprehensive policies to highlight the importance of increased access to rehabilitation and AT services.
Since there is a dearth of public spaces (such as parks, shopping malls, markets, bus stops, hotels, and healthcare centres) that user-friendly for differently-abled people, Pakistan is taking action to tackle this issue. Recently, a research-based programme of Learning, Acting and Building for Rehabilitation in Health Systems (ReLAB-HS) was introduced in Peshawar and Swat districts of Khyber Pakhtunkhwa (KP) and in Karachi East and Jamshoro districts of Sindh province two years ago. The projects have been officially launched in the two provinces last month.
“Rehabilitation has been an ignored area and access to AT services has always been a great challenge for the marginalised and low-income population. This is due to many reasons including financial barriers and a lack of awareness of rehabilitation and AT,” tells Muhammad Khan Ranjha, Provincial Secretary for the Department of Empowering Persons with Disabilities (DEPD). “ReLAB-HS will leverage existing opportunities including co-developing innovative, cost-effective service delivery models at the primary care level and exploring the use of information technology. It will engage with end users, people with rehabilitation needs, including persons with disabilities and civilian victims of conflict, as well as stakeholders at all levels of the health system, to co-design solutions. It will create an enabling environment for the enhancement of rehabilitation and AT services for people to bridge the gap between demand-supply,” he highlights.
Funded by the USAID, the programme is a five-year global activity that will support strengthening of health systems that are responsive to the growing needs for rehabilitation within populations. It is a consortium of six international partners with expertise in health systems, implementation science and delivery innovations. It is led by the Johns Hopkins International Injury Research Unit at the Johns Hopkins Bloomberg School of Public Health, USA, and co-led by the Nossal Institute for Global Health, Australia. Other global partners include Humanity and Inclusion, MiracleFeet, Momentum Wheels for Humanity and Physiopedia.
“Founded on principles of implementation and systems science with a person-centred health systems lens, this programme will guide the transformation of health systems in Pakistan to embed rehabilitation inclusive of AT, adapt to new challenges, and support scale-up. It will inspire a new generation of rehabilitation leaders through a leadership academy,” states Dr Talib Lashari, Technical Advisor & Focal Person, FP-2030 Sindh, Departments of Health and Population Welfare, Government of Sindh.
Pakistan is one of four countries where this programme will co-design and implement innovative, comprehensive, cost-effective interventions that strengthen health systems for the provision of rehabilitation and AT. It will focus on integrating rehabilitation and AT services across all levels of care within the health systems. In its first year, the programme engaged with stakeholders to introduce the activity, conduct a situation analysis, and develop the foundation for collaboration on key activities to move forward.
The basic goal is to support the development of health systems that are responsive to the growing needs for rehabilitation across lifespan. Rehabilitation is an essential health service along with prevention, promotion, treatment and palliation, which focuses on the functioning of an individual and not the condition.
Aster Jane is visually impaired and working as Vice Principal, Special Education, DEPD (Department of Empowerment of Persons with Disability). She finds an integrated system to be the need of hour. “I faced immense challenges during my academic and professional career, where absence of reference books in audio format, non-availability of proper writers during my exams, and travelling while discharging my duties are to name a few,” she relays.
Holding two Masters Degrees in English Literature and Special Education, with additional degrees of B.Ed and Med, Aster had come a long way to reach this position. “We are the people with special health needs, and our problems aggravate with growing age. Integration of the health system with rehabilitation and assistive technology is a way forward to ease the life of disable people, especially females with multiple disabilities in Pakistan,” she points out.
Aster insists on paying attention to health education which is an ignored subject in our country. “Before rehabilitation, we need to work on habilitation. People fall ill, go to the hospital and their disability increases. If they know what is good for them, they will take care of their health,” she advises.
Another great thing about the programme is its aspect of gender equality and social inclusion. It addresses marginalisation and discrimination fuelled by overlapping factors, such as gender, ethnicity, race, wealth, disability, age, and education. Vulnerable groups, including women and girls, will be involved in programme design, delivery, and monitoring and evaluation. Through this inclusive approach, Re-LAB-HS will promote equal rights, opportunities, and respect for all.
“This new initiative will help in streamlining differently-abled people in the health system. We will work on capacity building of the health providers on subjects like rights, special needs and respectful behaviour towards differently-abled people, reproductive health, family planning needs, adolescent health and hygiene of disabled females, and how their needs can be met at different age brackets. The team will be assessing of infrastructure and build ramps and do other changes as per the needs of these people. Similarly, to better equip the health system in order tp accommodate such people, mapping of assistive technology will also be done,” explains Dr Talib Lashari.
In close partnership with key stakeholders, the programme will support the Government of Pakistan, the Pakistan Health Services Academy, and WHO to conduct a national Systematic Assessment of the situation. “The project will develop context-specific models for coordinated rehabilitation care across community, primary, secondary, and tertiary levels of the health system, develop and strengthen institutionalised capacity development and a standardised rehabilitation curriculum for the rehabilitation workforce,” expresses Caroline Duconseille, Country Director for Handicap International in Pakistan. “The programme will also explore opportunities to integrate rehabilitation indicators into health information systems and develop and deploy telerehabilitation solutions to improve rehabilitation service delivery and its coordination among different levels of care. Our aim is to help support the provincial government in integrating and strengthening the already existing healthcare system by approaching institutions, hospitals and the healthcare providers to develop the system in such a way that quality care and services are accessible to everyone. Being run in three other countries Uganda, Ukraine and Myanmar, I see bright prospects for the programme in Pakistan,” she concludes.
The writer is the Editor of Supplements and Special report. She can be reached at email@example.com