How prepared are health systems in low- and middle-income countries to provide rehabilitation in conflict and disaster response? A scoping review

Abstract

Abstract Introduction Conflict and other disasters such as earthquakes or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. Aims The primary aim of this scoping review was to synthesize the evidence on the preparedness of health systems in low- and middle-income countries to respond with rehabilitation services and assistive technology to the demand associated with conflict and disaster situations. A secondary aim was to summarize related recommendations identified in the gathered literature. Methodology A scoping review was conducted using the Arksey and O’Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search range was 2010–2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. Results Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review collected the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters. The most prominent recommendations were; the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response. Conclusion: The literature demonstrates that rehabilitation is poorly integrated into health systems disaster preparedness and response in low- and middle-income countries, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of evidence available hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.