Community health workers’ provision of physical rehabilitation services in sub-Saharan Africa: a scoping review

Author:

Mapulanga Miriam1,Kgarosi Kabelo2,Maluleke Kuhlula3,Hlongwa Mbuzeleni1,Dlungwane Thembelihle1

Affiliation:

1. Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building

2. Department of Library Services, Faculty of Health Sciences, University of Pretoria

3. School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria

Abstract

Abstract Background The increase in the prevalence of non-communicable diseases as a result of increasing life expectancy and changing lifestyles from active to sedentary has increased the demand for physical rehabilitation. Due to this increased demand, services are required as close to people as possible through task-shifting physical rehabilitation services thereby strengthening services at primary health care level. We systematically mapped evidence and described the scope of physical rehabilitation services delivered by CHWs, their mode of physical rehabilitation services delivery, and the barriers and facilitators experienced by CHWs in delivering physical rehabilitation services in SSA.Methods We used the framework of Arksey and O'Malley and Levac et al’s to guide this scoping review. We searched PubMed, Scopus, Cochrane Central, and databases within the EBSCOhost platform using a mix of Medical Subject Heading terms and a combination of keywords for relevant literature without applying language restrictions. We included articles presenting evidence on CHWs’ provision of physical rehabilitation services in SSA from January 1978 to December 2022. Two independent reviewers screened articles at the abstract and full-text screening guided by the inclusion or exclusion criteria and the PCC elements. All relevant data were extracted using a google form and organized into themes and a summary of the results was reported narratively. The methodological quality of included studies was assessed using the mixed methods appraisal tool.Results A total of 6996 were identified through database search and other sources of which 29 met the included criteria and were included for data extraction. The included 29 studies were conducted in eight countries with the majority 16/29 from South Africa followed by 5/29 from Malawi, 3/29 from Uganda and 2/29 from Ethiopia. Of the 29 articles, each one was conducted in Eritrea, Kenya, Namibia and Mauritius. The review revealed the scope of practice for CHWs to be palliative care, disability, non-communicable diseases, HIV/AIDS, assistive devices, neurology, community-based rehabilitation, speech and language, and general rehabilitation while the modes of delivery are community-based, home-based, health facilities, community with health facilities and community with home-based. The review also revealed that the barriers experienced by CHWs in the delivery of physical rehabilitation services are transport and distance, societal and community attitudes, supplies, finance, weather, delivery capacity and governance while the facilitators were proximity to the community, personal attitude, knowledge and technology.Conclusion The review shows that CHWs are involved in physical rehabilitation service delivery in sub-Saharan Africa. It is therefore necessary to develop a training model for CHWs in physical rehabilitation services. Moreover, the review shows that there is need for the integration of CHWs into the national healthcare system as a sustainable solution to curb the chronic human resources for health shortage in SSA.

Publisher

Research Square Platform LLC

Reference72 articles.

1. World Health Organization. (2023). Rehabilitation. https://www.who.int/news-room/fact-sheets/detail/rehabilitation [Accessed April 3, 2023].

2. World Health Organization. (2019). FACTSHEET Sustainable Development Goals: health targets REHABILITATION. Denmark

3. Mills JA, Marks E, Reynolds T, Cieza A. Rehabilitation: essential along the continuum of care. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition. 2017 Nov 27.

4. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019;Cieza A;The Lancet

5. World Health Organization. Rehabilitation in health systems. World Health Organization; 2017.

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