Knowledge and experiences of community health workers in the delivery of physical rehabilitation services in Zambia- a qualitative interview study of trained community health workers

Abstract

ABSTRACTAimTo explore the knowledge and experiences of community health workers in the delivery of physical rehabilitation services in Zambia.DesignAn exploratory qualitative studySettingLusaka district, ZambiaParticipantsTen community health workers from the Zambia Enhanced Community-Based Rehabilitation ProgramResultsNine major themes emerged from the data. Four of these themes (patient management, treatment programs, issuing of appropriate assistive devices through a multidisciplinary approach, and levels of care) were highlighted as the required knowledge base of community health care workers (CHWs), whereas five themes (patient assessment and treatment, home program and family education, assistive devices issuing, a well-functioning referral system, unrealistic caregiver expectations, and resource constraints) were revealed as the essential experiences of CHWs who delivered the required physical rehabilitation services. The CHWs under study experienced unrealistic expectations from caregivers, such as the high expectation that physical rehabilitation would heal a child. These expectations were complicated by a lack of understanding among the caregivers of the role and capabilities of CHWs. Moreover, constraints such as limited resources and a lack of permanent employment were perceived as major challenges.ConclusionTrained community health workers have adequate knowledge and experience in delivering physical rehabilitation services in areas where more specialised and qualified physical rehabilitation workers do not exist. In light of the current shortage of qualified physical rehabilitation workers in Zambia, more investments are required, particularly in the training of community health care workers, to increase physical rehabilitation service coverage.KEY MESSAGESWhat is already known regarding this topicCommunity health workers have been involved in the delivery of physical rehabilitation services. They are therefore key in improving the quality of life of the general population and that of disabled people through the various roles that are task-shifted to them by trained and qualified physical rehabilitation workers. However, their knowledge and experiences in delivering physical rehabilitation services remained relatively unknown until the current study on which this paper is based.What this study adds to the pool of knowledgeThe findings affirm that, with appropriate training in physical rehabilitation, community health workers can effectively deliver physical rehabilitation services and issue appropriate assistive devices at community level in Zambia.How this study might affect research, practice, and policyThe study proposes that appropriately trained community health care workers be utilised to effectively deliver physical rehabilitation services at community level where such services by appropriately qualified physical rehabilitation workers are lacking.