The Special Fund for the Disabled (SFD) and our partner the Tanzania Training Center for Orthopaedic Technologists (TATCOT) are proud to release the:
“Survey report on management and rehabilitation services care delivery in health facilities in Tanzania“
The survey was successfully organized and conducted between 2014 and 2015, and would not have been possible without the joint efforts and contributions of a number of organizations/institutions and individuals.
Rehabilitation includes measures to provide or restore functions, or compensate for the loss or absence of a function or for a functional limitation. It is aimed at enabling people with disabilities to reach their optimal physical, sensory, intellectual, psychiatric or social functional levels; to change their lives towards a higher level of independence. It is estimated that, 0.8% of the world populations suffer from handicaps which require orthotics or prosthetics treatment, WHO (2004).
This report represents a study of its kind which was carried out in Tanzania in 2014 on Management and Rehabilitation Services Care Delivery at different facility levels. The objective of the survey was to assess technical orthopaedic infrastructure, quality and quantity of rehabilitation services rendered, distribution of rehabilitation services, location, catchments areas of the facilities, technology practiced, feedback from patients fitted with different assistive devices and referral system in sampled centres.
This was a cross sectional descriptive study which included both quantitative and qualitative methods. A convenient sampling method was used of which two hundred (200) sample size was obtained. A three-stage Strata/Clusters, Stratified and Random sampling design which involved the formal five (5) and two (2) other zones, i.e. Eastern zone (Zanzibar and Dar es salaam), Western zone (Kigoma, Tabora and Shinyanga) were purposefully included. Twenty three (23) health facilities in twelve (12) Regions responded and 171 clients who responded, 30/171, (17.5%) were clients utilizing the health facilities for rehabilitation services who responded on quantitative questionnaire. 29/200, (14.5%) responded on Qualitative questionnaire. The overall response rate for quantitative was by 85.5% while the qualitative was by 100%.
The feedback on the degree of competencies of professionals practicing in the different technical orthopaedic facilities was provided by thirty (30) clients. The competence of individual service provider as per client response were rated to be within the range of 21/30, (71.7%), and their professional skills level was rated as 28/30, (93.3%). On technical orthopaedic consumables, it was revealed that, there was a gross shortage of all kind of resources i.e. machines, equipment, material and supplies and funds to meet the operational costs.
There was also an acute shortage of manpower required for the provision of services. It was also revealed that there are no standard guidelines available for Prosthetist and Orthotist professionals to refer in offering quality of health service to the physical disabled population while others professional cadres are available and are in use.
Corresponding budget related to the policy document (2004) for Disability Care Delivery in Tanzania was not in place to the majorities of the respondents of the health facilities, with an exception of 5/23 facilities (21.7%). However, these few facilities were offering rehabilitation services to physical disabled persons based on cost sharing scheme of which clients and donors/sponsors subsidized the total cost of the assistive device. This was a big constraint for physical disabled persons in health seeking behaviour for health services especially in cost sharing for the assistive devices required as per individual needs. 9/23 (39.1%) reported to have strategic action plan on issues related to rehabilitation of people with disability been on their respective institutional agenda. The referral system was in place in all the responded institutions 23/23, (100%) which was done by designed clients/patients referral form. 10/23, (43.5%) had staff development plan involved in the field of technical orthopaedics.
The main challenges that were mostly reported were inadequate resources, i.e. human, material and financial resources. Most of these resources are highly inadequate and an immediate action for an intervention to address the equalization of opportunity to health/rehabilitation and social services are to be made available and accessible to all people with disabilities.
There is a dare need to improve rehabilitation services and care to physical disabled population, reformulating functional clinical teams for rehabilitation at facilities levels, provision of standards guideline to technical orthopaedic professional for references in quality services provision, set corresponding budget for operational activities of rehabilitation services, ensure improved existing rehabilitation workshops and installation of new departments/units for physical rehabilitation in all centres around the country. Ensure adequate skilled rehabilitation professionals by recruiting higher number of professionals, deployment immediate after graduation to improve human resource for health services provision in Tanzania.
Ministry of Health and Social Welfare, departments of the Government of Republic of Tanzania and Zanzibar provided valuable support for their contributions and responses to the questionnaire contents, National institute for Medical Research (NIMR), Kilimanjaro Christian Medical University College (KCMU-Co) of Tumaini University Makumira for enabling the survey to be conducted.
A special acknowledgement and thanks is presented to the Special Fund for Disability (SFD) for funding the project and enabling the team to address the gap highlighted in the report. TATCOT Management is appreciated for the support granted in availing its team who worked tirelessly in completing the task taking into account the complexity of the geographical location of some of the centres visited.
We are also grateful for the support granted by the Clients, Regional Administrative Secretaries (RAS), Regional Medical Officers (RMOs), District Medical Officers (DMOs), Hospital Secretaries, Matrons, Heads of Orthopedics Workshops and Physiotherapies Departments/Units, Field staff Assistants who supported the survey through offices of RMOs to all sampled Regions with their valuable guide on research processes at their regions and ensure smooth data collections within the study period and for their hospitality from themselves and from the facilities staff at large.
Our special thanks are directed to Prof. R. Olomi, Prof. M. Nyindo, Ms. Beatrice Temba and Mr. G. Kapanda for their technical inputs in this work as well as Mr. Linder E. Mtui, Mrs. C. Lyimo and Mr. H. Muhanaya for their support in ensuring the logistic are all under control. We are indeed indebted to the commitment extended to this work by Ms. S. Saria who was behind the entire project in ensuring its implementation as well as contributions from the Co-Authors; Mr. D. Shirima, Mr. R. Simba, Mr. L. Mtalo and Mr. J. Nagel for their efforts made in collecting the data and ensuring this project becomes a success.
Harold G Shangali,
Management and Rehabilitation Services Care Delivery to Disabled population in Tanzania 2014.
The full report is available upon request, please contact us