According to the National Household Survey, the poverty rate in Tanzania has decreased somewhat in recent years, but 9 out of 10 Tanzanians still earn less than 3 USD per day. Nearly 8% of the population has disabilities, including visual (32%) and mobility (20%) impairments. In light of the UNCRPD, Tanzania passed the Persons with Disabilities Act in 2010. However, implementation of the Act and other related laws still needs to be improved, along with the budget allocation for physical rehabilitation services. Centres in remote areas lack raw materials and motivated staff; some people lack the funds for treatment from private service providers.
To improve the structure and sustainability of the national physical rehabilitation sector, we support the development of national strategies for health financing/insurance, based on existing government policies. We also encourage the Ministry of Health and Social Welfare (MoHSW) to create a coordinating body for physical rehabilitation, and urge stakeholders – including organizations for orthoprosthetists and for persons with disabilities – to form a policy platform that will lobby for legislation in their favour. Should these be created, we will provide them with comprehensive support, including funds for meetings and staff salaries.
The Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), a hospital that treats many children with disabilities and serves as a regional centre of excellence, receives extensive support from us. Specifically, the CCBRT receives raw materials for prosthetic/orthotic devices and subsidies for patients’ fees to enable economically vulnerable people to access their services. We also aid them to improve their facilities and their training for staff/students, in order to meet international standards and obtain accreditation in both areas. Furthermore, we help ortho-prosthetists from the region hone their skills through specialized courses and on-the-job training at CCBRT, and help professionals from the Tanzania Training Center for Orthopaedic Technologists (TATCOT) discuss best practices with their peers at conferences by sponsoring their attendance. In addition to our policy and implementing partners, we also work with other organizations. For example, we donate sports equipment and co-organize events such as a yearly basketball tournament. We also work with the Tanzanian Red Cross (member of the Platform) with the role to: identify, refer and follow-up on people in need of physical rehabilitation services.
RESOURCES USED (As at September 2016)
- CHF 738’552 Budget 2016
- CHF 458’167 Expenditure as at September 2016
- 167 working days of P&O expert
- 173 working days of a disability advisor
MAIN ACTIVITIES AND ACHIEVEMENTS (Jul-Sep 2016)
- The platform has completed their fourth meeting and completed an action plan for the group. The entity has been recognised by the Minister of Health Community Development, Gender, Elderly and Children (MoHCDGEC) as the task group for rehabilitation. The platform Chair and Secretary met with Assistant director of NCD Prof Ayoub R. Magimba to explain the activities and aspiration of the platform. An official letter was received from the MoHCDGEC in recognition of the platforms activities and the compilation of the members.
- Following discussion with Motivation (http://www.motivation.org.uk) during the Fédération Africaine des Techniciens Orthoprothésistes (FATO) congress, in relation to the support given to the PT department and to the head of physical rehab department at CCBRT, proposals were made to organise a parent carer training (similar to Hambisela with the financial and technical support of SFD).
- ICRC and SFD are collaborating with Physiopedia (http://www.physio-pedia.com); 11’000 initial participants started the Cerebral Palsy management course resulting in a total of more than 800 participants completing the course. SFD East AF PT and P&O Advisors participated in the course development and supervision.
- Wheelchair user participated in the Para Olympic games in Rio achieving tenth position in the Discuss. The privately sponsored wheelchair was assembled and fit at the CCBRT by the wheelchair technologist under supervision and support of SFD.
- Three ICRC 4bar Knees were tested in the CCBRT during the Ischial Containment Socket (ICS) course. This is the third iteration of the field test for the 4bar knees. The field test will continue until December whereby results will be collated and sent to GVA.
- 8 participants receive two week training at CCBRT during ICS course presented by TATCOT, Rwanda teachers and CCBRT senior clinical staff. The seminar objective was to upgrade the skills and knowledge of CAT II prosthetists working in Tanzania public services. The SFD provided technical support to the team of lecturers. The organization of the course and subject content related to client assessment and gait training was the main topics of contribution.
- The SFD sponsored 3 persons from TATCOT and 1 person from CCBRT to attend FATO Congress in Lomé.
- The Online tutoring and resource development continues with the British Council teacher (Moodle). This innovative teaching approach enhances the skills of physical rehabilitation professionals in Tanzania.
- Support has been given to the PT team at CCBRT, particularly to the person in charge of the unit, to enhance their skills by including them in the online Massive Open Online Course – Physiopedia on Managing Children with Cerebral Palsy (Physiopedia MOOC).
- The bue prints for an external gait training route and wellness garden is discussed with CCBRT program development and Head of Rehabilitation. The gait training route will allow clients to use their devices under supervision of trained professionals who examine their ability to functionally control their new devices before they are discharged. The successful functional testing with devices is a precursor to confident use and application of a device after discharge.
- The Shiviawata will carry out the Beneficiary Feedback (BF) and the Technical Assessments (TA) with the 20 clients interviewed in 2016. The TA will be done with the inclusion of an external P&O who will be employed by Shiviawata in the project that is financially supported by the SFD. The interview process will also reach to 20 new beneficiaries in Q4.
- An appointment system has been introduced in the PT Unit to alleviate the rush of clients in the morning and provide the clinicians with a steady controlled and manageable flow of clients during the day.
- The SFD continuously promotes a multi-disciplinary approach to its partner service provider. Case management advice and mentoring is given to the P&O department during complicated cases particularly for spinal deformity in adolescent clients.
- The SFD gives regular support to the head of physical rehabilitation department at CCBRT related to her effort to improve the service provision (PT and wheel chair in particular) and the restructuring of the collaboration between the physical rehabilitation and CP department. Three physiotherapist are now full time based at the rehabilitation department.
INDICATORS (As at September 2016)
Physical Rehabilitation National Entity
- Existence of National plan: Yes
- % of health Budget allocated to physical rehabilitation: n/a
- Number of professionals employed by the entity: 1
Qualified professionals employed by our partners’ rehabilitation centers
- 5 P&O
- 3 Physiotherapists
- 2 other therapists
Quality of services delivered by our partners
- Technical assessment: n/a
- Beneficiary satisfaction survey: n/a
Beneficiaries’ statistics – Trainings (Jan-Sep 2016)
- 31 persons received Clinical training
- 21 TATCOT Teachers received Moodle training
Beneficiaries’ statistics – Services (Jan-Sep 2016)
- 1’279 physical rehabilitation services provided by our partners
- 79 devices reimbursed to persons with disabilities
CHALLENGES AND NEXT STEPS
- While using a number of training available through Internet (MOOC, MOODLE) a recurrent challenge lies with the poor access to quality Internet connection thus slowing down the training process.