Rehabilitation is a process that supports individuals to gain and maintain their abilities and functionality for daily living in the case of injury, illness or disability. The process involves therapy and interventions that include physical therapy, occupational therapy and speech therapy among others. The vital role of rehabilitation in disability restores functionality enabling individuals to recover movement, communication and daily living skills.
By teaching adaptive techniques and providing assistive technology, rehabilitation enables persons with disabilities to gain independence and promote social inclusion. Rehabilitation prevents further complications and secondary health issues which reduce long-term health care costs. According to the Convention on the Rights of Persons with Disabilities (CRPD), state parties should take effective and appropriate measures, including through peer support, to enable persons with disabilities to maintain maximum independence, full physical, mental, social and vocational ability to enhance their participation in all aspects of life.
Therefore, rehabilitation empowers people with disabilities to live more independently, participating actively in society and enhancing their quality of life.
Furthermore, the National Disability Policy has emphasised the importance of rehabilitation services has outlined in the CRPD and further highlighted the need to train community care workers (CCWs) and village health workers (VHWs) on disability issues. The policy also promotes the inclusion of persons with disabilities to be trained as rehabilitation workers.
The National Assistive Technology Strategy for Zimbabwe (2024–2025) highlights that many persons with disabilities face significant barriers in accessing rehabilitation services, including the provision of assistive devices. The limited provision of resources from the government and non -governmental entities, high cost of services, limited education and awareness have exacerbated the situation.
Tigere is a development practitioner and writes in her personal capacity. These weekly New Horizon articles, published in the Zimbabwe Independent, are coordinated by Lovemore Kadenge, an independent consultant, managing consultant of Zawale Consultants (Pvt) Ltd, past president of the Zimbabwe Economics Society and past president of the Chartered Governance & Accountancy Institute in Zimbabwe (CGI Zimbabwe). — [email protected] or mobile: +263 772 382 852.
The Living Conditions Survey Among People with Disabilities in Zimbabwe (2013) revealed that 63,6% of people with disabilities never received assistive devices including the support they required. The highest number of people in need of assistive devices is in rural areas. Most assistive devices were received without accompanying training, pausing more harm than good to people with disabilities.
In terms of inequities leading to poorer health, the Global Report on Health and Equity for Persons with Disabilities revealed that persons with disabilities have higher rates of acquiring new health conditions and increased morbidity driven by reduced access to health care including rehabilitation. If persons with disabilities do not receive rehabilitation services and assistive devices, they are at higher risk of exclusion attending school, work and participating in society. Rehabilitation is a key element of the spectrum for Universal Health Coverage (UHC). Despite the importance of rehabilitation services, persons with disabilities experience challenges accessing rehabilitation services for several reasons that include lack of facilities and trained professionals. There are few rehabilitation facilities making the services limited or unavailable. The distance to some of the rehabilitation facilities is a hindrance to most individuals with mobility challenges or mothers who must carry their children on their back. Rehabilitation services are generally not accessible and expensive, and many families cannot afford the cost of therapy, assistive devices or transport costs. If services are expensive and inaccessible, persons with disabilities will not get the help they need to recover, patients will not complete their treatment increasing complications. Due to limited awareness and education caregivers and families of people with disabilities may not be aware of the importance and benefits of rehabilitation and where to access the services. In some cases, rehabilitation is perceived as an expensive and luxurious addition to health care services resulting in it being undervalued in financing. Poor infrastructure and underfunded health care systems have worsened the situation.
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Recommendations for improving access to rehabilitation services
Considering the limited number of trained rehabilitation professionals in the public sector such as physiotherapists, occupational therapists, speech therapists there is need to invest in continuous training and staffing through education programs and incentives. The establishment of additional rehabilitation facilities in rural and underserved areas will bring the services closer to people in need, however adopting community-based approaches will empower communities. Community Based Rehabilitation programs will make use of local resources and community health workers to deliver services at grassroot level.
Rehabilitation services should respond to the needs of persons with disabilities and quality should not be compromised. The provision of comprehensive rehabilitation services depends on the financing function of the health system. Therefore, the government through the Ministry of Health and Child Care should allocate more resources for rehabilitation within the primary health care system. The financing function includes the pooling of resources in collaboration with development and private sector partners supporting the same cause. The budgets should consider, training of caregivers, provision of assistive devices and follow-up support. However, for the resources to be allocated efficiently there is need to ensure collection of data to help manage staffing, equipment and demand. Facilitating research on rehabilitation trends will influence healthcare policies that improve access and quality of services. Further monitoring the implementation of rehabilitation services will help strengthen service provision and ascertain the number of people in need of rehabilitation services and assistive devices.
Training should include the availability, knowledge and use of assistive devices and technologies as they relate rehabilitation. Supporting the local production and subsidizing costs of assistive devices such as wheelchairs and other mobility aids will make them more accessible. It is known that costs related to health care, assistive devices and accommodations related to disability can drive families further into poverty and reduced opportunities in education and employment. Programs and interventions should be designed to make rehabilitation services accessible and affordable to increase access and improve health outcomes. The adoption of technological innovations has the potential to increase access and improve efficiency of rehabilitation services, for example the use of mobile phone applications in screening and record management.
Comprehensive rehabilitation programs and services should be strengthened particularly in the areas of health, employment, education and social services. In addition, the services must be provided at the earliest possible stage based on multi-disciplinary assessments of individual needs and strengths. For example, conditions such as muscular dystrophy require early identification and rehabilitation to optimize development, and functioning. To manage diversity in disability, specific services can be provided to cater for specific impairments and health conditions of persons with disabilities such as vision rehabilitation or mainstream services such as regular screening and examinations. The provision of assistive technology should be systematically integrated within rehabilitation to promote access and continuity of health care. To address the stigma related with mental disability and psychosocial support it is important to educate people about mental health and benefits of rehabilitation to reduce fear and misunderstanding. Creating safe spaces for people to talk about mental health will help normalise it and reduce shame. Rehabilitation services play a critical role in optimizing health outcomes and should be prioritised and provided within different settings that include health facilities, home, workplace environments and community.
- Tigere is a development practitioner and writes in her personal capacity. These weekly New Horizon articles, published in the Zimbabwe Independent, are coordinated by Lovemore Kadenge, an independent consultant, managing consultant of Zawale Consultants (Pvt) Ltd, past president of the Zimbabwe Economics Society and past president of the Chartered Governance & Accountancy Institute in Zimbabwe (CGI Zimbabwe). — [email protected] or mobile: +263 772 382 852.
