Rehabilitation services in post-revolutionary Benghazi, Libya, from the perspective of disability workers: A case study of the Benghazi Rehabilitation and Handicap Centre

People with physical disability are one of minority groups that need more attention, especially in Middle East and North African countries. In Libya, there are many people with physical disabilities arising from the 2011 revolution and there are continuing risks such as landmines creating new casualties with physical disabilities. Consequently, the number of people with physical disabilities in Libya will continue to rise. Little is known about the services provided to them. This study investigated an area that has not been researched before. It is the first research study to examine adult physical rehabilitation services in Libya; to date, no study has been conducted on disability services at the national, district, or local level. Estimating the need for physical rehabilitation support services is difficult due to a lack of information. If the need for services is under-estimated, this could result in inadequate post-conflict development, leading to weaknesses in the provision of appropriate rehabilitation services. This thesis investigated services for people with physical disabilities in Libya after the 2011 revolution. As limited published information existed, a description of the only physical disability service open following the 2011 revolution was needed to ascertain services available and the organisational and human resource issues affecting them. Worker perspectives at this centre provided further information about service arrangements, professional development needs and worker wellbeing. The last was investigated because a link between job satisfaction and/or burnout and the quality of patient care has been previously demonstrated but has never been explored in a disability context in Libya or in the Middle East and North Africa. Methods: A multi-method case study design was used comprising: literature review, field study and worker survey. A review of published literature relating to people with disability in Libya, disability services in Libya, and issues that affect disability service quality was conducted. This was enhanced by two months of field work in Libya during the 2012 post-revolutionary period at the only Libyan adult physical disability service identified as functioning in 2012. A survey of workers at the Centre was conducted to ascertain workers’ demographic, occupation, professional development and wellbeing (job satisfaction and burnout) attributes. Three occupational groups participated in this study: therapists and specialist technicians, nurses, and administration staff. People with disability were not included in the study’s scope. Results: The study found that there was no national disability services plan or coordination between Libyan Government and international agencies. There was no community based rehabilitation. The Benghazi Rehabilitation and Handicap Centre (BRHC or the Centre) was the only physical rehabilitation service functioning in post-revolutionary Libya. It was a well-designed facility where all beds were utilized; 60 male beds only, most of them occupied by long term residents (some of them \u3e20 years). Female beds were decommissioned for a ward refurbishment that did not take place. Outpatient services were also provided free of charge. Almost all the ex-patriate workers (nurses and doctors) had left the Centre during the 2011 revolution. The remaining clinical and administrative staff were all Libyan citizens: 232 including nurses, therapists prosthesis technicians and one physician. Of these, 71 responded to the survey. Most participants had high school as their highest educational qualification. Administrative staff were more likely to hold degrees; therapists held diplomas. There was no competency certification apparent or performance appraisal in place. There was: a lack of information management systems; a major issue regarding patient flow-through processes with long term inpatient care resulting in ‘bed block’; limited staff awareness of community based rehabilitation services and the United Nations Convention on the Rights of Persons with Disabilities; and a distribution of employees across the Centre that did not reflect current service demands. Little professional development had been provided to BRHC staff before or after the revolution. The post-revolutionary conditions with uncertain and interim government arrangements meant there were major challenges in relation to financial planning, security, maintenance, consumables supply, and long patient waiting lists. Most workers were satisfied with their jobs, but there were gender and occupational differences. More than half the survey participants had moderate to high levels of burnout with statistically significant differences between male and female workers. Conclusion: There is a lack of sound information about physical disability in Libya; there is variable information on war injuries, impairment, functional limitations and types of disabilities. This can cause problems in assessing the Centre’s needs and planning to meet them. It can also cause difficulties in monitoring and in evaluating post-conflict needs and programs. Libya faces rehabilitation and disability services problems as there is a lack of a nation-wide disability policy and no national or regional disability strategy. After the revolution only one service centre was in operation. The BRHC had managed to continue providing physical disability services under difficult circumstances after the revolution with good local staff retention in spite of challenges relating to salary payments, consumables, overwhelming patient demand, a lack of coordinated information systems, and limited professional development. Centre-based care is not sufficient to meet post-revolutionary demand for disability services. Libya requires a coordinated and evidence-based approach to disability services investment and delivery that includes community based rehabilitation, new worker training, and professional development and credentialing for existing workers. Professional development to help support worker wellbeing is needed to enhance job satisfaction, and prevent and reduce levels of burnout, particularly among women workers. Sustainable, comprehensive disability services strategies are essential in the short and long term. Greater access to publicly available data is also required to help support the development of services and planning at local and national levels. This thesis will provide an evidence base currently lacking for service planners, funding bodies, managers and professional societies that will assist them better understand physical disability service arrangements, workforce attributes and worker needs in post-revolutionary Benghazi. This will help support the enhancement of rehabilitation services there and potentially contribute to service design and development elsewhere in Libya. Future research is recommended with regard to the needs of rehabilitation services and issues from the perspective of people with disabilities