Prosthetic and Orthotic Rehabilitation Service in Madagascar - the Staff´s Experience at two Rehabilitation Centres

BACKGROUND Madagascar is the fourth biggest island and one of the poorest countries in the world, with more than 75 % of the 24 million inhabitants living under poverty line. The health care system in the country is under development, as well as the field of rehabilitation services and the area of prosthetic and orthotic services in specific. There is very limited published research concerning rehabilitation services for people with physical disability in Madagascar. AIM The aim of this study was to describe and explore the rehabilitation services in Madagascar, with a focus on prosthetic and orthotic services, from the perspective of local rehabilitation staff. METHOD Eight staff members from two rehabilitation centres in Madagascar were interviewed, including one medical doctor, two prosthetic and orthotic technicians, two physiotherapists, one nurse, one social worker, and, one shoemaker. One centre was public and the other centre was run by a nongovernmental organization. Interviews were conducted in English with interpreter to Malagasy. A semi-structured interview guide was used. The data were analysed by using manifest content analysis. RESULTS Three main categories emerged from the analysis: i) Financial situation, distance, attitudes and lack of knowledge stops people from getting rehabilitation service. Dissemination of information about physical disabilities and rehabilitation services were needed to increase the awareness of people in general. There was also a need of more rehabilitation centres with staff to increase the access to rehabilitation services. Many persons with disability could not afford rehabilitation service, and the available financial assistance was not enough to support all who needed the services. However, all people with disability that were coming to the rehabilitation centres were treated equally; ii) Materials, equipment and level of knowledge among staff affect the rehabilitation services. The available materials and equipment differed a lot between the two rehabilitation centres. Further education for the staff was required to improve the quality of rehabilitation service. Appearance and information given by the staff affected acceptance of the assistive devices. Mobility skills were depending on the assistive device, type of disability, and the attitude of the individual patient; iii) Collaboration and communication need to be improved to give a more efficient rehabilitation service. Multidisciplinary approach contributed to good outcome for the patients. Collaboration with, and sponsorship from, nongovernment organizations could increase the quality of rehabilitation service. Furthermore, communication between different professions needed to be improved. An increased collaboration between rehabilitation centres and the Ministry of Health was needed. Finally, community based rehabilitation programs and mobility teams facilitated follow-up services. DISCUSSION & CONCLUSION In order to improve rehabilitation services in Madagascar a combination of measures including increased availability to rehabilitation services and increased financial assistance to people with disability is required. Sustainable economic and material supply chains for rehabilitation centres, and, opportunities for the rehabilitation staff to receive professional relevant basic and continuous training is also required. It was highlighted that awareness and knowledge concerning the needs of persons with disability and the existing rehabilitation service should be increased both among politicians and among the general public in Madagascar