Physical Disabilities Rehabilitation in Africa

Original Editor - Anarème Kpandressi  as part of the WCPT Network for Amputee Rehabilitation Project

Top Contributors - Sheik Abdul Khadir, Admin, Kim Jackson and Amrita Patro  

Introduction

Africa is the world's second-largest and second-most-populous continent. With 1.1 billion people as of 2013, it accounts for about 15% of the world's human population. The continent is surrounded by the Mediterranean Sea to the north, both the Suez Canal and the Red Sea along the Sinai Peninsula to the northeast, the Indian Ocean to the southeast, and the Atlantic Ocean to the west. The continent includes Madagascar and various archipelagos. It has 54 fully recognized sovereign states ("countries"), nine territories and two de facto independent states with limited or no recognition.
According to UN statistics, there are currently over 600 million persons with disabilities throughout the world of whom 400 million live in developing countries and 80 million in Africa. Most common disabilities in Africa are: physical, sensory (blindness) and mental disabilities. Our main focus in this paper will be on physical disability.
The main interventions being implemented regarding physical disability are:

• Community based rehabilitation, CBR,
• Provision of orthopedic devices and mobility aids
• Training and capacity development of rehabilitation personnel and orthopedic technicians, physiotherapists, etc.
• Policy development on disability and action plan on behalf of persons with disabilities, PwDs.
  

Community Based Rehabilitation

Community based rehabilitation (CBR) is a strategy within community development for the rehabilitation, equalization of opportunities, poverty reduction and social integration of people with disabilities. CBR is implemented through the combined efforts of disabled people themselves, their families and communities and the appropriate health, education vocational and social services.

Provision of orthopedic devices and mobility aids

Many programmes, centres, initiatives whether nationally, regionally or internationally recognized are set up to help people with physical disability to get an orthopaedic device that will help them get back up on their “feet”. These orthopaedic devices range from ankle foot orthoses, knee orthoses, knee ankle foot orthoses, hip knee ankle foot orthoses, trunk braces, foot prostheses, tibial prostheses, femoral prostheses, hip disarticulation prostheses to crutches, canes and wheelchairs. The technologies of Orthoses and Prostheses vary from country to country. In some countries, local solutions are being implemented whereas in others (more developped), new technologies are used. International/Regional organizations such as Handicap International, SFD/ICRC and OADCPH play an important role in the provision of orthopaedic devices and components on the continent.

Training and capacity development of rehabilitation personnel and orthopedic technicians, physiotherapists

Many formal schools and training institutes exist and different types of training are offered to different kinds of people in order to ensure quality rehabilitation services to patients.

Prosthetics and Orthotics training and capacity development

The existing schools, which are well distributed on the continent geographically as well as linguistically are in Tanzania, Togo, Sudan, Ethiopia, South Africa, Nigeria, Ghana, Rwanda, etc. Some of them are internationally recognized and thus train students from different countries whereas others are nationally recognized.
The training efforts in Africa are not just limited to those formal training institutions and schools alone but are also supported by some NGOs and Regional/International Organizations especially by providing a continuing education and modular trainings, such as SFD-ICRC, Human Study, etc.
Innovative methods such as e-learning are also implemented.
The different types of offered trainings are :

• P&O Cat.1 (Bachelor of Sciences): TATCOT-Tanzania ; HUMAN STUDY-Germany (e-learning) ; TUT-South Africa
• P&O Cat.2 : ENAM-Togo; Ethiopia, Rwanda
• Wheelchairs : TATCOT-Tanzania (Basic & Intermediate levels) ; FATO-WHO ;
• Spinal Orthotics : TATCOT-Tanzania (e-learning)
• Lower Limb Prostheses and Orthoses (one-month training) : SFD-ICRC (Togo and Tanzania)
• Upper limb prostheses (one-month training) : SFD-ICRC (Togo and Tanzania)

Physiotherapist training and capacity development

Physiotherapy is much more represented and recognized on the continent. For instance, in Burkina, the government doesn’t have Orthopaedic Technologists (OT) in their Official document nor in the list of Healthcare professions and OT are officially « Physiotherapist ». Many schools and training institutions exist on the continent. Countries in Africa who train Physiotherapists include Zambia, Zimbabwe, Kenya, Tanzania, Uganda, South Africa (up to PhD), Nigeria, Ethiopia, Rwanda, Egypt, Togo, Benin, Côte d’ivoire, etc. Physiotherapists training, initially leading to Diploma, has changed and moved towards Degree Programmes (B.Sc, M.Sc, PhD). Countries who don’t have training institutions are dependant on others who have it in order to have their own Physiotherapists.
NGOs are also involved in developping Physiotherapy in Africa by providing short/modular courses (SFD/ICRC), scholarships for formal training.

All these schools and training institutes exist but the needs in number of professionals, in continuing education, in training offers are far from being covered. Much more efforts must be done, new schools and training institutions must be created, other types of trainings must be added and new strategies need to be implemented in order to establish a strong, effective and sustaining education mechanism in rehabilitation in Africa.

Policy development on disability and action plan on behalf of persons with disabilities

A series of surveys conducted by FATO revealed that there remains a lot to be done regarding policy development on disability. The surveys involved 29 african countries and revealed the informations contained in the following table:

              

National development plans and Policies on Disability in Africa

	Strategy on poverty reduction		UN Convention on the Rights of People with Disabilities		Strategy on disability		Strategy or plan on physiotherapy and prosthetics & orthotics
YES	Existence	Budgeted	Signed	Ratified	Existence	Budgeted	Existence	Budgeted
	27 countries	20 countries	26 countries	19 countries	18 countries	12 countries	14 countries	11 countries
NO	2 countries	5 countries	3 countries	10 countries	10 countries	7 countries	14 countries	17 countries

Amputee rehabilitation in Africa

Generally speaking, amputee rehabilitation on the continent is performed on a multidisciplinary basis involving the surgeon, the nurse, the psychologist, the physiotherapist, the orthopaedic technologist, the social worker, etc. However, local or remote settings do not always involve all those actors. Sometimes the management stops at the amputation without any referral to a rehabilitation centre. At other times, it involves only the surgeon and the Orthopaedic technologist, and all these at the disadvantage of the amputee. National examples canstopsnational examples are worthy to be taken into account.