An investigation into the impact of a community-based rehabilitation intervention strategy on persons with physical disabilities in an urban and rural setting in Zambia

Banda-Chalwe, M. (2005-04)

Thesis (MMed)--Stellenbosch University, 2005.

Thesis

ENGLISH ABSTRACT:The decentralisation of health care services in the primary health care system poses a challenge to the delivery of care to the communities in Zambia. Little is being done in the Ministry of Health to incorporate community-based rehabilitation (CBR) in the mainstream of primary health care service delivery despite rehabilitation being regarded as the fourth component of primary health care. According to statistics, there are 256 690 (2.7%) persons with disabilities in Zambia, of which 38.8% are persons with physical disabilities. There are various community-based rehabilitation programmes in the country trying to meet the needs of persons with disabilities but these programmes have not been evaluated to determine the impact which CBR has on the lives of persons with disabilities. This study aimed to determine the impact of a community-based rehabilitation intervention strategy on persons with physical disabilities in an urban and rural setting in Zambia. It is hoped that the results of this study can be utilised as a means to lobby the Zambian government to become involved in the rehabilitation process. An experimental study was done using a community-based rehabilitation intervention strategy on 66 persons with physical disabilities, of which 62% were male and 38% female, from Lusaka urban and Chipata rural community-based rehabilitation programmes. The researcher completed a self-compiled questionnaire during a personal interview with the participants/proxy. The questionnaire comprised demographic data and an assessment of the disability status of persons with physical disabilities regarding movement, functional activities and their integration into the community. Perceptions of persons with physical disabilities or their proxy as regards their disability status and experiences were also assessed by means of two open-ended questions in the questionnaire. The community-based rehabilitation intervention strategy was conducted for six (6) months by the community rehabilitation workers who visited participants once a week. Data was analysed both quantitatively and qualitatively to determine the impact of a community-based rehabilitation intervention strategy and to test the null hypothesis. The results of this study showed that in Lusaka on one hand, persons with physical disabilities had improvements in movement, functional activities and integration level. On the other hand, Chipata showed that persons with physical disabilities had improvements only regarding integration into the community. However, combined scores showed that community-based rehabilitation had an impact on persons with physical disabilities regarding movement, functional activities and integration into the community. The study also showed that there was a correlation between integration and movement, and integration and functional activities. There was no correlation between integration and caregiver provision and dependency, whereas there was a negative correlation between perceptions and integration. Based on these findings, it is recommended that the Ministry of Health takes up the responsibility of spearheading and coordinating community-based rehabilitation programmes and incorporating the activities in the existing structures of primary health care.

AFRIKAANSE OPSOMMING:Die desentralisasie van gesondheidsorgdienste in die primere gesondheidstelsel hou 'n uitdaging vir dienslewering aan gemeenskappe in Zambie in. Die Ministerie van Gesondheid doen nie veel om gemeenskapsgebaseerde rehabilitasie (GBR) by die hoofstroom van primere gesondheidsorg dienslewering in te Iyf nie, ten spyte daarvan dat rehabilitasie as die vierde komponent van primere gesondheidsorg beskou word. Daar word beraam dat daar 256 690 (2.7%) mense met gestremdhede in Zambie is, waarvan 38.8% mense met liggaamlike gestremdhede is. Daar is verskeie gemeenskapsgebaseerde rehabilitasieprogramme in die land wat poog om in die behoeftes van mense met gestremdhede te voorsien, maar hierdie programme is nie geevalueer om die impak van GBR op die lewens van mense met gestremdhede te bepaal nie. Hierdie studie het ten doel gehad om die impak van 'n gemeenskapsgebaseerde rehabilitasieintervensiestrategie vir mense met liggaamlike gestremdhede in 'n stedelike en landelike omgewing in Zambie te bepaal. Daar word gehoop dat die resultate van hierdie studie gebruik kan word om druk op die Zambiese regering uit te oefen om by die rehabilitasieproses betrokke te raak. 'n Eksperimentele studie is gedoen deur 'n gemeenskapsgebaseerde rehabilitasie-intervensiestrategie op 66 mense met liggaamlike gestremdhede van die Lusaka stedelike en Chipata landelike gemeenskapsgebaseerde rehabilitasieprogramme toe te pas. Twee en sestig persent (62%) van die respondente was manlik en 38% vroulik. Die navorser het tydens 'n persoonlike onderhoud met deelnemers of hulle gevolmagtigdes 'n selfopgestelde vraelys voltooi. Die vraelys het uit demografiese data en 'n bepaling van die mense se gestremdheidstatus ten opsigte van beweging, funksionele aktiwiteite en hulle integrasie in die gemeenskap bestaan. Persepsies van mense met liggaamlike gestremdhede of hulle gevolmagtigdes rakende hulle gestremdheidstatus en ervarings is ook deur middel van twee oop vrae in die vraelys bepaal.Die gemeenskapsgebaseerde rehabilitasie-intervensiestrategie is vir ses (6) maande toegepas deur gemeenskapsrehabilitasiewerkers wat die deelnemers een maal 'n week besoek het. Data is sowel kwantitatief as kwalitatief ontleed om die impak van 'n gemeenskapsgebaseerde rehabilitasie-intervensiestrategie te bepaal en die nulhipotese te toets. Die resultate van die studie het aangedui dat mense met liggaamlike gestremdhede in Lusaka verbetering ten opsigte van beweging, funksionele aktiwiteite en vlak van integrasie getoon het. Mense met liggaamlike gestremdhede in Chipata, daarteenoor, het slegs ten opsigte van integrasie in die gemeenskap verbetering getoon. Gekombineerde tellings het egter getoon dat gemeenskapsgebaseerde rehabilitasie ten opsigte van beweging, funksionele aktiwiteite en integrasie in die samelewing 'n impak op mense met liggaamlike gestremdhede gehad het. Die studie het ook getoon dat daar 'n korrelasie tussen integrasie en beweging, en integrasie en funksionele aktiwiteite bestaan. Daar was geen korrelasie tussen integrasie en versorgervoorsiening en -afhanklikheid nie, en daar was 'n negatiewe korrelasie tussen persepsies en integrasie. Op grand van hierdie bevindinge word aanbeveel dat die Ministerie van Gesondheid verantwoordelikheid vir die leiding en koordinasie van gemeenskapsgebaseerde rehabilitasieprogramme aanvaar en hierdie aktiwiteite by die aktiwiteite van bestaande primere gesondheidsorgstrukture inlyf.

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