Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries

Jessica O'Dowd; Malcolm MacLachlan; Chapel Khasnabis; Priscille Geiser

doi:10.5463/dcid.v26i3.449

Jessica O'Dowd ⁽¹⁾, Malcolm MacLachlan ⁽²⁾, Chapel Khasnabis ⁽³⁾, Priscille Geiser ⁽⁴⁾

(1) Trinity College Dublin, Ireland,

(2) School of Psychology, Trinity College Dublin, Ireland,

(3) Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland,

(4) Handicap International, France

https://doi.org/10.5463/dcid.v26i3.449

Issue
Vol. 26 No. 3 (2015): Autumn 2015

Submitted
September 14, 2020

Published
October 24, 2015

Keywords:

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Abstract

Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers.

Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting.

Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families.

Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms.

Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.

Authors

Jessica O'Dowd

Trinity College Dublin

odowdje@tcd.ie (Primary Contact)

Malcolm MacLachlan

School of Psychology, Trinity College Dublin

Chapel Khasnabis

Department of Essential Medicines and Health Products, WHO, Geneva

Priscille Geiser

Handicap International

Author Biographies

Jessica O'Dowd, Trinity College Dublin

Jessica O'Dowd is a physiotherapist and PhD researcher in Global Health at Trinity College Dublin. Through her work as a physiotherapist in the field of disability and rehabiliation she gained valuable insight into person centred approaches to care. She completed an MSc Global Health in Trinity College Dublin with a special interest in community based rehabiliation and assistive health technologies. She was a founding member of the END FGM European Network and has an interest in womens health and disability.

Jessica is completing PhD research in conjunction with the Irish Health Research Board Trials Methodology Network (HRB TMRN) exploring how context affects implementation of rehabilitation interventions. She is also a member of the GATE Research Group in assistive technologies.

Malcolm MacLachlan, School of Psychology, Trinity College Dublin

Mac MacLachlan is Professor of Global Health at Trinity College Dublin, Ireland, and Extraordinary Professor of Rehabilitation at Stellenbosch University, South Africa. He was previously Head of the Department of Psychology at the University of Malawi and has worked as a clinician, consultant and academic in Europe, Africa and Asia. He is currently working on a number of projects addressing disability and social inclusion, with Handicap International, WHO, ILO, UNPRPD and UNESCO; and he is a member of the GATE Research Group.

Chapel Khasnabis, Department of Essential Medicines and Health Products, WHO, Geneva

Mr Chapal Khasnabis a prosthetist/orthotist from his early childhood, a social/technical innovator who spent most of his career in the field of prosthetics and orthotics, assistive technology, and rehabilitation, Community-based rehabilitation (CBR) in particular. Mr Khasnabis is currently working as a Technical Officer in the Public health and Innovation team in the department of Essential Medicines & Health Products of the World Health Organization and leading WHO’s new global initiative – Global cooperation on Assistive Technology (GATE) to improve access to assistive health technology for people with disabilities, ageing and others in need.

He completed Prosthetics and Orthotics Engineering from All India Institute of Physical Medicine and Rehabilitation, Mumbai, India and obtained a Masters degree in the Rehabilitation Science from Strathclyde University, UK. Besides his full time job, he is also doing PhD in the Trinity College, Dublin. He has 35 years of working experience - 14 years with Ministry of Health and Ministry of Social Welfare (Government of India), 9 years with Mobility India (NGO), which he founded in 1994 and 12 years with the World Health Organization. He has personal experience of working in more than 10 low-income countries and his work took him to more than 70 countries – mostly low-and middle-income countries.

Priscille Geiser, Handicap International

Priscille Geiser is Handicap International's Head of Technical Unit on “Support to Civil Society”. Her work involves providing technical support and guidance to improve participation of people with disabilities in development processes and to ensure the quality of HI’s project in promoting disability rights and policies. She is a political science graduate and has been working for over 13 years in the areas of accessibility, strengthening disabled people’s organizations and developing inclusive policies. She is also involved in international level advocacy for inclusive development as Chair of the International Disability and Cooperation Consortium’s (IDDC), and lectures at the EHESP School of Public Health in Rennes for the Master’s 2 in Disability and Social Participation.

1.

O'Dowd J, MacLachlan M, Khasnabis C, Geiser P. Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries. DCIDJ [Internet]. 2015 Oct. 24 [cited 2025 Mar. 14];26(3):5-43. Available from: https://dcidj.uog.edu.et/index.php/up-j-dcbrid/article/view/192

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