Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Project Phases
2.2. Stakeholders in each phase
3. Results
3.1. Epidemiological and Health System Data
3.2. Rehabilitation Workforce
3.3. Rehabilitation Service Delivery
3.4. Recommendations and Projects
Recommendation
- High priority (mean score: 1.00–1.49)
- PRM should be implemented as an independent medical specialty in Albania (mean score: 1.33)
- Rehabilitation as a health strategy must be implemented in all phases (acute, post-acute, long-term care including Community Based Rehabilitation) and levels of medical care (primary, secondary, and tertiary care), and should include early detection and intervention (mean score: 1.08)
- Work toward a participation model for the inclusion of persons with disabilities to be used as a basis of planning and decision making at all relevant fields of political actions such as health, education, labor, justice, social welfare as well as the planning of public and private buildings and public transport system. Such a model should replace the charity model of rehabilitation services and social compensation programs that nowadays is predominately used in Albania (mean score: 1.17)
- As above-mentioned, the implementation of rehabilitation medicine topics in undergraduate medical training can be a first step to increasing knowledge in rehabilitation in the medical community. In parallel, the implementation of PRM specialist training at the University of Medicine Medical Faculty in Tirana can be done (mean score: 1.42).
- To further develop the skills and competencies of already trained physiotherapists, it is recommended to develop standards for physiotherapy for different conditions and services based on the best available evidence (mean score: 1.09).
- Develop standards for staffing and technical equipment for specific rehabilitation services (mean score: 1.33)
- As some of the above projects will require financial support, it is important to develop a funding strategy for such projects (Charity funding, use existing national research funds, apply for European Union funds) (mean score: 1.42).
- Moderate priority (mean score: 1.50–1.99)
- Ensure that rehabilitation is fully integrated in the health system and rehabilitation services are given a priority together with the other element of universal health coverage (UHC) (mean score: 1.50).
- Ensure that the International Classification of Functioning, Disability and Health (ICF) is used for assessment and follow-up of disability as well as health care planning. The UN definition of disability as an interaction of an individual with a health condition and the environment should be implemented at all levels of decision making (mean score: 1.92).
- Asses systematically the prevalence of disability in Albania and estimate the needs for rehabilitation using the Model Disability Survey (MDS) of the WHO [26] or another appropriate method of needs assessments (mean score: 1.68).
- Increase the understanding and awareness of disability in Albanian society (e.g., by public relations campaigns) and ensure that disability and rehabilitation topics are taught in the undergraduate training of medical doctors, health professionals, and social workers as well as teachers, architects, city planners, and others (mean score: 1.75).
- The disability health policy should be based on the WHO’s modern understanding of disability (according to the ICF model) as an interaction of a person with a health condition and the environment (mean score: 1.75).
- Rehabilitation services should be conceptualized and implemented according to the international standards including qualification of rehabilitation professionals, team structures, and standards for technical equipment as well as assistive devices (mean score: 1.75).
- Primary care physicians should receive continuing education training in basic rehabilitation skills (mean score: 1.92).
- Training program and accreditation rules for occupational therapy should be developed and implemented (e.g., within the Faculty of Medical Technical Sciences) (Mean score: 1.50).
- Add clinical rehabilitation modules to the training programs for logopedists (SLT) and their numbers should be increased (mean score: 1.75).
- Training program and accreditation rules for prosthetics and orthotics should be developed and implemented (mean score: 1.50).
- A CME program for therapists (and a system for quality assurance (including audits) should be developed and implemented stepwise (mean score: 1.67).
- Implementation of occupational therapy in University of Medicine Faculty of Medical Technical Sciences (mean score: 1.67)
- Tele-health/tele-rehabilitation programs should be developed by a scientific expert group (mean score: 1.75)
- Low priority (score ≥ 2.00)
- Training courses in rehabilitation for nurses are recommended, particularly for nurses who work in acute rehabilitation and highly specialized rehabilitation centers) (mean score: 3.00).
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Rehabilitation Professionals | Total Numbers | Distribution Urban Rural; % in Primary, Secondary, Tertiary | Minimum Educational Requirement for Entry into the Workforce | Which of the Following are Offered in the Country | Number of Education Institutions Offering Courses | Number of National Graduates Each Year | Is there Professional Registration/Licensing? | Is There a Profession Association |
---|---|---|---|---|---|---|---|---|
PT | 1108 | No data | Bachelor | Bachelor, master, doctorate | 9 | 450 | Yes | Yes |
OT | None | None | None | None | None | None | None | None |
SLT | 136 | No data | Bachelor | Bachelor, master, doctorate | 2 | 60 | Yes | Yes |
P&O | None | None | None | None | None | None | None | None |
PRM physicians | None | None | None | None | None | None | Yes | None |
Rehabilitation Nurses | None | None | None | None | None | None | Yes | None |
Psychologists | >200* | No data | Bachelor | Bachelor, master, doctorate | 7 | 400 | Yes | Yes |
Other rehabilitation cadre | None | None | None | None | None | None | None | None |
Country | |||||
---|---|---|---|---|---|
Albania | Ukraine [19] | DPRK [20] | Egypt [18] | ||
Year of Project | 2019–2020 | 2015 | 2016–2017 | 2015 | |
Methodology | Initiated by | Civil Society (University) | Government (Ministry of Heath) | Government | Government (Ministry of Heath) |
Data collection tool | TRIC | RSAT | RSAT | RSAT | |
Site visit to the country and interview | 2 | 2 | No site visit | 2 | |
Additional working meetings | Video conferences | - | Two visits of DPRK team to Germany | Multiple correction loops with WHO country office via email | |
Team | PT, PRM, rehabilitation researcher | WHO, PRMs, neurorehabilitation | PRM, representative of persons with disability organization (KFPD), neurorehab | WHO, PRM | |
Stakeholders | Rehabilitation professional organizations (PT, ST), a representative of MOSP, rehabilitation service hospitals | Rehabilitation professional organizations (PT, ST), representative of MoH, MoSW rehabilitation service hospitals | Representative of persons disability organization (KFPD) and PRM from rehabilitation hospital | Rehabilitation professional organizations (PRM, PT) representative of MoH, MoSW, rehabilitation service hospitals | |
Priority Recommendations (categories) | Develop national rehabilitation action plan | - | Yes | Yes | Yes |
Strengthen inter-ministerial communication | - | Yes | Yes | Yes | |
Translation and implementation of ICF | Yes | Yes (has been started) | Yes | Yes | |
Implement rehabilitation professions | PRM, OT, P&O | PRM, OT, for PT transition to international standards | Transition to international standards | N | |
Expand rehabilitation services | Acute, post-acute services, and CBR | Acute, post-acute services and CBR | Acute, post-acute services, and CBR | Acute, post-acute services, and CBR | |
Improve delivery of Assistive Technology | Yes | Link with rehabilitation services | Yes | Yes | |
Strengthen rights of persons with disability | Yes | Yes | Yes | Yes | |
Priority projects | Development or adaptation of curricula for rehabilitation professions | Yes | Yes | Yes | Yes |
Perform national disability survey | Yes (i.e., start with InSCI project) | Yes | Yes | Yes | |
React to specific situation | - | Armed conflict in eastern Ukraine | Collaborate with international partners | Services for persons without health insurance |
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Nugraha, B.; Tani, K.; Gutenbrunner, C. Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach. Int. J. Environ. Res. Public Health 2020, 17, 7300. https://doi.org/10.3390/ijerph17197300
Nugraha B, Tani K, Gutenbrunner C. Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach. International Journal of Environmental Research and Public Health. 2020; 17(19):7300. https://doi.org/10.3390/ijerph17197300
Chicago/Turabian StyleNugraha, Boya, Klejda Tani, and Christoph Gutenbrunner. 2020. "Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach" International Journal of Environmental Research and Public Health 17, no. 19: 7300. https://doi.org/10.3390/ijerph17197300