Abstract
BackgroundThe challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood.ObjectivesThe aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this.MethodThis qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented.ResultsCommunity-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment.ConclusionCommunity-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.Keywordswheelchairs; less resourced settings; community-based rehabilitation; wheelchair service provision; service steps; Uganda; empowerment; inclusion; assistive device.
Highlights
The right to personal mobility is mandated by the United Nations Convention on the Rights of Persons with Disability (UNCRPD) (UN 2006)
An appropriate wheelchair and related services, information and training are crucial for many persons with disabilities (PWD) and can enhance potential to achieve personal health, development and participation in society (UN 2006; World Health Organization [WHO] 2008)
The WHO Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings recommend that a wheelchair should meet the individual user’s personal and contextual needs and should be provided by suitably trained service providers within a comprehensive service system (WHO 2008)
Summary
The right to personal mobility is mandated by the United Nations Convention on the Rights of Persons with Disability (UNCRPD) (UN 2006). Training of service personnel in the delivery of these steps is required and can have a positive impact on user satisfaction (Borg, Larsson & Östergren 2011a; Toro, Eke & Pearlman 2016; UN 2006; Visagie, Duffield & Unger 2015a). Global resources, such as the WHO Wheelchair Service Training Packages (WSTP), are available to equip service providers and managers in appropriate provision (WHO 2012, 2015). The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood
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