In Tanzania, like many other LMICs, there is shortage of Assistive Technology health care professionals, such as wheelchair fitting specialists. For stroke patients, having wheelchairs that enable them to obtain optimal level of functioning is an important step to re-integrate into society. The intervention I would design for this case would be to incorporate wheelchair fitting training as part of the pre-service curriculum so that OTs/PTs also have this specialized training.

Leveraging the RE-AIM framework, the parts of the intervention I would focus on are the following:
1. Effectiveness: Ensuring that there is evidence-based tools/supports (i.e. like the WHO guide for wheelchair fitting in LMICs) to deliver the intervention and ensuring there are ways to collect data, satisfaction and experience from students to understand the positive and negative consequences of the intervention
2. Adoption: Perhaps piloting the training material on one cohort to understand and evaluate the value and effectiveness will be a strategy to help broader adoption and institutionalization into pre-service training curriculum for the PT and OT cadres. Developing a business case to fully articulate the cost and benefits of this intervention may also be needed.
3. Implementation: To ensure consistency, there may be a need to have a train the trainer approach (i.e. having a specialized expert in wheelchairs deliver the training to a group of professors who can then implement across all; there should be strong guidance, data collection and evaluation of the train the trainer model to ensure consistency.

In terms of measuring success, I would use the following indicators:
1. # of teachers trained on wheelchair fitting
2. # of students in cohort who received wheelchair fitting
3. # of students who graduated in wheelchair fitting and are employed in settings where these services are delivered
4. # of patients who receive wheelchair fitting services (comparison of baseline vs. 1 year post implementation)
5. Multidisciplinary Rehab for People with Complex Needs – as per the WHO RIM
6. # of universities/programs that incorporate wheelchair fitting training into pre-service curricula (i.e. a measure of adoption)
7. Satisfaction surveys from students to understand value of this intervention and the use of this training in their daily jobs

Steps in Monitoring and Evaluation:
1. Development of a M&E plan during the design of the intervention that includes both M&E experts, researchers (if applicable), teachers, clinical staff and students
2. Development of data collection tools to capture data at the teacher level, student level, individual patient level and hospital level
3. Routine monitoring of the progress leveraging both input, output and outcome indicators; this can be then used to further adopt and scale up the intervention
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