Reply To: Discussion Forum 1

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1. What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?
While a lot of evidence exists on barriers to access to rehabilitation, limited evidence exists on barriers to access assistive technologies. Conducting a market of most prevalent rehab conditions and associated ATs that are need to support rehab efforts will be helpful to understand barriers to access from a financial, supply, demand and regulatory perspective. Conducting a market diagnostic will require looking at existing census data, demographic health data, procurement data, policies/regulations related to AT procurement, distribution, financing, etc. among other things as well as conducting key informant interviews with stakeholders including patients, government, NGOs, etc. The outputs from this diagnostic analysis will help to identify what the barriers are as well as their root causes.

2. How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
Given that my organization focuses on health system strengthening at the national level, I may consider implementing institutional or superstructural interventions.

3. What formative research might be needed to understand the precise intervention that would be most appropriate and impactful towards overcoming the challenges I identify?
Key informant interviews with patients and key government stakeholders (MoH, Social Ministries, Prime Minister’s Office), would be integral to understand the priorities (i.e. from patients – which assistive technologies are most needed and which ones aren’t currently available; from governments – where do they see the biggest challenges; how does this link with existing priorities such as economic productivity, universal health coverage, etc.). This can help to prioritize the area of focus for the intervention.

4. When considering potential interventions, what factors related to implementation do I need to consider?
Interventions will have to garner leadership buy-in, particularly if thinking about superstructural interventions. A cost impact analysis as well as acceptability will need to be considered (i.e. if developing product standards for specific AT products in the country and adding them to a product priority list, then the standards will have to be acceptable by the users, and meet the needs/quality expectations of users, etc.) In addition, sustainability of the intervention will need to be considered (i.e. will there be long-term and predictable financing for these products in the future; what will be the sources, etc.)?

5. What implicit biases may be at work in my culture or context and how do those implicit biases impact an individual’s ability to access and benefit from rehabilitation?
Many assistive technologies require time and investment in proper fitting, maintenance and follow-up. If patients are living very far from where AT products/services are being delivered, providers may not prescribe them any because they fear patients will not adhere to the required plan for fitting and maintenance. Providers may also be hesitant to offer any financial means for covering transport costs to overcome adherence challenges, because of the implicit bias related to income levels and fear that the money that is to be used for transport will be used for other things such as food, clothing, school, etc.