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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
Telerehabilitation aligns well with my organization’s priorities and includes increased accessibility: Telerehabilitation can extend rehabilitation services to patients in remote or underserved areas who may have difficulty accessing in-person services, as well as cost efficiency: By reducing the need for physical infrastructure and travel, telerehabilitation can lower the costs of delivering rehabilitation services.

• How does it fit with community values, including the values of diverse cultural groups?
Telerehabilitation has the potential to fit well with community values as it addresses several key areas:
Equity and Inclusion: Telerehabilitation bridges the gap for communities that face barriers to accessing traditional rehabilitation services, promoting health equity.
Respect for Cultural Practices: With cautious implementation, telerehabilitation can be adapted to respect and integrate cultural practices and preferences, ensuring culturally competent care.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention? Stakeholder identification, analysis, and engagement. Workshops, webinars, and training sessions for stakeholders.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention? Incentives, Support Systems, Resource Allocation, Change Champions, Clear Guidelines and Protocols, and Monitoring and Feedback mechanisms.

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
Using the RE-AIM framework,the aspects if the intervention I will focus on to guide planning an eventual success:
Target population: ensuring adequate representation of the population where the intervention will be implemented
Efficacy: Ensuring adequate resources for intervention before the start of the intervention

2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
Rehabilitation expenditure
Rehabilitation personnel density
Rehabilitation bed density

What steps will you take to ensure adequate monitoring and evaluation of the intervention?
Put processes in place for ongoing realtime feedback from the target population about the intervention.
Clearly outline the indicators, targets, outputs, and outcomes and ensure all stakeholders are carried along the monitoring process.

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1. Leadership behavior can be taught vs leaders are born. What do you think? Provide your rationale and an example of a born and made leader.
I believe that both innate traits and learned skills play crucial roles in effective leadership. One born without the traits can acquire them through training, coaching, mentorship, and life experiences. An example of a made leader is Nelson Mandela, An Example of a born leader is Queen Elizabeth.

2. Post your reflections on your strengths, areas that need attention, and development priorities as identified by the emotional intelligence questionnaire on the discussion board. Strengths: I have a strong sense of self-awareness, and understanding of my emotions, strengths, weaknesses, and values. This helps me stay grounded and make informed decisions.
Area needing attention: While I am aware of my emotions, I oftentimes struggle with controlling them, especially under pressure.
Development Priority: I need to focus on techniques for better managing stress and maintaining composure in high-stakes situations.

3. Research some vision statements of various organizations. Post at least two such statements on the discussion forum and explain how these may have evolved.
1. World Health Organization (WHO)
Vision Statement:
Achieve the highest possible level of health for all people.
Evolution:
Original Focus: When WHO was founded in 1948, its primary focus was on combating communicable diseases such as smallpox, malaria, and tuberculosis. The vision at that time was centered around eradicating these diseases and improving public health through global cooperation.
Current Focus: Today, WHO’s vision includes universal health coverage, health equity, and the social determinants of health. The emphasis is on achieving health for all, which recognizes the importance of access to quality healthcare services, preventive measures, and health education.

4. Post your reflections on building strong leadership and increasing political support for rehabilitation of your country on the discussion board. Building strong leadership and increasing political support for rehabilitation services in Nigeria is crucial for improving the lives of individuals with disabilities and chronic health conditions. Building strong leadership by optimizing leadership training programs, creating a clear vision for the future of rehabilitation, empowering community leaders, and encouraging local ownership of rehabilitation through advocacy.

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1. NGOs working on Rehabilitation Needs in Nigeria: CBM (Christian Blind Mission), Handicap International, Comprehensive Community Mental Health Programme (CCMHP), Sightsavers Nigeria, Leprosy Mission Nigeria.

2. Yes, Nigeria has been progressively incorporating the WHO Guide to Action on Disability and Rehabilitation in policies such as the National Health Policy, and Nigeria Disability Bill (2018).

3. Observed Experiences:
Access to Health Care: People with chronic diseases or disabilities often face difficulties accessing healthcare services due to inadequate facilities, high costs, and limited availability of specialized care.

Rehabilitation Services: Rehabilitation services are not widely available in Nigeria, especially in rural areas. Many people have to travel long distances to receive care, which can be costly and time-consuming.

Assistive Technology: Access to assistive devices like wheelchairs, hearing aids, and prosthetics is limited. Cost is a significant barrier, and there is often a lack of awareness about available resources.

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Nigeria

How many people are living with chronic health conditions? 41 million people have chronic health conditions.

How many people are living with disability? 5.2 million people are living with a disability.

What is the incidence of road safety injuries? According to the Federal Road Safety Corps (FRSC) and the National Bureau of Statistics (NBS), from 2013 to 2020, there were at least 5,000 deaths annually, with the highest toll recorded in 2020. In that year alone, 5,574 people lost their lives due to road traffic accidents​.

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Examples of Different Models of Disability in Nigeria
Moral Model:
Example: In some Nigerian communities, disability such as blindness is often viewed through a moral–spiritual lens. People with blindness are seen as bearing the consequences of their past actions or those of their parents.
Medical Model:
Example: Rehabilitation services, such as those provided for polio survivors or those injured in accidents, often emphasize the medical aspects of recovery.
Social Model:
Example: The Nigerian National Disability Act embodies principles of the social model by advocating for the removal of societal barriers and promoting accessibility and inclusion. Efforts to make public buildings accessible, provide inclusive education, and promote employment opportunities for people with disabilities reflect this model.

What do you think when you see someone with a disability?:

Being a medical practitioner, even though I feel empathy and a desire to help, I always view disability from the medical lens and try to decipher what must have led to it and the treatment modalities available and accessible for the individual to live an optimal life.

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Option 2.

In Nigeria, progress has been made to ensure accessibility and reduce disability through various laws and policies. One of the key legislative frameworks is the Discrimination Against Persons with Disabilities (Prohibition) Act, signed into law in January 2019. This law aims to eliminate discrimination and provide equal opportunities for persons with disabilities with penalties for violations, including fines and imprisonment for individuals and corporate entities.

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Rehabilitation involves activities designed to optimize functioning and reduce disability in persons with health conditions.

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In Nigeria, progress has been made to ensure accessibility and reduce disability through various laws and policies. One of the key legislative frameworks is the Discrimination Against Persons with Disabilities (Prohibition) Act, signed into law in January 2019. This law aims to eliminate discrimination and provide equal opportunities for persons with disabilities with penalties for violations, including fines and imprisonment for individuals and corporate entities.

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In Nigeria, the National Health Insurance Authority (NHIA) includes various rehabilitation services to improve the quality of life for individuals with disabilities or those recovering from illness or injury. The specific rehabilitation services covered depend on the insurance plan and insurance provider, but generally include:

Physiotherapy: Services to help restore movement and function when someone is affected by injury, illness, or disability. This can include exercises, manual therapy, and other treatments.

Occupational Therapy: Services to help people of all ages do what they want and need to do through the therapeutic use of daily activities (occupations).

Speech and Language Therapy: Services to support individuals with speech, language, communication, and swallowing disorders.

Psychological and Psychiatric Services: Services to support mental health rehabilitation, including counseling, therapy, and psychiatric treatment.

Prosthetics and Orthotics: Services to provide artificial limbs (prostheses) and devices to support or correct the function of a limb or the torso (orthotics).

Chiropractic Services: Services focused on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine.

Audiology Services: Services to diagnose and treat hearing and balance disorders.

Pulmonary Rehabilitation: A program to help people with COPD improve their breathing and overall quality of life.

Pain Management Services: Treatments and therapies aimed at reducing chronic pain and improving quality of life.

However, some critical maternal conditions that require rehabilitation are not included in the services offered by the NHIA. An example is rehabilitation services for women post vesicovaginal fistula (VVF) repair surgery.

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