[Zaynab Khalfan]

1. What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?
In Tanzania context the possible factor that have greater chance of being a barrier in implementing rehab program are
Resource: there is few or in no technical expert and rehab equipment (ie assistive technology)
Rehab indicator in health information system: in Tanzania context DHIS2 is the main warehouse that aggregate data from primary facility to finalise the health data but in this DHIS2 tool there is no indicator for rehab program that hinder to evaluate the rehab intervention
Policy: the guideline to support implementation of rehab intervention is very challengeable that possibly hinder the whole implementation of rehab program
Community perception: community tend to describe victim with disability as non-function that made most of them develop stigma that influence them not to engage in productivity
The level of obstacle are stated from individual, household ,institution, community and lastly superstructural

2. How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
The most effective part that can be addressed are clinical case and data analysis
By ensuring that every staff committed to his work so to ensure DALY is increased and prevent premature death
Data analysis is a crucial aspect in rehab program as it will stand to evaluate the economic evaluation of an intervention.

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?
The commonly formative research to be used are
Needs Assessment: Conduct a thorough needs assessment to identify specific barriers and gaps in current rehabilitation services.
Literature Review: Review existing literature on successful interventions in similar contexts to inform your approach.
Pilot Studies: Implement pilot studies to test the feasibility and effectiveness of potential interventions on a small scale before broader implementation

4. When considering potential interventions, what factors related to implementation do I need to consider?
Implementation Factors to Consider:
Resource Availability: Assess the availability of financial, human, and technological resources needed for the intervention.
Stakeholder Engagement: Engage key stakeholders, including patients, healthcare providers, and administrators, to ensure buy-in and support.
Training and Support: Develop training programs for staff to ensure they are equipped to implement the intervention effectively.
Scalability and Sustainability: Consider how the intervention can be scaled up and sustained over time.

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?
Implicit Biases Impact:
Racial and Ethnic Bias: Biases against certain racial or ethnic groups can lead to disparities in rehabilitation referrals and quality of care, reducing access and benefits for these populations.
Socioeconomic Bias: Assumptions about individuals from lower socioeconomic backgrounds may affect the resources allocated to their care and their adherence to rehabilitation programs.
Age Bias: Older adults might receive less aggressive or comprehensive rehabilitation due to assumptions about their recovery potential.
Disability Bias: Biases against individuals with disabilities can lower expectations for their improvement, impacting the quality and intensity of care provided.
Gender and Weight Bias: Gender stereotypes and weight biases can influence treatment recommendations and the level of encouragement patients receive.
Addressing Biases:
Training and Education: Provide implicit bias training for healthcare providers to raise awareness and reduce the impact of biases on decision-making.
Standardized Protocols: Implement standardized protocols to ensure consistent and equitable care across all patient groups.
Patient Advocacy: Promote patient advocacy initiatives to empower patients to voice their concerns and needs, ensuring their perspectives are considered in care planning.

[Zaynab Khalfan]

As an implementation facilitator for Telerehabilitation, it is crucial to first assess how this proposed intervention aligns with the priorities of the organizations involved. In this case, Telerehabilitation offers the potential to improve access to rehabilitation services, increase efficiency, and reduce costs, which are likely priorities for healthcare organizations aiming to provide high-quality care while managing resources effectively.

Next, considering how Telerehabilitation fits with community values, including those of diverse cultural groups, is essential. It is important to ensure that the implementation of Telerehabilitation respects and aligns with cultural values and preferences. This may involve adapting the intervention to be culturally sensitive, providing language support, and involving community members in the planning and delivery of services.

As for facilitating the implementation of Telerehabilitation, targeting key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention is critical. Strategies could include conducting educational sessions, providing evidence-based information on the benefits of Telerehabilitation, and addressing any concerns or misconceptions that stakeholders may have.

To target the motivation and capability of individuals and organizations to engage in the implementation process, strategies such as providing training and support, establishing clear communication channels, and involving stakeholders in decision-making can be effective. It is also important to monitor progress, gather feedback, and make adjustments as needed to ensure successful integration of Telerehabilitation into existing healthcare systems.

[Zaynab Khalfan]

Rehab service is an integral components in health care system,to increase productivity and improve life of people rehabilitation services should be considered as core components in expand the health care services especially in rural areas that show there is significant inequities in access service based on geographical, social economic status and disability type.
There is growing need of integrating rehab service in primary healthcare setting so as to improve access and ensure early intervention for people with disabilities or those recovering from injury

[Zaynab Khalfan]

At my district hospital as a focal person of DHIS2 the service we have for our client is only physiotherapy services with few or sometimes no client at all.
It happens while ago some of the client were attending the clinic due to fellow clients appear at the clinic with the tools for massaging and but the situation is different somehow to region hospital there is little improvement of the service like occupational therapy and for the national hospital there are numbers of service but most of clients can’t access the service due to social ecological factor despite the fact that the number of clients who are in need of rehab service is higher and the majority are home than who attend the clinic.

[Zaynab Khalfan]

My pop up thinking when hearing rehabilitation is “repairing”

[Zaynab Khalfan]

Hello everyone
My name is Zaynab Khalfan environmental health officer|health informatician.i have been working on under data management and analysis in rural area with low resources settings experience a big gap in rehabilitation services.
Am excited to join this forum to gain insights on issue of rehabilitation and how will integrate my ICT skills with implementation science skills to develop strategic tools to scale up rehabilitation services

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