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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?
There some research which are done to identify the barriers e.g. (Shayo, M.J. and Van den Bergh, G., 2015. Physiotherapy management of idiopathic clubfoot in Tanzania: experiences and challenges. Physiotherapy, 101, pp.e1374-e1375), which identified barriers in different levels including individual level lack of awareness and poor knowledge regarding clubfoot was a barrier to treatment, due to poor individual knowledge some family conflict existed and caused separation, at the level of institution few were trained on Ponsati methods of clubfoot management therefore treatment was inconsistent and varied from one institution to another; at the community level we found that stigma was a problem (clubfoot was associated with being cursed and in some tribes as a blessing that the family will have more cattle therefore they preferred not to take the child for treatment. Women and children had less rights in some society especially in rural society women would have been blamed for bringing a lame child to the family and led to less priority in rehabilitation services
2. How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
As a follow up of the same study in no 1 above effort was made to educate physiotherapists in the use of Ponseti methode for clubfoot management, as a physiotherapist and trainer I contacted the TCCO team which was receiving support from Miracle feet who provide training to staff and support clinics in Tanzania to provide Ponseti treatment. Now the clinics providing Ponseti treatment in Tanzania are many, and the supervision is led by MDH, I am a Ponseti trainer and a supervisor of clinics supported by Miracle feet in Northern Zone of Tanzania. What is provided is by Ponseti clinics is parental education (to affect the individual and house hold level), training to Ponseti providers and peripheral health centres(to build capacity a the institution level), creating awareness in the society (schools, religious gatherings and local government meetings). We are working close with the govement to include Ponseti method of clubfoot management in the curricula and in the implementation og the National Rehabilitation Action Plan.
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?
Currently we need to evaluate the impact of the existing program and do and explorative research to identify the need in this particular group, because the country large and the whole country is not covered. Some areas are covered yet we have a large area which is not covered
4. When considering potential interventions, what factors related to implementation do I need to consider?
For the evaluation mentioned in no. 3 above we will explore the following, acceptability of the treatment, commitment of the ministry of health to absorb the implementation into the system and budget if at all it is acceptable to the society, the intervention is carried out successfully and there is a training program which exists and it is used for African countries which ensures fidelity, however the extent that we can reach all children born with clubfoot in Tanzania need more evidence as we haven’t yest ensured sustainability in case the donor withdraws.
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?
Social economical groups and women

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1. The proposed intervention fit with the priority of my organization in the following points
a) My organisation is forcusing improving accessibility of rehabilitation services in our region through involving tele-rehabilitation. We have done the preliminary studies to feasibility of tele rehab in Tanzania (Shayo, M.J., Shayo, P., Haukila, K.F., Norman, K., Burke, C., Ngowi, K., Goode, A.P., Allen, K.D., Wonanji, V.T., Mmbaga, B.T. and Bettger, J.P., 2023. Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability. Frontiers in Rehabilitation Sciences, 3, p.982175.). In short it is our priority.
2. There is an on going study where we have reached a stage of developing physiotherapy prescription bank, and in this study we have preliminarly identified that about 98% of 300(n)adults with MSK attending our clinic use mobile phone, of them 64.7% use smart phone and 94% of them use it personally while 6% share the phone with another person.
Ninety four percent charge their phones with electricity at home, those who use text messages 100% (300N) can read them without help, 96% can write them without help. Through this preliminary results we have seen indicators that if tele-rehabilitation starts at our organisation; the community has phone, and by using text message many will be able to get the information, although majority use smart phone we may miss others if we start using videos in such group, however level of literacy is sufficient for basic communication and provision of printed exercise program for home use with text or call reminder

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1. I will approach this part by first conducting a fact finding mission through the community to identify the needs and the existing gap (e.g. what is practiced and what is lacking, number of organizations supporting the tele-rehabilitation, what are the barriers, how will the tel-rehab fit the intended community, readiness of the consumers users) and then disseminate the information to the key stake holders through different approach e.g. e-mails, stakeholder meeting, local leader meetings and consumers meeting, funders meeting, and tele-companies suggestion ond developing an easy program that will benefit all users
2. I will have to develop acceptable and eligible tools to help the intervention fit the community and easy. Mode of tele rehabilitation that will be used whether synchronized mode or asynchronized mode depending on the context (this will depend on the individual users affordability, accessibility and ability to use technology, listening and align the program to fit the user needs). By ensuring capacity building to the service providers through seminars and workshops and proper and timely reporting to policy makers, funders and the administrating authorities.

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I will use the RE-AIM framework to guide the planning and evaluation of the program

Reach: I will assess the methodology of identifying the target population and inclusion criteria for the sample size, as well as the characteristics of the participants if they meet the standards according to the existing guiding policy
Effect: here the short and long term results will be evaluated and the percentage of impact they will bring about to the society
Adoption: Is the project cost effective, are there expertise to ensure quality service delivery
Implementation: Quality of service, is the service following the laid down protocol and costs
Maintain: Will assess the individual behavior towards the service provided and the factors that ensure existence of the program (collaboration, inclusion e.t.c)

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Data source I will use to gather information will be:
1. The national census: (Tanzania National Census 2022) to inform me about the population and the proportion of disability within the country
2. Individual records in the health facilities (Health record system within the facility) : to get enlighten of the burden information on the health condition impairment and activity limitation
3. Social registry (Tanzania Registrar of Societies): to gather information regarding the services available in the society (e.g. registered societies for people living with disability) and the acceptability and accessibility in relation to social believes and task distribution
4. Service records (within the existing health facilities rehabilitation centers): will inform on number of services the clients receive, hence understanding the extent rehabilitation services is prescribed
5. Population survey (Tanzania National Beuro of Statistics): will inform me on resources available, resources needed, resources missing and services available
6. Resource records (from the available health facilities in the district): to examine the availability of assistive technology and human resource (availability of multidisciplinary services)
To add evidence and enhance strategies for implementation I will also include regional (east Africa, Africa) and global data

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My country Tanzania has already established a National Rehabilitation Strategic Plan 2021-2026, which has four major objectives named: 1. Strengthen rehabilitation leadership, planning, and generation of evidence and
information 2. Increase the availability of rehabilitation services and expand financing 3. Strengthen and expand the rehabilitation workforce 4.Increase the access and provision to assistive products
As this is the first Tanzania Rehabilitation Strategic Plan developed its implementation may undergo several challenges of which may include human resource and training. Human resource in rehabilitation is extensive and there may be a need of different specialties to full fill the task (some specialty are lacking due to lack of education institutions within the country e.g. physiotherapists, occupational therapists their training is available to bachelor level within the country. Higher level (master) may be needed to improve rehabilitation leadership and political support as this will stimulate researches to be conducted within the rehabilitation field and influence the policy makers on police changes.

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Greenvit health Tanzania: “We envision a society where individuals are in charge of their health and free from NCD burdens” This may have evolved from the idea of empowering individuals with non communicable diseases (NCD)to manage their own conditions (continuous self care) in order to prevent/avoid the disabilities that can be prevented, it has a client centered focus than on medical condition.

Bugando Medical Centre: “BMC envisions a healthy society served by skilled and competent health care providers” this may have evolved fro idea of having well trained and skilled service providers who will serve the community, the health of the society must be cared by skilled and competent individauls

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FROM THE TEST I REALIZED THAT I HAVE STRENGTHS IN SELF AWARENESS (36) AND EMOTION MANAGEMENT (38), HOWEVER I NEED TO PUT ATTENTION IN SELF MOTIVATION (24), EMPATHY (34) AND SOCIAL SKILLS (34). I NEED TO IMPROVE MY SKILLS THESE THREE ARES, I HOPE WITH AT THE END OF THIS TRAINING I MAY GET ENOUGH KNOWLEDGE AND SKILLS TO PUT THEM INTO PRACTICE

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AN EFFECTIVE LEADER IS MADE THROUGH LEARNING, EXPERIENCE AND STUDYING PEOPLE’S PSYCHOLOGY AND BEHAVIOR

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Physiotherapy, Occupational therapy, Prosthetic & Orthotic, and speech & language services are provided in my country, however urban areas receive most of the services than rural, most of rural areas receive non of the services because of lack of human resource.

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Hi everyone I am Mathew Shayo physiotherapist clinician working at Kilimanjaro Christian Medical Centre (KCMC) and an assistant lecturer at the Kilimanjaro Christian Medical University College (KCMUCo)-Tanzania. Currently I am the head of Physiotherapy Department. As a leader and instructor I am expecting to expand my knowledge in integrating rehabilitation services at all levels of health hierarchy at our country trough teaching and research, as well as exploring the global approach in provision of rehabilitation services including the use of assistive technology.

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Restoration of function to normal/near normal after injury/chronic illness

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