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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?

According to BMC Pulic Health publication 2019, a study on Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. Utilization of rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda, Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age , socioeconomic status, education level and awareness of the population about the rehabilitation services
The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Uganda. Factors that were significantly associated with utilization of rehabilitation services included; age, socioeconomic status, education level and awareness of the participants about the services. Therefore, the government and other relevant stake holders should increase sensitization and awareness of rehabilitation services, their benefits and facilities providing such services to people with physical disabilities, healthcare professionals and the general public.

Furthermore, in depth research is needed to get the up-to-date data on utilization of rehabilitation services basing on race, gender, culture, religion, economic status among others.

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 medical social worker, I am most effective in developing and launching an intervention through, aiding and counselling persons with disability through obtaining AT benefits, coordinating resources to help PWDs, mentoring different stakeholders on how to offer respectful care to diverse populations and how to recognize and address their unconscious beliefs about various social groups.

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 formative research I need would be based on needs assessment, ensuring leaders buy in the idea(religious and cultural, the political leaders), identifying priorities, then continuous monitoring and evaluation.

4. When considering potential interventions, what factors related to implementation do I need to consider?
I need to consider the cost implications, acceptability, perception from community, feasibility, fidelity, integration with other services on ground, political stability of an area, the sustainability of the program/intervention.

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 means having unconscious negative attitude, mindset, behavior impacting on others in the society, in specific a certain social group. For example it can be towards a certain gender, race, religion, culture, economic status. This creates a barrier to benefiting from rehabilitation where people cannot access certain services due to biased policies, unequal resource distribution ,knowledge gap thus a barrier in benefitting from rehabilitation.

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-How does the proposed intervention fit with the priorities of your organization?
The intervention aligns with our organizational mission, which is to provide the highest possible level of health services to all people in Uganda through delivery of promotive, preventive, curative, palliative and rehabilitative health services at all levels”. My Country Uganda has a big population with diverse cultural heritage. Therefore the introduction of Tele rehabilitation will increase the availability and provision of health services , and above all inclusion for all.

-How does it fit with community values, including the values of diverse cultural groups?
Tele rehabilitation will make health services accessible to all, since the medium is cost effective and not time consuming in reach. Different cultural groups will embrace the intervention positively without limitations’, However, In Uganda the Rural setting that comprises of low income earners ,highly peasants may face the challenge of poccessing the gadgets to use, the resources to keep updated always like having sustainable data plus reliable network.

-what strategies could you use to target key stakeholders’ awareness, knowledge, attitudes and intention to integrate the new intervention?
Through thorough involvements, making the stake holders part ad partial of the company, organizing regular meetings, capacity building, and as well encouraging feed back sessions for evaluation.

-what strategies could you use to target the motivation and capabilities of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
capacity building through trainings and workshops emphasizing the organizational goal and vision, appreciation and recognition to good performers inorder to motive other employees, bottom-top face to face interactions for clarity and comfort to create a sense of belonging in the organization, the giving opportunities for career growth would boast the productivity of the organization.

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As an advocate for equality and promoter of social functioning, we have a role to play in changing the social model from exclusiveness to Inclusion.

The mindset and cultural aspects associated with disability is far wayward for this generation, However, creating awareness and vigorously sensitizing communities on such health matters will promote Inclusion and equality for all.

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In this case scenario, as a new mayor, I would look at the root cause of stroke increase in that particular area then it’s management in the past. Look at the loopholes causing the problem statement in provision of rehabilitation services at large. All these will depend on data available and evidence on ground to facilitate decision making for the society’ well-being.

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In order to build strong leadership and increase political support for Rehabilitation in Uganda, positions in leadership should be filled majorly by members of the PWDs in the country for a louder vote of confidence and direct advocacy.

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Leaders are both born and made indeed.
For one to be called a good leader, they need a combination of traits to make them “whole” and refined. This brings in the aspect of experience, human nature is so dynamic, without experience in the management field, only in born traits cannot handle.
One needs experience and lessons attached, blended in with in born traits, to journey through this profession. thus Leaders are both and made.

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katalemwa Chesire is the NGO working in my area in Uganda.

yes, my country uses the WHO guide to action.

It has not always been easy or a walk over for some one with disability to get health care in my country, due to one reason or another, such as distance, finance, lack of awareness.

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In Uganda, all the three models are employed in different settings and amongst various groups of people. The moral Model is engulfed in the medical and social model, in a way that, people relocate, migrate, and change location thus changing beliefs and thinking. Most people think according to where they reside thus adaptation.

All in all, through vigorous sensitization and education of the masses ,attitude and stigma towards PLWDs can be reduced. Disability issues will cease from seeking help from native witch doctors but real hospitals with the attention of a well trained medical Doctor.

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Moral model; This is based on how someone was brought up. it entails, origin, background, religion and tribe.

medical model; this form of disability is brought up by taking wrong medication, injections ad vaccines.

social model; this model looks up for the right of those living with disability through acts, laws ad policies enacted. How ever, laws may exist but not being implemented

When I see a person Living with Disability, the first thought I get is helping the person in any way I can. I was raised with all the three models.
I choose the medical and Social model, because with this aspects of attitude and stigma is reduced due to awareness created, thus a better place for everyone is created.

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From my Research, I have learnt that laws and policies on disability exist and are clearly stated but lack implementation to the grassroot, involvement of the beneficiaries is still minimal and impractical.
In addition, the high costs of rehabilitation services leaves out the low income earners who cannot afford these services, thus creating a big gap between the beneficiaries and the available services.

I recommend further education and awareness, capacity building and empowerment of PWDs in Uganda and reduced costs of rehab services inorder to promote “INCLUSION FOR ALL” .

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In Uganda, the disability prevalence among women is at 15% and 10% among men, 15 percent of the disabilities were in urban areas and 12% in rural areas. Majority of persons with disabilities are subsistence farmers (73.7%) compared to persons without disabilities (61.6%) (according to UBOS, 2019). Rehabilitation services are provided within Kawempe division at Mulago hospital physiotherapy department and Katalemwa rehabilitation center in Kampala district, Uganda at a free and a subsidized cost to help to improve the function, independence, and quality of life of persons with physical disabilities. However, many people with physical disabilities do not utilize the services and the reasons are not clear.

To promote INCLUSION in Uganda, the Government draws its mandate from the Persons with Disabilities Act, 2020, Act 3 of 2020, An Act to provide for the respect and promotion of the fundamental and other human rights and freedoms of persons with disabilities. its mandate is not limited to, promote Access to justice, information and training ,Non discrimination in the provision of services on a commercial basis, Non discrimination in the provision of transport services, Accessibility to buildings, Non discrimination in employment, Habilitation and rehabilitation for persons with disabilities.

In uganda, Katalemwa Cheshire Home is a Children with disabilities focused NGO that provides holistic rehabilitation services. It was founded in Uganda in 1970 and officially opened in 1971, with the aim of providing a family home environment to people who were incurably sick or with physical disabilities. With over 50 years of existance, they support over 4000 children annually, over 250 projects excuted on PWDs, and produced over 4500 assistive devices annually. They offer, Advocacy, Inclusive Education Support, Livelihood & Economic Empowerment, Partnerships & Networks, Fabrication of assistive devices, Medical & Social Rehabilitation,

In Uganda, Persons with Disabilities Act, 2020, A person with a disability shall enjoy the fundamental and other human rights and freedoms in the constitution. The government and people of Uganda shall uphold the rights and freedoms of people with disabilities. The blueprint is in its final stages regarding disability and rehabilitation, thus efforts being made for “INCLUSION FOR ALL”

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Services offered in my Country Uganda include, physiotherapy, counselling, eye care, club foot, orthopedics, ENT. Some of these services have costs attached to due to limited Human resource, funding and equipments , for example a chiropractic service is almost not known yet very vital in rehabilitation.

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I am Atim Juliet Sharon, A Medical Social Worker by profession, working with the Department of Community Health, Disability Division, Ministry of Health , Uganda.
It is such an honor to be part of the 3rd Cohort of the Global Rehabilitation Leadership Institute, GLRI2024.
I am passionate in working with the division of disability, in advocacy and bridging the gap thereof for sustainable growth and development.

My expectations are:
Acquiring more skills and management in rehabilitation
How to manage rehabilitation amidst limited resources available
Learning more about rehabilitation and leadership for sustainable change.
An opportunity to network with experts from different parts of the globe.

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Alongside the government taking interest in streamlining rehabilitation and AT in the Health system, there are very few well trained professionals in that aspect, thus need to encourage people to take up courses on rehabilitation and AT, then further building the capacity of those already in the system.

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Inclusive communication bridges the gap between health, social, economic, political services and the public on rehabilitation and AT.

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