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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?
In order to identify the factors and levels that present the greatest barriers to rehabilitation in Kenya, I need to conduct a survey. For example, the rapid Assistive Technology Assessment (rATA) is a population-based household survey conducted in Kenya in 2020. This survey measured the need, demand, supply, user satisfaction, and barriers to accessing assistive technology. To understand the multilevel and intersectional factors associated with barriers to access and the benefits of rehabilitation services, a study will be conducted using the socioecological framework to assess the current situation in Kenya. Additionally, reference can be made to population surveys, census data, and the Rehabilitation and Assistive Technology Strategy of 2022-26 in Kenya.
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 rehabilitation focal person, I will collaborate with stakeholders to create an intervention that garners broad support and readiness for implementation. I will foster a culture of collective responsibility for developing, implementing, and embedding the intervention into routine practice. Within the organization, I will prioritize ensuring the availability of resources, enhancing workforce capacity, and cultivating a culture of motivation that supports evidence-informed 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?
We need to conduct formative research using both qualitative and quantitative methods to understand the specific intervention that would be suitable and effective at multiple levels in addressing the identified challenges. To achieve this, we will use a variety of methods, including telephone interviews, surveys and checklists, semi-structured interviews, and focus group discussions.
4. When considering potential interventions, what factors related to implementation do I need to consider?
In implementation of a potential intervention, there are factors to be considered that include:
a) Acceptability – considering if the intervention is satisfactory, agreeable or palatable to all stakeholders
b) Adoption- The uptake of the intervention by stakeholders
c) Feasibility-consider if the intervention can be successful carried out in my organization
d) Cost- cost of the intervention should be considered
e) Fidelity- whether the intervention will be implemented as per the protocol
f) Penetration- integration of intervention across settings
g) Sustainability-long term maintenance of an intervention in settings and at times integrated in the routine work.

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 bias refers to the unconscious attitudes, prejudices, and judgments that we unknowingly hold about people or groups. In my culture or context, various implicit biases may affect individuals’ access to and benefit from rehabilitation, such as gender, socioeconomic status, age, race, ethnicity, disability, employment status, and education level. These biases contribute to health disparities and can significantly hinder individuals from accessing and benefiting from rehabilitation.

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2a) What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
My focus would be on integration strategies such as;
– Conduct a stakeholders’ meetings and get to assess what their thoughts, knowledge, attitude towards the new initiative, introduce the intervention to them and let them brainstorm about what to adapt and what not. Address the pros and cons of the intervention, cost, and intended outcome among others. Share knowledge on policies that support the intervention.
2b) 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?
My focus would be on capacity building strategies such as;
Involving then, capacity building their knowledge gap on matters of the new intervention, collaborate with them, inform, consult and empower them. Its important for them to accept and own the new intervention.

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Today, rehabilitation is considered an integral part of Universal Health Coverage services. Rehabilitative services are essential to ensuring the population improves their quality of life. Increasing access to rehabilitation through telerehabilitation services fits well with the Kenyan rehabilitation and assistive technology strategy of 2022-26. There a huge unmet need for rehabilitation for especially people who reside in the hard -to -reach areas and the Kenyan government has a shortage of rehabilitation personnel to serve this need. The rehabilitation personnel have limited skills and knowledge on telerehabilitation and this can be explored and addressed. Although most Kenyan use a mobile phone, quite a number do not have smart phones and some areas have poor connectivity of electricity. However, the intervention of telerehabilitation is a grant idea.
Culturally, there are no limitations in use of mobile phones, though as mentioned, most populace do not have a smart phone and use of such devices may be limiting due to low literacy levels. Capacity building needs to be conducted if the community welcome the idea of the telerehabilitation intervention.
To enhance the acceptability of the telerehabilitation intervention, I will engage policy makers, stakeholders and right holders in sensitization meetings, so as that an informed decision is made and way forward arrived at. I will consult several data sources to identify the need for tele rehabilitation, consult the rehabilitation teams about their expertise in this field and where necessary plan for training of staff. AS a team, we shall come up with a detailed telerehabilitation program with a monitoring and evaluation plan.

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Q.1. To guide the planning and success of an intervention the following steps will be taken:
Will borrow heavily from the RE-AIM framework of Reach, effectiveness, adoption, implementation and maintenance)
-The problem will be defined and use of data sources will help justify the current situation. Sources of data will include: population survey, summary data tools, individual records, census, social registers, hospital records, service records among others.
-Select target population with varied characteristics to participate in the intervention. The settings for the intervention will be identified.
– Goals and objectives setting
-Selection of intervention(s) and possible source of resources will be identified
-Community engagement at all stages will be conducted to enhance ownership of the intervention.
-Develop activities and materials, train staff. pretest the intervention
-Implement the intervention
-Monitor and evaluate the intervention.
Q.2. The following indicators will be used to monitor the success of the intervention:
Indicators that will be used include:
-Rehabilitation expenditure to measure the rehabilitation expenditure in relation to health care expenditure,
-Rehabilitation personnel density
-Rehabilitation in tertiary hospital
-Multidisciplinary rehabilitation for people with complex needs.
-rehabilitation integrated in in health plans
Q.3. To ensure adequate monitoring and Evaluation
-Establish clear objectives and goals
-Identify good indicators to monitor progress
-set baseline and involve stakeholders
-identify data collection plan
-Create analysis plan
-Plan for dissemination and reporting
-Regular monitoring and periodic evaluation
–

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some studies reveal that there are great leaders born with qualities that make them succeed in achieving organizational goals , however , others develop skills through training and experience. I concur with the notion that, development pf leadership skills through training and experience is important even if one is not born with specific characteristics.
I consider the late president of South Africa, Nelson Mandela a born leader who lead with courage, embraced diversity , upheld unity and unlocked the potential in others. Late President , Martin Luther King was also a born leader. The former president of USA, Baraka Obama is an example of a made leader. He was born in a humble family and later developed leadership abilities to lead one of the most powerful continent in the world.
I realized that there is need to change and work on my emotional intelligence and leadership abilities. The self evaluation is a wake up call for me to reflect and work to improve my on my weakness.
Vision statement examples: 1) To be the national leader in high value rehabilitation and post acute care and to develop integrated systems of care.
2) Restoring hope and freedom through rehabilitation.
To gain strong leadership and political support for rehabilitation services in Kenya, we have come up with a rehabilitation and assistive technology strategy 2022-2026 that we hope to influence policy makers to adapt and implement. We hope to share data and research on knowledge translation forums to influence partners and policy makers to support rehabilitation.

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In Kenya, hearing loss is the leading condition (2.4m people), musculoskeletal conditions at 100k, neurological conditions at 100k, other injuries at 1.2 mm and low back pain at 100m among others.

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Disability is universal, a development priority and a human rights issue. Over a billion people, about 15% of the world’s population, have some form of disability – 1 in 7 people. (WHO report on disability 2019). Kenya has identified disability agenda as a critical development issue to be mainstreamed into all the sectors. The mainstreaming process is anchored on the international and regional instruments, local policy and institutional frameworks. The Convention on the Rights of Persons with Disability (CRPD) obligates Kenya as a signatory, to ensure and promote the full realization of the human rights of Persons with disabilities across the broad development sphere. At national level, the Constitution of Kenya 2010, the National Disability Policy 2018 and the Persons with Disability Act, 2003 serve as the anchor of the promotion of the rights of persons with disability in Kenya.
Despite disability being regarded as a core development and human rights issue, persons with disability are discriminated and considered a burden to the society. To improve the quality of life of Persons with disabilities and to enhance socio-economic development, Kenya cannot afford to leave behind persons with disability in matters of development. The Convention of rights of persons with disability (CRPD) recognizes accessibility as a stand-alone right (article. 9) and that removal of the multiple barriers to access in society is a key requirement for the inclusion of Persons with disabilities. Kenya is strive to create a barrier free and inclusive society

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Kenya has scanty NGOs that support programs on rehabilitation and disability. A few of the current NGOs implementing a rehabilitation program in Kenya include the clinton health access initiative (CHAI). This NGO support access to rehabilitation and assistive technology. The Association of physically disabled of Kenya (APDK), support rehabilitation outreaches and assistive technology as well.
Kenya at times uses the WHO guide to action.
I work in rehabilitation space and have come across many persons with disabilities. Their experience in accessing health care services and rehabilitation has been somehow challenging due to various barriers, such as, communication barrier, physical barrier and stigma and discrimination

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Moral model of disability- in some parts of Kenya view persons with disability as having sinned against God and so their disability is punishment from God. Some communities actually hide their children with disabilities in isolation in a dark room; Some are even chained so that they do not try to leave the dark rooms.
Medical model of disability – describes a person with disability as one who has something wrong that the doctors must fix. They view disability as a pathology to be treated.
Social model of disability -views the society as a barrier to disability. There is something wrong with the society that needs to change to accommodate persons with disability; such as, provide a sign language interpreter for the ‘DEAF’, construct ramps for the buildings and fix rails in a suitable universal toilet for the persons with disabilities among others.
I was raised up to pity the persons with disability, thinking that the family had done something wrong and this was a punishment from God. However now I have a different opinion, i feel the society should do something to accommodate persons with disabilities.

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Everyone at some point in life will need rehabilitation, how ever, there is 2.4m people with unmet need for rehabilitation. In my country most people who reside in the rural areas need rehabilitation , yet these services are not easily accessible to them. We need to rethink on issues of rehabilitation accessibility.

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rehabilitation is crucial universal healthcare and 2.4 m people have an unmet need for rehabilition

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Physiotherapy, occupational therapy, orthopedic technology, ear nose and throat clinics, eye clinics and mental health services are all available in my county. However, most of theses services are mainly available in urban areas, whereas most people with disabling conditions are in the rural areas. There is a huge percentage of unmet need for rehabilitation in my county,

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rehabilitation is a set of interventions geared towards restoration of function to minimize disability for persons with varied impairments.

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Victoria Sande a public health physiotherapist, currently working as a rehabilitation focal person in Kilifi County , Kenya. I expect to gain knowledge and hone my skills in implementing rehabilitation programs in the community, I also expect to network with great friends and gain best practices from the the network of colleagues.

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