Exploring the opportunities for improving the accessibility of rehabilitation services in rural communities in Uganda through the inclusion of CBR graduates at the primary health care level.

IntroductionThe increasing burden of disabilities and the need for rehabilitation services are significantly impacted by the ageing population, the rise of non-communicable diseases, and global conflicts, particularly in low and middle-income countries. The limited number of trained Allied Health Professionals for rehabilitation (Physical therapist, Occupational therapist, Speech therapist) in sub-Saharan Africa has prompted the rise of Community-Based Rehabilitation programmes to bridge this gap, particularly in rural and hard-to-reach communities. AimTo explore opportunities to improve access to clinical rehabilitation services in rural Ugandan communities by including Community-Based Rehabilitation (CBR) graduates in primary healthcare teams. MethodThis research used a case study approach, engaging 15 CBR graduates, Allied Health Professionals (AHPs), and CBR programme implementers in semi-structured interviews to understand the perceptions and experiences of CBR graduates delivery of basic rehabilitation services and the incorporation of CBR services into primary health settings to increase access to rehabilitation services in rural and hard-to-reach Ugandan communities. Thematic Analysis was used to examine and interpret the data. ResultsThe research revealed several key issues. 1) role confusion among stakeholders about how CBR graduates compare to other healthcare roles. 2) training discrepancies with notable variations across academic institutions and different organisations, 3) lack of globally recognised roles, responsibilities and competencies for CBR graduates hinders professional recognition, and 4) concerns regarding inadequate practical skills training and heavy theoretical curriculum. Conclusions and limitationsThere is an urgent need for professionals to provide holistic health and social care in resource-constrained contexts, including disability awareness, empowerment, community participation, social inclusion, rehabilitation, and health education. With curriculum enhancement and additional practical skills training, Ugandan CBR graduates may be able to provide these services under the supervision of rehabilitation therapists. A fundamental shift in government priorities and funding is also needed to create opportunities and address the shortages of human resources for health and rehabilitation services. While research on CBR programmes is scarce, this study delves into important questions related to their effectiveness. We employed diverse recruitment strategies and piloted the interviews to minimise bias resulting from the small sample size of the study. These proactive measures enhance the validity of our findings, providing a solid foundation for further study and insights into CBR programmes.