A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Abstract

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

“…We tested for two hierarchical levels of statistical significance: 99 and 95%, respectively. On Age-standardized YLD Rates, which adjusted YLDs for population size and ageing, Table 2 shows that only high-income and lower middle-income countries had a significant change since 1990, but while the latter had a linear growth ( LMICs remain quite limited [7,19,26,83,84]. The WHO estimates that skilled rehabilitation professionals for many LMICs are currently about one-tenth of those required [7].…”

“…The WHO estimates that skilled rehabilitation professionals for many LMICs are currently about one-tenth of those required [7]. Hence, many argue it is urgent to take action to supply LMICs with increased resources, [24,26,[83][84][85][86][87] and especially so given the higher nominal increases of physical rehabilitation needs.…”

Field-testing of a rapid survey method to assess the prevalence and causes of hearing loss in Gao’an, Jiangxi province, China

“…Evidence suggests that the current level of access to hearing specific services is inadequate in LMICs [19,20]. A recent systematic review of access to rehabilitation for people with disabilities found that coverage of assistive devices for people with hearing loss was unacceptably low across LMICs where data existed, ranging from 0 to 24% at the population-level [21].…”

No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

“…It is estimated that 15% of the global population-1 billion people-are living with a disability, with the majority residing in low and middle-income countries [1]. As a group, people with disabilities face an increased risk of poverty and social exclusion, due to barriers to participating in paid work and education, negative attitudes towards disability, inaccessible environments and information, extra disability-related costs (e.g., assistive devices, personal assistance), and lack of affordable, quality disability-related services and support [1][2][3][4]. The United Nations Convention on the Rights of People with Disabilities (UNCRPD), which has been ratified by 177 countries, codifies the rights of people with disabilities to full inclusion on an equal basis as others [5,6].…”