Strengthening Rehabilitation in Health system: Stakeholders’ perception of factors contributing to the adoption of World Health Organizations guide to strengthen rehabilitation in the Rwandan healthcare system

Strengthening Rehabilitation in Health system: Stakeholders’ perception of factors contributing to the adoption of World Health Organizations guide to strengthen rehabilitation in the Rwandan healthcare system | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Strengthening Rehabilitation in Health system: Stakeholders’ perception of factors contributing to the adoption of World Health Organizations guide to strengthen rehabilitation in the Rwandan healthcare system Ines Musabyemariya, Dr. Amanuel Kidane Andegiorgish (MSc., Ph.D.) This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4739863/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Rwanda has achieved a significant improvement in the overall healthcare delivery. Although stakeholders’ perception of the adoption of the World Health Organization (WHO) guide to strengthen rehabilitation is crucial for improving healthcare delivery, however, little is known about strengthening the rehabilitation services in the Rwandan health systems following the WHO guide. A cross-sectional qualitative study was conducted to interview several rehabilitation stakeholders representing institutions that played a role in implementing the WHO guide to strengthen Rehabilitation in Health system. A structured data collection questionnaire and interview guide were used. Questionnaire data were collected using a 5-point Likert Scale, and analyzed using SPSS version 21, while interviews were recorded,transcribed, coded , cathegorizes thematically analyzed. A total of 180 stakeholders have filled the questionnaire, with 64% of them being males. The majority (43%) of the research participants were aged between 41-45 years. More than eight-tenth (83.3%) of the participants had a first degree and 10% had a master’s degree level of education. Overall, 7 themes and 13 sub-teams emerged from the key informant's interviews of stakeholders. The increase need for rehabilitation services is highly perceived by all governmental and non-governmental organizations in Rwanda. Rwanda's successful adoption of the WHO guide to strengthen rehabilitation in its healthca system can be attributed to the country's commitment justified by existing policies, guidelines, and the robust disability movement and this could be an inspiring model for other countries to follow. Additionally, Rwanda's ambition to become a premier tourist destination in East Africa has played a pivotal role in driving the adoption of WHO guidelines. Along with emphasizing stakeholders' perspectives, the results have identified obstacles that may hinder the desired outcome of strengthening rehabilitation in the national health system, such as a shortage of skilled and specialized professionals in the field of rehabilitation services, lack of data on the needs of rehabilitation services in Rwanda, and lack of experts to oversee the implementation of the rehabilitation strategic plan. Moreover, lack of enough rehabilitation facilities, inadequate financial resources, geographical barriers, and a lack of a responsible person at the central level to supervise rehabilitation activities are some of the potential obstacles that may impede the effective implementation of strenthening rehabilitation in Rwanda s health system. Conclusion Rehabilitation Sector in Rwanda is providing a valuable model for other Low and Middle-Income Countries seeking to improve their rehabilitation services. With the demand for such services on the rise, investment in human resources and retaining those who are in practice, equipment, and infrastructure is necessary to satisfy the population's needs. Moreover, appointing a rehabilitation professional to oversee the implementation ofrehabilitation activities is imperative. It is recommended to build on identified contributing factors for the future sustainability of the process. Addressing the discussed challenges is crucial to ensure the intended outcome of integrating rehabilitation into Rwanda's healthsystem. Health Policy Physical Medicine & Rehab Rehabilitation Health sytesm Stakeholders Perception Health Policy Rwanda Figures Figure 1 Background According to various authors, strengthening rehabilitation in national healthcare systems is an important step towards meeting the growing demand for rehabilitation care. Currently, an estimated 2.4 billion people worldwide require rehabilitation, and this number is expected to rise without strategic action [ 1 – 4 ]. The World Health Organization's (WHO) strategy towards rehabilitation is strengthening the health system to reach its full potential. This involves making rehabilitation part of care at all levels of the health system, and ensuring it is incorporated as part of universal health coverage. To this end, on 7 February 2017, WHO, Member States, international and professional organizations, nongovernmental organizations, and rehabilitation experts issued Rehabilitation 2030: a call for action, a commitment to key actions to strengthen rehabilitation services in Member States [ 5 ]. These actions include: improving rehabilitation governance and investment; expanding a high-quality rehabilitation workforce; and enhancing rehabilitation data collection. The commitment to strengthen health systems to provide rehabilitation services should make it possible for millions of people not only to live longer but to live well. Globally, people living with disability have poorer health, lower education achievements, less economic involvement, and higher rates of poverty than people without disabilities [ 6 ]. As populations age and chronic health problems become increasingly prevalent [ 6 ], more and more people are living with multimorbidity and disability [ 7 ]. For them, rehabilitation is essential if they are to remain as independent as possible, participate in education and work, and fulfill meaningful roles in life. Along with prevention, promotion, treatment, and palliation, rehabilitation addresses the health needs of a population and contributes to universal health coverage[ 8 ]. In low- and middle-income countries including Rwanda, the need is high and likely to increase in the future because people are now living longer, injuries are increasing due to wars, road traffic accidents, natural calamities, and the increasing number of people suffering from chronic noncommunicable diseases[ 2 , 3 , 9 ]. These poor socioeconomic outcomes are largely due to the widespread barriers faced by people living with disabilities in accessing health, education, employment, and information-related services [ 10 , 11 ]. Patterns of disability in a particular country are influenced by trends in health conditions and trends in environmental and other factors –such as road traffic crashes, natural disasters, conflict, diet and substance abuse [ 6 ]. In Rwanda, people in need of rehabilitation services is increasing [ 12 ]. This became noticed after the 1994, genocide against the Tutsi. The conflict left a significant number of war-wounded soldiers and civilians, including people with disabilities. However, people are facing different challenges of access to quality services and this leads to their loss of function, which complicates their quality of life and later leads to their death as well as household financial difficulties [ 13 ]. To address this challenge, there is a need to strengthen rehabilitation in the National Healthcare system. The Ministry of Health (MOH) has a goal to offer affordable and quality healthcare services that focus on promotion, prevention, treatment, and rehabilitation. This will contribute to poverty reduction as well as the improvement of the overall well-being of the Rwandan population [ 14 ]. Even though the healthcare system has made significant progress, there are still areas of improvement including the rehabilitation Sector. According to a study conducted by Wickenden et al. (2012), they found that diverse stakeholder communities can actively shape policy and practice through participatory consultations. National agencies, particularly those stemming from civil conflicts, and shortcomings in the current health system impact both rehabilitation needs and the feasibility of implementation. The WHO guide is a series of tools, that help the country to assess its rehabilitation sector, develop strategic planning, and the establishment of monitoring and evaluation systems that will support the country to track changes over time [ 15 ]. Rwanda has adopted the WHO guide to address the issues identified in the Rehabilitation sector to work closely with stakeholders, who have been actively involved in the sector for many years of under-prioritization and this has improved policy dialogue and enabled effective coordination among its development partners [ 13 ]. Stakeholders in the Rehabilitation Sector are working and supporting at different levels such as community sensitization, service provision, human resource development/academicians, private sector, civil society, international NGOs, and all people not only people with disabilities[ 16 , 17 ]. Although the Rwandan healthcare system has thoroughly followed the WHO guide for Action[ 18 ]. Rehabilitation services may be inadequate, and there are many barriers to accessing the available services [ 8 ]. Developing policies and health systems interventions targeting the determinants of these inequalities requires urgent policy attention at national and international levels. There is a gap in evidence regarding Stakeholders’ perceptions and factors contributing to the adoption of the World Health Organization guide to strengthen rehabilitation in the Rwandan healthcare system. Methodology Study design A cross-sectional qualitative study was conducted to evaluate the perceptions of Stakeholders on factors contributing to the adoption of the World Health Organization guide to strengthen rehabilitation in the Rwandan healthcare system. Study setting This study took place among different institutions and stakeholders who have offices in Rwanda. The study setting included offices of International and local non-governmental organizations, specialized rehabilitation Hospitals, organizations of people with disability, Ministry of Health and Public Hospitals, Academicians, and Private clinics. Study population The study enrolled 180 stakeholders (64.4% men and 35.6% women) and 32 key informants. The target population of this research was composed of staff who were engaged in different phases of the adoption of the WHO Guide to strengthen rehabilitation in the Rwandan healthcare system. Sample Size Determination and Sampling Techniques The researcher is fully aware of the importance of representative sampling, particularly when studying the entire population, and conducting a survey or census is the most efficient and accurate way to obtain data from a small and accessible population. This approach provides several advantages, including an accurate population count without sampling errors. Despite the initial inclusion of all 190 identified stakeholders, only 180 of them agreed (95% response rate) to participate fully in this study. Nonetheless, this sample size still provides meaningful insights for the research and could be considered representative of the population under study as shown in Fig. 1 . Data Collection A structured questionnaire guide adapted from the Pathfinder International (PI) questionnaire composed of questions designed to align with the World Health Organization's (WHO) expectations on the provision of rehabilitation services and integration was used [ 19 ]. one questionnaire and interview guide were designed. Bilingual data collectors or interviewers were recruited and all data collection activities were conducted in Kinyarwanda or English as per the primary choice of the participants. Data collectors were trained on the objectives of the study, interview process, data recording and preservation, and research ethics, as well as probing questions for extensive interviews for qualitative interviews before the actual data collection. the data collection tool was reviewed and piloted to evaluate its appropriateness with the Rwandan Local Context. In-depth interviews were conducted by trained interviewers and took place inside each participant’s office, or outside, based on the study participant’s choice and the ability to find private space for the interview. Data collected through in-depth interviews were audio recorded using smartphones or computers with the consent of participants. Translation of interviews from Kinyarwanda to English was conducted during the transcription process by the data collectors, who were native Kinyarwandan speakers. Furthermore, all questions were digitalized in the Kobo data collection system to facilitate a quick process of data collection and entry for questionnaire data. Data analysis Questionnaire information was exported from Kobo statistical software to Excel for data cleaning and then to a statistical package for social sciences (SPSS Version 25.0) to analyze the information. Descriptive statistics of sociodemographic characteristics related to frequency distributions and percentages were presented in tables. Attiduted of research participants was presented using percent and mean and Standard deviations. Qualitative data were first coded based on themes manually and using the digital process for completeness and appropriate coding. All audio records were transcribed and then translated verbatim to English by five trained research assistants(public health professionals). Every transcribed and translated interview was again validated by another research assistant. Finally, each transcription and translation was approved by the lead researcher (PI). Verbatims were repeatedly read to identify important phrases or words related to the main outcome of the study and were coded by selecting a significant word or phrase from the interviewee’s statement. Codes allowing with their summary notes were aggregated and classified in meaningful categories. The major categories were then labeled as themes and presented as narratives. Sub-categories of each theme were considered sub-themes. A narrative approach was used to deliver qualitative results. To illustrate the theme and sub-theme, selected quotations are presented with codes for participants from MoH (MoH1, MoH2..), international and local NGOs ( INGO1, INGO2…, and LNGO1, LNGO2..) Service provider (SP1, SP2..) Service users (SU1, SU2..). Results Demographic Characteristics of Study Participants Two-thirds (64.4%) of the study participants were males. A majority (83.3%) of the study participants have attained their first degree from a university and 10% had a Master’s degree. More than a quarter (26.7%) of the research participants in the present study were affiliated with MoH and Public Hospitals and 21.1% were affiliated with Specialized Rehabilitation Hospitals (Table 1 ). Table 1 Demographic Characteristics of the study participants Variables Frequency Percent (%) Gender of Participants Male 116 64.4 Female 64 35.6 Age of Participants =46Years 30 16.6 Level of Education Diploma 4 2.2 Degree 140 77.8 Master’s degree 28 15.6 Ph.D. 8 4.4 Organization of Participants International NGO 14 7.8 Local NGO 22 12.2 Specialized Rehabilitation Hospital 38 21.1 Organizations of people with Disabilities 24 13.3 MoH & Public Hospitals 48 26.7 Academician 8 4.4 Private Clinics 26 14.4 NGO: Non-governmental organization, MOH: Ministry of Health Emerging Themes To understand the perception of stakeholders on the factors contributing to the adoption of the WHO guide to strengthen rehabilitation in the Rwandan healthcare system, qualitative information was analyzed based on different emerging themes and sub-themes. According to the perspective of the stakeholders, 7 themes and 13 sub-themes were generated as presented in the table Table 2 : Table 2 Emerging Themes from Qualitative Interview S.No Themes Sub-themes 1 Status of Rehabilitation Services in Rwanda Demand 2 Rehabilitation Service Delivery Quality, Accessibility 3 Rehabilitation Workforce Density, Brain Drain, Specialties, Professionals Retention 4 Information Data on Rehabilitation Needs in Rwanda, and Research in Rehabilitation 5 Assistive Devices, Medical Rehabilitation products and technologies Availability Affordability 6 Rehabilitation Sector Financing Under prioritization, and heavy reliance on external funding 7 Leadership and Governance Central level representation Stakeholders’ Perception about the increasing need for rehabilitation services in Rwanda In this study, 10 questions related to assessing the respondent’s perception of the need for rehabilitation services in the Rwandan context were asked as shown in Table 3 . About two-thirds (64.4%) of the participating stakeholders agreed that the demand for rehabilitation services in Rwanda has been on the rise following the genocide against the Tutsi in 1994, which has resulted in an increased number of people with disabilities (3.7 ± 0.69 out of a 5-points). Moreover, about half (48.9%) of all stakeholders strongly agreed that the demand for rehabilitation services has increased because of the availability of skilled professionals (4.4 out of 5 points), followed by conflicts in the region (4.2 out of 5 points). The role of various programs that help with early identification and appropriate referral services to individuals with disabilities in the community was highly recognized (4.0 out of 5 points). The contribution of non-communicable diseases and a large number of people born with disabilities were slightly perceived with a lower average score of 3.6 points out of 5. Nevertheless, the availability of social support programs in Rwanda and its contribution to an increase in demand for rehabilitation services due to gaining access to such services and due to increased awareness of the rights of people with disabilities was profoundly perceived (64.4%). More than one in four of the study participants disagreed on factors like the increase in road traffic accidents, increased number of injuries, and home and workplace accidents contributing to a growing demand for rehabilitation services in Rwanda (Table 3 ). Information from KII also showed a similar perception of the importance of the adoption of the WHO Guide to Integrate Rehabilitation into the Rwandan healthcare system. ……………“A strong government commitment towards improving the lives of the community, and improved awareness of the importance of Rehabilitation to address non-communicable diseases which is on the rise in Rwanda” …………… Service User3. Does Rwanda have to adopt WHO guidelines instead of setting up its own? ……………“I think the adoption of the existing Guide is the best way to set up benchmarks that are based on evidence-based literature and that are globally recognized without the country spending time and money to start from scratch” …………… Service Provider1. Table 3 Stakeholder’s perception on the increasing need for Rehabilitation services in Rwanda, 2023 (N = 180) S.No Independent variables SA A NoP DA SDA Mean ± SD 1 The demand for rehabilitation services in Rwanda has been on the rise following the genocide against the Tutsi in 1994, which has resulted in an increased number of people with disabilities. 12(6.7) 116(64.4) 40(22.2) 12(6.7) 0 3.7 ± 0.69 2 The number of disabilities is increasing due to the increase in road traffic accidents, and home and workplace accidents, there has been a growing demand for rehabilitation services due to the increased number of injuries. 22(12.2) 0 110(61.1) 48(26.7) 0 3.9 ± 0.61 3 Now we are seeing a large number of people who born with disabilities due to climate change and other health-related factors 24(13.3) 80(44.4) 62(34.4) 14(7.8) 0 3.6 ± 0.81 4 Rehabilitation services are becoming more necessary in Rwanda due to the rise of non-communicable diseases. 26(14.4) 64(35.6) 86(47.8) 4(2.2) 0 3.6 ± 0.76 5 Rwanda is experiencing a rise in demand for rehabilitation services due to the conflicts in the region, which has led to an increased number of refugees seeking help in the country. 60(33.3) 96(53.3) 24(13.3) 0 0 4.2 ± 0.66 6 Rehabilitation facilitates improving the well-being of people with disabilities 18(10.0) 82(45.6) 72(40.0) 8(4.4) 0 3.6 ± 0.73 7 The demand for rehabilitation services has risen due to various programs that help recognize individuals with disabilities in the community and refer them to appropriate services. 40(22.2) 100(55.6) 40(22.2) 0 0 4.0 ± 0.67 8 The demand for rehabilitation services in Rwanda has risen due to increased awareness of the rights of people with disabilities. 40(22.2) 116(64.4) 24(13.3) 0 0 4.1 ± 0.59 9 The demand for rehabilitation services has increased because of the availability of skilled professionals. 88(48.9) 76(42.2) 16(8.9) 0 0 4.4 ± 0.65 10 The availability of social support programs has led to an increase in demand for rehabilitation services, as they assist individuals in gaining access to such services. 26(14.4) 118(65.6) 36(20.0) 0 0 3.9 ± 0.59 SA = Strongly agree, A = Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree From the demand side or rehabilitation service in Rwanda, almost all participants said: ……………“ there is a high demand for rehabilitation services, but unfortunately, there are very limited deliverables from the implementers or service providers. I see the current view is only within the scope of the health sector, however, it should be seen as a cross-cutting intervention involving different actors and ministries to be more meaningful”…………… SP7. Similarly, another participant expressed his perception by stating: ……………“The current status of rehabilitation in Rwanda is increasingly recognized as essential due to the rising prevalence of chronic non-communicable diseases, the aging population, and a significant number of people living with injuries' consequences or congenital and developmental disabilities. All these individuals require rehabilitation services, and it should be viewed as an important component of healthcare”……………INGO5 Regarding the current status of rehabilitation services in Rwanda, a participant from an international NGO elaborated: ……………“ In Rwanda, the rehabilitation sector is still in its initial stages. Some progress has been made, but there is a long way to go to address all the necessary aspects to be on a good track. This means that there are many unmet needs, and the current rehabilitation interventions are scattered and lack a unified approach to generate impactful outcomes. However, there are promising ambitions from the government and stakeholders to drive this rehabilitation initiative forward, so it can become more operationalized”…………… INGO4 The contribution of skilled professionals and referral services was positively perceived. A response from a Rehabilitation service provider with over 32 years of work experience: ……………“Receiving many referral cases for rehabilitation from other healthcare facilities indicates it is well recognized by the need for specialized care. Moreover, this demonstrates doctors' understanding of the importance of rehabilitation”……………SP21 Factors influencing the integration of Rehabilitation into the Rwandan Healthcare system. Eleven questions were asked to rate their level (Table 4 ). One-third (33.3%) of the stakeholders strongly agreed that the Rwandan government's commitment and the policies in place towards improving the provision of rehabilitation services into the national healthcare system have accelerated the process of integrating rehabilitation into the national healthcare system. A higher proportion (67.8%) of stakeholders agreed that the availability of community-based health insurance (CBHI) which offers affordable basic rehabilitation services is a contributing factor. Moreover, the contribution of the policies of the government towards the provision of rehabilitation services in Rwanda and the political commitment towards improving the provision of rehabilitation services and integrating the service into its national healthcare system was highly perceived (mean score = 4.2). What do you perceive as successful drivers for the government of Rwanda’s adoption of the WHO guide for action to strengthen the rehabilitation sector in the Rwandan Healthcare System? …………… “the political will of the Ministry of Health. they have this will that rehabilitation services should advance, the determination to establish sustainable rehabilitation strategies, and the availability of a technical working group for rehabilitation is a very key drivers in achieving positive outcomes. Furthermore, having partners in rehabilitation who are willing to work together and play their respective roles contributes to the success of the efforts. What is needed is just to coordinate them. Rwanda's enabling policies, in line with WHO recommendations, also act as key drivers for progress”………LNGO3 However, comparatively, the mean scores for some of the statements like, at the time of the study rehabilitation services are part of the National Health Sector Strategic Plan. (HSSP IV), and rehabilitation services are included in the National healthcare service package, disability-driven movements to enhance the provision of rehabilitation and others have lower mean scores which imply that policymakers in Rwanda have to further advance the integration of these factors and should be nurtured and strengthened. Rehabilitation Service Provision in Rwanda Exploring the perception of participants about the demand for rehabilitation services in Rwanda might be helpful to understanding the needs of the community by stakeholders for better planning and policy proposals to re-integrate rehabilitation care as the main component of the healthcare system. Participants had different views about the quality-of-service provision of existing rehabilitation services in Rwanda as illustrated in the following quotations: ……………“ I can say that the quality is still poor, there is still a long way to go when it comes to rehabilitation service provision, some services don’t have basic equipment to provide services, staff don’t have a plan for Continuous professional development, the multidisciplinary team is not complete, there is no continuum of care, etc.” …………… SP8. Another quote worth highlighting from a project manager in an international non-governmental organization who said that transforming the process for quality rehabilitation service requires: ……………“Quality is a process and it takes time to become a culture. Currently, quality standards for the rehabilitation specialized hospitals and centers have been launched by the Ministry of Health, these will help hospitals to improve the quality and help hospitals and centers to embark on the journey of continuous quality improvement” ……… INGO15. Table 4 Stakeholders' opinions about Contributing factors that have influenced the Integration of Rehabilitation into the National Healthcare System (N = 180) S.No Independent variables SA A NoP DA SDA Mean ± SD 11 Rwanda has policies in place that provide support for the provision of rehabilitation services. 56(31.1) 98(54.4) 26(14.4) 0 0 4.2 ± 0.66 12 Rwanda is committed to improving the provision of rehabilitation services and integrating them into its national healthcare system. 60(33.3) 102(56.7) 18(10.0) 0 0 4.2 ± 0.62 13 Rehabilitation services are part of the National Health Sector Strategic Plan. (HSSP IV), and rehabilitation services are included in the National healthcare service package. 6(3.3) 92(51.1) 76(42.2) 6(3.3) 0 3.5 ± 0.62 14 There is a strong disability movement in Rwanda that strives to enhance the provision of rehabilitation and assistive device services, actively puts pressure on the government. 6(3.3) 92(51.1) 76(42.2) 6(3.3) 0 3.5 ± 0.62 15 Availability of rehabilitation training Institutions that produce skilled rehabilitation professionals, ready to give the services. 22(12.2) 68(37.8) 82(45.6) 8(4.4) 0 3.6 ± 0.76 16 There is a recognition of the crucial role that rehabilitation services play in restoring functioning and preventing disability in the Rwandan community. 18(10.0) 96(53.3) 62(34.4) 4(2.2) 0 3.7 ± 0.67 17 Availability of Development partners: International organizations and donors through local organizations that provide financial support to the rehabilitation sector in Rwanda. 8(4.4) 110(61.1) 62(34.4) 0 0 3.7 ± 0.55 18 Stakeholders' coordination to prevent duplication of interventions: a technical working group at the Ministry of Health is responsible for advising the government on rehabilitation-related matters. 14(7.8) 80(44.4) 86(47.8) 0 0 3.6 ± 0.63 19 Community-based health insurances (CBHI) offer affordable basic rehabilitation services but not all services. 14(7.8) 122(67.8) 44(24.2) 0 0 3.8 ± 0.55 20 Increased knowledge and innovation in healthcare service provision in Rwanda, and globally. 22(12.2) 112(62.2) 42(23.3) 4(2.2) 0 3.8 ± 0.65 21 The government of Rwanda is actively working towards establishing itself as a prominent tourist hub in East Africa. 26(14.4) 120(66.7) 34(18.9) 0 0 4.0 ± 0.58 SA = Strongly agree, A = Agree, NoP: No opinon, DA: Disagree, and SDA: Strongly disagree Possible challenges for the intended outcome of strengthening rehabilitation into the national healthcare system. It is essential to recognize that every policy designed to benefit the public community will encounter challenges that need to be addressed to achieve its goals. Participants were asked to rate some statements using a five-point scale (Table 5 ). A total of nine questions related to the possible challenges for the successful establishment and integration of rehabilitation services into the national healthcare system were administered. About half (48.9%) agreed that the rehabilitation centers in the country are limited, with a mean response of 3.5 ± 0.77, which indicates generally above the average. What is your perception of the quality of rehabilitation services provided in Rwanda? ……………“ Thank you. You know, when something is in its initial phase, the quality is often challenged. We have issues with quality. For example, in the workforce part, there is an issue of quality because the people are not adequately trained to deliver the services. They are not equipped enough to provide the necessary level of care. Even when we look at the existing workforce, they are limited in terms of resources. So, the quality is low, especially at the primary healthcare level. However, at the tertiary level, the quality is good. But, of course, at the tertiary level, it's very limited, and the need for rehab is at the community and primary care level, where the quality is very poor”…… Director of Hospital2. Could you please share with us your perspective on the existing rehabilitation services and the challenges of integrating them with the healthcare system in Rwanda? ……………“ It is time for the government to take the lead and improve the Rehabilitation Sector that has been in the hands of religious people and Humanitarian Agencies. It is time to change and for the government to be responsible for the Rehabilitation Sector. In the meantime, community leaders could potentially be a bridge between community members and the MOH”……… from a Service provider28. Worth highlighting another quote from a rehabilitation professional in a community center owned by a local NGO shared that rehabilitation services are not accessible: ……………“ I feel that rehabilitation services in Rwanda are not easily accessible due to the hilly terrain and the location of hospitals mainly in urban areas. This creates challenges for people living in remote communities to access these services. Although some improvements have been made, there is still a need to decentralize the service delivery and make it available at the community level, where many service users reside” ………… LNGO9. In this study, more than half (52.2%) of the participants had no opinion regarding whether the existing rehabilitation services suffer from inadequate funding or heavily rely on donations. Another common challenge mentioned by the majority of the participants was the lack of data on rehabilitation needs in Rwanda which might help in a better understanding of the rehabilitation needs in the country and 65.5% agree with this response. To improve credibility, many informants expressed keenness to receive continuous training and adequate materials, stating that those might help with their work. To overcome this challenge, a majority (62.2%) of the participants agreed that the MOH of Rwanda must appoint a rehabilitation specialist to oversee the implementation of the rehabilitation strategic plan. The highest average score was about 3.9 ± 0.82 regarding a statement stating that there is a shortage of skilled and specialized professionals in the field of rehabilitation services. Furthermore, the lack of evidence-based information/scarcity of rehabilitation research that has the potential to offer valuable insights to policymakers is another major challenge at present to the existing healthcare delivery system. This statement was supported by qualitative information. One female respondent indicated the ……………“ I feel like I don’t receive enough information about the condition of my child, it is as if my therapist is not able to explain to me and I am confused with the future of my child who was born with mental problems” …………… From an organization of People with Disabilities4. Do you meet challenges as an institution related to your interventions in line with strengthening the Rehabilitation Sector in Rwanda? Describe the main challenges. ……………“ In a few words, I can mention some of these challenges can be managed by our organization, while others are beyond our control. One of them is the low public awareness about clubfoot and disability. Additionally, limited treatment spaces and inadequate infrastructure pose obstacles. For instance, when providing services at hospitals, our parent advisors need a conducive area for counseling, but sometimes space is very limited. Moreover, there's a challenge with staff turnover. We invest resources in training, but personnel might be appointed elsewhere, making continuity difficult. Another challenge is the low level of government involvement in specific preventive measures. For example, when it comes to clubfoot management and the need for casting supplies, it should be the government's responsibility to provide them, rather than solely relying on our organization. Furthermore, there's a lack of data and research in Rwanda, which is a common issue faced by rehabilitation-related organizations. The scarcity of evidence hinders our efforts.” ………… Acadamician7. Table 5 Stakeholders' insight about possible challenges that could hinder the intended outcome (N = 180) S.No Independent variables SA A NoP DA SDA Mean ± SD 23 There are only a few rehabilitation centers in the country. 12(6.7) 88(48.9) 62(34.4) 18(10.0) 0 3.5 ± 0.77 24 Rehabilitation services suffer from inadequate funding and rely heavily on donations. 4(2.2) 66(36.7) 94(52.2) 16(8.9) 0 3.3 ± 0.67 25 Rehabilitation services are not given enough priority at the national level, especially within the MOH. 14(7.8) 68(37.8) 98 (54.4) 0 0 3.5 ± 0.64 26 Lack of data on rehabilitation in Rwanda to better understand the rehabilitation needs in the country. 16(8.9) 118(65.6) 46(25.6) 0 0 3.8 ± 0.57 27 There is a shortage of skilled and specialized professionals in the field of rehabilitation services. 42(23.3) 80(44.4) 50(27.8) 8(4.4) 0 3.9 ± 0.82 28 Geographic limitations can make it difficult for some individuals to access existing services, and attending these services may result in added expenses for the users. 2(1.1) 68(37.8) 94(52.2) 16(8.9) 0 3.3 ± 0.65 29 Insufficient funding for Assistive Technology in the country. 8(4.4) 82(45.6) 74(41.1) 16(8.9) 0 3.5 ± 0.72 30 At present, there exists a scarcity of rehabilitation research that has the potential to offer valuable insights to policymakers. 18(10.0) 96(53.3) 56(31.1) 10(5.6) 0 3.7 ± 0.73 31 It is necessary for the MOH to appoint a rehabilitation specialist to oversee the implementation of the rehabilitation strategic plan. 20(11.1) 112(62.2) 44(24.4) 4(2.2) 0 3.8 ± 0.65 SA = Strongly agree, A = Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree Accessibility of Rehabilitation Services in Rwanda Participants again raised issues on accessibility of existing rehabilitation services as a challenge to rehabilitation service delivery, as mentioned by rehabilitation professionals below: ……………“ Service users always raise concerns about the added expenses incurred due to services being located far from their homes as the reasons why they don’t come regularly to physiotherapy services and the reason for abandoning the treatment. These costs include transportation, food, and lodging” ……. from a physiotherapist in a district hospital22. ……………“ It is not accessible due to a lack of awareness of the appropriate rehabilitation services. If the doctor is unaware of the benefits of rehabilitation, the client may suffer for a long time without receiving the necessary treatment. Hopefully, this will change soon, because rehabilitation is now growing more than ever before” …………. INGO11. Stakeholders' Recommendations for Rehabilitation Sector Improvement in Rwanda. It is well understood that obtaining feedback from relevant stakeholders is crucial to improving the process of strengthening rehabilitation services in Rwanda. Research participants were further interviewed on questions that highlight the growing demand for rehabilitation services in Rwanda, as well as the obstacles that could hinder the intended outcomes. Table 6 describes the results from stakeholders' overall perception of the recommendations for future improvement in the rehabilitation sector in Rwanda. More than one-fifth (22.2%) of the stakeholders strongly agreed with the statement of community-level mobilization to increase awareness regarding the role of rehabilitation centers. Furthermore, 62.2% and 50% of the participants agreed on collaborating with international organizations to enhance the technical skills of locals thereby contributing to the development of the rehabilitation sector in Rwanda and more advocacy to policymakers to prioritize rehabilitation as an important aspect of healthcare in the country, respectively. Additionally, more than half of them agreed with the statement on the need for assistance in enhancing the quality improvement process in the current rehabilitation centers to ensure the delivery of high-quality rehabilitation services in Rwanda. The majority (75.6%) of the participants had no opinion towards enhancing collaboration with the private sector to increase the number of rehabilitation service providers. Similarly, more than half of the participants had no opinion on the need for mobilizing more funds to establish rehabilitation centers nationwide (62.2%) and the importance of incorporating rehabilitation services into the community healthcare service package to ensure service coverage for all (53.3%). In this research, 24.4% and 13% of the study participants disagreed with the statement on the need for mobilizing more funds to establish rehabilitation centers in the country and the need for enhanced collaboration with the private sector to increase the number of rehabilitation service providers (Table 6 ). ………………….” heavy reliance on external funding is a potential obstacle to the advancement of the rehabilitation Sector in Rwanda, there is a need of brainstorming on how to mobilize internal funds to strengthen the system” ………… from a rehabilitation professional association leader4. Table 6 Stakeholders' perceptions on recommendations for future improvement in the Rehabilitation Sector (N = 180) S.No Independent variables SA A NoP DA SDA Mean ± SD 32 The government should support the advancement of rehabilitation specialists in Rwanda. 2(1.1) 84(46.7) 90(50.0) 2(2.2) 0 3.5 ± 0.56 33 There is a need for mobilizing more funds to establish rehabilitation centers nationwide. 2(1.1) 22(12.2) 112(62.2) 44(24.4) 0 2.9 ± 0.64 34 Assist in enhancing the quality improvement process in current rehabilitation centers to ensure the delivery of high-quality rehabilitation services. 10(5.6) 94(52.2) 70(38.9) 6(3.3) 0 3.6 ± 0.65 35 Mobilization on community level to increase awareness regarding the role of rehabilitation centers 40(22.2) 70(38.9) 64(35.6) 6(3.3) 0 3.8 ± 0.82 36 It is important to incorporate rehabilitation services into the community healthcare service package to ensure service coverage for all. 10(5.6) 54(30.0) 96(53.3) 20(11.1) 0 3.3 ± 0.74 37 Enhance collaboration with the private sector to increase the number of rehabilitation service providers. 8(4.4) 12(6.7) 136(75.6) 24(13.3) 0 3.0 ± 0.62 38 Collaborating with international organizations to enhance the technical skills of locals, thus contributing to the development of the rehabilitation sector in Rwanda. 28(15.6) 112(62.2) 38(21.1) 2(1.1) 0 3.9 ± 0.64 39 Keep advocating to policymakers to prioritize rehabilitation as an important aspect of healthcare in our country. 18(10.0) 90(50.0) 68(37.8) 4(2.2) 0 3.7 ± 0.68 SA = Strongly agree, A = Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree Discussion Understanding the perspectives of stakeholders on the factors contributing to the integration of rehabilitation services into the Rwandan health system as recommended by the WHO guide for Action is crucial for need-driven planning . Parallel to this engaging with key informants of the local and international partners, non-government organizations, and others who can provide valuable insights for the development of national and international guidelines is significant for a better delivery of the local needed best service[1]. Several multi-level factors contribute to the current rehabilitation sector needs, enabling them to provide rich and comprehensive insights. The study findings demonstrated that stakeholders agreed with the statement on the need for rehabilitation services in Rwanda which is increasing. This is in line with the current evidence on the Global Burden of Disease [15]. Furthermore, the present findings highlighted the unique factors contributing to the demand for rehabilitation services in Rwanda as the past genocide against the Tutsi in 1994 increased by people with disabilities in the country[20]. Additionally, stakeholders highlight the availability of skilled professionals, social support programs, and increased awareness of the rights of people with disabilities are among the drivers for the integration of rehabilitation services in the Rwandan health system [1]. The present findings revealed additional insights and understanding of the government of Rwanda's commitment to providing universal healthcare access to all, which may be also another factor for the increasing need for rehabilitation care [18] . However, it's important to note the specific factors and guiding approaches to the demand for rehabilitation services in Rwanda to develop targeted policies to address them. Overall, the findings on the factors that are contributing to the adoption of the WHO guide to strengthen rehabilitation in the national healthcare systems are similar to other studies [4, 21–23]. However, specific positive points for Rwanda have been captured: The active disability movement which advocates for access to quality rehabilitation healthcare services and assistive devices put pressure on the government for change, the existence of active development partners, a commitment of the government to overall stakeholder’ coordination, and well-established community-based health insurance (CBHI). Finally, the government's efforts to establish itself as a prominent tourist hub in East Africa. All these factors are also in line with a study published by Shahabi and colleagues in 2022 [24] Research participants' opinions about potential obstacles that could impede the integration of rehabilitation service in the national health system revealed that lack of data on rehabilitation needs in Rwanda, a shortage of skilled and specialized rehabilitation professionals, a scarcity of rehabilitation research, and a lack of a responsible person to oversee the rehabilitation activities at National level are the main challenges. These challenges are common to most Low and Middle-income countries as stated in the Rehabilitation 2030 Call for Action[5]. The recommendations which are important for implications towards improving and sustaining Rwanda's rehabilitation sector are by supporting the education of rehabilitation specialists, enhancing the offer of quality services in existing specialized rehabilitation hospitals and centers, continuously increasing awareness of the community and policy makers on the importance of rehabilitation, incorporating rehabilitation services into community healthcare service packages, collaborating with international organizations to develop local capable and enough workforce, and advocating for rehabilitation to be prioritized in healthcare policy, Rwanda can significantly improve healthcare accessibility and the quality of rehabilitation services provided to its citizens. These actions would contribute towards building a stronger and more sustainable healthcare system in Rwanda, benefitting the health and well-being of the entire population. Research participants appreciate and commend the Rwandan government for its dedicated efforts towards enhancing the rehabilitation sector in the country. Conclusions Rehabilitation services are in high demand due to disabilities caused by the genocide, road traffic accidents, and increased recognition of disability rights. Integrating these services into the healthcare system faces challenges such as a shortage of skilled professionals and limited financial resources. To address these issues, stakeholders recommend prioritizing and investing in rehabilitation services, supporting specialists' training, mobilizing funds, and advocating for the appointment of a national-level official to oversee rehabilitation Sector. The study provides valuable insights applicable to other low- and middle-income countries. Overall, Rwanda's progress towards creating a conducive environment for the rehabilitation sector is an inspiring model for other countries to follow Declarations Ethical consideration Ethical Clearence was obtained from the University to conduct the study.Stakeholders who agreed to participate in this study were approached both for written and verbal consent. References Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396:2006–17. Geberemichael SG, Tannor AY, Asegahegn TB, Christian AB, Vergara-Diaz G, Haig AJ. Rehabilitation in Africa. Phys Med Rehabil Clin N Am. 2019;30:757–68. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392:1789–858. Marchal B, Cavalli A, Kegels G. Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric? PLoS Med. 2009;6:e1000059. WHO. Rehabilitation 2030 :Call for Action (2017). https://cdn.who.int/media/docs/default-source/documents/health-topics/rehabilitation/callforaction2.pdf?sfvrsn=50299fc6_2&download=true. Høyer E, Opheim A, Moe-Nilssen R, Strand LI. Community living after in-hospital specialized rehabilitation in patients with severe disability after stroke: a long-term follow-up after a randomized controlled trial. Disabil Rehabil. 2023;45:1822–9. Lindström M, Lindholm L, Liv P. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities. Trials. 2022;23:657. Shakespeare T, Officer A. Breaking the barriers, filling the gaps. Disabil Rehabil. 2014;36:1487–8. WHO. Rehabilitation in health systems: guide for action (2019). https://www.who.int/publications/i/item/9789241515986. Lindström M. Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities. Front Psychiatry. 2022;13:954068. Cannata G, Douryang M, Ljoka C, Giordani L, Monticone M, Foti C. The Burden of Disability in Africa and Cameroon: A Call for Optimizing the Education in Physical and Rehabilitation Medicine. Front Rehabil Sci. 2022;3:873362. Kumurenzi A, Richardson J, Thabane L, Kagwiza J, Musabyemariya I, Bosch J. Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study. Afr J Disabil. 2022;11. MOH. A Situation Assessment of Rehabilitation In Republic of Rwanda Prepared for Rwanda Ministry of Health with support from the United States Agency for International Development, ICRC and the World Health Organization (2021). MOH. About Ministry of Health of Rwanda (2023). https://www.moh.gov.rw/about. Krug E, Cieza A. Strengthening health systems to provide rehabilitation services. Neuropsychol Rehabil. 2019;29:672–4. MOH. National Strategy and Costed Action Plan for the Prevention and Control of Non-Communicable Diseases in Rwanda (2020). WRA. Advocating for Rehabilitation. https://www.who.int/initiatives/world-rehabilitation-alliance (2020). Nyandekwe M, Nzayirambaho M, Kakoma JB. Universal health coverage in Rwanda: dream or reality. Pan Afr Med J. 2014;17. Bailey KD. Methods of social research. 4th ed. New York : Toronto : New York: Free Press ; Maxwell Macmillan Canada ; Maxwell Macmillan International; 1994. Inerpeace. Healing the invisible wounds of violence in Rwanda (2020). https://reliefweb.int/report/rwanda/healing-invisible-wounds-violence-rwanda. Cieza A, Kwamie A, Magaqa Q, Paichadze N, Sabariego C, Blanchet K, et al. Framing rehabilitation through health policy and systems research: priorities for strengthening rehabilitation. Health Res Policy Syst. 2022;20:101. McPherson A, Durham J, Richards N, Gouda H, Rampatige R, Whittaker M. Strengthening health information systems for disability-related rehabilitation in LMICs. Health Policy Plan. 2016;:czw140. Stucki G, Bickenbach J, Melvin J. Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems. Am J Phys Med Rehabil. 2017;96:677–81. Shahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res. 2022;22:1317. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4739863","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":326824534,"identity":"40c6974e-70ee-48c9-b248-1e0178b76f6e","order_by":0,"name":"Ines Musabyemariya","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-1001-1443","institution":"Mount Kenya university","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ines","middleName":"","lastName":"Musabyemariya","suffix":""},{"id":326824535,"identity":"7bfd0997-480d-48de-bb73-afe1c9861fae","order_by":1,"name":"Dr. Amanuel Kidane Andegiorgish (MSc., Ph.D.)","email":"","orcid":"https://orcid.org/0000-0002-3045-3153","institution":"Mount Kenya University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"Dr.","firstName":"Amanuel","middleName":"Kidane Andegiorgish","lastName":"(MSc.","suffix":"Ph.D."}],"badges":[],"createdAt":"2024-07-14 21:54:35","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4739863/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4739863/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60433932,"identity":"08dabe4a-a26d-4fc5-84b2-d61eed37c30d","added_by":"auto","created_at":"2024-07-16 17:03:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16730,"visible":true,"origin":"","legend":"\u003cp\u003eThe percentage proportion of respondents according to their level of responsibility (n = 180 for questionnaire and 32 for key informants interviews)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4739863/v1/e312d89908a13c51f2802631.png"},{"id":60433934,"identity":"9e8d3901-26b1-409d-9bd8-e253bf141786","added_by":"auto","created_at":"2024-07-16 17:03:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1023563,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4739863/v1/dd38559e-b9ff-4b43-9278-aabbfe6f4730.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eStrengthening Rehabilitation in Health system: Stakeholders’ perception of factors contributing to the adoption of World Health Organizations guide to strengthen rehabilitation in the Rwandan healthcare system\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to various authors, strengthening rehabilitation in national healthcare systems is an important step towards meeting the growing demand for rehabilitation care. Currently, an estimated 2.4\u0026nbsp;billion people worldwide require rehabilitation, and this number is expected to rise without strategic action [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization's (WHO) strategy towards rehabilitation is strengthening the health system to reach its full potential. This involves making rehabilitation part of care at all levels of the health system, and ensuring it is incorporated as part of universal health coverage. To this end, on 7 February 2017, WHO, Member States, international and professional organizations, nongovernmental organizations, and rehabilitation experts issued Rehabilitation 2030: a call for action, a commitment to key actions to strengthen rehabilitation services in Member States [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These actions include: improving rehabilitation governance and investment; expanding a high-quality rehabilitation workforce; and enhancing rehabilitation data collection. The commitment to strengthen health systems to provide rehabilitation services should make it possible for millions of people not only to live longer but to live well.\u003c/p\u003e \u003cp\u003eGlobally, people living with disability have poorer health, lower education achievements, less economic involvement, and higher rates of poverty than people without disabilities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As populations age and chronic health problems become increasingly prevalent [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], more and more people are living with multimorbidity and disability [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For them, rehabilitation is essential if they are to remain as independent as possible, participate in education and work, and fulfill meaningful roles in life. Along with prevention, promotion, treatment, and palliation, rehabilitation addresses the health needs of a population and contributes to universal health coverage[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn low- and middle-income countries including Rwanda, the need is high and likely to increase in the future because people are now living longer, injuries are increasing due to wars, road traffic accidents, natural calamities, and the increasing number of people suffering from chronic noncommunicable diseases[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These poor socioeconomic outcomes are largely due to the widespread barriers faced by people living with disabilities in accessing health, education, employment, and information-related services [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatterns of disability in a particular country are influenced by trends in health conditions and trends in environmental and other factors \u0026ndash;such as road traffic crashes, natural disasters, conflict, diet and substance abuse [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Rwanda, people in need of rehabilitation services is increasing [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This became noticed after the 1994, genocide against the Tutsi. The conflict left a significant number of war-wounded soldiers and civilians, including people with disabilities. However, people are facing different challenges of access to quality services and this leads to their loss of function, which complicates their quality of life and later leads to their death as well as household financial difficulties [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. To address this challenge, there is a need to strengthen rehabilitation in the National Healthcare system. The Ministry of Health (MOH) has a goal to offer affordable and quality healthcare services that focus on promotion, prevention, treatment, and rehabilitation. This will contribute to poverty reduction as well as the improvement of the overall well-being of the Rwandan population [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Even though the healthcare system has made significant progress, there are still areas of improvement including the rehabilitation Sector.\u003c/p\u003e \u003cp\u003eAccording to a study conducted by Wickenden et al. (2012), they found that diverse stakeholder communities can actively shape policy and practice through participatory consultations. National agencies, particularly those stemming from civil conflicts, and shortcomings in the current health system impact both rehabilitation needs and the feasibility of implementation.\u003c/p\u003e \u003cp\u003eThe WHO guide is a series of tools, that help the country to assess its rehabilitation sector, develop strategic planning, and the establishment of monitoring and evaluation systems that will support the country to track changes over time [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Rwanda has adopted the WHO guide to address the issues identified in the Rehabilitation sector to work closely with stakeholders, who have been actively involved in the sector for many years of under-prioritization and this has improved policy dialogue and enabled effective coordination among its development partners [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStakeholders in the Rehabilitation Sector are working and supporting at different levels such as community sensitization, service provision, human resource development/academicians, private sector, civil society, international NGOs, and all people not only people with disabilities[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the Rwandan healthcare system has thoroughly followed the WHO guide for Action[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Rehabilitation services may be inadequate, and there are many barriers to accessing the available services [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Developing policies and health systems interventions targeting the determinants of these inequalities requires urgent policy attention at national and international levels. There is a gap in evidence regarding Stakeholders\u0026rsquo; perceptions and factors contributing to the adoption of the World Health Organization guide to strengthen rehabilitation in the Rwandan healthcare system.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003e A cross-sectional qualitative study was conducted to evaluate the perceptions of Stakeholders on factors contributing to the adoption of the World Health Organization guide to strengthen rehabilitation in the Rwandan healthcare system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThis study took place among different institutions and stakeholders who have offices in Rwanda. The study setting included offices of International and local non-governmental organizations, specialized rehabilitation Hospitals, organizations of people with disability, Ministry of Health and Public Hospitals, Academicians, and Private clinics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe study enrolled 180 stakeholders (64.4% men and 35.6% women) and 32 key informants. The target population of this research was composed of staff who were engaged in different phases of the adoption of the WHO Guide to strengthen rehabilitation in the Rwandan healthcare system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Determination and Sampling Techniques\u003c/h2\u003e \u003cp\u003eThe researcher is fully aware of the importance of representative sampling, particularly when studying the entire population, and conducting a survey or census is the most efficient and accurate way to obtain data from a small and accessible population. This approach provides several advantages, including an accurate population count without sampling errors. Despite the initial inclusion of all 190 identified stakeholders, only 180 of them agreed (95% response rate) to participate fully in this study. Nonetheless, this sample size still provides meaningful insights for the research and could be considered representative of the population under study as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eA structured questionnaire guide adapted from the Pathfinder International (PI) questionnaire composed of questions designed to align with the World Health Organization's (WHO) expectations on the provision of rehabilitation services and integration was used [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. one questionnaire and interview guide were designed. Bilingual data collectors or interviewers were recruited and all data collection activities were conducted in Kinyarwanda or English as per the primary choice of the participants. Data collectors were trained on the objectives of the study, interview process, data recording and preservation, and research ethics, as well as probing questions for extensive interviews for qualitative interviews before the actual data collection. the data collection tool was reviewed and piloted to evaluate its appropriateness with the Rwandan Local Context. In-depth interviews were conducted by trained interviewers and took place inside each participant\u0026rsquo;s office, or outside, based on the study participant\u0026rsquo;s choice and the ability to find private space for the interview. Data collected through in-depth interviews were audio recorded using smartphones or computers with the consent of participants. Translation of interviews from Kinyarwanda to English was conducted during the transcription process by the data collectors, who were native Kinyarwandan speakers. Furthermore, all questions were digitalized in the Kobo data collection system to facilitate a quick process of data collection and entry for questionnaire data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eQuestionnaire information was exported from Kobo statistical software to Excel for data cleaning and then to a statistical package for social sciences (SPSS Version 25.0) to analyze the information. Descriptive statistics of sociodemographic characteristics related to frequency distributions and percentages were presented in tables. Attiduted of research participants was presented using percent and mean and Standard deviations. Qualitative data were first coded based on themes manually and using the digital process for completeness and appropriate coding. All audio records were transcribed and then translated verbatim to English by five trained research assistants(public health professionals). Every transcribed and translated interview was again validated by another research assistant. Finally, each transcription and translation was approved by the lead researcher (PI). Verbatims were repeatedly read to identify important phrases or words related to the main outcome of the study and were coded by selecting a significant word or phrase from the interviewee\u0026rsquo;s statement. Codes allowing with their summary notes were aggregated and classified in meaningful categories. The major categories were then labeled as themes and presented as narratives. Sub-categories of each theme were considered sub-themes. A narrative approach was used to deliver qualitative results. To illustrate the theme and sub-theme, selected quotations are presented with codes for participants from MoH (MoH1, MoH2..), international and local NGOs ( INGO1, INGO2\u0026hellip;, and LNGO1, LNGO2..) Service provider (SP1, SP2..) Service users (SU1, SU2..).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics of Study Participants\u003c/h2\u003e \u003cp\u003eTwo-thirds (64.4%) of the study participants were males. A majority (83.3%) of the study participants have attained their first degree from a university and 10% had a Master\u0026rsquo;s degree. More than a quarter (26.7%) of the research participants in the present study were affiliated with MoH and Public Hospitals and 21.1% were affiliated with Specialized Rehabilitation Hospitals (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender of Participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of Participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=30 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;35 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;40 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;45 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=46Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePh.D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganization of Participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational NGO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal NGO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized Rehabilitation Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrganizations of people with Disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoH \u0026amp; Public Hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate Clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNGO: Non-governmental organization, MOH: Ministry of Health\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eEmerging Themes\u003c/h2\u003e \u003cp\u003eTo understand the perception of stakeholders on the factors contributing to the adoption of the WHO guide to strengthen rehabilitation in the Rwandan healthcare system, qualitative information was analyzed based on different emerging themes and sub-themes. According to the perspective of the stakeholders, 7 themes and 13 sub-themes were generated as presented in the table Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmerging Themes from Qualitative Interview\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatus of Rehabilitation Services in Rwanda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDemand\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation Service Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuality, Accessibility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation Workforce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDensity, Brain Drain, Specialties, Professionals Retention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eData on Rehabilitation Needs in Rwanda, and Research in Rehabilitation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssistive Devices, Medical Rehabilitation products and technologies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailability Affordability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation Sector Financing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnder prioritization, and heavy reliance on external funding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership and Governance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCentral level representation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStakeholders\u0026rsquo; Perception about the increasing need for rehabilitation services in Rwanda\u003c/h2\u003e \u003cp\u003eIn this study, 10 questions related to assessing the respondent\u0026rsquo;s perception of the need for rehabilitation services in the Rwandan context were asked as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAbout two-thirds (64.4%) of the participating stakeholders agreed that the demand for rehabilitation services in Rwanda has been on the rise following the genocide against the Tutsi in 1994, which has resulted in an increased number of people with disabilities (3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 out of a 5-points). Moreover, about half (48.9%) of all stakeholders strongly agreed that the demand for rehabilitation services has increased because of the availability of skilled professionals (4.4 out of 5 points), followed by conflicts in the region (4.2 out of 5 points). The role of various programs that help with early identification and appropriate referral services to individuals with disabilities in the community was highly recognized (4.0 out of 5 points).\u003c/p\u003e \u003cp\u003eThe contribution of non-communicable diseases and a large number of people born with disabilities were slightly perceived with a lower average score of 3.6 points out of 5. Nevertheless, the availability of social support programs in Rwanda and its contribution to an increase in demand for rehabilitation services due to gaining access to such services and due to increased awareness of the rights of people with disabilities was profoundly perceived (64.4%).\u003c/p\u003e \u003cp\u003eMore than one in four of the study participants disagreed on factors like the increase in road traffic accidents, increased number of injuries, and home and workplace accidents contributing to a growing demand for rehabilitation services in Rwanda (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Information from KII also showed a similar perception of the importance of the adoption of the WHO Guide to Integrate Rehabilitation into the Rwandan healthcare system.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo;A strong government commitment towards improving the lives of the community, and improved awareness of the importance of Rehabilitation to address non-communicable diseases which is on the rise in Rwanda\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e Service User3.\u003c/p\u003e \u003cp\u003e Does Rwanda have to adopt WHO guidelines instead of setting up its own?\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo;I think the adoption of the existing Guide is the best way to set up benchmarks that are based on evidence-based literature and that are globally recognized without the country spending time and money to start from scratch\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e Service Provider1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStakeholder\u0026rsquo;s perception on the increasing need for Rehabilitation services in Rwanda, 2023 (N\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNoP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe demand for rehabilitation services in Rwanda has been on the rise following the genocide against the Tutsi in 1994, which has resulted in an increased number of people with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116(64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe number of disabilities is increasing due to the increase in road traffic accidents, and home and workplace accidents, there has been a growing demand for rehabilitation services due to the increased number of injuries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e110(61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNow we are seeing a large number of people who born with disabilities due to climate change and other health-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation services are becoming more necessary in Rwanda due to the rise of non-communicable diseases.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRwanda is experiencing a rise in demand for rehabilitation services due to the conflicts in the region, which has led to an increased number of refugees seeking help in the country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation facilitates improving the well-being of people with disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe demand for rehabilitation services has risen due to various programs that help recognize individuals with disabilities in the community and refer them to appropriate services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe demand for rehabilitation services in Rwanda has risen due to increased awareness of the rights of people with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116(64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe demand for rehabilitation services has increased because of the availability of skilled professionals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88(48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe availability of social support programs has led to an increase in demand for rehabilitation services, as they assist individuals in gaining access to such services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118(65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSA\u0026thinsp;=\u0026thinsp;Strongly agree, A\u0026thinsp;=\u0026thinsp;Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree\u003c/h2\u003e \u003cp\u003eFrom the demand side or rehabilitation service in Rwanda, almost all participants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; there is a high demand for rehabilitation services, but unfortunately, there are very limited deliverables from the implementers or service providers. I see the current view is only within the scope of the health sector, however, it should be seen as a cross-cutting intervention involving different actors and ministries to be more meaningful\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003eSP7.\u003c/p\u003e \u003cp\u003eSimilarly, another participant expressed his perception by stating:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo;The current status of rehabilitation in Rwanda is increasingly recognized as essential due to the rising prevalence of chronic non-communicable diseases, the aging population, and a significant number of people living with injuries' consequences or congenital and developmental disabilities. All these individuals require rehabilitation services, and it should be viewed as an important component of healthcare\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;INGO5\u003c/em\u003e \u003c/p\u003e \u003cp\u003eRegarding the current status of rehabilitation services in Rwanda, a participant from an international NGO elaborated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; In Rwanda, the rehabilitation sector is still in its initial stages. Some progress has been made, but there is a long way to go to address all the necessary aspects to be on a good track. This means that there are many unmet needs, and the current rehabilitation interventions are scattered and lack a unified approach to generate impactful outcomes. However, there are promising ambitions from the government and stakeholders to drive this rehabilitation initiative forward, so it can become more operationalized\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip; INGO4\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe contribution of skilled professionals and referral services was positively perceived. A response from a Rehabilitation service provider with over 32 years of work experience:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo;Receiving many referral cases for rehabilitation from other healthcare facilities indicates it is well recognized by the need for specialized care. Moreover, this demonstrates doctors' understanding of the importance of rehabilitation\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;SP21\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors influencing the integration of Rehabilitation into the Rwandan Healthcare system.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEleven questions were asked to rate their level (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). One-third (33.3%) of the stakeholders strongly agreed that the Rwandan government's commitment and the policies in place towards improving the provision of rehabilitation services into the national healthcare system have accelerated the process of integrating rehabilitation into the national healthcare system.\u003c/p\u003e \u003cp\u003eA higher proportion (67.8%) of stakeholders agreed that the availability of community-based health insurance (CBHI) which offers affordable basic rehabilitation services is a contributing factor. Moreover, the contribution of the policies of the government towards the provision of rehabilitation services in Rwanda and the political commitment towards improving the provision of rehabilitation services and integrating the service into its national healthcare system was highly perceived (mean score\u0026thinsp;=\u0026thinsp;4.2).\u003c/p\u003e \u003cp\u003eWhat do you perceive as successful drivers for the government of Rwanda\u0026rsquo;s adoption of the WHO guide for action to strengthen the rehabilitation sector in the Rwandan Healthcare System?\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip; \u0026ldquo;the political will of the Ministry of Health. they have this will that rehabilitation services should advance, the determination to establish sustainable rehabilitation strategies, and the availability of a technical working group for rehabilitation is a very key drivers in achieving positive outcomes. Furthermore, having partners in rehabilitation who are willing to work together and play their respective roles contributes to the success of the efforts. What is needed is just to coordinate them. Rwanda's enabling policies, in line with WHO recommendations, also act as key drivers for progress\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;LNGO3\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHowever, comparatively, the mean scores for some of the statements like, at the time of the study rehabilitation services are part of the National Health Sector Strategic Plan. (HSSP IV), and rehabilitation services are included in the National healthcare service package, disability-driven movements to enhance the provision of rehabilitation and others have lower mean scores which imply that policymakers in Rwanda have to further advance the integration of these factors and should be nurtured and strengthened.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRehabilitation Service Provision in Rwanda\u003c/h2\u003e \u003cp\u003eExploring the perception of participants about the demand for rehabilitation services in Rwanda might be helpful to understanding the needs of the community by stakeholders for better planning and policy proposals to re-integrate rehabilitation care as the main component of the healthcare system.\u003c/p\u003e \u003cp\u003eParticipants had different views about the quality-of-service provision of existing rehabilitation services in Rwanda as illustrated in the following quotations:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; I can say that the quality is still poor, there is still a long way to go when it comes to rehabilitation service provision, some services don\u0026rsquo;t have basic equipment to provide services, staff don\u0026rsquo;t have a plan for Continuous professional development, the multidisciplinary team is not complete, there is no continuum of care, etc.\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e SP8.\u003c/p\u003e \u003cp\u003eAnother quote worth highlighting from a project manager in an international non-governmental organization who said that transforming the process for quality rehabilitation service requires:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo;Quality is a process and it takes time to become a culture. Currently, quality standards for the rehabilitation specialized hospitals and centers have been launched by the Ministry of Health, these will help hospitals to improve the quality and help hospitals and centers to embark on the journey of continuous quality improvement\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e INGO15.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eStakeholders' opinions about Contributing factors that have influenced the Integration of Rehabilitation into the National Healthcare System (N\u0026thinsp;=\u0026thinsp;180)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNoP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRwanda has policies in place that provide support for the provision of rehabilitation services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98(54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRwanda is committed to improving the provision of rehabilitation services and integrating them into its national healthcare system.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e102(56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation services are part of the National Health Sector Strategic Plan. (HSSP IV), and rehabilitation services are included in the National healthcare service package.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92(51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76(42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is a strong disability movement in Rwanda that strives to enhance the provision of rehabilitation and assistive device services, actively puts pressure on the government.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92(51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76(42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of rehabilitation training Institutions that produce skilled rehabilitation professionals, ready to give the services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e82(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is a recognition of the crucial role that rehabilitation services play in restoring functioning and preventing disability in the Rwandan community.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of Development partners: International organizations and donors through local organizations that provide financial support to the rehabilitation sector in Rwanda.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110(61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStakeholders' coordination to prevent duplication of interventions: a technical working group at the Ministry of Health is responsible for advising the government on rehabilitation-related matters.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunity-based health insurances (CBHI) offer affordable basic rehabilitation services but not all services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e122(67.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased knowledge and innovation in healthcare service provision in Rwanda, and globally.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e112(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42(23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe government of Rwanda is actively working towards establishing itself as a prominent tourist hub in East Africa.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSA\u0026thinsp;=\u0026thinsp;Strongly agree, A\u0026thinsp;=\u0026thinsp;Agree, NoP: No opinon, DA: Disagree, and SDA: Strongly disagree\u003c/h2\u003e \u003cp\u003e \u003cb\u003ePossible challenges for the intended outcome of strengthening rehabilitation into the national healthcare system.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt is essential to recognize that every policy designed to benefit the public community will encounter challenges that need to be addressed to achieve its goals. Participants were asked to rate some statements using a five-point scale (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). A total of nine questions related to the possible challenges for the successful establishment and integration of rehabilitation services into the national healthcare system were administered.\u003c/p\u003e \u003cp\u003eAbout half (48.9%) agreed that the rehabilitation centers in the country are limited, with a mean response of 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77, which indicates generally above the average.\u003c/p\u003e \u003cp\u003eWhat is your perception of the quality of rehabilitation services provided in Rwanda?\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; Thank you. You know, when something is in its initial phase, the quality is often challenged. We have issues with quality. For example, in the workforce part, there is an issue of quality because the people are not adequately trained to deliver the services. They are not equipped enough to provide the necessary level of care. Even when we look at the existing workforce, they are limited in terms of resources. So, the quality is low, especially at the primary healthcare level. However, at the tertiary level, the quality is good. But, of course, at the tertiary level, it's very limited, and the need for rehab is at the community and primary care level, where the quality is very poor\u0026rdquo;\u0026hellip;\u0026hellip;\u003c/em\u003e Director of Hospital2.\u003c/p\u003e \u003cp\u003eCould you please share with us your perspective on the existing rehabilitation services and the challenges of integrating them with the healthcare system in Rwanda?\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; It is time for the government to take the lead and improve the Rehabilitation Sector that has been in the hands of religious people and Humanitarian Agencies. It is time to change and for the government to be responsible for the Rehabilitation Sector. In the meantime, community leaders could potentially be a bridge between\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ecommunity members and the MOH\u0026rdquo;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e from a Service provider28.\u003c/p\u003e \u003cp\u003eWorth highlighting another quote from a rehabilitation professional in a community center owned by a local NGO shared that rehabilitation services are not accessible:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; I feel that rehabilitation services in Rwanda are not easily accessible due to the hilly terrain and the location of hospitals mainly in urban areas. This creates challenges for people living in remote communities to access these services. Although some improvements have been made, there is still a need to decentralize the service delivery and make it available at the community level, where many service users reside\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003eLNGO9.\u003c/p\u003e \u003cp\u003eIn this study, more than half (52.2%) of the participants had no opinion regarding whether the existing rehabilitation services suffer from inadequate funding or heavily rely on donations. Another common challenge mentioned by the majority of the participants was the lack of data on rehabilitation needs in Rwanda which might help in a better understanding of the rehabilitation needs in the country and 65.5% agree with this response.\u003c/p\u003e \u003cp\u003eTo improve credibility, many informants expressed keenness to receive continuous training and adequate materials, stating that those might help with their work.\u003c/p\u003e \u003cp\u003eTo overcome this challenge, a majority (62.2%) of the participants agreed that the MOH of Rwanda must appoint a rehabilitation specialist to oversee the implementation of the rehabilitation strategic plan.\u003c/p\u003e \u003cp\u003eThe highest average score was about 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 regarding a statement stating that there is a shortage of skilled and specialized professionals in the field of rehabilitation services. Furthermore, the lack of evidence-based information/scarcity of rehabilitation research that has the potential to offer valuable insights to policymakers is another major challenge at present to the existing healthcare delivery system.\u003c/p\u003e \u003cp\u003eThis statement was supported by qualitative information. One female respondent indicated the\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; I feel like I don\u0026rsquo;t receive enough information about the condition of my child, it is as if my therapist is not able to explain to me and I am confused with the future of my child who was born with mental problems\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003eFrom an organization of People with Disabilities4.\u003c/p\u003e \u003cp\u003eDo you meet challenges as an institution related to your interventions in line with strengthening the Rehabilitation Sector in Rwanda? Describe the main challenges.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; In a few words, I can mention some of these challenges can be managed by our organization, while others are beyond our control. One of them is the low public awareness about clubfoot and disability. Additionally, limited treatment spaces and inadequate infrastructure pose obstacles. For instance, when providing services at hospitals, our parent advisors need a conducive area for counseling, but sometimes space is very limited. Moreover, there's a challenge with staff turnover. We invest resources in training, but personnel might be appointed elsewhere, making continuity difficult. Another challenge is the low level of government involvement in specific preventive measures. For example, when it comes to clubfoot management and the need for casting supplies, it should be the government's responsibility to provide them, rather than solely relying on our organization. Furthermore, there's a lack of data and research in Rwanda, which is a common issue faced by rehabilitation-related organizations. The scarcity of evidence hinders our efforts.\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003eAcadamician7.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStakeholders' insight about possible challenges that could hinder the intended outcome (N\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNoP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere are only a few rehabilitation centers in the country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88(48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation services suffer from inadequate funding and rely heavily on donations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation services are not given enough priority at the national level, especially within the MOH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98 (54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of data on rehabilitation in Rwanda to better understand the rehabilitation needs in the country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e118(65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is a shortage of skilled and specialized professionals in the field of rehabilitation services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42(23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50(27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeographic limitations can make it difficult for some individuals to access existing services, and attending these services may result in added expenses for the users.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient funding for Assistive Technology in the country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt present, there exists a scarcity of rehabilitation research that has the potential to offer valuable insights to policymakers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is necessary for the MOH to appoint a rehabilitation specialist to oversee the implementation of the rehabilitation strategic plan.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e112(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSA\u0026thinsp;=\u0026thinsp;Strongly agree, A\u0026thinsp;=\u0026thinsp;Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eAccessibility of Rehabilitation Services in Rwanda\u003c/h2\u003e \u003cp\u003eParticipants again raised issues on accessibility of existing rehabilitation services as a challenge to rehabilitation service delivery, as mentioned by rehabilitation professionals below:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; Service users always raise concerns about the added expenses incurred due to services being located far from their homes as the reasons why they don\u0026rsquo;t come regularly to physiotherapy services and the reason for abandoning the treatment. These costs include transportation, food, and lodging\u0026rdquo; \u0026hellip;\u0026hellip;.\u003c/em\u003e from a physiotherapist in a district hospital22.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026ldquo; It is not accessible due to a lack of awareness of the appropriate rehabilitation services. If the doctor is unaware of the benefits of rehabilitation, the client may suffer for a long time without receiving the necessary treatment. Hopefully, this will change soon, because rehabilitation is now growing more than ever before\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e INGO11.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStakeholders' Recommendations for Rehabilitation Sector Improvement in Rwanda.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt is well understood that obtaining feedback from relevant stakeholders is crucial to improving the process of strengthening rehabilitation services in Rwanda. Research participants were further interviewed on questions that highlight the growing demand for rehabilitation services in Rwanda, as well as the obstacles that could hinder the intended outcomes. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e describes the results from stakeholders' overall perception of the recommendations for future improvement in the rehabilitation sector in Rwanda.\u003c/p\u003e \u003cp\u003eMore than one-fifth (22.2%) of the stakeholders strongly agreed with the statement of community-level mobilization to increase awareness regarding the role of rehabilitation centers. Furthermore, 62.2% and 50% of the participants agreed on collaborating with international organizations to enhance the technical skills of locals thereby contributing to the development of the rehabilitation sector in Rwanda and more advocacy to policymakers to prioritize rehabilitation as an important aspect of healthcare in the country, respectively. Additionally, more than half of them agreed with the statement on the need for assistance in enhancing the quality improvement process in the current rehabilitation centers to ensure the delivery of high-quality rehabilitation services in Rwanda.\u003c/p\u003e \u003cp\u003eThe majority (75.6%) of the participants had no opinion towards enhancing collaboration with the private sector to increase the number of rehabilitation service providers. Similarly, more than half of the participants had no opinion on the need for mobilizing more funds to establish rehabilitation centers nationwide (62.2%) and the importance of incorporating rehabilitation services into the community healthcare service package to ensure service coverage for all (53.3%).\u003c/p\u003e \u003cp\u003eIn this research, 24.4% and 13% of the study participants disagreed with the statement on the need for mobilizing more funds to establish rehabilitation centers in the country and the need for enhanced collaboration with the private sector to increase the number of rehabilitation service providers (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo; heavy reliance on external funding is a potential obstacle to the advancement of the rehabilitation Sector in Rwanda, there is a need of brainstorming on how to mobilize internal funds to strengthen the system\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003efrom a rehabilitation professional association leader4.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStakeholders' perceptions on recommendations for future improvement in the Rehabilitation Sector (N\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNoP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSDA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe government should support the advancement of rehabilitation specialists in Rwanda.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84(46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is a need for mobilizing more funds to establish rehabilitation centers nationwide.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e112(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssist in enhancing the quality improvement process in current rehabilitation centers to ensure the delivery of high-quality rehabilitation services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70(38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMobilization on community level to increase awareness regarding the role of rehabilitation centers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70(38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is important to incorporate rehabilitation services into the community healthcare service package to ensure service coverage for all.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnhance collaboration with the private sector to increase the number of rehabilitation service providers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e136(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborating with international organizations to enhance the technical skills of locals, thus contributing to the development of the rehabilitation sector in Rwanda.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e112(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKeep advocating to policymakers to prioritize rehabilitation as an important aspect of healthcare in our country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSA\u0026thinsp;=\u0026thinsp;Strongly agree, A\u0026thinsp;=\u0026thinsp;Agree, NoP: No opinion, DA: Disagree, and SDA: Strongly disagree\u003c/h2\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnderstanding the perspectives of stakeholders on the factors contributing to the integration of rehabilitation services into the Rwandan health system as recommended by the WHO guide for Action is crucial for need-driven planning . Parallel to this engaging with key informants of the local and international partners, non-government organizations, and others who can provide valuable insights for the development of national and international guidelines is significant for a better delivery of the local needed best service[1].\u003c/p\u003e\n\u003cp\u003eSeveral multi-level factors contribute to the current rehabilitation sector needs, enabling them to provide rich and comprehensive insights. The study findings demonstrated that stakeholders agreed with the statement on the need for rehabilitation services in Rwanda which is increasing. This is in line with the current evidence on the Global Burden of Disease [15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, the present findings highlighted the unique factors contributing to the demand for rehabilitation services in Rwanda as the past genocide against the Tutsi in 1994 increased by people with disabilities in the country[20]. Additionally, stakeholders highlight the availability of skilled professionals, social support programs, and increased awareness of the rights of people with disabilities are among the drivers for the integration of rehabilitation services in the Rwandan health system [1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present findings revealed additional insights and understanding of the government of Rwanda\u0026apos;s commitment to providing universal healthcare access to all, which may be also another factor for the increasing need for rehabilitation care [18] . However, it\u0026apos;s important to note the specific factors and guiding approaches to the demand for rehabilitation services in Rwanda to develop targeted policies to address them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, the findings on the factors that are contributing to the adoption of the WHO guide to strengthen rehabilitation in the national healthcare systems are similar to other studies\u0026nbsp;[4, 21\u0026ndash;23]. However, specific positive points for Rwanda have been captured: The active disability movement which advocates for access to quality rehabilitation healthcare services and assistive devices put pressure on the government for change, the existence of active development partners, a commitment of the government to overall stakeholder\u0026rsquo; coordination, and well-established community-based health insurance (CBHI). Finally, the government\u0026apos;s efforts to establish itself as a prominent tourist hub in East Africa. All these factors are also in line with a study published by Shahabi and colleagues in 2022 [24]\u003c/p\u003e\n\u003cp\u003eResearch participants\u0026apos; opinions about potential obstacles that could impede the integration of rehabilitation service in the national health system revealed that lack of data on rehabilitation needs in Rwanda, a shortage of skilled and specialized rehabilitation professionals, a scarcity of rehabilitation research, and a lack of a responsible person to oversee the rehabilitation activities at National level are the main challenges. These challenges are common to most Low and Middle-income countries as stated in the Rehabilitation 2030 Call for Action[5].\u003c/p\u003e\n\u003cp\u003eThe recommendations which are important for implications towards improving and sustaining Rwanda\u0026apos;s rehabilitation sector are by supporting the education of rehabilitation specialists, enhancing the offer of quality services in existing specialized rehabilitation hospitals and centers, continuously increasing awareness of the community and policy makers on the importance of rehabilitation, incorporating rehabilitation services into community healthcare service packages, collaborating with international organizations to develop local capable and enough workforce, and advocating for rehabilitation to be prioritized in healthcare policy, Rwanda can significantly improve healthcare accessibility and the quality of rehabilitation services provided to its citizens. These actions would contribute towards building a stronger and more sustainable healthcare system in Rwanda, benefitting the health and well-being of the entire population. Research participants appreciate and commend the Rwandan government for its dedicated efforts towards enhancing the rehabilitation sector in the country.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eRehabilitation services are in high demand due to disabilities caused by the genocide, road traffic accidents, and increased recognition of disability rights. Integrating these services into the healthcare system faces challenges such as a shortage of skilled professionals and limited financial resources. To address these issues, stakeholders recommend prioritizing and investing in rehabilitation services, supporting specialists' training, mobilizing funds, and advocating for the appointment of a national-level official to oversee rehabilitation Sector. The study provides valuable insights applicable to other low- and middle-income countries. Overall, Rwanda's progress towards creating a conducive environment for the rehabilitation sector is an inspiring model for other countries to follow\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical Clearence was obtained from the University to conduct the study.Stakeholders who agreed to participate in this study were approached both for written and verbal consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396:2006\u0026ndash;17.\u003c/li\u003e\n \u003cli\u003eGeberemichael SG, Tannor AY, Asegahegn TB, Christian AB, Vergara-Diaz G, Haig AJ. Rehabilitation in Africa. Phys Med Rehabil Clin N Am. 2019;30:757\u0026ndash;68.\u003c/li\u003e\n \u003cli\u003eJames SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u0026ndash;2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392:1789\u0026ndash;858.\u003c/li\u003e\n \u003cli\u003eMarchal B, Cavalli A, Kegels G. Global Health Actors Claim To Support Health System Strengthening\u0026mdash;Is This Reality or Rhetoric? PLoS Med. 2009;6:e1000059.\u003c/li\u003e\n \u003cli\u003eWHO. Rehabilitation 2030 :Call for Action (2017). https://cdn.who.int/media/docs/default-source/documents/health-topics/rehabilitation/callforaction2.pdf?sfvrsn=50299fc6_2\u0026amp;download=true.\u003c/li\u003e\n \u003cli\u003eH\u0026oslash;yer E, Opheim A, Moe-Nilssen R, Strand LI. Community living after in-hospital specialized rehabilitation in patients with severe disability after stroke: a long-term follow-up after a randomized controlled trial. Disabil Rehabil. 2023;45:1822\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eLindstr\u0026ouml;m M, Lindholm L, Liv P. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities. Trials. 2022;23:657.\u003c/li\u003e\n \u003cli\u003eShakespeare T, Officer A. Breaking the barriers, filling the gaps. Disabil Rehabil. 2014;36:1487\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eWHO. Rehabilitation in health systems: guide for action (2019). https://www.who.int/publications/i/item/9789241515986.\u003c/li\u003e\n \u003cli\u003eLindstr\u0026ouml;m M. Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities. Front Psychiatry. 2022;13:954068.\u003c/li\u003e\n \u003cli\u003eCannata G, Douryang M, Ljoka C, Giordani L, Monticone M, Foti C. The Burden of Disability in Africa and Cameroon: A Call for Optimizing the Education in Physical and Rehabilitation Medicine. Front Rehabil Sci. 2022;3:873362.\u003c/li\u003e\n \u003cli\u003eKumurenzi A, Richardson J, Thabane L, Kagwiza J, Musabyemariya I, Bosch J. Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study. Afr J Disabil. 2022;11.\u003c/li\u003e\n \u003cli\u003eMOH. A Situation Assessment of Rehabilitation In Republic of Rwanda Prepared for Rwanda Ministry of Health with support from the United States Agency for International Development, ICRC and the World Health Organization (2021).\u003c/li\u003e\n \u003cli\u003eMOH. About Ministry of Health of Rwanda (2023). https://www.moh.gov.rw/about.\u003c/li\u003e\n \u003cli\u003eKrug E, Cieza A. Strengthening health systems to provide rehabilitation services. Neuropsychol Rehabil. 2019;29:672\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eMOH. National Strategy and Costed Action Plan for the Prevention and Control of Non-Communicable Diseases in Rwanda (2020).\u003c/li\u003e\n \u003cli\u003eWRA. Advocating for Rehabilitation. https://www.who.int/initiatives/world-rehabilitation-alliance (2020).\u003c/li\u003e\n \u003cli\u003eNyandekwe M, Nzayirambaho M, Kakoma JB. Universal health coverage in Rwanda: dream or reality. Pan Afr Med J. 2014;17.\u003c/li\u003e\n \u003cli\u003eBailey KD. Methods of social research. 4th ed. New York : Toronto : New York: Free Press ; Maxwell Macmillan Canada ; Maxwell Macmillan International; 1994.\u003c/li\u003e\n \u003cli\u003eInerpeace. Healing the invisible wounds of violence in Rwanda (2020). https://reliefweb.int/report/rwanda/healing-invisible-wounds-violence-rwanda.\u003c/li\u003e\n \u003cli\u003eCieza A, Kwamie A, Magaqa Q, Paichadze N, Sabariego C, Blanchet K, et al. Framing rehabilitation through health policy and systems research: priorities for strengthening rehabilitation. Health Res Policy Syst. 2022;20:101.\u003c/li\u003e\n \u003cli\u003eMcPherson A, Durham J, Richards N, Gouda H, Rampatige R, Whittaker M. Strengthening health information systems for disability-related rehabilitation in LMICs. Health Policy Plan. 2016;:czw140.\u003c/li\u003e\n \u003cli\u003eStucki G, Bickenbach J, Melvin J. Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems. Am J Phys Med Rehabil. 2017;96:677\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eShahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res. 2022;22:1317.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"N/A","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rehabilitation, Health sytesm, Stakeholders, Perception, Health Policy, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-4739863/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4739863/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Rwanda has achieved a significant improvement in the overall healthcare delivery. Although stakeholders’ perception of the adoption of the World Health Organization (WHO) guide to strengthen rehabilitation is crucial for improving healthcare delivery, however, little is known about strengthening the rehabilitation services in the Rwandan health systems following the WHO guide.\u003c/p\u003e\n\u003cp\u003eA cross-sectional qualitative study was conducted to interview several rehabilitation stakeholders representing institutions that played a role in implementing the WHO guide to strengthen Rehabilitation in Health system. A structured data collection questionnaire and interview guide were used. Questionnaire data were collected using a 5-point Likert Scale, and analyzed using SPSS version 21, while interviews were recorded,transcribed, coded , cathegorizes thematically analyzed.\u003c/p\u003e\n\u003cp\u003eA total of 180 stakeholders have filled the questionnaire, with 64% of them being males. The majority (43%) of the research participants were aged between 41-45 years. More than eight-tenth (83.3%) of the participants had a first degree and 10% had a master’s degree level of education.\u003c/p\u003e\n\u003cp\u003eOverall, 7 themes and 13 sub-teams emerged from the key informant's interviews of stakeholders. The increase need for rehabilitation services is highly perceived by all governmental and non-governmental organizations in Rwanda. Rwanda's successful adoption of the WHO guide to strengthen rehabilitation in its healthca system can be attributed to the country's commitment justified by existing policies, guidelines, and the robust disability movement and this could be an inspiring model for other countries to follow. Additionally, Rwanda's ambition to become a premier tourist destination in East Africa has played a pivotal role in driving the adoption of WHO guidelines. Along with emphasizing stakeholders' perspectives, the results have identified obstacles that may hinder the desired outcome of strengthening rehabilitation in the national health system, such as a shortage of skilled and specialized professionals in the field of rehabilitation services, lack of data on the needs of rehabilitation services in Rwanda, and lack of experts to oversee the implementation of the rehabilitation strategic plan. Moreover, lack of enough rehabilitation facilities, inadequate financial resources, geographical barriers, and a lack of a responsible person at the central level to supervise rehabilitation activities are some of the potential obstacles that may impede the effective implementation of strenthening rehabilitation in Rwanda s health system.\u003c/p\u003e\n\u003cp\u003eConclusion Rehabilitation Sector in Rwanda is providing a valuable model for other Low and Middle-Income Countries seeking to improve their rehabilitation services. With the demand for such services on the rise, investment in human resources and retaining those who are in practice, equipment, and infrastructure is necessary to satisfy the population's needs. Moreover, appointing a rehabilitation professional to oversee the implementation ofrehabilitation activities \u0026nbsp;is imperative. It is recommended to build on identified contributing factors for the future sustainability of the process. Addressing the discussed challenges is crucial to ensure the intended outcome of integrating rehabilitation into Rwanda's healthsystem.\u003c/p\u003e","manuscriptTitle":"Strengthening Rehabilitation in Health system: Stakeholders’ perception of factors contributing to the adoption of World Health Organizations guide to strengthen rehabilitation in the Rwandan healthcare system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 17:03:12","doi":"10.21203/rs.3.rs-4739863/v1","editorialEvents":[{"type":"communityComments","content":1}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3689e673-42de-4d4f-b1a2-0c9cb8f95358","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34580112,"name":"Health Policy"},{"id":34580113,"name":"Physical Medicine \u0026 Rehab"}],"tags":[],"updatedAt":"2024-07-16T17:03:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-16 17:03:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4739863","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4739863","identity":"rs-4739863","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}