Knowledge and experiences of community health workers in the delivery of physical rehabilitation services in Zambia – A qualitative study of trained community health workers

Abstract

While task shifting physical rehabilitation services to Community Health Workers (CHWs) improves accessibility, the services delivered  need to be of good quality. Therefore, this study examined the knowledge and experiences of CHWs in the provision of physical  rehabilitation services to children with disabilities in Zambia. An exploratory qualitative study involving ten CHWs from the Zambia  Enhanced Community-Based Rehabilitation Programme (ZECREP) was conducted in Lusaka district. Nine major themes emerged from  the data. Four of these themes (patient management, treatment programmes, issuing of appropriate assistive devices through a multidisciplinary approach, and levels of care) were highlighted as the required knowledge base of CHWs, whereas five themes (patient  assessment and treatment, home programme and family education, assistive devices issuing, a well-functioning referral system,  unrealistic caregiver expectations, and resource constraints) were revealed as the essential experiences of CHWs who delivered the  required physical rehabilitation services. The CHWs under study experienced unrealistic expectations from caregivers, such as physical  rehabilitation would heal a child. These expectations were complicated by a lack of understanding among the caregivers of the role and capabilities of CHWs. Moreover, constraints such as limited resources and a lack of permanent employment were perceived as major  challenges. The trained CHWs had adequate knowledge and notable experiences in provision of physical rehabilitation services. In light of  the current shortage of Human Resources for Health (HRH), standardised physical rehabilitation training of CHWs country-wide would  improve healthcare delivery in Zambia.