Strengthening Management Systems to Help People Walk and Work Again

  • By: Kate Wilson, MPH

Across the world, people with physical disabilities have poorer health, lower education achievements, fewer economic opportunities, and higher rates of poverty than people without disabilities. The World Report on Disability (World Health Organization, 2011) estimated that 30 million of these individuals in Africa, Asia, and Latin America need prostheses or orthotics and related services, and many live in countries whose health and social systems lack the capacity to meet their rehabilitation needs.

For over 30 years, the International Committee of the Red Cross (ICRC) has been a global leader in providing physical rehabilitation services to vulnerable groups, particularly those affected by conflict. Through the Physical Rehabilitation Programme (PRP) and the Special Fund for the Disabled (SFD), ICRC has helped hundreds of thousands of people regain their mobility. Restoring mobility through the provision prostheses, orthotics, walking aids, and wheelchairs is a critical first step toward improving the quality of life for people with physical disabilities to participate fully in society.

Supported by USAID’s Special Programs to Address the Needs of Survivors (SPANS), the Leadership, Management, and Governance Project (LMG) is working with the ICRC’s PRP and SFD to promote the long- term viability of local physical rehabilitation centers. ICRC has been working with these physical rehabilitation centers to improve the quality of services by providing materials to customize mobility devices for individual users, training prosthetic and orthotic professionals and other providers, and supporting additional capacity-building activities. LMG aims to complement ICRC’s good work and technical expertise through strengthening the centers’ leadership and management capacity.

LMG at the Bahir Dar Physical Rehabilitation Center, Ethiopia

In July, LMG staff traveled to Ethiopia to see ICRC’s activities on the ground, and to develop a strategy for our collaboration. We visited the Bahir Dar Physical Rehabilitation Center (BDPRC), one of two government physical rehabilitation centers in the Amhara region. Bahir Dar is a lakeside town in northwestern Ethiopia, and one of the fastest growing urban centers in the country. According to the Amhara National Regional State Bureau of Labor and Social Affairs (2011), there are approximately 33,000 persons with physical disabilities in BDPRC’s service area.  

On the outside, the physical rehabilitation center looked like an average public building, fairly non-descript, with plain concrete walls in a small compound off a gravel road. Inside the building we found an extremely welcoming and committed small staff who were busy modeling prostheses, treating a young girl with clubfoot, and fitting a wheelchair to an older man. We met with BDPRC’s manager, Endalkachew Getachew, who himself is physically disabled—though we never would have known if he had not shown us his prosthetic leg beneath his pants.

Mr. Getachew boasted about his staff’s passion for their clients and expressed gratitude for the support the clinical staff received from ICRC PRP experts. He also told us about his challenges, and his desire for greater knowledge and skills. Though he has a business degree, he has never had formal health leadership and management training and relied on searching the internet for professional development. He and the rest of the leadership team were further challenged by the lack of standard procedures and protocols to guide management actions such as supervision, planning, and human resources management.

Mr. Getachew gave us a tour of the clinical areas and the workshop where mobility devices are made. We were impressed by the number of job aids and other protocols displayed throughout these spaces—many provided by ICRC—that served as helpful reminders and guidelines for quality care. Everything was clearly ordered and organized. For example, in the workshop, each tool had a storage space on the wall and the outline of each tool was drawn in the exact place where that tool should be hung, so that each tool would fit in its specific spot and anyone who walked in would know exactly what was missing.

Organization system for workshop tools at BDPRC in Bahir Dar, Ethiopia

LMG Collaboration with ICRC

This ordered and organized picture is a good representation of how the LMG project will collaborate with ICRC to strengthen the leadership and management of BDPRC and other similar centers over the next few years. We will work with ICRC and local managers to develop standardized management systems to order and organize operations and administration. Along with clearly defined and established operational procedures, LMG will work to ensure that each center’s staff have the skills and competencies to run the systems through providing centers with a package of user-friendly Leadership Development Modules that can be self-directed by the local leadership teams. This standardized package will equip centers to strengthen their team dynamics, identify gaps in organizational capacity, develop a systematic way to ensure continuous improvement, and establish a pathway to sustainability in the future.

Kate Wilson, MPH, is the Project Officer for the Leadership, Management and Governance Project.

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