TOWARDS INTEGRATING REHABILITATION INTO HEALTH SYSTEMS THROUGH PROFESSIONAL REGULATION

Strengthening rehabilitation in health systems and integrating rehabilitation across all levels of care depends on a mix of strategies, however all depend on an appropriately trained, resourced and organized workforce. Indeed, among the ten areas for action described in the World Health Organization 2030 initiative is developing a strong multidisciplinary rehabilitation workforce that is suitable for country context, and promoting rehabilitation concepts across all health workforce education.   The rehabilitation workforce is constantly evolving as it strives to provide safe practices and treatment choices based on the best available evidence to improve function, promote independence and help people reach their maximum potential. However, barriers to this evolution include a lack of well-resourced training programs, variations in the competencies expected within the standard entry-level curriculum, limited opportunities for continuing professional development, geopolitical instability, competing demands for limited health budgets and persistent de-prioritization of rehabilitation.

Day Care Surgery at a New University Teaching Hospital: A Review out of the Aga Khan University Hospital, Nairobi

Introduction: Day Care Surgery (DCS) is the surgical care of patients on a planned non-residential basis. The objective of the study was to assess the performance of DCS in the context of a developing country within the private sector. Data from a new DCS unit was compared to internationally accepted indicators of the quality of care. Methodology: A hospital based retrospective chart review of all patients operated on within 10 surgical subspecialties was performed. The review period was the June 2006 to July 2007(12 months). Analysis (SPSS version 11.5): Outcome measures included in-patient to DCS ratio in the various specialties; inpatients qualifying for DCS; overall unplanned admission rates; morbidity rates and the number of inappropriate daycare cases. Univariate analysis was used to test for factors affecting the unplanned admission rate. A logistic regression model was used for multivariate analysis. Results: Inpatient to DCS ratio in all the subspecialties was below recommended benchmarks. Thirty six percent (36%, n=328/910) of inpatients were candidates for DCS. The unplanned admission rate was 12% (n=47/395) with lack of outpatient insurance cover being the commonest reason (48.93%, n=23/47). Multivariate analysis noted only two significant variables, ASA grading and postoperative morbidity. The overall morbidity rate of the DCS cases was 5% (n=18/395) pain being the most common type of morbidity. Almost 3 %( n=13/395) of patients were inappropriately treated as DCS patients. Conclusions: The unplanned admission rate of 12% compares unfavorably with other DCS units. Omitting cases of inappropriate insurance cover, the overall rate falls to 6.45%, comparing well to other units. The retrospective nature of the study placed important limitations on the data acquisition. DCS is a feasible system of healthcare delivery in the private sector of developing countries.