Needs, feasibility analysis and development of a proposal for a rehabilitation technician training curriculum in collaboration with the Nursing School and the Ministry of Public Health in the Sahrawi Refugees Camps.
Demanding organization :
Humanité & Inclusion Algérie
Place of the mission :
Sahrawi camps, Tindouf
Type of mission :
Consultancy
Indicative length of the mission :
20 days[A(1]
Period of time of the consultancy :
April 2019
Title of the supported project :Summary:**
After the training of trainers carried out by HI to the teachers of the Nursing School in maternity and child health linked to disability, HI is going to carry out a mission for the feasibility analysis of a rehabilitation technician training as specialization for the nursing school.
I. General context of the mission:
1.1 Frame of the mission
- Presentation of Humanité & Inclusion
Humanity & Inclusion (the new name of Handicap International) is an independent and impartial humanitarian aid organization working in contexts of poverty and exclusion, conflict and disaster. We work with people with disabilities and vulnerable populations, taking action and testifying to their situation in order to respond to their basic needs, improve their quality of life and promote respect for their dignity and fundamental rights. Since its founding in 1982, Humanity & Inclusion (HI) has worked in 59 countries around the world.
· Presentation of the Algerian program
Humanity & Inclusion stablished in Algeria in 1998 and it has been working in collaboration of its institutional partners and associates on the projects working in:
- Improvement of the support of children deprived of family;
- Access to the employment of vulnerable population;
- Promotion of inclusive education
- Improvement of life conditions of persons with disabilities in the Sahrawi camps.
Nowadays, it counts with about fifteen employees in the Algiers office, plus 5 persons based in Rabouni for the project in the Sahrawi camps.
- Presentation of the project of functional rehabilitation in the Sahrawi Camps.
In 2015, after the floods that hit the five Saharawi refugee camps in October, HI helped the humanitarian response by providing emergency rehabilitation of the infrastructure of special education centers and centers for children with disabilities. As a result of this intervention, it was possible to strengthen, in 2016, the long-term work of the health entities through specific training and accompanying actions to provide care for children with disabilities.
Currently, the main objective of the project is to strengthen the detection, orientation and care of disability among Saharawi refugees in the Tindouf area. It covers the 5 camps of Boujdour, Auserd, Smara, El Ayoun and Dakhla, as well as the health and rehabilitation structures of Rabuni. The action is carried out on three levels.
The first (R1) aims to strengthen health benefits in the detection of disability, particularly in children aged 0-5, and the referral of identified cases to existing rehabilitation services. It includes the incorporation of a module in the training course in disability and early detection for nurses, midwives and pediatricians, and the training of teachers in these courses so that they are able to teach the module independently and continuously. In parallel, for those professionals who are already working, together with the Ministry of Public Health, it was decided to organize an awareness-raising session on these issues throughout the year for 300 professionals, in order to launch a campaign of awareness raising and a change in practices.
The second level (R2) aims to sustainably strengthen the occupational therapy services provided in all rehabilitation centres in Rabuni, Bolle, Auserd, Smara and Dakhla, in addition to the physiotherapy services already provided. Thus, as part of the continuation of the activities carried out in 2016 by Handicap International, 10 rehabilitation professionals from the centers concerned will be trained in: (i) the diagnosis of occupational therapy needs; (ii) the production of molded plaster seats and simple orthoses of the splint type; (iii) the supervision of craftsmen for the production of culturally adapted technical assistance, such as seats or positioning backrests covered with local fabrics. Finally, Humanity & Inclusion proposes to conduct a study on the feasibility of a training programme for rehabilitation technicians at the Nursing Staff Training Centre, in order to find solutions to the lack of additional human resources in the rehabilitation sector and to enable the opening of new rehabilitation centres in Laayoune and Boujdour.
The third level (R3) foresees the resumption of basic home rehabilitation services until March 2019. 19 social workers will have their capacities for identification, provision of basic home rehabilitation care and orientation towards existing social, health and rehabilitation services strengthened. They will be trained and supervised, on a monthly basis, by the Director of the National Rehabilitation Centre, with the support of the Humanity & Inclusion Physical Therapist Technical Advisor. It will be gradually initiated through inter-service orientation mechanisms, while the possibility of a guidance and counter-orientation scheme involving social, health and education services will be explored in the framework of two inter-sectoral workshops.
Finally, the project will aim to ensure the sustainability of the proposed actions through an exit strategy designed from the outset of the project. In addition to the empowerment of professionals, it will be sought:
I. Institutionalization of awareness-raising activities in the Department of Prevention;
II. Institutionalization of the training programme at the National Nursing Staff Training Centre;
III. The integration of transport services to rehabilitation centres by ambulances of the Saharawi Red Crescent for beneficiaries who are unable to access services for physical or financial reasons;
IV. Finally, the regular supply to rehabilitation centres of consumables necessary for the production of technical assistance by Medico International.
1.2 Nature, justification and challenges of the mission
- Specific context
In this context, persons with disabilities are among the most vulnerable. In 2015, the Ministry of Social Affairs recorded a total of 2929 vulnerable persons, identified according to the following criteria: 1) paralyzed and bedridden persons; 2) wheelchair and paralyzed elderly persons; 3) single/isolated elderly persons; 4) persons with intellectual or visual disabilities.
Given the restrictive definition of disability that was used, these statistics exclude a large number of persons with disabilities. The World Health Organization estimates that the proportion of persons with disabilities, including older people, in a given population is 15%. Based on these estimates, it is calculated that more than 13500 persons with disabilities live in the camps.
In addition to the basic services available in the camps, the Sahrawi Ministry of Public Health is mobilizing to meet the physical and functional rehabilitation needs of persons with disabilities, with the support of non-governmental organizations and academia. On a national level, the Rabouni Rehabilitation Centre offers physical therapy services provided by a Saharawi professional trained in Cuba and his assistant, a service of orthotic and prosthetic equipment according to international standards, with the support of the ICRC. At the regional level (in the district or “wilaya”), there is the following: A rehabilitation centre in Bolle (near Bujadour), financed and managed by the Italian association Rio de Oro Onlus, which provides physiotherapy services, especially for children with disabilities, and has the capacity to accommodate them for periods ranging from 1 to 3 weeks (some are sent to Italy during the summer for specialized care). A rehabilitation centre in Smara, in the regional hospital, run by a Saharawi physiotherapist trained in Cuba, financially supported by the Italian NGO Rio de Oro Onlus. A rehabilitation centre in Ausserd, in the regional hospital, run by a nurse trained in physiotherapy thanks to specific training courses of various associations, currently closed for remodeling purposes. An early detection and care centre for people with disabilities in Dakhla, inaugurated in October 2016, which receives technical and financial support from the Spanish NGO Amal Esperanza and a rehabilitation center in Laayun, managed by a local physiotherapist trained in Cuba and built with the support of the NGO Oxfam.
This is therefore a total of 8 graduated Physiotherapists, as well as about 15 acting Physiotherapists providing services to children and adults with disabilities. According to data, a total of about 1500 persons get rehabilitation services each year. This latest figure remains far below expected needs of the population.
A Nursing School setup by the Ministry of Public Health, proposes a 3 years course to obtain the title of Nurse, and a possible 2 years specializations in pediatrics or midwifery. The midwife grade is also open to students with university background.
Following the Sahara Poniente NGO request, the University of Madrid, in collaboration with the University of Lleida (both in Spain) carried out early 2017 a field study on the possibility for the Nursing School to develop a curriculum centered on physiotherapy purposes.
The report highlights local health authorities and the nurses school representatives’ interest in welcoming this type of curriculum, and recommend the setup of a 2 years curriculum towards Physiotherapists training. The Sahrawi authorities expect professionals to be trained as Physiotherapists in a course 2 years’ long, even though international standards recommend a minimum of 3 years.
Besides, the Universities expressed their interest in working jointly with HI for this training implementation.
1.3 Place of the mission
The mission takes place in Rabouni: [A(2]
- Justification
Based on its experience in the Sahrawi camps, and following the results of the KAP survey carried out in 2015, HI has identified context related specificities that would require special attention in the setup of a training program on rehabilitation.
Here are some of observed issues:
- Movement constraints (cost and scarcity of means of transport) in and between camps deprive Sahrawi population to reach rehabilitation services
- No Occupational Therapist works in rehabilitation services, and some areas like home based adaptation, education for daily life autonomy, positioning of persons with disabilities, etc. are not tackled in treatment provision;
- Rehabilitation centers’ budget does not allow home based services. The considering the reduced number of Physiotherapists working in the camps they would not have the time to work both in centers and on home based services.
- The Ministry of Public Health hasn’t yet developed a strategy towards rehabilitation sector development
- Budget for rehabilitation services development highly (if not exclusively) depends on international aid. As a consequence, trained rehabilitation professionals might not find a place to work unless the need is brought to international donor’s eye.
- A brain drain is observed for professionals with international graduation. They leave camps to use their expertise in other countries (no position in the camps, too low salaries, and diploma recognized in other countries).
Based on HI’s experience in other countries having a much reduced number of rehabilitation professionals, culturally family/group oriented, living far from services and with low financial means, it appeared obvious and relevant to train rehabilitation technicians, with knowledge on both Physiotherapy and Occupational Therapy. These technicians, benefiting of a 2 years training, are working under the responsibility of graduated Physiotherapists and Occupational Therapists. Such group of professionals would drastically, and in a short term, increase the capacity of the rehabilitation sector to answer in a comprehensive way the rehabilitation needs. Ad hock training curriculum was developed, mixing knowledge on Physiotherapists and Occupational Therapists, and culturally bounded, and therefore specific to the place where it is proposed (no international recognition so far).
Based on these observations, HI is willing to deepen the feasibility study carried out in 2017 by the universities.
Based on this situation, evaluation hypothesis will be formulated to support the rehabilitation workforce development in the Sahrawi camps.
II. Objectives, results and methodology of the mission
2.1 Objectives and expected results of the mission
The overall purpose of the mission is to study the needs and, if confirmed, the need for and feasibility of the creation of a specialization as rehabilitation technicians in the professional nursing school of Smara and to provide guidance for the profession to develop in the most effective and contextually appropriate way in order to support the physical rehabilitation of persons with disabilities and other physically deprived groups.
· Specific objectives
Objective 1: The situation of rehabilitation in the Sahrawi camps is assessed, according to decision makers, services and training institute, and users’ perspectives.
Following (but not exclusively) issues might be tackled:
o Impact of disability on individuals and families (including personal stories / quotes), needs for rehabilitation, and perception of rehabilitation.
o Impact of disability on the community, community needs in rehabilitation, and perception of rehabilitation.
o Identification of unmet policy objectives in relation to community inclusion, and role of rehabilitation in supporting inclusion.
o Existing services and gaps/lacks in answering the demand (type of services, number of services, referral system…)
o Existing policies and action plans for rehabilitation sector, and implementation status, with a specific attention to workforce development
o Medical school and rehabilitation centres capacities, to respectively teach/implement a rehabilitation technicians certificate, and support students practice. [A(3]
Objective 2: Preconditions and orientations for rehabilitation workforce’s development in the Sahrawi camps are defined:
Following (but not exclusively) issues might be tackled:
o Prioritisation of rehabilitation need according to the profile of health conditions and socioeconomic needs of persons with disabilities, rights of persons with disabilities and gaps in existing services.
o Contribution that rehabilitation technicians can make towards the health system’s expectations.
o Identification of the profile and the number of rehabilitation professionals needed to answer the rehabilitation needs in the camps and the best place to carry the training out.
o Identification of relevant workforce’s development to progressively strengthen the rehabilitation provision in the camps.
o Rehabilitation technicians:
o Relevancy of promoting this type of professionals and developing this profession, complementarity with Physiotherapists and Occupational Therapists.
o Recognition and implementation of a new profession (rehabilitation technicians) by the Sahrawi Ministry of Public Health: job profile and functions, salary and employment conditions, role of Sahrawi Ministry of Public Health in workplace and positions’ creation, profession’s promotion, post qualification professional’s development and strategies for retention (within the profession and within the camps).
Objective 3: A contextualized and collectively developed training curriculum for rehabilitation technicians is available. Recommendations towards curriculum implementation are provided.
Following (but not exclusively) issues will be tackled:
o Training specificities: one shot/yearly basis training system, teachers/trainers specificities for theoretical and practical training, requirement for place of training.
o Implementation: identification of possible national and international support to the nurses’ school of Smara.
o Curriculum development (based on Haiti curriculum and context analysis): theory versus practice, topics prioritisation according to context analysis, length of training, identification of students, ongoing and final validation.
Objective 3: recommendations for developing a contextualized training curriculum for rehabilitation technicians as well as recommendations towards curriculum implementation are provided.
Following (but not exclusively) issues will be tackled:
o Training specificities: one shot/yearly basis training system, teachers/trainers specificities for theoretical and practical training, requirement for place of training….
o Implementation: identification of possible national and international support to the nurses’ school of Smara.
o Curriculum development (based on Haiti curriculum and context analysis): theory versus practice, topics prioritisation according to context analysis, length of training, initial identification of students, ongoing and final validation….
2.4 Methodology of the mission
The consultant will maintain frequent communication with the commissioning bodies together with the HI’s rehabilitation responsible.
Data collection methodologies will include:
· Review of the academic and grey (HI and others) literature and of relevant national laws and policies.
Documentation provided to the consultant by HI:
Rehabilitation policy paper
Rehabilitation in long term refugees’ camps
Rehabilitation professional training
2015 KAP survey in Sahrawi camps
· In-place gathering of testimonies from:
o Where possible, individuals within the camps who have benefitted from rehabilitation services and their carers. Otherwise personal stories / quotes from elsewhere which are as relevant as possible to the Sahrawi context.
o Potential service users.
o Providers of rehabilitation services at regional to national levels (government and non-government).
§ Ministry of Public Health (including the Director of cooperation and the Director of the rehabilitation services).
§ Related NGO’s working with persons with disabilities (International Committee of the Red Cross, Médicos del Mundo, Triangle Génération Humanitaire, Spanish Red Cross, etc).
§ Director of the nursing school (including teachers).
§ Rehabilitation professionals working in the camps.
§ Teachers of special education.
§ Social workers and midwives working in the community.
· Testimonies will explore participants’:
o Perceptions of need.
o For direct users of rehabilitation services – personal stories /quotes.
o From others, perceptions of the benefits of occupational therapy / or identify. absence of knowledge of occupational therapy.
o Recommendations.
o Perceptions of resources.
o Perceptions of barriers to service provision.
· Visits:
o Dispensaries
o Hospitals (regional and national)
o Rehabilitation centers
o Centers of special education and sensorial disabilities
o To beneficiaries (home based and center based)
· Where possible, focus group discussion of persons with disabilities and their families
· Analysis based in data collected by HI on the needs of the persons and on the rehabilitation services as well as HI’s previous experience in the camps.
· In case of development of curricula, to follow the quality standards by WHO.
By the end of the field mission, collected information and proposed strategies will be shared with the different actors. 3 steps are to be considered:
· 1st step: A restitution workshop is proposed to stakeholders involved in rehabilitation at the end of the feasibility studies. The purpose is for the consultant to provide stakeholders with study related outcomes and gather feedbacks. Feedbacks will be used to fine tune proposed recommendations.
· 2nd step: Facilitate the concerted and collective identification[CR4] of a context relevant curriculum for rehabilitation technicians training. Haiti curriculum and process developed by HI might be used as a starting document.
· 3rd step: A document gathering information collected, identified recommendations (strategic and training related, according to study and workshop) is made available and accessible to the Sahrawi ministry of health, HI and other stakeholders.
III. Mission delivery stages indicative calendar
HI’s Technical rehabilitation responsible of the project will be the focal point of the consultant. In addition, she will be the facilitator of the mission among the local authorities and other partners if needed.
The duration of the mission is estimated to be between 15 and 20 days depending of needs study and feasibility analysis.
Activities
Indicative duration
Indicative calendar
Responsibles
Dead line reception of application
1 day
March 18th
HI’s country director / HI’s Technical Responsible
Selection of the consultant
1 day
March 19th
HI’s country director / HI’s Technical Responsible
Contractualization
4 days
March 20th to 21st
Admin Algiers / Admin Camps
Travel to Rabouni
1 day
April 6th
Admin camps
Situation and needs analysis
5 days
April 7th to 11th
Consultant
Feasibility analysis
3 days
April 14th to 16th
Consultant
**Recommendations for development of a curriculum***
5 days
April 17th to 23rd
Consultant
Travel to Algiers – Home destination
1 day
April 24th
Consultant
Writing of report
5 days
April 25th to 27th
Consultant
Submission of the report
1 day
April 28th
Consultant
Validation of the report
2 days
April 29th to 30th
HI’s Technical Responsible / HI’s Technical referent
* If feasibility confirmed
** Depending on feasibility conclusions
IV. Deliverable
For the implementation of the mission:
· Elaboration of a report including :
o Situation of rehabilitation in Sahrawi camps, from the perspective of the different stakeholders. General recommendations towards sector development and specific recommendations related to workforce development.
o Rehabilitation workforce: recommendations for workforce strengthening, and study on feasibility of a rehabilitation technicians training.
o Detailed recommendations for rehabilitation technical training curriculum development, including times, schedules, personnel responsible of the coordination and deliverance of the specialization, and quality indicators related to the different steps of the training implementation.
o To include as annexes the minutes of the meetings and the visits carried out.
Report and presentation document must be delivered to HI at most two weeks after the end of the mission.
· A presentation document on rehabilitation technician profession and training. This document will be used for profession promotion, students recruitment, medical sector sensitization…
Report and presentation document (ideally in spanish, or english) must be delivered to HI at most two weeks after the end of the mission.
V. Budget of the mission
As indicative rate, the amount of the honorariums dedicated to this mission is stablished between 300 and 400 euro/day (no annexed fees) depending on experience. All the fees annexed related to the mission in the field (transportation, visa, etc.) will have to be detailed and presented in the financial proposition. [A(5] HI can however accommodate the consultant in the field.
[A(1]This is what is mentionned in the planning below and I don’t think it can be more than that. It is a lot of work to do. I would not be surprise if offers are even longer
[A(2]I have removed the maps as they are not the official one.
[A(3]There might be a problem in this sentence
[CR4]Was previously « desing »
[A(5]I have adjusted that one as rules have recently been changed. We are not anymore allowed to pay for transportation of consultant. They have to manage by themlseves
Profiles requested:
· Physiotherapist, Occupational Therapist or P&O, with/out master in public health, with more than 5 years’ experience in their field of expertise.
· Expertise in training and curriculum design and implementation.
· Experience in health and rehabilitation sectorial analysis.
· Working experience in international context (in refugees setting a plus).
· Working language is English per default. Spanish or/and Arabic are a plus. Report is expected in English.
Eligibility of the applicants:
Will be considered elegible:
• Physical persons independent consultants replying to the profiles requested (the registration number will be requested).
• Group of consultants replying to the profiles requested.
• Organisations or associations.
The selected person must have travel insurance and provide a copy.
Constitutive elements of the dossier of the candidacies:
Interested candidates please send your expression of interest before 18th of March [A(1] by email with the title “Feasibility study” to Laura Pasarin [email protected] with copy to Fabien Lapouge [email protected] and Claire Martel [email protected] including:
· Curriculum Vitae
· Methodological offer / technical offer
· Financial offer
· Indicative agenda
· Letter of motivation (optional)
Incomplete candidacies will not be taken in consideration
Humanité & Inclusion does not proceed to any discrimination for the recruitment, and actively encourages persons with disabilities to apply.
[A(1]I have added some more days as 2 weeks publication only is very short. It should be 3 weeks minimum
More Information
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