Strengthening rehabilitation services in rural communities: Considerations for community-oriented primary care

This opinion piece is based on a study that investigated the contribution of Rehabilitation Care Workers in strengthening rehabilitation in community-based services at the primary level of care level and a collaborative inquiry with the rehabilitation teams responsible for outreach community services in a rural district. We are of the opinion that rural contexts require a different set of community-based rehabilitation (CBR) competencies that those applicable in better-resourced urban and peri-urban settings. We investigated that the health system strengthening benefits of CBR as a facet of community orientated primary care (COPC) - which focuses on the inter-sectoral services that rehabilitation care workers who are subervised by rehabilitation therapists - can offer to persons with disabilities. We endorse extant public health literature on the urgent need to build rural inclusive health workforce capacity, suggesting that human resource training mid-level, multi-skilled CBR workders who are part of the ward-based teams with rehabilitation therapists. Community health workers (CHW) in rural areas who upgrade their skills set to include competencies in community-based disability inclusive development practice can adress the rehabilitation service gaps faced by persons with disabilities and their families. Implications for practice: Embedding community-based disability inclusive development practices in COPC will promote access to rehabilitatio services in rural communities. In addition to nurse-led, ward-based teams of CHWs, ward-based teams of RCWs led by rehabilitation therapists will strengthen the primary level rural health system. Health outcomes of rural populations with disability will be improved by access to RCWs with competencies in inter-sectoral collaboration.