Inequity in funding rehabilitation research in Africa: new priorities for funders
Author: Beatrice Sankah
Introduction
Rehabilitation is ‘a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions …’(para.7) Globally, rehabilitation is a highly unmet health need and, currently, about 2.5 million people live with health conditions that require rehabilitation, and this number is projected to double by the year 2050. Compared to the Global North, about 50% of people living in low- and middle-income countries (LMICs) do not receive the rehabilitation services they require. With the emergence of disasters and outbreaks within the region, rehabilitation is a crucial health need more than ever. Among many factors, the World Health Organization (WHO) identifies a lack of prioritisation, funding, and policies for rehabilitation at national levels; a lack of trained rehabilitation professionals in many LMICs; and the need for more research and data on rehabilitation. Research capacity strengthening is needed for rehabilitation to reach its full potential. Despite efforts by the Global North, research outputs from the Global South are lacking due to limited funding, lack of research capacity and poor prioritisation for rehabilitation within the region.
This article attempts to highlight the inequity in funding for rehabilitation in LMICs and present a case for relevant funding allocation for research and educational ventures in rehabilitation.
Gaps in funding rehabilitation research and educational activities
1. Unequal funding allocations
From WHO perspective, health financing is a core function of health systems that can progress universal health coverage by improving effective services and financial protection. Clinically, there are obvious gaps within the rehabilitation sector regarding workforce shortage, but this is even more evident in rehabilitation financing within health services globally. Despite the WHO’s advocacy for the integration of rehabilitation into health system financing, rehabilitation still only receives a small budget allocation compared with other healthcare services. This has resulted in a mismatch between the rehabilitation that is needed for the population, what is actually financed, and what is made available. While the WHO recognises the need to support countries in effectively budgeting for the institutionalisation of rehabilitation services, conversations regarding funding for rehabilitation research are also emerging. Similar to the inequity regarding funding for clinical rehabilitation services, inequity in research funding for rehabilitation is also an issue based on observations within the Ghanaian and African rehabilitation ecosystems.
Based on personal observations of the rehabilitation landscape in Ghana, experience in conducting research within the region, and challenges in securing funding for postgraduate studies and research, funding for rehabilitation is scarce and is a key barrier to advancing rehabilitation research in LMICs.
2. Shortage of rehabilitation workforce
Current evidence shows the high global shortage in the health workforce, and this is particularly heightened with regards to the rehabilitation workforce. Africa and other LMICs have recorded huge workforce shortages in recent years, largely due to migration to Western countries, such as the United Kingdom, Canada and the USA. While emigration has greatly impacted the workforce, it has also weakened health systems, which require strengthening through research and funding to halt the loss of skilled workers.
3. Poor evidence-based
Similarly, evidence on rehabilitation is scarce and, among the many contributing factors, lack of funding and the capacity to conduct health policy and systems research is also scarce, and needs to be addressed. With the global ageing population, rehabilitation is now a priority global health strategy for achieving the best health for patients needing it, and it is imperative for funders to consider its inclusion in their funding scope to support rehabilitation research. While research on rehabilitation is being conducted in Ghana and other African countries, the funding to support its publication and scale-up is not available. This is a limiting factor for research conduct and evidence use in Africa, and a huge gap between local evidence generation and global knowledge conversations.
4. Stakeholders’ information
The report ‘Seven recommendation for funding research in the global South’ suggests that funding bodies should consider empowering researchers to shape their own research ideas and needs. Conversations in the recent WHO E2P summit section around ‘funders on their priorities and expectations’ revealed that, while funders have their funding scope, there is a clear call for this to be informed by researchers and stakeholders. In addition to research reports on professionals’ feedback, informal stakeholder conversations and authors’ personal observations and research experiences, there is indeed the need for more research funding in rehabilitation in the Global South.
Emerging priorities for funders
Rehabilitation is an urgent global health need
The WHO’s Rehabilitation 2030 initiative was launched in response to the increasing and unmet global rehabilitation needs, and the under-developed rehabilitation services worldwide, particularly in developing countries. The newly launched package of interventions for rehabilitation contains essential evidence-based rehabilitation interventions for highly prevalent health conditions that need contextualization in some regions to facilitate implementation, which can be achieved through research. In addition, the World Rehabilitation Alliance (WRA) was also launched to support the implementation of interventions globally through advocacy activities in workforce, primary care, emergencies, external relations and research. On the topic of research, a huge gap regarding funding for research activities has been reported, particularly regarding contextualisation of these interventions within health systems.
Training of the rehabilitation workforce is crucial
Although there are generally limited postgraduate scholarships for rehabilitation professionals globally, there are more funding allocations for colleagues in the Global North than South. Based on personal observations, the case is even more dire in Ghana, as there are also no country-specific scholarships or funding opportunities to support this course. The only scholarships available are the general and globally recognised Commonwealth scholarships and Chevening scholarships, which are competitive and limited in number. These funding limitations are demotivating and limit the research capacity strengthening gained through postgraduate training for optimal effectiveness in supporting rehabilitation, be it service delivery or research conduct. Further, the WHO also highlights the need for research on rehabilitation workforce and their capacity building in research. Within LMICs, such global research needs can be realised with available funding specifically allocated to rehabilitation.
Bridging the gap in funding in LMICs
Global health communities, such as the WHO, can promote research capacity strengthening in rehabilitation in the Global South and among disadvantaged populations to ensure equitable funding for rehabilitation research. Only when this is done can equity, inclusivity and locally relevant research efforts by researchers in LMICs be achieved. Funders and funding bodies have an ethical responsibility to ensure equity in their funding policies. As such, in considering new approaches and policies, a focus on rehabilitation is encouraged based on its critical global need.
In addition, funders can partner with institutions, health ministries and think tanks to support the investment of funding for rehabilitation research or make a case for rehabilitation. Funders can also work with reputable non-governmental agencies to improve research quality and contribute to advancing health equity in Africa. Good examples to consider are eBase Africa, Science for Africa Foundation, Mawazo Institute and packs-Africa, among others. While these non-profit entities are doing well in their respective scopes, none is specifically focused on rehabilitation and its capacity building in Africa. Thus, an avenue for such a venture would support global efforts in addressing the rehabilitation needs discussed here. Such an agency can empower rehabilitation professionals to think on evidence generation in Africa, but also think more laterally as global citizens and evidence contributors.
Global funding giants, such as the National Institute for Health and Care Research and Wellcome trust, in addition to their current scope, could make room for rehabilitation-focused grant applications globally, but more specifically in LMICs, to support rehabilitation research.
Finally, based on research reports from South Africa, higher educational institutions, health ministries and health-focused think tanks in LMICs can also lobby for increased research allocations for strengthening rehabilitation research as part of their health systems research funding.
Take-home messages
- 1. Considering the current urgent need for rehabilitation strengthening in LMICs, a strong submission for ring-fenced funding opportunities for rehabilitation is recommended. Only with such focused measures can rehabilitation be improved and integrated into national health policies.
- 2. Investing in the training of rehabilitation professionals is an investment in the health of populations around the world. Funders should consider the advocacy call by the WHO and support its realisation globally, but especially in LMICs.
- 3. Funders are encouraged as part of their funding scope to consider impactful research focused on rehabilitation and the rehabilitation workforce, as they are key global research agendas for health system strengthening.
Author
Beatrice E.A. Sankah1,2
1. Evidence-based Practice Research Group, Ghana Physiotherapy Association, Ghana
2. University of Southampton, Southampton, UK
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
