Dunleavy Kim
Department of Physical Therapy, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan 48201, USA.
Disabil Rehabil. 2007;29(11-12):903-20. doi: 10.1080/09638280701240433.
Rehabilitation agencies, policy makers and donors are faced with the choice of the level of rehabilitation provider to promote in developing countries. This is particularly the case after conflict when new systems are considered and the need for rehabilitation becomes a priority. The complete decimation of medical services in Cambodia highlights the effects of both social change and development agency impact on the establishment of rehabilitation services. This paper discusses the factors that led to the development of four types of physical therapy provider levels in Cambodia with the goal of providing a framework for these decisions.
Case study analysis utilizing interviews, site analysis and literature review.
There are four levels of physical therapy provider systems that were initiated at different stages of the rebuilding of the country. Rehabilitation workers were trained during the war in refugee camps and afterwards in rehabilitation centers, professional physical therapists were trained in a university programme after the conflict ceased and community follow-up workers and community-based rehabilitation workers were trained to address some of the geographic accessibility issues. Factors that affected the different systems include the post-conflict development agency philosophy, instructor availability and training, financial support, high school education standards, geographic and rural/urban distribution and cost and time for training. The community-based rehabilitation and community follow-up models also address referral systems and social and vocational support.
The comparison of the different types of provider and the initiating or driving forces that led to development of these systems are discussed in order to provide agencies which are planning to implement training of rehabilitation providers in developing countries with a decision-making framework. A combined system is the optimal approach; however, the choice of which type of provider level to promote will differ according to political stability, stage of development, presence of trained educators, rural vs. urban need, funding agency philosophy and educational standards in the country.
康复机构、政策制定者和捐赠者面临着在发展中国家推广何种康复服务提供者水平的选择。在冲突之后考虑建立新系统且康复需求成为优先事项时，情况尤其如此。柬埔寨医疗服务的全面崩溃凸显了社会变革和发展机构对康复服务建立的影响。本文讨论了导致柬埔寨四种物理治疗服务提供者水平发展的因素，目的是为这些决策提供一个框架。
采用访谈、实地分析和文献综述进行案例研究分析。
在该国重建的不同阶段启动了四个级别的物理治疗服务提供者系统。康复工作者在战争期间于难民营接受培训，之后在康复中心接受培训；冲突结束后，专业物理治疗师在大学课程中接受培训；社区随访工作者和社区康复工作者接受培训以解决一些地理可达性问题。影响不同系统的因素包括冲突后发展机构的理念、教员可用性和培训、财政支持、高中教育标准、地理分布及城乡分布、培训成本和时间。基于社区的康复和社区随访模式还涉及转诊系统以及社会和职业支持。
讨论了不同类型服务提供者的比较以及导致这些系统发展的启动或驱动因素，以便为计划在发展中国家开展康复服务提供者培训的机构提供一个决策框架。综合系统是最佳方法；然而，根据政治稳定性、发展阶段、受过培训的教育工作者的存在情况、农村与城市需求、资助机构的理念以及该国的教育标准，推广哪种类型的服务提供者水平会有所不同。
