Training of Mid-Level Rehabilitation Workers for Community-Based Rehabilitation Programmes

Purpose: There is a lack of trained rehabilitation professionals, especially in the small towns and rural areas of low- and middle-income countries. In India, a new cadre of mid-level rehabilitation workers, the Rehabilitation Therapy Assistants (RTAs), are being trained by Mobility India, a Non-Governmental Organisation (NGO). This paper explores their training and experience after the training. Method: The paper has collected information from three different initiatives connected with the trained RTAs: An impact assessment of their training; interviews with RTAs during an evaluation; and a survey of 188 RTAs trained between 2002 and 2019. Results: Analysis of the information shows that RTAs have good skills to provide rehabilitation interventions in the field and are appreciated by clients and other stakeholders. Most of the RTAs work for NGOs in CBR programmes, and in private hospitals and clinics. There is no role for them in government services in most countries. The number of trained RTAs remains small in spite of the large needs. This may be due to lack of an accreditation system for RTAs and the low priority given to rehabilitation services in general. Conclusions: The analysis provides useful information to strengthen the RTA training courses. Training RTAs to provide rehabilitation services in smaller towns and rural areas of low- and middle-income countries can have a good impact through CBR programmes. However, this impact remains circumscribed to small areas where NGOs are active. Changes are needed in the health systems for the inclusion of mid-level rehabilitation workers in primary health care services.