Pilot implementation of rural rehabilitation services, India

OBJECTIVE: To implement rehabilitation services in a rural area of Raigad district, Maharashtra, India. METHODS: We piloted a rehabilitation service delivery model through the Mahatma Gandhi Mission Institute of Health Sciences, in five villages. The institute performed participatory rural appraisal and focus group discussions with stakeholders to identify general issues in village life that could affect delivery. To integrate rehabilitation service delivery into the existing primary care system, a team from the institute developed a strategic plan through multidisciplinary clinical meetings. A rehabilitation team conducted a door-to-door survey and referred people needing rehabilitation services to the outreach visits the team was making to the primary health centre twice a week. If needed, patients could be referred to a university teaching hospital for tertiary-level care. FINDINGS: The rural appraisal identified lack of awareness, inadequate workforce and infrastructure as key issues for rehabilitation services delivery. In response, we conducted awareness campaigns and formed a rehabilitation team consisting of personnel and students from the institute. Between 2018 and 2021, the team provided care to 1800 patients, of which half (900 patients) had musculoskeletal disorders. After rehabilitation, 360 (40%) of these 900 patients performed daily-living activities and continued to work with reduced pain within 2–3 days after rehabilitation. The team provided antenatal care to 1629 pregnant women with musculoskeletal pain or stress urinary incontinence. CONCLUSION: Provision of rehabilitation services built awareness about physiotherapy, developed a rehabilitation care pathway and established a need for regular services. Using existing resources of the institute and involving students rendered the model sustainable.