Date of Award

12-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Ms. Nousheen Pradhan

Second Advisor

Mr. Waqas Hameed

Third Advisor

Dr. Yasmeen Akhtar

Department

Community Health Sciences

Abstract

Introduction: Healthcare comprises promotive, preventive, curative, and rehabilitative services. Availability and provision of all these aspects are equally essential to achieve improved and quality health for citizens. The World Disability Report showed approximately 15% of the population with disabilities, mainly in low-middle-income countries (LMICs). Pakistan has approximately five million people living with disabilities and physical disabilities occupying the highest share accounting for approximately 80% of the total disabled population. Under the broader aspect of rehabilitation, physical therapy services play a major role in the prevention of movement disorders and the restoration of the optimal quality of life. WHO has strongly advocated for the strengthening of physical therapy services in health systems, particularly in LMICs to provide high-quality services. There is lesser data concerning the factors influencing the provision of musculoskeletal and neurological physical therapy services, particularly at public sector hospitals in Karachi, Pakistan. The evidence is significant in the planning and implementation of health policies and strategies addressing the provision of physical therapy services to restore health and improve living. Study Objective: The study aimed at assessing the availability of physical therapy services, exploring the factors associated with the service provision, and assessing the level of patient satisfaction in musculoskeletal and neurological domains at public sector tertiary care hospitals in Karachi
Methodology: Under cross-sectional study design, concurrent mixed-methods approach was used. The data was gathered by using both quantitative and qualitative methods simultaneously. Quantitative tools included structured checklists to assess the current status of physical therapy services and level of patient satisfaction. Qualitative tool included a semi-structured interview guide to understand the factors influencing the services. Study participants included the HODs, physical therapists, and patients utilizing services. These were selected through purposive sampling at the Outpatient Departments (OPDs) of three public sector hospitals in Karachi. Qualitative and quantitative data were collected and analyzed separately and results of all three study sites extracted from both components were triangulated using framework analysis to come up with the results based on WHO’s six building blocks frameworks.
Results: Study results were categorized based on six building blocks of the WHO health systems framework. Findings informed a variety of factors that were perceived to hinder the provision of physical therapy care including improper infrastructure, inefficient patient referral system, shortage of staff with lack of trained personnel, unavailability and malfunctioning of basic equipment, lack of financial support from the government, poor wages of physical therapists, and absence of regulatory council for physical therapy. These were also validated by structured checklists. Despite the identified gaps, the patient satisfaction level with physical therapy services was highest for staff communication 4.88/5, and lowest for the hospital environment 3.92/5.
Conclusion: There is a need to strengthen physical therapy services across all building blocks of WHO Health System Framework. Formation of regulatory council, increase in staff, availability of functional equipment and adequate financial support to physical therapy can help to achieve better service provision for patients at public sector hospitals in Karachi.

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