Date of Award

12-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Narjis Rizvi

Second Advisor

Dr. Nino Paichadze

Third Advisor

Dr. Nadeem Ullah Khan

Department

Community Health Sciences

Abstract

Background: There are 2.4 billion people in need of rehabilitation care according to World Health Organization (WHO). Literature has shown that 74% of all years lived with disability (YLD) could benefit from rehabilitation. However, the quality of the rehabilitation services remains understudied, particularly in the LMICs. WHO defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.” Rehabilitation services in Afghanistan are scarce, and there is a lack of research on the quality of these services. This study aimed to assess the quality of physical rehabilitation care through the perspectives of patients and health professionals in secondary and tertiary hospitals in Kabul, Afghanistan.
Methods: This was a concurrent mixed-methods study employing the Donabedian Model of Quality of Care as the conceptual framework. The study was conducted in 15 private and public hospitals in Kabul in November 2023. Participants included patients and physical rehabilitation professionals selected through universal sampling. However, due to the insufficiency of participants, data was collected from 64 health professionals. For the qualitative component, 7 health professionals and 7 patients were interviewed. Questionnaire and interview guides were developed based on the National Institute for Health and Care Excellence Guideline of UK and literature review. Quantitative data were analyzed using SPSS version 26. The mean and standard deviation for individual statements assessing structural, process, and outcome aspects of quality of care was calculated. Additionally, the average score was computed for all statements under structure, process, and outcome.
Results: The study included health professionals with a median work experience of 5 years, evenly distributed between private and public hospitals. Most professionals had post-graduate education (37%), followed by a diploma (33%) and a bachelor's degree (19%). Patients had an average age of 44.7 years, with 28% female and 72% male. The average mean score for statements on structural, process, and outcome quality was nearly 4 and above 4, indicating agreement among health professionals on the Likert Scale. They believed that facilities had sufficient resources, effective management, positive patient- provider interaction, existing guidelines, and patient satisfaction. However, qualitative data revealed that there was inadequate equipment and staff, inexistence of training and clinical guidelines, and a weak rehabilitation system. Patient satisfaction with services was lower compared to health professionals' assessments. Barriers to high-quality care include inadequate budget (47%), inadequate equipment (44%), insufficient staff (42%), lack of management commitment (34%), and lack of policies, guidelines, and standards (34%). Some professionals expressed lack of knowledge to improve care quality (14%). Conclusion: In conclusion, this study assessed the quality of physical rehabilitation care in secondary and tertiary hospitals in Kabul, Afghanistan, from the perspectives of patients and health professionals. The findings indicate physical rehabilitation care faces inadequate equipment and staff, lack of training and clinical guidelines, and a weak rehabilitation system. Patient satisfaction with services was comparatively lower than health professionals' assessments. The findings of the study offer several policy recommendations to increasing investment in rehabilitation services, strengthening human resources and training, improving physical infrastructure, addressing policy restrictions in the referral system, developing clinical guidelines, and establishing quality improvement programs.

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