Community health workers’ provision of physical rehabilitation services in sub-Saharan Africa: a scoping review
Authors: Mapulanga Miriam , Kgarosi Kabelo , Maluleke Kuhlula , Hlongwa Mbuzeleni , Dlungwane Thembelihle 
Published: April 2023

Background The increase in the prevalence of non-communicable diseases as a result of increasing life expectancy and changing lifestyles from active to sedentary has increased the demand for physical rehabilitation. Due to this increased demand, services are required as close to people as possible through task-shifting physical rehabilitation services thereby strengthening services at primary health care level. We systematically mapped evidence and described the scope of physical rehabilitation services delivered by CHWs, their mode of physical rehabilitation services delivery, and the barriers and facilitators experienced by CHWs in delivering physical rehabilitation services in SSA.Methods We used the framework of Arksey and O'Malley and Levac et al’s to guide this scoping review. We searched PubMed, Scopus, Cochrane Central, and databases within the EBSCOhost platform using a mix of Medical Subject Heading terms and a combination of keywords for relevant literature without applying language restrictions. We included articles presenting evidence on CHWs’ provision of physical rehabilitation services in SSA from January 1978 to December 2022. Two independent reviewers screened articles at the abstract and full-text screening guided by the inclusion or exclusion criteria and the PCC elements. All relevant data were extracted using a google form and organized into themes and a summary of the results was reported narratively. The methodological quality of included studies was assessed using the mixed methods appraisal tool.Results A total of 6996 were identified through database search and other sources of which 29 met the included criteria and were included for data extraction. The included 29 studies were conducted in eight countries with the majority 16/29 from South Africa followed by 5/29 from Malawi, 3/29 from Uganda and 2/29 from Ethiopia. Of the 29 articles, each one was conducted in Eritrea, Kenya, Namibia and Mauritius. The review revealed the scope of practice for CHWs to be palliative care, disability, non-communicable diseases, HIV/AIDS, assistive devices, neurology, community-based rehabilitation, speech and language, and general rehabilitation while the modes of delivery are community-based, home-based, health facilities, community with health facilities and community with home-based. The review also revealed that the barriers experienced by CHWs in the delivery of physical rehabilitation services are transport and distance, societal and community attitudes, supplies, finance, weather, delivery capacity and governance while the facilitators were proximity to the community, personal attitude, knowledge and technology.Conclusion The review shows that CHWs are involved in physical rehabilitation service delivery in sub-Saharan Africa. It is therefore necessary to develop a training model for CHWs in physical rehabilitation services. Moreover, the review shows that there is need for the integration of CHWs into the national healthcare system as a sustainable solution to curb the chronic human resources for health shortage in SSA.