Background

Getting started

2009Learning More

2010Evaluation was carried out early in 2010 to 1) determine the strengths and weaknesses of the

BPG development project from the perspective of the guideline developers and project coordinators and,

2) develop recommendations to facilitate future BPG formation.

The evaluation provided recommendations for changes in the project process. Several changes were made to the way that the project was carried out included shifting responsibility for project coordination to the Administrative Assistant of the BCCSDR, revising the funds available to group members, and changing methods of communication.

…the people you are working with are in different programs somehow from you,

it is very difficult to get the time to meet for discussion. – Group Leader

Continuing on despite difficulties

2011Work continued on guideline development in 2011.

I have learned a lot about the importance of starting at the beginning

of looking at what type of results we want, and what impact Vocational Rehabilitation has on Quality of Life – not just training people for the sake of training them and

then thinking about results. (CBR worker)

Literature review continues. Reading research and review articles was both interesting and challenging for participants but the groups continued to face several challenges in achieving project goals.

…we started off with lots of enthusiasm from a whole bunch of people - people in Canada and people in

Cameroon. There would be lots of people interested and had ideas of how to organize them, and it didn’t play out - so when it came down to getting people involved in a

meaningful way, it didn’t happen [consistently]. (Project Coordinator)

By the end of 2011, some groups had well developed draft guidelines, others were still part way along, and some had disbanded.

Connections with Government Ministries – • Throughout the project, the question of how to

liaise and consult with government ministries came up several times.

• At the beginning of the third year, the group discussed this issue again, and it was decided that more work needed to be done before formally going to government for collaboration or support.

• Establishing an appropriate communication and possible partnership with ministries will be pursued in the next phases.

Better Practices in Rehabilitation in Africa: Learning collaboratively to change frontline practices:

Lynn Cockburn1, 3, 4, Julius Wango2, Emmanuel Anjonga 2 Mukong Nicholas2,Ezekiel Benuh3, Kat Chow4, Shirin Kiani4, Alexa Bramall5

1 Department of Occupational Science & Occupational Therapy, University of Toronto 2Bamenda Coordinating Centre for Studies in Disability and Rehabilitation, Bamenda, Cameroon 3Socio-Economic Empowerment of Persons with Disabilities (SEEPD), Cameroon Baptist Convention Health Board, Bamenda, North West Region, Cameroon

4 International Centre for Disability and Rehabilitation, University of Toronto 5Student, Medicine, University of Toronto

Overview Reflecting and Planning

2012The initiative continues. We continue to reflect on what was learned and to develop the guidelines.

Using several methods of communication and information-sharing was important, including having in person meetings, using technology, providing hardcopies of information, and maximizing the use of mobile phone technology (i.e. text messaging) to coordinate meetings. Information and training workshops to increase knowledge and skills successfully brought together members of the project team.

Projects like this should find a good balance between having enough groups, while not overextending the project coordinators and the local practitioners. Groups will work in different ways and at different speeds; the project needs to be able to accommodate these variations.

Having intensive 1-2 day meetings with project coordinators or other experts to review information, write drafts of guidelines, and to consider impact appears to be more effective than a series of short half-day meetings. Longer collaborations, combined with other activities, could potentially be effective as well. The team plans to trial these models over the next few years.

Dissemination will continue, and should be sensitive to the many contexts in which BPG could be used. Guidelines are non-denominational, will be freely available, and considered to be useful for anyone working in rehabilitation in this region.

Contact UsLynn Cockburn ~~ l.cockburn@utoronto.caJulius Wango ~~ juwango68@gmail.com

Selected ReferencesAGREE ?? Other key references

Chow, K., & Aspiras, H. (2009, June). Development of best practice guidelines in rehabilitation for the Northwest Region of Cameroon. Paper presented at Thelma Cardwell Research Day, Toronto, ON, Canada.Grimshaw, J., Eccles, M, & Russell, I. (1995). Developing clinically valid practice guidelines. Journal of Evaluation in Clinical Practice, 1(1), 37-48.Institute of Medicine. (1990). Clinical practice guidelines: Directions for a new program. (Field, M. J., & Lohr, K). Washington, D.C.: National Academy Press.National Institute for Health and Clinical Excellence (NICE). (2007). The Guideline Manual, London: NICE.Turner, T. J. (2009). Developing evidence-based clinical practice guidelines in hospitals in Australia, Indonesia, Malaysia, the Philipines and Thailand: values, requirements and barriers. BMC Health Services Research, 9(235), 1-7.Turner, T. J., & Short, J. (2009). Maternal and perinatal guideline development in hospitals in South East Asia: The experience of the SEA-ORCHID project. Health Research Policy and Systems, 7(10), 1-9.

Acknowledgements

We gratefully acknowledge funding for this project provided to the BCCSDR by the CBCHB SEEPD Program, which is in turn funded by AusAID through CBM Australia.

The BPG Project is being carried out by the BCCSDR as part of a larger research initiative included in the Socioeconomic Empowerment of People with Disabilities

(SEEPD) program.The BCCSDR supplemented the project activities and the writing of the report through

financial and in-kind support.

We are very grateful for the significant contributions of all of the members of the groups over the four years of this project.

Shirin Kiani joined the project in the third year, and made significant contributions. We are very grateful for her insights, enthusiasm, and expertise in working with us.

During the first year the focus was on planning appropriate processes and establishing project goals, carrying out guideline development, and formative project evaluation.

Literature review conducted:• the meaning of current best practices• the use and barriers related to best practices

in developing countries.

Ongoing discussion within the team, which included a social worker, occupational therapists (OTs), physical therapists, community based rehabilitation workers, OT students, and other professionals.

Draft discussion paper and workshop outlining how best practices could be developed and used in the NWR. The BCCSDR BPG development process outlined eight stages for each topic:

Topics were priorized and selected.

Small work groups then began to work on the guidelines. Each work group was composed of members of the core project team, and other members. The scope of each topic guideline was developed. This work began in 2009 and continued on into 2010.

There is a need for improved rehabilitation services in Africa. The Bamenda Coordinating Centre for Studies in Disability and Rehabilitation (BCCSDR), with partners from several other organizations, began a process of creating best practice guidelines (BPG) in rehabilitation which would be relevant and applicable in the North West Region of Cameroon.

The purpose of this project is to:• develop a general understanding of best practices,• recognize current barriers to implementing best

practices, • develop practical BPGs for use in the NWR of

Cameroon and• explore what is feasible for using them.

This project builds on ongoing collaborations between: • University of Toronto – ICDR and the Department of Occupational

Science & Occupational Therapy• CBC- Health Board – SEEPD Program (Socio-Economic

Empowerment for People with Disabilities) and CBR Services• Bamenda Coordinating Centre for Studies in Disability and

Rehabilitation• SAJOCAH Rehabilitation Centre, Bafut, Cameroon

BamendaCoordinatingCentre forStudies inDisability andRehabilitation

The project began in January 2009 and continues. A key outcome is the interest and commitment among front line providers to using research and evidence to improve rehabilitation practices which is part of a larger, exciting, and evolving practice and social change process.

Panel presentation on Best Practices at the 2011 Bamenda Conference on Disability and Rehabilitation.

The Topics• Assessment of individuals in the acute stages of

stroke rehabilitation and management• Hearing impairment and deafness: initial

identification, medical assessment, and referral to rehabilitation facilities.

• Early stages of vocational rehabilitation services - includes identification, assessment, counseling regarding the purposes of VR

• Identification and assessment of children with low vision and blindness for early intervention, integration and rehabilitation.

• Family centred care, best care practices for children with disabilities within family group

• Communication Materials on HIV and AIDS for people with disabilities (e.g. posters)

Once people joined the project, they had difficulties maintaining their participation. Several participants noted that it was difficult to find the time to schedule meetings, which therefore hindered their group’s ability to complete their work.

And again, we are not really together because many of us are busy, even though we are at least five of us, but maybe

about three of us are really busy. - Group Leader

An example of communication

materials - A poster developed

to raise awareness in the disability

community about HIV and AIDS