"We don't treat feet, we treat children" analyzing the integration of rehabilitation services into the health system through a qualitative case study of the National Clubfoot Program Uganda.

PURPOSE: Clubfoot is a congenital birth condition that persists as lifelong disability without early treatment. The National Clubfoot Program Uganda is one of the oldest clubfoot programs in a low-income country and offers a case study for how to integrate rehabilitation services into health systems. The objective of this study was to identify opportunities, challenges, and lessons learned for the integration of rehabilitation services into health systems.

METHODS

We conducted 61 interviews to learn about the program's implementation and cost structure and conducted a thematic analysis of findings complemented with a bottom-up costing model.

RESULTS

The program's use of existing orthopedic officers to deliver care, leveraging of the public supply chain, and longstanding commitment from the Ministry of Health were found to support health systems integration. Use of a dedicated patient records system, dedicated training and supportive supervision, and filling supplies during stockouts improved quality of care but reduced integration. Overall, the program fills service availability and readiness gaps, but demand side barriers persist.

CONCLUSION

Findings illustrate how the integration of rehabilitation services into the health system is predicated on the strength of the health system and requires an intersectoral and comprehensive approach to supporting patient identification, treatment, and follow-up.