Persons with Disabilities living in African countries are amongst the poorest of the Poor. Most have no income, no insurance and no one to financially support them. They often need Rehabilitation services, especially Physical Therapy, which have fees rendering them inaccessible to this population.  

In order to better meet the needs of Persons with Disabilities in Africa, three rehabilitation Projects have set up Rehabilitation Equity Funds (REF) in Mali, Togo and Rwanda. We believe this is the first time around the world that the model of Health Equity Funds has been used for Physical Therapy Services.

REF is a method of financing care for the poorest of the Poor. These funds are based on the principle of the third-party payer. The management of the three REFs is entrusted to the third-party through steering committees in each country made up of social workers, association members, and NGOs.  Managing a REF consists in identifying and monitoring beneficiaries, monitoring the quality and cost of the care provided, and making monetary disbursements. For the first stage, the REFs were funded for 3 years each. They were implemented by three independent teams with different stakeholders.

An external consultant conducted a qualitative and economic evaluation of the REFs.  During one week in each country he met with more than 70 people involved in the funds including beneficiaries, associations, government officials, rehabilitation professionals and Handicap International’s teams. The theoretical framework was based on the evaluation of four Health Equity Funds held in Cambodia. The issues addressed during the evaluation included the description of the three Rehabilitation Funds, their implementation, relevance, sustainability and impact. A cost calculation and a cost analysis were also performed by the consultant.

1,718 persons have benefited from the three funds. The most sustainable fund is the one which trained and involved the partners from the start. The average amount of rehabilitation fees per beneficiary is similar between the countries as well as is the functioning cost of each Fund.

Based on the evaluation, the consultant made recommendations such as the early delegation of management to already existing national institutions rather than to a service provider, to have a simple yet effective identification and selection of beneficiaries, and to require an affordable financial contribution by the beneficiary.

The study allowed us to identify the strength and the weaknesses of the equity funds. The implementation and functioning costs are considerable, but of greater importance, these funds allowed poor and remote people to access rehabilitation services they could not otherwise afford. These funds establish an equitable, reliable system and encourage donors to finance rehabilitation care which are not covered by insurance. The challenge is now to find new donors for their sustainability. Physical Therapy care can change the quality of daily life of persons with disabilities. REFs are one of the best ways to improve poor people’s access to Physical Therapy services in developing countries.