Service development for communication disability rehabilitation in Sub-Saharan Africa: The positioning of the profession of speech and language therapy within the service landscape

Abstract

This thesis explores and critically reflects on the positioning of the speech and language therapy (SLT) profession within the landscape of rehabilitation services for people with communication disabilities (PWCD) in sub-Saharan Africa (SSA) and, in particular, in Ghana. Findings from three research stages are drawn together to describe rehabilitation services, from the perspectives of speech and language therapists (SLTs), the community and other service providers. Stage 1 used a mixed-methods survey to explore the workforce and services provided by 33 SLTs in SSA in nine Anglophone countries. Challenges to workforce sustainability, stability, and equity are described. Stage 2 focused the inquiry on a single country, Ghana. A qualitative descriptive survey explored the likely self-help and help-seeking actions of 136 community members in response to communication disability. Findings indicated that individuals may use a range of self-help strategies and seek help across sectors. The importance of improving the accessibility of information and the capacity for self-help in resource-limited contexts is discussed. Stage 3 used semi-structured interviews to describe rehabilitation services offered to PWCD by a sample of doctors (3), herbalists (3) and pastors (3). Participants described offering rehabilitation supports in three key ways: providing direct interventions, offering explanations and promoting strategies to support communication. Findings illustrate the contributions of a range of community services to rehabilitation for PWCD in SSA and support the need for cross-sectoral engagement. Findings from this research highlight the need for SLT in SSA to create unique approaches to rehabilitation that address the needs of communities as well as individuals. Understanding the broader service landscape, engaging with communities and working across sectors may assist SLTs to contribute to the development of equitable and appropriate rehabilitation services in SSA.