Rebuilding Rehabilitation: Evolution of Physiotherapy Services in Liberia after the Civil War (1990s to Present)

Background The national health system of Liberia was severely damaged during its civil war in the 1990s, especially the rehabilitation and physiotherapy services. During the post-conflict time, however, steps have been taken to improve rehabilitation and physiotherapy infrastructure as well as the number of trained staff to deliver physiotherapy services. Nevertheless, systematic documentation of the progression, current conditions, and sustainability of physiotherapy services currently exists in Liberia is still quite limited. Methods By utilising a cross-sectional study design, Researchers conducted a national examination of the changes that had occurred in Liberia's physical therapy sector since the end of the civil war. A structured survey instrument was developed using a Likert Scale. The completed versions of this survey were sent to 950 unique participants, comprising Physiotherapists and other Rehabilitation Providers; Administrators within the Health System, Instructors and Students majoring in Fields of Physical Education. This survey instrument collected information on how the civil conflict affected the physical therapy profession; Workforce Development; Infrastructure Issues; Policy & Governance; the Role of International Agencies; Service Delivery Utilisation; Challenges; and Sustaining Services. The data analysis was performed utilising both descriptive and inferential statistical techniques to identify trends and explore relationships among the respondent's demographic groups. Results Challenges to access physiotherapy services were reported to be disrupted significantly at times during and after the civil war. However, improvements were reported to have occurred in workforce development, institutional capabilities, and the availability of physiotherapy services after the civil war. Respondents cited many of the services available in their area were provided through the involvement of international and non-governmental organisations who played a significant role in the recovery of the rehabilitation systems. Many of the respondents reported continuing challenges even after these improvements, including lack of financial resources; lack of equal distribution of physiotherapy services across geographic areas; limited availability of equipment and shortages of trained physiotherapists, especially in rural parts of the country. Gaps in governance, as well as long-range planning, were identified by respondents, as evidenced by mixed responses regarding both the level of policy support for physiotherapy services, and the degree to which physiotherapy services are integrated into the national health system. Conclusion The major findings from this study indicate that participation in Physiotherapy services since the end of the Civil War is largely due to external partnerships and workforce training programs which have been developed & established with the help of International Agencies. However, significant structural, financial, and policy-induced impediments will hinder the continued development of Physiotherapy services within Liberia. There is a need to work together to build on existing strengths and provide greater government investment through increased funding, to strengthen support to the various local training programmes and improve overall system integration as part of the effort to build a sustainable rehabilitation service in post-conflict Liberia.