The MAURITIUS RESEARCH COUNCIL NNEEDS ASSESSMENT ON NEUROLOGICAL REHABILITATION SERVICES IN MAURITIUS Report ©Mauritius Research Council, February 2012 ACKNOWLEDGEMENTS This study was carried out in collaboration with the following institutions: Ministry of Health and Quality of Life Ministry of Social Security, National Solidarity and Reform Institutions NEEDS ASSESSMENT ON NEUROLOGICAL REHABILITATION SERVICES IN MAURITIUS i TABLE OF CONTENTS List of Tables ................................................................................................................................ viii List of Figures ................................................................................................................................. ix List of Pictures ................................................................................................................................ ix List of Boxes .................................................................................................................................... ix I) PREFACE .................................................................................................................................... x II) INTRODUCTORY NOTE FROM DRs SOOPRAMANIEN AND SOHUR ....................... xi III) EXECUTIVE SUMMARY ....................................................................................................... xiii Chapter One: BACKGROUND, RATIONALE AND SCOPE OF STUDY ................................ 1 1.1 Background & Significance: A Summary .................................................................................. 1 1.2 Rationale.............................................................................................................................................. 1 1.3 Defining the neurological conditions and services investigated .................................... 2 1.3.1 Stroke: A definition ......................................................................................................................... 2 1.3.2 Traumatic Brain Injury: A definition ....................................................................................... 3 1.3.3 Spinal Cord Injury: A definition ................................................................................................. 3 1.3.4 Neurological Rehabilitation ........................................................................................................ 3 1.4 Aims & Objectives of the Study .................................................................................................... 4 1.5 Medium to Long-Term Vision for Enhanced Neurological Rehabilitation in Mauritius ....................................................................................................................................... 5 1.6 Research Questions for the Needs Assessment ..................................................................... 5 1.7 Scope & Framework of the Needs Assessment ...................................................................... 5 Chapter Two: METHODOLOGY ................................................................................................... 6 2.1 Study Type .......................................................................................................................................... 6 2.2 Study Design ....................................................................................................................................... 6 2.3 Target groups ..................................................................................................................................... 7 2.3.1 Health Professionals ....................................................................................................................... 7 2.3.2 Patients (Stroke, TBI, SCI) & their relatives ......................................................................... 7 2.3.3 Criteria for inclusion or exclusion of participants ............................................................. 7 NEEDS ASSESSMENT ON NEUROLOGICAL REHABILITATION SERVICES IN MAURITIUS ii 2.4 Data Collection Instruments used .............................................................................................. 7 2.4.1 Data Collection for chapter on the Mauritian Context ..................................................... 8 2.4.2 Data Collection for chapter on Descriptive Statistics on Stroke, SCI and TBI ........ 8 2.4.3 Data Collection for chapter on Hospital Service Providers ............................................ 8 2.4.4 Data Collection for chapter on Human Resources & Training Opportunities ........ 9 2.4.5 Data Collection for chapter on Residential & Home-Based Care ............................... 10 2.4.6 Data Collection for chapter on Patient Interviews .......................................................... 10 2.5 Ethical Issues ................................................................................................................................... 11 2.6 Strengths of the Study .................................................................................................................. 11 2.7 Limitations of the Study .............................................................................................................. 12 Chapter Three: THE MAURITIAN CONTEXT ....................................................................... 14 3.1 Organization and Management of Health Services ........................................................... 14 3.2 The Mauritian Health Care System ......................................................................................... 14 3.2.1 Health Sector (Public) Services ............................................................................................... 15 3.2.2 Private Sector Services ................................................................................................................ 16 3.2.3 Human Resources for Health in Mauritius .......................................................................... 16 3.3 The Mauritian Demographic Context ..................................................................................... 16 3.3.1 The Mauritian Epidemiological Context .............................................................................. 17 3.4 The Mauritian Social Policy Context ....................................................................................... 18 3.4.1 Organization and Management of Welfare Services ....................................................... 18 3.4.2 The Disability Unit at the Ministry of Social Security ..................................................... 19 3.4.3 The Medical Unit at the Ministry of Social Security ........................................................ 19 3.4.4 Services offered by the Ministry of Social Security: ........................................................ 19 3.4.4.1 Carer's allowance .............................................................................................................. 19 3.4.4.2 Assistive devices ................................................................................................................. 19 3.4.4.3 Other Financial Support ................................................................................................. 19 3.5 Mauritian Policy on Accessibility for the Disabled ........................................................... 20 3.5.1 The UN Convention on the Rights of Persons with Disabilities ................................. 20 3.5.2 Policy Implications for Stroke, TBI and SCI cases ............................................................ 22 Chapter Four: DESCRIPTIVE STATISTICS ON STROKE, TBI AND SCI ......................... 23 4.1 Measuring Health: some definitions ....................................................................................... 23 NEEDS ASSESSMENT ON NEUROLOGICAL REHABILITATION SERVICES IN MAURITIUS iii 4.2 Stroke ................................................................................................................................................. 23 4.2.1 Comparing Stroke Prevalence, Incidence and Fatality Rates ...................................... 25 4.3 Traumatic Brain Injury ............................................................................................................... 25 4.3.1 Comparing TBI Prevalence, Incidence and Fatality Rates ............................................ 26 4.4 Spinal Cord Injury ......................................................................................................................... 27 4.5 Information Gathering System ................................................................................................. 28 4.6 Classification Methodology used for TBI, SCI & Stroke in Mauritius .......................... 28 4.6.1 TBI Classification ........................................................................................................................... 29 4.6.2 SCI Classification ............................................................................................................................ 29 4.6.3 Stroke Classification ..................................................................................................................... 29 4.7 Data Gathering Systems in Medical Institutions. ............................................................... 30 4.7.1 Reliability and Validity of the Quantitative Data obtained ........................................... 30 4.7.2 Human Error: Doctor’s Diagnosis