Date Published: April 12, 2018
Author(s): Karen Wylie, Lindy McAllister, Bronwyn Davidson, Julie Marshall.
Workforce factors present a significant barrier to the development of rehabilitation services for people with communication disabilities in sub-Saharan Africa (SSA). Exploring how the work of speech and language therapists (SLTs) in the region is organised and delivered can provide insight into existing services, areas for future workforce development and improved rehabilitation access for people with communication disability.
This paper describes the employment and service provision patterns and work roles of a sample of SLTs in SSA.
A broad, purpose-designed, mixed-methods survey was designed to collect data from SLTs living in Anglophone countries of SSA. Descriptive statistics and qualitative content analysis were undertaken. This paper reports on a subset of data from the wider survey.
A description of the employment and work roles of the 33 respondents to the survey and characteristics of their service users is presented. SLTs were commonly employed within private and not-for-profit sectors and frequently worked in temporary jobs. SLTs engaged in a range of work roles, including capacity building and training others. Services were provided by SLTs across age ranges, health conditions and settings, with paediatric, urban services commonly reported. Costs for service users and urban-centred services give indications of barriers to service access.
Knowledge of the way in which speech and language therapy services are organised and provided has the potential to shape the development of communication disability rehabilitation in SSA. This research has identified a range of issues requiring consideration as the profession develops and grows.
Despite an increasing global focus on inclusion and the rights of people with disabilities (PWD), rehabilitation services continue to be extremely limited in countries of the Majority World, including in sub-Saharan Africa (SSA). Many PWD report limited access to rehabilitation services (Eide & Loeb 2006; Eide & Kamaleri 2009; Loeb & Eide 2004; World Bank & World Health Organization 2011). Increasing the availability of rehabilitation and habilitation services for PWD is critical and forms one of the three objectives of the World Health Organization’s Disability Action Plan 2014–2021 (2015). (Note: In this paper the terms Majority and Minority World are used to replace the terminology ‘developed’ and ‘developing’ countries.) This paper focuses on workforce factors limiting the development of rehabilitation services for people with communication disability (PWCD) in SSA. PWCD have been described as:
Many people with communication disabilities may seek rehabilitation across their lifetime. In this paper, the term rehabilitation is used to represent:
Survey research was undertaken to investigate the characteristics, work and employment of SLTs across English-speaking countries in SSA. The methodology for this research has been described in more detail in a previous complementary article (Wylie et al. 2016). The current paper reports on a subset of data from the survey reporting on employment conditions, work roles of the respondents and characteristics of the PWCD to whom they provide rehabilitation services.
Thirty-three completed surveys were received from SLTs working across nine countries. The demographic mix of respondents is reported in Wylie et al. (2016). Two-thirds of the sample (n = 22) identified as African nationals while the remaining one-third (n = 11) were non-African nationals, predominantly from European countries.
The University of Queensland, Australia, where the first author was enrolled as a doctoral student at the time of the study development, granted ethical approval for this project (reference number 2011-SOMILRE-0018). Informed consent was inferred via survey response. Secure Sockets Layer technology was used to protect online survey data.
This paper reports data from a survey of the work of SLTs in SSA on employment patterns, position funding, characteristics of clients and activities undertaken by SLTs. Overall, private and not-for-profit sectors were the largest employers of SLTs in this sample. African nationality respondents were most frequently employed within the private sector, while non-African nationals were most frequently employed in the not-for-profit sector. As the profession of SLT grows in SSA, not-for-profit organisations may consider recruiting SLTs differently from current models of volunteerism (see Hickey et al. 2012). Rather than importing foreign volunteers, they may have capacity to offer longer term employment to locally based SLTs, which improves potential for service stability and language mix needed for culturally appropriate services (Wylie et al. 2016).
This is an initial exploration of the SLT workforce with limited data. Non-probability sampling methods and a small sample size limit the ability to generalise results. Selection bias was likely, as despite the use of multiple response modalities, respondents may have been more likely to respond if they had access to technology or were more connected in the international or local communication disability networks. However, this study offers an early exploration of a sample of the workforce and consideration of important factors of relevance to the profession in the region.
Speech and language therapy is beginning to grow in SSA with the development of local SLT training programmes (Wylie et al. 2016). It is timely to reflect on how the profession of SLT could and should be organised in SSA, particularly if the aim of expanding the profession is the development of sustainable and equitable communication disability rehabilitation services. This research presents the workforce profile of a sample of SLTs in SSA by describing their employment patterns, selected characteristics of people receiving SLT services and work roles. Services provided by SLTs were provided to PWCD across age ranges, health conditions and settings, with paediatric, urban services commonly reported. Training was a commonly reported role for SLTs in the sample. Consideration of employment, work and service factors has raised a number of issues around how SLTs are employed and work in the region, which may impact service sustainability and accessibility.