Rehabilitation services in Benghazi, Libya: An organizational case study

Context: Little is known about Libyan disability and rehabilitation services. Objectives: To describe workforce characteristics of the only functioning disability rehabilitation service in 2012 Libya. This was the Benghazi Rehabilitation and Handicap Center. The focus of the case study was the physical disability services including amputee care. Method: Organizational case study involving site visit, self-report workforce survey, and review of relevant policy, government and peak agency reports relevant to disability services. Results: The case study revealed that disability regulations in Libya focussed on social security entitlements and impairment focussed treatment. Community based rehabilitation or initiatives for social inclusion and participation were scant, creating problems for people requiring long term rehabilitation in the community. The center workforce continued to function in spite of conflict and in difficult circumstances. While expatriate staff left in the 2011 conflict, local staff retention was high. These workers were mono-lingual, had longevity of tenure, and a lack of qualification mobility. Some such as therapists and prosthetic technicians, had highly specialised skills requiring center facilities. The case study revealed: escalating patient demand; bed-block; and problems in supplies, capital and equipment maintenance. There were opportunities to increase capacity through: clinical and administrative staff training; development of inpatient facilities for women; discharge options for long-term male inpatients; and coordinated information systems. Of 232 eligible, n=72 staff, who participated in the survey (mean age was 39.4 years; n=40 males). Most therapists/ prosthetic technicians were male; most nurses/ administrative workers were female (p=.0001). The most common qualification across occupations was secondary school; 28.2% had intermediate secondary and 22.5% university degrees as their highest qualification. A third had been employed at the centre > 20 years, > 10 years and < 10 years respectively. 42% worked as part of a team. Conclusion: The study provides an insight into issues affecting disability services and revealed areas for future post-conflict workforce development and opportunities for disability service capacity building particularly in relation to coordinated information systems, qualification upgrades, in-service training, and development of inpatient discharge options including community based rehabilitation and supported accommodation.