A Social Business Model of Early Intervention and Rehabilitation for People with Disability in Rural Bangladesh

Abstract

Background: Despite the high burden of childhood disability in low-and middle-income countries (LMICs), the opportunity for early intervention and rehabilitation is very limited. Studies have found that community-based rehabilitation service is effective for children with cerebral palsy (CP); however, such services are not readily available in LMICs, and services run by non-profit organisations on external funding are often not sustainable. In this study, we report the lesson learnt in establishing a social business model of early intervention and rehabilitation services for children with CP and adults with disabilities in a rural subdistrict of Bangladesh. Methods: Case study of a rural early intervention and rehabilitation centre (i.e., the model centre) implemented between May 2018 and September 2019. An economic evaluation incorporating gross margin analysis along with descriptive statistics was performed to assess the social business potentials of the model centre. Results: The establishment of this model centre cost ~5955 USD with an average monthly running cost of ~994 USD. During the 17 months study period, 7038 therapy sessions (average eight sessions per patient) were offered to 862 patients with musculoskeletal and neurological disorders. The most common clinical presentations were low back pain (35.6%; n = 307). Six percent (n = 52) of the attendees were children with CP (mean (SD) age 6.3 (4.0) years; 35.7% (n = 19) were female), who received 1392 sessions, on average 27 sessions per child. The centre reached the break-even point at the 13th month and remained profitable for the next 4 months of the study period. An average session fee of 2.2 USD resulted in a gross margin of -1458 USD and 1940 USD in 2018 and 2019, respectively. Revenue to cost ratios for the 2 years were 0.27:1 and 0.51:1 while average rates of return were −41.4% and 10.1%, respectively. Sensitivity analysis revealed that session numbers including 5000, 6000, 7000, 8000, 9000, and 10,000 were required to break even at the session fees of 3.0, 2.50, 2.0, 2.0, 1.5, and 1.5 USD, respectively. Conclusion: Our social business model of an early intervention and rehabilitation service provides evidence of enhancing access to services for children with CP as well as adults with disabilities while ensuring the sustainability of the services in rural Bangladesh.

Public-private partnership models for rehabilitation service delivery: A scoping review

“…Of the nine included studies, approximately 56% ( n = 5) were from Australia (Farquhar, Moran & Schmidt 2020 ; Schmidt & Dmytryk 2014 ) and the remainder 44% ( n = 4) from Hong Kong (Schoeb 2016 ), Denmark (Larsen, Aust & Høgelund 2017 ), Bangladesh (Al Imam et al 2022 ) and the Netherlands (Ijntema et al 2022 ) with a study each. Qualitative study designs were mostly retrieved (44%).…”

“…All included studies focused on physiotherapy services. The PPP models discussed by these included studies were as follows: business model (Al Imam et al 2022 ; Carr, Kidd & Maloney 2013 ; Farquhar et al 2020 ; Ijntema et al 2022 ), informal PPP recruitment model (Schmidt & Dmytryk 2014 ), new graduate physiotherapists’ education PPP model (Schmidt & Dmytryk 2017 ), individual funding (IF) model (Dew et al 2013 ), social health model (Schoeb 2016 ) and Falck’s rehabilitation model (Larsen et al 2017 ). The services provided varied and primarily targeted all individuals requiring physiotherapy ( Table 1 ).…”

“…Of the nine included articles in the review, four from Australia reported research findings that involved a business model (Carr et al 2013 ; Farquhar et al 2020 ), Bangladesh (Al Imam et al 2022 ), and the Netherlands (Ijntema et al 2022 ).…”

Early care and support for young children with developmental disabilities and their caregivers in Uganda: The Baby Ubuntu feasibility trial

“…Several trials have shown positive effects on child motor and cognitive outcomes and caregiver mental health (17,18) impairments (NDIs) and may not all have been particularly "at risk" (19)(20)(21)(22). Few studies to date, have examined the feasibility, acceptability, impact and cost-effectiveness of such programs in LICs, and how they might be integrated into existing community programs to promote health and access to early education, although studies are underway (23)(24)(25)(26)(27)(28). A systematic, sustained and coordinated approach to implementing and monitoring early detection and intervention initiatives is needed, to improve the life chances of millions of affected children and their families.…”

Editorial: Early Detection and Early Intervention Strategies for Cerebral Palsy in Low and High Resource Settings

“…The next three studies explored service utilisation, community interventions, and a social business model of early intervention and rehabilitation for people with disability in LMICs. A case study of a rural early-intervention and rehabilitation centre in Bangladesh was presented by Al Imam and colleagues [ 6 ]. It highlighted the sustainability of such a model centre in these settings, which is critical for the long term success of such initiatives.…”