Manual Wheelchairs - World Health Organization

3.4.2 Referral networks
servIce delIvery I 87
Referral networks play a crucial role in wheelchair service delivery. Well-functioning referral
networks help to ensure services are accessible to users. Referral networks may consist of health
and rehabilitation personnel or volunteers working at community, district or regional level.
The importance of a strong link between specialist services and rehabilitation or health care
programmes is stressed in a joint statement of the International Society for Prosthetics and Orthotics
and WHO (6).
Wheelchair services are an example of a specialized service that cannot always be fully provided
within every community. In developing countries, the majority of those people with disabilities live
in rural areas and find it difficult to access rehabilitation services, which are often restricted to large
cities (7,8). Health and rehabilitation workers therefore need to play a proactive role in ensuring
that people living in rural areas can also access wheelchair services without difficulty.
The role of referral networks in wheelchair service delivery can include:
• identifying and referring people requiring wheelchairs;
• liaising between the users, their families and the wheelchair services to facilitate assessment,
fitting and follow-up;
• reinforcing wheelchair service training such as pressure sore prevention, prevention of secondary
complications, wheelchair maintenance and mobility skills;
• providing support, advice and possibly assistance in adapting the user’s home environment;
• encouraging measures to facilitate accessibility in the community;
• providing information to the wheelchair services about the acceptability and use of prescribed
wheelchairs;
• assisting the user to arrange repairs, and
• promoting the benefits of wheelchairs.
3.4.3 Service personnel
Wheelchair service personnel carry out managerial, clinical, technical and training duties (see Fig.
3.4). These roles may be fulfilled by personnel from a range of training and educational backgrounds.
They may also overlap: in a small service, for example, one person could carry out both the clinical
and technical roles. In another scenario, one person could carry out the clinical, training and
management roles with the support of a part-time technician.
At times, particularly when working with users who have complex needs, personnel may draw
on the expertise of other specialists such as occupational therapists, physiotherapists, speech
and language therapists, paediatricians, neurologists, physiatrists, orthotists, prosthetists and
orthopaedic specialists.
3