Expanding Access to Training: Hybrid training course for trainers to increase the provision of appropriate manual wheelchair services in the Dominican Republic
International Society of Wheelchair Professionals (ISWP) (
In 2019, the National Social Security Council from the Dominican Republic included manual wheelchairs and cushions in the Health Services Plan. Since then, ISWP initiated a partnership with the National Council on Disabilities (CONADIS) from the Dominican Republic with the support of the Pan-American Health Organization (PAHO) to strengthen the country’s wheelchair sector capacity. The first goal of this partnership was to strengthen the wheelchair provision workforce. A hybrid training of trainers’ course was conducted. The goal is to equip trainers to train wheelchair service personnel to provide appropriate manual wheelchairs which will enable wheelchair users to live an independent live.
ISWP estimates that 23 million wheelchairs are needed per year. Currently, about 3 million wheelchairs are produced each year, resulting in a 20 million deficit. This gap is in part due to an insufficient wheelchair workforce. The objective of our training was to help address this barrier by enhancing local capacity to train more wheelchair providers according to the WHO guidelines for appropriate wheelchair service in the Dominican Republic. An appropriate wheelchair is a fundamental human right for the wheelchair user, enabling him/her to transition from exclusion to inclusion to participate in all societal activities, sports and recreation, which all lead to independence, education, decent work, good health and improved quality of life but may also have an impact on the prevention of falls, further impairments and premature death.
For individuals who need a wheelchair, access to an appropriate product through appropriate services is a requirement for not being left behind in the sustainable development agenda. Wheelchair provision is about enabling people with disabilities to become mobile, remain healthy and participate fully in community. We trained 10 participants in the hybrid training of trainers’ course, based on the World Health Organization Wheelchair Service Training of Trainers' Package. They will now teach and make use of the skills, technologies and capacities to build the local wheelchair service network.
Since 2012, the WHO has published a series of open-access training packages to support the capacity building of wheelchair personnel and services around the world. These training packages are intended to be delivered in-person by experienced trainers. As an alternative training approach, in 2016, ISWP developed a hybrid course based on the WHO Wheelchair Service Training Package – Basic Level. It was pilot tested in 4 countries, and based on the positive feedback, ISWP developed several other online courses. The hybrid methodology uses a combination of self-paced online modules, live video conference meetings, and in-person sessions. It reduces the in-person training requirement, making it easier to scale and more adaptable to different training environments such as conferences and continuing education programs at universities. The hybrid training of trainers’ course in the Dominican Republic consisted of both synchronous (e.g., instantaneous exchange of information, webinars & live Q&A chats) and asynchronous activities (e.g., information sharing that is not live or instantaneous, email exchanges, discussion board & training modules). In week 1, participants engaged in an orientation session, completed the first half of the online modules and also attended recitations with the facilitators which were held online by video conference. In week 2, participants continued to complete the second half of the online modules and participated in another recitation. The online content was presented in such a way that each participant had to dedicate between 4-6 hours of individual study each week, including participation in a 90-minute video conference for recitations. In the final week, the in-person content was taught over two days virtually by the facilitators.
All participants answered the online survey anonymously. In summary, everyone was satisfied with the course. About the facilitators, participants mentioned that they were punctual, flexible and well prepared. Regarding the time spent online, 7 were satisfied and 3 were neither satisfied nor dissatisfied. Key messages were that the satisfaction with the courses was very high, which indicates that blended courses are an appropriate mechanism for the context as long as all the required factors are available: motivation, connectivity, platform and appropriate facilitation. The improvement in knowledge in the provision of wheelchairs measured by the ISWP test indicates that the hybrid course has an effect on knowledge. The constant, open and flexible collaboration between CONADIS and ISWP made it possible to implement the program and overcome all the challenges that arose. CONADIS will implement a series of trainings in 2021 where the cohort of new trainers will train wheelchair providers.
Online learning can be as demanding and effective as in-person training. To adequately meet the requirements of the course, each participant was required to have a computer, or a smartphone, and permanent access to the internet with minimum bandwidth throughout the course. PAHO financially supported this training. CONADIS provided all the support needed for the in-person session, including training tools and food for the participants. Initially, the plan was for the facilitators to travel to the in-person training, but they delivered all sessions virtually. It was cost-efficient since the number of in-person training days were reduced,
The hybrid training of trainers' course is hosted in ISWP's Wheelchair International Network (WIN) which supports this training to be used in any part of the world with internet access. This training provides evidence that the participants’ knowledge gain in wheelchair service training principles was not reduced when engaged in learning online which is typically delivered in-person. The participants who completed this training have access to the courses anytime through their WIN profile if they would like to review them as refresher in the future. We intend to replicate this training model in neighbouring regions. In WIN, people can find and connect with others and continue to increase awareness of and build a health community around the right to personal mobility. The training resources are readily available on WIN.
CONADIS’ commitment to the rights of persons with disabilities allowed this partnership to succeed in the midst of the pandemic challenges. Initially, this training was intended to be an in-person training. There was resistance to do a blended approach due to unstable internet access and limited successful experience with online learning. Due to COVID-19 restrictions, the program was implemented in a hybrid format. Significant planning and troubleshooting were undertaken to overcome the perceived digital barriers. It is important to highlight that the facilitators connected virtually even for the in-person sessions since international travel was restricted. The training was successful, which opens opportunities to explore similar training mechanisms in the future to help save costs.
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