THE IMPACT OF SOCIO-ECONOMIC STATUS ON CHILDREN'S ACCESS TO REHABILITATION SERVICES IN REPUBLIC OF MOLDOVA

Abstract

Objectives. National Statistics reports indicate there are about 15,000 children (aged 0-18) with varying degrees of disabilities. These children can access rehabilitation services in the capital city's third-level hospitals and at the municipal level, but there are no services available at the community level. Socio-economic status, among other factors, significantly impacts the accessibility of these rehabilitation services.

The aim of the study is to assess the initial situation of families to elucidate the social context in which the child grows and develops, and, subsequently, to determine and identify existing difficulties and risks affecting family functionality, and to evaluate perceptions regarding accessibility to rehabilitation among parents, based on their socio-economic status.

Material and Methods. The research comprises a cross-sectional study, which focuses on collecting data from 264 families (288 children), participating nationwide. The children benefited from a rehabilitation program within the Republican Rehabilitation Center for Children, between October 2023 and May 2024. The data were collected by applying the social survey, an internally adapted tool within the Republican Rehabilitation Center for Children, based on Annex No. 2 of the Order of the Minister of Labor and Social Protection No. 134 of September 15, 2023, and the support guide for the practical implementation of Case Management in the field of child protection. The social Case Management questionnaire (Ministry of Labour and Social Protection) was adapted by social workers to survey patients. When completing the questionnaires, bio-ethical principles were respected.

Results. The degree of disability was identified in 61% of cases (CI95: 50.7-71.3), with nearly half being severe, a rate twice that of developed countries. According to the type of disability, prevails motor disability – 34%, psycho-verbal – 22% and mixed – 4%. According to the age of the children with a degree of disability, more than half (62%) are between 6-18 years old, and 38% of the children are between 0-5 years old. It is determined that, out of the total number of children with a degree of disability (176 children), children with a severe degree predominate – 69% (CI95: 30.8-37.2). Of the total number of children, 29% (CI95:23.5-34.5) have at least one parent abroad, more than half of these children are in the process of determining the degree or already have a degree of disability. 20% of children grow up in incomplete families: most being incomplete following the divorce or separation of parents (55 families), the rest are incomplete following the death or detention of a parent. Of the total of children aged 4-17 years old, 15% require the use of diapers (44 children). More than half of the children (53%) come from families that have called at least once on social assistance services, predominantly the families come from rural areas, 121 children. Most of the families, about 70% (CI95:64.47-75.53), have significant difficulties in accessing rehabilitation services due to the costs, but also the geographical distance. Only 20% (CI95:15.17-24.83) reported easy access to rehabilitation services, and the other 10% of families (CI95:6.38-13.62) have a total lack of access to such services.

Conclusions. This study demonstrates that the economic aspects, the social context, the type of family in which a child who needs rehabilitation develops and grows, constitute and play an important role in terms of the entire rehabilitation process, starting from information, referral, access and the actual rehabilitation process. The multitude of socio-economic factors create difficulties that prevent the child from benefiting from rehabilitation, especially at an early stage, and also contribute to the fact that rehabilitation is not carried out systematically to ensure continuity, which is extremely important for increasing the efficiency of the rehabilitation process.