Equitable service delivery for children with communication difficulties in the Maldives: Finding the perfect fit

Abstract

Aim: The aim of this thesis was to examine an underserved community, the Maldives, in order to identify equitable speech-language therapy (SLT) service delivery approaches for children with communication difficulties living in remote regions. A framework was developed to achieve this, which required exploration of three specific areas: the ‘current situation’, ‘technological capacity’ and ‘resources and opportunities’ available in the context. Methods: A convergent mixed methods approach was used, involving (a) 62 online documents, (b) surveys with 73 parents of children with communication difficulties, 107 teachers and 25 island councillors, (c) interviews with 27 mainstream teachers, four special education needs teachers, four principals, three speech-language therapists (SLTs), three non-governmental organisations (NGOs), six atoll councillors, one information and communication technology (ICT) government official and one Ministry of Education official, and (d) school observations from four remote schools of the Maldives. Content analysis was used to analyse the data. Findings: The Maldivian population experienced barriers related to geography, dispersed population and transport limitations to access services. The current services were not adequate to meet the needs and remote regions received marginal services. The government provided financial aid for people with disabilities and students with special education needs in schools. Almost 100% of the population had access to mobile phones and mobile broadband internet. Most parents and teachers were active and frequent ICT users. SLTs delivered individualised and rehabilitative therapy in the capital island. NGOs were trialling alternative service delivery approaches to cater to remote regions. SLT services were not available in schools. Opportunities to enhance classroom communication support was discovered. Teachers were eager to receive training from SLTs. Stakeholders suggested possible measures to improve services including engaging active community groups and raising awareness. Conclusions: The findings of the study support the potential for alternative service delivery approaches. These may include, using available ICT in schools and households to provide asynchronous SLT services, collaborating with service providers and the community to reallocate and redistribute existing resources, building capacity among parents, teachers and community groups to create community-based communication workers, and using community-based support systems for prevention, early identification and intervention of communication difficulties.