where to start?

In the face of challenges ranging from physician shortages and unequal resource distribution, to underfunded training and practice facilities and inadequate infrastructure, it's hard to recommend a starting point for improving rehabilitation services for the disabled population. Just making sure people have access to safe water and toilet facilities presents a challenge, providing rehabilitation services for the 95% of the disabled population in Ghana that does not even receive services seems like an issue too huge to address-- and in many ways thus it has been treated by the infrastructure. The government issued a persons with disabilities bill which appears to attempt to address some of the challenges the disability population faces in Ghana, though in reality it seems the government has been able to do little to put the bill into action. It has fallen to the community to adapt and fulfill its own needs-- as we saw in the example with the villagers who used donated motorcycles to establish a system that allowed a nurse and a medical assistant to travel through rural areas to administer basic services resulting in an increase in vaccination coverage to 75% from 40%. It is the ingenuity, resourcefulness and determination of the villagers and the professionals who stay (or return) to practice in their own country who make the difference in their communities. They are the ones who identify the needs and the opportunities for change and are able to make and execute plans for change that will get those needs met. When I first did the reading I thought, where would you even start, people don't even have clean water?! But perhaps I need to think less about that and be ready to just jump in where ever and go with the motorcycle riding vaccination team and the home grown birth attendant carrying her wares in a wooden box and let direction for the infrastructure come from the people to the government instead of expecting it to be vice versa.