riwc_para_a187 strengthening rehabilitation in the health system worldwide
TRANSCRIPT
Strengthening Rehabilitation in the Health System Worlwide
Prof. Dr. med. Christoph Gutenbrunner, Prof. Dr. med. Gerold Stucki, Boya Nugraha, MS, PhD
23rd World Congress of Rehabilitation International27.10.2016
Presenter: Boya Nugraha
Overview
• The WHO Global Disability Action plan: 2014-2021
• The ISPRM-WHO Collaboration Plan 2014-2017
• Strengthening rehabilitation service• Strategy
• Methodology
• Results (Examples)
• Egypt
• Ukraine
WHO‘s Global Disability Action Plan (GDAP): 2014-2021
GDAP: Relevant Aspects
It addresses health (and functioning)
It calls (and urges governments) for concrete action (with measurable outcomes)
The strengthening and implementation of rehabilitation services (where needed) is directly addressed
It is based on a comprehensive understanding of rehabilitation
It stresses the importance of data collection and research
It is a huge step towards defining health-related rehabilitation as part of universal health coverage
GDAP: Objectives
1.To remove barriers and improve access to health services
and programmes
2.To strengthen and extend rehabilitation, habilitation,
assistive technology, assistance and support services, and
community-based rehabilitation.
3.To strengthen collection of relevant and internationally
comparable data on disability, and support research on
disability and related services.
GDAP: Objectives
2.4 Expand and strengthen rehabilitation and
habilitation services ensuring integration, across
the continuum of care, into primary (including
community), secondary and tertiary levels of
the health care system, and equitable access,
including timely early intervention services for
children with disabilities
3.1 Improve disability data collection through the
development and application of a standardized
model disability survey
ISPRM-WHO Collaboration Plan: 2014-2017
ISPRM-WHO Collaboration Plan 2014-2017
• Specific area of collaboration 1: Learning Health Systems for Spinal Cord Injury, an initiative incl. international spinal cord injury survey (in co-leadership with ISCoS)
• Specific area of collaboration 2: Fast Response Teams on strategies and plans of rehabilitation and related services
• Specific area of collaboration 3: ICF based routine data collection in national health information systems
• Specific area of collaboration 4: Contribution to WHO meetings and consultations and collaboration with other WHO departments (FIC, EMTI)
Matrix of Association: GDAP and ISPRM-WHO Coll. Plan
ISPRM-WHO Coll Plan
Collaboration project 1: Learning Health Systems for Spinal Cord Injury, an initiative incl. international spinal cord injury survey (in co-leadership with ISCoS)
Collaboration project 2: Fast Response Teams on strategies and plans of rehabilitation and related services
Collaboration project 3: ICF based routine data collection in national health information systems
GDAP Objective
1To remove barriers and improve access to health services and programmes
2To strengthen and extend rehabilitation, habilitation, assistive technology , assistance and support services, and community-based rehabilitation.
3To strengthen collection of relevant and internationally comparable data on disability, and support research on disability and related services.
Strenghtening Rehabilitation Services
Specific Collaboration Area 2: fast response team (Rehabilitation Service Situation Analysis & Implementation)
• To carry out consultations with countries on request and suggested by the DTO aiming at strengthening rehabilitation services and building capacity of the rehabilitation workforce
• To provide matrix and checklists to analyse existing rehabilitation services as well as to identify gaps in service provision
• To establish Rehabilitation Services Advisory Teams of experts with global and regional health systems understanding that can provide guidance to governments
• (…) This includes Rehabilitation Service Advisory Meetings and Stakeholder Dialogues
Specific Area Collaboration 2: Rehabilitation Service Implementation
Goal: Giving advice for rehabilitation planning on request of country and WHO
Experts: 1-3 experts with global health systems perspective, clinical knowledge and understanding for local situation (incl. language and culture)
Working principles: Applying principles, recommendations and actions of WRD and GDAP
Working methods: Data collection, consultation with stakeholders, site visits, stakeholder dialogue
Outcome: Report with National Disability, Health, and Rehabilitation Plan incl. recommendations
Guiding principles:
◦ Assessment of existing services (incl. workforce)
◦ Development of recommendations & projects
◦ Stakeholder dialogues
Tools (some are still under development):
◦ Rehabilitation service assessment tool (RSAT) (under development-WHO)
◦ International Classification of Service Organization in Rehabilitation (ICSO-R) (Gutenbrunner et al. 2015)
◦ Rehabilitation Service Implementation Framework (RSIF) (under development)
◦ WHO Health Systems Building Blocks (WHO, 2010)
Recommendations:
◦ According to WRD or GDAP
Specific Area Collaboration 2: Rehabilitation Service Implementation
Specifi Collaboration are 2: Rehabilitation Services Implementation Strategy Cycle
Government (Ministry of Health)
Government (Ministry of Health)
WHO (country office)
WHO (country office)
ISPRM-WHO-LC (Rehabilitation
Advisory Teams)
ISPRM-WHO-LC (Rehabilitation
Advisory Teams)
WHO (Geneva Headquarters)WHO (Geneva Headquarters)
National Disability, Health and
Rehabilitation Plan
National Disability, Health and
Rehabilitation Plan
requestsrequests requestsrequests
requestsrequestsInvestigates and
develops recommendations
Investigates and develops
recommendations
contractscontracts
Rehabilitation Service Implementation Strategy
Rehabilitation Advisory Team
Collecting data
Visit Country I
Collecting additional data (Stakeholders dialogue), site visits
Analyse and drafting
recommendation
Visit Country II
Prioritizing and consensus of Recommmendation
(Stakeholders Dialogue)
Final Recommendation
Transpose to Health Systems Building Blocks
RSAT GDAP/WRD
RSAT: Rehabilitation Situation Assessment ToolGDAP:Global Disability Action Plan: 2014-2021WRD: World Report on Disability
Health Systems Building Blocks
WHO & Ministry of
Health
Rehabilitation Service Implementation
National Disability Health and Rehabilitation Plan
• Egypt (Christoph Gutenbrunner) (on behalf of WHO)
• Ukraine (Christoph Gutenbrunner, Piotr Tederko, Klemen Grabljevec)
(on behalf of WHO)
• Democratic People‘s Republic of Korea (Boya Nugraha and
Christoph Gutenbrunner) (in collaboration with Handicap International)
Egypt Mission: Situation analysis (examples)
Data on the prevalence of disability seems to be inconclusive
In the Ministry of Health and Population, the only person responsible for disability issues and only working on children with special needs
Some rehabilitation professions are not existent, such as OT and P &O
The health insurance system does not cover all population groups.
Results
Recommendations: examples (Egypt)
Defining disability as a priority of health policies and rehabilitation as a major health strategy to be implemented in all sectors of health care (rehabilitation as universal health coverage)
Include detection on the prevalence of disability into all health surveys
Establish training programs for (missing) rehabilitation professions (occupational therapists, prosthetists and orthotists, speech and language therapists, visual and
auditory trainers) as well as primary health care rehabilitation workers
Projects: examples (Egypt)
Translate relevant international documents on disability and
rehabilitation into Arabic language and make culturally adapted
explanations (of definitions)
Develop feasible and culturally accepted tools to use the ICF in
health reporting and clinical assessment of disability and
functioning (...)
Perform a model disability survey in one or two different model
regions using the model disability survey, and include
functioning properties in the registry of diseases
Responsibilities for disability and rehabilitation are split-up into two ministries
The understanding of disability and rehabilitation is not compatible with the international understanding of disability
The rehabilitation professionals are not trained according to international standards.
ResultsUkraine Mission: Situation analysis (examples)
Health related rehabilitation services must be implemented at all levels of health care (primary, secondary, tertiary) and for all phases of health care (acute, post-acute, long-term).
The primary health care sector needs to take a stronger role in long-term rehabilitation and as an entrance point for specialized rehabilitation services
In order to establish a high-qualified rehabilitation workforce international definitions and curricula of rehabilitation professions should be implemented
Results Ukraine Mission: Recommendations (examples)
Recommendations: examples (Ukraine)
Health related rehabilitation services must be implemented at
all levels of health care and for all phases of health care. As in
Ukraine many rehabilitation services already exist, a transition
plan should be developed.
In order to establish a high-qualified rehabilitation workforce
international definitions and curricula of rehabilitation
professions should be implemented (…). Here also, a transition
plan is required
Results Ukraine Mission: Projects (examples)
Perform an expert workshop to find and agree on an appropriate translation of term “disability”, “functioning”, and other related terms
Perform a population-based survey of the prevalence on disability with internationally accepted
methods in two regions of Ukraine
Develop curricula for rehabilitation professionals according to the “choosing the best” from international models
Thank you very much!
Boya Nugraha, MS, [email protected]
Department of Rehabilitation MedicineHannover Medical School
Carl-neuberg-Str.1, 30625-Hannover, Germany