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RIWC_PARA_A187 strengthening rehabilitation in the health system worldwide

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A187 strengthening rehabilitation in the health system worldwide

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RIWC_PARA_A187 strengthening rehabilitation in the health system worldwide

  1. 1. 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 International 27.10.2016 Presenter: Boya Nugraha
  2. 2. 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
  3. 3. WHO‘s Global Disability Action Plan (GDAP): 2014-2021
  4. 4. 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
  5. 5. 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.
  6. 6. 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
  7. 7. ISPRM-WHO Collaboration Plan: 2014-2017
  8. 8. 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)
  9. 9. 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 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.
  10. 10. Strenghtening Rehabilitation Services
  11. 11. 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
  12. 12. 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
  13. 13.  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
  14. 14. 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 requestsrequests Investigates and develops recommendations Investigates and develops recommendations contractscontracts
  15. 15. 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 Tool GDAP:Global Disability Action Plan: 2014-2021 WRD: World Report on Disability Health Systems Building Blocks WHO & Ministry of Health
  16. 16. 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)
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20.  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)
  21. 21.  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)
  22. 22. 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
  23. 23. 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
  24. 24. Thank you very much! Boya Nugraha, MS, PhD Nugraha.Boya@mh-hannover.de Department of Rehabilitation Medicine Hannover Medical School Carl-neuberg-Str.1, 30625-Hannover, Germany

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