NCDs, disability & rehabilitation in Nepal's Public Health System - A summary in view of World Health Organisation's action plan and future needs on strengthening the health system for emerging health needs.

1. NCDs, Disability and Rehabilitation
in Nepal’s Public Health System:
Strengthened National agencies for policy
and practice reform
Wesley Pryor, PhD
Principal Adviser, Rehabilitation – HI Federation, Asia

2. BACKGROUND
Physical rehabilitation, disability & NCDs

3. Public Health & Rehabilitation
• Limited rehabilitation in health policy
• NCD data are usually available
• Current high level reports (STEPS) exclude
disability
• Very limited economic data on rehabilitation
impact

4. NCDs
Health
Disability
Rehab.
Rehabilitation of disabling
disease / Rehabilitation as
secondary prevention
Understanding disabling effects
of NCDs / increasing profile of
musculoskeletal implications of
NCDs
Access to health for people with
disabilities / health implications
of disability
Access to and effectiveness of
physical rehabilitation services /
CBR

5. NCDs, Maternal Health & Nepal
• NCDs account for more than 50% of all deaths
• Injury another 7%
• Cardiovascular disease and diabetes the greatest
contributors
• Perinatal death is disproportionately high
• Low-birth weight & prenatal issues large
contributor to disability burden

6. RESEARCH FOR PUBLIC HEALTH
CAPACITY
Physical rehabilitation, disability & NCDs

7. Three linked research areas
WHA 66.9 & WRD DAP
1. Health of people with disabilities
2. Disability in mainstream healthcare: Access &
effectiveness
3. Disability in specific healthcare: Continuity of
care, innovative programming, medium-term
impact

8. 1. Health of people with disabilities
• Policy analysis – is Nepal’s suite of health
policy disability inclusive?
• What is the health of people with disabilities
compared with matched controls – A disability
& health survey

9. 2. Access to mainstream health
• Retrospective study of experience with
mainstream health of people with chronic
disabilities
– Pre-morbid situation
– Continuity of care
– Qual/quant

10. 3. Access to specific health
• Retrospective clinical audit of gaps in
continuity
• Prospective research: The health and QoL
impact of inclusive health policy
• Cohort study: Monitoring post stroke or
childhood disability for 2.5-3 years

11. Key question Population DVs Methods Agencies
1
Policy analysis – is Nepal’s
suite of health policy disability
inclusive?
-
‘Equiframe’ disability
component +
Systematic review,
policy analysis,
consensus development
Research Lead Implementing Other
U.Syd,
PHFN
Trinity? MoH,
WHO, UNICEF,
disability
group
Health of people with
disabilities compared with
matched controls – A disability &
health survey
People with disabilities in
representative districts
and controls. 100/100
Demographics, Core suite
NCD indicators
Health consumption
indicator survey
Household survey / link
with SINTEF?
NHRC,
PHFI
PHFN
MoH, disability
group? PHC
actor, Nurses,
PTs
2
Retrospective study of
experience with mainstream
health of people with chronic
disabilities
People with disabilities in
multiple districts.
Including those who have
and have not accessed
rehab services
MMCI, indicators of type of
services, quality of services,
demographics, + qualitative
& thematic review
Survey, interviews U.Syd PHFN
Disability
group?
3
Retrospective clinical audit of
gaps in continuity MMCI modified for rehab,
functional outcomes, RTW
or other economic
indicators
Surveys, interviews U.Syd PHFN PHC actors
The health and QoL impact of
inclusive health systems: A
prospective study
People who receive a
package of
comprehensive care
Intervention
Surveys, interviews
U.Syd
PHFN, HI,
Service
providers
Cohort study: Monitoring post
stroke or childhood disability for
2.5-3 years
People who are injured,
have a stroke or cardiac
event in multiple districts
Health, function and
economic indicators, QoL,
mortality
Surveys, periodic
surveillance
PHFI /
U.Syd
Service
providers
, PHFN,
HI
PHC agencies?

12. Methods Capacity development areas Activities Remarks
1 2 3 4 5
1
Systematic review,
policy analysis,
consensus
development
Current disability policy     
Disability theory  
Disability in public health  
Disability in surveillance 
Research agendas in disability, policy & NCDs 
2
Household survey / link
with SINTEF?
Interplay between NCDs and disability  
Disability and health / disabling diseases   
Contemporary rehabilitation services  
Current evidence on rehabilitation and health   
Survey, interviews
Access and barriers to health consumption in
people with disabilities
   
3
Intervention
Surveys, interviews
Best practice in disability inclusive programming
CBR, current good practice and evidence
    
Contemporary rehabilitation services, health, social
and mobility indicators of effectiveness of
rehabilitation
   
Surveys
Surveillance on key health and higher-order
indicators of participation
  
Key
1 Short courses / CPD /
other
2 Exposure visits
3 Regional workshops
4 Leadership devt
5 Collaborative
research

13. Key result Objective Activities Output Link to research Agencies
1 National
level
Build expertise in
disability, health and
rehabilitation
Support with better
awareness of current
evidence base and
through new, locally
specific data
Policy analysis, short courses,
exposure, empirical research,
national events
‘Equiframe’ disability
component +,
publications, Better
awareness in health
workers about
disability,
rehabilitation and links
with CBR
Systematic review,
policy analysis,
consensus
development
Research
Lead
Implementin
g
Other
U.Syd,
PHFN
Trinity?
MoH, WHO,
UNICEF,
disability
group
2
South-south
cooperation
Regional interaction
Training on policy
development, advocacy
In country consultations,
disability and NCD specific
training, empirical research
Bi-yearly meetings to monitor
action
Demographics, Core
suite NCD indicators
Health consumption
indicator survey,
publications, scaling
rehab monitor
Household survey /
link with SINTEF?
NHRC,
PHFI
Nepal
MoH,
disability
group? PHC
actor,
Nurses, PTs
3
Global
collaboration
Global expertise in the
interface between
disability, health and
rehabilitation and in
developing research
agenda
Exposures to conference and
symposiums,
Link up with aid agencies
working in nepal to disseminate
information and build basic
awareness of the interface
between MCH and infant
mortality action and CBR/
rehab services
Publications,
leadership
development
Cohort study,
prospective
research on rehab
outcomes,
retrospective work
on understanding
service gaps
All 4 ?

14. @wespryor_