Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 15

J Rehabil Med 2018; 50: 317–325 SPECIAL REPORT STRENGTHENING HEALTH-RELATED REHABILITATION SERVICES AT THE NATIONAL LEVEL Christoph GUTENBRUNNER, MD, PhD 1 , Jerome BICKENBACH, LLB, PHD 2–4 , John MELVIN, MD, PhD 3,5 , Jorge LAINS, MD 6,7 and Boya NUGRAHA, MS, PhD 1,8 From the 1 Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany, 2 Department of Health Sciences and Health Policy, Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, 3 Swiss Paraplegic Research (SPF), 4 ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland, 5 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA, 6 Centro de Medicina de Reabilitação da Região Centro, Tocha, 7 Universidade Católica Portugesa, Medicina Dentária, Centro Regional de Viseu, Portugal and 8 Graduate Program Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia Objective: One of the aims of the World Health Organization’s Global Disability Action Plan is to strengthen rehabilitation services. Some countri- es have requested support to develop (scale-up) rehabilitation services. This paper describes the measures required and how (advisory) missions can support this purpose, with the aim of deve- loping National Disability, Health and Rehabilita- tion Plans. Recommendations: It is important to clarify the involvement of governments in the mission, to de- fine clear terms of reference, and to use a syste- matic pathway for situation assessment. Informa- tion must be collected regarding policies, health, disability, rehabilitation, social security systems, the need for rehabilitation, and the existing reha- bilitation services and workforce. Site visits and stakeholder dialogues must be done. In order to develop a Rehabilitation Service Implementa- tion Framework, existing rehabilitation services, workforce, and models for service implementa- tion and development of rehabilitation professi- ons are described. Governance, political will and a common understanding of disability and rehabi- litation are crucial for implementation of the pro- cess. The recommendations of the World Report on Disability are used for reporting purposes. Conclusion: This concept is feasible, and leads to concrete recommendations and proposals for pro- jects and a high level of consensus stakeholders. Key words: World Health Organization Global Disa- bility Action Plan; National Disability Health and Rehabilitation Plan; rehabilitation advisory team. Accepted Feb 7, 2017, Epub ahead of print April 6, 2017 J Rehabil Med 2018; 50: 317–325 Correspondence address: Christoph Gutenbrunner, De- partment of Rehabilitation Medicine, Hannover Medical School, DE-30625 Hannover, Germany. E-mail: guten- [email protected] A pproximately 1 billion people worldwide experience disability, with increasing survival rates following severe disease and trauma, increa- sing prevalence of chronic health conditions, and population ageing (1). The prevalence of disabi- lity is higher in low- and lower-middle- income countries. Since rehabilitation, as a health strategy, aims to enables people experiencing disability to participate fully in all areas of life (2), it is arguably the health strategy of the 21 st century (3). Conse- quently, the World Health Organization (WHO) has identified health-related rehabilitation as an es- sential component of universal health coverage (4). The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD; (5)) states that access to rehabilitation is a human right. After assessing the global need for rehabilitation, the WHO has called in its Global Disability Action Plan (GDAP) 2014–2021 for action on the part of countries to “strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabi- litation” (4). Countries have formally committed themselves to this goal. However, it is not always clear how countries can meet this commitment, and what measures they need to take. Provision of rehabilitation services for all people in need is a huge challenge, particularly in low- and lower- middle-income countries. Information about the prevalence of disability in these countries is poor, and their health systems are generally less developed and health resources limited. There is also a lack of standardization of rehabilitation services, which leads to problems in goal-setting and implementation planning. The International Society of Physical and Rehabilitation Medicine (ISPRM) has made a comm