320 C . Gutenbrunner et al .
national language ; although a language barrier can also be overcome by a good interpreter .
Information collection
For the recommendations it is important to collect sufficient information about relevant policies in the area of disability and rehabilitation , the need for rehabilitation at the population level , the health and social security systems , and existing rehabilitation services and workforce . Three main approaches were used to gather this information :
Searching accessible statistical sources about the population , economy , epidemiology , and health policies , and the existing rehabilitation services and workforce , including information from WHO country reports and other UN agencies ( e . g . United Nations Development Programme ( UNDP )/ the Office of the United Nations high Commissioner for Human Rights ( OHCHR )).
• Asking the MOH and WHO country office for information specified in the Rehabilitation Service Assessment Tool 1 .
• Site visits with experts , users , decision-makers and persons with disabilities , to collect information to provide an important insight into the “ real ” situation and provide an impression of the lived experience of people living in the country . It is crucial to develop an understanding of the needs , existing services and policies in the country .
Site visits
For site visits , it is important to ensure that existing rehabilitation services and the most important stakeholders are visited . These stakeholders are , in particular , representatives of :
• the Ministry of Health ;
• the Ministry of Social Affairs ;
• other ministries involved ( e . g . the Ministry of Education , Ministry of Labour , Ministry of Justice , Ministry of Defence , and others );
• organizations of persons with disabilities ;
• professional organizations of rehabilitation professionals ;
• rehabilitation service providers ( including rehabilitation teams );
• institutions of rehabilitation research and epidemiology ( if they exist ).
1 For the missions performed thus far a self-developed
Rehabilitation Service Assessment Tool ( RSAT ) has been used and revised after testing . The authors have been informed that a WHO situation analysis tool is under development .
The local organizer of the site visit ( e . g . from the WHO country office ) should ensure that the rehabilitation services visited are representative of rehabilitation services in the country . The services visited should include hospitals and rehabilitation units as well as mobile and community-based services .
The views of relevant stakeholders ; not only government officials and rehabilitation professionals , but also organizations of persons with disabilities , must be involved in the information process . It is advantageous if the wider scientific community and its institutions are also involved .
Governance and political will
Rehabilitation service implementation ( as with other service implementation ) is dependent on governance and political will . Implementation will be influenced by responsibilities that are sometimes split between different stakeholders and even within governments : health-related rehabilitation is often the responsibility of the MOH , while social compensation and , in many cases , delivery of assistive devices , is the responsibility of the Ministry of Social Affairs , and the training of rehabilitation professionals is the responsibility of the Ministry of Education . Thus , it is important to investigate responsibilities for rehabilitation issues across all relevant government ministries . Rehabilitation is one of the health strategies and has equal value to those of prevention , curative care and health maintenance ( 3 ). If the responsibility is split between ministries , the manner of communication and coordination between ministries is important . Finally , the RAT should have knowledge of relevant laws and regulations ( both existing laws and those in preparation ).
The mission depends on being aware of how disability and rehabilitation is understood at government , expert and population levels . This includes cultural norms and attitudes . It is evident in the laws and policies of many countries , as well as in how these terms are used in the local language , that they do not follow the WHO definition of disability as “ the outcome of an interaction between a health condition and the person ’ s environment ” ( 9 ). Language use often represents attitudes towards people with disabilities and understanding of disability itself .
REHABILITATION SERVICE IMPLEMENTATION FRAMEWORK
In order to develop recommendations for service implementation , it is important to provide www . medicaljournals . se / jrm