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