324 C. Gutenbrunner et al.
national professional groups, who may be in competition. Experts in service provision and financing( e. g. health insurance) should also be consulted.
• It is important that RAT missions are carried out on behalf of the WHO( or another international organization) to ensure that there is“ objectivity” underlying the mission. Lobbying for any specific interest is contraproductive. It is important that RAT members develop a good understanding of the situation in the country as well as having a clear understanding of health, disability and rehabilitation principles. RATs must work with empathy and sensitivity regarding local expertise and cultural backgrounds.
• Stakeholder dialogues are an important tool to reach consensus in the country. Approximately 70 % of the recommendations from the RATs were agreed without any controversial discussion. The other recommendations were agreed after explanation and discussion; some with modifications. During the stakeholder dialogues a few additional recommendations and projects were proposed and agreed. The prioritization exercise provided good insight into the predominant needs and led to an understanding of specific challenges.
Recommendations
The resulting recommendations at the country level included the following topic areas:
• Understanding of disability and goal-setting in disability and rehabilitation policies.
• Working structures within and between ministries.
• Data collection and surveys on prevalence of disability and the need for rehabilitation.
• Standards of rehabilitation services and principles of implementation( including technical equipment).
• Strengthening rehabilitation workforce according to international standards( including description of professions and academic curricula), including community-based rehabilitation workers.
• Improving knowledge about disability and rehabilitation of all health professionals, as well as influencing positive attitudes towards disability in the general population.
• Suggesting concrete implementation projects, including model rehabilitation services, training sites as well as local or regional disability surveys.
• Research on implementation and outcome in the field of health-related rehabilitation.
Experience at the country level shows that it would be helpful if WHO headquarters, in collaboration with regional and country offices, took a strong role in the following aspects:
• translating and culturally adapting documents( including definitions, classifications, checklists, and assessment questionnaires). This must include not only the official WHO languages. In Egypt, for example, the medical workforce speaks English for healthcare purposes, but Egyptian Arab is required for translation of patients’ assessments. In the Ukraine, using Russian makes documentation available to a high proportion of professionals and other populations, but is a barrier to wider use, as Ukrainian is widely used and provides national identity. It is important to facilitate the translation and description of disability and functioning to national languages;
• providing and lobbying for a uniform system of disability data collection, and supporting model testing. These systems could be the Model Disability Survey that has been developed, and which uses a common definition of, and conceptual framework for, disability based on the International Classification of Functioning, Disability and Health( ICF)( 20).
• supporting the implementation of the abovespecified rehabilitation services, and collecting and publishing data regarding evidence about whether these services result in better outcomes( e. g. by the Rehabilitation Guideline Development Group).
CONCLUSION
The application and testing of this plan for conducting missions to strengthen rehabilitation services at the country level in Egypt, Ukraine and the DPRK shows that it is feasible and can lead to concrete recommendations and proposals for projects and a high level of consensus of stakeholders. However, more projects should be carried out, and internationally agreed tools for data collection and implementation goals( i. e. model rehabilitation services and standards for rehabilitation workforce competencies) developed.
REFERENCES
1. World Health Organization, The World Bank. World report on disability. Geneva: WHO; 2011. www. medicaljournals. se / jrm