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