Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 24

J Rehabil Med 2018; 50: 326–332 SPECIAL REPORT PRINCIPLES OF ASSESSMENT OF REHABILITATION SERVICES IN HEALTH SYSTEMS: LEARNING FROM EXPERIENCE Christoph GUTENBRUNNER, MD, PhD and Boya NUGRAHA, MS, PhD From the Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany Objective: Strengthening of health-related re- habilitation services must start from the needs of persons with health conditions experiencing disability and should be implemented within health systems. The implementation of rehabili- tation services in health systems should be plan- ned and realized according to the World Health Organization’s 6 constituents of health systems (i.e. health service delivery; health workforce; health information systems; essential medicines; financing; and leadership and governance). The development of recommendations based on situ- ation analysis and best-available data is crucial. Methods: In order to facilitate such data collec- tion at a national level, a checklist and a related questionnaire (Rehabilitation Service Assess- ment Tool (RSAT)) were developed and imple- mented. The following steps were followed to develop a checklist for implementation of reha- bilitation services: a literature search, drafting, checking and testing the list, and development of the RSAT. Results: The RSAT comprises 8 sections deri- ved from 5 main domains of the most important areas of information (i.e. country profile; health system; disability and rehabilitation; national policies, laws, and responsibilities; and relevant non-governmental stakeholders). Conclusion: The implementation of RSAT in dif- ferent missions has shown that the principles are working well and that RSAT is feasible and helpful. Further field testing is important and the development of an internationally agreed tool should be promoted. Key words: rehabilitation service assessment; health system building blocks; rehabilitation ser- vice implementation. Accepted May 11, 2017; Epub ahead of print Jun 28, 2017 J Rehabil Med 2018; 50: 326–332 Correspondence address: Christoph Gutenbrunner, De- partment of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625-Hannover, Germa- ny. E-mail: [email protected] R esponding to the Global Disability Action Plan 2014–2021 (GDAP) of the World Health Organization (WHO), “the implementation of measures that are designed to meet the rights of persons with disabilities” is a high priority for all member states of the United Nations. In order to develop national implementation plans, methods and tools are needed for the analysis of doi: 10.2340/16501977-2246 rehabilitation needs and existing policies, services and workforce. This paper describes the development of a draft Rehabilitation Service Assessment Tool (RSAT) and provides a draft proposal for such a checklist/ questionnaire. The aim is to provide a feasible tool for collection of information relevant to the development of National Disability, Health and Rehabilitation Plans (NDHRP) for supporting countries to develop policies on disability and rehabilitation, and to implement rehabilitation services including training of a highly qualified rehabilitation workforce (1). According to the WHO the following 6 compo- nents are essential in order to build health systems and/or implement health services (2): 1. health service delivery; 2. health workforce; 3. health information systems; 4. access to essential medicines; 5. financing; 6. leadership and governance. For monitoring and implementation of health services, the WHO suggests the sequence shown in Fig. 1. This is also relevant for implementing (new or additional) rehabilitation services in health systems and for monitoring and evaluation of such services. Thus, the assessment of rehabilitation services should include the following domains: 1. Governance and financing as an essential pre- condition of rehabilitation service delivery. 2. Infrastructure technologies, workforce, supp- ly chain and information as essential parts of rehabilitation service organization (domains 1 and 2 represent inputs and processes). 3. Rehabilitation interventions including ac- cess, readiness, quality and safety (outputs). 4. Coverage of rehabilitation interventions (including assistive devices) and prevalence or level of impairment (outcome). 5. Improved health and functioning as well as equity, social and financial risks (impact). This also will improve responsiveness to the need of persons experiencing disability and efficiency of service delivery. To evaluate domains 1 and 2 administrative sources must be assessed. Information on domain This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2018 Foundation of Rehabilitation Information. ISSN 1650-1977