Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 25

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Principles of assessment of rehabilitation services in health systems
Financing
Domains
Inputs & processes
Outputs
Outcomes
Infra-
stucture,
information
& communi-
cation Intervention access &
services readiness Coverage of
interventions
Health
workforce Intervention quality &
safety Prevalence of
functioning & disability
Impact
Improved health &
functioning outcomes
Equity of access
Social inclusion &
financial protection
Responsiveness
Supply
chain
Administrative resources
Data
Efficiency
Facility & service
assessment
Population based surveys
Clinical reporting systems
Analysis
Use
Process
Data quality assessment, estimates, in-depth studies, use of research results, assessment of health systems
Targeted & comprehensive reporting, regular review process, global reporting
Fig. 1. Principles of monitoring and evaluation of health systems strengthening (from WHO 2009-modified; (3)).
3 comes from facility assessments. Domains 4 and
5 are in in the outcomes and impact, respectively.
The se can be done by population-based surveys
which can provide information, including preva-
lence of disability, life situation, participation and
inclusion of persons with disabilities and social
status (see Fig. 1). As shown in Fig.1, all aspects
must be covered by data quality assessment,
estimates and projections, in-depth studies, use
of research results, assessment of progress and
performance and efficiency of health systems,
and should be used for targeted and compre-
hensive reporting, regular review processes and
global reporting. This matches the development
of National Disability, Health and Rehabilitation
Plans (NDHRP) (1) and their implementation
monitoring and evaluation.
According to the GDAP, health system con-
stituents, in combination with rehabilitation
principles, are crucial for the process of rehabi-
litation service implementation (4). Thus, these
principles have been used to develop a RSAT for
use in missions developing NDHRP.
DEVELOPMENT PROCESS
In order to develop a checklist for important in-
formation for rehabilitation service implementa-
tion the following steps were undertaken by the
authors in iterative discussion with teams in the
missions (5–7):
• Drafting the preliminary RSAT INTR
using
principles as defined in the World Report on
Disability (8), the WHO GDAP (4), the health
system building blocks (3), the International
Classification of Health Accounts (9), available
definitions and descriptions of rehabilitation
services (8, 10, 11), and based on the expe-
riences gained during the technical consultancy
to develop a National Disability and Health
Plan for Egypt (6);
• Testing the draft preliminary RSAT by using
it for the development of a NDHRP for Ukraine
(5) and modifying it on the basis of the model
testing; and finally,
• Developing a RSAT, which has been
tested in a mission for the Democratic
People’s Republic of Korea (7).
Principles
With regard to rehabilitation service implementa-
tion the 6 health system building blocks (12) can
be modified as follows:
A. Rehabilitation service delivery (e.g. reha-
bilitation units in hospitals, rehabilitation
centres, community-based rehabilitation
services, assistive devices, integrated and
multi-professional service delivery).
B. Rehabilitation workforce (e.g. physical and
rehabilitation medicine, physiotherapy, oc-
cupational therapy, speech and language
therapy, prosthetics and orthotics, rehabilita-
J Rehabil Med 50, 2018