Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 33

Developing a National Disability, Health and Rehabilitation Plan for Egyp
tians. The system covers all diseases, and the
contribution, or exemption from contribution,
of citizens is regulated by law according to their
income levels (…)
• The state is committed to improving the doctors,
nursing staff and workers in the health sector.”
In order to achieve these goals, health expenditure
should be doubled and increase to 3% of GDP.
The rights of persons with disability are
guaranteed in Article 81 of the constitution:
“The state is committed to ensuring the rights of
persons with disabilities and dwarves [sic], in
all aspects; health, economic, social, cultural,
entertainment, sports and education, and provide
job opportunities for them, with the allocation of
a percentage of jobs to persons with disability,
and also is committed to the creation of enabling
public facilities and environment surrounding
them (…)”.
Main findings from site visits
In summary, the main findings from site visits
were:
• Data on the prevalence of disability are incon-
clusive. Such data do not agree with internatio-
nal data-sets (8). This may be due to the method
of data collection, starting with the understan-
ding or definition of disability (the survey
appears to concentrate on congenital disability
and neglect acquired disability), the method of
data collection (interviews in family homes)
and/or cultural or societal attitudes (e.g. the
trend to hide disability in public). Data on the
prevalence and incidence of diseases frequently
causing disabilities is very scarce; however, the
few available data suggest a high and unmet
need for health-related rehabilitation.
• In the MOHP, a single person is responsible
for disability issues She works in the integra-
ted care and nursing sector and is responsible
only for children with special needs. No cross-
sectional strategy to deal with disability issues
and promote rehabilitation was seen. A strong
sector with the power to make decisions ap-
pears to be lacking.
• Some rehabilitation services (e.g. assistive
devices) are delivered under the responsibility
of the Ministry of Social Solidarity. Coordina-
tion with rehabilitation professionals is weak
and technical standards are lacking. This leads
to insufficient use of such devices, which may
impact on the activities and participation of
persons with disability.
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• Health-related rehabilitation services under the
direction of the MOHP exist in hospitals and
primary healt hcare centres. In addition, there
are some health-related rehabilitation services
outside MOHP responsibility. Many of these
services do not reach international standards
in terms of human resources and technical
equipment. Also, there appears to be no com-
prehensive plan on the need for rehabilitation
services along the continuum of care and across
levels of healthcare and for all ages (e.g. no
post-acute rehabilitation services exist and
highly specialized rehabilitation services do
not belong to the MOHP).
• Strong fragmentation of the health system is
also very obvious in health-related rehabi-
litation services. This is an important factor
causing inequities and gaps in health-related
rehabilitation services.
• In Egypt, there is an existing workforce of
rehabilitation professionals (MDs with specia-
lization in physical medicine, rheumatology,
and rehabilitation, physiotherapists, and speech
and language therapists). However, other pro-
fessions either do not exist (e.g. occupational
therapists, prosthetist and orthotists), or do not
have accreditation according to international
standards. Some community workers have
been trained by NGOs; however, there is no
systematic nationwide training programme.
Another important issue is the lack of collabo-
ration between existing rehabilitation profes-
sions. A synergistic team-oriented philosophy
of collaboration of rehabilitation professionals
at international standard is lacking in Egypt.
• Egypt has a health insurance system; however,
it is highly segmented and does not cover all
population groups. Gaps in health insurance,
in particular, concern children who are not
going to school and other vulnerable groups.
It can be assumed that large groups of persons
with disability are not included in the health
insurance system.
Recommendations
Preliminary recommendations were developed
following evaluation of the information collec-
ted. These recommendations were discussed in a
stakeholder dialogue (12) with 20 representatives
of the following organizations: Hannover Medical
School (technical advisor), Ministry of Public
Health, Ministry of Social Solidarity, the Health
Insurance Head Office, the National Council of
Disability Affairs, National Society of Rheuma-
J Rehabil Med 50, 2018