340 C . Gutenbrunner et al .
• For disability and rehabilitation policy , legislation and data collection , it is crucial to translate and adapt international definitions ( e . g . “ functioning ”, “ disability ”) and tools ( e . g . the International Classification of Functioning , Disability and Health ( ICF ) Core Sets ) into Ukrainian .
• For mid-term planning of rehabilitation services , a sound database on the epidemiology of disability ( including chronic and mental diseases ) and the need for rehabilitation must be established . It should use international ( ICFbased ) tools .
• Health-related rehabilitation services should be implemented at all levels of healthcare ( primary , secondary , tertiary ) and for all phases of healthcare ( acute , post-acute , long-term ). Since many rehabilitation services already exist in Ukraine , a transition plan has been developed . The primary healthcare sector must take a stronger role in long-term rehabilitation and as an entrance point for specialized rehabilitation services .
• In order to establish a highly-qualified rehabilitation workforce , international definitions and curricula of rehabilitation professions ( physical and rehabilitation medicine , physiotherapy , occupational therapy , speech and language therapy , prosthetist and orthotists , nurses , social workers , psychotherapists , and others ) should be implemented and a new accreditation system implemented . A transition plan was proposed .
• In light of the armed conflict in eastern Ukraine , the special needs of persons with disability living in the region , as well as the expansion of rehabilitation services for victims , should be realized .
In addition , the following projects were proposed :
• An expert workshop to determine and agree on appropriate translations of terms such as “ disability ”, “ functioning ”, etc .
• A project to adapt the ICF for use in Ukraine and to test the products within selected services .
• A population-based survey , using internationally accepted methods , of the prevalence of disability in 2 regions of Ukraine .
• Multi-professional rehabilitation teams in rehabilitation services to be set up and outcomes of rehabilitation programs evaluated .
• Model rehabilitation services to be implemented and outcomes evaluated ( acute rehabilitation services in 2 hospitals at secondary and tertiary level , post-acute rehabilitation service in at least 2 indications ( e . g . stroke , limb amputation , multiple trauma , or cardiac surgery ), 1 of which could integrate an existing sanatorium , and long-term service ( e . g . community-based service in a rural area ))
• Model services to be implemented , including delivery and integration of assistive devices in medical rehabilitation programmes and medical and vocational rehabilitation .
• Develop curricula for rehabilitation professionals ( i . e . physical and rehabilitation medicine doctors , physiotherapists , occupational therapists ) including training programmes for existing professionals .
• Organize education and training courses for rehabilitation professionals with international support .
• Develop a model for an adequate , motivating and fair payment system for rehabilitation services ( based on international experience , a “ pay per case ” system , taking into account the severity of cases , is recommended )
• A survey of existing rehabilitation facilities ( number of rehabilitation institutions , departments and beds ).
DISCUSSION
The aim of this mission was the development of a NDHRP for Ukraine . The methods were based on the model of RATs , as developed by the ISPRM ( 2 ). Data collection was based on information available from public sources ( WHO and NGO reports , published papers , etc .), consultations with different stakeholders , including government officials , NGOs ( including professional organizations and organizations of persons with disabilities ) and site visits to hospitals , rehabilitation centres and research institutions . The RAT consisted of members of the ISPRM . Data collection was structured according to a previously developed checklist ( 6 ). Before finalizing the report the recommendations for actions and projects were discussed with relevant stakeholders in disability and rehabilitation in Ukraine . During this meeting priorities were established through participant voting . The high level of agreement with the recommendations indicates that the mission has summarized relevant data on the situation of persons with disabilities and the health and rehabilitation systems and drawn relevant and comprehensive conclusions . Based on the advisors ’ experience , the most relevant factors contributing to this outcome were :
• a good level of planning of the country visit ;
• a high level of commitment from governwww . medicaljournals . se / jrm