Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 41

Supporting the national disability and rehabilitation plan in the DPRK
from each of the following organizations: KFPD and
Mun Su. The stages of the consultation were:
• Review accessible documents and data about health
and disability, health system, policies and services,
using the Rehabilitation Service Assessment Tool
(RSAT) (4) (in August 2016).
• Discuss the results of the review in a workshop and
prepare models (in August 2016).
• Develop draft recommendations based on the prin-
ciples of the World Report on Disability (WRD) (5).
• National Strategy and Action Plan on Comprehensive
Rehabilitation (NSAPCR) (in March 2017).
RESULTS
Main findings of the situation analysis based on
the RSAT:
• At the time of the first consultation process
(August 2016), the DPRK had signed, but not
yet ratified, the UN-CRPD.
• The common causes of death in the DPRK are
NCDs, such as stroke, lung disease, coronary
heart disease and cancer. Smoking and exces-
sive alcohol consumption are risk factors for
many diseases. Based on this information, the
need to improve rehabilitation services in the
DPRK is urgent and highly relevant.
• There is agreement at government level, among
clinicians, and NGOs that the rehabilitation
system needs improvement, including a better
common understanding of disability, a modern
structure of the rehabilitation workforce with a
higher level of training, and increased capacity
rehabilitation services
• Responsibilities for disability and rehabilita-
tion in the DPRK are mostly viewed from the
health perspective, and are lacking in terms
of the social perspective. The understanding
of disability and rehabilitation in the DPRK
is based on the outdated WHO definition, the
International Classification of Impairments,
Diseases, and Handicaps (ICIDH), which laun-
ched in 1980. The new definition is based on
the International Classification of Functioning,
Disability and Health (ICF) (6). According to
the latter document, disability is defined as an
interaction of a person with a health condition
and the environment. Use of the new definition
highlights deficits in disability data collection
and planning of rehabilitation services, as
well as individual disability assessment and
goal-setting, and thus alters the rehabilitation
outcomes
• Rehabilitation professionals in the DPRK are
343
not trained in accordance with international
standards. This is evident, as the description of
professions, training curricula and accreditation
criteria differ significantly from international
standards. The number of rehabilitation profes-
sionals is insufficient (e.g. there is a low number
of Physical and Rehabilitation Medicine (PRM)
doctors, and no clear concept of, and distinction
between, the role of physiotherapist (PT) and
occupational therapist (OT)).
• Available rehabilitation professionals in the
country are PRM physicians, PTs, OTs, nurses,
and Prosthetics and Orthotics (P&Os). There
are no speech and language therapists.
• There are some rehabilitation services, but there
is no systematic plan for rehabilitation services
in acute, post-acute and long-term settings.
Some rehabilitation units (sanatoria) deliver
rehabilitation services using a traditional ap-
proach (Koryo medicine), and some modern
rehabilitation units have been established.
However, these units are single models that
are not representative of the overall healthcare
system. This leads to significant deficits in
rehabilitation care.
• Most rehabilitation services are provided by
the sanatoria, but with no clear concept re-
garding the service itself, including a lack of
multi-professional teamwork in the sanatorium
centres. Most rehabilitation professionals who
work in sanatoria are PTs and OTs.
• Instead of rehabilitation, the term ”sanatorium”
is used as one of health strategies together with
preventive, curative, supportive. This lead to
misunderstanding the purpose.
Recommendations
The recommendations listed below, based on core
principles of the WRD (5) and UNCRPD (2) were
developed during the consultation and discussed
with KFPD representatives and a PRM physician
from the DPRK.
1. For disability and rehabilitation policy, le-
gislation, and data collection, it is crucial to
translate and adapt international definitions
(e.g. “functioning”, “disability”) and tools
(e.g. ICF Core Sets) into Korean and adapt
them to the situation in the DPRK.
2. In order to improve the quality of national
disability statistics and compare them with
international data, an ICF-based survey
(WHO’s Model Disability Survey) should
be implemented.
J Rehabil Med 50, 2018