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3. As rehabilitation is 1 of 4 main health strategies, it requires services within different sectors of the health.
4. Since rehabilitation also concerns other life areas, such as social support, education and justice, strong coordination between government ministries is indispensable( optimally as an inter-ministerial coordination committee at a high level of responsibility)
5. For mid-term planning of rehabilitation services a sound database on the epidemiology of disability( including a registry of chronic diseases and mental health) and the need for rehabilitation must be established, using international( ICF-based) tools( Model Disability Surveys).
6. A registry of existing of rehabilitation facilities( including quantity: number of institutions and beds; and quality) must be established to provide a sound basis for planning service provision to meet the needs of persons with disabilities( including those with chronic health conditions).
7. Health-related rehabilitation services must be implemented at all levels of healthcare( primary, secondary, tertiary) and for all phases of healthcare( acute, post-acute, long-term). Many rehabilitation services already exist as sanatoria; therefore a transition plan should be developed. The primary healthcare sector must take a stronger role in long-term rehabilitation and as an entry point for specialized rehabilitation services
8. In order to establish a highly qualified rehabilitation workforce in accordance with international definitions, nomenclature and curricula of rehabilitation professions and a new accreditation system should be implemented according to the WHO classification of health workers( medical doctors, therapists, nurses, social workers, psychotherapists and others). A transition plan is also required.
9. A system for supplementary, compulsory and continuous education of physicians currently practicing in rehabilitation should be set up, after first identifying the clinical-practical needs and goals( clinical topics) regarding the current situation in the country, using external expertise( e. g. the International Society of Physical and Rehabilitation Medicine; ISPRM).
10. A return-to-work policy should be implemented as one of the main goals and results of rehabilitation interventions. Functional aspects of disability should be based on the ICF, return-to-work or workplace adaptation.
DISCUSSION, RECENT DEVELOPMENTS AND CONCLUSION
By reflecting on UNCRPD Article 26 about habilitation and rehabilitation, the government of the DPRK, through KFPD has realized the importance of making improvements in rehabilitation as an integral part of health systems, which should be implemented at all levels. Thus, KFPD, accompanied by PRM physician, undertook consultation with external experts( the current authors) to propose a national strategy of comprehensive rehabilitation to the government.
The methodology for the consultation process was clearly defined by Gutenbrunner et al. in 2017( 3), and should include data collection, site visits, development of recommendations, and stakeholder dialogues to enable prioritization. However, some of these steps, e. g. site visits, could not be followed in the DPRK.
During the development process, in the period between the first and second consultations, the DPRK made some improvements, including ratification of the UNCRPD in December 2016. This was a significant achievement, which led to the next level of improvement in the situation regarding disability and rehabilitation-related topics in the country. Meanwhile, one of recommendations was to collect data with regard to rehabilitation professionals, rehabilitation service providers and provision. KFPD had already implemented this project, and brought these data to the second consultation.
During the second consultation process, the data on rehabilitation services, collected using the RSAT( 4), and the list of recommendations, drawn up during the first consultation process, were used to develop a draft of the National Strategy and Action Plan on Comprehensive Rehabilitation( NSAPCR) in the DPRK 2017 – 2020. The NS- APCR was discussed with the external experts. Finally, advice was given on improvement of this document. The NSAPCR was subsequently presented to a high-level UN meeting in New York in May 2017.
The consultation process has several limitations, as mentioned above; for example, a workshop with only 2 representatives, 1 from each of the following organizations: KFPD and Mun Su and no site visits by the advisory team to the country. www. medicaljournals. se / jrm