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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