Journal of Rehabilitation Medicine: Special Issue 50-4bokBW

Disability and rehabilitation in Mongolia 363 Table I. Potential challenges and facilitators in implementation of the World Health Organization (WHO) Global Disability Action Plan 2014–2021 in Mongolia (n=77) Potential challenges/barriers Potential facilitators/enablers in the next 5–6 years • Lack of strong leadership, need for a central body for developing governance • Health priority more driven towards acute sector and communicable disease • Limited commitment from the government, limited funding or under- funded programmes • Inadequate investment for health sector and financial support for HCPs • Poor coordination/collaboration among different government sectors and ministries • Limited coordination/collaboration among different healthcare sectors [hospitals (private and public), primary, community, INGOs and NGOs] • Lag in implementation of health policies • Inclusion of traditional medicine with rehabilitation (traditional medicine prioritized) • Poor education/knowledge about disability/rehabilitation amongst policy-makers, government authorities, etc. • Legislation policy for employment/education/health for PwD not enforced • Scarcity of disability-related data (inaccurate data; under-estimation and under-representation of disability prevalence, cost data, etc.) • Lack of specific regulation (job description) for specific healthcare professionals (such as allied health professionals) • Lack of processes to involve all stakeholders (including PM&R professionals) in policy development • Few specific disability-rehabilitation standards or key performance indicators (not up to date) • Limited leadership development programmes and professional development programmes for HCPs • Poor provision of infrastructure, accessibility in public places and transport for PwD • Limited specialized PM&R centres, such as for stroke, spinal cord injuries, etc. • Lack of multidisciplinary team approach and systems/models of care • Rehabilitation services not well integrated with acute services and lack of inpatient rehabilitation facilities • Limited numbers of community healthcare facilities and disability services, particularly in rural areas for PwD • Lack of structured standard referral systems from acute to sub-acute care and to community • Maldistribution of human resources (HCPs more centralized in capital and urban areas) and demoralized workforce • Poor awareness, misconception and cultural belief about disability • Belief in traditional medicine amongst general public and health practitioners • Limited number of adequate primary care services • Lack of continuum of care • Lack of emergency assistance programmes for PwD • Lack of evidence-base guidelines/protocols and disability centred measures and tools • Lack of undergraduate courses in rehabilitation in medical institutions and limited professional courses/training programmes in academic institution • No staff development or appraisal systems in hospitals or community settings • Limited access to education or web-based learning, professional development, training in new innovations and therapy • Poor awareness amongst healthcare professionals about disability and PM&R • Minimal integration of community-based programmes with acute services • Lack of family/carer education and limited provision of inclusion of caregivers of PwD and/or PwD in care programmes, decision-making • Minimal information available to public about access to rehabilitation services • Rehabilitation workforce minimally trained in research methodology including data collection; research not identified as a priority • Limited funding for research and lack of awards or recognition for research work • Limited staff capacity, training support, guidance and/or mentorship and facilities available for research • Establishment of legislative and central capacity building body • Education/awareness programmes about disability and PM&R for policy-makers, government authorities, hospital administrators • Inclusion of HCPs including rehabilitation physicians in policy development • Strengthening management capacity, public-private partnerships • Establishment of healthcare standards/policies and implementation and evaluation • Development of Key Performance Indicators, Standards of Care and accreditation criteria for rehabilitation facilities and staff by the Ministry of Health • Coordination and communication between governmental bodies, healthcare sectors, various INGOs/NGOs and community organizations • More active role of PM&R departments in facilitating leadership skills and governance • International cooperation and support for PM&R development and training • Development of evidence-based guidelines/protocols and outcome measures for disability and rehabilitation • Development of Continuous Medical Education (CME) programmes for HCPs, skill training and educational programmes (national/international) • Increased health budget expenditure for disability and PM&R • Development of standard data collection systems (training ICF) • Training and educational programme for PwD, families and carers of PwD • Improvement of social welfare, livelihood and benefits for PwD • Development of new rehabilitation infrastructure and re- evaluation of existing services • Development of standard referral systems • Promotion of CBR • Development of inpatient rehabilitation units, and specialized rehabilitation facilities (including in remote areas) • Development of telerehabilitation • Public awareness and educational programmes • New medical equipment and technology supportive to the local needs (including in rural areas) • Development of consumer organizations (including PwD at national and local level) • Initiatives/programmes and funding for development of allied health professionals • Development of vocational rehabilitation programme (jobs, education etc.) for PwD • More active role of national society of PM&R • Development of innovative teaching models, using interactive problem-based learning and clinical capacity through organized educational activities • Collaboration with international partners for staff education/ training • More CBR services linked with main hospital networks and through inclusion of carers, PwD in decision-making processes • Adequate financial support and advocacy for assistive devices and technology and expansion to rural areas • Development of Mobile Rehabilitation Units to deliver care in remote areas • Build research capacity in rehabilitation by training and educating medical staff in research methodologies • Development of research, data collection methods/ measurement tools in disability and rehabilitation • Involvement of government and academic institutions to establish national research centre/foundation • Collaboration with international partners in research and development • International aid/assistance in research capacity building CBR: community-based rehabilitation; HCP: healthcare professionals; ICF: International Classification of Functioning, Disability and Health; INGO: international non-governmental organization; IT: information technology; NGO: non-governmental organization; PM&R: physical medicine and rehabilitation; PwD: persons with disabilities; WHO: World Health Organization. J Rehabil Med 50, 2018

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