Disability and rehabilitation in Mongolia 365
Some limitations in this study cannot be ruled out . This is a cross-sectional study and did not intend to test specific hypotheses through systematic analysis . Content analytical technique summarized data derived from the interactive feedback from participants attending an organized workshop programme . This study was intended as a preliminary descriptive study , with the aim of summarizing disability and rehabilitation efforts in Mongolia based on the GDAP , and to identify barriers / challenges and facilitators from the perspective of participants for the implementation of this action plan . The study cohort of health professionals were invited by MNUMS and did not include other stakeholders ( such as governmental , social work organizations , organizations of PwD ), which may limit the generalizability and validity of these findings . However , the study cohort included PM & R professionals from a wide geographical population in Mongolia , and was representative of the wider sample currently operational in the community both in urban and rural areas . The visiting team was not involved in participant selection , as this was beyond their authority . The team contacted some NGOs and a few family members of PwD to include their viewpoint . The authors believe the findings reflect the current issues / problems faced by the PM & R workforce in Mongolia at large . They are unaware of any similar study in Mongolia addressing such issues .
Mongolia has made good progress in building its national health capacity for the acute healthcare sector , public health emergency preparedness , and infection prevention and control ( 11 ). However , there is a critical need to build the system , integrating and linking other emerging capacities , like PM & R . Effective delivery of healthcare services , including rehabilitation , especially in rural areas , is challenging due to the sparse and scattered distribution of the population , long distances and nomadic lifestyles ( mainly in rural areas ) ( 13 , 20 ). Other potential problems for implementation of the GDAP include repeated restructuring of the health system , poor financial support for education and health sectors , rising unemployment and rapid urbanization . The needs of PwD can easily be overlooked in the current environment .
In summary , like many developing countries , the rights and healthcare needs of PwD in Mongolia have many barriers to their inclusion in key aspects of society . There were many similarities in the barriers identified in consensus exercises in both Madagascar and Pakistan PM & R ( 14 , 16 ) to those of their Mongolian counterparts . Many
PwD remain marginalized and their capabilities underestimated . Despite strong commitment from government for disability-inclusive and sustainable development programmes , there remains a gap between policy and practice . The key issues raised by the participants are listed below .
• Leadership from the Ministry of Health ( and other governmental authorities ) for development of PM & R standards , accreditation and key performance indicators .
• Evidence-based models of care .
• Organized integrated healthcare systems ( patient referrals , continuum of care after discharge , CBR , etc .).
• Integration of PM & R with acute health services and development of inpatient PM & R facilities .
• Tailoring the GDAP recommendations to suit the local environment for accessibility to mainstream services .
• Development of systematic data collection methods for disability ( such as a national disability registry ).
• Improving infrastructure for disabled access for transport and buildings and social support systems .
• Upskilling , educating and developing the PM & R workforce using innovation , technology / web-based systems .
• Promoting awareness of disability and rehabilitation needs .
• Investment in research and ( national and international ) collaboration . In conclusion , the role of PM & R in the Mongolian healthcare system is expanding to address the rights and needs of the growing numbers of PwD . All PM & R participants stressed the need to empower PwD for active participation in society DISCand development . The interactive consensus method using the GDAP as a tool was useful to gather
ACKN
information , improve access and to strengthen PM & R services in Mongolia .
ACKNOWLEDGEMENTS
This report was supported from internal resources of the Rehabilitation Department , Royal Melbourne Hospital , Melbourne , Australia . The authors are grateful to all participants , and to MNUMS for their kind hospitality and support . The authors would like to acknowledge the Committees on Rehabilitation Disaster Relief , of the International Society of Physical and Rehabilitation Medicine ( ISPRM ) and the WHO Liaison Committee of the ISPRM . This paper does not reflect views of above mentioned ISPRM committees .
J Rehabil Med 50 , 2018