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
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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