Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 65

J Rehabil Med 2018; 50: 367–376 SPECIAL REPORT CHALLENGES AND BARRIERS FOR IMPLEMENTATION OF THE WORLD HEALTH ORGANIZATION GLOBAL DISABILITY ACTION PLAN IN LOW- AND MIDDLE- INCOME COUNTRIES Fary KHAN, MBBS, MD, FAFRM (RACP) 1–3 , Mayowa Ojo OWOLABI, MBBS, MWACP, FMCP, MSc, DrM 4–6 , Bhasker AMATYA, DMedSc, MD, MPH 1–3 , Talhatu Kolapo HAMZAT, PhD (Neuro- physiotherapy), BSc, MNSP 7 , Adesola OGUNNIYI, MBChB, FWACP, FRCP, FRCPE 5 , Helen OSHINOWO, PhD 8 , Alaeldin ELMALIK, MBBS, FAFRM (RACP) 1,3 and Mary P GALEA, PhD, BAppSci (Physio), BA, Grad Dip Physio, Grad Dip Neurosci 1–3 From the 1 Department of Rehabilitation Medicine, 2 Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, 3 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia, 4 Center for Genom ic and Precision Medicine, College of Medicine, 5 Department of Medicine, 6 WFNR- Blossom Specialist Medical Center, Ibadan, 7 Department of Physiotherapy, College of Medicine and 8 Department of Psychology, University of Ibadan, Ibadan, Nigeria Objective: To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries. Methods: A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conduc- ted intensive workshops at medical/academic in- stitutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabi- litation facilities. A modified Delphi method iden- tified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia. Results: Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (govern- mental/policymakers) and micro levels (com- munity/social/individual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabi- litation workforce, guidelines and accreditation standards; coordination amongst healthcare sec- tors; social issues; data and research; legislation and political commitment. Common potential fa- cilitators included: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research. Conclusion: Disability care is an emerging prio- rity in low- and middle-income countries to add- ress the needs of people with disability. The chal- lenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services. Key words: disability; rehabilitation; low- and middle-income countries; World Health Organiza- tion. Accepted Aug 18, 2017; Epub ahead of print Oct 5, 2017 J Rehabil Med 2018; 50: 367–376 Correspondence address: Fary Khan, Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34– 54 Poplar Road Parkville, Melbourne VIC 3052, Austra- lia. E-mail: [email protected] T he World Health Organization (WHO) and the World Bank estimate that there are 1 billion dis­abled people worldwide (15% of the world’s population), which equates to 1 in 7 people (1). Of these, 110–190 million have significant difficulties, such as inability to walk, perform self-care, or communicate, or to participate in education or employment (1). An estimated 80% of persons with disability (PwD) live in low- and middle-income countries (LMICs) (1). The United Nations (UN) “Convention on Rights of Persons with Disabilities” (CRPD) of- fers a blueprint for a “rights-based” approach to mainstreaming PwD by highlighting disability as a human experience that occurs as an interaction of a person with a health condition or impairment with his/her environment, and personal factors (2). This is consistent with the International Clas- sification of Functioning, Disability and Health (ICF) framework, that disability is a human condition and should not be viewed as a specific phenomenon affecting a limited group of people (3). The CRPD was the first UN treaty to protect the fundamental rights of PwD, and encourages all member states to adopt appropriate measures to eliminate discrimination and poverty, improve health, quality education and employment of PwD (1, 2). It identifies Physical Medicine and Rehabilitation (PM&R) as a fundamental process to support physical independence, mental, social and vocational ability (Article 26) and encourages Member States to identify and address the barriers faced by PwD (Article 31) (1). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2018 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2276