370 F. Khan et al.
Table I. Summary of current health systems / resources for Disability and Physical Medicine and Rehabilitation in 4 |
low- and middle-income countries( LMICs) |
|
Madagascar |
Mongolia |
Pakistan |
Nigeria |
Population, mil Life expectancy at birth, years( 2015) |
24.2( 2015) 65.5 |
3( 2015) 68.8 |
201.9( 2016) 66.4 |
182.2( 2015) 54.5 |
Economic statistics GDP per capita a: $ 390
( 2014); Total expenditure on health: 3 % of GPD HDI rank: 154
Human resources( healthcare)
Health Services / Infrastructure
Skilled health professionals: 4.8 / 10,000 Physicians: 0.14 / 1,000 people; In 2012: 3,188 doctors, 4,858 nurses / midwives, PT < 1 / 10,000 people
3 hospital beds / 10,000 people( 2010) Hospitals total density / 100,000 population: 0.47( 2013)
GDP per capita a: $ 4,353( 2014); Total expenditure on health: 4.7 % of GPD HDI rank: 90
Skilled health professionals: 64.6 / 10,000 Physicians: 2.9 / 1,000 people; In 2011: 7,140 doctors, 10,143 nurses / midwives
3 hospital beds / 10,000 people( 2010) Hospitals total density / 100,000 population: 2.5( 2013)
Disability data |
PwD: ≈1.8 mil( 2000) |
PwD: 108,000 |
|
Disability-prevalence: 7 – 8 %
Disability-prevalence:
|
( 2000) Mortality from NCDs b: 23.4 % |
3.9 %( 2010) Mortality from NCDs b: 32.0 % |
Disability type Polio; stroke; leprosy; congenital diseases; malnutrition; drug and alcohol consumption; Alzheimer’ s disease, cerebral palsy
Legislation of disability for Persons with disability
CBR
Research and evaluation
1998 law for equal rights to PwD, CRPD ratified: 2007; National Decade of Disabled Persons( 2003), The Madagascar Action Plan 2007 – 2012
No National CBR programme, most funded by NGOs Recent research on orthoses for clubfoot; no inter-country collaboration; member of ISPRM
Physical: 29 % Mental / intellectual: 19 %, Visual: 15 %, hearing: 12 %, speech disability: 6 %
CRPD signature – no, ratification 2009; Law of Mongolia on Social Security of Persons with Disabilities 2005; National Program for Promoting Persons with Disabilities, 2006 – 2012
Government, NGO-funded CBR programmes
Currently on an upward trend in research in medical rehabilitation
GDP per capita a: $ 1,427( 2015); Total expenditure on health: 2.8 % of GPD HDI rank: 147
Skilled health professionals: 14.0 / 10,000 Physicians: 0.8 / 1,000 people In 2014: 149,142 doctors, 111,857 nurses / midwives 6 / 10,000 people; rehab physicians: 38( 25 military), PT / OT < 1 / 10,000 people
GDP per capita a: $ 2,640( 2016); Total expenditure on health: 3.7 % of GPD HDI rank: 152 Skilled health professionals: 20.1 / 10,000 Physicians: 0.4 / 1,000 people; In 2008: 56,526 doctors, 224,943 nurses / midwives, PT < 2 / 10,000 people
6 beds / 10,000 people
Total 34,173 health Hospitals total density / 100,000 facilities( 2011): population: 0.53( 2013)
88 % primary, 12 % 989 public & 800 private secondary, 1 % tertiary hospitals, 596 rural health 22 healthcare centres, 4,910 health units at facilities / 100,000 basic primary healthcare level people( 2010) 15 departments of rehabilitation medicine, 32 PT departments( mainly in the army) PwD: 3.3 mil Disability prevalence: 2.5 %( 1998) Mortality from NCDs b: 20.5 %
Physical: 18.9 %, visual: 8.1 %, hearing: 7.4 %, Intellectual: 7.6 %, Mental: 6.4 %, multiple: 8.2 %, others 43.4 %
CRPD signature 2008, ratification 2011; National Policy for PwD: 2002; National Plan of Action 2006 – 2025; the Disabled Persons( Employment and Rehabilitation) Ordinance 1981; Convention on Rights of the Child 1990; Convention on Elimination of all Forms of Discrimination against Women 1996 No National CBR programme, most funded by NGOs
Currently on an upward trend in research in medical rehabilitation; member ISPRM
PwD: 3.3 mil Disability prevalence: 2.3 %( 2016) Mortality from NCDs b: 19.6 % Visual, hearing & physical impairment; intellectual & communication impairments
CRPD signature 2007, ratification 2010; Nigerians with Disability Decree 1993; Lagos State Special People’ s Law 2011; The Child Rights Act, 2003; National Social Welfare Policy 2012
No National CBR programme, most funded by NGOs Currently on an upward trend in research in medical rehabilitation
( Main sources: WHO World Health Statistics 2016; WHO Country Profile; WHO Health Statistics 2011; WHO Disability and Rehabilitation Status 2004( 14); ESCAP 2012, Statistical Yearbook for Asia and the Pacific 2014, Umeh et al. African Disability Rights Yearbook 2013,
Wikipedia 2017). a GPD( nominal). b NCDs = cardiovascular disease( CVD), cancer, diabetes and chronic respiratory disease. c Skilled health professional density
2005 – 2013, refers to: primarily nurses / midwives and physicians. CBR: community-based rehabilitation; CRPD: Convention on the Rights of Persons with Disabilities; GDP: gross domestic product; GNI: gross national income; HDI: Human Development Index; ISPRM: International Society of Physical and Rehabilitation Medicine; LMICs: Lowand Middle-Income Countries; OT: occupational therapists; mil: million; NGO: non-governmental organization; NCDs: non-communicable diseases; P & O: prosthetics and orthotics; PM & R: Physical Medicine and Rehabilitation; PT: physiotherapists; PwD: persons with disability; SLTs: speech and language therapists; WHO: World Health Organization.
that there are fewer than 2 PTs for 10,000 people. Despite the scarcity of rehabilitation resources( infrastructure and human resources), to date, there are limited systems to evaluate and / or build rehabilitation capacity( personal communication with workshop participants).
Based on the current World Bank Group’ s classification to define income status of the countries( gross national income( GNI) in 2015), except Madagascar( categorized as a low-income country; GNI per capita ≤ US $ 1,045), all 3 countries of interest( Mongolia, Nigeria and www. medicaljournals. se / jrm