Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 79

Strengthening rehabilitation services in Indonesia
2. Government:
In Indonesia, PWD are under the responsibility
of different ministries; therefore, the recommen-
dations are as follows:
• Regarding the health services, inter-ministerial
coordination should be optimized, particularly
between the Ministry of Health and Ministry
of Social Affairs, working closely together
on PWD.
• Rehabilitation also concerns other life areas,
such as social support, education, justice, etc.
Therefore, strong coordination between mi-
nistries is important.
• A policy of return-to-work should be imple-
mented as 1 of the main goals and results of
rehabilitation interventions. Functional aspects
of disability should be based on the ICF, return-
to-work or workplace adaptation.
3. Rehabilitation services:
• Health-related rehabilitation services must be
implemented at all levels of healthcare (pri-
mary, secondary, tertiary) and for all phases
of healthcare (acute, post-acute, long-term).
The primary healthcare sector must take a
stronger role in long-term. rehabilitation and
as an entrance point for specialized rehabilita-
tion services.
• Models of comprehensive rehabilitation care
should be developed, including rehabilitation
specialist consultation in the communities,
defined referral systems, and the use of tele-
medicine.
• A registry of existing rehabilitation facilities
(including quantity: number of institutions and
beds; and quality) should be established, as a
sound basis for planning service provision to
meet the needs of PWD (including those with
chronic health conditions).
4. Rehabilitation workforce:
• The poor distribution of rehabilitation profes-
sionals in many parts of the country should be
overcome.
• Education curricula for medical students regar-
ding disability should be established, including
its definition based on the ICF framework.
• A system for supplementary, compulsory and
continuous education of currently practicing
physicians in the field of rehabilitation should
be established, after identifying the clinical-
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practical needs and goals (clinical topics)
regarding the current situation in the country,
using external expertise (e.g. International So-
ciety of Physical and Rehabilitation Medicine
(ISPRM)).
• A more systematic survey of rehabilitation-
related professionals should be established.
DISCUSSION
The aim of this article was to analyse the situation
of rehabilitation services and disability in Indone-
sia. Thus, it does not follow the overall methodo-
logy for developing a National Disability, Health
and Rehabilitation Plan (NDHRP) (26–28).
However, the RSAT questionnaire was used as a
tool on which to base the systematic collection
of information and data. The data sources were
based on available public sources (e.g. the WHO,
government and non-governmental organization
(NGO) documents and reports, published papers,
etc.), consultations with NSAs, including national
professional organizations, was carried out by
direct discussion, phone and/or email.
The results of this study confirm that the RSAT
is feasible for use in analysing the situation of
disability and rehabilitation services in a country.
However, the analysis was not comprehensive,
as some limitations occurred, including site
visits, discussion with government offices (such
as representatives of the Ministry of Health and
the Ministry of Social Welfare) and discussion
with NSA of PWD. Site visits to rehabilitation
centres were represented by one of our authors
RES
(IRD), who works at a rehabilitation centre at a
tertiary hospital in West Java Province and has
many years’ experience in rehabilitation services.
The results show that the reported prevalence
of PWD in Indonesia is lower than the average
of worldwide data published by the WHO (4.3%
and 15%, respectively). However, it is likely that
the number of PWD in Indonesia is greater than
4.3%. This difference, and the difficulties of as-
sessing disability in the country, could be due to a
different definition of disability used in the survey,
lack of awareness and understanding of disability
by the general population, and other factors (29).
Therefore, the use of the WHO – Model Disability
Survey is recommended in order to collect more
comprehensive data for comparison with that
from other countries.
An ageing population, chronic health condi-
tions, environmental and other factors are the
causes of disability worldwide, including in
Indonesia. Regarding the ageing population,
J Rehabil Med 50, 2018