guidelines for establishing medical rehabilitation in developing countries martin grabois, m.d....

Guidelines for Establishing Medical Guidelines for Establishing Medical Rehabilitation in Developing Rehabilitation in Developing

CountriesCountries

Martin Grabois, M.D.Martin Grabois, M.D.Professor and ChairmanProfessor and Chairman

Baylor College of MedicineBaylor College of MedicineDepartment of Physical Medicine and RehabilitationDepartment of Physical Medicine and Rehabilitation

Houston, Texas USAHouston, Texas USA

Treasurer, Rehabilitation InternationalTreasurer, Rehabilitation InternationalFormer Chair – Rehabilitation International Health and Former Chair – Rehabilitation International Health and

Function CommitteeFunction Committee

Sao Paulo, BrazilSao Paulo, BrazilNovember 2011November 2011

Guidelines for Establishing Medical Guidelines for Establishing Medical Rehabilitation in Developing CountriesRehabilitation in Developing Countries

GOALSGOALS

1)1) To provide oversight on UN Conventional on Rights of People with To provide oversight on UN Conventional on Rights of People with Disabilities, WHO World Report on Disability, and Community Based Disabilities, WHO World Report on Disability, and Community Based GuidelinesGuidelines

2)2) To provide you with how these reports and my personal experience with To provide you with how these reports and my personal experience with medical rehabilitation practices worldwide shaped the RI Guidelines on medical rehabilitation practices worldwide shaped the RI Guidelines on Establishing Rehab in Developing Countries.Establishing Rehab in Developing Countries.

3)3) Present the RI Health and Function and RI approved Guidelines for Present the RI Health and Function and RI approved Guidelines for Establishing Rehab in Developing Countries.Establishing Rehab in Developing Countries.

4)4) Provide Review of Community Based Rehabilitation Program and how Provide Review of Community Based Rehabilitation Program and how they can and cannot be a part of a plan of actionthey can and cannot be a part of a plan of action

5)5) To challenge you to implement these guidelinesTo challenge you to implement these guidelines


International Federation of PM&R Conference at RI Congress in Kenya, Africa 1992

Problems Perceived in Establishing Rehabilitation Services in Developing Countries

Lack of trained personnelLack of trained personnel Lack of appropriate facilitiesLack of appropriate facilities Lack of clear governmental and Lack of clear governmental and nongovernmental policies on nongovernmental policies on rehabilitationrehabilitation Lack of transportation for disabledLack of transportation for disabled


International Federation of PM&R Conference at RI International Federation of PM&R Conference at RI Congress in Kenya, Africa 1992Congress in Kenya, Africa 1992

Problems Perceived in Establishing Rehabilitation Problems Perceived in Establishing Rehabilitation Services in Developing Countries (cont’d)Services in Developing Countries (cont’d)

Lack of equipment and suppliesLack of equipment and supplies Lack of recognition of importance of Lack of recognition of importance of

medical rehabilitationmedical rehabilitation Lack of training facilitiesLack of training facilities Lack of financesLack of finances


UN Convention on Rights of People with Disabilities UN Convention on Rights of People with Disabilities – Article 25, Health– Article 25, Health

Right to the enjoyment of the Right to the enjoyment of the highest attainable standard of health without highest attainable standard of health without

discrimination on the basis of disabilitydiscrimination on the basis of disability Same range, quality and standard of free or Same range, quality and standard of free or

affordable healthcare and programs for those affordable healthcare and programs for those with and without disabilitieswith and without disabilities

Provide those health services needed by persons Provide those health services needed by persons with disabilities specifically because of their with disabilities specifically because of their disabilities.disabilities.


UN Convention on Rights of PeopleUN Convention on Rights of Peoplewith Disabilities – Article 25, Health (cont’d)with Disabilities – Article 25, Health (cont’d)

Provide these health services a close as possible to the Provide these health services a close as possible to the individualindividual

Require health professionals to provide care of the same Require health professionals to provide care of the same quality to personas with disabilities as to othersquality to personas with disabilities as to others

Prohibit discrimination against persons with disabilities in Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurancethe provision of health insurance, and life insurance

Prevent discriminatory denial of healthcare or health Prevent discriminatory denial of healthcare or health services or food and fluids on the basis of disabilityservices or food and fluids on the basis of disability


Unconventional on Rights of People with Disabilities Unconventional on Rights of People with Disabilities

Article 26 – Habilitation and RehabilitationArticle 26 – Habilitation and Rehabilitation

To enable people with disabilities to attain and maintain To enable people with disabilities to attain and maintain maximum independence.maximum independence.

Begin at the earliest possible age, and treatment is based Begin at the earliest possible age, and treatment is based on the multidisciplinary assessment of individual needs and on the multidisciplinary assessment of individual needs and strengths.strengths.

Promote the development of initial and continuing training Promote the development of initial and continuing training for professionals and stafffor professionals and staff

Promote the availability, knowledge and use of assistive Promote the availability, knowledge and use of assistive devices and technologies, designed for persons with devices and technologies, designed for persons with disabilities, as they related to habilitation and rehabilitationdisabilities, as they related to habilitation and rehabilitation


World Report on Disability Addressing Barriers to World Report on Disability Addressing Barriers to

Healthcare and RehabilitationHealthcare and Rehabilitation

Making all levels of existing healthcare systems more inclusive and making public healthcare programs accessible to people with disabilities will reduce health disparities and unmet needs

To improve health service provider attitudes, knowledge, and skills, education for healthcare professionals


World Report on Disability Addressing Barriers to World Report on Disability Addressing Barriers to Healthcare and Rehabilitation (cont’d)Healthcare and Rehabilitation (cont’d)

Involving people with disabilities, as providers of education and training that can improve knowledge and attitudes.

A range of financing options has the potential to improve coverage and affordability of healthcare services.


World Report on Disability Addressing Barriers to Healthcare World Report on Disability Addressing Barriers to Healthcare and Rehabilitation (cont’d)and Rehabilitation (cont’d)

Rehabilitation is a good investment because it builds human capacity. It should be incorporated into general legislation on health

For established services the focus should be on improving efficiency and effectiveness.

Integrating rehabilitation into primary and secondary healthcare settings with goal of improve availability.


World Report on Disability Addressing Barriers to World Report on Disability Addressing Barriers to Healthcare and Rehabilitation (cont’d)Healthcare and Rehabilitation (cont’d)

Increasing access to assistive technology increases independence, improves participation, that can reduce care and support costs.

Given the global lack of rehabilitation professionals, more training capacity is needed.

Financing strategies include the redistribution or reorganization of existing services.


People to People Citizen Ambassador Program to South AfricaJuly 1996

A report developed reflected the group’s observations and recommendations for developing, implementing and maintaining rehabilitation resources is all developing countries.

It was felt that if these guidelines are an integrated part of the process, the acceptance and success of rehabilitation of medicine in improving the quality of life of people with disabilities will be full realized and resources will be utilized optimally and appropriately.


RI Guidelines for Establishing Medical Rehabilitation in RI Guidelines for Establishing Medical Rehabilitation in Developing CountriesDeveloping Countries

Political, social, and economic stability should be present

A healthcare plan should be in place to provide appropriate basic medical care

Facilities, personnel and financial resources should be available through national, international, public, and private organizations appropriate to the undertaking


RI Guidelines for Establishing Medical Rehabilitation in RI Guidelines for Establishing Medical Rehabilitation in Developing Countries (cont’d)Developing Countries (cont’d)

A commitment to the concept of medical rehabilitation and to integration of the individual with a disability into the community

An educational structure should be in place to provide adequate healthcare workers and rehabilitation professionals for the rehab team included but not limited to the administrative, physician, nursing, psychology, social workers, occupational and physical therapists, and community worker levels.


RI Guidelines for Establishing Medical Rehabilitation RI Guidelines for Establishing Medical Rehabilitation in Developing Countries (cont’d)in Developing Countries (cont’d)

An integrated continuum of care should be in place at the preventive, curative, and restorative levels with inpatient, outpatient, and community level services should be available.

A commitment for empowerment and involvement of consumer, based disability organizations should be present



A mechanism for consultation and interaction with A mechanism for consultation and interaction with appropriate national and international allied appropriate national and international allied rehabilitation organizational originations should rehabilitation organizational originations should be present.be present.

Recognition, acceptance, and integration of the Recognition, acceptance, and integration of the traditional cultures of the country for traditional cultures of the country for development of services to disabled individuals development of services to disabled individuals should be in place.should be in place.



A long range strategic plan should be developed A long range strategic plan should be developed that includes mission, goals, objectives, plan of that includes mission, goals, objectives, plan of action, responsibilities, timeframe, and financing action, responsibilities, timeframe, and financing to accomplish the goal for medical rehabilitation to accomplish the goal for medical rehabilitation servicesservices


Community Based RehabilitationCommunity Based RehabilitationWorld Report on Disability NotesWorld Report on Disability Notes

Community based rehabilitation has been successful in less-resourced settings at facilitating access for disabled people to existing services and in screening and promoting preventive healthcare services.


Community Based RehabilitationCommunity Based Rehabilitation

To decentralize and integrate the delivery of services in order to reach the disabled persons in the community

To assess the effectiveness of CBR technology

To evaluate the impact of CBR on the life of handicapped people, and their families and communities



Arne HusveqArne Husveq

CBR is cheaper than no rehabCBR is cheaper than no rehab

Government push for cheaper solutionGovernment push for cheaper solution

Disabled individuals not considered importantDisabled individuals not considered important



Problems and SolutionsProblems and Solutions

Acceptance and involvement by healthcare professional

Leadership

Outcome studies

Guidelines for Establishing Medical Rehabilitation Guidelines for Establishing Medical Rehabilitation in Developing Countriesin Developing Countries

Community Based Rehabilitation Community Based Rehabilitation

Revised Guidelines 2010Revised Guidelines 2010

Reviewed UN Conventional on Rights of People with Disabilities as applied to health, habilitation and rehabilitation

Reviewed WHO World Report on Disability as it applies to health and rehabilitation

Reviewed my personal experiences with medical rehabilitation in developing countries

Presented RI Guidelines for Establishing Medical Rehabilitation in Developing Countries

Presented WHO Guidelines on Community Based Rehabilitation as a small component of what can and needs to be done


guidelines for establishing medical rehabilitation in developing countries martin grabois, m.d....

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rehabilitation services

ri health

health services

developing countriesgoalsto

health contdprovide

ri guidelines

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ri approved guidelines