2. Guidelines for Establishing Medical Rehabilitation in Developing Countries Martin Grabois, M.D. Professor and Chairman Baylor College of Medicine Department of Physical Medicine and Rehabilitation Houston, Texas USA Treasurer, Rehabilitation International Former Chair – Rehabilitation International Health and Function Committee Sao Paulo, Brazil November 2011

3. Guidelines for Establishing Medical Rehabilitation in Developing Countries GOALS 1) To provide oversight on UN Conventional on Rights of People with Disabilities, WHO World Report on Disability, and Community Based Guidelines 2) To provide you with how these reports and my personal experience with medical rehabilitation practices worldwide shaped the RI Guidelines on Establishing Rehab in Developing Countries. 3) Present the RI Health and Function and RI approved Guidelines for Establishing Rehab in Developing Countries. 4) Provide Review of Community Based Rehabilitation Program and how they can and cannot be a part of a plan of action 5) To challenge you to implement these guidelines

4. Guidelines for Establishing Medical Rehabilitation in Developing Countries 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 personnel  Lack of appropriate facilities  Lack of clear governmental and nongovernmental policies on nongovernmental policies on rehabilitation rehabilitation  Lack of transportation for disabled

5. Guidelines for Establishing Medical Rehabilitation in Developing Countries International Federation of PM&R Conference at RI Congress in Kenya, Africa 1992 Problems Perceived in Establishing Rehabilitation Services in Developing Countries (cont’d)  Lack of equipment and supplies  Lack of recognition of importance of medical rehabilitation  Lack of training facilities  Lack of finances

6. Guidelines for Establishing Medical Rehabilitation in Developing Countries UN Convention on Rights of People with Disabilities – Article 25, Health  Right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability highest attainable standard of health without discrimination on the basis of disability  Same range, quality and standard of free or affordable healthcare and programs for those with and without disabilities  Provide those health services needed by persons with disabilities specifically because of their disabilities.

7. Guidelines for Establishing Medical Rehabilitation in Developing Countries UN Convention on Rights of People with Disabilities – Article 25, Health (cont’d)  Provide these health services a close as possible to the individual  Require health professionals to provide care of the same quality to personas with disabilities as to others  Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance  Prevent discriminatory denial of healthcare or health services or food and fluids on the basis of disability

8. Guidelines for Establishing Medical Rehabilitation in Developing Countries Unconventional on Rights of People with Disabilities Article 26 – Habilitation and Rehabilitation  To enable people with disabilities to attain and maintain maximum independence.  Begin at the earliest possible age, and treatment is based on the multidisciplinary assessment of individual needs and strengths.  Promote the development of initial and continuing training for professionals and staff  Promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they related to habilitation and rehabilitation

9. Guidelines for Establishing Medical Rehabilitation in Developing Countries World Report on Disability Addressing Barriers to Healthcare 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

10. Guidelines for Establishing Medical Rehabilitation in Developing Countries World Report on Disability Addressing Barriers to 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.

11. Guidelines for Establishing Medical Rehabilitation in Developing Countries World Report on Disability Addressing Barriers to Healthcare 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.

12. Guidelines for Establishing Medical Rehabilitation in Developing Countries World Report on Disability Addressing Barriers to 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.

13. Guidelines for Establishing Medical Rehabilitation in Developing Countries People to People Citizen Ambassador Program to South Africa July 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.

14. Guidelines for Establishing Medical Rehabilitation in Developing Countries RI Guidelines for Establishing Medical Rehabilitation in Developing 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

15. Guidelines for Establishing Medical Rehabilitation in Developing Countries RI Guidelines for Establishing Medical Rehabilitation in 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.

16. Guidelines for Establishing Medical Rehabilitation in Developing Countries RI Guidelines for Establishing Medical Rehabilitation 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

17. Guidelines for Establishing Medical Rehabilitation in Developing Countries RI Guidelines for Establishing Medical Rehabilitation in Developing Countries (cont’d) A mechanism for consultation and interaction with appropriate national and international allied rehabilitation organizational originations should be present. Recognition, acceptance, and integration of the traditional cultures of the country for development of services to disabled individuals should be in place.

18. Guidelines for Establishing Medical Rehabilitation in Developing Countries RI Guidelines for Establishing Medical Rehabilitation in Developing Countries (cont’d) A long range strategic plan should be developed that includes mission, goals, objectives, plan of action, responsibilities, timeframe, and financing to accomplish the goal for medical rehabilitation services

19. Guidelines for Establishing Medical Rehabilitation in Developing Countries Community Based Rehabilitation World 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.

20. Guidelines for Establishing Medical Rehabilitation in Developing Countries Community 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

21. Guidelines for Establishing Medical Rehabilitation in Developing Countries Community Based Rehabilitation World Report on Disability Notes Arne Husveq  CBR is cheaper than no rehab  Government push for cheaper solution  Disabled individuals not considered important

22. Guidelines for Establishing Medical Rehabilitation in Developing Countries Community Based Rehabilitation World Report on Disability Notes Problems and Solutions  Acceptance and involvement by healthcare professional  Leadership  Outcome studies

23. Guidelines for Establishing Medical Rehabilitation in Developing Countries Community Based Rehabilitation Revised Guidelines 2010

24. 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