Discussion Forum 3

[kbalsara]

Pick one of the following exercises to complete prior to discussion:

o One principle of rehabilitation is that rehabilitation uses an interdisciplinary team model to deliver services. Another principle is that rehabilitation takes place in many different locations. Determine what rehabilitation hospitals, outpatient centers, or home services are available in your town or district. What rehabilitation services are provided in these locations?

o Disability is a result of the interaction between a person’s impairments, arising from disease or injury, and the environment. The environment includes both the physical structures (buildings, ramps, and braille signs) and social structures (discrimination, stigma, laws, and policies). Research what laws or policies regarding accessibility are in place in your district or country that can help reduce disability by providing access to physical structures, reduce stigma and discrimination, and provide access to health care services.

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In Mongolia three ministries each bear some responsibility for rehabilitation, albeit for different aspects. The Ministry for Health (MOH) is answerable for rehabilitation care and services as part of its legislated responsibility for medical care, health insurance and health policy and planning. The Ministry of Labour and Social Protection (MOLSP) is legally responsible for caring for disabled children and adults. It operates rehabilitation and training centres. The MOLSP is responsible for registering people with disabilities and providing, social security benefits and assistive products. The Ministry of Education and Science (MOES) has a legalized responsibility for educating children with disabilities, including vocational education and university education and for including appropriate rehabilitation in its educational services. The MOH aims to strengthen Mongolian rehabilitation to reach internationally accepted standards. The planning process is being undertaken with technical support from WHO, following the four-step process outlined in WHO’s Rehabilitation in Health Systems: Guide for Action package.In the Law of MONGOLIA on human rights of persons with disabilities included both the physical structures (buildings, ramps, and braille signs) and social structures.

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The “Conventions on the Rights of Persons with Disabilities” was developed by the United Nations in 2006, and Mongolia adopted it in 2009. Incheon’s Strategy “Let’s make the rights of people with disabilities a reality in the Asia-Pacific region” was accepted and adopted in Mongolia in March 2014.

Currently, three ministries of Mongolia are responsible for people with disabilities as Ministry of Health, the Ministry of Education and Science, and the Ministry of Labor and Social Security. The General Department of Development of People with Disabilities under the Ministry of Labor and Social Security is the organization working in the direction of promoting social participation of people with disabilities, promoting employment, providing education, and providing assistive products.

Laws and decisions applicable in Mongolia:
1. Constitution of Mongolia
2. Law on the Rights of Persons with Disabilities
3. Law on auto roads
4. Law on Auto Transport
5. Law on Construction
6. Law on Urban Development

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In my country, rehabilitation services are available in different locations. Those services are mostly physical therapy and prosthetic and orthotic services. Physiotherapy services are included in more than 40 hospitals and clinics and more than 20 outpatients centers. Most of them are concentrated in the urban area. Some programs deliver community based rehabilitation for children with disability but are very few. Prosthetic and orthotic services are very few and are all delivered in outpatients centers. The interdisciplinary principle is used in some few outpatient centers, but is not comprehended by other health workers. Those available rehabilitation services seem to be isolated in their functioning though many of them are integrated into hospitals and clinics. Other rehabilitation services are not available. A national mental health program have recently started the integration of psychological care into all levels of the health system care with a concentration at the community level.

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I chose first exercise. In Mongolia, A. Specialized high-intensity rehabilitation: 1. New service is in planning 2. Public and private hospitals, sanatoria and small centers have rehabilitation services of various levels or degrees B. Rehabilitation integrated into other medical specialties in tertiary and secondary healthcare: Tertiary hospitals begin multidisciplinary teams work but still traditional & electrical therapies mainly, with recent introduction of PTs and OTs etc. International standard rehabilitation doctors and nurses starting change to evidence -based rehabilitation processes. C. Rehabilitation integrated into primary healthcare: Some locations provide electrical therapy and traditional medicine mainly and some advice about mobility aids.
D. Community delivered rehabilitation soum (Bigger than village) & village: Out-patient clinic, NGO service Only in some area of Ulaanbaatar capital city of Mongolia. Child early intervention system (in process of launching in 6 provinces)
E. Informal and self-directed care: mostly Mongolian traditional approaches/Beliefs.

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in tanzania rehabilitation are found in national,zonal and some regional hospitals and we have some home based care in some cities,and it involves hollstic approach with multidisplinary team involved ..this is done with support of the government,private hospitals and implemmenting partenrs IP
the ministry of health oversees this through available gidelines

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In Uganda the interdisciplinary team model to deliver rehabilitation services is witnessed at the National (Four national referral hospitals) and regional hospitals(17 regional referral hospitals ) where the rehabilitation professionals are employed. Services at this level mainly include inpatients and outpatients services in prosthetics and Orthotics, physiotherapy, occupational therapy, Optician, ENT. The ATs services are also provided by NGOs who do most of the community outreaches and home services.

[Yasmin Garcia Mendez]

In Mexico, there are different laws, policies or norms regarding accessibility to help reduce disability by providing access to physical structures, reduce stigma and discrimination, and provide access to health care services:

The Federal Law to Prevent and eliminate discrimination. Discrimination by public establishments, services and facilities is considered as lack (or causing obstruction) of accessibility in the physical environment, transportation, information, technology and communications. It is also considered as a discriminatory action to stigmatize or deny services to persons with mental, psychosocial or physical disability.

Accessibility aspects are also considered in the General Health Law. This law considers accessibility of information and services.

And the Official Mexican Norm or Regulation that states the architectonic characteristics of health establishments for hospitals and other health facilities in the national health system to facilitate access, traffic, use and stay of people with disabilities.

[Tshering Penjor]

Here at the apex hospital in our country, Bhutan, some of the rehabilitation services include physiotherapy interventions. occupational therapy interventions, SLP interventions and prosthesis and orthosis. But in the districts it is usually the PT services available, the rest of the professionals do not exist there.

Another scenario is once the patient is discharged from the ward they will be referred to continue the rehab at the opd settings. If need be OT,SLPs and PNOs referrals are also made. Those families who can afford the home service on monetary basis, hires the rehab professionals to come at their house and do the necessaries. A palliative care at its infancy stage is also trying to cater the rehabilitation services to those families who are financially deprived and can not afford to bring the patient to the daily opd services.

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Option two: Case Study, Uganda

Disability, often perceived as a static condition, is a multifaceted phenomenon that arises from the interplay between an individual’s impairments and the environment they live in. The environment encompasses both physical and social structures. Physical structures, such as buildings, ramps, and braille signs, can significantly impact a person’s ability to navigate and access their surroundings. Discrimination and stigma, rooted in prejudice and misconceptions, are pervasive social barriers that perpetuate disability.
Uganda has made significant strides in enacting laws and policies that aim to promote accessibility and reduce disability. The country’s constitution, adopted in 1995, prohibits discrimination on the grounds of disability and mandates the provision of reasonable accommodation for individuals with disabilities.
In 2006, Uganda enacted the Disability Act, which provides a comprehensive framework for addressing disability issues. Key provisions of the Act include:
* Establishing the National Council for Persons with Disabilities (NCPD) as the coordinating body for disability matters.
* Requiring public buildings and facilities to be accessible to persons with disabilities.
* Prohibiting discrimination against individuals with disabilities in education, employment, health care, and other areas.
* Promoting the use of sign language and assistive devices.

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Option #2: Disability is a result of the interaction between a person’s impairments, arising from disease or injury, and the environment. The environment includes both the physical structures (buildings, ramps, and braille signs) and social structures (discrimination, stigma, laws, and policies). Research what laws or policies regarding accessibility are in place in your district or country that can help reduce disability by providing access to physical structures, reduce stigma and discrimination, and provide access to health care services.

The United Republic of Tanzania undertook a situational analysis of the rights of persons with disabilities (PWD) with the report being published in 2021. The report highlights the following policies/legislations that foster rights of PWD to access services:

PWD Specific Legislations/Policies:
1. Tanzania has ratified the UN’s Convention of the Rights of Persons with Disabilities (CRPD)
2. Persons with Disabilities Act
3. National Policy on Disability

The above policies guarantee people with disabilities the right to social support, healthcare, education, employment, accessibility and rehabilitation. However, the policies do not acknowledge factors such as non-inclusive environment and infrastructure that can contribute to exclusion, particularly for children. There is not a particular focus on the specific rights of women with disabilities as well. While the policies are in place, the implementation is inadequate particularly in the areas of awareness on disability inclusion among stakeholders, social stigma, inaccessibility of services and the physical environment and inadequate funding, among others.

PWD often face challenges in accessing public infrastructure, public transportation and recreation spaces. There is further access challenges in rural settings and women and children with disabilities are more marginalized than others.

The government of Tanzania has made progress in integrating disability in service provision, with the creation of loans for students with disabilities, construction of schools inclusive of PWDs and the appointment of PWDs to ministerial positions.

The biggest challenge across these policies is lack of adequate funding for implementation and lack of awareness. With the introduction of the Universal Health Insurance Bill in Tanzania, I would advocate for inclusion of rehabilitation services and ATs in a more progressive way within the minimum benefit package as well as encourage more funding from development partners and bi-laterals to invest in data systems to monitor rehabilitation needs across the country and integrate them into national medical information systems (such as DHIS2, GoTHMIS, etc.)

Non-PWD Specific Legislation/Policies:

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Option 2.

In Nigeria, progress has been made to ensure accessibility and reduce disability through various laws and policies. One of the key legislative frameworks is the Discrimination Against Persons with Disabilities (Prohibition) Act, signed into law in January 2019. This law aims to eliminate discrimination and provide equal opportunities for persons with disabilities with penalties for violations, including fines and imprisonment for individuals and corporate entities.

[Samuel Lagu]

In Uganda Rehabilitation is handled mainly by the National referral hospitals, Regional referral hospitals and District Hosptals. However, my District Gulu does not have a hospital and therefore rehabilitation services are handled at the only Awach Health Centre IV and at the Health Centre IIIs. However, it is imperative to note that as Gulu District we have a very good rehabilitation referral System courtesy of ReLAB-HS. Our referral system for rehabilitation cases starts right from village health teams, Health Centre IIs,IIIs and IV then to Gulu Regional referal Hospital that serve the entire Acholi Sub region in Northern Uganda.
The major rehabilitation services at our facilities mainly include screening and handling minor cases. Please note further that in Uganda AT are mainly donated by politicians after also getting donations of ATs from donors or NGOs.

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