Discussion Forum 6

[kbalsara]

1. What NGOs are working in your country or district to meet the rehabilitation needs of the population?
2. Is your country using the WHO Guide to Action?
3. You may be someone or know someone, or indeed many people, with a chronic disease or disability. What has been their experience in getting health care, rehabilitation, or assistive technology?

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1. “Equal Society Union” NGO, Italian “AIFO” NGO, Civil Society Organizations and Disabled People’s Organizations work actively in Mongolia.
2. Yes, Mongolia using the WHO Guide to Action. Situation assessment was done in 2019. Action Plan approved by Minister of Health in 2021. Now some of actions implement in Mongolia.
3. Yes, I met many people. Most of them said poor service they get usually.

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In Uganda we have a good number of NGOs offering rehabilitation and AT services and these include; AVIS, Humanity and inclusion, Miracle feet, Momentum wheels for humanity, Re-LAB HS, Comprehensive Rehabilitation Services for People with Disability in Uganda, Katalemwa Cheshire Home for Rehabilitation Services
Swiss Limb and Swiss Ability, International Committee of the Red Cross, Motivation Africa and many more.
Uganda is using the WHO guide to action plan that is why the National strategic plan for rehabilitation and ATs is in its final stage of ministry of health approval.
Access to rehabilitation services is still low and a problem in government facilities due to lack of direct budget for buying materials and machines while those living in areas where the rehabilitation NGOs operate have easy access to free rehabilitation and AT services.

[Yasmin Garcia Mendez]

What NGOs are working in your country or district to meet the rehabilitation needs of the population? Teleton Mexico, mostly. Some wheelchair donations from LDS, American Wheelchair Mission, Rotary International. There is on hospital from Shriners.

Is your country using the WHO Guide to Action? No

You may be someone or know someone, or indeed many people, with a chronic disease or disability. What has been their experience in getting health care, rehabilitation, or assistive technology? They usually access health care through the public health system which sometimes does not provide medicines and people has to pay out of pocket. The health care sector is reducing the number of services and treatments being provided. However, people still can access services with waiting times. Assistive products are frequently provided or donated without related services. People have to pay out-of-pocket as these products are not covered by the health system. Other times people wait for donations of wheelchairs, spectacles and hearing aids.

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Yes, Nepal has adapted the WHO guide for action for development of National Rehabilitation Strategic plan. There are so many among which WHO, Handicap International, CBM, Help Age, Karuna Foundation, Independent Center for Living, local NGOs, private hospital are the few names who are working to meet the rehabilitation needs. According to the voices of services users, family and caregivers, access to rehabilitation is inadequate, out of pocket expenditure is high while accessing the services and comprehensive rehabilitation needs has not been fully addressed.

[Tshering Penjor]

Soma of the NGOs related to disability and rehabilitation are:
1. Disabled people Organisation
2. Bhutan Stroke Foundation
3 Ability Bhutan Society
4. Draktsho ( Vocational training)

I don’t think so we follow the WHO guide to action

Since I dealt with many people living with disabilities, the main issues is with the financial crises. As years add on, the family members are affected depriving them from working as a full time earner. Though the primary health care is free out here and no issues in availing health care. But there are so many environmental barriers which hinders them in availing rehabilitation services whilst provided with assistive technology.

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1. NGOs are ;Comprehensive Rehabilitation Services in Uganda (CoRSU), Association of Orthopaedic Prosthetists and Rehabilitation Technicians (AOPRT),CURE Children’s Hospital of Uganda, Humanity & Inclusion (HI) ,etc

2.Yes, the WHO Guide to Action on the Prevention and Management of Non-Communicable Diseases (NCDs) is a comprehensive framework that outlines best practices for preventing and managing NCDs, including rehabilitation services.

3.In Uganda, I know of many people with disabilities and chronic diseases who have faced barriers to accessing healthcare and rehabilitation services, including high costs, limited availability, and stigma.

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1.The Zambia Agency for Persons with Disabilities (ZAPD) has the responsibility to coordinate the implementation of the National Policy on Disability and acts as an advisory body to the Ministry.

2. Yes Zambia uses the WHO guide action This occurs through actions such as improving leadership and governance; developing a strong multidisciplinary committee

3 they usually access health care services from public health care point of which most of the drugs are usually out of stock and patients have to sources these drugs of their own finances. The expirence has not been so good.

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Nepal is following WHO Guide to Action to initiate its Systematic assessment of rehabilitation situation (STARS) which was conducted from October 2019 to February 2020. The STARS report has been published in 2022 following the drafting of the National Rehabilitation Strategic Plan. The STARS was conducted in a leadership of Ministry of health and population (MoHP) Nepal particularly a focal section- Leprosy control and disability Management section (LCDMS) with technical support from the WHO and USAID’s Physical Rehabilitation Activity (PRA) implemented by Handicap International (HI) Nepal. In the Southeast Asia Region, Nepal is the second country after Myanmar to have completed a STARS assessment. With successful accomplishment of STARS MoHP/LCDMS has started to draft National Rehabilitation Strategic Plan in close coordination with health and rehabilitation stakeholders which is anticipated to be finalized withing few months of time.

[Albert Erongu]

1. Several NGOs are working in Uganda; AVIS, Physiopedia, Humanity, Momentum Wheels for Humanity and Inclusion, Miracle Feet, Re-LAB HS, Comprehensive Rehabilitation Services for People with Disability in Uganda, CURE Children’s Hospital, Community Focused International, O.J Disability Foundation, Katalemwa Cheshire Home for Rehabilitation Services, African Centre for Treatment and Rehabilitation of Torture Victims (ACTV), Swiss Limb and Swiss Ability etc
2. Uganda is using the WHO guide to action and currently, the National Strategic Plan is in the final stage for approval by the Ministry of Health.
3. I have directly interacted with many people in need of rehabilitation and AT services. However, a huge gap still exists in communication or information about rehabilitation and, the high cost of assistive products like artificial limbs, wheelchairs, axillary crutches, etc. Some of the NGOs in the Country are providing services based on donor-targeted population categories.

[Hoeung HEAM “[email protected]”]

1) In Cambodia, it used to be 5 international NGOs are the key players of rehabilitation service. They mostly started or supported rehabilitation service since later 1990s or early 2000s. They were HI France, HI Belgium, ICRC, Veterans International, Cambodia Trust. However, there are three of them exist for supporting current rehabilitation service in Cambodia are HI (now is Humanity and Inclusion), ICRC, and Exceed World Wide (formerly Cambodia Trust). These three INGO now are also facing challenges in funding rehabilitation service.
2) Rehabilitation in Cambodia is under the leadership or mandate of Ministry of Social Affairs. Recently, government issued a directive to instruct the Ministry of Social Affairs and the Ministry of Health (MoH) to transfer rehabilitation service under the MoH. Therefore, practically this is part of the consideration of the WHO Guide to Action. In addition, MoH is now including rehabilitation service into its hospital service policy and guideline. The issue is that it has been almost two years, the transition of rehabilitation service is not moving forward because the Ministry of Social Affairs seems does want to let the rehabilitation service go to MOH. It is important to note that there are some initiative on the development of rehabilitation service guideline under the social affair mandate. This service guideline was based on the WHO building block.
3) Rehabilitation service is poor from my opinion and experience. Once it was with funding support from 5 INGOs, there were quite a lot of services available including support for accessing rehabilitation service that help people from limited socioeconomic background. However, since less support began in early the 2010s, many people cannot user rehabilitation service. For instance, many children with moderate to severe cerebral palsy in poor family and in the rural communities cannot have wheelchairs or seating system, children with autism cannot access to service due to no such service available or only available at the capital city, epilepsy children can access to physiotherapy and convolution medication, etc. However, we have not reliable data on the real need of rehabilitation service in country. It is noted that the democratic survey 2021 reports that the county have disability prevalence of 25% of the population.

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NGOs in Tanzania include (note this is not an exhaustive list):
– Humanity and Inclusion
– Hellen Keller International
– Sightsaves
– Light for the World
– CBM
– Kilimanjaro Center for Community Opthalmology
– Results for Development
– UNICEF
– Brian Holden Vision Institute
– Open University
of Tanzania

Yes, Tanzania is using the WHO Action Guide and has conducted a situational assessment as well as developed its first national rehabilitation strategic plan.

I have experienced parents navigating the private health care system for access to spectacles and hearing aids for their children; in the private sector, if you have the resources it’s readily available and the quality of both products and services is good. However, in the public sector, there are many challenges related to awareness, stigma, access to good primary and secondary screening, lack of referral pathways, and unaffordability to products such as hearing aids that are not covered through the national health insurance program and are very expensive.

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1. NGOs working on Rehabilitation Needs in Nigeria: CBM (Christian Blind Mission), Handicap International, Comprehensive Community Mental Health Programme (CCMHP), Sightsavers Nigeria, Leprosy Mission Nigeria.

2. Yes, Nigeria has been progressively incorporating the WHO Guide to Action on Disability and Rehabilitation in policies such as the National Health Policy, and Nigeria Disability Bill (2018).

3. Observed Experiences:
Access to Health Care: People with chronic diseases or disabilities often face difficulties accessing healthcare services due to inadequate facilities, high costs, and limited availability of specialized care.

Rehabilitation Services: Rehabilitation services are not widely available in Nigeria, especially in rural areas. Many people have to travel long distances to receive care, which can be costly and time-consuming.

Assistive Technology: Access to assistive devices like wheelchairs, hearing aids, and prosthetics is limited. Cost is a significant barrier, and there is often a lack of awareness about available resources.

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In Tanzania, several NGOs, such as the Tanzania Red Cross Society and the Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT), are actively working to meet the rehabilitation needs of individuals with disabilities and chronic health conditions. These organizations provide vital services, including physical rehabilitation, community-based support, and access to assistive technologies. The Tanzanian government has been making efforts to align with the WHO Guide to Action on disability and rehabilitation, promoting inclusive health systems. However, many individuals with chronic diseases or disabilities still face challenges in accessing quality healthcare and rehabilitation services, often due to resource constraints, limited availability of assistive devices, and socio-economic barriers. Personal experiences vary widely, but many report difficulties in navigating the healthcare system and a lack of adequate support, highlighting the need for continued advocacy and improved services.

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