[[email protected]]

1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
1. Increase accessibility improve access to rehabilitation services, especially for patients in remote or underserved areas
2. Technology and innovation: using digital tools for rehab services is important
3. Cost effective
4. Improve patient outcome especially continuing of care which is key priority of our organization. But we need to integrate current rehab program, train our staff and prepare infrastructure etc.
• How does it fit with community values, including the values of diverse cultural groups?
1. Community values: accessibility and equity. It will help decreasing healthcare gap. Patient centered outcome and family or carers’ involvement.
2. Cultural values: multilanguage is important, respect tradition, involve community leaders.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
We will organize webinars, workshops, use champion history or cases, distribute information through multi channels, encourage pilot studies, hand on demonstration etc.
• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Leadership top-down support which align strategic goals, partnership cooperation, capacity building (training), evaluation and use feedback mechanisms.

[[email protected]]

1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
A.Evidence based practices (incorporate interventions with strong evidence of efficacy in stroke rehabilitation), B.Multidisciplinary approach (teamwork required), C. Patient centered care D. Care continuum (short term and long-term outcome), E.Education and support. We will use RE AIM framework. 1. Define the target population for the intervention, including stroke patients eligible for rehabilitation services, caregivers, and healthcare providers involved in care delivery. 2. Specify the desired outcomes of the intervention, such as improvements in motor function, cognitive abilities, quality of life, and functional independence. 3. Engage healthcare providers and facilities in adopting evidence-based rehabilitation practices, establish partnerships with rehabilitation centers, and promote adherence to guidelines. 4. Develop standardized protocols for delivering rehabilitation interventions, ensure adequate training for healthcare professionals, and address barriers to implementation.5. Design strategies for sustaining the intervention’s impact over time, including long-term follow-up care, community support programs, and continuity of services post-discharge.
2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
1. Rehabilitation integrated into health plans 2. Priority assistive product list 3. Rehabilitation expenditure 4. Rehabilitation personnel density 5. Rehabilitation beds and day program places 6. Rehabilitation in tertiary hospitals 7. Rehabilitation integrated secondary and primary level 8. Rehabilitation utilization and effectiveness (add one or 2 indicators) RIM WHO 2019.
What steps will you take to ensure adequate monitoring and evaluation of the intervention? 1.Define clear objective and outcome 2. Select good indicators (suitable), 3. Establish baseline 4. Regular monitoring and reporting 5. Documentation 6. Make changes and adopt

[[email protected]]

1. Leadership behavior can be taught vs leaders are born. What do you think? Provide your rationale and an example of a born and made leader.
Some people influence and lead group at very early age proves born capabilities. But mostly leadership behavior can be taught because leadership is dynamic interplay. Born leaders’ example is Mahatma Gandhi, he was natural influencer. Made leaders’ example is Angela Merkel. She was scientist person later developed her leadership skills and became the first female Chancellor of Germany.
2. Post your reflections on your strengths, areas that need attention, and development priorities as identified by the emotional intelligence questionnaire on the discussion board. I finished EI questionnaire. My strengths are self-awareness, motivating oneself, empathy and social skill. Areas that need attention is managing emotions.
3. Research some vision statements of various organizations. Post at least two such statements on the discussion forum and explain how these may have evolved.
A. WHO vision statement is “A world in which all people attain the highest possible level of health.” At first WHO’s primary goal was communicable diseases and public health emergencies. Later on, vision evolved broader including NCD, mental health, strengthening health services etc. Currently WHO vision broadened to holistic and complex approach.
B. ISPRM vision statement is “To optimize functioning and health-related quality of life and minimize disability in persons with disabilities and medical conditions throughout the world.” At first ISPRM vision was to promote rehab specialty, improve clinical care etc. Later on, more and more comprehensive rehabilitation encouraged. Now ISPRM vision meet global needs it means became broadening.
4. Post your reflections on building strong leadership and increasing political support for rehabilitation of your country on the discussion board.
About Mongolia, strong leadership and political support are crucial. Develop strong leadership need education and training, mentorship programs and international networking. If we have more and more strong leaders in rehabilitation field will advance rehab care and services. Political support first thing to do is raising awareness because the country needs to develop rehab. Then develop policies and strengthening collaboration of stakeholders must establish inter-ministerial committee including other key stakeholders.

[[email protected]]

I fully agreed with you. Awareness is essential component. Mongolian National Rehabilitation Strategic Plan includes areas of action such as 4.2.
Using multiple public media channels develop campaigns to educate the community about international standard, evidence-based rehabilitation 4.3.Promote international standard, evidence-based rehabilitation services to ministries, province and district administrations, and to hospital administrators.

[[email protected]]

The 2017 Global Burden of Disease (GBD) data and the Health Indicators for 2018 in Mongolia, indicate that the health conditions most associated with disability and amenable to rehabilitation are cardiovascular disease, hypertension, ischemic heart disease, stroke, road injuries, falls, arthritis, neck and low back pain, congenital defects, neonatal disorders, cancer (particularly liver cancer) and mental disorders including depression and stress. Currently, rehabilitation needs are largely unmet.
Estimates of need for rehabilitation are now available from the Institute of Health Metrics and Evaluation website at https://vizhub.healthdata.org/rehabilitation/. These data demonstrate that in Mongolia (based on Global Burden of Disease 2019 data) approximately 2 persons in 7 could benefit from rehabilitation; that is 990, 000 people experienced conditions that could benefit from rehabilitation. Of these 230,000 were affected by fractures. In total for all conditions, in Mongolia, 110,000 years are lived with disability. Musculo-skeletal disorders were, in 2019, by far the most prevalent condition at 24.4k per 100,000 persons (23.2-25.6k); followed by sensory impairments at 7.9k (7.38k-8.50k), neurological disorders 3.21k (3.06k-3.38k), mental disorders at 1.82k(1.46k-2.10k), chronic respiratory diseases at 501 per 100,000 persons (385-615), cardio-vascular disease 373 per 100,000 persons (294-472), and neoplasms 308 per 100,000 persons (88.3-131).
Currently there is no MOH data that directly addresses unmet rehabilitation needs in Mongolia, however the GBD data, together with reports and experiences from practitioners and consumer groups suggest that there is clearly a significant unmet need for rehabilitation in Mongolia.

[[email protected]]

I think, Mongolia’s rehab situation is getting better step by step. We need to have one voice and support and push Ministries to develop this field.

[[email protected]]

In Mongolia, all hospitals should work on disability inclusive at least rehab department should be on ground floor near entry door. All new buildings must be inclusive

[[email protected]]

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.

[[email protected]]

In Mongolia, Chronic health condition 990k (960k-1.0 M) and 110k YLDs (82-140k) which I found on vizhub.healthdata.org. About road safety injuries 29,474 in 2018, 25,302 in 2019, 21,768 in 2020, 22,482 incidents in 2021 reported by National Statistic Office of Mongolia.

[[email protected]]

I see all moral, medical and social model examples. Predominant is medical model. When I see someone with disability I think social model. I raised with medical model.

[[email protected]]

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.

[[email protected]]

About rehabilitation care and services Primary and referral included in health insurance of Mongolia.

[[email protected]]

Rehabilitation is an essential part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”.

[[email protected]]

Hello everyone. My name is Zolzaya Batdavaajav (you can call me Zola). I am PRM doctor. Currently, selected as a President of Mongolian Society of PRM. I had been working as a national consultant of WHO CO Mongolia. One of my involved works is MOH approved Rehabilitation Action Plan 2021-2026. Also, Disability Inclusive Health Service DIHS toolkit implemented in Mongolia with WHO CO support. I hope, I will learn a lot during this course mostly expected on networking and looking for cost effective models which suitable our country. Thank you.

[[email protected]]

Start life again, enhance optimal functioning

[Author]

Posts