template f r rehabilitation information collection

A tool accompanying the Systematic Assessment of Rehabilitation Situation (STARS)

TEMPLATE F R REHABILITATION INFORMATION

COLLECTION

TRIC

IN HEALTH SYSTEMSGUIDE FOR ACTION

iii

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

iv

Template for Rehabilitation Information Collection (TRIC): a tool accompanying the Systematic Assessment of Rehabilitation Situation (STARS)

ISBN 978-92-4-151601-3

© World Health Organization 2019

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v

Contents

Acronyms 1

BACKGROUND 2

USING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC) 4

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 6

SECTION 1: GENERAL COUNTRY INFORMATION 6

1.1 POPULATION PROFILE 6

1.2 SOCIOCULTURAL PROFILE 6

1.3 REHABILITATION NEEDS 7

SECTION 2: TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 8

2.1 LEADERSHIP AND GOVERNANCE 8

2.2 FINANCING FOR REHABILITATION 10

2.3 HUMAN RESOURCES FOR REHABILITATION 12

2.4 REHABILITATION SERVICE DELIVERY 16

2.5 ASSISTIVE TECHNOLOGY 22

2.6 REHABILITATION INFRASTRUCTURE 26

2.7 REHABILITATION INFORMATION 27

2.8 EMERGENCY PREPAREDNESS 29

SECTION 3: SOURCES OF INFORMATION 30

3.1 STAKEHOLDERS INTERVIEWED 30

3.2 LITERATURE AND ONLINE SOURCES 31

ANNEX 1: GUIDANCE FOR COMPLETING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 32

ANNEX 2: REHABILITATION MAPPING 41

1

Acronyms

ACTOR Action on Rehabilitation

AP Assistive Products

FRAME Framework for Rehabilitation Monitoring and Evaluation

GRASP Guidance for Rehabilitation Strategic Planning

ICD International Classification of Diseases

NCD Noncommunicable disease

NGO Nongovernmental organization

RIM Rehabilitation Indicator Menu

SHA System of National Health Accounts

SDGs Sustainable Development Goals

STARS Systematic Assessment of Rehabilitation Situation

TRIC Template for Rehabilitation Information Collection

UHC Universal Health Coverage

WHO World Health Organization

2

BACKGROUND

he World Health Organization’s Template for Rehabilitation Information Collection (TRIC) is part of the Systematic Assessment of Rehabilitation Situation (STARS) guidance (see Figure 1). STARS guides users through Phase 1 of a four-phase process that supports governments in strengthening rehabilitation in their health systems. Findings from a STARS situation assessment should inform development of a rehabilitation strategic plan. Phase 1 includes four steps, and completion of the TRIC by government occurs during step 2. The TRIC directs the collation of data across the six-health system building blocks: leadership and governance, financing, human resources, health services, medicines and technology, health information systems, and includes a section on emergency preparedness and infrastructure. The information collected in the TRIC supports steps 3 and 4 of STARS.

3

Figure 1: Overview of phases, steps and accompanying guidance and tools in the WHO rehabilitation in health systems: guide for action

4

USING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC) Before completing the TRIC, it is essential that users read the STARS guidance in WHO’s Rehabilitation in health systems: guide for action. Who completes the TRIC and when? Only one version of this template should be completed by government, typically by the focal person for rehabilitation within the Ministry of Health. This person may draw on government and other non-governmental stakeholders to collect the information. They must compile all the data and then return one version to WHO and the consultant (if one is being used) prior to the in-country assessment period. The TRIC should be given to the government approximately 8 weeks before the in-country assessment period of STARS to allow enough time for data collation.

This tool has been designed for low- and middle-income countries and for use at either national or subnational level. If the assessment is being done at subnational level, substitute “national” or “country” in TRIC with “subnational”, “state”, or “province”, as appropriate.

Is there a brief version of the TRIC available? In each section of the template, certain questions are shaded red. Collectively these questions constitute a rapid assessment. A rapid assessment can be conducted when the information necessary to complete the full tool is not available or when time and human resources are lacking. A rapid assessment, based on this subset of questions, only provides a basic overview of the rehabilitation and it is strongly recommended that, if possible, users complete the full assessment.

Where can information to complete the TRIC be found? Information to complete the TRIC can be drawn from various sources. Completing the TRIC will require desk-based data collection and, when necessary, stakeholder interviews.

Desk-based data collection The following desk-based sources should provide much of the information necessary to complete the TRIC:

o Peer-reviewed literature o WHO/UN statistics o Data from the National Statistics Office o Administrative data from the Ministry of Health and/or Ministry of Social Affairs

Stakeholder interviews Interviews with the following stakeholders may provide additional information to complete the TRIC:

o Government rehabilitation focal points o Ministry of Health and Ministry for Social Affairs (or national equivalents) o Rehabilitation professional associations o Representatives of rehabilitation training institutes or programmes o Nongovernmental and international organizations engaged in rehabilitation service delivery, training or

development o Health facility staff, such as hospital or hospital department managers

Further detail on sources of information to complete TRIC can be found in Annex 1 of this document.

5

How long does it take to complete the TRIC? The length of time it takes to complete the TRIC depends on how readily available rehabilitation information is in the country and how well the government prioritizes the task. Where rehabilitation is regularly collected and compiled, the TRIC may take several hours. However, where this is not the case and information needs to be obtained from multiple sources, the TRIC may take several days spread over a period of 3–4 weeks. Sources should be recorded and attached to the information to assist with analysis.

What is contained in the different sections of the TRIC? Section one: “General country information” includes questions about demographics and data on rehabilitation needs.

Section two: The TRIC includes questions relating to the situation of rehabilitation in the following areas:

o Leadership and governance o Financing for rehabilitation o Human resources for rehabilitation o Rehabilitation service delivery o Assistive technology o Rehabilitation infrastructure and medications o Rehabilitation information and research o Emergency preparedness It is recommended that this section be completed with Annex 1 at hand so that possible sources of information and relevant definitions can be readily referred to. Section three: “Sources of information” is a template to record the sources from which information was drawn. Recording the sources of information can help to verify details, speed up future assessments, and strengthen mechanisms for routine data collection. Annex 1. “Guidance for completing the TRIC tool” provides more detailed information on completing the different sections of the questionnaire, including possible sources of information and definitions. Annex 2. “Rehabilitation service map” provides a template to record what rehabilitation services exist and where they are located. This is particularly useful when there are only a limited number of services in the country or area being assessed.

6

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

SECTION 1: GENERAL COUNTRY INFORMATION Name of the country and area (state, region, province) in which this assessment is being conducted

Name of person responsible for this assessment Designation and qualification Address Email Telephone number Development partner(s) involved (include name and contact details)

1.1 POPULATION PROFILE

1.1.1 Total population 1.1.2 Age distribution of population (%)

Adjust age brackets as required 0–5 years: 6–15 years: 16–60 years: > 60 years:

1.1.3 Sex distribution (%) Male: Female:

1.1.4 Rural-urban distribution (%) Rural: Urban: Slum1 population (if applicable):

1.1.5 Life expectancy at birth

1.1.6 Disability prevalence (%) Include source, multiple if available

% and source:

1.1.7 Any other population-related factors that need to be considered in planning services Include details of indigenous, ethnic minorities and displaced population(s) if applicable

1.2 SOCIOCULTURAL PROFILE

1.2.1 Languages 1.2.2 Religions

Add approximate % population for each

1.2.3 Literacy rate (as a % of total population)

1 The United Nations defines a slum by five characteristics: inadequate access to safe water; inadequate access to sanitation and infrastructure; poor structural quality of housing; overcrowding; and insecure residential status (see the Housing and slum upgrading section of UN Habitat’s website at http://unhabitat.org/urban-themes/housing-slum-upgrading/, accessed 11 June 2016).

7

1.2.4 Other significant sociocultural factors, such as the country’s experience of war or natural disasters

1.3 REHABILITATION NEEDS

This section seeks only quality information that can inform rehabilitation needs in the population. Use only quality data from population surveys or administration data such as registries. Include any information relevant to the country, and the source of the information. A separate sheet may be used. 1.3.1 Trauma (number of cases a year

or rates per 10 000) Road traffic injuries: Significant burns:2 Falls: Injuries: Additional trauma relevant to country or area being assessed and for which robust data are available:

1.3.2 Prevalence of noncommunicable disease (% of population)

Cancer: Diabetes: Cardiovascular disease: Respiratory disease: Other:

1.3.3 Number of cases of stroke per year

1.3.4 Prevalence of significant communicable disease (% of population)

For example, prevalence of HIV/AIDS, neglected tropical diseases:

1.3.5 Prevalence of disabling vision loss3 (% of population)

1.3.6 Prevalence of disabling hearing loss2 (% of population)

1.3.7 Prevalence of age-related health conditions

For example, frailty, dementia:

1.3.8 Prevalence of developmental and neurological conditions in children (% of population if available)

For example, intellectual impairment, developmental delay, autism, cerebral palsy, spina bifida, epilepsy:

1.3.9 Prevalence of neurological conditions in adults (% of population if available)

For example, multiple sclerosis, spinal cord injury, traumatic brain injury

1.3.10 Prevalence of mental health conditions (% of population if available)

Depression: Anxiety: Schizophrenia: Bipolar disorder: Other significant mental health conditions relevant to the country or area being assessed:

2 Include definition of “significant burn” based on degree and total body surface area (TBSA) used to establish the figure provided. 3 If information not available, indicate definition used in estimation of prevalence.

8

1.3.11 Prevalence of congenital anomalies (% of population if available)

Cleft lip: Club foot: Other congenital anomalies significant to country or area being assessed:

1.3.12 Musculoskeletal conditions

Prevalence of osteoarthritis and rheumatoid arthritis (% of population): Incidence of hip fractures (cases per year): Prevalence of lower limb amputations (total number or % of population): Any other significant musculoskeletal conditions for which there is reliable data (such as low back pain):

1.3.13 Other information related to need and demand for rehabilitation

SECTION 2: TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

2.1 LEADERSHIP AND GOVERNANCE

2.1.1 Which ministry is responsible for rehabilitation in the country? If multiple, list all

Details:

2.1.2 Is rehabilitation included in health policy and legislation frameworks? If yes, describe how and where it is included

Yes No Details:

2.1.3 Is rehabilitation included in the national health strategic plan? If yes, describe how and where it is included

Yes No Details:

2.1.4 Has rehabilitation been included within health service planning processes? If yes, describe how this has occurred – for example, within which other areas of health?

Yes No Details:

2.1.5 Is there a designated unit and/or officer for rehabilitation within the ministry structure?

Yes No Details:

9

If yes, provide details, including number of equivalent full-time staff allocated to rehabilitation

2.1.6 Is there a dedicated national rehabilitation policy or legislative framework? If yes, attach it

Yes No Details:

2.1.7 Is there a dedicated strategic plan specifically for rehabilitation? If yes, provide title, timeframe and attach them

Yes No Details:

2.1.8 Is there a clear governance structure for rehabilitation? Describe this, including if it has a committee, steering group, technical working group etc.

Yes No

2.1.9 Are there any mechanisms for coordination of rehabilitation between ministries? If yes, provide details

Yes No Details:

2.1.10 Are there any national reporting processes and/or monitoring frameworks for rehabilitation? If yes, provide details of this, including frequency of reporting

Yes No Details:

2.1.11 Is information and evidence regarding rehabilitation service availability and uptake used to inform service planning? If yes, describe what evidence is used

Yes No Details:

2.1.12 Do regulatory frameworks for health exist and apply to rehabilitation? If yes, describe which ones apply to rehabilitation. For example, health professional accreditation, health facility

Yes No Details:

10

accreditation, medical product standards

2.1.13 Are rehabilitation users included in the governance and/or decision-making process for rehabilitation? If yes, describe how they are included

Yes No Details:

2.1.14 Is there an early childhood development (ECD) policy, and does it include early childhood intervention? Are there inter-sectoral leadership and coordination mechanisms that include early childhood intervention?

ECD Policy Yes No ECD Policy inclusive of ECI Yes No

Yes No Details:

Comments and additional information

2.2 FINANCING FOR REHABILITATION

2.2.1 Is there an allocated budget for rehabilitation? If yes, from which ministry or ministries?

Yes No Ministry/ministries:

2.2.2 What is the annual public expenditure for rehabilitation? If from multiple ministries, then include amount from each

Ministry and amount:

2.2.3 Is there an allocated budget for assistive products? If yes, from which ministry/ministries

Yes No Ministry/ministries:

2.2.4 What is the annual public expenditure for assistive products? If from multiple ministries, then include amount from each.

Ministry and amount: Are assistive products included in rehabilitation expenditure?

11

Specify if assistive product expenditure is included in the rehabilitation expenditure and disaggregate if possible.

2.2.5 What is the annual total health expenditure?

Amount:

2.2.6 What are the major health financing mechanisms that include rehabilitation? Name these mechanisms and describe how rehabilitation is included

Details:

2.2.7 Which type of rehabilitation is covered by which major health financing mechanisms?

Details:

2.2.8 Are there any financing mechanisms that include rehabilitation targeting children with developmental delays and disabilities? These may be linked to early childhood intervention services and special education services

Details:

2.2.9 Does the government contract agencies, such as nongovernmental organizations (NGOs) to deliver rehabilitation services – either within, or separate from, major health financing mechanisms? If yes, provide details on number of organizations contracted, amount spent and services they deliver

Yes No Organizations contracted: Services delivered: Annual amount spent:

2.2.10 What is the percent of out-of-pocket (OOP) health costs in the country? Is there specific information in relation to rehabilitation? If so, describe. What are the typical OOP costs for rehabilitation in a government facility? Provide an example for a hip fracture

OOP as % of total health expenditure: Specific information about rehabilitation OOP costs: Typical OOP rehabilitation costs in government facility:

12

2.3

H

UMAN

RES

OUR

CES

FOR

REHA

BILI

TATI

ON

2.3.

1 W

hich

, if a

ny, o

f the

follo

win

g re

habi

litat

ion

prof

essio

nals

are

avai

labl

e at

the

prim

ary

leve

l?

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sioth

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ists4

Occ

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l the

rapi

sts

Spe

ech

and

lang

uage

ther

apist

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udio

logi

sts

Pro

sthe

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and

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sical

and

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ctor

s P

sych

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Oth

er re

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prof

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adre

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2.

3.2

Whi

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f any

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he fo

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ork

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P

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Psy

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ther

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re(s

):

2.3.

3 Co

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l lev

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f hea

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the

coun

try

(ofte

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pr

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and

tert

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), lis

t eac

h le

vel a

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ark

if re

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ion

prof

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are

avai

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e. T

he li

nes p

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are

for a

six-

leve

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adj

ust a

s app

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.

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l nam

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2.

3.4

For e

ach

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ealth

serv

ice in

you

r cou

ntry

, list

the

tota

l num

ber o

f fa

ciliti

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nd th

e nu

mbe

r of f

acili

ties w

ith re

habi

litat

ion

prof

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Re

peat

for e

ach

leve

l.

*If f

easib

le, p

rovi

de fu

rthe

r det

aile

d in

form

atio

n on

a se

para

te sh

eet a

bout

th

e nu

mbe

r of r

ehab

ilita

tion

prof

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nd p

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avai

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ities

. For

exa

mpl

e: Le

vel 2

hos

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hos

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5 w

ith

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ls; 1

2 w

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+ re

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litat

ion

prof

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otal

180

pr

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Leve

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Tota

l num

ber o

f fac

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his

leve

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umbe

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acili

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habi

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prof

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4 Phy

sioth

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re sy

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s with

phy

sical

ther

apist

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the

cont

ext o

f thi

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l. 5 S

peec

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re sy

nony

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s with

spee

ch a

nd la

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ge p

atho

logi

sts i

n th

e co

ntex

t of t

his t

ool.

13

2.3.

5 2.

3.6

2.3.

7 2.

3.8

2.3.

9 2.

3.10

2.

3.11

2.

3.12

2.

3.13

2.

3.14

To

tal

num

bers

Nu

mbe

r per

10

000

Di

strib

utio

n

Ed

ucat

iona

l re

quire

men

t for

en

try

into

the

wor

kfor

ce

Whi

ch o

f the

fo

llow

ing

are

offe

red

in th

e co

untr

y?

Num

ber o

f ed

ucat

ion

inst

itutio

ns

offe

ring

cour

ses

Num

ber o

f na

tiona

l gra

duat

es

each

yea

r

Is th

ere

prof

essio

nal

accr

edita

tion?

Is th

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a pr

ofes

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l as

socia

tion?

% q

ualif

ied

pers

onne

l th

at

emig

rate

an

nual

ly?

A Ph

ysio

ther

apist

s Pu

blic

sect

or:

Priv

ate

sect

or:6

NGO

s:

Tota

l:

Ur

ban

%:

Rura

l %:

Prim

ary:

%

Seco

ndar

y: %

Te

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ry: %

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lor

Mas

ter

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tora

te

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er:

Na

tiona

l: In

tern

atio

nal:7

Yes

N

o

Yes

N

o

B O

ccup

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nal

ther

apist

s Pu

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sect

or:

Priv

ate

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or:

Tota

l:

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ban

%:

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l %:

Prim

ary:

%

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Te

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ache

lor

Mas

ter

Doc

tora

te

Oth

er:

Na

tiona

l: In

tern

atio

nal:

Yes

N

o

Yes

N

o

C Sp

eech

and

la

ngua

ge

ther

apist

s

Publ

ic se

ctor

: Pr

ivat

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ctor

: To

tal:

Ur

ban

%:

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l %:

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ary:

%

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Te

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Dip

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ter

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tern

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nal:

Yes

N

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N

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D Pr

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s and

or

thot

ics8

pers

onne

l (c

ateg

ory

I)

Publ

ic se

ctor

: Pr

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e se

ctor

: To

tal:

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ban

%:

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l %:

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ary:

%

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ter

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tora

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tiona

l: In

tern

atio

nal:

Yes

N

o

Yes

N

o

E Pr

osth

etic

s and

or

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ics

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onne

l (c

ateg

ory

II)

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: Pr

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:

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:

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:

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tern

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nal:

Yes

N

o

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N

o

6 It is

und

erst

ood

that

in m

any

coun

trie

s reh

abili

tatio

n pr

ofes

siona

ls w

ill b

e w

orki

ng in

bot

h pu

blic

and

priv

ate

sect

or si

mul

tane

ously

– d

ual p

ract

ice. W

here

this

occu

rs, i

t is s

ugge

sted

to o

nly

coun

t the

pr

ofes

siona

ls w

ho a

re w

orki

ng fu

ll-tim

e in

the

priv

ate

sect

or.

7 “Int

erna

tiona

l” re

fers

to so

meo

ne w

ho h

as co

me

from

ano

ther

coun

try,

bee

n tr

aine

d th

ere,

and

is n

ow su

pple

men

ting

the

wor

kfor

ce in

the

coun

try

bein

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)?

2.3.

17

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any

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kind

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xpla

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Wha

t sup

port

and

supe

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on m

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in p

lace

for r

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pers

onne

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Desc

ribe:

16

2.4 REHABILITATION SERVICE DELIVERY

Rehabilitation is assessed under the following headings: Availability of common types of rehabilitation:11

1. Specialized, high intensity rehabilitation 2. Community-delivered rehabilitation 3. Rehabilitation integrated into tertiary health care 4. Rehabilitation integrated into secondary health care 5. Rehabilitation integrated into primary health care 6. Rehabilitation that is informal and self-directed occurring in community settings 7. Rehabilitation across all phases of acute, subacute and long-term care 8. Rehabilitation for children 9. Rehabilitation for the target population groups

Quality: Effective, timely, person-centred and safe

Specialized, high-intensity rehabilitation

2.4.1 Are there specialized, high-intensity and longer stay rehabilitation centres/wards/units/hospitals for people with complex rehabilitation needs? If yes, provide details of their bed capacity, the patient groups they cater for (such as people with spinal cord injury or traumatic brain injury) if applicable, and which agency operates the centre If insufficient space, complete on a separate sheet

Yes No Name: Rehabilitation bed capacity: Rehabilitation outpatient/day programme capacity: Patient group(s): Operated by:

Government Nongovernmental and international

organizations Private providers

Name: Rehabilitation bed capacity: Rehabilitation outpatient/day programme capacity: Patient group(s): Operated by:



Name: Rehabilitation bed capacity: Rehabilitation outpatient/day programme capacity: Patient group(s): Operated by:


organizations

11 The structure of this section aligns to the Rehabilitation in Health Framework that forms part of the STARS guidance in the WHO Rehabilitation in health systems: guide for action. Refer to the guide to view this framework. See Annex 1 of this document for descriptions of these different types of rehabilitation.

17

Private providers

2.4.2 What is the total number of dedicated rehabilitation beds in the country (if any)?

Total rehabilitation beds:

Community-delivered rehabilitation

2.4.3 Are there rehabilitation services being delivered in the community?12 If yes, which agency provides these services? Select all that apply Describe the range of community-delivered rehabilitation services, e.g. community outreach, mobile clinics, community-based rehabilitation, condition specific. If no, proceed to question 2.4.7

Yes No

Public Ministry for health Ministry for social affairs Other: Nongovernmental and international


Details:

2.4.4 Are community-delivered rehabilitation services available across all districts in the country? Describe coverage, include the total number of districts and number that are covered

Yes No Details of coverage: Total number of districts: Number of districts covered:

Rehabilitation integrated into tertiary and secondary health care

18

2.4.5 Is rehabilitation integrated into tertiary and secondary health care in both hospital and clinic settings?

Rehabilitation in tertiary health care: Yes No In some hospitals, but not

others (describe what is available and where) Rehabilitation in secondary health care:

Yes No In some hospitals, but not others (describe what is available and where)

Are inpatient and/or outpatient rehabilitation services available in tertiary and secondary level hospitals?

Inpatient Outpatient Both Varies depending on the hospital

Rehabilitation integrated primary health care

2.4.6 Is rehabilitation integrated into primary health care? Does the country have a defined package of services for provision of primary health care? If yes, are rehabilitation services/interventions integrated in the package? If yes, outline them

Yes No Describe: Package of services for provision of primary health care

Yes No Rehabilitation services/interventions integrated in the package

Yes No Outline the rehabilitation services:

Informal and self-directed rehabilitation. For example, by carers in the home or a long-term care setting

2.4.7 Is informal and self-directed rehabilitation widely occurring in community settings? Examples of this may be carers supporting rehabilitation in long-term care settings; childcare or education workers carrying out rehabilitation with clients

Yes No Details of its occurrence:

19

Rehabilitation services across all phases of care: acute, subacute and long-term care

2.4.8 Is rehabilitation available in acute care – e.g. within intensive care units, emergency departments and acute medical wards?

Yes No Details:

2.4.9 Is rehabilitation available in subacute care – e.g. within general hospitals, outpatients, and rehabilitation centres?

Yes No Details:

2.4.10 Is rehabilitation available in long-term care, e.g. within long-term care facilities, day centres, and community centres?

Yes No Details:

Rehabilitation for children

2.4.11 Is there hospital-based paediatric rehabilitation for children with developmental delays and disabilities? Describe these, e.g. multi-disciplinary developmental assessment clinics, children’s hospital programmes

Yes No Details:

2.4.12 Is there paediatric rehabilitation for children with disabilities or developmental delays in the community? If yes, state who delivers these and include information on coverage

Yes No Details:

2.4.13 Are mechanisms in place within health services that support early identification and referral for children with developmental delays and disabilities? If yes, describe these

Yes No Details:

2.4.14 Is rehabilitation provided in schools, or for school-aged children?

Yes No Details of programmes delivered and the coverage:

20

If yes, describe who delivers these and include information on coverage

2.4.15

Are there programmes available for children with specific developmental delays and disabilities? If yes, list them For example, autism spectrum disorder, intellectual disability, club foot

Yes No Details:

2.4.16 Is there an early childhood intervention network, association, or programme operating in the country?

Yes No Details:

Rehabilitation for target population groups

2.4.17 Are data on rehabilitation needs in specific target population group available? For example, for victims of unexploded ordinance? If yes, name groups

Yes No Details:

2.4.18 Is there any rehabilitation designed specifically to meet the needs of specific/target population groups? If yes, please list them (Below are questions for older people, people with mental health conditions, and people with vision and hearing impairments)

Yes No List the rehabilitation programmes that have been developed for target populations:

2.4.19 Is there rehabilitation that targets older people, e.g. fall prevention programmes, programmes addressing frailty?

Yes No Details:

2.4.20 Is there rehabilitation for people with vision or hearing loss? If yes, describe it.

Yes No Details:

21

2.4.21 Is there rehabilitation for people with mental health conditions? If yes, describe it.

Yes No Details:

Rehabilitation quality

2.4.22 Are there national clinical practice guidelines, models of care, standards and protocols that support delivery of effective evidence-based rehabilitation services? If yes, indicate which exist and rate their availability

National clinical practice guidelines Very few Some Many

Models of care Very few Some Many

Standards Very few Some Many

Protocols Very few Some Many

2.4.23 Are there effective referral processes, care pathways, case management and case coordination practices that support timely delivery of rehabilitation along a continuum of care? If yes, rate the extent to which these practices occur and list the common practices.

None Very few Some Many

Details/list:

2.4.24 Within rehabilitation, are the practices of goal setting, multidisciplinary teamwork and measurement of functioning outcomes utilized? To what extent are they utilized?

Not commonly utilized Sometimes utilized Frequently utilized Consistently utilized

Details/list:

2.4.25 Is the practice of person-centred care commonly used in rehabilitation? This

Not commonly utilized Sometimes utilized Frequently utilized

22

includes frequent education and empowerment of users and their family/carers, user input to service decision making, delivering flexible, tailored services Rate the extent to which person-centred care is utilized and list the common practices

Consistently utilized Details/list:

2.4.26 Is there a system by which rehabilitation is regularly monitored for quality, e.g. quality assurance programmes, facility level accreditation programmes, service audits and regular service user feedback analysis?

Yes No Details:


2.5 ASSISTIVE TECHNOLOGY

2.5.1 Does the country have a strategy, plan or roadmap that incudes assistive products (AP)?

Yes No Details:

2.5.2 Does the country have an essential list of APs? If yes, provide information and attach the list. Refer to WHO 50 priority assistive products (APL13) if needed.

Yes No Details of list:

2.5.3 Is there a financial mechanism /scheme that covers or subsidizes the cost of AP – e.g. a national health insurance, or national AP programme? If yes, name the financial mechanism/scheme and who is entitled to benefit. Please attach a list of products (or

Yes No Name of scheme: Beneficiaries: Percentage of population covered by scheme:

13 Refer to Annex 1 for the WHO Priority Assistive Product List, or go to http://apps.who.int/iris/bitstream/10665/207694/1/WHO_EMP_PHI_2016.01_eng.pdf?ua=1, accessed 12 June 2019.

23

groups of products) covered by the scheme

Details of scheme, including if assessment, fitting, training etc is included:

2.5.4 Are there taxes and duties on imported assistive products and or their component parts? If so please specify the tax and or duties on each product?

Yes No Details:

2.5.5 What regulatory mechanism are relevant to AP? Any quality or safety standards before AP can be placed on the market? If yes, provide details:

Yes No Details:

2.5.6 Do written guidelines or service standards exist for the provision of AP? If yes, provide details of who sets for what products?

Yes No Who sets the standards?

2.5.7 Who are the main stakeholders who procure AP in the country? List the top 3. Select all that apply

Main Stakeholders:

Bulk purchase. From whom: Yearly tendering. From whom: Individual need. From whom: Other (specify):

2.5.8 Are there technical specifications available to guide procurement of assistive products? If so, for which assistive products?

Yes No Details:

2.5.9 Who is the key workforce that provide assistive products? Please specify the key personnel who provide AP across the 6 domains of AP.

Mobility products: Hearing products: Vision products: Communication products: Self-care products: Cognition products:

24

2.5.10 Which types of AP are available within the country? Are any of these AP produced locally?

MOBILITY Manual wheelchairs, assistant controlled Manual wheelchairs, for active users Electric/powered wheelchairs Walking frames and Rollators Canes/sticks (including tripods, quadripods) Crutches, axilliary/elbow Therapeutic footwear; diabetic, neuropathic,

orthopaedic Chairs for bath/shower/toilet Orthoses Prostheses Club foot braces Ramps, portable Pressure-relief14 cushions

VISION Spectacles Magnifiers, optical Magnifiers, digital, hand-held Braille equipment White canes Watches, talking/touching Audio players with DAISY capability15

HEARING Hearing aids (digital) and batteries Alarm signallers with light/sound/vibration Communication boards/books/cards

SELF CARE / COGNITIVE Incontinence products, absorbent Charis for bath/shower/toilet Pill organizers Personal emergency alarm systems Simplified mobile phones

Products produced and /or assembled locally, if any:

2.5.11 Are there quality regulations or safety standards for AP that need to be met before they are made available to users? If yes, outline standards or regulations on a separate sheet, or provide a link

Yes No Details:

14 In this context, pressure-relieving products include those made from air or high-profile foam that are specifically designed for pressure relief. 15 DAISY (Digital Accessible Information System) is software that enables text to be converted to audio and is typically used by people with a visual and/or cognitive impairment that limits their ability to read.

25

2.5.12 Are there service standards for the provision of AP? If yes, who sets these standards?

Yes No Who sets the standards?


26

2.6 REHABILITATION INFRASTRUCTURE

2.6.1 Which of these statements is most accurate when describing the availability of rehabilitation equipment and consumables in the country or area being assessed?

Rehabilitation providers in both community and hospital settings have access to all the equipment and consumables they require to provide quality rehabilitation

Rehabilitation providers in both community and hospital settings have access to some of the rehabilitation equipment and consumables they require to provide quality rehabilitation

Rehabilitation providers in hospital settings have access to some of the equipment and consumables they require to provide quality rehabilitation but access to those in community settings is inadequate

Access to rehabilitation equipment and consumables is generally inadequate in both community and hospital settings

Other (describe the situation regarding rehabilitation equipment and consumable availability):

2.6.2 Which, if any, of the following commonly used rehabilitation-related medications is available in government services in the country?

Botulinum toxin A – for muscle spasticity Baclofen Corticosteroids Non-steroidal anti-inflammatory drugs

(NSAIDS)

2.6.3 Do secondary and tertiary hospitals have designated purpose-built space/gyms available for rehabilitation assessment and interventions?

Yes No

Therapy gymnasium(s) Number of hospitals (if known)? Describe common equipment in gym:

Kitchen and bathroom for activity of daily living assessment and intervention Number of hospitals (if known)?

Separate treatment rooms and cubicles for different professional services


27

2.7 REHABILITATION INFORMATION

Health information system 2.7.1 Within the health information

system, are data collected regarding the functioning of the population, e.g. through comprehensive disability surveys or the WHO Model Disability Survey? If yes, provide details

Yes No Details:

2.7.2 Within the health information system (such as the district health management information systems – DHMIS), are data routinely collected regarding the availability and uptake of rehabilitation services? If yes, describe what data are collected

Yes No Details:

2.7.3 Do agencies, other than the government rehabilitation facilities (e.g. NGOs), collect rehabilitation related data? List the agencies and what data they collect

Agency and data collected:

2.7.4 Do data collected in rehabilitation facilities reach the Ministry of Health rehabilitation unit/focal officer? Explain how the data are transmitted, what the data cover, and how much is sent

Yes No Details:

2.7.5 Within the health information system, are data collected that apply the coding of the International Classification of Functioning, Disability and Health (ICF)?

Yes No

28

2.7.6 Are any high-level indicators related to rehabilitation reported on by the government? If yes, list these

Yes No List of indicators:

Research 2.7.8 Are any agencies or institutes

conducting research in the field of rehabilitation? If yes, provide the names of the agencies or institutes If no, proceed to section 2.8

Yes No Names:

2.7.9 What is the main focus of the research in the field of rehabilitation?

Clinical rehabilitation research Rehabilitation system-level research Research related to the cost-effectiveness

of rehabilitation Other (please specify):

2.7.10 Which are the key funding bodies

supporting research in the field of rehabilitation? Is rehabilitation a priority area of research for any of these funding bodies?

Details:

Yes No


29

2.8 EMERGENCY PREPAREDNESS

If the country or area being assessed is not at risk of experiencing emergencies, skip this section 2.8.1 Is rehabilitation integrated in

emergency response plans?

Yes No

2.8.2 Is there a plan for managing a potential surge of rehabilitation needs in the event of a sudden onset disaster? If yes, attach plan to report

Yes No

2.8.3 Is the rehabilitation capacity mapped and known to the Ministry of Health and Health Emergency Operation Centre/National Emergency Management Agency?

Yes No

2.8.4 Is there rehabilitation available in areas at high risk of sudden onset disaster? If yes, outline the type(s) of rehabilitation services

Yes No Number and types of services:

2.8.5 Is there a stockpile of AP in high-risk areas? If yes, select which AP are stored and add quantities if possible If there are multiple stockpiles in different areas, detail these on a separate sheet

Yes No In some high-risk areas, but not others Assistive products:

Wheelchairs Crutches Walking frames Prefabricated orthoses Other (specify):

2.8.6 Are there established referral pathways between rehabilitation services in high risk areas and those in low risk areas? If yes, attach details to report

Yes No If yes, attach details


30

SECTION 3: SOURCES OF INFORMATION

3.1 STAKEHOLDERS INTERVIEWED

Name and job title/role (If listed in stakeholder analysis, simply record number, e.g. 3.1.4)

Contact details

3.1.1 Telephone: Email:




















31

3.2 LITERATURE AND ONLINE SOURCES (Peer-reviewed articles, books, online resources, or other written sources of information) 3.2.1

3.2.2

3.2.3

3.2.4

3.2.5

3.2.6

3.2.7

3.2.8

3.2.9

3.2.10

3.2.11

3.2.12

3.2.13

3.2.14

3.2.15

3.2.16

3.2.17

3.2.18

3.2.19

3.2.20

32

ANNEX 1: GUIDANCE FOR COMPLETING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

GLOSSARY – GENERAL

Rehabilitation intervention. A health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions. A rehabilitation intervention is a form of health intervention that is designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Health conditions refers to disease (acute or chronic), disorder, injury or trauma. A health condition may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. Rehabilitation may be needed by anyone with a health condition who experiences some form of limitation in functioning, such as in mobility, vision or cognition. Rehabilitation. Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Rehabilitation occurs in specialised rehabilitation services and when the delivery of rehabilitation interventions is integrated into a wide range of other health services. Rehabilitation - health strategy. Rehabilitation is characterized by interventions that address impairments, activity limitations and participation restrictions, as well as personal and environmental factors (including assistive technology) that have an impact on functioning. WHO considers rehabilitation to be a health strategy alongside health promotion, prevention, curative and palliative care. Rehabilitation is a highly person-centred health strategy; treatment caters to the underlying health condition(s) as well as goals and preferences of the user. Rehabilitation user. A rehabilitation user(s) is a person(s) who are recipients of rehabilitation interventions. They are also sometimes referred to as clients, patients and consumers. Rehabilitation personnel. Rehabilitation personnel include both rehabilitation professionals and informally trained health workers who support or conduct the work of rehabilitation professionals in their absence or because of a limited number. Rehabilitation professionals. Rehabilitation professionals cover a range of professions, including physiotherapy, occupational therapy, orthotics and prosthetics, rehabilitation nursing, physical rehabilitation medicine (physiatry), psychology, and speech and language therapy, and more. The scope of practice, qualifications and registration of each profession varies by country. See definitions of key professions below. Other health personnel. This phrase is used in the context of the Rehabilitation in health systems; guide for action to describe all the other health personnel that are not specifically rehabilitation personnel, these personnel may also be trained to deliver rehabilitation interventions.

1.1 Population, socio-political profile and rehabilitation needs SOURCES

Possible sources of information on the country or area’s population profile include:

Most recent national census data United Nations Department of Economic and Social Affairs: www.un.org/development/desa/en/ The World Bank: www.worldbank.org Global Health Observatory: www.who.int/gho/countries/en/ WHO State of inequality report: www.who.int/gho/health_equity/report_2015/en/

33

International Telecommunications Union: www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx Institute for International Health Metrics and Evaluation: www.healthdata.org/gbd

2.1 Leadership and governance SOURCES

Information about how rehabilitation is positioned and represented in the government and about rehabilitation policy can be obtained through review of government documents and stakeholder interviews with relevant personnel in the Ministry of Health and/or the Ministry for Social Affairs (or national equivalents). Information may also be found on government websites and public health publications.

2.1.2–2.1.7

DEFINITIONS A rehabilitation policy, plan or strategic plan refers to a document that details the country’s priorities, goals and direction regarding rehabilitation.

2.2 Financing for rehabilitation SOURCES

See 2.1 above. 2.3 Human resources for rehabilitation SOURCES

Information on the rehabilitation workforce may be available through administrative sources in the ministry of health, national professional councils, other government departments including the department for education, and professional associations:

World Confederation of Physical Therapy (WCPT): http://www.wcpt.org/ World Federation of Occupational Therapy (WFOT): http://www.wfot.org/ International Association of Logopedics and Phoniatrics (IALP) (speech therapists):

http://www.ialp.info/ International Society of Audiology (ISA): http://www.isa-audiology.org/ International Society for Prosthetics and Orthotics (ISPO): http://www.ispoint.org/ International Society for Physical and Rehabilitation Medicine (ISPRM): http://www.isprm.org/ International Council of Psychologists (ICP): http://www.icpweb.org/

Information on professional accreditation may be sought from professional associations or regulators.

34

2.3.1, 2.3.2 and 2.3.5

DEFINITIONS These definitions are provided as a guide, so countries should use their own national classifications of the different levels of health care. Primary health care. This refers to services delivered by health professionals who act as a first point of consultation.16 Where needed they provide a link to more specialized care. Primary care is usually based at the local level and provided in a range of settings. Secondary health care. This is health care provided by medical specialists and other health professionals, it is not the first entry point to the health services. Secondary care is usually based at the district/regional level and provided in a range of hospital and clinic settings. The hospital settings are often those with five to 10 clinical specialties; size ranges from 200 to 800 beds; often referred to as a provincial, general or regional hospital.17 Tertiary health care. This is considered more specialized and consultative health care. Tertiary care is usually based at the national level and provided in hospital settings. The hospital settings are those that provide highly specialized care and may have teaching facilities. They typically range from 300-1500 beds and are often referred to as national, central or teaching hospitals.15

See definitions of the various rehabilitation-related professions below. Physiotherapists are people professionally trained through a formal diploma or degree in physiotherapy (or physical therapy). Physiotherapists provide services that develop, maintain and restore maximum movement and functional ability throughout the lifespan.18 Occupational therapists are people professionally trained through a formal diploma or degree in occupational therapy. Occupational therapists provide services that help people participate in everyday activities.19 Speech and language therapists are people professionally trained through a formal diploma or degree in speech and language therapy. Speech and language therapists provide services that assess and treat people with speech and language disorders, and with swallowing disorders.20 Prosthetics and orthotics personnel are those who assess, prescribe and fit prostheses and orthotics. Orthotics and prosthetics personnel are categorized into three levels according to their education and scope of practice: Category I (prosthetists and orthotists) are people professionally trained through a formal degree (4-year university degree or equivalent); Category II (either orthopaedic technologist, lower limb prosthetics or orthotics technologist,or upper limb prosthetics/orthotics and spinal orthotics technologist) have different degree requirements (3-year formal structured education for orthopaedic technologists and 1-year formal structured education plus relevant clinical experience for the remaining category II groups; and

16 Ear and hearing care situation analysis tool, 2016. Geneva; World Health Organization; 2016. 17 Henser M, Price M, Adomakoh S. Referral hospitals. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB et al., editors. Disease Control Priorities in Developing Countries. Washington DC: Oxford University Press and The World Bank: 2006. 18 Description of physical therapy [policy statement]. London: World Confederation of Physical Therapy. (http://www.wcpt.org/policy/ps-descriptionPT, accessed 12 June 2019). 19 About Occupational Therapy [website]: World Federation of Occupational Therapists. https://www.wfot.org/about-occupational-therapy accessed 12 June 2019) 20 Speech, language, and swallowing [website]. Rockville, MD: American Speech-Language-Hearing Association (http://www.asha.org/public/speech/, accessed 12 June 2019).

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Category lll (prosthetic/orthotic technician, or equivalent term), have usual requirements for technician training in that country, often basic education with 2 years or less formal training as well as on-the-job training. Physical and rehabilitation doctors are people with a medical degree that have undergone additional education or training in physical and rehabilitation medicine. Physical and rehabilitation doctors provide assessment and medical interventions focused on function.21 Rehabilitation nurses are registered/professional nurses who have undergone additional education and training in rehabilitation nursing. They work to diagnose and treat individuals and groups who have experienced actual health problems resulting from altered functional ability and altered lifestyle, as well as preventative care for potential health problems.22 Psychologists are people professionally trained through a formal diploma or degree in psychology. Psychologists are concerned with people’s mental (including cognitive) health and provide psychological assessment and support. Other rehabilitation cadres. Most commonly this include community-based rehabilitation (CBR) workers or therapy assistants. When reporting CBR workers for TRIC, only record if their scope of practice includes individual rehabilitation interventions – i.e. the rehabilitation and assistive technology elements of the CBR matrix.23 Do not record CBR workers in this assessment if their role is largely focused on disability mainstreaming or disability-inclusive development, i.e. the education, livelihood, social and empowerment components of the CBR matrix.

21 What is a physiatrist? [website]. Rosemont, Il: American Academy of Physical Medicine and Rehabilitation (http://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry, accessed 12 June 2019). 22 Scope of rehabilitation nursing practice [website]. Chicago, Il: United States of America Association of Rehabilitation Nurses http://www.rehabnurse.org/about/content/Scope-of-Practice.html, accessed 12 June 2019). 23 About the community-based rehabilitation (CBR) matrix. Geneva: World Health Organization (http://www.who.int/disabilities/cbr/matrix/en/, accessed 12 June 2019).

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2.4 Rehabilitation delivery 2.4.1 – 2.4.21

SOURCES Information regarding service delivery models, infrastructure and service providers is best sought from administrative data and experts within the Ministry of Health and/or Ministry of Social Affairs. In addition, information regarding rehabilitation service delivery in the community, in hospitals and for specific user groups should be sought from relevant service/hospital managers, coordinators or other well-informed rehabilitation service providers.

DEFINITIONS

The Rehabilitation in Health Framework informs the STARS guidance by providing a common structure and organization of rehabilitation. Across countries there is significant variation in the configuration of rehabilitation. This framework highlights common types of rehabilitation and suggests an optimal mix of rehabilitation in a country. It utilizes an adapted version of the commonly applied pyramidal structure of primary to tertiary health care. The following definitions accompany Figure 5 in the STARS guidance. These definitions also shape the data collection within the TRIC.

Specialized, high-intensity rehabilitation Characteristics: This type of rehabilitation is specialized with capacity for high-intensity delivery in a longer-stay facility or programme. This rehabilitation is commonly for people with complex needs that impact on multiple domains of functioning. This rehabilitation is considered tertiary care that may start in the acute phase and continue into the sub-acute phase. Services may be highly specialised for one health condition, such as in a spinal cord injury, or provide rehabilitation for people with a range of health conditions in a dedicated rehabilitation centre. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other specialised health personnel. Key user groups: People with spinal cord injury, traumatic brain injury, burns, stroke, major trauma, orthopaedic fracture and replacements, deconditioning, pain, organ transplant, amputation and a range of other cardiovascular, neurological and psychiatric conditions. Settings: Inpatient, outpatient and day programmes in longer-stay rehabilitation hospitals, departments, programmes and centres. It may also include specialised units where rehabilitation is intensely delivered, such as a burn or stroke unit. Community-delivered rehabilitation Characteristics: This type of rehabilitation is delivered in community settings for people whom delivery in these settings further optimizes their functioning, and who have difficulties accessing rehabilitation outside of these settings. Community-delivered rehabilitation is a form of secondary and tertiary care occurring during the sub-acute and long-term phases of care, this distinguishes it from primary healthcare. It encompasses moderate- to low-intensity rehabilitation over a short-, intermittent- or long-term period. It may include specialised rehabilitation, such as for people transitioning into the community with ongoing rehabilitation needs or it may be integrated into a range of other health services and community programmes, such as in-home nursing care or early childhood intervention programmes. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other health personnel. Key user groups: People recently discharged from a longer-stay facility with complex rehabilitation needs; people with intermittent rehabilitation needs; people with limited access to transportation; children with disabilities; older people participating in health programmes; people with vision, degenerative disease or workplace injury; and people receiving rehabilitation in nursing homes or palliative care services and programmes. Settings: Localised health clinics, single or multi-professional practices, homes, schools, childcare settings, workplaces, leisure settings, long-term care facilities, hospices and local community centres.

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Rehabilitation integrated into medical specialties in tertiary and secondary health care Characteristics: This type of rehabilitation is less specialized and typically delivered for a short period during the acute- or sub-acute phases of care. It is integrated into health services and programmes for people with a wide range of conditions who are being treated in tertiary and secondary health care. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other health personnel. Key user groups: People with a wide range of musculoskeletal, neurological, cardiovascular, respiratory, geriatric, psychiatric, internal organ, hearing, vision, gynaecological, paediatric and other health conditions. Settings: Tertiary or secondary hospital and clinic settings. Hospitals may be general with multiple medical specialties or they may be specialised, such as an eye, ear or cancer hospital. Rehabilitation integrated into primary health care Characteristics: This type of rehabilitation is delivered within the context of primary health care, which includes the services and professionals that act as a first point of contact into the health system. It may be delivered during the acute-, sub-acute and long-term phases of care. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other primary health care personnel. Key user groups: People with musculoskeletal, neurological, or psychiatric conditions. Settings: Primary health care centres, clinics, single- or multi-professional practices. Informal and self-directed rehabilitation Characteristics: This type of rehabilitation is informal and self-directed, occurring where there may be no rehabilitation or health personnel present. It occurs during a rehabilitation process and or as part of an individual rehabilitation plan, it may also occur when people initiate their own rehabilitation to maintain or further improve their functioning, commonly over long-term period. Examples of this include carers supporting rehabilitation in long-term care settings, education workers carrying out rehabilitation with children with disability in schools, people with lower back pain undertaking yoga or tai chi classes, and coaches incorporating rehabilitation into sports training programmes. It also includes the rehabilitation exercise performed by people in their homes to maintain or improve their functioning. Key user groups: People with a wide range of musculoskeletal, neurological, cardiovascular, respiratory, geriatric, psychiatric, gynaecological, paediatric and other health conditions. Settings: Home, school, park, workplace, health club or resort, swimming pool, community group, long-term care facilities.

Rehabilitation across all phases of acute, subacute and long-term care is defined as rehabilitation care delivered for any health condition during these phases which are defined as follows:

Acute: short-term treatment for an acute health condition. This is primarily delivered in hospital settings that should include medical and surgical wards, intensive care units and emergency departments. Subacute (and post-acute): inpatient or outpatient care following an acute health condition or exacerbation of a health condition. It is of moderate duration and this care may be designed to improve the transition from hospital to the community. This is primarily delivered through tertiary and secondary hospitals, rehabilitation wards, units, programmes, and could also be in public or private single or multi-professional practices. Long term: care that is provided over a long period to meet both the medical and non-medical needs of people with a chronic health condition or disability. This primarily occurs in rehabilitation centres and programmes (often ambulatory programmes), programmes for

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long-term degenerative conditions, and in respite or institutional settings such as nursing homes.

Rehabilitation for children is focused on services for children with developmental difficulties and disabilities. But, as is the case with other items in this tool, the assessment is not exhaustive and other areas of paediatric rehabilitation exist but are not included. Services for children with development difficulties and disabilities are commonly divided into early childhood intervention services (0–7years) and school-age services. These include hospital and community-based services as well as the early identification mechanisms.

Rehabilitation for target population groups refers to rehabilitation that has been developed for a group of people in the population that have significant rehabilitation needs and benefit from targeted/specifically designed programmes and services. Common examples of programmes are for amputees (e.g. from landmines), burns or degenerative conditions such as Parkinson’s. In the context of this tool, there are also specific questions for people in need of rehabilitation for vision and hearing impairments, mental health conditions, as well as older people. Regarding mental health conditions, in the context of this tool, rehabilitation services for people with mental health conditions do not include provision of medication or electroconvulsive therapy.

2.5 Assistive technology SOURCES

Information regarding the availability and financing of assistive products may be sought from administrative data and the government ministry or ministries responsible for assistive products. Depending on the context, this may include the ministries of health, social affairs (or equivalent), education, and the military. Further information may also be sourced from major manufacturers and organizations involved in the distribution and provision of assistive products.

2.5.1–2.5.9

DEFINITIONS Assistive technology. This is the application of organized knowledge and skills related to assistive products, including systems and services. Assistive technology is a subset of health technology.

Assistive products. Any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence, and thereby promote their well-being. Assistive products are also used to prevent impairments and secondary health conditions24.

Priority assistive products. Those products that are highly needed, an absolute necessity to maintain or improve an individual’s functioning and which need to be available at a price the community/state can afford.

24 Priority assistive product list. Improving access to assistive technology for everyone, everywhere. Geneva: WHO Press; 2016.

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2.5.3 World Health Organization’s 50 Priority assistive products list (APL) 1. Alarm signallers with light/sound/vibration 2. Audio players with DAISY capability 3. Braille displays (note takers) 4. Braille writing equipment/braillers 5. Canes/sticks 6. Chairs for shower/ bath/toilet 7. Closed captioning displays 8. Club foot braces 9. Communication boards/books/cards 10. Communication software 11. Crutches, axillary/ elbow 12. Deafblind communicators 13. Fall detectors 14. Gesture to voice technology 15. Global positioning system (GPS) locators 16. Handrails/grab bars 17. Hearing aids (digital) and batteries 18. Hearing loops/FM systems 19. Incontinence products, absorbent 20. Keyboard and mouse emulation software 21. Magnifiers, digital hand-held 22. Magnifiers, optical 23. Orthoses, lower limb 24. Orthoses, spinal 25. Orthoses, upper limb 26. Personal digital assistant (PDA) 27. Personal emergency alarm systems 28. Pill organizers 29. Pressure relief cushions 30. Pressure relief mattresses 31. Prostheses, lower limb 32. Ramps, portable 33. Recorders 34. Rollators 35. Screen readers 36. Simplified mobile phones 37. Spectacles; low vision, short distance, long distance, filters and protection 38. Standing frames, adjustable 39. Therapeutic footwear; diabetic, neuropathic, orthopaedic 40. Time-management products 41. Travel aids, portable 42. Tricycles 43. Video communication devices 44. Walking frames/ walkers 45. Watches, talking/ touching 46. Wheelchairs, manual for active use 47. Wheelchairs, manual assistant-controlled 48. Wheelchairs, manual with postural support 49. Wheelchairs, electrically powered 50. White canes

2.6 Rehabilitation infrastructure and medications SOURCES

Information regarding rehabilitation infrastructure and medications is best sought from experts within the Ministry of Health and/or Ministry of Social Affairs. Information may also be sourced from relevant service/hospital managers, coordinators or other well-informed rehabilitation service providers.

2.6.1 DEFINITIONS Basic rehabilitation equipment and infrastructure includes but is not limited to: Plinths

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Rigid transfer boards Plaster of Paris bandages Plaster cutters Plaster spreaders Upper limb slings Stump compression bandages Tubular compression bandages Compression bandages Spirometers Stump boards Sliding boards for wheelchair transfers Leg raisers for wheelchairs Stethoscopes Blood pressure monitors Percussion/reflex hammers Goniometers Tape measures Splinting equipment25 Abdominal binders

2.7 Rehabilitation information and research SOURCES

Information about health information systems may be sourced from administrative data from the Ministry of Health, statistical offices (national or subnational), or from researchers in the field. Research information may be obtained from research institutions and prominent researchers in the field.

2.7.6

DEFINITIONS The International Classification of Functioning, Disability and Health (ICF) is a classification of health and health-related domains. It includes a coding system for reporting information related to body functions, body structures, activities and participation, and environmental factors.26

2.8 Emergency preparedness SOURCES

Information about rehabilitation services in areas at high risk of emergency and about preparedness initiatives may be sought from administrative data and rehabilitation focal points within government (when possible), or from subnational rehabilitation managers/directors. More detailed information regarding the stockpiling of assistive products may need to be sourced from the rehabilitation services themselves.

2.8.1

DEFINITIONS In the context of this assessment, a sudden onset disaster is a geophysical event – such as an earthquake, tsunami, landslide, or volcanic activity or other event – that can result in high numbers of deaths and injuries, and overwhelm local health services.

25 Splinting equipment includes, but is not limited to, thermoplastic sheets, heat gun, portable water heater (hydrocollator or large pan), velcro (adhesive hook and non-adhesive loop), splinting scissors, neoprene glue and padding. 26 International Classification of Functioning, Disability and Health. Geneva: WHO Press; 2008.

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