Rehabilitation was described as a main health strategy in the Declaration of Alma Ata in 1978, with functioning as a the main outcome of interest. Current demographic and epidemiological trends such as ageing populations and the growing number of chronic non-communicable diseases are creating increasing rehabilitation needs and pressuring healthcare systems. WHO is stating that the rehabilitative health strategy should be strengthened and scaled up, especially in low and middle income countries. Therefore, rehabilitation should become the key health strategy for the 21st Century. WHO gathered an impressive group of rehabilitation stakeholders from across the world, professionals, politicians as well as consumers, to meet in their headquarters in Geneva on February 6th and 7th. There were 208 participants, of which 46 % came from Europe. The aims of the meeting were: - to draw attention to the increasing needs for rehabilitation;
- to highlight the role of rehabilitation in achieving the Sustainable Development Goals (SDGs) proposed by the United Nations;
- to call for coordinated and concerted global action towards strengthening rehabilitation in health systems.
Several ESPRM collaborators were involved. Christoph Gutenbrunner (Germany) represented the Hannover Medical School. Stefano Negrini (Italy), chair of the ESPRM-SISC on Evidence Based Medicine, participated as Director of Cochrane Rehabilitation and chief editor of the European Journal of PRM. Also Katharina Stibrant-Sunnerhagen (Sweden), chair of the ESPRM-SISC on stroke, was present as representative of the World Stroke Organisation and the Foundation for Rehabilitation Information (that owns the Journal of Rehabilitation Medicine).
Stefano Negrini and Christoph Gutenbrunner at the WHO Rehab 2030 meeting, February 6-7 2017 Evidence on the number of rehabilitation health professionals suggests that the need for rehabilitation is much higher than the services provided, especially in LMIC, even in Europe as shown in the figure below (Gimigliano F, Negrini S. The World Health Organization “Rehabilitation 2030: a call for action”. Eur J Phys Rehabil Med 2017;53:155-68). The impact of health conditions (injuries, diseases, ageing) on a person’s experience in every aspect of his/her life, referred to as “Functioning”, has been introduced in WHO’s International classification of functioning, disability and health (ICF, WHO 2001). To strengthen rehabilitation in the health system, health status information should collect, along with mortality and morbidity data, reliable and comprehensive information on functioning and well-being in Health Information Systems (HIS) (Stucki G et al. Am J Phys Med & Rehabil 2016). Therefore, the UEMS (European Union of Medical Specialists) PRM Section and Board are already leading a normative effort towards the system-wide implementation of ICF in PRM, rehabilitation and the healthcare at large.
In the call for action the participants of the meeting Rehabilitation 2030 acknowledge the following (http://www.who.int/disabilities/care/CallForAction.pdf?ua=1 ) : A. The unmet rehabilitation need around the world, and especially in low- and middle-income countries, is profound. B. Demand for rehabilitation services will continue to increase in light of global health and demographic trends, including population ageing and the increasing number of people living with the consequences of disease and injury. C. Greater access to rehabilitation services is required to “Ensure healthy lives and promote wellbeing for all at all ages” (Sustainable Development Goal [SDG] 3) and to reach SDG Target 3.8 “Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. D. Rehabilitation is an essential part of the continuum of care, along with prevention, promotion, treatment and palliation, and should therefore be considered an essential component of integrated health services. E. Rehabilitation is relevant to the needs of people with many health conditions and those experiencing disability across the lifespan and across all levels of health care. Thus, rehabilitation partnerships should accordingly engage all types of rehabilitation users, including persons with disability. F. Rehabilitation is an investment in human capital that contributes to health, economic and social development. G. The role of rehabilitation is instrumental for effective implementation of the Global strategy and action plan on ageing and health (2016–2020), the Mental health action plan (2013–2020) and the Framework on integrated people-centred health services, and as a contribution to the efforts of the Global Cooperation on Assistive Technology (GATE) initiative. H. Current barriers to strengthen and extend rehabilitation in countries include: i. under-prioritization by government amongst competing priorities; ii. absence of rehabilitation policies and planning at national and sub-national levels; iii. limited coordination between ministries of health and social affairs where both are involved in rehabilitation governance; iv. non-existent or inadequate funding; v. a dearth of evidence of met and unmet rehabilitation needs; vi. insufficient numbers and skills of rehabilitation professionals; vii. absence of rehabilitation facilities and equipment; and viii. lack of integration into health systems. I. There is an urgent need for concerted global action by all relevant stakeholders, including WHO Member States and Secretariat, other UN agencies, rehabilitation user groups and service providers, funding bodies, professional organizations, research organizations, and nongovernmental and international organizations to scale up quality rehabilitation. |