Cambodia National Rehabilitation Conference 2017 -

How the rehabilitation system works in Cambodia

Vivath CHOU, MD, MPH

Disability and Rehabilitation Technical Officer , WHO Cambodia

15th Nov, 2017, National Paediatric Hospital (NPH), Phnom Penh, Cambodia

What is Rehabilitation?

  • Rehabilitation is a set of interventions designed to reduce disability and optimize functioning in individuals with health conditions in interaction with their environment

Rehab medicine

Therapy

Assistive Technologies

Improving functioning, Reducing impairments, Preventing or treating complication

Restoring & compensating

Preventing or slowing deterioration in functioning

Increase, maintain or improve the functional capabilities

Health condition 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 thus maximizes people’s ability to live, work and learn to their best potential. Evidence also suggests that rehabilitation can reduce the functional difficulties associated with ageing and improve quality of life

Rehabilitation Medicine includes Rehab Doctors, other medical specialists (psychiatrists, Geriatrists, Orthopedic surgeons…). Country limited limitation of workforce, Doctors and PT replacing this role.

Therapy includes PT, OT, ST, PO, SW, Technicians…

AT includes Prostheses, Orthosese, Wheelchairs, Crutches, … In some countries assistive devices are part of the health care and are provided through he health care system.

PROMOTION

PREVENTION

TREATMENT

REHABILITATION

Infectious diseases

ageing

NCD

disability

Injuries

Why Rehabilitation (continue)

The world is experiencing certain health and demographic trends:

Why Rehabilitation?

  • UNCRPD-Art 26 calls on Member States to organize, strengthen, and extend comprehensive rehabilitation
  • Disability law-Art 14, 15, 16, 17 and 19 outline specific provisions relating to physical rehabilitation
  • NDSP-Obj2: Equal access to quality health as well as rehabilitation
  • GDAP-Obj2: Strengthening rehabilitation, AT, Support services, and CBR
  • Target 3.8 of the SDG3: Achieve UHC
  • Rehabilitation 2030-A call for action

1

The last time WHO held a global meeting on rehabilitation at its headquarters, it was 1958.

And the recent meeting was organized in Feb 2017 at its HQ

Why Rehabilitation in Health System

Along the continuum of care

Acute Post-acute Long-term

Primary

Secondary

Tertiary

Community

Some may ask: why we are promoting rehabilitation in the health system (and not, for example, in the social sector).

Because they are provided in the health sector:

Rehabilitation System Strengthening (RSS)

RSS

MoH, MoSVY & Others, but unclear leadership

46PH, 11PRCs…, but limited coverage

463PT, 133PO, 127SW …, but no Rehab Doc, OT, ST…

38% (PRCs), 60% (Hosp) from Govt, but other from donors/users

Almost 30% of 50APL are available, but Qs need to improve, to be considered as part of EML

Data on rehab financing, needs and unmet needs are limited

Key progress (P) and way forward (F)

P: Rehabilitation strategic plan; Physical Rehabilitation transition plan; Health care policy and strategy

F: Rehab Task Force; NAPAH, Rehab Financing policy, Study on rehab workforce capacity

P: Rehab guidelines for Stroke, PT standards, Rehab in new MPA, PRCs & OCF production, Mobile WS, Referral pathways

F: PRC-SOP, Demonstration project based-rehab in health, AT as part of health services

Key progress (P) and way forward (F)

P: Training on Stroke guidelines, Collaborate with professional associations, Rehab financing analysis

F: Rehab training module for MPA, Guidelines on Rehab services, SHP for Rehab (HEF, NSPPF…)

P: 2014 CDHS secondary analysis reports; Rehab financing report, PRC annual statistics…

F: Rehab needs/unmet needs, Rehab services directory

3mins Video on Rehabilitation in the Western Pacific Region

References

  • World Report of Disability, WHO and World Bank, 2011
  • United Nation Convention on the Right of Persons With Disabilities (UNCRPD)
  • Law on the Protection and the Promotion of the Rights of Persons With Disabilities, 2009
  • National Disability Strategic Plan (NDSP), 2014-2018
  • WHO Global Action Plan on Disability, 2014-2021
  • Rehabilitation 2030-A call for action
  • National Health Care policy and strategy for older people, 2016
  • Rehabilitation Strategic Plan, 2018-2020 (draft)
  • Rehabilitation sector financing, 2017 (final draft)
  • Minimum Package of Activities (PMA) clinical guidelines, 2016-2020 (draft)

Thank You!

Chou Vivath_WHO_How the rehabilitation system works in Cambodia - Google Slides