By Kate Hawkins
On the 24 of February 2021 hundreds of participants from around the world gathered together online to help us launch ReLAB-HS. The creation of this consortium, with funding from USAID, is testament to the growing desire to integrate rehabilitation and assistive technology into health systems. You can watch the full video of the event or read the transcript, but for those who want a summary here are five things that we learned at the launch.
1. The need is great
Kiki Lentz of USAID introduced the event by acknowledging the important role that physical rehabilitation plays in comprehensive health services. There are an estimated 2.4 billion people that would benefit from physical rehabilitation and assistive technology services. Abdul Bachani of the Johns Hopkins University, reminded the audience that how access to rehabilitation remains a daunting challenge despite the growing need.
This was a point taken up by Barbara McPake of the Nossal Institute. She argued that rehabilitation assumes a particular importance in the context of epidemiological and demographic transitions. Where there are more older people there are many who could benefit from rehabilitation services and it’s also particularly important in settings recovering from conflict where there are high levels of traumatic injury.
Alarcos Ciezza from the WHO explained that Universal Health Coverage is fundamental and foundational for rehabilitation. It includes the provision of health services for rehabilitation which should be provided without the creation of financial hardship.
Muhammad Iqbal from Humanity & Inclusion prompted us to consider the health service needs of persons with disabilities, one of the most marginalized segments of the society who would benefit hugely from the provision of these services within the broader health systems.
2. Rehabilitation services are an integral part of health systems
From discussions at the launch it was clear that if we want to strengthen access to and availability of quality, sustainable physical rehabilitation and assistive technology services, we have to reframe them as an integral part of the health system to allow continuity of care. As Alarcos put it, “Rehabilitation is not only a highly specialized service to be delivered tertiary level.”
Rehabilitation needs to be completely integrated into the secondary level of the health system and particularly at primary, or community level where most people can benefit.
Abdul Ghaffar – of the Alliance for Health Policy and Systems Research – highlighted how the community is often overlooked within health systems models and policies although it is an integral part of our efforts to promote better health outcomes. The community comes with its own social, cultural, environmental and political ecosystem that we have to pay attention to.
Ellen McKenzie and David Peters from Johns Hopkins University emphasized the need to work with health systems in low- and middle-income countries and achieve integration of rehabilitation in the context of local needs.
3. Improving demand for and supply of services
While we know the need for rehabilitation services is high this does not necessarily mean that people understand what is available or what they are entitled to. Lesya Kalandyak remarked that reaching out to communities to get them on the pathway to access will be key. Households and powerful household members have a huge sway over people’s access to care. Discrimination against people with disabilities can mean that their needs may not be taken care of. Conversely, families are the first line of care in many settings, particularly women, supporting those that need it in their homes and communities.
As Ghaffar pointed out, even when services are available people may not be able to access then for economic, social or geographical reasons. In many low- and middle-income settings health services have been medicalised and so the determinants of health and social protection have had less prominence.
Barbara suggested that to improve the integration of rehabilitation into health systems we will need to look at the composition of the health workforce and create better recognition of the range of professions that are essential. While Iqbal explained that health workers require training on the identification of persons with disability and rehabilitation needs.
We heard from many speakers such as Perth Rosen, that we need to bring systems for the procurement and dispersal of assistive technology into the mainstream of health systems.
We will also need to build the capacity of policy-makers and health managers so that rehabilitation is given the prominence it should have at international, national and sub-national levels. In this we will need to consider the frequent turnover of staff in Ministries of Health and the need to institutionalise new ways of doing things.
4. Knowledge is key
As Rachael Lowe presented, ReLAB-HS has been created to generate new ways of doing things and documenting and measuring this to advance the evidence base. We were shown quite startling slides that demonstrated the huge gap in journal article publishing between high- and low- and middle-income countries. There are also issues of data quality and the creation of the types of evidence that can help us to build systems that are fit for purpose. To this end, ReLAB-HS will employ embedded, implementation research that is grounded in systems thinking.
Perth Rosen pointed out that there is a need to establish better communication and collaboration across different stakeholder groups so that knowledge can spread. ReLAB-HS will develop tools that can guide policy and programme prioritisation to improve service delivery across all levels of care. This will strengthen governance.
5. Moving forward in unity
Throughout the event we heard strong pleas for unity. Experts in health systems and rehabilitation need to come together to progress this agenda, learning from each other’s perspectives and histories. Multi-sectoral action across different government ministries will be needed to create a whole of government approach. Countries must share knowledge across regions and globally to demonstrate what works under what circumstances. Health professionals must join together with affected communities to ensure that their systems are truly people-centred. As Chiara Retis put it, “Inclusion of service users in rehabilitation is the first step.”
While the road ahead may be a little daunting, we must travel it together.
Date: 24th of February 2021, 8.00am – 9.30am (EST) via Zoom video conferencing
Abdulgafoor M. Bachani, PhD MHS
Director, Johns Hopkins International Injury Research Unit
Program Director, ReLAB-HS
Ellen J. MacKenzie, PhD
Johns Hopkins Bloomberg School of Public Health
Senior Technical Advisor for Rehabilitation
Barbara McPake, PhD
Director, Nossal Institute of Global Health
Co-Program Director, ReLAB-HS
Rehabilitation 2030: Expanding access to rehabilitation services globally
Alarcos Cieza, PhD
Unit Head, Vision, Hearing, Disability, Rehabilitation
World Health Organization
Duration 10 minutes
Health Systems of the Future: Where does Rehabilitation fit?
Abdul Ghaffar, PhD
Alliance for Health Policy and Systems Research
Duration 10 minutes
Alarcos Cieza oversees the World Health Organization’s work on vision, hearing, disability and rehabilitation in her position of Unit Head, Sensory Functions, Disability and Rehabilitation.
Prior to joining WHO in September 2014, she served as Chair and Professor of Medical Psychology at the Faculty of Social and Human Sciences at the University of Southampton in the United Kingdom. After obtaining her MSc in psychology in Madrid, Spain, she conducted a Masters in Public Health and obtained a PhD in Medical Psychology from the Ludwig-Maximillians University in Munich, Germany. She led the research unit for over ten years at the Department of Physical Medicine and Rehabilitation and then at the Pettenkofer School of Public Health at the Ludwig-Maximilians University, Munich, Germany.
Abdul Ghaffar is the Executive Director of the Alliance for Health Policy and Systems Research at the World Health Organization. He has worked for over 30 years in low- and middle-income countries managing research for health; planning, designing and evaluating national health systems; and teaching health policy and management. Before joining the Alliance in 2010, Dr Ghaffar served as Regional Advisor for Research in the Eastern Mediterranean Office of the World Health Organization. Earlier, he worked as a Health Policy and Systems Specialist at the Global Forum for Health Research. Dr Ghaffar began his career in Pakistan as a public health physician, eventually transitioning into various senior leadership positions such as Assistant Director-General of Policy and Planning; Deputy Director-General of International Health; and Director of the Health Services Academy, a national school of public health. Dr Ghaffar has played a leading role in establishing and managing policy and research fora involving civil society, policy-makers and development partners, both at national and international levels. His desire and interest is to trigger a global movement to generate and use research evidence for improved policy and management decisions at the country level.
David Peters is an expert in health systems who has worked as a researcher, policy advisor, educator, manager, and clinician in dozens of low-and middle-income countries (LMICs). Peters’ work seeks to improve the performance of health systems in LMICs through implementation science, building institutional capacity and applying innovations in organization, technology, and financing, with a focus on improving health equity. He has worked with the World Health Organization, UNICEF, the World Bank, and other agencies in developing the field of implementation research as a multi-disciplinary and multi-stakeholder endeavor, and has directed a wide range of implementation and policy research programs, including the Future Health Systems Research Consortium. He chairs a Department of over 200 full time faculty and 200 graduate students, with over 250 projects around the world. He has published eight books and monographs, more than 20 book chapters, and over 150 articles. While working at the World Bank, he pioneered the Sector Wide Approach (SWAps) in health, which is used by countries to define and implement national strategies and the allocation of foreign assistance. In India, he led a research program with local researchers, government, and civil society to examine inequities in their health systems, forming a basis for major policy change. In Afghanistan, he created the first nationally implemented Balanced Scorecard to assess and manage health services, and conducted trials where the results led to the end of user fees in primary care facilities. During the 2014-16 West Africa Ebola epidemic, Peters worked closely with the Ministry of Health in Liberia to re-focus the outbreak strategy on integrated community-based responses, which was critical to its eventual containment.
Introduction to ReLAB-HS:
Rachael Lowe, Co-founder and President, Physiopedia
Duration – 8 minutes
Panel Discussion: How can ReLAB-HS shape the health systems of the future?
Panel Chair: Daphne Sorensen, President, MiracleFeet
Duration – 30 minutes
Daphne de Souza Lima Sorensen
Daphne de Souza Lima Sorensen is president of MiracleFeet, overseeing the organization’s global programs and staff. MiracleFeet is expanding access to the non-surgical treatment for clubfoot, a leading birth defect and treatable cause of disability that affects millions worldwide. Daphne has 20 years of experience in international development, social justice and child and human rights, leading teams across Latin America and Africa. Previously, she led programs at the Lumos Foundation, Save the Children, and CARE and has lived and worked in Bolivia, Mozambique, Panama, Uganda and Angola. Born in Brazil, Daphne grew up in Venezuela, the United Kingdom, and United States and is fluent in English, Portuguese, and Spanish. She earned her master’s degree in Leadership from Duquesne University and bachelor’s in International Studies and Development and Economics from American University
Rachael is a physiotherapist, digital innovator and entrepreneur from the United Kingdom, she is President of the Physiopedia charity, CEO of Physiopedia Plus and co-founder of both. Rachael is passionate about utilising technology to share rehabilitation knowledge, empower the profession and elevate standards of practice globally. She has a 15-year history of providing e-learning and technology support to the international rehabilitation community.
Muhammad works as a Disability, Gender and Age specialist with Federation Handicap International Pakistan. He has been active in the disability movement since 2011. As a disability researcher, he has conducted a number of studies on disability related issues in Pakistan, but the most important was the submission of alternative report on the implementation of 2030 agenda in line with CRPD in Pakistan in 2019 to the UN through International Disability Alliance. Along with this, he is connected with following groups:
A physiotherapist trained in Italy with a specialization in neurological conditions, since 2003 Chiara has been working for non-government organizations in low-resource settings, initially providing capacity building services (Yemen, Jordan, Afghanistan). Chiara has a long experience in support to policy reform for the promotion of physical rehabilitation, including designing evidence-based health sector policies (Nepal). Her knowledge and experience in Public Health includes global health issues, disaster preparedness, health promotion, quality assurance, organization and management of services. Based in Cambodia as a rehabilitation specialist for programmes in Asia for Humanity & Inclusion since 2016, she has joined ReLAB-HS as interim coordinator for HI.
Lesya Kalandyak is a physical therapist in Ukraine that has worked with UCP Wheels for Humanity as a technical advisor since 2015, supporting USAID-funded projects designed to strengthen rehabilitation service delivery systems through the development of policy and regulatory frameworks; the professionalization of physical therapy; and awareness raising about the importance of rehabilitation services.
In addition to her work with UCP Wheels, Lesya is a founder and board member of the Ukrainian Association of Physical Therapy. She has worked in Children’s Rehabilitation Centre “Dzherelo” and Rehabilitation Department of the Lviv Military Hospital, led several trainings for medical and rehabilitation personnel in areas including pediatric and adult neurorehabilitation, and is certified by the International Society of Wheelchair Professionals as a trainer of the Wheelchair Service Training Package – Basic level.
Perth Rosen is the Senior Director of Programs at UCP Wheels for Humanity, where she has led a health-systems approach to assistive technology-inclusive rehabilitation in over twenty countries, including Ukraine, Indonesia, El Salvador, and Nicaragua. For over twenty years, she has worked at the intersection of health products and services in several sectors including rehabilitation and assistive technology, HIV/AIDS, water and sanitation, nutrition, and reproductive health. She has worked and collaborated with NGOs, government partners, and ministries of health to drive global health programming.
Prior to Perth’s work with UCP Wheels, she worked with Lutheran Immigration and Refugee Services, Freedom from Hunger, the University of California, San Diego, and the International Organization of Migration among others. She holds an Advanced Master’s in International Relations with a focus on health security.
Nabeel Akram, MBBS MSc
Director Operations, ReLAB-HS