From the 1Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany, 2Department of Rehabilitation, First Medical Faculty, Medical University of Warsaw, Warsaw, Poland and 3Brain Injury Rehabilitation Department, University Rehabilitation Institute, Ljubljana, Slovenia
In order to support the development of a National Disability, Health and Rehabilitation Plan (NDHRP) for Ukraine, a technical consultation was carried out by a Rehabilitation Advisory Team (RAT) of the International Society of Physical and Rehabilitation Medicine (ISPRM) in 2015. The consultation was based on assessment of the situation of persons with disabilities and the rehabilitation system in Ukraine.
Recommendations for activities and projects to improve rehabilitation services within the healthcare system were developed and proposed. In order to reach consensus on the recommendations, dialogues were held with different stakeholders, including the Ministry of Public Health. The recommendations included: coordination of disability and rehabilitation policies within the Ministry of Public Health and among other involved ministries; translation and adaptation of international definitions of functioning, disability, and assessment tools into Ukrainian; data collection on the epidemiology of disability and the need for rehabilitation; implementation of health-related rehabilitation services; and implementation of international definitions and curricula of rehabilitation professions.
The mission was regarded as successful and one year later a few changes had been adopted by the Ukrainian government. Further action based on this research is necessary. It will be important to track the changes and evaluate the results after an appropriate period of time.
Key words: rehabilitation service situation analysis; Rehabilitation Advisory Team; National Disability, Health and Rehabilitation Plan; rehabilitation services; rehabilitation professions.
Accepted Oct 20, 2017; Epub ahead of print Dec 22, 2017
J Rehabil Med 2018: 50: 00–00
Correspondence address: Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. E-mail: firstname.lastname@example.org
Ukraine has been an independent country since 1991, when it gained independence from the Soviet Union. It has a population of approximately 45 million. According to national registries 2.7 million people live with disability; 22.6% due to diseases of the circulatory system, 21.5% due to neoplasms, 11.2% due to musculoskeletal causes, and 10.8% as consequence of trauma or injury. The health system is based on a state funding system and includes some rehabilitation services. Its philosophy, and the description of health professionals, is based on the health system of the Soviet Union. The government of Ukraine (in particular the Ministry of Health) has decided to implement the principles of the World Health Organization (WHO) Global Disability Action Plan 2014–2021 (GDAP; 1).
In 2015, a technical consultation was carried out by a Rehabilitation Advisory Team (RAT) of the International Society of Physical and Rehabilitation Medicine (ISPRM) in order to support the development of a National Disability, Health and Rehabilitation Plan (NDHRP) for Ukraine (2). The mission was based on the United Nations (UN) Convention of the Rights of Persons with Disabilities (3) and the World Report on Disability (WRD; 4)). The goal-setting is derived from the WHO GDAP Better Health for All People with Disabilities (1), which was adopted by the World Health Assembly in 2014 (5).
The mission was based on assessment of the current situation of persons with disabilities and the rehabilitation system (including rehabilitation services and rehabilitation workforce training), and the application of international standards that lead to recommendations to improve the system. The mission consisted of the collection of relevant data on the health and rehabilitation system (6), site visits, and consultations with relevant stakeholders in disability and rehabilitation (2). Recommendations were developed by the advisors and discussed with different stakeholders in Ukraine. In addition, a stakeholder workshop about the recommendations was held to achieve consensus with stakeholders, including non-governmental organizations (NGOs), organizations of people with disabilities, and representatives of professional groups.
Consultations were held with different stakeholders, including representatives of the Ministries of Public Health, Social Policy and Education and Science, and the National Assembly of Invalids.
Site visits were made to the following locations:
Based on the information gained from these consultations and site visits a NDHRP was drafted setting out recommendations for actions and projects to improve rehabilitation service provision. These recommendations were discussed and prioritized in a stakeholder dialogue that included the following bodies and institutions:
A comprehensive report and executive summary were compiled based on this information and the results of the stakeholder dialogues.
In describing the current situation of rehabilitation service delivery, 4 main problems were identified from consultations and site visits:
The report recommends the following actions are implemented in order to improve health, functioning and quality of life for all persons with disability in Ukraine:
In addition, the following projects were proposed:
The aim of this mission was the development of a NDHRP for Ukraine. The methods were based on the model of RATs, as developed by the ISPRM (2). Data collection was based on information available from public sources (WHO and NGO reports, published papers, etc.), consultations with different stakeholders, including government officials, NGOs (including professional organizations and organizations of persons with disabilities) and site visits to hospitals, rehabilitation centres and research institutions. The RAT consisted of members of the ISPRM. Data collection was structured according to a previously developed checklist (6). Before finalizing the report the recommendations for actions and projects were discussed with relevant stakeholders in disability and rehabilitation in Ukraine. During this meeting priorities were established through participant voting. The high level of agreement with the recommendations indicates that the mission has summarized relevant data on the situation of persons with disabilities and the health and rehabilitation systems and drawn relevant and comprehensive conclusions. Based on the advisors’ experience, the most relevant factors contributing to this outcome were:
Regarding the situation in Ukraine with respect to disability and rehabilitation, it was important to take into consideration that the health system is based on the tradition of the former Soviet Union. Firstly, the term “invalidity” does not express the international model of disability, which is not an attribute of a person, but occurs due to the interaction of a person with a health condition and the environment (1). Since all political documents in Ukraine are based on this out-dated terminology, some changes in terminology and understanding are necessary.
Rehabilitation services are also based on the traditional central and eastern European model of health-resort medicine and sanatoria for patients with chronic health conditions. Thus, acute, post-acute and community-based rehabilitation services are scarce, and existing rehabilitation professions do not meet international standards. However, the existing services and rehabilitation workforce are good starting points from which to develop a modern rehabilitation system. Concrete recommendations for the transition of services and professions were included in the report and model projects were suggested.
Overall, the mission was successful, and 1 year later a number of changes had been adopted by the Ukrainian government (Box 1). From this starting point a good deal of further action is needed. It will also be important to monitor the changes and evaluate the results after an appropriate period of time.
The authors would like to thank Associate Professor Volodymyr Golyk, one of the representatives from Ukraine, for the success of this project.