Landmark WHO Resolution on Global Rehabilitation Passed!
Statement on "Strengthening Rehabilitation in Health Systems"
In the recently concluded 76th WHO Health Assembly, 194 countries acknowledged the need to embed and strengthen rehabilitation programs in their countries. The resolution “Strengthening Rehabilitation in Health Systems” calls for key actions to be undertaken by governments, organizations, and other key stakeholders to strengthen rehabilitation in health care systems. The forum agreed to undertake steps to ensure implementation of the WHO’s Rehabilitation 2030*, by focusing and adapting strategy to develop greater awareness, technical guidance and resources, feasible targets and indicators as well as integrating rehabilitation and assistive technology into emergency medical teams and other health settings.
Some highlights:
raising awareness of rehabilitation among policy and decision makers
better equip countries to respond to rehabilitation needs
common challenge faced regarding accessibility to rehabilitation services
the lack of an adequate rehabilitation global workforce
*WHO 2030 is a call for action that requires states to acknowledge and take practical steps to make rehabilitation available throughout all life stages, integrating rehabilitation in all levels of healthcare, and establishing rehabilitation as an essential health service that is crucial for achieving universal health coverage.
AN INTROSPECTIVE LOOK
I am personally glad that the WHO has reinvigorated efforts to integrate rehabilitation into the health system especially as it seems to have been overwhelmed by the recently concluded COVID pandemic (WHO Declares Covid-19 Emergency is Over”). The participation of the WCPT and ISPRM underscores the importance of creating greater multidisciplinary cooperation and alliances. And while we encourage participatory efforts, the WHO needs to ensure greater involvement of those sectors that have continued to breathe life into rehabilitation. It goes without saying that rehabilitation has come a long way and it hasn’t been on the heels of resolutions put out by the WHO or any other direct UN effort, but rather on the needs of millions, efforts of thousands of rehabilitation professionals, and the global acceptance of its theory and practice. Maybe this was their attempt at recognizing the rehabilitation sector, perhaps.
Pondering the details of the resolution, the timeframe of 7 years concerns me. As it sits, can we expect to see anything done on ground level of LMIC? While the resolution is future-centric; one must remember the infamous wisdom: The future is already here, its just unevenly distributed. Obviously developed countries like Israel (which put this resolution forward) are already further ahead than most countries of the world, having already an advanced healthcare system. So it seems logical to assume that we are the ones they are talking about. We have a very big problem, called priority funding. Funding for primary health services (if any) is the priority of our governments, while tertiary services like assistive devices are not prioritized. So we need funding, and funding for healthcare programs is never recouped, so how do they propose we fund? What type of real conversations are taking place now? While global organizations are interesting venues for high level conversations regarding policy and legislation, they are notorious for little in terms of providing practical applications, albeit intentions are good.
ANECDOTE OF THE WHO
My opinion stems from my experience with the WHO and other organizations working in rehabilitation. In all my years working in the field of physical therapy and rehabilitation in several settings in LMIC, I can only recall a single visit by a WHO representative to a prosthetic center I used to work at. I remember his team arriving and having a discussion with the center’s director, and then disappearing. When I asked about the visit, I was told that the newly arrived regional head of the WHO Rehabilitation Program was on visit and came to introduce himself. I immediately imagined those typical high profile meetings with tea and biscuits and pleasantries and little substance. Needless to say this took place almost 6 years ago, and since then the WHO has not been seen again in that setting, nor was there any higher level engagement; so what was the practical purpose? What was the tangible result of that visit? Where’s the pragmatism? How will this resolution be binding? We need not list other initiatives laying curbside like the Global Action Plan for curbing antimicrobial resistance. What can we as service providers and support groups expect on the ground? Unfortunately none of these are actually alluded to accurately in the report.
WAY FORWARD
While this resolution will not have me jumping out of my seat, it did get me imagining a world where rehabilitation professionals had more a more conducive environment to carry out their work. From my discussions with colleagues around the world, I think we would like to see greater autonomy, an improved profile in the medical team, streamlining of red tape for registering physical therapy services, greater funding for education and research, and most importantly better funding in the healthcare system (through private and government insurance and social services). If we could just guarantee better insurance coverage for our services, there would be a dramatic effect on accessibility. There would immediately be greater accessibility of lower socioeconomic sectors to our services as well as more rural communities that are often dependent on government health services. I think it also goes without saying that the field requires greater autonomy, with its own ethics and professional boards that would ensure the non-interference of other sectors of the health sector, especially physicians. Collaborations are great, domination is not.
WRAP UP
Finally, I hope that the WHO can exert greater effort in assisting governments not only adopt policy, BUT IMPLEMENT policy. Only then would we come full circle from conceptualization to implementation and success.
Thank you and make sure you are heard by voicing your opinions to your local WHO office or through their website by writing in. Let’s become more proactive! Continue the conversation!
Have they begin the funding process; how they plan to communicate with the private sector like insurance companies that are usually important sources of funding for physical therapy services, and the government sectors which in LMIC are usually lagging and less attentive to tertiary care.