NCDs, disability & rehabilitation in Nepal's Public Health System

NCDs, Disability and Rehabilitation in Nepal’s Public Health System:

Strengthened National agencies for policy and practice reform

Wesley Pryor, PhDPrincipal Adviser, Rehabilitation – HI Federation, Asia

BACKGROUNDPhysical rehabilitation, disability & NCDs

Public Health & Rehabilitation

• Limited rehabilitation in health policy

• NCD data are usually available

• Current high level reports (STEPS) exclude disability

• Very limited economic data on rehabilitation impact

NCDs

Health

Disability

Rehab.

Rehabilitation of disabling disease / Rehabilitation as

secondary prevention

Understanding disabling effects of NCDs / increasing profile of musculoskeletal implications of

NCDs

Access to health for people with disabilities / health implications

of disability

Access to and effectiveness of physical rehabilitation services /

CBR

NCDs, Maternal Health & Nepal

• NCDs account for more than 50% of all deaths

• Injury another 7%

• Cardiovascular disease and diabetes the greatest contributors

• Perinatal death is disproportionately high

• Low-birth weight & prenatal issues large contributor to disability burden

RESEARCH FOR PUBLIC HEALTH CAPACITY

Physical rehabilitation, disability & NCDs

Three linked research areasWHA 66.9 & WRD DAP

1. Health of people with disabilities

2. Disability in mainstream healthcare: Access & effectiveness

3. Disability in specific healthcare: Continuity of care, innovative programming, medium-term impact

1. Health of people with disabilities

• Policy analysis – is Nepal’s suite of health policy disability inclusive?

• What is the health of people with disabilities compared with matched controls – A disability & health survey

2. Access to mainstream health

• Retrospective study of experience with mainstream health of people with chronic disabilities

– Pre-morbid situation

– Continuity of care

– Qual/quant

3. Access to specific health

• Retrospective clinical audit of gaps in continuity

• Prospective research: The health and QoLimpact of inclusive health policy

• Cohort study: Monitoring post stroke or childhood disability for 2.5-3 years

Key question Population DVs Methods Agencies

1

Policy analysis – is Nepal’s suite of health policy disability

inclusive?

-‘Equiframe’ disability

component +

Systematic review, policy analysis,

consensus development

Research Lead Implementing Other

U.Syd, PHFN

Trinity? MoH, WHO, UNICEF,

disability group

Health of people with disabilities compared with

matched controls – A disability & health survey

People with disabilities in representative districts and controls. 100/100

Demographics, Core suiteNCD indicators

Health consumption indicator survey

Household survey / link with SINTEF?

NHRC, PHFI

PHFN

MoH, disability group? PHC

actor, Nurses, PTs

2

Retrospective study of

experience with mainstream health of people with chronic

disabilities

People with disabilities inmultiple districts.

Including those who have and have not accessed

rehab services

MMCI, indicators of type of services, quality of services, demographics, + qualitative

& thematic review

Survey, interviews U.Syd PHFNDisability group?

3

Retrospective clinical audit ofgaps in continuity MMCI modified for rehab,

functional outcomes, RTW or other economic

indicators

Surveys, interviews U.Syd PHFN PHC actors

The health and QoL impact of inclusive health systems: A

prospective study

People who receive a package of

comprehensive care

InterventionSurveys, interviews

U.SydPHFN, HI,

Service providers

Cohort study: Monitoring post stroke or childhood disability for

2.5-3 years

People who are injured, have a stroke or cardiac

event in multiple districts

Health, function and economic indicators, QoL,

mortality

Surveys, periodic surveillance

PHFI / U.Syd

Service providers, PHFN,

HI

PHC agencies?

Methods Capacity development areas Activities Remarks

1 2 3 4 5

1

Systematic review, policy analysis,

consensus development

Current disability policy

Disability theory

Disability in public health

Disability in surveillance

Research agendas in disability, policy & NCDs

2

Household survey / link with SINTEF?

Interplay between NCDs and disability

Disability and health / disabling diseases

Contemporary rehabilitation services

Current evidence on rehabilitation and health

Survey, interviewsAccess and barriers to health consumption in people with disabilities

3

InterventionSurveys, interviews

Best practice in disability inclusive programming CBR, current good practice and evidence

Contemporary rehabilitation services, health, social and mobility indicators of effectiveness of rehabilitation

SurveysSurveillance on key health and higher-order indicators of participation

Key

1 Short courses / CPD / other

2 Exposure visits

3 Regional workshops

4 Leadership devt

5 Collaborative research

Key result Objective Activities Output Link to research Agencies

1 National level

Build expertise in disability, health and

rehabilitationSupport with better

awareness of current evidence base and

through new, locally specific data

Policy analysis, short courses, exposure, empirical research,

national events

‘Equiframe’ disability component +,

publications, Betterawareness in health

workers about disability,

rehabilitation and links with CBR

Systematic review, policy analysis,

consensus development

Research Lead

Implementing

Other

U.Syd, PHFN

Trinity?MoH, WHO,

UNICEF,disability

group

2South-south cooperation

Regional interaction

Training on policy development, advocacyIn country consultations,

disability and NCD specific training, empirical research

Bi-yearly meetings to monitor action

Demographics, Core suite NCD indicatorsHealth consumption

indicator survey, publications, scaling

rehab monitor

Household survey / link with SINTEF?

NHRC, PHFI

Nepal

MoH, disability

group? PHCactor,

Nurses, PTs

3Global

collaboration

Global expertise in the interface between

disability, health and rehabilitation and in developing research

agenda

Exposures to conference and symposiums,

Link up with aid agencies working in nepal to disseminate

information and build basic awareness of the interface between MCH and infant mortality action and CBR/

rehab services

Publications, leadership

development

Cohort study,prospective

research on rehab outcomes,

retrospective work on understanding

service gaps

All 4 ?

@wespryor_