||Antony Duttine1, Martin Bevalot2, Isabelle Urseau3, Jeanne Battello4
||1Health and Prevention Unit, Handicap International Federation, Washington D.C, United States, 2Technical Resource Department, Handicap International Federation, Lyon, France, 3Techncial Resource Department, Handicap International Federation, Lyon, France, 4Advocacy Unit, Handicap International Federation, Brussels, Belgium.
|Country - ies of focus
|Relevant to the conference tracks
||Advocacy and Communication
||With the targets for global health being heavily focused on mortality reduction, allied health services such as rehabilitation are largely overlooked. However with changing global demographics and increased life expectancy data shows that the world is living longer but with increased ill health and disabilities. For the past 2 years, Handicap International, a disability and rehabilitation focused organization, has begun a process to engage closer with the global health community to ensure that health beyond 2015 ensures a fuller continuity of care across a life course.
|What challenges does your project address and why is it of importance?
||Rehabilitation services in low and middle income countries have historically only been funded when there has been a specific perceived demand for them, often an outbreak of polio, war or conflict or natural disaster. There is a well-documented improvement in services for persons with disabilities in countries post-crisis, but these struggle to become fully integrated and when the relief turns into development actions the ongoing needs for persons with disabilities are forgotten. Global health implementation, driven by the MDG targets, has focused on the prevention of deaths, successfully seeing a reduction in maternal, child, HIV and malaria mortality over the past 14 years. This is creating new global health implications, to which the world is being slow to react. The Global Burden of Disease 2010 clearly demonstrated that whilst we are living longer, we are doing so with more ill health and disabilities. As more children survive their first 5 years, UNICEF has suggested that the number of children with disabilities may stay the same or even increase as a result. Furthermore, what kills us is not necessarily what ails us and health issues such as bone and joint disease, mental health, burns and other chronic diseases are ignored in a "siloed" health agenda.
|How have you addressed these challenges? Do you see a solution?
||Handicap International has been working in the field of physical rehabilitation since its foundation in 1982. Initially born out of a response to the scourge of landmines on the Thai/Cambodia border, the organization bears witness and responds to global development trends which are having a major impact on disability. In 2011, HI embarked on a new process of advocacy and awareness raising at a global level on the importance of rehabilitation services to be included in the future of global health planning. Initially mapping key trends and health developments, several clear global health movements were noted as having high potential for the inclusion of rehabilitation for non communicable diseases, maternal and child health, HIV/AIDS and the global health workforce. Specific targeting of these sectors took place through a variety of means, including presenting at national and international forums, contributing to the discussions on health in the post MDG agenda, publishing articles on rehab in health and developing specific messages around the importance of considering health beyond the prevention of deaths. Furthermore, links to HI projects to develop closer linkages between health and rehabilitation services at national and local levels have begun in a number of countries on specific health issues (such as diabetes) or as part of broader health system strengthening approaches. In link with the WHO and academic institutions, HI is contributing to the development of information packages on health related rehabilitation service delivery, workforce and leadership and governance. Beginning in 2014 HI intends to further partner with academic institutions to research and gather data on key aspects of rehabilitation services which seem to have been misconceived by the global health community. This includes cost effectiveness and general awareness of what rehabilitation means.
|How do you know whether you have made a difference?
||Since 2011 HI's presence in global health discussions, particularly in North America, has increased significantly. Whilst initially heavily focused on prevention and targets around deaths, the NCD movement has begun to recognize and respond to the clear links to disability and NCDs. In September 2013 two briefing papers lead by mainstream NCD actors - the NCD Alliance and NCD Child, with support from HI - were launched and focused upon the disability related implications of NCDs. At the same time a major panel discussion took place on disability and NCDs at the UN with key NCD actors such as Sir George Alleyne and Dr Carissa Etienne, head of PAHO. This marked a remarkable turnaround from just two years previously where at the High Level Meeting on NCDs, very little attention to rehabilitation services was given despite HI being present as part of the France delegation. The 3rd International Human Resource for Health forum in Recife Brazil in November 2013 will include a side event on the rehabilitation workforce. Papers on rehabilitation in global health have been submitted and accepted, notably a co-authored article on physical therapy in global health in World Medical and Health Policy and a contribution to the Beyond 2015 consultation process on inequalities. The maternal and child health community also appear to be bringing morbidity and disability into focus with attention and interest on early childhood development and disability and the management of obstetric fistula. The objective of ensuring that health in the post millennium development agenda goes beyond setting targets simply for the reduction of mortality appears to be beginning to succeed, though this cannot be attributed directly to this process and much more still needs to be done
|Have you or the project mobilized others and if so, who, why and how?
||The project has aimed to better bridge the health and disability sectors and key actors from both have been engaged in the process. The Disability and Rehabilitation unit at the WHO has been addressing similar aspects in parallel, culminating in the development of the Disability Resolution at the WHA in 2013 and subsequent action plan under current development, to which HI has contributed. Several mainstream health convening bodies have welcomed and embraced the new focus on global health discussions, most notably Coregroup, Interaction and the NCD roundtable based in the US and the Global Health Workforce Alliance.
|When your donor funding runs out how will your idea continue to live?
||The idea behind any process for advocating change is that this change will be absorbed into the mainstream. Funding for health approaches will continue and the long term vision of HI is that these will include to provide rehabilitation services as a core component of a health system as per the definition of universal health coverage. In order to achieve this, targets set must not simply focus on mortality, but also take into account and set goals around healthy living and disability.