Global Webinar Rehabilitation and Assistive Technology in Universal Health Coverage

Global Webinar Rehabilitation and Assistive Technology in Universal Health Coverage

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thank you very much for the opportunity to speak to the forum and also thank you for the question. Now, I just want to set the scene for my answer, because I am the team lead for access to assistive technology at WHO , and so my response will be weighted towards assistive technology in its broadest context, and considering the six functional groups of products and also using the term assistive technology to refer to the products, as well as the systems -- (Overlapping speakers). >> VALENTINA POMATTO: We would ask participants to mute so to avoid noises. Thank you . Sorry, Kylie. Please, go ahead. >> KYLIE SHAE: When I use the term assistive technology, I'm using it to refer to products, as well as the systems, the services and the policy environment needed to ensure effective access.

So, I just want to flag in terms of these policy frameworks, five years ago the World Health Assembly adopted Resolution WHO 71.8, which embeds access to assistive technology as an integral component of Universal Health Coverage, and, of course, just this year we have all celebrated the first resolution on rehabilitation, highlighting the compliment GANHRI role of assistive technology within rehab. The assistive technology resolution called upon WHO amongst other obligations to prepare the first global report on assistive technology and that was launched last year and the report provides really quite startling insights about the need and the unmet need for assistive technology and it also partly answers the question regarding the access barriers that people face. I wanted to share the statistic that's been highlighted, 2.5 billion people need technology and that's expected to grow by 3.5 billion to 2050. At present there is not enough system and human resource capacity to meet this need and that means we have this significant inequity of access between countries and settings. Also, the report shows the

largest group of assistive technology users are older people. So two in three of people aged over 60 need at least one assistive product, and yet this group does not fit the profile of those that are most actively referred to or participating in organized rehabilitation in many countries. So, they are often overlooked. Also the majority of people accessing their assistive products are accessing them from private shops or clinics and they pay out of pocket, which is not part of the principle of Universal Health Coverage. So, an estimated 67% of people are not benefiting of support through competent personnel when select ing, fitting or using their assistive products which has associated risks and those who cannot afford to pay are missing out entirely . And finally, we have this barrier of distance to services, and that is exacerbated by a continued tendency to centralize access to services at tertiary level. So, considering these statistics

and the barriers, I will shift gear to some solutions or some suggested solutions. So, we need to increase our focus and advocacy in support of access to AT as part of Universal Health Coverage, but we have to ensure that our efforts are inclusive of the six functional domains of assistive technology and that we are integrating access not only in the context of rehabilitation, but also across the whole health system, including in prevention palliative care and long-term care. To do this, I can offer a few strategies, but this is not all, but these are a few highlights.

Firstly, we need to think about increasing awareness and understanding of assistive technology and this refers to rehab as well , across the whole health workforce. So it becomes routine in the case of assistive technology to, perhaps, identify the possible need for hearing aid for an older person attending a routine health check, or early identification of a child that could benefit from cognitive assistive product if they are struggling at school. But this needs broad awareness across the health workforce for this identification to occur. We need to recognize, in particular, Primary Health Care as the front line for health services and that means empowering primary health care workers through competency based training, adequate systems and supplies to not only identify and prefer, but also to provide on the spot those assistive products that can safely be provided at this level of healthcare. And in particular and linked to the above, we have to respond to the growing and urgent need for timely access to AT for older persons. We need to reduce access barriers such as embedded requirements for assessment of description only by higher trained personnel, because this system is failing, as it is not feasible to keep up with the demand. Rather, we can work on protocols

that enable safe provision, referring only those with identified risks and reducing the barriers. And finally, I just want to highlight the potential to harness the power of digital technology. Not only just innovation within the products themselves, but as a tool to improve service delivery, including through smart assessment tools which can reduce service delivery time, and also reducing distant barriers through remote consultations. Thank you very much . >> VALENTINA POMATTO: Thank you. That was very straight to the point but very important key messages . And I would like also to hear another perspective regarding this first topic of discussion. So, I would invite Ms. Shrestha, deputy

chief physical therapist deputy ministry population from kneel to take the floor and provide her point of view in regard to this guiding question. Thank you. >> NISTHA SHRESTHA: Thank you, Valentina and thank you, everyone, for joining today. I will be focusing my discussion from the perspective of Nepal. So, as we know Nepal is a landlocked country and South Asia region with approximately population of 30.3 million and has a federal system of governance. We do

have various policies like national health policy 2019, Public Health Service , 2018 that has prioritized assistive technology and it's also integrated in general health services. In Nepal, we are progressing towards the Universal Health Coverage and the Universal Health Coverage index has progressed over the years and it was 2003 where it's doubled and 53 in 2019. Focus ing on the rehabilitation activities in Nepal, based on rehab 2030 and I didn't -- various too laves have been adopted in Nepal, such as rehabilitation, national rehab rehabilitation guide for rehabilitation -- as Kylie mentioned to take the training and take the products to the Primary Health Care centre level , assistive product, the rapid technology assessment and we would like to thank our stakeholders and partners , actually, with whom we were able to make this possible, especially USA W2 Handicap International . However, in Nepal, approximately 90% of the rehab service, still it's been provided by the private sectors and it's largely uncovered by the benefit package. We find challenges and potential at multiple level. Focusing on the leadership and governance perspective, in Nepal, leprosy control and disability management section is the focal you need for implementing activities related to disability management, assistive technology and provisions plus the leprosy, but we believe there must be a separate entity leading -- which will lead related to rehabilitation and assistive technology in the health system. Considering its massive need at the population scale.

Talking about the provincial and local level, we still need to integrate rehabilitation and assistive technology at that point. Talking about the coverage of the rehabilitation service, there is large unmet of rehabilitation service at all the level of the healthcare in Nepal. As we know, based on the (?) of the healthcare service delivery , a large number of service receiver is at the BAC level and we still need to integrate rehabilitation and ET at the P FC level. We also need to integrate competitive rehabilitation service at the tertiary, specialized and secondary hospital with good quality service provisions. So, there's some solutions that should be implemented.

For integration of rehabilitation at the PAC level, we need to adopt task shifting approach like how we are doing in Nepal. We have started training health professionals and healthcare workers related to the rehabilitation service based on the data from the WHO rehabilitation lead estimator. We also have advocated with the healthcare system leaders to establish a comprehensive rehabilitation setup at the tertiary and secondary level. And the quality of service delivery can be improved through generating few guidelines protocol and quality indicators which we have developed two guidelines and protocols. There should be a continuous professional

development and (?) environment for the rehabilitation professionals, and about the research and evidence generation, there should be a proper evidence generation at the country level by collaborating with academics, institutions, development partners and the users group. Not forgetting about the community level linkage, there should be a strong linkage between the Primary Health Care deliverers and community workers and the volunteer. Talking about the financial aspect, we do have a social security protection scheme which is in line with the Universal Health Coverage. The first the basic health service package, which is the benefit package for the Primary Health Care. That still needs to integrate rehabilitation.

But we have national health insurance, which includes physiotherapy, speech therapy and assistive products in the list. We do provide conditional grants, tax exemptions for the fabricated assistive product and we are implementing public/private partnership, but we still need to expand provision of the rehabilitation at the PNC level, mostly utilizing low-cost and high yield interventions. We also have to integrate rehab and ET at the basic health service package, which will be implemented at the primary level. And there should be a wide spectrum of different rehabilitation service at the national health insurance level, the insurance health scheme is in revision phase and we are continuously in the advocacy phase. So, focusing

on the human resource, it's similar with the global perspective, in kneel we do have a critical sorters of human resource, and most of the human resource , approximately 71% as mentioned in the (?) conducted in 2018 is in the urban area, mostly on the capital city. There are inflows of rehabilitation workers. But the efficiencies are limited because of the poor financial initiatives as well as the limited infrastructure. However, we do witness some good progress at the provincial and local level. Provincial and local hospitals has started recruiting rehabilitation professionals and other -- in the far west region of the Nepal the provincial government in support of U.S. aide physical rehabilitation activity which is managed by Handicap International or humanity Inclusion is catalyze ing the establishment of prosthetic and ortho department which will help for the service provision as well as human resource utilization. So, in conclusion, recognizing rehab and assistive technology as a part of Universal Health Coverage is essential and there should be a collaborative thought among the stakeholders to overcome all the challenges that we faced in different level and we need to ensure equitable access to the basic health service, including rehabilitation and assistive technology, as mentioned in our policy document. And thank you, everyone. And thank

you for inviting me to discuss in this panel discussion. Thank you. >> VALENTINA POMATTO: Thank you very much to both panelists who kindly replied to these first questions under topic number 1, and providing an (?) and also country-level perspective. We now go to the second topic of our discussion today. Universal Health

Coverage is high on the global agenda with the upcoming high-level meeting on 21st of September. But what is the place of rehabilitation and assistive technology in the current status of the UHC debate ? What are the levers to increase political attention on rehabilitation and assistive technology, equally to the other components of the UHC continuum, which are prevention, promotion, treatment and palliative care? I would like to ask to reply to these questions to Sophietou Diop as advisory group of the civil society engagement mechanism for UHC 2030. Sophietou, the floor is yours. >> SOPHIETOU DIOP: Thanks a lot, Valentina. Good morning, all, good afternoon, as well as as Valentina

said my name is Sophietou Diop, I'm advisory member of the civil society engagement mechanism for UHC 2030. And civil society (?) and global multistakeholder movement for Universal Health Coverage. And such organization voice to ensure that inclusive and equitable. Coming back to the topic, I just wanted to highlight the fact that rehabilitation and assistive technology as an essential part of Universal Health Coverage, you know. But also on the con, what we see is there's a lack of awareness and information, barriers that are a key reason for not seeking or saving rehabilitation and assistive technology, you know, as clearly include these as key components for U.S. in general

. And what I just wanted to highlight that is rehabilitation and assistive technology has not been really integrated, you know, into the health (?) context . Living in Africa, Senegal, where I live and also work. But if I look what happens, there is few programmes that integrated rehabilitation or assistive technology as a major access to ensuring universal access to basic healthcare, you know,. And the most compelling example is related to topical disease, which really continue to disproportionately affect the poorest members of the global community, mainly in areas where they don't have access to water, to sanitation, but also to basic healthcare system, you know,. But I think there is time for us to really think deeper , you know, on what the rehabilitation assistive technology means for us, you know. Do we have the same understanding at global level, at regional level, but also at national level? Why it's not really include in the health in low-income countries and I think we need to step back and think more on that and, perhaps, if we do that, perhaps we have -- we will have more results, you know,.

And also, there is a need to confident concretely think on how to rehabilitation in existing health development plans. It's one thing to have all we have at the global level and also at the regional level, but the work it's mainly at the country level. And in order to move forward, you know, and ensure that it include and is part of our discussion, there is a need to have project for treatment but also to have project for rehabilitation. And I think, actually, you have many opportunities, you know. And the main opportunity we have right now to in place political attention on rehabilitation and assistive technology is united national high-level meeting on USC that will take place on September 21, as Valentina already said. And I think during this meeting we will have, you know, leaders on concrete commitment that will be -- that will shape the U.S. agenda for many years

to come. And it stand for us as civil society organizations , for example, to make the case and ensure that rehabilitation is mainly include, you know, on the overall discussion. It's also important to highlight the fact that negotiation on Political Declaration are now in final stage and could process we start in May, you know, the civil society engagement mechanism for USC. We have worked closely with civil society corps at both regional, national and regional level. And with our colleague

, for example, (?) who is online, we really work to ensure that the political -- the final Political Declaration include strong language on assistive technology and rehabilitation, you know,. And as we see, you know, the last version will contain strong languages on assistive technology and rehabilitation services, which is really (?) At the national level, there is a need to put emphasis on key main points. The first one is research and evidence, you know. Because as we all know, hope research and evidence demonstrated the positive impact on rehabilitation and assistive technology and I think policymakers, you know, at national level really need to have some highlights, you know, and some data in order to see why it's important to prioritize , you know, rehabilitation into the overall healthcare system.

The main key point is linked to policy integration . Because in reality, you know, as I said earlier, if you look at the over overall health parameters in low-income countries, you realize we have prevention, we have treatment, but there is most of the time no mention to have rehabilitation. But if you have mentioned, they do not go deeper. And if you look at the strategy, we really have nothing, you know,. And I think there is really a need

to increase the political attention on rehabilitation, assistive technology equal to other component of USC continuum in order to ensure it's aligned. For example the (?) declaration that really highlighted the need to include rehabilitation on the overall Primary Health Care system. We also need to put an emphasis or capacity strengthening and for capacity strengthening not just only for the health workers, you know, or for the decisionmakers, but also for civil society organization, because we cannot have this concept, you know, in global included on policy documents if civil society organizations does not work, you know, with policymakers and other actors like private sector in order to ensure it's included. For that, we really need

to put their capacity in order to ensure that they can -- for example, the health workers can deliver rehabilitation services, but also civil society organizations can clearly support. One of the thing also, in terms of putting in place for -- sorry, final shore mechanism that are really aligned with country priorities, you know, and with country realities. And I think also there is a need for policymakers to explore values mechanism, such as ensure coverage, subsidize , you know, in order to make rehabilitation and assistive technology more affordable and accessible to all. But also, lastly, I think there is a need to have advocacy and strategic partnerships. And what does it mean in reality? We really need to ensure that we involve international organizations like what has organization at the table, invite them at the table. We also include civil society organization, private sector, community actors, you know, in order to ensure that we can think more broadly on the concept and at the end of the day it's really include on that. And in order to do that, there is

really a need to have integrated approach on health, you know,. Just in order to conclude, I think that there are many opportunities to engage and influence discussion at global and regional levels to continue having attention to the need for rehabilitation and assistive technology, including the G7 meeting, the G 20 meeting, (?) assembly. African. I know in African we have the Africa Climate Summit and all of us are here on occasion for us as actors to ensure that we continue to move forward with this discussion and also we have concrete decision that -- and that will be implemented on the (?) . Thanks, Valentina. >> VALENTINA POMATTO: Thank you, Sophie, too,. I now invite Tamara Chikhradze to

reply to these questions. And I add the slides that come with your presentation. >> TAMARA CHIKHRADZE: Thank you very much, Valentina. Thank you to my esteemed co-panelists for setting the stage up and discussing very discussing -- very important issues that I want to build on a little bit from my comment. First of all, yes, of course , rehabilitation and assistive technologies need to be at the heart of universal healthcare debate. We know that UHC is a means to the end, the end being the goal for good health and well-being for the population. And we know that

well-being and good health go beyond the things like being cured of a disease or preventing of disease. We cannot achieve well-being without having a population that is protected, fulfilled and functional in their environment. So, definitely rehabilitation and assistive technologies need to be integrated in the continuum of care for Universal Health Coverage, as that essential link that moves us from saving lives towards ensuring the prosperity of these lives. Now, the one lever I want to discuss with my fellow do already, is the importance of health financing , and health financing as a lever to not only progress towards achieving Universal Health Coverage, but also elevating rehabilitation on the agenda and the debate for Universal Health Coverage. Now, why health financing? The two main reasons. One is

a very clear that it provides financing and coverage for population (muffled audio) rehabilitation services and assistive technologies they need. Two and more importantly for the topic of our discussion here today, is that integrating something like rehabilitation or any health service in health financing , especially if this is a public health financing mechanism inherently puts it on the policy priority agenda in the country and globally, and puts it as an important point for universal healthcare debates. Now, the three main issues I want to discuss here when we considered rehabilitation in health financing for Universal Health Coverage, are, one, the integration of rehabilitation services in health benefits packages that have financed. And this is important. If it's not already integrated at the country level, to get that foot through the door. Even if

we start with just a few services or just a few conditions, putting rehabilitation on a map through health benefits packages, and then strategically spending money for rehabilitation will open that door significantly over the years to come. And the country of Georgia is a good example here, whom our organization results for development and the health system, strengthening accelerator project is supporting to integrate rehabilitation in their universal healthcare financing programme, where just in the last November, they started financing adult rehabilitation services, a very limited package, and less than a year later, there's already discussions in the country of expanding that package and putting in place other resources that support the coverage, such as standards guidelines, expanding services , expanding (muffled audio) and so on and so forth. The second issue I want to bring up is the importance for us on the health side to figure out how to work and collaborate with all sectors and institutions involved in financing rehabilitation services . So, if a rehabilitation is suddenly prioritized in Universal Health Coverage in the health sector, does that mean that other sectors like defense education, social protection , insurance schemes for disability and accidents and other mechanisms financing rehabilitation, does that mean that they have to pay less attention or deprioritize it? Well, of course not . We need to work together. We need to collaborate and coordinate with all the actors, not just to expand coverage and make sure there's universality in coverage but also join forces for the needed advocacy rehabilitation on the UHC agenda, not just in the country, but also at the global level. And last, but not the least, I want to highlight the importance of strategic use of funds in financing rehabilitation services. For three main reasons. One being that there cannot be Universal Health Coverage without strategically using the limited funds that we have and figuring out what services are we funding with which providers, for which population groups. How , and so on and so forth. Two, is that the

strategic use of funds will help us create high-quality services and better (muffled audio) meets the population needs and the unmet needs is out there and this is a potential for generating huge demand in the population and the demand in the population translates very often to establishment of the service on the health policy agenda at the highest levels. And last but not the least, values resources make a very good case for advocacy and opportunities for even additional resources going into this field. So, I will end here. But I would like to highlight the report coming out , collaboration and results for development in World Health Organization that discusses these issues in even further details. If you could switch to the next slide. And my colleagues will

also paste, insert a link in the chat. So, a report is called rehabilitation in health financing and discusses these issues in further detail. It is -- it is in final design stages for publication. So, if you

follow this link, you can sign up and give us your contact information. If you are interested, we will send it directly to your email as soon as it is published. So, thank you very much and I am happy to take additional questions if there are any.

>> VALENTINA POMATTO: Thank you. Thank you very much for panelists to reply. I invite participants to type comments and questions in the chat as a Q&A moment approaches. We go to the third and last topic of our discussion today. In order to reach Universal Health Coverage , health systems must be oriented toward the Primary Health Care approach. The questions are, what are the overall benefits when

rehabilitation is integrated at the Primary Health Care level and what are examples of effective integration of rehabilitation in Primary Health Care . Please I give the floor to Andrew Mubangizi, assistant commissioner and he works at the ministry in Uganda. Thank you. The floor is yours. >> ANDREW MUBANGIZI: Thank you, the Moderator. Once again, Andrew Mubangizi from Uganda . And again I have to cross-check whether I am loud and clear. Can you say whether I am loud and clear? >> VALENTINA POMATTO: Yes, we can hear you perfectly. >> ANDREW MUBANGIZI: Okay. As far as these questions concerned, of course , the Universal Health Coverage is key, but as far as the Primary Health Care level is concerned, Universal Health Coverage has not been integrated. There is no integrated rehabilitation and assistive technology services at that level.

But for Uganda, we are in the initial stages where we have started on the pilot to have the networks of care, as a pilot in the regions of the country, of course, supported by (?) we established for networks of care, whereby we are trying to priority the basic rehabilitation package, the clinical social manual and protocols and we are , actually, starting. To go to the question in this regard, the benefits, indeed they are, and one of the benefits are, actually, the benefits line -- align with the prevention , promotion, timely treatment , rehabilitation, and the easy access to all these, including the palliative care, including 18 general and all the rehabilitation services. And when it is integrated, that is number one is access. And number two, it is -- enables

comprehensive rehabilitation services. Number three, it reduces costs because once it is integrated, that means that we don't need a special arrangement, special funding and, actually, the associates within different departments of the hospital or the service unit, they can compliment each other. And at the same time, based on our model whereby we are implement ing the basic rehabilitation package, it should not only keep rehabilitation experts or professionals who are (?) integrated in rehabilitation services. It is all health workers, could be nurses, technicians, could be midwives, could be medical facility.

We are trying to orient them into this basic approach to providing rehabilitation related services at such a level . And in this regard, actually, we expect to accrue many benefits. Like the turnover for the services will be high, limiting the complications, and also overall the outcome of intervention, which related to the code of life, to people who are receiving services . So I may not be specific on what are the examples of rehabilitation. Maybe I can say that when we orient or when we, we bring on board all the -- all the health workers, which we call interdisciplinary approach or collaboration, I think that's a good example of effective integration . Then also the effective integration in specific to eight is the normal medicine and supply chain, including the AT supplies. So, we also in this way , we also in Uganda trying to priority this with our national medical stores on the entire chain of AT (?). And in this way, we, actually, wanted to

train the health workers to build capacity, and the understanding what we need in respect AT, understanding the procedure to physician, and then storage, and even maintenance for the rehabilitation professionals, in that once the national supply chain is ready, then people can be able to maintain the processes. So, if that is not taking much time, I would stop here. Then I may be able to accept any questions related to this. I thank you

. >> VALENTINA POMATTO: Thank you very much. That was very nice of you to share some insight from Uganda. And I will now ask Eliana Monteforte, global health council, to take the floor and this topic for discussion. >> ELIANA MONTEFORTE: Yes. Thank

you so much. And I know that we don't have a whole lot of time and we want some time for questions. So, I am going to try to be quick, especially since my colleagues already made some really great points that I was going to make. So, I will try not to be repetitive. My intervention is going to take us to a little bit more of a macro level. I'm going to start by talking about UHC and how it links to Primary Health Care. So, Universal Health Coverage

guarantees that all people, no matter their disability, race, income , education, sexual orientation , et cetera have access to health without suffering financial hardship and that includes rehabilitation and AT services. So, to achieve Universal Health Coverage and ensure that all people have access to rehabilitative care they need, global health council, in collaboration with UHC 2030 and other partners are strongly advocating for governments to reorient their health systems to Primary Health Care . So, when we say Primary Health Care, what do we mean? Primary Health Care is a whole of society approach to health and it aims to ensuring the highest possible level of health and well-being, and their equitable distribution by focusing on the people's needs and as early as possible along the continuum of care. So, when we talk about the continuum of care, we are saying promotion, prevention, treatment , rehabilitation, and palliative care. And really key to Primary Health Care is that it brings these health services to the people's everyday environment. So, how does that benefit rehabilitative care? Well, first, Primary Health Care ensures that people receive quality, comprehensive care. So, as I mentioned, rehabilitative care and AT services are included in that (AT not 80). And it brings it as close to the people as possible. So

it makes it accessible to the people. The other benefit is that PHC is the most inclusive, equitable and cost-effective , efficient approach to enhance people's physical and mental health and social well-being. So, it's not enough to just offer rehabilitative and AT services if it's not reaching the people who need it the most, if it's not reaching the most vulnerable and marginalized populations. And PHC can really help expand and broaden that reach . I'm going to talk a little bit about the pandemic and how that affected rehabilitation and AT services and how PHC could be a solution to that in the future. We saw in COVID-19 how we urgently need Universal Health Coverage. And

we also saw enormous disruptions in health services, including rehabilitative health services. And that was caused either because of lockdowns, because resources were being diverted to COVID-19. But if we have strong PHC systems that are made for and by the people, this can really ensure that health systems are resilient in health crises like the COVID-19 pandemic. And we can make sure that people even when we are in a public health emergency, have continual rehabilitative and AT services at their fingertips when they need it. This is extremely important since coming out of the pandemic we have seen an increase of NCDs, of non communicable diseases, many of which require Reeb tiff and AT services . So, making sure that we have Primary Health Care systems that can address those needs will be incredibly important. And I'm going to end with a few calls to action that -- to governments that we as global health council have really been pushing. So, to realize Primary Health Care

and ensure people to have the rehabilitative and AT services that they need, we need leaders to become political champions for UHC and PHC. So, that means strengthening and financing comprehensive essential healthcare and basic packages of health and that these (in) based on epidemiological and disease needs that you're prioritizing Primary Health Care as a foundation for health services, UHC and health security, and we are also asking governments that they implement policies, laws and regulations that allow for integrated PHC services. So, this includes adopting and integrating frameworks that strengthen PHC institutions, that support the workforce and those ecosystems. And then of course, we are also asking for governments to please increase their financing for Primary Health Care to strengthen those PHC services and scale up those PHC services, which include rehabilitation and AT services. That's it for me. And hopefully that gives us enough time for questions. >> VALENTINA POMATTO: Thank you

very much. Thank you, Eliana and all the other panelists that kindly shared with us their perspective and insights. I think that we have at least one question that I already saw in the chat. It's about more concrete examples of rehabilitation in Primary Health Care to really get into the more operational and practical aspects of this work. I wonder if Tamara, she Tamara Chikhradze would like to share also experiences results of development, knowing that this is also work in progress at your level. If you might provide a one-minute insight on this, if you wish . >> TAMARA CHIKHRADZE: Yes, of course, and thank you. So, our

project in supporting the Ministry of Health in Ethiopia to integrate rehabilitation service at the Primary Health Care level and it's at the beginning stages where there's still discussions on what are the rehabilitation services that can and should be accessible at that level and how do we move forward from here, what are the opportunities to link this and integrate this within the existing health system structures and levels . So, I will stop here and see if there are any additional insights here, questions on this, but this is one of the starting points of, you know, promoting rehabilitation on the UHC agenda and ensuring that the coverage is there and it's one of the more strategic decisions that any Ministry of Health can make to expand the access to this service. >> VALENTINA POMATTO: Thank you very much, Tamara. And there was also -- there were also very good points raised around the need for data for research. And maybe just digging a bit more into this topic, I would like to ask Ms. Kylie Shae to tell us more about how important it was to have recent and very accurate data on assistive technology . I recall the global report launched at the beginning of this year on the assistive technology. How did it change to really have good data to move forward with political attention and partner integration in Universal Health Coverage. How did that help? >> KYLIE SHAE: Thanks, Valentina,

for the question. And, yes, I remember the launch, and I remember the words of our Assistant Director General at the time. She said measure what you treasure. And I think about that often in the work that we are

doing in the AT team at headquarters, which is all about -- it's not all about, but one of the key pieces of work that we are doing is strengthening and streamlining the tools that we have available to support member states and our civil society partners to better measure and understand the population need . In terms of the importance, it's been an absolute game changer. Being able to represent in the global report the data set that we gathered with the support of member states and, actually, many of the partners on this call. That has really provided us with that strength and the conviction and the surety around the scale of the need , as well as having some of the data that gives us really good evidence of the top barriers. And I

presented earlier, one of the top barriers was the fact that 67% of people accessing assistive technology through private shops and out-of-pocket payments. And being able to present that and show that within then all of the work that's going on around the health system, financing and some of the great work that's been presented here, we can show that urgency of that and why that really, really matters. And I think just quickly to finish, it's important not to just be looking at the numbers of how many people need assistive technology, but we need to measure the gap. So how many people have and how many people do not have, which is something that we can do with the population based survey that we developed for the global report. But we also need to be measuring

the system preparedness, which is, you know, another piece of our data collection toolkit. We need governments to be measuring themselves against progress indicators, which we are doing every four years in partnership with member states. And we need to measure the impact of access to assistive technology, because with that, we then are able to, again, strengthen the political will to provide support for this area of service delivery. Thank you. >> VALENTINA POMATTO: Thank you very much. And I think there's also another question for you in the chat, which I don't know if you would reply to. It's inviting. Is there any list of assistive technology products and what are the augment services for rehabilitation.

Because there was also another question for national-level insight. So if you can reply . >> KYLIE SHAE: I am doing it now. >> VALENTINA POMATTO: Thank you very much. I will ask to reply really quickly in one minute to Mr. Mubangizi and Ms. (?). If you can summarize in a simple point, what would

actually encourage this change to happen at the national level so the decisionmakers are convinced that rehabilitation and assistive technology deserve a place in Universal Health Coverage. Please, if you can, you both, one and the other, one after the other, take the floor and be very concise about this. Thank you . I would invite Andrew Mubangizi to -- >> ANDREW MUBANGIZI: Kindly, I beg your pardon in that question or didn't come through clear. >> VALENTINA POMATTO: The question would be, what does trigger change at the national level, what would convince decisionmakers at the national level to integrate rehabilitation in Universal Health Coverage. If you can say the one thing that for you would really be influential. >> ANDREW MUBANGIZI: All right.

For me, what would trigger or maybe, actually, it's not an obvious thing , but yeah , the turnaround. When more people turn up for the services and when they are registered in the health information system and when the reports are high, no matter it is what awakens the policymakers or government. And that is related to demand. So, if we set up in a service of this nature, ensure that you cause demand to be seen or demand to be in place in that facility, concerted show of need. >> VALENTINA POMATTO: Okay. Really the demand-driven services are the most important. Yeah.

Is there anything you would like to add on this, Ms. Sheriff about national change. The one thing that could be game changer . >> NISTHA SHRESTHA: Yeah. As we know for the Universal Health Coverage and we also know there is an increase in noncommunicable disease and injuries that we do have datas that there is a huge burden cause due to all of this problems or situations, so, the government needs to mostly focus on the Universal Health Coverage (shrestha) and provide the benefit service, include rehabilitation in the benefit service package and reduce the out-of-pocket expenditure. And the most important thing that we need in context of our country is awareness. Among the health system leaders and among the -- since we have federalizations , there is awareness in this central or federal level, but at the provincial and local level where we are planning to implement rehabilitation at the PNC level, we need to increase our awareness at that level. If we do that, that might be the game changer, if we focus more on the local government perspective and provincial government perspective for implementation of rehabilitation and assistive technology. So, that would be the main game

changer. >> VALENTINA POMATTO: Thank you for sharing this point. The webinar is going to end. I really thank everyone for being with us today. Our distinguished panelists, the co-organizers and all the participants who joined and contributed to the discussions.

Thank you very much. And we look forward for a very powerful UHC Political Declaration with strong references to rehabilitation and assistive technology. Thank you very much, everyone. >> ELIANA MONTEFORTE: Thank you. >> KYLIE SHAE: Thanks. Bye. >> ANDREW MUBANGIZI: Thank you. Bye.

2023-09-17 11:53

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