As lifespans increase and chronic diseases rise, the need for diverse services like occupational therapy grows. Occupational therapists, for instance, enhance safety and independence at home. This article highlights rehabilitation's importance and challen

REHABILITATION FOR ALL

Globally, about 2.4 billion people are currently living with a health condition that may benefit from rehabilitation, that is around 1 in 3 people. It includes not only people with disabilities or long-term or physical impairments. Rather, rehabilitation is an essential health service for anyone with an acute or chronic health condition, impairment, or injury that limits its functioning.

WHO defines rehabilitation as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.

With advancements in medical sciences, people are living longer, with the number of people over 60 years of age predicted to double by 2050, and more people are living with chronic diseases such as diabetes, stroke and cancer.

Rehabilitation complements other health interventions, such as medical and surgical interventions, helping to facilitate recovery and achieve the best outcome possible. It can help to prevent, reduce, or manage complications of a broad range of health conditions, including diseases (acute or chronic), illnesses, or injuries.

Some examples of rehabilitation services include:

  • Occupational therapists modify an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls, contributing to healthy aging
  • Speech-language therapists provide speech and language training to improve a person’s communication after a brain injury
  • Physical therapists work with patients in intensive care to improve their breathing, prevent complications, and speed their recovery after critical illness
  • Educating a person with heart disease on how to exercise safely
  • Prosthetists and Orthotists fabricating spinal braces for a person with developing spinal deformities
  • PMRs prescribing medicine to reduce spasticity for a child with cerebral palsy
  • Psychologists providing psychological therapies for a person with emotional distress following a spinal cord injury
  • Prescribing assistive products like reading glasses, walkers, hearing and communication devices, sensory devices, and white canes.
  • Social skills training for persons with schizophrenia, autism spectrum disorders, or disorders of intellectual disability

Rehabilitation is highly individualized and is catered to a person’s needs, goals, and what they find meaningful. Rehabilitation can be provided in many different places, such as inpatient or outpatient hospital settings, outpatient physio- or occupational therapy practices, and community settings such as an individual’s home, a school, or a workplace.

A good rehabilitation service will have a multidisciplinary team comprising different health workers, including but not limited to occupational therapists, physiotherapists, speech and language therapists and audiologists, orthotists and prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses. Many other health workers, such as general practitioners, surgeons, social workers, and community health workers may also play an important role in a person’s rehabilitation.

Rehabilitation practically is an investment with long-term social, economic, and health benefits as it helps to avoid costly hospitalization, reduce hospital length of stay, prevent re-admissions, return to work and employment, or remain independent at home minimizing the need for caregiver support.

Being an important part of universal health coverage, a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”, rehabilitation is emphasized by many governments around the world.

It is estimated, however, that in low- and middle-income countries, more than 50% of people do not receive the rehabilitation they require.

For a country like Nepal, the scarcity of qualified workforce, lack of awareness and education, our geography, poor availability of resources, improper implementation of health plans, leadership, and governance, unavailability of academic institutions for related programs, lack of dedicated rehabilitation infrastructures play a major role in the gap in rehabilitation services.

The 2015 earthquake was a major awakening call for the need for rehabilitation in emergencies which generated overwhelming rehabilitation needs, health system preparedness, and early response.

In Nepal, the Leprosy Control and Disability Management Section (LCDMS) under the Department of Health Services (DoHS), Ministry of Health and Population (MoHP) is the focal unit for disability, rehabilitation, and related activities. LCDMS works in coordination with various organizations like Handicap International (HI)- Nepal, World Health Organization (WHO)-Nepal, and various levels of hospitals/healthcare centers to expand its rehabilitation activities to align with the Universal Health Coverage (UHC).

Currently, the majority of the required rehabilitation services (around 90%) are being provided by the private sector including INGOs, NGOs, and private clinics. The Nepal Government is actively developing plans and policies to expand rehabilitation services in collaboration with various ministries.

Rehabilitation is neither a luxury health service nor an optional one. It is an essential part of health care, requiring it to be delivered alongside other health interventions. Ensuring quality rehabilitation services for all enables a child, adult, or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation, and meaningful life roles. Rehabilitation is essential, for all.