Abstracts Health Sciences

Health related rehabilitation and human rights: Turning fine aspirations into measurable progress

by Dimitrios Skempes

Today there is a nearly universal recognition of rehabilitation as an indispensable component of the right to health of persons with disabilities as expressed in the Convention on the Rights of Persons with Disabilities (CRPD). However, a firm academic clarification of the right to access rehabilitation is lacking and concrete knowledge on monitoring progress with its implementation is very limited. The goal of this thesis was to develop relevant guidance and analytic tools, especially indicators, to assist governments and those seeking to support them monitor efforts to strengthen rehabilitation in health systems in line with the CRPD. Methods involved hermeneutic literature reviews and an exploratory concept mapping study. Article 25, when read in conjunction with other Articles in the CRPD, especially Article 26 on ‘Habilitation and rehabilitation’ give rise to a set of entitlements and corresponding State duties. These extend across several human right commitment areas: Equality and non-discrimination, public participation, progressive realization, protection of privacy, informed consent, availability, accessibility, acceptability and quality of rehabilitation facilities, services, information and technologies; and accountability and monitoring. Collectively, these requirements clarify the parameters by which appropriateness of rehabilitation must be judged and create the demand for analytical approaches capable of measuring the legal, policy and programmatic factors that impede access to rehabilitation. The combined input of experts who participated in the concept mapping study resulted in a framework of 107 indicators grouped in 11 clusters: Legal Commitments and Strategic Priorities; Evidence informed and rights based programming; Workforce Development; Monitoring and Accountability; Service Financing and Quality Control; Access Barriers; Service Coverage, Utilization and Outcomes; Disability Statistics; Social Mobilization and Research; Workforce Planning and Performance; and Higher Education. Overall, the indicator framework emphasizes the importance and relationship of human rights with strategic, operational and organizational aspects of rehabilitation policy and services offering a menu of measures to monitor CRPD implementation. The results also suggest that the framework possesses dynamic features and articulates a systems view of rehabilitation, which make it relevant to broader assessments of rehabilitation in the context of health systems strengthening. The framework offers an evidence based platform to ensure constructive accountability as it successfully combines normative and operational requirements for strengthening rehabilitation and serves as a preliminary template for integrative monitoring. If properly understood and applied, the framework has the potential to assist in the monitoring and evaluation of rehabilitation services and the full and effective realization of the right to health.