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Of 38 WFOT: Comments on the “WHO GCM-WG 3.1 Draft Interim Report”

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Of 38 WFOT: Comments on the “WHO GCM-WG 3.1 Draft Interim Report” WFOT: Comments on the “WHO GCM-WG 3.1 draft interim report” September 2016 These comments were provided by a WFOT international review team covering a total of ten high, middle and low income countries. Overall comments: This document is appropriate for all countries. The focus on integration and integrated care is appreciated, as is the focus on prevention and the promotion of people-centred primary health care and universal health coverage. It is a highly ambitious policy and while this is exciting, the practical implications at all levels are considerable, particularly for resource- poor countries. Overall, the policy addresses key considerations and the structure of the document potentially aids understanding and action, though opportunities exist to strengthen clarity and coherence, and there are some omissions that warrant articulation. Examples follow below. The explanation of ‘integrated care’ and ‘integration’ (page 2, paragraph 2) may be confusing for some audiences (e.g. both talk about ‘organising’). The Overarching Principles, draft Recommendations and Policy Options neglect to specify particular vulnerable groups (only referring to youth, families, communities and patients); people with disability, indigenous populations, and refugees are among those who should also be explicitly identified, not least because specific inclusion/integration strategies may be required as well as making the link with human rights, equity principles and other UN/WHO policies and conventions. The notion of presenting ‘policy options’ for each of the draft Recommendations is a positive one but in actuality the points listed are more ‘indicative/suggested strategies’ rather than ‘options’; furthermore, many are co-dependent and most are complex and, as has been identified, will require substantial resources (including expertise and funding). The Concept of Integration and the Overarching Principles promote the need for a ‘whole of government’/whole of community type of approach but the nine draft Recommendations don’t adequately reflect or incorporate this – they are MOH-centric, and while it is appreciated that Health sectors will take the lead, there is a need to strengthen reference to strategies for promoting/developing cross-sectoral collaboration and integration. This is especially the case, for example, for people with disability whose wellbeing tends to come under departments of social services/welfare. Page 1 of 38 Grouping the draft Recommendations under two sub-headings (Governance/Upstream/vertical and Service Delivery/Downstream/Horizontal) is somewhat confusing. An introductory statement referring to these dimensions may be more valuable. Health system stewardship and evidence informed policy making has a role to play in engaging relevant sectors for enhanced national multisectoral collaboration and coordination, enabling proper participation of communities, and ensuring institutional and financial mechanisms are fit for purpose. This WHO concept is not mentioned and perhaps should be. This document is comprehensive with context-sensitive recommendations with respect to the prevention and control of noncommunicable diseases (NCDs). One notable gap, from an occupational therapy perspective, was that this paper was essentially silent with respect to the special concerns of people with disabilities in preventing and managing NCDs. People with physical disabilities, cognitive impairments, and severe mental illness have significantly higher risk of contracting NCDs and of their NCDs being poorly managed or controlled. There are many significant barriers to NCD prevention and control in this population that warrant attention: Healthcare providers are often poorly trained in how to provide appropriate preventive care to this population. They may not even be aware of the need for, and potential benefits of, preventive care because of preconceived notions of this population's being destined to experience poor health, or that, given that they have a disability/impairment, it is 'too late' to prevent illness and there is no added benefit with respect to the health and quality of life of these persons to devoting resources to NCD prevention and control. There are environmental barriers to accessing care, such as the physical accessibility of facilities and medical equipment. Many of the sequelae of disabilities (such as limited movement) and medications used to treat symptoms of impairment or disability may themselves predispose this population to developing NCDs People with disabilities are disproportionately poor and from underrepresented minority groups, and thus are subject to health disparities due to demographic characteristics in addition to the disparities related to having a disability - thus in a sense they are doubly disadvantaged with respect to NCD prevention and control. In addition to the above, given the emphasis throughout the document on access, equity, and local control of healthcare decision making, it is recommended that there is more discussion of health disparities related to sociodemographic variables. It is clear that special efforts are needed to counter these disparities. The focus on patient/family/community centered care, and attention to geographic equity of services, will go some way towards closing the gap with respect to health disparities but without devoting specific resources to marginalized communities, it is likely that their health will continue to lag behind those of more advantaged groups. Page 2 of 38 Overall, providing the right care, for the right people, at the right place resonates with the ethics of occupational therapy and occupational justice - depending on the definition of the “right” people. Occupational therapists can play a key role in alleviating the effects of NCDs on human beings to preserve the ability to achieve functional and independent life activities. Service delivery most importantly should include occupational therapists. The strategies should be health oriented with occupational therapists in place where ever necessary in prevention, intervention, treatment, rehabilitation and integration of services, and the development and maintenance of a sustained workforce. When governments consider leadership from the health sector, occupational therapists and occupational therapy models must be included. Occupational therapists are important to the success of NCD strategies and achievement of related goals. The inclusion of occupational therapy and occupational therapists is essential to teams and the health support system. Related expenditure must be addressed. Assessment, diagnosis, treatment and functional rehabilitation will also require occupational therapists to play a key role in health care process. There is a compelling need to develop built in systems and procedures to deliver policies/plans/services to the beneficiaries/stakeholders. Potential staff burnout and retention must be addressed in the total system. In order to guarantee these changes will be made it is suggested that each country could provide a full report., containing data about the actual situation, tailored objectives and the actions that will accomplish the overall goals. The recommendations could address the role of NGO's in promoting health and wellness to individuals and the community. Examples of Occupational Therapy addressing the NCDs, Wellness Promotion, and related information: WFOT Bulletin – The World Federation of Occupational Therapists (WFOT) Bulletin is the official publication of the WFOT. Its aim is to promote awareness and understanding of the WFOT and its activities and services, the development of the occupational therapy profession worldwide, and the international exchange of professional knowledge and experience. International articles relating to NCDs and occupational therapy are regularly included in the Bulletin. More information is available at http://www.wfot.org/Bulletin.aspx Examples of publications relating to Occupational Therapy and NCDs include: Page 3 of 38 Health Promotion in the Seychelles. http://www.health.gov.sc/index.php/2016/07/15/health- minister-opens-symposium-on-patient-centred-care/ Neufeld, P. & Kniepmann, K. (2001). Gateway to Wellness: An Occupational Therapy Collaboration with the National Multiple Sclerosis Society. OCCUPATIONAL THERAPY IN HEALTH CARE. Retreived from http://dx.doi.org/10.1080/J003v13n03_07 Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016, September 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 1–19. doi.org/10.1177/1077558716666981https://doi.org/10.1177/1077558716666981 See more at: http://www.aota.org/Publications-News/AOTANews/2016/Occupational-Therapy- Reduces-Hospital-Readmissions.aspx#sthash.nUymgKYX.dpuf Scott, A., (1999). Wellness Works: Community Service Health Promotion Groups Led by Occupational Therapy Students. American Journal of Occupational Therapy, November/December 1999, Vol. 53, 566-574. doi:10.5014/ajot.53.6.566 Page 4 of 38 The following WFOT Position Statements inform the occupational therapy perspective in the promotion of the inclusion of the prevention and control of noncommunicable diseases (NCDs). WFOT Position Statements can be accessed from the WFOT website www.wfot.org >Resource Centre > filter resources by category: Position Statements Activities of Daily Living (2012) Client-centredness in Occupational Therapy (2010) Community Based Rehabilitation (2004) Consumer Interface with Occupational
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