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Globalization and Health
Published in: Globalization and Health 1/2016

Open Access 01-12-2016 | Research

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis

Authors: Joanne McVeigh, Malcolm MacLachlan, Brynne Gilmore, Chiedza McClean, Arne H. Eide, Hasheem Mannan, Priscille Geiser, Antony Duttine, Gubela Mji, Eilish McAuliffe, Beth Sprunt, Mutamad Amin, Charles Normand

Published in: Globalization and Health | Issue 1/2016

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Abstract

Background

Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation.

Methods

An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation.

Results

Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability.

Conclusions

Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
Literature
1.
2.
3.
4.
5.
Mikkelsen-Lopez I, Wyss K, de Savigny D. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights. 2011;11(13):1–11. doi:10.​1186/​1472-698X-11-13.
6.
Amin M, MacLachlan M, Mannan H, El Tayeb S, El Khatim A, Swartz L, et al. EquiFrame: a framework for analysis of the inclusion of human rights and vulnerable groups in health policies. Health Hum Rights. 2011;13(2):82–101.
7.
McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, et al. Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ. 2008;86(11):871–6.CrossRefPubMedPubMedCentral
8.
Jiménez P, Medlen KP, Fleitas Estévez I. Diagnostic imaging for global health: implementation and optimization of Radiology in the developing world. In: Mollura DJ, Lungren MP, editors. Radiology in global health: strategies, implementation and applications. New York: Springer; 2014. p. 127–38.
9.
Meyer T, Gutenbrunner C, Kiekens C, Skempes D, Melvin JL, Schedler K, et al. ISPRM Discussion paper: promising a conceptual description of health-related rehabilitation services (special report). J Rehabil Med. 2014;46(1):1–6. doi:10.​2340/​16501977-1251.CrossRefPubMed
10.
Skempes D, Stucki G, Bickenbach J. Health-related rehabilitation and human rights: analyzing States’ obligations under the United Nations Convention on the Rights of Persons with Disabilities (special communication). Arch Phys Med Rehabil. 2014;96(1):163–73. doi:10.​1016/​j.​apmr.​2014.​07.​410.CrossRefPubMed
11.
12.
13.
14.
15.
WHO (World Health Organization), UNESCO (United Nations Educational, Scientific and Cultural Organization), ILO (International Labour Organization), IDDC (International Disability and Development Consortium). Community-Based Rehabilitation Guidelines. WHO, UNESCO, ILO, IDDC. 2010a. http://​www.​who.​int/​disabilities/​cbr/​guidelines/​en/​. Accessed 10 Aug 2016.
16.
17.
18.
19.
20.
21.
Westhorp G. Realist impact evaluation: an introduction. London: Overseas Development Institute; 2014.
22.
Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review – a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10(1):21–34.CrossRefPubMed
23.
Rycroft-Malone J, McCormack B, Hutchinson AM, DeCorby K, Bucknall TK, Kent B, et al. Realist synthesis: illustrating the method for implementation research. Implement Sci. 2012;7(33):1–10. doi:10.​1186/​1748-5908-7-33.
24.
25.
Pawson R, Tilley N. Realistic evaluation. London: Sage Publications Ltd.; 1997.
26.
McCormack B, Rycroft-Malone J, Decorby K, Hutchinson AM, Bucknall T, Kent B, et al. A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency. Implement Sci. 2013;8(107):1–12. doi:10.​1186/​1748-5908-8-107.
27.
28.
Egüez MI. NGOs and UN Agencies Assisting Persons with Disabilities: A Non-Exhaustive Reference List of Organizations Working with and for Persons with Disabilities World-wide. Geneva: Office of the United Nations High Commissioner for Refugees (UNHCR); 2008. http://​www.​refworld.​org/​pdfid/​48297a4e2.​pdf. Accessed 10 Aug 2016.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
NiMhurchadha S, Gallagher P, MacLachlan M, Wegener ST. Identifying successful outcomes and important factors to consider in upper limb amputation rehabilitation: an international web-based Delphi survey. Disabil Rehabil. 2013;35(20):1726–33. doi:10.​3109/​09638288.​2012.​751138.CrossRefPubMed
41.
Gilmore B, MacLachlan M, McVeigh J, McClean C, Carr S, Duttine A, et al. (in review). A realist synthesis of human resource skills required to implement the health-related aspects of the CBR Guidelines. Arch Phys Med Rehabil.
42.
Araya R, Alvarado R, Sepulveda R, Rojas G. Lessons from scaling up a depression treatment program in primary care in Chile. Rev Panam Salud Pública. 2012;32(3):234–40.CrossRefPubMed
43.
Boersma M. Protecting children with disabilities from violence in CBR projects: why we need to work with a different form of child protection policy for children with disabilities. Disabil, CBR Inclusive Dev. 2013;24(3):112–22. doi:10.​5463/​DCID.​v24i3.​261.CrossRef
44.
Bricout JC, Baker PMA. Deploying information and communication technologies (ICT) to enhance participation in local governance for citizens with disabilities. Int J Inf Commun Technol Hum Dev. 2010;2(2):34–51. doi:10.​4018/​jicthd.​2010040103.CrossRef
45.
46.
Caldwell J, Switzer ME. Leadership development of self advocates: life stories and perspectives of leaders within the self-advocacy movement. Chicago: Department of Disability and Human Development, University of Illinois at Chicago; 2008.
47.
48.
Eide AH, Amin M, MacLachlan M, Mannan H, Schneider M. Human rights, social inclusion and health equity in International Donors’ policies. Disabil, CBR Inclusive Dev. 2012;23(4):24–40. doi:10.​5463/​DCID.​v23i4.​144.
49.
50.
51.
52.
Kuipers P, Wirz S, Hartley S. Systematic synthesis of community-based rehabilitation (CBR) project evaluation reports for evidence-based policy: a proof-of-concept study. BMC Int Health Hum Rights. 2008;8(3):1–15. doi:10.​1186/​1472-698x-8-3.
53.
Mannan H, McVeigh J, Amin M, MacLachlan M, Swartz L, Munthali A, et al. Core concepts of human rights and inclusion of vulnerable groups in the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. J Disabil Policy Stud. 2012;23(2):67–81. doi:10.​1177/​1044207312439103​.CrossRef
54.
Plotner AJ, Trach JS. Leadership development perspectives from Community Rehabilitation Program Directors, managers, and direct-service personnel. J Rehabil. 2010;76(2):3–9.
55.
56.
Ribeiro CTM, Ribeiro MG, Araújo AP, Mello LR, Rubim Lda C, Ferreira JE. The public health care system and rehabilitation actions in Brazil. Rev Panam Salud Pública. 2010;28(1):43–8.CrossRefPubMed
57.
58.
Ferreira K, Hodges S, Israel N, Mazza J. System Implementation Issue Brief No. 3 - Lessons from Successful Systems: Leadership Qualities in Successful Systems of Care. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health; 2007. http://​www.​oregon.​gov/​oha/​amh/​wraparound/​steering/​brief3.​pdf. Accessed 10 Aug 2016.
59.
Huss R, Green A, Sudarshan H, Karpagam SS, Ramani KV, Tomson G, et al. Good governance and corruption in the health sector: lessons from the Karnataka experience. Health Policy Plan. 2011;26(6):471–84. doi:10.​1093/​heapol/​czq080.CrossRefPubMed
60.
61.
Banda-Chalwe M, Nitz JC, de Jonge D. Globalising accessibility: drawing on the experiences of developed countries to enable the participation of disabled people in Zambia. Disabil Soc. 2012;27(7):917–34. doi:10.​1080/​09687599.​2012.​692024.CrossRef
62.
63.
Cornielje H, Velema JP, Finkenflugel H. Community based rehabilitation programmes: monitoring and evaluation in order to measure results. Lepr Rev. 2008;79(1):36–49.PubMed
64.
Ebenso B, Idah M, Anyor T, Opakunmi F. Lessons from the evolution of a CBR programme for people affected by leprosy in Northern Nigeria. Lepr Rev. 2010;81(4):318–31.PubMed
65.
66.
67.
Kiima D, Jenkins R. Mental health policy in Kenya – an integrated approach to scaling up equitable care for poor populations. Int J Ment Health Syst. 2010;4(19):1–8. doi:10.​1186/​1752-4458-4-19.
68.
Kirchner C. Seize the moment! Establishing vision-related rehabilitation and access in the nation’s public health policy agenda. J Vis Impair Blind. 2006;100:780–92.
69.
Lazcano-Ponce E, Katz G, Allen-Leigh B, Magaña Valladares L, Rangel-Eudave G, Minoletti A, et al. Intellectual development disorders in Latin America: a framework for setting policy priorities for research and care. Rev Panam Salud Pública. 2013;34(3):204–9.PubMed
70.
71.
72.
73.
74.
75.
76.
WHO, Regional Office for Africa. Implementation of UN standard rules on the equalization of opportunities for persons with disabilities, Brazzaville, Republic of Congo, 17-19 November 2004, Inter-Country Meeting Report. Geneva: WHO; 2005.
77.
78.
79.
80.
81.
82.
83.
84.
Walsh-Danishmandi A, MacLachlan M. Environmental risk to the self: factor analysis and development of sub-scales for the Environmental Appraisal Inventory (EAI) with an Irish sample. J Environ Psychol. 2000;20(2):141–9.CrossRef
85.
86.
Elkins MR, Herbert RD, Moseley AM, Sherrington C, Maher C. Rating the quality of trials in systematic reviews of Physical Therapy interventions. Cardiopulm Phys Ther J. 2010;21(3):20–6.PubMedPubMedCentral
87.
Metadata
Title
Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis
Authors
Joanne McVeigh
Malcolm MacLachlan
Brynne Gilmore
Chiedza McClean
Arne H. Eide
Hasheem Mannan
Priscille Geiser
Antony Duttine
Gubela Mji
Eilish McAuliffe
Beth Sprunt
Mutamad Amin
Charles Normand
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2016
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-016-0182-8

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