3) Global Needs and Opportunities for Rehabilitation
Chair： Mr. T. Durston
The workshop made the following recommendations ：
1. Estimating the global need for rehabilitation
1.1 A conceptual framework needs to be adopted by those involved in rehabilitation in the field of leprosy. The workshop recommends that the WHO International Classification of Impairments, Activiities (Disabilities) and Participation (Handicaps) , draft 2 (ISIDH-2) should be adopted for this purpose. This would facilitate communication and building alliances with those working in other areas of rehabilitation.
1.2 To assess the needs at the different levels of impairment, activity and participation, and to monitor and evaluate interventions at these levels, additional tools and indicators are needed. The workshop recommends that as far as possible existing tools should be used or adapted for use with leprosy-affected people. Examples： for impairment grading the WHO grading system, for ADL the questionnaire from the WHO disability training manual and for participation/handicap the grading developed by Dr P K Gopal or the assessment developed by Sr. Senkenesh in Ethiopia.
1.3 The Workshop recommends that a workshop should be convened in the near future to look at what tools are currently available (see 1.2) , how they could be used or adapted for use in leprosy, and to make recommendations for their use. This should be done in coordination with the GLRA-organized workshop on socio-economic rehabilitation in May 1999.
1.4 The workshop recommends that a special study should be done in selected areas to devise a more accurate method to estimate the global needs in relation to rehabilitation.
1.5 The workshop recommends that a cohort-based system of assessment and reporting of impairment status of people registered in leprosy programmes should be urgently introduced. This should be included in the appropriate reporting formats of the WHO and ILEP. The aims are quality assessment of programmes and collection of data for advocacy purposes.
1.6 It should be recognised that people with impairments (even deformities) are not necessarily in need of rehabilitation. Rehabilitation should address problems in activities of daily living and social participation. People who do not experience problems in these areas may happily live with their impairments. However, many would still need to continue to prevent their impairments from getting worse. They need to learn how to do this and may be in need of certain protective devices.
1.7 Needs assessment should incorporate or be targeted at providing solutions. Interventions should follow such assessments. This is also the WHO approach to CBR. Community workers are trained in problem solving rather than in standard techniques for particular disabilities. Needs assessment should therefore not be done in a vaccum, but should take into account the resources (potentially) available for rehabilitation interventions in a given area.
