《中国康复理论与实践》

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (9): 996-1005.doi: 10.3969/j.issn.1006-9771.2021.09.002

• 专稿 • 上一篇    下一篇

国际康复政策架构与核心内容研究：基于世界卫生组织康复政策文件的内容分析

汤修齐1,2,3,4,邱服冰1,2,3(),邱卓英2,3,5(),吕军6,周晓英7,邱芬4,刘静4,李安巧2,3,陈迪2,5,张爱民5   

  1. 1.深圳大学体育部体育与健康科学研究中心,广东深圳市 518060
    2.世界卫生组织国际分类家族合作中心,北京市 100068
    3.中国ICF研究院,山东潍坊市 261000
    4.武汉理工大学体育部体育科学研究所,湖北武汉市 430070
    5.中国康复研究中心/中国康复科学所,北京市 100068
    6.复旦大学公共卫生学院,上海市 200032
    7.中国人民大学信息资源管理学院,北京市 100872
  • 收稿日期:2021-08-31 修回日期:2021-09-13 出版日期:2021-09-25 发布日期:2021-10-09
  • 通讯作者: 邱服冰,邱卓英 E-mail:13902932056@163.com;qiutiger@hotmail.com
  • 作者简介:汤修齐(1999-),女,汉族,湖南岳阳市人,硕士研究生,主要研究方向：健康与康复政策、身体活动与健康,ICF。|邱卓英(1962-),男,汉族,湖北武汉市人,博士,研究员、教授,世卫组织国际分类家族合作中心联合主任,世卫组织《健康服务体系中的康复》指南制定专家委员会委员,主要研究方向：WHO-FICs、ICF、健康与康复政策、残疾研究、健康与康复科学、康复信息。
  • 基金资助:
    国家社会科学基金项目(17ZDA078);国家社会科学基金项目(20AZD132);中央财政支持地方高校专项体育部学科建设项目(0000290701)

Theoretical Framework and Key Elements of International Rehabilitation Policy: Contents Analysis of WHO Rehabilitation Policy Documents

TANG Xiu-qi1,2,3,4,QIU Fu-bing1,2,3(),QIU Zhuo-ying2,3,5(),LÜ Jun6,ZHOU Xiao-ying7,QIU Fen4,LIU Jing4,LI An-qiao2,3,CHEN Di2,5,ZHANG Ai-min5   

  1. 1. Center of Physical Education, Sport and Health Sciences, Department of Physical Education, Shenzhen University, Shenzhen, Guangdong 518060, China
    2. WHO-FIC Collaborating Center in China, Beijing 100068, China
    3. China Academy of ICF, Weifang, Shandong 261000, China
    4. Institute for Sport Science, Department of Physical Education of Wuhan University of Technology, Wuhan, Hubei 430070, China
    5. China Rehabilitation Research Centre/China Rehabilitation Science Institute, Beijing 100068, China
    6. School of Public Health, Fudan University, Shanghai 200032, China
    7. School of Information Resources Management, Renmin University of China, Beijing 100872, China
  • Received:2021-08-31 Revised:2021-09-13 Published:2021-09-25 Online:2021-10-09
  • Contact: QIU Fu-bing,QIU Zhuo-ying E-mail:13902932056@163.com;qiutiger@hotmail.com
  • Supported by:
    National Social Science Foundation of China(17ZDA078);National Social Science Foundation of China(20AZD132);Central Finance Support Discipline Construction Project of Special Physical Education Department in Local Universities(0000290701)

RichHTML

PDF (PC)

摘要：

目的 运用世界卫生组织(WHO)健康服务构成要素的理论,从健康服务体系视域,对WHO有关康复服务的政策架构与行动战略进行系统的内容分析,探讨WHO国际康复政策的理论基础与方法、康复政策架构以及行动战略的核心内容。方法 WHO发布的康复相关政策文件包括《健康服务体系中的康复》《健康服务体系中的康复：行动指南》《康复指标清单：康复监测和评估架构配套的工具》和《康复现状系统评估配套工具(STARS)：康复信息收集模板(TRIC)》,形成国际康复政策体系。本研究运用内容分析方法,根据WHO健康服务构成的六大要素,即领导力和治理能力、筹资、健康人力资源、服务提供、医药技术、健康信息系统,详细分析国际康复政策的理论基础与方法、政策架构以及行动战略的核心内容与康复服务优先发展领域。结果 现代康复服务政策核心依据WHO有关构建以人为本的健康服务、关注健康的社会决定因素的理论,依据《国际功能、残疾与健康分类》的功能、残疾和健康理论,明确发展康复是实现联合国可持续发展目标三,确保健康的生活方式,促进各年龄段人群的福祉,即“全民健康覆盖”的重要路径。系统分析了领导力和治理能力、筹资、健康人力资源、服务提供、医药技术、健康信息系统六大领域,WHO的国际政策架构、行动战略以及发展内容与优先领域。WHO倡导制定国家康复规划,建立与完善康复治理结构并发展康复治理能力,采取多种途径为发展康复服务筹资。将康复融入现代健康服务体系,在健康服务连续体中提供不同层次的康复服务,在健康服务体系中构建康复服务体系,培训专业人员,建立服务信息网络,提升服务质量和服务覆盖率,关注重点领域和优先项目,以满足不同人群的多样化需求,实现全民健康覆盖。将辅助技术作为医药技术领域纳入康复服务体系。在健康信息系统中,收集有关功能和康复需求的信息以及康复服务结果和影响的数据,并开展基于循证的康复政策系统研究。结论 基于健康服务体系六大构成要素,从宏观、中观和微观三个层面,系统研究了国际康复政策架构。现代康复发展的理念是要实现全民健康覆盖。发展康复必须建立以人为中心的现代健康服务体系,并且关注社会决定因素。发展康复是实现联合国2030年可持续发展目标的重要举措。国际康复的政策体系围绕康复领导力和治理、康复筹资、康复人力资源、康复服务提供、康复相关医药技术以及康复与健康信息六大领域,从理论与政策、政策行动、实施工具和路径(评价指标体系和实施效果评估)三个层级,构建了康复发展的政策和行动战略以及具体的实施方法与工具的体系。实施WHO康复政策,需要采取如下行动：加强康复服务领导力、治理、规划和协调能力;构建合理的康复筹资机制,为康复筹措必要资金;健全康复人力资源培养与保障机制;提升康复人员专业能力,提升康复服务提供能力并改善服务质量;提高辅助产品和辅助技术服务的质量与可及性;建立涵盖功能、残疾和康复的健康信息系统并开展康复科学研究。

关键词: 健康服务体系, 康复, 康复政策

Abstract:

Objectives To systematically analyze the framework and contents of World Health Organization (WHO) policy and action strategies on rehabilitation using the theory of WHO health service components, to explore the theoretical bases, methodology, framework and core elements of WHO's international rehabilitation policy.Methods WHO has launched rehabilitation-related policy documents, mainly including Rehabilitation in Health Systems, Rehabilitation in Health Systems: Guide for Action, Rehabilitation Indicator Menu: a tool accompanying the Framework for Rehabilitation Monitoring and Evaluation (FRAME), Template for Rehabilitation Information Collection (TRIC): a tool accompanying the Systematic Assessment of Rehabilitation Situation (STARS), and established systems of international rehabilitation policy architecture system. Using content analysis, this study analyzed in detail the theoretical basis and methodology of international rehabilitation policy, the policy framework, and the core elements of the action strategy and priority areas of rehabilitation service development in perspective of WHO six building blocks of health system, namely leadership and governance, financing, human resources for health, service delivery, medical technology, and health information systems.Results WHO rehabilitation policy is developed based on WHO's theories of person-centered health services, social determinants of health, and functioning, disability and health of International Classification of Functioning, Disability and Health. WHO rehabilitation policy recognized that the development of rehabilitation was an important pathway achieving United Nations 2030 Sustainable Development Goals 3, ensure healthy lives and promote well-being for all at all ages, i.e. Unlversal Health Coverage. This paper systematically analyzed WHO's international policy framework, action strategies, and development areas, content and priorities in six major areas: leadership and governance, financing, human resources for health, service delivery, medicine and technology, and health information systems. WHO rehabilitation policies advocates to develop national rehabilitation plans, to establish and improve rehabilitation leaderships and the development of mechanism and capacity of rehabilitation governance, to develop multiple approaches of rehabilitation financing, to integrate rehabilitation into health service system, provides different levels of rehabilitation services in the health service continuum, and to build networks of service delivery, to train professionals, to foster rehabilitation information system within health system, to enhance service quality and service coverage, to focus on key areas and priority programs to meet the diverse needs of different populations, and achieve universal health coverage; to include assistive technology into the rehabilitation service system as a field of medicine and technology; and to collect information on functioning and rehabilitation needs, outcomes and impacts of rehabilitation services in the health information system, and conduct evidence-based researches on rehabilitation systems.Conclusion The framework and contents of WHO's international rehabilitation policies have systematically reviewed at the macro, meso, and micro levels with the perspective of WHO six building blocks of the health system. The goal of rehabilitation development is to achieve universal rehabilitation coverage. The conceptual theories of rehabilitation are based on the theories of people-centered health services and social determinants of health. Rehabilitation is an important initiative to achieve the United Nations 2030 Sustainable Development Goals. The international rehabilitation health policy system is built on six major areas of rehabilitation: leadership and governance, rehabilitation financing, rehabilitation human resources, rehabilitation service delivery, rehabilitation-related medicine and technology, and rehabilitation and health information system. The policy and action strategies for rehabilitation development, as well as specific implementation paths and methods, at macro, meso and micro levels: theory and policy, policy action, and implementation methods and tools have been reviewed and discussed. The implementation of the WHO rehabilitation policies advocates to take the following actions: strengthening the leadership, governance, planning and coordination capacity of rehabilitation services; constructing a reasonable rehabilitation financing mechanism and raising necessary funds for rehabilitation; improving the training and guarantee mechanism of rehabilitation human resources; enhancing the professional capacity of rehabilitation personnel, improving the capacity of rehabilitation service delivery and improving service quality; improving the quality and accessibility of assistive products and assistive technology services; establishing health information system covering functioning, disability and rehabilitation, and conducting scientific researches on rehabilitation.

Key words: health service system, rehabilitation, policy of rehabilitation