WHO Systematic Assessment of Rehabilitation Situation (STARS): Results of the Field Testing in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Assessment of Rehabilitation Situation Tool
2.2. Selection of Countries and Assessors
2.3. Evaluation of Completeness, Usefulness, Accessibility and Feasibility
2.4. Data Analyses
3. Results
3.1. Evaluation of Completeness, Usefulness, Accessibility and Feasibility
3.1.1. Completeness
3.1.2. Usefulness
3.1.3. Accessibility
3.1.4. Feasibility
3.1.5. Rating the Importance of the Rehabilitation Maturity Model Components
3.2. STARS Revision by WHO
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Interview Questions | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Completeness | To what extent did the tool cover all aspects that are relevant to rehabilitation? | ||||||||||
No aspects relevant to rehabilitation All aspects relevant to rehabilitation | |||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
What areas were missing? | |||||||||||
Usefulness | To what extent did the tool provide an accurate picture of rehabilitation in a country? | ||||||||||
Not accurate picture of rehabilitation Accurate picture of rehabilitation | |||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
What were the areas of inaccuracy? | |||||||||||
Accessibility | To what extent was the tool easy to implement and be completed? These questions were repeated for each of the three STARS components, the STARS Manual, Rehabilitation Capacity Questionnaire and Rehabilitation Maturity Model. | ||||||||||
Not easy to implement and complete Easy to implement and complete | |||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
Explain why the STARS Manual/Rehabilitation Capacity Questionnaire/Rehabilitation Maturity Model was not easy to implement or complete? | |||||||||||
What suggestions do you have to improve this? | |||||||||||
Feasibility | To what extent was the tool feasible to be implemented? When answering this question please consider the feasibility in terms of commonly applied parameters such as, number of days to complete, associated cost, information availability and time to retrieve it, availability of key informants in-country, and ability of WHO staff to support assessments while in-country. | ||||||||||
Not feasible at all Feasible | |||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
Explain what aspects of the tool are not feasible and what suggestions do you have to improve this? | |||||||||||
Overall comments | What worked well? What did not work well? What would you do differently? |
Country STARS Occurred within | Government Representative | National Rehabilitation Experts | Consultant | WHO Country or Regional Staff |
---|---|---|---|---|
GUYANA | 1 | - | 1 | 1 (WHO Americas) |
JORDAN | 1 | 1 | 1 | 1 (Country staff) |
MYANMAR | 1 | 1 | - | 1 (Country staff) |
SRI LANKA | 1 | - | - | 1 (Country staff) |
HAITI | - | - | 1 | 1 (WHO Americas) |
SOLOMON ISLANDS | 1 | 1 | - | 1 (WHO Western Pacific) |
LAOS | - | - | 1 | 1 (WHO Western Pacific) |
Key Informant Interview Question | Total Respondents | Score on Scale from 1 (Lowest/Negative) to 10 (Highest/Positive) Number of Respondents for Each Score | Mean | Median | Range | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |||||
1. To what extent did the tool cover elements relevant to rehabilitation? | 17 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7 | 5 | 5 | 8.88 | 9 | 8–10 |
2. To what extent did the tool provide an accurate picture of rehabilitation in the country? | 17 | 0 | 0 | 0 | 0 | 1 | 1 | 2 | 7 | 3 | 3 | 8.12 | 8 | 5–10 |
3a. To what extent was the tools STARS Manual easy to implement and be completed? | 17 | 0 | 0 | 0 | 0 | 0 | 1 | 9 | 2 | 3 | 2 | 7.76 | 7 | 6–10 |
3b. To what extent was the tools TRIC easy to implement and be completed? | 17 | 0 | 1 | 0 | 0 | 0 | 3 | 5 | 6 | 2 | 0 | 7.12 | 7 | 2–9 |
3c. To what extent was the tools RMM easy to implement and be completed? | 17 | 1 | 0 | 0 | 0 | 2 | 3 | 7 | 4 | 0 | 0 | 6.47 | 7 | 1–8 |
4. To what extent was the tool feasible to be implemented? | 17 | 0 | 0 | 1 | 0 | 2 | 0 | 3 | 9 | 1 | 1 | 7.35 | 8 | 3–10 |
Component of the Rehabilitation Maturity Model | Total Respondents | Score across 4 Levels of Importance % of Respondents for Each Level | Mean | Median | Range | |||
---|---|---|---|---|---|---|---|---|
Not Important (Score-1) | A Little Important (Score-2) | Somewhat Important (Score-3) | Very Important (Score-4) | |||||
GOVERNANCE | ||||||||
1. Rehabilitation has legislation, policies and plans | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
2. There is high level coordination for rehabilitation | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
3. There is planning to expand the service delivery of rehabilitation | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
4. The capacity and levers for rehabilitation plan implementation are in place | 16 | 0% | 0% | 50% | 50% | 3.50 | 3.5 | 3–4 |
5. There is high level accountability and reporting for rehabilitation | 16 | 0% | 0% | 25% | 75% | 3.75 | 4 | 3–4 |
6. There is transparency for rehabilitation | 16 | 0% | 12.5% | 50% | 37.5% | 3.25 | 3 | 2–4 |
7. Rehabilitation is regulated | 16 | 0% | 12% | 44% | 44% | 3.31 | 3 | 2–4 |
8. There is leadership, collaboration and coalition building for rehabilitation | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
9. Assistive Technology has legislation, policies and plans | 16 | 6% | 0% | 31% | 63% | 3.50 | 4 | 1–4 |
10. Assistive Technology has effective AT procurement | 16 | 0% | 6% | 31% | 63% | 3.56 | 4 | 2–4 |
INFORMATION | ||||||||
11. Information is generated about rehabilitation needs, including population functioning and disability | 16 | 0% | 6% | 44% | 50% | 3.44 | 3.5 | 2–4 |
12. Information is generated about the availability and utilization of rehabilitation services | 16 | 0% | 0% | 6% | 94% | 3.94 | 4 | 3–4 |
13. Information is generated about outcomes, quality and efficiency of rehabilitation services | 16 | 0% | 0% | 37.5% | 62.5% | 3.63 | 4 | 3–4 |
14. Information is used to inform policy and programme decision making | 16 | 0% | 0% | 25% | 75% | 3.75 | 4 | 3–4 |
FINANCING | ||||||||
15. The financing for rehabilitation covers all the population | 16 | 0% | 0% | 19% | 81% | 3.81 | 4 | 3–4 |
16. The financing for rehabilitation covers a wide range of prioritized services | 16 | 0% | 0% | 19% | 81% | 3.81 | 4 | 3–4 |
17. The financing for rehabilitation prevents financial hardship | 16 | 0% | 6% | 25% | 69% | 3.63 | 4 | 2–4 |
WORKFORCE | ||||||||
18. There is adequate workforce available, it is sustainable and aligned to the market needs | 16 | 0% | 0% | 12.5% | 87.5 | 3.88 | 4 | 3–4 |
19. The workforce is trained with appropriate skills to match tasks and meet need | 16 | 0% | 0% | 6% | 94% | 3.94 | 4 | 3–4 |
20. The rehabilitation workforce is well managed and planned | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
21. The rehabilitation workforce is motivated and supported | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
SERVICE ACCESSIBILITY—AVAILABILITY/AFFORDABILITY/ACCEPTABILITY | ||||||||
22. Rehabilitation is available across tertiary levels of health care | 16 | 0% | 0% | 6% | 94% | 3.94 | 4 | 3–4 |
23. Rehabilitation is available across secondary levels of health care | 16 | 0% | 0% | 6% | 94% | 3.94 | 4 | 3–4 |
24. Rehabilitation is available in primary healthcare | 16 | 0% | 6% | 19% | 75% | 3.69 | 4 | 2–4 |
25. Rehabilitation is delivered in community settings | 16 | 0% | 6% | 13% | 81% | 3.75 | 4 | 2–4 |
26. Rehabilitation is available across the acute phases of care | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
27. Rehabilitation is available across the sub-acute phases of care | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
28. Rehabilitation is available across the long-term phases of care | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
29. Assistive Products are available | 16 | 0% | 0% | 6% | 94% | 3.94 | 4 | 3–4 |
30. Assistive Product follow-up and maintenance is available | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
31. Rehabilitation is available for adults with complex rehabilitation needs | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
32. There is early identification and referral to rehabilitation for children with developmental delays and disabilities | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
33. There is rehabilitation available in hospital and clinical settings for children with developmental delays and disabilities | 16 | 0% | 0% | 50% | 50% | 3.50 | 3.5 | 3–4 |
34. There is rehabilitation available in community settings during early childhood for children with developmental delays and disabilities | 16 | 0% | 6% | 50% | 44% | 3.38 | 3 | 2–4 |
35. There is rehabilitation available in community settings during school age for children with developmental delays and disabilities | 16 | 0% | 19% | 56% | 25% | 3.06 | 3 | 2–4 |
36. Rehabilitation is available for target populations in need | 16 | 0% | 13% | 81% | 6% | 2.94 | 3 | 2–4 |
37. Rehabilitation infrastructure, equipment and medicines are available | 16 | 0% | 0% | 12.5% | 87.5% | 3.88 | 4 | 3–4 |
SERVICE QUALITY | ||||||||
38. Rehabilitation is effective, it utilizes evidence-based interventions | 16 | 0% | 6% | 19% | 75% | 3.69 | 4 | 2–4 |
39. Rehabilitation is effective, it utilizes effective and efficient dosages of rehabilitation interventions | 16 | 0% | 12.5% | 25% | 62.5% | 3.50 | 4 | 2–4 |
40. Rehabilitation is effective, it is timely and delivered along a continuum of care | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
41. Rehabilitation is person-centered, it empowers and engages users, family, carers | 16 | 0% | 0% | 31% | 69% | 3.69 | 4 | 3–4 |
42. Rehabilitation is convenient, and socially and culturally acceptable | 16 | 0% | 0% | 37.5% | 62.5% | 3.63 | 4 | 3–4 |
43. Rehabilitation is safe | 16 | 0% | 0% | 25% | 75% | 3.75 | 4 | 3–4 |
OUTCOMES AND ATTRIBUTES | ||||||||
44. Rehabilitation is Accessible—it is available to all who need it | 16 | 0% | 0 | 19 | 81 | 3.81 | 4 | 2–4 |
45. Rehabilitation is Accessible—it is affordable to all who need it | 16 | 0% | 0 | 19 | 81 | 3.81 | 4 | 2–4 |
46. Rehabilitation is Accessible—it is acceptable to all who need it | 16 | 0% | 6 | 38 | 56 | 3.50 | 4 | 2–4 |
47. Rehabilitation is Equitable—across spectrum of functioning in the population | 16 | 0% | 12 | 44 | 44 | 3.31 | 3 | 2–4 |
48. Rehabilitation is Equitable—across disadvantaged population groups | 16 | 0% | 6 | 19 | 75 | 3.69 | 4 | 2–4 |
49. Rehabilitation is Efficient—it has allocative efficiency | 16 | 0% | 13 | 56 | 31 | 3.19 | 3 | 2–4 |
50. Rehabilitation is Efficient—it has technical efficiency | 16 | 0% | 6 | 63 | 31 | 3.25 | 3 | 2–4 |
51. Rehabilitation is Accountable—Governing Agencies are accountable | 16 | 0% | 6 | 31 | 63 | 3.56 | 4 | 2–4 |
52. Rehabilitation is Accountable—Service Providers are accountable | 16 | 0% | 6 | 31 | 63 | 3.56 | 4 | 2–4 |
53. Rehabilitation is Accountable—Practitioners are accountable | 16 | 0% | 6 | 31 | 63 | 3.56 | 4 | 2–4 |
54. Rehabilitation is Sustainable—it has financial sustainability | 16 | 0% | 6 | 19 | 75 | 3.69 | 4 | 2–4 |
55. Rehabilitation is Sustainable—it has institutional sustainability | 16 | 0% | 6 | 19 | 75 | 3.69 | 4 | 2–4 |
56. Rehabilitation is Sustainable—it is resilient to crisis and disaster | 16 | 0% | 6 | 31 | 63 | 3.56 | 4 | 2–4 |
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Kleinitz, P.; Sabariego, C.; Cieza, A. WHO Systematic Assessment of Rehabilitation Situation (STARS): Results of the Field Testing in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana. Int. J. Environ. Res. Public Health 2021, 18, 11549. https://doi.org/10.3390/ijerph182111549
Kleinitz P, Sabariego C, Cieza A. WHO Systematic Assessment of Rehabilitation Situation (STARS): Results of the Field Testing in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana. International Journal of Environmental Research and Public Health. 2021; 18(21):11549. https://doi.org/10.3390/ijerph182111549
Chicago/Turabian StyleKleinitz, Pauline, Carla Sabariego, and Alarcos Cieza. 2021. "WHO Systematic Assessment of Rehabilitation Situation (STARS): Results of the Field Testing in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana" International Journal of Environmental Research and Public Health 18, no. 21: 11549. https://doi.org/10.3390/ijerph182111549