Toward an optimization of rehabilitation services for persons with spinal cord injury in Mongolia: the perspective of medical doctors

Abstract

Purpose

To explore medical doctors’ views on what are barriers in providing rehabilitation services for persons with SCI in Mongolia.

Methods

A qualitative study with semi-structured interviews was conducted with 12 medical doctors. Participants were purposely sampled. The World Health Organization (WHO)’s report International Perspectives on Spinal Cord Injury was chosen as a guide to structure the interviews. The study used inductive thematic analysis.

Results

Five barriers in the provision of rehabilitation services were identified: low awareness and limited knowledge regarding SCI and rehabilitation issues, inadequate rehabilitation policies, deficiencies in infrastructure, deficiencies in equipment and medication, and a shortage of well-prepared rehabilitation workforce.

Conclusions

Based on WHO recommendations “Rehabilitation in health systems”, this study provides suggestions on how to strengthen rehabilitation services in Mongolia to better respond to the needs of the SCI population. Our findings highlight that a core issue is the lack of awareness among policymakers regarding rehabilitation and its benefits at the micro, meso and macro levels of the health system. Actions are needed at the level of health policies to ensure, for instance, adequate financing and access to the services. Also, synergies between the Ministries of Education and Health can improve the training of the workforce.

Implications for rehabilitation

• Evidence that rehabilitation services contribute to improving health outcomes and cost-effectiveness could raise awareness among Mongolian policymakers and inform their decisions on funding schemes.

• Health policies in Mongolia should be reformed to remove barriers in the provision of rehabilitation services for persons with complex and chronic health conditions.

• Rehabilitation services need to be included into the Mongolian health insurance scheme in order to improve the quality and accessibility of rehabilitation services.

• Synergies between the Ministry of Education and the Ministry of Health in Mongolia are needed to develop training standards for rehabilitation professionals.

Keywords:

• Health strategy
• International Classification of Functioning, Disability and Health
• continuum of care
• service provision
• low- and middle-income countries
• Mongolian health system

Acknowledgements

The authors thank all the participants for their time and efforts made in responding to our questions. The authors also acknowledge the Rehabilitation Medicine Department of the Mongolian National University of Medical Sciences for their collaboration in recruitment. This study was supported by the Swiss Paraplegic Research as well as by the Swiss Government Excellence Scholarship for Foreign Scholars and Artists.

Disclosure statement

No potential conflict of interest was reported by the authors.