Reply To: Topic Discussion 1: Improving health system

[Yin Moe Khaing]

I would like to consider that an example of a health system improvement could be the integration of rehabilitation services into the primary health care (PHC) system at township and community levels.
Rather than delivering rehabilitation only through NGO or hospital clinics, rehabilitation—including physiotherapy, basic functional assessments, early intervention, caregiver education, and provision of simple assistive devices—would be embedded into routine primary health care services. This means training primary health care workers and community volunteers to deliver basic rehabilitation support, detect developmental delays early, and refer children with complex needs to higher levels of care. Integrating rehabilitation into PHC brings services closer to families, reduces travel cost and delays, and improves equitable access for children in rural or underserved areas. This approach reflects WHO’s guidance that rehabilitation should be part of universal health coverage and included at primary care level to reduce cost and improve timeliness and equity of service delivery.
However, there could be possible barriers in this process. First, there may be insufficient training programs or ongoing supervision for primary healthcare staffs. Without a strong, well-trained workforce, integration can be ineffective or inconsistent. Second, integrating rehabilitation requires funds for training, basic equipment, supervision, and assistive devices. In resource-limited settings like many parts of Myanmar, health budgets may prioritize acute care and infectious diseases, leaving rehabilitation underfunded. Third, leadership and governance, clear policies and leadership at national and local levels are needed to support integration. Moreover, health information and monitoring systems are also needed. Routine health information systems often do not capture rehabilitation data, making it difficult to monitor coverage, quality, or outcomes. Without clear indicators, planning and advocacy are weakened. Last but not least, stigma and lack of awareness about disability can limit caregiver engagement with rehabilitation services.
Reference: https://www.who.int/activities/integrating-rehabilitation-into-health-systems
https://www.who.int/publications/i/item/9789241515986