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C.A. Barth1,2
1University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland, 2Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
Background: Protracted crises lead to a degradation of population health and high rehabilitation needs. Violence-caused trauma is compounded by the breakdown and fragmentation of systems, which negatively impacts healthcare and prevention. To understand and strengthen rehabilitation in conflict, it is important to consider factors unique to extremely fragile, complex and unpredictable circumstances. This abstract presents the “Rehabilitation in Conflict (RiC)” framework as a guide for improving the response to rehabilitation needs in protracted crises.
Purpose: The purpose was to develop and present a conceptual framework to
- understand all the components that impact rehabilitation services in fragile conflict settings and how they interact,
- develop approaches to strengthen rehabilitation in these settings.
Methods: Methods included a literature review that included publications on rehabilitation and conflict research, systems thinking, and existing conceptual frameworks (ICF, health systems building blocks, intersectionality, etc.) informed by lived experience in clinical work, management, and conflict research.
Results: The RiC framework consists of four interacting components: Context, Systems, Population, and Services.
"Context" affects all other components, defines the population, the services provided for these populations, and the systems. It is the environment within a protracted crisis where rehabilitation is needed. Contexts are complex and diverse in terms of geopolitical instability, socioeconomic capabilities, environmental challenges and, accordingly, different implications, recommendations and conclusions apply, both between and within countries.
"Systems" define the services provided and the populations served. They include the health, social, education and economic systems of a context, the diversity of the informal and private sectors, and the international organisations present in these contexts, interacting with local systems in various ways.
"Services" and "population" influence each other and both can affect systems.
“Population” describes persons in need of rehabilitation services, their demographic and clinical profiles, and includes two groups: Those who have access and those who do not. It is assumed that the second unknown group, which is a research gap, is particularly vulnerable.
“Services” represents the rehabilitation infrastructure, workforce and services within the continuum of care. It describes how rehabilitation services are delivered in conflict and is closely linked to health systems at the meta-level.
"Context" affects all other components, defines the population, the services provided for these populations, and the systems. It is the environment within a protracted crisis where rehabilitation is needed. Contexts are complex and diverse in terms of geopolitical instability, socioeconomic capabilities, environmental challenges and, accordingly, different implications, recommendations and conclusions apply, both between and within countries.
"Systems" define the services provided and the populations served. They include the health, social, education and economic systems of a context, the diversity of the informal and private sectors, and the international organisations present in these contexts, interacting with local systems in various ways.
"Services" and "population" influence each other and both can affect systems.
“Population” describes persons in need of rehabilitation services, their demographic and clinical profiles, and includes two groups: Those who have access and those who do not. It is assumed that the second unknown group, which is a research gap, is particularly vulnerable.
“Services” represents the rehabilitation infrastructure, workforce and services within the continuum of care. It describes how rehabilitation services are delivered in conflict and is closely linked to health systems at the meta-level.
Conclusions: To strengthen rehabilitation in conflict, it is critical to
- act at the service level to drive change by providing quality and collecting relevant data and evidence to develop services that can be better integrated into systems,
- actively engage the population in rehabilitation concepts and research and identify the unknown group of non-participants,
- invest in integrating rehabilitation into the existing, albeit fragmented, volatile and flexible, systems of the respective context,
- understand and respect the context.
Implications: As with systems thinking, the RiC framework is a multidimensional model in which all elements are interconnected. Every action at one point has an impact on others. This goes in two directions: While components can negatively impact each other, constructive actions at different levels also create feedback effects and positively influence each other. The RiC framework can help effectively understand and strengthen rehabilitation under extreme conditions and work toward the sustainable development goal of "health for all."
Funding acknowledgements: not applicable
Keywords:
Conflict
Conceptual framework
Rehabilitation strengthening
Conflict
Conceptual framework
Rehabilitation strengthening
Topics:
Disaster management
Professional issues: business skills, leadership, advocacy & change management
Service delivery/emerging roles
Disaster management
Professional issues: business skills, leadership, advocacy & change management
Service delivery/emerging roles
Did this work require ethics approval? No
Reason: This abstract presents a theoretical framework and does not require ethical approval
All authors, affiliations and abstracts have been published as submitted.
