康复体育政策架构、优先领域及其核心内容:基于WHO康复政策内容分析

Framework,core contents and priority of rehabilitation of physical activity and exercise in health service:a content analysis of WHO rehabilitation policies

目的运用世界卫生组织(WHO)健康服务6大构成要素理论,对康复体育的政策架构、核心内容以及优先领域进行内容分析,从宏观、中观和微观3个层次,探讨康复体育的政策架构、行动战略以及实施方法。方法依据WHO发布的《健康服务体系中的康复》和《健康服务体系中的康复:行动指南》,结合其配套使用工具等政策文件,运用内容分析方法,探讨康复体育服务体系的政策架构以及行动战略、核心内容与优先发展领域。结果康复体育是现代康复的组成部分,依据《国际功能、残疾与健康分类》的功能、残疾和健康理论,秉持以人为本的理念,采取措施满足残疾人康复体育服务需求,整合于健康服务连续体之中,促进实现全民健康覆盖的可持续发展目标。康复体育服务发展涉及领导力和治理、筹资、人力资源、服务提供、设备/技术/设施和监测评估与信息系统6大领域。在康复体育法规、政策与治理领域,国家为发展康复体育制定法律法规、政策文件、行动指南等,提升政府领导力与治理;拓宽康复体育筹资渠道并优化经费分配方案;完善康复体育人才培养体系,将康复体育专业人员匹配到三级卫生健康服务机构中,确保有康复体育需求的功能障碍者能够在不同层级的健康体系中获得高质量的康复体育服务;提高辅助技术和产品的利用率和可及性;建立服务的监测评估机制和大数据的康复体育健康信息系统,为基于循证的相关科学研究提供理论基础与数据支撑。结论康复体育是以体育活动为基本手段,针对功能障碍者的身体功能和结构、活动和参与以及环境因素和个人因素,开展的一系列健康相关措施,康复体育运用了各种以身体活动为主的健康相关的干预手段和方法,并且结合辅助技术的应用和无障碍环境的建设,康复体育的干预涉及预防、治疗、康复和健康促进4大类康复手段,最终目标为促进功能障碍者功能最大化,提高生活质量和福祉。发展康复体育服务需要从6个健康服务构成要素入手,即领导力与治理能力、筹资、人力资源、服务提供、设备/技术/设施和监测评估与信息系统。从宏观的政策与治理架构、中观的行动战略与实施以及微观的实施方法和监测评估3个层面构建了康复体育的政策架构、优先领域及其核心内容。康复体育发展的优先领域及其核心内容主要涉及:强化康复体育服务的领导力与治理、规划和协调能力;构建适宜的康复体育筹资机制;发展康复体育人力资源;提升康复体育服务覆盖率、可及性、有效性以及服务质量;开发康复体育辅助技术和产品;建立康复体育监测评估与信息系统,开展相关的研究。

Objective To conduct a content analysis of the policy framework,core contents and priority areas of rehabilitation of physical activity and exercise in health service(RPAEHS)using World Health Organization(WHO)theory of six building blocks of health service,and to explore the policy framework,action strategies and implementation methods of RPAEHS at macro,meso and micro levels.Methods Based on WHO Rehabilitation in Health Systems and Rehabilitation in Health Systems:A Guide to Action,together with their accompanying use tools and other policy documents,a content analysis approach was applied to explore the policy framework as well as action strategies,core contents and priority development areas of RPAEHS.Results RPAEHS is an integral part of modern rehabilitation,based on the International Classification of Functioning,Disability and Health(ICF)theory of functioning,disability,and health,and the concept of person-centeredness,with measures to meet the needs of RPAEHS,integrated into the health service continuum,and contributing to the sustainable development goal of universal health coverage.The development of RPAEHS involves six major areas:leadership and governance,financing,human resources,service delivery,rehabilitation sports equipment/technology/facilities,and RPAEHS monitoring and evaluation,and information systems.In the area of RPAEHS regulations,policies and governance,the state formulate laws and regulations,policy documents,and action guidelines for the development of RPAEHS to enhance government leadership and governance;broaden the funding channels for RPAEHS and optimize the funding allocation programs;improve the RPAEHS personnel training system,match RPAEHS professionals to the three levels of health and health services,and ensure that people with functioning who have RPAEHS needs can access the different levels of the health system;improve the utilization and accessibility of assistive technologies and products;and establish a monitoring and evaluation mechanism for services and health information system with big data to provide a scientific research base and data support for evidence-based related research.Conclusion RPAEHS is a series of health-related measures that use physical activity and exercise as the fundamental means to address the physical function and structure,activity and participation,and environmental and personal factors of people with functioning.RPAEHS interventions involve prevention,treatment,rehabilitation and health promotion,with the ultimate goal of promoting maximum functioning,quality of life,and well-being for people with functioning.The development of RPAEHS needs to approach from six health service components:leadership and governance,financing,human resources,service delivery,equipment/technology/facilities,and health monitoring evaluation and information systems.The policy framework,priority areas,and their core components for rehabilitation sport are constructed at three levels:macro-level policy and governance framework,meso-level action strategies and implementation,and micro-level implementation practices and monitoring and evaluation.The priority areas of RPAEHS and their core contents are mainly involved in the fields:strengthening the leadership and governance,planning and coordination capacity of RPAEHS;constructing an appropriate RPAEHS funding mechanism;developing RPAEHS human resources;improving the coverage,accessibility,effectiveness and service quality of RPAEHS;developing RPAEHS assistive technologies and products;establishing RPAEHS monitoring and evaluation and information systems,and conducting related research.