Although the ICRC had undertaken some physical rehabilitation activities before 1979, setting up the Physical Rehabilitation Programme (PRP) that year marked the beginning of a major commitment in this field. Over time, the ICRC has acquired a leadership position in physical rehabilitation, mainly because of the scope of its activities worldwide, the development of its in-house technology, its acknowledged expertise and its long-term commitment to assisted projects.
In addition to its operational Physical Rehabilitation Programme, the ICRC also supports the field of physical rehabilitation through its Special Fund for the Disabled (SFD). Created in 1983, the Special Fund's mission is to support physical rehabilitation in low-income countries, with priority for projects formerly run by the ICRC. For more information on the SFD see www.icrc.org/fund-disabled
ICRC physical rehabilitation projects are planned and implemented in such a way as to strengthen the physical rehabilitation services offered in the country concerned, the primary aims being to improve the accessibility of services for the physically disabled, upgrade the quality of those services, and ensure their long-term availability.
Improving accessibility to services
For the ICRC, improving accessibility to services means:
• that the services exist, and that potential service users know they exist and how to access them
• that users have equal access to services, without any type of discrimination, and that the services provided are affordable, without compromising on quality
• that the services are physically accessible to users, that they are provided as close as possible to where users live, and that users have access to other services within the rehabilitation chain
In order to achieve these aims, the ICRC has taken a twin-track approach: support is given to both the national system and to users of its services. Support to the national system aims to ensure that the system has the means to provide services. This support may include construction/renovation of facilities, donation of machines, tools, other equipment, raw materials and components, developing local human resources and supporting the development of a national strategy for physical rehabilitation. Support to users is intended to ensure that they have access to the services. This includes covering travel, accommodation and food expenses as well as the cost of treatment at the centres.
Since 1979, the PRP’s activities have diversified and expanded throughout the world, from two projects in two countries in 1979 to a total of 83 projects in 25 countries and I territory in 2010. In most countries where the ICRC has provided physical rehabilitation support, such services were previously either minimal or non-existent. In most cases, ICRC support has served as a basis for establishing a national rehabilitation service that cares for those in need.
Between 1979 and 2009, the Physical Rehabilitation Programme supported 128 projects in 41 countries and one territory. Since 1979, hundreds of thousands of people have benefited from services such as the provision of prostheses, orthoses, wheelchairs and walking aids, physiotherapy, and follow-up (repairs and maintenance of devices).
Improving quality of services
The ICRC promotes improvement of quality of services through training of national professionals and expatriate specialists, support provided by expatriate specialists, improvements in ICRC-developed polypropylene technology, the drafting and implementation of treatment guidelines, promoting a multidisciplinary patient-management approach, and emphasizing quality rather than quantity of services provided.
Initially, the ICRC used materials and machinery from western suppliers to produce prosthetic and orthotic products and components. It subsequently developed its own polypropylene-based alternative technology to help reduce costs – widely adopted since by other organizations involved in physical rehabilitation. The ICRC was awarded the Brian Blatchford Prize by the International Society of Prosthetics Orthotics (ISPO) in 2004 in recognition of its role in making rehabilitative appliances more widely available.
Since the quality of services depends largely on the availability of trained professionals, the training component within ICRC-assisted projects has gained in importance over the years. In addition, the presence of trained professionals increases the chances of rehabilitation facilities continuing to function in the long term. In 2003, an in-house training package for orthotic/prosthetic technicians (Certificate of Professional Competency – CPC) was developed by the ICRC and recognized by the ISPO. Since 1979 the ICRC has run formal prosthetic and orthotic (P&O) programmes leading to a diploma in more than 12 countries, as well as formal training in physiotherapy in one country. It has also provided scholarships enabling a number of candidates to be trained at recognized schools in P&O or physiotherapy.
Besides developing technologies and training professionals, the ICRC uses its specialists to promote quality services. It has by far the largest international pool of experts among the international organizations working in the same field. Over time, the average number of expatriates per project has dropped from seven (in 1979) to 0.7 in 2009, mainly because of greater experience on the part of the ICRC and the growing number of locally trained professionals working in assisted centres.
Promoting long-term availability of services
The ICRC endeavors to ensure services over the long term not only by supporting training but also by implementing projects in close cooperation with local partners, continuing to develop management tools, supporting the work of bodies coordinating local rehabilitation, and promoting development of national policies for the provision of physical rehabilitation services.
ICRC projects are designed and implemented to strengthen the overall physical rehabilitation services in a given country. For that reason, it supports local partners (governments, NGOs, etc.) in providing these services. However, in certain circumstances the ICRC may substitute entirely for the authorities
In order to improve the chances of services continuing to function after it has withdrawn, the ICRC uses a long-term approach when setting up and managing its projects.
Implementing projects with local partners is the cornerstone of this strategy. Of the 82 projects assisted by the ICRC in 2009, 48 had been undertaken in conjunction with governments (ministries of health or of social affairs), 15 with local NGOs, three with private entities, and six with National Societies. Ten other projects were implemented directly by the ICRC.
While the top priorities are to maintain high quality and increase accessibility, the ICRC is always attentive to fostering its partners’ management capacity from the outset. It does this by training and mentoring, by improving facilities, and by promoting an effective physical rehabilitation policy within the government. Since 1979, the ICRC has developed several tools (e.g. stock management, patient management, treatment protocols,) to support managers of assisted centres. These management tools have also been distributed to other organizations working in the same realm.
Even when the ICRC has completely withdrawn from a country, the organization’s Special Fund for the Disabled can follow up. This long-term commitment to patients and facilities, unique among aid organizations, is much appreciated by the ICRC's partners in both centres and governments. It is considered one of the ICRC’s major strengths.