Health and justice: Value of rehabilitation and scope of liability of rehabilitation workers

Abstract

Rehabilitation is now covering a wider perspective to include any visceral disabilities which would include chronic illnesses including mental health, not only restricted to physical injuries. Rehabilitation can now be regarded as tertiary prevention, prevention of complications and further deterioration of existing chronic condition and restoration of usual functional capacity as far as possible; and quaternary prevention, prevention of complications of medical interventions. The scope of rehabilitative services is not only in the hands of particular specialties and healthcare professionals, to allow wider accessibility and affordability in achieving equity in health. Self-management and self-care, and patient empowerment programmes now also play an important part in rehabilitation, and the providers would go beyond the main stream healthcare professionals, such as physicians, nurses, physical therapists, and medical social workers. Introducing the concept of community health practitioners with basic training in health would play a critical role in supporting self-management, self-care, and empowerment which would be very time-consuming and costly if only relied on the main stream healthcare professionals. Revisitation of the concept of duty of care and definition of reasonable standard of care is warranted for the community health practitioners, so they have better understanding their scope of liability. As rehabilitation is a long term process, it is more than the physical process of treatment. Psychosocial rehabilitation is very much needed to support the patients and care-givers to manage the chronic conditions in community setting. This paper will discuss the credentials of community health practitioners and the issue of liability involved in rehabilitation particularly in community setting. This would enable them to play a greater role to fill in the gaps of services which might not be fully covered by the main stream healthcare professionals. Chronic illnesses now pose greatest health burden globally and the value of rehabilitation should cover wider perspective of health to address the needs of care in community. Universal health coverage should include community-based rehabilitation to focus on addressing the psychosocial perception and self-efficacy in chronic disease management in achieving justice and equity in health.