Wheelchair service training package for managers

Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes Manual de Referência para Participantes (Inclui o Livro de Exercícios do Participante) Manual de Referência do WSTP para Gerentes – Página 2 Editores: Sarah Frost, Chapal Khasnabis, Kylie Mines e Lourdes de la Peza. Contribuidores: Michael Allen, Johan Borg, Alberto Cairo, Lauren Flaherty, Ricardo Guzman Hefferan, Cristi Ispas, Margaret Lamiell, Henry Lumley, Colin Macfarlane, Peter Mbuguah, Matt McCambridge, Ray Mines, Stephen Muldoon, Isaac Nyathi, Alana Officer, Kiran Patwardhan, Chris Rushman, Elsje Scheffler, Adarsh Shah, Rebecca Jackson Stoeckle, Sruti Mohapatra, Katherine Selengia, Nicky Seymour, Kate Wilson e Eric Wunderlich. Ilustrador: Melissa Puust Fotografias: David Constantine, Chapal Khasnabis e Jesse Moss Vídeos: Chapal Khasnabis, Amanda McBaine e Jesse Moss Apoio financeiro: Agência dos Estados Unidos da América para o Desenvolvimento Internacional Organizações parceiras para projetos pilotos: Cheshire Services Ethiopia (CSE), International Orthodox Christian Charities (IOCC), Management Sciences for Health (MSH), Mobility India, Motivation Africa e United Cerebral Palsy Wheels for Humanity (UCP). Publicado pela Organização Mundial da Saúde em 2015 sob o título Wheelchair Service Training Package for Managers © Organização Mundial de Saúde 2015 A Organização Mundial da Saúde concedeu direitos de tradução e publicação para uma edição em português da Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID), que é o único responsável pela qualidade e fidelidade da versão em português. No caso de qualquer inconsistência entre as versões inglesa e portuguesa, a versão original em inglês deve ser a versão vinculativa e autêntica. Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes © USAID 2017 Manual de Referência do WSTP para Gerentes – Página 3 Terminologia: Os termos usados no pacote de capacitação estão definidos abaixo. Cadeira de rodas adequada Cadeira de rodas que atenda às necessidades e condições ambientais do cadeirante; tenha dimensões e suporte postural adequados, além de ser segura e durável; esteja disponível no país; e possa ser obtida e mantida, com serviços sustentáveis no país ao preço mais econômico e acessível. Cadeira de rodas manual Cadeira de rodas impulsionada pelo próprio cadeirante ou empurrada por outra pessoa. Cadeira de rodas Equipamento que oferece mobilidade sobre rodas e suporte para uma pessoa sentada, que tenha dificuldade para andar ou deslocar-se. Fornecimento de cadeiras de rodas Termo geral que abrange o projeto, a produção e o fornecimento de cadeiras de rodas, assim como o fornecimento de serviços. Serviço de cadeiras de rodas O aspecto do fornecimento de cadeiras de rodas que assegura o fornecimento de uma cadeira de rodas adequada a cada cadeirante. Equipe de serviços de cadeiras Pessoas capacitadas no fornecimento de de rodas uma cadeira de rodas adequada. Cadeirante Pessoa com dificuldade para andar ou locomover-se e que utilize uma cadeira de rodas para mobilidade. Manual de Referência do WSTP para Gerentes – Página 4 Sumário: Manual de Referência do WSTP para Gerentes – Página 5 Sobre o Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes Introdução Após a publicação das Diretrizes para o Fornecimento de Cadeiras de Rodas Manuais em Áreas com Menos Recursos em 2008i, do Pacote de Capacitação para Serviços de Cadeiras de Rodas – Nível Básico (WSTPb) em 2012ii e do Pacote de Capacitação para Serviços de Cadeiras de Rodas – Nível Intermediário (WSTPi) em 2013iii, a Organização Mundial da Saúde (OMS), em parceria com a Agência dos Estados Unidos da América para o Desenvolvimento Internacional (USAID), elaborou este Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes (WSTPm). Esta é a terceira parte do Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas (WSTP), que se concentra mais nos sistemas e procedimentos necessários para que gerentes possam prestar um apoio eficaz ao fornecimento de serviços de cadeiras de rodas adequadas. A cadeira de rodas é um dos dispositivos assistivos mais comuns para viabilizar a mobilidade pessoal. Para pessoas com dificuldade para andar ou locomover-se, a cadeira de rodas é uma ferramenta essencial para a sua mobilidade, emancipação, dignidade e bem-estar geral. A mobilidade abre oportunidades para que os cadeirantes sejam independentes e tenham acesso a saúde, educação, trabalho e emprego, ajudando-os a participar de atividades sociais e culturais. Contudo, a OMS estima que mais de 70 milhões de pessoas precisam de cadeira de rodas e apenas 5% a 15% têm acesso a uma. A importância da mobilidade está refletida na Convenção sobre os Direitos das Pessoas com Deficiência (CDPD)iv, que defende "medidas eficazes para assegurar a mobilidade pessoal das pessoas com deficiência, com a maior independência possível". Para assegurar a sua efetiva mobilidade pessoal, os cadeirantes precisam de uma cadeira de rodas, que esteja corretamente adaptadas ao seu corpo e que atenda às suas necessidades específicas, sobretudo ambientais e de estilo de vida. Isso requer uma abordagem sensível às necessidades individuais. Uma forma eficaz de atender às necessidades individuais dos cadeirantes é com o fornecimento de cadeiras de rodas por meio de um sistema bem organizado de fornecimento de serviços de cadeiras de rodas, que atente às expectativas dos cadeirantes, respeite a sua dignidade e seja prestado por pessoal capacitado. Além disso, são limitadas as oportunidades de capacitação de pessoal para que obtenham os conhecimentos e as capacidades necessárias para fornecer cadeiras de rodas com eficácia. Objetivo O objetivo geral do pacote de capacitação é sensibilizar e desenvolver as capacidades e os conhecimentos de todo o pessoal envolvido no fornecimento de serviços de cadeiras de rodas. A OMS compreende que pessoal capacitado por si só não é suficiente para assegurar o fornecimento de cadeiras de rodas adequadas no país ou cumprir com as responsabilidades descritas nas Diretrizes para Cadeiras de Rodas, a menos que e até que haja um envolvimento de alto nível para estabelecer ou melhorar o fornecimento de cadeiras de rodas no país. Este Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes apresenta uma visão geral da função do gerente de serviço de reabilitação/cadeiras de rodas em engajar pessoas e liderar a implementação das oito etapas de serviço de cadeiras de rodas e das respectivas questões. Entre elas destacam-se os recursos humanos e físicos necessários para fornecer um serviço de cadeiras de rodas, inclusive planejamento, organização, provimento de pessoal, direção, custeio/financiamento, monitoramento e avaliação. Manual de Referência do WSTP para Gerentes – Página 6 O pacote de capacitação pode ser apresentado em 13 ou 14 horas, e esse período pode ser prolongado ou reduzido de acordo com as necessidades específicas e os recursos disponíveis. A apresentação deste pacote de capacitação ajudará os gerentes a: 1. Planejar melhor o fornecimento de serviços de cadeiras de rodas; 2. Aumentar a qualidade do fornecimento de serviços de cadeiras de rodas; 3. Melhorar a retenção de pessoal; 4. Aumentar a quantidade de cadeirantes que recebem cadeiras de rodas que atendem às suas necessidades; e 5. Aumentar a sustentabilidade do fornecimento de serviços de cadeiras de rodas. Público alvo Este pacote de capacitação destina-se a todo o pessoal responsável pela implementação, gestão e avaliação de serviços de reabilitação, inclusive serviços de cadeiras de rodas ou o fornecimento de serviços de cadeiras de rodas. Não é obrigatório ter experiência anterior em gestão de serviços de cadeiras de rodas; contudo, a oficina foi concebida pressupondo-se que os participantes já tenham capacidades gerais de gestão. Abrangência O pacote de capacitação inclui: • Uma visão geral das principais etapas de serviço de cadeiras de rodas descritas nos pacotes de capacitação da OMS para serviços de cadeiras de rodas; • Conhecimentos básicos necessários para o fornecimento de serviços de cadeiras de rodas; • Criação de um serviço de cadeiras de rodas; • Administração de um serviço de cadeiras de rodas; e • Como dar sustentabilidade ao fornecimento de serviços de cadeiras de rodas. Como utilizar o Manual de Referência Este Manual de Referência contém um sumário dos conhecimentos apresentados no Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes. Os participantes podem utilizar o Manual de Referência após o programa de capacitação para relembrar-se dos pontos principais ensinados em cada sessão da capacitação. O manual é dividido em três seções: A: Conhecimentos básicos; B: Criação de um serviço de cadeiras de rodas; e C: Administração de um serviço de cadeiras de rodas. O Manual de Referência também vem com o Livro de Exercícios do Participante. O objetivo do Livro de Exercícios do Participante é desenvolver as capacidades e os conhecimentos do pessoal envolvido no fornecimento de serviços de cadeiras de rodas. O Livro de Exercícios do Participante contém exercícios que ajudam a testar e desenvolver os conhecimentos e as capacidades dos participantes. O Livro de Exercícios do Participante contém material de aulas, apresentações e o Manual de Referência. O objetivo é que os participantes guardem as suas cópias do Manual de Referência juntamente com o livro de exercícios para referência futura, caso necessário. Manual de Referência do WSTP para Gerentes – Página 7 A. Conhecimentos básicos Manual de Referência do WSTP para Gerentes – Página 8 A.1 O que é o fornecimento de cadeiras de rodas adequadas? Fornecimento de cadeiras de rodas é um termo geral referente à concepção, produção, suprimento e fornecimento de serviços de cadeiras de rodas. As cadeiras de rodas são alguns dos dispositivos assistivos mais comuns, oferecendo mobilidade sobre rodas para pessoas com deficiência de mobilidade. A mobilidade é um passo importante no caminho para a inclusão. Quando uma pessoa recebe uma cadeira de rodas adequada por meio de um serviço, abrem-se oportunidades de vida social, trabalho e educação. Além disso, os familiares ficam liberados para participar na comunidade e no emprego.v Não são apenas os indivíduos e as suas famílias que se beneficiam com a maior mobilidade. A economia local e mais ampla é beneficiada com a maior quantidade de membros contribuintes da sociedade. Além disso, as pessoas que têm uma cadeira de rodas adequada apresentam menor tendência de sofrer complicações secundárias de saúde (como, por exemplo, úlceras por pressão) e, portanto, menor tendência de precisar de serviços de saúde. Há uma necessidade urgente de mudanças para podermos ver mais pessoas com acesso ao fornecimento de cadeiras de rodas adequadas. Quantas pessoas precisam de cadeiras de rodas? A OMS estima que 1% de qualquer população precisa de cadeiras de rodas. Isso significa que, em termos globais, estima-se que 70 milhões de pessoas ou mais precisam de uma cadeira de rodas. Essa estatística pode servir como ponto de início para estimar quantas pessoas precisam de uma cadeira de rodas em cada país, distrito ou cidade. Isso significa que gerentes não necessitam esperar por levantamentos detalhados para começar a planejar o fornecimento de serviços de cadeiras de rodas. População 1% Quantidade aproximada de pessoas que precisam de uma cadeira de rodas População mundial 7.000.000.000 1% 70.000.000 Brasil 203.657.000 1% 2.036.570 China 1.401.587.000 1% 14.015.870 Egito 84.706.000 1% 84.760 Índia 1.282.390.000 1% 12.823.900 Nigéria 183.523.000 1% 1.835.230 Rússia 142.098.000 1% 1.420.980 Convenções, estratégias e políticas em apoio ao fornecimento de cadeiras de rodas Muitas pessoas que precisam de cadeiras de rodas ainda não têm uma cadeira de rodas adequada. É necessário empreender uma campanha vigorosa para aumentar o acesso a cadeiras de rodas adequadas. Os gerentes podem utilizar políticas globais, regionais e nacionais para ajudar a defender os direitos à mobilidade das pessoas com deficiência de mobilidade. O quadro abaixo mostra exemplos de convenções, estratégias, políticas e diretrizes que podem ser ferramentas para os gerentes na defesa desses direitos. Política internacional Exemplo regional: a Estratégia de Incheon Políticas e diretrizes nacionais O instrumento de política de mais alto nível é a Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (CDPD). O Artigo 20 da CDPD diz que todas as pessoas têm direito à mobilidade pessoal. Outros artigos da CDPD reforçam a importância e relevância do fornecimento de cadeiras de rodas adequadas. Entre estes: A: 26 – Reabilitação A: 19 – Vida independente e inclusão na comunidade A: 24 – Educação A: 25 – Saúde A: 27 – Trabalho e emprego A: 30 – Participação em atividades culturais, recreativas, esportivas e de lazer. Em 2012, foi adotada a Estratégia de Incheon para "concretizar o direito para pessoas com deficiência na Ásia e no Pacífico. A Estratégia de Incheon tem 10 objetivos. O objetivo número três é o de melhorar o acesso ao ambiente físico, transportes públicos, conhecimentos, informações e comunicação. Durante a elaboração da estratégia, foi apresentado um forte argumento de que esse objetivo não poderia ser alcançado sem acesso a dispositivos assistivos adequados, inclusive cadeiras de rodas. Portanto, o Objetivo 3 inclui uma meta para pela metade a proporção de pessoas com deficiência que precisam, mas não têm dispositivos assistivos ou produtos adequados. Os governos que assinaram a Estratégia de Incheon agora estão empenhados em elaborar planos nacionais para cumprir essa obrigação. O exemplo da Estratégia de Incheon mostra como as políticas internacionais e regionais podem apoiar e incentivar a elaboração de uma política nacional. Planos, políticas e diretrizes nacionais podem ajudar a aumentar a eficácia e sustentabilidade do fornecimento de cadeiras de rodas.vi A elaboração de políticas e diretrizes nacionais requer colaboração entre todas as partes interessadas, inclusive pessoas com deficiência e fornecedores de serviços governamentais e não governamentais. A CDPD e as estratégias regionais pertinentes podem dar apoio à elaboração de planos, políticas e diretrizes nacionais. As diretrizes nacionais podem ajudar a definir como os dispositivos assistivos, inclusive os dispositivos de mobilidade, devem ser fornecidos. Por exemplo, a África do Sul publicou as suas Diretrizes Nacionais para o Fornecimento de Dispositivos Assistivos em 2003, estabelecendo padrões mínimos para as etapas de serviço, a capacitação de pessoal, a criação e gestão de listas de espera, orçamentos e o fornecimento de serviços de reparo e manutenção. A.2 Fornecimento de serviços Os serviços de cadeiras de rodas desempenham uma função importante no fornecimento de cadeiras de rodas. Os serviços de cadeiras de rodas trabalham com os cadeirantes para identificar a cadeira de rodas mais adequada (dentre as disponíveis) para o utilizador. Serviços de cadeiras de rodas de nível básico e intermediário Toda cadeira de rodas bem adaptada ao corpo do cadeirante oferece suporte postural. Encosto, almofada, apoios para os pés e os braços oferecem suporte postural quando ajustados ao tamanho do cadeirante. Contudo, muitas crianças e adultos precisam de suporte postural adicional nas suas cadeiras de rodas. Isso significa que é necessário oferecer diferentes níveis de serviço. Um serviço de cadeiras de rodas de nível básico trabalha com cadeirantes com capacidade de sentar-se eretos sem suporte postural adicional. Um serviço de cadeiras de rodas de nível intermediário trabalha com cadeirantes que precisam de suporte postural adicional para poderem sentar-se eretos com conforto. É importante que os gerentes de um serviço de cadeiras de rodas definam se o seu serviço é de nível "básico" ou "intermediário", pois o serviço intermediário requer pessoal com um nível mais elevado de capacitação, uma variedade maior de cadeiras de rodas, assim como mais materiais e equipamentos. Atendimento adequado às necessidades de mobilidade e suporte postural Clara vive no Timor Leste. Ela trabalha na loja da família, que funciona na parte da frente da sua casa. Clara tem pólio e precisa de uma cadeira de rodas para locomover-se dentro de casa, trabalhar na loja e transitar pela aldeia. Ela consegue sentar-se ereta sem suporte adicional e utiliza uma cadeira de rodas manual, que foi ajustada e adaptada para o seu corpo. Clara é um exemplo de alguém que pode receber uma cadeira de rodas por meio de um serviço de nível básico. Ishade tem oito anos e vive no Sri Lanka. Ela tem paralisia cerebral. Para Ishade, isso significa que ela tem dificuldades para controlar braços, pernas, cabeça e pescoço. Ela não consegue sentar-se ereta sem suporte. Ishade precisa de suporte postural adicional na sua cadeira de rodas. Ishade é um exemplo de alguém que deve receber uma cadeira de rodas por meio de um serviço de nível intermediário. Manual de Referência do WSTP para Gerentes – Página 11 As oito etapas do fornecimento de serviços de cadeiras de rodas; Etapa Resumo 1. Encaminhamen to e consulta A forma de encaminhamento de cadeirantes varia. Os cadeirantes podem encaminhar-se a si mesmos ou ser encaminhados por meio de redes compostas de profissionais governamentais ou não governamentais de saúde e reabilitação que trabalham no nível comunitário, distrital ou regional. Alguns serviços de cadeiras de rodas podem ter de identificar ativamente os potenciais cadeirantes que ainda não recebem serviços sociais ou de saúde nem participam de atividades escolares, profissionais ou comunitárias. 2. Avaliação Cada cadeirante precisa de uma avaliação individual. Isso inclui a recolha de informações sobre o estilo de vida do cadeirante, o seu trabalho, onde vivem e as suas condições físicas. 3. Prescrição (seleção) Com base nas informações obtidas na avaliação, a prescrição de uma cadeira de rodas é definida em conjunto com o cadeirante, familiar ou atendente. A prescrição detalha a seleção de cadeira de rodas em termos de tipo, tamanho, recursos especiais e modificações. Além disso, especifica a capacitação necessária para o cadeirante utilizar e manter a cadeira de rodas corretamente. 4. Financiamento e encomenda Identifica-se uma fonte de financiamento e a cadeira de rodas é obtida do estoque mantido pelo serviço ou encomendada junto ao fornecedor. 5. Preparação dos produtos Funcionários capacitados preparam a cadeira de rodas para a adaptação inicial. Dependendo do produto e das instalações do serviço, esse processo pode incluir a montagem e eventual modificação de produtos fornecidos por fabricantes ou a fabricação de produtos na oficina do serviço. 6. Adaptação O cadeirante experimenta a a cadeira de rodas. São feitos ajustes finais para assegurar a montagem e configuração correta da cadeira de rodas. Quando há necessidade de componentes de suporte postural, pode ser necessário fazer adaptações adicionais. 7. Capacitação do cadeirante O cadeirante e os atendentes aprendem a utilizar e manter a cadeira de rodas com segurança e eficácia. 8. Acompanhame nto, manutenção e reparos Visitas de acompanhamento oferecem a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Modelos de fornecimento de serviços Todos os serviços de cadeiras de rodas devem seguir as oito etapas do fornecimento de serviços de cadeiras de rodas. Contudo, há formas diferentes de fornecer as oito etapas de serviço, como descrito nos modelos de fornecimento de serviços. Uma combinação de diferentes modelos pode fazer parte de um serviço nacional geral. O melhor modelo de fornecimento de serviços depende do contexto e deve ser escolhido em consulta com todas as partes interessadas. O quadro abaixo mostra alguns exemplos dos diferentes modelos de fornecimento de serviços. Serviço baseado em centro Área exclusiva para avaliação Num serviço baseado em centro, os cadeirantes deslocam-se até uma instalação permanente, onde há funcionários capacitados para fornecer serviços. Sendo uma instalação permanente, o serviço pode ter funcionários e áreas exclusivas para o fornecimento de serviços de cadeiras de rodas. O serviço baseado em centro pode ser eficiente para o pessoal. Contudo, para os cadeirantes que moram longe do serviço, o deslocamento pode ser difícil. Área exclusiva para capacitação de mobilidade com cadeiras de rodas Serviço integrado Serviço de cadeiras de rodas integrado a uma clínica comunitária A maioria dos serviços baseados em centro também são "serviços integrados", ou seja, um serviço de cadeiras de rodas é integrado com outro(s) serviço(s). Por exemplo, ele pode ser integrado com um serviço de próteses/órteses, um departamento de fisioterapia ou uma clínica. Nesse contexto, quando o pessoal desempenha outras funções além do fornecimento de serviços de cadeiras de rodas, é importante que tenham tempo suficiente para realizar todas as atividades que lhe sejam designadas. As instalações podem ser partilhadas ou exclusivas. As funções administrativas, financeiras e de gestão podem ser partilhadas. Nesse contexto, uma área da oficina é dedicada à preparação de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 13 Serviço em campo Os locais de fornecimento de serviço em campo podem variar. Exemplos: clínicas comunitárias, prefeituras, locais de reunião, residência do cadeirante Num serviço de cadeiras de rodas em campo, o pessoal de um centro ou serviço integrado desloca-se até as residências dos cadeirantes ou um local centralizado em outro distrito/região – para ver os cadeirantes do distrito/região e fornecer serviços de cadeiras de rodas. Os modelos de serviço em campo em geral baseiam-se numa parceria com uma ou mais organizações do distrito/região. É importante que haja uma boa coordenação com as organizações locais. A oferta de alguma capacitação a funcionários ou voluntários locais pode ajudar a aumentar o sucesso do fornecimento de serviços em campo o nível de apoio da comunidade. A vantagem para os cadeirantes é que a distância de deslocamento é menor. O pessoal em campo deve ser flexível e levar equipamentos essenciais consigo Serviço ambulante Exemplo de um veículo dedicado ao serviço ambulante de cadeiras de rodas Um serviço ambulante é outra forma de fornecer serviços em campo. Contudo, nessa situação, o pessoal tem um veículo especial, que é utilizado para transportar as cadeiras de rodas, assim como as ferramentas e os equipamentos necessários. O pessoal pode atender numa variedade maior de locais e assim alcançar mais cadeirantes. A capacidade de transportar mais ferramentas, equipamentos, materiais e peças sobressalentes aumenta a oportunidade de realizar reparos de cadeiras de rodas no local e o potencial de fornecer alguns serviços de nível intermediário. Com a utilização de um veículo especial, o pessoal pode transportar mais equipamentos e ferramentas Fornecimento colaborativo de serviços Nem todas as oito etapas do fornecimento de serviços de cadeiras de rodas precisam ser realizadas pela mesma organização. A colaboração em uma rede de organizações pode ajudar a aumentar a eficiência, além de ampliar o acesso dos cadeirantes a todas as oito etapas. A etapa um (encaminhamento e consulta) requer colaboração e cooperação com organizações e indivíduos que compõem a rede de encaminhamento do serviço de cadeiras de rodas. As etapas sete (capacitação do cadeirante) e oito (acompanhamento, manutenção e reparo) em geral podem ser fornecidas por um parceiro, como, por exemplo, uma rede de organizações baseadas na comunidade ou organizações de pessoas com deficiência. Esse diagrama mostra como as oito etapas de fornecimento de serviços podem ser oferecidas por meio de uma parceria entre um fornecedor de serviços de cadeiras de rodas e organizações baseadas na comunidade. As etapas 2–7 são realizadas nas instalações do serviço e as etapas 1 e 8, na comunidade. Esse modelo requer que se considere a capacitação de todos os funcionários e voluntários envolvidos. A função do gerente no fornecimento de serviços de cadeiras de rodas O gerente de um serviço de cadeiras de rodas é responsável por apoiar o pessoal que executa as oito etapas do fornecimento de serviços e coordenar a "trajetória" do cadeirante (e seu atendente/familiar) por essas etapas. O gerente também tem funções mais amplas, que são importantes para apoiar o fornecimento de serviços, como: • Realizar campanhas de sensibilização sobre o fornecimento de cadeiras de rodas adequadas; • Melhorar a acessibilidade; • Aumentar as oportunidades de capacitação do pessoal de fornecimento de serviços de cadeiras de rodas; • Desenvolver a sustentabilidade – para a continuidade do fornecimento de serviços de cadeiras de rodas; • Influenciar a política nacional de fornecimento de cadeiras de rodas adequadas; • Aumentar a variedade de cadeiras de rodas disponíveis. Envolvimento ativo dos cadeirantes no fornecimento de serviços O envolvimento ativo de cadeirantes em todos os aspectos do fornecimento de serviços de cadeiras de rodas ajuda a melhorar o resultado para os cadeirantes. Algumas sugestões de estratégias para os gerentes assegurarem o envolvimento de cadeirantes no seu serviço de cadeiras de rodas:vii Manual de Referência do WSTP para Gerentes – Página 15 • Instrua o pessoal a envolver cadeirantes como membros da equipe de fornecimento de serviços em todas as etapas que antecedem o fornecimento da cadeira de rodas. • Crie um sistema no serviço para obter regularmente as opiniões dos cadeirantes sobre o serviço e sugestões para melhorá-lo. • Quando possível, recrute cadeirantes como membros da equipe de fornecimento de serviços. Isso pode ser feito publicando-se anúncios de vagas por meio do setor de deficiência e assegurando-se que todas as áreas do serviço de cadeiras de rodas sejam acessíveis. Cadeirantes na equipe na Romênia Uma ONG que oferece um serviço de cadeiras de rodas na Romênia ativamente recruta cadeirantes para as suas equipes de fornecimento de serviços de cadeiras de rodas. Os recrutas da equipe de fornecimento de serviços em geral passam pela rede de capacitação da organização e pelos programas esportivos para cadeirantes. Os cadeirantes desempenham diferentes funções na equipe, dependendo das suas capacidades. Essa ONG tem observado um impacto enormemente positivo com a inclusão de cadeirantes no pessoal do serviço de cadeiras de rodas. Todos os membros da equipe ficam mais conscientes das necessidades dos cadeirantes com a interação diárias com os colegas; os clientes cadeirantes tendem a sentir-se mais à vontade para compartilhar as suas experiências com o cadeirante membro da equipe, e o cadeirante torna-se um modelo para os outros. A.3 Função de liderança do gerente no processo de mudança A criação ou melhora do fornecimento de serviços de cadeiras de rodas em geral requer mudanças na organização. Contudo, pode ser difícil liderar as mudanças. Parte da função do gerente de um serviço de cadeiras de rodas é liderar mudanças, sendo que algumas atividades essenciais nesse sentido são: • Ajudar a criar uma visão comum para o fornecimento de cadeiras de rodas adequadas; • Comunicar a importância do fornecimento de cadeiras de rodas adequadas a todas as partes interessadas, inclusive autoridades, outros fornecedores de serviços e potenciais doadores; • Alinhar o pessoal e os recursos corretos; • Motivar, engajar e incentivar o pessoal. Criar uma visão comum para o fornecimento de cadeiras de rodas adequadas A criação de uma visão comum de todas as partes interessadas para melhorar o fornecimento de cadeiras de rodas no país pode ajudar a inspirar todas as pessoas que devem trabalhar juntas para concretizar as mudanças. A visão deve descrever o futuro desejado. Por exemplo: "Um mundo onde os cadeirantes são incluídos e participam plenamente de todos os aspectos da vida". É importante partilhar a visão positiva com entusiasmo para que todo o pessoal se sensibilize e se empenhe em melhorar a qualidade devida das pessoas com deficiência. Manual de Referência do WSTP para Gerentes – Página 16 Comunicar a importância do fornecimento de cadeiras de rodas adequadas; Para continuar a inspirar o pessoal e outras partes interessadas, os gerentes devem comunicar constantemente a importância do fornecimento de cadeiras de rodas adequadas. Os gerentes têm de deixar claro que a criação ou melhora do fornecimento de serviços de cadeiras de rodas é uma prioridade e que é urgente. Senso de urgência significa que há uma necessidade que não pode ser evitada ou postergada. As pessoas seguem as prioridades dos seus supervisores; portanto, as ações de um gerente devem criar o senso de urgência. Como comunicar a importância e urgência do fornecimento de cadeiras de rodas adequadas o Fale sobre a necessidade não atendida de cadeiras de rodas adequadas em nível global e nacional, o direito à mobilidade pessoal e os benefícios que os indivíduos, a comunidade e a sociedade derivam com o fornecimento de cadeiras de rodas adequadas. o Discuta o progresso no sentido de criar ou melhorar o fornecimento de serviços de cadeiras de rodas nas reuniões regulares do pessoal. o Conte histórias de sucesso, como, por exemplo, em reuniões do pessoal, e afixe cartazes nas paredes do serviço. Alinhar pessoal e recursos Serviços de cadeiras de rodas precisam de pessoal capacitado, instalações e recursos. Todos os membros da equipe do serviço de cadeiras de rodas devem: • Trabalhar juntos, no mesmo sentido; • Sentir-se apoiados com os recursos necessários para realizar o seu trabalho; • Ser reconhecidos pelas suas contribuições. Como alinhar pessoal e recursos • Identifique as instalações que podem ser usadas no fornecimento de serviços de cadeiras de rodas. • Priorize o fornecimento de serviços de cadeiras de rodas ao designar o tempo do pessoal, as instalações, os equipamentos e os recursos. • Utilize a visão comum e os benefícios do fornecimento de cadeiras de rodas adequadas para relembrar o pessoal do motivo por que o serviço fornece cadeiras de rodas. • Reconheça e recompense o bom trabalho do pessoal de fornecimento de serviços de cadeiras de rodas. • Facilite as condições para os funcionários trabalharem juntos, em equipe. Motivar, engajar e incentivar o pessoal Os gerentes podem ajudar a motivar, engajar e empenhar o pessoal ao: Manual de Referência do WSTP para Gerentes – Página 17 • Incluir o pessoal no planejamento e na implementação – para que possam contribuir as suas experiências e capacidades e para ajudá-los a compreender melhor o que as mudanças significarão e a sua função na implementação. • Superar os obstáculos juntos – para que o pessoal compreenda melhor as causas dos problemas e como resolvê-los. • Definir metas de curto prazo e reconhecer o cumprimento dessas metas – para que o pessoal saiba que os seus esforços têm um impacto e são valorizados. • Integrar as mudanças nos sistemas e na cultura da organização. Por exemplo, crie uma cultura de comemoração do sucesso e incentive as pessoas a falar sobre os sucessos e as histórias positivas durante as reuniões e os intervalos. Além disso, assegure a persistência das mudanças bem- sucedidas ao incluir novas responsabilidades nas descrições das funções de cada indivíduo e atualizar as políticas organizacionais. Manual de Referência do WSTP para Gerentes – Página 18 Seção B: Criação de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 19 B.1 Acesso aos serviços O que significa "serviço equitativo"? Um "serviço equitativo" é um serviço que assegure a mesma oportunidade para cada cadeirante receber uma cadeira de rodas. Isso inclui: • homens, mulheres, meninos e meninas; • jovens, pessoas de meia idade e idosos; • pessoas que vivem próximas e pessoas que vivem em áreas mais distantes – por exemplo, nas zonas rurais; • pessoas de diferentes etnias e condições socioeconômicas. Serviços equitativos reconhecem que todas as pessoas, qualquer que seja a sua deficiência, idade, sexo, religião, riqueza, idioma e grupo étnico, têm o mesmo direito aos serviços. Um serviço equitativo de cadeiras de rodas não é o mesmo que fornecer uma quantidade igual de cadeiras de rodas a pessoas de diferentes grupos (por exemplo, uma quantidade igual de cadeiras de rodas para homens e mulheres), pois as necessidades dos diferentes grupos podem variar. Lembre-se: O acesso a um serviço não significa apenas "chegar ao serviço". Significa saber que o serviço existe, chegar ao serviço ou receber o serviço nas suas casas. Há alguns grupos de pessoas que podem ter dificuldade de acesso aos serviços. Eis alguns exemplos: • mulheres e meninas; • pessoas que vivem distantes dos serviços/pessoas que vivem nas zonas rurais; • pessoas pobres; • crianças; • pessoas de diferentes grupos religiosos ou étnicos; • idosos; • grupos específicos – por exemplo, pessoas com HIV ou lepra podem sofrer discriminação. Os gerentes devem estar cientes dos diferentes grupos abrangidos no seu contexto, que provavelmente têm menos acesso aos serviços. Manual de Referência do WSTP para Gerentes – Página 20 Encaminhamento e consulta Encaminhamento e consulta é a primeira etapa no fornecimento de serviços de cadeiras de rodas. Etapa Resumo 1. Encaminhamen to e consulta A forma de encaminhamento de cadeirantes varia. Os cadeirantes podem encaminhar-se a si mesmos ou ser encaminhados por meio de redes compostas de profissionais governamentais ou não governamentais de saúde e reabilitação que trabalham no nível comunitário, distrital ou regional. Alguns serviços de cadeiras de rodas podem ter de identificar ativamente os potenciais cadeirantes que ainda não recebem serviços sociais ou de saúde nem participam de atividades escolares, profissionais ou comunitárias. O encaminhamento eficaz requer bons vínculos entre um serviço de cadeiras de rodas e a comunidade, pois são as pessoas na comunidade que identificam e encaminham cadeirantes para o seu serviço. Diferentes indivíduos e organizações com maior probabilidade de identificar cadeirantes e encaminhá-los ao seu serviço de cadeiras de rodas: • hospital local; • postos de saúde comunitários; • redes de reabilitação baseada na comunidade; • líderes de aldeia/conselho/igreja; • organizações de pessoas com deficiência; • outros cadeirantes; • médicos/enfermeiras. O que os gerentes podem fazer para desenvolver uma rede de encaminhamento? • Identifique as fontes de encaminhamento (indivíduos e organizações) da sua área. • Discuta com o pessoal do serviço de cadeiras de rodas que informações as fontes de encaminhamento necessitam para poder identificar cadeirantes que precisam de uma cadeira de rodas e como encaminhá-los ao serviço. • Prepare (ou peça ao pessoal que prepare) materiais/panfletos com as informações necessárias para as fontes de encaminhamento. • Visite (ou peça ao pessoal que visite) indivíduos ou organizações que possam fazer encaminhamentos para conversar sobre o serviço de cadeiras de rodas. • Organize um dia de visita no serviço de cadeiras de rodas para cadeirantes e fontes de encaminhamento. • Ofereça a capacitação para redes de encaminhamento às fontes de encaminhamento. • Considere a elaboração de um formulário de encaminhamento para as fontes de encaminhamento preencherem. Os formulários devem ser simples, e o seu serviço deve responder aos encaminhamentos (com a marcação de uma consulta para o cadeirante encaminhado) e enviar um feedback positivo às fontes de encaminhamento que utilizam o formulário. Manual de Referência do WSTP para Gerentes – Página 21 Aumento do acesso equitativo aos serviços Os gerentes desempenham uma função importante, ajudando a aumentar o acesso equitativo aos serviços. O quadro abaixo contém algumas sugestões sobre como aumentar o acesso para diferentes grupos. O que os gerentes podem fazer para aumentar o acesso equitativo aos serviços? Pa ra m ul he re s e m en in as • Assegure a disponibilidade de informações sobre o serviço de várias formas – por exemplo, pelo rádio, panfletos/cartazes com textos simples, imagens visuais. • Certifique-se de que, além dos homens, mulheres também estejam apresentadas nos anúncios do serviço. • Identifique modelos de mulheres cadeirantes que possam falar sobre a importância das cadeiras de rodas para as mulheres em público e na comunidade. • Fale com os líderes da comunidade sobre como as cadeiras de rodas são de igual importância para mulheres, crianças e homens. • Apóie e incentive a participação de mulheres em todos os níveis dos serviços de cadeiras de rodas, inclusive em cargos de gestão e liderança. • Ofereça às OPD informações sobre o serviço de cadeiras de rodas e enfatize que tanto mulheres como homens precisam de cadeiras de rodas para mobilidade. • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para homens, mulheres e crianças – não simplesmente "pessoas". Pa ra c ria nç as • Assegure a disponibilidade de informações sobre o serviço em locais eventualmente frequentados pelos pais de crianças com deficiência – por exemplo, clínicas comunitárias, serviços de reabilitação, mercados, centros comunitários, igrejas, mesquitas, templos. • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para homens, mulheres e crianças – não simplesmente "pessoas". • Ofereça educação e informações sobre o serviço a pessoas que possam tratar crianças com deficiência – por exemplo, médicos, enfermeiras, profissionais de saúde comunitária. • Certifique-se de que, além dos adultos, crianças também estejam apresentadas nos anúncios do serviço. • Explique as vantagens do fornecimento de cadeiras de rodas a crianças em idade precoce sempre que falar sobre o serviço. Além disso, explique as vantagens do fornecimento de cadeiras de rodas a famílias/atendentes de crianças. Pa ra p es so as po br es • Reduza o custo dos serviços o máximo possível. • Identifique formas de oferecer assistência financeira aos cadeirantes sem condições para pagar por transporte até os serviços de cadeiras de rodas ou pelas cadeiras de rodas (quando cobradas). Por exemplo, crie um fundo para cadeiras de rodas. Manual de Referência do WSTP para Gerentes – Página 22 Pa ra id os os • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para todos – inclusive os idosos. • Inclua fotografias de pessoas idosas utilizando cadeiras de rodas nos anúncios sobre o serviço. • Explique as vantagens de uma cadeira de rodas para pessoas idosas, e as suas famílias, ao falar sobre o serviço de cadeiras de rodas. Pa ra p es so as q ue v iv em d is ta nt es d os s er vi ço s/ pe ss oa s qu e vi ve m n as z on as ru ra is • Assegure a disponibilidade de informações sobre o serviço nas zonas rurais – por exemplo, clínicas rurais, mercados, centros comunitários, igrejas, mesquitas, templos. • Ofereça informações sobre o serviço a pessoas que trabalham com pessoas que vivem nas zonas rurais – por exemplo, profissionais de reabilitação baseados na comunidade. • Identifique formas de auxiliar os cadeirantes rurais com transporte caso o serviço não atenda em campo. Por exemplo – assistência financeira para transporte, colaborações com outras organizações que possam ajudar a transportar pessoas até o serviço. • Descubra se é possível oferecer acomodações para cadeirantes de zonas rurais ao visitar o serviço. • Ofereça serviços em campo nas zonas rurais. • Capacite pessoas que já trabalham nas zonas rurais (por exemplo, profissionais de saúde comunitária) para darem apoio aos cadeirantes da comunidade, fazer acompanhamento e ajudar com procedimentos simples de manutenção e reparo de cadeiras de rodas. • Assegure a disponibilidade de cadeiras de rodas que possam ser efetivamente utilizadas em terrenos acidentados nas zonas rurais e ofereça informações sobre como fazer adaptações simples (por exemplo, rampas ou nivelamento de caminhos) para facilitar a utilização de cadeiras de rodas nas zonas rurais. Pa ra d ife re nt es gr up os ét ni co s/ so ci oe co n ôm ic os • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para todos – qualquer que seja o seu grupo socioeconômico. • Inclua fotografias de pessoas de diferentes grupos étnicos e religiosos da área atendida pelo serviço em todos os anúncios sobre o serviço. • Quando possível, contrate pessoas de diferentes grupos socioeconômicos para trabalhar no serviço. Manual de Referência do WSTP para Gerentes – Página 23 B.2 Instalações e equipamentos O fornecimento de serviços de cadeiras de rodas pode ser realizado em vários locais. Contudo, onde quer que seja, serão necessárias algumas instalações e equipamentos. Os serviços de nível básico precisam de menos espaço e equipamentos do que os serviços de nível intermediário. Instalações e equipamentos para todos os serviços de cadeiras de rodas (básico e intermediário) Área de recepção e espera Qual é o espaço necessário? É necessário ter uma área de registro, onde os cadeirantes e as suas famílias também possam esperar juntos. Caso haja alguma probabilidade de que as pessoas viajem alguma distância para chegar ao serviço, pense sobre onde poderão comprar um lanche. Na ilustração à direita, um comerciante local tem uma barraca do lado de fora da clínica local. Uma área tranquila onde os cadeirantes possam deitar-se enquanto esperam pode ser muito útil. Isso é particularmente importante para: • Pessoas fracas e frágeis, que precisem descansar durante a consulta; • Crianças cansadas; • Qualquer pessoa identificada com uma úlcera por pressão numa área que sustente peso no seu corpo. É necessário ter sanitários acessíveis próximos à área de recepção e espera e à área de avaliação e adaptação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Equipamentos recomendados: • Equipamentos para registro: mesa/escrivaninha, cadeira, telefone e uma local para guardar e arquivar documentos com segurança. • É recomendável ter cartazes, panfletos e vídeos disponíveis na área de espera. Quando um serviço observa uma grande proporção de crianças, é recomendável ter alguns brinquedos simples disponíveis enquanto esperam. Manual de Referência do WSTP para Gerentes – Página 24 Área de escritório para o pessoal Qual é o espaço necessário? O pessoal precisa de um espaço onde possam trabalhar e reunir-se, escrever notas e guardar registros com segurança. Área para avaliação e adaptação Qual é o espaço necessário? É necessário ter um espaço relativamente tranquilo e privado onde os cadeirantes possam ser avaliados pelo pessoal e onde a cadeira de rodas possa ser adaptada. O espaço deve ser acessível para cadeiras de rodas, acomodar familiares e ter iluminação suficiente. É recomendável identificar uma parede acessível e vazia para servir como fundo para a avaliação e fotografias. Num serviço baseado em centro, as dimensões sugeridas para esse espaço são as seguintes (variam muito, dependendo do volume de casos): • Área clínica de nível básico: 3 m x 2,5 m • Área clínica de nível intermediário: 4 m x 3,5 m Às vezes a área clínica fica na residência de alguém. e a ênfase é na flexibilidade e adaptabilidade, sendo necessário levar os equipamentos essenciais consigo. Equipamentos: • Divisórias – caso sejam examinados mais de um cliente de cada vez, devem ser utilizadas cortinas ou divisórias para oferecer privacidade. • Banco ou leito de avaliação – uma estrutura firme e estável com a altura da cadeira de rodas para o cadeirante sentar-se durante a avaliação. A superfície deve ter algum estofamento para proteger a pele, como, por exemplo, EVA ou uma esteira de ginástica ou ioga. Posicione o leito de forma que o avaliador possa trabalhar atrás ou na frente do cadeirante. • Apoios para os pés – um jogo de apoios de diferentes tamanhos para apoiar os pés do cadeirante. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Câmera – é útil ter uma câmera para gravar os pontos principais do processo de avaliação e adaptação (com a autorização assinada do cadeirante). • Fita métrica ou paquímetros. Manual de Referência do WSTP para Gerentes – Página 25 Área para preparação, manutenção e reparo de cadeiras de rodas Qual é o espaço necessário? É necessário ter uma área "técnica" para: • montar, reparar e manter cadeiras de rodas; • fabricar modificações, quando necessário. O espaço deve ser bem iluminado, ventilado e seco, assim como ter uma boa temperatura para trabalhar. A segurança é importante para ferramentas manuais e elétricas. O ideal é ter um armário de metal com fechadura para armazená-las. Num serviço permanente/baseado em centro, a área técnica deve ser dividida da seguinte forma: • Uma área "limpa" para a montagem final dos componentes e o ajuste dos produtos e para realizar as verificações de segurança e prontidão. A área deve ter espaço livre e espaço para bancos. • Uma área de "fabricação" é necessária para fazer modificações e reparos, como cortar e colar espuma, perfurar em geral, lixar, limar e pintar. A área deve ter espaço livre e espaço para bancos. Nem todos os trabalhos técnicos têm de ser realizados na área técnica do próprio serviço. Por exemplo, um serviço de cadeiras de rodas pode terceirizar alguns aspectos técnicos, como a costura de estofamento (a um alfaiate local) e a soldagem (a uma oficina local de metalurgia). Equipamentos: • Armários, prateleiras e quadros de ferramentas suficientes para manter a área organizada e maximizar o espaço livre. • Ferramentas para montagem e ajuste de cadeiras de rodas e fabricação de modificações. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Uma lista de materiais para modificações. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Pelo menos uma bancada para cada técnico. Recomenda-se que pelo menos uma bancada tenha altura ajustável caso haja um cadeirante na equipe. O banco deve ser posicionado com espaço atrás e na frente para que se possa trabalhar no nível do piso. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. (Obs.: as instalações e os equipamentos necessários para uma oficina de fabricação de cadeiras de rodas são bem mais extensos e ultrapassam a abrangência deste manual). Manual de Referência do WSTP para Gerentes – Página 26 Área de armazenamento Qual é o espaço necessário? É necessário ter uma área protegida para armazenar cadeiras de rodas, peças sobressalentes e materiais. A área de armazenamento deve estar próxima à área técnica e ser protegida, seca e livre de animais/pestes. Uma grade de metal na janela oferece segurança adicional. Quando não é possível ter uma sala exclusiva, prepare uma área exclusiva dentro de uma sala. Nesse caso, é necessário considerar as necessidades de segurança. Preparação de uma área de armazenamento: As sugestões abaixo podem ser úteis para a preparação de uma área organizada para armazenamento: • Prateleiras ajudam a maximizar o espaço. • O acesso e a eficiência aumentam deixando-se uma passagem entre prateleiras, caixas e cadeiras de rodas montadas. A passagem deve ficar desimpedida. • Organize os artigos por tipo e tamanho. Para facilitar o controle e a reposição de estoque, recomenda-se agrupar os artigos por tipo. • Artigos pequenos, como parafusos, porcas e arruelas, podem ser guardados em caixas pequenas, uma para cada artigo e tamanho. Marque o nome do artigo na frente da caixa. • Caixas e materiais não devem ser colocados diretamente no chão ou encostados numa parede exterior para não sofrerem danos de umidade. Estrados são úteis para não guardar artigos no chão. • Caso haja uma janela, pode-se acrescentar uma grade para aumentar a segurança. Capacitação do cadeirante Qual é o espaço necessário? É necessário ter uma área de capacitação de cadeirantes para ensinar: • transferências e educação de saúde; • manobra, cuidado e manutenção de cadeiras de rodas; • capacidades de mobilidade. Transferências e educação de saúde podem ser ensinadas numa área clínica, na residência do cliente ou numa instalação em campo. Equipamentos: • Recomenda-se ter os equipamentos básicos, como um leito para praticar transferências. Manual de Referência do WSTP para Gerentes – Página 27 Manobra, cuidado e manutenção de cadeiras de rodas podem ser ensinados na área limpa de uma oficina ou em qualquer outro local apropriado. Equipamentos: • É necessário ter os equipamentos básicos de manutenção de cadeiras de rodas. Capacidades de mobilidade em geral são ensinadas numa área exterior, mas áreas interiores também servem. Uma área exterior construída especificamente para capacitação de mobilidade pode simular as diferentes superfícies que os cadeirantes encontrarão na sua vida diária – como terreno acidentado, terreno mole, drenos, lombadas, guias, degraus, escadas. Num serviço integrado – a área de capacitação de mobilidade pode ser utilizada por pessoas com outras deficiências de mobilidade, como, por exemplo, pessoas que necessitam aprender a utilizar uma prótese de membro ou reaprender a andar após uma lesão. Quando não há espaço para uma área dedicada à capacitação de mobilidade – identifique espaços existentes que possam ser utilizados para capacitação de mobilidade com segurança. Evite áreas onde haja muitos transeuntes e procure um lugar com uma variedade de obstáculos. Os equipamentos portáteis de capacitação de mobilidade podem ser fabricados e instalados no local de fornecimento de serviços de cadeiras de rodas. A ilustração à direita mostra equipamentos portáteis de capacitação de mobilidade instalados sob uma tenda. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Manual de Referência do WSTP para Gerentes – Página 28 Instalações e equipamentos adicionais para serviços de nível intermediário Para fornecer um serviço de cadeiras de rodas de nível intermediário, é necessário ter espaço e alguns equipamentos adicionais. Os requisitos adicionais que os gerentes devem considerar estão descritos abaixo. Área de avaliação e adaptação Um serviço intermediário requer um leito de avaliação para o cadeirante deitar-se durante a avaliação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Uma caixa especializada de avaliação pode ser muito útil para serviços de nível intermediário. Uma caixa de avaliação oferece um apoio ajustável para os pés e um bom acesso para dar apoio durante a simulação das mãos. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Blocos de espuma firme para os suportes temporários devem estar disponíveis durante a avaliação e adaptação. • Um espelho de corpo inteiro pode ser muito útil para o cadeirante e o pessoal do serviço observarem a postura e o alinhamento de diferentes ângulos. • Brinquedos e fotografias nas paredes criam um ambiente mais amistoso para as crianças. Armazenamento No nível intermediário, há uma necessidade maior de armazenamento dos materiais necessários para modificações e componentes de suporte postural. Entre os materiais figuram lâminas de espuma, que devem ser armazenadas na posição horizontal e em local seco. Portanto, é necessário ter mais espaço e prateleiras de armazenamento. Área de preparação, manutenção e reparo de cadeiras de rodas O serviço precisa de uma área limpa e uma máquina de costura industrial para estofar componentes e cintas de suporte postural modificados ou fabricados. Sem o espaço e os equipamentos, o serviço terá de terceirizar essa tarefa. Organização do espaço de trabalho Manual de Referência do WSTP para Gerentes – Página 29 Uma vez que as instalações e os equipamentos tenham sido obtidos, o gerente deve atribuir as responsabilidades pela organização de cada instalação, aplicando as quatro etapas abaixo: 1. Elimine a desordem: remova todas as ferramentas, peças, equipamentos, documentos desnecessários. 2. Identifique os artigos utilizados com regularidade: ferramentas, peças, instruções e documentos. Os artigos utilizados com regularidade devem ser organizados para facilitar e agilizar a sua localização. 3. Sistema e responsabilidade: tenha um sistema para cada local de trabalho e alguém responsável pela implementação do sistema. 4. Monitore: o sistema para assegurar a "persistência" da mudança. B.3 Variedade de cadeiras de rodas adequadas O que significa uma cadeira de rodas e almofada adequada? As necessidades dos cadeirantes variam. Mas todos precisam de uma cadeira de rodas e almofada adequada. As diretrizes da OMS para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos oferecem a seguinte definição de cadeira de rodas adequada: • Atende às necessidades e condições ambientais do cadeirante; • Adapta-se bem ao corpo do cadeirante e oferece o suporte postural correto; • É segura e durável; • Está disponível no país; e • Pode ser obtida e mantida, com serviços sustentáveis no país ao custo mais econômico e acessível. Para atender às necessidades dos cadeirantes que utilizam um serviço de cadeiras de rodas, os serviços devem oferecer pelo menos alguns tipos diferentes de cadeiras de rodas e almofadas. O melhor tipo de almofada para o cadeirante depende das suas necessidades. Contudo, todas as pessoas em risco de desenvolver uma úlcera por pressão precisam de uma almofada de alívio de pressão e capacitação sobre como utilizá-la. Custo de não ter os equipamentos corretos em combinação com a capacitação dos cadeirantes A esperança de vida média em países com bons recursos é de aproximadamente 38 anos após a lesão quando esta é sofrida entre os 25 e 34 anos de idade.viii Em contraste, um estudo realizado em Bangladesh constatou que a esperança de vida mediana após uma lesão medular é de 5,36 anos, com 56,4% a falecer dentro de 5 anos após a lesão.ix Das pessoas incluídas no estudo, 80% faleceram em casa e um terço destes apresentavam úlceras por pressão no falecimento. Num hospital de reabilitação no Sri Lanka, foi realizado um levantamento dos custos do hospital na unidade de lesões medulares em 1999. Nessa época, levava-se cerca de 6 semanas para uma úlcera por pressão superficial sarar, a um custo de US$ 286. Uma úlcera por pressão profunda precisava de aproximadamente um ano para sarar, ao custo estimado de US$ 2.483. O mesmo levantamento demonstrou que, com a introdução de uma cadeira de rodas, almofada e colchão corretos, com a devida educação para o paciente, a incidência de úlceras por pressão durante o internamento no hospital poderia ser reduzida em 70% e os gastos com curativos, em quase 60%. Um programa hospitalar em São Paulo, Brasil, criou um serviço voltado à educação para reduzir as complicações secundárias em pessoas com lesões medulares. A incidência de úlceras por pressão foi reduzida em 23%x. Manual de Referência do WSTP para Gerentes – Página 31 Seleção de uma variedade de cadeiras de rodas e almofadas adequadas Adapta-se bem ao corpo do cadeirante e oferece suporte Os cadeirantes precisam de cadeiras de rodas bem adaptadas ao seu tamanho. Quando o tamanho não está certo, a cadeira de rodas pode ser desconfortável, não oferece um bom suporte postural e pode causar lesões ao cadeirante. Isso significa que o serviço de cadeiras de rodas precisa de um estoque de cadeiras de rodas de diferentes tamanhos ou cadeiras de rodas com tamanho ajustável. A maioria dos cadeirantes passa várias horas sentada. Isso significa que a cadeira de rodas não é apenas um recurso de mobilidade. Também lhes dá ajuda a sentar-se eretas com conforto. As pessoas também têm necessidades diferentes de suporte postural e, portanto, precisam de cadeiras de rodas com tipos diferentes de suporte. As pessoas com necessidades de suporte postural de nível básico precisam do suporte de uma cadeira de rodas bem adaptada ao corpo do cadeirante. As pessoas com necessidades de suporte postural de nível intermediário precisam de uma cadeira de rodas bem adaptada ao corpo do cadeirante e suporte adicional. O suporte adicional pode ser criado acrescentando-se suportes posturais adicionais à cadeira de rodas ou instalando-se um assento com suporte especial. O custo de não fornecer o tamanho correto ou o suporte correto O pessoal do Centro de Reabilitação do Western Cape, na África do Sul, documentou as complicações observadas num grupo de crianças em escolas e centros de atendimento, que precisavam de suporte postural. Dentre elas, 21% das crianças desenvolveram outras complicações posturais. O custo dessas complicações para as crianças, as suas famílias e os serviços foi: • Maiores complicações e mais tempo gasto em consultas • Saúde mais frágil • Postura pior e maior desconforto • Menor tolerância na posição sentada (menos tempo sentado com conforto) Manual de Referência do WSTP para Gerentes – Página 32 • Menor participação em programas educacionais • Deterioração da qualidade de vida. Atende às necessidades e condições ambientais do cadeirante Uma cadeira de rodas adequada deve ajudar o cadeirante a fazer o que necessitam fazer. Os cadeirantes precisam subir e descer da cadeira de rodas, empurrá-la, dobrá-la para transporte e armazenamento, assim como realizar as suas atividades diárias. O tipo correto de cadeira de rodas, com os recursos corretos, pode facilitar tudo isso para o cadeirante. Os cadeirantes também precisam de uma cadeira de rodas que funcione bem no seu ambiente. Diferentes cadeiras de rodas são melhores para diferentes ambientes. Por exemplo, algumas cadeiras de rodas são melhores para utilização interna, outras são melhores para ambientes exteriores e terrenos acidentados. Equipamentos abandonados: ter algo é melhor do que não ter nada? Quando não atendem às necessidades do cadeirante, em geral são abandonados. Essa ilustração conta uma história comum. O cadeirante tem três cadeiras de rodas doadas, mas nenhuma atende às necessidades, e não consegue sair de casa. As duas primeiras estão inutilizáveis, pois estão quebradas, sem peças sobressalentes disponíveis. A terceira é nova, mas é de má qualidade, parece bamba e instável quando utilizada fora de casa, fazendo o cadeirante sentir-se inseguro. Segurança e durabilidade Os cadeirantes querem produtos seguros e duráveis, que possam ser reparados a um custo acessível. Os serviços de cadeiras de rodas também são beneficiados quando fornecem cadeiras de rodas seguras, duráveis e com opções de reparo local. Isso pode ajudar a reduzir o custo de reposição das cadeiras de rodas e facilitar a manutenção. Muitos cadeirantes em áreas com menos recursos utilizam as suas cadeiras de rodas sobre terrenos acidentados e expostas à chuva, areia e lama. Essas cadeiras de rodas devem ser fortes e fabricadas para durar nessas condições. As cadeiras de rodas de má qualidade quebram-se com rapidez (por exemplo, em 3 a 6 meses). Em contraste, cadeiras de rodas bem projetadas e bem mantidas podem durar de 3 a 5 anos. Assim obtém-se um valor muito maior pelo preço. Alguns problemas comuns com cadeiras de rodas de má qualidade: • Estofamento de má qualidade no assento e encosto rasga ou afunda; • Roldanas (eixos, pneus, mancais, garfos) quebram-se; • Rodas traseiras (eixo das rodas, aro de impulso, raios, mancais, pneus) quebram-se ou desgastam-se; • Os freios enferrujam e param de funcionar; • Os apoios para os pés quebram-se; • Não têm almofadas ou as almofadas são de má qualidade e perdem a funcionalidade com rapidez; • Peças removíveis se perdem. Manual de Referência do WSTP para Gerentes – Página 33 Função do gerente Os gerentes de serviços de cadeiras de rodas desempenham uma função importante na obtenção e no recebimento de cadeiras de rodas doadas. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. A sua função é a de assegurar: • O serviço tem várias opções de cadeiras de rodas e almofadas – para poder atender (o tanto quanto possível) às diferentes necessidades dos cadeirantes. Isso inclui considerar as diferentes necessidades de variedade de tamanho, suporte postural, meio ambiente e estilo de vida; • As cadeiras de rodas selecionadas são duráveis – sobretudo quando utilizadas em terrenos acidentados e ambientes rigorosos; • As cadeiras de rodas podem ser reparadas localmente. Isso pode incluir a aquisição (ou doação) de peças sobressalentes ou a disponibilidade local de peças sobressalentes para compra. É importante solicitar ativamente feedback dos cadeirantes sobre os produtos fornecidos pelo serviço de cadeiras de rodas. Os gerentes e o pessoal do serviço podem falar com os cadeirantes em visitas em casa, reuniões em grupo ou por meio de Organizações de Pessoas com Deficiência. Ao oferecer um novo tipo de cadeira de rodas ou almofada pela primeira vez, o serviço de cadeiras de rodas pode optar por fazer um teste com um grupo de cadeirantes que experimentem o produto novo durante um período e dêem feedback. O feedback pode ser obtido em entrevistas individuais ou em grupos de discussão. Como os gerentes podem assegurar a durabilidade e a possibilidade de reparo das cadeiras de rodas? Os gerentes podem fazer perguntas aos fornecedores (ou doadores) para obter mais informações sobre as cadeiras de rodas. Por exemplo, os gerentes podem perguntar: • A cadeira de rodas tem alguma certificação (por exemplo: testes de desempenho e testes de garantia de qualidade administrados por um órgão profissional)? Caso sim, quais foram os resultados? • O fornecedor recomenda alguma vida útil específica para a cadeira de rodas? • O fornecedor tem um sistema para comunicação de falhas? • Quem mais compra e utiliza as cadeiras de rodas? O gerente pode entrar em contato com outros serviços que fornecem a cadeira de rodas para obter mais informações sobre o respectivo desempenho? • Quais são as ferramentas necessárias para montar e/ou ajustar a cadeira de rodas? • Há disponibilidade de peças sobressalentes? Essas peças precisam ser compradas no exterior ou algumas das peças sobressalentes necessárias estão prontamente disponíveis no país? • A cadeira de rodas já foi experimentada no país e, caso sim, quais foram os comentários/resultados? • Se a armação quebrar – o reparo pode ser local? • A cadeira de rodas vem com um guia de manutenção? Manual de Referência do WSTP para Gerentes – Página 34 Manutenção e reparo de cadeiras de rodas A etapa oito do fornecimento de serviços de cadeiras de rodas é acompanhamento, manutenção e reparo. 8. Acompanhame nto, manutenção e reparos Visitas de acompanhamento oferecem a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Um aspecto importante dessa etapa é ensinar aos cadeirantes e às famílias como manter a cadeira de rodas. A manutenção regular, quando realizada em casa, pode ajudar a assegurar a durabilidade da cadeiras de rodas e reduzir a necessidade de grandes reparos. Os serviços de cadeiras de rodas também podem capacitar parceiras colaboradoras para fornecer serviços de manutenção e reparo, assim como identificar recursos na comunidade (por exemplo, lojas de conserto de bicicletas) que possam realizar a manutenção e o reparo de cadeiras de rodas. Manual de Referência do WSTP para Gerentes – Página 35 B.4 Alinhamento de pessoal Funções num serviço de cadeiras de rodas Os serviços de cadeiras de rodas com frequência são fornecidos por um grupo de pessoas que trabalham em equipe. Diferentes membros da equipe desempenham diferentes funções – como clínica, técnica, administrativa e gerencial. Diferentes indivíduos podem desempenhar uma ou mais funções. Por exemplo, uma pessoa responsável por uma função clínica também pode participar da gestão do serviço. Em algumas situações, funcionários de diferentes organizações podem trabalhar juntos para desempenhar as diferentes funções. O quadro abaixo mostra como o pessoal responsável por diferentes funções cobrem as diferentes atividades envolvidas no fornecimento de serviços de cadeiras de rodas. Clínica Técnica Capacitaçã o de cadeirantes Administrativ a Gerencial Gestão e desenvolvimento do serviço Promoção do serviço      Obtenção de financiamento  Desenvolvimento da base de encaminhamento     Contato com outras organizações      Avaliação do serviço      Etapas principais do fornecimento de serviços 1. Encaminhamento e consulta     2. Avaliação    3. Prescrição    4. Financiamento e encomenda     5. Montagem e/ou produção  6. Adaptação   7. Capacitação do cadeirante    8. Acompanhamento, manutenção e reparos    Capacitação e desenvolvimento profissional Capacitação do pessoal da rede de encaminhamento    Capacitação do pessoal da rede de acompanhamento    Capacitação do pessoal de fornecimento de serviços    Manual de Referência do WSTP para Gerentes – Página 36 Capacitação As funções do serviço podem ser desempenhadas por pessoas com diferentes históricos educacionais e profissionais, desde que tenham recebido a devida capacitação.1 É importante que o pessoal responsável pelas funções clínicas, técnicas e de capacitação tenha recebido capacitação. • O pessoal clínico e técnico responsável por serviços de nível básico devem ser capacitados nas competências descritas no Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas – Nível Básico. • O pessoal clínico e técnico responsável por serviços de nível intermediário devem ser capacitados nas competências descritas no Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas – Nível Intermediário. Lembre-se: Ao oferecer capacitação ao pessoal, é recomendável capacitar pelo menos duas pessoas de cada vez. Se houver apenas uma pessoa capacitada, o serviço fica muito vulnerável à possibilidade de essa pessoa sair da organização com todos os seus conhecimentos e experiências. Planejamento da capacidade do serviço Os gerentes devem ter a capacidade de planejar o seu serviço com base em quantos cadeirantes poderão atender a cada mês e ano, o que se pode denominar "capacidade do serviço". A capacidade do serviço abrange: • A quantidade de cadeirantes que receberão uma cadeira de rodas pela primeira vez; • A quantidade de cadeirantes que receberão acompanhamento. A capacidade de serviço está diretamente ligada ao: • Número de funcionários disponíveis para o fornecimento de serviços de cadeiras de rodas; • Tempo do pessoal disponível para o fornecimento de serviços de cadeiras de rodas; • Número de cadeiras de rodas que o serviço consegue obter – o que, por sua vez, com frequência depende está diretamente ligado ao orçamento. Cálculo do tempo do pessoal Para estimar a capacidade do serviço, os gerentes devem calcular o tempo que o pessoal dedicará ao fornecimento de serviços de cadeiras de rodas. Para tanto, os gerentes necessitam saber: • A quantidade de semanas de trabalho disponíveis em cada ano (deduzindo-se os feriados e períodos de férias); • A parcela do tempo que o pessoal dedicará ao fornecimento de serviços de cadeiras de rodas (e não a outras responsabilidades, funções ou atividades). Os gerentes também devem considerar quanto tempo o pessoal gasta nas diferentes etapas do fornecimento de serviços de cadeiras de rodas. Há vários fatores envolvidos. Por exemplo, o grau de experiência do pessoal do serviço; a necessidade de modificar ou não a cadeira de rodas fornecida. Contudo, como referência, uma equipe experiente (clínica e técnica) pode ter a capacidade de fornecer: • uma cadeira de rodas nova a dois clientes de nível básico por dia; ou • uma cadeira de rodas nova a dois clientes de nível intermediário por dia. 1 Diretrizes da OMS: Potenciais candidatos para capacitação para desempenhar essas diferentes funções: Profissionais ou voluntários de RBC, os funcionários atuais do serviço que ainda não receberam capacitação, enfermeiras qualificadas, fisioterapeutas, terapeutas ocupacionais, protesistas, ortesistas, médicos e outros profissionais de reabilitação de saúde, cadeirantes interessados em trabalhar com outros cadeirantes como parte da equipe de serviço. Manual de Referência do WSTP para Gerentes – Página 37 O quadro abaixo contém um exemplo de capacidade de serviço estimada com base numa equipe de duas pessoas que trabalham juntas. Um membro da equipe desempenha uma função clínica, a outra desempenha uma função técnica, e ambos oferecem capacitação para os cadeirantes. A equipe trabalha 5 dias/semana, 42 semanas por ano. Havendo cadeiras de rodas e materiais suficientes, a equipe pode fornecer: • um serviço de cadeiras de rodas de nível básico para uma quantidade estimada de 357 cadeirantes por ano; ou • um serviço de cadeiras de rodas de nível intermediário para uma quantidade estimada de 179 cadeirantes por ano. Serviço básico Serviço intermediário Planejamento da semana de trabalho Número de dias de trabalho por semana 5 5 Número de semanas de trabalho por ano (deduzindo-se os feriados e períodos de férias) 42 42 Estimativa da capacidade de serviço Número de utilizadores do serviço por dia 2 1 Número de utilizadores do serviço por semana 10 5 Número de utilizadores do serviço por ano 420 210 Contingência de 15% (para eventos inesperados) -63 -32 Número estimado de utilizadores por ano 357 179 A função do gerente é a de criar ou desenvolver uma equipe de fornecimento de serviços de cadeiras de rodas • Identifique funcionários atuais ou novos para desempenhar as diferentes funções do serviço de cadeiras de rodas. • Organize uma capacitação para o pessoal que ainda não tem as capacidades necessárias. • Defina o tempo que o pessoal tem disponível para dedicar ao fornecimento de serviços de cadeiras de rodas, com base numa estimativa realista das suas outras responsabilidades, funções ou atividades. • Estime a capacidade anual de serviço – e comunique à equipe. • Dê apoio ao pessoal no desempenho das suas funções de fornecimento de serviços de cadeiras de rodas. Por exemplo: o Envolva o pessoal no planejamento do serviço; o Crie uma ferramenta de planejamento semanal/mensal – com consultas e outras atividades; o Faça reuniões semanais para verificar o progresso, destacar os sucessos e resolver dificuldades. Manual de Referência do WSTP para Gerentes – Página 38 B.5 Custo de um serviço de cadeiras de rodas Uma função importante do gerente é identificar o custo do fornecimento de serviços de cadeiras de rodas. O quadro abaixo mostra algumas das rubricas mais importantes do orçamento associadas à criação e administração de um serviço de cadeiras de rodas. Os custos efetivos variam de acordo com o contexto. Rubrica orçamental Feedback Custos iniciais Concepção dos produtos Compra de uma variedade de produtos Ferramentas Equipamento Prédio/instalações Pode incluir prédio/reforma/modernização. Estoque de materiais Custos operacionais Cadeiras de rodas Estoque de cadeiras de rodas – com base na estimativa de capacidade de serviço e das necessidades previstas para os clientes cadeirantes. Peças sobressalentes É muito recomendável manter um estoque das peças sobressalentes geralmente necessárias. Materiais No nível básico, alguns materiais são necessários para modificações. No nível intermediário, são necessários mais materiais. Frete (transporte de produtos) Transporte e impostos para cadeiras de rodas importadas. Transporte de cadeiras de rodas para centros satélites. Pessoal Administração O guia de orçamentação abrange uma ampla variedade de possíveis funcionários. Não se espera que todos os serviços tenham todos esses funcionários. As marcas (veja a planilha) indicam atividades relacionadas com as etapas de serviço. Um funcionário pode ser responsável pela realização de mais de uma atividade. Pessoal clínico Pessoal técnico Capacitador/capacitador de pares Administrador Transporte local Custos de transporte local de funcionários Por exemplo, acompanhamento, serviços em campo; redes de encaminhamento para capacitação. Transporte local de clientes Deslocamento até o serviço para consultas. Acomodações para clientes custo de acomodações para clientes que precisam passar a noite (caso seja coberto/apoiado pelo serviço). Materiais impressos Formulários, listas de verificação e informações para o cadeirante. Materiais consumíveis Cola, linha, tinta, etc. Reposição de ferramentas Ferramentas desgastam-se – e, portanto, é necessário orçamentar recursos para a reposição. Custos administrativos Considere eletricidade, água, aluguel – para as diferentes áreas do serviço (clínica, técnica, de armazenamento, de capacitação de cadeirantes, de escritórios). Capacitação do pessoal Considere eventuais custos de capacitação do pessoal do serviço Manual de Referência do WSTP para Gerentes – Página 39 Capacitação de parceiros/redes de encaminhamento Considere eventuais atividades de capacitação/sensibilização para parceiros ou organizações encaminhadoras. Angariação de recursos O custo de eventuais atividades de angariação de recursos também deve ser orçamentado. Monitoramento e avaliação Custos associados a monitoramento e avaliação – por exemplo, visitas aos utilizadores do serviço para obter feedback. Os custos podem incluir deslocamentos ou pessoal adicional para realizar o monitoramento e a avaliação. Soluções econômicas Os gerentes que trabalham em áreas com menos recursos devem identificar formas de reduzir os custos. Algumas formas de reduzir os custos: Serviços integrados • Um serviço integrado, que efetivamente partilhe as mesmas instalações, pode oferecer oportunidades significativas de divisão de custos em comparação com a criação de serviços separados. Divisão de custos com outras organizações Um serviço pode formar parcerias com outras organizações para dividir custos. Por exemplo: • Algumas organizações internacionais de doadores/desenvolvimento podem ter interesse em dividir o custo das cadeiras de rodas. A vantagem para o centro de serviço é que os produtos ficam mais acessíveis. A vantagem para a organização internacional é que os seus recursos têm um impacto maior e ajudam o centro de serviço a demonstrar a sua capacidade de alcançar a sustentabilidade financeira. • As organizações comunitárias locais podem estar dispostas a formar uma parceria com o serviço para fornecer mais serviços locais. A parceira comunitária pode ter a capacidade de oferecer instalações e alguns funcionários para realizar algumas das etapas do fornecimento de serviços de cadeiras de rodas (por exemplo, acompanhamento e capacitação de cadeirantes). A vantagem para os cadeirantes é que isso reduziria deslocamentos e custos. A vantagem para o centro de serviço é que os serviços poderiam expandir-se para dentro da comunidade. Potenciais fontes de financiamento Mais informações sobre como obter financiamentos para os custos de criação e administração de um serviço de cadeiras de rodas estão apresentadas em C.4: Planejamento da sustentabilidade financeira. Manual de Referência do WSTP para Gerentes – Página 40 Seção C: Administração de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 41 C.1 Como saber se o seu serviço funciona? Monitoramento e avaliação ajudam o gerente a ver o que está (ou não está) acontecendo como resultado das atividades da sua equipe. Também ajudam o gerente e a sua equipe a aprender o que está e o que não está funcionando, assim como compreender o que os utilizadores do serviço e as partes interessadas acham. O que é monitoramento e avaliação? Monitoramento Avaliação Quando são realizados? • Continuamente • Integrados nas atividades diárias do serviço • Nas fases principais do serviço – por exemplo, durante uma avaliação anual. (embora algumas informações possam ser obtidas continuamente) O que se mede? • Atividades do serviço • Cadeiras de rodas e suportes adicionais utilizados • Quantidade e população de pessoas beneficiadas • Impacto em indivíduos e comunidades • Sustentabilidade Que fontes de informações são utilizadas? • Bancos de dados de utilizadores do serviço • Notas do serviço • Dados do serviço • Feedback dos utilizadores • Relatórios financeiros • Análise do tempo do pessoal • Levantamentos • Questionários • Discussões em grupo • Visitas em casa • Observação do serviço na prática • Análise das contas Serviços eficientes e eficazes Como o monitoramento e a avaliação são úteis para os gerentes e outros indivíduos envolvidos no serviço? • Oferece informações importantes para melhorar a qualidade do fornecimento de serviços • Oferece informações para orientar a compra de produtos • Ajuda a conter os custos, aumentando a eficiência, e a justificar o financiamento atual e proposto • Permite que os serviços demonstrem, com evidências, a eficácia do serviço aos financiadores – inclusive o governo e ONG doadoras • Ajuda a identificar e quantificar as necessidades não atendidas • Ajuda a distribuir recursos corretamente • Aumenta a sensibilização quanto aos benefícios do serviço • Desenvolve parcerias mais sólidas com os beneficiários do serviço. Manual de Referência do WSTP para Gerentes – Página 42 Ao planejar o monitoramento e a avaliação de um serviço, é recomendável criar um modelo com três etapas. Detalhes adicionais encontram-se no quadro 3.5 das Diretrizes para Cadeiras de Rodas. 1. Planejamento da área a ser monitorada 2. Definição de metas de desempenho 3. Identificação de formas de obtenção de informações Ao analisar as informações e os dados recolhidos, que há duas considerações importantes. • Quando uma atividade não está indo bem, trabalhe junto com os utilizadores do serviço, o pessoal do serviço e outras partes interessadas para identificar a raiz do problema. • Quando um atividade está indo bem e as metas são alcançadas, identifique formas de partilhar e comemorar o sucesso para motivar a equipe do serviço e outras partes interessadas. Importância do feedback dos cadeirantes A avaliação permite que o serviço reflita sobre o que funciona e o que necessita mudar. Também permite que o serviço considere se está a cumprir o objetivo geral. O objetivo da avaliação, segundo as Diretrizes para Cadeiras de Rodas, é: • Promover a mobilidade pessoal com a maior independência possível; • Melhorar a qualidade de vida mediante a ampliação do acesso a cadeiras de rodas; • Aumentar a inclusão e a participação. Há vários critérios que podem ser utilizados para avaliar um serviço. Entre estes: Manual de Referência do WSTP para Gerentes – Página 43 • Os cadeirantes atendidos e a intervenção recebida; • Custo do serviço, inclusive o custo dos produtos e do fornecimento de serviços; • Pessoal (quantidade de funcionários e as suas funções e competências); • Instalações e equipamentos disponíveis para o serviço; • A qualidade do fornecimento de serviços (as Diretrizes para Cadeiras de Rodas contêm recomendações de boas práticas na seção 3.3); • O impacto do serviço nos cadeirantes e as suas famílias. É muito importante envolver cadeirantes na avaliação de serviços de cadeiras de rodas. Ao planejar o feedback dos cadeirantes, há algumas considerações importantes. • Transporte e tempo são dois dos custos mais significativos. É possível que os cadeirantes que oferecem feedback precisem de apoio com os respectivos custos de deslocamento ou tempo. • O feedback pode ser obtido rotineiramente de cada utilizador do serviço ou de forma aleatória a cada mês ou ano. • O serviço só tem a beneficiar-se quando os seus utilizadores sentem-se à vontade para oferecer um feedback aberto e franco. Pode ser útil encarregar uma pessoa que não faça parte diretamente do serviço para realizar as entrevistas. Um exemplo dos benefícios da avaliação do serviço na Etiópia: Dois representantes em campo entrevistaram 140 cadeirantes de sete centros de serviço no país. Ambos os representantes tinham uma deficiência de mobilidade, e constatou-se que isso foi muito vantajoso para o seu trabalho. Os próprios representantes em campo ficaram bem informados sobre as dificuldades enfrentadas pelos cadeirantes no seu país. O processo os capacitou como ativistas em prol das necessidades e dos direitos dos cadeirantes. Os utilizadores do serviço tiveram benefícios emocionais e psicológicos ao serem entrevistados por alguém que lhes dava um exemplo positivo. Após as entrevistas de avaliação, formou-se uma rede informal que reforçou o relacionamento entre os fornecedores de serviços e os cadeirantes. Além disso, por meio da avaliação, foram identificados alguns casos de cadeirantes que não tinham recebido uma cadeira de rodas adequada às suas necessidades. Isso ajudou a identificar a necessidade de capacitação no serviço, e o serviço pôde tomar medidas. Importância dos dados iniciais ao avaliar o impacto Para examinar o impacto do serviço nas pessoas que recebem uma cadeira de rodas, é importante registrar a situação de um indivíduo antes de qualquer intervenção, ou seja, antes do início da avaliação. Possíveis oportunidades para a obtenção de dados iniciais: • quando se faz o encaminhamento – pelo pessoal de um centro de encaminhamento ou clínica; • entre o encaminhamento e a avaliação – numa visita em casa ou por telefone; • no momento da avaliação – antes de iniciar a avaliação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Ao realizar as entrevistas para obter informações dos utilizadores do serviço, é importante preparar a(s) pessoa(s) que fará(ão) as entrevistas, para que se possa obter uma resposta clara e completa para cada pergunta. Isso é importante para a validade dos dados. Manual de Referência do WSTP para Gerentes – Página 44 Conselhos de técnica de entrevista Preparação • Antes da entrevista, pratique o que dirá. Não diga mais do que o necessário. Técnica • Leia as perguntas exatamente como estão formuladas. • Não sugira respostas ao entrevistado, nem que seja de forma sutil. • Seja neutro caso precise explicar alguma coisa. • Registre as respostas corretamente. Respeite a pessoa • Não continue se a pessoa não concordar em ser entrevistada de livre e espontânea vontade. • Ajude a pessoa a relaxar. • Não demonstre choque, satisfação ou insatisfação com nada que a pessoa diga. • Trate as respostas da pessoa com sigilo. O estabelecimento de um bom sistema de dados iniciais dos utilizadores aumenta a qualidade do fornecimento de serviços de cadeiras de rodas, o que, por sua vez, reflete o impacto do serviço na qualidade de vida do utilizador. Isso pode ser feito: • como parte rotineira do acompanhamento; • como uma atividade distinta. Avaliação do impacto em crianças Quando possível, é importante dar "voz" às crianças e obter o seu feedback sobre o impacto das suas cadeiras de rodas e do serviço. Um exemplo é a utilização do dado de sentimentos.xi Primeiro, categorizam-se os diferentes sentimentos com a criança. Em seguida, pode-se pedir-lhe que complete afirmações como "Sinto-me feliz quando…" ou "Sinto-me triste quando…". Zangado Triste Magoado Envergonhado Animado Feliz Registro e processamento de dados O monitoramento e a avaliação envolvem registro, obtenção, armazenamento e processamento de informações (dados). O registro eficiente de dados pode economizar tempo e dinheiro. O ideal é introduzir os dados diretamente na base de dados, que é criada para processar os resultados e elaborar a maioria dos relatórios do serviço. Os computadores tablets portáteis podem ser muito úteis, pois permitem registrar dados tanto no centro como em visitas em campo. A tecnologia de telefonia móvel avança com rapidez e também pode oferecer um método para introduzir, enviar e receber dados. Elaboração de um plano de serviço Um plano anual de serviço, que é monitorado durante todo o ano, pode ajudar a assegurar um serviço eficiente e eficaz. Não se esqueça de motivar, engajar e incentivar o pessoal do serviço e de envolvê-los na elaboração do plano e das metas. O plano de serviço pode incluir uma avaliação no fim do ano. Um exemplo da estrutura de um plano de serviço encontra-se abaixo. Manual de Referência do WSTP para Gerentes – Página 45 Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Em comparação com os homens, uma quantidade muito menor de mulheres (20% mulheres, 80% homens) utilizou o serviço de cadeiras de rodas no ano passado. Para ampliar a identificação e o encaminhamento de mulheres ao serviço: • Converse com as fontes de encaminhamento, inclusive representantes de aldeias, sobre como identificar mulheres, • Colabore com a OPD nacional para identificar mulheres que possam servir como modelos para incentivar as mulheres a procurar o serviço. Aumente a porcentagem de mulheres com acesso ao serviço de cadeiras de rodas para pelo menos 40%. Continue a atualizar a base de dados de cadeirantes para identificar quantos homens e quantas mulheres utilizam o serviço. C.2 Gestão da demanda Para administrar um serviço, há um equilíbrio importante entre as necessidades dos utilizadores, que geram a demanda, e a capacidade do pessoal do serviço para fornecer um serviço adequado. Geração de demanda A necessidade de serviços pode ser estimada calculando-se 1% da população da área onde o serviço atua. Contudo, quando as pessoas não sabem sobre o serviço e os seus benefícios ou não têm acesso ao serviço, a demanda pode ser baixa a despeito da necessidade. Quando a demanda por serviços é baixa, o custo por utilizador aumenta, o que ameaça a sustentabilidade financeira do serviço. A função do gerente é a de identificar a raiz da baixa quantidade de encaminhamentos. Entre as possibilidades destacam-se: • O serviço não identificou as fontes de encaminhamento mais adequadas. Manual de Referência do WSTP para Gerentes – Página 46 • As pessoas que precisam de uma cadeira de rodas não utilizam as fontes de encaminhamento. • A capacitação da rede de encaminhamento não conseguiu estabelecer os benefícios e a importância de um serviço de cadeiras de rodas. • Os cadeirantes não conseguem utilizar o serviço – por ser longe demais de onde vivem, por não haver transportes disponíveis, etc. Após a identificação da causa da falta de encaminhamentos, o gerente e a sua equipe podem trabalhar para gerar demanda. Gestão da demanda Se a quantidade de pessoas encaminhadas a um serviço ultrapassa a capacidade do pessoal, há três resultados prováveis: • O pessoal dedica menos tempo que o necessário para cada pessoa – e a qualidade do serviço piora; • O tempo que os cadeirantes têm de esperar por uma consulta aumenta; ou • Alguns cadeirantes são rejeitados. Em cada caso, a situação é desmoralizante tanto para os utilizadores do serviço como o pessoal do serviço. Portanto, é muito útil fazer uma gestão cuidadosa da demanda. Os gerentes devem trabalhar inicialmente com menos fontes de encaminhamento, a começar pelas fontes mais próximas. Isso tem a vantagem de facilitar o acompanhamento na fase inicial do serviço. Os meios de comunicação em massa e telefones gratuitos nacionais tendem a gerar demanda em massa de longas distâncias. Sem uma rede de serviço, seria difícil atender e oneroso para os utilizadores do serviço e os fornecedores de serviços. Criação e gestão de listas de espera Quando a demanda por um serviço é alta; crie uma lista de espera. Vale a pena investir tempo na criação de um sistema com uma base de dados para registrar essas informações. Isso permite que o gerente e o pessoal do serviço consultem as informações com eficiência e facilita o processamento de estatísticas do serviço. Após uma pessoa utilizar o serviço, poderão ser acrescentadas informações adicionais, como data da avaliação, data da adaptação, visita de acompanhamento. Triagem de encaminhamentos e listas de espera À medida que aumenta a quantidade de pessoas na lista de espera, algumas organizações fazem uma triagem e priorizam os encaminhamentos. Prioridade deve ser dada aos seguintes grupos de pessoas: • Crianças – em virtude da importância do encaminhamento precoce e do maior risco de desenvolver desvios de postura durante surtos de crescimento; • Cadeirantes em risco de desenvolver uma úlcera por pressão – pois esse é um problema que causa risco de vida; • Cadeirantes com um problema progressivo – em virtude da urgência da sua posição; • Pessoas com dores causadas pela falta de uma cadeira de rodas ou uma cadeira de rodas mal adaptada. Manual de Referência do WSTP para Gerentes – Página 47 Alguns campos essenciais na base de dados a considerar para facilitar a triagem e o planejamento de consultas: • idade; • tipo de deficiência; • motivo do encaminhamento; • localização geográfica. Capacidade de serviço É importante controlar as expectativas do que um serviço pode oferecer – em termos de quantidade de cadeirantes que podem ser atendidos e do nível de fornecimento de serviços. Embora haja necessidade de serviços intermediários e avançados, nem todo serviço tem a capacidade de atender nesses níveis. Contudo, o pessoal do serviço encontrará utilizadores com necessidades além dos seus conhecimentos, capacidades e disponibilidade de produtos. Os gerentes devem ter uma estratégia para lidar com essa situação. Os gerentes podem: • Assegurar a clareza das informações sobre o serviço (o que o serviço pode fazer) nos panfletos/livretos. • Entrar em contato com outros fornecedores de serviços para explorar a possibilidade de encaminhamento ou colaboração nos casos de pessoas com necessidades que ultrapassem a capacidade do seu serviço. • Documentar as necessidades que não podem ser atendidas e planejar a ampliação da capacidade do pessoal e da disponibilidade de produtos. A importância do encaminhamento precoce de crianças Muitas crianças que precisam de cadeiras de rodas também podem precisar de suporte postural adicional. Isso significa que muitas crianças precisam de um serviço de nível intermediário. É muito importante que todas as crianças sejam encaminhadas a serviços o mais cedo possível para prevenir ou retardar os problemas de postura. As necessidades específicas das crianças e os benefícios do encaminhamento precoce são discutidos na sessão sobre Crianças no pacote de capacitação WSTPi. O encaminhamento precoce é importante para crianças pelos seguintes motivos: • Crianças com dificuldade para sentar-se eretas podem desenvolver problemas posturais se não tiverem suporte. Se a criança for encaminhada com atraso, alguns problemas posturais poderão tornar-se permanentes. Isso pode criar dificuldades para a criança sentar-se confortavelmente, até mesmo com suporte. • Sem a experiência de sentar-se e ter mobilidade, o desenvolvimento da criança pode ser retardado • Para crianças com alguma capacidade para andar, a cadeira de rodas pode facilitar a sua vida diária e dar-lhes a oportunidade de fazer mais coisas num dia. Infelizmente, às vezes as crianças não são encaminhadas a um serviço de cadeiras de rodas tão cedo quanto deveriam. Os pais talvez sintam esperança de que a criança fique curada e volte a andar Alguns pais preocupam-se com o custo de uma cadeira de rodas ou não sabem do serviço. Em alguns casos, os pais podem achar que a cadeira de rodas impedirá a criança de andar. É importante que toda a equipe do serviço esteja clara sobre por que o encaminhamento precoce é importante. O pessoal também pode tranquilizar os pais e as fontes de encaminhamento acerca da cadeira de rodas, pois é improvável que impeça a criança de andar quando essa é uma Manual de Referência do WSTP para Gerentes – Página 48 possibilidade. A experiência da mobilidade por meio de uma cadeira de rodas quando a criança está aprendendo a andar beneficiará o seu desenvolvimento de várias formas. Diretrizes para o encaminhamento de crianças Encaminhe crianças que:  tenham dificuldade para sentar-se eretas ou não consigam levantar-se com 1 ano de idade ou que não andem sozinhas com 2 de idade; ou  tenham deficiências físicas significativas ou estejam atrasadas em relação aos marcos de desenvolvimento. Exemplo de sucesso: encaminhamento precoce por pais no México (para atividade em grupo) Este é um exemplo de como um grupo de centros de reabilitação para crianças no México desenvolveu uma rede eficaz de encaminhamento precoce. Embora tivessem médicos neonatais e pediatras como os alvos principais das suas atividades de sensibilização, os centros de reabilitação também realizavam uma grande campanha anual de angariação de recursos na comunidade em geral, utilizando os meios de comunicação em massa, como rádio e televisão. Isso resultou em muitos encaminhamentos por pessoas que ouviram falar do serviço e muitos pais que auto-encaminham os seus filhos. Nessas campanhas de sensibilização, a mensagem era clara: a importância de encaminhar crianças para reabilitação ao nascerem. Também apresentaram uma visão potente de sucesso, com muitas histórias positivas relacionadas com a integração e as realizações das crianças com quem trabalham. Num período de 15 anos, os centros de reabilitação têm observado uma mudança cultural, com pediatras e famílias que agora ativamente fazem encaminhamentos precoces. O resultado: Um terço de todos os encaminhamentos são de crianças com até três anos de idade. Como os gerentes podem incentivar encaminhamentos precoces com sucesso • Mensagem clara sobre os alvos • Objetivo claro para o que se quer realizar • Uma abordagem diferente para profissionais e pais • Partilhar histórias de sucesso para incentivar pais e profissionais a encaminhar • Sensibilização constante durante vários anos. Administração de um serviço eficiente e eficaz Análise da eficiência e eficácia do serviço Após o início das operações do serviço, é recomendável analisar cada etapa de serviço e observar quanto tempo requer. Para aumentar a eficiência das etapas de serviço, é importante: • incentivar um bom trabalho em equipe; • planejar o que se pode preparar com antecedência para cada etapa de serviço. O quadro abaixo oferece algumas sugestões para aumentar a eficiência do serviço. Manual de Referência do WSTP para Gerentes – Página 49 Diferentes formas de aumentar a eficiência do serviço – para cada etapa do fornecimento de serviços de cadeiras de rodas Encaminhamento • Defina metas e objetivos claros para o nível de demanda que o serviço deseja atender. • Mensagem clara sobre quem o serviço atende. • Identifique uma variedade de organizações e profissões de encaminhamento para campanhas de sensibilização. • Monitore atentamente os volumes de encaminhamentos. • Partilhe histórias de sucesso com o pessoal do serviço e a rede de encaminhamento uma vez que os encaminhamentos aumentem. Avaliação • Planeje o nível adequado de capacitação para o pessoal do serviço. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. • Verifique se todos os equipamentos estão instalados para a realização de avaliações. Prescrição • Crie sistemas eficazes de controle de estoques. • Quando os produtos têm ajustabilidade limitada, as modificações devem ser prescritas de forma a adaptar o produto ao corpo do cadeirante. • Oriente o pessoal a discutir soluções de prescrição com o cadeirante e, se possível, mostrar-lhe as opções de produtos. Isso evitará a rejeição de soluções pelo cadeirante. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Financiamento e encomenda • Clareza na documentação de informações e nos registros. • Crie sistemas eficazes de controle de estoques. Preparação dos produtos • Adquira produtos com o máximo possível de ajustabilidade. • Adquira produtos que possam ser facilmente modificados. • Fabrique com antecedência dispositivos de suporte postural e/ou adquira produtos com dispositivos de suporte postural. • Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos. • Adquira os materiais necessários para a fabricação e modificação de almofadas e DSP. • Crie sistemas eficazes de controle de estoques. • Prepare um pequeno estoque de cadeiras de rodas em diferentes tamanhos. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Adaptação • Equipes clínicas e técnicas trabalham juntas durante a adaptação. • Prepare com antecedência amostras de opções de configuração de produtos. • Adquira produtos com o máximo possível de ajustabilidade. • Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos. • Adquira produtos que possam ser facilmente modificados. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Capacitação do cadeirante • Designe uma pessoa específica para a capacitação de cadeirantes, como, por exemplo, um capacitador de pares. • Identifique uma instalação para a capacitação de cadeirantes próximo às Manual de Referência do WSTP para Gerentes – Página 50 áreas clínica e técnica. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Acompanhamento • Desenvolva a capacidade de parceiros comunitários para fazer o acompanhamento de clientes na comunidade, com consultas ao serviço quando há algum problema que não possa ser resolvido no nível comunitário. Geral • Faça reuniões regularmente com a equipe para elaborar planos de trabalho compartilhados. • Agendamento claro de trabalhos conjuntos. • Clareza na documentação de informações e nos registros. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Transição de um serviço exclusivamente básico para um serviço básico e intermediário Muitos serviços de cadeiras de rodas começam por oferecer apenas o fornecimento de serviços de cadeiras de rodas de nível básico. É um bom começo, pois o serviço pode concentrar-se no desenvolvimento de sistemas associados às oito etapas de fornecimento, e o pessoal pode ganhar experiência. Contudo, como observado acima, muitos serviços de cadeiras de rodas encontram a demanda pelo fornecimento de serviços de cadeiras de rodas de nível intermediário. Isso não é de se surpreender, pois estima-se que 35% das necessidades dos cadeirantes são de nível básico e 65%, de nível intermediário ou avançado. Portanto, o gerente do serviço provavelmente terá de começar a planejar o atendimento às necessidades de nível intermediário no seu serviço. Como mencionado anteriormente, os serviços de nível intermediário requerem: • pessoal com capacitação adequada; • mais instalações, equipamentos e materiais. Algumas possíveis estratégias para a consideração dos gerentes ao fazer a transição de serviços básicos para intermediários: • Trabalhar com o pessoal para identificar como poderiam oferecer serviços intermediários. Considerar as instalações e os equipamentos adicionais necessários e o modelo de serviço a ser utilizado. • Verificar se o pessoal dos serviços de nível básico teria a capacidade para fornecer serviços de nível intermediário com mais capacitação. Caso sim – primeiro identificar e capacitar substitutos para os serviços de nível básico e, em seguida, capacitar o pessoal identificado para o nível intermediário. • Considerar se é possível colaborar com outras organizações – caso o seu serviço não possa identificar funcionários ou não tenha recursos para contratar mais funcionários. Manual de Referência do WSTP para Gerentes – Página 51 C.3 Planejamento do acompanhamento O acompanhamento é a oitava etapa do fornecimento de cadeiras de rodas. Todos os cadeirantes se beneficiam. É importante que o serviço tenha um plano para realizar o acompanhamento. Durante o acompanhamento, os serviços também se beneficiam da oportunidade de aprender sobre o impacto do serviço no cadeirante, nos seus familiares e na comunidade. 8. Acompanhamento, manutenção e reparos O acompanhamento oferece a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Importância do acompanhamento Alguns exemplos da importância do acompanhamento Duli: é uma mulher de 21 anos que vive com a sua família. Durante o acompanhamento, a equipe descobriu que ela não conseguia sair de casa porque a sua cadeira de rodas estava com os pneus furados. A cadeira de rodas havia sido abandonada debaixo da sua casa. Os furos foram reparados e a família recebeu conselhos. Duli passou a conseguir sair de casa novamente. A família não valorizava o acompanhamento até observar os benefícios. A equipe do serviço decidiu colar adesivos com o telefone de contato do serviço em todas as cadeiras de rodas para reduzir o problema no futuro. Maria: recebeu uma cadeira de rodas adequada nove meses depois de sofrer uma lesão medular. Durante o acompanhamento, ela não se sentia confortável e sofria espasmos, que ela atribuía à cadeira de rodas. Descobriu-se que havia uma infestação de insetos no estofamento da cadeira de rodas, que a estavam picando. Isso poderia ter causado graves complicações de saúde e o abandono do produto. Contudo, o problema foi identificado e resolvido, e Maria agora está saudável e feliz com a sua cadeira de rodas. Anton: era conhecido na sua comunidade pela sua destreza como jogador de rugby, até sofrer um acidente no jogo, que causou uma lesão medular. Ele recebeu uma cadeira de rodas adequada e capacitação, mas descobriu-se, durante o acompanhamento, que ele não saía de casa. Um capacitador fazia parte da equipe de acompanhamento e conversou com Anton, descobrindo que ele havia perdido a confiança e não queria ver os amigos. Ele se sentia totalmente isolado, só e envergonhado por "ser deficiente". O capacitador voltou no dia seguinte para sair com ele pela primeira vez. Desde esse dia, Anton retomou a sua vida. Gihan: é um menino de três anos que vive com os seus pais e irmão. No acompanhamento, constatou-se que o seu assento de suporte estava coberto de comida e não recebia manutenção. Os seus pais disseram que Gihan tinha dificuldades para sentar-se ereto e não se sentia confortável na cadeira. Eles tinham perdido a confiança no produto e não gostavam dele. Foi marcada uma reavaliação para Gihan com uma equipe com capacitação de nível intermediário. Foram feitas modificações na cadeira de rodas, e Gihan passou a sentar-se ereto, a olhar ao seu redor e a explorar o seu ambiente. Gihan e os seus pais ficaram muito felizes e prestaram atenção às instruções sobre como cuidar da cadeira de rodas de Gihan e fazer manutenção. Benefícios do acompanhamento para o cadeirante e o serviço • O pessoal pode confirmar (ou não) se a cadeira de rodas atende às necessidades do cadeirante no seu próprio ambiente. Manual de Referência do WSTP para Gerentes – Página 52 • As visitas em casa e na comunidade são uma boa oportunidade para identificar histórias de cadeirantes que possam ser utilizadas como feedback para o serviço e para ajudar na angariação de recursos. • O acompanhamento baseado no centro também pode ser uma oportunidade para identificar histórias de cadeirantes que possam ser utilizadas como feedback para o serviço e para ajudar na angariação de recursos. Objetivo do acompanhamento e onde deve ocorrer O objetivo do acompanhamento é: • obter informações do cadeirante; • verificar se a cadeira de rodas está em bom estado; • verificar se a cadeira de rodas está bem ajustada. Ações comuns de acompanhamento Algumas das ações comuns que decorrem de uma visita de acompanhamento: • mais conselhos ou capacitação; • reajuste da cadeira de rodas; • realização de pequenos reparos; • encaminhamento do cadeirante para outro serviço para receber apoio ou assistência, se necessário. Sempre que possível, as visitas de acompanhamento não devem transformar-se numa nova avaliação nem no recondicionamento completo da cadeira. Caso seja necessário realizar uma avaliação completa ou trabalhos extensos na cadeira, deve-se marcar uma consulta específica. Onde deve ser realizado o acompanhamento? O acompanhamento pode ser realizado na casa do cadeirante, no centro de serviço de cadeiras de rodas centre ou em qualquer outro local conveniente para o cadeirante e o pessoal do serviço. As vantagens do acompanhamento realizado nos diferentes locais estão relacionadas no quadro abaixo. Vantagens do acompanhamento na casa do cadeirante ou na comunidade local Vantagens do acompanhamento num centro de serviço • Mais econômico para o cadeirante e a sua família. • O pessoal obtém mais informações sobre os obstáculos à participação e inclusão que as pessoas enfrentam nas suas residências e comunidades. • A observação do pessoal em ação pode aumentar a sensibilização da comunidade e, portanto, a quantidade de encaminhamentos. • Menor custo e utilização mais eficiente do tempo do pessoal/serviço. • Com todas as instalações da oficina, é possível realizar reparos mais complexos. • Todos os equipamentos e as instalações já estão preparados. • Outros colegas disponíveis para oferecer outras opiniões. Manual de Referência do WSTP para Gerentes – Página 53 Planejamento do acompanhamento Todos os cadeirantes são beneficiados pelo acompanhamento. Contudo, o acompanhamento é mais importante para: • Crianças com deficiência; • Cadeirantes em risco de desenvolver uma úlcera por pressão; • Cadeirantes com um problema progressivo; • Cadeirantes que precisam de suporte adicional nas suas cadeiras de rodas (nível intermediário) • Cadeirantes que tiveram dificuldades na capacitação de transferência, mobilidade, saúde ou manutenção da cadeira de rodas. Frequência do acompanhamento Não há nenhuma regra para quando o acompanhamento deve ocorrer, pois o melhor momento depende das necessidades do cadeirante: • É recomendável fazer o acompanhamento de cadeirantes intermediários dentro de seis meses após o recebimento de uma nova cadeira de rodas para verificar se atende às suas necessidades. • Para crianças e pessoas com um problema progressivo, o ideal é fazer o acompanhamento pelo menos a cada seis meses, pois as necessidades das crianças ou pessoas com um problema progressivo podem mudar com rapidez. • O ideal é que todos os demais cadeirantes tenham um acompanhamento nos primeiros doze meses após receber as suas cadeiras de rodas. Impacto do acompanhamento quando não há parcerias com a comunidade Acompanhamento dos cadeirantes Novos potenciais cadeirantes Total de cadeirantes Lembre-se: O acompanhamento deve ser integrado ao modelo de serviço durante o planejamento inicial do serviço. As parcerias com a comunidade são essenciais para criar a capacidade de acompanhamento. Manual de Referência do WSTP para Gerentes – Página 54 O impacto do acompanhamento na disponibilidade de novas consultas é logo sentido quando um serviço não planeja. Os serviços intermediários, em particular, correm o risco de aproximar-se da saturação no ano três. Uma solução para isso é colaborar com organizações baseadas na – e capacitar o respectivo pessoal para realizar o acompanhamento o máximo possível. O pessoal baseado na comunidade pode conseguir realizar várias das tarefas de acompanhamento mais simples, encaminhando os cadeirantes de volta ao serviço de cadeiras de rodas apenas para reavaliações, reparos mais complexos ou outros problemas que não consigam resolver. Há várias vantagens quando essa função é desempenhada por alguém que sirva como um exemplo positivo, como, por exemplo, uma pessoa com deficiência de mobilidade. Criar parcerias com a comunidade e planejar o modelo de serviço Um parceiro pode apoiar o encaminhamento e o acompanhamento, assim como manutenção e reparos Um parceiro também pode apoiar a capacitação de cadeirantes De acordo com a sua capacidade, um parceiro também pode apoiar algumas das responsabilidades mais amplas do serviço Redução dos obstáculos ao acompanhamento Não obstante os benefícios para os utilizadores e fornecedores do serviço, a quantidade de pessoas que recebem acompanhamento em geral é baixa. Para superar os obstáculos e melhorar o serviço, é importante identificar o motivo por que a quantidade é baixa. Possíveis obstáculos à participação dos cadeirantes no acompanhamento em campo • Custos de deslocamento do pessoal do centro de serviço até as comunidades; • Tempo de deslocamento do pessoal do centro de serviço até a comunidade; • O acompanhamento não é priorizado pelos gerentes do serviço; • O acompanhamento não é valorizado pelos utilizadores do serviço até observar os benefícios. Possíveis obstáculos à participação dos cadeirantes no acompanhamento baseado no centro • O custo de deslocamento e a ausência de um ou mais familiares no trabalho é um custo financeiro duplo para a família; • Os cadeirantes e familiares com frequência não estão cientes dos benefícios do acompanhamento após receber uma cadeira de rodas; • Dificuldade para encontrar um transporte acessível; • Pode haver pressão para concentrar-se em novas consultas no centro de serviço sem deixar Manual de Referência do WSTP para Gerentes – Página 55 tempo para o acompanhamento; • Dificuldade para marcar consultas: os cadeirantes podem aparecer quando o pessoal não está disponível ou não aparecer quando o pessoal está disponível. Um exemplo de abordagem ao acompanhamento na Indonésia Em vez de cobrar diretamente, um programa de fornecimento de cadeiras de rodas na Indonésia cobra "taxas de associação" que contribuem para o serviço, o acompanhamento, a manutenção e os custos administrativos. Essa taxa de associação dá aos "associados" o direito a um serviço de qualidade e apoio contínuo. Há um sistema de taxas "progressivas", no qual o valor pago por um indivíduo é determinado com base na sua renda familiar, que é calculada com base nas contas de serviços públicos, documentos de contratação do funcionalismo público, auto-declarações e outros indicadores de renda. Esse programa de cadeiras de rodas constatou que o sistema de associação é eficaz em vários níveis: • Os membros sentem-se habilitados para esperar um serviço e produto de qualidade. • Como pagam um valor significativo relativamente ao seu nível de renda (em geral na faixa de US$ 2– 20, podendo chegar a US$ 150), os membros tendem a valorizar as suas cadeiras de rodas e ter orgulho de serem os proprietários. • Como a associação lhes dá o direito a um acompanhamento gratuito ou descontado durante um período de dois anos, aumenta a probabilidade de os associados solicitarem o acompanhamento mais cedo. Possíveis ações para superar os obstáculos ao acompanhamento Motive, engaje e incentive os utilizadores do serviço a descobrir os benefícios do acompanhamento: • Explique os benefícios do acompanhamento durante a capacitação do cadeirante na etapa 7 do serviço; • Partilhe histórias sobre os benefícios do acompanhamento na sala de espera, nos websites, em quadros de avisos na comunidade; • Sistema de associação para os utilizadores do serviço. Motive, engaje e incentive o pessoal do serviço a descobrir os benefícios do acompanhamento: • Implemente um esquema piloto de acompanhamento fornecido pelo pessoal do serviço; • Reúna estudos de casos sobre os benefícios do acompanhamento. Identifique um resultado imediato e mensurável: • Defina metas para um esquema piloto de acompanhamento; • Recolha e partilhe histórias de sucesso. Dê prioridade ao acompanhamento ao distribuir recursos: • Utilize histórias de sucesso sobre os benefícios do acompanhamento para apoiar a angariação de recursos para cobrir custos específicos relacionados com o acompanhamento; • Reserve tempo para desenvolver parcerias com a comunidade, além de capacitar e orientar o pessoal na comunidade; • Tenha acessibilidade a todos os transportes. Mantenha o apoio para enfrentar desafios constantes: • Monitore os dados do acompanhamento com atenção e identifique as raízes dos problemas; • Integre o acompanhamento no modelo de serviço, sistemas e procedimentos. Manual de Referência do WSTP para Gerentes – Página 56 Inclusão e participação na comunidade O acompanhamento é o momento de avaliar o impacto do serviço e verificar se cumpre a visão geral: melhorar a qualidade de vida, inclusão e participação na comunidade. Uma das funções mais amplas de um serviço de cadeiras de rodas é aumentar a acessibilidade. Isso pode ter um impacto significativo na inclusão e participação dos cadeirantes na comunidade. Residências e espaços públicos acessíveis Um dos principais obstáculos ao retorno à casa com frequência é o acesso aos sanitários Orientações sobre medidas simples que podem ser tomadas em casa podem fazer uma enorme diferença na qualidade de vida Uma campanha contra obstáculos arquitetônicos na Nicarágua Na Nicarágua, uma OPD chamada CADISCA realizou uma campanha na capital, Manágua, para destacar o problema da altura de guias e degraus. Os membros da OPD (todos cadeirantes) construíram 200 rampas e guias rebaixadas (nivelando uma pequena extensão da guia com a rua) em apenas três meses, criando acesso a áreas públicas. Os associados da CADISCA foram vistos na sua comunidade, engajados numa atividade positiva, o que aumentou o apoio e instigou empresas locais a patrocinar a construção de mais guias rebaixadas e rampas na cidade. No início, a CADISCA utilizou o basquete em cadeiras de rodas para promover a auto-confiança e aumentar o envolvimento dos associados nas atividades da OPD. As sessões de capacitação esportiva também criaram oportunidades para reuniões regulares da OPD, onde foram elaborados planos para campanhas de sensibilização. Essas sessões de capacitação foram realizadas num parque público, expondo a comunidade às atividades da OPD e aumentado a sensibilização. Em última análise, o programa esportivo ajudou a influenciar o sucesso da campanha de acesso por meio da sensibilização do público e do apoio a pessoas com deficiência. Isso ajudou a exercer pressão sobre o governo para financiar as guias rebaixadas em toda a cidade de Manágua. A remoção de obstáculos físicos tem oferecido igualdade de oportunidades para os cadeirantes no acesso a áreas financeiras, educacionais e sociais importantes da cidade. Manual de Referência do WSTP para Gerentes – Página 57 O custo da inclusão de recursos de acessibilidade no momento da construção é mínimo – às vezes menos de 1% do custo de construção. O acesso à educação pode ser impedido por algo tão simples como a largura de uma passagem e o acesso a sanitários. Ter a capacidade de oferecer recursos e informações sobre prédios e passagens acessíveis pode habilitar as escolas a ser inclusivas. Há vários recursos para dar acessibilidade a prédios.2 Ao oferecer orientações e informações sobre ambientes acessíveis, os serviços podem facilitar o acesso a residências, transportes e educação, assim como maximizar as oportunidades de inclusão e participação das pessoas com deficiência de mobilidade. Transportes acessíveis O transporte é um obstáculo comum para os cadeirantes. Desafios: • convencer os meios de transporte a parar pelo tempo suficiente para transferir e embarcar uma cadeira de rodas • cobrança de uma taxa adicional pelo transporte de uma cadeira de rodas • risco de roubo de peças removíveis, como, por exemplo, as rodas • dificuldade de acesso a transportes por causa de entradas e portas. Há iniciativas de transportes inclusivos em vários países, como a Dial a Ride na África do Sul e o sistema de ônibus expressos na Colômbia. Há vários recursos úteis sobre transportes acessíveis no mundo inteiro.3 2 Consideração de Projeto para Acessibilidade 2006 – Acessibilidade: Instalações de Saúde 2006; Acessibilidade: Escolas 2006. Para obter mais informações sobre acessibilidade, organizações internacionais como a CBM e a Handicap International oferecem recursos detalhados. 3 Recursos úteis com mais informações sobre transportes acessíveis: International Transport Forum (ITF), Accessible Multimodal Transport, África do Sul, Access Exchange International Newsletter, Paratransit Guide – Guidebook to Transport Issues. Manual de Referência do WSTP para Gerentes – Página 58 C.4 Planejamento da sustentabilidade financeira O que é sustentabilidade financeira? Para um serviço de cadeiras de rodas, sustentabilidade financeira significa ter os fundos e recursos necessários para realizar as oito etapas do fornecimento de serviços de cadeiras de rodas e cumprir as responsabilidades mais amplas do serviço – continuamente. Os gerentes de serviços de cadeiras de rodas desempenham uma função essencial na elaboração de um plano para dar sustentabilidade financeira ao serviço de cadeiras de rodas. Exemplo da declaração de sustentabilidade financeira de um serviço Um programa sustentável de fornecimento de cadeiras de rodas é aquele que tem a capacidade de fornecer cadeiras de rodas adequadas por meio das oito etapas de serviço a uma quantidade constante de indivíduos ao longo de um período significativo de tempo. Isso requer investimentos contínuos em produtos, na capacitação do pessoal, em espaço e em sistemas de monitoramento e avaliação. Um serviço alcança a sustentabilidade financeira quando tem a capacidade constante de assegurar os fundos e recursos necessários para viabilizar o investimento contínuo. Planejamento da sustentabilidade financeira O planejamento da sustentabilidade financeira inclui: • identificar claramente os fundos e recursos necessários para sustentar o serviço (veja B.5); • identificar potenciais fontes de financiamento; • identificar potenciais apoios não monetários; • elaborar uma estratégia para assegurar financiamentos e doações em espécie. Identificação de potenciais fontes de financiamento Os serviços de cadeiras de rodas podem ser financiados de várias formas diferentes, por uma série de diferentes fontes de financiamento. Alguns serviços podem ter uma única fonte de financiamento (por exemplo, o governo), mas a maioria dos serviços obtêm os fundos e recursos necessários de uma variedade de fontes. Cada fonte de financiamento pode contribuir para área(s) específica(s) do orçamento ou das necessidades de recursos. Diferentes fontes de financiamento que os gerentes podem considerar Governo Estruturas nacionais de seguro Doadores e patrocinadores individuais Doadores e patrocinadores empresariais Contribuições dos cadeirantes ou preço total Geração de receitas/empreendimento social Grupos comunitários/instituições beneficentes Missões diplomáticas ONG internacionais e nacionais Identificação de potenciais apoios não monetários O apoio não monetário inclui doações em espécie (por exemplo, doações de equipamentos, cadeiras de rodas, materiais), apoio de voluntários, disponibilização de instalações. O apoio não monetário pode reduzir o valor dos fundos necessários para gerir o serviço. Alguns serviços de cadeiras de rodas podem receber regularmente doações de cadeiras de rodas. Embora isso possa ser muito útil, sempre é importante que o serviço avalie se as cadeiras de rodas são adequadas e de boa qualidade. Nem todas as cadeiras de rodas doadas são adequadas. Manual de Referência do WSTP para Gerentes – Página 59 Combinação de diferentes fontes de financiamento para sustentar um serviço de cadeiras de rodas O quadro abaixo apresenta exemplos das diferentes fontes de financiamento que um exemplo de serviço de cadeiras de rodas identificou e como essas fontes de financiamento contribuem para os fundos e recursos necessários para a sustentabilidade financeira da organização. Fontes de financiamento para um exemplo de serviço de cadeiras de rodas Fonte de financiamento Fundos ou recursos fornecidos Governo • Contribui 50% do custo de cada cadeira de rodas fornecida pelo serviço; • Financia dois funcionários que trabalham para o serviço de cadeiras de rodas (50% do orçamento de recursos humanos). Empresas • Uma empresa local faz uma doação anual à rubrica de cadeiras de rodas do orçamento; • Outra empresa local comprometeu-se a patrocinar dez crianças por ano – cobrindo o custo das cadeiras de rodas e do fornecimento dos serviços. Indivíduos • Fazem doações ao serviço (não direcionadas a nenhuma rubrica específica do orçamento). Atividades de empreendimento social: • O serviço de cadeiras de rodas realiza várias atividades de empreendimento social, como a realização de auditorias de acessibilidade (de prédios) e o fornecimento de produtos de controle urinário. Os lucros do trabalho são utilizados para apoiar o serviço de cadeiras de rodas e geralmente são suficientes para financiar pelo menos 50% do orçamento de recursos humanos. ONG internacionais • O serviço recebeu dois financiamentos de ONG internacionais para fornecer cadeiras de rodas a pessoas que vivem em áreas específicas. Organização religiosa: • Faz uma contribuição anual de 200 cadeiras de rodas (selecionadas pelo serviço). Elaboração de uma estratégia Após a identificação de potenciais fontes de financiamento, os gerentes do serviço devem elaborar uma estratégia para o tipo de apoio que solicitarão de cada potencial fonte de financiamento e em que valor. Parte da elaboração de uma estratégia inclui considerar a probabilidade de a fonte de financiamento fazer uma contribuição, o valor que a fonte de financiamento poderia oferecer e quanto tempo e esforço serão necessários para obter o financiamento. Para ajudar a elaborar uma estratégia, os gerentes podem priorizar as diferentes fontes de financiamento e planejar como assegurarão o financiamento. Os gerentes devem considerar: • Fonte de financiamento: quem será contatado? • Apoio: o gerente pedirá o apoio da fonte de financiamento para o quê? Pode concentrar-se numa rubrica do orçamento, como, por exemplo, produtos, ou numa etapa (ou etapas) de serviço com várias rubricas orçamentais associadas. Considere a fonte específica de financiamento e o que tendem a apoiar. • Solicitação: que valor será solicitado da fonte de financiamento? Entre os fatores a considerar destacam-se recursos da fonte de financiamento e o volume de doações anteriores ao serviço ou a outras instituições. Solicite um valor realista. Manual de Referência do WSTP para Gerentes – Página 60 • Probabilidade: qual é a probabilidade de que a fonte de financiamento atenderá/apoiará o serviço? Pode ser categorizada como baixa, média e alta. • Esforço: o que será necessário para assegurar o financiamento, e quais serão os relatórios ou outras obrigações? O nível de esforço para assegurar o financiamento deve ser proporcional ao valor do financiamento. As obrigações também devem ter um custo acessível/viável para o serviço. O quadro abaixo apresenta dois exemplos. Ao considerar o tipo de apoio, a solicitação, a probabilidade de sucesso e o esforço necessário, os gerentes podem priorizar melhor as fontes de financiamento a serem exploradas. Abordagens de financiamento Pode ser difícil obter fontes de financiamento sustentável para um serviço de cadeiras de rodas. Abaixo apresentamos alguns exemplos de diferentes abordagens de financiamento para consideração. Observe que as abordagens com frequência são diferentes, de acordo com a fonte de financiamento. Uma abordagem comercial para atender a uma necessidade social e gerar receitas Fonte de financiamento Tipo de apoio Solicitação Probabilidade Esforço 1. Empresas Doação ao orçamento de compra de cadeiras de rodas 10% do orçamento de cadeiras de rodas Média (ofereceu um financiamento anteriormente, mas nem sempre financia a mesma organização todos os anos) Pelo menos duas reuniões com o gerente comercial; proposta de 2 páginas e apresentação de um orçamento, além de um convite ao gerente para o próximo dia de visita 2. Governo local Potencialmente pode financiar os custos de todas as visitas em campo a cadeirantes da sua área 20% de todos os custos em campo + 20% dos salários do pessoal do serviço Alta (já há discussões com esse governo local há algum tempo. Foi realizado um trabalho em campo na sua área. Estão muito ansiosos para apoiar o trabalho e parece haver recursos disponíveis) Apresentação de proposta formal e orçamento. Relatórios obrigatórios – exigem dados precisos de todas as pessoas visitadas na sua área, além de relatórios financeiros Manual de Referência do WSTP para Gerentes – Página 61 Uma ONG na Romênia utiliza o empreendimento social como parte da sua abordagem à sustentabilidade financeira. A abordagem tem dois objetivos principais: um social e um financeiro. Os cadeirantes são empregados como parte de equipes multidisciplinares que fornecem equipamentos de mobilidade e suprimentos médicos de qualidade a pessoas com deficiência. A qualidade dos serviços é alta, pois as equipes estão bem conscientes da importância do posicionamento correto e da prevenção de problemas de saúde. A atividade oferece empregos para pessoas com deficiência, criando consumidores hábeis. Os serviços também geram receitas para apoiar outros programas administrados pela ONG. Compra direta pelo fornecedor Alguns serviços de cadeiras de rodas exigem uma contribuição mínima do cadeirante para receber uma cadeira de rodas e serviços de cadeiras de rodas. Com frequência há um sistema de taxas "progressivas", no qual o valor pago por um indivíduo é determinado com base na sua renda familiar, que é calculada com base nas contas de serviços públicos, documentos de contratação do funcionalismo público, auto-declarações e outros indicadores de renda. Os serviços que obtêm alguns recursos dessa forma têm de assegurar que as pessoas sem condições de pagar por quaisquer custos da cadeira de rodas não fiquem em desvantagem. Empresas doadoras e patrocinadoras O Teletón, no México, é um evento anual de televisão e rádio organizado para angariar recursos para centros de reabilitação de crianças (centros CRIT). O programa é produzido pela Televisa e mais de 600 meios de comunicação mexicanos e de outros países; e 20 empresas comerciais patrocinam o evento. Eles vendem a sua visão de sucesso com histórias positivas e marcantes sobre a integração e as realizações. Durante um período de três meses antes do evento, são divulgados estudos de casos pelos meios de comunicação, para aumentar o interesse. Personalidades de alto perfil participam na promoção do evento. Na Romênia, uma ONG tem um relacionamento com uma empresa patrocinadora. Para consolidar esse relacionamento, há um evento de gala anual de natação num prestigioso centro de saúde. Equipes integradas com funcionários da empresa, capacitadores, pessoal da ONG e pessoas com deficiência de aprendizagem competem entre si. É um evento divertido com benefícios em vários níveis. Os funcionários da empresa oferecem um apoio contínuo durante todo o ano com contribuições diretas ou eventos de angariação de recursos. Financiamentos do governo No Quênia, o Ministério dos Serviços Médicos entrou em parceria com uma ONG de cadeira de rodas e correspondentes serviços de reabilitação. A ONG oferece todo o apoio logístico a oito filiais alojadas em hospitais públicos. O governo contribui os recursos humanos. Até esta data, o Ministério já designou 56 funcionários às filiais da ONG. Manual de Referência do WSTP para Gerentes – Página 62 Para obter mais recursos de apoio ao fornecimento de serviços de cadeiras de rodas de nível básico e intermediário, consulte o DVD/Pendrive Estrutura nacional de seguro na Romênia • A primeira etapa para o cadeirante é solicitar um certificado de deficiência. Sem esse certificado, não é possível solicitar uma cadeira de rodas. • Em seguida, deve marcar uma consulta com um médico de reabilitação que prescreve uma cadeira de rodas. • O cadeirante apresenta uma solicitação à Agência Nacional de Seguro (NIA, na sigla em inglês) do país. • Ao receber a aprovação/o cupom, o cadeirante escolhe um fornecedor e uma das suas cadeiras de rodas. • Caso o preço da cadeira de rodas seja inferior ao subsídio, a cadeira de rodas é fornecida e paga com o cupom, que o fornecedor utiliza para receber o pagamento da NIA. • Caso o preço da cadeira de rodas seja superior ao subsídio, o cadeirante tem de encontrar fontes complementares de financiamento, como, por exemplo, doadores, empresas e indivíduos. Observe que o livro de exercícios do participante vem em seguida – o livro de exercícios não é separado como no WSTPb/WSTPi. Manual de Referência do WSTP para Gerentes – Página 63 Referências 1. i Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. Genebra: Organização Mundial da Saúde; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 2. ii Wheelchair Service Training Package – Basic Level. Genebra: Organização Mundial da Saúde; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. iii Wheelchair Service Training Package – Intermediate Level. Genebra: Organização Mundial da Saúde; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4. iv Convenção sobre os Direitos das Pessoas com Deficiência, Resol. A.G. 61/106 (2007) Nova York: Organização das Nações Unidas; 2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. v Há relatos sobre como os dispositivos assistivos fornecidos por meio de um serviço reduzem o tempo e o esforço físico para os atendentes (Allen et al., 2006). 6. vi Diretrizes para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos. 7. vii Diretrizes da OMS para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos 2008, pág. 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 8. viii Wyndaele M, Wyndaele JJ (2006). Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 44: 523–529. 9. ix Razzak ATMA, Helal SU, Nuri RP (2011). Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclusive Development Journal; 22(1): 114-123. 10. x Relatório Mundial da Organização Mundial da Saúde e do Banco Mundial sobre Deficiência, página 115. Genebra: Organização Mundial da Saúde; 2011 (http://www.who.int/disabilities/world_report/2011/report/en/). 11. xi Messiou, K. (2008) Encouraging children to think in more inclusive ways, British Journal of Special Needs Education, 35, 1, pág. 26-32. Manual de Referência do WSTP para Gerentes – Página 64 Livro de Exercícios do Participante Ações para gerentes para criar ou melhorar o fornecimento de serviços de cadeiras de rodas A. Conhecimentos básicos B: Criação de um serviço de cadeiras de rodas C: Administração de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 65 A.3 Liderança de mudanças Examine os facilitadores de mudança relacionados abaixo. Registre as ações que você pode empreender para criar ou melhorar o fornecimento de cadeiras de rodas no seu centro de serviço. 1. Criar uma visão comum para o fornecimento de cadeiras de rodas adequadas 2. Comunicar a importância do fornecimento de cadeiras de rodas adequadas com um senso de urgência 3. Alinhar pessoal e recursos 4. Motivar, engajar e incentivar o pessoal. • Incluir o pessoal no planejamento e na implementação • Superar os obstáculos juntos • Criar e reconhecer as conquistas de curto prazo • Dar persistência à mudança nos sistemas e na cultura da sua organização B.1 Acesso aos serviços 1. Ações que posso empreender para identificar fontes de encaminhamento 2. Ações que posso empreender para desenvolver uma rede de encaminhamento Manual de Referência do WSTP para Gerentes – Página 66 3. Ações que posso empreender para decidir se promovo um formulário de encaminhamento ou não 4. Ações que posso empreender para trabalhar ativamente para assegurar um serviço de cadeiras de rodas equitativo. B.2 Instalações e equipamentos 1. Ações que posso empreender para identificar instalações e equipamentos adequados para o meu modelo de serviço 2. Ações que posso empreender para integrar formulários e listas de verificação nas etapas de serviço 3. Ações que posso empreender para organizar as instalações 4. Ações que posso empreender para criar sistemas e procedimentos para cada instalação, inclusive a delegação de trabalho onde possível B.3 Variedade de cadeiras de rodas adequadas 1. Ações que posso empreender para identificar as necessidades dos utilizadores do serviço e as características mais importantes dos produtos para atender a essas necessidades 2. Ações que posso empreender para identificar a devida variedade de cadeiras de rodas adequadas, almofadas e peças sobressalentes Manual de Referência do WSTP para Gerentes – Página 67 3. Ações que posso empreender para identificar suprimentos adequados de materiais para fazer modificações nos produtos 4. Ações que posso empreender para discutir a relação custo/benefício de cadeiras de rodas e almofadas adequadas fornecidas por meio de um serviço com diferentes partes interessadas B.4 Alinhamento de pessoal 1. Ações que posso empreender para identificar pessoal para o serviço 2. Ações que posso empreender para incluir o pessoal do serviço no planejamento 3. Coordenar o trabalho em equipe e estabelecer um plano de trabalho semanal 4. Ações que posso empreender para identificar a capacidade anual do serviço B.5 Custo de um serviço de cadeiras de rodas 1. Ações que posso empreender para considerar a integração do serviço ao planejar um modelo de serviço 2. Ações que posso empreender para considerar parcerias comunitárias ao planejar um modelo de serviço 3. Ações que posso empreender para elaborar um orçamento para o modelo de serviço planejado Manual de Referência do WSTP para Gerentes – Página 68 C.1 Como sei se o meu serviço funciona? Áreas e atividades do serviço Metas de desempenho do serviço Métodos de recolha de informações Encaminhamento Quantidade de cadeirantes encaminhados O serviço receberá 30 encaminhamentos por mês Registre os encaminhamentos recebidos Fornecimento de cadeiras de rodas Quantidade de cadeirantes que recebem uma cadeira de rodas O serviço prescreverá e adaptará cadeiras de rodas para 20 cadeirantes por mês As prescrições de cadeiras de rodas são registradas nas pastas dos cadeirantes População de cadeirantes atendida Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural O serviço incentivará a igualdade de acesso Quantidade de mulheres, homens, meninas e meninos que utilizam o serviço, de acordo com os dados registrados nas pastas do cadeirantes Custos do serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço O custo individual de cada cadeira de rodas será inferior a (valor especificado de acordo com o orçamento e o custo realista dos produtos disponíveis) Endereço residencial dos cadeirantes que utilizam o serviço – de acordo com os dados registrados nas pastas do cadeirantes Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Manual de Referência do WSTP para Gerentes – Página 69 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. Registre as ações que você pode empreender para saber se o serviço funciona (caso haja tempo) 1. Ações que posso empreender para criar um plano de serviço 2. Ações que posso empreender para monitorar o pessoal ao elaborar um plano de serviço 3. Ações que posso empreender para avaliar o grau de eficácia do serviço no cumprimento do seu objetivo 4. Ações que posso empreender para reconhecer a equipe ou sucessos individuais C.2 Gestão da demanda 1. Ações que posso empreender para estabelecer um sistema para monitorar encaminhamentos e gerir listas de espera 2. Ações que posso empreender para partilhar as histórias de sucesso de encaminhamentos precoces com pais e fontes de encaminhamento 3. Ações que posso empreender para planejar a gestão de encaminhamentos com necessidades que ultrapassem a capacidade do serviço Manual de Referência do WSTP para Gerentes – Página 70 4. Ações que posso empreender para monitorar e aumentar a eficiência das etapas de serviço. C.3 Planejamento do acompanhamento 1. Ações que posso empreender para planejar o acompanhamento 2. Ações que posso empreender para criar e capacitar parceiros comunitários 3. Ações que posso empreender para identificar potenciais candidatos para capacitação e acompanhamento de cadeirantes 4. Ações que posso empreender para obter e divulgar histórias de sucesso sobre os benefícios do acompanhamento Manual de Referência do WSTP para Gerentes – Página 71 C.4 Planejamento da sustentabilidade financeira 1. Ações que posso empreender para criar uma visão comum da sustentabilidade financeira 2. Ações que posso empreender para identificar os fundos e recursos necessários 3. Ações que posso empreender para identificar fontes de encaminhamento 4. Ações que posso empreender para priorizar as fontes de encaminhamento e elaborar uma estratégia de angariação de recursos Manual de Referência do WSTP para Gerentes – Página 72 Seção A. Atividades relacionadas com os conhecimentos básicos A.1 Apoio ao fornecimento de cadeiras de rodas adequadas: Política nacional • Leia os dois exemplos de política nacional referente ao fornecimento de cadeiras de rodas. • Considere as políticas já adotadas no seu país • Discuta o grau de utilidade que as políticas abaixo teriam no seu país e considere onde se enquadrariam na estrutura do governo Exemplo 1: Política de fornecimento de cadeiras de rodas no Afeganistão Em outubro de 2003, o Ministério dos Mártires e Pessoas com Deficiência do Afeganistão publicou uma Política Nacional Abrangente sobre Deficiência. A política foi “elaborada em colaboração com todas as partes interessadas, inclusive organização de pessoas com deficiência e grupos de auto- ajuda; ONG nacionais e internacionais que trabalham com deficiências; ministérios importantes, como o Ministério da Educação, Ministério da Saúde Pública, Ministério do Trabalho e Questões Sociais, Ministério de Questões da Mulher e Ministério dos Mártires e Pessoas com Deficiência; órgões pertinentes da ONU; e o Gabinete da Presidência” (4). Espera-se que a política inicial resulte num plano de ação mais detalhado e priorizado. A política declara: O apoio oferecido a pessoas com deficiência física deve incluir centros de reabilitação ortopédica; serviços de fisioterapia, assim como dispositivos ortopédicos, assistivos e de mobilidade. Esses serviços devem ser oferecidos próximo a um hospital regional ou provincial com serviços de cirurgia ortopédica para facilitar o acesso da população local. Todos os pacientes têm o direito de receber dispositivos. Os dispositivos devem ser bem fabricados, bem adaptados e com materiais locais sempre que possível, além de poderem ser reparados localmente. A respectiva tecnologia deve ser padronizada em todo o país. Deve-se criar um mecanismo de padronização nacional, com peritos relevantes, em colaboração com o Ministério da Saúde Pública Exemplo 2: Política de fornecimento de cadeiras de rodas na África do Sul Manual de Referência do WSTP para Gerentes – Página 73 Em 2003, a África do Sul publicou diretrizes nacionais para dispositivos assistivos no país. Essas diretrizes foram elaboradas em consulta com todas as províncias da África do Sul. A contribuição feita pela província do Western Cape baseou-se na sua experiência na elaboração de diretrizes provinciais. A elaboração de diretrizes provinciais foi iniciada por um grupo de clínicos que forneciam serviços de cadeiras de rodas. Consultaram um gerente do programa provincial e os serviços locais de reabilitação para elaborar um plano para profissionalizar o padrão de serviços de cadeiras de rodas. O plano tinha três áreas de enfoque principais: 1. Realizar uma análise da situação dos serviços de cadeiras de rodas na província; 2. Implementar a capacitação dos fornecedores de serviços de cadeiras de rodas; e 3. Definir diretrizes para a estratégia provincial para a gestão de cadeira de rodas. Foram elaboradas diretrizes provinciais que incluíram padrões mínimos para as principais etapas de serviço, assim como as principais etapas de gestão, como capacitação do pessoal, criação e gestão de listas de espera, orçamentos e fornecimento de serviços de reparo e manutenção. A gestão provincial ajudou o grupo a tornar-se um grupo assessor formal. Os representantes desse grupo passaram a acompanhar os administradores provinciais em reuniões nacionais e contribuíram para a definição de diretrizes nacionais para dispositivos assistivos na África do Sul. A.2 Fornecimento de serviços Funções mais amplas dos gerentes Manual de Referência do WSTP para Gerentes – Página 74 Ações comuns para melhorar o fornecimento de cadeiras de rodas adequadas no país Ações que posso empreender nos próximos três meses Manual de Referência do WSTP para Gerentes – Página 75 Seção B. Início das atividades de um serviço de cadeiras de rodas B.2.1 Instalações e equipamentos: Identificação de instalações adequadas • Examine a lista de instalações abaixo • Pense sobre soluções práticas que funcionariam no seu serviço. Instalações de nível básico Essas instalações já existem? Essas instalações poderiam ser compartilhadas com um serviço existente? Uma sala com outra finalidade poderia ser convertida? Uma sala já existente poderia ser reorganizada ou reestruturada? 1. Sala de espera e recepção 2. Área tranquila para deitar-se 3. Sanitários acessíveis 4. Área de escritório para o pessoal 5. Área clínica para avaliação e adaptação Manual de Referência do WSTP para Gerentes – Página 76 6. Área técnica para preparação, manutenção e reparo de cadeiras de rodas 7. Armazenamento 8. Capacitação do cadeirante Instalações adicionais de nível intermediário Essas instalações já existem? Essas instalações poderiam ser compartilhadas com um serviço existente? Uma sala com outra finalidade poderia ser convertida? Uma sala já existente poderia ser reorganizada ou reestruturada? 9. Área de avaliação e adaptação com leito para avaliação com a pessoa deitada 10. Espaço adicional para armazenamento de materiais 11. Área adicional de preparação de produtos: costura e estofamento B.2.2 Instalações e equipamentos: identificação dos equipamentos • Consulte as diretrizes para equipamentos e documentação no manual de referência Manual de Referência do WSTP para Gerentes – Página 77 Equipamentos • Consulte o manual de referência • Identifique os equipamentos que já estão disponíveis e em utilização no seu centro de serviço e anote eventuais equipamentos a serem fabricados ou comprados Já disponíveis A serem fabricados ou comprados Documentos Examine a lista de formulários e listas de verificação na pasta recursos adicionais no DVD/Pendrive. • Que formulários e listas de verificação já estão integrados e em utilização? Anote quaisquer formulários ou listas de verificação a serem integrados no dia-a-dia Já disponíveis A serem integrados no serviço existente B.2.3 Instalações e equipamentos: organização do espaço de trabalho • Consulte as diretrizes para instalações e equipamentos no manual de referência. • Consulte as recomendações para a boa organização do espaço de trabalho relacionadas abaixo 1. Elimine a desordem: remova todas as ferramentas, peças, equipamentos e documentos desnecessários 2. Identifique os artigos utilizados com regularidade: ferramentas, peças, instruções e documentos. Esses artigos devem ser organizados para facilitar e agilizar a sua localização 3. Sistema e responsabilidade: tenha um sistema para cada local de trabalho e alguém responsável pela implementação do sistema 4. Monitore: o sistema para assegurar a "persistência" da mudança Manual de Referência do WSTP para Gerentes – Página 78 Área técnica Analise o exemplo e faça recomendações para melhorias Área clínica e técnica em campo Analise o exemplo e faça recomendações para melhorias B.3.1 Variedade de cadeiras de rodas adequadas: durabilidade, possibilidade de reparo • Trabalhe em conjunto com o seu grupo e responda à série de perguntas designada a você – com base no número do seu grupo. • Baseie-se nos seus próprios conhecimentos e experiências, além do manual de referência, para realizar a atividade. Grupo 1 • Que perguntas você pode fazer sobre a segurança e durabilidade dos produtos fornecidos? • Como você pode descobrir se os produtos recebidos do fornecedor (doador, fabricante) são seguros e duráveis no seu contexto específico? • Com quem mais você pode falar para obter informações sobre a segurança e durabilidade dos produtos oferecidos por um doador/fabricante/fornecedor? Manual de Referência do WSTP para Gerentes – Página 79 Durabilidade Grupo 2 • Mesmo os produtos que são duráveis têm peças que normalmente se desgastam e quebram. Quais são algumas dessas peças vulneráveis? Peças que se desgastam e quebram Grupo 3 • Um serviço precisa de peças sobressalentes • Como você pode identificar as peças sobressalentes necessárias? • Como você sabe que peças sobressalentes têm de ser encomendadas? Peças sobressalentes B.3.2 Variedade de cadeiras de rodas adequadas: fornecimento de cadeiras de rodas adequadas Cenário 1 • Leia o cenário designado a você abaixo. Em seguida, leia os "Princípios do fornecimento de dispositivos de mobilidade adequados" • Prepare um cenário de encenação com autoridades provinciais e um grupo de partes interessadas promovendo uma mudança no sistema de compra de cadeiras de rodas (de 3 a 5 minutos de encenação). Ao discutir a encenação, pense sobre • Quais são os problemas identificados no cenário? • Possíveis ações para superar os problemas Manual de Referência do WSTP para Gerentes – Página 80 Um hospital público na sua região adotou um orçamento para o fornecimento de cadeiras de rodas. Todos os anos, o orçamento é reexaminado e a lista de produtos é reconsiderada. Todos os anos há solicitações de mudança de produtos disponíveis, mas nunca ocorre nenhuma mudança e o departamento de compras adquire dois tipos de produtos com base no custo. Princípios do fornecimento de dispositivos de mobilidade adequados Para que os países possam cumprir com as suas obrigações relacionadas com a tecnologia assistiva (dispositivos de mobilidade), definidas na Convenção sobre os Direitos das Pessoas com Deficiência, é necessário considerar os seguintes princípios chave: • Aceitabilidade – pessoas com deficiência devem participar em todas as etapas do fornecimento de dispositivos de mobilidade; • Acessibilidade – dispositivos de mobilidade e serviços afins devem ser acessíveis para todos que tenham uma necessidade identificada; • Adaptabilidade – dispositivos de mobilidade e serviços afins devem ser adaptados e modificados para que sejam adequados às necessidades do indivíduo; • Viabilidade econômica – dispositivos de mobilidade e serviços afins devem ser economicamente viáveis; • Disponibilidade – instalações, pessoal e produtos devem ser suficientes para as necessidades da população e estar localizados o mais próximo possível das comunidades das pessoas; • Qualidade – produtos, instalações e serviços devem ter qualidade adequada. Cenário 2 • Leia sobre os dois sistemas de licitação do governo abaixo • Resuma o sistema atual do seu país. • Consulte os "Princípios do fornecimento de dispositivos de mobilidade adequados" (na página anterior) • Prepare sugestões para criar ou melhorar o sistema de licitação do governo para o fornecimento de cadeiras de rodas no seu país. África do Sul Manual de Referência do WSTP para Gerentes – Página 81 Na África do Sul, a compra de cadeiras de rodas pelo governo é controlada por uma Licitação Nacional. O governo trabalha com pessoas de diferentes províncias com experiência em cadeiras de rodas e serviços de cadeiras de rodas. Também consulta os atuais fornecedores de cadeiras de rodas. Após a consulta, as categorias de produtos e os artigos dessas categorias são finalizados, com uma especificação detalhada de cada produto. As categorias abrangem uma variedade de almofadas para conforto e casos de alto risco. São especificados os padrões mínimos de durabilidade para cada produto. Após a finalização e aprovação das especificações da licitação, o tesouro nacional abre o processo de licitação. Todos os produtos apresentados na licitação são inspecionados por representantes experientes antes da concessão dos contratos. Os contratos incluem prazos mínimos de entrega e as cláusulas de penalidades por descumprimento das condições dos contratos. Romênia O financiamento público de cadeiras de rodas na Romênia é como o subsídio para medicamentos. O processo de subsídio para cadeiras de rodas começou em 2001, quando o Estado organizou uma licitação para fornecedores de cadeiras de rodas. Como resultado da licitação, um preço de base/referência foi definido de comum acordo, mas não houve nenhuma definição de qualidade dos produtos ou do fornecimento de serviços. O valor do subsídio é reestabelecido a cada ano. A primeira etapa para o cadeirante é solicitar um certificado de deficiência. Sem o certificado, é impossível ter acesso a uma cadeira de rodas. Em seguida, o cadeirante deve marcar uma consulta com um médico de reabilitação, que prescreverá uma cadeira de rodas. O cadeirante apresenta uma solicitação à Agência Nacional de Seguro (NIA, na sigla em inglês) do país. Ao receber a aprovação/o cupom, o cadeirante escolhe um fornecedor ee, em seguida, uma cadeira de rodas. Caso o preço da cadeira de rodas seja inferior ao subsídio, a cadeira de rodas é fornecida e paga com o cupom, que o fornecedor utiliza para receber o pagamento da NIA. Caso o preço da cadeira de rodas seja superior ao subsídio, o cadeirante tem de encontrar fontes complementares de financiamento, como, por exemplo, doadores, empresas e indivíduos. Cenário 3 • Prepare um cenário de encenação que demonstre uma reunião com um doador, na qual você apresenta um plano para fornecer cadeiras de rodas adequadas por meio do sistema de fornecimento de serviços (de 3 a 5 min de encenação). Ao planejar a encenação • Discuta como as cadeiras de rodas doadas são distribuídas atualmente no seu país • Leia os "Princípios do fornecimento de dispositivos de mobilidade adequados" Manual de Referência do WSTP para Gerentes – Página 82 B.4 Alinhamento de pessoal: funções • Examine o quadro com as funções do pessoal do serviço de cadeiras de rodas. • Escreva o nome do responsável por cada função do quadro. • Caso seja responsável por mais de um centro de serviço, relacione o pessoal de cada centro de serviço. Clínica Técnica Capacitaçã o de cadeirantes Administrati va Centro de serviço Centro de serviço Centro de serviço Manual de Referência do WSTP para Gerentes – Página 83 B.5.2 Custo de um serviço de cadeiras de rodas: integração de serviços 1. Examine: cada rubrica na ferramenta de orçamentação abaixo e considere os custos que podem ser divididos ou economizados com a integração de um serviço de cadeiras de rodas a um serviço existente. 2. Explique: Marque com um círculo preto todos os custos que podem ser economizados. Marque com um círculo vermelho todos os custos que podem ser divididos. Cenário de exemplo de um serviço integrado Um serviço de próteses e órteses planeja integrar um serviço de cadeiras de rodas. Dois funcionários foram escolhidos e enviados para receber capacitação de WSTP básico. Ambos os funcionários trabalharão três dias por semana no serviço de cadeiras de rodas e dois dias per semana no serviço de próteses e órteses. Foi designado um espaço de trabalho na oficina para um técnico de cadeiras de rodas. O departamento de terapia eliminou todos os equipamentos avariados e não utilizados para criar espaço para uma área de trabalho para a função clínica. Budget Guide Referral & appointment Assessment Perscription Funding & ordering Product preparation Fitting User - training Follow-up, maint. & rep. START-UP COSTS Product design ✓ Sourcing range of products ✓ Tools ✓ ✓ Equipment ✓ ✓ Building/facilities ✓ ✓ ✓ Stock of materials ✓ OPERATIONAL COSTS Wheelchairs ✓ ✓ Spare parts ✓ Materials ✓ ✓ ✓ Freight (product transport) ✓ ✓ Personnel Management ✓ ✓ ✓ Clinical staff ✓ ✓ ✓ ✓ ✓ ✓ ✓ Technical staff ✓ ✓ ✓ ✓ ✓ Peer trainer ✓ ✓ Administrator ✓ ✓ ✓ ✓ ✓ Local transport Local transport for personnel ✓ ✓ ✓ ✓ Local transport for clients ✓ ✓ ✓ Accommodation for clients ✓ ✓ Printed materials ✓ ✓ ✓ ✓ Consumables ✓ ✓ ✓ Tool replacement ✓ ✓ ✓ Overheads ✓ ✓ ✓ ✓ ✓ ✓ Training of personnel ✓ ✓ ✓ ✓ ✓ ✓ Training partners / referral network ✓ ✓ ✓ Fundraising ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Monitoring & evaluation ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ SERVICE STEPS Manual de Referência do WSTP para Gerentes – Página 84 Seção C. Administração de um serviço de cadeiras de rodas C.1.1 Serviços eficientes e eficazes: monitoramento Seção 1 • No seu grupo: leia e preencha a sua seção do quadro abaixo. • Algumas das caixas foram preenchidas para agilizar o início. As caixas restantes devem ser preenchidas. • Registre por que é útil saber se essas metas foram alcançadas. Áreas e atividades Exemplos de metas de desempenho Obtenção de dados Encaminhamento Quantidade de cadeirantes encaminhados O serviço receberá 30 encaminhamentos por mês Registre os encaminhamentos recebidos Tempo médio de espera entre o encaminhamento e a consulta Registre a data de recebimento do encaminhamento e a data da avaliação na pasta do cadeirante Fornecimento de cadeiras de rodas Quantidade de cadeirantes que recebem uma cadeira de rodas O serviço prescreverá e adaptará cadeiras de rodas para 20 cadeirantes por mês Tempo médio de espera entre a avaliação e a adaptação Quantidade de consultas de acompanhamento realizadas Registre por que é útil saber se essas metas foram alcançadas Metas alcançadas Metas não alcançadas Quantidade de cadeirantes encaminhados Tempo médio de espera entre o encaminhamento e a consulta Quantidade de cadeirantes que recebem uma cadeira de rodas Tempo médio de espera entre a avaliação e a adaptação Quantidade de consultas de acompanhamento realizadas Manual de Referência do WSTP para Gerentes – Página 85 Seção 2 Áreas e atividades Exemplos de metas de desempenho Obtenção de dados População de cadeirantes atendida Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural O serviço incentivará a igualdade de acesso O objetivo do serviço será atender às necessidades de cadeirantes que precisem de cadeiras de rodas básicas e os que precisem de modificações e suporte postural Quantidade de mulheres, homens, meninas e meninos que utilizam o serviço, de acordo com os dados registrados nas pastas do cadeirantes Tipos de necessidades posturais apresentadas e cadeiras de rodas prescritas, de acordo com os dados registrados nas pastas do cadeirantes Área geográfica abrangida pelo serviço Endereço residencial dos cadeirantes que utilizam o serviço – de acordo com os dados registrados nas pastas do cadeirantes Custos do serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço O custo individual de cada cadeira de rodas será inferior a (valor especificado de acordo com o orçamento e o custo realista dos produtos disponíveis) Tempo dedicado pelo pessoal nas atividades do serviço (avaliação, acompanhamento, capacitação, etc.) Registre por que é útil saber se essas metas foram alcançadas Possíveis respostas: Metas alcançadas Metas não alcançadas Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural Área geográfica abrangida pelo serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço Tempo dedicado pelo pessoal nas atividades do serviço (avaliação, acompanhamento, capacitação, etc.) Manual de Referência do WSTP para Gerentes – Página 86 C.1.2 Serviços eficientes e eficazes: feedback dos utilizadores • Há algumas considerações importantes ao planejar a obtenção de feedback dos utilizadores do serviço. Utilize esta lista de verificação e faça anotações para o seu serviço Planejamento do feedback dos utilizadores do serviço Pontos a considerar (transporte e tempo são dois dos custos mais significativos): Quando será realizado? Quem o realizará? Que perguntas de feedback devem ser feitas? Dados iniciais (consulte as ferramentas armazenadas na pasta recursos adicionais no DVD/Pendrive) Pontos a considerar: Para avaliar o impacto do serviço, é importante registrar a situação antes de qualquer intervenção, ou seja, antes do início da avaliação Quando serão obtidos os dados iniciais? Quem obterá esses dados? Os dados serão obtidos com que frequência? Registro e processamento de dados Pontos a considerar: O registro eficiente de dados economiza tempo e dinheiro Como você registrará os dados? Que métodos você pode utilizar para aumentar a eficiência do registro e processamento de dados o máximo possível? Quem registrará os dados? Quem processará os dados? Manual de Referência do WSTP para Gerentes – Página 87 C.1.3 Desenvolvimento de serviços eficientes: monitoramento de um plano de serviço o Crie um plano de serviço para o seu serviço. o Selecione uma necessidade ou dificuldade a ser monitorada pelo seu próprio serviço e preencha as informações sob cada título Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Manual de Referência do WSTP para Gerentes – Página 88 C.2.1 Gestão da demanda: geração de demanda e encaminhamento precoce • Leia o exemplo • Discuta e, em seguida, relacione os motivos do sucesso Exemplo de sucesso: encaminhamento precoce por pais no México Este é um exemplo de como um grupo de centros de reabilitação para crianças no México desenvolveu uma rede eficaz de encaminhamento precoce. Embora tivessem médicos neonatais e pediatras como os alvos principais das suas atividades de sensibilização, os centros de reabilitação também realizavam uma grande campanha anual de angariação de recursos na comunidade em geral, utilizando os meios de comunicação em massa, como rádio e televisão. Isso resultou em muitos encaminhamentos por pessoas que ouviram falar do serviço e muitos pais que auto-encaminham os seus filhos. Nessas campanhas de sensibilização, a mensagem era clara: a importância de encaminhar crianças para reabilitação ao nascerem. Também apresentaram uma visão potente de sucesso, com muitas histórias positivas relacionadas com a integração e as realizações das crianças com quem trabalham. Num período de 15 anos, os centros de reabilitação têm observado uma mudança cultural, com pediatras e famílias que agora ativamente fazem encaminhamentos precoces. O resultado: Um terço de todos os encaminhamentos são de crianças com até três anos de idade. Fatores de sucesso Manual de Referência do WSTP para Gerentes – Página 89 C.2.3 Gestão da demanda: análise das etapas do serviço Tempo disponível para o fornecimento de serviços a cada dia: _______ minutos o Trabalhem juntos, em grupos o Leia cada desafio no serviço na coluna 2 o Leia as possíveis estratégias para aumentar a eficiência do fornecimento de serviços no quadro abaixo o Corresponda os desafios no serviço com as estratégias para aumentar a eficiência. Anote o número de cada estratégia na coluna 3. Um desafio pode precisar de várias estratégias. Estratégias para aumentar a eficiência do serviço 1. Adquira produtos com o máximo possível de ajustabilidade 2. Adquira produtos que possam ser facilmente modificados 3. Adquira produtos com dispositivos de suporte postural 4. Prepare com antecedência amostras de opções de configuração de produtos 5. Fabrique com antecedência dispositivos de suporte postural 6. Agendamento claro para permitir trabalhos conjuntos 7. Reuniões da equipe para elaborar planos de trabalho compartilhados 8. Equipes clínicas e técnicas trabalham juntas durante a adaptação 9. Equipes clínicas e técnicas discutem soluções de prescrição 10. Clareza na documentação de informações e nos registros. 11. Planeje o nível adequado de capacitação para o pessoal do serviço 12. Adquira os materiais necessários para a fabricação e modificação de almofadas e DSP 13. Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos 14. Designe uma pessoa específica para a capacitação de cadeirantes, como, por exemplo, um capacitador de pares 15. Identifique uma instalação para a capacitação de cadeirantes próximo às áreas clínica e técnica 16. Crie sistemas eficazes de controle de estoques 17. Prepare um pequeno estoque de cadeiras de rodas em diferentes tamanhos 18. Crie parcerias com a comunidade para identificar utilizadores do serviço e oferecer transporte ao centro de serviço na comunidade 19. Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário 20. Esteja aberto a novas ideias – inovação. Coluna 1: desafios do serviço Coluna 2: estratégias do serviço Manual de Referência do WSTP para Gerentes – Página 90 Avaliação: 1. Se o pessoal do serviço viaja até o serviço ou faz visitas em casa, o tempo de deslocamento deve ser incluído na avaliação 2. Quando os membros da equipe são inexperientes, a avaliação leva mais tempo Prescrição: 3. Quando os produtos têm ajustabilidade limitada, as modificações devem ser prescritas de forma a adaptar o produto ao corpo do cadeirante 4. Quando os suportes posturais adicionais têm de ser fabricados, medições e desenhos adicionais são necessários Preparação do produto: 5. Acesso rápido ao tipo e tamanho de produto necessários 6. Quando uma cadeira de rodas tem ajustabilidade limitada, a preparação do produto pode exigir mais tempo 7. Quando é necessário fazer modificações para suporte postural, é necessário mais tempo Adaptação: 8. Caso a cadeira de rodas tenha sofrido modificações ou recebido suportes adicionais, a adaptação levará mais tempo 9. Caso tenham sido feitas modificações na configuração da cadeira de rodas durante a adaptação, será necessário fazer outras verificações de adaptação Capacitação do cadeirante: 10. Caso seja a primeira cadeira de rodas que a pessoa recebe ou haja uma complicação de saúde, será necessário mais tempo para a capacitação do cadeirante em saúde, mobilidade, manobra da cadeira de rodas, cuidado e manutenção, assim como o encaminhamento a outras fontes de encaminhamento Manual de Referência do WSTP para Gerentes – Página 91 C3: Planejamento do acompanhamento: superação dos obstáculos • Leia a lista de possíveis obstáculos ao acompanhamento abaixo e acrescente eventuais obstáculos adicionais que o grupo tenha destacado • Discuta ações para superar os obstáculos ao acompanhamento e relacione no quadro abaixo. Obstáculos ao acompanhamento Obstáculos ao serviço de acompanhamento em campo • Custos de deslocamento do pessoal do centro de serviço até as comunidades • Tempo de deslocamento do pessoal do centro de serviço até a comunidade • O acompanhamento não é priorizado pelos gerentes do serviço • O acompanhamento não é valorizado pelos utilizadores do serviço até observar os benefícios Obstáculos ao serviço de acompanhamento baseado no centro • Custo de deslocamento e ausência de um ou mais familiares no trabalho • Os cadeirantes e familiares com frequência não estão cientes dos benefícios do acompanhamento • Dificuldade para encontrar um transporte acessível • Pode haver pressão para concentrar-se em novas consultas no centro de serviço sem deixar tempo para o acompanhamento • Dificuldade para marcar consultas: os cadeirantes podem aparecer quando o pessoal não está disponível ou não aparecer quando o pessoal está disponível Ações para superar os obstáculos ao acompanhamento Manual de Referência do WSTP para Gerentes – Página 92 C.4.1 Desenvolvimento da sustentabilidade financeira: potenciais fontes de financiamento • Leia a lista de possíveis fontes de encaminhamento e consulte o manual de referência para obter mais detalhes. • Escolha as três fontes que, na sua opinião, têm o maior potencial imediato para o seu serviço e preencha o quadro abaixo com as fontes de financiamento selecionadas. Diferentes fontes de financiamento para a consideração dos gerentes. 1. Governo 2. Estruturas nacionais de seguro 3. Doadores e patrocinadores individuais 4. Doadores e patrocinadores empresariais 5. Contribuições dos cadeirantes ou preço total de compra 6. Geração de receitas/empreendimento social 7. Grupos comunitários/instituições beneficentes 8. Missões diplomáticas 9. ONG internacionais e nacionais Fontes de financiamento selecionadas Número em ordem de prioridade com base em • Esforço necessário • Retorno financeiro a curto ou longo prazo (ou ambos) Priorid ade Fonte de financiamento Investimento/esforço necessário Alto / Médio / Baixo Retorno a curto prazo Alto / Médio / Baixo Retorno a longo prazo Alto / Médio / Baixo Manual de Referência do WSTP para Gerentes – Página 93 C.4.2 Desenvolvimento da sustentabilidade financeira: elaboração de uma estratégia • Leia os dois exemplos de estratégia abaixo • Relacione as três fontes de financiamento do exercício anterior no quadro • Preencha as colunas do quadro com as fontes de financiamento selecionadas Fonte de financiamento Tipo de apoio Solicitação Probabilidade Esforço 1. Empresas Doação ao orçamento de compra de cadeiras de rodas 10% do orçamento de cadeiras de rodas Média (ofereceu um financiamento anteriormente, mas nem sempre financia a mesma organização todos os anos). Pelo menos duas reuniões com o gerente comercial; proposta de 2 páginas e apresentação de um orçamento, além de um convite ao gerente para o próximo dia de visita. 2. Governo local Potencialmente pode financiar os custos de todas as visitas em campo a cadeirantes da sua área. 20% de todos os custos em campo + 20% dos salários do pessoal do serviço. Alta (já há discussões com esse governo local há algum tempo. Foi realizado um trabalho em campo na sua área. Estão muito ansiosos para apoiar o trabalho e parece haver recursos disponíveis). Apresentação de proposta formal e orçamento. Relatórios obrigatórios – exigem dados precisos de todas as pessoas visitadas na sua área, além de relatórios financeiros.

ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ ၂၀၁၅ ခုုႏွစ္တြင္ ပံုုႏွိပ္ထုုတ္ေဝခဲ့ပါသည္။ ထုုတ္ေဝခဲ့သည့္ ေခါင္းစဥ္မွာ Wheelchair Service Training Package for Managers ပင္ျဖစ္ပါသည္။ © ကမာၻ့က်န္းမာေရးအဖြဲ႔အစည္း ၂၀၁၅ ခုုႏွစ္ ျမန္မာဘာသာျဖင့္ တည္းျဖတ္ျပီး ဘာသာျပန္ထုုတ္ေဝခြင့္အား ယင္း ျမန္မာဘာသာျပန္အရည္အေသြးႏွင့္ တိက်ေသခ်ာမႈတုုိ႔အတြက္ အဓိက တာဝန္ရွိေသာ USAID သုုိ႔ ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ အခြင့္အေရး အပ္ႏွင္းလုုိက္ပါသည္။ အဂၤလိပ္ဘာသာစကားႏွင့္ ထည့္သြင္းျပန္ဆုုိရမည့္ ဘာသာမ်ားၾကား မဆီေလ ွ်ာ္မႈ အေၾကာင္းအရာ တစ္စံုုတစ္ရာ ရွိခဲ့ေသာ္ မူရင္း အဂၤလိပ္ဘာသာသည္သာလ ွ်င္ အတည္ျဖစ္သည္။ မန္ေနဂ်ာမ်ားအတြက္ လက္တြန္းထုုိင္ခံုုလွည္းဝန္ေဆာင္မႈဆုုိင္ရာ ေလ့က်င့္သင္ၾကားေရး သင္ခန္းစာ © USAID (၂၀၁၆) ဦးတင္ေအးမွ ဘာသာျပန္ဆုုိခဲ့ျပီး အီးေမးလ္မွာ mgtinaye@gmail.com ျဖစ္ျပီး က်န္းမာေရးစီမံခန္႔ခြဲမႈသိပၺံ အဖြဲ႔မွ စီမံပါသည္။ rm w d u m ၁ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးျခင္းအတြက္ အစီအစဥ္ ျဖစ္ႏိုင္ေခ်ရွိေသာ မဟာဗ်ဴဟာမ်ား3 ၃ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈမ်ား (အေျခခံ) လႊဲေျပာင္းေပးအပ္မႈပံုစံ ၅ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈမ်ား (အလယ္တန္း) လႊဲေျပာင္းေပးအပ္မႈပံုစံ ၇ ဝန္ေဆာင္မႈ ပံုစံ စာရင္းမ်ားႏွင့္ စစ္ေဆးရန္အခ်က္မ်ား ၈ အကဲျဖတ္ စစ္ေဆးမႈ ေသတၱာျပဳလုပ္ျခင္း ၁၀ အကဲျဖတ္ စစ္ေဆးမႈ ကုတင္ျပဳလုပ္ျခင္း ၁၂ ေျခေထာက္ အရံအတား ျပဳလုပ္ျခင္း ၁၃ တိုင္းတာမႈ ကိရိယာ နမနူာမ်ား ၁၄ နည္းပညာ လုပ္ငန္းသံုး ကိရိယာမ်ား လမ္းညႊန္ လုပ္ငန္းထိုင္ခံုရွည္ ႏွင့္ အေျခခံလုပ္ငန္းနယ္ပယ္ ၁၅ အေျခခံ ဝန္ေဆာင္မႈ လမ္းညႊန္နည္းပညာ ရင္းျမစ္မ်ား ၁၇ အလယ္တန္း ဝန္ေဆာင္မႈ လမ္းညႊန္ နည္းပညာရင္းျမစ္မ်ား ၂၃ ေရျမႈတ္ျဖတ္ရန္ သံျဖတ္လႊ ျပင္ဆင္ျခင္း ၂၄ အေျခခံ ႏွင့္ အလယ္တန္းဝန္ေဆာင္မႈ - လိုအပ္ေသာ အရာမ်ား ၂၈ လႈပ္ရွားသြားလာမႈ ကၽြမ္းက်င္မႈ နယ္ပယ္ထူေထာင္ေရး လမ္းညႊန္မ်ား ၃၂ ဘီတပ္ထိုင္ခံု ပံ့ပိုးမႈနည္းအမ်ိဳးမ်ိဳး ႏိႈင္းယွဥ္ေလ့လာျခင္း ၃၈ အေထာက္အကူျပဳ နည္းပညာ ေနာက္ဆက္တြဲအကဲျဖတ္ စစ္ေဆးခ်ိန္တြင္ ပါဝင္ေဆာင္႐ြက္မႈ တိုင္းတာေရး ကိရိယာမ်ား ၃၉ အေထာက္အကူျပဳ နည္းပညာ ေနာက္ဆက္တြဲ စစ္ေဆးခ်ိန္ ေက်နပ္မႈ ႏွင့္ ရလဒ္ တိုင္းတာေရး ကိရိယာမ်ား ၄၅ ခ်ဥ္းကပ္ႏုိင္မႈ သတင္းအခ်က္အလက္ VI 1 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ VI 1 ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈ အစီအစဥ္တစ္ခုထုတ္လုပ္ရန္ ျဖစ္ႏိုင္ေျခရွိေသာ မဟာဗ်ဴဟာမ်ား ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈ အစီအစဥ္တခုထုတ္လုပ္ရန္ ျဖစ္ႏိုင္ေခ်ရွိေသာ မဟာဗ်ဴဟာမ်ားသည္ ႏိုင္ငံတြင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ လက္ရိွအေျခအေန၊ ရရွိႏိုင္ေသာရင္းျမစ္မ်ားႏွင့္ ဝန္ေဆာင္မႈလုပ္ငန္းက ျဖည္းဆည္းရမည့္ လိုအပ္ခ်က္မ်ားတို႔ အေပၚမူတည္သည္။ ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈ စီစဥ္ေသာအခါ ဘီးတပ္ထိုင္ခံု လမ္းညႊန္္မ်ားတြင္ ေကာက္ေၾကာင္း ေဖၚျပထားေသာ ေအာက္ပါ ေမးခြန္းမ်ားႏွင့္ မဟာဗ်ဴဟာမ်ားကို ထည့္သြင္းစဥ္းစားျခင္းသည္ အ သံုးဝင္သည္။ • အသံုးျပဳသူမ်ား ၏ စ႐ိုက္လကၡဏာႏွင့္ တိက်ေသာ လိုအပ္ခ်က္မ်ားသည္ မည္သည္တို႔နည္း။ • ပါဝင္ပတ္သက္သူအုပ္စုရွိပါသလား၊ ရွိလွ်င္ ၄င္းတို႔ အက်ိဳးစီးပြားႏွင့္ထင္ျမင္ခ်က္မ်ားသည္ မည္သည္တို႔နည္း။ • ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈရွိၿပီး ျဖစ္ပါသလား(ေဒသအလုပ္႐ံု၊ ရပ္ရြာအေျချပဳျပန္လည္သန္စြမ္းေရး၊ မသန္စြမ္းသူ မ်ားအသင္း၊ အျခား အစိုးရမဟုတ္ေသာအဖြဲ႕ မ်ား၊ ပုဂၢလိက သို႔မဟုတ္ အစိုးရက႑မွတဆင့္) • တရားဝင္အေျခခံအေဆာက္အအံုျပင္ပမွ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈရွိပါသလား။ ဥပမာ - ဘီးတပ္ထိုင္ခံုအမ်ားအျပား တင္သြင္းပံ့ပုိးျခင္း။ • လက္ရွိရင္းျမစ္မ်ားျဖင့္ မည္သည္တို႔ေဆာင္႐ြက္ႏိုင္မည္နည္း။ • လက္ရွိ ဘဏၰာေငြပံံ့ပိုးမႈ ယႏၱရားသည္ မည္သည္တို႔နည္း။ ၁။ အစိုးရက အမ်ိဳးသား ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ အစီအစဥ္တစ္ခု ထူေထာင္လိုသည္။ စိတ္ဝင္စားေသာ အစိုးရမဟုတ္သည့္အဖြဲ႕မ်ား၊ မသန္စြမ္းသူမ်ားအသင္းမ်ား၊ အသံုးျပဳပံုမ်ား၊ က်န္းမာေရးကၽြမ္း က်င္သူေလ့က်င့္ေရးအစီအစဥ္မ်ားႏွင့္ ကမၻာ႔က်န္းမာေရးအဖြဲ႕ (WHO)၊ ႏိုင္ငံတကာေျခတုလက္တုႏွင့္ သြား လာမႈ ေထာက္ကူျပဳကိရိယာထုတ္လုပ္သူမ်ား(ISPO)၊ ႏိုင္ငံတကာ အဖြဲ႔အစည္း၊ ဘီးတပ္ထိုင္ခံု ကၽြမ္းက်င္ သူမ်ား ႏိုင္ငံတကာအဖြဲ႕(ISWP)ႏွင့္ သက္ဆိုင္ရာအစိုးရမဟုတ္ေသာ ႏိုင္ငံတကာအဖြဲ႕အစည္းမ်ားကို သင့္ ေတာ္ေသာ အမ်ိဳးသားအဆင့္ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ အစီအစဥ္ေဖၚထုတ္ရန္ အစိုးရသည္ ဆက္သြယ္ လာႏိုင္သည္။အစိုးရသည္ ၄င္းပိုင္ေျခတုလက္တုႏွင့္သြားလာမႈ ေထာက္ကူျပဳပစၥည္း ဝန္ေဆာင္မႈမ်ားကို ဘီး တပ္ထိုင္ခံုဝန္ေဆာင္မႈ ျပဳလုပ္ရန္ အေျခခံအျဖစ္ ျမင္ႏိုင္သည္။ ၄င္းသည္ အျခားႏိုင္ငံမ်ားမွ အစိုးရအဖြဲ႕အ စည္းမ်ားထံမွ ၄င္းတို႔၏အေတြ႔အႀကံဳမွေလ့လာရန္ ႏွင့္ အႀကံဥာဏ္ ေတာင္းရန္လည္း ဆက္သြယ္ႏိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 2 3 ၂။ ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈရွိသည္။ သို႔ေသာ္အေသးစားအဆင့္သာရွိၿပီး လြတ္လပ္ေသာအဖြဲ႕အစည္းမ်ားမွ တဆင့္ လုပ္ေဆာင္သည္။ ပူးေပါင္းေဆာင္႐ြက္မႈ မရွိပါ။ အစိုးရေဒသခံ အဖြဲ႕အစည္းမ်ား သုိ႔မဟုတ္ ႏိုင္ငံတကာ အစိုးရမဟုတ္ေသာ အဖြဲ႕အစည္းတခုသည္ လုပ္ငန္း မ်ားကို တိုးခ်ဲ႕ႏိုင္သည္။ ပူးေပါင္းေဆာင္႐ြက္ အားထုတ္မႈတြင္ အဖြဲ႕အစည္းအသီးသီးမွ ပုဂၢိဳလ္မ်ား ပါဝင္ေစရန္ ရင္းျမစ္အစုတစ္ခုကို ထူေထာင္ႏိုင္သည္။ ထိုရင္းျမစ္အစုသည္ ေနာင္တြင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈေပးရာ တြင္ စိတ္ဝင္စားသူမ်ား၏ စုေပါင္းမဟာမိတ္အဖြဲ႕ သို႔မဟုတ္ လြတ္လပ္ေသာ ကိုယ္ပိုင္လုပ္ပိုင္ခြင့္ရွိ အစိုးရမ ဟုတ္ေသာ အဖြဲ႕ အစည္းအျဖစ္ ေပၚေပါက္လာႏိုင္သည္။ ၃။ ႏိုင္ငံတြင္ အဖြဲ႕အစည္းမ်ားရွိသည္။ သို႔ေသာ္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ ပံ့ပိုးျခင္းမရွိပါ။ စိတ္ဝင္စားေသာ အစိုးရမဟုတ္သည့္အဖြဲ႕အစည္း သို႔မဟုတ္ မသန္စြမ္းသူမ်ားအသင္းသည္ ရင္းျမစ္ အစု၏ အေျခခံအဖြဲ႕အစည္းအျဖစ္ ထမ္းေဆာင္ႏိုင္သည္။ ထိုအဖြဲ႕အစည္းသည္ ဘီးတပ္ထိုင္ခုံပံ့ပိုးမႈ အေတြ႕ အႀကံဳရွိေသာ သင့္ေတာ္သည့္အဖြဲ႕အစည္းကို လုပ္ေဖၚကိုင္ဖက္အဖြဲ႕အျဖစ္ ရွာေဖြၿပီး(ဥပမာ အိမ္နီးခ်င္း ႏိုင္ငံမွ အစိုးရ သို႔မဟုတ္ အစိုးရအဖြဲ႕အစည္း သို႔မဟုတ္ ႏုိင္ငံတကာ အစိုးရမဟုတ္ေသာအဖြဲ႕အစညး္) ျဖစ္ရပ္ ၄ တြင္ေဖၚျပထားသည့္ ၄င္း၏ ကနဦးေျခလွမ္းမ်ားအတိုင္း ေဆာင္႐ြက္သင့္သည္။ အျခားတနည္းမွာ ထိုလုပ္ငန္း စဥ္ကို ႏိုင္ငံတကာ အစိုးရ မဟုတ္ေသာအဖြဲ႕တခုကလုပ္ေဆာင္ၿပီး ထိုေနာက္ ၄င္းက ေဒသခံ အစိုးရ မဟုတ္ေသာအဖြဲ႕၊ မသန္စြမ္းသူမ်ားအဖြဲ႔ကို လုပ္ေဖၚကိုင္ဖက္ အဖြဲ႕အျဖစ္ရွာေဖြျခင္းျဖစ္သည္။ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ စတင္လုပ္ကိုင္ျခင္းတြင္ အလားတူ အေတြ႕အႀကံဳရွိအျခား အဖြဲ႕အစည္းမ်ား၊ ႏိုင္ငံမ်ားႏွင့္ရွာေဖြ ကြန္ယက္ဖြဲ႕ရန္ အားထုတ္သင့္သည္။ ၄။ ႏိုင္ငံတကာ အဖြဲ႕အစည္းမရွိဘဲ ပံုမွန္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ၊ ေပးျခင္းမရွိပါ။ ႏိုင္ငံတကာအစိုးရမဟုတ္ေသာ အဖြဲ႕အစည္းတစ္ခုသည္ ၄င္း၏ ကိုယ္ပိုင္အစီအစဥ္ျဖင့္ျဖစ္ေစ အစိုးရ၏ ဖိတ္ ေခၚမႈသို႔မဟုတ္ အျခားၿမိဳ႕ႀကီးတၿမိဳ႕တြင္ရင္းျမစ္ဌာနထူေထာင္ႏိုင္သည္၊ ထိုရင္းျမစ္ဌာနသည္လက္ရွိျပန္လည္ ထူေထာင္ေရးဌာန၏ တေပါင္းတစည္းတည္းေသာ အစိတ္အပိုင္းျဖစ္ႏိုင္သည္။ ထိုရင္းျမစ္ဌာနသည္အသံုးျပဳ သူမ်ား၊ ၄င္းတို႔၏မိသားစုမ်ား၊ ေစာင့္ေရွာက္သူမ်ား သို႔မဟုတ္က်န္းမာေရး ပညာရွင္မ်ားကို လႈပ္ရွားသြားလာ ႏိုင္မႈလိုအပ္ခ်က္မ်ားႏွင့္ လႈပ္ရွားသြားလာႏိုင္မႈႏွင့္သက္ဆိုင္ေသာ ပိုမိုက်ယ္ျပန္႔သည့္ျပႆနာမ်ားႏွင့္ ပတ္ သက္အေရးႀကီးေသာ သတင္းအခ်က္အလက္မ်ားေပးျခင္းျဖင့္ စတင္ႏုိင္သည္။အစိုးရမဟုတ္ေသာ ႏိုင္ငံတ ကာအဖြဲ႔အစည္းသည္ ပါဝင္ပတ္သက္သူမ်ား ခြဲျခမ္းစိတ္ျဖာေလ့လာခ်က္တရပ္ ျပဳလုပ္သင့္ၿပီး ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူမ်ားႏွင့္ ဝန္ေဆာင္မႈမ်ားအတြက္ ကြာဟမႈကိုေဖၚထုတ္ရန္ႏွင့္ လိုအပ္ခ်က္မ်ားကိုဆံုးျဖတ္ရန္ ဘီးတပ္ထိုင္ခံုသံုးသူ၊ လိုအပ္သူမ်ားကိုေလ့လာစမ္းသပ္မႈ ျပဳလုပ္သင့္သည္၊ ကနဦး ပါဝင္ေဆာင္႐ြက္မႈ သု ေတသနသည္လိုအပ္ခ်က္မ်ားျဖည့္ဆည္းရန္ ေ႐ြးခ်ယ္စရာမ်ားကိုေဖၚျပေပးမည္။ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈ စတင္ ရန္ ဘ႑ာေငြ ရွိသင့္သည္။ အမ်ိဳးသားဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈဌာနထူေထာင္ရန္ ပထမ အဆင့္ အေနျဖင့္ ရင္းျမစ္ဌာနႏွင့္အစိုးရအဖြဲ႕အစည္းမ်ားၾကား အလုပ္လုပ္ႏုိ္င္ေသာဆက္ဆံေရးထူေထာင္အားထုတ္သင့္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 2 3 ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ(အေျခခံ)လႊဲေျပာင္းေပးပို႔မႈပံုစံ   နမူနာလႊဲေျပာင္းေပးပို႔မႈပံုစံ။ ဤပံုစံကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈမ်ားက ျပဳျပင္ျဖည့္စြက္ႏိုင္ၿပီး ဘီးတပ္ ထိုင္ခံုသံုးသူကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ရာတြင္ အေထာက္အကူျဖစ္ေစရန္ လႊဲ ေျပာင္းလက္ခံမႈ ရင္းျမစ္သို႔ ေပးပို႔ႏိုင္သည္။ လႊဲေျပာင္းမႈ ပံုစံ ကို ျဖည့္စြက္ၿပီး(ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈအမည္ႏွင့္ လိပ္စာ) သို႔ေပးပို႔ပါ။ လႊဲေျပာင္းေပးပို႔သူ အမည္ - လုပ္ကိုင္ေနေသာအဖြဲ႕အစည္း- လႊဲေျပာင္းေပးပို႔သူ အဆက္အသြယ္ အေသးစိတ္(သင့္ကိုဆက္သြယ္ရန္အေကာင္းဆံုးနည္းလမ္း)- ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူအမည္- ေမြးေန႔သကၠရာဇ္- မိဘ/ေစာင့္ေရွာက္သူအမည္- လိပ္စာ- ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကိုမည္သို႔ဆက္သြယ္ရမည္ စာတုိက္ ကိုယ္ပိုင္တယ္လီဖုန္း မိတ္ေဆြအိ္မ္နီးခ်င္း၏ဖုန္း ဖုန္းျဖင့္ဆက္သြယ္ရန္ျဖစ္ပါက ဖုန္းနံပါတ္- ဘီးတပ္ထိုင္ခံုသံုးသူ၏ မသန္စြမ္းမႈ သိရွိပါက- လႊဲေျပာင္းေပးပို႔ေသာအေၾကာင္းရင္း - • ဘီးတပ္ထိုင္ခံုမရွိျခင္း • ပ်က္ေနေသာဘီးတပ္ထိုင္ခံုရွိျခင္း • အသံုးျပဳသူ၏လိုအပ္ခ်က္ႏွင့္မကိုက္ညီေသာဘီးတပ္ထိုင္ခံုရွိျခင္း) ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈအတြက္သိရွိရန္အေရးႀကီးသည္ဟုသင္ယူဆေသာဘီးတပ္ထိုင္ခံုသံုးသူႏွင့္ပတ္သက္ သည့္အျခားမည္သည့္အခ်က္အလက္မဆိုျဖည့္စြက္ေရးသားပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 4 5 ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ခံရျခင္းကိုဘီးတပ္ထိုင္ခံု သံုးသူကသေဘာတူၿပီးျဖစ္ပါသလား။ သေဘာတူၿပီး သေဘာမတူေသး လႊဲေျပာင္းေပးပို႔သူလက္မွတ္ ရက္စြဲ - bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 4 5 ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ(အလယ္တန္း)လႊဲေျပာင္းေပးပို႔မႈပံုစံ နမူနာလႊဲေျပာင္းေပးပို႔မႈပံုစံ။ ဤပံုစံကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈမ်ားက ျပဳျပင္ျဖည့္စြက္ႏိုင္ၿပီး ဘီးတပ္ ထိုင္ခံုသံုးသူကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ရာတြင္ အေထာက္အကူျဖစ္ေစရန္ လႊဲ ေျပာင္းလက္ခံမႈ ရင္းျမစ္သို႔ ေပးပို႔ႏိုင္သည္။ လႊဲေျပာင္းမႈ ပံုစံ ကို ျဖည့္စြက္ၿပီး(ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈအမည္ႏွင့္ လိပ္စာ) သို႔ေပးပို႔ပါ။ လႊဲေျပာင္းေပးပို႔သူ အမည္ - လုပ္ကိုင္ေနေသာအဖြဲ႕အစည္း- လႊဲေျပာင္းေပးပို႔သူ အဆက္အသြယ္ အေသးစိတ္(သင့္ကိုဆက္သြယ္ရန္အေကာင္းဆံုးနည္းလမ္း)- ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူအမည္- မိဘ/ေစာင့္ေရွာက္သူအမည္- လိပ္စာ- ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကို မည္သို႔ဆက္သြယ္ရမည္ စာတုိက္ ကိုယ္ပိုင္တယ္လီဖုန္ မိတ္ေဆြအိ္မ္နီးခ်င္း၏ဖုန္း ဖုန္းျဖင့္ဆက္သြယ္ရန္ျဖစ္ပါက ဖုန္းနံပါတ္- ဘီးတပ္ထိုင္ခံုသံုးသူ၏ မသန္စြမ္းမႈ သိရွိပါက- လႊဲေျပာင္းေပးပို႔ေသာအေၾကာင္းရင္း • ဘီးတပ္ထိုင္ခံုမရွိျခင္း • ပ်က္ေနေသာဘီးတပ္ထိုင္ခံုရွိျခင္း • အသံုးျပဳသူ၏လိုအပ္ခ်က္ႏွင့္မကိုက္ညီေသာဘီးတပ္ထိုင္ခံုရွိျခင္း) ကေလးမ်ားအတြက္ o အသက္ ၁ ႏွစ္တြင္ တည့္မတ္စြာမထိုင္ႏိုင္ သို႔မဟုတ္ မတ္တပ္မရပ္ႏိုင္ o အသက္ ၂ ႏွစ္တြင္ တေယာက္တည္းလမ္းမေလွ်ာက္ႏိုင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈအတြက္သိရွိရန္အေရးႀကီးသည္ဟုသင္ယူဆေသာဘီးတပ္ထိုင္ခံုသံုးသူႏွင့္ပတ္သက္ သည့္အျခားမည္သည့္အခ်က္အလက္မဆိုျဖည့္စြက္ေရးသားပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 6 7 ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ခံရျခင္းကိုဘီးတပ္ထိုင္ခံုသံုး သူကသေဘာတူၿပီးျဖစ္ပါသလား။ သေဘာတူၿပီး သေဘာမတူေသး လႊဲေျပာင္းေပးပို႔သူလက္မွတ္ ရက္စြဲ - bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 6 7 ဝန္ေဆာင္မႈ ပံုစံမ်ားစာရင္းႏွင့္ စစ္ေဆးရန္အခ်က္မ်ား မွတ္စု ။ ။ ဤလက္စြဲစာအုပ္တြင္ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ လႊဲေျပာင္းေပးပို႔ျခင္းပံုစံပါဝင္သည္။ အျခားေသာပံုစံမ်ား အားလံုးကို Pen Drive မွဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈေလ့က်င့္ေရး အစီအစဥ္ အေျခခံႏွင့္အလယ္တန္းတြင္ေတြ႕ႏိုင္သည္။ အေျခခံအဆင့္ဝန္ေဆာင္မႈမ်ား ၁။ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ (အေျခခံအဆင့္) လႊဲေျပာင္းေပးပို႔မႈပံုစံ ၂။အေျခခံ ဘီးတပ္ထိုင္ခံု စစ္ေဆးအကဲျဖတ္ျခင္း ပံုစံ ၃။ အေျခခံ ဘီးတပ္ထိုင္ခံု ညႊန္ၾကားျခင္း (ေ႐ြးခ်ယ္ျခင္း) ပံုစံ ၄။ အေျခခံ ဘီးတပ္ထိုင္ခံု အႏွစ္ခ်ဳပ္ပံုစံ ၅။ အေျခခံ ဘီးတပ္ထိုင္ခံု အံဝင္ဂြင္က်မႈ စစ္ေဆးရန္အခ်က္မ်ား ၆။ ဘီးတပ္ထိုင္ခံု လံုၿခံဳမႈ ႏွင့္ အသင့္ျဖစ္မႈ စစ္ေဆးရန္အခ်က္မ်ား ၇။ ဘီးတပ္ထိုင္ခံု ေနာက္ဆက္တြဲ စစ္ေဆးမႈ ပံုစံ * အလယ္တန္းအဆင့္ဝန္ေဆာင္မႈမ်ား ၈။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ လႊဲေျပာင္းေပးပို႔ျခင္းပံုစံ ၉။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု စစ္ေဆးအကဲျဖတ္ျခင္းပံုစံ ၁၀။ အလယ္တန္းအဆင့္ဘီးတပ္ထိုင္ခံု ညႊန္ၾကားမႈ (ေ႐ြးခ်ယ္ျခင္း) ပံုစံ ၁၁။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အႏွစ္ခ်ဳပ္ပံုစံ ၁၂။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အံဝင္ဂြင္က်မႈ စစ္ေဆးရန္အခ်က္မ်ား ၁၃။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူ ေလ့က်င့္ေရးစစ္ေဆးရန္အခ်က္မ်ား ၁၄။ ကိုယ္ေနဟန္ ေထာက္ကူမႈ ကိရိယာ(PSD) ဇယား *ဤ ပံုစံမ်ားႏွင့္စစ္ေဆးရန္ အခ်က္မ်ားသည္အေျခခံ ႏွင့္ အလယ္တန္း အဆင့္ႏွစ္ခုလံုးအတြက္ သင့္ေတာ္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 8 9 အကဲျဖတ္ စစ္ေဆးမႈ ကိရိယာတခု ျပဳလုပ္ျခင္း စစ္ေဆးအကဲျဖတ္ကိရိယာတခုျပဳလုပ္ရန္ ညႊန္ၾကားခ်က္မ်ား ၁။ အထပ္သားအားလံုးကို ၁၈ မမ အျဖစ္ဆြဲပါ။ မရႏိုင္လွ်င္ ၁၅ မမ သို႔မဟုတ္ ၂၀ မမ သံုးပါ။ ၂။ ခ်ိန္ၫွိႏိုင္ေသာ အျမင့္ ေျခတင္ခံုသည္ လမ္းေၾကာင္းအတြင္း လြယ္ကူစြာ ေလွ်ာဝင္ ေလွ်ာထြက္ႏိုင္ရမည္။ ၃။ ထိုင္ခံုမ်က္ႏွာျပင္ႏွင့္ေျခတင္ခံုမ်က္ႏွာျပင္ကိုခိုင္မာေသာ ၅-၁၀ မမ ေရႃမႈတ္ (EVA) သို႔မဟုတ္ အခ်ိဳ႕ဘီးတပ္ထိုင္ခံု ေျခတင္ခံုေပၚတြင္သံုးေသာ အကုပ္ အဖံုးအကာျဖင့္ ဖံုးအုပ္သင့္သည္။ ေဒသလုပ္အကဲျဖတ္ေသတၱာ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 8 9 အကဲျဖတ္ေသတၱာအတိုင္းအတာမ်ား 450 mm 18 mm 650 mm ထိပ္ပုိင္း 45 0 m m 45 0 m m 36 0 m m 42 0 m m 18 m m 18 m m 10 m m 25 mm 450 mm 430 mm ခ်ိန္ညွိ၍ရေသာ ေျခတင္အျမင့္ 18 mm အထပ္သား 200 mm ေရွ႕ 20 pieces 20 mm x 20 mm x 430 mm long hardwood 20 m m 20 m m ေဘး 50 mm bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 10 11 အကဲျဖတ္ စစ္ေဆး ကုတင္ျပဳလုပ္ျခင္း စစ္ေဆးအကဲျဖတ္ကုတင္သည္ ဘီးတပ္ထိုင္ခံုၫႊန္ၾကားမႈတခု ျပဳလုပ္ရန္အတြက္ ေကာင္းမြန္ေသာ အကဲ ျဖတ္စစ္ေဆးျခင္းတခုျပဳလုပ္ရန္ ကုသေပးသူကို တက္ႏုိင္ေစေသာေနရာတြင္ ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကို သက္ ေတာင့္သက္သာ ထိုင္ေစႏိုင္သည္။ စစ္ေဆးအကဲျဖတ္ကုတင္သည္ တည္ၿငိမ္ အႏၱရာယ္ကင္းၿပီး ဘီးတပ္ထိုင္ခံုမွ အကူးအေျပာင္းျပဳလုပ္ရန္ သင့္ေတာ္ေသာအျမင့္ရွိရမည္။ အတိုင္းအတာမ်ား အၾကမ္းဖ်င္း အလ်ား မွာ ၁၈၀၀ မမ x အက်ယ္ ၆၀၀ မမ ႏွင့္ အျမင့္ ၅၀၀ မမ ပံုမွန္ ဘီးတပ္ထိုင္ခံု ႏွင့္ပတ္သက္ေသာ အကဲျဖတ္ စစ္ေဆးျခင္းအတြက္ရွိသင့္သည္။ ပစၥည္းႏွင့္တည္ေဆာက္ပံု • ကိုယ္ထည္ကို သစ္သား၊ သံမဏိ တို႔ျဖင့္ ျပဳလုပ္ႏိုင္သည္။ • ကူရွင္ o ၁၃ မမ အထပ္သားေအာက္ခံ o ၅၀ မမ ထူထပ္ေသာေရျမႈတ္ အတံုး o ၂၅ မမ ႏူးညံ့ေသာေရျမႈတ္ အေပၚလႊာ • ကူရွင္ကိုသားေရတုသို႔မဟုတ္သားေရကဲ႔သို႔ေသာသန္႔ရွင္းေရးျပဳလုပ္ရန္လြယ္ကူသည့္အရာမ်ားျဖင့္ဖံုးအုပ္သင့္ သည္။ • သားေရကိုပံုသြင္းရန္၊ေခါက္ရန္၊ေကာ္ကပ္ရန္ ႏွင့္သူ၏ ေနရာတြင္ ထားရန္အထပ္သားတြင္ေကာ္ကပ္ထားရန္ ျပဳလုပ္သင့္သည္။ • သံေခ်းမတက္ေသာ ေအာက္ခံ ေဆးသုတ္သံမဏိ ကိုယ္ထည္ၿပီးေအာင္ျပဳလုပ္ၿပီး အေပၚတြင္ မႈတ္ေဆးျဖင့္သုတ္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 10 11 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 12 13 ေျခေထာက္အရံအတားျပဳလုပ္ျခင္း ေျခေထာက္အရံအတားမ်ားသည္ အကဲျဖတ္စစ္ေဆးစဥ္အတြင္း ေကာင္းမြန္ေသာထိုင္လ်က္ အေနအထား ျဖစ္ေစရန္ ဘီးတပ္ထိုင္ခံုသံုးသူ၏ ေျခေထာက္မ်ားကို သင့္ေတာ္ေသာအျမင့္တြင္ထားရန္ေထာက္ကူသည္။ ဘီးတပ္ထိုင္ခံုသံုးသူ၏ေျခေထာက္ကို မွန္ကန္စြာ ေနရာခ်ရန္အတြက္ အျမင့္အမ်ိဳးမ်ိဳးရွိေသာေျခေထာက္ အရံအတားမ်ား သို႔မဟုတ္ အျမင့္ခ်ိန္ၫ ိွႏိုင္ေသာေျခေထာက္အရံအတားမ်ား ရရွိေအာင္ ျပဳလုပ္ရန္ အေရးႀကီးသည္။ အတိုင္းအတာ မ်က္ႏွာျပင္ဧရိယာ ၄၀၀ မမ x ၃၀၀ မမ အျမင့္ ၁၅ မွ ၁၅၀ မမ အတြင္းအမ်ိဳးမ်ိဳး ပစၥည္းႏွင့္တည္ေဆာက္ပံု • အထပ္လိုက္ထားႏိုင္ေသာ အျမင့္အမ်ိဳးမ်ိဳးရွိ အတံုးမ်ား သို႔မဟုတ္ ခ်ိန္ၫွိႏိုင္ေသာအတံုးမ်ား • အထပ္သားဖြဲ႕စည္းပံု • ေျခဖဝါး အနိမ့္အျမင့္မည္သို႔ေသာအေျခအေနႏွင့္အသံုးျပဳသူမ်ားအတြက္(ေျခေထာက္အရွည္ကြာဟမႈ ေၾကာင့္ျဖစ္ေစ အျခားေသာျပႆနာမ်ားေၾကာင့္ျဖစ္ေစ) အျမင့္မတူေသာေျခေထာက္အရံအတားတံုးမ်ား သံုးရန္လိုသည္။ ေျခေထာက္အရံအတားတံုးမ်ား အေျခခံထပ္ထားျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 12 13 တိုင္းတာမႈ ကိရိယာ နမူနာမ်ား ကယ္လီပါမ်ား သစ္သားတိုင္တာေရးကိရိယာမ်ား အသံုးျပဳပစၥည္း - အထပ္သား ၃ -၉ မမ ခ်ိန္ၫွိႏိုင္ေသာေဘးအရံအတားမ်ား ျပဳလုပ္ရန္ အတိုင္းအတာအမွတ္အသားႏွင့္ သစ္သားအေျခမ်ားႏွင့္ Velero ပိတ္စမ်ား သစ္သားေဘးဘက္အရံအတားမ်ား - တစ္ဘက္ကို အေသတပ္ထားၿပီး အျခားတဘက္ကိုခ်ိန္ၫွိႏိုင္သည္။ ဗီြႏိုင္းတိုင္းတာေရးကိရိယာမ်ား အတိုင္းအတာ အမွတ္အသားႏွင့္ ဗီြႏိုင္းအေျခမ်ား သစ္သားေဘးအရံအတား - တစ္ဘက္ကုိ အေသတပ္ထားၿပီး အျခားတဘက္ကိုခ်ိန္ၫွိႏိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 14 15 လုပ္ငန္းသံုး ကိရိယာ ပစၥည္းမ်ားလမ္းညႊန္ - လုပ္ငန္းသံုးခံုတန္းရွည္ ႏွင့္ အေျခခံ လုပ္ငန္းနယ္ပယ္ လုပ္ငန္းသုံး ခုံတန္းရွည္ ပညာရွင္၏ အလုပ္လုပ္ရန္ ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ လုပ္ငန္းသံုး ခံုတန္းရွည္၏ အနက္မွာ ၇၅၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ေနရာ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 14 15 အေျခံ ဝန္ေဆာင္မႈ ပညာရပ္ဆိုင္ရာ ရင္းျမစ္မ်ား လမ္းညႊန္ ေအာက္တြင္ေဖၚျပထားေသာကိရိယာမ်ားသည္ တပ္ဆင္ရန္၊ တည္ေဆာက္ရန္၊ ခ်ိန္ၫွိရန္၊ ျပဳျပင္ထိန္း သိမ္းရန္ ႏွင့္ထုတ္ကုန္ကို ျပင္ဆင္ျဖည့္စြက္ရန္အတြက္ျဖစ္သည္။ (WSTP အေျခခံသင္တန္းသင္႐ုိးတြင္ ေဖၚျပထား သည့္အတိုင္း) ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ မက္ထရစ္စနစ္ေပါင္းစပ္ စပန္နာမ်ား ၈ မမ မွ ၂၀ မမ (၈ ၊ ၁၀ ၊ ၁၃ ၊ ၁၉ ၊ မမ အ႐ြယ္မ်ား ပါဝင္ရမည္။) ၂ မက္ထရစ္စနစ္ေပါင္းစပ္ စပန္နာမ်ား ၁ မက္ထရစ္ အလန္ ေသာ့မ်ား ကိုယ္ထည္ရွည္ အမ်ိဳးအစားသည္ အေကာင္းဆံုး ျဖစ္သည္။ T ပံုစံတန္းႏွင့္ ပစၥည္းကို ပိုမိုႏွစ္သက္သည္။ ၂ သတၳဳေပႀကိဳးမ်ား ၅ မီတာအရွည္ ၁ ဖိလစ္ ဝက္အူလွည့္မ်ား အရြယ္အစား အႀကီးႏွင့္ အလတ္မ်ား ၁ ေခါင္းျပား ဝက္အူလွည့္မ်ား အရြယ္အစား အႀကီးႏွင့္ အလတ္မ်ား ၁ ရာဘာတူမ်ား ၈ ေအာင္စ ေခါင္း ၁ ပလိုင္ယာမ်ား အလယ္အလတ္ ေရပိုက္ေခါင္းအတို ၁ အေပါက္ေဖါက္ရန္သံခၽြန္မ်ား ေသးငယ္ေသာအသြားျပား ပံုစံ သံခၽြန္ ၁ သတၳဳ တံဇဥ္း မ်ား(သံုးခု) အမ်ိဳးအစား - အလယ္အလတ္ အ႐ြယ္ ဒုတိယ ျဖတ္ေတာက္မႈတံစဥ္း ၊ စက္ဝိုင္းျခမ္းတံစဥ္း ၊ စက္ဝိုင္းတံစဥ္း ၊ တံစဥ္းျပား။ ၁ ပိုက္ျဖတ္ ကိရိယာငယ္မ်ားႏွင့္ အပိုလႊသြားမ်ား ၁၂ မမ မွ ၃၈ မမ အထိ ျဖတ္ျပြန္မ်ား ၁ လက္သံုးလႊ သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ၁၂ လက္မ သံျဖတ္လႊ ႏွင့္ အသြားမ်ား သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ေရ ႁမႈတ္ျဖတ္ဓါး သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ဗူးခြံျဖတ္ဓား ႏွင့္ အသြား ပိုမ်ား ၁ ကပ္ေၾကးအႀကီးစားမ်ား ၁ အပ္ႏွင့္ အပ္ခ်ည္အစုံ အပ္ အ႐ြယ္အစား အမ်ိဳးမ်ိဳး ခိုင္မာေသာ ႏိုင္လြန္ခ်ည္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 16 17 ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ တာယာအတြက္ ေလထုိးတံ Schrader ႏွင့္ Presra စက္ဘီးတာယာ အဖြင့္ အပိတ္မ်ား ၁ ဘီးေပါက္ဖာရန္ ပစၥည္းစံုႏွင့္ တာယာလီဗာ ၁ ေကာင္းမြန္ေသာ မွတ္သား ေဘာပင္ ၁ စပုတ္ကီး ၫွပ္ ၁ အႏ ၱရာယ္ ကင္းရွင္းေရး မ်က္မွန္မ်ား ၁ ေဆးသုတ္တံမ်ား ၁ သန္႔ရွင္းေရး ပစၥည္းစံု ေရပုန္းႏွင့္စုတ္တံမ်ား ၁ ရွိသင့္ေသာ လွ်ပ္စစ္သံုး ကိရိယာမ်ား အလုပ္႐ံု အတြက္ ဗို႔အားျမွင့္စက္ စက္ႏွင့္ လက္သံုးကိရိယာမ်ား* ၁ အပ္ခ်ဳပ္စက္ - အႀကီး ၁ အပ္ခ်ဳပ္စက္ - အႀကီး အပ္အစံု ၁ လွ်ပ္စစ္ ေဖါက္စက္ ၃ - ၁၃ မမ ေဖါက္စက္ ၊ အျမန္ႏႈန္းအမ်ိဳးမ်ိဳး ၁ သစ္သားေဖါက္စက္ ၁ သတၱဳ ေဖါက္စက္ ၁ လွ်ပ္စစ္လႊ ၁ သစ္၊ သတၱဳ ျဖတ္ဓားမ်ား ၁ လွ်ပ္စစ္ angle grinder ၁ အလယ္အလတ္ သံျပားစံု ၁ လွ်ပ္စစ္ဓာတ္ႀကိဳး တိုးခ်ဲ႕ရန္ႀကိဳး ၁၀ မီတာ ၁ ဓာတ္အားျမင့္တက္မႈ ကာကြယ္ရန္ကိရိယာ ၁ သိုေလွာင္မႈ ကိရိယာေသတၱာ ၁ ေသာ့ခေလာက္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 16 17 ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ ေသာ့ပါေသာ သတၱဳေၾကာင္အိ္မ္ ၁ အစားထုိးပစၥည္းမ်ား ေခ်ာဆီ အစံု ေကာ္ PVA သစ္သား ကပ္ေကာ္ အျပင္သစ္သား အေရာင္တင္ဆီ ျပင္ပ သတၱဳသုတ္ေဆး ေဆးႀကဲေဆးမ်ား ဆပ္ျပာ ေရျမႈတ္ အဝတ္စမ်ား အလယ္တန္းဝန္ေဆာင္မႈ နည္းပညာရင္းျမစ္မ်ား လမ္းညႊန္ အေျခခံ ဝန္ေဆာင္မႈ နည္းပညာရင္းျမစ္မ်ား လမ္းညႊန္တြင္ ေဖၚျပထားေသာ ကိရိယာမ်ား အားလံုးကို အလယ္တန္းဝန္ေဆာင္မႈ နည္းပညာ ရင္းျမစ္မ်ားလမ္းညႊန္တြင္လည္း လိုအပ္သည္။ ထို႔အျပင္ အေျခခံ ဝန္ေဆာင္မႈ နည္းပညာ ရင္းျမစ္လမ္းညႊန္တြင္ ခေရပြင့္ ျပထားေသာကိရိယာမ်ားတြင္ အလယ္အလတ္အဆင့္အတြက္ ေထာက္ခံ တင္ျပေသာကိရိယာမ်ားထပ္မံ လိုအပ္ေၾကာင္းအတည္ျပဳရန္ အထူးေဖၚျပထားသည္။ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ အဓိက ကိရိယာမ်ား အလုပ္႐ံုအတြက္ ဗို႔အားျမွင့္စက္ စက္ႏွင့္ လက္သံုးကိရိယာမ်ား * ၁ အပ္ခ်ဳပ္စက္ အႀကီး လိုအပ္လွ်င္ ပိတ္စႀကီးမ်ားကိုခ်ဳပ္ႏိုင္ရမည္။ ၁ ရွိသင့္ေသာ ကိရိယာမ်ား Arc ႏွင့္ Mig ဂေဟေဆာ္စက္ ၁ ဂေဟေဆာ္ရာတြင္ သံုးေသာ လက္အကာအကြယ္ သားေရ အထူ၊ အေပါက္ ၆ လက္မ လက္အိတ္မ်ား ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 18 19 Arc ဂေဟေဆာ္ မ်က္လံုး အကာအကြယ္ မ်က္ႏွာဖံုး ၁ Bench grinder ေဖါက္စက္ အၾကမ္း ႏွင့္ အႏု အဆင့္ရွိ ဘီးမ်ား ၁ ေကာ္ပတ္ႀကိဳး ႏွင့္ ဖုန္ထုတ္စက္ ၁ ေကာ္ပတ္ႀကိဳး အစံု (အႏု ၊ အၾကမ္း) ၁ လႊ သစ္သား ၊ အထပ္သား ၊ PU , EVA ႏွင့္ ေရျမွတ္ အတြက္ အလယ္အလတ္ အ႐ြယ္အစား ၁ ေလမႈတ္စက္ ၂၄ L ၁ ေဆးမႈတ္ ပစၥည္းစံု ႏွင့္ ပိုက္ေခါင္းမ်ား ၁ ဓာတ္ေငြ႔ မႈတ္သံုး ဂေဟေဆာ္ကိရိယာ ႏႈတ္သီးေခါင္း အမ်ိဳးမ်ိဳး ႏွင့္ ဂေဟေဆာ္ကိရိယာ ဗို႔အားျမွင့္စက္ႏွင့္ေခါင္းမ်ား ၁ ဂေဟေဆာ္မ်က္လံုး အကာအကြယ္မ်က္မွန္ ၁ ေဖာက္စက္မ်ား(၃ မမ မွ ၁၃ မမ အေပါက္အထိ) ညွပ္ပါေသာေဖာက္စက္ တင္ခံု (ဆက္စပ္ သံုးေသာဘက္စံုညွပ္ပါေဖာက္ခံု) ၁ လွ်ပ္စစ္ ဓာတ္အားသံုးကိရိယာမ်ား အဓိကကိရိယာမ်ား ကိရိယာမ်ား အေသးစိတ္ အမွတ္ လက္ကိုင္လွ်ပ္စစ္ အေပါက္ေဖါက္စက္ (၃ - ၁၃ မမ အေပါက္) (အျမန္ႏႈန္းအမ်ိဳးမ်ိဳး ႏွင့္ အဘက္ဘက္မွ လွည့္ႏိုင္ေသာ ကိရိယာသည္ ပိုမိုလိုအပ္သည္။) ၁ လက္ကိုင္လွ်ပ္စစ္လႊ ၁ Angle grinder ျဖတ္စက္ ၁ ျဖတ္စက္ဝိုင္း အ႐ြယ္စံု အႏု ၊ အၾကမ္း ျဖတ္စက္ဝိုင္းမ်ား ၁ ျဖတ္စက္ အကာအကြယ္ လက္အိတ္မ်ား ၁ တိုးခ်ဲ႕ ရန္ လွ်ပ္စစ္ႀကိဳး ၅ မီတာ မွ ၁၀ မီတာ ၂ ရွိသင့္ေသာ ကိရိယာမ်ား လွ်ပ္စစ္ ဝက္အူလွည့္စက္ ႀကိဳးမဲ့ဝက္အူလွည့္ အမ်ိဳးမ်ိဳး ၊ ေခါင္းအမ်ိဳးမ်ိဳး ၊ Allen Key ဝက္အူလွည့္ အမ်ိဳးမ်ိဳး ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 18 19 ႀကိဳးမဲ့ လွ်ပ္စစ္ ေဖာက္စက္၊ ၃ - ၁၃ မမ အေပါက္အ႐ြယ္အစား) ၁၈ ဗို႔ အျမန္ႏႈန္းအမ်ိဳးမ်ိ္ဳး ႏွင့္ အဘက္ဘက္သို႔ လွည့္ႏိုင္ေသာအမ်ိဳးအစားသည္ ပိုမို အသံုးဝင္သည္။ ၁ လႊဝိုင္း (အနည္းဆုံး ၁၈၅ မမ အသြား) ၁ တြဲဆက္ေပးေသာသံ ျဖတ္ထားေသာ ဖ်င္စထူနားကို အနားလံုးရန္ ႏွင့္ ဖ်င္စထူတြင္ အေပါက္ေဖာက္ရန္ သံခၽြန္ ၁ လက္သံုးကိရိယာမ်ား အဓိက ကိရိယာမ်ား လက္ကိုင္လႊ (universal) ၂၂ လက္မ အႏုစိတ္အသြား ၁ သံျဖတ္လႊနွင့္လႊသြားစုံ သစ္အေခ်ာျဖတ္ရန္ ၁ အေပါက္ေဖာက္ရန္လြန္ပူစံု ၁ ဝက္အူစံု ၁ (မူလီအေသတပ္) ကပ္ေၾကးႀကီး လက္သမား အလုပ္စားပြဲ တြင္တပ္ဆင္ထားေသာ ၁ ညႇပ္ (မူလီနွင့္)* ၆ လက္မ ၂ ပလာယာ နႈတ္သီးရွည္၊ အလတ္ ၁ ေလာ့ကင္းပလာယာ (mole grips) နႈတ္သီးတို၊ အလတ္ ၂ ေလာ့ကင္းပလာယာ (mole grips) နႈတ္သီးရွည္၊ အလတ္ ၂ ညႇပ္ ၆ လက္မ ၂ ညႇပ္ ၆ လက္မ ၂ ကြင္းေပါက္ေဖာက္စက္နွင့္ကြင္းမ်ိဳးစုံ အ႐ြယ္စုံ ၁ ခ်ဳပ္စက္ (သစ္သား) ၁ ရပစ္ရိုက္စက္ ၁ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ သံေပတံ* ၁ မီတာ၊ (မက္ထရစ္နွင့္အင္ပီရီရယ္စေကး) ၁ သံေပတံ ၃၀ စင္တီ ၂ သတၱဳေပႀကိဳး* ၅ မီတာ ၁ ဗာနီယာကာလီပါအခ်င္းတိုင္းစက္ ၁၅၀ မမ ပါးစပ္အက်ယ္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 20 21 သတၱဳစက္ဝိုင္းျခမ္း ၁ မွ ၁၈၀ ဒီဂရီ (တိက်မႈ ၁ ဒီဂရီ) ၁ အလယ္မွတ္ မွတ္သားရန္သံခ်ြန္ ၂ ေရးမွတ္ရန္သံခ်ြန္ ၂ လက္လွည့္လြန္ပူ* လြန္ပူနွင့္ဓာတ္အားမရလွ်င္အသုံးဝင္သည္ ၁ လက္သမားစကြဲ ၆၀၀ မမ x ၄၀၀ မမ သံမဏိ ၁ ခ်ိန္ညႇိနိုင္ေသာ စပန္နာ ၁လက္မ အမ်ားဆံုးအက်ယ္ ၁ ေဆာ့ကက္စံု မက္ထရစ္( ၈၊၁၀၊၁၃၊၁၇၊၁၉ မမ မ်ားအပါအဝင္) ၁ တာရာခ်ိန္ညႇိတံမ်ား* ၄ ခု တစုံ ၁ စပုတ္တံခ်ိန္ညႇ္ိကိရိယာ* ၁ လံုၿခံဳေရးမ်က္မွန္* အလုပ္ရုံသုံးမ်က္လံုးအကာအကြယ္ ၄ နားအကာအကြယ္ ၂ ဖံုကာမ်က္နွာဖံုး ၄ သစ္သားစားတံစဥ္းျပား အလတ္ ၁ သစ္သားစားတံစဥ္းစုံ ၁ သစ္သားစားတံစဥ္းစုံ (သစ္သားအတြက္) ၁ ရွိသင့္ေသာအရာမ်ား ေဆာ့ကက္စုံ အင္ပီရီရယ္ ၁ ကြန္ဘိုင္ေနးရွင္း စပန္နာစုံ* အင္ပီရီရယ္ ¼–1½ ၁ အလန္ကီး ( L ပံု) အင္ပီရီရယ္ ၁ စပုပ္ေရွ႕ ၁ ကြန္ဘ္ိုင္ေနးရွင္းစကြဲ ၁ ေထာင့္ခ်ိန္နိုင္ေသာ ဘီဗယ္ ေထာင့္စြန္းလံုးစက္ ၁ စကြဲအေသး ၁၀ လက္မ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 20 21 အေထြေထြ အလုပ္႐ုံ အမိႈက္ပံုးမ်ား ၃ ၾကမ္းတိုက္ဘရပ္ရွ္ ၁ အမိႈက္ေဂၚနွင့္ ဘရပ္တံမ်က္စီး ၁ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ ဖုန္သုပ္အဝတ္ ၁ အလုပ္ရံုသန္႔ရွင္းေရးေရပံုးနွင့္ ေရျမႇုတ္ ၂ အလုပ္႐ုံပရိေဘာဂႏွင့္ လုံၿခံဳသည့္သုိေလွာင္မႈ ကိရိယာထည့္ရန္အပိတ္ပါသတၱဳဘီရို* ၂ ပစၥည္းထည့္ရန္သတၱဳဘီရို ၂ အေထြေထြသုံးအပြင့္ဘီရို ၁ PSD အစိတ္အပိုင္းထည့္ရန္အပြင့္ဘီရို ၁ ေခြးေျခထိုင္ခံု ၃ အလုပ္စားပြဲ* ၃ စင္ ၂ အေျခာက္ခံစင္ ေဆးသုပ္၊ အေရာင္တင္ပစၥည္းမ်ားအတြက္ ၁ အစားထုိးပစၥည္းမ်ား ေအာက္ခံေဆး ျပင္ပသစ္သားေဆး အေပၚေဆး ျပင္ပသစ္သားေဆး အေရာင္တင္ဆီ ျပင္ပအဆင့္ အရက္ပ်ံျဖဴ* ဘရပ္နွင့္ေဆးမႈတ္ကိရိယာသန္႔ရွင္းေရးအတြက္ သုပ္ေဆး၊ အေရာင္တင္ဆီ၊ ေကာ္ ပံုးမ်ား ေကာ္ပတ္ အဆင့္ ၄၀၊ ၈၀၊ ၁၅၀ အျမႇင္ေျမျဖဴ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 22 23 ဂေဟေခ်ာင္းစံု ဂေဟေခ်ာင္းစံု အ႐ြယ္စံု ဂေဟသုံုး flux လႊသြားမ်ား သစ္သား၊ သတၱဳနွင့္ပလပ္စတစ္ျဖတ္ရန္ လႊသြားမ်ား စာအုပ္ခ်ဳပ္အပ္ ၅ မမ နွင့္ ၈ မမအနက္ စက္ခ်ဳပ္အပ္ အ႐ြယ္စုံ စတီးအတြက္ဂေဟေခ်ာင္းမ်ား ၂ မမ၊ ၄ မမ ၊၆မမ အ႐ြယ္ ကြင္းမ်ား အ႐ြယ္စုံ ရပစ္မ်ား ၄ မမ နွင့္ ၆ မမ အခ်င္းအ႐ြယ္စုံ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 22 23 ေရျမႇုတ္ျဖတ္ရန္သံျဖတ္လႊအသြားႀကိဳတင္ျပင္ဆင္ျခင္း • သာမန္သတၱဳသံျဖတ္လႊအသြားတခုက္ို ယူပါ(သံုးၿပီးအေဟာင္ျဖစ္လွ်င္ပိုေကာင္းသည္)။ လႊသြားမ်ားကိုထက္ ေသာဓားခ်ြန္ျဖစ္ရန္ ေသြးပါ။ (Vပံုစံျဖတ္ပိုင္းပံု) • ၾကားခံနွင့္သိပ္သည္းမႈနည္းေသာ ပိုလီယူသိန္း ေရျမႇုတ္ နွင့္ ခ်ပ္ေရျမႇုတ္တို႔ကို လြယ္ကူလွ်င္ျမန္စြာျဖတ္နိုင္ေသာ ပါးလႊာသည့္ လႊသြားဓားတလက္ျဖစ္လာမည္။ • လက္ကိုင္ျပဳလုပ္ရန္နွင့္ သင္၏လက္ေခ်ာင္းမ်ားကိုဓားသြားမွကာကြယ္ရန္ လႊဓား၏တဘက္အစြန္းတြင္တိပ္မ်ား ရစ္ပတ္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 24 25 အေျခခံနွင့္အလယ္တန္းဝန္ေဆာင္မႈလမ္းၫႊန္ - ပစၥည္းမ်ား ျဖည့္စြက္ကိုယ္ေနဟန္အေထာက္အကူျပဳကိရိယာမ်ား ျပင္ဆင္ျဖည့္စြက္ျခင္းနွင့္ ေပါင္းစပ္ထုတ္လုပ္ျခင္း အတြက္ပစၥည္းမ်ားကို အလယ္တန္းအဆင့္တြင္မ်ားေသာအားျဖင့္သံုးသည္။ သို႔ေသာ္ အေျခခံအဆင့္ ဝန္ေဆာင္မႈ မ်ားသည္လည္း အလားတူပစၥည္းမ်ားသုံး၍ ရိုးရွင္းေသာျပင္ဆင္ျဖည့္စြက္မႈမ်ား လုပ္ေဆာင္ရနိုင္သည္။ လိုအပ္ေသာ ပစၥည္းမ်ား၏အရည္အေသြးသည္ ဝန္ေဆာင္မႈရယူေသာ ဘီးတပ္ထုိင္ခုံသုံးစြဲသူ အေရအတြက္၊ အလယ္တန္းအ ဆင့္ ဘီးတပ္ကုလားထိုင္ဝန္ေဆာင္မႈေပးသည့္ပမာဏနွင့္ ေပးသည့္ဘီးတပ္ထိုင္ခုံအမ်ိဳးအစား အပါအဝင္ အခ်က္ အမ်ားအျပားအေပၚ မူတည္သည္။ ေဆးခန္းနွင့္နည္းပညာဝန္ထမ္းမ်ားသည္ သင့္ေတာ္ေသာပစၥည္းမ်ား ရယူရာတြင္ ပါဝင္သင့္သည္။ ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ သတၱဳ/ပလပ္စတစ္/ သစ္သား သတၱဳ/ပလပ္စတစ္/သစ္သား သည္ကိုယ္ေနဟန္ေထာက္ကူမႈ ကိရိယာတခု၏ ကိုယ္ထည္ကိုဖြဲ႕စည္းသည္။ ဥပမာ အမာထည္ ထိုင္ခံုနွင့္ ေနာက္မွီမ်ား။ ၁၂ မမ အထပ္သားသည္ အမာထည္ ထိုင္ခံုနွ င့္ေနာက္မွီမ်ားျပဳလုပ္ရာတြင္ အလြန္အသုံးဝင္သည္။ ၎သည္ခိုင္မာသည္ သို႔ေသာ္နိႈင္းယွဥ္ခ်က္အားျဖင့္ေပါ့ပါးသည္။ မရိန္း အထပ္သားသည္ ေရရွည္ခံေသာ ေ႐ြးခ်ယ္စရာျဖစ္သည္ သို႔ေသာ္ေဈးႀကီးနိုင္သည္။ ရနိုင္လွ်င္ ၃ မမ အလူမီနီယမ္ နွင့္ ၆ မမ ေရာင္ျပန္ သို႔မဟုတ္ ABS ပလပ္စတစ္ခ်ပ္မ်ားကိုလည္း အမာထည္ေနာ က္မွီမ်ားလုပ္ရန္သုံးနိုင္သည္။ ပလပ္စတစ္ခ်ပ္ကို ေခါက္ၿပီးထည့္လွ်င္ ပို၍မာသည္။ အခ်ပ္အလႊာနွင့္ပစၥည္းကိုသုံးလ်င္ အသုံးျပဳသူ အႏၲရာယ္ကင္းရန္ ထက္ေသာအစြန္မ်ားကို ဖယ္ရွားရန္ သို႔မဟုတ္ ဖံုးအုပ္ရန္ ပိုမိုဂရုျပဳပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 24 25 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ေရျမွဳတ္/အဖုံးအကာ ဘီးတပ္ထိုင္ခုံအသုံးျပဳ သူ၏ခႏၶာ ကိုယ္နွင့္တိုက္ရိုက္ထိေနေသာ ကိုယ္ေနဟန္ေထာက္ကူမႈ ကိရိယာ အစိတ္အပိုင္းမ်ား အားလံုးတြင္ ေရျမႇုတ္/ အဖံုးအကာေရျမႇုတ္ကိုသုံးသည္။ ၎၏မူရင္းပံုအတိုင္းရွိေသာ အခုိင္အမာေရျမွဳတ္ကုိ ကုိယ္ေနဟန္ အေထာက္အကူကိရိယာမ်ား မွန္ကန္ေသာ ေထာက္ကူမႈေပးရန္လုိေသာ ပုံစံေပးရန္ သုံးသည္။ ပုိမုိႏူးညံ့ေသာေရျမွဳတ္ကုိ သက္ေတာင့္သက္သာမႈႏွင့္ ဖိအားေလွ်ာ့ခ်ေပးရန္အတြက္ သုံးသည္။ ေရျမႇုတ္အသုံးျပဳမႈဥပမာမ်ား - • ဖိအားေလ်ာ့ခ်ရန္နွင့္ပိုမိုသက္ေတာင့္ သက္သာရွိရန္ သိုင္းႀကိဳးမ်ားသို႔ေပါင္း ထည့္သင့္သည္။ ေဒသတြင္ရနိုင္ေသာေရျမႇုတ္ရွာေဖြရန္ ေဒသေဈးမ်ားတြင္ရွာပါ။ ေရျမႇုတ္၊ရွဴးဖိနပ္၊ေမႊ့ယာနွင့္ ပရိေဘာဂစက္ရံုမ်ားသို႔သြားပါ။ အထူအမ်ိဳးမ်ိဳး နွင့္ ခိိုင္မာမႈ အမ်ိဳးမ်ိဳး ရွိေသာ ေဒသ ေရျမႇုတ္ နမူနာမ်ားရွာရန္ႀကိဳးစားပါ။ EVA သည္အလြန္မာေသာေရျမႇုတ္နမူနာျဖစ္ၿပီး ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိယာမ်ားအတြက္ကိုယ္ ထည္နွင့္ခိုင္မာေသာေထာက္ကူမႈေပးရန္ ေကာင္းမြန္သည္။ ရွဴးဖိနပ္ထုတ္လုပ္ေသာေနရာမ်ား တြင္ EVA ကိုေတြ႕နိင္သည္။ EVA အစား ေျခညႇပ္ဖိ နပ္လုပ္သည့္ရာဘာကိုသုံးနိုင္သည္။ အေရအေသြးေကာင္းေသာ Chip ေရျမႇုတ္သည္ ခိုင္မာမႈအလယ္အလတ္ရွိ ေရျမႇုတ္နမူနာျဖစ္သည္။ Chip ေရျမႇုတ္က္ို တင္ပါးစုံရိုးေနာက္ဘက္ သို႔မဟုတ္ Pre-seat အရိုးအတြက္ အခုအခံျပဳလုပ္ရန္ နွင့္ အမာထည္ ေနာက္မွီ တြင္ေဖာင္းႂကြျပဳလုပ္ရန္ ေဖာင္းႂကြ/အလႊာလိုက္ရွိေသာကူရွင္တြင္ ေအာက္ခံလႊာအျဖစ္သုံးနိုင္သည္။ ႏူးည့ံေသာ ေမႊ့ရာ ေရျမႇုတ္ သည္ သက္ေတာင့္သက္သာရွိေစေသာ အေပၚလႊာေရျမႇုတ္ ဥပမာျဖစ္သည္။ ေရျမႇုတ္/အခုအခံ • အလြန္ခိုင္မာေသာေရျမႇုတ္ (ဥပမာ EVA ေရျမႇုတ္) ကို ေျခတင္ခံု အခုအခံ သို႔မဟုတ္ သပ္ နွင့္ ကိုယ္ခႏၶာေဘးဘက္ အခုအခံျပဳလုပ္ရန္သုံးနိုင္သည္။ အလြယ္ကူဆုံးရနိုင္ေသာ ေဈးအသက္ သာဆံုးႏူးည့ံေသာေရျမႇုတ္သက္သက္ မွာ ခိုင္မာေသာေရျမႇုတ္ေအာက္ခံမပါဘဲ ဖိအားသက္သာေစေသာကူရွင္ျပဳ လုပ္ရာတြင္သုံးရန္ မသင့္ေတာ္ေပ။ ခိုင္မာေသာေရျမႇုတ္ေနရာမ်ားတြင္ အုန္းဆံကိုသုံးနိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 26 27 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ပိတ္စ ပိတ္စကို ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိ ယာမ်ား(PSDs)တြင္ ဖံုးအုပ္ရန္သုံးသည္။ ေရရွည္ခံၿပီးသန္႔ရွင္းေရးျပဳလုပ္ရလြယ္ ေသာပိတ္စရွာပါ (ေရပတ္တိုက္၍ျဖစ္ေစ ျဖဳတ္ယူ ေလ်ာ္ဖြတ္၍ျဖစ္ေစ)။ ဘီးတပ္ကုလားထိုင္သုံးသူ ဆီးဝမ္းမထိမ္းနိုင္လ်င္ ေရခုခံနိုင္ေသာပိတ္စသည္ ထိုင္ခံုနွင့္ ေနာက္မွီအတြက္အသုံးဝင္သည္။ ပိုပိုႏူးည့ံေသာ တီရွပ္ပုံစံပိတ္စသည္ (ခ်ည္ထည္ သို႔မဟုတ္ ခ်ည္ထည္နွင့္ အဆန္႔အတင္းလုပ္ႏိုင္ေသာ အသားကပ္ ပိတ္) ေခါင္းမွီႏွင့္ ကိုယ္ခႏၶာေဘး အေထာက္အကူျပဳလုပ္ရန္ အသုံးဝင္သည္။ အဆန္႔အတင္းလုပ္နိုင္ေသာ ပိတ္စသည္ ကိုယ္ေနဟန္ေထာက္ကူမုု ကိရိယာမ်ား၏ပံုစံ နွင့္လိုက္ေလ်ာညီေထြလြယ္ကူစြာျဖစ္နိုင္သည္။ သဘာဝမဟုတ္ေသာ ပိတ္စသည္ သဘာဝပိတ္စထက္လူကို ပိုမိုပူေလာင္ေစသည္။ ျဖစ္နိုင္လွ်င္ ဘီးတပ္ထိုင္ခုံသုံးသူကို ေ႐ြးခ်ယ္ခြင့္ေပးၿပီး အေရာင္အမ်ိဳးမ်ိဳးရေအာင္ ႀကိဳးစားပါ။ နိုင္လြန္ပိတ္စႀကိဳး၊ ကပ္ခြာ သို႔မဟုတ္ ခါးပတ္ေခါင္းကဲ့သ္ို႔ ေသာ ခ်ိတ္မ်ား နိုင္လြန္ပိတ္စႀကိဳး၊ကပ္ခြာ သို႔မဟုတ္ ခါးပတ္ေခါင္းကဲ့သ္ို႔ေသာခ်ိတ္မ်ားကို တင္ပါးစုံရိုးသိုင္းႀကိဳး၊ ပုခံုးထိန္း၊ ေျခသ လံုးနွင့္ေျခေထာက္သိုင္းႀကိဳးမ်ားအပါ အဝင္ သိုင္းႀကိဳးမ်ားျပဳလုပ္ရန္သုံးသည္။ ၂၅၊၃၅ နွင့္ ၅၀ မမ သိုင္းၾက္ိုးမ်ာသည္ အသုံးဝင္သည္။ သိုင္းႀကိဳးက်ယ္ေလေလ ဖိအားညီမ်ေလေလျဖစ္သည္။ ျဖတ္ၿပီးအပူေပးကာလံုးထားလွ်င္ နိုင္လြန္သိုင္းႀကိဳးမ်ားသည္ ေျပေလ်ာ့မထြက္ေစေပ။ ခ်ည္သိုင္းႀကိဳးမ်ားသည္ ထိေရာက္မႈမ်ားစြာေလ်ာ့နည္းသည္။ ေက်ာပိုးအိတ္မ်ားတြင္သုံးေသာ ညႇပ္ခါးပတ္ေခါင္းခ်ိတ္မ်ားသည္ အသုံးျပဳရလြယ္ကူသည္။ ရနိုင္လွ်င္ အေရအေသြး ေကာင္းေသာခါးပတ္ေခါင္းခ်ိတ္ မ်ားသုံးပါ။ ၎တို႔သည္ေရရွည္ခံေသာေၾကာင့္ ျဖစ္သည္။ ၎တို႔ကို ညႇပ္ၿပီးဆြဲျဖဳတ္ ျခင္းျဖင့္စစ္ေဆးပါ။ ၎တို႔သည္ညႇပ္သြားၿပီး အလြယ္တကူျပဳတ္သြားသင့္သည္။ သို႔ေသာ္ ျပဳတ္မသြားလ်င္ဆက္မဆြဲသင့္ပါ။ ကပ္ခြာသည္ေကာင္းေသာတြယ္ခ်ိတ္စရာကိရိ ယာျဖစ္သည္။ သို႔ေသာ္၎ကိုသန္႔ရွင္းေအာင္ ထားရၿပီး မထားက အလုပ္မလုပ္ေတာ့ေပ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 26 27 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ေကာ္မ်ား ေကာ္မ်ားကို သစ္သားနွင့္ေရျမႇုတ္ကို ကပ္ရန္သုံးသည္။ သစ္သားကပ္ေကာ္ (ေကာ္ျဖဴ သို႔မဟုတ္ PVA ဟုလူသ္ိမ်ားသည္) နွင့္ ေရျမႇုတ္ေကာ္ (contact ေကာ္၊ ရွဴးဖိနပ္ေကာ္၊ ေကာ္ဝါဟုလူသိမ်ားသည္)တို႔ကိုထားရွိပါ။ ေကာ္အသုံုးျပဳသူမည္သူမဆို မည္သို႔အသုံးျပဳရ သည္ကိုသိရန္ေသခ်ာပါေစ။ ခ်ိတ္ဆက္ ကိရိယာမ်ား ခ်ိတ္ဆက္ကိရိယာမ်ားကို ကိုယ္ေနဟန္ ေထာက္ကူမႈကိရိယာမ်ားကို ဘီးတပ္ထိုင္ခုံတြင္ တပ္ဆင္ရန္သုံးသည္။ အသံုးဝင္ေသာခ်ိတ္ဆက္ကိရိယာမ်ားတြင္ေ အာက္ပါတို႔ပါဝင္သည္။ • မူလီနွင့္နပ္္မ်ား နွင့္ ဝါရွာမ်ား (အပိတ္ပါနပ္ မ်ားပိုမိုေကာင္းသည္)၊ • တီပံုစံနပ္မ်ား (နပ္မ်ားအစားသစ္သားတြင္ အေသတပ္သည္)၊ • စာအုပ္ခ်ဳပ္စက္အပ္မ်ား (ကူရွင္အဖံုးအကာတပ္ဆင္ရန္) ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိယာ ပ်က္စီးသြားလ်င္ အႏၲရာယ္ျဖစ္နိုင္ေသာေၾကာင့္ ခ်ြန္ေသာဝက္အူမ်ားမသုံးရ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 28 29 လႈပ္ရွားသြားလာမႈ က်ြမ္းက်င္မႈ နယ္ပယ္ထူေထာင္ေရးလမ္းၫႊန္ လႈပ္ရွားသြားလာမႈ က်ြမ္းက်င္မႈေလ့က်င့္ေရးနယ္ပယ္သည္ ဘီးတပ္ထိုင္ခုံသုံုးသူမ်ား ၎တို႔၏ ဘီးတပ္ ထိုင္ခုံမ်ားကို မွန္ကန္ေဘးကင္းစြာသုံးရန္အတြက္ ေလ့လာရာတြင္ အေရးပါသည္။ ၎တြင္အနည္းဆံုးေအာက္ပါတို႔ပါဝင္သင့္သည္ - • ေဒသအလိုက္ သင့္ေတာ္ေသာ ေျမမ်က္နွာသြင္ျပင္အမ်ိဳးမ်ိဳး • ဆင္ေျခေလ်ာမ်ား • ေလွခါးထစ္မ်ား ၎သည္ ဝန္ေဆာင္မႈ၏ ေနာက္တဆင့္ျဖစ္ၿပီး အသုံးျပဳသူ ဘီးတပ္ထိုင္ခုံ စမ္းသပ္ေမာင္းနွင္ၿပီးေနာက္ လိုအပ္ေသာ ဘီးတပ္ထိုင္ခုံတည္ေဆာက္မႈျပန္လည္ခ်ိန္ညႇိမႈျပဳလုပ္ရန္ တပ္ဆင္ေသာေနရာနွင့္နီးကပ္စြာရွိသင့္ သည္။ ရာသီဥတုဆိုး႐ြားေသာေနရာမ်ဳိးတြင္ အမိုးအကာနွ႔င္ျဖစ္ပါကအသုံးဝင္သည္။ ေဒသေျမမ်က္နွာျပင္ပံုစံတူ အတားအဆီးမ်ားနွင့္ ၁x၁၂ ကုန္းေပါင္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 28 29 ေ႐ြ႕လ်ားသြားလာေရးကၽြမ္းက်င္မႈေလ့က်င့္ေရးနယ္ပယ္တခုတြင္ ေအာက္ပါတို႔ပါဝင္သည္။ အမ်ိဳးအမည္ အတိုင္းအတာမ်ား ရည္႐ြယ္ခ်က္: ဘီးတပ္ထိုင္ခုံ အသုံးျပဳသူနွင့္ ၎တို႔၏ ကူသူမ်ားေလ့က်င့္ရန္ ေျမျပန္႔ ၁၀မီတာရွည္ၿပီး ၁မီတာက်ယ္ေသာ အေျခခံတြန္းျခင္း ေဒသေျမမ်က္နွာျပင္ ပုံစံတူ (နယ္ပယ္ ၃ခု) သဲ၊မ်က္ခင္း၊ေက်က္ထူေျမျပင္ နယ္ပယ္တခုစီသည္ အနည္းဆံုး ၂၀၀၀ မမ ရွည္ၿပီး ၁၀၀၀ မမ က်ယ္သင့္သည္။ အသုံးျပဳသူ၏ေဒသတြင္ေတြ႕ရ ေသာပတ္ဝန္းက်င္ ဘေလာ့ ၁ ၁၅၀၀ x ၁၅၀၀ x ၂၅ မမ အျမင့္ တဆင့္ခ်င္း ဆုတ္တက္လႈပ္ရွားျခင္း ဘေလာ့ ၂ ၁၅၀၀ x ၁၅၀၀ x ၁၀၀ မမ အျမင့္ ဘေလာ့ ၃ ၁၅၀၀ x ၁၅၀၀ မမ x ၂၀၀ မမ အျမင့္ ၁:၁၂ ကုန္းေပါင္ ၁:၁၂ ကုန္းေပါင္ အၾကမ္းဖ်င္း ၃၆၀၀ မမ ရွည္ၿပီး ၁၀၀၀ မမ အက်ယ္ ဆင္ေျခေလ်ာဒီဂရီ - ၀ မမ (အနိမ့္ဘက္) မွ ၃၀၀ မမ (အျမင့္ဘက္) စံဆင္ေျခေလွ်ာတြင္ ဆုတ္တက္လႈပ္ရွားျခင္း ၁X၈ ကုန္းေပါင္ အၾကမ္ျဖင္း ၂၄၀၀ မမ အရွည္x၁၀၀၀ မမ အက်ယ္ ဆင္ေျခေလ်ာဒီဂရီ - ၀ မမ (အနိမ့္ဘက္) မွ ၃၀၀ မမ (အျမင့္ဘက္) မတ္ေစာက္ေသာ ဆင္ေျခေလွ်ာတြင္ ဆုတ္တက္လႈပ္ရွားျခင္း ဝင္ေပါက္ (အတားအဆီးမ်ား) (ပုံ၁တြင္ၾကည့္) ၆၀ မမ အျမင့္X၅၀ မမ အက်ယ္x ၁၀၀၀ မမ အရွည္ ဝင္ေပါက္(အတားအဆီးမ်ား အေနွာင့္အယွက္မ်ား) ၂ (ပံု ၁ ၾကည့္) ၉၀ မမ အျမင့္X ၅၀ မမ အက်ယ္ x ၁၀၀၀ မမ အရွည္ ေလွခါးထစ္မ်ား ( ပံု ၂ ၾကည့္) ခန္႔မွန္ေျခ ၃၀၀ မမ အနက္၊ ၁၅၀ မမ အျမင့္ နွင့္ ၁၁၀၀ မမအက်ယ္ ေလွခါးထစ္မ်ားတက္ျခင္း ဆင္းျခင္း အႀကံျပဳထားေသာ စံနႈန္းမ်ားနွင့္ သိသိသာသာကြဲလြဲလွ်င္ အထက္ပါဇယားတြင္ေဖာ္ျပထားေသာ အတိုင္း အတာမ်ားကို ေဒသအေျခအေနအရျပဳျပင္ရမည္။ လူမ်ားအေနျဖင့္ ဤေလ့က်င့္မႈမွတဆင့္ ေဒသပတ္ဝန္းက်င္တြင္ ခ်ိန္ညႇိေဆာင္႐ြက္တတ္ရန္အေရးႀကီးသည္။ လႈပ္ရွားသြားလာမႈေလ့က်င့္ေရး နယ္ပယ္၏ မည္သည့္အပိုင္းသို႔မဆို ရနိုင္ရန္လုပ္ေပးပါ။ တခါတရံ ရနိုင္ေသာ သဘာဝေျမမ်က္နွာျပင္ကို သုံုးၿပီး ဝန္ေဆာင္မႈေနရာနွင့္ နီးေသာေနရာကို သတ္မွတ္နိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 30 31 အျမင့္အမ်ိဳးမ်ိဳးျဖင့္ ဝင္ေပါက္ နမူနာမ်ား 400 50 50 60 90 (2) (2) (1) (1) 1000 mm ပုံ ၁ (အတုိင္းအတာ မီလီ) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 30 31 ေလွကားထစ္ ပုံစံျပ နမူနာမ်ား ပုံ ၂ (အတုိင္းအတာ မီလီ) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 32 33 ဘီးတပ္ထိုင္ခုံပ့ံပိုးျခင္းနည္းလမ္းအမ်ိဳးမ်ိဳးကို နွိုင္းယွဥ္ေလ့လာျခင္း စဥ္းစားရမည့္အဓိကဘီးတပ္ထိုင္ခုံပ့ံပိုးေရးနည္းလမ္းမ်ားမွာ ေဒသတြင္ဘီးတပ္ထိုင္ခုံထုတ္လုပ္ျခင္း၊ ဘီး တပ္ထိုင္ခုံသစ္မ်ား တင္သြင္းျခင္းနွင့္ ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား တင္သြင္းျခင္းတုိ႔ ျဖစ္သည္။ ဘီးတပ္ထိုင္ခုံဝန္ေဆာင္မႈတခုအတြင္း ဘီးတပ္ကုလားထိုင္မ်ားကို ျပန္လည္ျပင္ဆင္အသုံးျပဳနိုင္သည္။ ေရရွည္မွီခိုအားထားနိုင္ေသာ ထုတ္ကုန္အမ်ိဳးမ်ိဳး ပ့ံပိုးမႈ ဘီးတပထ္ိုင္ခုအံသုံးျပဳသူမ်ားသည္ "ဘီးတပထ္ိုင္ခုလံမ္းၫႊန္မ်ား" တြင္ဖြင့္ဆိုထားသည့္ သင့္ေတာ္ေသာ ထုတ္ကုန္အမ်ိဳးမ်ိဳးကို ေရရွည္ရရွိရန္လိုသည္။ မည္သည့္ပ့ံပိုးမႈနည္းလမ္းျဖင့္မဆို ေရရွည္အားထားနိုင္ေသာ ထုတ္ကုန္ပ့ံပိုးမႈသည္ အေရးပါသည္။ ပ့ံပိုးမႈနည္းလမ္းအားလံုးသည္ ေရရွည္ရနိုင္မႈနွင့္ အေရအေသြးထိန္းခ်ဳပ္မႈအရ စိန္ေခၚမႈမ်ားရွိၾကၿပီး အေျခအေနအမ်ိဳးမ်ိဳးတြင္ ကိစၥတခုျခင္းအရ စဥ္းစားသုံးသပ္ရန္လိုသည္။ ဘီးတပထ္ိုင္ခုသံုံးသူမ်ားသည္ ဘီးတပထ္ိုင္ခုပံ့ံပိုးျခင္း၏ ႀကိဳတင္စမီံျခင္း၊ အေကာင္အထည္ေဖာ္ျခင္း၊ စီမံခန္႔ခြဲျခင္း၊ အကဲျဖတ္ျခင္း တို႔တြင္ပါဝင္ေဆာင္႐ြက္သင့္ၿပီး၁ ထို႔ေၾကာင့္ အေျခအေနတခုအတြက္အေကာင္းဆံုး အေျဖကို ေ႐ြးခ်ယ္ရာတြင္ပါဝင္သင့္သည္။ ေဒသဆိုင္ရာ ကိုယ္လက္အဂၤါတုနွင့္ သြားလာမႈအေထာက္အကူဝန္ေဆာင္မႈရွိပါက ၎တို႔၏ ေဒသ ထုတ္လုပ္မႈနွင့္ တင္သြင္းကိရိယာေ႐ြးခ်ယ္မႈ ဆံုးျဖတ္ခ်က္သည္ ဘီးတပထ္ိုင္ခုဝံန္ေဆာင္မႈသို႔ ဘီတပထ္ိုင္ခု ံ ပ့ံပိုးမႈနည္းလမ္း ဆံုးျဖတ္ရာတြင္အေထာက္အကူျပဳနိုင္သည္။ စတီးပရိေဘာဂနွင့္ စက္ဘီးကဲ့သို႔ေသာ ေဒသေဈး ကြက္မွ အလာတူပစၥည္းမ်ား ကိုစဥ္းစားၿပီး ဤေဒသခံစီးပြားေရးမ်ားသည္ မည္သည့္အတြက္ေၾကာင့္ ပစၥည္းမ်ား ကို ထုတ္လုပ္သည္၊တင္သြင္းသည္ ကုိနားလည္လ်င္ လည္းအသုံးဝင္သည္။ အျခားေသာေဒသဆိုင္ရာကုန္ထုတ္လုပ္ ငန္းရွိျခင္း မရွိျခင္း သည္လည္း ဘီးတပ္ကုလားထိုင္ထုတ္လုပ္မႈေအာင္ျမင္နိုင္မျမင္နိုင္ကို ၫြဳန္ျပေသာအေရးႀကီး သည့္အခ်က္ျဖစ္သည္။ ပစၥည္းတင္သြင္းသည့္ ထူေထာင္ၿပီး ေဒသစီးပြားေရးလုပ္ငန္ရွိျခင္းမရွိျခင္း သြင္းကုန္မ်ား အတြက္ မွခီိုအားထားေလာက္ေသာေထာက္ပ့ံေရးကြင္းဆက္ရွိနိုင္ေျခကို ၫႊန္ျပေသာအခ်က္ျဖစ္သည္။ မည္သည့္ပ့ံပိုးမႈပံုစံကိုသုံးမည္ဟုဆံုးျဖတ္ခ်က္မခ်မီ ျပည့္စုံေသာျဖစ္နိင္ေျခစမ္းစစ္မႈျပဳရန္အႀကံျပဳသည္။ စရိတ္ကိုတြက္ခ်က္နွိုင္းယွဥ္ရန္လိုသည္။ သြင္းကုန္တခု၏အျပည့္အဝကုန္က်စရိတ္ကို ႀကိဳတင္တြက္ခ်က္နိုင္သည္ (ထုတ္ကုန္ေဈးနႈန္း၊ သေဘၤာတင္ျခင္း၊တင္သြင္းျခင္း၊သိုေလွာင္ျခင္း) သို႔ေသာ္ သေဘၤာတင္ေနွာင့္ေနွးျခင္းနွင့္ ေငြလဲ နႈန္း အတက္အက်ကဲ့သို႔ေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ မထိန္းခ်ဳပ္နိုင္ေသာကိစၥမ်ားကိုလည္း အာရံုစိုက္ရန္ လို သည္။ ေဒသတြင္ထုတ္လုပ္ေသာ ထုတ္ကုန္အတြက္ကုန္က်စရိတ္တြက္ခ်က္ျခင္းတြင္ အမွန္တကယ္ထုတ္လုပ္မႈ ကုန္က်စရိတ္အျပင္ အလုပ္ရံုလည္ပတ္စရိတ္နွင့္ပတ္သက္၍ႀကီးမားေသာ ဗဟုသုတလိုၿပီး ႀကိဳတင္ခန္႔မွန္းရန္ခက္ခဲ ၁။ ရင္းျမစ္နည္းေသာအေျခအေနမ်ားတြင္လက္သုံးဘီးတပ္ကုလားထိုင္ပ့ံပိုးေရးလမ္းၫြဳန္မ်ား ၂၀၀၈။ စာမ်က္နွာ ၃၄။ (http://www.who.int/ disabilities/publications/technology/wheelchairguidelines/en/). bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 32 33 နိုင္သည္။ လိုအပ္ေသာဝန္ထမ္း၊ သိုေလွာင္ရန္လိုအပ္ခ်က္၊ သြင္ကုန္လုပ္ငန္းစီမံခန္႔ခြဲျခင္း သို႔မဟုတ္ ေဒသထုတ္ လုပ္ေရးလိုအပ္ခ်က္မ်ားကဲ့သို႔ေသာ အစီအစဥ္မ်ား ကိုစဥ္းစားရန္လိုသည္။ ေဒသထုတ္ကုန္နွင့္သြင္းကုန္အက်ိဳးေက်းဇူးမ်ားနွိုင္းယွဥ္ျခင္း ထုတ္ကုန္မ်ားကိုေဒသတြင္ ထုတ္လုပ္သည္ျဖစ္ေစ တင္သြင္းသည္ျဖစ္ေစ ဘီးတပထ္ုိင္ခုမံ်ားသည္ ဘီးတပ္ ထုိင္ခုလံမ္းၫႊန္မ်ား၂ တြင္ ဖြင့္ဆိုထားသည့္အတိုင္း သင့္ေတာ္သင့္သည္။ ယခင္က ရင္းျမစ္နည္းေသာအေျခအေနမ်ား အတြက္ ရည္႐ြယ္ပံုစံထုတ္ထားေသာ ဘီးတပထ္ုိင္ခုမံ်ား တင္သြင္းရန္မျဖစ္နိုင္ေပ။ ထို႔ေၾကာင့္ေဒသတြင္ထုတ္လုပ္ျခင္းသည္ သင့္ေတာ္ေသာထုတ္ကုန္ရရွိရန္ တခုတည္းေသာ နည္းလမ္း ျဖစ္ခဲ့သည္။ သို႔ေသာ္ ရင္းျမစ္နည္းေသာအေျခေနမ်ားအတြက္ ရည္႐ြယ္ေသာ ဘီးတပထ္ုိင္ခုမံ်ားကို သြင္းကုန္မွ ပိုမိုရရွိလာၾကသည္။ ၎ကိုသိရွိၿပီး နည္းလမ္းနွစ္ခုလံုး၏အက်ိဳးေက်းဇူးမ်ားကို နႈိင္းယွဥ္ပါက ပိုမိုအသံုးဝင္သည္။ နႈိင္းယွဥ္မႈဇယားသည္ ဘီးတပထ္ုိင္ခုအံသုံးျပဳသူမ်ားအတြက္ သင့္ေတာ္ေသာ ဘီးတပထ္ုိင္ခုအံမ်ိဳးမ်ိဳးရရန္ အေကာင္းဆံုးအာမခံနိုင္ေသာ ပ့ံပိုးမႈ နည္းလမ္းေ႐ြးခ်ယ္ရာတြင္ စဥ္းစားရမည့္အခ်က္မ်ားကို မီးေမာင္းထိုး ေဖာ္ျပ ထားသည္။ ၂။ ရင္းျမစ္နည္းေသာအေျခအေနမ်ားတြင္လက္သုံးဘီးတပ္ကုလားထိုင္ပ့ံပိုးေရးလမ္းၫြဳန္မ်ား ၂၀၀၈။ စာမ်က္နွာ ၇၁ (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 34 35 ေဒသထုတ္လုပ္မႈ ေကာင္က်ိဳးမ်ား ဆိုးက်ိဳးမ်ား • ေဒသထုတ္လုပ္မႈကို အစိုးရက ကတိကဝတ္ျပဳျခင္းသည္ မသန္စြမ္းမႈသည္ ရပ္႐ြာအသိုင္းအဝန္းနွင႔္ဆိုင္ေသာ ျပႆနာ တခုျဖစ္ေၾကာင္း နွင့္ ဘီးတပ္ကုလားထိုင္ထုတ္လုပ္ မႈအပါအဝင္ ၎၏သြင္ျပင္လကၡဏာမ်ားကို ကိုင္တြယ္ေျဖရွင္းရန္လိုေၾကာင္း သတင္းစကားေပးပို႔နိုင္သည္။ • ထုတ္လုပ္မႈကိုေဒသလိုအပ္ခ်က္အတိုင္း ပံုသြင္းနိုင္သည္။ • ထုတ္ကုန္ကို ေဒသတြင္ရနိုင္ေသာ အပိုပစၥည္းမ်ားျဖင့္ အလြယ္တကူ ပ့ံပိုးနိုင္သည္။ • ေဒသဘီးတပ္ကုလားထိုင္ ျပဳျပင္ ထိန္းသိမ္းေရးကို ပ့ံပိုးနိုင္ေသာ ေဒသ ထုတ္လုပ္ေရးအလုပ္မ်ားနွင့္ က်ြမ္းက်င္မႈမ်ား ဖန္တီးေပးသည္။ • ေဒသထုတ္လုပ္သူတြင္စြမ္းရည္ရွိလ်င္ သုံးစြဲသူအတြက္ျပဳလုပ္ေပးေသာ ဘီးတပ္ကုလားထိုင္လိုအပ္ခ်က္ ကိုေျဖရွင္းနိုင္မည္။ • ေဒသထုတ္လုပ္မႈျဖင့္ လိုက္ေလ်ာညီေထြရွိေသာ သိုေလွာင္မႈကို ထိန္းသိမ္းထားနိုင္ရန္ပိုမိုလြယ္ကူ မည္။ • စဥ္ဆက္မျပတ္ လိုသလိုရနိုင္ေသာ ထုတ္လုပ္မႈေၾကာင့္ ေလွာင္ကုန္အတြက္ေနရာ အနည္းဆံုးလိုအပ္ျခင္း • ထုတ္ကုန္ထုတ္လုပ္ေရးနွင့္ ျပႆနာနွင့္လိုအပ္ခ်က္မ်ား ကိုတုန္႔ျပန္ရာတြင္ ေဒသအသုံးျပဳသူမ်ားကို ထည့္သြင္းရန္ မ်ားစြာ ပိုမိုလြယ္ကူျခင္း • အေသးစား စက္မႈထုတ္လုပ္မႈမဟုတ္ေသာေၾကာင့္ အေရအေသြးထိန္းရန္ခက္ခဲျခင္း • စက္ယႏၲယား၊ကိရိယာ၊ ထုတ္လုပ္ရန္ေနရာနွင့္ဝန္ ထမ္းေလ့က်င့္ေရးအတြက္ ကနဦးရင္းနွီးျမႇုတ္နွံမႈလို ျခင္း • ထုတ္ကုန္အမွာစာမ်ားသည္ အလုပ္ရံုလည္ပတ္မႈနွင့္ ထုတ္လုပ္မုစရိတ္ကို မကာမိေသာအခါ အလုပ္ရံုဝန္ထမ္းမ်ားကို ထိန္းသိမ္းရန္ ခက္ခဲျခင္း • ထုတ္လုပ္မႈအလုပ္ရံုကိုစီမံခန္႔ခြဲျခင္းသည္ ရႈပ္ေထြးနိုင္သည္။ • ပစၥည္းနွင့္အစိတ္အပိုင္းမ်ား ေဒသတြင္ရနိုင္မႈအေပၚ မွီခိုရျခင္း • အကန္႔အသတ္ရွိေသာ ထုတ္လုပ္မႈအေရအတြက္သည္ ထုတ္လုပ္မႈစရိတ္ျမင့္မားေစျခင္း • - ေဒသထုတ္လုပ္မႈ၏လုပ္အားစိုက္မႈ သေဘာသဘာဝေၾကာင့္ ဘီးတပ္ကုလားထိုင္ပ့ံပိုးမႈ၏ ကုသမႈသြင္ျပင္လကၡဏာမ်ားကို အာရုံစိုက္ရန္အခ်ိန္နည္းျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 34 35 တင္သြင္းဘီးတပ္ထိုင္ခုံမ်ား ေကာင္းက်ိဳးမ်ား ဆိုးက်ိဳးမ်ား • တင္သြင္းဘီးတပ္ထိုင္ခုံမ်ားသည္ ေဒသတြင္ရနိုင္ ေ သာဘီးတပ္္ထိုင္ခုံမ်ားကို အသုံးျပဳသူမ်ား၏တဦးခ်င္းလို အပ္ခ်က္မ်ားျပည့္မီရန္ အမ်ိဳးမ်ိဳးေသာထုတ္ကုန္မ်ားနွင့္ အစိတ္အပိုင္းမ်ား ရနိုင္ေၾကာင္း ေသခ်ာေစရန္ အက်ိဳးျပဳနိုင္သည္။ • ေကာင္းမြန္စြာထူေထာင္ၿပီးေသာ အေရအေသြးထိန္းခ်ဳပ္ေရး ယႏၲရားနွင့္ တည္ၿငိမ္ၿပီး ထုတ္လုပ္သူတို႔ေၾကာင့္ ေရွ႕ေနာက္ညီၫႊတ္ေသာ ထုတ္ ကုန္အေရအေသြး • ေဒသအရျဖစ္နိုင္ေသာ ထုတ္လုပ္မႈထက္ျမင့္မားေသာ ထုတ္လုပ္မႈပမာဏေၾကာင့္ ျဖစ္နိုင္ေသာ ထုတ္လုပ္မႈကုန္က်စရိတ္သက္သာျခင္း စရိတ္သက္သာ ျခင္းသည္ ဘီးတပ္္ထိုင္ခုံပိုမိုျဖန္႔ခ်ိျခင္းျဖစ္နိင္သည္။ • ထုတ္လုပ္မႈတြင္အာရံုစိုက္ရန္ အခ်ိန္ကုန္သက္သာသျဖင့္ ဘီးတပ္္ထိုင္ခုံဝန္ေဆာင္မႈသည္ စြမ္းရည္ကို ကုသေရး က်ြမ္းက်င္မႈတြင္ပိုမိုအာရံုစိုက္နိုင္ျခင္းရရွိမည္။ • တပ္ဆင္ျခင္း၊ ခ်ိန္ညႇိျခင္း၊ ကိုယ္ေနဟန္ေထာက္ကူမႈျပဳ ျပင္ျဖည့္စြက္ျခင္း၊ျပဳျပင္ထိန္းသိမ္းျခင္းတို႔အတြက္ ေဒသအလုပ္မ်ားရနိုင္ျခင္း • ေဒသထုတ္လုပ္မႈထက္ စက္ယႏၲရား၊ ကိရိယာ၊ ပစၥည္းနွင့္ လံုၿခံဳေရးအတြက္ကနဦးရင္းနွီးျမႇုတ္နွံမႈစရိတ္နည္းျခင္း။ • ေဒသထုတ္လုပ္မႈထက္ ရႈပ္ေထြးမႈနည္းေသာ အလုပ္ရံု/ နည္းပညာ စီမံခန္႔ခြဲမႈသာလိုျခင္း • စီစဥ္မႈနွင့္သြင္းကုန္အေကာက္အခြန္စရိတ္ • သေဘၤာတင္ပို႔စရိတ္သည္ ကုန္က်မႈသက္သာေစရန္ ပိုမို မ်ားျပားေသာအမွာစာလိုျခင္း • အနည္းဆံုးအမွာစာအေရအတြက္အရ ေပ်ာ့ေျပာင္းမႈနည္းျခင္း • အနည္းဆံုးအေရအတြက္ လိုအပ္ခ်က္ရွိလွ်င္ ထုတ္လုပ္မႈမစတင္မီ ပိုမိုရွည္ၾကာေသာ တင္ပို႔ခ်ိ္န္နင့္ ထုတ္လုပ္ခ်ိန္ရွိျခင္း • ပမာဏပိုမိုႀကီးမားေသာအမွာစာမ်ားသည္ ႀကီးမားေသာအရင္းအနွီး၊ ပိုမိုက်ယ္ျပန္႔ေသာ သိုေလွာင္ စရာေနရာနွင့္ ပိုမိုႀကီးမားေသာ သိုေလွာင္ပစၥည္းစာရင္း ယႏၲရားလိုျခင္း • အမွာစာနည္းေသာပိုမိုမ်ားျပားသည့္ သိုေလွာင္ပစၥည္းဝယ္ ယူမႈနွင့္ပတ္သက္ေသာ ညီၫြတ္သည့္ေလွာင္ကုန္ထိမ္း သိမ္းရန္ခက္ခဲျခင္း • အေတြ႕ရမ်ားေသာသြင္ကုန္မ်ားသည္ ေဒသလိုအပ္ခ်က္ မ်ားအတိုင္းျပဳလုပ္မထားနိုင္ျခင္း • ထုတ္ကုန္ကို ေဒသတြင္ရနိုင္ေသာအပိုပစၥည္းမပ့ံပိုးနိုင္ျခင္း • ေဒသကုန္ထုတ္လုပ္ေရးအလုပ္မဖန္တီးနိုင္ျခင္း • ထုတ္ကုန္ထုတ္လုပ္ရာတြင္ ေဒသအသုံးျပဳသူမ်ားပါဝင္ရန္ ပိုမိုခက္ခဲျခင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား တင္သြင္းျခင္း ရင္းျမစ္ႂကြယ္ဝေသာအေျခအေနအမ်ားအျပားတြင္ ဘီးတပ္ထိုင္ခုံမၾကာခဏလဲလွယ္ျခင္း နွင့္ ကာလတို အသုံးျပဳျခင္းတို႔ေၾကာင့္ အသုံးျပဳၿပီးဘီးတပ္ထိုင္ခုံ အမ်ားအျပားရွိေနၾကသည္။ တုန္႔ျပန္ေဆာင္႐ြက္သည့္အေနျဖင့္ အဖြဲ႕အစည္းမ်ားသည္ ထိုဘီးတပ္ထုိင္ခုံမ်ားကို စုေဆာင္း ျပန္လည္ထိန္းသိမ္းၿပီး ရင္ျမစ္ႂကြယ္ဝမႈနည္းေသာ အေျခ အေနမ်ားသို႔ တင္ပို႔ၾကသည္။ ျပန္လည္အသုံးျပဳ ဘီးတပ္ထိုင္ခုံမ်ားကို သင့္အဖြဲ႕အစည္းတင္သြင္းရန္ဆံုးျဖတ္ေသာအခါ သင့္ေတာ္ေသာ ဘီးတပ္ထိုင္ခုံ၏အဓိပၸာယ္ဖြင့္ဆိုခ်က္ကို ထည့္သြင္းစဥ္းစားရမည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 36 37 • အသုံးျပဳသူ၏လိုအပ္ခ်က္မ်ား၊ပတ္ဝန္းက်င္အေျခအေနမ်ားနွင့္ကိုက္ညီျခင္း • စနစ္က်အံဝင္ကြင္က်မႈနွင့္ ကိုယ္ေနဟန္ေထာက္ကူမႈေပးျခင္း • ေဘးကင္းၿပီးေရရွည္ခံျခင္း • နိုင္ငံတြင္ရနိုင္ျခင္း နွင့္ • ရယူထိန္းသိမ္းနိုင္ျခင္းနွင့္ သက္သာေသာနႈန္းထားျဖင္နိုင္ငံတြင္ဝန္ေဆာင္မႈထိန္းသိမ္းနိုင္ျခင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံတင္သြင္းေသာအခါ စဥ္းစားရန္အခ်ိဳ႕မွာ • ရနိုင္ေသာထုတ္ကုန္သည္ ရင္းျမစ္နည္းေသာအေျခအေနနွင့္သင့္ေတာ္ေၾကာင္း မည္သို႔ေသခ်ာေစမည္ • ရနိုင္ေသာထုတ္ကုန္သည္ အမ်ိဳးအစား၊ အ႐ြယ္အစားနွင့္အရည္အေသြးအမ်ိဳးမ်ိဳးွလြန္စြာကြဲျပားေနလွ်င္ နိုင္ငံတ နိုင္ငံအတြင္း လုိအပ္ခ်က္မ်ားကိုမည္သို႔ရွာေဖြတုန္႔ျပန္မည္။ • အပိုပစၥည္မ်ားမည္သို႔ေရရွည္ေထာက္ပ့ံမည္။ • မတူညီေသာထုတ္လုပ္သူမ်ား၏ထုတ္ကုန္အမ်ိဳးမ်ိဳးကို ခ်ိန္ညႇိရန္နွင့္ ထူေထာင္ရန္ မွန္ကန္ေသာကိရိယာမ်ား မည္သို႔ေပးမည္။ • လက္ရွိေဒသခံထုတ္လုပ္သူမ်ားနွင့္ဝန္ေဆာင္မႈေပးသူမ်ားအေပၚရိုက္ခတ္မႈ။ လက္ရွိဝန္ေဆာင္မႈအတြင္း ဘီးတပထ္ိုင္ခုမံ်ားကိုျပန္လည္အသုံးျပဳျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းႀကီးထြားလာေသာအခါ ေဖာက္သည္အခ်ိဳ႕သည္ ဘီးတပ္ထိုင္ခုံထက္ ႀကီးထြားလာ ၾကမည္၊ ဘီးတပ္ထိုင္ခုံသစ္ရယူၾကမည္၊ ဘီးတပ္ကုလားထိုင္ကိုဆက္လက္အသုံးမျပဳၾကေတာ့မည္ကို ေရွာင္လႊ၍ဲ မရေပ။ ၎ကိုတုန္႔ျပန္သည့္အေနျဖင့္ အခ်ိဳ႕အဖြဲ႕အစည္းမ်ားသည္ ဘီးတပ္ထိုင္ခုံမ်ားကိုဝန္ေဆာင္မႈသို႔ ျပန္အပ္ၿပီး အျခားအသုံးျပဳသူသို႔ ျပန္လည္သံုးေသာစနစ္တခု ထူေထာင္ရန္ေ႐ြးခ်ယ္မည္။ ၎သည္ ပိုမိုမ်ားျပားေသာအသုံးျပဳ သူမ်ားကို အက်ိဳးျပဳနိုင္သည္။ သုိ႔ေသာ္ ၎သည္ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ေကာင္းမြန္ေသာေ႐ြးခ်ယ္မႈ ျဖစ္ေၾကာင္းမဆံုးျဖတ္မီ စဥ္းစားစရာအမ်ားအျပားရွိသည္။ အဖြဲ႕အစည္းတခုသည္ ျပန္လည္အသုံးျပဳထုတ္ကုန္မ်ားကို ေ႐ြးခ်ယ္ပါက ထိုျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ ခုံသည္ အသုံးျပဳသူအတြက္ သင့္ေတာ္ေနဆဲျဖစ္သလားဟု စဥ္းစားရန္အေရးႀကီးသည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 36 37 အစိတ္အပိုင္းအမ်ားအျပားကို အစားထိုး သို႔မဟုတ္ ျပဳျပင္ရန္လိုမည္ျဖစ္ၿပီး ေနာက္အသုံးျပဳသူ လံုၿခံဳမႈနွင့္ က်န္းမာ ေရးအတြက္ ဘက္တီးရီယားမ်ားရိွနိုသ္ေသာမည္သည့္အစိတ္အပိုင္း(ေရျမႇုတ္၊ ကူရွင္အဖံုးအကာ၊ သိုင္းႀကိဳးမ်ား စသည္) ကိုမဆို လဲလွယ္သင့္သည္။ သင္၏အစီအစဥ္အတြင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား၏ ရႈပ္ေထြးမႈနွင့္ လက္ေတြ႕အသုံးျပဳနိုင္မႈ အေပၚသက္ေရာက္ေသာ အခ်က္အခ်ိဳ႕မွာ - • အစားထိုးအစိတ္အပိုင္းမ်ားရနိုင္ျခင္း • ၾကည့္ရႈေသာေဖာက္သည္ပမာဏ • ေဖာက္သည္မ်ားနွင့္သုံးေသာေငြေၾကးပ့ံပိုးမႈနည္းလမ္း • ေဖာက္သည္မ်ား၏အသက္အ႐ြယ္ • ပ့ံပိုးေသာထုတ္ကုန္အရည္အေသြး ေဒသေျမမ်က္နွာျပင္နွင့္ သဘာဝပတ္ဝန္းက်င္အခ်က္အလက္မ်ား (၎တို႔သည္ ဘီးတပထ္ိုင္ခုံ ထပ္မံ စဥ္းစားရန္အခ်က္မ်ားတြင္ ေအာက္ပါတို႔ပါဝင္သည္။ • ျပန္လည္အသုံးျပဳရန္ ဝန္ေဆာင္မႈသို႔ ဘီးတပ္ထိုင္ခုံကိုျပန္လည္ပို႔ေဆာင္ရန္လိုျခင္း • ျပန္လည္ျပဳျပင္ရန္ အလုပ္ရံုအတြက္ေနရာ ထပ္မံလိုအပ္ျခင္း • အဆင့္ျမင့္နည္းပညာနွင္အ့ရည္အေသြးထိန္းခ်ဳပ္မႈေလ့က်င့္ရန္လိုျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 38 39 အေထာက္အကူျပဳနည္းပညာအတြက္အကဲျဖတ္စစ္ေဆးခ်ိန္တြင္ ပါဝင္ေဆာင္႐ြက္မႈ တိုင္းတာေရးကိရိယာ ေျဖၾကားသူ - ေနရာ - ရက္စြဲ - ေမးျမန္းသူအမည္ - ၁။ သင့္တြင္မည္သည့္အေထာက္အကူျပဳကိရိယာမဆိုရွိပါသလား။ ရွိသည္ မရွိပါ (၅ သို႔သြားပါ) ၂။ ရွိပါက မည္သည့္အေထာက္အကူျပဳကိရိယာနည္း။ ၃။ ရွိပါက သင့္တြင္ရွိေသာ အေထာက္အကူျပဳကိရိယာမ်ားကို လက္ရွိအသုံးျပဳေနပါသလား။ သံုးသည္ မရွိပါ (၅ သို႔သြားပါ) ၄။ သုံးေနပါက မည္သည္တို႔နည္း။ အားလုံး အခ်ိဳ႕ , အေသးစိတ္ - ေနာက္ေမးခြန္မ်ားသည္ သင္၏အိမ္တြင္ေန႔စဥ္လုပ္ငန္းမ်ားေဆာင္႐ြက္ရာ၌ မည္မ်ခက္ခဲသည္နွင့္ ဆိုင္ ေသာေမးခြန္းမ်ားျဖစ္သည္။ ဤေနရာတြင္ အျခားသူမ်ားထံမွ အကူအညီနွင့္ အေထာက္အကူျပဳကိရိယာ သုံးစြဲမႈပါဝင္သည္။ ၅။ ခရီးသည္အျဖစ္သြားလာရာတြင္ သယ္ယူပို႔ေဆာင္ေရးသုံးရာ၌ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၆။ ေလ်ာ္ဖြတ္ေဆးေၾကာျခင္း ကဲ့သို႔ေသာ အိမ္အလုပ္လုပ္ရန္ မည္သည့္အတိုင္းအတာအထိျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၇။ ေက်ာင္းသြားသင္ယူရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၈။ အလုပ္ရရန္ ၿမဲရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၉။ အားကစား၊ ၿပိဳင္ပြဲ၊ ပန္းခ်ီနွင့္လက္မႈပညာ၊ အက၊ဂီတ စသည့္ အပမ္းေျဖလႈပ္ရွားမႈမ်ားတြင္ပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၁၀။ လူမႈေရးလႈပ္ရွားမႈမ်ားတြင္တက္ႂကြစြာပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 38 39 အေထာက္အကူျပဳနည္းပညာေနာက္ဆက္တြဲ အကဲျဖတ္စစ္ေဆးခ်ိန္တြင္ ရလာဒ္ နွင့္ ေက်နပ္မႈ တိုင္းတာေရးကိရိယာ ေျဖၾကားသူ - ေနရာ - ရက္စြဲ - ေမးျမန္းသူအမည္ - ၁။ မည္သည့္အေထာက္အကူုျပဳကိရိယာ အသုံုးျပဳေနသနည္း။ ၂။ ၎ကိုရသည္မွာမည္မ်ၾကာၿပီနည္း။ ၃။အေထာက္အကူျပဳကိရိယာကိုလတ္တေလာအသုံးျပဳပါသလား။ ျပဳသည္(၅သို႔သြားပါ) မသုံးပါ ၄။ မသုံးက မည္သည္ေၾကာင့္နည္း။ (ေမးခြန္း ၄ ကိုေျဖလွ်င္ က်န္ေမးခြန္းမ်ားကိုေက်ာ္ပါ) လာမည့္ေမးခြန္မ်ားသည္ သင္၏အိမ္တြင္ေန႔စဥ္လုပ္ငန္းမ်ားေဆာင္႐ြက္ရာ၌ မည္မ်ခက္ခဲသည္နွင့္ဆိုင္ေသာ ေမးခြန္းမ်ားျဖစ္သည္။ ဤေနရာတြင္ အျခားသူမ်ားထံမွ အကူအညီနွင့္ အေထာက္အကူျပဳကိရိယာသုံးစြဲမႈ ပါဝင္သည္။ ၅။ ခရီးသည္အျဖစ္သြားလာရာတြင္ သယ္ယူပို႔ေဆာင္ေရးသုံးရာ၌ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၆။ ေလ်ာ္ဖြတ္ေဆးေၾကာျခင္း ကဲ့သို႔ေသာ အိမ္အလုပ္လုပ္ရန္ မည္သည့္အတိုင္းအတာအထိျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၇။ ေက်ာင္းသြားသင္ယူရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 40 41 ၈။ အလုပ္ရရန္ ၿမဲရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၉။ အားကစား၊ ၿပိဳင္ပြဲ၊ ပန္းခ်ီနွင့္လက္မႈပညာ၊ အက၊ဂီတ စသည့္ အပမ္းေျဖလႈပ္ရွားမႈမ်ားတြင္ပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က္ ၁၀။ လူမႈေရးလႈပ္ရွားမႈမ်ားတြင္တက္ႂကြစြာပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ လာမည့္ေမးခြန္မ်ားသည္ အေထာက္အကူျပဳကိရိယာနွင့္ပတ္သက္၍ သင္မည္မွ်ေက်နပ္သည္နွင့္ ပတ္သက္ ေသာေမးခြန္းအခ်ိဳ႕ျဖစ္သည္။ ၁၁။ ၎၏အ႐ြယ္အစားကိုသင္မည္မ်ေက်နပ္သနည္း။ (၎သည္မည္မ်ႀကီးသနည္း။) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၂။ ၎၏အေလးခ်ိန္နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ (မည္မ်ေလးသနည္း) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 40 41 ၁၃။ တေနရာမွတေနရာသို႔သြားရန္လြယ္ကူမႈနွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၄။ ၎၏ပုံသဏၰန္နွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၅။ အသုံးလြယ္ကူမႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၆။ တည္ေဆာက္ရန္ၾကာခ်ိန္နွင့္ပတ္သက္၍သင္မည္မွ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၇။ ၎၏မွီခိုအားထားနိုင္မႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 42 43 သုံးသပ္ခ်က ္ ၁၈။ သင္၏လိုအပ္ခ်က္မ်ားျဖည့္ဆည္းေပးမႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္ပါသနည္း။ ( ၎သည္သင္လုပ္ေစ လိုသည္မ်ားအားလံုးကိုသင့္ေတာ္ေသာအခ်ိန္အတြင္း လုပ္ပါသလား။ ) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က္ ေရွ႕ေမးခြန္းမ်ားသည္ သင္ အေထာက္အကူျပဳကိရိယာ ရရွိေသာနည္းလမ္းနွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သည္ နွင့္ဆိုင္ေသာေမးခြန္းမ်ားျဖစ္သည္။ ၁၉။ မည္သည့္နည္းပညာသည္သင့္အတြက္အေကာင္းဆံုးျဖစ္ေၾကာင္းေပးေသာအႀကံဥဏ္ နွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၂၀။ ရရွိရန္ၾကာခ်ိန္ နွင့္ပတ္သက္၍သင္မည္မွ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၂၁။ ၎သည္စနစ္တက်အလုပ္မလုပ္လ်င္ အေထာက္အကူ နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 42 43 သုံးသပ္ခ်က္ ၂၂။ ၎က္ိုမည္သို႔သုံးမည္နွင့္ပတ္သက္၍ ေပးေသာ အႀကံဥဏ္နွင့္အကူအညီ နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္ သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ေရွ႕ေမးခြန္မ်ားသည္ ေထာက္ကူမႈကိရိယာအသုံးျပဳေသာသင္၏အေတြ႕အႀကံဳနွင့္ဆိုင္ေသာ ေမးခြန္းအခ်ိဳ႕ျဖစ္သည္။ ၂၃။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္းသင္သည္ သင္၏လက္ရွိအေထာက္အကူျပဳကိရိယာကို မည္မ်အသုံးျပဳသနည္း၊ ပ်မ္း မ်တရက္လွ်င္နာရီမည္မ်သုံးသနည္းကိုစဥ္းစားပါ။ မသံုးပါ တေန႔တနာရီေအာက္ တေန႔ ၁ နာရီမွ ၄ နာရီ တေန႔ ၄ နာရီမွ ၈ နာရီ တေန႔ ၈ နာရီအထက္ သုံးသပ္ခ်က ္ ၂၄။ လက္ရွိအေထာက္အကူျပဳကိရိယာကိုမရမီ သင္ျပဳလုပ္ခ်င္ဆံုးေသာ၊ပိုမိုေကာင္းမြန္ေအာင္လုပ္ လိုေသာ အေနအထားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း ဤအေထာက္အကူျပဳကိရိယာသည္ ထိုအေနအထားတြင္သင့္ကို မည္မ် အေထာက္အကူျပဳသနည္း။ လံုးဝအေထာက္အကူမရ လံုးဝအေထာက္အကူမရ အတန္အသင့္ရသည္ အလြန္ရသည္။ သုံးသပ္ခ်က ္ ၂၅။ သင္အလုပ္ခ်င္ဆံုး သို႔မဟုတ္ပိုမိုေကာင္းေအာင္လုပ္လိုေသာအေနအထားကိုထပ္မံစဥ္းစားပါ။။ သင္၏လက္ရွိအ ေထာက္အကူျပဳကိရိယာကိုသုံးေသာအခါ ထိုအေနအထားအတြက္အခက္အခဲမည္မ် ရွိေနဆဲျဖစ္သနည္း။ မျဖစ္နိုင္ အမ်ားအျပားရွိ အတန္အသင့္ရွိ အနည္းငယ္ရွိ မရွိ သုံးသပ္ခ်က္ ၂၆။ အရာရာကိုထည့္သြင္းစဥ္းစားၿပီေနာက္ သင္လက္ရွိသုံးေနေသာ အေထာက္အကူျပဳကိရိယာသည္ လံုေလာက္ စြာအသုံးဝင္သည္ဟုသင္ယူဆပါသလား။ ( ဤအေထာက္အကူျပဳကိရိယာမွသ္ရေသာ အက်ိဳးေက်းဇူးမ်ားသည္ မည္သည့္အခက္အခဲထက္မဆိုသာလြန္ပါသလား၊ သိုေလွင္ျခင္း၊ ျပဳျပင္ထိန္းသိမ္းျခင္း၊ သယ္ယူပို႔ေဆာင္ျခင္း၊ ကိိရိယာအသုံးျပဳျခင္း) လံုးဝမထိုက္တန္ အနည္းငယ္ထိုက္တန္သည္ အတန္အသင့္ထိုက္တန္သည္ ထိုက္တန္သည္ အလြန္ထိုက္တန္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 44 45 သုံးသပ္ခ်က္ ၂၇။ ဤအေထာက္အကူျပဳကိရိယာရယူေစရန္ ျဖစ္ေပၚခဲ့ေသာ အခက္အခဲမ်ားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း သင္၏အေထာက္အကူျပဳကိရိယာျဖင့္ သင္လုပ္လိုေသာအရာမ်ားအေပၚ သင္၏ အေထာက္အကူျပဳကိရိယာက အခက္အခဲမည္မွ်သက္ေရာက္ေစသနည္း။ Impossible Significantly affected Moderately affected Slightly affected Not affected at all သုံးသပ္ခ်က ္ ၂၈။ ဤအေထာက္အကူျပဳကိရိယာရယူေစရန္ ျဖစ္ေပၚခဲ့ေသာ အခက္အခဲမ်ားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း သင္၏လက္ရွိအေထာက္အကူျပဳ ကိရိယာျဖင့္ သင္အေထာက္အကူျပဳကိရိယာရရွိေသာအခက္အခဲ မ်ားနွင့္ပတ္သက္၍ အျခားသူမ်ားကမည္မ်စိုးရိမ္ခဲ့ၾကသနည္း။ Very much Quite a lot Moderately Slightly Not at all သုံးသပ္ခ်က ္ ၂၉။ အရာရာကိုထည့္သြင္းစဥ္းစားၿပီး သင္၏အေထာက္အကူျပဳကိရိယာက သင့္ဘဝကိုမည္မ်ေျပာင္းလဲေစခဲ့သနည္း။ Worse No change Slightly better Quite a lot Very much သုံးသပ္ခ်က္ ရင္းျမစ္ - WHO International Classification of Functioning, Disability and Health (ICF). QUEST 2.2. Modified from the QUEST 2.1: Children’s Version by Sonya Murchland 2011. IOI-HA. Cox RM, Stephens D, Kramer SE (2002). Translations of the International Outcome Inventory for Hearing Aids (IOI-HA). International Journal of Audiology 41(1):3-26. bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 44 45 ခ်ဥ္းကပ္နိုင္မႈသတင္းအခ်က္အလက္မ်ား အစိုးရဝန္ႀကီးဌာနမ်ားနွင့္ပူးေပါင္းေဆာင္႐ြက္ျခင္း - က်န္းမာေရး၊ ပညာေရး၊သယ္ယူပ္ို႔ေဆာင္ေရးနွင့္ရရွိနိုင္ မႈ အႀကံ ေပးေသာ ရပ္႐ြာအဖြဲ႕အစည္းမ်ား သည္ ေ႐ြ႕လ်ားသြားလာနိုင္မႈထိခိုက္ေနသူမ်ား လူ႔အဖြဲ႕အစည္းတြင္ ပါဝင္နိုင္ေရး နွင့္ထည့္သြင္းေရးကို သိသိသာသာတိုးတက္ေစသည္။ တည္ေဆာက္ခ်ိန္တြင္ အေဆာက္အအံုမ်ားကို ခ်ဥ္းကပ္နုိင္ ေအာင္ျပဳလုပ္ထားျခင္သည္ ေနာင္မွ ျပင္ဆင္ျဖည့္စြက္ရျခင္းထက္မ်ားစြာ ကုန္က်စရိတ္သက္သာေစသည္။ ရိုးရွင္းေသာအခ်က္အလက္အခ်ိဳ႕ကိုေအာက္တြင္ေဖာ္ျပထားသည္။ အေသးစိတ္မ်ားကို ဤသင္ရိုးတြင္ ေဖာ္ျပထား ေသာ ရင္းျမစ္မ်ားတြင္ရနိုင္သည္။ ေနအိမ္ကိုခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ျခင္း • အဓိက စဥ္းစားရမည့္အခ်က္မ်ားတြင္ အဆင့္မ်ား၏အျမင့္နွင့္ အလုပ္မ်က္နွာျပင္ေအာက္သို႔ခ်ဥ္းကပ္မႈပါဝင္သည္။ • တံခါးေပါက္အဝင္လမ္းမ်ား: အက်ယ္၊အဖြင့္ဦးတည္ဘက္၊ လက္ကိုင္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 46 47 တံခါးအဝင္ေပါက္မ်ား • တံခါးေပါက္အက်ယ္: ၉၀၀ မမ။ • တံခါးမ်ားကို အတြင္းဘက္သို႔ အလုပ္မ်ားေသာေနရာမွ ပိုမိုတိတ္ဆိပ္ေသာေနရာသို႔ ပြင့္ေအာင္ပတၱာတပ္ရန္ႀကိဳးစားပါ။ ဥပမာ ေည့္ခန္းမွအိပ္ခန္းသို႔။ • ၁၈၀ဒီဂရီနီးပါး ပြင့္နိုင္ေသာပတၱာမ်ားရရန္ ႀကိဳးစားပါ။ • လွည့္ပတ္ရန္ေနရာ: တံခါး၏နွစ္ဘက္လံုးတြင္ ရွင္းလင္းေသာခ်ဥ္းကပ္ရန္ေနရာလိုသည္။ • ခ်ဥ္းကပ္ရန္ အကန္႔အသတ္ရွိေသာေနရာ: ေလ်ာတံခါးတခုကိုစဥ္းစားနိုင္သည္။ (ပံုတြင္ၾကည့္ပါ - ခ်ဥ္းကပ္နိုင္ေသာအိမ္သာ) တံခါးေကာင္းစြာေလ်ာနိုင္ရန္ ၾကမ္းျပင္လမ္းေၾကာင္းကို ေကာင္းစြာထိန္းသိမ္းရမည္။ အိမ္သာမ်ား • ေရအိမ္တြင္သို႔ ပြင့္ေသာတံခါးမ်ားသည္ ေရအိမ္တြင္းေနရာကိုေလွ်ာခ်ၿပီး ျဖစ္နိုင္လွ်င္ ေရွာင္ရွားသင့္သည္။ အျခားေ႐ြးစရာမွာ ေလွ်ာတံခါးျဖစ္သည္။ • အိမ္သာနွင့္ကပ္လ်က္ ကိုင္စရာသံတန္းမွာ ဘီးတပ္ထိုင္ခုံအကူးအေျပာင္းအတြက္ အသုံးဝင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 46 47 ရပ္႐ြာခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ျခင္း လူသြားလမ္းမ်ား • လူသြားလမ္းအက်ယ္သည္ အဟန္အတားမရွိေသာ ၉၀၀ မမ ရွိသင့္သည္။ • အသုံးမ်ားေသာလူသြားလမ္းမ်ားသည္ ဘီးတပ္ထိုင္ခုံ ၂ စီး တစီးနွင့္တစီးျဖတ္သန္းႏုိုင္ရန္ ၁၅၀၀ မမ က်ယ္သင့္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ပလက္ေဖာင္းအဆင့္မ်ား • ကိုင္းၫြတ္ပလက္ေဖာင္းအဆင့္မ်ား-အနိမ့္အျမင့္ေျပာင္းလဲေသာေနရာရွိ အဆင့္မ်ား၊ထိန္းခ်ဳပ္ကုန္း ေပါင္မ်ား ( ေအာက္ပါသရုပ္ေဖာ္ပံုကိုၾကည့္ပါ) ကုန္းေပါင္မ်ား အေဆာက္အအံုမ်ားသို႔ ခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ေသာအခါ လူအားလံုး၏လိုအပ္ခ်က္ကို စဥ္းစားပါ။ ဘီးတပ္ထိုင္ခုံသုံးသူမ်ားအတြက္ ေအာက္ပါအခ်က္မ်ားကိုစဥ္းစားပါ။ • ဆင္ေျခေလ်ာအေစာင္းဒီဂရီ ၁:၁၂၊ ျပင္ပ ၁:၁၅။ • မ်က္နွာျပင္ - မေခ်ာရ။ • လက္တန္းမ်ား - ေအာက္ေျခမွအဆင္းထိပ္အထိ မၿပီးဆုံးမီ ၃၀၀ မမဆက္ရွိသင့္။ • အဆင္းက္ို ဆင္ေျခေလွ်ာ၏ေအာက္ေျခနွင့္ ထိပ္တြင္ထားသင့္။ ဦးတည္ဘက္ေျပာင္းပါက ၁၂၀၀ မွ ၁၅၀၀ မမ အတိုင္းအတာ။ • ထိပ္အဆင္းမ်ားကို တံခါးအဖြင္းစက္ဝိုင္းအစြန္းမွ တိုင္းတာသင့္သည္။

ISBN 978 92 4 154908 0 ပုိမုိသိရွိလုိပါက ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ အမွတ္ ၂ဝ အက္ပီယာရိပ္သာလမ္း၊ စီအိပ္ခ်္ ၁၂၁၁ ဂ်ီနီဗာ ၂၇၊ ဆြစ္ဇာလန္ (တယ္လီဖုန္း၊ (+၄၁ ၂၂) ၇၉၁-၂၇၁၅ ဖက္စ္၊ (+ ၄၁ ၂၂) ၇၉၁ ၄၈၇၄ http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int တြင္ စုံစမ္းပါ။

WHEELCHAIR SERVICE TRAINING PACKAGE For Managers For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int 978 92 4 154908 0 Trainer’s Manual

WHEELCHAIR SERVICE TRAINING PACKAGE Trainer’s Manual For Managers Contributors: Editors: Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza Contributors: Michael Allen, Johan Borg, Alberto Cairo, Christine Cornick, Lauren Flaherty, Ricardo Guzman Hefferan, Cristian Ispas, Henry Lumley, Colin Macfarlane, Peter Mbuguah, Matt McCambridge, Ray Mines, Sruti Mohapatra, Stephen Muldoon, Isaac Nyathi, Alana Officer, Kiran Patwardhan, Chris Rushman, Elsje Scheffler, Katherine Selengia, Nicky Seymour, Rebecca Jackson Stoeckle, and Eric Wunderlich Illustrator: Melissa Puust Photo credits: David Constantine, Chapal Khasnabis and Jesse Moss Video credits: Chapal Khasnabis, Amanda McBaine, and Jesse Moss Financial support: US Agency for International Development Partner organizations: Cheshire Services Ethiopia (CSE), International Orthodox Christian Charities (IOCC), Management Sciences for Health (MSH), Mobility India, Motivation Africa, and United Cerebral Palsy Wheels for Humanity (UCP) WHO Library Cataloguing-in-Publication Data. Wheelchair service training package for managers/edited by Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza. Contents: Trainer’s Manual for Managers – Reference Manual and Workbook for Managers – Additional Resources for Managers – Trainer’s Manual for Stakeholders. 1. Wheelchairs – standards. 2. Disabled persons – rehabilitation. 3. Teaching materials. I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. World Health Organization. ISBN 978 92 4 154908 0 (NLM classification: WB 320) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Malta Design by Inís Communication – www.iniscommunication.com Content packaging by Bizgraphics (http://bizgraphic.ch/) Terminology The following terms used throughout the training package are defined below. Appropriate wheelchair A wheelchair that meets the user’s needs and environmental conditions; provides proper fit and postural support; is safe and durable; is available in the country; and can be obtained and maintained and services sustained in the country at the most economical and affordable price. Manual wheelchair A wheelchair that is propelled by the user or pushed by another person. Postural support device (PSD) A physical device that provides additional postural support. Wheelchair A device providing wheeled mobility and seating support for a person with difficulty in walking or moving around. Wheelchair modification A change made to a wheelchair. Wheelchair provision An overall term for wheelchair design, production, supply and service delivery. Wheelchair service That part of wheelchair provision concerned with ensuring that each user receives an appropriate wheelchair. Wheelchair service personnel Persons skilled in the provision of an appropriate wheelchair. Wheelchair user A person who has difficulty in walking or moving around and uses a wheelchair for mobility. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 1 About the Wheelchair Service Training Package for Managers 1 Introduction 2 Target audience 2 Purpose 3 Scope 3 Trainers 4 How to get started 5 1. Guidance notes for trainers 5 1.1 Training overview 5 1.2 Training package timetable and duration 6 1.3 Session plans 6 1.4 PowerPoint presentations 6 1.5 Evaluating the training programme after each delivery 7 1.6 Good practice training tips 8 2. How to prepare to deliver the training package 8 2.1 Know the current situation for wheelchair provision 8 2.2 Clarify the participants’ role in wheelchair service delivery 8 2.3 Review each session plan and adjust if necessary 8 2.4 Prepare facilities 9 2.5 Prepare resources and equipment 12 3. Detailed session plans 12 Welcome, introduction and overview 15 A: Core knowledge 15 A.1: What is appropriate wheelchair provision? 23 A.2: Service delivery 33 A.3: Managers who lead change 42 B: Starting a wheelchair service 42 B.1: Accessing services 50 B.2: Facilities and equipment 57 B.3: Range of appropriate wheelchairs C O N T EN T S 72 B.4: Align personnel 79 B.5: What does a wheelchair service cost? 87 C: Running a wheelchair service 87 C.1: How do you know if your service is working? 96 C.2: Managing demand 111 C.3: Planning follow-up 125 C.4: Planning for financial sustainability 132 Putting it all together 136 References vi FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 1About the Wheelchair Service Training Package for Managers Introduction Following the release in 2008 of the Guidelines on the provision of manual wheelchairs in less resourced settings(1), in 2012 the first package within a range of Wheelchair Service Training Packages (WSTP) was released: the Wheelchair Service Training Package – Basic Level (WSTPb)(2). This was followed in 2013 by the release of the Wheelchair Service Training Package – Intermediate Level (WSTPi)(3). The World Health Organization (WHO) in partnership with the United States Agency for International Development (USAID) has now developed the third part of the WSTP consisting of two sub-packages: the Wheelchair Service Training Package for Managers (WSTPm) and the Wheelchair Service Training Package for Stakeholders (WSTPs). This third part of the WHO WSTP is designed to support managers to effectively support appropriate wheelchair provision; and to raise awareness among stake- holders and promote their involvement in establishing appropriate wheelchair provision in their country/region. The wheelchair is one of the most commonly used assistive devices for enabling personal mobility. For people who have difficulty in walking or moving around, a wheelchair is an essential tool for their mobility, empowerment, dignity, and overall well being. Mobility opens up the opportunities for wheelchair users to be independent and access health care, education, work and employment, and also assists wheelchair users to participate in social and cultural activities. However, WHO estimates that more than 70 million people need a wheelchair and only 5–15% have access to one. In addition, training opportunities for personnel to gain the knowledge and skills needed to effectively deliver a wheelchair are limited. The importance of mobility is reflected in the United Nations Convention on the Rights of Persons with Disabilities (CRPD)(4), which advocates for “effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities”. To ensure effective personal mobility, wheelchair users need a wheelchair that fits correctly and meets their specific needs, especially lifestyle and environment. This requires an approach that is responsive to individual needs. WHEELCHAIR SERVICE TRAINING PACKAG E 2An effective way of meeting the individual needs of wheelchair users is the provision of wheelchairs through a well organized wheelchair provision system that is responsive to the expectations of the users, respects their dignity and is delivered by well trained personnel. Target audience This training package is for all personnel responsible for implementing, managing and evaluating rehabilitation services including wheelchair provision or wheelchair services. Previous experience in wheelchair service management is not necessarily required; however, the workshop has been designed assuming that participants will begin the workshop with general management skills. Note: the actual time taken for each session will vary depending on the following factors: • the experience and skills of participants; • the overall number of participants; • whether there is a need for translation during sessions; • whether additional material is included. Depending on these factors more or less time may be needed. Trainers are strongly encouraged to adapt and modify the timetable to suit the local context and the learning needs of participants. Purpose The purpose of the overall training package is to create awareness and develop the skills and knowledge of all personnel involved in wheelchair service delivery. WHO realizes that trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is a higher level involvement to establish or improve wheelchair provision within the country. This Wheelchair Service Training Package for Managers (WSTPm) provides an overview of the rehabilitation/wheelchair service manager’s role in engaging people and leading the implementation of the eight steps of wheelchair service delivery and issues related to it. This will include the human and physical resources required to provide a wheelchair service; including planning, organizing, staffing, directing, costing/funding, and monitoring and evaluation. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 3Delivery of this training package will help the managers to: • better plan wheelchair provision; • increase the quality of wheelchair service delivery; • improve staff retention; • increase the number of users who receive a wheelchair that meets their needs; and • increase the sustainability of wheelchair provision. Scope The training package can be delivered in 13–14 hours, although this period may be extended or reduced according to the specific needs and resources available. The training package includes: • an overview of the key steps of wheelchair service delivery described in the WHO wheelchair service training packages; • core knowledge required for wheelchair service delivery; • starting a wheelchair service; • running a wheelchair service; and • making wheelchair provision sustainable. Trainers Skills: Trainers delivering this training package should have a good understanding of the subject and of the context in which they are delivering the training. They should be aware of any existing wheelchair provision initiatives and gaps as well as relevant local laws, strategies and policies. Good selection of the trainer/s is important for its success. It is recommended that they have: • experience training and facilitating people at an appropriate level; • experience managing multi-level audiences; • a strong conviction that introducing appropriate wheelchair provision is beneficial to wheelchair users. Number of trainers: It is recommended that there is one trainer for every 8–10 participants. Having an experienced wheelchair user, who knows the subject and training package well, can be an asset. Where more than one trainer is involved, it is recommended that sessions are split between the trainers to avoid one person leading too many consecutive sessions. WHEELCHAIR SERVICE TRAINING PACKAG E 4How to get started Before carrying out the training programme, you must copy the relevant Pen Drive contents (inside the folder of the WHO Wheelchair Service Training Package (WSTP) for Managers and Stakeholders) to your computer’s hard drive. The simplest way to deliver the training programme is: 1. Open the Trainer’s Manual from the manual folder and: 1.1 Read the sections About the Wheelchair Service Training Package and Guidance Notes for Trainers; 1.2 Print and bind one copy of the Trainer’s Manual for each trainer, if you do not have a hard copy; 1.3 Print a timetable and training evaluation forms. 2. Make all the necessary arrangements, as suggested in the section How to Prepare to Deliver the Training Package. Refer to the Training of Trainers Card Decks for additional information. 3. Give each participant a full set of training materials including: the Reference Manual and Workbook, and one poster of the wheelchair service steps. If you do not have these in stock, they can be printed from the Pen Drive. 4. Open the timetable of the relevant training programme and click the hyperlinks for each session, which will take you to the exact slides and video location. The best way to deliver the training is to proceed through the lessons in sequential order with respect to the timing allotted for each session, as much as possible. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 51. Guidance notes for trainers 1.1 Training overview Session Minutes Welcome, introduction and overview. 30 A. Core knowledge A.1: What is appropriate wheelchair provision? 50 A.2: Service delivery 40 A.3: Managers who lead change 45 B. Starting a wheelchair service B.1: Accessing services 45 B.2: Facilities and equipment 55 B.3: Range of appropriate wheelchairs 80 B.4: Align personnel 50 B.5: What does a wheelchair service cost? 60 C. Running a wheelchair service C.1: How do you know if your service is working? 75 C.2: Managing demand 85 C.3: Planning follow-up 85 C.4: Planning for financial sustainability 70 Putting it all together 30 Total 800 1.2 Training package timetable and duration This training package can be delivered on consecutive days or in blocks over a period of time. The minimum time to teach the complete package is 13–14 hours. An estimate of the time needed to teach each session is included in the respective session plan. A sample timetable is available on the Pen Drive. Trainers are encouraged to adapt and modify the timetable to suit the local context and the learning needs of participants. WHEELCHAIR SERVICE TRAINING PACKAG E 61.3 Session plans For each session, there is a detailed session plan. This can be used by the trainers to plan and deliver each session. At the beginning of each session plan is the following information: • Objectives: detailing the aim of that particular session; • Resources: what resources are needed for the session; • Context: how the session may need to be adapted for different contexts (or situations); • To prepare: how to prepare for the session; • Outline: a framework of the main parts of the session. The rest of the session plan is divided into topics. For each topic, the session plan provides instructions on how to present the information for that topic. At the end of each session plan, there is a list of recommended actions for managers. Managers are encouraged to consider how they will apply these actions in their context at the end of each session. 1.4 PowerPoint presentations PowerPoint presentations (PPT) with videos are provided for the sessions. Trainers should note that only the key points are written on the slides. 1.5 Evaluating the training programme after each delivery It is good practice to evaluate the training programme after it has been delivered. Trainers may also record their own thoughts about the training programme as it is delivered. This information can help them to evaluate the training programme at the end, including identifying its strengths and weaknesses. This will help trainers to evaluate both the training package itself and their own skills for delivery in their context in future. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 71.6 Good practice training tips Be prepared • read each session plan carefully before the training starts; • make sure you are confident of the material you are delivering; • gather training resources and prepare the training room well. Present information clearly • speak clearly and calmly; • check to make sure everyone in the training room can hear you; • ask questions to check that you have been understood; • make sure your writing on the whiteboard can be read by everyone; • repeat important points to reinforce them. Manage session time • note the time allowed for each session and work to keep to time; • if it is likely that additional time will be needed, plan for this at the beginning; • be sure to complete all the sessions planned for a given day. Build success in the small group activities • observe group activities closely and give help if needed; • ensure that you circulate between the small groups and check the progress of each group. Encourage participants to be active and engaged throughout the training • use the different training styles and methods given in the session plans; • avoid talking too much – encourage participants to speak and discuss among themselves; • ask questions to encourage participants to think about the answers themselves, rather than always telling them the answer; • encourage everyone to speak; do not let one participant dominate; • praise good work from participants and give positive feedback; • let participants know they can ask questions at any time; • link learning to real examples that the participants will recognize; • keep the training fun! Use short “warm-up” activities/games • use short warm-up activities (5–10 minutes) in between to help focus attention. Use activities that are inclusive of participants with disabilities. Consider the needs of people with different abilities • think about the needs of any participants with visual, hearing or mobility differences – some activities and training approaches may need to be adapted accordingly. WHEELCHAIR SERVICE TRAINING PACKAG E 82. How to prepare to deliver the training package 2.1 Know the current situation for wheelchair provision Organizations and facilitators organizing a WSTP Managers’ workshop need to have a thorough understanding of wheelchair provision in the region, country, or district. This includes: • being aware of any existing wheelchair provision activities or initiatives; • understanding current gaps in wheelchair provision; • knowledge of relevant regional/national laws, strategies, policies, and action plans related to wheelchair provision. 2.2 Clarify the participants’ role in wheelchair service delivery Find out how wheelchair service delivery fits within the participants’ overall duties at their place of work. For example, will participants be working only in wheelchair service delivery, or do they have other duties as well? 2.3 Review each session plan and adjust if necessary Review each session plan carefully – some sessions may need to be adjusted to suit the local context. Suggestions for adjusting sessions to different contexts are provided at the beginning of each session plan under the heading “context”. 2.4 Prepare facilities The training space needs to be large enough to allow for participants to break into small groups for group activities. All areas, including toilets and space for lunch and refreshments, must be wheelchair accessible. The following checklist can be used to assess and prepare training facilities. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 9Facilities checklist: Training room Lecture area  Chairs for each participant – with facility for participants to write notes  Space for participants to break into small groups of 2–4  Adequate lighting and ventilation  Lunch/refreshment area Clean area for eating  Tables and chairs  Nearby space for washing hands – clean towels and soap  Toilets Clean toilets supplied with water, toilet paper, hand washing facilities and bins  2.5 Prepare resources and equipment Resource materials Resource Quantity  Comment/instructions Manuals, workbook: Trainer’s Manual 1 per trainer  Order from WHO or print and bind Reference Manual and Workbook 1 per participant  Order from WHO or print and bind Supplementary resources for Trainer/s. Also decide how to share relevant resources with participants. For example on a USB stick/Pen Drive; via an internet based sharing facility; or by providing website references. WHO Guidelines on the provision of manual wheelchairs in less resourced settings At least 1 sample copy  Resource on Pen Drive Joint position paper on provision of assistive devices in less resourced settings At least 1 sample copy  Resource on Pen Drive WHEELCHAIR SERVICE TRAINING PACKAG E 10 United Nations Convention on the Rights of Persons with Disabilities (CRPD) At least 1 sample copy  Resource on Pen Drive CBR Guidelines Introductory booklet and Health component At least 1 sample copy  Resource on Pen Drive Managers who lead 1 per trainer  Resource on Pen Drive Design Considerations for Accessibility – 2006 At least 1 sample copy  Resource on Pen Drive WSTP logo 1 high resolution sample  Resource on Pen Drive Participants register form 1 per workshop  Use this form to keep a record of participants attending Name tags 1 per participant and per trainer  Produce locally using WSTP logo Timetable 1 per participant  Sample available on Pen Drive; adjust to suit local context Photo consent form 1 per participant  Adapt this form for the host/training organization Attendance certificate 1 per participant  Prepare participant certificate or adapt the template provided Posters – awareness-raising posters to be put up in workshop venue: WSTP Basic: wheelchair service steps; wheelchair mobility skills, pressure sores and how to care for a wheelchair at home 4  Print from Pen Drive WSTP Intermediate: children and wheelchairs; different positions; postural support device (PSD) table and intermediate wheelchair user training checklist 4  FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 11 Equipment Item Quantity  Comment/instructions Data projector 1  Computer 1  Speakers 1 set  To assist in hearing the videos Microphone 2 or more, depending on participant numbers  A “roving” microphone(s) for participants asking questions or to gain feedback from small groups Large whiteboard 1  Whiteboard marker pens 3–4  Flip chart stand and paper 1 stand and 1 pack of paper  Flip chart pens 3–4  Post-it notes 3–4 blocks  Masking tape or similar 1 roll  To attach flip chart sheets and posters to walls Sample wheelchairs 1 per 3 participants  Samples of locally available wheelchairs for participants to use during breaks Managers should be encouraged to ride in the different wheelchairs available (with a “buddy” for safety) during the breaks. WHEELCHAIR SERVICE TRAINING PACKAG E 12 3. Detailed session plans Welcome, introduction and overview O B JE C T IV E S By the end of this session, participants will: … know the objectives of the training programme; … know the names of the trainers and participants; … have an overview of the training programme timetable; … know any important rules to remember during the training programme. R E S O U R C E S For the session: … PPT slides: Introduction; … Reference Manual and Workbook for each participant; … video: Wheelchair service delivery; … copy of the timetable for each participant; … name tags for trainer/s and each participant. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … include an opening ceremony if appropriate to the culture/context; … change or adapt the section ‘Introduction of trainer/s and participants’ to suit the trainer/s and participants; … change, adapt and/or add to the list of ‘Housekeeping and expectations’; … change the overview slide if the training programme has been modified. T O P R E PA R E … Read through the session plan, gather resources, review PPT slides, and watch video. … Give out timetable, Reference Manual and Workbook, and name tags during registration. O U T L IN E 1. Opening ceremony (if any) 2. Introduction of trainer/s and participants 3. Workshop overview 4. Training programme timetable, housekeeping and expectations. 10 10 5 5 Total session time 30 FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 13 1. Opening ceremony (estimated length 10 minutes) The workshop may be opened with an opening ceremony as per local culture and customs. 2. Introduction of trainer/s and participants (10 minutes) Trainer: Introduce yourself. Provide a brief overview of your background and experience of wheelchair delivery and service management. Ask participants in turn to introduce themselves, stating their name, the organization they come from and what they hope to gain from the workshop. 3. Workshop overview (5 minutes) This workshop will provide participants with knowledge and skills to help them to begin or improve wheelchair provision for girls, boys, women and men in their country. 2. Introduction Overview Explain: The aim of this programme – read from the slide. WSTP for mana gers This workshop is for managers and this training package is divided into three sections: A. Core knowledge B. Starting a wheelchair service C. Running a wheelchair service. 3. Introduction Read the slide, reinforce if needed. Explain: The workshop builds on the CRPD – recognizing that people with a disability have the same human rights as everyone else, and describing the role of a wheelchair service in realizing those rights. WHEELCHAIR SERVICE TRAINING PACKAG E 14 Video presentati on Wheelchair service delivery 4. Introduction Introduce video: Wheelchair service delivery. This video will show the eight steps of wheelchair service delivery that are covered in Wheelchair Service Training Packages (WSTP) at both basic and intermediate levels. Ask participants to watch the video and note each service step. Show video. 4. Training programme timetable, housekeeping and expectations (5 minutes) Ask participants to refer to their copy of the workshop timetable. Highlight the start and finish times and breaks. Explain: the general housekeeping: • location of toilets • who to talk to about accommodation and travel • what to do in the event of an emergency. Explain: the expectations: • each session will begin on time • turn off mobile phones during the sessions • questions are encouraged. Explain: During the training programme, participants will be riding in and pushing wheelchairs. Whenever using the wheelchairs, remember the following safety rules: • do not stand on footrests when getting in and out of the wheelchair; • keep fingers clear of the wheel spokes and brakes; • when riding the wheelchair up and down slopes, have an assistant behind you in case you tip backwards. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 15 A: Core knowledge A.1: What is appropriate wheelchair provision? O B JE C T IV E S By the end of this session, participants will be able to: … quantify the need for wheelchairs in their country and globally; … list two articles in the CRPD that reinforce the importance of appropriate wheelchair provision; … define appropriate wheelchair provision; … discuss how national policies can support wheelchair provision; … explain how the Wheelchair Guidelines can support the development of national policy. R E S O U R C E S For the session: … PPT slides: A.1: What is appropriate wheelchair provision? … Reference Manual and Workbook. C O N T E X T Adapt this session to suit the context that participants will be working in. For example: … identify census statistics and other relevant numbers to quantify the need for wheelchairs in the country; … research any existing national or regional policies that relate to wheelchair provision. T O P R E PA R E … Read through the session plan and gather resources. … Prepare PPT slide 3 by inserting country/regional statistics. O U T L IN E 1. Introduction 2. What is the need and unmet need for wheelchairs? 3. Right to personal mobility 4. Supporting appropriate wheelchair provision 5. Summary of action points for managers. 4 4 20 20 2 Total session time 50 WHEELCHAIR SERVICE TRAINING PACKAG E 16 1. Introduction (4 minutes) Explain: In this session we will talk about appropriate wheelchair provision and the importance of the user’s individual needs being central to the whole process. The importance of personal mob ility • The right to personal mobility is an important first step to remain healthy, independent and productive. • People with difficulty in walking or moving around often require access to an appropriate wheelchair, according to their need and choice for their mobility. • Only a well-functioning wheelchair provision system with well-trained personnel can guarantee the highest possible personal mobility. A.1.2 What is appropriate wheelchair provision? Read the slide, reinforce if needed. 2. What is the need and unmet need for wheelchairs? (4 minutes) • WHO estimates that more than 70 million people need a wheelchair (1% of any population) but only 5–15% have access to one. (WHO factsheet on disability). • There is a need for urgent action to improve access to high quality affordable wheelchairs. A.1.3 What is appropriate wheelchair provision? Unmet need fo r services Read the slide, reinforce if needed. Ask: Do you know how many people in your country need wheelchairs? Acknowledge answers. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 17 What is the nee d in our country ? Population People who need a wheelchair WHO 7 000 000 000 70 000 000 Insert country Insert country population Insert 1% of country population A.1.4 What is appropriate wheelchair provision? Explain: • WHO estimates that 1% of any population need a wheelchair. • The population of this country is X (Insert population from census. Calculate 1% of the census population of the country). 3. Right to personal mobility (20 minutes) Video presentati on What an appropriate wheelchair means to me A.1.5 What is appropriate wheelchair provision? Introduce video: What an appropriate wheelchair means to me. In this video experienced wheelchair user Faustina explains the difference it made to her life when she received a wheelchair through a service. Show video. Ask: What were some of the differences when Faustina received a wheelchair through a service? Most important answers: • Faustina no longer falls out of her wheelchair on rough roads (dignity); • Faustina is able to sit upright because her wheelchair is the correct size and gives good support (helps her to sit upright and comfortably); • Faustina is able to push safely and independently on rough roads and slopes (independence); • Faustina feels less disabled (confidence); • Faustina feels better about herself because the wheelchair is personal to her (self-esteem). WHEELCHAIR SERVICE TRAINING PACKAG E 18 Human rights f or everybody Development and human rights for all • UN Convention on the Rights of Persons with a Disability (CRPD). • The focus of the CRPD is to make sure that everybody recognizes that the people who need a wheelchair have the right to have one. A.1.6 What is appropriate wheelchair provision? Explain: We all know that many people who need wheelchairs still do not have an appropriate wheelchair. However, there is an important tool that managers can use to advocate for the rights of people who need wheelchairs. Explain: • This is the United Nations Convention on the Rights of Persons with Disabilities (CRPD). • The focus of the CRPD is to make sure that everyone recognizes that these are rights for all; including people with a disability. Ask: Has your country signed the CRPD? Notes for trainers: • signing the CRPD indicates the government’s moral intention to be bound by the convention; • ratifying the CRPD indicates the government’s moral and legal obligation to implement the convention. Explain: There are a number of articles in the CRPD that reinforce the importance and relevance of appropriate wheelchair provision. Ask: Does anyone know which article of the CRPD specifically refers to mobility? Acknowledge answers. What does‘pers onal mobility’me an? CRPD Article 20: Personal mobility • All people have a right to personal mobility. • Personal mobility means: The ability to move in a manner and at the time of one’s own choice, and at an affordable cost. A.1.7 What is appropriate wheelchair provision? Read the slide, reinforce if needed. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 19 Mobility is part o f rehabilitation Appropriate wheelchairs + Inclusive services = Effective wheelchair provision CRPD Article 26: • Habilitation and rehabilitation • States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation. A.1.8 What is appropriate wheelchair provision? Explain: • Article 26 talks about the importance of rehabilitation and habilitation. • Personal mobility is an essential part of rehabilitation. Notes for trainers: • Rehabilitation – restoring abilities to participate in society; • Habilitation – building abilities for the first time. Mobility gives a ccess to other ri ghts Appropriate wheelchairs + Inclusive services = Effective wheelchair provision Mobility is often the first step: Article 19 – Living independently and being included in the community. Article 24 – Education. Article 25 – Health. Article 27 – Work and employment. Article 30 – Participation in cultural life, recreation, leisure and sport. A.1.9 What is appropriate wheelchair provision? Read the slide, reinforce if needed. First step to inc lusion Appropriate wheelchairs + Inclusive services = Effective wheelchair provision A.1.10 What is appropriate wheelchair provision? Explain: • Mobility is often the first step to inclusion and participation: • When a person receives an appropriate wheelchair through a service, opportunities for social life, work and education open up. WHEELCHAIR SERVICE TRAINING PACKAG E 20 The first step to wards participat ion A.1.11 What is appropriate wheelchair provision? Explain: • An appropriate wheelchair can assist in opening up a new world for the user – from exclusion to inclusion, participation in all societal activities, and sports and recreation – which all leads to independence and better health. Benefits for the country • Other family members are freed up to participate in community activities and go for work or employment. • The economy of the country benefits from more contributing members of society. • From a charity-recipient to a tax-payer of the country. A.1.12 What is appropriate wheelchair provision? Explain: It is win-win for all: • Other family members are freed up to participate in the community and employment. • The economy of the country benefits from more contributing members of society and less demands on health services due to secondary health complications. 4. Supporting appropriate wheelchair provision (20 minutes) Explain: We have been using the term wheelchair provision. Ask: What does this term actually mean according to the Wheelchair Guidelines? Acknowledge answers: write on the whiteboard. Most important answers: • providing products that meet the definition of an appropriate wheelchair ; • products are provided through a service; • personnel providing the service have received appropriate training; • supported by policy, both within the organization and at the national level. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 21 Where to begin ? • Appropriate products • Service delivery • Training • Policy and planning A.1.13 What is appropriate wheelchair provision? Read the four key areas of the Wheelchair Guidelines. Explain: For wheelchair provision to be effective and sustainable, it is necessary to be supported by policy and planning. The Wheelchair Guidelines highlight that international and regional polices and strategies can support and inform national policy on wheelchair provision. The highest level document is the CRPD. Importance of m obility • In 2012, the Incheon Strategy to “Make the Right Real” for persons with disabilities in Asia and the Pacific was adopted. • The Incheon Strategy has 10 goals. Goal 3 is to enhance access to the physical environment, public transportation, knowledge, information and communication. • A strong case was made that this Goal could not be achieved without access to appropriate assistive devices, including wheelchairs. A.1.14 What is appropriate wheelchair provision? Read the key points, reinforce if needed. Make the right r eal Incheon Goals and Targets (INGOT): Goal 3: Enhance access to the physical environment. Target: Halve the proportion of persons with disabilities who need but do not have appropriate assistive devices or products. Indicator: Proportion of persons with disabilities who need assistive devices or products and have them. A.1.15 What is appropriate wheelchair provision? Explain: • Goal 3 of the Incheon Strategy therefore includes a target to halve the proportion of persons with disabilities who need but do not have appropriate assistive devices or products. • The indicator for reporting was set as the proportion of people with disabilities who need assistive devices or products and have them. Explain: The governments who have signed the Incheon Goals and Targets are now committed to develop national plans and programmes to fulfil this obligation. The Incheon strategy example shows how international and regional policy can support and encourage the development of national policy. WHEELCHAIR SERVICE TRAINING PACKAG E 22 Explain: National policy can also be developed within the country. We are going to look at an example from South Africa. Activity Groups: Divide participants into three groups. Instructions: Read the example of national policy relating to wheelchair provision (Workbook Page 87). Consider what policy already exists in your country. Discuss how useful the policy below would be in your country and consider where this policy would fit within your government structure. Monitor: Monitor the groups, and assist as needed. Time: Allow 6 minutes and 9 minutes for discussion. Feedback: Ask each group to feedback to the whole group. Record answers on the whiteboard. Note if the policy on wheelchair provision already exists within the country and who are the major stakeholders responsible for wheelchair provision. Note any suggested improvements based on the example of South Africa. Example: Policy in South Africa relating to wheelchair provision In the Western Cape province of South Africa, a group of clinicians providing wheelchair services in Cape Town became increasingly uncomfortable and frustrated with the disjointed, patchy approach to wheelchair services. After consulting with a provincial programme manager and the local rehabilitation services, they outlined their plans to improve and professionalize the standard of wheelchair services and got permission to implement their plan. The plan had three major focus areas: 1. Performing a situation analysis of wheelchair services in the province 2. Implement training of wheelchair service providers and 3. Setting up guidelines for a provincial wheelchair management strategy. Situation analysis: The extensive situation analysis confirmed the fragmentation and lack of structure and procedure in wheelchair provision. Few wheelchair users received individual assessment, prescription and fitting for their wheelchair and even fewer were trained to use it properly. Often, wheelchairs were issued to users by social workers or administrative staff with no specific training in wheelchair services. Although most service providers indicated that there was a huge unmet need for wheelchairs, they could not quantify the need because they did not keep waiting lists. Follow-up, repair and maintenance services hardly existed. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 23 Implement training: From the situation analysis, the group identified training needs and started small training workshops covering the missing service steps. Provincial guidelines were drafted that included minimum standards for key service steps, as well as key management steps, such as training of staff, setting up and management of waiting lists, allocating budgets and provision of repair and maintenance services. Setting up guidelines: The provincial management recognized the importance of this self-driven group in driving change in wheelchair and rehabilitation services and assisted the group in becoming a formal advisory group to the provincial rehabilitation programme. Representatives of this group accompanied the provincial managers to national meetings on wheelchairs and assistive devices, and contributed to the establishment of the national guidelines for assistive devices in South Africa, which was published in 2003. 5. Summary of action points for managers (2 minutes) Summarize: Influencing policy and planning is not the role of one individual or organization. It requires collaboration between a number of different stakeholders. Key point summ ary • Importance of appropriate wheelchair and appropriate wheelchair service provision. • Need and unmet need. • Linkage among wheelchair guidelines, national and international legislation or commitment such as CRPD and Incheon strategy. • Importance of policy and planning to support appropriate wheelchair provision. • Win-win for all. A.1.16 What is appropriate wheelchair provision? Read the key points. A.2: Service delivery O B JE C T IV E S By the end of this session, participants will be able to: … discuss service delivery models; … explain the difference between a basic and intermediate service; … discuss the role of the manager in service delivery; … discuss the role of wheelchair users in the culture of the organization. R E S O U R C E S For the session: … PPT slides: A.2: Service delivery; … Reference Manual and Workbook; … Post-it notes. WHEELCHAIR SERVICE TRAINING PACKAG E 24 C O N T E X T Adapt this session to suit the context in which the participants will be working. For example: … research local service delivery models. T O P R E PA R E … Read through the session plan and gather resources. … Ensure that the wheelchair service steps poster is pinned up where participants can clearly see it. … Position whiteboard next to projector screen. O U T L IN E 1. Introduction 2. Service delivery levels 3. Service delivery models 4. Broader roles of a manager 5. Active involvement of wheelchair users in service delivery 6. Summary of action points for managers. 2 5 10 15 5 3 Total session time 40 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in service delivery. Wheelchair services provide a framework for assessing the mobility needs of individual users: • assisting users to select an appropriate wheelchair; • providing users and caregivers with training, ongoing support and referral to other services where appropriate. 2. Service delivery levels (5 minutes) Explain: Every well fitting wheelchair provides its user with some postural support. The backrest, cushion, footrests, and armrests provide postural support when adjusted to suit the user’s size. However, many children and adults need additional postural support in their wheelchair. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 25 Clara A.2.2 Service delivery Introduce Clara: Clara lives in East Timor. She works in her family’s shop, which is at the front of their house. Clara has polio, and needs a wheelchair to move inside the house, to work in the shop, and to move around her village. She can sit upright without any extra support, and uses a manual wheelchair, which has been adjusted and fitted to suit her. Clara is an example of someone who can be provided with a wheelchair through a basic level service. Ishade A.2.3 Service delivery Introduce Ishade: Ishade is 8 years old and lives in Sri Lanka. She has cerebral palsy. For Ishade, this means she has trouble controlling her arms, legs, head and neck. She cannot sit upright without support. Ishade is an example of someone who needs extra postural support in her wheelchair. She should be provided with a wheelchair through an intermediate level service. Explain: A link is required between the user’s needs, service delivery and training of service personnel. Linking user nee ds and training n eeds • Clara requires a basic level service. • Service personnel require basic level training. • Personnel identified for training will depend on who will deliver the eight service steps. A.2.4 Service delivery Explain: • Clara requires a basic level service. • Therefore, service personnel require basic level training. • The personnel identified for training depends on who will be delivering the eight service steps. WHEELCHAIR SERVICE TRAINING PACKAG E 26 Linking user nee ds and training n eeds • Ishade requires a service from personnel with more knowledge and skill in order to correctly provide the extra support that she needs. • The personnel identified for training require a foundation of knowledge at basic level; with the addition of intermediate level training. A.2.5 Service delivery Explain: • Ishade requires a service from personnel with more knowledge and skill in order to correctly provide the extra support that she needs. • The personnel identified for training require a foundation of knowledge at basic level, with the addition of intermediate level training. Ask: Do you have people with basic or intermediate needs coming to your service? Acknowledge answers. Notes for trainers: • There is no right or wrong answer. Sometimes a service focuses on specific needs, for example, children’s services or spinal cord injury rehabilitation. In all regions, there will be a combination of user needs. Therefore, in all regions there will be a need for both basic and intermediate level services. • Clarify that both adults and children require intermediate level services. 3. Service delivery models (10 minutes) Eight service ste ps 1. Referral and appointment 2. Assessment 3. Prescription (selection) 4. Funding and ordering 5. Product (wheelchair) preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow up. A.2.6 Service delivery Explain: All wheelchair services should follow the eight service steps. There are different ways of delivering the steps through different service delivery models. Regardless of the model, all users will benefit if the delivery model follows the eight steps. Explain: We will look at different models for wheelchair service delivery. There are many variations possible on the examples provided. We will briefly look at some of the differences in the facilities and roles of personnel. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 27 Centre-based se rvice A.2.7 Service delivery Introduce a centre-based service. Explain: • The facilities may have a dedicated area for wheelchair service delivery, including a dedicated mobility skills area and a full wheelchair repair and maintenance area. • The service team may include a team of trained personnel working full-time in wheelchair service delivery. Integrated servi ce A.2.8 Service delivery Introduce an integrated wheelchair service. Explain: • Most centre-based services are also “integrated services”. This means that the wheelchair service is integrated with activities of another service/s. • For example, wheelchair service delivery could be integrated with a prosthetics/ orthotics service, physiotherapy department or health clinic. • Service personnel may have dedicated days for wheelchair service delivery and dedicated days for other services within the hospital or organization. WHEELCHAIR SERVICE TRAINING PACKAG E 28 Outreach servi ce A.2.9 Service delivery Introduce an outreach wheelchair service. Explain: • The facilities may be temporary. A room or building is provided by a partner organization or home visits are carried out. • Centre-based service personnel may share some of the service steps with a partner organization. • A small stock of wheelchairs may be stored at the partner organization. • Training will be required to increase the capacity of the partner organization. • It may be necessary to identify repair and maintenance service facilities in the community, for example, welding, woodwork, and upholstery. Mobile service A.2.10 Service delivery Introduce a mobile service. Explain: • Assembled or unassembled wheelchairs along with necessary tools and equipment are transported by vehicle. • Service personnel travel with a vehicle. • A limited repair and maintenance service is possible. • The mobile service may use community buildings or take everything they need to provide a wheelchair service at the community level. Explain: Not all of the eight steps in wheelchair service delivery need to be carried out by the same organization. Collaboration between a network of organizations can help to increase the efficiency of the service and also increase access to the full eight steps by wheelchair users. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 29 An example 2. Assessment 3. Prescription 4. Funding & ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance repairs & follow-up 1. Referral & appointment Activities in the service setting A.2.11 Service delivery Explain: • The division between centre-based service activities and community-based service activities will vary according to the context. • This model shows an eight step service carried out in a centre, with referral and follow-up carried out through community partnerships. Activity Groups: Divide group in to pairs. Instructions: Explain: We will be talking about your service models in more detail throughout the workshop. For now: Discuss with your partner whether any of the eight steps of wheelchair service delivery are carried out by other organizations with which your service has partnered (for example, referral, follow-up) Write down on separate Post-it notes if any service steps are delivered by a partner organization. Use a new Post-it note for each service step. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes in total. Feedback: List each service step one at a time, referring to the wheelchair service steps poster. Ask groups to place Post-it note next to the service step if it is delivered by a partner organization. Summarize at the end, highlighting that all organizations need to work in partnership on referral and that we will talk more later in the workshop about the benefits of partnerships on the other service steps. Ask: What are some of the considerations for identifying and planning a suitable service model? Acknowledge answers and write them on the whiteboard. WHEELCHAIR SERVICE TRAINING PACKAG E 30 Most important answers: • location of service centre in relation to service users; • geographical reach of the service (closeness to wheelchair users); • geography of the environment (island communities, mountainous areas with few roads); • capacity of potential partner organizations. Explain: When starting a new partnership, it is important to discuss training needs with the partner organization and plan how their knowledge and skills can be developed to include some or all of the eight service steps. This is discussed later in the workshop. 4. Broader roles of a manager (15 minutes) Explain: The manager is responsible for overall quality of service provision. They are also responsible for supporting the staff to deliver the eight steps of service delivery and co-ordinating the user’s (and their carer/family member’s) progress through those steps to meet the user’s expectations. The manager also has broader roles, which are important for supporting service delivery. Now we will look at those broader roles. Activity Groups: Divide into groups of three. Instructions: Hand out Post-it notes. Ask participants to write down what they think a manager’s broader roles are? Monitor: Encourage participants to think about what is important for sustainable appropriate wheelchair provision? Time: Allow 3 minutes for Post-it notes and 7 minutes to summarize wider roles. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 31 Feedback: Role of the mana gers Raising awareness Monitoring and evaluation Improving access and meeting users' expectations Having motivated well-trained workforce Developing sustainability Developing a well- functioning system A.2.12 Service delivery Whole group for feedback. Project the illustration showing six wider roles (as described in the Wheelchair Guidelines) onto the whiteboard. Ask for a volunteer to go first and read out their Post-it notes. Stick the Post-it note next to the relevant heading. Note any gaps or additions in the suggestions made by participants. 5. Active involvement of wheelchair users in service delivery (5 minutes) Explain: Actively involving wheelchair users is highly recommended during the design, delivery, and monitoring and evaluation of the service. • Users are actively involved as members of the service team in all steps leading to the provision of their wheelchair. • Services actively collect feedback from users about the service and how it can be improved. A.2.13 Service delivery Good practice in wheelchair service delivery Active involveme nt of the users Explain: The Wheelchair Guidelines make recommendations for good practice in wheelchair service delivery. Read the slide, reinforce if needed. Explain: In addition to actively seeking the opinion of wheelchair users, it is also very beneficial for wheelchair users to be members of the service delivery team. If any of the participants are wheelchair users, ask them what they feel are the benefits of having wheelchair users as part of the service delivery team? Ask: Do any of you work in services that have wheelchair users working as part of the service team? What are the benefits of actively involving wheelchair users in service delivery? WHEELCHAIR SERVICE TRAINING PACKAG E 32 Most important answers: • role models for service users and within the community; • challenging beliefs of the wider community; • a positive attitude within the service team – it is very motivating to work alongside a positive role model; • positive message of commitment to participation and inclusion of wheelchair users; • can increase responsiveness of service to the needs of wheelchair users. Explain: An organization in Romania values the benefits of having wheelchair users in its service delivery team so much that they employ a wheelchair user in every service team. Wheelchair users on the team in Romania An NGO wheelchair service in Romania has actively recruited wheelchair users to their wheelchair service delivery teams. Wheelchair users fulfil different roles on the team, depending on their skills. This NGO has seen a huge positive impact through having wheelchair users as wheelchair service personnel. Every member of the team is more aware of the needs of wheelchair users through their daily interaction as colleagues; wheelchair user clients often feel more comfortable sharing their experiences with the wheelchair user of the team; and the wheelchair user is a role model for others. 6. Summary of action points for managers (3 minutes) Actions for man agers Work with wheelchair service staff and key stakeholders to: • Plan an appropriate level of service and training for service personnel. • Plan an appropriate service model. • Encourage wheelchair users to be involved as equal partners. • Encourage broader involvement of wheelchair users in taking on roles and responsibilities within the service team. A.2.14 Service delivery Read the slide, reinforce if needed. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 33 A.3: Managers who lead change O B JE C T IV E S By the end of this session, participants will be able to: … explain the role managers should play in leading people through the introduction or improvement of appropriate wheelchair provision; … propose strategies for leading people and aligning personnel and resources through the change process. R E S O U R C E S For the session: … PPT slides: A3: Managers who lead change; … Reference Manual and Workbook. For facilitators: … “Leading change for better health.” Chapter 6 in Managers Who Lead, page 149 (5). C O N T E X T Adapt this session to suit the context in which participants will be working. For example: … if the facilitator has personal experience of local efforts to introduce change in wheelchair service delivery (or other services), it is useful to share these experiences. They may have either engaged the people involved leading to good results; or not engaged the people involved; creating resistance to change and resulting in failure. T O P R E PA R E … Gather resources. … Read “Leading change for better health”. Chapter 6 in Managers Who Lead, page 149. … Review PPT slides and read through session plan. … Prepare four sheets of flip chart paper with the following headings: 1. Actions that managers can take to: create a shared vision of appropriate wheelchair provision. 2. Actions that managers can take to: communicate the importance of appropriate wheelchair provision. 3. Actions that managers can take to: align personnel and resources. 4. Actions that managers can take to: motivate, engage and commit personnel. O U T L IN E 1. Manager’s role in leading the change process 2. Create a shared vision of appropriate wheelchair provision 3. Communicate the importance of appropriate wheelchair provision with a sense of urgency 4. Align personnel and resources 5. Motivate, engage, and commit personnel 6. Actions for managers. 10 7 5 5 12 6 Total session time 45 WHEELCHAIR SERVICE TRAINING PACKAG E 34 1. Manager’s role in leading the change process (10 minutes) Introduce: Link this session with previous sessions. In the previous sessions, we discussed the huge unmet need in wheelchair provision. Personal mobility allows people with disabilities to become more productive members of their communities. For many people, an appropriate, well designed and well-fitted wheelchair can be the first step towards inclusion and participation in society. Change in wheel chair provision • There is a big unmet need for wheelchair provision, only 5–15% have access to one. • WHO in partnership with USAID has developed the Wheelchair Service Training Package (WSTP) to improve access to high quality affordable wheelchairs. Management responsible for wheelchair provision can ensure this A.3.2 Managers who lead change Explain: • In order to train human resources appropriately and provide a good wheelchair delivery system based on the Guidelines on the provision of manual wheelchairs in less resourced settings, WHO, in partnership with USAID, has developed the Wheelchair Service Training Package (WSTP). Explain: The purpose of the overall training package is to create awareness and develop the skills and knowledge of all personnel involved in wheelchair provision. However, these trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is management-level involvement to establish or improve wheelchair provision within the country. Ask: What do you think should be the manager’s role to ensure the establishment or improvement of wheelchair provision within your country? Encourage answers and write on the whiteboard. Most important answers: • create awareness and advocate for the need; • plan and budget the provision of wheelchairs; • coordinate efforts; • organize the services; • monitor and evaluate the provision of wheelchairs. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 35 Explain: Introducing or improving wheelchair provision implies an organizational change. However, organizational change can be very hard. Factors for succ ess 1. Create a shared vision of appropriate wheelchair provision. 2. Communicate the importance of appropriate wheelchair provision and create a sense of urgency. 3. Align personnel and resources. 4. Motivate, engage and commit personnel. A.3.3 Managers who lead change Explain: Many studies have been carried out to increase understanding of the things that make organizational change more likely to succeed. During this workshop – we are going to focus on four major things that managers can do to lead change. These are: 1. Create a shared vision of appropriate wheelchair provision 2. Communicate the importance of appropriate wheelchair provision 3. Align personnel and resources 4. Motivate, engage, and commit personnel. 2. Create a shared vision of appropriate wheelchair provision (7 minutes) Create a shared vision • It is helpful to create a shared vision amongst all stakeholders about the improvement of wheelchair provision within the country. • A vision should be inspiring and give a picture of the desired future, for example: ‘A world in which wheelchair users are included and fully participate in all aspects of life’ or ‘Ensuring a good quality of life for wheelchair users’. A.3.4 Managers who lead change Read the slide, reinforce if needed. Ask: Is this statement (or a statement like it) useful? WHEELCHAIR SERVICE TRAINING PACKAG E 36 Most important answers: • gives a feeling of shared purpose; • gives a shared direction; • gives a starting point for working together; • motivating. Notes for trainers: • it is not possible to create a vision or mission statement as part of this workshop, as not all the stakeholders are present; • suggestions on how to create a shared vision statement are included in the stakeholder package. Share the positiv e vision It is important to enthusiastically share the positive vision so that all staff members are sensitized and committed to improve the quality of life of people with disabilities. A.3.5 Managers who lead change Read the slide, reinforce if needed. Share positive st ories There will be many obstacles along the way and it is important to focus on the positive results and continually describe healthy and happy wheelchair users that become active members of their communities. A.3.6 Managers who lead change Read the slide, reinforce if needed. 3. Communicate the importance of appropriate wheelchair provision with a sense of urgency (5 minutes) Ask: How do you think you communicate the importance of appropriate wheelchair provision? FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 37 Most important answers: • talk about the unmet need in the country; • talk about the global need for wheelchairs; • talk about the right to personal mobility; • talk about what makes a wheelchair appropriate and the need for a service; • share positive stories of success; • share the benefits to the individual, community and society of appropriate wheelchair provision. Explain: A sense of urgency means that there is a need that cannot be avoided or delayed. People follow their supervisors’ priorities; therefore a manager’s actions must create the sense of urgency. People follow the ir manager’s prio rities • Is the manager communicating the vision and urgency to introduce or improve the service? • Is the manager talking about the importance of the wheelchair service at every opportunity? • How much time is the manager investing in improving wheelchair service provision? • How much money is budgeted? • Is there follow up on how agreed actions are to be carried out? A.3.7 Managers who lead change Ask: How do you think you can create a sense of urgency about improving wheelchair provision? Read the questions on the slide slowly and allow participants to think about the answers. 4. Align personnel and resources (5 minutes) Explain: Wheelchair services need trained personnel, facilities, and resources. Align personnel and resources All members of the team should be: • working together in the same direction with the same goal • feel supported with the resources they need to do their job • be recognized for their contributions. A.3.8 Managers who lead change Read the slide, reinforce if needed. Ask: What can managers do to align personnel and resources to the provision of wheelchairs? WHEELCHAIR SERVICE TRAINING PACKAG E 38 Encourage answers and write on whiteboard. Most important answers: • identify facilities that can be used in wheelchair provision; • prioritize wheelchair provision when allocating resources; • use the vision and organization values to remind personnel why you are providing wheelchairs; • reward and recognize good performance on wheelchair provision; • facilitate teamwork. Notes for trainers: • participants may spend a lot of time talking about funding – do not allow this to happen; • acknowledge that funding is an essential element of this – and this is going to be discussed later; • ask participants to focus on additional things that a manager can do to align personnel and resources. 5. Motivate, engage, and commit personnel (12 minutes) Ask: What can a manager do to motivate and involve their personnel? Encourage answers and relate to the following slide. Motivate, engage , and commit pe rsonnel • Include all the key personnel including the users in planning and implementation. • Overcome obstacles together. • Create short-term wins and provide acknowledgement when they are achieved. • Make the change stick in organizational systems and culture. A.3.9 Managers who lead change Acknowledge: As you have noticed, personnel are more likely to be engaged and motivated if they are included and their voices are taken into account. Four key actions you can take to motivate them are: 1. Include personnel in planning and implementation. 2. Overcome obstacles together. 3. Create and recognize short-term wins. 4. Make the change stick in your organization’s systems and culture. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 39 Causes of resista nce to change Personnel are more likely to resist change if they do not understand: • what the change involves • why it is important • what the change will mean for them and their work. A.3.10 Managers who lead change Explain: Personnel are more likely to resist change if they do not understand … • … what the change involves • … why it is important • … what the change will mean for them and their work. Ask: How can managers include personnel in planning and implementation? Acknowledge answers. Involve personn el Involve all the key personnel in: • creating a shared vision • planning improved service delivery. Inclusion of users in such planning always gives added value. A.3.11 Managers who lead change Explain: Personnel often have experience and skills – make their input valuable. • Personnel who have shared in creating a vision for the service and in planning how to implement the wheelchair service – are more likely to have energy and enthusiasm to support implementation. • When personnel are involved in planning improved service delivery – they understand the importance, they understand what the change will involve, and they understand what their role will be in implementing the service. • Inclusion of users in such planning always gives added value. Ask: How does a manager overcome obstacles with their team? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 40 Overcome obst acles together • Empower people with authority, knowledge, and skills. • Observe the service steps and provide feedback and resources needed. • Identify the root causes of the obstacles instead of working on symptoms. A.3.12 Managers who lead change Explain: People need to feel supported by their manager. • In order to face challenges, personnel need to have the authority, knowledge, and skills to carry out the new activities. • Observe the service steps and provide feedback and the resources needed. • Identify the root causes of the obstacles to success instead of working on the symptoms. Ask: How does a manager create short-term wins? Read the slide and give an example for each point. Creating short-t erm wins • Identify a measurable, immediate result. • Tell the success stories. • Acknowledge and prize the good results. A.3.13 Managers who lead change • Identify measurable immediate results that can be achieved in a short period: ° for example: identify four new referral sources by the end of the month. • Tell success stories in a way that is meaningful to clients, providers, and donors: ° for example, share stories about people who receive an appropriate wheelchair and as a result are participating in their community or have returned to work. Acknowledge and reward the good results. For example, provide specific and public recognition so people can see positive results in the short-term, feel recognized for their efforts and remain involved. Ask: How does a manager make the change stick in the organization’s systems and culture? Read the slide and give an example for each point. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 41 Making the chan ge stick • If the change does not become part of the organization’s system and culture, it won’t last. • Incorporate new values, behaviours, and processes into routine organizational systems. A.3.14 Managers who lead change Explain: • If the change does not become part of the organization’s systems and culture, it won’t last. For example, create a culture of celebrating success and encourage people to share successes and positive stories during meetings and breaks. • Incorporate new values, behaviours, and processes into routine organizational systems. For example, make successful changes stick by writing new responsibilities into individual job descriptions and updating organizational policies. 6. Summary of action points for managers (6 minutes) Actions for man agers Change facilitators: 1. Create a shared vision of appropriate wheelchair provision. 2. Communicate the importance of appropriate wheelchair provision with a sense of urgency. 3. Align personnel and resources. 4. Motivate, engage, and commit personnel. A.3.15 Managers who lead change Read out list of actions for managers and refer them to their workbooks. Put up four pieces of flip chart paper with the four headings: 1. Create a shared vision 2. Communicate the importance of wheelchair provision with a sense of urgency 3. Align stakeholders and resources 4. Motivate, engage, and commit stakeholders. Explain: these “change facilitators” will remain up throughout the workshop. They are a place to record shared actions that managers and stakeholders can take to improve appropriate wheelchair provision in the country. WHEELCHAIR SERVICE TRAINING PACKAG E 42 Activity Groups Whole group. Instructions Encourage participants to write on Post-it notes any ideas that they have already. Explain: that we will review the suggestions at the end of the workshop. Refer participants to their workbook. Explain: that this is where they can record personal actions to introduce or improve appropriate wheelchair provision in their own service setting. Ask participants to share two examples of what they are planning to record as their personal actions. Explain: You will have a chance to record your actions at the end of each session. Monitor Encourage participants to write down any ideas that they have already. Time Allow 5 minutes in total. Feedback Ask a volunteer to clarify the difference between recording suggestions on the paper on the wall and the workbook. Confirm that the flip chart is for shared actions between different organizations and stakeholders and the workbook is for personal actions relating to appropriate wheelchair provision in their own service setting. B: Starting a wheelchair service B.1: Accessing services O B JE C T IV E S By the end of this session, participants will be able to: … explain what is meant by an “equitable service”; … describe at least three actions that managers can take to develop a referral network; … list groups of people who find it more difficult than others to access wheelchair services; … list actions that wheelchair service managers can carry out to increase access to wheelchair services for all wheelchair users. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 43 R E S O U R C E S For the session: … PPT slides: B.1: Accessing services; … Reference Manual and Workbook; … Additional Resources for Managers Manual. C O N T E X T Adapt this session to suit the context in which participants will be working. For example: … identify positive examples of effective referral systems in the participants’ countries or regions that could be used to replace the examples provided in the session plan; … find out what barriers different groups of people may face in accessing services, including wheelchair services in the local context. For example – look at relevant local service statistics; read relevant articles; speak to people who run services; speak to disabled people’s organizations (DPOs); speak to people in the community. T O P R E PA R E … Read through the session plan and gather resources. O U T L IN E 1. Introduction. 2. What is an equitable service? 3. Referral and appointment. 4. What can managers do to ensure their service is equitable? 5. Summary of action points for managers. 2 5 15 20 3 Total session time 45 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in developing a referral system. This includes building a referral network; creating a system for referrals and appointments; and ensuring that the service is equitable. 2. What is an ‘equitable service’? (5 minutes) Explain: An “equitable service” is one that works to make sure that every wheelchair user has an equal opportunity to receive a wheelchair. WHEELCHAIR SERVICE TRAINING PACKAG E 44 Equitable service s • Men, women, boys and girls. • Children, young, middle aged and elderly. • People who live close by and people who live further away – for example in rural areas. • People who come from different ethnic or socio- economic background. B.1.2 Accessing services This includes: • men, women, boys and girls; • young, middle-aged and elderly people; • people who live close by and people who live further away – for example, in rural areas; • people who come from different ethnic or socioeconomic backgrounds. Ask: Are there some groups of people who may find it hard to access rehabilitation services in the participants’ local area? Remind participants that “accessing” a service does not just mean “getting to the service”. It means being able to find out about the service, get to the service or have the service come to them. Encourage answers and write on the whiteboard. Most important answers: • women and girls; • people who live a long way from the services/people living in rural areas; • people who are poor; • children; • people from different ethnic groups or socioeconomic backgrounds; • elderly people; • specific groups – for example people with HIV or leprosy may face discrimination. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 45 • Equitable services recognize that all people have an equal right to services. • An equitable wheelchair service is not the same as providing an equal number of wheelchairs to users from different groups. • Equitable services are about making sure those people who need a wheelchair have the same access to the service as anyone else. B.1.3 Accessing services Equal access to s ervices for all Explain: • Equitable services recognize that all people, regardless of their disability, age, gender, religion, wealth, or ethnic group have an equal right to services. • An equitable wheelchair service is not the same as providing an equal number of wheelchairs to users from different groups (for example, equal number of wheelchairs to men and women). This is because the needs of different groups may vary. • Equitable services are about making sure those people who need a wheelchair have the same access to the service as anyone else. 3. Referral and appointment (15 minutes) Explain: Referral and appointment is the first step in wheelchair service provision. 2. Assessment 3. Prescription 4. Funding & ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance repairs & follow-up 1. Referral & appointment B.1.4 Accessing services 1. Referral and a ppointment Highlight this step on the wheelchair service delivery graphic. Explain: • Effective referral requires good links between a wheelchair service and the community, as it is people in the community who will identify and refer wheelchair users to your service. Ask: Who are the individuals and organizations most likely to identify wheelchair users and refer them to your wheelchair service? Encourage answers and write on the whiteboard under the heading: “Referral network”. WHEELCHAIR SERVICE TRAINING PACKAG E 46 Most important answers: • local hospital; • community health centres; • community-based rehabilitation (CBR) networks; • village/council/church leaders; • disabled people’s organizations; • other wheelchair users; • doctors/nurses/rehabilitation professionals/social workers. Explain: It is very important for managers to have identified the referral sources in their area. Activity Groups: Divide participants into two groups. Instructions: Assign each group one of the questions on the worksheet “B.1: Accessing services” in their workbook. Monitor: Monitor the groups, and assist as needed. Time: Allow 10 minutes in total. Feedback: Ask each group to give feedback to the whole group. Record answers on the whiteboard. Question Possible answers include: Question 1: Building a Referral Network As a manager, what actions can you take to build a network of individuals and organizations able to identify and refer wheelchair users to your wheelchair service? • identify the referral sources (individuals and organizations) in your area; • discuss with wheelchair service staff what information referral sources need to be able to identify wheelchair users (who need a wheelchair); and how to refer them to the service; • prepare (or support personnel to prepare) handouts/ brochures that will provide the information referral sources need; • visit (or support personnel to visit) potential referral individuals or organizations to talk about the wheelchair service; • hold an open day at the wheelchair service for wheelchair users and referral sources; • run referral network training for referral sources. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 47 Question 2: Referral Forms Look at the sample referral forms in the Additional Resources for Managers Manual on the Pen Drive. Would this referral form (or an adapted version of this form) be a useful tool for your service? If no, why not? If yes – as the manager of your service – what can you do to introduce a referral form? (Note – if your service/s are already using a system, you can describe what you as manager/s have done to introduce or support the referral form). If no: Some of the challenges that services face in introducing a referral form include: • referral sources require training to be able to complete the form; • even after training, referral sources do not complete the referral form; • not all referral sources have the time to complete a form; • referral sources are unable to post/send the referral form; • there is already a system of referral in place – which does not include a specific “wheelchair” referral. If yes: Actions that managers can take to introduce a referral form include: • make sure that the referral form is concise – and has only the most essential referral information for their service; • include introduction of the referral form in any training/introduction to the wheelchair service for all referral sources; • provide copies of the referral form to all possible referral sources; • provide positive feedback to referral sources when referral forms are received; • ensure that referral forms received result in appointments being made for wheelchair users – so that referral sources see the system working. 4. What can managers do to ensure their service is equitable? (20 minutes) Explain: We have already identified groups of people who may find it harder to access services. When building a referral network – it is important to remember to keep these groups of people in mind. The following activity will help managers to consider ways to ensure that any actions to build a referral network include the groups of people who are going to find it most difficult to access a wheelchair service. WHEELCHAIR SERVICE TRAINING PACKAG E 48 Activity Groups Divide participants into four groups. Instructions Assign each group one of the following: • women and girls • people living in rural areas and people who are poor • children and elderly people • groups with different ethnic or socioeconomic backgrounds. Ask each group to: • write down actions that managers can take to make it easier for people in their assigned groups to access a wheelchair service; • encourage the groups to consider the ideas already discussed in this session for building a referral network; • emphasize that the actions they list should be realistic and practical within their context. Monitor Monitor the groups, and assist as needed. Time Allow 10 minutes for activity and 10 minutes for feedback. Feedback Ask each group to give feedback on their ideas to the whole group. Record answers on the whiteboard. Examples of actions that managers can take to increase access to wheelchair services (participants may identify others) Women and girls: • Make sure information about the service is available in different ways – for example, through the radio, simple text brochures/posters, and visual images. • Make sure that women are pictured in publicity about the service as well as men. • Identify women wheelchair user role models who can speak about the importance of wheelchairs for women publicly and in the community. • Speak to community leaders about how wheelchairs are equally important to women, children and men. • Support and encourage women’s participation in all levels of wheelchair services, including management and leadership positions. • Provide DPOs with information about the wheelchair service and emphasize that women and men both need wheelchairs for mobility. • When talking about the wheelchair service always say that the service is for men, women and children – not just for “people”. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 49 Children: • Make sure that information about the service is available at places that parents of a child with a disability may visit – for example, community health clinics, rehabilitation services, market places, community centres, churches, mosques, and temples. • When talking about the wheelchair service, always say that the service is for men, women and children – not just for “people”. • Provide education and information about the service to people who may treat children with a disability – for example doctors, nurses, community health workers. • Make sure that children are pictured in publicity about the service as well as adults. • Explain the benefits of providing wheelchairs to children at an early age whenever talking about the service. Also explain the benefits for the families/carers of children that the provision of a wheelchair provides. People who are poor: • Make sure that services are as cost effective as possible. • Identify ways to provide financial support for wheelchair users who are unable to pay for transport to wheelchair services, or are unable to pay for their wheelchair (if there is a charge). For example, establish a wheelchair fund. People who are elderly: • When talking about the wheelchair service, always say that the service is for all people – including elderly people. • Include pictures of elderly people using wheelchairs in publicity about the service. • Explain the benefits of a wheelchair for people who are elderly, and for their families, when talking about the wheelchair service. People who live a long way from the services/people living in rural areas: • Make sure that information about the service is available in rural locations – for example rural health clinics, market places, community centres, churches, mosques, and temples. • Provide information about the service to people who work with people living in rural areas – for example community-based rehabilitation workers. • Identify ways to assist rural wheelchair users with transport if the service does not offer outreach. For example – financial assistance with transport, working with other organizations that can help to transport people to the service. • Find out if it is possible to offer accommodation for wheelchair users visiting the service from rural locations. • Provide outreach services to rural areas. • Train people working in rural areas (for example community health workers) how to support wheelchair users in the community; how to carry out follow-up; and how to help with simple wheelchair maintenance and repairs. • Ensure wheelchairs are available that can be used effectively in rural areas, over rough terrain, and provide information on how to make simple adaptations (for example, ramps or smoothing pathways) to make it easier to use a wheelchair in rural areas. WHEELCHAIR SERVICE TRAINING PACKAG E 50 Ensure representation of different ethnic and socioeconomic groups: • When talking about the wheelchair service, always say that the service is for all people – regardless of ethnicity or socioeconomic background. • Include pictures of people from the different ethnic and religious groups in the area served by the service in all publicity about the service. • Where possible, employ staff from different ethnic and religious groups in the service. 5. Summary of action points for managers (3 minutes) • Establish connection with the local groups/organizations working on disability. • Identify referral sources. • Build a referral network. • Decide whether the service will promote a referral form or not. • Work to ensure the wheelchair service is available to all – equitable service provision. B.1.5 Accessing services Actions for man agers Read the list of actions for managers. Work with wheelchair service staff and key stakeholders to: • identify referral sources • build a referral network • decide whether the service will promote a referral form or not • actively work to ensure the wheelchair service is equitable. Ask participants to refer to their workbook and record their own actions for creating change in their organization. If they already have a good referral network they do not need to note this as an action. B.2: Facilities and equipment O B JE C T IV E S By the end of this session, participants will be able to: … identify the service model for their context; … identify the facilities required for basic and intermediate services; … identify the equipment, forms and checklists required for basic and intermediate services; … describe four systems and procedures for workspace organization. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 51 R E S O U R C E S For the session: … PPT slides: B.2: Facilities and equipment; … Reference Manual and Workbook; … Additional Resources for Managers Manual; … Design Considerations for Accessibility from Pen Drive under Supplementary resources; … Sample wheelchairs to walk through facilities. C O N T E X T Adapt this session to suit the context in which participants will be working. For example: … it is helpful to know what service models are being implemented and if possible, visit the services prior to the workshop; … a facility is a place for doing something. Several specialists can work in the same facility. Work areas are places where personnel use their equipment. There might be a technical facility with a basic, intermediate and P&O work area. T O P R E PA R E … Read through the session plan and gather resources. … Discuss with the service centre (if it is in the same location as where the training is taking place) whether a walk through the service facilities is possible? Explain the purpose of the activity. Check what facilities are available and who is involved in each service step in preparation for the activity (Referrals – where referrals are received; Registration and waiting area; Assessment area; Toilet; Storage area; Product preparation area; Fitting area; User training area: Mobility skills/health, Wheelchair handling; Maintenance and repair. O U T L IN E 1. Introduction 2. Facilities and service flow 3. Equipment, forms, and checklists 4. Organization of facilities 5. Summary of action points for managers. 2 23 10 15 5 Total session time 55 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in identifying facilities and sourcing the necessary equipment to deliver an appropriate eight step service. The facilities and equipment required increase when moving from basic to intermediate level services. WHEELCHAIR SERVICE TRAINING PACKAG E 52 2. Facilities and service flow (23 minutes) Explain: Wheelchair services can happen in lots of different locations. • The facilities for service delivery require consideration in each location, however small. • In integrated services, some facilities may have shared work areas, for example, a therapy department may have basic level, intermediate level, and out-patient work areas within the clinical facility. B.2.2 Facilities and equipment Always plan the facilities Read the slide, reinforce if needed. Activity Groups: Whole group refer to Reference Manual and Workbook. Instructions: Consider how many of the facilities you already have. Remind participants that in small services, it is not expected to have a separate room for each facility. However, consideration must be given to the needs of each facility. Where the facilities do not exist, consider whether you could create them. For example: • How many of the suggested facilities already exist? • Could the suggested facilities be integrated within an existing service? • Could a room with another purpose be converted? • Could an existing room be reorganized or restructured? Monitor: Monitor the group, and assist as needed. Time: Allow 10 minutes in total. Feedback: Ask whether anyone already has all the identified facilities? Ask whether anyone has come up with a solution that involves integrating into an existing facility and creating a new work area within it? Ask whether anyone has come up with a solution to change the purpose of an existing room or building? Ask whether anyone has come up with a solution to reorganize or restructure an existing building or room? FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 53 Explain: We have discussed the facilities which may be required for basic and intermediate services. Entrance Registration Waiting Toilet Office Workshop Toilet Assessment room Optional Store Mobility skills Assessment room Instructions T em po ra ry ac co m m od at io n w ith d in in g B.2.3 Facilities and equipment Service flow – an example Explain: • Now we will consider the “flow” of the service in relation to how the team work together and the wheelchair user’s experience from the time they arrive at the service, until the time they leave. Activity Groups: Whole group or in two smaller groups if more appropriate. Ask two volunteers to use a wheelchair and two additional volunteers to be their “buddy” and assist them as necessary. Explain: This is to help consider wheelchair access whilst moving around the service centre. Instructions: Move through the facilities in the following sequence: • referrals – where referrals are received • registration and waiting area • assessment area • toilet • storage area • product preparation area • fitting area • user training area • mobility skills area. Monitor: Walk through the service centre together. Time: Allow 10 minutes for the activity and 2 minutes for summary of discussion at the end. Feedback: Summarize if there were any identified problems with the service flow and possible solutions. WHEELCHAIR SERVICE TRAINING PACKAG E 54 3. Equipment, forms, and checklists (10 minutes) B.2.4 Facilities and equipment Equipment & pa perwork – an exa mple Explain: • Examples of equipment, forms and service checklists are listed in the reference manual. • The manager’s role is to align personnel and resources so that individual personnel have responsibility for ensuring the necessary equipment and paperwork is available. • This may mean adjusting equipment to make it transportable and suitable for different settings. Activity Groups: Whole group. Participants from the same service centre can work together. Instructions: Review the facilities and equipment information in the reference manual and list of forms and checklists from the Additional Resources for Managers Manual on the Pen Drive. • Which equipment is already available and in use at your service centre? Note any equipment that can be made or purchased. • Which forms and checklists are already integrated and in use? Note any forms or checklists which can be integrated into daily use. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for activity and 4 minutes for feedback. Feedback: Ask if there are any questions? Notes for trainers: • In community settings, it may be necessary to identify carpentry, welding, upholstery skills locally, who already have the necessary equipment. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 55 4. Organization of facilities (15 minutes) Explain: We have looked at the facilities and equipment required for service delivery. The final step for a manager is to allocate responsibility for each facility to ensure it is well organized. Well organized facilities encourage a professional and efficient service. Poorly organized facilities give an impression of an unprofessional and poorly organized service. Explain: There are four steps that need to be applied to each facility in any service model. 1. Ensure cleanliness of the work place. 2. Identify regularly used items – keep those in an easily accessible place. 3. Establish a system and agree responsibilities. 4. Monitor from time to time. B.2.5 Facilities and equipment Organization of facilities Explain: the need: 1. Remove clutter: eliminate all unnecessary tools, parts, equipment, out of date paperwork. 2. Identify regularly used items: tools, parts, instructions and paperwork. Regularly used items should be arranged so they are easiest and quickest to locate. 3. System and responsibility: have a system for each workspace and someone responsible for implementing the system. 4. Monitor: the system to make sure the change sticks. Activity Groups: Divide participants into four groups. Instructions: Ask each group to review the two poorly organized facilities in the workbook (Page 92). Ask the groups to refer to their reference manuals and make recommendations for the facilities, equipment and workspace organization. Monitor: Monitor the groups, and assist as needed. Time: Allow 6 minutes to review the workspaces and 4 minutes for feedback. Feedback: Ask for a group to volunteer to feedback on the first facility. Record answers on the whiteboard. Repeat for facility two. WHEELCHAIR SERVICE TRAINING PACKAG E 56 Examples of recommendations to improve organization of facilities and equipment (participants may identify others) Technical facilities and equipment: • identify role of technical area (product preparation, making modifications); • remove all unnecessary tools, parts, equipment; • shelves to store equipment; • shelf and/or tool board for regularly used items close to workbench; • workbench should be clear ; • meet with staff: confirm system and allocate responsibility for implementing. Outreach clinical and technical facilities: • table to organize tools and equipment; • portable workbench; • tools in toolbox; • sheets or screen to create a private area for assessment; • assessment surface and foot blocks. 5. Summary of action points for managers (5 minutes) • Identify facilities and equipment appropriate for the service delivery model. • Integrate paperwork and checklists into service steps. • Organize facilities. • Establish systems and procedures for each facility and allocate responsibilities. B.2.6 Facilities and equipment Actions for man agers Read the list of actions for managers. Work with wheelchair service staff and key stakeholders to: • identify facilities and equipment appropriate for the service delivery model; • integrate paperwork and checklists into service steps; • organize facilities; • establish systems and procedures for each facility and allocate responsibilities. Ask participants to refer to their workbook and record their own actions for organising facilities and equipment. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 57 B.3: Range of appropriate wheelchairs O B JE C T IV E S By the end of this session, participants will be able to: … define an appropriate wheelchair and cushion; … explain the importance of proper fit and postural support; … explain the importance of user’s needs and environment when selecting an appropriate wheelchair ; … discuss three factors which influence the safety and durability of products; … discuss considerations for a “start-up” range of wheelchairs. R E S O U R C E S For the session: … PPT slides: B3: Range of appropriate wheelchairs … Reference Manual and Workbook; … video: Benefits of extra support – Chaeli; … video: Benefits of an appropriate wheelchair ; … video: Meeting the wheelchair user’s needs – Mark and Ryan; … example of a pressure relief cushion; … Joint position paper on provision of mobility devices in less resourced settings from the Supplementary resources of the Pen Drive. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … Consider the range of wheelchairs locally available and use as examples if appropriate. T O P R E PA R E … Read through the session plan and gather resources. … Read the Appropriate Wheelchairs reference information from WSTP basic and reference information on Children in WSTP intermediate. … Read Chapter 7 of the Joint position paper on provision of mobility devices in less resourced settings. WHEELCHAIR SERVICE TRAINING PACKAG E 58 O U T L IN E 1. Introduction 2. What is an appropriate wheelchair and cushion? 3. Providing proper fit and postural support 4. Meeting the user’s needs and environment 5. Importance of a safe and durable product 6. Starting range of wheelchairs 7. Summary of action points for managers. 2 8 10 10 20 25 5 Total session time 80 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in working with a range of stakeholders to identify a minimum range of products to help address the needs of children and adults accessing their service. 2. What is an appropriate wheelchair and cushion? (8 minutes) Explain: The Wheelchair Guidelines define an appropriate wheelchair. An appropriate wheelchair: – Meets the user’s needs; – Meets the user’s environment; – Is the right match for the user (size and support); – Is safe and durable; – Can be maintained and repaired locally. Fit for purpose B.3.2 Range of appropriate wheelchairs What is an appr opriate wheelcha ir? Read the slide, reinforce if needed. Explain: Every wheelchair user needs a cushion. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 59 • Every wheelchair user needs to have a cushion. • The type of cushion best suited to the user will depend on their needs and health condition. • Any person at risk of developing a pressure sore needs a pressure relief cushion. B.3.3 Range of appropriate wheelchairs Need for cushion s Explain: The type of cushion best suited to the user will depend on their needs and health condition. For this reason, wheelchair services need to have at least a small range of cushions available. Summarize: A service should be able to supply a pressure relief cushion. Ask: We are stressing the importance of a pressure relief cushion because we know pressure sores can lead to death so preventing them is very important. Can anyone suggest specific groups of wheelchair users who are likely to need a pressure relief cushion? Most important answers: • people who have a spinal cord injury; • anyone who has had a pressure sore in the past; • elderly or frail people; and • people who have difficulty moving and changing position. Pass around at least one example of a pressure relief cushion. • Average life expectancy in well- resourced countries is approximately 38 years for people injured between the ages of 25-34. • However, data from a developing country suggest the median life expectancy following spinal cord injury is 5.36 years, with 56.4% of people dying within 5 years of injury. B.3.4 Range of appropriate wheelchairs Need for cushion s Explain: • There is a cost to not having the right cushion and teaching people how to use it. • Average (median) life expectancy in well resourced countries is approximately 38 years post injury for people injured between the ages of 25 and 34 years (6). • In contrast, a study carried out in Bangladesh found the median life expectancy following spinal cord injury to be 5.36 years, with 56.4% of people dying within 5 years of their injury (7). WHEELCHAIR SERVICE TRAINING PACKAG E 60 • The same study shows 80% of them died at home, and one-third of them had pressure sores at the time of death. • Pressure relief cushions reduce the chance of developing pressure sores. B.3.5 Range of appropriate wheelchairs Need for cushion s Explain: • However, the same study shows 80% of the people within the study died at home, and of those who died at home, one-third had pressure sores at the time of death. Hospital cost survey, Sri Lanka (1999) • A superficial pressure sore – 6 weeks to heal and cost was about US$ 286. • A deep pressure sore – one year to heal and cost was about US$ 2483. • Introduction of the right wheelchair, cushion and mattress with adequate patient education reduced incidence of pressure sores during hospital stay by 70% and expenditure on dressings by nearly 60%. B.3.6 Range of appropriate wheelchairs Cost of pressure sores Explain: • In a rehabilitation hospital in Sri Lanka, a hospital cost survey demonstrated that the introduction of the right wheelchair, cushion, and mattress with adequate patient education, could reduce incidence of pressure sores during hospital stay by 70%, and expenditure on dressings by nearly 60%. According to the WHO World Report on Disability (8) a hospital programme in Sao Paulo Brazil introduced a service with a focus on education to reduce secondary complications for people with spinal cord injury and this helped to reduce the incidence of pressure sores by 23%. Explain: Having access to an appropriate cushion with education on how to use it is an important part of preventing health complications. How to make a pressure relief cushion is taught in WSTP basic. The ability to modify a cushion is covered in WSTP intermediate. Fabrication of cushions often requires identifying a regular supply of good quality foam. 3. Providing proper fit and postural support (10 minutes) Explain: To provide proper fit a range of sizes is required; including an option for children. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 61 B.3.7 Range of appropriate wheelchairs Importance of p roper fit Click to bring up one image at a time. Ask: What do you see here? Most important answers: • child in adult shoes; • wrong size, too big; • child not able to run around and do what they need to do. Click on next image of well fitting shoes. Explain: The child now has the right type of shoes, which fit correctly and they are able to run around and play. Click on image of child in wheelchair. Ask: What do you see here? Most important answers: • child in adult’s wheelchair, wrong size; • difficult to move around and play. Click on final image. Explain: With the right type and size of wheelchair, a child has the maximum opportunity to do what they need to do. B.3.8 Range of appropriate wheelchairs Different needs: support Different needs: support Explain: • People have different posture support needs and therefore require wheelchairs with different types of support. Explain: • People with basic level posture support needs require the support of a well fitting wheelchair. WHEELCHAIR SERVICE TRAINING PACKAG E 62 Explain: People with intermediate level posture support needs require a well fitting wheelchair with extra support. B.3.9 Range of appropriate wheelchairs Different needs: support Explain: • Extra support can be provided by adding extra posture supports to the wheelchair, or by providing a dedicated supportive seat. Explain: There is a cost to not providing extra support when it is needed – particularly for children who are growing and will experience growth spurts. Prevention of secondary complications In group with: For last 5 months 2007–8 2008–9 Group 1 Group 2 Group 1 Group 2 Number of clients 384 282 723 355 Number of new spinal deviations 0 98 3 75 % of new spinal deviations 0.00% 34.75% 0.4% 21% Western Cape Rehabilitation Centre, South Africa B.3.10 Range of appropriate wheelchairs Cost of lack of ex tra support Staff at the Western Cape Rehabilitation Centre in South Africa documented the complications observed in a group of children at schools and care centres seen in different services. All children were seen before any changes in posture developed. Highlight the column headings and explain group 1 received a well fitting wheelchair plus extra support for the trunk – before a change in posture developed. Group 2 received a well fitting wheelchair with no extra support (before a change in posture developed). Group 1, who received extra support only developed 0.4% postural complications (change in posture). Group 2, who did not receive extra support, developed 21% postural complications (changes in posture). The cost of these complications for the children and their families and services were: • increased complications and more time attending appointments • poorer health FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 63 • poorer posture and discomfort • lower sitting tolerance (sitting less time in comfort) • decreased participation in educational programmes • decreased quality of life. Notes for trainers: this is additional information in case the participants ask more questions On further analysis; the following risk factors increased the risk of postural complications developing: • asymmetrical muscle control of the trunk; • strong movement creating postural tendencies; • growth spurt; • existing bony lesions; • weakness/paralysis of the trunk (high level). Benefits of extra support - Chaeli B.3.11 Range of appropriate wheelchairs Video presentati on Introduce video: Benefits of extra support – Chaeli. Ask participants to listen to Chaeli describing how extra support from a young age has helped her. Show video. Ask: What did you think about Chaeli’s comments about the benefits of extra support from a young age? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 64 4. Meeting the user’s needs and environment (10 minutes) Benefits of an appropriate wheelchair B.3.12 Range of appropriate wheelchairs Video presentati on Introduce video: Benefits of an appropriate wheelchair. Ask participants to observe how the different wheelchairs help people in the video carry out their work or activities. Show video. Ask: What were some of the activities that you saw? Most important answers: • working (in supermarket, gym); • dancing; • walking (with Mum and dog); • playing basketball; • get to places you need to go to (school, overcome physical barriers in environment). Introduce video: Meeting the wheelchair user’s needs. Meeting the wheelchair user’s needs - Mark and Ryan B.3.13 Range of appropriate wheelchairs Video presentati on Ask participants to look for the different features that help users to carry out different work or activities. Show video. Ask: What were some of the features that you saw? FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 65 Most important answers: • Mark: propels with one foot and swing away footrests make it possible. Both arms are free for working. • Dawid and Pinky: both are able to propel independently – one with a powered wheelchair and one manually. • Faizel: good rear wheel position for propelling, backrest low enough not to interfere with propelling. No armrest which allows easier access to the desk. • Keith and Ralph: No armrests so easy to put pieces of equipment on their lap. Good set- up for propelling. • Ryan: wheelchair folds and rear wheels are quickly removable. Allows him to get in and out of car independently. A kind of abuse…. B.3.14 Range of appropriate wheelchairs Abandoned prod ucts – an examp le Explain: The video highlights that different wheelchairs are suited to different environments. When people receive a product which does not work well in their environment, the wheelchairs are often discarded. Explain: • In this image, there are three wheelchairs. The first two have been abandoned because they need repair and there are no spare parts available. • The third donated one is new; however, it feels wobbly and unstable when used outside and the person who received it feels unsafe. • This person has three wheelchairs but none of them provide an appropriate solution for his needs. 5. Importance of a safe and durable product (20 minutes) Explain: We have discussed the importance of the product matching the person and their environment. Now we will consider factors which influence the safety and durability of products. Ask: What happens when a wheelchair is not durable? WHEELCHAIR SERVICE TRAINING PACKAG E 66 Most important answers: • it will not last long; • it will quickly break down. • Products which are not durable have to be reissued more often than durable products. • An inappropriate product may break down within 1-6 months and require replacing. • An appropriate product can last 3–5 years and provide better value for money in the long run. B.3.15 Range of appropriate wheelchairs Cost of poor dur ability Explain: • Products that are not durable have to be replaced more often than durable products. • An inappropriate product may break down within 1–6 months and require replacing. An appropriate product can last 3–5 years (six to ten times longer) and provide better value for money. Ask: What are some of the costs of having piles of discarded wheelchairs? Most important answers: • there is a cost to breaking down and getting rid of discarded equipment; • abandoned products take up valuable space in facilities; • donated equipment often lacks one person who has the responsibility and authority to make decisions on how it is used/stored and removed. Wheelchair graveyard B.3.16 Range of appropriate wheelchairs Cost of not cons idering environm ent Click through the pictures. Explain: • These examples of piles of discarded wheelchairs that cannot be repaired are found in many countries around the world filling up rooms or discarded outside the service centre. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 67 A manager’s role when procuring or receiving donated products is to ensure that: • different sizes are provided • wheelchairs come with cushions • the range of products is suitable for the environments in which they will be used • products are durable when used in rough and harsh environments • the available products can be repaired locally. B.3.17 Range of appropriate wheelchairs Manager’s role in product supply Explain: A manager’s role when procuring or receiving donated products is to ensure that: • the range of products is suitable for the environments in which they will be used; • products are durable when used in rough and harsh environments; • the available products can be repaired locally. Ask: Who do you receive wheelchairs from? Possible answers – will vary according to the participants and their context: • donors; • faith based organizations; • manufacturers; • suppliers. Explain: Wheelchair users want safe and durable products, which can be repaired at an affordable cost. There are important questions to ask about existing products available at your service, or when sourcing new products for your service. Activity Groups: Divide participants into three groups. Instructions: Give each group a number 1–3 and assign the appropriate assignment in the workbook: B.2 Range of appropriate wheelchairs: durability, repairability. Ask participants to answer questions assigned to their group in their workbook. Explain: that participants may refer to the reference manual and use their own knowledge and experience to complete the activity. Explain: that participants have 5 minutes to answer the assigned question. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes to prepare. Allow 10 minutes (in total) for feedback; this timing is based on three groups, adjust the timing if more groups are feeding back. Feedback: Ask each group in turn to present their feedback. Trainer should refer to the notes in the reference material to guide the discussion points. WHEELCHAIR SERVICE TRAINING PACKAG E 68 What questions can you ask about the safety and durability of the products supplied? • Has the product passed any certified standards (has the product passed performance tests and quality assurance tests set by a professional body)? What were the results? • Does the supplier recommend a particular lifespan? • Does the supplier have a system for reporting faults? • Who else buys and uses their products? • Has the product been tried in the country; and if so, what feedback/results were there? • Are there spare parts available? Do these parts need to be purchased overseas; or are some of the spare parts that may be needed readily available in your country? • If the frame breaks – can this be repaired locally? What are some of the wheelchair parts that commonly break or wear out? • Poor quality upholstery tears or sags. • Castor wheels (axles, tyres, bearings, castor forks). • Rear wheels (wheel axle, push ring, spokes, bearings, tyres). • Brakes. • Footrests. • Cushions. How do you calculate which spare parts to order? • Ask if the supplier has any recommendations. • Identify what spare parts can be purchased locally (either by the service or the user). • Consider how many follow-up appointments are predicted for the next year and order stock for 30% of this number as a starting point. • Keep clear records of how many spare parts are used each year and use this to predict future orders. Ask: Who else can you talk to in order to find out about safety and durability of products? Acknowledge answers. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 69 • Ask for feedback from users through home visits, focus group meetings, meeting DPOs. • Ask for feedback from service providers in different organizations. • Always procure a small number of products to trial. B.3.18 Range of appropriate wheelchairs Ask about safety and durability • Ask for feedback from users through home visits, focus group meetings, through DPOs. • Ask for feedback from service providers in different organizations. • Purchase a small number of products to trial before you make a big purchase. • During a product trial, people often want to judge a product based only on how it looks. • Often opinions change – both positive and negative after actually using the product. • It is important to actually try a product before making a positive or negative decision. B.3.19 Range of appropriate wheelchairs Product trial Explain: • During a product trial, people often want to judge a product based only on how it looks. • Often opinions change – both positively and negatively after actually using a product. • It is important to actually try a product for a few months before making a positive or negative decision. Explain: Step eight of a service is follow up, maintenance and repairs. All users and their family members should be taught simple maintenance and repair to prolong the life of their product. This is taught in WSTP basic. B.3.20 Range of appropriate wheelchairs Maintenance and repair Maintenance and repair Explain: The manager’s role is to: • Ensure that service users have access to a maintenance and repair service. • Train partners to provide maintenance and repair services. • Identify resources in the community who can provide maintenance and repair services. Explain: Follow-up is discussed further later in the workshop. WHEELCHAIR SERVICE TRAINING PACKAG E 70 6. Starting range of wheelchairs (25 minutes) Acknowledge that in some situations there is only one type of wheelchair available. Read the example of government introducing standards for wheelchairs in Sri Lanka below. Highlight: Governments that sign up to the CRPD have a moral and legal commitment to address standards in assistive devices. National standards for wheelchair provision in Sri Lanka A process for establishing wheelchair standards was initiated in Sri Lanka as a result of more than three years of lobbying. The result is that any supplier or manufacturer of wheelchairs has to meet the same basic standards in their products. If the government are purchasing wheelchairs, as in the case of Sri Lanka, standards can be used as leverage to increase the spend per wheelchair, giving the users greater benefits by providing more durable and functional equipment. The purchaser also benefits as their money lasts longer. Explain: That the next activity considers how stakeholders can work with government or donors to improve the supply of appropriate wheelchairs. Activity Groups: Divide participants into three groups. Instructions: Give each group a scenario from the Workbook: B.2.2 Supply of appropriate wheelchairs: role play. Ask participants to read the scenarios. Explain that participants have 10 minutes to prepare the assigned scenario. Monitor: Monitor the groups, and assist as needed. Time: Allow 10 minutes to prepare. Allow 12 minutes (in total) for feedback; this timing is based on three groups; adjust the timing if more groups are feeding back. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 71 Feedback: Ask each group in turn to present their feedback Trainer should refer to the principles in Chapter 6 of the Joint position paper on provision of mobility devices in less resourced settings to guide the discussion points. The principles of providing appropriate mobility devices In order for countries to meet their obligations related to assistive technology (mobility devices), outlined in the Convention on the Rights of Persons with Disabilities the following key principles need to be considered (9): • Acceptability – people with disabilities must be involved in all stages of mobility device provision. • Accessibility – mobility devices and related services must be accessible to everyone with an identified need. • Adaptability – mobility devices and related services need to be adapted and modified to ensure they are appropriate to the needs of the individual. • Affordability – mobility devices and associated services must be affordable. • Availability – facilities, personnel and products must be sufficient for the needs of the population and provided as close as possible to the people’s own communities. • Quality – products, facilities and services are of an appropriate quality. 7. Summary of action points for managers (5 minutes) Read the action points for managers. • Identify the needs of your service users and the most important product features to meet those needs. • Identify a suitable range of appropriate wheelchairs, cushions and spare parts. • Identify suitable supplies of materials for making modifications to products. • Discuss the cost:benefit ratio of appropriate wheelchairs and cushions delivered through a service at every opportunity with different stakeholders. B.3.21 Range of appropriate wheelchairs Actions for man agers Explain: Work with wheelchair service staff and key stakeholders to: • identify the needs of your service users and the most important product features to meet those needs; • identify a suitable range of appropriate wheelchairs, cushions and spare parts; • identify suitable supplies of materials for making modifications to products; • discuss the cost-benefit of appropriate wheelchairs and cushions delivered through a service at every opportunity with different stakeholders. WHEELCHAIR SERVICE TRAINING PACKAG E 72 Ask: participants to refer to their workbook and record their own actions for improving the range of appropriate wheelchairs in their service. B.4: Align personnel O B JE C T IV E S By the end of this session, participants will be able to: … describe four roles of a wheelchair service delivery team; … identify personnel required for a basic and intermediate service; … plan the integration of roles into new or existing schedules; … estimate annual service capacity. R E S O U R C E S For the session: … PPT slides: B.4: Align personnel … Reference Manual and Workbook; C O N T E X T Adapt this session to suit the context participants will be working in. For example: … consider existing models of service delivery in the region and how wheelchair services may integrate into these models. T O P R E PA R E … Read through the session plan and gather resources. O U T L IN E 1. Introduction 2. Roles in a wheelchair service 3. Include staff in planning 4. Encourage teamwork 5. Assessing service capacity 6. Summary of action points for managers. 2 10 5 5 25 3 Total session time 50 FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 73 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in identifying and aligning personnel to deliver the different roles and responsibilities. We will focus on four key roles: clinical, technical, training, administrative. 2. Roles in a wheelchair service (10 minutes) Explain: The service roles can be delivered by people with different educational and professional backgrounds, as long as the appropriate training has been given. For this reason, different types of organizations can be involved in wheelchair provision. • One person may fulfil more than one role. • Different individuals may be responsible for each role. • In some situations, personnel from different organizations may work together to cover the different roles. B.4.2 Align personnel Roles in a wheelc hair service Explain: • One person may fulfil more than one role or cover one step of the eight steps. • Different individuals may be responsible for different roles. • In some situations, personnel from different organizations may work together to cover the different roles or to cover different steps of the eight steps. • Intermediate service level roles require a foundation of knowledge and experience at basic level. • Consider mentoring and training a new basic level team, and allow the existing team to progress to intermediate level. B.4.3 Align personnel Intermediate ser vice level roles Explain: • Intermediate service level roles require a foundation of knowledge and experience at basic level. • Consider mentoring and training a new basic level team, to allow the existing team to progress to intermediate level. Explain: The first responsibility of the manager is to identify new or existing personnel to carry out the different roles in the wheelchair service. If personnel from another organization are involved – managers from each service will need to work together. WHEELCHAIR SERVICE TRAINING PACKAG E 74 Activity Groups: Divide in to different organizations. Participants from the same organization should work together. It is not necessary to work in groups if participants are from different organizations. Instructions: Explain: that a sample table has been completed listing the main roles of wheelchair service personnel (Workbook Page 98). Participants should put a name next to each role. Remind participants that one person may carry out more than one role. If service teams have not yet been identified, consider who may fulfil these roles. If more than one service is supported by the manager, list each service. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes. Feedback: Ask if anyone would like to comment on that activity? Explain that it is important that someone has responsibility for each of the highlighted roles. 3. Include staff in planning (5 minutes) Explain: We talked about the importance of including personnel in planning, in the session on leading change. Ask: Why is it important to include personnel? Most important answers: • resistance to change usually comes from a lack of knowledge about the change; • people are more likely to support what they help create; • staff will have experience and ideas of how to start or improve the service. B.4.4 Align personnel Involve all key pe rsonnel in planni ng Explain: that by bringing together the service personnel and involving them in planning, it: • starts the process of creating a team and • encourages good teamwork. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 75 4. Encourage teamwork (5 minutes) Explain: Once you have created a team, it is important to work together to plan how to create or improve the service. Two key activities which help coordinate the team and smooth running of the service are to: • create a weekly or monthly planner • hold weekly, two-weekly or monthly team meetings – depending on the workload. B.4.5 Align personnel Encourage team work Explain: Two key activities which help coordinate the team and smooth running of the service are to create a weekly or monthly planner, which is visible in each clinical and technical facility, and to hold regular team meetings: • weekly, twice monthly or monthly planner • weekly, twice monthly or monthly team meetings. 5. Assessing service capacity (25 minutes) Explain: We are going to consider how to plan service capacity when starting or improving a service. • Number of staff available for wheelchair service delivery. • Annual product supply linked to product procurement budget. B.4.6 Align personnel Service capacity Explain: Service capacity is linked to: • number of staff available for wheelchair service delivery; • annual product supply linked to product procurement budget. Highlight that we will focus on the link between capacity of service personnel and annual number of service users. Budgeting will be considered in the next session. Explain: There is a direct link between the number of staff and the hours they work and the annual capacity of the service for new and follow-up appointments. WHEELCHAIR SERVICE TRAINING PACKAG E 76 • It is recommended that a minimum of two staff per organization are trained at both basic and intermediate level. • If only one person is trained and they leave the organization all the knowledge and experience leaves with them. B.4.7 Align personnel Number of staff Explain: • It is recommended that a minimum of two staff per organization are trained at both basic and intermediate level. • If only one person is trained, the service is very vulnerable if they leave and all the knowledge and experience leaves with them. B.4.8 Align personnel • The number of working weeks available each year should be calculated, deducting public holidays and annual leave. • This will give an approximate idea on the number of wheelchair users who can be seen each year. Number of work ing weeks Explain: • The number of working weeks available each year should be calculated, deducting public holidays and annual leave. • This will impact on the number of wheelchair users seen each year. Ask participants to calculate how many working weeks are available for service personnel each year in their service. Remember to deduct public holidays and annual leave. Explain: A working week may be five days. However, personnel may not be available for wheelchair service delivery on all five days. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 77 • The number of days available each week to work directly on the service steps should also be estimated, deducting weekly meetings, stock control, paperwork and breaks. • This will impact on the number of wheelchair users who can be seen each week. • If a person has a role other than wheelchair service delivery, it is important to clearly identify the time available for each role. B.4.9 Align personnel Number of days per week Explain: • The number of days available each week to work directly on the service steps should also be estimated. Weekly meetings, paperwork, stock control and breaks all need to be taken into consideration and deducted from the time available for service delivery. • This will impact on the number of wheelchair users who can be seen each week. • If a person has a role other than wheelchair service delivery, it is important to clearly identify the time available for each role. Explain: As a starting point for planning, we will consider approximately how many basic level users and intermediate level users can be seen in a day. There are many factors which will influence this, for example, whether service personnel are new or experienced; whether the wheelchair provided requires modification or not. These factors will be considered more in the next section of the workshop: running a wheelchair service. B.4.10 Align personnel Different service levels • An experienced team may be able to see two basic level clients per day. • An experienced team may be able to take care of one intermediate level client per day. • Note: this is based on a service in a day: from step 2: assessment to step 7: user training. Service estimates should be adjusted to reflect the service model. Refer to the Excel spreadsheet in the PowerPoint presentation. Explain that we will go through a process which can help a manager to calculate how many wheelchair users their service can see each year. WHEELCHAIR SERVICE TRAINING PACKAG E 78 Planning the working week Number of working days per week 5 Number of working weeks per year 42 Estimating Service Capacity Basic Intermediate Number of working hours per day Estimated number of hours per user Number of service users per day Number of service users per week Number of service users per year Contingency (unexpected events) Estimated number of users per year B.4.11 Align personnel Estimating servi ce capacity Introduce spreadsheet and explain that the first two rows should be calculated according to their individual service. • Number of working days per week? • Number of working weeks per year? Planning the working week Number of working days per week 5 Number of working weeks per year 42 Estimating Service Capacity Basic Intermediate Number of service users per day 2 1 Number of service users per week 10 5 Number of service users per year 420 210 Contingency 15% (unexpected events) -63 -31 Estimated number of users per year 357 179 B.4.12 Align personnel Estimating servi ce capacity Refer to the service data already entered to help calculate the service capacity: • Enter number of service users per day; ×1 for basic, ×2 for intermediate. • Calculate number of service users per week: number of service users per day × number of working days. • Calculate number of service users per year: weekly rate × working weeks. • Allow for a contingency of 15% for unexpected events and loss of working hours and deduct this number from the total. • Calculate an estimated service capacity for a year. Ask for a volunteer to give their estimated figures and enter into the spreadsheet. Explain: This does not include step eight: follow-up. We will look at planning follow-up in a later session. Summarize: Look at the total predicted numbers on the spreadsheet for basic and intermediate level. Are those numbers more or less than you expected? Encourage discussion. Explain: We will discuss this estimate again in the running services part of the workshop. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 79 6. Summary of action points for managers (3 minutes) • Identify service personnel. • Include service personnel in planning. • Coordinate teamwork and establish a weekly working plan. • Estimate annual service capacity. B.4.13 Align personnel Actions for man agers Read the slide, reinforce if needed. Ask participants to refer to their workbook and record their own actions for aligning personnel. B.5: What does a wheelchair service cost? O B JE C T IV E S By the end of this session, participants will be able to: … identify key budget lines for an eight step service; … explain at least two benefits of sharing costs when integrating services; … explain at least two benefits of sharing costs when partnering with other organizations. R E S O U R C E S For the session: … PPT slides: B5: What does a wheelchair service cost? … Reference Manual and Workbook; … flip chart; … blue, black and red pens. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … it is assumed that participants will have general budgeting skills. WHEELCHAIR SERVICE TRAINING PACKAG E 80 T O P R E PA R E … Read through the session plan and gather resources. … Prepare list of budget headings on the whiteboard and leave space to write down suggested budget lines. O U T L IN E 1. Introduction 2. Budget guide 3. Benefits of integrating services 4. Benefits of cost sharing through partnerships 5. Key actions for managers. 2 20 20 13 5 Total session time 60 1. Introduction (2 minutes) Explain: Identifying the cost of all eight service steps from the outset of setting up a service is important. In this session, we will talk about how to calculate the cost of starting or improving a service. We will also discuss different ways to share costs. 2. Budget guide (20 minutes) Refer to budget headings listed on whiteboard. Explain: that we are going to consider the budget lines which would sit under these headings. Activity Groups: Divide into three groups. Participants not to refer to workbook at this time. Instructions: Show the budget headings on the whiteboard. Refer participants to the wheelchair service steps poster to think about each service step. Ask each group to discuss what budget lines they would expect under these headings? Whole group: feedback suggested budget lines under each budget heading. Monitor: Encourage answers. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 81 Time: Allow 5 minutes for discussion and 10 minutes for feedback. Feedback: Record answers under budget headings on whiteboard. Refer participants to completed budget guide in workbook (Page 99). Acknowledge that some services may have additional budget lines, which are not listed here. Not all services will use all budget lines listed. Ask participants to refer to their workbook. Encourage participants to record budget notes against the budget lines (5 minutes). Refer to notes below. Notes for trainers: Budget item Comments Start-up costs Product design Sourcing range of products Tools Equipment Building/facilities May include building/renovation/refurbishment. Stock of materials Operational costs Wheelchairs Wheelchair stock – based on estimated service capacity and anticipated needs of wheelchair user clients. Spare parts Maintaining a stock of commonly needed spare parts is very useful. Materials At basic level, some materials are required for modifications. At intermediate level more materials are required. Freight (product transport) Shipping and customs for imported wheelchairs. Transporting wheelchairs to satellite centres. Personnel Management A wide range of potential staff are listed in the budget guide. It is not expected that each service will have all of these staff members. The ticks (see spreadsheet) represent activities relating to service steps. One member of staff may be responsible for carrying out more than one activity. Clinical personnel Technical personnel Trainer/peer trainer Administrator WHEELCHAIR SERVICE TRAINING PACKAG E 82 3. Benefits of integrating services (20 minutes) Ask: Does anyone work in a wheelchair service, which is integrated within another service? Acknowledge answers. • An integrated service, such as combined facilities for orthotics, prosthetics and wheelchairs can save costs in comparison to establishing individual services. B.5.2 What does a wheelchair service cost? Benefits of integ rated services Explain: • An integrated service, which effectively shares facilities, can provide significant cost sharing opportunities compared to establishing individual services. Local transport Local transport for personnel For example follow-up; outreach services; training referral networks. Local transport for clients Travelling to the service for appointments. Accommodation for clients Cost of providing accommodation for clients who need to stay overnight (if this is covered/supported by the service). Printed materials Forms, checklists and user information. Consumables For example, glue, thread, paint. Tool replacement Tools wear out – and funds therefore need to be budgeted for replacement. Overheads Consider electricity, water, rent – for the different service areas (clinical, technical, storage, user training, office). Training of personnel Consider any training costs for service personnel. Training partners/referral networks Consider any training/awareness activities for partners or referral network organizations. Fundraising The cost of any fundraising activities should be budgeted. Monitoring and evaluation Costs associated with monitoring and evaluating – for example visiting service users to gather feedback. The costs may include travel or additional personnel. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 83 • Prosthetics and orthotics service: 170m2. • Basic level wheelchair service: 100m2. • Intermediate level wheelchair service: 140m2. • Total if all built separately: 410m2. But if all are integrated into one shared facility: one can manage with 200–250m2. B.5.3 What does a wheelchair service cost? Integrated facilit ies – an example Explain (an example): • A Prosthetics and Orthotics (P&O) service might require approximately 170m2 of floor space • A basic wheelchair service might require approximately 100m2 of floor space • And an intermediate wheelchair service might require approximately 140m2 of floor space • Total if all built separately: 410m2 • Total if all integrated into one shared facility: one can manage within 200–250m2 • This represents an almost 40–50% saving on floor space needed to be funded and constructed. Activity Groups: Whole group. Instructions: If no-one is currently integrating a service: work through the example scenario below. Review each line in the budget guide and consider which costs can be shared or saved in integrated services. Note: there is not a definite right or wrong answer. The purpose is to recognize cost saving benefits of integrating services. Explain: Circle in black pen all costs, which can be saved. Circle in blue pen all costs which can be shared. Circle in red pen all costs which require fundraising (some items will have a blue and red circle). Monitor: Encourage answers. Time: Allow 15 minutes. Feedback: Ask participants to share their thoughts on the benefits of integrating services. Acknowledge that this is not the only way to save costs: cost sharing through partnership with other organizations also saves costs. WHEELCHAIR SERVICE TRAINING PACKAG E 84 Integrated service scenario: if participants do not have experience of an integrated service share the scenario below. A P&O service is planning to integrate a wheelchair service. Two personnel have been identified and sent on WSTP basic training. Both personnel will work three days per week on the wheelchair service and two days per week in the P&O service. A workspace has been allocated in the workshop for a wheelchair technician. The therapy department had a clearout of broken and unused equipment and this has created space for a work area for the clinical role. The outdoor gait training area has been modified to include some additional barriers for wheelchair skills training. Suggestions for shared costs Stock of materials Personnel salaries Equipment Tools Local transport (depends on service model) Monitoring and evaluation Fundraising Training of partners/referral networks Tools replacement Consumables Printed materials Accommodation for clients Personnel. Suggestions for saved costs Building/facilities Overheads. Suggestions for additional funding Supply of wheelchairs Spare parts Modifying an existing mobility skills area (costs will be less because most of it already exists) Some tools Some equipment Printed materials Training of personnel. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 85 4. Benefits of cost sharing through partnerships (13 minutes) Explain: Organizations may partner with other organizations to share costs. Ask: Do any of you have examples of cost sharing to provide products? Encourage answers. Products and service provision • In addition to the product, also consider the cost of service provision. • Cost sharing among different stakeholders leads to a sustainable model. • Benefit for service centre and wheelchair users: products are more affordable • Benefit for international organizations: service centre is demonstrating capacity to work towards financial sustainability. B.5.4 What does a wheelchair service cost? International par tnerships Explain: • International organizations can cost share the price of products with the service centre. • Benefit for service centre: products are more affordable for service users. • Benefit for international organization: service centre is demonstrating capacity to work towards financial sustainability. Ask: Do any of you have examples of cost sharing on service delivery (staff, facilities, transport)? Encourage answers. Partnerships in c ommunity Outreach to community • A partner may provide facilities or support staff in the community. • Local staff can be trained in some of the service steps such as referral, follow-up and user training. • Benefit for wheelchair users: less travel and cost • Benefit for service centre: cost sharing for providing services in community. B.5.5 What does a wheelchair service cost? Explain: Partnerships in the community can allow centralized services to reach the community more effectively. • A partner may initially be able to provide facilities, or support staff. • They may also be able to provide staff to be trained in some of the service steps – for example referral, follow-up and user training. • Benefit for wheelchair users: less travel and cost. • Benefit for service centre: services can expand into the community, without the cost for services in the community. Ask: Do any of you have examples of cost sharing on training? WHEELCHAIR SERVICE TRAINING PACKAG E 86 Encourage answers. Funding training activities • Better quality of service. • Benefit for wheelchair users: better health, comfort and function leading to increased participation. • Benefit for funder: better services, greater credibility and fulfilling their corporate social responsibility. • Win-win for all. B.5.6 What does a wheelchair service cost? Partnerships in t raining Explain: International and private organizations may fund training: • Benefit for wheelchair users: increased health, comfort and function leading to increased participation. • Benefit for funder: increasing capacity of an organization to better meet the needs of people with a mobility disability. May help private organization meet their corporate social responsibility targets. Explain: Once you have planned a service model and developed a budget, it is necessary to identify potential funding sources. More information on how to source funding for wheelchair service set-up and running costs is discussed in C.4: Planning for financial sustainability. 5. Summary of action points for managers (5 minutes) • Consider service integration when planning a service model. • Consider community partnerships when planning a service model. • Develop partnerships with disabled people's organizations in particular. • Prepare a budget for the planned service model. • Identify possible supporters to achieve the ultimate goal. B.5.7 What does a wheelchair service cost? Actions for man agers Read the action points for managers. Work with wheelchair service staff and key stakeholders to: • consider service integration when planning a service model; • consider community partnerships when planning a service model; • prepare a budget for the planned service model. Ask participants to refer to their workbook and record their own actions for identifying costs for setting up and running a wheelchair service. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 87 C: Running a wheelchair service C.1: How do you know if your service is working? O B JE C T IV E S By the end of this session, participants will be able to: … explain the differences between monitoring and evaluation (M&E); … describe how to prepare a service plan; … discuss at least three ways to improve service efficiency and effectiveness; … describe how to gather user feedback to inform service provision. R E S O U R C E S For the session: … PPT slides: C.1: How do you know if your service is working? … Reference Manual and Workbook; … Post-it notes; … tool for measuring participation at time of assessment; … tool for measuring satisfaction and outcomes at time of follow-up. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … consider meeting with some service users and completing user satisfaction questionnaires to inform discussion during the session. … consider reviewing an existing service plan and relating it to the service plan framework. T O P R E PA R E … Read through the session plan and gather resources. O U T L IN E 1. Introduction 2. What is monitoring and evaluation? 3. Efficient and effective services 4. Importance of user feedback 5. Creating a service plan 6. Summary of action points for managers. 2 10 20 23 15 5 Total session time 75 WHEELCHAIR SERVICE TRAINING PACKAG E 88 1. Introduction (2 minutes) Explain: The next part of the workshop focuses on running a wheelchair service. In this session we will talk about the manager’s role in developing an efficient and effective service with an annual service plan. 2. What is monitoring and evaluation? (10 minutes) Explain: Monitoring and evaluation (M&E) helps a manager see what is (or is not) happening as a result of their team’s activities. It also helps a manager and their team to learn what is and isn’t working, and to understand what their service users and stakeholders think. Monitoring • How well a service is carrying out its activities. Evaluation • Impact of activities on service users. C.1.2 How do you know if your service is working? Is the service fit for purpose? Monitoring and e valuation Ask: How would you describe monitoring? Explain: Monitoring measures performance. It looks at how well a service is delivering the service steps at a moment in time. Ask: How would you describe evaluation? Explain: Evaluation goes a step further than monitoring: • It looks at the impact of the service activities on the service users. Monitoring Evaluation When is it done? Daily, weekly, monthly Annual review What is measured? Service activities, resources used and number of people benefitting. Impact on individuals and communities and how sustainable the service is overall. C.1.3 How do you know if your service is working? Difference betwe en M&E Explain: that we will look a little closer at key differences between monitoring and evaluation. Ask: When is it done? Explain: Monitoring is regular throughout the year. Evaluation is less frequent and can be performed annually. Ask: What is measured? Explain: Generally, monitoring assesses efficiency – of service activities, resources used and number of people benefitting. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 89 Generally, evaluation assesses effectiveness – impact on individuals and communities and how sustainable the service is overall. Activity Groups: Divide participants into groups of four. Instructions: Explain: There are several examples of the benefits of monitoring and evaluation and the aim is to see which group thinks of the most examples. Ask the participants to write examples down on separate Post-it notes. Stick the Post-it notes on a flip chart as it gets completed. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes. Feedback: Leave the Post-it notes on flip chart paper or wall during the session. Acknowledge their contribution. Most important answers: • provides important information to improve the quality of service delivery; • provides information to guide product procurement; • helps to contain costs by increasing efficiency and justifying current and proposed funding; • enables services to demonstrate with evidence the effectiveness of the service to funders – including the government and NGO donors; • helps identify and quantify unmet needs; • informs appropriate allocation of resources; • raises awareness of the benefits of the service; • develops stronger partnerships with service recipients. 3. Efficient and effective services (20 minutes) Explain: Earlier in the workshop we focussed on starting a wheelchair service and putting in place those things that would help to improve efficiency, including: WHEELCHAIR SERVICE TRAINING PACKAG E 90 Some common findings of an evaluation: • Further actions are needed to create an equitable service. • Need to improve referral, appointments and follow up. • Upgrade facilities and create better systems and procedures for service provision. • Improve the quality of available products or increase the range of products. C.1.4 How do you know if your service is working? Follow up agreed actions • Actions to create an equitable service. • Actions to improve referral and appointments. • Organizing facilities and creating systems and procedures. • Actions to improve the quality of available products. Explain: It is important to follow up and assess how efficiently systems and procedures for each service step are working. Explain: When planning how to monitor and evaluate a service, it is helpful to create a three step framework. Further details can be found in table 3.5 of the Wheelchair Guidelines. Introduce group activity and explain that we will look at how we can assess how efficiently and effectively a service is working. Activity Groups: Divide groups into people working in the same or similar organizations. Assign half the groups to work on completing the shaded section of the table in section C1.1 Monitoring in their workbook, and the other half to work on the unshaded section of the table. Instructions: Explain the table: • column one lists service areas and activities to be monitored; • column two lists some possible service performance targets; • column three lists methods of information collection to compare what is actually happening to the targets (what should be happening). Explain the activity: • some of the boxes on the activity worksheet of the Workbook have been completed to help get started. The remaining boxes should be filled in. Ask why it is important to record this information. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for the activity and 10 minutes to discuss the completed table. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 91 Feedback: Bring groups together and complete each row (answers will vary, it is the process which is important). Add suggestions that the group may not have thought of. Examples of service areas that could be monitored, performance targets, and ways of collecting information Service areas and activities Service performance targets Methods of information collection Referral Number of users referred The service will receive 30 referrals per month Record referrals received Average waiting time from referral to appointment Waiting time from referral to appointment should be less than 1 month Record date referral received and assessment date on user file Wheelchair provision Number of users who receive a wheelchair The service will prescribe and fit wheelchairs for 20 users per month Wheelchair prescriptions recorded on users’ files Average waiting time from assessment to fitting Waiting time from assessment to fitting should be less than 2 months Record date of assessment and date of fitting on user file Number of follow-up appointments carried out Follow-up appointments will be carried out for at least 15 users per month Follow-up appointments documented in users’ files Wheelchair population served Details of users referred to the service, such as age, gender, disability, postural support needs The service will encourage equal access The service will aim to meet the needs of users requiring basic wheelchairs and those requiring modifications and postural support Number of women, men, girls and boys accessing the service recorded on user files Types of postural need presented and wheelchairs prescribed recorded on user files Geographical area covered by the service The service will provide wheelchairs for people living within (defined region/area) Home address of users accessing the service – recorded on user files WHEELCHAIR SERVICE TRAINING PACKAG E 92 Service costs Cost of products supplied, including modifications made within the service The individual cost of each wheelchair will be less than (amount specified according to budget and realistic cost of available products) Cost of product and any modifications recorded on user file Amount of time spent by personnel on service activities (for example, assessment, follow-up and training) The service will provide wheelchairs for people living within (defined region/area) Time spent by personnel recorded on user file Explain: when analysing the information and data gathered there are two important considerations: • When an activity is not going well, work together with service users, service personnel and other stakeholders to get to the root cause of the problem. • When an activity is going well and targets have been achieved, find ways to share and celebrate the success. This is very motivating for the service team and other stakeholders. Celebrate success! C.1.5 How do you know if your service is working? Achieving target s Explain: • It is important to celebrate success and prize the good results. Ask: Do you celebrate success with personnel in your organization? How do you do this? 4. Importance of user feedback (23 minutes) Explain: Evaluation allows the service to reflect on what is working well and what needs to change. It also allows the service to reflect on whether it is achieving its overall purpose. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 93 • To promote personal mobility with the greatest possible independence. • To enhance quality of life of service users through improved access to wheelchairs. C.1.6 How do you know if your service is working? Reiterate purpos e of service Explain: • The ultimate purpose of the wheelchair provision – read from the slide. Explain: There are a number of suggestions on how to evaluate your service in table 3.6 of the Wheelchair Guidelines. Further details are included in the reference manual. Some examples: • Users served • Cost of service • Staffing • Facilities • Quality of service delivery • Impact on users and their families. C.1.7 How do you know if your service is working? What to evaluat e Explain: • Users served and the intervention they received. • Cost of service, including cost of products and service delivery. • Staffing (numbers of personnel and their roles and competences). • Facilities and equipment available to the service. • Quality of service delivery – good practice recommendations are listed in the Wheelchair Guidelines. • Impact on users and their families. Ask participants if they are already evaluating their services? Acknowledge answers. Ask if they are evaluating any of the listed areas? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 94 Benefits and importance of user feedback. C.1.8 How do you know if your service is working? Impact on users and their familie s Explain: • We are going to focus on the final point on the list: impact on users and their families. • We will discuss the benefits and importance of feedback from service users. Explain that you would like to share an example from Ethiopia about the benefits of people with mobility disabilities being involved in gathering user feedback. Read or tell the story. Example from Ethiopia Two field officers interviewed 140 wheelchair users from seven service centres across the country. Both field officers had a mobility disability and this was found to be very beneficial for their role. Benefits of the process: The field officers themselves became well informed of issues facing wheelchair users in their country. The process has empowered them as advocates for the needs and rights of wheelchair users. The service users gained emotional and psychological benefits from being interviewed by a positive role model. Following interviews, an informal network has evolved which has led to a stronger relationship between the service providers and users. In addition, through the evaluation, some instances were identified where a wheelchair user had not received a wheelchair suitable for their needs. This was traced back to a training need within the service, and the service has been able to act on this. Explain: There are some important considerations when planning to gather feedback from service users. Refer to the workbook. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 95 Activity Groups: As a group: participants from the same organization can work together. Instructions: Introduce the Tools “Assessing participation at time of assessment” and “Measuring satisfaction and outcomes at time of follow-up” from the Additional Resources for Managers Manual on the Pen Drive. Explain: There are some important considerations when planning to gather feedback from service users. Complete this checklist to make notes for your service (Workbook Page 103). Monitor: Monitor the groups, and assist as needed. Time: Allow 8 minutes for group activity and 5 minutes for feedback. Feedback: Ask for one volunteer to share their plan. Explain: There are important considerations and preparations required before interviewing service users. Refer to reference manual for more information. 5. Creating a service plan (15 minutes) Explain: Monitoring and evaluation information can be used to create a service plan. Introduce service plan framework and talk through each heading. Identify a need/problem to be monitored Action/objective to address need/ problem Target Information collection C.1.9 How do you know if your service is working? Creating a servic e plan Explain: • First consider a service need or problem. • Then consider what action is required to address that need or problem. • Set a target (or “short-term win”). • Decide how you will collect information to show that the target is being met. Activity Groups: As a group. Instructions: Ask participants to refer to their workbook and identify three needs or problems and complete the service plan framework (Workbook Page 104). Monitor: Monitor the groups, and assist as needed. WHEELCHAIR SERVICE TRAINING PACKAG E 96 Time: Allow 5 minutes for activity and 9 minutes for feedback. Feedback: Project the table headings in the PPT. Ask for two volunteers to explain their examples. Type in the examples; clarify any points as necessary. 6. Summary of action points for managers (5 minutes) • Create a service plan. • Monitor personnel in working towards a service plan. • Evaluate how well the service is achieving its purpose. • Recognize and appreciate team or individual success. C.1.10 How do you know if your service is working? Actions for man agers Read the action points for managers. Ask participants to refer to their Workbook and record their own actions for creating a service plan to know if their service is working or not. C.2: Managing demand O B JE C T IV E S By the end of this session, participants will be able to: … list at least two actions for managers when referrals are too low; … list at least two actions for managers when referrals are too high; … describe three reasons why early referral for children is important; … describe at least three actions to monitor and improve service efficiency. R E S O U R C E S For the session: … PPT slides: C.2: Managing demand; … Reference Manual and Workbook; FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 97 C O N T E X T Adapt this session to suit the context participants will be working in. For example: … If running a workshop for a specific partner: gather data on time of service steps. T O P R E PA R E … Read through the session plan and gather resources. … Pre-write benefits of early referral on flip chart paper. O U T L IN E 1. Introduction 2. Creating demand 3. Managing demand 4. The importance of early referral for children 5. Running efficient and effective services 6. Summary of action points for managers. 2 20 18 20 20 5 Total session time 85 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in developing their service supply to meet the demand. This includes managing referrals; the importance of early referral for children; and suggestions to improve service efficiency and effectiveness. 2. Creating demand (20 minutes) Explain: We are going to consider what action a manager should take when referrals to the service are too low. WHEELCHAIR SERVICE TRAINING PACKAG E 98 Too few referrals Cost of service goes up C.2.2 Managing demand Balancing referra ls and appointme nts Explain: • When there are too few referrals the service becomes costly to run. Ask: What actions were suggested in previous sessions to develop a referral network? Encourage answers and write on the whiteboard. Most important answers: • identify referral sources; • visit potential referral organizations; • run referral network training; • hold an open day at the service. Ask: What could be the root cause of problems if referrals are too low? Encourage answers and write on the whiteboard. Most important answers: • the service has not identified the most appropriate referral sources; • people who need a wheelchair are not accessing the referral sources; • referral network training did not get across the benefits and importance of a wheelchair service; • wheelchair users are unable to access the service – for example, because it is too far from where they live, or there is no transport available. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 99 Activity Groups: Divide participants into pairs. Instructions: Read the example of a successful referral network below. Ask participants to consider why this has been successful and list their reasons. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for activity and 5 minutes for feedback. Feedback: Ask participants to share their thoughts on factors for success. Record answers on the whiteboard. If necessary, suggest factors that they have not thought of at the end. An example of success: generating referrals from Bangladesh A “Walk for Life” programme in Bangladesh is working in partnership with the Ministry of Health to develop national sustainable services to correct clubfoot deformity for children under 3. The Walk for Life goal is for no family to have to travel more than 60 km anywhere in the country in order to be able to access a service for clubfoot. For this goal to be achieved, the Walk for Life programme needs an efficient referral network. The programme identified the following groups as potential referral sources: health workers and fieldworkers from both government and non-government organizations, including doctors, therapists, nurses and medical assistants. The programme then targeted these groups to carry out activities to raise their awareness of the importance of early referrals for children with clubfoot. The result: on average, over 60% of the number of children in Bangladesh estimated to be born with clubfoot deformity are identified and treated within 12 months of being born. In Dhaka division, which serves a population of 50 million, the figure rises to 75%. Most important answers: • clear message about who is being targeted; • clear goal of what they want to achieve; • identified different types of organizations as well as different professions; • identified centre-based and community-based organizations; • close monitoring of referrals – stories of success in generating early referrals are motivating for all personnel involved. WHEELCHAIR SERVICE TRAINING PACKAG E 100 3. Managing demand (18 minutes) Explain: When there is a high demand for the service, people cannot be seen immediately. This can be demoralising for service users and service personnel. Too many referrals – less resources Quality of service goes down/long waiting list C.2.3 Managing demand Balancing referra ls and appointme nts Explain: If the number of people being referred to a service becomes more than the personnel can manage, there are three likely results: • personnel are forced to spend less time than they need with each person – and the quality of service goes down; or • the time that wheelchair users have to wait for an appointment goes up; or • some wheelchair users are turned away. Explain: If possible, a manager should therefore carefully manage the demand. • Start with organizations close by or working in a similar field. • Avoid toll free numbers and mass media initially, as this is likely to generate mass demand from long distances, which will be difficult and costly to manage without adequate resources and systems in place. TV C.2.4 Managing demand Plan developmen t of referral netw ork Read the slide, reinforce if needed. • Record the demand by creating a waiting list. • Consider creating a database to record this information to help efficiency and processing of service statistics. • Waiting list information needs to be regularly updated – delete name of the recipient from the waiting list once they access the service. C.2.5 Managing demand Develop a waitin g list Explain: The first step is to record the demand by creating a waiting list: • It is very helpful if a database is created to record this information. • This will allow a manager and personnel to access information efficiently and allow easy processing of service statistics. • This waiting list information can be added to once the user accesses the service. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 101 Explain: When the waiting list builds up, some organizations prioritize referrals. Ask: Do any of you have a system for screening and prioritising referrals in your organization? Acknowledge answers. Prioritize those whose requirement might change rapidly or develop further health complications: • children with disabilities • wheelchair users at risk of developing a pressure sore • wheelchair users who have a progressive health condition • people who are experiencing pain due to lack of a wheelchair or a poorly fitting wheelchair. C.2.6 Managing demand Prioritizing refer rals Explain: When there are a lot of referrals it can be important to review the list and prioritize those whose needs might change rapidly or develop health complications: • Children with disabilities – because of the risk of developing bad posture or secondary deformities. • Wheelchair users at risk of developing a pressure sore – because this is a life- threatening condition. • Wheelchair users who have a progressive health condition. • People who are experiencing pain due to lack of a wheelchair or a poorly fitting wheelchair. Ask: What information do you think would be important to help screen referrals? Most important answers: • age; • type of disability; • reason for referral; • geographical location. Explain: It is important to manage expectations of what a service can provide – in terms of the number of wheelchair users who can be seen, and the level of service delivery. Every region in every country will have people with basic, intermediate and advanced posture support needs. Every region in every country will have a need for an intermediate (and later advanced) service. However, not every service will have the capacity to deliver intermediate (or advanced) services. WHEELCHAIR SERVICE TRAINING PACKAG E 102 • Make information leaflets and publicity clear about the level of service available. • Start by developing a foundation of knowledge and skill at the basic level. • Discuss how to manage referrals for the more complex intermediate and advanced user needs. C.2.7 Managing demand Managing expect ations Explain: • Make information leaflets and publicity clear about the level of service available. • Start by developing a foundation of knowledge and skill at basic level with the supporting systems and procedures for an eight step service. • Discuss how to manage referrals for more complex – intermediate and advanced user needs. Explain: It is helpful to document needs that cannot be met – to help planning for increasing the capacity of personnel and products available. Some services can go on to train personnel and develop intermediate level services with an appropriate range of products and posture support devices. Some services will require the ability to refer to an intermediate level service. When starting out, it is important to make information leaflets and publicity clear about the level of service which is available. Notes for trainers: The reality in the field is that service personnel will be presented with service users who have needs that go beyond their knowledge, skill, product availability and, therefore, service capacity. It is important for both service users and service personnel that a clear discussion and strategy is in place for how to deal with this situation. Creating publicity information about the level of service available will help facilitate these discussions. It is important to liaise with other service providers to see if referral or collaboration is possible for people with needs that go beyond the service capacity. 4. The importance of early referral for children (20 minutes) Explain: Many children who require a wheelchair may also need additional posture support. This means that many children require an intermediate level service. It is very important for all children to be referred to services as early as possible, to prevent or delay the development of bad posture. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 103 C.2.8 Managing demand Importance of an early referral fo r children Ask: In the participants’ experience, are children referred for a wheelchair when they are very young, or when they are older and become difficult for the parent/carer to carry? Encourage answers. Ask: Why are some parents reluctant to bring young children for a wheelchair assessment? Encourage answers. Most important answers: • parents may be hoping the child will be “cured” and begin walking; • parents may think that if they give the child a wheelchair, they will no longer try to walk; • while children are young and light, it is easier to carry them than manage a wheelchair over difficult terrain and inaccessible environments; • parents may not have funds to pay for a wheelchair and will delay until it becomes too difficult to carry the child; • the family may be experiencing guilt or fear that they will be seen in a bad light by others if their child is seen to have a disability. Ask participants to suggest some of the benefits of early referral. Place the pre-prepared list of benefits of early referral on the wall and cross check if all benefits have been suggested: • children who have difficulty sitting upright can develop postural problems if not well supported; • if a child is referred late, some postural problems may have become fixed. This can make it difficult for the child to sit comfortably even with support; • without the experience of sitting and being mobile, a child’s development can be delayed; • for children who have some ability to walk, using a wheelchair may make their daily life easier and allow them to do more things in a day. WHEELCHAIR SERVICE TRAINING PACKAG E 104 Comfortable gait speed (metres/minute) Additional energy expenditure Person with no mobility impairment 80 Below knee amputation with prosthesis 60 33–58% Above knee amputation with prosthesis 36–51 60–116% Amputee mobilizing with crutches 71 41–61% Person with hemiplegia 42–49 61% Paraplegic mobilizing with braces 27 230% Wheelchair user propelling with arms 75 9% C.2.9 Managing demand Lifestyle choice Explain: • Using a combination of walking aids and/ or prostheses as well as a wheelchair can enable people to do more; due to the added speed and reduced energy cost of using a well set-up wheelchair. • The table below shows the difference in speed (metres/minute) of the different methods of mobility and the energy expenditure (in comparison with walking the same distance with no mobility impairment). It is important to reassure parents and referral sources that a wheelchair is unlikely to prevent a child from walking if this is possible for them. The experience of mobility through a wheelchair while the child is learning to walk will benefit their development in many other ways. C.2.10 Managing demand Referring childre n to a wheelchai r service Explain: Wheelchair services can encourage referral networks to refer children who: • have difficulty sitting upright or are not pulling up to stand by the age of 1; or • are not walking alone by the age of 2. Explain: Children do not spend much time sitting down. They change the activity they are doing and their position many times during the day. This means that although a wheelchair is important, children should not spend all day in a wheelchair. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 105 • Work with children and their family members/ caregivers to find different positions the child can use during the day. • Close collaboration with services for children and parent/carer training should be encouraged. C.2.11 Managing demand Different positio ns Explain: • Wheelchair service personnel need to work with children and their family members/caregivers to find different positions the child can use during the day. • This may include different supported sitting positions, standing, and lying. • Close collaboration with services for children and parent/carer training should be encouraged. Activity Groups: Divide participants into pairs. Instructions: Ask participants to read the example of success in early referral by parents in Mexico (Workbook Page 105). Ask participants to consider why this has been successful and list their reasons. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for activity and 5 minutes for feedback. Feedback: Ask participants to share their thoughts on factors for success. Record answers on the whiteboard. Example of success: early referral by parents in Mexico Here is an example of how a group of rehabilitation centres for children in Mexico built up an effective early referral network. The rehabilitation centres targeted awareness-raising about their service at neonatal doctors and paediatricians. In addition, they targeted the general community through a major annual fundraising campaign, which uses extensive media coverage including radio and television. This has led to a lot of word of mouth referrals; and many parents self- referring their children. During their awareness-raising, they had a clear message: the importance of referring children for rehabilitation when they are born. They also presented a powerful vision of success; with many positive stories relating to integration and achievements of the children that they work with. Over a period of 15 years, the rehabilitation centres have seen a cultural change as paediatricians and families are now actively making early referrals. The result: A third of all referrals are for newborns up to 3 years old. WHEELCHAIR SERVICE TRAINING PACKAG E 106 Most important answers: • clear message about who is being targeted; • clear goal of what they want to achieve; • a different approach for professionals and parents; • sharing success stories to encourage parents and professionals to refer ; • sustained awareness-raising over a period of years. 5. Running efficient and effective services (20 minutes) Explain: We looked at estimating annual service capacity for a basic and intermediate service in the session B.4: Align personnel. Once a service is running, it is useful to look at this in more detail and analyse: • How long each service step is taking; and • Making each of the service steps as efficient as possible by focussing on: ° teamwork ° what can be prepared in advance for each service step? Ask participants to estimate how many working hours are available each day for service delivery in their service centre. Take into consideration tea/coffee/lunch breaks; time to complete paperwork; meetings and any cultural issues, which influence start and finish times. Acknowledge that this will only be an estimate. Ask participants to note this figure in their workbook. Highlight that this is a useful activity to go through with service personnel so that management and personnel can set realistic service targets together. Service steps Basic level in minutes Referral - Assessment 20 –40 Prescription 10–20 Product preparation 20–40 Fitting 20–60 User training 30–60 Total 100–220 Follow up 30–60 An example: C.2.12 Managing demand Timing of servic e steps – basic le vel Show timing of service steps – basic level. Ask participants to estimate number of wheelchairs (basic level) they can provide annually. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 107 Service steps Intermediate level in minutes Referral - Assessment 30–60 Prescription 30–60 Product preparation 30–120 Fitting 30–120 User training 60–120 Total 180–480 Follow up 45–120 An example: C.2.13 Managing demand Timing of servic e steps – interme diate level Show timing of service steps – intermediate level. Ask participants to estimate number of wheelchairs (intermediate level) they can provide annually. Acknowledge that there is a large variation between the estimated timings for each service step. Explain that we will look at some of the reasons for the variation. Activity Groups: Divide into groups of two or three. Instructions: Explain: the focus of the activity is to think about team working and what can be prepared in advance to reduce time spent on each step of service delivery. Read column 1 listing reasons for service steps taking more time. Read some ideas for working more efficiently and reducing time spent on service steps. Draw a line to match up problem and solution. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for the activity and 10 minutes for discussion. Feedback: Ask volunteers to read out their selected strategies to improve efficiency of the service steps. Encourage other groups to add additional ideas if they have not been covered. WHEELCHAIR SERVICE TRAINING PACKAG E 108 1. Source products with as much range of adjustability as possible. 2. Source products which can easily be modified. 3. Source products with postural support devices (PSDs). 4. Pre-prepare sample product set-up options. 5. Pre-fabricate PSDs. 6. Clear scheduling to allow for joint working. C.2.14 Managing demand Strategies for effi cient service ste ps Read the slide content, reinforce if needed. 7. Hold team meetings to create shared workplans. 8. Clinical and technical teams work together during fitting. 9. Clinical and technical teams discuss prescription solutions. 10. Clear documenting of information and record keeping. 11. Plan appropriate level of training for service personnel. C.2.15 Managing demand J38 Strategies for effi cient service ste ps Read the slide content, reinforce if needed. 12. Source appropriate materials for cushion and PSD fabrication and modifications. 13. Source appropriate tools for making quick product adjustments. 14. Allocate user training to a specific person, for example a peer trainer. 15. Identify facility for user training close to clinical and technical areas. C.2.16 Managing demand J39 Strategies for effi cient service ste ps Read the slide content, reinforce if needed. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 109 16. Establish effective stock control systems. 17. Prepare a small stock of wheelchairs in different sizes. 18. Establish community partnerships to identify service users and provide transport to a service centre in the community. 19. Build capacity of community partners to provide basic level services and refer intermediate level service users. 20. Be open to new ideas – innovation. C.2.17 Managing demand J40 Strategies for effi cient service ste ps Read the slide content, reinforce if needed. Column 1: Service challenges Column 2: Service strategies Assessment: 1. If service personnel are travelling to a service or carrying out home visits, travel time may need to be factored in to the assessment. 18 2. If team members are inexperienced the assessment will take longer. 11 Prescription: 3. If products have limited adjustability, modifications must be prescribed to make the products fit individual users. 1, 2 4. If extra posture supports require fabrication, additional measurements and drawings are required. 5, 9, 10, 16, 19 Product preparation: 5. Quick access to type and size of product required. 16, 17 6. If a wheelchair has limited adjustability then more time may be required on product preparation. 1, 2, 12, 13 7. If modifications for posture support are necessary, more time will be required. 1, 2, 4, 5, 12, 13 Fitting: 8. If modifications have been made or extra supports added to the wheelchair, fitting will take longer. 3, 6, 8 9. If any changes are made to the wheelchair set-up during fitting; further fitting checks are required. 1, 2, 3, 6, 8, 10, 13 User training: 10. If it is the first time a person is receiving a wheelchair, or a health complication exists, more time will be required to cover user training in health, mobility, handling the wheelchair and care and maintenance and referring on to other referral sources. 6, 7, 10, 11, 14, 15 Note: 20: Be open to new ideas – innovation can apply to all areas. WHEELCHAIR SERVICE TRAINING PACKAG E 110 Explain: Planning and management of follow-up has a huge impact on service development. Follow-up is discussed in the next session. • The need for intermediate services is becoming more visible. • Expect more demand in near future. • Train and develop the teams accordingly. C.2.18 Managing demand Planning interm ediate services Explain: • The need for intermediate services is emerging as increasingly greater. • When expanding services to intermediate level, a large demand should be expected. • Therefore, it is recommended to have a team dedicated to intermediate level service provision as for basic level service provision. Explain: At intermediate level significant clinical and technical knowledge and skill is required. This can be developed in one person. However, it is more common to have two personnel – one with a clinical skill and the other with a technical skill. Ask: How do you think you should plan development of personnel to run both a basic and intermediate service? Most important answers: • train new person or team for basic level services first: WSTP basic; • consider developing staff from partner organization if service is not able to support additional salaries; • identify new person or team for intermediate level service; • plan service model and facilities for intermediate level; • train new team in intermediate skills: WSTP intermediate. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 111 6. Summary of action points for managers (5 minutes) • Establish a system to monitor referrals and manage waiting lists. • Share success stories of early referral with parents and referral sources. • Plan how to manage referrals with needs which are beyond the capacity of the service. • Plan how to monitor and improve efficiency of service steps. C.2.19 Managing demand Actions for man agers Read the action points for managers. Explain: Work with wheelchair service staff and key stakeholders to: • establish a system to monitor referrals and manage waiting lists; • share success stories of early referral with parents and referral sources; • plan how to manage referrals with needs which are beyond the capacity of the service; • plan how to monitor and improve efficiency of service steps. Ask participants to refer to their workbook and record their own actions to create and manage a balance in service supply and demand. C.3: Planning follow-up O B JE C T IV E S By the end of this session, participants will be able to: … describe at least four user groups who need more regular follow-up; … describe at least three benefits of follow-up in the person’s community or at the service centre; … list at least two barriers to follow-up and how to overcome them; and … discuss how community partnerships can support inclusion and participation of service users in their community. R E S O U R C E S For the session: … PPT slides: C.3: Planning follow-up; … Reference Manual and Workbook. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … consider the service models that the participants are working in and adjust examples if necessary; … collect useful resources relevant to the context. WHEELCHAIR SERVICE TRAINING PACKAG E 112 T O P R E PA R E … If possible bring a wheelchair user/s to talk about the benefits of follow-up and what it has meant for them. O U T L IN E 1. Introduction 2. Importance of follow-up 3. Purpose of follow-up and where it should happen 4. Planning for follow-up 5. Reducing barriers to follow-up 6. Inclusion and participation in the community 7. Summary of action points for managers. 2 10 15 20 20 13 5 Total session time 85 1. Introduction (2 minutes) Explain: Follow up is the eighth step of wheelchair provision. All wheelchair users benefit from being followed up. It is important for a service to have a plan for how follow-up will be carried out. During follow-up, services also benefit from the opportunity to learn about the impact of the service on the user, their family members and their community. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 113 2. Importance of follow-up (10 minutes) Notes for trainers: If possible, bring a wheelchair user(s) to talk about the benefits of follow-up and what it has meant for them and their family. If it is not possible to have a wheelchair user share their experience, read some of the following examples of the importance of follow-up. Duli: is a 21-year-old woman living with her family. On follow-up the team found out she was not leaving her home because her wheelchair had flat tyres due to punctures. The wheelchair had been abandoned underneath the house. The punctures were repaired and advice given to the family. Duli is able to leave her home again. The family did not value follow-up until they experienced the benefits. The service team decided to create stickers with the service contact number for all wheelchairs to reduce this problem in the future. Maria: received an appropriate wheelchair nine months after having a spinal cord injury. On follow-up, she was uncomfortable and was experiencing spasms, which she thought were due to the wheelchair. It was discovered that bugs had infested the wheelchair upholstery and were biting her. This could have led to serious health complications and abandonment of the product. However, the problem was identified and dealt with and Maria is now healthy and happy with her wheelchair. Anton: was known in his community for his ability as a rugby player. Then he had a rugby injury, causing a spinal cord injury. He received an appropriate wheelchair and user training but on follow-up it was found he was not leaving his home. A peer trainer was part of the follow-up team and spent time talking with Anton and discovered he had lost his confidence and did not want to meet his friends. He felt isolated, lonely and embarrassed about “being disabled”. The peer trainer returned next day to go out with him for the first time. Since that day, Anton’s life has moved forward. Gihan: is a three-year-old boy living with his parents and brother. At follow-up his supportive seat was found to be covered in food, and was not maintained. His parents reported that Gihan had difficulty sitting up and was not comfortable in the chair. They had lost confidence in the product and did not like it. Gihan was booked in for re-assessment with a team who had received intermediate level training. Modifications were made to the wheelchair set-up and Gihan was able to sit upright and started looking round and exploring his environment. Gihan and his parents were very happy and watched closely when they were shown how to care for and maintain Gihan’s wheelchair. Ask: Do you have experience of follow-up working in any type of service? Encourage answers. Discuss: • Is it useful? • Is it planned? • How often does it happen? WHEELCHAIR SERVICE TRAINING PACKAG E 114 3. Purpose of follow-up and where it should happen (15 minutes) Explain: Service personnel should be clear about the purpose of follow-up and how it is different to a new appointment. • Gather information from the wheelchair user. • Check that the wheelchair is in good working order. • Check the fit of the wheelchair. C.3.2 Planning follow-up The purpose of f ollow-up Read the slide content, reinforce if needed. Make use of some of the answers, which participants have given before. • Providing more advice or training. • Re-adjusting the wheelchair. • Carrying out minor repairs. • Referring the wheelchair user to other service providers for support or assistance, if needed. C.3.3 Planning follow-up Common follow- up actions Read the slide content, reinforce if needed. Highlight: Follow-up should not turn into a new assessment or significant refurbishment of the wheelchair. This is not possible in the time available for follow-up and a new appointment should be given for a full assessment. • In the wheelchair user’s home. • At the wheelchair service centre. • At any other location that suits the wheelchair user and the wheelchair service personnel. C.3.4 Planning follow-up Common follow- up actions Explain: Follow-up can happen: • in the wheelchair user’s home; or • at the wheelchair service centre; or • at any other location that suits the wheelchair user and the wheelchair service personnel. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 115 Explain: There are benefits to doing follow-up in a person’s home or close to the community where they live. Ask: What do you think these benefits are? Acknowledge answers and write on whiteboard. Most important answers: • more cost-effective for user and their family: family do not have to take time off work and pay for transport; • education of service providers: about the barriers to participation and inclusion that people face in their homes and communities; • quality of service: confirmation (or not) that the wheelchair is meeting the user’s needs; • community awareness: seeing the service provider in action can increase referrals and possibly community fundraising; • supports fundraising: allows gathering of case studies and user stories which can be used to support fundraising. Explain: There are also benefits of doing follow-up at a service centre. Ask: What do you think these benefits are? Acknowledge answers and write on whiteboard. Most important answers: • efficient use of staff time: no time lost in travel; • major repairs are able to be carried out with full workshop facilities; • all equipment and facilities are already set up; • staff are available for a second opinion; • direct feedback on quality of service: confirmation (or not) that the wheelchair is meeting the user’s needs; • supports fundraising: allows gathering of case studies and user stories which can be used to support fundraising. WHEELCHAIR SERVICE TRAINING PACKAG E 116 4. Planning for follow-up (20 minutes) • All wheelchair users benefit from follow-up. • Follow-up is particularly important to wheelchair users who: - are children; - are at risk of developing a pressure sore; - have a progressive health condition. - need additional postural support in their wheelchair; - have had difficulty with any of the training or instruction given to them. C.3.5 Planning follow-up Who needs follo w-up? Explain: All wheelchair users will benefit from follow-up. However, follow-up is most important for: • children with disabilities; • wheelchair users at risk of developing a pressure sore; • wheelchair users who have a progressive condition; • wheelchair users who need extra support in their wheelchair (intermediate level); • wheelchair users who have had difficulty with training in transfers, mobility, health or wheelchair maintenance. • There is no rule. • It is helpful to offer a follow-up service within six weeks from the date of delivery for intermediate users. • It is ideal to follow-up children and people with a progressive health condition, every six months. • It is ideal if all other users are offered follow-up within twelve months from the date of delivery. C.3.6 Planning follow-up When should fol low-up happen? Explain: There is no rule about when follow up should happen, as the best time to follow up will depend on the needs of the wheelchair user. • It is helpful to review intermediate users within six weeks to check on comfort and abilities with the new support. • For children and people with a progressive condition, it is ideal if follow up is every six months. This is because their needs can change quickly. • It is ideal if all other users are offered follow-up within twelve months of receiving their wheelchair. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 117 Planning basic le vel follow-up Follow-up clients New clients Total wheelchair users C.3.7 Planning follow-up Introduce the visual tool for a basic level service. Explain: • Blue = Follow-up appointment • Green = New appointment • Orange = Total number of service slots available • In the first year there are no follow up appointments and all appointment slots are used for new service users (green column). • The total service users (orange column) are all new appointments. Ask: Do you think it is realistic that there will be no follow-up appointments required in the first year? Acknowledge that some people will require a priority follow-up. In some services, this can be up to 30% of the caseload. Click to bring up year 2: note the blue column is follow-up appointments from year 1. Ask: What has happened to the green column for new appointment slots? Acknowledge that it has gone down and less new appointments are available. Click to bring up year 3. Highlight that the total number of slots for new appointments continues to go down. Ask: What actions could be considered to maintain the number of new service slots each year? WHEELCHAIR SERVICE TRAINING PACKAG E 118 Most important answers: • develop service support role to carry out follow-up; • identify follow-up facility, tools and equipment at service centre; • train personnel at partner organization in community to carry out follow-up; • train more service personnel to manage increased workload. Planning interm ediate level follo w-up C.3.8 Planning follow-up Follow-up clients New clients Total wheelchair users Introduce the visual tool for an intermediate level service. Explain: • Blue = Follow-up appointment • Green = New appointment • Orange = Total number of service slots available. Explain: in the first year, follow-up appointments start usually after six months. Click to bring up year 2. Ask: What is the difference between the basic level service and the intermediate level service in year 2? Acknowledge that the number of follow-ups is greater and the number of new appointment slots is significantly less. Click on year 3. Ask: What is happening now? Acknowledge that less than half of the appointments are available to see new service users. Ask: When do you need to start planning follow-up at your service centre? Acknowledge answers. Highlight that it is important to plan for follow-up from the very beginning and build it into the service model. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 119 Explain: The impact of follow-up on the availability of new appointments will be felt very quickly if a service does not plan ahead. Intermediate services in particular are at risk of getting close to saturation by year three. C.3.9 Planning follow-up Plan the follow-u p model • One solution to this is to collaborate with community based organizations – and train their personnel to carry out as much follow-up as possible. Community- based personnel may be able to manage many of the simpler follow up tasks, only referring back to the wheelchair service for re-assessment, major repairs, or other problems they cannot solve. • There are many benefits of this role being carried out by a positive role model such as a person with a mobility disability. 5. Reducing barriers to follow-up (20 minutes) Explain: Despite the benefits to service users and service providers, the numbers receiving follow-up are often low. It is important to get to the root cause of why numbers are low, in order to overcome the barriers and improve the service. Ask: In your experience, what are the barriers to follow-up? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 120 Most important answers: Barriers to an outreach follow-up service: • costs of service centre staff travelling to communities; • time for service centre staff to travel to the community; • follow-up is not prioritized by service managers; • follow-up is not valued by service users until they experience the benefits. Barriers to centre-based follow-up: • cost of travel and time off work for one or more family members is a double financial cost to the family; • users and family members are often not aware of the benefits of follow-up once they have received a wheelchair ; • difficulty finding accessible transport; • there can be pressure to focus on new appointments at the service centre, with no time left for follow-up; • difficulty scheduling appointments: users may turn up when staff not available, or not turn up when staff are available. Read an example of how one organization in Indonesia has approached follow-up For a wheelchair provision programme in Indonesia; rather than charge a fee directly for the wheelchair itself, they charge “membership fees” that contribute to the service, follow up, maintenance, and administration costs. This membership fee entitles ‘members’ to a quality service and on-going support. There is a ‘sliding scale’ fee system, in which the amount that an individual pays is determined based upon that individual’s household income, as identified via utility bills, civil service employment documents, self-reporting and other supporting income indicators.  This wheelchair programme has found that the membership system is effective on a number of levels:  • members feel empowered to expect a quality service and product; • because members have paid a significant amount relative to their income level (usually in the range of US$ 2–20, but anywhere up to US$ 150), they are more likely to value their wheelchair and feel a sense of pride in owning it; • because the membership entitling them to free or discounted follow-up service, which expires within two years, members are more likely to seek out follow-up sooner.  FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 121 Activity Groups: Divide in groups of three or four. Instructions: Read the list of possible barriers to follow-up (Workbook Page 108). Add any additional barriers, which the group have highlighted to the table. Consider the strategies for leading change and apply them to help overcome barriers to follow-up. List possible strategies in the blank section of the table. Monitor: Monitor the groups, and assist as needed. Time: Allow 5 minutes for activity and 10 minutes for feedback. Feedback: Consider each of the strategies for overcoming barriers to follow- up and ask participants to suggest how this can help to overcome barriers to follow-up. Possible actions for overcoming barriers to follow-up Motivate, engage and commit service users to the benefits of follow-up: • explain benefits of follow-up during user training, service step 7; • share stories of the benefits of follow-up in waiting room, on websites, and on community noticeboards; • membership system for service users. Motivate, engage and commit service personnel to the benefits of follow-up: • pilot a follow-up scheme delivered by service personnel; • collect case studies of the benefits of follow-up. Identify an immediate and measurable result: • set targets for a pilot follow-up scheme; • gather and share stories of success. Prioritize follow-up when allocating resources: • use stories of success about the benefits of follow-up to support fundraising for specific costs relating to follow-up; • allocate time to develop community partnerships and train and mentor personnel in the community. Maintain support for facing continuing challenges: • monitor follow-up data closely and identify root cause of problems; • make follow-up part of the service model, systems and procedures. WHEELCHAIR SERVICE TRAINING PACKAG E 122 6. Inclusion and participation in the community (13 minutes) Explain: As we have discussed already, follow-up is a time to assess the impact of the service and whether it is achieving the overall vision of: increasing quality of life, inclusion and participation in the community. One of the wider roles of a wheelchair service is improving accessibility. This can have a significant impact on the inclusion and participation of wheelchair users in the community. The example below explains the cost of not addressing access in the home and community. Read about access barriers delaying discharge in Sri Lanka Not addressing access in the home and community can be very costly for government. In a rehabilitation hospital in Sri Lanka a hospital cost survey was carried out on the spinal injuries unit in 1999.The average cost/day for in patient stay was US$6.8. There were 16 patients on Ward 8 (a ward for patients who were not able to be discharged) with an average length of stay of 61 months costing Rs 858,270 (US$ 12,438) each. Paying to make the home accessible so that people could return to their homes would have saved the hospital and government a lot of money. C.3.10 Planning follow-up Access to homes Access to homes Explain: • One of the main barriers at home is access to a toilet. C.3.11 Planning follow-up Access inside ho mes Explain: • Advice on simple changes to the home can make a huge difference to quality of life. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 123 Highlight: In studies, the World Bank found that the cost of building-in accessible features at the time of construction is minimal. It has been shown that making buildings accessible adds less than one percent to construction costs. Read about an architectural barriers campaign in Nicaragua In Nicaragua, a DPO called CADISCA ran a campaign in the capital city Managua to highlight the problem of high kerbs and steps. It built 200 ramps and dropped kerbs (making a small area of a kerb level with the road) in just three months with a team of wheelchair users, creating access to public areas. The members of CADISCA were seen out in their community doing something positive, which raised support and resulted in local companies sponsoring the building of more dropped kerbs and ramps throughout the city. Early on, CADISCA used wheelchair basketball to promote self-confidence and boost member involvement in DPO activities. Sport training sessions also gave an opportunity for regular DPO meetings, where plans for awareness-raising were organized. These training sessions were held in a public park, exposing the community to the DPO’s activities and raising awareness. Ultimately, the sport programme helped influence the success of the access campaign through gaining public awareness and support for disabled people. This helped to eventually pressure the government to fund dropped kerbs throughout Managua. The removal of physical barriers has given wheelchair users an equal opportunity to access key financial, educational and social areas within the city. C.3.12 Planning follow-up Removing archit ectural barriers Explain: Transport is a common barrier for wheelchair users. Challenges include: • getting transport to stop long enough to transfer and stow a wheelchair; • being charged an additional fee to carry a wheelchair; • risk of removable parts being stolen – for example, wheels; • difficulty accessing transport due to thresholds and doorways. WHEELCHAIR SERVICE TRAINING PACKAG E 124 C.3.13 Planning follow-up Removing transp ort barriers Introduce the picture of a modified motorbike in Thailand and modified auto- rickshaw in India. Explain: • There are inclusive transport initiatives in many countries, including South Africa and Colombia. Some useful resources are referenced in the reference manual. C.3.14 Planning follow-up Access to educat ion Explain: • Access to education can be prevented by something as simple as the width of a pathway and access to a toilet. • Being able to offer resources and information on accessible buildings and pathways can empower schools to be inclusive. Summarize: By providing advice and information on accessible environments and working in partnership to facilitate access to homes, transport and education; a service is maximising the opportunities for inclusion and participation of people with mobility disabilities. 7. Summary of action points for managers (5 minutes) • Plan follow-up. • Establish and develop partnerships especially at community level. • Identify a dedicated team for user training and follow- up, if possible. • Gather and share stories about the benefits and success of follow-up. C.3.15 Planning follow-up Actions for man agers Read: the action points for managers. Work with wheelchair service staff and key stakeholders to: • plan follow-up; • establish and train community partners; • identify a dedicated role for user training and follow-up; • engage all stakeholders in the importance of follow-up by gathering stories of the benefits and success. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 125 Ask participants to refer to their workbook and record their own actions for planning follow-up. C.4: Planning for financial sustainability O B JE C T IV E S By the end of this session, participants will be able to: … define financial sustainability; … describe how to plan for financial sustainability; … identify at least three funding sources; … outline a fundraising strategy. R E S O U R C E S For the session: … PPT slides: C.4: Planning for financial sustainability; … Reference Manual and Workbook. C O N T E X T Adapt this session to suit the context participants will be working in. For example: … research the service model of participating service centres; … add specific local sources of funding or examples of success to the reference material or create a supplementary resource to support this session. T O P R E PA R E … Read through the session plan and gather resources. … Go through the fundraising framework. O U T L IN E 1. Introduction 2. What is financial sustainability? 3. Planning for financial sustainability 4. Identifying potential sources of funding 5. Planning a fundraising strategy 6. Summary of action points for managers. 2 15 8 20 20 5 Total session time 70 WHEELCHAIR SERVICE TRAINING PACKAG E 126 1. Introduction (2 minutes) Explain: In this session, we will talk about the manager’s role in developing a strategy for funding the service steps and wider service responsibilities; with the overall aim of ensuring the wheelchair service is sustainable. 2. What is financial sustainability? (15 minutes) Explain: We are going to create a statement about ‘What is financial sustainability in wheelchair service provision?’ Financial sustainability in wheelchair provision is… C.4.2 Planning for financial sustainability What is financia l sustainability? Project the slide. Introduce the group activity. Activity Groups: Divide participants into three groups. Instructions: Ask each group to write down a statement about what is financial sustainability in wheelchair service provision. Explain that it sometimes helps to write down what it is not and then turn that into a positive statement. For example, financial sustainability of a wheelchair service is not just considering product costs; this can become: “Financial sustainability of a wheelchair service must include more than product costs.” This can provide a starting point to build a financial sustainability statement. Monitor: Monitor the groups, and assist as needed. Ask groups to write down their statement on financial sustainability on flip chart paper. Time: Allow 5 minutes for activity and 8 minutes for feedback and creating the statement. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 127 Feedback: Ask one representative from each group to present their statement to the rest of the participants. Remark on the common elements of the statements and create one shared statement of financial sustainability. Write common statement on flip chart and place on wall. Notes for trainers: An example of a possible statement • A sustainable wheelchair provision programme is one with the capacity to provide appropriate wheelchairs through the eight steps of service to a consistent number of individuals over a significant period of time. • This requires continuous investments in product supply, trained personnel, space, and monitoring and evaluation systems. Financial sustainability is reached when a service has secured, or is consistently able to secure, the funds and resources necessary to enable this continuous investment. 3. Planning for financial sustainability (8 minutes) • Identify funds and resources needed. • Identify potential sources of funding. • Identify potential non-monetary support. • Develop a strategy for securing funding and donations in kind. C.4.3 Planning for financial sustainability Planning for fina ncial sustainabili ty? Explain: Planning for financial sustainability includes: • clearly identifying the funds and resources needed to sustain the service (this was discussed in B.5); • identifying potential sources of funding; • identifying potential non-monetary support; • developing a strategy for securing funding and donations in kind. Ask: What are some potential funding sources in participant’s context? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 128 • Government • National insurance schemes • Private donors and sponsors • Corporate (business) donors and sponsors • User contributions or full purchase • Income generation/social enterprise • Community groups/charitable societies • Diplomatic missions • International and national NGOs. C.4.4 Planning for financial sustainability Potential funding sources Explain: There are many different possible funding sources. Show slide. Explain: • Wheelchair services can be funded in many different ways. • Some services may have one single funding source (for example Government), however most services will secure the funds and resources needed from a range of different sources. • Non-monetary support can include: • Donations in kind: − Equipment − Wheelchairs − Materials • Volunteer support • Provision of facilities. • Non-monetary support reduces the funds that the service needs to secure. C.4.5 Planning for financial sustainability Potential non-m onetary support Explain: • As well as sources of funding, there are also sources of non-monetary support. • This includes donations in kind (for example donations of equipment, wheelchairs, and materials) and volunteer support. • Non-monetary support can reduce the amount of funds required to manage the service. Ask: Does anyone have any examples of non-monetary support? Acknowledge answers. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 129 Read example from Mexico: Engaging the community and user contributions The Teletón in Mexico is an annual TV and radio broadcast, started in 1996, to raise money for children’s rehabilitation centres (known as Centro de Rehabilitación Infantil Teletón or CRIT – “Teletón Children’s Rehabilitation Center” in English) for disabled children. It is produced by Televisa and more than 600 Mexican and foreign media; and 20 commercial firms sponsor the event. They sell their vision of success with powerful positive stories about integration and achievements. Over a three month period prior to the event, the case studies are released through the media as part of the build-up. High profile personalities are involved in the promotion of the event. The CRIT centres are completely financially sustainable and growing; with the combined income streams of this annual fundraising event and service user contributions. Acknowledge: The Teleton awareness-raising is on a massive scale but it is also very successful. Explain: Gathering and sharing success stories is a powerful fundraising tool. Services will benefit from planning awareness-raising in their communities. 4. Identify initial funding sources (20 minutes) Explain: Once you have planned a service model and developed a budget, it is necessary to identify funding sources. Activity Groups: Divide in to small groups. Participants from the same organization can work together. Instructions: Read the list of possible funding sources (Workbook Page 109). Choose the three sources that you believe have the greatest potential for your service and list them in the table below. Consider how much effort will be required and what the short-term or long-term rewards might be. Number in priority order. Monitor: Monitor groups and answer any questions. Time: Allow 12 minutes for activity and 8 minutes for feedback. Feedback: Ask for volunteers to discuss which funding sources they have selected and why. Ask whether anyone is considering a funding source that they haven’t approached before? WHEELCHAIR SERVICE TRAINING PACKAG E 130 5. Planning a fundraising strategy (20 minutes) Explain: Once potential funding sources have been identified, service managers need to develop a strategy for what kind of support will be requested from which potential funding source, and for how much. Consider: • which funding sources to approach • what support to ask for • size of the request • likelihood of success • effort required. C.4.6 Planning for financial sustainability Planning a fundr aising strategy Explain: • To help plan a strategy, managers need to prioritize the different funding sources, and plan how they will approach securing funding. • Managers need to consider: ° funding source: who will be approached; ° support: what support the manager will ask from the funding source. Fundraising framework – an example: Request: How much will you ask the funding source to provide/support? Likelihood: What is the likelihood that the funding source will fund/support the request? This can be categorized as low, medium and high. Effort: What will be required to secure the funding, and what reporting or other obligations will there be? FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 131 Funding source Type of Support Request Likelihood Effort A table can help managers prioritize funding sources and plan a strategy. C.4.7 Planning for financial sustainability Fundraising fram ework Explain: • A table can help managers prioritize funding sources and plan a strategy. Consider: • Type of support: This may focus on a budget line for example products, or a service step (or steps), with a number of associated budget lines. Consider the specific funding source, and what they are most likely to want to support. • How much to request: Consider the size of previous donations to the service or others. Aim to ask for a realistic amount. • Effort: The amount of effort to secure funding should be in proportion to the amount of the funding. Obligations should also be affordable/manageable for the service. Activity Groups: Remain in same groups. Instructions: Read the examples in the table (Workbook Page 110). List the three funding sources from the previous exercise. Complete the table for the selected funding sources. Acknowledge that it may not be possible to complete all sections precisely but to go through the process and add as much information as possible. Monitor: Monitor the groups, and assist as needed. Time: Allow 15 minutes for the activity. Feedback: Ask for feedback on structuring fundraising using the strategy outlined in the table. Explain: It is important to create a budget forecast to inform fundraising efforts, linking work from earlier sessions on annual predicted caseload and budgeting. WHEELCHAIR SERVICE TRAINING PACKAG E 132 6. Summary of action points for managers (5 minutes) • Create a shared vision of financial sustainability. • Identify the funds and resources required. • Identify potential funding sources. • Prioritise funding sources to be targeted. • Develop a fund raising strategy and then act. C.4.8 Planning for financial sustainability Actions for man agers Read: the action points for managers. Work with wheelchair service staff and key stakeholders to: • create a shared vision of financial sustainability; • identify the funds and resources required; • identify potential funding sources; • prioritize funding sources to be targeted; • develop a fundraising strategy and act. Ask participants to refer to their workbook and record their own actions for planning for financial sustainability of the service. Putting it all together O B JE C T IV E S By the end of this session, participants will be able to: … Reflect on actions that managers can take to encourage stakeholders to improve wheelchair provision in the country. R E S O U R C E S For the session: … PPT slides: Closing session: Putting it all together; … video: Take home message; … evaluation forms (to be given out on previous day and collected during this session). C O N T E X T Adapt this session to suit the context participants will be working in. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 133 T O P R E PA R E … Read through the session plan and gather resources. … Ensure certificates have been printed and signed by trainers. … Review flip chart paper with change facilitators (put up at the beginning of the workshop). O U T L IN E 1. Introduction 2. Actions to lead change 3. Closing ceremony and presentation of certificates. 2 18 10 Total session time 30 1. Introduction (2 minutes) Explain: that in this final session the managers can take the lead in proposing actions to move forward improvement of wheelchair provision in the country. 2. Actions to lead change (18 minutes) Activity Groups: Whole group. Instructions: Refer to the flip chart paper “change facilitators” which were put up at the beginning of the workshop as a place to record shared actions that managers and stakeholders can take to improve appropriate wheelchair provision. Monitor: Encourage participants to add any ideas that they have not put down already (allow 5 minutes). Time: Allow 18 minutes in total. WHEELCHAIR SERVICE TRAINING PACKAG E 134 Feedback: Ask for a volunteer to lead on reviewing Communicate the importance of wheelchair provision with a sense of urgency and Create a shared vision. Ask: What will be the next steps? • Are you going to form a task force to initiate some of the actions proposed? • Who will take these actions further? • Are you going to meet again? When? Repeat for Align stakeholders and resources. Repeat for Motivate, engage and commit stakeholders. Record: Take notes of the next steps, with people responsible and dates on a flip chart. 3. Closing ceremony and presentation of certificates (10 minutes) 2. Closing session Overview Explain: • The logo represents a commitment to get people on the road – no more locked inside their houses or huts – increasing the participation and inclusion of people with disabilities: through provision of appropriate wheelchairs delivered through services by trained personnel. Encourage participants to use the logo. Ask managers to hand in their completed evaluation forms given out the previous day. Wheelchair service delivery 3. Closing session Video presentati on Introduce video: Take home message. Show video. FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E 135 Notes for trainers: • Trainers may choose how they wish to present certificates and close the training programme. Each participant can also be given a poster of the wheelchair service steps as part of this session if this was not provided earlier. WHEELCHAIR SERVICE TRAINING PACKAG E 136 References 1 Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). 2 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). 4 Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007) New York: United Nations; 2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5 Bragar Galer, Joan, Alison Ellis and Sylvia Vriesendorp. “Leading change for better health.” Chapter 6 in Managers Who Lead. Cambridge: Management Sciences for Health; 2005 6 Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006; 44: 523–529. 7 Razzak A, Helal SU, Nuri RP. Life Expectancy After Spinal Cord Injury in a Developing Country – A Retrospective Study At CRP, Bangladesh. Disability, CBR & Inclusive Development, 2011. Vol. 22. 2011. 8 World Health Organization, World Bank World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/report/en/). 9 Joint position paper on the provision of mobility devices in less resourced settings. Geneva: World Health Organization; 2013 (http://whqlibdoc.who.int/ publications/2011/9789241502887_eng.pdf?ua=1&ua=1). FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E

WHEELCHAIR SERVICE TRAINING PACKAGE For Managers For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int 978 92 4 154908 0 Trainer’s Manual

WHEELCHAIR SERVICE TRAINING PACKAGE For Stakeholders ISBN 978 92 4 154908 0 Trainer’s Manual

WHEELCHAIR SERVICE TRAINING PACKAGE Trainer’s Manual For Stakeholders ii Contributors: Editors: Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza Contributors: Udaya Adhikari, Sanjay Bantawa, Christine Cornick, Jennifer Howitt Browning, Richard Frost, Francesca Garton, Dhabaleswar Nanda, Lucie Pannell, Adarsh Shah, Natalie Snell, Shudarson Subedi, Purna Bhakta Tandukar, and Prakash Wagle Illustrator: Melissa Puust Photo credits: David Constantine, Chapal Khasnabis and Jesse Moss Video credits: Chapal Khasnabis, Amanda McBaine, and Jesse Moss Financial support: US Agency for International Development Partner organizations: BIKASH Nepal, Handicap International, Motivation Charitable Trust, National Federation of the Disabled–Nepal, and Spinal Injury Rehabilitation Centre–Nepal WHO Library Cataloguing-in-Publication Data. Wheelchair service training package for stakeholders/edited by Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza. Contents: Trainer’s Manual for Managers – Reference Manual and Workbook for Managers – Additional Resources for Managers – Trainer’s Manual for Stakeholders. 1. Wheelchairs – standards. 2. Disabled persons – rehabilitation. 3. Teaching materials. I. Frost, Sarah. II. Khasnabis, Chapal. III. Mines, Kylie. IV. de la Peza, Lourdes and V. World Health Organization. ISBN 978 92 4 154908 0 (NLM classification: WB 320) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Malta Design by Inís Communication – www.iniscommunication.com Content packaging by Bizgraphics (http://bizgraphic.ch/) iii Terminology The following terms used throughout the training package are defined below. Appropriate wheelchair A wheelchair that meets the user’s needs and environmental conditions; provides proper fit and postural support; is safe and durable; is available in the country; and can be obtained and maintained and services sustained in the country at the most economical and affordable price. Manual wheelchair A wheelchair that is propelled by the user or pushed by another person. Postural support device (PSD) A physical device that provides additional postural support. Wheelchair A device providing wheeled mobility and seating support for a person with difficulty in walking or moving around. Wheelchair modification A change made to a wheelchair. Wheelchair provision An overall term for wheelchair design, production, supply and service delivery. Wheelchair service That part of wheelchair provision concerned with ensuring that each user receives an appropriate wheelchair. Wheelchair service personnel Persons skilled in the provision of an appropriate wheelchair. Wheelchair user A person who has difficulty in walking or moving around and uses a wheelchair for mobility. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS iv C O N T EN T S 1 About the Wheelchair Service Training Package for Stakeholders 1 Introduction 2 Target audience 3 Purpose 3 Scope 3 Trainers 4 How to get started 5 1. Guidance notes for trainers 8 2. How to prepare for the Stakeholder Workshop 16 Detailed session plans 16 S.1: Introduction 19 S.2: Policy to practice 29 S.3: Range of appropriate wheelchairs 37 S.4: Working together for change 49 Annexes 49 Annex 1: Brief for government representative 51 Annex 2: Brief for wheelchair user representative 53 Annex 3: Some common quotes and statistics 54 Annex 4: The eight steps of wheelchair provision 56 Annex 5: Appropriate wheelchair provision benefits all 57 References 1About the Wheelchair Service Training Package for Stakeholders Introduction Following the release in 2008 of the Guidelines on the provision of manual wheelchairs in less resourced settings(1), in 2012 the first package within a range of Wheelchair Service Training Packages (WSTP) was released: the Wheelchair Service Training Package Basic Level (WSTPb)(2). This was followed in 2013 by the release of the Wheelchair Service Training Package – Intermediate Level (WSTPi)(3). The WSTPb and the WSTPi are intended to support the training of personnel fulfilling the clinical and technical roles in a wheelchair service; in order to increase the number of personnel trained in basic and intermediate level wheelchair service delivery. However, WHO recognises that in order for this training to be effective; and for personnel to have access to the facilities, equipment and materials required to provide appropriate wheelchairs – effective planning, policy and support mechanisms need to be in place. Hence, the World Health Organization (WHO) in partnership with the United States Agency for International Development (USAID) has now developed the third part of the WSTP consisting of two sub-packages: the Wheelchair Service Training Package for Managers (WSTPm) and the Wheelchair Service Training Package for Stakeholders (WSTPs). To establish a good wheelchair provision system in a country, all the related stakeholders including policy-makers, planners and implementers, manufacturers and suppliers of wheelchairs, providers of wheelchair services, disabled people’s organizations, and wheelchair users, need to be involved. However, it is important that they are well informed, and understand the need for, and the benefit of appropriate wheelchair provision. This Wheelchair Service Training Package for Stakeholders (WSTPs) is therefore aimed at increasing awareness and involving them to establish appropriate wheelchair provision in their country/region. This training package draws on the following key documents: The United Nations Convention on the Rights of Persons with Disabilities (CRPD)(4); the Guidelines on the provision of manual wheelchairs in less resourced settings; and the Joint position paper on the provision of mobility devices in less resourced settings(5). WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 2The wheelchair is one of the most commonly used assistive devices for enabling personal mobility. For people who have difficulty in walking or moving around, wheelchairs are essential tools for their mobility, empowerment, dignity and overall well-being. Mobility opens up the opportunities for wheelchair users to be independent and to access health care, education, work and employment, and also assists the wheelchair user to participate in social and cultural activities. However, WHO estimates that more than 70 million people need a wheelchair and only 5–15% have access to one. The importance of mobility is reflected in the CRPD, which advocates for “effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities”. To ensure effective personal mobility, wheelchair users need a wheelchair that fits correctly and meets their specific needs – especially lifestyle and environment. This requires an approach responsive to individual needs. An effective way of meeting the individual needs of wheelchair users is the provision of wheelchairs through a well organized wheelchair service delivery system that is responsive to the expectations of the users, respects their dignity and is delivered by well trained personnel. Trainers are encouraged to use this package to facilitate a standalone workshop focusing entirely on the need for and the benefit of developing an appropriate wheelchair provision system, or as an important element of a broader workshop addressing, for example, national rehabilitation or disability policy development/ review. Target audience The Stakeholder Workshop is intended for all kinds of personnel who could influence in developing or sustaining appropriate wheelchair provision. Stakeholders may include: • policy planners and implementers (for example, government); • influential/respected leaders or politicians; • disabled people’s organizations; • users, their families, and caregivers; • philanthropists/funders/donors; • media (both digital and print); • wheelchair manufacturers and suppliers; • professional groups (such as the National/Regional Association of Physiotherapists); WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 3• international and local non-governmental organizations; and • any other local individuals or organizations who have the potential to contribute. Purpose WHO realizes that trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is a higher level of involvement to establish or improve wheelchair provision within the country. The purpose of the training package is to create awareness and develop the skills and knowledge of all personnel required to be involved (stakeholders) in establishing appropriate wheelchair provision in their country/region. This package provides an overview of the stakeholder’s role, informing them about the need for and benefit of appropriate wheelchair provision and getting their support to develop an appropriate wheelchair provision programme. Scope The training package can be delivered in a minimum of 3–4 hours, although this period may be extended according to the specific needs and resources available. Delivery of this training package will help stakeholders to: • improve their understanding about the need for and benefit of an appropriate wheelchair; • be better informed about their role in developing appropriate wheelchair provision; • increase the quality of wheelchair service delivery; • attain better understanding of barrier-free environments; • gain more commitment to seek/provide appropriate budgetary support; and • increase the sustainability of the wheelchair provision. Trainers The WSTPs Trainer’s Manual is intended to be used by any organization or group of organizations intending to convene a WSTP Stakeholder Workshop. To ensure continuity with other WSTP packages, this training manual has been labelled as a Trainer’s Manual but considering the diversity of the participants attending a WSTPs workshop, trainers need to play the role of facilitators and follow the basic principles of adult learning. Good selection of the trainers/facilitators of the workshop is important for its success. It is recommended that they have: WHEELCHAIR SERVICE TRAINING PACKAG E 4• experience training and facilitating people at an appropriate level; • experience managing multi-stakeholder and multi-level audiences; • a strong conviction that introducing appropriate wheelchair provision is beneficial to wheelchair users; and • the ability to listen to and welcome different opinions, while at the same time ensuring the core principles of appropriate wheelchair provision are maintained and the purpose of the workshop is upheld. The workshop trainers/facilitators will be referred to as trainers throughout the remainder of this manual. It is recommended that there is one trainer for every 8–10 participants. Having an experienced wheelchair user, who knows the subject and training package well, can be an asset. Where more than one trainer is involved, it is recommended that sessions are split between the trainers to avoid one person leading too many consecutive sessions. How to get started Before carrying out the training programme, you must copy the relevant sections from the Pen Drive (inside the folder) to your hard drive. The simplest way to deliver the training programme is: 1. Open the Trainer’s Manual from the manual folder and 1.1. Read sections Guidance notes for trainers and How to prepare for the Stakeholder Workshop; 1.2. Print and bind one copy of the Trainer’s Manual for each trainer, if you do not have a hard copy; 1.3. Print a timetable. 2. Make all the necessary arrangements, as suggested in the section How to prepare for the Stakeholder Workshop. 3. Give each participant one poster of the wheelchair service steps. If you do not have these in stock, they can be printed from the Pen Drive. 4. Open the timetable and click the hyperlinks of each session, which will take you to the exact slides and video location. The best way to deliver the training is to proceed through the lessons in sequential order, following the time allotted for each session as closely as possible. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 51. Guidance notes for trainers 1.1 Workshop overview Session Minutes S.1. Introduction including keynote address 30 S.2. Policy to practice 45 S.3. Range of appropriate wheelchairs 30 Break 30 S.4. Working together for change 100 Closing address 5 Total 240 1.2 Workshop timetable and duration The Stakeholder Workshop is outlined here as a half day workshop. It will be beneficial to allocate more time if possible, particularly in a situation where organizers hope to reach agreement from stakeholders on specific plans or actions. The Stakeholder Workshop may be delivered as one half day session within a broader conference/workshop; or immediately before or after delivery of the WSTP Managers module. A sample timetable for a morning half day workshop is provided below: Time Topic Presenter 08:30 – 09:00     Registration 09:00 – 09:30     Introduction including keynote address Head of the host organization Guest speakers Representative/s from government and others User or leader of disabled people’s organization/s 09:30 – 10:15 Policy to practice Trainer 10:15 – 10:45 Break WHEELCHAIR SERVICE TRAINING PACKAG E 610:45 – 11:15 Range of appropriate wheelchairs Trainer 11:15 – 12.55 Working together for change Trainer 12.55 – 13:00 Closing address Trainer 13:00 – 14:00 Lunch Note: the timing will vary according to the number of guest speakers. 1.3 Session plans For each of the sessions there is a detailed session plan to guide trainers in delivery. At the beginning of each session plan is the following information: • Objectives: detailing what that particular session is designed to achieve for participants; • Resources: what resources are needed for the session; • Context: how the session may need to be adapted for different contexts (or situations); • To prepare: how to prepare for the session; • Outline: an outline for the main parts of the session. The rest of the session plan is divided into topics. For each topic, the session plan provides instructions on how to present or facilitate the information for that topic. 1.4 PowerPoint presentations PowerPoint presentations (PPT) are provided for the sessions: • Introduction • Policy to practice • Range of appropriate wheelchairs • Working together for change. 1.5 Good practice training tips Below are some tips for trainers to help make the workshop a success: • keep discussions focussed on the session’s topic; • be an active listener–you will need to truly hear and understand what people say in order to guide the discussion effectively; • listening carefully will set a good example for participants; WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 7• stimulate and moderate discussions; • do not allow an aggressive, talkative person or group to dominate; • stay neutral and be cautious about expressing your own values; • use conflict of opinion productively and don’t allow participants to personalize their disagreements. WHEELCHAIR SERVICE TRAINING PACKAG E 82. How to prepare for the Stakeholder Workshop 2.1 Know the current situation for wheelchair provision Organizations and trainers organizing a WSTP Stakeholder Workshop need a thorough understanding of wheelchair provision in the country, region, district or Sub-district. This includes: • clearly identifying the different stakeholder organizations and key individuals; • being aware of any existing wheelchair provision activities or initiatives; • understanding current gaps in wheelchair provision; and • knowledge of relevant regional/national laws, strategies, policies and action plans. The checklist below can be used to summarise the national legal framework, such as the CRPD, national strategies, action plans, and laws(6). WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 9This information will be used to create a legal framework handout to support Session 2: Policy to practice. Legal framework Aspect to check Checklist CRPD Have the CRPD and its Optional Protocol been signed?  Have the CRPD and its Optional Protocol been ratified?  Strategies Does the country have a strategy or a national action plan in the poverty-reduction field?  Does the country have a strategy or national action plan on disability issues? (For example, “strategy for promoting and protecting the rights of persons with disabilities”).  Laws, decrees If they exist, are these strategies in the disability sector accompanied by specific legislative documents (such as laws, implementation orders)?  Sector-based strategies Does the country have a strategy or specific national action plan in the following sectors: • social services • education • inclusive education • employment • employment of people with disabilities • health • mental health • gender equality • ethnic minorities • children • elderly • social welfare in general • assistive technologies • other significant sector/s for access to quality services for persons with disabilities  Local strategies Does the practice of community planning exist in the respective country? Is the planning process (in the field of disability and social services) centralized or decentralized? Up to which level of decentralization? Do community disability action plans (or similar) exist?  WHEELCHAIR SERVICE TRAINING PACKAG E 10 The significance of signing and ratifying the CRPD Signing the CRPD is a first step in government support of appropriate wheelchair provision: • signing the CRPD indicates the government’s moral intention to be bound by the Convention; • ratifying the CRPD indicates the government’s moral and legal obligation to implement the Convention. 2.2 Review each session plan and adjust if necessary Review each session plan and identify who will facilitate each session. The sessions may need to be adjusted to suit the local context. Suggestions for adjusting sessions to different contexts are provided at the beginning of each session plan under the heading “context”. 2.3 Identify and prepare guest speakers The overall purpose of the Stakeholder Workshop is to create awareness of the importance of appropriate wheelchair provision and the difference it can make to the lives of wheelchair users. Strong presentations by relevant keynote speakers are an important part of the strategy to ensure that this message is well represented; and should be as relevant as possible to the context in which the Stakeholder Workshop is being held. It is recommended to invite speakers representing the government and disability sectors (see Session 1). 1. Government representative/s: to represent government recognition and support of the right to mobility and the importance of wheelchair provision. In some countries, more than one ministry has responsibilities relating to wheelchair provision. 2. Representative/s of the disability sector Wheelchair user representative: A person who has the lived experience of using a wheelchair and is willing to share their personal experience of how appropriate wheelchair provision has had a positive impact on their life. Such a presentation will highlight the importance of personal mobility with the greatest possible independence. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 11 Respected leader in the disability sector: Keynote speaker who is well respected in the field, with the authority of their position, experience and leadership. Their role is to clearly present the message and to generate a sense of urgency and enthusiasm for change among the stakeholders. Note: It is possible that one person may be able to fulfil the role of two of the above. The trainer/s needs to identify and prepare the most appropriate speakers well in advance. A brief for the speakers is included in the Annexes. Some discussion between the trainer and the speakers is likely to be needed to refine the presentation to ensure that it will be appropriate to the context and current situation for wheelchair provision; and that it suits the speakers own style. Prior to the workshop – check with the speakers whether they wish to use a PPT. If so, request that they provide the PPT no later than the day before. If this is not possible, ensure that the speakers arrive before the workshop starts, and have someone ready to load their PPT onto the workshop computer. 2.4 Invite participants It is important to ensure that all relevant stakeholders are invited. Consult widely to make sure that no key organizations or individuals are missed. Think carefully about stakeholders whose voices need to be heard; stakeholders who have the potential to influence change; and stakeholders with the energy and commitment to act to create change. Sending invitations well in advance will help to ensure that people are able to attend. Ensure that the invitations clearly indicate the purpose of the workshop, and why it is important that stakeholders attend. Number of participants: The number of participants will vary, depending on the number of stakeholders in the country, region, district or sub-district. Represent all groups: The trainer should closely review the participant register list in order to represent all groups and organizations during the opening session of the workshop. 2.5 Plan the venue and room layout Venue: The venue should also be booked well in advance. Ideally, the venue should provide an appropriate sized room for the number of participants and an area for the break. The venue must be wheelchair accessible throughout. This WHEELCHAIR SERVICE TRAINING PACKAG E 12 includes access into: the building; the room in which the workshop will be held; the area for refreshments; and the toilets. Setting up the room: Trainers should plan carefully how the room is set up. The Stakeholder Workshop includes plenary and group work sessions. Therefore, the layout should facilitate easy transition between plenary and group work. The layout will depend on the number of participants. Some suggestions have been given below: Room layout for groups of up to 30 people The best room layout is setting up round tables in a semicircle, or rectangular tables like a fishbone, as shown below. This allows the group to be simultaneously organized into subgroups by table for discussion and in plenary to listen to presentations or sharing in plenaries. Option 1: Round tables in a semicircle WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 13 Option 2: Oblong tables in a fishbone Room layout for larger groups (50 or more) WHEELCHAIR SERVICE TRAINING PACKAG E 14 For bigger groups and smaller rooms, participants can be seated in rows like in an auditorium but with mobile chairs, so people in the first row can turn their chairs around to make a group with people in the second row as shown above. This allows the group to shift between plenary and small group work quickly. 2.6 Prepare resources and equipment Resource Quantity  Comment/instructions Trainer’s Manual 1 per trainer  Order from WHO or print and bind Service steps poster 1 per participant  Order from WHO or print Supplementary resources: references for trainer/s. Also decide how to share these with participants according to resources available. For example on a USB stick/Pen Drive; via an internet based sharing facility; or by providing website references. Guidelines on the provision of manual wheelchairs in less resourced settings At least 1 sample copy  United Nations Convention on the Rights of Persons with Disabilities (CRPD) At least 1 sample copy  Joint position paper on provision of assistive devices in less resourced settings At least 1 sample copy  CBR Guidelines Introductory booklet and Health component At least 1 sample copy  WSTP logo 1 high resolution sample  For participants to use to show their commitment to appropriate wheelchair provision Forms: Participants register form 1 per workshop  Sample available on Pen Drive Name tags 1 per participant/ speaker/trainer  Produce locally and use WSTP logo Timetable 1 per participant  Sample available on Pen Drive Photo consent form 1 per participant  Adapt the sample form on the Pen Drive for the host organisation Attendance certificate 1 per participant  Prepare participant attendance certificate or adapt the template provided on Pen Drive WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 15 Posters – awareness-raising posters to be put up in workshop venue: WSTP basic: wheelchair service steps; wheelchair mobility skills; pressure sores; and how to care for a wheelchair at home. 4  Order from WHO or translate (if necessary) and print Available on Pen DriveWSTP intermediate: children and wheelchairs; different positions; postural support device (PSD) table; and intermediate wheelchair user training checklist. 4  Videos – with English subtitles: What an appropriate wheelchair means to me S.2.  Available on Pen Drive. Consider editing subtitles to local languageWheelchair service delivery S.2.  Benefits of extra support–Chaeli S.3.  Benefits of an appropriate wheelchair S.3.  Equipment Item Quantity Comment/instructions Data projector 1  Computer 1  Speakers 1 set  To assist in hearing the Videos Microphones 2 or more, depending on participant numbers  A microphone for the trainer and speakers; and a “roving” microphone/s for participants asking questions or for gaining feedback from small groups Large whiteboard 1  Whiteboard marker pens 3–4  Flip chart stand and paper 1 stand and 1 pack of paper  Flip chart pens 3-4  Masking tape or similar 1 roll  To attach flip chart sheets and posters to walls Note: For groups of less than 20 people, feedback from small groups to the plenary can be written on flip chart paper. However, for larger groups – feedback may be typed into a PowerPoint slide and projected as small groups give feedback. WHEELCHAIR SERVICE TRAINING PACKAG E 16 Detailed session plans S.1: Introduction O B JE C T IV E S By the end of this session, participants will be able to:  have a better understanding of the current situation/policy of wheelchair provision in the country and a way forward for further improvement and sustainability. R E S O U R C E S For the session:  PPT: S.1: Welcome and keynote address C O N T E X T Adapt this session to suit the context participants will be working in. Think about:  whether an opening ceremony should be included appropriate to the culture and context;  what start time is appropriate for guest speakers and participants. T O P R E PA R E  Invite guest speakers well in advance.  Meet guest speakers well in advance to support preparation of presentations (refer to brief for speakers in Annexes).  Insert name/s of workshop speakers on first slide  Check uploaded presentations for guest speakers (if applicable).  Upload relevant image on slide in PPT for guest wheelchair user representative.  Review the participant register in order to acknowledge all the different stakeholder groups/organizations participating during the welcome address.  Review number of speakers and timing of their presentations prior to finalising the timetable. O U T L IN E 1. Introduction 2. Guest speakers 3. Keynote address - wheelchair user/representative 4. Questions and answers. 5 10 10 5 Total session time 30 WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 17 1. Introduction (5 minutes) WHEELCHAIR SERvICE TRAnI ng PACkAgE For stakeholders Introduction Introductions: Guest speakers and trainer/s: Host to welcome all participants and introduce dignitaries and trainer/s. Participants: The introduction of participants (name and organization that they represent) will vary according to the size of the group and as per local culture and customs. For larger groups, it is not practical for every participant to introduce themselves. It is however, helpful to introduce the range of stakeholders present and encourage them to talk to each other during the breaks. 2. Guest speakers (10 minutes) 2. Introduction • Host organisation to add speakers name/s guest Speakers Introduce: Invite the first guest speaker and request him/her to describe the current state of wheelchair provision in the country. Introduce: Invite the second guest speaker, preferably a government representative, to talk about what the government is doing to address the needs of wheelchair users in the country. 3. Keynote address – wheelchair user/representative (10 minutes) Introduce: Keynote speaker to share his/ her experience of living as a wheelchair user and what he/she thinks is the way forward for wheelchair provision in the country. WHEELCHAIR SERVICE TRAINING PACKAG E 18 4. Questions and answers (5 minutes) Explain: • There are five minutes available for questions for guest speakers. Invite questions from the audience to the speakers. Monitor time closely. Explain: • There will be further opportunities for questions during the workshop. Participants are also encouraged to make the most of breaks for exchanging questions and information. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 19 S.2: Policy to practice O B JE C T IV E S By the end of this session, participants will be able to:  create a sense of urgency about the importance of appropriate wheelchair provision;  highlight the needs of wheelchair users in the country and the benefits to all when wheelchair users are as mobile and as independent as possible;  advocate for national policies and standards and awareness of disability rights; in order for users to access quality wheelchairs through a service. R E S O U R C E S For the session:  legal framework handout – one for each participant, plus one additional copy per group for the activity;  sample copy of Wheelchair Guidelines; CBR Guidelines Introductory booklet and Health component; Joint position paper on provision of assistive devices in less resourced settings;  PPT: S.2: Policy to practice;  video: What an appropriate wheelchair means to me;  video: Wheelchair service delivery. C O N T E X T Adapt this session to suit the context. Think about:  the most relevant case studies for the context;  the key messages you want to communicate. T O P R E PA R E  Plan grouping according to the number of participants – see notes in How to prepare for the stakeholder workshop on planning the venue and room layout.  Research information required to complete the summary of official policies in section 2.1 and prepare and translate a legal framework handout in advance. O U T L IN E 1. Introduction 2. What is the need and unmet need? 3. Importance of wheelchair provision 4. Importance of government support 5. Everyone has rights 6. Policy reaches the individual through services 7. Make rights real with a national plan 8. Benefits for all 9. Key point summary 2 3 3 5 5 5 17 3 2 Total session time 45 WHEELCHAIR SERVICE TRAINING PACKAG E 20 1. Introduction (2 minutes) For stakeholders 2. Policy to practice WHEELCHAIR SERvICE TRAnI ng PACkAgE Start with the aim of the workshop. Highlight: It is important that we work together to achieve a shared vision for wheelchair provision in our country. An appropriate wheelchair is an essential step to participation in social life, work and education. Personal mobility is a right that can be met by receiving an appropriate wheelchair delivered through a service by trained personnel. Housekeeping Ask participants to refer to their copy of the workshop timetable. Highlight the start and finish times and breaks. Explain the general housekeeping: • location of toilets • refreshments • who to talk to about travel logistics (if required) • what to do in the event of an emergency. Explain expectations: • turn off mobile phones during the sessions • sharing your thoughts and opinions is encouraged. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 21 2. What is the need and unmet need? (3 minutes) Ask: Do you know how many people in our country need wheelchairs? Acknowledge answers. Population People who need a wheelchair WHO 7 000 000 000 70 000 000 Insert country Insert country population Insert 1% of country population 2.2 Policy to practice What is the need in our country? Explain: • WHO estimates that 1% of any population need a wheelchair. • The population of this country is X (insert population from census. Calculate 1% of the census population of the country)(7). • WHO estimates that more than 70 million people (1% of any population) need a wheelchair but only 5–15% have access to one. (WHO factsheet on disability) • There is a need for urgent action to improve access to high quality affordable wheelchairs. 2.3 Policy to practice Unmet need for services Explain: • The need and unmet need. Ask: • What percentage of the population in need can access a wheelchair within the country? Acknowledge answers. 3. Importance of wheelchair provision (3 minutes) Introduce video: What an appropriate wheelchair means to me. In this video, experienced wheelchair user Faustina explains the difference it made to her life when she received a wheelchair through a service. What an appropriate wheelchair means to me 2.4 Policy to practice video presentati on Show video. WHEELCHAIR SERVICE TRAINING PACKAG E 22 Highlight: An appropriate wheelchair provided through a service gave Faustina: Dignity: because she no longer falls out of her wheelchair on rough roads. Independence: because she is now able to push safely and independently on rough roads and slopes near her home and work. Confidence: because she feels less disabled. Increased self-esteem: because she feels better about herself because the wheelchair is personal to her. Introduce Shobha from India’s story, which demonstrates the impact of an appropriate wheelchair on Shobha and her community. Explain: This story highlights the importance of receiving an appropriate wheelchair through a service as a first step to inclusion and participation in society. Shobha lives in a village in Herepalya, Karnataka State, India. Shobha contracted polio when she was less than a year old, and had to crawl around her home and local village in order to get around. This continued for many years until Shobha was assessed by the rural wheelchair service team of the Association of People with Disability (APD) and prescribed an appropriate wheelchair. With her wheelchair, Shobha can now move about her home and community independently. As well as positively affecting Shobha’s mobility, her wheelchair has increased her economic independence. APD provided Shobha with the opportunity to participate in a tailoring vocational training programme and she now runs her own tailoring service from her home. With an appropriate wheelchair, she can now travel easily and safely around her village and further afield to visit her customers and deliver orders. Shobha is keen to continue expanding her own tailoring enterprise and live independently. 4. Importance of government support (5 minutes) Explain: We need to create a strong and urgent message, which makes the government feel compelled to act. 2.5 Policy to practice Call to action Explain: • We will hear a story from Kenya on government policy on the provision of assistive devices. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 23 Read how government support of appropriate wheelchair provision has developed in Kenya The first legislation supporting people with disabilities in Kenya was passed after then- president Mwai Kabaki was involved in a road accident after which he had to use a wheelchair for about seven months. The first act he passed after returning to his duties as president was the Persons with Disabilities Act No. 14 of 2003, which established The National Council for Persons with Disabilities as a state corporation in November 2004. Why was this the first Act passed? Because he realised how difficult life could be without mobility. At that time, he was campaigning for an upcoming election and it was not possible to continue without the wheelchair. He personally felt the need for personal mobility and accessibility. When he won the election, on the basis of the new law, he started making assistive devices available and government buildings accessible. 5. Everyone has rights (5 minutes) Development and human rights for all (http://www.un.org/disabilities/) • UN Convention on the Rights of Persons with Disabilities (CRPD) • The focus of the CRPD is to make sure that everybody recognizes that these are rights for all; including people with a disability. 2.6 Policy to practice Human rights ap ply to everybody Explain: • Everyone has the same rights. • The UN Convention on the Rights of Persons with Disabilities (CRPD) clarifies and qualifies how all categories of rights apply to persons with disabilities and identifies areas in which adaptations have to be made for persons with disabilities to effectively exercise their rights. Explain: There are a number of articles in the CRPD that reinforce the importance and relevance of appropriate wheelchair provision. Ask: Does anyone know which article of the CRPD specifically refers to mobility? Acknowledge answers. WHEELCHAIR SERVICE TRAINING PACKAG E 24 • Article 20 of the CRPD says: ⎯ All people have a right to personal mobility. • Personal mobility means: ⎯ The ability to move in a manner and at the time of one’s own choice. 2.7 Policy to practice What does ‘pers onal mobility’ m ean? Explain: Article 20 of the CRDP says: • All people have a right to personal mobility. Personal mobility means: • The ability to move in a manner and at a time of one’s own choice. Appropriate wheelchairs + Inclusive services = Effective wheelchair provision Article 26 • Habilitation and Rehabilitation States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation. 2.8 Policy to practice Mobility is part o f rehabilitation Explain: • Article 26 talks about the importance of rehabilitation and habilitation. • Personal mobility is an essential part of rehabilitation. Notes for trainers: • Rehabilitation – restoring abilities to participate in society; • Habilitation – building abilities for the first time. Appropriate wheelchairs + Inclusive services = Effective wheelchair provision Article 19: Living independently and being included in the community. Article 24: Education. Article 25: Health. Article 27: Work and employment. Article 30: Participation in cultural life, recreation, leisure and sport. Mobility is the first step to accessing other rights: 2.9 Policy to practice Mobility gives ac cess to other rig hts Explain: Mobility is also the first step in creating access to other rights: • Article 19 – Living independently and being included in the community. • Article 24 – Education. • Article 25 – Health. • Article 27 – Work and employment. • Article 30 – Participation in cultural life, recreation, leisure and sport. Appropriate wheelchairs + Inclusive services = Effective wheelchair provision 2.10 Policy to practice First step to incl usion Explain: • In brief, mobility is the first step to inclusion or for any next steps. • However, one needs to have an appropriate wheelchair. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 25 6. Policy reaches the individual through services (5 minutes) To ensure the optimal match between the users and the products, wheelchairs need to be delivered by appropriately trained personnel following eight steps. 2.11 Policy to practice The importance of trained perso nnel Explain: • It is through a proper wheelchair provision system that individual needs are met. • Importance of training of service providers and eight steps of wheelchair service. • Essential for individuals to be as independent as possible. • Major role in environmental adaptation, repair and maintenance of their wheelchair. • A permanent wheelchair user requires lifelong access to wheelchair services. 2.12 Policy to practice The importance of training users Explain: • Training of users is equally important, especially to make optimum use of the wheelchair in their own environment and also in repair and maintenance. • A permanent wheelchair user requires lifelong access to services. Wheelchair service delivery 2.13 Policy to practice video presentati on Introduce video: Wheelchair service delivery Explain: • The Wheelchair Guidelines define eight key service steps. These eight steps are taught on WSTPb and WSTPi. The video describes an approach to wheelchair provision, which supports the Wheelchair Guidelines. Show the video. WHEELCHAIR SERVICE TRAINING PACKAG E 26 7. Make rights real with a national plan (17 minutes) Explain: We have been using the term wheelchair provision. Ask: What does this term actually mean according to the Wheelchair Guidelines? Encourage answers. • Follow the Wheelchair Guidelines. • Develop a service delivery system and training programmes as outlined in the Guidelines and WSTP. 2.14 Policy to practice Where to start? Explain: The Guidelines on the provision of manual wheelchairs in less resourced settings make recommendations on: • design • production • supply and • service delivery. The wheelchair service training packages (WSTP) provide the necessary knowledge and skills to establish appropriate wheelchair provision. Explain: For wheelchair provision to be effective and sustainable, it is necessary to be supported by policy and planning. The Wheelchair Guidelines are a tool to develop policy and implement the CRPD. Introduce the group activity. Explain: We are going to work in groups to review a handout of government support for people with disabilities. This will summarise the support from government now: Activity Groups: Divide participants into four groups. Allow up to 10 participants per group – and create additional groups if necessary. Instructions: Ask participants to refer to their copy of the legal framework handout. Request one volunteer per group to record any comments or corrections from the group. Give an additional handout to each group leader. Monitor: Monitor the groups, and assist as needed. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 27 Activity Time: Allow 5 minutes to review the handout and 10 minutes for feedback. Allow more time for feedback if more than four groups are giving feedback. Feedback: Request feedback from each group in turn. Note any comments on flip chart paper. For large groups, it may be necessary to write on a slide in PPT so that everyone can read the comments. 8. Benefits for all (3 minutes) Explain: When a person receives an appropriate wheelchair through a service, opportunities for social life, work and education open up. • Assistive technologies, when appropriate to the user and the user’s environment, have a significant impact on the level of participation which people with disabilities are able to achieve. • Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers. 2.15 Policy to practice Benefits for all Explain: • Studies have shown that assistive technologies, when appropriate to the user and the user’s environment, have a significant impact on the level of participation which people with disabilities are able to achieve(8). • Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers(9). Introduce the story of Saraswathi from India, which demonstrates the impact of an appropriate wheelchair on an individual and her family Saraswathi was born in 1985 and at the age of 4 contracted polio, which paralysed both her legs. Unable to walk, despite the use of calipers and regular therapy, Saraswathi became completely dependent on her family, who live in a very small village in Karnataka State. As a young adult, Saraswathi came into contact with the wheelchair service provider in the region, the Association for People with Disability (APD). This organization assessed her needs and prescribed her an appropriate wheelchair. After receiving it and learning new mobility skills through APD, Saraswathi was then able to establish a small shop selling general provisions. This employment earns her enough money to be the main financial support for her entire family of six. With greater independence and mobility, she has also been able to develop a much wanted social life within her community. WHEELCHAIR SERVICE TRAINING PACKAG E 28 9. Key point summary (2 minutes) Summarise: Wheelchair provision is about enabling people with disabilities to become mobile, remain healthy, and participate fully in community life. • The United Nations Convention on the Rights of Persons with Disabilities (CRPD) says: All people have a right to personal mobility (Article 20). • Personal mobility is possible when people receive an appropriate wheelchair through a service that they can access and which meets their needs. • The Wheelchair Guidelines is a good tool to realize Article 20 of the CRPD. 2.16 Policy to practice key point summ ary Read the key points: • The UN Convention on the Rights of Persons with Disabilities (CRPD) says: All people have the right to personal mobility. • Personal mobility is possible when people receive an appropriate wheelchair through a service that they can reach. • To better ensure implementation of Article 20, stakeholders can refer to the Wheelchair Guidelines and Chapter 7 of the Joint position paper on provision of assistive devices in less resourced settings. Summarise: We cannot afford not to support appropriate wheelchair provision in our country. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 29 S.3: Range of appropriate wheelchairs O B JE C T IV E S By the end of this session, participants will be able to:  Explain what makes a wheelchair appropriate and the need for a range of different types of wheelchairs. R E S O U R C E S For the session:  PPT: S.3: Range of appropriate wheelchairs;  video: Benefits of extra support – Chaeli;  video: Benefits of an appropriate wheelchair. C O N T E X T Adapt this session to suit the context participants will be working in. Think about:  the range of products locally available;  how such products perform in different environments. T O P R E PA R E  Gather resources and read through the session plan.  Read Chapter 6 and 7 of the Joint position paper on the provision of mobility devices in less resourced settings. O U T L IN E 1. Introduction 2. Importance of an appropriate wheelchair and cushion 3. Providing proper fit and postural support 4. Meeting the user’s needs and environment 5. Importance of a safe and durable product 6. Principles of providing appropriate wheelchairs 7. Key point summary. 2 7 5 5 5 4 2 Total session time 30 WHEELCHAIR SERVICE TRAINING PACKAG E 30 1. Introduction (2 minutes) Explain: In this session we will look at the importance of having access to a range of appropriate wheelchairs. 2. What is an appropriate wheelchair and cushion (7 minutes) Explain: The Wheelchair Guidelines define what is an appropriate wheelchair. An appropriate wheelchair (fit for purpose): – meets the user’s needs; – meets the user’s environment; – right match for the user (size and support); – safe and durable; – can be maintained and repaired locally. 3.2 Range of appropriate wheelchairs What is an appro priate wheelchai r? Read the definition of an appropriate wheelchair. An appropriate wheelchair: • meets the user’s needs; • meets the user’s environment; • is the right match for the user (size and support) to sit upright; • is safe and durable; • can be maintained and repaired locally. Explain: Every wheelchair user needs a cushion. • Every wheelchair user should use a cushion. • The type of cushion best suited to the user will depend on their needs. • Any person at risk of developing a pressure sore needs a pressure relief cushion. 3.3 Range of appropriate wheelchairs need for cushion s Explain: • The type of cushion best suited to the user will depend on their needs. For this reason, wheelchair services need to have at least a small range of cushions available. • Every wheelchair user should use a cushion. • Any person at risk of developing a pressure sore needs a pressure relief cushion. Explain: Comparatively, there is a higher cost to not having the right cushion and teaching people how to use it; for example, treating pressure sores, which can take months or years to heal. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 31 • Average life expectancy in well resourced countries is approximately 38 years for people injured between the ages of 25-34. • Data from a Bangladesh study suggests the median life expectancy following spinal cord injury is 5.36 years. • 80% of the people within the study died at home, and of those who died at home, one-third had pressure sores at the time of death. 3.4 Range of appropriate wheelchairs Reduced life exp ectancy Explain: • The average (median) life expectancy in well resourced countries is approximately 38 years post injury for people injured between the ages of 25-34 years(10). • In contrast, a study carried out in Bangladesh found the median life expectancy following spinal cord injury to be 5.36 years, with 56.4% of people dying within five years of their injury(11). • 80% of the people within the study died at home, and of those who died at home, one-third had pressure sores at the time of death. In 1999, a hospital cost survey in Sri Lanka showed: • a superficial pressure sore taking 6 weeks to heal @ US$ 286 and • deep pressure sore taking one year to heal @US$ 2483. Introduction of the right equipment and patient education reduced incidence of pressure sores during hospital stay by 70% and expenditure on dressings by nearly 60%. 3.5 Range of appropriate wheelchairs Cost of pressure sores Explain: • In a rehabilitation hospital in Sri Lanka, a hospital cost survey was carried out on the spinal injuries unit in 1999. At that time, it took an estimated six weeks to heal a superficial pressure sore at a cost of US$ 286. A deep pressure sore requiring one year to heal cost an estimated US$ 2483. • Within one year of introducing a focus on education; low-cost pressure relieving cushions and pressure relieving mattresses within the hospital, the incidence of pressure sores developed in hospital reduced by 70% and expenditure on dressings reduced by just under 60%. • According to the WHO World Report on Disability(12), a hospital programme in Sao Paulo, Brazil introduced a service with a focus on education to reduce secondary complications for people with spinal cord injury and this helped to reduce the incidence of pressure sores by 23%. Explain: Having access to an appropriate cushion with education on how to use it is an important part of preventing health complications and even premature death. WHEELCHAIR SERVICE TRAINING PACKAG E 32 3. Providing proper fit and postural support (5 minutes) Explain: To provide proper fit a size range is required; including an option for children. 3.6 Range of appropriate wheelchairs Importance of p roper fit Click to bring up one image at a time. Ask: What do you see here? Suggest: • Child in adult shoes. • Wrong size, too big. • Child unable to run around and do what he/she needs to do. Click on next image of well-fitting shoes. Explain: The child now has the right type of shoes, which fit correctly, enabling the child to run around and play. Click: on image of child in wheelchair. Ask: What do you see here? Suggest: • Child in adults chair, wrong size. • Difficulty moving around and playing. Click on final image. Explain: With the right type and size of wheelchair, a child has the maximum opportunity to do what they need to do. Explain: People have different postural support needs and therefore require wheelchairs with different types of support. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 33 Introduce video: Benefits of extra support – Chaeli Benefits of extra support - Chaeli campaign 3.7 Range of appropriate wheelchairs video presentati on Ask: participants to listen to Chaeli describing how extra support from a young age has helped her. Show video. 4. Meeting the user’s needs and environment (5 minutes) Introduce video: Benefits of an appropriate wheelchair. Benefits of an appropriate wheelchair 3.8 Range of appropriate wheelchairs video presentati on Ask: participants to observe how the different wheelchairs help people in the video carry out their work or activities. Show video. Explain: The video highlights that different wheelchairs are suited to different environments. When people receive a product that does not work well in their environment – the wheelchairs are often discarded. 3.9 Range of appropriate wheelchairs Abandoned prod ucts Explain: • In this image, there are three wheelchairs. The first two have been abandoned because they need repair and there are no spare parts available. • The third has been donated and is new; however, it feels wobbly and unstable when used outside and the person who received it feels unsafe. • This person has three wheelchairs but none of them provides an appropriate solution for his needs. WHEELCHAIR SERVICE TRAINING PACKAG E 34 5. Importance of a safe and durable product (5 minutes) Explain: We have discussed the importance of the product matching the person and their environment. Now we will consider factors that influence the safety and durability of products. Ask: What happens when a wheelchair is not durable? • Products which are not durable have to be replaced more often than durable products. • A cheap and inappropriate product may break down after a few weeks or months and require replacing – it also can cause injury to the user. • An appropriate product can last 3–5 years and provide better value for money in the long run. 3.10 Range of appropriate wheelchairs Cost of poor dur ability Explain: • Products that are not durable have to be replaced more often than durable products. • An inappropriate product may break down after 1-6 months and require replacing. An appropriate product can last 3–5 years (6–10 times longer) and provide better value for money. 3.11 Range of appropriate wheelchairs Cost of not cons idering environm ent Click through the pictures and Explain: • These examples of piles of discarded wheelchairs that cannot be repaired are found in many countries around the world. 3.12 Range of appropriate wheelchairs Cost of not cons idering environm ent • They either remain within storerooms/ gymnasiums or outside along with other broken or discarded equipment or hospital waste. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 35 When procuring or receiving donated products ensure that: • the range of products are suitable for the environments in which they will be used; • products are durable when used in rough and harsh environments; • the available products can be repaired locally. 3.13 Range of appropriate wheelchairs Appropriate pro duct supply Explain: When procuring or receiving donated products ensure that: • the range of products are suitable for the environments in which they will be used; • products are durable when used in rough and harsh environments; • the available products can be repaired locally. 3.14 Range of appropriate wheelchairs Maintenance, rep airs and follow-u p Explain: • Step eight of the eight wheelchair service steps is maintenance, repairs and follow-up. • All users and their family members should be taught simple maintenance and repairs to prolong the life of their product. 6. Principles of providing appropriate wheelchairs (4 minutes) No single product can meet the needs of all users. Therefore, a range of wheelchairs is required. Explain: In order for countries to meet their obligations related to assistive technology (mobility devices), outlined in the CRPD the following key principles need to be considered(13). WHEELCHAIR SERVICE TRAINING PACKAG E 36 Principles of developing provision system for appropriate wheelchairs: 1. Acceptability – users must be involved in all stages of wheelchair provision. 2. Accessibility – wheelchairs and related services must be accessible to everyone with an identified need. 3. Adaptability – wheelchairs and related services need to be adapted and modified to ensure they are appropriate to the needs of the individual. 3.15 Range of appropriate wheelchairs Some key factor s – 5A/Q 4. Affordability – wheelchairs and associated services must be affordable. 5. Availability – facilities, personnel and products must be sufficient for the needs of the population and provided as close as possible to the people’s own communities. 6. Quality – Products, facilities and services are of an appropriate quality. 3.16 Range of appropriate wheelchairs Some key factor s – 5A/Q Read the list slowly. 1. Acceptability – People with disabilities must be involved in all stages of mobility device provision. 2. Accessibility – Mobility devices and related services must be accessible to everyone with an identified need. 3. Adaptability – Mobility devices and related services need to be adapted and modified to ensure they are appropriate to the needs of the individual. 4. Affordability – Mobility devices and associ- ated services must be affordable. 5. Availability – Facilities, personnel and prod- ucts must be sufficient for the needs of the population and provided as close as possible to the people’s own communities. 6. Quality – Products, facilities and services are of an appropriate quality. 7. Key point summary (2 minutes) • There is no one wheelchair type that will meet the needs of every wheelchair user. • Wheelchair users need a wheelchair that meets their needs, suits their environment and is safe and durable. 3.17 Range of appropriate wheelchairs key point summ ary Explain: • There is no one wheelchair type that will meet the needs of every wheelchair user. • Wheelchair users need a wheelchair that meets their needs, suits their environment and is safe and durable. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 37 S.4: Working together for change O B JE C T IV E S By the end of this session, participants will be able to:  explain the role stakeholders should play in facilitating the introduction or improvement of adequate wheelchair provision;  propose strategies to help the change process: create a sense of urgency, form a powerful partnership, communicate the vision of success, remove obstacles, and provide support. R E S O U R C E S For the session:  PPT slides: S.4: Working together for change;  video: A take home message. For trainers:  “Leading change for better health” Chapter 6 of Managers Who Lead MSH 2005 page 149. C O N T E X T Adapt this session to suit the context in which participants will be working. Investigate to provide local examples about:  statistics and stories of living conditions of people with mobility disabilities, and their access to appropriate wheelchair services to support the need to create a sense of urgency;  current efforts and successes in wheelchair provision;  institutions and organizations that can be involved and committed to support wheelchair provision. T O P R E PA R E  Gather resources.  Read “Leading change for better health” Chapter 6 of Managers Who Lead MSH 2005 page 149.  Review PPT slides and read through session plan. Prepare the slide on the number of people requiring a wheelchair in the slide in PPT Working together for change.  Identify a person to record minutes and agreed actions.  Prepare four sheets of flip chart paper with the following headings: Sense of urgency; Creating a core team; Communicating the vision and strategy; Immediate actions to provide support. O U T L IN E 1. Introduction 2. How to communicate a sense of urgency 3. How to involve and commit stakeholders 4. How to communicate the vision or picture of success 5. Developing a positive vision or picture of the desired future 6. How to provide support and remove obstacles 7. Strategies to help the change process 6 3 5 3 40 3 40 Total session time 100 WHEELCHAIR SERVICE TRAINING PACKAG E 38 1. Introduction (6 minutes) Link this session with previous sessions. In the previous sessions, we discussed the huge unmet need in wheelchair provision. Personal mobility allows many people with disabilities to become productive members of their family and communities. For many people, an appropriate, well designed and well-fitted wheelchair can be the first step towards inclusion and participation in society. Introduce the challenges for stakeholders to help the change process. • Meeting the unmet need - improving access to high- quality wheelchairs at an affordable cost. • Implementing WHO Wheelchair Guidelines and the Wheelchair Service Training Package (WSTP). There is a need of higher level involvement to establish or improve wheelchair provision within the country 4.2 Working together for change Challenges for t he stakeholders Explain: • WHO, in partnership with USAID, has developed the Wheelchair Service Training Packages (WSTP) to help ensure people can access appropriate wheelchairs. • The purpose of the overall training package is to create awareness and develop the skills and knowledge of all personnel involved in wheelchair provision. • However, these trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is higher-level involvement to establish or improve wheelchair provision within the country. Ask: What do you think should be the stakeholders’ role to ensure the establishment or improvement of wheelchair provision within the country? Acknowledge answers and write on the whiteboard. Most important answers: • creating awareness of the need; • promoting and developing new policies; • facilitating access to resources; • creating partnerships and alliances. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 39 Explain: Introducing or improving wheelchair provision implies an organizational change. However, organizational change can be very hard. Stakeholders can play an important role to facilitate this change as agents of change. 1. Create a sense of urgency about the need for change, in order to create appropriate wheelchair provision. 2. Build a core team of stakeholders with power and commitment to promote the change. 3. Create a powerful shared vision and strategy and communicate them at every opportunity and venue. 4. Provide support and remove obstacles that managers cannot overcome. 4.3 Working together for change key factors for s uccess Explain: Key factors for success. • Many studies have been carried out to increase understanding of the things that make organizational change more likely to succeed(14). Explain: During this workshop, we are going to focus on four major things that Stakeholders can do to lead change. These are: 1. Organizations face many competing priorities. Unless stakeholders create a clear and consistent message about the sense of urgency, appropriate wheelchair provision will be lost in the managers´ priorities. 2. It is necessary to form a partnership of stakeholders with the power and commit- ment to promote the change. 3. In order to involve and commit different stakeholders, a clear, powerful vision or pic- ture should be created and communicated at every opportunity and venue. 4. When the implementation starts, stakeholders should be there to provide support and remove the obstacles that managers at the service delivery level cannot overcome. WHEELCHAIR SERVICE TRAINING PACKAG E 40 2. How to communicate a sense of urgency (3 minutes) Ask: How do you think you can create a sense of urgency? • Avoid complacency: “We are doing what we can.” • Show others the need for change with compelling stories and statistics. • Maintain the sense of urgency in all messages and actions through the change process. • Show dramatic evidence that demonstrates that change is required and is good for all. 4.4 Working together for change key factors for s uccess Explain: • Avoid complacency: “We are doing what we can.” • Show others the need for change with compelling stories and statistics. • Maintain the sense of urgency in all messages and actions through the change process. • Show valid and dramatic evidence that demonstrates that change is required. Highlight: A sense of urgency means there is a need that cannot be avoided or delayed • Stakeholders’ actions and decisions must demonstrate that appropriate wheelchair provision is a priority. Do not underestimate the effort it takes to change the current situation. • If there is no sense of urgency, people are not going to make the additional effort it takes to make a change. 3. How to involve and commit stakeholders (5 minutes) Explain: Research has demonstrated that there are a few people who easily adopt change and a few people very resistant to change. The majority of people rest in the middle waiting to see how a change process goes before deciding which side to take. If you make a graph and distribute in columns the number of people who easily adopt the change in the first column; the more resistant in the last column, and the others in the middle, you will find a graph like that shown on the slide. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 41 Innovators 2.5% Early Adopters 13.5% Early Majority 34% Late Majority 34% Conservatives 16% - Time of adoption + 4.5 Working together for change Characteristics o f adopters Explain: Adopter categorization: • Innovators, small group of around 2.5%: They are happy to take risks, like to do new things. • Early Adopters, 13.5%: This is a very important group because they are usually opinion leaders, well known. People look to them and follow them. • Early Majority, 34%: Pay attention to see what others are doing to learn from them, especially from the Early Adopters. • Late Majority, 34%: Adopt when the change is already in place. They need proof something works before changing. • Conservatives or traditionalists, 16%: It is important to know what their concerns are and address them, but all efforts should not be focused in trying to change them. Explain: As we want to introduce a new approach to wheelchair provision, where should we focus? Very often, we focus on arguing or trying to convince the conservatives or traditionalists. We should focus most on supporting the Early Adopters and the Early Majority. Studies show that after these groups adopt a change, it is difficult to stop that change. Explain: According to the previous slide, there is a need for early adopters who are committed to change to create a core team for change. Ask: What kind of qualities should the members of the core team have? The core team should have a combination of people with enough power to make things happen and enthusiasm and commitment: • Power of their position • Experience • Leadership • Credibility • Team work. 4.6 Working together for change Build a core tea m of stakeholder s Explain: • The core team should have a combination of people with enough power to make things happen and enthusiasm and commitment to involve others. Read the list of qualities on the slide. WHEELCHAIR SERVICE TRAINING PACKAG E 42 Explain: Depending on the particular circumstances of wheelchair provision in the country, the list of stakeholders may change. • Policy planners and implementers (For example, government). • Manufacturers and suppliers. • Professional groups (such as Physiotherapists/Occupational Therapists). • International NGOs. • Disabled people’s organizations or users groups. • Disabled people, their families, and caregivers. 4.7 Working together for change Who are the sta keholders? Read the list of the stakeholders on the slide. Explain: To be successful at forming the core team, it is necessary to: • Showing enthusiasm and commitment to involve others. • Modelling the behaviour needed: commitment, trust and teamwork. • Structuring productive meetings. • Focusing on the early adopters. 4.8 Working together for change Build a core team of stakeholders Read the characteristics on the slide. 4. How to communicate the vision or picture of success (3 minutes) Explain: To involve and convince people about the importance of appropriate wheelchair provision, you need to create a clear and moving vision of where you want to go and what you want the service or programme to become, a picture of the desired future. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 43 • Create a clear and moving vision of the desired future. • Involve those who will need to carry out the vision when creating it. • The vision will remind you why are you doing what you are doing and provide inspiration when facing obstacles. • It is also necessary to create a clear strategy of how the process will be implemented. 4.9 Working together for change Create a picture of the desired fu ture • People usually support what they create. Try to create a shared vision or picture that is developed and owned by those who will need to carry it out. • Leading with vision helps to remind you why you are doing what you are doing and provides inspiration to keep the team going in the face of obstacles. • It is also necessary to create a strategy for implementing the change. Follow the eight steps from the beginning. 4.10 Working together for change Be consistent w ith the message Explain: • Keep communication simple and catchy. • Take audience needs and concerns into account when preparing your messages. • Use all opportunities at hand: For example, face-to-face meetings, conferences, local radio/TV, webpages, cell phone messages. • Be consistent with your messages. One action speaks louder than a thousand words. 5. Developing a positive vision or picture of the desired future (40 minutes) Explain: As we can see from the previous sessions, there are many benefits of appropriate wheelchair provision. It is important to have a powerful and engaging vision statement to communicate to all people involved. We are going to create a shared vision. This is the picture of what we want to achieve or create in the future together. WHEELCHAIR SERVICE TRAINING PACKAG E 44 Activity Groups: Individually. Instructions: Explain: Think about a time in the future, three years from now. Imagine that we have accomplished all that is important to us in wheelchair provision. • What picture do you see in your mind that represents this achievement? • What impact do you see on wheelchair users? • What changes do you see in stakeholder participation? • What changes do you see in provision? Ask each participant to write a newspaper headline reporting the group accomplishments three years from now. This can be through words or pictures. Monitor: Monitor the group, and assist as needed. Time: 10 minutes in total. Feedback: Encourage two or three participants to share their examples and write on the whiteboard. Most important answers: • people with disabilities now become mobile and are able to participate in community life; • stakeholders are organized and co-operate to provide access to affordable, durable, and appropriate wheelchairs for users in need; • service providers are offering integrated services adapted to the clients’ needs including training for users to use and maintain their wheelchairs; • better accessible environments exist so people with disabilities can use their wheelchairs everywhere. Activity Groups: Divide into groups of 4–6 people (be sure to mix people from different organizations in each group). Instructions: Ask each group to share among its members their individual vision or picture for the future of appropriate wheelchair provision. Ask them to create one shared vision combining the best aspects of individual visions. Record their vision on a flip chart to share in the plenary. Monitor: Monitor the groups, and assist as needed. Time: 20 minutes to discuss and 10 minutes for feedback. Feedback: Ask each group to present their vision with the plenary. Remark on the common elements of the visions and ask for volunteers to combine the visions and share it with the group later. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 45 6. How to provide support and remove obstacles (3 minutes) Explain: We talked about three key elements to introduce organizational change successfully: • create a sense of urgency; • form a core team of people to move the initiative forward; and • communicate the vision or picture of success and the strategy at every opportunity. What kind of obstacles cannot be overcome by managers alone? • Wheelchair provision policy. • Human resources policies and incentives. • Budget allocation. • Establish national standards for wheelchairs. • Educate and train relevant personnel. 4.11 Working together for change Provide support and remove obst acles Explain: • The fourth key factor is an important role that stakeholders should play – provide support and remove obstacles that managers alone cannot overcome. Read the possible areas of intervention on the slide. Highlight: Stakeholders can use their power and relationships to move forward and support wheelchair provision. Summarise: There are four key elements to help the change process that become important roles for all stakeholders such as you. Population People who need a wheelchair WHO 7 000 000 000 70 000 000 Insert country Insert country population Insert 1% of country population 4.12 Working together for change What is the nee d in our country ? Explain: Now that you know the size of the need. Read out the estimated number of people requiring a wheelchair in the country. Ask: 1. How are you going to contribute to create a sense of urgency about the need for change in wheelchair provision in our country? WHEELCHAIR SERVICE TRAINING PACKAG E 46 1. Create a sense of urgency about the need for appropriate wheelchair provision. 2. Build a core team of stakeholders with power and commitment to promote the change. 3. Create a powerful shared vision and strategy and communicate them at every opportunity and venue. 4. Provide support and remove obstacles that managers cannot overcome. 4.13 Working together for change What is the nee d in our country ? 2. How can you contribute to form a core team with power and commitment to pro- mote the change? 3. How can you share the positive vision or picture of the future of adequate and appro- priate wheelchair provision? 4. How can you provide support and help remove obstacles, so appropriate wheelchair provision can be improved or implemented? 7. Strategies to help the change process (40 minutes) Explain: In order to take us further, we will discuss your ideas for actions we as stakeholders can take to implement or improve wheelchair provision. Activity Groups: Divide in groups of 4–8 people. Decide if mixed (different types of organization or similar) groups will be more useful to take actions forward. Instructions: Ask each group to analyse what actions are needed to move forward in the implementation or improvement of wheelchair provision by answering the following questions: • What actions can we as stakeholders do to create a sense of urgency in the appropriate provision of wheelchairs? • What can we do to create a core team of stakeholders with enough power and commitment to move this initiative forward? • How can we communicate the vision or picture of success and the strategy of adequate wheelchair provision? (eight steps). • What immediate actions can we undertake to provide support for wheelchair provision? Ask each group to record their answers to be shared in the whole group discussion. Monitor: Monitor the groups, and assist as needed. Time: 15 minutes to discuss and 20 minutes to feedback. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 47 Feedback: Ask a representative of each team to share the actions they propose to move forward the implementation or improvement of wheelchair provision as follows: • Team 1 presents actions it proposes to create a sense of urgency. After finishing, the rest of the teams can contribute more actions if they are different. • Team 2 presents actions to create a core team of stakeholders. The rest of the teams can contribute any complementary actions. • Team 3 presents actions to communicate the vision and the strategy. The teams can complement if needed. • Team 4 presents immediate actions to provide support for wheelchair provision. The other teams can complement if needed. Record: Take notes of the actions proposed on a flip chart. Use one sheet for each key factor labelled with its title: Sense of urgency, Creating a core team, Communicating the vision and strategy and Immediate actions to provide support. Display: the four flip chart sheets on the wall. Ask: What will be the next steps? • Who will be responsible for compiling the visions into one? • When will it be distributed to everyone? • Are you going to form a task force to initiate some of the actions proposed? • Who will take these actions further? • Are you going to meet again? When? Record: Take notes of the next steps, with people responsible and dates on a flip chart or directly into a PPT. WHEELCHAIR SERVICE TRAINING PACKAG E 48 Closing address (5 minutes) 4.14 Working together for change WSTP Logo Explain: • The logo represents a commitment to get people on the road – no more locked inside their houses or huts – increasing the participation and inclusion of people with disabilities: through provision of appropriate wheelchairs delivered through services by trained personnel. Encourage participants to use the WSTP logo. A take home message 4.15 Working together for change video presentati on Introduce video: A take home message. Show video. Thank all the stakeholders for their active participation and contributions. Notes for trainers: Trainers/local host may choose how they wish to present certificates and close the training programme. Wheelchair service steps poster can be given out here or during an earlier session. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 49 Annexes Annex 1: Brief for government representative Suggested points for consideration Time suggested: 5–10 minutes Purpose of communication To stress the urgency of the situation of disabled people in the country, highlighting what the government is doing to address the issue and urging other stakeholders to also take action where they can. Introduction • Who are you and what department do you represent? • What is its role in disability? The current situation • Legislation exists but there is still a huge need. • Outline the need for wheelchairs (1% of the country’s population). • Outline the other needs of disabled people as you see them: for example rehabilitation, education, employment and inclusion in community life. Background • When did your country ratify the CRPD and Optional Protocol? Refer to Article 20, which is specifically about the right to personal mobility. • Outline any local laws or policy relating to disability. • How do you monitor and enforce legislation? • What are the challenges with this? The next steps The Wheelchair Guidelines are a tool to support the implementation of the CPRD. WHEELCHAIR SERVICE TRAINING PACKAG E 50 Possible recommendations that you may wish to consider: • Collaborate: Together we can achieve more – the government wants to work with rehabilitation services and disabled people, NGOs, INGOs, DPOs, to improve the situation and fulfil its obligations under the CRPD. • Work together to develop national policy on assistive devices. • Products (for example, wheelchairs, tricycles): Improve the volume, range and quality of products available to disabled people. • Standards: Adopt specific wheelchair standards, in line with the Wheelchair Guidelines. • Services: Develop more services, of better quality. Conclusions and next steps • All stakeholders in this room can play a role in moving forward with the next steps. • We need to act quickly as disabled people are some of the most marginalized in our country. • We need to ensure that the conclusions from this workshop are moved forward and should elect a task force to oversee that this is done. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 51 Annex 2: Brief for wheelchair user representative Time suggested: 5–10 minutes. Tone: People will be motivated by a passionate, engaged and urgent tone. Purpose of communication To bring to life a picture of what it is like being a wheelchair user in your country so that workshop participants are compelled to act to quickly bring about change and improve the quality of life of wheelchair users. Introduction Who are you and what organization (if any) do you represent? Background Some key messages • The CRPD provides a framework for how life should be for disabled people in our country. Of particular relevance to this workshop is Article 20 on mobility, which pledges “to ensure personal mobility with the greatest possible independence for persons with disabilities”, including through access to quality mobility devices and training(15). • Why is mobility so important? Because inclusion and participation of disabled people can only be achieved if disabled people are mobile. • In order to be mobile, disabled people need appropriate wheelchairs that fit them. Current situation Your story: People will be engaged by your story. When you look through these questions and think about your experience as a wheelchair user, ask yourself if this is representative of the majority of wheelchair users in your country. If it is not, include what it would be like for a typical wheelchair user as well. If you have real-life examples, use them. You want this part to vividly highlight the challenges that disabled people face. • When did you become disabled? • How long have you been a wheelchair user? • What challenges have you faced? • Did you have to go far to get your wheelchair? Did you have a choice in the type of wheelchair you received and did you have to pay for it? • Is your wheelchair safe and reliable and can you get it repaired if you need to? WHEELCHAIR SERVICE TRAINING PACKAG E 52 • How easy is it for you to carry out your day-to-day activities in the wheelchair? Do you feel included in society? Conclusions and next steps Key message • Inclusion and participation of disabled people can only be achieved if disabled people are mobile. • We all need to work together to ensure that this is made possible – all stakeholders in this room can play a role. Consider finishing by addressing this question • What are your hopes for the future (for yourself and for all wheelchair users)? Method of presentation It is not necessary to have a PPT for this presentation. However, it would be helpful to have one image to insert into a PPT while the wheelchair user is sharing their story. If the speaker would prefer to prepare a PPT, ensure it is uploaded in advance of the workshop if possible. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 53 Annex 3: Some common quotes and statistics • Disability and Poverty(16) There are 1 billion people in the world with a disability, and 700 million of these people live in economically poorer countries. Within this 700 million: - only 10% of primary-school aged children go to school - the adult literacy rate is just 3% - unemployment is about 80%. • Poverty and exclusion mutually reinforce one another. People with disabilities are disproportionally represented among the world’s poorest people. • In economically poorer countries, 98% of children with a disability do not attend school(17). Universal primary education requires specifically targeting children with disabilities. • An estimated 10% of the world’s population have disabilities and about 80% of these live in developing countries(18). • Children under 5 diagnosed with a disability are less likely to receive the same level of health care as is given to non-disabled children. Disabled children can be looked on as a burden, and families living in poverty may be unable or unwilling to spend scarce resources on a disabled child. • Disability issues are inseparable from development issues. A true global partnership for development cannot be achieved as long as people with disabilities remain outside development policy, planning and programming (See articles 31 & 32 of the CRPD). • Disabled people‘s exclusion has a devastating impact on economies both in the developing and developed world. • In many low-middle income countries only 5–15% of people who require assistive devices and technologies have access to them(19). • “Disability is not a specialist issue: it is a human rights issue. Disabled people’s priorities are for food, shelter, family life, clothing, income and full participation just the same as anyone else(20).” • Poor people with disabilities are caught in a vicious cycle of poverty and disability, each being both a cause and a consequence of the other(21). WHEELCHAIR SERVICE TRAINING PACKAG E 54 Annex 4: The eight steps of wheelchair provision Step Summary 1. Referral and appointment The way that wheelchair users are referred will vary. Users may refer themselves or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities. 2. Assessment Each user needs an individual assessment. This includes gathering information about the wheelchair user’s lifestyle, the work they do, where they live, and their physical condition. 3. Prescription (selection) Using the information from the assessment, a wheelchair prescription is developed together with the user, family member or caregiver. The prescription details the selected wheelchair type, size, special features and modifications. Also detailed is the training the user needs to use and maintain the wheelchair well. 4. Funding and ordering A funding source is identified and the wheelchair is ordered from stock held by the service or from the supplier. 5. Product preparation Trained personnel prepare the wheelchair for the initial fitting. Depending on the product and service facilities, this may include assembly, and possible modification, of products supplied by manufacturers or production of products in the service workshop. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 55 Step Summary 6. Fitting The user tries the wheelchair. Final adjustments are made to ensure the wheelchair is correctly assembled and set up. If modifications or postural support components are required, additional fittings may be necessary. 7. User training The user and caregivers are taught how to safely and effectively use and maintain the wheelchair. 8. Follow-up, maintenance and repairs Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. WHEELCHAIR SERVICE TRAINING PACKAG E 56 Annex 5: Appropriate wheelchair provision benefits all Government Individual Society Implement articles of CRPD Equal opportunities Enjoying human rights Living in dignity Education and work Inclusion in society Less time and physical burden on caregivers Increased productivity and quality of life Increased productivity, improved health and quality of life Personal mobility provision of manual resourced settings Countries promote access to appropriate assistive devices Increased productive members of society contributing to GDP of country Decreased healthcare costs wheelchairs in less Guidelines on the WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS 57 References 1. Guidelines on the provision of manual wheelchairs in less resourced settings. Gene- va: World Health Organization; 2008 (http://www.who.int/disabilities/publications/ technology/wheelchairguidelines/en/). 2. Wheelchair Service Training Package - Basic Level. Geneva: World Health Organiza- tion; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. Wheelchair Service Training Package - Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). 4. Convention on the Rights of Persons with Disabilities, G. A. Res. 61/106 (2007) New York: United Nations; 2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. Joint position paper on the provision of mobility devices in less resourced settings. Geneva: World Health Organization; 2013 (http://whqlibdoc.who.int/publications/ 2011/9789241502887_eng.pdf?ua=1&ua=1). 6. Chiriacescu D, De Backer M, Botokro R. Access to services. Lyon: Handicap Interna- tional. 2011; 56–57. 7. Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). p21. 8. World Health Organization, World Bank World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/report/en/). 9. Allen S, Resnik L, Roy J. Promoting independence for wheelchair users: the role of home accommodations. Gerontologist, 2006;46(1):115–123. 10. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord inju- ry: what learns a worldwide literature survey? Spinal Cord. 2006; 44: 523–529. 11. Razzak A, Helal SU, Nuri RP. Life expectancy after spinal cord injury in a developing country – a retrospective study at CRP, Bangladesh. Disability, CBR & Inclusive Devel- opment. 2011; 22 (2): 114–123. 12. World Health Organization, World Bank World report on disability. Geneva: World Health Organization; 2011; 115 (http://www.who.int/disabilities/world_report/2011/ report/en/). 13. Joint position paper on the provision of mobility devices in less resourced settings. Chapter 6. Geneva: World Health Organization; 2013 (http://whqlibdoc.who.int/ publications/2011/9789241502887_eng.pdf?ua=1&ua=1). 14. Kotter JP. Leading change: Why transformation efforts fail. Harvard Business Review. 1995; 73(2):59–67. WHEELCHAIR SERVICE TRAINING PACKAG E 58 15. Convention of the Rights of Persons with Disabilities, Optional Protocol, http://www. un.org/disabilities/documents/convention/convoptprot-e.pdf, p. 14. 16. Disability and Development: www.disabilityanddevelopment.ie 17. http://www.unescobkk.org/index.php?id=3063 UNESCO 2003 18. WHO Press Release, 3 December 1999 19. WHO, 2014. Disabilities and rehabilitation: Assistive devices/technologies (http://www. who.int/disabilities/technology/en/) 20. EDF Policy Paper: Development Cooperation and Disability, p.15 (http://www. disabilityrightsfund.org/node/505) 21. DFID. (2000). Disability, poverty, and development. London: DFID. WHEELCHAIR SERVICE TRAINING PACKAG E FOR STAKEHOLDERS WHEELCHAIR SERVICE TRAINING PACKAG E

62 WHEELCHAIR SERVICE TRAINING PACKAGE For Stakeholders ISBN 978 92 4 154908 0 Trainer’s Manual

WHEELCHAIR SERVICE TRAINING PACKAGE For Managers Reference Manual and Workbook WHEELCHAIR SERVICE TRAINING PACKAGE Reference Manual and Workbook For Managers WHEELCHAIR SERVICE TRAINING PACKAGE Reference Manual and Workbook For Managers Contributors: Editors: Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza Contributors: Michael Allen, Johan Borg, Alberto Cairo, Christine Cornick, Lauren Flaherty, Ricardo Guzman Hefferan, Cristian Ispas, Margaret Lamiell, Henry Lumley, Colin Macfarlane, Peter Mbuguah, Matt McCambridge, Ray Mines, Stephen Muldoon, Isaac Nyathi, Alana Officer, Kiran Patwardhan, Chris Rushman, Elsje Scheffler, Adarsh Shah, Rebecca Jackson Stoeckle, Sruti Mohapatra, Katherine Selengia, Nicky Seymour, Kate Wilson and Eric Wunderlich Illustrator: Melissa Puust Photo credits: David Constantine, Chapal Khasnabis, and Jesse Moss Video credits: Chapal Khasnabis, Amanda McBaine, and Jesse Moss Financial support: US Agency for International Development Partner organizations: Cheshire Services Ethiopia (CSE), International Orthodox Christian Charities (IOCC), Management Sciences for Health (MSH), Mobility India, Motivation Africa, and United Cerebral Palsy Wheels for Humanity (UCP) WHO Library Cataloguing-in-Publication Data. Wheelchair service training package for managers/edited by Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza. Contents: Trainer’s Manual for Managers – Reference Manual and Workbook for Managers – Additional Resources for Managers – Trainer’s Manual for Stakeholders. 1. Wheelchairs – standards. 2. Disabled persons – rehabilitation. 3. Teaching materials. I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. World Health Organization. ISBN 978 92 4 154908 0 (NLM classification: WB 320) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Malta Design by Inís Communication – www.iniscommunication.com Content packaging by Bizgraphics (http://bizgraphic.ch/) Terminology The following terms used throughout the training package are defined below. Appropriate wheelchair A wheelchair that meets the user’s needs and environmental conditions; provides proper fit and postural support; is safe and durable; is available in the country; and can be obtained and maintained and services sustained in the country at the most economical and affordable price. Manual wheelchair A wheelchair that is propelled by the user or pushed by another person. Postural support device (PSD) A physical device that provides additional postural support. Wheelchair A device providing wheeled mobility and seating support for a person who has difficulty in walking or moving around. Wheelchair modification A change made to a wheelchair. Wheelchair provision An overall term for wheelchair design, production, supply and service delivery. Wheelchair service That part of wheelchair provision concerned with ensuring that each user receives an appropriate wheelchair. Wheelchair service personnel Persons skilled in the provision of an appropriate wheelchair. Wheelchair user A person who has difficulty in walking or moving around and uses a wheelchair for mobility. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS C O N T EN T S 1 About the Wheelchair Service Training Package for Managers 4 A. Core knowledge 4 A.1: What is appropriate wheelchair provision? 7 A.2: Service delivery 14 A.3 Managers who lead change 17 B: Starting a wheelchair service 17 B.1 Accessing services 22 B.2 Facilities and equipment 29 B.3: Range of appropriate wheelchairs 35 B.4 Align personnel 39 B.5: What does a wheelchair service cost? 42 C: Running a wheelchair service 42 C.1: How do you know if your service is working? 48 C.2: Managing demand 55 C.3: Planning follow-up 65 C.4: Planning for financial sustainability 71 References 73 Workbook 1WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS About the Wheelchair Service Training Package for Managers Introduction Following the release in 2008 of the Guidelines on the provision of manual wheelchairs in less resourced settings(1), in 2012 the first package within a range of Wheelchair Service Training Packages (WSTP) was released: the Wheelchair Service Training Package – Basic Level (WSTPb)(2) This was followed in 2013 by the release of the Wheelchair Service Training Package – Intermediate Level (WSTPi)(3). The World Health Organization (WHO) in partnership with the United States Agency for International Development (USAID) has now developed the third part of the WSTP consisting of two sub-packages: the Wheelchair Service Training Package for Managers (WSTPm) and the Wheelchair Service Training Package for Stakeholders (WSTPs). This third part of the WHO WSTP is designed to support managers to effectively support appropriate wheelchair provision; and to raise awareness among stakeholders and promote their involvement in establishing appropriate wheelchair provision in their country/region. The wheelchair is one of the most commonly used assistive devices for enabling personal mobility. For people who have difficulty in walking or moving around, a wheelchair is an essential tool for their mobility, empowerment, dignity and overall well-being. Mobility opens up opportunities for wheelchair users to be independent and to access health care, education, work and employment, and also assists wheelchair users to participate in social and cultural activities. However, WHO estimates that more than 70 million people need a wheelchair and only 5–15% have access to one. In addition, training opportunities for personnel to gain the knowledge and skills needed to effectively deliver a wheelchair are limited. The importance of mobility is reflected in the United Nations Convention on the Rights of Persons with Disabilities (CRPD)(4), which advocates for “effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities”. To ensure effective personal mobility, wheelchair users need a wheelchair that fits correctly and meets their specific needs; especially lifestyle and environment. This requires an approach responsive to individual needs. 2WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS An effective way of meeting the individual needs of wheelchair users is the provision of wheelchairs through a well organized wheelchair provision system that is responsive to the expectations of the users, respects their dignity and is delivered by well trained personnel. Target audience This training package is for all personnel responsible for implementing, managing, and evaluating rehabilitation services, including wheelchair services or wheelchair provision. Previous experience in wheelchair service management is not necessarily required; however, the workshop has been designed assuming that participants will begin the workshop with general management skills. Purpose The purpose of the overall training package is to create awareness and develop the skills and knowledge of all personnel involved in wheelchair service delivery. WHO realizes that trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is a higher level of involvement to establish or improve wheelchair provision within the country. This Wheelchair Service Training Package for Managers (WSTPm) provides an overview of the rehabilitation/wheelchair service manager’s role in engaging people and leading the implementation of the eight steps of wheelchair service delivery and the issues related to it. This includes the human and physical resources required to provide a wheelchair service; including planning, organizing, staffing, directing, costing/funding, monitoring, and evaluation. The training package can be delivered in 13–14 hours, although this period may be extended or reduced according to the specific needs and resources available. Delivery of this training package will help the managers to: • better plan wheelchair provision; • increase the quality of wheelchair service delivery; • improve staff retention; • increase the number of wheelchair users who receive a wheelchair that meets their needs; and • increase the sustainability of wheelchair provision. 3WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Scope The training package includes: • an overview of the key steps of wheelchair service delivery described in the WHO wheelchair service training packages; • core knowledge required for wheelchair service delivery: o starting a wheelchair service; o running a wheelchair service; and, o making wheelchair provision sustainable. How to use the Reference Manual and Workbook This Reference Manual gives a summary of the knowledge provided in the Wheelchair Service Training Package for Managers (WSTPm). Participants may use the Reference Manual and Workbook after the training programme to remind themselves of the key points taught in each session during the training. The manual is divided into three sections: A. Core knowledge B. Starting a wheelchair service and C. Running a wheelchair service. The Reference Manual also includes a workbook, the purpose of which is to develop the skills and knowledge of personnel involved in wheelchair service delivery. The workbook contains exercises that will help to test and develop participants’ knowledge and skills. The workbook contains material from lectures, slide presentations and the reference manual; and it is intended that the participants will keep their copy of the Reference Manual and Workbook for future reference, if needed. 4WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS A. Core knowledge A.1: What is appropriate wheelchair provision? Wheelchair provision is an overall term for the design, production, supply and service delivery of wheelchairs. Wheelchairs are one of the most commonly used assistive devices, providing wheeled mobility for people with a mobility disability. Mobility is an important step towards inclusion. When a person receives an appropriate wheelchair through a service, opportunities for social life, work and education open up. In addition, other family members are freed up to participate in the community and employment.(5) It is not only individuals and their families who benefit from enhanced mobility. Local and broader economies benefit from having more contributing members. Also, people who have an appropriate wheelchair are less likely to have secondary health complications (for example, pressure sores) and are therefore less likely to need health services. There is an urgent need for change in order to see more people accessing appropriate wheelchair provision. How many people need wheelchairs? WHO estimates that 1% of any population need a wheelchair. This means that globally more than 70 million people need a wheelchair. This statistic can be a starting point when working out how many people need a wheelchair in each country, district or town. This means that managers do not need to wait for detailed surveys to be carried out in order to begin planning wheelchair provision. 5WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Population % Approximate number of people who need a wheelchair World population 7 000 000 000 1% 70 000 000 Brazil 203 657 000 1% 2 036 570 China 1 401 587 000 1% 14 015 870 Egypt 84 706 000 1% 847 060 India 1 282 390 000 1% 12 823 900 Nigeria 183 523 000 1% 1 835 230 Russia 142 098 000 1% 1 420 980 Conventions, strategies and policies in support of wheelchair provision Many people who need wheelchairs still do not have an appropriate wheelchair. Strong advocacy is needed to increase access to appropriate wheelchairs. Managers can use global, regional and national policies to help advocate for the right to mobility on behalf of people with a mobility impairment. The table below gives examples of conventions, strategies, policies and guidelines that can be advocacy tools for managers. 6WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS International policy Regional example: the Incheon Strategy National policies and guidelines The highest level policy instrument is the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Article 20 of the CRPD says that all people have a right to personal mobility. Other articles of the CRPD reinforce the importance and relevance of appropriate wheelchair provision. These include: A: 19 – Living independently and being included in the community A: 24 – Education A: 25 – Health A: 26 – Rehabilitation A: 27 – Work and employment A: 30 – Participation in cultural life, recreation, leisure and sport. In 2012, the Incheon Strategy to “Make the Right Real”; for persons with disabilities in Asia and the Pacific was adopted. The strategy has 10 goals. Goal 3 is to enhance access to the physical environment, public transportation, knowledge, information and communication. During the drafting of the strategy, a strong case was made that this goal could not be achieved without access to appropriate assistive devices, including wheelchairs. Therefore, Goal 3 includes a target to halve the proportion of persons with disabilities who need but do not have appropriate assistive devices or products. The governments who have signed Incheon are now committed to develop national plans in order to fulfil this obligation. The Incheon Strategy example shows how international and regional policy can support and encourage the development of national policy. National planning, policies and guidelines can help to increase the effectiveness and sustainability of wheelchair provision. (6) The development of national policies and guidelines requires collaboration among all stakeholders including people with disabilities, governmental and nongovernmental service providers. The CRPD and relevant regional strategies can support national planning, policy and guideline development. National guidelines can help to define how assistive devices, including mobility devices, should be provided. For example, National Guidelines on the Provision of Assistive Devices were published in South Africa in 2003, providing minimum standards for service steps, training of staff, setting up and management of waiting lists, budgets and provision of repair and maintenance services. 7WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS A.2: Service delivery Wheelchair services play an important role in wheelchair provision. Wheelchair services work with wheelchair users to find the most suitable wheelchair (from those available) for that user. Basic and intermediate level wheelchair services Every well fitting wheelchair provides the user with some postural support. The backrest, cushion, footrests and armrests provide postural support when adjusted to suit the wheelchair user’s size. However, many children and adults need additional postural support in their wheelchair. This means that there needs to be different levels of service delivery. A basic level wheelchair service works with wheelchair users who are able to sit upright without additional postural support. An intermediate level wheelchair service works with wheelchair users who need additional postural support to be able to sit upright comfortably. It is important for managers of a wheelchair service to define whether their service is at the “basic” level or “intermediate” level. This is because an intermediate service requires: personnel with a higher level of training; a larger range of wheelchairs; more materials and equipment. Meeting mobility and postural support needs appropriately Clara lives in East Timor. She works in her family’s shop, which is at the front of their house. Clara has polio, and needs a wheelchair to move inside the house, to work in the shop, and to move around her village. She can sit upright without any extra support, and uses a manual wheelchair, which has been adjusted and fitted to suit her. Clara is an example of someone who can be provided with a wheelchair through a basic level service. 8WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Ishade is 8 years old and lives in Sri Lanka. She has cerebral palsy. For Ishade, this means she has trouble controlling her arms, legs, head and neck. She cannot sit upright without support. Ishade needs extra postural support in her wheelchair. Ishade is an example of someone who should be provided with a wheelchair through an intermediate level service. The eight steps of wheelchair service delivery Step Summary 1. Referral and appointment The way that wheelchair users are referred will vary. Users may refer themselves or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities. 2. Assessment Each user needs an individual assessment. This includes gathering information about the wheelchair user’s lifestyle, the work they do, where they live, and their physical condition. 3. Prescription (selection) Using the information from the assessment, a wheelchair prescription is developed together with the user, family member or caregiver. The prescription details the selected wheelchair type, size, special features and modifications. Also detailed is the training the user will need to use and maintain the wheelchair well. 4. Funding and ordering A funding source is identified and the wheelchair is ordered from stock held by the service or from the supplier. 5. Product preparation Trained personnel prepare the wheelchair for the initial fitting. Depending on the product and service facilities, this may include assembly, and possible modification, of products supplied by manufacturers or production of products in the service workshop. 9WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 6. Fitting The user tries the wheelchair. Final adjustments are made to ensure the wheelchair is correctly assembled and set up. If modifications or postural support components are required, additional fittings may be necessary. 7. User training The user and caregivers are taught how to safely and effectively use and maintain the wheelchair. 8. Follow-up, maintenance and repair Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. Service delivery models All wheelchair services should follow the eight steps of wheelchair service delivery. However, there are different ways of delivering the eight service steps, described as service models. A combination of different service delivery models may make up an overall national service. The most appropriate service delivery model/s will depend on the context, and should be decided in consultation with all related stakeholders. The table below shows some examples of the different models of service delivery. 10 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Centre-based service Dedicated assessment area In a centre-based service, wheelchair users travel to a permanent facility, where trained personnel are available to provide a service. As a permanent facility, the service may have dedicated personnel and areas for wheelchair service delivery. Centre-based services can be efficient for personnel; however, it can be difficult for wheelchair users who live any distance from the service to get there. Dedicated wheelchair mobility skills area Integrated service Wheelchair service integrated with a community health clinic Most centre-based services are also “integrated services”. This means that a wheelchair service is integrated with activities of another service or services. For example, wheelchair service delivery could be integrated with a prosthetics/orthotics service, physiotherapy department or health clinic. In this context, if personnel are fulfilling a range of duties as well as wheelchair service delivery, it is important to ensure personnel have sufficient time to carry out all of the activities required of them. Facilities may be shared, or dedicated space provided. Administration, financial and management functions may be shared. In this context one area of a workshop is dedicated to wheelchair preparation 11 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Outreach service Outreach locations can vary. Examples include community health clinics, town halls, village meeting places, and the wheelchair user’s home In an outreach wheelchair service, personnel from a centre or integrated service either travel to wheelchair users’ homes or to a central location in another district/ region – to meet wheelchair users from that district/region to carry out service delivery. Outreach service models are usually carried out in partnership with an organization/s in the outreach district/region. Good coordination with the local organization/s is important. Some training of local personnel or volunteers can help to increase the success of outreach service delivery and increase community-level support. The advantage for wheelchair users is that the distance they need to travel is less. Outreach personnel need to be flexible, carrying essential equipment with them Mobile service Example of a dedicated vehicle for a mobile wheelchair service A mobile service is another form of outreach; however in this situation, personnel have a dedicated vehicle that is used to carry the wheelchairs and the tools and equipment needed. Personnel are able to set up in a wider range of locations, and in this way may be able to reach more wheelchair users. The ability to carry more tools, equipment, materials and spare parts increases the opportunity to carry out repairs on the spot, and the potential to manage some intermediate level service delivery. With the use of a dedicated vehicle, personnel are able to pack more of the equipment and tools they need 12 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Collaborative service delivery Not all of the eight steps in wheelchair service delivery need to be carried out by the same organization. Collaboration between a network of organizations can help to increase the efficiency of the service and also increase access to the full eight steps by wheelchair users. Step one (referral and appointment) necessarily requires collaboration and cooperation among organizations and individuals that make up a referral network for the wheelchair service. Step seven (user training) and step eight (maintenance, repairs and follow-up) can often be provided by a collaborating partner. For example, a network of community-based organizations, or disabled people’s organizations may carry out these steps in the community. An example 2. Assessment 3. Prescription 4. Funding & ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance repairs & follow-up 1. Referral & appointment Activities in the service setting A.2.11 Service delivery This diagram shows how the eight steps of service delivery may be carried out through a partnership between a wheelchair service provider and community-based organizations. Steps 2–7 are carried out in the service setting and steps 1 and 8 are carried out in the community. This model requires consideration of the training needed for all personnel and volunteers involved. The manager’s role in wheelchair service delivery The manager of a wheelchair service is responsible for supporting personnel to deliver the eight steps of service delivery and coordinating the user’s (and their carer/family member’s) progress through those steps. The manager also has broader roles, which are important for supporting service delivery. These roles include: 13 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS • raising awareness of appropriate wheelchair provision; • improving accessibility; • increasing training opportunities for wheelchair service delivery personnel; • developing sustainability – so that wheelchair service delivery is consistently maintained; • influencing national policy on appropriate wheelchair provision; • improving the range of wheelchairs available. Role of the mana gers Raising awareness Monitoring and evaluation Improving access and meeting users' expectations Having motivated well-trained workforce Developing sustainability Developing a well- functioning system A.2.12 Service delivery Active involvement of wheelchair users in service delivery Actively involving wheelchair users in every aspect of wheelchair service delivery will help to improve the outcome for wheelchair users. Some suggested strategies for managers to ensure that wheelchair users are involved in their wheelchair service are to:(7) • ensure personnel involve wheelchair users as members of the service delivery team in all steps leading to the provision of their wheelchair; • establish a system within the service to regularly collect feedback from users about their opinion of the service and how it may be improved; • where possible, recruit wheelchair users as members of the service delivery team. This may mean advertising new positions through the disability sector, and ensuring that all areas of the wheelchair service are wheelchair accessible. Wheelchair users on the team in Romania An NGO wheelchair service in Romania has actively recruited wheelchair users to their wheelchair service delivery teams. Wheelchair users fulfil different roles on the team, depending on their skills. This NGO has seen a huge positive impact through having wheelchair users as wheelchair service personnel. Every member of the team is more aware of the needs of wheelchair users through their daily interaction as colleagues; wheelchair user clients often feel more comfortable sharing their experiences with the wheelchair user member of the team, and the wheelchair user is a role model for others. 14 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS A.3 Managers who lead change Introducing or improving wheelchair service delivery often requires changes within an organization. However, leading change can be difficult. Part of the role of a wheelchair service manager is leading change and some key activities to achieve this are: • helping to create a shared vision of appropriate wheelchair provision; • communicating the importance of appropriate wheelchair provision to all related stakeholders including policy-makers, other service providers and potential donors; • aligning the right personnel and resources; • motivating, engaging and committing personnel. Create a shared vision of appropriate wheelchair provision Creating a shared vision among all stakeholders about the improvement of wheelchair provision within the country can help to inspire all of the people who need to work together to bring about change. The vision should give a picture of the desired future. For example: ‘A world in which wheelchair users are included and fully participate in all aspects of life’. It is important to enthusiastically share the positive vision so that all staff are sensitized and committed to improve the quality of life of people with disabilities. 15 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Communicate the importance of appropriate wheelchair provision To continue to inspire personnel and other stakeholders, managers need to consistently communicate the importance of appropriate wheelchair provision. Managers need to make it clear that introducing or improving wheelchair service delivery is a priority, and that it is urgent. A sense of urgency means that there is a need that cannot be avoided or delayed. People follow their supervisor’s priorities; therefore, a manager’s actions must create the sense of urgency. How to communicate the importance and urgency of appropriate wheelchair provision • Talk about the global and national unmet need for appropriate wheelchairs; the right to personal mobility; and the benefits to individuals, community and society of appropriate wheelchair provision. • Discuss progress towards introducing or improving wheelchair service delivery at regular staff meetings. • Share positive stories of success, for example at staff meetings, and with posters on the service walls. Align personnel and resources Wheelchair services need trained personnel, facilities and resources. All members of the wheelchair service team should: • be working together in the same direction; • feel supported with the resources they need to do their job; • be recognized for their contributions. 16 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS How to align personnel and resources • Identify facilities that can be used for wheelchair service delivery. • Prioritize wheelchair service delivery when allocating personnel time, facilities, equipment and funding. • Use the shared vision, and the benefits of appropriate wheelchair provision to remind personnel why the service is providing wheelchairs. • Recognize and reward the good work of personnel on wheelchair service delivery. • Facilitate personnel to work together as a team. Motivate, engage, and commit personnel Managers can help to motivate, engage and commit personnel by: • Including personnel in planning and implementation – so that they can contribute their experience and skills; and to help them better understand what the change will involve and their roles in implementing change. • Overcoming obstacles together – so that personnel have a better understanding of the causes of problems and how to solve them. • Creating short-term goals and recognizing achievement of those goals – so that personnel have a sense that their efforts are having an impact and are appreciated. • Integrating changes into the organization’s systems and culture. For example, create a culture of celebrating success and encourage people to share successes and positive stories during meetings and breaks. Also, ensure that successful changes are maintained by writing new responsibilities into individual job descriptions and updating organizational policies. 17 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS B: Starting a wheelchair service B.1 Accessing services What is meant by an “equitable service”? An “equitable service” is a service that works to make sure that every wheelchair user has an equal opportunity to receive a wheelchair. This includes: • men, women, boys and girls • young, middle-aged and elderly people • people who live close by and people who live further away – for example in rural areas • people who come from different ethnic or socioeconomic backgrounds. Equitable services recognize that all people – regardless of their disability, age, gender, religion, wealth, language and ethnic group have an equal right to services. An equitable wheelchair service is not the same as providing an equal number of wheelchairs to users from different groups (for example, an equal number of wheelchairs to men and women). This is because the needs of different groups may vary. Remember: Accessing a service does not just mean “getting to the service”. It means being able to find out about the service, get to the service or have the service come to them. 18 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS There are some groups of people who may find it hard to access services. Some examples are listed below: • women and girls; • people who live a long way from the services/people living in rural areas; • people who are poor; • children; • people from different religious or socioeconomic groups; • elderly people; • specific groups – for example people with HIV or leprosy may face discrimination. Managers need to be aware of the different groups in their context who are less likely to be able to access services. Referral and appointment Referral and appointment is the first step in wheelchair service delivery. Step Summary 1. Referral and appointment The way that wheelchair users are referred will vary. Users may refer themselves or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities. Effective referral requires good links between a wheelchair service and the community; as it is people in the community who will identify and refer wheelchair users to your service. Different individuals and organizations that are likely to identify wheelchair users and refer them to your wheelchair service are: 19 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS • local hospitals; • community health centres; • community-based rehabilitation networks; • village/council/church leaders; • disabled people’s organizations; • other wheelchair users; • doctors/nurses. What can managers do to build a referral network? • Identify the referral sources (individuals and organizations) in your area. • Discuss with wheelchair service staff what information referral sources need to be able to identify wheelchair users who need a wheelchair, and how to refer them to the service. • Prepare (or support personnel to prepare) handouts/brochures that provide the information referral sources need. • Visit (or support personnel to visit) potential referral individuals or organizations to talk about the wheelchair service. • Hold an open day at the wheelchair service for wheelchair users and referral sources. • Run referral network training for referral sources. • Consider developing a referral form that referral sources can complete. Ensure that any forms are simple; ensure your service responds to the referral (by providing the wheelchair user referred with an appointment); and give positive feedback to referral sources that use the form. Increasing equitable access to services Managers play an important role in helping to increase equitable access to services. The following table provides some suggestions for how to increase access for different groups. 20 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS What can managers do to increase equitable access to services? Fo r w o m en a nd g ir ls • Make sure information about the service is available in different ways – for example through the radio, simple text brochures/posters, and visual images. • Make sure that women are pictured in publicity about the service as well as men. • Identify women wheelchair user role models who can speak about the importance of wheelchairs for women publicly and in the community. • Speak to community leaders about how wheelchairs are equally important to women, children and men. • Support and encourage women’s participation in all levels of wheelchair services, including management and leadership positions. • Provide disabled people’s organizations with information about the wheelchair service and emphasize that women and men both need wheelchairs for mobility. • When talking about the wheelchair service always say that the service is for men, women and children – not just for “people”. Fo r ch ild re n • Make sure that information about the service is available at places that parents of a child with a disability may visit – for example, community health clinics, rehabilitation services, market places, community centres, churches, mosques, and temples. • When talking about the wheelchair service always say that the service is for men, women and children – not just for “people”. • Provide education and information about the service to people who may treat children with a disability – for example doctors, nurses, community health workers. • Make sure that children are pictured in publicity about the service as well as adults. • Explain the benefits of providing wheelchairs to children at an early age whenever talking about the service. Also explain the benefits for the families/carers of children that the provision of a wheelchair provides. Fo r pe o pl e w ho a re po o r • Make sure that services are as cost effective as possible. • Identify ways to provide financial support for wheelchair users who are unable to pay for transport to wheelchair services, or are unable to pay for their wheelchair (if there is a charge). For example, establish a wheelchair fund. Fo r pe o pl e w ho a re el de rl y • When talking about the wheelchair service always say that the service is for all people – including elderly people. • Include pictures of elderly people using wheelchairs in publicity about the service. • Explain the benefits of a wheelchair for elderly people, and for their families, when talking about the wheelchair service. 21 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Fo r pe o pl e w ho li ve a lo ng w ay fr o m t he se rv ic es /p eo pl e liv in g in r ur al a re as • Make sure that information about the service is available in rural locations – for example rural health clinics, market places, community centres, churches, mosques, and temples. • Provide information about the service to people who work with people living in rural areas – for example community-based rehabilitation workers. • Identify ways to assist rural wheelchair users with transport if the service does not offer outreach. For example – financial assistance with transport, working with other organizations that can help to transport people to the service. • Find out if it is possible to offer accommodation for wheelchair users visiting the service from rural locations. • Provide outreach services to rural areas. • Train people working in rural areas (for example community health workers) how to support wheelchair users in the community; how to carry out follow-up; and how to help with simple wheelchair maintenance and repairs. • Ensure wheelchairs are available that can be used effectively in rural areas over rough terrain, and provide information on how to make simple adaptations (for example, ramps or smoothing pathways) to make it easier to use a wheelchair in rural areas. Fo r di ff er en t et hn ic o r so ci o ec o no m ic gr o up s • When talking about the wheelchair service always say that the service is for all people – regardless of ethnicity or socioeconomic background. • Include pictures of people from the different ethnic and religious groups in the area served by the service in all publicity about the service. • Where possible, employ staff from different ethnic and socioeconomic groups in the service. 22 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS B.2 Facilities and equipment Wheelchair service delivery can be carried out in many locations. However, wherever the service is carried out, some facilities and equipment are needed. Basic level services need less space and equipment than intermediate level services. Facilities and equipment for all wheelchair services (basic and intermediate) An area for reception and waiting What space is needed? An area for registration and where wheelchair users and their families can wait together is needed. When it is likely that people will have travelled some distance to get to the service, think about where they will be able to get refreshments. In the illustration on the right, a local trader runs a stall outside a local health clinic. A quiet area where wheelchair users may lie down while waiting can be very useful. This is particularly important for : • people who are weak and frail and need to rest during the appointment; • children who are tired; • anyone identified with a pressure sore in a weight-bearing area of their body. An accessible toilet should be close by to the reception and waiting area, as well as near the assessment and fitting area. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. 23 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Recommended equipment: Equipment for registration includes: table/desk, chair, telephone, and a place to securely store and file paperwork. It is helpful to have posters, leaflets, and video resources available in the waiting area. If a service sees a high proportion of children it is helpful to have some simple toys available while they are waiting. An office area for personnel What space is needed? Personnel need a space where they can work and meet together, write notes and safely store records. An area to carry out assessment and fitting What space is needed? A relatively quiet and private space is needed where wheelchair users can be assessed by personnel, and where wheelchair fitting can be carried out. The space needs to be wheelchair accessible, allow enough room for family members to be present, and there should be sufficient light. It is helpful to identify one clear accessible wall to use as a backdrop for assessment and also photos. In a centre-based service, suggested dimensions for this space are as follows (varies depending on the workload): • Basic level clinical area: 3 m x 2.5 m. • Intermediate level clinical area: 4 m x 3.5 m. Sometimes the clinical area is in someone’s home. The emphasis then is on being flexible and adaptable and bringing essential equipment with you. 24 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS An area to carry out assessment and fitting Equipment: • Privacy screens – if more than one client is seen at a time, curtains or screens divide the area for privacy. • Assessment bench or bed – a firm, stable structure at wheelchair height for the wheelchair user to sit on during assessment. The top surface should have some cushioning to protect the skin, for example EVA or, a piece of exercise mat or yoga mat. Position the bed so that that the assessor can work with the user from in front or behind. • Foot blocks – a set of foot supports of different sizes to support the user’s feet correctly. • For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. • Camera – helpful for recording key stages in the assessment and fitting process (with the wheelchair user’s signed permission). • Tape measure or calipers. An area for wheelchair preparation, maintenance and repair What space is needed? A “technical” area is needed for : • assembly, repair and maintenance of wheelchairs • fabrication of modifications where necessary. The space needs to be well lit, ventilated, waterproof and a good temperature for working. Security is important for hand and power tools. Ideally they should be stored in a lockable metal cabinet. 25 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS In a permanent/centre-based service, the technical area should be divided as follows: • A “clean” area for final assembly of components and product adjustment, and for completing safe and ready checks. Floor space and bench space is needed for this area. • A “fabrication” area is needed for making modifications and repairs including foam shaping and gluing, general drilling, sanding, filing and painting. Floor space and bench space is needed for this area. Not all technical work needs to be carried out in the services own technical area. For example, a wheelchair service may outsource some technical aspects, such as sewing of upholstery (to a local tailor) and welding (to a local metal workshop). Equipment: • Enough cupboards, shelves and tool boards to keep the area tidy and optimize floor space. • Tools for assembly and adjustment of wheelchairs and fabricating modifications. • A materials list for modifications. • At least one workbench for each technician. It is recommended that at least one workbench is adjustable in height if a wheelchair user is part of the team. The bench should be positioned so that there is space in front or behind for work to be carried out at floor level. For more information on tools, materials and equipment needs refer to the Additional Resources for Managers Manual on the Pen Drive. (Note: The facilities and equipment needed for a wheelchair manufacturing workshop are much more extensive, and are beyond the scope of this manual). An area for storage What space is needed? A secure storage area for wheelchairs, spare parts and materials is needed. The area should be close to the technical area, secure, waterproof, and free from animals/pests. A metal grille over a window gives added security. If a dedicated room is not possible, set up a dedicated area within a room. In this instance, additional consideration should be given to security. 26 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Setting up a storage area: The following suggestions may help in setting up an organized storage area. • Shelving and racks help to maximize space. • A walkway between shelving, racks, boxes and assembled wheelchairs improves access and efficiency. The walkway should be kept clear. • Arrange items by type and size. Having the same items together makes it easier to count for stock control and reordering. • Small items, such as screws, nuts, washers may be kept in small boxes, one for each article and size. Mark the name of the item on the front of the box. • Boxes and materials should not be placed directly on the floor or against an external wall as they can easily be damaged by moisture. Pallets are useful to raise items off the floor. • If there is a window, a grille can be added to improve security. An area for user training What space is needed? A user training area is required for teaching: • transfers and health education • wheelchair handling, care and maintenance • mobility skills. Transfers and health education can be taught in a clinical area, client’s home or outreach setting. Equipment: • Basic equipment such as a bed to practise transfers is helpful. Wheelchair handing, care and maintenance can be taught in the clean area of a workshop, or in any other suitable location. Equipment: • Basic wheelchair maintenance equipment is needed. 27 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Mobility skills are commonly taught outside, however inside is also fine. A purpose-built outdoor mobility skills area can simulate the different surfaces that wheelchair users will need to be able to traverse in their daily life – such as rough ground, soft ground, drains, speed bumps, kerbs, steps, and stairs. In an integrated service – the mobility skills area may be used by people with other mobility impairments. For example, people learning to use a prosthetic limb, or regaining walking skills after an injury. Where there is no space for a dedicated mobility skills area – identify existing spaces that can be safely used for mobility skills training. Avoid areas where there are a lot of people coming and going; and aim to find a range of different obstacles. Portable mobility skills training equipment can be fabricated, and set up wherever a wheelchair service is being delivered. The illustration on the right shows portable mobility skills equipment set up under a shade shelter. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. Additional facilities and equipment for intermediate level services Providing an intermediate level wheelchair service requires some additional space and equipment. The additional requirements that managers need to consider are discussed below. 28 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Assessment and fitting area For an intermediate service, an assessment bed is needed for the wheelchair user to lie down during the assessment. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. A specialized assessment box can be very helpful for intermediate level services. An assessment box provides adjustable foot support and good access to provide support during hand simulation. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. • Firm foam blocks for temporary supports need to be on hand during assessment and fitting. Also a wipe- clean mat for floor work as well as cushions. • A full-length mirror can be very helpful for both the wheelchair user and service personnel to observe posture and alignment from different angles. • Toys and pictures on the walls encourage a more child-friendly environment. Storage At intermediate level, there is a greater need for storage of the materials required for modifications and for postural support components. Materials include sheets of foam which need to be stored flat and kept dry. More storage space and storage racks are therefore needed. Wheelchair preparation, maintenance and repair area A clean area and an industrial sewing machine enable the service to upholster modified or fabricated postural support components and straps. Without this space and equipment, the service will need to outsource such tasks. 29 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Workspace organization When the facilities and equipment are in place, a manager should allocate responsibility for the organization of each facility by applying the following four steps: 1. Remove clutter : eliminate all unnecessary tools, parts, equipment, out-of-date paperwork. 2. Identify regularly used items: tools, parts, instructions and paperwork. Regularly used items should be arranged so they are easiest and quickest to locate. 3. System and responsibility: have a system for each workspace and someone responsible for implementing the system. 4. Monitor : the system to make sure the change sticks. B.3: Range of appropriate wheelchairs What is meant by an appropriate wheelchair and cushion? The needs of each wheelchair user will vary. However, they all need an appropriate wheelchair and cushion. The WHO Guidelines on the provision of manual wheelchairs in less resourced settings define an appropriate wheelchair as follows: • meets the user’s needs and environmental conditions; • provides proper fit and postural support; • is safe and durable; • is available in the country and; • can be obtained and maintained and services sustained in the country at the most economical and affordable price. To meet the needs of the wheelchair users accessing a wheelchair service, services need a supply of at least a few different types of wheelchairs and wheelchair cushions. The type of cushion best suited to the user will depend on their needs. 30 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS However, any person at risk of developing a pressure sore needs a pressure relief cushion along with training in its use. Cost of not having the right equipment in combination with user training Average life expectancy in well-resourced countries is approximately 38 years post-injury for people injured between the ages of 25 and 34 years(8). In contrast, a study carried out in Bangladesh found the median life expectancy following spinal cord injury to be 5.36 years, with 56.4% of people dying within five years of their injury(9). Of the people within the study, 80% died at home, and of those who died at home, one third had pressure sores at the time of death. In a rehabilitation hospital in Sri Lanka, a hospital cost survey was carried out on the spinal injuries unit in 1999. At that time, it took an estimated six weeks to heal a superficial pressure sore at a cost of $ 286. A deep pressure sore required approximately one year to heal and cost an estimated $ 2483. The same survey demonstrated that the introduction of the right wheelchair, cushion and mattress and adequate patient education could reduce the incidence of pressure sores during hospital stays by 70% and expenditure on dressings by nearly 60%. A hospital programme in Sao Paulo Brazil introduced a service with a focus on education to reduce secondary complications for people with spinal-cord injury. The incidence of pressure sores reduced by 23%(10). Selecting a range of appropriate wheelchairs and cushions Providing proper fit and support Wheelchair users need wheelchairs that fit their size. The wrong sized wheelchair can be uncomfortable, will not provide good postural support, and may cause the wheelchair user harm. This means that a wheelchair service will need a supply of different sized wheelchairs, or wheelchairs that can be adjusted in size. Most wheelchair users spend many hours a day sitting. This means that their wheelchair is not just a mobility aid. It also helps to support them to sit upright comfortably. People also have different postural support needs and therefore require wheelchairs with different types of support. 31 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS People with basic level posture support needs require the support of a well fitting wheelchair. People with intermediate level posture support needs require a well fitting wheelchair with extra support. Extra support can be provided by adding extra posture supports to the wheelchair, or by providing a dedicated supportive seat. The cost of not providing the right size, or the right support Staff at the Western Cape Rehabilitation Centre in South Africa documented the complications observed in a group of children at schools and care centres who needed postural support but did not have it within their wheelchairs. Among them, 21% of the children developed additional postural complications. The cost of these complications for the children and their families and services were: • increased complications and more time attending appointments; • poorer health; • poorer posture and discomfort; • lower sitting tolerance (sitting less time in comfort); • decreased participation in educational programmes; • decreased quality of life. Meeting the user’s needs and environment An appropriate wheelchair should make it easier for a wheelchair user to carry out the things they need to do. Wheelchair users need to be able to get in and out of their wheelchair, to push their wheelchair, to fold the wheelchair for transport and storage and carry out their daily activities. The right type of wheelchair and the correct features on the wheelchair can make doing these things easier for the wheelchair user. 32 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Wheelchair users also need a wheelchair that will work well for them in their environment. Different wheelchairs are suited to different environments. For example, some wheelchairs are better for use indoors, others are better for use outdoors and over rough terrain. Abandoned equipment: is something better than nothing? When equipment does not meet the needs of the user – it is often abandoned. This illustration tells a common story. This wheelchair user has three donated wheelchairs – however none meet his needs, and he cannot leave his house. The first two wheelchairs are no longer usable as they are broken and there are no spare parts available. The third is new; however, it is a poor quality wheelchair, which feels wobbly and unstable when used outside, so the wheelchair user feels unsafe. Safety and durability Wheelchair users want safe and durable products, which can be repaired at an affordable cost. Wheelchair services also benefit from ensuring that the wheelchairs they provide are safe, durable and can be repaired locally. This can help to reduce the cost of replacing wheelchairs and make the work of wheelchair maintenance easier. Many wheelchair users in less resourced settings use their wheelchair to travel over rough terrain, and may have to expose their wheelchair to rain, sand and mud. This means that their wheelchairs need to be strong and made to last in these conditions. Poor quality wheelchairs will break down quickly (for example in 1–6 months); however well designed wheelchairs that are well maintained can last for 3–5 years. This is much better value for money. 33 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Some common problems with poor quality wheelchairs include: • poor quality seat and backrest upholstery tears or sags; • castor wheels (axles, tyres, bearings, castor forks) break down; • rear wheels (wheel axle, push ring, spokes, bearings, tyres) break or wear out; • brakes become rusted and do not work; • footrests break; • cushions are either not provided, or are of a poor quality and quickly break down; • removable parts get lost. The manager’s role Wheelchair service managers play an important role in procuring or receiving donated wheelchairs. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. Their role is to ensure that: • The service has a choice of wheelchairs and cushions – to be able to meet (as much as possible) the different needs of wheelchair users. This includes considering the different size range, postural support, environment and lifestyle needs. • Wheelchairs selected will be durable – particularly when used in rough and harsh environments. • Wheelchairs can be repaired locally. This may include ensuring that spare parts are procured (or provided with a donation), or that spare parts can easily be purchased locally. Actively seeking feedback from wheelchair users about the products being provided by the wheelchair service is important. Managers and service personnel can speak to wheelchair users through home visits, group meetings, or via disabled people’s organizations. When introducing a new type of wheelchair or cushion for the first time, a wheelchair service may choose to run a product trial with a group of wheelchair users who try out the new product over a period of time and provide feedback. Feedback may be gathered via individual interviews or through focus groups. 34 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS How can managers ensure wheelchairs they procure or receive are durable and can be repaired? Managers can ask questions of suppliers (or donors) to find out more about the wheelchairs. For example, managers can ask: • Has the wheelchair passed any certified standards (for example: performance tests and quality assurance tests set by a professional body)? If yes, what were the results? • Does the supplier recommend a particular lifespan for the wheelchair? • Does the supplier have a system for reporting faults? • Who else buys and uses the wheelchairs? It is possible for the manager to get in touch with other services that provide the wheelchair to find out more about its performance? • What tools are required to assemble and/or adjust the wheelchair? • Are there spare parts available? Do these parts need to be purchased overseas, or are some of the spare parts that may be needed readily available in your country? • Has the wheelchair been tried in the country, and if so what feedback/results were there? • If the frame breaks – can this be repaired locally? • Does the wheelchair come with a maintenance guide? Wheelchair maintenance, repairs and follow-up Step eight in wheelchair service delivery is follow-up, maintenance and repair. Follow-up, maintenance and repair Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. An important part of this step is teaching wheelchair users and their families how to maintain their wheelchair. Regular maintenance, carried out at home, can help to ensure that wheelchairs last longer, and there is less need for major repairs. 35 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Wheelchair services may also train collaborating partners to provide maintenance and repair services, and identify resources in the community (for example, bicycle repair shops) where wheelchair maintenance and repair can be carried out. B.4 Align personnel Roles in a wheelchair service Wheelchair service delivery is often provided by a group of people working as a team. Different members of the team fulfil different roles – such as clinical, technical, training, administration and management. Different individuals may fulfil one or more roles. For example, a person carrying out a clinical role may also play a role in managing the service. In some situations, personnel from different organizations may work together to fulfil the different roles. The table below shows how personnel fulfilling different roles cover the different activities involved in wheelchair service delivery. 36 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS C lin ic al Te ch ni ca l T ra in in g fo r w he el ch ai r us er s A dm in is tr at io n M an ag em en t Service management and development Promoting the service      Sourcing funding  Developing referral sources     Liaising with other organizations      Service evaluation      Key steps in service delivery 1. Referral and appointment     2. Assessment    3. Prescription    4. Funding and ordering     5. Product preparation  6. Fitting   7. User training    8. Follow-up, maintenance and repair    Training and professional development Training referral network personnel    Training network personnel    Training service delivery personnel    37 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Training The service roles can be delivered by people with different educational and professional backgrounds as long as the appropriate training has been given. It is important that personnel fulfilling the clinical, technical and training roles have received training. • Clinical and technical personnel providing a basic level service should be trained to the competencies outlined in the WHO Wheelchair Service Training Package – Basic Level. • Clinical and technical personnel providing an intermediate level service should be trained to the competencies outlined in the WHO Wheelchair Service Training Package – Intermediate Level. Remember: When providing personnel with skills training, it is a good idea to train at least two people at one time. If only one person is trained, the service is very vulnerable – if he or she leaves, all the knowledge and experience leaves with him or her. Planning your service capacity Managers need to be able to plan their service based on how many wheelchair users they will be able to provide a service for each month and year. This can be called the “service capacity”. Service capacity includes: • the number of wheelchair users who will receive a wheelchair for the first time; • the number of wheelchair users who will be followed up on. Service capacity is directly linked to: • the number of personnel available for wheelchair service delivery; • the amount of time personnel have available for wheelchair service delivery; • the number of wheelchairs the service is able to procure – which in turn is often directly linked to the budget. Calculating personnel time Managers need to calculate how much time their personnel will spend on wheelchair service delivery in order to estimate service capacity. To do this, managers need to know: 38 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS • the number of working weeks available each year (deducting public holidays and annual leave); • the percentage of time personnel will spend on carrying out wheelchair service delivery (and not other duties, roles or activities). Managers should also consider how long their personnel take to carry out the different wheelchair service delivery steps. There are many factors that will influence this. For example, whether service personnel are new or experienced; whether the wheelchair provided requires modification or not. However, as a guide, an experienced team (clinician and technician) may be able to provide: • two basic level clients with a new wheelchair per day or • one intermediate level client with a new wheelchair per day. The table below provides an example of estimated service capacity based on a team of two people working together. One member of the team fulfils a clinical role, the other fulfils a technical role, and both provide user training. The team works 5 days/week, for 42 weeks of the year. If there are sufficient wheelchairs and materials, this team can provide: • an estimated 357 wheelchair users with a basic level wheelchair service each year; or • an estimated 179 wheelchair users with an intermediate level wheelchair service per year. Basic service Intermediate service Planning working week Number of working days/week 5 5 Number of working weeks/year (deducting holidays and leave) 42 42 Estimating service capacity Number of service users/day 2 1 Number of service users/week 10 5 Number of service users/year 420 210 Contingency @ 15% (for unexpected events) -63 -31 Estimated number of users/year 357 179 39 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS The role of the manager in creating or developing a wheelchair service delivery team • Identify existing or new personnel to carry out the different roles in the wheelchair service. • Arrange for training for those personnel who do not already have the necessary skills. • Define the time personnel have available to spend on wheelchair service delivery, making sure that this time is realistic based on any other duties, roles or activities they fulfil. • Estimate the annual service capacity – and communicate this to the team. • Support personnel to carry out their wheelchair service delivery roles. For example: o involve personnel in planning for the service; o create a weekly/monthly planning tool – showing appointments and other activities; o hold weekly meetings to check on progress, highlight successes, and address challenges. B.5: What does a wheelchair service cost? Identifying the cost of wheelchair service delivery is an important role for the manager. The following table shows some of the common budget lines associated with setting up and running a wheelchair service. The actual costs will vary depending on the context. 40 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Budget item Comments Start-up costs Product design Sourcing a range of products Tools Equipment Building/facilities May include building/renovation/refurbishment. Stock of materials Operational costs Wheelchairs Wheelchair stock – based on estimated service capacity and anticipated needs of wheelchair user clients. Spare parts Maintaining a stock of commonly needed spare parts is very useful. Materials At the basic level, some materials are required for modifications. At the intermediate level, more materials are required. Freight (product transport) Shipping and customs for imported wheelchairs. Transporting wheelchairs to satellite centres. Personnel Management A wide range of potential staff are listed in the budget guide. It is not expected that each service will have all of these staff members. The ticks (see spreadsheet) represent activities relating to service steps. One member of staff may be responsible for carrying out more than one activity. Clinical staff Technical staff Trainer/peer trainer Administrator Local transport Local transport for personnel For example, follow-up, outreach services, training referral networks. Local transport for clients Travelling to the service for appointments. Accommodation for clients Cost of providing accommodation for clients who need to stay overnight (if this is covered/supported by the service). Printed materials Forms, checklists and user information. Consumables For example, glue, thread, and paint. Tool replacement Tools wear out – and funds therefore need to be budgeted for replacement. Overheads Consider electricity, water, rent – for the different service areas (clinical, technical, storage, user training, and office). Training of personnel Consider any training costs for service personnel. Training partners/referral networks Consider any training/awareness activities for partners or referral network organizations. Fundraising The cost of any fundraising activities should be budgeted for. Monitoring and evaluation Costs associated with monitoring and evaluating – for example, visiting service users to gather feedback. The costs may include travel or additional personnel. 41 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Cost-effective solutions Managers working in less resourced settings need to look for ways to reduce costs. Some ways that costs can be reduced are: Integrated services • An integrated service, which effectively shares facilities, can provide significant cost-sharing opportunities compared to establishing individual services. Cost-sharing with other organizations A service may partner with other organizations to share costs. For example: • Some international donor/development organizations may be interested in sharing the cost of wheelchairs. The benefit for the service centre is that the products are more affordable. The benefit for the international organization is that their funds go further, and they see that the service centre is demonstrating capacity to work towards financial sustainability. • Local community organizations may be willing to partner with the service to provide more local services. The community partner may be able to provide facilities, and some personnel to carry out some of the wheelchair service delivery steps (for example, follow-up and user training). The benefit for wheelchair users is that there would be less travel and cost. The benefit for the service centre is that services can expand into the community. Potential funding sources More information on how to source funding for wheelchair service set-up and running costs is discussed in C.4: Planning for financial sustainability. 42 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS C: Running a wheelchair service C.1: How do you know if your service is working? Monitoring and evaluation (M&E) helps managers see what is (or is not) happening as a result of their teams’ activities. It also helps managers and their teams to learn what is and is not working, and to understand what their service users and stakeholders think. What is monitoring and evaluation? Monitoring Evaluation When is it done? • Continuously • Integrated into daily service activities • At key stages of the service – for example during an annual review (although some information may be collected continuously) What is measured? • Service activities • Wheelchairs and extra supports used • Number and population of people benefitting • Impact on individuals and communities • Sustainability What sources of information are used? • Service user databases • Service notes • Service data • User feedback • Financial reports • Analysis of staff time • Surveys • Questionnaires • Group discussions • Home visits • Observation of service in practice • Review of accounts 43 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Efficient and effective services How is M&E useful for managers and others involved in the service? • Provides important information to improve the quality of service delivery. • Provides information to guide product procurement. • Helps to contain costs by increasing efficiency and justify current and proposed funding. • Enables services to demonstrate with evidence the effectiveness of the service to funders – including the government and NGO donors. • Helps identify and quantify unmet needs. • Informs appropriate allocation of resources. • Raises awareness of the benefits of the service. • Develops stronger partnerships with service recipients. When planning how to monitor and evaluate a service, it is helpful to create a three-step framework. Further details can be found in table 3.5 of the Wheelchair Guidelines. 1. Planning area to be monitored 2. Setting performance targets 3. Identifying ways of collecting information When analysing the information and data gathered there are two important considerations: • when an activity is not going well, work together with service users, service personnel and other stakeholders to get to the root cause of the problem; 44 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS • when an activity is going well and targets have been achieved, find ways to share and celebrate the success. This is very motivating for the service team and other stakeholders. The importance of user feedback Evaluation allows the service to reflect on what is working well and what needs to change. It also allows the service to reflect on whether it is achieving its overall purpose. The purpose, as stated in the Wheelchair Guidelines is: • to promote personal mobility with the greatest possible independence; • to enhance quality of life through improved access to wheelchairs; • to increase inclusion and participation. There are a number of criteria that can be used to evaluate a service. These include: • users served and the intervention they received; • cost of service, including cost of products and service delivery; • staffing (numbers of personnel, their roles and competencies); • the facilities and equipment available to the service; • the quality of service delivery (good practice recommendations are listed in the Wheelchair Guidelines in section 3.3); • the impact the service has had on users and their families. 45 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS It is very important to involve wheelchair users in the evaluation of wheelchair services. When planning user feedback, here are some important considerations: • Transport and time are two of the most significant costs. Wheelchair users providing feedback may need support to cover any associated travel or time. • Feedback could be routinely gathered from every service user, or on a random selection each month or year. • The service will only benefit if service users feel free to be open and honest with their feedback. It can be helpful to have a person who is not directly part of the service carry out interviews. An example of the benefit of service evaluation from Ethiopia: Two field officers interviewed 140 wheelchair users from seven service centres across the country. Both field officers had a mobility disability and this was found to be very beneficial for their role. The field officers themselves became well informed of issues facing wheelchair users in their country. The process has empowered them as advocates for the needs and rights of wheelchair users. The service users gained emotional and psychological benefits from being interviewed by a positive role model. Following the evaluation interviews, an informal network evolved which led to a stronger relationship between the service providers and users. In addition, through the evaluation, some instances were identified where a wheelchair user had not received a wheelchair suitable for their needs. This was traced back to a training need within the service, and the service has been able to act on this. Importance of baseline information when evaluating impact In order to look at the impact that the service has for people who receive a wheelchair, it is important to record the situation for an individual before any intervention, that is, before an assessment begins. 46 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Possible opportunities for gathering baseline information include: • when a referral is made – by personnel at a referral centre or clinic; • between referral and assessment – through a home visit or by telephone; • at the time of assessment – before starting the assessment. For more information, refer to the Additional Resources for Managers Manual on the Pen Drive. When carrying out interviews to gather information from service users it is important to prepare the person/s who will carry out the interviews. This is in order to get a clear, complete response to each question. This is important for valid data. Advice on interview technique Preparation: • practice what you will say before the interview. Don’t say more than is necessary. Technique: • read questions as they are stated; • do not suggest answers to the respondent, not even subtly; • be neutral if you need to explain anything; • record responses correctly. Respect the person: • do not proceed unless the person freely and voluntarily agrees to be interviewed; • help the person to feel relaxed; • do not appear shocked, pleased or upset by anything the person says; • treat the person’s answers as confidential. Establishing a good baseline user information system will improve the quality of the wheelchair service, which in turn will reflect on the impact of the service on the user’s quality of life. This can be carried out: • as a routine part of follow-up; • as a separate activity. 47 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Evaluating impact for children Where possible, it is important to give children “a voice” in feeding back on the impact of their wheelchair and service. An example is the use of Feeling Dice(11). First, the different feelings are categorized with the child. Then, they can be asked to complete statements such as “I am happy when…”, “I am sad when…” Angry Sad Hurt Embarrassed Excited Happy Recording and processing data Monitoring and evaluation involves recording, collecting, storing, and processing information (data). Efficient recording of data can save time and money. It is ideal to enter the data directly into a database, which is set up to process results and create the most useful reports for the service. Portable tablet computers can be very useful as they allow data to be recorded in field visits as well as at a centre. Mobile phone technology is progressing rapidly and may also be a method for entering, sending, and receiving data. Creating a service plan An annual service plan, which is monitored throughout the year, can help to ensure an efficient and effective service. Remember to motivate, engage and commit service personnel by involving them in creating the plan and targets. The service plan may include an evaluation at the end of the year. A sample service plan framework with one example is presented below. 48 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Service plan framework Identify a need/ problem to be monitored Action/objective to address the need/problem Target Information collection Far fewer women than men (20% women, 80% men) have accessed the wheelchair service in the past year. Increase identification and referral of women to the service by: • talking to referral sources – including village representatives about identifying women • collaborating with the national DPO to identify women role models who can encourage women to attend the service. Increase the percentage of women accessing the wheelchair service to at least 40%. Continue to keep wheelchair user database up to date – as this identifies how many men and how many women are accessing the service. C.2: Managing demand When running a service there is an important balance between user needs generating demand and the capacity of service personnel to supply an appropriate service. Creating demand The need for services can be estimated by calculating 1% of the population in the area in which the service is working. However, if people lack awareness of the service and its benefits, or are unable to access the service, then demand may be low despite the need. 49 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS When the demand for services is low; the cost per service user goes up; threatening the financial sustainability of the service. Too few referrals Cost of service goes up C.2.2 Managing demand Balancing referra ls and appointme nts A manager’s role is to get to the root cause of why referrals are low. Possibilities include: • the service has not identified the most appropriate referral sources; • people who need a wheelchair are not accessing the referral sources; • referral network training did not get across the benefits and importance of a wheelchair service; • wheelchair users are unable to access the service – because it is too far from where they live, and/or there is no transport available. Once the cause or causes of lack of referrals is known, managers and their teams can work to generate demand. Managing demand If the number of people being referred to a service becomes more than the personnel can manage, there are three likely results: • personnel spend less time than they need with each person – and the quality of service goes down; or • the time that wheelchair users have to wait for an appointment goes up; or • some wheelchair users are turned away. In each case, the situation is demoralizing for both service users and service personnel. Too many referrals – less resources Quality of service goes down/long waiting list C.2.3 Managing demand Balancing referra ls and appointme nts 50 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS It is therefore very helpful to carefully manage demand. Managers should initially target fewer referral sources, starting with sources close by. This has the added advantage of making follow-up easier while the service is new. Mass media and national toll-free numbers are likely to generate mass demand from long distances. Without a service network, this will be difficult and costly for the service users and service providers to manage. Creating and managing waiting lists When demand for a service is high; create a waiting list. It is cost effective to invest time in creating a system that uses a database to record this information. This will allow a manager and service personnel to access information efficiently and enable easy processing of service statistics. Once a person accesses the service, additional information can be added, for example date of assessment, date of fitting, follow-up appointment. Screening referrals and waiting lists As numbers on waiting lists increase, some organizations screen and prioritize referrals. The following groups of people should be considered a priority: • children – because of the importance of early referral and increased risk of developing posture deviations during growth spurts; • wheelchair users at risk of developing a pressure sore – because this is a life-threatening condition; • wheelchair users who have a progressive condition – because of the urgency of their position; • people who are experiencing pain because of a lack of wheelchair or a poorly fitting wheelchair. 51 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Some key database fields to consider to help screening and planning appointments include: • age; • type of disability; • reason for referral; • geographical location. Service capacity It is important to manage expectations of what a service can provide – in terms of the number of wheelchair users who can be seen, and the level of service delivery. Although the need will exist for intermediate and advanced services, not every service will have the capacity to deliver at these levels. However, service personnel will be presented with service users who have needs that go beyond their knowledge, skill and product availability. Managers need to ensure there is a strategy for how to deal with this situation. Managers can: • ensure that information about the service (what the service can do) is clear on brochures/leaflets; • liaise with other service providers to see if referral or collaboration is possible for people with needs that go beyond the capacity of their service; • document needs that cannot be met – and plan for increasing the capacity of personnel and products available. The importance of early referral for children Many children who require wheelchairs, may also need additional posture support. This means that many children require an intermediate level service. It is very important for all children to be referred to services as early as possible, to prevent or slow down problems with posture. The specific needs of children and the benefits of early referral are discussed in the session on Children in the WSTP intermediate training. Early referral is important for children for the following reasons: 52 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS • Children who have difficulty sitting upright can develop postural problems if they are not well supported. If a child is referred after a delay some postural problems may have become fixed. This can make it difficult for the child to sit comfortably even with support. • Without the experience of sitting and being mobile, a child’s development can be delayed. • For children who have some ability to walk – using a wheelchair may make their daily life easier and allow them to do more things in a day. Unfortunately, children are frequently not referred to a wheelchair service as soon as they should be. Parents may be hoping that their child will be “cured” and will walk again. Some parents worry that a wheelchair will cost too much, or do not know about the service. In some instances, parents may think that providing a wheelchair will stop their child from walking. It is important that the whole service team is clear about the reasons why early referral is important. Personnel can also reassure parents and referral sources that a wheelchair is unlikely to prevent a child from walking if this is possible for them. The experience of mobility through a wheelchair while the child is learning to walk will benefit their development in many other ways. Example of success: early referral by parents in Mexico Here is an example of how a group of rehabilitation centres for children in Mexico built an effective early referral network. Although rehabilitation centres primarily targeted neonatal doctors and paediatricians with their awareness-raising activities, they also had a major annual fund-raising campaign aimed at the general community that used extensive media coverage including radio and television. This led to a lot of word-of-mouth referrals and many parents self-referring their children. During the awareness activities, the centres had a clear message: the importance of referring children for rehabilitation when they are born. They also presented a powerful vision of success with many positive stories relating to integration and achievements of the children with whom they work. Over a period of 15 years, the rehabilitation centres have seen a cultural shift as paediatricians and families are now actively making early referrals. The result: A third of all referrals are for children aged 3 years and younger. How managers can build success in encouraging early referrals • clear message about who is being targeted; • clear goal of what they want to achieve; • a different approach for professionals and parents; • sharing success stories to encourage parents and professionals to refer ; • sustained awareness-raising activities over a period of years. 53 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Running efficient and effective services Analysing service efficiency and effectiveness Once a service is running, it is useful to analyse each service step and observe how long each step is taking. Improving the efficiency of the service steps should focus on: • encouraging good teamwork; • planning what can be prepared in advance for each service step. The table below provides some suggestions for how to improve service efficiency. Different ways to improve service efficiency – for each step in wheelchair service delivery Referral • Set clear goals and targets for the level of demand the service wants to achieve. • Clear message about who the service is for. • Identify a range of referral organizations and professions for awareness-raising. • Closely monitor the levels of referrals. • Share success stories with service personnel and the referral network when referrals increase. Assessment • Plan the appropriate level of training for service personnel. • Build the capacity of community partners to provide basic level services and refer intermediate level service users. • Ensure all equipment is in place for assessment to be carried out. Prescription • Establish effective stock control systems. • If products have limited adjustability, modifications must be prescribed to make the products fit individual users. • Ensure personnel discuss prescription solutions with the wheelchair user, and if possible show the user the product options. This will avoid the user rejecting solutions. • Build the capacity of community partners to provide basic level services and refer intermediate level service users. Funding and ordering • Clear documenting of information and record keeping. • Establish effective stock control systems. 54 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Different ways to improve service efficiency – for each step in wheelchair service delivery Product preparation • Source products with as much range of adjustability as possible. • Source products that can easily be modified. • Prefabricate posture support devices and/or source products with PSDs. • Source appropriate tools for making quick product adjustments. • Source appropriate materials for cushion and PSD fabrication and modifications. • Establish effective stock control systems. • Prepare a small stock of wheelchairs in different sizes. • Build the capacity of community partners to provide basic level services and refer intermediate level service users. Fitting • Clinical and technical teams work together during fitting. • Pre-prepare sample product set-up options. • Source products with as much range of adjustability as possible. • Source appropriate tools for making quick product adjustments. • Source products that can easily be modified. • Build the capacity of community partners to provide basic level services and refer intermediate level service users. User training • Allocate user training to a specific person, for example, a peer trainer. • Identify facility for user training close to clinical and technical areas. • Build the capacity of community partners to provide basic level services and refer intermediate level service users. Follow-up • Build capacity of community partners to follow-up clients in the community, referring back to the service when a problem is identified that cannot be solved at the community level. Overall • Hold regular team meetings to create shared work plans. • Clear scheduling for joint working. • Clear documenting of information and record keeping • Build the capacity of community partners to provide basic level services and refer intermediate level service users. Transition from basic only service to basic and intermediate service Many wheelchair services begin by offering only basic wheelchair service delivery. This is a good place to start, as the service can focus on building the systems associated with delivering the eight steps, and personnel can gain experience. However, as noted above, many wheelchair services will face a demand for intermediate level wheelchair service delivery. This is not surprising, as it is 55 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS estimated that 35% of users needs are at basic level and 65% at intermediate or advanced level. Therefore, service managers are likely to need to begin planning for how they can meet intermediate level needs within their service. As previously noted, intermediate level services require: • personnel with the appropriate training • more facilities, equipment and materials. Some possible strategies for managers to consider when transitioning from basic services to intermediate services include: • Work with personnel to identify how intermediate services could be offered. Consider the additional facilities and equipment required, and the service model that would be used. • Identify whether personnel providing basic level services have the capacity to deliver intermediate level services with more training. If yes – identify and train replacement personnel for basic level services first; and then train the identified intermediate level personnel. • Consider whether it is possible to collaborate with other organizations – if your service cannot identify personnel or does not have funds to pay more personnel. C.3: Planning follow-up Follow-up is the eighth step in wheelchair provision. All wheelchair users benefit from being followed up. It is important for a service to have a plan for how follow- up will be carried out. During follow-up, services also benefit from the opportunity to learn about the impact of the service on the user, their family members and their community. 8. Follow-up, maintenance and repairs Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. 56 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Importance of follow-up Some examples of why follow-up is important Duli: is a 21-year-old woman living with her family. On follow-up, the team found that she was unable to leave her house because her wheelchair had flat tyres due to punctures. The wheelchair had been abandoned underneath the house. The punctures were repaired and advice was given to the family. Duli was then able to leave her home again. The family did not value follow-up until they experienced the benefits. The service team decided to create stickers with the service contact number for all wheelchairs to reduce this problem in the future. Maria: received an appropriate wheelchair nine months after having a spinal cord injury. On follow-up, she was uncomfortable and was experiencing spasms, which she thought were due to the wheelchair. It was discovered that bugs had infested the wheelchair upholstery and were biting her. This could have led to serious health complications and abandonment of the product. However, the problem was identified and dealt with and Maria is now healthy and happy with her wheelchair. Anton: was known in his community for his ability as a rugby player. Then he had a rugby injury, causing a spinal cord injury. He received an appropriate wheelchair and user training but on follow-up it was found he was not leaving his home. A peer trainer was part of the follow-up team and spent time talking with Anton and discovered he had lost confidence and did not want to meet his friends. He felt isolated, lonely and embarrassed about “being disabled”. The peer trainer returned the next day to go out with him for the first time. Since that day, Anton’s life has moved forward. Gihan: is a 3-year-old boy living with his parents and brother. At follow-up, his supportive seat was found to be covered in food, and was not maintained. His parents reported that Gihan had difficulty sitting up and was uncomfortable in the chair. They had lost confidence in the product and did not like it. Gihan was booked in for reassessment with a team who had received intermediate level training. Modifications were made to the wheelchair set-up and Gihan was able to sit upright and started looking around and exploring his environment. Gihan and his parents were very happy and watched closely when they were shown how to care for and maintain Gihan’s wheelchair. Benefits of follow-up for the user and the service • Personnel can confirm whether or not the wheelchair is meeting the user’s needs in their own environment. • Home and community visits are a good opportunity to gather user stories – which can be used to provide feedback for the service and help with fundraising. • Centre-based follow-up is still an opportunity to gather user stories to provide feedback for the service and help with fundraising. 57 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Purpose of follow-up and where it should happen The purpose of follow-up is to: • gather information from the wheelchair user • check that the wheelchair is in good working order • check the fit of the wheelchair. Common follow-up actions Some of the common actions that arise from a follow-up visit are: • providing more advice or training • readjusting the wheelchair • carrying out minor repairs • referring the wheelchair user to another service for support or assistance if needed. Wherever possible, follow-up appointments should not turn into a new assessment or full refurbishment of a wheelchair. If the need to carry out a full assessment, or do major work on the wheelchair is identified – an appointment should be made for that to happen. Where should follow-up happen? Follow-up can happen in the wheelchair user’s home or at the wheelchair service centre or any other location that suits the wheelchair user and the wheelchair service personnel. The advantages of follow-up in different locations are listed in the table below. 58 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Benefits of follow-up in the user’s home or local community Benefits of follow-up at a service centre • More cost effective for user and their family. • Personnel learn more about the barriers to participation and inclusion that people face in their homes and communities. • Seeing personnel in action can increase community awareness – and therefore referrals. • More cost and time effective for personnel/the service. • Major repairs can be carried out with full workshop facilities. • All equipment and facilities are already set-up. • Other personnel are available for a second opinion. Planning for follow-up All wheelchair users benefit from follow-up. However, follow-up is most important for: • children with disabilities; • wheelchair users at risk of developing a pressure sore; • wheelchair users who have a progressive condition; • wheelchair users who need extra support in their wheelchair (intermediate level); • wheelchair users who have had difficulty with training in transfers, mobility, health or wheelchair maintenance. Timing of follow-up There are no rules about when follow-up should happen, as the best time to follow-up will depend on the needs of the wheelchair user. • It is helpful to review intermediate users within six weeks of receiving a new wheelchair to check that the wheelchair is meeting their needs. • For children and people with a progressive condition, it is ideal if follow-up is at least every six months. This is because the needs of children or people with a progressive condition can change quickly. • It is ideal if all other users are offered follow-up within 12 months of receiving their wheelchair. 59 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Remember: Follow-up should be built into the service model when first planning a service. Community partnerships are vital to create follow-up capacity. Impact of follow-up if community partnerships are not established The impact of follow-up on the availability of new appointments will be felt very quickly if a service does not plan. Intermediate services in particular are at risk of getting close to saturation by year three. One solution for this is to collaborate with community-based organizations – and train their personnel to carry out as much follow-up as possible. Community- based personnel may be able to manage many of the simpler follow-up tasks, only referring back to the wheelchair service for reassessment, major repairs, or other problems they cannot solve. There are many benefits of this role being carried out by a positive role model such as a person with a mobility disability. Follow-up users New potential users Total wheelchair users Basic Service Year 3 Total Slots Intermediate Service Year 3 Total Slots 60 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Establish community partnerships and plan the service model C.3.9 Planning follow-up Plan the follow-u p model C.3.9 Planning follow-up Plan the follow-u p model C.3.9 Planning follow-up Plan the follow-u p model A partner may support referral and follow-up including maintenance and repairs A partner may also support user training Depending on the capacity of the partner, they may also support some of the wider responsibilities of a service Reducing barriers to follow-up Despite the benefits to service users and service providers, the number of people receiving follow-up are often low. It is important to get to the root cause of why numbers are low, in order to overcome the barriers and improve the service. Possible barriers to users attending an outreach-based follow-up service: • costs of service centre staff travelling to communities; • time for service centre staff to travel to the community; • follow-up is not prioritized by service managers; • follow-up is not valued by service users until they experience the benefits. Possible barriers to users attending a centre-based follow-up service: • cost of travel and time off work for one or more family member; • users and family members are often not aware of the benefits of follow-up; • difficulty finding accessible transport; • pressure to focus on new appointments at the centre can leave no time for follow-up; • difficulty scheduling appointments: users may turn up when staff are not available, or not turn up when staff are available. 61 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS An example of an approach to follow-up in Indonesia For a wheelchair provision programme in Indonesia; rather than charge a fee directly for the wheelchair itself, they charge membership fees that contribute to the service, follow- up, maintenance, and administration costs. This membership fee entitles “members” to a quality service and ongoing support. There is a “sliding scale” fee system, in which the amount that an individual pays is determined based upon that individual’s household income, as identified via utility bills, civil service employment documents, self-reporting and other supporting income indicators.  This wheelchair programme has found that the membership system is effective on a number of levels:  • Members feel empowered to expect a quality service and product. • Because members have paid a significant amount relative to their income level (usually in the range of $ 2–20, but anywhere up to $ 150), they are more likely to value their wheelchair and feel a sense of pride in owning it. • Because the membership entitles them to free or discounted follow-up service, which expires within two years, members are more likely to seek follow-up sooner.  62 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Possible actions for overcoming barriers to follow-up Motivate, engage and commit service users to the benefits of follow-up: • explain benefits of follow-up during user training, service step seven; • share stories of the benefits of follow-up in the waiting room, on websites, on community noticeboards; • membership system for service users. Motivate, engage and commit service personnel to the benefits of follow-up: • pilot a follow-up scheme delivered by service personnel; • collect case studies of the benefits of follow-up. Identify an immediate and measurable result: • set targets for a pilot follow-up scheme; • gather and share stories of success. Prioritize follow-up when allocating resources: • use stories of success about the benefits of follow-up to support fundraising for specific costs relating to follow-up; • allocate time to develop community partnerships and train and mentor personnel in the community; • make sure all transport is accessible. Maintain support for facing ongoing challenges: • monitor follow-up data closely and identify the root causes of problems; • make follow-up part of the service model, systems and procedures. Inclusion and participation in the community Follow-up is a time to assess the impact of the service and whether it is achieving the overall vision: of increasing quality of life, inclusion and participation in the community. One of the wider roles of a wheelchair service is improving accessibility. This can have a significant impact on the inclusion and participation of wheelchair users in the community. 63 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Accessible homes and public spaces One of the main barriers to returning home is often access to a toilet Advice on simple changes to the home can make a huge difference to quality of life An architectural barriers campaign in Nicaragua In Nicaragua, a DPO called CADISCA ran a campaign in its capital city to highlight the problem of high kerbs and steps. The DPO members (all wheelchair users) built 200 ramps and “drop” kerbs (making a small area of a kerb level with the road) in just three months, creating access to public areas. The members of CADISCA were seen out in their community doing something positive, which raised support and resulted in local companies sponsoring the building of more dropped kerbs and ramps throughout the city. Early on, CADISCA used wheelchair basketball to promote self-confidence and boost member involvement in DPO activities. Sport training sessions also gave an opportunity for regular DPO meetings, where plans to raise awareness were organized. These training sessions were held in a public park, exposing the community to the DPO’s activities and raising awareness. Ultimately, the sports programme helped influence the success of the access campaign through gaining public awareness and support for disabled people. This helped to eventually pressure the government to fund dropped kerbs throughout Managua. The removal of physical barriers has given wheelchair users an equal opportunity to access key financial, educational and social areas within the city. C.3.12 Planning follow-up Removing archit ectural barriers 64 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS The cost to build in accessible features at the time of construction is minimal – sometimes less than 1% of the construction cost. Access to education can be prevented by something as simple as the width of a pathway and access to a toilet. Being able to offer resources and information on accessible buildings and pathways can empower schools to be inclusive. There are many resources on making buildings accessible. By providing advice and information on accessible environments; services can facilitate access to homes, transport and education; in this way, a service is maximizing the opportunities for inclusion and participation of people with mobility disabilities. Accessible transport Transport is a common barrier for wheelchair users. Challenges include: • getting transport to stop long enough to transfer and stow a wheelchair • being charged an additional fee to carry a wheelchair • risk of removable parts being lost or stolen, for example, wheels • difficulty accessing transport due to thresholds and doorways. There are inclusive transport initiatives in many countries; including Dial-a-Ride in South Africa and the Bus Rapid Transit system in Colombia. There are many useful resources on accessible transport around the world.(1) 1 Useful resources for more information on accessible transport: International Transport forum (ITF), Accessible Multimodal Transport, South Africa, Access Exchange International newsletter, Paratransit Guide – guidebook to transport issues. 65 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS C.4: Planning for financial sustainability What is financial sustainability? Financial sustainability for a wheelchair service means having the funds and resources required to carry out the eight steps of wheelchair service delivery and wider service responsibilities – consistently. Wheelchair service managers play a key role in developing a plan for how their wheelchair service will become financially sustainable. Example of a service statement on financial sustainability A sustainable wheelchair provision program is one with the capacity to provide appropriate wheelchairs through the eight steps of service to a consistent number of individuals over a significant period of time. This requires continuous investments in product supply, trained personnel, space, and monitoring and evaluation systems. Financial sustainability is reached when a service has secured, or is consistently able to secure, the funds and resources necessary to enable this continuous investment. Planning for financial sustainability This includes: • clearly identifying the funds and resources needed to sustain the service (see B.5) • identifying potential sources of funding • identifying potential non-monetary support • developing a strategy for securing funding and donations in kind. Identifying potential sources of funding Wheelchair services can be funded in many different ways, through a range of different funding sources. Some services may have one single funding source (for example, the government), but most services will secure the funds and resources needed from a range of different sources. Each funding source may contribute to specific area/s of the budget or resource requirements. 66 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Different funding sources that managers may consider Government National insurance schemes Private donors and sponsors Corporate (business) donors and sponsors User contributions or full purchase Income generation/social enterprise Community groups/charitable societies Diplomatic missions International and national NGOs Identifying potential non-monetary support Non-monetary support includes donations in kind (for example, donations of equipment, wheelchairs or materials), volunteer support, and provision of facilities. Non-monetary support can reduce the amount of funds required to manage the service. Some wheelchair services may regularly receive donated wheelchairs. While this can be very helpful – it is always important for the service to assess the quality and suitability of these wheelchairs. Not all donated wheelchairs are appropriate. Combining different funding sources to sustain a wheelchair service The table below provides an example of the different funding sources an example wheelchair service has identified; and how those funding sources contribute to the funds and resources needed for the organization to be financially sustainable. 67 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Funding sources for an example wheelchair service Funding source Funds or resources provided Government • Provides 50% of the cost of each wheelchair provided by the service; • Funds two personnel working for the wheelchair service (50% of the personnel budget). Corporate (business) • One local company provides an annual donation each year to the wheelchair budget line; • Another local company has pledged to sponsor 10 children each year – covering the cost of their wheelchairs and service delivery. Individuals • Provide donations to the service (not specified to any particular budget line). Social enterprise activities • The wheelchair service carries out a number of social enterprise activities. These include accessibility audits (of buildings) and supply of urinary management products. The profits from this work are used to support the wheelchair service, and are usually sufficient to fund at least 50% of the personnel budget. INGOs • The service has been awarded grant funding to provide wheelchairs to people living in specific areas through International NGOs on two occasions. Faith based organization • Provides an annual donation of 200 wheelchairs (wheelchairs selected by the service). Developing a strategy Once potential funding sources have been identified, service managers need to develop a strategy for what kind of support will be requested from which potential funding source, and how much. Part of developing a strategy includes considering how likely it is that the funding source will provide funds; how much the funding source may be able to provide; and how much time and effort will be required to secure this funding. 68 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS To help plan a strategy, managers can prioritize the different funding sources, and plan how they will approach securing funding. Managers need to consider: • Funding source: who will be approached? • Support: what will the manager ask that funding source to support. This may focus on a budget line, such as products – or a service step (or steps), with a number of associated budget lines. Consider the specific funding source, and what they are most likely to want to support. • Request: how much will you ask the funding source to provide/support? Factors to consider include resources of the funding source and the size of previous donations to the service or others. Aim to ask for a realistic amount. • Likelihood: the likelihood that the funding source will fund/support the service. This can be categorized as low, medium and high. • Effort: what will be required to secure the funding, and what reporting or other obligations will there be. The amount of the support should be in proportion to the amount of the funding. Obligations should also be affordable/manageable for the service. Two examples have been given in the table below. By considering the type of support, request, likelihood of success and the effort required, managers can better prioritize which funding sources to pursue. Funding source Type of support Request Likelihood Effort 1. Corporate (local business) Donation to wheelchair procurement budget. 10% of wheelchair budget. Medium (have funded previously, however do not always fund the same organization each year). At least two meetings with the business manager; 2 page proposal and budget to be submitted and invite manager to next open day. 2. Local government Potentially may fund costs of all outreach visits to wheelchair users in their area. 20% of all outreach costs and 20% of service personnel salaries. High (have been in discussion with this local government for a while. Have run one outreach to their area. They are very keen to support this and funding seems to be available). Formal proposal and budget to be submitted. Reporting commitments – require accurate data of all people seen from their area and financial reporting. 69 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Funding approaches Securing sustainable funding sources for a wheelchair service can be hard. The following are some examples of different funding approaches and ideas that could be considered. Note that often the approaches are different depending on the funding source. A business approach to meet a social need and generate income An NGO in Romania uses social enterprise as part of its approach to financial sustainability. The approach has two key objectives: a social impact and a financial impact. Wheelchair users are employed as part of multidisciplinary teams providing quality mobility equipment and medical supplies to people with disabilities. The quality of services is high as the team are very aware of the importance of correct positioning, and prevention of health care complications. The activity provides employment to people with disabilities, creating empowered consumers. The services also generate income to support other programmes run by the NGO. Direct purchase by the provider Some wheelchair services require a minimum contribution from the wheelchair user for the receipt of a wheelchair and wheelchair service delivery. Often there is a “sliding scale“ fee system, in which the amount that an individual pays is determined based upon that individual’s household income, as identified via utility bills, civil service employment documents, self-reporting and other supporting income indicators. Services securing some funds in this way do need to ensure that people who cannot pay any costs towards their wheelchair are not disadvantaged. Corporate donors and sponsors The Teletón in Mexico is an annual TV and radio event, held to raise money for children’s rehabilitation centres (CRIT centres). It is produced by Televisa and more than 600 Mexican and foreign media; and 20 commercial firms sponsor the event. They sell their vision of success with powerful positive stories about integration and achievements. Over a three month period prior to the event, the case studies are released through the media as part of the build-up. High profile personalities are involved in the promotion of the event. 70 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS In Romania, an NGO has a relationship with a corporate sponsor. To consolidate this relationship, an annual swimming gala is held at a prestigious health centre. Integrated teams involving the corporate staff, peer trainers, NGO staff and people with learning disabilities compete against each other. It is a fun event with benefits at many levels. Corporate staff then give ongoing financial support throughout the year; either direct contributions or through fundraising events. Government funding In Kenya, the Ministry of Medical Services has partnered with an NGO in wheelchair and other related rehabilitation services. The NGO provides all the logistical support to eight branches housed in government hospitals. The government provides the human resources. To date the Ministry has allocated 56 staff to the NGO branches. National Insurance Scheme in Romania • The first step for the wheelchair user is to apply for a disability certificate. Without this certificate an application for a wheelchair is not possible. • Next is to make an appointment with a rehab doctor who writes a prescription for a wheelchair. • The wheelchair user then makes an application to the county National Insurance Agency (NIA). • When the wheelchair user receives the approval/voucher, he/she chooses a supplier, and one of its wheelchairs. • If the wheelchair price is less than the subsidy, then the supplier provides the wheelchair to user in exchange for the voucher, which it uses to invoice the NIA. • If the wheelchair price is more than the subsidy, then the user must pay the balance or find complementary sources of funding, for example, donors, employers, and individuals. For further resources to support wheelchair services of basic and intermediate levels, please refer to the digital files in the Pen Drive. 71 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS References 1. Guidelines on the provision of manual wheelchairs in less resourced settings. Gene- va: World Health Organization; 2008 (http://www.who.int/disabilities/publications/ technology/wheelchairguidelines/en/). 2. Wheelchair Service Training Package - Basic Level. Geneva: World Health Organization; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. Wheelchair Service Training Package - Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). 4. Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007) New York: United Nations;2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers (Allen et al., 2006). 6. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 113 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 7. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 8. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006;44: 523–529. 9. Razzak ATMA, Helal SU, Nuri RP. Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclu- sive Development Journal. 2011; 22(1): 114-123. 10. World Health Organization, World Bank World report on disability, page 115. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/ report/en/). 11. Messiou K. Encouraging children to think in more inclusive ways. British Journal of Spe- cial Needs Education. 2008;35(1):26–32.

WHEELCHAIR SERVICE TRAINING PACKAGE Workbook For Managers Workbook

C O N T EN T S 77 Part One77 A. Core knowledge 77 A.1: Leading change 78 B. Starting a wheelchair service 78 B.1: Accessing services 79 B.2: Facilities and equipment 80 B.3: Range of appropriate wheelchairs 81 B.4: Align personnel 81 B.5: What does a wheelchair service cost? 82 C. Running a wheelchair service 82 C.1: How do you know if your service is working? 84 C.2: Managing demand 84 C.3: Planning follow-up 85 C.4: Planning for financial sustainability 86 Part Two 86 A. Core knowledge 86 A.1: Appropriate wheelchair provision: National policy 88 A.2: Service delivery 89 B. Starting a wheelchair service 89 B.1: Facilities and equipment 93 B.2: Range of appropriate wheelchairs 98 B.3: Align personnel: Roles 98 B.4: What does a wheelchair service cost? 100 C. Running a wheelchair service 100 C.1: Efficient and effective services 104 C.2: Developing efficient services 105 C.3: Managing demand 108 C.4: Planning follow-up 109 C.5: Developing financial sustainability Actions for managers to create or improve wheelchair provision The Workbook is divided into two parts: Part One: What needs to be done to start a service? This section focuses on the eight steps of wheelchair provision, facilities, equipment, range of appropriate wheelchairs, initial costs of starting a service and managing a demand. Part Two: What needs to be done to make a service sustainable beyond the initial start-up investment? This section focuses on appropriate wheelchair provision, running a service and actions to improve the efficiency, effectiveness, and responsiveness of service delivery. Financial sustainability is also discussed, including the importance of establishing partnerships and income streams to cover the ongoing costs of running and expanding a service. Both parts are divided into three sections: A. Core knowledge B. Starting a wheelchair service C. Running a wheelchair service. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 77 Part One A. Core knowledge A.1: Leading change • Review the change facilitators listed below. Record actions that you can take to introduce or improve wheelchair provision at your service centre. 1. Create a shared vision of appropriate wheelchair provision 2. Communicate the importance of appropriate wheelchair provision with a sense of urgency 3. Align personnel and resources 4. Motivate, engage and commit personnel: • include personnel in planning and implementation • overcome obstacles together • create and recognize short term wins • make the change stick in your organization’s systems and culture. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 78 B. Starting a wheelchair service B.1: Accessing services Questions Answers Question 1: Building a Referral Network As a manager, what actions can you take to build a network of individuals and organizations able to identify and refer wheelchair users to your wheelchair service? Question 2: Referral Forms Look at the sample referral forms in the Additional Resources for Managers Manual on the Pen Drive. Would this referral form (or an adapted version of this form) be a useful tool for your service? If no, why not? If yes - as the manager of your service – what can you do to introduce a referral form? (Note – if your service/s are already using a system, you can describe what you as manager/s have done to introduce or support the referral form). 1. Actions I can take to identify referral sources 2. Actions I can take to build a referral network 3. Actions I can take to decide whether to promote a referral form 4. Actions I can take to actively work towards an equitable wheelchair service WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 79 B.2: Facilities and equipment 1. Actions I can take to identify facilities and equipment suitable for my service model 2. Actions I can take to integrate forms and checklists into the service steps 3. Actions I can take to organize the facilities 4. Actions I can take to create systems and procedures for each facility including delegation of work where possible WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 80 B.3: Range of appropriate wheelchairs 1. Actions I can take to identify the needs of service users and the most important product features to meet those needs 2. Actions I can take to identify a suitable range of appropriate wheelchairs, cushions and spare parts 3. Actions I can take to identify suitable supplies of materials for making modifications to products 4. Actions I can take to discuss with different stakeholders the cost–benefit of appropriate wheelchairs and cushions delivered through a service WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 81 B.4: Align personnel 1. Actions I can take to identify service personnel 2. Actions I can take to include service personnel in planning 3. Actions I can take to coordinate teamwork and establish a weekly working plan 4. Actions I can take to identify annual service capacity B.5: What does a wheelchair service cost? 1. Actions I can take to consider service integration when planning a service model 2. Actions I can take to consider community partnerships when planning a service model 3. Actions I can take to prepare a budget for the planned service model WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 82 C. Running a wheelchair service C.1: How do you know if your service is working? Service areas and activities Service performance targets Methods of information collection Referral Number of users referred The service will receive 30 referrals per month Record referrals received Wheelchair provision Number of users who receive a wheelchair The service will prescribe and fit wheelchairs for 20 users per month Wheelchair prescriptions recorded on users’ files Wheelchair population served Details of users referred to the service, such as age, gender, disability, postural support needs The service will encourage equal access Number of women, men, girls and boys accessing the service recorded on user files Service costs Cost of products supplied, including modifications made within the service The individual cost of each wheelchair will be less than (amount specified according to budget and realistic cost of available products) Home address of users accessing the service recorded on user files WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 83 Service plan framework Identify a need/ problem to be monitored Action/objective to address the need/problem Target Information collection 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. Record actions to know if the service is working (if time permits) 1. Actions I can take to create a service plan 2. Actions I can take to monitor personnel in working towards a service plan 3. Actions I can take to evaluate how effectively the service is achieving its goal 4. Actions I can take to recognize team or individual success WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 84 C.2: Managing demand 1. Actions I can take to establish a system to monitor referrals and manage waiting lists 2. Actions I can take to share success stories of early referrals with parents and referral sources 3. Actions I can take to plan management of referral of clients with needs beyond the capacity of the service 4. Actions I can take to monitor and improve efficiency of service steps C.3: Planning follow-up 1. Actions I can take to plan follow-up 2. Actions I can take to establish and train community partnerships WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 85 3. Actions I can take to identify potential candidates for user training and follow-up 4. Actions I can take to gather and share success stories of the benefits of follow-up C.4: Planning for financial sustainability 1. Actions I can take to create a shared vision of financial sustainability 2. Actions I can take to identify the funds and resources required 3. Actions I can take to identify funding sources 4. Actions I can take to prioritize funding sources and develop a fundraising strategy WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 86 Part Two A. Core knowledge A.1: Appropriate wheelchair provision: National policy • Read the two examples of national policy relating to wheelchair provision. • Consider what policies already exist in your country. • Discuss how useful the policies below would be in your country and consider where they would fit within your government`s structure. Example 1: Policy in Afghanistan relating to wheelchair provision In October 2003, the Ministry of Martyrs and Disabled in Afghanistan published a Comprehensive National Disability Policy. The policy was “developed in a collaborative manner by all stakeholders including disabled people organizations and self-help groups; disability NGOs both national and international; major line ministries including Ministry of Education, Ministry of Public Health, Ministry of Labor and Social Affairs, Ministry of Women Affairs, and Ministry of Martyrs and Disabled (MMD); related UN agencies; and the President’s Office” (4). It is expected that the initial policy will lead to a more detailed and prioritized plan of action. The policy goes on to state: Provisions for people with physical disability should include orthopaedic rehabilitation centres; physiotherapy services, and orthopaedic, assistive and mobility devices. These services should be close to a regional or provincial hospital with orthopaedic surgical services so that the local population has easy access. Persons with disabilities have the right to receive devices. Devices should be well-made, well-fitting, of local materials whenever possible and repairable locally. Appropriate technology should be standardized throughout the country. A mechanism for national standardization should be created with relevant experts in collaboration with MOPH [the Ministry of Public Health]. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 87 Example 2: Policy in South Africa relating to wheelchair provision In 2003 national guidelines for assistive devices in South Africa were published. These guidelines were developed through consultation among all provinces of South Africa. The contribution made by the Western Cape province was based on their experience of developing provincial guidelines. The development of provincial guidelines was started by a group of clinicians providing wheelchair services. They consulted a provincial programme manager and the local rehabilitation services to develop a plan to professionalize the standard of wheelchair services. The plan had three major focus areas: 1. Perform a situation analysis of wheelchair services in the province 2. Implement training of wheelchair service providers 3. Set up guidelines for a provincial wheelchair management strategy. Provincial guidelines were drafted which included minimum standards for key service steps, as well as key management steps, such as training of staff, setting up and management of waiting lists, budgets and provision of repair and maintenance services. The provincial management assisted the group in becoming a formal advisory group. Representatives of this group accompanied the provincial managers to national meetings and contributed to the establishment of the national guidelines for assistive devices in South Africa. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 88 A.2: Service delivery Broader role of a manager Awareness Policy Raising awareness Improving accessibility Developing sustainability Influencing national policy Improving range of products available Increasing training opportunities Shared actions to improve appropriate wheelchair provision in the country Actions I can take in the next three months WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 89 B. Starting a wheelchair service B.1: Facilities and equipment B.1.1 Identifying suitable facilities • Look at the list of facilities below. • Think about practical solutions that will work in your service. Basic level facilities Does this facility already exist? Could this be a shared facility with an existing service? Could a room with another purpose be converted? Could an existing room be reorganized or restructured? 1. Waiting and reception 2. Quiet area for lying down 3. Accessible toilet 4. Office area for personnel 5. Clinical: area for assessment and fitting 6. Technical: area for wheelchair preparation, maintenance and repair WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 90 7. Storage 8. User training Additional intermediate level facilities Does this facility already exist? Could this be a shared facility with an existing service? Could a room with another purpose be converted? Could an existing room be reorganized or restructured? 9. Assessment and fitting area with bed for assessment in lying position 10. Additional storage space for materials 11. Additional product preparation area: sewing and upholstery WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 91 B.1.2 Identifying equipment • Refer to the reference manual for guidelines on equipment and paperwork. Equipment • Identify what equipment is already available and in use at your service centre and take note of any equipment to be made or purchased. Already available To be made or purchased Paperwork • Review the list of forms and checklists in the Additional Resources for Managers on the Pen Drive. • Which forms and checklists are already integrated and in use? Take note of any forms or checklists to be integrated into daily use. Already available To be integrated into existing service B.1.3 Workspace organization • Refer to the reference manual for guidelines on facilities and equipment. • Review tips on good workspace organization listed below: 1. Remove clutter : eliminate all unnecessary tools, parts, equipment, and out-of-date paperwork. 2. Identify regularly used items: tools, parts, instructions and paperwork. These items should be arranged so they are easiest and quickest to locate. 3. System and responsibility: have a system for each workspace and someone responsible for implementing the system. 4. Monitor : monitor the system to make sure the change sticks. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 92 Technical area • Analyse the example and make recommendations for improvement. Outreach clinical and technical area • Analyse the example and make recommendations for improvement. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 93 B.2: Range of appropriate wheelchairs B.2.1 Durability, repairability • Work together with your group and complete a set of questions assigned to you – based on your group number. • Use your own knowledge and experience along with the reference manual to complete the activity. Group 1 • What questions can you ask about the safety and durability of the products supplied? • How can you find out whether the product supplier (donor, manufacturer) is supplying products that will be safe and durable for your specific context? • Who else can you talk to in order to find out about safety and durability of products being offered by a donor/manufacturer/supplier? Durability Group 2 • Even products that are durable have parts that commonly wear out and break. What are some of these vulnerable parts? Parts which break and wear out Group 3 • A service needs spare parts. • How can you identify which spare parts are needed? • How do you know which spare parts need to be ordered? Spare parts WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 94 B.2.2 Supply of appropriate wheelchairs Scenario 1 • Read your assigned scenario below. Then read 'Principles of providing appropriate mobility devices'. • Prepare a role-playing scenario among provincial officials and a group of stakeholders advocating for a change in the wheelchair procurement system (3-5 minutes for role play). When discussing the role play, think about: • What are the problems in the scenario? • Possible actions to overcome the problems. A government hospital in your region has allocated a budget for the provision of wheelchairs. Annually the budget gets reviewed and the product list gets reconsidered. Even though each year there are requests to change the products available there is never any change and the procurement department purchases two types of product based on cost. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 95 Principles of providing appropriate mobility devices In order for countries to meet their obligations related to assistive technology (mobility devices), outlined in the Convention on the Rights of Persons with Disabilities the following key principles need to be considered: • Acceptability – people with disabilities must be involved in all stages of mobility device provision • Accessibility – mobility devices and related services must be accessible to everyone with an identified need • Adaptability – mobility devices and related services need to be adapted and modified to ensure they are appropriate to the needs of the individual • Affordability – mobility devices and associated services must be affordable • Availability – facilities, personnel and products must be sufficient for the needs of the population and provided as close as possible to the people’s own communities • Quality – products, facilities and services are of an appropriate quality. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 96 Scenario 2 • Read about the two government tender systems below. • Summarize the current system in your country now. • Refer to the ‘Principles of providing appropriate mobility devices’. • Prepare suggestions to create or improve a government tender system for supply of wheelchairs in your country. South Africa In South Africa purchase of wheelchairs by the government is controlled by a National Tender. The government works with people from different provinces who have expertise on wheelchairs and wheelchair services. They also consult with current wheelchair providers. Following the consultation, the product categories and the items in those categories are finalized, including a detailed specification of each product. Categories include a range of comfort and high risk cushions. Minimum durability standards for each product are specified. Once the tender specifications are finalized and approved, the national treasury opens the tender for the bidding process. Knowledgeable representatives inspect all products submitted for the bidding before contracts are awarded. The contracts include minimum delivery periods and penalty clauses for breach of contract conditions. Romania State funding for wheelchairs in Romania follows the pattern of subsidy for medicines. The subsidy process for wheelchairs started in 2001 when the State organized a tender for suppliers of wheelchairs. As a result of the tender, a base/reference price was agreed upon but nothing was defined regarding product quality or service delivery. The value of the subsidy is re-established every year. The first step for a wheelchair user is to apply for a disability certificate. Without this certificate it is impossible to access a wheelchair. Next, the user should make an appointment with a rehabilitation doctor who will write a prescription for a wheelchair. The wheelchair user then submits an application to the county National Insurance Agency (NIA). When the wheelchair user receives the approval/voucher, he or she first chooses a supplier, then a wheelchair. If the wheelchair price is less than the subsidy, the supplier provides the wheelchair to the user in exchange for the voucher, which is then used to invoice the NIA. If the wheelchair price is more than the subsidy, the user must pay the balance or find complementary sources of funding, for example donors, employers, and individuals. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 97 Scenario 3 • Prepare a role play scenario that demonstrates a meeting with a donor where you come up with a plan to supply appropriate wheelchairs through your service delivery system (3-5 min role play). When planning your role play: • Discuss how donated wheelchairs are currently distributed in your country. • Read the ‘Principles of providing appropriate mobility devices’. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 98 B.3: Align personnel: Roles • Look at the table listing the roles of wheelchair service personnel. • Write the name of who is responsible for each role in the table. • If you are responsible for more than one service centre be sure to list the personnel in each location. C lin ic al Te ch ni ca l U se r T ra in in g A dm in is tr at io n Service centre Service centre Service centre B.4: What does a wheelchair service cost? Review: each line in the budget below and consider which costs can be shared or saved by integrating a wheelchair service into an existing service. Circle in black pen all costs that can be saved. Circle in red pen all costs that can be shared. Example scenario of an integrated service A P&O service is planning to integrate a wheelchair service. Two personnel have been identified and sent on the WSTP basic course. Both personnel will work three days per week in the wheelchair service and two days per week in the P&O service. A workspace has been allocated in the workshop for a wheelchair technician. The therapy department have cleared out all broken and unused equipment to create space for a work area for the clinical role. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 99 Budget Guide SERVICE STEPS R ef er ra l & ap po in tm en t A ss es sm en t Pe rs cr ip ti o n F un di ng & o rd er in g P ro du ct pr ep ar at io n F it ti ng U se r - tr ai ni ng M ai nt en an ce , r ep ai rs & fo llo w -u p START-UP COSTS Product design Sourcing range of products  Tools    Equipment   Building/facilities    Stock of materials  OPERATIONAL COSTS Wheelchairs   Spare parts  Materials    Freight (product transport)   Personnel Management    Clinical staff        Technical staff      Trainer/Peer trainer   Administrator      Local transport Local transport for personnel     Local transport for clients    Accommodation for clients   Printed materials      Consumables    Tool replacement    Overheads       Training of personnel       Training partners/referral network    Fundraising         Monitoring and evaluation         WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 100 C. Running a wheelchair service C.1: Efficient and effective services C.1.1 Monitoring Section 1 • In your group: read and complete your section of the table below. • Some of the boxes have been completed to help you get started. The remaining boxes should be filled in. Areas and activities Example performance targets Information collection Referral Number of users referred The service will receive 30 referrals per month Record referrals received Average waiting time from referral to appointment On the user’s file record the date when the referral was received and the assessment date Wheelchair provision Number of users who receive a wheelchair The service will prescribe and fit wheelchairs for 20 users per month Average waiting time from assessment to fitting Number of follow up appointments carried out WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 101 • Record below why it is useful to know whether or not targets have been met. Useful to know targets met because: Useful to know targets not met because: Number of users referred Average waiting time from referral to appointment Number of users who receive a wheelchair Average waiting time from assessment to fitting Number of follow up appointments carried out Section 2 Areas and activities Example performance targets Information collection Wheelchair population served Details of users referred to the service, such as age, gender, disability, postural support needs The service will encourage equal access The service will aim to meet the needs of users requiring basic wheelchairs and those requiring modifications and postural support Number of women, men, girls and boys accessing the service – recorded on user files Types of postural needs presented and wheelchairs prescribed – recorded on user files Geographical area covered by the service Home address of users accessing the service – recorded on user files WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 102 Service costs Cost of products supplied, including modifications made within the service The individual cost of each wheelchair will be less than (amount specified according to budget and realistic cost of available products) Amount of time spent by personnel on service activities (For example assessment, follow-up, and training.) • Record below why it is useful to know whether or not targets have been met. Useful to know targets met because: Useful to know targets not met because: Details of users referred to the service, such as age, gender, disability, postural support needs Geographical area covered by the service Cost of products supplied, including modifications made within the service Amount of time spent by personnel on service activities (for example, assessment, follow-up, training) WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 103 C.1.2 User feedback • There are some important considerations when planning to gather feedback from service users. Use this checklist to make notes for your service. Planning feedback from service users Points to consider: Transport and time are two of the most significant costs. When will it happen? Who will do it? What feedback questions should be asked? Baseline information (Refer to the tools stored in the Additional Resources for Managers Manual on the Pen Drive) Points to consider: In order to assess the impact of the service, it is important to record the situation before any intervention. That is, before an assessment begins. When will baseline information be gathered? Who will gather this information? At what intervals will information be collected? WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 104 Recording and processing data Points to consider: Efficient recording of data saves time and money How will you record the data? What methods can you use to make the recording and processing of the data as efficient as possible? Who will record the data? Who will process the data? C.2: Developing efficient services C.2.1 Monitoring a service plan • Create a service plan for your service. • Select a need or problem to be monitored from your own service and fill in the information under each heading. Service plan framework Identify need/ problem to be monitored Action/objective to address need/ problem Target Information collection WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 105 C.3: Managing demand C.3.1 Generating demand and early referral • Read the example. • Discuss and then list the reasons for success. Example of success: early referral by parents in Mexico Here is an example of how a group of rehabilitation centres for children in Mexico built up an effective early referral network. Although rehabilitation centres primarily targeted neo natal doctors and paediatricians with their awareness raising activities, they also had a major annual fundraising campaign aimed at the general community that used extensive media coverage including radio and television. This led to a lot of word of mouth referrals and many parents self-refering their children. During the awareness raising, the centres had a clear message: the importance of referring children for rehabilitation when they are born. They also presented a powerful vision of success with many positive stories relating to integration and achievements of the children that they work with. Over a period of 15 years, the rehabilitation centres have seen a cultural shift as paediatricians and families are now actively making early referrals. The result: A third of all referrals are for children 3 years old and younger. Reasons for success WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 106 C.3.2 Analysing service steps Time available for service delivery each day: _______mins • Work together in groups. • Read each service challenge in column 1. • Read possible strategies for more efficient service delivery in the table below. • Match service challenges with strategies to improve efficiency. List the number of each strategy in column 2. A challenge may require a number of strategies. Strategies to improve service efficiency 1. Source products with as much range of adjustability as possible 2. Source products which can easily be modified 3. Source products with posture support devices (PSDs) 4. Pre-prepare sample product set-up options 5. Pre-fabricate posture support devices 6. Clear scheduling to allow for joint working 7. Hold team meetings to create shared work plans 8. Clinical and technical teams to work together during fitting 9. Clinical and technical teams to discuss prescription solutions 10. Clear documenting of information and record keeping 11. Plan appropriate level of training for service personnel 12. Source appropriate materials for cushion and PSD fabrication and modifications 13. Source appropriate tools for making quick product adjustments 14. Allocate user training to a specific person, for example, a peer trainer 15. Identify facility for user training close to clinical and technical areas 16. Establish effective stock control systems 17. Prepare a small stock of wheelchairs in different sizes 18. Establish community partnerships to identify service users and provide transport to the service centre 19. Build capacity of community partners to provide basic level services and refer intermediate level service users 20. Be open to new ideas – innovation. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 107 Column 1: service challenges Column 2: service strategies Assessment: 1. If service personnel are travelling to a service or carrying out home visits, travel time may need to be factored into the assessment 2. If team members are inexperienced the assessment will take longer Prescription: 3. If products have limited adjustability, modifications must be prescribed to make the products fit individual users 4. If extra posture supports require fabrication, additional measurements and drawings are required Product preparation: 5. Quick access to type and size of product required 6. If a wheelchair has limited adjustability then more time may be required for product preparation 7. If modifications for posture support are necessary, more time will be required Fitting: 8. If modifications have been made or extra supports added to the wheelchair, fitting will take longer 9. If any changes are made to the wheelchair set-up during fitting; further fitting checks are required User training: 10. If it is the first time a person is receiving a wheelchair, or a health complication exists, more time will be required to cover user training in health, mobility, handling the wheelchair as well as care and maintenance, and referring to other referral sources WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 108 C.4: Planning follow-up C.4.1 Overcoming barriers • Read the list of possible barriers to follow-up below and add any additional barriers that the group has highlighted. • Discuss actions to overcome the barriers to follow-up and list them in the table below. Barriers to follow-up Possible barriers to an outreach follow-up service: • costs of service centre staff travelling to communities; • time for service centre staff to travel to the community; • follow-up is not prioritized by service managers; • follow-up is not valued by service users until they experience the benefits Possible barriers to a centre based follow-up service: • cost of travel and time off work for one or more family members; • users and family members are often not aware of the benefits of follow-up; • difficulty finding accessible transport; • pressure to focus on new appointments at the service centre can leave no time for follow-up; • difficulty scheduling appointments: users may turn up when staff are not available, or not turn up when staff are available. Actions for overcoming barriers to follow-up WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 109 C.5: Developing financial sustainability C.5.1 Identifying funding sources • Read through the list of possible funding sources and refer to the reference manual for more details. • Choose the three sources that you believe have the greatest immediate potential for your service and complete the table below for the selected funding sources. Different funding sources for managers to consider 1. Government 2. National insurance schemes 3. Private donors and sponsors 4. Corporate (business) donors and sponsors 5. User contributions or full purchase 6. Income generation/social enterprises 7. Community groups/charitable societies 8. Diplomatic missions 9. International and national NGOs Selected funding sources Number in priority order by considering the: • Effort required • Short- or long-term financial reward (or both) Priority Funding source Investment/ effort required high/medium/ low Short-term reward high/medium/ low Long-term reward high/medium/ low WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS 110 C.5.2 Developing a strategy • Read the example strategy below. • List the three funding sources from the previous exercise in the table. • Complete the columns of the table for the selected funding sources. Funding source Type of support Request Likelihood Effort 1. Corporate (local business) Donation to wheelchair procurement budget. 10% of wheelchair budget. Medium (have funded previously. However, do not always fund the same organization each year). At least two meetings with the business manager; 2-page proposal and budget to be submitted and invite manager to next open day. 2. Local government Potentially may fund costs of all outreach visits to wheelchair users in their area. 20% of all outreach costs and 20% of service personnel salaries. High (have been in discussion with this local government for a while. Have run one outreach to their area. They are very keen to support this and funding seems to be available). Formal proposal and budget to be submitted. Reporting commitments – require accurate data of all people seen from their area and financial reporting. WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS

WHEELCHAIR SERVICE TRAINING PACKAGE For Managers Reference Manual For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int ISBN 978 92 4 154908 0

WHEELCHAIR SERVICE TRAINING PACKAGE Participant’s WorkbookFo Managers Additional Resources WHEELCHAIR SERVICE TRAINING PACKAGE For Managers Additional Resources WHEELCHAIR SERVICE TRAINING PACKAGE For Managers Additional Resources

C O N T EN T S 1 Possible strategies for developing a wheelchair provision programme 3 Wheelchair Service (Basic) Referral Form 4 Wheelchair Service (Intermediate) Referral Form 5 List of service forms and checklists 6 Making an Assessment Box 8 Making an Assessment Bed 9 Making Foot Blocks 10 Examples of Measuring Tools 11 Guide to Technical Facilities: Workbench and Ground Work Area 12 Guide to Basic Service Technical Resources 14 Guide to Intermediate Service Technical Resources 18 Preparing a Hacksaw Blade for Foam Cutting 19 Guide to Basic and Intermediate Service – Materials 21 Guide to Setting Up a Mobility Skills Area 25 Comparison of different methods of supplying wheelchairs 29 Tool for measuring participation at time of assessment for assistive technology 30 Tool for measuring satisfaction and outcomes at time of follow-up of assistive technology 35 Accessibility Information 1FOR MANAGERS Possible strategies for developing a wheelchair provision programme The best strategy for developing a national wheelchair provision programme will depend on the current state of wheelchair services in the country, the available resources, and the needs the service has to meet. It is useful to consider the following questions and strategies outlined in the Wheelchair Guidelines when planning wheelchair provision. • What are the characteristics and specific needs of the user population? • Do stakeholder groups exist and, if so, what are their interests and opinions? • Do wheelchair services already exist (through local workshops, community- based rehabilitation, disabled people’s organizations, other nongovernmental organizations, the private sector or government)? • Is there any wheelchair provision outside of the formal infrastructure, for example, provision of mass imported wheelchairs? • What can be done with existing resources? • What are the current funding mechanisms? 1. The government wants to establish a national wheelchair service programme. The government may contact interested nongovernmental and disabled people’s organizations, users, training programmes for health professionals, international organizations such as the World Health Organization (WHO), the International Society for Prosthetics and Orthotics (ISPO), the International Society of Wheelchair Professionals (ISWP) and relevant international nongovernmental organizations to develop an appropriate plan for a national wheelchair service. The government may look at its own prosthetic and orthotic services and use these as a basis for developing a wheelchair service. It may also contact government bodies in other countries to learn from their experience and seek advice. 2. Wheelchair provision exists, but on a small scale through independent organizations; there is no collaboration. The government, local organizations or an international nongovernmental organization could assess the possibility of scaling up the operation. A resource centre can be set up to involve people from the different organizations in a collaborative effort. The resource centre can then evolve into either a coalition of organizations interested in wheelchair services or an independent nongovernmental organization in its own right. WHEELCHAIR SERVICE TRAINING PACKAG E 23. There are organizations in the country but no wheelchair service delivery. An interested nongovernmental or disabled people’s organization can serve as the nucleus for a resource centre. The organization needs to identify an appropriate organization with wheelchair provision experience as a partner (e.g. a governmental or nongovernmental organization in a neighbouring country or an international nongovernmental organization) and should follow the other initial steps in scenario 4 below. Alternatively, this process may be started by an international nongovernmental organization, which then seeks out local nongovernmental and disabled people’s organizations as partners. Efforts should be made to identify and network with other countries or organizations that have had similar experience in initiating wheelchair services. 4. There are no organizations in the country and no regular wheelchair service delivery. An international nongovernmental organization, either on its own initiative or at the invitation of or in partnership with the government, could establish a resource centre in the capital or other major city. The resource centre could be an integral part of an already existing rehabilitation institute. The resource centre should begin by providing important information to users, their families or caregivers and health professionals about mobility needs and wider issues pertaining to mobility. The international nongovernmental organization should develop a stakeholder analysis and survey people who use or require wheelchairs, in order to identify gaps and determine the need for wheelchairs and services. Preliminary participatory research will present options for meeting the needs. Funding should be secured to begin wheelchair provision. Efforts should be made to establish a working relationship between the resource centre and relevant governmental bodies as a first step in establishing a national wheelchair service. WHEELCHAIR SERVICE TRAINING PACKAG E 3FOR MANAGERS Wheelchair Service (Basic) Referral Form Sample referral form: This form can be adapted by wheelchair services and provided to referral sources to help them refer wheelchair users to the wheelchair service. Please complete referral form and send to: (Wheelchair service name and address) Name of referral person: Organization you work for : Referral person contact details (the best way to contact you): Wheelchair user’s name: Date of Birth: Parent/carer’s name: Address: How can the wheelchair user be contacted? Post Own telephone Friend/neighbour’s telephone If by telephone, what is their phone number: Wheelchair user’s disability, if known: Reason for referral: • Has no wheelchair • Has a broken wheelchair • Has a wheelchair that does not meet their needs Please add any other information about the wheelchair user that you think is important for the wheelchair service to know: Has the wheelchair user agreed to being referred to the wheelchair service? Yes No Signature of referring person: Date: WHEELCHAIR SERVICE TRAINING PACKAG E 4Wheelchair Service (Intermediate) Referral Form Sample referral form: This form can be adapted by wheelchair services and provided to referral sources to help them refer wheelchair users to the wheelchair service. Please complete referral form and send to: (Wheelchair service provider's name and address) Name of referral person: Organization you work for : Referral person contact details (the best way to contact you): Wheelchair user’s name: Date of Birth: Parent/carer’s name: Address: How can the wheelchair user be contacted? Post Own telephone Friend/neighbour’s telephone If by telephone, what is their phone number: Wheelchair user’s disability, if known: Reason for referral: • Has no wheelchair • Has a broken wheelchair • Has a wheelchair that does not meet their needs • For children: o unable to sit upright or not able to pull up to stand by the age of 1; o unable to walk alone by the age of 2. Please add any other information about the wheelchair user that you think is important for the wheelchair service to know: Has the wheelchair user agreed to being referred to the wheelchair service? Yes No Signature of referring person: Date: WHEELCHAIR SERVICE TRAINING PACKAG E 5FOR MANAGERS List of service forms and checklists Note: The Wheelchair Service Referral Forms are included in this manual. All other forms can be found in the WSTP Basic and Intermediate Packages on the Pen Drive. Basic level services 1. Wheelchair Service (Basic) Referral Form 2. Basic Wheelchair Assessment Form 3. Basic Wheelchair Prescription (selection) Form 4. Basic Wheelchair Summary Form 5. Basic Wheelchair Fitting Checklist 6. Wheelchair Safe and Ready Checklist* 7. Wheelchair Follow-up Form* Intermediate level services 8. Wheelchair Service (Intermediate) Referral Form 9. Intermediate Wheelchair Assessment Form 10. Intermediate Wheelchair Prescription (Selection) Form 11. Intermediate Wheelchair Summary Form 12. Intermediate Wheelchair Fitting Checklist 13. Intermediate Wheelchair User Training Checklist 14. Postural Support Device (PSD) Table * Forms and checklists are suitable for both basic and intermediate level services WHEELCHAIR SERVICE TRAINING PACKAG E 6Making an Assessment Box Instructions for making an assessment box 1. All plywood is drawn as 18 mm. If unavailable use 15 mm or 20 mm. 2. Adjustable height footrest should slide easily in and out between rails. 3. Seat surface and footrest surface should be covered by firm 5-10 mm foam (EVA), or a grip mat similar to the type used on some wheelchair footrests. Locally made assessment box Hardwood rails, glued & screwed to plywood side. 45° cut on inside corner Rounded corners Back Adjustable height footrest should slide easily in and out, and be able to be tted in any of the height positions 5–10 mm EVA foam glued to 18mm plywood 4 pieces 25 mm x 50 mm x 420 mm hardwood glued and screwed to plywood sides WHEELCHAIR SERVICE TRAINING PACKAG E 7FOR MANAGERS Assessment box dimensions 450 mm 18 mm 650 mm Top 45 0 m m 45 0 m m 36 0 m m 42 0 m m 18 m m 18 m m 10 m m 25 mm 450 mm 430 mm Adjustable height footrest 18 mm Plywood 200 mm Front 20 pieces 20 mm x 20 mm x 430 mm long hardwood 20 m m 20 m m Side 50 mm WHEELCHAIR SERVICE TRAINING PACKAG E 8Assessment box dimensions Making an Assessment Bed The assessment bed enables the wheelchair user to sit comfortably in a position where the clinician will be able to make a good assessment for a wheelchair prescription. The assessment bed should be stable, safe, and at a height suitable for transfers from a wheelchair. Dimensions Approximate length is 1800 mm x width 600 mm x height 500 mm for normal wheelchair related assessment. Materials and construction • Frame can be made from wood or steel • Cushion: o 13 mm plywood base o 50 mm dense chip foam o 25 mm soft foam top layer. • The cushion should be covered in easy-to-clean fabric such as imitation leather (Rexene) or leather. Rexene/leather should be cut to shape, folded, glued and stapled or tacked to the plywood to hold it in place. • Finish steel frames with anti-corrosive undercoat and top coat with spray-paint finish. WHEELCHAIR SERVICE TRAINING PACKAG E 9FOR MANAGERS Making Foot Blocks Foot blocks support the wheelchair user’s feet at an appropriate height during the assessment, in order to give them a good sitting position. In order to position the wheelchair user’s feet correctly, it is important that there are a range of foot blocks of varying heights available, or that the foot block is adjustable. Dimensions Surface area: 400 mm x 300 mm. Heights: Varied from 15-150 mm. Materials and construction • Blocks of different heights that can be stacked, or an adjustable block. • Plywood construction. • For users with a condition that results in uneven foot bases (whether leg length discrepancy or some other problem), two separate blocks of different heights need to be used. Basic stacking of foot blocks WHEELCHAIR SERVICE TRAINING PACKAG E 10 Examples of Measuring Tools Callipers Wooden measuring tool Material: Plywood 3-9 mm. Wooden base with measurement markings and strips of Velcro to secure the adjustable side. Wooden sides: One side is fixed and the other side is adjustable. Vinyl measuring tool Vinyl base with measurement markings. Wooden sides: One side is fixed and the other side is adjustable. WHEELCHAIR SERVICE TRAINING PACKAG E 11 FOR MANAGERS Guide to Technical Facilities: Workbench and Ground Work Area Workbench Depth of technician’s working area is 1500 mm Width of workbench and technician’s working area is 1500 mm Depth of workbench is 750 mm Total 2250 mm Technician’s working area WHEELCHAIR SERVICE TRAINING PACKAG E 12 Guide to Basic Service Technical Resources The tools listed below are for assembly, set-up, adjustment, maintenance and repair plus basic modifications of products (as covered in the WSTP basic training course). Tools Details Number Set of metric combination spanners 8 mm to 22 mm (Must include 8, 10, 13, 19 mm sizes) 2 Set of imperial combination spanners 1 Set of metric Allen keys Long-stem types are best – preferably with a T-bar handle 2 Metal measuring tape 5 m length 1 Philips screwdriver set Large and medium sizes 1 Flat head screwdriver set Large and medium sizes 1 Rubber mallet 8 oz head 1 Pliers Medium short nose 1 Bradawl Small “flat blade” type point 1 Metal file set (3 files) Type: medium size second-cut file, half round file, round file, flat file 1 Small pipe cutter and spare blades Cutting tubes from 12 mm to 38 mm 1 Hand wood saw A wood “cut’’ saw (not a ripsaw) 1 12” hacksaw and blades For metal cutting 1 Foam-cutting knife Either a long slightly serrated blade or a standard bread knife 1 Box cutter knife and spare blades 1 Heavy duty scissors 1 Needle and thread set Range of needle sizes, strong nylon thread 1 Air pump for tyres For both “Schrader” and “Presta” types of bicycle tyre valves 1 Puncture repair kit with tyre levers 1 Fine marker pen 1 Spoke key (wrench) 1 WHEELCHAIR SERVICE TRAINING PACKAG E 13 FOR MANAGERS Tools Details Number Safety glasses 1 Paint brushes 1 Cleaning kit Bucket and brushes 1 Desirable power tools Voltage regulator for workshop machinery and hand tools* 1 Sewing machine – heavy duty 1 Heavy duty sewing machine needle set 1 Electric drill 3-13 mm chuck, multiple speed 1 Drill bit set for wood 1 Drill bit set for metal 1 Electric jigsaw 1 Set of wood and metal fine-cut blades 1 Electric angle grinder 1 Set of medium and fine grinding disks 1 Electric extension cables 10 m 2 Power surge protector 1 Storage Toolbox 1 Padlocks 2 Metal cabinet with lock 1 Consumables Light lubricating oil Contact adhesive glue Standard PVA wood glue Exterior wood varnish Enamel metal paint Paint thinners Soap Sponges Cloths WHEELCHAIR SERVICE TRAINING PACKAG E 14 Guide to Intermediate Service Technical Resources All of the items listed in the Basic Service Technical Resources list are also needed for an intermediate service. In addition, Items marked with * appear in the Basic Service Technical Resources list and have been highlighted to confirm that an additional set is recommended for an intermediate service. Tools Details Number Essential items Voltage regulator for workshop machinery and hand tools* 1 Sewing machine Heavy duty – able to sew heavy fabrics if required 1 Desirable items Arc welder/Mig welder 1 Pair of welding hand protection gloves Thick leather–6” opening 1 Arc welding eye protection mask 2 Bench grinder Coarse and fine grade wheels 1 Belt sander With dust extraction facility 1 Set of sanding belts Coarse and fine grades 1 Band saw Medium sized for wood, plywood, PU and EVA foam 1 Compressor 24 L 1 Spray gun kit with hoses 1 Gas brazing kit Welding torch with assorted nozzle sizes, regulators and hoses 1 Brazing eye protection goggles 1 Pillar drill (3-13 mm chuck size) Bench standing or floor standing With drill vice clamp (ideally a swivel base cross multidirectional drill vice clamp) 1 Power tools Essential items WHEELCHAIR SERVICE TRAINING PACKAG E 15 FOR MANAGERS Tools Details Number Hand-held electric drill (3-13 mm chuck size) Multi-speed and multi-torque settings are useful 1 Hand-held electric jigsaw 1 Angle grinder 1 Set of grinding disks Coarse and fine disks 1 Angle grinder hand protection gloves 1 Electric extension cables* 5 m or 10 m 2 Desirable items Electric screwdriver Cordless, with a set of assorted screwdriver, socket and Allen-key head sizes 1 Cordless hand-held electric drill (3-13 mm chuck size) 18V Multi-speed and multi-torque settings are useful 1 Circular saw (minimum 185 mm blade) 1 Soldering iron Pointed end for making holes in webbing and flat end for sealing end of cut webbing 1 Hand tools Essential Items Hand wood saw (universal) 22”, fine cut teeth 1 Coping saw and set of blades Fine cut for wood 1 Spade bits set 1 Countersink bit 1 Cutting shear (with fixing bolts) Bench-mounted 1 Bench vice (with fixing bolts)* 6” 2 Pliers Long-nosed – medium 1 Locking pliers (mole grips) Short-nosed – medium 2 Locking pliers (mole grips) Long-nosed – medium 2 C-clamp 6” opening 2 C-clamp 8” opening 2 Eyelet punch set and eyelets Assorted sizes 1 Staple gun (for wood) 1 Rivet gun (pop riveter) 1 WHEELCHAIR SERVICE TRAINING PACKAG E 16 Tools Details Number Metal ruler* 1 metre (metric and imperial scales) 1 Metal ruler 30 cm 2 Metal measuring tape* 5 m 1 Vernier caliper 150 mm jaw width 1 Metal protractor 1-180 degrees (1-degree accuracy) 1 Centre punch 2 Scribe 2 Bradawl* Useful when drill or power not available 1 Carpenters square 600 mm x 400 mm steel 1 Adjustable spanner 1” Max opening 1 Socket Set Metric (including 8, 10, 13, 17, 19 mm sizes) 1 Tyre levers* Set of 4 1 Spoke key* 1 Safety glasses* General workshop eye protection 4 Ear defenders 2 Dust masks 4 Flat wood file Medium 1 Wood rasp file set 1 Half round file set (for wood) 1 Desirable items Socket set Imperial 1 Combination spanner set* Imperial ¼–1½ 1 Allen key set (L-shape) Imperial 1 Spokeshave 1 Combination square 1 Adjustable angle bevel 1 Small square 10” 1 Workshop general Waste bins 3 Floor brush 1 Dustpan and brush 1 WHEELCHAIR SERVICE TRAINING PACKAG E 17 FOR MANAGERS Tools Details Number Cleaning cloths 1 Workshop cleaning buckets and sponges 2 Workshop furniture and safe storage Metal locking cabinet for tools* 2 Locking cabinet for materials 2 Opening cabinet for general use 1 Opening cabinet for PSD components 1 Stool 3 Workbench* 3 Shelving 2 Drying rack For painted or varnished parts 1 Consumables Paint undercoat Exterior wood paint Paint top coat Exterior wood paint Varnish Exterior grade White spirit* For cleaning brushes and spray gun Paint/varnish/glue pots Sandpaper Grades 40, 80 and 150 Fabric chalk Grease Brazing rod pack Assorted sizes Brazing flux Jigsaw blades Packets of (fine cutting) blades for wood, metal, and plastic Staples 5 mm and 8 mm depth Sewing needles Assorted sizes Arc welding rods for steel Size: 2 mm, 4 mm, 6 mm Eyelets Assorted sizes Rivets Diameter 4 mm and 6 mm Assorted rivet lengths WHEELCHAIR SERVICE TRAINING PACKAG E 18 Preparing a Hacksaw Blade for Foam Cutting • Take an ordinary metal hacksaw blade (preferably an old used one) and grind down the saw tooth edge to a sharp knife point (a V-shape cross section). • This gives you a thin sharp serrated knife blade that cuts through medium and low density Polyurethane foam and chip foam very easily and quickly. • Wrap some tape around one end of the saw blade to make a handle and protect your fingers from the blade. WHEELCHAIR SERVICE TRAINING PACKAG E 19 FOR MANAGERS Guide to Basic and Intermediate Service – Materials Materials for modifications and fabricating additional postural support devices (PSDs) are used more often at the intermediate level. However, basic level services may also carry out simple modifications using similar materials. The quantity of materials required will depend on a number of factors including the number of wheelchair users accessing the service, the volume of intermediate level wheelchair service delivery, and the types of wheelchairs provided. Clinical and technical staff should be involved in sourcing appropriate materials. Materials Used for: What to look for: Metal/plastic/ wood Metal/plastic/wood form the structure of a postural support device – for example rigid seats and backrests. 12 mm plywood is very useful for making rigid seats and backrests. It is strong but relatively lightweight. Marine plywood is the most durable option but it can also be expensive. 3 mm aluminium and 6 mm acrylic or ABS plastic sheets, if available, can also be used to make rigid backrests. Adding a fold in the sheet can increase rigidity. When using any sheet material, take additional care to remove or pad the sharp edges for user safety. Foam/padding Foam is used in all PSDs in areas that are in direct contact with the wheelchair user’s body. Firm foam, which holds its shape, is used to give PSDs the shape they need to provide the right support. Softer foam is used to add comfort and reduce pressure. Examples of the use of foam: • should be added to straps to reduce pressure and add comfort. • firm foam can be used to make a side trunk wedge or added to a cushion to make a side thigh support or inside thigh support. Check local markets and visit foam, shoe, mattress and furniture factories to find locally available foam. Try to find local examples of foam in different thicknesses (25 mm and 50 mm) and different firmness. EVA is an example of very firm foam, which is good for providing firm support and structure for a PSD. EVA can sometimes be found where shoes are manufactured. The firm rubber used to make flip flops can be used in place of EVA. Good quality chip foam is an example of a foam of medium firmness. Chip foam can be used as the base of a contoured/layered cushion to make a rear pelvis pad or pre-seat bone shelf, or to provide contours on a rigid backrest. Soft “mattress foam” is an example of softer foam used for comfort layers. WHEELCHAIR SERVICE TRAINING PACKAG E 20 Materials Used for: What to look for: Foam/padding • Very firm foam (for example EVA) can be used to make a footrest build up or wedge and lateral trunk pads. The most commonly available, cheapest “very soft” foam is unsuitable on its own for making pressure relieving cushions without a firmer foam base. Coir (coconut fibre) can be used in place of firm foam. Fabric Fabric is used to cover PSDs. Look for a fabric that will be durable and easily cleaned (either by wiping down or removing for washing). A water-resistant fabric is useful for the seat and backrest if wheelchair users are incontinent. A softer, T-shirt type material (cotton or cotton/Lycra) can be used for headrests and trunk side supports. A fabric with some stretch will more easily conform to the shape of the PSD. Synthetic fabrics usually make the person hotter than natural fabrics. Try to have at least a few different colours, and offer wheelchair users a choice, if possible. Nylon webbing and Velcro or buckles Nylon webbing and Velcro or buckles are used to make straps, including a pelvis strap, shoulder harness, calf and foot straps. 25 mm, 35 mm and 50 mm nylon webbing is useful. The wider the strap, the more even the pressure. Melting the cut end of nylon webbing stops it from fraying. Cotton webbing is much less effective. Clip buckles (such as those used on backpacks) can be very easy to use. Use good quality buckles, if available, as these will last longer. Test them by clipping them together and trying to pull them apart. They should clip together and undo easily, but still not pull apart unless released. Velcro is a good fastener, however it needs to be kept clean or it will stop working. Pads should be placed under all webbing straps to protect the user’s body. Adhesives Adhesives are used to stick the wood and foam together. Have a supply of wood glue (commonly known as white glue or PVA) and foam glue (contact adhesive, shoe glue or yellow glue). Ensure that anyone using adhesives knows how to use them correctly. Fasteners Fasteners are used to attach the PSD to the wheelchair. Useful fasteners include: • bolts with nuts (preferably lock-nuts) and washers • T-nuts (fixed into plywood instead of a nut) • staples (for fixing upholstery). Avoid using sharp screws as they may become a hazard if the PSD is damaged. WHEELCHAIR SERVICE TRAINING PACKAG E 21 FOR MANAGERS Guide to Setting Up a Mobility Skills Area A mobility skills training area is essential for wheelchair users to learn to use their wheelchairs correctly and safely. It should include as a minimum: • varying locally appropriate terrain • slopes • steps It should be located close to the fitting area, as this is the next service step, and adjustments are often required to the wheelchair set-up once the user has tried to propel the wheelchair. A covered section will be useful in poor weather conditions. Simulation of local terrain Blocks and 1:12 ramp WHEELCHAIR SERVICE TRAINING PACKAG E 22 A mobility skills training area will comprise the following: Item Dimensions Purpose: For wheelchair users and their assistants to practise: Flat ground 10 m long x 1 m wide Basic propelling Simulation of local terrain (3 areas), such as sand, grass, and rocky ground Each area should be a minimum of 2000 mm long and 1000 mm wide Environments found in the user’s locality Block 1 1500 mm x 1500 mm x 25 mm height Manoeuvring on an individual step Block 2 1500 mm x 1500 mm x 100 mm height Block 3 1500 mm x 1500 mm x 200 mm height 1:12 ramp Approximately 3600 mm long x 1000 mm wide Gradient: 0 mm (low end) to 300 mm (high end) Manoeuvring on a standard slope 1:8 ramp Approximately 2400 mm long x 1000 mm wide Gradient: 0 mm (low end) to 300 mm (high end) Manoeuvring on a steep slope Thresholds (curbs and obstacles) (See Figure 1) 60mm high x 50mm wide x 1000 mm long Overcoming obstacles in the path and door thresholdsThresholds (curbs and obstacles) 2 (See Figure 1) 90 mm high x 50 mm wide x 1000 mm long Stair steps (See Figure 2) Approximately 300 mm deep, 150 mm high and 1100 mm wide Going up and down a series of steps The dimensions stated in the table above must be amended for the local context if significantly different from suggested standards. It is important that people learn to negotiate their local environments through this training. Ensure that there is access to approach any single part of the mobility training area. Sometimes an area close to the service area can be identified using the natural terrain available. WHEELCHAIR SERVICE TRAINING PACKAG E 23 FOR MANAGERS Examples of thresholds with different heights 400 mm 50 mm 50 mm 60 mm 90 mm (2) (2) (1) (1) 1000 mm Figure 1 (measurements in mm) WHEELCHAIR SERVICE TRAINING PACKAG E 24 Example of stair simulator Figure 2 (measurements in mm) 1100 mm 950 mm 600 mm 2150 mm 700 mm 2000 mm 300 mm 300 mm 150 mm 150 mm 150 mm 150 mm 300 mm WHEELCHAIR SERVICE TRAINING PACKAG E 25 FOR MANAGERS Comparison of different methods of supplying wheelchairs The main wheelchair supply methods to be considered are local production of wheelchairs, importing new wheelchairs and importing recycled wheelchairs. Wheelchairs can also be recycled within a wheelchair service. Long-term reliable supply of a range of products Wheelchair users need a long-term supply of a range of appropriate products, as defined in the Wheelchair Guidelines. With any supply model, it is crucial to consider the long-term reliability of the product supply. All supply models present challenges in terms of sustainability and quality control and need to be considered on a case-by-case basis in different settings. Wheelchair users should participate in the planning, implementation, management and evaluation of wheelchair provision1 and therefore should be involved in determining the best solution for a particular setting. If local prosthetic and orthotic (P&O) services exist, their choice of local production or imported devices can help decision making on the method of supplying wheelchairs to a wheelchair service. It is also useful to consider similar items in the local marketplace, such as bicycles or steel furniture, and understand the reasons why these local businesses have decided to produce or import their product. The presence or absence of other local manufacturing is a very important indicator of whether wheelchair manufacturing will succeed. The presence or absence of established local businesses which import products is a good predictor of the possibility of a reliable supply chain for importing goods. Before a decision is made on which supply model to use, it is recommended that a full feasibility study is carried out. Costs need to be calculated and compared. The full cost of an imported product can be estimated in advance (product quote, shipping and importation, storage), but attention needs to be paid to issues that will be outside of the wheelchair services’ control such as shipping delays or exchange-rate fluctuations. Establishing the cost of a locally manufactured product requires significant knowledge of workshop running costs alongside the actual product costs and can be unpredictable. Logistics such as staff required, storage needed, and management of the importation or local production needs to be calculated. 1 Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 34 (http://www.who.int/disabilities/ publications/technology/wheelchairguidelines/en/). WHEELCHAIR SERVICE TRAINING PACKAG E 26 Comparison of benefits of local production and imported products Whether products are produced locally or imported, all wheelchairs should be appropriate, as defined in the Wheelchair Guidelines2. In the past it was not possible to import wheelchairs which were specifically designed for less resourced settings; therefore, local production was the only way to ensure a supply of appropriate products. However, wheelchairs specifically designed for use in less resourced settings are becoming increasingly available for import. With this in mind, it is useful to consider the benefits of both approaches. The comparison table highlights a number of considerations when choosing a supply model to best ensure a range of appropriate wheelchairs are available for wheelchair users. Local production Advantages Disadvantages • Government commitment to local production can send a message that disability is an issue belonging to the community and has to be tackled in all its aspects, including wheelchair manufacturing.   • Production can be tailored to local needs. • Products can easily be supplied with locally accessible spare parts. • Creates local manufacturing jobs and skills that can then support local wheelchair repair and maintenance. • The need for customized wheelchairs can be addressed if the local manufacturer has capacity. • Easier to maintain consistent stock levels with local production. • Minimal storage for stock needed due to continual and flexible production. • Much easier to involve local users in product development and react faster to needs and problems. • Difficult to maintain quality with small scale non mechanized production. • Initial investment needed in machinery, tools, manufacturing space and staff training. • Difficult to retain workshop staff when product orders do not cover production workshop running costs. • Management of production workshop can be complex. • Reliant on consistent local availability of materials and components. • Limited production numbers can increase cost of products. • Less time to focus on clinical aspects of wheelchair provision due to labour intensive nature of local production. 2 Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 71 (http://www.who.int/disabilities/ publications/technology/wheelchairguidelines/en/). WHEELCHAIR SERVICE TRAINING PACKAG E 27 FOR MANAGERS Imported wheelchairs Advantages Disadvantages • Imported wheelchairs can complement locally available products to ensure a range of different products and components are available to meet individual needs of users. • Consistent product quality, due to established manufacturers with well established quality control mechanisms. • Potential cost savings due to higher volume production than may be possible locally. Cost savings can lead to more wheelchairs distributed. • Wheelchair service will have more capacity to focus on clinical skills as less time is spent on production. • Local jobs can be developed for assembly, adjustments, posture support modifications, maintenance and servicing. • Less initial investment needed in machinery, tools, materials, and security than for local production. • Less complicated workshop/technician management needed than for local production. • Logistics and cost of customs importation. • Cost of shipping can require larger volume orders to be cost effective.  • Less flexibility in terms of minimum order quantities. • Longer lead time on shipping, and potentially longer lead time on production if there is a minimum number requirement before production commences. • Larger volume orders require significant capital, larger storage space and greater inventory control mechanisms. • Difficult to maintain consistent stock levels with less frequent larger stock purchases. • Commonly available imported products may not be tailored to local needs. • Products may not be supplied with locally accessible spare parts.  • Does not create local manufacturing jobs. • Increased difficulty of involving local users in product development. Importing recycled wheelchairs In many well resourced settings, frequent replacement of wheelchairs or short- term use of wheelchairs often leads to stockpiles of used wheelchairs. As a response, several organizations have collected, restored and exported these wheelchairs for reuse in less resourced settings. When deciding if importing recycled wheelchairs is a good option for your organization, keep in consideration what an appropriate wheelchair means: • meets the user’s needs and environmental conditions; • provides proper fit and postural support; • is safe and durable; • is available in the country: and • can be obtained and maintained and services sustained in the country at an affordable cost. Some considerations when considering importing recycled wheelchairs are: • How do you ensure available products are suitable for less resourced settings? • How do you respond to identified needs within a country when available products may vary widely in type, size and quality? WHEELCHAIR SERVICE TRAINING PACKAG E 28 • How do you offer a consistent supply of spare parts? • How do you offer the right tools for adjustment and set-up of a wide range of products from different manufacturers? • The impact on existing local manufacturers and service providers. Recycling wheelchairs within the existing service provision As services grow, it is inevitable that a portion of clients will either grow out of their wheelchair, receive a new wheelchair, or no longer be using their wheelchair. As a response to this, some organizations will opt to develop a system where wheelchairs are returned to the service and recycled for another user. This can benefit more users, but there are many considerations to take into account before deciding if this is a good option for your service. If an organization does choose to recycle products it is important to keep in consideration that a recycled wheelchair should still be appropriate for the user. Many parts will need to be replaced or repaired and any part that can hold bacteria (foam, upholstery, straps, etc.) should be replaced for the safety and health of the next user. Some of the factors that will affect the complexity and viability of recycling wheelchairs within your programme are: • access to replacement parts • volume of clients seen • funding mechanisms used with clients • ages of clients • quality of products provided • local terrain and environmental factors (which will affect the lifespan of the wheelchair) Some additional considerations include the: • need to transport wheelchairs back to the service for recycling • additional workshop space for refurbishment • need for advanced technical and quality control training. WHEELCHAIR SERVICE TRAINING PACKAG E 29 FOR MANAGERS Tool for measuring participation at time of assessment for assistive technology Identify respondent: Location: Date: Name of interviewer: 1. Do you have any assistive devices? Yes No (Skip to 5) 2. If Yes, what assistive devices do you have? 3. If Yes, do you currently use any of the assistive devices you have? Yes No (Skip to 5) 4. If Yes, which ones do you use? All Some, specify: Next are some questions regarding how much difficulty you have carrying out daily activities in your home. This includes assistance from other people and the use of any assistive devices. 5. To what extent do you have problems using transportation as a passenger to get around? No problems Mild problems Moderate problems Severe problems Impossible Not applicable 6. To what extent do you have a problem to do housework like washing or cleaning? No problems Mild problems Moderate problems Severe problems Impossible Not applicable 7. To what extent do you have a problem to go to school and study? No problems Mild problems Moderate problems Severe problems Impossible Not applicable 8. To what extent do you have problems getting and keeping a job? No problems Mild problems Moderate problems Severe problems Impossible Not applicable 9. To what extent do you have problems participating in recreational and leisure activities such as sports, games, arts and crafts, dance, music, etc.? No problems Mild problems Moderate problems Severe problems Impossible Not applicable 10. To what extent do you have problems actively participating in social activities? No problems Mild problems Moderate problems Severe problems Impossible Not applicable WHEELCHAIR SERVICE TRAINING PACKAG E 30 Tool for measuring satisfaction and outcomes at time of follow-up of assistive technology Identify respondent: Location: Date: Name of interviewer: 1. What assistive device are you using? 2. How long ago did you get it? 3. Do you currently use the assistive device? Yes (Skip to 5) No 4. If No, why do you not use it? (Skip the remaining questions if you answered question 4.) Next are some questions about how much difficulty you currently have carrying out activities in your home. This includes assistance from other people and the use of assistive devices. 5. To what extent do you have problems using transportation as a passenger to get around? No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment 6. To what extent do you have a problem to do housework like washing or cleaning? No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment 7. To what extent do you have a problem to go to school and study? No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment 8. To what extent do you have problems getting and keeping a job? No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment WHEELCHAIR SERVICE TRAINING PACKAG E 31 FOR MANAGERS 9. To what extent do you have problems participating in recreational and leisure activities such as sports, games, arts and crafts, dance, and music. No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment 10. To what extent do you have problems actively participating in social activities? No problems Mild problems Moderate problems Severe problems Impossible Not applicable Comment Next are some questions about how satisfied you are with the assistive device. 11. How satisfied are you with its size? (How big it is?) Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 12. How satisfied are you with its weight? (How heavy it is?) Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 13. How satisfied are you with how easy it is to move from place to place? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment WHEELCHAIR SERVICE TRAINING PACKAG E 32 14. How satisfied are you with how it looks? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 15. How satisfied are you with how easy it is to use? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 16. How satisfied are you with the time it takes to set up? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 17. How satisfied are you with its reliability? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 18. How satisfied are you that it meets your needs? (Does it do everything that you want it to do, within a reasonable time?) Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment WHEELCHAIR SERVICE TRAINING PACKAG E 33 FOR MANAGERS Next are some questions about how satisfied you are with the way you got the assistive device. 19. How satisfied are you with the advice given on what technology would be best for you? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 20. How satisfied are you with the time it took to get? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 21. How satisfied are you with assistance if it is not working properly? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment 22. How satisfied are you with the help and advice you were given on how to use it? Terrible Unhappy Mostly dissatisfied Mixed Mostly satisfied Pleased Delighted Comment Next are some questions about your experiences using the assistive device. 23. Think about how much you used your present assistive device over the past two weeks. On an average day, how many hours did you use it? None Less than 1 hour a day 1 to 4 hours a day 4 to 8 hours a day More than 8 hours a day Comment WHEELCHAIR SERVICE TRAINING PACKAG E 34 24. Think about the situation where you most wanted to perform or do better before you got your present assistive device. Over the past two weeks, how much has the assistive device helped in that situation? Has not helped at all Helped slightly Helped moderately Helped quite a lot Helped very much Comment 25. Think again about the situation where you most wanted to perform or do better. When you use your present assistive device, how much difficulty do you STILL have in that situation? Impossible Quite a lot of difficulty Moderate difficulty Slight difficulty No difficulty Comment 26. Considering everything, do you think your present assistive device sufficiently useful? (Do the benefits you get from using the assistive device outweigh any difficulties storing/maintaining/ transporting/using the device?) Not at all worth it Slightly worth it Moderately worth it Worth it Very much worth it Comment 27. Consider the difficulties that led you to get an assistive device. Over the past two weeks, with your present assistive device, how much have the difficulties for which you got the assistive device affected the things you can do? Impossible Significantly affected Moderately affected Slightly affected Not affected at all Comment 28. Consider the difficulties that led you to get an assistive device. Over the past two weeks, with your present assistive device, how much do you think other people were concerned about the difficulties for which you got the assistive device? Very much Quite a lot Moderately Slightly Not at all Comment 29. Considering everything, how much has your present assistive device changed your enjoyment of life? Worse No change Slightly better Quite a lot Very much Comment Sources: WHO International Classification of Functioning, Disability and Health (ICF). QUEST 2.2. Modified from the QUEST 2.1: Children’s Version by Sonya Murchland 2011. IOI-HA. Cox RM, Stephens D, Kramer SE (2002). Translations of the International Outcome Inventory for Hearing Aids (IOI-HA). International Journal of Audiology 41(1):3-26. WHEELCHAIR SERVICE TRAINING PACKAG E 35 FOR MANAGERS Accessibility Information Partnerships with government ministries: health, education, transport and community organisations to advise on accessibility can significantly improve inclusion and participation of people with mobility disabilities in society. Making buildings accessible at the time of construction costs significantly less than modifying it later. Some simple information is listed below. Further details can be found in the resources included with this package. Making homes accessible • Key considerations include height of shelves and access under work surfaces • Doorways: width, opening direction, handles. WHEELCHAIR SERVICE TRAINING PACKAG E 36 Doorways • Width of doorway: 900 mm • Try to hinge doors so they open inwards from busier areas to quieter areas. For example, from a living area to a bedroom. • Try to get hinges that allow opening as close to 180° as possible. • Circulation space: a clear approach space on both sides of a door is required.3 • Where access is limited: a sliding door can be considered (see diagram: accessible toilet). Floor tracks must be well maintained for the door to slide well. Toilets • Doorways that open into a bathroom reduce space inside a bathroom and should be avoided if possible. An alternative is a sliding door. • A grab-rail next to the toilet is useful for wheelchair transfers. 3 Design Considerations for Accessibility, 2006, USAID, John Grooms, Motivation Charitable Trust UK, Disability Organisations Joint Front WHEELCHAIR SERVICE TRAINING PACKAG E 37 FOR MANAGERS Making the community accessible Pathways • The width of a pathway should be 900 mm of unobstructed space. • Heavily used pathways benefit from 1500 mm width to allow two wheelchair users to pass by each other. WHEELCHAIR SERVICE TRAINING PACKAG E 38 Kerbs • Dropped kerbs – kerbs/curbed ramps where there is a level change (see illustration below). Ramps When making buildings accessible – consider the needs of all people. For wheelchair users consider the following specific points: • Slope gradients: indoor 1:12, outdoor 1:15. • Surface: non-slip. • Handrails: should continue for 300 mm on bottom and top landings before finishing. • Landings should be present at the bottom and top of slopes and when there is a change of direction: dimensions 1200 mm – 1500 mm. • Top landings should be measured to the edge of the door opening circle. WHEELCHAIR SERVICE TRAINING PACKAG E

WHEELCHAIR SERVICE TRAINING PACKAGE Participant’s WorkbookFo Managers Additional Resources For more information, contact: World Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int ISBN 978 92 4 154908 0

世界卫生组织 轮椅服务管理者教程 教师手册 ［美］莎拉 ･ 弗罗斯特 等著 钟 磊 译 图书在版编目 (CIP)数据 轮椅服务管理者教程.教师手册/ (美)莎拉·弗罗斯特等著;钟磊译.-北京:求真 出版社,2017.8 ISBN978 7 80258 241 5 Ⅰ.①轮… Ⅱ.①莎…②钟… Ⅲ.①四肢-残疾人-社会服务-技术培训-教材 Ⅳ.①C913.69 中国版本图书馆CIP数据核字 (2017)第210460号 世界卫生组织于2015年出版,原标题为 (WheelchairServiceTrainingPackageFor Managers:Trainer’sManual)ⓒ世界卫生组织2015 世界卫生组织授予深圳市残疾人综合服务中心翻译中文版的权利,并委托求真出版社 出版。中文版的翻译质量和准确性由深圳市残疾人综合服务中心负责。若英文版与中 文版有任何出入,应以英文原版为准。 轮椅服务管理者教程.教师手册ⓒ世界卫生组织2015 轮椅服务管理者教程———教师手册 著 者:[美]莎拉·弗罗斯特 等 译 者:钟 磊 责任编辑:计 悦 出版发行:求真出版社 社 址:北京市西城区太平街甲6号 邮政编码:100050 印 刷:北京华联印刷有限公司 经 销:新华书店 开 本:787×1092 1/16 字 数:165千字 印 张:9 版 次:2017年8月第1版 2017年8月第1次印刷 书 号:ISBN978 7 80258 241 5/C·9 定 价:36.00元 编辑热线:(010)83190270 销售服务热线:(010)83190297 83190289 83190292 版权所有 侵权必究 印装错误可随时退换 术 语 本教程中的术语定义如下: 适用的轮椅 能够满足使用者需求以及环境状况的轮椅;提供适配和体位支撑并且安全耐 用;国内可得到且在国内能够以最经济实惠的价格购买和维修并接受持续的 服务。 手动轮椅 由使用者本人驱动或由其他人推行的轮椅。 体位支撑装置 (PSD) 用于提供附加体位支撑的装置,是中级轮椅服务的主要内容。 轮椅 为行走或移动困难者提供轮式移动和坐位支撑的器具。 轮椅改制 对轮椅进行改造。 轮椅供应体系 轮椅设计、生产、供应和提供服务的总术语。 轮椅服务 轮椅供应体系的一部分,以确保每位使用者都能获得一辆适用的轮椅。 轮椅服务人员 提供适用轮椅服务中具有专业技能的人员。 轮椅使用者 有行走或移动困难而需要使用轮椅代步的人士。

, 1 《轮椅服务管理者教程》概述 1 简介 1 目标人群 2 目的 2 范围 3 教师 3 如何开始 4 1.教师指引 4 1.1培训概述 5 1.2课程表与课时 5 1.3单元计划 5 1.4幻灯片演示 5 1.5每期培训结束后评估培训项目 6 1.6有效的实操培训提示 7 2.如何准备实施教程 7 2.1了解轮椅供应体系现状 7 2.2明确学员在轮椅服务中的角色 7 2.3检查每期单元计划,必要时进行调整 7 2.4设施准备 8 2.5资源和设备准备 11 3.详细的单元计划 11 欢迎、介绍和概述 14 A:核心知识 14 A.1:什么是适用的轮椅供应体系 23 A.2:提供轮椅服务 32 A.3:领导变革的管理者 42 B:开始轮椅服务 42 B.1:获得服务 50 B.2:设施和设备 57 B.3:适用轮椅的范围 72 B.4:人员配置 79 B.5:轮椅服务的成本 88 C:运营轮椅服务 88 C.1:如何确定轮椅服务是否有效 98 C.2:管理需求 113 C.3:规划随访 125 C.4:规划财务的可持续性 132 整合所有知识 135 参考文献 1 《轮椅服务管理者教程》概述 简介 世界卫生组织 (WHO)于2008年、2012年和2013年分别发布了 《资源有限地区手动轮椅服务 指南》①、《轮椅服务初级教程》(WSTPb)②和 《轮椅服务中级教程》(WSTPi)③。世界卫生组织与美国 国际开发署 (USAID)共同开发了轮椅服务教程的第三部分,它包括两个分教程: 《轮椅服务管理者 教程》(WSTPm)和 《轮椅服务利益相关者教程》(WSTPs)。世界卫生组织轮椅服务教程的第三部分 用于支持管理者有效地开发适用的轮椅服务体系,提高利益相关者的认识,并促进他们在所在国家或 地区建立适用的轮椅服务体系。 轮椅是能使个人移动的最常用辅助器具之一。对于行走或移动困难的人们来说,轮椅是他们移动、 赋能、获得尊严和生活幸福的基本工具。移动能够为轮椅使用者开启独立和享受健康、教育、工作和 参与社会文化活动的大门。然而,统计数据显示,有超过7000万人需要轮椅,但是只有5%~15%的 人获得了轮椅。此外,轮椅服务人员很少有机会获得开具有效轮椅处方所需知识和技能的培训。 移动能力的重要性也反映在联合国 《残疾人权利公约》(CRPD)④里,其倡导 “采取有效措施,确 保残疾人尽可能独立地享有个人移动能力”。为确保有效的个人移动,轮椅使用者就需要一辆正确适配 并满足他们具体需求的轮椅。这就需要有相应的能够反映个人需求的方法。 满足轮椅使用者个人需求的有效方法是通过组织良好的轮椅供应体系提供轮椅,该体系能够对使 用者的需求作出积极的反应,维护他们的尊严并由受过良好训练的人员来实施。 目标人群 本教程是为负责实施、管理和评价康复服务包括轮椅供应或轮椅服务的所有人员设计的。 以往的轮椅服务管理经验不是必须的,然而培训班的设计是假定学员在开始培训之前已具备基本 的管理技能。 注意:每单元的实际时间将根据以下因素而变化: ●学员的经验和技能; 2 ●全体学员的数量; ●培训中是否需要翻译; ●是否需要增加其他内容。 受以上因素的影响,完成教程的时间可能或长或短。强烈建议教师根据当地的情况及学员的培训 需求调整和修改课程表。 目的 本教程的目的是提高所有轮椅服务人员的认识,并提升他们的知识和技能。WHO认识到如果不 能充分参与建立或提高所在国家的轮椅供应体系,单独培训人员并不能确保在所在国家提供适用的轮 椅或完成 《资源有限地区手动轮椅服务指南》中的职责。 本教程提出了康复或轮椅服务管理者在组织和领导实施轮椅服务8个步骤中的职责和有关问题的 概述。它包括需要用于轮椅服务的人力和物力资源,如计划、组织、人员、指导、成本或资金、监督 和评价。 本教程的实施将有助于管理者: ●更好地规划轮椅供应体系; ●提高轮椅服务的质量; ●更好地留住专业人员; ●增加获得适用轮椅使用者的数量; ●提升轮椅供应体系的可持续性。 范围 本教程可以在13~14个小时内教授完成,根据不同情况的具体需求和可用资源,培训时间可能会 延长或缩短。本教程包括: ●WHO 《轮椅服务初级教程》中描述的轮椅服务关键步骤概述; ●轮椅服务需要的核心知识; ●开始轮椅服务; ●运作轮椅服务; ●使轮椅供应体系可持续。 3 教师 技能:实施本教程培训的教师应该很好地理解培训的主题和情景。他们应该意识到现有轮椅供应 体系的项目和差距,以及当地相关的法律、战略和政策。 精选教师对于培训成功很重要。建议教师具备: ●培训和帮助学员的经验; ●管理不同层次学员的经验; ●坚信引进适用的轮椅供应体系对轮椅使用者是有益的。 教师数量:建议每8~10名学员配一位教师。培训中有一名有经验的轮椅使用者,并且能够熟练 掌握培训主题与内容,可能是一笔培训财富。如果不止一位教师,建议按照单元进行分配以避免一位 教师讲得太多。 如何开始 在实施教程之前,你必须将光盘的内容 (在 WHO 《轮椅服务管理者教程》和 《轮椅服务利益相 关者教程》文件内)复制至电脑。实施本教程的最简便方法是: 1.从手册文件夹中打开 《教师手册》: 1.1 阅读 “轮椅服务教程”和 “教师指引”部分; 1.2 如果没有教材,为每位教师打印和装订 《教师手册》; 1.3 打印课程表和培训评价表。 2.按照 “如何准备实施教程”单元中的建议进行全部必要的安排。参阅培训教师卡上的其他 信息。 3.给每位学员一整套培训资料,包括:《学员手册和实训手册》、轮椅服务步骤的海报。如没有, 可以从光盘中打印。 4.打开培训教程的课程表并点击每单元的超级链接,你将进入对应的幻灯片和视频。实施培训的 最好方式是尽可能按照每单元分配的时间及顺序执行。 4 1.教师指引 1.1培训概述 单元 分钟 欢迎、介绍和概述 30 A:核心知识 A.1:什么是适用的轮椅供应体系 50 A.2:提供轮椅服务 40 A.3:领导变革的管理者 45 B:开始轮椅服务 B.1:获得服务 45 B.2:设施和设备 55 B.3:适用轮椅的范围 80 B.4:人员配置 50 B.5:轮椅服务的成本 60 C:运营轮椅服务 C.1:如何确定轮椅服务是否有效 75 C.2:管理需求 85 C.3:规划随访 85 C.4:规划财务的可持续性 70 整合所有知识 30 合计 800 5 1.2课程表与课时 本教程应在连续时间或在一定时间分段实施。完成本教程的培训至少需要13~14小时。每单元需 要的预估时间已经包括在该单元计划中。课程表的样表在光盘中。建议教师根据当地的情况及学员的 培训需求调整和修改课程表。 1.3单元计划 每单元都有详细的单元计划。教师可以用它来计划和实施每单元的内容。 在每单元计划的开始都有如下信息: ●目标:详述每单元的目的; ●资源:本单元需要什么资源; ●情境:本单元如何根据不同的情境或情况进行调整; ●准备:如何为本单元做准备; ●大纲:本单元主要内容大纲。 单元计划的其余部分被分为多个主题。对于每个主题,单元计划就如何传递主题信息给予指导。 每个单元计划最后,列出了管理者推荐的行动措施。鼓励管理者思考他们如何将每单元最后的这 些措施应用到情境中。 1.4幻灯片演示 所有的单元都准备了幻灯片演示和视频。教师应该明白只是关键点出现在幻灯片中。 1.5每期培训结束后评估培训项目 在每期培训结束后,对培训项目进行评估是较好的做法。教师可以在培训过程中记录自己对于培 训的想法。这些信息将有助于他们在培训结束后评估培训项目,包括发现优缺点。这也将有助于教师 评估教程本身,以及评估未来在他们情境中技能的实施。 6 1.6有效的实操培训提示 准 备 ●培训开始前仔细阅读每单元的培训计划; ●确保对讲授的内容胸有成竹; ●收集培训资源并准备好培训教室。 清晰地传递信息 ●清晰并从容地讲述; ●确保教室内的每位学员都能听到; ●通过提问来检查学员对授课内容的理解; ●确保每位学员都能看到白板上的书写内容; ●重复重要观点以示加强。 管理单元时间 ●注意每单元允许的时间及按时间执行; ●如果需要增加时间,应在开始时就计划; ●确保在计划的日期内完成所有的单元内容。 在小组活动中 促进成功 ●近距离观察小组活动并在需要时提供帮助; ●确保教师在小组之间巡视并检查他们的进展。 鼓励学员积极 参与整个培训 ●运用单元计划中的不同培训风格和方法; ●避免讲得太多,鼓励学员表达和讨论; ●通过提问来鼓励学员自己思考答案,而不总是告诉他们答案; ●鼓励每位学员发言,而不是让某位学员主导; ●表扬学员的优秀表现并给予积极反馈; ●让学员知道他们可以随时提问; ●将培训与学员了解的真实案例联系起来; ●让培训变得快乐! 运用简短的 热身活动或游戏 ●运用简短的热身活动 (5~10分钟)来帮助学员集中注意力。采用包括残疾 学员能参与的活动。热身游戏的选择包含在培训项目工具包中。 考虑不同能力 学员的需求 ●考虑到某些视力、听力或移动困难学员的需求,一些活动和教学方法可能 需要相应地进行调整。 7 2.如何准备实施教程 2.1了解轮椅供应体系现状 组织轮椅服务管理者培训的机构和主办方需要全面地了解所在国家或地区的轮椅供应体系。包括: ●了解所有现有的轮椅供应体系的活动或项目; ●了解轮椅供应体系的现有差距; ●了解相关国家或地区与轮椅供应体系有关的法律、战略、政策和行动计划。 2.2明确学员在轮椅服务中的角色 了解轮椅服务是否与学员所在工作区域的所有职责相适应。例如,学员将要做的仅仅是轮椅服务, 或者他们同时还有其他的职责吗? 2.3检查每期单元计划,必要时进行调整 仔细地检查每期单元计划,一些单元可能需要根据当地的情境进行调整。调整建议列在每单元计 划开始的 “情境”标题下。 2.4设施准备 培训空间需要足够大,以便学员能分成小组进行活动。所有的区域,包括卫生间和午餐、茶点区 域,必须是轮椅无障碍的。 以下的检查表用于评估和准备培训设施。 8 设施检查表: 培训教室 授课区域 □ 每位学员的椅子———方便学员记笔记 □ 学员分成2~3人一组的空间 □ 充足的光线及通风 □ 午餐或茶点区域 洁净的就餐区域 □ 桌与椅 □ 附近的洗手场所———干净的毛巾和肥皂 □ 卫生间 洁净的卫生间并提供水、卫生纸、洗手设施和垃圾箱 □ 2.5资源和设备准备 资源材料 资源 数量 √ 备注或说明 手册: 《教师手册》 每位教师1份 □ 从 WHO订购或印刷并装订 《学员手册和实训手册》 每位学员1份 □ 从 WHO订购或印刷并装订 教师的补充资源。 同时决定如何与学员分享相关的资料。例如,用U盘,通过互联网共享设备,或提供网址参考。 WHO 《资源有限地区手 动轮椅服务指南》 至少1本 □ 资料在光盘中 《资源有限地区行动辅具 服务的联合意见书》 至少1本 □ 资料在光盘中 9 续表 资源 数量 √ 备注或说明 联合国 《残疾人权利公 约》(CRPD) 至少1份 □ 资料在光盘中 《社区康复指南》中 《导 论篇》和 《健康篇》 至少1份 □ 资料在光盘中 引领的管理者 每位教师1份 □ 资料在光盘中 无障碍设计的思考2006 至少1份 □ 资料在光盘中 轮椅服务教程LOGO 高分辨率 □ 资料在光盘中 学员考勤表 每次培训1份 □ 用该表记录学员的出勤情况 胸牌 每位学员和教师1个 □ 用轮椅服务教程LOGO在当地制作 课程表 每位学员1份 □ 样表在光盘中;可根据当地的情境进 行调整 肖像同意表 每位学员1份 □ 为主办或培训机构修改本表 培训证书 每位学员1份 □ 准备学员证书或修改提供的样表 海报: 轮椅服务初级教程:轮椅 服务步骤;轮椅移动技 能;压疮和如何在家保养 轮椅 4 □ 轮椅服务中级教程:儿童与 轮椅;不同的姿势;体位支 撑装置 (PSD)表和中级轮 椅使用者培训检查表 4 □ 从光盘中打印 10 设备 资源 数量 √ 备注或说明 投影仪 1 □ 电脑 1 □ 音响 1套 □ 用于播放视频声音 麦克风 2个以上,取决于学员 数量 □ 一个移动麦克风用于学员提问或小组 反馈信息 大白板 1 □ 白板笔 3~4支 □ 活动挂图架和纸 1个架子和一摞纸 □ 活动挂图笔 3~4支 □ 便条贴 3~4叠 □ 胶带或类似物品 1卷 □ 用于把活动挂图和海报粘在墙上 轮椅样品 每3位学员1辆 □ 当地可得到的轮椅样品,用于学员在 休息时使用 鼓励管理者在休息时间使用不同的轮椅 (有一位伙伴在旁边保证安全)。 11 3.详细的单元计划 欢迎、介绍和概述 目标 本单元结束后,学员将: □了解本教程的目标; □熟悉教师和其他学员的姓名; □概括了解培训课程表; □熟悉许多需要记住的重要规则。 资源 本单元: □幻灯片:导论; □每位学员的 《学员手册和实训手册》; □DVD:提供轮椅服务; □每位学员1份课程表; □教师和学员的胸牌。 情境 根据学员将工作的情境修改本单元。例如: □适合当地文化或情境的开幕式; □根据教师和学员的情况,修改或调整 “介绍教师和学员”单元; □修改、调整或增加 “后勤和期望”列表; □如果培训教程修改了,也需调整概述的幻灯片。 准备 □浏览单元计划,收集资源,检查幻灯片并观看视频。 □在报到时分发课程表、《学员手册和实训手册》、胸牌。 大纲 1.开幕式 (如果有) 2.介绍教师和学员 3.教程概述 4.培训课程表、后勤和期望 10 10 5 5 总单元时间 30 12 1.开幕式 (10分钟) 根据当地的文化和风俗,可以在培训之前举行一个开幕式。 2.介绍教师和学员 (10分钟) 教师:介绍自己。简要介绍自己的背景和轮椅服务及管理经验。 让学员轮流介绍自己,包括姓名、所在单位以及他们想从培训中获得什么等。 3.培训概述 (5分钟) 说明:本教程的目标,来自于幻灯片内容。 讲出幻灯片的内容,强调要点。 说明:培训建立在联合国 《残疾人权利公约》的基础上,认识到残疾人与其他人享有同样的人权, 在实现这些权利的过程中描述轮椅服务的职责。 13 介绍视频:提供轮椅服务。 本视频将介绍 《轮椅服务初级教程》和 《轮 椅服务中级教程》中的轮椅服务8个步骤。 让学员观看视频并注意每个服务步骤。播放 视频。 4.培训课程表、后勤和期望 (5分钟) 让学员查看课程表。强调培训开始和结束以及休息的时间。 后勤管理: ●卫生间的地点; ●谁负责住宿和交通; ●如果遇到紧急情况怎么办。 期望: ●每堂课将准时开始; ●培训期间关闭手机; ●鼓励提问。 培训过程中,学员将亲自坐轮椅和推轮椅。在使用轮椅的时候,记住以下安全守则: ●当上下轮椅的时候,不要站在脚踏板上; ●手指不要放在轮辐和刹车上; ●当坐轮椅上坡或下坡的时候,务必有协助者在你身后以防轮椅后翻。 14 A:核心知识 A.1:什么是适用的轮椅供应体系 目标 本单元结束后,学员将能够: □计算所在国家和全球的轮椅需求; □列出联合国 《残疾人权利公约》的两个条款以强调适用轮椅供应体系的重要性; □定义适用轮椅供应体系; □讨论国家政策如何支持轮椅供应体系; □说明 《资源有限地区手动轮椅服务指南》如何支持国家政策的发展。 资源 本单元: □幻灯片:A.1:什么是适用的轮椅供应体系; □ 《学员手册和实训手册》。 情境 本单元可根据学员将工作的情境进行修改。例如: □确认人口统计数据和其他相关的数据来计算所在国家轮椅的需求; □研究所有与轮椅供应体系有关的现有国家或地区政策。 准备 □浏览单元计划并收集资源。 □在第3个幻灯片中输入所在国家或地区的统计数据。 大纲 1.介绍 2.轮椅的需求和未满足需求是什么 3.个人移动的权利 4.支持适用轮椅供应体系 5.管理者行动要点概括 4 4 20 20 2 总单元时间 50 15 1.介绍 (4分钟) 说明:本单元我们将讨论适用轮椅供应体系,以及以使用者的个人需求为全流程中心的重要性。 讲出幻灯片的内容,强调要点。 2.轮椅的需求和未满足需求是什么 (4分钟) 讲出幻灯片的内容,强调要点。 提问:你们知道我们国家有多少人需要轮椅吗? 感谢回答。 16 说明: ●WHO估计1%的人口需要轮椅。 ●国家的人口是X (输入人口调查数据,计 算1%的人口调查数据)。 3.个人移动的权利 (20分钟) 介绍视频:适用的轮椅对我意味着什么。本 视频中有一位有经验的轮椅使用者弗斯蒂 娜,她介绍通过轮椅服务获得一辆轮椅后给 自己带来的变化。 播放视频。 提问:当弗斯蒂娜通过轮椅服务获得一辆轮 椅后,有哪些变化? 最重要的答案: ●在粗糙地面上弗斯蒂娜不再摔出轮椅了 (尊严); ●由于她的轮椅是合适的尺寸并给予身体良好的支撑,弗斯蒂娜能够坐直了 (帮助她坐直和舒适); ●弗斯蒂娜能够安全和独立地在粗糙道路和斜坡上推行 (独立); ●弗斯蒂娜感到能力不那么差 (自信); ●由于轮椅是她个人的,弗斯蒂娜自我感觉良好了 (自尊)。 17 说明:我们知道许多需要轮椅的人士仍然没 有适用的轮椅。然而,管理者可以用以下的 文件作为重要工具来倡导需要轮椅人士的 权利。 ●联合国 《残疾人权利公约》(CRPD)。 ●CRPD的重点在于确保每个人都认识到这 是所有人的权利,包括残疾人。 提问:我们国家签署了联合国 《残疾人权利公约》吗? 教师提示: ●签署了CRPD意味着政府的道德意图受到公约的约束; ●批准CRPD意味着政府的道德和法律有责任来实施这个公约。 说明:联合国 《残疾人权利公约》中有许多条款来强调适用轮椅供应体系的重要性和现实意义。 提问:有人知道联合国 《残疾人权利公约》中的哪个条款特别提到了移动吗? 感谢回答。 讲出幻灯片的内容,强调要点。 18 说明: ●第26条表述康复和适应训练的重要性。 ●个人移动是康复的重要内容。 教师提示: ●康复:恢复能力以参与社会; ●适应训练:第一次建立能力。 讲出幻灯片的内容,强调要点。 说明: ●个人移动通常是融合和参与的第一步; ●当一个人通过服务获得一辆适用的轮椅 时,便获得了参与社会生活、就业和教育 的机会。 19 说明: ●适用的轮椅可以帮助使用者开启一个新的 世界:从排斥到包容,参与所有的社会活 动、运动和娱乐,带来独立和健康。 说明:对于所有人是双赢的。 ●解放家庭成员参与社区和工作。 ●由于有了适用的轮椅,有更多的社会成员 做贡献,以及减少对健康服务的需求,使 国家的经济从中获益。 4.支持适用轮椅供应体系 (20分钟) 说明:我们已经使用过 “轮椅供应体系”这个词汇。 提问:根据 《资源有限地区手动轮椅服务指南》,这个词的真正含义是什么? 感谢回答:把答案写在白板上。 最重要的答案: ●提供满足适用轮椅定义的产品; ●通过服务提供产品; ●提供服务的人员接受过适当的培训; ●受到国家层面和机构内部的政策支持。 20 讲出 《资源有限地区手动轮椅服务指南》内 容的4个重要范围。 说明:轮椅供应体系是有效和可持续的,它必须得到政策和规划的支持。《资源有限地区手动轮椅 服务指南》强调国际、地区政策和战略应该支持与体现轮椅供应体系的国家政策。最高层次的文件就 是联合国 《残疾人权利公约》。 讲出幻灯片的内容,强调要点。 说明: ●《仁川战略》的目标3是使那些需要,但 却无法获得适用辅助器具或产品的残疾人 比例减半。 ●报告的指标是需要而且能够切实享用辅助 器具或产品的残疾人所占比例。 21 说明:签署了 “仁川目标和具体目标”的政府现在致力于发展国家规划和项目来履行这个职责。 《仁川战略》范例显示出国际和地区政策如何支持和促进国家政策的发展。 说明:国家政策也可以促进国内发展。我们将看到南非的案例。 活动 分组 所有学员分成3组。 指导 阅读与轮椅供应体系有关的国家政策案例 〔见 《学员手册和实训手册》中 “实训手册”部 分 (以下简称 “实训手册”)第76~77页〕。 思考你所在的地区已经有哪些政策。 讨论以下的政策如何在你所在的地区发挥作用,以及思考这个政策如何适应你当地的政府架构。 监督 监督各组,在需要时提供帮助。 时间 预留6分钟和9分钟进行讨论。 反馈 让每组向所有学员反馈。 把答案记录在白板上。 注意所在地区是否已经有了轮椅供应体系方面的政策,谁是轮椅供应体系的主要利益相 关者。 注意基于南非案例的所有改进意见。 案例:南非轮椅供应体系的政策 南非的西开普省,在开普敦一群提供轮椅服务的临床医生越来越对分割、零散的轮椅服务感到不舒 服和沮丧。经过咨询省级的项目经理和当地的康复机构后,他们列出了改进和使轮椅服务标准化、 专业化的计划并得到允许实施他们的计划。该计划有3方面主要的内容: (1)分析所在省的轮椅服务情况。 (2)对轮椅服务的提供者进行培训。 (3)制定省级轮椅管理战略的指导方针。 情况分析:广泛的情况分析证实轮椅供应体系结构和流程的分散和缺乏。很少有轮椅使用者获得个性化评 定、处方和适配,甚至很少人接受过正确使用轮椅的训练。通常,轮椅由没有受过轮椅服务专业培训的社 工或行政人员配发给使用者。尽管大多数服务提供者指出轮椅使用的很大需求未被满足,但是他们不能确 定需求的数量,因为他们不能让使用者长时间等待。很少有随访、维修和保养服务。 22 实施培训:通过情况分析,识别培训需求的小组开始小规模的培训项目,以弥补缺少的服务步骤。 拟定省级准则,包括关键服务步骤的最低标准,以及关键管理步骤,例如培训人员、建立和管理等 候人员、资金分配、提供维修和保养服务。 建立准则:省级管理者认识到在轮椅和康复服务方面推进变革的自我激励的重要性,并且帮助该小 组成为省级康复项目的正式顾问小组。该小组的代表陪同省级管理者参加轮椅和辅助器具的国家会 议,积极建立南非辅助器具的国家准则,该准则于2013年发布。 5.管理者行动要点概括 (2分钟) 概括:影响政策和规划不是个人或组织的职责。它需要许多不同利益相关者的合作。 讲出要点。 23 A.2:提供轮椅服务 目标 本单元结束后,学员将能够: □讨论提供轮椅服务模型; □说明初级轮椅服务与中级轮椅服务的区别; □讨论管理者在轮椅服务中的职责; □讨论轮椅使用者在组织文化中扮演的角色。 资源 本单元: □幻灯片:A.2:提供轮椅服务; □ 《学员手册和实训手册》; □便条贴。 情境 本单元可根据学员将工作的情境进行修改。例如: □研究当地的轮椅服务模式。 准备 □浏览单元计划并收集资源。 □确保轮椅服务步骤的海报挂在学员可以清楚看到的地方。 □把白板放在幻灯投影屏幕的旁边。 大纲 1.前言 2.轮椅服务的层次 3.轮椅服务模式 4.管理者的广义职责 5.轮椅使用者积极参与轮椅服务 6.管理者行动要点概括 2 5 10 15 5 3 总单元时间 40 24 1.前言 (2分钟) 说明:本单元我们将讨论轮椅服务中管理者的职责。轮椅服务为评估个人的移动需求提供了一个 框架: ●协助使用者选择适用的轮椅; ●为使用者和看护者提供培训、持续支持和转介至其他适合的服务机构。 2.轮椅服务的层次 (5分钟) 说明:每辆适配的轮椅为使用者提供一定的体位支撑。当调整到适合使用者的尺寸时,靠背、坐 垫、脚踏板和扶手提供体位支撑。然而,许多儿童和成人在他们的轮椅上还需要附加体位支撑。 介绍克莱拉:克莱拉生活在东帝汶。她在自 己家的商店上班,商店在他们家房子的前 面。克莱拉患有小儿麻痹症,她需要一辆轮 椅进出房间,在商店工作并在村里移动。她 能够不需要任何支撑坐直,并使用一辆已经 调整和适配的手动轮椅。 克莱拉是一个可以通过初级服务获得轮椅的 例子。 介绍易莎德:易莎德8岁,生活在斯里兰 卡。她是脑瘫患者。对易莎德来说,这意味 着她控制上肢、下肢、头颈有困难。没有支 撑她不能坐直。 易莎德是在轮椅上需要附加体位支撑的一个 例子。这些内容并不在 《轮椅服务初级教 程》中讲授。 说明:使用者的需求、提供服务和服务人员的培训需要联系起来。 25 说明: ●克莱拉需要初级服务。 ●因此,服务人员需要初级培训。 ●根据谁负责8个服务步骤,确定接受培训 的人员。 说明: ●易莎德需要由有更多知识和技能的人员的 服务,才能获得她需要的附加支撑。 ●确定接受培训的人员需要具备初级服务的 知识基础,外加中级培训。 提问:你们机构有需要初级或中级服务的使用者吗? 鼓励回答。 教师提示: ●无所谓答案正确或错误。有时一项服务针对特殊的需求,例如儿童服务或脊髓损伤康复。在所有 区域,都是使用者需求的组合。因此,在所有区域同时需要初级和中级服务。 ●厘清成人和儿童都需要中级服务。 26 3.轮椅服务模式 (10分钟) 说明:所有的轮椅服务应该遵循8个步骤。 可以采取不同的服务模式用不同的方式来实 施服务步骤。 无论哪种服务模式,如果服务模式按照8个 步骤实施,所有的使用者都将受益。 说明:我们将看到轮椅服务的不同模式。在提供的案例上可能会有所不同。我们将简要地看到机 构和人员职责的一些不同。 介绍机构轮椅服务模式。 说明: ●该模式的机构有轮椅服务的专用区域,包 括专用的移动技能训练区域和完整的轮椅 维修和保养区域。 ●服务团队包括经过培训的轮椅服务全职专 业人员。 介绍综合轮椅服务模式。 说明: ●大多数机构为基础的服务也是 “综合服 务”。这意味着把轮椅服务与其他服务活 动整合在一起。 ●例如把轮椅服务与假肢或矫形器服务、物 理治疗部门、卫生诊所整合在一起。 ●在医院或机构内,服务人员可能有固定的 轮椅服务日和其他服务日。 27 介绍社区轮椅服务模式。 说明: ●该模式的机构可能是暂时的。由合作机构 提供一间房或一栋楼实施家访。 ●机构服务的人员可能与合作机构一起共同 承担一些服务工作。 ●小批量的轮椅可以存放在合作机构。 ●需要通过培训来增强合作机构的服务 能力。 ●可能需要找到社区的维修和保养服务机 构,例如焊接、木工和家具装饰。 介绍流动轮椅服务模式。 说明: ●汽车运输组装或未组装的轮椅以及必要的 工具和设备。 ●服务人员由汽车运输。 ●可能进行小范围的维修和保养服务。 ●可能使用社区的建筑物或携带他们需要的 工具在社区提供轮椅服务。 说明:不是轮椅服务的8个步骤都需要在同一个机构实施。机构网络之间的协作可以帮助提高服 务的效率,并且有助于轮椅使用者获得完整的8个步骤。 28 说明: ●根据情境的不同,机构服务和社区服务的 边界将会不同。 ●该模式显示在机构进行的8个服务步骤, 通过社区合作机构实施转介和随访。 活动 分组 学员分成两人一组。 指导 说明:在整个培训期间,我们将详细地讨论你们的服务模式。 与你的同伴讨论,轮椅服务的一些步骤是否由与你们服务相关的机构实施 (例如转介、随 访)。 如果一些服务步骤由合作机构实施,写在单独的便条贴上。 每个服务步骤用一张新的便条贴。 监督 监督各组并在需要时提供协助。 时间 总共允许5分钟。 反馈 每次列出一个服务步骤,参考轮椅服务步骤海报。 如果某个步骤由合作机构实施,让学员把便条贴粘在该步骤旁边。 最后总结,强调所有的机构在转介上都需要协作,并且随后我们将更多地讨论其他服务步 骤合作的益处。 提问:确定和计划适合的服务模式,需要思考的因素是什么? 感谢回答并把答案写在白板上。 29 最重要的答案: ●与使用者有关的服务机构位置; ●服务的地理范围 (接近轮椅使用者); ●地理环境 (海岛社区、很少道路的山区); ●潜在合作机构的服务能力。 说明:当开发一个新的合作伙伴时,重要的是与合作机构讨论培训需求,并计划如何发展他们的 知识和技能,以承担8个服务步骤的全部或部分。这将稍后讨论。 4.管理者的广义职责 (15分钟) 说明:管理者负责服务的整体质量。他们也负责支持员工实施8个服务步骤并与使用者 (他们的 护理者或家庭成员)合作改进这些步骤以满足使用者的期望。 管理者也有更广义的职责,它对于支持提供服务很重要。现在我们将看到这些广义的职责。 活动 分组 把学员分成3人一组。 指导 分发便条贴。 让学员写下他们认为管理者的广义职责是什么。 监督 鼓励学员思考对于持续地提供适用的轮椅服务,什么是重要的? 时间 允许3分钟写便条贴以及7分钟总结广义的职责。 反馈 所有学员一起反馈。 投影插图显示6个广义的职责 (如 《资源有 限地区手动轮椅服务指南》所描述的)到白 板上。 请一位主动的学员读出他们的便条贴内容。 把便条贴粘在相关的标题旁边。 注意学员提出的所有不同或增加的建议。 30 5.轮椅使用者积极参与轮椅服务 (5分钟) 说明:强烈建议轮椅使用者积极参与服务的设计、实施、监督和评价。 说明: ●《资源有限地区手动轮椅服务指南》就轮 椅服务的良好实践提出建议。 ●讲出幻灯片的内容,强调要点。 说明:为了积极地征求轮椅使用者的意见,轮椅使用者成为轮椅服务团队的成员是非常有益的。 如果有学员是轮椅使用者,向他们询问,把轮椅使用者作为服务团队的成员感觉怎么样? 提问:你们所在的机构服务团队中有轮椅使用者吗? 让轮椅使用者积极地参与轮椅服务的好处是 什么? 最重要的答案: ●在社区里为使用者树立榜样; ●挑战更广泛社区的理念; ●服务团队里的积极态度,与正面榜样一起工作是很有激励作用的; ●轮椅使用者参与和融合的积极信息; ●可以提高对轮椅使用者需求的响应能力。 说明:罗马尼亚的一个机构非常重视轮椅使用者参与服务团队,因此他们的所有服务团队中都雇 用了一名轮椅使用者。 31 罗马尼亚的轮椅使用者团队 罗马尼亚的一个非政府轮椅服务机构招聘了一些轮椅使用者到他们的轮椅服务团队中。根据他们的 技能水平,轮椅使用者在团队中发挥不同的作用。该非政府机构发现轮椅使用者作为轮椅服务人员 的积极作用。作为同事在日常工作中的相互影响让每位团队成员更加认识到轮椅使用者的作用,轮 椅需求者与团队中的轮椅使用者分享他们的经验通常感到更加自然,轮椅使用者是他们的模范。 6.管理者行动要点概括 (3分钟) 讲出幻灯片的内容,强调要点。 32 A.3:领导变革的管理者 目标 本单元结束后,学员将能够: □说明在引进或改进适用轮椅供应体系中,管理者应该领导团队发挥的作用; □通过变革过程对领导员工及整合人员和资源,提出相应对策。 资源 本单元: □幻灯片:A.3:领导变革的管理者; □ 《学员手册和实训手册》。 有经验的学员: □ 《管理者的领导力》第6章149页 “领导变革促进健康”。 情境 根据学员将工作的情境修改本单元。例如: □如果某些学员在轮椅服务或其他服务方面,有努力引进变革的个人经验,分享这些经验是有 用的。他们可能让人们参与导致良好的结果,或不让人们参与,抵制变革而导致失败。 准备 □收集资源。 □阅读 《管理者的领导力》第6章149页 “领导变革促进健康”。 □检查幻灯片并浏览单元计划。 □准备带有以下标题的4张白纸: 1.管理者可以采取的行动:建立适用轮椅供应体系的共同愿景。 2.管理者可以采取的行动:以紧迫感传播适用轮椅供应体系的重要性。 3.管理者可以采取的行动:整合人员和资源。 4.管理者可以采取的行动:激励、参与和动员员工。 大纲 1.领导变革过程中的管理者职责 2.建立适用轮椅供应体系的共同愿景 3.以紧迫感传播适用轮椅供应体系的重要性 4.整合人员和资源 5.激励、参与和动员员工 6.管理者行动要点概括 10 7 5 5 12 6 总单元时间 45 33 1.领导变革过程中的管理者职责 (10分钟) 介绍:把本单元与前面单元联系起来。 在前面单元,我们已经讨论过在轮椅供应方面存在着巨大的未满足需求。个人移动让残疾人成为 他们社区更加有创造性的成员。对于很多人来说,一辆适用、设计优良和精确适配的轮椅是迈向包容 和参与社会的第一步。 说明: ●基于 《资源有限地区手动轮椅服务指南》, 为了培训合适的人力资源和提供良好的轮 椅服务体系,WHO和 USAID开发了轮 椅服务教程。 说明:整个培训教程的目的是提高认识,以及开发所有轮椅供应体系人员的技能和知识。 然而,如果没有管理人员参与建立或改进所在地区的轮椅供应体系,仅仅这些经过培训的人员不 能确保所在地区适用轮椅供应体系或按照 《资源有限地区轮椅服务指南》履行他们的职责。 提问:为了确保建立或改进所在地区的轮椅供应体系,你认为管理者的职责是什么? 鼓励回答并把答案写在白板上。 最重要的答案: ●提高认识和倡导需求; ●计划和预算轮椅的供应; ●协调努力; ●组织服务; ●监督和评价轮椅的供应。 34 说明:引进或改进轮椅供应体系意味着组织变革。然而,组织变革可能很艰难。 说明:人们已经进行了很多研究来增加对组 织变革成功的理解。 本次培训,我们将关注管理者领导变革的4 个方面: (1)建立适用轮椅供应体系的共同愿景; (2)传播适用轮椅供应体系的重要性并制造 紧迫感; (3)整合人员和资源; (4)激励、参与和动员员工。 2.建立适用轮椅供应体系的共同愿景 (7分钟) 讲出幻灯片的内容,强调要点。 提问:这样的陈述有用吗? 最重要的答案: ●提出共同目标的感受; ●提出共同方向; ●提出共同努力的起点; ●激励。 35 教师提示: ●作为培训的一部分不可能建立愿景或宗旨,因为不是所有的利益相关者都会出席; ●如何建立共同愿景的建议已列在 《轮椅服务利益相关者教程———教师手册》中。 讲出幻灯片的内容,强调要点。 讲出幻灯片的内容,强调要点。 36 3.以紧迫感传播适用轮椅供应体系的重要性 (5分钟) 提问:你认为应如何传播适用轮椅供应体系的重要性? 最重要的答案: ●谈谈所在地区未满足的需求; ●谈论轮椅的全球需求; ●谈论个人移动的权利; ●谈论什么使轮椅适用以及服务的需求; ●分享成功的正面故事; ●分享适用轮椅供应体系对个人、社区和社会的好处。 说明:紧迫感意味着需求不能被忽略或耽误。人们遵照他们主管的优先事项安排行动,因此管理 者的行动必须建立紧迫感。 提问:你认为如何能够为改进轮椅供应体系 树立紧迫感? 缓慢地读出幻灯片上的问题,让学员思考 答案。 37 4.整合人员和资源 (5分钟) 说明:轮椅服务需要受过培训的人员、设施和资源。 讲出幻灯片的内容,强调要点。 提问:针对轮椅供应体系,管理者能做什么来整合人员和资源? 鼓励回答并把答案写在白板上。 最重要的答案: ●确定可以用于轮椅供应体系的设施; ●当分配资源时优先保证轮椅供应体系; ●用愿景和组织价值来提醒人员,你为什么要提供轮椅服务; ●奖励和认可轮椅服务的良好表现; ●促进团队合作。 教师提示: ●学员可能花大量的时间来讨论经费,不要让这种情况发生; ●承认经费是重要的内容,经费稍后会讨论; ●让学员重点关注其他一些事情,管理者可以用它们来整合人员和资源。 38 5.激励、参与和动员员工 (12分钟) 提问:管理者能做什么来激励和动员他们的员工? 鼓励回答并与以下幻灯片联系起来。 承认:正如你注意到的,如果员工被接纳以 及他们的意见被考虑,他们更容易参与和被 激励。你可以采取4个主要措施来激励 他们: (1)让员工参与计划和实施; (2)一起克服障碍; (3)创造和赞赏短期成果; (4)使变革根植于组织系统和文化中。 说明: 如果员工不理解,他们更容易抵制变革: ●变革涉及哪些内容; ●它为什么重要; ●变革对他们和他们的工作意味着什么。 39 提问:管理者如何使员工参与规划和实施? 感谢回答。 说明:员工通常具备经验和技能,使他们的 努力有价值。 ●员工都要参与建立服务愿景,以及参与 如何实施轮椅服务的规划,这样他们才 更可能有精力和热情去支持实施服务。 ●当员工参与规划改进服务,他们理解重要 性,他们了解将有哪些变化,以及他们明 白在实施服务的过程中自己的职责是 什么。 ●在这些规划过程中让使用者参与会带来附 加价值。 提问:管理者如何与他们的团队一起克服障碍? 感谢回答。 说明:员工需要感到获得管理者的支持。 ●为了应对挑战,员工需要被赋予权力、知 识和技能来开展他们的新活动。 ●观察服务步骤并提供需要的反馈和需要的 资源。 ●找到障碍的根源以获得成功,而不是研究 症状。 40 提问:管理者如何实现短期成功? 讲出幻灯片的内容并为每个要点举例。 ●找到短期内可以实现的可衡量直接成果: 例如月底之前找到4个新的转介来源。 ●以有意义的方式向客户、供应商和捐助者 讲述成功故事:例如分享使用者获得适用 轮椅而参与社区或重返工作岗位的故事。 ●感谢并奖励好的结果。例如给予具体和公开的认可,因此员工可以看到短期的正面成果,感到 管理者对他们努力的认可并会继续参与轮椅服务。 提问:管理者如何让变革根植于组织系统和文化中? 讲出幻灯片的内容并为每个要点举例。 说明: ●如果变革没有成为组织系统和文化的一部 分,它就不会长久。例如,建立庆祝成功 的文化,以及在会议期间和间隙鼓励员工 分享成功和正面的故事。 ●整合新的价值、行为和流程到常规的组织 系统中。例如,把成功的变革作为新的职 责写入个人工作描述中,并更新组织 政策。 41 6.管理者行动要点概括 (6分钟) 读出管理者行动要点并阅读 “实训手册”。 把有4个标题的4张白板纸挂起来: (1)建立共同愿景。 (2)以紧迫感传播适用轮椅供应体系的重 要性。 (3)整合利益相关者和资源。 (4)激励、参与和动员利益相关者。 说明:这4个 “变革理念”将会贯穿整个培训。在空白处记录管理者和利益相关者可以采取的共 同行动,用这些共同行动来改进所在地区的适用轮椅供应体系。 活动 分组 不用分组。 指导 鼓励学员把他们的所有想法写在便条贴上。 说明:我们将在培训结束时评述这些建议。 学员可参阅他们的 “实训手册”。 说明:他们可以记录个人行动来引进或改进自己服务机构的适用轮椅供应体系。 让学员分享他们计划记录个人行动的两个例子。 说明:你将有机会在每单元结束时记录自己的行动。 监督 鼓励学员写下他们的任何想法。 时间 总共允许5分钟。 反馈 让一位学员来厘清墙上记录的建议与 “实训手册”上的不同。 确认白板纸上的是不同组织和利益相关者之间的共同行动,以及确认 “实训手册”上的内 容是他们在自己服务机构有关适用轮椅供应体系的个人行动。 42 B:开始轮椅服务 B.1:获得服务 目标 本单元结束后,学员将能够: □说明什么是 “公平的服务”; □描述管理者可以用来开发转介网络的至少3个措施; □列出比普通人更难获得轮椅服务的人群; □列出轮椅管理者可以用来提高所有轮椅使用者获得轮椅服务的措施。 资源 本单元: □幻灯片:B.1:获得服务; □ 《学员手册和实训手册》; □ 《轮椅服务管理者教程———附加资源手册》。 情境 本单元可根据学员将工作的情境进行修改。例如: □发现学员所在地区或区域有效转介制度的正面案例,用它来替换单元计划中的案例; □发现不同人群获得服务的障碍,包括当地情境下的轮椅服务。例如,查阅当地的相关数 据;阅读相关的文章;与负责服务的人交谈;与残疾人组织沟通;与社区人员沟通。 准备 □浏览单元计划并收集资源。 大纲 1.前言 2.什么是公平的服务 3.转介和预约 4.管理者可以怎样做来确保他们的服务是公平的 5.管理者行动要点概括 2 5 15 20 3 总单元时间 45 43 1.前言 (2分钟) 说明:本单元,我们将讨论管理者在建立转介系统中的职责。它包括建立转介网络,创建转介和 预约制度,确保服务是公平的。 2.什么是公平的服务 (5分钟) 说明:“公平的服务”是指确保每位轮椅使用者有相同的机会获得轮椅。 它包括: ●成年人、儿童; ●年轻人、中年人和老年人; ●居住较近和较远的人,例如农村地区; ●不同民族或不同经济社会背景的人。 提问:学员所在地区哪些人群获得康复服务会比较困难? 提醒学员获得服务并不仅仅意味着 “到达服务机构”,它意味着能够了解服务,获得服务或服务来 到他们身边。 鼓励回答并把答案写在白板上。 最重要的答案: ●妇女和女孩; ●居住地离服务机构较远或生活在农村地区的人们; ●贫困人群; ●儿童; ●不同民族或社会经济背景的人们; ●老年人; ●特定人群,例如患艾滋病或麻风病的人会受到歧视。 44 ●公平的服务是指所有的人,不论他们的残 疾、年龄、性别、信仰、财富或民族状 况,都有相同的机会获得服务。 ●公平的服务不是指为不同人群 (例如男人 和女人)的使用者提供同样数量的轮椅。 这是因为不同人群的需求会不同。 ●公平的服务是确保那些需要轮椅的人与其 他人一样获得服务。 3.转介和预约 (15分钟) 说明:转介和预约是轮椅服务的第一步。 在轮椅服务图表上强调这个步骤。 说明: ●有效转介需要轮椅服务和社区之间的良好 衔接,因为社区的人员能发现和转介轮椅 使用者到你的服务机构。 提问:哪些个人和机构最可能发现轮椅使用者,并转介他们到你的轮椅服务机构? 鼓励回答并把答案写在白板上 “转介网络”的标题下。 45 最重要的答案: ●当地医院; ●社区卫生中心; ●社区康复 (CBR)网络; ●地方政府的领导人; ●残疾人组织; ●其他轮椅使用者; ●医生、护士、康复专业人员、社工。 说明:管理者找到他们所在区域的转介资源非常重要。 活动 分组 把学员分成两组。 指导 每组分配 “实训手册”B.1:获得服务工作表上的一个问题。 监督 监督各组并在需要时提供协助。 时间 总共允许10分钟。 反馈 让每组进行反馈。 在白板上记录答案。 46 问题 可能的答案 问题1:建立转介网络 作为一名管理者,你可以采取哪些措施来建 立个人和机构的网络,以便发现和转介轮椅 使用者到你的轮椅服务机构? ●找到你所在区域的转介来源 (个人和机构); ●与轮椅服务人员讨论,转介来源需要哪些信息才能发现 轮椅使用者,以及如何转介他们至轮椅服务机构; ●准备或让专业人员准备转介来源需要信息的传单或 小册子; ●拜访或让专业人员拜访潜在的转介个人或机构以讨 论轮椅服务; ●在轮椅服务机构为轮椅使用者和转介来源组织一次 开放日; ●为转介来源开展转介网络培训。 问题2:转介表格 翻阅 《轮椅服务管理者教程———附加资源手 册》上的转介样表。 该转介表或该表的修改版本对你的机构有 用吗? 如果没有用,为什么没用? 如果有用,作为机构的管理者,你可以怎样 做来引进转介表? (注意,如果你的机构已经使用了转介系统, 作为管理者,你可以怎样做来引进或支持转 介表) 如果没有用,服务机构在引进转介表的过程中可能面 临一些问题,包括: ●转介来源需要培训才能完成该表; ●甚至经过培训,转介来源也不会填写转介表; ●不是所有的转介来源都有时间填写该表; ●转介来源不能够邮寄或派送转介表; ●已经有了转介系统,它并没有包含具体的轮椅 转介。 如果有用,管理者可以采取措施来引入转介表,包括: ●确保转介表是简洁的,有他们服务所需最基本的转 介信息; ●所有培训包含对转介表的介绍或向所有的转介来源 介绍轮椅服务; ●向所有可能的转介来源提供转介表; ●当收到转介表时,向转介来源提供积极的反馈; ●确保转介来源收到轮椅使用者预约的结果,这样转 介来源知道系统是有用的。 47 4.管理者可以怎样做来确保他们的服务是公平的 (20分钟) 说明:我们已经发现获得轮椅服务困难的人群。当建立转介网络时,重要的是把这些人群记在心 上。以下活动将帮助管理者思考一些方法,用这些方法确保建立转介网络的所有措施,包括对获得轮 椅服务最困难的人群的措施。 活动 分组 把学员分成4组。 指导 每组分配以下一个人群: ●妇女和女孩。 ●生活在农村的人和贫困的人。 ●儿童和老年人。 ●不同民族或社会经济背景的人。 让每组: ●写下管理者可以采取的措施,以便让他们分配的人群更容易获得轮椅服务; ●鼓励各组思考已经在本单元讨论过的建立转介网络的观点; ●强调他们列出的措施应该在现有条件下符合实际和切实可行。 监督 监督各组,并在需要时给予协助。 时间 允许10分钟活动和10分钟反馈。 反馈 让每组向所有学员反馈他们的观点。 在白板上记录答案。 48 管理者可以采取措施来增加轮椅服务的获得性举例 (学员可以找到其他措施) 妇女和女孩: ●确保服务的信息可以从不同的渠道获得,例如电台、简易文字手册或海报、视频。 ●确保女性同男性一样,也能出现在服务宣传图片中。 ●找到女性轮椅使用者的榜样,她可以公开地在社区宣讲轮椅对妇女的重要性。 ●向社区管理者宣讲轮椅对妇女、儿童和对男性同样重要。 ●支持和鼓励妇女参与各层次的轮椅服务,包括管理和领导职务。 ●向残疾人组织提供轮椅服务的信息,并强调妇女和男性都需要轮椅来移动。 ●当谈论轮椅服务时,应该说男性、妇女和儿童的服务,而不仅仅说 “人们”。 儿童: ●确保服务的信息发布在残疾儿童父母可以看到的地方,例如社区卫生诊所、康复服务机构、集市、 社区中心、教堂、清真寺和寺庙。 ●当谈论轮椅服务时,应该说为男性、妇女和儿童服务,而不仅仅说 “人们”。 ●为那些治疗残疾儿童的人员提供服务的信息,例如医生、护士、社区卫生工作者。 ●保证在宣传中,跟成年人一样,儿童的形象也要有所体现。 ●无论何时在谈论服务时,都要说明为幼儿提供轮椅的好处,也要说明提供轮椅为家人或儿童看护 者带来的好处。 贫困人群: ●确保服务尽可能做到节约成本。 ●确定为轮椅使用者提供经济支持的方法,这些轮椅使用者无法为轮椅服务支付运输费用,或无法 支付轮椅费用 (如果有收费),例如设立轮椅基金。 老年人: ●当谈论轮椅服务时,应该说为所有人服务,包括老年人。 ●进行轮椅服务公共宣传时也要包括老人的图片。 ●当谈论轮椅服务时,说明轮椅对老人及其家人的好处。 49 续表 居住地离服务机构较远的人们或生活在农村的人们: ●确保服务信息发布在农村地区人们可以看得到的地方,例如乡村卫生诊所、集市、社区中心、教堂、清 真寺和寺庙。 ●为农村地区工作的人员提供服务信息,例如社区康复工作者。 ●如果机构不能提供社区服务,找到方法协助农村的轮椅使用者解决交通问题。例如提供交通补贴、 与可以帮助提供交通服务的其他机构合作。 ●了解是否可能为农村地区的轮椅使用者提供食宿。 ●为农村地区提供社区服务。 ●培训农村地区的工作人员 (例如社区卫生工作者)如何在社区支持轮椅使用者,如何进行随访, 如何进行简单的轮椅保养和维修服务。 ●确保可得到在农村地区粗糙地面使用的轮椅,并提供如何进行简易改制 (例如斜坡或光滑路面) 的信息使其更容易在农村地区使用轮椅。 不同民族和社会经济背景的人: ●当谈论轮椅服务时,应该说服务是为所有人,不论民族或社会经济背景。 ●在服务机构当地进行轮椅服务公共宣传时,也应包括不同民族和信仰人员的图片。 ●如果可能,服务机构可雇用不同民族和信仰的员工。 5.管理者行动要点概括 (3分钟) 讲出管理者行动要点。 与轮椅服务员工和主要利益相关者一起: ●确定转介来源。 ●建立转介网络。 ●决定服务机构是否宣传转介表。 ●积极工作以确保轮椅服务是公平的。 让学员翻阅他们的 “实训手册”并记录促进机构变革的行动措施。如果他们已经有了一个完善的 转介网络,则不需要关注本措施。 50 B.2:设施和设备 目标 本单元结束后,学员将能够: □确定适合他们情境的服务模式; □确定初级和中级服务需要的设施; □确定初级和中级服务需要的设备、表格和检查表; □描述工作场所布置的4种系统和流程。 资源 本单元: □幻灯片:B.2:设施和设备; □ 《学员手册和实训手册》; □ 《轮椅服务管理者教程———附加资源手册》; □ 《轮椅服务管理者教程———附加资源手册》里的无障碍设计思考; □轮椅样品。 情境 本单元可根据学员将工作的情境进行修改。例如: □了解正在实施的哪些服务模式是有用的,如果可能,在培训之前拜访服务机构。 □设施是做事的场所。几位专家可以在一个场所工作。工作区是员工使用工具的地方。初 级及中级轮椅服务和假肢矫形工作会要求有一些技术设备。 准备 □浏览单元计划并收集资源。 □与服务机构 (如果与培训场所在同一个地方)讨论是否允许穿过服务设施? 说明活动的 目的。检查哪些设施可用以及谁负责每个服务步骤的准备活动 (转介———转介在哪里进 行;注册和等候区;评定区;卫生间;仓库;产品准备区;适配区;使用者培训区;移 动技能训练或健康培训;轮椅操作;保养和维修。) 大纲 1.前言 2.设施和服务流程 3.设备、表格和检查表 4.设施的组织 5.管理者行动要点概括 2 23 10 15 5 总单元时间 55 51 1.前言 (2分钟) 说明:本单元,我们将学习管理者在确定设施和必要设备中的职责,以便开展适用轮椅服务的8 个步骤。当从初级到中级轮椅服务时,所需要的设施和设备会增加。 2.设施和服务流程 (23分钟) 说明:轮椅服务可以在很多不同的地方进行。 讲出幻灯片的内容,强调要点。 活动 分组 不分组,参考 《学员手册和实训手册》。 指导 思考你已经有了多少设施。提醒学员在小型服务机构,不要期望每个设备占用一个独立的 房间。然而,必须考虑每个设施是否需要。如果一些设施没有,思考你是否可以创造。 例如: ●建议的设施已经有了多少? ●建议的设施是否可以整合在现有的服务中? ●其他用途的房间是否可以调整? ●现有的房间是否可以重新调整或改建? 监督 监督各组,在需要时提供协助。 52 续表 活动 时间 总共允许10分钟。 反馈 提问是否有人已经有了全部的设施? 提问是否有人想到了解决办法,整合到现有的设施中并在里面建立一个新的工作区? 提问是否有人想到了解决办法,改变现有房间或建筑的用途? 提问是否有人想到了解决办法,重新调整或改建现有的建筑或房间? 说明:我们已经讨论了初级和中级轮椅服务需要的设施。 说明: ●现在我们将思考服务的流程,该流程与以 下事项相关:团队如何在一起工作,以及 从轮椅使用者到达服务机构直到他们离开 的全过程。 53 活动 分组 不分组或如果两个组会更加合适。 让两位学员使用一辆轮椅,以及另外两位学员视他们的同伴在必要的时候协助他们。 说明:在服务机构使用轮椅时,有助于思考轮椅无障碍。 指导 按照以下顺序穿过设施: ●转介———转介接收的地方 ●注册和等候区 ●评定区 ●卫生间 ●仓库 ●产品准备区 ●适配区 ●使用者培训区 ●移动技能训练区 监督 一起穿过服务中心。 时间 允许10分钟活动以及最后2分钟讨论概括。 反馈 如果发现有服务流程的问题和可能的解决办法,进行总结。 3.设备、表格和检查表 (10分钟) 说明: ●设备、表格和服务检查表已经在 《学员手 册和实训手册》中 “学员手册”部分 (以 下简称 “学员手册”)里了。 ●管理者的职责是整合人员和资源,因此个 别人员要负责确保必要的设备和文件准 备好。 ●这可能意味着调整设备使其便于运输以及 适合不同的环境。 54 活动 分组 不分组。来自于同一个机构的学员可以在一起工作。 指导 检查 “学员手册”上的设施和设备信息,以及检查 《轮椅服务管理者教程———附加资源手 册》上的表格和检查表。 ●哪些设备已经有了并且已在你的服务机构使用? 注意可以制作或购买的任何设备。 ●哪些表格和检查表已经整合并在使用? 注意可以整合进日常使用的任何表格或检查表。 监督 监督各组并在需要时给予协助。 时间 允许5分钟活动以及4分钟反馈。 反馈 询问有没有任何问题。 教师提示: ●在社区可以找到当地的木工、焊接工、家具装饰技工,他们具备必要的设备。 4.设施的组织 (15分钟) 说明:我们已经看到开展服务所需要的设施和设备。管理者的最后步骤是分配每个设施的管理职 责以确保都组织好。组织良好的设施会促进专业和有效的服务。组织较差的设施会导致不专业和服务 较差的印象。 说明:以下的4个步骤需要应用到所有服务模式的每个设施中。 说明: (1)清除杂物:清除所有不必要的工具、零 件、设备、过期的文件。 (2)确定日常使用的物品:工具、零件、说 明书和文件。日常使用的东西应该放 好,这样容易快速地找到。 (3)制度和职责:每个工作区有一个制度, 有人负责执行该制度。 (4)监督:确保制度调整固定下来。 55 活动 分组 把学员分成4组。 指导 让每组翻阅 “学员手册”(80页)上的两个组织较差的设施。 让各组参考他们的 “学员手册”并对设施、设备和工作场所提出建议。 监督 监督各组并在需要时给予协助。 时间 允许6分钟检查工作场所以及4分钟反馈。 反馈 让一组来对第一个设施进行反馈。 把答案写在白板上。 第二个设施重复进行。 改进机构设施和设备建议的例子 (学员可以提出其他建议) 技术设施和设备: ●发现技术区 (产品准备、改制)的职责; ●清理所有不必要的工具、零件和设备; ●存放设备的架子; ●用于摆放日常物品的架子或工具台应靠近工作台; ●工作台面应干净; ●与员工商讨,确认制度和分配执行的职责。 社区临床和技术设施: ●桌子用于摆放工具和设备; ●便携式工作台; ●工具箱中的工具; ●薄板或屏风用于为评定建立一个私密区域; ●评定坐面和足垫块。 56 5.管理者行动要点概括 (5分钟) 讲出管理者行动要点。 与轮椅服务员工和主要利益相关者一起: ●为服务模式找到适合的设施和设备; ●把文件和检查表整合进服务步骤中; ●组织设施; ●为每个设施建立制度和流程并分配职责。 让学员参考他们的 “实训手册”,并把他们对组织设施和设备的措施记录下来。 57 B.3:适用轮椅的范围 目标 本单元结束后,学员将能够: □定义适用轮椅和坐垫; □说明适配和体位支撑的重要性; □当选择适用轮椅时,说明使用者需求和环境的重要性; □讨论影响产品安全和耐用性的3个因素; □讨论并思考轮椅服务如何启动。 资源 本单元: □幻灯片:B.3:适用轮椅的范围; □ 《学员手册和实训手册》; □视频:附加支撑的好处———查理; □视频:适用轮椅的好处; □视频:满足轮椅使用者的需求———马克和瑞恩; □减压坐垫样品; □ 《资源有限地区行动辅具服务联合意见书》。 情境 本单元可根据学员将工作的情境进行修改。例如: □思考当地可得到的轮椅范围,如果可能提供一些样品。 准备 □浏览单元计划并收集资源。 □阅读 《轮椅服务初级教程》关于适用轮椅的参考资料和 《轮椅服务中级教程》关于儿童 的参考资料。 □阅读 《资源有限地区行动辅具服务联合意见书》第7章。 大纲 1.前言 2.什么是适用的轮椅和坐垫 3.提供适配和体位支撑 4.满足使用者的需求和环境 5.安全和耐用产品的重要性 6.轮椅产品范围 7.管理者行动要点概括 2 8 10 10 20 25 5 总单元时间 80 58 1.前言 (2分钟) 说明:本单元,我们将在与各种利益相关者合作的过程中,讨论管理者的职责以确定产品的最小 范围,来帮助儿童和成人获得服务。 2.什么是适用的轮椅和坐垫 (8分钟) 说明:《资源有限地区手动轮椅服务指南》定义了适用的轮椅。 讲出幻灯片的内容,强调要点。 说明:每位轮椅使用者都需要坐垫。 说明:最适合于使用者的坐垫类型将取决于 他们的需求和健康状况。由于这个原因,轮 椅服务机构至少需要有一定规格的坐垫。 总结:服务机构应该能够提供减压坐垫。 提问:我们强调减压坐垫的重要性,是因为我们知道压疮可以导致死亡,因此预防压疮非常重要。 有人能够想到具体的某类轮椅使用者可能需要减压坐垫吗? 59 最重要的答案: ●脊髓损伤者; ●曾经患过压疮者; ●老人或虚弱者; ●移动和改变姿势困难者。 传递至少一个减压坐垫样品。 说明: ●没有使用合适的坐垫和没有教使用者如何 使用坐垫是要付出代价的。 ●发达国家受伤年龄在25~34岁之间的人, 平均寿命是受伤后大约38年⑥。 ●相比之下,一项在孟加拉国进行的研究发 现,脊髓损伤后人们的平均寿命是5.36 年,56.4%的人在他们受伤5年内死亡⑦。 说明: ●该研究显示80%的人在家死亡,这些在家 死亡的人中,1/3的人死亡时患有压疮。 60 说明: ●斯里兰卡一家康复医院的费用调查显示, 使用合适的轮椅、坐垫和床垫以及进行充 分的病患教育,可以降低住院期间70%的 压疮发生率,减少60%的照料费用。 WHO 《世界残疾报告》⑧中提到,在巴西圣保罗一家医院的一个项目中,该医院引进了一项旨在 降低脊髓损伤者并发症的培训服务,使压疮发生率降低了23%。 说明:获得适用的坐垫以及培训如何使用坐垫,是预防医疗并发症的重要内容。《轮椅服务初级教 程》介绍了如何制作减压坐垫。《轮椅服务中级教程》介绍了坐垫改制。制作坐垫通常需要定期供应质 量好的泡沫塑料。 3.提供适配和体位支撑 (10分钟) 说明:需要提供一定尺寸范围的适配,包括儿童的选择。 每次点击显示一张图片。 提问:你看到了什么? 最重要的答案: ●儿童穿大人的鞋; ●尺寸不适合,太大了; ●儿童不能到处跑并且不能做他们应该做 的事情。 点击显示鞋子适配较好的下一张图片。 说明:该儿童现在有大小合适且正确适配的鞋子,他能够到处跑和玩耍。 点击显示儿童坐在轮椅上的图片。 61 提问:你看到了什么? 最重要的答案: ●儿童坐大人的轮椅,尺寸不合适; ●移动和玩耍困难。 点击显示最后一张图片。 说明:有了正确类型和合适尺寸的轮椅,儿童就可以享有充分的机会来做他们应该做的事情。 说明: ●每个人有不同的体位支撑需求,因此需要 不同支撑类型的轮椅。 ●有初级体位支撑需求的人需要适配良好轮 椅的支撑。 说明:有中级体位支撑装置需求的人需要有附加支撑且适配良好的轮椅。 说明: ●在轮椅上增加附加体位支撑装置或提供专 用的支持性椅座附加支撑。 说明:当需要时不提供附加支撑会付出代价,尤其是处于生长发育期的儿童,他们会快速生长。 62 南非西开普省康复中心的工作人员记录了在 学校和康复中心接受观察的一组儿童并发症 数据。 在姿势发育的任何变化之前,工作人员对所 有的儿童都进行了记录。 强调列标题,说明第1组在姿势发育之前得 到了适配良好的轮椅以及躯干的附加支撑。 第2组得到了适配良好的轮椅但是没有附加支撑。 得到附加支撑的第1组仅仅有0.4%的人有因不良姿势引起的并发症。没有得到附加支撑的第2组 有21%的人有因不良姿势引起的并发症。 这些并发症对于儿童和他们家庭以及服务机构的代价是: ●并发症增加以及花更多的时间预约看病; ●健康更差; ●不良姿势以及不舒适; ●低的座位耐受性 (不能长时间坐); ●参与教育的机会减少; ●降低生活质量。 教师提示:这是案例的其他信息,学员可能会问其他问题 进一步分析,以下风险因素增加了不良姿势引起并发症的风险: ●躯干肌肉力量不均衡; ●不良运动导致姿势偏向一侧; ●生长发育过快; ●骨骼损伤; ●躯干无力或瘫痪 (高位)。 63 介绍视频:附加支撑的好处———查理。 让学员听查理叙述年轻时候附加支撑如何给 她带来帮助。 播放视频。 提问:你怎样看待查理年轻时附加支撑给她 带来的好处? 感谢回答。 4.满足使用者的需求和环境 (10分钟) 介绍视频:适用轮椅的好处。 让学员观察,不同轮椅如何帮助视频中的人 从事他们的工作或活动。 播放视频。 提问:你看到了哪些活动? 最重要的答案: ●工作 (超市、健身房); ●跳舞; ●散步 (和妈妈及小狗); ●打篮球; ●去你想去的地方 (学校、克服环境障碍)。 64 介绍视频:满足轮椅使用者的需求。 让学员思考有助于轮椅使用者从事不同工作 或活动的不同特点。 播放视频。 提问:你看到哪些特点? 最重要的答案: ●马克:可外转脚踏板使其用单脚推轮椅成为可能。双手用于工作。 ●大卫和平基:两人都可以独立地使用轮椅,一人用电动轮椅而另一人用手推。 ●法伊泽尔:后轮的位置有利于推行,靠背足够低不会妨碍推行。没有扶手使轮椅更容易靠近桌子。 ●基斯和拉尔夫:无扶手便于把工具放在他们的大腿上。良好的设置有利于推行。 ●瑞恩:轮椅可以折叠以及后轮能快速取下。让他独立地进出小汽车。 说明:该视频强调不同的轮椅适合不同的环 境。当人们得到一辆不能在他们环境很好使 用的轮椅,轮椅通常会被弃用。 说明: ●图中有3辆轮椅。前两辆被弃用,因为它 们需要维修但是没有备用零件。 ●第3辆捐赠轮椅是新的,但是,在户外使 用时感觉摇摆不稳定,使用该轮椅的人感 觉不安全。 ●虽然这个人有3辆轮椅,但是没有一辆能 满足他的需求。 65 5.安全和耐用产品的重要性 (20分钟) 说明:我们已经介绍过满足个人和他们环境产品的重要性。现在我们将思考影响产品安全和耐用 性的因素。 提问:当一辆轮椅不耐用时会发生什么? 最重要的答案: ●不会用太久; ●很快就会坏。 说明: ●质量差的产品比质量好的产品需要更频繁 的更换。 ●不合适的产品在1~6个月内可能会损坏 并需要更换。 ●合适的产品可以使用3~5年 (寿命比不 合适的产品长6~10倍)并且物有所值。 提问:一大批弃用轮椅的成本是什么? 最重要的答案: ●花钱去拆解和处理丢弃的轮椅; ●弃用的产品需要占用设施中的有用空间; ●捐赠的产品通常无人负责和做决定如何使用、储存和清理。 66 单击图片。 说明: ●丢弃大量无法维修轮椅的案例可以在世界 很多国家看到,轮椅堆满房间或丢弃在服 务机构外面。 单击图片。 说明:当取得或收到捐赠的产品时,管理者 的职责是确保以下要求。 ●产品的规格适合使用的环境; ●当在不平坦和粗糙地面环境使用时,产品 是耐用的; ●产品可以在当地维修。 提问:你从哪里获得轮椅? 可能的回答,根据学员和他们的情境而变化: ●捐赠者; ●宗教组织; ●厂商; ●供应商。 说明:轮椅使用者想要安全和耐用的产品,并且可负担维修的费用。关于你服务中心现有产品或 何时为你的服务机构找寻新产品,这里有一些重要的问题。 67 活动 分组 学员分成3组。 指导 给每组1~3编号并布置合适任务,内容见 “实训手册”B.3:适用轮椅的范围,耐用及可 维修。 让学员回答布置给他们组 “实训手册”上的问题。 说明:学员可以参考 “学员手册”并用他们自己的知识和经验来完成该活动。 说明:学员有5分钟来回答布置的问题。 监督 监督各组并在需要时给予协助。 时间 允许5分钟准备。 允许10分钟反馈,这个时间是基于3组,如果有更多的组则反馈调整更多的时间。 反馈 让每组轮流陈述他们的反馈。 教师应该参阅参考资料上的注释来引导讨论要点。 关于供应产品的安全和耐用性,你可以问哪些问题? ●产品通过了标准认证 (产品通过了由专业机构组织的性能测试和质量保证测试)吗? 结果怎么样? ●供应商能否明确给出轮椅的寿命? ●供应商有缺陷报告的制度吗? ●还有谁购买和使用他们的产品? ●产品在所在地区试验了吗? 如果有,反馈或结果怎么样? ●有备用零件吗? 这些备用零件需要在国外采购吗? 或者一些备用零件在你们地区需要提前准备 好吗? ●如果车架损坏,可以在当地维修吗? 68 续表 哪些轮椅零件经常会损坏或磨损? ●质量较差的装饰面料撕裂或松弛。 ●小脚轮 (轮轴、轮胎、轴承、小脚轮叉)。 ●后轮 (轮轴、手推圈、轮辐、轴承、轮胎)。 ●刹车。 ●脚踏板。 ●坐垫。 你如何预测零件的订购量和品种? ●询问供应商是否有推荐。 ●确定哪些备用零件可以在当地购买 (由服务机构或使用者)。 ●思考下一年度预测有多少随访预约,订购该数字的30%作为库存起点。 ●清楚地记录每年使用多少备用零件并用它来预测未来的订购量。 提问:为了了解产品的安全和耐用性,你还可以和谁交流? 感谢回答。 ●通过家访、目标人群会议、残疾人组织获 得使用者的反馈。 ●从不同组织的服务提供者获得反馈。 ●在你大批量采购之前,先采购少量产品来 试用。 69 说明: ●在产品试用的最初阶段,人们通常只是基 于它的外观来评价一个产品。 ●在真正使用产品后,通常意见会发生改变 (正面和负面的)。 ●在作出正面或负面的决定之前,重要的是 真正地试用该产品几个月。 说明:轮椅服务的第8步是随访、保养和维修。轮椅服务人员应该教会所有的使用者及其家人简 单的保养和维修技术来延长轮椅的寿命。这在 《轮椅服务初级教程》中有相关介绍。 说明:管理者的职责如下。 ●确保服务的使用者获得保养和维修服务。 ●培训合作伙伴提供保养和维修服务。 ●找到社区可以提供保养和维修服务的 资源。 说明:随访将在稍后单元进行讨论。 6.轮椅产品范围 (25分钟) 承认在某些情况下只有一种类型的轮椅。 阅读下面斯里兰卡政府引入轮椅标准的案例。 强调:签署联合国 《残疾人权利公约》的政府有道义和法律责任来制订辅助器具标准。 70 斯里兰卡轮椅供应体系国家标准 经过超过3年的游说,斯里兰卡发起了建立轮椅标准的过程。结果是所有的轮椅供应商或厂家产品 必须满足相同的基本标准。如果政府采购了轮椅,轮椅标准可以确保厂家增加每辆轮椅的投入,通 过提供更耐用和更具功能性的产品让使用者受益。采购方也会受益,因为他们的资金发挥的效益更 长久。 说明: 下一个活动是思考利益相关者如何与政府或捐助者合作来改进适用轮椅的供应。 活动 分组 学员分成3组。 指导 给每组分配 “实训手册”B.2.2提供适用的轮椅:角色扮演的一个场景。 让学员阅读场景。 说明学员有10分钟准备分配的场景。 监督 监督各组,并在需要时给予协助。 时间 允许10分钟准备。 允许总共12分钟反馈,这个时间是基于3组,如果有更多的小组参与则调整反馈时间。 反馈 让每组轮流陈述他们的反馈。 教师应该参考 《资源有限地区行动辅具服务联合意见书》第6章的准则。 提供适用行动辅具准则 为了国家履行与辅助技术 (行动辅具)相关的义务,联合国 《残疾人权利公约》列出了以 下应该考虑的主要准则⑨: ●可接受性———残疾人必须参与行动辅具提供的所有阶段。 ●可及性———具有明确需求的人必须可获得行动辅具和相关的服务。 ●适应性———行动辅具和相关的服务应该可适应和修改以确保它们适合个人的需求。 ●可负担性———行动辅具和相关的服务必须可负担。 ●可得性———设施、人员和产品必须对于人口的需求是充足的,并且尽可能接近人们自己的 社区。 ●质量———产品、设施和服务具有合适的质量。 71 7.管理者行动要点概括 (5分钟) 阅读管理者行动要点。 说明:与轮椅服务人员和利益相关者一起合作: ●确定你服务的使用者的需求,以及产品最 重要的特点来满足这些需求; ●确定适用轮椅、坐垫和备用零件的合适 范围; ●找到产品改制材料的合适供应商; ●对不同利益相关者每次提供的适用轮椅和 坐垫,要进行成本效益的讨论。 提问:学员查阅自己的 “实训手册”,并把在他们机构改进适用轮椅范围的行动措施记录下来。 72 B.4:人员配置 目标 本单元结束后,学员将能够: □描述轮椅服务团队的4个角色; □确定初级和中级服务所需的人员; □规划角色整合到新的或现有安排中; □预估年度服务能力。 资源 本单元: □幻灯片:B.4:人员配置; □ 《学员手册和实训手册》。 情境 本单元可根据学员将工作的情境进行修改。例如: □思考所在区域现有的服务模式,以及轮椅服务如何整合到这些模式中。 准备 □浏览单元计划并收集资源。 大纲 1.前言 2.轮椅服务中的职责 3.员工参与规划 4.鼓励团队工作 5.评估服务能力 6.管理者行动要点概括 2 10 5 5 25 3 总单元时间 50 73 1.前言 (2分钟) 说明:本单元我们将讨论管理者的职责,确定和协调员工在实施过程中的不同角色和责任。我们 将关注4个角色的主要职责:临床、技术、培训和管理。 2.轮椅服务中的职责 (10分钟) 说明:只要进行适当的培训,服务职责可以由不同教育和专业背景的人来承担。因为这个原因, 不同类型的机构都可以参与到轮椅供应服务中。 说明: ●一个人可以承担不止一项职责或实施8个 步骤中的1个步骤。 ●不同的人可能承担不同的职责。 ●在一些情况下,不同机构的人员可能在一 起工作承担不同的职责或实施8个步骤中 的不同步骤。 说明: ●中级服务角色需要以初级服务的知识和经 验为基础。 ●考虑指导和培训一个新的初级团队,并且 让现有团队逐步提高到中级水平。 说明:管理者的首要职责是发现新的或现有人员来承担轮椅服务中的不同角色。如果有其他机构 的人员参与,不同服务机构的管理者则需要合作。 74 活动 分组 对学员进行分组,来自于相同机构的学员应该在一起。如果学员来自于不同的机构,他们 没有必要分在一起。 指导 说明:已经完成的样表列在了轮椅服务人员的主要职责中 (“实训手册”85页)。 学员应该把名字写在每一项职责旁边。提醒学员一个人可以承担多项职责。 如果服务团队还没有确定,思考谁可以承担这些职责。 如果管理者支持不止一项服务,列出每项服务。 监督 监督各组,并在需要时给予协助。 时间 允许5分钟。 反馈 询问是否有人想对这项活动发表意见。说明每项职责都有人负责的重要性。 3.员工参与规划 (5分钟) 说明:我们已经在领导变革的单元讨论过员工参与规划的重要性。 提问:员工参与为什么重要? 最重要的答案: ●抵抗变革通常来自于对变革知识的缺乏; ●人们更愿意支持他们参与创造的事物; ●员工有如何开始或改进服务的经验和想法。 说明: 把服务人员召集在一起并让他们参与规划。 ●开始建立团队的过程; ●鼓励良好的团队工作。 75 4.鼓励团队工作 (5分钟) 说明:一旦你建立了团队,接下来的重要事情就是一起工作来计划如何建立或改进服务。 说明: 有助于协调团队和服务平稳运行的两项主要 活动是建立周或月度记事簿,这在每个临床 和技术机构是可以看得到的,召开定期团队 会议。 ●每周、两周一次或月度计划; ●每周、两周一次或每月团队会议。 5.评估服务能力 (25分钟) 说明:当开始或改进服务时,我们将思考如何计划服务能力。 说明:服务能力与以下相关。 ●实施轮椅服务的员工数量; ●与产品采购预算相关的年度产品供应量。 强调我们将关注服务人员的能力与使用者的年度服务数量之间的关系。预算将在下一单元考虑。 说明:员工数量和他们的工作时间与新预约和随访预约的年度服务能力之间有直接的联系。 76 说明: ●建议每个机构至少应有两名员工参加初级 和中级培训。 ●如果只有一名员工参加培训,一旦他们离 开,所有的知识和经验都将被带走,服务 机构是比较脆弱的。 说明: ●应该计算每年的工作周数,减去公共假期 和年休假时间。 ●这将影响每年服务的轮椅使用者数量。 让学员计算服务人员每年在他们服务机构的工作时间,记住减去公共假期和年休假。 说明:每周工作5天。然而,服务人员可能不是5天时间都提供轮椅服务。 说明: ●每周直接用于轮椅服务工作的天数也应该 进行估算。考虑每周会议、文字工作、库 存管理和休息的时间,这些时间应该从服 务的可用时间中扣除。 ●这将影响每年服务的轮椅使用者数量。 ●如果员工承担的职责不仅仅是轮椅服务, 那么清晰地界定每项工作的时间就显得尤 为重要。 77 说明:作为计划的起点,我们将思考每天大约服务多少初级和中级轮椅使用者。 这受很多因素的影响,例如,服务人员是新来的或有经验的,提供的轮椅是否需要改制。这些因 素应在下一章节 “运营轮椅服务”中更多地考虑。 ●有经验的团队能够每天服务两位初级使 用者。 ●有经验的团队能够每天服务一位中级使 用者。 注意:这是基于一天的服务,从 “步骤2: 评定”到 “步骤7:使用者培训”。服务 量的预测应该根据服务模式进行调整。 参阅幻灯片中的电子表格。 说明我们将看到一个程序,这个程序将帮助管理者计算他们的服务机构每年可以服务多少轮椅使 用者。 介绍表格并说明前两行应该按照他们的个性 化服务进行计算。 ●每周工作天数? ●每年的工作周数? 78 引用已经输入的服务数据来帮助计算服务 能力: ●输入每天服务使用者的数量;初级×2, 中级×1。 ●计算每周服务使用者的数量:每天服务使 用者的数量×工作天数。 ●计算每年服务使用者的数量:每周服务数 量×工作周数。 ●允许15%的应急突发事件,并从总时间中 减去。 ●计算每年的估计服务能力。 让一位自愿上来的学员给出他们的估计数字并输入表格。 说明:这并不包含步骤8:随访。我们将在稍后单元介绍规划随访。 总结:看看表格上初级和中级的总共预测数字。这些数字比你预想的是多还是少了? 鼓励讨论。 说明:我们将在运营轮椅服务部分再次讨论服务估算。 6.管理者行动要点概括 (3分钟) 讲出幻灯片的内容,强调要点。 让学员参阅他们的 “实训手册”并记录他们人员配置的措施。 79 B.5:轮椅服务的成本 目标 本单元结束后,学员将能够: □确定8个服务步骤的关键预算项目; □说明整合服务共享成本的至少两个好处; □说明与其他机构合作共享成本的至少两个好处。 资源 本单元: □幻灯片:B.5:轮椅服务的成本; □ 《学员手册和实训手册》; □白板纸; □蓝色、黑色和红色笔。 情境 本单元可根据学员将工作的情境进行修改。例如: □假定学员具备基本预算技能。 准备 □浏览单元计划并收集资源。 □准备白板上的预算栏标题,并预留空白处以便填写建议的预算项目。 大纲 1.前言 2.预算指南 3.综合服务的好处 4.通过合作成本分担的好处 5.管理者行动要点概括 2 20 20 13 5 总单元时间 60 80 1.前言 (2分钟) 说明:建立服务一开始,确定所有8个服务步骤的成本非常重要。本单元,我们将介绍如何计算 初始服务或改进服务的成本。我们也将讨论用不同的方式来分担成本。 2.预算指南 (20分钟) 参阅白板上列出的预算标题。 说明:我们将思考这些标题下的预算项目。 活动 分组 分成3组。这时学员不能翻阅 “实训手册”。 指导 展示白板上的预算标题。 让学员参考轮椅服务步骤海报以思考每个服务步骤。 让每组讨论这些标题下他们希望什么预算项目? 全体学员:反馈每个预算标题下的建议预算项目。 监督 鼓励回答。 时间 允许5分钟讨论以及10分钟反馈。 反馈 在白板的预算标题下记录答案。 让学员参阅 “实训手册”上已完成的预算项目 (86~87页)。 承认一些服务机构可能有其他预算项目没有列在这里。不是所有的服务机构都使用列出的 所有预算项目。 让学员查阅 “实训手册”。鼓励学员对照预算项目来记录预算笔记 (5分钟)。参阅下面的 注释。 81 教师提示: 预算项目 备注 启动成本 产品设计 采购一系列的产品 工具 设备 建筑物或设施 可能包含建设、装修或修缮。 材料仓储 运营成本 轮椅 轮椅仓储———基于预测的服务量和轮椅使用者的预期需求。 备用零件 保持一定库存的常用备用零件是非常有用的。 材料 初级服务,为了改制需要一些材料。中级服务需要更多的材料。 货运 (产品运输) 进口轮椅的海运费用和关税。运输轮椅至郊区中心。 人员 管理人员 临床人员 技术人员 教师 行政人员 更大范围的潜在人员列在项目指南中。不要期望每个服务机构都配备所 有这些人员。 画钩 (见表格)代表与服务步骤相关的活动。一位员工可能负责实施不 止一项活动。 当地运输 服务人员的当地运输 例如,随访、社区服务、培训转介网络。 服务对象的当地运输 按照预约时间到服务机构。 服务对象的食宿 为需要过夜的服务对象提供食宿的费用 (如果费用由服务机构承担)。 打印的资料 表格、检查表和使用者信息。 82 续表 运营成本 易耗品 例如,胶水、线、油漆。 更换工具 工具损坏,因此需要预留更换的经费。 日常管理 不同的服务区域 (临床、技术、存储、使用者培训、办公室)考虑电、 水、房租。 人员培训 考虑服务人员的所有培训成本。 培训合作者或转介网络 为合作者或转介网络机构组织所有的培训或认识活动。 筹款 所有筹款活动的成本应该有预算。 监督和评价 监督和评价相关的成本,例如拜访服务使用者以收集反馈信息。成本可 能包括差旅或其他人力。 3.综合服务的好处 (20分钟) 提问:有人在包含轮椅服务的综合机构工作吗? 感谢回答。 说明: ●综合服务与独立服务相比,能够更有效地 共享设施,可以显著地分担成本。 83 说明 (案例): ●假肢矫形服务可能需要大约170平方米的 占地面积。 ●初级轮椅服务可能需要大约100平方米的 占地面积。 ●中级轮椅服务可能需要大约140平方米的 占地面积。 ●如果所有设施分别设置,总共需要410平 方米。 ●如果所有的服务整合到一个共享的设施,一个人就可以管理,总共需要200~250平方米。 ●这表示节省几乎40%~50%占地面积的投资和建设。 活动 分组 不分组。 指导 如果目前没有人在综合服务机构工作,完成下面的场景案例。 检查预算指南的每个项目并考虑在综合服务中哪些成本可以分担或节省。注意:没有绝对 正确或错误的答案。目的是认识到整合服务对成本节省的好处。 说明: 用黑笔对可以节省的费用画圈。 用蓝笔对可以分担的费用画圈。 用红笔对需要筹集资金的费用画圈 (有些项目同时有蓝圈和红圈)。 监督 鼓励回答。 时间 允许15分钟。 反馈 让学员分享他们对综合服务好处的思考。 承认节省成本不是只有一种办法。通过与其他机构合作分担成本也可以节省成本。 84 整合服务场景:如果学员没有整合服务的经验,分享下面的场景。 假肢矫形器服务机构计划整合轮椅服务。挑选了两位专业人员并派出接受轮椅服务初级培训。 两位专业人员每周进行3天轮椅服务以及2天假肢矫形器服务。 在工场为轮椅技术员分配了工作场地。治疗部门清理损坏和未使用的设备,这为临床服务提供了工 作场地。 为了增加轮椅技能训练所需的一些其他障碍,调整户外步态训练区。 成本分担的建议 材料的仓储 人员工资 设备 工具 当地的运输 (取决于服务模式) 监督和评价 经费筹集 培训合作伙伴或转介网络 工具更换 易耗品 打印资料 服务对象的食宿 人员 节省成本的建议 建筑物或设施 间接成本 85 续表 附加费用的建议 轮椅供应 备用零件 调整现有的移动训练区 (由于大多数区域已经存在,费用会减少) 一些工具 一些设备 打印的资料 人员的培训 4.通过合作分担成本的好处 (13分钟) 说明:可与其他机构合作来分担成本。 提问:你们有利用分担成本来提供产品的案例吗? 鼓励回答。 说明: ●国际机构可以与服务中心分担产品的价格 成本。 ●对服务中心的好处:产品让使用者负担 得起。 ●对国际机构的好处:服务中心展示努力实 现财务可持续性的能力。 提问:你们有利用分担成本来提供服务 (人员、设施、交通方面)的案例吗? 鼓励回答。 86 说明: 社区的合作伙伴可以让集中式服务更有效地 到达社区。 ●合作伙伴可能开始就能够提供设施,或支 持员工。 ●他们也可以让员工接受一些服务步骤的培 训,例如转介、随访和使用者培训。 ●对轮椅使用者的好处:减少交通奔波和 成本。 ●对服务中心的好处:服务可以延伸至社 区,不需要社区的服务成本。 提问:你们有培训方面分担成本的案例吗? 鼓励回答。 说明: 国际和私营机构可以资助培训。 ●对轮椅使用者的好处:提升健康性、舒适 性和功能性以增加参与度。 ●对资助者的好处:提升机构的能力以更好 地满足移动功能障碍者的需求。可以帮助 私营机构实现他们的企业社会责任目标。 说明:一旦你计划了一种服务模式并列出了预算,必须要找到潜在的资金来源。如何找到轮椅服 务开办和运作成本资金来源将在C.4:规划财务的可持续性单元进行讨论。 87 5.管理者行动要点概括 (5分钟) 讲出管理者行动要点概括。 与轮椅服务人员和主要利益相关者一起: ●当规划服务模式时,思考服务的整合; ●当规划服务模式时,思考社区合作伙伴; ●为规划的服务模式准备预算。 让学员翻阅 “实训手册”并把他们确定开办和运营轮椅服务的成本的活动记录下来。 88 C:运营轮椅服务 C.1:如何确定轮椅服务是否有效 目标 本单元结束后,学员将能够: □说明监督与评价的不同之处; □描述如何准备服务计划; □讨论改进服务效率和有效性的至少3种方式; □描述如何收集使用者反馈来告知服务提供方。 资源 本单元: □幻灯片:C.1:如何确定轮椅服务是否有效; □ 《学员手册和实训手册》; □便条贴; □在评定时测量参与度的工具; □在随访时测量满意度和效果的工具。 情境 本单元可根据学员将工作的情境进行修改。例如: □可能会与一些使用者会面,并在本单元完成使用者满意度调查问卷。 □思考检查现有的服务计划并把它与服务计划框架联系起来。 准备 □浏览单元计划并收集资源。 大纲 1.前言 2.什么是监督和评价 3.有效和高效的服务 4.使用者反馈的重要性 5.建立服务计划 6.管理者行动要点概括 2 10 20 23 15 5 总单元时间 75 89 1.前言 (2分钟) 说明:教程的本部分关注运营服务。本单元我们将讨论管理者的职责,并借助年度服务计划来发 展高效优质的服务。 2.什么是监督和评价 (10分钟) 说明:监督和评价帮助管理者看到,由于他们的团队活动结果发生了什么或没有发生什么。它也 有助于管理者和他们的团队知道哪些活动是有效的,哪些是无效的,并了解他们服务的使用者和利益 相关者想些什么。 提问:你如何描述监督? 说明: 监督评估绩效。它着眼于服务机构在某一时 段提供服务步骤的效果如何。 提问:你如何描述评价? 说明:评价比监督更进一步。 ●它着眼于服务活动对使用者的影响。 说明:我们将仔细地看一下监督与评价的主 要不同。 提问:什么时候开展? 说明:监督是全年定期进行。评价的频率低 些,可以每年进行。 提问:评估什么内容? 说明:通常,监督评估的效率,是指在服务活动中使用的资源和受益的人数。 通常,评价所评估的有效性,是指个人和社区的影响,以及整体服务如何可持续。 90 活动 分组 把学员分成4人一组。 指导 说明:这里有监督和评价好处的许多案例,以及目的是了解哪组想到最多的案例。 让学员把案例写在单独的便条贴上。 当完成的时候把便条贴粘在白纸上。 监督 监督各组,并在需要时给予协助。 时间 允许5分钟。 反馈 本单元期间让便条贴留在白纸或墙上。 感谢他们的付出。 最重要的答案: ●提供重要的信息来改进服务的质量; ●提供信息来指导产品的采购; ●帮助控制成本,需要提高效率和证明当前和建议的资金是合理的; ●让服务机构用有效率的服务来向资助者 (包括政府和NGO捐助者)证明; ●帮助确定和量化未满足的需求; ●了解资源的适当分配; ●提高服务效益的意识; ●与服务受益者发展更牢固的合作关系。 3.有效和高效的服务 (20分钟) 说明:本培训较早前我们关注开始轮椅服务,以及付诸实施以下这些事情来帮助提高效率。 91 ●建立公平服务的行动; ●改进转介和预约的行动; ●组织设施和建立制度及流程; ●改进可得到产品质量的措施。 说明:随访以及评价每个服务步骤的制度和 流程,关注它们如何有效地进行非常重要。 说明:当计划如何监督和评价服务时,建立3个步骤框架是有用的。更详细的信息可以在 《资源 有限地区手动轮椅服务指南》表3.5中找到。 介绍小组活动,并说明我们还会研究如何评价服务有效和高效地进行。 活动 分组 把学员按照所在机构进行分组。 分配一半的小组完成 “实训手册”上C1.1监督章节表格的阴影部分,另外的小组完成表格 的非阴影部分。 指导 说明表格: ●第1列列出服务的区域和监督的活动; ●第2列列出一些可能的服务绩效目标; ●第3列列出信息收集的方法来比较目标真正发生了什么 (什么应该发生)。 说明活动: ●“实训手册”活动工作表的一些方框已经完成了。其余的方框应该填上。 提问记录这些信息为什么重要。 监督 监督各组,并在需要时给予协助。 时间 允许5分钟活动以及10分钟讨论完成的表格。 反馈 把学员召集在一起并完成每行 (答案会不同,这是重要的过程)。 增加各组没有想到的其他建议。 92 监督服务区域,绩效目标以及收集信息方式的案例。 服务区域和活动 服务绩效目标 信息收集的方法 转介 转介使用者的数量。 服务机构每月将接收30名转 介者。 记录接收到的转介。 从转介到预约的平均等待时间。 从转介到预约的等待时间应该小 于1个月。 在使用者档案上记录接收的转 介日期和评定日期。 轮椅供应 收到轮椅的使用者数量。 服务机构每月将为20名使用者 开具处方和适配轮椅。 在使用者档案上记录轮椅处方。 从评定到适配的平均等待时间。 从评定到适配的等待时间应该小 于2个月。 在使用者档案上记录评定和适 配日期。 随访预约的数量。 每月将为至少15名使用者随访 预约。 在使用者档案上记录随访预约。 轮椅服务的人数 转介至服务的使用者信息,例如 年龄、性别、残疾、体位支撑 需求。 服务机构将促进平等获得服务。 服务机构的目标是满足初级轮椅 服务的使用者以及那些需要改制 和体位支撑者的需求。 在使用者档案上记录获得服务 的成人、儿童的数量。 在使用者档案上记录需要的姿 势类型以及处方的轮椅。 服务所涵盖的地理区域。 服务机构将为生活在一定范围 (区域或场所)的人提供轮椅。 在使用者档案上记录获得服务 的使用者的家庭地址。 服务成本 产品供应的成本,包括在服务机 构的改制。 每辆轮椅的单独成本将会少些 (根据预算和可得到产品的真实 成本确定具体的金额)。 在使用者档案上记录产品和所 有改制的成本。 服务活动所花费的时间 (例如, 评定、随访和培训)。 服务机构将为生活在一定范围 (区域或场所)的人提供轮椅。 在使用者档案上记录花费的 时间。 93 说明:当分析收集的信息和数据时,有两个重要的事情要考虑。 ●当活动进行不顺利时,与使用者、服务人员以及其他利益相关者一起找到问题的根源。 ●当活动进展顺利以及目标实现时,找到分享和庆祝成功的方法。这对于服务团队和其他利益相 关者非常有激励作用。 说明: ●庆祝成功并奖励好的结果非常重要。 提问:你会与你机构的员工庆祝成功吗? 你 会怎样做? 4.使用者反馈的重要性 (23分钟) 说明:评价让服务机构思考哪些进展顺利以及哪些需要改进,也让服务机构思考是否实现整体的 目标。 说明: ●在幻灯片中讲出轮椅供应体系的终极 目标。 说明:《资源有限地区手动轮椅服务指南》中表3.6有很多如何评价服务的建议。更详细的信息列 在 “学员手册”中。 94 说明: ●服务的使用者和他们获得的干预。 ●服务的成本,包括产品和提供服务的 成本。 ●人员配备 (人员的数量和他们的职责和能 力)。 ●服务机构的设施和设备。 ●提供服务的质量、良好实践的建议列在 《资源有限地区手动轮椅服务指南》中。 ●对使用者及其家人的影响。 向学员提问,他们是否已经评价了自己的服务? 感谢回答。 询问他们是否评价列出的所有内容? 感谢回答。 说明: ●我们将关注列表上的最后一点,即对使用 者及其家人的影响。 ●我们将讨论从使用者获得反馈的好处和重 要性。 说明你愿意分享埃塞俄比亚移动功能障碍者的案例,他们参与收集使用者反馈而受益。 讲出故事。 95 埃塞俄比亚的案例 两名地区工作人员调查了来自于埃塞俄比亚全国7个服务中心的140名轮椅使用者。因为两位工作 人员都是行动障碍者,这对履行他们的职责非常有用。 对调查流程的好处: 地区工作人员非常了解他们国家轮椅使用者面临的问题,该流程授权他们倡导轮椅使用者的需求和 权利。 使用者从正面榜样的面谈中获得情感和心理的好处。面谈后,非正式的网络逐渐形成,这会使服务 提供者和使用者之间的关系更牢固。 另外,通过评价,发现一些轮椅使用者没有得到满足他们需求轮椅的案例。这会追溯服务机构的培 训需求,该服务机构就能够在这方面采取行动。 说明:当计划从轮椅使用者收集信息时,有一些重要的考虑因素。参阅 “实训手册”。 活动 分组 作为一个团队:同一机构的学员可以在一起。 指导 介绍 《轮椅服务管理者教程———附加资源手册》中的 “辅助器具评估的参与度测量工具” 和 “辅助器具随访的满意度和效果测量工具”表格。 说明:当计划从轮椅使用者收集信息时有一些重要的考虑因素。 完成这个检查表为你的服务做记录 (“实训手册”第91页)。 监督 监督各组,并在需要时提供协助。 时间 允许8分钟小组活动和5分钟反馈。 反馈 让一位志愿者分享他们的计划。 说明:在面谈使用者之前需要考虑和准备的重要因素。参阅 “学员手册”获取更多的信息。 96 5.建立服务计划 (15分钟) 说明:监督和评价信息可以用作建立服务计划。 介绍服务计划框架以及每个标题。 说明: ●首先考虑服务需求或问题。 ●然后思考需要哪些措施来解决这些需求或 问题。 ●建立一个目标或 “短期赢”。 ●决定你将如何收集信息来展示实现的 目标。 活动 分组 不分组。 指导 让学员参考他们的 “实训手册”并找到3个需求或问题以及完成服务计划框架 (“实训手 册”第92页)。 监督 监督各组并在需要时提供协助。 时间 允许5分钟活动和9分钟反馈。 反馈 投影幻灯片中的表格标题。 让两位学员说明他们的案例。 输入案例,厘清所有必要的要点。 97 6.管理者行动要点概括 (5分钟) 讲出管理者行动要点。 让学员参考他们的 “实训手册”,为了了解他们的服务是否有效,应记录他们自己对建立服务计划 的行动措施。 98 C.2:管理需求 目标 本单元结束后,学员将能够: □当转介太少时为管理者列出至少2个行动措施; □当转介太多时为管理者列出至少2个行动措施; □描述早期转介对儿童重要的3个原因; □描述至少3个行动措施来监督和改进服务效率。 资源 本单元: □幻灯片:C.2:管理需求; □ 《学员手册和实训手册》。 情境 本单元可根据学员将工作的情境进行修改。例如: □如果为特定的合作伙伴举行培训,收集服务步骤时间的数据。 准备 □浏览单元计划并收集资源。 □提前在白纸上写下早期转介的好处。 大纲 1.前言 2.创造需求 3.管理需求 4.儿童早期转介的重要性 5.运行有效和高效的服务 6.管理者行动要点概括 2 20 18 20 20 5 总单元时间 85 99 1.前言 (2分钟) 说明:本单元,我们将讨论管理者在发展服务以满足需求中的职责。它包括管理转介、儿童早期 转介的重要性、改进服务有效性和效率的建议。 2.创造需求 (20分钟) 说明:我们将思考当转介至服务机构数量太少时,管理者应该采取什么措施。 说明: ●当转介太少时服务运营成本太高。 提问:在上一个单元建议采取什么措施来发展转介网络? 鼓励回答并将答案写在白板上。 最重要的答案: ●确定转介来源; ●拜访潜在的转介机构; ●转介网络培训; ●在服务机构举行开放日活动。 100 提问:如果转介数量太少,问题的根本原因是什么? 鼓励回答并将答案写在白板上。 最重要的答案: ●服务机构没有找到最合适的转介来源; ●需要轮椅的人无法获得转介来源的信息; ●转介网络培训并不能使人们了解轮椅服务的好处和重要性; ●轮椅使用者不能获得服务,例如,服务机构离他们住的地方太远,或者交通不方便。 活动 分组 把学员分成两组。 指导 阅读下面成功转介网络的案例。 让学员思考为什么会成功以及列出原因。 监督 监督各组,并在需要时提供协助。 时间 允许5分钟活动和5分钟反馈。 反馈 让学员分享他们对成功因素的思考。 记录答案在白板上。 如果必要,在最后提出他们没有想到的因素。 成功的案例:孟加拉国的转介 孟加拉国 “为生命行走”项目与卫生部合作,为3岁以下马蹄内翻足畸形儿童发展全国可持续矫形 服务。“为生命行走”项目的目标是:确保不让全国任何地方的一个家庭跋涉超过80公里来获得马 蹄内翻足服务。 为了保证这个目标的实现,“为生命行走”项目需要有效的转介网络。项目找到以下人群为潜在的转 介网络:来自于政府和非政府组织的卫生工作者和基层工作者,包括医生、治疗师、护士和医师助 理。项目面向这些人群开展活动提高他们对马蹄内翻足儿童早期转介的重视。 结果:孟加拉国超过60%的天生马蹄内翻足儿童被找到,并且在他们出生12个月之内接受了治疗。 在达卡,服务的人口是5000万,服务人口的数量百分比提高到75%。 101 最重要的答案: ●谁是目标人群; ●他们想达成什么样的清晰目标; ●找到不同类型的组织以及不同的专业; ●找到机构为中心和社区为中心的组织; ●密切监督转介,早期转介的成功故事激励参与的所有人。 3.管理需求 (18分钟) 说明:当使用者对服务有较高的要求时,他们的要求不能立即被发现,这对于服务使用者和服务 人员来说都是令人沮丧的。 说明: 如果转介至服务机构的人数超过可以服务的 人数,有3个可能的结果。 ●服务人员被迫减少每个人的服务时间,服 务质量会下降; ●轮椅使用者不得不延长等待的时间; ●一些轮椅使用者会离开。 说明:如果可能,管理者应该小心地处理需求。 讲出幻灯片的内容,强调要点。 102 说明: 第一步是通过创建等候名单来记录需求。 ●建立数据库来记录这些信息是非常有 用的。 ●它让管理者和服务人员有效地获得信息并 容易处理服务数据。 ●一旦使用者获得服务,等候名单就可以增 加新的使用者。 说明:当等候名单建立起来后,机构可以根据情况的轻重缓急对转介人员排序。 提问:你们机构对于筛查和优先排序转介人员有制度吗? 感谢回答。 说明: 当有很多转介人员等待时,检查名单并优先 那些需求变化很快或有健康并发症的人尤为 重要。 ●残疾儿童,有形成不良姿势或继发畸形的 风险。 ●有发生压疮风险的轮椅使用者,因为压疮 会威胁生命。 ●有进行性疾病的轮椅使用者。 ●由于没有轮椅或有适配较差的轮椅,而正 在经历痛苦的人们。 103 提问:你认为哪些信息对于筛查转介人员是重要的? 最重要的答案: ●年龄; ●残疾类别; ●转介的原因; ●地理位置。 说明:按照可以服务的轮椅使用者数量、提供服务的层次以及服务机构可以提供什么服务的期望, 对轮椅服务进行管理。 每个国家的每个地区都有人需要初级、中级和高级姿势支撑。每个国家的每个地区都需要中级服 务以及高级服务。然而,不是每个服务机构都有开展中级或高级服务的能力。 说明: ●制作信息宣传活页资料并清晰地宣传提供 服务的层次。 ●要从开发知识和技能的基础开始,也就是 说,要从8个服务步骤的流程和配套制度 这个基本水平开始。 ●讨论如何管理更加复杂的中级和高级使用 者需求的转介。 说明:记录没有满足的需求是有用的,它有助于计划增加服务人员的能力和产品。 一些服务机构可以继续培训服务人员和开发有合适范围产品和体位支撑装置的中级服务。 一些服务机构需要具备引入中级服务的能力。开始阶段,把信息做成小册子并清晰地宣传提供服 务的层次尤为重要。 104 教师提示: 该领域的现实情况是服务人员将向有需求的使用者展示不仅仅是他们的知识、技能、可得到的产品 以及服务能力。 对使用者和服务人员来说,清晰地讨论和已经为如何处理这种状况准备好策略非常重要。创建服务 层次的宣传信息有助于促进这种讨论。 与其他服务提供者联系,来了解对超出服务能力的需求是否可能转介或合作尤为重要。 4.儿童早期转介的重要性 (20分钟) 说明:许多需要轮椅的儿童也需要附加体位支撑。这意味着很多儿童需要中级服务。所有儿童尽 可能早地转介至服务机构,预防或延缓不良姿势的发展非常重要。 提问:根据学员的经验,儿童应当年幼时转 介至轮椅服务,还是等到他们变得太重而无 法搬动时才转介至轮椅服务? 鼓励回答。 提问:为什么一些家长不愿意让幼儿接受轮椅评定? 鼓励回答。 最重要的答案: ●家长可能希望儿童可以 “治愈”并能开始走路; ●家长可能认为如果他们给儿童适配一辆轮椅,他们将不再尝试行走; ●当儿童年幼和体重较轻时,比较容易搬动他们,而不是用轮椅来通过难走的地面和有障碍的环境; ●家长可能没有钱来买轮椅而一直耽误,直到变得越来越困难而无法搬动儿童; ●家人可能觉得愧疚或担忧,如果他们的孩子被人看到有残疾,他们将被别人看到负面的形象。 105 让学员提出一些早期转介的好处。 把之前准备好的早期转介好处的列表贴在墙上,并反复检查是否所有的好处都提到了: ●坐直困难的儿童如果不能得到良好的支撑,就会有姿势问题; ●如果儿童转介晚了,有些姿势问题就会不可逆转。即使给予支撑,儿童也很难舒适地坐着; ●如果缺少坐和移动的经历,儿童的发育将会迟缓; ●对于那些有行走能力的儿童,使用轮椅可以让他们的日常生活更容易,并且白天可以做更多的 事情。 说明: ●由于使用设置良好的轮椅,提高了移动速 度以及减少了能量的消耗,与轮椅一起使 用行动辅具和假肢可以让人们做更多 事情; ●左侧的表格显示了不同方式移动的速度 (米/分钟)和能量消耗 (与没有行动障碍 走相同的距离相比)。 消除家长和转介来源的顾虑,使他们明白轮椅不会降低儿童的行走能力,这一点很重要。当儿童 学习行走的时候,通过轮椅来移动的经验将在其他很多方面有益于他们的发展。 说明: 轮椅服务机构可以鼓励转介来源转介以下情 况的儿童。 ●坐直困难或到1岁时不能拉起站立; ●2岁仍不能独自行走。 106 说明:儿童通常并不总是坐着,一天里他们会不断地活动改变体位。这意味着尽管轮椅很重要, 儿童也不应该整天都坐在轮椅上。 说明: ●轮椅服务人员需要与儿童及其家长或看护 者一起找到儿童白天能够采取的不同 姿势。 ●这包括不同支撑的坐姿、站和躺。 ●为了儿童、家长或看护者的培训,应鼓励 与服务机构密切合作。 活动 分组 把学员分成两人一组。 指导 让学员阅读墨西哥父母早期转介的成功案例 (“实训手册”第93页)。 让学员思考案例为什么会成功并列出原因。 监督 监督各组,并在需要时给予协助。 时间 允许5分钟活动以及5分钟反馈。 反馈 让学员分享他们对成功因素的想法。 把答案记录在白板上。 107 成功案例:墨西哥父母的早期转介 这个案例介绍了墨西哥的儿童康复中心如何建立有效的早期转介网络。 康复中心的目标是提高新生儿医生和儿科医生对他们服务的认识。另外,他们针对普通社区开展年 度资金募集活动,使用广泛的媒体覆盖,包括广播和电视。这产生了很好的口碑效应,许多家长亲 自转介他们的孩子。 在宣传活动过程中,康复中心有一个清晰的观念:当儿童出生时转介儿童进行康复至关重要。被服 务的儿童的融合状况和取得的成绩有很多正面故事,他们用这些故事来宣传成功的强大愿景。经过 15年的发展,由于儿科医生和家长现在积极地进行早期转介,康复中心看到了文化意识层面的 转变。 结果:1/3的转介对象是从新生儿到3周岁的幼儿。 最重要的答案: ●信息明确,针对性强; ●目标清晰; ●对专业人员和家长采取不同的方法和措施; ●分享成功故事来鼓励家长和专业人员进行转介; ●常年持续地提高认识。 5.运行有效和高效的服务 (20分钟) 说明:我们看一下B.4:人员配置中 “评估服务能力”部分。一旦服务开展,详细地了解这些信 息是有用的,分析以下几点。 ●每个服务步骤要多长时间; ●通过关注以下方面使每个服务步骤尽可能地有效。 ○团队合作; ○每个服务步骤可以提前准备些什么? 让学员预测他们的服务机构每天有多少小时可以用于提供服务。考虑喝茶、咖啡、午餐时间,完 成文书工作的时间,会议和所有文化因素,这些会影响开始和结束的时间。 108 承认这只是一个预测。 让学员注意 “实训手册”上的数字。 强调这是一项有益的活动,应与服务人员一起完成。因此管理者和服务人员可以共同建立实际的 服务目标。 显示初级服务步骤的时间。 让学员预测每年他们可以提供的轮椅数量 (初级)。 显示中级服务步骤的时间。 让学员预测每年他们可以提供的轮椅数量 (中级)。 承认每个服务步骤的预测时间会有较大的差异。 说明我们将看一下出现差异的一些原因。 109 活动 分组 把学员分成2组或3组。 指导 说明:活动的关注点在于思考团队合作,以及可以提前做什么准备来减少每个服务步骤所 需要的时间。 阅读第1列列出服务步骤花费较多时间的原因。 学习更有效工作以及减少服务步骤时间的一些观点。 画一条线连接问题和解决办法。 监督 监督各组,并在需要时给予协助。 时间 允许5分钟活动以及10分钟讨论。 反馈 让学员讲出改进服务步骤效率的策略。 如果有些观点没有谈到,鼓励其他组补充。 讲出幻灯片的内容,强调要点。 讲出幻灯片的内容,强调要点。 110 讲出幻灯片的内容,强调要点。 讲出幻灯片的内容,强调要点。 第1列:服务的挑战 第2列:服务策略 评定 1.如果服务人员前往服务或进行家访,路程时 间需要考虑到评定中。 18 2.如果团队成员缺乏评定经验会耗时较多。 11 处方 3.如果产品的调节范围有限,必须开具处方改 制方案以使产品适合使用者。 1、2 4.如果需要制作附加体位支撑装置,需要进行 其他测量和绘图。 5、9、10、16、19 111 续表 产品准备 5.迅速找到需要的产品类型和尺寸。 16、17 6.如果轮椅的调节范围有限,产品准备可能需 要较多的时间。 1、2、12、13 7.如果体位支撑装置需要修改,则需要更多的 时间。 1、2、4、5、12、13 适配 8.如果轮椅进行了改制或安装了附加支撑装置, 适配将会耗时较多。 3、6、8 9.如果适配过程中对轮椅的设置进行调整,需 要进一步的适配检查。 1、2、3、6、8、10、13 使用者培训 10.如果使用者第一次得到轮椅,或存在并发 症,需要更多的时间培训使用者,包括健康、移 动、操作轮椅、保养、维护和转介到其他机构。 6、7、10、11、14、15、20 注意:20.对新理念持开放态度,鼓励创新,可以应用到所有领域。 说明:随访的计划和管理对服务的发展有很大的影响。随访在下一单元讨论。 说明: ●中级轮椅服务的需求越来越大。 ●当服务扩展至中级服务时,应该估计到较 大的需求。 ●因此,与初级轮椅服务一样,建议有一个 团队专门负责中级轮椅服务。 112 说明:中级服务需要较多的临床和专业知识以及技术。中级服务工作可以由一个人来承担,然而 更常见的是由两个人分担,一位具备临床技术而另一位具备专业技术。 提问:你认为应该如何培训专业人员来开展初级和中级轮椅服务? 最重要的答案: ●首先为新人或团队培训初级轮椅服务:《轮椅服务初级教程》; ●如果服务机构不能承担增加的工资,可以考虑从合作机构发展人员; ●为中级轮椅服务找到新人或团队; ●为中级轮椅服务计划服务模式和设施; ●培训中级服务技能的新团队:《轮椅服务中级教程》。 6.管理者行动要点概括 (5分钟) 讲出管理者行动要点。 说明:与轮椅服务人员和主要的利益相关者 一起。 ●建立制度来监督转介和管理等候者名单; ●与使用者家长和转介来源一起分享早期转 介的成功故事; ●计划如何管理超出服务能力的转介需求; ●计划如何监督和改进服务的效率。 让学员参考 “实训手册”并记录他们的行动措施,用来建立和管理服务供给与需求的平衡。 113 C.3:规划随访 目标 本单元结束后,学员将能够: □描述需要更多常规随访的至少4类使用者人群; □描述随访在社区或服务中心进行的至少4种好处; □列出随访的两种障碍以及如何克服; □讨论社区合作机构如何支持使用者在社区的融合和参与。 资源 本单元: □幻灯片:C.3:规划随访; □ 《学员手册和实训手册》。 情境 本单元可修改以适应学员将工作的情境。例如: □如果必要,思考学员工作的服务模式并调整案例; □收集与情境相关的有用资源。 准备 □如果可能,邀请轮椅使用者来讨论随访的好处,以及随访对他们意味着什么。 大纲 1.前言 2.随访的重要性 3.随访的目的和随访应该在哪里进行 4.计划随访 5.克服随访障碍 6.社区融合和参与 7.管理者行动要点概括 2 10 15 20 20 13 5 总单元时间 85 114 1.前言 (2分钟) 说明:随访是轮椅服务的第8步。所有的轮椅使用者都会从随访受益。服务机构对如何随访有一 个计划非常重要。在随访过程中,了解服务对使用者、他们的家人和他们所在社区的影响,服务机构 也会从中受益。 2.随访的重要性 (10分钟) 教师提示: 如果可能,邀请轮椅使用者来讨论随访的好处,以及随访对于他们和家人意味着什么。如果没有邀 请到轮椅使用者分享他们的经验,讲出随访重要性的下列案例。 杜丽:她是一位21岁的女孩,与家人生活在一起。在随访中团队成员发现她不能走出家门,因为她 的轮椅轮胎被扎破了。轮椅被丢弃在地下室。工作人员把轮胎修补好并给她家人一些建议。杜丽能 够再次走出家门了。家人没有对随访进行评价直到他们感受到了随访的好处。服务团队决定对所有 的轮椅张贴服务联系号码标贴,来减少以后这种问题的发生。 玛丽亚:她在脊髓损伤9个月之后得到了一辆轮椅。在随访中,团队成员发现她不舒服并有痉挛, 玛丽亚认为是轮椅导致的。工作人员经过检查发现虫子大量滋生于轮椅装饰面料中。这可能引起严 重的医疗并发症并最终导致轮椅的弃用。工作人员立即对这个问题进行了处理。玛丽亚现在很健康 并且在轮椅上很快乐。 安东:他本是社区里知名的橄榄球运动员,有一次打橄榄球受了伤,导致脊髓损伤。后来他得到了 一辆合适的轮椅并进行了使用者培训。但是在随访中,团队成员发现他仍不能走出家门。轮椅使用 者培训人员恰好是随访团队中的一员,在与安东交谈后培训人员发现他缺乏信心,不想见他的朋友。 他对于残疾感到孤单、尴尬。培训人员第二天又去了安东家并且陪着安东第一次外出。从此以后, 安东的生活变得积极向上起来。 吉汉:他是一位3岁的男孩,与父母和哥哥生活在一起。在随访中团队成员发现他的支持性椅座摆 满了食物,而且轮椅也从未做过保养。吉汉的父母说他很难坐起来,在椅子上也不舒服。他们不喜 欢这个产品。吉汉预约了由参加过中级服务培训的团队再次评定。工作人员对轮椅的设置进行了修 改,使吉汉能够坐直并且四处张望来探索周围的环境。吉汉和他的父母很开心,当服务人员演示如 何保养和维护吉汉的轮椅时,他们看得很仔细。 提问:你有在不同类型服务机构开展随访的经验吗? 鼓励回答。 115 讨论: ●有用吗? ●这是计划的吗? ●多长时间一次? 3.随访的目的和随访应该在哪里进行 (15分钟) 说明:服务人员应该清楚随访的目的,以及它与新的预约有何不同。 讲出幻灯片的内容,强调要点。利用学员之 前提出的一些答案。 讲出幻灯片的内容,强调要点。 强调:随访不应该变成一次新的评定或对轮椅的全面翻新。如果随访需要时间过长或需要全面评 定轮椅使用者的情况,则应该进行新的预约。 116 说明:随访可以在以下地点进行。 ●轮椅使用者家中; ●轮椅服务机构; ●适合轮椅使用者和轮椅服务人员的任何 地方。 说明:在使用者的家中或靠近他们居住的社区进行随访是有好处的。 提问:你们认为有哪些好处? 感谢回答并把答案写在白板上。 最重要的答案: ●使用者及其家人的成本效益更高:家人不用请假并支付交通费用; ●服务提供者的教育:了解使用者在他们家里和社区面临的参与和融合障碍; ●服务的质量:确认或不能确认轮椅满足使用者的需求; ●社区认识:看到服务提供者在行动可以增加转介和可能的社区资金募集; ●支持资金募集:可以进行个案研究和用于支持资金募集的使用者故事的收集。 说明:在服务中心进行随访也有好处。 提问:你们认为有哪些好处? 感谢回答并把答案写在白板上。 最重要的答案: ●有效利用服务人员的时间:没有时间耗费在路途中; ●在完整的车间设施下可以进行大型维修; ●所有的设备和设施已经安装好了; ●服务人员可以采取多种选择; ●直接反馈服务质量:确认轮椅满足使用者的需求; ●支持资金募集:可以进行个案研究和用于支持资金募集的使用者故事的收集。 117 4.计划随访 (20分钟) 说明:所有的轮椅使用者都从随访中受益。 然而,随访对于以下人员最重要。 ●残疾儿童; ●有发生压疮风险的轮椅使用者; ●有进行性疾病的轮椅使用者; ●在轮椅上需要附加支撑的轮椅使用者 (中 级服务); ●在转移、移动、健康或轮椅保养方面接受 培训有困难的轮椅使用者。 说明:对于何时进行随访没有明确的规定,因 为随访的最佳时间取决于轮椅使用者的需求。 ●在6周之内随访中级轮椅使用者以检查新 支撑装置的舒适性和支撑度是有帮助的。 ●对于儿童和进行性疾病的人,每6个月进 行随访是比较理想的。这是因为他们的需 求变化很快。 ●其他使用者在收到轮椅的12个月之内进 行随访是比较理想的。 介绍初级服务的可视化工具。说明: ●黑色=随访预约。 ●灰色=新的预约。 ●白色=可提供的总服务数量。 ●第一年没有随访预约,所有的预约位置都 用于新的使用者 (灰色条)。 ●总共服务使用者 (白色条)是所有的新 预约。 118 提问:你们认为第一年不需要随访预约,这是现实的情况吗? 承认一些人需要优先随访。在一些服务机构,优先随访最高可以占到个案总量的30%。 点击显示第2年:注意黑色条是来自于第1年的随访预约。 提问:对于新的预约位置,灰色条发生了什么? 承认它降低了并且新的预约机会少了。 点击显示第3年。 强调新的预约位置总数量继续减少。 提问:可以考虑采取什么措施来维持每年新服务的数量? 最重要的答案: ●发展服务支持的作用来进行随访; ●在服务中心找到随访设施、工具和设备; ●培训社区合作机构的专业人员进行随访; ●培训更多的服务人员来处理增加的工作量。 介绍中级服务的可视化工具。 说明: ●黑色=随访预约。 ●灰色=新的预约。 ●白色=可提供的总服务数量。 说明:第1年,随访预约通常在6个月后 开始。 点击显示第2年。 提问:第2年初级服务和中级服务有什么不同? 承认随访数量大很多并且新的预约数量少了很多。 点击显示第3年。 提问:现在发生什么? 119 承认少于一半的预约用来服务新的使用者。 提问:在你们的服务中心,你们需要什么时候开始计划随访? 感谢回答。 强调从初期计划随访并使它成为服务模式的一部分非常重要。 说明:如果服务机构不提前计划,会很快感受到随访对新预约的影响。尤其是中级服务第3年随 访会接近饱和状态。 ●一种解决办法是与社区的机构合作,培训 他们的人员尽可能地开展随访。社区服务 人员能够处理很多简单的随访任务,只需 要转介回轮椅服务机构进行再次评定、大 型维修或其他他们不能解决的问题。 ●这个职责由正面榜样例如移动功能障碍者 承担有很多好处。 5.克服随访障碍 (20分钟) 说明:尽管对使用者和服务提供者有很多好处,接受随访的数量通常很少。为了克服障碍和改进 服务,重要的是找到为什么数量很少的原因。 提问:根据你们的经验,随访的障碍是什么? 感谢回答。 最重要的答案: 社区随访服务的障碍是: ●服务中心人员到社区的交通成本; ●服务中心人员到社区耗费的时间; ●服务机构管理者不会优先考虑随访; ●使用者不会认识到随访的价值直到他们感受到好处。 120 续表 最重要的答案: 机构随访服务的障碍是: ●一位或多位家庭成员请假的时间和交通成本是服务人员到使用者家里的两倍; ●一旦使用者得到轮椅后,使用者和家人通常不会认识到随访的好处; ●难以找到无障碍的交通工具; ●注意力集中于服务机构新的预约上,没有时间关注随访; ●难以安排随访:当服务人员没有空的时候使用者可能出现,或当服务人员有空的时候使用者没 有来。 阅读印度尼西亚的机构如何解决随访问题的案例 印度尼西亚的轮椅服务项目,不是直接收取轮椅的费用,他们收取会费来支撑服务、随访、保养和 行政成本。会费使会员有权利享有高质量的服务和持续的支持。有一个 “浮动汇率制”系统,个人 支付的会费根据其家庭收入,通过水电费账单、城市服务就业资料、自我报告和其他支持收入的指 标来决定。 该轮椅服务项目发现会员制度在多个层面是有效的: ●会员积极期待高质量的服务和产品; ●因为会员缴纳了与其收入水平相关的大笔费用 (通常在2~20美元之间,但是有时也高达150美 元),他们更加珍惜自己的轮椅并为拥有它感到很自豪; ●因为会员资格让他们享受免费或优惠的随访服务,会员资格有效期是两年,会员更愿意尽快寻求 随访服务。 活动 分组 把学员分成3人或4人一组。 指导 讲出随访可能的障碍 (“实训手册”第96页)。 增加小组强调的其他障碍到表格中。 思考领导变革的策略以及应用它们来克服随访的障碍。 在表格空白部分列出可能的措施。 121 续表 活动 监督 监督各组,并在需要时给予协助。 时间 允许5分钟活动以及10分钟反馈。 反馈 思考克服随访障碍的每个措施,并让学员提出如何克服随访障碍的建议。 克服随访障碍的可能措施 激励、参与和促使使用者了解随访的好处: ●在服务步骤7:使用者培训的过程中说明随访的好处; ●在休息室、网站和社区公告栏分享随访好处的案例; ●使用者的会员制度。 激励、参与和促使服务人员了解随访的好处: ●尝试实行服务人员提供的随访计划; ●收集随访好处的案例研究。 找到立即和可衡量的结果: ●为试点随访计划建立目标; ●收集和分享成功的故事。 优先为随访分配资源: ●用随访好处的成功案例帮助筹款,支持随访的具体开支; ●分配时间发展社区合作机构,以及培训和指导社区的工作人员。 敢于面对不断出现的挑战: ●仔细地检查随访数据和找到问题的根本原因; ●使随访成为服务模式、制度和流程的一部分。 6.社区融合和参与 (13分钟) 说明:正如我们讨论过的,随访是评价服务效果和是否实现总体目标的机会,目标包括提高轮椅 使用者的生活质量、促进社区融合和参与。 轮椅服务更广泛的作用之一是提高可及性。它可以对轮椅使用者在社区的融合和参与产生很大的 影响。 下面的案例说明没有实现居家和社区无障碍的成本。 122 阅读斯里兰卡居家和社区障碍导致病人延迟出院的案例 居家和社区障碍使政府成本很高。斯里兰卡一家康复医院于1999年进行了脊髓损伤的医院成本调 查。调查结果显示医院每天的成本是6.8美元。 有16位病人在8号病房 (该病房住的是不能够出院的病人),平均每位病人在医院时间是61个月, 花费858270斯里兰卡卢比 (12438美元)。花钱使居家无障碍因此他们可以回家,节省医院和政府 的费用。 说明: ●居家的主要障碍之一是卫生间。 说明: ●对居家进行简单的调整可以极大地改善生 活质量。 强调:经研究,世界银行发现在建设时考虑到无障碍的成本是最低的。研究显示建筑无障碍对建 设成本增加不超过1%。 123 阅读尼加拉瓜建筑无障碍运动 尼加拉瓜一家叫做CADISCA的残疾人机构在首 都马拉瓜发起一项运动,以强调高路缘和台阶的 问题。他们与轮椅使用者团队一起在3个月内为 社区修建了200个坡道和路缘 (做一个与马路水 平的坡口)。CADISCA在社区的善举,促使了当 地企业赞助在全市修建更多的路缘和坡道。 早期,CADISCA用轮椅篮球来提高残疾人的自信和促进成员参与残疾人机构活动。 体育训练也为日常残疾人组织例会创造了契机,例会上人们举行了多项服务残疾人、提高认识的活动。这 些训练在公园进行,让社区接触残疾人组织的活动并提高认识。最后,体育项目得到了公众对残疾人的关 注和支持,推动了无障碍运动的成功。这有助于最后给政府施压,让政府在马拉瓜全市资助路缘建设。物 质环境障碍的消除让轮椅使用者在所在城市获得经费、教育和社会领域的平等机会。 说明:交通是轮椅使用者的常见障碍。挑战包括以下几点。 ●让交通工具停留时间足够长以转移和存放轮椅; ●携带轮椅要多交费用; ●可拆部件被偷的风险,例如轮子; ●由于门槛和出入口难以出行。 介绍泰国改装摩托车和印度改装自动三轮车 的图片。 说明: ●许多国家有包容性交通倡议,包括南非和 哥伦比亚。 “学员手册”中可查阅一些有 用的资源。 124 说明: ●简单如道路宽窄和卫生间是否无障碍可能 成为上学的障碍。 ●提供无障碍建筑和道路的资源和信息可以 使学校具有包容性。 概括:通过提供无障碍环境的建议和信息以及合作促进居家无障碍、交通无障碍并获得教育的机 会;服务目标是最大限度地提高移动功能障碍者融合和参与的机会。 7.管理者行动要点概括 (5分钟) 讲出:管理者行动要点。 与轮椅服务人员和主要的利益相关者一起。 ●计划随访; ●建立和培训社区合作伙伴; ●确定使用者培训和随访的职责; ●通过收集受益和成功的故事让所有利益相 关者参与重要的随访。 让学员查阅 “实训手册”并记录他们计划随访的措施。 125 C.4:规划财务的可持续性 目标 本单元结束后,学员将能够: □定义财务可持续性; □描述如何规划财务可持续性; □确定至少3种资金来源; □概述资金募集策略。 资源 本单元: □幻灯片:C.4:规划财务可持续性; □ 《学员手册和实训手册》。 情境 本单元可根据学员将工作的情境进行修改。例如: □研究服务机构的服务模式; □增加当地具体的资金来源或成功案例到参考资料中或建立补充资源以支持本单元。 准备 □浏览单元计划并收集资源。 □认真检查资金募集框架。 大纲 1.前言 2.什么是财务的可持续性 3.规划财务的可持续性 4.确定潜在的资金来源 5.规划资金募集策略 6.管理者行动要点概括 2 15 8 20 20 5 总单元时间 70 126 1.前言 (2分钟) 说明: 本单元,我们将讨论管理者在发展战略中的两个职责,第一是要为服务步骤和扩大服务责任提供 资金,第二是确保轮椅服务的总体目标是可持续的。 2.什么是财务的可持续性 (15分钟) 说明:我们将建立 “轮椅服务中什么是财务可持续性”的表述。 播放幻灯片。 介绍小组活动。 活动 分组 学员分成3组。 指导 让每组写下轮椅服务中什么是财务可持续性的表述。 说明有时候写下它不是什么,然后把它变成一个正面的表述。例如,轮椅服务的财务可持 续性不仅仅考虑产品成本,它可以变成: “轮椅服务的财务可持续性必须包括不止产品 成本。” 它可以提供建立财务可持续性表述的起点。 监督 监督各组,并在需要时提供协助。 让各组在白纸上写下他们对财务可持续性的表述。 时间 允许5分钟活动和8分钟反馈并建立表述。 127 续表 活动 反馈 让每组的一位代表来向其他人员表述他们的陈述。 评论陈述的共同内容并建立一个对财务可持续性的共同表述。 把共同表述写在白纸上并贴在墙上。 教师提示:可能表述的例子 ●一个可持续的轮椅服务项目,是指有能力在相当长一段时间内,按照服务的8个步骤为持续数量 的使用者提供适用的轮椅。 ●它需要对产品供应、受过培训的人员、场地、监督和评价系统进行持续的投资。当服务得到保证, 或持续得到保证,必要的资金和资源使这种持续的投资成为可能时就可实现财务的可持续性。 3.规划财务的可持续性 (8分钟) 说明:规划财务的可持续性包括以下几点。 ●清晰地明确维持服务所需要的资金和资源 (这在单元B.5中已讨论过); ●确定潜在的资金来源; ●确定潜在的非资金支持; ●为获得资金和实物捐助制订策略。 提问:在学员所处的环境中有哪些潜在的资金来源? 感谢回答。 128 说明:有许多不同的资金来源。 播放幻灯片。 说明: ●轮椅服务机构可以从许多不同的途径获得 资助。 ●一些服务机构可能只有一种资金来源 (例 如政府),然而大多数服务机构从不同途 径获得需要的资金和资源。 说明: ●与资金来源一样,这里也有非资金支持的 来源。 ●它包括实物捐赠 (例如捐赠设备、轮椅和 物资)、志愿者支持和设施提供。 ●非资金支持可以减少管理服务机构所需的 资金数量。 提问:有人有非资金支持的案例吗? 感谢回答。 阅读墨西哥的案例:让社区和使用者捐款 墨西哥一年一度的电视和广播节目Teleton诞生于1996年,举办目的是为儿童康复中心的残疾儿童 募集资金。 该节目由墨西哥电视公司制作,超过600家墨西哥和海外媒体以及20家商业企业赞助该活动。他们 借助大量融合与成就相关的积极故事推销他们的成功愿景。在活动的3个月之前,案例研究作为宣 传的一部分通过媒体发布。高知名度人士参与到该活动的宣传中。 Teleton儿童康复中心在财务上是完全可持续和增长的,其财务来源是每年的资金募集活动和使用者 捐助的总收入。 129 承认:Teleton对助残意识的培养是大规模的,也是非常成功的。 说明:收集和分享成功故事是强大的资金募集工具。服务机构将受益于在他们社区的助残意识宣 传活动。 4.确定潜在的资金来源 (20分钟) 说明:一旦你计划了一种服务模式并制定预算,就必须要确定资金来源。 活动 分组 分成小组。来自于同一机构的学员在一起。 指导 阅读可能的资金来源列表 (“实训手册”97页)。 选择你认为对你的服务机构有最大可能的3个资金来源,并把它们列在下面的表格中。 思考需要多大的努力以及短期或长期回报是什么。 按照优先次序排序。 监督 监督各组并回答问题。 时间 允许12分钟活动和8分钟反馈。 反馈 让学员讨论他们选择了哪种资金来源以及为什么。 提问是否有人想到了他们之前没有提出的资金来源? 5.规划资金募集策略 (20分钟) 说明:一旦确定潜在的资金来源,服务机构的管理者就要为潜在的资金来源需要何种支持和多大 的支持制订策略。 说明: ●为了帮助规划策略,管理者需要对不同资 金来源进行优先排序,并计划他们将如何 处理获得的资金。 ●管理者需要考虑: ○资金来源:谁将获得; ○支持:管理者要求从资金来源处获得什 么支持。 130 募集资金框架案例: 要求:你要求资金来源机构提供或支持多少钱? 可能:资金来源机构资助或支持的可能性多大? 可以分类为低、中和高。 努力:需要什么来获得资金,以及报告什么或其他责任? 说明: ●表格可以帮助管理者对资金来源优先排序 和计划策略。 思考: ●支持的类型:这可能集中在示范产品的预 算项目或服务步骤,以及若干相关预算项 目。思考具体的经费来源,他们最可能需 要什么支持。 ●要求多少:思考上次捐助给服务机构或其他 机构的规模。目标是寻求切实可行的金额。 ●努力:获得资金付出的努力应该与资金量 成正比。责任应该对服务机构是可负担或 可管理的。 活动 分组 同样的分组。 指导 阅读表上的案例 (“实训手册”98页)。 从上次练习中列出3个资金来源。 为选定的资金来源完成表格。 承认不可能精准地完成所有内容,但是仔细检查流程并增加尽可能多的信息。 监督 监督各组,并在需要时提供协助。 时间 允许15分钟活动。 反馈 要求用表中列出的策略对结构性资金募集进行反馈。 131 说明:联系之前单元的年度预测工作量和预算工作,建立预算预测来了解资金募集的努力非常 重要。 6.管理者行动要点概括 (5分钟) 讲出:管理者行动要点。 与轮椅服务人员和主要利益相关者一起。 ●建立财务可持续性的共同理念; ●确定需要的资金和资源; ●确定潜在的资金来源; ●目标是对资金来源进行优先排序; ●制定资金募集策略并行动。 让学员参考 “实训手册”,对于服务机构财务可持续性的计划,学员应把他们自己的行动记录 下来。 132 整合所有知识 目标 本单元结束后,学员将能够: □思考管理者可以采取的行动,以激励利益相关者改进所在地区的轮椅服务。 资源 本单元: □幻灯片:结束单元,整合所有知识; □视频:临别赠言; □评估表格 (前一天分发并在本单元收集)。 情境 □本单元可根据学员将工作的情境进行修改。 准备 □浏览单元计划并收集资源; □确保已经打印了证书并有教师签字; □检查变革理念的白板纸 (在培训开始前张贴)。 大纲 1.前言 2.领导变革的行动 3.闭幕式和颁发证书 2 18 10 总单元时间 30 133 1.前言 (2分钟) 说明:在最后单元中,管理者可以带头采取行动来改进所在地区的轮椅服务。 2.领导变革的行动 (18分钟) 活动 分组 不分组。 指导 参考培训开始张贴的白板纸 “变革理念”,并在上面记录管理者和利益相关者可以采取的措 施来改进适用的轮椅供应体系。 监督 鼓励学员增加他们还没有记录下来的任何观点 (允许5分钟)。 时间 允许18分钟。 反馈 让一位学员引导回顾以紧迫感传播轮椅供应服务的重要性,并建立共同愿景。 提问:下一个步骤是什么? ●你们将成立一个专责小组来启动建议的一些措施吗? ●谁将进一步采取这些行动? ●你们将来会再次相聚吗? 什么时候? 再次整合利益相关者与资源。 再次激励、参与和动员利益相关者。 记录:在白板上记录下一个步骤,以及人员的职责和日期。 3.闭幕式和颁发证书 (10分钟) 说明: ●图中的LOGO代表致力于让人们走出来, 而不是封闭在他们家里或小房子中,由受 过培训的专业人员提供适用的轮椅服务, 提高残疾人的参与和融合。 鼓励学员使用这个LOGO。 134 让管理者上交前一天分发给他们完成的评估表。 介绍视频:临别赠言。 播放视频。 教师提示: ●教师可以选择他们希望怎样颁发证书和结束培训。如果之前没有给学员海报,作为本单元的一部 分内容,每位学员也可以得到一份轮椅服务步骤的海报。 135 参考文献 ①资源有限地区手动轮椅服务指南.日内瓦:世界卫生组织;2008 (http://www.who.int/disa- bilities/publications/technology/wheelchairguidelines/en/). ②轮椅服务初级教程.日内瓦:世界卫生组织;2012 (http://www.who.int/disabilities/tech- nology/wheelchairpackage/en/). ③轮椅服务中级教程.日内瓦:世界卫生组织;2013 (http://www.who.int/disabilities/tech- nology/wheelchairpackage/wstpintermediate/en/). ④残疾人权利公约,G.A.Res.61/106 (2007)纽约:美国;2008 (http://www.un.org/esa/ socdev/enable/rights/convtexte.htm). ⑤BragarGaler,Joan,AlisonElisandSylviaVriesendorp. 《管理者的领导力》第6章 “领导变 革促进健康”.剑桥:健康管理科学;2005. ⑥WyndaeleM,WyndaeleJJ.Incidence,脊髓损伤的流行和流行病学:世界文献调查学习到什么? 脊髓,2006;44:523-529. ⑦RazzakA,HelalSU,NuriRP.发展中国家脊髓损伤后的预期寿命,在CRP的回顾研究,孟加 拉国.残疾,社区康复和融合发展,2011.Vol.22.2011. ⑧世界卫生组织,世界银行,世界残疾报告. 日内瓦:世界卫生组织;2011 (http:// www.who.int/diabilities/world_report/2011/report/en/). ⑨资源有限地区行动辅具服务的联合意见书.日内瓦:世界卫生组织;2013(http://whqlib- doc.who.int/publications/2011/9789241502887_eng.pdf? ua=1&ua=1).

轮椅服务管理者教程 学员手册和实训手册 ［美］莎拉 ･ 弗罗斯特 等著 张丽姣 柳博飞 钟 磊 译 世界卫生组织 图书在版编目 (CIP)数据 轮椅服务管理者教程.学员手册和实训手册/ (美)莎拉·弗罗斯特等著;张丽姣,柳 博飞,钟磊译.-北京:求真出版社,2017.8 ISBN978 7 80258 239 2 Ⅰ.①轮… Ⅱ.①莎…②张…③柳…④钟… Ⅲ.①四肢-残疾人-社会服务-技术 培训-教材 Ⅳ.①C913.69 中国版本图书馆CIP数据核字 (2017)第210462号 世界卫生组织于2015年出版,原标题为 (WheelchairServiceTrainingPackageFor Managers:ReferenceManualandWorkbook)ⓒ世界卫生组织2015 世界卫生组织授予深圳市残疾人综合服务中心翻译中文版的权利,并委托求真出版社 出版。中文版的翻译质量和准确性由深圳市残疾人综合服务中心负责。若英文版与中 文版有任何出入,应以英文原版为准。 轮椅服务管理者教程.学员手册和实训手册ⓒ世界卫生组织2015 轮椅服务管理者教程———学员手册和实训手册 著 者:[美]莎拉·弗罗斯特 等 译 者:张丽姣 柳博飞 钟 磊 责任编辑:计 悦 出版发行:求真出版社 社 址:北京市西城区太平街甲6号 邮政编码:100050 印 刷:北京华联印刷有限公司 经 销:新华书店 开 本:787×1092 1/16 字 数:124千字 印 张:6.5 版 次:2017年8月第1版 2017年8月第1次印刷 书 号:ISBN978 7 80258 239 2/C·8 定 价:26.00元 编辑热线:(010)83190270 销售服务热线:(010)83190297 83190289 83190292 版权所有 侵权必究 印装错误可随时退换 术 语 本教程中的术语定义如下: 适用的轮椅 能够满足使用者需求以及环境状况的轮椅;提供适配和体位支撑并且安全耐 用;国内可得到且在国内能够以最经济实惠的价格购买和维修并接受持续的 服务。 手动轮椅 由使用者本人驱动或由其他人推行的轮椅。 体位支撑装置 (PSD) 用于提供附加体位支撑的装置,是中级轮椅服务的主要内容。 轮椅 为行走或移动困难者提供轮式移动和坐位支撑的器具。 轮椅改制 对轮椅进行改造。 轮椅供应体系 轮椅设计、生产、供应和提供服务的总术语。 轮椅服务 轮椅供应体系的一部分,以确保每位使用者都能获得一辆适用的轮椅。 轮椅服务人员 提供适用轮椅服务中具有专业技能的人员。 轮椅使用者 有行走或移动困难而需要使用轮椅代步的人士。

, 1 《轮椅服务管理者教程》概述 4 学员手册 4 A:核心知识 4 A.1:什么是适用的轮椅供应体系 6 A.2:提供轮椅服务 12 A.3:领导变革的管理者 15 B:开始轮椅服务 15 B.1:获得服务 19 B.2:设施和设备 27 B.3:适用轮椅的范围 32 B.4:人员配置 35 B.5:轮椅服务的成本 38 C:运营轮椅服务 38 C.1:如何确定轮椅服务是否有效 43 C.2:管理需求 50 C.3:规划随访 58 C.4:规划财务的可持续性 63 参考文献 64 实训手册 64 管理者创建或改善轮椅服务供应体系的活动 65 第一部分 65 A:核心知识 65 A.1:领导变革 66 B:开始轮椅服务 66 B.1:获得服务 67 B.2:设施和设备 68 B.3:适用轮椅的范围 69 B.4:人员配置 70 B.5:轮椅服务的成本 71 C:运营轮椅服务 71 C.1:如何确定轮椅服务是否有效 73 C.2:管理需求 74 C.3:规划随访 75 C.4:规划财务的可持续性 76 第二部分 76 A:核心知识 76 A.1:适用的轮椅供应体系:国家政策 77 A.2:提供轮椅服务 78 B:开始轮椅服务 78 B.1:设施和设备 81 B.2:适用轮椅的范围 85 B.3:人员配置:职责 85 B.4:轮椅服务的成本 88 C:运营轮椅服务 88 C.1:有效和高效的服务 92 C.2:发展高效的服务 93 C.3:管理需求 96 C.4:规划随访 97 C.5:规划财务的可持续性 1 《轮椅服务管理者教程》概述 简介 世界卫生组织 (WHO)于2008年发布了 《资源有限地区手动轮椅服务指南》①,2012年发布了 《轮椅服务初级教程》(WSTPb)②,这是轮椅服务教程系列的第一部分,随后在2013年发布了第二部 分 《轮椅服务中级教程》 (WSTPi)③。世界卫生组织与美国国际开发署 (USAID)共同开发了这套 《轮椅服务管理者教程》和 《轮椅服务利益相关者教程》。《轮椅服务管理者教程》是世界卫生组织轮椅 服务系列教程的第三部分,用于支持管理者的培训,帮助他们有效支持适用轮椅供应体系;同时提高 利益相关者的认识,推动在国家或地区内建立适用的轮椅供应体系。 轮椅是帮助个人移动的最常用辅助器具之一。对于行走或移动有困难的人来说,轮椅是帮助个人 移动、提高能力和获得尊严、保障全面健康必不可少的工具。轮椅的可移动性为轮椅使用者提供了独 立获得医疗、教育、工作和就业的机会,也有助于轮椅使用者参加社会和文化活动。然而,据世界卫 生组织统计,全世界超过7000万人需要轮椅,但是只有5%~15%的人能够获得一辆适配的轮椅。此 外,轮椅服务人员获得开具有效轮椅处方所需技能的培训机会很有限。 移动能力的重要性在联合国 《残疾人权利公约》(CRPD)④中也有所体现,公约倡导 “采取有效措 施,确保残疾人尽可能独立地享有个人移动能力”。为确保有效的个人移动能力,轮椅使用者就需要一 辆适配正确且能满足他们具体需求的轮椅,尤其是生活方式和环境方面的需求。这就要求有一种方法 来响应个人的需求。 满足轮椅使用者个性化需求的一种有效方式,是通过建立组织良好的、能够满足使用者、尊重使 用者的供应体系,进而通过训练有素的人员来提供轮椅。 目标人群 本教程适用于负责实施、管理和评估康复服务的所有人员,包括轮椅服务人员和轮椅供应人员。 学员不需要具有以往的轮椅服务经验,培训的设计是假定学员具备基本的管理技能。 2 目的 本教程的目的在于,帮助所有轮椅服务供应体系相关人员树立意识、提高知识和技能。世界卫生 组织意识到,单靠受训人员本身难以保障国内适用的轮椅体系很好地运作,也难以切实履行 《资源有 限地区手动轮椅服务指南》列出的责任,这就要求更高水平的人员参与建立或者改善国内轮椅供应 体系。 这套 《轮椅服务管理者教程》旨在概述康复管理者或轮椅服务管理者的职责:雇佣人员,引导实 施轮椅服务以及其他相关事情。本教程提到了轮椅服务所需要的人力、物质资源,包括计划、组织、 人事、指导、成本或经费、监督和评价等。 本教程可以在13~14个小时内完成,根据不同情况的具体需求和可用资源,时间可能会延长或缩 短。本教程的实施有助于管理者: ●更好地规划轮椅供应体系; ●提高轮椅服务的质量; ●降低员工的流失率; ●增加获得适用轮椅的使用者数量; ●提升轮椅供应体系的可持续性。 范围 本教程包括: ●WHO轮椅服务系列教程中轮椅服务8个步骤的概述; ●轮椅服务所需要的核心知识: ○开始轮椅服务; ○运营轮椅服务; ○使轮椅供应体系可持续。 如何使用 《学员手册和实训手册》 本手册中的 “学员手册”部分对 《轮椅服务管理者教程》中涉及的知识进行了总结。学员可在培 训课程后使用 《学员手册和实训手册》,巩固每个训练环节中的关键点。 “学员手册”分为以下3个 部分: A.核心知识; 3 B.开始轮椅服务; C.运营轮椅服务。 本手册中的 “实训手册”部分,其目的是培训轮椅服务人员的知识和技能。“实训手册”部分包含 有助于测试和发展学员知识与技能的练习,包括课堂资料、幻灯片和参考资料,目的在于让学员保留 他们的 “实训手册”,以便将来需要时可以作为参考。 4 学员手册 A:核心知识 A.1:什么是适用的轮椅供应体系 轮椅供应体系是轮椅设计、生产、供应和提供服务的总术语。轮椅是最常用的辅助器具之一,为 行动不便的人提供轮式移动。 移动是实现融合非常重要的一步。一个人通过服务获得一辆适用的轮椅后,就有机会参与教育、 工作和社会生活。另外,其他家庭成员也可以解脱出来参加社区活动以及就业⑤。 移动方便,受益的不仅仅是个人和家庭。当地以及更广范围的经济体也会因为做出贡献的社会成 员增加而受益。此外,拥有适用轮椅的使用者不太可能有继发性健康并发症 (比如压疮),所以也较少 需要卫生服务。 为了让更多人获得适用的轮椅服务,轮椅服务管理者迫切需要做出改变。 多少人需要轮椅 据世界卫生组织统计,需要轮椅的人数占全球人口的1%,也就是全球超过7000万人需要轮椅。 当计算每个国家、每个地区、每个城镇有多少人需要轮椅时,这个数据可以是初始数据。也就意味着 管理者无需进行详细的调查,就可以先开始规划轮椅供应事宜。 人口 百分比 需要轮椅的人数 全球总人口 7000000000 1% 70000000 巴西 203657000 1% 2036570 中国 1401587000 1% 14015870 埃及 84706000 1% 847060 印度 1282390000 1% 12823900 尼日利亚 183523000 1% 1835230 俄罗斯 142098000 1% 1420980 5 支持轮椅供应体系的公约、策略和政策 很多人需要轮椅但是却没有适用的轮椅。因此,非常有必要加大宣传以增加人们获得适用轮椅的 机会或渠道。 管理者可以通过全球性政策、区域性政策以及国家政策帮助那些有移动障碍的人们争取移动的 权利。 下面的表格中列出了公约、策略、政策及指导方针示例,可作为管理者的宣传工具。 国际政策 地区案例:仁川战略 国家政策和指导方针 联合国 《残疾人权利公约》 (CRPD)是最高级别的政策 文件。 该公约第20条提出,所有人 都享有 “个人移动”的权利。 该公约的其他条款也强调了适 用轮椅供应体系的重要性。 ●独立生活和融入社区 (第19 条); ●受教育的权利 (第24条); ●可达到的最高健康标准的权 利 (第25条); ●康复的权利 (第26条); ●工作和就业的权利 (第27 条); ●参与文化生活、娱乐、休闲 和体育活动的权利 (第30 条)。 2012年, 《仁川战略》正式实 施,该战略旨在帮助亚洲和太平 洋地区的残疾人真正实现他们的 权利。 该战略拟定了10项目标。目标 3是增加获得物理环境、公共交 通、知识、信息和通讯的机会。 战略制定过程中,各方达成一项 共识:如果缺少包括轮椅在内的 辅助器具,该战略目标将难以 实现。 因此,目标3还涉及一项任务: 统计那些需要但是没有辅助器具 的残疾人比例。 签署 《仁川战略》的各个政府, 为履行义务,目前正致力于实施 多项国家计划。 《仁川战略》的 案例展示了国际和地区政策是如 何支持、鼓励国家政策发展的。 国家制定规划、政策和指导方针 有助于提高轮椅供应体系的有效 性和可持续性⑥。国家政策和指 导方针的制定,需要残疾人、政 府和非政府的服务提供者之间的 通力合作。 联合 国 《残 疾 人 权 利 公 约》 (CRPD)以及相关的区域政策, 均支持国家规划、政策和指导方 针的制定。 国家的指导方针有助于界定包括 移动设备在内的辅助器具的提供 方式。例如,2003年南非出版了 《辅助器具供应体系国家指南》, 提供了以下各项服务的最低标准: 人员培训;建立和管理候诊清单; 制定预算;提供保养和维修服务。 6 A.2:提供轮椅服务 轮椅服务在轮椅供应体系中发挥着重要的作用。轮椅服务工作就是从众多可获得的轮椅中找到最 适合使用者的轮椅。 初级轮椅服务和中级轮椅服务 每辆适用的轮椅都可以为使用者提供体位支撑。当靠背、坐垫、脚踏板和扶手调整到适合轮椅使 用者的位置时,它们会提供体位支撑。然而,很多儿童和成年人在他们的轮椅上需要附加体位支撑, 也就是说,他们需要不同级别的服务。 初级轮椅服务对象是无需体位支撑就可以坐直的轮椅使用者。 中级轮椅服务对象是需要附加体位支撑才能舒服地坐直的轮椅使用者。 对轮椅服务管理者来说,重要的是明确他们需要的服务是初级还是中级。因为中级服务要求具有 较高水平的人员、可选范围更多的轮椅、更多的材料和设备。 满足移动需求和体位支撑需求 克莱拉生活在东帝汶,在自己家里的商店工作,商店位于他们家房 子的前面。克莱拉患有小儿麻痹症,需要一辆轮椅进出房间、在商 店工作并在村里移动。她能够不需要任何支撑坐直,并使用一辆已 经调整和适配的手动轮椅。 克莱拉属于通过初级服务获得轮椅的案例。 易莎德8岁,生活在斯里兰卡。她患有脑瘫,难以控制上下肢和头 颈。如果没有支撑,她没办法自己坐直,因此,在她的轮椅上需要 附加体位支撑。 易莎德属于通过中级服务获得轮椅的案例。 7 轮椅服务的8个步骤 步骤 概要 1.转介和预约 轮椅使用者的转介方式各不相同。使用者可以自 己求助或通过由社区、地区一级政府或非政府单 位组成的网络中工作的卫生和康复工作者或志愿 者进行转介。如果某些潜在的轮椅使用者以前没 有接受过任何社会、卫生保健服务或参加过学 校、工作单位、社区活动,则轮椅服务单位需要 积极地对他们进行识别。 2.评定 考虑到每位轮椅使用者的生活方式、工作环境和 身体状况不同,需要对其进行单独评定。 3.处方 (选择) 根据评定的信息,与使用者、家人或护理者一起 确定轮椅处方。处方 (选择)中详细说明了选定 轮椅的类型、尺寸、特殊功能和改制方案。处方 的内容也包括使用者正确地使用和保养轮椅所需 要进行的培训内容。 4.经费和订购 确定资金来源,并从轮椅服务机构的库存中或从 供应商处订购轮椅。 8 续表 步骤 概要 5. 产 品 (轮 椅) 准备 受过培训的人员为初次适配准备轮椅。该准备取 决于可得到的产品和服务设施,可以包括由制造 商提供的产品进行组装和适当地改制,或者在轮 椅服务车间制作产品。 6.适配 使用者试用轮椅。对轮椅进行最后的调试以确保 其组装和配置正确。如果需要改制或安装体位支 撑部件,则可能需要再次适配。 7.使用者培训 培训使用者和护理者如何安全有效地使用和保养 轮椅。 8. 保养、维修和 随访 随访是检查轮椅适配情况并进一步提供培训和支 持的机会。随访时间取决于使用者的需求和他们 是否还可以得到其他形式的服务。对于不能在社 区解决的技术问题,轮椅服务机构应该提供保养 和维修服务。 9 提供服务的模式 所有的轮椅服务都应该遵循轮椅服务的8个步骤。但是,这8个服务步骤也分不同的模式,称为 服务模式。不同服务模式组合在一起,可以构成整个国家服务体系。最适用的服务模式取决于服务内 容,同时也应当取决于与其他利益相关者的协商。 下面的表格显示了不同的服务模式案例。 机构服务 专用评估区 机构服务模式下,轮椅使用者前 往固定的场所,机构受训人员为 其提供服务。 因为场所是固定的,所以服务机 构有专门的人员和区域提供轮椅 服务。 机构服务对服务人员来说是非常 高效的,但是对于距离机构较远 的轮椅使用者来说却有一定的 困难。 专用轮椅移动技能区 综合服务 社区卫生诊所中的轮椅服务 大多数机构服务都是 “综合服 务”,即轮椅服务与其他服务或 其他服务活动整合在一起。例 如,轮椅服务可以整合在假肢或 矫形器服务中,整合在理疗科或 诊所中。在这种服务模式下,如 果服务人员在从事轮椅服务外还 要承担其他工作,一定要确保服 务人员有充分的时间完成所有的 工作。 可以共享设备或者提供专用空 间,行政、财务以及管理功能也 可以共享。 这种服务模式中,设有专用轮椅 准备区 10 续表 社区服务 社区服务的地点可以变换,可 以是社区诊所、市政厅、村民 集会地、轮椅使用者的家里 等等。 在社区服务模式下,为了满足该 地区轮椅使用者的需求,中心服 务人员或者综合服务人员需要前 往轮椅使用者家中或者另一地区 的中心地带,提供轮椅服务。 社区服务模式通常是与一个或者 多个组织在社区共同合作开展。 与当地组织进行良好的沟通与协 调是非常重要的。对当地人员或 志愿者的培训,有助于成功提供 社区服务,也有助于提高社区支 持力度。 对于轮椅使用者来说,社区服务 模式的优势在于使用者不用远距 离奔波。 服务人员需要灵活机动,随身携 带必要的设备。 流动服务 流动轮椅服务的专用车辆案例 流动服务是社区服务的一种形 式。在这种服务模式下,服务人 员有一辆专用车辆,配有服务所 需要的轮椅、工具和设备等。 服务人员可以在更多地方进行组 装,而且通过这种方式可以惠及 更多的轮椅使用者。 流动服务模式下,服务人员可以 携带更多的工具、设备、材料和 零部件,这样就增加了在现场进 行及时维修的可能性,也有利于 提高中级服务的能力。 因为配有专用车辆,服务人员能 够携带更多服务所需要的设备和 工具。 11 共同提供服务 轮椅服务的8个步骤不一定都由同一个机构实施。组织网络之间的沟通协作有助于提高服务效率, 也有助于促进轮椅使用者获得完整的轮椅服务。 第1步 (转介和预约)必然要求机构与个人之间的沟通与合作,为轮椅使用者构建起转介网络。 第7步 (使用者培训)和第8步 (保养、维修和随访)通常由合作组织提供。比如,社区机构网 络或者残疾人组织网络,都可以在社区完成这两个步骤。 左图显示了轮椅服务过程中轮椅提供者和社 区组织之间合作的8个步骤。 第2步到第7步均需要在服务机构进行,而 第1步和第8步可以在社区进行。 这种模式需要考虑到所有服务人员和志愿者 的培训。 轮椅服务过程中管理者的职责 轮椅服务管理者负责支持服务人员完成8个步骤,并负责协助使用者和使用者监护人、家属按照 上述8个步骤开展服务。 管理者还有很多其他职责,对提供服务均有非常重要的作用。这些职责包括: ●提高适用轮椅供应体系的认识; ●提高服务的可得性; ●增加轮椅服务人员的培训机会; ●促进可持续发展,使轮椅服务始终保 持可持续发展; ● 影响适用轮椅供应体系有关的国家 政策; ●扩大可得到轮椅的范围。 12 轮椅使用者积极参与轮椅服务 轮椅使用者积极参与轮椅服务的各个环节有助于完善服务效果。相关人士建议管理者要确保轮椅 使用者可以参与以下环节⑦: ●确保服务人员让轮椅使用者成为服务团队的成员,积极参与轮椅服务的所有步骤; ●建立服务信息反馈系统,定期收集使用者意见和改进建议; ●如果可能,可以招募轮椅使用者作为服务团队的成员。也就是说,可以通过有关部门发布岗位 信息,并确保轮椅服务的所有区域都是无障碍的。 罗马尼亚服务团队中的轮椅使用者 罗马尼亚的一家轮椅服务非政府组织,积极招募轮椅使用者加入他们的服务团队。不同轮椅使用者 具有不同的技能,在团队中发挥着不同的作用。这一非政府组织看到了轮椅使用者作为轮椅服务人 员所发挥的积极影响。通过日常互动,团队中所有成员都越发意识到轮椅使用者在团队中的重要性。 由于轮椅使用者会与他们的服务对象分享自己的经历,这些服务对象往往会觉得这样的服务更加舒 适,同时也会视他们为榜样。 A.3:领导变革的管理者 引进或者改进轮椅服务的工作往往需要组织内部的变革。但是,领导变革非常困难。轮椅服务管 理者的部分职责是领导变革,实现变革的一些关键活动包括: ●帮助建立适用轮椅供应体系的共同愿景; ●向所有的利益相关者传播适用轮椅供应体系的重要性,包括政策制定者、其他服务提供者以及 潜在的捐赠者; ●整合合适的人员和资源; ●激励、参与并动员员工。 建立适用轮椅供应体系的共同愿景 在所有利益相关者之间建立一个改善该地区轮椅服务供应体系的共同愿景,有助于鼓励那些需要 一起工作的人们进行变革。这些共同愿景应当描绘一个美好未来的蓝图。比如: 13 “一个轮椅使用者融入且充分地参与生活各个方面 的世界。” 重要的是积极分享这一愿景,以使所有人员可以全 身心致力于提高残疾人的生活质量。 传播适用轮椅供应体系的重要性 为了进一步激励服务人员和利益相关者,管理者需要不断地强调适用轮椅供应体系的重要性。管 理者需要明确的是:引进或者改进轮椅服务是当前工作的重中之重,非常紧迫。紧迫感意味着需求不 能被忽略或耽误。员工会遵循他们主管做出的优先排序,因此,管理者的行动必须营造一种紧迫感。 如何传播适用轮椅供应体系的重要性和紧迫性 ●讨论全球范围内以及国家范围内对适用轮椅未满足的需求;个人移动的权利;适用轮椅供应体系 对个人、社区、社会的好处。 ●在定期的员工会议上,讨论引进或改进提供轮椅服务的进展。 ●在员工会议或者服务墙的海报上,分享正能量的成功故事。 整合人员和资源 轮椅服务需要训练有素的人员、设备和资源。轮椅 服务团队的所有人员都应该: ●向共同目标努力; ●感到自己的工作获得所需资源的支持; ●自己的贡献获得认可。 14 如何整合人员和资源 ●确定能够用于轮椅服务的设施。 ●分配人员时间、设施、设备以及资金时,优先安排提供轮椅服务的工作。 ●用共同愿景和适用轮椅供应体系的好处,提醒服务人员,为什么服务机构要提供轮椅。 ●在轮椅服务过程中,对服务人员做得好的地方给予肯定和奖励。 ●帮助员工以团队方式工作。 激励、参与和动员员工 管理者可以通过以下方式激励、参与和动员员工: ●让员工参与计划和实施过程,以便贡献他们的经 验和技能;同时这样也可以帮助他们更好地理解 变革涉及的内容,以及他们实施变革中的职责。 ●一起克服困难,以便服务人员更好地了解问题的 起因以及如何解决。 ●建立短期目标并认可这些目标成果,以便服务人 员能够感觉到他们的努力起到了作用,并且能够 得到认可和赞赏。 ●将变革植入组织系统和文化当中。比如,可以创 造一种庆祝成功的文化,鼓励人们在会议和休息 期间分享成功和积极的故事。此外,通过完善个 人工作职责和更新组织政策来确保变革成功。 15 B:开始轮椅服务 B.1:获得服务 什么是 “公平的服务” “公平的服务”是指通过服务工作,确保每位轮椅使用者都有机会获得一辆轮椅。具体包括: ●成年男性、女性,男孩和女孩; ●年轻人、中年人和老年人; ●生活在附近的人,生活在偏远地区 (比如农村地区)的人; ●来自不同种族或社会经济背景的人。 公平的服务认为,所有人 (无关残疾、年龄、性别、宗教、财富、语言和民族)都有接受服务的 权利。 公平的轮椅服务,不是向不同群体的使用者提供同等数量的轮椅 (比如,向男性和女性提供同等 数量的轮椅)。这是因为,不同人群的需求不尽相同。 记住:获得服务,不仅仅是 “到达服务机构”,更多的是能够了解服务、接触到服务机构或者服务能 够来到他们身边。 有一些人可能很难获得服务。下面列举了一些例子: ●妇女和女孩; ●居住地离服务机构较远的人,比如住在农村地区的人; ●穷人; ●儿童; ●不同宗教或社会经济背景的人; 16 ●老年人; ●特殊群体,比如携带艾滋病病毒或者患麻风病的人可能会遭到歧视。 管理者需要根据他们掌握的情况,关注那些不太可能获得服务的人群。 转介和预约 转介和预约是轮椅服务的第一步。 步骤 概要 1.转介和预约 轮椅使用者的转介方式各不相同。使用者可以自 己求助,或通过社区、地区以及一级政府或非政 府单位组成的网络中工作的卫生和康复工作者或 志愿者进行转介。如果某些潜在的轮椅使用者以 前没有接受过任何社区服务、卫生保健服务或参 加过学校、工作单位、社区的活动,则轮椅服务 机构需要积极地对他们进行识别。 高效的转介要求轮椅服务机构和社区之间保持良好沟通,因为进行识别和转介的正是社区人员。 识别轮椅使用者并进行转介的个人和组织可以是: ●当地医院; ●社区健康服务中心; ●社区康复服务机构; ●地方政府的领导; ●残疾人组织; ●其他轮椅使用者; ●医生/护士。 17 建立转介网络管理者需要做什么 ●确定所在地区的转介来源 (个人或者组织)。 ●与轮椅服务人员讨论,识别轮椅使用者时转介来源需要哪些信息,以及如何完成转介。 ●准备或协助服务人员准备讲义、小册子,提供转介来源所需要的信息。 ●拜访或协助服务人员拜访潜在的转介个人或转介组织,探讨轮椅服务事宜。 ●为轮椅使用者和转介来源举办一个开放日。 ●为转介来源提供转介网络培训。 ●考虑制定转介来源可以自行完成的转介表格。表格一定要简单,确保服务和转介一致 (为转介来 的轮椅使用者提供预约);另外,还要向使用该表格的转介来源积极提供反馈。 提高服务的公平性 管理者在提高服务的公平方面发挥重要的作用。下面的表格就如何提高不同群体对服务的获得提 出了一些建议。 为提高服务的公平性,管理者可以做些什么 妇女和女孩 ●确保可以通过不同的方式获得服务信息,比如广播、简单的文字手册或海报 以及视觉图像。 ●确保女性同男性一样,也能出现在服务宣传图片中。 ●找到女性轮椅使用者的模范代表,可以在公开场合或社区向女性轮椅使用者 讲解轮椅的重要性。 ●向社区领导讲清楚,轮椅对妇女、儿童以及男性同样重要。 ●支持并鼓励妇女参与各级轮椅服务,也包括管理和领导岗位。 ●向残疾人组织提供轮椅服务的信息,并强调女性和男性为克服移动障碍,同 样需要轮椅。 ●谈到轮椅服务时,要具体提到为成年人和儿童服务,而不只是笼统地说为 “人们”服务。 18 续表 为提高服务的公平性,管理者可以做些什么 儿童 ●确保残疾儿童的父母在他们可能去的地方能获得相关的服务信息,例如,社 区卫生诊所、康复服务机构、社区中心、基督教堂、清真寺和寺庙等。 ●谈到轮椅服务时,要具体提到为成年人和儿童服务,而不只是笼统地说为 “人们”服务。 ●为那些治疗残疾儿童的人员提供服务信息和教育机会,比如医生、护士、社 区卫生工作者等。 ●保证在宣传中,跟成年人一样,儿童的形象也要有所体现。 ●不管什么时候谈到轮椅服务,都要讲清楚儿童在早期使用轮椅所带来的好处, 以及向残疾儿童的看护者或者家人说明使用轮椅的好处。 穷人 ●确保服务工作尽可能做到节约成本。 ●对那些无法支付去轮椅服务机构的交通费或无法支付轮椅费用的轮椅使用者, 找到为他们提供经费支持的方式。比如,建立轮椅基金。 老年人 ●谈及轮椅服务时,应该说为所有人服务,这其中也包括 “老年人”。 ●服务宣传过程中涵盖老年人使用轮椅的照片。 ●谈及轮椅服务时,说清楚轮椅为老年人及其家人带来的好处。 居住地离服务机构 很远的人,比如住 在农村地区的人 ●确保农村地区可以获得相关服务信息,例如农村卫生诊所、集市、社区中心、 基督教堂、清真寺和寺庙等。 ●向那些服务于农村地区的人提供服务信息,比如社区康复工作者。 ●如果服务机构不提供社区服务,找到协助农村轮椅使用者往来的方式。例如: 交通补贴,可以和其他机构合作为人们提供交通帮助。 ●了解是否有可能为农村地区的轮椅使用者提供住宿。 ●为农村地区提供社区服务。 ●培训农村地区的工作人员 (例如社区卫生工作者),学习如何为社区的轮椅使 用者服务,如何进行随访,如何帮助他们对轮椅进行简单的保养和维修。 ●确保可获得的轮椅可以在农村崎岖的地形条件下依然正常使用,提供简单调 整轮椅的方法 (比如斜坡道路或平坦道路),以更好地在农村地区使用轮椅。 19 续表 为提高服务的公平性,管理者可以做些什么 来自不同民族或 社会经济背景的人 ●谈及轮椅服务时应该说为 “所有人”服务,不管民族背景如何、不管社会经 济背景如何。 ●服务宣传过程中,要涵盖该服务地区不同民族、不同宗教所有人群的照片。 ●在可能的情况下,也可以雇佣不同民族和不同社会经济背景的人到服务团 队中。 B.2:设施和设备 轮椅服务可以在很多地方进行。但是不管在哪里进行,都需要一定的设施和设备。比起中级服务, 初级服务需要更少的场地和设备。 所有轮椅服务 (初级服务和中级服务)需要的设施和设备 接待和候诊区域 需要什么样的空间? 首先必须有一个候诊区,轮椅使用者和他们的家人可 以在此等候。 对于那些能够去服务区接受服务的人,他们应该希望 可以用些茶点。如右图所示,当地的商人在卫生诊所 外经营一个茶点摊位。 轮椅使用者还需要一个可以躺下来候诊的安静区域。 这对于以下几类人群尤其重要: ●比较虚弱、脆弱,在预约期间需要休息的人; ●疲惫的儿童; ●身体负重部位有压疮的人。 20 续表 接待和候诊区域 无障碍卫生间一定要靠近接待和候诊区,同时也要靠 近评定和适配区。 更多相关信息,请参阅 《轮椅服务管理者教程———附 加资源手册》。 推荐设备: 接诊设备包括:桌子或书桌、椅子、电话、安全存 储区。 候诊区可以配置相关的海报、宣传单以及视频资料 等。如果服务人员预见到该服务区有大量的儿童,那 么准备一些简单的玩具将有助于服务的开展。 人员办公区 需要什么样的空间? 服务人员需要可以正常工作、一起会谈、记录要点并 安全储存相关记录的区域。 21 续表 评定和适配区 需要什么样的空间? 首先需要一个相对安全和隐私的空间,以保证服务人 员可以对轮椅使用者进行评定,相关轮椅适配工作可 以正常进行。 评估适配区要确保轮椅畅行,为陪同家属留出足够的 空间,还要确保有足够的采光。 还需要选取一面干净可用的墙用作投放评定结果和所 有照片的背景墙。 机构服务中,评估适配区的面积大小,建议如下 (根 据工作量而不同): ●初级临床区:3m×2.5m ●中级临床区:4m×3.5m 有时候,从某种意义上来说,诊所就是一个人的家。 所以重点强调灵活性、适应性,以及配备必需的 设备。 设备: ●屏风———如果同一时段内有多位患者,那么窗帘或 者屏风可以分割区域以保护隐私。 ●评定台或检查床——— 稳固的结构,与轮椅相同高度 且在评定时可以坐在上面。评定台或者检查床的表 面应该有软垫,这样可以保护皮肤,例如EVA材 质或一块运动垫或者瑜伽垫。摆放好检查床以便于 评定者从前面或后面进行评估。 22 续表 评定和适配区 ●足垫块——— 一套不同高度的足垫块用于支撑使用者 的双脚。 ●更多相关信息,请参阅 《轮椅服务管理者教程——— 附加资源手册》。 ●相机——— 有助于记录评定和适配阶段的关键步骤 (前提是轮椅使用者同意拍照)。 ●卷尺或卡尺。 轮椅准备、保养和维修区 需要什么样的空间? 需要一个技术区,用于: ●装配、维修和保养轮椅; ●必要时进行改制。 空间要求具备良好的照明和通风条件,以及适宜的工 作温度,另外要求能够防水。 不管是手工工具还是电动工具,安全都是最重要的。 最理想的是能够把这些工具放置在上锁的金属柜里。 在固定的服务机构,技术区域可划分为: ●清洁区:用于最终的组件安装、产品调试以及安全检查。这个区域还要留出地面空间和台面空间。 ●制造区:用于改制和维修,比如黏合和加工泡沫塑料、普通钻削、砂纸打磨、锉和上油漆。这个 区域同样需要地面空间和台面空间。 并不是所有的技术工作都需要在服务机构自己的技术区内完成。轮椅服务机构可以把部分技术工作 外包出去,比如,垫套缝纫工作可以外包给当地的裁缝;焊接工作可以外包给当地的焊接车间。 23 续表 轮椅准备、保养和维修区 设备: ●配备足够的橱柜、货架和工具板,用以保持区域整洁,同时优化地面空间的使用。 ●轮椅装配、调试和改制工具。 ●改制材料清单。 ●每位技术工人至少有一个工作台。如果服务团队中有轮椅使用者,那么最好保证至少有一个可以 调整高度的工作台。摆放工作台以保证服务人员在轮椅使用者的前方和后方都有足够的空间。 关于工具、材料和设备更多的信息,可以参考 《轮椅服务管理者教程———附加资源手册》。 (备注:轮椅制造车间所需要的设施和设备还有很多,但不在本手册范围之内)。 储存区 需要什么样的空间? 配置安全储存区,用以存放需要的轮椅、零部件和各 种材料。储存区应当保证安全、防水,靠近技术区, 远离动物或宠物。窗户上安装金属防护栏可以增加安 全保障。 如果不可能专门设置一个房间作储存区,那就在房间 内划定一片区域用作储存区。如果这样,需要格外注 意安全。 建立储存区: 以下建议有助于建立一个有序的储存区。 ●货架和支架有助于最大限度地利用空间。 ●货架、支架、箱子以及组装轮椅之间的通道有助于提高服务效率,因此,通道应该保持畅通。 ●按照物品的类型和大小,将相同的物品放在一起,可以更方便地记录库存和仓库控制。 ●螺丝、螺母、垫圈等小物件可存放在小箱子里,大小相同的同类物品放在同一个箱子里,并在箱 子前面标记物件的名称。 ●存储箱和材料不能直接放置在地板上或者靠在外墙上,因为它们很容易受潮。所以可以用托盘, 将它们远离地面。 ●如果有窗户,还需要增加防护网,以保障安全。 24 续表 使用者训练区 需要什么样的空间? 使用者训练区可以进行以下教学: ●转移与健康教育; ●轮椅操作、保养和维护; ●移动技能。 转移与健康教育的地点可以是诊所,可以是患者家 里,也可以是社区服务点。 设备: ●像床这一类基础设备,对练习转移很有帮助。 轮椅操作、维护和保养培训,可以在一个洁净的区域 或者其他适合的地方进行。 设备: ●基本的轮椅保养设备是必不可少的。 移动技能培训通常在户外进行,当然,在室内也 可以。 户外专用的移动技巧区可以模拟轮椅使用者在日常生活 中可能遇到各种不同的路面情况,比如粗糙路面、松软 路面、排水沟、减速带、路缘、台阶以及楼梯等。 在综合服务机构,其他移动障碍的人也可以使用移动 技能区。例如,学习使用假肢或者在受伤后恢复行走 能力的人。 25 续表 使用者训练区 如果没有空间用于开辟专门的移动技能区,那么确保 有可以用于移动技能培训的安全区域。 避开很多人来来往往的区域,找一些不同类型的 障碍。 可以制作便携式移动技能训练设备,并放在轮椅服务 的场所。 右图所示是在遮阳篷下安装的便携式移动技能设备。 更多相关信息,请参阅 《轮椅服务管理者教程———附 加资源手册》。 中级服务需要的其他设施和设备 中级轮椅服务需要一些其他的空间和设备。管理者需要考虑到以下其他需求: 评定和适配区 中级服务评定期间,轮椅使用者需要检查床卧躺。 更多相关信息,请参阅 《轮椅服务管理者教程———附 加资源手册》。 对于中级服务来说,专门的检查凳是非常有帮助的。 检查凳可以在用手模拟过程中,提供可调整的脚 支撑。 26 续表 更多相关信息,请参阅 《轮椅服务管理者教程———附 加资源手册》。 ●评定和适配过程中,用于临时支撑的硬泡沫块需要 触手可及。另外,地面上需要放置一块擦拭干净的 垫子以及坐垫。 ●一面全身镜对轮椅使用者和服务人员来说都很有帮 助,服务人员可以从不同的角度观察轮椅使用者的 体位并进行调整。 ●适当的玩具和墙上的图片有利于创造一个对儿童友 好的环境。 储存 中级服务过程中,需要更大的空间存放改制材料、体 位支撑组件。包括泡沫塑料板在内的这些材料,需要 平放,且保持干燥。 因此,需要更多的储存空间和储物架。 轮椅准备、保养和维修区 清洁区和工业缝纫机使服务机构能够修改装饰面料或 制作体位支撑部件和绑带。如果没有这些空间和设 备,那么就需要把这些工作外包出去。 空间组织 设施和设备到位后,管理者应当按照以下4个步骤为每个设施分配责任: 1.清除杂物:清除所有不必要的工具、零件、设备、过期的文件等。 2.确定定期常用物品:工具、零件、说明书和文件。日常使用的物品应放好,便于快速找到。 3.制度和责任:为每个工作区建立制度,并有人负责执行该制度。 4.监督:制度确保调整固定下来。 27 B.3:适用轮椅的范围 什么是适用的轮椅和坐垫 轮椅使用者的需求虽然各不相同,但他们都需要适用的轮椅和坐垫。《资源有限地区手动轮椅服务 指南》对适用轮椅的定义如下: ●满足使用者的需求以及环境状况; ●提供适配和体位支撑; ●安全耐用; ●国内可以获得; ●在国内能够以最经济实惠的价格购买和维修,并可以接受持续的服务。 为了满足轮椅使用者获取轮椅服务的需求,服务人员需要提供至少几种不同类型的轮椅和坐垫。 最适合使用者的坐垫类型取决于他们的需求。 然而,任何有发生压疮风险的人都需要减压坐垫和培训如何使用。 没有使用正确的辅具以及使用者培训的成本 在发达国家,25~34岁之间受伤的群体,其平均寿命是受伤后38年⑧。相比之下,孟加拉国的一项 研究表明:脊髓损伤后的平均寿命为5.36年,56.4%的人在受伤后5年内死亡⑨。参与研究的样本 人群中,80%的人死在家中,而这些在家死亡的人中,1/3的人死亡时患有压疮。 斯里兰卡的一家康复医院于1999年在脊髓损伤科进行了医疗成本调查。当时,治疗压疮大约需要6 周的时间,费用是286美元;而治疗深度压疮大约需要1年的时间,费用约为2483美元。同样的调 查表明,使用正确的轮椅、坐垫和床垫,以及充分的病患教育,有助于住院期间压疮发生概率下降 70%,照料费用下降60%。 巴西圣保罗某医院推出了一项服务,重点关注教育以减少脊髓受伤人们的二次并发症。压疮发生概 率下降了23%⑩。 28 选择一系列适用的轮椅和坐垫 提供适配和体位支撑 轮椅使用者需要适合他们的轮椅。而不适合的轮椅会让他们觉得不舒 适,而且难以为他们提供良好的体位支撑,甚至还会给他们带来损伤。这 意味着,轮椅服务需要很多大小不等的轮椅,或者是尺寸可调整的轮椅。 大多数轮椅使用者要在轮椅上坐很长时间,这就意味着轮椅不只是一个移动辅具,它还需要支撑 使用者舒适地坐直。人们有不同的体位支撑需求,因此,需要不同支撑类型的轮椅。 需要初级体位支撑的人们要求适配良好的轮椅。 需要中级体位支撑的人们要求适配良好、带有附加支撑的轮椅。关于 附加支撑,可以通过给轮椅增加附加体位支撑的方式,也可以通过提供专 门的支撑座椅的方式。 29 轮椅不合适或缺乏正确支撑的成本 南非西开普康复中心的工作人员记录了在学校和康复中心接受观察的一组儿童的并发症数据,这群 儿童需要带有体位支撑的轮椅,但是他们现有的轮椅并没有体位支撑。记录数据显示,其中21%的 孩子们出现了附加体位并发症。出现这些并发症之后,对于孩子、家长以及整个轮椅服务,需要付 出的代价是: ●并发症增多,预约接受医疗服务时间增多; ●健康状况变差; ●不良姿势和不舒适; ●低的座位耐受性 (不能长时间坐); ●参与教育的机会减少; ●生活质量降低。 满足使用者的需求以及环境状况 适用的轮椅应让轮椅使用者更容易地完成他们想做的事情。轮椅使用者需要能够上下轮椅、推轮 椅、折叠轮椅以便于运输、存储和进行日常活动。有了适用的轮椅,使用者就能够更轻松地做所有这 些事情。 轮椅使用者需要一辆能在他们所处环境中使用良好的轮椅。不同的轮椅适用于不同的环境。比如, 有些轮椅更适用于室内,而有些则更适用于户外以及崎岖的地形。 废弃的设备:一无是处? 设备如果不能满足使用者需求,往往会被丢弃。 右图反映了一个普遍的问题。 右图中的轮椅使用者有三辆捐赠的轮椅,但是没有一 辆满足他的需求。他还是走不出自己的房间。前两辆 轮椅不能用,是因为坏掉了而且没有备用零件。第三 辆虽然是新的,但是质量较差,摇摇晃晃,让使用者 没有安全感。 30 安全耐用 轮椅使用者想要安全耐用的产品,而且维修费用能够在他们的承受范围之内。确保轮椅安全耐用 并且可以在当地维修,有助于减少轮椅更换成本,简化轮椅维修工作,总体有利于轮椅服务工作的 进行。 资源有限地区的很多轮椅使用者需要借助轮椅通过一些崎岖的路,还会在雨里、沙里、泥地里使 用轮椅。所以,他们的轮椅必须要耐用,能适应以上这些情况。质量差的轮椅可能很快就会坏掉 (也 许1~6个月),而保养得好、设计得好的轮椅能用3~5年,这就是物有所值。 质量差轮椅的一些常见问题 ●质量差的座椅套和靠背套会裂开或者凹陷; ●小脚轮 (车轴、轮胎、轴承、轮叉)损坏; ●后轮 (车轴、手推圈、辐条、轴承、轮胎)断裂或磨损; ●刹车生锈或失灵; ●脚踏板毁坏; ●要么没有坐垫,要么坐垫质量较差或者很快就坏掉; ●可拆卸零件丢失。 管理者职责 轮椅服务管理者在采购和接收捐赠轮椅的过程中发挥着重要的作用。更多相关信息,请参阅 《轮 椅服务管理者教程———附加资源手册》。 管理者的作用在于确保: ●服务中选择的轮椅和坐垫能够或尽可能地满足轮椅使用者的不同需求。包括要考虑不同的尺寸 范围、体位支撑、环境和生活需求。 ●选择的轮椅要耐用,尤其是在崎岖不平或者粗糙的路面环境下。 ●轮椅可以在当地维修。确保能在当地获得零件或有人捐赠,或者能在当地很容易买到。 积极收集轮椅使用者对轮椅服务的反馈信息是非常重要的。管理人员和服务人员一般通过家访、 小组会议或残疾人组织与轮椅使用者进行沟通交流。 首次引进一款新型轮椅或坐垫时,轮椅服务机构可能会选择让一组轮椅使用者在一段时间内试用 新产品并提供反馈,然后通过个别访谈或者目标群体获得反馈信息。 31 管理者如何确保他们采购或接收的轮椅耐用以及能够维修? 管理者可以通过询问供应商或者捐赠者来了解更多的信息。比如,管理者可以问: ●轮椅通过标准认证 (如由专业机构设立的性能测试和质量测试)了吗? 如果认证过,那么结果 如何? ●供应商能否明确给出轮椅的寿命? ●供应商有没有缺陷报告制度? ●还有谁购买和使用了相同的轮椅? 是否可以与其他购买轮椅的服务机构取得联系,进而了解更多 关于这款轮椅的使用情况。 ●组装或调试轮椅需要哪些工具? ●提供备用零件吗? 这些零件需要到海外采购吗? 可能会用到的部分零件在国内有现成的吗? ●在全国范围内试验过吗? 如果试验过,反馈结果如何? ●如果框架损坏,可以在当地维修吗? ●轮椅上附带维修指南吗? 轮椅保养、维修和随访 轮椅服务的第8个步骤是保养、维修和随访。 保养、维修 和随访 随访预约是检查轮椅适配情况并提供进一步培训和支持的一 个机会。随访的时间取决于使用者的需求和他们是否还可以 得到其他形式的服务。对于不能在社区解决的技术问题,轮 椅服务机构应提供保养和维修服务。 该步骤的主要内容是教会轮椅使用者和他们的家人怎样保养 轮椅。在家中进行定期保养,有助于确保轮椅使用时间更长,而 且可以减少大修。 32 轮椅服务机构还可以培训合作伙伴以提供保养和维修服务,并找到社区里 (如自行车维修店)可 以进行保养和维修的资源。 B.4:人员配置 轮椅服务中的职责 轮椅服务通常由一个团队来完成。团队中不同的成员发挥不同的作用,比如临床、技术、培训、 行政和管理。 不同的人可以承担一项或多项职责,例如,临床人员也可以负责管理事务。很多情况下,来自不 同组织的个人可以一起工作,同时履行不同的职责。 下面的表格显示了在轮椅服务中,服务人员是如何通过不同的活动履行不同的职责。 临床 技术 培训轮椅使用者 行政 管理 服务管理与发展 提升服务 √ √ √ √ √ 寻找资金 √ 发展转介来源 √ √ √ √ 联络其他机构 √ √ √ √ √ 服务评价 √ √ √ √ √ 提供服务的关键步骤 1.转介和预约 √ √ √ √ 2.评定 √ √ √ 3.处方 √ √ √ 4.经费和订购 √ √ √ √ 5.产品 (轮椅)准备 √ 6.适配 √ √ 7.使用者培训 √ √ √ 8.保养、维修和随访 √ √ √ 33 续表 临床 技术 培训轮椅使用者 行政 管理 培训与专业发展 培训转介网络人员 √ √ √ 培训社区服务人员 √ √ √ 培训服务人员 √ √ √ 培训 不同教育背景、专业背景的人都可以承担服务任务,前提是接受过适当的培训。但有一点很重要, 负责临床、技术和培训的人员本身必须是接受过培训的。 ●负责提供初级服务的临床和技术人员应在接受培训后,达到世界卫生组织 《轮椅服务初级教程》 的水平要求。 ●负责提供中级服务的临床和技术人员应在接受培训后,达到世界卫生组织 《轮椅服务中级教程》 的水平要求。 记住:对人员进行技能培训时,最好同时培训两个人。如果只培训一个人,服务会比较脆弱,因为 这位受训者一旦离开,他所拥有的知识和经验也就被带走了。 规划服务能力 管理者需要根据每月、每年可服务的轮椅使用者数量规划他们的服务。这称之为 “服务能力”。 服务能力包括: ●首次获得轮椅的使用者数量; ●随访的轮椅使用者数量。 与服务能力有直接联系的是: ●可提供轮椅服务的人员数量; ●可提供轮椅服务的人员时间; ●可采购的轮椅数量———相应的,也直接与预算相关。 34 统计人员时间 为了估算服务能力,管理者需要计算服务人员在轮椅服务上花费的时间。要统计这个,管理者需 要知道: ●每年工作周数 (扣除公共假期和年假); ●人员在轮椅服务上花费的时间比例 (不包括其他职责、角色或活动)。 管理者也应该考虑他们在不同服务步骤上花的时间。这受到很多不同因素的影响。比如,服务人 员是新人还是有经验的;提供的轮椅是否需要改制。但是,一个有经验的团队 (临床人员和技术人员) 可以: ●每天服务两名初级轮椅使用者,或者 ●每天服务一名中级轮椅使用者。 下面的表格显示了两人团队的预期服务能力。团队中一人负责临床,另一人负责技术,两人都可 以培训使用者。团队每周工作5天,每年工作42周。如果有足够的轮椅和材料,这个团队可以: ●每年服务大约357名初级轮椅使用者,或者 ●每年服务大约179名中级轮椅使用者。 初级服务 中级服务 计划工作周 工作日/周 5 5 工作周/年 (扣除节假日和休假) 42 42 预计服务能力 服务使用者数量/天 2 1 服务使用者数量/周 10 5 服务使用者数量/年 420 210 应急 @15% (意外事件) -63 -31 预计使用者数/年 357 179 35 管理者在建立或发展轮椅服务团队中的职责 ●确定现有人员或新人在轮椅服务中承担不同的职责。 ●为那些没有必备技能的人员安排培训。 ●确定服务人员可以用于轮椅服务的时间,确保这个时间根据他们承担的其他职责、角色或活动是 实事求是的。 ●预计年度服务能力,并与团队沟通。 ●支持服务人员在服务过程中承担他们的职责。比如: ○让服务人员参与规划服务; ○建立周/月度规划工具,显示预约和其他活动。 ○召开周例会来检查进度、肯定成功、应对挑战。 B.5:轮椅服务的成本 对管理者来说,确定轮椅服务的成本,是非常重要的。下面的表格显示与建立和运营轮椅服务有 关的一些常见预算项目。实际成本会根据具体情况有所变化。 预算项目 备 注 启动成本 产品设计 采购一系列的产品 工具 设备 建筑或设施 包括建筑、装修、翻新。 材料仓储 运营成本 轮椅 轮椅库存———基于轮椅使用者的预期需求和预计服务能力。 零件 保持常用零件的一定库存量是非常有用的。 36 续表 预算项目 备 注 材料 初级服务需要一些改制材料,而中级服务需要更多的改制材料。 货运 (产品运输) 进口轮椅的航运费用和海关费用。把轮椅运达其他服务中心的费用。 人员 管理人员 临床人员 技术人员 培训师 行政人员 虽然预算项目中列出了大量的潜在人员,但并不是每项服务都需要这 些人员。 画钩 (见电子表格)表示与服务步骤有关的活动。一名员工可以同时 承担多项职责。 当地运输 服务人员本地交通费 例如:随访、社区服务、培训转介网络。 服务对象本地交通费 到机构接受服务的交通。 服务对象住宿费 为需要留宿的服务对象提供住宿费 (如果服务中包括或者支持该费 用)。 材料印刷 表格、清单和使用者信息。 易耗品 例如,胶水、线和油漆。 工具更换 工具磨损,因此需要列出工具更换的资金预算。 日常管理 不同服务领域 (临床、技术、存储、使用者培训和办公室)都要考虑 水、电、房租。 人员培训 考虑服务人员的培训成本。 培训合作伙伴或转介网络 考虑对合作伙伴或者转介网络机构进行的培训、认识活动。 筹款 所有筹款活动的成本都应该列入预算。 监督和评价 监督和评价产生的成本费,比如拜访使用者收集反馈信息,可能还包 括差旅费和额外的人员费用。 37 成本效益的解决方案 资源有限地区的管理者需要想方设法减少成本。可以降低成本的方法如下: 综合服务 ●与独立服务相比,综合服务能够共享设施、分担成本。 与其他机构一起分担成本 轮椅服务机构可以与其他机构合作,共同分担成本。比如: ●有些国际援助、发展组织可能对承担轮椅成本感兴趣。服务中心的优势是产品更实惠。而国际 组织的优势在于,他们的资金可以发挥更大的作用,他们看到服务中心正在展示其实现财务可 持续的能力。 ●当地社区组织可能愿意与轮椅服务机构合作,并提供更多的当地服务。社区合作伙伴可以提供 设施,一些人员可以承担部分服务工作,比如随访、使用者培训。对于轮椅使用者来说,其优 势在于可以减少出行和成本。而对于服务中心来说,其好处在于他们的服务可以延伸至社区。 潜在的资金来源 关于如何获得轮椅服务启动和运营资金的更多信息,将在 “C.4:规划财务的可持续性”中进一 步讨论。 38 C:运营轮椅服务 C.1:如何确定轮椅服务是否有效 监督和评价有助于管理者知晓他们服务的结果,也有助于管理者和他们的团队了解他们的工作进 展,以及他们的服务对象和利益相关者的想法。 什么是监督和评价 监督 评价 何时完成 ●持续性 ●融入日常服务活动 ●一般在服务的关键阶段,比如年度审查期 间 (虽然有些信息需要持续不断地收集) 衡量对象是什么 ●服务活动 ●使用的轮椅和附加支撑 ●受益人数与人口 ●对个人和社区的影响 ●可持续性 使用什么信息来源 ●使用者数据 ●服务记录 ●服务数据 ●使用者反馈 ●财务报告 ●员工时间分析 ●调查表 ●问卷调查 ●小组讨论 ●上门拜访 ●服务实践中的观察 ●审查账目 39 有效和高效的服务 对于参与服务的管理者和其他人,监督和评价有何作用 ●提供重要信息以提高服务质量。 ●提供信息指导产品采购。 ●帮助控制成本,需要提高效率和证明当前和建议的资金是合理的。 ●让服务机构用高效的服务向投资者展示,包括政府和非政府捐赠者。 ●帮助识别和量化未满足的需求。 ●了解资源的适当分配。 ●提高服务效益意识。 ●与服务接受者建立更紧密的合作关系。 当计划如何监督和评价服务时,创建一个三步框架是非常有帮助的。进一步的细节可以参考 《资 源有限地区手动轮椅服务指南》的表3.5。 1.规划监督的范围 2.设置绩效目标 3.确定收集信息的方法 对收集的信息和数据进行分析时,有两个方面需要重点考虑: ●某项活动进行得不顺利时,可以与使用者、服务人员以及其 他利益相关者一起找出问题的根本原因; 40 ●如果活动顺利、目标实现,可以通过适当的方式分享和庆祝 成功。这对服务团队和其他利益相关者来说也是一种激励。 使用者反馈的重要性 评价让服务机构思考,哪些工作正在有序进行,哪些工作还需要改进。也可以让服务机构思考是 否实现了整体目标。 《资源有限地区手动轮椅服务指南》中描述的目标如下: ●尽可能独立地提高个人移动能力; ●通过改善轮椅获得性来提高生活质量; ●提高包容性和参与性。 一些标准用于评价服务,比如: ●服务的使用者以及他们获得的干预程度; ●服务成本,包括产品费用和服务过程中产生的费用; ●人员 (员工数量,他们的职责和能力); ●提供服务的设施和设备; ●服务的质量 (好的实践建议,详见 《资源有限地区手动轮椅服务指南》的3.3部分); ●服务对使用者和家庭产生的影响。 让轮椅使用者参与轮椅服务的评价是非常重要的。当规划使用 者反馈时,可以重点考虑以下几个方面: ●运费和时间是最重要的两项成本。轮椅使用者反馈信息时, 可能需要获得差旅费用或时间上的支持。 ●使用者反馈信息可以定期收集,也可以每年或每月随机选择 收集。 ●如果轮椅使用者在反馈信息时能够坦诚相待,那么轮椅服务 一定会从中受益。让没有直接参与轮椅服务的人员进行面谈 对反馈是有益的。 41 埃塞俄比亚服务效益评价案例 两名地区工作人员采访了埃塞俄比亚全国各地7个服务中心的140名轮椅使用者。这两名地区工作 人员都是移动障碍者,这恰好有利于推动他们发挥自身的职责。 这两名地区工作人员很了解国内轮椅使用者面临的问题。他们获得授权后,积极倡导轮椅使用者的 需求和权利。由正能量榜样进行的面谈,使轮椅使用者在精神上和心理上获得了双重慰藉。 面谈评价后,会形成一个非正式的网络,进而在服务提供者和使用者之间建立更紧密的联系。此外, 通过评价了解到,某些情况下轮椅使用者获得的轮椅并不符合他们的需求。这个问题可以追溯到服 务中的培训需求环节,服务机构已经做了妥善处理。 基础信息对评价的重要影响 为了观察服务对轮椅使用者产生的影响,很重要的一点是要在任何干预之前,也就是在评定之前, 记录好个人情况。 收集基础信息的可能机会: ●进行转介时———通过转介中心或诊所的工作人员; ●转介与评定期间———通过家访或通过电话; ●评定时———在评定之前。 更多相关信息,请参阅 《轮椅服务管理者教程———附加资源手册》。 进行面谈收集使用者信息时,很重要的一点是要安排好采访的人。这是为了确保每个问题都能获 得清楚且完整的答案。这一点,对于获得有效数据来说,非常重要。 面谈技巧的建议 准备: ●面谈前练习要说的话,不说不必要的话。 技巧: ●读一遍问题清单; ●不要向回答者暗示答案,即使是非常隐蔽的; ●如果你需要作出解释,请保持中立的态度; ●准确记录他们的答案。 42 续表 面谈技巧的建议 尊重他人: ●除非当事人自愿接受采访,否则不要强行进行; ●帮助制造轻松气氛; ●不要对他人的讲话表现出过于震惊、高兴或不高兴。 ●对他人的回答信息保密。 建立良好的使用者基础信息制度将有助于提高轮椅服务质量,同时,反过来也可以反映轮椅服务 对使用者生活质量产生的影响。 方式如下: ●作为随访的例行环节; ●作为单独活动。 评价对儿童的影响 在可能的情况下:让孩子们反馈轮椅和轮椅服务的感受,也是非常重要的。举个例子,就是使用 “情绪骰子”􀃊􀁉􀁓。首先,把孩子的情绪进行归类,然后,请他们完成以下陈述,比如:“……时,我很高 兴”;“……时,我很难过。” 生气 难过 伤心 尴尬 兴奋 高兴 记录和处理数据 监督和评价,包括记录、收集、存储和处理信息 (数据)。有效的数据记录可以节省时间和金钱。 比较理想的是,直接把数据输入数据库,然后再进行数据处理,为轮椅服务创建最有用的报告。不管 是在实地考察时还是在服务中心,记录数据时带一个便携式平板电脑都是非常有用的。另外,移动互 联网技术正在迅速发展,可能也是一种输入、发送和收集信息的好方法。 43 创建服务计划 年度计划是对全年的监督,有助于保证服务的有效性和高效性。记得让相关人员参与到计划和目 标任务中,这样可以激励、参与和动员全体员工。服务计划还可以包括年底评价。下面是一个服务计 划框架示例。 服务计划框架 确定监督的 需求或问题 解决需求或问题 的行动或措施 目标 信息收集 在过去的一年里,接 受轮椅服务的女性数 量远小于男性。 (女 性20%,男性80%) 通过以下方式增加对 女性使用者的识别和 转介: ●与转介来源进行会 谈,转介来源包括 能够识别女性使用 者的村民代表。 ●与国家残疾人组织 合作找到女性使用 者模范,通过这些 模范鼓励女性轮椅 使用 者 参 与 轮 椅 服务。 提高女性接受轮椅服 务的比例,至少提高 到40%。 保持轮椅使用者数据更新,因 为这可以确定分别有多少男性 和多少女性正在接受服务。 C.2:管理需求 运营轮椅服务时,为了能提供适当的服务,使用者需求和服务能力之间需要达到某种平衡。 创造需求 服务需求数量预计是轮椅服务当地人口的1%。但是,人们如果没有认识到服务及其好处,或者 不能获得服务,那么需求数量可能低于实际的需要。 44 服务需求较少时,每位使用者的服务成本 就会上升,并且对财务的可持续性非常不利。 管理者的职责就是弄清楚为什么转介这么少。其原因可能是: ●服务机构还没有找到最合适的转介来源; ●需要轮椅的人并不知晓转介来源; ●转介网络培训并不能使人们了解轮椅服务的好处和重要性; ●由于服务机构离他们住的地方太远或者是交通不便,轮椅使用者无法到达服务机构。 转介较少的原因一旦确定后,管理者和他们的团队就可以努力创造需求。 管理需求 如果转介服务的人数超过了可以服务的数 量,那么可能会出现以下3种结果: ●服务人员会减少服务的时间,服务质量 也就有所下降; ●轮椅使用者等待预约的时间增加; ●很多轮椅使用者遭到拒绝。 不管是以上哪种情况,都会让使用者和服 务人员倍感沮丧。 因此,精心管理使用者需求是非常有用的。管理者最初应该设定较少的转介来源,从附近的使用 者开始。服务机构设立之初进行随访更容易,并具有额外的优势。从长远来看,大众媒体和国家免费 数字网络可能会产生大量的需求。如果没有服务网络,对使用者以及服务提供者的管理将会非常困难 和昂贵。 45 创建和管理候诊清单 当服务需求较多时,需要建立候诊清单。花点时间建立一个记录信息的数据库系统,可以实现成 本效益。该系统可以帮助管理者和服务人员更有效地访问信息、更方便地处理数据。个人一旦到达服 务机构,相关数据就会增加进来,比如评定日期、适配日期、随访预约日期等。 筛选转介和候诊清单 随着候诊清单上人数的增加,一些机构会筛选并优先选 择转介人员。以下几组人可以优先考虑: ●儿童———原因在于早期转诊的重要性以及儿童生长期 内发生姿势畸形风险的概率会越来越高; ●有发生压疮风险的轮椅使用者———原因在于压疮会危 及生命; ●有进行性疾病的轮椅使用者———原因在于紧迫性; ●由于没有轮椅或轮椅不适配正在经历痛苦的人。 数据库中有助于筛选和规划预约的一些关键字段包括: ●年龄; ●残疾类型; ●转介原因; ●地理位置。 服务能力 管理服务期望非常重要,而这取决于能够预见到的轮椅使用者数量以及提供轮椅服务的水平。 尽管中级服务和高级服务的需求总是不断,但不是每一项内容都能提供相应水平的服务。不过, 即使轮椅使用者出现了超出服务人员知识和技能、轮椅服务范围的需求时,仍然要有相应的服务人员 可以满足他们的需求。要做到这一点,管理者需要: ●确保宣传册或宣传单上的服务信息 (或者该服务能做到什么)清楚明确; ●联络其他服务提供者,弄清楚对于那些需求超出了服务能力的人,是否有可能进行转介或寻求 合作; ●记录那些不能满足的需求,同时计划提高服务人员的能力,增加可获得的轮椅。 46 儿童早期转介的重要性 很多需要轮椅的儿童,可能还需要附加的体位支撑。换句话说,很多儿童需要中级服务。对于儿 童来说,尽早转介是非常重要的,这可以预防或减缓姿势问题。 儿童的特殊需求和尽早转介的好处,在 《轮椅服务中级教程》中的儿童部分都有相关论述。儿童 尽早转介非常重要的原因在于: ●坐直困难的儿童如果没有得到良好的支撑,就会有姿势问题。如果儿童转介晚了,有些姿势问 题就会不可逆转。在这种情况下,即使给予支撑,儿童也很难舒适地坐着。 ●如果缺少坐和移动的经历,儿童的发育将会迟缓。 ●对于那些有行走能力的儿童,使用轮椅可以让他们的日常生活更容易,并且能够白天做更多的 事情。 不幸的是,儿童通常都不会尽早进行转介。对于父母而言,可能期望他们的孩子还可以治愈、还 可以继续行走。还有一些父母担心轮椅费用太高,又或者根本不了解轮椅服务。在某些情况下,父母 可能也觉得,一旦用了轮椅,他们的孩子就再也不可能正常走路了。 重要的是,服务团队要明确儿童尽早转介非常重要的原因是什么。服务人员需要消除父母和孩子 的顾虑,告诉他们,如果孩子确实有行走的可能,那么轮椅并不会降低儿童的行走能力。孩子在学习 如何行走的时候,通过轮椅来移动的经验,将在很多方面有益于儿童的发展。 成功案例:墨西哥父母的早期转介 这个案例介绍了墨西哥的儿童康复中心如何建立有效的早期转介网络。 虽然康复中心最初主要通过新生儿医生和儿科医生开展提高认识的宣传活动,但后来也开始进行年 度筹款活动,目的是通过广泛的媒体覆盖,包括广播和电视,在普通社区进行宣传。这产生了很好 的口碑,很多家长自己就会转介他们的孩子。 提高认识的宣传活动期间,康复中心有一个清晰的观念:孩子出生时转介至康复中心非常重要。他 们服务过的儿童在融合和成绩方面有很多正面的故事,他们用这些故事来宣传成功的强大愿景。经 过15年的发展,由于儿科医生和家庭都积极致力于早期转介,康复中心看到了文化意识层面的 转变。 转变的结果是:转介来源的1/3是3岁或者更小的儿童。 47 管理者如何在鼓励早期转介方面实现成功 ●信息明确,针对性强; ●目标清晰; ●对专业人士和家长采取不同的方法措施; ●分享成功案例,鼓励家长和成功人士转介; ●常年持续地提高认识。 运营有效和高效的服务 分析服务的有效性和高效性 服务一旦开始运营,分析每个步骤并观察每个服务步骤需要的时间是非常有用的。提高每个服务 步骤的效率应着眼于: ●鼓励团队合作; ●每个步骤实施前都提前规划和准备。 下面的表格对如何提高服务效率提出了一些建议。 提高每个轮椅服务步骤效率的不同方法 转介 ●为服务机构想要实现的需求层次制定清晰的目标。 ●服务对象信息要清晰。 ●确定一系列转介机构和需要提高认识的岗位。 ●密切监督转介的水平。 ●转介数量增加时,与服务人员和转介网络分享成功案例。 评定 ●为服务人员规划适当水平的培训。 ●加强社区合作伙伴能力建设,提供初级服务、转介需要中级服务的轮椅使 用者。 ●确保所有的评定设备都摆放到位。 48 续表 提高每个轮椅服务步骤效率的不同方法 处方 ●建立有效的仓储控制系统。 ●如果产品可调范围有限,那么必须对轮椅进行适当的改制以适应个人需求。 ●确保服务人员与轮椅使用者对处方方案进行讨论,如果可能,给予使用者产 品选择权。这可以避免使用者不接受处方方案。 ●加强社区合作伙伴能力建设,提供初级服务,转介需要中级服务的轮椅使 用者。 经费和订购 ●信息记录要清晰,并且保持记录的持续性。 ●建立有效的仓储控制系统。 产品 (轮椅)准备 ●获取可调性尽可能多的产品。 ●获取容易改制的产品。 ●预制体位支撑装置或获取带有体位支撑装置的产品。 ●获取快速调整产品的合适工具。 ●获取用于坐垫、体位支撑装置制作以及改制等合适的材料。 ●建立有效仓储控制系统。 ●准备少量不同大小的轮椅。 ●加强社区合作伙伴能力建设,提供初级服务,转介需要中级服务的轮椅使 用者。 适配 ●适配过程中,临床和技术人员通力合作。 ●提前准备好产品样品的设置选项。 ●获取可调性尽可能多的产品。 ●获取快速调整产品的合适工具。 ●获取容易改制的产品。 ●加强社区合作伙伴能力建设,提供初级服务、转介需要中级服务的轮椅使 用者。 49 续表 提高每个轮椅服务步骤效率的不同方法 使用者培训 ●给特定人员安排使用者培训,比如同侪培训者。 ●确定靠近临床和技术区的培训设备。 ●加强社区合作伙伴能力建设,提供初级服务,转介需要中级服务的轮椅使 用者。 随访 ●加强社区合作伙伴的能力建设,以随访社区的使用者,当发现的问题不能在 社区解决时,转介回服务机构。 总结 ●定期召开团队会议,制定共同的工作计划。 ●明确合作工作的时间进度。 ●信息记录要清晰,并且保持记录的持续性。 ●加强社区合作伙伴能力建设,提供初级服务,转介需要中级服务的轮椅使 用者。 从只有初级服务过渡到初级和中级服务 很多轮椅服务机构起初只提供初级服务。这是一个良好的开端,因为这样,服务机构可以致力于 建立8个步骤的服务系统,服务人员也获得很多工作经验。 然而,如上所述,很多轮椅服务机构将面临中级服务水平的需求。这并不令人惊讶,因为据估计, 35%的轮椅使用者需要初级服务,而65%的轮椅使用者需要中级或高级服务。 因此,管理者可能需要开始规划如何满足中级使用者的需求。正如上文中提到的,中级轮椅服务 要求: ●受过适当培训的人员。 ●更多的设施、设备和材料。 从初级服务过渡到中级服务,管理者需要考虑到的可能性策略包括: ●与服务人员共同确认,如何提供中级服务。考虑额外需要的设施设备,以及服务模式。 ●确定初级服务人员接受更多培训后,是否能够提供中级服务。如果可以,首先找到并培训初级 服务的更换人员,然后培训已经确定的中级服务人员。 ●如果你所在机构没办法确定人员或者没有足够经费支持更多人力,可以考虑是否有可能与其他 机构进行合作。 50 C.3:规划随访 随访是轮椅服务的第8个步骤。所有的轮椅使用者都受益于随访。对于轮椅服务,有计划地进行 随访是非常重要的。随访期间,服务机构也可以借此机会了解服务对使用者、家庭以及社区产生的 影响。 8. 保养、维修和 随访 随访是检查轮椅的适配情况并提供进一步培训和 支持的一个机会。随访的时间取决于使用者的需 求和他们是否还可以得到其他形式的服务。对于 不能在社区解决的技术问题,轮椅服务机构应提 供保养和维修服务。 随访的重要性 随访为什么重要的一些案例 杜丽:一位21岁的女孩,和她的家人一起生活。随访中,团队人员发现,她轮椅的轮胎被刺破而瘪 了,导致她无法使用轮椅外出。 轮椅早已经被遗弃在家里的角落。随访人员帮忙修补了轮胎,并给予了很多建议。杜丽能够再次离 开自己的家了。以往杜丽的家人并没有重视随访,直到他们体会到随访的好处。服务团队决定为所 有的轮椅张贴服务联系电话,以防未来再次出现这类问题。 玛丽亚:脊髓损伤9个月后收到一辆适用的轮椅。但是在随访中大家得知玛丽亚觉得不舒服,她曾 有过痉挛和抽搐,而她觉得正是因为这辆轮椅。后来发现,是轮椅装饰面料上滋生了臭虫,一直在 咬玛丽亚。这引发了健康并发症,导致了轮椅的弃用。不过好在问题发现后得到了及时处理,现在 轮椅上的玛丽亚很健康很快乐。 安东:社区里知名的橄榄球运动员。橄榄球运动受伤造成了脊髓损伤。他获得了一辆适用的轮椅以 及使用者培训,但在随访中却发现,他不能走出家门。安东的同侪培训者也是随访团队中的一员, 跟安东聊过之后发现,安东失去了自信,不想再见到他的朋友们。他因为 “残疾”而把自己隔离起 来,觉得很孤单很窘迫。同侪培训者次日再次来到安东家里,第一次带他从家里走了出来。从此之 后,安东的生活积极向上。 51 续表 随访为什么重要的一些案例 吉安:一位3岁的小男孩,与他的父母和兄弟住在一起。随访时发现,他的支撑椅座上满是食物, 而且轮椅也未曾做过保养。他父母说,吉安难以坐直,在轮椅上坐着总觉得不舒服。他们对轮椅失 去了信心,不喜欢用它了。吉安预约了由参加过中级服务培训团队的再次评定。服务人员修改轮椅 设置后,吉安能坐直而且能够四处张望探索周围的环境。对此,吉安和他的父母都非常高兴。当服 务人员演示如何保养和维护吉安的轮椅时,他们看得很仔细。 随访对使用者和服务带来的好处 ●服务人员可以确认轮椅是否满足了使用者需求。 ●家访和社区随访是收集使用者故事很好的机会,这些故事可以用于提供服务反馈和帮助筹款。 ●机构随访也是收集使用者故事,提供服务反馈,帮助筹款的好机会。 随访的目的和地点 随访是为了: ●收集轮椅使用者的反馈信息; ●检查轮椅是否处于良好的工作状态; ●检查轮椅的适配情况。 常见的随访措施 随访中一些常见的措施有: ●提供更多的建议或培训; ●重新调整轮椅; ●进行小型维修; ●如果需要,转介轮椅使用者至其他服务机构 寻求支持或帮助。 不管什么时候,随访都不应该变成新的评定,也不应该对轮椅进行全面翻新。如果有必要进行全 面评定或需要进行全面翻新,可以重新预约。 随访应该在哪里进行 随访可以在轮椅使用者家里、轮椅服务中心或者其他适合轮椅使用者及轮椅服务人员的地方。 不同地点进行随访的好处,详见下表。 52 在使用者家中或当地社区进行随访的好处 在服务中心进行随访的好处 ●对使用者和家庭来说,最节约成本。 ●服务人员更能够了解到使用者在家和社区中 面临的参与和融入障碍。 ●社区中看到随访人员的服务有助于提高社区 意识,从而进行转介。 ●对服务人员和服务机构来说,节约时间 和成本。 ●可通过完整的车间设施进行大型维修。 ●所有的设施和设备都是设置好的。 ●其他人员可提供不同意见。 计划随访 所有的轮椅使用者都将从随访中受益。不过,随访对于以下人群来说最为重要: ●残疾儿童; ●有发生压疮风险的轮椅使用者; ●有进行性疾病的轮椅使用者; ●轮椅上需要附加体位支撑的轮椅使用者 (中级服务); ●接受转移、移动、健康或轮椅保养等培 训有困难的轮椅使用者。 随访时间 何时应该进行随访没有明确的规定,因为随访的最佳时机取决于轮椅使用者的需要。 ●在轮椅交付后的6周之内对中级服务使用者进行随访是非常有用的,确保轮椅满足使用者需求。 ●对于儿童和进行性疾病的人来说,至少每6个月进行一次随访是比较理想的。这是因为随着儿 童的成长,他们的需求变化很快。 ●对于所有的使用者来说,如果能在接收轮椅之后的12个月之内完成随访,是比较理想的。 记住:首次规划服务时,应将随访列入服务模式中。社区的合作关系对提高随访服务能力至关重要。 53 如果社区合作关系没有建立,随访影响如下: 如果不做服务规划,随访很快会对新预约服务的数量产生影响。尤其是,第3年中级服务存在饱 和的风险。 其中一个解决方案就是,与社区机构合作,培训相关人员承担尽可能多的随访任务。社区人员可 以管理较为简单的随访任务,但是像重新评定、专业维修以及其他不能解决的问题,则需要进行转介。 积极的榜样 (比如移动障碍人士)承担这一管理者职责,可以有很多好处。 建立社区伙伴关系并规划服务模式 合作伙伴可能会支持转介和随 访,包括保养和维修。 合作伙伴可能也会支持使用者 培训。 根据合作伙伴的能力,他们可能 也会承担更大的服务责任。 54 克服随访障碍 虽然随访对服务使用者和服务提供者有很多好处,但是目前接受随访的使用者数量很少。为了克 服随访障碍、提高服务质量,找出接收使用者数量少的根本原因是非常重要的。 使用者参加社区随访服务可能存在的障碍 ●服务人员前往社区的费用; ●服务人员前往社区的时间; ●服务管理者没有优先安排随访服务; ●使用者只有在体会到好处之后才会重视随访服务。 使用者参加机构随访服务可能存在的障碍 ●一个或多个家庭成员耽误的工作时间、出行成本; ●使用者和家庭成员往往没有认识到随访的好处; ●难以找到无障碍的交通工具; ●注意力集中于服务机构新的预约,往往导致没有时间进行随访; ●难以计划预约:服务人员都在忙的时候,轮椅使用者出现了;或者,服务人员都不忙的时候,没 有轮椅使用者。 印度尼西亚随访方法的案例 印度尼西亚的轮椅服务项目不是直接收取轮椅的费用,而是通过收取会费,用以支撑服务、随访、 保养、维修和管理费用。会费可以赋予会员们优质服务和持续支持。这里用的是 “浮动制”计费, 根据这一计费制度,个人支付额度取决于个人家庭收入情况,而确定方式是:公用事业账单、文职 就业证明文件、个人报告以及其他收入指标等。 这个轮椅项目发现,该会员制度的有效性体现在以下几个方面: ●会员有权期望优质的服务和产品。 ●会员因为交纳了与其收入水平相对应的大笔会费 (通常在2~20美元之间,有的地方达到了150美 元),所以可能更加珍惜自己的轮椅,而且有一种拥有此轮椅的自豪感。 ●会员在两年内可以享受免费或者优惠的随访服务,所以他们可能会尽早寻求随访服务。 55 克服随访障碍的可能性措施 激励、参与和促使使用者了解随访的好处: ●使用者培训期间,向使用者解释随访的好处; ●在候诊室、网站、社区论坛分享随访好处的故事; ●对使用者实行会员制。 激励、参与和促使服务人员了解随访的好处: ●尝试实行服务人员提供的随访计划; ●收集随访好处的病例研究。 直接给出可衡量的结果: ●为试点随访计划制定目标; ●收集和分享成功的故事。 优先为随访配置资源: ●用随访好处的成功案例帮助筹款,支持随访的具体开支; ●分配时间发展社区合作关系,培训并指导社区人员; ●确保所有的交通工具都可用。 敢于面对不断出现的挑战: ●密切监督随访日期,找出问题的根源; ●使随访成为服务模式、服务系统和服务程序的一部分。 社区融合和参与 随访是评价服务影响以及整体目标是否达成的一个时机,整体目标包括:提高生活质量、社区融 合和参与等。 轮椅服务众多职责之一是提高可及性。这对于轮椅使用者融入社区、参与社区具有重要的影响。 56 居家无障碍和公共空间 居家障碍通常是卫生间。 对居家设施的简单调整可以对他们的生活质量 产生重要的影响。 尼加拉瓜的建筑无障碍运动 尼加拉瓜一家叫做CADISCA的残疾人机构在首都发起了一项运动, 强调高路肩和台阶的问题。残疾人机构成员 (所有的轮椅使用者) 仅在3个月之内就建了200个坡道和路缘 (做一个与马路水平的坡 口),这样可以无障碍地通向公共区域。CADISCA成员在他们的社 区做一些积极的事情获得了很多支持,当地企业也开始资助他们在 整个城市建更多的路缘和坡道。 早期,CADISCA成员通过轮椅篮球来增加自信,鼓励各位成员积极参与残疾人机构的活动。体育 训练期间也为残疾人机构例会创造了契机,例会上制定了多项提高认识的活动。这些训练都是在公 园进行,社区充分感受到了残疾人机构的活动氛围,同时也提高了认识。最终,体育项目获得了残 疾人的关注和支持,促进了无障碍运动的成功。这都迫使政府开始资助马拉瓜的路缘建设。物质环 境障碍的消除,赋予了轮椅使用者获得财政支持、教育和参与城市社会活动的平等机会。 57 在建筑物建设时考虑到无障碍特点的成本是最小的,有时甚至不到建筑成本的1%。 接受教育会受到很多简单小事的阻碍,比如路面宽度、无障 碍卫生间等。如果能提供无障碍建筑和道路的资源、信息,那么 无疑会使学校更具包容性。建筑无障碍有很多资源。 通过提供无障碍环境的建议和信息,服务可以促进家庭、交 通和教育无障碍,这样,服务就能够最大限度地保障移动障碍人 士融入和参与的机会。 无障碍交通 交通是轮椅使用者常见的障碍。一般面临的挑战包括: ●转移和装卸轮椅不得不让交通工具停留很长时间; ●运输轮椅需要交纳额外的费用; ●可拆卸零部件 (比如轮子)存在遗失和被偷的风险; ●由于门槛和通道引起的交通困难。 很多国家都有包容性运输计划,比如南非的拨号叫车服务、哥伦比亚的快速公交系统。世界上有 很多无障碍交通的有用资源*。 * 更多关于无障碍交通的有用资源:国际运输论坛 (ITF),无障碍复式联运,南非,访问交换国际通讯,辅助客 运系统指南———运输问题指南。 58 C.4:规划财务的可持续性 什么是财务可持续性 轮椅服务的财务可持续性是指具备资金和资源,用来开展轮椅服务的8个步骤和承担更大的职责。 轮椅管理者在制定轮椅服务的财务可持续性计划方面具有至关重要的作用。 关于财务可持续性服务声明的案例 可持续的轮椅供应项目是指通过轮椅服务的8个步骤,长期持续为个人提供适用的轮椅。 它需要对产品供应、人员训练、占地空间、监督和评价系统进行持续投资。当服务机构已经确保或 者能够持续确保必要的资金资源可以保证持续投资,即可实现财务的可持续性。 规划财务的可持续性 包括: ●明确维持服务需要的资金、资源 (见B.5部分); ●确定潜在的资金来源; ●确定潜在的非资金支持; ●为获得资金和实物捐赠制定策略。 确定潜在的资金来源 轮椅服务可以有不同的资金来源,采取不同的方式。很多服务机构可能只有单一的资金来源,比 如政府,但是大多数服务机构都可以通过不同的来源确保服务资金和资源。每个资助来源可能都对特 定的预算领域或资源需求领域有所帮助。 管理者可能会考虑的不同资金来源 政府 国家保险计划 私人捐赠者和赞助商 企业 (商业)捐赠者和赞助商 使用者补贴或全额付费 创收企业或社会企业 社区团体或慈善团体 外交机构 国际国内非政府组织 59 确定潜在的非资金支持 非资金支持包括实物捐赠 (例如,设备、轮椅或材料),志愿者支持和提供设施等。非资金支持可 以减少管理服务所需的资金数量。 很多轮椅服务机构可能会定期收到捐赠的轮椅。虽然这对于轮椅服务很有帮助,因为定期捐赠轮 椅对评价轮椅的质量和可持续性具有重要作用,但并不是所有捐赠的轮椅都是适用的轮椅。 整合不同的资金来源以维持轮椅服务 下面的表格介绍了一家轮椅服务机构找到不同资金的案例。以及这些资金来源是如何有助于机构 需要的资金和资源,以实现财务可持续。 轮椅服务资金来源的案例 资金来源 提供的资金或资源 政府 ●承担服务机构提供的每辆轮椅成本的50%; ●资助两名轮椅服务工作人员 (人员预算的50%)。 企业 (商业) ●当地一家公司每年向轮椅预算项目捐赠一次; ●当地另一家公司承诺每年资助10位儿童,包括轮椅费用和服务费用。 个人 ●向服务提供捐赠 (不会具体到特定的预算项目)。 社会企业活动 ●轮椅服务机构承担了很多社会企业的活动,比如 (建筑物)无障碍检查、 泌尿管理产品的供应等。这些工作的利润用来支撑轮椅服务,通常足以负 担人员预算成本的50%。 非政府组织 ●服务机构获得拨款补助之后,可以通过国际非政府组织在两个地方向居住 在特定地区的人提供两次轮椅。 宗教组织 ●每年捐赠200辆轮椅 (轮椅由服务机构选定)。 发展策略 资金来源一旦确定之后,管理人员需要为潜在的资金来源所需的支持制定发展策略。制定发展策略 时,其中要考虑到潜在的资金来源确实能够提供资金的可能性有多大,另外需要投入多少时间和精力。 管理者为了更好地制定策略、优先安排不同的资金来源、计划如何获得资金,需要考虑: 60 ●资金来源:谁将获得? ●支持:管理者希望资金来源用于支持什么? 这主要集中在预算项目的问题,比如产品的预算项 目或者是服务步骤的预算项目。还要考虑到特定的资金来源,及其他们最愿意支持什么。 ●要求:管理者希望资金来源能提供或支持多少资金? 这其中要考虑的因素包括资金来源和以往 捐赠规模的相关资料,目的是要求切实可行的资金数量。 ●可能性:资金来源能够资助或支持轮椅服务的可能性,可以归结为3个等级:低等、中等和 高等。 ●努力:为确保获得资金有哪些要求,还需要报告什么或者应该承担其他什么义务? 支持的力度应 与资助金额成比例,义务也应该确保在服务机构可承担或可控范围内。 下面的表格中给出了两个例子。通过考虑支持类型、要求、成功的可能性以及需要作出的努力, 管理者可以更好地选择优先跟进的资金来源。 资金来源 支持类型 要求 可能性 努力 1. 企业 (当地业 务) 以捐赠的形式支持 轮椅采购的预算。 轮椅预算的10%。 中等 (以前资助 过,但不是每年都 资助同一个组织)。 与业务管理者至 少召开两次会议; 提交两页纸的建 议和预算,邀请 管理者在下一个 开放日出席。 2.当地政府 当地所有社区拜访 轮椅使用者需要的 潜在资金费用。 所有社区服务费用 的20%以及服务 人员工资的20% 。 高等 (已经与当地 政府洽谈过一段时 间,已经在当地进 行过社区活动。他 们非常热衷于支持 这类活动,资金是 足够的)。 提交正式的议案 和预算。承诺报 告———需要 当 地 所有人员的准确 数据和财务报告。 61 资助方法 确保轮椅服务资金来源的可持续性是非常困难的。下面的案例,提供了不同的资助方法,以及可 参考的想法。要注意的是,通常来说,资助方法都各不相同,这取决于资金来源。 满足社会需求和实现创收的商业方法 罗马尼亚一个非政府组织用社会企业的方式来实现财务可持续性。该方法有两个关键目标:社会 影响和财务影响。 作为多学科团队的成员,轮椅使用者可以为残疾人提供优质的移动设备和医疗用品。因为团队非 常重视人员精准定位以及预防医疗并发症,所以服务质量很高。 该活动为残疾人士提供了就业机会及增强了使用者的能力。服务创收部分还可以用以支持非政府 组织运营的其他项目。 提供者直接购买 一些轮椅服务机构要求轮椅使用者对获得的轮椅和轮椅服务支付最少的费用。通常有一个 “浮动 汇率制”式的收费制度,其中个人支付的金额取决于个人的家庭收入,比如通过公用事业账单、文职 就业证明文件、个人报告以及其他证明收入的文件来确定。服务机构用这种方式获得资金,需要确保 无法支付任何费用的人获得轮椅没有障碍。 公司捐赠者和赞助商 墨西哥一年一度的电视和广播节目Teleton,举办目的是为儿童康复 (CRIT)中心筹款。该活 动由Televisa电视台和600家国内外媒体合作制作,并由20多家商业公司赞助。他们借助大量融合 与成就相关的积极故事推销他们的成功愿景。他们销售成功的视野,以及融合和成就的强大正面故 事。在活动的三个月之前,案例研究作为宣传的一部分通过媒体发布,高知名度人士参与到该活动 的宣传中。 罗马尼亚的一家非政府组织与赞助商建立了密切联系。为巩固关系,一年一度的游泳盛会在著名 的健康中心举行。包括公司员工、同侪培训者、非政府组织成员以及具有学习障碍的人在内的综合团 队进行比赛。这是一个具有多层利益关系的有趣活动。公司员工全年度给予持续的财务支持,或者是 直接捐助又或者是筹款活动。 政府资金 肯尼亚的医疗服务部已经与轮椅和其他康复相关的非政府组织服务机构合作。非政府组织为政府 62 医院的8个分支机构提供了所有的后勤服务。到目前为止,医疗部已经向非政府组织提供了56名工作 人员。 罗马尼亚国家保险计划 ●轮椅使用者要进行的第一步是申请残疾证。没有残疾证者不可申请轮椅。 ●预约有资格开具轮椅处方的康复医生。 ●轮椅使用者向国家保险局提交申请 (NIA)。 ●轮椅使用者收到批复或收据后,他或她可以选择供应商和一辆轮椅。 ●如果轮椅价格低于补贴金额,那么供应商在提供轮椅时需要轮椅使用者交出申请批复或收据,这 用于向国家保险局开具发票。 ●如果轮椅价格高于补贴金额,那么使用者需要支付差价或者找到补充资金来源,例如捐赠者、雇 主、个人等。 更多支持初级和中级轮椅服务的资源,请参考随书光盘。 63 参考文献 ①资源有限地区手动轮椅服务指南.日内瓦:世界卫生组织;2008 (http://www.who.int/disa- bilities/publications/technology/wheelchairguidelines/en/). ②轮椅服务初级教程.日内瓦:世界卫生组织;2012 (http://www.who.int/disabilities/tech- nology/wheelchairpackage/en/). ③轮椅服务初级教程.日内瓦:世界卫生组织;2013 (http://www.who.int/disabilities/tech- nology/wheelchairpackage/wstpintermediate/en/). ④残疾人权利公约,日内瓦.61/106(2007)纽约:联合国;2008 (http://www.un.org/esa/soc- dev/enable/rights/convtexte.htm). ⑤据报道,通过服务提供的辅助器具可以为看护者节约时间和减轻身体负担 (艾伦等人,2006). ⑥资源有限地区手动轮椅服务指南2008,p113(http://www.who.int/disabilities/publications/ technology/wheelchairguidelines/en/). ⑦资源有限地区手动轮椅服务指南2008,p78(http://www.who.int/disabilities/publications/ technology/wheelchairguidelines/en/). ⑧WyndaeleM,WyndaeleJJ.脊髓损伤的发病率、流行和流行病学:全世界文献研究获得了什么? 脊髓,2006;44:523–529. ⑨RazzakATMA,HelalSU,NuriRP.孟加拉国达卡康复中心治疗的脊髓损伤患者 (SCI)的预期 寿命.残疾、社区康复和包容性发展杂志.2011;22 (1):114-123. ⑩世界卫生组织和世界银行联合撰写的世界残疾报告,P115.日内瓦:世界卫生组织;2011(ht- tp://www.who.int/disabilities/world_report/2011/report/en/). 􀃊􀁉􀁓MessiouK.鼓励孩子以更具包容性的思维方式进行思考.英国特殊需要教育杂志.2008;35 (1):26–32. 64 实训手册 管理者创建或改善轮椅服务供应体系的活动 “实训手册”分为两部分: 第一部分:开始服务前需要做什么 这一部分主要侧重于轮椅服务的8个步骤,设施、设备、适用轮椅的范围、开始服务的成本和管 理需求。 第二部分:为确保服务可持续发展,除了最初的启动资金,需要采取什么 措施 这一部分侧重于适用的轮椅供应体系、运营服务、提高轮椅服务的有效性、效率以及响应度的活 动。还讨论了财务可持续性,包括建立伙伴关系的重要性,以及收入来源用于支付运营和扩大服务所 需的成本。 这两部分都可以划分为以下3节: A.核心知识; B.开始轮椅服务; C.运营轮椅服务。 65 第一部分 A:核心知识 A.1:领导变革 ●检查下面列出的变革促进因素。记录您在服务中心为引进和改善轮椅供应体系而采取的行动。 1.创建适用轮椅供应体系的共同愿景 2.传播适用轮椅供应体系的重要性和紧迫性 3.整合人员和资源 4.激励、参与和动员员工 ●让员工参与计划和实施。 ●一起克服障碍。 ●建立并确认短期成果。 ●让变革根植于组织系统和文化。 66 B:开始轮椅服务 B.1:获得服务 问题 答案 问题1:建立转介网络 作为管理者,你可以采取什么措施来建立个人和机构网络,进而识 别和转介轮椅使用者? 问题2:转介表 查看 《轮椅服务管理者教程———附加资源手册》中的轮椅服务转介 样表。 该转介表或这张表的其他版本对您的服务机构有用吗? 如果没用,原因是什么? 如果有用,作为管理者,你如何引入转介表? (注:如果服务机构正在使用某个系统,那么请描述一下你作为管 理者为引进和支持转介表做了些什么?) 1.我可以采取什么措施来找到转介来源 2.我可以采取什么措施建立转介网络 3.我可以采取什么措施来决定是否需要提供一张转介表 4.我可以采取什么措施来积极推动公平的轮椅服务 67 B.2:设施和设备 1.我可以采取什么措施来找到适合自己服务模式的设施和设备 2.我可以采取什么措施将表格和清单整合到服务步骤中 3.我可以采取什么措施来安排设施 4.我可以采取什么措施来为每个设施 (包括条件允许情况下工作的委派)建立制度和程序 68 B.3:适用轮椅的范围 1.我可以采取什么措施来确定使用者的需求,以及确定满足该需求的最重要的产品功能 2.我可以采取什么措施确定合适的轮椅、坐垫及零件的范围 3.对产品进行改制时,我可以采取什么措施来确定合适的供应材料 4.我可以采取什么措施来和利益相关者讨论,服务过程中提供的适用轮椅和坐垫的成本效益 69 B.4:人员配置 1.我可以采取什么措施来确定服务的人员 2.我可以采取什么措施让服务人员参与规划 3.我可以采取什么措施来协调团队合作并建立周工作计划 4.我可以采取什么措施来确定年服务能力 70 B.5:轮椅服务的成本 1.当规划服务模式时,我可以采取什么措施来考虑服务的整合 2.当规划服务模式时,我可以采取什么措施来考虑社区合作伙伴 3.我可以采取什么措施来规划服务模式的相关预算 71 C:运营轮椅服务 C.1:如何确定轮椅服务是否有效 服务领域和活动 服务绩效目标 信息收集的方法 转介 转介的轮椅使用者数量 服务机构每月都会收到30个转 介来源 记录收到的转介 轮椅供应 获得轮椅的使用者数量 服务机构每月可以为20位轮椅 使用者开具处方和适配轮椅 在使用者档案上记录轮椅处方 轮椅服务的人数 转介到服务机构的详细信息, 比如年龄、性别、残疾、体位 支撑需求 服务机构鼓励公平的服务 获得服务的人数,按女士、男士、 女孩和男孩分类记录在使用者档 案上 服务成本 提供产品的成本,包括服务机 构内的改制成本 每辆轮椅的单件成本将低于基于 预算的指定数额和可获得产品的 实际成本 在使用者档案上记录获得服务的 使用者家庭地址 服务计划框架 确定监督的需求和问 题 解决需求和问题的措 施或目标 目标 信息收集 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. 72 记录措施以确定服务是否有效 (如果时间允许) 1.我可以采取什么措施来创建服务计划 2.我可以采取什么措施来督促服务人员向服务目标努力 3.我可以采取什么措施来评价服务机构如何有效地实现目标 4.我可以采取什么措施来肯定团队或个人的成功 73 C.2:管理需求 1.我可以采取什么措施来建立制度,以监督转介和管理候诊清单 2.我可以采取什么措施来与父母和转介来源分享早期转介的成功案例 3.当转介有需求的轮椅使用者超出服务能力时,我可以采取什么措施来计划管理 4.我可以采取什么措施来监督和改善服务效率 74 C.3:规划随访 1.我可以采取什么措施来规划随访 2.我可以采取什么措施来建立和培训社区的合作伙伴 3.我可以采取什么措施来找到开展使用者培训和随访的人员 4.我可以采取什么措施来收集和分享随访好处的成功故事 75 C.4:规划财务的可持续性 1.我可以采取什么措施来建立财务可持续性的共同愿景 2.我可以采取什么措施来找到所需的资金和资源 3.我可以采取什么措施来找到资金来源 4.我可以采取什么措施来优先安排资金来源并制定筹款策略 76 第二部分 A:核心知识 A.1:适用的轮椅供应体系:国家政策 ●阅读下面有关轮椅供应体系国家政策的两个案例。 ●综合考虑你所在国家已经有的政策。 ●讨论以下政策在你国家有何用,思考这些政策如何适应你们国家的政府体系。 案例1:阿富汗轮椅供应体系的政策 2003年10月,阿富汗的烈士和残疾人部发布了一项全面的国家残疾政策。该项政策通过合作制定 出台,合作方有:包括残疾人组织和自助组织在内的所有利益相关者;国内外的非政府残疾组织; 包括教育部、卫生部、劳动和社会事务部、妇女事务部、烈士和残疾人部 (MMD)在内的主要部 门;联合国相关机构;总统办公室。据估计,该项政策会带来更详细的优先安排的行动计划。该政 策还规定:对肢体障碍人士的服务应该包括矫形康复,物理治疗服务、矫形、辅助和移动器具等。 这些服务机构应该靠近有骨科手术服务的地区或省医院,以便于当地人容易到达。残疾人享有获得 辅具的权利。这些器具应该达到的标准如下:制作良好、适配精准、尽可能采用本地的材料、当地 可维修。适用的技术应该在全国范围内标准化。公共卫生部应与有关专家合作建立国家标准化机制。 案例2:南非轮椅供应体系的政策 2003年,南非发布了国家辅助器具指导方针。这些指导方针由南非所有省份共同协商制定。西开普 参与制定国家指导方针,是基于他们制定省内指导方针的经验。 制定省内指导方针是由一群提供轮椅服务的临床医生发起的。他们咨询了省内的项目管理人员以及 当地康复服务机构,然后制定了轮椅服务标准化的计划。该计划主要集中于以下3个领域: 1.分析所在省的轮椅服务情况。 2.对轮椅服务提供者进行培训。 3.制定省级轮椅管理战略的指导方针。 77 续表 案例2:南非轮椅供应体系的政策 起草的省级指导方针涵盖了关键服务步骤和管理步骤的最低标准,比如员工培训、候诊清单的建立 和管理、维修与保养服务的提供和预算。 省级管理层帮助该小组成为了正式的咨询小组。小组代表陪同省级管理人员参加了国家会议,进而 为建立南非的国家辅助器具指南做出贡献。 A.2:提供轮椅服务 管理者更大的职责 改善所在地区适用轮椅供应体系的共同措施 未来3个月我可以采取什么措施 78 B:开始轮椅服务 B.1:设施和设备 B.1.1确定合适的设施 ●请看下面的设施列表。 ●考虑在你们服务过程中切实可行的解决方案。 初级设施 设施已经有了吗? 该设施可以 与现有服务共享吗? 有其他用途的房间 可以调整吗? 现有房间可以重 新调整或改建吗? 1.候诊和接待 2. 躺 下 的 安 静 区域 3.无障碍卫生间 4.人员办公区 5. 临床:评定和 适配区 6. 技术:轮椅准 备、维修和保养区 7.仓储 8.使用者培训 79 续表 附加的中级设施 设施已经有了吗? 该设施可以 与现有服务共享吗? 有其他用途的房间 可以调整吗? 现有房间可以重 新调整或改建吗? 9. 用于卧位检查 的评定和适配区 10.材料的其他存 放空间 11.附加产品准备 区:缝纫和装饰 B.1.2确定设备 ●参照 “学员手册”部分设备和文件的指南。 设备 ●确定你的服务中心已经获得并且正在使用的设备,记录需要制作或购买的所有设备。 已经有的 需制作或购买的 文件资料 ●哪些表格和清单已经整合到一起使用了。 ●注意可能在日常使用的所有表格或清单。 已经有的 整合到现有服务中的 80 B.1.3工作区组织 ●参照 “学员手册”部分中设施和设备指南。 ●回顾以下列出的良好工作场所组织的建议: 1.清除杂物:清除所有不必要的工具、零件、设备、过期的文件等。 2.确定常用物品:工具、零件、说明书和文件。这些物品应摆好,在使用时就可以快速定位,及 时找到。 3.制度和责任:为每个工作区建立一个制度,并为落实制度安排相应的责任人。 4.监督:监督制度确保调整固定下来。 技术区 ●分析案例并提出改进建议 社区临床和技术区 ●分析案例并提出改进建议 81 B.2:适用轮椅的范围 B.2.1耐用及可维修 ●与你所在的小组一起工作,完成分配给你们的问题。 ●结合 “学员手册”部分,利用你的知识和经验完成这项任务。 1组 ●关于提供产品的安全性和耐用性,你可以提出什么问题? ●你如何判断产品供应商 (捐赠者、生产商)是否提供符合你们特定要求 的安全且耐用的产品? ●你还可以通过哪些途径了解捐赠者、制造商或供应商提供产品的安全性 和耐用性? 耐用 2组 ●即使是耐用的产品,一般也有易磨损和断裂的零件。容易出问题的零件 有哪些? 损坏以及 磨损的零件 3组 ●服务需要备用零件。 ●你怎么确定需要哪些零部件? ●你怎么知道哪些零部件需要订购? 备用零件 82 B.2.2提供适用的轮椅 场景1 ●模拟以下场景,然后阅读 “提供适用行动辅具准则”。 ●为省级官员和那些支持轮椅采购制度变革的利益相关者策划角色扮演的场景 (3~5分钟的角色 扮演)。 讨论角色扮演时,思考以下问题: ●场景中有什么问题? ●解决这些问题的可能性措施。 你所在地区的公立医院已经制定了轮椅供应 的预算。每年都会审查预算并确定产品清 单。虽然每年都提出调整产品的要求,但实 际并没有任何变化,采购部门还是根据预算 购买两类产品。 提供适用行动辅具准则 为了国家履行与辅助技术 (行动辅具)相关的义务,《残疾人权利公约》列出了以下应该考虑的主要 准则: ●可接受性———残疾人必须参与行动辅具提供的所有阶段。 ●可及性———具有明确需求的人必须可获得行动辅具和相关的服务。 ●适应性———行动辅具和相关的服务应该可适应和修改以确保它们适应个人的需求。 ●可负担性———行动辅具和相关的服务必须可负担。 ●有效性———设施、人员和产品必须对于人口的需求是充足的并且尽可能靠近人们自己的社区。 ●质量———产品、设施和服务具有合适的质量。 83 场景2 ●阅读下面的两个政府招标制度。 ●总结你所在国家目前的制度。 ●参考 “提供适用行动辅具准则”。 ●为建立健全轮椅供应的政府招标制度提出建议。 南非 在南非,政府购买轮椅必须按照全国招标制度。政府人员与来自不同省份的具有轮椅和轮椅服务专 业知识的人们一起工作。同时,他们也会与当前的轮椅供应商进行协商。 协商后,产品目录以及具体项目得以最终确定。包括每种产品的详细规格。产品目录包括了一系列 舒适的坐垫。 明确每种产品的最低耐用标准。 招标规格一旦确定并得以批准,国家财政部开始着手进行招标工作的投标手续。签订合同之前,懂 行的代表要检查投标提交的所有产品。合同包括最短交货期和违约处罚条款等。 罗马尼亚 在罗马尼亚,国家对轮椅的资助采用医疗补贴模式。对轮椅的补贴始于2001年,当时国家组织了一 次轮椅供应商投标活动。招标结束后,确定了参考价格,但是关于产品质量和提供服务的条款一条 也没有确定。具体的补贴金额,每年确定一次。 轮椅使用者要进行的第一步是申请残疾证。没有残疾证者不可申请轮椅。下一步预约可以开具轮椅 处方的康复医生。然后轮椅使用者向国家保险局 (NIA)提交申请。轮椅使用者收到批复或收据后, 他或她首先选择一家供应商,然后选择轮椅。如果轮椅价格低于补贴金额,那么供应商在提供轮椅 时需要轮椅使用者交出申请批复或收据,这用于向国家保险局开具发票。如果轮椅价格高于补贴金 额,那么使用者需要支付差价或者找到补充资金来源,例如捐赠者、雇主、个人等。 84 场景3 ●准备一个角色扮演 (3~5分钟)的场景,演示一位捐赠者在场的会议,会议上你可以提出一项 计划:通过你的服务系统提供适用的轮椅。 准备角色扮演时: ●讨论你们所在地区捐赠的轮椅如何进行分配。 ●阅读 “提供适用行动辅具准则”。 85 B.3:人员配置:职责 ●请看轮椅服务人员职责的表格清单。 ●在表格中写下承担每项职责的人员姓名。 ●如果你不只负责一个服务中心,那么务必把每个中心的人员都列出来。 临床 技术 使用者培训 行政管理 服务中心 服务中心 服务中心 B.4:轮椅服务的成本 回顾:下面预算中的每一行。思考通过把轮椅服务整合到现有的服务中,哪些成本可以分担或节约。 可以节约的成本,用黑色笔圈出。 可以分担的成本,用红色笔圈出。 综合服务的示例场景 假肢矫形 (P&O)服务计划整合轮椅服务。已经确定了两名人员,并派他们参加了轮椅服务初级课 程的学习。 这两名人员,每周拿出三天时间负责轮椅服务工作,两天时间负责P&O服务工作。 分配了轮椅技术的工作区。治疗部清除了所有坏掉的和不用的设备,为临床人员工作腾出空间。 86 预算项目 服务步骤 转 介 和 预 约 评 定 处 方 经 费 和 订 购 产 品 ︵轮 椅 ︶ 准 备 适 配 使 用 者 培 训 保 养 ︑ 维 修 和 随 访 启动成本 产品设计 产品的采购范围 √ 工具 √ √ √ 设备 √ √ 建筑或设施 √ √ √ 材料仓储 √ 运营成本 轮椅 √ √ 备用零件 √ 材料 √ √ √ 运费 (产品运输) √ √ 人员 管理人员 √ √ √ 临床人员 √ √ √ √ √ √ √ 技术人员 √ √ √ √ √ 培训者 √ √ 行政人员 √ √ √ √ √ 87 续表 预算项目 服务步骤 转 介 和 预 约 评 定 处 方 经 费 和 订 购 产 品 ︵轮 椅 ︶ 准 备 适 配 使 用 者 培 训 保 养 ︑ 维 修 和 随 访 当地交通 服务人员当地交通 √ √ √ √ 服务对象当地交通 √ √ √ 服务对象的住宿 √ √ 印刷材料 √ √ √ √ √ 易耗品 √ √ √ 工具更换 √ √ √ 日常管理 √ √ √ √ √ √ 人员培训 √ √ √ √ √ √ 培训伙伴或转介网络 √ √ √ 筹款 √ √ √ √ √ √ √ √ 监督和评价 √ √ √ √ √ √ √ √ 88 C:运营轮椅服务 C.1:有效和高效的服务 C.1.1监督 第一节 ●你所在的小组:阅读并完成下面的表格。 ●为帮助你填写以下表格,部分内容已经填完,请将剩余部分填写完整。 区域和活动 绩效目标示范 信息收集 转介 转介的使用者数量 每月接收30位转介 记录接收的转介 从转介到预约的平均等候时间 在使用者档案上记录接收转介的 时间和评定时间 轮椅供应 获得轮椅的使用者数量 每月可以为20位使用者开具处 方和适配轮椅 从评定到适配的平均等候时间 随访预约的次数 89 ●为什么了解目标是否达成很有用,把原因记录在下面表格中。 了解目标已达成 是很有用的,原因是: 了解目标尚未达成 很有用,原因是: 转介的使用者数量 从转介到评定的平均等候时间 获得轮椅的使用者数量 从评定到适配的平均等候时间 随访预约的次数 第二节 区域和活动 绩效目标示范 信息收集 轮椅服务的人数 转介服务使用者的详细信息, 比如年龄、性别、残疾、体位 支撑需求等 服务的目的是满足使用者的需 求,他们需要基本轮椅,以及需 要改制和体位支撑 获得服务的人数,按女士、男士 和女孩、男孩分类记录在使用者 档案上 体位需求类型和处方轮椅类型记 录在使用者档案上 服务覆盖的地理区域 获得服务的使用者的家庭地址——— 记录在使用者档案上 90 续表 区域和活动 绩效目标示范 信息收集 服务成本 提供产品的成本,包括服务机 构内的改制费用 每辆轮椅的单件成本将低于基于 预算的指定数额和可获得产品的 实际成本 服务人员在服务活动上花的时 间 (例如:评定、随访和培 训) ●为什么了解目标是否达成很有用,把原因记录在下面表格中。 了解目标已达成 是很有用的,原因是: 了解目标尚未达成 很有用,原因是: 转介服务使用者的详细信息, 比如年龄、性别、残疾、体位 支撑需求等 服务覆盖的地理区域 提供产品的成本,包括服务机 构内的改制费用 服务人员在服务活动上花的时 间 (例如:评定、随访和培 训) 91 C.1.2使用者反馈 ●计划收集轮椅使用者反馈时,有几个要点需要考虑。请用此清单为你的服务做笔记。 计划收集使用者的反馈 重点考虑:交通和时间是最重要的两大成本。 什么时间收集反馈信息? 谁来收集反馈信息? 收集反馈信息时,应该问什么问题? 基础信息 (参阅 《轮椅服务管理者教程———附加资源手册》上的工具) 思考点:为了评价服务影响,记录好服务介入前的情况是非常重要的。也就是说,在评价开始之前 做记录。 什么时候收集基础信息? 谁来收集基础信息? 多长时间间隔收集信息? 92 续表 记录和处理数据 思考点:有效地记录数据会节约时间和金钱。 你如何记录数据? 通过什么方法可以尽可能高效地记录和处理数据? 谁来记录数据? 谁来处理数据? C.2:发展高效的服务 C.2.1监督服务计划 ●为你的服务创建服务计划。 ●从你自己的服务中选择一个需求或问题进行监督,然后在每个标题下填写相应的信息。 服务计划框架 确定需要监督的需求或问题 解决需求或问题的行动或目标 目的 信息收集 93 C.3:管理需求 C.3.1产生需求和早期转介 ●阅读下面的案例。 ●讨论并列出成功的原因。 成功案例:墨西哥父母的早期转介 这个案例讲述了墨西哥的儿童康复中心是如何建立有效的早期转介网络的。 虽然康复中心最初主要通过新生儿医生和儿科医生开展提高认识的宣传活动,但后来也开始进行年 度筹款活动,目的是通过广泛的媒体覆盖,包括广播和电视,在普通社区进行宣传。这产生了很好 的口碑,很多家长就会转介他们的孩子。 提高认识的宣传活动期间,康复中心有一个清晰的观念:孩子出生时转介至康复中心非常重要。他 们所服务的儿童有许多融合和有成就的积极故事,他们用这些故事来宣传强大的成功愿景。15年后 的今天,由于儿科医生和家庭都积极致力于早期转介,康复中心看到了文化意识层面的转变。 转变的结果是:1/3的转介来源是3岁或者更小的儿童。 成功的原因 94 C.3.2分析服务步骤 每天可提供服务的时间: 分钟。 ●小组一起工作。 ●阅读第1栏中的每项服务挑战。 ●阅读下面表格中提高服务效率的可能性策略。 ●根据服务挑战制定策略来提高效率。在第2栏中列出每项策略。一种挑战可能需要多种解决 策略。 提高服务效率的策略 1.获取可调范围尽可能大的产品 2.获取可容易改制的产品 3.获取带有体位支撑装置的产品 (PSDs) 4.提前准备好样品产品的设置选项 5.预制体位支撑装置 6.明确合作工作的时间进度 7.召开团队会议,制定共同的工作计划 8.适配期间,临床和技术团队共同工作 9.临床和技术团队讨论处方方案 10.信息记录要清晰,并且保持记录的连续性 11.为服务人员计划适当水平的培训 12.获取坐垫、体位支撑装置和改制需要的合适材料 13.获取快速调节产品的适用工具 14.为特定人员安排使用者培训,比如同侪培训者 15.使用者培训的设施尽可能靠近临床和技术区 16.建立有效的仓储控制系统 17.准备少量不同规格的轮椅 18.建立社区合作伙伴关系,并找到使用者,提供到服务中心的交通 19.加强社区合作伙伴能力建设,提供初级服务,转介需要中级服务的使用者 20.鼓励新想法 ——— 创新 95 第1栏:服务挑战 第2栏:服务策略 评定: 1. 服务人员前往服务或进行家访时,路途时间需要纳入评定环节的考虑范 围之内 2. 如果团队成员经验不足,那么评定时间则需要更久 处方: 3. 如果产品调节范围有限,那么必须开具改制的处方,以满足使用者的个 人需求 4. 如果需要附加体位支撑,那么还需要其他测量和画图 产品 (轮椅)准备: 5. 快速获得所需要产品的类型和尺寸 6. 如果轮椅调节范围有限,准备产品时则需要更多的时间 7. 如果体位支撑装置需要修改,则需要更多的时间 适配: 8. 如果需要改制或安装体位支撑装置,则适配时间会更长 9. 如果在适配时,轮椅设置进行了任何调整,则需要进一步适配检查 使用者培训: 10. 如果使用者第一次获得轮椅或者存在并发症,则需要更多的时间对使用 者进行以下培训:健康、移动、操作轮椅、维修和保养轮椅、转介至其 他机构。 96 C.4:规划随访 C.4.1克服障碍 ●阅读下面的随访障碍列表,并补充小组强调的其他障碍。 ●讨论可以克服随访障碍的措施,然后填在下面的表格中。 随访障碍 社区随访服务可能存在的障碍: ●服务中心人员前往社区的费用; ●服务中心人员前往社区的时间; ●管理者没有优先安排随访服务; ●使用者只有在体会到随访的好处时才会重视随访服务。 在服务机构进行随访服务可能存在的障碍: ●一个或多个家庭成员耽误的工作时间、出行费用; ●使用者和家庭成员往往没有意识到随访的好处; ●难以找到无障碍的交通工具; ●注意力集中在服务中心新的预约上,往往导致没有时间进行随访; ●难以协调的预约状况:服务人员都在忙的时候,轮椅使用者出现了;或者,服务人员都不忙的时 候,一个轮椅使用者也没有。 克服随访障碍的措施 97 C.5:规划财务的可持续性 C.5.1确定资金来源 ●通读资金来源的清单列表,参阅 “学员手册”部分以获得更多信息。 ●选择3项你认为最有可能的资金来源,填写下面的表格。 管理者需要考虑的不同资金来源 1.政府 2.国家保险计划 3.私人捐赠者和赞助商 4.企业 (商业)捐赠者和赞助商 5.使用者补贴或全额付费 6.创收企业或社会企业 7.社区团体或慈善协会 8.外交机构 9.国际国内非政府组织 可选择的资金来源 可根据以下因素按照先后顺序编号: ●需要的努力。 ●短期资金支持还是长期资金支持 (抑或两者兼有)。 优先次序 资金来源 需要的投入或努力 高或中或低 短期支持 高或中或低 长期支持 高或中或低 98 C.5.2制定策略 ●阅读下面的策略示例。 ●从上面练习的表格中,列出了3项资金来源。 ●为已选定的资金来源,填写下列表格。 资金来源 支持类型 要求 可能性 努力 1.企业 (当地业务) 以捐赠的形式支持 轮椅采购的预算。 轮椅预算的10%。 中等 (以前资助 过,但不是每年都 资助同一个机构)。 与业务管理者至 少召开两次会议; 提交两页纸的建 议和预算,邀请 管理者在下一个 开放日出席。 2.当地政府 当地所有社区拜访 轮椅使用者需要的 潜在的资金费用。 所有社区服务的 20%以及服务人员 工资的20%。 高等 (已经与当地 政府洽谈过一段时 间,已经在当地进 行过社区活动。他 们非常热衷于支持 这类活动,资金是 足够的)。 提交正式的建议 和预算。承诺报 告———需要 当 地 所有人员的准确 数据和财务报告。

轮椅服务管理者教程 附加资源手册 ［美］莎拉 ･ 弗罗斯特 等著 李 婷 钟 磊 译 世界卫生组织 图书在版编目 (CIP)数据 轮椅服务管理者教程.附加资源手册/ (美)莎拉·弗罗斯特等著;李婷,钟磊译.-北京: 求真出版社,2017.8 ISBN978 7 80258 242 2 Ⅰ.①轮… Ⅱ.①莎…②李…③钟… Ⅲ.①四肢-残疾人-社会服务-技术培训- 教材 Ⅳ.①C913.69 中国版本图书馆CIP数据核字 (2017)第210461号 世界卫生组织于2015年出版,原标题为 (WheelchairServiceTrainingPackageFor Managers:AdditionalResources)ⓒ世界卫生组织2015 世界卫生组织授予深圳市残疾人综合服务中心翻译中文版的权利,并委托求真出版社 出版。中文版的翻译质量和准确性由深圳市残疾人综合服务中心负责。若英文版与中 文版有任何出入,应以英文原版为准。 轮椅服务管理者教程.附加资源手册ⓒ世界卫生组织2015 轮椅服务管理者教程———附加资源手册 著 者:[美]莎拉·弗罗斯特 等 译 者:李 婷 钟 磊 责任编辑:计 悦 出版发行:求真出版社 社 址:北京市西城区太平街甲6号 邮政编码:100050 印 刷:北京华联印刷有限公司 经 销:新华书店 开 本:787×1092 1/16 字 数:63千字 印 张:3 版 次:2017年8月第1版 2017年8月第1次印刷 书 号:ISBN978 7 80258 242 2/C·10 定 价:12.00元 编辑热线:(010)83190270 销售服务热线:(010)83190297 83190289 83190292 版权所有 侵权必究 印装错误可随时退换

1 发展轮椅供应服务项目的可行策略 制定全国性的轮椅服务项目,最好能够以本国当前的轮椅服务情况、现有资源以及刚性服务需求 为依据。对下列问题的思考以及 《资源有限地区手动轮椅服务指南》中的策略概述有利于发展轮椅服 务项目。 ●使用人群有何特点,有何特殊需求? ●是否有利益相关群体? 如果有,他们有何利益要求和意见? ●是否已经有轮椅服务 (由当地培训项目、社区康复、残疾人组织和其他非政府组织、私营部门 或政府提供)? ●除了正式的基础设施之外,是否还有其他的轮椅供应服务? 例如:提供大量的进口轮椅。 ●如何利用好现有资源? ●当前的资助机制是什么? 1.政府希望建立全国性的轮椅服务项目。 政府可以联系有兴趣的非政府和残疾人组织、使用者、卫生专业人员培训项目、国际组织,如世界 卫生组织 (WHO)、国际假肢矫形器协会 (ISPO)、国际轮椅协会 (ISWP)和其他有关的国际非政 府组织,建立一个适合的全国轮椅服务计划。政府可将其看作是自己的假肢、矫形器服务,并且作 为发展轮椅服务的基础。也可以联系其他国家政府机构,向他们学习经验,寻求建议。 2.有轮椅服务,但是由独立的机构提供少量的轮椅服务,没有合作。 政府、当地机构或国际非政府组织可以评估提高服务量的可行性。可以建立资源中心让不同机构 的人参与到合作中。资源中心可以发展成为对轮椅服务感兴趣的机构联盟或独立的非政府组织。 3.国内有相关组织但没有轮椅服务。 感兴趣的非政府组织或残疾人组织可以作为资源中心的核心。该机构需要找到一个有轮椅服务经验 的合适组织作为合作伙伴 (例如:邻国政府或非政府组织、国际非政府组织),应该按照下面第4种 情况的初始步骤运作。或者这个过程可以由一个国际非政府组织启动,然后寻求与当地非政府、残 疾人组织建立合作伙伴关系来发展轮椅服务。应努力与其他有类似启动轮椅服务经验的国家或组织 建立联系网络。 2 4.国内没有机构和常规的轮椅服务。 一个国际非政府组织,无论是主动前来还是应政府邀请或与之合作,都可以在首都或其他主要城市 建立一个资源中心。该资源中心可以作为现有康复机构的一个组成部分。该资源中心应当首先向使 用者、他们的家人或者护理人员、健康专业人员提供关于移动需求和与移动性有关更广泛问题的重 要信息。国际非政府组织应当开展利益相关者分析,对轮椅使用者或需求者进行调查,以便找出差 距和确定轮椅及服务需求。初步参与性研究将提出满足需求的选择。在开始提供轮椅服务时就应该 有资金保障。建立全国性轮椅服务项目的首要步骤是要努力建立资源中心和有关政府机构的合作 关系。 3 轮椅服务 (初级)转介表 转介表样板:此表格可以由轮椅服务机构进行修改,并提供给转介来源,以帮助他们转介轮椅使用 者到轮椅服务机构。 请将转介表填写完整并邮寄至: (轮椅服务单位名称和地址) 转介人姓名: 工作单位: 转介人联系方式 (有效联系方式): 轮椅使用者姓名 : 出生日期 : 父母/护理者姓名: 地 址: 如何联系轮椅使用者: 邮件□ 个人电话□ 朋友/邻居电话□ 若通过电话联系,电话号码为: 轮椅使用者残疾类型 (如果知道): 转介原因 : ●没有轮椅 ●轮椅损坏 ●现有轮椅无法满足其需求 □ □ □ 请补充轮椅服务机构需要了解的关于轮椅使用者的其他任何重要信息 : 4 续表 轮椅使用者同意被转介到轮椅服务单位吗? 是□ 否□ 转介人签名: 日 期: 5 轮椅服务 (中级)转介表 转介表样板:此表格可以由轮椅服务机构进行修改,并提供给转介来源,以帮助他们转介轮椅使用 者到轮椅服务机构。 请将转介表填写完整并邮寄至: (轮椅服务单位名称和地址) 转介人姓名: 工作单位: 转介人联系方式 (有效联系方式): 轮椅使用者姓名 : 出生日期 : 父母/护理者姓名: 地 址: 如何联系轮椅使用者: 邮件□ 个人电话□ 朋友/邻居电话□ 若通过电话联系,电话号码为: 轮椅使用者残疾类型 (如果知道): 转介原因 : ●没有轮椅 ●轮椅损坏 ●现有轮椅无法满足其需求 儿童 : ●到1岁时不能坐直或无法拉起站立 ●到2岁时仍不能行走 □ □ □ □ □ 6 续表 请补充轮椅服务机构需要了解的关于轮椅使用者的其他任何重要信息 : 轮椅使用者同意被转介到轮椅服务单位吗? 是□ 否□ 转介人签名: 日期: 7 服务表格和清单列表 提示:轮椅服务转介表列在本手册中。其余所有表格均在 《轮椅服务初级教程》、《轮椅服务中级 教程》所附光盘中。 初级服务 1.轮椅服务 (初级)转介表 2.初级轮椅评定表 3.初级轮椅处方 (选择)表 4.初级轮椅参数表 5.初级轮椅适配检查表 6.轮椅安全和准备检查表* 7.轮椅随访表* 中级服务 8.轮椅服务 (中级)转介表 9.中级轮椅评定表 10.中级轮椅处方 (选择)表 11.中级轮椅参数表 12.中级轮椅适配检查表 13.中级轮椅使用者培训检查表 14.体位支撑装置 (PSD)表 *标注的表格均适用于初级和中级服务 8 制作检查凳 检查凳制作说明 1.如果没有15mm或20mm厚的胶合板时,就用18mm厚 的胶合板。 2.脚踏板位于滑轨之间,可调节高度并且应当易于滑动。 3.座面和脚踏板表面应当覆盖5mm~10mm的硬泡沫塑料 (EVA)或者与轮椅脚踏板上类似的防滑垫。 9 检查凳尺寸 10 制作检查床 检查床能够让轮椅使用者舒适地坐在上面,以便让医生更好地为其进行轮椅评估。 检查床应当稳固、安全,并且其高度合适便于患者从轮椅转移到检查床上。 尺寸 普通轮椅评定所需检查床尺寸约为:1800mm×600mm×500mm (长×宽×高)。 材料和结构 ●检查床框架可由木头或钢制成。 ●垫子: ○13mm厚的底部胶合板 ○50mm厚的高密度泡沫塑料 ○25mm厚的顶层软泡沫塑料 ●坐垫应包覆易于清洁的面料,如人造革或皮革。人造革或皮革应当切割成形,折叠、粘贴、装订 或钉在胶合板上,予以固定位置。 ●钢制框架应涂刷防腐底漆,再喷涂面漆。 11 制作足垫块 足垫块能够让轮椅使用者的双脚在评估过程中处于适合的高度,以便让其保持良好的坐姿。 为了使轮椅使用者的双脚处于正确位置,重要的是有一系列不同高度的足垫块或者可调节高度的 足垫块。 尺寸 表面面积:400mm×300mm。 高度可调节:15mm~150mm。 材料和结构 ●多个可以叠放的、不同高度的足垫块,或者是可调节高度的足垫块。 ●胶合板结构。 ●针对使用者双脚不均匀着地的情况 (双腿不等长或其他问题),需要使用两个不同高度的足垫块。 足垫块的基本堆积 12 测量工具样品 卡尺 木质测量工具 材料:3mm~9mm厚的胶合板。 木质底面带有刻度和魔术贴,用来固定可调侧。 木质侧面:一侧固定,另一侧可调。 乙烯基测量工具 底面是带有刻度的乙烯基材质。 木质侧面:一侧固定,另一侧可调。 13 技术设施指引:工作台与工作区 14 初级服务技术资源指南 下列工具用于组装、设置、调整、保养和维修产品,同时还可以满足产品的基本改制 (详见 《轮 椅服务初级教程》)。 工具 参数 数量 公制组合扳手系列 8mm~22mm (必须包含8mm、10mm、13mm、19mm型号) 2 英制组合扳手系列 1 公制内六角扳手系列 最好是长柄,特别是T型手柄 2 金属卷尺 长度5m 1 十字螺丝刀组 大号和中号 1 一字螺丝刀组 大号和中号 1 橡胶锤 锤重8盎司 1 钳子 中短号钳嘴 1 小钻 小 “平叶片”型 1 金属锉刀组 (3套) 类型:中号中细锉、半圆锉、圆锉、平锉 1 小型切管机和备用刀片 切割12mm~38mm管子 1 手工木锯 锯木头的锯子 (不是粗齿锯) 1 12英寸钢锯和刀片 用于锯金属 1 泡沫塑料切割刀 稍长且带锯齿的刀片或标准的切面包刀 1 切纸刀和备用刀片 1 重型剪刀 1 针线包 各种大小的针,强力尼龙线 1 轮胎气泵 可用于美式气嘴和一般气嘴两种自行车胎的阀门 1 带有轮胎撬杠的补胎套件 1 细记号笔 1 15 续表 工具 参数 数量 辐条扳手 (扳钳) 1 防护眼镜 1 油漆刷 1 清洁工具 桶和刷子 1 推荐电动工具 用于车间机械和手动工具 的变压器* 1 缝纫机 (重型) 1 重型缝纫机针组 1 电钻 钻头3mm~13mm,可变速 1 用于钻木头的钻头组 1 用于钻金属的钻头组 1 电钢丝锯 1 用于切割金属和木头的细 切刀片组 1 电动角磨机 1 中型和细的磨盘组 1 延长电缆 10m 2 稳压器 1 存储 工具箱 1 挂锁 2 带锁金属柜 1 耗材 轻质润滑油 黏合胶 标准PVA木胶 外观木器清漆 16 续表 工具 参数 数量 搪瓷金属烤漆 油漆稀释剂 肥皂 海绵 布料 17 中级服务技术资源指南 中级服务也需要初级服务技术资源列表中列出的所有工具。此外,在初级服务列表中标有*的项 目突出显示,以建议中级服务需要增加一套。 工具 参数 数量 必备物品 用于车间机械和手动工具的变 压器* 1 缝纫机 重型,能够缝制厚重织物 (如需要) 1 推荐物品 电焊机/惰性气体保护焊机 1 电焊手套 厚皮革,6英寸开口 1 电焊护眼面罩 2 砂轮机 粗、细砂轮片 1 砂带磨光机 带有除尘设备 1 砂带组 粗、细砂带 1 带锯 中型用于切割木材,胶合板,PU和EVA泡沫 1 压缩机 24L 1 带软管喷枪套件 1 气体钎焊工具包 焊枪带有各种直径喷嘴、调节器和软管 1 钎焊护眼眼罩 1 柱式钻床 (夹头尺寸3mm~ 13mm) 台式或落地式,带有钻台虎钳夹 (最好是旋转底座交叉多向 钻台虎钳夹) 1 电动工具 必备工具 手持电钻 (夹头尺寸3mm~ 13mm) 多段速和多扭矩设置更为有用 1 18 续表 工具 参数 数量 手持电动钢丝锯 1 角磨机 1 研磨盘组 粗盘、细盘 1 角向磨光机防护手套 1 延长电缆* 5m或10m 2 推荐工具 电动螺丝刀 无线式、一套配套螺丝刀、插座、内六角扳手 1 无线 手 持 电 钻 (夹 头 尺 寸 3mm~13mm)18V 多段速和多扭矩设置更为有用 1 圆锯 (最小185mm刀片) 1 烙铁 尖端用于在带子上打孔,平端用于密封切割后的带子 1 手动工具 必备工具 手工木锯 (通用) 22英寸,细齿 1 弓锯和锯条组 锯木头的细齿 1 铲形钻头组 1 埋头钻嘴 1 裁刀 (带固定螺栓) 台式安装 1 台用虎钳 (带固定螺栓)* 6英寸 2 钳子 长夹头,中号 1 老虎钳 (莫尔扳手) 短夹头,中号 2 老虎钳 (莫尔扳手) 长夹头,中号 2 C形夹 6英寸开口 2 C形夹 8英寸开口 2 打孔机和孔模 各种尺寸 1 钉枪 (钉木头) 1 铆钉枪 (拉钉枪) 1 金属尺* 1m (公制和英制) 1 19 续表 工具 参数 数量 金属尺 30cm 2 金属卷尺* 5m 1 游标卡尺 钳口宽度150mm 1 金属量角器 1~180度 (精确到1度) 1 定中心点的冲头 2 画线笔 2 锥子* 当没有钻头和电源时使用 1 角尺 600mm×400mm钢 1 可调扳手 最大开口1英寸 1 套筒扳手组 公制 (包括8mm、10mm、13mm、17mm、19mm尺寸) 1 轮胎撬杠* 4组 1 辐条扳手* 1 防护眼镜* 普通车间防护眼镜 4 耳朵保护罩 2 防尘面具 4 平木锉 中号 1 木锉组 1 半圆木锉组 1 推荐工具 套筒扳手组 英制 1 组合扳手组* 英制,1/4~11/2 1 内六角扳手 (L形) 英制 1 辐刨 1 组合直角尺 1 可调角度斜面 1 小直角尺 10英寸 1 普通车间 垃圾箱 3 20 续表 工具 参数 数量 地板刷 1 簸箕和刷子 1 抹布 1 车间清洁桶和海绵 2 车间家具和安全存储 带金属锁工具柜* 2 存放材料的锁柜 2 通常用的开放式橱柜 1 存放PSD部件的无锁柜 1 凳子 3 工作台* 3 排架 2 干燥架 用于摆放上了颜料和油漆的零件 1 耗材 油漆底漆 木器外漆 油漆面漆 木器外漆 亮光漆 外观等级 石油溶剂* 用于清洁刷子和喷枪 装油漆、亮光漆、胶的罐 砂纸 等级40目、80目和150目 粉笔 润滑脂 钎焊杆包 各种尺寸 钎焊剂 钢丝锯的锯条 分别用于切割木材、金属和塑料 订书针 深度为5mm和8mm 缝纫针 各种尺寸 电弧焊接棒 (焊接钢) 尺寸:2mm、4mm、6mm 孔模 各种尺寸 铆钉 直径为4mm和6mm 各种长度 21 准备切割泡沫塑料的锯条 ●取一个普通手工金属锯的锯条 (最好是使用过的),磨掉边缘锋利的齿尖 (V形截面)。 ●这样薄而锋利的锯齿刀在切割中密度和低密度的聚氨酯泡沫和聚合泡沫塑料时既方便又快捷。 ●在锯条的一端缠绕胶带作为手柄,以防止割伤手指。 22 初级和中级服务材料指南 改制和制作附加体位支撑装置 (PSDs)的材料通常用于中级服务。但是,初级服务也可以利用相 似的材料进行简单的改制。所需的材料数量取决于诸多因素,包括轮椅使用者的数量、中级轮椅服务 的数量和提供轮椅的类型。临床和技术人员应参与采购适合的材料。 材料 用途 注意事项 金 属/塑 料/木材 金属/塑料/木材形成PSD的结构,例如 硬椅座和靠背。 12mm厚的胶合板用来制作硬椅座和靠背非常 有用。它很坚固但是重量相对较轻。船用胶合 板最耐用,但是比较贵。 3mm的铝板和6mm的亚克力板或 ABS塑料 板也能用于制作硬靠背。在板中加入一层可以 增加刚度。 无论使用哪种板材,为了使用者安全,都要特 别留意去除或包覆尖锐边角。 泡沫塑 料/衬垫 泡沫塑料用于包覆PSDs与轮椅使用者 身体直接接触的区域。 硬泡沫塑料能保持其形状,用于实现 PSDs需要的形状来提供正确的支撑。 较软的泡沫塑料用于增加舒适性并降低 压力。 使用泡沫塑料的例子: ●软泡沫塑料应该加到带子上以分散压 力和增加舒适性; ●硬泡沫塑料可以用于制作躯干侧楔形 垫,加入到坐垫上做成大腿外侧楔形 垫或大腿内侧楔形垫; ●非常硬的泡沫塑料 (例如,EVA)可 以用于制作脚踏板补高或脚踏板楔形 垫和躯干侧垫。 在当地市场寻找并参观泡沫塑料、鞋、床垫和 家具厂,发现当地可得到的泡沫塑料。 尝试找到当地不同厚度 (25mm、50mm)和 不同硬度的泡沫塑料样品。 EVA是非常硬的泡沫塑料,它对提供坚固的 支撑和PSD的结构有用。EVA有时可以在生 产鞋的工厂找到。 用于制作人字拖的硬橡胶可以用来代替EVA。 质量好的聚合泡沫塑料是中等硬度的泡沫塑 料。聚合泡沫塑料可以用作波形或多层坐垫的 底座,制作骨盆后垫或坐骨前垫高,或在硬靠 背上塑造轮廓。 软 “床垫泡沫塑料”是软泡沫塑料用于舒适层 的实例。 23 续表 材料 用途 注意事项 如果没有硬泡沫塑料底座,最常用、便宜的非常 软的泡沫塑料不太适合单独用于制作减压坐垫。 椰壳纤维 (椰子纤维)可以用来代替硬泡沫塑料。 面料 面料用于包覆PSDs。 寻找一种耐用和便于清洁的面料 (通过擦拭或 取下清洗)。如果轮椅使用者大小便失禁,防 水面料对于椅座、坐垫和靠背都有用。柔软 的、T恤类材料 (棉或棉/莱卡)可以用作头 靠和躯干侧垫和躯干侧楔形垫。有弹性的面料 更容易适应PSDs的形状。 合成面料通常比天然面料让人感觉更热。 如果可能,尝试提供至少几种不同的颜色让轮 椅使用者选择。 尼龙带/ 尼龙搭 扣/带扣 尼龙带/尼龙搭扣/带扣用于制作绑带, 包括骨盆带、肩带、小腿带和足带。 25mm、35mm和50mm 的尼龙带是有用的。 带子越宽压力越均匀。熔化尼龙带的切割端以 防磨损。棉织带效果差些。 插扣 (例如背包上使用的)非常容易使用。使 用质量好的插扣将会更耐用。通过把插扣合在 一起和分开来测试。插扣应该容易地分和合, 除非松开否则不被拉开。 尼龙搭扣是一种很好的紧固件,然而,它需要 保持清洁,否则会失效。 软泡沫塑料垫应该放在所有的织带下面以保护 轮椅使用者的身体。 黏合剂 黏合剂用于黏合木材和泡沫塑料。 有木材胶 (通常称为白胶水或PVA)和泡沫 塑料胶 (接触黏合剂、鞋胶水或黄胶水)。 确保使用黏合剂的所有人都知道如何正确地 使用。 紧固件 紧固件用于安装PSDs在轮椅上。 有用的紧固件包括: ●螺栓及螺母 (最好是锁紧螺母)和垫圈。 ●T形螺母 (取代螺母钉进胶合板); ●订书针 (用于固定装饰面料)。 避免使用尖的螺钉,因为如果PSD损坏了, 它们会导致危险。 24 建立移动技能训练区指南 为了让使用者学会安全、正确地操作自己的轮椅,建立移动技能训练区是必不可少的。 至少应包括 ●符合当地的不同地形 ●斜坡 ●台阶 训练区应当靠近适配区,因为适配是下一个服务步骤,同时,当使用者尝试推动轮椅时,也常常 需要进行适配调整。在恶劣天气条件下,还应搭建一个顶棚。 移动技能训练区包括以下内容 项目 尺寸 用途:轮椅使用者和 他们的助手进行练习 平地 10m×1m (长×宽) 基本推行 模拟当地地形 (3个区域),例 如:沙地、草地和石头的地面 每个区域应当最少2000mm长, 1000mm宽 使用者当地的环境 25 续表 项目 尺寸 用途:轮椅使用者和 他们的协助者进行练习 障碍1 1500mm×1500mm×25mm高 障碍2 1500mm×1500mm×100mm高 在单台阶上练习 障碍3 1500mm×1500mm×200mm高 在单台阶上练习 1∶12坡道 约3600mm×1000mm (长×宽), 倾 斜 度:0mm (最 低 点)~ 300mm (最高点) 在标准斜坡上练习 1∶8坡道 约2400mm×1000mm (长×宽), 倾 斜 度:0mm (最 低 点)~ 300mm (最高点) 在陡坡上进行练习 门槛 (路缘和障碍)(见图一) 60mm高×50mm宽×1000mm长 门槛 (路缘和障碍)(见图一) 90mm高×50mm宽×1000mm长 越过道路中的障碍或门槛 楼梯 (见图2) 大约300mm 深,150mm 高和 1100mm宽 上下楼梯 如果当地的情况与建议的标准有较大差异,上表中列出的尺寸可按照当地的情况进行修改。重要 的是,可以通过这种培训学会如何应对当地环境,确保能够无障碍地到达移动训练区的任何区域。 有时,可以选用与服务区临近的自然地形区域作为自然训练区。 26 不同高度门槛的示例 图1 (单位mm) 27 模拟楼梯示例 图2 (单位mm) 28 轮椅供应的不同方法比较 轮椅供应的主要方式是本地生产轮椅、引进新轮椅和引进二手轮椅。在轮椅服务机构,轮椅也可 以回收再利用。 系列产品的长期稳定供应 正如 《资源有限地区手动轮椅服务指南》中表述的一样,轮椅使用者需要一系列适合的产品长期 供应。不论何种供应模式,其关键都要考虑到产品供应的长期稳定性。所有的供应模式都面临可持续 性和质量管理这两方面的挑战,要根据不同的情况、不同的环境进行考量。 轮椅使用者应当参与轮椅供应体系的计划、实施、管理和评估①,因此也包括参与特定环境下最 佳解决方案的选择。 如果当地有假肢矫形器服务机构,他们选择当地生产的产品还是引进产品,有助于决定轮椅供 应的方式。思考当地市场的类似产品,例如自行车或钢制家具,也有助于理解当地企业决定自行生 产或进口的原因。有或者没有当地其他生产企业是轮椅生产企业未来是否成功非常重要的指标。 在决定使用哪种供应模式之前,建议先做好充分的可行性研究,还要计算和比较成本。引进产品 的所有花费可以提前估计 (产品报价、运输和进口、仓储),但是要注意一些轮椅服务中不可控的问 题,如运输延误和汇率波动等。要想确定由本地制造商所生产产品的费用,需要深入了解车间的运行 费用、实际的生产成本和不可预知的费用。应该计算物流费用,如引进或本地生产两种方式所需的人 员、仓储和管理费用。 ① 资源有限地区手动轮椅服务指南,2008,P34(http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). 29 本地生产和进口产品优缺点的比较 《资源有限地区手动轮椅服务指南》指出,不论是本地产品还是进口产品,所有的轮椅都应当是适 用的①。在过去,为资源有限地区进口专门设计轮椅是不可能的事情。因此,本地生产轮椅是保证提 供适用轮椅的唯一途径。然而,为资源有限地区进口专门设计的轮椅正在变得越来越多。基于这一点, 思考这两种方式的优缺点是非常有必要的。 为了确保给轮椅使用者提供一系列适用的轮椅,在选择轮椅供应模式时,下面的对照表列出了不 同轮椅供应模式的优缺点。 本地生产 优点 缺点 ●政府致力于本地生产,可以传递一个信息,残 疾是属于社区的问题,必须全面解决,包括轮 椅制造。 ●可以根据当地的需求生产。 ●容易为产品提供本地的零配件。 ●创造当地生产制造业的就业机会,技能用于支 持当地轮椅维修和保养。 ●如果本地制造商有能力,可以满足定制轮椅的 需求。 ●本地生产更易与当地库存水平保持一致。 ●持续而灵活的生产能够满足所需库存的最小 存储。 ●当地使用者更容易参与产品研发,更快地反映 问题和需求。 ●难以保证规模较小的非机械化生产质量。 ●机械、工具、生产场地和人员培训需要初始 投资。 ●当产品订单无法满足生产车间的运行成本时, 很难留住车间员工。 ●生产车间管理可能很复杂。 ●始终依赖本地原材料和零件的供应。 ●有限的生产数量会增加产品的成本。 ●由于本地生产的劳动密集型,在轮椅服务的临 床方面则会投入精力过少。 ① 资源有限地区手动轮椅服务指南,2008,P71(http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). 30 续表 进口轮椅 优点 缺点 ●进口轮椅可以作为本地产品的补充,以确保向 使用者提供一系列不同的产品和元件,满足使 用者的个性化需求。 ●由于生产商建立了良好的质量控制机制,可以 保证产品质量的稳定性。 ●由于较大的生产量节约了潜在成本,从而可以 配送更多的轮椅。 ●由于生产所需的时间较少,轮椅服务机构可以 更多地专注于临床技能的提升。 ●可以在组装、调试、改制体位支撑、保养和服 务方面创造本地就业机会。 ●相较于本地生产,在机械、工具、材料和安全 上所需要的初始投资较少。 ●车间、技术人员管理没有本地生产复杂。 ●有物流和海关关税成本。 ●就运输成本而言,大批量的订单更符合成本 效益。 ●最小订货量的灵活性较低。 ●运输时间较长。在生产开始前,如果有最少订 货要求,可能会导致生产时间增加。 ●大批量的订单要求更多的资金、更大的存储空 间和更高的库存控制机制。 ●周期长的大批量采购,很难维持稳定的库存量。 ●通常进口产品可能无法适应当地的需求。 ●可能无法为产品提供本地的零配件。 ●无法创造本地制造业的就业机会。 ●本地使用者参与产品研发较困难。 进口回收轮椅 在许多经济发达地区,频繁更换轮椅或短期使用轮椅的情况通常导致需要二手轮椅库存。作为应 对,一些机构会回收、翻新和出口这些轮椅,以在资源有限地区再利用。 机构在决定进口二手轮椅是否是一个好的选择时,需要先弄清 “适用轮椅”的定义: ●能够满足使用者需求和环境状况; ●提供适配和体位支撑; ●安全耐用; ●国内可得到; ●在国内能够以经济和实惠的价格购买和维修,并获得持续的服务。 进口二手轮椅时的一些注意事项: ●如何确保这些轮椅适用于资源有限地区? ●当所提供的产品在型号、尺寸和质量方面有较大差别时,如何对国内确定的需求作出反应? ●如何提供零配件的稳定供应? ●如何为不同厂商各种产品调试和安装提供正确的工具? ●对本地制造商和服务供应商的影响。 31 现有服务供应体系中回收轮椅 随着服务的发展,一些使用者会长大而丢弃现有的轮椅,获得新的轮椅,或者不再使用轮椅,这 都是不可避免的。 由此,有些机构会建立制度,回收轮椅再给其他使用者。这样可以惠及更多的使用者。然而在确 定对你的服务机构是否是一个好的选择之前,需要考虑很多因素。 如果机构选择回收轮椅,重要的是要考虑回收的轮椅是否对使用者仍然适用。许多部件需要更换、 维修,带有细菌的任何部件 (泡沫材料、装饰材料、带子等等)都应当更换,以保证下一位使用者的 安全和健康。 影响回收轮椅复杂性和可行性的一些因素: ●替代零件的获得性; ●服务的使用者数量; ●使用者享受的资助机制; ●使用者年龄; ●提供产品的质量; ●当地的地形和环境因素 (可能影响轮椅的使用寿命)。 一些其他的考虑因素: ●需要将轮椅运回服务机构进行回收; ●翻新轮椅所需额外的厂房空间; ●需要先进技术和质量控制的培训。 32 辅助器具评估的参与度测量工具 受访者姓名: 地点: 日期: 采访者姓名: 1.您有辅助器具吗? □有 □无 (跳至问题5) 2.如果有,请问是何种辅助器具? 3.如果有,您正在使用辅助器具吗? □有 □无 (跳至问题5) 4.如果有,您在什么时候使用辅助器具? □一直 □有时,特定情况 (请填写): 接下来是一些关于您进行日常活动时困难程度的问题,包括在他人的帮助和使用辅助器具的情况下: 5.您在搭乘交通工具时的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法搭乘 不适用 6.您在做家务时的困难程度? 如洗衣或打扫。 □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法做家务 不适用 7.您在去学校和学习时的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法上学、学习 不适用 8.您在找工作和工作时的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法工作 不适用 33 9.您在参加娱乐和休闲活动时的困难程度? 如:运动、游戏、工艺美术、舞蹈和音乐等。 □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法参加 不适用 10.您在参与社会活动时的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法参加 不适用 34 辅助器具随访的满意度和效果测量工具 受访者姓名: 地点: 日期: 采访者姓名: 1.您正在使用何种辅助器具? 2.您什么时候获得这种辅助器具的? 3.您现在正在使用这个辅助器具吗? □有 (跳至问题5) □否 4.如果没有,为何不使用? (如您已回答问题4,请跳过余下问题。) 接下来是一些关于您进行日常活动时困难程度的问题,包括在他人的帮助和使用辅助器具的情况下: 5.您在搭乘交通工具时的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法搭乘 不适用 备注: 6.您在做家务时的困难程度? 如洗衣或打扫。 □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法做家务 不适用 备注: 7.您去学校和学习的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法上学、学习 不适用 备注: 35 8.您找工作和工作的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法工作 不适用 备注: 9.您参加娱乐和休闲活动的困难程度? 如:运动、游戏、工艺美术、舞蹈和音乐。 □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法参与 不适用 备注: 10.您参与社会活动的困难程度? □ □ □ □ □ □ 没有困难 轻微困难 中等困难 严重困难 无法参与 不适用 备注: 接下来是您对辅助器具满意程度的一些问题: 11.您对尺寸的满意程度? (有多大?) □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 12.您对重量的满意程度? (有多重?) □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 36 13.您对是否易于移动的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 14.您对外观的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 15.您对易于使用的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 16.您对安装所需时间的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 37 17.您对可靠性的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 18.您对满足自己需求的满意程度? (在合理时间内,它能够完成您想做的事情吗?) □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 接下来是一些关于您对获得辅助器具途径满意程度的问题: 19.您对提供给您的最佳技术建议的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 20.您对获得辅助器具所耗时间的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 38 21.如果不能正常使用,您对所提供帮助的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 22.您对为您提供如何使用辅助器具的帮助和建议的满意程度? □ □ □ □ □ □ □ 很糟糕 不好 基本不满意 一般 基本满意 满意 非常满意 备注: 接下来是一些关于您使用辅助器具经历的问题: 23.在过去的两周内,您使用了多少次 (多久)辅助器具? 平均每天、每个小时呢? □ □ □ □ □ 没有使用 每天少于1小时 每天1~4小时 每天4~8小时 每天超过8小时 备注: 24.回想一下在您得到现在的辅助器具之前,您最想完成或做好的事情。在过去两周内,辅助器具对此 起到了多大的作用? □ □ □ □ □ 完全没有帮助 稍有帮助 基本有帮助 帮助很大 非常有帮助 备注: 25.回想一下此前您最想完成或想做得更好的情景。当您使用现在的辅助器具时,您在这种情况下困 难程度多大? □ □ □ □ □ 不可能 困难很大 中等困难 轻度困难 没有困难 备注: 39 26.针对各种情况,您认为现在所使用的辅助器具足够有用吗? (使用辅助器具所带来的好处,是否大 于其在存储、维护、运输和使用中的困难?) □ □ □ □ □ 完全没用 有一点用 基本有用 有用 非常有用 备注: 27.考虑您获得辅助器具的困难,在过去的两周内使用现在的辅助器具,获得辅助器具的困难对您做 事情的影响有多大? □ □ □ □ □ 不可能 很大影响 中等影响 有一点影响 完全没有影响 备注: 28.考虑您获得辅助器具的困难,在过去的两周内使用现在的辅助器具,您认为其他人对您获得辅助 器具关注程度有多大? □ □ □ □ □ 非常关心 很关心 中等关心 稍微关心 完全不关心 备注: 29.考虑到各种情况,现在所使用的辅助器具对您的生活影响如何? □ □ □ □ □ 很差 没有改变 有一些 很大 非常大 备注: 来源: 世卫组织国际功能、残疾和健康分类 (ICF). SonyaMurchland于2011年出版的儿童版:QUEST2.1修订为QUEST2.2. IOI-HA.CoxRM,StephensD,KramerSE (2002).助听器国际成果清单的翻译. (IOI-HA).国际听力学杂志41 (1):3-26. 40 无障碍信息 与政府部门合作,如卫生、教育、交通和社区组织,提出无障碍的建议,可以显著提高移动障碍 人士参与社会的包容性和参与度。在设计建造时考虑到无障碍建设,比完成后再改建明显花费更少。 下面列出基本信息,更多内容可以在本书的光盘中了解。 居家无障碍 ●主要考虑因素是隔架的高度以及工作台面下方的可及性。 ●门口:宽度、开启方向、把手。 41 门口 ●宽度:900mm ●尽量使门从繁忙区朝向较安静区内侧开启。 例如,从客厅向卧室开启。 ●尽可能采用接近180度开合的铰链。 ●行动空间:门前后两侧过道需要保持畅通无障碍①。 ●入口受限的地方:建议安装推拉门 (见图:无障碍卫生 间)。门轨必须妥善维护,保证门的滑动流畅。 卫生间 ●向卫生间内开的门会减少卫生间内部空间,如果可能,应尽量避免占用内部空间。可使用推拉门 替代。 ●坐便器旁安装扶手有利于轮椅转移。 ① 无障碍设计注意事项,2006年,美国国际开发署,JohnGrooms,英国 motivation慈善信托基金,残疾组织联 合阵线. 42 社区无障碍 通道 ●应留有900mm 宽的无障碍通道。 ●通行量大的通道应有1500mm宽,以方便两位轮椅使用 者同时通过。 43 路缘 ●下斜路缘———缘石坡道是指有高度改变。(如下图) 坡道 建筑无障碍———要考虑所有人的需求。对于轮椅使用者,需要考虑以下几点特殊设计: ●坡度:室内1∶12室外1∶15。 ●坡面:防滑。 ●扶手:应伸出坡道起止点300mm。 ●坡道起点、终点及转向处,都应当留有大小为1200mm ~1500mm的平地。 ●坡道上方平地的测量应从开门处最大圆周的边缘量起。

PACHET DE IN STRUIRE PEN TRU MANAGE RI SERVICII PENTR U UTILIZATORII DE SCAUN RULANT MANUALUL F ORMATORUL UI

PACHET DE INST RUIRE PENTRU M ANAGERI SERVICII PENTRU UTILIZATORII DE SCA UN RULANT MANUALUL FOR MATORULUI Publicat de Organizația Mondială a Sănătății în 2015, cu tlul Wheelchair service training package for managers. Trainer's manual. © World Health Organizaon 2015 Organizația Mondială a Sănătății a acordat Fundației Movaon România dreptul de a traduce și de a publica ediția în limba română, aceasta fiind singura responsabilă pentru calitatea și acuratețea versiunii în limba română. În cazul în care vor exista discrepanțe între versiunea în limba engleză și cea în limba română, va prevala versiunea originală, în limba engleză. Servicii pentru ulizatorii de scaun rulant – Pachet de instruire pentru manageri. Resurse suplimentare © Fundația Movaon România 2016 Conținut: Manualul formatorului pentru manageri – Manualul și caietul parcipantului pentru manageri – Resurse suplimentare pentru manageri – Manualul formatorului pentru părțile interesate. 1. Scaune rulante – standarde. 2. Persoane cu dizabilități – recuperare. 3. Materiale didacce I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. Organizația Mondială a Sănătății. Fundația Movaon România Descrierea CIP a Bibliotecii Naţionale a României ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (GENEVA) SERVICII PENTRU UTILIZATORII DE SCAUN RULANT : PACHET DE INSTRUIRE PENTRU MANAGERI / ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (OMS) ; ED.: SARAH FROST, CHAPAL KHASNABIS, KYLIE MINES, LOURDES DE LA PEZA. – BUCUREŞTI : CONTAPLUS, 2015 BIBLIOGR. ISBN I. Frost, Sarah (ed.) II. Khasnabis, Chapal (ed.) III. Mines, Kylie (ed.) IV. De la Peza, Lourdes (ed.) 615.478.3 Această publicație a fost realizată de Fundația Movaon România în colaborare cu World Vision, în cadrul sub- grantului nr. APC-GM-0029-008, prin Advancing Partners & Communies (APC), un acord de cooperare de 5 ani finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională – USAID, prin Acordul nr. AID-OAA-A-12-00047, începând cu 1 octombrie, 2012. Terminologie Următorii termeni, utilizaţi în pachetul de instruire, sunt definiţi mai jos. Scaun rulant corespunzător Scaun rulant cu antrenare manuală Dispozitiv de suport postural (DSP) Scaun rulant Modificare scaun rulant Furnizare scaune rulante Servicii pentru utilizatorii de scaun rulant Personal furnizor de servicii pentru utilizatorii de scaun rulant Utilizator de scaun rulant Un scaun rulant care corespunde nevoilor utilizatorului şi caracteristicilor mediului în care acesta trăiește; care are dimensiunea potrivită și care oferă suport postural adecvat; care poate fi utilizat în condiții de siguranță şi este durabil; fiind disponibil în ţara utilizatorului; care poate fi obţinut şi întreţinut, iar serviciile sunt sustenabile în ţara respectivă, la cel mai accesibil preţ. Un scaun rulant a cărui propulsie se efectuează de către utilizator sau de către o altă persoană. Un dispozitiv fizic care oferă suport postural suplimentar. Un dispozitiv cu roţi care oferă mobilitate şi suport postural, utilizat de persoanele cu dificultăţi de mers sau de deplasare. Efectuarea unei schimbări la nivelul scaunului rulant Este termenul generic pentru proiectarea, producţia, furnizarea de scaune rulante şi servicii pentru utilizatorii de scaun rulant. Reprezintă acea parte a procesului de furnizare a scaunelor rulante care se ocupă de dotarea utilizatorului cu un scaun rulant corespunzător. Persoane specializate în furnizarea scaunelor rulante corespunzătoare. O persoană care are dificultăţi de mers sau de deplasare şi foloseşte pentru mobilitate un scaun rulant. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 4 CUPRINS Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri / 5 Introducere / 5 Grupul țintă / 6 Obiectiv / 6 Conținut / 7 Formatori / 7 Etapa inițială / 8 1. Recomandări pentru formatori / 9 1.1. Structura modulului de instruire / 9 1.2. Orarul modulului și durata sesiunilor / 9 1.3. Planul de desfășurare a sesiunilor / 10 1.4. Prezentările PowerPoint / 10 1.5. Evaluarea modulului de instruire după fiecare livrare / 10 1.6. Exemple de bună practică pentru formatori / 11 2. Cum să vă pregătiți pentru livrarea modulului de instruire? / 12 2.1. Familiarizați-vă cu situația actuală a furnizării serviciilor pentru utilizatorii de scaun rulant / 12 2.2. Clarificați rolul pe care îl au participanții în furnizarea serviciilor pentru utilizatorii de scaun rulant / 12 2.3. Parcurgeți fiecare plan de desfășurare a sesiunii și adaptați-l, dacă acest lucru este necesar / 12 2.4. Pregătiți spațiul unde va avea loc instruirea / 12 2.5. Pregătiți resursele și echipamentele / 13 3. Planuri detaliate pentru susținerea sesiunilor / 16 Bun venit, introducere și prezentare generală / 16 A: Noțiuni fundamentale / 19 A.1. Ce înseamnă furnizarea unui scaun rulant corespunzător? / 19 A.2. Furnizarea serviciilor pentru utilizatorii de scaun rulant / 28 A.3. Managerii care determină schimbarea / 37 B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 47 B.1. Accesarea serviciilor / 47 B.2. Spații și echipamente / 55 B.3. Gama de scaune rulante corespunzătoare / 62 B.4. Organizarea resurselor umane / 77 B.5. Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 85 C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 93 C.1. Cum stabilesc că activitatea mea este eficientă? / 93 C.2. Gestionarea cererii / 103 C.3. Planificarea activității de monitorizare / 118 C.4. Planificarea sustenabilității financiare / 131 Încheiere / 138 Bibliografie / 141 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 5 Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri Introducere În urma lansării în anul 2008 a Ghidului pentru furnizarea scaunelor rulante cu antrenare manuală în zone cu resurse limitate (1), în anul 2012 a fost publicat primul pachet de instruire, numit Servicii pentru utilizatorii de scaun rulant. Pachet de instruire – nivel de bază (2). Acesta a fost urmat în anul 2013 de lansarea Serviciilor pentru utilizatorii de scaun rulant. Pachet de instruire – nivel intermediar (3). Organizaţia Mondială a Sănătăţii (OMS), în parteneriat cu Agenţia Statelor Unite pentru Dezvoltare Internaţională (USAID) a elaborat acum a treia parte, care cuprinde două materiale: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri şi Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părţile interesate. Această a treia parte a fost creată pentru a susţine managerii în efortul de eficientizare a procesului de furnizare a scaunelor rulante corespunzătoare şi pentru a creşte gradul de conştientizare în rândul părţilor interesate şi a promova implicarea lor în dezvoltarea unor servicii de furnizare a scaunelor rulante corespunzătoare în ţara/zona lor Scaunul rulant este unul dintre echipamentele asistive cel mai frecvent utilizate pentru facilitarea mobilităţii personale. În cazul persoanelor care întâmpină dificultăţi de mers sau de deplasare, scaunul rulant este un instrument esenţial care facilitează mobilitatea, creşte capacitatea de a desfăşura anumite activităţi, oferă sentimentul de demnitate şi de stare de bine generală. Pentru utilizatorii de scaun rulant, mobilitatea înseamnă independenţă, accesul la servicii de sănătate, la educaţie, la angajare şi, de asemenea, participarea acestora la activităţi sociale şi culturale. OMS estimează faptul că peste 70 de milioane de persoane au nevoie de scaune rulante şi că doar 5 – 15% dintre acestea au acces la un astfel de echipament de mobilitate. În plus, oportunităţile de instruire a personalului în vederea acumulării cunoştinţelor şi dobândirii abilităţilor necesare pentru furnizarea eficientă a scaunelor rulante sunt limitate. Importanţa mobilităţii este reflectată în Convenţia Organizaţiei Naţiunilor Unite pentru Drepturile Persoanelor cu Dizabilităţi (CONUDPD) (4), care pledează pentru „măsuri eficiente în vederea asigurării mobilităţii persoanelor cu dizabilităţi în cel mai înalt grad de independenţă posibil”. Pentru realizarea mobilităţii personale, utilizatorii au nevoie de scaune rulante care au măsurile corespunzătoare şi care răspund nevoilor lor specifice, în special celor legate de stilul de viaţă şi mediul în care trăiesc. Acest aspect necesită o abordare orientată către nevoile individuale ale utilizatorilor de scaun rulant. O modalitate eficientă de a răspunde acestor nevoi individuale ale utilizatorilor de scaun rulant este furnizarea scaunelor rulante printr-un sistem bine organizat, care răspunde aşteptărilor utilizatorilor, care le respectă demnitatea şi este gestionat de către un personal bine pregătit. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Obiectivul întregului pachet de instruire este creșterea gradului de conştientizare şi dezvoltarea abilităţilor şi a nivelului de cunoştinţe ale personalului implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant. OMS înţelege faptul că doar personalul instruit nu poate asigura furnizarea de scaune rulante corespunzătoare şi că aceştia nu îşi pot îndeplini responsabilităţile în conformitate cu Ghidul privind furnizarea scaunelor rulante, fără ca la nivel de ţară să existe implicare la nivel mai înalt pentru dezvoltarea sau îmbunătăţirea sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachetul de instruire pentru manageri oferă o privire de ansamblu asupra rolului de manager al unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant, cu privire la implicarea personalului şi gestionarea implementării celor opt paşi ai acestuia, precum şi a problemelor apărute. Ne referim aici la resursele umane şi materiale necesare furnizării serviciilor pentru utilizatorii de scaun rulant, inclusiv la planificare, organizare, personal, management, costuri/finanţare şi monitorizare şi evaluare. Acest pachet de instruire va ajuta managerii: ź să planifice mai bine activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant; ź să crească nivelul de calitate al procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant; ź să crească gradul de retenţie a personalului; ź să crească numărul de utilizatori de scaune rulante care primesc un scaun rulant care răspunde nevoilor lor și ź să crească gradul de sustenabilitate a activităţii de furnizare a scaunelor rulante. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 6 Obiectiv Grupul ţintă Acest pachet de instruire se adresează întregului personal responsabil cu implementarea, administrarea şi evaluarea serviciilor de recuperare, inclusiv furnizarea scaunelor rulante şi a serviciilor pentru utilizatorii de scaun rulant. Nu este neapărat necesar ca participanții să aibă deja experienţă în ceea ce privește managementul furnizării serviciilor pentru utilizatorii de scaun rulant; cu toate acestea, modulul de instruire se bazează pe faptul că participanţii au abilităţi generale de management. Observaţii: durata fiecărei sesiuni poate varia în funcţie de următorii factori:· ź experienţa şi abilităţile pe care le au participanţii; ź numărul total de participanţi; ź nevoia de traducere pe parcursul sesiunilor; ź includerea unor materiale suplimentare. Acești factori vor determina de cât timp este nevoie pentru susținerea sesiunilor. Formatorii sunt încurajaţi să adapteze şi să modifice programul de desfăşurare, astfel încât acesta să se potrivească contextului local şi nevoilor de învăţare ale participanţilor. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 7 Formatori Conținut Pachetul de instruire poate fi parcurs în 13-14 ore, acest interval putând fi extins sau redus, în funcţie de cerinţele specifice şi de resursele disponibile. Pachetul de instruire include: ź o prezentare generală a paşilor cheie ai procesului de furnizare a scaunelor rulante descris în pachetele de instruire create de OMS: ź cunoştinţe de bază necesare furnizării serviciilor pentru utilizatorii de scaun rulant: ź inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant; ź gestionarea unui sistem de furnizare a acestor servicii; ź asigurarea sustenabilităţii sistemului de furnizare a acestor servicii. Abilități: Formatorii care susțin modulul de instruire trebuie să înțeleagă foarte bine subiectul acestuia, precum și contextul în care care se desfășoară instruirea participanților. Formatorii trebuie să cunoască dacă există inițiative de furnizare a serviciilor pentru utilizatorii de scaun rulant, aspectele problematice, legislația locală relevantă în domeniu, strategiile și politicile. O bună selecție a formatorului/formatorilor este un element important pentru succesul modulului de instruire. Se recomandă ca aceștia să aibă: ź experiență în activitatea de instruire și de facilitare, la un nivel corespunzător; ź experiență în gestionarea de grupe de participanți cu nivel de cunoștințe mixt; ź convingerea fermă că introducerea unui sistem pentru furnizarea de servicii corespunzătoare este în beneficiul utilizatorilor de scaun rulant. Numărul de formatori: Se recomandă să existe câte un formator pentru fiecare grupă de 8 – 10 participanți. Prezența unui utilizator de scaun rulant cu experiență, care cunoaște bine conținutul pachetului de instruire va constitui un avantaj. Se recomandă ca în cazul în care există mai mulți formatori, activitatea să fie împărțită de așa manieră încât să se evite susținerea de către o singură persoană a unui număr mare de sesiuni consecutive. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 8 Etapa inițială Înainte de susținerea modulului de instruire, copiați în calculator conținutul memory stick-ului din fișierul Pachet de instruire pentru manageri și părți interesate. Modalitatea cea mai simplă de susținere a sesiunii de instruire este următoarea: 1. Deschideți fișierul care conține Manualul formatorului și: 1.1 Citiți secțiunile Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri și Recomandări pentru formatori; 1.2 Tipăriți și îndosariați un exemplar al acestui manual, pentru fiecare formator care va susține modulul de instruire, dacă nu aveţi deja un manual tipărit; 1.3 Tipăriţi orarul şi formularele de evaluare a cursului. 2. Parcurgeți toate etapele de pregătire aşa cum sunt descrise în secţiunea Cum să vă pregătiți pentru modulul de instruire pentru manageri. Pentru informații suplimentare, consultați materialele pentru instruirea formatorilor (Card Decks). 3. Daţi fiecărui participant un set complet de materiale de instruire, care cuprinde: Manualul şi caietul participantului și afișul cu cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Dacă nu dețineți aceste materiale, ele pot fi tipărite de pe memory stick. 4. Deschideți orarul programului de instruire și faceți clic pe hyperlinkurile aferente fiecărei sesiuni, care vă vor deschide fișierul unde se află prezentările în Power Point și materialele video corespunzătoare. Cea mai bună metodă de susținere a modulului de instruire este să parcurgeți secțiunile în ordinea în care se află ele, respectând într-o cât mai mare măsură durata de timp alocată. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 9 1. Recomandări pentru formatori 1.1 Structura modulului de instruire Sesiune Durata (minute) Bun venit, introducere și prezentare generală 30 A. Noțiuni fundamentale A.1. Ce înseamnă furnizarea unui scaun rulant corespunzător? 50 A.2. Furnizarea serviciilor pentru utilizatorii de scaun rulant 40 A.3. Managerii care determină schimbarea 45 B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1. Accesarea serviciilor 45 B.2. Spații și echipamente 55 B.3. Gama de scaune rulante corespunzătoare 80 B.4. Organizarea resurselor umane 50 B.5. Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? 60 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1. Cum stabilesc că activitatea mea este eficientă? 75 C.2. Gestionarea cererii 85 C.3. Planificarea activității de monitorizare 85 C.4. Planificarea sustenabilității financiare 70 Încheiere 30 Total 800 minute 1.2. Orarul modulului și durata sesiunilor Acest modul de instruire poate fi susținut în zile consecutive sau în etape, pe parcursul unui interval de timp mai mare. Durata minimă a cursului este de 13 - 14 ore. Planul sesiunilor cuprinde o estimare a timpului alocat fiecărei sesiuni. Un model de orar este disponibil pe memory stick. Formatorii sunt încurajaţi să adapteze şi să modifice programul de desfăşurare, astfel încât acesta să se potrivească contextului local şi nevoilor de învăţare ale participanţilor. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 10 1.3. Planul de desfășurare a sesiunilor Există un plan detaliat pentru a facilita susținerea fiecărei sesiuni. Acesta poate fi folosit de către formatori pentru pregătirea şi livrarea fiecărei sesiuni. La începutul planului de desfășurare a fiecărei sesiuni găsiți următoarele informații: ź Obiectivele: detalii privind obiectivele de învățare ale respectivei sesiuni; ź Resurse: care sunt resursele necesare susținerii fiecărei sesiuni; ź Context: modul în care sesiunea poate fi adaptată în funcție de context (sau situație); ź De pregătit: modalitatea de pregătire a sesiunii; ź Structură: principalele elemente ale sesiunii. Restul planului de desfășurare a sesiunii este împărțit pe teme. Pentru fiecare dintre aceste teme, planul oferă instrucțiuni cu privire la modalitatea de prezentare și de livrare a informațiilor. La finalul fiecărui plan există o listă de recomandări pentru manageri. La sfârşitul fiecarei sesiuni, managerii sunt încurajați să se gândească la modalitatea de punere în aplicare a acestor recomandări, în contextul în care aceştia își desfășoară activitatea. 1.4. Prezentările PowerPoint Pentru susținerea sesiunilor există prezentări în format PowerPoint (PPT) şi filme video. Formatorii trebuie să ştie ca pe slide-uri sunt scrise doar punctele principale. 1.5. Evaluarea modulului de instruire după fiecare livrare Este recomandată evaluarea modulului de instruire după fiecare livrare, ca o bună practică. Formatorii pot să noteze propriile lor idei despre programul de instruire chiar pe parcursul cursului. La final, aceste informații îi pot ajuta să evalueze modulul de instruire, pentru identificarea atât a punctelor tari, cât și a elementelor care trebuie îmbunătățite. Astfel, formatorii pot evalua atât pachetul de instruire în sine, cât și abilitățile lor de livrare în contextul dat, pentru viitoarele instruiri. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 11 1.6. Exemple de bună practică pentru formatori Fiți pregătiți ź înainte de începerea cursului, citiți cu atenție planul de desfășurare a sesiunii; ź asigurați-vă că v-ați familiarizat cu conținutul materialului; ź pregătiți resursele necesare și sala în care va avea loc modulul de instruire. Prezentați informația clar ź vorbiți clar și calm; ź asigurați-vă că toți cei aflați în sală vă pot auzi; ź puneți întrebări pentru a vă asigura că participanții vă înțeleg; ź asigurați-vă că ceea ce scrieți pe tablă poate fi înțeles de către toți participanții; ź repetați elementele importante pentru ca participanții să le poată reține Gestionați durata alocată fiecărei sesiuni ź fiți atenți la durata fiecărei sesiuni și nu o depășiți; ź dacă există posibilitatea ca intervalul de timp alocat să fie insuficient, planificaţi acest lucru de la început; ź asigurați-vă că parcurgeți toate sesiunile planificate pentru ziua respectivă. Încurajați activitățile în grupuri mici ź monitorizați îndeaproape activitățile de grup și oferiți ajutor atunci când acest lucru este necesar; ź asigurați-vă că treceți pe la fiecare grup de participanți pentru a verifica modul cum progresează activitatea desfășurată. Încurajați participanții să fie activi și să se implice pe toată durata programului de instruire ź utilizați diferitele stiluri și metode de predare prevăzute în planurile de desfăşurare a sesiunilor; ź evitați să vorbiți prea mult – încurajați participanții să vorbească și să discute între ei; ź puneți întrebări pentru a încuraja participanții să se gândească ei înşişi la răspunsuri, evitând să le daţi intotdeauna direct răspunsul; ź încurajați toți participanții să vorbească, nu lăsați ca unul dintre ei să domine discuția; ź apreciați reuşitele și oferiți feedback pozitiv; ź comunicați-le participanților că pot pune întrebări în orice moment; ź dați exemple concrete, reale, pe care participanții să le recunoască; ź încurajați buna dispoziție! Folosiți activități/jocuri scurte, „de încălzire” ź folosiți din când în când activități/jocuri scurte, „de încălzire” (5 – 10 minute), pentru a ajuta participanții să se concentreze. Utilizați activități în care să poată fi implicate și persoanele cu dizabilități. Luați în considerare nevoile persoanelor cu abilități diferite ź luați în considerare nevoile participanților cu deficiențe vizuale, de auz sau de mobilitate. Este posibil ca unele activități sau abordarea modalității de susținere a modulului de instruire să fie necesar a fi adaptate în consecință. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 12 2. Cum să vă pregătiți pentru livrarea modulului de instruire 2.1. Familiarizaţi-vă cu situația actuală a furnizării serviciilor pentru utilizatorii de scaun rulant Organizațiile și formatorii care susțin acest modul de instruire pentru manageri trebuie să înțeleagă specificul procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant din respectiva regiune sau țară. Acest lucru se referă la: ź deținerea informațiilor cu privire la orice activitate de furnizare a serviciilor pentru utilizatorii de scaun rulant sau a iniţiativelor existente în acest domeniu; ź înțelegerea actualelor lacune în furnizarea serviciilor pentru utilizatorii de scaune rulante; ź cunoașterea legislației regionale/naționale, a strategiilor, politicilor și planurilor de acțiune din domeniul furnizării scaunelor rulante. 2.2. Clarificaţi rolul pe care îl au participanții în furnizarea serviciilor pentru utilizatorii de scaun rulant Trebuie să înțelegeți modul în care furnizarea acestui tip de servicii se încadrează în activitatea pe care participanții o desfășoară la locul de muncă. De exemplu, participanții își vor desfășura activitatea doar în acest domeniu sau vor avea și alte atribuții la locul de muncă? 2.3. Parcurgeţi fiecare plan de desfășurare a sesiunii și adaptaţi-l, dacă acest lucru este necesar Analizați cu atenţie fiecare plan de desfășurare a sesiunii – este posibil să fie necesară adaptarea unor sesiuni la contextul local. La începutul fiecărui plan de desfășurare a sesiunii, la secțiunea „context”, veți găsi sugestii pentru modul cum sesiunile pot fi adaptate la diferite contexte. 2.4. Pregătiţi spațiul unde va avea loc instruirea Spațiul trebuie să fie suficient de mare pentru a permite împărţirea participanţilor în grupuri mai mici în vederea desfășurării unor activități de grup. Toate spaţiile, inclusiv toaletele şi spaţiul pentru servirea pauzelor de cafea şi a prânzului trebuie să fie accesibile pentru utilizatorii de scaun rulant. Folosiți următoarea listă de verificare pentru a evalua și a pregăti spațiul în care va avea loc instruirea. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 13 Listă de verificare a spațiului pentru instruire: Sala de curs Zonă pentru predare o Scaune pentru fiecare participant – cu dotări care să le permită participanților să ia notiţe o Spațiu care să permită participanţilor împărţirea în grupuri mici de câte 2 - 4 participanți o Lumină și ventilație corespunzătoare o Zonă pentru pauzele de cafea/prânz Zonă curată adecvată consumului de alimente o Mese și scaune o Spațiu pentru spălarea mâinilor aflat în proximitate – săpun și prosoape curate o Toalete Toalete curate cu apă curentă, hârtie igienică, posibilitatea de spălare a mâinilor și dotate cu coșuri de gunoi o 2.5. Pregătiți resursele și echipamentele Materiale tipărite Resursa Cantitatea ü Comentarii / instrucțiuni Manuale, caiet exerciții practice Manualul formatorului 1 per formator o Comandați la OMS sau tipăriți și legați Manualul și caietul participantului 1 per participant o Comandați la OMS sau tipăriți și legați Resurse suplimentare pentru formator(i). De asemenea, decideți cum să împărțiți resursele relevante cu participanții. De exemplu: pe un memory stick/DVD; printr-o facilitate de partajare bazată pe internet; sau prin furnizarea de referințe pentru site-uri web. Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate Cel puțin un exemplar o Resursă pe suport DVD/ memory stick Document de poziție comun privind furnizarea dispozitivelor asistive în regiuni cu resurse limitate Cel puțin un exemplar o Resursă pe suport DVD/ memory stick Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 14 Manualul format orului Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD) Cel puțin un exemplar o Resursă pe suport DVD/ memory stick Ghidul privind Recuperarea bazată pe comunitate - broșura introductivă și componenta de sănătate Cel puțin un exemplar o Resursă pe suport DVD/ memory stick Managerii care determină schimbarea 1 per formator o Resursă pe suport DVD/ memory stick Sugestii de design pentru accesibilitate - 2006 Cel puțin un exemplar o Resursă pe suport DVD/ memory stick Logo-ul WSTP Un model la rezoluție înaltă o Resursă pe suport DVD/ memory stick Formular înregistrare participanți 1 per modul de instruire o Folosiți acest formular pentru a păstra informațiile cu privire la participanții prezenți Ecusoane 1 per participant și per formatori o Realizate local cu sigla WSTP Orar 1 per participant o Modelul este disponibil pe memory stick; adaptați în funcție de contextul local. Formular acord foto 1 per participant o Adaptați acest formular la cerințele organizației gazdă. Certificat de participare 1 per participant o Pregătiți certificate de participare sau adaptați modelul furnizat Afișe – afișe de creștere a gradului de conștientizare care vor fi folosite în sala unde se desfășoară instruirea: Servicii pentru utilizatorii de scaun rulant – Nivel de bază: etapele furnizării serviciilor pentru utilizatorii de scaun rulant; abilități de manevrare a scaunului rulant, escarele și întreținerea scaunului rulant la domiciliu. 4 o De tipărit de pe memory stick Servicii pentru utilizatorii de scaun rulant – Nivel intermediar: utilizatori de scaun rulant copii; poziții diferite; tabel dispozitive de suport postural (DSP) și listă de verificare instruire utilizator de scaun rulant de nivel intermediar. 4 o Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 15 Echipamente Articol Cantitate ü Comentarii/Instrucțiuni Videoproiector 1 o Computer 1 o Boxe 1 set o Pentru a asigura sonorul materialelor video Microfon 2 sau mai multe în funcție de numărul de participanți o Microfon mobil pentru întrebările adresate de către participanți sau pentru a obține feedback de la grupurile de lucru Tablă 1 o Markere pentru tablă 3-4 o Hârtie și suport pentru flipchart 1 suport flipchart și 1 set de coli de hârtie o Markere pentru flipchart 3-4 o Post-it-uri 3-4 seturi o Bandă adezivă sau un produs similar 1 rolă o Pentru a lipi pe perete afișe și coli de flipchart Scaune rulante - mostre 1 per 3 participanți o Mostre de scaune rulante disponibile pe plan local, pentru a fi utilizate de către participanți în timpul pauzelor. Încurajați participanții ca pe parcursul pauzelor să utilizeze diferitele scaune rulante disponibile (cu un „însoțitor”, pentru respectarea măsurilor de siguranță). Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 16 3. Planuri detaliate pentru suținerea sesiunilor Bun venit, introducere și prezentare generală O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor cunoaște obiectivele modulului de instruire; q vor cunoaște numele participanților și al formatorilor; q vor avea structura orarului modulului de instruire; q vor cunoaște regulile importante care trebuie respectate pe durata modulului de instruire. R E S U R S E Pentru sesiune: q Prezentarea PPT: Introducere; q Manualul și Caietul participantului – un exemplar pentru fiecare participant; q Materialul video: Etapele furnizării serviciilor pentru utilizatorii de scaun rulant ; q Orarul modulului de instruire – un exemplar pentru fiecare participant; q Ecusoane pentru formatori și pentru fiecare participant. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q includeți o ceremonie de deschidere, dacă acest lucru este potrivit în contextul cultural local; q modificați sau adaptați secțiunea „Prezentarea formatorilor și a participanților” pentru ca aceasta să fie adecvată fiecărei situații; q modificați, adaptați și/sau adăugați noi elemente la lista de „Reguli și așteptări”; q în cazul în care ați făcut schimbări în program, modificați slide-ul cu structura modulului de instruire. D E P R E G Ă T IT q Atunci când are loc înregistrarea participanților, înmânați-le acestora orarul, manualele, seturile de materiale suport și ecusoanele. qPregătiți toate resursele, parcurgeți prezentările PPT, vizionați materialul video și citiți planul de desfășurare a sesiunii. S T R U C T U R Ă 1. Ceremonia de deschidere (dacă este cazul) 2. Prezentarea formatorilor și participanților 3. Structura modulului de instruire 4. Orarul modulului de instruire, reguli și așteptări 10 10 5 5 Total durată sesiune 30 Pagina 17 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 1. Ceremonia de deschidere (durată estimată: 10 minute) Modulul de instruire poate debuta cu o ceremonie de deschidere, în funcție de contextul cultural și de obiceiurile locale. 2. Prezentarea formatorilor și participanților (10 minute) Formatori: Prezentați-vă. Oferiți participanților o prezentare concisă a experienței pe care o dețineți în domeniul furnizării serviciilor pentru utilizatorii de scaun rulant și al managementului acestui tip de servicii. Rugați participanții să se prezinte la rândul lor, spunându-și numele, organizația de la care vin și care le sunt așteptările în legătură cu acest modul de instruire. 3. Structura modulului de instruire (5 minute) Explicați: Scopul acestui program, citiți de pe slide. Citiți de pe slide, repetați dacă este necesar. Explicați: Modulul de instruire se bazează pe CONUDPD - recunoașterea faptului că persoanele cu dizabilități au aceleași drepturi ca orice altă persoană și descrierea, în acest context, a rolului unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant în realizarea acestor drepturi. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 18 Material video: Furnizarea serviciilor pentru utilizatorii de scaun rulant Acest material video prezintă cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant, care au fost parcurse în modulele de nivel de bază și intermediar Cereți participanților să urmărească materialul video și să noteze fiecare etapă a procesului. Prezentați materialul video. 4. Orarul modulului de instruire, reguli și așteptări (5 minute) Solicitați-le participaților să parcurgă orarul primit. Evidențiați orele de începere și de final și pauzele. Explicați regulile: ź localizarea toaletelor ź persoana căreia i se pot adresa pentru aspecte legate de cazare și transport ź care este procedura pentru situații de urgență Explicați așteptările: ź punctualitate ź setarea telefoanelor pe modulul silențios pe parcursul sesiunii ź participanții sunt încurajați să pună întrebări Explicați: În timpul modulului de instruire, participanții vor utiliza și manevra scaune rulante. Ori de câte ori folosiți scaunele rulante, amintiți-vă următoarele reguli de siguranță: ź nu stați pe suportul de picioare atunci când vă așezați și vă ridicați din scaunul rulant; ź nu țineți degetele pe spițele și frânele roților; ź când utilizați scaunul rulant pe suprafete înclinate, asigurați-vă că aveți întotdeauna un asistent în spatele dumneavoastră pentru a nu cădea pe spate. Furnizarea serviciilor pentru utilizatorii de scaun rulant Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 19 A.1. Ce înseamnă furnizarea unui scaun rulant corespunzător? O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea cuantifica nevoia de scaune rulante la nivelul țării lor și global; q vor știi să enumere două articole din CONUDPD care se referă la importanța furnizării serviciilor adecvate destinate utilizatorilor de scaun rulant; q vor putea defini ce înseamnă furnizarea unui scaun rulant corespunzător; q vor discuta despre modalitatea prin care politicile la nivel național pot sprijini furnizarea acestui tip de servicii; q vor putea explica modul în care Ghidul privind furnizarea scaunelor rulante poate contribui la dezvoltarea politicilor la nivel național. R E S U R S E Pentru sesiune: q Prezentarea PPT: A.1.: Ce înseamnă furnizarea unui scaun rulant corespunzător? q Manualul și Caietul participantului. C O N T E X T Adaptați conținutul acestei sesiuni, astfel încât aceasta sã fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q identificarea datelor statistice, din recensământ și a altor date relevante, în vederea cuantificării cererii de servicii destinate utilizatorilor de scaun rulant, în țara în care participanții își desfășoară activitatea; q studiul politicilor existente la nivel național și regional care se referă la acest aspect. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele q Pregătiți prezentarea PPT - slide 4 inserând denumirea țării/statisticile care se referă la aceasta. S T R U C T U R Ă 1. Introducere 2. Care este cererea de scaune rulante și în ce măsură este satisfăcută? 3. Dreptul la mobilitate personală 4. Sprijinul pentru furnizarea de scaune rulante corespunzătoare 5. Acțiuni pentru manageri – recapitulare 4 4 20 20 2 Total durată sesiune 50 A: Noțiuni fundamentale Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 20 1. Introducere (4 minute) Explicați: Pe parcursul acestei sesiuni vom vorbi despre furnizarea de scaune rulante corespunzătoare și despre modul în care nevoile individuale ale utilizatorului sunt elementul central al întregului proces. Citiți slide-ul, repetați dacă este necesar. 2. Care este nevoia de scaune rulante și în ce măsură este satisfăcută? (4 minute) Citiți slide-ul, repetați dacă este necesar. Întrebați: Știți câte persoane din țara dumneavoastră au nevoie de un scaun rulant? Validați răspunsurile. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 21 Explicați: ź OMS estimează că 1% din populație are nevoie de scaune rulante; ź Populația acestei țări este X (Inserați datele din recensământ. Calculați 1% din această cifră). 3. Dreptul la mobilitate personală (20 minute) Prezentați materialul video: Ce înseamnă pentru mine un scaun rulant corespunzător? În acest material video, un utilizator de scaun rulant cu experiență, Faustina, explică ce a însemnat pentru ea primirea echipamentului de mobilitate prin intermediul unui furnizor de servicii dedicate utilizatorilor de scaun rulant. Prezentați materialul video. Întrebați: Care sunt schimbările care au apărut în viața Faustinei după primirea scaunului rulant? Cele mai importante răspunsuri: ź Nu mai există riscul ca Faustina să cadă din scaunul rulant atunci când se deplasează pe drumuri accidentate (sentimentul de demnitate); ź Faustina poate menține poziția așezat datorită faptului că scaunul rulant are dimensiunea potrivită și pentru că îi oferă gradul de sprijin postural necesar (postură, confort); ź Faustina poate manevra scaunul rulant independent și în condiții de siguranță, chiar și pe drumuri accidentate sau aflate în pantă (independență); ź Se simte mai puțin limitată de dizabilitate (sentimentul de încredere); ź Se simte mai bine pentru că scaunul rulant este personalizat conform nevoilor ei (stima de sine) . Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 22 Explicați: Știm cu toții că un număr mare de persoane care au nevoie de scaun rulant nu dețin încă un astfel de echipament de mobilitate. Totuși, există un instrument important de care managerii se pot folosi pentru a susține și a promova drepturile persoanelor care au nevoie de scaune rulante. Explicați: ź Aceasta este Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD). ź Punctul central al acestei convenții îl reprezintă recunoașterea de către toți a faptului că drepturile se aplică tuturor, inclusiv persoanelor cu dizabilități Întrebați: A semnat țara noastră CONUDPD? Note pentru formatori: ź semnarea CONUDPD reprezintă intenția morală a guvernului de a respecta prevederile acestui document. ź ratificarea CONUDPD reprezintă obligația guvernului din punct de vedere moral și legal de a implementa prevederile convenției. Citiți slide-ul, repetați dacă este necesar. Explicați:Există câteva articole în CONUDPD care susțin importanța și relevanța furnizării unui scaun rulant corespunzător. Întrebați: Știe cineva ce articole din CONUDPD se referă in mod special la mobilitate? Validați răspunsurile. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 23 Explicați: ź Articolul 26 se referă la importanța recuperării și „abilitării”. ź Mobilitatea personală este o parte esențială a procesului de recuperare. Note pentru formatori: ź recuperare – recuperarea abilităților necesare incluziunii sociale; ź „abilitare” – dobândirea pentru prima dată a unor abilități. Citiți slide-ul, repetați dacă este necesar. Explicați: ź Mobilitatea este primul pas către incluziune. ź Atunci când o persoană beneficiază de un scaun rulant corespunzător oferit de un furnizor de servicii pentru utilizatorii de scaun rulant, rezultatul este crearea de noi oportunități pentru viața socială, pentru angajare și pentru educație. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 24 Explicați: ź Un scaun rulant corespunzător poate însemna pentru utilizator deschiderea către o nouă lume – de la excludere la incluziune, precum și participarea la toate activităţile sociale, sportive şi de petrecere a timpului liber. Toate acestea cresc gradul de independenţă şi sunt benefice din punct de vedere al stării de sănătate. Explicați: Mobilitatea personală înseamnă beneficii pentru toate părțile implicate: ź Membrii familiei au posibilitatea de a lua parte la activitățile din comunitate sau de a se angaja. ź Economia țării beneficiază de pe urma faptului că există mai mulți contribuabili și mai puține solicitări privind serviciile sociale, cauzate de complicații de ordin medical 4. Sprijinul pentru furnizarea de scaune rulante corespunzătoare (20 minute) Explicați: Am folosit termenul de furnizare de servicii pentru utilizatorii de scaun rulant. Întrebați: Ce înseamnă acest lucru conform Ghidului privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate? Încurajați participanții să răspundă și notați ideile pe tablă. Cele mai importante răspunsuri: ź Furnizarea de produse care sunt în acord cu definiția scaunului rulant corespunzător. ź Produsele sunt oferite prin intermediul unui furnizor de servicii pentru utilizatorii de scaun rulant. ź Personalul care furnizează aceste servicii a beneficiat de o instruire corespunzătoare. ź Există politici care să sprijine furnizarea serviciilor de acest tip, atât la nivel de organizație, cât și la nivel national. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 25 Citiți cele 4 domenii cheie ale Ghidului privind furnizarea scaunelor rulante. Explicați: Pentru ca furnizarea serviciilor pentru utilizatorii de scaun rulant să fie un proces eficient și sustenabil, este nevoie să fie sprijinită prin politici în domeniu și planificare. Ghidul privind furnizarea scaunelor rulante subliniază faptul că, în ceea ce privește furnizarea acestui tip de servicii, politicile regionale și internaționale constituie un suport și o resursă pentru politicile naționale. În acest sens, cel mai relevant document este CONUDPD. Citiți slide-ul, repetați dacă este necesar. Explicați: ź Obiectivul 3 al Strategiei Incheon își propune astfel să reducă la jumătate numărul persoanelor cu dizabilități care au nevoie de dispozitive asistive corespun-zătoare, dar care nu le dețin. ź S-a stabilit că indicatorul pentru îndeplinirea obiectivului este proporția de persoane cu dizabilități care are nevoie de echipamente sau dispozitive asistive și care dețin un astfel de echipament. Explicați: Guvernele statelor care au semnat Strategia Incheon s-au angajat să dezvolte planuri și programe naționale pentru a-și îndeplini această obligație. Acesta este un exemplu al modalității prin care politicile internaționale și regionale pot sprijini și încuraja dezvoltarea politicilor la nivel naţional. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 26 Explicați: Politicile la nivel național se pot dezvolta și în interiorul statelor. Mai jos vom analiza un exemplu care provine din Africa de Sud. Activitate Grupe Împărțiți participanții în trei grupe. Instrucțiuni Citiți exemplul referitor la politici naționale de furnizare a scaunelor rulante (Caietul de exerciții practice, pagina 92). Analizați politicile la nivel național care există deja. Discutați modalitatea prin care politicile de mai jos ar putea fi folosite în țara noastră și felul în care ea ar putea fi inclusă în sistemul de stat. Monitorizare Monitorizați desfășurarea activității și oferiți ajutorul în cazul în care acest lucru este necesar. Durata Acordați 6 minute pentru prima parte și 9 minute pentru discuții. Feedback Solicitați fiecărei echipe să își prezinte ideile în fața tuturor participanților. Notați răspunsurile pe tablă. Stabiliți dacă există deja în țară un sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant și care sunt principalele părți interesate. Notați orice sugestii pentru îmbunătățire cu ajutorul exemplului din Africa de Sud. Exemplu: Politici referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant în Africa de Sud În provincia Western Cape din Africa de Sud, un grup de specialiști din domeniul medical, care furniza servicii pentru utilizatorii de scaun rulant din Cape Town a devenit, treptat, din ce în ce mai nemulțumit din cauza abordării neunitare și nereglementate a procesului de furnizare a acestui tip de servicii. În urma colaborării cu un manager de programe desfășurate la nivelul respectivei provincii și cu furnizorii de servicii de recuperare din zonă, au dezvoltat un plan privind crearea unor standarde de profesionalism în furnizarea de servicii pentru utilizatorii de scaun rulant. Planul includea trei direcții de acțiune majore: 1. Analiza situației furnizării serviciilor pentru utilizatorii de scaun rulant în respectiva provincie; 2. Implementarea planului de instruire a celor care furnizează acest tip de servicii; 3. Stabilirea unor linii directoare cu privire la o strategie de management a furnizării de servicii pentru utilizatorii de scaun rulant, pentru provincia respectivă. Analiza situației: Analiza complexă a situației a confirmat lipsa structurii și a procedurilor, precum și faptul că abordarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant era una fragmentată. Numărul utilizatorilor care fuseseră evaluați individual, cărora li se prescriseseră scaune rulante și la care avusese loc probarea produsului era redus, iar numărul celor care beneficiaseră de instruire pentru folosirea echipamentului de mobilitate era chiar mai mic. În mod frecvent, scaunele rulante erau distribuite de către lucrători din domeniul social sau de către personal administrativ care nu aveau nicio pregătire specifică necesară furnizării scaunelor rulante. Cu toate că cei mai mulți furnizori de acest tip de servicii declarau că există o cerere foarte mare pentru astfel de echipamente de mobilitate, nu reușeau să cuantifice această nevoie, deoarece nu existau liste de așteptare. Activitățile specifice de monitorizare, efectuare reparații și întreținere aproape că nu existau. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 27 Implementarea instruirii: Prin analiza situației, grupul a identificat nevoia de instruire existentă și a început organizarea unor mici sesiuni practice de instruire care să acopere etapele lipsă din procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. La nivelul provinciei, au fost elaborate linii directoare care să stabilească standardele minime pentru implementarea pașilor esențiali în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant, precum și pentru managementul acestuia, cum ar fi instruirea personalului, generarea și gestionarea listelor de așteptare, alocarea bugetului și furnizarea serviciilor de întreținere și efectuare a reparațiilor. Stabilirea unor linii directoare: Managementul la nivelul provinciei a înțeles rolul important pe care îl avea acest grup de inițiativă în determinarea unei schimbări în domeniul furnizării scaunelor rulante și al serviciilor de recuperare și i-a oferit sprijin, astfel încât acesta să se constituie ca un grup de consultanță în ceea ce privește activitățile din domeniul recuperării desfășurate în respectiva provincie. Reprezentanți ai acestui grup de experți au participat, împreună cu managerii din provincia respectivă, la întâlnirile la nivel național referitoare la scaune rulante și dispozitive asistive, contribuind la stabilirea unor linii directoare la nivel național privind dispozitivele asistive în Africa de Sud, care au fost publicate în 2003. 5. Acțiuni pentru manageri - recapitulare (2 minute) Sumarizați: IInfluențarea politicilor și a planificării nu este un rol care îi revine unui individ sau unei organizații. Este necesar ca diferiți actori implicați să colaboreze în acest sens. . Citiți slide-ul ”Recapitulare puncte cheie”. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 28 1. Introducere (2 minute) Explicați: Pe parcursul acestei sesiuni vom discuta despre rolul managerului în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Aceste servicii oferă un cadru pentru evaluarea nevoii de mobilitate a fiecărui utilizator de scaun rulant, prin: ź asistența oferită utilizatorilor în alegerea unui scaun rulant corespunzător; ź instruirea utilizatorilor și a însoțitorilor, sprijin constant și direcționarea lor către alți furnizori de servicii, atunci când este necesar. A.2. Furnizarea serviciilor pentru utilizatorii de scaun rulant O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor discuta despre modele de furnizare a serviciilor pentru utilizatorii de scaun rulant; q vor putea explica diferența dintre modelul de furnizare a serviciilor de nivel de bază și modelul pentru servicii de nivel intermediar; q vor discuta despre rolul managerului în furnizarea serviciilor pentru utilizatorii de scaun rulant; q vor discuta rolul utilizatorilor de scaun rulant în cultura organizației R E S U R S E Pentru sesiune: q Prezentare PPT: A.2: Furnizarea serviciilor pentru utilizatorii de scaun rulant; q Manualul și caietul participantului; q Post-it-uri. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q Studiați modelele de furnizare a serviciilor pentru utilizatorii de scaun rulant disponibile local. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele; q Asigurați-vă că afișul cu cele 8 etape ale procesului de furnizare a serviciilor se află în sală într-un loc vizibil; q Poziționați panoul pentru scris lângă panoul folosit pentru proiectarea prezentării PPT. S T R U C T U R Ă 1. Introducere 2. Niveluri de furnizare a serviciilor pentru utilizatorii de scaun rulant 3. Modele de furnizare a serviciilor pentru utilizatorii de scaun rulant 4. Rolul complex al managerului în procesul de furnizare a acestui tip de servicii 5. Implicarea activă a utilizatorilor de scaun rulant în furnizarea serviciilor destinate lor 6. Acțiuni pentru manageri – recapitulare 2 5 10 15 5 3 Total durată sesiune 40 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 29 Prezentați-o pe Clara: Clara trăiește în Timorul de Est. Ea lucrează în magazinul deținut de familia ei, care se află în partea din față a casei lor. Clara a fost diagnosticată cu poliomielită și are nevoie de un scaun rulant pentru a se deplasa în interiorul casei, pentru a lucra în magazin și pentru a se deplasa în afara casei. Clara reușește să mențină poziția așezat fără suport suplimentar și folosește un scaun rulant cu antrenare manuală, care a fost adaptat astfel încât să se potrivească dimensiunilor corpului ei. Clara este un exemplu de persoană căreia îi poate fi furnizat un scaun rulant printr-un serviciu de nivel de bază. Prezentați-o pe Ishade: Ishade are vârsta de opt ani și locuiește în Sri Lanka. A fost diagnosticată cu paralizie cerebrală. Acest lucru înseamnă că Ishade nu își poate controla membrele superioare, cele inferioare, capul și gâtul. Ea nu poate menține poziția așezat fără suport. Ishade reprezintă un exemplu de persoană care are nevoie de suport postural suplimentar în timpul folosirii scaunului rulant. Lui Ishade trebuie să i se furnizeze un scaun rulant prin intermediul unui serviciu de nivel intermediar. Explicați: Trebuie să corelăm cerințele individuale ale utilizatorului, furnizarea de servicii și instruirea personalului care livrează aceste servicii. 2. Niveluri de furnizare a serviciilor pentru utilizatorii de scaun rulant (5 minute) Explicații: Fiecare scaun rulant care i se potrivește utilizatorului îi oferă acestuia un anumit grad de suport postural. Spătarul, perna, suporturile pentru picioare și pentru brațe furnizează suport postural atunci când sunt ajustate astfel încât să se potrivească dimensiunilor utilizatorului. Cu toate acestea, un număr mare de utilizatori de scaun rulant, copii și adulți, au nevoie de suport postural suplimentar în timpul folosirii echipamentului de mobilitate. Explicați: ź Clara are nevoie de servicii pentru utilizatorii de scaun rulant cu cerințe de nivel de bază. ź Personalul furnizor are nevoie de instruire – nivel de bază. ź Personalul care va fi instruit este cel care va implementa cei opt pași ai procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 30 Explicați: ź În cazul lui Ishade este necesar ca serviciile să fie furnizate de către un personal care are un nivel mai ridicat de cunoștințe și abilități și care poate să îi ofere suportul postural suplimentar de care ea are nevoie. ź Personalul identificat pentru instruire trebuie să fie familiarizat cu informațiile din modulul de bază, la care se adaugă instruirea de nivel intermediar în furnizarea serviciilor pentru utilizatorii de scaun rulant. Întrebați: Utilizatorii care apelează la sprijinul vostru au nevoie de servicii de nivel de bază sau intermediar? Validați răspunsurile. Note pentru formatori: ź La această întrebare nu există răspunsuri corecte sau răspunsuri greșite. Uneori, furnizorul de servicii se concentrează pe un anumit tip de nevoi, de exemplu, servicii pentru utilizatori de scaun rulant copii sau recuperarea persoanelor cu leziuni medulare. În toate regiunile va exista o îmbinare a tipurilor de cerințe. În consecință, peste tot vor fi necesare atât serviciile de nivel de bază, cât și cele de nivel intermediar. ź Clarificați faptul că atât utilizatorii adulți, cât și utilizatorii de scaun rulant copii pot avea nevoie de servicii de nivel intermediar. 3. Modele de furnizare a serviciilor pentru utilizatorii de scaun rulant (10 minute) Explicați: Orice proces de furnizare a serviciilor pentru utilizatorii de scaun rulant trebuie să conțină cele opt etape. Diferitele modalități de parcurgere a acestora constituie modele de furnizare a serviciilor. Indiferent de modelul folosit, toți utilizatorii trebuie să aibă acces la toți acești opt pași. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 31 Explicați: Vom analiza diferite modele de furnizare a serviciilor pentru utilizatorii de scaun rulant. Există un număr mare de variațiuni ale acestor modele. Vom parcurge rapid diferențele care pot exista, în termeni de spațiul unde se furnizează aceste servicii și de rolurile pe care le pot avea membrii echipei. Prezentați un model de furnizare a serviciilor pentru utilizatorii de scaun rulant care se desfășoară la sediul furnizorului. Explicați: ź Spațiul poate avea o zonă destinată furnizării serviciilor, inclusiv una pentru exersarea abilităților de manevrare a scaunului rulant și o zonă pentru reparații și operațiuni de întreținere echipamente de mobilitate. ź Echipa implicată în această activitate poate include persoane a căror activitate să fie dedicată în întregime furnizării de servicii pentru utilizatorii de scaun rulant. Prezentați un model integrat de furnizare a serviciilor pentru utilizatorii de scaun rulant. Explicați: ź Cei mai mulți furnizori oferă „servicii integrate”. Acest lucru înseamnă că furnizarea serviciilor pentru utilizatorii de scaun rulant se integrează în celelalte tipuri de activități desfășurate. ź De exemplu, furnizarea serviciilor poate fi integrată unui centru de protezare/ortezare, departamentului de fizioterapie sau poate fi parte a activității unei clinici. ź Activitatea personalului este împărțită în zile dedicate furnizării acestui tip de servicii și zile în care se desfășoară alte tipuri de activități în cadrul organizației/spitalului. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul i caietul participantului Pagina 32 Prezentați un furnizor de servicii pentru utilizatorii de scaun rulant care își desfășoară activitatea în comunitate (pe teren). Explicați: ź Spațiul utilizat poate fi unul provizoriu. Fie o organizație parteneră oferă acces la o încăpere sau o clădire, fie se desfășoară vizite la domiciliu. ź Unele activități specifice celor opt etape ale furnizării serviciilor pot fi împărțite între personalul de la sediu și o organizație parteneră. ź Un stoc limitat de scaune rulante poate fi depozitat la organizația parteneră. ź Este nevoie de instruire pentru a crește capacitatea organizației partenere. ź Poate fi necesar să identificăm în comunitate diverși furnizori care au competențe în servicii de reparare și întreținere, de exemplu sudură, lucrări de tâmplărie sau de tapițerie. Prezentați un tip de serviciu mobil în furnizarea serviciilor pentru utilizatorii de scaun rulant. Explicați: ź Scaunele rulante asamblate sau neasamblate, împreună cu sculele și echipamentele necesare sunt transportate cu ajutorul unui vehicul. ź Personalul care furnizează serviciile se deplasează cu ajutorul acestui vehicul. ź Este posibilă efectuarea unor reparații și operațiuni de întreținere. ź Acest serviciu de tip mobil poate să folosească clădiri din comunitate sau să transporte toate elementele necesare furnizării serviciilor pentru utilizatorii de scaun rulant in comunitate. Explicați: Nu toate cele opt etape ale furnizării serviciilor pentru utilizatorii de scaun rulant trebuie să fie oferite de către aceeași organizație. Colaborarea în cadrul unei rețele de organizații ajută la creșterea eficienței serviciului și a gradului de acces al utilizatorilor de scaun rulant la aceste servicii. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 33 Explicați: ź Împărțirea atribuțiilor între furnizorii care își desfășoară activitatea la sediu și cei care lucrează în comunitate (pe teren) variază în funcție de context. ź Imaginea prezintă un model de furnizare a serviciilor pentru utilizatorii de scaun rulant structurat în opt etape, unde trimiterea și monitorizarea sunt activități desfășurate de către parteneri din comunitate. Activitate Grupe Împărțiți participanții în perechi. Instrucțiuni Explicați: pe parcursul modulului de instruire vom aborda detaliile referitoare la modelul de furnizare a serviciilor aplicat în organizațiile unde lucrează participanții. Pentru început: Discutați cu partenerul dacă vreunul din cei 8 pași ai procesului de furnizare a scaunelor rulante este realizat de alte organizații partenere (de exemplu: trimiterea, monitorizarea). Notați pe post-it-uri, care sunt acele etape ale procesului de furnizare a serviciilor care sunt implementate de către o organizație parteneră. Folosiți câte un post-it pentru fiecare etapă a procesului de furnizare a serviciilor. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata alocată acestui exercițiu este de 5 minute Feedback Enumerați fiecare pas, conform afișului cu etapele procesului de furnizare a serviciilor. Solicitați-le participanților să plaseze post-it-uri în dreptul etapelor care sunt implementate de către organizații partenere. Sumarizați ideile la final, punând accentul pe faptul că toate organizațiile trebuie să lucreze în parteneriat în ceea ce privește trimiterea utilizatorului către furnizorul de servicii și că urmează să discutați ulterior despre beneficiile parteneriatului în implementarea altor etape ale procesului de furnizare. Întrebați: Care sunt argumentele care susțin identificarea și planificarea unui model corespunzător de furnizare a serviciilor pentru utilizatorii de scaun rulant? Validați răspunsurile și notați-le pe tablă. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 34 Cele mai importante răspunsuri: ź locul unde se află sediul furnizorului de servicii în raport cu cei care beneficiază de aceste servicii; ź aria geografică de acțiune a furnizorului de servicii pentru utilizatorii de scaun rulant (proximitatea față de beneficiarii serviciului); ź caracteristicile geografice ale zonei (comunități localizate pe insule, zone montane cu puține căi de acces); ź capacitatea de care dispun potențialele organizații partenere. 4. Complexitatea rolului de manager (15 minute) Explicați: Managerul este responsabil de calitatea serviciilor oferite. De asemenea, managerul are responsabilitatea de a sprijini personalul în activitatea de furnizare a celor opt etape și de a coordona „traseul” utilizatorului în scaun rulant (și al însoțitorului/membrilor de familie) în parcurgerea acestora, astfel încăt să răspundă așteptărilor utilizatorului. De asemenea, managerul deține un rol mai complex, care este important în sprijinirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Vom analiza acum în ce constă complexitatea acestui rol. Activitate Grupe Împărțiți participanții în grupe de câte trei. Instrucțiuni Înmânați-le participanților post-it-uri. Cereți-le să noteze ideile lor cu privire la rolurile pe care le deține managerul. Monitorizare Încurajați participanții să se gândească care sunt elementele importante pentru un sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant care să fie sustenabil. Durata Alocați 3 minute pentru a nota ideile pe post-it-uri și 7 minute pentru a sumariza aspectele legate de rolul managerului. Explicați: Atunci când inițiem un parteneriat este important să discutăm cu organizația parteneră despre nevoia de instruire și să planificăm modul în care cunoștințele și abilitățile personalului acesteia pot fi dezvoltate, astfel încât respectiva organizație să poată implementa parțial sau total cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Vom discuta despre acest lucru pe parcursul modulului de instruire. Feedback Implicați întregul grup pentru feedback. Proiectați imaginea care prezintă cele șase roluri complexe (așa cum sunt ele descrise în Ghidul de furnizare a scaunelor rulante). Solicitați unui voluntar din fiecare grupă să citească ideile notate pe post-it-uri. Poziționați post-it-urile în dreptul elementelor la care se referă. Observați eventuale omisiuni și completați sugestiile participanților, acolo unde este necesar. Pagina 35 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Ghidul privind furnizarea scaunelor rulante oferă recomandări de bune practici în furnizarea serviciilor pentru utilizatorii de scaun rulant. Citiţi slide-ul, repetaţi dacă este necesar. Explicați: Pe lângă măsurile active pentru solicitarea părerilor utilizatorilor de scaun rulant, există numeroase avantaje în includerea acestora ca membri ai echipei care furnizează serviciile. Dacă printre participanții la modulul de instruire există și persoane utilizatoare de scaun rulant, întrebați-i care consideră ei că sunt beneficiile includerii utilizatorilor de scaun rulant în echipa care furnizează acest tip de servicii. Întrebați: Echipa din care faceți parte include și persoane utilizatoare de scaun rulant? Care sunt avantajele implicării active a utilizatorilor de scaun rulant în furnizarea serviciilor? 5. Implicarea activă a utilizatorilor de scaun rulant în procesul de furnizare a serviciilor de acest tip (5 minute) Explicați: Se recomandă implicarea activă a utilizatorilor de scaun rulant în proiectarea, livrarea, monitorizarea și evaluarea sistemului de furnizare a serviciilor. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pagina 36 Cele mai importante răspunsuri: ź constituie modele pentru alți utilizatori de scaun rulant din comunitate; ź schimbarea percepțiilor la nivel de comunitate; ź o stare de spirit pozitivă în cadrul echipei – atunci când lucrăm cu persoane care constituie; un exemplu pozitiv, gradul de motivație crește; ź transmiterea unui mesaj pozitiv cu privire la angajamentul luat în ceea ce privește; participarea și incluziunea utilizatorilor de scaun rulant; ź crește măsura în care furnizarea de servicii răspunde cerințelor utilizatorilor de scaun rulant. Explicați: faptul că o organizație din România a înțeles de ce este atât de importantă prezența utilizatorilor de scaun rulant în cadrul echipei care furnizează servicii de acest tip, încît a luat decizia să includă câte un utilizator de scaun rulant în componența fiecărei astfel de echipe. Manualul format orului 6. Acțiuni pentru manageri – recapitulare (3 minute) Citiți slide-ul, repetați dacă este necesar. Utilizatorii de scaun rulant în echipele de furnizare servicii din România O organizație nonguvernamentală din România, care furnizează servicii destinate utilizatorilor de scaun rulant, a recrutat persoane din rândul acestora pentru a face parte din echipele sale de furnizare a serviciilor. Utilizatorii de scaun rulant au diferite roluri în cadrul echipelor, în funcție de abilitățile lor. Acest ONG a observat un impact pozitiv major în angajarea utilizatorilor de scaun rulant. Prin interacțiunea zilnică la locul de muncă, în calitate de colegi, fiecare membru al echipei conștientizează mai bine care sunt nevoile utilizatorilor de scaun rulant, clienții utilizatori de scaun rulant se simt mai în largul lor să își împărtășească problemele cu utilizatorii de scaun rulant din cadrul echipei, iar aceștia constituie un model pentru ceilalți. Pagina 37 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului A.3. Managerii care determină schimbarea O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea explica rolul pe care trebuie să îl aibă managerii în coordonarea persoanelor implicate în crearea sau dezvoltarea unui sistem de furnizare de servicii adecvate destinate utilizatorilor de scaun rulant; q vor propune strategii pentru coordonarea personalului, precum și pentru organizarea acestuia și a resurselor pe parcursul procesului de schimbare. R E S U R S E Pentru sesiune: q Prezentare PPT: A.3: Managerii care determină schimbarea q Manualul și caietul participantului Pentru formatori: q ”Leading change for better health” („Schimbare pentru o mai bună stare de sănătate”), Capitolul 6 din Managers Who Lead, pagina 149 (5). C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q În cazul în care formatorul deține informații relevante sau are experiență în ceea ce privește eforturile făcute la nivel local pentru schimbarea modului de furnizare a serviciilor pentru utilizatorii de scaun rulant (sau alt tip de servicii) este util să împărtășească aceste informații. Poate da exemple de: mobilizare a resurselor umane implicate, cu rezultate pozitive sau de neimplicare a resurselor umane care a creat rezistență la schimbare, ceea ce a dus la eșec. D E P R E G Ă T IT q Pregătiți resursele. q Citiți ”Leading change for better health” („Schimbare pentru o mai bună stare de sănătate”), Capitolul 6 din Managers Who Lead, pagina 149. q Parcurgeți prezentarea PPT și citiți planul de desfășurare a sesiunii. q Pregătiți patru coli de flipchart cu următoarele titluri: 1. Acțiuni pe care le pot întreprinde managerii pentru a crea o viziune comună cu privire la furnizarea unor servicii corespunzătoare dedicate utilizatorilor de scaun rulant. 2. Acțiuni pe care le pot întreprinde managerii pentru a transmite mesajul privind importanța furnizării unor servicii corespunzătoare pentru utilizatorii de scaun rulant. 3. Acțiuni pe care le pot întreprinde managerii pentru a corela resursele umane și materiale. 4. Acțiuni pe care le pot întreprinde managerii pentru motivarea, implicarea și mobilizarea personalului. S T R U C T U R Ă 1. Rolul managerului în coordonarea procesului de schimbare 2. Crearea unei viziuni comune cu privire la furnizarea serviciilor corespunzătoare dedicate utilizatorilor de scaun rulant 3.Transmiterea mesajului că procesul de furnizare a serviciilor corespunzătoare pentru utilizatorii de scaun rulant trebuie să aibă prioritate 4. Corelarea resurselor umane și materiale 5. Motivarea, implicarea și mobilizarea personalului 6. Acțiuni pentru manageri - recapitulare. 10 7 5 5 12 6 Total durată sesiune 45 Pagina 38 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului 1. Rolul managerului în coordonarea procesului de schimbare (10 minute) Introducere: corelați această sesiune cu cele anterioare. În sesiunile anterioare am discutat despre nevoia uriașă de scaune rulante, nevoie care nu a fost încă soluționată. Mobilitatea personală le permite persoanelor cu dizabilități să fie membri activi ai comunităților din care fac parte. Pentru mulți dintre aceștia, scaunul rulant cu design potrivit și care este pe măsura lor poate însemna primul pas către incluziune și participare. Explicați: ź Pentru a putea instrui corespunzător resursele umane și pentru a avea un sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant bazat pe Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiunile cu resurse limitate, OMS și partenerul său USAID au dezvoltat Servicii pentru utilizatorii de scaun rulant. Pachet de instruire. Explicați: Scopul general al pachetului de instruire este să contribuie la creșterea gradului de conștientizare privind nevoia de instruire și la dezvoltarea abilităților și cunoștințelor tuturor celor implicați în furnizarea serviciilor pentru utilizatorii de scaun rulant. Cu toate acestea, la nivel de țară, este nevoie de implicarea celor aflați în management, care să sprijine crearea sau dezvoltarea sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant, deoarece doar personalul instruit nu deține capacitatea necesară de a livra servicii adecvate și nu-și poate îndeplini atribuțiile așa cum sunt ele prevăzute în Ghidul privind furnizarea scaunelor rulante. Întrebați:În România, care credeți că trebuie să fie rolul managerului în ceea ce privește crearea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant? Încurajați participanții să răspundă și notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź creșterea gradului de conștientizare și promovarea nevoii de servicii corespunzătoare pentru utilizatorii de scaun rulant; ź crearea bugetului și planificarea furnizării scaunelor rulante; ź coordonarea eforturilor; ź organizarea procesului de furnizare; ź monitorizarea și evaluarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pagina 39 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Inițierea sau îmbunătățirea sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant implică o schimbare la nivel organizaţional. O astfel de schimbare se poate dovedi foarte dificilă. Explicați: S-au făcut numeroase studii pentru a facilita înțelegerea factorilor care pot contribui la reușita procesului de schimbare organizațională. Pe parcursul acestui modul de instruire ne vom concentra asupra a patru aspecte prin care managerii pot influența schimbarea organizațională. Acestea sunt: 1. Crearea unei viziuni comune cu privire la furnizarea de servicii corespunzătoare pentru utilizatorii de scaun rulant. 2. Transmiterea mesajului privind importanța furnizării unor scaune rulante corespunzătoare. 3. Organizarea personalului și a resurselor. 4. Motivarea, implicarea și mobilizarea personalului. 2. Crearea unei viziuni comune cu privire la furnizarea de servicii corespunzătoare pentru utilizatorii de scaun rulant (7 minute) Citiți slide-ul, repetați dacă este necesar. Întrebați: Considerați că această afirmație (sau una similară) este utilă? Cele mai importante răspunsuri: ź oferă sentimentul că există un scop comun; ź indică o direcție comună; ź oferă un punct de pornire pentru o acțiune comună; ź este un factor de motivație. Pagina 40 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri Manualul și caie tul participantul ui SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Note pentru formatori: ź nu este posibilă stabilirea unei viziuni sau afirmarea unei misiuni în cadrul acestui modul, deoarece nu sunt prezente toate părțile interesate; ź sugestiile cu privire la crearea unei afirmații care să exprime o viziune comună sunt incluse în pachetul dedicat părților interesate. Citiți slide-ul, repetați dacă este necesar. Citiți slide-ul, repetați dacă este necesar. 3. Transmiterea mesajului referitor la importanța furnizării unor scaune rulante corespunzătoare și faptul ca aceasta reprezintă o nevoie urgentă (5 minute) Întrebați: Cum credeți că puteți transmite mesajul referitor la importanța furnizării unor servicii corespunzătoare pentru utilizatorii de scaun rulant? Pagina 41 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: ź discutați despre nevoia de servicii de acest tip, la nivel ce țară, care nu este acoperită; ź discutați despre nevoia de scaune rulante la nivel global; ź discutați despre dreptul la mobilitate personală; ź discutați despre caracteristicile scaunului rulant corespunzător și despre nevoia furnizării acestuia împreună cu serviciile necesare; ź împărtășiți poveștile de succes; ź împărtășiți beneficiile la nivel individual, pentru comunitate și pentru societate, care decurg din furnizarea unor scaune rulante corespunzătoare. Explicați: Nevoie urgentă înseamnă faptul că există o nevoie de astfel de servicii care nu poate fi evitată sau amânată. Oamenii urmează prioritățile stabilite de cel care îi coordonează, în consecință, demersurile managerului trebuie să transmită ideea necesității de a acționa rapid. 4. Corelarea resurselor umane și materiale (5 minute) Explicați: Furnizarea serviciilor pentru utilizatorii de scaun rulant presupune personal instruit, spațiu adecvat şi resurse. Întrebați: Cum credeți că puteți comunica ideea nevoii de acțiune rapidă în ceea ce privește îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant? Citiți rar întrebările de pe slide, dându-le participanților posibilitatea să se gândească la răspunsuri. Citiți de pe slide, repetați dacă este necesar. Întrebați: Ce pot face managerii pentru a organiza resursele umane și materiale în vederea furnizării serviciilor pentru utilizatorii de scaun rulant? Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 42 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Încurajați participanții să răspundă și notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź să identifice spațiile care pot fi folosite pentru furnizarea acestor servicii; ź să aloce cu prioritate resurse pentru activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant; ź să folosească viziunea și valorile declarate ale organizației pentru a reaminti personalului care este scopul furnizării scaunelor rulante corespunzătoare; ź să își exprime aprecierea și să recompenseze performanțele deosebite în furnizarea serviciilor pentru utilizatorii de scaun rulant; ź să faciliteze lucrul în echipă. Note pentru formatori: ź participanții vor avea tendința de a petrece mult timp discutând despre finanțare - nu permiteți acest lucru; ź validați ideea că finanțarea este un element esențial al acestui proces, despre care veți discuta mai târziu; ź cereți-le participanților să se concentreze pe alte elemente pe care un manager le poate utiliza pentru corelarea resurselor umane și materiale. 5. Motivarea, implicarea și mobilizarea personalului (12 minute) Întrebați: Ce poate face un manager pentru a motiva personalul pe care îl coordonează? Încurajați participanții să răspundă și faceți legătura cu următorul slide. Explicați: așacum ați observat deja, probabilitatea ca personalul să fie mai motivat și mai implicat este mai mare atunci când oamenii se simt incluși și când părerea lor contează. Există patru modalități cheie de motivare a personalului: 1. Includerea personalului în planificare și implementare; 2. Depășirea obstacolelor prin acțiuni comune; 3. Crearea de rezultate pe termen scurt și recunoașterea acestora; 4. Integrarea schimbărilor în sistemul și cultura organizației. Pagina 43 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Există posibilitatea ca personalul să dovedească rezistență la schimbare dacă nu înțeleg... ź ....ce anume implică schimbarea; ź ....de ce este importantă schimbarea; ź ....ce înseamnă schimbarea în ceea ce îi privește pe ei și activitatea lor. Întrebați: Care sunt modalitățile prin care managerii pot include personalul în etapele de planificare și implementare? Validați răspunsurile. Explicați: Deseori, personalul poate aduce o contribuție valoroasă prin experiența și abilitățile pe care le deține. ź Personalul care a fost implicat în crearea unei viziuni pentru sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant și în planificarea implementării acestui sistem va avea, cel mai probabil, mai multă energie și mai mult entuziasm în sprijinirea implementării. ź Atunci când personalul este implicat în procesul de planificare pentru îmbunătățirea furnizării serviciilor – acesta înțelege importanța acestor servicii, înțelege ce implică schimbarea și rolul pe care îl vor avea în implementarea acestora. ź Includerea utilizatorilor de scaun rulant în acest proces de planificare reprezintă întotdeauna o sursă de valoare adaugată. Întrebați: Cum depășește un manager obstacolele împreună cu echipa sa? Validați răspunsurile. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 44 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: Membrii echipei trebuie să simtă că beneficiază de sprijinul managerului. ź Pentru a face față provocărilor, personalul trebuie să aibă autoritatea, cunoștințele și abilitățile necesare desfășurării noilor activități. ź Observați etapele procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant și oferiți feedback, precum și resursele necesare. ź Identificați cauzele problemelor și nu vă ocupați doar de simptomele acestora. Întrebați: Care sunt modalitățile prin care managerul creează rezultate pe termen scurt? Citiți informațiile de pe slide și dați câte un exemplu pentru fiecare enunț. ź Identificați care sunt rezultatele imediate, măsurabile, care pot fi obținute într-un interval de timp scurt. o De exemplu: identificarea a patru surse noi pentru trimiteri, până la sfârșitul lunii. ź Prezentați poveștile de succes într-o modalitate care să fie relevantă din punctul de vedere al clienților, furnizorilor și al sponsorilor. o De exemplu: împărtășiți cazurile unor oameni care au primit un scaun rulant corespunzător, iar dupa aceea, au putut participa la viața comunității sau si-au gasit un loc de muncă. Apreciați și răsplătiți rezultatele bune. De exemplu, exprimați-vă aprecierea, în mod public, astfel încât membrii echipei să vadă care sunt rezultatele pozitive obținute pe termen scurt și să simtă că sunt apreciați pentru efortul lor, astfel incât nivelul lor de implicare să poată fi menținut. Întrebați: Care sunt modalitățile prin care managerul poate permanentiza schimbările în sistemul și cultura organizației? Citiți informațiile de pe slide și dați câte un exemplu pentru fiecare enunț. Pagina 45 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: ź Dacă schimbarea nu devine parte integrantă a sistemului și a culturii organizaționale, ea nu va rezista în timp. De exemplu: crearea unui obicei de sărbătorire a rezultatelor pozitive, încurajarea împărtășirii poveștilor de succes în cadrul întâlnirilor sau în pauzele de lucru. ź Încorporarea în sistemul de lucru al organizației a noilor valori, comportamente și procese. De exemplu: permanentizarea schimbărilor pozitive prin introducerea de noi responsabilități în fișa postului și prin actualizarea politicilor la nivel de organizație. 6. Acțiuni pentru manageri - recapitulare (6 minute) Citiţi lista acțiunilor recomandate managerilor și cereți participanților să lucreze cu caietul de exerciții practice. Pregătiți patru coli de flipchart cu următoarele titluri: 1. Crearea unei viziuni comune 2. Modalitatea de a transmite mesajul referitor la importanța si urgența furnizării unor servicii corespunzătoare pentru utilizatorii de scaun rulant 3. Organizarea părților interesate și a resurselor 4. Motivarea, implicarea și mobilizarea părților interesate. Explicați că acești „facilitatori ai schimbării” vor rămâne vizibili pe întreaga durată a sesiunilor. Aici vor fi notate acțiuni comune pe care managerii și părțile interesate le pot face pentru a îmbunătăți sistemul privind furnizarea scaunelor rulante corespunzătoare, la nivel de țară. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 46 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Întregul grup de participanți Instrucțiuni Încurajați participanții să noteze pe etichete autoadezive orice idee pe care o au. Explicați că la finalul modulului de instruire veți trece în revistă toate aceste sugestii. Cereți-le participanților să utilizeze caietele de exerciții practice. Explicați că pot nota în aceste caiete exemple de acțiuni individuale care au ca scop crearea sau îmbunătățirea furnizării serviciilor adecvate pentru utilizatorii de scaun rulant in contextul în care ei își desfășoară activitatea. Solicitați-le participanților să dea câte două exemple de acțiuni individuale pe care le vor nota în caietul lor de exerciții practice. Explicați că vor avea oportunitatea să noteze propriile acțiuni la sfârșitul fiecărei sesiuni. Monitorizare Încurajați participanții să noteze ideile pe care le au deja. Durata Durata exercițiului este de 5 minute. Feedback Rugați un voluntar să clarifice diferența dintre notarea sugestiilor pe colile de flipchart pregătite și notarea în caietul de exerciții practice a acțiunilor planificate. Confirmați faptul că ideile notate pe colile de flipchart sunt acțiuni comune ale diferitelor organizații sau ale părților interesate, în timp ce caietul de exerciții practice este pentru notarea acțiunilor personale legate de furnizarea serviciilor pentru utilizatorii de scaun rulant, în cadrul organizației unde își desfășoară ei activitatea. Pagina 47 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului B.1. Accesarea serviciilor B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea explica ce înseamnă un „serviciu echitabil”; q vor putea descrie cel puțin trei acțiuni pentru manageri care au ca scop dezvoltarea rețelei de surse care pot face trimiteri; q vor putea enumera acele categorii de persoane care au un acces mai dificil la serviciile pentru utilizatorii de scaun rulant; q vor putea enumera acțiuni pentru manageri cu scopul de a crește gradul de acces la servicii pentru toți utilizatorii de scaun rulant. R E S U R S E Pentru sesiune: q Prezentare PPT: B.1: Accesarea serviciilor; q Manualul și caietul participantului; q Manualul Resurse Suplimentare pentru Manageri. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care participanții își vor desfășura activitatea. De exemplu: q identificați exemple pozitive ale unor sisteme de trimiteri în țara sau regiunea de unde sunt participanții, care pot fi folosite pentru a înlocui exemplele cuprinse în planul de desfășurare a sesiunii; q identificați care sunt barierele de care se lovesc diverse grupuri de oameni în accesarea serviciilor, inclusiv a serviciilor pentru utilizatorii de scaun rulant, în contextul local. De exemplu: analizați statistici relevante pentru serviciile din respectiva regiune, citiți articole relevante în domeniu, discutați cu persoane care coordonează furnizarea serviciilor, cu reprezentanți ai organizațiilor persoanelor cu dizabilități sau cu persoane din comunitate. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. S T R U C T U R Ă 1. Introducere 2. Ce este un serviciu echitabil? 3. Trimiterea și programarea 4. Ce pot face managerii pentru a asigura furnizarea de servicii echitabile? 5. Acțiuni pentru manageri – recapitulare 2 5 15 20 3 Total durată sesiune 45 Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 48 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 1. Introducere (2 minute) Explicați: Pe parcursul acestei sesiuni vom discuta despre rolul pe care îl are managerul în dezvoltarea unui sistem pentru trimiteri. Acest lucru include crearea unei rețele de surse de trimiteri, a unui sistem pentru trimiteri și programări și asigurarea caracterului echitabil al acestui serviciu. Explicați: Un „serviciu echitabil” este cel prin care utilizatorii de scaun rulant au oportunități egale de a primi un scaun rulant. 2. Ce este ”serviciul echitabil” (5 minute) Aici includem: ź bărbați, femei, băieți și fete; ź tineri, persoane de vârsta mijlocie și vârstnici; ź persoane care locuiesc în apropiere sau în zone mai îndepărtate – de exemplu, în mediul rural; ź persoane care aparțin anumitor grupuri etnice sau au o anumită situație socio-economică. Întrebați: În regiunea unde vă desfășurați activitatea există categorii de persoane care întâmpină dificultăți în accesarea serviciilor de recuperare? Reamintiți-le participanților că „accesul” la servicii nu înseamnă doar accesul la locul unde acestea sunt furnizate. Accesul la servicii înseamnă posibilitatea de a fi informat despre existența acestora, deplasarea la locul furnizării sau primirea acestor servicii la domiciliu. Încurajați participanții să răspundă și notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź femei și fete; ź persoane care locuiesc la o distanță mare de locul furnizării serviciilor / persoane care locuiesc în mediul rural; ź persoane cu venituri mici; ź copii; ź persoane aparținând unor grupuri etnice sau cu o anumită situație socio-economică; ź persoane vârstnice; ź grupuri specifice – de exemplu, este posibil ca persoanele cu HIV sau cele diagnosticate cu lepră să fie discriminate. Pagina 49 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: ź Serviciile echitabile se bazează pe faptul că toți oamenii au drepturi egale în ceea ce privește furnizarea de servicii pentru utilizatorii de scaun rulant, indiferent de dizabilitate, vârstă, sex, religie, resurse financiare, limba vorbită sau de grupul etnic din care fac parte. ź Un serviciu echitabil nu înseamnă furnizarea unui număr egal de scaune rulante unor beneficiari aparținând anumitor grupuri (de exemplu, un număr egal de scaun rulante pentru femei și bărbați). Acest lucru se datorează faptului că nevoile variază de la un grup la altul. ź Servicii echitabile înseamnă că cei care au nevoie de un scaun rulant beneficiază de același acces la servicii ca oricine altcineva. 3. Trimiterea și programarea (15 minute) Explicați: Trimiterea și programarea reprezintă prima etapă în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Evidențiați această etapă pe graficul etapelor furnizării serviciilor pentru utilizatorii de scaun rulant. Explicați: Un sistem de trimiteri eficient presupune relații bune între furnizorul de servicii pentru utilizatorii de scaun rulant și comunitate, deoarece membrii comunității sunt cei care îi vor identifica pe utilizatori și îi vor îndrepta către furnizor. Întrebați: Cine sunt persoanele și organizațiile care vor identifica și vor trimite utilizatorii de scaun rulant către furnizorul de servicii? Încurajați participanții să răspundă și notați răspunsurile pe tablă, la capitolul: ”Rețeaua de trimiteri”. Pachet de instru ire pentru mana geri Manualul format orului SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 50 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: ź spitalul din localitate; ź centre pentru sănătate aflate în comunitate; ź rețele de recuperare bazată pe comunitate; ź autorități la nivelul așezărilor rurale, membrii ai consiliilor locale, reprezentanți ai bisericii; ź organizații ale persoanelor cu dizabilități; ź alți utilizatori de scaun rulant; ź medici/asistente medicale/profesioniști din domeniul recuperării medicale/asistenți sociali. Explicați: Este foarte important ca managerii să identifice sursele care pot face aceste trimiteri, în zona în care își desfășoară activitatea. Activitate Grupe Împărțiți participanții în două grupe. Instrucțiuni Indicați fiecărei echipe la care dintre întrebările de pe fișa de lucru B.1: „Accesarea serviciilor” (din Caietul participantului) trebuie să răspundă. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata exercițiului este de 10 minute. Feedback Solicitați fiecărei echipe să prezinte răspunsurile în fața tuturor participanților. Notați răspunsurile pe tablă. Pagina 51 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Întrebare Potențiale răspunsuri Întrebarea 1: Crearea unei rețele de surse de trimiteri În calitate de manager, care sunt acțiunile necesare pentru a construi o rețea de persoane și organizații capabile să identifice și să direcționeze utilizatoriii de scaun rulant către serviciile pe care le oferă organizația dumneavoastră? ź identificarea surselor care pot face trimiteri (persoane și organizații) existente în zona unde vă desfășurați activitatea; ź stabilirea cu personalul furnizor de servicii pentru utilizatorii de scaun rulant care sunt tipurile de informații de care au nevoie aceste surse pentru a putea identifica persoanele care au nevoie de scaun rulant și cum le pot îndruma către furnizorul de astfel de servicii; ź pregătirea (sau sprijinirea personalului care trebuie să facă acest lucru) formularelor/pliantelor care să conțină informațiile de care au nevoie aceste potențiale surse pentru a face trimiteri; ź efectuarea de vizite (sau sprijinirea personalului care trebuie să facă acest lucru) la persoanele sau organizațiile care pot deveni surse pentru trimiteri pentru prezentarea serviciilor furnizate; ź organizarea unui eveniment de tipul „porți deschise” la care să participe utilizatori de scaun rulant și potențialele surse pentru trimiteri; ź organizarea unei sesiuni de instruire privind rețeaua pentru trimiteri, pentru aceste surse de trimiteri. Întrebarea 2: Formulare de trimitere Parcurgeți modelele de formular de trimitere din pachetul de instruire pentru manageri - Resurse suplimentare, aflat pe memory stick. V-ar fi de folos un astfel de formular de trimitere (sau o versiune adaptată a acestuia)? Dacă nu, de ce nu? Dacă da, în calitate de manager, ce puteți face pentru a introduce folosirea acestui formular? (Notă – dacă utilizați deja un sistem de trimiteri, descrieți care au fost pașii pentru a introduce și a sprijini folosirea formularului de trimitere) Dacă nu: Unele dintre provocările cu care se confruntă furnizorii de servicii pentru utilizatorii de scaun rulant în încercarea de a introduce utilizarea formularului de trimitere: ź sursele care pot face trimiteri au nevoie de instruire în ceea ce privește completarea formularului de trimitere; ź chiar și după instruire, sursele de trimitere nu completează formularul de trimitere; ź nu toate persoanele care pot face trimiteri au timpul necesar pentru a completa aceste formulare; ź sursele nu au posibilitatea de a transmite formularele; ź există deja un sistem pentru trimiteri – care nu include un formular specific pentru utilizatorii de scaun rulant. Dacă da: Acțiuni pentru manageri în vederea introducerii formularului de trimitere: ź folosirea unui formular de trimitere scurt – conține doar informațiile esențiale de care are nevoie furnizorul de servicii pentru utilizatorii de scaun rulant; ź includerea prezentării acestui formular de trimitere în toate activitățile de instruire/ prezentare a serviciului de furnizare a scaunelor rulante pentru potențiale surse de trimitere; ź furnizarea formularului de trimitere, în variantă tipărită, tuturor potențialelor surse; ź oferirea unui feedback pozitiv la primirea formularelor; ź stabilirea de programări ca urmare a primirii formularelor de trimitere – astfel încât sursele pentru trimiteri să vadă că sistemul funcționează. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 52 4. Ce pot face managerii pentru a asigura furnizarea de servicii echitabile? (20 de minute) Explicați: Am identificat deja categorii de persoane care ar putea întâmpina dificultăți în accesarea serviciilor pentru utilizatorii de scaun rulant. Este important să avem în vedere aceste categorii atunci când construim o rețea de surse pentru trimiteri. Următoarea activitate are rolul de a-i ajuta pe manageri să se asigure că grupurile care se confruntă cu obstacole în accesarea serviciilor pentru utilizatorii de scaun rulant sunt luate în calcul în procesul de creare a rețelei pentru trimiteri. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Împărțiți participanții în patru echipe. Instrucțiuni Indicați fiecărei echipe care este categoria de utilizatori de care se va ocupa: ź femei și fete; ź persoane din mediul rural și persoane cu venituri limitate; ź copii și vârstnici; ź persoane aparținând anumitor grupuri entice sau având o anumită situație socio-economică. Solicitați fiecărei echipe: ź să noteze care sunt acțiunile prin care managerii pot facilita accesul la servicii al persoanelor din grupul care le-a fost indicat; ź încurajați echipele să ia în considerare ideile discutate anterior, la secțiunea despre crearea rețelei de surse pentru trimiteri. ź evidențiați faptul că acțiunile enumerate trebuie să fie realizabile și practice în contextul în care își desfășoară participanții activitatea. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 10 minute pentru activitate și 10 minute pentru feedback. Feedback Cereți fiecărei echipe să prezinte tuturor participanților ideile notate. Notați răspunsurile pe tablă. Pagina 53 Exemple de acțiuni prin care managerii pot crește gradul de acces la servicii pentru utilizatorii de scaun rulant (este posibil ca participanții să identifice și alte modalități) Femei și fete: ź Diseminarea, prin diverse metode, a informației referitoare la serviciile disponibile – de exemplu, radio, broșuri cu texte simple, afișe, alte mijloace vizuale; ź Materialele de promovare trebuie să reprezinte atât femei, cât și bărbați; ź Identificarea unor utilizatoare de scaun rulant care pot constitui un exemplu și care să vorbească public despre importanța scaunelor rulante în cazul femeilor care au nevoie de acestea; ź Comunicarea cu reprezentanții autorităților din comunități, pentru a transmite ideea că scaunele rulante sunt importante în egală măsură în cazul femeilor, copiilor și al bărbaților; ź Sprijinirea și încurajarea participării femeilor la toate aspectele legate de furnizarea serviciilor pentru utilizatorii de scaun rulant, inclusiv la nivel de management și de conducere; ź Transmiterea către organizații ale persoanelor cu dizabilități a informațiilor referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant și evidențierea faptului că atât femeile, cât și bărbații au nevoie de scaune rulante pentru mobilitate; ź Descrierea furnizării serviciilor pentru utilizatorii de scaun rulant ca fiind o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”. Copii: ź Să ne asigurăm că informația legată de furnizarea serviciilor este disponibilă în locurile frecventate de părinții copiilor cu dizabilități – de exemplu, centre pentru sănătate din comunitate - spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei, temple; ź Descrierea furnizării de servicii pentru utilizatorii de scaun rulant ca fiind o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”; ź Furnizarea de informații și instruire persoanelor care lucrează cu copii cu dizabilități – de exemplu; medici, asistente, lucrători din domeniul sănătății care își desfășoară activitatea în comunități; ź Materialele de promovare trebuie să includă atât imagini cu copii, cât și cu adulți; ź Explicarea beneficiilor furnizării de scaune rulante pentru utilizatorii copii, la o vârstă cât mai mică. Explicarea impactului pozitiv asupra familiilor / însoțitorilor acestor copii. Persoane cu venituri limitate: ź Asigurarea faptului că serviciile sunt cât mai eficiente din punct de vedere al costurilor; ź Identificarea modalităților de sprijin financiar pentru utilizatorii care nu au resursele necesare pentru a se deplasa la furnizorul de servicii sau care nu își permit achiziționarea unui scaun rulant (în cazul în care există costuri) – de exemplu: crearea unui fond pentru echipamente de mobilitate. Persoane vârstnice: ź Includerea în prezentarea serviciilor a informației că acestea se adresează tuturor categoriilor, inclusiv persoanelor vârstnice; ź Includerea, în materialele de promovare, a imaginii unor persoane vârstnice care utilizează scaune rulante; ź Explicarea beneficiilor pe care le are utilizarea de către persoanele vârstnice a scaunelor rulante, inclusiv impactul asupra familiilor lor. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 54 Persoane care locuiesc la distanță mare de furnizorul de servicii / persoane din mediul rural: ź Să ne asigurăm că informația legată de furnizarea serviciilor este disponibilă în zonele rurale – de exemplu, centre pentru sănătate din comunitate - spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei, temple; ź Furnizarea informațiilor cu privire la servicii celor care lucrează cu persoane din zona rurală – de exemplu: asistenți sociali; ź Identificarea metodelor prin care utilizatorii de scaun rulant din zonele rurale pot beneficia de asistență în ceea ce privește transportul, în cazul în care furnizorul nu își desfășoară activitatea pe teren. De exemplu: sprijin financiar pentru transport, colaborarea cu alte organizații care pot ajuta cu transportarea utilizatorilor la furnizorul de servicii; ź Identificarea posibilităților de a oferi cazare acelor utilizatori de scaun rulant care vin din zone rurale; ź Desfășurarea pe teren, în comunitate, a activităților legate de furnizarea serviciilor pentru utilizatorii de scaun rulant; ź Instruirea celor care lucrează în mediul rural (de exemplu, persoane care lucrează în domeniul sănătății) cu privire la modalitățile de sprijin pentru utilizatorii de scaun rulant din respectivele comunități; realizarea monitorizării, asistență pentru efectuarea de reparații minore și operațiuni de întreținere a scaunului rulant; ź Asigurarea disponibilității de scaune rulante adecvate utilizării în mediul rural, pe teren accidentat și informarea cu privire la efectuarea unor operațiuni de adaptare minore (de exemplu, rampe sau nivelarea căilor de acces), pentru a facilita utilizarea echipamentelor în mediul rural. Persoane aparținând diferitelor grupuri etnice şi socio-economice: ź Menționarea faptului că furnizarea serviciilor pentru utilizatorii de scaun rulant se adresează tuturor, indiferent de apartenența la grupuri etnice de orice fel sau de situația socio-economică; ź Includerea în toate materialele de promovare a imaginilor care înfățișează persoane aparținând diverselor grupuri etnice și religioase; ź Acolo unde acest lucru este posibil, angajarea de personal aparținând unor diverse grupuri etnice sau religioase. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 5. Acțiuni pentru manageri – recapitulare (3 minute) Citiți lista acțiunilor recomandate managerilor. Colaborarea cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź identificarea surselor de trimitere care pot face trimiteri; ź construirea unei rețele de trimiteri; ź decizia privind utilizarea sau nu a unui formular de trimitere; ź acțiuni care să asigure echitabilitatea serviciului. Cereți-le participanților să lucreze cu caietul de exerciții practice și să noteze acțiunile individuale planificate pentru implementarea schimbării la nivel organizational. În cazul în care există deja o rețea funcțională de surse pentru trimiteri, nu mai este cazul ca participanții să noteze acest aspect. Pagina 55 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului B.2. Spații și echipamente O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea identifica modelul de furnizare a serviciilor pentru utilizatorii de scaun rulant potrivit contextului în care își desfășoară activitatea; q vor putea identifica spațiul necesar pentru furnizarea serviciilor de nivel de bază și nivel intermediar; q vor ști să identifice echipamentele, formularele și listele de verificare de care este nevoie în procesul de furnizare a serviciilor de nivel de bază și nivel intermediar; q vor putea descrie patru sisteme și proceduri pentru organizarea spațiului în care se desfășoară activitatea. R E S U R S E Pentru sesiune: q Prezentare PPT: B.2: Spațiu și echipamente; q Manualul și caietul participantului; q Resurse suplimentare pentru Manualul participantului; q Idei de proiectare pentru accesibilitate de pe memory stick, de la Resurse suplimentare; q Mostre de scaune rulante pentru a fi utilizate în spațiul respectiv. C O N T E X T Adaptați conținutul aceastei sesiuni astfel încât conținutul să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q este util să cunoașteți care sunt modelele de furnizare a serviciilor pentru utilizatorii de scaun rulant implementate și, în cazul în care acest lucru este posibil, să vizitați respectivii furnizori înaintea workshopului. q spațiul este un perimetru pentru desfășurarea unei activități. În același spațiu pot lucra mai mulți specialiști. Spațiul de lucru este cel în care personalul utilizează echipamentul de lucru. Poate fi vorba despre un spațiu pentru operațiuni tehnice, care să includă și spațiu alocat furnizării serviciilor de nivel de bază și nivel intermediar, precum și de ortezare și protezare. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. q În cazul în care modulul de instruire are loc într-un spațiu unde se furnizează servicii pentru utilizatorii de scaun rulant verificați dacă există posibilitatea să efectuați o vizită. Explicați care este scopul activității. Pregătiți-vă pentru activitate verificând spațiul disponibil și aflând care sunt persoanele implicate în fiecare etapă a procesului (trimiteri – unde se primesc formularele de trimiteri, zona de recepție și de așteptare, zona pentru efectuarea evaluărilor, toaletele, zona de depozitare, zona de pregătire a produselor, zona pentru probarea și ajustarea scaunului rulant, zona pentru instruirea utilizatorilor de scaun rulant: abilități de manevrare, aspecte legate de starea de sănătate, reparații și întreținerea scaunului rulant. S T R U C T U R Ă 1. Introducere 2. Spațiul și fluxul de furnizare a serviciilor 3. Echipamente, formulare și liste de verificare 4. Organizarea spațiului 5. Acțiuni pentru manageri – recapitulare 2 23 10 15 5 Total durată sesiune 55 Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 56 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 1. Introducere (2 minute) Explicați În această sesiune vom vorbi despre rolul managerului în identificarea spațiului și în asigurarea echipamentului necesar parcurgerii celor opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Spațiul și echipamentele devin mai complexe atunci când se trece de la furnizarea serviciilor de nivel de bază la furnizarea celor de nivel intermediar. 2. Spațiul și fluxul de furnizare a serviciilor (23 minute) Explicați: Serviciile pentru furnizorii de scaun rulant pot fi furnizate în diverse locuri. Citiți slide-ul, repetați dacă este necesar. Pagina 57 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Am discutat despre spațiul necesar furnizării serviciilor pentru utilizatorii de scaun rulant – nivel de bază și nivel intermediar. Explicați: ź Acum vom discuta despre „fluxul” în furnizarea serviciilor, în raport cu modul în care membrii echipei lucrează împreună și cu experiența pe care o trăiește utilizatorul de scaun rulant din momentul sosirii și până în momentul în care pleacă. Activitate Grupe Toți participanții consultă Manualul și caietul participantului. Instrucțiuni Luați în calcul câte dintre zonele de lucru menționate există deja acolo unde vă desfășurați activitatea. Reamintiți-le participanților că în cazul spațiilor de dimensiuni reduse, nu se așteaptă să existe zone distincte pentru fiecare activitate. Totuși, trebuie avute în vedere cerințele specifice pentru fiecare astfel de zonă. Acolo unde nu există spațiu alocat, participanții trebuie să se gândească dacă este posibilă crearea unui astfel de spațiu. De exemplu: ź Câte dintre zonele de lucru menționate există deja? ź Pot fi incluse zonele de lucru sugerate în spațiul deja existent? ź Există posibilitatea de a reamenaja o zonă care în prezent are o altă destinație? ź Există posibilitatea reorganizării sau restructurării uneia dintre zonele existente? Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata exercițiului este de 10 minute. Feedback Întrebați dacă vreunul dintre spațiile unde își desfășoară activitatea participanții are deja toate zonele menționate. Întrebați dacă cineva a găsit o soluție care implică integrarea și crearea unei noi zone de lucru în cadrul unui spațiu deja existent. Întrebați dacă cineva a găsit o soluție pentru schimbarea destinației unui spațiu sau a unei clădiri deja existente? Întrebați dacă cineva a găsit o soluție pentru reorganizarea sau restructurarea unui spațiu deja existent. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 58 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Toți participanții sau două grupe de participanți, dacă este necesar. Rugați doi voluntari să joace rolul utilizatorului de scaun rulant și alți doi cel de însoțitor. Oferiți-le sprijin, dacă este necesar. Explicați că acest lucru ajută la înțelegerea cerințelor în ceea ce privește accesul utilizatorilor de scaun rulant în spațiul unde se furnizează serviciile. Instrucțiuni Parcurgeți zonele în următoarea ordine: ź trimiteri – locul unde se primesc trimiterile ź recepția și sala de așteptare ź spațiul pentru desfășurarea evaluării ź toalete ź spațiul de depozitare ź spațiul pentru pregătirea produsului ź spațiul pentru probarea și ajustarea produsului ź spațiul pentru instruirea utilizatorilor de scaun rulant ź spațiul pentru dobândirea abilităților de manevrare a scaunului rulant Monitorizare Parcurgeți împreună zonele din spațiul de furnizare a serviciilor. Durata Durata este de 10 minute pentru activitate și 2 minute pentru sumarizarea ideilor la finalul acesteia. Feedback Sumarizați eventualele probleme identificate în fluxul de furnizare a serviciilor, precum și potențialele soluții. 3.Echipamente, formulare și liste de verificare (10 minute) Explicați: ź În Manualul și caietul participantului se găsesc exemple de echipamente, formulare și liste de verificare. ź Rolul managerului este să coreleze resursele umane și cele materiale, astfel încât fiecare membru al echipei să fie responsabil pentru asigurarea disponibilității echipamentului și a documentației de care este nevoie pentru desfășurarea activității. ź Acest lucru poate însemna adaptarea echipamentului pentru transport și utilizare corespunzătoare, în diverse medii. Pagina 59 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Întregul grup de participanți. Participanții care reprezintă același furnizor de servicii pot lucra împreună. Instrucțiuni Revedeți informațiile referitoare la spațiu și la echipamente din Manualul și caietul participantului, precum și formularele și listele de verificare de la Resursele suplimentare. ź Care sunt echipamentele disponibile folosite în procesul de furnizare a serviciilor acolo unde vă desfășurați activitatea? Notați toate exemplele de echipamente care pot fi confecționate sau achiziționate. ź Care sunt formularele și listele de verificare care sunt deja folosite? Notați formularele sau listele de verificare care pot fi integrate în activitatea zilnică. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata exercițiului este de 5 minute pentru activitate și 4 minute pentru feedback. Feedback Verificați dacă există întrebări. Note pentru formatori: ź În comunități (pe teren) poate fi necesară identificarea unor furnizori din domeniul tâmplăriei, sudurii și tapițeriei și care dețin deja echipamentul necesar. 4. Organizarea spațiului (15 minute) Explicați: Am discutat despre spațiul și echipamentele de care avem nevoie pentru a furniza servicii destinate utilizatorilor de scaun rulant. O etapă importantă a activității managerului se referă la alocarea responsabilităților pentru a se asigura că spațiul este organizat în mod adecvat. Un spațiu bine organizat înseamnă furnizarea serviciilor într-un mod profesionist și eficient. Un spațiu organizat în mod necorespunzător va da impresia de lipsă de profesionalism și de dezorganizare. Explicați: Există patru pași care trebuie aplicați la fiecare spațiu de lucru în orice model de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 60 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Împărțiți participanții în patru grupe. Instrucțiuni Cereți fiecărei grupe să analizeze cele două exemple de spații organizate deficitar descrise în Caietul de exerciții practice, pagina 96. Indicați-le participanților să utilizeze Manualul participantului și să formuleze recomandări pentru organizarea spațiului, a zonelor de lucru și a echipamentelor. Monitorizare Monitorizați desfășurarea activității și oferiți suport atunci când acest lucru este necesar. Durata Durata exercițiului este de 6 minute pentru analiza stării spațiului de lucru și 4 minute pentru feedback. Feedback Cereți fiecărei grupe să prezinte recomandările pentru primul exemplu. Notați răspunsurile pe tablă. Repetați pașii pentru cel de-al doilea exemplu. 1.Evitaţi acumularea de obiecte: eliminați toate instrumentele și sculele, părțile componente și echipamentele inutile, precum și documentele care nu mai sunt de actualitate. 2.Identificați care sunt acele obiecte pe care le folosiți în mod curent: scule, părți componente, documente. Obiectele folosite în mod regulat trebuie aranjate în așa fel încât să poată fi localizate cât mai ușor și rapid. 3.Sistem și responsabilitate: stabiliți un sistem pentru fiecare spațiu de lucru și desemnați un responsabil pentru implementarea sistemului. 4.Monitorizați sistemul pentru a vă asigura că schimbarea se permanentizează. Pagina 61 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Exemple de recomandări pentru îmbunătățirea organizării spațiului și echipamentelor (participanții pot identifica și alte exemple) Spațiile pentru activități tehnice și echipamentele: ź identificarea rolului pe care îl are spațiul pentru activități tehnice (pregătirea produsului, efectuarea modificărilor); ź eliminarea tuturor acelor scule, părți componente și echipamente care nu mai sunt folosite; ź instalarea unor rafturi pentru depozitarea echipamentelor; ź raftul sau spațiul de depozitare pentru obiecte folosite în mod frecvent trebuie să fie aproape de bancul de lucru; ź bancul de lucru trebuie să fie curat; ź întâlniri cu personalul: agrearea sistemului și alocarea responsabilității pentru implementare. Spațiu în comunitate (pe teren) pentru activități din domeniul clinic și tehnic: ź masă pentru aranjarea sculelor și a echipamentelor; ź banc de lucru portabil; ź păstrarea sculelor în cutie; ź paravan pentru a delimita o zona folosită pentru efectuarea evaluării ; ź suprafață pentru efectuarea evaluării și suporturi pentru picioare. 5.Acțiuni pentru manageri - recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Lucrați împreună cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź a identifica spațiul și echipamentele corespunzătoare modelului de furnizare a serviciilor pentru utilizatorii de scaun rulant; ź a integra documentele și listele de verificare în etapele procesului de furnizare serviciilor; ź a organiza spațiul; ź a stabili sistemele și procedurile pentru fiecare spațiu și pentru a desemna responsabilii. Cereți-le participanților să utilizeze Caietul de exerciții practice pentru a nota acțiunile planificate în vederea organizării spațiului și a echipamentelor. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 62 B.3. Gama de scaune rulante corespunzătoare O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea defini ce înseamnă scaunul rulant corespunzător și perna adecvată; q vor putea explica de ce sunt importante dimensiunea potrivită a scaunului rulant și suportul postural; q vor putea explica de ce sunt importante cerințele individuale ale utilizatorului și caracteristicile mediului în care trăiește, atunci când se face selecția scaunului rulant; q vor discuta despre trei factori care influențează utilizarea în condiții de siguranță a produselor și durabilitatea acestora; q vor discuta despre aspecte legate de crearea unei game de scaune rulante. R E S U R S E Pentru sesiune: q Prezentarea PPT: B. 3: Gama de scaune rulante corespunzătoare; q Manualul și caietul participantului; q Material video: Chaeli - Beneficiile suportului postural suplimentar; q Material video: Beneficiile unui scaun rulant corespunzător; q Material video: Mark și Ryan - Răspunsul la nevoile utilizatorilor de scaun rulant; q Mostre de perne pentru reducerea presiunii; q Document de poziție comun privind furnizarea echipamentelor de mobilitate – de la Resurse suplimentare. C O N T E X T Adaptați conținutul acestei sesiuni astfel încât conținutul să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q Luați în considerare gama de scaune rulante disponibile local și folosiți-o ca exemplu, dacă este posibil. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. q Citiți informațiile referitoare la scaunele rulante corespunzătoare din pachetul de instruire – nivel de bază și informațiile referitoare la utilizatorii de scaun rulant copii din pachetul de instruire – nivel intermediar. q Citiți capitolul 7 din Document de poziție comun privind furnizarea dispozitivelor de mobilitate. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Pagina 63 S T R U C T U R Ă 1. Introducere 2. Ce înseamnă un scaun rulant corespunzător și o pernă adecvată? 3. Dimensiunea potrivită și furnizarea suportului postural adecvat 4. Nevoile utilizatorului de scaun rulant și caracteristicile mediului în care trăiește 5. Importanța durabilității produsului și a utilizării sale în condiții de siguranță 6. Crearea gamei de scaune rulante disponibile 7. Acțiuni pentru manageri - recapitulare 2 8 10 10 20 25 5 Total durată sesiune 80 1. Introducere (2 minute) Explicați: În această sesiune vom vorbi despre rolul managerului în parteneriatul cu părțile implicate, cu scopul identificării gamei minime de produse care să corespundă cerințelor utilizatorilor adulți și copii. 2.C e înseamnă un scaun rulant corespunzător și o pernă adecvată? (8 minute) Citiți de pe slide, repetați dacă este necesar. Explicați: Fiecare utilizator de scaun rulant are nevoie de o pernă. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Ghidul privind furnizarea scaunelor rulante definește noțiunea de scaun rulant corespunzător. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 64 Explicați: Tipul de pernă adecvat va depinde de nevoile individuale ale utilizatorului de scaun rulant. Acesta este motivul pentru care este necesar ca furnizorii de servicii pentru utilizatorii de scaun rulant să aibă disponibilă cel puțin o gamă minimă de perne. Sumarizați: Furnizorul de servicii pentru utilizatorii de scaun rulant trebuie să aibă capacitatea de a oferi perne pentru reducerea presiunii. Întrebați: Punem accent pe importanța pernelor pentru reducerea presiunii deoarece știm că prevenirea apariției escarelor este esențială, acestea putând cauza decesul. Puteți să dați exemple de categorii de utilizatori de scaun rulant care au nevoie de pernă pentru reducerea presiunii? Cele mai importante răspunsuri: ź persoane cu leziuni medulare; ź orice persoană care a avut escare anterior; ź persoane vârstnice sau cu constituția fragilă; ź persoane care au probleme de mobilitate sau care își schimbă poziția cu dificultate. Arătați tuturor participanților cel puțin un tip de pernă pentru reducerea presiunii. Explicați: ź Absența pernei adecvate și a instruirii cu privire la utilizarea acesteia va avea anumite costuri. ź În țările dezvoltate, speranța de viață medie este de 38 de ani de la momentul apariției leziunii medulare pentru persoanele care au dobândit leziunea la o vârstă între 25 și 34 de ani (6). ź Dimpotrivă, un studiu din Bangladesh sugerează că speranța de viață în urma unei leziuni medulare este de 5,36 ani de la momentul apariției leziunii; 56,4% dintre aceste persoane decedând într-un interval de 5 ani (7). Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Pagina 65 Explicați: ź 80% dintre persoanele cuprinse în acest studiu au murit la domiciliu, iar dintre acestea, o treime aveau escare la momentul decesului. Explicați: ź Într-un centru de recuperare din Sri Lanka, o analiză a costurilor a demonstrat că introducerea scaunelor rulante corespunzătoare, a pernelor și a saltelelor adecvate, precum și a instruirii pacienților pentru prevenirea escarelor, pot reduce cu 70% incidența apariției escarelor pe perioada spitalizării și cu 60% cheltuielile pentru achiziționarea consumabilelor medicale necesare tratamentului acestora. Conform Raportului OMS privind dizabilitatea (8), într-un spital din Sao Paulo, Brazilia, a fost introdus un program de instruire privind reducerea complicațiilor medicale secundare în cazul persoanelor cu leziuni medulare. Astfel incidența escarelor s-a redus cu 23%. Explicați: Accesul la perne adecvate și la instruire pentru folosirea acestora constituie o parte importantă a prevenirii problemelor de sănătate. Pachetul de instruire – nivel de bază explică modul de confecționare a pernelor pentru reducerea presiunii. Informațiile pentru modificarea unei astfel de perne sunt cuprinse în modulul de nivel intermediar. Frecvent, confecționarea pernelor presupune identificarea unui furnizor constant pentru achiziționarea de burete/spumă de bună calitate. Explicați: Pentru a furniza un scaun rulant cu dimensiunea potrivită, este nevoie de o gamă care să includă mai multe mărimi, inclusiv opțiuni pentru copii. 3. Dimensiunea potrivită și furnizarea suportului postural adecvat (10 minute) Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 66 Faceți clic pentru ca imaginile să apară consecutiv. Întrebați: Ce vedeți în aceste imagini? Cele mai importante răspunsuri: ź un copil purtând încălțăminte pentru adulți; ź dimensiunea necorespunzătoare, prea mare; ź copilul nu se poate deplasa și nu poate desfășura diverse activități. Explicați: Copilul poartă acum pantofi corespunzători, care au măsura potrivită și cu care se poate deplasa. Faceți clic pe imaginea copilului în scaun rulant. Întrebați: Ce vedem în această imagine? Cele mai importante răspunsuri: ź utilizator copil în scaun rulant pentru adulți, măsura greșită; ź dificultăți în a se deplasa și a se juca. Faceți clic pe ultima imagine. Explicați: modelul și dimensiunea potrivite ale scaunului rulant oferă utilizatorilor copii oportunitatea de a desfășura activitățile cât mai bine posibil. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Faceți clic pe următoarea imagine, care înfățișează pantofi de mărime corespunzătoare. Explicați: ź Nevoia de suport postural diferă de la un utilizator de scaun rulant la altul. În consecință este nevoie de scaune rulante care furnizează diferite tipuri de suport postural. Explicați: ź Utilizatorii care au nevoie de suport postural de bază vor folosi un scaun rulant cu dimensiunea potrivită. Pagina 67 Explicați: Utilizatorii care au nevoie de suport postural de nivel intermediar vor folosi un scaun rulant cu dimensiunea potrivită și cu dispozitiv de suport postural suplimentar. Explicați: ź Gradul de suport postural poate fi crescut prin adăugarea dispozitivelor de suport postural suplimentar sau prin furnizarea unui sistem de poziționare. Personalul Centrului de Recuperare Western Cape din Africa de Sud a documentat complicațiile apărute în cazul unui grup de copii din diferite școli și centre. Toți copiii au fost consultați înainte de apariția schimbărilor de postură. Indicați participanților capul de tabel și explicați - grupa 1 a primit scaune rulante corespunzătoare și suport postural suplimentar pentru trunchi – înainte de apariția modificării posturale. Explicați: Absența suportului postural suplimentar, atunci când este necesar, are consecințe – în special în cazul utilizatorilor copii, care trec prin pusee de creștere. Grupa 2 a primit scaune rulante corespunzătoare fără suport postural adecvat (înainte de apariția modificării posturale). În grupa 1, a cărei membri au beneficiat de suport postural suplimentar, s-a constatat apariția unor complicații doar la 0.4% dintre copii (modificări posturale). În cazul copiilor din grupa 2, care nu au beneficiat de suport postural suplimentar, 21% dintre ei au prezentat complicații ale posturii (modificări posturale). Consecințele pentru copii și pentru familiile lor și pentru furnizorii de servicii au fost: ź complicații și mai mult timp petrecut cu programările la furnizorii de servicii pentru utilizatorii de scaun rulant; ź deteriorări ale stării de sănătate; ź postură incorectă și senzație de disconfort; ź nivel scăzut de toleranță pentru menținerea poziției așezat (durată scăzută a menținerii unei poziții corecte confortabile); ź participare scăzută în activități educaționale; ź diminuarea nivelului de calitate a vieții. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 68 Note pentru formatori: informații suplimentare în cazul în care participanții pun mai multe intrebări O analiză suplimentară a arătat că următorii factori au crescut riscul apariției complicațiilor de ordin postural: ź asimetria controlului muscular la nivelul trunchiului; ź tendințele posturale determinate de mișcări puternice; ź puseele de creștere; ź existența leziunilor osoase; ź lipsa de forță / paralizia la nivelul trunchiului (leziune la nivel înalt). Prezentare material video: Beneficiile suportului postural suplimentar – Chaeli Cereți participanților să urmărească materialul în care Chaeli descrie în ce fel a ajutat-o intervenția timpurie prin suport postural suplimentar. Prezentați materialul video. Întrebați: Ce părere aveți despre cele spuse de Chaeli cu privire la beneficiile intervenției timpurii prin furnizarea de suport postural suplimentar? Validați răspunsurile. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 4. Nevoile utilizatorului de scaun rulant și caracteristicile mediului în care trăiește (10 minute) Prezentare material video: Beneficiile unui scaun rulant corespunzător Solicitați participanților să urmărească modul în care diferitele tipuri de scaune rulante îi ajută pe utilizatorii prezentați în film să muncească sau să își desfășoare activitățile. Prezentați materialul video. Întrebați: Care erau activitățile desfășurate de către utilizatorii de scaun rulant din materialul video? Pagina 69 Cele mai importante răspunsuri: ź lucru (în supermarket, la sala de sport); ź dans; ź plimbare (cu mama și câinele); ź baschet; ź deplasare (la școală, depășirea barierelor arhitecturale). Prezentare material video: Răspunsul la nevoile utilizatorului de scaun rulant Cereți participanților să identifice acele caracteristici ale scaunelor rulante care îi ajută pe utilizatori să muncească sau să desfășoare diverse activități. Prezentați materialul video. Întrebați: Care sunt caracteristicile pe care le-ați identificat? Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: ź Mark: efectuează propulsia scaunului rulant cu ajutorul membrului inferior, lucru la care contribuie suportul de picioare pliabil lateral. In acest fel, există libertate de mișcare la nivelul membrelor superioare, pentru a desfășura activitățile. ź Dawid și Pinky: amândoi pot efectua în mod independent propulsia scaunului rulant – unul cu un scaun rulant cu antrenare manuală, iar celălalt cu un scaun rulant cu antrenare electrică. ź Faizel: poziția roților din spate contribuie la efectuarea propulsiei, spătarul este suficient de jos pentru a nu împiedica această acțiune. Nu există suporturi de brațe, ceea ce permite accesul facil la mobilierul de birou. ź Keith și Ralph: Nu există suporturi de brațe, astfel că utilizatorii pot așeza echipamentul pe genunchi. Scaunul rulant este configurat corespunzător pentru efectuarea propulsiei. ź Ryan: scaunul rulant poate fi pliat, iar roțile din spate pot fi îndepărtate cu ușurință. Acest lucru îi permite să facă în mod independent transferul în și din mașină. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 70 Explicați: Materialul video subliniază ideea că diferitele tipuri de scaune rulante se potrivesc unor medii de utilizare diferite. Atunci când utilizatorul primește un produs care nu se potrivește folosirii în mediul în care acesta trăiește sau lucrează, în mod frecvent scaunul rulant va fi abandonat. Explicați: ź În această imagine vedem trei scaune rulante. Primele două au fost abandonate pentru că necesită reparații și pentru că nu sunt disponibile piese de schimb. ź Cel de-al treilea echipament de mobilitate este un scaun rulant primit prin donație și care, în ciuda faptului că e nou, dă senzația de instabilitate atunci când este folosit în exterior, iar utilizatorul care l-a primit nu se simte în siguranță atunci când îl folosește. ź Acest utilizator deține trei scaune rulante, dar niciunul dintre ele nu constituie soluția adecvată pentru nevoile sale de mobilitate. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 5. Importanța durabilității produsului și a utilizării sale în condiții de siguranță (20 de minute) Explicați: Am discutat despre cât de important este ca produsul să corespundă cerințelor individuale ale utilizatorului și caracteristicilor mediului în care va fi utilizat. Acum vom analiza factorii care influențează gradul de rezistență și modul în care produsele pot fi utilizate în condiții de siguranță. Întrebați: Ce se întâmplă atunci când un scaun rulant nu este durabil? Cele mai importante răspunsuri: ź perioada de utilizare va fi redusă; ź se va defecta rapid. Explicați: ź Produsele cu un grad scăzut de durabilitate trebuie înlocuite mai frecvent decât cele cu o durabilitate crescută. ź Un produs necorespunzător poate să se defecteze după un interval de 1-6 luni și astfel să fie necesară înlocuirea sa. Un produs corespunzător poate dura 3 – 5 ani (de 6 până la 10 ori mai mult) și să fie mai eficient din punct de vedere al raportului cost - durată. Pagina 71 Cele mai importante răspunsuri: ź dezmembrarea și eliminarea echipamentului abandonat implică anumite costuri; ź produsele abandonate ocupă spații importante, care ar putea fi valorificate în alt mod; ź deseori, se trece cu vederea desemnarea unei persoane care să aibă responsabilitatea și autoritatea de a decide cum sunt folosite/depozitate și eliminate echipamentele de mobilitate primite donație. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Întrebați: Care sunt costurile numărului mare de scaune rulante abandonate? Faceți click pe slide-uri pentru a arăta imaginile. Explicați: ź Vom întâlni aceste exemple de grămezi de scaune rulante abandonate, care nu mai pot fi reparate, în multe țări de pe întregul glob, depozitate în încăperi sau abandonate în afara centrelor care furnizează servicii pentru utilizatorii de scaun rulant. Explicați: Rolul managerului la achiziționarea echipamentelor de mobilitate sau la primirea de produse donate este: ź să se asigure că echipamentele de mobilitate sunt adecvate pentru mediul în care vor fi utilizate; ź să se asigure că produsele sunt fiabile atunci când sunt utilizate în medii cu teren accidentat și dificil; ź să se asigure că produsele pot fi reparate local. Întrebați: Care sunt furnizorii voștri de scaune rulante? Potențiale răspunsuri - vor varia în funcție de participanți și de contextul în care își desfășoară activitatea: ź donatori; ź organizații religioase; ź producători; ź furnizori. Explicați: Utilizatorii de scaun rulant vor produse rezistente, care pot fi folosite în condiții de siguranță și care pot fi reparate cu costuri acceptabile. Există câteva întrebări importante care trebuie puse cu privire la produsele disponibile la serviciul dumneavoastră de scaune rulante sau atunci când doriți să introduceți produse noi în gama de echipamente de mobilitate. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 72 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Împărțiți participanții în trei grupe. Instrucțiuni Indicați fiecărei grupe de participanți un număr de la 1-3, care va reprezenta sarcina de lucru din Caietul de exerciții practice: B.3 Gama de scaune rulante corespunzătoare: durabilitate, efectuarea reparațiilor, pagina 98. Solicitați-le participanților să răspundă întrebărilor de la exercițiul care le-a fost indicat. Explicați-le participanților că pentru completarea exercițiului pot folosi Manualul participantului, precum și cunoștințele și experiența lor. Comunicați-le participanților că au la dispoziție 5 minute pentru a răspunde la întrebări. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata alocată pentru pregătirea răspunsurilor este de 5 minute. Durata etapei de feedback este de 10 minute (în total). Acest interval de timp este calculat pentru 3 grupe, dacă există mai multe grupe de participanți, modificați durata alocată. Feedback Cereți fiecărei grupe să prezinte răspunsurile, pe rând. Faceți referire la informațiile din manual pentru a ghida discuția. Care sunt întrebările pe care le puteți adresa cu privire la durabilitatea și folosirea în condiții de siguranță a produselor furnizate? ź Produsul are certificate de standard (a trecut teste de performanță și de calitate prevăzute de un organism profesionist)? Care au fost rezultatele? ź Furnizorul prevede o anumită durată de viață a produselor? ź Furnizorul are un sistem de înregistrare și raportare a defectelor? ź Cine sunt ceilalți cumpărători și utilizatori ai produselor lor? ź Produsul a fost testat de alți utilizatori din țară? Dacă da, care a fost feedback-ul/care au fost rezultatele? ź Există piese de schimb? Piesele de schimb trebuie achiziționate din străinătate sau unele dintre ele sunt disponibile și în țară? ź În cazul în care se rupe cadrul – acesta poate fi reparat pe plan local? Care sunt acele componente care se defectează sau care se uzează în mod obișnuit? ź Materialul textil de calitate inferioară se rupe sau se deformează; ź Roțile din față (axul, anvelopele, rulmenții, furcile); ź Roțile din spate (axul roții, inelele de antrenare, spițele, rulmenții, anvelopele); ź Frânele; ź Suporturile pentru picioare; ź Pernele. Pagina 73 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cum calculați care sunt piesele de schimb care trebuie comandate? ź Întrebați furnizorul echipamentelor de mobilitate dacă are recomandări în acest sens. ź Identificați care sunt piesele de schimb care pot fi achiziționate local (fie de către furnizorul de servicii, fie chiar de către utilizator). ź Estimați câte întâlniri de monitorizare sunt previzionate pentru următorul an și creați un stoc de 30% din necesar – ca punct de plecare. ź Țineți o evidență clară a numărului de piese de schimb utilizate anual și folosiți aceste date pentru a face previzionări referitoare la viitoarele comenzi. Întrebați: La cine mai puteți apela pentru informații cu privire la durabilitatea și gradul de siguranță în utilizarea produselor? Validați răspunsurile. ź Solicitați feedback de la utilizatori, prin vizite la domiciliu, organizarea de grupuri focus și întâlniri cu reprezentanți ai organizațiilor pentru persoanele cu dizabilități. ź Cereți feedback de la alte organizații furnizoare de servicii pentru utilizatorii de scaun rulant. ź Achiziționați un număr redus de produse, cu scopul de a le testa înainte de a face comenzi mai mari. Explicați: ź În timpul testării produsului, deseori există tendința de a evalua produsul pe baza aspectului său fizic. ź În mod frecvent părerile se schimbă – fie în sens pozitiv sau negativ, după utilizarea produsului. ź Înainte de luarea oricărei decizii, este important să testăm produsul prin utilizarea sa timp de cîteva luni. Explicați: A opta etapă din procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant o reprezintă monitorizarea, întreținerea și reparațiile. Toți utilizatorii și membrii familiilor lor trebuie instruiți cu privire la operațiuni simple de reparație și întreținere, pentru a prelungi durata de viață a produselor. Această secțiune este inclusă în pachetul de instruire nivel de bază. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 74 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: Rolul managerului este: ź Să se asigure că utilizatorii au acces la servicii de reparații și întreținere; ź Să instruiască partenerii pentru ca aceștia să poată efectua reparații și operațiuni de întreținere; ź Să identifice furnizorii de servicii de reparații și de întreținere din comunitate. Explicați: Activitatea de monitorizare va fi discutată ulterior, pe parcursul modulului de instruire. 6. Crearea gamei de scaune rulante disponibile (25 de minute) Luați în considerare faptul că în anumite situații există un singur tip de scaun rulant disponibil. Citiți: exemplul cu privire la introducerea standardelor pentru furnizarea scaunelor rulante de către autoritățile din Sri Lanka. Subliniați: Guvernele care aderă la Convenția ONU privind drepturile persoanelor cu dizabilități au obligația morală și legală de a respecta standardele în furnizarea echipamentelor asistive. Standarde naționale în furnizarea scaunelor rulante din Sri Lanka În Sri Lanka a fost inițiat un proces pentru stabilirea standardelor în furnizarea scaunelor rulante, care a fost rezultatul a mai mult de trei ani de lobby. Consecința este că produsele livrate de către toți furnizorii sau producătorii de scaune rulante trebuie să respecte aceleași standarde minime. Atunci când clientul care achiziționează scaunele rulante este statul, ca în Sri Lanka, standardele reprezintă o pârghie pentru a crește suma alocată pentru fiecare scaun rulant, ajungându-se la echipamente mai durabile și cu un grad de funcționalitate mai ridicat, ceea ce aduce beneficii utilizatorilor. În același timp, cumpărătorul are avantajul de a putea profita mai mult timp de investiția făcută. Explicați: Următoarea activitate se referă la modalitatea prin care părțile interesate pot lucra cu instituții de stat sau cu donatori cu scopul de a îmbunătăți procesul de furnizare a scaunelor rulante corespunzătoare. Pagina 75 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Împărțiți participanții în trei grupe. Instrucțiuni Desemnați fiecărei grupe câte un caz descris în Caietul de exerciții practice: B.2.2 Gama de scaune rulante corespunzătoare: joc de rol, pag 98. Cereți-le participanților să citească instrucțiunile. Explicați-le că au la dispoziție 10 minute pentru a pregăti scenariul indicat. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 10 minute pentru pregătirea exercițiului. Alocați 12 minute (în total) pentru feedback. Acest interval de timp este calculat pentru 3 grupe, dacă există mai multe grupe de participanți, modificați durata alocată. Feedback Solicitați fiecărei grupe să prezinte rezolvarea exercițiului. Pentru a ghida discuțiile legate de această temă, formatorul trebuie să facă referire la principiile cuprinse în Capitolul 6 al Documentului de poziție comun privind furnizarea echipamentelor de mobilitate. Principiile furnizării echipamentelor de mobilitate corespunzătoare Pentru ca țările să respecte obligațiile legate de tehnologia asistivă (echipamente de mobilitate) prevăzute în Convenția Organizației Națiunilor Unite privind Drepturilor Persoanelor cu Dizabilități, trebuie luate în considerare următoarele principii cheie (9): ź Implicare - persoanele cu dizabilități trebuie implicate în toate stadiile furnizării echipamentelor de mobilitate. ź Accesibilitate - echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile tuturor persoanelor care au nevoie de ele. ź Adaptabilitate – echipamentele de mobilitate și serviciile aferente trebuie să fie adaptate și modificate astfel încât să corespundă nevoilor persoanei. ź Preț accesibil - echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile din punct de vedere financiar. ź Disponibilitate – trebuie să existe suficient spațiu, personal și produse pentru a răspunde cererii, iar serviciile să fie furnizate cât mai aproape posibil de comunitățile din care oamenii fac parte. ź Calitate - produsele, spațiile și serviciile trebuie să respecte standarde de calitate adecvate. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 76 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 7. Acțiuni pentru manageri – recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Explicați: Colaborarea cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź identificarea nevoilor utilizatorilor și a celor mai importante caracteristici ale echipamentelor de mobilitate, care să răspundă acestor nevoi; ź identificarea unei game adecvate de scaune rulante corespunzătoare, de perne și de piese de schimb; ź identificarea surselor potrivite de materiale pentru confecționarea adaptărilor necesare pentru produsele furnizate; ź discutarea, împreună cu părțile interesate, a raportului cost – beneficii care decurge din furnizarea scaunelor rulante și a pernelor corespunzătoare. Cereți participanților să utilizeze Caietul de exerciții practice pentru a nota acțiunile pe care le vor desfășura cu scopul de a îmbunătăți gama de scaune rulante corespunzătoare disponibile la furnizorul de servicii unde își desfășoară activitatea. Pagina 77 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului B.4. Organizarea resurselor umane O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea descrie patru dintre rolurile pe care le deține echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant; q vor cunoaște necesarul de resurse umane pentru furnizarea serviciilor de nivel de bază și de nivel intermediar; q vor putea planifica integrarea de noi roluri în orarul de lucru al personalului; q vor putea estima capacitatea anuală de furnizare a serviciilor pentru utilizatorii de scaun rulant. R E S U R S E Pentru sesiune: q Prezentarea PPT: B.4.: Organizarea resurselor umane; q Manualul participantului și Caietul de exerciții practice. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q analizați modelele de procese de furnizare a serviciilor din respectiva regiune și modalitatea prin care furnizarea serviciilor pentru utilizatorii de scaun rulant poate fi integrată. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. S T R U C T U R Ă 1. Introducere 2. Rolurile în echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant. 3. Implicarea personalului în planificarea activității de furnizare a serviciilor pentru utilizatorii de scaun rulant. 4. Încurajarea muncii în echipă. 5. Evaluarea capacității de furnizare a serviciilor pentru utilizatorii de scaun rulant. 6. Acțiuni pentru manageri - recapitulare. 2 10 5 5 25 3 Total durată sesiune 50 Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 78 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 1. Introducere (2 minute) Explicați: Pe parcursul acestei sesiuni vom discuta despre rolul pe care îl deține managerul în organizarea personalului, pentru ca echipa să își asume diferitele roluri și responsabilități. Vom pune accentul pe patru roluri cheie: clinic, tehnic, de instruire și administrativ. 2. Rolurile în echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant (10 minute) Explicați: ź O persoană poate deține mai multe astfel de roluri sau poate desfășura activități specifice unei singure etape a procesului în 8 pași. ź Diferiți membri ai echipei pot fi responsabili pentru diferite roluri. ź În anumite situații, personalul care face parte din organizații diferite poate colabora pentru a acoperi toata gama de roluri necesare sau diferiți pași din procesul de furnizare a serviciilor pentru utilizatorilor de scaun rulant. Explicați: ź Furnizarea serviciilor de nivel intermediar presupune că personalul deține cunoștințele necesare și că are experiență în furnizarea serviciilor la nivel de bază. ź Luați în considerare varianta instruirii unei noi echipe pentru a furniza servicii de nivel de bază, pentru a permite echipei existente să progreseze către furnizarea de servicii de nivel intermediar. Explicați: Cea dintâi responsabilitate a managerului este să identifice care sunt acele resurse umane existente sau noi care vor îndeplini diferite roluri în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Dacă sunt implicate persoane și din alte organizații, managerii din fiecare organizație trebuie să colaboreze. Explicați: Rolurile din cadrul echipei de furnizare a serviciilor pot fi îndeplinite de către persoane cu pregătire și experiență profesională variate, cu condiția ca aceste persoane să beneficieze de instruire adecvată. Acesta este motivul pentru care mai multe tipuri de organizații pot fi implicate în furnizarea serviciilor pentru utilizatorii de scaun rulant. Pagina 79 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Împărțiți participanții în funcție de organizația din care fac parte. Se recomandă ca participanții care aparțin aceleiași organizații să lucreze împreună. Nu este nevoie să formați grupe de lucru dacă participanții fac parte din aceeași organizație. Instrucțiuni Explicați că există un model de tabel gata completat, care include principalele roluri ale personalului din cadrul unei echipe de furnizare a serviciilor pentru utilizatorii de scaun rulant. Participanții trebuie să pună în dreptul fiecărui rol numele persoanei care va fi responsabilă de desfășurarea respectivei activități. Reamintiți-le că o persoană poate avea mai multe roluri. În cazul în care componența echipelor nu a fost încă stabilită, participanții trebuie să se gândească cine poate îndeplini fiecare rol. Dacă există manageri care gestionează mai multe sisteme de furnizare a serviciilor pentru utilizatorii de scaun rulant, ei trebuie să enumere rolurile pentru fiecare echipă pe care o coordonează. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru efectuarea exercițiului. Feedback Întrebați dacă participanții au observații referitoare la această activitate? Explicați că este esențial ca responsabilitatea pentru îndeplinirea fiecărui rol să îi fie alocată unui membru al echipei de furnizare a serviciilor pentru utilizatorii de scaun rulant. 3. Implicarea personalului în planificarea activității de furnizare a serviciilor pentru utilizatorii de scaun rulant (5 minute) Explicați: În secțiunea despre determinarea schimbării, am discutat despre importanța implicării personalului în planificarea activității. Întrebați: De ce este importantă implicarea personalului? Cele mai importante răspunsuri: ź rezistența la schimbare este, de obicei, rezultatul faptului că personalul nu cunoaște ce presupune această schimbare; ź oamenii sunt mai dispuși să sprijine procesul de schimbare atunci când participă la crearea acestuia; ź personalul are experiență și idei cu privire la modalitatea de a iniția sau de a îmbunătăți sistemul de furnizare a serviciilor. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 80 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 4. Încurajarea lucrului în echipă (5 minute) Explicați: atunci când membrii echipei lucrează împreună și sunt implicați în activitatea de planificare, ne putem aștepta la următoarele rezultate: ź demararea procesului prin care se ajunge la crearea unei echipe; ź încurajarea lucrului în echipă. Explicați: Odată ce s-a format echipa, este important ca membrii acesteia să lucreze împreună cu scopul de a iniția sau de a îmbunătăți procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Explicați: Stabilirea planului de activitate săptămânal și a planului de activitate lunar, împreună cu întâlnirile de echipă care au loc la intervale regulate, sunt două dintre activitățile cheie care contribuie la coordonarea echipei și la desfășurarea cât mai eficientă a activității. Acest lucru este valabil pentru orice activitate de tip clinic sau tehnic. ź planificarea săptămânală, bisăptămânală sau planificarea lunară; ź întâlniri ale echipei care au loc săptămânal, o dată la două săptămâni sau lunar. 5. Evaluarea capacității de furnizare a serviciilor pentru utilizatorii de scaun rulant (25 de minute) Explicați: În cele ce urmează, vom discuta despre modalitatea de a planifica parametrii care definesc capacitatea de furnizare a serviciilor, atunci când inițiem un sistem de furnizare a serviciilor sau când avem ca scop îmbunătățirea unui astfel de sistem existent. Explicați: Capacitatea de furnizare a serviciilor depinde de: ź numărul personalului disponibil pentru activitatea de furnizare a serviciilor de acest tip; ź stocul anual de produse, corelat cu bugetul pentru achiziționarea produselor. Pagina 81 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Subliniați faptul că vom pune accentul pe legătura dintre capacitatea personalului și numărul anual al utilizatorilor care beneficiază de serviciile furnizate. Partea referitoare la buget va fi abordată în următoarea sesiune. Explicați: Există o corelație directă între numărul de personal și orele de lucru aferente și capacitatea anuală a furnizorului de servicii pentru programări noi și pentru programări pentru monitorizare. Explicați: ź Se recomandă ca cel puțin două persoane din cadrul organizației să parcurgă programele de instruire pentru nivel de bază și nivel intermediar. ź Dacă în organizație există o singură persoană care a parcurs modulele de instruire, organizația este vulnerabilă din punct de vedere al livrării acestor servicii. Dacă persoana părăsește organizația, se pierd cunoștințele și experiența în domeniu. Explicați: ź Trebuie calculat numărul de săptămâni de lucru disponibile în fiecare an, deducând zilele aferente sărbătorilor naționale și concediului anual. ź Acest lucru va influența numărul de utilizatori de scaun rulant care vor fi deserviți în fiecare an. Cereți participanților să calculeze numărul de săptămâni de lucru disponibile anual, în cazul organizațiilor unde își desfășoară activitatea. Reamintiți-le să scadă zilele de sărbători naționale și zilele de concediu de odihnă ale personalului. Explicați: De regulă, săptămâna de lucru are cinci zile lucrătoare. Cu toate acestea, este posibil ca personalul să nu poată dedica toate cele cinci zile activității de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 82 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: ź Este nevoie de o estimare a numărului de zile rezervate săptămânal activităților legate de furnizarea serviciilor. Trebuie avut în vedere și scăzut timpul alocat întâlnirilor săptămânale, întocmirii documentației, verificării stocului, precum și pauzelor. ź Acest lucru va avea impact asupra numărului de utilizatori de scaun rulant pe care echipa îi poate vedea săptămânal. ź Dacă un membru al echipei are și un alt rol, în afara furnizării serviciilor pentru utilizatorii de scaun rulant, este important să se stabilească care este bugetul de timp disponibil pentru fiecare activitate. Explicați: Ca punct de plecare în activitatea de planificare, vom lua în considerare numărul de utilizatori cu cerințe de nivel de bază și de nivel intermediar pe care furnizorul de servicii îi poate deservi în decursul unei zile. Există un număr mare de factori care vor influența această estimare. De exemplu, dacă personalul este nou sau experimentat sau dacă scaunul rulant furnizat necesită efectuarea unor modificări sau nu etc. Aceste situații vor fi abordate în detaliu în următoarea secțiune, cea care se referă la gestionarea unui sistem de furnizare a serviciilor. ź O echipă cu experiență în domeniu va putea furniza servicii de nivel de bază unui număr de doi utilizatori, pe zi. ź O echipă cu experiență în domeniu va putea furniza servicii de nivel intermediar unui utilizator pe zi. Notă: această estimare se bazează pe modelul de furnizare a serviciilor pe parcursul unei zile: de la etapa 2 – evaluarea la etapa 7 – instruirea utilizatorului de scaun rulant. Estimările trebuie ajustate în fiecare caz, pentru a fi în acord cu modelul pe care se bazează procesul de furnizare a serviciilor. Faceți referire la fișierul excel din prezentarea PPT. Explicați: vom parcurge acum un proces care îi va ajuta pe manageri că calculeze numărul anual de utilizatori de scaun rulant care pot beneficia de pe urma activității de furnizare a serviciilor destinate lor. Prezentați fișierul excel și explicați că primele două linii trebuie să conțină datele referitoare la modelul de activitate folosit de către participanți. ź Care este numărul de zile lucrătoare pe săptămână? ź Care este numărul de zile lucrătoare pe an? Faceți referire la informațiile care sunt deja incluse, pentru a calcula capacitatea de furnizare a serviciilor. ź Introduceți numărul de utilizatori de scaun rulant care beneficiază zilnic de aceste servicii; x1 pentru nivel intermediar și x2 pentru nivel de bază. ź Calculați numărul de utilizatori care beneficiază săptămânal de serviciile furnizate: valoarea zilnică x numărul de zile lucrătoare din fiecare săptămână. ź Calculați numărul de utilizatori care beneficiază anual de serviciile furnizate: valoarea săptămânală x numărul de săptămâni lucrătoare. ź Luați în considerare o valoare de 15% pentru evenimente neplanificate și pierderi în termeni de zile lucrătoare, pe care o veți scădea din valoarea totală. ź Estimați capacitatea anuală de furnizare a serviciilor pentru utilizatorii de scaun rulant. Cereți unuia dintre participanți să prezinte cifrele estimate și înregistrați-le în fișierul excel. Explicați: Acest calcul nu include cea de-a opta etapă a procesului de furnizare a serviciilor, și anume monitorizarea. Planificarea acestei activități va fi abordată într-o sesiune ulterioară. Sumarizați: Analizați valorile care reprezintă totalul pentru servicii nivel de bază și nivel intermediar. Sunt aceste valori mai mari sau mai mici decât v-ați așteptat? Încurajați participanții să discute pe marginea cifrelor obținute. Explicați: Vom reveni asupra acestor cifre în secțiunea care se referă la gestionarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pagina 83 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 84 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 6. Acțiuni pentru manageri – recapitulare (3 minute) Citiți de pe slide, repetați dacă este necesar. Cereți participanților să lucreze cu Caietul de exerciții practice și să noteze care sunt acțiunile lor pentru organizarea resurselor umane. Pagina 85 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului B.5. Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor ști să identifice liniile de buget cheie ale procesului în 8 pași de furnizare a serviciilor; q vor putea explica cel puțin două beneficii ale partajării costurilor în cazul serviciilor integrate; q vor putea explica cel puțin două beneficii ale partajării costurilor în cazul parteneriatelor cu alte organizații. R E S U R S E Pentru sesiune: q Prezentarea PPT: B.5: Care sunt costurile furnizării serviciilor pentru utilizatorii de scaun rulant? q Manualul și caietul participantului; q flipchart; q pixuri cu cerneală albastră, neagră și roșie. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q se pornește de la premisa că participanții au abilitățile necesare pentru generarea de bugete. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele q Pregătiți coala de flipchart cu capul de tabel pentru buget pe tablă și lăsați spațiu pentru a trece liniile de buget sugerate. S T R U C T U R Ă 1. Introducere 2. Ghid pentru buget 3. Beneficiile serviciilor integrate 4. Beneficiile partajării costurilor prin parteneriate 5. Acțiuni pentru manageri – recapitulare 2 20 20 13 5 Total durată sesiune 60 Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 86 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 1. Introducere (2 minute) Explicați: Este important să identificăm ce costuri implică implementarea celor opt etape ale procesului de furnizare a serviciilor, chiar de la stadiul inițierii acestui proces. În această sesiune vom discuta despre modalitatea de a calcula care sunt costurile pentru demararea sau îmbunătățirea procesului de furnizare a serviciilor. De asemenea, vom vedea care sunt diferitele metode de partajare a costurilor 2. Ghid pentru buget (20 de minute) Faceți referire la categoriile de buget de pe coala de flipchart. Explicați că veți lucra cu liniile de buget aferente acestor categorii de cheltuieli. Activitate Grupe Împărțiți participanții în trei echipe. Pentru această activitate, participanții nu vor folosi Caietul de exerciții practice. Instrucțiuni Indicați categoriile de buget de pe coala de flipchart. Rugați participanții să se uite la afișul cu cele opt etape de furnizare a serviciilor pentru utilizatorii de scaun rulant și să se gândească la fiecare etapă. Cereți fiecărei echipe să discute care sunt acele linii de buget pe care le-ar include la fiecare dintre aceste categorii. Toți participanții: prin rotație, fiecare grup va prezenta ideile pentru fiecare categorie de buget. Monitorizare Încurajați participanții să răspundă. Durata Alocați 5 minute pentru discuții și 10 minute pentru feedback. Feedback Notați răspunsurile pe coala de flipchart. Indicați-le participanților modelul de buget completat din Caietul de exerciții practice, pagina 104. Luați în considerare faptul că este posibil ca unii furnizori de servicii să aibă linii de buget suplimentare, care nu sunt menționate aici. De asemenea, nu toți furnizorii de servicii vor utiliza toate liniile de buget enumerate. Cereți participanților să utilizeze Caietul de exerciții practice. Încurajați-i să noteze ideile referitoare la fiecare linie de buget (5 minute). Faceți referire la informațiile din continuare. Pagina 87 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Note pentru formatori Tipul de cheltuieli Comentarii Costuri inițiale Proiectarea produsului Aprovizionarea cu o gamă de produse Unelte Echipamente Clădire/ spații Posibilitatea de a include costuri de construcție/ renovare/ reamenajare Stoc de materiale . Costuri operaționale Scaune rulante Stoc de scaune rulante - în funcție de estimarea capacității de furnizare a serviciilor și de anticiparea nevoilor utilizatorilor de scaun rulant. Piese de schimb Este utilă crearea unui stoc de piese de schimb care sunt necesare în mod frecvent. Materiale Necesarul de materiale pentru efectuarea modificărilor este mai mare în cazul serviciilor de nivel intermediar decât în cazul celor de nivel de bază. Transportul produselor Livrarea și taxele vamale în cazul scaunelor rulante importate. Transportul scaunelor rulante la centre satelit. Resurse umane ź Management În ghidul de buget sunt enumerate diverse poziții din cadrul echipei. Nu există așteptarea ca fiecare echipă care furnizează servicii pentru utilizatorii de scaun rulant să aibă această componentă. Bifele (vezi foaia de calcul) reprezintă activitățile din etapele procesului de furnizare a serviciilor. Există posibilitatea ca același membru al echipei să fie responsabil de implementarea mai multor activități. ź Personal cu atribuții clinice ź Personal cu atribuții tehnice ź Instructor/instructor- utilizator de scaun rulant ź Administrator Transport local ź Costuri de transport local pentru personal De exemplu: monitorizare, servicii furnizate în comunitate, instruirea rețelelor de surse de trimitere ź Transport local pentru beneficiarii serviciilor Deplasarea la sediul furnizorului de servicii, conform programărilor. Cazare pentru beneficiarii serviciilor Costul pentru cazarea beneficiarilor serviciilor în cazul în care aceștia au nevoie să rămână peste noapte (dacă furnizorul acoperă acest tip de costuri). Tipărituri Formulare, liste de verificare și informații pentru utilizatori. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 88 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Consumabile De exemplu: lipici, ață, vopsea etc Înlocuirea sculelor Deoarece sculele se uzează trebuie incluse fonduri pentru înlocuirea acestora. Cheltuieli indirecte Trebuie luate în calcul cheltuielile cu electricitatea, furnizarea apei, chiria - pentru diversele activități (de tip clinic, tehnic, de depozitare, instruirea utilizatorilor, pentru birouri). Instruirea personalului Trebuie luate în considerare toate costurile de instruire pentru personalul furnizor de servicii pentru utilizatorii de scaun rulant. Instruirea partenerilor/ rețelelor de surse de trimitere Costurile activităților de instruire/ conștientizare destinate partenerilor, organizațiilor și rețelelor de surse de trimitere. Strângere de fonduri Orice activitate care are ca scop strângerea de fonduri trebuie bugetată. Monitorizare și evaluare Costurile asociate activităților de monitorizare și evaluare - de exemplu, vizitarea utilizatorilor de scaun rulant pentru obținerea feedback-ului. Costurile pot include deplasarea sau personalul suplimentar necesar. 3. Beneficiile serviciilor integrate (20 de minute) Întrebați: Există printre participanți persoane care desfășoară activitatea de furnizare a serviciilor conform modelului de servicii integrate? Validați răspunsurile. . Explicați: ź Serviciile integrate, care folosesc în mod eficient același spațiu, înseamnă posibilitatea de a partaja costuri, spre deosebire de crearea unui sistem individual de furnizare de servicii. . Pagina 89 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați (exemplu): ź Furnizarea serviciilor de ortezare și protezare 2 necesită o suprafață de aproximativ 170 m . ź Furnizarea serviciilor pentru utilizatorii de scaun rulant - nivel de bază necesită o 2 suprafață de aproximativ 100 m . ź Furnizarea serviciilor pentru utilizatorii de scaun rulant - nivel intermediar necesită o 2 suprafață de aproximativ 140 m . ź Total necesar dacă fiecare tip de furnizare de 2 servicii deține un spațiu individual: 410m . ź Total necesar dacă aceste servicii se 2 furnizează integrat: 200 - 250m . ź Acest lucru înseamnă că spațiul necesar se poate reduce cu aproape 40 - 50%, ceea ce are ca rezultat reducerea costurilor de finanțare a spațiului sau de construcție a acestuia. Activitate Grupe Întregul grup de participanți. Instrucțiuni Dacă niciunul dintre participanți nu își desfășoară activitatea conform modelului de servicii integrate, parcurgeți exemplul de mai jos: Analizați fiecare linie de buget din model și discutați care sunt acele categorii de cheltuieli care pot fi reduse sau partajate în cazul modelului de servicii integrate. Notă: nu există răspunsuri în totalitate corecte sau eronate. Scopul este identificarea beneficiilor modelului de furnizare a serviciilor integrate. Explicați: Încercuiți cu pix negru toate costurile care pot fi reduse. Încercuiți cu pix albastru toate costurile care pot fi partajate. Încercuiți cu pix roșu toate costurile pentru care este nevoie de strângere de fonduri (unele dintre costuri vor fi încercuite atât cu roșu, cât și cu albastru). Monitorizare Încurajați participanții să răspundă Durata Alocați15 minute pentru efectuarea exercițiului. Feedback Cereți participanților să-și prezinte opiniile cu privire la serviciile integrate. Subliniați faptul că aceasta nu este singura metodă de a reduce costurile, partajarea cheltuielilor prin parteneriate cu alte organizații constituie o altă modalitate în acest sens. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 90 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Scenariu pentru un model de servicii integrate: în cazul în care participanții nu au experiență în acest domeniu, prezentați-le exemplul de mai jos. Un centru de protezare și ortezare intenționează să integreze în activitatea sa un proces de furnizare a serviciilor pentru utilizatorii de scaun rulant. Au fost alese două persoane din echipă, care au participat la modulul de instruire pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant - nivel de bază. Cele două persoane instruite vor desfășura activități de furnizare a serviciilor pentru utilizatorii de scaun rulant trei zile pe săptămână, iar două zile pe săptămână vor furniza servicii de protezare și ortezare. În atelier a fost alocat un spațiu pentru un tehnician de scaune rulante. Departamentul de terapie a eliminat echipamentele defecte și nefolosite, astfel creându-se un spațiu de lucru pentru personalul cu atribuții clinice. Spațiul exterior, dedicat testării abilităților de mobilitate a fost modificat prin includerea unor bariere suplimentare pentru exersarea abilităților de manevrare a scaunului rulant. Sugestii pentru partajarea costurilor Stocul de materiale Salariile personalului Echipamentele Uneltele Transportul local (depinde de modelul de furnizare a serviciilor utilizat) Monitorizarea și evaluarea Strângerea de fonduri Instruirea partenerilor / instruirea surselor de trimitere Înlocuirea sculelor Consumabile Tipărituri Cazarea beneficiarilor Personalul Sugestii pentru reducerea costurilor Clădirea / spațiile Cheltuielile generale Sugestii pentru suplimentarea fondurilor Stocul de scaune rulante Piesele de schimb Modificarea spațiului pentru dobândirea abilităților de manevrare a scaunului rulant (costurile vor fi reduse pentru că o mare parte din acest spațiu există deja) Unele unelte Unele echipamente Tipărituri Instruirea personalului Pagina 91 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 4. Beneficiile partajării costurilor prin parteneriate (13 minute) Explicați: Organizațiile pot crea parteneriate în vederea partajării costurilor. Întrebați: Puteți să dați exemple de partajare a costurilor în ceea ce privește furnizarea produselor? Încurajați participanții să răspundă. Explicați: ź Organizațiile internaționale și furnizorii de servicii pentru utilizatorii de scaun rulant pot împărți costurile produselor. ź Beneficii pentru furnizorul de servicii: prețul produselor devine mai accesibil utilizatorilor de scaun rulant. ź Beneficii pentru organizația internațională: dovada că activitatea furnizorului de servicii este sustenabilă din punct de vedere financiar Întrebați: Puteți să dați exemple de partajare a costurilor în ceea ce privește furnizarea serviciilor (personal, spații, transport)? Încurajați participanții să răspundă. Explicați: Parteneriatele la nivel de comunitate permit furnizorului de servicii care își desfășoară activitatea la sediu să aibă acces mai ușor la utilizatorii de scaun rulant din respectivele comunități. ź Partenerul poate fi în măsură să contribuie cu spațiu sau cu personal. ź De asemenea, există posibilitatea ca partenerul să aibă capacitatea de a pune la dispoziție personalul care să fie instruit pentru implementarea anumitor etape ale procesului de furnizare a serviciilor – de exemplu, trimiterea, monitorizarea și instruirea utilizatorului de scaun rulant. ź Beneficii pentru utilizatorii de scaun rulant: reducerea cheltuielilor, inclusiv a celor de deplasare. ź Beneficii pentru furnizorul de servicii: oportunitatea extinderii activității în comunitate, fără a susține financiar un model de furnizare care să fie situat în respectiva comunitate. Întrebați: Puteți să dați exemple de partajare a costurilor necesare pentru instruire? Încurajați participanții să răspundă. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 92 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: Există posibilitatea ca organizațiile internaționale sau private să finanțeze activitatea de instruire: ź Beneficii pentru utilizatorii de scaun rulant: îmbunătățirea stării de sănătate, creșterea gradului de confort și a funcționalității, pentru creșterea nivelului de participare. ź Beneficii pentru finanțator: creșterea capacității unei organizații de a răspunde mai bine nevoilor persoanelor cu dizabilități de mobilitate. Poate ajuta organizațiile private în privința atingerii obiectivelor de responsabilitate socială. Explicați: După planificarea modelului de furnizare a serviciilor și generarea bugetului, este necesară identificarea potențialelor surse de finanțare. Mai multe informații despre modalități de finanțare pentru demararea procesului de furnizare a serviciilor și pentru acoperirea costurilor de funcționare găsim în secțiunea C4: Planificarea sustenabilității financiare. 5. Acțiuni pentru manageri – recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Colaborarea cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź folosirea sistemului de servicii integrate atunci când se stabilește modelul de furnizare a serviciilor; ź stabilierea parteneriatelor la nivel de comunitate atunci când se planifică furnizarea serviciilor; ź pregătirea unui buget pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant. Cereți participanților să lucreze cu Caietul de exerciții practice și să noteze care sunt acțiunile pe care le vor desfășura pentru identificarea costurilor necesare demarării și funcționării procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pagina 93 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant O B IE C T IV E La sfârșitul acestei sesiuni, participanții: qvor putea explica diferența dintre monitorizare și evaluare; q vor ști să descrie modalitatea de a pregăti un plan de furnizare a serviciilor; q vor discuta cel puțin trei modalități de creștere a gradului de eficiență în furnizarea serviciilor; q vor putea descrie metodele de obținere a feedback-ului din partea utilizatorilor de scaun rulant. R E S U R S E Pentru sesiune: q Prezentarea PPT: C1: Cum stabilesc că activitatea mea este eficientă? q Manualul și caietul participantului; q Post-it-uri; q Instrument pentru măsurarea gradului de participare socială la momentul evaluării; q Instrument pentru măsurarea gradului de satisfacție și a rezultatelor la momentul efectuării monitorizării. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q luați în considerare varianta de a completa în avans câteva chestionare, împreună cu utilizatori de scaun rulant, chestionare pe care să le folosiți în timpul sesiunii de instruire. q luați în considerare varianta analizei unui plan de furnizare a serviciilor și corelarea acestuia cu cadrul general de planificare a furnizării serviciilor. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. S T R U C T U R Ă 1. Introducere 2. Ce sunt monitorizarea și evaluarea? 3. Furnizarea eficientă a serviciilor 4. Importanța feedback-ului oferit de către utilizatori 5. Întocmirea unui plan de furnizare a serviciilor 6. Acțiuni pentru manageri – recapitulare 2 10 20 23 15 5 Total durată sesiune 75 C.1.Cum stabilesc că activitatea mea este eficientă? Pagina 94 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 1. Introducere (2 minute) Explicați: Următoarea secțiune va pune accentul pe gestionarea unui sistem de furnizare a serviciilor. Vom vorbi despre rolul managerului în creșterea gradului de eficiență a serviciilor pe baza unui plan de acțiune anual. 2. Ce sunt monitorizarea și evaluarea? (10 minute) Explicați: Monitorizarea și evaluarea (M&E) ajută managerul să aibă o imagine asupra a ceea ce se întâmplă (sau nu se întâmplă) ca rezultat al activității echipei sale. De asemenea, contribuie la înțelegerea, atât de către manager, cât și de către echipă, a aspectelor care funcționează sau nu, precum și a opiniei utilizatorilor sau a părților interesate. Întrebați: cum ați descrie voi activitatea de monitorizare? Explicați: Monitorizarea măsoară performanța. Oferă o imagine a modului în care sunt furnizate serviciile la un anumit moment. Întrebați: cum ați descrie voi activitatea de evaluare? Explicați: Evaluarea merge cu un pas mai departe decât monitorizarea. ź Oferă o imagine a impactului pe care procesul de furnizare a serviciilor îl are asupra celor care beneficiază de ele. Explicați că veți analiza mai atent diferențele fundamentale dintre monitorizare și evaluare. Întrebați: Când are loc fiecare? Explicați: Monitorizarea se desfășoară constant, pe tot parcursul anului. Evaluarea are o frecvență mai redusă și poate fi desfășurată anual. Întrebaţi: Ce se măsoară? Explicați: De regulă, monitorizarea măsoară eficiența în activitățile de furnizare a serviciilor, în utilizarea resurselor și numărul de beneficiari. De regulă, evaluarea măsoară eficacitatea, adică impactul pe care furnizarea serviciilor îl are asupra indivizilor și al comunităților și gradul de sustenabilitate al procesului, în ansamblu. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 95 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Împărțiți participanții în patru grupe. Instrucțiuni Explicați: Există mai multe exemple ale beneficiilor pe care le au monitorizarea și evaluarea, iar scopul este să vedem care dintre echipe poate identifica cel mai mare număr de astfel de avantaje. Cereți-le participanților să noteze fiecare idee pe câte un post-it. Afișați post-it-urile pe o coală de flipchart, pe măsură ce participanții identifică exemple de beneficii. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru efectuarea exercițiului. Feedback Păstrați post-it-urile cu răspunsuri pe coala de flipchart, pe tot parcursul sesiunii. Validați răspunsurile participanților. Cele mai importante răspunsuri: ź oferă informații importante în vederea creșterii calității procesului de furnizare a serviciilor; ź oferă informații care contribuie la deciziile legate de achiziționarea de produse; ź ajută la limitarea costurilor prin creșterea eficienței, precum și la justificarea finanțărilor actuale și viitoare; ź permite furnizorilor să demonstreze finanțatorilor eficiența procesului de furnizare a serviciilor - inclusiv reprezentanților autorităților și donatorilor organizații non-guverna- mentale; ź ajută la identificarea și cuantificarea nevoilor nesatisfăcute; ź contribuie la alocarea corespunzătoare a resurselor; ź crește nivelul de conștientizare cu privire la beneficiile serviciilor pentru utilizatorii de scaun rulant; ź duce la dezvoltarea unor parteneriate mai puternice cu beneficiarii serviciilor de acest tip. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 96 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 3. Furnizarea eficientă a serviciilor (20 de minute) Explicați: Ne-am referit mai devreme la ce înseamnă crearea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant și la aspectele care contribuie la creșterea gradului de eficiență, inclusiv la: ź Acțiuni pentru generarea de servicii echitabile; ź Acțiuni pentru îmbunătățirea activității de trimitere și programare; ź Organizarea spațiilor și stabilirea sistemelor și procedurilor; ź Acțiuni pentru creșterea nivelului de calitate a produselor disponibile. Explicați: Este important să monitorizăm și să evaluăm gradul de eficiență al sistemelor și procedurilor care corespund fiecărei etape a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Explicați: Atunci când planificăm modalitatea de monitorizare și evaluare a procesului de furnizare a serviciilor, se recomandă să folosim un cadru care are trei pași. Mai multe detalii găsim în schema 3.5 din Ghidul privind furnizarea scaunelor rulante. Prezentați activitatea de grup și explicați faptul că vom analiza modalitatea prin care putem să stabilim gradul de eficiență a activității de furnizare a serviciilor. Activitate Grupe Împărțiți participanții în grupe alcătuite din persoane care lucrează în cadrul aceleiași organizații sau în organizații care au activități similare. Desemnați care sunt grupele care vor lucra la completarea secțiunii hașu- rate a tabelului și care sunt grupele care vor complete partea nehașurată a tabelului din secțiunea C1.1 Monitorizarea din Caietul de exercitii. Instrucțiuni Explicați tabelul: ź prima coloană cuprinde aspectele și activitățile care trebuie monitorizate; ź a doua coloană enumeră posibili indicatori de performanță; ź a treia coloană prezintă metode de obținere a informațiilor pentru a compara obiectivele cu rezultatele (care ar trebuie să fie de fapt situația). Explicați în ce constă activitatea: ź unele dintre rubricile tabelului au fost completate pentru a oferi un punct de pornire. Restul de rubrici trebuie completate. Întrebați de ce este important să înregistrăm aceste informații. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru parcurgerea exercițiului și 10 minute pentru a discuta informațiile care au fost trecute în tabel. Pagina 97 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Feedback Reuniți grupele și completați fiecare linie a tabelului (răspunsurile vor varia, procesul în sine este important). Formatorii vor adăuga sugestiile lor, cu privire la aspecte pe care participanții nu le-au menționat. Exemple de arii de acțiune care pot fi monitorizate, indicatori de performanță și metode de strângere a informațiilor Arii de acțiune Exemple de indicatori de performanță Metode de strângere a informațiilor Trimitere Numărul de utilizatori trimiși Furnizorul de servicii va primi lunar 30 de trimiteri Înregistrați trimiterile Perioada medie de așteptare între momentul efectuării trimiterii și programare Intervalul dintre momentul înregistrării trimiterii și programare nu trebuie să depășească o lună Notați în dosarul utilizatorului data înregistrării trimiterii și data evaluării Furnizarea scaunelor rulante Numărul de utilizatori care primesc un scaun rulant Se vor prescrie și se vor pregăti lunar scaune rulante pentru 20 de utilizatori Înregistrați prescrierile scaunelor rulante în dosarele utilizatorilor Perioada medie de așteptare între evaluare și probare. Intervalul dintre etapa de evaluare și cea de probare și ajustare nu trebuie să depășească două luni Înregistrați în dosarul utilizatorului de scaun rulant datele la care au loc evaluarea și probarea Numărul de întâlniri de monitorizare efectuate. Lunar, se vor efectua acțiuni de monitorizare pentru cel puțin 15 utilizatori de scaun rulant. Înregistrați în dosarul utilizatorului de scaun rulant data la care au loc monitorizările. Persoanele care beneficiază de serviciile furnizate Detalii despre utilizatorii îndrumați către furnizorul de servicii, cum ar fi vârsta, genul, dizabilitatea, nevoi de suport postural Încurajarea accesului egal Obiectivul este ca serviciile oferite să răspundă atât cerințelor utilizatorilor care au nevoie de servicii pentru utilizatorii de scaun rulant - nivel de bază cât și ale celor care au nevoie de scaune rulante adaptate sau de suport postural. Înregistrați numărul de femei, bărbați, fete și băieți care au accesat serviciile furnizate. Înregistrați în dosarele utilizatorilor de scaun rulant cerințele de suport postural și tipul de scaune rulante prescrise. Zona geografică acoperită de către furnizorul de servicii pentru utilizatorii de scaun rulant Furnizorul de servicii se va adresa utilizatorilor de scaun rulant dintr-o regiune/ arie desemnată. Înregistrați adresele în dosarele utilizatorilor de scaun rulant care au accesat serviciile furnizate. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 98 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Costurile furnizării serviciilor Costul produselor furnizate, incluzând modificările efectuate în cadrul centrului furnizorului de servicii Costurile individuale pentru fiecare scaun rulant vor fi mai mici decât _____ (sumă specificată conform bugetului și prețurilor reale ale produselor disponibile) Înregistrați în dosarul utilizatorului costul produsului și al modificărilor, pentru fiecare scaun rulant prescris Timpul folosit de către personal în activitățile procesului de furnizare a serviciilor (evaluare, monitorizare, instruire etc.) Serviciul va furniza scaune rulante pentru persoanele care locuiesc în zona/ regiunea stabilită Completați în dosarul utilizatorului timpul pe care personalul îl alocă activității de furnizare a serviciilor. Explicați: Atunci când analizăm informațiile colectate, trebuie să avem în vedere două aspecte importante: ź Atunci când o activitate nu are rezultatele dorite, trebuie să colaborăm cu beneficiarii, personalul furnizor de servicii și cu alte părți interesate, pentru identificarea cauzelor problemelor. ź Atunci când o activitate își atinge obiectivele, trebuie să găsim modalități de a face cunoscut acest lucru și de a sărbători rezultatele. Acest lucru este un factor motivant important atât pentru echipă, cât și pentru părțile implicate. Explicați: ź Este important să sărbătoriți succesul și să premiați rezultatele bune. Întrebați: voi sărbătoriți succesul împreună cu echipele voastre, în cadrul organizațiilor unde lucrați? Cum faceți acest lucru? Pagina 99 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 4. Importanța feedback-ului oferit de către utilizatori (23 de minute) Explicați: Evaluarea permite furnizorului de servicii să identifice care sunt acele aspecte care funcționează în mod adecvat și unde este necesar să se intervină. De asemenea, evaluarea ne arată în ce măsură se atinge scopul activității de furnizare a serviciilor. Explicați: ź Scopul final al furnizării serviciilor pentru utilizatorii de scaun rulant – citiți de pe slide. Explicați: În schema 3.6 a tabelului din Ghidul privind furnizarea scaunelor rulante, există câteva sugestii care pot fi folosite pentru a evalua procesul de furnizare a scaunelor rulante. Manualul participantului conține detalii suplimentare. Explicați: ź Utilizatorii care au beneficiat de servicii și intervențiile efectuate; ź Costul serviciului inclusiv costul furnizării produselor și a furnizării serviciilor; ź Personalul (numărul angajaților, rolurile și competențele acestora); ź Spațiile și echipamentele de care dispune furnizorul de servicii pentru utilizatorii de scaun rulant; ź Calitatea furnizării serviciilor - în Ghidul privind furnizarea scaunelor rulante găsim exemple de bună practică); ź Impactul pe care furnizarea serviciilor l-a avut asupra utilizatorilor și a familiilor acestora. Întrebați participanții dacă acolo unde își desfășoară activitatea există deja activitatea de evaluare a sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Notați răspunsurile. Întrebați participanții dacă evaluează vreuna din ariile enumerate mai sus. Notați răspunsurile. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 100 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: ź Ne vom concentra atenția asupra ultimului punct de pe listă: impactul furnizării serviciilor asupra utilizatorilor de scaun rulant și al familiilor lor. ź Vom discuta despre importanța și beneficiile obținerii unui feedback din partea celor cărora li se adresează furnizarea serviciilor. Explicați că vreți să prezentați un exemplu din Etiopia care demonstrează beneficiile care decurg din implicarea persoanelor cu dizabilități locomotorii în obținerea feedback-ului din partea utilizatorilor. Citiți sau relatați povestea. Exemplu din Etiopia Doi reprezentanți au intervievat 140 de utilizatori de scaun rulant din șapte centre de servicii din întreaga țară. Amândoi sunt persoane cu dizabilități locomotorii, iar acest lucru a avut un impact pozitiv în ceea ce privește desfășurarea activității de evaluare. Beneficii ale acestui proces: Prin realizarea acestui studiu, cei doi reprezentanți au obținut multe informații privind provocările cu care se confruntă utilizatorii de scaun rulant din Etiopia. Prin acest proces ei au dobândit astfel capacitatea de a promova drepturile și nevoile utilizatorilor de scaun rulant. Interacțiunea cu cei doi reprezentanți a avut un semnificativ impact psihic și emoțional asupra beneficiarilor serviciilor, ei având astfel posibilitatea de a vedea un model pozitiv. În urma interviurilor, s-a realizat o rețea informală care a dus la o relație mai strânsă între furnizorii de servicii și utilizatori. În plus, evaluările au contribuit la identificarea unor cazuri de utilizatori care nu primiseră scaune rulante corespunzătoare. Acest lucru a semnalat faptul că este nevoie de o instruire suplimentară a personalului, iar furnizorul a acționat în consecință. Explicați: Există câteva aspecte importante atunci când plănuim obținerea feedback-ului de la utilizatorii care au primit servicii. Participanții vor utiliza Caietul de exerciții practice. Pagina 101 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Se lucrează în echipe. Participanții care lucrează în aceeași organizație pot lucra împreună. Instrucțiuni Prezentați: „Instrumentul pentru măsurarea gradului de participare socială la momentul evaluării” și „ Instrument pentru măsurarea gradului de satisfacție și a rezultatelor la momentul efectuării monitorizării” din Resursele suplimentare de pe memory stick. Explicați: Există câteva aspecte importante ale procesului de obținere a feedback-ului din partea utilizatorilor de scaun rulant. Completați lista de verificare pentru a nota idei referitoare la contextul în care vă desfășurați activitatea (Caietul de exerciții practice pag. 103). Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 8 minute pentru parcurgerea exercițiului și 5 minute pentru feedback. Feedback Întrebați cine se oferă voluntar pentru prezentarea planului. Explicați: Procesul de intervievare a beneficiarilor serviciilor furnizate necesită pregătire. Pentru mai multe informații, participanții vor lucra cu Manualul participantului. 5. Întocmirea unui plan de furnizare a serviciilor (15 minute) Explicați: Monitorizarea și evaluarea oferă informații care pot fi folosite în planificarea furnizării serviciilor pentru utilizatorii de scaun rulant. Prezentați modelul de plan de furnizare a serviciilor și parcurgeți fiecare secțiune. Explicați: ź Identificați nevoia sau problema. ź Identificați acțiunea care răspunde acestei nevoi sau care tratează problema. ź Stabiliți un obiectiv (sau „un rezultat pe termen scurt”). ź Decideți care va fi modalitatea de obținere a informațiilor pentru a stabili dacă obiectivele au fost atinse. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 102 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Activitate Grupe Toți participanții. Instrucțiuni Cereți participanților să lucreze cu Caietul de exerciții practice și să identifice trei probleme sau nevoi, iar apoi să completeze modelul de plan de furnizare a serviciilor (pagina 111). Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru parcurgerea exercițiului și 9 minute pentru feedback. Feedback Folosiți slide-ul cu capul de tabel. Rugați doi participanți să prezinte exemplele lor. Notați exemplele în fișierul PPT. Clarificați toate aspectele 6. Acțiuni pentru manageri – recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Cereți participanților să lucreze cu Caietul de exerciții practice și să noteze acțiunile necesare pentru a crea un plan de furnizare a serviciilor pentru utilizatorii de scaun rulant, astfel încât să stabilească dacă activitatea este eficientă sau nu. Pagina 103 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului C.2. Gestionarea cererii O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea enumera cel puțin două acțiuni recomandate managerilor în cazul în care numărul de trimiteri este redus; q vor putea enumera cel puțin două acțiuni recomandate managerilor în cazul în care numărul de trimiteri este prea ridicat; q vor putea descrie trei motive pentru care intervenția timpurie în cazul copiilor reprezintă un aspect foarte important; q vor putea descrie cel puțin trei acțiuni pentru monitorizarea și îmbunătățirea gradului de eficiență în furnizarea serviciilor pentru utilizatorii de scaun rulant. R E S U R S E Pentru sesiune: q Prezentarea PPT: C.2: Gestionarea cererii; q Manualul participantului și Caietul de exerciții practice. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q Dacă programul de instruire se livrează unui anumit partener, obțineți informații despre etapele procesului de furnizare a serviciilor D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele q Pregătiți o coală de flipchart pe care notați dinainte beneficiile intervenției timpurii. S T R U C T U R Ă 1. Introducere 2. Generarea cererii 3. Gestionarea cererii 4. Importanța intervenției timpurii în cazul utilizatorilor copii 5. Gestionarea eficientă a procesului de furnizare a serviciilor 6. Acțiuni pentru manageri – recapitulare 2 20 18 20 20 5 Total durată sesiune 85 Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 104 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 1. Introducere (2 minute) Explicați: Pe parcursul acestei sesiuni vom discuta despre rolul managerului în dezvoltarea ofertei de servicii, astfel încât acestea să răspundă cererii. Aici includem următoarele: gestionarea trimiterilor, importanța intervenției timpurii în cazul utilizatorilor copii și sugestii pentru creșterea gradului de eficiență. 2. Generarea cererii (20 de minute) Explicați: Vom discuta care sunt acțiunile recomandate în cazul în care numărul de trimiteri este prea scăzut. Explicați: ź Atunci când sunt prea puține trimiteri gestionarea sistemului de furnizare a serviciilor devine prea costisitoare. Întrebați: Care sunt acțiunile recomandate pentru dezvoltarea unei rețele de surse de trimiteri despre care am discutat în sesiunile anterioare? Încurajați participanții să răspundă și notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź identificarea surselor care pot face trimiteri; ź vizite la organizații care pot deveni surse de trimitere; ź instruirea surselor de trimitere; ź organizarea evenimentelor de tipul „porți deschise” la sediul furnizorului de servicii pentru utilizatorii de scaun rulant. Întrebați: Care pot fi cauzele numărului scăzut de trimiteri? Încurajați participanții să răspundă și notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź furnizorul nu a identificat cele mai adecvate surse de trimiteri; ź persoanele care au nevoie de un scaun rulant nu accesează sursele care ar putea să le direcționeze către furnizorul de servicii; ź la instruirea rețelei de surse de trimitere nu s-a transmis în mod corespunzător informația despre beneficiile și importanța serviciilor pentru utilizatorii de scaun rulant; ź utilizatorii de scaun rulant nu au posibilitatea de a accesa serviciile – centrul se află la o distanță prea mare de locul în care trăiesc, nu sunt disponibile mijloace de transport etc. Pagina 105 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Grupați participanții în perechi. Instrucțiuni Citiți exemplul referitor la o rețea de trimiteri eficientă, prezentat mai jos. Cereți participanților să analizeze de ce acesta reprezintă un caz de succes și să enumere motivele. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Durata exercițiului este de 5 minute pentru activitate și 5 minute pentru feedback. Feedback Cereți participanților să discute ideile referitoare la factorii de succes. Notați răspunsurile pe tablă. Dacă este necesar, enumerați factorii pe care participanții nu i-au avut în vedere. Un exemplu de succes: generarea de trimiteri din Bangladesh Programul „Walk for Life” din Bangladesh se desfășoară în parteneriat cu Ministerul Sănătății și are ca scop dezvoltarea unor servicii la nivel național pentru corectarea afecțiunii varus equin în cazul copiilor cu vârsta mai mică de trei ani. Obiectivul „Walk for Life” este ca nicio familie să nu fie nevoită să se deplaseze pe distanțe mai mari de 60 km pentru a accesa acest tip de servicii. Pentru ca acest obiectiv să fie îndeplinit, programul „Walk for Life” are nevoie de o rețea eficientă de trimiteri. Au fost identificate următoarele grupuri ca posibile surse pentru trimiteri: persoane care lucrează în domeniul sănătății atât din cadrul unor instituții guvernamentale cât și de la organizații non-guvernamentale, inclusiv medici, terapeuți sau asistenți medicali. Aceste grupuri au fost implicate în activități pentru creșterea gradului de conștientizare cu privire la importanța intervenției timpurii în cazul copiilor cu acest tip de afecțiune. Rezultatul: în medie, în Bangladesh, peste 60% din numărul copiilor care prezintă la naștere afecțiunea varus equin sunt identificați și tratați într-un interval de 12 luni de la naștere. În cadrul diviziei Dhaka, cea care deservește o populație de 50 milioane, acest procent ajunge la 75%. Cele mai importante răspunsuri: ź mesaj clar cu privire la cine constituie grupul țintă; ź obiectiv formulat clar; ź identificarea diverselor tipuri de organizații și a diferitelor profesii; ź identificarea organizațiilor care oferă servicii la sediu sau care lucrează în comunitate; ź monitorizarea atentă a trimiterilor – cazurile de succes în generarea de trimiteri cât mai timpurii constituie un factor de motivare pentru întreg personalul implicat. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 106 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 3. Gestionarea cererii (18 minute) Explicați: Atunci când există un număr mare de cereri, timpul de așteptare crește, deoarece utilizatorii de scaun rulant nu pot beneficia imediat de furnizarea serviciilor. Acest lucru îi poate demoraliza atât pe utilizatorii de scaun rulant, cât și personalul furnizor de servicii. Explicați: În cazul în care numărul persoanelor care apelează la furnizorul de servicii pentru utilizatorii de scaun rulant depășește capacitatea de răspuns a personalului, acest lucru poate avea trei potențiale consecințe: ź personalul este nevoit să reducă durata de timp alocată fiecărui beneficiar – astfel, scade nivelul de calitate a serviciilor furnizate; ź crește timpul de așteptare înainte de programare; sau ź vor exista cazuri în care furnizorul va fi nevoit să refuze furnizarea de servicii către un anumit număr de utilizatori de scaun rulant. Explicați: În consecință, managerul trebuie să gestioneze cererea cât mai eficient posibil. Citiți slide-ul, repetați dacă este necesar. Explicați: Primul pas este înregistrarea cererii prin generarea unei liste de așteptare. ź Se recomandă crearea unei baze de date în care să fie înregistrate toate informațiile. ź Acest lucru le va permite managerului și personalului furnizor să acceseze informația în mod eficient și va facilita procesarea informațiilor și generarea de statistici. ź Odată ce o persoană apelează la furnizorul de servicii se poate adăuga informația în lista de așteptare. Pagina 107 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: În generarea listei de așteptare, unele organizații prioritizează trimiterile înregistrate. Întrebați: Folosiți vreun sistem de selecție și prioritizare a trimiterilor înregistrate? Notați răspunsurile. Explicați: Atunci când numărul de trimiteri înregistrate este mare, devine important să acordăm prioritate acelor utilizatori a căror situație se poate deteriora rapid sau la care pot apărea complicații ale stării de sănătate: ź Copiii cu dizabilități – din cauza riscului de apariție a deviațiilor posturale și a viciilor de postură secundare. ź Utilizatorii de scaun rulant la care există riscul apariției escarelor - deoarece acestea pun în pericol viața persoanei. ź Utilizatorii de scaun rulant care au o afecțiune degenerativă. ź Persoanele la care există senzația de durere din cauza lipsei unui scaun rulant sau a unui scaun rulant care nu li se potrivește. Întrebați: Care credeți că sunt informațiile necesare pentru a face selecția trimiterilor? Cele mai importante răspunsuri: ź vârsta; ź tipul de dizabilitate; ź motivul pentru care utilizatorul a fost direcționat către furnizorul de servicii; ź zona geografică Explicați: Contează mult modalitatea de gestionare a așteptărilor cu privire la capacitatea de furnizare a serviciilor – atât din punct de vedere al numărului de utilizatori de scaun rulant, cât și din cel al nivelului serviciilor furnizate. În fiecare regiune a oricărei țări există utilizatori de scaun rulant care au nevoie de suport postural de nivel de bază, intermediar și avansat. Fiecare regiune va avea nevoie de servicii de nivel intermediar (și ulterior de nivel avansat). Cu toate acestea, nu toți furnizorii de servicii pentru utilizatorii de scaun rulant vor avea capacitatea de a livra servicii de nivel intermediar (sau avansat). Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 108 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: ź Asigurați-vă că informațiile despre serviciile furnizate (ceea ce pot oferi acestea) sunt clar prezentate în broșuri/prospecte. ź Începeți prin a dezvolta o bază de cunoștințe și competențe de nivel de bază, cu sistemele de suport și procedurile necesare pentru un proces în opt etape. ź Discutați modalitatea de gestionare a trimiterilor în cazul utilizatorilor cu nevoi de o complexitate mai mare – intermediar și avansat. Explicați: Se recomandă să documentăm acele nevoi care nu pot fi acoperite pentru a putea planifica într-un mod mai eficient creșterea capacității resurselor umane și a gamei de produse disponibile. Unii furnizori de servici vor instrui personalul și vor dezvolta servicii de nivel intermediar, incluzând aici gama de produse corespunzătoare și de dispozitive de suport postural. Unii furnizori vor direcționa utilizatorii către cei care oferă servicii de nivel intermediar. Este important ca de la bun început broșurile și materialele publicitare să conțină informații clare cu privire la nivelul serviciilor furnizate. Note pentru formatori: În realitate, membrii echipei se vor confrunta cu cazuri de utilizatori ale căror nevoi specifice vor depăși nivelul lor de cunoștințe, competențe și gama de produse disponibile, în consecință, capacitatea de furnizare a serviciilor pe care o dețin. Este esențial, atât pentru utilizatori, cât și pentru personalul furnizor de servicii, să se stabilească o strategie care să contribuie la gestionarea acestui tip de situație. Atunci când informația cu privire la nivelul de complexitate al serviciilor furnizate este disponibilă, se va îmbunătăți discutarea acestor aspecte. Se recomandă menținerea legăturii cu alți furnizori de servicii pentru a putea colabora în cazurile utilizatorilor de scaun rulant ale căror nevoi depășesc capacitatea noastră de răspuns. 4. Importanța intervenției timpurii în cazul utilizatorilor copii (20 de minute) Explicați: Mulți copii care au nevoie de scaun rulant vor avea nevoie și de suport postural suplimentar. Acest lucru înseamnă că există un număr mare de copii care necesită servicii de nivel intermediar. Este foarte important ca toți copiii care se află în această situație să fie direcționați către furnizorul de servicii pentru utilizatorii de scaun rulant cât mai timpuriu posibil, în vederea prevenirii sau încetinirii evoluției problemelor posturale. Pagina 109 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Întrebați: Din experiența voastră, când ajung utilizatorii copii la furnizorul de servicii? La o vârstă foarte mică sau atunci când părinții sau însoțitorii nu mai reușesc să îi transporte în brațe? Încurajați participanții să răspundă. Întrebați: De ce sunt unii părinți refractari la ideea de a aduce copiii pentru a fi evaluați de către furnizorul de servicii pentru utilizatorii de scaun rulant? Încurajați participanții să răspundă. Cele mai importante răspunsuri: ź părinții speră în continuare că în final copilul „se va vindeca” și va începe să meargă; ź părinții consideră că din cauza utilizării scaunului rulant, copiii nu vor mai încerca să meargă; ź atunci când copiii au vârste foarte mici și o greutate mică, părinților le este mai ușor să îi transporte în brațe decât să manevreze un scaun rulant pe un teren accidentat sau într-un mediu neaccesibil; ź părinții nu au mijloacele financiare pentru a achiziționa un scaun rulant și vor amâna momentul până când greutatea copilului nu le mai permite să îl transporte în brațe; ź familia trăiește un sentiment de vinovăție sau de teamă că cei din jur vor avea o părere negativă despre faptul că copilul are o dizabilitate. Cereți participanților să dea exemple de beneficii ale intervenției timpurii. Afișați pe perete coala de flipchart pregătită, cea care enumeră beneficiile ce decurg din intervenția timpurie și verificați dacă au fost menționate toate ideile notate. ź în lipsa suportului adecvat, în cazul utilizatorilor copiii care au dificultăți în menținerea poziției așezat, există riscul apariției problemelor posturale; ź dacă un utilizator copil nu este direcționat către furnizorul de servicii în timp util, anumite probleme posturale pot deveni fixe. Acest lucru face dificilă menținerea poziției așezat în condiții confortabile, chiar și în prezența suportului. ź atunci când este absent obiceiul de menținere a poziției așezat și cel al mobilității, pot apărea întârzieri în dezvoltarea copilului; ź în cazul copiilor la care este prezentă, într-o oarecare măsură, capacitatea de deplasare, utilizarea unui scaun rulant le poate ușura viața de zi cu zi și le poate permite desfășurarea mai multor activități pe parcursul unei zile. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 110 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Explicați: ź Utilizarea unei combinații de echipamente asistive pentru deplasare și/sau dispozitive de tip proteze sau orteze, precum și a unui scaun rulant, le permite utilizatorilor să desfășoare o gamă mai largă de activități, datorită vitezei suplimentare și a consumului redus de energie prin utilizarea unui scaun rulant bine ajustat. ź Tabelul de mai jos prezintă diferența de viteză (metri/minut) în cazul mai multor metode de mobilitate, împreună cu valorile consumului de energie (în comparație cu parcurgerea aceleiași distanțe atunci când nu există dizabilități de mobilitate). Este important să li se explice în mod clar atât părinților, cât și surselor pentru trimiteri că este improbabil ca un scaun rulant să împiedice un copil să meargă, dacă el are această capacitate. Experiența mobilității cu ajutorul unui scaun rulant, atunci când copilul învață să meargă, va avea un impact pozitiv asupra dezvoltării sale, din mai multe puncte de vedere. Explicați: Furnizorii de sevicii pot să încurajeze rețelele de trimiteri să direcționeze către ei, copiii care: ź au dificultăți în menținerea poziției așezat sau nu se ridică în picioare înainte de vârsta de un an; ź nu merg singuri înainte de vârsta de 2 ani. Explicați: Copiii nu petrec mult timp în poziția așezat. Poziția și activitățile lor se schimbă de mai multe ori pe parcursul unei zile. Acest lucru înseamnă că deși scaunul rulant este important, ei nu ar trebui să își petreacă întreaga zi într-un scaun rulant. Explicați: ź Personalul furnizor de servicii trebuie să lucreze împreună cu copiii, membrii lor de familie/ însoțitorii, pentru a identifica acele poziții pe care copiii le pot adopta pe parcursul zilei. ź Aici sunt incluse poziția așezat cu suport postural, poziția ortostatică și cea de decubit. ź Colaborarea strânsă cu furnizorii de servicii pentru copii și instruirea părinților/însoțitorilor trebuie încurajate. Pagina 111 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Împărțiți participanții în echipe de câte două persoane. Instrucțiuni Solicitați-le participanților să citească exemplul de succes din Caietul de exerciții practice pag. 105 – cazul din Mexic referitor la intervenția timpurie. Cereți-le participanților să analizeze motivele pentru care s-au obținut rezultate pozitive și notați ideile lor. Monitorizare Monitorizați cu atenție activitatea și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru efectuarea exercițiului și 5 minute pentru feedback. Feedback Cereți-le participanților să-și prezinte opiniile cu privire la factorii de succes. Notați răspunsurile pe tablă. Exemplu de succes privind intervenția timpurie – un caz din Mexic În continuare avem un exemplu din Mexic, despre modul în care un grup de centre de recuperare pentru copii a reușit să dezvolte o rețea eficientă de trimiteri pentru intervenția timpurie. Centrele de recuperare au avut ca obiectiv creșterea gradului de conștientizare cu privire la serviciile lor în rândul medicilor neonatologi și al pediatrilor. În plus, au reușit să abordeze întreaga comunitate printr-o importantă campanie anuală de strângere de fonduri, care este bine mediatizată, atât prin radio, cât și prin televiziune. Acest lucru a dus la multe trimiteri care au rezultat din discuții individuale; mulți părinți recomandând altora aceste servicii, în beneficiul copiilor. Pe parcursul campaniei de conștientizare, mesajul a fost clar: este foarte important ca în cazul copiilor recomandarea pentru recuperare să se facă la momentul nașterii acestora. De asemenea, a fost prezentată o viziune pozitivă puternică; cu un număr mare de povești de succes care s-au referit la integrarea și realizările copiilor cu care au lucrat aceste centre. În 15 ani, centrele de recuperare au observat o schimbare de mentalitate, deoarece medicii pediatri și familiile fac acum trimiteri timpurii în mod activ. Rezultatul: O treime din numărul trimiterilor se referă la copii cu vârsta sub trei ani. Cele mai importante răspunsuri: ź mesaj clar cu privire la cine constituie grupul țintă; ź obiective clar formulate cu privire la ce fel de rezultate trebuie obținute prin respectivul program; ź abordări diferite în cazul specialiștilor și al părinților; ź promovarea cazurilor de succes pentru a încuraja părinții și specialiștii să facă trimiteri; ź campanie de conștientizare desfășurată pe parcursul mai multor ani. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 112 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului 5. Gestionarea eficientă a procesului de furnizare a serviciilor (20 de minute) Explicați: În sesiunea B4: Organizarea resurselor umane, am discutat despre estimarea capacității anuale de furnizare a serviciilor, atât pentru serviciile la nivel de bază, cât și pentru cele de nivel intermediar. Odată ce procesul de furnizare a serviciilor începe să funcționeze, se recomandă o analiză mai atentă a acestuia: ź Durata pe care o necesită implementarea fiecărei etape a procesului de furnizare a serviciilor. ź Creșterea gradului de eficiență a fiecărei etape, prin intermediul următoarelor acțiuni: ° încurajarea lucrului în echipă; ° planificarea a ceea ce poate fi pregătit în avans pentru implementarea fiecărei etape a procesului de furnizare a serviciilor. Cereți-le participanților să estimeze numărul de ore de lucru disponibile zilnic pentru activitatea de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Trebuie luate în considerare pauzele de prânz și de cafea, timpul necesar completării documentelor, timpul alocat întâlnirilor, aspecte legate de obiceiuri (caracteristici culturale) care influențează orele de început și de sfârșit ale programului de lucru. Subliniați faptul că aceasta reprezintă doar o estimare. Cereți participanților să noteze valoarea obținută în Caietul de exerciții practice. Scoateți în evidență ideea că este util ca acest calcul să fie făcut de către management împreună cu personalul furnizor de servicii, astfel încât să poată fi stabilite niște obiective realiste. Prezentați: Durata etapelor procesului de furnizare a serviciilor – nivel de bază. Cereți-le participanților să estimeze numărul anual de utilizatori de scaun rulant cu cerințe de nivel de bază cărora le pot oferi servicii. Prezentați: Durata etapelor procesului de furnizare a serviciilor – nivel intermediar. Cereți-le participanților să estimeze numărul anual de utilizatori de scaun rulant cu cerințe de nivel intermediar cărora le pot oferi servicii. Pagina 113 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Validați faptul că există variații semnificative în estimarea duratei necesare desfășurării fiecărei etape a procesului de furnizare a serviciilor. Explicați: vom analiza câteva dintre cauzele care produc aceste variații. Activitate Grupe Împărțiți participanții în echipe de câte două sau trei persoane Instrucțiuni Explicați: scopul activității este să analizăm munca în echipă și aspectele care pot fi pregătite în avans, pentru a reduce durata necesară implementării fiecărei etape. Citiți coloana 1 care enumeră cauzele care duc la creșterea duratei etapelor de furnizare a serviciilor. Citiți sugestiile cu privire la creșterea gradului de eficiență și reducerea duratei necesare desfășurării fiecărei etape. Trageți concluziile pentru a corela fiecare problemă cu soluția adecvată. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru parcurgerea exercițiului și 10 minute pentru discuții. Feedback Cereți-le participanților să citească strategiile alese de ei pentru creșterea eficienței în desfășurarea etapelor procesului de furnizare a serviciilor. În cazul în care nu au fost menționate toate aspectele, încurajați celelate grupe să adauge idei. Citiți slide-ul, repetați dacă este necesar. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Pagina 114 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Manualul format orului Citiți slide-ul, repetați dacă este necesar. Citiți slide-ul, repetați dacă este necesar. Citiți slide-ul, repetați dacă este necesar. Pagina 115 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Coloana 1: Provocări în furnizarea serviciilor Coloana 2: Strategii Evaluare 1 În cazul în care personalul se deplasează la un centru furnizor de servicii sau dacă efectuează vizite la domiciliu, timpul necesar deplasării trebuie încorporat în intervalul alocat evaluării. 18 2 În cazul în care membrii echipei nu au experiență, etapa de evaluare va avea o durată mai mare. 11 Prescriere 3 În cazul în care produsele au opțiuni de reglare limitate, trebuie prescrise anumite modificări, astfel încât produsul să corespundă cerințelor individuale ale utilizatorului. 1, 2 4 În cazul în care este necesară confecționarea unor dispozitive de suport postural în plus, se vor face măsurători și schițe suplimentare 5, 9, 10, 16, 19 Pregătirea produsului 5 Se impune accesul rapid la produse de tipul și mărimea necesare. 16, 17 6 În cazul în care un scaun rulant are o gamă de opțiuni de reglaje limitată, pregătirea produsului poate dura mai mult. 1, 2, 12, 13 7 În cazul în care este nevoie de modificări pentru asigurarea suportului postural, pregătirea produsului va dura mai mult. 1, 2, 4, 5, 12, 13 Probarea și ajustarea 8 În cazul în care au fost efectuate modificări sau dacă scaunului rulant i-au fost adăugate suporturi suplimentare, etapa de probare și ajustare va avea o durată mai mare. 3, 6, 8 9 În cazul în care, pe parcursul etapei de probare și ajustare, se fac modificări ale setării scaunului rulant, vor fi necesare verificări suplimentare în ceea ce privește poziționarea utilizatorului. 1, 2, 3, 6, 8, 10, 13 Instruirea utilizatorului 10 Atunci când un utilizator primește pentru prima oară un scaun rulant sau atunci când există complicații legate de starea de sănătate, etapa de instruire va avea o durată mai mare - pentru a putea aborda temele legate de starea de sănătate, mobilitate, manevrarea scaunului rulant, întreținerea acestuia și direcționarea utilizatorului către alte surse de trimiteri. 6, 7, 10, 11, 14, 15, 20 Notă: 20: Fiți deschiși la idei noi, inovații pot fi făcute în toate domeniile. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 116 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Planificarea și gestionarea activității de monitorizare au un impact major asupra dezvoltării procesului de furnizare a serviciilor. Monitorizarea face obiectul discuției din următoarea sesiune. Explicați: ź Crește constant nevoia de servicii pentru utilizatorii cu cerințe de nivel intermediar. ź Atunci când se demarează furnizarea serviciilor de nivel intermediar, trebuie să ne așteptăm la un volum mare de cereri. ź De aceea, se recomandă crearea unei echipe dedicate care să furnizeze servicii de nivel intermediar la fel ca cea dedicată furnizării serviciilor de nivel de bază. Explicați: Pentru a putea furniza servicii de nivel intermediar, sunt necesare cunoștințe și abilități tehnice și clinice temeinice. Aceste două roluri pot fi îndeplinite de către aceeași persoană, dar este mai frecvent întâlnit cazul în care există două persoane - una cu abilități clinice și alta cu abilități tehnice. Întrebați: Cum credeți că trebuie să planificați instruirea personalului, astfel încât să puteți furniza atât servicii de nivel de bază, cât și de nivel intermediar? Cele mai importante răspunsuri: ź începeți instruirea noii echipe sau a noilor membrii ai echipei cu modulul de bază; ź în cazul în care organizația nu are resursele financiare necesare pentru personal suplimentar, luați în considerare varianta instruirii personalului unei organizații partenere; ź identificați o persoană sau o echipă nouă care va furniza serviciile de nivel intermediar; ź decideți care va fi modelul de furnizare a serviciilor și care este necesarul de spații pentru furnizarea serviciilor de nivel intermediar; ź instruiți o nouă echipă pentru furnizarea serviciilor de nivel intermediar: prin modulul intermediar. Pagina 117 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cereți-le participanților să lucreze cu Caietul de exerciții practice și să noteze acțiunile necesare pentru a echilibra cererea și capacitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant. 6. Acțiuni pentru manageri – recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Explicați: Colaboraţi cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile implicate pentru: ź stabilirea unui sistem pentru monitorizarea trimiterilor și gestionarea listelor de așteptare; ź diseminarea poveștilor de succes referitoare la intervenția timpurie – prezentarea lor către părinți și surse care pot face trimiteri; ź planificarea gestionării beneficiarilor ale căror nevoi specifice depășesc capacitatea centrului de furnizare a serviciilor; ź planificarea metodei de monitorizare și îmbunătățire a eficienței în desfășurarea etapelor de furnizare a serviciilor. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 118 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea descrie cel puțin patru categorii de utilizatori de scaun rulant care au nevoie de monitorizare la intervale regulate; q vor putea descrie cel puțin trei beneficii ale activității de monitorizare desfășurate în comunitatea în care trăiesc utilizatorii de scaun rulant sau la sediul furnizorului de servicii; q vor putea enumera cel puțin două obstacole în desfășurarea monitorizării și modalitățile de a le depăși; q vor discuta modalitatea prin care parteneriatele în comunitate pot sprijinii incluziunea și participarea utilizatorilor de scaun rulant la viața comunității. R E S U R S E Pentru sesiune: q Prezentarea PPT: C3: Planificarea activității de monitorizare; q Manualul participantului și Caietul de exerciții practice. C O N T E X T Adaptați conținutul aceastei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q Luați în considerare modelele de furnizare a serviciilor care se aplică în cazul organizațiilor unde își desfășoară activitatea participanții și adaptați exemplele, dacă este necesar. q Centralizați resurse utile relevante pentru subiect. D E P R E G Ă T IT q În cazul în care acest lucru este posibil, invitați un utilizator de scaun rulant care să prezinte beneficiile monitorizării și ce a însemnat aceasta în cazul său. S T R U C T U R Ă 1. Introducere 2. Importanța monitorizării 3. Scopul monitorizării și locul de desfășurare 4. Planificarea activității de monitorizare 5. Reducerea barierelor în efectuarea activității de monitorizare 6. Incluziunea și participarea la viața comunității 7. Acțiuni pentru manageri - recapitulare 2 10 15 20 20 13 5 Total durată sesiune 85 C.3. Planificarea activității de monitorizare Pagina 119 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 1. Introducere (2 minute) Explicați: Monitorizarea este cea de-a opta etapă a procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Toți utilizatorii de scaun rulant beneficiază de pe urma monitorizării. Se recomandă ca furnizorul să planifice desfășurarea activității de monitorizare. Monitorizarea reprezintă o oportunitate și pentru furnizorul de servicii, de a obține informații despre impactul pe care serviciile furnizate îl au asupra utilizatorului, membrilor familiei și comunității acestuia. 2. Importanța monitorizării (10 minute) Note pentru formatori: În cazul în care este posibil, invitați un utilizator de scaun rulant care să prezinte beneficiile monitorizării și impactul asupra vieții sale și a familiei sale. În cazul în care nu poate fi prezent niciun utilizator de scaun rulant care să împărtășească experiența sa, alegeți unul dintre următoarele exemple care ilustrează beneficiile monitorizării. Duli: este o femeie în vârstă de 21 ani, care locuiește cu familia. La monitorizare, echipa a aflat că ea nu putea ieși din casă, deoarece scaunul ei rulant avea roțile dezumflate, anvelopele fiind perforate. Scaunul rulant a fost abandonat în subsolul casei sale. Anvelopele scaunului rulant au fost recondiționate, iar familia ei a beneficiat de sfaturi cu privire la echipamentul de mobilitate. Astfel, Duli a avut posibilitatea de a ieși din nou din casă. Familia ei nu a înțeles importanța activității de monitorizare decât în momentul în care a văzut care sunt avantajele care decurg de aici. Echipa furnizoare de servicii a decis să creeze autocolante pentru toate scaunele rulante pe care le oferă, pe care să apară numărul de contact al furnizorului, pentru a preîntâmpina astfel de cazuri. Maria: a primit un scaun rulant corespunzător la 9 luni după o leziune a măduvei spinării. La monitorizare, Maria a explicat că scaunul rulant îi produce senzația de disconfort și că utilizarea acestuia are ca rezultat apariția spasticității. Echipa a constatat că materialul textil al scaunului rulant era infestat cu insecte care o înțepau. Acest lucru ar fi putut determina apariția unor probleme de sănătate grave și renunțarea la utilizarea scaunului rulant. Însă problema a fost identificată și rezolvată, iar Maria este acum sănătoasă și mulțumită de scaunul ei rulant. Anton: era cunoscut în comunitatea sa datorită aptitudinilor sale de jucător de rugby. În timpul unui joc de rugby Anton a avut un accident care i-a provocat o leziune la nivelul măduvei spinării. A primit un scaun rulant corespunzător și a fost instruit, dar la monitorizare s-a constatat că nu ieșea din casă. Din echipa de monitorizare făcea parte și un instructor în scaun rulant, iar acesta a discutat cu Anton. Instructorul a aflat că Anton își pierduse încrederea de sine și nu dorea să se întâlnească cu prietenii lui. Se simțea izolat, singur și rușinat de faptul că avea o dizabilitate. Instructorul în scaun rulant a revenit a doua zi și l-a însoțit prima dată când Anton a decis să iasă din casă. După acest eveniment, Anton a fost capabil să își continue viața. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 120 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Gihan: este un băiat în vârstă de trei ani care locuiește cu părinții și fratele său. La monitorizare, s-a constatat că sistemul de poziționare al lui Gihan avea numeroase urme de mâncare și că nu era întreținut. Părinții au afirmat că Gihan avea dificultăți în menținerea poziției așezat și că nu se simțea confortabil în scaunul său. Ei și-au pierdut încrederea în respectivul echipament de mobilitate și nu erau mulțumiți de ceea ce oferea acesta. Gihan a fost reprogramat pentru o nouă evaluare efectuată de către o echipă care a beneficiat de instruire pentru furnizarea serviciilor de nivel intermediar. S-au făcut modificări la setările scaunului rulant, iar ca urmare a acestui fapt, Gihan a reușit să mențină poziția așezat în scaunul rulant și a început să descopere și să exploreze mediul în care trăia. Gihan și părinții lui au fost foarte bucuroși de această schimbare și au urmărit cu atenție când li s-a arătat care sunt operațiunile necesare pentru întreținerea sistemului de poziționare. Întrebați: Aveți experiență în desfășurarea activității de monitorizare pentru orice model de furnizare a serviciilor pentru utilizatorilor de scaun rulant? Încurajați participanții să răspundă. Discutați: ź Este monitorizarea o activitate utilă? ź Este monitorizarea o activitate planificată? ź Cât de frecvent are loc? 3. Scopul activității de monitorizare și locul de desfășurare (15 minute) Explicați: Personalul furnizor de servicii pentru utilizatorii de scaun rulant trebuie să cunoască foarte bine scopul activității de monitorizare și felul în care aceasta se deosebește de o nouă programare. Citiți de pe slide, repetați dacă este necesar. Folosiţi răspunsurile pe care participanții le-au dat anterior. Citiți slide-ul, repetați dacă este necesar. Pagina 121 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Există beneficii care decurg din efectuarea monitorizării la domiciliul utilizatorilor de scaune rulante sau în apropiere de comunitatea unde locuiesc aceștia. Întrebați: Care credeți că sunt aceste beneficii? Notați răspunsurile pe tablă. Cele mai importante răspunsuri: ź eficiența costurilor din punct de vedere al utilizatorului și al familiei acestuia: aparținătorii nu sunt nevoiți să solicite zile libere de la locul de muncă și nu există cheltuieli de transport; ź conștientizarea personalului furnizor de servicii cu privire la obstacolele în calea participării și incluziunii, cu care se confruntă utilizatorii la domiciliu și în comunitate; ź calitatea serviciului furnizat: confirmarea sau infirmarea faptului că scaunul rulant răspunde cerințelor utilizatorului; ź creșterea gradului de conștientizare la nivelul comunităților: prezența și vizibilitatea personalului crește gradul de conștientizare la nivelul comunității, mărind numărul de trimiteri către furnizorul de servicii pentru utilizatorii de scaun rulant precum și posibilitățile de fundraising la nivelul comunității; ź sprijinirea activității de strângere de fonduri: permite centralizarea cazurilor de succes și a poveștilor utilizatorilor care pot fi folosite pentru strângere de fonduri. Explicați: Monitorizarea poate avea loc: ź la domiciliul utilizatorului de scaun rulant; ź la sediul furnizorului de servicii pentru utilizatorii de scaun rulant; ź în orice alt loc care este convenabil atât pentru utilizatorul de scaun rulant, cât și pentru personalul furnizor de servicii. Subliniați: Activitatea de monitorizare nu trebuie să se transforme într-o nouă activitate de evaluare și nu trebuie să aibă ca rezultat efectuarea de modificări majore ale echipamentului de mobilitate. Durata alocată monitorizării nu permite acest lucru, astfel că se recomandă stabilirea unei noi programări pentru o evaluare completă. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 122 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: ź utilizare eficientă a timpului personalului furnizor de servicii: nu se pierde timpul cu deplasările; ź posibilitatea efectuării unor reparații majore cu ajutorul dotărilor complete care există la sediu; ź toate echipamentele și spațiile sunt aranjate corespunzător; ź posibilitatea de a solicita o opinie celorlați membrii ai echipei; ź obținerea unui feedback direct cu privire la calitatea serviciilor furnizate: confirmarea sau infirmarea faptului că scaunul rulant răspunde nevoilor utilizatorului; ź sprijinirea activității de strângere de fonduri: centralizarea cazurilor de succes și a poveștilor utilizatorilor care pot fi folosite pentru strângere de fonduri. 4. Planificarea activității de monitorizare (20 de minute) Explicați: Toți utilizatorii de scaun rulant beneficiază de pe urma activității de monitorizare. Cu toate acestea, se recomandă efectuarea monitorizării în special în următoarele cazuri: ź copii cu dizabilități; ź utilizatori de scaun rulant la care există riscul apariției escarelor; ź utilizatori de scaun rulant care au o afecțiune degenerativă; ź utilizatori de scaun rulant care au nevoie de suport postural suplimentar (cu cerințe de nivel intermediar); ź utilizatori de scaun rulant care au întâmpinat dificultăți în ceea ce privește instruirea pentru efectuarea transferului, dobândirea abilităților de mobilitate, prevenirea problemelor de sănătate sau întreținerea scaunului rulant. Explicați: Există avantaje și în cazul în care monitorizarea se desfășoară la sediul furnizorului de servicii pentru utilizatorii de scaun rulant. Întrebați: Care credeți că sunt aceste beneficii? Notați răspunsurile pe tablă. Pagina 123 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Întrebați: Credeți că e realist să presupunem că în primul an nu vor exista cereri pentru activitatea de monitorizare? Luați în considerare faptul că în cazul unora dintre utilizatori, monitorizarea va fi prioritară. Pentru unii furnizori de servicii, aceste cazuri pot reprezenta chiar și 30% din volumul total de activitate. Dați click ca să apară anul 2: coloana albastră reprezintă programările de monitorizare din primul an. Explicați: Nu există o regulă cu privire la intervalul de timp la care trebuie efectuată monitorizarea, deoarece acesta va depinde de nevoile individuale ale utilizatorului de scaun rulant. ź Se recomandă ca în cazul utilizatorilor cu cerințe de nivel intermediar, monitorizarea să aibă loc într-un interval de șase săptămâni de la primirea noului scaun rulant, pentru a verifica confortul și abilitățile în prezența noului suport. ź În cazul utilizatorilor copii și adulți cu afecțiuni degenerative, monitorizarea ar trebui să aibă loc la intervale de câte șase luni. Acest lucru este rezultatul faptului că în aceste cazuri, nevoile se pot schimba rapid. ź Se recomandă ca toți ceilalți utilizatori să fie monitorizați într-un interval de douăsprezece luni de la primirea scaunului rulant. Explicați: ź Albastru = durată alocată programărilor pentru monitorizare; ź Verde = durată alocată programărilor noi ź Portocaliu = durata totală privind disponibilita- tea pentru furnizarea serviciilor; ź Pe parcursul primului an nu sunt alocate resurse de timp pentru desfășurarea activității de monitorizare, toate programările fiind utilizate pentru furnizarea serviciilor către utilizatori noi (coloana verde). ź Numărul total al utilizatorilor (coloana portocalie) reprezintă programări noi. Prezentați instrumentul vizual, din prezentarea PowerPoint, pentru a explica procesul de furnizare a serviciilor de nivel de bază. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 124 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: ź dezvoltarea capacității de furnizare a activității de monitorizare (rolul de suport); ź identificarea, la centrul furnizorului de servicii, a spațiilor unde se poate desfășura monitorizarea, precum și a instrumentelor și echipamentelor necesare; ź instruirea personalului din organizații partenere aflate în comunități, pentru ca acesta să poată desfășura activitatea de monitorizare; ź instruirea unui număr mai mare de persoane, pentru a gestiona un volum de lucru crescut. Prezentați instrumentul vizual (prezentare PowerPoint) pentru explicarea procesului de furnizare a serviciilor de nivel intermediar. Explicați: ź Albastru = durată alocată programărilor pentru monitorizare; ź Verde = durată alocată noilor programări; ź Portocaliu = durata totală privind disponibilitatea pentru furnizarea serviciilor. Explicați: În primul an de funcționare, programările pentru monitorizare încep de obicei după a șasea lună de activitate. Dați click ca să apară anul 2. Întrebați: Care este diferența dintre furnizarea serviciilor de nivel de bază și cele de nivel intermediar în anul 2 de funcționare? Subliniați faptul că numărul programărilor pentru monitorizare este mai mare, iar numărul programărilor dedicate noilor beneficiari este semnificativ mai mic. Dați click ca să apară anul 3 de funcționare. Întrebați: Care este situația în acest caz? Scoateți în evidență faptul că mai puțin de jumătate din numărul de programări sunt disponibile pentru beneficiarii noi. Întrebați: Ce s-a întâmplat cu coloana verde, care reprezintă durata de timp alocată programărilor noilor beneficiari? Validați faptul că a scăzut durata de timp alocată programărilor pentru beneficiarii noi. Dați click ca să apară anul 3 de funcționare. Subliniați faptul că durata alocată programărilor pentru beneficiarii noi continuă să scadă. Întrebați: Care sunt acțiunile care ar putea contribui la menținerea numărului de programări pentru beneficiarii noi în fiecare an? Pagina 125 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: În absența planificării, disponibilitatea pentru noi programări a furnizorului de servicii pentru utilizatorii de scaun rulant va fi rapid influențată de desfășurarea activității de monitorizare. În special în cazul serviciilor de nivel intermediar, furnizorii riscă să atingă nivelul de saturație în cel de-al treilea an de activitate. ź O posibilă soluție o reprezintă colaborarea cu organizațiile din comunitate, precum și instruirea personalului acestora, astfel încât activitatea de monitorizare să fie efectuată într-o cât mai mare măsură de către acesta. Personalul din cadrul comunității poate gestiona multe dintre sarcinile mai simple aferente monitorizării, adresându-se furnizorului de servicii doar atunci când este nevoie de o reevaluare, de reparații majore sau când există alte probleme pe care ei nu le pot rezolva. ź Există multe beneficii atunci când această activitate este desfășurată de o persoană care reprezintă un model de urmat, cum ar fi o persoană cu dizabilități locomotorii. 5. Reducerea barierelor în efectuarea activității de monitorizare (20 de minute) Explicați: În ciuda beneficiilor pe care le are activitatea de monitorizare, atât în cazul utilizatorilor de scaun rulant, cât și al furnizorilor de servicii, numărul utilizatorilor monitorizați este adesea redus. Este important să identificăm principala cauză a acestui fapt, pentru a depăși obstacolele și pentru a îmbunătăți furnizarea serviciilor pentru utilizatorii de scaun rulant. Întrebați: Cu ce fel de bariere v-ați confruntat în desfășurarea activității de monitorizare? Validați răspunsurile. Întrebați: Care este momentul în care trebuie să demarați planificarea activității de monitorizare? Validați răspunsurile. Subliniați cât este de important ca planificarea activității de monitorizare să aibă loc chiar de la început și să fie integrată în modelul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 126 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Cele mai importante răspunsuri: Posibile bariere în desfășurarea monitorizării în comunitate: ź costurile pentru deplasarea în comunitate a personalului de la sediul furnizorului de servicii; ź timpul de care are nevoie personalul pentru a se deplasa în comunități; ź managerii nu consideră că monitorizarea este o prioritate; ź utilizatorii nu înțeleg care sunt beneficiile monitorizării decât după ce le experimentează. Posibile obstacole în desfășurarea monitorizării la sediul furnizorului de servicii pentru utilizatorii de scaun rulant: ź costul deplasării și absența de la locul de muncă al unuia sau mai multor membri ai familiei reprezintă o cheltuială dublă pentru familie; ź în numeroase cazuri, utilizatorii și membrii familiei nu cunosc care sunt beneficiile monitorizării după primirea scaunului rulant; ź dificultatea în găsirea mijloacelor de transport accesibile; ź presiunea de a ne concentra pe stabilirea de programări noi, în detrimentul timpului alocat activității de monitorizare; ź dificultăți în programarea vizitelor: utilizatorii ajung la sediul furnizorului atunci când personalul nu este disponibil sau nu au cum să ajungă atunci când personalul este disponibil. Citiți exemplul referitor la o organizație din Indonezia, pentru a vedea ce abordare a ales aceasta în ceea ce privește monitorizarea În cadrul unui program de furnizare a scaunelor rulante din Indonezia, în locul perceperii unei taxe pentru furnizarea echipamentului de mobilitate, se percep „taxe de membru” care contribuie la susținerea costurilor pe care le presupun funcționarea sistemului de furnizare a serviciilor, monitorizarea, întreținerea echipamentelor și aspectele administrative. Această „taxă de membru” le asigură utilizatorilor servicii de calitate și suport permanent. Există un sistem de plată „flexibil”, unde valoarea achitată de către o persoană este determinată în funcție de veniturile familiei, identificate prin facturile de utilități, documente de la serviciile publice, declarația proprie și alți indicatori privind veniturile. S-a constatat că acest program de furnizare a scaunelor rulante bazat pe taxe de membru reprezintă o soluție viabilă din mai multe puncte de vedere: ź membrii simt că au dreptul de a se aștepta la servicii și produse de calitate; ź deoarece membrii au achitat o sumă semnificativă raportat la veniturile lor (de obicei, sumele sunt cuprinse între 2-20 USD, dar pot ajunge și până la 150 USD), crește probabilitatea ca ei să aprecieze în mod real scaunul rulant și să aibă un sentiment de mândrie că îl dețin; ź deoarece calitatea de membru le permite accesul gratuit sau cu preț redus la servicii de monitorizare, valabile timp de doi ani de la primirea scaunului rulant, crește probabilitatea ca membrii să solicite efectuarea monitorizării mai devreme, înainte de expirarea acestui termen. Pagina 127 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Împărțiți participanții în grupe de câte trei sau patru persoane. Instrucțiuni Citiți lista potențialelor bariere în desfășurarea monitorizării (Caietul de exerciții practice, pag 114). Adăugați și alte exemple de obstacole, pe care le-au identificat participanții. Luați în considerare strategiile pentru implementarea schimbării și aplicați-le pentru rezolvarea problemelor legate de monitorizare În coloana necompletată, enumerați potențialele strategii. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 5 minute pentru efectuarea exercițiului și 10 minute pentru feedback. Feedback Analizați fiecare dintre strategiile pentru depășirea barierelor în desfășurarea activității de monitorizare și cereți-le participanților să explice cum pot fi acestea utile. Potențiale acțiuni pentru depășirea barierelor în activitatea de monitorizare Motivarea și implicarea utilizatorilor de scaun rulant cu privire la beneficiile activității de monitorizare: ź în timpul instruirii utilizatorilor (etapa 7), explicați care sunt beneficiile monitorizării; ź faceți cunoscute poveștile despre avantajele monitorizării, făcându-le vizibile în sala de așteptare, pe site-uri web, pe panourile de informare plasate în comunitate; ź creați un sistem pe bază de „abonament de membru”. Motivarea și implicarea personalului cu privire la beneficiile activității de monitorizare: ź puneți în aplicare un model pilot de furnizare a serviciilor de monitorizare; ź colectați studii de caz despre beneficiile monitorizării. Identificați un rezultat imediat, care să fie măsurabil: ź stabiliți obiective pentru modelul pilot; ź identificați și diseminați poveștile de succes. Acordați prioritate monitorizării atunci când alocați resursele: ź folosiți povești de succes despre beneficiile monitorizării pentru a susține strângerea de fonduri pentru acoperirea costurilor specifice monitorizării; ź alocați timp pentru dezvoltarea de parteneriate în comunitate și pentru a instrui și îndruma personalul din aceste comunități. Oferiți sprijin constant pentru a face față provocărilor continue: ź analizați cu atenție datele obținute din activitatea de monitorizare și identificați cauzele problemelor; ź integrați monitorizarea în sistemele și procedurile modelului de furnizare a serviciilor. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 128 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 6. Incluziunea și participarea la viața comunității (13 minute) Explicați: Așa cum am menționat anterior, monitorizarea reprezintă etapa în care evaluăm impactul furnizării serviciilor pentru utilizatorii de scaun rulant și în care stabilim dacă acestea își ating obiectivul general: de a îmbunătăți calitatea vieții, incluziunea și participarea la viața comunității. Unul dintre rolurile mai largi ale unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant este îmbunătățirea accesibilității. Accesibilitatea poate influența într-o foarte mare măsură incluziunea și participarea la viața comunității a utilizatorilor de scaun rulant. Exemplul următor arată care sunt dezavantajele care decurg din lipsa de accesibilitate la domiciliu și în comunitate. Citiți despre lipsa de accesibilitate care impune amânarea externării – un exemplu din Sri Lanka Lipsa de abordare a problemelor legate de accesibilitate la domiciliu și în comunitate poate avea un impact semnificativ asupra cheltuielilor pe care statul este nevoit să le facă. În anul 1999, în secția pentru leziuni medulare a unui spital de recuperare din Sri Lanka, s-a făcut un studiu cu privire la costurile impuse de tratament. Costul mediu pe zi, pentru un pacient internat, se ridica la suma de 6,8 USD. La acea data, în secția 8, existau 16 pacienți (o secție pentru pacienții care nu puteau fi externați), a căror perioadă de internare ajungea, în medie, la 61 de luni. Acest lucru determina cheltuieli în valoare de 858,270 Rs (12,438 USD) pentru fiecare dintre acești pacienți. Investițiile în accesibilizarea domiciliului acestor persoane, astfel încât ele să poată să se întoarcă la casele lor, ar fi însemnat economii importante pentru spital și pentru stat. Explicați: ź Una dintre principalele bariere la domiciliu o constituie accesul la toaletă. Explicați: ź Sfaturile cu privire la modificări minore care pot fi realizate la domiciliul utilizatorilor de scaun rulant pot avea un impact pozitiv semnificativ asupra calității vieții. Pagina 129 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Subliniați: Studiile făcute de către Banca Mondială au arătat faptul că bugetul necesar integrării elementelor de accesibilitate arhitecturală, în timpul procesului de construcție a clădirilor, este minim. S-a demonstrat că accesibilizarea clădirilor adaugă mai puțin de 1% la costul construcțiilor. Explicați: Transportul este unul dintre cele mai des întâlnite obstacole cu care se confruntă utilizatorii de scaun rulant. Provocările includ: ź timpul de staționare trebuie să fie suficient de lung pentru ca utilizatorul de scaun rulant să se poată transfera în mijlocul de transport; ź perceperea unor taxe suplimentare pentru transportarea scaunului rulant; ź riscul ca anumite piese componente, de exemplu roțile, să fie furate; ź dificultatea accesului în mijloacele de transport în comun din cauza pragurilor și a ușilor de acces. Citiți cazul campaniei de accesibilizare arhitecturală din Nicaragua A O organizație a persoanelor cu dizabilități din Nicaragua, numită CADISCA¸ a demarat în capitala țării Managua, o campanie care avea ca scop semnalarea problemei pe care o reprezentau bordurile înalte și treptele. Cu ajutorul unei echipe de utilizatori de scaun rulant, pe parcursul a trei luni, au fost construite 200 de rampe și au fost accesibilizate bordurile (prin aducerea unei porțiuni de bordură la același nivel cu drumul) îmbunătățind astfel accesul la spațiile publice. A Membrii organizației CADISCA au devenit vizibili în comunitate, prin activitățile lor pozitive, ceea ce a atras mai mult sprijin, rezultatul fiind primirea de sponsorizări din partea companiilor locale pentru construirea mai multor rampe și borduri accesibilizate prin oraș. Anterior, CADISCA a folosit baschetul în scaun rulant pentru a promova încrederea în sine a utilizatorilor de scaun rulant și a stimula implicarea membrilor în activitățile organizației. Antrenamentele sportive au constituit o bună oportunitate pentru organizarea de întâlniri regulate ale organizației, în care au fost planificate acțiunile de conștientizare. Antrenamentele aveau loc într-un parc, comunitatea fiind astfel expusă la contactul cu problematica dizabilității și cu acțiunile organizației. Programul sportiv a contribuit la succesul campaniei de conștientizare și la sprijinirea persoanelor cu dizabilități. În cele din urmă, acest lucru a dus la presiuni asupra guvernului pentru a aloca fonduri publice pentru accesibilizarea bordurilor din orașul Managua. Eliminarea barierelor arhitecturale a oferit utilizatorilor de scaun rulant oportunități egale de acces la spații cheie dedicate activităților financiare, educaționale și sociale din oraș. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 130 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Prezentați imaginea unei motociclete modificate din Thailanda și a unei ricșe modificate din India. Explicați: ź În multe state există inițiative pentru furnizarea de transport adaptat, inclusiv în Africa de Sud și în Columbia. Câteva resurse utile sunt menționate în Manualul participantului. Explicați: ź Accesul la educație poate fi îngreunat de elemente banale, cum ar fi lățimea căii de acces sau accesul la toaletă. ź Furnizarea către școli a resurselor și a informațiilor cu privire la clădiri și căi accesibile va contribui la transformarea școlilor în medii incluzive. Sumarizați: Oferind consultanță și informații pentru accesibilizarea mediului și lucrând în parteneriat pentru a facilita accesul la domiciliul utilizatorilor de scaun rulant, la transport și la educație, furnizorul de servicii maximizează oportunitățile pentru incluziunea și participarea persoanelor cu dizabilități la viața socială. 7. Acțiuni pentru manageri - recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Colaborați cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź planificarea monitorizării; ź crearea de parteneriate la nivel de comunitate și instruirea partenerilor; ź identificarea persoanelor responsabile pentru instruirea utilizatorilor de scaun rulant și pentru monitorizare; ź identificarea și prezentarea cazurilor de succes referitoare la monitorizare. Cereți participanților să noteze în Caietul de exercii practice măsurile pe care le vor lua în vederea planificării activității de monitorizare. Pagina 131 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului C.4. Planificarea sustenabilității financiare O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor ști să definească sustenabilitatea financiară; q vor putea descrie modalitatea de planificare a sustenabilității financiare; q vor putea identifica cel puțin trei surse de finanțare; q vor ști să elaboreze o strategie de strângere de fonduri. R E S U R S E Pentru sesiune: q Prezentarea PPT: C.4: Planificarea sustenabilității financiare; q Manualul și caietul participantului. C O N T E X T Adaptați conținutul acestei sesiuni, astfel încât acesta să fie în concordanță cu contextul local în care își vor desfășura activitatea participanții. De exemplu: q analizați modelul de servicii adoptat de către organizațiile participante la sesiunea de instruire; q adăugați la materialul de referință informații cu privire la surse de finanțare prezente pe plan local sau exemple de cazuri de succes. O alternativă este să creați un material suplimentar care să contribuie la susținerea acestei sesiuni. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele. q Parcurgeți modelul-cadru de strângere de fonduri. S T R U C T U R Ă 1. Introducere 2. Ce este sustenabilitatea financiară? 3. Planificarea sustenabilității financiare 4. Identificarea potențialelor surse de finanțare 5. Elaborarea unei strategii pentru strângerea de fonduri 6. Acțiuni pentru manageri - recapitulare 2 15 8 20 20 5 Total durată sesiune 70 Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 132 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 1. Introducere (2 minute) Explicați: În cadrul acestei sesiuni vom discuta despre rolul managerului în dezvoltarea unei strategii de finanțare a etapelor procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant și despre responsabilitățile mai largi ale acestor servicii. Scopul general este asigurarea sustenabilității procesului de furnizare a serviciilor pentru ultilizatorii de scaun rulant. 2. Ce este sustenabilitatea financiară? (15 minute) Explicați: Vom crea un enunț despre ce înseamnă sustenabilitatea financiară a serviciilor de furnizare a scaunelor rulante. Prezentați slide-ul. Prezentați activitatea de grup. Activitate Grupe Împărțiți participanții în trei grupe. Instrucțiuni Cereți fiecărei grupe să scrie un enunț despre ce înseamnă sustenabilitatea financiară în contextul furnizării serviciilor pentru utilizatorii de scaun rulant. Explicați că uneori este mai ușor să începem cu ceea ce nu reprezintă sustenabilitate financiară, pentru ca apoi să transformăm ideile în afirmații cu sens pozitiv. De exemplu: sustenabilitatea financiară a unui sistem de furnizare a serviciilor nu înseamnă doar acoperirea costurilor produselor. Aceasta poate deveni o afirmație de tipul: Sustenabilitatea financiară în furnizarea serviciilor pentru utilizatorii de scaun rulant trebuie să includă mai mult decât costul produselor.” Acesta va constitui un punct de pornire pentru definirea conceptului de sustenabilitate financiară. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Cereți grupelor să noteze enunțul lor despre sustenabilitatea financiară pe coli de flipchart. Durata Alocați 5 minute pentru rezolvarea exercițiului și 8 minute pentru feedback și formularea enunțului. Pagina 133 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Feedback Rugați câte un reprezentant din fiecare grup să prezinte enunțul formulat către ceilalți participanți. Evidențiați elementele comune ale enunțurilor și formulați un enunț comun despre sustenabilitatea financiară. Notați enunțul comun pe o coală de flipchart și afișați-o pe perete. Note pentru formatori: Un exemplu de enunț posibil ź Un program de furnizare a scaunelor rulante sustenabil are capacitatea de a oferi scaune rulante corespunzătoare, prin cele opt etape ale procesului de furnizare a serviciilor, unui număr constant de utilizatori de scaun rulant, de-a lungul unei perioade de timp semnificative. ź Acest lucru presupune investiții permanente în stocul de produse, instruirea personalului, spații, precum și sisteme de monitorizare și evaluare. Sustenabilitatea financiară este atinsă atunci când furnizorul de servicii a asigurat, sau este în măsură să asigure în mod constant, fondurile și resursele necesare care să permită aceste investiții continue. 3. Planificarea sustenabilității financiare (8 minute) Explicați: Planificarea sustenabilității financiare include: ź identificarea fondurilor și resurselor necesare pentru a susține serviciile (așa cum s-a discutat în secțiunea B.5); ź identificarea potențialelor surse de finanțare; ź identificarea potențialelor surse de sprijin non financiar; ź dezvoltarea unei strategii care să aibă ca rezultat asigurarea finanțării și a donațiilor în natură. Întrebați: Care sunt potențialele surse de finanțare în contextul în care vă desfășurați activitatea? Validați răspunsurile. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 134 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Există mai multe posibile surse de finanțare. Prezentați slide-ul. Explicați: ź Există multiple opțiuni pentru finanțarea furnizării serviciilor pentru utilizatorii de scaun rulant. ź Unii furnizori de servicii pot avea o singură sursă de finanțare (de exemplu, de la bugetul de stat). Totuși, cele mai multe servicii vor asigura fondurile și resursele necesare funcționării apelând la diferite surse. Explicați: ź Pe lângă resursele financiare, există și alt tip de resurse, non financiare. ź Acestea includ: donațiile în natură (de exemplu: donațiile de echipamente, scaune rulante, materiale) și voluntarii. ź Sprijinul non-financiar contribuie la reducerea fondurilor necesare gestionării sistemului de furnizare a serviciilor. Întrebați: Puteți să dați exemple de sprijin non- financiar? Validați răspunsurile. Citiți exemplul din Mexic: Mobilizarea comunității și atragerea de contribuții din partea utilizatorilor Teletonul din Mexic este o emisiune TV și radio care se desfășoară anual. A fost demarat în 1996 cu scopul de a atrage fonduri pentru centrele de recuperare destinate copiilor cu dizabilități (cunoscute sub numele de Centro de Rehabilitación Infantil Teletón sau CRIT – Teletonul Centrelor de Recuperare pentru Copii). Producătorul emisiunii este Televisa, în parteneriat cu peste 600 de reprezentanți ai mass- media din Mexic și din străinătate. Evenimentul este sponsorizat de 20 de companii. Emisiunea promovează o viziune de succes prin prezentarea unor exemple pozitive de mare impact despre integrarea și realizările copiilor cu dizabilități. Cu trei luni înainte de eveniment, cazurile de succes sunt promovate în mass media, pentru a atrage atenția asupra Teletonului. Evenimentul este susținut de persoane publice cunoscute. Centrele CRIT sunt în întregime sustenabile din punct de vedere financiar și sunt în plină dezvoltare. Acest lucru se datorează surselor de finanțare care combină veniturile rezultate din evenimentul anual de strângere de fonduri și contribuțiile beneficiarilor serviciilor furnizate. Pagina 135 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului 4. Identificarea surselor de finanțare inițiale (20 de minute) Explicați: Odată ce ați planificat modelul de furnizare a serviciilor și ați elaborat un buget, trebuie să identificați sursele de finanțare. Subliniați: Acest eveniment, denumit Teleton, reprezintă o campanie de conștientizare de mari proporții, care are un succes semnificativ. Explicați: Identificarea și promovarea cazurilor de succes constituie un puternic instrument de strângere de fonduri. Furnizorii serviciilor pentru utilizatorii de scaun rulant vor avea de câștigat de pe urma planificării unor campanii de conștientizare în cadrul comunităților unde își desfășoară activitatea. Activitate Grupe Împărțiți participanții în grupe mici. Participanții din cadrul aceleiași organizații pot lucra împreună. Instrucțiuni Citiți lista potențialelor surse de finanțare din Caietul de exerciții practice, pag.115. Selectați acele trei surse despre care considerați că au cel mai mare potențial de finanțare a activității voastre și notați-le în tabelul de mai jos. Estimați cantitatea de efort care va fi necesară, precum și rezultatele pe termen scurt și pe termen lung. Numerotați în ordinea priorității. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 12 minute pentru parcurgerea activității și 8 minute pentru feedback. Feedback Întrebați participanții cine se oferă voluntar să prezinte sursele de finanțare selectate și motivele alegerii. Întrebați dacă participanții au în vedere abordarea unei surse de finanțare pe care nu au utilizat-o până la această dată. 5. Elaborarea unei strategii pentru strângerea de fonduri (20 de minute) Explicați: După identificarea potențialelor surse de finanțare, managerii care gestionează furnizarea serviciilor pentru utilizatorii de scaun rulant trebuie să elaboreze o strategie care să arate ce fel de sprijin va fi solicitat, care sunt potențialele surse de finanțare și cât anume se va solicita. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 136 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Prezentați imaginea unei motociclete modificate din Thailanda și a unei ricșe modificate din India. Explicați: ź Pentru a putea dezvolta o astfel de strategie, managerii trebuie să prioritizeze diferitele surse de finanțare și să planifice modalitatea prin care pot asigura fondurile necesare funcționării. ź Managerii trebuie să ia în considerare următoarele: o sursa de finanțare: pe cine vor aborda; o sprijinul: tipul de sprijin pe care managerul îl va solicita din partea sursei. Model-cadru pentru activitatea de strângere de fonduri – exemplu: Cerere: Care sunt parametrii resurselor solicitate? (Cât anume veți solicita de la sursa de finanțare?) Probabilitatea: Care este probabilitatea ca sursa de finanțare să ofere finanțare/ să susțină solicitarea. Aici există trei categorii: scăzută, medie și ridicată. Efortul: Care sunt acțiunile necesare pentru a asigura finanțarea, care sunt modalitățile de raportare sau alte tipuri de obligații. Explicați: ź Acest tabel îi ajută pe manageri să prioritizeze sursele de finanțare și să elaboreze o strategie. Luați în considerare următoarele elemente: ź Tipul de sprijin: acesta se poate referi fie la o linie de buget, de exemplu, la produse, fie la una sau mai multe etape ale procesului de furnizare a serviciilor, cu liniile de buget aferente fiecăreia. Aveți în vedere specificul sursei de finanțare și care sunt activitățile pe care aceasta ar fi interesată să le sprijine. ź Cât de mult să solicităm: Analizați donațiile pe care respectiva sursă le-a oferit anterior, fie serviciului dumneavoastră, fie altor organizații. Scopul este acela de a cere o sumă realistă. ź Efortul: Gradul de efort, pe care trebuie să îl depuneți pentru a obține finanțarea, ar trebui să fie direct proporțional cu suma finanțată. Obligațiile care decurg din obținerea finanțării trebuie de asemenea să fie gestionabile de către furnizorul de servicii. Pagina 137 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Explicați: Este important să creați o previzionare de buget pentru a sprijini eforturile de strângere de fonduri necesare; corelați informațiile din sesiunile anterioare referitoare la volumul de muncă anual estimat și la buget. 6. Acțiuni pentru manageri – recapitulare (5 minute) Citiți lista acțiunilor recomandate managerilor. Colaborarea cu personalul furnizor de servicii pentru utilizatorii de scaun rulant și cu părțile interesate pentru: ź crearea unei viziuni comune în ceea ce privește sustenabilitatea financiară; ź identificarea fondurilor și a resurselor necesare; ź identificarea potențialelor surse de finanțare; ź prioritizarea surselor de finanțare ce urmează a fi abordate; ź dezvoltarea unei strategii de strângere de fonduri și implementarea acesteia. Cereți participanților să lucreze cu Caietul de exerciții practice pentru a nota propriile acțiuni pe care le vor folosi în vederea planificării sustenabilității financiare a sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Activitate Grupe Păstrați componența grupelor de la exercițiul anterior. Instrucțiuni Citiți exemplele din tabel (Caietul de exerciții practice, pag 116). Enumerați cele trei surse de finanțare din exercițiul anterior. Completați tabelul pentru sursele de finanțare selectate. Luați în calcul faptul că este posibil să nu putem completa exact toate rubricile tabelului, dar, cu toate acestea, parcurgeți exercițiul și introduceți cât mai multe informații posibil. Monitorizare Monitorizați desfășurarea activității și oferiți ajutor atunci când acest lucru este necesar. Durata Alocați 15 minute pentru parcurgerea activității. Feedback Cereți feedback cu privire la structura activității de strângere de fonduri, folosind strategia din tabel. Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 138 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor reflecta asupra acțiunilor pe care le pot face managerii pentru a încuraja părțile interesate să sprijine îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant din țară. R E S U R S E Pentru sesiune: q Prezentare PPT: Sesiune de încheiere q Material video: Mesajul de final q Formulare de evaluare (participanții primesc formularele de evaluare în ziua anterioară, le completează și le predau la finalul modulului de instruire). C O N T E X T Adaptați conținutul aceastei sesiuni pentru a fi în concordanță cu contextul local în care își vor desfășura activitatea participanții. D E P R E G Ă T IT q Citiți planul de desfășurare a sesiunii și pregătiți resursele q Asigurați-vă că certificatele sunt pregătite și semnate de către formatori. q Revedeți coala de flipchart cu facilitatorii schimbării (cea pregătită la începutul programului de instruire) S T R U C T U R Ă 1. Introducere 2. Acțiuni pentru determinarea schimbării 3. Ceremonia de încheiere și înmânarea certificatelor 2 18 10 Total durată sesiune 30 Încheiere 1. Introducere (2 minute) Explicați: în cadrul acestei sesiuni de final, managerii vor face propuneri de acțiuni pentru îmbunătățirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pagina 139 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Activitate Grupe Toți participanții. Instrucțiuni Faceți referire la coala de flipchart cu factorii care facilitează producerea schimbării, care a fost pregătită la începutul programului de instruire cu scopul de a nota acțiunile comune, prin care managerii și părțile interesate pot contribui la îmbunătățirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Monitorizare Încurajați participanții să adauge orice idee nouă, pe care nu au menționat-o anterior (alocați 5 minute). Durata Alocați un total de 18 minute. Feedback Cereți unui voluntar să facă o recapitulare a secțiunilor despre transmiterea mesajului referitor la importanța furnizării scaunelor rulante corespunzătoare și a faptului că aceasta reprezintă o nevoie urgentă și crearea unei viziuni comune. Întrebați: În ce vor consta următorii pași? ź Veți crea o echipă specială care să inițieze câteva din acțiunile propuse? ź Cine va implementa pe mai departe aceste acțiuni? ź Vă veți mai întâlni cu această echipă? Când? Repetați acești pași pentru secțiunea despre corelarea resurselor și a părților implicate. Repetați acești pași pentru secțiunea despre motivarea, implicarea și mobilizarea părților interesate. Notați pe o coală de flipchart care sunt următorii pași menționați de către participanți, inclusiv responsabilii și datele limită. 2. Acțiuni pentru implementarea schimbării (18 minute) Ceremonia de încheiere și înmânarea certificatelor (10 minute) Explicați: ź Logo-ul reprezintă un angajament pentru facilitarea mobilității persoanelor, deoarece trebuie ca oamenii să nu mai stea închiși în case. Este un angajament pentru creșterea gradului de participare și incluziune a persoanelor cu dizabilități, prin accesul la scaune rulante corespunzătoare livrate de către furnizori de servicii pentru utilizatorii de scaun rulant, care au personal instruit. Încurajați participanții să folosească logo-ul pachetului de instruire (WSTP). Pachet de instru ire pentru mana geri SERVICII PENTR U UTILIZATORII DE SCAUN RUL ANT Manualul format orului Pagina 140 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Solicitați participanților să vă înmâneze formularele de evaluare completate, pe care le-au primit în ziua anterioară. Prezentați materialul video: Mesaj de luat acasă. Vizionați materialul video. Note pentru formatori: ź Este la latitudinea formatorilor să decidă care este cea mai bună modalitate de înmânare a certificatelor și de încheiere a programului de instruire. Furnizarea serviciilor de scaune rulante Pagina 141 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul formatorului Bibliografie 1. Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate (Guidelines on the provision of manual wheelchairs in less resourced settings). Geneva: Organizația Mondială a Sănătății; 2008) http://www.who.int/disabilities/publications/. 2. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire - nivel de bază (Wheelchair Service Training Package - Basic Level). Geneva: Organizația Mondială a Sănătății; 2012 http://www.who.int/disabilities/technology/wheelchairpackage/en/ 3. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire - nivel intermediar (Wheelchair Service Training Package – Intermediate Level). Geneva: Organizația Mondială a Sănătății; 2013 http://www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/ 4. Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (Convention on the Rights of Persons with Disabilities); , G.A. Res. 61/106 (2007) New York: Națiunile Unite; 2008. http://www.un.org/esa/socdev/enable/rights/convtexte.htm 5. Bragar Galer, Joan, Alison Ellis and Sylvia Vriesendorp. “Leading change for better health.” Capitolul 6 în Managers Who Lead. Cambridge: Management Sciences for Health; 2005. 6. Wyndaele M. Wyndaele JJ. Incidența, răspândirea și epidemiologia leziunii medulare: rezultatele unui studiu internațional al literaturii de specialitate (Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?) Spinal Cord. 2006; 44: 523–529. 7. Razzak A, Helal SU, Nuri RP. Speranța de viață după o leziune a măduvei în țările aflate în curs de dezvoltare - Un studiu de retrospectivă la CRP, Bangladesh. Dizabilitatea, RBC și dezvoltarea incluzivă. (Life expectancy after spinal cord injury in a developing country – a retrospective study at CRP, Bangladesh. Disability, CBR & Inclusive Development), 2011; 22. 8. Organizația Mondială a Sănătății, Banca Mondială, Raportul Mondial privind dizabilitatea (World Health Organization, World Bank World report on disability). Geneva: Organizația Mondială a Sănătății; 2011 http://www.who.int/disabilities/world_report/2011/report/en/ 9. Document de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zonele cu resurse limitate. Geneva: Organizația Mondială a Sănătății; 2013 (Joint position paper on the provision of mobility devices in less resourced settings. Chapter 6, Geneva: World Health Organization; 2013), http://whqlibdoc.who.int/publications/2011/9789241502887_eng.pdf?ua=1&ua=1

Materialul nu poate fi reprodus integral sau parțial fără menționarea sursei și fără acordul scris al Fundației Motivation România. Fundația Motivation România Str. Podișor nr 1, Sat Buda, Comuna Cornetu, Ilfov, România Fax: 021 448 11 07 Email: info@motivation.ro www.motivation.ro Telefonul utilizatorului de scaun rulant: 0800.030.762 Tel: 021 448 02 42

PACHET DE IN STRUIRE PEN TRU PĂRȚILE INTERESATE SERVICII PENTR U UTILIZATORII DE SCAUN RULANT MANUALUL F ORMATORUL UI

PACHET DE INST RUIRE PENTRU P ĂRȚILE INTERSA TE SERVICII PENTRU UTILIZATORII DE SCA UN RULANT MANUALUL FOR MATORULUI Publicat de Organizația Mondială a Sănătății în 2015, cu titlul Wheelchair service training package for stakeholders. Trainer’s Manual for Stakeholders. © World Health Organization 2015 Organizația Mondială a Sănătății a acordat Fundației Motivation România dreptul de a traduce și de a publica ediția în limba română, aceasta fiind singura responsabilă pentru calitatea și acuratețea versiunii în limba română. În cazul în care vor exista discrepanțe între versiunea în limba engleză și cea în limba română, va prevala versiunea originală, în limba engleză. Servicii pentru utilizatorii de scaun rulant – Pachet de instruire pentru părțile interesate. Manualul Formatorului © Fundația Motivation România 2016 Conținut: Manualul formatorului pentru manageri – Manualul și caietul participantului pentru manageri – Resurse suplimentare pentru manageri – Manualul formatorului pentru părțile interesate. 1. Scaune rulante – standarde. 2. Persoane cu dizabilități – recuperare. 3. Materiale didactice I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. Organizația Mondială a Sănătății. Fundația Motivation România Descrierea CIP a Bibliotecii Naţionale a României ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (GENEVA) SERVICII PENTRU UTILIZATORII DE SCAUN RULANT : PACHET DE INSTRUIRE PENTRU MANAGERI / ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (OMS) ; ED.: SARAH FROST, CHAPAL KHASNABIS, KYLIE MINES, LOURDES DE LA PEZA. – BUCUREŞTI : CONTAPLUS, 2015 BIBLIOGR. ISBN I. Frost, Sarah (ed.) II. Khasnabis, Chapal (ed.) III. Mines, Kylie (ed.) IV. De la Peza, Lourdes (ed.) 615.478.3 Această publicație a fost realizată de Fundația Motivation România în colaborare cu World Vision, în cadrul sub- grantului nr. APC-GM-0029-008, prin Advancing Partners & Communities (APC), un acord de cooperare de 5 ani finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională – USAID, prin Acordul nr. AID-OAA-A-12-00047, începând cu 1 octombrie, 2012. Scaun rulant corespunzător Un scaun rulant care corespunde nevoilor utilizatorului și caracteristicilor mediului în care acesta trăiește, care are dimensiunea potrivită și care furnizează suport postural adecvat; care poate fi utilizat în condiții de siguranță și este durabil, fiind disponibil în țara utilizatorului; care poate fi obținut și întreținut, iar serviciile sunt sustenabile în țara respectivã, la cel mai accesibil preț. Scaun rulant cu antrenare manuală Un scaun rulant a cărui propulsie se efectuează de către utilizator sau de către o altă persoană. Dispozitiv de suport postural (DSP) Un dispozitiv fizic care oferă suport postural suplimentar. Scaun rulant Un dispozitiv cu roți care oferă mobilitate și suport postural, utilizat de persoanele cu dificultăți de mers sau de deplasare. Modificare scaun rulant Efectuarea unei schimbări la nivelul scaunului rulant. Furnizare scaune rulante Termen generic pentru proiectarea, producția, furnizarea de scaune rulante și servicii pentru utilizatorii de scaun rulant. Servicii pentru utilizatorii de scaun rulant Reprezintă acea parte a procesului de furnizare a scaunelor rulante care se ocupă de dotarea utilizatorului cu un scaun rulant corespunzator. Personalul furnizor de servicii pentru utilizatorii de scaun rulant Este personalul specializat în furnizarea scaunelor rulante corespunzătoare. Utilizator de scaun rulant O persoană care are dificultăți de mers sau de deplasare și care folosește pentru mobilitate un scaun rulant. Terminologie Mai jos sunt definiți termenii folosiți în acest pachet de instruire. CUPRINS Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri / 5 Introducere / 5 Grupul țintă / 6 Obiectivul / 6 Conținutul / 7 Formatorii / 7 Etapa inițială / 8 1. Recomandări pentru formatori / 9 2. Cum să vă pregătiți pentru susținerea Workshopului pentru Părțile Interesate / 11 Planuri detaliate pentru susținereea sesiunilor /20 S.1. Introducere / 20 S.2. De la politici la practici / 23 S.3. Gama de scaune rulante corespunzătoare / 33 S.4. Împreună creăm o schimbare / 41 Anexe / 53 Anexa 1: Rezumat pentru reprezentantul guvernamental / 53 Anexa 2: Rezumat pentru reprezentantul utilizator de scaun rulant / 55 Anexa 3: Citate și statistici uzuale / 57 Anexa 4: Cei opt pași ai procesului de furnizare a scaunelor rulante / 58 Anexa 5: Beneficii generale ale furnizării scaunelor rulante corespunzătoare / 60 Referințe / 61 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 5 Despre Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate Introducere În urma publicării în anul 2008 a Ghidului privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate(1), în 2012 a devenit disponibil primul modul din pachetul de instruire Servicii pentru utilizatorii de scaun rulant, denumit Servicii pentru utilizatorii de scaun rulant. Pachet de instruire - nivel de bază(2). Acesta a fost urmat în anul 2013 de modulul Servicii pentru utilizatorii de scaun rulant. Pachet de instruire – nivel intermediar(3). Pachetele de instruire pentru modulul de bază și pentru cel intermediar au ca scop să sprijine instruirea personalului cu atribuții clinice și tehnice al furnizorului de servicii pentru utilizatorii de scaun rulant, pentru a crește numărul de angajați cu competențe în furnizarea de servicii destinate utilizatorilor de scaun rulant, cu cerințe de nivel de bază și intermediar. Cu toate acestea, OMS subliniază faptul că pentru ca această instruire să fie eficientă și pentru ca personalul să aibă acces la facilitățile, echipamentele și materialele necesare furnizării unor scaune rulante corespunzătoare, este nevoie de planificare eficace, de politici și de mecanisme de sprijin funcționale. Astfel, Organizația Mondială a Sănătății (OMS), în parteneriat cu Agenția Statelor Unite pentru Dezvoltare Internațională (USAID) au dezvoltat un al treilea modul, cu două componente: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri și Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Pentru ca într- o țară să existe un sistem adecvat de furnizare a serviciilor destinate utilizatorilor de scaun rulant, este necesar să fie implicate toate părțile interesate, incluzând aici entitățile responsabile de crearea politicilor, de planificare și implementare, producătorii și furnizorii de scaune rulante, furnizorii de servicii pentru utilizatorii de scaun rulant, organizațiile pentru persoanele cu dizabilități , precum și utilizatorii de scaune rulante. Este important ca părțile interesate să fie bine informate și să înțeleagă necesitatea și beneficiile furnizării de scaune rulante corespunzătoare. Astfel, obiectivul acestui modul Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate este creșterea gradului de conștientizare și implicarea părților interesate în dezvoltarea unui sistem de furnizare de scaune rulante corespunzătoare în țara/ regiunea unde se află acestea. Acest pachet de instruire are la bază următoarele documente cheie: Convenția Organizației Națiunilor Unite pentru Drepturile Persoanelor cu Dizabilități (CONUDPD)(4), Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate și Documentul de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zone cu resurse limitate (5). Scaunul rulant este unul dintre echipamentele asistive cel mai frecvent utilizate pentru facilitarea mobilității personale. În cazul persoanelor care întâmpină dificultăți de deplasare, scaunele rulante reprezintă un instrument esențial pentru mobilitate, creșterea capacității de a desfășura activități, pentru sentimentul de demnitate și starea lor generală de bine. Mobilitatea oferă utilizatorilor de scaun rulant posibilitatea de a fi independenți și de a avea acces la servicii de sănătate, la educație precum și la oportunități de angajare, contribuind de asemenea Pagina 6 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului la participarea acestora la activități sociale și culturale. OMS estimează că peste 70 de milioane de persoane au nevoie de scaune rulante, dar că procentul celor care au acces la un astfel de dispozitiv se situează între 5 și 15%. Importanța mobilității este reflectată în CONUPDP, care pledează pentru „măsuri eficiente pentru asigurarea mobilității persoanelor cu dizabilități, în cel mai înalt grad de independență posibil”. Pentru a avea un nivel ridicat de mobilitate personală, utilizatorul are nevoie de un scaun rulant pe măsura sa și care răspunde nevoilor sale specifice; în special în ceea ce privește stilul de viață și mediul în care trăiește. Acest aspect presupune o abordare centrată pe nevoile individuale ale utilizatorului de scaun rulant. O modalitate eficientă de a răspunde acestor nevoi individuale ale utilizatorilor o reprezintă furnizarea scaunelor rulante printr-un sistem bine organizat, care răspunde așteptărilor acestora, care le respectă demnitatea și cu ajutorul unui personal bine instruit. Formatorii sunt încurajați să folosească acest pachet de instruire fie pentru susținerea unui modul individual, care să se centreze în totalitate pe necesitatea și beneficiile dezvoltării unui sistem de furnizare a scaunelor rulante corespunzătoare, fie ca element important al unui workshop mai complex, care să vizeze, de exemplu, dezvoltarea /revizuirea politicilor naționale privind recuperarea sau problematica dizabilității. Grupul țintă Modulul de instruire destinat părților interesate se adresează oricărei persoane care poate influența dezvoltarea sau susținerea procesului de furnizare a scaunelor rulante corespunzătoare. Părțile interesate pot fi: z entități responsabile de planificarea sau implementarea politicilor (de exemplu, guvernul); z lideri care beneficiază de respectul comunității/ persoane cu influență sau oameni politici; z organizații pentru persoane cu dizabilități; z utilizatori de scaun rulant, familiile acestora și însoțitorii lor; z filantropi/finanțatori/donatori; z media (atât cea audiovizuală, cât și cea tipărită); z producători și furnizori de scaune rulante; z grupuri profesionale (cum ar fi Colegiul Fizioterapeuților din Romania la nivel național / regional); z organizații non-guvernamentale locale sau internaționale; z orice altă persoană sau organizație la nivel local, care are potențialul să contribuie la acest obiectiv. Obiectivul OMS este conștientă de faptul că doar existența personalului instruit nu poate asigura furnizarea de scaune rulante corespunzătoare în respectiva țară și că responsabilitățile acestuia formulate în Ghidul privind furnizarea scaunelor rulante nu pot fi îndeplinite atât timp cât nu există implicare la nivel înalt în ceea ce privește crearea sau îmbunătățirea sistemului de furnizare a scaunelor rulante. Obiectivul modulului de instruire este creșterea gradului de conștientizare, precum și dezvoltarea abilităților și cunoștințelor întregului personal care este necesar să fie implicat (părțile interesate) în înființarea unui sistem de furnizare a scaunelor rulante corespunzătoare în țara/regiunea lor. Pagina 7 Acest pachet de instruire oferă o prezentare generală despre rolul părților interesate, oferindu-le informații despre nevoia și beneficiile furnizării de scaune rulante corespunzătoare și încercând să obțină suportul acestora pentru dezvoltarea unui program de furnizare a scaunelor rulante corespunzătoare. Conținutul Durata minimă necesară parcurgerii modulului este de 3-4 ore, ea putând fi extinsă în funcție de cerințele specifice și de resursele disponibile. Acest pachet de instruire va ajuta părțile interesate: z să își îmbunătățească cunoștințele cu privire la nevoia utilizării unui scaun rulant corespunzător, precum și la beneficiile ce decurg de aici; z să fie mai bine informate despre rolul pe care îl au în dezvoltarea unui sistem de furnizare a scaunelor rulante corespunzătoare; z să îmbunătățească calitatea serviciilor destinate utilizatorilor de scaun rulant; z să înțeleagă mai bine aspectele legate de crearea unor medii accesibile, lipsite de bariere; z să crească gradul de angajament în ceea ce privește identificarea/furnizarea unui sprijin financiar adecvat; z să crească gradul de sustenabilitate a procesului de furnizare a scaunelor rulante. Formatorii Manualul formatorului poate fi folosit de către orice organizație sau grup de organizații care își propune să organizeze un modul de instruire pentru părțile interesate. În vederea asigurării continuității cu celelalte pachete de instruire, acest manual de instruire a fost denumit Manualul formatorului. Cu toate acestea, având în vedere diversitatea categoriilor de participanți, formatorii trebuie să își asume rolul de facilitator și să urmeze principiile de bază ale programelor de instruire pentru adulți. O bună selecție a formatorilor/ facilitatorilor care să susțină workshopul reprezintă un element important al succesului acestuia. Se recomandă ca formatorii să aibă: z experiență adecvată în instruire și facilitare; z experiență în gestionarea grupurilor compuse din mai multe părți interesate sau cu niveluri de cunoștințe diferite; z convingerea fermă că introducerea unui sistem de furnizare a scaunelor rulante corespunzătoare este benefică pentru utilizatori; z capacitatea de a asculta și de a accepta diverse opinii, asigurându-se, în același timp, că sunt respectate principiile de bază ale furnizării scaunelor rulante corespunzătoare și că obiectivul modulului de instruire este susținut. În acest manual, formatorul/ facilitatorul workshopului va fi denumit „formator”. Se recomandă alocarea unui formator pentru fiecare grupă de 8-10 participanți. Participarea unui utilizator de scaun rulant experimentat, care cunoaște bine subiectul și conținutul pachetului de instruire, poate fi un aspect benefic. În cazul în care există mai mulți formatori, se recomandă ca sesiunile să fie împărțite între aceștia, evitând astfel susținerea mai multor sesiuni consecutive de către aceeași persoană. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 8 Etapa inițială Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Înainte de începerea modulului de instruire, copiați pe hard disk-ul din calculator secțiunile relevante aflate pe memory stick (din fișier). Cea mai simplă metodă de susținere a sesiunii de instruire este următoarea: 1. Deschideți Manualul formatorului din fișierul respectiv și 1.1. Citiți secțiunile ”Recomandări pentru formatori” și ”Cum să vă pregătiți pentru susținerea Workshopului pentru Părțile Interesate”; 1.2. În cazul în care nu aveți un exemplar tipărit al Manualului formatorului, tipăriți și pregătiți câte un exemplar pentru fiecare formator; 1.3. Tipăriți un orar al modulului de instruire. 2. Pregătiți toate elementele necesare, conform sugestiilor prezentate în capitolul „Cum să vă pregătiți pentru susținerea Workshopului pentru Părțile Interesate”. 3. Oferiți fiecărui participant un afiș cu etapele furnizării serviciilor pentru utilizatorii de scaun rulant. În cazul în care nu aveți aceste afișe, ele pot fi tipărite de pe memory stick. 4. Deschideți fisierul care conție orarul și faceți click pe hyperlink-urile de la fiecare capitol pentru a accesa slide-urile și materialele video aferente. Cea mai bună modalitate de susținere a sesiunii de instruire este prezentarea secvențială a temelor, respectând cât mai mult posibil duratele de timp alocate. Pagina 9 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului 1. Recomandări pentru formatori 1.1 Structura modulului de instruire Sesiune Durata (minute) S.1. Introducere, inclusiv discursul principal 30 S.2. De la politici la practici 45 S.3. Gama de scaune rulante corespunzătoare 30 Pauză 30 S.4. Împreună creăm o schimbare 100 Încheiere 5 Total 240 1.2. Orarul modulului și durata sesiunilor Modulul de instruire pentru părțile interesate este prezentat aici ca un workshop având durata de o jumătate de zi. Acolo unde este posibil, se recomandă extinderea perioadei de timp alocate, în special în situația în care organizatorii consideră că există oportunități pentru realizarea unui acord între părțile interesate, cu privire la diverse planuri sau activități specifice. Modulul de instruire pentru părțile interesate poate fi livrat ca un modul de o jumătate de zi în cadrul unei conferințe/atelier de lucru mai extins sau poate avea loc imediat înainte sau după modulul de instruire pentru manageri. Mai jos este prezentat un model de orar pentru un workshop cu durata de o jumătate de zi: Interval orar Temă Prezentator 08:30 - 09:00 Înregistrarea participanților 09:00 - 09:30 Introducere, inclusiv discursul principal Liderul organizației gazdă Invitați cheie Reprezentant/ți al/ai guvernului și al/ai altor instituții Utilizator de scaun rulant sau reprezentant al unei/unor organizații pentru persoanele cu dizabilități. 09:30 - 10:15 De la politici la practică Formator 10:15 - 10:45 Pauză 10:45 - 11:15 Gama de scaune rulante corespunzătoare Formator Pagina 10 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului 11:15 - 12:55 Împreună creăm o schimbare Formator 12:55 - 13:00 Încheiere Formator 13:00 - 14:00 Prânz Notă: Durata sesiunilor poate varia în funcție de numărul invitaților cheie. 1.3. Planul de desfășurare a sesiunilor Pentru fiecare sesiune există un plan de desfășurare detaliat, al cărui scop este să ofere asistență formatorilor. La începutul fiecărui plan veți găsi următoarele informații: z Obiective: prezentarea în amănunt a obiectivelor specifice din acea sesiune; z Resurse: care sunt resursele necesare pentru desfășurarea sesiunii; z Context: modalitatea în care sesiunea poate fi adaptată în funcție de context (sau situație); z De pregătit: modalitatea de pregătire a susținerii sesiunii; z Structură: un rezumat al principalelor părți ale sesiunii. Restul planului de desfășurare este împărțit pe teme. Pentru fiecare temă abordată, planul de desfășurare a sesiunii include instrucțiuni cu privire la modalitatea de prezentare sau livrare a informațiilor pentru tema respectivă. 1.4. Prezentările PowerPoint Pentru fiecare sesiune, sunt disponibile prezentări PowerPoint (PPT): z Introducere z De la politici la practici z Gama de scaune rulante corespunzătoare z Împreună creăm o schimbare. 1.5. Sfaturi de bună practică Mai jos sunt prezentate câteva sugestii pentru formatori, care să contribuie la succesul modulului de instruire: z asigurați-vă că discuțiile rămân axate pe subiectul sesiunii; z fiți niște ascultători activi - este necesar să auziți și să înțelegeți corect ceea ce spun participanții pentru a putea ghida discuția în mod eficient; z fiind atent/ă la discuții, veți oferi un exemplu pozitiv celorlați participanți; z încurajați dialogul și moderați discuțiile; z nu permiteți unei persoane sau unui grup cu atitudine agresivă, care vorbește mult, să domine discuția; z mențineți o poziție de neutralitate și fiți precauți în exprimarea propriilor voastre valori; z transformați conflictul de opinii într-o situație constructivă și nu permiteți ca neînțelegerile dintre participanți să devină personale. Pagina 11 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului 2. Cum să vă pregătiți pentru susținerea Workshopului pentru Părțile Interesate 2.1. Familiarizați-vă cu situația actuală a furnizării scaunelor rulante Organizațiile și formatorii care organizează un Workshop pentru Părțile Interesate trebuie să înțeleagă foarte bine ce presupune furnizarea scaunelor rulante în țara, regiunea, județul sau zona în care își desfășoară activitatea. Aceasta include următoarele aspecte: z identificarea exactă a organizațiilor implicate și a persoanelor cheie; z cunoașterea activităților sau inițiativelor existente în domeniul furnizării scaunelor rulante; z înțelegerea actualelor lacune în domeniul furnizării scaunelor rulante; z cunoașterea legilor, strategiilor, politicilor și planurilor de activitate regionale/naționale relevante. Lista de verificare de mai jos poate fi utilizată pentru rezumarea cadrului legislativ național, cum ar fi Convenția Organizației Națiunilor Unite pentru Drepturile Persoanelor cu Dizabilități (CONUDPD), strategiile la nivel național, planurile de acțiune și legile(6). Pagina 12 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Aceste informații vor fi utilizate pentru a produce un material suport cu privire la cadrul legislativ, pentru Sesiunea 2: De la politici la practici. Cadrul legislativ Aspecte de verificat Listă de verificare CONUDPD Au fost semnate CONUDPD și Protocolul opțional al acesteia? q Au fost ratificate CONUDPD și Protocolul opțional al acesteia? q Strategii Există în țară o strategie sau un plan de acțiune la nivel național pentru reducerea sărăciei? q Există în țară o strategie sau un plan de acțiune la nivel național legat de problematica dizabilității? (De exemplu, „strategie pentru promovarea și protejarea drepturilor per- soanelor cu dizabilități”). q Legi, decrete În cazul în care există, sunt aceste strategii din domeniul dizabilității însoțite de documente legislative specifice (cum ar fi legi, norme de aplicare)? q Strategii sectoriale specifice Există în țară o strategie sau un plan de acțiune la nivel național pentru următoarele sectoare: z servicii sociale z educație z educație incluzivă z ocuparea forței de muncă z angajarea persoanelor cu dizabilități z sănătate z sănătate mintală z egalitate de gen z minorități etnice z copii z persoane vârstnice z protecție socială în general z tehnologii asistive z alte sectoare relevante pentru accesul la servicii de calitate pentru persoanele cu dizabilități q Strategii la nivel local Se practică în respectiva țară planificarea la nivel de comunitate a acțiunilor necesare? Procesul de planificare (în domeniile dizabilității și serviciilor sociale) este centralizat sau descentralizat? Până la ce nivel există descentralizare? Există la nivel de comunitate planuri de acțiune (sau ceva similar) în domeniul dizabilității? q Importanța semnării și ratificării CONUDPD Semnarea CONUDPD este primul pas în ceea ce privește sprijinul guvernului pentru furnizarea scaunelor rulante corespunzătoare: z semnarea CONUDPD indică intenția morală a guvernului de a-și asuma obligațiile Convenției; z ratificarea CONUDPD indică obligația morală și legală a guvernului de a implementa prevederile Convenției. 2.2. Parcurgeți fiecare plan de desfășurare a sesiunii și ajustați-l, dacă este necesar Parcurgeți fiecare plan de desfășurare a sesiunii și stabiliți cine va susține sesiunea. Este posibil să fie nevoie să adaptați sesiunile la contextul local. La începutul fiecărui plan de desfășurare a sesiunii, la secțiunea „Context” veți găsi sugestii despre modul cum sesiunile pot fi adaptate la diferite contexte. 2.3. Identificați și pregătiți fiecare invitat cheie Obiectivul general al modulului pentru părțile interesate este creșterea gradului de conștientizare privind importanța furnizării de scaune rulante corespunzătoare și schimbarea pe care acest aspect o poate aduce în viața fiecărui utilizator de scaun rulant. Invitații cheie, care au prezentări de impact, reprezintă o parte importantă a strategiei care are ca scop transmiterea acestui mesaj. Aceste prezentări trebuie să fie cât mai relevante pentru contextul în care are se desfășoară Workshopul pentru Părțile Interesate. Vă recomandăm să invitați vorbitori cheie care reprezintă instituții guvernamentale și sectorul dedicat persoanelor cu dizabilități (vezi Sesiunea 1). 1. Reprezentant/ți al/ai guvernului: pentru a arăta că statul recunoaște și susține dreptul la mobilitate și importanța furnizării scaunelor rulante corespunzătoare. În anumite țări, există mai multe ministere care au responsabilități referitoare la furnizarea scaunelor rulante. 2. Reprezentant/ți al/ai sectorului dedicat persoanelor cu dizabilități Reprezentant al utilizatorilor de scaun rulant: O persoană care a trecut prin experiența utilizării unui scaun rulant și care este dispusă să împărtășească din propria experiență aspecte legate de impactul pozitiv pe care îl are folosirea unui scaun rulant corespunzător. O prezentare de acest tip va sublinia importanța mobilității personale în cel mai înalt grad de independență posibil. Lider reprezentativ din sectorul dedicat persoanelor cu dizabilități: Un vorbitor cheie, o persoană respectată în acest domeniu, având autoritate, experiență și calități de lider. Rolul său este să prezinte mesajul cu claritate și să transmită faptul că e nevoie urgentă de schimbare și să genereze entuziasmul necesar pentru schimbare, în răndul părților interesate. Notă: Este posibil ca aceeași persoană să poată îndeplini ambele roluri menționate mai sus. Pagina 13 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 14 Formatorii trebuie să identifice care sunt persoanele cele mai potrivite pentru rolul de vorbitori și să le pregătească cu suficient de mult timp înainte. În anexe veți găsi un rezumat cu informații pentru acești vorbitori cheie. Discuții între formator și vorbitorii cheie pot fi necesare pentru a ajusta forma finală a prezentării, astfel încât aceasta să se potrivească contextului și stadiului actual al sistemului de furnizare a scaunelor rulante. De asemenea, este important ca prezentarea să se potrivească stilului fiecărui vorbitor. Înainte de începerea workshopului, întrebați vorbitorii cheie dacă intenționează să folosească o prezentare PPT. În cazul unui răspuns afirmativ, asigurați-vă că prezentarea ajunge la voi cel târziu cu o zi înainte de ziua în care se desfășoară modulul de instruire. Dacă acest lucru nu este posibil, asigurați-vă că vorbitorii sosesc înainte de începerea workshopului și că există o persoană care să copieze fișierul PPT pe calculatorul pe care îl veți folosi. 2.4. Invitați participanții Este important să vă asigurați că ați invitat toate părțile interesate relevante. Realizați o consultare largă pentru a fi siguri că nu ați trecut cu vederea organizații sau persoane cheie. Gândiți-vă bine la părțile interesate ale căror voci trebuie să fie auzite; care pot influența procesul de schimbare; părți interesate care au energia necesară pentru a acționa în vederea schimbării și care sunt pregătite să se dedice acestui proces. Trimiterea invitațiilor cu suficient de mult timp în avans crește șansele ca persoanele invitate să fie disponibile pentru participare. Asigurați-vă de faptul că invitațiile precizează în mod clar care este obiectivul workshopului și motivul pentru care este importantă participarea părților interesate. Numărul participanților: Numărul participanților va varia în funcție de numărul părților interesate din țară, regiune, județ sau zonă. Prezentarea tuturor grupurilor: Formatorul trebuie să analizeze cu atenție lista participanților înregistrați, pentru a prezenta în cadrul secțiunii de început toate grupurile și organizațiile prezente. 2.5. Alegeți locul de desfășurare și amenajați sala Locul de desfășurare: Locul de desfășurare trebuie rezervat cu suficient timp înainte. În mod ideal, acesta ar trebui să fie un spațiu care să corespundă numărului de participanți și să aibă o zonă dedicată pauzelor. Locul de desfășurare trebuie să fie total accesibil utilizatorilor de scaun rulant. Aceasta include accesul în: clădire; sala în care va avea loc modulul de instruire; zona pentru pauze; toalete. Amenajarea sălii: Formatorii trebuie să planifice cu atenție modul de amenajare a sălii în care va avea loc Workshopul pentru Părțile Interesate. Trebuie să avem în vedere sesiunile în plen și cele de lucru în grupuri. Astfel, spațiul trebuie să fie organizat de așa manieră încât să faciliteze tranziția dintre cele două tipuri de activități. Modalitatea în care se amenajează spațiul depinde de numărul de participanți. În continuare găsiți câteva sugestii în acest sens: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 15 Amenajarea sălii pentru grupuri de până la 30 de persoane Cea mai bună schemă de amenajare a sălii presupune folosirea unor mese rotunde, așezate în formă de semicerc sau a unor mese dreptunghiulare, așezate sub forma oaselor de pește, ca în figura de mai jos. Acest lucru permite crearea de grupe de participanți (la fiecare masă) pentru discuții, precum și desfășurarea sesiunilor în plen, facilitând urmărirea prezentărilor și schimbul de opinii. Varianta I: Mese rotunde în semicerc Varianta II: Mese dreptunghiulare în formă de oase de pește Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 16 În cazul în care avem grupuri mari și săli mai mici, mesele și scaunele pot fi așezate ca într-o sală de spectacol, dar cu utilizarea unor scaune mobile, care să permită persoanelor din primul rând să le întoarcă, pentru a forma o grupă de lucru cu cei așezați în al doilea rând așa cum este arătat mai sus. Acest lucru permite tranziția rapidă de la sesiunile în plen la activitățile de grup. 2.6. Pregătiți resursele și echipamentele Resursa Cantitatea Comentarii/instrucțiuni Manualul formatorului 1 per formator Comandați de la OMS sau tipăriți și legați exemplarul Afiș cu etapele procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant 1 per participant Comandați de la OMS sau tipăriți Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Amenajarea sălii pentru grupuri mari (50 sau mai mulți) Pagina 17 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD) cel puțin un exemplar Document de poziție comun privind furnizarea dispozitivelor asistive în zone cu resurse limitate cel puțin un exemplar Ghidul privind Recuperarea Bazată pe Comunitate - Broșură Introductivă și Componentă de Sănătate cel puțin un exemplar Logo Pachete de instruire OMS - servicii pentru utilizatorii de scaun rulant imagine cu rezoluție mare Participanții vor utiliza logoul pentru sublinierea angajamentului lor pentru furnizarea scaunelor rulante corespunzătoare. Formulare: Formular de înregistrare a participanților 1 per workshop Model disponibil pe memory-stick Ecusoane 1 per participant/ invitat/formator Realizate local folosind logoul Pachetelor de instruire OMS - servicii pentru utilizatorii de scaun rulant Orar 1 per participant Model disponibil pe memory-stick Formular acord foto 1 per participant Adaptați modelul de pe memory-stick pentru organizația gazdă Certificat de participare 1 per participant Pagina 18 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Afișe - pentru creșterea gradului de conștientizare care vor fi folosite la locul de desfășurare a workshopului Servicii pentru utilizatorii de scaun rulant - nivel de bază: etapele procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant; abilități de manevrare a scaunului rulant; escare; întreținerea unui scaun rulant la domiciliu. 4 Comandați la OMS sau traduceți (dacă e cazul) și tipăriți. Disponibil pe memory-stick Servicii pentru utilizatorii de scaun rulant - nivel intermediar: copiii și scaunele rulante; poziționari diverse; tabel cu dispozitivele de suport postural (DSP); și lista de verificare pentru instruirea unui utilizator de scaun rulant de nivel intermediar. 4 Materiale video - cu subtitrare: Ce înseamnă pentru mine scaunul rulant corespunzător? S.2 Disponibile pe memory- stick. Luați în considerare subtitrarea în limba locală.Procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant S.2 Beneficiile suportului postural suplimentar - Chaeli S.3 Beneficiile utilizării unui scaun rulant corespunzător S.3 Pagina 19 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Echipament Articol Cantitate Comentarii/Instrucțiuni Videoproiector 1 q Computer 1 q Boxe audio 1 set q Pentru sonorul materialelor video. Microfoane 2 sau mai multe, în funcție de numarul de participanți q Un microfon pentru formator și invitați și un microfon mobil pentru participanți pentru a pune întrebări și a primi feedback de la grupele de lucru. O tablă mare 1 q Markere pentru tablă 3-4 q Flipchart și coli pentru flipchart 1 flipchart și un set de coli q Markere pentru flipchart 3-4 q Bandă adezivă sau produse similare 1 rolă q Pentru a lipi afișele și colile de flipchart pe perete. Notă: În cazul în care avem mai puțin de 20 de participanți, feedback-ul pe care îl dau grupele de participanți poate fi notat pe colile de flipchart. Totuși, în cazul grupurilor mai mari, se recomandă transferul feedback-ului într-un slide PowerPoint, care să fie proiectat în timp ce grupurile mici dau feedback. Pagina 20 S.1: Introducere O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea să înțeleagă mai bine situația și politicile actuale referitoare la furnizarea scaunelor rulante în țară, precum și direcția necesară pentru îmbunătățirea sistemului și pentru asigurarea sustenabilității acestuia. R E S U R S E Pentru sesiune: q Prezentarea PPT: S.1: Primirea participanților și partea introductivă C O N T E X T q Trimiteți cu mult timp înainte invitații către toți vorbitorii. q Luați legătura din timp cu vorbitorii, pentru a-i asista în activitatea de pregătire a prezentărilor (consultați rezumatul cu informații pentru vorbitori din Anexe). q Introduceți numele vorbitorilor în primul slide. q Verificați dacă a fost încărcată prezentarea fiecărui vorbitor (dacă este cazul). q Salvați în PPT imaginile relevante pentru secțiunea susținută de către reprezentantul utilizator de scaun rulant. q Analizați lista de participanți pentru a menționa toate grupurile/organizațiile care participă în mesajul de bun venit. q Înainte de finalizarea orarului de desfășurare, revizuiți numărul de vorbitori și durata alocată fiecărei prezentări. S T R U C T U R Ă 1. Introducere 2. Discursul invitaților 3. Discurs - utilizator de scaun rulant / reprezentant al unei organizații a persoanelor cu dizabilități 4. Întrebări și răspunsuri 5 10 10 5 30 Planuri detaliate pentru susținerea sesiunilor D E P R E G Ă T IT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 21 Prezentări: Invitați și formator/i: Reprezentantul gazdelor le urează bun venit participanților și prezintă invitații și formatorii. Participanți: Prezentarea participanților (numele și organizația pe care o reprezintă) va varia în funcție de dimensiunea grupului, cultura și specificul local. În cazul grupurilor mai mari, prezentarea fiecărui participant nu reprezintă un demers practic.Totuși se recomandă prezentarea categoriilor de părți interesate prezente și încurajarea interacțiunii pe parcursul pauzelor. 2. Discursuri invitați (10 minute) Prezentare: Invitați primul vorbitor să descrie starea actuală a sistemului de furnizare a scaunelor rulante din țară. Prezentare: Invitați cel de-al doilea vorbitor, de preferat un reprezentant al guvernului, pentru a discuta despre demersurile făcute de autorități pentru a răspunde nevoilor utilizatorilor de scaun rulant din țară. Introducere: Vorbitorul va împărtăși aspecte legate de experiența sa de utilizator de scaun rulant și va prezenta care este, în opinia sa, calea de urmat cu privire la sistemul de furnizare a scaunelor rulante în țară. 3. Discursul principal - utilizator de scaun rulant/reprezentant (10 minute) 1. Introducere (5 minute) Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 22 4. Întrebări și răspunsuri (5 minute) Explicați: z Sunt cinci minute disponibile pentru întrebări adresate invitaților. Solicitați participanților să pună întrebări invitaților. Monitorizați durata acestei secțiuni. Explicați: z Vor mai fi oportunități de a pune întrebări în timpul workshopului. De asemenea, participanții sunt încurajați să folosească pauzele pentru a pune întrebări și a face schimb de informații. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 23 O B IE C T IV E La sfârșitul acestei sesiuni, participanții: q vor putea să înțeleagă de ce furnizarea de scaune rulante corespunzătoare este un domeniu prioritar; q vor ști să evidențieze atât nevoile utilizatorilor de scaun rulant din țară, cât și beneficiile care decurg pentru toată lumea din faptul că utilizatorii de scaun rulant sunt cât mai mobili și cât mai independenți cu putință; q vor avea capacitatea să își exprime susținerea pentru politici și standarde la nivel național și pentru creșterea gradului de conștientizare în ceea ce privește drepturile persoanelor cu dizabilități, astfel încât utilizatorii să aibă acces la scaune rulante de calitate, prin intermediul unui furnizor de servicii destinate lor. R E S U R S E Pentru sesiune: q Material despre cadrul legislativ – câte un exemplar pentru fiecare participant, plus un exemplar suplimentar pentru activitatea de grup; q Un exemplar din Ghidul privind furnizarea scaunelor rulante; Partea introductivă și Componenta de sănătate a Ghidului RBC; Document de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zonele cu resurse limitate; q PPT: S.2: De la politici la practici; q Material video: Ce înseamnă pentru mine un scaun rulant corespunzător; q Material video: Procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. C O N T E X T Adaptați conținutul sesiunii astfel încât să fie în concordanță cu contextul. Luați în considerare următoarele: q cele mai relevante studii de caz pentru acest context; q mesajele cheie pe care doriți să le transmiteți. q Planificați modalitatea de formare a grupelor de lucru în funcție de numărul de participanți - consultați notele de la secțiunea Alegeți locul de desfășurare și amenajați sala din capitolul Cum să vă pregătiți pentru susținerea workshopului pentru părțile interesate . qStudiați informațiile de care aveți nevoie pentru a întocmi un rezumat cu privire la politicile oficiale de la secțiunea 2.1, pregătiți și traduceți din timp materialul referitor la cadrul legislativ. S T R U C T U R Ă 1. Introducere 2. Care este nevoia de scaune rulante corespunzătoate și în ce măsură este satisfăcută? 3. Importanța furnizării scaunelor rulante 4. Importanța sprijinului oferit de către instituțiile guvernamentale 5. Fiecare persoană are drepturi 6. Politicile ajung la individ prin intermediul serviciilor furnizate 7. Transformarea drepturilor în realitate printr-un plan la nivel național 8. Beneficii pentru toți 9. Rezumat puncte cheie 2 3 3 5 5 5 17 3 2 45 S.2: De la politici la practici D E P R E G Ă T IT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 24 1. Introducere (2 minute) Începeți cu obiectivul workshopului. Subliniați următoarele aspecte: Este important să lucrăm împreună cu scopul de a crea o viziune comună cu privire la sistemul de furnizare a scaunelor rulante în țară. Scaunul rulant corespunzător reprezintă un pas esențial în accesul la viața socială, pe piața muncii și la educație. Mobilitatea personală este un drept care poate fi respectat prin accesul la scaune rulante corespunzătoare, furnizate de personal instruit prin intermediul unui serviciu specializat. Organizatorice: Cereți participanților să parcurgă orarul de desfășurare a modulului de instruire. Evidențiați orele la care încep și la care se încheie prezentările, precum și pauzele. Explicați aspectele organizatorice necesare: z unde sunt localizate toaletele; z unde are loc pauza de cafea; z persoana de contact pentru chestiuni referitoare la transport (dacă este necesar); z procedura pentru situații de urgență. Explicați participanților ce așteptări aveți de la aceștia: z pe parcursul modulului de instruire să păstreze închise telefoanele mobile; z încurajați participanții să își exprime ideile și opiniile. 2. Care este nevoia de scaune rulante corespunzătoare și în ce măsură este satisfăcută? (3 minute) Întrebați: Știți de câte scaune rulante este nevoie în țara noastră? Validați răspunsurile. Explicați: z OMS estimează că 1% din populație are nevoie de un scaun rulant. z Populația acestei țări este de X (introduceți populația din recensământ. Calculați 1% din populația țării) (7). Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 25 3. Importanța furnizării scaunelor rulante (3 minute) Explicați: z Nevoia de scaune rulante și faptul că această nevoie nu este satisfăcută. Întrebare: z În țara noastră, ce procent din populația care are nevoie de scaune rulante are și acces la astfel de echipamente de mobilitate? Validați răspunsurile. Prezentați materialul video: Ce înseamnă pentru mine un scaun rulant corespunzător. În acest material video, Faustina, un utilizator de scaun rulant experimentat, prezintă care au fost schimbările care au avut loc în viața ei după primirea echipamentului de mobilitate prin intermediul unui furnizor de servicii pentru utilizatorii de scaun rulant. Prezentați materialul video. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 26 Subliniați următoarele aspecte: Scaunul rulant corespunzător pe care Faustina l-a primit prin intermediul unui furnizor de servicii pentru utilizatorii de scaun rulant înseamnă: Demnitate: deoarece nu mai cade din scaunul rulant atunci când se deplasează pe suprafețe denivelate. Independență: deoarece acum are posibilitatea de a efectua propulsia scaunului rulant în condiții de siguranță și în mod independent, pe suprafețele denivelate și pe pantele aflate în apropierea casei și a locului ei de muncă. Încredere: deoarece se diminuează sentimentul că este o persoană cu dizabilități. Stimă de sine crescută: are mai multă încredere în sine deoarece scaunul rulant este adaptat cerințelor ei. Prezentați cazul Shobhei din India, care demonstrează impactul pe care îl poate avea un scaun rulant corespunzător atât asupra ei, cât și a comunității din care face parte. Explicați: Acest exemplu scoate în evidență de ce este important ca utilizatorii să primească scaune rulante corespunzătoare, prin intermediul unui furnizori de servicii de acest tip, ca un prim pas spre incluziune și participare socială. Shobha locuiește într-un sat din Herepalya, statul Karnataka, India. Shobha a fost diagnosticată cu poliomielită când avea mai puțin de un an. Pentru a se putea deplasa în casă și în jurul acesteia, ea era nevoită să se târască. Această situație a continuat timp de mai mulți ani, până când Shoba a fost evaluată de către Asociația pentru Persoanele cu Dizabilități (APD), cu ajutorul unei echipe care furnizează servicii pentru utilizatorii de scaun rulant din mediul rural. În urma acestei evaluări, i s-a prescris un scaun rulant corespunzător. Cu ajutorul scaunului rulant, Shobha poate acum să se deplaseze în mod independent, atât în casă, cât și în comunitate. Pe lângă impactul pozitiv asupra gradului de mobilitate, scaunul rulant a contribuit și la independența ei economică. APD i-a oferit oportunitatea de a participa la un curs de calificare în domeniul croitoriei, iar la ora actuală Shobha are propriul ei atelier de croitorie, acasă la ea. Cu ajutorul scaunului rulant corespunzător, ea se poate deplasa în condiții de siguranță atât în satul ei, cât și pe distanțe mai mari, pentru a-și vizita clienții și pentru a livra comenzile. Shobha intenționează să continue dezvoltarea afacerii ei de croitorie și să trăiască în mod independent. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 27 4. I mportanța sprijinului oferit de instituțiile guvernamentale (5 minute) Explicați: Trebuie să creăm un mesaj puternic, care să fie tratat ca o prioritate și care să comunice instituțiilor guvernamentale necesitatea de a acționa. Explicați: z Vom asculta o relatare din Kenya, despre politica guvernului privind furnizarea dispozitivelor asistive. Citiți despre modalitatea prin care s-a dezvoltat în Kenya sprijinul instituțiilor guvernamentale pentru furnizarea scaunelor rulante corespunzătoare Prima legislație pentru susținerea persoanelor cu dizabilități din Kenya a fost aprobată după ce președintele din acea perioadă, Mwai Kabaki, a fost implicat într-un accident rutier în urma căruia a fost nevoit să utilizeze un scaun rulant timp de aproximativ șapte luni. Prima lege pe care a aprobat-o când și-a reluat atribuțiile de președinte a fost Legea Persoanelor cu Dizabilități nr. 14 din 2003, prin care a fost constituită, în noiembrie 2004, compania de stat denumită Consiliul Național al Persoanelor cu Dizabilități. Care a fost motivul aprobării acestei legi? Faptul că președintele a înțeles cât de dificil este să trăiești lipsit de mobilitate. La acea dată, el se afla în campanie electorală și i-ar fi fost imposibil să își continue activitatea fără folosirea unui scaun rulant. A simțit el însuși nevoia de mobilitate personală și accesibilitate. După câștigarea alegerilor, în baza noii legi, a început să asigure disponibilitatea dispozitivelor asistive și accesibilizarea clădirilor guvernamentale. 5. T oate persoanele au drepturi (5 minute) Explicați: z Toate persoanele au drepturi egale. z Convenția ONU privind Drepturile Persoanelor cu Dizabilități (CONUDPD) clarifică și califică modul în care toate categoriile de drepturi se aplică persoanelor cu dizabilități și identifică ariile în care sunt necesare adaptări, astfel încât persoanele cu dizabilități să își poată exercita drepturile în mod eficient. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 28 Explicați: În cadrul CONUDPD există articole care consolidează importanța și relevanța furnizării de scaune rulante corespunzătoare. Întrebați: Știe cineva care este articolul din CONUDPD care se referă în mod specific la mobilitate? Validați răspunsurile. Explicați: Articolul 20 din CONUDPD prevede că: z Toate persoanele au dreptul la mobilitate personală. Mobilitatea personală înseamnă: z Capacitatea de deplasare în maniera și la momentul alese de către fiecare persoană Explicați: z Articolul 26 se referă la importanța recuperării și a abilitării. z Mobilitatea personală este o componentă esențială a recuperării. Note pentru formatori: z Recuperare – restabilirea abilităților necesare pentru participare socială; z Abilitare – dobândirea unor abilități pentru prima dată. Explicați: Mobilitatea reprezintă primul pas spre alte drepturi. z Articolul 19 - Viață independentă și incluziune în comunitate z Articolul 24 - Educație z Articolul 25 - Sănătate z Articolul 27 - Activitate profesională și acces la piața muncii z Articolul 30 - Participare la activități culturale, recreative, de petrecere a timpului liber și sportive. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 29 Explicați: z În esență, mobilitatea este primul pas spre incluziune sau spre oricare dintre următoarele etape. z Pentru ca acest lucru să fie posibil, utilizatorul are nevoie de un scaun rulant corespunzător. 6. P oliticile ajung la individ prin intermediul serviciilor furnizate (5 minute) Explicați: z Nevoile individuale ale utilizatorilor sunt satisfăcute doar prin intermediul unui sistem de furnizare de scaune rulante corespunzătoare. z Este important ca furnizorii de servicii să fie instruiți și să parcurgă cei opt pași ai procesului de furnizare a unui scaun rulant corespunzător. Explicați: z Instruirea utilizatorilor este la fel de importantă. Instruirea contribuie în special la optimizarea folosirii scaunului rulant în condițiile în care trăiește utilizatorul, dar se referă și la aspectele legate de reparații și întreținerea acestuia. z Un utilizator permanent are nevoie de acces la acest tip de servicii pe tot parcursul vieții. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 30 Prezentați materialul video: Procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Explicați: z Ghidul privind furnizarea scaunelor rulante definește opt pași esențiali în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Acești opt pași sunt prezentați în pachetele de instruire pentru nivel de bază și nivel intermediar. Materialul video descrie o abordare a procesului de furnizare a scaunelor rulante în conformitate cu Ghidul privind furnizarea scaunelor rulante. Prezentarea materialului video. 7. Transformarea drepturilor în realitate printr-un plan la nivel național (17 minute) Explicați: Am folosit termenul de furnizare a serviciilor pentru utilizatorii de scaun rulant. Întrebați: Ce înseamnă de fapt acest termen, conform Ghidului privind furnizarea scaunelor rulante? Încurajați participanții să răspundă. Explicați: Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în zone cu resurse limitate formulează recomandări în ceea ce privește: z proiectarea z producția z aprovizionarea z furnizarea serviciilor. Pachetele de instruire pentru serviciile destinate utilizatorilor de scaun rulant oferă cunoștințele și abilitățile necesare dezvoltării sistemului de furnizare a scaunelor rulante corespunzătoare. Explicați: Pentru ca sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant să fie eficient și durabil, el trebuie să fie susținut prin politici și de planificare. Ghidul privind furnizarea scaunelor rulante este un instrument pentru dezvoltarea de politici și implementarea prevederilor CONUDPD. Prezentați activitatea de grup. Explicați: Lucrând în grupe, vom analiza un material care se referă la sprijinul pe care instituțiile guvernamentale îl acordă persoanelor cu dizabilități. Materialul descrie situația la ora actuală: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 31 Activitate Grupe Împărțiți participanții în patru grupe. Permiteți un maxim de 10 participanți per grupă - dacă este cazul, creați grupe suplimentare. Instrucțiuni Cereți participanților să folosească materialul referitor la cadrul legislativ. Solicitați unui voluntar din cadrul fiecărei grupe să noteze orice comentariu sau corectură sugerată de către membrii grupei. Oferiți liderului de grup un exemplar suplimentar din respectivul material. Monitorizare Durata Acordați participanților 5 minute pentru parcurgerea materialului și 10 minute pentru feedback. Prelungiți durata alocată etapei de feedback, în cazul în care există mai mult de patru grupe. Feedback Solicitați feedback din partea fiecărei grupe, pe rând. Notați pe flip chart toate comentariile. În cazul în care avem un număr mare de participanți, recomandarea este să notați ideile într-un slide PPT, astfel încât comentariile să fie vizibile tuturor. 8. B eneficii pentru toți (3 minute) Explicați: Atunci când o persoană primește un scaun rulant corespunzător, prin intermediul unui furnizor de servicii de acest tip, se creează oportunități pentru accesul la viață socială, muncă și educație. Explicați: z Studiile au arătat că tehnologiile asistive, atunci când răspund nevoilor utilizatorului și caracteristicilor mediului în care trăiește acesta, au un impact semnificativ asupra gradului de participare socială a persoanelor cu dizabilități (8). z Dispozitivele asistive accesate printr-un furnizor de servicii de acest tip reduc timpul dedicat îngrijirii persoanelor cu dizabilități și gradul de oboseală fizică a însoțitorilor (9). Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 32 Discutați despre cazul lui Saraswathi, din India, care demonstrează impactul pe care scaunul rulant corespunzător îl are asupra utilizatorului și familiei acestuia Saraswathi s-a născut în 1985, iar la vârsta de patru ani s-a îmbolnăvit de poliomielită, devenind paraplegică. Incapabilă de a se mai deplasa, în ciuda cârjelor și a tratamentului, ea a ajuns să depindă complet de familia ei, cu care locuia într-un sat foarte mic din statul Karnataka, India. Ca tânără adultă, ea a intrat în legătură cu un furnizor de servicii pentru utilizatorii de scaun rulant din respectiva regiune – Asociația Persoanelor cu Dizabilități. Reprezentanții acestei organizații au evaluat-o pe Saraswathi pentru a-i identifica nevoile și pentru a-i prescrie un scaun rulant corespunzător. După ce a primit echipamentul de mobilitate și după ce a fost instruită pentru deprinderea abilităților de manevrare ale acestuia, Saraswathi a putut să își deschidă un mic magazin în care vinde produse de uz cotidian. Acest lucru a ajuns să îi aducă suficienți bani pentru ca ea să devină principalul sprijin financiar pentru familia ei care numără șase persoane. Nivelul crescut de independență și mobilitate i-a permis să participe la viața comunității, așa cum își dorea ea. 9. R ezumatul punctelor cheie (2 minute) Sumarizați: Furnizarea scaunelor rulante se referă la facilitarea accesului la mobilitate a persoanelor cu dizabilități, la menținerea stării de sănătate și la participarea completă la viața comunității. Citiți punctele cheie: z Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD) prevede: Toate persoanele au dreptul la mobilitate personală. z Mobilitatea personală este posibilă atunci când persoanele obțin un scaun rulant corespunzător printr-un furnizor de servicii pentru utilizatorii de scaun rulant, la care au acces. z Pentru o mai bună implementare a Articolului 20, părțile interesate pot consulta Ghidul privind furnizarea scaunelor rulante și Capitolul 7 al Documentului de poziție comun cu privire la furnizarea echipamentelor asistive în zonele cu resurse limitate. Concluzie: Nu ne permitem să nu susținem furnizarea de scaune rulante corespunzătoare în țara noastră. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 33 S.3: Gama de scaune rulante corespunzătoare O B IE C T IV E La finalul acestei sesiuni, participanții: q vor putea să explice care sunt caracteristicile scaunului rulant corespunzător și de ce este necesar să existe acces la o gamă diversă de tipuri de scaune rulante. R E S U R S E Pentru sesiune: q PPT: S.3: Gama de scaune rulante corespunzătoare; q Material video: Beneficiile suportului postural suplimentar - Chaeli; q Material video: Beneficiile unui scaun rulant corespunzător. C O N T E X T Adaptați conținutul sesiunii astfel încât informațiile să fie în concordanță cu contextul în care vor lucra participanții. Luați în considerare următoarele: q Gama de produse disponibile la nivel local; q Modul de funcționare al acestor produse, în diverse medii de utilizare. D E P R E G Ă T IT q Pregătiți toate materialele și parcurgeți planul de desfășurare a sesiunii. q Citiți Capitolele 6 și 7 din Document de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zonele cu resurse limitate. S T R U C T U R Ă 1. Introducere 2. Ce este s a ăcaunul rulant corespunzător și pern adecvat 3. Furnizarea unui scaun rulant corespunzător și a unui suport postural 4. ului la Satisfacerea nevoilor beneficiar raportate mediul în care trăiește 5. Importanța unui produs durabil și care poate fi utilizat în condiții de siguranță 6. Principiile furnizării scaunelor rulante corespunzătoare 7. Rezumatul punctelor cheie 2 7 5 5 5 4 2 30 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 34 1. Introducere (2 minute) Explicați: Această secțiune este dedicată discuților despre importanța accesului la o gamă de scaune rulante corespunzătoare. 2. Ce este scaunul rulant corespunzător și perna adecvată (7 minute) Explicați: Ghidul privind furnizarea scaunelor rulante definește ce înseamnă un scaun rulant corespunzător. Citiți definiția unui scaun rulant corespunzător. Un scaun rulant corespunzător: z răspunde nevoilor utilizatorului; z corespunde caracteristicilor mediului în care trăiește utilizatorul; z este potrivit pentru respectivul utilizator (în termeni de dimensiune și suport postural) pentru menținerea poziției așezat; z poate fi utilizat în condiții de siguranță și este durabil; z poate fi întreținut și reparat la nivel local. Explicați: Fiecare utilizator de scaun rulant are nevoie de o pernă. Explicați: z Tipul de pernă care i se potrivește fiecărui utilizator va depinde de nevoile acestuia. Din acest motiv, furnizorii de servicii pentru scaune rulante trebuie să dețină cel puțin o mică gamă de perne disponibile. z Fiecare utilizator de scaun rulant trebuie să folosească o pernă. z Orice utilizator de scaun rulant la care există riscul apariției escarelor trebuie să folosească o pernă pentru reducerea presiunii. Explicați: Prin comparație, cheltuielile cauzate de lipsa unei perne adecvate și a instruirii pentru folosirea acesteia sunt mai ridicate; de exemplu, tratarea escarelor este un proces care poate dura mai multe luni sau chiar mai mulți ani. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 35 Explicați: z În țările dezvoltate, speranța de viață medie după momentul apariției leziunii este de 38 de ani, în cazul persoanelor la care leziunea medulară s-a produs la o vârstă între 25-34 de ani (10). z În contrast, un studiu realizat în Bangladesh arată faptul că speranța de viață medie în urma unei leziuni medulare este de 5,36 de ani, iar 56,4% dintre aceste persoane decedează într-un interval de 5 ani de la producerea leziunii (11). z 80% dintre persoanele cuprinse în acest studiu au decedat la domiciliu, o treime dintre acestea având escare la momentul survenirii decesului. Explicați: z În 1999, la secția pentru leziuni medulare a unui spital de recuperare din Sri Lanka a fost efectuat un studiu cu privire la costuri. La acea vreme, timpul de vindecare a unei escare superficiale era de aproximativ 6 săptămâni, costurile ridicându-se la 286 USD. O escară de profunzime necesita un an de tratament și costa aproximativ 2,483 USD. z Pe parcursul unui an, în care în spital s-a pus accentul pe instruirea privind prevenirea apariției escarelor și au fost introduse perne și saltele pentru reducerea presiunii, cu costuri accesibile, incidența escarelor apărute în perioada spitalizării s-a redus cu 70%, împreună cu cheltuielile legate de pansamente, care au scăzut cu aproape 60%. z Conform Raportului privind dizabilitatea al OMS (12), într-un spital din Sao Paulo, Brazilia, a fost introdus un program de instruire cu accent pe educarea privind reducerea complicațiilor medicale secundare în cazul persoanelor cu leziuni medulare. Incidența escarelor a fost redusă astfel cu 23%. Explicați: Accesul la o pernă adecvată și la instruire privind modalitatea de utilizare a acesteia reprezintă o parte importantă în prevenirea complicațiilor de ordin medical și chiar a decesului prematur. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 36 3. F urnizarea unui scaun rulant corespunzător și a unui suport postural (5 minute) Explicați: Pentru a avea capacitatea de a furniza scaune rulante cu dimensiunile potrivite, este nevoie de o gamă de echipamente de mobilitate de diverse mărimi, inclusiv de un model destinat utilizatorilor copii. Faceți click pentru a afișa pe rând câte o imagine. Întrebați: Ce vedeți aici? Sugerați: z Copil purtând pantofi pentru adulți. z Mărime nepotrivită, pantofi prea mari. z Copil care nu poate alerga și care nu poate desfășura activitățile necesare. Faceți click pe următoarea imagine care prezintă pantofi de mărime potrivită. Explicați: Copilul are acum pantofi corespunzători, pe măsura piciorului lui, acum el poate să alerge și să se joace. Faceți click pe imaginea cu copilul aflat în scaun rulant. Întrebați: Ce vedeți aici? Sugerați: z Copil într-un scaun rulant pentru adulți, mărime necorespunzătoare. z Dificultăți în ceea ce privește deplasarea și jocul. Faceți click pe ultima imagine. Explicați: Atunci când folosește un tip de scaun rulant corespunzător, care are mărimea adecvată, un copil are oportunitatea maximă de a-și putea desfășura activitățile necesare. Explicați: Utilizatorii au nevoi diferite în ceea ce privește suportul postural și, în consecință, le sunt necesare scaune rulante care furnizează tipuri de suport diferite. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 37 Rugați participanții să o urmărească pe Chaeli vorbind despre cum a ajutat-o pe ea suportul postural de care a beneficiat la o vârstă foarte mică. Prezentați materialul video. 4. S atisfacerea nevoilor beneficiarului raportate la mediul în care trăiește (5 minute) Prezentarea materialului video: Beneficiile suportului postural suplimentar - Chaeli Rugați participanții să observe modul în care diferitele tipuri de scaun rulant facilitează desfășurarea activităților de către utilizatorii din materialul video. Prezentați materialul video. Explicați: Materialul video prezintă modul în care diferitele tipuri de scaune rulante pot fi folosite în medii cu caracteristici diferite. Atunci când utilizatorii primesc un produs care nu funcționează corespunzător în mediul lor, deseori ei renunță să îl mai folosească. Explicați: z În această imagine există trei scaune rulante. Primele două au fost abandonate pentru că necesită reparații și nu există piese de schimb disponibile. z Al treilea a fost donat și este nou; cu toate acestea, utilizatorul are senzația de instabilitate atunci când îl folosește în exterior și nu se simte în siguranță. z Această persoană are trei scaune rulante și niciunul nu oferă o soluție adecvată nevoilor sale. Prezentarea materialului video: Beneficiile unui scaun rulant corespunzător. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 38 5. Importanța unui produs durabil și care poate fi folosit în condiții de siguranță (5 minute) Explicați: Am discutat despre cât de important este ca produsul să i se potrivească atât utilizatorului, cât și caracteristicilor mediului în care trăiește acesta. Acum vom vedea care sunt factorii care influențează durabilitatea și utilizarea în condiții de siguranță a scaunelor rulante. Întrebați: Ce se întâmplă atunci când un scaun rulant nu este durabil? Explicați: z Produsele care nu sunt durabile trebuie înlocuite mai frecvent decât cele durabile. z Un produs necorespunzător poate să se defecteze după 1-6 luni, fiind necesară înlocuirea acestuia. z Un produs corespunzător poate funcționa între 3 și 5 ani (de șase până la zece ori mai mult) și reprezintă o opțiune mai bună din punct de vedere al costurilor. Faceți click pe imagini. Explicați: z Astfel de imagini, cu grămezi de scaune rulante defecte, care nu pot fi reparate, pot fi văzute în multe țări ale lumii. z Acestea sunt lăsate fie în spații de depozitare/ săli de sport, fie afară, împreună cu alte echipamente deteriorate sau deșeuri provenind din spitale. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 39 Explicați: În cazul procurării sau primirii unor produse donate, asigurați-vă de faptul că: z gama de produse include echipamente care se potrivesc caracteristicilor mediului de utilizare; z produsele sunt durabile, chiar și atunci când sunt utilizate într-un mediu mai solicitant și cu teren accidentat; z produsele disponibile pot fi reparate local. Explicați: z Etapa a opta a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant se referă la întreținere, reparații și monitorizare. z Toți utilizatorii și membrii familiilor lor trebuie instruiți cu privire la operațiuni simple de întreținere și reparații, pentru a prelungi durata de utilizare a produsului lor. 6. Principiile furnizării scaunelor rulante corespunzătoare (4 minute) Nu există acel produs unic care să răspundă nevoilor tuturor utilizatorilor de scaun rulant. Acesta este motivul pentru care trebuie să existe o gamă de scaune rulante. Explicați: Pentru ca țările să respecte obligațiile referitoare la tehnologia asistivă (dispozitivele de mobilitate) prevăzute în CONUDPD, trebuie luate în considerare următoarele principii cheie (13). Citiți rar lista. 1. Acceptare - persoanele cu dizabilități trebuie să fie implicate în toate etapele furnizării dispozitivelor de mobilitate; 2. Accesibilitate - dispozitivele de mobilitate și serviciile conexe trebuie să fie accesibile tuturor persoanelor în cazul cărora a fost identificată o astfel de nevoie; 3. Adaptabilitate - dispozitivele de mobilitate și serviciile conexe trebuie adaptate și modificate pentru ca ele să răspundă nevoilor individuale ale fiecărui utilizator; Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 40 4. Preț accesibil - dispozitivele de mobilitate și serviciile conexe trebuie să fie accesibile din punct de vedere al costurilor; 5. Disponibilitate – trebuie să existe suficient spațiu, personal și produse pentru a răspunde nevoilor populației, iar procesul de furnizare trebuie să se desfășoare cât mai aproape posibil de comunitățile unde locuiesc acești oameni. 6. Calitate - Produsele, spațiile și serviciile trebuie să fie adecvate din punct de vedere al calității. 7. R ezumatul punctelor cheie (2 minute) Explicați: z Nu există un scaun rulant unic care să poată satisface nevoile fiecărui utilizator. z Utilizatorii au nevoie de scaune rulante care corespund nevoilor și mediului lor, care sunt durabile și pot fi utilizate în condiții de siguranță. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 41 S.4: Împreună creăm o schimbare Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului La finalul acestei sesiuni, participanții: q vor putea să explice rolul pe care trebuie să îl aibă părțile interesate în facilitarea inițierii sau îmbunătățirii procesului de furnizare a scaunelor rulante corespunzătoare; q vor putea să propună strategii pentru sprijinirea procesului de schimbare: transmiterea mesajului că aceasta este o prioritate, formarea unui parteneriat puternic, comunicarea unei viziuni de succes, eliminarea obstacolelor și furnizarea de suport. Pentru sesiune: q Prezentarea PPT: S.4: Împreună creăm o schimbare; q Material video: Mesaj pentru acasă. Pentru formatori: q „Leading change for better health” Capitolul 6 din Managers Who Lead, MSH 2005, pagina 149. Adaptați această sesiune astfel încât informațiile să fie în concordanță cu contextul în care vor lucra participanții. Analizați situația pentru a găsi exemple locale: q Statistici și relatări de cazuri cu privire la condițiile de trai ale persoanelor cu dizabilități locomotorii și la accesul acestora la servicii corespunzătoare, cu scopul de a transmite ideea că acest aspect constituie o prioritate; q Eforturile care se fac la ora actuală și reușite în furnizarea de scaune rulante corespunzătoare; q Instituții și organizații care pot fi implicate și care își pot asuma rolul de a sprijini procesul de furnizare a scaunelor rulante corespunzătoare. q Adunați toate resursele. q Citiți „Leading change for better health” Capitolul 6 din Managers Who Lead, MSH 2005, pagina 149. q Parcurgeți informația din slide-urile PPT și citiți planul de desfășurare a sesiunii. Pregătiți slide-ul legat de numărul de persoane care au nevoie de scaun rulant (Prezentarea PPT Împreună creăm o schimbare). q Identificați o persoană care să întocmească minuta și să consemneze care au fost acțiunile asupra cărora s-a căzut de acord. q Pregătiți patru coli de flipchart cu următoarele titluri: Ideea de prioritate; Crearea unei echipe de bază; Prezentarea viziunii și a strategiei; Acțiuni imediate pentru furnizarea de suport. 1. Introducere 2. Cum să transmitem mesajul că aceasta este o prioritate 3. Cum să implicăm și să mobilizăm părțile interesate 4. Cum prezentăm viziunea sau imaginea succesului 5. Dezvoltarea unei viziuni sau a unei imagini privind obiectivul stabilit 6. Cum să oferim sprijin și să eliminăm obstacolele 7. Strategii pentru facilitarea procesului de schimbare 6 3 5 3 40 3 40 Total durată sesiune 100 O B IE C T IV E R E S U R S E C O N T E X T D E P R E G Ă T IT S T R U C T U R Ă Pagina 42 1. Introducere (6 minute) Corelați această secțiune cu cele anterioare, unde s-a discutat despre cererea uriașă de scaune rulante la nivel global, care nu este satisfăcută. Mobilitatea personală permite multor persoane cu dizabilități să devină membri productivi ai familiei și ai comunităților în care trăiesc. În multe cazuri, scaunul rulant corespunzător, proiectat şi adaptat nevoilor individuale, reprezintă primul pas spre incluziune şi participare socială. Prezentați provocările pe care le întâmpină părțile interesate în sprijinirea procesului de schimbare. Explicați: z OMS, în parteneriat cu USAID, a dezvoltat Servicii pentru utilizatorii de scaun rulant - Pachet de instruire cu scopul de a asigura accesul utilizatorilor la scaune rulante corespunzătoare. z Obiectivul general al pachetului de instruire este creșterea gradului de conștientizare, precum și dezvoltarea abilităților și cunoștințelor de care are nevoie întregul personal implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant. z Cu toate acestea, doar existența unui personal instruit nu poate asigura furnizarea unor scaune rulante corespunzătoare sau îndeplinirea responsabilităților acestuia, în conformitate cu Ghidul privind furnizarea scaunelor rulante, dacă nu există un grad de implicare la nivel înalt pentru crearea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant sau pentru îmbunătățirea celui existent. Întrebați: Care credeți că ar trebui să fie rolul părților interesate în inițierea sau îmbunătățirea sistemului de furnizare a scaunelor existent în țară? Validați răspunsurile și notați-le pe tablă. Cele mai importante răspunsuri: z Creșterea gradului de conștientizare cu privire la nevoia de scaune rulante; z Promovarea și dezvoltarea unor noi politici; z Facilitarea accesului la resurse; z Crearea parteneriatelor și a alianțelor. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 43 Explicați: Inițierea sau îmbunătățirea unui sistem de furnizare a scaunelor rulante impune o schimbare la nivel organizațional. Totuși, acest lucru se poate dovedi foarte dificil. Rolul părților interesate este acela de a facilita producerea schimbării, acționând ca agenți ai schimbării. Explicați: Pe parcursul acestui workshop ne vom concentra asupra celor patru aspecte principale prin care părțile interesate pot promova schimbarea. Acestea se referă la următoarele: 1. Organizațiile se confruntă cu priorități concurente. În cazul în care părțile interesate nu transmit un mesaj clar și coerent despre faptul că furnizarea scaunelor rulante corespunzătoare constituie o urgență, aceasta se va fi pierde printre alte priorități ale managerilor. 2. Este nevoie de crearea unui parteneriat între părțile interesate care au puterea de a promova schimbarea și care își asumă responsabilitatea de a face acest lucru. 3. Pentru implicarea și mobilizarea diverselor părți interesate, se recomandă crearea unei viziuni sau imagini clare și puternice, care să fie prezentată cu fiecare ocazie sau la fiecare întâlnire. 4. În momentul începerii implementării, părțile interesate trebuie să fie prezente pentru a oferi sprijin și pentru a elimina obstacolele pe care managerii de la nivelul furnizării serviciilor nu le pot depăși. Explicați: Factori cheie pentru a avea succes. z A fost efectuat un număr mare de studii având ca scop creșterea gradului de înțelegere a factorilor care pot asigura succesul unei schimbări la nivel organizațional(14). 2. Cum să transmitem mesajul că aceasta este o prioritate (3 minute) Întrebați: Cum credeți că ați putea transmite mesajul că furnizarea scaunelor rulante corespunzătoare este o prioritate? Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 44 Explicați: z Evitați automulțumirea de tipul „Facem ce putem.” z Demonstrați-le celorlalți necesitatea schimbării, prezentând cazuri de succes și statistici. z Mențineți ideea de prioritate în toate acțiunile și mesajele legate de procesul de schimbare. z Prezentați dovezi valide și de impact, care demonstrează motivele pentru care se impune o schimbare. Evidențiați: Prioritate înseamnă că există o nevoie a cărei rezolvare nu poate fi evitată sau amânată z Activitățile și deciziile părților interesate trebuie să arate că furnizarea scaunelor rulante corespunzătoare este o necesitate. Nu subestimați efortul necesar pentru producerea unei schimbări a situației curente. z În cazul în care nu se transmite ideea că este nevoie de o schimbare urgentă, oamenii nu vor face eforturile suplimentare necesare pentru a produce schimbarea. Explicați: Studiile au demonstrat faptul că există puține persoane care se adaptează ușor la schimbare și puține persoane foarte rezistente la schimbare. Majoritatea oamenilor se află în zona mediană, așteptând să vadă cum se derulează schimbarea înainte de a decide care este poziția lor. În cazul în care creăm un grafic cu coloane, în care numărul persoanelor care se adaptează ușor la schimbare este prezentat în prima coloană, cei mai rezistenți la schimbare în ultima coloană, iar în coloana din mijloc restul persoanelor, vom obține un grafic asemenea celui din slide. 3. Cum să implicăm și să m obilizăm părțile interesate (5 minute) Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 45 Explicați: Categorii de atitudine în fața schimbării: z Inovatori, grup restrâns de aproximativ 2,5%: Sunt persoane care acceptă riscurile, le place să facă lucruri noi. z Reacție timpurie - 13,5%: Acesta este un grup foarte important deoarece, de regulă, este al liderilor de opinie și persoanelor cunoscute, pe care oamenii îi apreciază și îi urmează. z Majoritate cu reacție timpurie - 34%: Sunt persoane atente la ceea ce fac alții, cu scopul de a învăța de la aceștia, în special de la persoanele care fac parte din categoria celor care manifestă o reacție timpurie. z Majoritate cu reacție târzie - 34%: Aderă la schimbare atunci când aceasta s-a produs deja. Au nevoie de dovezi că schimbarea funcționează, înainte de a o accepta. z Conservatori sau tradiționaliști - 16%: Este important să cunoaștem care sunt îngrijorările lor și cum pot fi ele gestionate, dar eforturile nu ar trebui să se concentreze pe încercarea de a-i schimba. Explicați: Care sunt aspectele asupra cărora trebuie să ne concentrăm atunci când vrem să introducem o nouă abordare în furnizarea serviciilor pentru utilizatorii de scaun rulant? Deseori punem accentul pe dezbaterea cu grupurile de conservatori sau tradiționaliști și pe încercarea de a-i convinge pe aceștia. Ar trebui însă să ne concentrăm mai ales pe sprijinul acordat persoanelor care se înscriu în categoriile „reacție timpurie” și „majoritate cu reacție timpurie”. Studiile au arătat faptul că, odată ce aceste grupuri au adoptat schimbarea, este dificil să împiedici procesul de schimbare. Explicați: Conform slide-ului anterior, este nevoie de persoanele din categoria „reacție timpurie”, care sunt persoane dedicate procesului de schimbare, pentru a crea o echipă de bază pentru schimbare. Întrebați: Care sunt calitățile pe care trebuie să le aibă membrii acestei echipe de bază? Explicați: z Echipa trebuie să fie formată din persoane care dețin suficientă putere pentru a iniția schimbarea și care să aibă entuziasmul necesar pentru a implica și mobiliza alte persoane. Citiți de pe slide lista calităților. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 46 Explicați: Lista părților interesate se poate modifica în funcție de contextul specific al sistemului de furnizare a scaunelor rulante din respectiva țară. Citiți pe slide lista părților interesate. Explicați: Pentru a forma o echipă de bază eficientă, este nevoie de următoarele elemente: Citiți caracteristicile menționate pe slide. 4. Cum prezentăm viziunea sau imaginea succesului (3 minute) Explicați: Pentru a-i putea implica pe cei din jur și pentru a-i convinge de importanța pe care o are furnizarea scaunelor rulante corespunzătoare, trebuie să creăm o viziune clară și de impact care să reprezinte direcția de acțiune sau o imagine a obiectivului stabilit. z De obicei, oamenii susțin ceea ce ei creează. Încercați să creați o viziune sau imagine cu care să se identifice toți cei care vor fi implicați în implementare. z Viziunea este cea care vă reamintește care este motivul implicării și constituie o sursă de inspirație în vederea mobilizărea echipei, atunci când aceasta întâmpină obstacole. z De asemenea, trebuie să creați o strategie pentru implementarea schimbării. Folosiți-vă încă de la început de cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 47 Explicați: z Comunicarea trebuie să fie simplă și să suscite interesul. z Atunci când pregătiți mesajele, trebuie să aveți în vedere care sunt nevoile publicului țintă, precum și aspectele care îl preocupă. z Utilizați toate metodele disponibile: întâlniri față în față, conferințe, posturi de radio/ televiziune locale, pagini de Internet, SMS-uri. z Fiți consecvenți în mesajele transmise. O faptă este mai puternică decât o mie de cuvinte. 5. Dezvoltarea unei viziuni sau a unei imagini privind obiectivul stabilit (40 de minute) Explicați: După cum reiese din sesiunile anterioare, există numeroase beneficii ale furnizării de scaune rulante corespunzătoare. Este important ca viziunea să fie una puternică, să aibă capacitatea de a mobiliza și să fie transmisă tuturor persoanelor implicate. Vom crea o viziune comună. Aceasta este imaginea a ceea ce dorim să obținem sau să construim împreună în viitor. Activitate Grupe Lucru individual. Instrucțiuni Explicați: Gândiți-vă la un moment din viitor, care este situat peste trei ani. Imaginați-vă că am atins toate obiectivele importante în ceea ce privește furnizarea scaunelor rulante. • Care este imaginea pe care o vedeți și care reprezintă această realizare? • Care este impactul asupra utilizatorilor de scaun rulant? • Ce schimbări vedeți în participarea părților interesate? • Ce schimbări vedeți în furnizarea scaunelor rulante? Solicitați fiecărui participant să scrie un titlu de articol de ziar care să prezinte realizările grupului, așa cum vor putea fi ele descrise peste trei ani. Participanții pot folosi atât imagini, cât și cuvinte. Monitorizare Monitorizați activitatea fiecărei grupe și oferiți asistență în cazul în care acest lucru este necesar. Durata Durata este de 10 minute. Feedback Încurajați doi sau trei dintre participanți să își prezinte exemplele și notați-le pe tablă. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 48 Cele mai importante răspunsuri: z Persoanele cu dizabilități beneficiază de mobilitate și au capacitatea de a participa la viața comunității; z Părțile interesate sunt bine organizate și cooperează pentru a le oferi utilizatorilor, care au nevoie, scaune rulante corespunzătoare, durabile, la un preț accesibil; z Furnizorii de servicii oferă servicii integrate, adaptate nevoilor clienților, inclusiv instruire privind utilizarea și întreținerea scaunului rulant; z Există spații cu un grad mai ridicat de accesibilitate, astfel încât persoanele cu dizabilități pot folosi oriunde scaunul rulant. Activitate Grupe Formați grupe de câte 4 - 6 persoane (asigurați-vă că fiecare grupă este formată din participanți provenind de la organizații diferite). Instrucțiuni Solicitați membrilor fiecărei grupe să le prezinte colegilor de echipă viziunea individuală sau reprezentarea pe care o au cu privire la viitorul furnizării scaunelor rulante corespunzătoare. Rugați-i să creeze o viziune comună, care să cuprindă cele mai bune elemente ale viziunilor individuale. Notați viziunea comună pe o coală de flip chart pentru a o prezenta și celorlalți participanți. Monitorizare Monitorizați activitatea fiecărei grupe și oferiți asistență în cazul în care acest lucru este necesar. Durata Durata activității este de 20 de minute pentru discuții și 10 minute pentru feedback. Feedback Rugați fiecare grupă să împărtășească rezultatele cu toți ceilalți participanți. Observați elementele comune care se regăsesc în viziunile enunțate, identificați câțiva voluntari care să le îmbine și care să le prezinte mai târziu întregului grup. 6. C um să oferim sprijin și să eliminăm obstacolele (3 minute) Explicați: Am discutat despre trei dintre elementele cheie de care avem nevoie pentru a putea implementa cu succes o schimbare organizațională: z transmiterea mesajului că acest aspect constituie o prioritate; z crearea unei echipe de bază care să implementeze inițiativa; z promovarea imaginii succesului sau a viziunii și a strategiei, folosind orice oportunitate. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 49 Explicați: z Al patrulea factor cheie îl reprezintă unul dintre rolurile esențiale ale părților interesate - sprijin pentru manageri și eliminarea obstacolelor pe care aceștia nu le pot depăși fără ajutor. Citiți de pe slide lista potențialelor arii de intervenție. Subliniați: Părțile interesate pot folosi autoritatea și relațiile pe care le dețin pentru a promova și sprijini procesul de furnizare a scaunelor rulante. Sumarizați: Există patru elemente cheie care intervin în procesul de producere a schimbării și care reprezintă rolurile pe care trebuie să și le asume părțile interesate implicate. Explicați: Suntem în etapa în care cunoașteți dimensiunea cererii de scaune rulante. Citiți numărul estimativ al persoanelor din țară care au nevoie de un scaun rulant. Întrebați: 1. Cum veți contribui la transmiterea mesajului că schimbarea sistemului de furnizare a scaunelor rulante constituie o prioritate în țara dvs.? 2. Cum puteți contribui la crearea unei echipe de bază care să aibă puterea de a promova schimbarea și care să fie dedicată acestui proiect? 3. Cum puteți prezenta viziunea sau imaginea pozitivă legată de viitorul sistemului de furnizare a scaunelor rulante corespunzătoare? 4. Cum puteți oferi sprijin și cum puteți contribui la depășirea obstacolelor astfel încât sistemul de furnizare a scaunelor rulante corespunzătoare să poată fi implementat sau îmbunătățit? Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 50 7. Strategii pentru facilitarea procesului de schimbare (40 de minute) Explicați: În continuare vom discuta despre direcțiile de acțiune pe care noi, în calitate de părți interesate, le putem aborda cu scopul de a implementa sau de a îmbunătăți sistemul de furnizare a scaunelor rulante. Activitate Grupe Formați grupe de câte 4 - 8 persoane. Decideți dacă grupurile mixte (formate din persoane provenind de la organizații cu profile diferite sau organizații cu profil similar) sunt mai potrivite pentru implementarea acțiunilor viitoare. Instrucțiuni Rugați fiecare grupă de lucru să analizeze acțiunile de care este nevoie pentru inițierea sau îmbunătățirea procesului de furnizare a scaunelor rulante corespunzătoare, pornind de la următoarele întrebări: z Care sunt acțiunile pe care le pot desfășura părțile interesate pentru a transmite ideea că furnizarea scaunelor rulante corespunzătoare este urgentă și prioritară? z Ce putem face ca să creăm o echipă de bază formată din părți interesate, care să dețină suficientă autoritate și care să fie dedicată dezvoltării acestei inițiative? z Cum putem prezenta viziunea sau imaginea succesului și strategia pentru furnizarea scaunelor rulante corespunzătoare? (cele opt etape). z Care sunt acțiunile ce pot fi desfășurate imediat pentru a sprijini sistemul de furnizare a scaunelor rulante? Cereți fiecărei grupe să noteze răspunsurile, pe care apoi le vor prezenta tuturor participanților. Monitorizare Monitorizați activitatea fiecărei grupe și oferiți asistență în cazul în care acest lucru este necesar. Durata Durata activității este de 15 minute pentru discuții și 20 de minute pentru feedback. Feedback Cereți câte unui participant din fiecare grupă de lucru să prezinte acțiunile propuse pentru inițierea sau îmbunătățirea sistemului de furnizare a scaunelor rulante, după cum urmează: z Echipa 1 prezintă activitățile propuse pentru a transmite ideea de prioritate a demersului. După prezentare, restul echipelor pot aduce completări. z Echipa 2 prezintă activitățile necesare pentru crearea unei echipe de bază alcătuită din părți interesate. Restul echipelor pot aduce completări. z Echipa 3 prezintă activitățile necesare pentru prezentarea viziunii și a strategiei. Dacă este cazul, celelalte echipe pot aduce completări. z Echipa 4 prezintă acțiunile ce pot fi implementate imediat pentru susținerea sistemului de furnizare a scaunelor rulante. Dacă este cazul, celelalte echipe pot aduce completări. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 51 Notați: Scrieți activitățile propuse de fiecare echipă pe un flipchart. Folosiți câte o coală pentru fiecare din următoarele secțiuni: Prioritatea; Crearea unei echipe de bază; Prezentarea viziunii și a strategiei; Acțiuni imediate pentru a oferi suport. Afișați: postați toate cele patru coli de flipchart pe un perete. Întrebați: Care vor fi următorii pași? z Cine va fi responsabil de crearea unei viziuni comune folosindu-le pe cele individuale? z Când va fi această viziune distribuită tuturor? z Veți forma un grup operativ pentru inițierea anumitor activități propuse? z Cine va continua implementarea acestor acțiuni? z Vă veți mai întâlni din nou? Când? Notați: Transcrieți următorii pași pe o coală de flipchart sau într-un slide PPT, adăugând persoanele responsabile și datele. Încheiere (5 minute) Explicați: z Utilizarea logo-ului reprezintă un angajament pentru facilitarea mobilității persoanelor, deoarece trebuie ca oamenii să nu mai stea închiși în case. Este un angajament pentru creșterea gradului de participare și incluziune a persoanelor cu dizabilități, prin accesul la scaune rulante corespunzătoare livrate de către furnizori de servicii pentru utilizatorii de scaun rulant, care au personal instruit. Încurajați participanții să folosească logo-ul pachetului de instruire (WSTP). Prezentarea materialului video: Mesaj pentru acasă. Prezentați materialul video. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Mulțumiți-le tuturor reprezentanților părților interesate pentru participarea activă și pentru contribuția lor. Pagina 52 Note pentru formatori: Formatorii/organizatorii pot alege modul în care vor înmâna certificatele și cum vor încheia modulul de instruire. Afișul cu etapele furnizării serviciilor pentru utilizatorii de scaun rulant poate fi înmânat la final sau pe parcursul uneia dintre sesiunile anterioare. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 53 Anexe Anexa 1: Rezumat pentru reprezentantul guvernamental Recomandări Durata propusă: 5 - 10 minute Scopul intervenției Accentuarea ideii că situația persoanelor cu dizabilități din țară constituie o prioritate, subliniind care sunt activitățile pe care le desfășoară guvernul pentru gestionarea problemei și încurajând celălalte părți interesate să acționeze acolo unde acest lucru este posibil. Introducere z Cine sunteți dvs. și ce departament reprezentați? z Care este rolul acestuia în problematica dizabilității? Situația actuală z Există cadru legislativ și, totodată, un număr mare de arii neacoperite din acest punct de vedere. z Puneți accentul pe nevoia de scaune rulante (1% din populația țării). z Subliniați și celelalte nevoi ale persoanelor cu dizabilități pe care dvs. le considerați relevante, de exemplu: recuperare, educație, acces la piața muncii și incluziune în viața comunității. Context z Când a ratificat țara dvs. CONUDPD și Protocolul opțional? Faceți referire la Articolul 20 care prevede, în mod specific, dreptul la mobilitate personală. z Scoateți în evidență orice lege sau politici la nivel local care se referă la dizabilitate. z Cum monitorizați și aplicați prevederile legale? z Care sunt provocările cu care vă confruntați? Următorii pași Ghidul privind furnizarea scaunelor rulante este un instrument pentru implementarea prevederilor CONUDPD. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 54 Sugestii de care vă puteți folosi: z Colaborare: Împreună putem realiza mai multe - guvernul dorește să colaboreze cu furnizorii de servicii de recuperare și cu persoanele cu dizabilități, ONG-uri, ONG-uri internaționale și organizații ale persoanelor cu dizabilități pentru a îmbunătăți situația și pentru a respecta obligațiile asumate prin CONUDPD. z Colaborați pentru a dezvolta politici la nivel național referitoare la dispozitivele asistive. z Produse (de exemplu, scaune rulante, tricicluri): creșterea volumului, îmbunătățirea gamei și a calității produselor disponibile pentru persoanele cu dizabilități. z Standarde: Adoptarea unor standarde specifice pentru scaunele rulante, în conformitate cu Ghidul privind furnizarea scaunelor rulante. • Servicii: Dezvoltarea unui număr mai mare de servicii, de mai bună calitate. Concluzii. Următorii pașii z Toate părțile interesate aflate în această încăpere pot juca un rol în continuarea implementării procesului. z Trebuie să acționăm cât mai repede posibil, deoarece în țara noastră persoanele cu dizabilități sunt printre categoriile cu cel mai înalt grad de marginalizare. z Trebuie să ne asigurăm de faptul că concluziile acestei întâlniri vor fi puse în practică și trebuie să creăm un grup operațional pentru a superviza îndeplinirea acestora. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 55 Anexa 2: Rezumat pentru reprezentantul utilizator de scaun rulant Durata propusă: 5 - 10 minute. Tonul: Participanții vor fi mai motivați de un ton care inspiră entuziasm, implicare și mobilizare. Scopul discursului Prezentarea perspectivei unui utilizator de scaun rulant din țara în care are loc modulul de instruire, cu scopul de a mobiliza participanții, astfel încât aceștia să acționeze pentru îmbunătățirea calitatății vieții utilizatorilor de scaun rulant. Introducere Cine sunteți dvs. și ce organizație reprezentați (dacă se aplică)? Context Câteva mesaje cheie z CONUDPD oferă un cadru despre cum ar trebui să fie viața persoanelor cu dizabilități. Pentru acest modul de instruire, o importanță deosebită o are Articolul 20 privind mobilitatea, care obligă la: „asigurarea mobilității personale, în cel mai înalt grad de independenţă posibil pentru persoanele cu dizabilităţi”, inclusiv prin accesul la dispozitive de mobilitate de calitate și instruire(15). z De ce este mobilitatea atât de importantă? Deoarece incluziunea și participarea persoanelor cu dizabilități sunt realizabile doar dacă acestea beneficiază de mobilitate. z Pentru a avea mobilitate, persoanele cu dizabilități au nevoie de un scaun rulant corespunzător, care li se potrivește. Situația actuală Povestea dvs.: Cei care vă ascultă vor fi captivați de povestea dvs. Atunci când parcurgeți următoarele întrebări și vă gândiți la experiența dvs. de utilizator de scaun rulant, întrebați-vă dacă situația este reprezentativă pentru majoritatea utilizatorilor de scaun rulant din țara dvs. Dacă nu, includeți și ce înseamnă să fii un utilizator de scaun rulant tipic. Dacă aveți exemple reale, folosiți-le. Scopul dvs. este ca această parte să accentueze provocările existente în viața persoanelor cu dizabilități. z Când ați devenit o persoană cu dizabilități? z De cât timp sunteți utilizator de scaun rulant? z Ce provocări ați întâmpinat? z A trebuit să vă deplasați pe o distanță mare pentru a primi un scaun rulant? Ați putut alege tipul de scaun rulant pe care îl aveți și a trebuit să plătiți pentru el? z Scaunul rulant este durabil și poate fi folosit în condiții de siguranță? Poate fi reparat în caz de defecțiune? z Cât de ușor vă este să desfășurați activitățile zilnice folosind scaunul rulant? z Vă simțiți inclus în societate? Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 56 Concluzii și următorii pași Mesaj cheie z Incluziunea și participarea persoanelor cu dizabilități sunt realizabile doar dacă aceste persoane beneficiază de mobilitate. z Trebuie să lucrăm împreună pentru a ne asigura că acest obiectiv este îndeplinit – fiecare dintre părțile interesate aflate în această încăpere poate avea un rol în acest proces. În încheiere, luați în considerare următoarea întrebare: z Care sunt speranțele dvs. pentru viitor (pentru dvs. și pentru toți utilizatorii de scaun rulant)? Modul de prezentare Nu este necesar să aveți un document PPT pentru susținerea acestei prezentări. Totuși, ar fi indicat să introduceți o imagine într-un slide PPT, pe care să o prezentați în timp ce utilizatorul de scaun rulant își spune „povestea”. În cazul în care vorbitorul preferă să pregătească un PPT, asigurați-vă că fișierul este încărcat înainte de începerea sesiunii de instruire. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 57 Anexa 3: Citate și statistici uzuale z Dizabilitatea și sărăcia (16) La nivel mondial, există 1 miliard de oameni cu dizabilități, iar 700 de milioane dintre aceștia locuiesc în țările cele mai sărace din punct de vedere economic. Din această cifră de 700 de milioane : Š doar 10% dintre copiii cu vârstă de școală primară frecventează o unitate de învățământ Š procentajul de alfabetizare a adulților este de doar 3% Š șomajul este de aproximativ 80% z Sărăcia și excluderea se consolidează reciproc. Persoanele cu dizabilități sunt reprezentate în mod disproporționat în categoria celor mai sărace persoane din lume. z În țările sărace, 98% dintre copiii cu dizabilități nu frecventează o școală (17). Educația primară universală prevede concentrarea atenției asupra copiilor cu dizabilități. z Aproximativ 10% din populața mondială are o dizabilitate, 80% din aceștia locuiesc în țări aflate în curs de dezvoltare(18). z Copiii sub vârsta de 5 ani, diagnosticați cu o dizabilitate, au șanse mai scăzute de a beneficia de aceleași îngrijiri medicale de care beneficiază copiii fără dizabilități. Copiii cu dizabilități pot fi priviți ca o povară și este posibil ca familiile cu venituri reduse să nu aibă posibilitatea sau disponibilitatea de a cheltui resursele lor limitate pentru copilul cu dizabilități. z Nu putem separa problematica dizabilității de cea a dezvoltării. Nu poate fi realizat un parteneriat global pentru dezvoltare autentic câtă vreme persoanele cu dizabilități sunt excluse din politicile, planificările și programele de dezvoltare (Vezi articolele 31 și 32 din CONUDPD). z Excluderea persoanelor cu dizabilități are un impact devastator asupra economiei țărilor dezvoltate sau în curs de dezvoltare. z În multe dintre țările cu venituri mici sau medii, doar 5-15% dintre persoanele care au nevoie de un dispozitiv asistiv au acces la un astfel de echipament(19). z „Dizabilitatea nu este o problemă rezervată atenției specialiștilor: este o problemă care ține de drepturile omului. Prioritățile persoanelor cu dizabilități sunt hrana, adăpostul, viața de familie, îmbrăcămintea, veniturile și participarea completă, la fel ca în cazul oricărui alt individ(20).” z Persoanele cu dizabilități sărace se află blocate într-un cerc vicios al sărăciei și al dizabilității, fiecare dintre acestea reprezentând atât o cauză, cât și o consecință a celuilalt factor(21). Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 58 Anexa 4: Cei opt pași ai procesului de furnizare a scaunelor rulante Pas Descriere 1. Programarea și trimiterea Modalitatea prin care utilizatorii de scaun rulant sunt direcționați către furnizorul de servicii dedicate lor va varia. Utilizatorii pot apela ei înșiși la un furnizor sau pot fi recomandați prin intermediul unor rețele alcătuite din personal sau voluntari ai serviciilor de sănătate și recuperare guvernamentale sau non-guvernamentale, din cadrul comunității, la nivel local sau regional. Unii furnizori de servicii pentru utilizatorii de scaun rulant trebuie să identifice în mod activ potențialii utilizatori, și anume pe cei care la acel moment nu beneficiază de servicii sociale sau de sănătate, care nu participă la activități școlare, comunitare sau care nu sunt angajați. 2. Evaluarea Este nevoie de o evaluare individuală în cazul fiecărui utilizator de scaun rulant. Aceasta include strângerea informațiilor despre stilul de viață al utilizatorului de scaun rulant, munca sa, mediul în care trăiește și condiția sa fizică. 3. Prescrierea (selecția) Pe baza informațiilor dobândite pe parcursul evaluării, se face prescrierea scaunului rulant, împreună cu utilizatorul, familia sau însoțitorul acestuia. Prescrierea prezintă în detaliu tipul, mărimea, caracteristicile speciale și modificările aduse scaunului rulant. De asemenea, se notează în detaliu și aspectele legate de instruirea de care are nevoie utilizatorul pentru folosirea și întreținerea adecvată a scaunului rulant. Se identifică o sursă de finanțare și se plasează comanda pentru scaunul rulant, care provine din stocul furnizorului sau este livrat de către producător. 5. Pregătirea produsului (a scaunului rulant) Personalul calificat pregătește scaunul rulant pentru prima utilizare. În funcție de produs și adaptările sale, pregătirea poate include asamblarea și posibilele modificări ale produselor furnizate de către producător sau fabricarea unor produse în atelierul furnizorului de servicii. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 59 Pas Descriere 6. Probarea și ajustarea produsului (a scaunului rulant) Utilizatorul probează scaunul rulant. Se efectuează ajustările finale pentru a ne asigura că scaunul rulant este corect asamblat și reglat. În cazul în care este nevoie de modificări sau componente pentru suport postural, se vor efectua ajustări suplimentare. 7. Instruirea utilizatorului de scaun rulant Utilizatorul și însoțitorul sunt instruiți în legătură cu utilizarea eficientă și în condiții de siguranță și cu modalitatea de întreținere a scaunului rulant. 8. Întreținerea, reparațiile și monitorizarea Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și reparații în cazul problemelor tehnice, care nu pot fi rezolvate cu ușurință în cadrul comunității. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 60 Anexa 5: Beneficii generale ale furnizării scaunelor rulante corespunzătoare Guvern Individ Societate Implementarea articolelor din CONUDPD Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în zone cu resurse limitate Reducerea cheltuielilor medicale Creșterea numărului de contributori la PIB-ul țării Mobilitate personală Educație și angajare Egalitatea de șanse Bucurându-se de drepturile omului. Trăind decent Creșterea productivității, imbunătățirea sănătății și calității vieții. Incluziune socială Scăderea timpului și efortului fizic al insoțitorului sau a asistentului personal. Creșterea productivității și calității vieții. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 61 Referințe 1. Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate (Guidelines on the provision of manual wheelchairs in less resourced settings) Geneva: Organizația Mondială a Sănătății; 2008 (http://www.who.int/disabilities/ publications/ technology/wheelchairguidelines/en/). 2. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire - nivel de bază (Wheelchair Service Training Package - Basic Level). Geneva: Organizația Mondială a Sănătății; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. Servicii pentru utilizatorii de scaun rulant. Pachet de instruire - nivel intermediar (Wheelchair Service Training Package - Intermediate Level) Geneva: Organizația Mondială a Sănătății; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4. Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (Convention on the Rights of Persons with Disabilities), G.A. Res. 61/106 (2007) New York: Națiunile Unite; 2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm) 5. Document de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zonele cu resurse limitate (Joint position paper on the provision of mobility devices in less resourced settings. Geneva: Organizația Mondială a Sănătății; 2013 (http://whqlibdoc.who. int/publications/ 2011/9789241502887_eng.pdf?ua=1&ua=1). 6. Chiriacescu D, De Backer M, Botokro R. Acces la servicii (Access to services). Lyon: Handicap International. 2011; 56–57. 7. Ghidul privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate (Guidelines on the provision of manual wheelchairs in less resourced settings) Geneva: Organizația Mondială a Sănătății; 2008 (http://www.who.int/disabilities/publications/ technology/ wheelchairguidelines/en/). p 21. 8. Organizația Mondială a Sănătății, Banca Mondială, Raportul Mondial privind dizabilitatea (World Health Organization, World Bank World report on disability). Geneva: Organizația Mondială a Sănătății; 2011 (http://www.who.int/disabilities/world_report/2011/report/en/). 9. Allen S, Resnik L, Roy J. Promovarea independenței utilizatorilor de scaun rulant: rolul adaptării locuințelor (Promoting independence for wheelchair users: the role of home accommodations). Gerontologist, 2006;46(1):115–123. 10. Wyndaele M,Wyndaele JJ. Incidența, răspândirea și epidemiologia leziunii medulare: rezultatele unui studiu internațional al literaturii de specialitate (Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?) Spinal Cord. 2006; 44: 523–529. 11. Razzak A, Helal SU, Nuri RP. Speranța de viață după o leziune a măduvei într-o țară în curs de dezvoltare - Un studiu de retrospectivă la CRP, Bangladesh. Dizabilitatea, RBC și dezvoltarea incluzivă.(Life expectancy after spinal cord injury in a developing country – a retrospective study at CRP, Bangladesh. Disability, CBR & Inclusive Development), 2011; 22 (2): 114-123 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului Pagina 62 ISBN 978 92 4 154908 0 Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părțile interesate. Manualul formatorului 12. Organizația Mondială a Sănătății, Banca Mondială, Raportul mondial privind dizabilitatea. Geneva: Organizația Mondială a Sănătății (World Health Organization, World Bank World report on disability. Geneva: World Health Organization), 2011; 115, (http://www.who.int/ disabilities/world_report/2011/ report/en/). 13. Document de poziție comun cu privire la furnizarea echipamentelor de mobilitate în zonele cu resurse limitate Capitol 6 Geneva: Organizația Mondială a Sănătății; 2013 (Joint position paper on the provision of mobility devices in less resourced settings. Chapter 6. Geneva: World Health Organization; 2013), (http://whqlibdoc.who.int/publications/2011/ 9789241502887_eng.pdf?ua=1&ua=1). 14. Kotter JP. Conducând procesul de schimbare: De ce eșuează eforturile de schimbare. (Kotter JP. Leading change: Why transformation efforts fail). Harvard Business Review. 1995; 73(2):59–67. 15. Convenția privind Drepturile Persoanelor cu Dizabilități, Protocol Opțional, (Convention of the Rights of Persons with Disabilties, Optional Protocol), (http://www.un.org/disabilities/ documents/convention/convoptprot-e.pdf, p.14). 16. Dizabilitate și dezvoltare (Disability and Development): (www.disabilityanddevelopment.ie) 17. http://www.unescobkk.org/index.php?id=3063 UNESCO 2003 18. Comunicat de presă OMS, 3 decembrie 1999 (WHO Press Release, 3 December 1999) 19. WHO, 2014. Dizabilitate și recuperare: Dispozitive/tehnologii asistive (Disabilities and rehabilitation: Assitive devices/technologies), (http://www.who.int/disabilities/technology/en/) 20. Document EDF: Dezvoltare, cooperare și dizabilitate (EDF Policy Paper: Development Cooperation and Disability, p.15), (http://www.disabilityrightsfund.org/node/505) 21. DFID. (2000). Dizabilitate, sărăcie și dezvoltare.Londra: DFID. (Disability, poverty, and development. London: DFID).

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PACHET DE INSTRUIRE P ENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULA NT MANUALUL ȘI CAIET UL PARTICIPANTULU I

PACHET DE INSTRUIRE PENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULANT MANUALUL ȘI CAIETUL PA RTICIPANTULUI Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 2 Publicat de Organizația Mondială a Sănătății în 2015, cu titlul Wheelchair service training package for managers. Reference Manual and Workbook. © World Health Organization 2015 Organizația Mondială a Sănătății a acordat Fundației Motivation România dreptul de a traduce și de a publica ediția în limba română, aceasta fiind singura responsabilă pentru calitatea și acuratețea versiunii în limba română. În cazul în care vor exista discrepanțe între versiunea în limba engleză și cea în limba română, va prevala versiunea originală, în limba engleză. Servicii pentru utilizatorii de scaun rulant – Pachet de instruire pentru manageri. Manualul și caietul participantului © Fundația Motivation România 2016 Conținut: Manualul formatorului pentru manageri – Manualul și caietul participantului pentru manageri – Resurse suplimentare pentru manageri – Manualul formatorului pentru părțile interesate. 1. Scaune rulante – standarde. 2. Persoane cu dizabilități – recuperare. 3. Materiale didactice I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. Organizația Mondială a Sănătății. Fundația Motivation România Descrierea CIP a Bibliotecii Naţionale a României ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (GENEVA) SERVICII PENTRU UTILIZATORII DE SCAUN RULANT : PACHET DE INSTRUIRE PENTRU MANAGERI / ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (OMS) ; ED.: SARAH FROST, CHAPAL KHASNABIS, KYLIE MINES, LOURDES DE LA PEZA. – BUCUREŞTI : CONTAPLUS, 2015 BIBLIOGR. ISBN I. Frost, Sarah (ed.) II. Khasnabis, Chapal (ed.) III. Mines, Kylie (ed.) IV. De la Peza, Lourdes (ed.) 615.478.3 Această publicație a fost realizată de Fundația Motivation România în colaborare cu World Vision, în cadrul sub- grantului nr. APC-GM-0029-008, prin Advancing Partners & Communities (APC), un acord de cooperare de 5 ani finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională – USAID, prin Acordul nr. AID-OAA-A-12-00047, începând cu 1 octombrie, 2012. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 3 Terminologie Următorii termeni, utilizaţi în pachetul de instruire, sunt definiţi mai jos. Scaun rulant corespunzător Un scaun rulant care corespunde nevoilor utilizatorului şi caracteristicilor mediului în care acesta trăiește; care are dimensiunea potrivită și care oferă suport postural adecvat; care poate fi utilizat în condiții de siguranță şi este durabil; fiind disponibil în ţara utilizatorului; care poate fi obţinut şi întreţinut, iar serviciile sunt sustenabile în ţara respectivă, la cel mai accesibil preţ. Scaun rulant cu antrenare manuală Un scaun rulant a cărui propulsie se efectuează de către utilizator sau de către o altă persoană. Dispozitiv de suport postural (DSP) Un dispozitiv fizic care oferă suport postural suplimentar. Scaun rulant Un dispozitiv cu roţi care oferă mobilitate şi suport postural, utilizat de persoanele cu dificultăţi de mers sau de deplasare. Modificare scaun rulant Efectuarea unei schimbări la nivelul scaunului rulant. Furnizare scaune rulante Este termenul generic pentru proiectarea, producţia, furnizarea de scaune rulante şi servicii pentru utilizatorii de scaun rulant. Servicii pentru utilizatorii de scaun rulant Reprezintă acea parte a procesului de furnizare a scaunelor rulante care se ocupă de dotarea utilizatorului cu un scaun rulant corespunzător. Personal furnizor de servicii pentru utilizatorii de scaun rulant Persoane specializate în furnizarea scaunelor rulante corespunzătoare. Utilizator de scaun rulant O persoană care are dificultăţi de mers sau de deplasare şi care foloseşte pentru mobilitate un scaun rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 4 CUPRINS MANUALUL ȘI CAIETUL PARTICIPANTULUI / 1 Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri / 5 Introducere / 5 Grupul ţintă / 5 Obiectiv / 6 Conținut / 6 Cum se utilizează Manualul participantului şi Caietul de exerciţii / 7 A. Noțiuni fundamentale / 8 A.1 Ce înseamnă furnizarea unui scaun rulant corespunzător? / 8 A.2 Furnizarea serviciilor pentru utilizatorii de scaun rulant / 10 A.3 Managerii care determină schimbarea / 17 B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 20 B.1 Accesarea serviciilor / 20 B.2 Spații și echipamente / 25 B.3 Gama de scaune rulante corespunzătoare / 32 B.4 Organizarea resurselor umane / 38 B.5 Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 43 C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 46 C.1 Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? / 46 C.2 Gestionarea cererii / 52 C.3 Planificarea activității de monitorizare / 60 C.4 Planificarea sustenabilității financiare / 69 Referinţe bibliografice / 75 CAIET DE EXERCIŢII PRACTICE / 77 CUPRINS Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 5 Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri Introducere În urma lansării în anul 2008 a Ghidului pentru furnizarea scaunelor rulante cu antrenare manuală în zone cu resurse limitate(1), în anul 2012 a fost publicat primul pachet de instruire, numit Servicii pentru utilizatorii de scaun rulant. Pachet de instruire – nivel de bază (2). Acesta a fost urmat în anul 2013 de lansarea Serviciilor pentru utilizatorii de scaun rulant. Pachet de instruire – nivel intermediar (3). Organizaţia Mondială a Sănătăţii (OMS), în parteneriat cu Agenţia Statelor Unite pentru Dezvoltare Internaţională (USAID) a elaborat acum a treia parte, care cuprinde două materiale: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri şi Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părţile interesate. Această a treia parte a fost creată pentru a susţine managerii în efortul de eficientizare a procesului de furnizare a scaunelor rulante corespunzătoare şi pentru a creşte gradul de conştientizare în rândul părţilor interesate şi a promova implicarea lor în dezvoltarea unor servicii de furnizare a scaunelor rulante corespunzătoare în ţara/zona lor. Scaunul rulant este unul dintre echipamentele asistive cel mai frecvent utilizate pentru facilitarea mobilităţii personale. În cazul persoanelor care întâmpină dificultăţi de mers sau de deplasare, scaunul rulant este un instrument esenţial care facilitează mobilitatea, creşte capacitatea de a desfăşura anumite activităţi, oferă sentimentul de demnitate şi de stare de bine generală. Pentru utilizatorii de scaun rulant, mobilitatea înseamnă independenţă, accesul la servicii de sănătate, la educaţie, la angajare şi, de asemenea, participarea acestora la activităţi sociale şi culturale. OMS estimează faptul că peste 70 de milioane de persoane au nevoie de scaune rulante şi că doar 5 – 15% dintre acestea au acces la un astfel de echipament de mobilitate. În plus, oportunităţile de instruire a personalului în vederea dobândirii cunoştinţelor şi abilităţilor necesare pentru furnizarea eficientă a scaunelor rulante sunt limitate. Importanţa mobilităţii este reflectată în Convenţia Organizaţiei Naţiunilor Unite pentru Drepturile Persoanelor cu Dizabilităţi (CONUDPD) (4), care pledează pentru „măsuri eficiente în vederea asigurării mobilităţii persoanelor cu dizabilităţi în cel mai înalt grad de independenţă posibil”. Pentru realizarea mobilităţii personale, utilizatorii au nevoie de scaune rulante care au măsurile corespunzătoare şi care răspund nevoilor lor specifice; în special celor legate de stilul de viaţă şi mediul în care trăiesc. Acest aspect necesită o abordare orientată către nevoile individuale ale utilizatorilor de scaun rulant. O modalitate eficientă de a răspunde acestor nevoi individuale ale utilizatorilor de scaun rulant este furnizarea scaunelor rulante printr-un sistem bine organizat, care răspunde aşteptărilor utilizatorilor, care le respectă demnitatea şi este gestionat de către un personal bine pregătit. Grupul ţintă Acest pachet de instruire este destinat întregului personal care răspunde de implementarea, gestionarea şi evaluarea serviciilor de recuperare, incluzând aici furnizarea serviciilor pentru utilizatorii de scaun rulant sau furnizarea scaunelor rulante. Nu este necesar ca participanții să dețină deja experienţă în ceea ce privește managementul furnizării serviciilor pentru utilizatorii de scaun rulant; cu toate acestea, modulul de instruire se bazează pe faptul că participanţii au abilităţi generale de management. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 6 Obiectiv Obiectivul întregului pachet de instruire este creșterea gradului de conştientizare şi dezvoltarea abilităţilor şi a nivelului de cunoştinţe al personalului implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant. OMS înţelege faptul că doar personalul instruit nu poate asigura furnizarea de scaune rulante corespunzătoare şi că acesta nu îşi poate îndeplini responsabilităţile în conformitate cu Ghidul privind furnizarea scaunelor rulante, fără ca la nivel de ţară să existe un înalt grad de implicare pentru dezvoltarea sau îmbunătăţirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachetul de instruire pentru manageri oferă o privire de ansamblu asupra rolului managerului unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant, cu privire la implicarea personalului şi punerea în aplicare a celor opt etape ale procesului de furnizare a scaunelor rulante și alte aspecte legate de acesta. Ne referim aici la resursele umane şi materialele necesare furnizării serviciilor pentru utilizatorii de scaun rulant, inclusiv la planificare, organizare, personal, management, costuri/finanţare, monitorizare şi evaluare. Pachetul de instruire poate fi parcurs în 13-14 ore, acest interval putând fi extins sau redus, în funcţie de cerinţele specifice şi de resursele disponibile. Acest modul de instruire va ajuta managerii: • să planifice mai bine activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant; • să crească nivelul de calitate al procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant; • să crească gradul de retenţie a personalului; • să crească numărul de utilizatori de scaune rulante care primesc un scaun rulant adecvat cerinţelor lor; • să crească gradul de sustenabilitate a activităţii de furnizare a scaunelor rulane. Conținut Pachetul de instruire include: • un rezumat al paşilor cheie ai procesului de furnizare a scaunelor rulante descriși în pachetele de instruire create de OMS; • cunoştinţe de bază necesare furnizării serviciilor pentru utilizatorii de scaun rulant: o inițierea unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant; o gestionarea unui proces de furnizare a acestor servicii; o asigurarea sustenabilităţii procesului de furnizare a acestor servicii. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 7 Cum se utilizează Manualul participantului şi Caietul de exerciţii Acest Manual al participantului oferă un rezumat al cunoştinţelor din Pachetul de instruire pentru manageri (WSTPm). Participanţii pot folosi Manualul participantului şi Caietul de exerciţii după finalizarea programului de instruire pentru a-şi reaminti punctele cheie predate în fiecare sesiune. Manualul este împărţit în trei secţiuni: A. Noțiuni fundamentale B. Inițierea unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant. Manualul participantului include şi un caiet de exerciţii, scopul acestuia fiind dezvoltarea cunoștințelor și abilităţilor personalului care furnizează servicii pentru utilizatorii de scaun rulant. Caietul de exerciţii conţine exerciţii pentru testarea şi dezvoltarea cunoştinţelor participanţilor, precum și materiale din sesiunile de instruire, prezentările PowerPoint şi din Manualul participantului. Se recomandă ca participanţii să păstreze Manualul participantului şi Caietul de exerciţii pentru a le putea utiliza ulterior, dacă va fi necesar. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 8 A. Noțiuni fundamentale A.1 Ce înseamnă furnizarea unui scaun rulant corespunzător? Furnizarea de scaune rulante este un termen generic pentru proiectarea, producția, livrarea și furnizarea serviciilor destinate utilizatorilor de scaun rulant. Scaunul rulant este unul dintre dispozitivele asistive cel mai frecvent utilizate, oferindu-le persoanelor cu dizabilități locomotorii posibilitatea de a se deplasa. Mobilitatea este un pas important spre incluziune. Atunci când o persoană primește un scaun rulant corespunzător prin intermediul unui furnizor specializat, se creează oportunități pentru viață socială, găsirea unui loc de muncă și acces la educație. Mai mult decât atât, ceilalți membri ai familiei au astfel posibilitatea de a participa la activitățile din comunitate și să se angajeze (5). Nu doar persoanele în cauză și familiile acestora beneficiază de gradul crescut de mobilitate. Economia locală și naţională au de câștigat, deoarece societatea are mai mulți membri care își aduc contribuția. În plus, în cazul utilizatorilor de scaune rulante corespunzătoare scade probabilitatea apariției diverselor probleme de sănătate secundare (de exemplu, a escarelor) și astfel este mai puțin probabil ca ei să aibă nevoie de servicii medicale. Există o nevoie urgentă de schimbare, astfel încât să crească numărul de utilizatori care beneficiază de pe urma furnizării scaunelor rulante corespunzătoare. Care este numărul persoanelor care au nevoie de scaun rulant? Organizația Mondială a Sănătății estimează că 1% din populație are nevoie să folosească scaune rulante. Acest lucru înseamnă că, la nivel global, 70 de milioane de persoane au nevoie de scaune rulante. Această statistică ar putea fi un punct de pornire în stabilirea numărului de persoane din fiecare țară, județ sau oraș. În consecință, managerii nu trebuie să aștepte realizarea unor studii detaliate pentru a putea începe planificarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Populație % Numarul aproximativ al persoanelor care necesită un scaun rulant Populația la nivel mondial 7.000.000.000 1% 70.000.000 Brazilia 203.657.000 1% 2.036.570 China 1.401.587.000 1% 14.015.870 Egipt 84.706.000 1% 847.060 India 1.282.390.000 1% 12.823.900 Nigeria 183.523.000 1% 1.835.230 Rusia 142.098.000 1% 1.420.980 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 9 Convenții, strategii și politici pentru susținerea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Un număr mare de persoane care au nevoie de scaun rulant nu dețin încă un astfel de echipament de mobilitate corespunzător. Este necesar să existe un sprijin puternic pentru creșterea accesului la scaune rulante corespunzătoare. Managerii pot utiliza politici la nivel global, regional și național în vederea promovării dreptului la mobilitate, în numele persoanelor cu deficiențe de mobilitate. Tabelul de mai jos conține exemple de convenții, strategii, politici și linii directoare care pot constitui instrumente pentru manageri. Politică la nivel internațional Exemplu regional: Strategia Incheon Politici și linii directoare la nivel național Cel mai important instrument este Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD). Articolul 20 al CONUDPD prevede că toți oamenii au dreptul la mobilitate personală. Alte articole ale CONUDPD consolidează importanța și relevanța furnizării de scaune rulante corespunzătoare. Acestea includ: • Articolul 19 – Viaţa independentă şi dreptul la incluziune în comunitate • Articolul 24 – Educația • Articolul 25 – Sănătatea • Articolul 26 – Recuperarea • Articolul 27 – Viața profesională și angajarea • Articolul 30 – Participarea la viaţa culturală, activități de petrecere a timpului liber și la activități sportive În 2012 a fost adoptată Strategia Incheon pentru transformarea drepturilor în realitate (‘Make the Right Real‘) pentru persoanele cu dizabilități din Asia și zona Pacificului. Strategia Incheon are 10 obiective, iar obiectivul 3 se referă la îmbunătățirea accesului la mediul fizic, transport în comun, la cunoștințe, informație și comunicare. În timpul elaborării strategiei s-a pus un accent deosebit pe demonstrarea faptului că acest obiectiv nu poate fi atins fără accesul la dispozitive asistive adecvate, inclusiv la scaune rulante. Prin urmare, obiectivul 3 își propune să reducă la jumătate numărul persoanelor cu dizabilități care au nevoie de dispozitive asistive corespunzătoare, dar care nu le dețin. Guvernele statelor care au semnat Strategia Incheon s-au angajat să dezvolte planuri naționale pentru a-și îndeplini această obligație. Acesta este un exemplu al modalității în care politicile internaționale și regionale pot sprijini și încuraja dezvoltarea politicilor la nivel național. Planificarea, politicile și liniile directoare la nivel național pot contribui la creșterea eficacității și sustenabilității procesului de furnizare a scaunelor rulante (6). Dezvoltarea politicilor și liniilor directoare la nivel național impune colaborarea tuturor părților interesate, inclusiv a persoanelor cu dizabilități, a furnizorilor de servicii guvernamentali și non- guvernamentali. CONUDPD și strategiile regionale relevante sprijină dezvoltarea planificării, politicilor și a liniilor directoare la nivel național. Liniile directoare la nivel național pot fi de ajutor în definirea modalității de furnizare a dispozitivelor asistive, inclusiv a dispozitivelor de mobilitate. De exemplu, în anul 2003, în Africa de Sud au fost publicate principiile la nivel național cu privire la furnizarea dispozitivelor asistive, asigurându-se standarde minime pentru etapele procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant, instruirea personalului, crearea și gestionarea listelor de așteptare, bugete și furnizarea de servicii de reparație și întreținere. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 10 A.2 Furnizarea serviciilor pentru utilizatorii de scaun rulant Serviciile destinate utilizatorilor de scaun rulant joacă un rol important în furnizarea acestor echipamente de mobilitate. Personalul furnizor de servicii pentru utilizatorii de scaun rulant lucrează împreună cu acești beneficiari cu scopul găsirii celui mai potrivit scaun rulant (dintre cele disponibile) pentru respectivul utilizator. Servicii pentru utilizatorii de scaun rulant – nivel de bază și nivel intermediar Orice scaun rulant care i se potrivește utilizatorului, îi oferă acestuia un anumit grad de suport postural. Spătarul, perna, suporturile pentru picioare și pentru brațe furnizează suport postural atunci când sunt ajustate astfel încât să se potrivescă dimensiunilor utilizatorului de scaun rulant. Cu toate acestea, un număr mare de utilizatori de scaun rulant, copii și adulți, au nevoie de suport postural suplimentar în timpul folosirii echipamentului de mobilitate. Acest lucru înseamnă că este nevoie de niveluri diferite de furnizare a acestui tip de servicii. Furnizarea serviciilor pentru utilizatorii de scaun rulant cu cerințe de nivel de bază se adresează utilizatorilor de scaun rulant care pot menține poziția așezat fără suport postural suplimentar. Furnizarea serviciilor pentru utilizatorii de scaun rulant cu cerințe de nivel intermediar se adresează utilizatorilor de scaun rulant care au nevoie de suport postural suplimentar pentru menținerea poziției așezat. Este important ca managerii care gestionează furnizarea serviciilor destinate utilizatorilor de scaun rulant să definească dacă acestea se încadrează la servicii de nivel de „bază” sau „intermediar”. Acest lucru este rezultatul faptului că furnizarea serviciilor la nivel intermediar presupune existența unui personal cu un nivel de instruire mai ridicat, o gamă mai largă de scaune rulante, mai multe materiale și echipamente. Răspunsul adecvat la nevoile referitoare la mobilitate și suport postural Clara trăiește în Timorul de Est. Ea lucrează în magazinul deținut de familia ei, care se află în partea din față a casei lor. Clara a fost diagnosticată cu poliomielită și are nevoie de un scaun rulant pentru a se deplasa în interiorul casei, pentru a lucra în magazin și pentru a se deplasa în afara casei. Clara reușește să mențină poziția așezat fără suport suplimentar și folosește un scaun rulant cu antrenare manuală, care a fost adaptat astfel încât să se potrivească dimensiunilor corpului ei. Clara este un exemplu de persoană căreia îi poate fi furnizat un scaun rulant printr-un serviciu de nivel de bază. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 11 Ishade are vârsta de 8 ani și locuiește în Sri Lanka. A fost diagnosticată cu paralizie cerebrală. Acest lucru înseamnă că Ishade nu își poate controla membrele superioare, cele inferioare, capul și gâtul. Ea nu poate menține poziția așezat fără suport postural. Ishade reprezintă un exemplu de persoană care are nevoie de suport postural suplimentar în timpul folosirii scaunului rulant. Lui Ishade trebuie să i se furnizeze un scaun rulant printr-un serviciu de nivel intermediar. Cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Etapa Rezumat 1. Trimiterea și programarea Modalitatea prin care utilizatorii de scaun rulant sunt direcționați către furnizorul de servicii dedicate lor va varia. Utilizatorii pot apela la un furnizor la recomandarea altor persoane utilizatoare de scaun rulant sau prin intermediul rețelelor alcătuite din personal sau voluntari ai serviciilor de sănătate și recuperare guvernamentale sau non-guvernamentale, din cadrul comunității, la nivel local sau regional. Unii furnizori de servicii pentru utilizatorii de scaun rulant trebuie să identifice în mod activ potențialii utilizatori, și anume pe cei care la acel moment nu beneficiază de servicii sociale sau de sănătate, care nu participă la activități școlare, comunitare sau care nu sunt angajați. 2. Evaluarea Este nevoie de o evaluare individuală în cazul fiecărui utilizator de scaun rulant. Aceasta include strângerea informațiilor despre stilul de viață al utilizatorului de scaun rulant, activitatea sa, mediul în care trăiește și condiția sa fizică. 3. Prescrierea (selecția) Prin utilizarea informațiilor dobândite pe parcursul evaluării, se pregătește prescrierea scaunului rulant. Această etapă implică utilizatorul, familia sau însoțitorul acestuia. Prescrierea prezintă în detaliu tipul, mărimea, caracteristicile speciale și modificările aduse scaunului rulant. De asemenea, se notează în detaliu și aspectele legate de instruirea de care are nevoie utilizatorul pentru folosirea și întreținerea adecvată a scaunului rulant. 4. Finanțarea și plasarea comenzii Se identifică o sursă de finanțare și se plasează comanda pentru scaunul rulant, care provine din stocul furnizorului sau este livrat de către producător. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 12 5. Pregătirea produsului Personalul calificat pregătește scaunul rulant pentru prima utilizare. În funcție de produs și adaptările sale, probarea poate include asamblarea și posibilele modificări ale produselor furnizate de către producător sau fabricarea unor produse adaptate în atelierul furnizorului de servicii. 6. Probarea produsului Utilizatorul probează scaunul rulant. Se efectuează ajustările finale pentru a ne asigura că scaunul rulant este corect asamblat și reglat. În cazul în care este nevoie de modificări sau componente pentru suport postural, se vor efectua adaptări suplimentare. 7. Instruirea utilizatorilor Utilizatorul și însoțitorul sunt instruiți în legătură cu utilizarea în condiții de siguranță și cu modalitatea de întreținere eficientă a scaunului rulant. 8. Monitorizarea, întreținerea și reparațiile Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, care nu pot fi rezolvate cu ușurință în cadrul comunității. Modele de furnizare a serviciilor pentru utilizatorii de scaun rulant Orice sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant trebuie să conțină cele opt etape. Cu toate acestea, există modalități diferite de parcurgere a acestora, ele fiind descrise ca modele de furnizare. O combinație de diferite modele de furnizare a serviciilor poate constitui un ansamblu de servicii, la nivel național. Cel/e mai potrivit/e model/e de furnizare a serviciilor va/vor depinde de context, iar decizia trebuie luată prin consultarea tuturor părților interesate. Tabelul de mai jos prezintă câteva exemple de modele de furnizare a serviciilor pentru utilizatorii de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 13 Furnizarea serviciilor la sediu Loc special prevăzut pentru evaluarea utilizatorilor de scaun rulant În cazul furnizării serviciilor la sediu, utilizatorii de scaun rulant se deplasează la un centru cu caracter permanent, unde este disponibil un personal calificat în acest sens. Fiind un centru permanent, există personal și spații special prevăzute pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant. Este posibil ca furnizarea serviciilor la sediu să fie un proces eficient în ceea ce privește personalul. Cu toate acestea, utilizatorii de scaun rulant care locuiesc la distanță pot întâmpina dificultăți în deplasarea la sediul furnizorului. Loc special prevăzut pentru exersarea abilităților de manevrare a scaunului rulant Serviciul integrat Activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant desfășurată într-o clinică din comunitate. Majoritatea serviciilor furnizate la centru sunt, de asemenea, „servicii integrate”. Acest lucru înseamnă că furnizarea serviciilor pentru utilizatorii de scaun rulant este integrată în cadrul activităților unui alt serviciu (sau altor servicii). De exemplu, furnizarea serviciilor pentru utilizatorii de scaun rulant poate fi integrată cu activitatea de furnizare a protezelor/ortezelor, într-un departament de fizioterapie sau într-o clinică. În acest caz, dacă personalul îndeplinește o serie de sarcini, inclusiv furnizarea de servicii pentru utilizatorii de scaun rulant, este important să se aloce suficient timp pentru efectuarea tuturor activităților prevăzute. Spațiile în care se lucrează sunt fie comune, fie există zone special prevăzute pentru desfășurarea respectivelor activități. Funcțiile administrative, financiare și de management pot fi comune. În acest caz, există un spațiu de lucru dedicat activităților de pregătire a scaunului rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 14 Furnizarea serviciilor în comunitate Locurile unde se furnizează serviciile pot varia. Exemplele includ clinici din comunitate, primării, locuri de întâlnire din mediul rural, domiciliul utilizatorului de scaun rulant. În cazul furnizării serviciilor în comunitate, personalul care în mod obișnuit își desfășoară activitatea la un centru sau în cadrul unor servicii integrate se deplasează fie la domiciliul utilizatorului de scaun rulant, fie la un centru dintr-un alt district/altă regiune – cu scopul de a se întâlni cu utilizatorii de scaun rulant din acel district/acea regiune pentru furnizarea serviciului respectiv. Acest model de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune, de obicei, un parteneriat cu o organizație/ organizații localizată/localizate în regiunea unde se oferă acest tip de asistență. Este important ca să existe o bună coordonare cu organizația/organizațiile locală/locale. Instruirea personalului local sau a voluntarilor contribuie la creșterea șanselor de succes în furnizarea serviciilor și la creșterea gradului de susținere existent în comunitate. În cazul utilizatorilor de scaun rulant, avantajul îl reprezintă distanța mai mică pe care trebuie să o parcurgă pentru a accesa serviciile. Personalul care furnizează servicii în comunitate trebuie să fie flexibil și să aducă echipamentul de bază. Serviciul mobil Exemplu de vehicul specializat pentru serviciul mobil destinat utilizatorilor de scaun rulant Serviciul mobil este o altă modalitate de a furniza servicii în comunitate; totuși, în această situație, personalul deține un vehicul specializat care este utilizat pentru a transporta scaunele rulante, precum și instrumentele și echipamentele necesare. Personalul are posbilitatea de a-și desfășura activitatea în mai multe locuri și de a ajunge astfel la mai mulți utilizatori de scaun rulant. Posibilitatea de a transporta mai multe instrumente, echipamente, materiale și piese de schimb crește șansele de a efectua pe loc reparații de scaune rulante, precum și potențialul de a furniza servicii de nivel intermediar. Prin utilizarea unui vehicul specializat, personalul are posibillitatea de a transporta mai multe dintre echipamentele și instrumentele necesare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 15 Furnizarea în parteneriat a serviciilor destinate utilizatorilor de scaun rulant Nu toate cele opt etape ale furnizării serviciilor pentru utilizatorii de scaun rulant trebuie să fie oferite de aceeași organizație. Colaborarea în cadrul unei rețele de organizații poate să ajute la creșterea eficienței serviciului și a gradului de acces al utilizatorilor de scaun rulant la aceste servicii. Etapa 1 (trimiterea și programarea) necesită în mod obligatoriu colaborarea între organizații și persoane care alcătuiesc o rețea de surse de trimitere pentru furnizorul de servicii destinate utilizatorilor de scaun rulant. Etapa 7 (instruirea utilizatorilor) și etapa 8 (întreținere, reparații şi monitorizare) pot fi adesea furnizate de către un partener. De exemplu, o rețea de organizații din comunitate sau organizații pentru persoane cu dizabilități pot desfășura în cadrul comunității activitățile specifice acestor pași ai procesului de furnizare a serviciilor. 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea Activităţi desfăşurate la centru EXEMPLU A. 2. 11. Furnizarea serviciilor pentru utilizatorii de scaun rulant Diagrama prezintă modul în care cele opt etape ale procesului de furnizare a serviciilor pot fi parcurse prin intermediul unui parteneriat între un furnizor de servicii pentru utilizatorii de scaun rulant și organizații din comunitate. Etapele 2-7 au loc la sediul furnizorului de servicii, în timp ce etapele 1 și 8 se desfășoară în comunitate. Acest model presupune să luăm în considerare nevoia de instruire atât a întregului personal, cât și a voluntarilor implicați. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 16 Rolul managerului în furnizarea serviciilor pentru utilizatorii de scaun rulant Managerul unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant are responsabilitatea de a sprijini personalul în parcurgerea celor opt etape ale furnizării serviciilor și de a coordona parcursul utilizatorului (însoțitorului/membrului din familie) prin aceste etape. Totodată, managerul îndeplinește și un rol mai general, important în sprijinirea furnizării serviciilor. Acest rol include: • creșterea gradului de conștientizare cu privire la furnizarea serviciilor corespunzătoare destinate utilizatorilor de scaun rulant; • îmbunătățirea accesibilității; • sporirea oportunităților de instruire pentru personalul care furnizează servicii pentru utilizatorii de scaun rulant; • dezvoltarea sustenabilităţii – astfel încât furnizarea serviciilor pentru utilizatorii de scaun rulant să fie o activitate constantă; • influențarea politicii naționale cu privire la furnizarea de scaune rulante corespunzătoare; • îmbunătățirea gamei de scaune rulante disponibile. Creşterea gradului de conştentizare Monitorizare și evaluare Creşterea gradului de acces și satisfacerea așteptărilor utilizatorilor Personal motivat şi bine instruit Dezvoltarea sustenabilității Dezvoltarea unui sistem funcţional ROLUL MANAGERULUI A. 2. 11. Furnizarea serviciilor pentru utilizatorii de scaun rulant Implicarea activă a utilizatorilor de scaun rulant în procesul de furnizare a serviciilor Implicarea activă a utilizatorilor de scaun rulant în toate aspectele furnizării serviciilor destinate lor va avea ca rezultat îmbunătățirea acestor servicii. Mai jos se găsesc câteva sugestii de strategii pentru manageri prin care se asigură implicarea activă a utilizatorilor de scaun rulant în procesul de furnizare a serviciilor (7): • asigurați-vă de faptul că personalul implică utilizatorul de scaun rulant în toate etapele care duc la furnizarea scaunului rulant, considerându-l pe acesta un membru al echipei. • elaborați un sistem pentru colectarea cu regularitate a feedback-ului din partea utilizatorilor, pentru a vedea care este opinia lor despre procesul de furnizare și pentru identificarea modalităților de îmbunătățire. • dacă este posibil, recrutați utilizatori de scaun rulant ca membri ai echipei de furnizare a serviciilor. Acest lucru poate însemna publicarea noilor poziții vacante prin intermediul sectorului care se ocupă de aspectele legate de dizabilitate și necesitatea ca toate spațiile de lucru să fie accesibile utilizatorilor de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 17 Utilizatori de scaun rulant în echipele de furnizare a serviciilor din România O organizație neguvernamentală din România, care furnizează servicii destinate utilizatorilor de scaun rulant, a recrutat astfel de persoane ca membri în echipele de lucru. Utilizatorii de scaun rulant au diferite roluri în cadrul echipelor, în funcție de abilitățile lor. Angajarea utilizatorilor de scaun rulant a avut un impact pozitiv imens. Prin interacțiunea zilnică la locul de muncă, fiecare membru al echipei conștientizează într-un grad mai mare care sunt nevoile utilizatorilor de scaun rulant, beneficiarii serviciilor se simt mai în largul lor să își împărtășească problemele cu alte persoane care utilizează scaune rulante, iar aceștia pot fi un model pentru cei din jur. A.3 Managerii care determină schimbarea Inițierea sau îmbunătățirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune, în mod frecvent, producerea unor schimbări în cadrul unei organizații. Efectuarea acestor schimbări se poate dovedi dificilă. Un aspect al rolului pe care îl are managerul se referă la crearea premiselor pentru producerea schimbărilor, iar acest lucru poate fi realizat prin: • sprijin pentru crearea unei viziuni comune cu privire la furnizarea serviciilor pentru utilizatorii de scaun rulant; • transmiterea către personal, către actorii implicați în crearea de politici sau alți furnizori de astfel de servicii, precum și către potențiali finanțatori a importanței furnizării serviciilor corespunzătoare dedicate utilizatorilor de scaun rulant; • alocarea personalului și a resurselor adecvate; • motivarea, mobilizarea și implicarea personalului. Crearea unei viziuni comune cu privire la furnizarea serviciilor corespunzătoare dedicate utilizatorilor de scaun rulant Crearea unei viziuni, care să fie comună tuturor actorilor dintr-o anumită țară implicați în îmbunătățirea procesului de furnizare a scaunelor rulante contribuie la motivarea celor care trebuie să lucreze în parteneriat, cu scopul de a produce o schimbare. Viziunea înseamnă o reprezentare a unei imagini a viitorului, o traducere a scopului. De exemplu: „O lume a incluziunii pentru utilizatorii de scaun rulant, în care aceștia participă la toate aspectele vieții” Este important ca această viziune pozitivă să fie transmisă într-o manieră care să ducă la mobilizarea întregului personal, care să adere la această idee și să se mobilizeze pentru procesul de îmbunătățire a calității vieții persoanelor cu dizabilități. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 18 Transmiterea mesajului privind importanța furnizării serviciilor corespunzătoare pentru utilizatorii de scaun rulant Pentru a putea motiva în mod constant atât personalul, cât și celelalte părți interesate, managerii trebuie să comunice în mod coerent care este importanța furnizării de scaune rulante corespunzătoare. Managerii trebuie să comunice clar faptul că introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant constituie o prioritate și o urgență. Urgența situației constă în faptul că abordarea acestei nevoi nu poate fi evitată sau amânată. Oamenii se aliniază priorităților celor care îi coordonează, în consecință, demersurile managerului trebuie să transmită ideea că e nevoie de acțiune rapidă. Modalitatea de a transmite ideea că furnizarea scaunelor rulante corespunzătoare este o problemă importantă și urgentă • Discutați despre nevoia de scaune rulante la nivel global și național; dreptul la mobilitate personală; impactul benefic pe care îl au aceste servicii în ceea ce privește utilizatorii, comunitatea și societatea; • Discutați, în cadrul ședințelor de echipă care au loc la intervale regulate, despre progresele făcute în introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant; • Împărtășiți cazurile de succes și rezultatele pozitive, de exemplu, în cadrul ședințelor de personal sau folosind afișe în locuri vizibile, în spațiul unde se furnizează aceste servicii. Corelarea resurselor umane și materiale Procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune existența personalului instruit, a spațiilor de lucru și a resurselor. Toți membrii echipei trebuie: • să lucreze în mod unitar, având același scop; • să simtă că dețin resursele de care au nevoie pentru a-și îndeplini sarcinile; • să beneficieze de apreciere pentru contribuția adusă. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 19 Modalități de organizare a resurselor umane și materiale • Identificați spațiile care pot fi folosite la furnizarea serviciilor destinate utilizatorilor de scaun rulant. • Atunci când alocați resurse umane, timp, spațiu, echipamente și resurse financiare, acordați prioritate procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. • Folosiți viziunea comună și beneficiile furnizării unui scaun rulant corespunzător ca instrumente prin care să reamintiți personalului care este scopul activității de furnizare a acestui tip de servicii. • Arătați apreciere și recompensați munca de calitate a personalului în furnizarea serviciilor destinate utilizatorilor de scaun rulant. • Antrenați personalul să lucreze în mod unitar, ca o echipă. Motivarea, implicarea și mobilizarea personalului Managerii pot contribui la motivarea, implicarea și mobilizarea resurselor umane prin: • Includerea personalului în etapele de planificare și implementare – pentru ca aceștia să poată contribui cu experiența și aptitudinile lor; pentru a-i ajuta să înțeleagă mai bine ce implică schimbarea și care este rolul lor în implementarea ei. • Depășirea obstacolelor prin acțiuni comune – pentru ca personalul să aibă o imagine mai clară asupra cauzelor și modalității de rezolvare a acestora. • Crearea de obiective pe termen scurt și exprimarea aprecierii pentru atingerea acelor obiective – pentru ca personalul să simtă că eforturile sale au un impact și că sunt apreciate. • Integrarea schimbărilor în sistemul și cultura organizației. De exemplu, introduceți obiceiul de a sărbători succesul în activități și încurajați oamenii să împărtășească cazurile și exemplele pozitive în timpul ședințelor și al pauzelor. De asemenea, asigurați-vă că schimbările în bine sunt menținute prin introducerea de noi responsabilități în fișele de post individuale și prin actualizarea politicilor organizaționale. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 20 B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1 Accesarea serviciilor Ce înseamnă „servicii echitabile”? Furnizarea unor „servicii echitabile” înseamnă asigurarea faptului că toți utilizatorii de scaun rulant au acces egal la primirea echipamentelor de mobilitate de care au nevoie. Acest aspect include: • beneficiari bărbați, femei, băieți și fete; • tineri, persoane adulte (de vârstă mijlocie) și persoane vârstnice; • persoane care locuiesc în proximitate și care locuiesc la distanță – de exemplu, în mediul rural; • persoane care provin din diferite grupuri etnice sau medii socio-economice. Serviciile echitabile se fundamentează pe ideea că toți oamenii, indiferent de tipul de dizabilitate, vârstă, sex, religie, situație materială, limba vorbită sau grupul etnic de care aparțin, au drepturi egale în ceea ce privește accesul la servicii. Furnizarea serviciilor echitabile nu înseamnă furnizarea unui număr egal de scaune rulante utilizatorilor din diverse grupuri (de exemplu, număr egal de scaune rulante pentru bărbați și femei). Acest lucru este consecința faptului că nevoile respectivelor grupuri pot varia. Rețineți: Accesarea serviciilor nu se rezumă doar la faptul de a avea acces la ele. Accesarea serviciilor presupune posibilitatea de a fi informați despre existența lor, accesul la ele sau deplasarea furnizorului de servicii acolo unde se află utilizatorul de scaun rulant. Există categorii de persoane care pot întâmpina dificultăți în accesarea serviciilor pentru utilizatorii de scaun rulant. Mai jos sunt prezentate câteva exemple: • femei – copii și adulte; • persoane care locuiesc la o distanță mare de locul furnizării serviciilor/persoane care locuiesc în mediul rural; • persoane cu venituri mici; • copii; Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 21 • persoane aparținând unor diferite grupuri etnice sau socio-economice; • persoane vârstnice; • grupuri specifice – de exemplu, persoanele diagnosticate ca fiind purtătoare ale virusului HIV sau cele diagnosticate cu lepră se pot confrunta cu discriminarea. Managerii trebuie să țină seama de context și să fie conștienți de existența diverselor grupuri care ar putea întâmpina dificultăți în accesarea serviciilor pentru utilizatorii de scaun rulant. Trimiterea și programarea Trimiterea și programarea reprezintă prima etapă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Etapa Rezumat 1. Trimiterea și programarea Modalitatea prin care utilizatorii de scaun rulant sunt direcționați către furnizorul de servicii dedicate lor va varia. Utilizatorii pot apela la un furnizor la recomandarea altor persoane utilizatoare de scaun rulant sau prin intermediul rețelelor alcătuite din personal sau voluntari ai serviciilor de sănătate și recuperare guvernamentale sau non- guvernamentale, din cadrul comunității, la nivel local sau regional. Unii furnizori de servicii pentru utilizatorii de scaun rulant trebuie să identifice în mod activ potențialii utilizatori, și anume pe cei care la acel moment nu beneficiază de servicii sociale sau de sănătate, care nu participă la activități școlare, comunitare sau care nu sunt angajați. Un sistem de trimiteri eficient presupune relații bune între furnizorul de servicii pentru utilizatorii de scaun rulant și comunitate, deoarece membrii comunității sunt cei care îi vor identifica pe utilizatori și îi vor îndrepta către furnizor. Mai jos sunt enumerate exemple de persoane sau organizații care ar putea identifica și direcționa utilizatorii de scaun rulant către furnizorul de servicii: • spitale locale; • centre de sănătate din comunitate; • rețele de recuperare din comunitate; • autorități la nivelul așezărilor rurale, membri ai consiliilor locale, reprezentanți ai bisericii; • organizații ale persoanelor cu dizabilități; • alți utilizatori de scaun rulant; • medici, asistente medicale. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 22 Ce pot face managerii pentru a dezvolta o rețea de surse de trimiteri? • Identificați sursele care pot face trimiteri (persoane și organizații) din zona în care vă desfășurați activitatea. • Discutați cu personalul furnizor de servicii pentru utilizatorii de scaun rulant despre tipurile de informații necesare, astfel încât aceste surse să poată identifica persoanele care au nevoie de scaun rulant și să le direcționeze către furnizorul de astfel de servicii. • Pregătiți (sau oferiți sprijin personalului care trebuie să facă acest lucru) formulare/pliante, care să conțină informațiile de care au nevoie aceste potențiale surse pentru a face trimiteri. • Vizitați (sau oferiți sprijin personalului care trebuie să facă acest lucru) persoanele sau organizațiile care au potențialul de a deveni surse de trimiteri și prezentați-le serviciile furnizate. • Organizați un eveniment de tipul „porți deschise” la care să participe utilizatori de scaun rulant și potențialele surse de trimiteri. • Organizați o sesiune de instruire pentru aceste surse, cu privire la crearea unei rețele pentru trimiteri. • Luați în considerare elaborarea unui formular de trimitere care să poată fi completat de către sursele de trimitere. Asigurați-vă că formularul este simplu de folosit și că există un răspuns din partea voastră (prin programarea utilizatorului de scaun rulant direcționat către voi); totodată, acordați feedback pozitiv celor care folosesc formularul de trimitere. Creșterea gradului de acces la servicii echitabile Managerii joacă un rol important în creșterea gradului de acces la servicii echitabile. Următorul tabel prezintă câteva sugestii cu privire la metode de facilitare a accesului diferitelor grupuri. Ce pot face managerii pentru a se asigura că procesul de furnizare a serviciilor este unul echitabil? P en tr u fe m ei – c op ii și a du lte • Asigurați-vă că informațiile sunt diseminate în diverse moduri – de exemplu, la radio, broșuri/afișe simple şi imagini vizuale. • Asigurați-vă că în materialele de promovare a serviciilor pentru utilizatorii de scaun rulant, femeile sunt reprezentate în aceeași măsură ca bărbații. • Identificați utilizatoare de scaun rulant care pot constitui un exemplu și care să vorbească public despre importanța scaunelor rulante în cazul femeilor care au nevoie de acestea. • Discutați cu reprezentanții autorităților din comunități, pentru a transmite ideea că scaunele rulante sunt importante în egală măsură în cazul femeilor, copiilor și al bărbaților. • Susțineți și încurajați participarea femeilor la toate aspectele legate de furnizarea serviciilor pentru utilizatorii de scaun rulant, inclusiv la nivel de management și de conducere. • Transmiteți către organizații ale persoanelor cu dizabilități informații referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant și evidențiați faptul că atât femeile, cât și bărbații au nevoie de scaune rulante pentru mobilitate. • Atunci când descrieți procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant, precizați că aceasta este o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 23 P en tr u co pi i • Asigurați-vă de faptul că informația legată de furnizarea serviciilor este disponibilă în locurile frecventate de părinții copiilor cu dizabilități – de exemplu, centre de sănătate din comunitate – spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei, temple. • Atunci când descrieți procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant, precizați că el este o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”. • Furnizați instruire și informații persoanelor care lucrează cu copii cu dizabilități – de exemplu: medici, asistente, lucrători din domeniul sănătății care își desfășoară activitatea în comunități. • Asigurați-vă că în materialele de promovare a serviciilor pentru utilizatorii de scaun rulant, copiii și adulții sunt reprezentați în aceeași măsură. • Explicați beneficiile furnizării scaunelor rulante utilizatorilor copii la o vârstă cât mai mică. De asemenea, explicați impactul pozitiv asupra familiilor/ însoțitorilor acestor copii. P en tr u pe rs oa ne c u ve ni tu ri m ic i • Asigurați-vă că furnizarea serviciilor este pe cât se poate de eficientă din punct de vedere al costurilor. • Identificați modalitățile de oferire a unui sprijin financiar utilizatorilor care nu au resursele necesare pentru a se deplasa la furnizorul de servicii sau care nu își permit achiziționarea unui scaun rulant (în cazul în care există costuri) – de exemplu, crearea unui fond pentru echipamente de mobilitate. P en tr u pe rs oa ne vâ rs tn ic e • Atunci când prezentați serviciile pentru utilizatorii de scaun rulant, menționați întotdeauna că acestea se adresează tuturor categoriilor, inclusiv persoanelor vârstnice. • Includeți în materialele de prezentare imagini cu persoane vârstnice, care utilizează scaune rulante. • Atunci când discutați despre serviciile destinate utilizatorilor de scaun rulant, explicați care sunt beneficiile unui scaun rulant pentru persoanele în vârstă și familiile acestora. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 24 P en tr u pe rs oa ne c ar e lo cu ie sc la d is ta nț ă de fu rn iz or ul d e se rv ic ii / p er so an e di n m ed iu l r ur al • Asigurați-vă de faptul că informația legată de furnizarea serviciilor este disponibilă în zonele rurale – de exemplu, centre de sănătate din comunitate – spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei şi temple. • Furnizați informații persoanelor care lucrează cu persoane din mediul rural – de exemplu, lucrători din centre comunitare de recuperare. • În cazul în care furnizorul nu își desfășoară activitatea pe teren, identificați metode pentru a oferi asistență în ceea ce privește transportul utilizatorilor de scaun rulant din zonele rurale. De exemplu, sprijin financiar pentru transport, colaborarea cu alte organizații care pot ajuta cu transportarea utilizatorilor la furnizorul de servicii. • Stabiliți dacă există posibilitatea de a oferi cazare acelor utilizatori de scaun rulant care se vin din localități rurale. • Furnizați servicii în comunitățile situate în zonele din mediul rural. • Instruiți persoanele care lucrează în mediul rural (de exemplu, persoane din domeniul sănătății) cu privire la modalitățile de a oferi sprijin utilizatorilor de scaun rulant din comunitate, la desfășurarea monitorizării și la posibilitățile de a oferi asistență pentru întreținerea scaunelor rulante și efectuarea reparațiilor lipsite de complexitate. • Asigurați-vă că sunt disponibile scaune rulante adecvate utilizării în mediul rural, pe teren accidentat și oferiți informații cu privire la efectuarea unor operațiuni de adaptare minore (de exemplu, rampe sau nivelarea căilor de acces), pentru a facilita utilizarea echipamentelor în mediul rural. P en tr u di fe ri te gr up ur i e tn ic e/ so ci o- ec on om ic e • Atunci când prezentați serviciile pentru utilizatorii de scaun rulant, menționați întotdeauna că furnizarea acestora se adresează tuturor, indiferent de apartenența la grupuri etnice sau socio-economice. • Includeți în materialele de prezentare imagini cu persoane din diferite grupuri etnice și religioase. • Acolo unde este posibil, angajați personal aparținând diverselor grupuri etnice și socio-economice. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 25 B.2 Spații și echipamente Furnizarea serviciilor pentru utilizatorii de scaun rulant se poate desfășura în diverse locuri. Totuși, indiferent de locul unde se furnizează serviciile, sunt necesare anumite spații și echipamente. Serviciile pentru utilizatorii de scaun rulant cu cerințe de nivel de bază necesită mai puțin spațiu și un număr mai mic de echipamente decât serviciile de nivel intermediar. Spații și echipamente pentru toate tipurile de servicii destinate utilizatorilor de scaun rulant (nivel de bază și nivel intermediar) Spațiu desemnat pentru recepție și sala de așteptare Ce fel de spațiu este necesar? Este necesar un spațiu pentru o zonă de recepție și un loc unde utilizatorii de scaun rulant și familiile acestora pot aștepta împreună. În cazul în care persoanele au călătorit de la o distanță mai mare pentru a ajunge la furnizorul de servicii, se recomandă să aveți în vedere un loc unde au acces la alimente și băuturi răcoritoare. În imaginea din dreapta, un comerciant local administrează un stand în afara unei clinici dintr-o localitate. Poate fi utilă o zonă retrasă, unde utilizatorii de scaun rulant se pot întinde pe perioada așteptării. Acest lucru este important în special în cazul: • persoanelor cu un grad crescut de fragilitate și care au nevoie de odihnă pe durata vizitei la centrul furnizorului de servicii; • copiilor care sunt obosiți; • persoanelor la care sunt prezente escare în zone ale corpului asupra cărora greutatea exercită presiune. Trebuie să existe o toaletă accesibilă în apropierea zonei de recepție, precum și în apropierea zonei unde se efectuează evaluarea și probarea echipamentului de mobilitate. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 26 Echipamente recomandate: Echipamentele pentru înregistrare includ: masă/birou, scaun, telefon și un loc unde documentele pot fi depozitate și îndosariate în siguranță. Este utilă dispunerea în zona de așteptare a afișelor, pliantelor și materialelor video disponibile. În cazul în care centrul este vizitat de un număr mare de copii, se recomandă să aveți disponibile câteva jucării simple, pe care aceștia să le poată folosi pe parcursul perioadei de așteptare. Spațiu pentru birourile personalului Ce fel de spațiu este necesar? Personalul are nevoie de un spațiu unde membrii echipei au posibilitatea de a lucra împreună, de a se reuni, unde își pot scrie notițele și unde pot depozita în siguranță documentele cu care lucrează. Spațiu pentru desfășurarea evaluării și probării Ce fel de spațiu este necesar? Este necesar un spațiu cât mai liniștit și retras unde utilizatorii de scaun rulant pot fi evaluați de către personal și unde poate avea loc probarea scaunelor rulante. Spațiul trebuie să fie accesibil utilizatorilor de scaun rulant, să fie suficient de mare, astfel încât membrii de familie să fie prezenți și să fie suficient de luminos. Este utilă identificarea unui perete gol, într-o zonă accesibilă, care să fie folosit pe parcursul evaluării pentru a face fotografii. În cazul în care activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant se desfășoară la sediu, se sugerează ca spațiul să aibă următoarele dimensiuni (dimensiunile pot varia în funcţie de volumul de muncă): • Spațiu pentru examinări clinice – nivel de bază: 3 m x 2.5 m • Spațiu pentru examinări clinice – nivel intermediar: 4 m x 3.5 m Uneori, zona de examinare clinică o constituie domiciliul utilizatorului de scaun rulant. În acest caz, sunt importante flexibilitatea, adaptabilitatea și echipamentele esențiale. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 27 Echipamente: • Paravane – în cazul în care sunt examinați mai mulți utilizatori de scaun rulant, se vor folosi perdele sau paravane pentru a asigura confortul utilizatorului. • Bancheta sau patul de evaluare – o structură fermă, stabilă, situată la aceeași înălțime ca scaunul rulant, pe care utilizatorul se așază pe durata evaluării. Suprafața superioară trebuie acoperită cu un material care să asigure protecția pielii, de exemplu, polistiren sau o saltea pentru gimnastică sau yoga. Poziționați patul de evaluare astfel încât cel care efectuează evaluarea să poată sta în fața sau în spatele utilizatorului de scaun rulant. • Suport pentru picioare – un set de suporturi de diferite mărimi pentru susținerea corectă a picioarelor utilizatorului. • Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. • Aparat foto/video – un astfel de aparat este util pentru înregistrarea etapelor cheie din cadrul evaluării și probării (cu acordul scris al utilizatorului de scaun rulant). • Ruletă și etrier reglabil. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 28 Spațiu pentru pregătirea, întreținerea și repararea scaunelor rulante Ce fel de spațiu este necesar? Este necesar un spațiu desemnat pentru „activități tehnice” care să fie folosit pentru: • asamblarea, repararea și întreținerea scaunelor rulante • confecționarea adaptărilor, acolo unde este cazul. Spațiul trebuie să fie bine iluminat, ventilat, izolat și cu o temperatură potrivită pentru desfășurarea activității. În cazul sculelor manuale și electrice, sunt importante măsurile de siguranță. În mod ideal, acestea trebuie depozitate în dulapuri metalice, care pot fi încuiate. În cazul în care activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant se desfășoară la sediu, spațiul tehnic ar trebui împărțit după cum urmează: • Un spațiu „curat”, desemnat pentru asamblarea finală a componentelor și reglarea produsului, precum și pentru efectuarea controalelor de siguranță și pregătirea echipamentului. Pentru acest spațiu sunt necesare suprafețe de sol și suprafețe de tip banc de lucru. • Pentru efectuarea modificărilor și reparațiilor este necesară o zonă de „fabricare”. Aici sunt incluse activitățile de modelare și lipire a buretelui, operațiunile generale de găurire, șlefuire, tăiere și vopsire. Pentru acest spațiu sunt necesare suprafețe de sol și suprafețe de tip banc de lucru. Nu este obligatoriu ca toate operațiunile tehnice să fie efectuate în spațiul pentru activități tehnice din cadrul centrului furnizorului de servicii pentru utilizatorii de scaun rulant. De exemplu, este posibil ca un furnizor să externalizeze anumite operațiuni tehnice, cum ar fi coaserea materialului textil (către un croitor local) și sudarea (către un atelier de confecții metalice local). Echipamente: • Un număr suficient de dulapuri, rafturi și polițe pentru depozitarea instrumentelor, pentru menținerea ordinii în spațiul respectiv și optimizarea suprafeței de sol. • Scule pentru asamblarea și reglarea scaunelor rulante și pentru realizarea adaptărilor. • O listă cu materiale pentru adaptări. • Cel puțin un banc de lucru pentru fiecare tehnician. Se recomandă ca cel puțin unul dintre bancurile de lucru să fie ajustabil pe înălțime, pentru cazul în care din echipă face parte și un utilizator de scaun rulant. Se recomandă ca bancul de lucru să fie poziționat astfel încât să existe spațiu în fața sau în spatele acestuia, pentru lucrările care se fac la nivelul solului. Pentru mai multe informații despre necesarul de scule, materiale și echipamente consultați resursele suplimentare de pe memory stick. (Notă: spațiile și echipamentele necesare atelierelor de fabricare a scaunelor rulante sunt mult mai complexe și depășesc sfera subiectelor abordate în acest manual). Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 29 Spațiu de depozitare Ce fel de spațiu este necesar? Este necesar să existe un spațiu pentru depozitarea scaunelor rulante, pieselor de schimb și a materialelor. Spațiul de depozitare trebuie să se situeze în proximitatea spațiului pentru activități tehnice, să respecte prevederile privind siguranța, să nu permită accesul apei, al animalelor/dăunătorilor. Un grilaj metalic aplicat pe fereastră constituie o măsură de siguranță suplimentară. Dacă nu există un spațiu care să poată fi folosit ca spațiu de depozitare, amenajați o zonă din cadrul unei încăperi. În acest caz, trebuie să acordați atenție suplimentară măsurilor de siguranță. Amenajarea unui spațiu de depozitare Următoarele sugestii pot ajuta la amenajarea unui spațiu de depozitare bine organizat: • Rafturile și etajerele ajută la maximizarea spațiului disponibil. • Un culoar între etajere, rafturi, cutii și scaune rulante asamblate îmbunătățește accesul și crește eficiența. Culoarul trebuie menținut liber. • Aranjați articolele în funcție de tip și de dimensiune. Poziționând articolele de același tip în același loc, facilitați operațiunile de numărare necesare pentru controlul stocului, precum și cele de reorganizare. • Articolele mici, cum ar fi șuruburile, piulițele, șaibele pot fi ținute în cutii mici, câte una pentru fiecare articol și mărime. Marcați numele articolului pe fața cutiei. • Cutiile și materialele nu ar trebui așezate direct pe sol sau lângă un perete extern, deoarece ar putea fi deteriorate cu ușurință, din cauza umezelii. Pentru a împiedica depozitarea articolelor direct pe sol, utilizați paleți. • Dacă există ferestre, luați în considerare montarea unor grilaje, pentru creșterea gradului de siguranță. Spaţiu pentru instruirea utilizatorilor de scaun rulant Ce fel de spațiu este necesar? Este necesar un spațiu desemnat pentru desfășurarea activităților de instruire pentru: • instruirea privind efectuarea transferurilor și aspectele legate de starea de sănătate; • manevrarea și întreținerea scaunului rulant; • însușirea abilităților de manevrare a scaunului rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 30 Instruirea privind transferurile și aspectele legate de sănătate poate avea loc într-un spațiu destinat activităților de tip clinic, la domiciliul utilizatorului sau în comunitate, acolo unde se furnizează serviciile. Echipamente: • Se recomandă folosirea unor echipamente de bază, cum ar fi un pat pentru exersarea transferurilor. Instruirea privind manevrarea și întreținerea scaunului rulant poate avea loc într-o zonă adecvată dintr-un atelier sau în orice alt spațiu corespunzător. Echipamente: • Este nevoie de echipamente de bază pentru operațiunile de întreținere a scaunului rulant. Instruirea pentru dobândirea abilităților de manevrare a scaunului rulant are loc de obicei în exterior, dar se poate efectua, de asemenea, și în interior. Există varianta folosirii unui spațiu în aer liber, proiectat special pentru a simula diversele tipuri de suprafețe pe care utilizatorii de scaun rulant vor trebui să le traverseze în viața de zi cu zi – cum ar fi teren accidentat, teren plat, șanțuri, praguri limitatoare de viteză, borduri, praguri şi scări. În cazul serviciilor integrate, spațiul dedicat însușirii abilităților de mobilitate poate fi utilizat și de către persoane cu alte tipuri de dizabilități motorii – de exemplu, persoane care învață să utilizeze o proteză pentru membre sau care trebuie să se recupereze din punct de vedere al mobilității, în urma unui accident. Acolo unde nu există spațiu pentru a amenaja o zonă în vederea exersării abilităților de manevrare a scaunului rulant, identificați care sunt acele spații care există deja și care pot fi folosite în condiții de siguranță în activitatea de instruire pentru manevrarea scaunului rulant. Evitați zonele în care se circulă în mod constant și încercați să găsiți mai multe tipuri de obstacole. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 31 Oriunde se furnizează servicii pentru utilizatorii de scaun rulant, există posibilitatea de a fabrica echipamente portabile pentru instruirea în vederea dobândirii abilităților de manevrare a scaunului rulant. Imaginea din partea dreaptă prezintă un echipament portabil pentru exersarea abilităților de manevrare a scaunului rulant, amenajat sub un adăpost care oferă umbră. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Spații și echipamente suplimentare pentru furnizarea serviciilor de nivel intermediar Furnizarea serviciilor de nivel intermediar necesită spații și echipamente în plus. Cerințele suplimentare pe care trebuie să le aibă în vedere managerii sunt prezentate mai jos. Spațiu pentru evaluare și pentru probarea produsului Pentru serviciile de nivel intermediar este necesar un pat de evaluare, pe care utilizatorul de scaun rulant să poată sta culcat pe durata evaluării. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Se recomandă ca în timpul evaluării utilizatorilor cu cerințe de nivel intermediar să folosim un suport specializat pentru evaluare. Avem astfel un suport pentru picioare ajustabil și posibilitatea de a avea gradul de suport necesar pe durata procedurii de simulare manuală. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. • Bucățile de burete rigid, pentru crearea unui suport temporar, trebuie să fie la îndemână pe întreaga durată a evaluării și probării produsului. • O oglindă de dimensiuni mari îi este de folos atât utilizatorului de scaun rulant, cât și personalului furnizor de servicii, pentru a observa mai bine postura și alinierea părților corpului, din diferite unghiuri. • Jucăriile și imaginile afișate pe pereți creează un mediu mai prietenos pentru copii. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 32 Depozitare Serviciile de nivel intermediar necesită un spațiu de depozitare mai mare pentru materialele necesare adaptărilor și pentru componentele dispozitivelor de suport postural. Materialele includ plăci de burete care trebuie depozitate pe o suprafață plată și care trebuie să rămână uscate. De aceea, sunt necesare mai multe spații și rafturi de depozitare. Spațiu pentru pregătirea, întreținerea și repararea scaunelor rulante Un spațiu curat și o mașină de cusut industrială permit confecționarea și modificarea componentelor și a centurilor din material textil, folosite pentru suport postural. În lipsa unui astfel de spațiu și a echipamentului adecvat, aceste operațiuni vor trebui externalizate. Organizarea spațiului de lucru Odată ce spațiile au fost desemnate și echipamentele au fost procurate, managerul trebuie să desemneze responsabilii pentru organizarea fiecărui spațiu, parcurgând următorii patru pași: 1. Evitarea acumulării de obiecte: înlăturați toate sculele, piesele și echipamentele nefolosite, precum și documentele perimate, care nu mai sunt necesare. 2. Identificarea obiectelor utilizate în mod curent: instrumente, piese, instrucțiuni și documente. Articolele folosite în mod regulat trebuie aranjate astfel încât să fie localizate cât mai ușor și mai rapid. 3. Stabilirea unui sistem și desemnarea responsabililor: creați un sistem pentru fiecare spațiu de lucru și numiți un responsabil pentru implementarea sistemului. 4. Monitorizare: supervizați sistemul pentru a vă asigură că schimbarea se menține. B.3 Gama de scaune rulante corespunzătoare Ce înseamnă scaunul rulant corespunzător și perna adecvată? Nevoile individuale ale fiecărui utilizator de scaun rulant variază. Totuși, toți utilizatorii au nevoie de scaune rulante corespunzătoare și de perne adecvate. Ghidul Organizației Mondiale a Sănătății privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate definește scaunul rulant corespunzător ca fiind cel care: • răspunde nevoilor utilizatorului și corespunde caracteristicilor mediului în care trăiește acesta; • este potrivit ca dimensiune și furnizează suport postural adecvat; Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 33 • poate fi utilizat în condiții de siguranță și este durabil; • este disponibil în țară; • poate fi obținut și întreținut în țară, la cel mai convenabil preț, fiind disponibile și serviciile aferente. Pentru a răspunde nevoilor utilizatorilor de scaun rulant care accesează servicii destinate lor, furnizorii acestor servicii trebuie să dețină un stoc care să includă cel puţin câteva tipuri diferite de scaune rulante şi de perne potrivite acestora. Tipul de pernă cel mai indicat va depinde de nevoile individuale ale fiecărui utilizator. Totuşi, orice persoană la care există riscul apariției escarelor are nevoie de pernă pentru reducerea presiunii si de instruire cu privire la folosirea acesteia. Costurile lipsei de echipamente corespunzătoare și de instruire a utilizatorilor de scaun rulant În țările care dispun de resurse, speranța de viață medie pentru persoanele care devin utilizatoare de scaun rulant în intervalul de vârstă 25 – 34 de ani este de aproximativ 38 de ani după momentul apariției leziunii medulare (8). Dimpotrivă, un studiu realizat în Bangladesh sugerează că speranța de viață medie în urma unei leziuni medulare este de 5,36 ani de la momentul apariției leziunii, iar 56,4% dintre aceste persoane decedează într-un interval de 5 ani de la apariţia leziunii (9). 80% dintre persoanele cuprinse în acest studiu au decedat la domiciliu; dintre acestea, o treime aveau escare la momentul decesului. În anul 1999, în secția pentru leziuni medulare a unui centru de recuperare din Sri Lanka, s-a făcut un studiu cu privire la costurile impuse de tratament. La acea oră, timpul de vindecare al unei escare superficiale era de aproximativ 6 săptămâni, iar costurile se ridicau la 286$. O escară de profunzime necesita un an de tratament și suma de 2483$. Acelaşi studiu a demonstrat că folosirea scaunelor rulante potrivite, a pernelor și a saltelelor adecvate, precum şi instruirea corespunzătoare a pacientului pot reduce incidenţa escarelor pe perioada spitalizării cu 70%, precum şi cheltuielile cu tratamentul acestora cu aproape 60%. Într-un spital din Sao Paulo, Brazilia, a fost introdus un program de instruire pentru reducerea complicațiilor medicale secundare în cazul persoanelor cu leziuni medulare. Incidența escarelor s-a redus cu 23% (10). Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 34 Selecția gamei de scaune rulante corespunzătoare și de perne adecvate Dimensiunea potrivită și furnizarea suportului postural adecvat Utilizatorii au nevoie de scaune rulante cu dimensiunea corectă. Scaunul rulant de mărime necorespunzătoare produce senzația de disconfort, nu furnizează suport postural corect și poate dăuna utilizatorului de scaun rulant. Acest lucru înseamnă că furnizorul de servicii pentru utilizatorii de scaun rulant are nevoie de un stoc de scaune rulante de diferite mărimi sau de scaune rulante care pot fi ajustate în ceea ce privește mărimea. Cei mai mulți utilizatori de scaun rulant petrec zilnic un număr mare de ore în poziția așezat. Acest lucru înseamnă că scaunul lor rulant nu este doar un dispozitiv pentru facilitarea mobilității, ci contribuie și la adoptarea unei poziții confortabile în poziția așezat. Utilizatorii au nevoie de diferite tipuri de suport postural și, implicit, de scaune rulante care furnizează diferite tipuri de astfel de suport. Un scaun rulant care are dimensiunile potrivite oferă suportul postural adecvat utilizatorilor care au nevoie de servicii de nivel de bază. Persoanele care au nevoie de un grad ridicat de suport postural, de nivel intermediar, necesită un scaun rulant de dimensiuni potrivite, cu suport postural suplimentar. Acest lucru se poate realiza prin adăugarea unor dispozitive de suport postural sau prin furnizarea unui sistem de poziționare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 35 Consecințele utilizării scaunelor rulante de dimensiuni necorespunzătoare sau a lipsei de suport postural adecvat Personalul Centrului de Recuperare Western Cape din Africa de Sud a documentat complicațiile apărute în cazul unui grup de copii din diferite școli și centre, care ar fi avut nevoie de suport postural suplimentar, dar nu au beneficiat de acesta. În cazul a 21% dintre aceștia au apărut probleme posturale. Consecințele, în ceea ce privește copiii, familiile şi furnizorii de servicii, au constat în: • complicații mai grave și mai mult timp petrecut în întâlniri cu furnizorii de servicii pentru utilizatorii de scaun rulant; • deteriorări ale stării de sănătate; • postură incorectă, disconfort; • nivel scăzut de toleranță pentru menținerea poziției așezat (durată scăzută a menținerii unei poziții corecte confortabile); • participarea scăzută la programe educaționale • diminunarea nivelului calității vieții. Nevoile specifice și mediul în care trăiește utilizatorul de scaun rulant Rolul unui scaun rulant corespunzător este să faciliteze desfășurarea activităților. Utilizatorii de scaun rulant trebuie să aibă posibilitatea de a efectua transferul în și din scaunul rulant, de a realiza propulsia scaunului rulant, de a plia scaunul rulant pentru transport și depozitare și de a-și îndeplini sarcinile zilnice. Utilizarea tipului de scaun rulant adecvat și funcționarea corectă a acestuia contribuie la toate aceste aspecte. De asemenea, utilizatorii au nevoie de un scaun rulant care va funcționa corespunzător în mediul în care va fi folosit. Medii diferite impun utilizarea unor tipuri diferite de scaune rulante. De exemplu, unele scaune rulante sunt mai potrivite pentru utilizarea în interior, altele pot fi folosite în spații deschise și pe teren accidentat. Echipamente abandonate: este de preferat un echipament necorespunzător decât niciun echipament? Atunci când echipamentele nu se potrivesc cerințelor utilizatorilor, ele sfârșesc deseori prin a fi abandonate. Imaginea alăturată ilustrează o situație obișnuită. Acest utilizator de scaun rulant are trei scaune rulante primite donație – totuși, niciunul nu răspunde nevoilor sale și de aceea, el nu poate ieși din casă. Primele două scaune rulante nu mai pot fi folosite pentru că s-au defectat, iar piesele de schimb nu sunt disponibile. Al treilea este nou, dar este un scaun rulant de o calitate care lasă de dorit, nu oferă senzația de siguranță și pare instabil atunci când este folosit în exterior, astfel încât utilizatorul nu se simte în siguranță. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 36 Siguranță și durabilitate Utilizatorii de scaun rulant vor produse sigure și durabile care pot fi reparate la costuri acceptabile. Este avantajos și pentru furnizorii de servicii să se asigure că scaunele rulante pe care le furnizează pot fi folosite în condiții de siguranță, că sunt durabile și pot fi reparate local. Acest lucru ar putea contribui la reducerea costurilor de înlocuire a scaunelor rulante și la simplificarea operațiunilor de întreținere. Numeroși utilizatori din regiunile cu resurse limitate folosesc scaunul rulant pentru a se deplasa pe teren accidentat. Este posibil ca scaunul rulant să fie expus la ploaie, nisip și noroi. În consecință, aceste scaune rulante trebuie să fie durabile și făcute să reziste în astfel de condiții. Scaunele rulante de calitate inferioară se vor strica rapid (de exemplu, în decurs de 1-6 luni); în timp ce scaunele rulante fabricate corespunzător, care sunt întreținute în mod adecvat, pot rezista 3-5 ani, aceasta reprezentând un raport calitate-preț mult mai avantajos. Probleme întâlnite frecvent în cazul scaunelor rulante de calitate inferioară: • materialul textil de calitate necorespunzătoare folosit pentru suprafața de ședere sau pentru spătar se rupe sau se deformează; • roțile de direcție (axe, anvelope, rulmenți, furci) se defectează; • roțile posterioare (axa roții, inel de antrenare, spițe, rulmenți, anvelope) se defectează sau se uzează; • frânele ruginesc și nu mai funcționează; • suporturile pentru picioare se defectează; • pernele fie lipsesc, fie sunt de calitate necorespunzătoare și se rup repede; • părțile detașabile se pierd. Rolul managerului Managerii responsabili de furnizarea serviciilor destinate utilizatorilor de scaun rulant au un rol important în procurarea sau recepționarea scaunelor rulante donate. Pentru mai multe informații, consultați resursele de pe memory stick. Managerii trebuie să se asigure că: • Există o gamă adecvată de scaune rulante și perne – pentru a putea răspunde (într-o cât mai mare măsură) diverselor nevoi ale utilizatorilor de scaun rulant. Asta înseamnă să avem în vedere o gamă care include mărimi diferite, nevoia de suport postural, cerințele specifice legate de mediul utilizatorului și de stilul de viață al acestuia. • Scaunele rulante selectate sunt rezistente – în special în cazurile în care vor fi folosite pe terenuri accidentate sau în medii dificile. • Scaunele rulante pot fi reparate local. Acest lucru poate însemna că există piese de schimb (fie procurate, fie furnizate prin donație) sau că piesele de schimb pot fi achiziționate cu ușurință și local. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 37 Este important ca furnizorul de servicii să obțină de la utilizatorii de scaun rulant un feedback cu privire la produsele furnizate. Managerii și personalul pot discuta cu utilizatorii de scaun rulant în timpul vizitelor la domiciliu, la întâlniri de grup sau prin intermediul organizațiilor persoanelor cu dizabilități. Atunci când începe furnizarea unui nou tip de scaun rulant sau de pernă care nu a mai fost oferit înainte, furnizorul de servicii poate opta pentru testarea produsului cu ajutorul unui grup de utilizatori. Aceștia vor folosi noul produs pe o perioadă de timp determinată și vor furniza feedback. Feedback-ul poate fi obținut prin interviuri individuale sau prin intermediul focus grupurilor. Cum se pot asigura managerii de faptul că scaunele rulante pe care le achiziționează sau pe care le primesc sunt durabile și pot fi reparate? Managerii pot adresa întrebări furnizorilor (sau donatorilor) pentru a afla mai multe informații cu privire la scaunele rulante. Exemple de întrebări: • Are produsul certificate de standard (a trecut teste de performanță și de calitate prevăzute de un organism profesional)? Dacă da, care au fost rezultatele? • Prevede furnizorul o anumită durată de viață a produselor? • Are furnizorul un sistem pentru raportarea defectelor? • Cine sunt ceilalți cumpărători și utilizatori ai produselor lor? Există posibilitatea contactării altor furnizori de servicii pentru utilizatorii de scaun rulant pentru a afla mai multe informații legate de echipamentul de mobilitate? • Ce scule sunt necesare pentru asamblarea și/sau reglarea scaunului rulant? • Sunt disponibile piese de schimb? Piesele trebuie achiziționate în străinătate sau unele dintre ele sunt disponibile și în țară? • A fost produsul testat de către utilizatori din țară și dacă da, ce feedback/rezultate au fost înregistrate? • În cazul în care se rupe cadrul – acesta poate fi reparat pe plan local? • Se furnizează și un ghid de întreținere? Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 38 Monitorizarea, întreținerea și repararea scaunului rulant Cea de-a opta etapă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant o reprezintă monitorizarea, întreținerea și repararea. Monitorizarea, întreținerea și repararea Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, probleme care nu pot fi rezolvate cu ușurință în cadrul comunității. O parte importantă a acestei etape o reprezintă instruirea utilizatorilor de scaun rulant și a familiilor acestora cu privire la operațiunile de întreținere a scaunului rulant. Întreținerea la intervale regulate, efectuată la domiciliu, contribuie la creșterea duratei de viață a scaunelor rulante și la evitarea necesității unor reparații majore. De asemenea, există și posibilitatea ca furnizorii de servicii pentru utilizatorii de scaun rulant să instruiască partenerii cu care colaborează în ceea ce privește operațiunile de întreținere și reparații sau să identifice alte resurse în cadrul comunității (de exemplu, ateliere pentru reparații biciclete), unde pot fi efectuate întreținerea și reparația scaunului rulant. B.4 Organizarea resurselor umane Roluri în cadrul echipei de furnizare a serviciilor pentru utilizatorii de scaun rulant Furnizarea serviciilor pentru utilizatorii de scaun rulant este deseori rezultatul muncii unei echipe. Aceștia îndeplinesc diverse roluri: personal cu atribuții clinice, tehnice, de instruire, administrativ și de management. Aceeași persoană poate avea unul sau mai multe roluri. De exemplu, unul din membrii echipei poate fi responsabil deopotrivă pentru partea clinică și pentru gestionarea întregului proces de furnizare a serviciilor pentru utilizatorii de scaun rulant. Există situaţii în care personalul aparținând unor organizaţii diferite colaborează pentru a efectua sarcinile specifice diverselor roluri. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 39 Tabelul de mai jos prezintă modul prin care rolurile din cadrul echipei sunt corelate cu activitățile de furnizare a serviciilor destinate utilizatorilor de scaun rulant. A ct iv ită ți de ti p cl in ic A ct iv ită ți de ti p te hn ic In st ru ir ea u til iz at or ilo r de s ca un r ul an t A dm in is tr at iv M an ag em en t Management și dezvoltare Promovarea procesului de furnizare a serviciilor ü ü ü ü ü Identificarea surselor de finanţare ü Dezvoltarea rețelei de surse de trimiteri ü ü ü ü Asigurarea legăturii cu alte organizații ü ü ü ü ü Evaluarea procesului de furnizare ü ü ü ü ü Etapele furnizării serviciilor 1. Trimiterea și programarea ü ü ü ü 2. Evaluarea ü ü ü 3. Prescrierea ü ü ü 4. Finanțarea și plasarea comenzii ü ü ü ü 5. Pregătirea produsului ü 6. Probarea produsului ü ü 7. Instruirea utilizatorilor de scaun rulant ü ü ü 8. Monitorizarea, întreținerea și reparațiile ü ü ü Instruirea și dezvoltarea profesională Instruirea personalului din rețeaua de surse de trimiteri ü ü ü Instruirea personalului care desfășoară monitorizarea ü ü ü Instruirea personalului care furnizează servicii pentru utilizatorii de scaun rulant ü ü ü Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 40 Instruirea Activitățile din cadrul procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant pot fi desfășurate de către persoane cu pregătire educațională și profesională din diverse domenii, cu condiția ca ele să fie instruite în mod corespunzător. Este important ca personalul cu responsabilități clinice, tehnice și de instruire să fie pregătit în mod adecvat. • Personalul cu atribuții clinice și tehnice care furnizează servicii de nivel de bază trebuie instruit în conformitate cu competențele prevăzute în pachetul de instruire privind furnizarea serviciilor pentru utilizatorii de scaun rulant – nivel de bază, creat de Organizația Mondială a Sănătății. • Personalul cu atribuții clinice și tehnice care furnizează servicii de nivel intermediar trebuie instruit în conformitate cu competențele prevăzute în pachetul de instruire privind furnizarea serviciilor pentru utilizatorii de scaun rulant – nivel intermediar, creat de Organizația Mondială a Sănătății. Rețineți: Se recomandă instruirea a cel puțin două persoane, simultan. Atunci când există o singură persoană care deține abilitățile necesare, procesul de furnizare a serviciilor se află într-o poziție de vulnerabilitate; în cazul în care aceasta părăsește echipa, se pierd experiența și cunoștințele acumulate. Planificarea capacității de furnizare a serviciilor Managerii trebuie să fie capabili să-și planifice activitatea în funcție de numărul de utilizatori de scaun rulant care vor beneficia de servicii specifice, lunar și anual. Acest lucru reprezintă „capacitatea de furnizare a serviciilor”. Capacitatea de furnizare a serviciilor include: • numărul de utilizatori care vor primi pentru prima oară un scaun rulant; • numărul utilizatorilor de scaun rulant care vor fi monitorizați. Capacitatea de furnizare a serviciilor este în corelație directă cu: • numărul membrilor echipei care sunt disponibili pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant; • durata de timp pe care personalul o poate folosi pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant; • numărul de scaune rulante pe care furnizorul de servicii le poate procura – acesta este în strânsă relație cu bugetul disponibil. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 41 Calcularea timpului pe care îl alocă personalul activității de furnizare a serviciilor pentru utilizatorii de scaun rulant Pentru a estima capacitatea de furnizare a serviciilor, managerii trebuie să calculeze cât timp să aloce personalul acestei activități. În acest scop, managerii trebuie să cunoască următoarele aspecte: • numărul săptămânilor lucrătoare care există în fiecare an (excluzând sărbătorile oficiale și zilele de concediu), • proporția din timpul total de lucru pe care personalul îl va dedica procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant (și nu altor sarcini, roluri sau activități). Managerii trebuie, de asemenea, să aibă în vedere timpul necesar parcurgerii etapelor specifice procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Există mulți factori care vor influența acest aspect; de exemplu, dacă membrii echipei au sau nu experiență în domeniu; dacă scaunul rulant furnizat necesită sau nu modificări. Totuși, ca punct de referință, putem considera că o echipă experimentată (cu atribuții clinice și tehnice) este în măsură să atingă următoarele obiective zilnice: • să furnizeze scaune rulante noi pentru doi utilizatori care au nevoie de servicii de nivel de bază sau • să furnizeze un scaun rulant nou pentru un utilizator care are nevoie de servicii de nivel intermediar. Tabelul de mai jos prezintă un exemplu de estimare a capacității de furnizare a serviciilor pentru utilizatorii de scaun rulant pornind de la ideea unei echipe formate din două persoane care lucrează împreună. Unul dintre membrii echipei are atribuții clinice, iar celălalt tehnice, ambii asigurând instruirea utilizatorilor. Echipa lucrează 5 zile/săptămână, timp de 42 de săptămâni pe an. În cazul în care există suficiente scaune rulante și materiale, pe parcursul unui an, această echipă poate furniza: • servicii de nivel de bază unui număr de 357 de utilizatori de scaun rulant; sau • servicii de nivel intermediar unui număr de 179 de utilizatori de scaun rulant. Servicii nivel de bază Servicii nivel intermediar Planificarea săptămânii de lucru Număr de zile lucrătoare/săptămână 5 5 Număr de săptămâni lucrătoare/an (excluzând sărbătorile oficiale și zilele de concediu) 42 42 Estimarea capacității de furnizare a serviciilor Număr de utilizatori de servicii/zi 2 1 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 42 Număr de utilizatori de servicii/săptămână 10 5 Număr de utilizatori de servicii/an 420 210 Marjă de risc 15% (pentru evenimente neprevăzute) -63 -31 Număr estimat de utilizatori/an 357 179 Rolul managerilor în crearea sau dezvoltarea echipei de furnizare a serviciilor pentru utilizatorii de scaun rulant • Identificați acele resurse umane existente sau noi care pot să își asume diferitele roluri din cadrul echipei care furnizează acest tip de servicii; • Asigurați instruirea personalului care nu deține competențele necesare; • Definiți timpul pe care personalul pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant îl poate dedica acestei activități, asigurându-vă că estimarea este realistă, și ia în calcul celelalte sarcini, roluri sau activități; • Estimați capacitatea anuală de furnizare a serviciilor – comunicați aceste informații echipei; • Oferiți sprijin membrilor echipei în activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant. De exemplu: • implicați personalul în planificarea activității; • creați un instrument de planificare săptămânală/lunară – acesta trebuie să includă programările și alte activități; • organizați întâlniri săptămânale pentru a monitoriza progresul, scoateți în evidență realizările și abordați aspectele care constituie o provocare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 43 B.5 Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? Identificarea costurilor pe care le implică furnizarea serviciilor pentru utilizatorii de scaun rulant reprezintă unul dintre rolurile importante ale managerului. Următorul tabel prezintă câteva dintre liniile de buget care sunt asociate în mod obișnuit creării și gestionării unui proces de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Costurile vor varia în funcție de context. Tipuri de cheltuieli Comentarii Costuri inițiale Planificarea produsului Aprovizionarea cu o gamă de produse Unelte Echipamente Clădire/spații Posibilitatea de a include costuri de construcție/renovare/ reamenajare Stoc de materiale Costuri operaționale Scaune rulante Stoc de scaune rulante – în funcție de estimarea capacității de furnizare a serviciilor și de anticiparea nevoilor utilizatorilor de scaun rulant Piese de schimb Este utilă crearea unui stoc de piese de schimb care sunt necesare în mod frecvent Materiale Necesarul de materiale pentru efectuarea modificărilor este mai mare în cazul serviciilor de nivel intermediar decât în cazul celor de nivel de bază Transportul produselor Livrarea și taxele vamale în cazul scaunelor rulante importate. Transportul scaunelor rulante la centre satelit. Resurse umane Management În ghidul de buget sunt enumerate diverse poziții din cadrul echipei. Nu există așteptarea ca fiecare echipă care furnizează servicii pentru utilizatorii de scaun rulant să aibă această componență. Bifele (vezi foaia de calcul) reprezintă activitățile din etapele procesului de furnizare a serviciilor. Există posibilitatea ca același membru al echipei să fie responsabil de implementarea mai multor activități. Personal cu atribuții clinice Personal cu atribuții tehnice Instructor/instructor utilizator de scaun rulant Administrator Transport local Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 44 Costuri de transport local pentru personal De exemplu: monitorizare, servicii furnizate în comunitate, instruirea rețelelor de surse de trimitere Transport local pentru beneficiarii serviciilor Deplasarea la sediul furnizorului de servicii, conform programărilor Cazare pentru beneficiarii serviciilor Costul pentru cazarea beneficiarilor serviciilor în cazul în care aceștia au nevoie să rămână peste noapte (dacă furnizorul acoperă acest tip de costuri) Tipărituri Formulare, liste de verificare și informații pentru utilizatori Consumabile Lipici, ață, vopsea, etc. Înlocuirea sculelor Uzarea sculelor – trebuie incluse fonduri pentru înlocuirea acestora Cheltuieli indirecte Trebuie luate în calcul cheltuielile cu electricitatea, furnizarea apei, chiria – pentru diversele activități (de tip clinic, tehnic, de depozitare, instruirea utilizatorilor, pentru birouri) Instruirea personalului Trebuie luate în considerare toate costurile de instruire pentru personalul furnizor de servicii pentru utilizatorii de scaun rulant Instruirea partenerilor/rețelelor de surse de trimitere Costurile activităților de instruire/conștientizare destinate partenerilor, organizațiilor și rețelelor de surse de trimitere Strângere de fonduri Orice activități care au ca scop strângerea de fonduri. Monitorizare și evaluare Costurile asociate activităților de monitorizare și evaluare – de exemplu, vizitarea utilizatorilor de scaun rulant pentru obținerea feedback-ului. Costurile pot include deplasarea sau personalul suplimentar. Soluții de eficientizare a costurilor Managerii care lucrează în regiuni cu resurse limitate trebuie să identifice metode de reducere a costurilor. Mai jos sunt enumerate câteva modalități de reducere a costurilor: Servicii integrate • Serviciile integrate, care împart în mod eficient spațiul, constituie oportunități semnificative de partajare a costurilor, în contrast cu statutul de furnizor individual. Partajarea costurilor cu alte organizații Un furnizor de servicii se poate asocia cu alte organizații, cu scopul de a partaja costurile. De exemplu: • Unele organizații internaționale donatoare/pentru dezvoltare pot fi interesate de partajarea costurilor scaunelor rulante. În ceea ce privește furnizorul de servicii, beneficiul îl constituie creșterea gradului de accesibilitate a produselor din punct de vedere al costurilor. Beneficiul Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 45 pentru organizația internațională îl constituie faptul că fondurile acoperă o arie mai extinsă și dovada că activitatea furnizorului de servicii poate fi sustenabilă din punct de vedere financiar. • Există posibilitatea ca organizațiile din comunitate să fie interesate să se asocieze cu furnizorul de servicii pentru a avea mai multe servicii disponibile la nivel local. Partenerul din comunitate poate fi în măsură să ofere spațiu și personal pentru implementarea unora dintre etapele procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant (de exemplu, monitorizarea și instruirea utilizatorilor). Beneficiul pentru utilizatorii de scaun rulant este reducerea costurilor de deplasare. Beneficiul pentru furnizorul de servicii este oportunitatea extinderii activității în comunitate. Potențiale surse de finanțare Mai multe informații despre identificarea surselor de finanțare pentru acoperirea costurilor de creare/gestionare a sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant sunt discutate la secțiunea C.4: Planificarea sustenabilității financiare. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 46 C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1 Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? Monitorizarea și evaluarea (M&E) ajută managerii să aibă o imagine a ceea ce se întâmplă (sau nu se întâmplă) ca rezultat al activităților echipelor lor. De asemenea, contribuie la înțelegerea, atât de către manageri, cât și de către echipe, a aspectelor care funcționează sau nu, precum și a opiniei utilizatorilor sau a părților implicate. Ce înseamnă monitorizarea și evaluarea? Monitorizarea Evaluarea Când se efectuează? • În mod constant • Integrată în activitățile zilnice ale furnizorului de servicii • În momentele cheie ale procesului de furnizare a serviciilor – de exemplu, în timpul evaluării anuale. (deși unele informații pot fi culese în mod permanent) Ce se monitorizează? • Activitățile de furnizare a serviciilor • Scaunele rulante și dispozitivele de suport postural suplimentar utilizate • Numărul și categoriile de beneficiari • Impactul asupra persoanelor și al comunităților • Sustenabilitatea Ce fel de surse de informații se folosesc? • Bazele de date cu informații despre beneficiarii serviciilor • Documentele aferente furnizării serviciilor • Informații despre procesul de furnizare a serviciilor • Feedback din partea utilizatorilor • Rapoarte financiare • Analiza timpului de care dispune personalul • Sondaje • Chestionare • Discuții de grup • Vizite la domiciliu • Observarea directă a activității • Analiza rapoartelor Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 47 Servicii eficiente În ce mod le sunt utile monitorizarea și evaluarea, atât managerilor, cât și altor persoane implicate în furnizarea serviciilor? • Oferă informații importante în vederea creșterii calității procesului de furnizare a serviciilor. • Oferă informații care contribuie la deciziile legate de achiziționarea produselor. • Ajută la limitarea costurilor prin creșterea eficienței și la justificarea finanțărilor actuale și viitoare. • Permite furnizorului de servicii să demonstreze finanțatorilor eficiența serviciilor oferite, pe baza unor date concrete – finanțatorii includ atât instituții guvernamentale, cât și donatori organizații neguvernamentale. • Ajută la identificarea și cuantificarea nevoilor nesatisfăcute. • Contribuie la alocarea corespunzătoare a resurselor. • Crește nivelul de conștientizare cu privire la beneficiile serviciilor pentru utilizatorii de scaun rulant. • Dezvoltă parteneriate mai puternice cu beneficiarii serviciilor de acest tip. Există un cadru cu trei etape care ajută la planificarea activității de monitorizare și evaluare a procesului de furnizare a serviciilor. Detalii suplimentare pot fi găsite în tabelul 3.5 din Ghidul privind furnizarea scaunelor rulante cu antrenare manuală. 1. Identificarea ariilor care urmează să fie monitorizate 2. Stabilirea indicatorilor de performanță 3. Identificarea metodelor de colectare a informațiilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 48 Atunci când se face analiza informațiilor și datelor colectate, trebuie avute în vedere două aspecte importante: • dacă o activitate nu are rezultatele preconizate, colaborați cu beneficiarii serviciilor, personalul furnizor și cu alte părți interesate pentru identificarea cauzei problemei. • dacă o activitate are rezultate bune, atunci când se ating obiectivele stabilite, găsiți modalități prin care să sărbătoriți succesul. Acest lucru este un factor care îi motivează atât pe membrii echipei care furnizează servicii, cât și pe toți cei implicați. Importanța feedback-ului oferit de către utilizatorii de scaun rulant Evaluarea permite furnizorului de servicii să identifice care sunt acele aspecte care funcționează în mod adecvat și ce este necesar să se schimbe. De asemenea, evaluarea ne arată în ce măsură este atins scopul activității de furnizare a serviciilor. Scopul evaluării, așa cum este prezentat în Ghidul privind furnizarea scaunelor rulante, se referă la: • promovarea mobilității personale la cel mai înalt grad de independență posibil; • îmbunătățirea calității vieții prin îmbunătățirea accesului la scaune rulante; • creșterea gradului de incluziune și participare. Există un număr de criterii care pot fi utilizate pentru a evalua procesul de furnizare a scaunelor rulante. Acestea includ: • utilizatorii care au beneficiat de servicii și intervențiile efectuate; • costul furnizării serviciilor, inclusiv costul furnizării produselor și serviciilor; • personalul (numărul angajaților, rolurile și competențele acestora); • spațiile și echipamentele de care dispune furnizorul de servicii pentru utilizatorii de scaun rulant; • calitatea furnizării serviciilor (în Ghidul privind furnizarea scaunelor rulante, la secțiunea 3.3 sunt oferite exemple de bună practică); • impactul pe care furnizarea serviciilor l-a avut asupra utilizatorilor și familiilor acestora. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 49 Este foarte important ca utilizatorii de scaun rulant să fie implicați în evaluarea serviciilor care le sunt destinate. Planificarea acțiunilor de obținere a feedback-ului de la utilizatorii de scaun rulant presupune câteva aspecte esențiale: • Transportul și timpul reprezintă două dintre cele mai importante costuri. Este posibil ca utilizatorii de scaun rulant care oferă feedback să aibă nevoie de asistență financiară pentru deplasare și pentru intervalul de timp asociat acesteia. • Feedback-ul poate fi solicitat fie de la fiecare beneficiar al serviciilor, în mod sistematic, fie de la un eșantion selectat aleatoriu, lunar sau anual. • Solicitarea de feedback va fi utilă doar în cazul în care utilizatorii simt că au libertatea de a-și exprima opiniile în mod deschis și sincer. În acest sens, putem lua în considerare opțiunea ca persoana care efectuează interviurile de evaluare să nu facă parte din echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant. Beneficiile evaluării procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant – un exemplu din Etiopia: Doi reprezentanți au intervievat 140 de utilizatori de scaun rulant din șapte centre furnizoare de servicii din întreaga țară. Amândoi sunt persoane cu dizabilități locomotorii, iar acest lucru a avut un impact pozitiv în ceea ce privește implementarea activității de evaluare. Prin realizarea acestui studiu, cei doi reprezentanți au obținut multe informații privind provocările cu care se confruntă utilizatorii de scaun rulant din Etiopia. Ei au dobândit astfel capacitatea de a promova drepturile și nevoile utilizatorilor de scaun rulant. Interacțiunea cu cei doi reprezentanți, a avut un impact pozitiv din punct de vedere psihic și emoțional asupra beneficiarilor serviciilor, ei având astfel posibilitatea de a fi intervievați de persoane care reprezintă modele de succes. Ca urmare a interviurilor de evaluare, s-a creat o rețea informală care a avut drept consecința îmbunătățirea comunicării dintre furnizorii de servicii și utilizatorii de scaun rulant. În plus, evaluările au contribuit la identificarea unor cazuri de utilizatori care nu primiseră scaune rulante corespunzătoare. Acest lucru a semnalat faptul că este nevoie de o instruire suplimentară a personalului, iar furnizorul a acționat în acest sens. Rolul informațiilor inițiale în evaluarea impactului pe care îl are procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant Pentru a putea analiza impactul pe care serviciile furnizate îl au asupra persoanelor care primesc un scaun rulant, este important să documentăm situația utilizatorului înainte de orice intervenție, adică, înainte de începerea evaluării. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 50 Diverse oportunități de obținere a informațiilor inițiale: • la efectuarea unei trimiteri – de către personalul unui centru sau al unei clinici; • în intervalul dintre etapa de trimitere și cea de evaluare – prin intermediul unei vizite la domiciliu sau telefonic; • în momentul evaluării – înainte de începerea evaluării. Pentru mai multe informații, consultați resursele de pe memory stick. Este important ca persoana (persoanele) care urmează să realizeze interviurile pentru obținerea de informații de la utilizatori să fie instruite în ceea ce privește desfășurarea acestora. Scopul este să obținem răspunsuri clare și complete la fiecare întrebare. Acest lucru este important pentru a putea avea date valide. Recomandări referitoare la tehnica de realizare a interviurilor Pregătire: • înainte de interviu, exersați ceea ce veți spune. Nu spuneți mai mult decât este necesar. Tehnica: • enunțați întrebările așa cum sunt ele formulate; • nu influențați respondenții sugerând răspunsurile, nici măcar într-un mod subtil; • în cazul în care trebuie să explicați ceva, păstrați o atitudine neutră; • înregistrați corect răspunsurile. Respectați interlocutorul: • continuați interviul de evaluare doar dacă persoana consimte liber și în mod voluntar să răspundă întrebărilor care îi sunt adresate; • ajutați persoana să se simtă relaxată; • nu vă exprimați sentimentele (șoc, acord, supărare) în legătură cu cele spuse de respondent; • tratați răspunsurile persoanei ca fiind confidențiale. Stabilirea unui sistem eficient de centralizare a informațiilor inițiale va crește calitatea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant, iar acest lucru se va reflecta în impactul pe care aceste servicii îl au asupra calității vieții beneficiarilor. Obținerea informațiilor poate fi: • unul dintre pașii activității de monitorizare; • o activitate de sine stătătoare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 51 Evaluarea impactului activității de evaluare în cazul utilizatorilor de scaun rulant copii Ori de câte ori este posibil, este important să dăm utilizatorilor de scaun rulant copii oportunitatea de a oferi feedback cu privire la impactul pe care îl au asupra lor scaunul rulant și serviciile furnizate. Un exemplu în acest sens îl reprezintă Zarul emoțiilor (11). În primul rând, discutăm cu utilizatorul copil despre diferitele tipuri de emoții. Apoi, îi rugăm să completeze afirmații precum „Sunt fericit/ă atunci când...”, „Sunt trist/ă atunci când...” 47 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Evaluating impact for children Wher possible, it is import nt to give children “a voice” in feedi g back on the impact of their wheelchair and service. An example is the use of Feeling Dice(11). First, the different feelings are categorized with the child. Then, they can be asked to complete statements such as “I am happy when…”, “I am sad when…” Angry Sad Hurt Embarrassed Excited Happy Recording and processing data Monitoring and evaluation involves recording, collecting, storing, and processing information (data). Efficient recording of data can save time and money. It is ideal to enter the data directly into a database, which is set up to process results and create the most useful reports for the service. Portable tablet computers can be very useful as they allow data to be recorded in field visits as well as at a centre. Mobile phone technology is progressing rapidly and may also be a method for entering, sending, and receiving data. Creating a service plan An annual service plan, which is monitored throughout the year, can help to ensure an efficient and effective service. Remember to motivate, engage and commit service personnel by involving them in creating the plan and targets. The service plan may include an evaluation at the end of the year. A sample service plan framework with one example is presented below. Furios/oasă Trist/ă Rănit/ă Rușinat/ă Bucuros/oasă Fericit/ă Înregistrarea și procesarea informațiilor onitorizarea și evaluarea implică înregistrarea, centralizarea, păstrarea și procesarea informațiilor (datelor). Înregistrarea eficientă a informațiilor înseamnă economie de timp și bani. Metoda ideală o reprezintă posibilitatea de a introduce informațiile direct într-o bază de date care procesează rezultatele și creează cea mai mare parte a rapoartelor. Calculatoarele portabile tip tabletă pot fi foarte utile deoarece permit înregistrarea informațiilor cu ocazia vizitelor pe t ren, precum și la centru. Tehnologia telefoniei m bil evoluează rapid și poate fi, de asemenea, o metodă de înregistrare, transmitere și receptare a informațiilor. Crearea unui plan de furnizare a serviciilor pentru utilizatorii de scaun rulant Un plan anual de furnizare a serviciilor, care să fie monitorizat pe tot parcursul anului, este un instrument util pentru sigurarea unui proces eficient. Nu itați să motivați, să implicați și să mobilizați personalul furnizor de servicii, implicându-l în stabilirea planului și a obiectivelor. Planul de furnizare a serviciilor poate include și o evaluare la finalul intervalului de un an. Mai jos găsiți un model de astfel de plan de furnizare a serviciilor. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 52 Model de plan de furnizare a serviciilor Identificați o nevoie/problemă care necesită monitorizare Acțiune/obiectiv pentru abordarea nevoii/ problemei Scop Culegerea informațiilor Mult mai puține femei decât bărbați (20% femei, 80% bărbați) au accesat servicii pentru utilizatorii de scaun rulant, în anul precedent Creșterea numărului de utilizatori femei identificate sau direcționate către furnizorul de servicii pentru utilizatorii de scaun rulant: • discuții cu sursele de trimitere – inclusiv cu reprezentanții din mediul rural, referitor la identificarea persoanelor din această categorie; • colaborarea cu organizațiile naționale pentru persoanele cu dizabilități pentru a identifica exemple de succes (femei), care să încurajeze femeile să apeleze la serviciile destinate utilizatorilor de scaun rulant. Creșterea procentului de femei care accesează serviciile pentru utilizatorii de scaun rulant, până la atingerea pragului de 40% Actualizarea permanentă a bazei de date în care sunt înregistrați utilizatorii de scaun rulant – deoarece aici găsim numărul femeilor și bărbaților care accesează serviciile pentru utilizatorii de scaun rulant. C.2 Gestionarea cererii În gestionarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant trebuie să existe un echilibru între cererea generată de nevoile utilizatorului și capacitatea personalului de a furniza un serviciu corespunzător. Generarea cererii Nevoia de servicii poate fi estimată prin calcularea valorii care reprezintă 1% din populația zonei unde își desfășoară activitatea furnizorul de servicii pentru utilizatorii de scaun rulant. Totuși, dacă oamenii nu sunt informați despre existența acestor servicii și despre beneficiile acestora sau dacă nu au au acces la ele, atunci cererea poate fi redusă, în ciuda faptului că există o nevoie pentru aceste servicii. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 53 Atunci când cererea pentru servicii este redusă, costul furnizării serviciilor raportat la utilizatorul individual crește, amenințând sustenabilitatea financiară a serviciului. Poza 1 Poza 2 Rolul managerului este să identifice cauzele numărului redus de trimiteri. Acestea pot fi următoarele: • nu au fost identificate cele mai adecvate surse de trimiteri; • persoanele care au nevoie de un scaun rulant nu accesează sursele care ar putea să le direcționeze către furnizorul de servicii; • instruirea rețelei de surse de trimitere nu a transmis în mod corespunzător informația despre beneficiile și importanța serviciilor pentru utilizatorii de scaun rulant; • utilizatorii de scaun rulant nu au posibilitatea de a accesa serviciile – centrul se află la o distanță prea mare de locul în care trăiesc, nu sunt disponibile mijloace de transport etc. Odată ce se stabilește cauza sau cauzele absenței sau a numărului mic de trimiteri, managerul și echipa sa se pot concentra pe aspectele legate de generarea cererii. Gestionarea cererii În cazul în care numărul persoanelor care apelează la furnizorul de servicii pentru utilizatorii de scaun rulant depășește capacitatea de răspuns a personalului, acest lucru poate avea trei consecințe: • personalul este nevoit să reducă durata de timp alocată fiecărui beneficiar – astfel, scade nivelul de calitate a serviciilor furnizate; • crește timpul de așteptare înainte de programare; sau • vor exista cazuri în care furnizorul va fi nevoit să refuze să ofere servicii unui anumit număr de utilizatori de scaun rulant. În oricare dintre aceste cazuri, atât furnizorul de servicii, cât și utilizatorii de scaun rulant pot fi demoralizați de situație. Poza 1 Poza 2 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 54 În consecință, gestionarea atentă a cererii este un aspect cât se poate de util. În prima fază, se recomandă ca managerii să se adreseze unui număr mai mic de surse de trimitere, începând cu cele aflate în proximitate. Avantajul constă în facilitarea desfășurării monitorizării în stadiul inițial al procesului de furnizare a serviciilor. Mass media și liniile de telefonie naționale, care pot fi apelate gratuit, pot genera cereri în masă, de la distanțe mari. Fără o rețea de furnizare a serviciilor, această situație va fi dificil de gestionat și va genera costuri ridicate, atât în cazul utilizatorilor, cât și al furnizorilor de servicii. Generarea și gestionarea listelor de așteptare Atunci când cererea este crescută, creați o listă de așteptare. Se va dovedi rentabilă investiția de timp în generarea unui sistem care folosește o bază de date pentru înregistrarea acestor informații. Acest lucru va permite managerului și personalului furnizor de servicii să acceseze eficient informațiile și va ușura procesarea statisticilor. Odată ce o persoană apelează la furnizorul de servicii pentru utilizatorii de scaun rulant, există posibilitatea de a adăuga informații suplimentare, cum ar fi data evaluării, data probării echipamentului de mobilitate, programarea monitorizării cazului. Verificarea trimiterilor și a listelor de așteptare Creșterea numărului de persoane înscrise pe listele de așteptare determină unele organizații să verifice și să aranjeze trimiterile în ordinea priorităților. Următoarele categorii de persoane trebuie considerate ca având prioritate: • copiii – din cauza importanței intervenției timpurii și a riscului crescut de apariție a deviațiilor posturale în timpul puseelor de creștere accelerată; • utilizatorii de scaun rulant la care există riscul apariției escarelor – deoarece acestea pun în pericol viața persoanei; • utilizatorii de scaun rulant care au o afecțiune degenerativă – situația lor presupune intervenție urgentă; • persoane la care există senzația de durere din cauza lipsei unui scaun rulant sau din cauza unui scaun rulant care nu li se potrivește. Pentru a ajuta la verificarea și planificarea programărilor, trebuie incluse în baza de date câteve câmpuri esențiale: • vârsta; • tipul de dizabilitate; • motivul pentru care utilizatorul a fost direcționat către furnizorul de servicii; • zona geografică. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 55 Capacitatea de furnizare a serviciilor Este importantă modalitatea de gestionare a așteptărilor cu privire la capacitatea de furnizare a serviciilor – ne referim aici la numărul de utilizatori de scaun rulant și la nivelul de furnizare a serviciilor. Cu toate că vor exista cereri pentru servicii de nivel de intermediar și avansat, nu toți furnizorii de servicii vor avea capacitatea să ofere servicii de această complexitate. Totuși, membrii echipei se vor confrunta cu cazuri de utilizatori de servicii ale căror nevoi specifice vor depăși nivelul de cunoștințe, competențe și gama de produse disponibile. Managerii trebuie să se asigure că există o strategie pentru abordarea acestor situații. Managerii au următoarele opțiuni: • să se asigure că informațiile despre serviciile furnizate (ceea ce pot oferi acestea) sunt clar prezentate în broșuri/pliante; • să mențină legătura cu alți furnizori de servicii pentru a vedea dacă este posibilă direcționarea utilizatorilor către aceștia sau să colaboreze în cazul persoanelor cu nevoi care depășesc capacitatea serviciuliu propriu; • să documenteze nevoile care nu pot fi satisfăcute – și să planifice creșterea capacității în termeni de resurse umane și produse disponibile. Importanța intervenției timpurii în cazul utilizatorilor copii Mulți dintre copiii care au nevoie de scaun rulant vor avea nevoie și de suport postural suplimentar. Acest lucru înseamnă că există un număr mare de copii pentru care trebuie furnizate servicii de nivel intermediar. Este important ca toți copiii care se află în această situație să fie direcționați către furnizorul de servicii pentru utilizatorii de scaun rulant cât mai timpuriu posibil, în vederea prevenirii sau încetinirii evoluției problemelor posturale. Nevoile specifice ale copiilor și beneficiile intervenției timpurii sunt prezentate în pachetul de instruire pentru furnizarea serviciilor de nivel intermediar, secțiunea referitoare la utilizatorii copii. Intervenția timpurie este importantă pentru copii din următoarele motive: • În lipsa suportului adecvat, la utilizatorii copii care au dificultăți în menținerea poziției așezat, există riscul apariției problemelor posturale. Dacă un utilizator copil nu este direcționat spre furnizorul de servicii în timp util, anumite probleme posturale pot deveni fixe. Acest lucru face dificilă menținerea poziției așezat în condiții confortabile, chiar și în prezența suportului. • Atunci când experiența de menținere a poziției așezat și cea a mobilității sunt absente, pot apărea întârzieri în dezvoltarea utilizatorului copil. • În cazul copiilor la care capacitatea de a merge este prezentă, într-o oarecare măsură, utilizarea unui scaun rulant le poate ușura viața de zi cu zi și le poate permite desfășurarea mai multor activități pe parcursul unei zile. Din păcate, uneori, intervenția nu are loc atât de devreme pe cât ar fi necesar. În anumite cazuri, părinții speră că ei se vor vindeca și vor merge din nou. Unii părinți sunt îngrijorați de faptul că un scaun rulant va costa prea mult sau nu au informații despre furnizorul de servicii pentru utilizatorii de scaun rulant. Există și cazuri în care părinții consideră că utilizarea unui scaun rulant îi va împiedica pe copiii lor să meargă. Este important ca întreaga echipă furnizoare de servicii să expună în mod clar motivele pentru care intervenția timpurie este esențială. Totodată, personalul trebuie să îi convingă pe părinți și pe aceia care pot deveni surse de trimitere de faptul că este improbabil ca un scaun rulant să împiedice utilizatorul copil de a merge, atunci când acesta are capacitatea de a se deplasa. Experiența mobilității cu ajutorul unui scaun rulant pe perioada în care copilul învață să meargă va avea un impact pozitiv asupra dezvoltării sale, din mai multe puncte de vedere. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 56 Exemplu de succes privind intervenția timpurie – un caz din Mexic În continuare, avem un exemplu despre modul în care un grup de centre de recuperare pentru copii din Mexic a reușit să dezvolte o rețea eficientă pentru intervenția timpurie. Centrele de recuperare au avut ca obiectiv creșterea gradului de conștientizare în ceea ce privește serviciile lor în rândul medicilor și al pediatrilor neonatologi. În plus, au reușit să abordeze întreaga comunitate printr-o importantă campanie anuală de strângere de fonduri, care este bine mediatizată, atât prin radio, cât și prin televiziune. Acest lucru a dus la multe trimiteri care au rezultat din discuții individuale, mulți părinți recomandând altora aceste servicii, în beneficiul copiilor. Pe parcursul campaniei de conștientizare, mesajul a fost clar: este foarte important ca recomandarea pentru recuperare în cazul copiilor să se producă la momentul nașterii acestora. De asemenea, a fost prezentată o viziune de succes, puternică, cu multe cazuri de succes cu privire la integrarea și realizările copiilor cu care au lucrat aceste centre. În 15 ani, centrele de recuperare au observat o schimbare de mentalitate, deoarece medicii pediatri și familiile apelează în mod activ la intervenția timpurie. Rezultatul: O treime din numărul trimiterilor se referă la copii până la vârsta de trei ani. Ce pot face managerii pentru a obține rezultate pozitive în ceea ce privește încurajarea intervenției timpurii? • să stabilească un obiectiv clar referitor la acest aspect; • să transmită un mesaj clar cu privire la cine se încadrează în grupul țintă; • să utilizeze abordări diferite în cazul specialiștilor și al părinților; • să promoveze cazurile de succes pentru a încuraja părinții și specialiștii; • să desfășoare activități sustenabile de creștere a gradului de conștientizare, pe parcursul mai multor ani. Gestionarea eficientă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Analiza gradului de eficiență și de utilitate a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Odată ce procesul de furnizare a serviciilor funcționează, se recomandă efectuarea unei analize a fiecărei etape și observarea duratei de desfășurare a activităților specifice acestora. Creșterea gradului de eficiență a etapelor ar trebui să se focalizeze pe următoarele aspecte: • încurajarea lucrului în echipă; • planificarea a ceea ce poate fi pregătit în avans pentru implementarea fiecărei etape a procesului de furnizare a serviciilor. Tabelul de mai jos prezintă câteva sugestii cu privire la modalitatea de creștere a gradului de eficiență în furnizarea serviciilor pentru utilizatorii de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 57 Modalități de creștere a gradul de eficiență – pentru fiecare etapă a procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant Trimiterea • Stabiliți scopuri și obiective clare care să seteze nivelul de cerere pe care vreți să îl gestionați. • Transmiteți un mesaj clar cu privire la cine sunt beneficiarii serviciilor. • Identificați organizații care să devină surse de trimitere și specialiști pentru activități care să ducă la creșterea gradului de conștientizare. • Monitorizați cu atenție numărul de trimiteri. • Promovați cazurile de succes în rândul personalului furnizor de servicii și al surselor de trimitere. Evaluarea • Planificați modul în care personalul furnizor de servicii poate atinge nivelul de instruire corespunzător. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. • Asigurați-vă de faptul că sunt disponibile toate echipamentele necesare pentru efectuarea evaluării. Prescrierea • Creați sisteme eficiente pentru controlul stocului. • În cazul în care produsele au opțiuni de ajustare limitate, trebuie prescrise modificări pentru ca produsele să fie potrivite nevoilor individuale ale utilizatorilor. • Asigurați-vă de faptul că personalul furnizor de servicii discută soluțiile împreună cu utilizatorul de scaun rulant și, în cazul în care acest lucru este posibil, că îi prezintă utilizatorului opțiunile de produse disponibile. Astfel se va evita respingerea de către utilizator a echipamentului de mobilitate. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Finanțarea și plasarea comenzii • Asigurați înregistrarea clară a informațiilor și păstrarea documentelor. • Creați sisteme eficiente pentru controlul stocului. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 58 Pregătirea produsului • Identificați produsele cu cea mai complexă gamă de ajustări posibile. • Identificați produsele care pot fi modificate cu ușurință. • Confecționați în avans dispozitive de suport postural și/sau identificați produse prevăzute cu dispozitive de suport postural. • Identificați uneltele de care aveți nevoie pentru a efectua modificări rapide. • Identificați materialele corespunzătoare pentru confecționarea și modificarea pernelor și a dispozitivelor de suport postural. • Creați sisteme eficiente pentru controlul stocului. • Pregătiți un stoc redus de scaune rulante de diferite mărimi. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Probarea produsului • Asigurați-vă că pe durata etapei de probare, personalul cu atribuții clinice lucrează împreună cu personalul cu atribuții tehnice. • Pregătiți în avans diferite tipuri de dispozitive pentru adaptări. • Identificați produsele cu cea mai complexă gamă de ajustări posibile. • Identificați uneltele de care aveți nevoie pentru a efectua modificări rapide. • Identificați produsele care pot fi modificate cu ușurință. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Instruirea utilizatorilor • Desemnați persoana responsabilă pentru instruirea utilizatorilor de scaun rulant, de exemplu, instructorul utilizator de scaun rulant. • Identificați spațiul adecvat pentru activitățile de instruire a utilizatorilor în proximitatea spațiilor dedicate activităților clinice și tehnice. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Monitorizarea • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. În general • Organizați ședințe de echipă, în mod regulat, pentru a crea planuri de acțiune comune. • Organizați activitatea de așa manieră încât membrii echipei să aibă posibilitatea de a lucra împreună. • Asigurați-vă că există o procedură clară de înregistrare și păstrare a informațiilor și datelor. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 59 Tranziția de la furnizarea serviciilor numai la nivel de bază, la furnizarea serviciilor atât la nivel de bază cât și la nivel intermediar Un număr mare de furnizori de servicii destinate utilizatorilor de scaun rulant încep activitatea prin a oferi servicii care răspund nevoilor de nivel de bază. Acesta constituie un bun punct de pornire, deoarece furnizorul se poate concentra pe crearea sistemelor asociate parcurgerii celor opt etape, iar personalul dobândește experiență. Însă, așa cum s-a menționat anterior, mulți furnizori de servicii se vor confrunta cu cereri care, în termeni de complexitate, se vor încadra la nivelul intermediar. Acest lucru nu ne surprinde, de vreme ce s-a estimat că 35% dintre nevoile individuale ale utilizatorilor corespund nivelului de bază și 65% nivelului intermediar sau avansat. De aceea, este posibil ca managerii să fie nevoiți să planifice furnizarea serviciilor de nivel intermediar. Acest tip de servicii presupune următoarele: • personal instruit corespunzător, • un număr mai mare de spații alocate, echipamente și materiale. Mai jos sunt enumerate câteva strategii pentru managerii care trebuie să gestioneze tranziția de la servicii nivel de bază la servicii de nivel intermediar: • Colaborați cu membrii echipei pentru a identifica modalitățile prin care ar putea fi furnizate serviciile de nivel intermediar. Luați în considerare ce fel de spații și echipamente suplimentare sunt necesare, precum și modelul de furnizare a serviciilor care va fi folosit. • Stabiliți dacă, în urma instruirii adecvate, personalul care furnizează servicii de nivel de bază are capacitatea de a oferi servicii de nivel intermediar. Dacă da – primul pas este să identificați și să instruiți personalul care îl va înlocui pe cel actual în furnizarea serviciilor de bază, apoi instruiți personalul care va furniza serviciile mai complexe, de nivel intermediar. • Stabiliți dacă este posibilă colaborarea cu alte organizații – în cazul în care nu reușiți să identificați personal adecvat sau nu aveți fondurile necesare pentru plata personalului suplimentar. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 60 C.3 Planificarea activității de monitorizare Monitorizarea este cea de-a opta etapă a procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Toți utilizatorii de scaun rulant beneficiază de pe urma monitorizării. Este important să existe o planificare a acțiunilor care țin de această etapă. Monitorizarea reprezintă o oportunitate și pentru furnizorul de servicii, dând posibilitatea acestuia să obțină informații despre impactul pe care serviciile îl au asupra utilizatorului, membrilor familiei și comunității acestuia. 8. Monitorizarea, întreținerea și reparațiile Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, probleme care nu pot fi rezolvate cu ușurință în cadrul comunității. Importanța activității de monitorizare Câteva exemple privind importanța activității de monitorizare Duli: este o femeie în vârstă de 21 ani, care locuiește cu familia. La monitorizare, echipa a aflat că ea nu își putea părăsi casa, deoarece scaunul ei rulant avea roțile dezumflate, anvelopele fiind perforate. Scaunul rulant a fost abandonat în subsolul casei sale. Anvelopele scaunului rulant au fost recondiționate, iar familia ei a beneficiat de sfaturi cu privire la echipamentul de mobilitate. Astfel, Duli a avut posibilitatea de a ieși din nou din casă. Familia ei nu a înțeles importanța activității de monitorizare decât în momentul în care a văzut care sunt avantajele care decurg de aici. Echipa furnizoare de servicii a decis să creeze autocolante pentru toate scaunele rulante pe care le oferă, pe care să apară numărul de contact al furnizorului, pentru a preîntâmpina astfel de cazuri. Maria: a primit un scaun rulant corespunzător la 9 luni după ce a dobândit o leziune a măduvei spinării. La monitorizare, Maria a explicat că scaunul rulant îi produce senzația de disconfort și că utilizarea acestuia are ca rezultat apariția spasticității. Echipa a constatat că materialul textil al scaunului rulant era infestat cu insecte care o înțepau. Acest lucru ar fi putut determina apariția unor probleme de sănătate grave și renunțarea la utilizarea scaunului rulant. Însă problema a fost identificată și rezolvată, iar Maria este acum sănătoasă și mulțumită de scaunul ei rulant. Anton: era cunoscut în comunitatea sa datorită aptitudinilor sale de sportiv. În timpul unui joc de rugby Anton a avut un accident care a provocat o leziune la nivelul măduvei spinării. A primit un scaun rulant corespunzător și a fost instruit, dar la monitorizare s-a constatat că nu își părăsea locuința. Din echipa de monitorizare făcea parte și un instructor în scaun rulant, iar acesta a discutat cu Anton. Instructorul a aflat că Anton își pierduse încrederea de sine și nu dorea să se întâlnească cu prietenii lui. Se simțea izolat, singur și rușinat de faptul că avea o dizabilitate. Instructorul în scaun rulant a revenit a doua zi și l-a însoțit prima dată când Anton a decis să iasă din casă. După acest eveniment, Anton a fost capabil să își continue viața. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 61 Gihan: este un băiat în vârstă de trei ani care locuiește cu părinții și fratele său. La monitorizare, s-a constatat că sistemul de poziționare al lui Gihan avea numeroase pete de mâncare și că nu era întreținut. Părinții au afirmat că Gihan avea dificultăți în menținerea poziției așezat și că nu se simțea confortabil în scaunul său. Ei și-au pierdut încrederea în respectivul echipament de mobilitate și nu erau mulțumiți de ceea ce oferea acesta. Gihan a fost reprogramat pentru o nouă evaluare efectuată de către o echipă care a beneficiat de instruire pentru furnizarea serviciilor de nivel intermediar. S-au făcut adaptări și ajustări ale scaunului rulant, iar ca urmare a acestui fapt, Gihan a reușit să mențină poziția așezat în scaunul rulant și a început să descopere și să exploreze mediul în care trăia. Gihan și părinții lui au fost foarte bucuroși de această schimbare și au urmărit cu atenție când li s-a arătat care sunt operațiunile necesare pentru întreținerea scaunului rulant. Beneficiile monitorizării în cazul utilizatorilor de scaun rulant și al furnizorului de servicii • Personalul poate confirma (sau nu) faptul că scaunul rulant răspunde nevoilor utilizatorului și caracteristicilor mediului în care trăiește acesta. • Vizitele la domiciliu și în comunitate sunt o oportunitate bună pentru identificarea cazurilor de succes, care pot fi folosite pentru a oferi feedback echipei și pentru acțiunile de strângere de fonduri. • Monitorizarea desfășurată la sediul furnizorului de servicii pentru utilizatorii de scaun rulant constituie o ocazie pentru identificarea cazurilor de succes, care pot fi folosite pentru a oferi feedback echipei și pentru acțiunile de strângere de fonduri. Scopul activității de monitorizare și locul unde ar trebui să se desfășoare Scopul monitorizării este: • obținerea de informații de la utilizatorul de scaun rulant; • verficarea funcționării corespunzătoare a scaunului rulant; • verificarea faptului că scaunul rulant i se potrivește utilizatorului. Acțiuni de monitorizare obișnuite Acțiunile obișnuite în cadrul vizitelor de monitorizare includ: • informare și instruire suplimentare • reajustarea scaunului rulant • efectuarea unor reparații minore • în cazul în care este necesar, direcționarea utilizatorului de scaun rulant către un alt furnizor de servicii, pentru sprijin sau asistență. În măsura în care acest lucru este posibil, activitatea de monitorizare nu ar trebui să se transforme într-o nouă evaluare sau într-o activitate de recondiționare totală a scaunului rulant. Dacă se identifică necesitatea unei noi evaluări complete sau dacă scaunul rulant are nevoie de modificări majore, se va stabili o programare pentru rezolvarea acestor aspecte. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 62 Unde ar trebui să se desfășoare activitatea de monitorizare? Monitorizarea poate avea loc la domiciliul utilizatorului de scaun rulant, la sediul furnizorului de servicii sau în orice altă loc agreat de către utilizator și de către personalul furnizor de servicii. Avantajele activității de monitorizare desfășurate în diferite locuri sunt prezentate în tabelul de mai jos: Beneficiile monitorizării desfășurate la domiciliul utilizatorului sau în comunitate Beneficiile monitorizării desfășurate la sediul furnizorului de servicii • Mai eficient din punct de vedere al costurilor pentru utilizator și familia acestuia; • Personalul află mai multe informații despre obstacolele pe care le întâmpină utilizatorul de scaun rulant în ceea ce privește participarea și incluziunea, atât la domiciliu, cât și în comunitate; • Prezența și vizibilitatea personalului crește gradul de conștientizare la nivelul comunității, mărind numărul de trimiteri către furnizorul de servicii pentru utilizatorii de scaun rulant. • Mai eficient pentru personalul furnizor de servicii din punct de vedere al costurilor și al alocării timpului; • Posibilitatea efectuării unor reparații majore cu ajutorul dotărilor complete care există la sediu; • Toate echipamentele și instrumentele sunt deja instalate; • Posibilitatea de a solicita o opinie celorlați membri ai echipei. Planificarea activității de monitorizare Toți utilizatorii de scaun rulant beneficiază de pe urma monitorizării. Cu toate acestea, monitorizarea este indicată în special în următoarele cazuri: • Utilizatori de scaun rulant copii; • Utilizatori de scaun rulant la care există riscul apariției escarelor; • Utilizatori de scaun rulant care au o afecțiune degenerativă; • Utilizatori de scaun rulant care au nevoie de suport postural suplimentar atunci când utilizează echipamentul de mobilitate; • Utilizatori de scaun rulant care au întâmpinat dificultăți în ceea ce privește instruirea pentru efectuarea transferului, dobândirea abilităților de mobilitate, prevenirea problemelor de sănătate sau întreținerea scaunului rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 63 Calendarul monitorizării Nu există o regulă cu privire la intervalul la care trebuie realizată monitorizarea, deoarece asta va depinde de nevoile individuale ale utilizatorului de scaun rulant. • Se recomandă ca în cazul utilizatorilor care au nevoie de servicii de nivel intermediar, monitorizarea să aibă loc într-un interval de șase săptămâni de la primirea scaunului rulant nou, pentru a verifica dacă acesta răspunde sau nu nevoilor acestora. • În cazul utilizatorilor copii și adulți care au afecțiuni degenerative, monitorizarea ar trebui să aibă loc la intervale de câte șase luni. Acest lucru este consecința faptului că în aceste cazuri schimbările se pot produce cu rapiditate. • Se recomandă ca toți ceilalți utilizatori să fie monitorizați într-un interval de douăsprezece luni de la primirea scaunului rulant. Rețineți: Monitorizarea trebuie să fie inclusă în modelul de furnizare a serviciilor încă de la stagiul planificării inițiale. Parteneriatele cu actori din comunitate sunt vitale pentru dezvoltarea capacității de efectuare a monitorizării. Impactul activității de monitorizare în cazul în care nu s-au stabilit parteneriate în comunitate Beneficiari monitorizaţi Beneficiari noi Total utilizatori scaun rulant Servicii de nivel de baza Servicii de nivel intermediar Total utilizatori Total utilizatori anul 3 anul 3 În absența planificării, disponibilitatea furnizorului de servicii pentru utilizatorii de scaun rulant de a genera noi programări va fi rapid influențată de desfășurarea activitității de monitorizare. În cazul serviciilor de nivel intermediar, cu precădere, furnizorii ajung să atingă nivelul de saturație în al treilea an de activitate. O posibilă soluție o reprezintă colaborarea cu organizațiile din comunitate, precum și instruirea resurselor umane ale acestora, astfel încât activitatea de monitorizare să fie desfășurată într-o cât mai mare măsură de către acest personal. Personalul din cadrul comunității poate administra multe dintre sarcinile mai simple care țin de monitorizare, contactând furnizorul de servicii doar când este nevoie de o reevaluare, pentru reparații majore sau alte probleme pentru a căror rezolvare are nevoie de personalul specializat al acestuia. Atunci când această activitate este desfășurată de o persoană care poate fi un model pozitiv, cum ar fi o persoană cu dizabilități locomotorii, există mai multe avantaje. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 64 Stabiliți parteneriate cu actori din comunitate și planificați modelul de furnizare a serviciilor Activităţi desfăşurate la centru A.2.11 Furnizarea serviciilor pentru utilizatorii de scaun rulant 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea Creșterea gradului de conștientizare, inclusiv influențarea politicii nationale Cresterea gradului de acces și satisfacerea așteptărilor utilizatorilor Monitorizare și evaluare Personal motivat și bine instruit Dezvoltarea unui sistem funcțional Dezvoltarea sustenabilității Un partener din comunitate poate face trimiteri și poate prelua activitatea de monitorizare, inclusiv întreținerea și efectuarea reparațiilor. De asemenea, partenerul din comunitate poate susține etapa de instruire a utilizatorului. În funcție de capacitatea partenerului din comunitate, aceasta poate să sprijine și aspecte mai complexe care țin de activitatea furnizorului de servicii pentru utilizatorii de scaun rulant. Reducerea obstacolelor în efectuarea activității de monitorizare În ciuda beneficiilor pe care le aduce activitatea de monitorizare atât utilizatorilor de scaun rulant, cât și furnizorilor de servicii, numărul utilizatorilor monitorizați este adesea redus. Este important să identificăm cauza principală, pentru a depăși obstacolele și pentru a îmbunătăți furnizarea serviciilor pentru utilizatorii de scaun rulant. Potențiale obstacole în desfășurarea monitorizării în comunitate • costurile pentru deplasarea în comunitate a personalului de la sediul furnizorului de servicii; • timpul de care are nevoie personalul pentru a se deplasa în comunități; • managerii nu consideră că monitorizarea este o prioritate; • utilizatorii nu înțeleg care sunt beneficiile monitorizării decât după ce le experimentează; Potențiale obstacole în desfășurarea monitorizării la sediul furnizorului de servicii pentru utilizatorii de scaun rulant • costul deplasării și absența de la locul de muncă al unuia sau mai multor membri ai familiei reprezintă o cheltuială dublă pentru familie; • în numeroase cazuri, utilizatorii și membrii familiei nu cunosc care sunt beneficiile monitorizării după primirea scaunului rulant; • dificultatea de a găsi mijloace de transport accesibile; • presiunea concentrării pe stabilirea de noi programări, în detrimentul timpului alocat pentru activitatea de monitorizare; • dificultăți în programarea vizitelor: utilizatorii ajung la sediul furnizorului atunci când personalul nu este disponibil sau nu au cum să ajungă atunci când personalul este disponibil. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 65 Abordarea activității de monitorizare – un exemplu din Indonezia În cadrul unui program de furnizare a scaunelor rulante din Indonezia, în locul perceperii unei taxe pentru furnizarea echipamentului de mobilitate, se percep „taxe de membru” care contribuie la susținerea costurilor pe care le presupun funcționarea sistemului de furnizare a serviciilor, monitorizarea, întreținerea echipamentelor și aspectele administrative. Această „taxă de membru” le asigură utilizatorilor servicii de calitate și suport permanent. Există un sistem de plată „flexibil”, unde valoarea achitată de către o persoană este determinată în funcție de veniturile familiei, identificate prin facturile de utilități, documente de angajare, indicatori de venit bazate pe declarația proprie sau de alt tip. S-a constatat că acest program destinat utilizatorilor de scaun rulant reprezintă o soluție viabilă din mai multe puncte de vedere: • Membrii simt că au dreptul să se aștepte la servicii și produse de calitate. • Deoarece membrii au achitat o sumă semnificativă raportat la veniturile lor (de obicei, sumele sunt cuprinse între 2$ – 20$, dar pot ajunge și până la 150$), crește probabilitatea ca ei să aprecieze în mod real scaunul rulant și să aibă un sentiment de mândrie că îl dețin. • Deoarece calitatea de membru le permite accesul gratuit sau cu preț redus la servicii de monitorizare, valabile timp de doi ani de la primirea scaunului rulant, crește probabilitatea ca membrii să solicite acest serviciu înainte de expirarea acestui termen. Sugestii de acțiuni pentru depășirea obstacolelor în desfășurarea monitorizării Motivați, implicați și mobilizați utilizatorii de scaun rulant, ajutându-i să înțeleagă care sunt avantajele pe care le aduce activitatea de monitorizare: • în timpul etapei de instruire (etapa șapte), explicați-le care sunt beneficiile monitorizării; • faceți cunoscute poveștile despre avantajele monitorizării, prin materiale de promovare care să fie vizibile în sala de așteptare, pe pagina web, pe panourile de informare plasate în comunitate; • creați un sistem care le dă utilizatorilor posibilitatea de a participa la procesul de furnizare a serviciilor în calitate de membri care beneficiază de aceste servicii. Motivați, implicați și mobilizați personalul furnizor de servicii, ajutându-l să înțeleagă care sunt avantajele pe care le aduce activitatea de monitorizare: • testați un model de monitorizare care să fie implementat de către personalul furnizor de servicii; • centralizați studii de caz care să demonstreze care sunt avantajele care decurg din monitorizare. Identificați un rezultat imediat și măsurabil: • stabiliți obiective pentru un program de monitorizare pilot; • identificați și faceți cunoscute studii de caz care să demonstreze care sunt avantajele care decurg din monitorizare. Atunci când alocați resursele, acordați prioritate activității de monitorizare: • utilizați poveștile de succes despre beneficiile monitorizării ca sprijin pentru strângerea de fonduri în vederea acoperirii costurilor specifice acestei activități; • alocați timp pentru a dezvolta parteneriate în comunitate; instruiți și îndrumați personalul din comunitate; • asigurați-vă că există transport accesibilizat. Oferiți sprijin în eforturile de abordare a provocărilor specifice furnizării serviciilor de monitorizare: • analizați informațiile obținute la monitorizare și identificați cauzele problemelor; • integrați activitatea de monitorizare în modelul, sistemele și procedurile de furnizare a serviciilor. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 66 Incluziunea și participarea la viața comunității Monitorizarea reprezintă etapa în care se evaluează impactul pe care îl are serviciul de furnizare a scaunelor rulante și în care se stabilește dacă acesta își atinge scopul principal, care se referă la îmbunătățirea calității vieții, incluziune și participare la viața comunității. Unul dintre rolurile extinse ale serviciului de furnizare a scaunelor rulante este îmbunătățirea accesibilității. Accesibilitatea poate influența într-o foarte mare măsură incluziunea și participarea la viața comunității a utilizatorilor de scaun rulant. Locuințe și spații publice accesibile Frecvent, accesul la toaletă reprezintă unul dintre principalele obstacole legate de întoarcerea la domiciliu a utilizatorului de scaun rulant. Sfaturile cu privire la modificările minore necesare pentru adaptarea locuinței utilizatorilor de scaun rulant au un impact pozitiv semnificativ asupra calității vieții. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 67 O campanie de accesibilizare arhitecturală în Nicaragua ÎNLĂTURAREA BAR IERELOR ARHITECT URALE C. 3. 12. Planificarea activității de monitorizare În Nicaragua, în capitala țării, o organizație pentru persoanele cu dizabilități numită CADISCA a desfășurat o campanie prin care a scos în evidență problemele legate de înălțimea bordurilor și a treptelor. În doar trei luni, membrii organizației pentru persoanele cu dizabilități (toți utilizatori de scaun rulant) au construit 200 de rampe și borduri înclinate (aducând la nivelul drumului o mică parte a bordurii), creând astfel acces la spațiile publice. Comunitatea a perceput acțiunea membrilor CADISCA ca pe ceva pozitiv, ceea ce a sporit sprijinul acordat organizației și a avut ca rezultat construirea mai multor borduri și rampe în oraș, cu ajutorul sponsorizărilor făcute de companiile locale. Anterior, CADISCA a utilizat baschetul pentru utilizatorii de scaun rulant ca mijloc de promovare a încrederii în propria persoană a persoanelor cu dizabilități și de creștere a gradului de implicare în activitățile organizației. Sesiunile de antrenament sportiv au însemnat, totodată, o oportunitate pentru desfășurarea unor ședințe regulate ale organizației, unde au fost planificate acțiuni de creștere a vizibilității. Aceste sesiuni de antrenament au avut loc în parcuri publice, expunând comunitatea la activitățile organizației pentru persoanele cu dizabilități și sporind vizibilitatea acesteia. În cele din urmă, programul sportiv a influențat succesul campaniei privind accesibilitatea, prin creșterea gradului de conștientizare în rândul publicului și de sprijin pentru persoanele cu dizabilități. Rezultatul a fost presiunea exercitată asupra guvernului pentru ca acesta să finanțeze construirea de borduri înclinate în Managua. Eliminarea obstacolelor fizice a acordat utilizatorilor de scaun rulant oportunități egale în accesul la zone cheie din oraș, pentru activități din domeniul financiar, educațional și social. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 68 Bugetul necesar integrării elementelor de accesibilitate arhitecturală în timpul procesului de construcție a clădirilor este minim - în general, sub 1% din costul construcției. Accesul la educație este îngreunat chiar de elemente banale, cum ar fi lățimea căii de acces sau accesul la toaletă. Furnizarea către școli a resurselor și a informațiilor cu privire la accesibilizarea clădirilor și căilor de acces va contribui la transformarea acestora în medii incluzive. Prin intermediul consultanței și a informațiilor legate de accesibilizarea mediului, furnizorul de servicii poate facilita accesul la domiciliul utilizatorilor de scaun rulant, la transport și la educație, astfel încât oportunitățile de incluziune și participare a persoanelor cu dizabilități să fie folosite la maximum. Transportul accesibil Transportul în comun este unul dintre cele mai frecvente obstacole cu care se confruntă utilizatorii de scaun rulant. Aici ne referim la: • timp de staționare insuficient pentru ca utilizatorul de scaun rulant să se poată transfera în mijlocul de transport; • perceperea unor taxe suplimentare pentru transportarea scaunului rulant; • riscul ca anumite piese componente, de exemplu roțile, să se piardă sau să fie furate; • dificultatea accesului la mijloace de transport în comun din cauza pragurilor și a căilor de acces. În multe state există inițiative pentru furnizarea de transport adaptat, de exemplu Dial a Ride din Africa de Sud și sistemul Rapid Bus Transit din Columbia. Peste tot în lume există un număr semnificativ de resurse utile cu privire la problema transportului accesibil în lume.1 1 Resurse utile pentru mai multe informații despre transport accesibil: International Transport forum (ITF), Accessible multimodal transport, South Africa, Access Exchange International newsletter, Paratransit Gui- de – guidebook to transport issues (Forumul de Transport International, Transport multimodal accesibil, Africa de Sud, Buletin informativ Access Exchange International, Ghidul Paratranzit – ghid pentru proble- me de transport) Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 69 C.4 Planificarea sustenabilității financiare Ce este sustenabilitatea financiară? Sustenabilitatea financiară a unui furnizor de servicii destinate utilizatorilor de scaun rulant presupune ca acesta să dispună de fondurile și resursele necesare furnizării scaunelor rulante conform celor opt etape ale procesului, precum și asumării unor responsabilități complexe în acest domeniu. Managerii au un rol esențial în dezvoltarea unei strategii prin care procesul de furnizare al serviciilor pe care îl gestionează să devină unul viabil din punct de vedere financiar. Exemplu de definiție a sustenabilității financiare Un program de furnizare a serviciilor pentru utilizatorii de scaun rulant este sustenabil atunci când are capacitatea de a oferi scaune rulante corespunzătoare unui număr constant de utilizatori de scaun rulant, de-a lungul unei perioade semnificative, prin parcurgerea celor opt etape ale procesului de furnizare. Acest lucru presupune efectuarea de investiții permanente în stocul de produse, în instruirea personalului, în spații, precum și în sisteme de monitorizare și evaluare a activității. Sustenabilitatea financiară este atinsă atunci când furnizorul de servicii a reușit să asigure, sau asigură în mod constant, fondurile și resursele necesare acestei investiții constante. Planificarea sustenabilității financiare Planificarea sustenabilității financiare include: • identificarea fondurilor și a resurselor necesare pentru a asigura sustenabilitatea serviciilor (vezi B.5); • identificarea potențialelor surse de finanțare; • identificarea potențialelor surse de sprijin non-financiar; • dezvoltarea unei strategii care să aibă ca rezultat asigurarea finanțării și a donațiilor în natură. Identificarea potențialelor surse de finanțare Există multiple opțiuni pentru finanțarea serviciilor pentru utilizatorii de scaun rulant. Unii furnizori de servicii vor avea o singură sursă de finanțare (de exemplu, de la bugetul de stat). Totuși, cei mai mulți furnizări de servicii vor asigura fondurile și resursele necesare apelând la mai multe surse. Fiecare sursă de finanțare poate contribui la o anumită/anumite linii de buget sau unor cerințe specifice. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 70 Potențiale surse de finanțare pe care managerii le pot avea în vedere: Guvern Sisteme naționale de asigurare Donatori și sponsori privați Donatori și sponsori societăți comerciale (din mediul de afaceri) Contribuții sau achiziții complete din partea utilizatorilor Generare de venituri/întreprinderi sociale Grupuri comunitare/societăți caritabile Misiuni diplomatice ONG-uri naționale sau internaționale Identificarea potențialului suport non-financiar Suportul non-financiar include: donațiile în natură (de exemplu: donațiile de echipamente, scaune rulante sau materiale), voluntariatul și obținerea unui spațiu pentru desfășurarea activităților. Sprijinul non-financiar contribuie la reducerea fondurilor necesare gestionării procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Unii furnizori de servicii de scaune rulante pot primi în mod regulat donații de scaune rulante. Deși acestea pot fi foarte utile -- este important ca întotdeauna furnizorul de servicii să evalueze calitatea și cât de adecvate sunt aceste scaune rulante. Nu toate scaunele rulante donate sunt corespunzătoare. Combinarea diverselor surse de finanțare pentru susținerea unui serviciu de furnizare a scaunelor rulante În tabelul de mai jos avem un exemplu de surse de finanțare diferite identificate de către un furnizor de servicii pentru utilizatorii de scaun rulant, precum și modalitatea prin care aceste surse de finanțare contribuie la fondurile și resursele necesare organizației, astfel încât aceasta să fie viabilă din punct de vedere financiar. Exemplu de surse de finanțare pentru susținerea unui serviciu de furnizare a scaunelor rulante Sursă de finanțare Fonduri și resurse furnizate Guvern • Asigură 50% din costul fiecărui scaun rulant furnizat de către serviciu; • Finanțează remunerația a două persoane din echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant (50% din bugetul alocat personalului). Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 71 Societate comercială • O companie locală oferă anual o donație pentru susținerea liniei de buget destinată achiziționării scaunelor rulante; • O altă companie din comunitate s-a angajat să ofere anual sponsorizare pentru un număr de zece copii – acoperind astfel costul scaunelor rulante și al furnizării serviciilor aferente. Persoane • Oferă donații către furnizorul de servicii pentru utilizatorii de scaun rulant (fără a specifica o linie bugetară anume pentru care se va utiliza respectivă sumă). Activități ale întreprinderilor sociale • Furnizorul de servicii pentru utilizatorii de scaun rulant desfășoară mai multe activități specifice întreprinderilor sociale, cum ar fi: audit privind accesibilitatea (în cazul clădirilor) sau furnizarea dispozitivelor pentru management urinar. Profitul rezultat în urma acestor activități este utilizat pentru susținerea furnizării serviciilor pentru utilizatorii de scaun rulant și, în general, asigură cel puțin 50% din bugetul alocat personalului. ONG-uri internaționale • În cadrul a două proiecte, furnizorul de servicii a primit finanțare din partea unor ONG-uri internaționale, pentru furnizarea de scaune rulante către persoane care locuiesc în anumite zone geografice. Organizații religioase • Oferă, anual, o donație de 200 de scaune rulante (selectate de către furnizorul de servicii pentru utilizatorii de scaun rulant). Elaborarea unei strategii pentru strângerea de fonduri După ce identifică potențialele surse de finanțare, managerii care gestionează furnizarea serviciilor pentru utilizatorii de scaun rulant trebuie să elaboreze o strategie care să arate tipul de sprijin care va fi solicitat, sursele și cuantumul acestuia. O componentă a elaborării strategiei este evaluarea probabilității ca sursa de finanțare să acorde respectivele fonduri, stabilirea parametrilor sprijinului pe care sursa de finanțare îl poate oferi, cuantificarea timpului și a efortului care vor fi investite de către echipa de furnizare a serviciilor, în vederea asigurării acestei finanțări. Pentru a putea dezvolta o astfel de strategie, managerii trebuie să prioritizeze diferitele surse de finanțare și să planifice modalitatea de a atrage fondurile necesare funcționării. Managerii trebuie să ia în considerare: • Sursa de finanțare: pe cine vor aborda? • Sprijinul: tipul de sprijin pe care managerul îl va solicita. Acesta se poate concentra pe o linie de buget, cum ar fi produsele sau pe una sau mai multe etape ale procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant, cu numărul de linii bugetare aferente. Luați în considerare sursa de finanțare specifică și ceea ce este cel mai probabil să-și dorească să finanțeze. • Cererea: care sunt parametrii resurselor solicitate? Trebuie să aveți în vedere resursele sursei de finanțare și valoarea donațiilor anterioare către serviciul dumneavoastră sau către alte organizații. Scopul este de a solicita o sumă realistă. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 72 • Probabilitatea: probabilitatea ca sursa de finanțare să sprijine furnizorul de servicii. Aici există trei categorii: scăzută, medie și ridicată. • Efortul: care sunt acțiunile necesare pentru a asigura finanțarea, care sunt modalitățile de raportare sau alte tipuri de obligații. Cuantumul sprijinului trebuie să fie proporțional cu valoarea finanțării. Obligațiile asumate trebuie să fie, de asemenea, ușor de gestionat de către furnizorul de servicii pentru utilizatorii de scaun rulant. În tabelul de mai jos sunt prezentate două astfel de exemple. Luând în considerare tipul de sprijin, cererea, probabilitatea de a obține rezultatul dorit și efortul necesar pentru atingerea obiectivului, managerii pot stabili într-un mod mai eficient care dintre sursele de finanțare pe care doresc să le abordeze vor constitui o prioritate. Sursa de finanțare Tipul de susținere Cererea Probabilitatea Efortul 1. Societate comercială (afacere locală) Donație pentru bugetul de achiziționare a scaunelor rulante 10% din bugetul pentru scaune rulante Mediu (au finanțat în trecut, totuși nu finanțează în fiecare an aceeași organizație) Cel puțin două întâlniri cu managerul companiei; propunere de 2 pagini și buget de depus şi invitarea managerului la următoarea acțiune de tip „ziua porților deschise” 2. Autoritate locală Este posibil să finanțeze vizitele la domiciliul utilizatorilor de scaune rulante din zona lor. 20% din costurile totale ale activităților desfășurate în comunitate și 20% din salariile personalului furnizorului de servicii Ridicat (se discută deja despre acest aspect cu autoritățile locale). S-au furnizat servicii în respectiva comunitate. Sunt interesați în mod real în susținerea furnizării acestui tip de servicii și se pare că există fonduri disponibile) Propunere și buget de depus. Condiții de raportare – necesită informații corecte despre toate persoanele vizitate din acea zonă și raportare financiară Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 73 Abordarea sustenabilității financiare Asigurarea sustenabilității financiare a unui serviciu pentru utilizatorii de scaun rulant este o problemă dificilă. În cele ce urmează, vom vedea diferite idei și abordări privind finanțarea, care pot fi luate în considerare. Rețineți faptul că deseori abordările sunt diferite, în funcție de specificul sursei de finanțare. O abordare antreprenorială, pentru a răspunde unei nevoi sociale și a genera venit Un ONG din România a ales ca sursă de asigurare a sustenabilității financiare înființarea unei societăți comerciale. Această variantă are două obiective cheie: crearea unui impact social și al unui impact financiar. Utilizatorii de scaun rulant sunt angajați ca parte a echipelor multidisciplinare care furnizează echipamente de mobilitate de calitate și dispozitive medicale, destinate persoanelor cu dizabilități. Nivelul de calitate a serviciilor este crescut, deoarece echipa cunoaște foarte bine importanța poziționării corecte în scaunul rulant și a prevenirii complicațiilor medicale. Activitatea reprezintă o oportunitate de angajare pentru persoanele cu dizabilități, iar consumatorii iau decizii pe baza unor informații cât mai exacte și complexe. Serviciile oferite de către această societate comercială generează, de asemenea, venituri pentru susținerea altor programe implementate de către acest ONG. Achiziția directă de către utilizator Unii furnizori de servicii pentru utilizatorii de scaun rulant solicită o contribuție minimă din partea utilizatorilor, astfel încât să fie posibilă furnizarea scaunelor rulante și a serviciilor destinate lor. De multe ori, există un sistem de plată „flexibil”, unde valoarea achitată de către o persoană este determinată în funcție de veniturile familiei, identificate prin facturile la utilități, documente emise de serviciile sociale publice, declarație proprie privind veniturile sau alte tipuri de indicatori privind venitul realizat. Furnizorii care adoptă acest sistem trebuie să se asigure că acele persoane care nu pot contribui cu nicio sumă la primirea scaunului rulant nu vor fi dezavantajate. Donatori societăți comerciale și sponsori Teletonul din Mexic este o emisiune tv și radio care se desfășoară anual cu scopul de a atrage fonduri pentru centrele de recuperare destinate copiilor cu dizabilități (centrele CRIT). Producătorul emisiunii este Televisa, în parteneriat cu peste 600 de reprezentanți ai mass media din Mexic și din străinătate. Evenimentul este sponsorizat de 20 de companii. Emisiunea promovează o viziune de succes prin prezentarea unor exemple pozitive, cu impact puternic, privind integrarea copiilor și realizările acestora. Cu trei luni înainte de eveniment, cazurile de succes sunt promovate în mass media, pentru a atrage atenția asupra Teletonului. Persoane publice cunoscute sunt implicate în promovarea evenimentului. În România, un ONG a încheiat un parteneriat cu un sponsor reprezentat de o companie. Pentru a consolida acest parteneriat, în fiecare an se organizează un concurs de înot, la care participă echipe integrate formate din angajați ai companiei, instructori în scaun rulant, personal al ONG- ului și persoane cu dizabilități intelectuale care concurează între ele. Este un eveniment recreativ care aduce beneficii din mai multe perspective. Angajații companiei oferă apoi susținere financiară în mod constant, pe parcursul întregului an, fie prin contribuții directe sau prin evenimente de strângere de fonduri. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 74 Finanțare guvernamentală În Kenya, ministerul care răspunde de serviciile medicale lucrează în parteneriat cu un ONG care oferă atât servicii dedicate utilizatorilor de scaun rulant, cât și alte tipuri servicii de recuperare asociate. ONG-ul furnizează întregul suport logistic pentru opt filiale găzduite de spitale guvernamentale. Guvernul furnizează resursele umane. Până la ora actuală, acest minister a alocat filialelor ONG-ului un număr de 56 de angajați. Sistemul național de asigurări de sănătate din România • Primul pas presupune ca utilizatorul de scaun rulant să solicite obținerea unui certificat de dizabilitate. În lipsa acestui certificat, nu este posibilă solicitarea unui scaun rulant. • Următorul pas este programarea la un medic de recuperare, care prescrie un scaun rulant. • Apoi, utilizatorul de scaun rulant formulează o cerere către Casa de Asigurări de Sănătate (CAS) a județului de domiciliu. • Atunci când utilizatorul de scaun rulant primește decizia/cuponul valoric, el/ea alege un furnizor și unul dintre scaunele rulante oferite de acesta. • Dacă prețul scaunului rulant este mai mic decât subvenția acordată, atunci furnizorul livrează utilizatorului scaunul rulant în schimbul cuponului valoric, pe care îl folosește pentru a factura echipamentul de mobilitate către CAS. • Dacă prețul scaunului rulant depășește suma prevăzută de subvenție, atunci utilizatorul trebuie să găsească surse suplimentare de finanțare, cum ar fi donatori, angajatori, alte persoane fizice. Pentru resurse suplimentare în vederea dezvoltării de servicii pentru utilizatorii de scaun rulant nivel de bază sau intermediar, consultați fișierele de pe memory stick. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 75 Referinţe bibliografice 1. Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/ technology/ wheelchairguidelines/en/). 2. Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). 4. Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007) New York: United Nations;2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers (Allen et al., 2006). 6. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 113 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 7. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 8. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006;44: 523–529. 9. Razzak ATMA, Helal SU, Nuri RP. Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclusive Development Journal. 2011; 22(1): 114-123. 10. World Health Organization, World Bank World report on disability, page 115. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/ report/en/). 11. Messiou K. Encouraging children to think in more inclusive ways. British Journal of Special Needs Education. 2008;35(1):26–32. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 76 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 77 PACHET DE INSTRUIRE PENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULANT CAIET DE EXERCIŢII PRAC TICE Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 78 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 79 CUPRINS Partea 1 / 81 A. Noţiuni fundamentale / 81 A.1: Cum determinați o schimbare? / 81 B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 82 B.1: Accesarea serviciilor / 82 B.2: Spații și echipamente / 84 B.3: Gama de scaune rulante corespunzătoare / 85 B.4: Organizarea resurselor umane / 86 B.5: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 86 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 87 C.1: Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? / 87 C.2: Gestionarea cererii / 89 C.3: Planificarea activității de monitorizare / 89 C.4: Planificarea sustenabilității financiare / 90 Partea a doua / 91 A. Noțiuni fundamentale / 91 A.1: Furnizarea unui scaun rulant corespunzător: Politici la nivel național / 91 A.2: Furnizarea serviciilor pentru utilizatorii de scaun rulant / 93 B. Iniţierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 94 B.1: Spații și echipamente / 94 B.2: Gama de scaune rulante corespunzătoare / 98 B.3: Organizarea resurselor umane: Roluri / 103 B.4: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 103 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 106 C.1: Servicii eficiente / 106 C.2: Dezvoltarea unor servicii eficiente / 111 C.3: Gestionarea cererii / 112 C.4: Planificarea activității de monitorizare / 115 C.5: Dezvoltarea sustenabilității financiare / 116 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 80 Activități pentru manageri în vederea inițierii sau îmbunătățirii sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant Caietul de exerciții practice include două părți: Partea 1: Care sunt pașii pentru inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant? Această secțiune pune accentul pe cele opt etape ale activității de furnizare a scaunelor rulante, spații, echipamente, gama de scaune rulante corespunzătoare, costuri inițiale pentru inițierea procesului și gestionarea cererii. Partea 2: Care sunt modalitățile de asigurare a sustenabilității după investiția inițială? Această secțiune pune accentul pe furnizarea scaunelor rulante corespunzătoare, gestionarea procesului de furnizare și pe activitățile necesare în vederea creșterii gradului de eficiență și a capacității de reacție. De asemenea, se abordează problema sustenabilității financiare, inclusiv importanța creării de parteneriate și asigurării surselor de venituri, pentru a acoperi costurile de funcționare și extindere a activității. Ambele părți sunt împărțite, la rândul lor, în câte trei secțiuni: A. Noțiuni fundamentale B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant C. Gestionarea sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 81 Partea 1 A. Noţiuni fundamentale A.1: Cum determinați o schimbare? Revizuiți posibilitățile de facilitare a schimbării prezentate mai jos. Înregistrați activitățile pe care le puteți efectua pentru introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant în cadrul centrului unde vă desfășurați activitatea. 1. Creați o viziune comună în ceea ce privește furnizarea de scaune rulante corespunzătoare 2. Prezentați importanța furnizării scaunelor rulante corespunzătoare, transmițând ideea că aceste servicii sunt prioritare 3. Corelați personalul și resursele 4. Motivați, implicați și facilitați asumarea obligațiilor de către personal: • includeți personalul în planificare și implementare; • depășiți obstacolele împreună; • obțineţi rezultate bune pe termen scurt şi oferiți apreciere pentru eforturile depuse pentru atingerea acestora • fixați schimbările pozitive în sistemul de lucru și în cultura organizațională. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 82 B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1: Accesarea serviciilor Întrebări: Răspunsuri: Întrebarea 1: Dezvoltarea unei rețele de trimiteri şi programări În calitate de manager, ce activități puteți întreprinde pentru a dezvolta o rețea de persoane și organizații care să poată identifica și direcționa utilizatorii de scaun rulant către serviciul dumneavoastră de furnizare a scaunelor rulante? Întrebarea 2: Formulare de trimitere şi programare Parcurgeți modelul de formular de trimitere şi programare din Resurse suplimentare la Manualul Managerului, aflate pe memory stick. Ar fi acest formular de trimitere şi programare (sau o versiune adaptată a acestuia) un instrument eficient pentru activitatea dumneavoastră? Dacă nu – de ce nu? Dacă da – ca manager al unei activități de furnizare a serviciilor pentru utilizatorii de scaun rulant – ce puteți face pentru a introduce folosirea unui formular de trimitere şi programare? (Notă – în cazul în care folosiți deja un sistem, descrieți care au fost pașii pe care i-ați făcut, în calitate de manager, pentru a încuraja utilizarea formularului de trimitere şi programare) Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 83 1. Activități pe care le pot desfășura pentru identificarea surselor de trimitere 2. Activități pe care le pot desfășura pentru a dezvolta o rețea de trimiteri şi programări 3. Activități pe care le pot desfășura pentru a decide dacă formularul de trimitere şi programare va fi utilizat în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant 4. Activități pe care le pot desfășura pentru a crea un sistem echitabil de furnizare a serviciilor pentru utilizatorii de scaun rulant Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 84 B.2: Spații și echipamente 1. Activități pentru identificarea spațiilor și echipamentelor potrivite modelului de furnizare a serviciilor pentru utilizatorii de scaun rulant pe care îl implementez 2. Activități pentru integrarea formularelor și listelor de verificare în etapele procesului de furnizare a serviciilor 3. Activități pentru organizarea spațiilor 4. Activități pentru crearea sistemelor și procedurilor pentru fiecare spațiu de furnizare a serviciilor pentru utilizatorii de scaun rulant și pentru alocarea responsabilităților Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 85 B.3: Gama de scaune rulante corespunzătoare 1. Activități pentru identificarea nevoilor utilizatorilor de scaun rulant și a celor mai importante caracteristici ale produselor care să răspundă acestor nevoi 2. Activități pentru identificarea unei game adecvate de scaune rulante, perne și piese de schimb corespunzătoare 3. Activități pentru identificarea unei surse adecvate de materiale necesare adaptării produselor 4. Activități pentru a discuta cu diverse părți interesate despre beneficiile privind costurile, în cazul furnizării scaunelor rulante corespunzătoare și a pernelor adecvate printr-un serviciu specializat Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 86 B.4: Organizarea resurselor umane 1. Activități pentru identificarea personalului unui furnizor de servicii pentru utilizatorii de scaun rulant 2. Activități pentru includerea personalului în etapa de planificare 3. Activități pentru coordonarea muncii în echipă și stabilirea unui plan de lucru săptămânal 4. Activități pentru identificarea capacității anuale de furnizare a serviciilor pentru utilizatorii de scaun rulant B.5: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? 1. Activități pentru includerea variantei „servicii integrate” în planificarea unui model de furnizare a serviciilor pentru utilizatorii de scaun rulant 2. Activități pentru crearea unor parteneriate în comunitate ca parte a planificării unui model de furnizare a serviciilor pentru utilizatorii de scaun rulant 3. Activități pentru pregătirea unui buget adecvat modelului ales pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 87 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1: Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? Domenii și activități ale sistemului de furnizare a serviciilor Obiective de performanţă ale sistemului de furnizare a serviciilor Metode de colectare a informaţiei Trimitere Numărul de utilizatori trimiși către furnizorul de servicii Furnizorul de servicii va primi lunar 30 de trimiteri Înregistrați trimiterile primite Furnizarea scaunelor rulante Numărul de utilizatori care primesc un scaun rulant Lunar, furnizorul de servicii va prescrie şi va proba scaune rulante pentru 20 de utilizatori Prescrierile de scaune rulante sunt înregistrate în dosarele utilizatorilor Utilizatori de scaun rulant care au beneficiat de servicii Detalii ale utilizatorilor direcționați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, nevoia de suport postural Furnizorul de servicii va încuraja accesul egal al utilizatorilor de scaun rulant Numărul de femei, bărbați, fete și băieți care au accesat serviciile, înregistrați în dosarele utilizatorilor. Costurile furnizării serviciilor pentru utilizatorii de scaun rulant Costul produselor furnizate, incluzând adaptării efectuate de către furnizorul de servicii Costurile individuale pentru fiecare scaun rulant vor fi mai mici decât _____ (suma specificată conform bugetului și prețurilor reale ale produselor disponibile) Adresele utilizatorilor care au accesat serviciile, înregistrate în dosarele utilizatorilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 88 Schemă pentru planificarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Identificați nevoia/problema care trebuie monitorizată Activități/obiective pentru a răspunde nevoii/a soluționa problema Obiectiv Colectarea informațiilor 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. Înregistrați activitățile pentru a vedea dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează (în cazul în care vă permite timpul) 1. Activități pe care le pot desfășura pentru a crea un plan de furnizare a serviciilor 2. Activități pe care le pot desfășura pentru a monitoriza personalul implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant 3. Activități pe care le pot desfășura pentru a evalua gradul de realizare a obiectivelor activității de furnizare a serviciilor pentru utilizatorii de scaun rulant 4. Activități pe care le pot desfășura pentru a arăta apreciere pentru reușitele individuale sau ale echipei Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 89 C.2: Gestionarea cererii 1. Activități pentru crearea unui sistem de monitorizare a trimiterilor și pentru gestionarea listelor de așteptare 2. Activități pentru promovarea în rândul părinților și al surselor de trimitere a cazurilor de succes în ceea ce privește intervenția timpurie 3. Activități pentru gestionarea trimiterilor care depășesc capacitatea furnizorului de servicii de a răspunde cererii 4. Activități pentru monitorizarea și creșterea eficienței implementării etapelor din procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant C.3: Planificarea activității de monitorizare 1. Activități pentru planificarea etapei de monitorizare 2. Activități în vederea identificării și instruirii partenerilor din comunitate 3. Activități în vederea identificării potenţialilor candidaţi pentru activitatea de instruire și monitorizare a utilizatorului Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 90 4. Activități pentru colectarea şi diseminarea cazurilor de succes privind beneficiile activității de monitorizare C.4: Planificarea sustenabilității financiare 1. Activități pentru crearea unei viziuni comune cu privire la sustenabilitatea financiară 2. Activități pentru identificarea fondurilor și resurselor necesare 3. Activități pentru identificarea surselor de finanțare 4. Activități pentru prioritizarea surselor de finanțare și pentru dezvoltarea unei strategii de strângere de fonduri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 91 Partea a doua A. Noțiuni fundamentale A.1: Furnizarea unui scaun rulant corespunzător: Politici la nivel național • Citiți cele două exemple de politici la nivel național referitoare la furnizarea scaunelor rulante. • Luați în considerare politicile care există deja la noi în țară. • Discutați despre utilitatea, în contextul țării noastre, a politicilor prezentate mai jos, luând în considerare modul în care respectivele politici se potrivesc structurii noastre guvernamentale. Exemplul 1: Politici referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant din Afganistan În octombrie 2003, Ministerul pentru Martiri și Persoane cu Dizabilități din Afghanistan a publicat o Politică Națională Complexă privind Problematica Dizabilității. Această politică a fost „dezvoltată prin cooperarea tuturor părților interesate, incluzând aici organizații ale persoanelor cu dizabilități și grupuri de auto-susținere; ONG-uri naționale și internaționale pentru persoanele cu dizabilități, ministere a căror activitate este relevantă în acest domeniu, inclusiv Ministerul Educației, Ministerul Sănătății, Ministerul Muncii și al Prestațiilor Sociale, Ministerul pentru Problematica Femeilor și Ministerul pentru Martiri și Persoane cu Dizabilități; agenții ONU care se ocupă de acest domeniu și Cabinetul Președintelui” (4). Așteptarea este ca politica inițială să ducă la un plan de acțiune mai detaliat și cu priorități stabilite. Politica este una la nivel de stat: Prevederile pentru persoanele cu dizabilități fizice ar trebui să includă centrele de recuperare ortopedică, serviciile de fizioterapie, dispozitivele ortopedice, asistive și de mobilitate. Aceste servicii trebuie să fie în proximitatea unui spital care deservește o regiune sau o provincie, având servicii de chirurgie ortopedică, care să poată fi accesat ușor de către populația din zonă. Persoanele cu dizabilități au dreptul de a primi dispozitive. Acestea trebuie să fie confecționate în mod corespunzător, să se potrivească utilizatorului, să conțină materiale disponibile la nivel local, ori de câte ori acest lucru este posibil, și să poată fi reparate local. Tehnologia adecvată trebuie să fie standardizată pe tot teritoriul țării. Un mecanism de standardizare la nivel național trebuie dezvoltat de către experți în domeniu, în colaborare cu Ministerul Sănătății. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 92 Exemplul 2: Politici referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant din Africa de Sud În anul 2003, în Africa de Sud au fost publicate liniile directoare la nivel național cu privire la dispozitivele asistive. Acestea au fost stabilite prin consultarea tuturor provinciilor Africii de Sud. Contribuția adusă de provincia Western Cape s-a bazat pe experiența lor în ceea ce privește dezvoltarea politicii la nivelul acestei unități administrative. Inițiativa a aparținut unui grup format din personal clinic specializat în furnizarea serviciilor pentru utilizatorii de scaun rulant. Ei au colaborat cu un manager de programe din provincia respectivă și cu furnizorii de servicii de recuperare din zonă, în vederea dezvoltării unui plan pentru crearea unor standarde de profesionalism în furnizarea de servicii pentru utilizatorii de scaun rulant. Planul includea trei direcții de acțiune majore: 1. analiza situației furnizării serviciilor pentru utilizatorii de scaun rulant în respectiva provincie; 2. implementarea planului de instruire a celor care furnizează acest tip de servicii; 3. stabilirea unui set de linii directoare cu privire la strategia de management a furnizării de servicii pentru utilizatorii de scaun rulant pentru provincia respectivă. A fost elaborat un set de principii care includea un minimum de cerințe standard cu privire la etapele procesului de furnizare, precum și pași cheie în gestionarea acestuia, cum ar fi instruirea personalului, crearea și gestionarea listelor de așteptare, bugete, efectuarea reparațiilor și a operațiunilor de întreținere. Managementul la nivelul provinciei a sprijinit grupul, astfel încât acesta a devenit un organism consultativ. Reprezentanții grupului au însoțit managerii din provincie la întâlnirile la nivel național și au contribuit la stabilirea liniilor directoare la nivel național pentru furnizarea dispozitivelor asistive în Africa de Sud. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 93 A.2: Furnizarea serviciilor pentru utilizatorii de scaun rulant Rolul extins al managerului Creşterea gradului de conştientizare Sporirea oportunităţilor de instruire Îmbunătăţirea gamei de scaune rulante Influenţarea politicii naţionale Dezvoltarea sustenabilităţii Îmbunătăţirea accesibilităţii Conştientizare Politici Activități comune pentru îmbunătățirea furnizării scaunelor rulante corespunzătoare în țară Acţiuni pe care le pot desfășura în următoarele trei luni Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 94 B. Iniţierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1: Spații și echipamente B.1.1 Identificarea spațiilor corespunzătoare • Parcurgeți lista spațiilor din tabelul de mai jos. • Gândiți-vă la soluțiile practice care pot funcționa în cazul activității voastre ca furnizori de servicii pentru utilizatorii de scaun rulant. Spații pentru furnizarea serviciilor pentru utilizatorii de scaun rulant – de nivel de bază Există deja spațiul necesar? Poate fi acesta un spațiu comun, folosit împreună cu un alt serviciu existent? Poate fi reamenajată o zonă care la ora actuală este folosită cu un alt scop? Poate fi reorganizată sau restructurată o sală existentă? 1. Sală de așteptare și recepție 2. Zonă liniștită unde utilizatorii de scaun rulant se pot întinde 3. Toaletă accesibilă 4. Zonă de birouri pentru personal 5. Zonă pentru activități clinice: pentru evaluare și probare Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 95 6. Zonă activități tehnice: pentru pregătirea, întreținerea și repararea scaunelor rulante 7. Depozitare 8. Instruirea utilizatorilor de scaun rulant Spații suplimentare pentru furnizarea serviciilor pentru utilizatorii de scaun rulant – de nivel intermediar Există deja spațiul necesar? Poate fi acesta un spațiu comun, folosit împreună cu un alt serviciu existent? Poate fi reamenajată o zonă care la ora actuală este folosită cu un alt scop? Poate fi reorganizată sau restructurată o sală existentă? 9. Zonă pentru evaluare și probare dotată cu pat pentru evaluare (evaluare în poziția ortostatică) 10. Zonă suplimentară pentru depozitare materiale 11. Zonă suplimentară pentru pregătirea produselor: activități de cusut și tapiţerie Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 96 B.1.2 Identificarea echipamentului • Utilizați Manualul participantului pentru recomandările referitoare la echipamente și documentație. Echipament • Identificați care sunt echipamentele disponibile deja şi utilizate în centrul în care vă desfășurați activitatea. Notați care sunt echipamentele care urmează a fi confecționate sau achiziționate. Echipamente care există deja Echipamente care trebuie confecționate sau achiziționate Documentație • Parcurgeți lista de formulare și listele de verificare din resurse suplimentare pentru manageri, aflate pe memory stick. • Care sunt formularele și listele de verificare deja integrate în activitate și utilizate? Notați care sunt formularele sau listele de verificare care urmează a fi folosite în activitatea zilnică. Formulare și liste de verificare care există deja Formulare și liste de verificare care trebuie integrate în activitate B.1.3 Organizarea spațiului de lucru • Utilizați Manualul participantului pentru recomandări cu privire la spații și echipamente. • Luați în considerare sugestiile de mai jos referitoare la organizarea corespunzătoare a spațiului de lucru: 1. Evitați acumularea de obiecte: eliminați toate sculele, componentele, echipamentele și documentele expirate, care nu mai sunt necesare. 2. Identificați care sunt elementele utilizate în mod regulat: scule, componente, fișe de instrucțiuni și documente. Acestea trebuie aranjate astfel încât localizarea lor să fie cât mai ușoară și rapidă. 3. Sistem și responsabilitate: se recomandă să stabiliți un sistem pentru fiecare spațiu de lucru și o persoană responsabilă pentru implementarea acestuia. 4. Monitorizare: sistemul trebuie monitorizat pentru a vă asigura că el este respectat pe termen lung. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 97 Zona pentru activități tehnice • Analizați exemplul și formulați recomandări pentru îmbunătățiri. Zona pentru activități tehnice și clinice (activități pe teren) • Analizați exemplul și formulați recomandări pentru a aduce îmbunătățiri. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 98 B.2: Gama de scaune rulante corespunzătoare B 2.1 Durabilitate, posibilitatea de efectuare a reparațiilor • Lucrați în echipă și răspundeți la setul de întrebări care v-a fost indicat – conform numărului grupului din care faceți parte. • Pentru parcurgerea exercițiului, folosiți-vă de cunoștințele și experiența pe care le aveți, precum și de Manualul participantului. Grupul 1 • Care sunt întrebările pe care le puteți adresa cu privire la durabilitatea și utilizarea în condiții de siguranță a produselor furnizate? • Cum puteți afla dacă furnizorul (donatorul, producătorul) oferă produse durabile și care pot fi utilizate în condiții de siguranță în contextul în care vă desfășurați activitatea? • Cu cine mai puteți discuta pentru a afla detalii despre utilizarea în condiții de siguranță și despre durabilitatea produselor oferite de un donator/producător/furnizor? Durabilitate Grupul 2 • Chiar și produsele durabile au componente care se uzează sau se defectează în mod frecvent. Care sunt aceste componente vulnerabile? Componente care se uzează sau se defectează Grupul 3 • Un furnizor de servicii pentru utilizatorii de scaun rulant are nevoie de piese de schimb. • Cum puteți identifica piesele de schimb necesare? • Cum puteți calcula numărul de piese de schimb ce urmează a fi comandate? Piese de schimb Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 99 B.2.2 Aprovizionarea cu scaune rulante corespunzătoare Scenariul 1 • Citiți scenariul de mai jos care v-a fost repartizat. Apoi citiți „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. • Pregătiți un joc de rol în care participanții să fie reprezentanți ai autorității locale și un grup de persoane interesate, care susține ideea unei schimbări în sistemul de achiziționare a scaunelor rulante (alocați 3-5 minute pentru jocul de rol). Atunci când discutați despre jocul de rol, luați în considerare următoarele aspecte: • Care sunt problemele identificate în scenariul respectiv? • Care sunt posibilele soluții pentru rezolvarea problemelor? Un spital de stat din zona în care lucrați a alocat un buget pentru achiziționarea de scaune rulante. Bugetul este revizuit anual și lista de produse este reanalizată. Chiar dacă în fiecare an există solicitări pentru schimbarea produselor disponibile, acest lucru nu se întâmplă, iar departamentul de achiziții cumpără două tipuri de produse, având drept criteriu prețul acestora. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 100 Principiile furnizării echipamentelor de mobilitate corespunzătoare Pentru ca țările să respecte obligațiile legate de tehnologia asistivă (echipamente de mobilitate) prevăzute în Convenția Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități, trebuie luate în considerare următoarele principii cheie: • Implicare – persoanele cu dizabilități trebuie implicate în toate stadiile furnizării echipamentelor de mobilitate; • Accesibilitate – echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile tuturor persoanelor care au nevoie de ele; • Adaptabilitate – echipamentele de mobilitate și serviciile aferente trebuie să fie adaptate și modificate pentru a ne asigura că ele corespund nevoilor individuale ale utilizatorilor; • Preț accesibil – echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile din punct de vedere al costurilor; • Disponibilitate – pentru a răspunde cererii, trebuie să existe suficient spațiu, personal și produse furnizate cât mai aproape posibil de comunitățile locale; • Calitate – produsele, spațiile și serviciile trebuie să respecte un standard de calitate adecvat. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 101 Scenariul 2 • Citiți despre cele două sisteme de finanțare guvernamentale prezentate mai jos. • Faceți un rezumat al sistemului actual din țara dvs. • Consultați „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. • Pregătiți sugestii pentru crearea sau îmbunătățirea sistemului guvernamental de finanțare pentru furnizarea scaunelor rulante în țara dumneavoastră. Africa de Sud În Africa de Sud, achiziționarea de scaune rulante de către guvern este controlată printr-o licitație la nivel național. Guvernul lucrează cu persoane din diferite provincii care au experiență în furnizarea de scaune rulante și servicii conexe. De asemenea, aceștia se consultă și cu furnizorii de scaune rulante. În urma acestei consultări, se ajunge la o formă finală a categoriilor de produse, incluzând specificațiile detaliate ale fiecărui produs. Categoriile includ o gamă de perne pentru confort și pentru utilizatorii la care există un risc ridicat de apariție a escarelor. Standardele minime de durabilitate sunt specificate pentru fiecare produs. Odată ce specificațiile de finanțare sunt finalizate și aprobate, trezoreria națională începe un proces de licitație. Înainte de acordarea contractelor, reprezentanți specializați verifică toate produsele depuse pentru licitație. Contractele includ perioade minime de livrare și penalizări pentru încălcarea clauzelor contractuale. România În România, finanțarea pe care statul o acordă pentru scaune rulante urmează tiparul subvențiilor pentru medicamente. Procesul de subvenții pentru scaunele rulante a fost inițiat în anul 2001, atunci când statul a organizat o licitație pentru furnizorii de scaune rulante. Ca rezultat al acestei licitații, s-a ajuns la un acord legat de prețul de bază/de referință, dar nu s-a definit niciun aspect legat de calitatea produselor sau furnizarea serviciilor. Valoarea subvenției este restabilită în fiecare an. Primul pas în cazul unui utilizator de scaun rulant este depunerea actelor pentru certificatul de dizabilitate. Fără acest certificat este imposibilă accesarea unui scaun rulant. În continuare, utilizatorul trebuie să facă o programare la un medic specializat în recuperare, care va completa o recomandare pentru un scaun rulant. Apoi, utilizatorul de scaun rulant depune o cerere la Casa Județeană de Asigurări de Sănătate (CAS). Atunci când utilizatorul de scaun rulant primește aprobarea/decizia, acesta alege un furnizor, apoi un scaun rulant. În cazul în care prețul scaunului rulant este mai mic decât subvenția, furnizorul oferă scaunul rulant utilizatorului în schimbul acestei decizii, care apoi este folosită pentru facturarea către CAS. În cazul în care prețul scaunului rulant este mai mare decât subvenția, utilizatorul trebuie să achite diferența ori să găsească surse complementare de finanțare, ca de exemplu, donatori, angajatori sau persoane fizice. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 102 Scenariul 3 • Pregătiți un joc de rol; prezentați o întâlnire cu un donator; încercați să găsiți o soluție comună pentru aprovizionarea cu scaune rulante corespunzătoare în vederea furnizării de servicii pentru utilizatorii de scaun rulant, prin intermediul serviciului dumneavoastră (joc de rol de 3-5 minute). Când planificaţi jocul de rol: • Discutați despre modul în care scaunele rulante donate sunt distribuite în prezent în țara dumneavoastră. • Citiți „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 103 B.3: Organizarea resurselor umane: Roluri • Folosiți tabelul în care sunt prezentate rolurile personalului furnizor de servicii pentru utilizatorii de scaun rulant. • Notați în tabel numele persoanei responsabile pentru fiecare rol. • În cazul în care activitatea voastră presupune coordonarea mai multor astfel de centre, enumerați membrii echipei din fiecare centru furnizor de servicii pentru utilizatorii de scaun rulant. Clinic Tehnic Instruire utilizator Administrativ Centru furnizor de servicii pentru utilizatorii de scaun rulant Centru furnizor de servicii pentru utilizatorii de scaun rulant Centru furnizor de servicii pentru utilizatorii de scaun rulant B.4: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? Citiți fiecare categorie de buget din tabelul de mai jos și gândiți-vă la costurile care pot fi împărțite sau economisite prin integrarea furnizării serviciilor pentru utilizatorii de scaun rulant într-un serviciu deja existent. Încercuiți cu negru toate costurile care pot fi eliminate. Încercuiți cu roșu toate costurile care pot fi împărțite. Exemplu de furnizare a unor servicii integrate Un centru de protezare și ortezare planifică integrarea serviciilor pentru utilizatorii de scaun rulant. Au fost alese două persoane din echipă, care au participat la modulul de instruire pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant – nivel de bază. Ambele persoane vor desfășura activități de furnizare a serviciilor pentru utilizatorii de scaun rulant trei zile pe săptămână, iar două zile pe săptămână vor lucra pentru furnizarea serviciilor de protezare și ortezare. În atelier a fost alocat un spațiu pentru un tehnician de scaune rulante. Departamentul de terapie a eliminat toate echipamentele defecte și nefolosite, astfel creându-se un spațiu de lucru pentru personalul cu rol clinic. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 104 Linii de buget orientative Etapele furnizării serviciilor pentru utilizatorii de scaun rulant Tr im ite re ș i pr og ra m ar e E va lu ar e P re sc ri er e Fi na nț ar ea ș i pl as ar ea c om en zi i P re gă tir ea pr od us ul ui P ro ba re a In st ru ir ea ut ili za to ru lu i d e sc au n ru la nt M on ito ri za re , în tr eț in er e, re pa ra ții Costuri inițiale Design produs Asigurarea unui stoc inițial de produse ü Instrumente/scule ü ü ü Echipament ü ü Clădire/spații ü ü ü Stoc de materiale ü Costuri operaționale Scaune rulante ü ü Piese de schimb ü Materiale ü ü ü Transport ü ü Personal Management ü ü ü Personal clinic ü ü ü ü ü ü ü Personal tehnic ü ü ü ü ü Instructor/Instructor de viață independentă utilizator de scaun rulant ü ü Administrator ü ü ü ü ü Transport local Transport local pentru personal ü ü ü ü Transport local pentru clienți ü ü ü Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 105 Linii de buget orientative Etapele furnizării serviciilor pentru utilizatorii de scaun rulant Tr im ite re ș i pr og ra m ar e E va lu ar e P re sc ri er e Fi na nț ar ea ș i pl as ar ea c om en zi i P re gă tir ea pr od us ul ui P ro ba re a In st ru ir ea ut ili za to ru lu i d e sc au n ru la nt M on ito ri za re , în tr eț in er e, re pa ra ții Cazare clienți ü ü Tipărire materiale ü ü ü ü ü Consumabile ü ü ü Înlocuire instrumente/scule ü ü ü Costuri indirecte ü ü ü ü ü ü Instruire personal ü ü ü ü ü ü Instruire parteneri/surse de trimiteri ü ü ü Strângere fonduri ü ü ü ü ü ü ü ü Monitorizare și evaluare ü ü ü ü ü ü ü ü Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 106 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1: Servicii eficiente C.1.1 Monitorizarea Secțiunea 1 • Lucrați în grupe. În tabelul de mai jos, citiți și completați secțiunea care v-a fost indicată. • Unele dintre rubrici au fost completate pentru a vă da indicații. Completați restul tabelului. Arii de acțiune Exemple de indicatori de performanță Colectarea informațiilor Trimitere Numărul de utilizatori trimiși Furnizorul de servicii va primi lunar 30 de trimiteri Înregistrați trimiterile primite Perioada medie de așteptare între momentul efectuării trimiterii și programare Notați în dosarul utilizatorului data înregistrării trimiterii și data evaluării Furnizare scaun rulant Numărul de utilizatori care primesc un scaun rulant Se vor prescrie și se vor proba lunar scaune rulante pentru 20 de utilizatori Perioada medie de așteptare între etapa de evaluare și cea de probare Numărul de monitorizări efectuate Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 107 • Notați mai jos motivul pentru care este util să știm dacă aceste obiective au fost atinse. De ce este util să știm că obiectivele au fost realizate? De ce este util să știm că obiectivele nu au fost realizate? Numărul de utilizatori cu trimitere Perioada medie de așteptare între momentul efectuării trimiterii și programare Numărul de utilizatori care primesc un scaun rulant Perioada medie de așteptare între etapa de evaluare și cea de probare Numărul de monitorizări efectuate Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 108 Secțiunea 2 Arii de acțiune Exemple de indicatori de performanță Înregistrarea informațiilor Utilizatori de scaun rulant care au beneficiat de serviciile furnizate Detalii despre utilizatorii îndrumați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, nevoia de suport postural Încurajarea accesului egal Obiectivul este ca serviciile oferite să răspundă atât cerințelor utilizatorilor care au nevoie de servicii pentru utilizatorii de scaun rulant – nivel de bază cât și ale celor care au nevoie de scaune rulante adaptate sau de suport postural Înregistrați numărul de femei, bărbați, fete și băieți care au accesat serviciile furnizate. Înregistrați în dosarele utilizatorilor de scaun rulant cerințele de suport postural și tipul de scaune rulante prescrise Zona geografică acoperită de către furnizorul de servicii pentru utilizatorii de scaun rulant Înregistrați adresele în dosarele utilizatorilor de scaun rulant care au accesat serviciile furnizate Costurile furnizării serviciilor Costul produselor furnizate, incluzând modificările efectuate în cadrul centrului furnizorului de servicii Costurile individuale pentru fiecare scaun rulant vor fi mai mici decât _____ (sumă specificată conform bugetului și prețurilor reale ale produselor disponibile). Timpul folosit de către personal în activitățile procesului de furnizare a serviciilor (evaluare, monitorizare, instruire etc.) • Notați motivul pentru care este util să știm în ce măsură au fost realizate aceste obiective. De ce este util să știm că obiectivele au fost realizate? De ce este util să știm că obiectivele nu au fost realizate? Detalii despre utilizatorii îndrumați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, necesitatea suportului postural Zona geografică acoperită de către furnizorul de servicii pentru utilizatorii de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 109 Costul produselor furnizate, incluzând adaptările efectuate în cadrul centrului furnizorului de servicii Timpul folosit de către personal în activitățile procesului de furnizare a serviciilor (evaluare, monitorizare, instruire etc.) C.1.2 Feedback-ul utilizatorului • Există câteva aspecte importante care trebuie luate în considerare atunci când planificați să solicitați feedback din partea utilizatorilor de scaun rulant care beneficiază de serviciile oferite. Folosiți această listă de verificare pentru a înregistra informațiile. Planificarea solicitării de feedback de la utilizatorii serviciilor Aspecte de luat în considerare: Transportul și timpul reprezintă două dintre cele mai semnificative costuri. Când va avea loc? Cine se va ocupa? Care sunt întrebările pe care trebuie să le adresăm pentru a primi feedback-ul necesar de la utilizatorii de scaun rulant, beneficiari ai serviciilor oferite? Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 110 Informații iniţiale (Consultați secţiunea de instrumente din Resursele Suplimentare la Manual, de pe memory stick.) Aspecte de luat în considerare: Pentru a analiza impactul serviciilor furnizate, este important să înregistrați starea de fapt înainte de efectuarea oricărui tip de intervenție, cu alte cuvinte, înainte de începerea evaluării. Când se colectează informațiile iniţiale? Cine se va ocupa de culegerea acestor informații? La ce interval de timp se vor culege informaţiile? Înregistrarea și procesarea informațiilor Aspecte de luat în considerare: Înregistrarea eficientă a datelor are ca rezultat economisirea resurselor de timp și de bani. Cum veți înregistra informațiile? Ce metode puteți folosi pentru ca înregistrarea și procesarea informațiilor să se desfășoare cât mai eficient? Cine va înregistra informațiile? Cine va procesa informațiile? Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 111 C.2: Dezvoltarea unor servicii eficiente C.2.1 Monitorizarea unui plan de servicii • Creați un plan pentru furnizarea serviciilor. • Selectați o nevoie sau o problemă care trebuie monitorizată și completați informațiile de la fiecare punct. Matrice pentru planificarea furnizării serviciilor Identificați nevoia / problema care trebuie monitorizată Activități / obiective pentru a răspunde nevoii / soluționa problema Obiectiv Culegerea informațiilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 112 C.3: Gestionarea cererii C.3.1 Generarea cererii și intervenția timpurie • Citiți exemplul de mai jos. • Discutați și enumerați cauzele care au dus la succes. Exemple de succes: intervenţie timpurie ca rezultat al trimiterilor făcute de către părinţi, în Mexic Avem în continuare un exemplu despre felul în care un grup de centre de recuperare pentru copii, din Mexic, a reușit să dezvolte o rețea eficientă pentru realizarea intervenției timpurii. Deşi centrele de recuperare au avut ca obiectiv principal creșterea gradului de conștientizare în rândul medicilor neonatologi și al pediatrilor cu privire la serviciile oferite, acestea au reușit să abordeze întreaga comunitate, printr-o campanie anuală majoră de strângere de fonduri, care a fost intens mediatizată inclusiv la radio și la televiziune. Acest lucru a dus la realizarea unui număr mare de trimiteri, care au rezultat din transmiterea informaţiei în mod direct, mulți părinți aducându-şi singuri copiii ca să beneficieze de aceste servicii. Pe parcursul campaniei de conștientizare, centrele au avut un mesaj clar: este foarte important ca în cazul copiilor trimiterea către furnizorul de servicii de recuperare să se producă imediat după naștere. Pentru asta a fost nevoie să se prezinte o viziune de succes, puternică, bazată pe multe cazuri de succes referitoare la integrarea și realizările copiilor cu care au lucrat aceste centre. În cei 15 ani, centrele de recuperare au observat o schimbare de mentalitate, deoarece medicii pediatri și familiile apelează în mod activ la intervenția timpurie. Rezultatul: O treime din numărul trimiterilor se referă la copii până la vârsta de trei ani. Factori care au dus la succes Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 113 C.3.2 Analiza etapelor procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Timpul zilnic disponibil pentru furnizarea serviciilor: _______minute • Lucrați împreună, în grupe. • Citiți fiecare caz menționat în coloana 1. • În tabelul de mai jos, citiți despre posibilele strategii pentru creșterea eficienței furnizării serviciilor pentru utilizatorii de scaun rulant. • Corelați provocările cu strategiile pentru sporirea eficienței. În a doua coloană, notați numărul care corespunde fiecărei strategii. O problemă poate necesita utilizarea mai multor strategii. Strategii pentru creșterea eficienței serviciilor 1. Achiziționarea de produse cu o gamă cât mai mare de opțiuni de ajustare 2. Achiziționarea de produse ce pot fi modificate cu ușurință 3. Achiziționarea de produse cu dispozitive de suport postural 4. Pregătirea în avans a unor mostre diferite de produse 5. Prefabricarea dispozitivelor de suport postural 6. Planificare clară pentru facilitarea muncii în echipă 7. Ședințe ale echipei pentru o planificare comună 8. Colaborarea dintre echipa cu atribuții clinice și cea cu atribuții tehnice pe parcursul etapei de probare a produsului 9. Discutarea de către echipa cu atribuții clinice și cea cu atribuții tehnice a soluțiilor referitoare la prescrierea scaunului rulant 10. Înregistrarea şi evidenţa clară a informațiilor 11. Planificarea instruirii pentru personalul furnizor de servicii, în conformitate cu nevoia de instruire. 12. Procurarea materialelor corespunzătoare pentru confecționarea pernelor și pentru fabricarea şi modificarea dispozitivelor de suport postural 13. Procurarea sculelor corespunzătoare pentru ajustarea rapidă a produselor 14. Alocarea unui membru al echipei pentru desfășurarea activității de instruire a utilizatorului, de exemplu, instructorul în scaun rulant 15. Identificarea unui spațiu pentru instruirea utilizatorului care să fie aproape de zonele desemnate pentru activitățile de tip clinic și tehnic 16. Stabilirea unor sisteme eficiente pentru controlul stocului 17. Pregătirea unui stoc redus de scaune rulante de diferite dimensiuni 18. Stabilirea unor parteneriate în comunitate pentru a identifica potențialii beneficiari şi pentru a le asigura transportul la centrul unde se furnizează serviciile pentru utilizatorii de scaun rulant 19. Dezvoltarea capacității partenerilor din comunitate pentru a furniza servicii de nivel de bază și de a genera trimiteri în cazul utilizatorilor care au nevoie de servicii de nivel intermediar 20. Deschiderea în ceea ce privește ideile noi - inovație Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 114 Coloana 1: provocări în furnizarea serviciilor Coloana 2: strategii Evaluare: 1. În cazul în care personalul se deplasează la un centru furnizor de servicii sau dacă efectuează vizite la domiciliu, timpul necesar deplasării trebuie încorporat în intervalul alocat evaluării. 2. În cazul în care membrii echipei nu au experiență, etapa de evaluare va avea o durată mai mare. Prescriere: 3. În cazul în care produsele au opțiuni de reglare limitate, trebuie prescrise anumite adaptări, astfel încât produsul să corespundă cu nevoile individuale ale utilizatorului. 4. În cazul în care trebuie confecționate dispozitive de suport postural suplimentare, sunt necesare măsurători și schițe suplimentare. Pregătirea produsului: 5. Este necesar să putem avea acces rapid la produse care au tipul și mărimea necesare. 6. În cazul în care un scaun rulant are o gamă limitată de opțiuni de ajustare, pregătirea produsului poate dura mai mult. 7. În cazul în care este nevoie de adaptări pentru asigurarea suportului postural, este necesar un timp suplimentar pentru pregătirea produsului. Probare: 8. În cazul în care au fost efectuate adaptări sau dacă scaunului rulant i-au fost adăugate suporturi suplimentare, etapa de probare va avea o durată mai mare. 9. În cazul în care, pe parcursul etapei de probare, se fac alte modificări ale scaunului rulant, vor fi necesare verificări suplimentare. Instruirea utilizatorului: 10. Atunci când un utilizator primește pentru prima oară un scaun rulant sau atunci când există complicații legate de starea de sănătate, etapa de instruire va avea o durată mai mare, pentru a putea aborda teme referitoare la starea de sănătate, mobilitate, manevrarea scaunului rulant, întreținerea acestuia și direcționarea utilizatorului către alte surse de trimiteri. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 115 C.4: Planificarea activității de monitorizare C.4.1 Depășirea obstacolelor • Citiți lista de potențiale obstacole în desfășurarea activității de monitorizare și adăugați alte bariere suplimentare menționate de către grupul de lucru • Discutați despre activitățile care pot facilita depășirea obstacolelor în cazul etapei de monitorizare și notați-le în tabelul de mai jos. Obstacole în activitatea de monitorizare Posibile obstacole în activitatea de monitorizare în cazul furnizorilor de servicii care își desfășoară activitatea în comunitate (pe teren): • Costurile legate de deplasările personalului furnizorului de servicii în comunități; • Timpul necesar pentru ca personalul furnizorului de servicii să efectueze deplasările în comunitate; • Activitatea de monitorizare nu constituie o prioritate a managerilor; • Activitatea de monitorizare nu este apreciată de către utilizatorii serviciilor până când aceștia nu experimentează beneficiile ce decurg din aceasta; Obstacole în activitatea de monitorizare efectuată la centrul furnizorului de servicii: • Costurile legate de deplasare și perioada de absență de la locul de muncă al unuia sau al mai multor membri din familia utilizatorului; • În mod frecvent, utilizatorii și membrii familiei acestuia nu cunosc beneficiile monitorizării; • Dificultăți în găsirea unor mijloace de transport accesibile; • Presiunea care rezultă din faptul că se pune accentul pe generarea de noi programări în vederea furnizării de servicii, ceea ce reduce timpul alocat activității de monitorizare; • Dificultăți în stabilirea programărilor: utilizatorii vin la furnizorul de servicii atunci când personalul nu este disponibil sau nu se prezintă atunci când personalul este disponibil. Sugestii de activități pentru depășirea obstacolelor în activitatea de monitorizare Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 116 C.5: Dezvoltarea sustenabilității financiare C.5.1 Identificarea surselor de finanțare • Citiți lista potențialelor surse de finațare și apelați la Manualul participantului pentru mai multe informații. • Alegeți trei surse despre care considerați că au cel mai mare potențial de producere a unor rezultate pe termen scurt; completați tabelul de mai jos pentru sursele de finanțare selectate. Diverse surse de finanțare ce pot fi luate în considerare de către manageri 1. Guvern 2. Sisteme de asigurări la nivel național 3. Donatori sau sponsori privați 4. Donatori sau sponsori din domeniul corporatist (business) 5. Contribuții ale utilizatorilor sau achitarea sumei integrale pentru achiziționarea produselor 6. Generare de venituri/întreprinderi sociale 7. Grupuri din comunitate/organizații caritabile 8. Misiuni diplomatice 9. Organizații non-guvernamentale internaționale sau naționale Surse de finanțare selectate Numerotați în ordinea priorității, luând în considerare următoarele: • Efortul necesar • Câștigul financiar pe termen scurt sau lung (sau ambele) Prioritatea Sursa de finanțare Investiție/ efort necesar ridicat/mediu/scăzut Câștig pe termen scurt ridicat/mediu/scăzut Câștig pe termen lung ridicat/mediu/ scăzut Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 117 C.5.2 Dezvoltarea unei strategii • Citiți exemplul de strategie de mai jos. • Enumerați cele trei surse de finanțare identificate în tabelul de la exercițiul anterior. • Completați coloanele din tabel cu informații referitoare la sursele de finanțare selectate. Sursa de finanțare Tipul de susținere Solicitare Probabilitate Efort 1. Societate comercială Donație pentru bugetul de achiziționare a scaunelor rulante 10% din bugetul pentru scaune rulante Mediu (au finanțat în trecut, totuși nu finanțează în fiecare an aceeași organizație) Cel puțin două întâlniri cu managerul companiei; propunere de 2 pagini și buget de depus şi invitarea managerului la următoarea acțiune de tip „ziua porților deschise”. 2. Autoritate locală Este posibil să finanțeze vizitele la domiciliul utilizatorilor de scaune rulante din zonă. 20% din costurile totale ale deplasărilor în comunitate și 20% din salariile personalului furnizor de servicii Ridicat (se discută deja despre acest aspect cu autoritățile locale. S-au furnizat servicii în respectiva comunitate. Sunt interesați în mod real în susținerea furnizării acestui tip de servicii și aparent există fonduri disponibile). Propunere și buget de depus. Condiții de raportare – necesită informații corecte despre toate persoanele vizitate în acea zonă și raportare financiară.

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PACHET DE INSTRUIRE P ENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULA NT MANUALUL ȘI CAIET UL PARTICIPANTULU I

PACHET DE INSTRUIRE PENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULANT MANUALUL ȘI CAIETUL PA RTICIPANTULUI Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 2 Publicat de Organizația Mondială a Sănătății în 2015, cu titlul Wheelchair service training package for managers. Additional resources for managers. © World Health Organization 2015 Organizația Mondială a Sănătății a acordat Fundației Motivation România dreptul de a traduce și de a publica ediția în limba română, aceasta fiind singura responsabilă pentru calitatea și acuratețea versiunii în limba română. În cazul în care vor exista discrepanțe între versiunea în limba engleză și cea în limba română, va prevala versiunea originală, în limba engleză. Servicii pentru utilizatorii de scaun rulant – Pachet de instruire pentru manageri. Resurse suplimentare © Fundația Motivation România 2016 Conținut: Manualul formatorului pentru manageri – Manualul și caietul participantului pentru manageri – Resurse suplimentare pentru manageri – Manualul formatorului pentru părțile interesate. 1. Scaune rulante – standarde. 2. Persoane cu dizabilități – recuperare. 3. Materiale didactice I. Frost, Sarah, II. Khasnabis, Chapal. III. Mines, Kylie. IV. De la Peza, Lourdes. V. Organizația Mondială a Sănătății. Fundația Motivation România Descrierea CIP a Bibliotecii Naţionale a României ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (GENEVA) SERVICII PENTRU UTILIZATORII DE SCAUN RULANT : PACHET DE INSTRUIRE PENTRU MANAGERI / ORGANIZAŢIA MONDIALĂ A SĂNĂTĂŢII (OMS) ; ED.: SARAH FROST, CHAPAL KHASNABIS, KYLIE MINES, LOURDES DE LA PEZA. – BUCUREŞTI : CONTAPLUS, 2015 BIBLIOGR. ISBN I. Frost, Sarah (ed.) II. Khasnabis, Chapal (ed.) III. Mines, Kylie (ed.) IV. De la Peza, Lourdes (ed.) 615.478.3 Această publicație a fost realizată de Fundația Motivation România în colaborare cu World Vision, în cadrul sub- grantului nr. APC-GM-0029-008, prin Advancing Partners & Communities (APC), un acord de cooperare de 5 ani finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională – USAID, prin Acordul nr. AID-OAA-A-12-00047, începând cu 1 octombrie, 2012. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 3 Terminologie Următorii termeni, utilizaţi în pachetul de instruire, sunt definiţi mai jos. Scaun rulant corespunzător Un scaun rulant care corespunde nevoilor utilizatorului şi caracteristicilor mediului în care acesta trăiește; care are dimensiunea potrivită și care oferă suport postural adecvat; care poate fi utilizat în condiții de siguranță şi este durabil; fiind disponibil în ţara utilizatorului; care poate fi obţinut şi întreţinut, iar serviciile sunt sustenabile în ţara respectivă, la cel mai accesibil preţ. Scaun rulant cu antrenare manuală Un scaun rulant a cărui propulsie se efectuează de către utilizator sau de către o altă persoană. Dispozitiv de suport postural (DSP) Un dispozitiv fizic care oferă suport postural suplimentar. Scaun rulant Un dispozitiv cu roţi care oferă mobilitate şi suport postural, utilizat de persoanele cu dificultăţi de mers sau de deplasare. Modificare scaun rulant Efectuarea unei schimbări la nivelul scaunului rulant. Furnizare scaune rulante Este termenul generic pentru proiectarea, producţia, furnizarea de scaune rulante şi servicii pentru utilizatorii de scaun rulant. Servicii pentru utilizatorii de scaun rulant Reprezintă acea parte a procesului de furnizare a scaunelor rulante care se ocupă de dotarea utilizatorului cu un scaun rulant corespunzător. Personal furnizor de servicii pentru utilizatorii de scaun rulant Persoane specializate în furnizarea scaunelor rulante corespunzătoare. Utilizator de scaun rulant O persoană care are dificultăţi de mers sau de deplasare şi care foloseşte pentru mobilitate un scaun rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 4 CUPRINS MANUALUL ȘI CAIETUL PARTICIPANTULUI / 1 Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri / 5 Introducere / 5 Grupul ţintă / 5 Obiectiv / 6 Conținut / 6 Cum se utilizează Manualul participantului şi Caietul de exerciţii / 7 A. Noțiuni fundamentale / 8 A.1 Ce înseamnă furnizarea unui scaun rulant corespunzător? / 8 A.2 Furnizarea serviciilor pentru utilizatorii de scaun rulant / 10 A.3 Managerii care determină schimbarea / 17 B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 20 B.1 Accesarea serviciilor / 20 B.2 Spații și echipamente / 25 B.3 Gama de scaune rulante corespunzătoare / 32 B.4 Organizarea resurselor umane / 38 B.5 Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 43 C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 46 C.1 Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? / 46 C.2 Gestionarea cererii / 52 C.3 Planificarea activității de monitorizare / 60 C.4 Planificarea sustenabilității financiare / 69 Referinţe bibliografice / 75 CAIET DE EXERCIŢII PRACTICE / 77 CUPRINS Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 5 Despre Servicii pentru utilizatorii de scaun rulant – pachet de instruire pentru manageri Introducere În urma lansării în anul 2008 a Ghidului pentru furnizarea scaunelor rulante cu antrenare manuală în zone cu resurse limitate(1), în anul 2012 a fost publicat primul pachet de instruire, numit Servicii pentru utilizatorii de scaun rulant. Pachet de instruire – nivel de bază (2). Acesta a fost urmat în anul 2013 de lansarea Serviciilor pentru utilizatorii de scaun rulant. Pachet de instruire – nivel intermediar (3). Organizaţia Mondială a Sănătăţii (OMS), în parteneriat cu Agenţia Statelor Unite pentru Dezvoltare Internaţională (USAID) a elaborat acum a treia parte, care cuprinde două materiale: Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri şi Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru părţile interesate. Această a treia parte a fost creată pentru a susţine managerii în efortul de eficientizare a procesului de furnizare a scaunelor rulante corespunzătoare şi pentru a creşte gradul de conştientizare în rândul părţilor interesate şi a promova implicarea lor în dezvoltarea unor servicii de furnizare a scaunelor rulante corespunzătoare în ţara/zona lor. Scaunul rulant este unul dintre echipamentele asistive cel mai frecvent utilizate pentru facilitarea mobilităţii personale. În cazul persoanelor care întâmpină dificultăţi de mers sau de deplasare, scaunul rulant este un instrument esenţial care facilitează mobilitatea, creşte capacitatea de a desfăşura anumite activităţi, oferă sentimentul de demnitate şi de stare de bine generală. Pentru utilizatorii de scaun rulant, mobilitatea înseamnă independenţă, accesul la servicii de sănătate, la educaţie, la angajare şi, de asemenea, participarea acestora la activităţi sociale şi culturale. OMS estimează faptul că peste 70 de milioane de persoane au nevoie de scaune rulante şi că doar 5 – 15% dintre acestea au acces la un astfel de echipament de mobilitate. În plus, oportunităţile de instruire a personalului în vederea dobândirii cunoştinţelor şi abilităţilor necesare pentru furnizarea eficientă a scaunelor rulante sunt limitate. Importanţa mobilităţii este reflectată în Convenţia Organizaţiei Naţiunilor Unite pentru Drepturile Persoanelor cu Dizabilităţi (CONUDPD) (4), care pledează pentru „măsuri eficiente în vederea asigurării mobilităţii persoanelor cu dizabilităţi în cel mai înalt grad de independenţă posibil”. Pentru realizarea mobilităţii personale, utilizatorii au nevoie de scaune rulante care au măsurile corespunzătoare şi care răspund nevoilor lor specifice; în special celor legate de stilul de viaţă şi mediul în care trăiesc. Acest aspect necesită o abordare orientată către nevoile individuale ale utilizatorilor de scaun rulant. O modalitate eficientă de a răspunde acestor nevoi individuale ale utilizatorilor de scaun rulant este furnizarea scaunelor rulante printr-un sistem bine organizat, care răspunde aşteptărilor utilizatorilor, care le respectă demnitatea şi este gestionat de către un personal bine pregătit. Grupul ţintă Acest pachet de instruire este destinat întregului personal care răspunde de implementarea, gestionarea şi evaluarea serviciilor de recuperare, incluzând aici furnizarea serviciilor pentru utilizatorii de scaun rulant sau furnizarea scaunelor rulante. Nu este necesar ca participanții să dețină deja experienţă în ceea ce privește managementul furnizării serviciilor pentru utilizatorii de scaun rulant; cu toate acestea, modulul de instruire se bazează pe faptul că participanţii au abilităţi generale de management. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 6 Obiectiv Obiectivul întregului pachet de instruire este creșterea gradului de conştientizare şi dezvoltarea abilităţilor şi a nivelului de cunoştinţe al personalului implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant. OMS înţelege faptul că doar personalul instruit nu poate asigura furnizarea de scaune rulante corespunzătoare şi că acesta nu îşi poate îndeplini responsabilităţile în conformitate cu Ghidul privind furnizarea scaunelor rulante, fără ca la nivel de ţară să existe un înalt grad de implicare pentru dezvoltarea sau îmbunătăţirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Pachetul de instruire pentru manageri oferă o privire de ansamblu asupra rolului managerului unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant, cu privire la implicarea personalului şi punerea în aplicare a celor opt etape ale procesului de furnizare a scaunelor rulante și alte aspecte legate de acesta. Ne referim aici la resursele umane şi materialele necesare furnizării serviciilor pentru utilizatorii de scaun rulant, inclusiv la planificare, organizare, personal, management, costuri/finanţare, monitorizare şi evaluare. Pachetul de instruire poate fi parcurs în 13-14 ore, acest interval putând fi extins sau redus, în funcţie de cerinţele specifice şi de resursele disponibile. Acest modul de instruire va ajuta managerii: • să planifice mai bine activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant; • să crească nivelul de calitate al procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant; • să crească gradul de retenţie a personalului; • să crească numărul de utilizatori de scaune rulante care primesc un scaun rulant adecvat cerinţelor lor; • să crească gradul de sustenabilitate a activităţii de furnizare a scaunelor rulane. Conținut Pachetul de instruire include: • un rezumat al paşilor cheie ai procesului de furnizare a scaunelor rulante descriși în pachetele de instruire create de OMS; • cunoştinţe de bază necesare furnizării serviciilor pentru utilizatorii de scaun rulant: o inițierea unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant; o gestionarea unui proces de furnizare a acestor servicii; o asigurarea sustenabilităţii procesului de furnizare a acestor servicii. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 7 Cum se utilizează Manualul participantului şi Caietul de exerciţii Acest Manual al participantului oferă un rezumat al cunoştinţelor din Pachetul de instruire pentru manageri (WSTPm). Participanţii pot folosi Manualul participantului şi Caietul de exerciţii după finalizarea programului de instruire pentru a-şi reaminti punctele cheie predate în fiecare sesiune. Manualul este împărţit în trei secţiuni: A. Noțiuni fundamentale B. Inițierea unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant. Manualul participantului include şi un caiet de exerciţii, scopul acestuia fiind dezvoltarea cunoștințelor și abilităţilor personalului care furnizează servicii pentru utilizatorii de scaun rulant. Caietul de exerciţii conţine exerciţii pentru testarea şi dezvoltarea cunoştinţelor participanţilor, precum și materiale din sesiunile de instruire, prezentările PowerPoint şi din Manualul participantului. Se recomandă ca participanţii să păstreze Manualul participantului şi Caietul de exerciţii pentru a le putea utiliza ulterior, dacă va fi necesar. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 8 A. Noțiuni fundamentale A.1 Ce înseamnă furnizarea unui scaun rulant corespunzător? Furnizarea de scaune rulante este un termen generic pentru proiectarea, producția, livrarea și furnizarea serviciilor destinate utilizatorilor de scaun rulant. Scaunul rulant este unul dintre dispozitivele asistive cel mai frecvent utilizate, oferindu-le persoanelor cu dizabilități locomotorii posibilitatea de a se deplasa. Mobilitatea este un pas important spre incluziune. Atunci când o persoană primește un scaun rulant corespunzător prin intermediul unui furnizor specializat, se creează oportunități pentru viață socială, găsirea unui loc de muncă și acces la educație. Mai mult decât atât, ceilalți membri ai familiei au astfel posibilitatea de a participa la activitățile din comunitate și să se angajeze (5). Nu doar persoanele în cauză și familiile acestora beneficiază de gradul crescut de mobilitate. Economia locală și naţională au de câștigat, deoarece societatea are mai mulți membri care își aduc contribuția. În plus, în cazul utilizatorilor de scaune rulante corespunzătoare scade probabilitatea apariției diverselor probleme de sănătate secundare (de exemplu, a escarelor) și astfel este mai puțin probabil ca ei să aibă nevoie de servicii medicale. Există o nevoie urgentă de schimbare, astfel încât să crească numărul de utilizatori care beneficiază de pe urma furnizării scaunelor rulante corespunzătoare. Care este numărul persoanelor care au nevoie de scaun rulant? Organizația Mondială a Sănătății estimează că 1% din populație are nevoie să folosească scaune rulante. Acest lucru înseamnă că, la nivel global, 70 de milioane de persoane au nevoie de scaune rulante. Această statistică ar putea fi un punct de pornire în stabilirea numărului de persoane din fiecare țară, județ sau oraș. În consecință, managerii nu trebuie să aștepte realizarea unor studii detaliate pentru a putea începe planificarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Populație % Numarul aproximativ al persoanelor care necesită un scaun rulant Populația la nivel mondial 7.000.000.000 1% 70.000.000 Brazilia 203.657.000 1% 2.036.570 China 1.401.587.000 1% 14.015.870 Egipt 84.706.000 1% 847.060 India 1.282.390.000 1% 12.823.900 Nigeria 183.523.000 1% 1.835.230 Rusia 142.098.000 1% 1.420.980 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 9 Convenții, strategii și politici pentru susținerea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Un număr mare de persoane care au nevoie de scaun rulant nu dețin încă un astfel de echipament de mobilitate corespunzător. Este necesar să existe un sprijin puternic pentru creșterea accesului la scaune rulante corespunzătoare. Managerii pot utiliza politici la nivel global, regional și național în vederea promovării dreptului la mobilitate, în numele persoanelor cu deficiențe de mobilitate. Tabelul de mai jos conține exemple de convenții, strategii, politici și linii directoare care pot constitui instrumente pentru manageri. Politică la nivel internațional Exemplu regional: Strategia Incheon Politici și linii directoare la nivel național Cel mai important instrument este Convenția Organizației Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități (CONUDPD). Articolul 20 al CONUDPD prevede că toți oamenii au dreptul la mobilitate personală. Alte articole ale CONUDPD consolidează importanța și relevanța furnizării de scaune rulante corespunzătoare. Acestea includ: • Articolul 19 – Viaţa independentă şi dreptul la incluziune în comunitate • Articolul 24 – Educația • Articolul 25 – Sănătatea • Articolul 26 – Recuperarea • Articolul 27 – Viața profesională și angajarea • Articolul 30 – Participarea la viaţa culturală, activități de petrecere a timpului liber și la activități sportive În 2012 a fost adoptată Strategia Incheon pentru transformarea drepturilor în realitate (‘Make the Right Real‘) pentru persoanele cu dizabilități din Asia și zona Pacificului. Strategia Incheon are 10 obiective, iar obiectivul 3 se referă la îmbunătățirea accesului la mediul fizic, transport în comun, la cunoștințe, informație și comunicare. În timpul elaborării strategiei s-a pus un accent deosebit pe demonstrarea faptului că acest obiectiv nu poate fi atins fără accesul la dispozitive asistive adecvate, inclusiv la scaune rulante. Prin urmare, obiectivul 3 își propune să reducă la jumătate numărul persoanelor cu dizabilități care au nevoie de dispozitive asistive corespunzătoare, dar care nu le dețin. Guvernele statelor care au semnat Strategia Incheon s-au angajat să dezvolte planuri naționale pentru a-și îndeplini această obligație. Acesta este un exemplu al modalității în care politicile internaționale și regionale pot sprijini și încuraja dezvoltarea politicilor la nivel național. Planificarea, politicile și liniile directoare la nivel național pot contribui la creșterea eficacității și sustenabilității procesului de furnizare a scaunelor rulante (6). Dezvoltarea politicilor și liniilor directoare la nivel național impune colaborarea tuturor părților interesate, inclusiv a persoanelor cu dizabilități, a furnizorilor de servicii guvernamentali și non- guvernamentali. CONUDPD și strategiile regionale relevante sprijină dezvoltarea planificării, politicilor și a liniilor directoare la nivel național. Liniile directoare la nivel național pot fi de ajutor în definirea modalității de furnizare a dispozitivelor asistive, inclusiv a dispozitivelor de mobilitate. De exemplu, în anul 2003, în Africa de Sud au fost publicate principiile la nivel național cu privire la furnizarea dispozitivelor asistive, asigurându-se standarde minime pentru etapele procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant, instruirea personalului, crearea și gestionarea listelor de așteptare, bugete și furnizarea de servicii de reparație și întreținere. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 10 A.2 Furnizarea serviciilor pentru utilizatorii de scaun rulant Serviciile destinate utilizatorilor de scaun rulant joacă un rol important în furnizarea acestor echipamente de mobilitate. Personalul furnizor de servicii pentru utilizatorii de scaun rulant lucrează împreună cu acești beneficiari cu scopul găsirii celui mai potrivit scaun rulant (dintre cele disponibile) pentru respectivul utilizator. Servicii pentru utilizatorii de scaun rulant – nivel de bază și nivel intermediar Orice scaun rulant care i se potrivește utilizatorului, îi oferă acestuia un anumit grad de suport postural. Spătarul, perna, suporturile pentru picioare și pentru brațe furnizează suport postural atunci când sunt ajustate astfel încât să se potrivescă dimensiunilor utilizatorului de scaun rulant. Cu toate acestea, un număr mare de utilizatori de scaun rulant, copii și adulți, au nevoie de suport postural suplimentar în timpul folosirii echipamentului de mobilitate. Acest lucru înseamnă că este nevoie de niveluri diferite de furnizare a acestui tip de servicii. Furnizarea serviciilor pentru utilizatorii de scaun rulant cu cerințe de nivel de bază se adresează utilizatorilor de scaun rulant care pot menține poziția așezat fără suport postural suplimentar. Furnizarea serviciilor pentru utilizatorii de scaun rulant cu cerințe de nivel intermediar se adresează utilizatorilor de scaun rulant care au nevoie de suport postural suplimentar pentru menținerea poziției așezat. Este important ca managerii care gestionează furnizarea serviciilor destinate utilizatorilor de scaun rulant să definească dacă acestea se încadrează la servicii de nivel de „bază” sau „intermediar”. Acest lucru este rezultatul faptului că furnizarea serviciilor la nivel intermediar presupune existența unui personal cu un nivel de instruire mai ridicat, o gamă mai largă de scaune rulante, mai multe materiale și echipamente. Răspunsul adecvat la nevoile referitoare la mobilitate și suport postural Clara trăiește în Timorul de Est. Ea lucrează în magazinul deținut de familia ei, care se află în partea din față a casei lor. Clara a fost diagnosticată cu poliomielită și are nevoie de un scaun rulant pentru a se deplasa în interiorul casei, pentru a lucra în magazin și pentru a se deplasa în afara casei. Clara reușește să mențină poziția așezat fără suport suplimentar și folosește un scaun rulant cu antrenare manuală, care a fost adaptat astfel încât să se potrivească dimensiunilor corpului ei. Clara este un exemplu de persoană căreia îi poate fi furnizat un scaun rulant printr-un serviciu de nivel de bază. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 11 Ishade are vârsta de 8 ani și locuiește în Sri Lanka. A fost diagnosticată cu paralizie cerebrală. Acest lucru înseamnă că Ishade nu își poate controla membrele superioare, cele inferioare, capul și gâtul. Ea nu poate menține poziția așezat fără suport postural. Ishade reprezintă un exemplu de persoană care are nevoie de suport postural suplimentar în timpul folosirii scaunului rulant. Lui Ishade trebuie să i se furnizeze un scaun rulant printr-un serviciu de nivel intermediar. Cele opt etape ale procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Etapa Rezumat 1. Trimiterea și programarea Modalitatea prin care utilizatorii de scaun rulant sunt direcționați către furnizorul de servicii dedicate lor va varia. Utilizatorii pot apela la un furnizor la recomandarea altor persoane utilizatoare de scaun rulant sau prin intermediul rețelelor alcătuite din personal sau voluntari ai serviciilor de sănătate și recuperare guvernamentale sau non-guvernamentale, din cadrul comunității, la nivel local sau regional. Unii furnizori de servicii pentru utilizatorii de scaun rulant trebuie să identifice în mod activ potențialii utilizatori, și anume pe cei care la acel moment nu beneficiază de servicii sociale sau de sănătate, care nu participă la activități școlare, comunitare sau care nu sunt angajați. 2. Evaluarea Este nevoie de o evaluare individuală în cazul fiecărui utilizator de scaun rulant. Aceasta include strângerea informațiilor despre stilul de viață al utilizatorului de scaun rulant, activitatea sa, mediul în care trăiește și condiția sa fizică. 3. Prescrierea (selecția) Prin utilizarea informațiilor dobândite pe parcursul evaluării, se pregătește prescrierea scaunului rulant. Această etapă implică utilizatorul, familia sau însoțitorul acestuia. Prescrierea prezintă în detaliu tipul, mărimea, caracteristicile speciale și modificările aduse scaunului rulant. De asemenea, se notează în detaliu și aspectele legate de instruirea de care are nevoie utilizatorul pentru folosirea și întreținerea adecvată a scaunului rulant. 4. Finanțarea și plasarea comenzii Se identifică o sursă de finanțare și se plasează comanda pentru scaunul rulant, care provine din stocul furnizorului sau este livrat de către producător. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 12 5. Pregătirea produsului Personalul calificat pregătește scaunul rulant pentru prima utilizare. În funcție de produs și adaptările sale, probarea poate include asamblarea și posibilele modificări ale produselor furnizate de către producător sau fabricarea unor produse adaptate în atelierul furnizorului de servicii. 6. Probarea produsului Utilizatorul probează scaunul rulant. Se efectuează ajustările finale pentru a ne asigura că scaunul rulant este corect asamblat și reglat. În cazul în care este nevoie de modificări sau componente pentru suport postural, se vor efectua adaptări suplimentare. 7. Instruirea utilizatorilor Utilizatorul și însoțitorul sunt instruiți în legătură cu utilizarea în condiții de siguranță și cu modalitatea de întreținere eficientă a scaunului rulant. 8. Monitorizarea, întreținerea și reparațiile Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, care nu pot fi rezolvate cu ușurință în cadrul comunității. Modele de furnizare a serviciilor pentru utilizatorii de scaun rulant Orice sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant trebuie să conțină cele opt etape. Cu toate acestea, există modalități diferite de parcurgere a acestora, ele fiind descrise ca modele de furnizare. O combinație de diferite modele de furnizare a serviciilor poate constitui un ansamblu de servicii, la nivel național. Cel/e mai potrivit/e model/e de furnizare a serviciilor va/vor depinde de context, iar decizia trebuie luată prin consultarea tuturor părților interesate. Tabelul de mai jos prezintă câteva exemple de modele de furnizare a serviciilor pentru utilizatorii de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 13 Furnizarea serviciilor la sediu Loc special prevăzut pentru evaluarea utilizatorilor de scaun rulant În cazul furnizării serviciilor la sediu, utilizatorii de scaun rulant se deplasează la un centru cu caracter permanent, unde este disponibil un personal calificat în acest sens. Fiind un centru permanent, există personal și spații special prevăzute pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant. Este posibil ca furnizarea serviciilor la sediu să fie un proces eficient în ceea ce privește personalul. Cu toate acestea, utilizatorii de scaun rulant care locuiesc la distanță pot întâmpina dificultăți în deplasarea la sediul furnizorului. Loc special prevăzut pentru exersarea abilităților de manevrare a scaunului rulant Serviciul integrat Activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant desfășurată într-o clinică din comunitate. Majoritatea serviciilor furnizate la centru sunt, de asemenea, „servicii integrate”. Acest lucru înseamnă că furnizarea serviciilor pentru utilizatorii de scaun rulant este integrată în cadrul activităților unui alt serviciu (sau altor servicii). De exemplu, furnizarea serviciilor pentru utilizatorii de scaun rulant poate fi integrată cu activitatea de furnizare a protezelor/ortezelor, într-un departament de fizioterapie sau într-o clinică. În acest caz, dacă personalul îndeplinește o serie de sarcini, inclusiv furnizarea de servicii pentru utilizatorii de scaun rulant, este important să se aloce suficient timp pentru efectuarea tuturor activităților prevăzute. Spațiile în care se lucrează sunt fie comune, fie există zone special prevăzute pentru desfășurarea respectivelor activități. Funcțiile administrative, financiare și de management pot fi comune. În acest caz, există un spațiu de lucru dedicat activităților de pregătire a scaunului rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 14 Furnizarea serviciilor în comunitate Locurile unde se furnizează serviciile pot varia. Exemplele includ clinici din comunitate, primării, locuri de întâlnire din mediul rural, domiciliul utilizatorului de scaun rulant. În cazul furnizării serviciilor în comunitate, personalul care în mod obișnuit își desfășoară activitatea la un centru sau în cadrul unor servicii integrate se deplasează fie la domiciliul utilizatorului de scaun rulant, fie la un centru dintr-un alt district/altă regiune – cu scopul de a se întâlni cu utilizatorii de scaun rulant din acel district/acea regiune pentru furnizarea serviciului respectiv. Acest model de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune, de obicei, un parteneriat cu o organizație/ organizații localizată/localizate în regiunea unde se oferă acest tip de asistență. Este important ca să existe o bună coordonare cu organizația/organizațiile locală/locale. Instruirea personalului local sau a voluntarilor contribuie la creșterea șanselor de succes în furnizarea serviciilor și la creșterea gradului de susținere existent în comunitate. În cazul utilizatorilor de scaun rulant, avantajul îl reprezintă distanța mai mică pe care trebuie să o parcurgă pentru a accesa serviciile. Personalul care furnizează servicii în comunitate trebuie să fie flexibil și să aducă echipamentul de bază. Serviciul mobil Exemplu de vehicul specializat pentru serviciul mobil destinat utilizatorilor de scaun rulant Serviciul mobil este o altă modalitate de a furniza servicii în comunitate; totuși, în această situație, personalul deține un vehicul specializat care este utilizat pentru a transporta scaunele rulante, precum și instrumentele și echipamentele necesare. Personalul are posbilitatea de a-și desfășura activitatea în mai multe locuri și de a ajunge astfel la mai mulți utilizatori de scaun rulant. Posibilitatea de a transporta mai multe instrumente, echipamente, materiale și piese de schimb crește șansele de a efectua pe loc reparații de scaune rulante, precum și potențialul de a furniza servicii de nivel intermediar. Prin utilizarea unui vehicul specializat, personalul are posibillitatea de a transporta mai multe dintre echipamentele și instrumentele necesare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 15 Furnizarea în parteneriat a serviciilor destinate utilizatorilor de scaun rulant Nu toate cele opt etape ale furnizării serviciilor pentru utilizatorii de scaun rulant trebuie să fie oferite de aceeași organizație. Colaborarea în cadrul unei rețele de organizații poate să ajute la creșterea eficienței serviciului și a gradului de acces al utilizatorilor de scaun rulant la aceste servicii. Etapa 1 (trimiterea și programarea) necesită în mod obligatoriu colaborarea între organizații și persoane care alcătuiesc o rețea de surse de trimitere pentru furnizorul de servicii destinate utilizatorilor de scaun rulant. Etapa 7 (instruirea utilizatorilor) și etapa 8 (întreținere, reparații şi monitorizare) pot fi adesea furnizate de către un partener. De exemplu, o rețea de organizații din comunitate sau organizații pentru persoane cu dizabilități pot desfășura în cadrul comunității activitățile specifice acestor pași ai procesului de furnizare a serviciilor. 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea Activităţi desfăşurate la centru EXEMPLU A. 2. 11. Furnizarea serviciilor pentru utilizatorii de scaun rulant Diagrama prezintă modul în care cele opt etape ale procesului de furnizare a serviciilor pot fi parcurse prin intermediul unui parteneriat între un furnizor de servicii pentru utilizatorii de scaun rulant și organizații din comunitate. Etapele 2-7 au loc la sediul furnizorului de servicii, în timp ce etapele 1 și 8 se desfășoară în comunitate. Acest model presupune să luăm în considerare nevoia de instruire atât a întregului personal, cât și a voluntarilor implicați. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 16 Rolul managerului în furnizarea serviciilor pentru utilizatorii de scaun rulant Managerul unui proces de furnizare a serviciilor pentru utilizatorii de scaun rulant are responsabilitatea de a sprijini personalul în parcurgerea celor opt etape ale furnizării serviciilor și de a coordona parcursul utilizatorului (însoțitorului/membrului din familie) prin aceste etape. Totodată, managerul îndeplinește și un rol mai general, important în sprijinirea furnizării serviciilor. Acest rol include: • creșterea gradului de conștientizare cu privire la furnizarea serviciilor corespunzătoare destinate utilizatorilor de scaun rulant; • îmbunătățirea accesibilității; • sporirea oportunităților de instruire pentru personalul care furnizează servicii pentru utilizatorii de scaun rulant; • dezvoltarea sustenabilităţii – astfel încât furnizarea serviciilor pentru utilizatorii de scaun rulant să fie o activitate constantă; • influențarea politicii naționale cu privire la furnizarea de scaune rulante corespunzătoare; • îmbunătățirea gamei de scaune rulante disponibile. Creşterea gradului de conştentizare Monitorizare și evaluare Creşterea gradului de acces și satisfacerea așteptărilor utilizatorilor Personal motivat şi bine instruit Dezvoltarea sustenabilității Dezvoltarea unui sistem funcţional ROLUL MANAGERULUI A. 2. 11. Furnizarea serviciilor pentru utilizatorii de scaun rulant Implicarea activă a utilizatorilor de scaun rulant în procesul de furnizare a serviciilor Implicarea activă a utilizatorilor de scaun rulant în toate aspectele furnizării serviciilor destinate lor va avea ca rezultat îmbunătățirea acestor servicii. Mai jos se găsesc câteva sugestii de strategii pentru manageri prin care se asigură implicarea activă a utilizatorilor de scaun rulant în procesul de furnizare a serviciilor (7): • asigurați-vă de faptul că personalul implică utilizatorul de scaun rulant în toate etapele care duc la furnizarea scaunului rulant, considerându-l pe acesta un membru al echipei. • elaborați un sistem pentru colectarea cu regularitate a feedback-ului din partea utilizatorilor, pentru a vedea care este opinia lor despre procesul de furnizare și pentru identificarea modalităților de îmbunătățire. • dacă este posibil, recrutați utilizatori de scaun rulant ca membri ai echipei de furnizare a serviciilor. Acest lucru poate însemna publicarea noilor poziții vacante prin intermediul sectorului care se ocupă de aspectele legate de dizabilitate și necesitatea ca toate spațiile de lucru să fie accesibile utilizatorilor de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 17 Utilizatori de scaun rulant în echipele de furnizare a serviciilor din România O organizație neguvernamentală din România, care furnizează servicii destinate utilizatorilor de scaun rulant, a recrutat astfel de persoane ca membri în echipele de lucru. Utilizatorii de scaun rulant au diferite roluri în cadrul echipelor, în funcție de abilitățile lor. Angajarea utilizatorilor de scaun rulant a avut un impact pozitiv imens. Prin interacțiunea zilnică la locul de muncă, fiecare membru al echipei conștientizează într-un grad mai mare care sunt nevoile utilizatorilor de scaun rulant, beneficiarii serviciilor se simt mai în largul lor să își împărtășească problemele cu alte persoane care utilizează scaune rulante, iar aceștia pot fi un model pentru cei din jur. A.3 Managerii care determină schimbarea Inițierea sau îmbunătățirea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune, în mod frecvent, producerea unor schimbări în cadrul unei organizații. Efectuarea acestor schimbări se poate dovedi dificilă. Un aspect al rolului pe care îl are managerul se referă la crearea premiselor pentru producerea schimbărilor, iar acest lucru poate fi realizat prin: • sprijin pentru crearea unei viziuni comune cu privire la furnizarea serviciilor pentru utilizatorii de scaun rulant; • transmiterea către personal, către actorii implicați în crearea de politici sau alți furnizori de astfel de servicii, precum și către potențiali finanțatori a importanței furnizării serviciilor corespunzătoare dedicate utilizatorilor de scaun rulant; • alocarea personalului și a resurselor adecvate; • motivarea, mobilizarea și implicarea personalului. Crearea unei viziuni comune cu privire la furnizarea serviciilor corespunzătoare dedicate utilizatorilor de scaun rulant Crearea unei viziuni, care să fie comună tuturor actorilor dintr-o anumită țară implicați în îmbunătățirea procesului de furnizare a scaunelor rulante contribuie la motivarea celor care trebuie să lucreze în parteneriat, cu scopul de a produce o schimbare. Viziunea înseamnă o reprezentare a unei imagini a viitorului, o traducere a scopului. De exemplu: „O lume a incluziunii pentru utilizatorii de scaun rulant, în care aceștia participă la toate aspectele vieții” Este important ca această viziune pozitivă să fie transmisă într-o manieră care să ducă la mobilizarea întregului personal, care să adere la această idee și să se mobilizeze pentru procesul de îmbunătățire a calității vieții persoanelor cu dizabilități. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 18 Transmiterea mesajului privind importanța furnizării serviciilor corespunzătoare pentru utilizatorii de scaun rulant Pentru a putea motiva în mod constant atât personalul, cât și celelalte părți interesate, managerii trebuie să comunice în mod coerent care este importanța furnizării de scaune rulante corespunzătoare. Managerii trebuie să comunice clar faptul că introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant constituie o prioritate și o urgență. Urgența situației constă în faptul că abordarea acestei nevoi nu poate fi evitată sau amânată. Oamenii se aliniază priorităților celor care îi coordonează, în consecință, demersurile managerului trebuie să transmită ideea că e nevoie de acțiune rapidă. Modalitatea de a transmite ideea că furnizarea scaunelor rulante corespunzătoare este o problemă importantă și urgentă • Discutați despre nevoia de scaune rulante la nivel global și național; dreptul la mobilitate personală; impactul benefic pe care îl au aceste servicii în ceea ce privește utilizatorii, comunitatea și societatea; • Discutați, în cadrul ședințelor de echipă care au loc la intervale regulate, despre progresele făcute în introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant; • Împărtășiți cazurile de succes și rezultatele pozitive, de exemplu, în cadrul ședințelor de personal sau folosind afișe în locuri vizibile, în spațiul unde se furnizează aceste servicii. Corelarea resurselor umane și materiale Procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant presupune existența personalului instruit, a spațiilor de lucru și a resurselor. Toți membrii echipei trebuie: • să lucreze în mod unitar, având același scop; • să simtă că dețin resursele de care au nevoie pentru a-și îndeplini sarcinile; • să beneficieze de apreciere pentru contribuția adusă. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 19 Modalități de organizare a resurselor umane și materiale • Identificați spațiile care pot fi folosite la furnizarea serviciilor destinate utilizatorilor de scaun rulant. • Atunci când alocați resurse umane, timp, spațiu, echipamente și resurse financiare, acordați prioritate procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. • Folosiți viziunea comună și beneficiile furnizării unui scaun rulant corespunzător ca instrumente prin care să reamintiți personalului care este scopul activității de furnizare a acestui tip de servicii. • Arătați apreciere și recompensați munca de calitate a personalului în furnizarea serviciilor destinate utilizatorilor de scaun rulant. • Antrenați personalul să lucreze în mod unitar, ca o echipă. Motivarea, implicarea și mobilizarea personalului Managerii pot contribui la motivarea, implicarea și mobilizarea resurselor umane prin: • Includerea personalului în etapele de planificare și implementare – pentru ca aceștia să poată contribui cu experiența și aptitudinile lor; pentru a-i ajuta să înțeleagă mai bine ce implică schimbarea și care este rolul lor în implementarea ei. • Depășirea obstacolelor prin acțiuni comune – pentru ca personalul să aibă o imagine mai clară asupra cauzelor și modalității de rezolvare a acestora. • Crearea de obiective pe termen scurt și exprimarea aprecierii pentru atingerea acelor obiective – pentru ca personalul să simtă că eforturile sale au un impact și că sunt apreciate. • Integrarea schimbărilor în sistemul și cultura organizației. De exemplu, introduceți obiceiul de a sărbători succesul în activități și încurajați oamenii să împărtășească cazurile și exemplele pozitive în timpul ședințelor și al pauzelor. De asemenea, asigurați-vă că schimbările în bine sunt menținute prin introducerea de noi responsabilități în fișele de post individuale și prin actualizarea politicilor organizaționale. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 20 B: Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1 Accesarea serviciilor Ce înseamnă „servicii echitabile”? Furnizarea unor „servicii echitabile” înseamnă asigurarea faptului că toți utilizatorii de scaun rulant au acces egal la primirea echipamentelor de mobilitate de care au nevoie. Acest aspect include: • beneficiari bărbați, femei, băieți și fete; • tineri, persoane adulte (de vârstă mijlocie) și persoane vârstnice; • persoane care locuiesc în proximitate și care locuiesc la distanță – de exemplu, în mediul rural; • persoane care provin din diferite grupuri etnice sau medii socio-economice. Serviciile echitabile se fundamentează pe ideea că toți oamenii, indiferent de tipul de dizabilitate, vârstă, sex, religie, situație materială, limba vorbită sau grupul etnic de care aparțin, au drepturi egale în ceea ce privește accesul la servicii. Furnizarea serviciilor echitabile nu înseamnă furnizarea unui număr egal de scaune rulante utilizatorilor din diverse grupuri (de exemplu, număr egal de scaune rulante pentru bărbați și femei). Acest lucru este consecința faptului că nevoile respectivelor grupuri pot varia. Rețineți: Accesarea serviciilor nu se rezumă doar la faptul de a avea acces la ele. Accesarea serviciilor presupune posibilitatea de a fi informați despre existența lor, accesul la ele sau deplasarea furnizorului de servicii acolo unde se află utilizatorul de scaun rulant. Există categorii de persoane care pot întâmpina dificultăți în accesarea serviciilor pentru utilizatorii de scaun rulant. Mai jos sunt prezentate câteva exemple: • femei – copii și adulte; • persoane care locuiesc la o distanță mare de locul furnizării serviciilor/persoane care locuiesc în mediul rural; • persoane cu venituri mici; • copii; Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 21 • persoane aparținând unor diferite grupuri etnice sau socio-economice; • persoane vârstnice; • grupuri specifice – de exemplu, persoanele diagnosticate ca fiind purtătoare ale virusului HIV sau cele diagnosticate cu lepră se pot confrunta cu discriminarea. Managerii trebuie să țină seama de context și să fie conștienți de existența diverselor grupuri care ar putea întâmpina dificultăți în accesarea serviciilor pentru utilizatorii de scaun rulant. Trimiterea și programarea Trimiterea și programarea reprezintă prima etapă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Etapa Rezumat 1. Trimiterea și programarea Modalitatea prin care utilizatorii de scaun rulant sunt direcționați către furnizorul de servicii dedicate lor va varia. Utilizatorii pot apela la un furnizor la recomandarea altor persoane utilizatoare de scaun rulant sau prin intermediul rețelelor alcătuite din personal sau voluntari ai serviciilor de sănătate și recuperare guvernamentale sau non- guvernamentale, din cadrul comunității, la nivel local sau regional. Unii furnizori de servicii pentru utilizatorii de scaun rulant trebuie să identifice în mod activ potențialii utilizatori, și anume pe cei care la acel moment nu beneficiază de servicii sociale sau de sănătate, care nu participă la activități școlare, comunitare sau care nu sunt angajați. Un sistem de trimiteri eficient presupune relații bune între furnizorul de servicii pentru utilizatorii de scaun rulant și comunitate, deoarece membrii comunității sunt cei care îi vor identifica pe utilizatori și îi vor îndrepta către furnizor. Mai jos sunt enumerate exemple de persoane sau organizații care ar putea identifica și direcționa utilizatorii de scaun rulant către furnizorul de servicii: • spitale locale; • centre de sănătate din comunitate; • rețele de recuperare din comunitate; • autorități la nivelul așezărilor rurale, membri ai consiliilor locale, reprezentanți ai bisericii; • organizații ale persoanelor cu dizabilități; • alți utilizatori de scaun rulant; • medici, asistente medicale. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 22 Ce pot face managerii pentru a dezvolta o rețea de surse de trimiteri? • Identificați sursele care pot face trimiteri (persoane și organizații) din zona în care vă desfășurați activitatea. • Discutați cu personalul furnizor de servicii pentru utilizatorii de scaun rulant despre tipurile de informații necesare, astfel încât aceste surse să poată identifica persoanele care au nevoie de scaun rulant și să le direcționeze către furnizorul de astfel de servicii. • Pregătiți (sau oferiți sprijin personalului care trebuie să facă acest lucru) formulare/pliante, care să conțină informațiile de care au nevoie aceste potențiale surse pentru a face trimiteri. • Vizitați (sau oferiți sprijin personalului care trebuie să facă acest lucru) persoanele sau organizațiile care au potențialul de a deveni surse de trimiteri și prezentați-le serviciile furnizate. • Organizați un eveniment de tipul „porți deschise” la care să participe utilizatori de scaun rulant și potențialele surse de trimiteri. • Organizați o sesiune de instruire pentru aceste surse, cu privire la crearea unei rețele pentru trimiteri. • Luați în considerare elaborarea unui formular de trimitere care să poată fi completat de către sursele de trimitere. Asigurați-vă că formularul este simplu de folosit și că există un răspuns din partea voastră (prin programarea utilizatorului de scaun rulant direcționat către voi); totodată, acordați feedback pozitiv celor care folosesc formularul de trimitere. Creșterea gradului de acces la servicii echitabile Managerii joacă un rol important în creșterea gradului de acces la servicii echitabile. Următorul tabel prezintă câteva sugestii cu privire la metode de facilitare a accesului diferitelor grupuri. Ce pot face managerii pentru a se asigura că procesul de furnizare a serviciilor este unul echitabil? P en tr u fe m ei – c op ii și a du lte • Asigurați-vă că informațiile sunt diseminate în diverse moduri – de exemplu, la radio, broșuri/afișe simple şi imagini vizuale. • Asigurați-vă că în materialele de promovare a serviciilor pentru utilizatorii de scaun rulant, femeile sunt reprezentate în aceeași măsură ca bărbații. • Identificați utilizatoare de scaun rulant care pot constitui un exemplu și care să vorbească public despre importanța scaunelor rulante în cazul femeilor care au nevoie de acestea. • Discutați cu reprezentanții autorităților din comunități, pentru a transmite ideea că scaunele rulante sunt importante în egală măsură în cazul femeilor, copiilor și al bărbaților. • Susțineți și încurajați participarea femeilor la toate aspectele legate de furnizarea serviciilor pentru utilizatorii de scaun rulant, inclusiv la nivel de management și de conducere. • Transmiteți către organizații ale persoanelor cu dizabilități informații referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant și evidențiați faptul că atât femeile, cât și bărbații au nevoie de scaune rulante pentru mobilitate. • Atunci când descrieți procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant, precizați că aceasta este o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 23 P en tr u co pi i • Asigurați-vă de faptul că informația legată de furnizarea serviciilor este disponibilă în locurile frecventate de părinții copiilor cu dizabilități – de exemplu, centre de sănătate din comunitate – spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei, temple. • Atunci când descrieți procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant, precizați că el este o activitate care se adresează bărbaților, femeilor și copiilor – nu doar „persoanelor”. • Furnizați instruire și informații persoanelor care lucrează cu copii cu dizabilități – de exemplu: medici, asistente, lucrători din domeniul sănătății care își desfășoară activitatea în comunități. • Asigurați-vă că în materialele de promovare a serviciilor pentru utilizatorii de scaun rulant, copiii și adulții sunt reprezentați în aceeași măsură. • Explicați beneficiile furnizării scaunelor rulante utilizatorilor copii la o vârstă cât mai mică. De asemenea, explicați impactul pozitiv asupra familiilor/ însoțitorilor acestor copii. P en tr u pe rs oa ne c u ve ni tu ri m ic i • Asigurați-vă că furnizarea serviciilor este pe cât se poate de eficientă din punct de vedere al costurilor. • Identificați modalitățile de oferire a unui sprijin financiar utilizatorilor care nu au resursele necesare pentru a se deplasa la furnizorul de servicii sau care nu își permit achiziționarea unui scaun rulant (în cazul în care există costuri) – de exemplu, crearea unui fond pentru echipamente de mobilitate. P en tr u pe rs oa ne vâ rs tn ic e • Atunci când prezentați serviciile pentru utilizatorii de scaun rulant, menționați întotdeauna că acestea se adresează tuturor categoriilor, inclusiv persoanelor vârstnice. • Includeți în materialele de prezentare imagini cu persoane vârstnice, care utilizează scaune rulante. • Atunci când discutați despre serviciile destinate utilizatorilor de scaun rulant, explicați care sunt beneficiile unui scaun rulant pentru persoanele în vârstă și familiile acestora. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 24 P en tr u pe rs oa ne c ar e lo cu ie sc la d is ta nț ă de fu rn iz or ul d e se rv ic ii / p er so an e di n m ed iu l r ur al • Asigurați-vă de faptul că informația legată de furnizarea serviciilor este disponibilă în zonele rurale – de exemplu, centre de sănătate din comunitate – spitale, servicii de recuperare, piețe, centre pentru activități din comunitate, biserici, moschei şi temple. • Furnizați informații persoanelor care lucrează cu persoane din mediul rural – de exemplu, lucrători din centre comunitare de recuperare. • În cazul în care furnizorul nu își desfășoară activitatea pe teren, identificați metode pentru a oferi asistență în ceea ce privește transportul utilizatorilor de scaun rulant din zonele rurale. De exemplu, sprijin financiar pentru transport, colaborarea cu alte organizații care pot ajuta cu transportarea utilizatorilor la furnizorul de servicii. • Stabiliți dacă există posibilitatea de a oferi cazare acelor utilizatori de scaun rulant care se vin din localități rurale. • Furnizați servicii în comunitățile situate în zonele din mediul rural. • Instruiți persoanele care lucrează în mediul rural (de exemplu, persoane din domeniul sănătății) cu privire la modalitățile de a oferi sprijin utilizatorilor de scaun rulant din comunitate, la desfășurarea monitorizării și la posibilitățile de a oferi asistență pentru întreținerea scaunelor rulante și efectuarea reparațiilor lipsite de complexitate. • Asigurați-vă că sunt disponibile scaune rulante adecvate utilizării în mediul rural, pe teren accidentat și oferiți informații cu privire la efectuarea unor operațiuni de adaptare minore (de exemplu, rampe sau nivelarea căilor de acces), pentru a facilita utilizarea echipamentelor în mediul rural. P en tr u di fe ri te gr up ur i e tn ic e/ so ci o- ec on om ic e • Atunci când prezentați serviciile pentru utilizatorii de scaun rulant, menționați întotdeauna că furnizarea acestora se adresează tuturor, indiferent de apartenența la grupuri etnice sau socio-economice. • Includeți în materialele de prezentare imagini cu persoane din diferite grupuri etnice și religioase. • Acolo unde este posibil, angajați personal aparținând diverselor grupuri etnice și socio-economice. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 25 B.2 Spații și echipamente Furnizarea serviciilor pentru utilizatorii de scaun rulant se poate desfășura în diverse locuri. Totuși, indiferent de locul unde se furnizează serviciile, sunt necesare anumite spații și echipamente. Serviciile pentru utilizatorii de scaun rulant cu cerințe de nivel de bază necesită mai puțin spațiu și un număr mai mic de echipamente decât serviciile de nivel intermediar. Spații și echipamente pentru toate tipurile de servicii destinate utilizatorilor de scaun rulant (nivel de bază și nivel intermediar) Spațiu desemnat pentru recepție și sala de așteptare Ce fel de spațiu este necesar? Este necesar un spațiu pentru o zonă de recepție și un loc unde utilizatorii de scaun rulant și familiile acestora pot aștepta împreună. În cazul în care persoanele au călătorit de la o distanță mai mare pentru a ajunge la furnizorul de servicii, se recomandă să aveți în vedere un loc unde au acces la alimente și băuturi răcoritoare. În imaginea din dreapta, un comerciant local administrează un stand în afara unei clinici dintr-o localitate. Poate fi utilă o zonă retrasă, unde utilizatorii de scaun rulant se pot întinde pe perioada așteptării. Acest lucru este important în special în cazul: • persoanelor cu un grad crescut de fragilitate și care au nevoie de odihnă pe durata vizitei la centrul furnizorului de servicii; • copiilor care sunt obosiți; • persoanelor la care sunt prezente escare în zone ale corpului asupra cărora greutatea exercită presiune. Trebuie să existe o toaletă accesibilă în apropierea zonei de recepție, precum și în apropierea zonei unde se efectuează evaluarea și probarea echipamentului de mobilitate. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 26 Echipamente recomandate: Echipamentele pentru înregistrare includ: masă/birou, scaun, telefon și un loc unde documentele pot fi depozitate și îndosariate în siguranță. Este utilă dispunerea în zona de așteptare a afișelor, pliantelor și materialelor video disponibile. În cazul în care centrul este vizitat de un număr mare de copii, se recomandă să aveți disponibile câteva jucării simple, pe care aceștia să le poată folosi pe parcursul perioadei de așteptare. Spațiu pentru birourile personalului Ce fel de spațiu este necesar? Personalul are nevoie de un spațiu unde membrii echipei au posibilitatea de a lucra împreună, de a se reuni, unde își pot scrie notițele și unde pot depozita în siguranță documentele cu care lucrează. Spațiu pentru desfășurarea evaluării și probării Ce fel de spațiu este necesar? Este necesar un spațiu cât mai liniștit și retras unde utilizatorii de scaun rulant pot fi evaluați de către personal și unde poate avea loc probarea scaunelor rulante. Spațiul trebuie să fie accesibil utilizatorilor de scaun rulant, să fie suficient de mare, astfel încât membrii de familie să fie prezenți și să fie suficient de luminos. Este utilă identificarea unui perete gol, într-o zonă accesibilă, care să fie folosit pe parcursul evaluării pentru a face fotografii. În cazul în care activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant se desfășoară la sediu, se sugerează ca spațiul să aibă următoarele dimensiuni (dimensiunile pot varia în funcţie de volumul de muncă): • Spațiu pentru examinări clinice – nivel de bază: 3 m x 2.5 m • Spațiu pentru examinări clinice – nivel intermediar: 4 m x 3.5 m Uneori, zona de examinare clinică o constituie domiciliul utilizatorului de scaun rulant. În acest caz, sunt importante flexibilitatea, adaptabilitatea și echipamentele esențiale. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 27 Echipamente: • Paravane – în cazul în care sunt examinați mai mulți utilizatori de scaun rulant, se vor folosi perdele sau paravane pentru a asigura confortul utilizatorului. • Bancheta sau patul de evaluare – o structură fermă, stabilă, situată la aceeași înălțime ca scaunul rulant, pe care utilizatorul se așază pe durata evaluării. Suprafața superioară trebuie acoperită cu un material care să asigure protecția pielii, de exemplu, polistiren sau o saltea pentru gimnastică sau yoga. Poziționați patul de evaluare astfel încât cel care efectuează evaluarea să poată sta în fața sau în spatele utilizatorului de scaun rulant. • Suport pentru picioare – un set de suporturi de diferite mărimi pentru susținerea corectă a picioarelor utilizatorului. • Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. • Aparat foto/video – un astfel de aparat este util pentru înregistrarea etapelor cheie din cadrul evaluării și probării (cu acordul scris al utilizatorului de scaun rulant). • Ruletă și etrier reglabil. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 28 Spațiu pentru pregătirea, întreținerea și repararea scaunelor rulante Ce fel de spațiu este necesar? Este necesar un spațiu desemnat pentru „activități tehnice” care să fie folosit pentru: • asamblarea, repararea și întreținerea scaunelor rulante • confecționarea adaptărilor, acolo unde este cazul. Spațiul trebuie să fie bine iluminat, ventilat, izolat și cu o temperatură potrivită pentru desfășurarea activității. În cazul sculelor manuale și electrice, sunt importante măsurile de siguranță. În mod ideal, acestea trebuie depozitate în dulapuri metalice, care pot fi încuiate. În cazul în care activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant se desfășoară la sediu, spațiul tehnic ar trebui împărțit după cum urmează: • Un spațiu „curat”, desemnat pentru asamblarea finală a componentelor și reglarea produsului, precum și pentru efectuarea controalelor de siguranță și pregătirea echipamentului. Pentru acest spațiu sunt necesare suprafețe de sol și suprafețe de tip banc de lucru. • Pentru efectuarea modificărilor și reparațiilor este necesară o zonă de „fabricare”. Aici sunt incluse activitățile de modelare și lipire a buretelui, operațiunile generale de găurire, șlefuire, tăiere și vopsire. Pentru acest spațiu sunt necesare suprafețe de sol și suprafețe de tip banc de lucru. Nu este obligatoriu ca toate operațiunile tehnice să fie efectuate în spațiul pentru activități tehnice din cadrul centrului furnizorului de servicii pentru utilizatorii de scaun rulant. De exemplu, este posibil ca un furnizor să externalizeze anumite operațiuni tehnice, cum ar fi coaserea materialului textil (către un croitor local) și sudarea (către un atelier de confecții metalice local). Echipamente: • Un număr suficient de dulapuri, rafturi și polițe pentru depozitarea instrumentelor, pentru menținerea ordinii în spațiul respectiv și optimizarea suprafeței de sol. • Scule pentru asamblarea și reglarea scaunelor rulante și pentru realizarea adaptărilor. • O listă cu materiale pentru adaptări. • Cel puțin un banc de lucru pentru fiecare tehnician. Se recomandă ca cel puțin unul dintre bancurile de lucru să fie ajustabil pe înălțime, pentru cazul în care din echipă face parte și un utilizator de scaun rulant. Se recomandă ca bancul de lucru să fie poziționat astfel încât să existe spațiu în fața sau în spatele acestuia, pentru lucrările care se fac la nivelul solului. Pentru mai multe informații despre necesarul de scule, materiale și echipamente consultați resursele suplimentare de pe memory stick. (Notă: spațiile și echipamentele necesare atelierelor de fabricare a scaunelor rulante sunt mult mai complexe și depășesc sfera subiectelor abordate în acest manual). Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 29 Spațiu de depozitare Ce fel de spațiu este necesar? Este necesar să existe un spațiu pentru depozitarea scaunelor rulante, pieselor de schimb și a materialelor. Spațiul de depozitare trebuie să se situeze în proximitatea spațiului pentru activități tehnice, să respecte prevederile privind siguranța, să nu permită accesul apei, al animalelor/dăunătorilor. Un grilaj metalic aplicat pe fereastră constituie o măsură de siguranță suplimentară. Dacă nu există un spațiu care să poată fi folosit ca spațiu de depozitare, amenajați o zonă din cadrul unei încăperi. În acest caz, trebuie să acordați atenție suplimentară măsurilor de siguranță. Amenajarea unui spațiu de depozitare Următoarele sugestii pot ajuta la amenajarea unui spațiu de depozitare bine organizat: • Rafturile și etajerele ajută la maximizarea spațiului disponibil. • Un culoar între etajere, rafturi, cutii și scaune rulante asamblate îmbunătățește accesul și crește eficiența. Culoarul trebuie menținut liber. • Aranjați articolele în funcție de tip și de dimensiune. Poziționând articolele de același tip în același loc, facilitați operațiunile de numărare necesare pentru controlul stocului, precum și cele de reorganizare. • Articolele mici, cum ar fi șuruburile, piulițele, șaibele pot fi ținute în cutii mici, câte una pentru fiecare articol și mărime. Marcați numele articolului pe fața cutiei. • Cutiile și materialele nu ar trebui așezate direct pe sol sau lângă un perete extern, deoarece ar putea fi deteriorate cu ușurință, din cauza umezelii. Pentru a împiedica depozitarea articolelor direct pe sol, utilizați paleți. • Dacă există ferestre, luați în considerare montarea unor grilaje, pentru creșterea gradului de siguranță. Spaţiu pentru instruirea utilizatorilor de scaun rulant Ce fel de spațiu este necesar? Este necesar un spațiu desemnat pentru desfășurarea activităților de instruire pentru: • instruirea privind efectuarea transferurilor și aspectele legate de starea de sănătate; • manevrarea și întreținerea scaunului rulant; • însușirea abilităților de manevrare a scaunului rulant. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 30 Instruirea privind transferurile și aspectele legate de sănătate poate avea loc într-un spațiu destinat activităților de tip clinic, la domiciliul utilizatorului sau în comunitate, acolo unde se furnizează serviciile. Echipamente: • Se recomandă folosirea unor echipamente de bază, cum ar fi un pat pentru exersarea transferurilor. Instruirea privind manevrarea și întreținerea scaunului rulant poate avea loc într-o zonă adecvată dintr-un atelier sau în orice alt spațiu corespunzător. Echipamente: • Este nevoie de echipamente de bază pentru operațiunile de întreținere a scaunului rulant. Instruirea pentru dobândirea abilităților de manevrare a scaunului rulant are loc de obicei în exterior, dar se poate efectua, de asemenea, și în interior. Există varianta folosirii unui spațiu în aer liber, proiectat special pentru a simula diversele tipuri de suprafețe pe care utilizatorii de scaun rulant vor trebui să le traverseze în viața de zi cu zi – cum ar fi teren accidentat, teren plat, șanțuri, praguri limitatoare de viteză, borduri, praguri şi scări. În cazul serviciilor integrate, spațiul dedicat însușirii abilităților de mobilitate poate fi utilizat și de către persoane cu alte tipuri de dizabilități motorii – de exemplu, persoane care învață să utilizeze o proteză pentru membre sau care trebuie să se recupereze din punct de vedere al mobilității, în urma unui accident. Acolo unde nu există spațiu pentru a amenaja o zonă în vederea exersării abilităților de manevrare a scaunului rulant, identificați care sunt acele spații care există deja și care pot fi folosite în condiții de siguranță în activitatea de instruire pentru manevrarea scaunului rulant. Evitați zonele în care se circulă în mod constant și încercați să găsiți mai multe tipuri de obstacole. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 31 Oriunde se furnizează servicii pentru utilizatorii de scaun rulant, există posibilitatea de a fabrica echipamente portabile pentru instruirea în vederea dobândirii abilităților de manevrare a scaunului rulant. Imaginea din partea dreaptă prezintă un echipament portabil pentru exersarea abilităților de manevrare a scaunului rulant, amenajat sub un adăpost care oferă umbră. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Spații și echipamente suplimentare pentru furnizarea serviciilor de nivel intermediar Furnizarea serviciilor de nivel intermediar necesită spații și echipamente în plus. Cerințele suplimentare pe care trebuie să le aibă în vedere managerii sunt prezentate mai jos. Spațiu pentru evaluare și pentru probarea produsului Pentru serviciile de nivel intermediar este necesar un pat de evaluare, pe care utilizatorul de scaun rulant să poată sta culcat pe durata evaluării. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. Se recomandă ca în timpul evaluării utilizatorilor cu cerințe de nivel intermediar să folosim un suport specializat pentru evaluare. Avem astfel un suport pentru picioare ajustabil și posibilitatea de a avea gradul de suport necesar pe durata procedurii de simulare manuală. Pentru mai multe informații, consultați resursele suplimentare de pe memory stick. • Bucățile de burete rigid, pentru crearea unui suport temporar, trebuie să fie la îndemână pe întreaga durată a evaluării și probării produsului. • O oglindă de dimensiuni mari îi este de folos atât utilizatorului de scaun rulant, cât și personalului furnizor de servicii, pentru a observa mai bine postura și alinierea părților corpului, din diferite unghiuri. • Jucăriile și imaginile afișate pe pereți creează un mediu mai prietenos pentru copii. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 32 Depozitare Serviciile de nivel intermediar necesită un spațiu de depozitare mai mare pentru materialele necesare adaptărilor și pentru componentele dispozitivelor de suport postural. Materialele includ plăci de burete care trebuie depozitate pe o suprafață plată și care trebuie să rămână uscate. De aceea, sunt necesare mai multe spații și rafturi de depozitare. Spațiu pentru pregătirea, întreținerea și repararea scaunelor rulante Un spațiu curat și o mașină de cusut industrială permit confecționarea și modificarea componentelor și a centurilor din material textil, folosite pentru suport postural. În lipsa unui astfel de spațiu și a echipamentului adecvat, aceste operațiuni vor trebui externalizate. Organizarea spațiului de lucru Odată ce spațiile au fost desemnate și echipamentele au fost procurate, managerul trebuie să desemneze responsabilii pentru organizarea fiecărui spațiu, parcurgând următorii patru pași: 1. Evitarea acumulării de obiecte: înlăturați toate sculele, piesele și echipamentele nefolosite, precum și documentele perimate, care nu mai sunt necesare. 2. Identificarea obiectelor utilizate în mod curent: instrumente, piese, instrucțiuni și documente. Articolele folosite în mod regulat trebuie aranjate astfel încât să fie localizate cât mai ușor și mai rapid. 3. Stabilirea unui sistem și desemnarea responsabililor: creați un sistem pentru fiecare spațiu de lucru și numiți un responsabil pentru implementarea sistemului. 4. Monitorizare: supervizați sistemul pentru a vă asigură că schimbarea se menține. B.3 Gama de scaune rulante corespunzătoare Ce înseamnă scaunul rulant corespunzător și perna adecvată? Nevoile individuale ale fiecărui utilizator de scaun rulant variază. Totuși, toți utilizatorii au nevoie de scaune rulante corespunzătoare și de perne adecvate. Ghidul Organizației Mondiale a Sănătății privind furnizarea scaunelor rulante cu antrenare manuală în regiuni cu resurse limitate definește scaunul rulant corespunzător ca fiind cel care: • răspunde nevoilor utilizatorului și corespunde caracteristicilor mediului în care trăiește acesta; • este potrivit ca dimensiune și furnizează suport postural adecvat; Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 33 • poate fi utilizat în condiții de siguranță și este durabil; • este disponibil în țară; • poate fi obținut și întreținut în țară, la cel mai convenabil preț, fiind disponibile și serviciile aferente. Pentru a răspunde nevoilor utilizatorilor de scaun rulant care accesează servicii destinate lor, furnizorii acestor servicii trebuie să dețină un stoc care să includă cel puţin câteva tipuri diferite de scaune rulante şi de perne potrivite acestora. Tipul de pernă cel mai indicat va depinde de nevoile individuale ale fiecărui utilizator. Totuşi, orice persoană la care există riscul apariției escarelor are nevoie de pernă pentru reducerea presiunii si de instruire cu privire la folosirea acesteia. Costurile lipsei de echipamente corespunzătoare și de instruire a utilizatorilor de scaun rulant În țările care dispun de resurse, speranța de viață medie pentru persoanele care devin utilizatoare de scaun rulant în intervalul de vârstă 25 – 34 de ani este de aproximativ 38 de ani după momentul apariției leziunii medulare (8). Dimpotrivă, un studiu realizat în Bangladesh sugerează că speranța de viață medie în urma unei leziuni medulare este de 5,36 ani de la momentul apariției leziunii, iar 56,4% dintre aceste persoane decedează într-un interval de 5 ani de la apariţia leziunii (9). 80% dintre persoanele cuprinse în acest studiu au decedat la domiciliu; dintre acestea, o treime aveau escare la momentul decesului. În anul 1999, în secția pentru leziuni medulare a unui centru de recuperare din Sri Lanka, s-a făcut un studiu cu privire la costurile impuse de tratament. La acea oră, timpul de vindecare al unei escare superficiale era de aproximativ 6 săptămâni, iar costurile se ridicau la 286$. O escară de profunzime necesita un an de tratament și suma de 2483$. Acelaşi studiu a demonstrat că folosirea scaunelor rulante potrivite, a pernelor și a saltelelor adecvate, precum şi instruirea corespunzătoare a pacientului pot reduce incidenţa escarelor pe perioada spitalizării cu 70%, precum şi cheltuielile cu tratamentul acestora cu aproape 60%. Într-un spital din Sao Paulo, Brazilia, a fost introdus un program de instruire pentru reducerea complicațiilor medicale secundare în cazul persoanelor cu leziuni medulare. Incidența escarelor s-a redus cu 23% (10). Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 34 Selecția gamei de scaune rulante corespunzătoare și de perne adecvate Dimensiunea potrivită și furnizarea suportului postural adecvat Utilizatorii au nevoie de scaune rulante cu dimensiunea corectă. Scaunul rulant de mărime necorespunzătoare produce senzația de disconfort, nu furnizează suport postural corect și poate dăuna utilizatorului de scaun rulant. Acest lucru înseamnă că furnizorul de servicii pentru utilizatorii de scaun rulant are nevoie de un stoc de scaune rulante de diferite mărimi sau de scaune rulante care pot fi ajustate în ceea ce privește mărimea. Cei mai mulți utilizatori de scaun rulant petrec zilnic un număr mare de ore în poziția așezat. Acest lucru înseamnă că scaunul lor rulant nu este doar un dispozitiv pentru facilitarea mobilității, ci contribuie și la adoptarea unei poziții confortabile în poziția așezat. Utilizatorii au nevoie de diferite tipuri de suport postural și, implicit, de scaune rulante care furnizează diferite tipuri de astfel de suport. Un scaun rulant care are dimensiunile potrivite oferă suportul postural adecvat utilizatorilor care au nevoie de servicii de nivel de bază. Persoanele care au nevoie de un grad ridicat de suport postural, de nivel intermediar, necesită un scaun rulant de dimensiuni potrivite, cu suport postural suplimentar. Acest lucru se poate realiza prin adăugarea unor dispozitive de suport postural sau prin furnizarea unui sistem de poziționare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 35 Consecințele utilizării scaunelor rulante de dimensiuni necorespunzătoare sau a lipsei de suport postural adecvat Personalul Centrului de Recuperare Western Cape din Africa de Sud a documentat complicațiile apărute în cazul unui grup de copii din diferite școli și centre, care ar fi avut nevoie de suport postural suplimentar, dar nu au beneficiat de acesta. În cazul a 21% dintre aceștia au apărut probleme posturale. Consecințele, în ceea ce privește copiii, familiile şi furnizorii de servicii, au constat în: • complicații mai grave și mai mult timp petrecut în întâlniri cu furnizorii de servicii pentru utilizatorii de scaun rulant; • deteriorări ale stării de sănătate; • postură incorectă, disconfort; • nivel scăzut de toleranță pentru menținerea poziției așezat (durată scăzută a menținerii unei poziții corecte confortabile); • participarea scăzută la programe educaționale • diminunarea nivelului calității vieții. Nevoile specifice și mediul în care trăiește utilizatorul de scaun rulant Rolul unui scaun rulant corespunzător este să faciliteze desfășurarea activităților. Utilizatorii de scaun rulant trebuie să aibă posibilitatea de a efectua transferul în și din scaunul rulant, de a realiza propulsia scaunului rulant, de a plia scaunul rulant pentru transport și depozitare și de a-și îndeplini sarcinile zilnice. Utilizarea tipului de scaun rulant adecvat și funcționarea corectă a acestuia contribuie la toate aceste aspecte. De asemenea, utilizatorii au nevoie de un scaun rulant care va funcționa corespunzător în mediul în care va fi folosit. Medii diferite impun utilizarea unor tipuri diferite de scaune rulante. De exemplu, unele scaune rulante sunt mai potrivite pentru utilizarea în interior, altele pot fi folosite în spații deschise și pe teren accidentat. Echipamente abandonate: este de preferat un echipament necorespunzător decât niciun echipament? Atunci când echipamentele nu se potrivesc cerințelor utilizatorilor, ele sfârșesc deseori prin a fi abandonate. Imaginea alăturată ilustrează o situație obișnuită. Acest utilizator de scaun rulant are trei scaune rulante primite donație – totuși, niciunul nu răspunde nevoilor sale și de aceea, el nu poate ieși din casă. Primele două scaune rulante nu mai pot fi folosite pentru că s-au defectat, iar piesele de schimb nu sunt disponibile. Al treilea este nou, dar este un scaun rulant de o calitate care lasă de dorit, nu oferă senzația de siguranță și pare instabil atunci când este folosit în exterior, astfel încât utilizatorul nu se simte în siguranță. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 36 Siguranță și durabilitate Utilizatorii de scaun rulant vor produse sigure și durabile care pot fi reparate la costuri acceptabile. Este avantajos și pentru furnizorii de servicii să se asigure că scaunele rulante pe care le furnizează pot fi folosite în condiții de siguranță, că sunt durabile și pot fi reparate local. Acest lucru ar putea contribui la reducerea costurilor de înlocuire a scaunelor rulante și la simplificarea operațiunilor de întreținere. Numeroși utilizatori din regiunile cu resurse limitate folosesc scaunul rulant pentru a se deplasa pe teren accidentat. Este posibil ca scaunul rulant să fie expus la ploaie, nisip și noroi. În consecință, aceste scaune rulante trebuie să fie durabile și făcute să reziste în astfel de condiții. Scaunele rulante de calitate inferioară se vor strica rapid (de exemplu, în decurs de 1-6 luni); în timp ce scaunele rulante fabricate corespunzător, care sunt întreținute în mod adecvat, pot rezista 3-5 ani, aceasta reprezentând un raport calitate-preț mult mai avantajos. Probleme întâlnite frecvent în cazul scaunelor rulante de calitate inferioară: • materialul textil de calitate necorespunzătoare folosit pentru suprafața de ședere sau pentru spătar se rupe sau se deformează; • roțile de direcție (axe, anvelope, rulmenți, furci) se defectează; • roțile posterioare (axa roții, inel de antrenare, spițe, rulmenți, anvelope) se defectează sau se uzează; • frânele ruginesc și nu mai funcționează; • suporturile pentru picioare se defectează; • pernele fie lipsesc, fie sunt de calitate necorespunzătoare și se rup repede; • părțile detașabile se pierd. Rolul managerului Managerii responsabili de furnizarea serviciilor destinate utilizatorilor de scaun rulant au un rol important în procurarea sau recepționarea scaunelor rulante donate. Pentru mai multe informații, consultați resursele de pe memory stick. Managerii trebuie să se asigure că: • Există o gamă adecvată de scaune rulante și perne – pentru a putea răspunde (într-o cât mai mare măsură) diverselor nevoi ale utilizatorilor de scaun rulant. Asta înseamnă să avem în vedere o gamă care include mărimi diferite, nevoia de suport postural, cerințele specifice legate de mediul utilizatorului și de stilul de viață al acestuia. • Scaunele rulante selectate sunt rezistente – în special în cazurile în care vor fi folosite pe terenuri accidentate sau în medii dificile. • Scaunele rulante pot fi reparate local. Acest lucru poate însemna că există piese de schimb (fie procurate, fie furnizate prin donație) sau că piesele de schimb pot fi achiziționate cu ușurință și local. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 37 Este important ca furnizorul de servicii să obțină de la utilizatorii de scaun rulant un feedback cu privire la produsele furnizate. Managerii și personalul pot discuta cu utilizatorii de scaun rulant în timpul vizitelor la domiciliu, la întâlniri de grup sau prin intermediul organizațiilor persoanelor cu dizabilități. Atunci când începe furnizarea unui nou tip de scaun rulant sau de pernă care nu a mai fost oferit înainte, furnizorul de servicii poate opta pentru testarea produsului cu ajutorul unui grup de utilizatori. Aceștia vor folosi noul produs pe o perioadă de timp determinată și vor furniza feedback. Feedback-ul poate fi obținut prin interviuri individuale sau prin intermediul focus grupurilor. Cum se pot asigura managerii de faptul că scaunele rulante pe care le achiziționează sau pe care le primesc sunt durabile și pot fi reparate? Managerii pot adresa întrebări furnizorilor (sau donatorilor) pentru a afla mai multe informații cu privire la scaunele rulante. Exemple de întrebări: • Are produsul certificate de standard (a trecut teste de performanță și de calitate prevăzute de un organism profesional)? Dacă da, care au fost rezultatele? • Prevede furnizorul o anumită durată de viață a produselor? • Are furnizorul un sistem pentru raportarea defectelor? • Cine sunt ceilalți cumpărători și utilizatori ai produselor lor? Există posibilitatea contactării altor furnizori de servicii pentru utilizatorii de scaun rulant pentru a afla mai multe informații legate de echipamentul de mobilitate? • Ce scule sunt necesare pentru asamblarea și/sau reglarea scaunului rulant? • Sunt disponibile piese de schimb? Piesele trebuie achiziționate în străinătate sau unele dintre ele sunt disponibile și în țară? • A fost produsul testat de către utilizatori din țară și dacă da, ce feedback/rezultate au fost înregistrate? • În cazul în care se rupe cadrul – acesta poate fi reparat pe plan local? • Se furnizează și un ghid de întreținere? Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 38 Monitorizarea, întreținerea și repararea scaunului rulant Cea de-a opta etapă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant o reprezintă monitorizarea, întreținerea și repararea. Monitorizarea, întreținerea și repararea Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, probleme care nu pot fi rezolvate cu ușurință în cadrul comunității. O parte importantă a acestei etape o reprezintă instruirea utilizatorilor de scaun rulant și a familiilor acestora cu privire la operațiunile de întreținere a scaunului rulant. Întreținerea la intervale regulate, efectuată la domiciliu, contribuie la creșterea duratei de viață a scaunelor rulante și la evitarea necesității unor reparații majore. De asemenea, există și posibilitatea ca furnizorii de servicii pentru utilizatorii de scaun rulant să instruiască partenerii cu care colaborează în ceea ce privește operațiunile de întreținere și reparații sau să identifice alte resurse în cadrul comunității (de exemplu, ateliere pentru reparații biciclete), unde pot fi efectuate întreținerea și reparația scaunului rulant. B.4 Organizarea resurselor umane Roluri în cadrul echipei de furnizare a serviciilor pentru utilizatorii de scaun rulant Furnizarea serviciilor pentru utilizatorii de scaun rulant este deseori rezultatul muncii unei echipe. Aceștia îndeplinesc diverse roluri: personal cu atribuții clinice, tehnice, de instruire, administrativ și de management. Aceeași persoană poate avea unul sau mai multe roluri. De exemplu, unul din membrii echipei poate fi responsabil deopotrivă pentru partea clinică și pentru gestionarea întregului proces de furnizare a serviciilor pentru utilizatorii de scaun rulant. Există situaţii în care personalul aparținând unor organizaţii diferite colaborează pentru a efectua sarcinile specifice diverselor roluri. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 39 Tabelul de mai jos prezintă modul prin care rolurile din cadrul echipei sunt corelate cu activitățile de furnizare a serviciilor destinate utilizatorilor de scaun rulant. A ct iv ită ți de ti p cl in ic A ct iv ită ți de ti p te hn ic In st ru ir ea u til iz at or ilo r de s ca un r ul an t A dm in is tr at iv M an ag em en t Management și dezvoltare Promovarea procesului de furnizare a serviciilor ü ü ü ü ü Identificarea surselor de finanţare ü Dezvoltarea rețelei de surse de trimiteri ü ü ü ü Asigurarea legăturii cu alte organizații ü ü ü ü ü Evaluarea procesului de furnizare ü ü ü ü ü Etapele furnizării serviciilor 1. Trimiterea și programarea ü ü ü ü 2. Evaluarea ü ü ü 3. Prescrierea ü ü ü 4. Finanțarea și plasarea comenzii ü ü ü ü 5. Pregătirea produsului ü 6. Probarea produsului ü ü 7. Instruirea utilizatorilor de scaun rulant ü ü ü 8. Monitorizarea, întreținerea și reparațiile ü ü ü Instruirea și dezvoltarea profesională Instruirea personalului din rețeaua de surse de trimiteri ü ü ü Instruirea personalului care desfășoară monitorizarea ü ü ü Instruirea personalului care furnizează servicii pentru utilizatorii de scaun rulant ü ü ü Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 40 Instruirea Activitățile din cadrul procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant pot fi desfășurate de către persoane cu pregătire educațională și profesională din diverse domenii, cu condiția ca ele să fie instruite în mod corespunzător. Este important ca personalul cu responsabilități clinice, tehnice și de instruire să fie pregătit în mod adecvat. • Personalul cu atribuții clinice și tehnice care furnizează servicii de nivel de bază trebuie instruit în conformitate cu competențele prevăzute în pachetul de instruire privind furnizarea serviciilor pentru utilizatorii de scaun rulant – nivel de bază, creat de Organizația Mondială a Sănătății. • Personalul cu atribuții clinice și tehnice care furnizează servicii de nivel intermediar trebuie instruit în conformitate cu competențele prevăzute în pachetul de instruire privind furnizarea serviciilor pentru utilizatorii de scaun rulant – nivel intermediar, creat de Organizația Mondială a Sănătății. Rețineți: Se recomandă instruirea a cel puțin două persoane, simultan. Atunci când există o singură persoană care deține abilitățile necesare, procesul de furnizare a serviciilor se află într-o poziție de vulnerabilitate; în cazul în care aceasta părăsește echipa, se pierd experiența și cunoștințele acumulate. Planificarea capacității de furnizare a serviciilor Managerii trebuie să fie capabili să-și planifice activitatea în funcție de numărul de utilizatori de scaun rulant care vor beneficia de servicii specifice, lunar și anual. Acest lucru reprezintă „capacitatea de furnizare a serviciilor”. Capacitatea de furnizare a serviciilor include: • numărul de utilizatori care vor primi pentru prima oară un scaun rulant; • numărul utilizatorilor de scaun rulant care vor fi monitorizați. Capacitatea de furnizare a serviciilor este în corelație directă cu: • numărul membrilor echipei care sunt disponibili pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant; • durata de timp pe care personalul o poate folosi pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant; • numărul de scaune rulante pe care furnizorul de servicii le poate procura – acesta este în strânsă relație cu bugetul disponibil. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 41 Calcularea timpului pe care îl alocă personalul activității de furnizare a serviciilor pentru utilizatorii de scaun rulant Pentru a estima capacitatea de furnizare a serviciilor, managerii trebuie să calculeze cât timp să aloce personalul acestei activități. În acest scop, managerii trebuie să cunoască următoarele aspecte: • numărul săptămânilor lucrătoare care există în fiecare an (excluzând sărbătorile oficiale și zilele de concediu), • proporția din timpul total de lucru pe care personalul îl va dedica procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant (și nu altor sarcini, roluri sau activități). Managerii trebuie, de asemenea, să aibă în vedere timpul necesar parcurgerii etapelor specifice procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant. Există mulți factori care vor influența acest aspect; de exemplu, dacă membrii echipei au sau nu experiență în domeniu; dacă scaunul rulant furnizat necesită sau nu modificări. Totuși, ca punct de referință, putem considera că o echipă experimentată (cu atribuții clinice și tehnice) este în măsură să atingă următoarele obiective zilnice: • să furnizeze scaune rulante noi pentru doi utilizatori care au nevoie de servicii de nivel de bază sau • să furnizeze un scaun rulant nou pentru un utilizator care are nevoie de servicii de nivel intermediar. Tabelul de mai jos prezintă un exemplu de estimare a capacității de furnizare a serviciilor pentru utilizatorii de scaun rulant pornind de la ideea unei echipe formate din două persoane care lucrează împreună. Unul dintre membrii echipei are atribuții clinice, iar celălalt tehnice, ambii asigurând instruirea utilizatorilor. Echipa lucrează 5 zile/săptămână, timp de 42 de săptămâni pe an. În cazul în care există suficiente scaune rulante și materiale, pe parcursul unui an, această echipă poate furniza: • servicii de nivel de bază unui număr de 357 de utilizatori de scaun rulant; sau • servicii de nivel intermediar unui număr de 179 de utilizatori de scaun rulant. Servicii nivel de bază Servicii nivel intermediar Planificarea săptămânii de lucru Număr de zile lucrătoare/săptămână 5 5 Număr de săptămâni lucrătoare/an (excluzând sărbătorile oficiale și zilele de concediu) 42 42 Estimarea capacității de furnizare a serviciilor Număr de utilizatori de servicii/zi 2 1 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 42 Număr de utilizatori de servicii/săptămână 10 5 Număr de utilizatori de servicii/an 420 210 Marjă de risc 15% (pentru evenimente neprevăzute) -63 -31 Număr estimat de utilizatori/an 357 179 Rolul managerilor în crearea sau dezvoltarea echipei de furnizare a serviciilor pentru utilizatorii de scaun rulant • Identificați acele resurse umane existente sau noi care pot să își asume diferitele roluri din cadrul echipei care furnizează acest tip de servicii; • Asigurați instruirea personalului care nu deține competențele necesare; • Definiți timpul pe care personalul pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant îl poate dedica acestei activități, asigurându-vă că estimarea este realistă, și ia în calcul celelalte sarcini, roluri sau activități; • Estimați capacitatea anuală de furnizare a serviciilor – comunicați aceste informații echipei; • Oferiți sprijin membrilor echipei în activitatea de furnizare a serviciilor pentru utilizatorii de scaun rulant. De exemplu: • implicați personalul în planificarea activității; • creați un instrument de planificare săptămânală/lunară – acesta trebuie să includă programările și alte activități; • organizați întâlniri săptămânale pentru a monitoriza progresul, scoateți în evidență realizările și abordați aspectele care constituie o provocare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 43 B.5 Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? Identificarea costurilor pe care le implică furnizarea serviciilor pentru utilizatorii de scaun rulant reprezintă unul dintre rolurile importante ale managerului. Următorul tabel prezintă câteva dintre liniile de buget care sunt asociate în mod obișnuit creării și gestionării unui proces de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Costurile vor varia în funcție de context. Tipuri de cheltuieli Comentarii Costuri inițiale Planificarea produsului Aprovizionarea cu o gamă de produse Unelte Echipamente Clădire/spații Posibilitatea de a include costuri de construcție/renovare/ reamenajare Stoc de materiale Costuri operaționale Scaune rulante Stoc de scaune rulante – în funcție de estimarea capacității de furnizare a serviciilor și de anticiparea nevoilor utilizatorilor de scaun rulant Piese de schimb Este utilă crearea unui stoc de piese de schimb care sunt necesare în mod frecvent Materiale Necesarul de materiale pentru efectuarea modificărilor este mai mare în cazul serviciilor de nivel intermediar decât în cazul celor de nivel de bază Transportul produselor Livrarea și taxele vamale în cazul scaunelor rulante importate. Transportul scaunelor rulante la centre satelit. Resurse umane Management În ghidul de buget sunt enumerate diverse poziții din cadrul echipei. Nu există așteptarea ca fiecare echipă care furnizează servicii pentru utilizatorii de scaun rulant să aibă această componență. Bifele (vezi foaia de calcul) reprezintă activitățile din etapele procesului de furnizare a serviciilor. Există posibilitatea ca același membru al echipei să fie responsabil de implementarea mai multor activități. Personal cu atribuții clinice Personal cu atribuții tehnice Instructor/instructor utilizator de scaun rulant Administrator Transport local Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 44 Costuri de transport local pentru personal De exemplu: monitorizare, servicii furnizate în comunitate, instruirea rețelelor de surse de trimitere Transport local pentru beneficiarii serviciilor Deplasarea la sediul furnizorului de servicii, conform programărilor Cazare pentru beneficiarii serviciilor Costul pentru cazarea beneficiarilor serviciilor în cazul în care aceștia au nevoie să rămână peste noapte (dacă furnizorul acoperă acest tip de costuri) Tipărituri Formulare, liste de verificare și informații pentru utilizatori Consumabile Lipici, ață, vopsea, etc. Înlocuirea sculelor Uzarea sculelor – trebuie incluse fonduri pentru înlocuirea acestora Cheltuieli indirecte Trebuie luate în calcul cheltuielile cu electricitatea, furnizarea apei, chiria – pentru diversele activități (de tip clinic, tehnic, de depozitare, instruirea utilizatorilor, pentru birouri) Instruirea personalului Trebuie luate în considerare toate costurile de instruire pentru personalul furnizor de servicii pentru utilizatorii de scaun rulant Instruirea partenerilor/rețelelor de surse de trimitere Costurile activităților de instruire/conștientizare destinate partenerilor, organizațiilor și rețelelor de surse de trimitere Strângere de fonduri Orice activități care au ca scop strângerea de fonduri. Monitorizare și evaluare Costurile asociate activităților de monitorizare și evaluare – de exemplu, vizitarea utilizatorilor de scaun rulant pentru obținerea feedback-ului. Costurile pot include deplasarea sau personalul suplimentar. Soluții de eficientizare a costurilor Managerii care lucrează în regiuni cu resurse limitate trebuie să identifice metode de reducere a costurilor. Mai jos sunt enumerate câteva modalități de reducere a costurilor: Servicii integrate • Serviciile integrate, care împart în mod eficient spațiul, constituie oportunități semnificative de partajare a costurilor, în contrast cu statutul de furnizor individual. Partajarea costurilor cu alte organizații Un furnizor de servicii se poate asocia cu alte organizații, cu scopul de a partaja costurile. De exemplu: • Unele organizații internaționale donatoare/pentru dezvoltare pot fi interesate de partajarea costurilor scaunelor rulante. În ceea ce privește furnizorul de servicii, beneficiul îl constituie creșterea gradului de accesibilitate a produselor din punct de vedere al costurilor. Beneficiul Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 45 pentru organizația internațională îl constituie faptul că fondurile acoperă o arie mai extinsă și dovada că activitatea furnizorului de servicii poate fi sustenabilă din punct de vedere financiar. • Există posibilitatea ca organizațiile din comunitate să fie interesate să se asocieze cu furnizorul de servicii pentru a avea mai multe servicii disponibile la nivel local. Partenerul din comunitate poate fi în măsură să ofere spațiu și personal pentru implementarea unora dintre etapele procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant (de exemplu, monitorizarea și instruirea utilizatorilor). Beneficiul pentru utilizatorii de scaun rulant este reducerea costurilor de deplasare. Beneficiul pentru furnizorul de servicii este oportunitatea extinderii activității în comunitate. Potențiale surse de finanțare Mai multe informații despre identificarea surselor de finanțare pentru acoperirea costurilor de creare/gestionare a sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant sunt discutate la secțiunea C.4: Planificarea sustenabilității financiare. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 46 C: Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1 Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? Monitorizarea și evaluarea (M&E) ajută managerii să aibă o imagine a ceea ce se întâmplă (sau nu se întâmplă) ca rezultat al activităților echipelor lor. De asemenea, contribuie la înțelegerea, atât de către manageri, cât și de către echipe, a aspectelor care funcționează sau nu, precum și a opiniei utilizatorilor sau a părților implicate. Ce înseamnă monitorizarea și evaluarea? Monitorizarea Evaluarea Când se efectuează? • În mod constant • Integrată în activitățile zilnice ale furnizorului de servicii • În momentele cheie ale procesului de furnizare a serviciilor – de exemplu, în timpul evaluării anuale. (deși unele informații pot fi culese în mod permanent) Ce se monitorizează? • Activitățile de furnizare a serviciilor • Scaunele rulante și dispozitivele de suport postural suplimentar utilizate • Numărul și categoriile de beneficiari • Impactul asupra persoanelor și al comunităților • Sustenabilitatea Ce fel de surse de informații se folosesc? • Bazele de date cu informații despre beneficiarii serviciilor • Documentele aferente furnizării serviciilor • Informații despre procesul de furnizare a serviciilor • Feedback din partea utilizatorilor • Rapoarte financiare • Analiza timpului de care dispune personalul • Sondaje • Chestionare • Discuții de grup • Vizite la domiciliu • Observarea directă a activității • Analiza rapoartelor Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 47 Servicii eficiente În ce mod le sunt utile monitorizarea și evaluarea, atât managerilor, cât și altor persoane implicate în furnizarea serviciilor? • Oferă informații importante în vederea creșterii calității procesului de furnizare a serviciilor. • Oferă informații care contribuie la deciziile legate de achiziționarea produselor. • Ajută la limitarea costurilor prin creșterea eficienței și la justificarea finanțărilor actuale și viitoare. • Permite furnizorului de servicii să demonstreze finanțatorilor eficiența serviciilor oferite, pe baza unor date concrete – finanțatorii includ atât instituții guvernamentale, cât și donatori organizații neguvernamentale. • Ajută la identificarea și cuantificarea nevoilor nesatisfăcute. • Contribuie la alocarea corespunzătoare a resurselor. • Crește nivelul de conștientizare cu privire la beneficiile serviciilor pentru utilizatorii de scaun rulant. • Dezvoltă parteneriate mai puternice cu beneficiarii serviciilor de acest tip. Există un cadru cu trei etape care ajută la planificarea activității de monitorizare și evaluare a procesului de furnizare a serviciilor. Detalii suplimentare pot fi găsite în tabelul 3.5 din Ghidul privind furnizarea scaunelor rulante cu antrenare manuală. 1. Identificarea ariilor care urmează să fie monitorizate 2. Stabilirea indicatorilor de performanță 3. Identificarea metodelor de colectare a informațiilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 48 Atunci când se face analiza informațiilor și datelor colectate, trebuie avute în vedere două aspecte importante: • dacă o activitate nu are rezultatele preconizate, colaborați cu beneficiarii serviciilor, personalul furnizor și cu alte părți interesate pentru identificarea cauzei problemei. • dacă o activitate are rezultate bune, atunci când se ating obiectivele stabilite, găsiți modalități prin care să sărbătoriți succesul. Acest lucru este un factor care îi motivează atât pe membrii echipei care furnizează servicii, cât și pe toți cei implicați. Importanța feedback-ului oferit de către utilizatorii de scaun rulant Evaluarea permite furnizorului de servicii să identifice care sunt acele aspecte care funcționează în mod adecvat și ce este necesar să se schimbe. De asemenea, evaluarea ne arată în ce măsură este atins scopul activității de furnizare a serviciilor. Scopul evaluării, așa cum este prezentat în Ghidul privind furnizarea scaunelor rulante, se referă la: • promovarea mobilității personale la cel mai înalt grad de independență posibil; • îmbunătățirea calității vieții prin îmbunătățirea accesului la scaune rulante; • creșterea gradului de incluziune și participare. Există un număr de criterii care pot fi utilizate pentru a evalua procesul de furnizare a scaunelor rulante. Acestea includ: • utilizatorii care au beneficiat de servicii și intervențiile efectuate; • costul furnizării serviciilor, inclusiv costul furnizării produselor și serviciilor; • personalul (numărul angajaților, rolurile și competențele acestora); • spațiile și echipamentele de care dispune furnizorul de servicii pentru utilizatorii de scaun rulant; • calitatea furnizării serviciilor (în Ghidul privind furnizarea scaunelor rulante, la secțiunea 3.3 sunt oferite exemple de bună practică); • impactul pe care furnizarea serviciilor l-a avut asupra utilizatorilor și familiilor acestora. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 49 Este foarte important ca utilizatorii de scaun rulant să fie implicați în evaluarea serviciilor care le sunt destinate. Planificarea acțiunilor de obținere a feedback-ului de la utilizatorii de scaun rulant presupune câteva aspecte esențiale: • Transportul și timpul reprezintă două dintre cele mai importante costuri. Este posibil ca utilizatorii de scaun rulant care oferă feedback să aibă nevoie de asistență financiară pentru deplasare și pentru intervalul de timp asociat acesteia. • Feedback-ul poate fi solicitat fie de la fiecare beneficiar al serviciilor, în mod sistematic, fie de la un eșantion selectat aleatoriu, lunar sau anual. • Solicitarea de feedback va fi utilă doar în cazul în care utilizatorii simt că au libertatea de a-și exprima opiniile în mod deschis și sincer. În acest sens, putem lua în considerare opțiunea ca persoana care efectuează interviurile de evaluare să nu facă parte din echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant. Beneficiile evaluării procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant – un exemplu din Etiopia: Doi reprezentanți au intervievat 140 de utilizatori de scaun rulant din șapte centre furnizoare de servicii din întreaga țară. Amândoi sunt persoane cu dizabilități locomotorii, iar acest lucru a avut un impact pozitiv în ceea ce privește implementarea activității de evaluare. Prin realizarea acestui studiu, cei doi reprezentanți au obținut multe informații privind provocările cu care se confruntă utilizatorii de scaun rulant din Etiopia. Ei au dobândit astfel capacitatea de a promova drepturile și nevoile utilizatorilor de scaun rulant. Interacțiunea cu cei doi reprezentanți, a avut un impact pozitiv din punct de vedere psihic și emoțional asupra beneficiarilor serviciilor, ei având astfel posibilitatea de a fi intervievați de persoane care reprezintă modele de succes. Ca urmare a interviurilor de evaluare, s-a creat o rețea informală care a avut drept consecința îmbunătățirea comunicării dintre furnizorii de servicii și utilizatorii de scaun rulant. În plus, evaluările au contribuit la identificarea unor cazuri de utilizatori care nu primiseră scaune rulante corespunzătoare. Acest lucru a semnalat faptul că este nevoie de o instruire suplimentară a personalului, iar furnizorul a acționat în acest sens. Rolul informațiilor inițiale în evaluarea impactului pe care îl are procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant Pentru a putea analiza impactul pe care serviciile furnizate îl au asupra persoanelor care primesc un scaun rulant, este important să documentăm situația utilizatorului înainte de orice intervenție, adică, înainte de începerea evaluării. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 50 Diverse oportunități de obținere a informațiilor inițiale: • la efectuarea unei trimiteri – de către personalul unui centru sau al unei clinici; • în intervalul dintre etapa de trimitere și cea de evaluare – prin intermediul unei vizite la domiciliu sau telefonic; • în momentul evaluării – înainte de începerea evaluării. Pentru mai multe informații, consultați resursele de pe memory stick. Este important ca persoana (persoanele) care urmează să realizeze interviurile pentru obținerea de informații de la utilizatori să fie instruite în ceea ce privește desfășurarea acestora. Scopul este să obținem răspunsuri clare și complete la fiecare întrebare. Acest lucru este important pentru a putea avea date valide. Recomandări referitoare la tehnica de realizare a interviurilor Pregătire: • înainte de interviu, exersați ceea ce veți spune. Nu spuneți mai mult decât este necesar. Tehnica: • enunțați întrebările așa cum sunt ele formulate; • nu influențați respondenții sugerând răspunsurile, nici măcar într-un mod subtil; • în cazul în care trebuie să explicați ceva, păstrați o atitudine neutră; • înregistrați corect răspunsurile. Respectați interlocutorul: • continuați interviul de evaluare doar dacă persoana consimte liber și în mod voluntar să răspundă întrebărilor care îi sunt adresate; • ajutați persoana să se simtă relaxată; • nu vă exprimați sentimentele (șoc, acord, supărare) în legătură cu cele spuse de respondent; • tratați răspunsurile persoanei ca fiind confidențiale. Stabilirea unui sistem eficient de centralizare a informațiilor inițiale va crește calitatea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant, iar acest lucru se va reflecta în impactul pe care aceste servicii îl au asupra calității vieții beneficiarilor. Obținerea informațiilor poate fi: • unul dintre pașii activității de monitorizare; • o activitate de sine stătătoare. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 51 Evaluarea impactului activității de evaluare în cazul utilizatorilor de scaun rulant copii Ori de câte ori este posibil, este important să dăm utilizatorilor de scaun rulant copii oportunitatea de a oferi feedback cu privire la impactul pe care îl au asupra lor scaunul rulant și serviciile furnizate. Un exemplu în acest sens îl reprezintă Zarul emoțiilor (11). În primul rând, discutăm cu utilizatorul copil despre diferitele tipuri de emoții. Apoi, îi rugăm să completeze afirmații precum „Sunt fericit/ă atunci când...”, „Sunt trist/ă atunci când...” 47 WHEELCHAIR SERVICE TRAINING PACKAG E FOR MANAGERS Evaluating impact for children Wher possible, it is import nt to give children “a voice” in feedi g back on the impact of their wheelchair and service. An example is the use of Feeling Dice(11). First, the different feelings are categorized with the child. Then, they can be asked to complete statements such as “I am happy when…”, “I am sad when…” Angry Sad Hurt Embarrassed Excited Happy Recording and processing data Monitoring and evaluation involves recording, collecting, storing, and processing information (data). Efficient recording of data can save time and money. It is ideal to enter the data directly into a database, which is set up to process results and create the most useful reports for the service. Portable tablet computers can be very useful as they allow data to be recorded in field visits as well as at a centre. Mobile phone technology is progressing rapidly and may also be a method for entering, sending, and receiving data. Creating a service plan An annual service plan, which is monitored throughout the year, can help to ensure an efficient and effective service. Remember to motivate, engage and commit service personnel by involving them in creating the plan and targets. The service plan may include an evaluation at the end of the year. A sample service plan framework with one example is presented below. Furios/oasă Trist/ă Rănit/ă Rușinat/ă Bucuros/oasă Fericit/ă Înregistrarea și procesarea informațiilor onitorizarea și evaluarea implică înregistrarea, centralizarea, păstrarea și procesarea informațiilor (datelor). Înregistrarea eficientă a informațiilor înseamnă economie de timp și bani. Metoda ideală o reprezintă posibilitatea de a introduce informațiile direct într-o bază de date care procesează rezultatele și creează cea mai mare parte a rapoartelor. Calculatoarele portabile tip tabletă pot fi foarte utile deoarece permit înregistrarea informațiilor cu ocazia vizitelor pe t ren, precum și la centru. Tehnologia telefoniei m bil evoluează rapid și poate fi, de asemenea, o metodă de înregistrare, transmitere și receptare a informațiilor. Crearea unui plan de furnizare a serviciilor pentru utilizatorii de scaun rulant Un plan anual de furnizare a serviciilor, care să fie monitorizat pe tot parcursul anului, este un instrument util pentru sigurarea unui proces eficient. Nu itați să motivați, să implicați și să mobilizați personalul furnizor de servicii, implicându-l în stabilirea planului și a obiectivelor. Planul de furnizare a serviciilor poate include și o evaluare la finalul intervalului de un an. Mai jos găsiți un model de astfel de plan de furnizare a serviciilor. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 52 Model de plan de furnizare a serviciilor Identificați o nevoie/problemă care necesită monitorizare Acțiune/obiectiv pentru abordarea nevoii/ problemei Scop Culegerea informațiilor Mult mai puține femei decât bărbați (20% femei, 80% bărbați) au accesat servicii pentru utilizatorii de scaun rulant, în anul precedent Creșterea numărului de utilizatori femei identificate sau direcționate către furnizorul de servicii pentru utilizatorii de scaun rulant: • discuții cu sursele de trimitere – inclusiv cu reprezentanții din mediul rural, referitor la identificarea persoanelor din această categorie; • colaborarea cu organizațiile naționale pentru persoanele cu dizabilități pentru a identifica exemple de succes (femei), care să încurajeze femeile să apeleze la serviciile destinate utilizatorilor de scaun rulant. Creșterea procentului de femei care accesează serviciile pentru utilizatorii de scaun rulant, până la atingerea pragului de 40% Actualizarea permanentă a bazei de date în care sunt înregistrați utilizatorii de scaun rulant – deoarece aici găsim numărul femeilor și bărbaților care accesează serviciile pentru utilizatorii de scaun rulant. C.2 Gestionarea cererii În gestionarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant trebuie să existe un echilibru între cererea generată de nevoile utilizatorului și capacitatea personalului de a furniza un serviciu corespunzător. Generarea cererii Nevoia de servicii poate fi estimată prin calcularea valorii care reprezintă 1% din populația zonei unde își desfășoară activitatea furnizorul de servicii pentru utilizatorii de scaun rulant. Totuși, dacă oamenii nu sunt informați despre existența acestor servicii și despre beneficiile acestora sau dacă nu au au acces la ele, atunci cererea poate fi redusă, în ciuda faptului că există o nevoie pentru aceste servicii. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 53 Atunci când cererea pentru servicii este redusă, costul furnizării serviciilor raportat la utilizatorul individual crește, amenințând sustenabilitatea financiară a serviciului. Poza 1 Poza 2 Rolul managerului este să identifice cauzele numărului redus de trimiteri. Acestea pot fi următoarele: • nu au fost identificate cele mai adecvate surse de trimiteri; • persoanele care au nevoie de un scaun rulant nu accesează sursele care ar putea să le direcționeze către furnizorul de servicii; • instruirea rețelei de surse de trimitere nu a transmis în mod corespunzător informația despre beneficiile și importanța serviciilor pentru utilizatorii de scaun rulant; • utilizatorii de scaun rulant nu au posibilitatea de a accesa serviciile – centrul se află la o distanță prea mare de locul în care trăiesc, nu sunt disponibile mijloace de transport etc. Odată ce se stabilește cauza sau cauzele absenței sau a numărului mic de trimiteri, managerul și echipa sa se pot concentra pe aspectele legate de generarea cererii. Gestionarea cererii În cazul în care numărul persoanelor care apelează la furnizorul de servicii pentru utilizatorii de scaun rulant depășește capacitatea de răspuns a personalului, acest lucru poate avea trei consecințe: • personalul este nevoit să reducă durata de timp alocată fiecărui beneficiar – astfel, scade nivelul de calitate a serviciilor furnizate; • crește timpul de așteptare înainte de programare; sau • vor exista cazuri în care furnizorul va fi nevoit să refuze să ofere servicii unui anumit număr de utilizatori de scaun rulant. În oricare dintre aceste cazuri, atât furnizorul de servicii, cât și utilizatorii de scaun rulant pot fi demoralizați de situație. Poza 1 Poza 2 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 54 În consecință, gestionarea atentă a cererii este un aspect cât se poate de util. În prima fază, se recomandă ca managerii să se adreseze unui număr mai mic de surse de trimitere, începând cu cele aflate în proximitate. Avantajul constă în facilitarea desfășurării monitorizării în stadiul inițial al procesului de furnizare a serviciilor. Mass media și liniile de telefonie naționale, care pot fi apelate gratuit, pot genera cereri în masă, de la distanțe mari. Fără o rețea de furnizare a serviciilor, această situație va fi dificil de gestionat și va genera costuri ridicate, atât în cazul utilizatorilor, cât și al furnizorilor de servicii. Generarea și gestionarea listelor de așteptare Atunci când cererea este crescută, creați o listă de așteptare. Se va dovedi rentabilă investiția de timp în generarea unui sistem care folosește o bază de date pentru înregistrarea acestor informații. Acest lucru va permite managerului și personalului furnizor de servicii să acceseze eficient informațiile și va ușura procesarea statisticilor. Odată ce o persoană apelează la furnizorul de servicii pentru utilizatorii de scaun rulant, există posibilitatea de a adăuga informații suplimentare, cum ar fi data evaluării, data probării echipamentului de mobilitate, programarea monitorizării cazului. Verificarea trimiterilor și a listelor de așteptare Creșterea numărului de persoane înscrise pe listele de așteptare determină unele organizații să verifice și să aranjeze trimiterile în ordinea priorităților. Următoarele categorii de persoane trebuie considerate ca având prioritate: • copiii – din cauza importanței intervenției timpurii și a riscului crescut de apariție a deviațiilor posturale în timpul puseelor de creștere accelerată; • utilizatorii de scaun rulant la care există riscul apariției escarelor – deoarece acestea pun în pericol viața persoanei; • utilizatorii de scaun rulant care au o afecțiune degenerativă – situația lor presupune intervenție urgentă; • persoane la care există senzația de durere din cauza lipsei unui scaun rulant sau din cauza unui scaun rulant care nu li se potrivește. Pentru a ajuta la verificarea și planificarea programărilor, trebuie incluse în baza de date câteve câmpuri esențiale: • vârsta; • tipul de dizabilitate; • motivul pentru care utilizatorul a fost direcționat către furnizorul de servicii; • zona geografică. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 55 Capacitatea de furnizare a serviciilor Este importantă modalitatea de gestionare a așteptărilor cu privire la capacitatea de furnizare a serviciilor – ne referim aici la numărul de utilizatori de scaun rulant și la nivelul de furnizare a serviciilor. Cu toate că vor exista cereri pentru servicii de nivel de intermediar și avansat, nu toți furnizorii de servicii vor avea capacitatea să ofere servicii de această complexitate. Totuși, membrii echipei se vor confrunta cu cazuri de utilizatori de servicii ale căror nevoi specifice vor depăși nivelul de cunoștințe, competențe și gama de produse disponibile. Managerii trebuie să se asigure că există o strategie pentru abordarea acestor situații. Managerii au următoarele opțiuni: • să se asigure că informațiile despre serviciile furnizate (ceea ce pot oferi acestea) sunt clar prezentate în broșuri/pliante; • să mențină legătura cu alți furnizori de servicii pentru a vedea dacă este posibilă direcționarea utilizatorilor către aceștia sau să colaboreze în cazul persoanelor cu nevoi care depășesc capacitatea serviciuliu propriu; • să documenteze nevoile care nu pot fi satisfăcute – și să planifice creșterea capacității în termeni de resurse umane și produse disponibile. Importanța intervenției timpurii în cazul utilizatorilor copii Mulți dintre copiii care au nevoie de scaun rulant vor avea nevoie și de suport postural suplimentar. Acest lucru înseamnă că există un număr mare de copii pentru care trebuie furnizate servicii de nivel intermediar. Este important ca toți copiii care se află în această situație să fie direcționați către furnizorul de servicii pentru utilizatorii de scaun rulant cât mai timpuriu posibil, în vederea prevenirii sau încetinirii evoluției problemelor posturale. Nevoile specifice ale copiilor și beneficiile intervenției timpurii sunt prezentate în pachetul de instruire pentru furnizarea serviciilor de nivel intermediar, secțiunea referitoare la utilizatorii copii. Intervenția timpurie este importantă pentru copii din următoarele motive: • În lipsa suportului adecvat, la utilizatorii copii care au dificultăți în menținerea poziției așezat, există riscul apariției problemelor posturale. Dacă un utilizator copil nu este direcționat spre furnizorul de servicii în timp util, anumite probleme posturale pot deveni fixe. Acest lucru face dificilă menținerea poziției așezat în condiții confortabile, chiar și în prezența suportului. • Atunci când experiența de menținere a poziției așezat și cea a mobilității sunt absente, pot apărea întârzieri în dezvoltarea utilizatorului copil. • În cazul copiilor la care capacitatea de a merge este prezentă, într-o oarecare măsură, utilizarea unui scaun rulant le poate ușura viața de zi cu zi și le poate permite desfășurarea mai multor activități pe parcursul unei zile. Din păcate, uneori, intervenția nu are loc atât de devreme pe cât ar fi necesar. În anumite cazuri, părinții speră că ei se vor vindeca și vor merge din nou. Unii părinți sunt îngrijorați de faptul că un scaun rulant va costa prea mult sau nu au informații despre furnizorul de servicii pentru utilizatorii de scaun rulant. Există și cazuri în care părinții consideră că utilizarea unui scaun rulant îi va împiedica pe copiii lor să meargă. Este important ca întreaga echipă furnizoare de servicii să expună în mod clar motivele pentru care intervenția timpurie este esențială. Totodată, personalul trebuie să îi convingă pe părinți și pe aceia care pot deveni surse de trimitere de faptul că este improbabil ca un scaun rulant să împiedice utilizatorul copil de a merge, atunci când acesta are capacitatea de a se deplasa. Experiența mobilității cu ajutorul unui scaun rulant pe perioada în care copilul învață să meargă va avea un impact pozitiv asupra dezvoltării sale, din mai multe puncte de vedere. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 56 Exemplu de succes privind intervenția timpurie – un caz din Mexic În continuare, avem un exemplu despre modul în care un grup de centre de recuperare pentru copii din Mexic a reușit să dezvolte o rețea eficientă pentru intervenția timpurie. Centrele de recuperare au avut ca obiectiv creșterea gradului de conștientizare în ceea ce privește serviciile lor în rândul medicilor și al pediatrilor neonatologi. În plus, au reușit să abordeze întreaga comunitate printr-o importantă campanie anuală de strângere de fonduri, care este bine mediatizată, atât prin radio, cât și prin televiziune. Acest lucru a dus la multe trimiteri care au rezultat din discuții individuale, mulți părinți recomandând altora aceste servicii, în beneficiul copiilor. Pe parcursul campaniei de conștientizare, mesajul a fost clar: este foarte important ca recomandarea pentru recuperare în cazul copiilor să se producă la momentul nașterii acestora. De asemenea, a fost prezentată o viziune de succes, puternică, cu multe cazuri de succes cu privire la integrarea și realizările copiilor cu care au lucrat aceste centre. În 15 ani, centrele de recuperare au observat o schimbare de mentalitate, deoarece medicii pediatri și familiile apelează în mod activ la intervenția timpurie. Rezultatul: O treime din numărul trimiterilor se referă la copii până la vârsta de trei ani. Ce pot face managerii pentru a obține rezultate pozitive în ceea ce privește încurajarea intervenției timpurii? • să stabilească un obiectiv clar referitor la acest aspect; • să transmită un mesaj clar cu privire la cine se încadrează în grupul țintă; • să utilizeze abordări diferite în cazul specialiștilor și al părinților; • să promoveze cazurile de succes pentru a încuraja părinții și specialiștii; • să desfășoare activități sustenabile de creștere a gradului de conștientizare, pe parcursul mai multor ani. Gestionarea eficientă a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Analiza gradului de eficiență și de utilitate a procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Odată ce procesul de furnizare a serviciilor funcționează, se recomandă efectuarea unei analize a fiecărei etape și observarea duratei de desfășurare a activităților specifice acestora. Creșterea gradului de eficiență a etapelor ar trebui să se focalizeze pe următoarele aspecte: • încurajarea lucrului în echipă; • planificarea a ceea ce poate fi pregătit în avans pentru implementarea fiecărei etape a procesului de furnizare a serviciilor. Tabelul de mai jos prezintă câteva sugestii cu privire la modalitatea de creștere a gradului de eficiență în furnizarea serviciilor pentru utilizatorii de scaun rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 57 Modalități de creștere a gradul de eficiență – pentru fiecare etapă a procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant Trimiterea • Stabiliți scopuri și obiective clare care să seteze nivelul de cerere pe care vreți să îl gestionați. • Transmiteți un mesaj clar cu privire la cine sunt beneficiarii serviciilor. • Identificați organizații care să devină surse de trimitere și specialiști pentru activități care să ducă la creșterea gradului de conștientizare. • Monitorizați cu atenție numărul de trimiteri. • Promovați cazurile de succes în rândul personalului furnizor de servicii și al surselor de trimitere. Evaluarea • Planificați modul în care personalul furnizor de servicii poate atinge nivelul de instruire corespunzător. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. • Asigurați-vă de faptul că sunt disponibile toate echipamentele necesare pentru efectuarea evaluării. Prescrierea • Creați sisteme eficiente pentru controlul stocului. • În cazul în care produsele au opțiuni de ajustare limitate, trebuie prescrise modificări pentru ca produsele să fie potrivite nevoilor individuale ale utilizatorilor. • Asigurați-vă de faptul că personalul furnizor de servicii discută soluțiile împreună cu utilizatorul de scaun rulant și, în cazul în care acest lucru este posibil, că îi prezintă utilizatorului opțiunile de produse disponibile. Astfel se va evita respingerea de către utilizator a echipamentului de mobilitate. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Finanțarea și plasarea comenzii • Asigurați înregistrarea clară a informațiilor și păstrarea documentelor. • Creați sisteme eficiente pentru controlul stocului. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 58 Pregătirea produsului • Identificați produsele cu cea mai complexă gamă de ajustări posibile. • Identificați produsele care pot fi modificate cu ușurință. • Confecționați în avans dispozitive de suport postural și/sau identificați produse prevăzute cu dispozitive de suport postural. • Identificați uneltele de care aveți nevoie pentru a efectua modificări rapide. • Identificați materialele corespunzătoare pentru confecționarea și modificarea pernelor și a dispozitivelor de suport postural. • Creați sisteme eficiente pentru controlul stocului. • Pregătiți un stoc redus de scaune rulante de diferite mărimi. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Probarea produsului • Asigurați-vă că pe durata etapei de probare, personalul cu atribuții clinice lucrează împreună cu personalul cu atribuții tehnice. • Pregătiți în avans diferite tipuri de dispozitive pentru adaptări. • Identificați produsele cu cea mai complexă gamă de ajustări posibile. • Identificați uneltele de care aveți nevoie pentru a efectua modificări rapide. • Identificați produsele care pot fi modificate cu ușurință. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Instruirea utilizatorilor • Desemnați persoana responsabilă pentru instruirea utilizatorilor de scaun rulant, de exemplu, instructorul utilizator de scaun rulant. • Identificați spațiul adecvat pentru activitățile de instruire a utilizatorilor în proximitatea spațiilor dedicate activităților clinice și tehnice. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Monitorizarea • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. În general • Organizați ședințe de echipă, în mod regulat, pentru a crea planuri de acțiune comune. • Organizați activitatea de așa manieră încât membrii echipei să aibă posibilitatea de a lucra împreună. • Asigurați-vă că există o procedură clară de înregistrare și păstrare a informațiilor și datelor. • Contribuiți la creșterea capacității partenerilor din comunitate în ceea ce privește furnizarea serviciilor de nivel de bază și direcționarea către furnizor a utilizatorilor care necesită servicii de nivel intermediar. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 59 Tranziția de la furnizarea serviciilor numai la nivel de bază, la furnizarea serviciilor atât la nivel de bază cât și la nivel intermediar Un număr mare de furnizori de servicii destinate utilizatorilor de scaun rulant încep activitatea prin a oferi servicii care răspund nevoilor de nivel de bază. Acesta constituie un bun punct de pornire, deoarece furnizorul se poate concentra pe crearea sistemelor asociate parcurgerii celor opt etape, iar personalul dobândește experiență. Însă, așa cum s-a menționat anterior, mulți furnizori de servicii se vor confrunta cu cereri care, în termeni de complexitate, se vor încadra la nivelul intermediar. Acest lucru nu ne surprinde, de vreme ce s-a estimat că 35% dintre nevoile individuale ale utilizatorilor corespund nivelului de bază și 65% nivelului intermediar sau avansat. De aceea, este posibil ca managerii să fie nevoiți să planifice furnizarea serviciilor de nivel intermediar. Acest tip de servicii presupune următoarele: • personal instruit corespunzător, • un număr mai mare de spații alocate, echipamente și materiale. Mai jos sunt enumerate câteva strategii pentru managerii care trebuie să gestioneze tranziția de la servicii nivel de bază la servicii de nivel intermediar: • Colaborați cu membrii echipei pentru a identifica modalitățile prin care ar putea fi furnizate serviciile de nivel intermediar. Luați în considerare ce fel de spații și echipamente suplimentare sunt necesare, precum și modelul de furnizare a serviciilor care va fi folosit. • Stabiliți dacă, în urma instruirii adecvate, personalul care furnizează servicii de nivel de bază are capacitatea de a oferi servicii de nivel intermediar. Dacă da – primul pas este să identificați și să instruiți personalul care îl va înlocui pe cel actual în furnizarea serviciilor de bază, apoi instruiți personalul care va furniza serviciile mai complexe, de nivel intermediar. • Stabiliți dacă este posibilă colaborarea cu alte organizații – în cazul în care nu reușiți să identificați personal adecvat sau nu aveți fondurile necesare pentru plata personalului suplimentar. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 60 C.3 Planificarea activității de monitorizare Monitorizarea este cea de-a opta etapă a procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Toți utilizatorii de scaun rulant beneficiază de pe urma monitorizării. Este important să existe o planificare a acțiunilor care țin de această etapă. Monitorizarea reprezintă o oportunitate și pentru furnizorul de servicii, dând posibilitatea acestuia să obțină informații despre impactul pe care serviciile îl au asupra utilizatorului, membrilor familiei și comunității acestuia. 8. Monitorizarea, întreținerea și reparațiile Activitățile de monitorizare reprezintă o oportunitate pentru a verifica dacă scaunul rulant este corespunzător și pentru a oferi instruire și sprijin suplimentar. Intervalul de timp la care se efectuează monitorizarea depinde de nevoile utilizatorului și de tipul de servicii la care are acesta acces. De asemenea, furnizorul de servicii pentru utilizatorii de scaun rulant poate oferi și servicii de mentenanță și efectuare reparații în cazul problemelor tehnice, probleme care nu pot fi rezolvate cu ușurință în cadrul comunității. Importanța activității de monitorizare Câteva exemple privind importanța activității de monitorizare Duli: este o femeie în vârstă de 21 ani, care locuiește cu familia. La monitorizare, echipa a aflat că ea nu își putea părăsi casa, deoarece scaunul ei rulant avea roțile dezumflate, anvelopele fiind perforate. Scaunul rulant a fost abandonat în subsolul casei sale. Anvelopele scaunului rulant au fost recondiționate, iar familia ei a beneficiat de sfaturi cu privire la echipamentul de mobilitate. Astfel, Duli a avut posibilitatea de a ieși din nou din casă. Familia ei nu a înțeles importanța activității de monitorizare decât în momentul în care a văzut care sunt avantajele care decurg de aici. Echipa furnizoare de servicii a decis să creeze autocolante pentru toate scaunele rulante pe care le oferă, pe care să apară numărul de contact al furnizorului, pentru a preîntâmpina astfel de cazuri. Maria: a primit un scaun rulant corespunzător la 9 luni după ce a dobândit o leziune a măduvei spinării. La monitorizare, Maria a explicat că scaunul rulant îi produce senzația de disconfort și că utilizarea acestuia are ca rezultat apariția spasticității. Echipa a constatat că materialul textil al scaunului rulant era infestat cu insecte care o înțepau. Acest lucru ar fi putut determina apariția unor probleme de sănătate grave și renunțarea la utilizarea scaunului rulant. Însă problema a fost identificată și rezolvată, iar Maria este acum sănătoasă și mulțumită de scaunul ei rulant. Anton: era cunoscut în comunitatea sa datorită aptitudinilor sale de sportiv. În timpul unui joc de rugby Anton a avut un accident care a provocat o leziune la nivelul măduvei spinării. A primit un scaun rulant corespunzător și a fost instruit, dar la monitorizare s-a constatat că nu își părăsea locuința. Din echipa de monitorizare făcea parte și un instructor în scaun rulant, iar acesta a discutat cu Anton. Instructorul a aflat că Anton își pierduse încrederea de sine și nu dorea să se întâlnească cu prietenii lui. Se simțea izolat, singur și rușinat de faptul că avea o dizabilitate. Instructorul în scaun rulant a revenit a doua zi și l-a însoțit prima dată când Anton a decis să iasă din casă. După acest eveniment, Anton a fost capabil să își continue viața. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 61 Gihan: este un băiat în vârstă de trei ani care locuiește cu părinții și fratele său. La monitorizare, s-a constatat că sistemul de poziționare al lui Gihan avea numeroase pete de mâncare și că nu era întreținut. Părinții au afirmat că Gihan avea dificultăți în menținerea poziției așezat și că nu se simțea confortabil în scaunul său. Ei și-au pierdut încrederea în respectivul echipament de mobilitate și nu erau mulțumiți de ceea ce oferea acesta. Gihan a fost reprogramat pentru o nouă evaluare efectuată de către o echipă care a beneficiat de instruire pentru furnizarea serviciilor de nivel intermediar. S-au făcut adaptări și ajustări ale scaunului rulant, iar ca urmare a acestui fapt, Gihan a reușit să mențină poziția așezat în scaunul rulant și a început să descopere și să exploreze mediul în care trăia. Gihan și părinții lui au fost foarte bucuroși de această schimbare și au urmărit cu atenție când li s-a arătat care sunt operațiunile necesare pentru întreținerea scaunului rulant. Beneficiile monitorizării în cazul utilizatorilor de scaun rulant și al furnizorului de servicii • Personalul poate confirma (sau nu) faptul că scaunul rulant răspunde nevoilor utilizatorului și caracteristicilor mediului în care trăiește acesta. • Vizitele la domiciliu și în comunitate sunt o oportunitate bună pentru identificarea cazurilor de succes, care pot fi folosite pentru a oferi feedback echipei și pentru acțiunile de strângere de fonduri. • Monitorizarea desfășurată la sediul furnizorului de servicii pentru utilizatorii de scaun rulant constituie o ocazie pentru identificarea cazurilor de succes, care pot fi folosite pentru a oferi feedback echipei și pentru acțiunile de strângere de fonduri. Scopul activității de monitorizare și locul unde ar trebui să se desfășoare Scopul monitorizării este: • obținerea de informații de la utilizatorul de scaun rulant; • verficarea funcționării corespunzătoare a scaunului rulant; • verificarea faptului că scaunul rulant i se potrivește utilizatorului. Acțiuni de monitorizare obișnuite Acțiunile obișnuite în cadrul vizitelor de monitorizare includ: • informare și instruire suplimentare • reajustarea scaunului rulant • efectuarea unor reparații minore • în cazul în care este necesar, direcționarea utilizatorului de scaun rulant către un alt furnizor de servicii, pentru sprijin sau asistență. În măsura în care acest lucru este posibil, activitatea de monitorizare nu ar trebui să se transforme într-o nouă evaluare sau într-o activitate de recondiționare totală a scaunului rulant. Dacă se identifică necesitatea unei noi evaluări complete sau dacă scaunul rulant are nevoie de modificări majore, se va stabili o programare pentru rezolvarea acestor aspecte. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 62 Unde ar trebui să se desfășoare activitatea de monitorizare? Monitorizarea poate avea loc la domiciliul utilizatorului de scaun rulant, la sediul furnizorului de servicii sau în orice altă loc agreat de către utilizator și de către personalul furnizor de servicii. Avantajele activității de monitorizare desfășurate în diferite locuri sunt prezentate în tabelul de mai jos: Beneficiile monitorizării desfășurate la domiciliul utilizatorului sau în comunitate Beneficiile monitorizării desfășurate la sediul furnizorului de servicii • Mai eficient din punct de vedere al costurilor pentru utilizator și familia acestuia; • Personalul află mai multe informații despre obstacolele pe care le întâmpină utilizatorul de scaun rulant în ceea ce privește participarea și incluziunea, atât la domiciliu, cât și în comunitate; • Prezența și vizibilitatea personalului crește gradul de conștientizare la nivelul comunității, mărind numărul de trimiteri către furnizorul de servicii pentru utilizatorii de scaun rulant. • Mai eficient pentru personalul furnizor de servicii din punct de vedere al costurilor și al alocării timpului; • Posibilitatea efectuării unor reparații majore cu ajutorul dotărilor complete care există la sediu; • Toate echipamentele și instrumentele sunt deja instalate; • Posibilitatea de a solicita o opinie celorlați membri ai echipei. Planificarea activității de monitorizare Toți utilizatorii de scaun rulant beneficiază de pe urma monitorizării. Cu toate acestea, monitorizarea este indicată în special în următoarele cazuri: • Utilizatori de scaun rulant copii; • Utilizatori de scaun rulant la care există riscul apariției escarelor; • Utilizatori de scaun rulant care au o afecțiune degenerativă; • Utilizatori de scaun rulant care au nevoie de suport postural suplimentar atunci când utilizează echipamentul de mobilitate; • Utilizatori de scaun rulant care au întâmpinat dificultăți în ceea ce privește instruirea pentru efectuarea transferului, dobândirea abilităților de mobilitate, prevenirea problemelor de sănătate sau întreținerea scaunului rulant. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 63 Calendarul monitorizării Nu există o regulă cu privire la intervalul la care trebuie realizată monitorizarea, deoarece asta va depinde de nevoile individuale ale utilizatorului de scaun rulant. • Se recomandă ca în cazul utilizatorilor care au nevoie de servicii de nivel intermediar, monitorizarea să aibă loc într-un interval de șase săptămâni de la primirea scaunului rulant nou, pentru a verifica dacă acesta răspunde sau nu nevoilor acestora. • În cazul utilizatorilor copii și adulți care au afecțiuni degenerative, monitorizarea ar trebui să aibă loc la intervale de câte șase luni. Acest lucru este consecința faptului că în aceste cazuri schimbările se pot produce cu rapiditate. • Se recomandă ca toți ceilalți utilizatori să fie monitorizați într-un interval de douăsprezece luni de la primirea scaunului rulant. Rețineți: Monitorizarea trebuie să fie inclusă în modelul de furnizare a serviciilor încă de la stagiul planificării inițiale. Parteneriatele cu actori din comunitate sunt vitale pentru dezvoltarea capacității de efectuare a monitorizării. Impactul activității de monitorizare în cazul în care nu s-au stabilit parteneriate în comunitate Beneficiari monitorizaţi Beneficiari noi Total utilizatori scaun rulant Servicii de nivel de baza Servicii de nivel intermediar Total utilizatori Total utilizatori anul 3 anul 3 În absența planificării, disponibilitatea furnizorului de servicii pentru utilizatorii de scaun rulant de a genera noi programări va fi rapid influențată de desfășurarea activitității de monitorizare. În cazul serviciilor de nivel intermediar, cu precădere, furnizorii ajung să atingă nivelul de saturație în al treilea an de activitate. O posibilă soluție o reprezintă colaborarea cu organizațiile din comunitate, precum și instruirea resurselor umane ale acestora, astfel încât activitatea de monitorizare să fie desfășurată într-o cât mai mare măsură de către acest personal. Personalul din cadrul comunității poate administra multe dintre sarcinile mai simple care țin de monitorizare, contactând furnizorul de servicii doar când este nevoie de o reevaluare, pentru reparații majore sau alte probleme pentru a căror rezolvare are nevoie de personalul specializat al acestuia. Atunci când această activitate este desfășurată de o persoană care poate fi un model pozitiv, cum ar fi o persoană cu dizabilități locomotorii, există mai multe avantaje. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 64 Stabiliți parteneriate cu actori din comunitate și planificați modelul de furnizare a serviciilor Activităţi desfăşurate la centru A.2.11 Furnizarea serviciilor pentru utilizatorii de scaun rulant 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea 2. Evaluarea 3. Prescrierea 4. Finanţarea şi plasarea comenzii 5. Pregătirea produsului 6. Probarea 7. Instruirea utilizatorului 8. Întreţinere, monitorizare şi reparaţii 1. Trimiterea şi programarea Creșterea gradului de conștientizare, inclusiv influențarea politicii nationale Cresterea gradului de acces și satisfacerea așteptărilor utilizatorilor Monitorizare și evaluare Personal motivat și bine instruit Dezvoltarea unui sistem funcțional Dezvoltarea sustenabilității Un partener din comunitate poate face trimiteri și poate prelua activitatea de monitorizare, inclusiv întreținerea și efectuarea reparațiilor. De asemenea, partenerul din comunitate poate susține etapa de instruire a utilizatorului. În funcție de capacitatea partenerului din comunitate, aceasta poate să sprijine și aspecte mai complexe care țin de activitatea furnizorului de servicii pentru utilizatorii de scaun rulant. Reducerea obstacolelor în efectuarea activității de monitorizare În ciuda beneficiilor pe care le aduce activitatea de monitorizare atât utilizatorilor de scaun rulant, cât și furnizorilor de servicii, numărul utilizatorilor monitorizați este adesea redus. Este important să identificăm cauza principală, pentru a depăși obstacolele și pentru a îmbunătăți furnizarea serviciilor pentru utilizatorii de scaun rulant. Potențiale obstacole în desfășurarea monitorizării în comunitate • costurile pentru deplasarea în comunitate a personalului de la sediul furnizorului de servicii; • timpul de care are nevoie personalul pentru a se deplasa în comunități; • managerii nu consideră că monitorizarea este o prioritate; • utilizatorii nu înțeleg care sunt beneficiile monitorizării decât după ce le experimentează; Potențiale obstacole în desfășurarea monitorizării la sediul furnizorului de servicii pentru utilizatorii de scaun rulant • costul deplasării și absența de la locul de muncă al unuia sau mai multor membri ai familiei reprezintă o cheltuială dublă pentru familie; • în numeroase cazuri, utilizatorii și membrii familiei nu cunosc care sunt beneficiile monitorizării după primirea scaunului rulant; • dificultatea de a găsi mijloace de transport accesibile; • presiunea concentrării pe stabilirea de noi programări, în detrimentul timpului alocat pentru activitatea de monitorizare; • dificultăți în programarea vizitelor: utilizatorii ajung la sediul furnizorului atunci când personalul nu este disponibil sau nu au cum să ajungă atunci când personalul este disponibil. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 65 Abordarea activității de monitorizare – un exemplu din Indonezia În cadrul unui program de furnizare a scaunelor rulante din Indonezia, în locul perceperii unei taxe pentru furnizarea echipamentului de mobilitate, se percep „taxe de membru” care contribuie la susținerea costurilor pe care le presupun funcționarea sistemului de furnizare a serviciilor, monitorizarea, întreținerea echipamentelor și aspectele administrative. Această „taxă de membru” le asigură utilizatorilor servicii de calitate și suport permanent. Există un sistem de plată „flexibil”, unde valoarea achitată de către o persoană este determinată în funcție de veniturile familiei, identificate prin facturile de utilități, documente de angajare, indicatori de venit bazate pe declarația proprie sau de alt tip. S-a constatat că acest program destinat utilizatorilor de scaun rulant reprezintă o soluție viabilă din mai multe puncte de vedere: • Membrii simt că au dreptul să se aștepte la servicii și produse de calitate. • Deoarece membrii au achitat o sumă semnificativă raportat la veniturile lor (de obicei, sumele sunt cuprinse între 2$ – 20$, dar pot ajunge și până la 150$), crește probabilitatea ca ei să aprecieze în mod real scaunul rulant și să aibă un sentiment de mândrie că îl dețin. • Deoarece calitatea de membru le permite accesul gratuit sau cu preț redus la servicii de monitorizare, valabile timp de doi ani de la primirea scaunului rulant, crește probabilitatea ca membrii să solicite acest serviciu înainte de expirarea acestui termen. Sugestii de acțiuni pentru depășirea obstacolelor în desfășurarea monitorizării Motivați, implicați și mobilizați utilizatorii de scaun rulant, ajutându-i să înțeleagă care sunt avantajele pe care le aduce activitatea de monitorizare: • în timpul etapei de instruire (etapa șapte), explicați-le care sunt beneficiile monitorizării; • faceți cunoscute poveștile despre avantajele monitorizării, prin materiale de promovare care să fie vizibile în sala de așteptare, pe pagina web, pe panourile de informare plasate în comunitate; • creați un sistem care le dă utilizatorilor posibilitatea de a participa la procesul de furnizare a serviciilor în calitate de membri care beneficiază de aceste servicii. Motivați, implicați și mobilizați personalul furnizor de servicii, ajutându-l să înțeleagă care sunt avantajele pe care le aduce activitatea de monitorizare: • testați un model de monitorizare care să fie implementat de către personalul furnizor de servicii; • centralizați studii de caz care să demonstreze care sunt avantajele care decurg din monitorizare. Identificați un rezultat imediat și măsurabil: • stabiliți obiective pentru un program de monitorizare pilot; • identificați și faceți cunoscute studii de caz care să demonstreze care sunt avantajele care decurg din monitorizare. Atunci când alocați resursele, acordați prioritate activității de monitorizare: • utilizați poveștile de succes despre beneficiile monitorizării ca sprijin pentru strângerea de fonduri în vederea acoperirii costurilor specifice acestei activități; • alocați timp pentru a dezvolta parteneriate în comunitate; instruiți și îndrumați personalul din comunitate; • asigurați-vă că există transport accesibilizat. Oferiți sprijin în eforturile de abordare a provocărilor specifice furnizării serviciilor de monitorizare: • analizați informațiile obținute la monitorizare și identificați cauzele problemelor; • integrați activitatea de monitorizare în modelul, sistemele și procedurile de furnizare a serviciilor. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 66 Incluziunea și participarea la viața comunității Monitorizarea reprezintă etapa în care se evaluează impactul pe care îl are serviciul de furnizare a scaunelor rulante și în care se stabilește dacă acesta își atinge scopul principal, care se referă la îmbunătățirea calității vieții, incluziune și participare la viața comunității. Unul dintre rolurile extinse ale serviciului de furnizare a scaunelor rulante este îmbunătățirea accesibilității. Accesibilitatea poate influența într-o foarte mare măsură incluziunea și participarea la viața comunității a utilizatorilor de scaun rulant. Locuințe și spații publice accesibile Frecvent, accesul la toaletă reprezintă unul dintre principalele obstacole legate de întoarcerea la domiciliu a utilizatorului de scaun rulant. Sfaturile cu privire la modificările minore necesare pentru adaptarea locuinței utilizatorilor de scaun rulant au un impact pozitiv semnificativ asupra calității vieții. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 67 O campanie de accesibilizare arhitecturală în Nicaragua ÎNLĂTURAREA BAR IERELOR ARHITECT URALE C. 3. 12. Planificarea activității de monitorizare În Nicaragua, în capitala țării, o organizație pentru persoanele cu dizabilități numită CADISCA a desfășurat o campanie prin care a scos în evidență problemele legate de înălțimea bordurilor și a treptelor. În doar trei luni, membrii organizației pentru persoanele cu dizabilități (toți utilizatori de scaun rulant) au construit 200 de rampe și borduri înclinate (aducând la nivelul drumului o mică parte a bordurii), creând astfel acces la spațiile publice. Comunitatea a perceput acțiunea membrilor CADISCA ca pe ceva pozitiv, ceea ce a sporit sprijinul acordat organizației și a avut ca rezultat construirea mai multor borduri și rampe în oraș, cu ajutorul sponsorizărilor făcute de companiile locale. Anterior, CADISCA a utilizat baschetul pentru utilizatorii de scaun rulant ca mijloc de promovare a încrederii în propria persoană a persoanelor cu dizabilități și de creștere a gradului de implicare în activitățile organizației. Sesiunile de antrenament sportiv au însemnat, totodată, o oportunitate pentru desfășurarea unor ședințe regulate ale organizației, unde au fost planificate acțiuni de creștere a vizibilității. Aceste sesiuni de antrenament au avut loc în parcuri publice, expunând comunitatea la activitățile organizației pentru persoanele cu dizabilități și sporind vizibilitatea acesteia. În cele din urmă, programul sportiv a influențat succesul campaniei privind accesibilitatea, prin creșterea gradului de conștientizare în rândul publicului și de sprijin pentru persoanele cu dizabilități. Rezultatul a fost presiunea exercitată asupra guvernului pentru ca acesta să finanțeze construirea de borduri înclinate în Managua. Eliminarea obstacolelor fizice a acordat utilizatorilor de scaun rulant oportunități egale în accesul la zone cheie din oraș, pentru activități din domeniul financiar, educațional și social. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 68 Bugetul necesar integrării elementelor de accesibilitate arhitecturală în timpul procesului de construcție a clădirilor este minim - în general, sub 1% din costul construcției. Accesul la educație este îngreunat chiar de elemente banale, cum ar fi lățimea căii de acces sau accesul la toaletă. Furnizarea către școli a resurselor și a informațiilor cu privire la accesibilizarea clădirilor și căilor de acces va contribui la transformarea acestora în medii incluzive. Prin intermediul consultanței și a informațiilor legate de accesibilizarea mediului, furnizorul de servicii poate facilita accesul la domiciliul utilizatorilor de scaun rulant, la transport și la educație, astfel încât oportunitățile de incluziune și participare a persoanelor cu dizabilități să fie folosite la maximum. Transportul accesibil Transportul în comun este unul dintre cele mai frecvente obstacole cu care se confruntă utilizatorii de scaun rulant. Aici ne referim la: • timp de staționare insuficient pentru ca utilizatorul de scaun rulant să se poată transfera în mijlocul de transport; • perceperea unor taxe suplimentare pentru transportarea scaunului rulant; • riscul ca anumite piese componente, de exemplu roțile, să se piardă sau să fie furate; • dificultatea accesului la mijloace de transport în comun din cauza pragurilor și a căilor de acces. În multe state există inițiative pentru furnizarea de transport adaptat, de exemplu Dial a Ride din Africa de Sud și sistemul Rapid Bus Transit din Columbia. Peste tot în lume există un număr semnificativ de resurse utile cu privire la problema transportului accesibil în lume.1 1 Resurse utile pentru mai multe informații despre transport accesibil: International Transport forum (ITF), Accessible multimodal transport, South Africa, Access Exchange International newsletter, Paratransit Gui- de – guidebook to transport issues (Forumul de Transport International, Transport multimodal accesibil, Africa de Sud, Buletin informativ Access Exchange International, Ghidul Paratranzit – ghid pentru proble- me de transport) Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 69 C.4 Planificarea sustenabilității financiare Ce este sustenabilitatea financiară? Sustenabilitatea financiară a unui furnizor de servicii destinate utilizatorilor de scaun rulant presupune ca acesta să dispună de fondurile și resursele necesare furnizării scaunelor rulante conform celor opt etape ale procesului, precum și asumării unor responsabilități complexe în acest domeniu. Managerii au un rol esențial în dezvoltarea unei strategii prin care procesul de furnizare al serviciilor pe care îl gestionează să devină unul viabil din punct de vedere financiar. Exemplu de definiție a sustenabilității financiare Un program de furnizare a serviciilor pentru utilizatorii de scaun rulant este sustenabil atunci când are capacitatea de a oferi scaune rulante corespunzătoare unui număr constant de utilizatori de scaun rulant, de-a lungul unei perioade semnificative, prin parcurgerea celor opt etape ale procesului de furnizare. Acest lucru presupune efectuarea de investiții permanente în stocul de produse, în instruirea personalului, în spații, precum și în sisteme de monitorizare și evaluare a activității. Sustenabilitatea financiară este atinsă atunci când furnizorul de servicii a reușit să asigure, sau asigură în mod constant, fondurile și resursele necesare acestei investiții constante. Planificarea sustenabilității financiare Planificarea sustenabilității financiare include: • identificarea fondurilor și a resurselor necesare pentru a asigura sustenabilitatea serviciilor (vezi B.5); • identificarea potențialelor surse de finanțare; • identificarea potențialelor surse de sprijin non-financiar; • dezvoltarea unei strategii care să aibă ca rezultat asigurarea finanțării și a donațiilor în natură. Identificarea potențialelor surse de finanțare Există multiple opțiuni pentru finanțarea serviciilor pentru utilizatorii de scaun rulant. Unii furnizori de servicii vor avea o singură sursă de finanțare (de exemplu, de la bugetul de stat). Totuși, cei mai mulți furnizări de servicii vor asigura fondurile și resursele necesare apelând la mai multe surse. Fiecare sursă de finanțare poate contribui la o anumită/anumite linii de buget sau unor cerințe specifice. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 70 Potențiale surse de finanțare pe care managerii le pot avea în vedere: Guvern Sisteme naționale de asigurare Donatori și sponsori privați Donatori și sponsori societăți comerciale (din mediul de afaceri) Contribuții sau achiziții complete din partea utilizatorilor Generare de venituri/întreprinderi sociale Grupuri comunitare/societăți caritabile Misiuni diplomatice ONG-uri naționale sau internaționale Identificarea potențialului suport non-financiar Suportul non-financiar include: donațiile în natură (de exemplu: donațiile de echipamente, scaune rulante sau materiale), voluntariatul și obținerea unui spațiu pentru desfășurarea activităților. Sprijinul non-financiar contribuie la reducerea fondurilor necesare gestionării procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant. Unii furnizori de servicii de scaune rulante pot primi în mod regulat donații de scaune rulante. Deși acestea pot fi foarte utile -- este important ca întotdeauna furnizorul de servicii să evalueze calitatea și cât de adecvate sunt aceste scaune rulante. Nu toate scaunele rulante donate sunt corespunzătoare. Combinarea diverselor surse de finanțare pentru susținerea unui serviciu de furnizare a scaunelor rulante În tabelul de mai jos avem un exemplu de surse de finanțare diferite identificate de către un furnizor de servicii pentru utilizatorii de scaun rulant, precum și modalitatea prin care aceste surse de finanțare contribuie la fondurile și resursele necesare organizației, astfel încât aceasta să fie viabilă din punct de vedere financiar. Exemplu de surse de finanțare pentru susținerea unui serviciu de furnizare a scaunelor rulante Sursă de finanțare Fonduri și resurse furnizate Guvern • Asigură 50% din costul fiecărui scaun rulant furnizat de către serviciu; • Finanțează remunerația a două persoane din echipa de furnizare a serviciilor pentru utilizatorii de scaun rulant (50% din bugetul alocat personalului). Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 71 Societate comercială • O companie locală oferă anual o donație pentru susținerea liniei de buget destinată achiziționării scaunelor rulante; • O altă companie din comunitate s-a angajat să ofere anual sponsorizare pentru un număr de zece copii – acoperind astfel costul scaunelor rulante și al furnizării serviciilor aferente. Persoane • Oferă donații către furnizorul de servicii pentru utilizatorii de scaun rulant (fără a specifica o linie bugetară anume pentru care se va utiliza respectivă sumă). Activități ale întreprinderilor sociale • Furnizorul de servicii pentru utilizatorii de scaun rulant desfășoară mai multe activități specifice întreprinderilor sociale, cum ar fi: audit privind accesibilitatea (în cazul clădirilor) sau furnizarea dispozitivelor pentru management urinar. Profitul rezultat în urma acestor activități este utilizat pentru susținerea furnizării serviciilor pentru utilizatorii de scaun rulant și, în general, asigură cel puțin 50% din bugetul alocat personalului. ONG-uri internaționale • În cadrul a două proiecte, furnizorul de servicii a primit finanțare din partea unor ONG-uri internaționale, pentru furnizarea de scaune rulante către persoane care locuiesc în anumite zone geografice. Organizații religioase • Oferă, anual, o donație de 200 de scaune rulante (selectate de către furnizorul de servicii pentru utilizatorii de scaun rulant). Elaborarea unei strategii pentru strângerea de fonduri După ce identifică potențialele surse de finanțare, managerii care gestionează furnizarea serviciilor pentru utilizatorii de scaun rulant trebuie să elaboreze o strategie care să arate tipul de sprijin care va fi solicitat, sursele și cuantumul acestuia. O componentă a elaborării strategiei este evaluarea probabilității ca sursa de finanțare să acorde respectivele fonduri, stabilirea parametrilor sprijinului pe care sursa de finanțare îl poate oferi, cuantificarea timpului și a efortului care vor fi investite de către echipa de furnizare a serviciilor, în vederea asigurării acestei finanțări. Pentru a putea dezvolta o astfel de strategie, managerii trebuie să prioritizeze diferitele surse de finanțare și să planifice modalitatea de a atrage fondurile necesare funcționării. Managerii trebuie să ia în considerare: • Sursa de finanțare: pe cine vor aborda? • Sprijinul: tipul de sprijin pe care managerul îl va solicita. Acesta se poate concentra pe o linie de buget, cum ar fi produsele sau pe una sau mai multe etape ale procesului de furnizare a serviciilor destinate utilizatorilor de scaun rulant, cu numărul de linii bugetare aferente. Luați în considerare sursa de finanțare specifică și ceea ce este cel mai probabil să-și dorească să finanțeze. • Cererea: care sunt parametrii resurselor solicitate? Trebuie să aveți în vedere resursele sursei de finanțare și valoarea donațiilor anterioare către serviciul dumneavoastră sau către alte organizații. Scopul este de a solicita o sumă realistă. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 72 • Probabilitatea: probabilitatea ca sursa de finanțare să sprijine furnizorul de servicii. Aici există trei categorii: scăzută, medie și ridicată. • Efortul: care sunt acțiunile necesare pentru a asigura finanțarea, care sunt modalitățile de raportare sau alte tipuri de obligații. Cuantumul sprijinului trebuie să fie proporțional cu valoarea finanțării. Obligațiile asumate trebuie să fie, de asemenea, ușor de gestionat de către furnizorul de servicii pentru utilizatorii de scaun rulant. În tabelul de mai jos sunt prezentate două astfel de exemple. Luând în considerare tipul de sprijin, cererea, probabilitatea de a obține rezultatul dorit și efortul necesar pentru atingerea obiectivului, managerii pot stabili într-un mod mai eficient care dintre sursele de finanțare pe care doresc să le abordeze vor constitui o prioritate. Sursa de finanțare Tipul de susținere Cererea Probabilitatea Efortul 1. Societate comercială (afacere locală) Donație pentru bugetul de achiziționare a scaunelor rulante 10% din bugetul pentru scaune rulante Mediu (au finanțat în trecut, totuși nu finanțează în fiecare an aceeași organizație) Cel puțin două întâlniri cu managerul companiei; propunere de 2 pagini și buget de depus şi invitarea managerului la următoarea acțiune de tip „ziua porților deschise” 2. Autoritate locală Este posibil să finanțeze vizitele la domiciliul utilizatorilor de scaune rulante din zona lor. 20% din costurile totale ale activităților desfășurate în comunitate și 20% din salariile personalului furnizorului de servicii Ridicat (se discută deja despre acest aspect cu autoritățile locale). S-au furnizat servicii în respectiva comunitate. Sunt interesați în mod real în susținerea furnizării acestui tip de servicii și se pare că există fonduri disponibile) Propunere și buget de depus. Condiții de raportare – necesită informații corecte despre toate persoanele vizitate din acea zonă și raportare financiară Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 73 Abordarea sustenabilității financiare Asigurarea sustenabilității financiare a unui serviciu pentru utilizatorii de scaun rulant este o problemă dificilă. În cele ce urmează, vom vedea diferite idei și abordări privind finanțarea, care pot fi luate în considerare. Rețineți faptul că deseori abordările sunt diferite, în funcție de specificul sursei de finanțare. O abordare antreprenorială, pentru a răspunde unei nevoi sociale și a genera venit Un ONG din România a ales ca sursă de asigurare a sustenabilității financiare înființarea unei societăți comerciale. Această variantă are două obiective cheie: crearea unui impact social și al unui impact financiar. Utilizatorii de scaun rulant sunt angajați ca parte a echipelor multidisciplinare care furnizează echipamente de mobilitate de calitate și dispozitive medicale, destinate persoanelor cu dizabilități. Nivelul de calitate a serviciilor este crescut, deoarece echipa cunoaște foarte bine importanța poziționării corecte în scaunul rulant și a prevenirii complicațiilor medicale. Activitatea reprezintă o oportunitate de angajare pentru persoanele cu dizabilități, iar consumatorii iau decizii pe baza unor informații cât mai exacte și complexe. Serviciile oferite de către această societate comercială generează, de asemenea, venituri pentru susținerea altor programe implementate de către acest ONG. Achiziția directă de către utilizator Unii furnizori de servicii pentru utilizatorii de scaun rulant solicită o contribuție minimă din partea utilizatorilor, astfel încât să fie posibilă furnizarea scaunelor rulante și a serviciilor destinate lor. De multe ori, există un sistem de plată „flexibil”, unde valoarea achitată de către o persoană este determinată în funcție de veniturile familiei, identificate prin facturile la utilități, documente emise de serviciile sociale publice, declarație proprie privind veniturile sau alte tipuri de indicatori privind venitul realizat. Furnizorii care adoptă acest sistem trebuie să se asigure că acele persoane care nu pot contribui cu nicio sumă la primirea scaunului rulant nu vor fi dezavantajate. Donatori societăți comerciale și sponsori Teletonul din Mexic este o emisiune tv și radio care se desfășoară anual cu scopul de a atrage fonduri pentru centrele de recuperare destinate copiilor cu dizabilități (centrele CRIT). Producătorul emisiunii este Televisa, în parteneriat cu peste 600 de reprezentanți ai mass media din Mexic și din străinătate. Evenimentul este sponsorizat de 20 de companii. Emisiunea promovează o viziune de succes prin prezentarea unor exemple pozitive, cu impact puternic, privind integrarea copiilor și realizările acestora. Cu trei luni înainte de eveniment, cazurile de succes sunt promovate în mass media, pentru a atrage atenția asupra Teletonului. Persoane publice cunoscute sunt implicate în promovarea evenimentului. În România, un ONG a încheiat un parteneriat cu un sponsor reprezentat de o companie. Pentru a consolida acest parteneriat, în fiecare an se organizează un concurs de înot, la care participă echipe integrate formate din angajați ai companiei, instructori în scaun rulant, personal al ONG- ului și persoane cu dizabilități intelectuale care concurează între ele. Este un eveniment recreativ care aduce beneficii din mai multe perspective. Angajații companiei oferă apoi susținere financiară în mod constant, pe parcursul întregului an, fie prin contribuții directe sau prin evenimente de strângere de fonduri. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 74 Finanțare guvernamentală În Kenya, ministerul care răspunde de serviciile medicale lucrează în parteneriat cu un ONG care oferă atât servicii dedicate utilizatorilor de scaun rulant, cât și alte tipuri servicii de recuperare asociate. ONG-ul furnizează întregul suport logistic pentru opt filiale găzduite de spitale guvernamentale. Guvernul furnizează resursele umane. Până la ora actuală, acest minister a alocat filialelor ONG-ului un număr de 56 de angajați. Sistemul național de asigurări de sănătate din România • Primul pas presupune ca utilizatorul de scaun rulant să solicite obținerea unui certificat de dizabilitate. În lipsa acestui certificat, nu este posibilă solicitarea unui scaun rulant. • Următorul pas este programarea la un medic de recuperare, care prescrie un scaun rulant. • Apoi, utilizatorul de scaun rulant formulează o cerere către Casa de Asigurări de Sănătate (CAS) a județului de domiciliu. • Atunci când utilizatorul de scaun rulant primește decizia/cuponul valoric, el/ea alege un furnizor și unul dintre scaunele rulante oferite de acesta. • Dacă prețul scaunului rulant este mai mic decât subvenția acordată, atunci furnizorul livrează utilizatorului scaunul rulant în schimbul cuponului valoric, pe care îl folosește pentru a factura echipamentul de mobilitate către CAS. • Dacă prețul scaunului rulant depășește suma prevăzută de subvenție, atunci utilizatorul trebuie să găsească surse suplimentare de finanțare, cum ar fi donatori, angajatori, alte persoane fizice. Pentru resurse suplimentare în vederea dezvoltării de servicii pentru utilizatorii de scaun rulant nivel de bază sau intermediar, consultați fișierele de pe memory stick. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 75 Referinţe bibliografice 1. Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/ technology/ wheelchairguidelines/en/). 2. Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). 4. Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007) New York: United Nations;2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers (Allen et al., 2006). 6. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 113 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 7. Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 8. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006;44: 523–529. 9. Razzak ATMA, Helal SU, Nuri RP. Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclusive Development Journal. 2011; 22(1): 114-123. 10. World Health Organization, World Bank World report on disability, page 115. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/ report/en/). 11. Messiou K. Encouraging children to think in more inclusive ways. British Journal of Special Needs Education. 2008;35(1):26–32. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 76 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 77 PACHET DE INSTRUIRE PENTRU MANAGERI SERVICII PENTRU UTILIZATORII DE SCAUN RULANT CAIET DE EXERCIŢII PRAC TICE Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 78 Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 79 CUPRINS Partea 1 / 81 A. Noţiuni fundamentale / 81 A.1: Cum determinați o schimbare? / 81 B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 82 B.1: Accesarea serviciilor / 82 B.2: Spații și echipamente / 84 B.3: Gama de scaune rulante corespunzătoare / 85 B.4: Organizarea resurselor umane / 86 B.5: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 86 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 87 C.1: Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? / 87 C.2: Gestionarea cererii / 89 C.3: Planificarea activității de monitorizare / 89 C.4: Planificarea sustenabilității financiare / 90 Partea a doua / 91 A. Noțiuni fundamentale / 91 A.1: Furnizarea unui scaun rulant corespunzător: Politici la nivel național / 91 A.2: Furnizarea serviciilor pentru utilizatorii de scaun rulant / 93 B. Iniţierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant / 94 B.1: Spații și echipamente / 94 B.2: Gama de scaune rulante corespunzătoare / 98 B.3: Organizarea resurselor umane: Roluri / 103 B.4: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? / 103 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant / 106 C.1: Servicii eficiente / 106 C.2: Dezvoltarea unor servicii eficiente / 111 C.3: Gestionarea cererii / 112 C.4: Planificarea activității de monitorizare / 115 C.5: Dezvoltarea sustenabilității financiare / 116 Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 80 Activități pentru manageri în vederea inițierii sau îmbunătățirii sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant Caietul de exerciții practice include două părți: Partea 1: Care sunt pașii pentru inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant? Această secțiune pune accentul pe cele opt etape ale activității de furnizare a scaunelor rulante, spații, echipamente, gama de scaune rulante corespunzătoare, costuri inițiale pentru inițierea procesului și gestionarea cererii. Partea 2: Care sunt modalitățile de asigurare a sustenabilității după investiția inițială? Această secțiune pune accentul pe furnizarea scaunelor rulante corespunzătoare, gestionarea procesului de furnizare și pe activitățile necesare în vederea creșterii gradului de eficiență și a capacității de reacție. De asemenea, se abordează problema sustenabilității financiare, inclusiv importanța creării de parteneriate și asigurării surselor de venituri, pentru a acoperi costurile de funcționare și extindere a activității. Ambele părți sunt împărțite, la rândul lor, în câte trei secțiuni: A. Noțiuni fundamentale B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant C. Gestionarea sistemului de furnizare a serviciilor pentru utilizatorii de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 81 Partea 1 A. Noţiuni fundamentale A.1: Cum determinați o schimbare? Revizuiți posibilitățile de facilitare a schimbării prezentate mai jos. Înregistrați activitățile pe care le puteți efectua pentru introducerea sau îmbunătățirea furnizării serviciilor pentru utilizatorii de scaun rulant în cadrul centrului unde vă desfășurați activitatea. 1. Creați o viziune comună în ceea ce privește furnizarea de scaune rulante corespunzătoare 2. Prezentați importanța furnizării scaunelor rulante corespunzătoare, transmițând ideea că aceste servicii sunt prioritare 3. Corelați personalul și resursele 4. Motivați, implicați și facilitați asumarea obligațiilor de către personal: • includeți personalul în planificare și implementare; • depășiți obstacolele împreună; • obțineţi rezultate bune pe termen scurt şi oferiți apreciere pentru eforturile depuse pentru atingerea acestora • fixați schimbările pozitive în sistemul de lucru și în cultura organizațională. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 82 B. Inițierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1: Accesarea serviciilor Întrebări: Răspunsuri: Întrebarea 1: Dezvoltarea unei rețele de trimiteri şi programări În calitate de manager, ce activități puteți întreprinde pentru a dezvolta o rețea de persoane și organizații care să poată identifica și direcționa utilizatorii de scaun rulant către serviciul dumneavoastră de furnizare a scaunelor rulante? Întrebarea 2: Formulare de trimitere şi programare Parcurgeți modelul de formular de trimitere şi programare din Resurse suplimentare la Manualul Managerului, aflate pe memory stick. Ar fi acest formular de trimitere şi programare (sau o versiune adaptată a acestuia) un instrument eficient pentru activitatea dumneavoastră? Dacă nu – de ce nu? Dacă da – ca manager al unei activități de furnizare a serviciilor pentru utilizatorii de scaun rulant – ce puteți face pentru a introduce folosirea unui formular de trimitere şi programare? (Notă – în cazul în care folosiți deja un sistem, descrieți care au fost pașii pe care i-ați făcut, în calitate de manager, pentru a încuraja utilizarea formularului de trimitere şi programare) Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 83 1. Activități pe care le pot desfășura pentru identificarea surselor de trimitere 2. Activități pe care le pot desfășura pentru a dezvolta o rețea de trimiteri şi programări 3. Activități pe care le pot desfășura pentru a decide dacă formularul de trimitere şi programare va fi utilizat în procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant 4. Activități pe care le pot desfășura pentru a crea un sistem echitabil de furnizare a serviciilor pentru utilizatorii de scaun rulant Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 84 B.2: Spații și echipamente 1. Activități pentru identificarea spațiilor și echipamentelor potrivite modelului de furnizare a serviciilor pentru utilizatorii de scaun rulant pe care îl implementez 2. Activități pentru integrarea formularelor și listelor de verificare în etapele procesului de furnizare a serviciilor 3. Activități pentru organizarea spațiilor 4. Activități pentru crearea sistemelor și procedurilor pentru fiecare spațiu de furnizare a serviciilor pentru utilizatorii de scaun rulant și pentru alocarea responsabilităților Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 85 B.3: Gama de scaune rulante corespunzătoare 1. Activități pentru identificarea nevoilor utilizatorilor de scaun rulant și a celor mai importante caracteristici ale produselor care să răspundă acestor nevoi 2. Activități pentru identificarea unei game adecvate de scaune rulante, perne și piese de schimb corespunzătoare 3. Activități pentru identificarea unei surse adecvate de materiale necesare adaptării produselor 4. Activități pentru a discuta cu diverse părți interesate despre beneficiile privind costurile, în cazul furnizării scaunelor rulante corespunzătoare și a pernelor adecvate printr-un serviciu specializat Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 86 B.4: Organizarea resurselor umane 1. Activități pentru identificarea personalului unui furnizor de servicii pentru utilizatorii de scaun rulant 2. Activități pentru includerea personalului în etapa de planificare 3. Activități pentru coordonarea muncii în echipă și stabilirea unui plan de lucru săptămânal 4. Activități pentru identificarea capacității anuale de furnizare a serviciilor pentru utilizatorii de scaun rulant B.5: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? 1. Activități pentru includerea variantei „servicii integrate” în planificarea unui model de furnizare a serviciilor pentru utilizatorii de scaun rulant 2. Activități pentru crearea unor parteneriate în comunitate ca parte a planificării unui model de furnizare a serviciilor pentru utilizatorii de scaun rulant 3. Activități pentru pregătirea unui buget adecvat modelului ales pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 87 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1: Cum stabiliți dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează? Domenii și activități ale sistemului de furnizare a serviciilor Obiective de performanţă ale sistemului de furnizare a serviciilor Metode de colectare a informaţiei Trimitere Numărul de utilizatori trimiși către furnizorul de servicii Furnizorul de servicii va primi lunar 30 de trimiteri Înregistrați trimiterile primite Furnizarea scaunelor rulante Numărul de utilizatori care primesc un scaun rulant Lunar, furnizorul de servicii va prescrie şi va proba scaune rulante pentru 20 de utilizatori Prescrierile de scaune rulante sunt înregistrate în dosarele utilizatorilor Utilizatori de scaun rulant care au beneficiat de servicii Detalii ale utilizatorilor direcționați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, nevoia de suport postural Furnizorul de servicii va încuraja accesul egal al utilizatorilor de scaun rulant Numărul de femei, bărbați, fete și băieți care au accesat serviciile, înregistrați în dosarele utilizatorilor. Costurile furnizării serviciilor pentru utilizatorii de scaun rulant Costul produselor furnizate, incluzând adaptării efectuate de către furnizorul de servicii Costurile individuale pentru fiecare scaun rulant vor fi mai mici decât _____ (suma specificată conform bugetului și prețurilor reale ale produselor disponibile) Adresele utilizatorilor care au accesat serviciile, înregistrate în dosarele utilizatorilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 88 Schemă pentru planificarea procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Identificați nevoia/problema care trebuie monitorizată Activități/obiective pentru a răspunde nevoii/a soluționa problema Obiectiv Colectarea informațiilor 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. Înregistrați activitățile pentru a vedea dacă sistemul de furnizare a serviciilor pentru utilizatorii de scaun rulant funcționează (în cazul în care vă permite timpul) 1. Activități pe care le pot desfășura pentru a crea un plan de furnizare a serviciilor 2. Activități pe care le pot desfășura pentru a monitoriza personalul implicat în furnizarea serviciilor pentru utilizatorii de scaun rulant 3. Activități pe care le pot desfășura pentru a evalua gradul de realizare a obiectivelor activității de furnizare a serviciilor pentru utilizatorii de scaun rulant 4. Activități pe care le pot desfășura pentru a arăta apreciere pentru reușitele individuale sau ale echipei Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 89 C.2: Gestionarea cererii 1. Activități pentru crearea unui sistem de monitorizare a trimiterilor și pentru gestionarea listelor de așteptare 2. Activități pentru promovarea în rândul părinților și al surselor de trimitere a cazurilor de succes în ceea ce privește intervenția timpurie 3. Activități pentru gestionarea trimiterilor care depășesc capacitatea furnizorului de servicii de a răspunde cererii 4. Activități pentru monitorizarea și creșterea eficienței implementării etapelor din procesul de furnizare a serviciilor pentru utilizatorii de scaun rulant C.3: Planificarea activității de monitorizare 1. Activități pentru planificarea etapei de monitorizare 2. Activități în vederea identificării și instruirii partenerilor din comunitate 3. Activități în vederea identificării potenţialilor candidaţi pentru activitatea de instruire și monitorizare a utilizatorului Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 90 4. Activități pentru colectarea şi diseminarea cazurilor de succes privind beneficiile activității de monitorizare C.4: Planificarea sustenabilității financiare 1. Activități pentru crearea unei viziuni comune cu privire la sustenabilitatea financiară 2. Activități pentru identificarea fondurilor și resurselor necesare 3. Activități pentru identificarea surselor de finanțare 4. Activități pentru prioritizarea surselor de finanțare și pentru dezvoltarea unei strategii de strângere de fonduri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 91 Partea a doua A. Noțiuni fundamentale A.1: Furnizarea unui scaun rulant corespunzător: Politici la nivel național • Citiți cele două exemple de politici la nivel național referitoare la furnizarea scaunelor rulante. • Luați în considerare politicile care există deja la noi în țară. • Discutați despre utilitatea, în contextul țării noastre, a politicilor prezentate mai jos, luând în considerare modul în care respectivele politici se potrivesc structurii noastre guvernamentale. Exemplul 1: Politici referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant din Afganistan În octombrie 2003, Ministerul pentru Martiri și Persoane cu Dizabilități din Afghanistan a publicat o Politică Națională Complexă privind Problematica Dizabilității. Această politică a fost „dezvoltată prin cooperarea tuturor părților interesate, incluzând aici organizații ale persoanelor cu dizabilități și grupuri de auto-susținere; ONG-uri naționale și internaționale pentru persoanele cu dizabilități, ministere a căror activitate este relevantă în acest domeniu, inclusiv Ministerul Educației, Ministerul Sănătății, Ministerul Muncii și al Prestațiilor Sociale, Ministerul pentru Problematica Femeilor și Ministerul pentru Martiri și Persoane cu Dizabilități; agenții ONU care se ocupă de acest domeniu și Cabinetul Președintelui” (4). Așteptarea este ca politica inițială să ducă la un plan de acțiune mai detaliat și cu priorități stabilite. Politica este una la nivel de stat: Prevederile pentru persoanele cu dizabilități fizice ar trebui să includă centrele de recuperare ortopedică, serviciile de fizioterapie, dispozitivele ortopedice, asistive și de mobilitate. Aceste servicii trebuie să fie în proximitatea unui spital care deservește o regiune sau o provincie, având servicii de chirurgie ortopedică, care să poată fi accesat ușor de către populația din zonă. Persoanele cu dizabilități au dreptul de a primi dispozitive. Acestea trebuie să fie confecționate în mod corespunzător, să se potrivească utilizatorului, să conțină materiale disponibile la nivel local, ori de câte ori acest lucru este posibil, și să poată fi reparate local. Tehnologia adecvată trebuie să fie standardizată pe tot teritoriul țării. Un mecanism de standardizare la nivel național trebuie dezvoltat de către experți în domeniu, în colaborare cu Ministerul Sănătății. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 92 Exemplul 2: Politici referitoare la furnizarea serviciilor pentru utilizatorii de scaun rulant din Africa de Sud În anul 2003, în Africa de Sud au fost publicate liniile directoare la nivel național cu privire la dispozitivele asistive. Acestea au fost stabilite prin consultarea tuturor provinciilor Africii de Sud. Contribuția adusă de provincia Western Cape s-a bazat pe experiența lor în ceea ce privește dezvoltarea politicii la nivelul acestei unități administrative. Inițiativa a aparținut unui grup format din personal clinic specializat în furnizarea serviciilor pentru utilizatorii de scaun rulant. Ei au colaborat cu un manager de programe din provincia respectivă și cu furnizorii de servicii de recuperare din zonă, în vederea dezvoltării unui plan pentru crearea unor standarde de profesionalism în furnizarea de servicii pentru utilizatorii de scaun rulant. Planul includea trei direcții de acțiune majore: 1. analiza situației furnizării serviciilor pentru utilizatorii de scaun rulant în respectiva provincie; 2. implementarea planului de instruire a celor care furnizează acest tip de servicii; 3. stabilirea unui set de linii directoare cu privire la strategia de management a furnizării de servicii pentru utilizatorii de scaun rulant pentru provincia respectivă. A fost elaborat un set de principii care includea un minimum de cerințe standard cu privire la etapele procesului de furnizare, precum și pași cheie în gestionarea acestuia, cum ar fi instruirea personalului, crearea și gestionarea listelor de așteptare, bugete, efectuarea reparațiilor și a operațiunilor de întreținere. Managementul la nivelul provinciei a sprijinit grupul, astfel încât acesta a devenit un organism consultativ. Reprezentanții grupului au însoțit managerii din provincie la întâlnirile la nivel național și au contribuit la stabilirea liniilor directoare la nivel național pentru furnizarea dispozitivelor asistive în Africa de Sud. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 93 A.2: Furnizarea serviciilor pentru utilizatorii de scaun rulant Rolul extins al managerului Creşterea gradului de conştientizare Sporirea oportunităţilor de instruire Îmbunătăţirea gamei de scaune rulante Influenţarea politicii naţionale Dezvoltarea sustenabilităţii Îmbunătăţirea accesibilităţii Conştientizare Politici Activități comune pentru îmbunătățirea furnizării scaunelor rulante corespunzătoare în țară Acţiuni pe care le pot desfășura în următoarele trei luni Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 94 B. Iniţierea unui sistem de furnizare a serviciilor pentru utilizatorii de scaun rulant B.1: Spații și echipamente B.1.1 Identificarea spațiilor corespunzătoare • Parcurgeți lista spațiilor din tabelul de mai jos. • Gândiți-vă la soluțiile practice care pot funcționa în cazul activității voastre ca furnizori de servicii pentru utilizatorii de scaun rulant. Spații pentru furnizarea serviciilor pentru utilizatorii de scaun rulant – de nivel de bază Există deja spațiul necesar? Poate fi acesta un spațiu comun, folosit împreună cu un alt serviciu existent? Poate fi reamenajată o zonă care la ora actuală este folosită cu un alt scop? Poate fi reorganizată sau restructurată o sală existentă? 1. Sală de așteptare și recepție 2. Zonă liniștită unde utilizatorii de scaun rulant se pot întinde 3. Toaletă accesibilă 4. Zonă de birouri pentru personal 5. Zonă pentru activități clinice: pentru evaluare și probare Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 95 6. Zonă activități tehnice: pentru pregătirea, întreținerea și repararea scaunelor rulante 7. Depozitare 8. Instruirea utilizatorilor de scaun rulant Spații suplimentare pentru furnizarea serviciilor pentru utilizatorii de scaun rulant – de nivel intermediar Există deja spațiul necesar? Poate fi acesta un spațiu comun, folosit împreună cu un alt serviciu existent? Poate fi reamenajată o zonă care la ora actuală este folosită cu un alt scop? Poate fi reorganizată sau restructurată o sală existentă? 9. Zonă pentru evaluare și probare dotată cu pat pentru evaluare (evaluare în poziția ortostatică) 10. Zonă suplimentară pentru depozitare materiale 11. Zonă suplimentară pentru pregătirea produselor: activități de cusut și tapiţerie Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 96 B.1.2 Identificarea echipamentului • Utilizați Manualul participantului pentru recomandările referitoare la echipamente și documentație. Echipament • Identificați care sunt echipamentele disponibile deja şi utilizate în centrul în care vă desfășurați activitatea. Notați care sunt echipamentele care urmează a fi confecționate sau achiziționate. Echipamente care există deja Echipamente care trebuie confecționate sau achiziționate Documentație • Parcurgeți lista de formulare și listele de verificare din resurse suplimentare pentru manageri, aflate pe memory stick. • Care sunt formularele și listele de verificare deja integrate în activitate și utilizate? Notați care sunt formularele sau listele de verificare care urmează a fi folosite în activitatea zilnică. Formulare și liste de verificare care există deja Formulare și liste de verificare care trebuie integrate în activitate B.1.3 Organizarea spațiului de lucru • Utilizați Manualul participantului pentru recomandări cu privire la spații și echipamente. • Luați în considerare sugestiile de mai jos referitoare la organizarea corespunzătoare a spațiului de lucru: 1. Evitați acumularea de obiecte: eliminați toate sculele, componentele, echipamentele și documentele expirate, care nu mai sunt necesare. 2. Identificați care sunt elementele utilizate în mod regulat: scule, componente, fișe de instrucțiuni și documente. Acestea trebuie aranjate astfel încât localizarea lor să fie cât mai ușoară și rapidă. 3. Sistem și responsabilitate: se recomandă să stabiliți un sistem pentru fiecare spațiu de lucru și o persoană responsabilă pentru implementarea acestuia. 4. Monitorizare: sistemul trebuie monitorizat pentru a vă asigura că el este respectat pe termen lung. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 97 Zona pentru activități tehnice • Analizați exemplul și formulați recomandări pentru îmbunătățiri. Zona pentru activități tehnice și clinice (activități pe teren) • Analizați exemplul și formulați recomandări pentru a aduce îmbunătățiri. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 98 B.2: Gama de scaune rulante corespunzătoare B 2.1 Durabilitate, posibilitatea de efectuare a reparațiilor • Lucrați în echipă și răspundeți la setul de întrebări care v-a fost indicat – conform numărului grupului din care faceți parte. • Pentru parcurgerea exercițiului, folosiți-vă de cunoștințele și experiența pe care le aveți, precum și de Manualul participantului. Grupul 1 • Care sunt întrebările pe care le puteți adresa cu privire la durabilitatea și utilizarea în condiții de siguranță a produselor furnizate? • Cum puteți afla dacă furnizorul (donatorul, producătorul) oferă produse durabile și care pot fi utilizate în condiții de siguranță în contextul în care vă desfășurați activitatea? • Cu cine mai puteți discuta pentru a afla detalii despre utilizarea în condiții de siguranță și despre durabilitatea produselor oferite de un donator/producător/furnizor? Durabilitate Grupul 2 • Chiar și produsele durabile au componente care se uzează sau se defectează în mod frecvent. Care sunt aceste componente vulnerabile? Componente care se uzează sau se defectează Grupul 3 • Un furnizor de servicii pentru utilizatorii de scaun rulant are nevoie de piese de schimb. • Cum puteți identifica piesele de schimb necesare? • Cum puteți calcula numărul de piese de schimb ce urmează a fi comandate? Piese de schimb Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 99 B.2.2 Aprovizionarea cu scaune rulante corespunzătoare Scenariul 1 • Citiți scenariul de mai jos care v-a fost repartizat. Apoi citiți „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. • Pregătiți un joc de rol în care participanții să fie reprezentanți ai autorității locale și un grup de persoane interesate, care susține ideea unei schimbări în sistemul de achiziționare a scaunelor rulante (alocați 3-5 minute pentru jocul de rol). Atunci când discutați despre jocul de rol, luați în considerare următoarele aspecte: • Care sunt problemele identificate în scenariul respectiv? • Care sunt posibilele soluții pentru rezolvarea problemelor? Un spital de stat din zona în care lucrați a alocat un buget pentru achiziționarea de scaune rulante. Bugetul este revizuit anual și lista de produse este reanalizată. Chiar dacă în fiecare an există solicitări pentru schimbarea produselor disponibile, acest lucru nu se întâmplă, iar departamentul de achiziții cumpără două tipuri de produse, având drept criteriu prețul acestora. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 100 Principiile furnizării echipamentelor de mobilitate corespunzătoare Pentru ca țările să respecte obligațiile legate de tehnologia asistivă (echipamente de mobilitate) prevăzute în Convenția Națiunilor Unite privind Drepturile Persoanelor cu Dizabilități, trebuie luate în considerare următoarele principii cheie: • Implicare – persoanele cu dizabilități trebuie implicate în toate stadiile furnizării echipamentelor de mobilitate; • Accesibilitate – echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile tuturor persoanelor care au nevoie de ele; • Adaptabilitate – echipamentele de mobilitate și serviciile aferente trebuie să fie adaptate și modificate pentru a ne asigura că ele corespund nevoilor individuale ale utilizatorilor; • Preț accesibil – echipamentele de mobilitate și serviciile aferente trebuie să fie accesibile din punct de vedere al costurilor; • Disponibilitate – pentru a răspunde cererii, trebuie să existe suficient spațiu, personal și produse furnizate cât mai aproape posibil de comunitățile locale; • Calitate – produsele, spațiile și serviciile trebuie să respecte un standard de calitate adecvat. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 101 Scenariul 2 • Citiți despre cele două sisteme de finanțare guvernamentale prezentate mai jos. • Faceți un rezumat al sistemului actual din țara dvs. • Consultați „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. • Pregătiți sugestii pentru crearea sau îmbunătățirea sistemului guvernamental de finanțare pentru furnizarea scaunelor rulante în țara dumneavoastră. Africa de Sud În Africa de Sud, achiziționarea de scaune rulante de către guvern este controlată printr-o licitație la nivel național. Guvernul lucrează cu persoane din diferite provincii care au experiență în furnizarea de scaune rulante și servicii conexe. De asemenea, aceștia se consultă și cu furnizorii de scaune rulante. În urma acestei consultări, se ajunge la o formă finală a categoriilor de produse, incluzând specificațiile detaliate ale fiecărui produs. Categoriile includ o gamă de perne pentru confort și pentru utilizatorii la care există un risc ridicat de apariție a escarelor. Standardele minime de durabilitate sunt specificate pentru fiecare produs. Odată ce specificațiile de finanțare sunt finalizate și aprobate, trezoreria națională începe un proces de licitație. Înainte de acordarea contractelor, reprezentanți specializați verifică toate produsele depuse pentru licitație. Contractele includ perioade minime de livrare și penalizări pentru încălcarea clauzelor contractuale. România În România, finanțarea pe care statul o acordă pentru scaune rulante urmează tiparul subvențiilor pentru medicamente. Procesul de subvenții pentru scaunele rulante a fost inițiat în anul 2001, atunci când statul a organizat o licitație pentru furnizorii de scaune rulante. Ca rezultat al acestei licitații, s-a ajuns la un acord legat de prețul de bază/de referință, dar nu s-a definit niciun aspect legat de calitatea produselor sau furnizarea serviciilor. Valoarea subvenției este restabilită în fiecare an. Primul pas în cazul unui utilizator de scaun rulant este depunerea actelor pentru certificatul de dizabilitate. Fără acest certificat este imposibilă accesarea unui scaun rulant. În continuare, utilizatorul trebuie să facă o programare la un medic specializat în recuperare, care va completa o recomandare pentru un scaun rulant. Apoi, utilizatorul de scaun rulant depune o cerere la Casa Județeană de Asigurări de Sănătate (CAS). Atunci când utilizatorul de scaun rulant primește aprobarea/decizia, acesta alege un furnizor, apoi un scaun rulant. În cazul în care prețul scaunului rulant este mai mic decât subvenția, furnizorul oferă scaunul rulant utilizatorului în schimbul acestei decizii, care apoi este folosită pentru facturarea către CAS. În cazul în care prețul scaunului rulant este mai mare decât subvenția, utilizatorul trebuie să achite diferența ori să găsească surse complementare de finanțare, ca de exemplu, donatori, angajatori sau persoane fizice. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 102 Scenariul 3 • Pregătiți un joc de rol; prezentați o întâlnire cu un donator; încercați să găsiți o soluție comună pentru aprovizionarea cu scaune rulante corespunzătoare în vederea furnizării de servicii pentru utilizatorii de scaun rulant, prin intermediul serviciului dumneavoastră (joc de rol de 3-5 minute). Când planificaţi jocul de rol: • Discutați despre modul în care scaunele rulante donate sunt distribuite în prezent în țara dumneavoastră. • Citiți „Principiile furnizării echipamentelor de mobilitate corespunzătoare”. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 103 B.3: Organizarea resurselor umane: Roluri • Folosiți tabelul în care sunt prezentate rolurile personalului furnizor de servicii pentru utilizatorii de scaun rulant. • Notați în tabel numele persoanei responsabile pentru fiecare rol. • În cazul în care activitatea voastră presupune coordonarea mai multor astfel de centre, enumerați membrii echipei din fiecare centru furnizor de servicii pentru utilizatorii de scaun rulant. Clinic Tehnic Instruire utilizator Administrativ Centru furnizor de servicii pentru utilizatorii de scaun rulant Centru furnizor de servicii pentru utilizatorii de scaun rulant Centru furnizor de servicii pentru utilizatorii de scaun rulant B.4: Ce costuri implică furnizarea serviciilor pentru utilizatorii de scaun rulant? Citiți fiecare categorie de buget din tabelul de mai jos și gândiți-vă la costurile care pot fi împărțite sau economisite prin integrarea furnizării serviciilor pentru utilizatorii de scaun rulant într-un serviciu deja existent. Încercuiți cu negru toate costurile care pot fi eliminate. Încercuiți cu roșu toate costurile care pot fi împărțite. Exemplu de furnizare a unor servicii integrate Un centru de protezare și ortezare planifică integrarea serviciilor pentru utilizatorii de scaun rulant. Au fost alese două persoane din echipă, care au participat la modulul de instruire pentru furnizarea serviciilor destinate utilizatorilor de scaun rulant – nivel de bază. Ambele persoane vor desfășura activități de furnizare a serviciilor pentru utilizatorii de scaun rulant trei zile pe săptămână, iar două zile pe săptămână vor lucra pentru furnizarea serviciilor de protezare și ortezare. În atelier a fost alocat un spațiu pentru un tehnician de scaune rulante. Departamentul de terapie a eliminat toate echipamentele defecte și nefolosite, astfel creându-se un spațiu de lucru pentru personalul cu rol clinic. Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 104 Linii de buget orientative Etapele furnizării serviciilor pentru utilizatorii de scaun rulant Tr im ite re ș i pr og ra m ar e E va lu ar e P re sc ri er e Fi na nț ar ea ș i pl as ar ea c om en zi i P re gă tir ea pr od us ul ui P ro ba re a In st ru ir ea ut ili za to ru lu i d e sc au n ru la nt M on ito ri za re , în tr eț in er e, re pa ra ții Costuri inițiale Design produs Asigurarea unui stoc inițial de produse ü Instrumente/scule ü ü ü Echipament ü ü Clădire/spații ü ü ü Stoc de materiale ü Costuri operaționale Scaune rulante ü ü Piese de schimb ü Materiale ü ü ü Transport ü ü Personal Management ü ü ü Personal clinic ü ü ü ü ü ü ü Personal tehnic ü ü ü ü ü Instructor/Instructor de viață independentă utilizator de scaun rulant ü ü Administrator ü ü ü ü ü Transport local Transport local pentru personal ü ü ü ü Transport local pentru clienți ü ü ü Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 105 Linii de buget orientative Etapele furnizării serviciilor pentru utilizatorii de scaun rulant Tr im ite re ș i pr og ra m ar e E va lu ar e P re sc ri er e Fi na nț ar ea ș i pl as ar ea c om en zi i P re gă tir ea pr od us ul ui P ro ba re a In st ru ir ea ut ili za to ru lu i d e sc au n ru la nt M on ito ri za re , în tr eț in er e, re pa ra ții Cazare clienți ü ü Tipărire materiale ü ü ü ü ü Consumabile ü ü ü Înlocuire instrumente/scule ü ü ü Costuri indirecte ü ü ü ü ü ü Instruire personal ü ü ü ü ü ü Instruire parteneri/surse de trimiteri ü ü ü Strângere fonduri ü ü ü ü ü ü ü ü Monitorizare și evaluare ü ü ü ü ü ü ü ü Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 106 C. Gestionarea furnizării serviciilor pentru utilizatorii de scaun rulant C.1: Servicii eficiente C.1.1 Monitorizarea Secțiunea 1 • Lucrați în grupe. În tabelul de mai jos, citiți și completați secțiunea care v-a fost indicată. • Unele dintre rubrici au fost completate pentru a vă da indicații. Completați restul tabelului. Arii de acțiune Exemple de indicatori de performanță Colectarea informațiilor Trimitere Numărul de utilizatori trimiși Furnizorul de servicii va primi lunar 30 de trimiteri Înregistrați trimiterile primite Perioada medie de așteptare între momentul efectuării trimiterii și programare Notați în dosarul utilizatorului data înregistrării trimiterii și data evaluării Furnizare scaun rulant Numărul de utilizatori care primesc un scaun rulant Se vor prescrie și se vor proba lunar scaune rulante pentru 20 de utilizatori Perioada medie de așteptare între etapa de evaluare și cea de probare Numărul de monitorizări efectuate Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 107 • Notați mai jos motivul pentru care este util să știm dacă aceste obiective au fost atinse. De ce este util să știm că obiectivele au fost realizate? De ce este util să știm că obiectivele nu au fost realizate? Numărul de utilizatori cu trimitere Perioada medie de așteptare între momentul efectuării trimiterii și programare Numărul de utilizatori care primesc un scaun rulant Perioada medie de așteptare între etapa de evaluare și cea de probare Numărul de monitorizări efectuate Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 108 Secțiunea 2 Arii de acțiune Exemple de indicatori de performanță Înregistrarea informațiilor Utilizatori de scaun rulant care au beneficiat de serviciile furnizate Detalii despre utilizatorii îndrumați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, nevoia de suport postural Încurajarea accesului egal Obiectivul este ca serviciile oferite să răspundă atât cerințelor utilizatorilor care au nevoie de servicii pentru utilizatorii de scaun rulant – nivel de bază cât și ale celor care au nevoie de scaune rulante adaptate sau de suport postural Înregistrați numărul de femei, bărbați, fete și băieți care au accesat serviciile furnizate. Înregistrați în dosarele utilizatorilor de scaun rulant cerințele de suport postural și tipul de scaune rulante prescrise Zona geografică acoperită de către furnizorul de servicii pentru utilizatorii de scaun rulant Înregistrați adresele în dosarele utilizatorilor de scaun rulant care au accesat serviciile furnizate Costurile furnizării serviciilor Costul produselor furnizate, incluzând modificările efectuate în cadrul centrului furnizorului de servicii Costurile individuale pentru fiecare scaun rulant vor fi mai mici decât _____ (sumă specificată conform bugetului și prețurilor reale ale produselor disponibile). Timpul folosit de către personal în activitățile procesului de furnizare a serviciilor (evaluare, monitorizare, instruire etc.) • Notați motivul pentru care este util să știm în ce măsură au fost realizate aceste obiective. De ce este util să știm că obiectivele au fost realizate? De ce este util să știm că obiectivele nu au fost realizate? Detalii despre utilizatorii îndrumați către furnizorul de servicii, cum ar fi vârsta, sexul, dizabilitatea, necesitatea suportului postural Zona geografică acoperită de către furnizorul de servicii pentru utilizatorii de scaun rulant Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 109 Costul produselor furnizate, incluzând adaptările efectuate în cadrul centrului furnizorului de servicii Timpul folosit de către personal în activitățile procesului de furnizare a serviciilor (evaluare, monitorizare, instruire etc.) C.1.2 Feedback-ul utilizatorului • Există câteva aspecte importante care trebuie luate în considerare atunci când planificați să solicitați feedback din partea utilizatorilor de scaun rulant care beneficiază de serviciile oferite. Folosiți această listă de verificare pentru a înregistra informațiile. Planificarea solicitării de feedback de la utilizatorii serviciilor Aspecte de luat în considerare: Transportul și timpul reprezintă două dintre cele mai semnificative costuri. Când va avea loc? Cine se va ocupa? Care sunt întrebările pe care trebuie să le adresăm pentru a primi feedback-ul necesar de la utilizatorii de scaun rulant, beneficiari ai serviciilor oferite? Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 110 Informații iniţiale (Consultați secţiunea de instrumente din Resursele Suplimentare la Manual, de pe memory stick.) Aspecte de luat în considerare: Pentru a analiza impactul serviciilor furnizate, este important să înregistrați starea de fapt înainte de efectuarea oricărui tip de intervenție, cu alte cuvinte, înainte de începerea evaluării. Când se colectează informațiile iniţiale? Cine se va ocupa de culegerea acestor informații? La ce interval de timp se vor culege informaţiile? Înregistrarea și procesarea informațiilor Aspecte de luat în considerare: Înregistrarea eficientă a datelor are ca rezultat economisirea resurselor de timp și de bani. Cum veți înregistra informațiile? Ce metode puteți folosi pentru ca înregistrarea și procesarea informațiilor să se desfășoare cât mai eficient? Cine va înregistra informațiile? Cine va procesa informațiile? Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 111 C.2: Dezvoltarea unor servicii eficiente C.2.1 Monitorizarea unui plan de servicii • Creați un plan pentru furnizarea serviciilor. • Selectați o nevoie sau o problemă care trebuie monitorizată și completați informațiile de la fiecare punct. Matrice pentru planificarea furnizării serviciilor Identificați nevoia / problema care trebuie monitorizată Activități / obiective pentru a răspunde nevoii / soluționa problema Obiectiv Culegerea informațiilor Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 112 C.3: Gestionarea cererii C.3.1 Generarea cererii și intervenția timpurie • Citiți exemplul de mai jos. • Discutați și enumerați cauzele care au dus la succes. Exemple de succes: intervenţie timpurie ca rezultat al trimiterilor făcute de către părinţi, în Mexic Avem în continuare un exemplu despre felul în care un grup de centre de recuperare pentru copii, din Mexic, a reușit să dezvolte o rețea eficientă pentru realizarea intervenției timpurii. Deşi centrele de recuperare au avut ca obiectiv principal creșterea gradului de conștientizare în rândul medicilor neonatologi și al pediatrilor cu privire la serviciile oferite, acestea au reușit să abordeze întreaga comunitate, printr-o campanie anuală majoră de strângere de fonduri, care a fost intens mediatizată inclusiv la radio și la televiziune. Acest lucru a dus la realizarea unui număr mare de trimiteri, care au rezultat din transmiterea informaţiei în mod direct, mulți părinți aducându-şi singuri copiii ca să beneficieze de aceste servicii. Pe parcursul campaniei de conștientizare, centrele au avut un mesaj clar: este foarte important ca în cazul copiilor trimiterea către furnizorul de servicii de recuperare să se producă imediat după naștere. Pentru asta a fost nevoie să se prezinte o viziune de succes, puternică, bazată pe multe cazuri de succes referitoare la integrarea și realizările copiilor cu care au lucrat aceste centre. În cei 15 ani, centrele de recuperare au observat o schimbare de mentalitate, deoarece medicii pediatri și familiile apelează în mod activ la intervenția timpurie. Rezultatul: O treime din numărul trimiterilor se referă la copii până la vârsta de trei ani. Factori care au dus la succes Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 113 C.3.2 Analiza etapelor procesului de furnizare a serviciilor pentru utilizatorii de scaun rulant Timpul zilnic disponibil pentru furnizarea serviciilor: _______minute • Lucrați împreună, în grupe. • Citiți fiecare caz menționat în coloana 1. • În tabelul de mai jos, citiți despre posibilele strategii pentru creșterea eficienței furnizării serviciilor pentru utilizatorii de scaun rulant. • Corelați provocările cu strategiile pentru sporirea eficienței. În a doua coloană, notați numărul care corespunde fiecărei strategii. O problemă poate necesita utilizarea mai multor strategii. Strategii pentru creșterea eficienței serviciilor 1. Achiziționarea de produse cu o gamă cât mai mare de opțiuni de ajustare 2. Achiziționarea de produse ce pot fi modificate cu ușurință 3. Achiziționarea de produse cu dispozitive de suport postural 4. Pregătirea în avans a unor mostre diferite de produse 5. Prefabricarea dispozitivelor de suport postural 6. Planificare clară pentru facilitarea muncii în echipă 7. Ședințe ale echipei pentru o planificare comună 8. Colaborarea dintre echipa cu atribuții clinice și cea cu atribuții tehnice pe parcursul etapei de probare a produsului 9. Discutarea de către echipa cu atribuții clinice și cea cu atribuții tehnice a soluțiilor referitoare la prescrierea scaunului rulant 10. Înregistrarea şi evidenţa clară a informațiilor 11. Planificarea instruirii pentru personalul furnizor de servicii, în conformitate cu nevoia de instruire. 12. Procurarea materialelor corespunzătoare pentru confecționarea pernelor și pentru fabricarea şi modificarea dispozitivelor de suport postural 13. Procurarea sculelor corespunzătoare pentru ajustarea rapidă a produselor 14. Alocarea unui membru al echipei pentru desfășurarea activității de instruire a utilizatorului, de exemplu, instructorul în scaun rulant 15. Identificarea unui spațiu pentru instruirea utilizatorului care să fie aproape de zonele desemnate pentru activitățile de tip clinic și tehnic 16. Stabilirea unor sisteme eficiente pentru controlul stocului 17. Pregătirea unui stoc redus de scaune rulante de diferite dimensiuni 18. Stabilirea unor parteneriate în comunitate pentru a identifica potențialii beneficiari şi pentru a le asigura transportul la centrul unde se furnizează serviciile pentru utilizatorii de scaun rulant 19. Dezvoltarea capacității partenerilor din comunitate pentru a furniza servicii de nivel de bază și de a genera trimiteri în cazul utilizatorilor care au nevoie de servicii de nivel intermediar 20. Deschiderea în ceea ce privește ideile noi - inovație Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 114 Coloana 1: provocări în furnizarea serviciilor Coloana 2: strategii Evaluare: 1. În cazul în care personalul se deplasează la un centru furnizor de servicii sau dacă efectuează vizite la domiciliu, timpul necesar deplasării trebuie încorporat în intervalul alocat evaluării. 2. În cazul în care membrii echipei nu au experiență, etapa de evaluare va avea o durată mai mare. Prescriere: 3. În cazul în care produsele au opțiuni de reglare limitate, trebuie prescrise anumite adaptări, astfel încât produsul să corespundă cu nevoile individuale ale utilizatorului. 4. În cazul în care trebuie confecționate dispozitive de suport postural suplimentare, sunt necesare măsurători și schițe suplimentare. Pregătirea produsului: 5. Este necesar să putem avea acces rapid la produse care au tipul și mărimea necesare. 6. În cazul în care un scaun rulant are o gamă limitată de opțiuni de ajustare, pregătirea produsului poate dura mai mult. 7. În cazul în care este nevoie de adaptări pentru asigurarea suportului postural, este necesar un timp suplimentar pentru pregătirea produsului. Probare: 8. În cazul în care au fost efectuate adaptări sau dacă scaunului rulant i-au fost adăugate suporturi suplimentare, etapa de probare va avea o durată mai mare. 9. În cazul în care, pe parcursul etapei de probare, se fac alte modificări ale scaunului rulant, vor fi necesare verificări suplimentare. Instruirea utilizatorului: 10. Atunci când un utilizator primește pentru prima oară un scaun rulant sau atunci când există complicații legate de starea de sănătate, etapa de instruire va avea o durată mai mare, pentru a putea aborda teme referitoare la starea de sănătate, mobilitate, manevrarea scaunului rulant, întreținerea acestuia și direcționarea utilizatorului către alte surse de trimiteri. Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 115 C.4: Planificarea activității de monitorizare C.4.1 Depășirea obstacolelor • Citiți lista de potențiale obstacole în desfășurarea activității de monitorizare și adăugați alte bariere suplimentare menționate de către grupul de lucru • Discutați despre activitățile care pot facilita depășirea obstacolelor în cazul etapei de monitorizare și notați-le în tabelul de mai jos. Obstacole în activitatea de monitorizare Posibile obstacole în activitatea de monitorizare în cazul furnizorilor de servicii care își desfășoară activitatea în comunitate (pe teren): • Costurile legate de deplasările personalului furnizorului de servicii în comunități; • Timpul necesar pentru ca personalul furnizorului de servicii să efectueze deplasările în comunitate; • Activitatea de monitorizare nu constituie o prioritate a managerilor; • Activitatea de monitorizare nu este apreciată de către utilizatorii serviciilor până când aceștia nu experimentează beneficiile ce decurg din aceasta; Obstacole în activitatea de monitorizare efectuată la centrul furnizorului de servicii: • Costurile legate de deplasare și perioada de absență de la locul de muncă al unuia sau al mai multor membri din familia utilizatorului; • În mod frecvent, utilizatorii și membrii familiei acestuia nu cunosc beneficiile monitorizării; • Dificultăți în găsirea unor mijloace de transport accesibile; • Presiunea care rezultă din faptul că se pune accentul pe generarea de noi programări în vederea furnizării de servicii, ceea ce reduce timpul alocat activității de monitorizare; • Dificultăți în stabilirea programărilor: utilizatorii vin la furnizorul de servicii atunci când personalul nu este disponibil sau nu se prezintă atunci când personalul este disponibil. Sugestii de activități pentru depășirea obstacolelor în activitatea de monitorizare Pachet de instruire pentru ma nageri Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 116 C.5: Dezvoltarea sustenabilității financiare C.5.1 Identificarea surselor de finanțare • Citiți lista potențialelor surse de finațare și apelați la Manualul participantului pentru mai multe informații. • Alegeți trei surse despre care considerați că au cel mai mare potențial de producere a unor rezultate pe termen scurt; completați tabelul de mai jos pentru sursele de finanțare selectate. Diverse surse de finanțare ce pot fi luate în considerare de către manageri 1. Guvern 2. Sisteme de asigurări la nivel național 3. Donatori sau sponsori privați 4. Donatori sau sponsori din domeniul corporatist (business) 5. Contribuții ale utilizatorilor sau achitarea sumei integrale pentru achiziționarea produselor 6. Generare de venituri/întreprinderi sociale 7. Grupuri din comunitate/organizații caritabile 8. Misiuni diplomatice 9. Organizații non-guvernamentale internaționale sau naționale Surse de finanțare selectate Numerotați în ordinea priorității, luând în considerare următoarele: • Efortul necesar • Câștigul financiar pe termen scurt sau lung (sau ambele) Prioritatea Sursa de finanțare Investiție/ efort necesar ridicat/mediu/scăzut Câștig pe termen scurt ridicat/mediu/scăzut Câștig pe termen lung ridicat/mediu/ scăzut Manualul și caietul partici pantului SERVICII PENTRU UTILIZATO RII DE SCAUN RULANT Servicii pentru utilizatorii de scaun rulant. Pachet de instruire pentru manageri. Manualul și caietul participantului Pagina 117 C.5.2 Dezvoltarea unei strategii • Citiți exemplul de strategie de mai jos. • Enumerați cele trei surse de finanțare identificate în tabelul de la exercițiul anterior. • Completați coloanele din tabel cu informații referitoare la sursele de finanțare selectate. Sursa de finanțare Tipul de susținere Solicitare Probabilitate Efort 1. Societate comercială Donație pentru bugetul de achiziționare a scaunelor rulante 10% din bugetul pentru scaune rulante Mediu (au finanțat în trecut, totuși nu finanțează în fiecare an aceeași organizație) Cel puțin două întâlniri cu managerul companiei; propunere de 2 pagini și buget de depus şi invitarea managerului la următoarea acțiune de tip „ziua porților deschise”. 2. Autoritate locală Este posibil să finanțeze vizitele la domiciliul utilizatorilor de scaune rulante din zonă. 20% din costurile totale ale deplasărilor în comunitate și 20% din salariile personalului furnizor de servicii Ridicat (se discută deja despre acest aspect cu autoritățile locale. S-au furnizat servicii în respectiva comunitate. Sunt interesați în mod real în susținerea furnizării acestui tip de servicii și aparent există fonduri disponibile). Propunere și buget de depus. Condiții de raportare – necesită informații corecte despre toate persoanele vizitate în acea zonă și raportare financiară.

Materialul nu poate fi reprodus integral sau parțial fără menționarea sursei și fără acordul scris al Fundației Motivation România. Fundația Motivation România Str. Podișor nr 1, Sat Buda, Comuna Cornetu, Ilfov, România Tel: 021 448 02 42 Fax: 021 448 11 07 Email: info@motivation.ro www.motivation.ro Telefonul utilizatorului de scaun rulant: 0800.030.762

ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ ၂၀၁၅ ခုုႏွစ္တြင္ ပံုုႏွိပ္ထုုတ္ေဝခဲ့ပါသည္။ ထုုတ္ေဝခဲ့သည့္ ေခါင္းစဥ္မွာ Wheelchair Service Training Package for Managers ပင္ျဖစ္ပါသည္။ © ကမာၻ့က်န္းမာေရးအဖြဲ႔အစည္း ၂၀၁၅ ခုုႏွစ္ ျမန္မာဘာသာျဖင့္ တည္းျဖတ္ျပီး ဘာသာျပန္ထုုတ္ေဝခြင့္အား ယင္း ျမန္မာဘာသာျပန္အရည္အေသြးႏွင့္ တိက်ေသခ်ာမႈတုုိ႔အတြက္ အဓိက တာဝန္ရွိေသာ USAID သုုိ႔ ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ အခြင့္အေရး အပ္ႏွင္းလုုိက္ပါသည္။ အဂၤလိပ္ဘာသာစကားႏွင့္ ထည့္သြင္းျပန္ဆုုိရမည့္ ဘာသာမ်ားၾကား မဆီေလ ွ်ာ္မႈ အေၾကာင္းအရာ တစ္စံုုတစ္ရာ ရွိခဲ့ေသာ္ မူရင္း အဂၤလိပ္ဘာသာသည္သာလ ွ်င္ အတည္ျဖစ္သည္။ မန္ေနဂ်ာမ်ားအတြက္ လက္တြန္းထုုိင္ခံုုလွည္းဝန္ေဆာင္မႈဆုုိင္ရာ ေလ့က်င့္သင္ၾကားေရး သင္ခန္းစာ © USAID (၂၀၁၆) ဦးတင္ေအးမွ ဘာသာျပန္ဆုုိခဲ့ျပီး အီးေမးလ္မွာ mgtinaye@gmail.com ျဖစ္ျပီး က်န္းမာေရးစီမံခန္႔ခြဲမႈသိပၺံ အဖြဲ႔မွ စီမံပါသည္။ ပညာရပ္ဆုိင္ရာ ေဝါဟာရအသုံးအႏႈန္း သင္တန္းတေလွ်ာက္လံုး သံုးစြဲထားေသာေဝါဟာရမ်ားကုိ ေအာက္ပါအတုိင္းသတ္မွတ္ထားသည္။ သင့္ေတာ္သည့္ ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူ၏လုိအပ္ခ်က္ႏွင္႔လည္းေကာင္း၊ ပတ္ဝန္းက်င္ ေရးရာႏွင္႔လည္းေကာင္း ကုိက္ညီသည့္ဘီးတပ္ထုိင္ခုံ ျဖစ္သည္။ ယင္းသည္သံုးစြဲသူအတြက္အံကုိက္ျဖစ္ျပီးအေနအထား အတြက္အေထာက္အကူျဖစ္သည္၊ ေဘးကင္းမႈရွိျပီးတာရွည္ခံ သည္၊ ဝန္ေဆာင္မႈျပဳေသာႏုိင္ငံအတြင္း ရရွိႏုိင္ျပီးေစ်း အသက္သာဆံုးႏွင့္ တတ္ႏုိင္သည့္အတုိင္းအတာအရ ျပဳျပင္ ထိန္းသိမ္းႏုိင္သည္။ လက္တြန္းဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူက ဘီးကုိလွည္႔၍ျဖစ္ေစ၊ အျခားသူတစ္ဦးက တြန္းေပး ၍ျဖစ္ေစ ေရြ႔လ်ားေသာဘီးတပ္ထုိင္ခုံ ျဖစ္သည္။ ကိုယ္ေနဟန္ထားကုိအေထာက္အကူ ျပဳေသာကိရိယာ(PSD) ကုိယ္ေနဟန္ထားကုိေနာက္ထပ္ထပ္မံအေထာက္အကူျပဳေသာ ကိရိယာ။ ဘီးတပ္ထုိင္ခုံ လမ္းေလွ်ာက္ရန္ သုိ႔မဟုတ္ အနီးတဝုိက္ေရြ႕လ်ားရန္အခက္အခဲ ရွိေသာပုဂၢိဳလ္တစ္ဦးအတြက္ ထုိင္ရန္ႏွင့္ ဘီးလွိမ္႔ေရြ႕လ်ားရန္ အေထာက္အကူေပးေသာကိရိယာ။ ဘီးတပ္ထုိင္ခုံ မြမ္းမံျခင္း ဘီးတပ္ထုိင္ခုံတခုကုိ အေျပာင္းအလဲျပဳလုပ္ျခင္း။ ဘီးတပ္ထုိင္ခုံ ေထာက္ပံ့ျခင္း ဘီးတပ္ကုလားထုိင္၏ပံုစံ၊ ထုတ္လုပ္မႈ၊ ေပးသြင္းမႈ ႏွင္႔ ဝန္ေဆာင္မႈ တုိ႔အား ျခံဳငံုေခၚေဝၚသည့္ ေဝါဟာရျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈ ဘီးတပ္ထုိင္ခုံက အေထာက္အကူေပးသည့္ ဤအပုိင္းတြင္ သံုးစြဲသူတစ္ဦးခ်င္းစီသည္ သင့္ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံကုိ ရရွိေစရန္ ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း ဝန္ထမ္း သင့္ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံကုိ ေထာက္ပံ့ရာ၌ ကြၽမ္းက်င္သူျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံ အသုံးျပဳသူ လမ္းေလွ်ာက္ရန္ သုိ႔မဟုတ္ အနီးတဝုိက္ေရြ႕လ်ားရန္ အခက္အခဲ ရွိၿပီးေရြ႕လ်ားႏုိင္ရန္ ဘီးတပ္ထုိင္ခုံကုိ အသံုးျပဳရသူျဖစ္သည္။ bD;wyfxkdifckH pHEIef; ESifh owfrSwfcsufrsm;q kdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ VI 1 ၁ refae*smrsm;twGuf bD;wyfxkdifckH0efaqmifrIqkdif&m pHEIef;ESifhowfrSwfcsufrsm;oifwef;taMumif; odaumif;p&m ၅ u/ t"du odrSwfzG,f&mrsm; ၅ က.၁ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈဆုိသည္မွာအဘယ္နည္း9 ၈ က.၂ ဝန္ေဆာင္မႈေပးျခင္း ၂၀ က.၃ အေျပာင္းအလဲကုိ ဦးေဆာင္ဦး႐ြက္ျပဳေနသည့္ မန္ေနဂ်ာမ်ား ၂၄ c/ bD;wyfxkdifckH 0efaqmifrIvkyfief; pwifjcif; ၂၄ ခ.၁ ဝန္ေဆာင္မႈလုပ္ငန္းအား အကဲျဖတ္သုံးသပ္ျခင္း ၃၁ ခ.၂ အေထာက္အကူျပဳ အသုံးအေဆာင္မ်ားႏွင့္ ကိရိယာတန္ဆာပလာမ်ား ၄၃ ခ.၃ သင့္ေလ်ာ္သည့္ ဘီးတပ္ထုိင္ခုံမ်ား၏အတုိ္င္းအတာ၅၀ ၅၀ ခ.၄ ဝန္ေဆာင္သူမ်ားအား ေနရာခ်ထားျခင္း ၅၆ ခ.၅ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအတြက္ မည္မွ် ကုန္က်သနည္း ၅၉ */ bD;wyfxkdifckH0efaqmifrIvkyfief;aqmif½Gufjcif; ၅၉ ဂ.၁ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္း အလုပ္ျဖစ္ေနေၾကာင္းကုိ သင္မည္သုိ႔ သိႏုိင္မည္နည္း ၆၆ ဂ.၂ ဝယ္လုိအားကုိ စီမံခန္႔ခြဲျခင္း ၇၈ ဂ.၃ ေနာက္ဆက္တြဲလုပ္ငန္းစီစဥ္ျခင္း ၉၀ ဂ.၄ ဘဏၰာေရးတည္တံ့ခုိင္ၿမဲရန္ အစီအစဥ္ ၉၈ usrf;ukd;pm&if; ၁၀၁ avhusifhcef;pmtkyf rm w d u m VI 1 refae*smrsm;twGuf bD;wyfxkdifckH0efaqmifrIqkdif&m pHEIef;ESifhowfrSwfcsufrsm;oifwef;taMumif; odaumif;p&m ed'gef; ၂ဝဝ၈ ခုႏွစ္အတြင္း အရင္းအျမစ္နည္းပါးသည္႔အေျခအေနမ်ိဳး၌ လူအားျဖင့္ေရႊ႕လ်ားေသာဘီးတပ္ထုိင္ခုံ မ်ား ေထာက္ပံ့ျခင္းဆုိင္ရာလမ္းညႊန္ (၁) - Guidelines on the provision of manual wheelchairs in less resourced settings(1)ကုိ ထုတ္ျပန္ခဲ႔ျပီးေနာက္တြင္ ၂ဝ၁၂ ခုႏွစ္အတြင္း ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈစံႏႈန္းႏွင့္ သတ္မွတ္ခ်က္မ်ားဆုိင္ရာသင္တန္း - Wheelchair Service Training Packages (WSTP)၏ ေဘာင္အတြင္း ပထမအႀကိမ္စံႏႈန္းႏွင့္သတ္မွတ္ခ်က္မ်ားျဖစ္သည့္ ဘီးတပ္ကုလားထုိင္ဝန္ေဆာင္မႈစံႏႈန္းႏွင့္ သတ္မွတ္ခ်က္မ်ား ဆုိင္ရာသင္တန္း အေျခခံအဆင့္ (၂) - Wheelchair Service Training Package – Basic Level (WSTPb) (2)ကုိ ထုတ္ျပန္ခဲ့သည္။ တဖန္ ၂ဝ၁၃ ခုႏွစ္တြင္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈစံႏႈန္းႏွင့္ သတ္မွတ္ခ်က္မ်ားဆုိင္ရာ သင္တန္း အလယ္တန္းအဆင့္(၃) - Wheelchair Service Training Package – Intermediate Level (WSTPi)(3)ကုိ ထုတ္ျပန္ခဲ႔သည္။ ကမၻာ႔က်န္းမာေရးအဖြဲ႔ - World Health Organization (WHO) သည္ အေမရိကန္ႏုိင္ငံတကာ ဖြံ႔ၿဖိဳးေရးေအဂ်င္စီ - United States Agency for International Development (USAID) ႏွင့္ပူးေပါင္းျပီး WSTP တတိယပုိင္းျဖစ္သည္႔ ေခါင္းစဥ္ခဲြ (၂) ခု ပါဝင္ေသာ မန္ေနဂ်ာမ်ားအတြက္ ဘီးတပ္ကုလားထုိင္ ဝန္ေဆာင္မႈဆုိင္ရာစံႏႈန္းႏွင့္သတ္မွတ္ခ်က္မ်ားသင္တန္း - Wheelchair Service Training Package for Managers (WSTPm) ႏွင့္ ပါဝင္သက္ဆုိင္သူမ်ားအတြက္ ဘီးတပ္ကုလားထုိင္ဝန္ေဆာင္မႈဆုိင္ရာစံႏႈန္းႏွင္႔သတ္ မွတ္ခ်က္မ်ားသင္တန္း - Wheelchair Service Training Package for Stakeholders (WSTPs) ကုိ ျပဳစုခဲ႔သည္။ WHO၊ WSTP တတိယပုိင္းသည္ မန္ေနဂ်ာမ်ားက သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံပံ႔ပုိးေပးရာတြင္ ထိထိ ေရာက္ေရာက္ေဆာင္ရြက္ႏုိင္ေစရန္ႏွင့္ ပါဝင္ပတ္သက္သူအားလံုးအေနျဖင္႔ ယင္းကိစၥႏွင္႔ပတ္သက္ၿပီး အသိဝင္ လာေစသည္သာမက ၎တုိ႔၏ႏုိင္ငံ/ေဒသအတြင္း သင့္ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ့မႈလုပ္ငန္း ထူေထာင္ရာ တြင္ ပုိမုိပါဝင္လာေစရန္ ရည္ရြယ္ထားျခင္း ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံသည္ လူတစ္ဦးေရြ႔လ်ားႏုိင္ေစရန္ အေထာက္အကူျပဳသည့္ကိရိယာမ်ားအနက္ အမ်ားဆံုး အသံုးျပဳေသာအေထာက္အကူျပဳကိရိယာျဖစ္သည္။ လမ္းေလွ်ာက္ရန္ သုိ႔မဟုတ္ အနီးတစ္ဝုိက္လႈပ္ရွားသြားလာရန္ အခက္အခဲရွိေနသူမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံသည္ ၎တုိ႔လႈပ္ရွားသြားလာမႈ၊ ခြန္အားကုိရရွိေစမႈ၊ ဂုဏ္သိကၡာႏွင့္ အလံုးစံုေသာသက္သာေခ်ာင္ခ်ိမႈအတြက္ မရွိမျဖစ္ကိရိယာတစ္ခုျဖစ္ပါသည္။ လႈပ္ရွားသြားလာႏုိင္သည့္အတြက္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအတြက္ လြတ္လပ္မႈကုိျဖစ္ေပၚေစသည္သာမက က်န္းမာေရး၊ ပညာေရး၊ လုပ္ငန္းခြင္ ႏွင္႔အလုပ္အကုိင္တုိ႔ကုိ ဆက္သြယ္ေဆာင္ရြက္ႏုိင္ျပီး လူမႈေရးႏွင္႔ယဥ္ေက်းမႈလုပ္ငန္းမ်ားတြင္ ပါဝင္ေဆာင္ရြက္ ႏုိင္မည္ျဖစ္ပါသည္။ WHO ၏ခန္႔မွန္းခ်က္အရ လူဦးေရ သန္းေပါင္း (၇ဝ) ေက်ာ္မွာ ဘီးတပ္ထုိင္ခုံ လုိအပ္ေနျပီး ၎တို႔အနက္ ၅% မွ ၁၅ % အထိသာလွ်င္ ဘီးတပ္ထုိင္ခုံတစ္လံုးစီရွိၾကသည္။ ထုိမွ်သာမက ဘီးတပ္ထုိင္ခုံတစ္ လံုးအား ထိထိေရာက္ေရာက္အေထာက္အကူျပဳႏုိင္ရန္ လုိအပ္ေသာအသိပညာႏွင့္ အရည္အေသြးကုိ ဝန္ထမ္းမ်ားထံ ပုိ႔ခ်ေပးမည့္သင္တန္းအခြင္႔အလမ္းမွာလည္း ကန္႔သတ္ခ်က္မ်ားရွိေနပါသည္။ bD;wyfxkdifckH pHEIef; ESifh owfrSwfcsufrsm;q kdfif&m မန္ေနဂ်ာမ်ားအတြက္ 2 3 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေရြ႕လ်ားႏုိင္စြမ္း၏အေရးပါမႈကုိ မသန္စြမ္းပုဂၢိဳလ္မ်ား အခြင္႔အေရးဆုိင္ရာ ကုလသမဂၢသေဘာတူညီခ်က္ (၄) - CRPD(4) ၌ ေဖာ္ျပထားရာတြင္ ''မသန္စြမ္းပုဂၢိဳလ္မ်ားအတြက္လြတ္လြတ္လပ္လပ္အရွိဆံုးျဖင္႔ လႈပ္ရွားေဆာင္ ရြက္ႏုိင္ရန္ ထိေရာက္ေသာ အေရးယူေဆာင္ရြက္ခ်က္မ်ားျပဳလုပ္ေပးရမည္'' ဟုေဖာ္ျပထားပါသည္။ ထိထိေရာက္ ေရာက္ လႈပ္ရွားေဆာင္ရြက္ႏုိင္ေစရန္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအေနျဖင္႔ ၎တုိ႔ႏွင္႔ အထူးသျဖင့္ ၎တုိ႔၏ လူေနမႈပံုစံႏွင္႔လည္းေကာင္း၊ ပတ္ဝန္းက်င္ႏွင္႔လည္းေကာင္း အံဝင္ခြင္က်ျဖစ္ၿပီး ၎တုိ႔၏လုိအပ္ခ်က္မ်ားကုိ ျဖည့္ စြမ္းေပးႏုိင္စြမ္းရွိသည့္ ဘီးတပ္ထိုင္ခုံ လိုအပ္သည္။ ထုိအခ်က္ကုိျဖည့္ဆည္းေပးႏုိင္ရန္ တစ္ဦးခ်င္းစီ၏လုိအပ္ ခ်က္ႏွင့္ လုိက္ေလ်ာညီေထြရွိမည့္ ခ်ဥ္းကပ္မႈနည္းလမ္းတစ္ရပ္ လုိအပ္ပါသည္။ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား၏တစ္ဦးခ်င္းလုိအပ္ခ်က္ကုိ ျဖည္႔ဆည္းေပးႏုိင္မည့္ အထိေရာက္ဆံုးနည္းလမ္း မွာ စနစ္တက်စုဖြဲ႔ထားသည့္ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးစနစ္မွတစ္ဆင့္ ဘီးတပ္ထုိင္ခုံမ်ားအား စနစ္တက်ေလ့က်င့္ ေပးထားသည့္ ဝန္ထမ္းမ်ားက ေထာက္ပံ့ေပးျခင္းျဖစ္သည္။ ယင္းသည္ သံုးစြဲသူမ်ား၏ေမွ်ာ္လင့္ခ်က္ႏွင့္ လုိက္ ေလ်ာညီေထြရွိမည္ျဖစ္သည္သာမက၊ ၎တုိ႔၏ဂုဏ္သိကၡာကုိ ေလးစားရာေရာက္မည္ျဖစ္ပါသည္။ ypfrSwftkyfpk ဤသင္တန္းစံသတ္မွတ္ခ်က္သည္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း သုိ႔မဟုတ္ ဘီးတပ္ထုိင္ခုံ ေထာက္ပံ႔ ေရးလုပ္ငန္းမ်ားအပါအဝင္ ျပန္လည္ထူေထာင္ေရးလုပ္ငန္းမ်ားအား အေကာင္အထည္ေဖာ္ေဆာင္ရြက္ျခင္း၊ စီမံခန္႔ ခြဲျခင္း၊ အကဲျဖတ္ျခင္းအတြက္ တာဝန္ရွိသည့္ဝန္ထမ္းအားလံုးအတြက္ ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းစီမံခန္႔ခြဲျခင္းတြင္ ယခင္ကရရွိခဲ႔ေသာအေတြ႔အႀကံဳမ်ားသည္ ယခုအခါ မလုိအပ္ေတာ႔ပါ။ သို႔ရာတြင္ အလုပ္ရံုေဆြးေႏြးပြဲတြင္ ပါဝင္တက္ေရာက္သူမ်ားအေနျဖင္႔ အေထြေထြ စီမံခန္႔ခြဲမႈအ ရည္အေသြးမ်ားျဖင္႔ ယင္းအလုပ္ရုံေဆြးေႏြးပြဲတြင္ ပါဝင္ေဆြးေႏြးႏုိင္ေစရန္ အလုပ္ရံုေဆြးေႏြးပဲြမ်ားကုိ ျပဳလုပ္က်င္း ပျခင္း ျဖစ္ပါသည္။ &nf&G,fcsuf သင္တန္းစံသတ္မွတ္ခ်က္မ်ား၏အဓိကရည္ရြယ္ခ်က္မွာ ဘီးတပ္ထိုင္ခုံထိုင္ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ပါဝင္ ေနေသာ ဝန္ထမ္းအားလံုး၏အရည္အေသြးႏွင္႔ ပညာဗဟုသုတတုိးတက္လာေစေရးႏွင္႔ ၎တုိ႔၏အသိပညာၾကြယ္ဝ လာေစရန္ျဖစ္သည္။ ႏုိင္ငံအတြင္း ဘီးတပ္ထုိင္ခုံေထာက္ပံ့မႈလုပ္ငန္းတုိးတက္လာေစေရး သုိ႔မဟုတ္ ယင္းလုပ္ငန္း ကုိထူေထာင္ရန္ အဆင့္ျမင္႔အာဏာပုိင္မ်ား ပါဝင္ပတ္သက္လာမႈမရွိမခ်င္း ေလ႔က်င့္သင္တန္းေပးထားေသာ ဝန္ ထမ္းမ်ားသည္ ဘီးတပ္ထုိင္ခုံ လမ္းညႊန္ခ်က္တြင္ ေဖာ္ျပထားသည္႔တာဝန္မ်ားအားထမ္းေဆာင္ရန္ သုိ႔မဟုတ္ ဘီး တပ္ထုိင္ေထာက္ပံ႔မႈလုပ္ငန္းမ်ားအား ႏုိင္ငံအတြင္း ၎တုိ႔ဘာသာေဆာင္ရြက္ရန္မျဖစ္ႏုိင္ဟု WHO က မွတ္ယူ ထားသည္။ ဤ မန္ေနဂ်ာမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ သင္တန္းဆုိင္ရာ စံႏႈန္းႏွင္႔သတ္မွတ္ခ်က္မ်ား WSTPm သည္ ျပန္လည္ထူေထာင္ေရးလုပ္ငန္းမ်ားႏွင္႔ပတ္သက္၍လည္းေကာင္း၊ လူအမ်ားႏွင္႔ ထိေတြ႔ ဆက္ဆံရ ေသာ ဘီးတပ္ထုိင္ခုံပံ့ပုိးေရးလုပ္ငန္းပါအဆင့္ (၈) ဆင့္ႏွင္႔ ယင္းႏွင္႔ဆက္စပ္ေနေသာကိစၥမ်ားကုိ အေကာင္အထည္ 2 3 ေဖာ္ေဆာင္ရြက္ရေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာမ်ား၏အခန္းက႑ကုိလည္းေကာင္း ၿခံဳငံုသံုး သပ္ ေဖာ္ျပထားပါသည္။ ယင္းသို႔ေဖာ္ျပထားရာတြင္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ေပးရန္ လုိအပ္ ေသာ လူသားႏွင္႔ပစၥည္းပုိင္းဆုိင္ရာ အရင္းအျမစ္မ်ားပါဝင္ၿပီး စီမံခ်က္ေရးဆြဲျခင္း၊ စုဖြဲ႔ျခင္း၊ ဝန္ထမ္းမ်ား ခန္႔ထား ျခင္း၊ ညႊန္ၾကားခ်က္ေပးျခင္း၊ ကုန္က်စရိတ္ႏွင့္ ေငြေၾကးေထာက္ပံ့ျခင္း၊ ေစာင့္ၾကည့္ျခင္း ႏွင္႔ အကဲျဖတ္သံုးသပ္ျခင္း လုပ္ငန္းစဥ္မ်ား ပါဝင္ပါသည္။ သင္တန္းစံသတ္မွတ္ခ်က္မ်ားကုိ ၁၃ နာရီမွ ၁၄ နာရီအတြင္း အၿပီးပုိ႔ခ်ႏုိင္ေသာ္လည္း လုိအပ္ခ်က္အရ လည္းေကာင္း၊ ရရွိေသာအရင္းအျမစ္မ်ားေပၚမူတည္၍လည္းေကာင္း ယင္းအခ်ိန္ကုိ လုိအပ္သလုိ လုိတုိးပုိေလွ်ာ့ ျပဳ လုပ္ႏုိင္ပါသည္။ ဤသင္တန္းစံသတ္မွတ္ခ်က္မ်ားအား ပုိ႔ခ်ေပးျခင္းျဖင့္ မန္ေနဂ်ာမ်ားသည္ ေအာက္ပါတုိ႔ကုိ ေဆာင္ရြက္ရာ တြင္ အေထာက္အကူျဖစ္မည္ ျဖစ္ပါသည္- - ဘီးတပ္ထုိင္ခုံေထာက္ပံ့ေရးလုပ္ငန္းမ်ားအတြက္ ပုိမုိေကာင္းမြန္ေသာအစီအစဥ္မ်ား ခ်မွတ္ႏုိင္ျခင္း - ဘီးတပ္ထုိင္ခုံေထာက္ပံ့မႈအရည္အေသြးမ်ားအား တုိးတက္ေအာင္ျပဳလုပ္ႏုိင္ျခင္း - ဝန္ထမ္းတည္ၿမဲမႈတုိးတက္လာေစျခင္း - မိမိတုိ႔လုိအပ္ေသာဘီးတပ္ထုိင္ခုံကုိ ရရွိၾကသည္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအေရအတြက္ တုိးတက္လာျခင္း - ဘီးတပ္ထုိင္ခုံေထာက္ပံ့မႈလုပ္ငန္း ေရရွည္တည္တံ့ေရးကုိ တုိးျမင္႔လာေစျခင္း e,fy,ftwkdif;twm သင္တန္းစံႏႈန္းသတ္မွတ္ခ်က္တြင္ ေအာက္ပါအခ်က္မ်ား ပါဝင္ပါသည္- • WHO ၏ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈသင္တန္းစံႏႈန္းသတ္မွတ္ခ်က္တြင္ေဖာ္ျပပါရွိေသာ ဘီးတပ္ထုိင္ခုံဝန္ ေဆာင္မႈေပးေရးဆုိင္ရာ အဓိကအခ်က္မ်ားအား ၿခံဳငံုသံုးသပ္ေဖာ္ျပထားျခင္း • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈေပးေရးတြက္ လုိအပ္ေသာအဓိကဗဟုသုတမ်ားျဖစ္သည့္ - ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းစတင္ျခင္း - ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ျခင္း ႏွင္႔ - ဘီးတပ္ထုိင္ခုံထုိင္ဝန္ေဆာင္မႈလုပ္ငန္းေရရွည္တည္တံ့ေစရန္ေဆာင္ရြက္ျခင္း 4 5 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ukd;um;vufpGJpmapmifESifh avhusifhcef;ukd rnfokdY tokH;jyKrnfenf; ဤကုိးကားလက္စြဲစာေစာင္တြင္ မန္ေနဂ်ာမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈဆုိင္ရာစံႏႈန္းႏွင့္သတ္ မွတ္ခ်က္မ်ားသင္တန္း(WSTPm)တြင္ ပါဝင္သည့္ ပညာရပ္ပုိင္းဆုိင္ရာအက်ဥ္းခ်ဳပ္ကုိ ေဖာ္ျပထားသည္။ သင္တန္း ကာလအတြင္း ပုိ႔ခ်ေပးလုိက္ေသာအဓိကအခ်က္မ်ားအား မွတ္မိၿပီး သင္တန္းၿပီးဆံုးၿပီးေနာက္ ကုိးကားလက္စြဲစာ ေစာင္ႏွင့္ ေလ႔က်င္႔ခန္းမ်ားကုိ သင္တန္းသားမ်ားအေနျဖင္႔ အသံုးခ်ႏုိင္ရမည္ျဖစ္သည္။ လက္စြဲစာေစာင္ကုိ ေအာက္ ပါအတုိင္း အပုိင္း (၃) ပုိင္းခြဲ ေဖာ္ျပထားပါသည္- (က) အဓိကသိမွတ္ဖြယ္ရာမ်ား (ခ) ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းစတင္ျခင္း (ဂ) ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ျခင္း ကုိးကားလက္စြဲစာေစာင္တြင္ ေလ႔က်င္႔ခန္းပါဝင္ၿပီး ေလ႔က်င္႔ခန္းျပဳလုပ္ျခင္း၏ရည္ရြယ္ခ်က္မွာ ဘီးတပ္ ထုိင္ခုံ ဝန္ေဆာင္မႈေပးေရးလုပ္ငန္းတြင္ပါဝင္သည့္ဝန္ထမ္းမ်ား၏အရည္အေသြးႏွင့္ အသိပညာ ဗဟုသုတ တုိးတက္ လာေစရန္ ျဖစ္သည္။ ေလ႔က်င္႔ခန္းစာအုပ္တြင္ သင္တန္းသားမ်ား၏အရည္အေသြးႏွင္႔ဗဟုသုတကိုဆန္းစစ္ၿပီး တုိးတက္မႈရွိလာေစမည္႔ ေလ႔က်င္႔ခန္းမ်ားပါဝင္သည္။ ေလ႔က်င္႔ခန္းစာအုပ္တြင္ ပုိ႔ခ်ခ်က္မ်ား၊ ဓာတ္ပံုဆလုိက္ျဖင့္ တင္ဆက္မႈမ်ားႏွင့္ ကုိးကားလက္စြဲစာေစာင္တြင္ပါေသာအခ်က္မ်ားလည္း ပါဝင္ၿပီး သင္တန္းသားမ်ားအေနျဖင္႔ လုိအပ္ပါက ေနာင္တြင္ကုိးကားႏုိင္ရန္ ႏွင္႔ ကုိးကားလက္စြဲစာေစာင္ႏွင့္ ေလ႔က်င္႔ခန္းစာအုပ္ကိုကုိင္စြဲထားရန္ ရည္ ရြယ္ထားျခင္းျဖစ္ပါသည္။ 4 5 u/ t"du odrSwfzG,f&mrsm; u .1/ oifhavsmfaom bD;wyfxkdifckH axmufyHhrIqkdonfrSm tb,fenf;/ ဘီးတပ္ထုိင္ခုံေထာက္ပံ့ျခင္းဆုိသည္မွာ ဘီးတပ္ထုိင္ခုံ၏ပံုစံ၊ ထုတ္လုပ္မႈ၊ ပံ့ပုိးေပးမႈ ႏွင္႔ ဝန္ေဆာင္မႈတုိ႔အား ၿခံဳငံုေခၚေဝၚသည့္ေဝါဟာရျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံမ်ားသည္ေရြ႕လ်ားမႈျပဳလုပ္ရန္မစြမ္းေသာလူမ်ားအတြက္ ဘီးကုိ လွိမ့္ၿပီးေရြ႕လ်ားႏုိင္ေစရန္ အေထာက္အကူျပဳသည့္ကိရိယာမ်ားအနက္ အမ်ားဆံုးအသံုးျပဳေသာအေထာက္အကူျပဳ ကိရိယာျဖစ္သည္။ ေရြ႕လ်ားႏုိင္စြမ္းသည္ အမ်ားသူငါႏွင့္ေရာေႏွာပါဝင္ႏုိင္ေရးအတြက္ အေရးႀကီးေသာအဆင္႔တစ္ခုျဖစ္ သည္။ ပုဂၢိဳလ္တစ္ဦးတစ္ေယာက္အေနျဖင္႔ဝန္ေဆာင္မႈလုပ္ငန္းမွတစ္ဆင္႔ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံတစ္လံုးရ ၿပီဆုိလွ်င္ ၎အတြက္ လူမႈေရးလုပ္ငန္းမ်ား၊ အလုပ္အကုိင္မ်ား ႏွင္႔ ပညာေရးတုိ႔အတြက္လမ္းပြင္႔သြားျပီျဖစ္ပါ သည္။ ထိုမွ်သာမက အျခားေသာမိသားစုဝင္မ်ားမွာလည္း အားလပ္မႈရရွိသြားျပီး လူမႈအဖြဲ႔အစည္းႏွင္႔အလုပ္အကုိင္ မ်ားတြင္ ပါဝင္ခြင္႔ရရွိလာမည္ျဖစ္သည္။(၅) ေရြ႔လ်ားႏုိင္စြမ္းတုိးတက္လာမႈ၏ အက်ိဳးအျမတ္ကုိတစ္ဦးခ်င္းအေနျဖင္႔သာလည္းေကာင္း၊ ၎တုိ႔၏ မိ သားစုဝင္မ်ားသည္သာလည္းေကာင္း ရရွိၾကသည္မဟုတ္ပါ။ ေဒသႏၲရႏွင္႔ပုိမုိက်ယ္ျပန္႔ေသာစီးပြားေရးလုပ္ငန္းကုိ အေထာက္အကူျပဳမည့္ အဖြဲ႔ဝင္မ်ား ပုိမုိမ်ားျပားလာသည္႔အတြက္ ၄င္းတုိ႔သည္လည္း အက်ိဳးအျမတ္ကုိရရွိၾကမည္ ျဖစ္သည္။ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံတစ္လံုးကုိရရွိထားသူမ်ားအေနျဖင္႔ အျခားေသာေနာက္ဆက္တြဲက်န္းမာ ေရးဆုိင္ရာခြၽတ္ယြင္းခ်က္မ်ားျဖစ္မည့္ အေနအထား (ဥပမာ အပူေလာင္နာ)နည္းပါးသည္ျဖစ္ရာ က်န္းမာေရးဆုိင္ ရာဝန္ေဆာင္မႈလုိအပ္ခ်က္ နည္းပါးႏုိင္မည္ ျဖစ္ပါသည္။ သုိ႔ျဖစ္ေသာေၾကာင္႔ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေပးမႈအား လူအမ်ားပုိမုိရရွိရန္အတြက္ အ ေျပာင္းအလဲျပဳလုပ္ရန္ အေရးတႀကီးလုိအပ္ေနျပီျဖစ္ပါသည္။ bD;wyfxkdifckH vkdtyfol rnfrQ&Sdaeoenf;/ မည္သည္႔လူဦးေရ၏ ၁% မဆုိ ဘီးတပ္ထုိင္ခုံကုိလုိအပ္ေနၾကာင္း WHO ကခန္႔မွန္းထားပါသည္။ ဆုိလုိ သည္မွာ ကမၻာ႔လူဦးေရအနက္ သန္း (၇ဝ) ေက်ာ္သည္ဘီးတပ္ထုိင္ခုံမ်ားကုိလုိအပ္ေနသည္ဟူ၍ ျဖစ္ပါသည္။ ႏုိင္ငံ တစ္ႏုိင္ငံ၊ ခရုိင္တစ္ခု သုိ႔မဟုတ္ ၿမိဳ႔တစ္ၿမိဳ႔တြင္ ဘီးတပ္ထုိင္ခုံလုိအပ္ေနသူ မည္မွ်ရွိသည္ကုိတြက္ခ်က္ရန္ ဤစာရင္း ကုိ အေျချပဳၿပီး စတင္ေဖာ္ထုတ္ႏုိင္ပါသည္။ အဓိပၸါယ္မွာ မန္ေနဂ်ာမ်ားအေနျဖင္႔စီမံထားေသာ ဘီးတပ္ထုိင္ခုံေထာက္ ပံ႔ေပးေရးလုပ္ငန္းကုိစတင္ရန္ အေသးစိတ္ဆန္းစစ္ခ်က္မ်ားအား ေစာင္႔စားေနရန္မလိုဟူသည္ပင္ ျဖစ္ပါသည္။ 6 7 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ လူဦးေရ % ဘီးတပ္ထုိင္ခုံလုိအပ္သူ ခန္႔မွန္းအေရအတြက္ ကမၻာ့လူဦးေရ ၇ ၀၀၀ ၀၀၀ ၀၀၀ ၁% ၇၀ ၀၀၀ ၀၀၀ ဘရာဇီးလ္ ၂၀၃ ၆၅၇ ၀၀၀ ၁% ၂ ၀၃၆ ၅၇၀ တ႐ုတ္ ၁ ၄၀၁ ၅၈၇ ၀၀၀ ၁% ၁၄ ၀၁၅ ၈၇၀ အီဂ်စ္ ၈၄ ၇၀၆ ၀၀၀ ၁% ၈၄၇ ၀၆၀ အိႏၵိယ ၁ ၂၈၂ ၃၉၀ ၀၀၀ ၁% ၁၂ ၈၂၃ ၉၀၀ ႏုိင္ဂ်ီရီးယား ၁၈၃ ၅၂၃ ၀၀၀ ၁% ၁ ၈၃၅ ၂၃၀ ႐ုရွား ၁၄၂ ၀၉၈ ၀၀၀ ၁% ၁ ၄၂၀ ၉၈၀ bD;wyfxkdifckH axmufyHhay;&mwGif taxmuftuljyKaeonfh o a b m w l n D c s u f r s m ; ? r[mAsL[mrsm;ESifh rl0g'rsm; ဘီးတပ္ထုိင္ခုံလုိအပ္ေနသူအေျမာက္အမ်ားမွာ ယခုတုိင္ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံတစ္လံုးကုိ မရရွိ ၾကေခ်။ သင္႔ေတာ္ေသာဘီးတပ္ထုိင္ခုံရရွိသူမ်ားတုိးတက္လာေစရန္ အခုိင္အမာအားေပးေထာက္ခံမႈကုိ လုိအပ္ေန ၿပီလည္း ျဖစ္ပါသည္။ မန္ေနဂ်ာမ်ားသည္ေရြ႕လ်ားႏုိင္စြမ္းမရိွသူမ်ားကုိယ္စား ေရြ႕လ်ားပုိင္ခြင္႔အတြက္ဦးေဆာင္ဦး ရြက္ျပဳျပီး ကမၻာႏွင္႔ အဝွမ္း၊ ေဒသႏၲရႏွင္႔ အမ်ိဳးသားဆုိင္ရာမူဝါဒမ်ားကုိသံုးစြဲႏုိင္ရမည္ျဖစ္ပါသည္။ ေအာက္တြင္ေဖာ္ျပထားေသာဇယားသည္ မန္ေနဂ်ာမ်ားအတြက္ေရွ႕ေဆာင္ေရွ႕ရြက္ျပဳရာတြင္အသံုးျပဳႏုိင္ ေသာတနဆ္ာ ပလာမ်ားျဖစသ္ည္႔ သေဘာတညူခီ်က္မ်ား၊ မဟာဗ်ဴဟာမ်ား၊ မဝူါဒမ်ားႏငွ္႔ လမ္းညႊနခ္်ကမ္်ား ျဖစပ္ါသည-္ 6 7 ႏုိင္ငံတကာမူဝါဒ ေဒသႏၱရနမူနာ - အင္ခၽြမ္မဟာဗ်ဴဟာ အမ်ိဳးသားမူဝါဒမ်ားႏွင့္ လမ္းညႊန္ခ်က္မ်ား အျမင္႔ဆံုးအဆင္႔မူဝါဒမွာ မသန္ စြမ္းပုဂၢိဳလ္မ်ား အခြင္႔အေရးဆုိင္ရာ ကုလသမဂၢသေဘာတူညီခ်က္ (CRPD) ျဖစ္သည္။ CPRD ပုဒ္မ (၂ဝ) တြင္ လူအားလံုးသည္ တစ္ဦးခ်င္းအေနျဖင္႔ ေရြ႕လ်ားပုိင္ခြင္႔ရွိသည္ဟု ေဖာ္ျပထားသည္။ CPRD ၏အျခားေသာပုဒ္မမ်ား တြင္လည္း သင္႔ေလ်ာ္ေသာ ဘီးတပ္ထုိင္ခုံပံ့ပုိးေပးမႈ၏ အေရးၾကီးပံုႏွင္႔သက္ဆုိင္မႈကုိ အားျဖည့္ေပးထားရာတြင္ ေအာက္ပါတုိ႔ပါဝင္သည္ - A 19: အမွီခုိကင္းစြာ ေနထုိင္ျခင္း ႏွင့္ လူ႔အသုိင္း အဝုိင္းတြင္ ပါဝင္ျခင္း A 24: ပညာေရး A 25: က်န္းမာေရး A 26: ျပန္လည္ထူေထာင္ေရး A 27: အလုပ္အကုိင္ႏွင္႔အလုပ္ ခန္႔ထားေရး A 30: ယဥ္ေက်းမႈဘဝ၊ အပန္းေျဖျခင္းႏွင္႔ အားကစားလုပ္ငန္း မ်ားတြင္ပါဝင္ျခင္း ၂ဝ၁၂ ခုႏွစ္တြင္ ''အခြင္႔အေရးမ်ား အစစ္အမွန္ျဖစ္လာေစရန္ ေဆာင္ရြက္'' ဟူသည့္ အာရွႏွင္႔ ပစိဖိတ္ေဒသမွ မသန္စြမ္းပုဂၢိဳလ္မ်ားအတြက္ အင္ခြၽမ္မဟာဗ်ဴဟာကုိ ခ်မွတ္ခဲ႔သည္။ ယင္းမဟာဗ်ဴဟာတြင္ ရည္မွန္းခ်က္ ပန္းတုိင္ (၁ဝ) ခုရွိသည္။ အမွတ္ (၃) ရည္မွန္းခ်က္မွာ ရုပ္ပုိင္းဆုိင္ရာဝန္းက်င္၊ အမ်ား ျပည္သူသယ္ယူပုိ႔ေဆာင္ေရး၊ ပညာဗဟုသုတ၊ သတင္းအခ်က္ အလက္ႏွင္႔ ဆက္သြယ္ေရးလုပ္ ငန္းမ်ားအတြင္း ဝင္ဆန္႔မႈကုိ တုိးျမွင္႔ရန္ျဖစ္သည္။ ယင္းမဟာဗ်ဴဟာကုိ ေရးဆြဲေနစဥ္ အတြင္း ယင္းရည္မွန္းခ်က္သည္ ဘီးတပ္ထုိင္ခုံအပါအဝင္ အေထာက္အကူျပဳကိရိယာမ်ား မရရွိပဲ ေအာင္ျမင္ႏုိင္မည္ မဟုတ္ဟူေသာ ခုိင္မာသည္႔အျမင္ကုိ ခ်မွတ္ႏုိင္ခဲ႔သည္။ ထုိ႔ေၾကာင္႔ ရည္မွန္းခ်က္ အမွတ္ (၃) တြင္ သင္႔ေလ်ာ္ေသာအေထာက္အကူ ျပဳကိရိယာမ်ား သုိ႔မဟုတ္ ပစၥည္းမ်ားကုိ လုိအပ္ေနေသာ္လည္း မရရွိၾကသည္႔ မသန္စြမ္းပုဂၢိဳလ္မ်ား၏အခ်ိဳးကုိ ထက္ ဝက္ေလွ်ာ႔ခ်ရန္ဆုိသည္႔ရည္မွန္းခ်က္ ပါဝင္သည္။ အင္ခြၽမ္ကုိ လက္မွတ္ေရးထုိးထားၾကေသာ အစုိးရမ်ားသည္ ယခုအခါ ယင္းကတိ ကဝတ္ကုိျဖည္႔ဆည္းႏုိင္ရန္အတြက္ အမ်ိဳးသားအဆင္႔စီမံခ်က္မ်ားကုိ ထုတ္ေဖာ္ေနျပီျဖစ္ပါသည္။ ႏုိင္ငံ တကာႏွင္႔ေဒသႏၲရမူဝါဒမ်ားအေနျဖင္႔ အမ်ိဳးသားအဆင္႔မူဝါဒမ်ား ေဖာ္ထုတ္မႈကုိ မည္ကဲ႔သုိ႔ထာက္အကူျပဳႏုိင္သည္ ဆုိသည္ကုိ အင္ခြၽမ္မဟာဗ်ဴဟာနမူနာက ျပသေနပါသည္။ အမ်ိဳးသားအဆင္႔စီမံကိန္းမ်ား၊ မူဝါဒမ်ား ႏွင္႔လမ္းညႊန္ခ်က္မ်ား သည္ဘီးတပ္ထုိင္ခုံ ပံ႔ပုိးေရး လုပ္ငန္းထိေရာက္မႈရွိေရးႏွင္႔ ေရရွည္ တည္တံ့ေရးအတြက္ ပါဝင္ပါသည္။(၆) အမ်ိဳးသားအဆင္႔မူဝါဒမ်ား ႏွင္႔ လမ္းညႊန္ခ်က္မ်ားေဖာ္ထုတ္ ရာတြင္ မသန္စြမ္းပုဂၢိဳလ္မ်ား၊ အစုိးရႏွင္႔အစုိးရ မဟုတ္ေသာဝန္ ေဆာင္မႈေပးသည္႔အဖြဲ႔အစည္းမ်ား အၾကားေပါင္းစပ္ညွိႏႈိင္းမႈ ျပဳလုပ္ရန္ လုိသည္။ CPRD ႏွင္႔ဆက္စပ္ ေဒသႏၲရမဟာဗ်ဴဟာမ်ားသည္ အမ်ိဳးသားအဆင္႔ စီမံကိန္းမ်ား၊ မူဝါဒ ႏွင္႔လမ္းညႊန္ခ်က္ထုတ္ေဖာ္မႈကုိ အေထာက္အကူျပဳႏုိင္ပါသည္။ ေရြ႕ လ်ားမႈဆုိင္ရာကိရိယာမ်ားအပါအဝင္ အေထာက္အကူျပဳကိရိယာမ်ားအား မည္သုိ႔ မည္ပံုပံ႔ပုိးေပးသင္႔သည္။ ဥပမာ - ၂၀၁၃ ခုႏွစ္အတြင္း ေတာင္အာဖရိကႏုိင္ငံတြင္ အေထာက္အကူျပဳပစၥည္းမ်ား ပံ့ပုိးျခင္းဆုိင္ရာ အမ်ိဳးသားအဆင့္ လမ္းညႊန္ခ်က္ကုိ ထုတ္ျပန္ခဲ့သည္။ ယင္းလမ္းညႊန္ခ်က္တြင္ အနိမ့္ဆုံးအဆင့္ဝန္ေဆာင္မႈ၊ ဝန္ထမ္းမ်ားအား သင္တန္း ေပးျခင္း၊ ေစာင့္ဆုိင္းစာရင္းျပဳစု ျခင္းႏွင့္ စီမံခန္႔ခြဲျခင္း၊ ဘတ္ဂ်က္ႏွင့္ ျပင္ဆင္ေရးႏွင့္ ျပဳ ျပင္ထိန္းသိမ္းေရး လုပ္ငန္းမ်ားပါဝင္ပါသည္။ 8 9 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ u .2/ 0efaqmifrIay;jcif; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ ဘီးတပ္ထိုင္ခုံမ်ားပံ႔ပုိးေပးရာတြင္ အဓိကက်ေသာအခန္း က႑မွပါဝင္သည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားႏွင္႔ ပူးေပါင္းျပီး (ရရွိႏုိင္သည္႔အထဲမွ) အသင္႔ေလ်ာ္ဆံုးဘီးတပ္ထုိင္ခုံကုိ ထုိအသံုးျပဳသူအတြက္ရွာေဖြေပးသည္။ tajccHESifhtv,ftvwftqifh bD;wyfxkdifckH0efaqmifrIvkyfief; စနစ္တက်ေကာင္းမြန္စြာတပ္ဆင္ထားေသာဘီးတပ္ထုိင္ခုံသည္ အသံုးျပဳသူအတြက္တစံုတခုေသာကုိယ္ ေနဟန္ထားအေထာက္အကူကုိျဖစ္ေစပါသည္။ ေက်ာမွီ၊ ေအာက္ခင္း၊ ေျခတင္ခံု ႏွင္႔ လက္ရမ္းမ်ားအား ဘီးတပ္ ထုိင္ခုံ အသံုးျပဳသူ၏အရြယ္အစားႏွင္႔ကုိက္ညီေအာင္ခ်ိန္ညွိေပးပါက ကုိယ္ေနဟန္ထားကုိ အေထာက္အကူ ျဖစ္ေစ သည္။ သုိ႔ရာတြင္ ကေလးသူငယ္ႏွင္႔လူၾကီးမ်ားစြာတုိ႔အေနျဖင္႔ ၎တို႔၏ဘီးတပ္ထုိင္ခုံမ်ားအား ေနာက္ထပ္ ကုိယ္ ေနဟန္ထားကုိ အေထာက္အကူျဖစ္ေစရန္ လုိအပ္ေနေသးသည္။ အဓိပၸါယ္မွာ အဆင္႔မတူသည္႔ဝန္ေဆာင္မႈေပးရန္ လုိအပ္ေနေသးသည္ဟု ဆုိလုိျခင္း ျဖစ္ပါသည္။ အေျခခံအဆင့္ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈသည္ ေနာက္ထပ္ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳမႈ မလို အပ္ပဲ ကုိယ္ခႏၶာကုိတည့္တည့္မတ္မတ္ထားျပီး ထုိင္ႏုိင္သည္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအတြက္ျဖစ္ပါသည္။ အလယ္အလတ္အဆင္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈသည္ ကုိယ္ခႏၶာကုိတည္႔တည္႔ထားျပီး သက္ေတာင့္ သက္သာထုိင္ႏုိင္ရန္ ေနာက္ထပ္ကုိယ္ေနဟန္ထားအေထာက္အကူလုိအပ္ေသာ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ား အတြက္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာမ်ားအတြက္အေရးၾကီးသည္မွာ ၎တုိ႔၏ ဝန္ေဆာင္မႈလုပ္ငန္း သည္ ''အေျခခံ'' အဆင္႔ေလာ၊ ''အလယ္အလတ္''အဆင္႔ေလာ ဆုိသည္ကုိ သတ္မွတ္ရန္ျဖစ္သည္။ အေၾကာင္းမွာ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈအတြက္ ဝန္ထမ္းသည္ အဆင္႔ျမင္႔သင္တန္းကုိ တက္ေရာက္ျပီးသူျဖစ္ရန္လုိျခင္း၊ ဘီးတပ္ထုိင္ခုံ၏အတုိင္းအတာ ပုိၾကီးရန္လုိျခင္းႏွင္႔ ပစၥည္းကိရိယာတန္ဆာပလာမ်ား ပုိမုိလုိအပ္ျခင္းမ်ားေၾကာင္႔ျဖစ္ သည္။ 8 9 ေရြ႕လ်ားႏုိင္မႈႏွင့္ ကုိယ္ေနဟန္ထားအေထာက္အကူလုိအပ္ခ်က္အား သင္႔တင္႔ေလ်ာက္ပတ္စြာ ျဖည္႔ဆည္းေပးျခင္း ကလာရာသည္အေရွ႕တီေမာတြင္ေနထုိင္သူျဖစ္သည္။ သူမသည္ သူမ၏မိသားစုပုိင္ဆုိင္တြင္ အလုပ္လုပ္ကုိင္သည္။ ထုိဆုိင္ သည္ ၎တုိ႔၏အိမ္ေရွ႕တြင္ရွိသည္။ ကလာရာသည္ ပုိလီယုိေရာဂါကုိခံ စားေနရသူျဖစ္ရာ သူမ၏အိမ္အတြင္း သြားလာလႈပ္ရွားႏုိင္ရန္၊ ဆုိင္ အတြင္း အလုပ္လုပ္ႏုိင္ရန္ႏွင္႔ ရြာအတြင္း ဟုိဟုိဒီဒီသြားလာႏုိင္ရန္ ဘီးတပ္ထုိင္ခုံတစ္လံုးလုိအပ္သည္။ သူမသည္ ေနာက္ထပ္ အေထာက္အကူတစံုတရာမပါပဲ မတ္မတ္ထုိင္ႏုိင္သည့္အတြက္ လက္တြန္းဘီးတပ္ထုိင္ခုံကုိ အသံုးျပဳသည္။ ယင္းဘီးတပ္ထုိင္ခုံကုိ သူမႏွင္႔ကုိက္ညီေစရန္တပ္ဆင္ေပးထားသည္။ ကလာရာသည္ အေျခခံအဆင္႔ဝန္ေဆာင္မႈမွတဆင္႔ ဘီးတပ္ ထုိင္ခုံတစ္လံုးရရွိႏုိင္သူတစ္ဦးအတြက္နမူနာပင္ ျဖစ္ပါသည္။ အီရွိတ္သည္ အသက္ (၈) ႏွစ္အရြယ္ရွိျပီး သီရိလကၤာႏုိင္ငံတြင္ ေနထုိင္သူျဖစ္သည္။ သူမသည္ ေမြးရာပါကုိယ္အဂၤါ ခ်ိဳ႕ယြင္းေနသူ ေလးျဖစ္ရာ လက္မ်ား၊ ေျခေထာက္မ်ား၊ ေခါင္းႏွင္႔လည္ပင္းကုိ ထိန္းခ်ဳပ္ ရန္ျပႆနာရွိသည္။ သူမသည္ အေထာက္အကူမပါပဲ တည္႔မတ္စြာထုိင္ ႏုိင္ျခင္းလည္းမရွိေခ်။ အီရွိတ္အတြက္ သူမ၏ဘီးတပ္ကုလားထုိင္ အတြင္း ကုိယ္ေနဟန္ထားကုိ အေထာက္အကူျပဳမည္႔ ေနာက္ထပ္အပုိ ပစၥည္းမ်ားလုိအပ္ေနပါသည္။ အီရွိတ္သည္ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္း မွတဆင္႔ ဘီးတပ္ကုလားထုိင္တစ္လံုးပံ႔ပုိးေပးသင္႔သူတစ္ဦးအတြက္ နမူနာပင္ျဖစ္ပါသည္။ 10 11 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ tajccHESifhtv,ftvwftqifh bD;wyfxkdifckH0efaqmifrIvkyfief; အဆင့္ အက်ဥ္းခ်ဳပ္ ၁။ လႊဲေျပာင္းေပးျခင္း ႏွင့္ ခ်ိန္းဆုိျခင္း ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအား လႊဲေျပာင္းေပးသည္႔ နည္းလမ္းမွာတစ္ခုႏွင္႔တစ္ခု မတူပဲကြဲျပားျခားနားမႈရွိသည္။ အသံုးျပဳသူမ်ားသည္ ၎တုိ႔ဖာသာ ၎တုိ႔ကုိယ္ကုိ လႊဲေျပာင္းေပးျခင္းႏွင္႔ ၎တို႔အား လႊဲေျပာင္းေပးမႈခံရျခင္း မ်ိဳးျဖစ္သည္။ ထုိသုိ႔ျပဳလုပ္ရာတြင္အစုိးရ သုိ႔မဟုတ္ အစုိးရမဟုတ္ေသာအဖြဲ႔အစည္းမ်ား၏ က်န္းမာေရး ႏွင္႔ ျပန္လည္ထူေထာင္ေရးဝန္ထမ္းမ်ား သုိ႔မဟုတ္ လူမႈအဖြဲ႔အစည္း၊ ခရုိင္ သုိ႔မဟုတ္ ေဒသႏၲရအဆင္႔လုပ္ ငန္းမ်ား အတြင္းလုပ္အားေပးေဆာင္ရြက္ေနၾကေသာ ေစတနာ႔ဝန္ထမ္းမ်ားက တည္ေထာင္ထားေသာကြန္ယက္မ်ား မွတစ္ဆင္႔ လႊဲေျပာင္းေပးျခင္းျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံလုိအပ္ ႏုိင္သည္႔သူမ်ားအေနျဖင္႔ လူမႈေရးသုိ႔မဟုတ္ က်န္းမာေရး ေစာင္႔ေရွာက္မႈလုပ္ငန္းမ်ားအား မရရွိေသးျခင္း သုိ႔မဟုတ္ ေက်ာင္း၊ အလုပ္ခြင္ သုိ႔မဟုတ္ လူမႈအဖြဲ႔အစည္းအတြင္း လႈပ္ရွားေဆာင္ရြက္မႈမ်ားတြင္ ပါဝင္ႏုိင္မႈမရွိေသးျခင္းမ်ား ရွိပါက၄င္းတုိ႔အား အခ်ိဳ႔ေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ လုပ္ငန္းမ်ားအေနျဖင္႔ လုိလုိလားလားသတ္မွတ္ေပးရန္ လုိမည္ျဖစ္ပါသည္။ ၂။ အကဲျဖတ္ျခင္း သံုးစြဲသူတစ္ဦးခ်င္းစီအား အကဲျဖတ္သံုးသပ္မႈျပဳလုပ္ထားရန္လုိ မည္ျဖစ္ပါသည္။ ထုိသုိ႔ သံုးသပ္ရာတြင္ဘီးတပ္ထုိင္ခုံအသံုးျပဳ သူ၏ ေနထုိင္မႈပံုစံ၊ ၎တုိ႔လုပ္ကုိင္ေသာ အလုပ္၊ ၎တုိ႔ေနထုိင္ေသာေနရာ ႏွင္႔ ၎တုိ႔၏ရုပ္ပုိင္းဆုိင္ရာအေျခ အေနတုိ႔ႏွင္႔ ပတ္သက္ေသာသတင္းအခ်က္အလက္မ်ားကုိ စုေဆာင္းရယူထားရမည္ျဖစ္သည္။ 10 11 ၃။ ညႊန္ၾကားျခင္း (ေ႐ြးခ်ယ္ျခင္း) အကဲျဖတ္သံုးသပ္ခ်က္မွေပၚထြက္လာေသာ သတင္းအခ်က္ အလက္မ်ားကုိအသံုးျပဳျပီး အသံုးျပဳမည္႔သူ၊ မိသားစုဝင္မ်ား သို႔မဟုတ္ က်န္းမာေရးေစာင္႔ေရွာက္သူတုိ႔ႏွင္႔တုိင္ပင္ကာ ထုတ္ေပးမည္႔ဘီးတပ္ထုိင္ခုံအညႊန္းကုိ ေဖာ္ထုတ္ရမည္ျဖစ္ သည္။ အညႊန္းတြင္ ေရြးခ်ယ္ထားသည္႔ဘီးတပ္ထုိင္ခုံပံုစံ၊ အရြယ္အစား၊ အထူးျပဳလုပ္ထားေသာအသြင္သ႑ာန္ႏွင္႔ အထူးမြမ္းမံထားသည္႔အေၾကာင္းအရာ အေသးစိတ္ ပါဝင္ ရမည္ျဖစ္သည္။ အေသးစိတ္ေဖာ္ျပခ်က္တြင္ အသံုး ျပဳသူအေနျဖင္႔ အသံုးျပဳႏုိင္ရန္ ႏွင္႔ ဘီးတပ္ထုိင္ခုံအား စနစ္တက်ထိန္းသိမ္းႏုိင္ေစရန္ ၎အား သင္တန္းေပးျခင္း တုိ႔လည္း ပါဝင္ရမည္ျဖစ္ပါသည္။ ၄။ ရန္ပုံေငြႏွင့္ စီစဥ္ျခင္း ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္တစ္ခုကို သတ္မွတ္ ေပးထားရမည္ျဖစ္ျပီး ဘီးတပ္ထုိင္ခုံကုိ ဝန္ေဆာင္မႈလုပ္ငန္း သုိ႔မဟုတ္ ေပးသြင္းမည္႔သူက သုိေလွာင္ထားသည္႔ေနရာမွ မွာယူရမည္။ ၅။ ထုတ္ကုန္ ႀကိဳတင္ျပင္ဆင္ျခင္း ေလ႔က်င္႔သင္တန္းေပးထားေသာဝန္ထမ္းသည္ ဘီးတပ္ထုိင္ခုံအား ပဏာမတပ္ဆင္မႈျပဳလုပ္ႏုိင္ရန္ ျပင္ဆင္ထားရမည္။ ပစၥည္းအေနအထားႏွင္႔ဝန္ေဆာင္မႈ လုပ္ငန္းမွရရွိမည္႔ တန္ဆာပလာမ်ား၏အေနအထားေပၚ မူတည္ျပီး ဤအဆင္႔တြင္ ထုတ္လုပ္သူမ်ားက ေပးသြင္းေသာ ပစၥည္းမ်ား သုိ႔မဟုတ္ ဝန္ေဆာင္မႈလုပ္ငန္း၏အလုပ္ရံုမ်ားမွ ထုတ္လုပ္ေသာပစၥည္းမ်ားအား တပ္ဆင္ျခင္း ႏွင္႔ ျဖစ္ႏုိင္ပါက မြမ္းမံျပင္ဆင္ျခင္းမ်ား ျပဳလုပ္ေပးရမည္ျဖစ္ပါသည္။ ၆။ အံဝင္ခြင္က် တပ္ဆင္ျခင္း အသံုးျပဳမည္႔သူသည္ဘီးတပ္ထုိင္ခုံအား စမ္းသပ္သံုးစြဲ ၾကည္႔ရမည္။ ထုိေနာက္ ဘီးတပ္ထုိင္ခုံအား မွန္ကန္စြာတပ္ဆင္ တည္ေဆာက္ထားျခင္းျဖစ္ေၾကာင္း ေသခ်ာေစရန္ အျပီးသတ္ ခ်ိန္ညွိမႈျပဳလုပ္ရမည္။ မြမ္းမံျပင္ဆင္မႈျပဳလုပ္ရန္ သုိ႔မဟုတ္ ကုိယ္ေနဟန္ ထားကုိ အေထာက္အကူေပးမည္႔ အစိတ္အပုိင္းမ်ားအား တပ္ဆင္ရန္လုိမည္ဆုိပါက ေနာက္ထပ္တည္ေဆာက္တပ္ဆင္မႈ လုိေကာင္း လုိလာမည္ျဖစ္ပါသည္။ 12 13 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ၇။ အသုံးျပဳသူ သင္တန္း ဘီးတပ္ထုိင္ခုံအား မည္ကဲ႔သုိ႔ေဘးကင္းစြာ၊ ထိေရာက္စြာ အသံုးျပဳျပီး မည္သုိ႔ထိန္းသိမ္းထားရမည္ဆုိသည္ကုိ အသံုးျပဳမည္႔သူႏွင္႔ က်န္းမာေရးေစာင္႔ေရွာက္မႈေပးမည္႔သူ တုိ႔အားသင္ျပေပးထားရမည္။ ၈။ ေနာက္ဆက္တြဲ လုပ္ေဆာင္ျခင္း၊ ျပဳျပင္ျခင္းႏွင့္ ထိန္းသိမ္းျခင္း ေနာက္ဆက္တြဲျပန္လည္ျပသရန္ခ်ိန္းဆုိမႈသည္ ဘီးတပ္ထုိင္ ခုံသည္ အံဝင္ခြင္က် ျဖစ္မျဖစ္ဆုိသည္ကုိ စစ္ေဆးႏုိင္မည႔္ အခြင္႔အေရးပင္ျဖစ္ျပီး ေလ႔က်င္႔သင္တန္းေပးမႈႏွင္႔ အေထာက္ အကူျပဳမႈမ်ားအားထပ္မံျပဳလုပ္ေပးႏုိင္မည္ျဖစ္သည္။ ထုိသုိ႔ ေဆာင္ရြက္ႏုိင္ရန္အတြက္အခ်ိန္မွာ အသံုးျပဳသူ၏လုိအပ္ခ်က္ ေပၚတြင္လည္းေကာင္း၊ အျခားေသာဝန္ေဆာင္မႈလုပ္ငန္းရရွိမႈ ေပၚတြင္လည္းေကာင္း မူတည္မည္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈ လုပ္ငန္းသည္ ရပ္ကြက္အတြင္း အလြယ္တကူေျဖ ရွင္းရန္ မလြယ္ကူသည္႔ နည္းပညာပုိင္းဆိုင္ရာ ျပႆနာမ်ားအားေျဖ ရွင္းေပးႏုိင္ေရးအတြက္ ထိန္းသိမ္းမႈႏွင္႔ ျပဳျပင္မႈ လုပ္ငန္းမ်ားကုိလည္း ေဆာင္ရြက္ေပးႏုိင္မည္ ျဖစ္ပါသည္။ 12 13 0efaqmifrIay;onfhykHpHrsm; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈေပးသည္႔လုပ္ငန္းအားလံုးအေနျဖင္႔ အထက္ပါအဆင္႔ (၈) ဆင္႔ကုိ လုိက္နာ ေဆာင္ရြက္ရမည္ျဖစ္ပါသည္။ သုိ႔ရာတြင္ ယင္းအဆင္႔ (၈) ဆင္႔အား ဝန္ေဆာင္မႈေပးရာတြင္ လုပ္ကုိင္သည္႔နည္း လမ္းမ်ား ကြဲျပားျခားနားမႈရွိသည္။ ယင္းကုိ ဝန္ေဆာင္မႈပံုစံဟုေခၚသည္။ အသြင္မတူသည္႔ ဝန္ေဆာင္မႈေပးသည္႔ပံုစံ မ်ားအားစုစည္းလုိက္ျခင္းသည္ အမ်ိဳးသားအဆင္႔ဝန္ေဆာင္မႈတစ္ခုလံုး ျဖစ္ေပၚလာေစသည္။ အသင္႔ေလ်ာ္ဆံုး ေသာဝန္ေဆာင္မႈပံုစံသည္ အေျခအေနေပၚတြင္ မူတည္ျပီးဆက္စပ္သက္ဆုိင္ေနသည္႔ပါဝင္သူအားလံုးႏွင္႔ညွိႏႈိင္း တုိင္ပင္ျပီးမွဆံုးျဖတ္သင္႔သည္။ ေအာက္ေဖာ္ျပပါဇယားသည္ အသြင္မတူေသာ ဝန္ေဆာင္မႈပံုစံနမူနာအခ်ိဳ႕ ျဖစ္ပါသည္- ဌာနအေျခစုိက္ ဝန္ေဆာင္မႈ အကဲျဖတ္သံုးသပ္ျခင္း လုပ္ငန္းကုိ အဓိကထား ေဆာင္ရြက္သည္႔နယ္ေျမ ဌာနအေျခစုိက္ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူသည္ အျမဲတန္း ေထာက္ပံ႔ေရးပစၥည္း မ်ားရွိရာသုိ႔ သြားေရာက္ရသည္။ ထုိေနရာတြင္ေလ႔က်င္႔ေပးထားေသာ ဝန္ထမ္းမ်ားက ဝန္ေဆာင္မႈလုပ္ငန္းမ်ား ေပးသည္။ အျမဲတမ္းေထာက္ပံ႔ေရးပစၥည္းမ်ား ရွိ သည္႔ေနရာျဖစ္သည္႔အတြက္ ဝန္ေဆာင္ မႈလုပ္ငန္းအေနျဖင္႔ အျမဲတမ္းဝန္ထမ္း မ်ားကုိလည္းေကာင္း၊ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းနယ္ေျမကုိလည္း ေကာင္း ရရွိႏုိင္မည္ျဖစ္သည္။ ဌာနအေျခစုိက္ဝန္ေဆာင္မႈလုပ္ငန္း သည္ ဝန္ထမ္းမ်ားအတြက္အဆင္ေျပ ေသာ္လည္း အလွမ္းေဝးသည္႔ေနရာမွ ထုိေနရာသုိ႔ေရာက္ေအာင္လာရသည္႔ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအတြက္ အခက္အခဲရွိႏုိင္ပါသည္။ ဘီးတပ္ထုိင္ခုံျဖင္႔ ေရြ႔လ်ားမႈ အရည္အေသြးကုိ အဓိကထား ေဆာင္ရြက္သည္႔နယ္ေျမ 14 15 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေပါင္းစပ္ဝန္ေဆာင္မႈလုပ္ငန္း ရပ္႐ြာက်န္းမာေရး ေဆးေပးခန္းႏွင့္ ေပါင္းစပ္ထားေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ ဌာနအေျခစုိက္ဝန္ေဆာင္မႈလုပ္ငန္း အမ်ားစုသည္ 'ေပါင္းစပ္ဝန္ေဆာင္မႈ လုပ္ငန္း' မ်ားျဖစ္သည္။ ဆုိလုိသည္မွာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအား အျခားေသာဝန္ေဆာင္မႈလုပ္ငန္းမ်ားႏွင္႔ ေပါင္းစပ္ထားေပးျခင္းျဖစ္သည္။ ဥပမာအားျဖင္႔ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ လုပ္ငန္းအား ေျခတုလက္တု/အရုိး ေရာဂါကုလုပ္ငန္းမ်ား၊ အေၾကာကုသ ေရးဌာန၊ သို႔မဟုတ္ ေဆးေပးခန္းႏွင္႔ ခ်ိတ္ဆက္ေပးထားျခင္း ျဖစ္သည္။ ပစၥည္းမ်ားကုိ မွ်ေဝသံုးစြဲႏိုင္သည္။ သုိ႔မဟုတ္ ေနရာေပးႏုိင္သည္။ အုပ္ခ်ဳပ္ မႈဆုိင္ရာမ်ား၊ ဘ႑ာေရးႏွင္႔ စီမံခန္႔ခြဲ ေရးလုပ္ငန္းမ်ားအား မွ်ေဝႏုိင္မည္ ျဖစ္သည္။ ဤကိစၥႏွင္႔စပ္လ်ဥ္းလွ်င္ အလုပ္ရံု တစ္ခု၏နယ္ေျမတြင္ ဘီးတပ္ထုိင္ခုံ ျပင္ဆင္ေရးကုိ အဓိကထားလုပ္ကုိင္သည္။ 14 15 နယ္ေက်ာ္ဝန္ေဆာင္မႈ နယ္ေက်ာ္ေဒသမ်ားမွာ အမ်ိဳးမ်ိဳး ျဖစ္ႏုိင္ပါသည္။ ဥပမာ - ရပ္ကြက္ က်န္းမာေရးေဆးေပးခန္း၊ ၿမိဳ႕ ေတာ္ခန္းမ၊ ေက်းရြာစည္း ေဝးေနရာ၊ ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူေနအိမ္ တုိ႔ျဖစ္သည္။ နယ္ေက်ာ္ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ ငန္းတြင္ေပါင္းစပ္ဝန္ေဆာင္မႈဌာနမွ ဝန္ထမ္းမ်ားသည္ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူ၏ အိမ္သို႔သြားေရာက္ျခင္း သုိ႔မဟုတ္ အျခား ေသာခရုိင္/ေဒသမ်ားရွိ အခ်က္အျခာက် ေသာေနရာသုိ႔သြားေရာက္ျခင္းမ်ားျပဳလုပ္ သည္။ ထုိသုိ႔သြားေရာက္ျခင္းမွာ ထုိခရုိင္/ ေဒသမ်ားရွိဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအား ေတြ႔ဆံုရန္လည္းေကာင္း၊ ဝန္ေဆာင္မႈေပးရန္လည္းေကာင္း ျဖစ္သည္။ နယ္ေက်ာ္ဝန္ေဆာင္မႈပံုစံကုိ ထုိနယ္ရွိ အသင္းအဖြဲ႔မ်ားႏွင္႔ပူးေပါင္းျပီး ေဆာင္ရြက္ေလ႔ရွိသည္။ ေဒသႏၲရအသင္းအဖြဲ႔မ်ားႏွင္႔ ေပါင္းစပ္ ညွိႏႈိင္းမႈ ေကာင္းမြန္ရန္ အေရးၾကီးသည္။ ေဒသႏၲရဝန္ထမ္းမ်ား သုိ႔မဟုတ္ ေစတနာ႔ ဝန္ထမ္း လုပ္အားေပးမ်ားအား သင္တန္း အခ်ိဳ႕ေပးထားလွ်င္ နယ္ေက်ာ္ဝန္ေဆာင္မႈ လုပ္ငန္းေအာင္ျမင္မႈကုိ တုိးတက္လာေစ မည္ ျဖစ္ျပီး ရပ္ကြက္အဆင္႔ေထာက္ခံမႈကုိ ပုိမုိရရွိလာေစမည္ ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူ ရရွိမည္႔ အက်ိဳးအျမတ္မွာ အေဝးသုိ႔သြားေရာက္ရ မည္႔ခရီးလမ္းေၾကာင္းနည္းသြားျခင္း ျဖစ္ပါသည္။ နယ္ေက်ာ္သြား ေရာက္မည့္ဝန္ထမ္းမ်ား အေနျဖင့္ ေျပာင္းလြယ္ ျပင္လြယ္ရွိရမည္ ျဖစ္သည္။ ၎တုိ႔ႏွင့္အတူ မရွိမျဖစ္ပါရမည္ျဖစ္ေသာ ပစၥည္းမ်ားကုိ သယ္ ေဆာင္သြားရ မည္ျဖစ္သည္။ 16 17 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေ႐ြ႕လ်ားဝန္ေဆာင္မႈ ေရြ႕လ်ားဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္ မႈလုပ္ငန္းသံုး သီးသန္႔ယာဥ္ နမူနာ ေရြ႔လ်ားဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈ လုပ္ငန္းသံုး သီးသန္႔ယာဥ္ နမူနာ ေရြ႕လ်ားဝန္ေဆာင္မႈလုပ္ငန္းသည္ နယ္ေက်ာ္ေဆာင္ရြက္သည့္ ေနာက္ထပ္ပံုစံတစ္မ်ိဳးပင္ ျဖစ္သည္။ သုိ႔ေသာ္ ထုိသုိ႔ေသာအေျခအေနမ်ိဳးတြင္ ဝန္ထမ္းအတြက္ သီးသန္႔ အသံုးျပဳေသာ ယာဥ္ရွိရမည္ျဖစ္ျပီး ယင္းယာဥ္ျဖင္႔ ဘီးတပ္ထုိင္ခုံမ်ား၊ လုိအပ္ေသာ ပစၥည္းကိရိယာမ်ားကုိ တင္ေဆာင္ သြားရမည္ျဖစ္သည္။ က်ယ္ျပန္႔ေသာနယ္ေျမအတြင္း ဝန္ထမ္းမ်ား အား ေနရာခ်ထားႏုိင္သည္။ ထုိသုိ႔အားျဖင္႔ ဘီးတပ္ထုိင္ခုံသံုးမည္႔သူ အမ်ားအျပားထံ ေရာက္ရွိႏုိင္မည္ျဖစ္သည္။ ပစၥည္းကိရိယာမ်ားႏွင္႔အပုိပစၥည္းမ်ားအား ပုိမုိသယ္ေဆာင္ႏုိင္သည္ႏွင္႔အမွ် ျပဳျပင္ေရးလုပ္ငန္းကုိ ခ်က္ျခင္းေဆာင္ရြက္ ေပးႏုိင္မည္ျဖစ္သည္သာမက အလယ္ အလတ္အဆင္႔ ဝန္ေဆာင္မႈလုပ္ငန္း အခ်ိဳ႕ကုိလည္း ေဆာင္ရြက္ေပးႏုိင္သည္႔ အလားအလာမ်ား ပုိမုိလာမည္ျဖစ္သည္။ သီးသန္႔ယာဥ္ကုိ အသုံးျပဳၿပီး ဝန္ထမ္းမ်ားအေနျဖင့္ ၎တုိ႔လုိအပ္ေသာ ကိရိယာတန္ဆာပလာ မ်ားကုိ ပုိမုိထုတ္ပုိး တင္ေဆာင္ႏုိင္မည္ ျဖစ္သည္။ 16 17 aygif;pyfnSdEIdif;í 0efaqmifrIay;jcif; အဖြဲ႔အစည္းတစ္ခုတည္းက ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း အဆင္႔ (၈) ဆင္႔လံုးကုိ ေဆာင္ရြက္ရန္ မလုိပါ။ ကြန္ယက္တစ္ခုအတြင္းရွိအဖြဲ႔အစည္းမ်ားအၾကား ေပါင္းစပ္ညိွႏႈိင္းမႈျပဳလုပ္ျခင္းျဖင္႔ ဝန္ေဆာင္မႈစြမ္း ေဆာင္ ရည္ကုိတုိးတက္လာေစမည္ျဖစ္သည္သာမက ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားသည္လည္း အထက္ပါ အဆင္႔ (၈) ဆင္႔လုံးကုိ ရရွိႏုိင္မည္ ျဖစ္ပါသည္။ အဆင္႔-၁ (လႊဲေျပာင္းေပးျခင္းႏွင္ခ်ိန္းဆုိျခင္း) တြင္ဘီးတပ္ထုိင္ခုံလုပ္ငန္း ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ လႊဲေျပာင္းေရးကြန္ယက္ကုိထူေထာင္ထားၾကေသာအဖြဲ႔အစည္းမ်ားႏွင္႔တစ္ဦးခ်င္းတုိ႔အၾကားေပါင္းစပ္ညွိႏႈိင္းမႈႏွင္႔ ပူးေပါင္းေဆာင္ရြက္မႈရွိရန္ လုိသည္။ အဆင္႔-၇ (အသံုးျပဳသူအတြက္သင္တန္း) ႏွင္႔ အဆင္႔-၈ (ထိန္းသိမ္းျခင္း၊ ျပဳျပင္ျခင္း ႏွင္႔ေနာက္ဆက္တြဲ ျပသျခင္းလုပ္ငန္း) ကုိ ေပါင္းစပ္ညိွႏႈိင္းမႈျပဳလုပ္ထားၾကသည္႔မိတ္ဘက္အဖြဲ႔မ်ားက ေဆာင္ရြက္ေပးႏုိင္သည္။ ဥပ မာ- ရပ္ကြက္အေျချပဳအဖြဲ႔အစည္းမ်ား၏ ကြန္ယက္ သုိ႔မဟုတ္ မသန္စြမ္းပုဂၢိဳလ္မ်ားအဖြဲ႔သည္ မိမိတုိ႔ ရပ္ကြက္ အတြင္း ယင္းအဆင္႔မ်ားကုိေဆာင္ရြက္ႏုိင္ပါသည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈေပးသူႏွင့္ ရပ္ကြက္အေျခစုိက္အဖြဲ႔ အစည္းမ်ားအၾကားရွိ မိတ္ဘက္လုပ္ငန္းမွတစ္ဆင္႔ဝန္ေဆာင္ မႈအဆင္႔ (၈) ဆင္႔အားမည္သုိ႔ေဆာင္ရြက္သည္ကုိ ဤပံုစံက ျပသေနပါသည္။ အဆင္႔၂-၇ ကုိဝန္ေဆာင္မႈအခင္းအက်င္းအတြင္းေဆာင္ရြက္ ျပီး အဆင္႔ ၁ ႏွင္႔ ၈ ကုိ လူမႈအဖြဲ႔အစည္းအတြင္းေဆာင္ရြက္ ပါသည္။ ဤပံုစံသည္ ပါဝင္ပတ္သက္မည႔္ ဝန္ထမ္းမ်ားႏွင့္ ေစတနာ့ ဝန္ထမ္းအားလံုးအတြက္ လုိအပ္ေသာသင္တန္းေပးရန္ကိစၥ ကုိထည္႔သြင္းစဥ္းစားရန္ လုိမည္ျဖစ္ပါသည္။ bD;wyfxkdifckH0efaqmifrIvkyfief;aqmif½Guf&mwGif refae*sm\tcef;@ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာသည္ ဝန္ေဆာင္မႈအဆင္႔(၈)ဆင္႔ကုိ ဝန္ထမ္းမ်ားကေပးလာ ေအာင္ ပံ့ပုိးတြန္းအားေပးရမည္ျဖစ္သည္။ ထုိ႔အျပင္ ထုိအဆင္႔မ်ားအားေဆာင္ရြက္ေနသည္႔ အခ်ိန္တေလွ်ာက္လံုး အသံုးျပဳသူႏွင္႔လည္းေကာင္း၊ ၎တုိ႔အားေစာင္႔ေရွာက္သူ၊ မိသားစုဝင္မ်ားႏွင္႔လည္းေကာင္းေပါင္းစပ္ညွိႏႈိင္းမႈျပဳ လုပ္ရမည္ျဖစ္ပါသည္။ မန္ေနဂ်ာတြင္ ထုိထက္က်ယ္ျပန္႔ေသာအခန္းက႑မ်ားလည္း ရွိေသးသည္။ ယင္းအခန္းက႑မ်ားသည္ ဝန္ေဆာင္မႈေပးျခင္းအား အေထာက္အကူျပဳရာတြင္အေရးႀကီးသည္။ ေအာက္ပါအတုိင္းျဖစ္သည္- နမူနာပုံစံ 18 19 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ • သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ႔မႈႏွင္ ႔ပတ္သက္ သည္႔အသိမ်ားကုိတုိးျမွင္႔ေပးျခင္း • ရပုိင္ခြင္႔မ်ားကုိတုိးတက္ေအာင္ေဆာင္ရြက္ျခင္း • ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈဝန္ထမ္းမ်ားအတြက္သင္တန္း အခြင္႔အလမ္းမ်ားတုိးတက္ေဖာ္ထုတ္ေပးျခင္း • ေရရွည္တည္တံ ႔ခုိင္ျမဲမႈကုိတုိးတက္ေအာင္ျပဳလုပ္ေပး ျခင္းျဖင္ ႔ ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈလုပ္ငန္းကုိလုိ က္ ေလ်ာညီေထြစြာထိန္းထားေပးျခင္း • သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ႔မႈဆုိင္ရာအမ်ိဳး သားအဆင္႔မူဝါဒကုိအားေကာင္းေစျခင္း • ဘ ီးတပ္ထုိင္ခုံရရိွႏုိင္မႈအတုိင္းအတာကုိ တုိးတက္ေအာင္ ျပဳလုပ္ျခင္း 0efaqmifrIvkyfief;twGif; bD;wyfxkdifckHtokH;jyKolrsm; wuf<upGmyg0ifrI ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းက႑တုိင္းတြင္ ဘီးတပ္ထုိင္ခံုအသံုးျပဳသူမ်ား တက္ၾကြစြာပါဝင္ျခင္းျဖင့္ ဘီးတပ္ထုိင္ခံုသံုးစြဲသူမ်ားအတြက္ရလဒ္မ်ားကို တုိးတက္ျဖစ္ေပၚလာေစမည္ျဖစ္ပါသည္။ မန္ေနဂ်ာမ်ားအတြက္ မဟာဗ်ဴဟာဆုိင္ရာမ်ားႏွင္႔ပတ္သက္ၿပီး အခိ်ဳ႕ကအႀကံျပဳရာတြင္ ဘီးတပ္ထုိင္ခံုသံုးစြဲသူမ်ားအေနျဖင့္ ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္းပါဝင္ရျခင္းမွာ(၇) - • ဝန္ထမ္းမ်ားသည္ ဝန္ေဆာင္မႈေပးသည္႔အဖြဲ႔ဝင္မ်ားအေနျဖင္႔ ဘီးတပ္ထုိင္ခံုအသံုးျပဳသူမ်ားႏွင္႔နီးနီးကပ္ကပ္ ဆက္ဆံၿပီး ၎တို႔၏ဘီးတပ္ထုိင္ခံုမ်ားေထာက္ပံ႔သည္႔အဆင္႔သုိ႔ ေရာက္သြားေစရန္အတြက္ အဆင္႔တုိင္းတြင္ ပါဝင္ရန္ • ဝန္ေဆာင္မႈေပးသည္႔လုပ္ငန္းအေပၚအသံုးျပဳသူမ်ား၏ အျမင္ႏွင္႔ပတ္သက္သည္႔ တံု႔ျပန္အၾကံျပဳခ်က္မ်ားအား ပံုမွန္စုေဆာင္းရရွိႏုိင္ရန္ႏွင္႔ လုပ္ငန္းတုိးတက္မႈရွိေအာင္မည္သုိ႔ေဆာင္ရြက္မည္ဆုိသည္ကုိ သိရွိႏုိင္ရန္ ဝန္ ေဆာင္မႈလုပ္ငန္းအတြင္း စနစ္တစ္ခုတည္ေဆာက္ထားရန္ • ျဖစ္ႏုိင္ေျခရွိသည္႔ေနရာတုိင္းတြင္ ဘီးတပ္ထုိင္ခံု အသံုးျပဳသူမ်ားအား ဝန္ေဆာင္မႈေပးသည္႔လုပ္ငန္းအတြင္း အဖြဲ႔ဝင္အျဖစ္ပါဝင္လာေစရန္အတြက္ ၎တုိ႔အားစုစည္းသိမ္းသြင္းရန္ႏွင္႔ ထုိသုိ႔ေဆာင္ရြက္ျခင္းမွာ မသန္စြမ္း က႑မွတဆင္႔ရာထူးအသစ္မ်ားေၾကာ္ျငာေပးႏုိင္ရန္အျပင္ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈေပးသည္႔ ေနရာတုိင္းတြင္ ဘီးတပ္ထုိင္ခံုမ်ား အမွန္တကယ္ရရွိေစေရးေဆာင္ရြက္ရန္ မန္ေနဂ်ာမ်ား၏ အခန္းက႑ 18 19 ½kdar;eD;,m;EkdifiHwGif bD;wyfxkdifckHokH;pGJolrsm;u tzGJYtwGif; yg0ifaqmif½Gufjcif; ရုိေမးနီးယားႏုိင္ငံရွိ အစုိးရမဟုတ္ေသာဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုသည္ ဘီးတပ္ထုိင္ခံုသံုးစြဲသူ မ်ားအား ၎တို႔၏ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈအဖြဲ႔မ်ားအတြင္း ပါဝင္လာေစရန္ တက္တက္ၾကြၾကြ စုေဆာင္း သိမ္းသြင္းခဲ႔သည္။ ဘီးတပ္ထုိင္ခံု အသံုးျပဳသူမ်ားသည္ ၎တုိ႔၏အရည္အခ်င္းအလုိက္ အဖြဲ႔အတြင္းမတူညီသည္႔ က႑မ်ားမွပါဝင္ခဲ့ၾကသည္။ ထုိ႔ေၾကာင္႔ အဆုိပါ အင္န္ဂ်ီအုိသည္ ဘီးတပ္ထုိင္ခံု အသံုးျပဳသူမ်ားက ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ ဝန္ထမ္းမ်ားအျဖစ္ပါဝင္လာသည္႔အတြက္ အျပဳသေဘာေဆာင္ေသာ အက်ိဳးသက္ ေရာက္မႈမ်ားကုိ ရရွိခဲ႔သည္။ အဖြဲ႔ဝင္တုိင္းသည္ ၎တုိ႔ႏွင္႔ဘဝတူမ်ားႏွင္႔ ေန႔စဥ္ထိေတြ႔ဆက္ဆံမႈရွိသည္႔အတြက္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ား၏လုိအပ္ခ်က္ကုိ ေကာင္းစြာသိရွိၾကသည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသည္႔ ေဖာက္ သည္မ်ားအေနျဖင္႔လည္း အဖြ႔ဲအတြင္း ပါဝင္သည္႔ဘီးတပ္ကုလားထုိင္အသံုးျပဳသူမ်ားႏွင္႔ အေတြ႔အၾကံဳခ်င္း ဖလွယ္ႏုိင္ၾကသည္႔အတြက္ ပုိျပီးသက္ေတာင္႔သက္သာရွိၾကသည္သာမက ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားမွာ လည္း အျခားသူမ်ားအတြက္ စံျပနမူနာမ်ားျဖစ္လာၾကသည္။ 20 21 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ u .3 tajymif;tvJukd OD;aqmifOD;½GufjyKaeonfh refae*smrsm; ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအားစတင္ေဆာင္ရြက္ျခင္း သုိ႔မဟုတ္တုိးတက္မႈရွိေအာင္ျပဳ လုပ္ရာတြင္ အဖြဲ႔အစည္းအတြင္းအေျပာင္းအလဲရံဖန္ရံခါျပဳလုပ္ရန္လုိအပ္သည္။ သုိ႔ေသာ္အေျပာင္းအလဲအားဦးေဆာင္ဦးရြက္ျပဳ လုပ္ရန္မွာခဲယဥ္းပါသည္။ဘီးတပ္ထိုင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာတစ္ဦး၏အခန္းက႑တစိတ္တေဒသမွာအ ေျပာင္းအလဲကုိဦးစီးေဆာင္ရြက္ရန္ျဖစ္သည္။ ထုိသုိ႔ျပဳလုပ္ႏုိင္ရန္ အဓိကက်သည္႔ေဆာင္ရြက္ခ်က္မ်ားမွာ ေအာက္ ပါအတုိင္း ျဖစ္သည္- • သင္ ႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ ႔မႈႏွင္ ႔ပတ္သက္သည္႔တူညီေသာေမွ်ာ္မွန္းခ်က္ကုိထူေထာင္ရာတြင္ ပံ႔ပုိးေပးရန္ • မူဝါဒခ်မွတ္သူမ်ား၊ အျခားေသာဝန္ေဆာင္မႈေပးေနသူမ်ား ႏွင္႔ အလႈရွင္ျဖစ္လာႏုိင္သူမ်ားအပါအဝင္ ဆက္စပ္ေန သည္႔ပါဝင္ပတ္သက္သူအားလံုးထံသုိ ႔သင္ ႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ ႔မႈ၏အေရးပါပံုကိုဆက္သြယ္ အသိေပးရန္ • လူမွန္ေနရာမွန္ႏွင္႔အရင္းအျမစ္ေနရာခ်ထားမႈအမွန္ျဖစ္ေစေရးအတြက္ခ်ိန္ညွိေဆာင္ရြက္ရန္ • ဝန္ထမ္းမ်ားအား အားေပးလႈံ႔ေဆာ္ျခင္း၊ ၄င္းတုိ႔ႏွင္႔ထိေတြ႔ဆက္ဆံျခင္း ႏွင္႔ ၄င္းတုိ႔အားတာဝန္ယူျခင္း oifhawmfonfhbD;wyfxkdifckHaxmufyHhrIESifhywfoufonfh wlnDaomarQmfrSef;csufukd xlaxmifjcif; ႏုိင္ငံအတြင္းဘီးတပ္ထုိင္ခံုေထာက္ပံ႔မႈတုိးတက္လာေစေရးအတြက္ပါဝင္ပတ္သက္သူအားလံုး အတြင္းတူ ညီေသာေမွ်ာ္မွန္းခ်က္ကုိထူေထာင္ႏုိင္ျခင္းျဖင္႔အေျပာင္းအလဲျပဳလုပ္ရာတြင္အတူတကြလက္တြဲလုပ္ေဆာင္ရန္ လုိ အပ္သည္႔လူအားလံုးအားလံႈ႔ေဆာ္တြန္းအားေပးမႈျပဳလုပ္ႏုိင္မည္ျဖစ္ပါသည္။ယင္းေမွ်ာ္မွန္းခ်က္မွတဆင္႔ အနာဂတ္ ရည္မွန္းခ်က္ကုိ ပံုေဖာ္ႏုိင္မည္ျဖစ္ပါသည္။ ဥပမာ- "ဘီးတပ္ထိုင္ခုံ သံုးစြဲသူမ်ား ပါဝင္ၿပီး ဘဝ၏က႑အားလံုးတြင္ အျပည့္အဝပါဝင္ႏုိင္သည့္ ကမၻာတခ ု" အျပဳသေဘာေဆာင္သည္ ႔ေမွ်ာ္မွန္းခ်က္ကုိစိတ္ပါလက္ပါ မွ်ေဝရန္ အေရးၾကီးသည္။ ထုိသုိ႔အားျဖင္႔ ဝန္ထမ္းအားလံုး သည္မသန္စြမ္းပုဂၢိဳလ္မ်ား၏ဘဝအရည္အေသြးတုိးတက္ လာေစရန္ဟူသည္ ႔အသိႏိုး ၾကားလာျပီးယင္းရည္မွန္းခ်က္ ေအာင္ျမင္ရန္အားသြန္ခြန္စုိက္ေဆာင္ရြက္လာၾကမည္ျဖစ္ပါ သည္။ 20 21 oifhavsmfaom bD;wyfxkdifckH axmufyHhrI\ta&;BuD;ykHukd qufoG,ftoday;jcif; ဝန္ထမ္းမ်ားႏွင္ ႔အျခားေသာပါဝင္ပတ္သက္ေနသူမ်ားအားဆက္လက္လႈံ ႔ေဆာ္ႏုိင္ရန္မန္ေနဂ်ာမ်ား အေနျဖင္႔ သင္႔ေလ်ာ္ေသာဘီးတပ္ကုလားထုိင္ေထာက္ပံ႔မႈ၏အေရးၾကီးပံုကုိအျမဲတစ္ေစဆက္သြယ္အသိေပးေနရန္ လုိအပ္ပါသည္။ မန္ေနဂ်ာမ်ားအေနျဖင္႔ေဆာင္ရြက္ရမည္မွာဘီးတပ္ကုလားထုိင္ဝန္ေဆာင္မႈလုပ္ငန္းအစျပဳျခင္းသုိ႔ မဟုတ္တုိးတက္ေအာင္ ျပဳလုပ္ျခင္းသည္အဓိကဦးစားေပးလုပ္ငန္းျဖစ္ျပီးအပူတျပင္းေဆာင္ရြက္ရမည္႔လုပ္ငန္းျဖစ္ ေၾကာင္းအမ်ားသိလာေစရန္ေဆာင္ ရြက္ျခင္းျဖစ္သည္။အေရးေပၚလုပ္ငန္းဟူသည္႔အသိဆုိသည္မွာေရွာင္လႊဲ၍မရ ေသာ သုိ႔မဟုတ္ ဖင္႔ေႏွးေန၍မရေသာ လုိအပ္ခ်က္ရွိေနသည္ဆုိသည္႔ အဓိပၸါယ္ပင္ျဖစ္ပါသည္။ လူအမ်ားသည္ ၎တုိ႔အား ၾကီးၾကပ္ေနသူမ်ား၏ဦးစားေပးအစီအစဥ္အတုိင္းလုိက္နာ လုပ္ေဆာင္ၾကသည္ျဖစ္ရာမန္ေနဂ်ာမ်ား၏ ေဆာင္ရြက္ခ်က္မ်ားအေနျဖင္႔ အေရးၾကီးသည္ဆုိသည္႔အသိကုိ ဖန္တီးႏုိင္ရမည္ ျဖစ္ပါသည္။ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ႔ေရး၏အေရးၾကီးပံုႏွင္႔အေရးတၾကီးလိုအပ္ေနမႈကုိသိသာေစ ရန္မည္သုိ႔ေဆာင္ရြက္မည္နည္း။ • ကမၻာႏွင္႔တစ္ဝန္းေသာ္လည္းေကာင္း၊အမ်ိဳးသားအဆင္႔တြင္ေသာ္လည္းေကာင္းသင္႔ေလ်ာ္ေသာ ဘီး တပ္ထုိင္ခံုလုိအပ္ခ်က္ကုိျပည္႔မီေအာင္ျဖည္႔ဆည္းေပးႏုိင္မႈမရွိေသးေၾကာင္းထုတ္ေဖာ္ေျပာဆုိပါ။ လူ ပုဂၢိဳလ္တစ္ဦးလႈပ္ရွားသြားလာပုိင္ခြင္႔ကုိေျပာဆုိပါ။သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခံုေထာက္ပံ့ေပးျခင္း ျဖင့္ တစ္ဦးခ်င္းကုိေသာ္လည္းေကာင္း၊ လူ႔အဖြဲ႔အစည္းကုိေသာ္လည္းေကာင္း အက်ိဳးအျမတ္ျဖစ္ထြန္း ေစေၾကာင္းထုတ္ေဖာ္ေျပာဆုိပါ။ • ဝန္ထမ္းမ်ား၏ပံုမွန္အစည္းအေဝးမ်ားတြင္ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းစတင္မႈ သုိ႔မဟုတ္ တုိးတက္မႈမ်ားႏွင္႔ပတ္သက္ျပီး ေဆြးေႏြးပါ။ • ဝန္ထမ္းမ်ား၏ပံုမွန္အစည္းအေဝး တြင္လည္းေကာင္း၊ လုပ္ငန္းေဆာင္ရြက္သည္႔အခန္းနံရံမ်ားတြင္ ပုိစတာ မ်ား ကပ္၍လည္းေကာင္း အျပဳသေဘာျဖင္႔ေအာင္ျမင္မႈရသြားေသာလုပ္ငန္းမ်ားအေၾကာင္း မွ်ေဝပါ၊ 22 23 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 0efxrf;rsm;ESifh t&if;tjrpfrsm; vlrSefae&mrSefjzpfap&ef ae&mcsxm;jcif; ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ေလ႔က်င္႔ ေပးထားေသာဝန္ထမ္းမ်ား၊ ပစၥည္းမ်ားႏွင္႔အရင္းအျမစ္ မ်ားလုိအပ္သည္။ဘီးတပ္ထိုင္ခံုအားလံုးသည္ေအာက္ ပါအတုိင္း ေဆာင္ရြက္ရမည္ ျဖစ္သည္- • တူညီေသာဦးတည္ခ်က္အတြက္ အတူတကြလက္တြဲ ေဆာင္ရြက္ျခင္း • လုပ္ငန္းေဆာင္ရြက္ႏုိင္ရန္အတြက္ လုိအပ္ေသာ အ ရင္းအျမစ္မ်ားကုိပံ႔ပုိးေပးရမည္ဟူေသာအျမင္ရွိျခင္း • ပံ႔ပုိးေပးေနမႈမ်ားအားအသိအမွတ္ျပဳေျပာဆုိျခင္း 22 23 ၀န္ထမ္းမ်ားႏွင့္ အရင္းအျမစ္မ်ားအား လူမွန္ေနရာမွန္ျဖစ္ေစရန္ မည္သုိ႔ေဆာင္႐ြက္မည္နည္း။ • ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ အသံုးျပဳႏုိင္မည့္ ပစၥည္းကိရိယာမ်ားအား သတ္မွတ္ရမည္။ • ဝန္ထမ္းမ်ား၏အခ်ိန္ဇယား၊ ပစၥည္းကိရိယာမ်ားႏွင္႔ေငြေၾကးေထာက္ပံ႔မႈမ်ားအား သတ္မွတ္ေနရာခ်ထားရာ တြင္ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအား ဦးစားေပးေနရာတြင္သတ္မွတ္ထားရွိပါ။ • ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားက ဘီးတပ္ထုိင္ခံုကုိ အဘယ္ေၾကာင္႔ေထာက္ပံ႔ေပးေနရေၾကာင္း ဝန္ထမ္းမ်ားအား သတိေပးေနရန္အတြက္ တူညီေသာေမွ်ာ္မွန္းခ်က္အျမင္မ်ားကုိေသာ္လည္းေကာင္း၊ သင္႔ေလ်ာ္ေသာဘီးတပ္ ထုိင္ခံုေထာက္ပံ႔မႈမွရရွိေသာအက်ိဳးအျမတ္မ်ားကုိေသာ္လည္းေကာင္း အသံုးခ်ပါ။ • ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈေပးရာတြင္ ဝန္ထမ္းမ်ား၏စြမ္းေဆာင္ခ်က္မ်ားကုိ အသိအမွတ္ျပဳျပီး ဆုခ်ပါ။ • အဖြဲ႔အစည္းအသြင္ ေပါင္းစည္းေဆာင္ရြက္ႏုိင္ရန္ ဝန္ထမ္းမ်ားကုိအားေပးပါ။ 0efxrf;rsm;tm; wGef;tm;ay;vIHUaqmfjcif;? yg0ifaqmif½Gufapjcif;ESifh wm0efay;jcif; မန္ေနဂ်ာမ်ားသည္ေအာက္ပါတုိ႔ကုိေဆာင္ရြက္ျခင္းျဖင္႔ ဝန္ထမ္းမ်ားအားတြန္းအားေပးလံႈ႕ေဆာ္ျခင္း၊ ပါဝင္ ေဆာင္ရြက္ေစျခင္းႏွင္႔ တာဝန္ေပးျခင္းမ်ားျပဳလုပ္ႏုိင္ပါသည္ - • စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ား တြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း - စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔ အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ားတြင္ ဝန္ထမ္းမ်ားအား ပါဝင္ေစျခင္း။ • စီမံခ်က္ေရးဆြဲျခင္းႏွင့္ အေကာင္အထည္ေဖာ္ျခင္းလုပ္ ငန္းမ်ားတြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း - စီမံခ်က္ေရးဆြဲ ျခင္းႏွင္႔အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ားတြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း။ • စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ား တြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း - စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔ အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ားတြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း။ • စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ား တြင္ ဝန္ထမ္းမ်ားအားပါဝင္ေစျခင္း - စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔ အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ားတြင္ ဝန္ထမ္း မ်ားအားပါဝင္ေစျခင္း။ 24 25 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ c/ bD;wyfxkdifckH 0efaqmifrIvkyfief; pwifjcif; c .1/ 0efaqmifrIvkyfief;tm; tuJjzwfokH;oyfjcif; ''ညီမွ်ေသာဝန္ေဆာင္မႈလုပ္ငန္း'' ဆုိသည္မွာအဘယ္နည္း။ ''ညီမွ်ေသာဝန္ေဆာင္မႈလုပ္ငန္း''ဆုိသည္မွာ ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူတုိင္း ဘီးတပ္ထုိင္ခုံတစ္လံုးရရွိ ေရးအတြက္ တူညီေသာအခြင္႔အလမ္းရွိျခင္းကုိ ဆုိလုိပါသည္။ ယင္းတြင္ ေအာက္ပါအခ်က္မ်ား ပါဝင္ပါသည္- • ေယာက္်ား၊ မိန္းမ၊ ေယာက္်ားေလးႏွင္႔မိန္းကေလး • လူငယ္၊ လူလတ္ႏွင္႔သက္ႀကီးရြယ္အုိ • အနီးအပါးတြင္ေနထုိင္သူႏွင္႔ ေက်းလက္ေဒသကဲ႔သုိ႔ေသာ ေဝးလံေခါင္ဖ်ားတြင္ေနထုိင္သူ • တုိင္းရင္းသား သုိ႔မဟုတ္ လူမႈစီးပြားေရးမတူသည္႔ ေနာက္ခံမ်ားမွလာေရာက္သူမ်ား လူတုိင္းသည္ ၎တုိ႔၏မသန္စြမ္းျဖစ္မႈ၊ အသက္၊ လိင္ကြဲျပားမႈ၊ ဘာသာေရး၊ ဓနဥစၥာ၊ ေျပာဆုိေသာဘာသာ စကားႏွင္႔ လူမိ်ဳးစုအုပ္စုတုိ႔ႏွင္႔သက္ဆုိင္ျခင္းမရွိေစရပဲ ဝန္ေဆာင္မႈလုပ္ငန္းကုိခံစားပုိင္ခြင္႔ရွိေၾကာင္း ညီမွ်ေသာဝန္ ေဆာင္မႈလုပ္ငန္းက အသိအမွတ္ျပဳခံယူထားသည္။ ညီမွ်ေသာဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းဆုိသည္မွာ အသြင္မတူေသာအုပ္စုမ်ားမွ အသံုးျပဳသူမ်ားအား ဘီးတပ္ထုိင္ခံုမ်ားကုိ ညီတူညီမွ်ေပးအပ္ေထာက္ပံ႔ျခင္းဆုိသည္႔အဓိပၸါယ္ မဟုတ္ပါ။ (ဥပမာ-မိန္းမႏွင္႔ေယာက္်ား အားဘီးတပ္ထုိင္ခံုအေရအတြက္ ညီတူညီမွ်ေထာက္ပံ႔ေပးျခင္းကုိ ဆိုလုိသည္။) ထုိသုိ႔ျဖစ္ရျခင္းမွာ အသြင္မတူသည္႔ အုပ္စုမ်ား၏လုိအပ္ခ်က္မွာ ကြဲျပားျခားနားမႈရွိႏုိင္သည္႔အတြက္ ျဖစ္ပါသည္။ မွတ္သားရန္ - ဝန္ေဆာင္မႈလုပ္ငန္းရပုိင္ခြင္႔ဆုိသည္မွာ ယင္းဝန္ေဆာင္မႈအား ရရွိခံစားရံု သက္သက္သာ မဟုတ္ပါ။ ယင္းဝန္ေဆာင္မႈလုပ္ငန္းအေၾကာင္း သိနားလည္လာရန္၊ ဝန္ေဆာင္မႈလုပ္ငန္းအားရရွိရန္ သုိ႔မဟုတ္ ယင္းဝန္ေဆာင္မႈလုပ္ငန္း လူမ်ားထံေရာက္ရွိလာေစရန္ဆုိသည္႔အဓိပၸါယ္ သက္ေရာက္ပါသည္။ 24 25 ဝန္ေဆာင္မႈလုပ္ငန္းကုိရရွိရန္ခက္ခဲေနသည္႔အုပ္စုမ်ားလည္း ရွိပါသည္။ ေအာက္ပါတုိ႔မွာနမူနာအခ်ဳိ႕ ျဖစ္သည္- • မိန္းမမ်ားႏွင္႔မိန္းကေလးမ်ား • ဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔အလွမ္းကြာေသာေနရာတြင္ ေနထုိင္သူမ်ား/ေက်းလက္ေဒသတြင္ေနထုိင္သူမ်ား • ဆင္းရဲႏြမ္းပါးသူမ်ား • ကေလးသူငယ္မ်ား • မတူညီသည္႔ဘာသာေရးအုပ္စုသုိ႔မဟုတ္လူမႈစီးပြားေရးအုပ္စုဝင္မ်ား • သက္ၾကီးရြယ္အုိမ်ား • သီးျခားသတ္မွတ္ျခင္းခံရသည္႔အုပ္စုဝင္မ်ား၊ ဥပမာ- ခုခံစြမ္းအားက်ေရာဂါ သုိ႔မဟုတ္ အနာၾကီးေရာဂါခံစားေနရ သူမ်ားသည္ခြဲျခားဆက္ဆံမႈကိုခံရႏိုင္ပါသည္။ မန္ေနဂ်ာမ်ားအေနျဖင္႔ ၎တုိ႔၏နယ္ပယ္အတြင္း ဝန္ေဆာင္မႈရရွိရန္အခြင္႔အလမ္းနည္းပါးသည္္႔ အသြင္ မတူေသာ အုပ္စုဝင္မ်ားအေၾကာင္းသိရွိထားရန္လုိပါသည္။ 26 27 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ vTJajymif;ay;jcif;ESifh csdef;qkdjcif; လႊဲေျပာင္းေပးျခင္းႏွင္႔ ခ်ိန္းဆုိျခင္းသည္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈေပးျခင္းတြင္ ပထမအဆင္႔ျဖစ္သည္။ အဆင့္ အက်ဥ္းခ်ဳပ္ ၁။ လႊဲေျပာင္းေပး ျခင္းႏွင့္ ခ်ိန္းဆုိ ျခင္း ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအား လႊဲေျပာင္းေပးသည္႔ နည္းလမ္းမွာတစ္ခု ႏွင္႔တစ္ခု မတူပဲ ကြဲျပားျခားနားမႈ ရွိသည္။ အသံုးျပဳသူမ်ားသည္ ၎တုိ႔ဖာသာ ၎တုိ႔ကုိယ္ ကုိ လႊဲေျပာင္းေပးျခင္းႏွင္႔ ၎တို႔အား လႊဲေျပာင္းေပးမႈခံရ ျခင္းမ်ိဳးျဖစ္သည္။ ထုိသုိ႔ျပဳလုပ္ရာတြင္ အစုိးရ သုိ႔မဟုတ္ အစုိးရမဟုတ္ေသာအဖြဲ႔အစည္းမ်ား၏က်န္းမာေရးႏွင္႔ ျပန္လည္ထူေထာင္ေရးဝန္ထမ္းမ်ား သုိ႔မဟုတ္ လူမႈအဖြဲ႔အစည္း၊ ခရုိင္ သုိ႔မဟုတ္ ေဒသႏၲရအဆင္႔လုပ္ ငန္းမ်ားအတြင္း လုပ္အားေပး ေဆာင္ရြက္ေနၾကေသာ ေစတနာ႔ဝန္ထမ္းမ်ားက တည္ေထာင္ထားေသာ ကြန္ယက္မ်ားမွတစ္ဆင္႔ လႊဲေျပာင္းေပးျခင္းျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံလုိအပ္ႏုိင္သည္႔သူမ်ားအေနျဖင္႔ လူမႈေရး သုိ႔မဟုတ္ က်န္းမာေရးေစာင္႔ေရွာက္မႈလုပ္ငန္းမ်ားအား မရရွိေသးျခင္း သုိ႔မဟုတ္ ေက်ာင္း၊ အလုပ္ခြင္ သုိ႔မဟုတ္ လူမႈအဖြဲ႔အစည္းအတြင္း လႈပ္ရွားေဆာင္ရြက္မႈမ်ားတြင္ ပါဝင္ႏုိင္မႈမရွိေသးျခင္းမ်ားရွိပါက ၎တုိ႔အား အခ်ိဳ႕ေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ လုိလုိလားလားသတ္မွတ္ေပးရန္ လုိမည္ျဖစ္ပါသည္။ ထိထိေရာက္ေရာက္လႊဲေျပာင္းမႈျပဳလုပ္ႏုိင္ေရးအတြက္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔ လူမႈအဖြဲ႔အ စည္းအၾကား အဆက္အသြယ္ေကာင္းေနရန္လုိပါသည္။ အဘယ္ေၾကာင္႔ဆုိေသာ္ လူမႈအဖြဲ႔အစည္းအတြင္း ေနထုိင္ သူမ်ားသည္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူမ်ားအား ခြဲျခားသတ္မွတ္ျပီးသင္၏ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ လႊဲေျပာင္း ေပးမည္႔သူမ်ားျဖစ္သည္႔အတြက္ေၾကာင္႔ ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူမ်ားအား ခြဲျခားသတ္မွတ္ေပး ျပီး သင္၏ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔လႊဲေပးႏုိင္သည္႔ အသြင္မတူေသာတစ္ဦးခ်င္းစီ သုိ႔မဟုတ္ အဖြဲ႔အ စည္းမ်ားမွာ ေအာက္ပါအတုိင္းျဖစ္ပါသည္- • ေဒသႏၲရေဆးရံုမ်ား • ရပ္ကြက္က်န္းမာေရးဌာနမ်ား • ရပ္ကြက္အေျခစုိက္ျပန္လည္ထူေထာင္ေရးကြန္ယက္မ်ား • ေက်းရြာ/ေကာင္စီ/ဘုရားရွိခုိးေက်ာင္းေခါင္းေဆာင္ (ဘုန္းေတာ္ၾကီး) မ်ား 26 27 • မသန္စြမ္းပုဂၢိဳလ္မ်ားအသင္းအဖြဲ႔မ်ား • ဘီးတပ္ထုိင္ခုံသံုးစြဲသည္႔အျခားေသာသူမ်ား • ဆရာဝန္မ်ား/သူနာျပဳမ်ား လႊဲေျပာင္းေပးမႈကြန္ယက္အား တည္ေဆာက္ႏုိင္ရန္ မန္ေနဂ်ာမ်ားအေနျဖင္႔ မည္ကဲ႔သုိ႔လုပ္ေဆာင္ႏုိင္သနည္း • သင္၏နယ္ေျမအတြင္း (တစ္ဦးခ်င္းအလိုက္ျဖစ္ေစ၊ အသင္းအဖြဲ႔အလုိက္ျဖစ္ေစ) လႊဲေျပာင္းေပးမည္႔အရင္းအ ျမစ္မ်ားအား သတ္မွတ္ပါ၊ • လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားအေနျဖင္႔ ဘီးတပ္ထုိင္ခုံလုိအပ္ေနသည္႔ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား ကုိ သတ္မွတ္ေပးႏုိင္ရန္ မည္သုိ႔ေသာသတင္းအခ်က္အလက္မ်ား လုိအပ္သည္ဆုိသည္ႏွင္႔ ပတ္သက္၍ လည္းေကာင္း၊ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ ၎တုိ႔အား မည္သုိ႔လႊဲေျပာင္းေပးႏုိင္သည္ဆုိသည္ႏွင္႔ပတ္သက္၍ လည္းေကာင္း ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားႏွင္႔တုိင္ပင္ေဆြးေႏြးပါ၊ • လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ား လုိအပ္သည္႔သတင္းအခ်က္အလက္မ်ားကုိ ေဖာ္ျပထားေသာေဝစာမ်ား၊ လက္ကမ္းစာေစာင္မ်ားကုိ ျပင္ဆင္ (သုိ႔မဟုတ္ဝန္ထမ္မ်ားကုိျပင္ဆင္မႈကုိအားေပး) ထားပါ၊ • ဘီးတပ္ထုိင္ခုံလုပ္ငန္းႏွင္႔ပတ္သက္ျပီး ေျပာၾကားအသိေပးႏုိင္ရန္အတြက္ လႊဲေျပာင္းေပးရန္ အလားအလာရွိသည္႔ တစ္ဦးခ်င္း သုိ႔မဟုတ္ အသင္းအဖြဲ႔မ်ားထံသုိ႔ သြားေရာက္ (သုိ႔မဟုတ္ ဝန္ထမ္းမ်ား သြားေရာက္မႈကုိအားေပး) ပါ၊ • ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူမ်ားႏွင္႔ လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားအတြက္ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈ လုပ္ငန္းတြင္ မည္သူမဆုိဝင္ေရာက္ေလ႔လာႏုိင္သည္ဟူေသာအေနအထားကုိ ေဖာ္ေဆာင္ထားပါ၊ • လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားအတြက္ လႊဲေျပာင္းမႈကြန္ယက္သင္တန္း ျပဳလုပ္ပါ၊ • လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားက ျဖည္႔သြင္းႏုိင္သည္႔လႊဲေျပာင္းေရးပံုစံတစ္ခုကို ေဖာ္ထုတ္ႏုိင္ရန္ စဥ္းစားပါ၊ ထုိသုိ႔ေဆာင္ရြက္ရာတြင္ ပံုစံမ်ားမွာ ရုိးရွင္းလြယ္ကူမႈရွိေစရန္ ေဆာင္ရြက္ပါ၊ လႊဲေျပာင္းေပး မႈအားသင္၏ဝန္ေဆာင္မႈလုပ္ငန္းက (လႊဲေျပာင္းေပးသည္႔ဘီးတပ္ကုလားထုိင္အသံုးျပဳသူအားခ်ိန္းဆုိ ျခင္းျဖင္႔) တံု႔ျပန္ေဆာင္ရြက္လ်က္ရွိေၾကာင္း ထင္ရွားေစပါ၊ ထုိပံုစံအား အသံုးျပဳသည္႔လႊဲေျပာင္းေပးသည္႔ အရင္းအျမစ္ထံသုိ႔ အျပဳသေဘာေဆာင္သည္႔တံု႔ျပန္အၾကံျပဳခ်က္ ပုိ႔ေပးပါ။ 0efaqmifrIvkyfief;tm; tnDtrQ &ykdifcGifhukd wkd;wufapjcif; မန္ေနဂ်ာမ်ားသည္ ဝန္ေဆာင္မႈအား အညီအမွ်ရပုိင္ခြင္႔ကုိတုိးတက္ေစရန္ အေထာက္အကူျပဳရာ၌ အေရးပါေသာ အခန္းက႑မွပါဝင္ေနသူမ်ား ျဖစ္ပါသည္။ ေအာက္ေဖာ္ျပပါဇယားတြင္ အသြင္မတူေသာအုပ္စုမ်ား အတြက္ရပုိင္ခြင္႔မ်ား တုိးတက္လာေအာင္မည္သုိ႔ေဆာင္ရြက္ႏုိင္သည္ဆုိသည္ကုိ အၾကံျပဳထားပါသည္- 28 29 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ဝန္ေဆာင္မႈ အညီအမွ်ရရွိမႈကုိ တုိးတက္လာေစရန္ မန္ေနဂ်ာမ်ားအေနျဖင္႔ မည္သုိ႔ေဆာင္ရြက္ႏုိင္သနည္း။ မိန ္းမ မ် ား ႏွင ့္ မ ိန္း က ေလ းမ ်ား အ တ ြက ္ • ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္သည္႔သတင္းအခ်က္အလက္မ်ားအား မတူညီေသာနည္း လမ္းမ်ားျဖင္႔ရရွိႏုိင္ေစရန္ ေဆာင္ရြက္ပါ၊ ဥပမာ- ေရဒီယုိ၊ ရုိးရုိးရွင္းရွင္း ေဖာ္ျပ ထားေသာ လက္ကမ္းစာေစာင္/ပုိစတာမ်ားႏွင္႔ ရုပ္ပံုကားခ်ပ္မ်ား၊ • ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္ျပီး ေယာက္က်ားမ်ားကဲ႔သုိ႔ပင္ မိန္းမမ်ားအား လူအမ်ားျမင္ ေစေရးအတြက္ ထင္သာျမင္သာရွိေအာင္ ေဖာ္ျပရန္၊ • မိန္းမမ်ားအတြက္ဘီးတပ္ထုိင္ခုံသည္ အေရးၾကီးေၾကာင္းေျပာဆုိရွင္းျပႏုိင္သည္႔ စံျပ နမူနာဘီးတပ္ထုိင္ခုံသံုးသူမိန္းမမ်ားအား လူသိရွင္ၾကားႏွင္႔လူမႈအဖြဲ႔အစည္းအတြင္း သတ္မွတ္ေဖာ္ျပထားရန္၊ • မိန္းမ၊ ကေလးသူငယ္ႏွင္႔ ေယာက္်ားမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံသည္ တန္းတူ ညီမွ်အေရးၾကီးေၾကာင္း လူမႈအဖြဲ႔အစည္းေခါင္းေဆာင္မ်ားအား ရွင္းျပေျပာဆုိရန္၊ • စီမံခန္႔ခြဲမႈႏွင္႔ေခါင္းေဆာင္မႈအပုိင္းအပါအဝင္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း၏ အဆင္႔တုိင္းတြင္မိန္းမမ်ားပါဝင္မႈကုိ ပံ႔ပုိးေပးျပီး အားေပးအားေျမွာက္ျပဳလုပ္ရန္၊ • ဘီးတပ္ထုိင္ခုံႏွင္႔ပတ္သက္သည္႔သတင္းအခ်က္အလက္မ်ားအား မသန္စြမ္း အဖြဲ႔ အစည္းမ်ားသုိ႔ေပးရန္ႏွင္႔ ေရြ႔လ်ားႏုိင္စြမ္းရွိေရးအတြက္ မိန္းမေရာေယာက္်ားပါ ဘီးတပ္ထုိင္ခုံကုိ လုိအပ္ေၾကာင္း အေလးေပး ေျပာဆုိရန္၊ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈအေၾကာင္းရွင္းျပလွ်င္ ယင္းဝန္ေဆာင္မႈလုပ္ငန္းသည္ ''လူအမ်ား'' အတြက္သာမဟုတ္၊ ေယာက္်ား၊ မိန္းမႏွင္႔ကေလးသူငယ္မ်ားအတြက္ ျဖစ္ေၾကာင္း အျမဲတစ္ေစေျပာဆုိရွင္းျပရန္၊ က ေလ းသ ူငယ ္မ် ား အ တ ြက ္ • မသန္စြမ္းကေလးငယ္တစ္ဦး၏မိဘမ်ား သြားေရာက္ဖြယ္ရွိသည္႔ေနရာမ်ားတြင္ ဝန္ ေဆာင္မႈႏွင္႔ပတ္သက္သည္႔သတင္းအခ်က္အလက္မ်ားရရွိႏုိင္ေစရန္ ေဆာင္ရြက္ရန္၊ ဥပမာ- ရပ္ကြက္ေဆးခန္း၊ ျပန္လည္ထူေထာင္ေရးဝန္ေဆာင္မႈဌာန၊ ေစ်း၊ လူမႈအဖြဲ႔ အစည္းဆုိင္ရာဌာနမ်ား၊ ဘုရားရွိခုိးေက်ာင္း (ဘုန္းၾကီးေက်ာင္း)၊ ဗလီႏွင္႔ ဝတ္ ေက်ာင္းမ်ား၊ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈအေၾကာင္းရွင္းျပလွ်င္ ယင္းဝန္ေဆာင္မႈလုပ္ငန္းသည္ ''လူအမ်ား'' အတြက္သာမဟုတ္၊ ေယာက္်ား၊ မိန္းမႏွင္႔ကေလးသူငယ္မ်ားအတြက္ ျဖစ္ေၾကာင္း အျမဲတစ္ေစေျပာဆုိရွင္းျပရန္ • မသန္စြမ္းကေလးသူငယ္မ်ားအား ကုသေပးေနၾကသူမ်ားအား ဝန္ေဆာင္မႈႏွင္႔ ပတ္ သက္သည္႔သတင္းအခ်က္အလက္မ်ား၊ ပညာရပ္ဆုိင္ရာမ်ားကုိ ပံ႔ပုိးေပးရန္၊ ဥပမာ - ဆရာဝန္မ်ား၊ သူနာျပဳမ်ား၊ လူမႈအဖြဲ႔အစည္းဆုိင္ရာ က်န္းမာေရးဝန္ထမ္းမ်ား၊ • လူၾကီးမ်ားကဲ႔သုိ႔ပင္ ကေလးသူငယ္မ်ားကုိလည္း ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္ျပီးသိသာ ထင္ရွားစြာပံုေဖာ္ရန္၊ • ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္ျပီးရွင္းျပေျပာဆုိေလတုိင္း ကေလးသူငယ္မ်ားအတြက္ဘီး တပ္ထုိင္ခုံမ်ား ပံ႔ပုိးေပးျခင္းေၾကာင္႔ရရွိမည္႔အက်ိဳးအျမတ္မ်ားကုိ ရွင္းျပရန္ႏွင္႔ ဘီးတပ္ ထုိင္ခုံေထာက္ပံ႔ေပးျခင္းေၾကာင္႔ မိသားစုဝင္မ်ား၊ ကေလးထိန္းမ်ား ရရွိမည္႔အက်ိဳး အျမတ္မ်ားကုိလည္း ရွင္းျပရန္၊ 28 29 ဆ င္း ရဲႏ ြမ္း ပါ း သ ူမ် ား အ တ ြက ္ • ဝန္ေဆာင္မႈအား ေစ်းအသက္သာဆံုးျဖစ္ေအာင္ ေဆာင္ရြက္ရန္ • ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔သြားေရာက္ရန္ ခရီးစရိတ္မတတ္ႏုိင္သည္႔ ဘီးတပ္ထုိင္ခုံ သံုးစြဲသူမ်ားအတြက္လည္းေကာင္း၊ ေငြေပးဝယ္ရမည္႕ကိစၥမ်ိဳးရွိသည္ဆုိပါက ဘီးတပ္ထုိင္ခုံဝယ္ရန္ ေငြေၾကးမတတ္ႏုိင္သူမ်ားအတြက္ ဘဏၰာေရးအေထာက္အ ပံ႔မ်ားေပးႏုိင္မည္႔နည္းလမ္းမ်ားကုိ သတ္မွတ္ထားရန္၊ ဥပမာ - ဘီးတပ္ထုိင္ခုံရံပံုေငြ ထူေထာင္ထားျခင္း အ သ က ္အ ႐ြယ ္ ႀက ီးျမ င့္သ ူမ် ား အ တ ြက ္ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေၾကာင္း ရွင္းလင္းေျပာျပသည္႔အခါတုိင္း ဝန္ေဆာင္မႈလုပ္ငန္းသည္ လူအားလံုးအတြက္ျဖစ္ေၾကာင္းရွင္းလင္းေျပာဆုိရန္၊ ဥပမာ - သက္ၾကီးရြယ္အုိမ်ားအပါအဝင္ • ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္ျပီး ဘီးတပ္ထုိင္ခုံကုိအသံုးျပဳေနသည္႔ သက္ၾကီးရြယ္အုိ မ်ား၏ပံုကုိ ထည္႔သြင္းေဖာ္ျပရန္၊ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေၾကာင္း သက္ၾကီးရြယ္အုိမ်ားႏွင္႔ ၎တုိ႔၏ မိသားစုဝင္မ်ားကုိ ရွင္းျပေျပာဆုိရာတြင္ ဘီးတပ္ထုိင္ခုံ၏အက်ိဳးျပဳပံုကုိ ရွင္းလင္း ေျပာဆုိရန္၊ ဝန ္ေဆ ာင ္မႈလ ုပ္င န္း ႏွင ့္ အ လ ွမ္း က ြာေ ဝး သ ည ့္ေန ရာ တ ြင္ ေန ထ ုိင္သ ူမ် ား /ေ က ်းလ က ္တ ြင္ ေန ထ ုိင္သ ူမ် ား အ တ ြက ္ • ေက်းလက္ေဒသမ်ားတြင္ ဝန္ေဆာင္မႈႏွင္႔ပတ္သက္သည္႔သတင္းအခ်က္အလက္မ်ား ရရွိေစေရး ေဆာင္ရြက္ရန္၊ ဥပမာ - ေက်းလက္ေဆးေပးခန္း၊ ေစ်း၊ လူမႈအဖြဲ႔အစည္းဌာနမ်ား၊ ဘုရားရွိခုိးေက်ာင္း (ဘုန္းၾကီးေက်ာင္း)၊ ဗလီမ်ားႏွင္႔ဝတ္ေက်ာင္းမ်ား၊ • ေက်းလက္ေဒသတြင္ေနထုိင္သူမ်ားႏွင္႔အတူတကြအလုပ္လုပ္ကုိင္ေနၾကေသာသူမ်ား အားဝန္ေဆာင္မႈ ႏွင္႔ပတ္သက္သည္႔သတင္းအခ်က္အလက္မ်ားအေၾကာင္း ရွင္းလင္း ေျပာျပရန္၊ ဥပမာ- ရပ္ကြက္အေျခစုိက္ ျပန္လည္ထူေထာင္ေရးဝန္ထမ္းမ်ား၊ • ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ နယ္ေက်ာ္ေဆာင္ရြက္ႏုိင္ျခင္းမရွိပါက ေက်းလက္ေန ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအား သယ္ယူပုိ႔ေဆာင္ေရးျပဳလုပ္ေပးႏုိင္မည္႔နည္းလမ္း မ်ားသတ္မွတ္ထားရန္၊ ဥပမာ - သယ္ယူပုိ႔ေဆာင္ေရးအတြက္ ေငြေၾကးအေထာက္ အပံ႔ျပဳလုပ္ေပးျခင္းႏွင္႔ လူမ်ားအားဝန္ေဆာင္မႈလုပ္ငန္းရွိရာသုိ႔ သယ္ပုိ႔ေပးႏုိင္မည္႔ အျခားေသာအဖြဲ႔အစည္းမ်ားႏွင္႔အတူတကြေဆာင္ရြက္ျခင္း၊ • ေက်းလက္ေဒသမ်ားမွ ဝန္ေဆာင္မႈလုပ္ငန္းရွိရာသို႔သြားေရာက္မည္႔ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူမ်ားအတြက္ ေနရာထုိင္ခင္းစီစဥ္ေပးႏုိင္ျခင္းရွိ/မရွိ နည္းလမ္းေဖာ္ထုတ္ရန္ • ေက်းလက္ေဒသမ်ားသုိ႔ နယ္ေက်ာ္ဝန္ေဆာင္မႈျပဳလုပ္ေပးရန္ • လူမႈအဖြဲ႔အစည္းအတြင္းရွိ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအား မည္သုိ႔ ပံ႔ပုိးေပးရမည္၊ ေနာက္ဆက္တြဲ လုပ္ငန္းမ်ားအားမည္သုိ႔ေဆာင္ရြက္ရမည္၊ ဘီးတပ္ထုိင္ခုံထိန္းသိမ္း မႈႏွင္႔ျပဳျပင္မႈအား မည္ကဲ႔သုိ႔ ရုိးရုိးရွင္းရွင္း ျပဳလုပ္ရမည္ဆုိသည္မ်ားကုိ ေက်းလက္ ေဒသတြင္တာဝန္ ထမ္းေဆာင္ေနသူမ်ား (ဥပမာ လူမႈအဖြဲ႔အစည္းဆုိင္ရာက်န္းမာေရး ဝန္ထမ္းမ်ား) အား သင္တန္းေပးရန္ • ၾကမ္းတမ္းေသာေျမျပင္အေနအထားရွိသည္႔ ေက်းလက္ေဒသတြင္ ထိထိေရာက္ ေရာက္အသံုးျပဳႏုိင္ေသာ ဘီးတပ္ထုိင္ခုံမ်ား ရရွိႏုိင္ေရးေဆာင္ရြက္ရန္၊ ေက်းလက္ ေဒသမ်ားတြင္ ဘီးတပ္ထုိင္ခုံအား အလြယ္တကူအသံုးျပဳႏုိင္ေစေရးအတြက္ ဘီးတပ္ ထုိင္ခုံအား ေျမအေနအထားႏွင္႔လုိက္ေလ်ာညီေထြ ျဖစ္သြားေစရန္ ရုိးရုိးႏွင္႔ရွင္းရွင္း မည္သုိ႔ေဆာင္ရြက္ရသည္ဆုိသည္႔သတင္းအခ်က္အလက္မ်ားအား ပံ႔ပုိးေပးရန္ (ဥပမာ - ဆင္ေျခေလွ်ာျပဳလုပ္ျခင္း၊ လမ္းကုိေခ်ာေမြ႔ေအာင္ ေဆာင္ရြက္ျခင္း) 30 31 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ အ သ ြင္မ တ ူသ ည ့္ တ ုိင္း ရင ္းသ ား ( သ ုိ႔) လ ူမႈစ ီးပ ြား မတ ူသ ည ့္ အ ုပ္စ ုတ ြင္ ေန ထ ုိင္သ ူမ် ား အ တ ြက ္ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေၾကာင္း ရွင္းျပေျပာဆုိျပီဆုိလွ်င္ ဝန္ေဆာင္မႈ လုပ္ငန္းသည္ တုိင္းရင္းသားအုပ္စုႏွင္႔လည္းေကာင္း၊ လူမႈစီးပြား ေနာက္ခံအေျခ အေနႏွင္႔လည္းေကာင္း သက္ဆုိင္ျခင္းမရွိပဲ လူသားအားလံုးအတြက္ျဖစ္ေၾကာင္း အျမဲတေစရွင္းလင္းေျပာျပရန္ • ဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ေနသည္႔နယ္ေျမအတြင္းရွိ အသြင္မတူသည္႔ တုိင္း ရင္းသားႏွင္႔ဘာသာေရးအုပ္စုမ်ားမွ လူမ်ား၏ပံုမ်ားကုိ ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း သိသာထင္ရွားစြာထည္႔သြင္းေဖာ္ျပရန္၊ • ျဖစ္ႏုိင္ပါက အသြင္မတူသည္႔ တုိင္းရင္းသားႏွင္႔ လူမႈစီးပြားေရးအုပ္စုမ်ားမွ ဝန္ထမ္း မ်ားအား ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ခန္႔အပ္တာဝန္ေပးရန္ 30 31 c .2/ taxmuftuljyKtokH;taqmifrsm;ESifh ud&d,mwefqmyvmrsm; ေနရာေဒသအမ်ားအျပားတြင္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းကုိ ေဆာင္ရြက္ႏုိင္သည္။ သို႔ေသာ္ လုပ္ ငန္း ေဆာင္ရြက္မည္႔ေနရာတုိင္းတြင္ အေထာက္အကူပစၥည္းႏွင္႔ကိရိယာတန္ဆာပလာအခ်ိဳ႕ကုိ လုိအပ္မည္ျဖစ္သည္။ အေျခခံအဆင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားႏွင္႔စာလွ်င္ ေနရာ အက်ယ္အဝန္းႏွင္႔ ကိရိယာတန္ဆာပလာလုိအပ္မႈနည္းပါးမည္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအားလံုး(အေျခခံအဆင္႔ႏွင္႔ အလယ္အလတ္အဆင္႔)အတြက္ အေထာက္အကူ ပစၥည္းႏွင္႔ကိရိယာတန္ဆာပလာမ်ား ၾကိဳဆုိေရးႏွင္႔နားေနေဆာင္ အက်ယ္အဝန္းမည္မွ်လုိအပ္သနည္း။ မွတ္ပံုတင္ရန္ႏွင္႔ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူႏွင္႔ ၎၏ မိသားစုဝင္မ်ား အတူတကြ ေစာင္႔ဆုိင္းနားေနရန္အတြက္ ေနရာတစ္ခုလုိအပ္သည္။ လူအမ်ားအေနျဖင္႔ ဝန္ေဆာင္မႈေပးသည္႔ေနရာသုိ႔ ေရာက္ရွိလာရန္ ခရီးအတုိင္းအတာတစ္ခုအထိ လာေရာက္ ရဖြယ္ရွိသည္႔အတြက္ ၎တုိ႔အပန္းေျဖ စားေသာက္ႏိုင္မည္႔ ေနရာတစ္ခုကုိစဥ္းစားေပးထားရမည္ျဖစ္သည္။ လက္ယာဘက္တြင္ ေဖာ္ျပထားေသာပံုသည္ ေဒသခံ ကုန္သည္တစ္ဦးက ေဒသႏၲရေဆးေပးခန္းတစ္ခုတြင္ ကုန္စံု ဆုိင္တစ္ခုဖြင္႔လွစ္ေရာင္းခ်ေပးေနသည္႔ပံု ျဖစ္ပါသည္။ ေစာင္႔ဆုိင္းေနစဥ္အတြင္း ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူ လွဲ ေလ်ာင္းေနထုိင္ႏုိင္မည႔္ ဆိတ္ျငိမ္ေသာေနရာသည္လြန္စြာ မွပင္ အသံုးဝင္မည္ျဖစ္ပါသည္။ ယင္းသည္ ေအာက္ပါအ ေၾကာင္းမ်ားေၾကာင္႔အေရးၾကီးသည္ဟု ဆုိရျခင္း ျဖစ္ပါသည္- • ခ်ိန္းဆုိထားသည္႔အခ်ိန္အတြင္းအားအင္ခ်ိနဲ႔ေနျပီး ေမာပန္း ေနသျဖင္႔နားေနရန္လုိသူမ်ား • ပင္ပန္းေနေသာကေလးသူငယ္မ်ား • ကုိယ္ခႏၶာအေလးခ်ိန္ သက္ေရာက္သည္႔ေနရာတြင္ အပူေလာင္နာျဖစ္ေနသူမ်ား 32 33 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ၾကိဳဆုိလက္ခံေရးႏွင္႔ နားေနေဆာင္ေနရာတဝုိက္တြင္လည္း ေကာင္း၊ သံုးသပ္ခန္းႏွင္႔တပ္ဆင္ခန္းအနီးတြင္လည္းေကာင္း အလြယ္တကူသြားေရာက္ႏုိင္ေသာ သန္႔စင္ခန္း ရွိေနသင္႔ပါ သည္။ အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲ အတြက္ ထပ္တုိးအရင္းအျမစ္ကုိ ေလ႔လာပါ။ အသံုးျပဳသင္႔ေသာကိရိယာတန္ဆာပလာမ်ား မွတ္ပံုတင္ေရးအတြက္လုိအပ္ေသာပစၥည္းမ်ားမွာ စားပြဲ၊ ကုလားထုိင္၊ တယ္လီဖုန္း၊ စာရြက္စာတမ္းမ်ားအား လံုျခံဳစြာ သိမ္းဆည္းထားႏုိင္မည႔္ေနရာ။ ေစာင္႔ဆုိင္းရန္ေနရာတြင္ ပုိစတာ၊ လက္ကမ္းစာေစာင္၊ ဗီဒီယုိမ်ားထားရွိႏုိင္ပါက ပုိမုိအေထာက္အကူျဖစ္ေစပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ ကေလးသူငယ္မ်ား ပုိမ်ားပါကေစာင္႔ ဆုိင္းေနစဥ္အတြင္း ၎တုိ႔အတြက္ကစားစရာမ်ား ထားရွိေပး ႏုိင္ပါက ပုိေကာင္းပါသည္။ ဝန္ထမ္းမ်ားအတြက္ရံုးခန္း အက်ယ္အဝန္းမည္မွ်လုိအပ္သနည္း။ ဝန္ထမ္းမ်ားအတြက္ ၎တုိ႔အတူတကြ အလုပ္လုပ္ႏုိင္ျပီး တစ္ဦးႏွင္႔တစ္ဦး ေတြ႔ဆံုႏုိင္ရန္ႏွင္႔ မွတ္ခ်က္မ်ားေရးသားရန္၊ မွတ္တမ္းမ်ားအား လံုျခံဳစြာ ထိန္းသိမ္းထားႏုိင္ရန္ေနရာတစ္ခု လုိပါသည္။ 32 33 အကဲျဖတ္သံုးသပ္ခ်က္ႏွင္႔ ပစၥည္းတပ္ဆင္မႈျပဳလုပ္ရန္ေနရာ အက်ယ္အဝန္းမည္မွ်လုိအပ္သနည္း။ ဝန္ထမ္းမ်ားကဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအား အကဲျဖတ္ ႏုိင္မည္႔ သိသိသာသာဆိတ္ျငိမ္ျပီး သီးသန္႔ျဖစ္သည္႔ေနရာကို လုိအပ္သည္။ ယင္းေနရာတြင္ ဘီးတပ္ထုိင္ခုံတပ္ဆင္မႈ ျပဳလုပ္ႏုိင္ရမည္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံဆင္မည္႔ေနရာသည္ မိသားစုဝင္မ်ားလည္း ဝင္ေရာက္ႏုိင္ေလာက္ေအာင္ က်ယ္ဝန္းရမည္႔အျပင္ အလင္းေရာင္လံုေလာက္စြာရေသာ ေနရာမ်ိဳးျဖစ္ရမည္။ အကဲျဖတ္သံုးသပ္ရန္လည္းေကာင္း၊ ဓာတ္ပံု ရုိက္ရန္လည္းေကာင္း ေနာက္ခံကားခ်ပ္အျဖစ္ သံုးႏုိင္မည္႔ သန္႔ရွင္းေသာနံရံတစ္ခုရွိပါက ပုိေကာင္းပါသည္။ ဌာနအေျခစုိက္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအတြက္ ေနရာ အတုိင္းအတာမွာ (အလုပ္ပမာဏေပၚမူတည္ျပီး)ေအာက္ပါအ တုိင္းျဖစ္ေၾကာင္းအၾကံျပဳပါသည္- • အေျခခံအဆင္႔ ေဆးခန္းအက်ယ္ - ၃ မီတာ x ၂.၅ မီတာ • အလယ္အလတ္အဆင္႔ေဆးခန္းအက်ယ္ - ၄ မီတာ x ၃.၅ မီတာ တခါတရံတြင္ ေဆးခန္းနယ္ေျမသည္ တစံုတဦး၏ေနအိမ္ အတြင္းျဖစ္ႏုိင္ပါသည္။ ထုိသုိ႔ေသာအေျခအေနမ်ိဳးတြင္ ေျပာင္းလြယ္ ျပင္လြယ္ျဖစ္ျပီး ဌာနႏၲရႏွင္႔ လုိက္ေလ်ာ ညီေထြျဖစ္ေစကာ မရွိမျဖစ္ေသာ ကိရိယာ တန္ဆာပလာ မ်ားကုိ သင္ႏွင္႔ တပါတည္းယူေဆာင္သြားရမည္ျဖစ္ပါသည္။ 34 35 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ အကဲျဖတ္သံုးသပ္ခ်က္ႏွင္႔ပစၥည္းတပ္ဆင္မႈျပဳလုပ္ရန္ေနရာ ကိရိယာတန္ဆာပလာမ်ား - • သီးသန္႔လုိက္ကာ - တခ်ိန္တည္းတြင္ လူနာတစ္ဦးထက္ ပုိၾကည္႔မည္ဆုိပါက ေနရာသီးသန္႔ျဖစ္ေစရန္အတြက္ လုိက္ကာျဖင္႔ ကာထားရမည္၊ • အကဲျဖတ္ခံုတန္း သုိ႔မဟုတ္ ကုတင္ - အကဲျဖတ္မႈျပဳလုပ္ေနစဥ္အတြင္း ဘီးတပ္ထုိင္ခုံ အသံုး ျပဳသူထုိင္ရန္ ဘီးတပ္ထုိင္ခုံႏွင္႔အျမင္႔ခ်င္းတူ သည္႔ ခုိင္မာေတာင္႔တင္းျငိမ္သက္ေသာပံုစံျဖစ္သည္။ လူ၏အေရျပားကုိ အကာအကြယ္ျဖစ္ေစေရးအတြက္ (ဥပမာ EVA) အေပၚမ်က္ႏွာျပင္ကုိကူရွင္ခံထား ေပးျခင္း၊ ေလ႔က်င္႔ခန္းျပဳလုပ္သည္႔ဖ်ာ သုိ႔မဟုတ္ ေယာဂက်င္႔သင္ျဖဴးဖ်ာ ခင္းထားေပးျခင္းမ်ားျပဳ လုပ္ထားရမည္။ အကဲျဖတ္မည္႔သူအေနျဖင္႔ ဘီးတပ္ ကုလားထုိင္အသံုးျပဳသူ၏ေရွ႕ သုိ႔မဟုတ္ေက်ာမွေန၍ အလုပ္လုပ္ႏုိင္ရန္အတြက္ ကုတင္ကုိခင္းထားေပးရမည္။ • ေျခတင္ခံု - အသံုးျပဳမည္႔သူ၏ေျခေထာက္အား မွန္မွန္ ကန္ကန္ အေထာက္အကူျဖစ္ေစရန္ပမာဏကြဲျပားသည္႔ ေျခတင္ခံုမ်ားခ်ထားေပးရမည္။ • အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲ အတြက္ ထပ္တုိးအရင္းအျမစ္ ကုိေလ႔လာပါ။ • ကင္မရာ - အကဲျဖတ္သံုးသပ္ျခင္းႏွင္႔တပ္ဆင္ျခင္းလုပ္ငန္း ၏အဓိကအဆင္႔မ်ားအား (ဘီးတပ္ထုိင္ခုံသံုးစြဲသူ၏ လက္ မွတ္ပါဝင္ေသာခြင္႔ျပဳခ်က္ျဖင္႔) မွတ္တမ္းတင္ထားျခင္းသည္ လုပ္ငန္းအတြက္အေထာက္အကူျဖစ္ပါသည္။ • ေျခထိန္းသတၱဳေဒါက္မ်ားကုိစည္းေႏွာင္ထားပါ။ 34 35 ဘီးတပ္ထုိင္ခုံျပင္ဆင္ျခင္း၊ ထိန္းသိမ္းျခင္းႏွင္႔ ျပဳျပင္ျခင္း ျပဳုလုပ္သည္႔ေနရာ အက်ယ္အဝန္းမည္မွ်လုိအပ္သနည္း။ စက္မႈပုိင္းဆုိင္ရာေနရာကုိ ေအာက္ပါအေၾကာင္းမ်ားေၾကာင္႔ လုိအပ္ျခင္းျဖစ္သည္- • ဘီးတပ္ထုိင္ခုံမ်ား တပ္ဆင္ျခင္း၊ ျပင္ဆင္ျခင္းႏွင္႔ ျပဳ ျပင္ထိန္းသိမ္းျခင္းျပဳလုပ္ရန္ • လုိအပ္သည္႔ေနရာတုိင္းတြင္ အသစ္မြမ္းမံမႈမ်ား ဖန္တီးထုတ္လုပ္ရန္ အဆုိပါေနရာသည္ အလင္းေရာင္ေကာင္းစြာရွိရမည္။ ေလဝင္ေလထြက္ ေကာင္းရမည္။ မုိးယုိျခင္း မရွိေစရ။ အလုပ္ လုပ္ရန္အတြက္အပူခ်ိန္သင္႔တင္႔မွ်တမႈရွိရမည္။ လက္ကုိင္ကိရိယာမ်ားႏွင္႔လွ်ပ္စစ္ဓာတ္အားသံုးကိရိယာမ်ား သည္ေဘးကင္းလံုျခံဳ မႈရွိရမည္။ ၎တုိ႔အား ေသာ႔ခတ္ႏုိင္သည္႔ သတၱဳဗီဒုိအတြင္း သိမ္းဆည္းရမည္။ အျမဲတမ္း/ဌာနအေျခစုိက္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားတြင္ စက္မႈနယ္ေျမကုိ ေအာက္ပါအတုိင္းပုိင္းျခားထားသင္႔ပါ သည္- • အစိတ္အပုိင္းမ်ားအားအျပီးသတ္တပ္ဆင္ရန္ႏွင္႔တပ္ဆင္ျပီးေသာပစၥည္းမ်ားအားခ်ိန္ညွိရန္၊ ေဘးကင္းမႈ စမ္းသပ္ျခင္းႏွင္႔ အသံုးျပဳရန္အသင္႔စမ္းသပ္ျခင္းမ်ားျပဳလုပ္ရန္ အတြက္ ''သန္႔ရွင္း'' ေသာေနရာျဖစ္ရမည္၊ ဤအခန္းတြင္ ၾကမ္းျပင္ ႏွင္႔ခံုတန္းရွည္မ်ားအတြက္လည္း ေနရာလုိအပ္သည္။ • ေရျမႈပ္ေဖာ႔မ်ားပံုေဖာ္ျခင္း၊ ေကာ္သုပ္ျခင္း၊ လြန္ေဖာက္ျခင္း၊ စုစည္းျခင္းႏွင္႔ေဆးမႈတ္ျခင္း စသည္႔လုပ္ငန္းမ်ား အပါအဝင္ ျပဳျပင္ေရးလုပ္ငန္းမ်ားႏွင္႔မြမ္းမံမႈမ်ားျပဳလုပ္ရန္ ''ဖန္တီးမႈ''ေနရာ လုိအပ္သည္။ စက္မႈပုိင္းဆုိင္ရာလုိအပ္ခ်က္အားလံုးကုိ ဝန္ေဆာင္မႈလုပ္ငန္းပုိင္စက္မႈလုပ္ငန္းေနရာတြင္ ေဆာင္ရြက္ရန္ မလုိပါ။ ဥပမာ - ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအေနျဖင္႔ ကူရွင္အဖံုးခ်ဳပ္ျခင္းကုိ ေဒသႏၲရစက္ဆုိင္သို႔ လည္းေကာင္း၊ ဂေဟေဆာ္ျခင္းကုိ ေဒသႏၲရအတြင္းရွိတြင္ခံုသုိ႔လည္းေကာင္း ေပးပုိ႔ျခင္းကဲ႔သုိ႔ေသာေဆာင္ရြက္ မႈမ်ားျပဳလုပ္ျပီး အခ်ိဳ႕ေသာ စက္မႈပုိင္းဆုိင္ရာက႑မ်ားကုိ ျပင္ပတြင္အပ္ႏွံႏုိင္သည္။ 36 37 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ကိရိယာတန္ဆာပလာမ်ား - • လုပ္ငန္းေနရာသပ္သပ္ရပ္ရပ္ရွိရန္ႏွင္႔ ေနရာပုိထြက္လာေစရန္ ဗီရုိ၊ စင္ ႏွင္႔လက္သံုးပစၥည္းတင္ရန္ေနရာမ်ား အလံုအေလာက္ရွိရမည္။ • ဘီးတပ္ထုိင္ခုံမ်ားတပ္ဆင္ရန္ႏွင္႔ခ်ိန္ညွိရန္၊ မြမ္းမံဖန္တီးမႈအသစ္မ်ားျပဳလုပ္ႏုိင္ရန္ လက္ကုိင္တန္ဆာပလာမ်ား ရွိရမည္။ • မြမ္းမံျပင္ဆင္မႈျပဳလုပ္ေရးအတြက္ ပစၥည္းစာရင္းထားရွိရမည္။ • အနည္းဆံုးစက္မႈပညာရွင္တစ္ဦးလွ်င္ အလုပ္စားပြဲရွည္တစ္လံုး ရွိရမည္။ အကယ္၍ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူသည္ အလုပ္အဖြဲ႔တြင္ပါဝင္ေနသည္ဆုိပါက အနည္းဆံုးအလုပ္စားပြဲရွည္ တစ္လံုး၏အျမင္႔ကုိ လုိတုိးပုိေလွ်ာ႔ျပဳလုပ္ႏုိင္သည္႔ ပံုစံမ်ိဳးျဖစ္ရမည္။ စားပြဲရွည္၏ေရွ႔မွလည္းေကာင္း၊ ေနာက္မွ လည္းေကာင္း ၾကမ္းခင္းေပၚတြင္ အလုပ္လုပ္ႏုိင္ရန္အတြက္ ယင္းစားပြဲရွည္ကုိေနရာခ်ထားရမည္။ လက္သံုးပစၥည္းမ်ား၊ ပစၥည္းကိရိယာမ်ားႏွင္႔ပတ္သက္ျပီး အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္ကုိေလ႔လာပါ။ (မွတ္ခ်က္။ ဘီးတပ္ထုိင္ခုံထုတ္လုပ္ေရးအလုပ္ရံုတစ္ခုအတြက္ လုိအပ္ေသာအသံုးအေဆာင္မ်ားႏွင္႔ ပစၥည္း ကိရိယာမ်ားသည္ ယခုေဖာ္ျပထားသည္ထက္ ပုိမုိက်ယ္ျပန္႔သည္ျဖစ္ရာ ဤလက္စြဲစာေစာင္၏ နယ္ပယ္အတုိင္းအတာ ထက္ေက်ာ္လြန္ ပါသည္) သုိေလွာင္ရံုေနရာ အက်ယ္အဝန္းမည္မွ်လုိအပ္သနည္း။ ဘီးတပ္ထုိင္ခုံမ်ား၊ အပုိပစၥည္းမ်ားႏွင္႔ကိရိယာတန္ဆာပလာမ်ား ထားရွိရန္ လံုျခံဳမႈရွိေသာသုိေလွာင္ရံုတစ္ခု လုိအပ္ပါသည္။ ယင္းေနရာသည္ စက္မႈလုပ္ငန္းမ်ားေဆာင္ရြက္သည္႔ေနရာႏွင္႔ နီးရန္လုိအပ္ျပီး လံုျခံဳမႈရွိျခင္း၊ မုိးမယုိျခင္း၊ တိရိစၧာန္ႏွင္႔ပုိးမႊားမ်ားမွ ကင္းေဝးေသာေနရာျဖစ္ျခင္းတုိ႔ျဖစ္ရန္ လုိပါသည္။ ျပဴတင္းေပါက္တြင္ သံပန္းမ်ားတပ္ဆင္ေပးထားျခင္း ျဖင္႔လံုျခံဳမႈပုိမုိရွိေစမည္ ျဖစ္ပါသည္။ ထုိသုိ႔ေသာ သီးသန္႔ေနရာရရွိရန္ မလြယ္ကူပါက အခန္းတြင္းတြင္ သီးသန္႔ေနရာ သတ္မွတ္ထားရွိရ မည္ျဖစ္သည္။ ထုိသုိ႔ျဖစ္ပါက လံုျခံဳေရးကိစၥအတြက္ ထပ္မံထည္႔သြင္းစဥ္းစားရန္ လုိအပ္လာမည္ ျဖစ္ပါသည္။ 36 37 သုိေလွာင္ရံုနယ္ေျမထူေထာင္ျခင္း တစတုစည္းတည္းျဖစ္ေသာသုိေလွာငရ္ံတုစရ္ု ံထူေထာင္ႏုငိ္ေရးအတြက ္ ေအာကပ္ါအတုငိ္း ေဆာငရ္ြက ္ႏုငိပ္ါသည-္ • နံရံကပ္စင္ႏွင္႔ေလးတုိင္စင္မ်ားထားရွိျခင္းျဖင္႔ ေနရာပုိထြက္လာမည္ျဖစ္သည္။ • စင္မ်ား၊ ေသတၱာမ်ား၊ တပ္ဆင္ျပီးေသာဘီးတပ္ထုိင္ခုံမ်ားအၾကားတြင္ ေလွ်ာက္လမ္းျပဳလုပ္ထားျခင္းျဖင္႔ အဝင္အထြက္လြယ္ကူျပီး စြမ္းေဆာင္ရည္ကုိ ပုိမုိျမင္႔မားလာေစမည္ျဖစ္သည္။ ေလွ်ာက္လမ္းမ်ားတေလွ်ာက္ ရွင္းလင္းထားရမည္ျဖစ္သည္။ • ပစၥည္းမ်ားအား အရြယ္အစားအရလည္းေကာင္း၊ အမ်ိဳးအစားအရလည္းေကာင္း စီထားရမည္။ မ်ိဳးတူပစၥည္းမ်ားအား တစုတစည္းတည္းထားရွိျခင္းျဖင္႔ အထားအသုိကုိ ထိန္းသိမ္းျပီးပစၥည္းမ်ားအား ေရတြက္ရန္ ႏွင္႔လုိေသာပစၥည္းမ်ားအား မွာယူရန္္လြယ္ကူေစမည္ျဖစ္သည္။ • ဝက္အူ၊ နတ္၊ ဝါရွာကဲ႔သုိ႔ေသာအငယ္စားပစၥည္းမ်ားအား တစ္မ်ိဳးလွ်င္တစ္ခုစီေသာ္လည္းေကာင္း အရြယ္အစားလုိက္ေသာ္လည္းေကာင္း ေသတၱာအတြင္းထည္႔ထားရမည္။ ေသတၱာ၏အေရွ႕တြင္ ပစၥည္းအမ်ိဳးအမည္ကုိ ေရးထုိးထားရမည္။ • ေသတၱာမ်ားႏွင္႔ပစၥည္းမ်ားအားၾကမ္းျပင္ေပၚတြင္လည္းေကာင္း၊ နံရံတြင္ကပ္၍ေသာ္လည္းေကာင္း ေနရမခ် သင္႔ေပ။ အေၾကာင္းမွာ အစုိျပန္ျပီး အလြယ္တကူပ်က္စီးႏုိင္ေသာေၾကာင္႔ ျဖစ္ပါသည္။ ၾကမ္းေပၚတြင္ ကြပ္ပ်စ္မ်ား ခင္းထားေပးျခင္းျဖင္႔ ပစၥည္းမ်ားအား အျမင္႔တြင္ထားႏုိင္မည္ျဖစ္သည္။ • ျပဴတင္းေပါက္ရွိသည္ဆုိပါက သံပန္းမ်ားတပ္ထားျခင္းျဖင္႔ လံုျခံဳေရးကုိ အားေကာင္းေစမည္ျဖစ္ပါသည္။ အသံုးျပဳသူအတြက္သင္တန္းေနရာ အက်ယ္အဝန္း မည္မွ်လုိအပ္သနည္း။ ေအာက္ပါတုိ႔ကုိ သင္ၾကားေပးရန္ အသံုးျပဳသူသင္တန္းေနရာကုိလုိအပ္ပါသည္- • လႊဲေျပာင္းေပးျခင္းႏွင္႔ က်န္းမာေရးပညာေပးသင္တန္း • ဘီးတပ္ထုိင္ခုံကုိ ကုိင္တြယ္ျခင္း၊ ဂရုစုိက္ျခင္းႏွင္႔ ထိန္းသိမ္းျခင္းသင္တန္း • ေရြ႕လ်ားႏုိင္စြမ္းကုိ ပုိ႔ခ်ေပးေသာသင္တန္း 38 39 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ လႊဲေျပာင္းေပးျခင္းႏွင္႔ က်န္းမာေရးပညာေပးသင္တန္းကုိ ေဆးေပးခန္းနယ္ေျမ၊ လူနာ၏အိမ္ သုိ႔မဟုတ္ အျခားသတ္မွတ္ေန ရာမ်ားတြင္ျပဳလုပ္ႏုိင္သည္။ ပစၥည္းကိရိယာတန္ဆာပလာမ်ား - • လႊဲေျပာင္းျခင္းသင္ခန္းစာကုိေလ႔က်င္႔ရန္ ကုတင္ကဲ႔သုိ႔ေသာ အေျခခံပစၥည္းသည္ အသံုးတည္႔ပါသည္။ ဘီးတပ္ထုိင္ခုံကုိကုိင္တြယ္ျခင္း၊ ဂရုစုိက္ျခင္းႏွင္႔ ထိန္းသိမ္းျခင္း သင္တန္းကုိ အလုပ္ရံု၏သန္႔ရွင္းေသာေနရာ သုိ႔မဟုတ္ အျခားေသာ သင္႔ေတာ္မည္႔ မည္သည္႔ေနရာတြင္မဆုိ ျပဳလုပ္ႏုိင္သည္။ ပစၥည္းကိရိယာတန္ဆာပလာမ်ား - • ဘီးတပ္ထုိင္ခုံထိန္းသိမ္းေရးအတြက္ အေျခခံပစၥည္းမ်ားကုိ လုိအပ္ပါသည္။ ေရြ႔လ်ားႏုိင္စြမ္းကုိ ပုိ႔ခ်ေပးေသာသင္တန္းကုိ ျပင္ပတြင္ပုိ႔ခ်ႏုိင္သကဲ႔သုိ႔ အခန္းတြင္းတြင္လည္း ပုိ႔ခ်ႏုိင္ပါသည္။ ရည္ရြယ္ခ်က္ျဖင္႔ျပဳလုပ္ဖန္တီးထားေသာ ေရြ႔လ်ားႏုိင္စြမ္းကုိ ပုိ႔ခ်ေပးေသာသင္တန္း၏ ျပင္ပသင္ခန္းစာေနရာတြင္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ား ေန႔စဥ္ၾကံဳေတြ႔ရႏုိင္သည္႔ အေနအထားမ်ိဳးကုိဖန္တီးႏုိင္သည္။ ဥပမာ- ၾကမ္းတမ္းေသာေျမျပင္အေနအထား၊ ေပ်ာ႔ေျပာင္းေသာေျမ အေနအထား၊ ေရေျမာင္း၊ အရွိန္ထိန္းခံုး၊ ပလက္ေဖာင္းေဘာင္၊ ႏွင္႔ေလွကား၊ စုေပါင္းဝန္ေဆာင္မႈလုပ္ငန္းတြင္ေရြ႕လ်ားႏုိင္စြမ္းနယ္ေျမကုိ အျခား ေသာေရြ႕လ်ားႏုိင္စြမ္းမရိွသူမ်ားလည္း အသံုးျပုႏုိင္သည္။ ဥပမာ- ေျခတုလက္တုသံုးစြဲမႈကုိ ေလ႔က်င္႔ေနသူမ်ား၊ ဒဏ္ရာရျပီးေနာက္ လမ္းေလွ်ာက္ျခင္းကုိ ေလ႔က်င္႔ေနသူမ်ား။ 38 39 ေရြ႕လ်ားႏုိင္စြမ္းအတြက္ သီးသန္႔ေနရာမရွိလွ်င္ ေရြ႕လ်ားႏုိင္စြမ္း အရည္အေသြးသင္တန္းအတြက္ လံုျခံဳစိတ္ခ်စြာအသံုးျပဳႏုိင္မည္႔ ေနရာကုိေရြးခ်ယ္ရမည္။ လူအမ်ား သြားလာအသံုးျပဳေလ႔ရွိသည္႔ေနရာမ်ိဳးကုိ ေရွာင္ျပီး မတူညီသည္႔ အတားအဆီးမ်ားရွိသည္႔ေနရာမ်ိဳးကုိ ေရြးခ်ယ္ေပးရမည္။ အလြယ္တကူေရႊ႔ေျပာင္းသယ္ေဆာင္ႏုိင္ေသာ ေရြ႔လ်ားႏုိင္စြမ္း သင္တန္းသံုးပစၥည္းမ်ားကုိဖန္တီး ထားရမည္။ မည္သည္႔ေနရာတြင္ မဆုိ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈျပဳလုပ္ေပးႏုိင္ေစရန္ စီမံထား ရွိရမည္။ လက္ယာဘက္တြင္ေဖာ္ျပထားသည္႔ပံုမွာ အရိပ္ေအာက္တြင္ ထားရွိသည္႔ အလြယ္တကူ ေရႊ႔ေျပာင္းသယ္ေဆာင္ႏုိင္ေသာ ေရြ႕လ်ားႏုိင္စြမ္းသင္တန္းသံုးပစၥည္းျဖစ္သည္။ အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္ကုိ ေလ႔လာပါ။ 40 41 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ tv,ftvwftqifh0efaqmifrIvkyfief;twGuf xyfwkd;tokH;taqmifrsm;ESifh ypönf;rsm; အလယ္အလတ္အဆင္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈေပးရာတြင္ ေနာက္ထပ္ေနရာႏွင္႔ပစၥည္းမ်ားလုိအပ္လာ မည္ျဖစ္ပါသည္။ မန္ေနဂ်ာမ်ား စဥ္းစားေမွ်ာ္ျမင္ႏုိင္ရန္လုိသည္႔ ေနာက္တုိးပစၥည္းမ်ားႏွင္႔ပတ္သက္ျပီး ေအာက္တြင္ ေဆြးေႏြးထားပါသည္။ အကဲျဖတ္သံုးသပ္ျခင္းႏွင္႔တပ္ဆင္သည္႔ေနရာ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈတစ္ခုအတြက္ အကဲျဖတ္ သံုးသပ္မႈျပဳလုပ္စဥ္အတြင္း ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူလွဲေလ်ာင္းႏိုင္ ရန္ အကဲျဖတ္ကုတင္တစ္လံုး လုိအပ္မည္ျဖစ္သည္။ အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္ကုိ ေလ႔လာပါ။ အထူးျပဳလုပ္ထားသည္႔အကဲျဖတ္ေသတၱာသည္ အလယ္အလတ္ အဆင္႔ဝန္ေဆာင္မႈအတြက္မ်ားစြာ အသံုးဝင္သည္။ အကဲျဖတ္ေသတၱာသည္ ညိွႏုိင္ေသာ ေျခေထာက္အေထာက္အကူ ကုိေပးအပ္ႏုိင္ျပီး လက္ေလ႔က်င္႔ခန္းျပဳလုပ္ရာတြင္လည္း ေကာင္းမြန္ စြာအေထာက္အကူေပးႏုိင္ပါသည္။ အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္ကုိ ေလ႔လာပါ။ • အကဲျဖတ္စဥ္ႏွင္႔တပ္ဆင္စဥ္အေတာအတြင္း ယာယီ အေထာက္အပံ႔အတြက္ ေတာင္႔တင္းခုိင္မာေသာေရျမႈပ္တံုးကုိ လက္ဝယ္ရွိထားရမည္ျဖစ္သည္။ ထုိ႔အျပင္ ၾကမ္းျပင္ ေလ႔က်င္႔ခန္းအတြက္ ကူရွင္ႏွင္႔အခင္းမ်ား လုိမည္ျဖစ္သည္။ • ကိုယ္ေနဟန္ထားႏွင္႔ခ်ိန္သားကုိက္မႈကုိ ရႈေထာင္႔အမ်ိဳးမ်ိဳးမွ ၾကည္႔ႏုိင္ရန္အတြက္ ကုိယ္လံုးေပၚမွန္တစ္ခ်ပ္ထားရွိေပးျခင္းသည္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအတြက္ေရာ၊ ဝန္ေဆာင္မႈေပးသည္႔ ဝန္ထမ္းအတြက္ပါ အဆင္ေျပေစမည္ျဖစ္သည္။ • နံရံေပၚတြင္ကစားစရာမ်ား၊ ရုပ္ပံုကားခ်ပ္မ်ားထားေပးျခင္းျဖင္႔လည္း ကေလးသူငယ္မ်ားအတြက္ ႏွစ္သက္ဖြယ္ရာဝန္းက်င္တစ္ခုကုိျဖစ္ ေစပါသည္။ 40 41 စုေဆာင္းသုိေလွာင္ျခင္း အလယ္အလတ္အဆင္႔တြင္ ဆန္းသစ္မႈႏွင္႔ကုိယ္ေနဟန္ထား အေထာက္အကူျပဳ အစိတ္အပုိင္းမ်ားအတြက္ လုိအပ္ေသာပစၥည္း မ်ားအားစုေဆာင္းထားရွိရန္ပုိမုိလုိအပ္မည္ျဖစ္ပါသည္။ ထုိသုိ႔ေသာ ပစၥည္းမ်ားတြင္ေျခာက္ေသြ႔ျပီး အျပားလုိက္ထားရန္လုိသည္႔ေရျမႈပ္ ျပားမ်ားပါဝင္သည္။ ထုိ႔ေၾကာင္႔ သုိေလွာင္ရန္ေနရာႏွင္႔စင္မ်ား ပုိမုိ လုိအပ္မည္ ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံ ျပင္ဆင္၊ ထိန္းသိမ္း၊ ျပဳျပင္ရန္ေနရာ ကုိယ္ေနဟန္ထားကုိအေထာက္အကူျပဳမည္႔အစိတ္အပုိင္းမ်ားႏွင္႔ သုိင္းၾကိဳးမ်ားကုိဖန္တီးရန္ သုိ႔မဟုတ္ခ်ဳပ္လုပ္ေပးရန္သန္႔ရွင္းေသာ ေနရာႏွင္႔လုပ္ငန္းသံုးအပ္ခ်ဳပ္စက္သည္ ဝန္ေဆာင္မႈလုပ္ငန္းကုိ မ်ားစြာအေထာက္အကူျဖစ္ေစပါသည္။ ထုိသုိ႔ေသာေနရာႏွင္႔ပစၥည္း မ်ားမရွိပါက ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ ထုိသုိ႔ေသာလုပ္ငန္းမ်ား ကုိေဆာင္ရြက္ႏုိင္ရန္ ျပင္ပတြင္ငွားရမ္း လုပ္ကုိင္ရမည္ျဖစ္ပါသည္။ 42 43 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ လုပ္ငန္းေနရာဖြဲ႔စည္းျခင္း အသံုးအေဆာင္မ်ားႏွင္႔ပစၥည္းမ်ားေနရာတက်ျဖစ္ျပီဆုိပါက မန္ေနဂ်ာတစ္ဦးအေနျဖင္႔ ေအာက္ပါအဆင္႔မ်ားကုိ အသံုးျပဳျပီး အသုံးအေဆာငတ္စခ္ခု်င္းစကီုစိစုည္းႏုငိ္ေရးအတြက္ တာဝနခ္ြဲေဝသတမ္တ္ွမႈကု ိျပဳလပုရ္မည္ျဖစပ္ါသည-္ ၁။ ျဗဳတ္စဗ်င္းေတာင္းမ်ားကုိဖယ္ရွားျခင္း- မလုိေသာလက္သံုးကိရိယာမ်ား၊ အစိတ္အပုိင္းမ်ား၊ ပစၥည္းမ်ား၊ စာ ရြက္စာတမ္းအေဟာင္းမ်ားကုိ ဖ်က္သိမ္းဖယ္ရွားရမည္။ ၂။ ပံုမွန္အသံုးျပဳသည္႔ပစၥည္းမ်ားကုိသတ္မွတ္ျခင္း- လက္သံုးကိရိယာမ်ား၊ အစိတ္အပုိင္းမ်ား၊ ညႊန္ၾကားခ်က္မ်ား၊ စာရြက္စာတမ္းမ်ား ကုိအစီအစဥ္တက် ထားရွိရမည္၊ သုိ႔မွသာ ၎တုိ႔အားရွာေဖြရန္ လြယ္ကူျမန္ဆန္မည္ျဖစ္သည္။ ၃။ စနစ္ႏွင္႔တာဝန္ယူမႈရွိျခင္း- အလုပ္ဌာနတစ္ခုစီတုိင္းအတြက္ စနစ္ရွိျပီး ယင္းစနစ္မ်ားကုိ အေကာင္အထည္ ေဖာ္မႈကုိတာဝန္ယူရမည္႔ပုဂၢိဳလ္မ်ားကုိ တာဝန္ေပးခန္႔ထားရမည္။ ၄။ ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္း - အေျပာင္းအလဲသည္ပံုမွန္လည္ပတ္ေနေၾကာင္း ၾကီးၾကပ္ေဆာင္ရြက္သည္႔ စနစ္ျဖစ္သည္။ 42 43 c .3 oifhavsmfonfh bD;wyfxkdifckH trs dK ;rs dK ; သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံႏွင္႔ အခုအခံမ်ားသည္ မည္သည္႔အရာကုိ ဆုိလုိသနည္း။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူတစ္ဦးခ်င္းစီ၏လိုအပ္ခ်က္မွာကဲြျပားျခားနားမည္ျဖစ္ပါသည္။ သုိ႔ေသာ္ ၎တုိ႔ အေနျဖင္႔ ၎တုိ႔ႏွင္႔သင္႔ေလ်ာ္ေသာ ဘီးတပ္ထုိင္ခုံႏွင္႔ကူရွငမ္်ားကုိ လုိအပ္မည္ျဖစ္ပါသည္။ အရင္းအျမစ္ နည္းပါး ေသာေဒသမ်ားရွိ လက္တြန္းဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးႏွင္႔ပတ္သက္ျပီးး WHO လမ္းညႊန္ခ်က္တြင္ သင္႔ေလ်ာ္ ေသာ ဘီးတပ္ထုိင္ခုံကုိ ေအာက္ပါအတုိင္း အဓိပၸါယ္ဖြင္႔ဆုိထားပါသည္- • အသုံးျပဳသူ၏လုိအပ္ခ်က္ႏွင္႔ပတ္ဝန္းက်င္အေနအထားႏွင္႔ကုိက္ညီမႈရွိျခင္း • သင္႔ေလ်ာ္ေသာအံဝင္ခြင္က်ျဖစ္မႈႏွင္႔ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳမႈကိုေပးစြမ္းႏုိင္ျခင္း • ႏုိင္ငံအတြင္းရရွိႏုိင္ျခင္း • ေစ်းအသက္သာဆံုးႏွင္႔ အတတ္ႏုိင္ဆံုးေစ်းႏႈန္းျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းကုိႏုိင္ငံအတြင္း ရရွိထိန္းသိမ္းထား ႏုိင္ျခင္း ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းကုိရရွိႏုိင္မည္႔ အသံုးျပဳသူမ်ား၏လုိအပ္ခ်က္ကုိ ျဖည္႔ဆည္းေပးႏုိင္ရန္ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ အနည္းဆံုးအားျဖင္႔ပံုစံမတူေသာ ဘီးတပ္ထုိင္ခုံႏွင္႔အခုအခံမ်ားကုိရရွိေနရန္လုိ သည္။ အသံုးျပဳမည္႔သူႏွင္႔ အကုိက္ညီဆံုးျဖစ္ေစမည္႔အခုအခံပံုစံသည္ ၎၏လုိအပ္ခ်က္အေပၚ တည္မွီေနမည္ ျဖစ္ ပါသည္။ သုိ႔ေသာ္အပူေလာင္နာျဖစ္ေနသူမ်ားအတြက္ အနာသက္သာေစမည္႔ အခုအခံမ်ိဳးအား မည္သုိ႔အသံုးျပဳ ရမည္ဆုိသည္႔သင္တန္းေပးျခင္းႏွင္႔အတူ ယင္းသုိ႔ေသာ အခုအခံမ်ိဳး လုိအပ္မည္ျဖစ္ပါသည္။ 44 45 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ rSefuefonhfypönf;ukd tokH;jyKoloifwef;ESifhtwlr&&Sdonfhojzifh qkH;½IH;rIrsm; အရင္းအျမစ္ေကာင္းစြာရွိသည္႔ႏုိင္ငံမ်ား၌ အသက္ (၂၅) ႏွစ္မွ (၃၈) ႏွစ္အတြင္း ဒဏ္ရာရရွိခဲ႔သူမ်ား၏ဒဏ္ရာ ရျပီးေနာက္ ပွ်မ္းမွ်သက္တမ္းမွာ ခန္႔မွန္းေျခ (၃၈) ႏွစ္ျဖစ္သည္။ ယင္းႏွင္႔ဆန္႔က်င္ဖက္အေနျဖင္႔ ဘဂၤလားေဒ႔ရွ္ ႏုိင္ငံတြင္ ျပဳလုပ္ခဲ႔ေသာစစ္တမ္းတစ္ခုအရ ေက်ာရုိးမၾကီးအားထိခုိက္သည္႔ေဝဒနာကုိ ခံစားရျပီးေနာက္ ရွိသည္႔ ပွ်မ္းမွ်သက္တမ္းမွာ ၅.၃၆ ႏွစ္ျဖစ္ျပီး ၅၆.၄% မွာ ဒဏ္ရာရျပီး (၅) ႏွစ္အတြင္း ေသဆံုးသူမ်ားျဖစ္သည္ကုိ ေတြ႔ရွိ ခဲ႔ရသည္။ ထုိစစ္တမ္းအရ ေသဆုံးသူမ်ားအနက္ (၈ဝ)%မွာ အိမ္တြင္ေသဆံုးျခင္းျဖစ္ျပီး ၎တုိ႔အနက္ သံုးပံု တစ္ပံုမွာ ေသဆံုးခ်ိန္တြင္အပူေလာင္နာမ်ားျဖစ္ေနေၾကာင္း ေတြ႔ရွိရသည္။ သီရိလကၤာရွိျပန္လည္ထူေထာင္ေရးေဆးရံုတစ္ခုတြင္ ၁၉၉၇ ခုႏွစ္အတြင္း ေက်ာရုိးမၾကီးထိခုိက္ဒဏ္ ရာရရွိမႈဌာန၏ေသဆံုးမႈစစ္တမ္းတစ္ရပ္ကုိ ျပဳလုပ္ခဲ႔သည္။ ထုိအခ်ိန္က အေပၚယံအပူေလာင္နာကုိကုသရန္အ တြက္အခ်ိန္ ေျခာက္ပတ္ ယူရျပီးကုန္က်စရိတ္မွာ ၂၈၆ ေဒၚလာျဖစ္သည္။ လႈိက္စားေနသည္႔အပူေလာင္နာကုိ ကုသရန္အတြက္မူ အခိ်န္တစ္ႏွစ္ခန္႔ယူရျပီး ကုန္က်စရိတ္မွာ ၂၄၈၃ ေဒၚလာျဖစ္သည္။ အလားတူစစ္တမ္းမ်ိဳး အားျပဳလုပ္ရာတြင္ မွန္ကန္ေသာဘီးတပ္ထုိင္ခုံ၊ အခုအခံႏွင္႔ ဖ်ာမ်ားကုိအသံုးျပဳျပီး လူနာပညာေပးေရးလုပ္ငန္းကုိ အလံုအေလာက္ေဆာင္ရြက္ေပးခဲ႔ျပီးေနာက္ ေဆးရံုတြင္ တက္ေရာက္ကုသ ေနသည္႔အပူေလာင္နာ ျဖစ္ပြားမႈကုိ ၇ဝ%အထိ ေလွ်ာ႔ခ်ႏုိင္ခဲ႔ျပီး ေဆးထည္႔ျခင္းအတြက္ ကုန္က်စရိတ္မွာလည္း ၆ဝ% အထိေလ်ာ႔က်သြားပါသည္။ ဘရာဇီးႏုိင္ငံေဆာပုိလုိျမိဳ႔ရွိေဆးရံုတစ္ရံု၏အစီအစဥ္တစ္ခုအရ ေက်ာရုိးမၾကီးဒဏ္ရာရသူမ်ားအတြက္ ထပ္ဆင္႔ေဝဒနာမ်ားကုိေလွ်ာ႔ခ်ႏုိင္ရန္ ပညာေပးဝန္ေဆာင္မႈလုပ္ငန္းတစ္ရပ္ေဆာင္ရြက္ခဲ႔ရာ အပူေလာင္နာ ျဖစ္ပြားမႈကုိ ၂၃%အထိေလွ်ာ႔ခ်ႏုိင္ခဲ႔ပါသည္(၁၀)။ oifhavsmfaombD;wyfxkdifckHESifh ul&SiftrsdK;rsdK;ukd a½G;cs,fjcif; သင္႔တင္႔သည္႔တပ္ဆင္မႈႏွင္႔ အေထာက္အကူကို ပံ႔ပုိးေပးျခင္း ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအေနျဖင္႔ ၎တုိ႔ႏွင္႔အံဝင္ခြင္က်ျဖစ္ေသာဘီးတပ္ထုိင္ခုံမ်ား ကုိ လုိအပ္သည္။ အရြယ္အစားမကိုက္ညီသည္႔ ဘီးတပ္ထုိင္ခုံသည္ သက္ေတာင္႔သက္ သာရွိမည္မဟုတ္သကဲ႔သုိ႔ ကုိယ္ေနဟန္ထားအတြက္လည္း ေကာင္းမြန္ႏုိင္မည္ မဟုတ္ေခ်။ ထုိမွ်သာမက အသံုးျပဳသူအားနာက်င္ေစမည္ျဖစ္သည္။ အဓိပၸါယ္မွာ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ဘီးတပ္ထုိင္ခုံအရြယ္အစားအမ်ိဳးမ်ိဳး သုိ႔မဟုတ္ အရြယ္အစားကုိခ်ိန္သားကုိက္ႏုိင္ေသာ ဘီးတပ္ထုိင္ခုံမ်ားကုိ ေထာက္ပံ႔ ေပးရန္လုိမည္ဆုိသည္ပင္ ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားသည္ တစ္ရက္လွ်င္နာရီေပါင္းမ်ားစြာ ထုိင္ေနျခင္းျဖင္႔ အခ်ိန္ကုန္ဆံုးၾကရသည္။ ဆုိ လုိသည္မွာ ၎တို႔၏ဘီးတပ္ထုိင္ခုံသည္ ေရြ႔လ်ားႏုိင္စြမ္းကုိ အေထာက္အကူျပဳသည္သာမက ယင္းဘီးတပ္ထုိင္ခုံ သည္ ၎တုိ႔အား မတ္မတ္အေနအထားျဖင္႔ သက္ေတာင္႔သက္သာထုိင္ႏုိင္ေစရန္အေထာက္အကူျပဳေနသည္ဆုိ သည္႔အဓိပၸါယ္ပင္ ျဖစ္သည္။ လူမ်ားအေနျဖင္႔မတူညီေသာ ကုိယ္ေနဟန္ထားေထာက္ပင္႔မႈလိုအပ္ခ်က္မ်ားရွိသည္။ ထုိ႔ေၾကာင္႔လည္း အေထာက္အကူေပးရာတြင္မတူညီသည္႔ပံုစံရွိသည္႔ဘီးတပ္ထုိင္ခုံမ်ားကုိ လုိအပ္ျခင္းျဖစ္ပါသည္။ 44 45 အေျခခံအဆင္႔ ကုိယ္ေနဟန္ထားအေထာက္အကူကုိ လုိအပ္ေနသူမ်ားအေနျဖင္႔ စနစ္တက်တပ္ဆင္ထားေသာ ဘီးတပ္ထုိင္ခုံ၏အေထာက္အကူကုိ လုိအပ္မည္ ျဖစ္ပါသည္။ အလယ္အလတ္အဆင္႔ ကုိယ္ေနဟန္ထားအေထာက္အကူကုိ လိုအပ္သူမ်ားအေနျဖင္႔ အပုိေဆာင္း အေထာက္အကူပစၥည္းမ်ားပါဝင္ေသာ စနစ္တက်တပ္ဆင္ထားသည္႔ ဘီးတပ္ထုိင္ခုံကုိ လုိမည္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံတြင္ အပုိေဆာင္းကုိယ္ေနဟန္ထား အေထာက္အကူျပဳ ကိရိယာမ်ားတပ္ဆင္ေပးျခင္းျဖင္႔ အေထာက္အကူမ်ားထပ္မံရရွိႏုိင္ မည္ျဖစ္သည္။ ထုိသုိ႔မဟုတ္ပါကလည္း သီးသန္႔အေထာက္အကူျပဳထုိင္ခံုကုိေပးရမည္ ျဖစ္သည္။ rSefuefonhft½G,ftpm; okdYr[kwf rSefuefonfhtaxmuftulray;onfhtwGuf epfem qkH;½IH;rIrsm; ေတာင္အာဖရိကႏုိင္ငံ၊ အေနာက္အငူ ျပန္လည္ထူေထာင္ေရးဌာနမွဝန္ထမ္းမ်ားသည္ ေက်ာင္းမ်ားႏွင္႔ ေန႔က ေလးထိန္းဌာနမ်ားတြင္ ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳမႈကုိ လုိအပ္ေသာ္လည္း ဘီးတပ္ထုိင္ခုံမ်ားတြင္ ယင္းသုိ႔ေသာ အေထာက္အကူကုိမရၾကသည္႔ ကေလးသူငယ္အုပ္စုမ်ားအေပၚ ေလ႔လာမႈတစ္ရပ္ျပဳလုပ္ခဲ႔ရာ ယင္းသုိ႔ေသာ ကေလးသူငယ္မ်ားအနက္ ၂၁% မွာ ေနာက္တုိးကုိယ္ေနဟန္ထားေဝဒနာမ်ားျဖစ္ေပၚေၾကာင္း ေလ႔လာေတြ႔ရွိခဲ႔သည္။ ထုိသုိ႔ေသာေဝဒနာမ်ားေၾကာင္႔ ကေလးသူငယ္မ်ားႏွင္႔ ၎တုိ႔၏မိသားစုဝင္မ်ားရင္ဆုိင္ ၾကရသည္႔နစ္နာမႈမ်ားမွာ ေအာက္ပါအတုိင္း ျဖစ္သည္- • ေဝဒနာမ်ားပုိမုိမ်ားျပားလာသည္႔အတြက္ ခ်ိန္းဆုိမႈအတြက္ အခ်ိန္ပုိေပးရျခင္း • က်န္းမာေရးခြၽတ္ယြင္းလာျခင္း • ကိုယ္ေနဟန္ထားခြၽတ္ယြင္းလာျခင္းႏွင္႔သက္ေတာင္႔သက္သာမျဖစ္ျခင္း • ထုိင္ေနရျခင္းကုိသည္းမခံႏုိင္ျခင္း (ထုိင္ေနစဥ္တြင္သက္ေတာင္႔သက္သာျဖစ္မႈအခ်ိန္နည္းပါးျခင္း) • ပညာေရးအစီအစဥ္မ်ားတြင္ပါဝင္ေဆာင္ရြက္မႈက်ဆင္းလာျခင္း • ဘဝအရည္အေသြးက်ဆင္းလာျခင္း tokH;jyKol\vkdtyfcsufESifh ywf0ef;usiftaetxm;ESifh ukdufnDrI&SdatmifjyKvkyfjcif; သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံတစ္လံုးအေနျဖင္႔ ဘီးတပ္ထိုင္ခုံအသံုးျပဳသူမ်ားလုပ္ကုိင္ေဆာင္ရြက္ရန္ လုိ ေသာကိစၥမ်ားကုိအလြယ္တကူ ေဆာင္ရြက္ႏုိင္ေစရပါမည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအေနျဖင္႔ ၎၏ထုိင္ခုံမွ ဝင္ 46 47 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ႏုိင္ထြက္ႏုိင္ျဖစ္ရမည္၊ ဘီးတပ္ထိုင္ခုံကုိ တြန္းႏုိင္ရမည္၊ ဘီးတပ္ထုိင္ခုံကုိ သယ္ေဆာင္သြားႏုိင္ေရးအတြက္ ေခါက္ ႏုိင္၊ သိမ္းဆည္းႏိုင္ရမည္၊ ၎တို႔၏ေန႔စဥ္လုပ္ငန္းမ်ားကုိ ေဆာင္ရြက္ႏုိင္ရပါမည္။ ဘီးတပ္ထုိင္ခုံပံုစံအမွန္ႏွင္႔ ယင္း ေပၚရွိ မွန္ကန္ေသာအေနအထားမ်ားသည္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအတြက္ အထက္ပါအခ်က္မ်ားအား လြယ္လင္႔ တကူ ျပဳလုပ္ႏုိင္ေစရမည္ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအေနျဖင္႔ ၎တုိ႔၏ပတ္ဝန္းက်င္တြင္ ၎တုိ႔အတြက္ ေကာင္းစြာအလုပ္လုပ္ ေသာ ဘီးတပ္ထိုင္ခုံကုိ လုိအပ္မည္ျဖစ္သည္။ မတူညီေသာဘီးတပ္ထုိင္ခုံမ်ားသည္ မတူညီေသာပတ္ဝန္းက်င္ႏွင္႔ ကုိက္ညီမႈရွိသည္။ ဥပမာ - အခ်ိ ႕ဳေသာဘီးတပ္ထုိင္ခုံမ်ားသည္ အခန္းတြင္းအသံုးျပဳရန္ ပုိမုိေကာင္းမြန္ျပီး အခ်ိဳ႕မွာ ျပင္ပႏွင္႔ ၾကမ္းတမ္းေသာေျမအေနအထားတြင္သံုးရန္ ပုိမုိသင္႔ေတာ္သည္။ စြန္႔ပစ္ထားသည္႔ပစၥည္းမ်ား- မည္သည္႔အရာမွ်မရွိျခင္းထက္ တခုရွိျခင္းက သာ၍ေကာင္းသည္ ပစၥည္းမ်ားသည္အသံုးျပဳသူ၏လုိအပ္ခ်က္ကုိျဖည္႔ဆည္း ေပးႏုိင္မႈမရွိလွ်င္ ယင္းသည္ စြန္႔ပစ္ပစၥည္းျဖစ္သြားပါသည္။ လက္ယာဘက္မွပံုသည္ အလားတူဇာတ္လမ္းကုိ ေျပာျပေနပါသည္။ ဤဘီးတပ္ထုိင္ခုံအသံုးျပဳသူထံတြင္ အလႈရထားေသာဘီးတပ္ထုိင္ခုံ သံုးလံုးရွိသည္။ သုိ႔ေသာ္ တစ္လံုးမွ် ၎၏လုိအပ္ခ်က္မ်ားကုိ ျဖည္႔ဆည္းေပးႏုိင္ျခင္း မရွိသည္႔အတြက္ ၎အေနျဖင္႔ အိမ္ျပင္သုိ႔မသြားႏုိင္ေခ်။ ပထမႏွစ္လံုးမွာ က်ိဳးေနေသာေၾကာင္႔အသံုးျပဳ၍မရပဲ အပုိပစၥည္းမ်ားကုိလည္း မရႏုိင္ေခ်။ တတိယတစ္လံုးမွာ အသစ္ျဖစ္ေသာ္လည္း အဆင္႔မမီသည္႔ဘီးတပ္ထုိင္ခုံျဖစ္ေန သည္။ ယင္းကုိ အျပင္တြင္အသံုးျပဳပါက ဒယီးဒယိုင္ တုန္ခါ ေနျပီးတည္ျငိမ္မႈ မရွိေခ်။ ထုိ႔ေၾကာင္႔ အသံုးျပဳသူအတြက္ အႏၲရယ္ရွိေနပါသည္။ ab;uif;rIESifhwm&SnftokH;cHrI ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားသည္ စရိတ္စကသက္သက္သာသာျဖင္႔ျပဳျပင္ႏုိင္ရန္သာမက ေဘးကင္းမႈရွိ ျပီးတာရွည္အသံုးခံသည္႔ပစၥည္းမ်ိဳးကုိ အလုိရွိၾကသည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ၎တုိ႔ေပး လုိက္ေသာဘီးတပ္ထုိင္ခုံမ်ားသည္ ေဘးကင္းမႈရွိျခင္း၊ တာရွည္ခံျခင္းႏွင္႔ ေဒသႏၲရျပင္ဆင္ႏုိင္ျခင္းမ်ား ရွိပါက ၎တုိ႔အတြက္လည္း အက်ိဳးအျမတ္ျဖစ္ထြန္းသည္။ ထုိသုိ႔ေဆာင္ရြက္ႏုိင္ျခင္းအားျဖင္႔ဘီးတပ္ထုိင္ခုံအစားထုိး လဲလွယ္ရသည္႔စရိတ္ကုိ ေလ်ာ႔က်သြားေစမည္ျဖစ္သည္သာမက ဘီးတပ္ထိုင္ခုံျပဳျပင္ထိန္းသိမ္းေရးလုပ္ငန္းကုိ လည္း လြယ္ကူသြားေစမည္ ျဖစ္ပါသည္။ 46 47 အရင္းအျမစ္နည္းပါးသည္႔ေဒသမ်ားမွ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားသည္ ၾကမ္းတမ္းေသာ ေျမအေန အထားေပၚတြင္ ၎တုိ႔၏ဘီးတပ္ထိုင္ခုံမ်ားကုိ သံုးစြဲေလ႔ရွိၾကသည္။ ထုိ႔အျပင္မုိးရြာေနသည္႔ေအာက္၊ သဲမ်ားအတြင္း၊ ရႊံ႔မ်ားအတြင္း ပစ္ထားမႈမ်ိဳးလည္း ရွိႏုိင္သည္။ အဓိပၸါယ္မွာ ၎တို႔၏ဘီးတပ္ထုိင္ခုံမ်ားသည္ ခုိင္မာေတာင္႔တင္းရန္ လုိအပ္ျပီး အထက္ပါအေျခအေနမ်ိဳးတြင္ တာရွည္ခံႏုိင္ေအာင္ျပဳလုပ္ထားရန္ လုိသည္ဆုိသည္ပင္ ျဖစ္ပါသည္။ အရည္အေသြးမမီသည္႔ဘီးတပ္ထုိင္ခုံသည္ အခ်ိန္တုိအတြင္းပ်က္စီးသြားမည္ျဖစ္သည္။ (ဥပမာ - တစ္လမွ ေျခာက္လ အတြင္း) သုိ႔ေသာ္ စနစ္တက်ထိန္းသိမ္းျပီး စနစ္တက်ပံုစံထုတ္ ျပဳလုပ္ထားေသာ ဘီးတပ္ထုိင္ခုံဆုိလွ်င္မူ သုံုးႏွစ္မွ ငါးႏွစ္အထိ တာရွည္ခံႏိုင္မည္ျဖစ္သည္။ ယင္းသည္ ေငြကုန္သေလာက္အက်ိဳးအျမတ္ျပန္ရျခင္းပင္ျဖစ္ပါ သည္။ t&nftaoG;nHhzsif;onfh bD;wyfxkdifckHrsm;aMumifh BuHKawGU&avh&Sdonfh jyóemrsm;rSm atmufygtwkdif;jzpfonf - • အရည္အေသြးမမီသည္႔ထုိင္ခံုႏွင္႔ေက်ာမွီခ်ဳပ္ထားျခင္းေၾကာင္႔ စုတ္ျပဲျခင္း၊ ေလ်ာ႔တိေလ်ာ႔ရဲျဖစ္လာျခင္း • ဘီးငယ္မ်ား (ဝင္ရုိးမ်ား၊ တာယာမ်ား၊ကြင္းမ်ား၊ ဘီးငယ္ထိန္းအတံမ်ား) က်ိဳးျခင္း၊ • ေနာက္ဘီး (ဘီးဝင္ရုိးမ်ား၊ ေမာင္းႏွင္တံ၊ စပုတ္တုိင္မ်ား၊ ကြင္းမ်ား၊ တာယာမ်ား) က်ိဳးျခင္းသုိ႔မဟုတ္ ေဆြးျခင္း • အရွိန္ထိန္းဘရိတ္မ်ား သံေခ်းကုိက္ျခင္း၊ အလုပ္မလုပ္ျခင္း • ေျခတင္ခံုက်ိဳးျခင္း • အခုအခံမ်ားကုိတပ္ဆင္ထားေပးမႈမရွိျခင္း သုိ႔မဟုတ္ တပ္ဆင္ထားပါက လည္း အရည္အေသြးမမီသည္႔အတြက္ အခ်ိန္တုိအတြင္း ပ်က္စီးျခင္း • ျဖဳတ္ႏုိင္သည္႔အစိတ္အပုိင္းေပ်ာက္သြားျခင္း refae*sm\tcef;u@ ဘီးတပ္ထုိင္ခုံမ်ားအား အလႈအတန္းမွလက္ခံရယူျခင္း သုိ႔မဟုတ္ ဝယ္ယူျခင္းမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈ မန္ေနဂ်ာမ်ားသည္အဓိကအခန္းမွပါဝင္ေနၾကပါသည္။ အေသးစိတ္ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိ မန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္ကုိေလ႔လာပါ။ ၎တို႔၏အခန္းက႑မွာ ေအာက္ပါတုိ႔ကုိေဆာင္ရြက္ ရန္ျဖစ္သည္- • ဘီးတပ္ထုိင္ခုံသံုးစဲြသူမ်ား၏မတူညီေသာလုိအပ္ခ်က္မ်ားအား (အတတ္ႏုိင္ဆံုး) ျဖည္႔ဆည္းေပးႏုိင္ေရးအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ ဘီးတပ္ထုိင္ခုံမ်ားႏွင္႔အခုအခံမ်ားအားေရြးခ်ယ္ႏုိင္စြမ္းရွိေစရန္၊ ထုိသုိ႔ေရြးခ်ယ္ ႏုိင္ ရန္ မတူညီေသာအရြယ္အစားအတုိင္းအတာ၊ ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳမႈ၊ ပတ္ဝန္းက်င္ေရးရာႏွင္႔ ေနထုိင္မႈ ဘဝပံုစံလုိအပ္ခ်က္မ်ားကုိ ထည္႔သြင္းစဥ္းစားရမည္ျဖစ္သည္။ 48 49 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ • ေရြးခ်ယ္သည္႔ဘီးတပ္ထုိင္ခုံမ်ားသည္ တာရွည္ခံရမည္၊ အထူးသျဖင္႔ ၾကမ္းတမ္းေသာေျမမ်က္ႏွာျပင္ႏွင္႔ ပတ္ ဝန္းက်င္မ်ားတြင္ သံုးရမည္႔အေနအထားမ်ိဳးတြင္ျဖစ္သည္။ • ဘီးတပ္ထုိင္ခုံမ်ားအား ေဒသႏၲရျပဳျပင္ႏုိင္ရမည္။ ထုိသုိ႔ျပင္ဆင္ရာတြင္ အပုိပစၥည္းမ်ားအား ဝယ္ယူႏုိင္ျခင္း (သုိ႔မဟုတ္ အလႈမွရျခင္း) သုိ႔မဟုတ္ အပုိပစၥည္းမ်ားအား ေဒသႏၲရအတြင္း လြယ္ကူစြာဝယ္ယူႏုိင္ျခင္းရွိရမည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းက ေထာက္ပံ႔ေပးေသာပစၥည္းမ်ားႏွင္႔ပတ္သက္၍ ဘီးတပ္ထုိင္ခုံ အသံုး ျပဳသူထံမွ ျပန္လွန္အၾကံျပဳခ်က္ကို လုိလုိလားလားရယူရန္အေရးၾကီးပါသည္။ မန္ေနဂ်ာမ်ားႏွင္႔ဝန္ေဆာင္မႈလုပ္ငန္း ဝန္ထမ္းမ်ားသည္ အသံုးျပဳသူမ်ား၏အိမ္မ်ားသုိ႔ သြားေရာက္ျခင္း၊ အုပ္စုအစည္းအေဝးျပဳလုပ္ျခင္း သုိ႔မဟုတ္ မသန္ စြမ္းအဖြဲ႔အစည္းမ်ားမွတဆင္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားႏွင္႔ ထိေတြ႔ဆက္ဆံေျပာဆုိႏုိင္ပါသည္။ ဘီးတပ္ထုိင္ခုံ သုိ႔မဟုတ္ အခုအခံပံုစံအသစ္တစ္မ်ိဳးအား ပထမဆံုးအၾကိမ္မိတ္ဆက္ေတာ႔မည္ဆုိပါက ဝန္ ေဆာင္မႈလုပ္ငန္း လုပ္ကုိင္သူသည္ ယင္းပစၥည္းသစ္ကုိ အခ်ိန္အတုိင္းအတာတစ္ခုအထိ စမ္းသပ္သံုးစြဲျပီး ျပန္လွန္ အၾကံျပဳခ်က္မ်ားေပးမည္႔ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူအုပ္စုအခ်ိဳ႕ႏွင္႔အတူ ပစၥည္းစမ္းသပ္မႈကုိျပဳလုပ္ရမည္။ ယင္းအၾကံျပဳ ခ်က္မ်ားအားတစ္ဦးခ်င္းေတြ႔ဆံုေမးျမန္း၍ျဖစ္ေစ၊ အဓိကထားသည္႔အုပ္စုထံမွျဖစ္ေစ ျပန္လည္စုေဆာင္းရယူရမည္ ျဖစ္ပါသည္။ မန္ေနဂ်ာမ်ားအေနျဖင္႔ ၎တုိ႔ဝယ္ယူထားေသာ သုိ႔မဟုတ္ ရရွိထားေသာ ဘီးတပ္ထုိင္ခုံမ်ားသည္ တာရွည္အသံုးခံျပီး ျပင္ဆင္ႏုိင္ေၾကာင္းေသခ်ာေစရန္ မည္သုိ႔ေဆာင္ရြက္ႏုိင္သနည္း။ 48 49 မန္ေနဂ်ာမ်ားသည္ ဘီးတပ္ထုိင္ခုံႏွင္႔ပတ္သက္သည္႔အခ်က္အလက္မ်ားအား ပုိမုိသိရွိရန္ပစၥည္းေပးသြင္းသူ (သုိ႔မဟုတ္ အလႈရွင္) အား စံုစမ္းေမးျမန္းမႈမ်ားျပဳလုပ္ႏုိင္ပါသည္။ ဥပမာ- မန္ေနဂ်ာမ်ားသည္ ေအာက္ပါ တုိ႔ကုိ ေမးျမန္းႏုိင္သည္- • ဘီးတပ္ထုိင္ခုံသည္ အသိအမွတ္ျပဳစံႏႈန္းတစ္ခုခု (ဥပမာ- လုပ္ငန္းကြၽမ္းက်င္သူအဖြဲ႔တစ္ခုက သတ္မွတ္ထားသည္႔ စြမ္းေဆာင္ရည္စမ္းသပ္မႈႏွင္႔အရည္အေသြးအာမခံခ်က္စစ္ေဆးမႈ) ကို ေအာင္ျမင္ထားျခင္းရွိ/မရွိ၊ အေျဖက ေအာင္ျမင္ထားပါသည္ဟူ၍ျဖစ္လွ်င္ ရလဒ္ကမည္သုိ႔ရွိသနည္း၊ • ဘီးတပ္ထုိင္ခုံအတြက္ ပစၥည္းေပးသြင္းသူက သက္တမ္းအာမခံခ်က္ေပးသေလာ၊ • အမွားအယြင္းမ်ားႏွင္႔ပတ္သက္၍ ပစၥည္းေပးသြင္းသူအေနျဖင္႔ သတင္းေပးသည္႔စနစ္ရွိသေလာ၊ • ဘီးတပ္ထုိင္ခုံမ်ားအား မည္သူကဝယ္ယူအသံုးျပဳမည္နည္း၊ ဘီးတပ္ထုိင္ခုံ၏စြမ္းေဆာင္ရည္ႏွင္႔ ပတ္သက္ျပီး ပုိမုိသိရွိႏုိင္ရန္ ဘီးတပ္ထုိင္ခုံေပးသြင္းေနသည္႔ အျခားေသာဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအား မန္ေနဂ်ာ အေနျဖင္႔ဆက္သြယ္ရန္ ျဖစ္ႏုိင္ေခ်ရွိ/မရွိ။ • ဘီးတပ္ထုိင္ခုံအားတပ္ဆင္ရန္ သို႔မဟုတ္ ခ်ိန္ညွိရန္ မည္သည္႔လက္သံုးကိရိယာမ်ား လုိသနည္း၊ • အပုိပစၥည္းမ်ားရႏုိင္သေလာ၊ ယင္းအပုိပစၥည္းမ်ားအား ႏုိင္ငံျခားကဝယ္ယူရျခင္းေလာ သုိ႔မဟုတ္ လုိအပ္မည္႔အပုိပစၥည္းအခ်ိဳ႕ကုိ ႏုိင္ငံအတြင္းရရွိႏုိင္သေလာ၊ • ႏုိင္ငံအတြင္းဘီးတပ္ထုိင္ခုံကုိ စမ္းသပ္ၾကည္႔ျပီးျပီေလာ၊ စမ္းသပ္ျပီးပါက မည္သုိ႔ေသာအၾကံျပဳခ်က္၊ ရလဒ္မ်ိဳး ထြက္ေပၚသနည္း၊ • ေဘာင္ဘရိတ္ျဖစ္ပါက ယင္းဘရိတ္မ်ားကုိ ျပည္တြင္းတြင္ျပင္ဆင္ႏုိင္ျခင္းရွိ/မရွိ • ဘီးတပ္ထုိင္ခုံတြင္ ခုံထိန္းသိမ္းေရးလမ္းညႊန္ပါဝင္ျခင္းရွိ/မရွိ။ bD;wyfxkdifckH xdef;odrf;jcif;? jyifqifjcif;ESifh aemufqufwGJvkyfief; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔ (၈) သည္ ေနာက္ဆက္တြဲျပသျခင္းလုပ္ငန္း၊ ထိန္းသိမ္းျခင္းႏွင္႔ ျပဳျပင္ျခင္းျဖစ္သည္။ 50 51 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေနာက္ဆက္တြဲ လုပ္ေဆာင္ျခင္း၊ ထိန္းသိမ္းျခင္းႏွင့္ ျပင္ဆင္ျခင္း ေနာက္ဆက္တြဲျပန္လည္ျပသရန္ခ်ိန္းဆုိမႈသည္ ဘီးတပ္ထုိင္ခုံသည္ အံဝင္ခြင္က် ျဖစ္မျဖစ္ဆုိသည္ကုိ စစ္ေဆးႏုိင္မည႔္အခြင္႔အေရးပင္ျဖစ္ျပီး ေလ႔က်င္႔သင္တန္းေပးမႈႏွင္႔ အေထာက္အကူျပဳမႈမ်ားအား ထပ္မံျပဳလုပ္ေပးႏုိင္မည္ျဖစ္သည္။ ထုိသုိ႔ေဆာင္ရြက္ႏုိင္ရန္အတြက္ အခ်ိန္မွာ အသံုးျပဳသူ၏လုိအပ္ခ်က္ေပၚတြင္လည္းေကာင္း၊ အျခားေသာ ဝန္ေဆာင္မႈလုပ္ငန္းရရွိမႈေပၚတြင္လည္းေကာင္း မူတည္မည္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ရပ္ကြက္အတြင္း အလြယ္တကူ ေျဖရွင္းရန္ မလြယ္ကူသည္႔ နည္းပညာပုိင္းဆိုင္ရာျပႆနာမ်ားအား ေျဖရွင္းေပးႏုိင္ ေရးအတြက္ ထိန္းသိမ္းမႈႏွင္႔ ျပဳျပင္မႈလုပ္ငန္းမ်ားကုိလည္း ေဆာင္ရြက္ေပးႏုိင္မည္ျဖစ္ပါသည္။ ဤအဆင္႔၏အေရးၾကီးေသာအပုိင္းမွာ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူႏွင္႔ ၎တုိ႔၏မိသားစုဝင္မ်ားအား ဘီးတပ္ထုိင္ခုံကုိ မည္သုိ႔ထိန္းသိမ္းရ မည္ဆုိသည္ကုိ သင္ၾကားျပသျခင္းျဖစ္သည္။ အိမ္တြင္ေဆာင္ရြက္ ေသာပံုမွန္ထိန္းသိမ္းမႈသည္ ဘီးတပ္ထုိင္ခုံအား ေရရွည္ခံႏုိင္ရန္ အေထာက္အကူျဖစ္ေစျပီး အၾကီးစားျပဳျပင္မႈမ်ားျပဳလုပ္ရမည္႔ကိစၥ မ်ားကိုလည္း ေလ်ာ႔က်သြားေစမည္ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသည္ ေပါင္းစပ္ညွိႏႈိင္းေဆာင္ရြက္လ်က္ရွိေသာမိတ္ဖက္မ်ားကုိလည္း ထိန္းသိမ္း ေရးႏွင္႔ ျပဳျပင္ေရးဝန္ေဆာင္မႈလုပ္ငန္းမ်ားႏွင္႔ပတ္သက္ျပီး ေလ႔က်င္႔သင္ၾကားေပးရမည္ျဖစ္ပါသည္။ ထုိ႔အျပင္ ဘီးတပ္ထုိင္ခုံ ထိန္းသိမ္းေရးႏွင္႔ျပဳျပင္ေရးကုိေဆာင္ရြက္ႏုိင္ေသာ ရပ္ကြက္အတြင္းရွိအရင္းအျမစ္မ်ား (ဥပမာ- စက္ဘီးျပင္ဆုိင္) မ်ားကုိလည္း သတ္မွတ္ေပးထားရမည္။ c .4/ 0efaqmifolrsm;tm; ae&mcsxm;jcif; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအတြင္းရွိအခန္းက႑ မ်ားေသာအားျဖင္႔ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းကုိ အဖြဲ႔တစ္ခုအသြင္ျဖင္႔ေဆာင္ရြက္ေနေသာ အုပ္စု တစ္ခုက ေဆာင္ရြက္ေလ႔ရွိသည္။ မတူညီေသာအဖြဲ႔ဝင္မ်ားသည္ မတူညီေသာက႑မ်ားကုိျဖည္႔ဆည္းေပးသည္။ ဥပမာ- ေဆးခန္း၊ စက္မႈလုပ္ငန္း၊ ေလ႔က်င္႔သင္တန္းေပးျခင္း၊ အုပ္ခ်ဳပ္မႈ ႏွင္႔စီမံခန္႔ခြဲေရးလုပ္ငန္းမ်ားျဖစ္သည္။ မတူညီေသာတစ္ဦးခ်င္းစီသည္က႑တစ္ခု သုိ႔မဟုတ္ ထုိထက္ပုိျပီးျဖည္႔ဆည္းေပးႏုိင္သည္။ ဥပမာ-ေဆးခန္း အပုိင္းတြင္ ေဆာင္ရြက္ေသာသူတစ္ဦးသည္ ဝန္ေဆာင္မႈလုပ္ငန္းအားစီမံခန္႔ခြဲျခင္းလုပ္ငန္းကုိလည္း ေဆာင္ရြက္ႏုိင္ ျခင္းမ်ိဳးျဖစ္ပါသည္။ အခ်ိဳ႕ေသာအေျခအေနမ်ားတြင္ မတူညီသည္႔အသင္းအဖြဲ႔မ်ားမွ ဝန္ထမ္းမ်ားသည္ မတူညီေသာ အခန္းက႑မ်ားအား ျဖည္႔ဆည္းေပးႏုိင္ရန္ အတူတကြလုပ္ေဆာင္ျခင္းမ်ိဳးလည္း ရွိပါသည္။ 50 51 ေအာက္တြင္ေဖာ္ျပထားေသာဇယားသည္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔ပတ္သက္ေသာ ေဆာင္ ရြက္ခ်က္မ်ားအတြင္း မတူညီသည္႔က႑မ်ားအား ျဖည္႔ဆည္းေပးေနၾကသည္႔ဝန္ထမ္းမ်ား မည္သုိ႔ပါဝင္ေဆာင္ ရြက္ေနသည္ဆုိသည္ကုိ ေဖာ္ျပထားသည္ - ေဆ းေ ပး ခန ္း စက ္မႈလ ုပ္င န္း ဘ ီးတ ပ္ထ ုိင္ခ ုံ သ ုံးစ ြဲသ ူမ် ား အ တ ြက ္ သ င္တ န္း အ ုပ္ခ ်ဳပ ္မႈလ ုပ္င န္း စီမ ံခန ္႔ခြဲေ ရး လ ုပ္င န္း ၀န္ေဆာင္မႈ စီမံခန္႔ခြဲမႈႏွင့္ ဖြံ႔ၿဖိဳးတုိးတက္မႈ ၀န္ေဆာင္မႈလုပ္ငန္းကုိ ျမွင့္တင္ျခင္း      ရန္ပုံေငြ ရွာေဖြျခင္း  လႊဲေျပာင္းေပးမည့္ အရင္းအျမစ္ ေဖၚထုတ္ျခင္း     အျခားအသင္းအဖြဲ႔ မ်ားႏွင့္ညွိႏႈိင္းျခင္း      ဝန္ေဆာင္မႈလုပ္ငန္း အကဲျဖတ္ျခင္း      ဝန္ေဆာင္မႈေပးရာတြင္ အဓိကက်သည့္အဆင့္မ်ား ၁။ လြဲေျပာင္းျခင္း ႏွင့္ ခ်ိန္းဆုိျခင္း     ၂။ အကဲျဖတ္ျခင္း    ၃။ ညႊန္ၾကားျခင္း    ၄။ ရန္ပုံေငြ ႏွင့္ စီစဥ္ျခင္း     ၅။ ထုတ္ကုန္ ႀကိဳတင္ ျပင္ဆင္ျခင္း  ၆။ အံဝင္ခြင္က် တပ္ဆင္ျခင္း   52 53 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ၇။ အသုံးျပဳသူ အတြက္ သင္တန္း    ၈။ ေနာက္ဆက္တြဲ လုပ္္ငန္း၊ ထိန္းသိမ္းျခင္း၊ ျပင္ဆင္ျခင္း    သင္တန္းႏွင့္ လုပ္ငန္းကၽြမ္းက်င္မႈကုိ တုိးတက္ေစျခင္း လႊဲေျပာင္းေရး ကြန္ယက္ဝန္ထမ္းမ်ား သင္တန္း    ဝန္ေဆာင္သူ ကြန္ယက္ သင္တန္း    ဝန္ေဆာင္မႈေပးသည့္ ဝန္ေဆာင္သူ သင္တန္း    52 53 သင္တန္း သင္႔ေတာ္ေသာသင္တန္းမ်ားကုိျပဳလုပ္ေပးေနသေရြ႔ မတူညီေသာပညာေရးႏွင္႔ ကြၽမ္းက်င္မႈေနာက္ခံမတူ ညီသည္႔မည္သူမဆုိ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားကုိေဆာင္ရြက္ႏုိင္မည္ျဖစ္သည္။ ေဆးေပးခန္းလုပ္ငန္း၊ စက္မႈလုပ္ငန္း ႏွင္႔ သင္တန္းက႑မ်ားတြင္ ပါဝင္ေနသည္႔ဝန္ထမ္းမ်ားအား သင္တန္းေပးေရးမွာ အေရးၾကီးပါသည္။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈေပးေနသည္႔ေဆးေပးခန္းႏွင္႔စက္မႈဝန္ထမ္းမ်ားကုိ WHO ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ သင္တန္းစံႏွင္႔သတ္မွတ္ခ်က္မ်ား - အေျခခံအဆင္႔တြင္ ေဖာ္ျပထားေသာ အရည္အခ်င္းမ်ားကုိပုိ႔ခ်ေပးရန္ လုိ အပ္ပါသည္။ • အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈေပးေနသည္႔ ေဆးေပးခန္းႏွင္႔စက္မႈဝန္ထမ္းမ်ားကုိ WHO ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈသင္တန္းစံႏွင္႔သတ္မွတ္ခ်က္မ်ား - အလယ္အလတ္အဆင္႔တြင္ေဖာ္ျပထားေသာ အရည္အခ်င္းမ်ား ကုိ ပုိ႔ခ်ေပးရန္ လုိအပ္ပါသည္။ မွတ္သားရန ္- ဝန္ထမ္းမ်ားအားကြၽမ္းက်င္မႈသင္တန္းမ်ားေပးရာတြင္တစ္ၾကိမ္လွ်င္ အနည္းဆံုးႏွစ္ဦးအထိ ေပး သင္႔သည္။ တစ္ဦးတည္းကုိသာသင္တန္းေပးပါက ဝန္ေဆာင္မႈလုပ္ငန္း၏အေျခအေနမွာ အတိမ္းအေစာင္း မခံသည္႔အေျခအေန ျဖစ္သြားႏုိင္သည္။ အဘယ္ေၾကာင္႔ဆုိေသာ္ တစ္ဦးတည္းေသာထုိပုဂၢိဳလ္ထြက္သြားသည္ ဆုိပါက အေတြ႔အၾကံဳႏွင္႔ဗဟုသုတမ်ားသည္ ၎ႏွင္႔အတူ ပါသြားႏုိင္ျခင္းေၾကာင္႔ျဖစ္ပါသည္။ 0efaqmifrIvkyfief;pGrf;aqmif&nftwGuf pDrHjcif; တစ္လခ်င္းစီႏွင္႔တစ္ႏွစ္ခ်င္းစီအတြက္ ဘီးတပ္ထုိင္ခုံအသုံးျပဳသူမည္မွ်အား ဝန္ေဆာင္မႈေပးႏုိင္မည္ဆုိ သည္႔ အေပၚအေျခခံျပီး မန္ေနဂ်ာမ်ားအေနျဖင္႔ ၎တုိ႔၏ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအား စီမံထားရန္လုိမည္ျဖစ္ ပါသည္။ ယင္းကုိ ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္ဟု ေခၚပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္တြင္ ေအာက္ပါအခ်က္မ်ား ပါဝင္ပါသည္- • ဘီးတပ္ထုိင္ခုံအား ပထမဆံုးအၾကိမ္အျဖစ္ရရွိမည္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအေရအတြက္ • ေနာက္ဆက္တြဲျပန္လည္ျပသမည္႔ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူအေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္သည္ ေအာက္ပါအခ်က္မ်ားႏွင္႔ တုိက္ရုိက္ဆက္စပ္ေနပါသည္- • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ေပးႏုိင္သည္႔ဝန္ထမ္းအေရအတြက္ • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ရာတြင္ဝန္ထမ္းမ်ားေပးႏုိင္မည္႔အခ်ိန္ • ဝန္ေဆာင္မႈလုပ္ငန္းကဝယ္ယူႏုိင္မည္႔ဘီးတပ္ထုိင္ခုံအေရအတြက္၊ ယင္းသည္ ဘတ္ဂ်က္ႏွင္႔တုိက္ရုိက္ ဆက္ ႏြယ္ေနသည္။ 54 55 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 0efaqmifolrsm;\tcsdefukd wGufcsufjcif; ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္ကုိ ခန္႔မွန္းႏုိင္ရန္အတြက္ မန္ေနဂ်ာမ်ားသည္ ၎တုိ႔၏ဝန္ထမ္းမ်ား အေနျဖင္႔ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေပၚ အခ်ိန္မည္မွ်ေပးႏုိင္မည္ဆုိသည္ကုိ တြက္ခ်က္ႏုိင္ရန္ လုိအပ္ သည္။ ထုိသုိ႔ေဆာင္ရြက္ႏုိင္ရန္မန္ေနဂ်ာမ်ားအေနျဖင္႔ ေအာက္ပါအခ်က္မ်ားကုိသိထားရန္လုိပါသည္- • အမ်ားျပည္သူအလုပ္ပိတ္ရက္ႏွင္႔ခြင္႔မ်ားကုိ ႏႈတ္ျပီး တစ္ႏွစ္အတြင္းရရွိႏုိင္မည္႔ အလုပ္ခ်ိန္သီတင္းပါတ္မ်ားအေရ အတြက္ • အျခားေသာတာဝန္မ်ား၊ အခန္းက႑မ်ား၊ ေဆာင္ရြက္ခ်က္မ်ားမပါ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း ေဆာင္ ရြက္မႈအေပၚ ဝန္ထမ္းမ်ားအသံုးျပဳမည္႔အခ်ိန္ရာခုိင္ႏႈန္း မန္ေနဂ်ာမ်ားအေနျဖင္႔ မတူညီေသာဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈအဆင္႔မ်ားအား ေဆာင္ရြက္ရာတြင္ ၎တုိ႔ ၏ဝန္ထမ္းမ်ားအခ်ိန္မည္မွ်ယူသည္ဆုိသည္ကုိလည္းစဥ္းစားထားရမည္ျဖစ္သည္။ ဤကိစၥအေပၚလႊမ္းမုိးေနသည္႔ အေၾကာင္းအခ်က္မ်ားစြာ ရွိသည္။ဥပမာ - ဝန္ေဆာင္မႈဝန္ထမ္းသည္လူသစ္ေလာ၊ အေတြ႔အၾကံဳရွိသူေလာ၊ ေထာက္ ပံ႔ေပးထားသည္႔ဘီးတပ္ထုိင္ခုံမ်ားအားမြမ္းမံဆန္းသစ္ရန္လုိ/မလိုစသည္တုိ႔ျဖစ္သည္။ မည္သုိ႔ပင္ျဖစ္ေစ အေတြ႔အ ၾကံဳရွိေသာအဖြဲ႔ (ေဆးေပးခန္း ႏငွ္႔ စက္မႈ)သည ္ဦးစီးဦးေဆာင္ျပဳသမူ်ားအေနျဖင္႔ ေအာကပ္ါတုိ႔ကု ိေဆာငရ္ြက္ ေပးႏိငုပ္ါသည-္ • ဘီးတပ္ထုိင္ခံုအသစ္ျဖင္႔ တစ္ေန႔လွ်င္ အေျခခံအဆင္႔ သံုးစြဲသူ ႏွစ္ဦး • ဘီးတပ္ထုိင္ခံုအသစ္ျဖင္႔ တစ္ေန႔လွ်င္ အလယ္အလတ္အဆင္႔ သံုးစြဲသူ တစ္ဦး ေအာက္ေဖာ္ျပပါဇယားသည္အတူတကြလုပ္ငန္းေဆာင္ရြက္ၾကသည္႔အင္အားႏွစ္ဦးပါအဖြဲ႔အေပၚအေျခခံ ျပီးနမူနာအျဖစ္ေဖာ္ျပထားသည္႔ ခန္႔မွန္းဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္ျဖစ္ပါသည္။ အဖြဲ႔ဝင္တစ္ဦးသည္ေဆး ေပးခန္းက႑ကုိ ျဖည္႔ဆည္းေပးျပီး အျခားတစ္ဦးက စက္မႈက႑ကုိျဖည္႔ဆည္းေပးပါသည္။ ႏွစ္ဦးစလံုးသည္ အသံုး ျပဳသူသင္တန္းကုိပုိ႔ခ်ေပးသည္။ ထုိအဖြဲ႔သည္ တစ္ပါတ္လွ်င္ ၅ ရက္ျဖင္႔တစ္ႏွစ္လွ်င္ ၄၂ ပတ္အလုပ္လုပ္သည္။ ဘီး တပ္ထုိင္ခံုႏွင္႔ပစၥည္းကိရိယာမ်ား အလံုအေလာက္ရွိပါက ထုိအဖြဲ႔သည္ ေအာက္ပါတုိ႔ကုိေဆာင္ရြက္ႏုိင္မည္ျဖစ္သည္- • တစ္ႏွစ္လွ်င္ အေျခခံအဆင္႔ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈျဖင္႔ ခန္႔မွန္း ဘီးတပ္ထုိင္ခံုအသံုးျပဳသူ ၃၅၇ ဦး • တစ္ႏွစ္လွ်င္အလယ္အလတ္အဆင္႔ဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈျဖင္႔ခန္႔မွန္း ဘီးတပ္ထုိင္ခံုအသံုးျပဳသူ ၁၇၉ ဦး အေျခခံ ဝန္ေဆာင္မႈ အလယ္တန္း အဆင့္ ဝန္ေဆာင္မႈ စီမံခ်က္အလုပ္ခ်ိန္ သီတင္းပတ္ အလုပ္ခ်ိန္ရက္မ်ား/တပတ္အတြင္း ၅ ၅ အလုပ္ခ်ိန္ သီတင္းပတ္မ်ား/ တႏွစ္အတြင္း (အားလပ္ရက္မ်ားႏွင့္ ခြင့္မ်ားႏႈတ္ၿပီး) ၄၂ ၄၂ 54 55 ခန္႔မွန္းဝန္ေဆာင္မႈလုပ္ငန္း စြမ္းေဆာင္ရည္ ဝန္ေဆာင္မႈအသုံးျပဳသူမ်ား/တရက္အတြင္း ၂ ၁ ဝန္ေဆာင္မႈအသုံးျပဳသူမ်ား/တပတ္အတြင္း ၁၀ ၅ ဝန္ေဆာင္မႈအသုံးျပဳသူမ်ား/တႏွစ္အတြင္း ၄၂၀ ၂၁၀ ခန္႔မွန္းအေရးေပၚအျဖစ္အပ်က္မ်ား ၁၅% (မေမွ်ာ္လင့္ေသာျဖစ္ရပ္မ်ား) -၆၃ -၃၂ ဝန္ေဆာင္မႈအသုံးျပဳသူမ်ား ခန္႔မွန္းအေရအတြက္/တႏွစ္အတြင္း ၃၅၇ ၁၇၉ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအဖြဲ႔ထူေထာင္ျခင္း သုိ႔မဟုတ္ ေဖာ္ထုတ္ျခင္း၌ မန္ေနဂ်ာ၏အခန္းက႑ • ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း မတူညီသည္႔က႑မ်ားတြင္ပါဝင္ရန္ လက္ရွိဝန္ထမ္း သုိ႔မဟုတ္ ဝန္ထမ္းအသစ္ကုိ သတ္မွတ္ရန္ • အေျခခံအရည္အေသြးမ်ားမရရွိေသးသည္႔အဆုိပါဝန္ထမ္းမ်ားအားသင္တန္းေပးေရးအတြက္စီစဥ္ရန္ • ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအေပၚဝန္ထမ္းမ်ားေပးႏုိင္မည္႔အခ်ိန္ကုိသတ္မွတ္ရန္၊ ထုိအခ်ိန္သည္ ၎တုိ႔ထမ္းေဆာင္ေနရေသာ အျခားေသာ တာဝန္မ်ား၊ အခန္းက႑မ်ားႏွင္႔ လႈပ္ရွားေဆာင္ရြက္မႈမ်ား အေပၚအေျခ ျပဳထားျခင္းျဖစ္ေစရန္၊ • ႏွစ္စဥ္ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္ကုိခန္႔မွန္းျပီးအဖြဲ႔သုိ႔အသိေပးရန္ • ဝန္ထမ္းမ်ားအား ၎တုိ႔ပါဝင္ရမည္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈအခန္းက႑အတြက္ အေထာက္အကူေပးရန္- ဥပမာ- o ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ စီမံခ်က္ေရးဆြဲရာတြင္ဝန္ထမ္းမ်ား ပါဝင္လာေစရန္ o ရက္သတၱပတ္/လပတ္ စီမံခ်က္ဇယားေရးဆြဲရန္၊ ယင္းတြင္တာဝန္ေပးမႈႏွင္႔ အျခားေသာေဆာင္ရြက္ခ်က္မ်ား ထည္႔သြင္းရန္ o လုပ္ငန္းတုိးတက္မႈအေျခအေနကုိဆန္းစစ္ရန္အတြက္အပတ္စဥ္ေဆြးေႏြးပဲြျပဳလုပ္ရန္၊ ေအာင္ျမင္မႈမ်ားကုိ အေလးေပးေဖာ္ျပျပီး စိန္ေခၚမႈမ်ားအား ကုိင္တြယ္ေျဖရွင္းရန္ 56 57 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ c .5/ bD;wyfxkdifckH 0efaqmifrIvkyfief;wcktwGuf rnfrQukefusoenf;/ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းကုန္က်စရိတ္ကုိသတ္မွတ္ေရးမွာမန္ေနဂ်ာ၏အေရးၾကီးေသာ က႑ တစ္ရပ္ ျဖစ္ပါသည္။ ေအာက္ေဖာ္ျပပါဇယားသည္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈလုပ္ငန္တစ္ခုထူေထာင္ျခင္းႏွင္႔ လုပ္ကုိင္ေဆာင္ရြက္ျခင္းအတြက္ အသံုးျပဳေလ႔ရွိသည္႔ ဘတ္ဂ်က္ပံုစံျဖစ္ပါသည္- ဘတ္ဂ်က္အမ်ိဳးအစား ရွင္းလင္းခ်က္ အစပ်ိဳး ကုန္က်စရိတ္ ထုတ္ကုန္ဒီဇုိင္း ထုတ္ကုန္မ်ားကုိ ရွာေဖြျခင္း လက္သုံးပစၥည္းမ်ား ပစၥည္းကိရိယာမ်ား အေဆာကအ္အု/ံအသုံးအေဆာငမ္်ား အေဆာက္အအံုျပင္ဆင္ျခင္း/ျပန္လည္မြမ္းမံျခင္းလုပ္ငန္းမ်ားပါဝင္ႏုိင္ပါ သည္။ ပစၥည္းသုိေလွာင္မႈ လုပ္ငန္းကုန္က်စရိတ္မ်ား ဘီးတပ္ထုိင္ခုံ လုပ္ငန္းစြမ္းေဆာင္မႈႏွင္႔ေမွ်ာ္မွန္း ေဖာက္သည္ဘီးတပ္ထုိင္ခံု အသံုးျပဳသူ လုိအပ္ခ်က္ခန္႔မွန္းေျခအေပၚအေျချပဳထားသည္႔ ဘီးတပ္ထုိင္ခံုသုိေလွာင္မႈ အပုိပစၥည္းမ်ား အသံုးမ်ားျပီးလုိအပ္ေလ႔ရွိသည္႔အပုိပစၥည္းမ်ားအားသုိေလွာင္ထားရွိမႈ သည္ လြန္စြာ အသံုးဝင္ပါသည္။ ပစၥည္းမ်ား တင္သြင္းသည္႔ ဘီးတပ္ထုိင္ခံုမ်ားအတြက္ ပုိ႔ေဆာင္ျခင္းႏွင္႔ အေကာက္ ခြန္၊ ဘီးတပ္ထုိင္ခုံမ်ားအား အစြန္အဖ်ားေဒသမ်ားသုိ႔တင္ပုိ႔ ျခင္း၊ သယ္ပုိ႔(ထုတ္ကုန္ သယ္ယူပုိ႔ေဆာင္ေရး) တင္သြင္းသည္႔ဘီးတပ္ထုိင္ခံုမ်ားအတြက္ပုိ႔ေဆာင္ျခင္းႏွင္႔အေကာက္ ခြန္၊ ဘီးတပ္ထုိင္ခုံမ်ားအား အစြန္အဖ်ားေဒသမ်ားသုိ႔တင္ပုိ႔ျခင္း၊ ဝန္ထမ္းေရးရာ စီမံခန္႔ခြဲေရး ဘတ္ဂ်က္လမ္းညႊန္တြင္ ဝန္ထမ္းျဖစ္ရန္အလားအလာရွိသူ အမ်ားအျပားကုိ စာရင္းသြင္းထားရမည္။ ဝန္ေဆာင္မႈတစ္ခုခ်င္းစီသည္ ေဖာ္ျပပါ ဝန္ထမ္းအားလံုးကုိလုိအပ္မည္ မဟုတ္ပါ။ အမွတ္အသား (ဇယားစာတုိင္ကုိၾကည္႔ပါ) သည္ ဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔မ်ား ႏွင္႔ပတ္သက္သည္႔ လုပ္ငန္း ေဆာင္ရြက္ခ်က္မ်ားျဖစ္ပါသည္။ အဖြဲ႔ဝင္ဝန္ထမ္းတစ္ဦးသည္ အလုပ္ တစ္ခုထက္ပုိျပီးတာဝန္ယူေဆာင္ရြက္ႏုိင္ပါသည္။ ေဆးေပးခန္းဝန္ထမ္း နည္းပညာဝန္ထမ္း သင္တန္းဆရာ/အရည္အခ်င္းတူ သင္တန္းဆရာ အုပ္ခ်ဳပ္ေရးမွဴး 56 57 ေဒသတြင္း သယ္ယူပုိ႔ေဆာင္ေရး ဝန္ထမ္းမ်ားအား ေဒသတြင္း သယ္ယူပုိ႔ေဆာင္ေရး ဥပမာ - ေနာက္ဆက္တြဲျပန္လည္ျပသမႈ၊ နယ္ေက်ာ္ဝန္ေဆာင္မႈ၊ သင္တန္းလႊဲေျပာင္း ေပးမႈကြန္ယက္ အသံုးျပဳသူမ်ားအားေဒသႏၲရတြင္း သယ္ယူပုိ႔ေဆာင္ေပးျခင္း အသုံးျပဳသူမ်ားအား ေဒသတြင္း သယ္ယူပုိ႔ေဆာင္ေရး ခ်ိန္းဆုိထားမႈအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းရွိရာသုိ႔သြားေရာက္ျခင္း အသံုးျပဳသူမ်ားအတြက္ ေနရာထုိင္ခင္း ညအိပ္ေနထုိင္ရန္လုိေသာအသံုးျပဳသူမ်ားအတြက္ေနရာထုိင္ခင္း စီစဥ္ေပးရသည္႔ ကုန္က်စရိတ္ (ယင္းကုိဝန္ေဆာင္မႈလုပ္ငန္းက က်ခံ/ေထာက္ပံ႔ေပးမည္ဆုိလွ်င္) ပံုႏွိပ္စာရြက္စာတမ္းမ်ား ပံုစံမ်ား၊ စစ္ေဆးေရးပံုစံမ်ား၊ အသံုးျပဳသူအတြက္သတင္းအခ်က္ အလက္မ်ား သံုးကုန္ပစၥည္းမ်ား ဥပမာ - ေကာ္၊ အပ္ခ်ည္ၾကိဳး၊ သုတ္ေဆးမ်ား လက္သံုးပစၥည္း အစားထုိးလဲလွယ္ျခင္း ေဟာင္းႏြမ္းသြားသည္႔လက္သံုးကိရိယာမ်ားအား အစားထုိးရန္ ဘတ္ဂ်က္လုိသည္ အေထြေထြအသံုးစရိတ္ မတူညီသည္႔ဝန္ေဆာင္မႈနယ္ေျမမ်ားျဖစ္ေသာ ေဆးခန္း၊ စက္မႈလုပ္ငန္း၊ သုိေလွာင္ရံု၊ အသံုးျပဳသူသင္တန္း၊ ႏွင္႔ရုံးမ်ားအတြက္ လွ်ပ္စစ္မီး၊ ေရ၊ ငွားရမ္းခမ်ားကုိ ထည္႔သြင္း စဥ္းစားရမည္။ ဝန္ထမ္းမ်ားအတြက္သင္တန္း ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားအတြက္ မည္သည္႔သင္တန္းကုန္က် စရိတ္မ်ိဳးကုိမဆုိ ထည္႔သြင္းစဥ္းစားထားရမည္ မိတ္ဖက္မ်ား/လႊဲေျပာင္းေပးသည္႔ ကြန္ယက္မ်ားအတြက္ သင္တန္း မိတ္ဖက္မ်ားသုိ႔မဟုတ္လႊဲေျပာင္းေပးမည္႔ကြန္ယက္အဖြဲ႔အစည္းမ်ား အတြက္ သင္တန္း/အသိပညာတုိးျမင္႔ေရးေဆာင္ရြက္ခ်က္မ်ားကုိ ထည္႔ သြင္းစဥ္းစားရမည္။ ရန္ပုံေငြ ရွာေဖြျခင္း ရန္ပံုေငြရွာေဖြမည္သည္႔ေဆာင္ရြက္ခ်က္အတြက္မဆုိ ဘတ္ဂ်က္ေရးဆြဲထားရမည္။ ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔ အကဲျဖတ္ သံုးသပ္ျခင္း ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔ အကဲျဖတ္သံုးသပ္ျခင္းႏွင္႔ဆက္ႏြယ္ေသာ ကုန္က်စရိတ္မ်ား ဥပမာ - ျပန္လွန္အၾကံျပဳခ်က္မ်ားစုေဆာင္းရယူေရး အတြက္ဝန္ေဆာင္မႈလုပ္ငန္း အသံုးျပဳသူမ်ားထံသြားေရာက္ျခင္းျဖစ္ သည္။ ယင္းကုန္က်စရိတြင္ခရီးစရိတ္ႏွင္႔ အပုိပါလာေသာ ဝန္ထမ္း မ်ား၏ စရိတ္မ်ားပါဝင္သည္။ ukefusp&dwfoufomaom ajz&Sif;csufrsm; အရင္းအျမစ္နည္းပါးေသာေဒသမ်ားတြင္ တာဝန္ထမ္းေဆာင္ေနေသာမန္ေနဂ်ာမ်ားသည္ အသံုးစရိတ္ ေလွ်ာ႔ခ်ႏုိင္မည္႔နည္းလမ္းမ်ားကုိ စဥ္းစားထားရန္လုိသည္။ အသံုးစရိတ္ကုိေလွ်ာ႔ခ်ႏုိင္သည္႔နည္းလမ္းအခ်ိဳ႕မွာ ေအာက္ပါအတုိင္း ျဖစ္သည္- 58 59 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 0efaqmifrIvkyfief;rsm;ukd aygif;pnf;jcif; • အသံုးအေဆာင္မ်ားအားထိထိေရာက္ေရာက္မွ်ေဝသံုးစြဲသည္႔ ေပါင္းစည္းဝန္ေဆာင္မႈတစ္ခုသည္ ဝန္ေဆာင္မႈ လုပ္ငန္းတစ္ခုခ်င္းစီထူေထာင္ထားျခင္းႏွင္႔ႏႈိင္းစာပါက စရိတ္မွ်ေဝက်ခံျခင္းအခြင္႔အေရးကုိ သိသိသာသာ ေပး စြမ္းႏုိင္မည္ျဖစ္သည္။ tjcm;aomtoif;tzGJYrsm;ESifh p&dwfrQa0uscHjcif; ကုန္က်စရိတ္မ်ားကုိမွ်ေဝက်ခံရန္ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုသည္ အျခားေသာအသင္းအဖြဲ႔မ်ားႏွင္႔ မိတ္ ဖက္ျပဳလုပ္ႏုိင္ပါသည္။ ဥပမာ ေအာက္ပါအတုိင္းျဖစ္သည္- • အခ်ိဳ ႔ေသာႏုိင္ငံတကာအလႈရွင္မ်ား/ဖြံ ႔ျဖိဳးတိုးတက္ေရးအသင္းအဖြဲ ႔မ်ားသည္ဘီးတပ္ထိုင္ခံုအတြက္ကုန္က် စရိတ္ကုိ မွ်ေဝက်ခံေပးရန္စိတ္ပါဝင္စားမႈရွိႏုိင္သည္။ ထုိသုိ႔ေဆာင္ရြက္ျခင္းျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းဌာနမ်ား ရရွိႏုိင္သည္႔အက်ိဳးအျမတ္မွာ ထုတ္ကုန္မ်ားကုိဝယ္ယူႏုိင္သည္႔အင္အား ပုိမုိလာျခင္းျဖစ္ပါသည္။ ႏုိင္ငံတကာ အဖြဲ႔အစည္းမ်ားအတြက္ အက်ိဳးအျမတ္မွာမူ ၎တုိ႔၏ရံပုံေငြမ်ားပုိမုိကြာလွမ္းေသာေနရာသုိ႔ေရာက္ရွိႏုိင္ျခင္း ျဖစ္ ျပီး ၎တို႔အေနျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းဌာနသည္ ဘ႑ာေရးတည္တ႔ံခုိင္မာမႈရရွိေအာင္ေဆာင္ရြက္ႏုိင္စြမ္းကုိ ျပသႏုိင္သည္႔အဖြဲ႔အျဖစ္ ရႈျမင္လာမည္ျဖစ္သည္။ • ေဒသႏၲရအဖြဲ႔အစည္းမ်ားကလည္းေဒသတြင္းဝန္ေဆာင္မႈလုပ္ငန္းမ်ားေပးႏုိင္ေရးအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္း ႏွင္႔ မိတ္ဖက္ျပဳလုပ္ရန္ဆႏၵရွိၾကမည္ျဖစ္သည္။ လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္မ်ားသည္လည္း အသံုးအ ေဆာင္မ်ားအား ေထာက္ပံ႔ႏိုင္ျပီး အခ်ိဳ႔ေသာဝန္ထမ္းမ်ားသည္ ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔ အခ်ိဳ႕ ကုိ ေဆာင္ရြက္ေပးႏုိင္မည္ျဖစ္သည္။ ဥပမာ- ေနာက္ဆက္တြဲျပသမႈႏွင္႔ အသံုးျပဳသူသင္တန္းမ်ားတြင္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူရရွိႏုိင္သည္႔အက်ိဳးအျမတ္မွာ ခရီးထြက္သြားလာရမႈႏွင္႔ကုန္က်စရိတ္ေလ်ာ႔က်သြား ျခင္းပင္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈဌာနအတြက္ရရွိမည္႔အက်ိဳးအျမတ္မွာ လူမႈအဖြဲ႔အစည္းအတြင္း ပုိမုိက်ယ္ျပန္႔စြာ ထုိးေဖာက္ပါဝင္ႏုိင္ျခင္းမ်ားပင္ျဖစ္ပါသည္။ tvm;tvm&Sdaom aiGaMu;axmufyHhrIt&if;tjrpfrsm; အေသးစိတ္သိရွိရန္အခန္း (ဂ.၄) တြင္ေဖာ္ျပထားသည္႔ ဘဏၰာေရးေရရွည္တည္တံ႔မႈစီမံခ်က္တြင္ ေဆြး ေႏြးထားေသာ ဘီးတပ္ကုလားထိုင္ဝန္ေဆာင္မႈလုပ္ငန္းထူေထာင္ျခင္းအတြက္ ရံပံုေငြမည္သုိ႔ရွာေဖြရမည္ဆုိသည္ ႏွင္႔ ကုန္က်စရိတ္မ်ားအားစီမံခန္႔ခြဲျခင္းကုိ ေလ႔လာပါ။ 58 59 */ bD;wyfxkdifckH 0efaqmifrIvkyfief; aqmif½Gufjcif; * .1/ oif\0efaqmifrIvkyfief; tvkyfjzpfaeaMumif;ukd oifrnfokdYodEkdifrnfenf;/ ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္း ႏွင္႔ အကဲျဖတ္သံုးသပ္ျခင္း (M&E) ျပဳလုပ္ျခင္းျဖင္႔ အဖြဲ႔၏ေဆာင္ရြက္ခ်က္မ်ား ေၾကာင္႔ မည္သုိ႔မည္ပံုျဖစ္ပ်က္ေနသည္ဆုိသည္ကုိ မန္ေနဂ်ာမ်ားအေနျဖင္႔ သိရွိေတြ႔ျမင္ႏုိင္မည္ျဖစ္သည္။ ထုိ႔အျပင္ မည္သည္႔အရာက အလုပ္ျဖစ္ျပီးမည္သည္႔အရာက မျဖစ္သည္ဆုိသည္ကုိလည္း မန္ေနဂ်ာမ်ားႏွင္႔ ၎တုိ႔၏အဖြဲ႔မ်ား အေနျဖင္႔ ေလ႔လာႏုိင္မည္ျဖစ္ကာ ဝန္ေဆာင္မႈလုပ္ငန္းအသံုးျပဳသူမ်ားႏွင္႔ပါဝင္ပတ္သက္သူမ်ား၏အျမင္မ်ားကုိ လည္း သိရွိႏုိင္မည္ျဖစ္ပါသည္။ BuD;MuyfapmihfMunhfjcif;ESifh tuJjzwfokH;oyfjcif;qkdonfrSm tb,fenf;/ ႀကီးၾကပ္ေစာင့္ၾကည့္ျခင္း အကဲျဖတ္သုံးသပ္ျခင္း ဘာလုပ္ ေနသနည္း။ • တေလွ်ာက္လုံး • ေန႔စဥ္ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ေပါင္းစည္းေပးျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္း၏ အဓိကက် သည့္အဆင့္မ်ား ဥပမာ - အခ်ိဳ႕ေသာအခ်က္မ်ားအား ေတာက္ေလွ်ာက္ ေကာက္ယူ ထားရမည္ျဖစ္ေသာ္လည္း) ႏွစ္ပတ္လည္သုံးသပ္ခ်က္ ျပဳလုပ္သည့္အခ်ိန္ ဘာကုိ တုိင္းတာ သနည္း။ • ဝန္ေဆာင္မႈေဆာင္ရြက္ခ်က္မ်ား • အသံုးျပဳသည္႔ဘီးတပ္ထုိင္ခုံႏွင္႔ အပုိအေထာက္အကူမ်ား • အက်ိဳးအျမတ္ရွိသည္႔ လူအေရအတြက္ • တစ္ဦးခ်င္းစီႏွင္႔လူမႈအဖြဲ႔အစည္း အေပၚအက်ိဳးသက္ေရာက္မႈ • ေရရွည္တည္တံ႔ခုိင္ျမဲမႈ မည္သည့္ သတင္းအခ်က္ အလက္အရင္း အျမစ္မ်ားကုိ အသုံးျပဳသနည္း • ဝန္ေဆာင္မႈလုပ္ငန္းအသံုးျပဳသူ၏ သတင္းသုိေလွာင္ရာဌာန • ဝန္ေဆာင္မႈမွတ္တမ္းမ်ား • ဝန္ေဆာင္မႈအခ်က္အလက္မ်ား • အသံုးျပဳသူ၏ျပန္လွန္အၾကံျပဳခ်က္ • ဘ႑ာေရးအစီရင္ခံစာ • ဝန္ထမ္းမ်ား၏အခ်ိန္ကုိသံုးသပ္ျခင္း • စစ္တမ္း • ေမးခြန္းမ်ားေမးျမန္းျခင္း • အုပ္စုလိုက္ေဆြးေႏြးျခင္း • အိမ္မ်ားသုိ႔သြားေရာက္ျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းအား လက္ေတြ႔ က်က်ေလ႔လာျခင္း • ျဖစ္စဥ္သံုးသပ္ခ်က္ျပဳလုပ္ျခင္း 60 61 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ pGrf;aqmif&nfjynfh0NyD; xda&mufrI&Sdonfh0efaqmifrI စြမ္းေဆာင္မႈလုပ္ငန္းလုပ္ကုိင္ေနေသာ မန္ေနဂ်ာမ်ားႏွင့္ အျခားသူမ်ားအတြက္ ႀကီးၾကပ္ေစာင့္ၾကည့္ျခင္းႏွင့္ အကဲျဖတ္သုံးသပ္ျခင္း(M&E)က မည္သုိ႔ အသုံးဝင္သနည္း။ • ဝန္ေဆာင္မႈအရည္အေသြးပုိမိုတိုးတက္လာေစေရးအတြက္ အေရးပါေသာသတင္းအခ်က္အလက္မ်ားကုိ ေပးႏုိင္ျခင္း • ပစၥည္းဝယ္ယူေရးအတြက္လမ္းညႊန္ႏုိင္သည္႔သတင္းအခ်က္အလက္မ်ားကုိေပးႏုိင္ျခင္း • စြမ္းေဆာင္ရည္တုိးျမွင္႔ျခင္းျဖင္႔လည္းေကာင္း၊ လက္ရွိႏွင္႔အနာဂတ္ေငြေၾကးေထာက္ပံ႔ႏုိင္မႈအေျခအေနကုိ ခ်ိန္ညွိျပီး ကုန္က်စရိတ္မ်ားအားထိန္းထားႏုိင္ရန္အေထာက္ကူျပဳျခင္း • အစုိးရႏွင္႔ အစုိးရမဟုတ္ေသာအဖြဲ႔အစည္းမ်ားမွအလႈရွင္မ်ားအပါအဝင္ ေငြေၾကးေထာက္ပံ႔သူမ်ားအား ဝန္ ေဆာင္မႈလုပ္ငန္း၏ထိေရာက္မႈရွိပံုကုိ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားက သက္ေသအေထာက္အထားမ်ားျဖင္႔ ျပသႏုိင္ျခင္း • ျဖည္႔ဆည္းျခင္းမျပဳရေသးေသာလုိအပ္ခ်က္မ်ားကုိ သတ္မွတ္ျပီးေရတြက္ထားႏုိင္ျခင္း • အရင္းအျမစ္မ်ားအား သင္႔တင္႔ေလ်ာက္ပတ္စြာေနရာခ်ထားႏုိင္ရန္သိရွိႏိုင္ျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္း၏အက်ိဳးအျမတ္ႏွင္႔ ပတ္သက္သည္႔အသိပညာမ်ားကုိ တုိးျမွင္႔ႏုိင္ျခင္း • ဝန္ေဆာင္မႈရယူသူမ်ားႏွင္႔ခုိင္မာေသာမိတ္ဖက္ထူေထာင္ႏုိင္ျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအား ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔ အကဲျဖတ္သံုးသပ္ျခင္းအား မည္သုိ႔ျပဳလုပ္ မည္ဆုိသည္ကုိစီမံရာတြင္ အဆင္႔သံုးဆင္႔ပါဝင္ေသာ မူေဘာင္တစ္ရပ္ခ်မွတ္ျခင္းသည္ အသံုးဝင္မည္ျဖစ္သည္။ ေငြ ေၾကးေထာက္ပံ႔သူအေသးစိတ္အခ်က္အလက္မ်ားကုိ ဘီးတပ္ထုိင္ခုံလမ္းညႊန္ခ်က္ ဇယား ၃.၅ တြင္ ေတြ႔ရွိႏုိင္ပါ သည္။ ၁။ စီမံထားသည္႔ ၾကီးၾကပ္ ေစာင္႔ၾကည္႔ရမည္႔ေနရာ ၂။ ေဆာင္ရြက္မည္႔ပစ္မွတ္ေနရာ ထူေထာင္ျခင္း ၃။ သတင္းအခ်က္အလက္မ်ား စုေဆာင္းမည္႔နည္းလမ္းမ်ား သတ္မွတ္ျခင္း စုေဆာင္းထားသည္႔သတင္းမ်ားႏွင္႔အခ်က္အလက္မ်ားအား သံုးသပ္ရာတြင္ အေရးတၾကီးထည္႔သြင္း စဥ္း စားရမည္႔ အခ်က္ႏွစ္ခ်က္ရွိရာတြင္ ေအာက္ပါအတုိင္းျဖစ္သည္- 60 61 • လုပ္ငန္းေဆာင္ရြက္ခ်က္သည္ ေကာင္းစြာအလုပ္မျဖစ္ပါက ျပႆနာ၏ အရင္းအျမစ္ကုိရွာေဖြႏုိင္ရန္အတြက္ ဝန္ေဆာင္မႈကုိ အသံုးျပဳသူမ်ား၊ ဝန္ေဆာင္မႈဝန္ထမ္းမ်ားႏွင္႔ အျခားေသာပါဝင္ပတ္ သက္သူမ်ားႏွင္႔အတူတကြ တုိင္ပင္ေဆာင္ရြက္ျခင္း၊ • လုပ္ငန္းေဆာင္ရြက္ခ်က္မ်ား ေကာင္းစြာအလုပ္လုပ္ျပီး ရည္မွန္း ထားသည္႔အတုိင္း ေအာင္ျမင္ေပါက္ေျမာက္ေနပါက ယင္းကုိ မွ်ေဝ ရန္ႏွင္႔ ေအာင္ပြဲခံရန္ နည္းလမ္းရွာေဖြျခင္း၊ ယင္းသို႔ ေဆာင္ရြက္ ျခင္းျဖင္႔ ဝန္ေဆာင္မႈအဖြ႔ဲကုိလည္းေကာင္း၊ ပါဝင္ပတ္သက္ေနသူ မ်ားကုိလည္းေကာင္း အားျဖစ္ေစပါသည္။ tokH;jyKolxHrS &&Sdaom tjyeftvSeftBuHjyKcsuf\ta&;ygykH အကဲျဖတ္သံုးသပ္မႈျပဳလုပ္ျခင္းျဖင္႔ မည္သည္႔အရာသည္ေကာင္းစြာအလုပ္လုပ္ေနျပီး မည္သည္႔အပုိင္း မ်ားအား ျပဳျပင္ေျပာင္းလဲရန္ လိုအပ္သည္ဆုိသည္ကုိ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ သိရွိလာမည္ျဖစ္သည္။ ထုိ႔အျပင္ ရည္မွန္းခ်က္တစ္ခုလံုး ျပီးေျမာက္ေအာင္ျမင္မႈရွိ/မရွိဆုိသည္ကုိလည္း ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ သံုးသပ္ႏိုင္မည္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံလမ္းညႊန္ခ်က္တြင္ ေဖာ္ျပထားသည္႔ ရည္မွန္းခ်က္မ်ားမွာ ေအာက္ပါအတုိင္းျဖစ္သည္ - • အမွီအခုိကင္းကင္းျဖင္႔ လူတစ္ဦး၏ေရြ႔လ်ားႏုိင္စြမ္းကုိ အတတ္ႏုိင္ဆံုး တုိးျမွင္႔ရန္ • ဘီးတပ္ကုလားထုိင္ရပုိင္ခြင္႔ကုိ တုိးျမွင္႔ေပးျပီး ဘဝအရည္အေသြးကုိ ျမွင္႔တင္ေပးရန္ • ပါဝင္မႈမ်ားကုိ တုိးျမွင္႔ရန္ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအား အကဲျဖတ္သံုးသပ္ရန္ စံသတ္မွတ္ခ်က္မ်ားရွိပါသည္။ ယင္းတုိ႔တြင္ ေအာက္ပါအခ်က္မ်ား ပါဝင္ပါသည္- • ဝန္ေဆာင္မႈရရွိေသာအသံုးျပဳသူမ်ားႏွင္႔ ၎တုိ႔ရရွိသည္႔ေျဖရွင္းခ်က္မ်ား • ပစၥည္းမ်ားႏွင္႔ ဝန္ေဆာင္မႈေပးျခင္းအတြက္ ကုန္က်စရိတ္အပါအဝင္ ဝန္ေဆာင္မႈလုပ္ငန္း၏ကုန္က်စရိတ္ • ဝန္ထမ္းခန္႔ထားျခင္း (ဝန္ထမ္းအေရအတြက္၊ ၎တုိ႔၏အခန္းက႑ ႏွင္႔ အရည္အေသြး) • ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ရရွိႏုိင္ေသာ အသံုးအေဆာင္ႏွင္႔ပစၥည္းမ်ား 62 63 • ဝန္ေဆာင္မႈအရည္အေသြး(ေဆာင္ရြက္သင္႔သည္႔အေလ႔အထေကာင္းမ်ားအား အခန္း ၃.၃ ရွိ ဘီးတပ္ထုိင္ခုံ လမ္းညႊန္ခ်က္တြင္ ေဖာ္ျပထားသည္။) • ဝန္ေဆာင္မႈလုပ္ငန္းေၾကာင္႔အသံုးျပဳသူႏွင္႔ ၎တုိ႔၏မိသားစုဝင္မ်ားအေပၚအက်ိဳးသက္ေရာက္မႈ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသံုးသပ္ခ်က္အတြင္း ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူမ်ား ပါဝင္လာေရးမွာ အထူးပင္အေရးၾကီးပါ သည္။ အသံုး ျပဳသူ၏ျပန္လွန္အၾကံျပဳခ်က္ကုိ သံုးေတာ႔မည္ဆုိပါက ေအာက္ပါအ ခ်က္မ်ားကို ထည္႔သြင္းစဥ္းစားရန္လုိမည္ျဖစ္ပါသည္- • သယ္ယူပုိ႔ေဆာင္ေရးႏွင္႔အခ်ိန္သည္ ကုန္က်စရိတ္အမ်ားဆံုးပင္ ျဖစ္ပါသည္။ ျပန္လွန္အၾကံျပဳခ်က္ေပးမည္႔ ဘီးတပ္ထုိင္ခ ုအံသံုးျပဳသူ အေနျဖင္႔ ဆက္စပ္ေနသည္႔ မည္သည္႔ခရီးႏွင္႔အခ်ိန္အတြက္မဆုိ အေထာက္အပံ႔ ရသင္႔ပါသည္။ • ဝန္ေဆာင္မႈအသံုးျပဳသူတုိင္းထံမွ ျပန္လွန္အၾကံျပဳခ်က္မ်ားကုိ ပံုမွန္ စုေဆာင္းသင္႔သည္။ ထုိသုိ႔မဟုတ္ပါက တစ္လ သို႔မဟုတ္ တစ္ႏွစ္ အတြင္း အၾကံျပဳခ်က္ေကာက္ယူမႈကုိ က်ပန္းျပဳလုပ္သင္႔ပါသည္။ • ဝန္ေဆာင္မႈလုပ္ငန္းအသံုးျပဳသူမ်ားအေနျဖင္႔ ၎တုိ႔၏ အၾကံျပဳ ခ်က္မ်ားအေပၚ ပြင္႔လင္းျပီးရုိးသားမႈရွိသည္ဟု ခံစားမိၾကမွသာလွ်င္ ဝန္ေဆာင္မႈလုပ္ငန္းေအာင္ျမင္သည္ဟု ဆုိႏုိင္မည္ျဖစ္ပါသည္။ ထုိ႔ေၾကာင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔ တုိက္ရုိက္သက္ဆုိင္မႈမရွိသူ တစ္ဦးကေတြ႔ဆံုေမးျမန္းျခင္းမ်ားကိုျပဳလုပ္ျခင္းသည္ ပုိမုိထိေရာက္ မႈရွိႏုိင္မည္ျဖစ္ပါသည္။ 62 63 tDoD,kd;yD;,m;EkdifiHrS 0efaqmifrItuJjzwfjcif;vkyfief;rS aqmif½GufrIrS&onfh tuJjzwfjcif; erlem ေျမျပင္အရာရွိႏွစ္ဦးသည္ ႏုိင္ငံတစ္ဝန္းရွိဝန္ေဆာင္မႈလုပ္ငန္းဌာန (၇) ခုမွဘီးတပ္ထုိင္ခုံအသံုးျပဳသူ (၁၄ဝ) တုိ႔ အား ေတြ႔ဆံုေမးျမန္းမႈျပဳလုပ္ခဲ႔သည္။ ထုိအရာရွိႏွစ္ဦးလံုးသည္ ေရြ႕လ်ားႏုိင္စြမ္းခ်ိဳ႕တဲ႔သူမ်ားျဖစ္ၾကျပီး ယင္းသုိ႔ ျဖစ္ေနျခင္းကလည္း ၎တုိ႔ပါဝင္ေဆာင္ရြက္ရသည္႔ အခန္းက႑အတြက္ မ်ားစြာအေထာက္အကူျပဳသည္ကုိ ေတြ႔ရွိရသည္။ ၎တုိ႔သည္ ၎တုိ႔ႏုိင္ငံအတြင္းရွိ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ား ၾကံဳေတြ႔ၾကရသည္႔ကိစၥမ်ားကုိ ၎တုိ႔ကုိယ္တုိင္ သိရွိလာၾကသည္။ ထုိလုပ္ငန္းေၾကာင္႔ ၎တုိ႔အား ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ား၏လိုအပ္ခ်က္ႏွင္႔အခြင္႔အေရး မ်ားအတြက္ ေရွ႕ေဆာင္ေရွ႕ရြက္ျပဳလုပ္ေရးတြင္ အားေပးသကဲ႔သုိ႔ျဖစ္လာပါသည္။ ဝန္ေဆာင္မႈကုိအသံုးျပဳသူမ်ား အေနျဖင္႔လည္း စံနမူနာျပပုဂၢိဳလ္မ်ားက ေတြ႔ဆံုေမးျမန္းျခင္းေၾကာင္႔ စိတ္ပုိင္းဆုိင္ရာႏွင္႔ရုပ္ပုိင္းဆုိင္ရာအရ အက်ိဳးအျမတ္မ်ားရရွိခဲ႔သည္။ အကဲျဖတ္သံုးသပ္ျခင္းေတြ႔ဆံုေမးျမန္းခန္းလုပ္ငန္းျပီးေနာက္ ဝန္ေဆာင္မႈလုပ္ငန္းလုပ္ကုိင္သူမ်ားႏွင္႔အသံုးျပဳ သူမ်ားအၾကား ခုိင္မာေသာဆက္ဆံေရးသုိ႔ ဦးတည္သြားသည့္ အလြတ္သေဘာကြန္ယက္တစ္ခုတုိးတက္ျဖစ္ ထြန္းလာခဲ႔ပါသည္။ ထုိမွ်သာမက အကဲျဖတ္လုပ္ငန္းမွတဆင္႔ လုိအပ္ခ်က္ႏွင္႔ကုိက္ညီသည္႔ ဘီးတပ္ထုိင္ခုံမ်ားကုိ မရၾကေသာ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအား သတ္မွတ္ေဖာ္ထုတ္ႏုိင္ခဲ႔သည္။ အျပန္အလွန္အားျဖင္႔လည္း ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း သင္တန္းေပးရန္ လုိအပ္ခ်က္ကုိလည္း သိရွိလာၾကရာ ဝန္ေဆာင္မႈလုပ္ငန္းအေန ျဖင္႔ ယင္းကိစၥကုိ ေဆာင္ရြက္ေပးႏုိင္ခဲ႔ပါသည္။ tusdK;oufa&mufrIrsm;tm; tuJjzwfokH;oyf&mü tajccHowif;tcsuftvuf\ta&;ygykH ဘီးတပ္ထုိင္ခုံရရွိၾကသူမ်ားအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းက ရရွိေသာအက်ိဳးသက္ေရာက္မႈကုိ သိရွိႏုိင္ရန္ မည္သည္႔ၾကားဝင္ေဆာင္ရြက္မႈကိုမွ် ျပဳလုပ္ျခင္းမရွိမီ ဆုိလုိသည္မွာ မည္သည္႔အကဲျဖတ္သံုးသပ္မႈမ်ိဳးအား စတင္ေဆာင္ရြက္ျခင္းမျပဳမီ တစ္ဦးခ်င္းစီ၏အေျခအေနမ်ားကုိ မွတ္တမ္းတင္ထားရွိရန္ လုိအပ္ပါသည္။ အေျခခံသတင္းအခ်က္အလက္မ်ားစုေဆာင္းမႈအတြက္ အခြင္႔အလမ္းမ်ားေပၚေပါက္လာႏုိင္သည္႔အေျခအ ေနမွာ ေအာက္ပါအတုိင္း ျဖစ္ပါသည္- • လႊဲေျပာင္းေရးဌာန သုိ႔မဟုတ္ ေဆးခန္းတြင္ဝန္ထမ္းက လႊဲေျပာင္းျခင္းလုပ္ငန္းေဆာင္ရြက္သည္႔အခ်ိန္ • အိမ္မ်ားသုိ႔သြားေရာက္ျပီး သုိ႔တည္းမဟုတ္ ဖုန္းမွေျပာဆုိျပီး လႊဲေျပာင္းေပးမႈ ႏွင္႔ အကဲျဖတ္သံုးသပ္မႈကာလ အ ၾကား • အကဲျဖတ္သံုးသပ္မႈလုပ္ငန္းမစတင္မီ အကဲျဖတ္သံုးသပ္ခ်ိန္ အေသးစိတ္သတင္းအခ်က္အလက္မ်ားကုိထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္ တုိးအရင္းအျမစ္ကုိ ေလ႔လာပါ။ ဝန္ေဆာင္မႈလုပ္ငန္းအသံုးျပဳသူမ်ားထံမွ သတင္းအခ်က္အလက္မ်ားစုေဆာင္းရန္ ေတြ႔ဆံုေမးျမန္းခန္းျပဳ လုပ္စဥ္တြင္ ယင္းေတြ႔ဆံုေမးျမန္းခန္းအားမည္သူကျပဳလုပ္မည္ဆုိသည္ကုိ ျပင္ဆင္ထားရန္အေရးၾကီးပါသည္။ ထုိ 64 65 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ သုိ႔ေဆာင္ရြက္ျခင္းမွာ ေမးခြန္းတစ္ခုစီႏွင္႔ပတ္သက္၍ ရွင္းလင္းျပတ္သားျပီးျပည္႔စံုေသာအေျဖရရွိေစရန္ ျဖစ္သည္။ ယင္းသည္တိက်ခုိင္လံုေသာ အခ်က္အလက္မ်ားအတြက္ အေရးၾကီးသည္။ ေတြ႕ဆုံေမးျမန္းမႈနည္းလမ္းမ်ားႏွင့္ပတ္သက္သည့္ အႀကံျပဳခ်က္ ႀကိဳတင္ျပင္ဆင္ျခင္း - • ေတြ႔ဆံုေမးျမန္းစဥ္ မည္သည္႔အေၾကာင္းအရာအား ေျပာဆုိမည္ဆုိသည္ကုိ ေလ႔က်င္႔ပါ။ လုိသည္ထက္ ပုိမေျပာပါႏွင္႔။ နည္းလမ္း - • ေဖာ္ျပထားသည္႔အတုိင္း ေမးခြန္းမ်ားကုိ ဖတ္ျပပါ၊ • ေျဖၾကားမည္႔သူအား အေျဖႏွင္႔ပတ္သက္၍ အၾကံမျပဳပါႏွင္႔။ အနည္းငယ္ပင္လွ်င္ အရိပ္အေယာင္မျပပါႏွင္႔၊ • တစံုတခုကိုရွင္းျပရန္ လုိအပ္ပါက ၾကားေနပါ။ • တံု႔ျပန္ေျဖၾကားမႈမ်ားကုိ မွန္မွန္ကန္ကန္ မွတ္တမ္းတင္ပါ။ လူကုိေလးစားပါ - • အေတြ႔ခံမည္႔သူက ၎၏သေဘာဆႏၵအေလ်ာက္ လြတ္လြတ္လပ္လပ္ေတြ႔ဆံုေမးျမန္းမႈျပဳလုပ္ရန္ သေဘာတူညီမႈ မျပဳမခ်င္း ေရွ႕ဆက္မတုိးပါႏွင္႔။ • ၎အေနျဖင္႔ သက္ေတာင္႔သက္သာျဖစ္ေနေစရန္ ကူညီပါ။ • ၎ေျဖၾကားေျပာဆုိသည္႔ မည္သည္႔အေၾကာင္းအရာအတြက္မဆို တုန္လႈပ္ဟန္၊ ေက်နပ္ဟန္ သုိ႔မဟုတ္ စိတ္ပ်က္ဟန္ မျပပါႏွင္႔။ • အေျဖမ်ားကုိလွ်ိဳ႕ဝွက္ထားပါ။ အသံုးျပဳသူ၏အေျခခံသတင္းအခ်က္အလက္စနစ္ေကာင္းကုိ ထူေထာင္ႏုိင္ျခင္းျဖင္႔ ဘီးတပ္ထုိင္ခုံဝန္ ေဆာင္မႈလုပ္ငန္း၏ အရည္အေသြးကုိ တုိးျမင္႔လာေစမည္ျဖစ္သည္။ အျပန္အလွန္အားျဖင္႔ အသံုးျပဳသူ၏ ဘဝ အရည္အေသြးအေပၚ ဝန္ေဆာင္မႈလုပ္ငန္း၏အက်ိဳးသက္ေရာက္မႈကုိလည္း ထင္ဟပ္ေစမည္ျဖစ္ပါသည္။ ထုိသုိ႔ျဖစ္လာေစရန္ ေအာက္ပါအတုိင္းေဆာင္ရြက္ႏုိင္ပါသည္- • ေနာက္ဆက္တြဲျပသမႈအစိတ္အပုိင္းအျဖစ္ ပံုမွန္ျပဳလုပ္ျခင္း • သီးျခားေဆာင္ရြက္ခ်က္အေနျဖင္႔ ေဆာင္ရြက္ျခင္း 64 65 uav;oli,frsm;tay: tusdK;oufa&mufrIrsm;tm; tuJjzwfokH;oyfjcif; ျဖစ္ႏုိင္ေျခရွိသည္႔ေနရာတုိင္းတြင္ ဘီးတပ္ထုိင္ခုံေၾကာင္႔လည္းေကာင္း၊ ဝန္ေဆာင္မႈလုပ္ငန္းေၾကာင္႔ လည္းေကာင္း ျဖစ္ေပၚလာသည္႔အက်ိဳးသက္ေရာက္မႈႏွင္႔ပတ္သက္ျပီး ျပန္လွန္အၾကံျပဳခ်က္မ်ားေပးႏုိင္ရန္ ကေလး သူငယ္မ်ားအား ''ေျပာေရးဆုိခြင္႔တရပ္''ေပးရန္အေရးၾကီးပါသည္။ နမူနာမွာ စိတ္ခံစားမႈအံစာတံုး ၂ ကုိ အသံုးျပဳ ရန္ျဖစ္သည္။ ပထမဦးစြာ ကေလးႏွင္႔ပတ္သက္သည္႔ မတူညီေသာစိတ္ခံစားမႈမ်ားကုိ အဆင္႔အတန္းသတ္မွတ္ပါ။ ထုိေနာက္၊ ''-----ခ်ိန္တြင္ ကြၽႏု္ပ္ေပ်ာ္ရြင္သည္''၊ ''-----ခိ်န္တြင္ ကြၽႏု္ပ္စိတ္ညစ္သည္'' စသည္႔ေဖာ္ျပမႈမ်ိဳးကုိရရွိရန္ ကေလးသူငယ္မ်ားကုိေမးျမန္းပါ။ ေဒါသထြက္ ဝမ္းနည္း နာက်င္ စိတ္႐ႈတ္ စိတ္လႈပ္ရွား ေပ်ာ္ရႊင္ tcsuftvufrsm;tm; rSwfwrf;wifjcif;ESifh pdppftajz&Smjcif; ၾကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔ အကဲျဖတ္သံုးသပ္ျခင္းလုပ္ငန္းစဥ္တြင္ မွတ္တမ္းတင္ျခင္း၊ စုေဆာင္းျခင္း၊ သိမ္းဆည္းျခင္းႏွင္႔ အခ်က္အလက္မ်ားအား စိစစ္အေျဖရွာျခင္းလုပ္ငန္းမ်ား ပါဝင္သည္။ အခ်က္အလက္မ်ားအား အလံုအေလာက္သိမ္းဆည္းထားျခင္းျဖင္႔ ေငြကုန္၊ အခ်ိန္ကုန္သက္သာေစမည္ ျဖစ္သည္။ အခ်က္အလက္သုိေလွာင္ ရံုအတြင္းသုိ႔ အခ်က္အလက္မ်ားအား တုိက္ရုိက္ထည္႔သြင္းထားရန္လိုမည္ ျဖစ္သည္။ ယင္းအခ်က္အလက္သုိေလွာင္ ရံုသည္ ရလဒ္မ်ားအားထုတ္ေဖာ္ရန္ႏွင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ အသံုးအဝင္ဆံုးေသာအစီရင္ခံခ်က္မ်ားအား ဖန္တီးရန္တည္ေဆာက္ထားျခင္းျဖစ္သည္။ အလြယ္တကူသယ္ေဆာင္ႏုိင္ေသာကြန္ပ်ဴတာမ်ားသည္ အခ်က္အ လက္မ်ားကုိမွတ္တမ္းတင္ထားႏုိင္သည္႔အတြက္ ကြင္းဆင္းလုပ္ငန္းတြင္လည္းေကာင္း၊ ဌာနအတြင္းတြင္လည္း ေကာင္းလုပ္ငန္းေဆာင္ရြက္ရာတြင္လြန္စြာအသံုးတည္႔မည္ျဖစ္ပါသည္။ လက္ကုိင္ဖုန္းနည္းပညာမ်ားမွာလည္း လ်င္ ျမန္စြာတုိးတက္လာသည္ျဖစ္ရာယင္းတုိ႔ကုိအသံုးျပဳျပီး အခ်က္အလက္မ်ားထည္႔သြင္းျခင္း၊ ေပးပုိ႔ျခင္း၊ လက္ခံရယူ ျခင္းမ်ားအား ေဆာင္ရြက္ႏုိင္မည္ျဖစ္ပါသည္။ 0efaqmifrIpDrHcsufa&;qGJjcif; တစ္ႏွစ္ပတ္လံုးၾကီးၾကပ္ေစာင္႔ၾကည္႔ထားေသာ ႏွစ္စဥ္ဝန္ေဆာင္စီမံခ်က္သည္ စြမ္းေဆာင္ရည္ျပည္႔ဝျပီး ထိေရာက္မႈရွိသည္႔ ဝန္ေဆာင္မႈလုပ္ငန္းျဖစ္ေပၚလာေရးအတြက္ အေထာက္အကူျဖစ္ေစမည္ျဖစ္ပါသည္။ ယင္းစီမံ ခ်က္ႏွင္႔ရည္မွန္းခ်က္လုပ္ငန္းမ်ားအတြင္း ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ား ပါဝင္လာေစျခင္းျဖင္႔ ၎တုိ႔အားလႈံ႔ေဆာ္၊ ပါဝင္တာဝန္ေပးရန္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈစီမံခ်က္တြင္ ႏွစ္ကုန္အကဲျဖတ္သံုးသပ္ခ်က္လည္း ပါဝင္မည္ျဖစ္သည္။ ဝန္ေဆာင္မႈစီမံခ်က္မူေဘာင္နမူနာကုိ တဖက္တြင္ ေဖာ္ျပထားပါသည္။ 66 67 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ၀န္ေဆာင္မႈစီမံခ်က္မူေဘာင္ ႀကီးၾကပ္ေစာင့္ၾကည့္ ရမည့္လုိအပ္ခ်က္/ ျပႆနာကုိ သတ္မွတ္ျခင္း လုိအပ္ခ်က္/ျပႆနာကုိ ကုိင္တြယ္ေျဖရွင္းရန္ ေဆာင္႐ြက္ခ်က္/ ရည္႐ြယ္ခ်က္ ရည္မွန္းခ်က္ သတင္း အခ်က္အလက္ စုေဆာင္းျခင္း လြန္ခဲ့ေသာႏွစ္အတြင္း မိန္းမမ်ားက ေယာက်္ားမ်ားထက္ (မိန္းမ ၂၀%၊ ေယာက်္ား ၈၀%) နည္းၿပီး ဘီးတပ္ထုိင္ခုံ ရရွိၾကသည္။ ေအာက္ပါအတုိင္း ေဆာင္႐ြက္ၿပီး ဘီးတပ္ထုိင္ခုံကုိ တုိးျမွင့္သတ္မွတ္ပါ။ • မိန္းမမ်ားအား သတ္မွတ္ေပးရန္ ေက်း႐ြာကုိယ္စားလွယ္ မ်ားအား ေျပာၾကားျခင္း အပါအဝင္ လႊဲေျပာင္း ေပးမည့္ အရင္းအျမစ္မ်ားအား ေျပာဆုိျခင္း • မိန္းမမ်ားအေနႏွင့္ ဝန္ေဆာင္မႈအား ရရွိရန္အားေပးႏုိင္သည့္ မိန္းမစံျပနမူနာမ်ားအား သတ္မွတ္ႏုိင္ရန္အတြက္ အမ်ိဳးသားအဆင့္ DPO ႏွင့္ ေပါင္းစပ္ညွိႏႈိင္းပါ။ ဘီးတပ္ထုိင္ခုံအား မိန္းမမ်ားရရွိမႈ ရာခုိင္ႏႈန္းအား အနည္းဆုံး ၄၀%အထိ တုိးျမွင့္ရန္ ဘီးတပ္ထုိင္ခုံ အသုံးျပဳသူအခ်က္ အလက္ သုိေလွာင္႐ုံကုိ ေနာက္ဆုံးအေျခအ ေနထိ ဆက္လက္ ထိန္းသိမ္းထားပါ။ ထုိသုိ႔ေဆာင္႐ြက္ျခင္း ျဖင့္ ေယာက်္ားႏွင့္မိန္းမ အေရအတြက္ မည္မွ်ဝန္ေဆာင္မႈအား ရရွိေနသည္ဆုိသည္ကုိ သတ္မွတ္ႏုိင္မည္ ျဖစ္ပါသည္။ * .2 0,fvkdtm;ukd pDrHcefYcGJjcif; ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုေဆာင္ရြက္ျပီဆုိလွ်င္ ဝယ္လုိအားကုိျဖစ္ေပၚေစသည္႔ အသံုးျပဳသူလုိအပ္ခ်က္ႏွင္႔ သင္႔ေလ်ာ္ေသာဝန္ေဆာင္မႈကုိေပးမည္႔ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းတုိ႔၏စြမ္းေဆာင္ရည္တုိ႔အၾကား အေရးၾကီး ေသာ ဟန္ခ်က္ညီမႈတစ္ရပ္ ရွိပါသည္။ 66 67 0,fvkdtm;ukd zefwD;jcif; ဝန္ေဆာင္မႈလုိအပ္ခ်က္ကုိ ဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ေနေသာနယ္ေျမအတြင္းရွိသည္႔လူဦးေရ၏ ၁% ကို တြက္ခ်က္ျပီး ခန္႔မွန္းႏုိင္ပါသည္။ သို႔ေသာ္ ဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔ ယင္း၏အက်ိဳးအျမတ္ကုိ သိရွိျခင္း မရွိသူမ်ား သုိ႔မဟုတ္ ဝန္ေဆာင္မႈအခြင္႔အေရးကုိ မရၾကသူမ်ားရွိပါက လုိအပ္ခ်က္ရွိေနသည္႔တုိင္ ဝယ္လုိအားမွာ ေလ်ာ႔က်ေနမည္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈဝယ္လုိအားနည္းေနလွ်င္ ဝန္ေဆာင္မႈအသံုးျပဳသူ အတြက္ ကုန္က်စရိတ္မွာ ျမင္႔တက္လာမည္ျဖစ္သည္႔အတြက္ ဝန္ေဆာင္မႈလုပ္ငန္း၏ ဘဏၰာေရးေရရွည္ တည္တံ႔ခုိင္ျမဲမႈကုိ ျခိမ္းေျခာက္လာႏုိင္သည္။ မန္ေနဂ်ာ၏အခန္းက႑မွာ အဘယ္ေၾကာင္႔ လႊဲေျပာင္းေပးမႈမ်ားနည္းေနရသည္ဆုိသည္ကုိ သိရွိေအာင္ လုပ္ရန္ျဖစ္သည္။ ျဖစ္ႏုိင္သည္႔နည္းလမ္းမ်ားမွာ ေအာက္ပါအတုိင္းျဖစ္သည္- • အသင္႔ေလ်ာ္ဆံုးေသာလႊဲေျပာင္းေရးဆုိင္ရာအရင္းအျမစ္မ်ားအား ဝန္ေဆာင္မႈလုပ္ငန္းကသတ္မွတ္ခဲ႔မႈမရွိျခင္း၊ • ဘီးတပ္ထုိင္ခုံအားလုိအပ္ေနသူမ်ားအေနျဖင္႔ လႊဲေျပာင္းေရးဆုိင္ရာေနရာမ်ားသုိ႔ ေရာက္ရွိႏိုင္မႈမရွိျခင္း • လႊဲေျပာင္းေရးဆုိင္ရာကြန္ယက္သင္တန္းမ်ားအေနျဖင္႔ ဘီးတပ္ထိုင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း၏အက်ိဳးအျမတ္ႏွင္႔ အေရးပါမႈကုိ ေကာင္းစြာသေဘာမေပါက္ျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ၎တုိ႔ေနထုိင္သည္႔ေနရာမွ အင္မတန္အလွမ္းေဝးေသာေနရာတြင္ရွိျခင္းႏွင္႔ သယ္ယူ ပုိ႔ေဆာင္ေရးမရွိျခင္းမ်ားေၾကာင္႔ ဘီးတပ္ကုလားထုိင္အသံုးျပဳသူမ်ားအေနျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းကုိ မရရွိၾက ျခင္း လႊဲေျပာင္းေရးမရွိရသည္႔အေၾကာင္းရင္းမ်ားကုိသိသည္ႏွင္႔ မန္ေနဂ်ာႏွင္႔၄င္းတုိ႔၏အဖြဲ႔မ်ားသည္ဝယ္လုိ အားကုိ ျမွင္႔တင္ရန္ ေဆာင္ရြက္ႏုိင္မည္ျဖစ္ပါသည္။ 68 69 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 0,fvkdtm;ukd pDrHcefYcGJjcif; ဝန္ထမ္းမ်ားစီမံခန္႔ခြဲႏုိင္သည္႔အေရအတြက္ထက္ပုိ၍ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔လႊဲေျပာင္းေပးမည္ဆုိလွ်င္ အေျဖသံုးခု ေပၚထြက္လာႏိုင္ရာတြင္ ေအာက္ပါအတုိင္းျဖစ္ပါသည္- • ဝန္ထမ္းမ်ားအေနျဖင္႔ လႊဲေျပာင္းေပးသူတစ္ဦးခ်င္းစီ အ တြက္ လုိအပ္ေသာအခ်ိန္ထက္နည္းသည္႔အခ်ိန္ကုိသာ ေပးႏိုင္ျခင္း • ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအေနျဖင္႔ ခ်ိန္းဆုိမႈအတြက္ ေစာင္႔ဆုိင္းရေသာအခ်ိန္ပုိလာျခင္း • အခ်ိဳ႕ေသာဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား ျပန္သြားႏုိင္ျခင္း ျဖစ္စဥ္တစ္ခုစီတုိင္းတြင္အေျခအေနေၾကာင္႔ဝန္ေဆာင္ မႈလုပ္ငန္းကုိ အသံုးျပဳသူေရာ၊ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းပါ စိတ္ဓာတ္က်ဆင္းသြားႏုိင္ပါသည္။ ထုိေၾကာင္႔ လုိအပ္ခ်က္ကို စနစ္တက်ဂရုတစ္စုိက္စီမံခန္႔ခြဲရန္လုိအပ္ပါသည္။ အစပုိင္းတြင္ မန္ေနဂ်ာမ်ား သည္ အနီးဆံုးေနရာမွ စတင္ျပီးလႊဲေျပာင္းေပးမည္႔ အရင္းအျမစ္အနည္းကုိသာ ပစ္မွတ္ထားသင္႔သည္။ ဝန္ေဆာင္မႈ လုပ္ငန္းကအသစ္ျဖစ္ေနသည္႔အခ်ိန္တြင္ ထုိသုိ႔ေဆာင္ရြက္ျခင္းအားျဖင္႔ ေနာက္ဆက္တြဲလုပ္ငန္းမ်ားကုိ ပုိမုိလြယ္ကူ ေစမည္ ျဖစ္ပါသည္။ မီဒီယာမွတဆင္႔ေသာ္လည္းေကာင္း၊ အမ်ိဳးသားအဆင္႔ အခမဲ႔ဌာနမ်ားမွတဆင္႔ေသာ္လည္း ေကာင္း အလွမ္းကြာသည္႔ေဒသမ်ားမွ လုိအပ္ခ်က္အေျမာက္အမ်ားကုိ ေဖာ္ထုတ္ႏုိင္မည္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈ ကြန္ယက္မရွိလွ်င္ ဝန္ေဆာင္မႈအသံုးျပဳသူအတြက္ အခက္အခဲေတြ႔ႏုိင္သည္သာမက ကုန္က်စရိတ္လည္းမ်ားမည္ ျဖစ္ျပီး ဝန္ေဆာင္မႈေပးေနသူမ်ားအတြက္လည္း စီမံခန္႔ခြဲရန္လြယ္ကူမည္မဟုတ္ေခ်။ apmihfqkdif;pm&if;jyKvkyfjcif;ESifh pDrHcefYcGJjcif; ဝန္ေဆာင္မႈလုိအပ္ခ်က္ျမင္႔မားလာသည္ဆုိပါက ေစာင္႔ဆုိင္းစာရင္းျပဳလုပ္ရမည္ျဖစ္သည္။ သတင္း အခ်က္အလက္မ်ား ကုိမွတ္တမ္းတင္ရန္ အခ်က္အလက္သုိေလွာင္ရံုကုိအသံုးျပဳထားေသာ စနစ္အားထူေထာင္ ထားျခင္းသည္ကုန္က်စရိတ္ကုိ သက္သာေစမည္ျဖစ္သည္။ ထုိစနစ္ရွိျခင္းအားျဖင္႔ မန္ေနဂ်ာမ်ားႏွင္႔ဝန္ထမ္းမ်ား အေနျဖင္႔ သတင္းအခ်က္အလက္မ်ားကုိ အလံုအေလာက္ရရွိႏုိင္မည္ျဖစ္ျပီး ဝန္ေဆာင္မႈဆုိင္ရာစာရင္းအင္းမ်ားကုိ အလြယ္တကူထုတ္ယူႏုိင္မည္ျဖစ္သည္။ ဝန္ေဆာင္မႈလုပ္ငန္း၌ လူတစ္ဦးတုိးလာတုိင္း ေနာက္ထပ္သတင္းအခ်က္ အလက္တစ္ခုကုိထပ္ထည္႔ႏုိင္မည္ျဖစ္သည္။ ဥပမာ - အကဲျဖတ္သံုးသပ္ခ်က္ျပဳလုပ္သည္႔ရက္စြဲ၊ တပ္ဆင္သည္႔ ရက္စြဲ၊ ေနာက္ဆက္တြဲျပသရန္ခ်ိန္းဆုိမႈ စသည္တုိ႔ျဖစ္ပါသည္။ 68 69 vTJajymif;ay;jcif;ESifh apmifhqkdif;pm&if;ukd ppfaq;jcif; ေစာင္႔ဆုိင္းသူအေရအတြက္မ်ားလာသည္ႏွင္႔အမွ် အခ်ိဳ႕ေသာအဖြဲ႔ မ်ားသည္ လႊဲေျပာင္းေပးမည္႔သူမ်ားအားစစ္ထုတ္ျပီး ဦးစားေပးအစီ အစဥ္ ျပဳလုပ္ၾကသည္။ ေအာက္တြင္ေဖာ္ျပထားေသာအုပ္စုမ်ားကုိ ဦး စားေပးစာရင္းတြင္ ထည္႔သြင္းသင္႔ပါသည္ - • - ကေလးသူငယ္မ်ား - အဘယ္ေၾကာင္႔ဆုိေသာ္ ေဆာလ်င္စြာလႊဲ ေျပာင္းေပးရန္အေရးၾကီးျပီး ၾကီးျပင္းလာခိ်န္တြင္ ကုိယ္ေနဟန္ထား လြဲမွားမႈမ်ားျဖစ္ထြန္းလာႏုိင္သည္႔အတြက္ေၾကာင္႔ ျဖစ္ပါသည္။ • - အပူေလာင္နာအႏၲရယ္ရွိေသာဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား - အ ဘယ္ေၾကာင္႔ဆုိေသာ္ ယင္းသည္ အသက္အႏၲရာယ္ကုိ ျခိမ္း ေျခာက္ႏုိင္သည္႔အတြက္ျဖစ္သည္။ • - အေျခအေနတုိးတက္လာေသာဘီးတပ္ကုလားထုိင္သံုးစြဲသူမ်ား - အဘယ္ေၾကာင္႔ဆုိေသာ္ ၎တုိ႔၏အေနအထားအတြက္ အေရးေပၚ အေျခအေနျဖစ္ေနေသာေၾကာင္႔ ျဖစ္ပါသည္။ • -ဘီးတပ္ထုိင္ခုံမရွိသည္႔အတြက္ေၾကာင့္လည္းေကာင္း၊ အဆင္႔အ တန္းမမီသည္႔ဘီးတပ္ထုိင္ခုံေၾကာင္႔လည္းေကာင္း နာက်င္မႈေဝဒ နာကုိ ခံစားေနရသူမ်ား 70 71 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ စစ္ေဆးရန္ႏွင္႔ခ်ိန္းဆုိမႈမ်ားအားစီမံရာ၌ အေထာက္အကူျပဳျဖစ္ေစရန္ စဥ္းစားသင္႔ေသာအဓိကက်သည္႔ အခ်က္အလက္သုိေလွာင္ရံု အခ်ိဳ႕မွာေအာက္ပါအတုိင္းျဖစ္သည္- • အသက္ • မစြမ္းမသန္ျဖစ္မႈအမ်ိဳးအစား • လႊဲေျပာင္းေပးရသည္႔အေၾကာင္းရင္း • ေနထုိင္သည္႔ေနရာ 0efaqmifrIpGrf;&nf ေတြ႔ရွိႏုိင္ေသာဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအေရအတြက္ႏွင္႔ ဝန္ေဆာင္မႈအဆင္႔အတန္းႏွင္႔ပတ္သက္လာ လွ်င္ ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင႔္ မည္သည္႔အရာအား ေထာက္ပံ႔ေပးႏုိင္မည္ဆုိသည္႔ေမွ်ာ္လင္႔ခ်က္မ်ားအား စီမံ ခန္႔ခြဲေပးႏုိင္ရန္ အေရးၾကီးပါသည္။ အလယ္အလတ္အဆင္႔ႏွင္႔အဆင္႔ျမင္႔ဝန္ေဆာင္မႈမ်ားေပးရန္လုိအပ္ခ်က္မ်ားရွိေနလင္႔ကစား ဝန္ေဆာင္မႈ လုပ္ငန္းတုိင္းသည္ ယင္းအဆင္႔မ်ားကုိျဖည္႔ဆည္းေပးရန္ စြမ္းေဆာင္ႏုိင္မည္မဟုတ္ပါ။ သုိ႔ေသာ္ လုိအပ္ခ်က္မ်ား သည္ ၎တုိ႔၏ဗဟုသုတ၊ အရည္အေသြးႏွင္႔ထုတ္လုပ္ႏုိင္စြမ္းထက္ ေက်ာ္လြန္ေနသည္႔ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ ထမ္းမ်ားထံသုိ႔ ဝန္ေဆာင္မႈအသံုးျပဳသူမ်ားအား ပုိ႔ေပးႏုိင္ပါသည္။ မန္ေနဂ်ာမ်ားတြင္ ထုိသုိ႔ေသာအေျခအေနမ်ိဳးအား မည္သုိ႔ကုိင္တြယ္ေျဖရွင္းရမည္္ဆုိသည္ႏွင္႔ပတ္သက္သည္႔ မဟာဗ်ဴဟာတစ္ရပ္ ရွိေနရမည္ျဖစ္သည္။ မန္ေနဂ်ာမ်ား အေနျဖင္႔ ေအာက္ပါတုိ႔ကုိေဆာင္ရြက္ႏုိင္ပါသည္- • ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ မည္ကဲ႔သုိ႔ေဆာင္ရြက္ေပးႏုိင္မည္ဆုိသည္႔ ဝန္ေဆာင္မႈလုပ္ငန္းႏွင္႔ပတ္သက္ သည္႔ သတင္းအခ်က္အလက္မ်ားအား လက္ကမ္းစာေစာင္စာေစာင္မ်ားတြင္ ရွင္းလင္းစြာေဖာ္ျပထားျခင္း၊ • ဝန္ေဆာင္မႈလုပ္ငန္း၏အရည္အေသြးထက္ေက်ာ္လြန္ေနေသာလုိအပ္ခ်က္ရွိေနသူမ်ားအား လႊဲေျပာင္းေပးေရး သို႔မဟုတ္ ေပါင္းစပ္ညွိႏႈိင္းေဆာင္ရြက္ေရးသည္ျဖစ္ႏုိင္ေခ်ရွိမရွိဆုိသည္ကုိ သိရွိႏုိင္ရန္ အျခားေသာဝန္ေဆာင္မႈ လုပ္ငန္းမ်ားႏွင္႔ ညွိႏိႈင္းျခင္း၊ • ျဖည္႔ဆည္းေပးႏုိင္ျခင္းမရွိေသာလုိအပ္ခ်က္မ်ားအား မွတ္တမ္းတင္ထားပါ။ ဝန္ထမ္းမ်ား၏စြမ္းေဆာင္ရည္ႏွင္႔ ပစၥည္းရရွိႏုိင္မႈအေျခအေနကုိ တုိးတက္ေအာင္ေအာင္ရြက္ျခင္း၊ 70 71 uav;oli,frsm;twGuf apmvQifpGm vTJajymif;ay;a&;twGuf ta&;ygykH ဘီးတပ္ထုိင္ခုံမ်ားကုိ လိုအပ္ေနေသာကေလးသူငယ္မ်ားသည္ ေနာက္ထပ္ကုိယ္ေနဟန္ထားအေထာက္ အကူျပဳမႈကုိလည္း လုိအပ္ေကာင္းလုိအပ္မည္ျဖစ္ပါသည္။ ဆိုလုိသည္မွာကေလးသူငယ္အမ်ားအျပားသည္ အလယ္ အလတ္ အဆင္႔ဝန္ေဆာင္မႈကုိ လုိအပ္ေနသည္ဆုိျခင္းပင္ျဖစ္သည္။ ကုိယ္ေနဟန္ထားႏွင္႔ပတ္သက္သည္႔ ျပႆနာ ကုိတားဆီးရန္ သုိ႔မဟုတ္ ေလ်ာ႔က်သြားေစရန္ ကေလးသူငယ္အားလံုးအား ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ ျမန္ႏိုင္သမွ်အ ျမန္ဆံုးလႊဲေျပာင္းေပးေရးသည္ လြန္စြာမွပင္အေရးၾကီးပါသည္။ ကေလးသူငယ္မ်ား၏အထူးလုိအပ္ခ် က္ႏွင္႔ ေဆာလ်င္စြာလႊဲေျပာင္းေပးျခင္း၏အက်ိဳးေက်းဇူးကုိ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈသင္တန္းဆုိင္ရာစံႏႈန္းႏွင္႔သ တ္မွတ္ခ်က္မ်ား အလယ္အလတ္အဆင္႔ WSTP အခန္းတြင္ေဆြးေႏြးထားပါသည္။ ေအာက္ပါအေၾကာင္းမ်ားေၾကာ င္႔ေဆာလ်င္စြာလႊဲေျပာင္းေပးျခင္းသည္ကေလးသူငယ္မ်ားအတြက္အေရးၾကီးရျခင္းျဖစ္သည္- • စနစ္တက်ပံ႔ပုိးေပးမႈမရွိလွ်င္ မတ္မတ္ထုိင္ႏိုင္ျခင္းမရွိသည္႔ကေလးသူငယ္မ်ားအတြက္ ကုိယ္ေနဟန္ထား ျပႆနာမ်ား ျဖစ္ေပၚလာႏိုင္သည္။ ကေလးသူငယ္တစ္ဦးအား ေနာက္က်မွလႊဲေျပာင္းေပးလွ်င္ အခ်ိဳ႕ေသာ ကုိယ္ေနဟန္ထား ျပႆနာမ်ားမွာ ပံုေသျဖစ္သြားသည္။ ထုိသုိ႔ျဖစ္သြားပါကကေလးသည္အေထာက္အကူမ်ား တပ္ဆင္ေပးထားသည္႔တုိင္ သက္ေတာင္႔သက္သာထုိင္ႏုိင္ရန္ ခက္ခဲသြားမည္ျဖစ္ပါသည္။ • ထုိင္ျခင္းႏွင္႔ ေရြ႕လ်ားႏုိင္ျခင္းအေတြ႔အၾကံဳမရွိလွ်င္ ကေလး၏ဖြံ႔ျဖိဳးတုိးတက္မႈမွာလည္းေႏွးေကြးသြားမည္ျဖစ္ သည္။ • လမ္းေလွ်ာက္ႏုိင္သည္႔အရည္အေသြးအခ်ိဳ႔ရွိေသာ ကေလးသူငယ္မ်ားအတြက္ ဘီးတပ္ထုိင္ခုံကုိ အသံုးျပဳျခင္း ျဖင္႔ ၎တို႔၏ေန႔စဥ္ဘဝမွာ ပုိမုိလြယ္ကူသြားမည္ျဖစ္ျပီး ေန႔တေန႔တာအတြင္း ၎တုိ႔အေနျဖင္႔ အေၾကာင္းအရာ မ်ားစြာကုိ ေဆာင္ရြက္ႏုိင္မည္ျဖစ္သည္။ အေၾကာင္းမလွစြာပင္ ကေလးသူငယ္မ်ားမွာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ အျမန္ဆံုးလႊဲေပးသင္႔ သည္႔အခ်ိန္အတြင္း လႊဲေျပာင္းေပးျခင္းမခံၾကရပါ။ မိဘမ်ားအေနျဖင္႔ ၎တုိ႔၏ကေလးမ်ားသည္ ေရာဂါ''ေပ်ာက္ ကင္း''ျပီး လမ္းျပန္ေလွ်ာက္ႏုိင္မည္ဟု မွတ္ယူေနေလ႔ရွိသည္။ အခ်ိဳ႕ေသာမိဘမ်ားကမူ ဘီးတပ္ထုိင္ခုံသည္ လြန္ စြာမွပင္ စရိတ္စကၾကီးမားမည္ကို စုိးရိမ္ေနၾကသကဲ႔သုိ႔ ဝန္ေဆာင္မႈလုပ္ငန္းအေၾကာင္းကုိလည္း မသိၾကေခ်။ ကေလးအားဘီးတပ္ထုိင္ခုံေပးလုိက္ျခင္းျဖင္႔ ယင္းကေလးသည္လမ္းေလွ်ာက္ေတာ႔မည္မဟုတ္ဟု အခ်ိဳ႕ေသာ မိဘ မ်ားက ထင္မွတ္ေနျခင္းမ်ိဳးလည္း ရွိေသးသည္။ ေဆာလ်င္စြာလႊဲေျပာင္းေပးေရးသည္ မည္သည္႔အတြက္လြန္စြာအေရးၾကီးသည္ဆုိသည္ကုိ ဝန္ေဆာင္မႈ အဖြဲ႔မ်ားအေနျဖင္႔ ရွင္းရွင္းလင္းလင္း သေဘာေပါက္နားလည္ထားရန္လုိသည္။ လုိအပ္မည္ဆုိပါက ဝန္ထမ္းမ်ား သည္ မိဘမ်ားႏွင္႔လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားအား ဘီးတပ္ထုိင္ခုံသည္ ကေလးအားလမ္းေလွ်ာက္ျခင္းမွ အတားအဆီးျဖစ္လိမ္႔မည္မဟုတ္ဆုိသည္ကုိ ရွင္းလင္းေျပာၾကားရန္လည္း လုိသည္။ ကေလးသည္ လမ္းေလွ်ာက္ ရန္သင္ယူေနစဥ္အတြင္း ဘီးတပ္ထိုင္ခုံသံုးျပီး ေရြ႔လ်ားႏုိင္စြမ္းအေတြ႔အၾကံဳကုိရမည္ဆုိလွ်င္ ၎တုိ႔၏ဖြံ႔ျဖိဳးတုိးတက္မႈ အတြက္ အက်ိဳးေက်းဇူးမ်ားကုိနည္းလမ္းမ်ားစြာမွတဆင္႔ ရႏုိင္မည္ျဖစ္ပါသည္။ 72 73 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေအာင္ျမင္မႈဇာတ္လမ္း - မကၠဆီကိုရိွမိဘမ်ားက ေစာလ်င္စြာလႊေဲျပာင္းေပးျခင္း ေအာက္တြင္ေဖာ္ျပထားသည္မွာ ျပန္လည္ထူေထာင္ေရးဌာနမ်ားသည္ ေဆာလ်င္စြာလႊဲေျပာင္းေပးေရးကြန္ ယက္ကုိ မည္ကဲ႔သုိ႔ ထိထိေရာက္ေရာက္ ထူေထာင္ထားသည္ဆုိသည္႔နမူနာ ျဖစ္ပါသည္။ အစပုိင္းတြင္ ျပန္လည္ထူေထာင္ေရးဌာနမ်ားသည္ ၎တုိ႔၏အသိပညာျပန္႔ပြားေရးေဆာင္ရြက္ခ်က္မ်ားအား အရုိးအေၾကာကု ဆရာဝန္မ်ားႏွင္႔ကေလးအထူးကုဆရာဝန္မ်ားအတြက္ အဓိကထားခဲ႔ေသာ္လည္း ေရဒီယုိႏွင္႔ ရုပ္ျမင္သံၾကားကဲ႔သုိ႔ေသာ လူထုဆက္သြယ္ေရးလုပ္ငန္းကုိ တြင္တြင္က်ယ္က်ယ္အသံုးျပဳၾကေသာလူထုအား ရည္ရြယ္သည္႔ ရံပုံေငြျမွင္႔တင္ေရးေဆာင္ရြက္ခ်က္မ်ားကုိႏွစ္စဥ္ ျပဳလုပ္ခဲ႔သည္။ ယင္းသုိ႔ေဆာင္ရြက္ျခင္းေၾကာင္႔ လႊဲေျပာင္းေပးေရးလုပ္ငန္းသည္ တဆင္႔စကားတဆင္႔နားျဖင္႔ ပ်ံ႕သြားျပီး မိဘမ်ားက ၎တုိ႔၏ကေလးမ်ားအား ကုိယ္တုိင္လာေရာက္လႊဲေျပာင္းေပးမႈကုိ ျဖစ္ေစခဲ႔သည္။ အသိပညာျပန္႔ပြားေရးလုပ္ငန္းေဆာင္ရြက္ေနစဥ္အတြင္း ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ကေလးသူငယ္မ်ား အားေမြးဖြားသည္ႏွင္႔ျပန္လည္ထူေထာင္ေရးဌာနမ်ားသုိ႔ ပုိ႔ေပးရန္အေရးၾကီးပံုႏွင္႔ပတ္သက္သည္႔သတင္းအား ျဖန္႔ေဝေပးခဲ႔သည္။ ၎တုိ႔ေဆာင္ရြက္ေပးခဲ႔သည္႔အတြက္ ေအာင္ျမင္မႈရသြားၾကေသာကေလးသူငယ္မ်ားအ ေၾကာင္းကိုလည္းအင္ႏွင္႔အားႏွင္႔ျဖန္႔ေဝခဲ႔သည္။ (၁၅) ႏွစ္အတြင္းကေလးအထူးကုဆရာဝန္မ်ားႏွင္႔မိသားစုဝင္ မ်ားသည္ေဆာလ်င္စြာလႊဲေျပာင္းေပးျခင္းကိုေဆာင္ရြက္လာၾကသည္႔အတြက္ ျပန္လည္ထူေထာင္ေရးဌာနမ်ား အေနျဖင္႔ဓေလ႔ထံုးစံအေျပာင္းအလဲတစ္ရပ္ကုိေတြ႔ျမင္လာၾကရျပီျဖစ္သည္ဟု ဆုိရမည္ျဖစ္ပါသည္။ ရလဒ္ - လႊဲေျပာင္းေပးမႈ၏ သံုးပံုတစ္ပံုသည္ အသက္ ၃ ႏွစ္ႏွင္႔ေအာက္ကေလးမ်ားျဖစ္သည္။ ေစာလ်င္စြာလႊဲေျပာင္းေပးေရးလုပ္ငန္းအား အားေပးအားေျမွာက္ျပဳလုပ္ရာတြင္ မန္ေနဂ်ာမ်ားအေန ျဖင္႔ ေအာင္ျမင္မႈရရွိရန္ မည္သုိ႔ေဆာင္ရြက္ႏိုင္သနည္း • ပစ္မွတ္အုပ္စုကို ရွင္းရွင္းလင္းလင္းေဖာ္ျပျခင္း • ရည္မွန္းခ်က္ပန္းတုိင္ကုိ ရွင္းရွင္းလင္းလင္းသတ္မွတ္ျခင္း • ပညာရွင္မ်ားႏွင္႔မိဘမ်ားအတြက္မတူညီေသာခ်ဥ္းကပ္မႈ ျပဳလုပ္ျခင္း • မိဘမ်ားႏွင္႔ပညာရွင္မ်ားသိရွိေရးကုိအားေပးရာေရာက္သည္႔ ေအာင္ျမင္ျခင္းဇာတ္လမ္းမ်ားအား မွ်ေဝျခင္း • အသိပညာေပးလုပ္ငန္းမ်ားအား ႏွစ္အတန္ၾကာ ျပဳလုပ္ျခင္း pGrf;aqmif&nfjynfh0NyD; xda&mufrI&Sdonfh 0efaqmifrIvkyfief;rsm;aqmif½Gufjcif; ဝန္ေဆာင္မႈအရည္အေသြးႏွင္႔ထိေရာက္မႈကိုသုံးသပ္ျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ရပ္ကုိေဆာင္ရြက္ျပီဆုိလွ်င္ ဝန္ေဆာင္မႈအဆင္႔တစ္ခုခ်င္းစီကုိသုံုးသပ္ျပီး ယင္း အဆင္႔တစ္ခုစီသည္ အခ်ိန္မည္မွ်ၾကာျမင္႔ဆိုသည္ကို ေလ႔လာထားရမည္ျဖစ္ပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔မ်ား ၏အရည္အေသြးတုိးတက္ေအာင္ျပဳလုပ္ရာတြင္ ေဖၚျပပါအခ်က္မ်ားကုိအေလးထားေဆာင္ရြက္ရန္လုိမည္ျဖစ္သည္- 72 73 • ေကာင္းမြန္သည္႔အဖြဲ႔လုိက္စုေပါင္းလုပ္ေဆာင္မႈကုိအားေပးျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔တစ္ခုစီတိုင္းအတြက္ျပင္ဆင္ရန္လိုအပ္သည္မ်ားကိုၾကိဳတင္ျပင္ဆင္ထားႏိုင္ရန္စီမံ ေဆာင္ရြက္ျခင္း ေအာက္တြင္ေဖာ္ျပထားသည္႔ဇယားမွာ ဝန္ေဆာင္မႈအရည္အေသြးအား မည္သုိ႔တုိးတက္ေအာင္ျပဳလုပ္ႏုိင္ သည္ဆုိသည္ႏွင္႔ပတ္သက္သည္႔ အၾကံျပဳခ်က္မ်ားပင္ျဖစ္သည္- ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း အဆင္႔တစ္ခုစီတုိင္းအတြက္ ဝန္ေဆာင္မႈအရည္အေသြးတုိး ျမွင္႔ေရးမတူညီေသာ နည္းလမ္းမ်ား လႊဲေျပာင္းေပး ျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းကရွိလုိေသာဝယ္လုိအားအဆင္႔အတြက္ရွင္းလင္းျပတ္သားေသာ ရည္မွန္းခ်က္ ႏွင္႔ပန္းတုိင္မ်ားသတ္မွတ္ပါ။ • ဝန္ေဆာင္မႈလုပ္ငန္းသည္ မည္သူ႔အတြက္လုပ္ေဆာင္ေနျခင္းျဖစ္ေၾကာင္း ရွင္းလင္းစြာ အသိေပးပါ၊ • အသိပညာျမွင္႔တင္ေရးလုပ္ငန္းအတြက္ လႊဲေျပာင္းေပးေရးအသင္းအဖြဲ႔မ်ားႏွင္႔ လုပ္ငန္း ကြၽမ္းက်င္သူမ်ားကုိ သတ္မွတ္ပါ။ • လႊဲေျပာင္းမႈအဆင္႔မ်ားအားအနီးကပ္ၾကီးၾကပ္ေစာင္႔ၾကည္႔ပါ။ • လႊဲေျပာင္းေပးမႈမ်ား တုိးတက္လာသည္႔အခါ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားႏွင္႔လည္း ေကာင္း၊ လႊဲေျပာင္းေရးကြန္ယက္အတြင္းလည္းေကာင္း ေအာင္ျမင္မႈဇာတ္လမ္းမ်ားကုိ မွ်ေဝခံစားပါ။ အကဲျဖတ္ သုံးသပ္ျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားအတြက္ သင္႔ေလ်ာ္ေသာ သင္တန္းအဆင္႔အတန္းကုိ သတ္မွတ္ပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္ လူမႈအဖြဲ႔အစည္းအတြင္းရွိ မိတ္ဖက္မ်ားအ တြက္ အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ ေဆာင္မႈအသံုး ျပဳသူမ်ားအား လႊဲေျပာင္းေပးပါ။ • အကဲျဖတ္သံုးသပ္ခ်က္လုပ္ငန္းေဆာင္ရြက္ႏုိင္ေရးအတြက္ ပစၥည္းကိရိယာအားလံုး အားေနသားတက်ထားရွိပါ။ 74 75 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း အဆင္႔တစ္ခုစီတုိင္းအတြက္ ဝန္ေဆာင္မႈအရည္အေသြးတုိး ျမွင္႔ေရးမတူညီေသာ နည္းလမ္းမ်ား ညႊန္ၾကားျခင္း • ထိေရာက္မႈရွိသည္႔သုိေလွာင္မႈထိန္းခ်ဳပ္ေရးစနစ္မ်ား ထူေထာင္ပါ။ • ပစၥည္းသည္ခ်ိန္ညွိရန္ကန္႔သတ္ခ်က္ရွိပါက အသံုးျပဳမည္႔သူတစ္ဦးခ်င္းစီႏွင္႔ကုိက္ညီမႈရွိ ေစမည္႔ပစၥည္းအား ျပဳလုပ္ေပးႏုိင္ရန္ မြမ္းမံဆန္းသစ္မႈကုိ သတ္မွတ္ပါ။ • သတ္မွတ္ေပးေသာေျဖရွင္းခ်က္အား ဝန္ထမ္းက ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူႏွင္႔ တုိင္ပင္ညွိႏႈိင္းျပီး ျဖစ္ႏိုင္ပါက အသံုးျပဳမည္႔သူအား ေရြးခ်ယ္ႏုိင္သည္႔ပစၥည္းမ်ားကုိ ျပသပါ။ ထုိသုိ႔ေဆာင္ရြက္ျခင္းျဖင္႔ အသံုးျပဳသူက ေျဖရွင္းခ်က္အားျငင္းပယ္မႈကုိ ေရွာင္လႊဲႏုိင္မည္ ျဖစ္ပါသည္။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္လူမႈအဖြဲ႔အစည္းအတြင္းရွိ မိတ္ဖက္မ်ား အတြက္ အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈ အသံုးျပဳသူမ်ားအား လႊဲေျပာင္းေပးပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္ မ်ားအတြ က္အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ ေဆာင္မႈအသံုးျပဳ သူမ်ားအားလႊဲေျပာင္းေပးပါ။ ရန္ပုံေငြႏွင့္ စီစဥ္ျခင္း • သတင္းအခ်က္အလက္မ်ားအား မွတ္တမ္းတင္ျခင္းႏွင္႔မွတ္တမ္းထိန္းသိမ္းျခင္းလုပ္ငန္း မ်ားအား ရွင္းရွင္းလင္းလင္းျပဳလုပ္ပါ။ • ထိေရာက္ေသာသုိေလွာင္မႈထိန္းခ်ဳပ္ေရးစနစ္မ်ားကုိ ထူေထာင္ပါ။ 74 75 ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း အဆင္႔တစ္ခုစီတုိင္းအတြက္ ဝန္ေဆာင္မႈအရည္အေသြးတုိး ျမွင္႔ေရးမတူညီေသာ နည္းလမ္းမ်ား ထုတ္ကုန္ ႀကိဳတင္ ျပင္ဆင္ျခင္း • ခ်ိန္ညွိမႈကုိအတတ္ႏုိင္ဆံုးျပဳလုပ္ေပးႏုိင္သည္႔ပစၥည္းကုိ ရွာေဖြပါ။ • အလြယ္တကူမြမ္းမံဆန္းသစ္ႏုိင္ေသာပစၥည္းကုိ ရွာေဖြပါ။ • ကုိယ္ေနဟန္ထားကုိအေထာက္အကူျပဳမည္႔ပစၥည္း PSD မ်ားအား ၾကိဳတင္ဖန္တီးပါ သုိ႔မဟုတ္ PSD ပါဝင္ေသာပစၥည္းမ်ားအားရွာေဖြပါ။ • ပစၥည္းမ်ားအားခ်ိန္မႈကုိ အျမန္ဆံုးေဆာင္ရြက္ေပးႏုိင္မည္႔သင္႔ေလ်ာ္ေသာလက္သံုးပစၥည္း မ်ားကုိ ရွာေဖြပါ။ • အခုအခံမ်ားႏွင္႔ PSD ဖန္တီးမႈမ်ားႏွင္႔မြမ္းမံဆန္းသစ္မႈအတြက္ သင္႔ေတာ္ေသာပစၥည္း မ်ားကုိရွာေဖြပါ။ • ထိေရာက္ေသာသုိေလွာင္မႈထိန္းခ်ဳပ္ေရးစနစ္မ်ားကို ထူေထာင္ပါ။ • အရြယ္အစားမတူေသာ ဘီးတပ္ထုိင္ခုံအေရအတြက္အနည္းငယ္ကုိ သုိေလွာင္ႏိုင္ရန္ ျပင္ဆင္ထားပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္ လူမႈအဖြဲ႔အစည္းအတြင္းရွိ မိတ္ဖက္မ်ားအ တြက္အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈအသံုး ျပဳသူမ်ားအား လႊဲေျပာင္းေပးပါ။ အံဝင္ခြင္က် တပ္ဆင္ျခင္း • တပ္ဆင္မႈျပဳလုပ္ေနစဥ္အတြင္း ေဆးခန္းႏွင္႔စက္မႈလုပ္ငန္းဝန္ထမ္းမ်ား အတူတကြ လုပ္ငန္းေဆာင္ရြက္ပါ။ • ေရြးခ်ယ္ႏုိင္သည္႔နမူနာပစၥည္းထားရွိေရးအတြက္ၾကိဳတင္ျပင္ဆင္ပါ။ • ခ်ိန္ညွိမႈကုိအေကာင္းဆံုးျပဳလုပ္ေပးႏုိင္သည္႔ပစၥည္းကုိရွာေဖြပါ။ • ပစၥည္းမ်ားအားခ်ိန္မႈကုိအျမန္ဆံုးေဆာင္ရြက္ေပးႏုိင္မည္႔သင္႔ေလ်ာ္ေသာလက္ သံုးပစၥည္းမ်ားကုိရွာေဖြပါ။ • အလြယ္တကူမြမ္းမံဆန္းသစ္ႏုိင္မည္႔ ပစၥည္းမ်ိဳးကုိရွာေဖြပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္မ်ားအတြက္ အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ ေဆာင္မႈအသံုးျပဳသူ မ်ားအား လႊဲေျပာင္းေပးပါ။ 76 77 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္း အဆင္႔တစ္ခုစီတုိင္းအတြက္ ဝန္ေဆာင္မႈအရည္အေသြးတုိး ျမွင္႔ေရးမတူညီေသာ နည္းလမ္းမ်ား အသုံးျပဳသူ သင္တန္း • သတ္မွတ္ထားသူတစ္ဦးအားအသံုးျပဳသူသင္တန္းအတြက္ သတ္မွတ္ပါ။ ဥပမာ - အရည္ အခ်င္းတူသူသင္တန္းဆရာျဖစ္သည္။ • ေဆးေပးခန္းႏွင္႔လည္းေကာင္း၊ စက္မႈလုပ္ငန္းေနရာႏွင္႔လည္းေကာင္းနီးသည္႔ အသံုးျပဳ သူသင္တန္း ေနရာကုိ သတ္မွတ္ပါ။ • အေျခခံအဆင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္လူမႈအဖြဲ႔အစည္းအတြင္းရွိ မိတ္ဖက္မ်ားအ တြက္ အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈအသံုး ျပဳသူမ်ားအား လႊဲေျပာင္းေပးပါ။ ေနာက္ဆက္တြဲ လုပ္ေဆာင္ျခင္း • လူမႈအဖြဲ႔အစည္းအတြင္းရွိ ေနာက္ဆက္တြဲျပသမည္႔သူအား လုပ္ငန္းေဆာင္ရြက္ေပး ႏုိင္ေရးအတြက္ ယင္းအဖြဲ႔အတြင္းရွိမိတ္ဖက္အားအရည္အေသြးတည္ေဆာက္ေပးျပီး ရပ္ ကြက္အဆင္႔တြင္ ေျဖရွင္းေပးႏုိင္မရွိသည္႔ျပႆနာကုိ သတ္မွတ္သည္႔အခါ ၎ကုိဝန္ ေဆာင္မႈလုပ္ငန္းသုိ႔ ျပန္လည္လႊဲေျပာင္းေပးပါ။ အေထြေထြ • မွ်ေဝထားသည္႔လုပ္ငန္းစီမံခ်က္ကုိျပဳလုပ္ႏုိင္ရန္ ပုံမွန္အဖြဲ႔အစည္းအေဝးကုိ ျပဳလုပ္ပါ။ • ပူးတြဲလုပ္ငန္းအတြက္အစီအစဥ္ကုိရွင္းရွင္းလင္းလင္းျပဳလုပ္ပါ။ • သတင္းအခ်က္အလက္မွတ္တမ္းတင္ျခင္းႏွင္႔ မွတ္တမ္းထိန္းသိမ္းျခင္းလုပ္ငန္းကုိ ရွင္းရွင္းလင္းလင္းျပဳလုပ္ပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းေပးရန္ လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္မ်ားအ တြက္ အရည္အေသြးတုိးျမွင္႔တည္ေဆာက္ျပီး အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈအသံုး ျပဳသူမ်ားအားလႊဲေျပာင္းေပးပါ။ အေျခခံအဆင္႔သက္သက္ဝန္ေဆာင္မႈလုပ္ငန္းမွ အေျခခံႏွင္ ႔အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းသို ႔ ေျပာင္းလဲျခင္း ဘီးတပ္ထုိင္ခုံလုပ္ငန္းအမ်ားအျပားသည္ လုပ္ငန္းစတင္ခ်ိန္တြင္ အေျခခံအဆင္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္ မႈလုပ္ငန္းကုိသာ လုပ္ကုိင္ၾကသည္။ ယင္းသုိ႔လုပ္ကုိင္ျခင္းသည္အစေကာင္းျခင္းျဖစ္သည္။ အဘယ္ေၾကာင္႔ ဆုိေသာ္ ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ အဆင္႔ (၈) ဆင္႔ပံ႔ပုိးေပးျခင္းႏွင္႔ဆက္ႏြယ္ေနသည္႔စနစ္မ်ား တည္ေဆာက္မႈ ကုိ အေလးေပးလုပ္ကုိင္ႏုိင္မည္ျဖစ္သည္႔အျပင္ ဝန္ထမ္းမ်ားမွာလည္း အေတြ႔အၾကံဳမ်ားရရွိလာႏုိင္သည္႔အတြက္ ေၾကာင္႔ျဖစ္ပါသည္။ သုိ႔ေသာ္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ အလယ္အလတ္အဆင္႔ဘီးတပ္ထုိင္ခုံဝန္ ေဆာင္မႈေတာင္းဆုိလာမႈကုိ ရင္ဆိုင္လာရမည္ျဖစ္သည္။ ယင္းမွာ အံ႔ၾသဘြယ္ရာမဟုုတ္ပါ။ အဘယ္ေၾကာင္႔ဆုိေသာ္ 76 77 အသံုးျပဳသူလုိအပ္ခ်က္၏ ၃၅% မွာ အေျခခံအဆင္႔တြင္ျဖစ္ျပီး ၆၅% မွာ အလယ္အလတ္အဆင္႔တြင္ျဖစ္ေနသည္႔ အတြက္ျဖစ္ပါသည္။ ထုိ႔ေၾကာင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာမ်ားအေနျဖင္႔ ၎တုိ႔၏ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ အလယ္အလတ္ အဆင္႔ဝန္ေဆာင္မႈ လုိအပ္ခ်က္ကိုမည္သုိ႔မည္ပံုျဖည္႔ဆည္းေပးႏုိင္သည္ဆုိသည္႔စီမံခ်က္ေရးဆြဲျခင္းျဖင္႔ လုပ္ငန္း စတင္ေကာင္း စတင္ရမည္ျဖစ္ပါသည္။ ယခင္ကေဖာ္ျပခဲ႔သည္႔အတုိင္း အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္း သည္ ေအာက္ပါတုိ႔ကုိလုိအပ္မည္ျဖစ္ပါသည္ - • သင္႔ေလ်ာ္ေသာသင္တန္းတက္ေရာက္ျပီးသူ ဝန္ထမ္း • ပုိမုိေသာ အသံုးအေဆာင္၊ ပစၥည္းကိရိယာႏွင္႔ပစၥည္း အေျခခံအဆင္႔ဝန္ေဆာင္မႈမွအလယ္အလတ္အဆင္႔ ဝန္ေဆာင္မႈသုိ႔ ေျပာင္းလဲရာတြင္ မန္ေနဂ်ာမ်ား ထည္႔သြင္းစဥ္းစားရန္ လုိအပ္သည္႔ မဟာဗ်ဴဟာမ်ားတြင္ ေအာက္ပါတုိ႔ပါဝင္ပါသည္- • အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းအား မည္သုိ႔ေပးႏုိင္မည္ဆုိသည္ကုိ သတ္မွတ္ႏုိင္ေရးအတြက္ ဝန္ ထမ္းမ်ားႏွင္႔အတူတကြေဆာင္ရြက္ပါ။ ထပ္မံလုိအပ္မည္႔ အသုံးအေဆာင္မ်ားႏွင္႔ပစၥည္းမ်ားႏွင္႔ပတ္သက္၍ လည္းေကာင္း၊ အသံုးျပဳမည္႔ဝန္ေဆာင္မႈပံုစံႏွင္႔ ပတ္သက္၍လည္းေကာင္း စဥ္းစားထားပါ။ • အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းမ်ား ေဆာင္ရြက္ေပးေနၾကသည္႔ဝန္ထမ္းမ်ားအား သင္တန္းထပ္မံေပးပါက ၎တုိ႔အေနျဖင္႔ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားကုိေဆာင္ရြက္ရန္ စြမ္းေဆာင္ရည္ရွိ/မရွိ ဆုိသည္ကုိ သတ္မွတ္ပါ။ ရွိသည္ဆုိပါက ပထမဦးစြာ အေျခခံအဆင္႔ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ဝန္ထမ္း မ်ားအား အစားထိုးရန္ သတ္မွတ္ျပီးေလ႔က်င္႔သင္တန္းေပးပါ။ ထုိေနာက္တြင္ သတ္မွတ္ထားေသာ အလယ္ အလတ္အဆင္႔ဝန္ထမ္းမ်ားအား သင္တန္းေပးပါ။ • အကယ္၍ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ ဝန္ထမ္းမ်ားကုိ သတ္မွတ္ႏုိင္သည္႔အေနအထားတြင္ မရွိျခင္း သုိ႔မဟုတ္ ဝန္ထမ္းမ်ား ပုိမုိခန္႔ထားရန္ေငြမရွိျခင္းမ်ားျဖစ္ပါက အျခားေသာအသင္းအဖြဲ႔မ်ားႏွင္႔ေပါင္းစပ္ညွိႏႈိင္း ေဆာင္ရြက္ရန္ျဖစ္ႏုိင္ေျခရွိ/မရွိ ဆုိသည္ကုိ စဥ္းစားပါ။ 78 79 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ * .3 aemufqufwGJvkyfief; pDpOfjcif; ေနာက္ဆက္တြဲလုပ္ငန္းသည္ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈလုပ္ငန္းမွာ အဆင္႔ (၈) ျဖစ္သည္။ ေနာက္ဆက္တြဲ လုပ္ငန္းျဖင္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအားလံုးအက်ိဳးေက်းဇူးကုိ ခံစားၾကရပါသည္။ ေနာက္ဆက္တြဲလုပ္ငန္းအား မည္သုိ႔ေဆာင္ရြက္ႏုိင္မည္ဆုိသည္ႏွင္႔ပတ္သက္ျပီးဝန္ေဆာင္မႈလုပ္ငန္းမ်ားတြင္စီမံခ်က္ရွိရန္လုိပါသည္။ ေနာက္ ဆက္တြဲျပသစဥ္အတြင္း ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔လည္း အသံုးျပဳသူမ်ား၊ ၎တုိ႔၏မိသားစုဝင္မ်ားႏွင္႔ ၎တုိ႔၏လူမႈအဖြဲ႔အစည္းအေပၚသုိ႔ လုပ္ငန္း၏အက်ိဳးသက္ေရာက္မႈကုိေလ႔လာရန္အခြင္႔အေရးမွ အက်ိဳးအျမတ္ မ်ားကုိ ရရွိႏိုင္မည္ျဖစ္သည္။ ၈။ ေနာက္ဆက္ တြဲလုပ္ငန္း၊ ထိန္းသိမ္းျခင္းႏွင့္ ျပင္ဆင္ျခင္း ေနာက္ဆက္တြဲျပန္လည္ျပသရန္ခ်ိန္းဆုိမႈသည္ ဘီးတပ္ထုိင္ခုံသည္ အံဝင္ခြင္က်ျဖစ္ မျဖစ္ ဆုိသည္ကုိ စစ္ေဆးႏုိင္မည႔္အခြင္႔အေရး ပင္ျဖစ္ျပီး ေလ႔က်င္႔ သင္တန္းေပးမႈႏွင္႔အေထာက္အကူျပဳမႈမ်ားအား ထပ္မံျပဳလုပ္ေပးႏုိင္မည္ျဖစ္သည္။ ထုိသုိ႔ေဆာင္ရြက္ႏုိင္ရန္အတြက္ အခ်ိန္မွာအသံုးျပဳသူ၏လုိအပ္ခ်က္ေပၚတြင္လည္းေကာင္း၊ အျခား ေသာဝန္ေဆာင္မႈလုပ္ငန္းရရွိမႈေပၚတြင္လည္းေကာင္း မူတည္မည္ျဖစ္ ပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ရပ္ကြက္အတြင္း အလြယ္တကူ ေျဖရွင္းရန္မလြယ္ကူသည္႔ နည္းပညာပုိင္းဆိုင္ရာ ျပႆနာမ်ားအား ေျဖရွင္းေပးႏုိင္ေရးအတြက္ ထိန္းသိမ္းမႈႏွင္႔ ျပဳျပင္မႈလုပ္ငန္းမ်ား ကုိလည္း ေဆာင္ရြက္ေပးႏုိင္မည္ျဖစ္ပါသည္။ 78 79 aemufqufwGJvkyfief;\ ta&;ygrI ေနာက္ဆက္တြဲလုပ္ငန္းသည္အဘယ္ေၾကာင္႔အေရးၾကီးရသည္ဆိုသည္ႏွင္႔ပတ္သက္သည္႔နမူနာမ်ား ဒူလီ - သည္ အသက္ (၂၁) ႏွစ္ရွိအမိ်ဳးသမီးတစ္ဦးျဖစ္ျပီး ၎၏မိသားစုႏွင္႔အတူတကြေနထုိင္သူျဖစ္သည္။ ေနာက္ဆက္တြဲျပသရမည္႔အခ်ိန္တြင္ သူမသည္လာေရာက္ျပသမႈမရွိေၾကာင္း အဖြဲ႔ကေတြ႔ရွိခဲ႔သည္။ အေၾကာင္း မွာ သူမ၏ဘီးတပ္ထုိင္ခုံတာယာမ်ားေပါက္ေနေသာေၾကာင္႔ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံကုိ အိမ္ေအာက္တြင္ ပစ္ ထားျခင္း ျဖစ္သည္။ ယင္းအေပါက္ကုိျပန္ျပင္ေပးျပီး သူမ၏မိသားစုဝင္မ်ားအား အၾကံေပးမႈမ်ားျပဳလုပ္ခဲ႔သည္။ ထုိအခ်ိန္မွစ၍ ဒူလီသည္ အိမ္ျပင္သုိ႔ထြက္ႏုိင္ခဲ႔သည္။ မိသားစုဝင္မ်ားအေနျဖင္႔ အက်ိဳးေက်းဇူးကုိမသိမခ်င္း ေနာက္ဆက္တြဲျပသမႈ၏တန္ဖုိးကုိနားလည္ရေကာင္းမွန္းမသိခဲ႔ပါ။ အနာဂတ္တြင္ ထုိသုိ႔ေသာျပႆနာမ်ားကုိ ေလွ်ာ႔ခ်ႏိုင္ရန္အတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းအဖြဲ႔မ်ားသည္ ၎တုိ႔၏လုပ္ငန္းသုိ႔ဆက္သြယ္ႏုိင္မည္႔ တယ္လီဖုန္း အမွတ္ပါဝင္သည္႔စတစ္ကာမ်ားအား ဘီးတပ္ထုိင္ခုံအားလံုးတြင္ ကပ္ရန္ ဆံုးျဖတ္ခဲ႔ၾကပါသည္။ မာရီယာ - သည္ ေက်ာရုိးမၾကီးဒဏ္ရာရရွိခဲ႔ျပီးေနာက္ (၉) လအၾကာတြင္ သင္႔ေလ်ာ္ေသာ ဘီးတပ္ထုိင္ခုံတစ္လံုး ကုိ ရရွိခဲ႔သည္။ ေနာက္ဆက္တြဲျပသရာတြင္ သူမသည္အေၾကာဆြဲေနသလုိလႈပ္ရွားေနျပီး မသက္မသာ ျဖစ္ေန သည္။ ယင္းသည္ ဘီးတပ္ထုိင္ခုံေၾကာင္႔ျဖစ္သည္ဟု သူမကယူဆသည္။ ျဖစ္စဥ္မွာ ၾကမ္းပုိးမ်ားသည္ ဘီးတပ္ ထုိင္ခုံ၏ခ်ဳပ္ရုိးေၾကာင္းမ်ားအတြင္းဝင္ေနသျဖင္႔ သူမအားကုိက္ေနျခင္းျဖစ္သည္။ ယင္းသည္ က်န္းမာေရးဆုိင္ ရာျပႆနာမ်ားအျဖစ္သုိ႔ ေရာက္ရွိသြားႏုိင္ျပီး ပစၥည္းအားစြန္႔ပစ္ထားမႈကုိ ျဖစ္ေပၚလာေစႏုိင္သည္။ သုိ႔ေသာ္ ျပႆနာကုိသိလုိက္သည္႔အတြက္ ေျဖရွင္းလုိက္ႏုိင္သည္။ မာရီယာသည္ ယခုအခါ သူမ၏ဘီးတပ္ထုိင္ခုံႏွင္႔အတူ စိတ္ခ်မ္းသာ ကုိယ္က်န္းမာ ေနထုိင္ေနျပီျဖစ္ပါသည္။ အင္တန ္- သည္ ရပ္ဂ္ဘီကစားရာတြင္ထူးခြၽန္သျဖင္႔ သူ၏ရပ္ကြက္အတြင္း လူသိမ်ားသူျဖစ္သည္။ ထုိေနာက္တြင္ ရပ္ဂ္ဘီ ကစားရာမွ ဒဏ္ရာရရွိခဲ႔ရာ ေက်ာရုိးမၾကီးကုိ ထိခုိက္ခဲ႔သည္။ ၎သည္ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံကုိ ရရွိျပီးအသံုးျပဳသူ သင္တန္းကုိတက္ေရာက္ခဲ႔ရေသာ္လည္း ေနာက္ဆက္တြဲျပန္လည္ျပသရမည္႔အခ်ိန္တြင္ ၎ သည္ လာေရာက္ျပသမႈမရွိေၾကာင္း ေတြ႔ရွိၾကရသည္။ အရည္အခ်င္းတူသင္တန္းဆရာတစ္ဦးသည္ ေနာက္ ဆက္တြဲျပသမႈအဖြဲ႔ဝင္တစ္ဦးျဖစ္ျပီး အင္တန္ႏွင္႔ စကားစျမည္ေျပာဆုိခဲ႔ရာတြင္ အင္တန္သည္ မိမိကုိယ္ကုိယံု ၾကည္မႈေပ်ာက္ဆံုးျပီး မိတ္ေဆြမ်ားႏွင္႔ေတြ႔ဆုံလုိစိတ္မရွိေၾကာင္း ေပၚေပါက္လာသည္။ ၎သည္ အက်ဥ္ခံ ထားရျခင္း၊ အထီးက်န္ျဖစ္ျခင္းမ်ားကုိ ခံစားေနရျပီး''မစြမ္းမသန္''ျဖစ္ေနသည္႔အတြက္လည္း စိတ္မၾကည္မသာ ျဖစ္ေနသည္။ ေနာက္တစ္ေန႔တြင္ အဆုိပါအရည္အခ်င္းတူသင္တန္းဆရာသည္ အင္တန္ထံသုိ႔ ျပန္သြားျပီး ပထမဆံုးအၾကိမ္အျဖစ္ ၎ႏွင္႔အတူ အျပင္ထြက္ခဲ႔သည္။ ထုိေန႔မွစျပီး အင္တန္၏ဘဝသည္ေရွ႕သုိ႔သာ လွမ္းခ်ီ ပါေတာ႔သည္။ ဂီဟန ္ - သည္ အသက္ (၃) ႏွစ္သာရွိေသးသည္႔ ေယာက္်ားေလးတစ္ဦးျဖစ္ျပီး ၎၏မိဘ၊ အစ္ကုိျဖစ္သူ တုိ႔ႏွင္႔အတူ ေနထိုင္သည္။ ေနာက္ဆက္တြဲျပသခ်ိန္တြင္၄င္း၏အေထာက္အကူျပဳထုိင္ခံုမွာ အစားအေသာက္မ်ား ႏွင္႔ ေပလူးေနျပီး သန္႔ရွင္းေရး မလုပ္ရေသးေၾကာင္း ေတြ႔ရွိရသည္။ သူ၏မိဘမ်ားက သူသည္ မတ္မတ္ထုိင္ရန္ အခက္အခဲရွိေနျပီး ထုိင္ခံုအတြင္းသက္ေတာင္႔သက္သာမျဖစ္ေၾကာင္း ေျပာျပသည္။ မိဘမ်ားသည္ ပစၥည္းအ ေပၚ အယံုအၾကည္ကင္းမဲ႔သြားျပီး ယင္းကုိမႏွစ္သက္ေတာ႔ေခ်။ 80 81 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ အသုံးျပဳသူႏွင့္ ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ေနာက္ဆက္တြဲလုပ္ေဆာင္မႈအက်ိဳးေက်းဇူးမ်ား • ဘီးတပ္ထုိင္ခုံသည္ အသံုးျပဳသူ၏ဝန္းက်င္တြင္ ၎၏လုိအပ္ခ်က္အား ျဖည္႔ဆည္းေပးႏုိင္မႈရွိ/မရွိဆုိသည္ကုိ ဝန္ထမ္းမ်ားက အတည္ျပဳေပးႏုိင္ျခင္း • အိမ္ႏွင္႔လူမႈအဖြဲ႔အစည္းအတြင္းသုိ႔ သြားေရာက္ျခင္းသည္ အသံုးျပဳသူ၏ဇာတ္ေၾကာင္းမ်ားကုိ စုေဆာင္းရရွိရန္ အေကာင္းဆံုးေသာအခြင္႔အေရးမ်ားပင္ျဖစ္သည္။ ယင္းဇာတ္ေၾကာင္းမ်ားကုိအသံုးျပဳျပီး ဝန္ေဆာင္မႈလုပ္ငန္း အတြက္ ျပန္လွန္အၾကံျပဳခ်က္မ်ားေပးႏုိင္သကဲ႔သုိ႔ ရံပံုေငြရွာေဖြေရးအတြက္လည္းအေထာက္အကူျဖစ္ေစ မည္ ျဖစ္ပါသည္။ • ဌာနအေျခစုိက္ေနာက္ဆက္တြဲျပသျခင္းသည္ အသံုးျပဳသူ၏ဇာတ္ေၾကာင္းမ်ားကုိစုေဆာင္းရရွိရန္ အခြင္႔အ ေရးအျဖစ္ ရွိေနဆဲျဖစ္သည္။ ယင္းဇာတ္ေၾကာင္းမ်ားကုိအသံုးျပဳျပီး ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ျပန္လွန္ အၾကံျပဳခ်က္မ်ားေပးႏုိင္သကဲ႔သုိ႔ ရံပံုေငြရွာေဖြေရးအတြက္လည္း အေထာက္အကူျဖစ္ေစမည္ျဖစ္ပါသည္။ aemufqufwGJvkyfaqmifjcif;\ &nf½G,fcsufESifh rnfonfhae&mwGif ,if;ukd aqmif½Gufoifhoenf; ေနာက္ဆက္တြဲျပသျခင္း၏ရည္ရြယ္ခ်က္မွာေအာက္ပါတုိ႔ကုိေဆာင္ရြက္ရန္ျဖစ္သည္- • ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူထံမွသတင္းအခ်က္အလက္မ်ားစုေဆာင္းရန္ • ဘီးတပ္ထုိင္ခုံသည္အလုပ္ေကာင္းစြာလုပ္ႏုိင္သည္႔အေျခအေနရွိမရွိဆုိသည္ကုိစစ္ေဆးရန္ • ဘီးတပ္ထုိင္ခုံတပ္ဆင္ထားမႈအံဝင္ခြင္က်ျဖစ္မျဖစ္ဆုိသည္ကုိစစ္ေဆးရန္ ျပဳလုပ္ေနက်ျဖစ္ေသာ ေနာက္ဆက္တြဲလုပ္ငန္း ေဆာင္ရြက္ခ်က္မ်ား ေနာက္ဆက္တြဲျပသမႈမွေပၚေပါက္လာသည္႔ ျပဳလုပ္ေန က်အေရးယူေဆာင္ရြက္မႈအခ်ိဳ႕ မွာ ေအာက္ပါအတုိင္း ျဖစ္သည္ - • အၾကံဥာဏ္မ်ား သုိ႔မဟုတ္ သင္တန္းမ်ားအား ပုိမုိေပးႏုိင္ျခင္း • ဘီးတပ္ထုိင္ခုံကုိ ျပန္လည္ခ်ိန္ညွိမႈျပဳလုပ္ႏုိင္ျခင္း • အေသးစားျပင္ဆင္မႈမ်ားကုိျပဳလုပ္ေပးႏုိင္ျခင္း • လုိအပ္ပါက ကူညီေထာက္ပံ႔မႈမ်ား ျပဳလုပ္ႏုိင္ေရးအ တြက္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအား အျခားေသာ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုထံသုိ႔ လႊဲေျပာင္းေပးျခင္း ျဖစ္ႏုိင္သည္႔ေနရာတုိင္းတြင္ ေနာက္ဆက္တြဲျပသရန္ခ်ိန္းဆိုမႈသည္ အကဲျဖတ္သံုးသပ္မႈအသစ္ ျပဳလုပ္ျခင္း သုိ႔မဟုတ္ ဘီးတပ္ထုိင္ခုံအား အျပည္႔အဝ ျပန္လည္ျပင္ဆင္မြမ္းမံမႈ ျပဳလုပ္ျခင္းမ်ိဳးမျဖစ္သင္႔ေခ်။ အကယ္၍ အကဲ 80 81 ျဖတ္သံုးသပ္ခ်က္ အျပည္႔အစံုျပဳလုပ္ရန္ သုိ႔မဟုတ္ ဘီးတပ္ထုိင္ခုံအား အၾကီးစားျပင္ဆင္ေရးအတြက္ သတ္ မွတ္ရန္လုိသည္ဆုိပါက ထုိသုိ႔ေဆာင္ရြက္ႏုိင္ရန္ အခ်ိန္းအခ်က္တစ္ခု ျပဳလုပ္သင္႔ပါသည္။ မည္သည္႔ေနရာတြင္ ေနာက္ဆက္တြဲျပသမႈကို ျပဳလုပ္သင္႔သနည္း - ေနာက္ဆက္တြဲျပသမႈကို အသံုးျပဳသူ၏ေနအိမ္ သုိ႔မဟုတ္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းဌာန သုိ႔မ ဟုတ္ ဘီးတပ္ထိုင္ခုံအသံုးျပဳသူအတြက္ေရာ၊ ဘီးတပ္ထုိင္ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းအတြက္ပါ အဆင္ေျပ သည္႔ေနရာမ်ိဳးတြင္ ျပဳလုပ္ႏုိင္ပါသည္။ ေအာက္ပါဇယားတြင္ မတူညီသည္႔ေနရာမ်ား၌ျပဳလုပ္ေသာ ေနာက္ဆက္တြဲျပသမႈဆုိင္ရာ အက်ိဳးအျမတ္ မ်ားကုိ ေဖာ္ျပထားပါသည္- အသံုးျပဳသူ၏ေနအိမ္ သုိ႔မဟုတ္ ရပ္ကြက္အတြင္း ေနာက္ဆက္တြဲလုပ္ငန္းေဆာင္ ရြက္ျခင္းေၾကာင္႔ရရွိသည္႔ အက်ိဳးေက်းဇူးမ်ား ဝန္ေဆာင္မႈလုပ္ငန္းဌာနတြင္ ေနာက္ဆက္တြဲ လုပ္ငန္း ေဆာင္ရြက္ျခင္းေၾကာင္႔ရရွိသည္႔ အက်ိဳးေက်းဇူးမ်ား • အသံုးျပဳသူႏွင္႔ ၎၏မိသားစုအတြက္ ကုန္က် စရိတ္သက္သာေစျခင္း • လူမ်ားအေနျဖင္႔ ၎တုိ႔၏အိမ္ႏွင္႔အသုိက္အဝန္း အတြင္းၾကံဳေတြ႔ရမႈမ်ားေၾကာင္႔ ပူးေပါင္းပါဝင္ေဆာင္ ရြက္ေရးအတြက္အဟန္႔အတားျဖစ္ေနမႈမ်ားကုိ ဝန္ ထမ္းမ်ားအေနျဖင္႔ပုိမုိသိရွိႏုိင္ျခင္း • ဝန္ထမ္းမ်ားအေနျဖင္႔ သြားလာလုပ္ကုိင္ေနရသည္႔ အတြက္ လူ႔အဖြဲ႔အစည္းအေပၚ ပုိမုိသေဘာေပါက္ လာျပီး လႊဲေျပာင္းေပးမႈမ်ားကုိ ပုိမုိျပဳလုပ္လာႏုိင္ျခင္း • အသံုးျပဳသူႏွင္႔ ၎၏မိသားစုအတြက္ ကုန္က် စရိတ္သက္သာေစျခင္း • အလုပ္ရံုအသံုးအေဆာင္အျပည္႔အစံုျဖင္႔ အၾကီးစား ျပဳျပင္မႈမ်ားကုိေဆာင္ရြက္ေပးႏုိင္ျခင္း • ပစၥည္းမ်ားႏွင္႔အသံုးအေဆာင္အားလံုးအား တပ္ဆင္ထားျပီးျဖစ္ျခင္း • အျခားေသာဝန္ထမ္းမ်ား၏ ဒုတိယအျမင္ကုိ ရရွိႏုိင္ျခင္း 82 83 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ aemufqufwGJvkyfaqmifjcif;twGuf pDpOfjcif; ေနာက္ဆက္တြဲျပသမႈေၾကာင္႔ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားအေနျဖင္႔ အက်ိဳးေက်းဇူးကုိခံစားၾကရပါသည္။ သုိ႔ရာတြင္ ေနာက္ဆက္တြဲျပသျခင္းသည္ ေအာက္ပါတုိ႔အတြက္ အေရးအၾကီးဆံုးျဖစ္ပါသည္- • မသန္စြမ္းကေလးသူငယ္မ်ား • အပူေလာင္နာျဖစ္ပြားမည္႔အႏၲရာယ္ရွိသည္႔ ဘီးတပ္ထုိင္ခုံ သံုးစြဲသူမ်ား • အေျခအေနတုိးတက္လာေသာဘီးတပ္ထုိင္ခုံ သံုးစြဲသူမ်ား • ဘီးတပ္ထုိင္ခုံအတြင္း အပုိအေထာက္အကူ ပစၥည္းမ်ား လုိေနသည္႔ ဘီးတပ္ထုိင္ခုံ အသံုး ျပဳသူမ်ား (အလယ္အလတ္အဆင္႔) • လႊဲေျပာင္းေပးမႈ၊ ေရြ႔လ်ားႏုိင္မႈ၊ က်န္းမာေရး သုိ႔မဟုတ္ ဘီးတပ္ထုိင္ခုံ ထိန္းသိမ္းေရး သင္တန္းမ်ားတြင္ အခက္အခဲ ေတြ႔ေနၾကသည္႔ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား aemufqufwGJvkyfaqmifjcif; tcsdefZ,m; ေနာက္ဆက္တြဲျပသမႈျပဳလုပ္ရန္အေကာင္းဆံုးအခ်ိန္သည္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူ၏လုိအပ္ခ်က္အေပၚ တည္မွီေနမည္ျဖစ္သည္႔အတြက္ မည္သည္႔အခ်ိန္တြင္ေနာက္ဆက္တြဲျပသမႈျပဳလုပ္သင္႔သည္ဆုိသည္ႏွင္႔ ပတ္သက္ ၍ စည္းမ်ဥ္းသတ္မွတ္ခ်က္ မရွိပါ။ • ဘီးတပ္ထုိင္ခုံအသစ္တစ္လံုးအား ရရွိျပီးေနာက္ သီတင္းပတ္ (၆) ပတ္အတြင္း အလယ္အလတ္အဆင္႔ အသံုးျပဳ သူအား ျပန္လည္သံုးသပ္ျခင္းျဖင္႔ ၎ရရွိထားေသာဘီးတပ္ထုိင္ခုံသည္ ၎၏လုိအပ္ခ်က္ႏွင္႔ကုိက္ညီမႈ ရွိ မရွိ ဆုိသည္ကုိ စစ္ေဆးႏုိင္မည္ျဖစ္ေသာေၾကာင္႔ ထုိသုိ႔ေဆာင္ရြက္ျခင္းသည္ အေထာက္အကူျဖစ္သည္ဟု ဆုိရမည္ ျဖစ္ပါသည္။ • အေျခအေနတုိးတက္ေကာင္းမြန္သူမ်ားႏွင္႔ကေလးသူငယ္မ်ားအတြက္ ေျခာက္လတစ္ၾကိမ္ ေနာက္ဆက္တြဲ ျပသျခင္းသည္ အသင္႔ေတာ္ဆံုးျဖစ္သည္။ အဘယ္ေၾကာင္႔ဆုိေသာ္ အေျခအေနတုိးတက္ေကာင္းမြန္သူမ်ား ႏွင္႔ ကေလးသူငယ္မ်ား၏လုိအပ္ခ်က္သည္ လ်င္ျမန္စြာေျပာင္းလဲသြားႏုိင္သည္႔အတြက္ ျဖစ္ပါသည္။ • ဘီးတပ္ထုိင္ခုံကုိ ရရွိျပီးေနာက္ (၁၂) လအတြင္း ေနာက္ဆက္တြဲျပန္လည္ျပသရန္ အျခားေသာ အသံုးျပဳ သူမ်ားအား မွာၾကားျခင္းသည္ အသင္႔ေတာ္ဆံုးျဖစ္ပါသည္။ 82 83 မွတ္သားရန္ - ဝန္ေဆာင္မႈလုပ္ငန္းကုိစတင္မည္ဆုိလွ်င္ ဝန္ေဆာင္မႈပံုစံအတြင္း ေနာက္ဆက္တဲြျပသမႈကုိ ထည္႔သြင္းထားရမည္ ျဖစ္သည္။ လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္မ်ားသည္ ေနာက္ဆက္တြဲျပသမႈစြမ္း ေဆာင္ရည္ကုိ ဖန္တီးရာ၌အေရးပါသူမ်ား ျဖစ္ပါသည္။ လူမႈအဖြဲ႔အစည္းအတြင္း မိတ္ဖက္မ်ားမရွိပါက ေနာက္ဆက္တြဲျပသမႈ၌ေပၚေပါက္လာႏုိင္သည္႔ အက်ိဳး သက္ေရာက္မႈမ်ား ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ စီမံခ်က္ခ်ထားျခင္းမရွိပါက ခ်ိန္းဆုိမႈအသစ္မ်ားရရွိလာႏုိင္မႈအေပၚ ေနာက္ ဆက္တြဲလုပ္ေဆာင္မႈ၏ အက်ိဳးသက္ေရာက္မႈကုိ လ်င္ျမန္စြာခံစားရမည္ျဖစ္သည္။ တတိယႏွစ္သုိ႔ ေရာက္ရွိခ်ိန္တြင္ အလယ္အလတ္အဆင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ျပည္႔လွ်ံလုနီးပါးျဖစ္လာႏုိင္ပါသည္။ ထုိကိစၥကုိေျဖရွင္းႏုိင္သည္႔ တစ္ခုေသာေျဖရွင္းနည္းမွာ လူမႈအဖြဲ႔အစည္းအေျခစုိက္အသင္းအဖြဲ႔မ်ားႏွင္႔ညွိ ႏႈိင္းေဆာင္ရြက္ျခင္းပင္ျဖစ္သည္။ ထုိ႔အျပင္ ဝန္ထမ္းမ်ားကုိလည္း ေနာက္ဆက္တြဲျပသမႈလုပ္ငန္းမ်ား အတတ္ႏုိင္ဆံုး ေဆာင္ရြက္ႏုိင္ရန္သင္တန္းေပးရပါမည္။ လူမႈအဖြဲ႔အစည္းအေျခစုိက္ဝန္ထမ္းမ်ားသည္ သာမန္ေနာက္ဆက္တြဲ ျပ သျခင္းလုပ္ငန္းကုိ ေဆာင္ရြက္ႏုိင္စြမ္းရွိမည္ျဖစ္ျပီး ျပန္လည္အကဲျဖတ္သံုးသပ္ျခင္း၊ အၾကီးစားျပဳျပင္ျခင္းႏွင္႔ ၎တုိ႔ ေျဖရွင္းႏိုင္ျခင္းမရွိသည္႔အျခားေသာျပႆနာမ်ားကုိ သာလွ်င္ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ ျပန္လည္လႊဲေျပာင္းေပးမည္ ျဖစ္ပါသည္။ ေရြ႕လ်ားႏုိင္စြမ္းခ်ိဳ႕တဲ႔ေနသူကဲ႔သုိ႔ေသာ အျပဳသေဘာေဆာင္သည္႔စံနမူနာျပပုဂၢိဳလ္က ေဆာင္ရြက္သည္႔ ဤအခန္းက႑၏အက်ိဳးေက်းဇူးမ်ားစြာ ရွိပါသည္။ ေနာက္ဆက္တြဲ လုပ္ေဆာင္ေပးရမည့္သူမ်ား ဝန္ေဆာင္မႈယူသူ လူသစ္မ်ား ဘီးတပ္ထုိင္ခုံ အသုံးျပဳသူစုစုေပါင္း အေျခခံအဆင့္ တတိယႏွစ္ စုစုေပါင္းအဆင့္ အလယ္အလတ္အဆင့္ စုစုေပါင္းအဆင့္ တတိယႏွစ္ 84 85 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ လူမႈအဖြဲ႔အစည္းအတြင္း မိတ္ဖက္ထူေထာင္ျခင္းႏွင့္ စံနမူနာျပဝန္ေဆာင္မႈလုပ္ငန္းအတြက္စီမံျခင္း ထိန္းသိမ္းျခင္းလုပ္ငန္းနွင္ ႔ျပဳျပင္ျခင္း လုပ္ငန္းအပါအဝင္လႊဲေျပာင္းေပးျခင္း ႏွင္႔ ေနာက္ဆက္တြဲျပသျခင္းလုပ္ငန္းမ်ားကုိ မိတ္ဖက္ကအေထာက္အကူျပဳႏုိင္သည္။ အသုံးျပဳသူသင္တန္းအတြက္လည္း မိတ္ဖက္က ပံ့ပုိးေပးႏုိင္သည္။ မိတ္ဆက္၏စြမ္းေဆာင္ရည္ေပၚ မူတည္ၿပီး ဝန္ေဆာင္မႈလုပ္ငန္း၏ ပုိမုိ က်ယ္ျပန္႔ေသာလုပ္ငန္းမ်ားအား ပံ့ပုိးမႈေပးႏုိင္မည္ျဖစ္ပါသည္။ aemufqufwGJvkyfaqmifjcif;twGuf twm;tqD;rsm;ukd avQmhcsjcif; ဝန္ေဆာင္မႈေပးသူႏွင္႔အသံုးျပဳသူမ်ားအတြက္အက်ိဳးေက်းဇူးမ်ားရွိေသာ္လည္း ေနာက္ဆက္တြဲျပသမႈကုိရ သူအေရအတြက္မွာ နိမ္႔က်လ်က္ပင္ရွိေသးသည္။ ထုိ႔ေၾကာင္႔ အတားအဆီးမ်ားကုိ ေက်ာ္လႊားႏုိင္ေရးႏွင္႔ ဝန္ေဆာင္ မႈလုပ္ငန္းတုိးတက္လာေရးအတြက္ အဘယ္ေၾကာင္႔အေရအတြက္နည္းပါးေနသည္ဆုိသည္႔အေၾကာင္းရင္းကို သိရွိ ေအာင္လုပ္ရန္ အေရးၾကီးပါသည္။ နယ္ေက်ာ္အေျခစုိက္ေနာက္ဆက္တြဲျပသျခင္းဝန္ေဆာင္မႈလုပ္ငန္းကုိရရွိသည္႔အသံုးျပဳသူမ်ားအတြက္ ျဖစ္ႏုိင္ေခ်ရွိသည္႔ အတားအဆီးမ်ား • ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ား လူမႈအဖြဲ႔အစည္းမ်ားသုိ႔ သြားေရာက္ရသည္႔စရိတ္စက • ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ား လူမႈအဖြဲ႔အစည္းမ်ားသုိ႔ သြားေရာက္ရသည္႔အခ်ိန္ • ဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာမ်ားက ေနာက္ဆက္တြဲျပသမႈကုိ ဦးစားေပးအစီအစဥ္တြင္ထည္႔သြင္းမထားျခင္း • အက်ိဳးေက်းဇူးကုိမရမခ်င္း ဝန္ေဆာင္မႈအသံုးျပဳသူမ်ားက ေနာက္ဆက္တြဲျပသမႈကုိ တန္ဖုိးထားရေကာင္းမွန္းမသိျခင္း ဌာနအေျခစုိက္ေနာက္ဆက္တြဲျပသျခင္းဝန္ေဆာင္မႈလုပ္ငန္းကုိရရွိသည္႔အသံုးျပဳသူမ်ားအတြက္ ျဖစ္ႏုိင္ေခ်ရွိသည္႔ အတားအဆီးမ်ား • မိသားစုဝင္တစ္ဦး သုိ႔မဟုတ္ ထုိထက္ပုိျပီးအလုပ္မွခြာကာသြားရသည္႔ ကုန္က်စရိတ္ႏွင္႔ေပးရသည္႔အခ်ိန္ • ေနာက္ဆက္တြဲျပသမႈ၏အက်ိဳးေက်းဇူးကုိအသံုးျပဳသူမ်ားႏွင္႔မိသားစုဝင္မ်ားကမသိရွိၾကျခင္း • သြားေရာက္ႏုိင္သည္႔သယ္ယူပုိ႔ေဆာင္ေရးကုိရွာေဖြေတြ႔ရွိရန္ခက္ခဲေနျခင္း • ဌာနတြင္ၾကံဳေတြ႔ရမည္႔ခ်ိန္းဆုိမႈအသစ္အေပၚအာရံုစူးစုိက္ရမည္႔ဖိအားေၾကာင္႔ ေနာက္ဆက္တြဲျပသမႈအေပၚအခ်ိန္ မေပးလုိေတာ႔ျခင္း • ခ်ိန္းဆုိမႈအစီအစဥ္ေၾကာင္႔အခက္အခဲရွိျခင္း - အသံုးျပဳသူေရာက္လာခ်ိန္တြင္ဝန္ထမ္းမရွိျခင္းႏွင္႔ ဝန္ထမ္းမ်ားရွိခ်ိန္ တြင္အသံုးျပဳသူကေရာက္မလာျခင္း 84 85 tif'kdeD;&Sm;EkdifiH&Sd aemufqufwGJvkyfief;okdY csOf;uyfa&muf&SdEkdifonfh erlem အင္ဒုိနီးရွားႏုိင္ငံရွိ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးအစီအစဥ္တစ္ခုအရ ဘီးတပ္ထုိင္ခုံတန္ဖုိးကုိတုိက္ရုိက္ေကာက္ခံ ျခင္းမျပဳဘဲ အသင္းဝင္ေၾကးကုိေကာက္ခံသည္။ ယင္းသုိ႔ေကာက္ခံသည္႔အတြက္ဝန္ေဆာင္မႈလုပ္ငန္း၊ ေနာက္ ဆက္တြဲျပသျခင္း၊ ထိန္းသိမ္းျခင္း ႏွင္႔အုပ္ခ်ဳပ္မႈပုိင္းဆုိင္ရာစရိတ္စကမ်ားအတြက္ အေထာက္အကူျဖစ္ေစသည္။ အသင္းဝင္ေၾကးသည္ ''အသင္းဝင္'' မ်ားအား အရည္အခ်င္းျပည္႔ဝေသာဝန္ေဆာင္မႈႏွင္႔ဆက္တုိက္အေထာက္ အကူျပဳမႈကုိရရွိေစသည္။ ထုိ႔အျပင္ ''အေျခအေနေပၚမူတည္ျပီးႏႈန္းထားေျပာင္းလဲျခင္း'' စနစ္အရေပးရသည္႔ပမာ ဏသည္တစ္ဦးခ်င္းစီ၏မိသားစုဝင္ေငြ၊ ဝယ္ယူ သံုးစြဲထားေသာေျပစာမ်ား၊ အစုိးရဝန္ထမ္းျဖစ္ေၾကာင္းအ ေထာက္အထားမ်ား၊ ကိုယ္တုိင္ေရးအစီရင္ခံစာႏွင္႔အျခားေသာ အေထာက္အကူျပဳ ဝင္ေငြဆုိင္ရာအေထာက္ အထားမ်ားအေပၚမူတည္ဆံုးျဖတ္သည္။ အဆုိပါဘီးတပ္ထုိင္ခုံအစီအစဥ္အရ အသင္းဝင္စနစ္သည္ အတုိင္းအတာတစ္ရပ္အထိ ထိေရာက္မႈရွိသည္ကုိ ေတြ႔ရွိရသည္။ • အသင္းဝင္မ်ားအေနျဖင္႔ အရည္အေသြးျပည္႔ဝေသာဝန္ေဆာင္မႈႏွင္႔ပစၥည္းကုိ ေမွ်ာ္လင္႔ႏုိင္သည္။ • ေနရာတုိင္းတြင္ ေဒၚလာ ၁၅ဝ ခန္႔ေပးေနရသည္႔အခ်ိန္တြင္ အသင္းဝင္မ်ားအေနျဖင္႔ ၂ ေဒၚလာမွ ေဒၚလာ ၂ဝ အထိကိုသာလွ်င္ဝင္ေငြအေပၚမူတည္ျပီးေပးရသည္ျဖစ္ရာဘီးတပ္ကုလားထုိင္ကုိပုိမုိတန္ဖုိးထားျပီးယင္းကုိပုိင္ ဆုိင္ရသည္႔အတြက္ ဂုဏ္ယူစိတ္ကုိျဖစ္ေစသည္။ • အသင္းဝင္ထားျခင္းျဖင္႔ ေနာက္ဆက္တြဲျပသျခင္းဝန္ေဆာင္မႈကုိ အခမဲ႔ေသာ္လည္းေကာင္း၊ ေလွ်ာ႔ေစ်းျဖင္႔ ေသာ္လည္းေကာင္း ႏွစ္ႏွစ္သက္တမ္းအတြက္ရရွိထားသည္ျဖစ္ရာ အသင္းဝင္မ်ားအေနျဖင္႔ မၾကာမတင္မွာပင္ ေနာက္ဆက္တြဲ ျပသျခင္းကုိလုပ္ေဆာင္ၾကမည္ျဖစ္ပါသည္။ 86 87 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေနာက္ဆက္တြဲျပသမႈသုိ႔သြားေရာက္ရာတြင္ရွိေနသည္႔အတားအဆီးမ်ားအားေက်ာ္လႊားႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ေနာက္ဆက္တြဲျပသမႈလုပ္ငန္း၏အက်ိဳးေက်းဇူးအေၾကာင္းအသံုးျပဳသူမ်ားအားလႈ႔ံေဆာ္၊ ပါဝင္ႏွင္႔အေလးထား လုပ္ေဆာင္ေစျခင္း- • လုပ္ငန္းေဆာင္ရြက္မႈ အဆင္႔ (၇) တြင္ပါဝင္သည္႔အတုိင္းအသံုးျပဳသူသင္တန္းတြင္ ေနာက္ဆက္တြဲျပသမႈ၏ အက်ိဳးေက်းဇူးမ်ားကုိရွင္းလင္းေျပာျပျခင္း • ေစာင္႔ဆုိင္းခန္းမ်ား၊ ဝက္ဆုိဒ္၊ ရပ္ကြက္အတြင္းရွိေၾကာ္ျငာသင္ပုန္းမ်ားတြင္ ေနာက္ဆက္တဲြျပသမႈ၏ ေအာင္ျမင္မႈ ဇာတ္လမ္းမ်ားကုိေျပာဆုိအသိေပးျခင္း • ဝန္ေဆာင္မႈအသံုးျပဳသူမ်ားအတြက္ အသင္းဝင္ျပဳလုပ္သည္႔အစီအစဥ္ ေနာက္ဆက္တြဲျပသမႈလုပ္ငန္း၏အက်ိဳးေက်းဇူးအေၾကာင္းဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားအားလႈ႔ံေဆာ္၊ ပါဝင္ႏွင္႔အေလးထား လုပ္ေဆာင္ေစျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းကေဆာင္ရြက္ေပးေသာေနာက္ဆက္တြဲျပသမႈလုပ္ငန္းအစီအစဥ္ကုိေရွ႔ေျပးစမ္း သပ္မႈျပဳလုပ္ျခင္း • ေနာက္ဆက္တြဲျပသမႈ၏အက်ိဳးေက်းဇူးႏွင္႔ပတ္သက္သည္႔ ဆန္းစစ္ေလ႔လာခ်က္မ်ားစုေဆာင္းျခင္း အနီးစပ္ဆံုးႏွင္႔အေကာင္အထည္ေဖာ္ႏုိင္ေသာရလဒ္မ်ားကုိသတ္မွတ္ျခင္း • ေရွ႕ေျပးေနာက္ဆက္တြဲျပသမႈလုပ္ငန္းအစီအစဥ္၏ရည္မွန္းခ်က္မ်ားကုိ သတ္မွတ္ျခင္း • ေအာင္ျမင္မႈဇာတ္လမ္းမ်ားအားစုေဆာင္းမွ်ေဝျခင္း အရင္းအျမစ္မ်ားအားေနရာခ်ထားရာတြင္ေနာက္ဆက္တြဲျပသမႈကုိဦးစားေပးအဆင္႔တြင္ထားရွိျခင္း • ေနာက္ဆက္တြဲျပသမႈႏွင္႔ဆက္စပ္ေနသည္႔ကုန္က်စရိတ္မ်ားအတြက္ရံပံုေငြရွာေဖြႏုိင္ရန္ေနာက္ဆက္တြဲျပ သမႈ၏ အက်ိဳးေက်းဇူးမ်ားေၾကာင္႔ျဖစ္ေပၚလာသည္႔ေအာင္ျမင္မႈဇာတ္လမ္းမ်ားကုိ အသံုးျပဳျခင္း • လူမႈအဖြဲ႔အစည္းအတြင္းမွမိတ္ဖက္မ်ားကုိေဖာ္ထုတ္ႏုိင္ရန္အခ်ိန္ဇယားသတ္မွတ္ျပီး လူမႈအဖြဲ႔အစည္းအတြင္းရွိ ဝန္ထမ္းမ်ားအားသင္တန္းေပးျခင္း၊ လမ္းညႊန္မႈေပးျခင္း • သယ္ယူပုိ႔ေဆာင္ေရးစနစ္အားလံုးအသံုးျပဳႏုိင္ေအာင္ေဆာင္ရြက္ထားရွိျခင္း ရင္ဆုိင္ေနရသည္႔စိန္ေခၚမႈမ်ားအတြက္အေထာက္အကူရရွိေစရန္ေဆာင္ရြက္ထားရွိျခင္း • ေနာက္ဆက္တြဲျပသမႈဆုိင္ရာအခ်က္အလက္မ်ားအားအနီးကပ္ေစာင္႔ၾကည္႔ျပီးျပႆနာ၏အရင္းအျမစ္မ်ားကုိ ေဖာ္ထုတ္သတ္မွတ္ျခင္း • ေနာက္ဆက္တြဲျပသမႈကုိဝန္ေဆာင္မႈ၏စံနမူနာ၊ စနစ္မ်ား၊ လုပ္ငန္းစည္းမ်ဥ္း၏အစိတ္အပိုင္းတစ္ခုျဖစ္လာေစ ရန္ ေဆာင္ရြက္ျခင္း 86 87 vlYtokduft0kdif;twGif; yg0ifvIyf&Sm;jcif; ေနာက္ဆက္တြဲျပသမႈသည္ ဝန္ေဆာင္မႈလုပ္ငန္း၏အက်ိဳးသက္ေရာက္မႈကုိလည္းေကာင္း၊ ဘဝအရည္ အေသြးတုိးတက္မႈ၊ လူမႈအဖြဲ႔အစည္းပါဝင္လႈပ္ရွားမႈစသည္႔အလံုးစုံေမွ်ာ္မွန္းခ်က္မ်ားေအာင္ျမင္မႈရွိ/မရွိဆုိသည္ကုိ လည္းေကာင္း အကဲျဖတ္သံုးသပ္သည္႔အခ်ိန္ျဖစ္သည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခု၏ပုိမုိက်ယ္ျပန္႔ေသာအခန္းက႑မ်ားအနက္တစ္ခုမွာ ရပုိင္ခြင္႔ကို တုိးတက္ေစျခင္းပင္ျဖစ္သည္။ ယင္းသည္ လူမႈအဖြဲ႔အစည္းအတြင္းရိွ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ား၏ပါဝင္လႈပ္ရွားမႈအ ေပၚသိသိသာသာ အက်ိဳးသက္ေရာက္မႈရွိမည္ျဖစ္သည္။ tdrfrsm;ESifh trsm;okH;ae&mrsm;okdY 0ifa&mufEkdifjcif; အိမ္သုိ႔ျပန္လာျပီးေတြ႔ရသည္႔အခက္အခဲမ်ားအနက္ တစ္ခုမွာ သန္႔စင္ခန္းဝင္သည္႔အခ်ိန္ျဖစ္သည္။ အိမ္တြင္ရုိးရုိးရွင္းရွင္းအေျပာင္းအလဲမ်ားျပဳလုပ္ျခင္းျဖင္႔ ဘဝအရည္အေသြးတြင္ၾကီးမားေသာကြာျခားမႈတစ္ရပ္ကုိ ဖန္တီးႏုိင္မည္ျဖစ္သည္။ 88 89 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ eDum&m*Gg&Sd taqmufttkH twm;tqD;rsm;qkdif&m vIyf&Sm;rI နီကာရာဂြာႏုိင္ငံတြင္ CADISCA ဟုေခၚေသာ DPO တစ္ခုသည္ ျမင္႔ေသာပလက္ေဖာင္းေဘာင္မ်ားႏွင္႔ေလွကား မ်ားေၾကာင္႔ ၾကံဳေတြ႔ရသည္႔ျပႆနာကုိမီးေမာင္းထုိးျပသမည္႔လႈပ္ရွားမႈတစ္ခုအား ျမိဳ႔ေတာ္တြင္ျပဳလုပ္ခဲ႔သည္။ DPO အဖြဲ႔ဝင္မ်ားျဖစ္ၾကေသာ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူအားလံုးသည္ သံုးလအတြင္း ဆင္ေျခေလွ်ာႏွင္႔ေစာင္းေလွ်ာ အခု (၂ဝဝ) ကုိတည္ေဆာက္ျပီး လမ္းႏွင္႔အညီေဆာင္ရြက္ေပးရာ အမ်ားျပည္သူေနရာမ်ားသုိ႔ဝင္ထြက္သြား လာႏုိင္ခဲ႔ၾကသည္။ CADISCA အသင္းဝင္မ်ားသည္ လူမႈအဖြဲ႔အစည္းအတြင္းအျပဳသေဘာေဆာင္သည္႔ေဆာင္ ရြက္ခ်က္တစ္ခုသုိ႔မဟုတ္ တစ္ခုေဆာင္ရြက္ေလ႔ရွိရာ ေထာက္ခံမႈမ်ားရၾကျပီး ေဒသတြင္းရွိကုမၸဏီမ်ားကျမိဳ႕ ေတာ္အတြင္းဆင္ေျခေလွ်ာႏွင္႔ေစာင္းေလွ်ာမ်ားတည္ေဆာက္ရာတြင္ အကူအညီေပး လာၾကသည္။ အေစာပုိင္းက CADISCA သည္ မိမိကုိယ္ကုိယံုၾကည္မႈတုိးျမင္႔လာေစေရးအတြက္လည္းေကာင္း DPO ၏ လႈပ္ ရွားေဆာင္ရြက္မႈမ်ားအတြင္း အဖြဲ႔ဝင္မ်ားပါဝင္မႈတုိးျမင္႔ေရးအတြက္လည္းေကာင္း ဘီးတပ္ထုိင္ခုံဘတ္စကက္ ေဘာအားကစားလႈပ္ရွားမႈကုိ ေဆာင္ရြက္ခဲ႔သည္။ အားကစားသင္တန္းမ်ား ျပဳလုပ္ျခင္းျဖင္႔ တစ္ဦးကုိတစ္ဦးပံုမွန္ ေတြ႔ဆံုႏုိင္ၾကျပီး အသိပညာေပးေရးလုပ္ငန္းမ်ားကုိ တုိးျမွင္႔ လုပ္ေဆာင္လာႏုိင္သည္။ အားကစားသင္တန္း မ်ားကုိ အမ်ားျပည္သူပန္းျခံမ်ားတြင္ျပဳလုပ္ျခင္းျဖစ္ရာ DPO ၏လႈပ္ရွားေဆာင္ရြက္မႈမ်ားႏွင္႔ အသိပညာေပး လုပ္ငန္းမ်ားအား လူမ်ားက ပုိမုိသိရွိလာၾကသည္။အားကစားလႈပ္ရွားေဆာင္ရြက္ မႈမ်ားျပဳလုပ္ျခင္းျဖင္႔ရပုိင္ခြင္႔ လႈပ္ရွားမႈမ်ားေအာင္ျမင္လာျပီး မသန္စြမ္းမ်ားအတြက္ ေထာက္ခံအားေပးမႈမ်ားကုိ ရရွိလာေစခဲ႔သည္။ ထုိမွ တဆင္႔ မနာဂြာျမိဳ႔ေတာ္တစ္ခုလံုးတြင္ ဆင္ေျခေလွ်ာႏွင္႔ေစာင္းေလွ်ာမ်ားတည္ေဆာက္ေပးရန္ အစုိးရအား ဖိ အားေပး လုပ္ေဆာင္လာႏုိင္ခဲ႔သည္။ အဓိကအတားအဆီးမ်ားအားဖယ္ရွားေပးလုိက္ႏုိင္ျခင္းျဖင္႔ ဘီးတပ္ထုိင္ခုံ အသံုးျပဳသူမ်ားအေနျဖင္႔ ျမိဳ႔ေတာ္အတြင္းရွိဘ႑ာေရး၊ ပညာေရးႏွင္႔လူမႈေရးဆုိင္ရာေနရာမ်ားအား အမ်ားနည္း တူဝင္ေရာက္ႏုိင္ျပီ ျဖစ္ပါသည္။ 88 89 ေဆာက္လုပ္ေရးလုပ္ငန္းေဆာင္ရြက္ေနစဥ္အတြင္းခ်ဥ္းကပ္လမ္းမ်ားးတည္ေဆာက္မႈကုန္က်စရိတ္သည္ အနည္း ဆံုးပင္ျဖစ္ရာ ေဆာက္လုပ္ေရးကုန္က်စရိတ္၏ ၁% ထက္ပင္နည္းသည္။ သန္႔စင္ခန္းသို႔ ဝင္ေရာက္ရန္ႏွင္႔လမ္းေၾကာင္းမ်ားႏွင္႔ပတ္သက္ျပီး အခက္အခဲရွိသည္႔ အတြက္ပညာေရးကုိခ်ဥ္းကပ္ႏုိင္ခြင္႔မွာ အတားအဆီးျဖစ္ေနရသည္။ ခ်ဥ္းကပ္ဝင္ ေရာက္ႏုိင္ေသာ အေဆာက္အအုံမ်ားႏွင္႔လမ္းေၾကာင္းပံုစံမ်ားႏွင္႔ပတ္သက္သည္႔ အ ရင္းအျမစ္မ်ားႏွင္႔သတင္းအခ်က္အလက္မ်ား ပံ႔ပုိးေပးႏုိင္ျခင္းျဖင္႔ ေက်ာင္းမ်ားလည္း ပါဝင္လာေစရန္အေထာက္အကူျဖစ္ေစမည္ ျဖစ္ပါသည္။ အေဆာက္အအံုမ်ားသုိ႔ ဝင္ေရာက္ႏုိင္ရန္ျပဳလုပ္သည္႔အရင္းအျမစ္မ်ားစြာရွိပါသည္။ ခ်ဥ္းကပ္ဝင္ေရာက္ႏိုင္သည္႔ဝန္းက်င္အေနအထားတစ္ရပ္ေပၚေပါက္လာေစရန္ အၾကံျပဳျခင္းႏွင္႔သတင္းအခ်က္အလက္မ်ား ပံ႔႔ပုိးေပးျခင္းျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ား အေနျဖင္႔အိမ္မ်ား၊ သယ္ယူပုိ႔ေဆာင္ရာေနရာမ်ား၊ ပညာေရးလုပ္ငန္းမ်ားသုိ႔ ဝင္ ေရာက္ခြင္႔ကုိ တုိးျမွင္႔ေပးႏုိင္မည္ျဖစ္ျပီး ဤနည္းအားျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခု သည္ ေရြ႕လ်ားႏုိင္စြမ္းခ်ိဳ႔တဲ႔သူမ်ား၏ပါဝင္လႈပ္ရွားပုိင္ခြင္႔အခြင္႔အလမ္းမ်ားကုိ အျမင္႔ ဆံုးျဖစ္ေအာင္ ေဆာင္ရြက္ေပးႏုိင္မည္ျဖစ္ပါသည္။ csOf;uyf0ifa&mufEkdifaom o,f,lykdYaqmifa&; ဘီးတပ္ထိုင္ခုံသံုးစြဲသူမ်ားအတြက္သယ္ယူပုိ ႔ေဆာင္ေရးသည္ၾကံဳေတြ႔ေနက်အတားအဆီးတစ္ခုျဖစ္ပါ သည္။ စိန္ေခၚမႈမ်ားတြင္ ေအာက္ပါတုိ႔ပါဝင္ပါသည္- • ဘီးတပ္ထုိင္ခုံအား သယ္ေဆာင္ေရးႏွင္႔စနစ္တက်ထားသုိႏုိင္ရန္မစီစဥ္မေဆာင္ရြက္မိပဲ သယ္ယူပုိ႔ေဆာင္ျခင္း • ဘီးတပ္ထုိင္ခုံသယ္ေဆာင္မႈအတြက္ အပုိေၾကးေပးေဆာင္ရျခင္း • ျဖဳတ္ႏုိင္ေသာအစိတ္အပုိင္းမ်ားေပ်ာက္ဆံုးျခင္း သုိ႔မဟုတ္ အခုိးခံရျခင္း၊ ဥပမာ- ဘီးမ်ား • တံခါးခံုေနရာႏွင္႔တံခါးေပါက္မ်ားေၾကာင္႔ သယ္ယူပုိ႔ေဆာင္ရာ၌အခက္အခဲရွိျခင္း ႏုိင္ငံအမ်ားအျပားတြင္ လူအားလုံုးပါဝင္အသံုးျပဳႏုိင္ေသာသယ္ယူပုိ႔ေဆာင္ေရးစနစ္အမ်ားအျပား ရွိပါ သည္။ ဥပမာ - ေတာင္အာဖရိကႏိုင္ငံရွိ Dial-a-Ride ႏွင္႔ ကုိလံဘီယာရွိ ဘတ္စ္ကားအျမန္ကူးေျပာင္းေရးစနစ္မ်ား ျဖစ္သည္။ ကမၻာတစ္ဝန္းတြင္လည္း အသံုးတည္႔ေသာခ်ဥ္းကပ္ဝင္ေရာက္ႏုိင္သည္႔သယ္ယူပုိ႔ေဆာင္ေရးလုပ္ငန္း အရင္းအျမစ္မ်ားစြာလည္းရွိသည္။(၁) 90 91 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ * .4 bPÖma&; wnfwHhckdifNrJ&ef tpDtpOf bPÖma&; wnfwHhckdifNrJrIqkdonfrSm tb,fenf; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအတြက္ ဘဏၰာေရး တည္တံ႔ခုိင္ျမဲမႈဆုိသည္မွာ ဘီးတပ္ထုိင္ခုံဝန္ ေဆာင္မႈလုပ္ငန္းအဆင္႔ (၈) ဆင္႔ႏွင္႔ပုိမုိက်ယ္ျပန္႔ေသာဝန္ေဆာင္မႈလုပ္ငန္းဆုိင္ရာဝတၱရားမ်ားအား အေကာင္အ ထည္ေဖာ္ ထမ္းေဆာင္ႏုိင္ရန္လုိအပ္သည္႔ ရံပံုေငြႏွင္႔အရင္းအျမစ္မ်ားအား အျမဲတမ္းရရွိေနျခင္းကုိ ဆုိလုိပါသည္။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ လုပ္ငန္းမန္ေနဂ်ာမ်ားသည္ ၎တုိ႔၏ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအား ဘဏၰာ ေရးအရ ေရရွည္တည္တံ႔ခုိင္ျမဲသည္႔လုပ္ငန္းျဖစ္လာေစရန္ မည္ကဲ႔သို႔ေဆာင္ရြက္မည္ဆုိသည္ကုိ စီမံရာတြင္ အဓိက က်သူမ်ားျဖစ္သည္။ bPÖma&;a&&SnfwnfwHhckdifNrJrIqkdif&m 0efaqmifrIvkyfief; pmwrf;erlem သိသာေသာအခ်ိန္အတုိင္းအတာတစ္ခုအတြင္း အေရအတြက္အတုိင္းအတာတစ္ခုအထိရွိေသာ တစ္ဦးခ်င္းစီ ထံသုိ႔ ဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔ (၈) ဆင္႔မွတစ္ဆင္႔ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံမ်ားေထာက္ပ့ံရန္ အရည္ အေသြးရွိျခင္းသည္ ေရရွည္တည္တံ႔ခုိင္ျမဲမႈရွိေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးအစီအစဥ္တစ္ခုျဖစ္သည္ဟု ဆုိရ ပါမည္။ ထုိသုိ႔ျဖစ္လာႏုိင္ရန္အတြက္ ပစၥည္းေထာက္ပံ႔မႈ၊ ဝန္ထမ္းမ်ားအားေလ႔က်င္႔သင္တန္းေပးျခင္း၊ ေနရာႏွင္႔ ၾကီး ၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔အကဲျဖတ္သံုးသက္ျခင္းစနစ္မ်ားအတြင္း စဥ္ဆက္မျပတ္ရင္းႏွီးျမႈပ္ႏွံမႈျပဳလုပ္ေနရန္ လုိ အပ္ပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ ယင္းသုိ႔စဥ္ဆက္မျပတ္ရင္းႏွီးျမႈပ္ႏွံမႈျပဳလုပ္ႏုိင္ရန္လုိအပ္ေသာ ရံပံု ေငြမ်ားႏွင္႔အရင္းအျမစ္မ်ားအား စုေဆာင္းထားျခင္း သုိ႔မဟုတ္ စုေဆာင္းႏိုင္သည္႔အေနအထားသုိ႔ေရာက္ရွိျခင္း ကုိ ရယူေဆာင္ရြက္ႏုိင္ျပီဆုိလွ်င္ ဘ႑ာေရးတည္တံ႔ခုိင္ျမဲမႈရရွိျပီျဖစ္သည္ဟု ဆုိႏုိင္ပါသည္။ bPÖma&; wnfwHhckdifNrJ&ef tpDtpOf ေအာက္ပါအခ်က္မ်ားပါဝင္ပါသည္- • ဝန္ေဆာင္မႈလုပ္ငန္းေရရွည္တည္တံ႔ခုိင္ျမဲေရးအတြက္လုိအပ္ေသာ ရံပံုေငြမ်ားႏွင္႔အရင္းအျမစ္မ်ားအား ရွင္းရွင္း လင္းလင္းေဖာ္ထုတ္သတ္မွတ္ျခင္း (ဂ.၅ ကုိၾကည္႔ပါ) • ေငြေၾကးေထာက္ပံ႔ရန္အလားအလာရွိသည္႔ အရင္းအျမစ္မ်ားကုိ သတ္မွတ္ျခင္း • ေငြေၾကးမပါသည္႔ေထာက္ပံ႔မႈအလားအလာမ်ားကုိသတ္မွတ္ျခင္း • ေငြေၾကးေထာက္ပံ႔မႈႏွင္႔ပစၥည္းလႈဒါန္းမႈခုိင္ျမဲစိတ္ခ်ရမႈရွိေစေရးအတြက္ မဟာဗ်ဴဟာတစ္ရပ္ေဖာ္ထုတ္ျခင္း 90 91 aiGaMu;axmufyHh&ef tvm;tvm&Sdonfh t&if;tjrpfrsm;ukd owfrSwfjcif; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအား မတူညီသည္႔ေငြေၾကးေထာက္ပံ႔မႈအရင္းအျမစ္ အမ်ားအျပားမွ တဆင္႔ နည္းလမ္းေပါင္းစံုျဖင္႔ ေငြေၾကးေထာက္ပံ႔မႈျပဳလုပ္ႏုိင္ပါသည္။ အခ်ိဳ႕ေသာဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ တစ္ခုတည္းေသာ ေငြေၾကးေထာက္ပံ႔မႈအရင္းအျမစ္ကုိသာ ရွိႏုိင္သည္။ (ဥပမာ - အစုိးရ) သုိ႔ေသာ္ ဝန္ေဆာင္မႈ လုပ္ငန္းအမ်ားစုသည္ လုိအပ္ေသာ ေငြေၾကးရံပံုေငြ ႏွင္႔အရင္းအျမစ္မ်ားကုိ မတူညီသည္႔ အရင္းအျမစ္ မ်ားမွတဆင္႔ ရရွိႏုိင္ၾကပါသည္။ ေငြေၾကးေထာက္ပံ႔မႈ အရင္းအျမစ္တုိင္းသည္ ေငြစာရင္းေခါင္းစဥ္တစ္ခု သုိ႔မဟုတ္ အမ်ား သုိ႔မဟုတ္ အရင္းအျမစ္လုိအပ္ခ်က္ကုိလုိက္ျပီး အေထာက္အကူျပဳႏုိင္မည္ ျဖစ္ပါသည္။ မန္ေနဂ်ာမ်ားထည္႔သြင္းစဥ္းစားထားရမည္႔မတူညီေသာေငြေၾကးေထာက္ပံ႔မႈဆုိင္ရာအရင္းအျမစ္မ်ား အစုိးရ အမိ်ဳးသားအာမခံအစီအစဥ္ ပုဂၢလိကအလႈရွင္မ်ားႏွင္႔ပံ႔ပုိးေပးသူမ်ား လုပ္ငန္း (စီးပြားေရး) အလႈရွင္မ်ားႏွင္႔ပံ႔ပုိးေပးသူမ်ား အသံုးျပဳသူမွထည္႔ဝင္ျခင္း သုိ႔မဟုတ္ အျပည္႔အဝ ဝယ္ယူျခင္း ဝင္ေငြတုိးျမွင္႔ေရး/လူမႈေရးလုပ္ငန္းမ်ား လူမႈအဖြဲ႔အစည္းအတြင္းရွိအုပ္စုမ်ား/ေစတနာ႔ဝန္ ထမ္း အသင္းအဖြဲ႕မ်ား သံရံုးမ်ား ႏုိင္ငံတကာႏွင္႔ျပည္တြင္း NGO မ်ား aiGaMu;rygonfh axmufyHhrItvm;tvmrsm;ukd owfrSwfjcif; ေငြေၾကးမပါသည္႔ေထာက္ပံ႔မႈတြင္ ပစၥည္းလႈဒါန္းျခင္း၊ (ဥပမာ - တန္ဆာပလာမ်ား၊ ဘီးတပ္ထုိင္ခုံမ်ား၊ ပစၥည္းမ်ားအား လႈဒါန္းျခင္း) ေစတနာ႔လုပ္ငန္းအေထာက္အကူျပဳျခင္း၊ အသံုးအေဆာင္မ်ားေထာက္ပံ႔ျခင္းတုိ႔ ပါဝင္ပါသည္။ ေငြေၾကးမပါသည္႔ေထာက္ပံ႔မႈေၾကာင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းအားစီမံခန္႔ခြဲရာတြင္ လုိအပ္ေသာ ေငြေၾကး ပမာဏကုိ ေလ်ာ႔က်သြားေစမည္ျဖစ္ပါသည္။ အခ်ိဳ႕ေသာဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ လႈဒါန္းသည္႔ဘီးတပ္ထုိင္ခုံမ်ားအား ပံုမွန္ရရွိေနႏုိင္ သည္။ ယင္းသည္အေထာက္အကူျဖစ္သည္ဆုိပါက ဝန္ေဆာင္မႈလုပ္ငန္းအေနျဖင္႔ ယင္းဘီးတပ္ထုိင္ခုံမ်ား၏အရည္ အေသြးႏွင္႔ သင္႔ေလ်ာ္မႈကုိ အကဲဲျဖတ္ရန္အျမဲတမ္းအေရးၾကီးေနမည္ျဖစ္ပါသည္။ အဘယ္ေၾကာင္႔ဆုိေသာ္ လႈဒါန္း သည္႔ ဘီးတပ္ထုိင္ခုံတုိင္းသည္ သင္႔ေလ်ာမႈမရွိသည္႔အတြက္ ျဖစ္ပါသည္။ bD;wyfxdkifckH0efaqmifrIvkyfief; a&&SnfwnfwhHckdifNrJa&;twGuf rwlnDaom&efykHaiGt&if;tjrpfrsm;tm; pkpnf;jcif; ေအာက္တြင္ေဖာ္ျပထားေသာဇယားသည္ နမူနာဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုက သတ္မွတ္ထားေသာမတူညီ သည္႔ရံပံုေငြအရင္းအျမစ္မ်ားအတြက္ နမူနာျဖစ္ပါသည္။ ယင္းရံပုံေငြအရင္းအျမစ္မ်ားသည္ အဖြဲ႔အစည္း၏ ဘ႑ာ ေရး ေရရွည္တည္တံ႔ ခုိင္ျမဲမႈအတြက္ လုိအပ္ေသာရံပံုေငြမ်ားႏွင္႔အရင္းအျမစ္မ်ားအား မည္သုိ႔မည္ပံုအေထာက္ အကူျပဳေနသည္ဆုိသည္ကုိလည္း ေဖာ္ျပထားပါသည္။ 92 93 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ နမူနာဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအတြက္ ရံပံုေငြေထာက္ပံ႔ေရး အရင္းအျမစ္မ်ား ရန္ပုံေငြအရင္းအျမစ္ အေထာက္အပံ့ျပဳသည့္ ေငြေၾကးရန္ပုံေငြ သုိ႔မဟုတ္ အရင္းအျမစ္ အစုိးရ • ဝန္ေဆာင္မႈလုပ္ငန္းကေပးအပ္ေသာဘီးတပ္ထုိင္ခုံတစ္လံုးစီအတြက္ ကုန္က် စရိတ္ ၅ဝ% ကုိ ေထာက္ပံ႔ေပးျခင္း • ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္အလုပ္လုပ္ေပးေနေသာ ဝန္ထမ္းႏွစ္ဦးအား ေထာက္ပံ႔ျခင္း (ဝန္ထမ္းဘတ္ဂ်က္၏ ၅ဝ%) လုပ္ငန္း (စီးပြားေရး) • ဝန္ေဆာင္မႈလုပ္ငန္း၏ေငြစာရင္းသုိ႔ ေဒသႏၲရကုမၸဏီတစ္ခုက ႏွစ္စဥ္အလႈေငြ ထည႔္ဝင္ေပးျခင္း • ေနာက္ထပ္ေဒသႏၲရကုမၸဏီတစ္ခုက ဘီးတပ္ထုိင္ခုံကုန္က်စရိတ္ႏွင္႔ ဝန္ေဆာင္ မႈေပးျခင္းအတြက္က်ခံေပးျပီး တစ္ႏွစ္လွ်င္ကေလး (၁ဝ) ဦးအား တာဝန္ယူ မည္ဟု ကတိေပးျခင္း တစ္ဦးခ်င္း • ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ အလႈထည္႔ဝင္ျခင္း (မည္သည္႔ေငြစာရင္းေခါင္းစဥ္ အတြက္ဟူ၍ သီးသန္႔သတ္မွတ္ထားမႈ မရွိပါ) လူမႈေရးလုပ္ငန္း ေဆာင္ရြက္ခ်က္မ်ား • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသည္ လူမႈေရးလုပ္ငန္းေဆာင္ရြက္ခ်က္ အမ်ားအျပားကုိ ေဆာင္ရြက္ၾကသည္။ ယင္းလုပ္ငန္းမ်ားတြင္ ဝင္ခြင္႔ စာရင္း စစ္ျခင္း (အေဆာက္အအံုမ်ား) ႏွင္႔ ဆီးထိန္းပစၥည္းမ်ား ေထာက္ပံ႔ျခင္းတုိ႔ ပါဝင္သည္။ ဤလုပ္ငန္းမွရရွိေသာအက်ိဳးအျမတ္မ်ားသည္ ဘီးတပ္ထုိင္ခုံဝန္ ေဆာင္မႈလုပ္ငန္းအတြက္ အေထာက္အကူျဖစ္ေလ႔ရွိျပီး ဝန္ထမ္းဘတ္ဂ်က္၏ အနည္းဆံုး ၅ဝ% ကုိ ေထာက္ပံ႔ေပးႏုိင္သည္။ ႏုိင္ငံတကာ အစုိးရမဟုတ္ေသာ အဖြဲ႔ အစည္းမ်ား • ႏုိင္ငံတကာအစုိးရမဟုတ္ေသာအဖြဲ႔အစည္းမ်ားမွတဆင္႔ သီးသန္႔ေနရာမ်ားတြင္ ေနထုိင္ၾကသူမ်ားထံသုိ႔ ဘီးတပ္ထုိင္ခုံမ်ားေထာက္ပံ႔ရန္ ဝန္ေဆာင္မႈလုပ္ငန္း သည္ ေငြေၾကးအေထာက္ပံ႔ကုိ ႏွစ္ၾကိမ္ရရွိသည္။ ဘာသာေရး အဖြဲ႔အစည္းမ်ား • ႏွစ္စဥ္အလွဴအျဖစ္ ဘီးတပ္ထုိင္ခုံ ၂ဝဝ ေထာက္ပံ႔ေပးျခင္း (ဝန္ေဆာင္မႈလုပ္ ငန္းကေရြးခ်ယ္ေပးေသာ ဘီးတပ္ထုိင္ခုံမ်ား ျဖစ္သည္) 92 93 r[mAsL[m az:xkwfjcif; ေငြေၾကးအေထာက္အပံ႔ျပဳရန္အလားအလာရွိသည္႔အရင္းအျမစ္မ်ားကုိ သတ္မွတ္ျပီးျပီဆုိလွ်င္ ဝန္ေဆာင္ မႈလုပ္ငန္းမန္ေနဂ်ာမ်ားသည္ မည္သည္႔ေငြေၾကးအေထာက္အပံ႔ျပဳရန္အလားအလာရွိသည္႔အရင္းအျမစ္ထံမွ မည္ သည္႔ အေထာက္အပံ႔မ်ိဳးအား ေတာင္းဆုိမည္၊ မည္မွ်ေတာင္းဆုိမည္ဆုိသည္႔ မဟာဗ်ဴဟာတစ္ရပ္ကုိ ေဖာ္ထုတ္ရန္ လုိအပ္မည္ ျဖစ္ပါသည္။ ယင္းမဟာဗ်ဴဟာေဖာ္ထုတ္မႈ၏တစိတ္တေဒသအေနျဖင္႔ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္း အျမစ္သည္ ရံပံုေငြမ်ားအား မည္သို႔မည္ပံုေထာက္ပံ႔မည္၊ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္သည္ မည္မွ်ေလာက္ အထိ ေထာက္ပံ႔ႏုိင္မည္၊ ယင္းအေထာက္အပံ႔မ်ားကုိရရွိရန္ အခ်ိန္ႏွင္႔လံု႔လစုိက္ထုတ္မႈ မည္မွ်လုိမည္စသည္႔အ ခ်က္မ်ားကုိပါ ထည္႔သြင္းစဥ္းစားထားရမည္ျဖစ္သည္။ မဟာဗ်ဴဟာေဖာ္ထုတ္မႈကုိအေထာက္အကူျဖစ္ေစရန္ မန္ေနဂ်ာမ်ားသည္ မတူညီေသာေငြေၾကးေထာက္ ပံ႔မည္႔အရင္းအျမစ္မ်ားကို ဦးစားေပးအဆင္႔အတန္းသတ္မွတ္ေပးႏိုင္သည္။ ထုိေနာက္တြင္ ရံပံုေငြမ်ားရရွိေရးအ တြက္ မည္သုိ႔ခ်ဥ္းကပ္မည္ဆုိသည္ကုိ စီမံရပါမည္။ မန္ေနဂ်ာမ်ားအေနျဖင ္႔ ေအာက္ပါအခ်က္မ်ားအား ထည္႔သြင္း စဥ္းစားထားရန္လုိသည္- • ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္ - မည္သူ႔ထံခ်ဥ္းကပ္မည္နည္း • - အေထာက္အပံ႔ - ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္က မည္သည္႔အရာကုိေထာက္ပံ႔ေပးရမည္ဆုိသည္ကုိ မန္ေနဂ်ာက မည္သည္႔အရာကုိ ေတာင္းဆုိမည္နည္း၊ ယင္းသုိ႔ေတာင္းဆုိရာတြင္ ခြင္႔ျပဳႏုိင္သည္႔ဘတ္ဂ်က္ အတုိင္းအတာကုိလည္း ဂရုစုိက္ရမည္၊ ဥပမာ ခြင္႔ျပဳႏုိင္သည္႔ဘတ္ဂ်က္အတုိင္းအတာအမ်ိဳးမ်ိဳး ပါဝင္ေနသည္႔ ပစၥည္း သို႔မဟုတ္ဝန္ေဆာင္မႈအဆင္႔ (သုိ႔မဟုတ္ အဆင္႔မ်ား) ျဖစ္သည္။ ေငြေၾကးေထာက္ပံ႔မည႔္အရင္းအျမစ္ကုိ သတ္မွတ္ျပီးျပီဆုိလွ်င္ ၎တုိ႔အေနျဖင္႔မည္သည္႔အရာကုိ အမ်ားဆံုးေထာက္ပံ႔ေစခ်င္သည္ဆုိသည္ကုိ စဥ္း စားရမည္။ • - အဆိုျပဳျခင္း - ေထာက္ပံ႔ရန္/ပံ႔ပုိးေပးရန္ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္အား သင္ မည္မွ်ေတာင္းဆုိ မည္နည္း။ ထည္႔သြင္းစဥ္းစားရမည္႔အခ်က္မ်ားမွာ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္၏အရင္းအႏွီးအင္အား ႏွင္႔ဝန္ေဆာင္မႈလုပ္ငန္း သုိ႔မဟုတ္ အျခားဌာနမ်ားသုိ႔ ယခင္ကလႈဒါန္းခဲ႔သည္႔ပမာဏျဖစ္သည္။ • - ျဖစ္ႏုိင္ေျခရွိမႈ - ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္က ဝန္ေဆာင္မႈလုပ္ငန္းအား ေငြေၾကးေထာက္ပံ႔မႈ/ပံ႔ပုိးမႈ ျပဳလုပ္ႏုိင္ေျခရွိသည္႔အေနအထားကုိ ဆုိလုိသည္။ ယင္းကုိ နည္းပါး၊ အလယ္အလတ္၊ မ်ားျပား ဟူ၍ အဆင္႔ အတန္း ခြဲထားရမည္။ • - ၾကိဳးပမ္းေဆာင္ရြက္မႈ - ေငြေၾကးေထာက္ပံ႔မႈရရွိေအာင္ မည္သည္႔အရာ လုိအပ္သနည္း၊ ထုိသို႔ေသာ လုိအပ္ ခ်က္တြင္ သိရွိျပီးသား သုိ႔မဟုတ္ မသိေသးသည္႔ အျခားကတိကဝတ္မ်ား မည္သုိ႔ရွိသနည္း။ ပံ႔ပုိးေပးမည္႔ပမာဏ သည္ ေငြေၾကးေထာက္ပံ႔မည္႔ပမာဏႏွင္႔အခ်ိဳးကုိက္ ျဖစ္ရပါမည္။ ထမ္းေဆာင္ေပးရမည္႔ကတိကဝတ္မ်ားမွာ လည္းဝန္ေဆာင္မႈလုပ္ငန္းကတတ္ႏုိင္သည္႔ပမဏာ/တစ္ႏုိင္ျဖစ္ရပါမည္။ ေအာက္ေဖာ္ျပပါဇယားတြင္နမူနာႏွစ္ခုေပးထားပါသည္။ ပံ႔ပုိးမႈ၊ အဆုိျပဳမႈ၊ ျဖစ္ႏုိင္ေျခရွိမႈ၊ ႏွင္႔ လုိအပ္ေသာ ၾကိဳးပမ္းေဆာင္ရြက္မႈ ေအာင္ျမင္ႏုိင္သည္႔အေျခအေနမ်ားကုိထည္႔သြင္းစဥ္းစားျပီး မန္ေနဂ်ာမ်ားသည္ မည္သည္႔ 94 95 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ေငြေၾကး ေထာက္ပံ႔မႈအရင္းအျမစ္ ေနာက္သုိ႔လုိက္ရမည္ဆုိသည္ကို ဦးစားေပးအဆင္႔အတန္းခြဲျခားသတ္မွတ္ရမည္ ျဖစ္ပါသည္။ ေငြေၾကး ေထာက္ပံ့မႈ အရင္းအျမစ္ ပံ့ပုိးမႈ ပုံစံ အဆုိျပဳခ်က္ ျဖစ္ႏုိင္ေျခ ႀကိဳးပမ္းခ်က္ ၁။ လုပ္ငန္း (ေဒသႏၱရ စီးပြားေရး) ဘီးတပ္ထုိင္ခုံ ဝယ္ယူေရးဘတ္ ဂ်က္သို႔ လွဴဒါန္းျခင္း ဘီးတပ္ထုိင္ခုံ ဘတ္ဂ်က္၏ ၁၀% အလယ္အလတ္ (ယခင္က ေထာက္ပံ့ဖူးသည္၊ သုိ႔ေသာ္ အဖြဲ႔တခုတည္းကုိ ႏွစ္စဥ္အၿမဲတန္း လွဴဒါန္းျခင္းမရွိ။) စီးပြားေရးလုပ္ငန္း မန္ေနဂ်ာႏွင့္ အနည္း ဆုံး ႏွစ္ႀကိမ္ေဆြးေႏြး ရန္၊ ႏွစ္မ်က္ႏွာပါ အဆုိျပဳခ်က္ႏွင့္ ဘတ္ဂ်က္ကုိ တင္ျပရန္ႏွင့္ မန္ေနဂ်ာကုိဖြင့္ပြဲသုိ႔ ဖိတ္ၾကားရန္ ၂။ ေဒသႏၱရ အစုိးရ ၎တုိ႔နယ္ေျမ အတြင္းရွိ ဘီးတပ္ထုိင္ခုံ အသုံးျပဳသူမ်ား ထံသုိ႔ နယ္ေက်ာ္ ေဆာင္႐ြက္ေပးမႈ အားလုံး၏ ကုန္က်စရိတ္ မ်ားအတြက္ ေငြေၾကးေထာက္ ပံ့မည့္အလား အလာရွိသည္။ နယ္ေက်ာ္ ေဆာင္႐ြက္မႈ ကုန္က်စရိတ္ ၏ ၂၀%ႏွင့္ ဝန္ေဆာင္မႈ ဝန္ထမ္း လစာ၏ ၂၀% မ်ားျပား(ေဒသႏၱရ အစုိးရႏွင့္ အခ်ိန္ အတန္ၾကာ ေဆြးေႏြး ခဲ့ၿပီး၊ နယ္ေျမအတြင္း နယ္ေက်ာ္ ေဆာင္႐ြက္မႈတခုကုိ ေဆာင္႐ြက္ခဲ့ၿပီးျဖစ္၊ ဤကိစၥကုိ ပံ့ပုိးေပးရန္ လြန္စြာစိတ္အား ထက္သန္ေန၊ ေငြေၾကး ေထာက္ပံ့မႈရရွိရန္ အလားအလာေကာင္း တရားဝင္အဆုိျပဳခ်က္ ႏွင့္ ဘတ္ဂ်က္တင္ျပ ရန္၊ သိၿပီးသားကတိ ကဝတ္အေနျဖင့္ နယ္ေျမအတြင္း ေတြ႕ ရွိရေသာ လူသား အားလုံး အခ်က္အလက္ အတိအက်၊ ဘဏၰာေရး အစီရင္ခံ စာမ်ားကုိ တင္သြင္းရမည္။ 94 95 aiGaMu;axmufyHhrI&&Sd&ef BudK;yrf;rIenf;vrf;rsm; ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ေရရွည္တည္တံ႔ခုိင္ျမဲေသာေငြေၾကးေထာက္ပံ႔မႈအရင္းအျမစ္ တစ္ခုရရွိရန္ ခက္ခဲမႈရွိႏုိင္ပါသည္။ ေအာက္တြင္ေဖာ္ျပထားသည္႔အေၾကာင္းအရာမ်ားမွာ ထည္႔သြင္းစဥ္းစားသင္႔ သည္႔ ေငြေၾကးေထာက္ပံ႔မႈရရွိရန္ေဆာင္ရြက္ေသာမတူညီသည္႔နည္းလမ္းမ်ား ျဖစ္သည္။ မွတ္သားထားရန္မွာ ေငြေ ၾကးေထာက္ပံ႔မႈအရင္းအျမစ္အေပၚမူတည္ျပီး ခ်ဥ္းကပ္သည္႔နည္းလမ္းမ်ားမွာလည္း ကြဲျပားသြားမည္ဆုိသည္႔ အခ်က္ျဖစ္ပါသည္။ vlrIa&;qkdif&mvkdtyfcsufrsm;tm; jznhfqnf;ay;&efESifh0ifaiGwkd;jrSifhvm&ef pD;yGm;a&;t& csOf;uyfonhfenf;vrf; ရုိေမးနီးယားႏုိင္ငံရွိ NGO တစ္ခုသည္ ဘဏၰာေရးေရရွည္တည္တံ႔ခုိင္ျမဲမႈရွိေစေရး ခ်ဥ္းကပ္ေဆာင္ရြက္မႈ၏ တစိတ္ေဒသအေနျဖင္႔ လူမႈေရးလုပ္ငန္းတစ္ခုကုိ အသံုးျပဳသည္။ ယင္းသုိ႔ခ်ဥ္းကပ္သည္႔နည္းလမ္းတြင္ ရည္ရြယ္ ခ်က္ ႏွစ္ခု ရွိရာတြင္ လူမႈေရး အရအက်ိဳးသက္ေရာက္မႈရွိေရးႏွင္႔ ဘဏၰာေရးအရ အက်ိဳးသက္ေရာက္မႈရွိေရး ျဖစ္သည္။ မသန္စြမ္းပုဂၢိဳလ္မ်ားအတြက္ ေရြ႕လ်ားႏုိင္စြမ္းအေထာက္အကူျပဳပစၥည္းမ်ားႏွင္႔ ေဆးဝါးပစၥည္းမ်ား ေထာက္ ပံ႔ရာတြင္ ဘီးတပ္ထုိင္ခုံသံုးစြဲသူမ်ားအား ဘက္စံုၾကပ္မတ္ေရးအဖြဲ႕မ်ား၏အဖြဲ႔ဝင္မ်ားအျဖစ္ ခန္႔အပ္တာဝန္ ေပးထား သည္။ ထိုအဖြဲ႔မ်ားသည္ လူမွန္ေနရာမွန္ျဖစ္မႈႏွင္႔က်န္းမာေရးေစာင္႔ေရွာက္မႈဆုိင္ရာျပႆနာမ်ားအား တားဆီးရန္ အေရးၾကီးမႈကုိ ေကာင္းစြာသေဘာေပါက္ထားသည္႔အေလ်ာက္ ၎တုိ႔၏ဝန္ေဆာင္မႈအရည္အေသြးမွာ အထူးပင္ ျမင္႔မားပါသည္။ ထုိလႈပ္ရွားမႈသည္ မသန္စြမ္းပုဂၢိဳလ္မ်ားအတြက္ အလုပ္အကုိင္မ်ားေပးျပီး အားေကာင္းေသာသံုးစြဲသူမ်ားကုိ ဖန္တီးေပးပါသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ အဆုိပါ NGO ကေဆာင္ရြက္ေသာ အျခားအစီအစဥ္မ်ားကုိ အေထာက္အကူျဖစ္ေစရန္အတြက္လည္း ဝင္ေငြမ်ားကုိ ျမင္႔တက္လာေစပါသည္။ yHhykd;ay;olu wkduf½kduf0,f,ljcif; အခ်ိဳ႕ေသာဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ဘီးတပ္ထုိင္ခုံႏွင္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ လုပ္ငန္းကုိ လက္ခံရရွိရန္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူမ်ားထံမွ အနိမ႔္ဆံုးအဆင္႔ထည္႔ဝင္မႈကုိလုိအပ္သည္။ ''အေျခ အေနေပၚ မူတည္ျပီး ႏႈန္းထားေျပာင္းလဲျခင္း'' စနစ္ရွိျပီး တစ္ဦးခ်င္းေပးရသည္႔ပမာဏသည္ တစ္ဦးခ်င္းစီ၏ မိသားစုဝင္ေငြ၊ ဝယ္ယူသံုးစြဲထားေသာေျပစာမ်ား၊ အစုိးရဝန္ထမ္းျဖစ္ေၾကာင္းအေထာက္အထားမ်ား၊ ကိုယ္တုိင္ေရး အစီရင္ခံစာႏွင္႔အျခားေသာ အေထာက္အကူျပဳ ဝင္ေငြဆုိင္ရာအေထာက္အထားမ်ားအေပၚမူတည္ဆံုးျဖတ္သည္။ ဤနည္းလမ္းကုိသံုးျပီး အခ်ိဳ႕ေသာ ရံပုံေငြကုိရရွိၾကသည္႔ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ၎တုိ႔၏ ဘီးတပ္ထုိင္ ခုံအတြက္ တစ္ျပားတစ္ခ်ပ္မွမေပးႏုိင္သူမ်ားအတြက္ အခြင္႔အလမ္းမဲ႔သြားမႈမ်ိဳးမျဖစ္ေစရန္ ေဆာင္ရြက္ရမည္ျဖစ္ ပါသည္။ 96 97 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ vkyfief;tvSL&Sifrsm;ESifh yHhykd;ay;olrsm; မကၠဆီကုိႏုိင္ငံရွိ Teleton သည္ ႏွစ္ပတ္လည္ ရုပ္ျမင္သံၾကားႏွင္႔ေရဒီယုိအစီအစဥ္တစ္ခုျဖစ္ျပီး ကေလး သူငယ္ျပန္လည္ထူေထာင္ေရးဌာနမ်ား (CRIT ဌာနမ်ား) အတြက္ ေငြရွာေပးသည္။ ထုိအစီအစဥ္ကုိ Televisa ႏွင္႔ မကၠဆီကုိႏွင္႔ႏုိင္ငံျခား မီဒီယာ (၆ဝဝ) ေက်ာ္တုိ႔က ထုတ္လႊင္႔ျခင္းျဖစ္ျပီး စီးပြားေရးလုပ္ငန္း (၂ဝ) ကပံ႔ပုိးေပးသည္။ ၎တုိ႔သည္ ေပါင္းစည္းမႈႏွင္႔ေအာင္ျမင္ျခင္းႏွင္႔ပတ္သက္သည္႔ အားရွိျပီး အျပဳသေဘာေဆာင္သည္႔ ေအာင္ျမင္မႈ ရုပ္ပံုလႊာမ်ားအား ေစ်းကြက္သုိ႔တင္ဆက္ၾကသည္။ ထုိအစီအစဥ္မတုိင္မီ (၃) လအလုိတြင္ ၾကိဳတင္ျပင္ဆင္မႈတ စိတ္တပုိင္းအေနျဖင္႔ ဆန္းစစ္ေလ႔လာခ်က္မ်ားအား မီဒီယာမွတဆင္႔ ထုတ္လႊင္႔ခဲ႔သည္။ အဆုိပါအစီအစဥ္အား အေရာင္းျမွင္႔သည္႔အစီအစဥ္မ်ားတြင္ နာမည္ၾကီးပုဂၢဳိလ္မ်ား ပါဝင္ခဲ႔ၾကသည္။ ႐ုိေမးနီးယားႏုိင္ငံတြင္ NGO တစ္ခုသည္ လုပ္ငန္းပံ႔ပုိးသူတစ္ဦးႏွင္႔ဆက္ဆံေရးမ်ားရွိသည္။ ယင္းဆက္ဆံ ေရးကုိအားေကာင္း ေစရန္ႏွစ္စဥ္ေရကူးျပိဳင္ပြဲၾကီးတစ္ခုကိုဂုဏ္သိကၡာရွိက်န္းမာေရးဌာနတစ္ခုတြင္က်င္းပခဲ႔သည္။ လုပ္ငန္းမွဝန္ထမ္းမ်ား၊ အဆင္႔တူ သင္တန္းဆရာမ်ား၊ NGO ဝန္ထမ္းမ်ား ႏွင္႔ မသန္စြမ္းမႈအေၾကာင္းကုိ သင္ယူေန ၾကသူမ်ားသည္ ယင္းျပိဳင္ပြဲ၌ ပါဝင္ယွဥ္ျပိဳင္ၾကသည္။ ယင္းျပိဳင္ပြဲသည္ ေပ်ာ္ပြဲရႊင္ပဲြျဖစ္ျပီးအဆင္႔တုိင္း၌ အက်ိဳး ေက်းဇူးမ်ားရရွိခဲ႔သည္။ လုပ္ငန္းဝန္ထမ္းမ်ားသည္ လက္ရွိ ေဆာင္ရြက္ေနေသာဘဏၰာေရးအေထာက္အပံ႔ကုိ တုိက္ ရုိက္ပံ႔ပုိးေပးျခင္းျဖင္႔လည္းေကာင္း၊ ရံပံုေငြရွာေဖြေရးအခမ္းအနားမ်ားမွတဆင္႔ေသာ္လည္းေကာင္း တစ္ႏွစ္ပတ္လံုး ေဆာင္ရြက္ေပးခဲ႔သည္။ tpkd;&u aiGaMu;taxmuftyHhay;jcif; ကင္ညာႏိုင္ငံတြင္ ေဆးဝါးဝန္ေဆာင္မႈဝန္ၾကီးဌာနသည္ ဘီးတပ္ထုိင္ခုံႏွင္႔ အျခားေသာဆက္စပ္ျပန္ လည္ထူေထာင္ေရး ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားတြင္ NGO တစ္ဖြဲ႔ႏွင္႔မိတ္ဖက္လုပ္ကုိင္ခဲ႔သည္။ ယင္း NGO သည္ အစုိးရေဆးရံုမ်ားတြင္ တည္ေထာင္ထားေသာအဆင္႔ (၈) ဆင္႔အတြက္ ေထာက္ပ႔ံပုိ႔ေဆာင္ေရးဆုိင္ရာအကူအညီ မ်ားေပးခဲ႔သည္။ အစုိးရက လူသားအရင္းအျမစ္မ်ားျဖင္႔ ပံ႔ပုိးေပးသည္။ ယေန႔အထိ အဆုိပါဝန္ၾကီးဌာနသည္ NGO ၏လုပ္ငန္းခြဲမ်ားတြင္ ဝန္ထမ္း (၅၆) ဦးကုိ ခန္႔ထားျပီးျဖစ္သည္။ 96 97 ႐ုိေမးနီးယားႏုိင္ငံရွိ အမ်ိဳးသားအာမခံလုပ္ငန္းအစီအစဥ္ • ဘီးတပ္ထုိင္ခုံအသံုးျပဳသူအတြက္ ပထမဆံုးေဆာင္ရြက္ရမည္႔အဆင္႔မွာ မသန္စြမ္း လက္မွတ္ရယူရန္ ျဖစ္သည္။ လက္မွတ္မရွိပါက ဘီးတပ္ထုိင္ခုံ ေလွ်ာက္ထား၍မရပါ။ • ေနာက္တဆင္႔မွာ ဘီးတပ္ထုိင္ခုံအညႊန္းေရးေပးမည္႔ဆရာဝန္ႏွင္႔ေတြ႔ဆံုရန္ ရက္ခ်ိန္းရယူျခင္း ျဖစ္သည္။ • ထုိေနာက္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူသည္ ခရုိင္အမ်ိဳးသားအာမခံလုပ္ငန္းေအဂ်င္စီ(NIA)တြင္ ေလွ်ာက္ လႊာ တင္ရမည္ ျဖစ္ပါသည္။ • ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူအေနျဖင္႔ အတည္ျပဳခ်က္/ေျပစာတုိ႔ကုိရျပီဆုိလွ်င္ ၎သည္ ေပးသြင္းသူႏွင္႔ဘီး တပ္ထုိင္ခုံတစ္လံုးကုိ ေရြးခ်ယ္ရမည္ျဖစ္ပါသည္။ • ဘီးတပ္ထုိင္ခုံ၏တန္ဖုိးသည္ ေထာက္ပံ႔မည္႔ပမာဏထက္နည္းပါက ေပးသြင္းသူသည္ ဘီးတပ္ထုိင္ခုံကုိ ေပး ျပီး ေျပစာကုိရယူထားပါမည္။ ယင္းေျပစာျဖင္႔ ၎က (NIA)ထံ ကုန္ပုိ႔လႊာတင္မည္ ျဖစ္ပါသည္။ • ဘီးတပ္ထုိင္ခုံ၏တန္ဖုိးသည္ ေထာက္ပ့ံသည္႔ပမဏထက္မ်ားပါက အသံုးျပဳသူသည္ လုိအပ္မည္႔ေငြကုိ ေပး ျခင္း သုိ႔မဟုတ္ ေငြေၾကးျဖည္႔ဆည္းေထာက္ပံ႔မည္႔သူ (ဥပမာ - အလႈရွင္၊ အလုပ္ရွင္ သုိ႔မဟုတ္ တစ္ဦးခ်င္း) ကုိ ရွာေဖြရပါမည္။ အေျခခံႏွင္႔အလယ္အလတ္အဆင္႔ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေထာက္အပံ႔ေပးမည္႔ အရင္း အျမစ္မ်ားအား ထပ္မံသိရွိလုိပါက ပင္ဒရုိက္ရွိဒစ္ဂ်စ္တယ္ဖုိင္ကုိ ေလ႔လာပါ။ 98 99 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ usrf;ukd;pm&if; ၁။ အရင္းအျမစ္နည္းပါးသည္႔အေျခအေနမ်ိဳးတြင္လက္တြန္းဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈဆုိင္ရာလမ္းညႊန္။ ဂ်ီနီဗာ၊ ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ ၂ဝဝ၈ Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/ technology/wheelchairguidelines/en/). ၂။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသင္တန္းစံႏွင္႔သတ္မွတ္ခ်က္မ်ား - အေျခခံအဆင္႔၊ ဂ်ီနီဗာ၊ ကမၻာ႔က်န္း မာေရးအဖြဲ႔၊ ၂ဝ၁၂ Wheelchair Service Training Package - Basic Level. Geneva: World Health Organization; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). ၃။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းသင္တန္းစံႏွင္႔သတ္မွတ္ခ်က္မ်ား - အလယ္အလတ္အဆင္႔၊ ဂ်ီနီဗာ၊ ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ ၂ဝ၁၃ Wheelchair Service Training Package - Intermediate Level. Geneva: World Health Organization; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/ wstpintermediate/en/). ၄။ မသန္စြမ္းပုဂၢိဳလ္မ်ားအခြင္႔အေရးဆုိင္ရာသေဘာတူညီခ်က္၊G.A. Res. 61/106 (2007) နယူးေယာက္၊ ကုလသမဂၢ၊ ၂ဝဝ၈၊ Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007) New York: United Nations;2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). ၅။ ဝန္ေဆာင္မႈလုပ္ငန္းမွတဆင္႔ေပးအပ္ေသာအေထာက္အကူျပဳပစၥည္းမ်ားသည္ က်န္းမာေရး ေစာင္႔ေရွာက္သူမ်ားအတြက္ အခ်ိန္ႏွင္႔ဝန္ထုပ္ဝန္ပုိးကုိ ေလ်ာ႔က်ေစသည္ဆုိျခင္း (အလန္ ႏွင္႔ အျခားသူ မ်ား၊၂ဝဝ၆) Assistive devices provided through a service have been reported to reduce the time and physical burden for caregivers (Allen et al., 2006). ၆။ အရင္းအျမစ္နည္းပါးသည္႔အေျခအေနမ်ိဳးတြင္ လက္တြန္းဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈဆုိင္ရာ လမ္းညႊန္။ ၂ဝဝ၈၊ စာ-၁၁၃၊ 98 99 Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 113 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). ၇။ အရင္းအျမစ္နည္းပါးသည္႔အေျခအေနမ်ိဳးတြင္လက္အားသံုးဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈဆုိင္ရာလမ္းညႊန္။ ၂ဝဝ၈၊ စာ-၇၈၊ Guidelines on the provision of manual wheelchairs in less resourced settings 2008, p 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). ၈။ ဝိန္းေဒလီ အမ္၊ ဝိန္းေဒလီ ေဂ်ေဂ်၊ ေက်ာရုိးမၾကီးဒဏ္ရာျဖစ္စဥ္၊ ပ်ံ႕ပြားမႈႏွင္႔ကာကြယ္မႈ၊ ကမၻာအႏွံ႔စာေပစစ္တမ္းကုိ ေလ႔လာျခင္း၊ ေက်ာရုိးမၾကီး၊ ၂ဝဝ၆၊၄၄၊၅၂၃-၅၂၉။ Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006;44: 523–529. ၉။ ရာဇတ္အက္မာ၊ ဟီလာဆု၊ ႏူရီအာရ္ပီ၊ ဘဂၤလားေဒ႔ရွ္ႏိုင္ငံ၊ ဒါကာရွိ ျပန္လည္ထူေထာင္ေရးဌာန တြင္ကုသေပးေသာ ေက်ာရုိးမၾကီးဒဏ္ရာရရွိထားသူမ်ား (SCI) ၏သက္တမ္း၊ စီဘီအာရ္ ႏွင္႔အလံုးစံုဖြံ႔ျဖိဳး တုိးတက္ေရးဂ်ာနယ္၊ ၂ဝ၁၁၊ ၂၂ (၁)၊ ၁၁၄-၁၂၃။ Razzak ATMA, Helal SU, Nuri RP. Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclusive Development Journal. 2011; 22(1): 114-123. ၁ဝ။ မသန္စြမ္းပုဂၢိဳလ္မ်ားဆုိင္ရာ ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ ကမၻာ႔ဘဏ္ အစီရင္ခံစာ၊ စာမ်က္ႏွာ ၁၁၅၊ ဂ်ီနီဗာ၊ ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ ၂ဝ၁၁ World Health Organization, World Bank World report on disability, page 115. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/ report/en/). ၁၁။ မက္ဆီယုိ ေက၊ ကေလးသူငယ္မ်ားအားပုိမုိပါဝင္ေစရန္အားေပးမည္႔နည္းလမ္းကုိစဥ္းစားျခင္း၊ အထူးလုိအပ္သည္႔ ပညာေရးျဗိတိသွ်ဂ်ာနယ္၊ ၂ဝဝ၈၊၃၅ (၁)၊ ၂၆-၃၂ Messiou K. Encouraging children to think in more inclusive ways. British Journal of Special Needs Education. 2008;35(1):26–32.

၁၀၅ tykdif;(1) ၁၀၅ u/ t"du odrSwfzG,f&mrsm; ၁၀၅ က.၁ အေျပာင္းအလဲကုိဦးေဆာင္ျခင္း ၁၀၆ c/ bD;wyfxkdifckH0efaqmifrIvkyfief;wpfck pwifjcif; ၁၀၆ ခ.၁ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအားအကဲဲျဖတ္သံုးသပ္ျခင္း ၁၀၇ ခ.၂ အသုံးအေဆာင္ႏွင္႔ပစၥည္းကိရိယာမ်ား ၁၀၉ ခ.၃ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံမ ်ား၏အတုိင္းအတာ ၁၁၀ ခ.၄ ဝန္ထမ္းမ်ားအားေနရာခ်ထားျခင္း ၁၁၁ ခ.၅ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုလွ်င္မည္မွ်ကုန္က်သနည္း ၁၁၂ 8/ bD;wyfxkdifckH0efaqmifrIvkyfief; aqmif½Gufjcif; ၁၁၂ ဂ.၁ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္း အလုပ္ျဖစ္မျဖစ္ကုိ သင္မည္သုိ႔သိႏိုင္သနည္း ၁၁၄ ဂ.၂ စီမံခန္႔ခြဲမႈလုိအပ္ခ်က္ ၁၁၅ ဂ.၃ ေနာက္ဆက္တြဲျပသမႈျပဳလုပ္ရန္ စီမံျခင္း ၁၁၆ ဂ.၄ ဘဏၰာေရး ေရရွည္တည္တံ႔ခုိင္ျမဲေရးအတြက္ စီမံေဆာင္ရြက္ျခင္း ၁၁၇ tykdif;(2) ၁၁၇ u/ t"du odrSwfzG,f&mrsm; ၁၁၇ က.၁ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ျခင္း၊ အမ်ိဳးသားမူဝါဒ ၁၁၉ က.၂ ဝန္ေဆာင္မႈေပးျခင္း ၁၂၀ c/ bD;wyfxkdifckH0efaqmifrIvkyfief;wpfck pwifjcif; ၁၂၀ ခ.၁ အသံုးအေဆာင္ႏွင္႔ပစၥည္းကိရိယာမ်ား ၁၂၆ ခ.၂ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံ၏အတုိင္းအတာ ၁၃၃ ခ.၃ ဝန္ထမ္းမ်ားအားေနရာခ်ထားျခင္း - အခန္းက႑ ၁၃၃ ခ.၄ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုလွ်င္မည္မွ်ကုန္က်သနည္း ၁၃၆ 8/ bD;wyfxkdifckH0efaqmifrIvkyfief; aqmif½Gufjcif; ၁၃၆ ဂ.၁ စြမ္းရည္ျပည္႔ဝျပီးထိေရာက္သည္႔ဝန္ေဆာင္မႈလုပ္ငန္း ၁၄၃ ဂ.၂ စြမ္းရည္ျပည္႔ဝေသာဝန္ေဆာင္မႈလုပ္ငန္းကုိ တုိးတက္ျဖစ္ေပၚေစျခင္း ၁၄၄ ဂ.၃ ဝယ္လုိအားအတြက္စီမံခန္႔ခြဲျခင္း ၁၄၉ ဂ.၄ ေနာက္ဆက္တြဲျပသမႈအတြက္စီစဥ္ျခင္း ၁၅၀ ဂ.၅ ဘဏၰာေရးေရရွည္တည္တံ႔ခုိင္ျမဲေရးကုိတုိးတက္ေစျခင္း rm w d u m 104 105 ဘီးတပ္ထိုင္ခံုေထာက္ပံ ႔မႈဖန္တီးရန္ သို ႔မဟုတ ္တိုးတက္လာေစရန္ မန္ေနဂ်ာမ်ား ေဆာင္ရြက္ရမည္႔ကိစၥမ်ား avhusifhcef;pmtkyfukd tykdif;ESpfykdif; cGJxm;ygonf အပုိင္းတစ္ - ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုစတင္ရန္ မည္သည္တုိ႔ကုိ ေဆာင္ရြက္ရန္ လုိအပ္မည္နည္း ဤအခန္းတြင္ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈအဆင္႔ (၈) ဆင္႔၊ အသံုးအေဆာင္မ်ား၊ ပစၥည္းကိရိယာမ်ား၊ သင္႔ေလ်ာ္ေသာ ဘီးတပ္ထုိ္င္ခုံ၏အတုိင္းအတာ၊ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုစတင္ရာတြင္ ကနဦးကုန္က်စရိတ္ ႏွင္႔ စီမံခန္႔ခြဲမႈ လုိအပ္ခ်က္မ်ားအေၾကာင္းမ်ားကုိ ေဆြးေႏြးထားပါသည္။ အပိုင္း ႏွစ္ - ကနဦးရင္းႏွီးျမႈပ္ႏွံမႈျပဳလုပ္ျပီးေနာက္ ဝန္ေဆာင္မႈလုပ္ငန္း ေရရွည္တည္တံ႔ ခုိင္ျမဲေရအတြက္ မည္သုိ႔ေဆာင္ရြက္ ရန္လုိအပ္သနည္း ဤအခန္းတြင္ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပ့ံမႈ၊ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုေဆာင္ရြက္ျခင္း၊ စြမ္း ေဆာင္ရည္ တုိးျမင္႔လာေစရန္ အေရးယူေဆာင္ရြက္ခ်က္မ်ား၊ ထိေရာက္မႈ၊ ဝန္ေဆာင္မႈလုပ္ငန္း၏ လုိလုိလားလား ေဆာင္ရြက္မႈတုိ႔ႏွင္႔ပတ္သက္ျပီး ေဆြးေႏြးထားပါသည္။ ဘဏၰာေရးခုိင္မာမႈဆုိင္ရာမ်ားကိုလည္း ေဆြးေႏြးထား သည္။ ဤေနရာတြင္ လက္ရွိလုပ္ငန္း ကုန္က်စရိတ္ႏွင္႔ဝန္ေဆာင္မႈအားတုိးခ်ဲ႔လွ်င္ ျဖစ္ေပၚလာမည္႔ ကုန္က်စရိတ္ မ်ားအား ကာမိေစရန္ဝင္ေငြရရွိမႈလမ္းေၾကာင္းႏွင္႔ မိတ္ဖက္အဖြဲ႔မ်ားထူေထာင္ထားရွိရန္အေရးၾကီးမႈကိုထည္႔သြင္း ေဆြးေႏြးထားပါသည္။ အပုိင္း ႏွစ္ပုိင္းစလံုးကုိ ေအာက္ပါအတုိင္း အခန္း (၃) ခန္း ခြဲထားပါသည္။ က။ အဓိကသိမွတ္ဖြယ္ရာမ်ား ခ။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုစတင္ျခင္း ဂ။ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ျခင္း 104 105 အပုိင္း(၁) u/ t"du odrSwfzG,f&mrsm; u .1/ tajymif;tvJukd OD;aqmifjcif; • ေအာက္တြင္ေဖာ္ျပထားသည္႔ အေျပာင္းအလဲကိုျဖစ္ေပၚေစသည္႔အေၾကာင္းအရာမ်ားကုိ သံုးသပ္ပါ။ သင္၏ဝန္ ေဆာင္မႈလုပ္ငန္းဌာနတြင္ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ျခင္းလုပ္ငန္းအား စတင္ေဆာင္ရြက္ရန္ သုိ႔မဟုတ္ တုိးတက္လာေစရန္ သင္ေဆာင္ရြက္ႏုိင္သည္႔ အေရးယူေဆာင္ရြက္ခ်က္မ်ားကုိ မွတ္တမ္းတင္ပါ။ ၁။ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈအတြက္ တူညီေသာေမွ်ာ္မွန္းခ်က္တစ္ခုကုိ ဖန္တီးပါ။ ၂။ သင္႔ေလ်ာ္ေသာဘီးတပ္ထိုင္ခုံေထာက္ပံ႔မႈ၏အေရးပါမႈသည္ အျမန္ဆံုးေဆာင္ရြက္ရမည္႔ကိစၥ ျဖစ္ေၾကာင္းအေလးထားအသိေပး ေျပာၾကားပါ။ ၃။ ဝန္ထမ္းမ်ားႏွင္႔အရင္းအျမစ္မ်ားအား ေနရာခ်ထားပါ။ ၄။ ဝန္ထမ္းမ်ားအား လႈ႔ံေဆာ္အားေပး၊ ပါဝင္ေစျပီး တာဝန္ေပးပါ။ • • စီမံခ်က္ေရးဆြဲျခင္းႏွင္႔အေကာင္အထည္ေဖာ္ျခင္းလုပ္ငန္းမ်ားတြင္ဝန္ထမ္းမ်ားကုိပါဝင္ေစျခင္း • • အခက္အခဲအတားအဆီးမ်ားကိုအတူတကြျဖတ္ေက်ာ္ပါ။ • • ေရတုိေအာင္ျမင္မႈမ်ားဖန္တီးျပီးအသိအမွတ္ျပဳပါ။ • • အေျပာင္းအလဲကုိသင္႔အဖြဲ႔အစည္း၏စနစ္ႏွင္႔ထံုးစံအတြင္းစြဲျမဲေနေစရန္ေဆာင္ရြက္ပါ။ 106 107 c/ bD;wyfxkdifckH0efaqmifrIvkyfief;wck pwifjcif; c .1/ 0efaqmifrIvkyfief;rsm;tm; tuJjzwfokH;oyfjcif; ေမးခြန္းမ်ား အေျဖမ်ား ေမးခြန္း ၁။ လႊဲေျပာင္းမႈကြန္ယက္တခုကုိ တည္ ေဆာက္ျခင္း လႊဲေျပာင္းေရးကြန္ယက္တစ္ခုတည္ေဆာက္ျခင္းတစ္ ဦးခ်င္းစီႏွင္႔ အသင္းအဖြဲ႔မ်ားအေနျဖင္႔ ဘီးတပ္ ထုိင္ခုံ အသံုးျပဳသူမ်ားအား သတ္မွတ္ျပီးသင္၏ဘီးတပ္ ထုိင္ ခုံ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ လႊဲေျပာင္းေပးႏုိင္ေရးအ တြက္ ၎တုိ႔၏ ကြန္ယက္တစ္ခု တည္ေဆာက္ရန္ မန္ ေနဂ်ာတစ္ဦးအေနျဖင္႔ သင္မည္ကဲ႔သုိ႔ ေဆာင္ရြက္ မည္နည္း။ ေမးခြန္း ၂။ လႊဲေျပာင္းမႈပံုစံမ်ား ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအ ျမစ္တြင္ပါဝင္ေသာ လႊဲေျပာင္းမႈပံုစံနမူနာမ်ားကုိ ၾကည္႔ ပါ။ ယင္းလႊဲေျပာင္းေရးပံုစံ (သုိ႔မဟုတ္ ဤပံုစံႏွင္႔လုိက္ ဖက္ေအာင္ ျပင္္္ဆင္ထားေသာပံုစံ)သည္ သင္္၏ ဝန္ ေဆာင္မႈလုပ္ငန္းအတြက္ အသံုးဝင္ေသာ အေၾကာင္း အရာျဖစ္သေလာ။ ထုိသုိ႔မျဖစ္ပါက အဘယ္ေၾကာင္႔နည္း။ ထုိသုိ႔ျဖစ္ပါက လႊဲေျပာင္းမႈပံုစံအားအသံုးျပဳရန္ ဝန္ ေဆာင္မႈလုပ္ငန္း၏ မန္ေနဂ်ာတစ္ဦးအေနျဖင္႔ သင္ မည္သုိ႔ေဆာင္ရြက္မည္နည္း။ (မွတ္သားရန္ - သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ စနစ္ တစ္ခုကုိ အသံုးျပဳလ်က္ရွိသည္ဆိုပါက သင္သည္ မန္ ေနဂ်ာတစ္ဦးအေနျဖင္႔ လႊဲေျပာင္းမႈပံုစံအားအသံုးျပဳရ န္သုိ႔မဟုတ္ယင္းကုိေထာက္ခံခ်က္ေပးရန္ သင္ ဘာ လုပ္ထားသည္ ဆုိသည္ကုိ ေဖာ္ျပႏုိင္သည္။) ၁။ လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္မ်ားအား သတ္မွတ္ႏုိင္ေရးအတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ အေရးယူေဆာင္ရြက္ခ်က္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 106 107 ၂။ လႊဲေျပာင္းေပးမည္႔အရင္းအျမစ္ကြန္ယက္ကုိ တည္ေဆာက္ႏုိင္ေရးအတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၃။ လႊဲေျပာင္းမႈပံုစံအားအဆင္႔ျမွင္႔မည္/မျမွင္႔မီကုိဆံုးျဖတ္ရန္အတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၄။ ညီညြတ္မွ်တေသာဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေပၚေပါက္လာေစရန္ ကြၽႏု္ပ္အေနျဖင္႔တက္ တက္ၾကြၾကြျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား c .2/ tokH;taqmifESifh ypönf;ud&d,mrsm; ၁။ ကြၽႏု္ပ္၏ဝန္ေဆာင္မႈပံုစံႏွင္႔ကုိက္ညီသင္႔ေတာ္မည္႔ အသံုးအေဆာင္ႏွင္႔ပစၥည္းကိရိယာမ်ားအား သတ္မွတ္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ ဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔မ်ားအတြင္းသုိ႔ ပံုစံမ်ားႏွင္႔ေဆာင္ရြက္ရန္စာရင္းမ်ားကို ေပါင္းစည္း ထည္႔သြင္းႏုိင္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၃။ အသံုးအေဆာင္မ်ားအားစုစည္းရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား 108 109 ၄။ ျဖစ္ႏုိင္သည္႔ေနရာတုိင္းတြင္ လုပ္ငန္းလႊဲအပ္ေဆာင္ရြက္ျခင္းအပါအဝင္ အသံုးအေဆာင္တစ္ခုစီ တုိင္းအတြက္ စနစ္ႏွင္႔လုပ္ငန္း စည္းမ်ဥ္းမ်ားဖန္တီးႏုိင္ေရးအတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 108 109 c .3/ oifhavsm faombD;wyfxkdifckHrsm;\twkdif;twm ၁။ ဝန္ေဆာင္မႈလုပ္ငန္းအသံုးျပဳသူ၏လိုအပ္ခ်က္မ်ားကုိသတ္မွတ္ႏုိင္ရန္ႏွင္႔ ယင္းလုိအပ္ခ်က္ မ်ားအား ျဖည္႔ဆည္းေပးႏုိင္မည္႔ အေရးအၾကီးဆံုးေသာပစၥည္းပံုစံကုိ သတ္မွတ္ႏုိင္ရန္အတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ သင္႔ေလ်ာ္ေသာဘီးတပ္ကုလားထုိင္၊ အခုအခံမ်ား ႏွင္႔အပုိပစၥည္းမ်ားအတြက္ ကုိက္ညီမည္႔ အတုိင္းအတာကုိ သတ္မွတ္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၃။ ပစၥည္းမ်ားအားမြမ္းမံဆန္းသစ္မႈျပဳလုပ္ရန္အတြက္ သင္႔ေတာ္သည္႔ပစၥည္းမ်ား ေပးသြင္းမႈကုိ သတ္မွတ္ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၄။ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုမွေပးသြင္းလာေသာ သင္႔ေလ်ာ္သည္႔ဘီးတပ္ထုိင္ခုံမ်ားႏွင္႔ အခုအခံမ်ား၏ ကုန္က်စရိတ္ႏွင္႔အက်ိဳးအျမတ္ကုိ ျခားနားေသာပါဝင္ပတ္သက္သူမ်ားႏွင္႔ ေဆြးေႏြးရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား 110 111 c .4/ 0efaqmifrIrsm;tm; ae&mcsxm;jcif; ၁။ ဝန္ေဆာင္မႈဝန္ထမ္းမ်ာအား သတ္မွတ္ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ စီမံခ်က္လုပ္ငန္းတြင္ ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအားထည္႔သြင္းေရးအတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ ေ ဆာင္ရြက္ခ်က္မ်ား ၃။ အဖြဲ႔လုိက္ေဆာင္ရြက္မႈအား ေပါင္းစပ္ညွိႏိႈင္းေပးေရးႏွင္႔အပါတ္စဥ္လုပ္ငန္းအစီအစဥ္ကုိ ခ်မွတ္ေရးတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၄။ ႏွစ္စဥ္ဝန္ေဆာင္မႈလုပ္ငန္းစြမ္းေဆာင္ရည္ကုိသတ္မွတ္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္ မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 110 111 c .5/ bD;wyfxkdifckH0efaqmifrIvkyfief;wckvQif rnfrQukefusoenf;/ ၁။ ဝန္ေဆာင္မႈပံုစံတစ္ရပ္အားခ်မွတ္သည္႔အခါတြင္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအားေပါင္းစည္းရန္စဥ္း စားသံုးသပ္ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ ဝန္ေဆာင္မႈပံုစံတစ္ရပ္အားခ်မွတ္သည္႔အခါတြင္လူမႈအဖြဲ႔အစည္းမ်ားပါဝင္လာရန္စဥ္းစားသံုးသပ္ ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၃။ စီမံထားသည္႔ဝန္ေဆာင္မႈပံုစံအတြက္ဘတ္ဂ်က္ကုိျပင္ဆင္ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏိုင္သည္႔ေဆာင္ရြ က္ခ်က္မ်ား 112 113 */ bD;wyfxkdifckH 0efaqmifrIvkyfief;wckukd aqmif½Gufjcif; * .1/ oif\0efaqmifrIvkyfief; tvkyfjzpf rjzpfukd oifrnfokdY odEkdifoenf;/ ဝန္ေဆာင္မႈနယ္ေျမႏွင္႔ ေဆာင္ရြက္ခ်က္ ဝန္ေဆာင္မႈစြမ္းရည္ႏွင္႔ ရည္မွန္းခ်က္မ်ား သတင္းအခ်က္အလက္ စုေဆာင္းေရးနည္းလမ္းမ်ား လႊဲေျပာင္းေပးျခင္း လႊဲေျပာင္းေပးသည္႔အသံုးျပဳသူ အေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ တလလွ်င္ လႊဲေျပာင္းေပးသူ (၃၀)အား လက္ခံမည္။ လက္ခံရရွိသည္႔လႊဲေျပာင္းေပးသူ မ်ားအား မွတ္တမ္းတင္ျခင္း ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ျခင္း ဘီးတပ္ထုိင္ခုံရရွိသည္႔ အသံုးျပဳသူ အေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ တလလွ်င္ အသုံးျပဳသူ(၂၀)အား ဘီးတပ္ထုိင္ခုံမ်ား သတ္မွတ္၊ တပ္ဆင္ေပးမည္။ ေထာက္ပ႔ံသည္႔ ဘီးတပ္ထုိင္ခုံ အေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ လႊဲေျပာင္း ေပးသည့္ အသုံးျပဳသူမ်ား၏ အေသးစိတ္အခ်က္အလက္မ်ား၊ ဥပမာ- အသက္၊ လိင္၊ မသန္စြမ္းအမ်ိဳး အစား၊ ကုိယ္ေနဟန္ထား အေထာက္အကူျပဳမႈ လုိအပ္ခ်က္မ်ား ဝန္ေဆာင္မႈလုပ္ငန္း ညီတူညီမွ်ရွိေရးကုိ အားေပးသည္။ ဝန္ေဆာင္မႈရွိသည့္ ေယာက်္ား၊ မိန္းမ၊ ေယာက်္ားေလး၊ မိန္းကေလး အေရအတြက္ကုိ အသုံးျပဳသူဖုိင္တြင္ မွတ္တမ္းတင္ထားျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 112 113 ဝန္ေဆာင္မႈကုန္က်စရိတ္ ဝန္ေဆာင္မႈလုပ္ငန္း အတြင္းျပဳလုပ္ေသာ ဆန္းသစ္မြမ္းမံမႈမ်ားအပါအဝင္ ပစၥည္းေထာက္ပံ႔မႈကုန္က်စရိတ္ ဘီးတပ္ထုိ္င္ခုံတစ္လုံးခ်င္းစီ အတြက္တစ္ဦးခ်င္းကုန္က်စရိတ္ သည္(ဘတ္ဂ်က္အရလည္း ေကာင္း၊ ရရွိသည့္ကုန္ပစၥည္း ၏အမွန္တကယ္ ကုန္က်စရိတ္ အရလည္းေကာင္း သတ္မွတ္ထားသည့္ပမာဏ)ထက္ နည္းသည္။ အသုံးျပဳသူဖုိင္တြင္ ဝန္ေဆာင္မႈရရွိသည့္ အသုံးျပဳသူ မ်ား၏ေနအိမ္လိပ္စာကုိ မွတ္တမ္း တင္ထားျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းစီမံခ်က္မူေဘာင္ ေစာင္႔ၾကည္႔ရမည္႔ လုိအပ္ခ်က္/ ျပႆနာမ်ားကုိ သတ္မွတ္ျခင္း လိုအပ္ခ်က္/ ျပႆနာမ်ာကုိ ေျဖရွင္းမည္႔အေရးယူ ေဆာင္ရြက္ခ်က္/ ရည္ရြယ္ခ်က္ ပစ္မွတ္ 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. 114 115 0efaqmifrIvkyfief; tvkyf vkyf rvkyf qkdonfukd od&Sd&ef aqmif½Gufcsufrsm;ukd rSwfwrf;wifjcif; (tcsdef&rnfqkdygu) ၁။ ဝန္ေဆာင္မႈလုပ္ငန္းစီမံခ်က္တစ္ခုေရးဆြဲရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ ဝန္ေဆာင္မႈလုပ္ငန္းစီမံခ်က္အတြက္ ဦးတည္ေဆာင္ရြက္ေနၾကေသာ ဝန္ထမ္းမ်ားအား ေစာင္႔ၾကည္႔ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၃။ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ၎၏ရည္မွန္းခ်က္မ်ားအားမည္ကဲ႔သုိ႔ ထိထိေရာက္ေရာက္ ေအာင္ျမင္ေပါက္ေျမာက္ေနသည္ဆုိျခင္းကုိ အကဲျဖတ္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၄။ အဖြဲ႔လုိက္ သုိ႔မဟုတ္ တစ္ဦးခ်င္းစီ၏ေအာင္ျမင္မႈမ်ားကုိ အသိအမွတ္ျပဳရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား * .2/ pDrHcefY cGJrI vkdtyfcsuf ၁။ လႊဲေျပာင္းေပးသူမ်ားအား ေစာင္႔ၾကည္႔သည္႔စနစ္ႏွင္႔ေစာင္႔ဆုိင္းစာရင္းအား စီမံခန္႔ခြဲႏုိင္ရန္ကြၽႏု္ပ္ ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၂။ မိဘမ်ားႏွင္႔လႊဲေျပာင္းေပးသည္႔အရင္းအျမစ္မ်ားအား ေဆာလ်င္စြာလႊဲေျပာင္းေပးမႈေၾကာင္႔ ရရွိ သည္႔ ေအာင္ျမင္မႈဇာတ္လမ္းမ်ားကို မွ်ေဝခံစားရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 114 115 ၃။ ဝန္ေဆာင္မႈလုပ္ငန္းကစြမ္းေဆာင္ႏုိင္သည္ထက္ေက်ာ္လြန္ေနသည္႔ လုိအပ္ခ်က္မ်ားရွိသည္႔ ေဖာက္သည္မ်ားအားလႊဲေျပာင္းေပးမႈအတြက္ စီမံခန္႔ခြဲမႈျပဳလုပ္ရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၄။ ဝန္ေဆာင္မႈအဆင္႔မ်ား၏စြမ္းေဆာင္ရည္ကုိေစာင္႔ၾကည္႔ရန္ႏွင္႔တုိးတက္လာေစေရးအတြက္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား * .3/ aemufqufwGJaqmif½Guf&ef pDrHjcif; ၁။ ေနာက္ဆက္တြဲျပသမႈကုိစီမံရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၂။ လူမႈအဖြဲ႔အစည္းအတြင္းမိတ္ဖက္ထူေထာင္ရန္ႏွင္႔သင္တန္းေပးရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ ေဆာင္ရြက္ခ်က္မ်ား ၃။ အသံုးျပဳသူသင္တန္းႏွင္႔ ေနာက္ဆက္တြဲျပသမႈအတြက္ အလားအလာရွိေသာသင္တန္းသားမ်ား သတ္မွတ္ရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား 116 117 ၄။ ေနာက္ဆက္တြဲျပသမႈအက်ိဳးေက်းဇူးမ်ား၏ေအာင္ျမင္ျခင္းဇာတ္လမ္းမ်ားကုိ စုစည္းျပီးမွ်ေဝရန္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား * .4/ bPÖma&; a&&SnfwnfwHhckdifNrJa&;twGuf pDrHaqmif½Gufjcif; ၁။ ဘ႑ာေရးေရရွည္တည္တံ႔ခုိင္ျမဲေရးအတြက္တူညီေသာေမွ်ာ္မွန္းခ်က္မ်ားကိုဖန္တီးရာတြင္ ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္ သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၂။ လိုအပ္ေသာေငြေၾကးေထာက္ပံ႔မႈရံပံုေငြႏွင္႔အရင္းအျမစ္မ်ား သတ္မွတ္ရာတြင္ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ ရြက္ခ်က္မ်ား ၃။ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္မ်ားသတ္မွတ္ရာတြင္ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္သည္႔ေဆာင္ရြက္ခ်က္မ်ား ၄။ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္ကုိဦးစားေပးအစီအစဥ္သတ္မွတ္ရန္ႏွင္႔ ရံပံုေငြတုိးတက္ေရးမဟာဗ်ဴ ဟာေဖာ္ထုတ္ ရန္ကြၽႏု္ပ္ျပဳလုပ္ႏုိင္ သည္႔ေဆာင္ရြက္ခ်က္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 116 117 အပုိင္း(၂) u/ t"du odrSwfzG,f&mrsm; u .1/ oihfavsmfaom bD;wyfxkdifckH axmufyHhjcif; - trsdK;om;rl0g' • ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ျခင္းႏွင္႔ပတ္သက္သည္႔ အမိ်ဳးသားမူဝါဒ နမူနာႏွစ္ခုကုိ ဖတ္ပါ။ • သင္၏ႏုိင္ငံတြင္မည္သည္႔မူဝါဒမ်ားရွိႏွင႔္ျပီးျဖစ္သည္ဆုိသည္ကုိ စဥ္းစားပါ။ • ေအာက္တြင္ေဖာ္ျပထားေသာမူဝါဒမ်ားသည္ သင္၏ႏုိင္ငံအတြင္းမည္သုိ႔အသံုးဝင္မည္ဆုိသည္ကုိ ေဆြးေႏြးျပီး သင္၏အစုိးရပံုစံႏွင္႔မည္သည္႔ေနရာတြင္ ကုိက္ညီမႈရွိမည္ဆုိသည္ကုိ စဥ္းစားပါ။ နမူနာ - ၁။ အာဖဂန္နစၥတန္ႏုိင္ငံရွိ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးႏွင္႔ဆက္စပ္ေနသည္႔မူဝါဒ ၂ဝဝ၃ ခုႏွစ္ ေအာက္တုိဘာလတြင္ အာဖဂန္နစၥတန္ အာဇာနည္ႏွင္႔ မသန္စြမ္းပုဂၢိဳလ္မ်ားဝန္ၾကီးဌာနသည္ ျပီးျပည္႔စံုေသာ အမ်ိဳးသားမသန္စြမ္းဆုိင္ရာမူဝါဒတစ္ရပ္ကုိ ခ်မွတ္ခဲ႔သည္။ ယင္းမူဝါဒကုိ မသန္စြမ္းပုဂၢိဳလ္အဖြဲ႔ အစည္းမ်ားႏွင္႔ ကုိယ္ထူကုိယ္ထအုပ္စုမ်ား၊ ျပည္တြင္းႏွင္႔ႏုိင္ငံတကာ မသန္စြမ္း NGO မ်ား၊ အဓိကတာဝန္ရွိ သည္႔ဝန္ၾကီးဌာနမ်ားျဖစ္ေသာ ပညာေရးဝန္ၾကီးဌာန၊ ျပည္သူ႔က်န္းမာေရးဝန္ၾကီးဌာန၊ အလုပ္သမားႏွင္႔လူမႈ ေရးဝန္ၾကီးဌာန၊ အမ်ိဳးသမီးေရးရာဝန္ၾကီးဌာန၊ အာဇာနည္ႏွင္႔မစြမ္းမသန္ပုဂၢိဳလ္ဝန္ၾကီးဌာန၊ ဆက္စပ္ေနသည္႔ ကုလသမဂၢလုပ္ငန္း ႏွင္႔သမၼတရံုးတုိ႔အပါအဝင္ ပါဝင္ပတ္သက္သူအားလံုးႏွင္႔ေပါင္းစပ္ညွိႏႈိင္းျပီး ေဖာ္ထုတ္ ထားျခင္း ျဖစ္သည္။ ပဏာမမူဝါဒသည္ပုိမုိအေသးစိတ္ေသာမူဝါဒ အျဖစ္ေရာက္ရိွျပီးေဆာင္ရြက္ေရးစီမံခ်က္ကုိ ဦစားေပးခ်မွတ္ေပးႏုိင္မည္ဟုေမွ်ာ္လင္႔ရပါသည္။ ရုပ္ပုိင္းဆုိင္ရာမသန္စြမ္းျဖစ္ေနသူမ်ားအတြက္ ျပဌာန္းခ်က္မ်ားတြင္ အရုိးေရာဂါျပန္လည္ထူေထာင္ေရးဌာန၊ ဇီ ဝကမၼကုထံုးဌာနႏွင္႔အရုိးအေၾကာဆုိင္ရာ၊ အေထာက္အကူျပဳႏွင္႔ေရြ႕လ်ားႏုိင္စြမ္းပစၥည္းကိရိယာမ်ား ပါဝင္သင္႔ သည္။ ေဒသခံျပည္သူမ်ား အလြယ္တကူသြားေရာက္ႏုိင္ေရးအတြက္ ယင္းလုပ္ငန္းမ်ားသည္ အရုိးေရာဂါ ခြဲ စိတ္ကုသေရးလုပ္ငန္းပါဝင္သည္႔ ေဒသႏၲရ သုိ႔မဟုတ္ ျပည္နယ္ေဆးရံုမ်ား၏အနီးတြင ရွိသင္႔ပါသည္။ မသန္ စြမ္းပုဂၢိဳလ္မ်ားအေနျဖင္႔ အေထာက္အကူျပဳပစၥည္းမ်ားကုိ ရသင္႔သည္။ ယင္းပစၥည္းမ်ားမွာလည္း ေဒသထြက္ ပစၥည္းမ်ားျဖင္႔ စနစ္တက်ထုတ္လုပ္တပ္ဆင္ထားသည္႔ပစၥည္းမ်ားျဖစ္သင္႔ျပီး လိုအပ္သည္႔အခ်ိန္တုိင္းတြင္ ေဒ သႏၲရ ျပင္ဆင္ႏိုင္မႈရွိရမည္ျဖစ္သည္။ ႏုိင္ငံတစ္ဝန္းတြင္လည္း သင္႔ေလ်ာ္သည္႔နည္းပညာဆုိင္ရာစံႏႈန္းကုိ သတ္မွတ္ထားရမည္ျဖစ္သည္။ အမ်ိဳးသားစံႏႈန္းသတ္မွတ္ေရးယႏၲရားတစ္ခုကို ေဖာ္ေဆာင္ရန္အတြက္ သက္ ဆုိင္ရာကြၽမ္းက်င္သူမ်ားသည္ ျပည္သူ႔က်န္းမာေရးဝန္ၾကီးဌာနႏွင္႔ေပါင္းစပ္ညွိႏႈိင္းေဆာင္ရြက္ရမည္ ျဖစ္ပါ သည္။ 118 119 နမူနာ - ၂။ ေတာင္အာဖရိကႏုိင္ငံရွိ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရးႏွင္႔ဆက္စပ္ေနသည္႔မူဝါဒ ၂ဝဝ၃ ခုႏွစ္တြင္ အေထာက္အကူျပဳပစၥည္းမ်ားႏွင္႔ပတ္သက္သည္႔ အမ်ိဳးသားအဆင္႔လမ္းညႊန္ခ်က္ကုိ ေတာင္ အာဖရိကႏုိင္ငံတြင္ ထုတ္ျပန္ခဲ႔သည္။ ေတာင္အာဖရိကႏုိင္ငံျပည္နယ္အားလံုးတြင္တုိင္ပင္ညွိႏႈိင္းျပီး ယင္းလမ္း ညႊန္ခ်က္ကုိ ထုတ္ေဖာ္ခဲ႔ျခင္း ျဖစ္သည္။ အေနာက္အငူျပည္နယ္ကကူညီပံ႔ပုိးေပးမႈသည္ ျပည္နယ္အဆင္႔လမ္း ညႊန္ခ်က္ကုိထုတ္ေဖာ္ရာမွရသည္႔အေတြ႔အၾကံဳမ်ားအေပၚ အေျချပဳထားျခင္းျဖစ္သည္။ ျပည္နယ္အဆင္႔လမ္းညႊန္ခ်က္ထုတ္ေဖာ္မႈကုိ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းေဆာင္ရြက္ေနသည္႔ ဆရာ ဝန္မ်ားက စတင္ခဲ႔ျခင္းျဖစ္သည္။ ၄င္းတုိ႔သည္ ဘီးတပ္ထုိင္ခုံလုပ္ငန္းစံႏႈန္းမ်ားကုိ အတည္တက်ျဖစ္ေစမည္႔စီ မံခ်က္တစ္ရပ္ျပဳလုပ္ရန္ ျပည္နယ္မွအစီအစဥ္မန္ေနဂ်ာ၊ ေဒသႏၲရျပန္လည္ထူေထာင္ေရးလုပ္ငန္းမ်ားႏွင္႔တုိင္ ပင္ညွိႏႈိင္းခဲ႔သည္။ အဆုိပါစီမံခ်က္တြင္ ေအာက္ပါအတုိင္း အဓိကဦးတည္သည္႔နယ္ေျမ (၃) ခုရွိသည္- ၁။ ျပည္နယ္အတြင္း ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအေျခအေနသံုးသပ္ခ်က္ကုိ ျပဳလုပ္ျခင္း ၂။ ဘီးတပ္ထုိင္ခုံလုပ္ငန္းေဆာင္ရြက္မည္႔သူမ်ားအတြက္ သင္တန္းကုိ အေကာင္အထည္ေဖာ္ျခင္း ၃။ ျပည္နယ္အဆင္႔ ဘီးတပ္ထုိင္ခုံစီမံခန္႔ခြဲေရး မဟာဗ်ဴဟာတစ္ရပ္အတြက္ လမ္းညႊန္ခ်က္ကုိျပဳစုျခင္း ျပည္နယ္အဆင္႔လမ္းညႊန္ခ်က္မ်ားကုိေရးဆြဲရာတြင္ အဓိကဝန္ေဆာင္မႈလုပ္ငန္းအဆင္႔မ်ားအတြက္ အနိမ္႔ဆံုး စံႏႈန္းသတ္မွတ္ခ်က္မ်ားကုိ ထည္႔သြင္းထားသည္သာမက ဝန္ထမ္းမ်ားအားေလ႔က်င္႔သင္တန္းေပးျခင္း၊ ဖြဲ႔စည္း ျခင္းႏွင္႔ ေစာင္႔ဆုိင္းစာရင္းစီမံခန္႔ခြဲမႈ၊ ဘတ္ဂ်က္၊ ျပဳျပင္ထိန္းသိမ္းေရးလုပ္ငန္းမ်ားေဆာင္ရြက္ေပးျခင္းလုပ္ငန္း ကဲ႔သုိ႔ေသာ အဓိကစီမံခန္႔ခြဲေရးဆုိင္ရာအဆင္႔မ်ားကုိပါ ထည္႔သြင္းထားသည္။ ျပည္နယ္စီမံခန္႔ခြဲေရးကလည္း အဆုိပါအုပ္စုကုိ အေထာက္အကူေပးတရားဝန္အၾကံေပးအုပ္စုျဖစ္လာခဲ႔သည္။ အဆုိပါအုပ္စုမွ ကုိယ္စားလွယ္မ်ားသည္ျပည္နယ္မန္ေနဂ်ာမ်ားႏွင္႔အတူ အမ်ိဳးသားအဆင္႔ေဆြးေႏြးပဲြမ်ားသုိ႔ တက္ေရာက္ျပီး ေတာင္အာဖရိကႏုိင္ငံရွိ အေထာက္အကူျပဳပစၥည္းမ်ားအတြက္ အမ်ိဳးသားအဆင္႔လမ္းညႊန္ ခ်က္ကုိ ထူေထာင္ရန္အေထာက္အကူျပဳခဲ႔ၾကသည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 118 119 u .2/ 0efaqmifrIay;jcif; မန္ေနဂ်ာတဦး၏ ပုိ၍က်ယ္ျပန္႔ေသာအခန္းက႑ ႏုိင္ငံအတြင္းသင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေထာက္ပံ႔မႈတုိးတက္လာေစရန္ တူညီေသာေဆာင္ရြက္ ခ်က္မ်ားကုိ ျပဳလုပ္ျခင္း ေနာက္ (၃) လအတြင္း ကြၽႏု္ပ္ေဆာင္ရြက္ႏုိင္သည္႔အေရးယူေဆာင္ရြက္ခ်က္မ်ား 120 121 c/ bD;wyfxkdifckH0efaqmifrIvkyfief;pwifjcif; c .1/ tokH;taqmifESifh ypönf;rsm; c .1 .1/ oifhawmfaomtokH;taqmifrsm; owfrSwfjcif; • ေအာက္တြင္ေဖာ္ျပထားေသာအသံုးအေဆာင္စာရင္းကုိ ၾကည္႔ပါ။ • သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ အသံုးတည္႔မည္႔လက္ေတြ႔က်ေသာအေျဖကုိ စဥ္းစားပါ။ အေျခခံအဆင္႔အသံုးအေဆာင္မ်ား ယင္းအသုံးအ ေဆာင္မ်ား ရွိၿပီးျဖစ္သေလာ ယင္းသည္ ရွိၿပီးသား ဝန္ေဆာင္မႈ လုပ္ငန္းမ်ားႏွင့္ မွ်ေဝသုံးစြဲေနရ သည့္အသုံး အေဆာင္မ်ား ေလာ။ အျခားေသာရည္ ႐ြယ္ခ်က္တခု အတြက္ ထားသည့္ အခန္းတခန္းကုိ ေျပာင္းလဲႏုိင္ သေလာ။ ရွိၿပီးသားအခန္း တခန္းကုိ ျပန္ အသုံးျပန္ႏုိင္ သေလာ သုိ႔မဟုတ္ ျပန္ေဆာက္ႏုိင္သ ေလာ။ ၁။ ေစာင္႔ဆုိင္း ခန္းႏွင္႔ ၾကိဳဆုိ လက္ခံေရးုုေနရာ ၂။ လွဲေလ်ာင္း ေနရန္တိတ္ဆိတ္ ေသာေနရာ ၃။ အသံုးျပဳ ႏုိင္ေသာ သန္႔စင္ခန္း ၄။ ဝန္ထမ္းမ်ား အတြက္ရံုးခန္း ေနရာ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 120 121 ၅။ ေဆးေပးခန္း အကဲျဖတ္သုံး သပ္ရန္ႏွင့္ သန္႔စင္ခန္းေနရာ ၆။ စက္မႈလုပ္ငန္း ဘီးတပ္ထုိင္ခုံ ျပင္ဆင္ေရး၊ ထိန္း သိမ္းေရးႏွင့္ ျပဳျပင္ေရးလုပ္ငန္း မ်ားအတြက္ ေနရာ ၇။ သုိေလွာင္႐ုံ ၈။ အသုံးျပဳသူ သင္တန္း 122 123 အလယ္အလတ္အဆင္႔အတြက္ထပ္တုိးအသံုးအေဆာင္မ်ား ယင္းအသုံးအ ေဆာင္မ်ား ရွိၿပီးျဖစ္သေလာ ယင္းသည္ရွိၿပီးသား ဝန္ေဆာင္မႈ လုပ္ငန္းမ်ားႏွင့္မွ် ေဝသုံးစြဲေနရသည့္ အသုံးအေဆာင္ မ်ားေလာ။ အျခားေသာရည္ ႐ြယ္ခ်က္တခု အတြက္ ထားသည့္ အခန္းတခန္းကုိ ေျပာင္းလဲႏုိင္ သေလာ။ ရွိၿပီးသားအခန္း တခန္းကုိ ျပန္ အသုံးျပန္ႏုိင္ သေလာ သုိ႔မဟုတ္ ျပန္ေဆာက္ႏုိင္ သေလာ။ ၉။ လွဲေလ်ာင္း လ်က္ အေနအထားျဖင့္ အကဲျဖတ္ သုံးသပ္ခ်က္ ျပဳလုပ္ႏုိင္ေသာ ကုတင္ပါဝင္သည့္ အကဲျဖတ္သုံးသပ္ မႈႏွင့္ တပ္ဆင္မႈ ေနရာ ၁၀။ ပစၥည္း ထားသုိရန္ ေနာက္ထပ္ သုိေလွာင္႐ုံေနရာ ၁၁။ ေနာက္ထပ္ ပစၥည္းျပင္ဆင္ ေရးေနရာ၊ စက္ခ်ဳပ္လုပ္ငန္း ႏွင့္ အခ်ဳပ္အလုပ္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 122 123 c .1 .2/ ypönf;rsm; cGJjcm;owfrSwfjcif; • ပစၥည္းႏွင္႔ရံုးလုပ္ငန္းဆုိင္ရာလမ္းညႊန္အတြက္ ရည္ညႊန္းလက္စြဲကုိ ကုိးကားေလ႔လာပါ။ ပစၥည္း • သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းတြင္မည္သည္႔ပစၥည္းမ်ားကုိ ရရွိႏုိင္ျပီးအသံုးျပဳလ်က္ရွိသည္ ကုိ ခြဲျခားသတ္မွတ္ပါ။ ျပဳလုပ္ရမည္႔ သုိ႔မဟုတ္ ဝယ္ယူရမည္႔ မည္သည္႔ပစၥည္းမ်ိဳးကုိမဆုိ မွတ္သားထားပါ။ ရွိျပီးေသာ ျပဳလုပ္ရန္ သုိ႔မဟုတ္ ဝယ္ယူရန္ ရံုးလုပ္ငန္း • ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္တြင္ ပါဝင္ေသာ ပံုစံႏွင္႔ေဆာင္ရြက္ရမည္႔စာရင္း ကုိၾကည္႔ပါ။ • မည္သည္႔ပံုစံႏွင္႔ေဆာင္ရြက္ရမည္႔စာရင္းကုိေပါင္းစည္းထားျပီးအသံုးျပဳလ်က္ ရွိသနည္း၊ ေန႔စဥ္သံုးစြဲမႈသုိ႔ ေပါင္းစည္းရမည္႔မည္သည္႔ပံုစံသုိ႔မဟုတ္ေဆာင္ရြက္ရမည္႔စာရင္းကုိ မွတ္သားထားပါ။ ရွိျပီးေသာ လက္ရွိဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ေပါင္းစည္း ရမည္ျဖစ္ေသာ c .1 .3/ vkyfief;ae&mzGJYpnf;rI အသံုးအေဆာင္မ်ားႏွင္႔ပစၥည္းမ်ားဆုိင္ရာ လမ္းညႊန္ခ်က္အတြက္ ရည္ညႊန္းကုိးကားလက္စြဲကုိ ကုိးကားပါ။ • ေအာက္တြင္ေဖာ္ျပထားသည္႔ လုပ္ငန္းေနရာဖြဲ႔စည္းမႈေနရာေကာင္းနမူနာမ်ားကုိ သံုးသပ္ပါ- ၁။ ျဗဳတ္စဗ်င္းေတာင္းမ်ားကုိဖယ္ရွားပါ။ မလုိအပ္ေသာလက္သံုးပစၥည္းမ်ား၊ အစိတ္အပုိင္းမ်ား၊ ပစၥည္းမ်ား၊ ႏွင္႔ စာရြက္စာတမ္းအေဟာင္းမ်ားကုိဖ်က္ဆီးပါ။ ၂။ ပံုမွန္အသံုးျပဳသည္႔ပစၥည္းမ်ားအား သတ္မွတ္ပါ၊ လက္သံုးပစၥည္းမ်ား၊ အစိတ္အပိုင္းမ်ား၊ 124 125 ညႊန္ၾကားခ်က္မ်ားႏွင္႔ ရံုးစာမ်ား။ ယင္းပစၥည္းမ်ားအားအစီအစဥ္လုိက္ထားရွိရမည္။ သုိ႔မွသာ ၎တုိ႔ကုိရွာေဖြရန္ ျမန္ဆန္လြယ္ကူမည္ ျဖစ္သည္။ ၃။ စနစ္ႏွင္႔တာဝန္ယူမႈ၊ လုပ္ငန္းေနရာတစ္ခုစီတုိင္းအတြက္စနစ္ရွိပါေစ၊ ယင္းစနစ္ကုိ အေကာင္အထည္ေဖာ္ရန္ တာဝန္ယူမႈစနစ္ထားပါ။ ၄။ ေစာင္႔ၾကည္႔ျခင္း၊ အေျပာင္းအလဲသည္တည္တံ႔ခုိင္ျမဲေနေၾကာင္းေသခ်ာေစရန္စနစ္ကုိ ေစာင္႔ၾကည္႔ပါ။ စက္မႈလုပ္ငန္းေနရာ • နမူနာကုိသံုးသပ္ျပီးတုိးတက္မႈရွိေစေရး အၾကံျပဳပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 124 125 နယ္ေက်ာ္ေဆးေပးခန္းႏွင္႔စက္မႈလုပ္ငန္းေနရာ • နမူနာကုိသံုးသပ္ျပီးတုိးတက္မႈရွိေစေရး အၾကံျပဳပါ။ 126 127 c .2/ oifhawmfaom bD;wyfxkdifckHrsm;\ twkdif;twm c .2 .1/ wm&SnfcHjcif;? jyifqifEkdifjcif; • သင္၏အဖြဲ႔ႏွင္႔အတူ သင္႔အဖြဲ႔၏အေရအတြက္ေပၚမူတည္၍သင္႔ကုိေပးထားေသာေမးခြန္းမ်ားကုိေျဖပါ။ • ေဆာင္ရြက္မႈကုိအျပီးသတ္ရန္ရည္ညႊန္းကုိးကားလက္စြဲကိုကုိင္ျပီးသင္၏ကုိယ္ပုိင္ ဗဟုသုတႏွင္႔ အေတြ႔အၾကံဳ ကုိသံုးပါ။ အုပ္စု – ၁ • ေပးသြင္းထားေသာပစၥည္းမ်ား၏ေဘးကင္းမႈႏွင္႔တာရွည္ခံမႈႏွင္႔ပတ္သက္ျပီးမည္သည္႔ ေမးခြန္းကုိ သင္ေမးႏုိင္သနည္း။ • ပစၥည္းသြင္းသူ (အလွဴရွင္၊ ပစၥည္းထုတ္လုပ္သူ) သည္ သင္၏လုပ္ငန္းအတြက္ ေဘးကင္း ျပီး တာရွည္ခံေသာပစၥည္းမ်ားကုိေပးသြင္းေနျခင္းျဖစ္ေၾကာင္း သင္မည္သုိ႔သိႏုိင္မည္နည္း။ • အလွဴရွင္၊ ထုတ္လုပ္သူ၊ ပစၥည္းသြင္းသူကေပးသြင္းေနသည္႔ပစၥည္းမ်ား၏ေဘးကင္းမႈနွင္႔ တာရွည္ခံမႈတုိ႔ႏွင္႔ပတ္သက္ျပီး သိရွိႏုိင္ရန္ သင္မည္သူ႔ထံ စံုစမ္းႏုိင္မည္နည္း။ တာရွည္ခံမႈ အုပ္စု – ၂ • တာရွည္ခံပါသည္ဆုိေသာပစၥည္းမ်ားသည္ပင္လွ်င္ ေဟာင္းႏြမ္းျပီးပ်က္စီးသြားေလ႔ရွိသည္႔ အစိတ္အပုိင္းမ်ား ပါဝင္ပါသည္။ ယင္းအထိမခံသည္႔အစိတ္အပုိင္းအခ်ိဳ႕မွာ အဘယ္နည္း။ ပ်က္စီး ေဟာင္းႏြမ္း သြားသည့္ အစိတ္အပုိင္း မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 126 127 အုပ္စု ၃ • ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုသည္ အပုိပစၥည္းမ်ားကုိ လုိအပ္သည္။ • မည္သည္႔အပုိပစၥည္းမ်ား လုိအပ္ေနေၾကာင္း သင္ မည္သုိ႔သတ္မွတ္မည္နည္း။ • မည္သည္႔အပုိပစၥည္းမ်ားကုိ မွာယူရန္လုိေၾကာင္း သင္ မည္သုိ႔သိႏုိင္မည္နည္း။ အပုိပစၥည္း မ်ား c .2 .2/ oifhawmfaombD;wyfxkdifckH ay;oGif;jcif; ဇာတ္ညႊန္း - ၁ • သင္႔အားေပးထားေသာ ေအာက္ေဖာ္ျပပါအညႊန္းကုိ ဖတ္ပါ။ ထုိေနာက္ 'သင္႔ေလ်ာ္ေသာေရြ႔လ်ားႏုိင္စြမ္းပစၥည္း မ်ား ေထာက္ပံ႔ေပးသြင္းျခင္းဆုိင္ရာအေျခခံစည္းမ်ဥ္းမ်ား' ကုိ ဖတ္ပါ။ • ျပည္နယ္အရာရွိမ်ားအတြင္း သရုပ္ေဆာင္သည္႔အစီအစဥ္တင္ဆက္သူမ်ား၊ ဘီးတပ္ထုိင္ခုံဝယ္ယူမႈ စနစ္ အေျပာင္းအလဲ ျပဳလုပ္မႈကုိ ဦးစီးဦးေဆာင္ေနသည္႔ ပါဝင္ပတ္သက္သူအုပ္စုပါဝင္သည္႔ အခင္းအက်င္းမ်ိဳး အတြက္လည္းျပင္ဆင္ထားပါ။ (သရုပ္ျပအစီအစဥ္သည္ (၃) မိနစ္မွ (၅) မိနစ္အတြင္းျဖစ္သည္။) သရုပ္ေဆာင္အစီအစဥ္ႏွင္႔ပတ္သက္၍ေဆြးေႏြးရာတြင္ ေအာက္ပါအခ်က္မ်ားကုိ စဥ္းစားပါ- • ဇာတ္ညႊန္းအတြင္းရွိျပႆနာမွာ မည္သည္႔အေၾကာင္းအရာ ျဖစ္သနည္း • ယင္းျပႆနာမ်ားကုိ ေက်ာ္လႊားႏုိင္မည္႔ျဖစ္ႏုိင္ေျခရွိေသာ အေရးယူေဆာင္ရြက္ခ်က္မ်ား 128 129 သင္၏နယ္ေျမအတြင္းရွိ အစုိးရေဆးရံုတစ္ရံုသည္ ဘီးတပ္ထုိင္ခုံေထာက္ပံ႔ေရး အတြက္ ဘတ္ဂ်က္တစ္ခု သတ္မွတ္ထားသည္။ ႏွစ္စဥ္ဆုိ သလုိပင္ ယင္းဘတ္ဂ်က္အား သံုးသပ္ျပီး ပစၥည္းစာရင္းမ်ားအား ျပန္လည္စဥ္းစားသံုးသပ္သည္။ ႏွစ္စဥ္ပင္ ပစၥည္းမ်ားအားေျပာင္း လဲေပးရန္ေတာင္းဆုိမႈမ်ား ရွိေသာ္လည္း မည္သည္႔အခါမွ် ေျပာင္းလဲမႈ မျပဳလုပ္သကဲ႔သုိ႔ ပစၥည္းဝယ္ယူမႈဌာနသည္ ေစ်းႏႈန္းအေပၚ အေျချပဳသည္႔ ပစၥည္းႏွစ္မ်ိဳးကုိ ဝယ္ယူခဲ႔သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 128 129 သင္႔ေလ်ာ္ေသာေရြ႔လ်ားႏုိင္စြမ္းပစၥည္းမ်ားေထာက္ပံ႔ေရးဆုိင္ရာ အေျခခံစည္းမ်ဥ္းမ်ား မသန္စြမ္းပုဂၢိဳလ္မ်ားအခြင္႔အေရးဆုိင္ရာ သေဘာတူညီခ်က္တြင္ ေဖာ္ျပပါရွိေသာ အေထာက္အကူျပဳနည္းပညာ (ေရြ႔လ်ားႏုိင္စြမ္းပစၥည္း) ႏွင္႔ဆက္စပ္ေနေသာ ကတိကဝတ္မ်ားအား ႏုိင္ငံမ်ားကျဖည္႔ဆည္းေပးႏုိင္ေရးအတြက္ ေအာက္ေဖာ္ျပပါ အဓိကအေျခခံစည္းမ်ဥ္းမ်ားအား စဥ္းစားသံုးသပ္ရန္လုိမည္ျဖစ္ပါသည္- • - လက္ခံရရွိပုိင္ခြင္႔ရွိျခင္း - ေရြ႕လ်ားႏုိင္စြမ္းပစၥည္းမ်ားေထာက္ပံ႔မႈအဆင္႔အားလံုးတြင္ မသန္စြမ္း ပုဂၢိဳလ္မ်ားပါ ဝင္ႏုိင္ခြင္႔ရွိရမည္။ • - ရယူသံုးစြဲပုိင္ခြင္႔ ရွိျခင္း - ေရြ႕လ်ားႏိုင္စြမ္းပစၥည္းမ်ားႏွင္႔ဆက္စပ္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားကုိ လုိအပ္ခ်က္ရွိ သူတုိင္း ရယူပုိင္ခြင္႔ ရွိရမည္။ • - အလုိက္သင္႔ေျပာင္းလဲႏုိင္ျခင္း - ေရြ႕လ်ားႏုိင္စြမ္းပစၥည္းမ်ားႏွင္႔ဆက္စပ္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားသည္ တစ္ဦးခ်င္းစီ၏ လုိအပ္ခ်က္ႏွင္႔ကုိက္ညီေစေရးအတြက္ ၎တုိ႔အား အလုိက္သင္႔ေျပာင္းလဲရန္၊ မြမ္းမံရန္ လုိအပ္သည္။ • - တတ္ႏုိင္ျခင္း - ေရြ႔လ်ားႏုိင္စြမ္းပစၥည္းမ်ားႏွင္႔ဆက္စပ္ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအတြက္ အကုန္အက်ခံရန္ တတ္ႏုိင္ရမည္။ • - ရရွိႏုိင္ျခင္း - အသံုုးအေဆာင္မ်ား၊ ဝန္ထမ္းမ်ားႏွင္႔ပစၥည္းမ်ားသည္ လူအမ်ား၏လုိအပ္ခ်က္အတြက္ လံု ေလာက္မႈရွိျပီး ယင္းတုိ႔အား လူမႈအသုိက္အဝန္းႏွင္႔အနီးကပ္ဆံုးေနရာတြင္ ေထာက္ပံ႔ေပးႏိုင္မႈရွိရမည္။ • - အရည္အေသြး - ပစၥည္းမ်ား၊ အသံုုးအေဆာင္မ်ားႏွင္႔ ဝန္ေဆာင္မႈမ်ားသည္ သင္႔ေလ်ာ္ေသာ အရည္အေသြးရွိရမည္။ 130 131 ဇာတ္ညႊန္း - ၂ • ေအာက္တြင္ေဖာ္ျပထားေသာ အစုိးရတင္ဒါစနစ္ႏွစ္မ်ိဳးကုိ ဖတ္ပါ။ • လက္ရွိသင္၏ႏုိင္ငံအတြင္းက်င္႔သံုးေနသည္႔စနစ္ကုိ အက်ဥ္းေဖာ္ျပပါ။ • သင္႔ေလ်ာ္ေသာေရြ႔လ်ားႏုိင္စြမ္းပစၥည္းမ်ားေထာက္ပံ႔ေရးဆုိင္ရာအေျခခံစည္းမ်ဥ္းမ်ားကုိ ကုိးကားပါ။ • သင္၏ႏုိင္ငံအတြင္းဘီးတပ္ကုလားထုိင္ေပးသြင္းမႈအစုိးရတင္ဒါစနစ္တုိးတက္လာေစရန္ သုိ႔မဟုတ္ တင္ဒါစနစ္ကုိ ေဖာ္ေဆာင္ရန္အၾကံျပဳခ်က္မ်ား ျပင္ဆင္ပါ။ ေတာင္အာဖရိက ေတာင္အာဖရိကႏုိင္ငံတြင္ အစိုးရကဘီးတပ္ထုိင္ခုံဝယ္ယူမႈအား အမ်ိဳးသားတင္ဒါအဖြဲ႔က ထိန္းခ်ဳပ္ထားသည္။ အစုိးရသည္ ျပည္နယ္မ်ားမွ ဘီးတပ္ထုိင္ခုံႏွင္႔ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းကြၽမ္းက်င္သူမ်ားႏွင္႔ အတူတူ ေဆာင္ရြက္သည္။ ၎တုိ႔သည္ လက္ရွိဘီးတပ္ထုိင္ခုံေပးသြင္းေနသူမ်ားႏွင္႔လည္း တုိင္ပင္ညွိႏႈိင္းမႈျပဳလုပ္ၾက သည္။ တုိင္ပင္ညွိႏႈိင္းမႈမ်ားျပဳလုပ္အျပီးတြင္ ပစၥည္းတစ္ခုစီတုိင္းအတြက္ အေသးစိတ္သတ္မွတ္ခ်က္အပါအဝင္ ပစၥည္း မ်ား၏အမ်ိဳးအစားႏွင္႔ ယင္းအမ်ိဳးအစားမ်ားတြင္ပါသည္႔အေၾကာင္းအရာမ်ားကုိ အျပီးသတ္သေဘာတူညီမႈ ယူ ၾကသည္။ ပစၥည္းအမ်ိဳးအစားတြင္ သက္ေတာင္႔သက္သာျဖစ္မႈ ႏွင္႔ အဆင္႔ျမင္႔အခုအခံမ်ားပါဝင္သည္။ ပစၥည္းတစ္ခုစီတုိင္းအတြက္ အနိမ႔္ဆံုးအဆင္႔တာရွည္ခံမႈစံႏႈန္းကိုပါ သတ္မွတ္ထားသည္။ တင္ဒါသတ္မွတ္ခ်က္မ်ားအား အျပီးသတ္ျပီးေသာအခါ အစုိးရ၏အမ်ိဳးသားဘဏၰာထိန္းအဖြဲ႔သည္ တင္ဒါေခၚ ယူျခင္းလုပ္ငန္းစဥ္မ်ားကုိ စတင္ခဲ႔သည္။ လုပ္ငန္းကန္ထရုိက္မေပးမီ တင္ဒါသုိ႔တင္သြင္းလာေသာပစၥည္း အားလံုးအား ကြၽမ္းက်င္ကုိယ္စားလွယ္မ်ားက စစ္ေဆးၾကသည္။ ကန္ထရုိက္သေဘာတူညီခ်က္တြင္ ေပးသြင္း ရမည္႔ အနည္းဆံုးကာလႏွင္႔ ကန္ထရုိက္စည္းကမ္းခ်က္မ်ားအား ခ်ိဳးေဖာက္ပါကရရွိမည္႔ျပစ္ဒဏ္မ်ားကုိပါ ထည္႔သြင္းေဖာ္ျပထားသည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 130 131 ႐ုိေမးနီးယား ေဆးဝါးမ်ားအတြက္ အစုိးရကအေထာက္အပံ႔ေပးသည္႔စနစ္ကုိ စတင္ခဲ႔ျပီးေနာက္ ဘီးတပ္ထုိင္ခုံမ်ားအတြက္ ႏိုင္ငံေတာ္က ေငြေၾကးေထာက္ပံ႔မႈကုိ ရုိေမးနီးယားႏုိင္ငံတြင္ က်င္႔သုံးလာသည္။ ႏုိင္ငံေတာ္ ဘီးတပ္ထုိင္ခုံေပး သြင္းသမူ်ားအတြက ္တင္ဒါေခၚယူသည္႔ (၂ဝဝ၁)ခုႏွစ္အတြင္း ဘီးတပ္ထုငိ္ခုံမ်ားအတြက္ အမေတာ္ေၾကးေပးသည္႔ လုပ္ငန္းစဥ္ကုိ စတင္ေဆာင္ရြက္ခဲ႔ဲျခင္းျဖစ္သည္။ တင္ဒါေခၚယူလုိက္သည္႔အတြက္ ၾကမ္းခင္းေစ်း/ရည္ညႊန္းေစ်း မ်ားႏွင္႔ပတ္သက္၍ သေဘာတူညီမႈရယူႏုိင္ခဲ႔ေသာ္လည္း ပစၥည္းအရည္အေသြးႏွင္႔ ပတ္သက္၍လည္းေကာင္း၊ ဝန္ေဆာင္မႈေပးေရးႏွင္႔ပတ္သက္၍လည္းေကာင္း တိတိက်က်သတ္မွတ္ႏုိင္ျခင္းမရွိပါ။ အမေတာ္ေၾကးတန္ဖုိး ကုိ ႏွစ္စဥ္ျပန္လည္ေရးဆြဲပါသည္။ ဘီးတပ္ထုိင္ခုံသံုးစြဲမည္႔သူအေနျဖင္႔ ပထမဆံုးေဆာင္ရြက္ရသည္႔ကိစၥမွာ မသန္စြမ္းလက္မွတ္ေလွ်ာက္ထားျခင္း ျဖစ္သည္။ ယင္းလက္မွတ္မပါရွိပါက ဘီးတပ္ထုိင္ခုံရပုိင္ခြင္႔မရွိပါ။ ေနာက္တဆင္႔မွာ ဘီးတပ္ထုိင္ခုံအညႊန္း ေရး ေပးမည္႔ဆရာဝန္ႏွင္႔ေတြ႔ဆံုရန္ ရက္ခ်ိန္းရယူျခင္းျဖစ္သည္။ ထုိေနာက္ ဘီးတပ္ထုိင္ခုံအသံုးျပဳမည္႔သူသည္ ခရုိင္ အမ်ိဳးသားအာမခံလုပ္ငန္းေအဂ်င္စီ (NIA) တြင္ေလွ်ာက္လႊာ တင္ရမည္ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံ အသံုးျပဳမည္႔ သူအေနျဖင္႔ အတည္ျပဳခ်က္/ေျပစာတုိ႔ကို ရျပီဆုိလွ်င္ ၎သည္ ေပးသြင္းမည္႔သူ ႏွင္႔ ဘီးတပ္ထုိင္ခုံတစ္လံုးကုိ ေရြးခ်ယ္ရမည္ျဖစ္ပါသည္။ ဘီးတပ္ထုိင္ခုံ၏တန္ဖုိးသည္ ေထာက္ပံ႔မည္႔ပမာဏထက္နည္းပါက ေပးသြင္းသူသည္ ဘီးတပ္ထုိင္ခုံကုိေပးျပီး ေျပစာကို ရယူထားပါမည္။ ယင္းေျပစာျဖင္႔ ၄င္းက (NIA) ထံ ကုန္ပုိ႔လႊာတင္မည္ျဖစ္ပါ သည္။ ဘီးတပ္ထုိင္ခုံ၏တန္ဖုိးသည္ ေထာက္ပ့ံသည္႔ပမဏထက္မ်ားပါက အသံုးျပဳ သူသည္ လုိအပ္မည္႔ေငြကုိ ေပးျခင္း သုိ႔မဟုတ္ ေငြေၾကး ျဖည္႔ဆည္းေထာက္ပံ႔မည္႔သူ (ဥပမာ - အလွဴရွင္၊ အလုပ္ ရွင္ သုိ႔မဟုတ္ တစ္ဦးခ်င္း) ကုိ ရွာေဖြရပါမည္။ 132 133 ဇာတ္ညႊန္း ၃ • သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းစနစ္မွတဆင္႔ သင္႔ေလ်ာ္ေသာဘီးတပ္ထုိင္ခုံေပးသြင္းမည္႔အစီအမံျဖင္႔ သင္သည္အလွဴရွင္တစ္ဦးႏွင္႔ လာေရာက္ေတြ႔ဆံုသည္႔ သရုပ္ေဖာ္တင္ဆက္မႈဇာတ္ညႊန္းတစ္ခုကုိေရးပါ။ (သရုပ္ေဖာ္တင္ဆက္မႈသည္ ၃ မိနစ္မွ ၅ မိနစ္အတြင္းျဖစ္သည္။) သင္၏သ႐ုပ္ေဖာ္တင္ဆက္မႈကုိ စီစဥ္သည္႔အခါတြင္ ေအာက္ပါအခ်က္မ်ားကုိ ထည္႔သြင္းပါ- • အလွဴရထားသည္႔ဘီးတပ္ထုိင္ခုံမ်ားအား သင္၏ႏုိင္ငံအတြင္း လက္ရွိအားျဖင္႔ မည္သုိ႔မည္ပံုျဖန္႔ေဝေပးသည္ ဆုိသည္ကုိ ေဆြးေႏြးပါ။ • သင္႔ေလ်ာ္ေသာေရြ႔လ်ားႏုိင္စြမ္းပစၥည္းေထာက္ပံ႔ျခင္းဆုိင္ရာအေျခခံစည္းမ်ဥ္းမ်ားကုိ ဖတ္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 132 133 c .3/ 0efxrf;rsm;tm; ae&mcsxm;jcif; - tcef;u@rsm; • ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ား၏အခန္းက႑မ်ားကုိ ေဖာ္ျပထားေသာ ေအာက္ပါဇယားကုိ ၾကည္႔ပါ။ • အဆုိပါဇယားတြင္ မည္သူက မည္သည္႔အခန္းက႑အတြက္ တာဝန္ယူရသည္ဆုိသည္ကို အမည္တပ္ပါ။ • သင္သည္ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုထက္ပုိ၍တာဝန္ယူရလွ်င္ ဝန္ထမ္းမ်ားအား ေနရာတစ္ခုစီအတြက္ စာရင္း သြင္းပါ။ ေဆ းေ ပး ခန ္း စက ္မႈလ ုပ္င န္း အ သ ံုးျပ ဳသ ူသ င္တ န္း စီမ ံအ ုပ္ခ ်ဳပ ္ေရ း ၀န္ေဆာင္မႈ လုပ္ငန္းဌာန ၀န္ေဆာင္မႈ လုပ္ငန္းဌာန ၀န္ေဆာင္မႈ လုပ္ငန္းဌာန c .4/ bD;wyfxkdif0efaqmifrIvkyfief;wckvQif rnfrQukefusoenf;/ ျပန္လည္သံုးသပ္ျခင္း - ေအာက္တြင္ေဖာ္ျပထားေသာ ေငြစာရင္းေခါင္းစဥ္မ်ားအား ၾကည္႔္ျပီး မည္သည္႔ကုန္က် စရိတ္ကုိ မွ်ေဝက်ခံႏုိင္သည္ သုိ႔မဟုတ္ လက္ရွိဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းအား ေပါင္းစည္းျခင္းျဖင္႔ စရိတ္စကသက္သာေစႏုိင္သည္ဆုိသည္ကုိ စဥ္းစားသံုးသပ္ပါ။ ေခြၽတာႏုိင္မည္႔ကုန္က်စရိတ္အားလံုးကုိ မွင္အနက္ ျဖင္႔ဝုိင္းျပပါ။ မွ်ေဝက်ခံႏုိင္မည္႔ကုန္က်စရိတ္အားလံုးကုိ မွင္အနီ ျဖင္႔ဝုိင္းျပပါ။ ေပါင္းစည္းဝန္ေဆာင္မႈလုပ္ငန္းဇာတ္ညႊန္းနမူနာ 134 135 P&O ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအား သိမ္းသြင္းရန္စီစဥ္ေနသည္။ ဝန္ထမ္းႏွစ္ဦးအား သတ္မွတ္ ေရြးခ်ယ္ျပီး WSTP အေျခခံသင္တန္းသို႔တက္ေရာက္ေစသည္။ အဆုိပါဝန္ထမ္းႏွစ္ဦးလံုးသည္ တစ္ပါတ္လွ်င္သံုးရက္က်စီျဖင္႔ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈလုပ္ငန္းကုိ ေဆာင္ရြက္ ရျပီး တစ္ပါတ္လွ်င္ႏွစ္ရက္က်စီကုိ P&O ဝန္ေဆာင္မႈလုပ္ငန္းတြင္ တာဝန္ထမ္းေဆာင္ရသည္။ ဘီးတပ္ထုိင္ခုံနည္းပညာရွင္အတြက္ အလုပ္ရံုအတြင္း လုပ္ငန္းေနရာတစ္ခုသတ္မွတ္ေပးထားသည္။ ကုထံုးဌာန သည္ ေဆးေပးခန္းလုပ္ငန္းမ်ားေဆာင္ရြက္ႏုိင္ရန္ လုပ္ငန္းေနရာေပၚေပါက္လာေစရန္ ပစၥည္းအပ်က္အစီးမ်ားႏွင္႔ အသံုးမလုိသည္႔ ပစၥည္းအားလံုးအား ရွင္းထုတ္ခဲ႔သည္။ ဘတ္ဂ်က္လမ္းညႊန္ လုပ္ငန္းအဆင့္မ်ား လ ႊဲေျ ပာ င္း ေပ းျခ င္း ႏွင ္႔ခ် ိန္း ဆ ုိျခ င္း အ က ဲျဖ တ ္ သ ုံးသ ပ္ျ ခင ္း ည ႊန္ၾ က ား ျခ င္း ရန ္ပုံေ ငြႏ ွင့္ စီစ ဥ္ျ ခင ္း ထ ုတ ္က ုန္ အ ံဝင ္ခြင ္က ်တ ပ္ဆ င္ျ ခင ္း အ သ ုံးျပ ဳသ ူသ င္တ န္း ထ ိန္း သ ိမ္း ျခ င္း ၊ ျ ပဳ ျပ င္ျ ခင ္းႏ ွင့္ ေန ာက ္ဆ က ္တ ြဲလ ုပ္ေ ဆ ာင ္ျခ င္း ကနဦးကုန္က်စရိတ္ ထုတ္ကုန္ဒီဇုိင္း ထုတ္ကုန္အမ်ိဳးအစားကုိ ရွာေဖြျခင္း  လက္သုံးကိရိယာမ်ား    ပစၥည္းမ်ား   အေဆာက္အအုံ/အသုံးအေဆာင္မ်ား    ပစၥည္းသုိေလွာင္ျခင္း  လုပ္ငန္းကုန္က်စရိတ္ ဘီးတပ္ထုိင္ခုံမ်ား   အပုိပစၥည္းမ်ား  ပစၥည္းမ်ား    ကုန္တင္ျခင္း(ပစၥည္းသယ္ယူပုိ႔ေဆာင္ေရး)   ဝန္ထမ္းေရးရာ စီမံခန္႔ခြဲေရး    bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 134 135 ေဆးေပးခန္းဝန္ထမ္း        စက္မႈဝန္ထမ္း      သင္တန္းဆရာ/ အရည္အခ်င္းတူသင္တန္းဆရာ   အုပ္ခ်ဳပ္ေရးမွဴး      ေဒသတြင္း သယ္ယူပုိ႔ေဆာင္ေရး ဝန္ထမ္းမ်ားအတြက္ ေဒသတြင္းသယ္ပုိ႔ျခင္း     အသုံးျပဳသူမ်ားအတြက္ ေဒသတြင္းသယ္ပုိ႔ျခင္း    အသုံးျပဳသူမ်ားအတြက္ ေနရာထုိင္ခင္း   ပုံနွိပ္ေရးပစၥည္းကိရိယာမ်ား      သုံးကုန္ပစၥည္းမ်ား    လက္သုံးပစၥည္းအစားထုိးျခင္း    အေထြေထြအသုံးစရိတ္       ဝန္ထမ္းမ်ားအား သင္တန္းေပးျခင္း       မိတ္ဖက္မ်ား/ လႊဲေျပာင္းေရးကြန္ယက္မ်ားအတြက္ သင္တန္း    ရန္ပံုေငြျမွင္႔တင္ျခင္း         ႀကီးၾကပ္ေစာင္႔ၾကည္႔ျခင္းႏွင္႔အကဲျဖတ္သံုး သပ္ျခင္း         136 137 8/ bD;wyfxkdifckH0efaqmifrIvkyfief;wck aqmif½Gufjcif; * .1/ pGrf;aqmif&nfjynfh0NyD; xda&mufonhfvkyfief;rsm; * .1 .1/ BuD;MuyfapmihfMunfhjcif; အပုိင္း ၁ • သင္၏အဖြဲ႔အတြင္း၊ ေအာက္တြင္ေဖာ္ျပထားေသာဇယားရွိ သင္၏အပုိင္းကုိ ျဖည္႔ပါ။ • သင္စတင္ေျဖဆုိရာတြင္ အေထာက္အကူျဖစ္ေစရန္ အခ်ိဳ႔အကြက္မ်ားအား ျဖည္႔ထားေပးသည္။ က်န္အကြက္မ်ားအား ျဖည္႔ရန္ျဖစ္သည္။ နယ္ေျမႏွင္႔လႈပ္ရွားမႈ စြမ္းေဆာင္မႈရည္မွန္းခ်က္နမူနာ သတင္းအခ်က္အလက္ စုေဆာင္းျခင္း လႊဲေျပာင္းေပးျခင္း လႊဲေျပာင္းေပးသည္႔အသံုးျပဳသူ အေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသည္တစ္လလွ်င္ လႊဲေျပာင္းေပးသူ (၃ဝ) ကုိလက္ခံမည္ လက္ခံရရွိသည္႔လႊဲေျပာင္းေပး သူမ်ားအား မွတ္တမ္းတင္ျခင္း လႊဲေျပာင္းေပးသည္႔အခ်ိန္မွ ခ်ိန္းဆုိမႈျပဳသည္႔အခ်ိန္အထိ ပွ်မ္းမွ်ေစာင္႔ဆုိင္းရသည္႔အခ်ိန္ လႊဲေျပာင္းေပးမႈကုိလက္ခံရရွိ သည္႔ေန႔စြဲ ႏွင္႔အကဲျဖတ္ သံုးသပ္ခ်က္ျပဳလုပ္သည္႔ ေန႔စြဲကုိအသံုးျပဳသူဖုိင္တြင္ မွတ္တမ္းတင္ျခင္း ဘီးတပ္ထုိင္ခုံ ေထာက္ပံ့ျခင္း ဘီးတပ္ထုိင္ခုံရရွိသည္႔ အသံုးျပဳသူအေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသည္တစ္လလွ်င္ အသုံးျပဳသူ (၂ဝ) အတြက္ ဘီးတပ္ထုိင္ခုံအညႊန္းေပးျခင္း၊ တပ္ဆင္ ျခင္းျပဳလုပ္မည္ အကဲျဖတ္သံုးသပ္သည္႔ေန႔မွ တပ္ဆင္သည္႔ေန႔အထိ ပွ်မ္းမွ်ေစာင္႔ဆုိင္းရသည္႔အခ်ိန္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 136 137 ေနာက္ဆက္တြဲျပသမႈျပဳလုပ္ ရန္ခ်ိန္းဆုိသည္႔ အၾကိမ္အေရအတြက္ • ရည္မွန္းခ်က္မ်ားေအာင္ျမင္မႈရွိ/မရွိကုိ သိရွိႏုိင္ရန္ ေအာက္ပါအခ်က္မ်ား မည္သည္႔အတြက္ အသံုးဝင္ေၾကာင္းကုိ မွတ္တမ္းတင္ပါ။ ေအာင္ျမင္သည္႔ရည္မွန္းခ်က္ မ်ားကုိသိရွိရန္အသံုးဝင္သည္၊ အေၾကာင္းမွာ - မေအာင္ျမင္သည္႔ရည္မွန္းခ်က္ မ်ားကုိသိရွိရန္အသံုးဝင္သည္၊ အေၾကာင္းမွာ - လႊဲေျပာင္းေပးသည္႔အသံုးျပဳသူ အေရအတြက္ လႊဲေျပာင္းေပးသည္႔အခ်ိန္မွခ်ိန္းဆုိ မႈျပဳသည္႔အခ်ိန္အထိ ပွ်မ္းမွ်ေစာင္႔ ဆုိင္းရသည္႔အခ်ိန္ ဘီးတပ္ထုိင္ခုံရရွိသည္႔ အသံုးျပဳသူအေရအတြက္ အကဲျဖတ္သံုးသပ္သည္႔ေန႔မွ တပ္ဆင္သည္႔ေန႔အထိ ပွ်မ္းမွ်ေစာင္႔ဆုိင္းရသည္႔အခ်ိန္ ေနာက္ဆက္တြဲျပသမႈျပဳလုပ္ ရန္ခ်ိန္းဆုိသည္႔ အၾကိမ္အေရအတြက္ 138 139 အပုိင္း ၂ နယ္ေျမႏွင္႔လႈပ္ရွားမႈ စြမ္းေဆာင္မႈရည္မွန္းခ်က္နမူနာ သတင္းအခ်က္အလက္ စုေဆာင္းျခင္း ေထာက္ပံ႔သည္႔ဘီးတပ္ထုိင္ခုံအေရအတြက္ ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ လႊဲေျပာင္းေပးသည္႔ အသုံးျပဳသူမ်ား၏ အေသးစိတ္ အခ်က္အလက္မ်ား၊ ဥပမာ - အသက္၊ လိင္၊ မစြမ္းသန္အမ်ိဳးအစား ကုိယ္ေနဟန္ထား အေထာက္အကူျပဳမႈ လုိအပ္ခ်က္မ်ား ဝန္ေဆာင္မႈလုပ္ငန္းသည္ ညီတူညီမွ် ရရွိေရးကုိ အားေပးသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းသည္ အေျခခံဘီးတပ္ထုိင္ခုံမ်ား လုိအပ္ေနေသာ အသုံးျပဳသူမ်ား၊ မြမ္းမံမႈႏွင့္ ကုိယ္ေနဟန္ထား အေထာက္ အကူလုိေနသူမ်ား၏ လုိအပ္ခ်က္ကုိျဖည့္ဆည္းေပးရန္ ရည္မွန္းထားသည္။ ဝန္ေဆာင္မႈရရွိသည္႔ ေယာက္်ား၊ မိန္းမ၊ မိန္းကေလး၊ ေယာက္်ားေလး အေရအတြက္ကုိ အသံုးျပဳသူဖုိင္တြင္ မွတ္တမ္းတင္ထားျခင္း တင္ျပလာေသာကုိယ္ေနဟန္ထား လုိအပ္ခ်က္ပံုစံႏွင္႔ညႊန္းေပးေသာ ဘီးတပ္ထုိင္ခုံပံုစံကုိ အသံုးျပဳသူ ဖုိင္တြင္မွတ္တမ္းတင္ျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းကလႊမ္းျခံဳ ထားသည္႔ နယ္ေျမအက်ယ္အဝန္း ဝန္ေဆာင္မႈလုပ္ငန္းကုိ ရရွိၾကသည္႔ အသံုးျပဳသူမ်ား၏ ေနအိမ္လိပ္စာကုိ အသံုးျပဳသူဖုိင္တြင္ မွတ္တမ္းတင္ျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 138 139 ဝန္ေဆာင္မႈကုန္က်စရိတ္ ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ျပဳလုပ္ေသာ ဆန္းသစ္မြမ္းမံမႈမ်ား အပါအဝင္ပစၥည္း ေထာက္ပံ႔မႈကုန္က်စရိတ္ ဘီးတပ္ထုိင္ခုံတစ္လံုးခ်င္းစီ အတြက္ တစ္ဦးခ်င္း ကုန္က်စရိတ္သည္ (ဘတ္ဂ်က္အရလည္းေကာင္း ရရွိသည္႔ပစၥည္း၏ အမွန္တကယ္ ကုန္က်စရိတ္အရလည္းေကာင္း သတ္မွတ္ထားသည့္ ပမာဏ) ထက္နည္းသည္။ ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ဝန္ထမ္းမ်ား အသံုးျပဳရသည္႔ အခ်ိန္အေရအတြက္ (ဥပမာ - အကဲျဖတ္သံုးသပ္ျခင္း၊ ေနာက္ဆက္တြဲျပသျခင္းႏွင္႔သင္ တန္း) 140 141 • ရည္မွန္းခ်က္မ်ားေအာင္ျမင္မႈရွိ/မရွိကုိသိရွိႏုိင္ရန္ ေအာက္ပါအခ်က္မ်ား မည္သည္႔အတြက္ အသံုးဝင္ေၾကာင္းကုိ မွတ္တမ္းတင္ပါ။ ေအာင္ျမင္သည္႔ရည္မွန္းခ်က္မ်ား ကုိ သိရွိရန္အသံုးဝင္သည္၊ အေၾကာင္းမွာ - မေအာင္ျမင္သည္႔ရည္မွန္းခ်က္မ်ား ကုိ သိရွိရန္အသံုးဝင္သည္၊ အေၾကာင္းမွာ - ဝန္ေဆာင္မႈလုပ္ငန္းသုိ႔ လႊဲေျပာင္းေပးသည္႔ အသုံးျပဳသူမ်ား၏ အေသးစိတ္ အခ်က္အလက္မ်ား၊ ဥပမာ - အသက္၊ လိင္၊ မစြမ္းသန္အမ်ိဳးအစား ကုိယ္ေနဟန္ထား အေထာက္အကူျပဳမႈ လုိအပ္ခ်က္မ်ား ဝန္ေဆာင္မႈလုပ္ငန္းက လႊမ္းျခံဳထားသည္႔ နယ္ေျမအက်ယ္အဝန္း ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ျပဳလုပ္ေသာ ဆန္းသစ္မြမ္းမံမႈမ်ားအပါအဝင္ ပစၥည္းေထာက္ပံ႔မႈ ကုန္က်စရိတ္ ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ဝန္ထမ္းမ်ား အသံုးျပဳရသည္႔ အခ်ိန္အေရအတြက္ (ဥပမာ - အကဲျဖတ္သံုးသပ္ျခင္း၊ ေနာက္ဆက္တြဲျပသျခင္းႏွင္႔ သင္တန္း) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 140 141 * .1 .2/ tokH;jyKol\jyefvSeftBuHjyKcsuf • ဝန္ေဆာင္မႈအသံုးျပဳသူထံမွျပန္လွန္အၾကံျပဳခ်က္မ်ားေတာင္းခံစုေဆာင္းရန္စီစဥ္ရာတြင္ အေရးၾကီးေသာ ထည္႔သြင္းစဥ္းစားရန ္အခ်က္အခ်ိဳ႔ရွိပါသည္။ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက ္မွတ္သားႏိုင္ရန္ ေအာက္ေဖာ္ျပပါေဆာင္ရြက္ရန္စာရင္း ကုိအသံုးျပဳပါ။ ဝန္ေဆာင္မႈအသံုးျပဳသူထံမွျပန္လွန္အၾကံျပဳခ်က္အတြက္စီစဥ္ျခင္း စဥ္းစားရန္အခ်က္မ်ား၊ သယ္ယူပုိ႔ေဆာင္ေရးႏွင္႔အခ်ိန္သည္အသိသာဆံုးေသာကုန္က်စရိတ္ (၂) ခု ျဖစ္သည္။ မည္သည္႔အခ်ိန္တြင္ ျဖစ္ေပၚမည္နည္း။ မည္သူက ေဆာင္ရြက္မည္နည္း။ မည္သည္႔ျပန္လွန္အၾကံျပခ်က္ေမးခြန္မ်ိဳးကုိ ေမးမည္နည္း။ အေျခခံသတင္းအခ်က္အလက္မ်ား (ပင္ဒရုိက္ရွိမန္ေနဂ်ာလက္စြဲအတြက္ ထပ္တုိးအရင္းအျမစ္အတြင္းသုိမွီးထားေသာကိရိယာမ်ားကုိ ကုိးကားပါ) စဥ္းစားရန္အခ်က္မ်ား - ဝန္ေဆာင္မႈလုပ္ငန္း၏အက်ိဳးသက္ေရာက္မႈကုိအကဲျဖတ္ႏုိင္ရန္အတြက္ မည္သည္႔ ေဆာင္ရြက္ခ်က္ကုိမွ် မျပဳလုပ္မီအေျခအေနမ်ားအား မွတ္တမ္းတင္ထားရန္ အေရးၾကီးပါသည္။ ဆုိလုိသည္မွာ အကဲျဖတ္လုပ္ငန္းမစတင္မီကုိ ဆုိလုိျခင္းျဖစ္ပါသည္။ မည္သည္႔အခ်ိန္တြင္ အေျခခံသတင္းအခ်က္အလက္မ်ားကုိ စုေဆာင္းရယူမည္နည္း၊ ယင္းသတင္းအခ်က္အလက္မ်ားအား မည္သူက စုေဆာင္းရယူမည္နည္း၊ သတင္းအခ်က္အလက္မ်ားအား အခ်ိန္မည္မွ်ျခား၍ စုေဆာင္းရယူမည္နည္း၊ 142 143 ေဖာ္ထုတ္ထားေသာအခ်က္အလက္မ်ားအားမွတ္တမ္းတင္ျခင္း စဥ္းစားရန္အခ်က္မ်ား - အခ်က္အလက္မ်ားအားေကာင္းမြန္စြာသိမ္းဆည္းထားျခင္းသည္အခ်ိန္ႏွင္႔ ေငြကုိသက္သာေစႏုိင္မည္ ျဖစ္ပါသည္။ အခ်က္အလက္မ်ားကုိ သင္ မည္သုိ႔မွတ္တမ္းတင္မည္နည္း၊ အခ်က္အလက္မ်ားအား အေကာင္းဆံုးမွတ္တမ္းတင္ရန္ႏွင္႔ထုတ္ေဖာ္ရန္ မည္သည္႔နည္းလမ္းမ်ားအား သင္အသံုးျပဳႏိုင္သနည္း၊ အခ်က္အလက္မ်ားအား မည္သူက မွတ္တမ္းတင္မည္နည္း၊ အခ်က္အလက္မ်ားအား မည္သူက ထုတ္ေဖာ္မည္နည္း၊ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 142 143 * .2/ pGrf;aqmif&nfjynf h 0aom 0efaqmifrIvkyfief;ukd wkd;wufjzpfay:apjcif; * .2 .1/ 0efaqmifrItpDtpOftm; apmihfMunfhjcif; • သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္စီမံခ်က္ေရးဆြဲပါ။ • သင္၏ကုိယ္ပုိင္ဝန္ေဆာင္မႈလုပ္ငန္းအတြင္း ေစာင္႔ၾကည္႔ရမည္႔လုိအပ္ခ်က္ သုိ႔မဟုတ္ ျပႆနာကုိ ေရြးခ်ယ္ျပီး ေအာက္ပါေခါင္းစဥ္တစ္ခုစီ၏ေအာက္တြင္သတင္းအခ်က္အလက္မ်ားကုိျဖည္႔ပါ။ ဝန္ေဆာင္မႈလုပ္ငန္းစီမံခ်က္မူေဘာင္ ေစာင္႔ၾကည္႔ရမည္႔ လုိအပ္ခ်က္/ ျပႆနာကုိသတ္မွတ္ပါ လုိအပ္ခ်က္/ ျပႆနာကုိ ကုိင္တြယ္ေျဖရွင္းရန္ ေဆာင္႐ြက္ခ်က္၊ ရည္မွန္းခ်က္ ရည္မွန္းခ်က္ သတင္းအခ်က္အလက္ စုေဆာင္းျခင္း 144 145 * .3/ 0,fvkdtm;twGuf pDrHcefYcGJjcif; * .3 .1/ 0,fvkdtm;ukd zefwD;NyD; apmvQifpGm vTJajymif;ay;jcif; • နမူနာကုိဖတ္ပါ။ • တုိင္ပင္ေဆြးေႏြးျပီး ေအာင္ျမင္ရာအေၾကာင္းၾကီးမ်ားကုိ ေရးခ်ပါ။ ေအာင္ျမင္မႈနမူနာမ်ား - မကၠဆီကုိႏိုင္ငံတြင္ မိဘမ်ားက ေဆာလ်င္စြာလႊဲေျပာင္းေပးျခင္း မကၠဆီကုိႏုိင္ငံရွိ ကေလးသူငယ္ျပန္လည္ထူေထာင္ေရးဌာနမ်ားမွ အုပ္စုတစ္ခုသည္ထိေရာက္ေသာေဆာလ်င္ စြာလႊဲေျပာင္းေရး ကြန္ယက္တစ္ခုအားမည္သုိ႔ထူေထာင္ခဲ႔သည္ဆုိသည္႔နမူနာကုိေဖာ္ျပထားပါသည္။ ျပန္လည္ထူေထာင္ေရးဌာနမ်ားသည္အသိျမွ င္ ႔တင္ေရးလႈပ္ ရွားမႈ မ်ားျ ပဳလုပ္ ရာတြင္အေျခခံအားျဖင္ ႔ ေမြးကင္းစကေလးဆရာဝန္ မ်ားႏွင္႔ ကေလးသူငယ္ဆရာဝန္မ်ားကိုအဓိကထားေသာ္လည္း ေရဒီယုိႏွင္႔ရုပ္ျမင္ သံၾကားတုိ႔အပါအဝင္မီဒီယာထုတ္လႊင္႔မႈကုိ တြင္က်ယ္စြာအသံုးျပဳၾကေသာ လူထုကိုရည္ရြယ္သည္႔ရံပံုေငြျမွင႔္တ င္ေရးႏွစ္စဥ္လႈပ္ရွားမႈမ်ိဳးလည္းျပဳလုပ္ေလ႔ရွိသည္။ယင္းသုိ႔ေဆာင္ရြက္ျခင္းေၾကာင္႔လႊဲေျပာင္းေပးေရးလုပ္ငန္းသ ည္တစ္ဆင္႔စကားတစ္ဆင္႔နားျဖင္႔ ျပန္႔သြားျပီး မိဘမ်ားက ၄င္းတုိ႔၏ကေလးမ်ားအားကုိယ္တုိင္လာေရာက္လႊဲေျ ပာင္းေပးမႈကုိျဖစ္ေစခဲ႔သည္။ အသိပညာျပန္႔ပြားေရးလုပ္ငန္းေဆာင္ရြက္ေနစဥ္အတြင္း ဝန္ေဆာင္မႈလုပ္ငန္းမ်ားအေနျဖင္႔ ကေလးသူငယ္ မ်ားအားေမြးဖြားသည္ႏွင္႔ ျပန္လည္ထူေထာင္ေရးဌာနမ်ားသုိ႔ပုိ႔ေပးရန္အေရးၾကီးပံုႏွင္႔ပတ္သက္သည္႔သတင္း အားျဖန္႔ေဝေပးခဲ႔သည္။ ၄င္းတုိ႔ ေဆာင္ရြက္ေပးခဲ႔သည္႔အတြက္ေအာင္ျမင္မႈရသြားၾကေသာကေလးသူငယ္မ်ား အေၾကာင္းကိုလည္းအင္ႏွင္႔အားႏွင္႔ျဖန္႔ေဝခဲ႔သည္။ (၁၅) ႏွစ္အတြင္းကေလးအထူးကုဆရာဝန္မ်ားႏွင္႔မိသားစုဝ င္မ်ားသည္ေဆာလ်င္စြာလႊဲေျပာင္းေပးျခင္းကိုေဆာင္ရြက္လာၾက သည္႔အတြက္ျပန္လည္ထူေထာင္ေရးဌာနမ်ား အေနျဖင္႔ဓေလ႔ထံုးစံအေျပာင္းအလဲတစ္ရပ္ကုိေတြ႔ျမင္လာၾကရျပီျဖစ္သည္ဟု ဆုိရမည္ျဖစ္ပါသည္။ ရလဒ္ - လႊဲေျပာင္းေပးမႈ၏ သံုးပံုတစ္ပံုသည္ အသက္ ၃ ႏွစ္ႏွင္႔ေအာက္ကေလးမ်ားျဖစ္သည္။ ေအာင္ျမင္ရာအေၾကာင္းမ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 144 145 * .3 .1/ 0efaqmifrItqifhrsm;tm; tuJjzwfokH;oyfjcif; ဝန္ေဆာင္မႈေပးေရးအတြက္တစ္ေန႔တာအတြင္းရရွိသည္႔ အခ်ိန္ - မိနစ္ • အဖြဲ႔လုိက္ေဆာင္ရြက္ျခင္း • ေကာ္လံ - ၁ ရွိ ဝန္ေဆာင္မႈစိန္ေခၚခ်က္တစ္ခုစီကုိ ဖတ္ပါ။ • ေအာက္တြင္ေဖာ္ျပထားေသာဇယားမွ ပုိမုိထိေရာက္ေသာဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ ျဖစ္ႏုိင္ေျခရွိသည္႔ မဟာဗ်ဴဟာမ်ားကုိ ဖတ္ပါ။ • စြမ္းေဆာင္ရည္တုိးျမင္႔လာေစရန္ မဟာဗ်ဴဟာမ်ားအား ဝန္ေဆာင္မႈစိန္ေခၚခ်က္မ်ားႏွင္႔တြဲေပးပါ။ မဟာဗ်ဴဟာတစ္ခု စီ၏အမွတ္စဥ္ကုိ ေကာ္လံ - ၂ တြင္ေရးခ်ပါ။ စိန္ေခၚမႈတစ္ခုအတြက္ မဟာဗ်ဴဟာ အမ်ားအျပားရွိေနႏုိင္သည္။ 146 147 ဝန္ေဆာင္မႈအရည္အေသြးတုိးတက္လာေစမည္႔မဟာဗ်ဴဟာမ်ား ၁။ အတုိင္းအတာကုိ ခ်ိန္ညွိႏုိင္သမွ်ခ်ိန္ညွိႏုိင္သည္႔ပစၥည္းကုိေရြးထုတ္ပါ။ ၂။ အလြယ္တကူမြမ္းမံဆန္းသစ္ႏုိင္ေသာပစၥည္းကုိေရြးထုတ္ပါ။ ၃။ ကုိယ္ဟန္ေနထားအေထာက္အကူျပဳပစၥည္း (ဏွီ်) ပါဝင္ေသာပစၥည္းမ်ားကုိေရြးထုတ္ပါ။ ၄။ နမူနာပစၥည္းေရြးခ်ယ္ႏုိင္မႈကုိၾကိဳတင္ျပင္ဆင္ပါ။ ၅။ ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳပစၥည္းကုိၾကိဳတင္ဖန္တီးပါ။ ၆။ ပူးတြဲလုပ္ငန္းမ်ားေဆာင္ရြက္ရန္အတြက္အစီအစဥ္ကုိရွင္းလင္းစြာျပဳလုပ္ထားပါ။ ၇။ လုပ္ငန္းအစီအမံမ်ားအားမွ်ေဝမႈကုိေဖာ္ေဆာင္ႏုိင္ရန္အဖြဲ႔လုိက္ေဆြးေႏြးပြဲျပဳလုပ္ပါ။ ၈။ တပ္ဆင္မႈျပဳလုပ္စဥ္အတြင္းေဆးေပးခန္းႏွင္႔စက္မႈအဖြဲ႔မ်ားအတူတကြေဆာင္ရြက္ပါ။ ၉။ အညႊန္းေျဖရွင္းခ်က္ႏွင္႔ပတ္သက္ျပီးေဆးေပးခန္းႏွင္႔စက္မႈအဖြဲ႔မ်ားတုိင္ပင္ညွိႏႈိင္းပါ။ ၁ဝ။ သတင္းအခ်က္အလက္ႏွင္႔မွတ္တမ္းထိန္းသိမ္းေရးကုိရွင္းလင္းစြာမွတ္တမ္းတင္ထားပါ။ ၁၁။ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားအတြက္သင္႔ေလ်ာ္ေသာသင္တန္းအဆင္႔ကုိစီမံပါ။ ၁၂။ အခုအခံမ်ားႏွင္႔ကုိယ္ေနဟန္ထားအေထာက္အကူျပဳပစၥည္းမ်ားဖန္တီးမႈႏွင္႔မြမ္းမံဆန္းသစ္မႈအတြက္ သင္႔ေလ်ာ္ေသာပစၥည္းမ်ားအားေရြးထုတ္ပါ။ ၁၃။ ပစၥည္းမ်ားအားလ်င္လ်င္ျမန္ျမန္ခ်ိန္ညွိႏုိင္ေရးအတြက္သင္႔ေလ်ာေသာလက္သံုးပစၥည္းမ်ားအား ေရြးထုတ္ပါ။ ၁၄။ အသံုးျပဳသူသင္တန္းအတြက္အရည္အခ်င္းတူသင္တန္းဆရာကဲ႔သုိ႔ေသာပုဂၢိဳလ္ကုိသတ္မွတ္ပါ။ ၁၅။ ေဆးေပးခန္း၊ စက္မႈလုပ္ငန္းေနရာတုိ႔ႏွင္႔နီးကပ္ေသာအသံုးျပဳမႈသင္တန္းအတြက္ေနရာသတ္မွတ္ပါ။ ၁၆။ ထိေရာက္ေသာသုိေလွာင္မႈထိန္းခ်ဳပ္ေရးစနစ္ထူေထာင္ပါ။ ၁၇။ အရြယ္အစားမတူညီေသာဘီးတပ္ကုလားထုိင္အနည္းငယ္ကုိသုိေလွာင္ႏုိင္ရန္ျပင္ဆင္ပါ။ ၁၈။ ဝန္ေဆာင္မႈအသံုးျပဳမည္႔သူမ်ားအားသတ္မွတ္ႏုိင္ေရးႏွင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းဌာနသုိ႔ သယ္ယူပုိ႔ေဆာင္ေပးႏုိင္ေရး အတြက္လူမႈအဖြဲ႔အစည္းအတြင္းမိတ္ဖက္ထူေထာင္ထားပါ။ ၁၉။ အေျခခံအဆင္႔ဝန္ေဆာင္မႈေပးႏိုင္ေရးႏွင္႔ အလယ္အလတ္အဆင္႔ဝန္ေဆာင္မႈအသံုးျပဳမည္႔သူအား လႊဲေျပာင္းေပးႏုိင္ေရးအတြက္ လူမႈအဖြဲ႔အစည္းအတြင္းရွိမိတ္ဖက္မ်ား၏အရည္အေသြးကုိ တည္ေဆာက္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 146 147 ေကာ္လံ - ၁ - ဝန္ေဆာင္မႈလုပ္ငန္းစိန္ေခၚခ်က္မ်ား ေကာ္လံ ၂ -ဝန္ေဆာင္မႈ မဟာဗ်ဴဟာမ်ား အကဲျဖတ္သံုးသပ္ျခင္း ၁။ ဝန္ေဆာင္မႈလုပ္ငန္းဝန္ထမ္းမ်ားအေနျဖင္႔ ဝန္ေဆာင္မႈလုပ္ငန္းတစ္ခုအတြက္ ခရီးထြက္ရာတြင္ျဖစ္ေစ၊ အိမ္မ်ားသုိ႔ သြားေရာက္ရာတြင္ျဖစ္ေစ၊ အကဲျဖတ္လုပ္ငန္းအတြင္း ခရီးသြားေရာက္ရသည္႔အခ်ိန္ကုိ ထည္႔သြင္းထားရန္လုိသည္။ ၂။ အဖြဲ႔ဝင္မ်ားသည္ အေတြ႔အၾကံဳမရွိသူမ်ားျဖစ္ပါက အကဲျဖတ္လုပ္ငန္းသည္ အခ်ိန္ၾကာျမင္႔မည္ ျဖစ္သည္။ ညႊန္ၾကားျခင္း ၃။ ပစၥည္းမ်ားအား ခ်ိန္ညွိရန္ကန္႔သတ္ခ်က္ရွိပါက ယင္းပစၥည္းသည္ အသံုး ျပဳသူတစ္ဦးခ်င္းႏွင္႔ကုိက္ညီမႈရွိေရးအတြက္ မြမ္းမံဆန္းသစ္မႈသတ္မွတ္ ေပးရမည္။ ၄။ ကုိယ္ေနဟန္ထားအေထာက္အကူအပုိမ်ားအား ဖန္တီးရန္လုိပါက အတုိင္းအတာႏွင္႔ပံုၾကမ္းမ်ားအား ထပ္မံလုိအပ္လာမည္ျဖစ္သည္။ ထုတ္ကုန္ ႀကိဳတင္ျပင္ဆင္ျခင္း ၅။ လုိအပ္ေသာပစၥည္း၏ပံုစံႏွင္႔အရြယ္အစားကုိ အလ်င္အျမန္ရရွိႏိုင္ျခင္း ၆။ ဘီးတပ္ထုိင္ခုံတစ္လံုးသည္ ခ်ိန္ညွိရန္ကန္႔သတ္ခ်က္မ်ားရွိပါက ပစၥည္းျပင္ဆင္ေရးအတြက္ အခ်ိန္ပုိမုိလုိအပ္မည္ျဖစ္သည္။ ၇။ ကုိယ္ေနဟန္ထားအေထာက္အကူအတြက္ မြမ္းမံဆန္းသစ္မႈျပဳလုပ္ရန္ လုိအပ္ပါက အခ်ိန္ ပုိမုိလုိအပ္မည္ျဖစ္သည္။ အံဝင္ခြင္က် တပ္ဆင္ျခင္း ၈။ ဘီးတပ္ထုိင္ခုံတြင္ မြမ္းမံဆန္းသစ္မႈမ်ားျပဳလုပ္ျပီး အပုိအေထာက္ အကူမ်ား ထည္႔သြင္းမည္ဆုိပါက တပ္ဆင္မႈလုပ္ငန္းသည္ အခ်ိန္ပုိမုိၾကာ ျမင္႔မည္ျဖစ္သည္။ 148 149 ၉။ တပ္ဆင္မႈလုပ္ေနစဥ္ ဘီးတပ္ထုိင္ခုံ၌ အျခားေသာအေျပာင္းအလဲမ်ားကုိ ျပဳလုပ္မည္ဆုိလွ်င္ တပ္ဆင္မႈစစ္ေဆးျခင္းထပ္မံျပဳလုပ္ရန္လုိမည္ ျဖစ္သည္။ အသုံးျပဳသူသင္တန္း တစံုတေယာက္အေနျဖင္႔ ဘီးတပ္ထုိင္ခုံတစ္လံုးကုိ ပထမဦးဆံုး ရရွိျခင္းျဖစ္ေစ၊ က်န္းမာေရးျပႆနာမ်ား ရွိသည္ျဖစ္ေစ၊ အသံုးျပဳသူသင္တန္းတြင္ က်န္းမာေရး၊ ေရြ႔လ်ားႏုိင္စြမ္း၊ ဘီးတပ္ထုိင္ခုံ အား ကုိင္တြယ္အသံုးျပဳပံုတုိ႔အျပင္ ဂရုစုိက္ျခင္းႏွင္႔ထိန္းသိမ္းျခ င္း၊ အျခားေသာလႊဲေျပာင္းေရးအရင္းအျမစ္မ်ားသုိ႔ လႊဲေျပာင္းျခင္း စသည္တုိ႔ပါဝင္လာေစရန္ အခ်ိန္ပုိမုိလုိအပ္မည္ ျဖစ္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 148 149 * .4/ aemufqufwGJvkyfief;twGuf pDpOfjcif; * .4 .1/ tcuftcJtwm;tqD;rsm;tm; ausmfjzwfjcif; • ေအာက္တြင္ေဖာ္ျပထားေသာ ေနာက္ဆက္တြဲျပသမႈအတြက္ ရွိေနႏုိင္သည္႔အခက္အခဲအတားအဆီးစာရင္းကုိ ဖတ္ပါ။ အုပ္စုက အေလးေပးေဖာ္ျပထားေသာ ေနာက္ထပ္အတားအဆီးမ်ားကုိ ထပ္မံထည္႔သြင္းပါ။ • ေနာက္ဆက္တြဲျပသမႈအတြက္ရွိေနေသာအတားအဆီးမ်ားကုိ ေက်ာ္လႊားႏုိင္မည္႔နည္းလမ္းမ်ားကုိ ေဆြးေႏြးျပီး ေအာက္တြင္ေဖာ္ျပထားေသာဇယား၌ ေရးခ်ပါ။ ေနာက္ဆက္တြဲျပသမႈအတြက္ရွိေနေသာအတားအဆီးမ်ား နယ္ေက်ာ္ေနာက္ဆက္တြဲဝန္ေဆာင္မႈလုပ္ငန္းတြင္ရွိေနႏုိင္သည္႔အတားအဆီးမ်ား • လူမႈအဖြဲ႔အစည္းမ်ားသုိ႔ ဝန္ေဆာင္မႈဌာနဝန္ထမ္းမ်ားသြားေရာက္ရသည္႔ ကုန္က်စရိတ္ • လူမႈအဖြဲ႔အစည္းမ်ားသုိ႔ ဝန္ေဆာင္မႈဌာနဝန္ထမ္းမ်ား သြားေရာက္ရသည္႔အခ်ိန္ • ဝန္ေဆာင္မႈလုပ္ငန္းမန္ေနဂ်ာမ်ားက ေနာက္ဆက္တြဲျပသျခင္းလုပ္ငန္းကုိ ဦးစားေပးအဆင္႔တြင္ မထားရွိျခင္း • ဝန္ေဆာင္မႈအား အသံုးျပဳေနၾကသူမ်ားအေနျဖင္႔ အက်ိဳးေက်းဇူးမရမခ်င္း ေနာက္ဆက္တြဲျပသမႈကုိ တန္ဖုိးမထားျခင္း • ဌာနအေျခစုိက္ေနာက္ဆက္တြဲဝန္ေဆာင္မႈလုပ္ငန္းတြင္ ရွိေနႏုိင္သည္႔ အတားအဆီးမ်ား • မိသားစုဝင္တစ္ဦး သုိ႔မဟုတ္ ထုိထက္ပုိျပီးအလုပ္မွခြာကာ သြားရသည္႔ကုန္က်စရိတ္ႏွင္႔ ေပးရသည္႔အခ်ိန္ • ေနာက္ဆက္တြဲျပသမႈ၏အက်ိဳးေက်းဇူးကုိအသံုးျပဳသူမ်ားႏွင္႔မိသားစုဝင္မ်ားက မသိရွိၾကျခင္း • သြားေရာက္ႏုိင္သည္႔သယ္ယူပုိ႔ေဆာင္ေရးကုိ ရွာေဖြေတြ႔ရွိရန္ခက္ခဲေနျခင္း • ဌာနတြင္ၾကံဳေတြ႔ရမည္႔ခ်ိန္းဆုိမႈအသစ္အေပၚအာရံုစူးစုိက္ရမည္႔ဖိအားေၾကာင္႔ ေနာက္ဆက္တြဲျပသမႈအေပၚ အခ်ိန္မေပးလုိေတာ႔ျခင္း • ခ်ိန္းဆုိမႈအစီအစဥ္ေၾကာင္႔အခက္အခဲရွိျခင္း - အသံုးျပဳသူေရာက္လာခ်ိန္တြင္ဝန္ထမ္းမရွိျခင္းႏွင္႔ ဝန္ထမ္းမ်ားရွိခ်ိန္ တြင္အသံုးျပဳသူကေရာက္မလာျခင္း ေနာက္ဆက္တြဲျပသမႈအတြက္ရွိေနေသာအတားအဆီးမ်ားကုိေက်ာ္လႊားႏုိင္မည္႔နည္းလမ္းမ်ား 150 151 * .5/ bPÖma&;a&&SnfwnfwHhckdifNrJa&;udk wkd;wufapjcif; * .5 .1/ aiGaMu;taxmuftyHhay;rnfht&if;tjrpfukd owfrSwfjcif; • ေငြေၾကးေထာက္ပံ႔ႏုိင္သည္႔အရင္းအျမစ္မ်ားကုိ ဖတ္ျပီး အေသးစိတ္အခ်က္အလက္မ်ားထပ္မံရရွိရန္ ရည္ညႊန္းကုိးကားလက္စြဲကုိ ကုိးကားပါ။ • သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ အနီးစပ္ဆံုးအလားအလာရွိသည္ဟု သင္ယံုၾကည္ေသာအရင္းအျမစ္ (၃) ခုကုိ ေရြးခ်ယ္ျပီးေရြးခ်ယ္ထားသည္႔ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္မ်ားအတြက္ ေအာက္ေဖာ္ျပပါ ဇယားကုိ ျဖည္႔ပါ။ မန္ေနဂ်ာမ်ားထည္႔သြင္းစဥ္းစားထားရမည္႔ မတူညီေသာ ေငြေၾကးေထာက္ပံ႔မႈအရင္းအျမစ္မ်ား ၁။ အစုိးရ ၂။ အမိ်ဳးသားအာမခံအစီအစဥ္ ၃။ ပုဂၢလိကအလႈရွင္ႏွင္႔ကူညီပံ႔ပုိးသူမ်ား ၄။ လုပ္ငန္း (စီးပြားေရး) အလႈရွင္မ်ားႏွင္႔ကူညီပံ႔ပုိးသူမ်ား ၅။ အသံုးျပဳသူကထည္႔ဝင္ျခင္း သုိ႔မဟုတ္ အျပည္႔အဝဝယ္ယူျခင္း ၆။ ဝင္ေငြတုိးတက္ေရး/လူမႈေရးအသင္းအဖြဲ႔မ်ား ၇။ လူမႈအသုိက္အဝန္းအတြင္းရွိအဖြဲ႔မ်ား/ဂရုဏာအသင္းအဖြဲ႔မ်ား ၈။ သံရံုးမ်ား ၉။ ျပည္တြင္းႏွင္႔ျပည္ပ အစုိးရမဟုတ္ေသာအဖြဲ႔အစည္းမ်ား ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္ကုိေရြးခ်ယ္ျခင္း ေအာက္ပါတုိ႔ကုိစဥ္းစားသံုးသပ္ျပီးဦးစားေပးအစီအစဥ္သတ္မွတ္ပါ။ • လုိအပ္ေသာၾကိဳးပမ္းအားထုတ္မႈ • ေရတုိ သို႔မဟုတ္ ေရရွည္ဘ႑ာေရးအက်ိဳးအျမတ္ (သုိ႔မဟုတ္ ႏွစ္ခုစလံုး) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 150 151 ဦးစားေပး ေငြေၾကး ေထာက္ပံ့ မည့္အရင္း အျမစ္ ရင္းႏွီးျမွတ္ႏွံမႈ/ လုိအပ္ေသာ ႀကိဳးပမ္းအားထုတ္မႈ ျမင့္/လယ္/နိမ့္ ေရတုိအက်ိဳးအျမတ္ ျမင္႔/လယ္/နိမ္႔ ေရရွည္အက်ိဳး အျမတ္ * .5 .2/ r[mAsL[mw&yf az:xkwfjcif; • ေအာက္တြင္ေဖာ္ျပထားေသာ မဟာဗ်ဴဟာနမူနာကုိ ဖတ္ပါ။ • ဇယားအတြင္းရွိ ယခင္ေလ႔က်င္႔ခန္းမွ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္ (၃) ခုကို ေရးခ်ပါ။ • ေရြးခ်ယ္ထားသည္႔ ေငြေၾကးေထာက္ပံ႔မည္႔အရင္းအျမစ္မ်ားအတြက္ ဇယားပါေကာ္လံမ်ားကုိ ျဖည္႔ပါ။ ေငြေၾကး ေထာက္ပံ့မႈ အရင္းအျမစ္ ပံ့ပုိးမႈပုံစံ အဆုိျပဳခ်က္ ျဖစ္ႏုိင္ေျခ ႀကိဳးပမ္းခ်က္ ၁။ လုပ္ငန္း (ေဒသႏၲရ စီးပြားေရး) ဘီးတပ္ထုိင္ခုံ ဝယ္ယူေရး ဘတ္ဂ်က္သုိ႔ လွဴဒါန္းျခင္း ဘီးတပ္ထုိင္ခုံ ဘတ္ဂ်က္၏ ၁၀% အလယ္အလတ္ (ယခင္က ေထာက္ပံ့ဖူးသည္ သုိ႔ေသာ္ အဖြဲ႔တခု တည္းကုိ ႏွစ္စဥ္ အၿမဲတန္း) စီးပြားေရးလုပ္ငန္း မန္ေနဂ်ာႏွင့္ အနည္းဆုံး ႏွစ္ႀကိမ္ေဆြးေႏြးရန္၊ ႏွစ္မ်က္ႏွာပါ အဆုိျပဳခ်က္ႏွင့္ ဘတ္ဂ်က္ကုိ တင္ျပရန္ႏွင့္ မန္ေနဂ်ာကုိ ဖြင့္ပြဲသုိ႔ ဖိတ္ၾကားရန္။ ပုိမုိသိရွိလုိပါက ကမၻာ႔က်န္းမာေရးအဖြဲ႔၊ အမွတ္ ၂ဝ အက္ပီယာရိပ္သာလမ္း၊ စီအိပ္ခ်္ ၁၂၁၁ ဂ်ီနီဗာ ၂၇၊ ဆြစ္ဇာလန္ (တယ္လီဖုန္း၊ (+၄၁ ၂၂) ၇၉၁-၂၇၁၅ ဖက္စ္၊ (+ ၄၁ ၂၂) ၇၉၁ ၄၈၇၄ http://www.who.int/disabilities/en/ Email: assistivetechnology@who.int တြင္ စုံစမ္းပါ။ ISBN 978 92 4 154908 0

ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ ၂၀၁၅ ခုုႏွစ္တြင္ ပံုုႏွိပ္ထုုတ္ေဝခဲ့ပါသည္။ ထုုတ္ေဝခဲ့သည့္ ေခါင္းစဥ္မွာ Wheelchair Service Training Package for Managers ပင္ျဖစ္ပါသည္။ © ကမာၻ့က်န္းမာေရးအဖြဲ႔အစည္း ၂၀၁၅ ခုုႏွစ္ ျမန္မာဘာသာျဖင့္ တည္းျဖတ္ျပီး ဘာသာျပန္ထုုတ္ေဝခြင့္အား ယင္း ျမန္မာဘာသာျပန္အရည္အေသြးႏွင့္ တိက်ေသခ်ာမႈတုုိ႔အတြက္ အဓိက တာဝန္ရွိေသာ USAID သုုိ႔ ကမၻာ့က်န္းမာေရးအဖြဲ႔အစည္းမွ အခြင့္အေရး အပ္ႏွင္းလုုိက္ပါသည္။ အဂၤလိပ္ဘာသာစကားႏွင့္ ထည့္သြင္းျပန္ဆုုိရမည့္ ဘာသာမ်ားၾကား မဆီေလ ွ်ာ္မႈ အေၾကာင္းအရာ တစ္စံုုတစ္ရာ ရွိခဲ့ေသာ္ မူရင္း အဂၤလိပ္ဘာသာသည္သာလ ွ်င္ အတည္ျဖစ္သည္။ မန္ေနဂ်ာမ်ားအတြက္ လက္တြန္းထုုိင္ခံုုလွည္းဝန္ေဆာင္မႈဆုုိင္ရာ ေလ့က်င့္သင္ၾကားေရး သင္ခန္းစာ © USAID (၂၀၁၆) ဦးတင္ေအးမွ ဘာသာျပန္ဆုုိခဲ့ျပီး အီးေမးလ္မွာ mgtinaye@gmail.com ျဖစ္ျပီး က်န္းမာေရးစီမံခန္႔ခြဲမႈသိပၺံ အဖြဲ႔မွ စီမံပါသည္။ rm w d u m ၁ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးျခင္းအတြက္ အစီအစဥ္ ျဖစ္ႏိုင္ေခ်ရွိေသာ မဟာဗ်ဴဟာမ်ား3 ၃ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈမ်ား (အေျခခံ) လႊဲေျပာင္းေပးအပ္မႈပံုစံ ၅ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈမ်ား (အလယ္တန္း) လႊဲေျပာင္းေပးအပ္မႈပံုစံ ၇ ဝန္ေဆာင္မႈ ပံုစံ စာရင္းမ်ားႏွင့္ စစ္ေဆးရန္အခ်က္မ်ား ၈ အကဲျဖတ္ စစ္ေဆးမႈ ေသတၱာျပဳလုပ္ျခင္း ၁၀ အကဲျဖတ္ စစ္ေဆးမႈ ကုတင္ျပဳလုပ္ျခင္း ၁၂ ေျခေထာက္ အရံအတား ျပဳလုပ္ျခင္း ၁၃ တိုင္းတာမႈ ကိရိယာ နမနူာမ်ား ၁၄ နည္းပညာ လုပ္ငန္းသံုး ကိရိယာမ်ား လမ္းညႊန္ လုပ္ငန္းထိုင္ခံုရွည္ ႏွင့္ အေျခခံလုပ္ငန္းနယ္ပယ္ ၁၅ အေျခခံ ဝန္ေဆာင္မႈ လမ္းညႊန္နည္းပညာ ရင္းျမစ္မ်ား ၁၇ အလယ္တန္း ဝန္ေဆာင္မႈ လမ္းညႊန္ နည္းပညာရင္းျမစ္မ်ား ၂၃ ေရျမႈတ္ျဖတ္ရန္ သံျဖတ္လႊ ျပင္ဆင္ျခင္း ၂၄ အေျခခံ ႏွင့္ အလယ္တန္းဝန္ေဆာင္မႈ - လိုအပ္ေသာ အရာမ်ား ၂၈ လႈပ္ရွားသြားလာမႈ ကၽြမ္းက်င္မႈ နယ္ပယ္ထူေထာင္ေရး လမ္းညႊန္မ်ား ၃၂ ဘီတပ္ထိုင္ခံု ပံ့ပိုးမႈနည္းအမ်ိဳးမ်ိဳး ႏိႈင္းယွဥ္ေလ့လာျခင္း ၃၈ အေထာက္အကူျပဳ နည္းပညာ ေနာက္ဆက္တြဲအကဲျဖတ္ စစ္ေဆးခ်ိန္တြင္ ပါဝင္ေဆာင္႐ြက္မႈ တိုင္းတာေရး ကိရိယာမ်ား ၃၉ အေထာက္အကူျပဳ နည္းပညာ ေနာက္ဆက္တြဲ စစ္ေဆးခ်ိန္ ေက်နပ္မႈ ႏွင့္ ရလဒ္ တိုင္းတာေရး ကိရိယာမ်ား ၄၅ ခ်ဥ္းကပ္ႏုိင္မႈ သတင္းအခ်က္အလက္ VI 1 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ VI 1 ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈ အစီအစဥ္တစ္ခုထုတ္လုပ္ရန္ ျဖစ္ႏိုင္ေျခရွိေသာ မဟာဗ်ဴဟာမ်ား ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈ အစီအစဥ္တခုထုတ္လုပ္ရန္ ျဖစ္ႏိုင္ေခ်ရွိေသာ မဟာဗ်ဴဟာမ်ားသည္ ႏိုင္ငံတြင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ လက္ရိွအေျခအေန၊ ရရွိႏိုင္ေသာရင္းျမစ္မ်ားႏွင့္ ဝန္ေဆာင္မႈလုပ္ငန္းက ျဖည္းဆည္းရမည့္ လိုအပ္ခ်က္မ်ားတို႔ အေပၚမူတည္သည္။ ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈ စီစဥ္ေသာအခါ ဘီးတပ္ထိုင္ခံု လမ္းညႊန္္မ်ားတြင္ ေကာက္ေၾကာင္း ေဖၚျပထားေသာ ေအာက္ပါ ေမးခြန္းမ်ားႏွင့္ မဟာဗ်ဴဟာမ်ားကို ထည့္သြင္းစဥ္းစားျခင္းသည္ အ သံုးဝင္သည္။ • အသံုးျပဳသူမ်ား ၏ စ႐ိုက္လကၡဏာႏွင့္ တိက်ေသာ လိုအပ္ခ်က္မ်ားသည္ မည္သည္တို႔နည္း။ • ပါဝင္ပတ္သက္သူအုပ္စုရွိပါသလား၊ ရွိလွ်င္ ၄င္းတို႔ အက်ိဳးစီးပြားႏွင့္ထင္ျမင္ခ်က္မ်ားသည္ မည္သည္တို႔နည္း။ • ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈရွိၿပီး ျဖစ္ပါသလား(ေဒသအလုပ္႐ံု၊ ရပ္ရြာအေျချပဳျပန္လည္သန္စြမ္းေရး၊ မသန္စြမ္းသူ မ်ားအသင္း၊ အျခား အစိုးရမဟုတ္ေသာအဖြဲ႕ မ်ား၊ ပုဂၢလိက သို႔မဟုတ္ အစိုးရက႑မွတဆင့္) • တရားဝင္အေျခခံအေဆာက္အအံုျပင္ပမွ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈရွိပါသလား။ ဥပမာ - ဘီးတပ္ထိုင္ခံုအမ်ားအျပား တင္သြင္းပံ့ပုိးျခင္း။ • လက္ရွိရင္းျမစ္မ်ားျဖင့္ မည္သည္တို႔ေဆာင္႐ြက္ႏိုင္မည္နည္း။ • လက္ရွိ ဘဏၰာေငြပံံ့ပိုးမႈ ယႏၱရားသည္ မည္သည္တို႔နည္း။ ၁။ အစိုးရက အမ်ိဳးသား ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ အစီအစဥ္တစ္ခု ထူေထာင္လိုသည္။ စိတ္ဝင္စားေသာ အစိုးရမဟုတ္သည့္အဖြဲ႕မ်ား၊ မသန္စြမ္းသူမ်ားအသင္းမ်ား၊ အသံုးျပဳပံုမ်ား၊ က်န္းမာေရးကၽြမ္း က်င္သူေလ့က်င့္ေရးအစီအစဥ္မ်ားႏွင့္ ကမၻာ႔က်န္းမာေရးအဖြဲ႕ (WHO)၊ ႏိုင္ငံတကာေျခတုလက္တုႏွင့္ သြား လာမႈ ေထာက္ကူျပဳကိရိယာထုတ္လုပ္သူမ်ား(ISPO)၊ ႏိုင္ငံတကာ အဖြဲ႔အစည္း၊ ဘီးတပ္ထိုင္ခံု ကၽြမ္းက်င္ သူမ်ား ႏိုင္ငံတကာအဖြဲ႕(ISWP)ႏွင့္ သက္ဆိုင္ရာအစိုးရမဟုတ္ေသာ ႏိုင္ငံတကာအဖြဲ႕အစည္းမ်ားကို သင့္ ေတာ္ေသာ အမ်ိဳးသားအဆင့္ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ အစီအစဥ္ေဖၚထုတ္ရန္ အစိုးရသည္ ဆက္သြယ္ လာႏိုင္သည္။အစိုးရသည္ ၄င္းပိုင္ေျခတုလက္တုႏွင့္သြားလာမႈ ေထာက္ကူျပဳပစၥည္း ဝန္ေဆာင္မႈမ်ားကို ဘီး တပ္ထိုင္ခံုဝန္ေဆာင္မႈ ျပဳလုပ္ရန္ အေျခခံအျဖစ္ ျမင္ႏိုင္သည္။ ၄င္းသည္ အျခားႏိုင္ငံမ်ားမွ အစိုးရအဖြဲ႕အ စည္းမ်ားထံမွ ၄င္းတို႔၏အေတြ႔အႀကံဳမွေလ့လာရန္ ႏွင့္ အႀကံဥာဏ္ ေတာင္းရန္လည္း ဆက္သြယ္ႏိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 2 3 ၂။ ဘီးတပ္ထိုင္ခံုပံ့ပိုးမႈရွိသည္။ သို႔ေသာ္အေသးစားအဆင့္သာရွိၿပီး လြတ္လပ္ေသာအဖြဲ႕အစည္းမ်ားမွ တဆင့္ လုပ္ေဆာင္သည္။ ပူးေပါင္းေဆာင္႐ြက္မႈ မရွိပါ။ အစိုးရေဒသခံ အဖြဲ႕အစည္းမ်ား သုိ႔မဟုတ္ ႏိုင္ငံတကာ အစိုးရမဟုတ္ေသာ အဖြဲ႕အစည္းတခုသည္ လုပ္ငန္း မ်ားကို တိုးခ်ဲ႕ႏိုင္သည္။ ပူးေပါင္းေဆာင္႐ြက္ အားထုတ္မႈတြင္ အဖြဲ႕အစည္းအသီးသီးမွ ပုဂၢိဳလ္မ်ား ပါဝင္ေစရန္ ရင္းျမစ္အစုတစ္ခုကို ထူေထာင္ႏိုင္သည္။ ထိုရင္းျမစ္အစုသည္ ေနာင္တြင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈေပးရာ တြင္ စိတ္ဝင္စားသူမ်ား၏ စုေပါင္းမဟာမိတ္အဖြဲ႕ သို႔မဟုတ္ လြတ္လပ္ေသာ ကိုယ္ပိုင္လုပ္ပိုင္ခြင့္ရွိ အစိုးရမ ဟုတ္ေသာ အဖြဲ႕ အစည္းအျဖစ္ ေပၚေပါက္လာႏိုင္သည္။ ၃။ ႏိုင္ငံတြင္ အဖြဲ႕အစည္းမ်ားရွိသည္။ သို႔ေသာ္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ ပံ့ပိုးျခင္းမရွိပါ။ စိတ္ဝင္စားေသာ အစိုးရမဟုတ္သည့္အဖြဲ႕အစည္း သို႔မဟုတ္ မသန္စြမ္းသူမ်ားအသင္းသည္ ရင္းျမစ္ အစု၏ အေျခခံအဖြဲ႕အစည္းအျဖစ္ ထမ္းေဆာင္ႏိုင္သည္။ ထိုအဖြဲ႕အစည္းသည္ ဘီးတပ္ထိုင္ခုံပံ့ပိုးမႈ အေတြ႕ အႀကံဳရွိေသာ သင့္ေတာ္သည့္အဖြဲ႕အစည္းကို လုပ္ေဖၚကိုင္ဖက္အဖြဲ႕အျဖစ္ ရွာေဖြၿပီး(ဥပမာ အိမ္နီးခ်င္း ႏိုင္ငံမွ အစိုးရ သို႔မဟုတ္ အစိုးရအဖြဲ႕အစည္း သို႔မဟုတ္ ႏုိင္ငံတကာ အစိုးရမဟုတ္ေသာအဖြဲ႕အစညး္) ျဖစ္ရပ္ ၄ တြင္ေဖၚျပထားသည့္ ၄င္း၏ ကနဦးေျခလွမ္းမ်ားအတိုင္း ေဆာင္႐ြက္သင့္သည္။ အျခားတနည္းမွာ ထိုလုပ္ငန္း စဥ္ကို ႏိုင္ငံတကာ အစိုးရ မဟုတ္ေသာအဖြဲ႕တခုကလုပ္ေဆာင္ၿပီး ထိုေနာက္ ၄င္းက ေဒသခံ အစိုးရ မဟုတ္ေသာအဖြဲ႕၊ မသန္စြမ္းသူမ်ားအဖြဲ႔ကို လုပ္ေဖၚကိုင္ဖက္ အဖြဲ႕အျဖစ္ရွာေဖြျခင္းျဖစ္သည္။ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ စတင္လုပ္ကိုင္ျခင္းတြင္ အလားတူ အေတြ႕အႀကံဳရွိအျခား အဖြဲ႕အစည္းမ်ား၊ ႏိုင္ငံမ်ားႏွင့္ရွာေဖြ ကြန္ယက္ဖြဲ႕ရန္ အားထုတ္သင့္သည္။ ၄။ ႏိုင္ငံတကာ အဖြဲ႕အစည္းမရွိဘဲ ပံုမွန္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ၊ ေပးျခင္းမရွိပါ။ ႏိုင္ငံတကာအစိုးရမဟုတ္ေသာ အဖြဲ႕အစည္းတစ္ခုသည္ ၄င္း၏ ကိုယ္ပိုင္အစီအစဥ္ျဖင့္ျဖစ္ေစ အစိုးရ၏ ဖိတ္ ေခၚမႈသို႔မဟုတ္ အျခားၿမိဳ႕ႀကီးတၿမိဳ႕တြင္ရင္းျမစ္ဌာနထူေထာင္ႏိုင္သည္၊ ထိုရင္းျမစ္ဌာနသည္လက္ရွိျပန္လည္ ထူေထာင္ေရးဌာန၏ တေပါင္းတစည္းတည္းေသာ အစိတ္အပိုင္းျဖစ္ႏိုင္သည္။ ထိုရင္းျမစ္ဌာနသည္အသံုးျပဳ သူမ်ား၊ ၄င္းတို႔၏မိသားစုမ်ား၊ ေစာင့္ေရွာက္သူမ်ား သို႔မဟုတ္က်န္းမာေရး ပညာရွင္မ်ားကို လႈပ္ရွားသြားလာ ႏိုင္မႈလိုအပ္ခ်က္မ်ားႏွင့္ လႈပ္ရွားသြားလာႏိုင္မႈႏွင့္သက္ဆိုင္ေသာ ပိုမိုက်ယ္ျပန္႔သည့္ျပႆနာမ်ားႏွင့္ ပတ္ သက္အေရးႀကီးေသာ သတင္းအခ်က္အလက္မ်ားေပးျခင္းျဖင့္ စတင္ႏုိင္သည္။အစိုးရမဟုတ္ေသာ ႏိုင္ငံတ ကာအဖြဲ႔အစည္းသည္ ပါဝင္ပတ္သက္သူမ်ား ခြဲျခမ္းစိတ္ျဖာေလ့လာခ်က္တရပ္ ျပဳလုပ္သင့္ၿပီး ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူမ်ားႏွင့္ ဝန္ေဆာင္မႈမ်ားအတြက္ ကြာဟမႈကိုေဖၚထုတ္ရန္ႏွင့္ လိုအပ္ခ်က္မ်ားကိုဆံုးျဖတ္ရန္ ဘီးတပ္ထိုင္ခံုသံုးသူ၊ လိုအပ္သူမ်ားကိုေလ့လာစမ္းသပ္မႈ ျပဳလုပ္သင့္သည္၊ ကနဦး ပါဝင္ေဆာင္႐ြက္မႈ သု ေတသနသည္လိုအပ္ခ်က္မ်ားျဖည့္ဆည္းရန္ ေ႐ြးခ်ယ္စရာမ်ားကိုေဖၚျပေပးမည္။ ဘီးတပ္ထိုင္ခံု ပံ့ပိုးမႈ စတင္ ရန္ ဘ႑ာေငြ ရွိသင့္သည္။ အမ်ိဳးသားဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈဌာနထူေထာင္ရန္ ပထမ အဆင့္ အေနျဖင့္ ရင္းျမစ္ဌာနႏွင့္အစိုးရအဖြဲ႕အစည္းမ်ားၾကား အလုပ္လုပ္ႏုိ္င္ေသာဆက္ဆံေရးထူေထာင္အားထုတ္သင့္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 2 3 ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ(အေျခခံ)လႊဲေျပာင္းေပးပို႔မႈပံုစံ   နမူနာလႊဲေျပာင္းေပးပို႔မႈပံုစံ။ ဤပံုစံကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈမ်ားက ျပဳျပင္ျဖည့္စြက္ႏိုင္ၿပီး ဘီးတပ္ ထိုင္ခံုသံုးသူကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ရာတြင္ အေထာက္အကူျဖစ္ေစရန္ လႊဲ ေျပာင္းလက္ခံမႈ ရင္းျမစ္သို႔ ေပးပို႔ႏိုင္သည္။ လႊဲေျပာင္းမႈ ပံုစံ ကို ျဖည့္စြက္ၿပီး(ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈအမည္ႏွင့္ လိပ္စာ) သို႔ေပးပို႔ပါ။ လႊဲေျပာင္းေပးပို႔သူ အမည္ - လုပ္ကိုင္ေနေသာအဖြဲ႕အစည္း- လႊဲေျပာင္းေပးပို႔သူ အဆက္အသြယ္ အေသးစိတ္(သင့္ကိုဆက္သြယ္ရန္အေကာင္းဆံုးနည္းလမ္း)- ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူအမည္- ေမြးေန႔သကၠရာဇ္- မိဘ/ေစာင့္ေရွာက္သူအမည္- လိပ္စာ- ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကိုမည္သို႔ဆက္သြယ္ရမည္ စာတုိက္ ကိုယ္ပိုင္တယ္လီဖုန္း မိတ္ေဆြအိ္မ္နီးခ်င္း၏ဖုန္း ဖုန္းျဖင့္ဆက္သြယ္ရန္ျဖစ္ပါက ဖုန္းနံပါတ္- ဘီးတပ္ထိုင္ခံုသံုးသူ၏ မသန္စြမ္းမႈ သိရွိပါက- လႊဲေျပာင္းေပးပို႔ေသာအေၾကာင္းရင္း - • ဘီးတပ္ထိုင္ခံုမရွိျခင္း • ပ်က္ေနေသာဘီးတပ္ထိုင္ခံုရွိျခင္း • အသံုးျပဳသူ၏လိုအပ္ခ်က္ႏွင့္မကိုက္ညီေသာဘီးတပ္ထိုင္ခံုရွိျခင္း) ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈအတြက္သိရွိရန္အေရးႀကီးသည္ဟုသင္ယူဆေသာဘီးတပ္ထိုင္ခံုသံုးသူႏွင့္ပတ္သက္ သည့္အျခားမည္သည့္အခ်က္အလက္မဆိုျဖည့္စြက္ေရးသားပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 4 5 ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ခံရျခင္းကိုဘီးတပ္ထိုင္ခံု သံုးသူကသေဘာတူၿပီးျဖစ္ပါသလား။ သေဘာတူၿပီး သေဘာမတူေသး လႊဲေျပာင္းေပးပို႔သူလက္မွတ္ ရက္စြဲ - bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 4 5 ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈ(အလယ္တန္း)လႊဲေျပာင္းေပးပို႔မႈပံုစံ နမူနာလႊဲေျပာင္းေပးပို႔မႈပံုစံ။ ဤပံုစံကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈမ်ားက ျပဳျပင္ျဖည့္စြက္ႏိုင္ၿပီး ဘီးတပ္ ထိုင္ခံုသံုးသူကို ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ရာတြင္ အေထာက္အကူျဖစ္ေစရန္ လႊဲ ေျပာင္းလက္ခံမႈ ရင္းျမစ္သို႔ ေပးပို႔ႏိုင္သည္။ လႊဲေျပာင္းမႈ ပံုစံ ကို ျဖည့္စြက္ၿပီး(ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈအမည္ႏွင့္ လိပ္စာ) သို႔ေပးပို႔ပါ။ လႊဲေျပာင္းေပးပို႔သူ အမည္ - လုပ္ကိုင္ေနေသာအဖြဲ႕အစည္း- လႊဲေျပာင္းေပးပို႔သူ အဆက္အသြယ္ အေသးစိတ္(သင့္ကိုဆက္သြယ္ရန္အေကာင္းဆံုးနည္းလမ္း)- ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူအမည္- မိဘ/ေစာင့္ေရွာက္သူအမည္- လိပ္စာ- ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကို မည္သို႔ဆက္သြယ္ရမည္ စာတုိက္ ကိုယ္ပိုင္တယ္လီဖုန္ မိတ္ေဆြအိ္မ္နီးခ်င္း၏ဖုန္း ဖုန္းျဖင့္ဆက္သြယ္ရန္ျဖစ္ပါက ဖုန္းနံပါတ္- ဘီးတပ္ထိုင္ခံုသံုးသူ၏ မသန္စြမ္းမႈ သိရွိပါက- လႊဲေျပာင္းေပးပို႔ေသာအေၾကာင္းရင္း • ဘီးတပ္ထိုင္ခံုမရွိျခင္း • ပ်က္ေနေသာဘီးတပ္ထိုင္ခံုရွိျခင္း • အသံုးျပဳသူ၏လိုအပ္ခ်က္ႏွင့္မကိုက္ညီေသာဘီးတပ္ထိုင္ခံုရွိျခင္း) ကေလးမ်ားအတြက္ o အသက္ ၁ ႏွစ္တြင္ တည့္မတ္စြာမထိုင္ႏိုင္ သို႔မဟုတ္ မတ္တပ္မရပ္ႏိုင္ o အသက္ ၂ ႏွစ္တြင္ တေယာက္တည္းလမ္းမေလွ်ာက္ႏိုင္ ဘီးတပ္ထိုင္ခံုဝန္ေဆာင္မႈအတြက္သိရွိရန္အေရးႀကီးသည္ဟုသင္ယူဆေသာဘီးတပ္ထိုင္ခံုသံုးသူႏွင့္ပတ္သက္ သည့္အျခားမည္သည့္အခ်က္အလက္မဆိုျဖည့္စြက္ေရးသားပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 6 7 ဘီးတပ္ထုိင္ခံုဝန္ေဆာင္မႈသို႔လႊဲေျပာင္းေပးပို႔ခံရျခင္းကိုဘီးတပ္ထိုင္ခံုသံုး သူကသေဘာတူၿပီးျဖစ္ပါသလား။ သေဘာတူၿပီး သေဘာမတူေသး လႊဲေျပာင္းေပးပို႔သူလက္မွတ္ ရက္စြဲ - bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 6 7 ဝန္ေဆာင္မႈ ပံုစံမ်ားစာရင္းႏွင့္ စစ္ေဆးရန္အခ်က္မ်ား မွတ္စု ။ ။ ဤလက္စြဲစာအုပ္တြင္ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ လႊဲေျပာင္းေပးပို႔ျခင္းပံုစံပါဝင္သည္။ အျခားေသာပံုစံမ်ား အားလံုးကို Pen Drive မွဘီးတပ္ထုိင္ခံု ဝန္ေဆာင္မႈေလ့က်င့္ေရး အစီအစဥ္ အေျခခံႏွင့္အလယ္တန္းတြင္ေတြ႕ႏိုင္သည္။ အေျခခံအဆင့္ဝန္ေဆာင္မႈမ်ား ၁။ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ (အေျခခံအဆင့္) လႊဲေျပာင္းေပးပို႔မႈပံုစံ ၂။အေျခခံ ဘီးတပ္ထိုင္ခံု စစ္ေဆးအကဲျဖတ္ျခင္း ပံုစံ ၃။ အေျခခံ ဘီးတပ္ထိုင္ခံု ညႊန္ၾကားျခင္း (ေ႐ြးခ်ယ္ျခင္း) ပံုစံ ၄။ အေျခခံ ဘီးတပ္ထိုင္ခံု အႏွစ္ခ်ဳပ္ပံုစံ ၅။ အေျခခံ ဘီးတပ္ထိုင္ခံု အံဝင္ဂြင္က်မႈ စစ္ေဆးရန္အခ်က္မ်ား ၆။ ဘီးတပ္ထိုင္ခံု လံုၿခံဳမႈ ႏွင့္ အသင့္ျဖစ္မႈ စစ္ေဆးရန္အခ်က္မ်ား ၇။ ဘီးတပ္ထိုင္ခံု ေနာက္ဆက္တြဲ စစ္ေဆးမႈ ပံုစံ * အလယ္တန္းအဆင့္ဝန္ေဆာင္မႈမ်ား ၈။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု ဝန္ေဆာင္မႈ လႊဲေျပာင္းေပးပို႔ျခင္းပံုစံ ၉။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု စစ္ေဆးအကဲျဖတ္ျခင္းပံုစံ ၁၀။ အလယ္တန္းအဆင့္ဘီးတပ္ထိုင္ခံု ညႊန္ၾကားမႈ (ေ႐ြးခ်ယ္ျခင္း) ပံုစံ ၁၁။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အႏွစ္ခ်ဳပ္ပံုစံ ၁၂။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အံဝင္ဂြင္က်မႈ စစ္ေဆးရန္အခ်က္မ်ား ၁၃။ အလယ္တန္းအဆင့္ ဘီးတပ္ထိုင္ခံု အသံုးျပဳသူ ေလ့က်င့္ေရးစစ္ေဆးရန္အခ်က္မ်ား ၁၄။ ကိုယ္ေနဟန္ ေထာက္ကူမႈ ကိရိယာ(PSD) ဇယား *ဤ ပံုစံမ်ားႏွင့္စစ္ေဆးရန္ အခ်က္မ်ားသည္အေျခခံ ႏွင့္ အလယ္တန္း အဆင့္ႏွစ္ခုလံုးအတြက္ သင့္ေတာ္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 8 9 အကဲျဖတ္ စစ္ေဆးမႈ ကိရိယာတခု ျပဳလုပ္ျခင္း စစ္ေဆးအကဲျဖတ္ကိရိယာတခုျပဳလုပ္ရန္ ညႊန္ၾကားခ်က္မ်ား ၁။ အထပ္သားအားလံုးကို ၁၈ မမ အျဖစ္ဆြဲပါ။ မရႏိုင္လွ်င္ ၁၅ မမ သို႔မဟုတ္ ၂၀ မမ သံုးပါ။ ၂။ ခ်ိန္ၫွိႏိုင္ေသာ အျမင့္ ေျခတင္ခံုသည္ လမ္းေၾကာင္းအတြင္း လြယ္ကူစြာ ေလွ်ာဝင္ ေလွ်ာထြက္ႏိုင္ရမည္။ ၃။ ထိုင္ခံုမ်က္ႏွာျပင္ႏွင့္ေျခတင္ခံုမ်က္ႏွာျပင္ကိုခိုင္မာေသာ ၅-၁၀ မမ ေရႃမႈတ္ (EVA) သို႔မဟုတ္ အခ်ိဳ႕ဘီးတပ္ထိုင္ခံု ေျခတင္ခံုေပၚတြင္သံုးေသာ အကုပ္ အဖံုးအကာျဖင့္ ဖံုးအုပ္သင့္သည္။ ေဒသလုပ္အကဲျဖတ္ေသတၱာ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 8 9 အကဲျဖတ္ေသတၱာအတိုင္းအတာမ်ား 450 mm 18 mm 650 mm ထိပ္ပုိင္း 45 0 m m 45 0 m m 36 0 m m 42 0 m m 18 m m 18 m m 10 m m 25 mm 450 mm 430 mm ခ်ိန္ညွိ၍ရေသာ ေျခတင္အျမင့္ 18 mm အထပ္သား 200 mm ေရွ႕ 20 pieces 20 mm x 20 mm x 430 mm long hardwood 20 m m 20 m m ေဘး 50 mm bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 10 11 အကဲျဖတ္ စစ္ေဆး ကုတင္ျပဳလုပ္ျခင္း စစ္ေဆးအကဲျဖတ္ကုတင္သည္ ဘီးတပ္ထိုင္ခံုၫႊန္ၾကားမႈတခု ျပဳလုပ္ရန္အတြက္ ေကာင္းမြန္ေသာ အကဲ ျဖတ္စစ္ေဆးျခင္းတခုျပဳလုပ္ရန္ ကုသေပးသူကို တက္ႏုိင္ေစေသာေနရာတြင္ ဘီးတပ္ထိုင္ခံုအသံုးျပဳသူကို သက္ ေတာင့္သက္သာ ထိုင္ေစႏိုင္သည္။ စစ္ေဆးအကဲျဖတ္ကုတင္သည္ တည္ၿငိမ္ အႏၱရာယ္ကင္းၿပီး ဘီးတပ္ထိုင္ခံုမွ အကူးအေျပာင္းျပဳလုပ္ရန္ သင့္ေတာ္ေသာအျမင့္ရွိရမည္။ အတိုင္းအတာမ်ား အၾကမ္းဖ်င္း အလ်ား မွာ ၁၈၀၀ မမ x အက်ယ္ ၆၀၀ မမ ႏွင့္ အျမင့္ ၅၀၀ မမ ပံုမွန္ ဘီးတပ္ထိုင္ခံု ႏွင့္ပတ္သက္ေသာ အကဲျဖတ္ စစ္ေဆးျခင္းအတြက္ရွိသင့္သည္။ ပစၥည္းႏွင့္တည္ေဆာက္ပံု • ကိုယ္ထည္ကို သစ္သား၊ သံမဏိ တို႔ျဖင့္ ျပဳလုပ္ႏိုင္သည္။ • ကူရွင္ o ၁၃ မမ အထပ္သားေအာက္ခံ o ၅၀ မမ ထူထပ္ေသာေရျမႈတ္ အတံုး o ၂၅ မမ ႏူးညံ့ေသာေရျမႈတ္ အေပၚလႊာ • ကူရွင္ကိုသားေရတုသို႔မဟုတ္သားေရကဲ႔သို႔ေသာသန္႔ရွင္းေရးျပဳလုပ္ရန္လြယ္ကူသည့္အရာမ်ားျဖင့္ဖံုးအုပ္သင့္ သည္။ • သားေရကိုပံုသြင္းရန္၊ေခါက္ရန္၊ေကာ္ကပ္ရန္ ႏွင့္သူ၏ ေနရာတြင္ ထားရန္အထပ္သားတြင္ေကာ္ကပ္ထားရန္ ျပဳလုပ္သင့္သည္။ • သံေခ်းမတက္ေသာ ေအာက္ခံ ေဆးသုတ္သံမဏိ ကိုယ္ထည္ၿပီးေအာင္ျပဳလုပ္ၿပီး အေပၚတြင္ မႈတ္ေဆးျဖင့္သုတ္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 10 11 bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 12 13 ေျခေထာက္အရံအတားျပဳလုပ္ျခင္း ေျခေထာက္အရံအတားမ်ားသည္ အကဲျဖတ္စစ္ေဆးစဥ္အတြင္း ေကာင္းမြန္ေသာထိုင္လ်က္ အေနအထား ျဖစ္ေစရန္ ဘီးတပ္ထိုင္ခံုသံုးသူ၏ ေျခေထာက္မ်ားကို သင့္ေတာ္ေသာအျမင့္တြင္ထားရန္ေထာက္ကူသည္။ ဘီးတပ္ထိုင္ခံုသံုးသူ၏ေျခေထာက္ကို မွန္ကန္စြာ ေနရာခ်ရန္အတြက္ အျမင့္အမ်ိဳးမ်ိဳးရွိေသာေျခေထာက္ အရံအတားမ်ား သို႔မဟုတ္ အျမင့္ခ်ိန္ၫ ိွႏိုင္ေသာေျခေထာက္အရံအတားမ်ား ရရွိေအာင္ ျပဳလုပ္ရန္ အေရးႀကီးသည္။ အတိုင္းအတာ မ်က္ႏွာျပင္ဧရိယာ ၄၀၀ မမ x ၃၀၀ မမ အျမင့္ ၁၅ မွ ၁၅၀ မမ အတြင္းအမ်ိဳးမ်ိဳး ပစၥည္းႏွင့္တည္ေဆာက္ပံု • အထပ္လိုက္ထားႏိုင္ေသာ အျမင့္အမ်ိဳးမ်ိဳးရွိ အတံုးမ်ား သို႔မဟုတ္ ခ်ိန္ၫွိႏိုင္ေသာအတံုးမ်ား • အထပ္သားဖြဲ႕စည္းပံု • ေျခဖဝါး အနိမ့္အျမင့္မည္သို႔ေသာအေျခအေနႏွင့္အသံုးျပဳသူမ်ားအတြက္(ေျခေထာက္အရွည္ကြာဟမႈ ေၾကာင့္ျဖစ္ေစ အျခားေသာျပႆနာမ်ားေၾကာင့္ျဖစ္ေစ) အျမင့္မတူေသာေျခေထာက္အရံအတားတံုးမ်ား သံုးရန္လိုသည္။ ေျခေထာက္အရံအတားတံုးမ်ား အေျခခံထပ္ထားျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 12 13 တိုင္းတာမႈ ကိရိယာ နမူနာမ်ား ကယ္လီပါမ်ား သစ္သားတိုင္တာေရးကိရိယာမ်ား အသံုးျပဳပစၥည္း - အထပ္သား ၃ -၉ မမ ခ်ိန္ၫွိႏိုင္ေသာေဘးအရံအတားမ်ား ျပဳလုပ္ရန္ အတိုင္းအတာအမွတ္အသားႏွင့္ သစ္သားအေျခမ်ားႏွင့္ Velero ပိတ္စမ်ား သစ္သားေဘးဘက္အရံအတားမ်ား - တစ္ဘက္ကို အေသတပ္ထားၿပီး အျခားတဘက္ကိုခ်ိန္ၫွိႏိုင္သည္။ ဗီြႏိုင္းတိုင္းတာေရးကိရိယာမ်ား အတိုင္းအတာ အမွတ္အသားႏွင့္ ဗီြႏိုင္းအေျခမ်ား သစ္သားေဘးအရံအတား - တစ္ဘက္ကုိ အေသတပ္ထားၿပီး အျခားတဘက္ကိုခ်ိန္ၫွိႏိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 14 15 လုပ္ငန္းသံုး ကိရိယာ ပစၥည္းမ်ားလမ္းညႊန္ - လုပ္ငန္းသံုးခံုတန္းရွည္ ႏွင့္ အေျခခံ လုပ္ငန္းနယ္ပယ္ လုပ္ငန္းသုံး ခုံတန္းရွည္ ပညာရွင္၏ အလုပ္လုပ္ရန္ ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ လုပ္ငန္းသံုး ခံုတန္းရွည္၏ အနက္မွာ ၇၅၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ ေနရာမွာ ၁၅၀၀ မမ ျဖစ္သည္။ ပညာရွင္၏ အလုပ္လုပ္ရန္ေနရာ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 14 15 အေျခံ ဝန္ေဆာင္မႈ ပညာရပ္ဆိုင္ရာ ရင္းျမစ္မ်ား လမ္းညႊန္ ေအာက္တြင္ေဖၚျပထားေသာကိရိယာမ်ားသည္ တပ္ဆင္ရန္၊ တည္ေဆာက္ရန္၊ ခ်ိန္ၫွိရန္၊ ျပဳျပင္ထိန္း သိမ္းရန္ ႏွင့္ထုတ္ကုန္ကို ျပင္ဆင္ျဖည့္စြက္ရန္အတြက္ျဖစ္သည္။ (WSTP အေျခခံသင္တန္းသင္႐ုိးတြင္ ေဖၚျပထား သည့္အတိုင္း) ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ မက္ထရစ္စနစ္ေပါင္းစပ္ စပန္နာမ်ား ၈ မမ မွ ၂၀ မမ (၈ ၊ ၁၀ ၊ ၁၃ ၊ ၁၉ ၊ မမ အ႐ြယ္မ်ား ပါဝင္ရမည္။) ၂ မက္ထရစ္စနစ္ေပါင္းစပ္ စပန္နာမ်ား ၁ မက္ထရစ္ အလန္ ေသာ့မ်ား ကိုယ္ထည္ရွည္ အမ်ိဳးအစားသည္ အေကာင္းဆံုး ျဖစ္သည္။ T ပံုစံတန္းႏွင့္ ပစၥည္းကို ပိုမိုႏွစ္သက္သည္။ ၂ သတၳဳေပႀကိဳးမ်ား ၅ မီတာအရွည္ ၁ ဖိလစ္ ဝက္အူလွည့္မ်ား အရြယ္အစား အႀကီးႏွင့္ အလတ္မ်ား ၁ ေခါင္းျပား ဝက္အူလွည့္မ်ား အရြယ္အစား အႀကီးႏွင့္ အလတ္မ်ား ၁ ရာဘာတူမ်ား ၈ ေအာင္စ ေခါင္း ၁ ပလိုင္ယာမ်ား အလယ္အလတ္ ေရပိုက္ေခါင္းအတို ၁ အေပါက္ေဖါက္ရန္သံခၽြန္မ်ား ေသးငယ္ေသာအသြားျပား ပံုစံ သံခၽြန္ ၁ သတၳဳ တံဇဥ္း မ်ား(သံုးခု) အမ်ိဳးအစား - အလယ္အလတ္ အ႐ြယ္ ဒုတိယ ျဖတ္ေတာက္မႈတံစဥ္း ၊ စက္ဝိုင္းျခမ္းတံစဥ္း ၊ စက္ဝိုင္းတံစဥ္း ၊ တံစဥ္းျပား။ ၁ ပိုက္ျဖတ္ ကိရိယာငယ္မ်ားႏွင့္ အပိုလႊသြားမ်ား ၁၂ မမ မွ ၃၈ မမ အထိ ျဖတ္ျပြန္မ်ား ၁ လက္သံုးလႊ သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ၁၂ လက္မ သံျဖတ္လႊ ႏွင့္ အသြားမ်ား သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ေရ ႁမႈတ္ျဖတ္ဓါး သစ္ျဖတ္လႊ (သံျဖတ္လႊမဟုတ္) ၁ ဗူးခြံျဖတ္ဓား ႏွင့္ အသြား ပိုမ်ား ၁ ကပ္ေၾကးအႀကီးစားမ်ား ၁ အပ္ႏွင့္ အပ္ခ်ည္အစုံ အပ္ အ႐ြယ္အစား အမ်ိဳးမ်ိဳး ခိုင္မာေသာ ႏိုင္လြန္ခ်ည္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 16 17 ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ တာယာအတြက္ ေလထုိးတံ Schrader ႏွင့္ Presra စက္ဘီးတာယာ အဖြင့္ အပိတ္မ်ား ၁ ဘီးေပါက္ဖာရန္ ပစၥည္းစံုႏွင့္ တာယာလီဗာ ၁ ေကာင္းမြန္ေသာ မွတ္သား ေဘာပင္ ၁ စပုတ္ကီး ၫွပ္ ၁ အႏ ၱရာယ္ ကင္းရွင္းေရး မ်က္မွန္မ်ား ၁ ေဆးသုတ္တံမ်ား ၁ သန္႔ရွင္းေရး ပစၥည္းစံု ေရပုန္းႏွင့္စုတ္တံမ်ား ၁ ရွိသင့္ေသာ လွ်ပ္စစ္သံုး ကိရိယာမ်ား အလုပ္႐ံု အတြက္ ဗို႔အားျမွင့္စက္ စက္ႏွင့္ လက္သံုးကိရိယာမ်ား* ၁ အပ္ခ်ဳပ္စက္ - အႀကီး ၁ အပ္ခ်ဳပ္စက္ - အႀကီး အပ္အစံု ၁ လွ်ပ္စစ္ ေဖါက္စက္ ၃ - ၁၃ မမ ေဖါက္စက္ ၊ အျမန္ႏႈန္းအမ်ိဳးမ်ိဳး ၁ သစ္သားေဖါက္စက္ ၁ သတၱဳ ေဖါက္စက္ ၁ လွ်ပ္စစ္လႊ ၁ သစ္၊ သတၱဳ ျဖတ္ဓားမ်ား ၁ လွ်ပ္စစ္ angle grinder ၁ အလယ္အလတ္ သံျပားစံု ၁ လွ်ပ္စစ္ဓာတ္ႀကိဳး တိုးခ်ဲ႕ရန္ႀကိဳး ၁၀ မီတာ ၁ ဓာတ္အားျမင့္တက္မႈ ကာကြယ္ရန္ကိရိယာ ၁ သိုေလွာင္မႈ ကိရိယာေသတၱာ ၁ ေသာ့ခေလာက္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 16 17 ကိရိယာမ်ား အေသးစိတ္အခ်က္မ်ား အမွတ္ ေသာ့ပါေသာ သတၱဳေၾကာင္အိ္မ္ ၁ အစားထုိးပစၥည္းမ်ား ေခ်ာဆီ အစံု ေကာ္ PVA သစ္သား ကပ္ေကာ္ အျပင္သစ္သား အေရာင္တင္ဆီ ျပင္ပ သတၱဳသုတ္ေဆး ေဆးႀကဲေဆးမ်ား ဆပ္ျပာ ေရျမႈတ္ အဝတ္စမ်ား အလယ္တန္းဝန္ေဆာင္မႈ နည္းပညာရင္းျမစ္မ်ား လမ္းညႊန္ အေျခခံ ဝန္ေဆာင္မႈ နည္းပညာရင္းျမစ္မ်ား လမ္းညႊန္တြင္ ေဖၚျပထားေသာ ကိရိယာမ်ား အားလံုးကို အလယ္တန္းဝန္ေဆာင္မႈ နည္းပညာ ရင္းျမစ္မ်ားလမ္းညႊန္တြင္လည္း လိုအပ္သည္။ ထို႔အျပင္ အေျခခံ ဝန္ေဆာင္မႈ နည္းပညာ ရင္းျမစ္လမ္းညႊန္တြင္ ခေရပြင့္ ျပထားေသာကိရိယာမ်ားတြင္ အလယ္အလတ္အဆင့္အတြက္ ေထာက္ခံ တင္ျပေသာကိရိယာမ်ားထပ္မံ လိုအပ္ေၾကာင္းအတည္ျပဳရန္ အထူးေဖၚျပထားသည္။ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ အဓိက ကိရိယာမ်ား အလုပ္႐ံုအတြက္ ဗို႔အားျမွင့္စက္ စက္ႏွင့္ လက္သံုးကိရိယာမ်ား * ၁ အပ္ခ်ဳပ္စက္ အႀကီး လိုအပ္လွ်င္ ပိတ္စႀကီးမ်ားကိုခ်ဳပ္ႏိုင္ရမည္။ ၁ ရွိသင့္ေသာ ကိရိယာမ်ား Arc ႏွင့္ Mig ဂေဟေဆာ္စက္ ၁ ဂေဟေဆာ္ရာတြင္ သံုးေသာ လက္အကာအကြယ္ သားေရ အထူ၊ အေပါက္ ၆ လက္မ လက္အိတ္မ်ား ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 18 19 Arc ဂေဟေဆာ္ မ်က္လံုး အကာအကြယ္ မ်က္ႏွာဖံုး ၁ Bench grinder ေဖါက္စက္ အၾကမ္း ႏွင့္ အႏု အဆင့္ရွိ ဘီးမ်ား ၁ ေကာ္ပတ္ႀကိဳး ႏွင့္ ဖုန္ထုတ္စက္ ၁ ေကာ္ပတ္ႀကိဳး အစံု (အႏု ၊ အၾကမ္း) ၁ လႊ သစ္သား ၊ အထပ္သား ၊ PU , EVA ႏွင့္ ေရျမွတ္ အတြက္ အလယ္အလတ္ အ႐ြယ္အစား ၁ ေလမႈတ္စက္ ၂၄ L ၁ ေဆးမႈတ္ ပစၥည္းစံု ႏွင့္ ပိုက္ေခါင္းမ်ား ၁ ဓာတ္ေငြ႔ မႈတ္သံုး ဂေဟေဆာ္ကိရိယာ ႏႈတ္သီးေခါင္း အမ်ိဳးမ်ိဳး ႏွင့္ ဂေဟေဆာ္ကိရိယာ ဗို႔အားျမွင့္စက္ႏွင့္ေခါင္းမ်ား ၁ ဂေဟေဆာ္မ်က္လံုး အကာအကြယ္မ်က္မွန္ ၁ ေဖာက္စက္မ်ား(၃ မမ မွ ၁၃ မမ အေပါက္အထိ) ညွပ္ပါေသာေဖာက္စက္ တင္ခံု (ဆက္စပ္ သံုးေသာဘက္စံုညွပ္ပါေဖာက္ခံု) ၁ လွ်ပ္စစ္ ဓာတ္အားသံုးကိရိယာမ်ား အဓိကကိရိယာမ်ား ကိရိယာမ်ား အေသးစိတ္ အမွတ္ လက္ကိုင္လွ်ပ္စစ္ အေပါက္ေဖါက္စက္ (၃ - ၁၃ မမ အေပါက္) (အျမန္ႏႈန္းအမ်ိဳးမ်ိဳး ႏွင့္ အဘက္ဘက္မွ လွည့္ႏိုင္ေသာ ကိရိယာသည္ ပိုမိုလိုအပ္သည္။) ၁ လက္ကိုင္လွ်ပ္စစ္လႊ ၁ Angle grinder ျဖတ္စက္ ၁ ျဖတ္စက္ဝိုင္း အ႐ြယ္စံု အႏု ၊ အၾကမ္း ျဖတ္စက္ဝိုင္းမ်ား ၁ ျဖတ္စက္ အကာအကြယ္ လက္အိတ္မ်ား ၁ တိုးခ်ဲ႕ ရန္ လွ်ပ္စစ္ႀကိဳး ၅ မီတာ မွ ၁၀ မီတာ ၂ ရွိသင့္ေသာ ကိရိယာမ်ား လွ်ပ္စစ္ ဝက္အူလွည့္စက္ ႀကိဳးမဲ့ဝက္အူလွည့္ အမ်ိဳးမ်ိဳး ၊ ေခါင္းအမ်ိဳးမ်ိဳး ၊ Allen Key ဝက္အူလွည့္ အမ်ိဳးမ်ိဳး ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 18 19 ႀကိဳးမဲ့ လွ်ပ္စစ္ ေဖာက္စက္၊ ၃ - ၁၃ မမ အေပါက္အ႐ြယ္အစား) ၁၈ ဗို႔ အျမန္ႏႈန္းအမ်ိဳးမ်ိ္ဳး ႏွင့္ အဘက္ဘက္သို႔ လွည့္ႏိုင္ေသာအမ်ိဳးအစားသည္ ပိုမို အသံုးဝင္သည္။ ၁ လႊဝိုင္း (အနည္းဆုံး ၁၈၅ မမ အသြား) ၁ တြဲဆက္ေပးေသာသံ ျဖတ္ထားေသာ ဖ်င္စထူနားကို အနားလံုးရန္ ႏွင့္ ဖ်င္စထူတြင္ အေပါက္ေဖာက္ရန္ သံခၽြန္ ၁ လက္သံုးကိရိယာမ်ား အဓိက ကိရိယာမ်ား လက္ကိုင္လႊ (universal) ၂၂ လက္မ အႏုစိတ္အသြား ၁ သံျဖတ္လႊနွင့္လႊသြားစုံ သစ္အေခ်ာျဖတ္ရန္ ၁ အေပါက္ေဖာက္ရန္လြန္ပူစံု ၁ ဝက္အူစံု ၁ (မူလီအေသတပ္) ကပ္ေၾကးႀကီး လက္သမား အလုပ္စားပြဲ တြင္တပ္ဆင္ထားေသာ ၁ ညႇပ္ (မူလီနွင့္)* ၆ လက္မ ၂ ပလာယာ နႈတ္သီးရွည္၊ အလတ္ ၁ ေလာ့ကင္းပလာယာ (mole grips) နႈတ္သီးတို၊ အလတ္ ၂ ေလာ့ကင္းပလာယာ (mole grips) နႈတ္သီးရွည္၊ အလတ္ ၂ ညႇပ္ ၆ လက္မ ၂ ညႇပ္ ၆ လက္မ ၂ ကြင္းေပါက္ေဖာက္စက္နွင့္ကြင္းမ်ိဳးစုံ အ႐ြယ္စုံ ၁ ခ်ဳပ္စက္ (သစ္သား) ၁ ရပစ္ရိုက္စက္ ၁ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ သံေပတံ* ၁ မီတာ၊ (မက္ထရစ္နွင့္အင္ပီရီရယ္စေကး) ၁ သံေပတံ ၃၀ စင္တီ ၂ သတၱဳေပႀကိဳး* ၅ မီတာ ၁ ဗာနီယာကာလီပါအခ်င္းတိုင္းစက္ ၁၅၀ မမ ပါးစပ္အက်ယ္ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 20 21 သတၱဳစက္ဝိုင္းျခမ္း ၁ မွ ၁၈၀ ဒီဂရီ (တိက်မႈ ၁ ဒီဂရီ) ၁ အလယ္မွတ္ မွတ္သားရန္သံခ်ြန္ ၂ ေရးမွတ္ရန္သံခ်ြန္ ၂ လက္လွည့္လြန္ပူ* လြန္ပူနွင့္ဓာတ္အားမရလွ်င္အသုံးဝင္သည္ ၁ လက္သမားစကြဲ ၆၀၀ မမ x ၄၀၀ မမ သံမဏိ ၁ ခ်ိန္ညႇိနိုင္ေသာ စပန္နာ ၁လက္မ အမ်ားဆံုးအက်ယ္ ၁ ေဆာ့ကက္စံု မက္ထရစ္( ၈၊၁၀၊၁၃၊၁၇၊၁၉ မမ မ်ားအပါအဝင္) ၁ တာရာခ်ိန္ညႇိတံမ်ား* ၄ ခု တစုံ ၁ စပုတ္တံခ်ိန္ညႇ္ိကိရိယာ* ၁ လံုၿခံဳေရးမ်က္မွန္* အလုပ္ရုံသုံးမ်က္လံုးအကာအကြယ္ ၄ နားအကာအကြယ္ ၂ ဖံုကာမ်က္နွာဖံုး ၄ သစ္သားစားတံစဥ္းျပား အလတ္ ၁ သစ္သားစားတံစဥ္းစုံ ၁ သစ္သားစားတံစဥ္းစုံ (သစ္သားအတြက္) ၁ ရွိသင့္ေသာအရာမ်ား ေဆာ့ကက္စုံ အင္ပီရီရယ္ ၁ ကြန္ဘိုင္ေနးရွင္း စပန္နာစုံ* အင္ပီရီရယ္ ¼–1½ ၁ အလန္ကီး ( L ပံု) အင္ပီရီရယ္ ၁ စပုပ္ေရွ႕ ၁ ကြန္ဘ္ိုင္ေနးရွင္းစကြဲ ၁ ေထာင့္ခ်ိန္နိုင္ေသာ ဘီဗယ္ ေထာင့္စြန္းလံုးစက္ ၁ စကြဲအေသး ၁၀ လက္မ ၁ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 20 21 အေထြေထြ အလုပ္႐ုံ အမိႈက္ပံုးမ်ား ၃ ၾကမ္းတိုက္ဘရပ္ရွ္ ၁ အမိႈက္ေဂၚနွင့္ ဘရပ္တံမ်က္စီး ၁ ကိရိယာမ်ား အေသးစိတ္ အမွတ္ ဖုန္သုပ္အဝတ္ ၁ အလုပ္ရံုသန္႔ရွင္းေရးေရပံုးနွင့္ ေရျမႇုတ္ ၂ အလုပ္႐ုံပရိေဘာဂႏွင့္ လုံၿခံဳသည့္သုိေလွာင္မႈ ကိရိယာထည့္ရန္အပိတ္ပါသတၱဳဘီရို* ၂ ပစၥည္းထည့္ရန္သတၱဳဘီရို ၂ အေထြေထြသုံးအပြင့္ဘီရို ၁ PSD အစိတ္အပိုင္းထည့္ရန္အပြင့္ဘီရို ၁ ေခြးေျခထိုင္ခံု ၃ အလုပ္စားပြဲ* ၃ စင္ ၂ အေျခာက္ခံစင္ ေဆးသုပ္၊ အေရာင္တင္ပစၥည္းမ်ားအတြက္ ၁ အစားထုိးပစၥည္းမ်ား ေအာက္ခံေဆး ျပင္ပသစ္သားေဆး အေပၚေဆး ျပင္ပသစ္သားေဆး အေရာင္တင္ဆီ ျပင္ပအဆင့္ အရက္ပ်ံျဖဴ* ဘရပ္နွင့္ေဆးမႈတ္ကိရိယာသန္႔ရွင္းေရးအတြက္ သုပ္ေဆး၊ အေရာင္တင္ဆီ၊ ေကာ္ ပံုးမ်ား ေကာ္ပတ္ အဆင့္ ၄၀၊ ၈၀၊ ၁၅၀ အျမႇင္ေျမျဖဴ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 22 23 ဂေဟေခ်ာင္းစံု ဂေဟေခ်ာင္းစံု အ႐ြယ္စံု ဂေဟသုံုး flux လႊသြားမ်ား သစ္သား၊ သတၱဳနွင့္ပလပ္စတစ္ျဖတ္ရန္ လႊသြားမ်ား စာအုပ္ခ်ဳပ္အပ္ ၅ မမ နွင့္ ၈ မမအနက္ စက္ခ်ဳပ္အပ္ အ႐ြယ္စုံ စတီးအတြက္ဂေဟေခ်ာင္းမ်ား ၂ မမ၊ ၄ မမ ၊၆မမ အ႐ြယ္ ကြင္းမ်ား အ႐ြယ္စုံ ရပစ္မ်ား ၄ မမ နွင့္ ၆ မမ အခ်င္းအ႐ြယ္စုံ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 22 23 ေရျမႇုတ္ျဖတ္ရန္သံျဖတ္လႊအသြားႀကိဳတင္ျပင္ဆင္ျခင္း • သာမန္သတၱဳသံျဖတ္လႊအသြားတခုက္ို ယူပါ(သံုးၿပီးအေဟာင္ျဖစ္လွ်င္ပိုေကာင္းသည္)။ လႊသြားမ်ားကိုထက္ ေသာဓားခ်ြန္ျဖစ္ရန္ ေသြးပါ။ (Vပံုစံျဖတ္ပိုင္းပံု) • ၾကားခံနွင့္သိပ္သည္းမႈနည္းေသာ ပိုလီယူသိန္း ေရျမႇုတ္ နွင့္ ခ်ပ္ေရျမႇုတ္တို႔ကို လြယ္ကူလွ်င္ျမန္စြာျဖတ္နိုင္ေသာ ပါးလႊာသည့္ လႊသြားဓားတလက္ျဖစ္လာမည္။ • လက္ကိုင္ျပဳလုပ္ရန္နွင့္ သင္၏လက္ေခ်ာင္းမ်ားကိုဓားသြားမွကာကြယ္ရန္ လႊဓား၏တဘက္အစြန္းတြင္တိပ္မ်ား ရစ္ပတ္ပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 24 25 အေျခခံနွင့္အလယ္တန္းဝန္ေဆာင္မႈလမ္းၫႊန္ - ပစၥည္းမ်ား ျဖည့္စြက္ကိုယ္ေနဟန္အေထာက္အကူျပဳကိရိယာမ်ား ျပင္ဆင္ျဖည့္စြက္ျခင္းနွင့္ ေပါင္းစပ္ထုတ္လုပ္ျခင္း အတြက္ပစၥည္းမ်ားကို အလယ္တန္းအဆင့္တြင္မ်ားေသာအားျဖင့္သံုးသည္။ သို႔ေသာ္ အေျခခံအဆင့္ ဝန္ေဆာင္မႈ မ်ားသည္လည္း အလားတူပစၥည္းမ်ားသုံး၍ ရိုးရွင္းေသာျပင္ဆင္ျဖည့္စြက္မႈမ်ား လုပ္ေဆာင္ရနိုင္သည္။ လိုအပ္ေသာ ပစၥည္းမ်ား၏အရည္အေသြးသည္ ဝန္ေဆာင္မႈရယူေသာ ဘီးတပ္ထုိင္ခုံသုံးစြဲသူ အေရအတြက္၊ အလယ္တန္းအ ဆင့္ ဘီးတပ္ကုလားထိုင္ဝန္ေဆာင္မႈေပးသည့္ပမာဏနွင့္ ေပးသည့္ဘီးတပ္ထိုင္ခုံအမ်ိဳးအစား အပါအဝင္ အခ်က္ အမ်ားအျပားအေပၚ မူတည္သည္။ ေဆးခန္းနွင့္နည္းပညာဝန္ထမ္းမ်ားသည္ သင့္ေတာ္ေသာပစၥည္းမ်ား ရယူရာတြင္ ပါဝင္သင့္သည္။ ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ သတၱဳ/ပလပ္စတစ္/ သစ္သား သတၱဳ/ပလပ္စတစ္/သစ္သား သည္ကိုယ္ေနဟန္ေထာက္ကူမႈ ကိရိယာတခု၏ ကိုယ္ထည္ကိုဖြဲ႕စည္းသည္။ ဥပမာ အမာထည္ ထိုင္ခံုနွင့္ ေနာက္မွီမ်ား။ ၁၂ မမ အထပ္သားသည္ အမာထည္ ထိုင္ခံုနွ င့္ေနာက္မွီမ်ားျပဳလုပ္ရာတြင္ အလြန္အသုံးဝင္သည္။ ၎သည္ခိုင္မာသည္ သို႔ေသာ္နိႈင္းယွဥ္ခ်က္အားျဖင့္ေပါ့ပါးသည္။ မရိန္း အထပ္သားသည္ ေရရွည္ခံေသာ ေ႐ြးခ်ယ္စရာျဖစ္သည္ သို႔ေသာ္ေဈးႀကီးနိုင္သည္။ ရနိုင္လွ်င္ ၃ မမ အလူမီနီယမ္ နွင့္ ၆ မမ ေရာင္ျပန္ သို႔မဟုတ္ ABS ပလပ္စတစ္ခ်ပ္မ်ားကိုလည္း အမာထည္ေနာ က္မွီမ်ားလုပ္ရန္သုံးနိုင္သည္။ ပလပ္စတစ္ခ်ပ္ကို ေခါက္ၿပီးထည့္လွ်င္ ပို၍မာသည္။ အခ်ပ္အလႊာနွင့္ပစၥည္းကိုသုံးလ်င္ အသုံးျပဳသူ အႏၲရာယ္ကင္းရန္ ထက္ေသာအစြန္မ်ားကို ဖယ္ရွားရန္ သို႔မဟုတ္ ဖံုးအုပ္ရန္ ပိုမိုဂရုျပဳပါ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 24 25 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ေရျမွဳတ္/အဖုံးအကာ ဘီးတပ္ထိုင္ခုံအသုံးျပဳ သူ၏ခႏၶာ ကိုယ္နွင့္တိုက္ရိုက္ထိေနေသာ ကိုယ္ေနဟန္ေထာက္ကူမႈ ကိရိယာ အစိတ္အပိုင္းမ်ား အားလံုးတြင္ ေရျမႇုတ္/ အဖံုးအကာေရျမႇုတ္ကိုသုံးသည္။ ၎၏မူရင္းပံုအတိုင္းရွိေသာ အခုိင္အမာေရျမွဳတ္ကုိ ကုိယ္ေနဟန္ အေထာက္အကူကိရိယာမ်ား မွန္ကန္ေသာ ေထာက္ကူမႈေပးရန္လုိေသာ ပုံစံေပးရန္ သုံးသည္။ ပုိမုိႏူးညံ့ေသာေရျမွဳတ္ကုိ သက္ေတာင့္သက္သာမႈႏွင့္ ဖိအားေလွ်ာ့ခ်ေပးရန္အတြက္ သုံးသည္။ ေရျမႇုတ္အသုံးျပဳမႈဥပမာမ်ား - • ဖိအားေလ်ာ့ခ်ရန္နွင့္ပိုမိုသက္ေတာင့္ သက္သာရွိရန္ သိုင္းႀကိဳးမ်ားသို႔ေပါင္း ထည့္သင့္သည္။ ေဒသတြင္ရနိုင္ေသာေရျမႇုတ္ရွာေဖြရန္ ေဒသေဈးမ်ားတြင္ရွာပါ။ ေရျမႇုတ္၊ရွဴးဖိနပ္၊ေမႊ့ယာနွင့္ ပရိေဘာဂစက္ရံုမ်ားသို႔သြားပါ။ အထူအမ်ိဳးမ်ိဳး နွင့္ ခိိုင္မာမႈ အမ်ိဳးမ်ိဳး ရွိေသာ ေဒသ ေရျမႇုတ္ နမူနာမ်ားရွာရန္ႀကိဳးစားပါ။ EVA သည္အလြန္မာေသာေရျမႇုတ္နမူနာျဖစ္ၿပီး ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိယာမ်ားအတြက္ကိုယ္ ထည္နွင့္ခိုင္မာေသာေထာက္ကူမႈေပးရန္ ေကာင္းမြန္သည္။ ရွဴးဖိနပ္ထုတ္လုပ္ေသာေနရာမ်ား တြင္ EVA ကိုေတြ႕နိင္သည္။ EVA အစား ေျခညႇပ္ဖိ နပ္လုပ္သည့္ရာဘာကိုသုံးနိုင္သည္။ အေရအေသြးေကာင္းေသာ Chip ေရျမႇုတ္သည္ ခိုင္မာမႈအလယ္အလတ္ရွိ ေရျမႇုတ္နမူနာျဖစ္သည္။ Chip ေရျမႇုတ္က္ို တင္ပါးစုံရိုးေနာက္ဘက္ သို႔မဟုတ္ Pre-seat အရိုးအတြက္ အခုအခံျပဳလုပ္ရန္ နွင့္ အမာထည္ ေနာက္မွီ တြင္ေဖာင္းႂကြျပဳလုပ္ရန္ ေဖာင္းႂကြ/အလႊာလိုက္ရွိေသာကူရွင္တြင္ ေအာက္ခံလႊာအျဖစ္သုံးနိုင္သည္။ ႏူးည့ံေသာ ေမႊ့ရာ ေရျမႇုတ္ သည္ သက္ေတာင့္သက္သာရွိေစေသာ အေပၚလႊာေရျမႇုတ္ ဥပမာျဖစ္သည္။ ေရျမႇုတ္/အခုအခံ • အလြန္ခိုင္မာေသာေရျမႇုတ္ (ဥပမာ EVA ေရျမႇုတ္) ကို ေျခတင္ခံု အခုအခံ သို႔မဟုတ္ သပ္ နွင့္ ကိုယ္ခႏၶာေဘးဘက္ အခုအခံျပဳလုပ္ရန္သုံးနိုင္သည္။ အလြယ္ကူဆုံးရနိုင္ေသာ ေဈးအသက္ သာဆံုးႏူးည့ံေသာေရျမႇုတ္သက္သက္ မွာ ခိုင္မာေသာေရျမႇုတ္ေအာက္ခံမပါဘဲ ဖိအားသက္သာေစေသာကူရွင္ျပဳ လုပ္ရာတြင္သုံးရန္ မသင့္ေတာ္ေပ။ ခိုင္မာေသာေရျမႇုတ္ေနရာမ်ားတြင္ အုန္းဆံကိုသုံးနိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 26 27 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ပိတ္စ ပိတ္စကို ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိ ယာမ်ား(PSDs)တြင္ ဖံုးအုပ္ရန္သုံးသည္။ ေရရွည္ခံၿပီးသန္႔ရွင္းေရးျပဳလုပ္ရလြယ္ ေသာပိတ္စရွာပါ (ေရပတ္တိုက္၍ျဖစ္ေစ ျဖဳတ္ယူ ေလ်ာ္ဖြတ္၍ျဖစ္ေစ)။ ဘီးတပ္ကုလားထိုင္သုံးသူ ဆီးဝမ္းမထိမ္းနိုင္လ်င္ ေရခုခံနိုင္ေသာပိတ္စသည္ ထိုင္ခံုနွင့္ ေနာက္မွီအတြက္အသုံးဝင္သည္။ ပိုပိုႏူးည့ံေသာ တီရွပ္ပုံစံပိတ္စသည္ (ခ်ည္ထည္ သို႔မဟုတ္ ခ်ည္ထည္နွင့္ အဆန္႔အတင္းလုပ္ႏိုင္ေသာ အသားကပ္ ပိတ္) ေခါင္းမွီႏွင့္ ကိုယ္ခႏၶာေဘး အေထာက္အကူျပဳလုပ္ရန္ အသုံးဝင္သည္။ အဆန္႔အတင္းလုပ္နိုင္ေသာ ပိတ္စသည္ ကိုယ္ေနဟန္ေထာက္ကူမုု ကိရိယာမ်ား၏ပံုစံ နွင့္လိုက္ေလ်ာညီေထြလြယ္ကူစြာျဖစ္နိုင္သည္။ သဘာဝမဟုတ္ေသာ ပိတ္စသည္ သဘာဝပိတ္စထက္လူကို ပိုမိုပူေလာင္ေစသည္။ ျဖစ္နိုင္လွ်င္ ဘီးတပ္ထိုင္ခုံသုံးသူကို ေ႐ြးခ်ယ္ခြင့္ေပးၿပီး အေရာင္အမ်ိဳးမ်ိဳးရေအာင္ ႀကိဳးစားပါ။ နိုင္လြန္ပိတ္စႀကိဳး၊ ကပ္ခြာ သို႔မဟုတ္ ခါးပတ္ေခါင္းကဲ့သ္ို႔ ေသာ ခ်ိတ္မ်ား နိုင္လြန္ပိတ္စႀကိဳး၊ကပ္ခြာ သို႔မဟုတ္ ခါးပတ္ေခါင္းကဲ့သ္ို႔ေသာခ်ိတ္မ်ားကို တင္ပါးစုံရိုးသိုင္းႀကိဳး၊ ပုခံုးထိန္း၊ ေျခသ လံုးနွင့္ေျခေထာက္သိုင္းႀကိဳးမ်ားအပါ အဝင္ သိုင္းႀကိဳးမ်ားျပဳလုပ္ရန္သုံးသည္။ ၂၅၊၃၅ နွင့္ ၅၀ မမ သိုင္းၾက္ိုးမ်ာသည္ အသုံးဝင္သည္။ သိုင္းႀကိဳးက်ယ္ေလေလ ဖိအားညီမ်ေလေလျဖစ္သည္။ ျဖတ္ၿပီးအပူေပးကာလံုးထားလွ်င္ နိုင္လြန္သိုင္းႀကိဳးမ်ားသည္ ေျပေလ်ာ့မထြက္ေစေပ။ ခ်ည္သိုင္းႀကိဳးမ်ားသည္ ထိေရာက္မႈမ်ားစြာေလ်ာ့နည္းသည္။ ေက်ာပိုးအိတ္မ်ားတြင္သုံးေသာ ညႇပ္ခါးပတ္ေခါင္းခ်ိတ္မ်ားသည္ အသုံးျပဳရလြယ္ကူသည္။ ရနိုင္လွ်င္ အေရအေသြး ေကာင္းေသာခါးပတ္ေခါင္းခ်ိတ္ မ်ားသုံးပါ။ ၎တို႔သည္ေရရွည္ခံေသာေၾကာင့္ ျဖစ္သည္။ ၎တို႔ကို ညႇပ္ၿပီးဆြဲျဖဳတ္ ျခင္းျဖင့္စစ္ေဆးပါ။ ၎တို႔သည္ညႇပ္သြားၿပီး အလြယ္တကူျပဳတ္သြားသင့္သည္။ သို႔ေသာ္ ျပဳတ္မသြားလ်င္ဆက္မဆြဲသင့္ပါ။ ကပ္ခြာသည္ေကာင္းေသာတြယ္ခ်ိတ္စရာကိရိ ယာျဖစ္သည္။ သို႔ေသာ္၎ကိုသန္႔ရွင္းေအာင္ ထားရၿပီး မထားက အလုပ္မလုပ္ေတာ့ေပ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 26 27 ပစၥည္း အသုံးျပဳပံု ရွာေဖြရမည့္အရာ ေကာ္မ်ား ေကာ္မ်ားကို သစ္သားနွင့္ေရျမႇုတ္ကို ကပ္ရန္သုံးသည္။ သစ္သားကပ္ေကာ္ (ေကာ္ျဖဴ သို႔မဟုတ္ PVA ဟုလူသ္ိမ်ားသည္) နွင့္ ေရျမႇုတ္ေကာ္ (contact ေကာ္၊ ရွဴးဖိနပ္ေကာ္၊ ေကာ္ဝါဟုလူသိမ်ားသည္)တို႔ကိုထားရွိပါ။ ေကာ္အသုံုးျပဳသူမည္သူမဆို မည္သို႔အသုံးျပဳရ သည္ကိုသိရန္ေသခ်ာပါေစ။ ခ်ိတ္ဆက္ ကိရိယာမ်ား ခ်ိတ္ဆက္ကိရိယာမ်ားကို ကိုယ္ေနဟန္ ေထာက္ကူမႈကိရိယာမ်ားကို ဘီးတပ္ထိုင္ခုံတြင္ တပ္ဆင္ရန္သုံးသည္။ အသံုးဝင္ေသာခ်ိတ္ဆက္ကိရိယာမ်ားတြင္ေ အာက္ပါတို႔ပါဝင္သည္။ • မူလီနွင့္နပ္္မ်ား နွင့္ ဝါရွာမ်ား (အပိတ္ပါနပ္ မ်ားပိုမိုေကာင္းသည္)၊ • တီပံုစံနပ္မ်ား (နပ္မ်ားအစားသစ္သားတြင္ အေသတပ္သည္)၊ • စာအုပ္ခ်ဳပ္စက္အပ္မ်ား (ကူရွင္အဖံုးအကာတပ္ဆင္ရန္) ကိုယ္ေနဟန္ေထာက္ကူမႈကိရိယာ ပ်က္စီးသြားလ်င္ အႏၲရာယ္ျဖစ္နိုင္ေသာေၾကာင့္ ခ်ြန္ေသာဝက္အူမ်ားမသုံးရ။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 28 29 လႈပ္ရွားသြားလာမႈ က်ြမ္းက်င္မႈ နယ္ပယ္ထူေထာင္ေရးလမ္းၫႊန္ လႈပ္ရွားသြားလာမႈ က်ြမ္းက်င္မႈေလ့က်င့္ေရးနယ္ပယ္သည္ ဘီးတပ္ထိုင္ခုံသုံုးသူမ်ား ၎တို႔၏ ဘီးတပ္ ထိုင္ခုံမ်ားကို မွန္ကန္ေဘးကင္းစြာသုံးရန္အတြက္ ေလ့လာရာတြင္ အေရးပါသည္။ ၎တြင္အနည္းဆံုးေအာက္ပါတို႔ပါဝင္သင့္သည္ - • ေဒသအလိုက္ သင့္ေတာ္ေသာ ေျမမ်က္နွာသြင္ျပင္အမ်ိဳးမ်ိဳး • ဆင္ေျခေလ်ာမ်ား • ေလွခါးထစ္မ်ား ၎သည္ ဝန္ေဆာင္မႈ၏ ေနာက္တဆင့္ျဖစ္ၿပီး အသုံးျပဳသူ ဘီးတပ္ထိုင္ခုံ စမ္းသပ္ေမာင္းနွင္ၿပီးေနာက္ လိုအပ္ေသာ ဘီးတပ္ထိုင္ခုံတည္ေဆာက္မႈျပန္လည္ခ်ိန္ညႇိမႈျပဳလုပ္ရန္ တပ္ဆင္ေသာေနရာနွင့္နီးကပ္စြာရွိသင့္ သည္။ ရာသီဥတုဆိုး႐ြားေသာေနရာမ်ဳိးတြင္ အမိုးအကာနွ႔င္ျဖစ္ပါကအသုံးဝင္သည္။ ေဒသေျမမ်က္နွာျပင္ပံုစံတူ အတားအဆီးမ်ားနွင့္ ၁x၁၂ ကုန္းေပါင္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 28 29 ေ႐ြ႕လ်ားသြားလာေရးကၽြမ္းက်င္မႈေလ့က်င့္ေရးနယ္ပယ္တခုတြင္ ေအာက္ပါတို႔ပါဝင္သည္။ အမ်ိဳးအမည္ အတိုင္းအတာမ်ား ရည္႐ြယ္ခ်က္: ဘီးတပ္ထိုင္ခုံ အသုံးျပဳသူနွင့္ ၎တို႔၏ ကူသူမ်ားေလ့က်င့္ရန္ ေျမျပန္႔ ၁၀မီတာရွည္ၿပီး ၁မီတာက်ယ္ေသာ အေျခခံတြန္းျခင္း ေဒသေျမမ်က္နွာျပင္ ပုံစံတူ (နယ္ပယ္ ၃ခု) သဲ၊မ်က္ခင္း၊ေက်က္ထူေျမျပင္ နယ္ပယ္တခုစီသည္ အနည္းဆံုး ၂၀၀၀ မမ ရွည္ၿပီး ၁၀၀၀ မမ က်ယ္သင့္သည္။ အသုံးျပဳသူ၏ေဒသတြင္ေတြ႕ရ ေသာပတ္ဝန္းက်င္ ဘေလာ့ ၁ ၁၅၀၀ x ၁၅၀၀ x ၂၅ မမ အျမင့္ တဆင့္ခ်င္း ဆုတ္တက္လႈပ္ရွားျခင္း ဘေလာ့ ၂ ၁၅၀၀ x ၁၅၀၀ x ၁၀၀ မမ အျမင့္ ဘေလာ့ ၃ ၁၅၀၀ x ၁၅၀၀ မမ x ၂၀၀ မမ အျမင့္ ၁:၁၂ ကုန္းေပါင္ ၁:၁၂ ကုန္းေပါင္ အၾကမ္းဖ်င္း ၃၆၀၀ မမ ရွည္ၿပီး ၁၀၀၀ မမ အက်ယ္ ဆင္ေျခေလ်ာဒီဂရီ - ၀ မမ (အနိမ့္ဘက္) မွ ၃၀၀ မမ (အျမင့္ဘက္) စံဆင္ေျခေလွ်ာတြင္ ဆုတ္တက္လႈပ္ရွားျခင္း ၁X၈ ကုန္းေပါင္ အၾကမ္ျဖင္း ၂၄၀၀ မမ အရွည္x၁၀၀၀ မမ အက်ယ္ ဆင္ေျခေလ်ာဒီဂရီ - ၀ မမ (အနိမ့္ဘက္) မွ ၃၀၀ မမ (အျမင့္ဘက္) မတ္ေစာက္ေသာ ဆင္ေျခေလွ်ာတြင္ ဆုတ္တက္လႈပ္ရွားျခင္း ဝင္ေပါက္ (အတားအဆီးမ်ား) (ပုံ၁တြင္ၾကည့္) ၆၀ မမ အျမင့္X၅၀ မမ အက်ယ္x ၁၀၀၀ မမ အရွည္ ဝင္ေပါက္(အတားအဆီးမ်ား အေနွာင့္အယွက္မ်ား) ၂ (ပံု ၁ ၾကည့္) ၉၀ မမ အျမင့္X ၅၀ မမ အက်ယ္ x ၁၀၀၀ မမ အရွည္ ေလွခါးထစ္မ်ား ( ပံု ၂ ၾကည့္) ခန္႔မွန္ေျခ ၃၀၀ မမ အနက္၊ ၁၅၀ မမ အျမင့္ နွင့္ ၁၁၀၀ မမအက်ယ္ ေလွခါးထစ္မ်ားတက္ျခင္း ဆင္းျခင္း အႀကံျပဳထားေသာ စံနႈန္းမ်ားနွင့္ သိသိသာသာကြဲလြဲလွ်င္ အထက္ပါဇယားတြင္ေဖာ္ျပထားေသာ အတိုင္း အတာမ်ားကို ေဒသအေျခအေနအရျပဳျပင္ရမည္။ လူမ်ားအေနျဖင့္ ဤေလ့က်င့္မႈမွတဆင့္ ေဒသပတ္ဝန္းက်င္တြင္ ခ်ိန္ညႇိေဆာင္႐ြက္တတ္ရန္အေရးႀကီးသည္။ လႈပ္ရွားသြားလာမႈေလ့က်င့္ေရး နယ္ပယ္၏ မည္သည့္အပိုင္းသို႔မဆို ရနိုင္ရန္လုပ္ေပးပါ။ တခါတရံ ရနိုင္ေသာ သဘာဝေျမမ်က္နွာျပင္ကို သုံုးၿပီး ဝန္ေဆာင္မႈေနရာနွင့္ နီးေသာေနရာကို သတ္မွတ္နိုင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 30 31 အျမင့္အမ်ိဳးမ်ိဳးျဖင့္ ဝင္ေပါက္ နမူနာမ်ား 400 50 50 60 90 (2) (2) (1) (1) 1000 mm ပုံ ၁ (အတုိင္းအတာ မီလီ) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 30 31 ေလွကားထစ္ ပုံစံျပ နမူနာမ်ား ပုံ ၂ (အတုိင္းအတာ မီလီ) bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 32 33 ဘီးတပ္ထိုင္ခုံပ့ံပိုးျခင္းနည္းလမ္းအမ်ိဳးမ်ိဳးကို နွိုင္းယွဥ္ေလ့လာျခင္း စဥ္းစားရမည့္အဓိကဘီးတပ္ထိုင္ခုံပ့ံပိုးေရးနည္းလမ္းမ်ားမွာ ေဒသတြင္ဘီးတပ္ထိုင္ခုံထုတ္လုပ္ျခင္း၊ ဘီး တပ္ထိုင္ခုံသစ္မ်ား တင္သြင္းျခင္းနွင့္ ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား တင္သြင္းျခင္းတုိ႔ ျဖစ္သည္။ ဘီးတပ္ထိုင္ခုံဝန္ေဆာင္မႈတခုအတြင္း ဘီးတပ္ကုလားထိုင္မ်ားကို ျပန္လည္ျပင္ဆင္အသုံးျပဳနိုင္သည္။ ေရရွည္မွီခိုအားထားနိုင္ေသာ ထုတ္ကုန္အမ်ိဳးမ်ိဳး ပ့ံပိုးမႈ ဘီးတပထ္ိုင္ခုအံသုံးျပဳသူမ်ားသည္ "ဘီးတပထ္ိုင္ခုလံမ္းၫႊန္မ်ား" တြင္ဖြင့္ဆိုထားသည့္ သင့္ေတာ္ေသာ ထုတ္ကုန္အမ်ိဳးမ်ိဳးကို ေရရွည္ရရွိရန္လိုသည္။ မည္သည့္ပ့ံပိုးမႈနည္းလမ္းျဖင့္မဆို ေရရွည္အားထားနိုင္ေသာ ထုတ္ကုန္ပ့ံပိုးမႈသည္ အေရးပါသည္။ ပ့ံပိုးမႈနည္းလမ္းအားလံုးသည္ ေရရွည္ရနိုင္မႈနွင့္ အေရအေသြးထိန္းခ်ဳပ္မႈအရ စိန္ေခၚမႈမ်ားရွိၾကၿပီး အေျခအေနအမ်ိဳးမ်ိဳးတြင္ ကိစၥတခုျခင္းအရ စဥ္းစားသုံးသပ္ရန္လိုသည္။ ဘီးတပထ္ိုင္ခုသံုံးသူမ်ားသည္ ဘီးတပထ္ိုင္ခုပံ့ံပိုးျခင္း၏ ႀကိဳတင္စမီံျခင္း၊ အေကာင္အထည္ေဖာ္ျခင္း၊ စီမံခန္႔ခြဲျခင္း၊ အကဲျဖတ္ျခင္း တို႔တြင္ပါဝင္ေဆာင္႐ြက္သင့္ၿပီး၁ ထို႔ေၾကာင့္ အေျခအေနတခုအတြက္အေကာင္းဆံုး အေျဖကို ေ႐ြးခ်ယ္ရာတြင္ပါဝင္သင့္သည္။ ေဒသဆိုင္ရာ ကိုယ္လက္အဂၤါတုနွင့္ သြားလာမႈအေထာက္အကူဝန္ေဆာင္မႈရွိပါက ၎တို႔၏ ေဒသ ထုတ္လုပ္မႈနွင့္ တင္သြင္းကိရိယာေ႐ြးခ်ယ္မႈ ဆံုးျဖတ္ခ်က္သည္ ဘီးတပထ္ိုင္ခုဝံန္ေဆာင္မႈသို႔ ဘီတပထ္ိုင္ခု ံ ပ့ံပိုးမႈနည္းလမ္း ဆံုးျဖတ္ရာတြင္အေထာက္အကူျပဳနိုင္သည္။ စတီးပရိေဘာဂနွင့္ စက္ဘီးကဲ့သို႔ေသာ ေဒသေဈး ကြက္မွ အလာတူပစၥည္းမ်ား ကိုစဥ္းစားၿပီး ဤေဒသခံစီးပြားေရးမ်ားသည္ မည္သည့္အတြက္ေၾကာင့္ ပစၥည္းမ်ား ကို ထုတ္လုပ္သည္၊တင္သြင္းသည္ ကုိနားလည္လ်င္ လည္းအသုံးဝင္သည္။ အျခားေသာေဒသဆိုင္ရာကုန္ထုတ္လုပ္ ငန္းရွိျခင္း မရွိျခင္း သည္လည္း ဘီးတပ္ကုလားထိုင္ထုတ္လုပ္မႈေအာင္ျမင္နိုင္မျမင္နိုင္ကို ၫြဳန္ျပေသာအေရးႀကီး သည့္အခ်က္ျဖစ္သည္။ ပစၥည္းတင္သြင္းသည့္ ထူေထာင္ၿပီး ေဒသစီးပြားေရးလုပ္ငန္ရွိျခင္းမရွိျခင္း သြင္းကုန္မ်ား အတြက္ မွခီိုအားထားေလာက္ေသာေထာက္ပ့ံေရးကြင္းဆက္ရွိနိုင္ေျခကို ၫႊန္ျပေသာအခ်က္ျဖစ္သည္။ မည္သည့္ပ့ံပိုးမႈပံုစံကိုသုံးမည္ဟုဆံုးျဖတ္ခ်က္မခ်မီ ျပည့္စုံေသာျဖစ္နိင္ေျခစမ္းစစ္မႈျပဳရန္အႀကံျပဳသည္။ စရိတ္ကိုတြက္ခ်က္နွိုင္းယွဥ္ရန္လိုသည္။ သြင္းကုန္တခု၏အျပည့္အဝကုန္က်စရိတ္ကို ႀကိဳတင္တြက္ခ်က္နိုင္သည္ (ထုတ္ကုန္ေဈးနႈန္း၊ သေဘၤာတင္ျခင္း၊တင္သြင္းျခင္း၊သိုေလွာင္ျခင္း) သို႔ေသာ္ သေဘၤာတင္ေနွာင့္ေနွးျခင္းနွင့္ ေငြလဲ နႈန္း အတက္အက်ကဲ့သို႔ေသာ ဘီးတပ္ထုိင္ခုံဝန္ေဆာင္မႈ မထိန္းခ်ဳပ္နိုင္ေသာကိစၥမ်ားကိုလည္း အာရံုစိုက္ရန္ လို သည္။ ေဒသတြင္ထုတ္လုပ္ေသာ ထုတ္ကုန္အတြက္ကုန္က်စရိတ္တြက္ခ်က္ျခင္းတြင္ အမွန္တကယ္ထုတ္လုပ္မႈ ကုန္က်စရိတ္အျပင္ အလုပ္ရံုလည္ပတ္စရိတ္နွင့္ပတ္သက္၍ႀကီးမားေသာ ဗဟုသုတလိုၿပီး ႀကိဳတင္ခန္႔မွန္းရန္ခက္ခဲ ၁။ ရင္းျမစ္နည္းေသာအေျခအေနမ်ားတြင္လက္သုံးဘီးတပ္ကုလားထိုင္ပ့ံပိုးေရးလမ္းၫြဳန္မ်ား ၂၀၀၈။ စာမ်က္နွာ ၃၄။ (http://www.who.int/ disabilities/publications/technology/wheelchairguidelines/en/). bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 32 33 နိုင္သည္။ လိုအပ္ေသာဝန္ထမ္း၊ သိုေလွာင္ရန္လိုအပ္ခ်က္၊ သြင္ကုန္လုပ္ငန္းစီမံခန္႔ခြဲျခင္း သို႔မဟုတ္ ေဒသထုတ္ လုပ္ေရးလိုအပ္ခ်က္မ်ားကဲ့သို႔ေသာ အစီအစဥ္မ်ား ကိုစဥ္းစားရန္လိုသည္။ ေဒသထုတ္ကုန္နွင့္သြင္းကုန္အက်ိဳးေက်းဇူးမ်ားနွိုင္းယွဥ္ျခင္း ထုတ္ကုန္မ်ားကိုေဒသတြင္ ထုတ္လုပ္သည္ျဖစ္ေစ တင္သြင္းသည္ျဖစ္ေစ ဘီးတပထ္ုိင္ခုမံ်ားသည္ ဘီးတပ္ ထုိင္ခုလံမ္းၫႊန္မ်ား၂ တြင္ ဖြင့္ဆိုထားသည့္အတိုင္း သင့္ေတာ္သင့္သည္။ ယခင္က ရင္းျမစ္နည္းေသာအေျခအေနမ်ား အတြက္ ရည္႐ြယ္ပံုစံထုတ္ထားေသာ ဘီးတပထ္ုိင္ခုမံ်ား တင္သြင္းရန္မျဖစ္နိုင္ေပ။ ထို႔ေၾကာင့္ေဒသတြင္ထုတ္လုပ္ျခင္းသည္ သင့္ေတာ္ေသာထုတ္ကုန္ရရွိရန္ တခုတည္းေသာ နည္းလမ္း ျဖစ္ခဲ့သည္။ သို႔ေသာ္ ရင္းျမစ္နည္းေသာအေျခေနမ်ားအတြက္ ရည္႐ြယ္ေသာ ဘီးတပထ္ုိင္ခုမံ်ားကို သြင္းကုန္မွ ပိုမိုရရွိလာၾကသည္။ ၎ကိုသိရွိၿပီး နည္းလမ္းနွစ္ခုလံုး၏အက်ိဳးေက်းဇူးမ်ားကို နႈိင္းယွဥ္ပါက ပိုမိုအသံုးဝင္သည္။ နႈိင္းယွဥ္မႈဇယားသည္ ဘီးတပထ္ုိင္ခုအံသုံးျပဳသူမ်ားအတြက္ သင့္ေတာ္ေသာ ဘီးတပထ္ုိင္ခုအံမ်ိဳးမ်ိဳးရရန္ အေကာင္းဆံုးအာမခံနိုင္ေသာ ပ့ံပိုးမႈ နည္းလမ္းေ႐ြးခ်ယ္ရာတြင္ စဥ္းစားရမည့္အခ်က္မ်ားကို မီးေမာင္းထိုး ေဖာ္ျပ ထားသည္။ ၂။ ရင္းျမစ္နည္းေသာအေျခအေနမ်ားတြင္လက္သုံးဘီးတပ္ကုလားထိုင္ပ့ံပိုးေရးလမ္းၫြဳန္မ်ား ၂၀၀၈။ စာမ်က္နွာ ၇၁ (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 34 35 ေဒသထုတ္လုပ္မႈ ေကာင္က်ိဳးမ်ား ဆိုးက်ိဳးမ်ား • ေဒသထုတ္လုပ္မႈကို အစိုးရက ကတိကဝတ္ျပဳျခင္းသည္ မသန္စြမ္းမႈသည္ ရပ္႐ြာအသိုင္းအဝန္းနွင႔္ဆိုင္ေသာ ျပႆနာ တခုျဖစ္ေၾကာင္း နွင့္ ဘီးတပ္ကုလားထိုင္ထုတ္လုပ္ မႈအပါအဝင္ ၎၏သြင္ျပင္လကၡဏာမ်ားကို ကိုင္တြယ္ေျဖရွင္းရန္လိုေၾကာင္း သတင္းစကားေပးပို႔နိုင္သည္။ • ထုတ္လုပ္မႈကိုေဒသလိုအပ္ခ်က္အတိုင္း ပံုသြင္းနိုင္သည္။ • ထုတ္ကုန္ကို ေဒသတြင္ရနိုင္ေသာ အပိုပစၥည္းမ်ားျဖင့္ အလြယ္တကူ ပ့ံပိုးနိုင္သည္။ • ေဒသဘီးတပ္ကုလားထိုင္ ျပဳျပင္ ထိန္းသိမ္းေရးကို ပ့ံပိုးနိုင္ေသာ ေဒသ ထုတ္လုပ္ေရးအလုပ္မ်ားနွင့္ က်ြမ္းက်င္မႈမ်ား ဖန္တီးေပးသည္။ • ေဒသထုတ္လုပ္သူတြင္စြမ္းရည္ရွိလ်င္ သုံးစြဲသူအတြက္ျပဳလုပ္ေပးေသာ ဘီးတပ္ကုလားထိုင္လိုအပ္ခ်က္ ကိုေျဖရွင္းနိုင္မည္။ • ေဒသထုတ္လုပ္မႈျဖင့္ လိုက္ေလ်ာညီေထြရွိေသာ သိုေလွာင္မႈကို ထိန္းသိမ္းထားနိုင္ရန္ပိုမိုလြယ္ကူ မည္။ • စဥ္ဆက္မျပတ္ လိုသလိုရနိုင္ေသာ ထုတ္လုပ္မႈေၾကာင့္ ေလွာင္ကုန္အတြက္ေနရာ အနည္းဆံုးလိုအပ္ျခင္း • ထုတ္ကုန္ထုတ္လုပ္ေရးနွင့္ ျပႆနာနွင့္လိုအပ္ခ်က္မ်ား ကိုတုန္႔ျပန္ရာတြင္ ေဒသအသုံးျပဳသူမ်ားကို ထည့္သြင္းရန္ မ်ားစြာ ပိုမိုလြယ္ကူျခင္း • အေသးစား စက္မႈထုတ္လုပ္မႈမဟုတ္ေသာေၾကာင့္ အေရအေသြးထိန္းရန္ခက္ခဲျခင္း • စက္ယႏၲယား၊ကိရိယာ၊ ထုတ္လုပ္ရန္ေနရာနွင့္ဝန္ ထမ္းေလ့က်င့္ေရးအတြက္ ကနဦးရင္းနွီးျမႇုတ္နွံမႈလို ျခင္း • ထုတ္ကုန္အမွာစာမ်ားသည္ အလုပ္ရံုလည္ပတ္မႈနွင့္ ထုတ္လုပ္မုစရိတ္ကို မကာမိေသာအခါ အလုပ္ရံုဝန္ထမ္းမ်ားကို ထိန္းသိမ္းရန္ ခက္ခဲျခင္း • ထုတ္လုပ္မႈအလုပ္ရံုကိုစီမံခန္႔ခြဲျခင္းသည္ ရႈပ္ေထြးနိုင္သည္။ • ပစၥည္းနွင့္အစိတ္အပိုင္းမ်ား ေဒသတြင္ရနိုင္မႈအေပၚ မွီခိုရျခင္း • အကန္႔အသတ္ရွိေသာ ထုတ္လုပ္မႈအေရအတြက္သည္ ထုတ္လုပ္မႈစရိတ္ျမင့္မားေစျခင္း • - ေဒသထုတ္လုပ္မႈ၏လုပ္အားစိုက္မႈ သေဘာသဘာဝေၾကာင့္ ဘီးတပ္ကုလားထိုင္ပ့ံပိုးမႈ၏ ကုသမႈသြင္ျပင္လကၡဏာမ်ားကို အာရုံစိုက္ရန္အခ်ိန္နည္းျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 34 35 တင္သြင္းဘီးတပ္ထိုင္ခုံမ်ား ေကာင္းက်ိဳးမ်ား ဆိုးက်ိဳးမ်ား • တင္သြင္းဘီးတပ္ထိုင္ခုံမ်ားသည္ ေဒသတြင္ရနိုင္ ေ သာဘီးတပ္္ထိုင္ခုံမ်ားကို အသုံးျပဳသူမ်ား၏တဦးခ်င္းလို အပ္ခ်က္မ်ားျပည့္မီရန္ အမ်ိဳးမ်ိဳးေသာထုတ္ကုန္မ်ားနွင့္ အစိတ္အပိုင္းမ်ား ရနိုင္ေၾကာင္း ေသခ်ာေစရန္ အက်ိဳးျပဳနိုင္သည္။ • ေကာင္းမြန္စြာထူေထာင္ၿပီးေသာ အေရအေသြးထိန္းခ်ဳပ္ေရး ယႏၲရားနွင့္ တည္ၿငိမ္ၿပီး ထုတ္လုပ္သူတို႔ေၾကာင့္ ေရွ႕ေနာက္ညီၫႊတ္ေသာ ထုတ္ ကုန္အေရအေသြး • ေဒသအရျဖစ္နိုင္ေသာ ထုတ္လုပ္မႈထက္ျမင့္မားေသာ ထုတ္လုပ္မႈပမာဏေၾကာင့္ ျဖစ္နိုင္ေသာ ထုတ္လုပ္မႈကုန္က်စရိတ္သက္သာျခင္း စရိတ္သက္သာ ျခင္းသည္ ဘီးတပ္္ထိုင္ခုံပိုမိုျဖန္႔ခ်ိျခင္းျဖစ္နိင္သည္။ • ထုတ္လုပ္မႈတြင္အာရံုစိုက္ရန္ အခ်ိန္ကုန္သက္သာသျဖင့္ ဘီးတပ္္ထိုင္ခုံဝန္ေဆာင္မႈသည္ စြမ္းရည္ကို ကုသေရး က်ြမ္းက်င္မႈတြင္ပိုမိုအာရံုစိုက္နိုင္ျခင္းရရွိမည္။ • တပ္ဆင္ျခင္း၊ ခ်ိန္ညႇိျခင္း၊ ကိုယ္ေနဟန္ေထာက္ကူမႈျပဳ ျပင္ျဖည့္စြက္ျခင္း၊ျပဳျပင္ထိန္းသိမ္းျခင္းတို႔အတြက္ ေဒသအလုပ္မ်ားရနိုင္ျခင္း • ေဒသထုတ္လုပ္မႈထက္ စက္ယႏၲရား၊ ကိရိယာ၊ ပစၥည္းနွင့္ လံုၿခံဳေရးအတြက္ကနဦးရင္းနွီးျမႇုတ္နွံမႈစရိတ္နည္းျခင္း။ • ေဒသထုတ္လုပ္မႈထက္ ရႈပ္ေထြးမႈနည္းေသာ အလုပ္ရံု/ နည္းပညာ စီမံခန္႔ခြဲမႈသာလိုျခင္း • စီစဥ္မႈနွင့္သြင္းကုန္အေကာက္အခြန္စရိတ္ • သေဘၤာတင္ပို႔စရိတ္သည္ ကုန္က်မႈသက္သာေစရန္ ပိုမို မ်ားျပားေသာအမွာစာလိုျခင္း • အနည္းဆံုးအမွာစာအေရအတြက္အရ ေပ်ာ့ေျပာင္းမႈနည္းျခင္း • အနည္းဆံုးအေရအတြက္ လိုအပ္ခ်က္ရွိလွ်င္ ထုတ္လုပ္မႈမစတင္မီ ပိုမိုရွည္ၾကာေသာ တင္ပို႔ခ်ိ္န္နင့္ ထုတ္လုပ္ခ်ိန္ရွိျခင္း • ပမာဏပိုမိုႀကီးမားေသာအမွာစာမ်ားသည္ ႀကီးမားေသာအရင္းအနွီး၊ ပိုမိုက်ယ္ျပန္႔ေသာ သိုေလွာင္ စရာေနရာနွင့္ ပိုမိုႀကီးမားေသာ သိုေလွာင္ပစၥည္းစာရင္း ယႏၲရားလိုျခင္း • အမွာစာနည္းေသာပိုမိုမ်ားျပားသည့္ သိုေလွာင္ပစၥည္းဝယ္ ယူမႈနွင့္ပတ္သက္ေသာ ညီၫြတ္သည့္ေလွာင္ကုန္ထိမ္း သိမ္းရန္ခက္ခဲျခင္း • အေတြ႕ရမ်ားေသာသြင္ကုန္မ်ားသည္ ေဒသလိုအပ္ခ်က္ မ်ားအတိုင္းျပဳလုပ္မထားနိုင္ျခင္း • ထုတ္ကုန္ကို ေဒသတြင္ရနိုင္ေသာအပိုပစၥည္းမပ့ံပိုးနိုင္ျခင္း • ေဒသကုန္ထုတ္လုပ္ေရးအလုပ္မဖန္တီးနိုင္ျခင္း • ထုတ္ကုန္ထုတ္လုပ္ရာတြင္ ေဒသအသုံးျပဳသူမ်ားပါဝင္ရန္ ပိုမိုခက္ခဲျခင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား တင္သြင္းျခင္း ရင္းျမစ္ႂကြယ္ဝေသာအေျခအေနအမ်ားအျပားတြင္ ဘီးတပ္ထိုင္ခုံမၾကာခဏလဲလွယ္ျခင္း နွင့္ ကာလတို အသုံးျပဳျခင္းတို႔ေၾကာင့္ အသုံးျပဳၿပီးဘီးတပ္ထိုင္ခုံ အမ်ားအျပားရွိေနၾကသည္။ တုန္႔ျပန္ေဆာင္႐ြက္သည့္အေနျဖင့္ အဖြဲ႕အစည္းမ်ားသည္ ထိုဘီးတပ္ထုိင္ခုံမ်ားကို စုေဆာင္း ျပန္လည္ထိန္းသိမ္းၿပီး ရင္ျမစ္ႂကြယ္ဝမႈနည္းေသာ အေျခ အေနမ်ားသို႔ တင္ပို႔ၾကသည္။ ျပန္လည္အသုံးျပဳ ဘီးတပ္ထိုင္ခုံမ်ားကို သင့္အဖြဲ႕အစည္းတင္သြင္းရန္ဆံုးျဖတ္ေသာအခါ သင့္ေတာ္ေသာ ဘီးတပ္ထိုင္ခုံ၏အဓိပၸာယ္ဖြင့္ဆိုခ်က္ကို ထည့္သြင္းစဥ္းစားရမည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 36 37 • အသုံးျပဳသူ၏လိုအပ္ခ်က္မ်ား၊ပတ္ဝန္းက်င္အေျခအေနမ်ားနွင့္ကိုက္ညီျခင္း • စနစ္က်အံဝင္ကြင္က်မႈနွင့္ ကိုယ္ေနဟန္ေထာက္ကူမႈေပးျခင္း • ေဘးကင္းၿပီးေရရွည္ခံျခင္း • နိုင္ငံတြင္ရနိုင္ျခင္း နွင့္ • ရယူထိန္းသိမ္းနိုင္ျခင္းနွင့္ သက္သာေသာနႈန္းထားျဖင္နိုင္ငံတြင္ဝန္ေဆာင္မႈထိန္းသိမ္းနိုင္ျခင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံတင္သြင္းေသာအခါ စဥ္းစားရန္အခ်ိဳ႕မွာ • ရနိုင္ေသာထုတ္ကုန္သည္ ရင္းျမစ္နည္းေသာအေျခအေနနွင့္သင့္ေတာ္ေၾကာင္း မည္သို႔ေသခ်ာေစမည္ • ရနိုင္ေသာထုတ္ကုန္သည္ အမ်ိဳးအစား၊ အ႐ြယ္အစားနွင့္အရည္အေသြးအမ်ိဳးမ်ိဳးွလြန္စြာကြဲျပားေနလွ်င္ နိုင္ငံတ နိုင္ငံအတြင္း လုိအပ္ခ်က္မ်ားကိုမည္သို႔ရွာေဖြတုန္႔ျပန္မည္။ • အပိုပစၥည္မ်ားမည္သို႔ေရရွည္ေထာက္ပ့ံမည္။ • မတူညီေသာထုတ္လုပ္သူမ်ား၏ထုတ္ကုန္အမ်ိဳးမ်ိဳးကို ခ်ိန္ညႇိရန္နွင့္ ထူေထာင္ရန္ မွန္ကန္ေသာကိရိယာမ်ား မည္သို႔ေပးမည္။ • လက္ရွိေဒသခံထုတ္လုပ္သူမ်ားနွင့္ဝန္ေဆာင္မႈေပးသူမ်ားအေပၚရိုက္ခတ္မႈ။ လက္ရွိဝန္ေဆာင္မႈအတြင္း ဘီးတပထ္ိုင္ခုမံ်ားကိုျပန္လည္အသုံးျပဳျခင္း ဝန္ေဆာင္မႈလုပ္ငန္းႀကီးထြားလာေသာအခါ ေဖာက္သည္အခ်ိဳ႕သည္ ဘီးတပ္ထိုင္ခုံထက္ ႀကီးထြားလာ ၾကမည္၊ ဘီးတပ္ထိုင္ခုံသစ္ရယူၾကမည္၊ ဘီးတပ္ကုလားထိုင္ကိုဆက္လက္အသုံးမျပဳၾကေတာ့မည္ကို ေရွာင္လႊ၍ဲ မရေပ။ ၎ကိုတုန္႔ျပန္သည့္အေနျဖင့္ အခ်ိဳ႕အဖြဲ႕အစည္းမ်ားသည္ ဘီးတပ္ထိုင္ခုံမ်ားကိုဝန္ေဆာင္မႈသို႔ ျပန္အပ္ၿပီး အျခားအသုံးျပဳသူသို႔ ျပန္လည္သံုးေသာစနစ္တခု ထူေထာင္ရန္ေ႐ြးခ်ယ္မည္။ ၎သည္ ပိုမိုမ်ားျပားေသာအသုံးျပဳ သူမ်ားကို အက်ိဳးျပဳနိုင္သည္။ သုိ႔ေသာ္ ၎သည္ သင္၏ဝန္ေဆာင္မႈလုပ္ငန္းအတြက္ေကာင္းမြန္ေသာေ႐ြးခ်ယ္မႈ ျဖစ္ေၾကာင္းမဆံုးျဖတ္မီ စဥ္းစားစရာအမ်ားအျပားရွိသည္။ အဖြဲ႕အစည္းတခုသည္ ျပန္လည္အသုံးျပဳထုတ္ကုန္မ်ားကို ေ႐ြးခ်ယ္ပါက ထိုျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ ခုံသည္ အသုံးျပဳသူအတြက္ သင့္ေတာ္ေနဆဲျဖစ္သလားဟု စဥ္းစားရန္အေရးႀကီးသည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 36 37 အစိတ္အပိုင္းအမ်ားအျပားကို အစားထိုး သို႔မဟုတ္ ျပဳျပင္ရန္လိုမည္ျဖစ္ၿပီး ေနာက္အသုံးျပဳသူ လံုၿခံဳမႈနွင့္ က်န္းမာ ေရးအတြက္ ဘက္တီးရီယားမ်ားရိွနိုသ္ေသာမည္သည့္အစိတ္အပိုင္း(ေရျမႇုတ္၊ ကူရွင္အဖံုးအကာ၊ သိုင္းႀကိဳးမ်ား စသည္) ကိုမဆို လဲလွယ္သင့္သည္။ သင္၏အစီအစဥ္အတြင္း ျပန္လည္အသုံးျပဳဘီးတပ္ထိုင္ခုံမ်ား၏ ရႈပ္ေထြးမႈနွင့္ လက္ေတြ႕အသုံးျပဳနိုင္မႈ အေပၚသက္ေရာက္ေသာ အခ်က္အခ်ိဳ႕မွာ - • အစားထိုးအစိတ္အပိုင္းမ်ားရနိုင္ျခင္း • ၾကည့္ရႈေသာေဖာက္သည္ပမာဏ • ေဖာက္သည္မ်ားနွင့္သုံးေသာေငြေၾကးပ့ံပိုးမႈနည္းလမ္း • ေဖာက္သည္မ်ား၏အသက္အ႐ြယ္ • ပ့ံပိုးေသာထုတ္ကုန္အရည္အေသြး ေဒသေျမမ်က္နွာျပင္နွင့္ သဘာဝပတ္ဝန္းက်င္အခ်က္အလက္မ်ား (၎တို႔သည္ ဘီးတပထ္ိုင္ခုံ ထပ္မံ စဥ္းစားရန္အခ်က္မ်ားတြင္ ေအာက္ပါတို႔ပါဝင္သည္။ • ျပန္လည္အသုံးျပဳရန္ ဝန္ေဆာင္မႈသို႔ ဘီးတပ္ထိုင္ခုံကိုျပန္လည္ပို႔ေဆာင္ရန္လိုျခင္း • ျပန္လည္ျပဳျပင္ရန္ အလုပ္ရံုအတြက္ေနရာ ထပ္မံလိုအပ္ျခင္း • အဆင့္ျမင့္နည္းပညာနွင္အ့ရည္အေသြးထိန္းခ်ဳပ္မႈေလ့က်င့္ရန္လိုျခင္း bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 38 39 အေထာက္အကူျပဳနည္းပညာအတြက္အကဲျဖတ္စစ္ေဆးခ်ိန္တြင္ ပါဝင္ေဆာင္႐ြက္မႈ တိုင္းတာေရးကိရိယာ ေျဖၾကားသူ - ေနရာ - ရက္စြဲ - ေမးျမန္းသူအမည္ - ၁။ သင့္တြင္မည္သည့္အေထာက္အကူျပဳကိရိယာမဆိုရွိပါသလား။ ရွိသည္ မရွိပါ (၅ သို႔သြားပါ) ၂။ ရွိပါက မည္သည့္အေထာက္အကူျပဳကိရိယာနည္း။ ၃။ ရွိပါက သင့္တြင္ရွိေသာ အေထာက္အကူျပဳကိရိယာမ်ားကို လက္ရွိအသုံးျပဳေနပါသလား။ သံုးသည္ မရွိပါ (၅ သို႔သြားပါ) ၄။ သုံးေနပါက မည္သည္တို႔နည္း။ အားလုံး အခ်ိဳ႕ , အေသးစိတ္ - ေနာက္ေမးခြန္မ်ားသည္ သင္၏အိမ္တြင္ေန႔စဥ္လုပ္ငန္းမ်ားေဆာင္႐ြက္ရာ၌ မည္မ်ခက္ခဲသည္နွင့္ ဆိုင္ ေသာေမးခြန္းမ်ားျဖစ္သည္။ ဤေနရာတြင္ အျခားသူမ်ားထံမွ အကူအညီနွင့္ အေထာက္အကူျပဳကိရိယာ သုံးစြဲမႈပါဝင္သည္။ ၅။ ခရီးသည္အျဖစ္သြားလာရာတြင္ သယ္ယူပို႔ေဆာင္ေရးသုံးရာ၌ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၆။ ေလ်ာ္ဖြတ္ေဆးေၾကာျခင္း ကဲ့သို႔ေသာ အိမ္အလုပ္လုပ္ရန္ မည္သည့္အတိုင္းအတာအထိျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၇။ ေက်ာင္းသြားသင္ယူရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၈။ အလုပ္ရရန္ ၿမဲရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၉။ အားကစား၊ ၿပိဳင္ပြဲ၊ ပန္းခ်ီနွင့္လက္မႈပညာ၊ အက၊ဂီတ စသည့္ အပမ္းေျဖလႈပ္ရွားမႈမ်ားတြင္ပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ ၁၀။ လူမႈေရးလႈပ္ရွားမႈမ်ားတြင္တက္ႂကြစြာပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 38 39 အေထာက္အကူျပဳနည္းပညာေနာက္ဆက္တြဲ အကဲျဖတ္စစ္ေဆးခ်ိန္တြင္ ရလာဒ္ နွင့္ ေက်နပ္မႈ တိုင္းတာေရးကိရိယာ ေျဖၾကားသူ - ေနရာ - ရက္စြဲ - ေမးျမန္းသူအမည္ - ၁။ မည္သည့္အေထာက္အကူုျပဳကိရိယာ အသုံုးျပဳေနသနည္း။ ၂။ ၎ကိုရသည္မွာမည္မ်ၾကာၿပီနည္း။ ၃။အေထာက္အကူျပဳကိရိယာကိုလတ္တေလာအသုံးျပဳပါသလား။ ျပဳသည္(၅သို႔သြားပါ) မသုံးပါ ၄။ မသုံးက မည္သည္ေၾကာင့္နည္း။ (ေမးခြန္း ၄ ကိုေျဖလွ်င္ က်န္ေမးခြန္းမ်ားကိုေက်ာ္ပါ) လာမည့္ေမးခြန္မ်ားသည္ သင္၏အိမ္တြင္ေန႔စဥ္လုပ္ငန္းမ်ားေဆာင္႐ြက္ရာ၌ မည္မ်ခက္ခဲသည္နွင့္ဆိုင္ေသာ ေမးခြန္းမ်ားျဖစ္သည္။ ဤေနရာတြင္ အျခားသူမ်ားထံမွ အကူအညီနွင့္ အေထာက္အကူျပဳကိရိယာသုံးစြဲမႈ ပါဝင္သည္။ ၅။ ခရီးသည္အျဖစ္သြားလာရာတြင္ သယ္ယူပို႔ေဆာင္ေရးသုံးရာ၌ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၆။ ေလ်ာ္ဖြတ္ေဆးေၾကာျခင္း ကဲ့သို႔ေသာ အိမ္အလုပ္လုပ္ရန္ မည္သည့္အတိုင္းအတာအထိျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၇။ ေက်ာင္းသြားသင္ယူရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 40 41 ၈။ အလုပ္ရရန္ ၿမဲရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ ၉။ အားကစား၊ ၿပိဳင္ပြဲ၊ ပန္းခ်ီနွင့္လက္မႈပညာ၊ အက၊ဂီတ စသည့္ အပမ္းေျဖလႈပ္ရွားမႈမ်ားတြင္ပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က္ ၁၀။ လူမႈေရးလႈပ္ရွားမႈမ်ားတြင္တက္ႂကြစြာပါဝင္ရန္ မည္သည့္အတိုင္းအတာအထိ ျပႆနာရွိသနည္း။ ျပႆနာမရွိ အနည္းငယ္ရွိ အသင့္အတင့္ရွိ အျပင္းအထန္ရွိ မျဖစ္ႏုိင္ အသုံးမဝင္ သုံးသပ္ခ်က ္ လာမည့္ေမးခြန္မ်ားသည္ အေထာက္အကူျပဳကိရိယာနွင့္ပတ္သက္၍ သင္မည္မွ်ေက်နပ္သည္နွင့္ ပတ္သက္ ေသာေမးခြန္းအခ်ိဳ႕ျဖစ္သည္။ ၁၁။ ၎၏အ႐ြယ္အစားကိုသင္မည္မ်ေက်နပ္သနည္း။ (၎သည္မည္မ်ႀကီးသနည္း။) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၂။ ၎၏အေလးခ်ိန္နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ (မည္မ်ေလးသနည္း) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 40 41 ၁၃။ တေနရာမွတေနရာသို႔သြားရန္လြယ္ကူမႈနွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၄။ ၎၏ပုံသဏၰန္နွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၅။ အသုံးလြယ္ကူမႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၆။ တည္ေဆာက္ရန္ၾကာခ်ိန္နွင့္ပတ္သက္၍သင္မည္မွ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၁၇။ ၎၏မွီခိုအားထားနိုင္မႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 42 43 သုံးသပ္ခ်က ္ ၁၈။ သင္၏လိုအပ္ခ်က္မ်ားျဖည့္ဆည္းေပးမႈနွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္ပါသနည္း။ ( ၎သည္သင္လုပ္ေစ လိုသည္မ်ားအားလံုးကိုသင့္ေတာ္ေသာအခ်ိန္အတြင္း လုပ္ပါသလား။ ) ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က္ ေရွ႕ေမးခြန္းမ်ားသည္ သင္ အေထာက္အကူျပဳကိရိယာ ရရွိေသာနည္းလမ္းနွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သည္ နွင့္ဆိုင္ေသာေမးခြန္းမ်ားျဖစ္သည္။ ၁၉။ မည္သည့္နည္းပညာသည္သင့္အတြက္အေကာင္းဆံုးျဖစ္ေၾကာင္းေပးေသာအႀကံဥဏ္ နွင့္ပတ္သက္၍ သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၂၀။ ရရွိရန္ၾကာခ်ိန္ နွင့္ပတ္သက္၍သင္မည္မွ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ၂၁။ ၎သည္စနစ္တက်အလုပ္မလုပ္လ်င္ အေထာက္အကူ နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 42 43 သုံးသပ္ခ်က္ ၂၂။ ၎က္ိုမည္သို႔သုံးမည္နွင့္ပတ္သက္၍ ေပးေသာ အႀကံဥဏ္နွင့္အကူအညီ နွင့္ပတ္သက္၍သင္မည္မ်ေက်နပ္ သနည္း။ ဆိုး႐ြားသည္ စိတ္မခ်မ္းေျမ႕ မ်ားေသာအားျဖင့္ မေက်နပ္ ေရာေထြးေန မ်ားေသာအားျဖင့္ ေက်နပ္သည္။ ေက်နပ္သည္ အလြန္ေက်နပ္သည္ သုံးသပ္ခ်က ္ ေရွ႕ေမးခြန္မ်ားသည္ ေထာက္ကူမႈကိရိယာအသုံးျပဳေသာသင္၏အေတြ႕အႀကံဳနွင့္ဆိုင္ေသာ ေမးခြန္းအခ်ိဳ႕ျဖစ္သည္။ ၂၃။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္းသင္သည္ သင္၏လက္ရွိအေထာက္အကူျပဳကိရိယာကို မည္မ်အသုံးျပဳသနည္း၊ ပ်မ္း မ်တရက္လွ်င္နာရီမည္မ်သုံးသနည္းကိုစဥ္းစားပါ။ မသံုးပါ တေန႔တနာရီေအာက္ တေန႔ ၁ နာရီမွ ၄ နာရီ တေန႔ ၄ နာရီမွ ၈ နာရီ တေန႔ ၈ နာရီအထက္ သုံးသပ္ခ်က ္ ၂၄။ လက္ရွိအေထာက္အကူျပဳကိရိယာကိုမရမီ သင္ျပဳလုပ္ခ်င္ဆံုးေသာ၊ပိုမိုေကာင္းမြန္ေအာင္လုပ္ လိုေသာ အေနအထားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း ဤအေထာက္အကူျပဳကိရိယာသည္ ထိုအေနအထားတြင္သင့္ကို မည္မ် အေထာက္အကူျပဳသနည္း။ လံုးဝအေထာက္အကူမရ လံုးဝအေထာက္အကူမရ အတန္အသင့္ရသည္ အလြန္ရသည္။ သုံးသပ္ခ်က ္ ၂၅။ သင္အလုပ္ခ်င္ဆံုး သို႔မဟုတ္ပိုမိုေကာင္းေအာင္လုပ္လိုေသာအေနအထားကိုထပ္မံစဥ္းစားပါ။။ သင္၏လက္ရွိအ ေထာက္အကူျပဳကိရိယာကိုသုံးေသာအခါ ထိုအေနအထားအတြက္အခက္အခဲမည္မ် ရွိေနဆဲျဖစ္သနည္း။ မျဖစ္နိုင္ အမ်ားအျပားရွိ အတန္အသင့္ရွိ အနည္းငယ္ရွိ မရွိ သုံးသပ္ခ်က္ ၂၆။ အရာရာကိုထည့္သြင္းစဥ္းစားၿပီေနာက္ သင္လက္ရွိသုံးေနေသာ အေထာက္အကူျပဳကိရိယာသည္ လံုေလာက္ စြာအသုံးဝင္သည္ဟုသင္ယူဆပါသလား။ ( ဤအေထာက္အကူျပဳကိရိယာမွသ္ရေသာ အက်ိဳးေက်းဇူးမ်ားသည္ မည္သည့္အခက္အခဲထက္မဆိုသာလြန္ပါသလား၊ သိုေလွင္ျခင္း၊ ျပဳျပင္ထိန္းသိမ္းျခင္း၊ သယ္ယူပို႔ေဆာင္ျခင္း၊ ကိိရိယာအသုံးျပဳျခင္း) လံုးဝမထိုက္တန္ အနည္းငယ္ထိုက္တန္သည္ အတန္အသင့္ထိုက္တန္သည္ ထိုက္တန္သည္ အလြန္ထိုက္တန္သည္ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 44 45 သုံးသပ္ခ်က္ ၂၇။ ဤအေထာက္အကူျပဳကိရိယာရယူေစရန္ ျဖစ္ေပၚခဲ့ေသာ အခက္အခဲမ်ားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း သင္၏အေထာက္အကူျပဳကိရိယာျဖင့္ သင္လုပ္လိုေသာအရာမ်ားအေပၚ သင္၏ အေထာက္အကူျပဳကိရိယာက အခက္အခဲမည္မွ်သက္ေရာက္ေစသနည္း။ Impossible Significantly affected Moderately affected Slightly affected Not affected at all သုံးသပ္ခ်က ္ ၂၈။ ဤအေထာက္အကူျပဳကိရိယာရယူေစရန္ ျဖစ္ေပၚခဲ့ေသာ အခက္အခဲမ်ားကို စဥ္းစားပါ။ လြန္ခဲ့ေသာ ၂ ပတ္အတြင္း သင္၏လက္ရွိအေထာက္အကူျပဳ ကိရိယာျဖင့္ သင္အေထာက္အကူျပဳကိရိယာရရွိေသာအခက္အခဲ မ်ားနွင့္ပတ္သက္၍ အျခားသူမ်ားကမည္မ်စိုးရိမ္ခဲ့ၾကသနည္း။ Very much Quite a lot Moderately Slightly Not at all သုံးသပ္ခ်က ္ ၂၉။ အရာရာကိုထည့္သြင္းစဥ္းစားၿပီး သင္၏အေထာက္အကူျပဳကိရိယာက သင့္ဘဝကိုမည္မ်ေျပာင္းလဲေစခဲ့သနည္း။ Worse No change Slightly better Quite a lot Very much သုံးသပ္ခ်က္ ရင္းျမစ္ - WHO International Classification of Functioning, Disability and Health (ICF). QUEST 2.2. Modified from the QUEST 2.1: Children’s Version by Sonya Murchland 2011. IOI-HA. Cox RM, Stephens D, Kramer SE (2002). Translations of the International Outcome Inventory for Hearing Aids (IOI-HA). International Journal of Audiology 41(1):3-26. bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 44 45 ခ်ဥ္းကပ္နိုင္မႈသတင္းအခ်က္အလက္မ်ား အစိုးရဝန္ႀကီးဌာနမ်ားနွင့္ပူးေပါင္းေဆာင္႐ြက္ျခင္း - က်န္းမာေရး၊ ပညာေရး၊သယ္ယူပ္ို႔ေဆာင္ေရးနွင့္ရရွိနိုင္ မႈ အႀကံ ေပးေသာ ရပ္႐ြာအဖြဲ႕အစည္းမ်ား သည္ ေ႐ြ႕လ်ားသြားလာနိုင္မႈထိခိုက္ေနသူမ်ား လူ႔အဖြဲ႕အစည္းတြင္ ပါဝင္နိုင္ေရး နွင့္ထည့္သြင္းေရးကို သိသိသာသာတိုးတက္ေစသည္။ တည္ေဆာက္ခ်ိန္တြင္ အေဆာက္အအံုမ်ားကို ခ်ဥ္းကပ္နုိင္ ေအာင္ျပဳလုပ္ထားျခင္သည္ ေနာင္မွ ျပင္ဆင္ျဖည့္စြက္ရျခင္းထက္မ်ားစြာ ကုန္က်စရိတ္သက္သာေစသည္။ ရိုးရွင္းေသာအခ်က္အလက္အခ်ိဳ႕ကိုေအာက္တြင္ေဖာ္ျပထားသည္။ အေသးစိတ္မ်ားကို ဤသင္ရိုးတြင္ ေဖာ္ျပထား ေသာ ရင္းျမစ္မ်ားတြင္ရနိုင္သည္။ ေနအိမ္ကိုခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ျခင္း • အဓိက စဥ္းစားရမည့္အခ်က္မ်ားတြင္ အဆင့္မ်ား၏အျမင့္နွင့္ အလုပ္မ်က္နွာျပင္ေအာက္သို႔ခ်ဥ္းကပ္မႈပါဝင္သည္။ • တံခါးေပါက္အဝင္လမ္းမ်ား: အက်ယ္၊အဖြင့္ဦးတည္ဘက္၊ လက္ကိုင္မ်ား bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 46 47 တံခါးအဝင္ေပါက္မ်ား • တံခါးေပါက္အက်ယ္: ၉၀၀ မမ။ • တံခါးမ်ားကို အတြင္းဘက္သို႔ အလုပ္မ်ားေသာေနရာမွ ပိုမိုတိတ္ဆိပ္ေသာေနရာသို႔ ပြင့္ေအာင္ပတၱာတပ္ရန္ႀကိဳးစားပါ။ ဥပမာ ေည့္ခန္းမွအိပ္ခန္းသို႔။ • ၁၈၀ဒီဂရီနီးပါး ပြင့္နိုင္ေသာပတၱာမ်ားရရန္ ႀကိဳးစားပါ။ • လွည့္ပတ္ရန္ေနရာ: တံခါး၏နွစ္ဘက္လံုးတြင္ ရွင္းလင္းေသာခ်ဥ္းကပ္ရန္ေနရာလိုသည္။ • ခ်ဥ္းကပ္ရန္ အကန္႔အသတ္ရွိေသာေနရာ: ေလ်ာတံခါးတခုကိုစဥ္းစားနိုင္သည္။ (ပံုတြင္ၾကည့္ပါ - ခ်ဥ္းကပ္နိုင္ေသာအိမ္သာ) တံခါးေကာင္းစြာေလ်ာနိုင္ရန္ ၾကမ္းျပင္လမ္းေၾကာင္းကို ေကာင္းစြာထိန္းသိမ္းရမည္။ အိမ္သာမ်ား • ေရအိမ္တြင္သို႔ ပြင့္ေသာတံခါးမ်ားသည္ ေရအိမ္တြင္းေနရာကိုေလွ်ာခ်ၿပီး ျဖစ္နိုင္လွ်င္ ေရွာင္ရွားသင့္သည္။ အျခားေ႐ြးစရာမွာ ေလွ်ာတံခါးျဖစ္သည္။ • အိမ္သာနွင့္ကပ္လ်က္ ကိုင္စရာသံတန္းမွာ ဘီးတပ္ထိုင္ခုံအကူးအေျပာင္းအတြက္ အသုံးဝင္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ 46 47 ရပ္႐ြာခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ျခင္း လူသြားလမ္းမ်ား • လူသြားလမ္းအက်ယ္သည္ အဟန္အတားမရွိေသာ ၉၀၀ မမ ရွိသင့္သည္။ • အသုံးမ်ားေသာလူသြားလမ္းမ်ားသည္ ဘီးတပ္ထိုင္ခုံ ၂ စီး တစီးနွင့္တစီးျဖတ္သန္းႏုိုင္ရန္ ၁၅၀၀ မမ က်ယ္သင့္သည္။ bD;wyfxkdifckH pHEIef;ESifh owfrSwfcsufrsm;qkdfif&m oifwef; မန္ေနဂ်ာမ်ားအတြက္ ပလက္ေဖာင္းအဆင့္မ်ား • ကိုင္းၫြတ္ပလက္ေဖာင္းအဆင့္မ်ား-အနိမ့္အျမင့္ေျပာင္းလဲေသာေနရာရွိ အဆင့္မ်ား၊ထိန္းခ်ဳပ္ကုန္း ေပါင္မ်ား ( ေအာက္ပါသရုပ္ေဖာ္ပံုကိုၾကည့္ပါ) ကုန္းေပါင္မ်ား အေဆာက္အအံုမ်ားသို႔ ခ်ဥ္းကပ္နိုင္ရန္ျပဳလုပ္ေသာအခါ လူအားလံုး၏လိုအပ္ခ်က္ကို စဥ္းစားပါ။ ဘီးတပ္ထိုင္ခုံသုံးသူမ်ားအတြက္ ေအာက္ပါအခ်က္မ်ားကိုစဥ္းစားပါ။ • ဆင္ေျခေလ်ာအေစာင္းဒီဂရီ ၁:၁၂၊ ျပင္ပ ၁:၁၅။ • မ်က္နွာျပင္ - မေခ်ာရ။ • လက္တန္းမ်ား - ေအာက္ေျခမွအဆင္းထိပ္အထိ မၿပီးဆုံးမီ ၃၀၀ မမဆက္ရွိသင့္။ • အဆင္းက္ို ဆင္ေျခေလွ်ာ၏ေအာက္ေျခနွင့္ ထိပ္တြင္ထားသင့္။ ဦးတည္ဘက္ေျပာင္းပါက ၁၂၀၀ မွ ၁၅၀၀ မမ အတိုင္းအတာ။ • ထိပ္အဆင္းမ်ားကို တံခါးအဖြင္းစက္ဝိုင္းအစြန္းမွ တိုင္းတာသင့္သည္။

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ຊຸດຝຶກອົບຮົມການບໍລິການລົດເຂັນ ສໍາລັບຜູ້ຈັດການ ປ້ືມຄູ່ມືອ້າງອີງ ແລະ ປ້ືມຝຶກຫັດວຽກ

ຊຸດຝຶກອົບຮົມການບໍລິການລົດເຂັນ ສໍາລັບຜູ້ຈັດການ ປ້ືມຄູ່ມືອ້າງອີງ ແລະ ປ້ືມຝຶກຫັດວຽກ ຈັດພິມໂດຍອົງການສຸຂະພາບໂລກໃນປີ 2015 ພາຍໃຕ້ຫົວຂໍ ້ Wheelchair Service Training Package for Managers © ອົງການ ອະນາ ໄມ ໂລ 2015 ອົງການອະນາໄມໂລກໄດ້ຮັບສິ ດການແປພາສາແລະສິ ດເຜີຍແຜ່ສໍ າລັບການພິມໃນລາວກັບອົງການ ການພັດທະນາສາກົນ (USAID) ຂອງສະຫະລັດອາເມລິ ກາຊຶ່ ງເປັນຜູ້ຮັບຜິດຊອບພຽງແຕ່ສໍ າລັບຄຸນນະພາບແລະຄວາມຊື່ ສັດຂອງສະ ບັບພາສາລາວ. ໃນກໍລະນີ ທີ່ ມີ ຄວາມບໍ່ ສອດຄ່ອງກັນລະຫວ່າງສະບັບພາສາອັງກິດແລະລາວ, ສະບັບພາສາອັງກິດຕ້ົນສະບັບຈະຕ້ອງມີ ການຜູກມັດແລະຖື ກຕ້ອງ. ຊຸດຝຶ ກອົບຮົມການບໍ ລິ ການລົດເຂັ ນ ສໍ າລັບຜູ້ຈັດການ © USAID 2017 ປະມວນ ຄໍາສັບ ​ຄາໍ​ສັບ​ຕໍ່​ໄປ​ນີ້​ທີ່​ຖືກໃຊ້​ໃນຕະຫຼອດ​ຊຸດ​ການ​ຝຶກ​ອົບ​ຮບົ​ນີ້​ມີ​ນິຍາມ​ຄວາມ​ໝາຍ​ດັງ່​ລຸມ່ນີ.້ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ​ລົດ​ເຂັນ​ທີ່​ຕອບ​ສະໜອງ​ຄວາມ​ຕ້ອງ​ການ​ຂອງ​ຜູ້​ໃຊ້​​ແລະ​ ເງື່ອນ​ໄຂ​ສະພາບ​ແວດ​ລ້ອມ;​ໃຫ້​ຄວາມ​ພໍດີ​ທີ່​ເໝາ​ະສົມ​​ແລະ​ ການ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ຕ່າງໆ;​ປອດ​ໄພ​​ແລະ​ໃຊ້​ໄດ້​ຍາວ​ນານ;​ ມີ​ໃຫ້​ຢູ່​ໃນ​ປະ​ເທດ​ນັ້ນໆ;​​ແລະ​ສາມາດ​ມີ​​ແລະ​ໄດ້​ຮັບ​ການ​ ບໍາລຸງ​ສ້ອມ​ແປງ​​ແລະ​ການ​ບໍລິການ​ຍືນ​ຍົງ​ໃນ​ປະ​ເທດ​ນັ້ນໆ​ ດ້ວຍ​ລາຄາ​ທີ່​ປະຢັດ​ທີ່​ສຸດ​​ແລະ​ສາມາດ​ຊື້​ໄດ້. ລົດ ເຂັນ ແບບ ໃຊ້ ມື ລົດ​ເຂັນ​ທີ່​ຖືກ​ຂັບ​ເຄື່ອນ​ໂດຍ​ຜູ້​ໃຊ້​ຫຼື​ຍູ້​ໂດຍ​ບຸກຄົນ​ອື່ນ. ອຸ ປະ ກອນ ຮອງ ຮັບ ທ່າ ທາງ (PSD) ​ອຸ​ປະ​ກອນ​ປະຄອງ​ຮ່າງ​ກ່າຍ​ທີ່​ໃຫ້ການຮອງ​ຮັບ​​ແລະປະຄອງ​ ທ່າ​ທາງ​ຕ່າງໆ​ເພ່ີມ​ເຕີມ. ລົດ ເຂັນ ​ອຸ​ປະ​ກອນ​ທີ່​ໃຫ້​ການ​ເຄື່ອນ​ທີ່​ໄປ​ມາ​ທີ່​ມີ​ລໍ້​ແລະ​ຮອງ​ຮອບ​ການ​ ນັ່ງ​ສໍາ​ລັບ​ບຸກ​ຄົນ​ທີ່​ມີ​ຄວາມ​ລໍາ​ບາກ​ໃນ​ການ​ຍ່າງ​ຫຼື​ການ​ ເຄື່ອນ​ຍ້າຍ​ໄປ​ມາ. ການ ດັດ ແປງ ລົດ ເຂັນ ​ການ​ປ່ຽນ​ແປງ​ທີ່​ເຮັດກັບ​ລົດ​ເຂັນ. ການ ສະ ໜອງ ລົດ ເຂັນ ​ຄໍາ​ສັບ​ລວມສໍາລັບ​ການ​ອອກ​ແບບ,​ການ​ຜະລິດ,​ການ​ ສະໜອງ​​ແລະ​ການ​ໃຫ້ການ​ບໍລິການ​ບໍາລຸງ​ສ້ອມ​ແປງ​ລົດ​ ເຂັນ. ການ ບໍ ລິ ການ ລົດ ເຂັນ ນັ້ນ​ເປັນ​ສ່ວນ​ໜຶ່ງ​ຂອງ​ການ​ສະ​ໜອງ​ລົດ​ເຂັນ​ທີ່​ກ່ຽວ​ຂ້ອງ​ກັບ​ ການ​ຮັບ​ປະ​ກັນ​ວ່າ​ຜູ້​ໃຊ້​ແຕ່​ລະ​ຄົນ​ໄດ້​ຮັບ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ. ພະ ນັກ ງານ ໃຫ້ ບໍ ລິ ການ ລົດ ເຂັນ ​ບຸກ​ຄົນ​ທີ່​ມີ​ທັກ​ສະ​ໃນ​ການ​ສະ​ໜອງ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ ຜູ້ ໃຊ້ ລົດ ເຂັນ ​ບຸກ​ຄົນ​ທີ່​ມີ​ຄວາມ​ລໍາ​ບ​າກ​ໃນ​ການ​ຍ່າງ​ຫຼື​ເຄື່ອນ​ຍ້າຍ​ໄປ​ມາ​ ແລະ​ໃຊ້​ລົດ​ເຂັນ​ສໍາ​ລັບ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ​ສາ ລະ ບາ ນ ​ 1 ກ່ຽວ ກັບ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ລົດ ເຂັນ ສໍາລັບ ຜູ້ ຈັດການ 4 A. ຄວາມ ຮູ້ ຕ້ົນຕໍ 4 A.1​ການ​ສະໜອງ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ​ແມນ່​ຫຍງັ? 7​ A.2​ການ​ໃຫກ້ານ​ບລໍກິານ 15​ A.3​ຜູ​້ຈດັການ​ທີ​່ນາໍພາ​ການ​ປຽ່ນ​ແປງ 18 B: ການ ເລ່ີ ມການ ບໍລິການ ລົດ ເຂັນ 18​ B.1​​ການ​ເຂົາ້​ເຖງິ​ການ​ບ​ໍລ​ິການ 22​ B.2​​ສິງ່​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ອ​ຸປະ​ກອນ 32​ B.3​​ປະ​ເພດ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ 38​ B.4​​ຈດັ​ວາງ​ບກຸ​ຄະ​ລາ​ກອນ 43​ B.5​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ມີຄາ່​ໃຊ​້ຈາ່ຍ​ແນວ​ໃດ? 47 C: ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ 47 C.1​ທາ່ນ​ຮູ​້ໄດ​້ແນວ​ໃດ​ວາ່ການ​ບລໍກິານ​ຂອງ​ທາ່ນ​ກາໍລງັ​ໄດ້ຜນົ​ດ?ີ 53​ C.2​ການ​ຄຸມ້​ຄອງ​ຄວາມ​ຕອ້ງການ 61​ C.3​ການວາງ​ແຜນການ​ຕິດຕາມ 65 C.4​ການວາງ​ແຜນສາໍລັບ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ 71 ເອກະສານອ້າງ ອີງ 73 ສະໝຸດ ວຽກ ກ່ຽວ ກັບ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ລົດ ເຂັນ ສໍາລັບ ຜູ້ ຈັດການ ພາກ ສະ ເໜີ ຫຼງັຈາກ​ການ​ເຜີຍ​ແຜ​່ຂ້ໍ ແນະນໍາ ກ່ຽ ວກັບ ການ ສະໜອງ ລົດ ເຂັນ ແບບ ໃຊ້ ມື ໃນ ສະຖານ ທ່ີ ທ່ີ ມີ ຊັບພະຍາກອນ ຈໍາກັດ(1)​​ໃນ​ປ​ີ2008,​​ໄດ​້ມ​ີການ​ເຜີຍ​ແຜ່ຊດຸ​ຝກຶ​ອບົຮມົ​ທາໍ​ອິດ​ພາຍ​ໃນ​ຂອບ​ເຂດ​ ຂອງ​ບັນດາຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ລົດ ເຂັນ (WSTP)​​ໃນ​ປ​ີ2012:​ຊຸດ ຝຶກ ອົບຮົມ ການບໍລິການ ລົດ ເຂັນ – ລະດັບ ພ້ືນຖານ (WSTPb)(2)​ນີ​້ຕາ​ມມາ​ດວ້ຍ​ການ​ເຜີຍ​ແຜ​່ໃນ​ປ​ີ2013​ ຂອງ​ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍ ລິ ການ ລົດ ເຂັນ – ລະດັບ ປານ ກາງ (WSTPi)(3).​​ອງົການ​ອະນາ​ໄມ​ ໂລກ​(WHO)​​ໂດຍ​ຮວ່ມ​ມືກັບ​ອງົການ​ພັດທະນາ​ລະຫວາ່ງ​ປະ​ເທດ​ຂອງ​ສະຫະລັດ​(USAID)​​ໄດ້​ ພັດທະນາ​ສວ່ນ​ທ​ີສາມ​ຂອງ​ຊດຸ​ເອກະສານ​WSTP​​ເຊິງ່ປະກອບ​ມ​ີສອງ​ຊດຸ​ຍ່ອຍ​ດັງ່​ນີ:້​ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ລົດ ເຂັນ ສໍາລັບ ຜູ້ ຈັດການ (WSTPm)​​ແລະ​ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ລົດ ເຂັນ ສໍາລັບ ພາກສ່ວນ ກ່ຽວຂ້ອງ (WSTPs).​ສວ່ນ​ທ​ີສາມຂອງ​WHO​WSTP​ນີ້​ ຖກື​ອອກ​ແບບ​ມາ​ເພ່ືອ​ສະໜັບສະໜນູ​ບນັດາ​ຜູ​້ຈດັການ​ໃຫ​້ສາມາດ​ສະໜັບສະໜນູ​ການ​ສະໜອງ​ລົດ​ ເຂນັ​ໄດ​້ຢາ່ງ​ເໝາະສມົ;​​ແລະ​ຊວ່ຍ​ສາ້ງ​ຄວາມ​ຮູ​້ໃຫ​້ແກ​່ພາກສວ່ນ​ທີ​່ກຽ່ວຂອ້ງ​​ແລະ​ສົງ່​ເສມີ​ການ​ມີ​ ສວ່ນ​ຮວ່ມ​ຂອງ​ເຂາົ​ເຈົາ້​ໃນ​ການ​ສາ້ງ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ຢາ່ງ​ເໝາະ​ສມົ​ໃນ​ປະ​ເທດ/ພາກ​ພ້ືນ​ ຂອງ​ເຂາົ​ເຈົາ້. ລ​ົດ​ເຂນັ​ແມນ່​ໜຶງ່​ໃນ​ອປຸະກອນ​ຊວ່ຍທີ​່ມັກ​ໃຊ​້ຫາຼຍທີ​່ສຸດ​ເພ່ືອ​ໃຫ​້ສາມາດ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ໄດ.້​ສາໍລັບ​ ຄ​ົທີ​່ມ​ີຄວາມລາໍບາກ​ໃນ​ການ​ຍາ່ງ​ຫຼ​ືເຄື່ອນ​ໄຫວ​ໄປມາ,​ລົດ​ເຂນັ​ແມນ່​ເຄື່ອງມ​ືສາໍຄນັ​ສາໍລັບ​ການ​ ເຄື່ອນ​ໄຫວ​ໄປມາ,​ອາໍນາດ,​ກຽດ​ສັກ​ສ​ີ​ແລະ​ຄວາມ​ເປນັ​ຢູ​່ທີ​່ດ​ີໂດຍ​ລວມຂອງ​ເຂາົ​ເຈົາ້.​ການ​ເຄື່ອນ​ ໄຫວ​ໄປມາ​ໄດ​້ເປີດ​ໂອກາດ​ໃຫ​້ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ສາມາດ​ເພ່ິງ​ພາ​ຕນົ​ເອງ​ໄດ​້​ແລະ​ເຂົາ້​ເຖງິ​ການ​ດ​ູແລ​ເບິງ່​ ແຍງ​ສຸຂະພາບ,​ການ​ສຶກສາ,​ວຽກ​ເຮດັ​​ແລະ​ການ​ຈາ້ງ​ງານ,​ນອກ​ນັນ້​ຍງັ​ຊວ່ຍ​ໃຫ​້ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ ໄດເ້ຂົາ້​ຮວ່ມ​ໃນ​ບນັ​ດາ​ກິດຈະ​ກາໍ​ທາງ​ສັງຄມົ​​ແລະ​ວັດທະນະ​ທາໍ​ນາໍ​ອກີ.​​ແນວ​ໃດ​ກໍ່ຕາມ,​ອງົການ​ WHO​ຄາດ​ຄະ​ເນ​ວາ່​ຜູ​້ຄນົຫາຼຍກວາ່​70​ລາ້ນ​ຄນົ​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີລົດ​ເຂນັ​​ແລະ​ມ​ີພຽງ​ແຕ​່5–15%​​ ເທົາ່​ນັນ້ທີມ່​ີລົດ​ເຂນັ.​​ນອກ​ນັນ້,​​ໂອກາດ​ການ​ຝກຶ​ອບົຮມົ​ສາໍລັບ​ບກຸຄະລາ​ກອນ​ເພ່ືອ​ສາ້ງ​ຄວາມ​ຮູ້​​ ແລະ​ທກັ​ສະ​ທີ​່ຈາໍ​ເປນັ​​ເພ່ືອ​ໃຫ​້ກາ​ນບລໍກິານ​ລົດ​ເຂນັ​ແມນ່​ຍງັ​ມຈີາໍ​ກັດ​ຫາຼຍ. ຄວາມ​ສາໍຄນັ​ຂອງ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ໄດ​້ຖກື​ລບ​ຸໄວ​້ໃນ​ສນົທສິນັຍາຂອງ​ອງົການ​ສະຫະ​ປະຊາ​ ຊາດ​ວາ່​ດວ້ຍ​ສິດທ​ິຄນົ​ພິການ​(CRPD)(4),​​ເຊິງ່ສົງ່​ເສມີ​ໃຫ​້ມ​ີ“ມາດ​ຕະການ​ທີ​່ມ​ີປະສິດທ​ິຜນົ​ເພື່ອ​ ຮບັປະກນັ​ໃຫມ້​ີການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ໄດ​້ດວ້ຍ​ຕນົ​ເອງ​​ໂດຍ​ມ​ີການ​ເພ່ິງ​ຕນົ​ເອງ​ຫາຼຍທີ​່ສຸດ​ເທົາ່​ທີ​່ຈະ​ ເປນັ​ໄປ​ໄດ​້ສາໍລັບ​ຄນົ​ພິການ”.​​ເພ່ືອ​ຮບັປະກນັ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ດວ້ຍ​ຕນົ​ເອງ​ຢາ່ງ​ມ​ີປະສິດທ​ິຜນົ,​ ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຈາໍ​ເປນັ​ຕ້ອງ​ມ​ີລົດ​ເຂນັ​ທີ​່ປະກອບ​ຢາ່ງ​ຖກືຕອ້ງ​​ແລະ​ຕອບ​ສະໜອງ​ຄວາມ​ຕອ້ງການ​ສະ​ ເພາະ​ຂອງ​ເຂາົ​ເຈົາ້,​​ໂດຍ​ສະ​ເພາະ​ວຖິ​ີຊວີິດ​​ແລະ​ສະພາບ​ແວດ​ລ້ອມ​ຂອງ​ເຂາົ​ເຈົາ້.​​ນີ​້ຮຽກຮອ້ງ​ໃຫ​້ມີ​ ວທິ​ີການ​ທີ​່ຕອບ​ສະໜອງ​ຕໍ​່ກັບ​ຄວາມ​ຕ້ອງການ​ສະ​ເພາະ​ບກຸຄນົ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 2 3 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ​ວທິີທີ​່ມ​ີປະສິດທ​ິຜນົ​ໃນ​ການ​ຕອບ​ສະໜອງ​ຄວາມ​ຕ້ອງ​ການສະ​ເພາະ​ບ​ຸກຄນົ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ແມນ່​ການ​ ສະໜອງ​ລົດ​ເຂນັ​ຜາ່ນ​ລະບົບ​ສະໜອງ​ລົດ​ເຂນັ​ທີ​່ມ​ີການຈດັຕັງ້​ເປນັ​ຢາ່ງ​ດ​ີທີ​່ຕອບ​ສະໜອງ​ໄດ​້ຄວາມ​ຄາດ​ ຫວງັ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ,​​ເຄາົລົບ​ກຽດ​ສັກ​ສ​ີຂອງ​ເຂາົ​ເຈົາ້​​ແລະນາໍ​ສົງ່​ໃຫ​້ໂດຍ​ບກຸຄະ​ລາກ​ອນທີ​່ຜາ່ນ​ການ​ຝກຶ​ ອບົຮມົ​ມາ​ເປນັ​ຢາ່ງ​ດ.ີ ຜູ້ ຝຶກ ອົບຮົມ ເ ປ້ົາໝາຍ ​ຊດຸ​ຝກຶ​ອບົຮມົ​ນີ​້ແມນ່​ສາໍລັບ​ບກຸຄະລາ​ກອນ​ທກຸ​ຄ​ົທີ​່ຮບັຜິດຊອບ​ການຈດັ​ຕັງ້​ປະຕິບັດ,​ການ​ຄຸມ້​ຄອງ​​ແລະ​ ການ​ປະ​ເມນີ​ການ​ບລໍກິານ​ຟືນ້​ຟ​ູສຸຂະພາບ​​ເຊິງ່ລວມທງັ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ຫຼ​ືການ​ສະໜອງ​ລົດ​ເຂນັ. ບໍ​່ຈາໍ​ເປ​ັຕ້ອງ​ມີປະສົບ​ກາ​ຜ່ານ​ມາ​ໃນ​ການ​ຄຸມ້​ຄອງ​ການ​ບລໍກິານ​ລົດ​ເຂນັ;​​ແນວ​ໃດ​ກໍ່ຕາມ,​​ໂຮງບາໍລງຸ​ສ້ອມ​ ແປງ​ໄດ​້ຖກື​ອອກ​ແບບ​ມາ​​ໂດຍ​ສມົມຸດ​ວາ່​ຜູ້​ເຂົາ້​ຮວ່ມ​ຈະ​ເລີ​່ມ​ໂຮງ​ບາໍລງຸ​ສ້ອມ​ແປງ​ດວ້ຍ​ທກັ​ສະ​ການ​ຄຸມ້​ຄອງ​ ທົວ່​ໄປ. ຈຸດປະສົງ ​ຈດຸປະສົງ​ຂອງ​ຊດຸ​ຝກຶ​ອບົຮມົ​ໂດຍ​ລວມ​ແມນ່​ເພ່ືອ​ສາ້ງ​ຄວາມ​ຮບັຮູ​້​ແລະ​ພັດທະນາ​ທກັ​ສະ​​ແລະ​ຄວາມ​ຮູ້​ ຂອງ​ບກຸຄະລາ​ກອນ​ທງັ​ໝົດ​ທີ​່ກຽ່ວຂອ້ງ​ກັບ​ການ​ໃຫ​້ການບລໍກິາ​ນ​ລົດ​ເຂນັ.​WHO​ຮບັ​ຮູ​້ວາ່​ບກຸຄະລາ​ກອນ​ທີ່​ ຜາ່ນ​ການ​ຝກຶ​ອບົຮມົ​ຢາ່ງ​ດຽວ​ບໍ​່ສາມາດ​ຮບັປະກນັ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ຢາ່ງ​ເໝາະ​ສມົ​ໃນ​ປະ​ເທດ​ ຫຼືປະຕິບັດ​ຄວາມ​ຮບັຜິດຊອບ​ຂອງ​ເຂາົ​ເຈົາ້​ຕາມ​ທີ​່ກາໍນົດ​ໄວ​້ໃນ​ຂໍ​້ແນະນາໍ​ລົດ​ເຂນັ​​ໄດ,້​​ເວັນ້​ເສຍ​ແຕ​່ວາ່​​ແລະ​ ຈນົ​ກວາ່​ວາ່​ມ​ີການ​ມ​ີສວ່ນ​ຮວ່ມ​ໃນລະດັບ​ສງູ​ກວາ່​ເພ່ືອ​ສາ້ງ​ຫຼືປັບປງຸ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ຢູ​່ພາ​ຍ​ໃນ​ປະ​ເທດ​ ນນັ .ໆ ຊດຸ​ຝກຶ​ອບົຮມົ​ການ​ບລໍກິານ​ລົດ​ເຂນັສາໍລັບ​ຜູ​້ຈດັການ​(WSTPm)​ນີ​້ໃຫ​້ຄວາມ​ຮູ​້ໂດຍ​ລວມກຽ່ວ​ກັບ​ ບົດບາດດາ້ນ​ການ​ຟືນ້​ຟ​ູ​ແລະ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​ຜູ​້ຈດັການ​​ໃນ​ຄຸມ້​ຄອງ​ຜູ​້ຄນົ​​ແລະ​ນາໍພາ​ການຈດັ​ ຕັງ້​ປະຕິບັດ​ແປດ​ຂັນ້​ຕອນ​ຂອງ​ການ​ນາໍ​ສົງ່​ລົດ​ເຂນັ​​ແລະ​ບນັຫາ​ທີ​່ກຽ່ວຂອ້ງ​ກັບມນັ.​ນີ​້ລວມ​ມີ​ ຊບັພະຍາກອນມະນຸດ​​ແລະ​ວັດຖ​ຸທີ​່ຈາໍ​ເປນັ​​ເພ່ືອ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ;​​ເຊິງ່ລວມມ​ີການວາງ​ແຜນ,​ ການຈດັ​ຕັງ້,​ການປະກອບ​ພະນັກງານ,​ການ​ຊີ​້ນາໍ​ນາໍພາ,​ການຈດັ​ສນັ​ງົບປະມານ/ການ​ໃຫ​້ທ​ນຶ,​ການ​ ຕິດຕາມ​​ແລະ​ການ​ປະ​ເມນີ​ຜນົ. ​ຊດຸ​ຝກຶ​ອບົຮມົ​ສາມາດ​ດາໍ​ເນນີ​ໃນ​13–14​ຊົວ່​ໂມງ,​​ແນວ​ໃດ​ກໍ່ຕາມ​​ໄລຍະ​ເວລາ​ນີ​້ສາມາດ​ຂະຫຍາຍ​ອອກ​ ຫຼືຫຼຸດລງົ​ໄດ​້ອງີ​ຕາມ​ຄວາມ​ຈາໍ​ເປນັສ​ະ​ເພາະ​​ແລະ​ຊບັ​ພະຍາກອນ​ທີ​່ມ​ີໃຫ.້​ການ​ດາໍ​ເນນີ​ຊດຸ​ການ​ຝກຶ​ອບົຮມົ​ ນີ​້ຈະ​ຊວ່ຍ​ໃຫ​້ຜູ​້ຈດັການ: •​ ​ວາງ​ແຜນການ​ສະໜອງ​ລົດ​ເຂນັ​ໄດ​້ດກີ​ວາ່; •​ ​ເພີມ່​ຄນຸ​ນະພາ​ບຂອງ​ການ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ; •​ ​ປ​ັບປງຸ​ການ​ຮກັສາ​ພະນັກງານ​; •​ ​ເພີມ່​ຈາໍນວນ​ຂອງ​ຜູ້​ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ໄດ​້ຮບັ​ລົດ​ເຂນັ​ທີ​່ຕອບ​ສະໜອງ​ຄວາມ​ຕອ້ງການ​ຂອງ​ເຂາົ​ ເຈົາ້;​​ແລະ •​ ​ເພີມ່​ຄວາມ​ຍນື​ຍງົ​ຂອງ​ການ​ສະໜອງ​ລົດ​ເຂນັ. 2 3 ຂອບ ເຂດ ​ຊດຸ​ຝກຶ​ອບົຮມົ​ລວມມ:ີ •​ ​ລາ​ຍລະອຽດ​ໂດຍ​ລວມກຽ່ວ​ກັບ​ຂັນ້​ຕອນ​ທີ​່ສໍາຄນັ​ຂອງ​ການ​ໃຫ​້ການບລໍກິານລົດ​ເຂນັ​ທີ່​ ອະທິບາຍ​ໄວ​້ຢູ​່ໃນ​ຊດຸ​ຝກຶ​ອບົຮມົ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​WHO; •​ ຄວາມ​ຮູ​້ຫຼກັທີ​່ຈາໍ​ເປນັ​ສາໍລັບ​ການ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ: o ​ການ​ເລີ​່ມການ​ບລໍກິານ​ລົດ​ເຂນັ; o ​ການ​ດາໍ​ເນນີ​ການ​ບລໍກິານ​ລົດ​ເຂນັ;​​ແລະ, o ​ການ​ເຮດັ​ໃຫ​້ການ​ສະໜອງ​ລົດ​ເຂນັ​ມ​ີຄວາມ​ຍນື​ຍງົ. ວິທີ ໃຊ້ ຄູ່ ມື ອ້າງ ອີງ ແລະ ສະໝຸດ ວຽກ ຄູ​່ມ​ືອາ້ງ​ອງີນີ​້ໃຫ​້ຂໍ​້ມນູ​ສງັ​ລວມກຽ່ວ​ກັບ​ຄວາມ​ຮູ​້ທີ​່ມ​ີໃຫ​້ໃນ​ຊດຸ​ຝກຶ​ອບົຮມົ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ສໍາລັບ​ຜູ້​ ຈດັການ​(WSTPm).​ຜູ​້ເຂົາ້​ຮວ່ມ​ອາດ​ຈະ​ໃຊຄູ້​່ມ​ືອາ້ງ​ອງີ​​ແລະ​ສະໝຸດ​ວຽກ​ຫຼງັຈາກ​ໂປຣ​ແກຣມຝກຶ​ ອບົຮມົ​​ເພື່ອ​ເຕອືນ​ຄວາມ​ຈາໍຕນົ​ເອງ​ກຽ່ວ​ກັບຂໍ​້ສາໍຄນັ​ທີ​່ຮຽນ​ຮູ​້ໃນ​ແຕ​່ລະຕອນ​ການ​ຝກຶ​ອບົຮມົ.​ຄູ​່ມື​ ແບງ່​ອອກ​ເປນັ​ສາມ​ສ່ວນ: A.​​ຄວາມ​ຮູ​້ຫຼກັ B.​ການ​ເລີ​່ມການ​ບລໍກິານ​ລດົ​ເຂນັ​​ແລະ C.​​ການ​ດາໍ​ເນນີ​ການ​ບລໍກິານ​ລດົ​ເຂນັ. ​ຄູ​່ມ​ືອາ້ງ​ອງີ​ຍງັ​ລວມມ​ີສະໝຸດ​ວຽກ,​ຈດຸປະສົງ​ເພ່ືອ​ພັດທະນາ​ທກັ​ສະ​​ແລະ​ຄວາມ​ຮູ​້ຂອງ​ບກຸຄະລາ​ ກອນ​ທີ​່ກຽ່ວຂອ້ງ​ກັບ​ການ​ໃຫ​້ການ​ບລໍກິານ​ລົດ​ເຂນັ.​​ສະໝຸດ​ວຽກ​ປະກອບ​ມ​ີບົດ​ຝກຶ​ຫັດ​ທີ​່ຈະ​ຊວ່ຍ​ທົດ​ ສອບ​​ແລະ​ພັດທະນາ​ຄວາມ​ຮູ​້​ແລະ​ທກັ​ສະ​ຂອງ​ຜູ​້ເຂົາ້​ຮວ່ມຝກຶ​ອບົຮມົ.​ສະໝຸດ​ວຽກ​ປະກອບ​ມີ​ ເອກະສາ​ນຈາກ​ກາ​ນບນັຍາຍ,​ບົດ​ນາໍ​ສະ​ເໜ​ີແບບ​ສະ​ໄລ​​ແລະ​ຄູ​່ມ​ືອາ້ງ​ອງີ;​​ແລະ​ມນັ​ມ​ີຈດຸປະສງົ​ໃຫ້​ ຜູ​້ເຂົາ້​ຮວ່ມ​ຮກັສາ​ສາໍ​ເນາົ​ຂອງຄູ​່ມ​ືອາ້ງ​ອງີ​​ແລະ​ສະໜຸດວຽກ​ໃຫ​້ເ​ບິງ່​ໃນ​ອະນາຄົດ,​ຖາ້​ຈາໍ​ເປນັ. 4 5 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ A. ຄວາມ ຮູ້ ຫັຼກ A.1: ການ ສະໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ແມ່ນ ຫຍັງ? ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ແມນ່​ຄາໍ​ສັບ​ລວມສາໍລັບ​ການ​ອອກ​ແບບ,​ການ​ຜະລິດ,​ການ​ສະໜອງ​​ແລະ​ ການ​ໃຫກ້ານ​ບລໍກິານ​ບາໍລງຸ​ສ້ອມ​ແປງ​ລົດ​ເຂນັ.​​ລົດ​ເຂນັ​ແມນ່​ໜຶງ່​ໃນ​ອປຸະກອນຊວ່ຍ​ເຫຼືອ​ທີ​່ໃຊ້​ ກນັຫາຼຍທີ​່ສຸດ​​ເຊິງ່​ໃຫກ້ານ​ເຄື່ອນ​ທີ​່ແບບ​ໃຊ​້ລໍ​້ແກ​່ຄ​ົທີ​່ມ​ີຄວາມ​ພກິານ​ດາ້ນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ. ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ແມນ່​ຂັນ້​ຕອນ​ທີ​່ສາໍຄນັ​ໃນ​ການ​ເຂົາ້​ຮວ່ມ​ສິງ່​ຕາ່ງ .ໆ​​ເມື່ອ​ບກຸຄນົ​ໃດ​ໜຶງ່​ໄດ​້ຮບັ​ ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສົມ​ຜາ່ນ​ການ​ບລໍກິານ​ໃດ​ໜຶງ່,​​ໂອກາດ​ສາໍລັບ​ການ​ໃຊ​້ຊວີິດ​ໃນ​ສງັຄມົ,​ການ​ເຮດັ​ວຽກ​ ແລະ​ການ​ສຶກສາ​ຈະ​ເປີດ​ກວາ້ງອອກ.​​ນອກ​ນັນ້,​ຄນົ​ອືນ່​ໃນຄອບຄວົ​ຈະ​ມ​ີອິດສະຫຼະຫາຼຍຂຶນ້​ໃນ​ການ​ ເຂົາ້​ຮວ່ມ​ໃນ​ຊມຸ​ຊນົ​​ແລະ​ການ​ຈາ້ງ​ງານ.(5) ມນັບໍ​່ພຽງ​ແຕ​່ແມນ່​ບກຸຄນົ​​ແລະ​ຄອບຄວົ​ຂອງ​ເຂາົ​ເຈົາ້​ເທົາ່​ນັນ້​ທີ​່ໄດ​້ປະ​ໂຫຍ​ດຈາກ​ການ​ເຄື່ອນ​ໄຫວ​ ໄປມາ​ທີ​່ດ​ີຂຶນ້.​​ເສດຖະກິດ​ໃນ​ທ້ອງ​ຖິນ່​​ແລະ​ໃນ​ຂອບ​ເຂດ​ກວາ້ງ​ກວາ່​ນັນ້​ກໍ​່ໄດ​້ປະ​ໂຫຍ​ດຈາກ​ການ​ມີ​ ສະມາຊກິ​ທີ​່ປະກອບສວ່ນ​ເພີມ່​ຂຶນ້.​​ນອກນັນ້​ຄ​ົທີ​່ມ​ີລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ​ຍງັ​ເປນັ​ໄປ​ໄດ​້ໜ້ອຍ​ກວາ່​ທີ່​ ຈະ​ມ​ີຜນົ​ກະທົບ​ດາ້ນ​ສຸຂະພາບ​ສາໍຮອງ​(ຕວົຢາ່ງ​ວາ່​​ແຜ​ກ​ົທັບ)​​ແລະ​ສະ​ນັນ້​​ຈິງ່​ເປນັ​ໄປ​ໄດ​້ໜ້ອຍ​ ກວາ່​ທີ​່ຈະ​ຕອ້ງການ​ການ​ບລໍກິານ​ສຸຂະພາບ. ມ​ີຄວາມ​ຈາໍ​ເປນັ​ຮ​ີບດວ່ນ​ສາໍລັບ​ການ​ປຽ່ນ​ແປງ​​ເພ່ືອ​ໃຫ​້ຄນົ​ຫາຼຍຂຶນ້​ສາມາດ​ເຂົາ້​ເຖງິ​ການ​ສະໜອງ​ ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສົມ. ມີ ຈັກ ຄົນທ່ີ ຕ້ອງການ ລົດ ເຂັນ? ​ອງົການ​WHO​ຄາດ​ຄະ​ເນ​ວາ່​1%​ຂອງ​ປະຊາກອນ​ໃດໆ​ກໍ່ຕາມ​ມ​ີຄວາມ​ຕ້ອງການ​ລົດ​ເຂນັ.​​ນີ້​ ໝາຍ​ຄວາມ​ວາ່​ໃນ​ທົວ່​ໂລກ​ມ​ີຄນົຫາຼຍກວາ່​70​ລາ້ນ​ຄນົ​ຕອ້ງການ​ລົດ​ເຂນັ.​​ຕວົ​ເລກສະຖິຕິ​ນີ້​ ສາມາດ​ເປນັ​ຈດຸ​ເລີ​່ມຕົນ້​​ໃນ​ເວລາ​ຄິດ​ໄລວ່າ່​ມ​ີຈກັ​ຄນົ​ຕອ້ງການ​ລົດ​ເຂນັ​ໃນ​ແຕ່ລະ​ປະ​ເທດ,​ເມືອງ​ ຫຼືຕວົ​ເມືອງ.​​ນີ​້ໝາຍ​ຄວາມ​ວາ່​ຜູ​້ຈດັການ​ບໍ​່ຈາໍ​ເປນັ​ຕ້ອງ​ລຖໍາ້​ໃຫ​້ມ​ີການ​ດາໍ​ເນນີການ​ສາໍ​ຫວຼດລະອຽດ​​ ເພື່ອ​ເລີ​່ມການວາງ​ແຜນການ​ສະໜອງ​ລົດ​ເຂນັ. 4 5 ປະຊາກອນ % ຈໍານວນ ຄົນ ໂດຍ ປະມານ ທ່ີ ຕ້ອງການ ລົດ ເຂັນ ປະຊາກອນ​ທົ່ວ​ໂລກ 7​000​000​000 1% 70​000​000 ​ບຣາຊິນ 203​657​000 1% 2​036​570 ​ຈີນ 1​401​587​000 1% 14​015​870 ​ອີ​ຢິບ 84​706​000 1% 847​060 ​ອິນ​ເດຍ 1​282​390​000 1% 12​823​900 ​ໄນ​ຈີ​ເຣຍ 183​523​000 1% 1​835​230 ຣັດ​ເຊຍ 142​098​000 1% 1​420​980 ສົນທິສັນຍາ, ຍຸດ ທະ ສາດ ແລະ ນະ ໂຍບາຍ ທ່ີ ສະໜັບສະໜູນ ການ ສະໜອງ ລົດ ເຂັນ ​ຫາຼຍໆ​ຄ​ົນທີ​່ຕອ້ງການ​ລົດ​ເຂນັ​ຍງັ​ບໍ​່ທນັທ​ີລົດ​ເຂນັ​ທີ​່ເໝາະ​ສົມ​ເທື່ອ.​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີການ​ສ່ົງ​ເສມີ​ ສະໜັບສະໜນູ​ຢາ່ງ​ຈງິ​ຈງັ​​ເພ່ືອ​ເພ່ີມ​ການ​ເຂົາ້​ເຖງິ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ.​​ຜູ​້ຈດັການ​ສາມາດ​ໃຊ​້ນະ​ ໂຍບາຍ​ທົວ່​ໂລກ,​ລະດັບພາກ​ພ້ືນ​​ແລະ​ລະດັບ​ປະ​ເທດ​​ເພ່ືອ​ຊວ່ຍ​ສົງ່​ເສມີ​ສິດທ​ິໃນການ​ເຄື່ອນ​ໄຫວ​ ໄປມາ​​ໃນ​ນາມ​ຕາງໜາ້​ໃຫ​້ຄ​ົທີ​່ມ​ີການ​ບກົ​ຜ່ອງ​ດາ້ນການ​ເຄື່ອ​ນ​ໄຫວ​ໄປມາ. ຕາຕະລາງ​ຂາ້ງ​ລຸມ່​ໃຫ​້ຕົວຢາ່ງ​ກຽ່ວ​ກັບ​ສນົທສິນັຍາ,​ຍຸດ​ທະ​ສາດ,​ນະ​ໂຍບາຍ​​ແລະ​ຂໍ​້ແນະນາໍ​ທີ່​ ສາມາດ​ເປນັ​ເຄື່ອງມ​ືສົງ່​ເສມີ​ສາໍລັບ​ຜູ​້ຈດັການ​ໄດ.້ 6 7 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ນະ ໂຍບາຍ ສາກົນ ຕົວຢ່າ ລະດັບ ພາກ ພ້ືນ: ຍຸດ ທະ ສາດ ອິນ ຊອນ ນະ ໂຍບາຍ ແລະ ຂ້ໍ ແນະນໍາ ລະດັບ ປະ ເທດ ​ເຄື່ອງ​ດ້ານ​ນະ​ໂຍບາຍ​ລະດັບ​ ສູງ​ສຸດ​ແມ່ນ​ສົນທິສັນຍາ​ວ່າ​ ດ້ວຍ​ສິດທິ​ຄົນ​ພິການ​ຂອງ​ ອົງການ​ສະຫະ​ປະຊາ​ຊາດ​ (CRPD). ມາດຕາ​20​ຂອງ​CRPD​ ບອກ​ວ່າ​ທຸກ​ຄົນ​ມີ​ສິດ​ມີ​ການ​ ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ດ້ວຍ​ຕົນ​ ເອງ​ໄດ້. ​ມາດຕາ​ອື່ນ​ຂອງ​CRPD​ກໍ່​ ເນັ້ນ​ໜັກ​ຄວາມ​ສໍາຄັນ​​ແລະ​ ຄວາມ​ກ່ຽວຂ້ອງ​ຂອງ​ການ​ ສະໜອງ​ລົດ​ເຂັນ​ທີ່​ເໝາ​ະສົມ​ ເຊັ່ນ​ກັນ.​ສິ່ງ​ເຫຼົ່ານ້ີ​ລວມມີ: A:​19​– ການ​ດໍາ​ເນີນ​ຊີວິດ​ ແບບ​ເພິ່ງ​ຕົນ​ເອງ​​ແລະ​ການ​ ໄດ້​ເຂົ້າ​ຮ່ວມ​ໃນ​ຊຸມ​ຊົນ A:​24​– ການ​ສຶກສາ A:​25​– ສຸຂະ​ພາບ A:​26​– ການ​ຟື້ນ​ຟູ A:​27​– ການ​ເຮັດ​ວຽກ​​ແລະ​ ການ​ຈ້າງ​ງານ A:​30​– ການ​ມີ​ສ່ວນ​ຮ່ວມ​ໃນ​ ຊີວິດ​ທາງ​ວັດທະນະ​ທໍາ,​ ຄວາມ​ສະໜຸກ​ສະໜາ​ນ,​​ ເວລາ​ຫວ່າງ​​ແລະ​ກິລາ.​ ​ໃນ​ປີ​2012,​ມີ​ການ​ຮັບ​ເອົາຍຸດ​ທະ​ ສາດ​ອິນ​ຊອນ​​ເພ່ືອ​“​ເຮັດ​ໃຫ້​ສິດທິ​ ກາຍ​ເປັນ​ຈິງ”;​ສໍາລັບ​ຄົນ​ພິການ​ໃນ​ ອາຊີ​​ແລະ​ປາຊິ​ຟິກ. ຍຸດ​ທະ​ສາດ​ດັ່ງກ່າວ​ມີ​10​​ເປົ້າ​ ໝາຍ. ​ເປົ້າ​ໝາຍ​3​​ແມ່ນ​ເພື່ອ​ເພ່ີມ​ທະວີ​ ການ​ເຂົ້າ​ເຖິງ​ສະພາບ​ແວດ​ລ້ອມ​ ທາງ​ວັດຖຸ,​ການ​ຂົນ​ສົ່ງ​ ສາທາລະນະ,​ຄວາມ​ຮູ້,​ຂໍ້​ມູນ​ ຂ່າວສານ​​ແລະ​ການ​ສື່ສານ. ​ໃນ​ລະຫວ່າງ​ການ​ການ​ຮ່າງ​ຍຸດ​ທະ​ ສາດ​ນີ້,​ມີ​ການ​ສ້າງ​ກໍລະນີ​ທີ່​ໜັກ​ ແໜ້ນ​ວ່າ​​ເປົ້າ​ໝາຍ​ນີ້​ບໍ່​ສາມາດ​ ບັນລຸ​ໄດ້​​ໂດຍ​ບໍ່​ມີ​ການ​ເຂົ້າ​ເຖິງ​ ອຸປະກອນ​ຊ່ວຍທີ່​ບໍ່​ເໝາະ​ສົມ​​ ເຊິ່ງລວມທັງ​ລົດ​ເຂັນ. ​ສະ​ນັ້ນ,​​ເປົ້າ​ໝາຍ​3​ລວມ​ເອົາ​ ຄາດໝາຍ​ໃນ​ການຫຼຸດຈໍານວນ​ຄົນ​ ພິການ​ທີ່​ຕ້ອງການ​​ແຕ່​ບໍ່​ມີ​ ອຸປະກອນ​ຫຼືຜະລິດ​ຕະພັນ​ຊ່ວຍ​ ເຫຼືອທີ່​ເໝາະ​ສມົ. ບັນດາ​ປະ​ເທດ​ທີ່​ລົງ​ນາມ​ໃນ​ຍຸດ​ທະ​ ສາດ​ອິນ​ຊອນ​ດຽວ​ນີ້​ມຸ້ງໝ້ັນ​ ພັດທະນາ​ແຜນການ​ລະດັບ​ປະ​ເທດ​ ເພື່ອ​ປະຕິບັດ​ພັນທະ​ນີ້.​ຕົວຢ່າງ​ຍຸດ​ ທະ​ສາດ​ອິນ​ຊອນ​ສະ​ແດງ​ໃຫ້​ເຫັນ​ ວ່າ​ນະ​ໂຍບາຍ​ສາກົນ​​ແລະ​ລະດັບ​ ພາກ​ພ້ືນສາມາດ​ສະໜັບສະໜູນ​​ ແລະ​ສົ່ງ​ເສີມ​ກາ​ພັດທະນາ​ນະ​ ໂຍບາຍ​ລະດັບ​ປະ​ເທດ​ໄດ້​ແນວ​ໃດ. ການວາງ​ແຜນ​,​ນະ​ໂຍບາຍ​​ ແລະ​ຂໍ້​ແນະນໍາ​ລະດັບ​ປະ​ເທດ​ ສາມາດ​ຊ່ວຍ​ເພີ່ມ​ປະສິດທິ​ຜົນ​​ ແລະ​ຄວາ​ມຍືນ​ຍົງ​ຂອງ​ການ​ ສະໜອງ​ລົດ​ເຂັນ.(6)​ກາ​ ນພັດທະນາ​ນະ​ໂຍບາຍ​​ແລະ​ ຂໍ້​ແນະນໍາ​ລະດັບ​ປະ​ເທດ​ ຮຽກຮ້ອງ​ໃຫ້​ມີ​ການ​ຮ່ວ​ມມື​ກັນ​ ລະຫວ່າງ​ທຸກ​ພາກສ່ວນ​ທີ່​ ກ່ຽວຂ້ອງ​​ລວມທັງ​ຄົນ​ພິການ,​ ຜູ້​ໃຫ້​ບໍລິການ​ພາກ​ລັດຖະບານ​​ ແລະບໍ່​ແມ່ນ​ລັດຖະບານ.​​ນະ​ ໂຍບາຍ​CRPD​​ແລະ​ຍຸດ​ທະ​ ສາດ​ລະດັບ​ພາກ​ພ້ືນ​ທີ່​ ກ່ຽວຂ້ອງ​ສາມາດ​ ສະໜັບສະໜູນ​ການວາງ​ ແຜນ,​ກາ​ພັດທະນານະ​ ໂຍບາຍ​​ແລະ​ຂໍ້​ແນະນໍາ​ລະດັບ​ ປະ​ເທດ​ໄດ້. ຂໍ້​ແນະນໍາ​ລະດັບ​ປະ​ເທດ​ ສາມາດ​ຊ່ວຍ​ກໍານົດ​ວ່າ​ຄວນ​ ສະໜອງ​ອຸປະກອນ​ຊ່ວຍ​ ຕ່າງໆ​ລວມທັງ​ອຸປະກອນ​ ຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ ແນວ​ໃດ.​ຕົວຢ່າງ,​ຂໍ້​ແນະນໍາ​ ລະດັບ​ປະ​ເທດ​ກ່ຽວ​ກັບ​ການ​ ສະໜອງ​ອຸປະກອນ​ຊ່ວຍ​ຖືກ​ ພິມ​ເຜີຍ​ແຜ່​ໃນ​ອາ​ຝຣິກາ​ໃຕ້​ໃນ​ ປີ​2003,​​ເຊິ່ງ​ໃຫ້​ມາດຕະຖານ​ ຕໍ່າ​ສຸດ​ສໍາລັບ​ຂັ້ນ​ຕອນ​ການ​ ບໍລິການ,​ການ​ຝຶກ​ອົບຮົມ​ ພະນັກງານ,​ການ​ຕິດ​ຕັ້ງ​​ ແລະ​ການ​ຄຸ້ມ​ຄອງ​ບັນຊີລາຍ​ຊື່​ ລໍຖ້າ,​ງົບປະມານ​​ແລະ​ການ​ ໃຫ້ການ​ບໍລິການ​ສ້ອມ​ແປງ​​ ແລະ​ການ​ບໍາລຸງ​ຮັກສາ.​ 6 7 A.2: ການ ໃຫ້ການ ບໍລິການ ​ຝາ່ຍການ​ບລໍກິານ​ລົດ​ເຂນັ​ມ​ີບົດບາດ​ສາໍຄນັ​ໃນ​ການ​ສະໜອງ​ລົດ​ເຂນັ.​​ຝາ່ຍ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ ເຮດັ​ວຽກ​ກັບ​ຜູ​້ໃຊ​້ເພ່ືອ​ຊອກ​ຫາ​ລົດ​ເຂນັ​ທີ​່ເໝາະສມົ​(ຈາກ​ສິງ່​ທີ​່ມ​ີໃຫ)້​ສາໍລັບຜູ​້ໃຊ​້ນັນ້. ການ ບໍລິການ ລົດ ເຂັນ ລະດັບພ້ືນຖານ ແລະລະດັບ ປານ ກາງ ລົດ​ເຂນັ​ທີ​່ປະກອບ​ມາ​ເປນັ​ຢາ່ງ​ດ​ີແຕ​່ລ​ະ​ຄນັ​ຫ​ໃຫກ້ານ​ຮອ​ງຮບັ​ທາ່​ນັງ່​ຕາ່ງໆ​ແກ​່ຜູ​້ໃຊ.້​​ແນວ​ອງີ​ຫຼງັ,​​ ເບາະ​ນັງ່,​​ແນວ​ຮອງ​ຕນີ​​ແລະ​ແນວ​ຮອງ​ແຂນ​​ໃຫກ້ານ​ຮອງ​ຮບັ​ທາ່​ນັງ່​ຕາ່ງໆ​​ໃນ​ເວລາ​ດັດ​ປັບ​ເພື່ອ​ ໃຫ​້ເໝາະ​ສມົ​ກັບ​ຂະໜາດ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ.​​ແນວ​ໃດ​ກໍ່ຕາມ,​​ເດກັນ້ອຍ​​ແລະ​ຜູ​້ໃຫຍ​່ຫາຼຍໆ​ຄນົ​ຈາໍ​ ເປນັ​ຕອ້ງ​ມ​ີການປະຄອງ​ທາ່​ນັງ່​ເພ່ີມ​ເຕມີ​ໃນ​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້.​ນີ​້ໝາຍ​ຄວາມ​ວາ່​ຈາໍ​ເປນັ​ຕອ້ງ​ມີ​ ການ​ໃຫ​້ບລໍກິານ​ໃນ​ລະດັບ​ຕາ່ງກນັ. ການ ບໍລິການ ລົດ ເຂັນ ລະດັບ ພ້ືນຖານ​​ໃຊ​້ໄດ​້ກັບ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ສາມາດ​ນັງ່​ຕັງ້​ຊື​່ໄດ​້​ໂດຍ​ບໍ​່ມີ​ ການ​ປະຄອງ​ທາ່​ທາງ​ເພ່ີມ​ເຕີມ​. ການ ບໍລິການ ລົດ ເຂັນ ລະດັບ ປານ ກາງ​​ໃຊ​້ໄດກ້ັບ​ຜູ​້ໃຊ​້ລົດ​ເຂນັຜູ​້ທີ​່ຕ້ອງການ​ມ​ີການ​ປະ​ຄອງ​ທາ່​ ທາງ​ເພີມ່​ເຕມີ​​ເພ່ືອ​ໃຫສ້າມາດ​ນັງ່​ໃຫ​້ຕັງ້​ຊື​່ຢາ່ງ​ສະ​ດວກ​ສະບາຍ. ມນັ​ສາໍຄນັ​ສາໍລັບ​ຜູ​້ຈດັການ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ໃນ​ການ​ກາໍນົດ​ວາ່ການ​ບລໍກິານ​ຂອງ​ເຂາົ​ເຈົາ້​ແມນ່​ ຢູ​່ໃນ​ລະດັບ​“​ພ້ືນ​ຖານ”​ຫຼລືະດັບ​“ປານ​ກາງ”.​ນີ​້ເປນັ​ຍ້ອນ​ວາ່ການ​ບລໍ​ິການ​ລະດັບ​ປານ​ກາງ​ຈາໍ​ເປນັ​ ຕອ້ງ​ມ:ີ​ບກຸຄະລາ​ກອນ​ທີ​່ມ​ີການ​ຝກຶ​ອບົຮມົ​ລະດັບ​ສງູ​ກວາ່;​ລົດ​ເຂນັ​ທີ​່ຫາຼກຫາຼຍກວາ່;​​ວັດ​ສະດຸ​​ ແລະ​ອປຸະກອນ​ທີ​່ຫາຼຍກວາ່. ການຕອບ ສະໜອງ ຄວາມ ຕ້ອງການ ດ້ານການ ເຄ່ືອນ ໄຫວ ໄປມາ ແລະ ການ ປະຄອງ ທ່າທາງຢ່າງ ເໝາ ະສົມ Clara​ອາ​ໄສ​ຢູ່​ໃນ​ປະ​ເທດ​East​Timor.​​ລາວ​ເຮັດ​ວຽກ​ຢູ່​ຮ້ານ​ຂາຍ​ ເຄື່ອງ​ຂອງ​ຄອບຄົວ​ຂອງ​ລາວ​​ເຊິ່ງຕັ້ງ​ຢູ່​ໜ້າ​ເຮືອນ​ຂອງ​ເຂົາ​ເຈົ້າ.​ Clara​​ເປັນ​ໂປຣິ​ໂອ,​​ແລະ​ຕ້ອງການ​ລົດ​ເຂັນ​ເພ່ືອ​ເຄື່ອນທີ່​ໄປມາ​ຢູ່​ ພາຍໃນ​ເຮືອນ,​​ໄປ​ເຮັດ​ວຽກ​ຢູ່​ຮ້ານ​ຂາຍ​ເຄື່ອງ,​​ແລະ​ເພ່ືອ​ເຄື່ອນ​ ໄຫວໄປມາ​ຢູ່​ໃນ​ບ້ານ​ຂອງ​ລາວ.​ລາວ​ສາມາດ​ນັ່ງ​ຕັ້ງ​ຊື່​ໄດ້​ໂດຍ​ບໍ່ມີ​ ການ​ປະຄອງ​ເພີ່ມ​ເຕີມ​ໃດໆ,​​ແລະ​ໃຊ້​ລົດ​ເຂັນ​ແບບ​ໃຊ້​ມື,​​ເຊິ່ງຖືກ​ ດັດ​ແປງ​​ແລະ​ປະກອບ​ໃຫ້​ເໝາະ​ສົມ​ກັບ​ລາວ. Clara ແມ່ນຕົວຢ່າງ ຂອງ ບາງ ຄົນ ຜູ້ ທ່ີ ສາມາດ ໄດ້ ຮັບການ ສະໜອງ ລົດ ເຂັນ ຜ່ານ ການ ບໍລິການ ລະດັບ ພ້ືນຖານ. 8 9 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ Ishade​​ມີ​ອາຍຸ​8​ປີ​​ແລະ​ອາ​ໄສ​ຢູ່​ໃນ​Sri​Lanka.​​ລາວ​ເປັນ​ ອໍາມະພາດ​ສະໝອງ.​ສໍາລັບ​Ishade,​ນີ້​ໝາຍ​ຄວາມ​ວ່າ​ລາວ​ມີ​ ຄວາມ​ລໍາບາກ​ໃນ​ການ​ຄວບ​ຄຸມ​ແຂ​ນຂາ,​ຂາ,​ຫົວ​​ແລະ​ຄໍາ​ຂອງ​ ລາວ.​​ລາວ​ບໍ່​ສາມາດ​ນັ່ງ​ຕັ້ງ​ຊື່​ໄດ້​ໂດຍ​ບໍ່​ມີ​ການ​ປະຄອງ.​Ishade​ ຕ້ອງການ​ມີ​ການ​ປະຄອງ​ທ່າ​ນັ່ງ​ເພີ່ມ​ເຕີມຢູ່​ໃນ​ລົດ​ເຂັນ​ຂອງ​ລາວ. Ishade ແມ່ນຕົວຢ່າງ ຂອງ ບາງ ຄົນ ຜູ້ ທ່ີ ຄວນ ໄດ້ ຮັບການ ສະໜອງ ລົດ ເຂັນ ຜ່ານ ການ ບໍລິການ ລະດັບ ປານ ກາງ. ແປດ ຂ້ັນ ຕອນ ຂອງ ການ ໃຫ້ ບໍລິການ ລົດ ເຂັນ ຂ້ັນ ຕອນ ສັງ ລວມ 1. ການ ນໍາ ສ່ົງ ແລະ ການ ນັດ ໝາຍ ​ແບບ​ວິທີ​ທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຖືກ​ນໍາ​ສົ່ງ​ຈະ​ແຕກ​ຕ່າງ​ກັນ.​ຜູ້​ໃຊ້​ ອາດ​ຈະ​ນໍາ​ສົ່ງ​ຕົນ​ເອງ​ຫຼືຖືກ​ນໍາ​ສົ່ງ​ຜ່ານ​ເຄືອ​ຂ່າຍ​ທີ່​ ປະກອບ​ມີ​ພະນັກງານ​ຫຼືອາສາ​ສະໝັກ​ດ້ານ​ສຸຂະພາບ​​ ແລະ​ການ​ຟື້ນ​ຟູ​ຮ່າງກາຍ​ພາກ​ລັດຖະບານ​ຫຼືບໍ່​ແມ່ນ​ ລັດຖະບານ​ທີ່​ເຮັດ​ວຽກ​ຢູ່​ຂັ້ນ​ຊຸມ​ຊົນ,​​ເມືອງ​ຫຼື​ແຂວງ.​ ບາງ​ການ​ບໍລິການ​ລົດ​ເຂັນ​ອາດ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ລະບຸ​ຜູ້​ໃຊ້​ທີ່​ ເປັນ​ໄປ​ໄດ້​ຢ່າງ​ຈິງ​ຈັງ​​ຖ້າ​ພວກ​ເຂົາ​ບໍ່​ໄດ້​ຮັບ​ການ​ບໍລິການ​ດູ​ ແລ​ດ້ານ​ສັງຄົມ​ຫຼືສຸຂະພາບ​ໃດໆ​ຫຼືບໍ່​ໄດ້​ເຂົ້າ​ຮ່ວມ​ກິດຈະກໍາ​ ຂອງໂຮງຮຽນ,​ການ​ເຮັດ​ວຽກ​ຫຼືກິດຈະກໍາ​ຊຸມ​ຊົນ. 2. ການ ປະ ເມີນ ຜົນ ​ຜູ້​ໃຊ້​ແຕ່ລະຄົນ​ຈໍາ​ເປັນ​ຕ້ອງ​ເຮັດ​ການ​ປະ​ເມີນ​ຜົນ​ສະ​ເພາະ​ ບຸກຄົນ.​ນີ້​ລວມມີ​ການ​ເກັບ​ເອົາ​ຂໍ້​ມູນ​ກ່ຽວ​ກັບ​ວິຖີ​ຊີວິດ​ຂອງ​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ,​ວຽກ​ທີ່​ພວກ​ເຂົາ​ເຮັດ,​ບ່ອນ​ທີ່​ພວກ​ເຂົາ​ອາ​ ໄສ​ຢູ່,​​ແລະ​ສະພາບ​ຮ່າງກາຍ​ຂອງ​ເຂົາ​ເຈົ້າ.​ 3. ການ ກໍານົດ ໃຊ້ ລົດ ເຂັນ (ການ ເລືອກ) ​ໂດຍ​ໃຊ້​ຂຊ້ມູນ​ຈາກ​ການ​ປະ​ເມີນ​ຜົນ,​ການ​ກໍານົດ​ໃຊ້​ລົດ​ ເຂັນ​ຖືກ​ເຮັດ​ຮ່ວມ​ກັນ​ກັບ​ຜູ້​ໃຊ້,​ຄົນ​ໃນ​ຄອບຄົວ​ຫຼືຜູ້​ໃຫ້ການ​ ດູ​ແລ​ເບິ່ງ​ແຍງ.​ການ​ກໍານົດ​ໃຊ້​ໃຫ້​ລາຍ​ລະອຽດ​ກ່ຽວ​ກັບປະ​ ເພດ​ລົດ​ເຂັນ​ທີ່​ເລືອກ,​ຂະໜາດ,​ຄຸນສົມບັດ​ໃຊ້​ງານ​​ແລະ​ ການ​ດັດ​ແປງ​ພິ​ເສດ​ຕ່າງໆ.​ນອກ​ນັ້ນ​ຍັງ​ໃຫ້​ລາຍ​ລະອຽດ​ ກ່ຽວ​ກັບ​ການ​ຝຶກ​ອົບຮົມ​ທີ່​ຜູ້​ໃຊ້​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ເຮັດ​ເພ່ືອ​ໃຊ້​​ ແລະ​ບໍາລຸງ​ຮັກສາ​ລົດ​ເຂັນ​ໃຫ້​ໄ​ດ້ດີ. 4. ການ ໃຫ້ ທຶນ ແລະ ການ ສ່ັງ ຊ້ື ​ລະບຸ​ແຫຼ່ງການ​ໃຫ້​ທຶນ​​ແລະ​ເບີກ​ລົດ​ເຂັນ​ຈາກ​ຄັງ​ທີ່​ມີ​ຂອງ​ ການ​ບໍລິການ​ຫຼື​ສັ່ງ​ຊື້​ຈາກ​ຜູ້​ຜະລິດ.​ 5. ການ ກະກຽມ ຜະລິດ ຕະພັນ (ລົດ ເຂັນ) ບຸກຄະລາ​ກອນ​ທີ່​ຜ່ານ​ການ​ຝຶກ​ອົບຮົມ​ຈະ​ກະກຽມ​ລົດ​ເຂັນ​ ສໍາລັບ​ການ​ປະ​ກອບ​ເບື້ອງ​ຕົ້ນ.​​ໂດຍ​ຂຶ້ນ​ກັບ​ຜະລິດ​ຕະພັນ​​ ແລະ​ສະຖານ​ທີ່​ການ​ບໍລິການ,​ນີ້​ອາດ​ຈະ​ລວມມີ​ການ​ ປະກອບ,​ການ​ດັດ​ແປງ​ທີ່​ເປັນ​ໄປ​ໄດ້​ຕໍ່​ກັບ​ຜະລິດ​ຕະພັນ​ທີ່​ ສະໜອງ​ໃຫ້​ໂດຍ​ຜູ້​ຜະລິດ​ຫຼື​ການ​ຜະລິດ​ຜະລິ​ດຕະພັນ​ຢູ່​ ໃນ​ໂຮງ​ສ້ອມ​ແປງ​ຂອງ​ການ​ບໍລິການ. 8 9 6. ການ ປັບ ໃຫ້ ເໝາະ ສົມ ຜູ້​ໃຊ້​ລອງ​ໃຊ້​ລົດ​ເຂັນ.​ມີ​ການ​ເຮັດ​ການ​ດັດ​ປັບ​ສຸດ​ທ້າຍ​ເພ່ືອ​ ຮບັປະກນັ​ວາ່​ລດົ​ເຂນັ​ຖກື​ປະກອບ​​ແລະ​ຕດິ​ຕັງ້​ຢາ່​ງຖກືຕອ້ງ​ຫຼບືໍ.່​ ຖ້າ​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ການ​ດັດ​ແປງ​ຫຼືການ​ປະຄອງ​ທ່າ​ທາງ​ ຕ່າງໆ,​ກໍ່​ອາດ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ການ​ປັບ​ໃຫ້​ເໝາະ​ສົມ​ ເພີ່ມ​ເຕີມອີກ.​ 7. ການ ຝຶກ ອົບ ຮົມ ຜູ້ ໃຊ້ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​​ແລະ​ຜູ້​ໃຫ້ການ​ດູ​ແລ​ໄດ້​ຮັບ​ການ​ຝຶກ​ອົບຮົມ​ວິທີ​ ໃຊ້​​ແລະ​ບໍາລຸງ​ຮັກສາ​ລົດ​ເຂັນ​ຢ່າງ​ປອດ​ໄພ​​ແລະ​ມີ​ ປະສິດທິ​ຜົນ. 8. ການ ຕິດຕາມ ຜົນ, ການ ບໍາລຸງ ຮັກສາ ແລະ ການ ສ້ອມ ແປງ ການ​ນັດ​ໝາຍ​ເພ່ືອ​ຕິດຕາມ​ຜົນ​ແມ່ນ​ໂອກາດ​ໃນການກວດ​ ເບິ່ງ​ວ່າ​ລົດ​ເຂັນ​ເໝາະ​ສົມ​ດີ​ຫຼືບໍ່​​ແລະ​ໃຫ້ການ​ຝຶກ​ອົບຮົມ​​ ແລະ​ການ​ຊ່ວຍ​ເຫຼືອ​ເພ່ີມ​ເຕີມ.​ກໍານົດ​ເວລາ​ແມ່ນ​ຂຶ້ນ​ກັບ​ ຄວາມ​ຕ້ອງການ​ຂອງ​ຜູ້​ໃຊ້​​ແລະ​ການ​ບໍລິການ​ອື່ນ​ທີ່​ມີ​ໃຫ້​ ແກ່​ເຂົາ​ເຈົ້າ.​ນອກ​ນັ້ນ​ການ​ບໍລິການ​ອາດ​ຈະ​ໃຫ້ການ​ ບໍາລຸງ​ຮັກສາ​​ແລະ​ການ​ສ້ອມ​ແປງ​ສໍາລັບ​ບັນຫາ​ດ້ານ​ ເຕັກນິກ​ທີ່​ບໍ່​ສາມາດ​ແກ້​ໄຂ​ໄດ້​ຢ່າງ​ງ່າຍ​ດານ​ຍຢູ່​ໃນ​ຊຸມ​ຊົນ.​ ຮູບ ແບບ ການ ໃຫ້ ບໍລິການ ​ທກຸ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຄວນ​ປະຕິບັດ​ຕາມ​ແປດ​ຂັນ້​ຕອນ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ.​​ແນວ​ໃດ​ ກໍ່ຕາມ,​ມ​ີວທິ​ີແຕກຕ່າງ​ກນັ​ໃນ​ການ​ນາໍ​ສົງ່​ແປດ​ຂັນ້​ຕອນ​ການ​ບລໍກິານ​ດັງ່ກາ່ວ,​​ເຊິງ່​ເອີນ້​ວາ່​ຮບູ​ແບບ​ ການ​ບລໍ​ິການ.​ການ​ລວມຮບູ​ແບບ​ການ​ໃຫ​້ບລໍກິານ​ຕ່າງໆ​ເຂົາ້ກນັ​ອາດ​ຈະ​ປະກອບ​ເປນັ​ການ​ ບລໍກິານ​ລວມລະດັບ​ປະ​ເທດ.​ຮບູ​ແບບ​ການ​ໃຫ​້ບລໍກິານ​ທີ​່ເໝາະ​ສົມ​ທີ​່ສຸດຈະ​ຂຶນ້​ກັບ​ສະພາບ​ການ,​​ ແລະ​ຄວນ​ຖກື​ຕັດສນິ​ໃຈ​ໂດຍ​ປກຶສາ​ຫາລ​ືກັບ​ທກຸ​ພາກສວ່ນທີ​່ກຽ່ວຂອ້ງ. ຕາ​ຕະລາງ​ຂາ້ງ​ລຸມ່​ສະ​ແດງ​ບາງ​ຢາ່ງ​ກຽ່ວ​ກັບ​ຮບູ​ແບບ​ຕາ່ງໆ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ. 10 11 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ການ ບໍລິການ ທ່ີ ເອົາ ສູນ ເປັນພ້ືນ ຖານ ​ມີພ້ືນ​ທີ່​ການ​ປະ​ເມີນ​ຜົນ​ສະ​ ເພາະ ​ໃນການ​ບໍລິການ​ທີ່​ອີງ​ໃສ່​ສູນ,​ຜູ້​ໃຊ້​ລົດ​ ເຂັນ​ເດີນທາງ​ມາສະ​ຖານທີ່​ຖາວອນ​ ໃດ​ໜຶ່ງ​ບ່ອນ​ທີ່​ມີ​ບຸກຄະລາ​ກອນ​ທີ່​ ຜ່ານ​ການ​ຝຶກ​ອົບຮົມ​ມາ​ເປັນ​ຢ່າງ​ດີ​ໄວ້​ ຄອຍ​ໃຫ້ການບໍລິການ. ​ເພາະວ່າ​ເປັນ​ສະຖານ​ທີ່​ຖາວອນ,​ ການ​ບໍລິການ​ອາດ​ຈະ​ມີ​ພະນັກງານ​ ສະ​ເພາະ​​ແລະ​ພ້ືນ​ທີ່ຕ່າງໆ​ສໍາລັບ​ ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ. ​ການບໍລິການ​ທີ່​ອີງ​ໃສ່​ສູນ​ສາມາດ​ມີ​ ປະສິດທິພາບ​ສໍາລັບ​ບຸກຄະລາ​ກອນ;​​ ແນວ​ໃດ​ກໍ່ຕາມ,​ມັນ​ສາມາດ​ ຫຍຸ້ງຍາກ​ສໍາລັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ທີ່​ອາ​ໄສ​ ຢູ່​ໄກ​ອອກ​ໄປ​ຈາກ​ການ​ບໍລິການ​ທີ່​ຈະ​ ມາ​ເຖິງ​ທີ່​ນັ້ນ​ໄດ້. ພື້ນ​ທີ່​ສະ​ເພາະ​ສໍາລັບ​ທັກ​ສະ​ ດ້ານ​ການ​ໃຊ້​ລົດ​ເຂັນ​ເ​ພ່ືອ​ ເຄື່ອນ​ໄຫວ​ໄປມາ ການ ບໍລິການ ແບບ ຮ່ວມ ກັນ ​ການ​ບໍລິການ​ລົດ​ເຂັນ​ທີ່​ ເຊື່ອມ​ສານ​ກັບ​ຄລີ​ ນິກສຸຂະພາບ​ຊຸມ​ຊົນ ການ​ບໍລິການ​ທີ່​ອີງ​ໃສ່​ສູນ​ສ່ວນ​ໃຫຍ່​ ແມ່ນ​“ການ​ບໍລິການ​ແບບ​ຮ່ວມກັນ”.​ ນີ້​ໝາຍ​ຄວາມ​ວ່າການ​ບໍລິການ​ລົດ​ ເຂັນຖືກ​ລວມ​ເຂົ້​າກັບ​ກິດຈະ​ກໍາ​ຂອງ​ ການ​ບໍລິການ​ອື່ນ​ຫຼືການ​ບໍລິການ​ອື່ນ.​ ຕົວຢ່າງ,​ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ​ ສາມາດ​ເອົາ​ລວມ​ເຂົ້​າ​ກັບ​ການ​ ບໍລິການ​ດ້ານ​ອຸປະກອນ​ທຽມ​ສໍາລັບ​ ຮ່າງກາຍ,​ພະ​ແນ​ກກາ​ຍະ​ບໍາບັດ​ ຫຼືຄລີ​ນິກສຸຂະພາບ.​​ໃນ​ສະພາບ​ການ​ ນີ້,​ຖ້າ​ບຸ​ກຄະ​ລາກ​ອນກໍາລັງ​ປະ​ຕິ​ບັດ​ ຫຼາກຫຼາຍໜ້າ​ທີ່​​ໄປ​ພ້ອ​ມກັບ​ການ​ໃຫ້​ ບໍລິການ​ລົດ​ເຂັນ,​ມັນ​ສໍາຄັນ​ໃນ​ການ​ ຮັບປະກັນ​ວ່າ​ບຸກຄະລາ​ກອນ​ມີ​ເວລາ​ ພຽງພ​ໍເພືອ່​ດາໍ​ເນນີ​ທກຸ​ກດິຈະ​ກາໍ​ທີ​່ຈາໍ​ ເປັນ​ຂອງ​ເຂົາ​ເຈົ້າ. ອາດ​ຈະ​ໃຊ້​ສະຖານ​ທີ່ຮ່ວມ​ກັນ,​ ຫຼືອາດຈະ​ມີ​ພື້ນ​ທີ່​ສະ​ເພາະ​ໃຫ້.​ອາດ​ ຈະ​ມີ​ໜ່ວຍ​ງານ​ບໍລິຫານ,​ການ​ເງິນ​​ ແລະ​ການ​ຄຸ້ມ​ຄອງ​ຮ່ວມ​ກັນ.​ ​ໃນ​ສະພາບ​ການ​ນີ້​ພ້ືນ​ທີ່​ອັນ​ ໜຶ່ງ​ຂອງ​ໂຮງ​ສ້ອມ​ແປງຖືກ​ ກໍານົດ​ສະ​ເພາະ​ໃຫ້​ແກ່​ການ​ ກະກຽມ​ລົດ​ເຂັນ 10 11 ການ ບໍລິການ ຢູ່ ນອກ ສະຖານ ທ່ີ ສະຖານ​ທີ່​ໃຫ້​ບໍລິການ​ຢູ່ນອກ​ ສະຖານ​ທີ່​ສາມາດ​ແຕກ​ຕ່າງ​ ກັນ​ໄດ້.​​ຕົວຢ່າງ​ຄລີ​ນິກສຸກສະ​ ລາ​ຊຸມ​ຊົນ,​ສາລາ​ເມືອງ,​ບ່ອນ​ ປະຊຸມ​ຂັ້ນ​ບ້ານ,​​ແລະ​ເຮືອນ​ ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ ​ໃນ​ການ​ບໍລິການ​ລົດ​ເຂັນ​ຢູ່​ນອກ​ສະຖານ​ ທີ່,​ບຸກຄະລາ​ກອນ​ຈາກ​ສູນ​ຫຼືໜ່ວຍ​ ບໍລິການ​ແບບ​ຮ່ວມ​ກັນ​​ເດີນທາງ​ໄປ​ ເຮືອນ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຫຼື​ໄປ​ສະຖານ​ທີ່​ ໃຈກາງ​ໃນ​ເມືອງ​/​ເຂດ​ອື່ນ​– ​ເພ່ືອ​ພົບ​ກັບ​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຈາກ​ເມືອງ/​ເຂດ​ນັ້ນ​​ເພ່ືອ​ ໃຫ້ການ​ບໍລິການ. ຮູບ​ແບບ​ການ​ບໍລິການ​ຢູ່​ນອກ​ສະຖານ​ທີ່​ ໂດຍ​ປົກກະຕິ​ແລ້ວ​ຖືກ​ດໍາ​ເນີນ​ໂດຍ​ຮ່ວມ​ ມື​ກັບ​ອົງການ​ຈັດ​ຕັ້ງ​ໃນ​ເມືອງ/​ເຂດ​ທີ່​ໄປ​ ໃຫ້​ບໍລິ​ການ​ນັ້ນ. ການ​ປະ​ສານງານ​ທີ່​ດີ​ກັບ​ອົງການ​ຈັດ​ຕັ້ງ​ ໃນ​ທ້ອງ​ຖິ່ນ​ແມ່ນ​ສິ່ງ​ສໍາຄັນ​ຫຼາຍ.​ການ​ ຝຶກ​ອົ​ບຮົມ​ໃຫ້​ບຸກຄະລາ​ກອນ​ຫຼືອາສາ​ ສະໝັກ​ໃນ​ທ້ອງ​ຖິ່ນ​ສາມາດ​ຊ່ວຍ​ເພ່ີມ​ ຄວາມ​ສໍາ​ເລັດ​ຂອງ​ການ​ໃຫ້​ບໍລິການ​ຢູ່​ ນອກ​ສະຖານ​ທີ່​​ແລະ​ເພ່ີມ​ການ​ ສະໜັບສະໜູນ​ໃນ​ລະດັບ​ຊຸມ​ຊົນ​ໄດ້. ຂໍ້​ດີ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ມີ​ຢູ່​ວ່າ​ພວກ​ເຂົາ​ບໍ່​ ຈໍາ​ເປັນ​ຕ້ອງ​ເດີນທາງ​ໄກ.​ ບຸກຄະລາ​ກອນ​ທີ່​ໃຫ້​ ບໍລິການ​ນອກ​ສະຖານ​ທີ່​ ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ຄວາມ​ ຢືດຢຸນ,​​ແລະ​ຖື​ເອົາ​ ອປຸະກອນ​ທີ​່ສາໍຄນັ​ໄປ​ນາໍ​ ພວກ​ເຂົາ.​ ໜ່ວຍ ບໍລິການ ແບບ ເຄ່ືອນ ທ່ີ ​ຕົວຢ່າງ​ຂອງ​ພາຫະນະ​ສະ​ ເພາະ​ສໍາລັບ​ການ​ບໍລິການ​ລົດ​ ເຂັນ​ແບບ​ເຄື່ອນ​ທີ່ ​ການ​ບໍລິການ​ແບບ​ເຄື່ອນ​ທີ່​ແມ່ນ​ຮູບ​ ແບບໜຶ່ງ​ຂອງ​ການ​ໃຫ້​ບໍລິການ​ຢູ່​ນອກ​ ສະຖານ​ທີ່;​​ແນວ​ໃດ​ກໍ່ຕາມ​ໃນ​ສະພາບ​ ການ​ນີ້,​ບຸກຄະ​ລາກ​ອນມີ​ພາຫະນະ​ສ​ະ​ ເພາະ​ທີ່​ຖືກ​ໃຊ້​ເພື່ອບັນທຸກ​ລົດ​ເຂັນ​​ແລະ​ ເຄື່ອງ​​ແລະ​ອຸປະກອນ​ທີ່​ຈໍາ​ເປັນ. ບຸກຄະລາ​ກອນ​ສາມາດຕັ້ງ​ຢູ່​ໃນ​ ຫຼາກຫຼາຍສະຖານ​ທີ່,​​ແລະ​ໃນ​ວິທີ​ນີ້​ ອາດ​ຈະ​ສາມາດ​ເຂົ້າ​ເຖິງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້​ ຫຼາຍຂຶ້ນ. ຄວາມ​ສາມາດ​ຖື​ເຄື່ອງມື,​ອຸປະກອນ,​ວັດ​ ສະດຸ​​ແລະ​ອາ​ໄຫຼ່​ໄດ້​ຫຼາຍກວ່າ​ຊ່ວຍ​ເພ່ີມ​ ໂອກາດ​ໃນ​ການ​ດໍາ​ເນີນ​ການ​ສ້ອມ​ແປງ​ ກັບ​ສະຖານ​ທີ່​,​​ແລະ​ຄວາມ​ເປັນ​ໄປ​ໄດ້​ໃນ​ ກາ​ນຄຸ້ມ​ຄອງ​ບາງ​ການ​ໃຫ້ການ​ບໍລິການ​ ລະດັບ​ປານ​ກາງ​. ​ດ້ວຍ​ການ​ໃຊ້​ພາຫະນະ​ ສະ​ເພາະ,​ບຸກຄະລາ​ ກອນ​ສາມາດ​ບັນຈຸ​ ອຸປະກອນ​​ແລະ​ ເຄື່ອງມື​ທີ່​ພວກ​ເຂົາ​ ຕ້ອງການ​ໄດ້​ຫຼາຍຂຶ້ນ. 12 13 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ການ ໃຫ້ ການ ບໍລິການ ແບບ ຮ່ວມ ມື ກັນ ບໍ​່ແມນ່​ວາ່ທງັ​ໝົດ​ແປດ​ຂັນ້​ຕອນ​ໃນ​ການ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ​ຈາໍ​ເປນັ​ຕ້ອງ​ຖກື​ດາໍ​ເນນີ​ໂດຍ​ ອງົການ​ຈດັ​ຕັງ້​ດຽວ.​ການ​ຮວ່ມມ​ືກນັ​ລະຫວາ່ງ​ເຄືອ​ຂາ່ຍ​ອງົການ​ຈດັ​ຕັງ້​ສາມາດ​ຊວ່ຍ​ເພີມ່​ ປະສິດທິພາບຂອງ​ການ​ບລໍກິານ​ໄດ​້​ແລະ​ຍງັ​ເພີມ່​ການ​ເຂົາ້​ເຖງິ​ແປດ​ຂັນ້​ຕອນ​ເຕມັ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ ນາໍ​ອກີ. ຂ້ັນ ຕອນ ໜ່ຶງ (ການ ນໍາ ສ່ົງ ແລະ ການ ນັດ ໝາຍ)​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີການ​ຮວ່​ມມ​ື​ແລ​ະການ​ຮວ່ມ​ ງານ​ກນັ​ລະຫວາ່ງ​ບນັດາ​ອງົການ​ຈດັ​ຕັງ້​​ແລະ​ບກຸຄນົ​ທີ​່ປະກອບ​ເປນັ​ເຄືອ​ຂາ່ຍ​ການນາໍ​ສົງ່ສາໍລັບ​ ການ​ການ​ບລໍກິານ​ລົດ​ເຂນັ. ຂ້ັນ ຕອນ ເຈັດ (ການ ຝຶກ ອົບຮົມ ຜູ້ ໃຊ້) ແລະ ຂ້ັນ ຕອນ ແປດ (ການ ບໍາລຸງ ຮັກສາ, ການ ສ້ອມ ແປງ ແລະການ ຕິດຕາມ ຜົນ)​ສາມາດ​ໃຫ​້ບລໍກິານ​ໂດຍ​ຄູ​່ຮວ່ມ​ງານ​ໄດ.້​ຕວົຢາ່ງ,​​ເຄືອ​ຂາ່ຍ​ ອງົການ​ຈດັ​ຕັງ້​ຂັນ້​ຊມຸ​ຊນົ,​ຫຼືອງົການ​ຈດັ​ຕັງ້​ຄນົ​ພິການ​ອາດ​ຈະ​ເປນັ​ຜູ​້ດາໍ​ເນນີ​ຂັນ້​ຕອນ​ເຫຼົາ່ນີ​້ຢູ່ໃນ​ ຊມຸ​ຊນົ. An example 2. Assessment 3. Prescription 4. Funding & ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance repairs & follow-up 1. Referral & appointment Activities in the service setting A.2.11 Service delivery ​ແຜນ​ວາດ​ນີ້​ສະ​ແດງ​ໃຫ້​ເຫັນ​ວ່າ​ແປດ​ຂັ້ນ​ຕອນ​ຂອງ​ການ​ ໃຫ້​ບໍລິການ​ອາດ​ຈະ​ຖືກ​ດໍາ​ເນີນ​ແນວ​ໃດ​​ຜ່ານ​ການ​ເປັນ​ຄູ່​ ຮ່ວມ​ງານ​ກັນ​ລະຫວ່າງ​ຜູ້​ໃຫ້ບໍລິການ​ລົດ​ເຂັນ​ກັບ​ ອົງການ​ຈັດ​ຕັ້ງ​ຂັ້ນ​ຊຸມ​ຊົນ. ຂັ້ນ​ຕອນ​2–7​ຖືກ​ດໍາ​ເນີນ​ໃນ​ສະຖານ​ທີ່​ໃຫ້​ບໍລິການ​​ແລະ​ ຂັ້ນ​ຕອນ​1​​ແລະ​8​ຖືກ​ດໍາ​ເນີນ​ຢູ່​ໃນ​ຊຸມ​ຊົນ. ຮູບ​ແບບ​ນີ້​ຈໍາ​ເປັນ​ຕ້ອງ​ພິຈາລະນາ​ເຖິງ​ການ​ຝຶກ​ອົບຮົມ​ທີ່​ ຈໍາ​ເປັນ​ສໍາລັບ​ບຸກຄະລາ​ກອນ​​ແລະ​ອາສາ​ສະໝັກ​ທຸກ​ຄົ​ ນທີ່​ກ່ຽວຂ້ອງ. ບົດບາດ ຂອງ ຜູ້ ຈັດການ ໃນ ການ ໃຫ້ການ ບໍລິການ ລົດ ເຂັນ ​ຜູ​້ຈດັການ​ຝ່າຍ​ການ​ບລໍກິານ​ລົດ​ເຂນັຮບັຜິດຊອບ​ສະໜັບສະໜນູ​ບກຸຄະລາ​ກອນ​ໃນ​ການ​ນາໍ​ສົງ່​ແປດ​ ຂັນ້​ຕອນ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ​​ແລະ​ປະສານ​ງານ​ຄວາມ​ຄືບ​ໜາ້​ຂອງ​ຜູ​້ໃຊ​້(​ແລະ​ຜູ​້ໃຫກ້ານ​ດ​ູແລ/ຄນົ​ ໃນ​ຄອບ​ອຄວົ​ຂອງ​ເຂາົ​ເຈົາ້)​​ໃນ​ຕະຫຼອດຂັນ້​ຕອນ​ເຫຼົາ່ນັນ້. ຜູ​້ຈດັການ​ຍງັ​ມ​ີບດົບາດ​ທີ​່ກວາ້ງ​ກວາ່​​ເຊິງ່ສາໍຄນັ​ສາໍລບັ​ການ​ສະໜບັສະໜນູ​ການ​ໃຫ​້ບລໍກິານ.​ບດົບາດ​ ເຫຼົາ່ນີ​້ປະກອບ​ມ:ີ 12 13 •​ ສາ້ງ​ຄວາ​ມຮບັ​ຮູ​້ກຽ່ວ​ກັບ​ການສະໜອງ​ລົດ​ເຂນັ​ທີ່​ ເໝາ​ະສົມ; •​ ປັບປງຸ​ຄວາມ​ສາມາດ​ເຂົາ້​ເຖງິ; •​ ​ເພ່ີມ​ໂອກາດ​ການ​ຝກຶ​ອບົຮມົ​ສາໍລັບ​ບກຸຄະລາ​ ກອນ​ຝາ່ຍ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ; •​ ພັດທະນາ​ຄວາມ​ຍນື​ຍງົ​– ​ເພ່ືອ​ຮກັສາການ​ໃຫ້​ ບລໍກິານ​ລົດ​ເຂນັ​ໄວ​້ຢາ່ງ​ໝັນ້ຄງົ; •​ ມ​ີອ​ິດ​ທິພົນ​ຕໍ​່ກັບ​ນະ​ໂຍບາຍ​ລະດັບ​ປະ​ເທດ​ກຽ່ວ​ ກັບ​ການ​ສະໜອງ​ລົດ​ເຂນັທີ​່ເໝາະ​ສມົ. •​ ​ປ​ັບປງຸ​ຂອບ​ເຂດລົດ​ເຂນັ​ທີ​່ມ​ີໃຫ.້ Role of the mana gers Raising awareness Monitoring and evaluation Improving access and meeting users' expectations Having motivated well-trained workforce Developing sustainability Developing a well- functioning system A.2.12 Service delivery ການ ມີ ສ່ວນ ຮ່ວມ ຢ່າງ ຈິງ ຈັງ ຂອງ ຜູ້ ໃຊ້ ລົ ດ ເຂັນ ໃນ ການ ໃຫ້ ບໍລິການ ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທີ​່ມ​ີສວ່ນ​ຮວ່ມ​ຢາ່ງ​ຈງິ​ຈງັ​ໃນ​ທກຸໆ​ດາ້ນ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ຈະ​ຊວ່ຍ​ປັບປງຸ​ຜນົ​ ໄດ​້ຮບັ​ສາໍລັບຜູ​້ໃຊ​້ລົດ​ເຂນັ.​ບາງ​ຍຸດ​ທະ​ສາດ​ທີ​່ແນະນາໍ​ສາໍລັບ​ຜູ​້ຈດັການ​​ເພ່ືອ​ຮບັປະກນັ​ໃຫ​້ຜູ​້ໃຊ​້ລົດ​ ເຂນັມ​ີສວ່ນ​ຮວ່ມ​ໃນ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​ເຂ​ົາ​ເຈົາ້​​ແມນ່​ການ:(7) •​ ​ຮບັປະກນັ​ໃຫ​້ບກຸຄະລາ​ກອນ​ລວມ​ເອາົ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ເປນັ​ສະມາຊກິ​ຂອງ​ທ​ີມງານ​ໃຫ​້ການບລໍກິານ​ ໃນ​ທກຸ​ບາດກາ້ວທີນ່າໍ​ໄປ​ສູ​່ການ​ສະໜອງ​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້; •​ ສາ້ງ​ລະບົບ​ຢູ​່ພາຍ​ໃນ​ການ​ບລໍກິານ​ເພ່ືອ​ເກັບ​ເອາົ​ຄາໍ​ຕ​ິຊມົ​ຈາກ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຢາ່ງ​ເປນັ​ ປກົກະຕກິຽ່ວ​ກັບ​ການ​ບລໍກິານ​​ແລະວທິ​ີປັບປງຸ​ການ​ບລໍກິານ; •​ ​ໃນ​ບ່ອນ​ທີ​່ເປນັ​ໄປ​ໄດ,້​ວາ່​ຈາ້ງຜູ​້ໃຊ​້ລົດ​ເຂນັ​ເປນັ​ສະມາຊກິ​ທ​ີມງານ​ໃຫ​້ການ​ບລໍກິານ.​ນີ​້ອາດ​ຈະ​ ໝາຍ​ເຖງິ​ການ​ໂຄສະນາ​ຕາໍ​ແໜ​່ງ​ໃໝ​່ຜາ່ນ​ຂະ​ແໜງ​ຄນົ​ພກິານ,​​ແລະ​ຮບັປະກນັ​ວາ່​ທກຸ​ພ້ືນ​ທີ່​ ຂອງ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ແມນ່​ສາມາດ​ເຂົາ້​ເຖງິ​ໄດ​້ໂດຍ​ລົດ​ເຂນັ. ​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ຢູ່​ໃນ​ທີ​ມງານ​ໃນ​ປະ​ເທດ​ໂຣມາ​ເນຍ. ການ​ບໍລິການ​ລົດ​ເຂັນ​ຂອງອົງການ​NGO​​ໃນ​ໂຣມາ​ເນຍ​​ໄດ້​ວ່າ​ຈ້າງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ເຂົ້າ​ເປັນ​ສະມາຊິກ​ທີ​ ມງານ​ໃຫ້​ການບໍລິການ​ລົດ​ເຂັນ.​​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ເຮັດ​ໜ້າ​ທີ່​ຕ່າງໆ​ໃນ​ທີ​ມ,​​ໂດຍ​ຂຶ້ນ​ກັບ​ທັກ​ສະ​ຂອງ​ເຂົາ​ ເຈົ້າ.​ອົງການ​NGO​ນີ້​ໄດ້​ເຫັນ​ຜົນ​ກະທົບ​ດ້ານ​ບວກ​ທີ່​ໃຫຍ່​ຫຼວງຜ່ານ​ການ​ມີ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ເປັນ​ ພະນັກງານ​ຝ່າຍ​ບໍລິການ​ລົດ​ເຂັນ.​ສະມາຊິກ​ແຕ່ລະຄົນ​ຂອງ​ທີ​ມຮັບ​ຮູ້​ຄວາມ​ຕ້ອງການ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ ເຂັນ​ຫຼາຍຂຶ້ນ​ຜ່ານ​ການ​ສື່ສານ​ໃນ​ແຕ່​ລ​ະ​ວັນ​ຂອງ​ເຂົາ​ເຈົ້າ​ໃນ​ຖານະ​ເປັນ​ເພ່ືອນ​ຮ່ວມ​ງານ;​ລູກ​ຄ້າທີ່​ ເປັນ​ຜູ້​ໃຊ້​ລົດ​ເຂັນຮູ້ສຶກ​ສະບາຍ​ໃຈ​ກວ່າ​ໃນ​ການ​ແບ່ງປັນ​ປະສົບ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ​ກັບ​ສະມາຊິກ​ທີ​ມ ງາ​ນທີ່​ເປັນຜູ້​ໃຊ້​ລົດ​ເຂັນ,​​ແລະ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ແມ່ນ​ແບບຢ່າງ​ສໍາລັບ​ຄົນ​ອື່ນ. 14 15 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ A.3 ຜູ້ ຈັດການ ທ່ີ ນໍາພາ ການ ປ່ຽນ ແປງ ການ​ນາໍ​ສະ​ເໜ​ີຫຼກືານ​ປັບປງຸ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ມັກ​ຈະ​ຮຽກຮອ້ງ​ໃຫ​້ມ​ີການ​ປຽ່ນ​ແປງ​ຢູ​່ພາຍ​ ໃນ​ອງົການ​ຈດັ​ຕັງ້.​​ແນວ​ໃດ​ກໍ່ຕາມ,​ການ​ນາໍ​ພາການ​ປຽ່ນ​ແປງ​ສາມາດ​ເປນັ​ເລື່ອງ​ຍາກ.​ສວ່ນ​ໜຶງ່​ ຂອງ​ໜາ້​ທີ​່ຜູ້​ຈດັການ​ຝາ່ຍ​ບລໍກິານ​ລົດ​ເຂນັ​ແມນ່​ການ​ນາໍພາ​ການ​ປຽ່ນ​ແປງ​​ແລະ​ບາງ​ກິດຈະກາໍ​ ສາໍຄນັ​ເພື່ອ​ບນັລ​ຸໄດ​້ສິງ່​ນີ​້ປະກອບ​ມ:ີ •​ ຊວ່ຍ​ສາ້ງ​ວ​ິໄສ​ທັດ​ຮວ່ມ​ກນັ​ກຽ່ວ​ກັບານ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ; •​ ສືສ່ານ​ຄວາມ​ສາໍຄນັ​ຂອງ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ທີ​່ເໝາະສມົ​ໃຫ​້ທກຸ​ພາກສວ່ນ​ທີ​່ກຽ່ວຂອ້ງ​ຮບັ​ຮູ້​​ ລວມທງັ​ຜູ​້ກາໍນົດ​ນະ​ໂຍບາຍ,​ຜູ​້ໃຫ​້ບລໍກິານ​ອືນ່​​ແລະ​ຜູ​້ໃຫ​້ທນຶ​ທີ​່ເປນັ​ໄປ​ໄດ;້ •​ ຈດັ​ວາງ​ບກຸຄະລາ​ກອນ​​ແລະ​ຊບັພະຍາກອນ​ຢາ່ງ​ເໝາະ​ສມົ; •​ ກ​ະຕຸນ້,​​ເຂົາ້​ຮວ່ມ​​ແລະມອບ​ໝາຍ​ບກຸຄະລາ​ກອນ. ສ້າງ ວິ ໄສ ທັດ ຮ່ວມ ກັນ ກ່ຽວ ກັບ ການ ສະໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ການສາ້ງ​ວ​ິໄສ​ທັດ​ຮວ່ມ​ກນັ​ໃນ​ບນັດາ​ພາກສວ່ນ​ທີ​່ກຽ່ວຂອ້ງ​ທງັ​ໝົດ​ກຽ່ວ​ກັບ​ການ​ປັບປງຸ​ການ​ສະໜອງ​ ລ​ົດ​ເຂນັ​ຢູ​່ພາຍ​ໃນ​ປ​ະ​ເທດ​ສາມາດຊວ່ຍ​ກ​ຕຸນ້​ທກຸ​ຄນົ​ຜູ​້ທີ​່ຕ້ອງການ​ຮວ່ມ​ມ​ືກນັ​ເພ່ືອ​ນາໍ​ມາ​ເຊິງ່ການ​ ປຽ່ນ​ແປງ.​ວ​ິໄສ​ທັດ​ຄວນ​ເອາົ​ໃຫ​້ພາບ​ອະນາ​ຄົດ​ທີ​່ຕ້ອງການ.​ຕວົຢາ່ງ: ‘​ໂລກ​ທີ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ໄດ້ ​ເຂົາ້​ຮວ່ມ​​ແລະ​ມ​ີສວ່ນ​ຮວ່ມ​ຢາ່ງ​ເຕມັ​ສວ່ນ​ໃນ​ທກຸ​ດາ້ນ​ຂອງ​ຊວີິດí. ມນັ​ສາໍຄນັ​ໃນ​ການ​ແບງ່ປັນ​ວິ​ໄສ​ທັດ​ດາ້ນ​ບວ​ກຢາ່ງ​ຈງິ​ຈງັ​​ເພ່ືອ​ ໃຫ້​ພະນັກງານ​ທຸກ​ຄນົ​ມີ​ຄວາມ​ຮູສ້ຶກ​​ແລະ​ຄວາມມຸງ້​ໝ້ັນທີ່​ຈະ​ ປັບປງຸ​ຄນຸ​ນະພາ​ບຊວີິດ​ຂອງ​ຄນົ​ພິການ. 14 15 ສ່ືສານ ຄວາມ ສໍາຄັນ ຂອງ ການ ສະໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ​ເພື່ອ​ສືບ​ຕໍ​່ກະຕຸນ້ບກຸຄະລາ​ກອນ​​ແລະ​ພາກ​ສວ່ນ​ກຽ່ວຂອ້ງ​ອືນ່,​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕອ້ງ​ສື່ສານ​ແຈງ້​ ບອກ​ຄວາມ​ສໍາຄນັ​ຂອງ​ການ​ສະໜອງ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ​ຢາ່ງ​ຕໍ​່ເນື່ອງ.​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕ້ອງ​ເຮດັ​ ໃຫ​້ມນັ​ຈະ​ແຈງ້ວາ່​ການ​ນາໍ​ສະ​ເໜ​ີຫຼກືານ​ປັບປງຸ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ແມນ່​ບລູ​ິມະ​ສິດ,​​ແລະ​ມນັ​ ເປນັ​ສິງ່​ຮບີ​ດວ່ນ.​ຄວາມຮູສ້ຶກຮບີດວ່ນໝາຍຄວາມວາ່​ມີຄວາມຈາໍເປນັທີ​່ບໍ​່ສາມາດ​ຫຼກີລຽງ​ຫຼືຊກັ​ ຊາ້​ໄດ.້​ຜູ​້ຄນົ​ປະຕບິັດ​ຕາມ​ບລຸມິະສິດ​ຂອງ​ຫວົໜາ້​ສາຍ​ງານ​ຂອງ​ເຂາົ​ເຈົາ້;​ສະ​ນັນ້​ການ​ດາໍ​ເນນີ​ການ​ ຂອງ​ຜູ​້ຈດັການ​ຕອ້ງ​ສາ້ງ​ຄວາມ​ຮູສ້ຶກ​ຮບີ​ດວ່ນ. ວິທີ ສ່ືສານ ແຈ້ງ ບອກຄວາມ ສໍາຄັນ ຂອງ ການ ສະໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ •​ ​ໂອ້​ລົມ​ກ່ຽວ​ກັບ​ຄວາມ​ຕ້ອງການ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ​ໃນທົ່ວ​ໂລກ​​ແລະ​ລະດັບ​ປະ​ເທດ​ທີ່​ຍັງ​ບໍ່​ທັນ​ຕອບ​ ສະໜອງ​ໄດ້;​ສິທິ​ໃນ​ການ​ເຄື່ອນ​ທີ່​ໄປມາ​ຂອງ​ບຸກຄົນ;​​ແລະ​ຜົນ​ປະ​ໂຫຍ​ດຂອງ​ການ​ສະໜອງ​ລົດ​ເຂັນ​ທີ່​ ເໝາະ​ສົມຕໍ່​ກັບ​ບຸກຄົນ,​ຊຸມ​ຊົນ​​ແລະ​ສັງຄົມ. •​ ​ສົນທະນາ​ຄວາມ​ຄືບ​ໜ້າ​ຕໍ່​ກັບ​ການ​ນໍາ​ສະ​ເໜີ​ຫຼືການ​ປັບປຸງ​ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ​ຢູ່​ໃນ​ກອງປະຊຸມ​ ພະນັກງານ​ປົກກະຕິ. •​ ​ແບ່ງປັນ​ເລື່ອງ​ເລົ່າ​ຄວາມ​ສໍາ​ເລັດທີ່​ດີ​,​ຕົວຢ່າງ​ຢູ່​ໃນ​ກອງ​ປະຊຸມ​ພະນັກງານ,​​ແລະ​ດ້ວຍ​ໂປ​ສ​ເຕີ້​ຢູ່​ ເທິງ​ຝາ​ໃຫ້​ບໍລິການ. ຈັດ ວາງ ບຸກຄະລາ ກອນ ແລະ ຊັບພະຍາກອນ ຢ່າງ ເໝາະ ສົມ ​ການ​ບໍລິການ​ລົດ​ເຂັນ​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ບຸກຄະລາ​ ກອນ​ທີ່​ຜ່ານ​ການ​ຝຶກ​ອົບຮົມ,​ສ່ິງ​ອໍານວຍ​ຄວາມ​ ສະດວກ​​ແລະ​ຊັບພະຍາກອນ.​ສະມາຊິກ​ທຸ​ກຄົນ​ ຂອງ​ທີ​ມງານ​ບໍລິການ​ລົດ​ເຂັນ​ຄວນ: •​ ​ເຮັດ​ວຽກ​ຮ່ວມ​ກັນ​ໃນ​ທິດ​ທາງ​ດຽວ​ກັນ; •​ ຮູ້ສຶກ​ໄດ້​ຮັບ​ການ​ສະໜັບສະໜູນ​ພ້ອມ​ ຊັບພະຍາກອນ​ທີ່​ພວກ​ເຂົາ​ຕ້ອງການ​ເພ່ືອ​ເຮັດ​ ໜ້າ​ວຽກ​ຂອງ​ເຂົາ​ເຈົ້າ; •​ ​ໄດ້​ຮັບ​ການ​ຍ້ອງ​ຍໍ​ສໍາລັບ​ການ​ປະກອບສ່ວນ​ຂອງ​ ເຂົາ​ເຈົ້າ. 16 17 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ວິທີຈັດ ວາງ ບຸກຄະລາ ກອນ ແລະ ຊັບພະຍາກອນ ຢ່າງ ເໝາະ ສົມ •​ ​ລະບຸ​ສິ່ງ​ອໍານວຍ​ຄວາມ​ສະດວກ​ທີ່​ສາມາດ​ຖືກ​ໃຊ້​ສໍາລັບ​ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ. •​ ຈັດ​ບຸລິມະສິດ​ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ​​ໃນ​ເວລາ​ຈັດ​ສັນ​ບຸກຄະລາ​ກອນ,​ເວລາ,​ສິ່ງ​ອໍານວຍ​ຄວາມ​ ສະດວກ,​ອຸປະກອນ​​ແລະ​ທຶນ​ຮອນ. •​ ​ໃຊ້​ວິ​ໄສ​ທັດ​ຮ່ວມ​ກັນ,​​ແລະ​ຜົນ​ປະ​ໂຫຍ​ດຂອງ​ການ​ສະໜອງ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ​​ເພື່ອ​ແຈ້ງ​ເຕືອນ​ ພະນັກງານ​ຍ້ອນ​ຫຍັງ​ການ​ບໍລິການ​ຈິ່ງ​ກໍາລັງ​ສະໜອງ​ລົດ​ເຂັນ. •​ ຍ້ອງຍໍ​​ແລະ​ໃຫ້​ລາງວັນ​ພະນັກງານ​ທີ່​ມີ​ຜົນງານດີ​ເດັ່ນ​ໃນ​ການ​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ. •​ ອໍານວຍ​ຄວາມ​ສະດວກ​ໃຫ້​ພະນັກງານ​ເຮັດ​ວຽກ​ຮ່ວມ​ກັນ​ເປັນ​ທີ​ມ.​ ກ ະຕຸ້ນ, ເຂ້ົາ ຮ່ວມ ແລະ ເຮັດ ໃຫ້ ພະນັກງານມີ ຄວາມ ມຸ້ງ ໝ້ັນ ​ຜູ​້ຈດັການ​ສາມາດ​ຊວ່ຍ​ກ​ຕຸນ້,​​ເຂົາ້​ຮວ່ມ​​ແລະ​ເຮດັ​ໃຫ​້ພະນັກງານ​ມ​ີຄວາມ​ມຸງ້​ໝ້ັນ​ໄດ​້ໂດຍ​ການ: • ລວມ ເອົາພະນັກງານ ເຂ້ົາ ໃນ ການວາງ ແຜນ ແລະ ການຈັດ ຕ້ັງ ປະຕິບັດ– ​ເພ່ືອ​ໃຫ້​ພວກ​ເຂົາ​ສາມາດ​ ປະກອບສ່ວນ​ປະສົບ​ການ​​ແລະ​ທັກ​ສະ​ຂອງ​ເຂົາ​ເຈົ້າ;​​ ແລະ​ເພື່ອ​ຊ່ວຍ​ພວກ​ເຂົາ​ເຂົ້າ​ໃຈດີ​ຂຶ້ນ​ກ່ຽວ​ກັບ​ວ່າການ​ປ່ຽນ​ ແປງ​ຈະ​ກ່ຽວຂ້ອງຫຍັງ​​ແລະ​ບົດບາດ​ຂອງ​ເຂົາ​ເຈົ້າ​ເປັນ​ ແນວ​ໃດ​ໃນ​ການຈັດ​ຕັ້ງ​ປະຕິບັດ​ການ​ປ່ຽນ​ແປງ​ນັ້ນ. •​ ເອົາ​ຊະນະ​ອຸປະສັກ​ໄປ​ດ້ວຍ​ກັນ – ເພ່ືອ ໃຫ້ ພະນັກງານ ມີ ຄວາມ ເຂ້ົາ ໃຈດີ ຂ້ຶນ ກ່ຽວ ກັບ ສາ ເຫດ ຂອງ ບັນຫາ ແລະ ວິທີ ແກ້ ໄຂ ພວກ ມັນ. •​ ສ້າງ​ເປົ້າ​ໝາຍ​ໄລຍະ​ສັ້ນ​​ແລະ​ຍ້ອງຍໍ​ກາ​ນບັນລຸ​ໄດ້​ເປົ້າ​ ໝາຍ​ເຫຼົ່ານ້ັນ– ເພ່ືອ ໃຫ້ ພະນັກງານ ມີ ຄວາມ ຮູ້ສຶກ ວ່າຄວາ ມພະຍາຍາມ ຂອງ ເຂົາ ເຈົ້າ ກໍາລັງ ມີ ຜົນ ແລະ ໄດ້ ຮັບ ການ ຍ້ອງຍໍ ຊົມ ເຊີຍ. • ເຊ່ືອມ ສານ ການ ປ່ຽນ ເຂ້ົາ ໃນ ລະບົບ ແລະ ວັດທະນະທໍາ ຂອງ ອົງການ ຈັດ ຕ້ັງ.​ຕົວຢ່າງ,​ສ້າງ​ວັດທະນະທໍາ​ ແຫ່ງການ​ສະຫຼອງຄວາມສໍາ​ເລັດ​​ແລະ​ສົ່ງ​ເສີມ​ໃຫ້​ບຸກຄົນ​ ແບ່ງປັນ​ຄວາມ​ສໍາ​ເລັດ​​ແລະ​ເລື່ອ​ງ​ເລົ່າ​ທີ່​ດີ​ໃນ​ລະຫວ່າງ​ ກອງ​ປະຊຸມ​​ແລະ​ການຢຸດ​ພັກ​ຕ່າງໆ.​​ນອກ​ນັ້ນ,​ ຮັບປະກັນ​ວ່າການ​ປ່ຽນ​ແປງ​ທີ່​ສໍາ​ເລັດ​ຜົນ​ແ​ມ່ນຖືກ​ຮັກສາ​ ໄວ້​​ໂດຍ​ການ​ຂຽນ​ຄວາມ​ຮັບຜິດຊອບ​ໃໝ່​ເຂົ້າ​ໃສ່​ລາຍ​ ລະອຽດ​ໜ້າ​ວຽກ​ຂອງ​ບຸກຄົນ​​ແລະ​ອັບ​ເດດ​ນະ​ໂຍບາຍ​ຂອງ​ ອົງການ​ຈັດ​ຕັ້ງ. 16 17 B: ການ ເລ່ີ ມການ ບໍລິການ ລົດ ເຂັນ B.1 ການ ເຂ້ົາ ເຖິງ ການ ບໍລິການ “ກາ ນບໍລິການ ທ່ີ ທ່ົວ ເຖິງ” ໝາຍ ເຖິງ ຫຍັງ? “ກາ​ນບລໍກິານ​ທີ​່ທົວ່​ເຖງິ”​​ແມນ່​ການ​ບລໍກິານ​ທີ​່ຮບັປະກນັ​ໃຫ​້ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທກຸ​ຄນົ​ມ​ີໂອກາດ​ທີ່​ ເທົາ່ທຽມ​ກນັ​ໃນ​ການ​ໄດ​້ຮບັ​ລົດ​ເຂນັ.​ນີ​້ລວມມ:ີ •​ ຜູ​້ຊາຍ,​​ແມ່ຍງິ,​​ເດກັ​ຊາຍ​​ແລະ​ເດກັຍງິ •​ ​ໄວ​ໜຸມ່,​​ໄວ​ກາງຄນົ​​ແລະ​ຜູ​້ສງູ​ອາຍຸ •​ ຜູ​້ຄ​ົນທີ​່ອາ​ໄສ​ຢູ​່ໃກ​້​ແລະ​ຜູ​້ຄ​ົນທີ​່ອາ​ໄສ​ຢູ​່ຫາ່ງ​ໄກ​ອອກ​ໄປ​– ​ເຊັນ່​ວາ່​​ໃນ​ເຂດ​ຊນົນະບົດ •​ ຜູ​້ຄນົທີ​່ມາ​ຈາກ​ກຸມ່​ຊນົ​ເຜົາ່​ຫຼມືາ​ຈາກ​ພ້ືນຖານ​ເສດຖະກິດ​ສັງຄມົ​ທີ​່ແຕກ​ຕາ່ງ​ກນັ. ​ການ​ບລໍກິານ​ທີ​່ທົວ່​ເຖງິ​ຮບັ​ຮູ​້ວາ່​ທ​ຸຄນົ​– ​ໂດຍ​ບໍ​່ສນົ​ເລື່ອງ​ຄວາມ​ພິການ,​ອາຍ,ຸ​​ເພດ,​ສາສະໜາ,​ ຄວາມ​ຮັງ່ມ,ີ​ພາສາ​​ແລະ​ກຸມ່​ຊນົ​ເຜົາ່​ຂອງ​ເຂາົ​ເຈົາ້​ລວ້ນ​ແຕ​່ມ​ີສິດ​ເທົາ່​ທຽມ​ກນັ​ຕໍ​່ກັບ​ການ​ບລໍກິານ. ການ​ບລໍກິານ​ລົດ​ເຂນັ​ທີ​່ເທົາ່​ທຽມ​ກນັ​ແຕກ​ຕ່າງ​ຈາກ​ການ​ໃຫ​້ຈາໍນວນ​ລົດ​ເຂນັ​ທີ​່ເທົາ່​ກນັ​ແກ​່ຜູ​້ໃຊ​້ຈາກ​ ກຸມ່​ຕາ່ງໆ​(ຕວົຢາ່ງ,​​ໃຫຈ້າໍນວນ​ລົດ​ເຂນັ​ທີ​່ເ​ທົາ່ກນັ​ແກ​່ຜູ້​ຊາຍ​​ແລະ​ແມ່ຍງິ).​ນີ​້ເພາະວາ່​ຄວາມ​ ຕອ້ງການ​ຂອງ​ກຸມ່​ຕາ່ງໆ​ອາດ​ຈະ​ແຕກ​ຕາ່ງ​ກນັ. ຈ່ົງ ຈ່ື ວ່າ:​ການ​ເຂົ້າ​ເຖິງ​ການ​ບໍລິການ​ບໍ່​ໄດ້​ໝາຍ​ເຖິງ​“ການ​ໄປຫາການ​ບໍລິການ​”​​ພຽງ​ຢ່າງ​ດຽວເທົ່າ​ນັ້ນ.​ ​ ມັນ​ໝາຍ​ເຖິງ​ການ​ສາມາດ​ຊອກ​ຮູ້​ກ່ຽວ​ກັບ​ການ​ບໍລິການ,​​ໄປ​ຫາ​ການ​ບໍລິການ​ຫຼື​ໃຫ້ການ​ບໍລິການ​ນັ້ນ​ ມາ​ຫາ​ພວກ​ເຂົາ.​ 18 19 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ມ​ີຄນົ​ບາງ​ກຸມ່​ຜູ​້ທີ​່ອາດ​ຈະ​ພົບ​ຄວາມ​ຫຍຸງ້ຍາກ​ໃນ​ການ​ເຂົາ້​ເຖງິ​ການ​ບລໍກິານ.​ບາງ​ຕວົຢາ່ງ​ແມນ່​ມີ​ ລາຍການ​ຂາ້​ງລຸມ່: •​ ​ແມ່ຍງິ​​ແລະ​ເດກັ​ຍງິ; •​ ຄນົ​ຜູ​້ທີ​່ອາ​ໄສ​ຢູ​່ຫາ່ງ​ໄກ​ຈາກ​ການ​ບລໍກິານ/ຄ​ົທີ​່ອາ​ໄສ​ຢູ​່ໃນ​ເຂດ​ຊນົນະບົດ; •​ ຄນົ​ຜູ​້ທີ​່ທກຸ​ຍາກ; •​ ​ເດກັນ້ອຍ; •​ ຄນົ​ຈາກ​ກຸມ່​ທີ​່ມ​ີສາສະໜາ​ຫຼ​ືເສດຖະກິດ​ສງັຄມົ​ແຕກຕາ່ງ​ກນັ; •​ ຄນົ​ສງູ​ອາຍ;ຸ •​ ກຸມ່​ຄນົ​ສະ​ເພາະ​– ​ເຊັນ່​ວາ່​ຄນົ​ຕິດ​ເຊືອ້​HIV​ຫຼືພະຍາດ​ຂີທູ້ດ​ອາດ​ຈະ​ພົບ​ກັບ​ການ​ເລືອກ​ ປະຕບິັດ. ​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕ້ອງ​ຮູ​້ຈກັ​ກຸມ່​ຄນົ​ຕາ່ງໆ​ໃນ​ສະພາບ​ການ​ຂອງ​ເຂາົ​ເຈົາ້​ຜູ້​ທີ​່ເປນັ​ໄປ​ໄດ​້ໜ້ອຍ​ກວາ່​ທີ່​ ຈະ​ສາມາດ​ເຂົາ້​ເຖງິ​ການ​ບລໍກິານ​ໄດ.້ ການ ນໍາ ສ່ົງ ແລະ ການ ນັດ ໝາຍ ​ການ​ນາໍ​ສົງ່​​ແລະ​ກາ​ນນັດ​ໝາຍ​ໃນ​ຂັນ້​ຕອນ​ທາໍ​ອິດ​ໃນ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ. ຂ້ັນ ຕອນ ສັງ ລວມ 1.​ການ​ນໍາ​ສົ່ງ​​ ແລະ​ການ​ນັດ​ ໝາຍ ​ແບບ​ວິທີ​ທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຖືກ​ນໍາ​ສົ່ງ​ຈະ​ແຕກ​ຕ່າງ​ ກັນ.​ຜູ້​ໃຊ້​ອາດ​ຈະ​ນໍາ​ສ່ົງ​ຕົນ​ເອງ​ຫຼືຖືກ​ນໍາ​ສົ່ງ​ ຜ່ານ​ເຄືອ​ຂ່າຍ​ທີ່​ປະກອບ​ມີ​ພະນັກງານ​ຫຼືອາສາ​ ສະໝັກ​ດ້ານ​ສຸຂະພາບ​​ແລະ​ການ​ຟື້ນ​ຟູ​ ຮ່າງກາຍ​ພາກ​ລັດຖະບານ​ຫຼືບໍ່​ແມ່ນ​ລັດຖະບານ​ ທີ່​ເຮັດ​ວຽກ​ຢູ່​ຂັ້ນ​ຊຸມ​ຊົນ,​​ເມືອງ​ຫຼື​ແຂວງ.​ບາງ​ ການ​ບໍລິການ​ລົດ​ເຂັນ​ອາດ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ລະບຸ​ ຜູ້​ໃຊ້​ທີ່​ເປັນ​ໄປ​ໄດ້​ຢ່າງ​ຈິງ​ຈັງ​​ຖ້າ​ພວກ​ເຂົາ​ບໍ່​ໄດ້​ ຮັບ​ການ​ບໍລິການ​ດູ​ແລ​ດ້ານ​ສັງຄົມ​ຫຼືສຸຂະພາບ​ ໃດໆ​ຫຼືບໍ່​ໄດ້​ເຂົ້າ​ຮ່ວມ​ກິດຈະກໍາ​ຂອງໂຮງຮຽນ,​ ການ​ເຮັດ​ວຽກ​ຫຼືກິດຈະກໍາ​ຊຸມ​ຊົນ. ການ​ນາໍ​ສົງ່​ທີ​່ມ​ີປະສິດ​ທິຜນົ​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີການ​ເຊືອ່ມ​ໂຍງ​ທີ​່ດ​ີລະຫວາ່ງ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ກັບ​ ຊມຸ​ຊນົ;​​ເພາະວາ່​ມນັ​ແມນ່​ຄນົ​ໃນ​ຊ​ຸມຊນົ​ນັນ້​ຜູ​້ທີ​່ຈະ​ລະບ​ຸ​ແລະ​ນາໍສົງ່​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຫາ​ການ​ບລໍກິານ​ ຂອງ​ທາ່ນ.​ບກຸຄນົ​​ແລະ​ອງົການ​ຈດັ​ຕັງ້​ຕາ່ງໆ​ທີ​່ເປນັ​ໄປ​ໄດ​້ໃນ​ການ​ລະບ​ຸຜູ​້ໃຊ​້ລົດ​ເຂນັ​​ແລະ​ນາໍ​ສົງ່​ ພວກ​ເຂາົ​ຫາ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​ທາ່ນ​ປະກອບ​ມ:ີ 18 19 •​ ໂຮງໝ​ໍໃນ​ທ້ອງ​ຖິນ່; •​ ສກຸສາລາ​ໃນ​ຊມຸ​ຊນົ; •​ ​ເຄືອ​ຂາ່ຍ​ການ​ຟືນ້​ຟ​ູຮາ່ງກາຍ​ຂັນ້​ຊມຸ​ຊນົ; •​ ບາ້ນ/ຄະນະ​ກາໍມະການ/​ຫວົໜາ້​ໂບດ; •​ ອງົການ​ຈດັ​ຕັງ້​ຄນົ​ພິການ; •​ ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຄນົ​ອືນ່; •​ ທາ່ນໝ/ໍ​ພະຍາບານ. ຜູ້ ຈັດການ ສາມາດ ເຮັດ ຫຍັງ ໄດ້ ແດ່ ເພ່ືອ ສ້າງ ເຄືອ ຂ່າຍ ການ ນໍາ ສ່ົງ? •​ ລະບ​ຸແຫຼງ່​ການ​ນາໍ​ສົງ່​(ບກຸຄນົ​​ແລະ​ອງົການ​ຈດັ​ຕັງ້)​​ໃນ​ເຂ​ດ​ພ້ືນ​ທີ​່ຂອງ​ທາ່ນ. •​ ​ໂອ​້ລມົ​ກັບ​ພະນັກງານ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ກຽ່ວ​ກັບ​ວາ່​ຂໍ​້ມນູ​ໃດ​ແດ​່ທີ​່ແຫຼງ່ການນາໍ​ສົງ່​ ຕອ້ງການ​ເພື່ອ​ໃຫ​້ສາມາດ​ລະບ​ຸຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ຕ້ອງການ​ລົດ​ເຂນັ,​​ແລະ​ວທິ​ີນາໍ​ສົງ່​ພວກ​ເຂາົ​ ຫາ​ການ​ບລໍກິານ. •​ ກະກຽມ​(ຫຼ​ືສະໜັບສະໜນູ​ໃຫ​້ພະນັກງານ​ກະກຽມ)​​ເອກະສານ​ແຈກ​ຢາຍ/​ໃບ​ໂຄສະນາ​ທີ​່ໃຫ​້ຂໍ້​ ມນູ​ຂາ່ວສານ​ທີ​່ແຫຼງ່ການ​ນາໍ​ສົງ່​ຕ້ອງການ. •​ ​ໄປ​ຢຽ້ມຢາມ​(ຫຼສືະໜັບສະໜນູ​ໃຫ​້ພະນັກງານ​ໄປ​ຢຽ້ມຢາມ)​ບກຸຄນົ​ຫຼືອງົການ​ຈດັ​ຕັງ້ທີ​່ເຮດັ​ ການ​ນາໍ​ສົງ່​ທີ​່ເປນັ​ໄປ​ໄດ​້​ເພ່ືອ​ໂອ​້ລມົ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ. •​ ຈດັ​ມື​້ເຜີຍ​ແຜ​່ຂໍ​້ມນູ​ຢູ​່ການ​ບລໍກິານ​ລົດ​ເຂນັສໍາລັບ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​​ແລະ​ແຫຼງ່ການ​ນາໍ​ສົງ່. •​ ຈດັການ​ຝກຶ​ອບົຮມົ​ເຄືອ​ຂາ່ຍ​ການ​ນາໍ​ສົງ່​ໃຫ​້ແກ​່ແຫຼງ່ການ​ນາໍ​ສົງ່. •​ ພຈິາລະນາ​ສາ້ງ​ແບບ​ຟອມການ​ນາໍ​ສົງ່​ທີ​່ແຫຼງ່ການ​ນາໍ​ສົງ່​ສາມາດ​ປະ​ກອບ.​ຮບັປະກນັ​ວາ່​ ແບບ​ຟອມຕາ່ງໆ​ແມນ່​ງາ່ຍດາຍ;​ຮບັປະກນັ​ວາ່ການ​ບລໍກິານ​ຂອງ​ທາ່ນ​ຕອບ​ສະໜອງ​ຕໍ​່ກັບ​ ການ​ນາໍ​ສົງ່​(​ໂດຍ​ການ​ໃຫກ້ານ​ນັດ​ໝາຍ​ແກ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທີ​່ຖກື​ນາໍ​ສົງ່​ມາ);​​ແລະ​ໃຫ​້ຄາໍ​ຕ​ິຊມົ​ທີ່​ ດ​ີຕ່ໍ​ກັບ​ແຫຼງ່ການ​ນາໍ​ສົງ່​ທີ​່ໃຊ​້ແບບ​ຟອມ.​ ການ ເພ່ີມ ການ ເຂ້ົາ ເຖິງ ການ ບໍລິການຢ່າງຍຸ ຕິ ທໍາ ​ຜູ​້ຈດັການ​ມ​ີບົດບາດ​ສໍາຄນັ​ໃນ​ການ​ຊວ່ຍ​ເພ່ີມ​ການ​ເຂົາ້​ເຖງິ​ການ​ບລໍກິານ​ຢາ່ງ​ຍຸຕ​ິທາໍ.​ຕາ​ຕະລາງ​ຕໍ່​ ໄປ​ນີ​້ໃຫ​້ບາງ​ຄາໍ​ແນະນາໍ​ສາໍລັບ​ວທິ​ີເພ່ີມ​ການ​ເຂົາ້​ເຖງິ​ສາໍລັບ​ກຸມ່​ຄນົ​ຕາ່ງ .ໆ 20 21 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ຜູ້ ຈັດການ ສາມາດ ເຮັດ ຫຍັງ ໄດ້ ແດ່ເພ່ືອ ເພ່ີມການ ເຂ້ົາ ເຖິງ ການ ບໍລິການຢ່າງ ຍຸ ຕິ ທໍາ? ສໍ າລັ ບ ແ ມ່ ຍິ ງ ແ ລ ະ ເ ດັ ກ ຍິ ງ •​ ຮບັປະກນັ​ວາ່​ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ແມນ່​ມ​ີໃຫ​້ໃນ​ຮບູ​ແບບ​ຕາ່ງໆ​–​​ເຊັນ່ວາ່​ ຜາ່ນ​ວທິະຍ,ຸ​​ໃບ​ໂຄສະນາ/​ໂປ​ສ​ເຕ້ີ​ທີ​່ໃຊຂ້ໍຄ້ວາມ​ງ່າຍ ,ໆ​​ແລະຮບູ​ພາບ​ຕາ່ງ .ໆ •​ ຮບັປະກນັ​ໃຫ​້ມ​ີຮບູ​ແມ່ຍງິ​ຢູ​່ໃນ​ການ​ໂຄສະນາ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​​ເຊັນ່​ດຽວ​ກັບ​ຮບູ​ ຜູ​້ຊາຍ. •​ ລະບ​ຸແບບຢາ່ງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ເພດ​ຍງິ​ຜູ​້ທີສ່າມາດ​ເວົາ້​ກຽ່ວ​ກັບ​ຄວາມ​ສາໍຄນັ​ຂອງ​ລົດ​ ເຂນັ​ສາໍລັບ​ແມ່ຍງິ​ໃນ​ທົວ່​ໄປ​​ແລະ​​ໃນ​ຊມຸ​ຊນົ. •​ ​ເວົາ້​ກັບ​ຫວົໜາ້​ຊມຸ​ຊນົ​ກຽ່ວ​ກັບ​ວາ່​ລົດ​ເຂນັ​ມ​ີຄວາ​ມສາໍຄນັ​ເທົາ່ໆ​ກນັ​ຕ່ໍ​ກັບ​ແມ່ຍງິ,​​ ເດກັນ້ອຍ​​ແລະ​ຜູ​້ຊາຍ. •​ ສະໜັບສະໜນູ​​ແລະ​ສົງ່​ເສມີ​ການ​ມ​ີສວ່ນ​ຮວ່ມ​ຂອງ​ແມ່ຍງິ​ໃນ​ທກຸ​ລະດັບ​ຂອງ​ການ​ ບລໍກິານ​ລົດ​ເຂນັ,​ລວມທງັ​ຕາໍ​ແໜ​່ງການ​ຄຸມ້​ຄອງ​​ແລະ​ການ​ນາໍພາ. •​ ​ໃຫ​້ຂໍ​້ມນູ​ແກ​່ອງົການ​ຈດັຕັງ້​ຄນົ​ພິການ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ແລະ​ເນັນ້​ໜກັ​ ວາ່​ທງັ​ແມ່ຍງິ​​ແລະ​ຜູ​້ຊາຍ​ລວ້ນ​ແຕ່​ຕ້ອງການ​ລົດ​ເຂນັ​ສາໍລັບ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ. •​ ​ໃນ​ເວລາ​ໂອ​້ລມົ​ກຽ່ວກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ໃຫ​້ເວົາ້​ເລື້ອຍ​ໆ ​ວາ່ການ​ບລໍກິານ​ແມນ່​ ສາໍລັບ​ຜູ​້ຊາຍ,​​ແມ່ຍງິ​​ແລະ​ເດກັນ້ອຍ​– ບໍ​່ໃຫ​້ເວົາ້​ແຕ​່ວາ່​“ຜູ​້ຄນົ”. ສໍ າລັ ບ ເດັ ກ ນ້ ອ ຍ •​ ​ຮບັປະກນັ​ວາ່​ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ແມນ່​ມ​ີໃຫ​້ຢູ​່ສະຖານ​ທີ​່ຕາ່ງໆ​ທີ​່ພໍ​່ແມ​່ຂອງ​ ເດກັພກິານ​ອາດ​ຈະ​ໄປ​– ​ເຊັນ່​ວາ່​ສຸກສາລາ​ຊມຸ​ຊນົ,​ສນູ​ບລໍກິານ​ຟືນ້​ຟ,ູ​ຕະຫາຼດ,​ ສນູ​ຊມຸ​ຊນົ,​​ໂບດ,​ມັດ​ສະ​ຍິບ​​ແລະ​ວ​ັດ. •​ ​ໃນ​ເວລາ​ໂອ​້ລມົ​ກຽ່ວກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ໃຫ​້ເວົາ້​ເລື້ອຍ​ໆ ​ວາ່ການ​ບລໍກິານ​ແມນ່​ ສາໍລັບ​ຜູ​້ຊາຍ,​​ແມ່ຍງິ​​ແລະ​ເດກັນ້ອຍ​– ບໍ​່ໃຫ​້ເວົາ້​ແຕ​່ວາ່​“ຜູ​້ຄນົ”. •​ ​ໃຫກ້ານ​ສຶກສາ​​ແລະ​ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ແກ​່ຜູ​້ຄ​ົທີ​່ອາດ​ຈະ​ປິນ່ປວົ​ເດກັ​ພິການ​ – ​ເຊັນ່​ວາ່​ທາ່ນໝ,ໍ​ພະຍາບານ,​ພະນັກງານ​ແພດ​ປະ​ຈາໍ​ຊມຸ​ຊນົ. •​ ຮບັປະກນັ​ໃຫ​້ມ​ີຮບູ​ເດກັນ້ອຍ​ຢູ​່ໃນ​ການ​ໂຄສະນາ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​​ເຊັນ່​ດຽວ​ກັບ​ ຮບູຜູ​້ໃຫຍ.່ •​ ​ອະທິບາຍ​ຜນົ​ປະ​ໂຫຍ​ດຂອງ​ການ​ສະ​ໜອງ​ລົດ​ເຂນັ​ໃຫ​້ແກ​່ເດກັຕ້ັງ​ແຕ​່ອາຍ​ຸຍງັ​ນ້ອຍ​​ ໃນ​ທກຸຄັງ້​ທີ​່ໂອລ້ມົ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ.​ນອກ​ນັນ້​​ໃຫ​້ອະທິບາຍ​ຜນົ​ປະ​ໂຫຍ​ ດສາໍລັບ​ຄອ​ບຄວົ/ຜູ​້ໃຫກ້ານ​ດ​ູແລ​ເດກັນ້ອຍ​ທີ​່ການ​ສະໜອງ​ລົດ​ເຂນັ​ມ​ີໃຫ.້ ສໍ າລັ ບ ຄົ ນ ທຸ ກ ຍ າກ •​ ຮບັປະກນັ​ວາ່ການ​ບລໍກິານ​ມ​ີລາຄາຄຸມ້​ຄາ່​ທີ​່ສຸດ​ເທົາ່​ທີ​່ຈະ​ເປນັ​ໄປ​ໄດ.້ •​ ​ລະບ​ຸວທິ​ີທາງ​ເພື່ອ​ໃຫກ້ານ​ຊວ່ຍ​ເຫຼືອດາ້ນ​ການ​ເງິນ​ແກ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ບໍ​່ສາມາດ ​ຈາ່​ຍຄາ່​ເດນີທາງ​ມາ​ຫາ​ການ​ບລໍກິານ​ລົດ​ເຂນັ,​ຫຼືບໍ​່ສາມາດ​ຈາ່ຍ​ຄາ່​ລົດ​ເຂນັ​ (ຖາ້​ມີຄາ່​ໃຊ​້ຈາ່ຍ).​ຕວົຢາ່ງ,​ສາ້ງ​ກອງ​ທນຶ​ລົດ​ເຂນັ. ສໍ າລັ ບ ຜູ້ ສູ ງ ອ າຍຸ •​ ​ໃນ​ເວລາ​ໂອ​້ລມົ​ກຽ່ວກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ໃຫ​້ເວົາ້​ເລື້ອຍ​ໆ ​ວາ່ການ​ ບລໍກິານ​ແມນ່ສາໍລັບທກຸ​ຄນົ​– ລວມທງັ​ຜູ​້ສງູ​ອາຍ.ຸ •​ ​ລວມ​ເອາົ​ຮບູ​ຖາ່ຍ​ຂອງ​ຜູ​້ສງູ​ອາຍ​ຸທີ​່ໃຊ​້ລົດ​ເຂນັ​ຢູ​່ໃນ​ການ​ໂຄສະນາ​ກຽ່ວ​ກັບ​ ການ​ບລໍກິານ. •​ ອະທິບາຍ​ຜນົ​ປະ​ໂຫຍ​ດຂອງ​ລົດ​ເຂ​ັນສາໍລັບ​ຜູ​້ສູງ​ອາຍ,ຸ​​ແລະ​ສາໍລັບ​ຄອບຄວົ​ ຂອງ​ເຂາົ​ເຈົາ້,​​ໃນ​ເວລາ​ໂອ​້ລມົ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ. 20 21 ຄົ ນ ຜູ້ ທີ່ ອ າ ໄ ສ ຢູ່ ຫ່ າງ ໄກ ຈ າກ ກ ານ ບໍ ລິ ກ ານ /ຄົ ທີ່ ອ າ ໄ ສ ຢູ່ ໃນ ເຂ ດ ຊົ ນ ນ ະບົ ດ •​ ​ຮບັປະກນັ​ວາ່​ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ແມນ່​ມ​ີໃຫ​້ຢູ​່ສະຖານ​ທີ່ຊນົນະບົດ​– ​ເຊັນ່​ ວາ່​ສຸກສາລາ​ໃນ​ຊນົນະບົດ,​ຕະຫາຼດ,​ສນູ​ຊມຸ​ຊນົ,​​ໂບດ,​ມັດ​ສະ​ຍິບ​​ແລະ​ວ​ັດ. •​ ​ໃຫ​້ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບລໍກິານ​ແກ​່ຜູ​້ທີ​່ເຮດັ​ວຽກ​ກັບ​ປະຊາຊນົ​ທີ​່ອາ​ໄສ​ຢູ​່ໃນ​ເຂດ​ ຊນົນະບົດ​–​​ເຊັນ່​ວາ່​ພະນັກງານ​ຟືນ້​ຟ​ູສຸ​ຂະ​ພາບ​ຂັນ້​ຊມຸ​ຊນົ. •​ ລະບ​ຸວທິ​ີທາງ​ເພື່ອ​ຊວ່ຍ​ເຫຼືອຜູ​້ໃຊ​້ລົດ​ເຂນັ​ໃນ​ເຂດ​ຊນົນະບົດ​ໃນ​ເລື່ອງ​ການ​ເດນີທາງ​ ຖາ້​ການ​ບລໍກິານ​ບໍ​່ອອກ​ໄປ​ໃຫ​້ບລໍ​ິການ​ຢູ​່ຊ​ຸມຊນົ.​ຕວົຢາ່ງ​– ການ​ຊວ່ຍ​ເຫຼືອດາ້ນ​ ການ​ເງິນ​ສາໍລັບ​ຄາ່​ເດນີທາງ,​ການ​ເຮດັ​ວຽກ​ກັບ​ອງົການ​ຈດັ​ຕ້ັງ​ອືນ່​ທີ​່ສາມາດ​ຊວ່ຍ​ ຂນົ​ສົງ່​ຄນົ​ມາ​ຫາ​ການ​ບລໍກິານ. •​ ຊອກ​ຮູ​້ວາ່​ມນັ​ເປນັ​ໄປ​ໄດ​້ຫຼືບໍ​່ໃນ​ການ​ໃຫ​້ບ່ອນ​ພັກ​ເຊາົ​ແກ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທີ​່ມາ​ຫາ​ການ​ ບລໍກິານ​ຈາກ​ເຂດ​ຊນົນະບົດ. •​ ອອກ​ໄປ​ໃຫກ້ານ​ບລໍກິານ​ຢູ​່ໃນຊມຸຊນົຕ່ໍ​ກັບ​ເຂດ​ຊນົນະບົດ. •​ ຝກຶ​ອບົຮມົ​ໃຫ​້ຜູ​້ທີ​່ເຮດັ​ວຽກ​ຢູ​່ໃນ​ເຂດ​ຊນົນະບົດ​(​ເຊັນ່​ວາ່​ພະນັກງານ​ແພດ​ຊມຸ​ຊນົ)​ ກຽ່ວ​ກັບ​ວທິ​ີຊວ່ຍ​ເຫຼືອຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຢູ​່ໃນ​ຊມຸ​ຊນົ;​ວທິ​ີດາໍ​ເນນີ​ການ​ຕິດຕາມ​ຜົນ;​​ແລະ​ ວທິ​ີຊວ່ຍ​ໃນ​ເລື່ອງ​ການ​ບາໍລງຸ​ຮກັສາ​​ແລະ​ການ​ສ້ອມ​ແປງ​ລົດ​ເຂນັ​ທີ​່ງາ່ຍດາຍ. •​ ຮບັປະກນັ​ວາ່​ລົດ​ເຂນັ​ມ​ີໃຫ​້​ແລະ​ສາມາດ​ຖກື​ໃຊ​້ຢາ່ງ​ມ​ີປະສິດທ​ິຜົນ​ໃນ​ເຂດ​ ຊນົນະບົດທີ​່ມ​ີໜາ້ດນິ​ບໍ​່ຮາບ​ພຽງ,​​ແລະ​ໃຫ​້ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ວທິ​ີເຮດັ​ການ​ດັດ​ປັບ​ທີ່​ ງາ່ຍດາຍ​(ຕວົຢາ່ງ,​ທາງ​ເນນີ​ຫຼກືານ​ເຮດັ​ໃຫ​້ເສັນ້ທາງ​ຮາບ​ພຽງ)​​ເພ່ືອ​ເຮດັ​ໃຫ​້ມນັ​ ງາ່ຍຂຶນ້​ໃນ​ການ​ໃຊ​້ລົດ​ເຂນັ​ໃນ​ເຂດ​ພ້ືນ​ທີ​່ຊນົນະບົດ. ສໍ າລັ ບ ກຸ່ ມ ຊົ ນ ເຜົ່ າ ຫຼື ກຸ່ ມ ທີ່ ມີ ເສ ດ ຖ ະກິ ດ ສັ ງຄົ ມ ແ ຕ ກ ຕ່ າງ ກັ ນ •​ ​ໃນ​ເວລາ​ໂອ​້ລມົ​ກຽ່ວກັບ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ໃຫ​້ເວົາ້​ເລື້ອຍ​ໆ ​ວາ່ການ​ບລໍກິານ​ ແມນ່ສາໍລັບທກຸ​ຄນົ​– ​ໂດຍ​ບໍ​່ຄາໍນງຶ​ເຖງິ​ຊນົ​ເຜົາ່​ຫຼືພ້ືນຖານ​ເສດຖະກິດ​ສງັຄມົ. •​ ລວມ​ເອາົ​ຮບູ​ຂອງ​ບກຸຄນົ​ຈາກ​ກຸມ່​ຊນົ​ເຜ່ົາ​ຫຼສືາສະໜາ​ແຕກ​ຕາ່ງ​ກນັ​ໃນ​ເຂດ​ພ້ືນ​ທີ່​ ໃຫ​້ບລໍ​ິການ​​ເຂົາ້​ໃນ​ທກຸການ​ໂຄສະນາກຽ່ວ​ກັບ​ການ​ບລໍກິານ. •​ ​ໃ​ນບ່ອນ​ທີ​່ເປນັ​ໄປ​ໄດ,້​ວາ່​ຈາ້ງ​ພະນັກງານ​ຈາກ​ກຸມ່​ຊນົ​ເຜົາ່​​ແລະ​ພ້ືນຖານ​ ເສດຖະກິດ​ສງັຄມົ​ແຕກຕາ່ງ​ກນັ​ເຂົາ້​ໃນ​ການ​ບລໍກິານ. 22 23 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ B.2 ສ່ິງ ອໍານວຍ ຄວາມ ສະດວກ ແລະ ອຸປະກອນ ສາມາ​ດາໍ​ເນນີການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ຢູ​່ໃນ​ຫາຼຍໆ​ສະຖານ​ທີ.່​​ແນວ​ໃດ​ກໍ່ຕາມ,​ບໍ​່ວາ່​ຈະ​ດາໍ​ເນນີ​ ການ​ບລໍກິານ​ຢູ​່ບ່ອນ​ໃດ​ກໍ່ຕາມ,​ບາງ​ສິງ່​ອາໍ​ນວຍຄວາມ​ສະດວກ​​ແລະ​ອປຸະກອນ​ແມນ່​ຈາໍ​ເປນັ​ຕ້ອງ​ ມ.ີ​ການ​ບລໍກິານ​ລະດັບ​ພ້ືນຖານ​ຕອ້ງການ​ພ້ືນ​ທີ​່​ແລະ​ອປຸະກອນ​ໜ້ອຍ​ກວາ່​ການ​ບລໍກິານ​ລະດັບ​ ປານ​ກາງ. ສ່ິງ ອໍານວຍ ຄວາມ ສະ ດວກ ແ ລະ ອຸປະກອນ ສໍາລັບທຸກ ການ ບໍລິການ ລົດ ເຂັນ (ພ້ືນຖານ ແລະ ປານ ກາງ) ພ້ືນ ທ່ີ ສໍາລັບ ການ ຕ້ອນຮັບ ແລະ ການ ລໍຖ້າ ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ຈໍາ​ເປັນ​ຕ້ອງພ້ືນ​ທີ່​ສໍາລັບ​ການ​ລົງທະບຽນ​​ແລະ​ບ່ອນ​ທີ່​ຜູ້​ ໃຊ້​ລົດ​ເຂັນ​​ແລະ​ຄອບຄົວ​ຂອງ​ເຂົາ​ເຈົ້າ​ສາມາດ​ລໍຖ້າ​ຮ່ວມ​ ກັນ. ​ເມື່ອ​ເປັນ​ໄປ​ໄດ້​ວ່າ​ຜູ້ຄົນ​ໄດ້​ເດີນທາງ​ມາ​ແຕ່​ໄກ​ເພ່ືອ​ຮອດ​ ຫາ​ການ​ບໍລິການ,​​ໃຫ້​ຄິດ​ກ່ຽວ​ກັບ​ບ່ອນ​ທີ່​ພວກ​ເຂົາ​ ສາມາດ​ໄດ້ພັກຜ່ອນ​ເອົາ​ແຮງ.​​ໃນ​ຮູບອະທິບາຍ​ຢູ່​ເບື້ອງ​ ຂວາ,​ພໍ່ຄ້າທ້ອງ​ຖິ່ນ​ເປີດ​ຮ້ານ​ຂາຍ​ເຄື່ອງ​ຢູ່​ນອກຄລີ​ ນິກສຸຂະພາບ​ໃນ​ທ້ອງ​ຖິ່ນ. ບໍລິ​ເວນ​ທີ່​ມິດ​ງຽບ​ບ່ອນທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ສາມາດ​ນອນ​ພັກ​ ຜ່ອນ​​ໃນ​ຂະນະ​ລໍຖ້າ​ສາມາດ​ເປັນ​ປະ​ໂຫຍ​ດທີ່​ສຸດ.​ສ່ິງ​ນີ້​ ສໍາຄັນ​ໂດຍ​ສະ​ເ​ພາະສໍາລັບ: •​ ຜູ​້ທີ​່ອອ່ນ​ເພຍ​​ແລະ​ບໍ​່ແຂງ​ແຮງ​​ແລະ​ຕ້ອງການ​ ພກັຜ່ອນ​ໃນ​ລະຫວາ່ງ​ການ​ນັດ​ໝາຍ; •​ ​ເດກັນ້ອຍ​ທີ​່ອິດ​ເມື່ອຍ; •​ ທກຸ​ຄ​ົນທີ​່ພົບ​ວາ່​ມ​ີແຜ​ກ​ົດທັບ​ໃນ​ບລໍ​ິເວນ​ຮບັ​ນໍາ້ໜກັ​ ຂອງ​ຮາ່ງກາຍ. ຫ້ອງ​ນໍ້າທີ່​ສາມາດ​ເຂົ້າ​ເຖິງ​ໄດ້​ຄວນ​ຢູ່​ໃກ້​ກັບ​ບ່ອນ​ຕ້ອນຮັບ​ ແລະ​ລໍຖ້າ,​​ແລະ​ໃກ້​ກັບ​ບ່ອນ​ປະ​ເມີນ​ຜົນ​​ແລະ​ປະກອບ​ ລົດ​ເຂັນ. ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ດ້ວຍ​ແຫຼ່ງຊັບ​ ພະຍາກ​ອນ​ເພີ່ມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​Pen​Drive. 22 23 ອຸປະກອນ ທ່ີ ແນະນໍາ: ອຸປະກອນ​ສໍາລັບ​ການ​ລົງທະບຽນ​ລວມມີ:​​ໂຕະ,​ຕັ່ງ,​​ ໂທລະສັບ,​​ແລະ​ບ່ອນ​ເກັບມ້ຽນ​​ແລະຮັກສາ​ເອກະສານ​ ຕ່າງໆ​ໄວ້​ຢ່າງ​ປອ​ດ​ໄພ. ​ມັນ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ມີ​ໂປ​ສ​ເຕີ້,​​ແຜ່ນ​ພັບ​​ແລະ​ວິ​ດີ​ ໂອ​ທີ່​ມີ​ໃຫ້ຢູ່​ໃນ​ບໍລິ​ເວນ​ລໍຖ້າ.​ຖ້າ​ການ​ບໍລິການ​ເຫັນ​ວ່າ​ມີ​ ເດັກນ້ອຍ​ໃນ​ສັ​ດສ່ວນ​ທີ່​ສູງ​ມັນ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ມີ​ ເຄື່ອງຫຼິ້ນງ່າຍໆ​ຈໍານວນ​ໜຶ່ງ​​ໃນ​ຂະນະ​ທີ່​ພວກ​ເຂົາ​ ລໍຖ້າ. ພ້ືນ ທ່ີ ຫ້ອງການ ສໍາລັບ ພະນັກງານ ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ​ພະນັກງານ​ຕ້ອງການ​ມີ​ພື້ນ​ທີ່​ບ່ອນ​ທີ່​ພວກ​ເຂົາ​ສາມາດ​ ເຮັດ​ວຽກ​​ແລະ​ປະຊຸມ​ກັນ,​ຈົດ​ບັນທຶກ​​ ແລະ​​ເກັບ​ມ້ຽນ​ບັນທຶກ​ໄວ້​ຢ່າງ​ປອດ​ໄພ. ພ້ືນ ທ່ີ ເພ່ືອ ດໍາ ເນີນ ການ ປະ ເມີນ ຜົນ ແລະ ການ ດັດ ປັບ ລົດ ເຂັນ ໃຫ້ ເໝາະ ສົມ ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພື້ນ​ທີ່​ທີ່​ຂ້ອນ​ຂ້າງ​ມິດ​ງຽບ​​ແລະ​ເປັນ​ສ່ວນ​ ຕົວ​ບ່ອນ​ທີ່​ພະນັກງານ​ສາມາດ​ປະ​ເມີນຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້,​​ ແລະ​ບ່ອນ​ທີ່​ສາມາດ​ດໍາ​ເນີນການ​ປະກອບ​ແລະ​ດັບ​ ປັບລົດ​ເຂັນ​ໄດ້. ​ພື້ນ​ທີ່​ດັ່ງກ່າວ​ຈໍາ​ເປັນ​ຕ້ອງ​ເຂົ້າ​ເຖິງ​ໄດ້​ໂດຍ​ລົດ​ເຂັນ,​ມີ​ ພື້ນ​ທີ່​ພຽງພໍ​ສໍາລັບ​ສະມາຊິກ​ຄອບຄົວ​ທີ່​ຈະ​ໄປ​ຮ່ວມ​ນໍາ,​​ ແລະ​ຄວນ​ມີ​ແສງ​ສະຫວ່າງ​ພຽງ​ພໍ. ມັນ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ກໍານົດ​ຝາ​ຜະໜັງ​ທີ່​ເຂົ້າ​ເຖິງ​ ໄດ້ອັນ​ໜຶ່ງ​​ເພື່ອ​ໃຊ້​ເປັນ​ສາກ​ຫຼັງສໍາລັບ​ການ​ປະ​ເມີນ​ຜົນ​​ ແລະ​ກາ​ນຖ່າຍຮູບ. ​ໃນ​ການ​ບໍລິການ​ທີ່​ເຮັດ​ຢູ່​ສູນ,​ຂະໜາດ​ທີ່​ແນະນໍາ​ສໍາລັບ​ ພື້ນ​ທີ່​ນີ້​ມີ​ດັ່ງ​ຕໍ່​ໄປ​ນີ້​(​ອາດ​ແຕກ​ຕ່າງ​ກັນ​​ໂດຍ​ຂຶ້ນ​ກັບ​ ຈໍານວນ​ວຽກ): •​ ພືນ້​ທີ່ປິນ່ປວົລະດັບ​ພ້ືນຖານ:​3​ມ​x​2.5​ມ. •​ ພືນ້​ທີ່ປິນ່ປວົລະດັບປານ​ກາງ:​4​ມ​x​3.5​ມ. ບາ​ງຄັ້ງ​ພືນ້​ທີ່​ການ​ບໍລິການ​ແມ່ນ​ຢູ່​ໃນ​ເຮືອນ​ຂອງ​ບາງ​ຄົນ.​ ຈຸດ​ເນັ້ນ​ໜັກ​ແມ່ນ​ການ​ຢືດຢັນ​​ແລະ​ປັບ​ປ່ຽນ​ໄດ້​​ແລະ​ການ​ ນໍາ​ເອົາ​ອຸປະກອນ​ສໍາຄັນ​ໄປ​ນໍາ​ທ່ານ.​ 24 25 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ພ້ືນ ທ່ີ ເພ່ືອ ດໍາ ເນີນ ການ ປະ ເມີນ ຜົນ ແລະ ການ ດັດ ປັບ ລົດ ເຂັນ ໃຫ້ ເໝາະ ສົມ ອຸປະກອນ: •​ ສາກ​ກັ້ນ​ເພື່ອ​ຄວາມ​ເປັນ​ສ່ວນ​ຕົວ​– ຖ້າ​ລູກ​ຄ້າ​ ຫຼາຍກວ່າ​ໜຶ່ງ​ຄົນ​ມາ​ພົບ​ໃນ​ເວລາ​ດຽວ​ກັນ,​ຄວນ​ໃຊ້​ຜ້າ​ ກັ້ງ​ຫຼືສາກ​ບັງ​ແບ່ງ​ພື້ນ​ທີ່​ເພ່ືອ​ຄວາມ​ເປັນ​ສ່ວນ​ຕົວ. •​ ຕັ່ງ​ຍາວ​ຫຼືຕຽງສໍາລັບ​ກາ​ນປະ​ເມີນ​ຜົນ​– ມີ​ໂຄງ​ສ້າງ​ ແໜ້ນໜາ​ຖາວອນ​ທີ່​ມີ​ຄວາມ​ສູງ​ເທົ່າ​ກັບ​ລົດ​ເຂັນ​ເພື່ອ​ ໃຫ້​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ນັ່ງຢູ່​ເທິງ​ໃນ​ລະຫວ່າງ​ການ​ປະ​ ເມີນຜົນ.​ພື້ນ​ໜ້າດ້ານ​ເທິງ​ຄວນ​ມີ​ເບາະ​ນວມ​ເພ່ືອ​ປົກ​ ປ້ອງ​ຜິວໜັງ,​ຕົວຢ່າງ​EVA​ຫຼື​​ເສື່ອຮອງ​ອອກກໍາລັງ​ ກາຍ​ຫຼື​ເສື່ອ​ຮອງ​ຫຼິ້ນ​ໂຢຄະ.​ປັບ​ຕໍາ​ແໜ່​ງຂອງ​ຕຽງ​​ ເພື່ອ​ໃຫ້​ຜູ້​ປະ​ເມີນ​ສາມາດ​ເຮັດ​ວຽກ​ກັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ ຈາກທາງ​ດ້ານ​ໜ້າ​ຫຼືດ້ານ​ຫຼັງກ່ໍ​ໄດ້. •​ ​ແນວ​ກັ້ນ​ຕີນ​– ຊຸດ​ແນວ​ຮອງຕີນ​ຂະໜາດ​ຕ່າງໆ​​ ເພື່ອຮອງ​ຕີນ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຢ່າງ​ຖືກຕ້ອງ. •​ ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ດ້ວຍ​ແຫຼ່ງຊັບ​ ພະຍາກ​ອນ​ເພີ່ມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​ Pen​Drive. •​ ກ້ອງຖ່າຍຮູບ​– ​ເປັນ​ປະ​ໂຫຍ​ດສໍາລັບ​ກາ​ນອັດ​ບັນທຶກ​ ຂັ້ນ​ຕອນ​ທີ່​ສໍາຄັນ​ໃນ​ຂະ​ບວນການ​ປະ​ເມີນ​ຜົນ​​ແລະ​ ປະກອບ​ລົດ​ເຂັນ​(​ໂດຍ​ມີ​ການ​ອະນຸຍາດ​ທີ່​ມີ​ການ​ເຊັນ​ຊື່​ ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ). •​ ​ສາຍ​ວັດ​ແທກ​ຫຼື​​ເຄື່ອງ​ວັດ​ແທກຄາ​ລິບ​ເປີ.​ ພ້ືນ ທ່ີ ສໍາລັບ ການ ກະກຽມ , ການ ບໍາລຸງ ຮັກສາ ແລະ ການ ສ້ອມ ແປງ ລົດ ເຂັນ. ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ຈໍາ​ເປັນ​ຕ້ອງ​ມີພື້ນ​ທີ່​“​ເຕັກນິກ”​ສໍາລັບ: •​ ​ການປະກອບ,​ການສ້ອມ​ແປງ​​ແລະ​ການ​ບໍາລຸ​ງຮັກສາ​ ລົດ​ເຂັນ •​ ການ​ດັດ​ແປງລົດ​ເຂັນ​ໃນ​ບ່ອນ​ທີ່​ຈໍາ​ເປັນ. ພື້ນ​ທີ່​ຈໍາ​ເປັນ​ຕ້ອງມີ​ແສງ​ສະຫວ່າງ​ທີ່​ດີ,​ກັນ​ນໍ້າ​ໄດ້​​ແລະ​ ມີ​ອຸນຫະພູມ​ທີ່​ດີ​ສໍາລັບ​ການ​ເຮັດ​ວຽກ. ການ​ຮັກສາ​ຄວາມ​ປອດ​ໄພ​ແມ່ນ​ສໍາຄັນ​ສໍາລັບ​ເຄື່ອງມື​ທີ່​ ໃຊ້​ແຮງ​ຄົນ​​ແລະ​ໃຊ້​ໄຟຟ້າ.​​ໃຫ້​ດີ​ແທ້​ຄວນ​ເກັບ​ມ້ຽນ​ພວກ​ ມັນ​ໄວ້​ໃນ​ຕູ້​ໂລຫະ​ທີ່​ສາມາດ​ລັອກ​ໄດ້. 24 25 ​ໃນ​ການ​ບໍລິການ​ຖາວອນ/​ແບບ​ເຮັດ​ຢູ່​ສູນ,​ພ້ືນ​ທີ່​ເຕັກນິກ​ຄວນ​ແບ່ງ​ອອກ​ເປັນ​ດັ່ງ​ນີ້: •​ ພື້ນ​ທີ່​“ສະອາດ”​ສໍາລັບ​ການ​ປະກອບ​ຊິ້ນ​ສ່ວນ​ຕ່າງໆ​​ແລະ​ການ​ດັດ​ປັບ​ຜະລິດ​ຕະພັນ​ເປັນຂັ້ນ​ສຸດ​ ທ້າຍ,​​ແລະ​ສໍາລັບ​ການ​ເຮັດ​ການ​ກວດ​ຄວາມ​ປອດ​ໄພ​​ແລະ​ການ​ພ້ອມ​ໃຊ້​ງານ.​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພື້ນ​ທີ່​ ເປັນ​ພື້ນ​ຮາບ​​ແລະ​ພ້ືນ​ທີ່​ຕັ່ງ​ຍາວ​ສໍາລັບ​ເຂດ​ພ້ືນ​ທີ່​ນີ້. •​ ຈໍາ​ເປັນ​ຕ້ອງ​ມີພື້ນ​ທີ່​“ດັດ​ແປງ”​ສໍາລັບ​ການ​ເຮັດ​ການ​ດັດ​ແປງ​​ແລ​ະການ​ສ້ອມ​ແປງ​ຕ່າງໆ​ລວມທັງ​ ການ​ປັບ​ຮູບ​ຮ່າງ​ໂຟມ​​ແລະການ​ຕິດ​ກາວ,​ການ​ເຈະ​ທົ່ວ​ໄປ,​ການ​ຂັດ​ຊາຍ,​ການ​ປະ​ອບ​​ແລະ​ການ​ ທາສີ.​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພື້ນ​ທີ່​ເປັນ​ພ້ືນ​ຮາບ​​ແລະ​ພ້ືນ​ທີ່​ຕັ່ງ​ຍາວ​ສໍາລັບ​ເຂດ​ພ້ືນ​ທີ່​ນີ້. ​ບໍ່​ແມ່ນ​ວ່າ​ວຽກ​ເຕັກນິກ​ທັງ​ໝົດ​ຈໍາ​ເປັນ​ຕ້ອງ​ຖືກ​ດໍາ​ເນີນ​ຢູ່​ໃນ​ພ້ືນ​ທີ່​ເ​ຕັກ​ນິກຂອງ​ການ​ບໍລິການ​ເອງ.​ ຕົວຢ່າງ,​ການ​ບໍລິການ​ລົດ​ເຂັນ​ອາດ​ຈະ​ວ່າ​ຈ້າງ​ຄົນ​ພາຍ​ນອກ​ເຮັດ​ບາງ​ວຽກ​ເຕັກນິກ​​ເຊັ່ນ​ວ່າ​ການ​ ຫຍິບ​ແນວ​ຫຸ້ມ​ເບາະ​ນັ່ງ​(ຊ່າ​ງຕັດຫຍິບ​ໃນ​ທ້ອງ​ຖິ່ນ)​​ແລະ​ການ​ເຊື່ອມ​ຈອດ​(​ໂຮງ​ເຊື່ອມ​ຈອດ​ໂລຫະ​ໃນ​ ທ້ອງ​ຖິ່ນ).​ ອຸປະກອນ: •​ ມີ​ຕູ້​ຖ້ວຍຊາມ,​ຖ້ານ​ໄວ້​ເຄື່ອງ​​ແລະ​ບ່ອນ​ໄວ້​ເຄື່ອງມື​ຢ່າງ​ພຽງພໍ​​ເພ່ືອ​ຮັກສາ​ໃຫ້​ພ້ືນ​ທີ່​ເປັນ​ລະບຽບ​ ຮຽບຮ້ອຍ​​ແລະ​ປັບພ້ືນ​ທີ່​ໃຫ້​ເໝາະ​ສົມ. •​ ​ເຄື່ອງ​ມື​ສໍາລັບ​ການ​ປະກອບ​​ແລະ​ການ​ດັດ​ປັບ​ລົດ​ເຂັນ​​ແລະ​ເຮັດ​ການ​ດັດ​ແປງ​ຕ່າງໆ.​ •​ ​ລາຍການ​ວັດ​ສ​ດຸ​ສໍາລັບ​ການ​ດັດ​ແປງ.​ •​ ຢ່າງ​ໜ້ອຍຄວນ​ມີ​ໂຕະ​ຍາວ​ສໍາລັບ​ເຮັດ​ວຽກ​ຂອງ​ຊ່າງ​ເຕັກນິກ​ແຕ່ລະຄົນ.​ຂໍ​ແນະນໍາ​ວ່າ​ຢ່າງ​ໜ້ອຍ​ ຄວນ​ມີ​ໂຕະ​ຍາວ​ສໍາລັບ​ເຮັດ​ວຽກ​ທີ່​ສາມາດ​ປັບ​ຄວາມ​ສູງ​ໄດ້​ຖ້າ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ແມ່ນ​ສ່ວນໜຶ່ງ​ຂອງ​ທີ​ ມພະນັກງານ.​​ຄວນ​ຈັດ​ຕໍາ​ແໜ່ງໂຕະ​ເຮັດ​ວຽກ​​ເພື່ອ​ໃຫ້​ມີ​ພ້ືນ​ທີ່​ຈາກ​ດ້ານ​ໜ້າ​ຫຼືດ້ານ​ຫຼັງສໍາລັບ​ການ​ ເຮັດ​ວຽກ​ໃນ​ລະດັ​ບພື້ນ​ຫ້ອງ.​ ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມກ່ຽວ​ກັບ​ຄວາມ​ຕ້ອງການ​ດ້ານເຄື່ອງມື,​ວັດ​ສະດຸ​​ແລະ​ອຸປະກອນ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ ດ້ວຍ​ແຫຼ່ງຊັບ​ພະຍາກ​ອນ​ເພ່ີມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​Pen​Drive. (ໝາຍ​ເຫດ:​​ສ່ິງ​ອໍານວຍ​ຄວາມ​ສະດວກ​​ແລະ​ອຸປະກອນ​ທີ່​ຈໍາ​ເປັນ​ສໍາລັບ​ໂຮງ​ຜະລິດ​ລົດ​ເຂັນ​ແມ່ນ​ມີ​ ລາຄາ​ແພງ​ກວ່າ,​​ແລະ​ຢູ່​ນອກ​ເໜືອ​ຂອບ​ເຂດ​ຂອງຄູ່​ມື​ນີ້). ພ້ືນ ທ່ີ ສໍາລັບ ການ ເກັບ ມ້ຽນ ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພື້ນ​ທີ່​ເກັບມ້ຽນ​ທີ່​ປອດ​ໄພ​ສໍາລັບ​ລົດ​ເຂັນ,​ອາ​ ໄຫຼ່​​ແລະ​ວັດ​ສະດຸ​ຕ່າງໆ.​ພ້ືນ​ທີ່​ດັ່ງກ່າວ​ຄວນ​ໃກ້​ກັບ​ພ້ືນ​ທີ່​ ເຕັກນິກ,​ປອດ​ໄພ,​ກັນ​ນໍ້າ​ໄດ້,​​ແລະ​ບໍ່​ມີ​ສັດ/ສັດລ້ຽງ.​ກົງ​ ເຫຼັກຕິດ​ໃສ່​ປ່ອງຢ້ຽມ​ຈະ​ໃຫ້​ຄວາມ​ປອດ​ໄພ​ເພ່ີມ​ຂຶ້ນ. ຖ້າ​ບໍ່​ສາມາ​ດມີ​ຫ້ອງ​ສະ​ເພາະ​ໄດ້,​​ໃຫ້​ກໍານົດ​ບໍລິ​ເວນ​ສະ​ ເພາະ​ຢູ່​ພາຍ​ໃນ​ຫ້ອງ​ໃດ​ໜຶ່ງ.​​ໃນ​ຕົວຢ່າງ​ນີ້,​ຄວນ​ ພິຈາລະນາ​ເພ່ີມ​ເຕີມ​ເຖິງ​ການ​ຮັກສາ​ຄວາມ​ປອດ​ໄພ. 26 27 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ການຈັດ ຕ້ັງ ພ້ືນ ທ່ີ ເກັບ ມ້ຽນ: ຄໍາ​ແນະນໍາ​ຕໍ່​ໄປ​ນີ້​ອາດ​ຈະ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ຈັດ​ຕັ້ງ​ພ້ືນ​ທີ່​ເກັບ​ມ້ຽນ​ທີ່​ເປັນ​ລະບຽບ. •​ ຖານ​ໄວ້​ເຄື່ອງ​​ແລະ​ຮາວ​ຫ້ອຍ​ເຄື່ອງ​ຈະ​ຊ່ວຍ​ເຮັດ​ໃຫ້​ພ້ືນ​ທີ່​ກວ້າງ​ຂຶ້ນ. •​ ທາງ​ຍ່າງ​ລະຫວ່າງ​ຖ້ານ​ໄວ້​ເຄື່ອງ,​ຮາວ​ຫ້ອຍ​ເຄື່ອງ,​ກ່ອງ​​ແລະ​ລົດ​ເຂັນ​ທີ່​ປະກອບ​ແລ້ວ​ຊ່ວຍ​ປັບປຸງ​ ການ​ເຂົ້າ​ເຖິງ​​ແລະ​ປະສິດທິພາບ​ໃຫ້​ດີ​ຂຶ້ນ.​ຄວນ​ຮັກສາ​ໃຫ້ທາ​ງຍ່າງ​ໂລ່ງ​ບໍ່​ມີ​ສິ່ງ​ກີດຂວາງ. •​ ຈັດ​ວາງ​ລາຍການ​ຕ່າງໆ​ຕາມ​ຂະໜາດ​​ແລະ​ປະ​ເພດ.​ການ​ມີ​ເອົາ​ສ່ິງ​ຂອງ​ຊະນິດ​ດຽວ​ກັນ​ໄວ້​ນໍາ​ກັນ​​ ເຮັດ​ໃຫ້​ງ່າຍ​ຂຶ້ນ​ໃນ​ການ​ນັບ​ຈໍານວ​ນ​ເພ່ືອ​ຄວບ​ຄຸມຈໍານວນ​ໃນ​ຄັງ​​ແລະ​ການ​ສັ່ງ​ຊື້​ເຂົ້າ​ໃໝ່. •​ ອາດ​ຈະ​ເກັບ​ມ້ຽນສິ່ງ​ຂອງ​ນ້ອຍໆ​​ເຊັ່ນ​ວ່າ​ກຽວ,​ນັອດ,​​ແຫວນ​ຮອງ​ບູລອງ​​ໄວ້​ໃນ​ກ່ອງ​ນ້ອຍໆ,​ໜຶ່ງ​ ກ່ອງ​ສໍາລັບ​ແຕ່​ລະ​ຊະນິດ​​ແລະ​ຂະໜາດ.​ໝາຍ​ຊື່​ຂອງ​ສິ່ງ​ຂອງ​ນັ້ນ​ໃສ່​ດ້ານ​ໜ້າ​ຂອງ​ກ່ອງ. •​ ບໍ່​ຄວນ​ວາງ​ກ່ອງ​​ແລະ​ວັດ​ສະດຸ​ໃສ່​ເທິງ​ພ້ືນ​ໂດຍ​ກົງ​ຫຼືຕິດ​ກັບ​ຝາ​ພາຍນອກ​​ເພາະວ່າ​ພວກ​ມັນ​ສາມາດ​ ຖືກ​ເສຍຫາຍ​ຈາກ​ຄວາມ​ຊຸ່ມ​ໄດ້​ງ່າຍ.​​ແທ່ນ​ໄມ້​ແມ່ນ​ເປັນ​ປະ​ໂຫຍ​ດ​ເພ່ືອ​ຍົກ​ສິ່ງ​ຂອງ​ບໍ່​ໃຫ້​ຕິດ​ ກັບພື້ນ​ຫ້ອງ. •​ ​ຖ້າ​ມີ​ປ່ອ​ງຢ້ຽມ,​ສາມາດ​ເພ່ີມ​ກົງ​ເຫຼັກ​ໃສ່​ເພ່ືອ​ເພີ່ມ​ຄວາມ​ປອດ​ໄພ. ພ້ືນ ທ່ີ ສໍາລັບ ການ ຝຶກ ອົບຮົມ ຜູ້ ໃຊ້ ຕ້ອງການ ມີ ພ້ືນ ທ່ີ ແນວ ໃດ? ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພື້ນ​ທີ່​ສໍາ​ສັ​ບກາ​ນຝຶກ​ອົບຮົມ​ຜູ້​ໃຊ້​​ເພື່ອ​ສອນ: •​ ການ​ເຄື່ອນ​ຍ້າຍ​ໄປມາ​​ແລະ​ສຸຂະ​ສຶກສາ •​ ​ກາ​ນນໍາ​ໃຊ້,​ການ​ດູ​ແລ​ເບິ່ງ​ແຍງ​​ແລະ​ການ​ບໍາລຸ​ງຮັກສາລົດ​ເຂັນ •​ ​ທັກ​ສະ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ.​ ສາມາດ ສອນ ການ ເຄ່ືອນ ຍ້າຍ ແລະ ສຸຂະ ສຶກສາ​ຢູ່​ໃນ​ພື້ນ​ທີ່​ ຄລີ​ນິກ,​​ເຮືອນ​ຂອງ​ລູກ​ຄ້າ​ຫຼືສະຖານ​ທີ່​ບໍລິການ​ໃ​ນຊຸ​ມຊົນ. ອຸປະກອນ: •​ ​ອຸປະກອນ​ພື້ນຖານ​ເຊັ່ນ​ວ່າ​ຕຽງ​ນອນ​​ເພື່ອ​ຝຶກ​ແອັບ​ການ​ ເຄື່ອນ​ຍ້າຍ​​ແມ່ນ​ເປັນ​ປະ​ໂຫຍ​ດ.​ ສາມາດ ສອນ ການ ນໍາ ໃຊ້, ການ ດູ ແລ ເບ່ິ ແຍງ ແລະ ການ ບໍາລຸງ ຮັກສາ ລົດ ເຂັນ​ຢູ່​ໃນບໍລິ​ເວນ​ທີ່​ສະອາດຂອງ​ໂຮງ​ສ້ອມ​ ແປງ,​ຫຼືຢູ່​ໃ​ນສະຖານ​ທີ່​ອື່ນ​ທີ່​ເໝາະ​ສົມ. ອຸປະກອນ: •​ ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ອຸປະກອນ​ບໍາລຸງ​ຮັກສາ​ລົດ​ເຂັນ​ຂັ້ນ​ພ້ືນຖານ. 26 27 ທັກ ສະ ການ ເຄ່ືອນ ໄຫວ ໄປມາ​​ໂດຍ​ທົ່ວ​ໄປ​ແລ້ວ​ຖືກ​ສອນຢູ່​ ພາຍ​ນອກ,​​ແນວ​ໃດ​ກໍ່ຕາມ​ຢູ່​ພາຍ​ໃນ​ອາຄານ​ກໍ່​ສອນ​ໄດ້. ພື້ນ​ທີ່​ທັກ​ສະການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ຢູ່​ກາງ​ແຈ້ງ​ທີ່​ສ້າງ​ຂຶ້ນ​ ມາສະ​ເພາະ​ສາມາດ​ຈໍາ​ລອງ​ພື້ນ​ຜິວ​ຕ່າງໆ​ທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຈະ​ ຈໍາ​ເປັນ​ຕ້ອງ​ສາມາດຂ້າມ​ຜ່ານ​ໄດ້​ໃນ​ການ​ໃຊ້​ຊີວິດ​ປະ​ຈໍາ​ວັນ​ ຂອ​ງ​ເຂົາ​ເຈົ້າ​– ​ເຊັ່ນ​ວ່າ​ພ້ືນ​ດິນ​ທີ່​ບໍ່​ຮາບ​ພຽງ,​ພື້ນ​ດິນ​ອ່ອນ,​ ຮ່ອງນ້ໍາ,​​ແນວ​ກັ້ນ​ຄວາມ​ໄວ,​ຂອບ​ຖະໜົນ,​ບັນ​ໄດ​​ແລະ​ຂັ້ນ​ ໄດ. ​ໃນ​ການ​ບໍລິການ​ແບບ​ຮ່ວມ​ກັນ​– ພ້ືນ​ທີ່ທັກ​ສະການ​ເຄື່ອນ​ໄຫວ​ ໄປມາອາດ​ຈະ​ຖືກ​ໃຊ້​ໂດຍ​ຜູ້​ທີ່​ມີ​ຄວາມ​ບົ​ກຜ່ອງ​ດ້ານ​ການ​ເຄື່ອນ​ ໄຫວ​ອື່ນ​ເຊັ່ນ​ກັນ.​ຕົ​ວຢ່າງ,​ຄົ​ທີ່​ຮຽນ​ໃຊ້ຂາ​ທຽມ,​ຫຼືຝຶກ​ທັກ​ ສະການ​ຍ່າ​ງຄືນ​ໃໝ່​ຫຼັງຈາກ​ການ​ບາດ​ເຈັບ.​ ​ໃນບ່ອນ​ທີ່​ບໍ່​ມີ​ບ່ອນ​ຫວ່າງ​ສໍາລັບ​ພ້ືນ​ທີ່​ສະ​ເພາະ​ສໍາລັບການ​ ຝຶກທັກ​ສະ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​– ​ໃຫ້​ກໍານົດບ່ອນ​ຫວ່າງ​ທີ່​ມີ​ ຢູ່​ທີ​ສາມາດ​ຖືກ​ໃຊ້​ຢ່າງ​ປອດ​ໄພ​ສໍາລັບ​ການ​ຝຶກ​ທັກ​ສະການ​ ເຄື່ອນ​ໄຫ​ວ​ໄປມາ. ຫຼີກລຽງ​ພື້ນ​ທີ່​ບ່ອນ​ທີ່​ມີ​ຜູ້​ຄົນຫຼວງຫຼາຍ​ເຂົ້າໆ​ອອກ​ໆ ;​​ແລະ​ ຊອກ​ຫາ​ອຸປະສັກ​ປະ​ເພດ​ຕ່າງໆ. ສາມາດ​ປະດິດ​ອຸປະກອນ​ແບບ​ພົກ​ພາ​ສໍາລັບການ​ຝຶກ​ທັກ​ ສະການ​ເຄື່ອນ​ໄຫວ​ໄປມາ.​​ແລະ​ຕິດ​ຕັ້ງ​ໃນ​ທຸກ​ບ່ອນ​ທີ່​ມການ​ ໃຫ້ການ​ບໍລິການ​ລົດ​ເຂັນ. ຮູບ​ອະທິບາຍ​ຢູ່​ເບື້ອງ​ຂວາ​ມື​ສະ​ແດງ​ໃຫ້​ເຫັນ​ອຸປະກອນ​ແບບ​ ພົກ​ພາ​ສໍາລັບ​ກາ​ນຝຶກ​ທັກ​ສະ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​ທີ່​ຕິດ​ຕັ້ງ​ຢູ່​ ພາຍ​ໃຕ້ບ່ອນ​ພັກ​ເຊົາ​ທີ່​ເປັນ​ຮົ່ມ.​ ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ດ້ວຍ​ແຫຼ່ງຊັບ​ພະຍາກ​ ອນ​ເພີ່ມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​Pen​Drive.​ ສ່ິງ ອໍານວຍ ຄວາມ ສະດວກ ແລະ ອຸປະກອນ ເພ່ີມ ເຕີມ ສໍາລັບ ການ ບໍ ລິ ການ ລະດັບ ປານ ກາງ ການ​ໃຫກ້ານ​ບລໍກິານ​ລົດ​ເຂນັ​ລະດັບ​ປານ​ກາງຈາໍ​ເປນັ​ຕ້ອງ​ມ​ີພ້ືນ​ທີ​່​ແລະ​ອປຸະກອນ​ເພ່ີມ​ ເຕມີຈາໍນວນໜຶງ່.​ຄວາມ​ຕ້ອງການ​ເພ່ີມ​ເຕມີ​ທີ​່ຜູ​້ຈດັ​ການຈາໍ​ເປນັ​ຕອ້ງ​ພິຈາລະນາ​ແມນ່​ມ​ີລາຍ​ ລະອຽດຢູ​່ຂາ້ງ​ລຸມ່. 28 29 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ພ້ືນ ທ່ີ ສໍາລັບ ການ ປະ ເມີນ ຜົນ ແລະ ການ ປັບ ລົດ ເຂັນ ໃຫ້ ເໝາະສົມ ​ສໍາລັບ​ການ​ບໍລິການ​ລະດັບ​ປານ​ກາງ,​ຈໍາ​ເປັນ​ຕ້ອງ​ມີຕຽງສໍາລັບ​ ການ​ປະ​ເມີນ​ຜົນ​ເພື່ອ​ໃຫ້​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ນອນ​ລົງ​ໃນ​ລະຫວ່າງ​ການ​ ປະ​ເມີນຜົນ.​ ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ດ້ວຍ​ແຫຼ່ງຊັບ​ພະຍາກ​ອນ​ ເພີ່ມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​Pen​Drive. ກ່ອງການປະເມີນຜົນສະເພາະພິເສດສາມາດມີປະໂຫຍດຫຼາຍ ສໍາລັບການບໍລິການລະດັບປານກາງ.​ ກ່ອງການປະເມີນຜົນໃຫ້ການຮອງ​ຮັບຕີນ​​ແລະ​ການ​ເຂົ້າ​ເຖິງ​ທີ່​ ດີ​ເພ່ືອ​ໃຫ້ການ​ປະ​ຄອງ​ໃນ​ລະຫວ່າງ​ການ​ຈໍາລອງ​ມື.​ ​ສໍາລັບ​ຂໍ້​ມູນ​ເພ່ີມ​ເຕີມ,​​ໃຫ້​ເບິ່ງຄູ່​ມື​ວ່າ​ດ້ວຍ​ແຫຼ່ງຊັບ​ພະຍາກ​ອນ​ ເພີ່ມ​ເຕີມ​ສໍາລັບຜູ້​ຈັດການ​ຢູ່​ໃນ​Pen​Drive. •​ ​ແນວ​ກັ້ນ​ແບບ​ໂຟມທີ່​ແໜ້ນໜາ​ສໍາລັບ​ການ​ຮອງ​ຊົ່ວຄາວຈໍາ​ ເປັນ​ຕ້ອງ​ມີ​ໃນ​ມື​​ໃນ​ລະຫວ່າງ​ການ​ປະ​ເມີນ​ຜົນ​​ແລະ​ການ​ປັບ​ ລົດ​ເຂັນ​ໃຫ້​ເໝາະສົມ.​​ນອກ​ນັ້ນ​ຍັງຕ້ອງ​ມີ​ເສື່ອ​ກວ້າງ​ແລະ​ ສະອາດ​ສໍາລັບ​ການ​ເຮັດ​ວຽກ​ຢູ່​ພ້ືນ​​ແລະ​ເບາະ​ນັ່ງ. •​ ​ແວ່ນ​ທີ່​ມີ​ລວງ​ຍາວ​ເຕັມ​ສາມາດ​ເປັນ​ປະ​ໂຫຍ​ດຫຼາຍສໍາລັບ​ທັງ​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​​ແລະ​ພະນັກງານ​ໃຫ້​ບໍລິການ​​ເພື່ອ​ສັງ​ເກດ​ເບິ່ງ​ ທ່າ​ທາງ​​ແລະ​ຄວາມ​ພໍດີ​ຈາກ​ມຸມ​ມອງ​ຕ່າງໆ. •​ ​ເຄື່ອງຫຼິ້ນ​​ແລະ​ຮູບ​ພາບ​ຢູ່​ເທິງ​ຝາ​ຜະໜັງ​ສ່ົງ​ເສີມ​ສ​ະພາບ​ ແວດ​ລ້ອມ​ທີ່​ເປັນ​ມິດ​ກັບ​ເດັກນ້ອຍ​ຫຼາຍຂຶ້ນ. ການ ເກັບ ຮັກສາ ​ໃນ​ລະດັບ​ປານ​ກາງ,​ມີ​ຄວາມ​ຈໍາ​ເປັນຫຼາຍກວ່າ​ສໍາລັບ​ການ​ເກັບ​ ຮັກສາ​ວັດ​ສະດຸ​ທີ່ຈໍາ​ເປັນ​ສໍາລັບ​ການ​ດັດ​ແປງ​​ແລະ​ສ່ວນ​ ປະກອບການ​ປະຄອງ​ທ່າ​ທາງ​ຕ່າງໆ.​ວັດ​ສ​ະດຸ​ລວມມີ​ແຜ່ນ​ໂຟມ​ ເຊິ່ງຈໍາ​ເປັນ​ຕ້ອງ​ເກັບ​ຮັກສາ​ແບບ​ແຜ່​ໄວ້​​ແລະ​ຮັກສາ​ໃຫ້​ແຫ້ງ.​ ສະ​ນັ້ນ​ຈິ່ງ​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ພ້ືນ​ທີ່​ເກັບ​ມ້ຽນ​​ແລະ​ຮາວ​ເກັບ​ມ້ຽນ​ ຫຼາຍຂຶ້ນ. ພື້ນ​ທີ່​ສໍາລັບ​ການ​ກະກຽມ​,​ການ​ບໍາລຸງ​ຮັກສາ​​ແລະ​ການ​ສ້ອມ​ ແປງ​ລົດ​ເຂັນ ພື້ນ​ທີ່​ທີ່​ສະອາດ​​ແລະ​ຈັກ​ຫຍິບ​ອຸດສາຫະກໍາ​​ເຮັດ​ໃຫ້ການ​ ບໍລິການສາມາດ​ຫຸ້ມ​ເບາະສ່ວນປະກອບ​​ແລະ​ສາຍຮັດການ​ ປະຄອງ​ທ່າ​ທາງ​ທີ່​ມີການ​ດັດ​ແປງ​​ຫຼືປະດິດ​ຂຶ້ນ​ໃໝ່​ໄດ້.​ຖ້າ​ບໍ່​ມີ​ ພື້ນ​ທີ່​​ແລະ​ອຸປະກອນ​ນີ້,​ການ​ບໍລິການ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ວ່າ​ຈ້າງ​ ຄົນ​ພາຍ​ນອກໃຫ້​ເຮັດ​ວຽກ​ດັ່ງກ່າວ.​ 28 29 ການ ຈັດ ວາງ ພ້ືນ ທ່ີ ເຮັດ ວຽກ ​ເມື່ອ​ມີ​ສ່ິງ​ອໍານວຍ​ຄວາມ​ສະດວກ​​ແລະ​ອຸປະກອນ​ແລ້ວ,​ຜູ້​ຈັດການ​ຄວນ​ຈັດ​ສັນ​ຄວາມ​ຮັບຜິດຊອບ​ ສໍາລັບ​ການຈັດ​ຕ້ັງ​ແຕ່​ລະສະ​ຖານ​ທີ່​​ໂດຍ​ການ​ນໍາ​ໃຊ້​ສ່ີ​ຂັ້ນ​ຕອນ​ຕໍ່​ໄປ​ນີ້: 1.​ ​ເອົາສິ່ງ​ຂອງ​ທີ່​ຮົກ​ເຮື້ອ​ອອກ:​ກຳຈັດ​ເຄື່ອງມື​,​ອາ​ໄຫຼ່,​ອຸປະກອນທີ່​ບໍ່​ຈຳກັດ​​ແລະ​ເອກ​ະສານ​ ເກົ່າ​ທັງ​ໝົດ​ຖິ້ມ. 2.​ ກຳນົດ​ສິ່ງ​ຂອງ​ທີ່​ໃຊ້​ເປັນ​ປະຈຳ:​​ເຄື່ອງມື,​ອາ​ໄຫຼ່,​ຄຳ​ແນະນຳ​​ແລະ​ເອກະສານ.​ສິ່ງ​ຂອງ​ທີ່​ໃຊ້​ ເປັນປະຈຳ​ຄວນ​ຖືກ​ຈັດ​ວາງ​​ເພື່ອ​ໃຫ້​ຊອກ​ຫາ​ພວກ​ມັນ​ໄດ້​ງ່າຍ​ທີ່​ສຸດ​​ແລະ​ໄວ​ທີ່​ສຸດ. 3.​ ລະບົບ​​ແລະ​ຄວາມ​ຮັບຜິດຊອບ:​ມີ​ລະບົບ​ສຳລັບ​ແຕ່​ລະ​ພື້ນ​ທີ່​ເຮັດ​ວຽກ​​ແລະ​ໃຫ້ບາງ​ຄົນ​ຮັບຜິດ​ ຊອບ​ສຳລັບ​ການຈັດ​ຕັ້ງ​ລະບົບ​ນັ້ນ. 4.​ ​ຕິດຕາມ:​ລະບົບ​ເພື່ອ​ຮັບປະກັນ​ການ​ນຳພາ​ການ​ປ່ຽນ​ແປງ. B.3: ປະ ເພດ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ລົດ ເຂັນ ແລະ ເບາະ ນ່ັງ ທ່ີ ເໝາະ ສົມ ໝາຍ ເຖິງ ຫຍັງ? ຄວາມ​ຕ້ອງການ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ແຕລ່ະຄນົ​ຈະ​ແຕກຕາ່ງ​ກນັ.​​ແນວ​ໃດ​ກໍ່ຕາມ,​ພວກ​ເຂາົ​ທກຸ​ຄນົ​ ຕອ້ງການລົດ​ເຂນັ​​ແລະ​ເບາະ​ນັງ່​ທີເ່ໝາະສມົ.​ຂໍ​້ແນະນາໍ​ຂອງອງົການ​WHO​ກຽ່ວ​ກັບ​ການ​ ສະໜອງ​ລົດ​ເຂນັ​ແບບ​ໃຊ​້ແຮງ​ຄນົ​ໃນ​ສະຖານ​ທີ​່ທີ​່ມ​ີຊບັພະຍາກອນ​ຈາໍກັດ​​ໃຫ​້ນິຍາມ​ຄວາມ​ໝາຍ ​ຂອ​ງລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ​ດັງ່​ນີ:້ •​ ຕອບ​ສະໜອງ​ໄດ້ຄວາມ​ຈາໍ​ເປນັ​ຕ້ອງ​ຜູ​້ໃຊ​້​ແລະ​ເງືອ່ນ​ໄຂ​ສະພາບ​ແວດ​ລ້ອມ; •​ ​ໃຫ​້ຄວາມ​ພໍດ​ີທີ​່ເໝາ​ະສມົ​​ແລະ​ການ​ຮອງ​ຮບັ​ທາ່​ທາງ​ຕາ່ງ ;ໆ •​ ປອດ​ໄພ​​ແລະ​ໃຊ​້ໄດ​້ຍາວ​ນານ; •​ ມ​ີໃຫ​້ຢູ​່ໃນ​ປະ​ເທດ​ນັນ້ໆ​​ແລະ; •​ ສາມາດ​ມ​ີ​ແລະ​ໄດ​້ຮບັ​ການ​ບາໍລງຸ​ສ້ອມ​ແປງ​​ແລະ​ການ​ບລໍກິານ​ຍນື​ຍງົ​ໃນ​ປະ​ເທດ​ນັນ້ໆ​ດວ້ຍ​ ລາຄາ​ທີ​່ປະຢດັ​ທີ​່ສຸດ​​ແລະ​ສາມາດ​ຊື​້ໄດ.້ ​ເພື່ອ​ຕອບ​ສະໜອງ​ຄວາມ​ຕ້ອງການ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທີ​່ໃຊ​້ການ​ບລໍກິານ​ລົດ​ເຂນັ,​ການ​ບລໍກິານ​ຈາໍ​ ເປນັ​ຕອ້ງ​ມ​ີການ​ຈດັ​ສະໜອງ​ລົດ​ເຂນັ​​ແລະ​ເບາະ​ນັງ່​ລົດ​ເຂນັຢາ່ງ​ໜ້ອຍ​ສອງ​ສາມ​ປະ​ເພດ.​ປະ​ເພດ​ ເບາະ​ນັງ່​ທີ​່ເໝາະ​ສມົ​ທີ​່ສຸດ​ຕໍ​່ກັບ​ຜູ​້ໃຊ​້ຈະ​ຂຶນ້​ກັບ​ຄວາມ​ຕ້ອງການ​ຂອງ​ເຂາົ​ເຈົາ້.​​ແນວ​ໃດ​ກໍ່ຕາມ,​ຜູ​້ທີ່​ 30 31 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ມ​ີຄວາມສ່ຽງ​ເກີດ​ແຜ​ກ​ົດທັບ​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີເບາະ​ນັງ່​ຊວ່ຍ​ຫຼຸດບນັ​ເທາົ​ແຜ​ກ​ົດທັບ​ພ້ອມກັບ​ການ​ຝກຶ​ ອບົຮມົ​ການ​ໃຊ​້ມນັ. ຜົນ​ເສຍ​ຈາກ​ການ​ບໍ່​ມີ​ອຸປະກອນ​ທີ່​ຖືກຕ້ອງ​ບວກ​ກັບ​ການ​ຝຶກ​ອົບຮມົຜູ້​ໃຊ້ ອາຍຸຍືນ​ສະ​ເລ່ຍ​ໃນ​ບັນດາ​ປະ​ເທດ​ທີ່​ມີ​ແຫຼ່ງຄວາມ​ຊ່ວຍ​ເຫຼືອທີ່​ດີ​ແມ່ນ​ປະມານ​38​ປີ​ຫຼັງຈາກ​ການ​ບາ​ ດາ​ເຈັບ​ສໍາລັບ​ຜູ້​ທີ່​ໄດ້​ຮັບ​ບາດ​ເຈັບ​ອາຍຸ​ລະຫວ່າງ​25​ຫາ​34​ປີ(8).​ກົງກັນຂ້າມ,​ການ​ສຶກສາວິ​ໄຈ​ທີ່​ດໍາ​ ເນີນ​ໃນ​ປະ​ເທດ​ບັງ​ກະລາ​ເທດ​ພົບ​ວ່າ​ອາຍຸ​ຍືນ​ສະ​ເລ່ຍຫຼັງຈາກ​ການ​ບາດ​ເຈັບ​ໄຂ​ສັນຫຼັງ​ແມ່ນ​5.36​ປີ,​​ ໂດຍ​ທີ່​56.4%​ຂອງຄົນດັ່ງກ່າວ​ແມ່ນ​ເສຍ​ຊີວິດ​ພາຍ​ໃນ​ຫ້າ​ປີ​ນັບ​ຈາກ​ການບາດ​ເຈັບ(9).​​ຈາກ​ຄົ​ທີ່ຢູ່​ໃນ​ ການ​ສຶກສາວິ​ໄຈ,​80%​​ເສຍ​ຊີວິດ​ຢູ່​ເຮືອນ,​​ແລະ​ຈາກ​ຜູ້​ທີ່​ເສຍ​ຊີວິດ​ຢູ່​ເຮືອນ,​ໜຶ່ງສ່ວນ​ສາມ​ມີ​ແຜ​ກົດທັບ​ ໃນ​ເວລາ​ເສຍ​ຊີວິດ. ຢູ່​ໃນ​ໂຮງໝໍ​ຟື້ນ​ຟູ​ຮ່າງກາຍ​ໃນ​ປະ​ເທດ​ສີ​ລັງກາດ​ການສໍາ​ຫຼວດຄ່າ​ໃຊ້​ຈ່າຍ​ຢູ່​ໂຮງໝໍ​ຖືກ​ດໍາ​ເນີນ​ຕໍ່​ກັບ​ພະ​ ແນ​ກການ​ບາດ​ເຈັບ​ໄຂ​ກະດູກ​ສັນຫຼັງ​ໃນ​ປີ​1999.​​ໃນ​ເວລາ​ນັ້ນ,​ມັນ​ໃຊ້​ເວລາ​ປະມານ​ຫົກ​ອາທິດ​ເພ່ືອ​ ປິ່ນປົວ​ແຜ​ກົດທັບ​ຕື້ນໆ​ດ້ວຍ​ຄ່າ​ໃຊ້​ຈ່າຍ​$​286.​​ແຜ​ກົດທັບ​ທີ່​ເລິກ​ຈໍາ​ເປັນ​ຕ້ອງ​ໃຊ້​ເວລາ​ປະມານໜຶ່ງ​ປີ​ ໃນ​ການ​ປິ່ນປົວ​​ແລະ​ມີຄ່າ​ໃຊ້​ຈ່າຍ​ປະມານ​$​2483.​ການສໍາຫຼວດດຽວກັນສະແດງໃຫ້ເຫັນວ່າການນໍາ ສະເໜີລົດເຂັນ,​ເບາະນັ່ງ​ແລະເສື່ອຮອງທີ່ຖືກຕ້ອງ​ແລະ​ການໃຫ້ການ​ສຶກສາ​ອົບຮົມ​ທີ່​ພຽງພໍ​ແກ່​ຄົນ​ ເຈັບ​ສາມາດ​ຫຼຸດການ​ເກີດ​ແຜ​ກົດ​ທັບ​ໃນ​ລະຫວ່າງ​ກາ​ນພັກ​ເຊົາ​ຢູ່​ໂຮງໝໍ​ໄດ້​70%​​ແລະ​ລາຍ​ຈ່າຍ​ ສໍາລັບ​ຢາ​ແລະ​ຜ້າພັນບາດ​ໄດ້​ເກືອບ​60%. ​ແຜນ​ງານ​ຂອງ​ໂຮງໝໍ​ໃນ​ເມືອງ​ຊາວ​ເປົາ​ໂລ​ປະ​ເທດ​ບຣາຊິນ​​ໄດ້​ນໍາ​ສະ​ເໜີ​ການ​ບໍລິການ​ທີ່​ເນັ້ນ​ໜັກ​ໃສ່​ ການ​ໃຫ້ການ​ສຶກສາ​ເພື່ອ​ຫຼຸດຜ່ອນ​ອາການ​ສົນສໍາຮອງ​ສໍາລັບ​ຜູ້​ທີ່​ມີ​ການ​ບາດ​ເຈັບ​ໄຂ​ສັນຫຼັງ.​ການ​ເກີດ​ ບາດແຜ​ກົ​ດທັບ​ຫຼຸດລົງ​23%(10). ການ ເລືອກ ປະ ເພດ ລົດ ເຂັນ ແລະ ເບາະ ນ່ັງ ທ່ີ ເໝາະ ສົມ ການ ໃຫ້ ຄວາມ ພໍດີ ທ່ີ ເໝາ ະສົມ ແລະ ການ ຮອງ ຮັບ ທ່າ ຕ່າງໆ; ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຕ້ອງການ​ລົດ​ເຂັນ​ທີ່​ພໍດີ​ກັບ​ຂະໜາດ​ຂອງ​ເຂົາ​ເຈົ້າ.​ລົດ​ເຂັນ​ທີ່​ມີ​ ຂະໜາດບໍ່​ຖືກຕ້ອງ​ສາມາດ​ເຮັດ​ໃຫ້​ບໍ່​ສະບາຍ​ຕົວ,​ບໍ່​ໃຫ້ການ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ທີ່​ ດີ,​​ແລະ​ອາດ​ຈະ​ກໍ່​ໃຫ້​ເກີດ​ອັນຕະລາຍ​ຕໍ່​ກັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ.​ນີ້​ໝາຍ​ຄວາມ​ ວ່າການ​ບໍລິການ​ລົດ​ເຂັນ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ສະໜອງ​ລົດ​ເຂັນ​ທີ່​ມີ​ຂະໜາດ​ແຕກ​ ຕ່າງ​ກັນ,​ຫຼືລົດ​ເຂັນ​ທີ່​ສາມາດ​ປັບ​ຂະໜາດ​ໄດ້. ຜູ​້ໃຊ​້ລດົ​ເຂນັ​ສວ່ນ​ໃຫຍ​່ໃຊ​້ເວລາ​ຫາຼຍຊົວ່​ໂມງ​ຕ່ໍ​ມ​້ໃນ​ການ​ນັງ່.​ນີ​້ໝາຍ​ຄວາມ​ວາ່​ລດົ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ບໍ​່ພຽງ​ ແຕ່​ແມນ່​ອປຸະກອນ​ຊວ່ຍ​ໃຫ​້ເຄືອ່ນ​ທີ​່ໄປມາ​ເທົາ່​ນັນ້.​ມນັ​ຍງັ​ຊວ່ຍ​ປະຄອງ​ເຂາົ​ເຈົາ້​ໃຫ​້ນັງ່​ຕັງ້​ຊື​່ໄດ​້ຢາ່ງ​ສະບາຍ​ ຕວົ.​ນອກ​ນັນ້​ຜູ​້ຄນົ​ຍງັ​ມ​ີຄວາມ​ຕອ້ງການ​ດາ້ນ​ການ​ຮອງ​ຮບັ​ທາ່​ທາງ​ແຕກ​ຕາ່ງ​ກນັ​​ແລະ​ສະ​ນັນ້​ຈິງ່​ຈາໍ​ ເປນັຕອ້ງ​ມ​ີລດົ​ເຂນັ​ທີ​່ມ​ີການ​ຮອງ​ຮບັ​ແຕກຕາ່ງ​ກນັ. 30 31 ຄົນທີ່​ມີ​ຄວາມ​ຕ້ອງການ​ດ້ານການ​ຮອງ​ຮັບ​ທ່າທາງ​ລະດັບ​ພ້ືນຖານ​ຈໍາ​ເປັນ​ຕ້ອງ​ ມີ​ການ​ຮອງ​ຮັບ​ຈາກ​ລົດ​ເຂັນ​ທີ່ມີ​ການ​ປັບ​ໃຫ້​ພໍດີ​ກັບ​ເຂົາ​ເຈົ້າ. ​ຄົນທີ່​ມີ​ຄວາມ​ຕ້ອງການ​ດ້ານ​ການ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ລະດັບ​ປານ​ກາງ​ຈໍາ​ເປັນ​ ຕ້ອງ​ມີ​ລົດ​ເຂັນ​ທີ່​ມີ​ການ​ປັບ​ໃຫ້​ພໍ​ກັບ​ເຂົາ​ເຈົ້າພ້ອມ​ກັບການ​ຮອງ​ຮັບ​ພິ​ເສດ​ເພ່ີມ​ ເຕີມ.​​ສາມາດ​ໃຫ້ການ​ຮອງ​ຮັບ​ພິ​ເສດ​​ໂດຍ​ການ​ເພ່ີມ​ແນວ​ຮອງ​ຮັບ​ຫຼື​ແນວ​ ປະຄອງ​ທ່າ​ທາງ​ພິ​ເສດ​ໃສ່​ລົດ​ເຂັນ,​ຫຼືການ​ໃຫ້​ບ່ອນ​ນັ່ງ​ທີ່ຮອງ​ຮັບ​ສະ​ເພາະ. ຜົນ​ເສຍ​ຈາກ​ການ​ບໍ່​ໃຫ້​ຂະໜາດ​ທີ່​ຖືກຕ້ອງ​ຫຼືການ​ຮອງ​ຮບັ​ທີ່​ຖືກຕ້ອງ ​ພະນັກງານ​ຢູ່​ສູນ​ຟື້ນ​ຟູ​Western​Cape​​ໃນ​ອາ​ຝຣິກາ​ໃຕ້​​ໄດ້​ບັນທຶກ​ອາການ​ແຊກ​ຊ້ອນ​ທີ່​ສັງ​ເກດ​ເຫັນ​ ໃນ​ກຸ່ມ​ເດັກນ້ອຍ​ຢູ່​ໂຮງຮຽນ​​ແລະ​ສູນ​ດູ​ແລ​ເດັກ​ຜູ້​ທີ່​ຕ້ອງການ​ແນວ​ຮອງ​ຮັບ​ທ່າ​ທາງ​​ແຕ່​ບໍ່​ມີ​ມັນຢູ່​ພາຍ​ໃນ​ ລົດ​ເຂັນ​ຂອງ​ເຂົ​າ​ເຈົ້າ.​​ໃນ​ບັນດາ​ພວກ​ເຂົາ,​21%​ຂອງ​ເດັກນ້ອຍ​ເກີດ​ມີ​ອາການ​ແຊກ​ຊ້ອນດ້ານ​ທ່າ​ ທາງ​ເພ່ີມ​ເຕີມ.​ຜົນ​ເສຍ​ຂອງ​ອາການ​ແຊກ​ຊ້ອນ​ເຫຼົ່ານ້ີ​ສໍາລັບ​ເດັກນ້ອຍ​​ແລະ​ຄອບຄົວ​ຂອງ​ເຂົາ​ເຈົ້າ​​ ແລະ​ການ​ບໍລິການ​ມີ​ຄື: •​ ອາການ​ແຊກ​ຊ້ອນ​ເພ່ີມ​ຂຶ້ນ​​ແລະ​​ໃຊ້​ເວລາ​ຫຼາຍຂຶ້ນ​ໃນ​ການ​ເຂົ້າ​ຮ່ວມ​ກາ​ນັດ​ໝາຍ; •​ ສຸຂະພາບ​ຂີ້ຮ້າຍ​ລົງ; •​ ທ່າ​ທາງຂ້ີ​ຮ້າຍ​ລົງ​​ແລະ​ຄວາມ​ບໍ່​ສະບາຍດຕົວ; •​ ຄວາມ​ທົນ​ທານ​ໃນການ​ນັ່ງ​ຫຼຸດລົງ​(ນັ່ງ​ແບບ​ສະບາຍ​ຕົວ​ບໍ່​ໄດ້​ດົນ); •​ ການ​ເຂົ້າ​ຮ່ວມ​ໃນ​ການ​ໂປຣ​ແກຣມການ​ສຶກສາຫຼຸດລົງ; •​ ຄຸນ​ນະພາ​ບຊີວິດ​ຫຼຸດລົງ. ການ ຕອບ ສະໜອງ ຄວາມ ຕ້ອງການ ແລະ ສະພາບ ແວດ ລ້ອມ ຂອງ ຜູ້ ໃຊ້ ລົດ​ເຂນັ​ທີ​່ເໝາ​ະສມົຄວນ​ເຮດັ​ໃຫ​້ຜູ້​ໃຊ​້ລົດ​ເຂນັງ່າຍ​ຂຶນ້​ໃນ​ການ​ດາໍ​ເນນີສິງ່​ຕາ່ງໆ​ທີ​່ພວກ​ເຂາົ​ຕອ້ງ​ ເຮດັ.​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຈາໍ​ເປນັ​ຕອ້ງ​ສາມາດ​ເຂົາ້​​ແລະ​ອອກ​ຈາກ​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ໄດ,້​ຍູ​້ລົດ​ເຂນັ​ ຂອງ​ເຂ​ົາ​ເຈົາ້​ໄດ,້​ພັບ​ລົດ​ເຂນັ​ຂອງ​ເຂ​ົາ​ເຈົາ້​ສາໍລັບ​ການ​ຂນົ​ຍາ້ຍ​​ແລະ​ການ​ເກັບ​ມຽ້ນ​ໄດ​້​ແລະ​ດາໍ​ ເນນີ​ບນັ​ດາ​ກິດຈະກາໍ​ປະຈາໍ​ວນັ​ຂອງ​ເຂາົ​ເຈົາ້​ໄດ.້​ປະ​ເພດ​ທີ​່ເໝາະ​ສມົ​ຂອງ​ລົດ​ເຂນັ​​ແລະ​ ຄນຸສມົບັດ​ໃຊ​້ງານທີ​່ຖກືຕອ້ງ​ໃນ​ລົດ​ເຂນັ​ສາມາດ​ເຮດັ​ໃຫກ້ານ​ເຮດັ​ສ່ິງ​ເຫຼົາ່ນີ​້ງາ່ຍ​ຂຶນ້​ສາໍລັບ​ຜູ​້ໃຊ​້ລົດ​ ເຂນັ. 32 33 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຍງັ​ຕ້ອງການ​ລົດ​ເຂນັ​ທີ​່ຈະ​ໃຊ​້ໄດ​້ດ​ີສາໍລັບ​ເຂາົ​ເຈົາ້​ໃນ​ສະພາບ​ແວດ​ລ້ອມ​ຂອງ​ເຂາົ​ເຈົາ້.​ ລົດ​ເຂນັ​ຕາ່ງ​ກນັ​ເໝາະ​ສມົ​ກັບ​ສະພາບ​ແວດ​ລ້ອມ​ຕາ່ງ​ກນັ.​ຕວົຢາ່ງ,​ລົດ​ເຂນັ​ບາ​ງຊະນິດ​ດກີ​ວາ່​ ສາໍລັບ​ການ​ໃຊ​້ຢູ​່ພາຍ​ໃນ​ເຮອືນ,​ບາງ​ຊະນິດ​ດກີ​ວາ່​ສາໍລັບ​ການ​ໃຊຢູ້​່ນອກ​ເຮອືນ​​ແລະ​ຢູ​່ເທງິ​ພືນ້​ດນິ​ທີ່​ ບໍ​່ຮາບ​ພຽງ. ອຸປະກອນ ທ່ີ ຖືກ ປະ ຖ້ິມ: ມີ ບາງ ຢ່າງ ດີກ ວ່າ ບ່ໍ ມີ ຫຍັງແມ່ນ ບໍ? ​ເມື່ອ​ອຸປະກອນ​ບໍ່​ຕອບ​ສະໜອງ​ໄດ້​ຄວາມ​ຕ້ອງກາ​ນຂອງ​ ຜູ້​ໃຊ້​– ມັນ​ມັກ​ຈະ​ຖືກ​ປະ​ຖິ້ມ. ຮູບ​ອະທິບາຍ​ນີ້​ບອກ​ເລື່ອງ​ເລົ່າ​ທີ່​ມັກ​ພົບ​ເຫັນ.​ຜູ້​ໃຊ້​ລົດ​ ເຂັນ​ນີ້​ມີ​ລົດ​ເຂັນ​ທີ່​ໄດ້​ຮັບ​ບໍລິຈາກ​ສາມ​ຄັນ​– ​ແຕ່​ບໍ່​ມີ​ຄັນ​ ໃດ​ຕອບ​ສະໜອງ​ຄວາມ​ຕ້ອງການ​ຂອງ​ລາວ,​​ແລະ​ລາວ​ ບໍ່​ສາມາດ​ອອກ​ຈາກ​ເຮືອນ​ຂອງ​ລາວ​ໄດ້.​ລົດ​ເຂັນ​ສອງ​ ຄັນ​ທໍາ​ອິດ​ບໍ່​ສາມາດ​ໃຊ້​ໄດ້​ອີກ​ຕໍ່​ໄປ​​ເພາະວ່າ​ພວກ​ມັນ​ເ​ ພ​​ແລະ​ບໍ່​ມີ​ອາ​ໄຫຼ່ປ່ຽນ​ຖ່າຍ.​​ຄັນ​ທີ​ສາມ​ແມ່ນ​ລົດ​ໃໝ່;​​ ແຕ່​ເປັນ​ລົດ​ເຂັນ​ຄຸນ​ນະພາ​ບບໍ່​ດີ​​ເຊິ່ງຮູ້ສຶກ​ສັ່ນກວາຍ​ ໂຍກ​ເຍກ​​ແລະ​ບໍ່​ໝັ້ນຄົງ​​ໃນ​ເວລາ​ໃຊ້​ຢູ່​ນອກ​ເຮືອນ,​ສະ​ ນັ້ນ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຮູ້ສຶກ​ບໍ່​ປອດ​ໄພ.​ ຄວາມ ປອດ ໄພ ແລະ ຄວາມ ທົນ ທານ ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຕອ້ງການ​ລົດ​ເຂນັ​ທີ​່ປອດ​ໄພ​​ແລະ​ທນົ​ທານ​​ເຊິງ່ສາມາດ​ສ້ອມ​ແປງ​ໄດ​້ໃນ​ລາຄາ​ທີ​່ບໍ່​ ແພງ.​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຍງັ​ໄດ​້ປະ​ໂຫຍ​ດຈາກ​ການ​ຮບັປະກນັ​ວາ່​ລົດ​ເຂນັ​ທີ​່ພວກ​ເຂາົ​ສະໜອງ​ ໃຫ​້ແມນ່​ປອດ​ໄພ,​ທນົ​ທານ​​ແລະ​ສາມາດ​ສ້ອມ​ແປງ​ໄດ​້ຢູ​່ພາຍ​ໃນ​ທ້ອງ​ຖິນ່.​ນີ​້ສາມາດ​ຊວ່ຍ​ຫຼຸດຜ່ອນ​ ຄາ່​ໃຊ​້ຈາ່ຍ​ໃນ​ການ​ປຽ່ນ​ລົດ​ເຂນັ​ໃໝ​່​ແລະ​ເຮດັ​ໃຫ​້ວຽກ​ບາໍລງຸ​ສ້ອມ​ແປງ​ລົດ​ເຂນັ​ງ່າຍ​ຂຶນ້. ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຫາຼຍໆ​ຄນົທີ່ຢູ​່ໃນ​ສະຖານ​ທີ​່ມ​ີຊບັພະຍາກອນ​ຈາໍກັດ​ໃຊ​້ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ເພ່ືອ​ ເດນີທາງ​ໄປມາ​ຢູ​່ເທງິໜາ້ດນິ​ທີ​່ບໍ​່ຮາບ​ພຽງ​​ແລະ​ອາດ​ຈະ​ຈາໍ​ເປນັ​ຕ້ອງພະ​ເຊນີ​ກັບ​ຝນົຕົກ,​ຂີ​້ຊາຍ​​ ແລະ​ຂີຕ້ມົ.​ນີ​້ໝາຍ​ຄວາມ​ວາ່​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ຈາໍ​ເປນັ​ຕອ້ງ​ແໜນ້ໜາ​​ແລະ​ສາ້ງ​ມາ​ເພ່ືອ​ຄງົ​ທນົ​ ຕໍ​່ກັບ​ສະພາບ​ເຫຼົາ່ນີ.້​ລົດ​ເຂນັ​ຄນຸ​ນະພາ​ບບໍ​່ດ​ີຈະ​ເພ​ໄວ​(ຕວົຢາ່ງ​​ໃນ​1–6​​ເດືອນ);​​ແນວ​ໃດ​ກໍ່ຕາມ​ ລົດ​ເຂນັ​ທີ​່ຖກື​ອອກ​ແບບ​ມາ​ດ​ີທີ​່ມ​ີການ​ບາໍລງຸ​ຮກັສາ​ເປນັ​ຢາ່ງ​ດ​ີສາມາດ​ໃຊ​້ງານ​ໄດ​້ເຖງິ​3–5​ປ.ີ​ນີ້​ ຄຸມ້​ຄາ່​ກວາ່​ສາໍລັບ​ເງນິ​ທີ​່ຊື.້ 32 33 ບາງ ບັນຫາ ທ່ີ ມັກ ພົບ ເຫັນ ໃນ ລົດ ເຂັນຄຸນ ນະພາ ບຕ່ໍາ ລວມມີ: •​ ບ່ອນ​ນັ່ງ​ທີ່​ມີ​ຄຸນ​ນະພາ​ບຕໍ່າ​​ແລະ​​ແຜ່ນ​ຫຸ້ມ​ແນວ​ອີ​ງຫຼັງຈີກ​ຂາດ​ ຫຼືຢ່ອນ​ຍານ; •​ ລໍ້​ໜ້ານ້ອຍ​(​ແກນ​ເພົາ,​ຢາງ​ລໍ້,​​ລູກ​ຫວ່ານ,​ຂາ​ງ່າມ​ລໍ້)​​ເພ​ງ່າຍ, •​ ​ລໍ້​ຫຼັງ​(​ແກນ​ເພົາ,​ວົງລໍ້​ສໍາລັບ​ຍູ້,​ດິ້ວ​ລໍ້,​ລູກ​ຫວ່ານ,​ຢາງ​ລໍ້)​​ເພ​ ຫຼືຫຼູ້ຍຫ້ຽນ​ງ່າຍ; •​ ​ເບ​ກ​ເປັນ​ໝ້ຽງ​​ແລະ​ໃຊ້​ບໍ່​ໄດ້; •​ ​ແນວ​ຮອງ​ຕີນ​ເພ; •​ ບໍ່​ມີ​ເບາະ​ນັ່ງ,​ຫຼື​ເບາະ​ນັ່ງມີ​ຄຸນ​ນະພາ​ບຕໍ່າ​​ແລະ​ເພ​ໄວ; •​ ສ່ວນ​ທີ່​ຖອດ​ອອກ​ໄດ້​ເສຍ. ບົດບາດ ຂອງ ຜູ້ ຈັດການ ຜູ​້ຈດັການ​ຝ່າຍ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ມ​ີບົດບາດ​ສາໍຄນັ​ໃນ​ການຈດັ​ຊື​້ຫຼືຮບັ​ເອາົ​ລົດ​ເຂນັ​ບລໍຈິາກ.​​ ສາໍລັບ​ຂໍ​້ມນູ​ເພ່ີມ​ເຕມີ,​​ໃຫ​້ເບິງ່ຄູ​່ມ​ືວາ່​ດວ້ຍ​ແຫຼງ່ຊບັ​ພະຍາກ​ອນ​ເພ່ີມ​ເຕມີ​ສາໍລັບຜູ​້ຈດັການ​ຢູ​່ໃນ​Pen​ Drive. ບົດບາດ​ຂອງ​ເຂາົ​ເຈົາ້​ແມນ່​ຮບັປະກນັ​ວາ່: •​ ການ​ບລໍກິານ​ມ​ີລົດ​ເຂນັ​​ແລະ​ເບາະ​ນັງ່​ໃຫ​້ເລືອກ​– ​ເພ່ືອ​ສາມາດ​ຕອບ​ສະໜອງ​(​ຫາຼຍທີ​່ສຸດ​ເທົາ່​ ທີ​່ຈະ​ເປນັ​ໄປ​ໄດ)້​ຄວາມ​ຕ້ອງການ​ຕາ່ງໆ​ຂອງຜູ​້ໃຊ​້ລົດ​ເຂນັ.​ນີ​້ລວມມ​ີການ​ພິຈາລະນາ​ເຖງິ​ຄວາມ​ ຕອ້ງການ​ດາ້ນຂະໜາດ​,​​ແນວ​ຮອງ​ຮບັ​ທາ່​ທາງ,​ສະພາບ​ແວດ​ລ້ອມ​​ແລະ​ວຖິ​ີຊວີິດ​ທີ​່ແຕກ​ຕາ່ງ​ ກນັ. •​ ລົດ​ເຂນັ​ທີ​່ຖກື​ຈະ​ຕ້ອງ​ທນົ​ທານ​– ​ໂດຍ​ສະ​ເພະ​ເມື່ອ​ໃຊ​້ໃນ​ສະພາບ​ແວດ​ລ້ອມ​ທີ​່ບໍ​່ຮາບ​ພຽງ​​ແລະ​ ກນັດານ. •​ ລົດ​ເຂນັ​ສາມາດ​ສ້ອມ​ແປງ​ໄດ​້ຢູ​່ພາຍ​ໃນ​ທ້ອງຖິນ່.​ນີ​້ອາດ​ຈະ​ລວມ​ເອາົ​ການ​ຮບັປະກນັ​ວາ່​ມ​ີການ​ ຊື​້ອາ​ໄຫຼ​່(ສະໜອງ​ໃຫ​້ດວ້ຍ​ການ​ບລໍຈິາກ),​ຫຼືອາ​ໄຫຼສ່າມາດ​ຖກື​ຊື​້ໄດ​້ຢາ່ງ​ງ່າຍດາຍ​ໃນ​ທ້ອງ​ຖິນ່. ການຊອກ​ເອາົ​ຄາໍ​ຕ​ິຊມົ​ຈາກ​ຜູ​້ໃຊລ້ົດ​ເຂນັ​ຢາ່ງ​ຈງິ​ຈງັ​ກຽ່ວ​ກັບ​ຜະລິດ​ຕະພັນ​ທີ​່ສະໜອງ​ໃ​ໂດຍ​ການ​ ບລໍກິານ​ລົດ​ເຂນັ​​ແມນ່​ສາໍຄນັ​ຫາຼຍ.​​ຜູ​້ຈດັການ​​ແລະ​ພະນັກງານ​ຂອງການ​ບລໍກິານສາມາດ​ໂອ​້ລມົ​ ກັບ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ໃນ​ລະຫວາ່ງ​ການ​ໄປ​ຢຽ້ມຢາມ​ເຮອືນ,​ກອງ​ປະຊມຸ​ກຸມ່​ຫຼືຜາ່ນ​ອງົການ​ຈດັ​ຕັງ້​ຄນົ​ ພກິານ. ​ໃນ​ເວລາ​ນາໍ​ສະ​ເໜ​ີລົດ​ເຂນັ​ຫຼ​ືເບາະ​ນັງ່​ປະ​ເພດ​ໃໝ​່ເປນັ​ຄັງ້​ທາໍ​ອິດ,​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ອາດ​ຈະ​ ເລືອກ​ເຮດັ​ການ​ທົດ​ລອ​ງ​ໃຊ​້ຜະລິດ​ຕະພັນ​ກັບ​ກຸມ່​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ໃດ​ໜຶງ່​ຜູ​້ທີ​່ລອງ​ໃຊ​້ຜະລິດ​ຕະພນັ​ໃໝ່​ ເປນັ​ເວລາ​ໃດ​ໜຶງ່​​ແລະ​ໃຫ​້ຄາໍ​ເຫນັ​ຕ​ິຊມົ.​ຄາໍ​ເຫນັ​ຕ​ິຊມົ​ອາດ​ຈະ​ຖກື​ເກັບ​ເອາົ​ຜາ່ນ​ການ​ສາໍພາດ​ ລາຍບກຸຄນົ​ຫຼືຜາ່ນ​ກຸມ່​ສະ​ເພາະ. 34 35 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ຜູ້ ຈັດການ ສາມາດ ຮັບປະກັນ ໄດ້ ແນວ ໃດ ວ່າ ລົດ ເຂັນ ທ່ີ ພວກ ເຂົາ ຊ້ື ຫືຼ ໄດ້ ຮັບ ແມ່ນ ລົດ ເຂັນ ທ່ີ ທົນ ທານ ແລະ ສາມາດ ສ້ອມ ແປງ ໄດ້ ? ຜູ້​ຈັດການ​ສາມາດ​ຖາມ​ຄໍາ​ຖາມ​ກ່ຽວ​ກັບ​ຜູ້​ສະໜອງ​ສິນຄ້າ​(ຫຼືຜູ້​ບໍລິຈາກ)​​ເພ່ືອ​ຊອກ​ຮູ້​ເພ່ີມ​ເຕີມ​ກ່ຽວ​ກັບ​ ລົດ​ເຂັນ​ນັ້ນ.​ຕົວຢ່າງ,​ຜູ້​ຈັດການ​ສາມາດ​ຖາມ: •​ ລົດ​ເຂັນ​ນີ້​ໄດ້​ຜ່ານ​ມາດຕະຖານ​ທີ່​ຮັບຮອງ​ໃດໆ​ບໍ​(ຕົວຢ່າງ:​ການ​ທົດ​ສອບ​ການ​ໃຊ້​ງານ​​ແລະ​ການ​ທົດ​ ສອບ​ການ​ຮັບປະກັນ​ຄຸນ​ນະພາ​ບທີ່​ກໍານົດ​ໂດຍ​ໜ່ວຍ​ງານ​ວິຊາ​ຊີບ​ໃດ​ໜຶ່ງ)?​​ຖ້າ​ໄດ້​ຜ່ານ​,​ຜົນ​ການ​ທົດ​ ສອບ​ເປັນ​ແນວ​ໃດ? •​ ຜູ້​ສະໜອງ​ສິນຄ້າ​ແນະນໍາ​ອາຍຸ​ໃຊ້​ງານ​ສະ​ເພາະ​ສໍາລັບ​ລົດ​ເຂັນ​ບໍ? •​ ຜູ້​ສະໜອງ​ສິນຄ້າ​ມີ​ລະບົບ​ສໍາລັບ​ລາຍ​ງານ​ຄວາມ​ບົກ​ຜ່ອງ​ບໍ? •​ ​ໃຜ​ອື່ນ​ແດ​ທີ່​ຊື້​​ແລະ​ໃຊ້​ລົດ​ເຂັນ​ນີ້?​ມັນ​ເປັນ​ໄປ​ໄດ້​ສໍາລັບ​ຜູ້​ຈັດການ​ໃນ​ການ​ຕິດ​ຕໍ່​ຫາ​ການ​ບໍ​ການ​ອື່ນ​ທີ່​ ສະໜອງ​ລົດ​ເຂັນ​ນີ້​​ເພື່ອ​ຊອກ​ຮູ້​ເພ່ີມ​ເຕີມ​ກ່ຽວ​ກັບ​ປະສິດທິ​ພາບ​ໃຊ້​ງານ​ຂອງ​ມັນ. •​ ​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ເຄື່ອງມື​ໃດ​ແດ່​ເພ່ືອ​ປະກອບ​​ແລະ/ຫຼືດັ​ດປັບ​ລົດ​ເຂັນ​ນີ້? •​ ມີ​ອາ​ໄຫຼ່ສໍາຮອງ​ບໍ?​ອາ​ໄຫຼ່​ເຫຼົ່ານ້ີ​ຈໍາ​ເປັນ​ຕ້ອງ​ຊື້​ຈາກ​ຕ່າງປະ​ເທດ​ຫຼືາງອາ​ໄຫຼ່ທີ່​ອາດ​ຈະ​ຕ້ອງການ​ ແມ່ນ​ມີ​ໃຫ້​ຢູ່​ພາຍ​ໃນ​ປະ​ເທດ​ຂອງ​ທ່ານ​ບໍ? •​ ລົດ​ເຂັນ​ນີ້​ໄດ້​ຖືກ​ທົດ​ລອງ​ໃຊ້​ໃນ​ປະ​ເທດ​ແລ້ວ​ບໍ,​​ແລະ​ຖ້າ​ແມ່ນ​ຜົນ​ການ​ທົດ​ລອງ​ໃຊ້/ຄໍາ​ເຫັນ​ຕິ​ຊົມ​ເປັນ​ ແນວ​ໃດ? •​ ຖ້າ​ໂຄງ​ຮ່າງ​ລົດ​ເຂັນເພ​– ​ສາມາດ​ສ້ອມ​ແປງ​ສິ່ງ​ນີ້ຢູ່​ພາຍ​ໃນ​ທ້ອງ​ຖິ່ນ​ໄດ້​ບໍ? •​ ລົດ​ເຂັນ​ມາ​ພ້ອມ​ກັບ​ຄູ່​ມື​ແນະນໍາ​ການ​ບໍາລຸງ​ຮັກສາ​ບໍ? ການ ບໍາລຸງ ຮັກສາ, ການ ສ້ອ ມ ແປງ ແລະ ການ ຕິດຕາມ ຜົນ ລົ ດ ເຂັນ ​ຂັນ້​ຕອນທ​ີແປດ​ໃນ​ການ​ໃຫ້ບລໍກິານ​ລົດ​ເຂນັ​ແມນ່ການ​ຕິດຕາມ​ຜນົ,​ການ​ບາໍລງຸ​ຮກັສາ​​ແລະການ​ ສ້ອມ​ແປງ. ການ​ຕິດຕາມ​ ຜົນ,​ການ​ ບໍາລຸງ​ຮັກສາ​​ ແລະ​ການ​ ສ້ອມ​ແປງ ການ​ນັດ​ໝາຍ​ເພ່ືອ​ຕິດຕາມ​ຜົນ​ແມ່ນ​ໂອກາດ​ໃນການກວດ​ເບິ່ງ​ວ່າ​ ລົດ​ເຂັນ​ເໝາະ​ສົມ​ດີ​ຫຼືບໍ່​​ແລະ​ໃຫ້ການ​ຝຶກ​ອົບຮົມ​​ແລະ​ການ​ຊ່ວຍ​ ເຫຼືອ​ເພີ່ມ​ເຕີມ.​ກໍານົດ​ເວລາ​ແມ່ນ​ຂຶ້ນ​ກັບ​ຄວາມ​ຕ້ອງການ​ຂອງ​ຜູ້​ໃຊ້​ ແລະ​ການ​ບໍລິການ​ອື່ນ​ທີ່​ມີ​ໃຫ້​ແກ່​ເຂົາ​ເຈົ້າ.​ນອກ​ນັ້ນ​ການ​ບໍລິການ​ ອາດ​ຈະ​ໃຫ້ການ​ບໍາລຸງ​ຮັກສາ​​ແລະ​ການ​ສ້ອມ​ແປງ​ສໍາລັບ​ບັນຫາ​ ດ້ານ​ເຕັກນິກ​ທີ່​ບໍ່​ສາມາດ​ແກ້​ໄຂ​ໄດ້​ຢ່າງ​ງ່າຍ​ດານ​ຍຢູ່​ໃນ​ຊຸມ​ຊົນ.​ ສ່ວນ​ສໍາຄັນ​ຂອງ​ຂັ້ນ​ຕອນ​ນີ້​ແມ່​ນການ​ສອນ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​​ແລະ​ ຄອບຄົວ​ຂອງ​ເຂົາ​ເຈົ້າ​ວິທີ​ບໍາລຸງ​ຮັກສາ​ລົດ​ເຂັນ​ຂອງ​ເຂົາ​ເຈົ້າ.​ ການ​ບໍາລຸງ​ຮັກສາ​ຢ່າງ​ເປັນ​ປົກກະຕິ,​​ເຊິ່ງດໍາ​ເນີນ​ຢູ່​ເຮືອນ,​ ສາມາດ​ຊ່ວຍ​ຮັບປະກັນ​ໃຫ້​ລົດ​ເຂັນ​ໃຊ້​ງານ​ໄດ້​ດົນກວ່າ,​​ແລະ​ມີ​ ຄວາມ​ຈໍາ​ເປັນ​ໜ້ອຍ​ກວ່າ​ສໍາລັບ​ການ​ສ້ອມ​ແປງ​ຂະໜາດ​ໃຫຍ່. 34 35 ການ​ບລໍກິານ​ລົດ​ເຂນັ​ອາດ​ຈະ​ຝກຶ​ອບົຮມົ​ໃຫ້ບນັດາ​ຄູ​່ຮວ່ມ​ງານ​ເພ່ືອ​ເປນັ​ຜູ​້ໃຫ​້ບລໍກິານ​ບາໍລງຸ​ຮກັສາ​​ ແລະ​ກາ​ນສ້ອມ​ແປງ,​​ແລະ​ກາໍນົດ​ຊບັພະຍາກອນ​ໃນ​ຊ​ຸມຊນົ​(ຕວົຢາ່ງ,​ຮາ້ນ​ສ້ອມ​ແປງ​ລົດຖີບ)​ບ່ອນ​ ທີ​່ສາມາດ​ດາໍ​ເນນີ​ການ​ບາໍລງຸ​ຮກັສາ​​ແລະ​ການ​ສ້ອມ​ແປງ​ລົດ​ເຂນັ​ໄດ.້ B.4 ຈັດ ວາງ ບຸກຄະລາ ກອນ ບົດບາດ ໜ້າ ທ່ີ ໃນ ການ ບໍລິການ ລົດ ເຂັນ ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ມັກ​ຈະ​ຖກື​ສະໜອງ​ໃຫ​້ໂດຍ​ກຸມ່​ຄນົທີ​່ເຮດັ​ວຽກ​ເປນັ​ທ​ີມ.​ສະມາຊກິ​ຕ່າງ​ກນັ​ ໃນ​ທ​ີມງານ​ເຮດັ​ໜາ້​ທີ​່ຕາ່ງ​ກນັ​– ​ເຊັນ່​ວາ່​ການ​ປິນ່ປວົ,​​ເຕກັນິກ,​ການ​ຝຶກ​ອບົຮມົ,​ການ​ບລໍກິານ​​ ແລະ​ການ​ຄຸມ້​ຄອງ. ບກຸຄນົ​ຕາ່ງ​ໆ ​ອາດ​ຈະ​ປະຕບິັດ​ໜຶງ່​ຫຼືຫາຼຍໜາ້​ທີ.່​ຕວົຢາ່ງ,​ບກຸຄນົທີ​່ດາໍ​ເນນີໜາ້​ທີ​່ການ​ປິນ່ປວົອາດ​ ຈະ​ເຮດັ​ໜາ້​ທີ​່ໃນ​ການ​ຄຸມ້​ຄອງ​ການ​ບລໍກິານ​ນາໍ​ອກີ​ກໍ​່ໄດ.້​​ໃນ​ບາງ​ສະພາບ​ການ,​ພະນັກງານ​ຈາກ​ ຫາຼຍອງົການ​ຈດັ​ຕັງ້​ອາດ​ຈະ​ເຮດັ​ວຽກ​ຮວ່ມ​ກນັ​ເພ່ືອ​ປະຕິບັດ​ໜາ້​ທີ​່ຕາ່ງ .ໆ ຕາຕະລາງ​ຂາ້ງ​ລຸມ່​ສະ​ແດງ​ໃຫ​້ເຫນັ​ວາ່​ພະນັກງານ​ທີ່ປະຕິບັດ​ໜາ້​ທີ​່ຕາ່ງໆ​ເຮດັ​ກິດຈະ​ກາໍ​ຕາ່ງໆ​ທີ່​ ກຽ່ວຂອ້ງ​ກັບ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​ແນວ​ໃດ. 36 37 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ດ້ ານ ກ ານ ປິ່ ນ ປົ ວ ດ້ ານ ເຕັ ກ ນິ ກ ກ ານ ຝຶ ກ ອົ ບ ຮົ ມ ຜູ້ ໃຊ້ ລົ ດ ເຂັ ນ ກ ານ ບໍ ລິ ຫ ານ ກ ານ ຄຸ້ ມ ຄ ອ ງ ​ການ​ຄຸ້ມ​ຄອງ​​ແລະ​ກາ​ນພັດທະນາ​ການ​ບໍລິການ ການ​ສົ່ງ​ເສີມ​ການ​ບໍລິການ      ​ການ​ຊອກ​ແຫຼ່ງ​ທຶນ  ​ກາ​ພັດທະນາ​ແຫຼ່ງການ​ນໍາ​ສົ່ງ     ​ການ​ປະສານ​ງານ​ກັບ​ອົງການ​ຈັດ​ຕັ້ງ​ ອື່ນ      ​ການ​ປະ​ເມີນ​ຜົນ​ການ​ບໍລິການ      ​ຂັ້ນ​ຕອນ​ສໍາຄັນ​ໃນ​ການ​ໃຫ້​ບໍລິການ 1.​ ການ​ນຳ​ສົ່ງ​​ແລະ​ການ​ນັດ​ ໝາຍ     2.​ ການ​ປະ​ເມີນ​ຜົນ    3.​ ​ການ​ກຳນົດ​ໃຊ້​ລົດ​ເຂັນ    4.​ ການ​ໃຫ້​ທຶນ​​ແລະ​ການ​ສັ່ງ​ຊື້     5.​ ການ​ກະກຽມ​ຜະລິດ​ຕະພັນ​ (ລົດ​ເຂັນ)​  6.​ ການ​ປັບ​ໃຫ້​ເໝາະ​ສົມ   7.​ ການ​ຝຶກ​ອົບຮົມ​ຜູ້​ໃຊ້​    8.​ ການ​ຕິດຕາມ​ຜົນ,​ການ​ບຳລຸງ​ ຮັກສາ​​ແລະ​ການ​ສ້ອມ​ແປງ    ​ການ​ຝຶກ​ອົບຮົມ​​ແລະ​ກາ​ນພັດທະນາ​ວິຊາ​ຊີບ ​ການ​ຝຶກ​ອົບຮົມ​ພະນັກງານ​ເຄືອ​ຂ່າຍ​ ການ​ນໍາ​ສົ່ງ    ​ການ​ຝຶກ​ອົບຮົມ​ພະນັກງານ​ເຄືອ​ຂ່າຍ​    ການ​ຝຶກ​ອົບຮົມ​ພະນັກງານ​ ໃຫ້ການ​ບໍລິການ    36 37 ການ ຝຶກ ອົບຮົມ ໜາ້​ທີ​່ຕາ່ງໆ​ຂອງ​ການ​ບລໍກິານ​ສາມາດ​ຖກື​ເຮດັ​ໂດຍ​ບກຸຄນົ​ທີ​່ມ​ີພ້ືນຖານ​ດາ້ນ​ການ​ສຶກສາ​​ແລະ​ວຊິາ​ ຊບີ​ແຕກ​ຕາ່ງ​ກນັ​​ຕາບ​ໃດ​ທີມ່​ີການ​ໃຫກ້ານ​ຝກຶ​ອບົຮມົ​ທີ​່ເໝາະ​ສມົ(1).​ມນັ​ສາໍຄນັ​ວາ່​ພະນັກງານ​ທີ່​ ເຮດັ​ໜາ້​ທີ​່ດາ້ນ​ການ​ປິນ່ປວົ,​​ເຕກັນິກ​​ແລະ​ການ​ຝກຶ​ອບົຮມົ​ຕອ້ງໄດ​້ຮບັ​ການ​ຝກຶ​ອບົຮມົ. •​ ​ພະນັກງານ​ຝາ່ຍ​ປິນ່ປວົ​​ແລະ​ເຕກັ​ນິກທີ​່ໃຫກ້າ​ນບລໍກິານ​ລະດັບ​ພືນ້ຖານ​ຄວນ​ໄດ​້ຮບັ​ການ​ ຝກຶກຽ່ວ​ກັບ​ຄວາມ​ສາມາດ​ທີ​່ອະທິບາຍ​ໄວ​້ໃນ​ຊດຸ​ການ​ຝກຶ​ອບົຮມົ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​ ອງົການ​WHO​– ລະດັບ​ພືນ້ຖານ. •​ ​ພະນັກງານ​ຝາ່ຍ​ປິນ່ປວົ​​ແລະ​ເຕກັ​ນິກທີ​່ໃຫກ້າ​ນບລໍກິານ​ລະດັບ​ປານ​ກາງ​ຄວນ​ໄດ​້ຮບັ​ການ​ ຝກຶກຽ່ວ​ກັບ​ຄວາມ​ສາມາດ​ທີ​່ອະທິບາຍ​ໄວ​້ໃນ​ຊດຸ​ການ​ຝກຶ​ອບົຮມົ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​ຂອງ​ ອງົການ​WHO​– ລະດັບ​ປານ​ກາງ. ຈ່ົງ ຈ່ື ວ່າ:​​ໃນ​ເວລາ​ໃຫ້ການ​ຝຶກ​ອົບຮົມ​ທັກ​ສະ​ຕ່າງໆ​ແກ່​ພະນັກງານ,​ມັນ​ເປັນຄວາມ​ຄິດ​ທີ່​ດີ​ໃນ​ການ​ຝຶກ​ ໃຫ້​ຢ່າງ​ນ້ອຍ​ສອງ​ຄົນ​ໃນ​ຄັ້ງ​ໜຶ່ງ.​ຖ້າ​ຝຶກ​ໃຫ້​ແຕ່​ຄົນ​ດຽວ,​ການ​ບໍລິການຈະ​ບໍ່​ໝັ້ນຄົງ​– ຖ້າ​ບຸກຄົນລາ​ ອອກ,​ຄວາມ​ຮູ້​ທັງ​ໝົດ​ກໍ່​ຈະ​ອອກ​ໄປ​ນໍາ​ຜູ້​ນັ້ນ. ການວາງ ແຜນ ຄວາມ ສາມາດ ໃຫ້ ບໍລິການ ຂອງ ທ່ານ ​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕ້ອງ​ສາມາດ​ວາງ​ແຜນການ​ບລໍກິານ​ຂອງ​ເຂາົ​ເຈົາ້​​ໂດຍ​ອງີ​ໃສ່​ວາ່​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຈກັ​ ຄ​ົທີ​່ພວກ​ເຂາົ​ຈະ​ສາມາດ​ໃຫກ້ານ​ບລໍກິານ​ສາໍລັບ​ແຕລ່ະ​ເດືອນ​​ແລະ​ປ.ີ​ນີ​້ສາມາດ​ເອີນ້​ວາ່​“ຄວາມ​ ສາມາດ​ໃຫ​້ບລໍກິານ”. ​ຄວາ​ມສາມາດ​ໃຫ​້ບລໍກິານ​ລວມມ:ີ •​ ຈາໍນວນ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ຈະ​ໄດ​້ຮບັ​ລົດ​ເຂນັ​ເປນັ​ຄັງ້​ທາໍ​ອິດ; •​ ຈາໍນວນ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ຈະ​ຖ​ືກຕິດຕາມ​ຜົນ. ຄວາມ​ສາມາດ​ໃຫ​້ບລໍກິານ​ເຊືອ່ມ​ໂຍງ​ໂດຍ​ກ​ົກັບ: •​ ຈາໍ​ນວນ​ພະນັກງານ​ທີ​່ມ​ີສາໍລັບ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ; •​ ຈາໍ​ນວນ​ເວລາ​ທີ​່ພະນັກງານມ​ີສໍາລັບ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ; •​ ​ຈາໍນວນ​ລົດ​ເຂນັ​ທີ​່ການ​ບລໍກິານ​ສາມາດ​ຈດັ​ຊື​້– ​ເຊິງ່​ຕາມ​ລາໍດັບ​​ເຊືອ່ມ​ໂຍງ​ໂດຍ​ກງົ​ກັບ​ ງບົປະມານ. ການ ຄິດ ໄລ່ ເວລາ ຂອງ ພະນັກງານ ​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕ້ອງ​ຄິດ​ໄລວ່າ່​ພະນັກງານ​ຂອງ​ເຂາົ​ເຈົາ້​ຈະ​ໃຊ​້ເວລາ​ເທົາ່​ໃດ​ຕ່ໍ​ກັບ​ການ​ໃຫ​້ບລໍກິານ​ ລົດ​ເຂນັ​​ເພື່ອ​ຄາດ​ຄະ​ເນ​ຄວາມ​ສາມາດ​ໃຫ​້ບລໍກິານ.​​ເພ່ືອ​ເຮດັ​ສິງ່​ນີ,້​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕອ້ງ​ຮູ:້ 38 39 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ •​ ຈາໍນວນ​ອາທິດ​ເຮດັ​ວຽກ​ທີ​່ມ​ີໃຫ​້ໃນ​ແຕລ່ະ​ປ​ີ(ລົບ​ວນັພັກ​ທາງ​ການ​​ແລະ​ວນັພກັ​ປະຈາໍ​ປີ); •​ ​ເປ​ີເຊນັ​ເວລາ​ທີ​່ພະນັກງານ​ຈະ​ໃຊ​້ໃນ​ການ​ດາໍ​ເນນີ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​(​ແລະ​ບໍ​່ແມນ່​ໜາ້ທີ​່,​ ບົດ​ບົດ​ຫຼກືິດຈະກາໍ​ອືນ່). ນອກ​ນັນ້​ຜູ​້ຈດັການ​ຄວນ​ພິຈາລະນາ​ວາ່​ພະນັກງານ​ຂອງ​ເຂາົ​ເຈົາ້​ໃຊ​້ເວລາ​ດນົ​ປານ​ໃດ​ໃນ​ກາ​ນດາໍ​ ເນນີ​ຂັນ້​ຕອນ​ຕາ່ງໆ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ​ລົດ​ເຂນັ​.​ມີຫາຼຍໆ​ປັດ​ໃຈ​ທີ​່ຈະ​ສ່ົງ​ຜົນ​ກະທົບ​ຕໍສ່ິງ່​ນີ.້​ ຕວົຢາ່ງ,​ພະນັກງານການ​ບລໍກິານ​ແມນ່​ພະນັກງານ​ໃໝ​່ຫຼມື​ີປະສົບ​ການ;​ລົດ​ເຂນັ​ທີ​່ສະໜອງ​ໃຫ​້ຈາໍ​ ເປນັ​ຕອ້ງ​ມ​ີການ​ດັດ​ແປງ​ຫຼືບໍ.່​​ແນວ​ໃດ​ກໍ່ຕາມ,​ຄູ​່ມ,ື​ທ​ີມງານ​ທີ​່ມ​ີປະສົບ​ການ​(​ແພດ​ປິນ່ປວົ​​ແລະ​ ຊາ່ງ​ເຕກັນິກ)​ອາດ​ຈະ​ສາມາດ​ໃຫ:້ •​ ລົດ​ເຂນັ​ໃໝ​່ແກລ່ກູ​ຄາ້​ລະດັບ​ພ້ືນຖານ​ສອງ​ຄນົ​ຕໍ​່ວນັ​ຫຼື •​ ລົດ​ເຂນັ​ໃໝ​່ແກລ່ກູ​ຄາ້​ລະດັບ​ປານ​ກາງ​ໜຶງ່​ຄນົ​ຕໍ​່ວນັ. ຕາຕະລາງ​ຂາ້​ງລຸມ່​ໃຫ​້ຕົວຢາ່ງ​ກຽ່ວກັບ​ຄວາມ​ສາມາດ​ໃຫ​້ບລໍກິານ​ຕາມ​ຄາ​ດຄະ​ເນ​​ໂດຍ​ອງີ​ໃສ່ທີ​ ມງານ​ທີ​່ມ​ີສອງ​ຄນົ​ເຮດັ​ວຽກ​ຮວ່ມ​ກນັ.​ສະມາຊກິ​ຄນົ​ໜຶງ່​ຂອງ​ທ​ີມ​ເຮດັ​ໜາ້​ທີ​່ດາ້ນ​ການ​ປິນ່ປວົ,​ອກີ​ ຄນົ​ໜຶງ່​ເຮດັ​ໜາ້​ທີ​່ດາ້ນ​ເຕກັນິກ,​​ແລະ​ທງັ​ສອງ​ໃຫກ້ານ​ຝກຶ​ອບົຮມົ​ແກ່ຜູ​້ໃຊ.້​ທ​ີມງານ​ເຮດັ​ວຽກ​5​ວນັ/ ອາທິດ​​ເປນັ​ເວລາ​42​ອາທິດ​ຕໍ​່ປ.ີ​ຖາ້​ມ​ີລົດ​ເຂນັ​​ແລະ​ວັດ​ສະດ​ຸພຽງພໍ,​ທ​ີມນີ​້ສາມາດ​ໃຫ:້ •​ ການ​ບລໍກິານ​ລົດ​ເຂນັ​ລະດັບພ້ືນຖານ​ແກ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັປະມານ​357​ຄນົ​ຕໍ​່ປ.ີ •​ ການ​ບລໍກິານ​ລົດ​ເຂນັ​ລະດັບປານ​ກາງ​ແກ​່ຜູ​້ໃຊ​້ລົດ​ເຂນັປະມານ​179​ຄນົ​ຕໍ​່ປ.ີ ການ ບໍລິການ ລະດັບພ້ືນຖານ ການ ບໍລິການ ລະດັບ ປານ ກາງ ການວາງ​ແຜນ​ອາທິດ​ເຮັດ​ວຽກ ​ຈໍານວນ​ວັນ​ເຮັດ​ວຽກ/ອາທິດ 5 5 ຈໍາ​ນວນ​ອາທິດ​ເຮັດ​ວຽກ/ປີ​(ລົບ​ວັນພັກ​​ແລະ​ການ​ລາ​ພັກ) 42 42 ການຄາດ​ຄະ​ເນ​ຄວາມ​ສາມາດ​ໃຫ້​ບໍລິການ ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ບໍລິການ/ວັນ 2 1 ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ບໍລິການ/ອາທິດ 10 5 ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ບໍລິການ/ປີ 420 210 ​ເຫດການ​ບັງ​ເອີນ​@​15%​(ສໍາລັບ​ເຫດການ​ທີ່​ບໍ່​ຄາດ​ຄິດ) -63 -32 ​ຄາດ​ຄະ​ເນ​ຈໍານວນ​ຜູ້​ໃຊ້/ປີ 357 179 38 39 ບົດບາດ ຂອງ ຜູ້ ຈັດການ ໃນ ການ ສ້າງ ຫືຼພັດທະນາ ທີ ມງານ ໃຫ້ ບໍລິການ ລົດ ເຂັນ. •​ ​ລະບຸ​ພະນັກງານ​ທີ່​ມີ​ຢູ່​ແລ້ວ​ຫຼືພະນັກງານ​ໃໝ່​​ເພ່ືອ​ດໍາ​ເນີນ​ບົດບາດ​ຕ່າງໆ​ໃນ​ການ​ບໍລິການ​ລົດ​ເຂັນ. •​ ຈັດ​ຕຽມ​ການ​ຝຶກ​ອົບຮົມ​ສໍາລັບ​ພະນັກງານ​ເຫຼົ່ານ້ັນ​ຜູ້​ທີ່​ບໍ່​ທັນ​ມີ​ທັກ​ສະ​ທີ່​ຈໍາ​ເປັນ​ເທື່ອ. •​ ກໍານົດ​ເວລາ​ທີ່​ພະນັກງານ​ມີ​ເພື່ອ​ໃຊ້​ໃນ​ການ​ໃຫ້​ບໍລິການລົດ​ເຂັນ,​​ໂດຍ​ຮັບປະກັນ​ວ່າ​ເວລາ​ຕ້ອງເປັນ​ ຈິງ​​ໂດຍ​ຄໍານຶງ​ເຖິງ​ບົດບາດ,​​ໜ້າ​ທີ່,​ຫຼືກິດຈະກໍາ​ອື່ນ​ທີ່​ພວກ​ເຂົາ​ເຮັດ. •​ ຄາດ​ຄະ​ເນ​ຄວາມ​ສາມາດ​ໃຫ້​ບໍລິການ​ປະ​ຈໍາປີ​– ​ແລະ​ສື່ສານ​ແຈ້ງ​ບອກ​ສ່ິງ​ນີ້​ຕໍ່​ກັບ​ທີ​ມງານ. •​ ສະໜັບສະໜູນ​ໃຫ້​ພະນັກງານ​ດໍາ​ເນີນ​ໜ້າ​ທີ່​ໃຫ້​ບໍລິການ​ລົດ​ເຂັນ​ຂອງ​ເຂົາ​ເຈົ້າ.​ຕົວຢ່າງ: o ​ໃຫ້​ພະນັກງານ​ເຂົ້າ​ຮ່ວມ​ໃນ​ການວາງ​ແຜນ​ສໍາລັບ​ການ​ໃຫ້​ບໍລິການ; o ສ້າງ​ເຄື່ອງມື​ວາງ​ແຜນ​ປະຈໍາ​ອາທິດ/ປະຈໍາ​ເດືອນ​– ​ໂດຍ​ສະ​ແດງ​ໃຫ້​ເຫັນ​ກາ​ນນັດ​ໝາຍ​​ແລະ​ ກິດຈະກໍາ​ອື່ນ; o ຈັດ​ກອງ​ປະຊຸມ​ປະຈໍາ​ອາທິດ​ເພື່ອ​ກວດ​ເບິ່ງ​ຄວາມ​ຄືບ​ໜ້າ,​​ເນັ້ນ​ໜັກ​ຄວາມ​ສໍາ​ເລັດ​​ແລະ​ແກ້​ໄຂ​ສິ່ງ​ ທ້າ​ທາຍ. B.5: ການ ບໍລິການ ລົດ ເຂັນ ມີຄ່າ ໃຊ້ ຈ່າຍ ແນວ ໃດ? ການ​ກາໍນົດ​ຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ການ​ໃຫ້ບລໍກິານ​ລົດ​ເຂນັ​ແມນ່​ໜາ້​ທີ​່ສາໍຄນັ​ສາໍລັບ​ຜູ​້ຈດັການ.​ ຕາຕະລາງ​ຕໍ​່ໄປ​ນີ​້ສະ​ແດງ​ບາງ​ແຖວ​ງບົປະມານ​ທົວ່​ໄປ​ທີ​່ກຽ່ວຂອ້ງ​ກັບ​ການ​ຕັງ້​​ແລະ​ການ​ດາໍ​ເນນີ​ ການ​ບລໍກິານລົດ​ເຂນັ.​ຄາ່​ໃຊ​້ຈາ່ຍ​ຕວົ​ຈງິ​ຈະ​ແຕກ​ຕາ່ງ​ກນັ​​ໂດຍ​ຂຶນ້​ກັບ​ສະພາບ​ການ​ຕວົ​ຈງິ. 40 41 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ລາຍການ ງົບປະມານ ຄໍາ ເຫັນ ​ຄາ່​ໃຊ​້ຈາ່ຍ​ໃນການ​ເລີ​່ມຕົນ້ ການ​ອອກ​ແບບ​ຜະລດິ​ຕະພັນ ການ​ຊອກ​ຫາແຫຼງ່ຜະລດິ​ຕະພັນ ​ເຄືອ່ງມື ອປຸະກອນ ອາຄານ/ສິງ່​ອາໍນວຍ​ຄວາມ​ສະດວກ​ ​ອາດ​ຈະ​ລວມມ​ີການ​ກໍສ່າ້ງ/ການ​ປບັປງຸ​ໃໝ/່ການ​ຕບົ​ແຕງ່​ໃໝ່ ​ຄງັ​ວດັ​ສະດຸ ຄາ່​ໃຊ​້ຈາ່ຍ​ໃນ​ການ​ດາໍ​ເນນີ​ງານ ລດົເຂນັ ຄງັ​ລດົ​ເຂນັ​– ອງີ​ໃສ​່ຄວາມ​ສາມາດ​ໃຫ​້ບລໍກິານ​ທີ​່ຄາດ​ຄະ​ເນ​ໄວ​້​ແລະ​ ຄວາມຕອ້ງການ​ທີ​່ຄາດ​ໄວ​້ລວ່ງ​ໜາ້ຂອງ​ລກູ​ຄາ້​ຜູ​້ໃຊ​້ລດົ​ເຂນັ. ​ອາ​ໄຫຼ່ ການ​ມ​ີຄງັ​ອາ​ໄ​ຫຼທ່ີ​່ຈາໍ​ເປນັ​ທົວ່​ໄປ​​ແມນ່​ເປນັ​ປະ​ໂຫຍ​ດຫາຼຍ.​ ​ວດັ​ສະດຸ ​ໃນ​ລະດບັ​ພ້ືນຖານ,​ຈາໍ​ເປນັ​ຕອ້ງ​ມບີາງ​ວດັ​ສະດສຸາໍລບັ​ການ​ດດັ​ແປງ.​​ໃນ​ລະດບັ​ ປານ​ກາງ,​ຈາໍ​ເປນັ​ຕອ້ງ​ມ​ີວດັ​ສ​ະດຫຸາຼຍກວາ່. ການ​ຂນົ​ສ່ົງ​(ການ​ຂນົ​ສ່ົງ​ຜະລດິ​ຕະພັນ) ການ​ແລນ່​ເອກະສານ​​ແລະ​ພາສ​ີສໍາລບັ​ລດົ​ເຂນັ​ທີ​່ນາໍ​ເຂົາ້.​ການ​ຂນົ​ສ່ົງ​ລດົ​ເຂນັ​ໄປ​ ຫາ​ສນູ​ແຈກ​ຢາຍ. ບກຸຄະລາ​ກອນ ​ການ​ຄຸມ້​ຄອງ​ ຈາໍ​ນວນ​ພະນກັງານ​ທີ​່ເປນັ​ໄປ​ໄດ​້ແມນ່​ມ​ີລາຍ​ຊື​່ໃນ​ຄູ​່ມ​ືແນະນາໍ​ງົບປະມານ.​ບໍ່​ ຄາດວາ່​ແຕ​່ລະກາ​ນບລໍກິານ​ຈະ​ມ​ີພະນກັງານ​ທກຸ​ຄນົ​ເຫຼົາ່ນີ.້ ​ເຄືອ່ງໝາຍ​ຕກິ​(​ເບິງ່​ແຜນ່​ຕາຕະລາງ​ວຽກ)​ສະ​ແດງ​ເຖງິ​ບນັດາ​ກດິຈະກາໍ​ທີ່​ ກຽ່ວຂອ້ງ​ກບັ​ຂັນ້​ຕອນ​ການ​ບລໍກິານ​.​ພະນກັງານ​ຄນົ​ໜຶງ່​ອາດ​ຈະ​ຮບັຜດິ​ຊອບ​ດາໍ​ເນີ​ ນຫາຼຍກວາ່​ໜຶງ່​ກດິຈະກາໍ.​ ພະນກັງານ​ຝາ່ຍ​ປິນ່ປວົ ​ພະນກັງານ​ຝາ່ຍ​ເຕກັນກິ ຄ​ູຝກຶ/ຜູ​້ຊວ່ຍ​ຄ​ູຝກຶ ​ຜູ​້ບລໍຫິານ ​ການ​ຂນົ​ສ່ົງ​ໃນ​ທອ້ງ​ຖິນ່ ​ການ​ຂນົ​ສ່ົງ​ໃນ​ທອ້ງ​ຖິນ່​ສາໍລບັ​ ພະນກັງານ ​ຕວົຢາ່ງ,​ການ​ຕດິຕາມ​ຜນົ,​ການ​ອອກ​ໄປ​ໃຫບ້ລໍກິານ​ຢູ​່ໃນ​ຊມຸ​ຊນົ,​ການ​ຝກຶ​ອບົຮມົ​ ເຄອື​ຂາ່ຍ​ການ​ນາໍ​ສົງ່.​ ​ການ​ຂນົ​ສ່ົງ​ໃນ​ທອ້ງ​ຖິນ່​ສາໍລບັ​ລກູ​ຄາ້ ​ການ​ເດນີທາງ​ໄປ​ຫາ​ການ​ບລໍກິານ​ສາໍລບັ​ການ​ນດັ​ໝາຍ​ຕາ່ງໆ.​ ບອ່ນ​ພັກ​ເຊາົ​ສໍາລບັ​ລກູ​ຄາ້ ​ຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ການ​ໃຫ​້ບອ່ນ​ພັກ​ເຊາົ​ແກ​່ລກູ​ຄາ້​ຜູ​້ທີ​່ຕອ້ງການ​ພກັ​ຄາ້ງ​ຄນື​(ຖາ້​ນີ​້ໄດ້​ ຮບັ​ການ​ສະໜບັສະໜນູ/ຈາ່ຍ​ໃຫ​້ໂດຍ​ການ​ບລໍກິານ).​ ວດັ​ສະດ​ຸທີ​່ພມິ​ອອກ ​ແບບ​ຟອມ,​ລາຍການ​ກວດ​​ແລະ​ຂໍ​້ມນູ​ຜູ​້ໃຊ.້ ວດັ​ສ​ະ​ດສຸິນ້​ເປອືງ ຕວົຢາ່ງ,​ກາວ,​ດາ້ຍ,​​ແລະ​ສ.ີ ການ​ປຽ່ນ​ຖາ່ຍ​ເຄືອ່ງມື ​ເຄືອ່ງມ​ືຫຼຸຍ້ຫຽ້ນ​– ສະ​ນັນ້​ຈິ​່ງຕອ້ງ​ມ​ີງບົປະ​ມານສາໍລບັ​ການ​ປຽ່ນ​ໃໝ.່ ຄາ່​ໃຊ​້ຈາ່ຍ​ປະຈາໍ ພຈິາລະນາ​ຄາ່​ໄຟຟາ້,​ຄາ່​ນໍາ້,​ຄາ່​ເຊົາ່​– ສາໍລບັ​ຂງົ​ເຂດ​ການ​ບລໍກິານ​ຕາ່ງໆ​(ການ​ ປິນ່ປວົ,​​ເຕກັນກິ,​ການ​ເກບັມຽ້ນ,​ການ​ຝຶກ​ອບົຮມົ​ຜູ້​ໃຊ​້​ແລະ​ຫອ້ງການ).​ ​ການ​ຝກຶ​ອບົຮມົ​ພະນກັງານ​ ພຈິາລະນາ​ຄາ່​ໃຊ​້ຈາ່ຍຂອງ​ການ​ຝກຶ​ອບົຮມົ​ຕາ່ງໆ​ສາໍລບັ​ພະນກັງານ​ການ​ບລໍກິານ ​ການ​ຝກຶ​ອບົຮມົ​ຄູ​່ຮວ່ມ​ງານ/​ເຄອື​ຂາ່ຍ​ການ​ ນາໍ​ສົງ່ ​ພິຈາລະນາ​ກດິຈະກາໍ​ການ​ຝຶກ​ອບົຮມົ/ການ​ສາ້ງ​ຄວາມ​ຮູ​້ສາໍລບັ​ຄູ​່ຮວ່ມ​ງານ​ ຫຼອືງົການ​ເຄອື​ຂາ່ຍ​ການນາໍ​ສົງ່. ການ​ລະດມົ​ທນຶ ​ຄວນ​ມ​ີງບົປະມານ​ສາໍລບັຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ກດິຈະກາໍ​ລະດມົ​ທນຶ​ເຊັນ່​ກນັ. ກາ​ນຕິດຕາມ​​ແລະ​ການ​ປະ​ເມນີຜນົ ​ຄາ່​ໃຊ​້ຈາ່ຍ​ທີ​່ກຽ່ວຂອ້ງ​ກບັ​ການ​ຕດິຕາມ​​ແລະ​ການ​ປະ​ເມນີ​ຜນົ​– ຕວົຢາ່ງ,​ການ​ໄປ​ ຢຽ້ມຢາມຜູ​້ໃຊ​້ການ​ບລໍກິານ​ເພ່ືອ​ເ​ກບັ​ກາໍ​ເອາົ​ຄາໍ​ຕ​ິຊມົ.​ຄາ່​ໃຊ​້ຈາ່ຍ​ອາດ​ ຈະລວມມຄີາ່​ເດນີທາງ​ຫຼພືະນກັງານ​ເພ່ີມ​ເຕມີ.​ 40 41 ວິທີ ແກ້ ໄຂ ທ່ີ ຄຸ້ມ ຄ່າ ​ຜູ​້ຈດັການ​ທີ​່ເຮດັ​ວຽກ​ໃນ​ສະຖານທີ​່ທີ​່ມ​ີຊບັພະຍາກອນ​ຈາໍກັດ​ຈາໍ​ເປນັ​ຕອ້ງ​ຊອກ​ຫາ​ວທິ​ີຫຼຸດຜ່ອນ​ຄາ່ ​ໃ​ຊຈ້າ່ຍ.​ບາງ​ວທິ​ີທີ​່ສາມາດ​ຫຼຸດຜ່ອນ​ຄາ່​ໃຊ​້ຈາ່ຍ​ໄດ​້ແມນ່: ການ ບໍລິການ ແບບ ຮ່ວມ ກັນ •​ ​ການ​ບໍລິການ​ແບບ​ຮ່ວມ​ກັນ​​ເຊິ່ງ​ໃຊ້​ສິ່ງ​ອໍານວຍ​ຄວາມ​ສະດວກ​ຮ່ວມ​ກັນ​ຢ່າງ​ມີ​ປະສິດທິ​ຜົນ​ສາມາດ​ໃຫ້​ ໂອກາດ​ໃນ​ການ​ຮ່ວມ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຢ່າງ​ຫຼວງຫຼາຍ​​ເມື່ອ​ທຽບ​ກັບການ​ສ້າງ​ການ​ບໍລິການ​ແບບ​ສະ​ເພາະ​ຕ່າງ​ ຫາກ. ການ ຮ່ວມ ຄ່າ ໃຊ້ ຈ່າຍ ກັບ ອົງການ ຈັດ ຕ້ັງ ອ່ືນ ກາ​ນບລໍກິານ​ອາດ​ຈະ​ຮວ່ມ​ງານ​ກັບ​ອງົການ​ຈດັ​ຕັງ້​ອືນ່​ເພ່ືອ​ແບງ່ປນັ​ຄາ່​ໃຊ​້ຈາ່ຍ​ຮວ່ມ​ກນັ.​ຕວົຢາ່ງ: •​ ບາງ​ຜູ້​ໃຫ້​ທຶນ​ສາກົນ/ອົງການ​ຈັດ​ຕັ້ງ​ດ້ານ​ກາ​ນພັດທະນາ​ອາດ​ຈະ​ສົນ​ໃຈ​ແບ່ງປັນ​ຄ່າ​ໃຊ້​ຈ່າຍຂອງ​ລົດ​ ເຂັນ.​ຜົນ​ປະ​ໂຫຍ​ດສໍາລັບສູ​ນ​ບໍລິການມີ​ຢູ່​ວ່າ​ຜະລິດ​ຕະພັນຈະ​ຖືກກ​ວ່າ.​ຜົນ​ປະ​ໂຫຍ​ດສໍາລັບ​ອົງການ​ ຈັດ​ຕັ້ງ​ສາກົນມີ​ຢູ່​ວ່າ​​ເງິນ​ທຶນ​ຂອງ​ເຂົາ​ເຈົ້າ​ໄປ​ໄກ​ກວ່າ,​​ແລະ​ພວກ​ເຂົາ​ເ​ຫັນ​ວ່າສູນ​ບໍລິການກໍາລັງ​ສະ​ ແດງ​ຄວາມ​ສາມາດ​ໃນ​ການ​ເຮັດ​ວຽກ​ເພື່ອ​ບັນລຸ​ໄດ້​ຄວາມ​ຍືນ​ຍົງ​ດ້ານ​ການ​ເງິນ. •​ ອົງການ​ຈັດ​ຕັ້ງ​ຊຸມ​ຊົນ​ໃນ​ທ້ອງ​ຖິ່ນ​ອາດ​ຈະ​ເຕັມ​ໃຈ​ເປັນ​ຄູ່​ຮ່ວມ​ງານ​ກັບ​ການ​ບໍລິການ​ເພ່ືອ​ ສະໜອງການບໍລິການ​ໃນ​ທ້ອງ​ຖິ່ນ​ຫຼາຍຂຶ້ນ.​​ຄູ່​ຮ່ວມ​ງານ​ຂັ້ນ​ຊຸມ​ຊົນ​ອາດ​ຈະ​ສາມາດ​ສະໜອງ​ສ່ິງ​ ອໍານວຍ​ຄວາມ​ສະດວກ​​ແລະ​ພະນັກງານ​ຈໍາ​ນວນ​ໜຶ່ງ​ເພ່ືອ​ດໍາ​ເນີນ​ບາງ​ຂັ້ນ​ຕອນ​ການ​ໃຫ້ການ​ບໍລິການ​ ລົດ​ເຂັນ​(ຕົວຢ່າງ,​ການ​ຕິດຕາມ​ຜົນ​​ແລະ​ການ​ຝຶກ​ອົບຮົມຜູ້​ໃຊ້).​ຜົນ​ປະ​ໂຫຍ​ດ​ສໍາລັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ມີ​ຢູ່​ ວ່າ​ຈະ​ມີ​ການ​ເດີນທາງ​​ແລະ​ຄ່າ​ໃຊ້​ຈ່າຍ​ໜ້ອຍ​ລົງ.​ຜົນ​ປະ​ໂຫຍ​ດ​ສໍາລັບ​ສູນ​ບໍລິການ​ມີ​ຢູ່​ວ່າ​ການ​ ບໍລິການ​ສາມາດ​ຂະຫຍາຍ​ໄປ​ສູ່​ຊຸມ​ຊົນ​ໄດ້. ແຫ່ຼງການ ໃຫ້ ທຶນ ທ່ີ ເປັນ ໄປ ໄດ້ ​ຂໍ​້ມນູ​ເພ່ີມ​ເຕີມ​ກຽ່ວກັບ​ວທິ​ີຊອກ​ຫາ​ແຫຼງ່ທນຶ​ສາໍລັບ​ການ​ສາ້ງ​ຕັງ້ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ແລະ​ຄາ່​ໃຊ້​ ຈາ່ຍ​ປະຈາໍ​ແມນ່​ມ​ີຢູ​່ໃນ​ຂໍ​້C.4:​ການວາງ​ແຜນສາໍລັບ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ. 42 43 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ C: ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ C.1: ທ່ານ ຮູ້ ໄດ້ ແນວ ໃດ ວ່າການ ບໍລິການ ຂອງ ທ່ານ ກໍາລັງ ໄດ້ຜົນ ດີ? ການ​ຕິດຕາມ​​ແລະ​ການ​ປະ​ເມນີ​ຜນົ​(M&E)​ຊວ່ຍ​ໃຫ​້ຜູ​້ຈດັການ​ເຫນັ​ສ່ິງ​ກາໍລງັ​ເກີດ​ຂຶນ້​(ຫຼືບໍ​່ເກີດ​ ຂຶນ້)​ອນັ​ເປນັ​ຜນົ​ມາ​ຈາກ​ກິດຈະກາໍ​ຂອງ​ທມີງານ​ຂອງ​ເຂາົ​ເຈົາ້.​ນອກ​ນັນ້​ມນັ​ຍ​ັງຊວ່ຍ​ໃຫ​້ຜູ​້ຈດັການ​​ ແລະ​ທ​ີມງານ​ຂອງ​ເຂາົ​ເຈົາ້​ຮຽນ​ຮູ​້ສ່ິງ​ທີ​່ໄດ້ຜົນ​​ແລະ​ບໍ​່ໄດ້ຜນົ,​​ແລະ​ເ​ຂົາ້​ໃຈ​ສ່ິງ​ທີ​່ຜູ​້ໃຊ​້ການ​ບລໍກິານ​ ຂອງ​ເຂາົ​ເຈົາ້​​ແລະ​ພາກສວ່ນ​ກຽ່ວຂອ້ງ​ຄິດ. ການ ຕິດຕາມ ແລະ ການ ປະ ເມີນ ຜົນ ແມ່ນ ຫຍັງ? ການ ຕິດຕາມ ການ ປະ ເມີນ ຜົນ ມັນ ຖືກ ເຮັດ ເວລາ ໃດ? •​ ຢ່າງ​ຕໍ່​ເນື່ອງ •​ ​ເຊື່ອມ​ສານ​ເຂົ້າ​ໃນ​ບັນດາ​ກິດຈະກໍາ​ ການບໍລິການ​ປະ​ຈໍາ​ວັນ •​ ​ໃນ​ໄລຍະ​ສໍາຄັນ​ຂອງ​ການ​ ບໍລິການ​– ຕົວຢ່າງ​​ໃນ​ລະຫວ່າງ​ ການ​ທົບ​ທວນຄືນ​ປະຈໍາ​ປີ​(​ແນວ​ ໃດ​ກໍ່ຕາມ​​ບາງ​ຂໍ້​ມູນ​ອາດ​ຈະ​ຖືກ​ ເກັບ​ເອົາ​ຢ່າງ​ຕໍ່​ເນື່ອງ) ມີ ການ ວັດ ແທກ ຫຍັງ? •​ ກິດຈະ​ກໍາ​ການ​ບໍລິກາ​ນ •​ ລົດ​ເຂັນ​​ແລະການ​ສະໜັບສະໜູນ​ເພ່ີມ​ ເຕີ​ມທີ່​ໃຊ້ •​ ຈໍານວນ​​ແລະ​ປະຊາກອນ​ຂອງ​ຄົ​ນທີ່​ໄດ້​ ຮັບ​ຜົນ​ປະ​ໂຫຍ​ດ •​ ຜົນ​ກະທົບ​ຕໍ່​ກັບ​ບຸກຄົນ​​ແລະ​ ຊຸມຊົນ •​ ​ຄວາມ​ຍືນ​ຍົງ ມີ ການ ໃຊ້ ແຫ່ຼງຂ້ໍ ມູນ ໃດ ແດ່? •​ ຖານ​ຂໍ້​ມູນ​ຜູ້​ໃຊ້​ການ​ບໍລິການ •​ ​ບັນທຶກ​ການ​ບໍລິການ •​ ​ຂໍ້​ມູນ​ການ​ບໍລິການ •​ ​ຄໍາ​ເຫັນ​ຕິ​ຊົມ​ຂອງ​ຜູ້​ໃຊ້ •​ ​ລາຍ​ງານ​ການ​ເງິນ •​ ​ການ​ວິ​ເຄາະ​ເວລາ​ຂອງ​ພະນັກງານ •​ ​ການ​ສໍາ​ຫຼວດ •​ ​ແບບ​ສອບ​ຖາມ •​ ​ການ​ສົນທະນາ​ກຸ່ມ •​ ​ການ​ຢ້ຽມຢາມ​ເຮືອນ •​ ຂໍ້​ສັງ​ເກດ​ຂອງ​ການ​ບໍລິການ​ໃນ​ ການ​ປະຕິບັດ​ຕົວ​ຈິງ •​ ​ການ​ທົບ​ທວນ​ເບິ່ງບັນຊີ 42 43 ການ ບໍລິການ ທ່ີ ມີ ປະສິດ ພາບ ແລະ ປະສິດທິ ຜົນ ການຕິດຕາມ ແລະ ປະເມີນຜົນ ມີ ປະ ໂຫຍ ດ ແນວ ໃດ ສໍາລັບ ຜູ້ ຈັດການ ແລະ ຄົນ ອ່ືນ ທ່ີ ກ່ຽວຂ້ອງ ໃນ ການ ບໍ ລິ ການ? •​ ​ໃຫ້​ຂໍ້​ມູນ​ສໍາຄັນ​ເພື່ອ​ປັ​ບປຸງ​ຄຸນ​ນະພາ​ບຂອງ​ການ​ໃຫ້​ບໍລິການ. •​ ​ໃຫ້​ຂໍ້​ມູນ​ເພື່ອ​ເປັນ​ແນວທາງ​ຊີ້​ນໍາ​ການຈັດ​ຊື້​ຜະລິດຕະພັນ. •​ ຊ່ວຍ​ຄວບ​ຄຸມ​ຄ່າ​ໃຊ້​ຈ່າຍ​​ໂດຍ​ການ​ເພ່ີມ​ປະສິດທິພາບ​​ແລະ​ໃຫ້​ເຫດຜົນ​ສໍາລັບ​ການ​ໃຫ້​ທຶນ​ໃນ​ປະຈຸ​ບັນ​​ ແລະ​ທີ່​ສະ​ເໜີ​ມາ. •​ ​ເຮັດ​ໃຫ້ການ​ບໍລິການ​ສາມາດ​ສະ​ແດງ​ດ້ວຍ​ຫຼັກຖານ​ໃຫ້​ຜູ້​ໃຫ້​ທຶນ​ເຫັນປະສິດທິພາບ​ຂອງ​ການ​ບໍລິ​ການ​ – ລວມທັງ​ລັດຖະບານ​​ແລະ​ຜູ້​ໃຫ້​ທຶນ​NGO. •​ ຊ່ວຍ​ກໍານົດ​​ແລະບອກ​ຈໍານວນຄວາມ​ຕ້ອງການ​ທີ່​ຍັງ​ບໍ່​ທັນ​ຕອບ​ສະໜອງ​ໄດ້. •​ ​ໃຫ້​ຂໍ້​ມູນ​ແຈ້ງ​ບອກ​ການຈັດ​ສັນ​ຊັບພະຍາກອ​ນຢ່າງ​ເໝາະ​ສົມ. •​ ​ເພ່ີມ​ຄວາມ​ຮັບ​ຮູ້​ກ່ຽ​ວກັບ​ຜົນ​ປະ​ໂຫຍ​ດຂອງ​ການ​ບໍລິການ. •​ ສ້າງ​ການ​ຮ່ວມ​ງານ​ທີ່​ເຂັ້ມ​ແຂງ​ກວ່າ​ກັບ​ຜູ້​ໄດ້​ຮັບ​ການ​ບໍລິການ. ​ໃນ​ເວລາ​ວາງ​ແຜນ​ວທິ​ີຕິດຕາມ​​ແລະ​ປະ​ເມນີ​ຜນົ​ການ​ບລໍກິານ​ໃດ​ໜຶງ່​ມນັ​ເປນັ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ ສາ້ງ​ໂຄງ​ຮາ່ງ​ສາມ​ຂັນ້​ຕອນ.​ສາມາດ​ເບິງ່​ລາ​ຍລະອຽດ​ເພ່ີມ​ເຕມີ​ໄດ​້ໃນ​ຕາຕະລາງ​3.5​ຂອງ​ ຂໍ​້ແນະນາໍກຽ່ວ​ກັບ​ລົດ​ເຂນັ. 1. ການວາງ ແຜນ ຂົງ ເຂດ ທ່ີ ຈະ ຖືກ ຕິດຕາມ 2. ການ ກໍານົດ ຄາດໝາຍ ການ ປະຕິບັດ ງານ 3. ການ ກໍານົດ ວິທີ ເກັບ ເອົາ ຂ້ໍ ມູນ ​ໃນ​ເວລາ​ວ​ິເຄາະ​ຂໍ​້ມນູທີ​່ເກັບ​ກາໍ​ໄດ​້ມ​ີສອງ​ຂໍ​້ພິຈາລະນາ​ທີ​່ສາໍຄນັ​ດັງ່​ນີ:້ •​ ​ເມື່ອ​ກິດຈະກໍາ​ໃດ​ໜຶ່ງ​ບໍ່​ໄດ້ຜົນ​ດີ,​​ໃຫ້​ເຮັດ​ວຽກ​ຮ່ວມ​ກັບ​ຜູ້​ໃຊ້​ການ​ ບໍລິການ,​ພະນັກງານ​ການ​ບໍລິການ​​ແລະ​ພາກສ່ວນ​ກ່ຽວຂ້ອງ​ ອື່ນ​​ເພ່ືອ​ຊອກ​ຫາ​ສາ​ເຫດ​ຮາກ​ເ​ຫງົ້າຂອງ​ບັນຫາ; 44 45 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ •​ ​ເມື່ອ​ກິດຈະກໍາ​ດໍາ​ເນີນ​ໄປ​ໄດ້​ດີ​​ແລະ​ບັນລຸ​ໄດ້​ຄາດໝາຍ​ຕ່າງໆ,​​ ໃຫ້​ຊອກ​ວິທີ​ແບ່ງປັນ​​ແລະ​ສະຫຼອງຄວາມ​ສໍາ​ເລັດ.​ນີ້ຈະ​ເປັນ​ ການ​ກ​ະຕຸ້ນ​ສົ່ງ​ເສີມ​ທີ​ມງານ​ການ​ບໍລິການ​​ແລະ​ພາກສ່ວນ​ ກ່ຽວຂ້ອງ​ອື່ນ. ຄວາມ ສໍາຄັນ ຂອງ ຄໍາ ເຫັນ ຕິ ຊົມ ຂອງ ຜູ້ ໃຊ້ ການ​ປະ​ເມນີ​ຜນົ​ອະນຸຍາດ​ໃຫກ້ານ​ບລໍກິານ​ເບິງ່​ຄນື​ສິງ່​ທີ​່ກາໍລງັ​ໄດ​້ຜນົ​ດ​ີ​ແລະ​ສິງ່ທີ​່ຈາໍ​ເປນັ​ຕອ້ງ​ ປຽ່ນ​ແປງ.​ນອກ​ນັນ້​ມນັ​ຍງັ​ອະນຸຍາດ​ໃຫກ້ານ​ບລໍກິານ​ເບິງ່​ຄນື​ວາ່​ມນັ​ກາໍລງັ​ບນັລ​ຸໄດຈ້ດຸປະສງົ​ໂດຍ​ ລວມຂອງ​ຕນົ​ຫຼືບໍ.່ ຈດຸປະສົງ​ຂອງ​ການ​ປະ​ເມ​ີນຜນົ,​ຕາມ​ທີ​່ລະບ​ຸໄວ​້ໃນ​ຂໍ​້ແນະນາໍ​ກຽ່ວ​ກັບລົດ​ເຂນັ​​ແມນ່​ເພ່ືອ: •​ ​ສົງ່​ເສມີ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ຂອງ​ບກຸຄນົ​ໂດ​ຍມ​ີການ​ເພ່ິງ​ຕນົ​ເອງ​ໃຫ້ຫາຼຍທີ​່ສຸດ​ເທົາ່ທີ​່ຈະ​ເປນັ ​ໄ​ປ​ໄດ;້ •​ ​ພີມ່​ທະວ​ີຄນຸ​ນະພາ​ບຊວີິດ​ຜາ່ນ​ການ​ເຂົາ້​ເຖງິ​ລົດ​ເຂນັ​ທີ​່ປ​ັບປງຸ​ດ​ີຂຶນ້; •​ ​ເພື່ອ​ເພີ​່ມການ​ເຂົາ້​ຮວ່ມ​​ແລະ​ການ​ມ​ີສວ່ນ​ຮວ່ມ. ມ​ີເກນ​ເງືອ່ນ​ໄຂ​ຫາຼຍຢາ່ງ​ທີ​່ສາມາດ​ຖກື​ໃຊ​້ເພື່ອ​ປະ​ເມນີ​ຜົນ​ການ​ບລໍກິານ.​ສິງ່​ເຫຼົາ່ນີ​້ລວມມ:ີ •​ ຜູ​້ໃຊ​້ທີ​່ໄດ​້ຮບັ​ບລໍກິານ​​ແລະ​ການ​ຊວ່ຍ​ເຫຼືອທີ​່ພວກ​ເຂາົ​ໄດຮ້ບັ; •​ ຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ການ​ບລໍກິານ​ລວມທງັ​ຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ຜະລິດ​ຕະພັນ​​ແລະ​ການ​ໃຫ​້ບລໍກິານ; •​ ​ການປະກອບ​ພະນັກງານ​(ຈາໍນວນ​ພະນັກງານ,​ບົດບາດ​ໜາ້​ທີ​່​ແລະ​​ຄວາມ​ສາມາດ​ຂອງ​ເຂາົ​ ເຈົາ້); •​ ສີ​່ງອາໍນວຍ​ຄວາມ​ສະດວກ​​ແລະ​ອປຸະກອນ​ທີ​່ມ​ີໃຫ​້ແກ​່ການ​ບລໍກິານ; •​ ຄນຸ​ນະພາ​ບຂອງ​ການ​ໃຫ​້ບລໍກິານ​(ຄາໍ​ແນະນາໍ​ກຽ່ວ​ກັບ​ວທິ​ີປະຕບິັດ​ທີ​່ດ​ີແມນ່​ມ​ີຢູ​່ໃນ​ຂໍ​້ແນະນາໍ​ ກຽ່ວ​ກັບ​ລົດ​ເຂນັ​​ໃນ​ຂໍ​້3.3); •​ ​ຜນົ​ກະທົບ​ທີ​່ການ​ບລໍກິານ​ມ​ີຕໍ​່ກັບ​ຜູ​້ໃຊ​້​ແລະ​​ຄອບຄວົ​ຂອງ​ເຂາົ​ເຈົາ້. 44 45 ມນັ​ສາໍຄນັ​ຫາຼຍ​ໃນ​ການ​ໃຫ້ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ເຂົາ້​ຮວ່ມ​ໃນ​ການ​ປະ​ ເມນີ​ຜົນ​ຂອງ​ການ​ບໍລິ​ການ​ລົດ​ເຂນັ.​​ໃນ​ເວລາ​ວາງ​ແຜນ​ເກັບ​ ເອາົຄາໍ​ເຫນັ​ຕິ​ຊມົ​ຂອງ​ຜູ້​ໃຊ,້​ນີ້​ແມນ່​ບາງ​ຂໍ້​ພິຈາລະນາ​ທີ່​ ສາໍຄນັ: •​ ​ການ​ຂນົ​ສ່ົງ​​ແລະ​​ເວລາ​ແມນ່​ສອງ​ຄາ່​ໃຊ​້ຈາ່ຍ​ທີ​່ສາໍຄນັ​ທີ່​ ສຸດ.​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທີ​່ໃຫ​້ຄາໍ​ເຫນັ​ຕ​ິຊມົ​ອາດ​ຈະ​ຕ້ອງການ​ ການ​ສະໜັບສະໜນູ​ເພ່ືອ​ຈາ່ຍ​ຄາ່​ເດນີທາງ​ຫຼືຄາ່​ເສຍ​ ເວລາ​ທີ​່ກຽ່ວຂອ້ງ. •​ ສາມາດ​ເກັບ​ເອາົຄາໍ​ເ​ຫນັຕ​ິຊມົຢາ່ງ​ເປນັ​ປກົກະຕ​ິຈາກ​ຜູ​້ໃຊ້​ ການ​ບລໍກິານ​ແຕລ່ະຄນົ,​ຫຼ​ືໂດຍ​ການ​ສຸມ່​ເລືອກ​ໃນ​ແຕລ່ະ​ ເດືອນ​ຫຼືປ.ີ •​ ການ​ບລໍກິານ​ຈະ​ໄດ້ປະ​ໂຫຍ​ດ​ພຽງ​ແຕ​່ຖາ້​ຜູ​້ໃຊ​້ການ​ ບລໍກິານ​ຮູສ້ຶກ​ເປນັ​ອິດສະຫຼະ​ທີ​່ຈະ​ເປີດ​ກວາ້ງ​​ແລະ​ຈງິ​ໃຈ​ ໃຫ​້ຄາໍ​ເຫນັ​ຕ​ິຊມົ​ຂອງ​ເຂາົ​ເຈົາ້.​ມນັ​ສາມາດ​ເປນັ​ປະ​ໂຫຍ​ດ​ ໃນ​ການ​ມ​ີບກຸຄນົ​ໃດ​ໜຶງ່​ທີ​່ບໍ​່ແມນ່​ສວ່ນ​ໜຶງ່​ໂດຍ​ກງົ​ຂອງ​ ການ​ບລໍກິານ​ເປນັ​ຜູ​້ດາໍ​ເນ​ີນການ​ສາໍພາດ. ຕົວຢ່າງ ຂອງ ຜົນ ປະ ໂຫຍ ດຂອງ ການ ປະ ເມີນ ຜົນ ການ ບໍລິການ ຈາກປະ ເທດ ເອທີ ໂອ ເປຍ: ພະນັກງານ​ພາກ​ສະໜາມ​ສອງ​ຄົນ​ສໍາພາດ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​140​ຄົນ​ຈາກ​ສູນ​ບໍລິການ​ເຈັດ​ແຫ່ງ​ໃນ​ທົ່ວ​ປະ​ ເທດ.​ພະນັກງານ​ທັງ​ສອງ​ລ້ວນ​ແຕ່​ມີ​ຄວາມ​ພິການ​ດ້ານ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​​ແລະ​ມີ​ການ​ພົບ​ວ່າ​ ເປັນ​ປະ​ໂຫຍ​ດທີ່​ສຸດ​ສໍາລັບ​ໜ້າ​ທີ່​ຂອງ​ເຂົາ​ເຈົ້າ. ພະນັກງານ​ພາກ​ສະໜາມ​​ໄດ້​ຮັບ​ການ​ໃຫ້​ຂໍ້​ມູນ​ເປັນ​ຢ່າງ​ດີ​ກ່ຽວ​ກັບ​ບັນຫາ​ທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໃນ​ປະ​ເທດ​ ຂອງ​ເຂົາ​ເຈົ້າ​ພະ​ເຊີນ.​ຂະ​ບວນການ​ດັ່ງກ່າວ​ໄດ້​ເຮັດ​ໃຫ້​ພວກ​ເຂົາ​ເປັນ​ຜູ້​ສະໜັບ​ສະ​ໜູນສົ່ງ​ເສີມຄວາມ​ ຕ້ອງການ​​ແລະ​ສິດທິ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ.​ຜູ້​ໃຊ້​ການ​ບໍລິການ​​ໄດ້​ຮັບ​ຜົນ​ປະ​ໂຫຍ​ດດ້ານ​ອາລົມ​ຄວາມ​ ຮູ້ສຶກ​​ແລະ​ຈິດ​ໃຈ​ຈາກ​ການ​ຖືກ​ສໍາພາດ​ໂດຍ​ຜູ້​ທີ່​ເປັນ​ແບບຢ່າງ​ທີ່​ດີ. ຫຼັງຈາກ​ການ​ສໍາພາດ​ປະ​ເມີນ​ຜົນ,​​ເຄືອ​ຂ່າຍ​ບໍ່​ເປັນ​ທາງ​ການ​ໄດ້​ເກີດ​ຂຶ້ນ​​ເຊິ່ງນໍາ​ໄປ​ສູ່​ຄວາມ​ສໍາພັນ​ທີ່​ ເຂັ້ມ​ແຂງ​ກວ່າ​ລະຫວ່າງ​ຜູ້​ໃຫ້​ບໍລິການ​​ແລະ​ຜູ້​ໃຊ້.​ນອກ​ນັ້ນ,​ຜ່ານ​ການ​ປະ​ເມີນ​ຜົນ,​ບາງ​ຕົວຢ່າງ​ໄດ້​ ຖືກ​ລະບຸບ່ອນ​ທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນບໍ່​ໄດ້​ຮັບ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ​ສໍາລັບ​ຄວາມ​ຕ້ອງການ​ຂອງ​ເຂົາ​ເຈົ້າ.​ນີ້​ນໍາ​ ທາງ​ກັບ​ຄືນ​ໄປ​ຫາ​ຄວາມ​ຕ້ອງການ​ດ້ານ​ການ​ຝຶກ​ອົບຮົມ​ຢູ່​ພາຍ​ໃນ​ການ​ບໍລິການ​ນັ້ນ​​ແລະ​ການ​ບໍລິການ​ ສາມາດດໍາ​ເນີນ​ການ​ແກ້​ໄຂ​ສິ່ງ​ນີ້​.​ ຄວາມ ສໍາຄັນ ຂອງ ຂ້ໍ ມູນ ພ້ືນຖານ ໃນ ເວລາ ປະ ເມີນ ຜົນ ກະທົບ ​ເພື່ອ​ເບິງ່​ຜົນ​ກະທົບ​ທີ​່ການ​ບລໍກິານ​ມ​ີສາໍລັບ​ຄ​ົນທີ​່ໄດ​້ຮບັ​ລົດ​ເຂນັ,​ມນັ​ສາໍຄນັ​ໃນ​ກາ​ນ​ບນັທກຶ​ສະພາບ​ ການ​ສໍາລັບ​ບກຸຄນົ​ກ່ອນ​ທີ​່ຈະ​ມ​ີການ​ຊວ່ຍ​ເຫຼືອ​ໃດ ,ໆ​ນັນ້​ແມນ່,​ກ່ອນ​ການ​ປະ​ເມນີ​ຜນົ​ຈະ​ເລີ​່ມຕ້ົນ. 46 47 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ​ໂອກາດ​ທີ​່ເປນັ​ໄປ​ໄດ​້ສາໍລັບ​ການ​ເກັບ​ເອາົ​ຂໍ​້ມນູ​ພ້ືນຖານ​ລວມມ:ີ •​ ​ໃນ​ເວລາ​ມ​ີການ​ເຮດັ​ການ​ນາໍ​ສົງ່​– ​ໂດຍ​ພະນັກງານ​ຢູ​່ສນູ​ຫຼືຄລ​ີນິກການ​ນາໍ​ສົງ່; •​ ລະຫວາ່ງ​ການ​ນາໍ​ສົງ່​​ແລະ​ການ​ປະ​ເມນີ​ຜນົ​– ຜາ່ນ​ການ​ຢຽ້ມຢາມ​ເຮອືນ​ຫຼືທາງ​ໂທລະສັບ. •​ ​ໃນ​ເວລາ​ການ​ປະ​ເມນີ​ຜນົ​– ກ່ອນ​ເລີ​່ມການ​ປະ​ເມນີ​ຜນົ. ​ສາໍລັບ​ຂໍ​້ມນູ​ເພ່ີມ​ເຕມີ,​​ໃຫ​້ເບິງ່ຄູ​່ມ​ືວາ່​ດວ້ຍ​ແຫຼງ່ຊບັ​ພະຍາກ​ອນ​ເພ່ີມ​ເຕມີ​ສາໍລັບຜູ​້ຈດັການ​ຢູ​່ໃນ​ Pen​Drive. ​ໃນ​ເວລາ​ດາໍ​ເນນີ​ການ​ສາໍພາດ​ເພື່ອ​ເກັບ​ເອາົ​ຂໍ​້ມນູ​ຈາກ​ຜູ​້ໃຊ​້ການ​ບລໍກິານ​ມນັ​ສາໍຄນັ​ໃນ​ການ​ກະກຽມ​ ບກຸຄນົ​ຜູ​້ທີ​່ຈະ​ດາໍ​ເນນີ​ການ​ສາໍພາດ.​ນີ​້ແມນ່​ເພ່ືອ​ໄດ​້ຮບັ​ຄາໍ​ຕອບ​ທີ​່ຈະ​ແຈ​້ງຄົບ​ຖວ້ນ​ຕ່ໍ​ກັບ​ແຕລ່ະ​ຄາໍ​ ຖາມ.​ນີ​້ແມນ່​ສາໍຄນັ​ຫາຼຍສາໍລັບ​ຂໍ​້ມນູ​ທີຖ່ກືຕອ້ງ. ຄໍາ ແນະນໍາ ກ່ຽວ ກັບ ເຕັກນິກ ການ ສໍາພາດ ​ກາ​ນກະກຽມ: •​ ຝຶກ​ຊ້ອມ​ສິ່ງ​ທີ່​ທ່ານ​ຈະ​ເວົ້າ​ກ່ອນ​ການ​ສໍາພາດ.​ຢ່າ​ເວົ້າ​ຫຼາຍ​ກ​ວ່າ​ທີ່​ຈໍາ​ເປັນ. ​ເຕັກນິກ: •​ ອ່ານ​ຄໍາ​ຖາມ​ຕາມ​ທີ່​ພວກ​ມັນຖືກ​ກໍານົດ​ໄວ້; •​ ຢ່າ​ແນະນໍາ​ຄໍາ​ຕອບ​ແກ່​ຜູ້​ຕອບ,​​ແມ້ກະທັ້ງ​ແບບ​ລັບໆ; •​ ຈົ່ງ​ເປັນກາງ​ຖ້າ​ທ່ານ​ຈໍາ​ເປັນ​ຕ້ອງ​ອະທິບາ​ຍາງ​ຢ່າງ; •​ ບັນທຶກ​ຄໍາ​ຕອບ​ຢ່າງ​ຖືກຕ້ອງ. ​ເຄົາ​ລົບ​ຜູ້​ຄົນ: •​ ຢ່າ​ສໍາພາດ​​ເວັ້ນ​ເສຍ​ແຕ່​ວ່າ​ບຸກຄົນ​ນັ້ນ​ຕົກລົງ​ເຫັນ​ດີ​ໃຫ້​ສໍາພາດ​ຢ່າງ​ອິດສະ​ຫຼະ​​ແລະ​ສະໝັກ​ໃຈ; •​ ຊ່ວຍ​ໃຫ້​ບຸກຄົນ​ນັ້ນ​ຮູ້ສຶກ​ຜ່ອນຄາຍ; •​ ຢ່າປະກົດ​ວ່າ​ຕົກ​ຕະລຶງ,​ດີ​ໃຈ​ຫຼື​​ເສຍ​ໃຈຈາກ​ອັນ​ໃດໆ​ກໍ່ຕາມ​ທີ່​ບຸກຄົນ​ນັ້ນ​ເວົ້າ; •​ ​ປະຕິບັດ​ຕໍ່​ຄໍາ​ຕອບ​ຂອງ​ຜູ້​ບຸກຄົນ​ນັ້​ນຢ່າງ​ເປັນຄວາມ​ລັບ. ການສາ້ງ​ຕັງ້​ລະບົບ​ຂໍ​້ມນູ​ພ້ືນຖານ​ຂອງ​ຜູ​້ໃຊ​້ທີ​່ດ​ີຈະ​ປັບປງຸ​ຄນຸ​ນະພາ​ບຂອງ​ການ​ບລໍກິານ​ລົດ​ເຂນັ​​ ເຊິງ່ຈະ​ສະທ້ອນ​ໃຫ​້ເຫນັ​ຜນົ​ກະທົບ​ຂອງ​ການ​ບລໍກິານ​ຕໍ​່ກັບ​ຄນຸ​ນະພາ​ບຊວີິດ​ຂອງ​ຜູ​້ໃຊ.້​ ນີ​້ສາມາດ​ຖກື​ດາໍ​ເນນີ: •​ ​ເປນັ​ສວ່ນ​ທີ​່ເຮດັ​ປະຈາໍ​ຂອງ​ການ​ຕິດຕາມ​ຜນົ; •​ ​ເປນັ​ກິດຈະກາໍ​ແຍ​ກຕາ່ງຫາກ. 46 47 ການ ປະ ເມີນ ຜົນ ກະທົບ ສໍາລັບ ເດັກນ້ອຍ ​ໃນ​ບ່ອນ​ທີ​່ເປນັ​ໄປ​ໄດ,້​ມນັ​ສາໍຄນັ​ໃນ​ການ​“ຮບັ​ຟງັ”​​ເດກັນ້ອຍ​ໃນ​ການ​ສະ​ແດງ​ຄາໍ​ຕ​ິຊມົ​ກຽ່ວ​ກັບ​ຜນົ​ ກະທົບ​ຂອງ​ລົດ​ເຂນັ​​ແລະ​ການ​ບລໍກິານຂອງ​ເຂາົ​ເຈົາ້.​ຕວົຢາ່ງ​ແມນ່​ການ​ໃຊ​້ເກ​ມລກູ​ເຕ໋ົາຄວາມ​ ຮູສ້ຶກ(11).​ກ່ອນ​ອືນ່​​ໃຫ​້ແຍກ​ປະ​ເພດ​ຄວາມ​ຮູສ້ຶກ​ຕ່າງໆ​ກັບ​ເດກັນ້ອຍ.​ຈາກ​ນັນ້,​ສາມາດຮອ້ງ​ຂ​ໍໃຫ້​ ພວກ​ເຂາົ​ເຮດັ​ສໍາ​ເລັດຄາໍ​ເວົາ້​​ເຊັນ່​ວາ່​“ຂອ້ຍ​ດ​ີໃຈ​​ເມື່ອ…”,​“ຂອ້ຍ​ເສົາ້​ໃຈ​​ເມື່ອ…” ​ໃ​ຈຮ້າຍ ​ເສົ້າ​ໃຈ ​ເຈັບ​ປວດ ໜ້າ​ອາຍ ຕື່ນ​ເຕັ້ນ ດີ​ໃຈ ກາ ນບັນທຶກ ແລະ ການ ປະມວນ ຜົນຂ້ໍ ມູນ ​ການ​ຕິດຕາມ​​ແລະ​ການ​ປະ​ເມນີ​ຜນົ​ແມນ່ກຽ່ວຂອ້ງ​ການ​ບນັທກຶ,​ການ​ເກັບ​ເອາົ,​ການ​ເກັບ​ຮກັສາ​​ ແລະ​ການ​ປະມ​ວນຜນົ​ຂໍມ້ນູ​(ຂໍ​້ມນູ).​ກາ​ນ​ບນັທກຶ​ຂໍ​້ມນູ​ຢາ່ງ​ມ​ີປະສິດທິພາບສາມາດ​ຊວ່ຍ​ປະ​ຢດັ​ ເວລາ​​ແລະ​ເງນິ​ໄດ.້​ມນັ​ເປນັ​ການ​ດ​ີໃນ​ການ​ປອ້ນ​ຂໍ​້ມນູ​ໂດຍ​ກງົ​ເຂົາ້​ໃສ​່ຖານ​ຂໍ​້ມນູ​​ເຊິງ່ຖກື​ຕ້ັງ​ໃຫ້​ ປະມວນ​ຜນົ​ໄດ​້ຮບັ​​ແລະ​ສາ້ງ​ລາຍ​ງານ​ທີ​່ເປນັ​ປະ​ໂຫຍ​ດທີ​່ສຸດ​ສາໍລັບການ​ບລໍກິານ.​ຄອມ​ພິວ​ເຕີ​ ແທັບ​ເລັດ​ແບບ​ພົກ​ພາສາ​ມາດ​ເປນັ​ປະ​ໂຫຍ​ດທີ​່ສຸດ​​ເພາະ​ພວກ​ມນັ​ອະນຸຍາດ​ໃຫ​້ບນັທກຶ​ຂໍ​້ມນູ​ໄດ​້ໃນ​ ເວລາ​ຢຽ້ມຢາມ​ພາກ​ສະໜາມ​​ເຊັນ່​ດຽວ​ກັບ​ໃນ​ເວລາ​ຢູ​່ສນູ.​​ເຕກັ​ໂນ​ໂລ​ຊ​ີໂທລະສັບ​ມ​ືຖ​ືກາໍລງັ​ກາ້ວໜາ້​ ຢາ່ງ​ວອ່ງ​ໄວ​​ແລະ​ອາດ​ຈະ​ເປ​ັວທິ​ີໜຶງ່​ສໍາລັບ​ການ​ປອ້ນ​,​ການ​ສ່ົງ​​ແລະ​ການ​ຮບັ​ຂໍ​້ມນູ. ການ ສ້າງ ແຜນການ ບໍລິການ ​ແຜນການ​ບລໍກິານ​ປະຈາໍ​ປ​ີ​ເຊິງ່ຖກື​ຕິດຕາມ​ໃນ​ຕະຫຼອດປ​ີສາມາດ​ຊວ່ຍ​ຮບັປະກນັ​ການ​ບລໍກິານ​ທີ​່ມີ​ ປະສິດທ​ິຜນົ​​ແລະ​ປະສິດທິພາບ.​ຈົງ່​ຈື​່ວາ່​ຕອ້ງ​ກະຕຸ້ນ,​​ສົງ່​ເສມີ​​ແລະ​ເຮດັ​ໃຫ້ພະນັກງານ​ການ​ ບລໍກິານ​ມ​ີຄວາມ​ມຸງ້​ໝັນ້​​ໂດຍ​ການ​ໃຫ​້ພວກ​ເຂາົ​ມ​ີສ່ວນຮວ່ມ​ໃກນານ​ສາ້ງ​ແຜນການ​​ແລະ​ ຄາດໝາຍ.​​ແຜນການ​ບລໍກິານ​ອາດ​ຈະ​ລວມມ​ີການ​ປະ​ເມນີ​ຜນົ​ໃນ​ຕອ້ນ​ທາ້ຍ​ປ.ີ​​ໂຄງ​ຮາ່ງ​ແຜນການ​ ບລໍກິານ​ແບບຢາ່ງ​ທີ​່ມີໜຶງ່​ຕວົຢາ່ງ​ຖກື​ສະ​ແດງ​ຢູ​່ຂາ້ງ​ລຸມ່. 48 49 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ໂຄງ ຮ່າງ ແຜນການ ບໍລິການ ລະບຸ ຄວາມ ຕ້ອງການ/ ບັນຫາ ທ່ີ ຈະ ຖືກ ຕິດຕາມ ການ ດໍາ ເນີນ ການ/ຈຸດປະສົງ ໃນ ການ ແກ້ ໄຂ ຄວາມ ຕ້ອງການ/ບັນຫາ ນ້ັນ ຄາດໝາຍ ການ ເກັບ ຂ້ໍ ມູນ ມີ​ແມ່ຍິງ​ໜ້ອຍ​ກວ່າ​ຜູ້​ຊາຍ​ ຫຼາຍ​(​ແມ່ຍິງ​20%,​ ຜູ້​ຊາຍ​80%)​​ທີ່ເ​ຂົ້າ​ເຖິງ​ ການ​ບໍລິການລົດ​ເຂັນ​ ໃນປີຜ່ານມາ. ​ເພີ່ມ​ການ​ລະບຸ​​ແລະ​ການ​ນໍາ​ສົ່ງ​ ແມ່ຍິງ​ຫາ​ການ​ບໍລິການ​ໂດຍການ: •​ ​ໂອ້​ລົມ​ກັບ​ແຫຼ່ງການ​ນໍາ​ສົ່ງ​ – ​ເຊິ່ງລວມທັງ​ຜູ້ຕາງໜ້າ​ຂັ້ນ​ ບ້ານ​ກ່ຽວ​ກັບ​ການ​ລະບຸ​ແມ່ຍິງ •​ ​ຮ່ວມ​ມື​ກັບ​DPO​ລະດັບ​ປະ​ ເທດ​​ເພື່ອ​ລະບຸ​ແ​ມ່ຍິງ​ທີ່​ເປັນ​ ແບບຢ່າງ​ຜູ້​ທີ່​ສາມາດ​ສົ່ງ​ເສີມ​ ແມ່ຍິງ​ໃຫ້​ເຂົ້າ​ຮ່ວມ​ການ​ ບໍລິການ. ​ເພີ່ມ​ເປີ​ເຊັນ​ຂອງ​ ແມ່ຍິງ​ທີ່​ເຂົ້າ​ເຖິງ​ ການ​ບໍລິການ​ລົດ​ເຂັນ​ ໃຫ້​ໄດ້​ຢ່າງ​ໜ້ອຍ​ 40%. ສື​ບຕໍ່​ຮັກສາ​ຖານ​ຂໍ້​ມູນ​ຜູ້​ ໃຊ້​ລົດ​ເຂັນ​ໃຫ້​ໃໝ່​ຫຼ້າສຸດ​ – ​ເພາະວ່າ​ນີ້​ກໍານົດ​ວ່າ​ມີ​ ຜູ້ໍຊາຍ​ຈັກ​ຄົນ​​ແລະ​​ ແມ່ຍິງ​ຈັກ​ຄົນ​ທີ່​ກໍາລັງ​ ເຂົ້າ​ເຖິງ​ການ​ບໍລິການ. C.2: ການຄຸ້ມ ຄອງ ອຸປ ະ ສົງ ​ໃນ​ເວລາ​ດາໍ​ເນນີ​ການ​ບລໍກິານ​ມ​ີຄວາມ​ດນຸ​ດຽ່ງ​ທີ​່ສໍາຄນັ​ລະຫວາ່ງ​ອປຸ​ະ​ສົງທີ​່ເກີດ​ຈາກ​ຄວາມ​ຈາໍ​ ເປນັ​ຂອງ​ຜູ​້ໃຊກ້ັບ​ຄວາມ​ສາມາດ​ຂອງ​ພະນັກງານ​ໃຫ​້ບລໍກິານ​ໃນ​ການ​ສະໜອງ​ການ​ບລໍກິານ​ທີ່​ ເໝາະສົມ. ການ ສ້າງ ອຸປ ະ ສົງ ​ສາມາດ​ຄາດ​ຄະ​ເນ​ຄວາມ​ຕອ້ງການ​ສາໍລັບ​ການ​ບລໍ​ິການ​ໄດ​້​ໂດຍ​ການ​ຄິດ​ໄລ​່1%​ຂອງ​ປະຊາກອນ​ ໃນ​ເຂດ​ພືນ້​ທີ​່ທີ​່ການ​ບລໍກິານ​ກາໍລງັ​ເຮດັ​ວຽກ​ຢູ.່​​ແນວ​ໃດ​ກໍ່ຕາມ,​ຖາ້​ຜູ​້ຄນົ​ຂາດ​ການ​ຮບັ​ຮູ​້ການ​ ບລໍກິານ​​ແລະ​ຜນົ​ປະ​ໂຫຍ​ດຂອງ​ມນັ,​ຫຼືບໍສ່າມາດ​ເຂົາ້​ເຖງິການ​ບລໍກິານ​ໄດ,້​ຈາກ​ນັນ້​ອປຸ​ະ​ສົງ​ກໍ່​ ອາດ​ຈະ​ຕໍາ່​​ເຖງິ​ແມນ່​ຈະ​ມ​ີຄວາມ​ຕ້ອງການ​ກໍ່ຕາມ. 48 49 ​ເມື່ອ​ອຸປ​ະ​ສົງ​ສໍາລັບ​ການ​ບໍລິການ​ຕໍ່າ;​ຄ່າ​ໃຊ້​ຈ່າຍ​ຕໍ່​ຜູ້​ໃຊ້​ ການ​ບໍລິກາ​ນ​ເພ່ີມ​ຂຶ້ນ;​​ເຊິ່ງ​ເປັນອັນຕະລາຍ​ຕໍ່​ກັບ​ຄວາ​ ມຍືນ​ຍົງ​ດ້ານ​ການ​ເງິນ​ຂອງ​ການ​ບໍລິການ. Too few referrals Cost of service goes up C.2.2 Managing demand Balancing referra ls and appointme nts ​ໜາ້​ທີ​່ຂອງ​ຜູ​້ຈດັການ​ແມນ່​ການ​ຊອກ​ຮູ​້ສາ​ເຫດ​ຕົນ້ຕ​ໍກຽ່ວ​ກັບ​ວາ່​ຍ້ອນ​ຫຍງັ​ການ​ນາໍ​ສົງ່​ຈິງ່​ຕໍາ່.​ຄວາມ​ ເປນັ​ໄປ​ໄດ​້ປະກອບ​ມ:ີ •​ ການ​ບລໍກິານ​ບໍ​່ໄດ​້ກາໍນົດ​ແຫຼງ່ການ​ນາໍ​ສົງ່​ທີ​່ເໝາະ​ສົມ​ທີ​່ສຸດ; •​ ຜູ​້ຄນົທີ​່ຕ້ອງການ​ລົດ​ເຂນັ​ບໍ​່ເຂົາ້​ເຖງິ​ແຫຼງ່ການນາໍ​ສົງ່; •​ ການ​ຝຶກ​ອບົຮມົ​ເຄືອ​ຂາ່ຍ​ການ​ນາໍ​ສົງ່​ບໍ​່ໄດ​້ເຜີຍ​ແຜ​່ຜົນ​ປະ​ໂຫຍ​ດ​​ແລະ​ຄວາມ​ສາໍຄນັ​ຂອງ​ການ​ ບລໍກິານ​ລົດ​ເຂນັ; •​ ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ບໍ​່ສາມາດ​ເຂົາ້​ເຖງິ​ການ​ບລໍກິານ​ໄດ​້– ​ເພາະວາ່​ມນັ​ໄກ​ເກນີ​ໄປ​ຈາກ​ບ່ອນ​ທີ​່ພວກ​ເຂາົ​ ອາ​ໄສ​ຢູ,່​​ແລະ/ຫຼ​ືບໍ​່ມ​ີການ​ຂນົ​ສ່ົງ​ທີ​່ມ​ີໃຫ.້ ​ເມື່ອ​ຮູສ້າ​ເຫດ​ຫຼືບນັດາ​ສາ​ເຫດ​ຂອງ​ການ​ຂາດ​ການ​ນາໍ​ສົງ່​ແລວ້,​ຜູ​້ຈດັການ​​ແລະ​ທ​ີມງານ​ຂອງ​ເຂາົ​ ເຈົາ້​ສາມາດ​ເຮດັ​ວຽກ​ເພ່ືອ​ສາ້ງ​ອປຸ​ະ​ສງົ. ການ ຄຸ້ມ ຄອງອຸປ ະ ສົງ ຖ້າ​ຈໍານວນຄົນ​ທີ່​ຖືກ​ນໍາ​ສົ່ງ​ຫາ​ການ​ບໍລິການ​ຫຼາຍກວ່າ​ ຈໍານວນ​ທີ່​ພະນັກງານ​ສາມາດ​ຄຸ້ມ​ຄອງ​ໄດ້,​​ມີ​ສາມ​ຜົນ​ຕາ​ ມມາ​ທີ່​ເປັນ​ໄປ​ໄດ້: •​ ພະນັກງານ​ໃຊ້​ເວລາ​ໜ້ອຍ​ກວ່າ​ທີ່​ພວກ​ເຂົາ​ຈໍາ​ ເປັນຕ້ອງ​ໃຊ້​ກັບ​ແຕ່ລະຄົນ​– ​ແລະ​ຄຸນ​ນະພາ​ບຂອງ​ ການ​ບໍລິການ​ຫຼຸດລົງ;​ຫຼື •​ ​ເວລາທີ່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຈໍາ​ເປັນ​ຕ້ອງ​ລໍຖ້າ​ສໍາລັບ​ການ​ນັດ​ ໝາຍ​ຈະ​ເພີ່ມ​ຂຶ້ນ;​ຫຼື •​ ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ບາງ​ຄົນ​ໜີ​ຈາກ​ການ​ບໍລິການ. ​ໃນ​ແຕ່​ລະ​ກໍລະນີ,​ສະພາ​ບດັ່ງກ່າວ​ເຮັດ​ໃຫ້​ທັງ​ຜູ້​ໃຊ້​ ບໍລິການ​​ແລະ​ພະນັກງານ​ໃຫ້​ບໍລິການ​ເສຍ​ກໍາລັງ​ໃຈ. Too many referrals – less resources Quality of service goes down/long waiting list C.2.3 Managing demand Balancing referra ls and appointme nts 50 51 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ​ສະ​ນັນ້​ມນັ​ຈິງ່​ເປນັ​ປະ​ໂຫຍ​ດຫາຼຍ​ໃນ​ການຄຸມ້​ຄອງ​ອປຸ​ະ​ສງົ​ຢາ່ງ​ລະມັດລະວງັ.​ຜູ​້ຈດັການ​ໃນ​ເບື້ອງ​ ຕົນ້​ຄວນ​ເລງັ​ເປົາ້​ໝາຍ​ໃສ​່ແຫຼງ່ການ​ນາໍ​ສົງ່​​ເຊິງ່​ເລີມ່ດວ້ຍ​ແຫຼງ່ການ​ນາໍ​ສົງ່​ທີ​່ໃກ​້ຄຽງ.​ນີ​້ມ​ີຂໍ​້ດ​ີເພ່ີມ​ ເຕມີ​ກຽ່​ວກັບ​ການ​ເຮດັ​ໃຫກ້ານ​ຕິດຕາມ​ຜນົ​ງາ່ຍ​ນຂຶນ້​​ໃນ​ເວລາ​ທີ​່ການ​ບລໍກິານ​ຍງັ​ໃໝ່​ຢູ.່​ສື​່ສານມວນ​ ຊນົ​​ແລະ​ເບ​ີໂທ​ຟຣພີາຍ​ໃນ​ປະ​ເທດ​ແມນ່ວທິ​ີທີ​່ເປນັ​ໄປ​ໄດ​້ໃນ​ການສາ້ງ​ອປຸ​ະ​ສງົ​ຈາໍນວນຫາຼຍຈາກ​ ໄລຍະ​ໄກ.​​ໂດຍ​ບໍ​່ມ​ີເຄືອ​ຂາ່ຍ​ການ​ບລໍກິານ,​ນີ​້ຈະ​ຫຍຸງ້ຍາກ​​ແລະ​​ມີຄາ່​ໃຊ​້ຈາ່ຍ​ສງູ​ສາໍລັບ​ຜູ​້ໃຊ​້ການ​ ບລໍກິານ​​ແລະ​ຜູ​້ໃຫກ້ານ​ບລໍກິານ​ໃນ​ການ​ຄຸມ້​ຄອງ​. ການ ສ້າງ ແລະ ການ ຄຸ້ມ ຄອງ ລາຍຊ່ື ລໍຖ້າ ​ໃນ​ເວລາ​ທີ​່ອປຸ​ະ​ສງົ​ສາໍລັບ​ການບລໍ​ິການ​ສງູ​ຂຶນ້;​​ໃຫ​້ສາ້ງ​ລາຍ​ຊື​່ລຖໍາ້.​ມນັ​ຄຸມ້​ຄາ່​ໃນ​ການ​ລງົທ​ຶນ​ເວລາ​ ໃນ​ການ​ສາ້ງ​ລະບົບ​ທີ​່ໃຊ​້ຖານ​ຂໍ​້ມນູ​ເພ່ືອ​ບນັທກຶ​ຂໍ​້ມນູ​ນີ.້​ນີ​້ຈະ​ເຮດັ​ໃຫ​້ຜູ​້ຈດັການ​​ແລະ​ພະນັກງານ​ ໃຫ​້ບລໍກິານ​ເຂົາ້​ເຖງິ​ຂໍ​້ມນູ​ໄດ​້ຢາ່ງ​ມ​ີປະສິດທ​ິພາບ​​ແລະ​ເຮດັ​ໃຫ​້ສາມາດ​ປະມວນ​ຜນົ​ສະຖິຕ​ິຂອງ​ການ​ ບລໍກິານ​ໄດ້ຢາ່ງ​ງ່າຍດາຍ.​​ເມື່ອ​ບກຸຄນົ​ເຂົາ້​ໃຊ​້ການ​ບລໍກິານ,​ຂໍ​້ມນູ​ເພ່ີມ​ເຕ​ີມກໍ​່ສາມາດ​ຖກື​ເພີມ່​ເຂົາ້,​ ຕວົຢາ່ງ​ວນັ​ທ​ີຂອງ​ການ​ປະ​ເມນີ​ຜນົ,​ວນັ​ທ​ີການ​ດັດ​ປັບ​ໃຫ​້ເໝາະ​ສມົ,​ການ​ນັດ​ໝາຍ​ເພ່ືອ​ຕິດ​ຕາມ​ ຜນົ. ການ ກວດ ຄັດ ການ ນໍາ ສ່ົງ ແລະ ລາຍ ຊ່ື ລໍຖ້າ ​ໃນ​ເວລາ​ທີຈ່າໍ​ນວນ​ຄນົ​ໃນ​ລາຍ​ຊື່​ລຖໍາ້​ເພ່ີມ​ຂຶນ້,​ບາງ​ ອງົການ​ຈັດ​ຕັງ້​ເຮດັ​ການກວດຄັດ​​ແລະ​ຈັດ​ບຸລິ​ມະສິດ​ການ​ ນາໍ​ສົງ່.​ກຸມ່​ຄນົ​ຕໍ່​ໄປ​ນີ້​ຄວນ​ໄດ້​ຮບັ​ພິຈາລະນາ​ເປັນ​ ບຸລມິະສິດ: •​ ​ເດັກນ້ອຍ​– ​ເນື່ອງຈາກ​ຄວາມ​ສໍາຄັນ​ຂອງ​ການ​ນໍາ​ສົ່ງ​ໄວ​​ ແລະ​ຄວາມ​ສ່ຽງ​ທີ່​ເພ່ີມ​ຂຶ້ນ​ຂອງ​ການ​ເກີດ​ການຜິດ​ບ່ຽງດ້ານ​ ທ່າ​ທາງ​ໃນ​ລະຫວ່າງ​ການ​ເລັ່ງຈະ​ເລີ​ນ​ເຕີບ​ໂຕ​ຂອງ​ເດັກ; •​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ທີ່​ມີ​ຄວາມ​ສ່ຽງ​ເກີດ​ແຜ​ກົດທັບ​– ​ເພາ​ະ​ວ່າ​ນີ້​ແມ່ນ​ ສ​ະພາບ​ທີ່​ເປັ​ນອັນຕະລາຍ​ຕໍ່​ຊີວິດ; •​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຜູ້​ທີ່​ມີ​ສ​ະພາບອາການ​ຮ້າຍ​ແຮງ​ຂຶ້ນ​– ​ເນື່ອງ​ຈາກ​ ຄວາ​ມຮີບ​ດ່ວນ​ຂອງ​ສະພາບ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ. •​ ​ຜູ້​ທີ່​ກໍາລັງ​ປະສົບ​ກັບ​ຄວາມ​ເຈັ​ບປວດ​​ເນື່ອງ​ຈາກ​ການ​ຂາດ​ລົດ​ ເຂັນ​ຫຼືລົດ​ເຂັນ​ທີ່​ບໍ່​ເໝາະສົມ​ກັບ​ເຂົາ​ເຈົ້າ. 50 51 ບາງ​ຂງົ​ເຂດ​ຖານ​ຂໍ​້ມນູສາໍຄນັ​ໃຫ​້ພິຈາລະນາ​​ເພ່ືອ​ຊວ່ຍ​ກວດ​ຄັດ​​ແລະ​ວາງ​ແຜນການ​ນັດ​ໝາຍ​ ລວມມ:ີ •​ ອາຍ;ຸ •​ ປະ​ເພດ​ຄວາມ​ພິການ. •​ ​ເຫດຜນົ​ສາໍລັບ​ການ​ນາໍ​ສົງ່; •​ ສະຖາ​ນທີ​່ທາງ​ພມູີສາດ. ຄວາມ ສາມາດ ໃຫ້ ບໍລິການ ​ມນັ​ສາໍຄນັ​ໃນ​ການຄຸມ້​ຄອງ​ຄວາມ​ຄາດ​ຫວງັ​ກຽ່​ວກັບ​ສິງ່ທີ​່ການ​ບລໍກິານ​ສາມາດ​ໃຫ​້–​ໃນ​ດາ້ນ​ ຈາໍນວນຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຜູ​້ທີ​່ສາມາດ​ໄ​ດຮ້​ັບບລໍກິານ,​​ແລະ​ລະດັບ​ຂອງ​ການ​ໃຫ​້ບລໍກິານ. ​ເຖງິ​ແມນ່​ຈະ​ມ​ີຄວາມ​ຕອ້ງການ​ສາໍລັບ​ການ​ບລໍ​ິລະດັບ​ປາ​ນກາງ​​ແລະ​ລະດັບ​ສງູ,​ບໍ​່ແມນ່​ທກຸ​ການ​ ບລໍກິານ​ຈະ​ມ​ີຄວາມ​ສາມາດ​ໃຫກ້ານ​ບລໍກິານ​ໃນ​ລະດັບ​ເຫຼົາ່ນີ.້​ແນວໃດກໍ່ຕາມ,​ ພະນັກງານໃຫ້ບລໍກິານຈະ​ໄດ​້ພົບ​ກັບ​ຜູ​້ໃຊ​້ບລໍກິານ​ຜູ​້ທີ​່ມ​ີຄວາມ​ຕ້ອງການ​ທີ​່ເກນີ​ຄວາມ​ຮູ,້​ທກັ​ສະ​​ ແລະ​ການ​ມ​ີຢູຂ່ອງ​ຜະລິດ​ຕະພັນ​ຂອງ​ເຂາົ​ເຈົາ້.​​ຜູ​້ຈດັການ​ຈາໍ​ເປນັ​ຕອ້ງ​ຮບັປະກນັ​ໃຫ​້ມ​ີຍຸດ​ທະ​ສາດ​ ສາໍລັບ​ວທິ​ີຮບັ​ມ​ືກັບ​ສະພາບ​ການ​ນີ.້​ຜູ​້ຈດັການ​ສາມາດ: •​ ຮບັ​ປະ​ກນັ​ວາ່​ຂໍ​້ມນູ​ກຽ່ວ​ກັບ​ການ​ບ​ໍລ​ິການ​(ສິງ່​ທີ​່ການ​ບ​ໍລ​ິການ​ສາ​ມາດ​ເຮດັ​ໄດ)້​​ແມນ່ຈະ​ແຈງ້​ຢູ່ໃນ​ ໃບ​ໂຄ​ສະ​ນາ/​ແຜນ່​ພັບ; •​ ຕິດ​ຕ່ໍ​ປະ​ສານງ​ານ​ກັບ​ຜູ​້ໃຫ​້ບ​ໍລ​ິການ​ອືນ່ໆ​ເພ່ືອ​ເບິງ່ວາ່​ການ​ນາໍ​ສົງ່ຫາ​ຫຼ​ືການ​ຮວ່ມ​ມ​ືກນັ​ແມນ່​ ເປນັ​ໄປ​ໄດ​້ບ​ໍສາໍ​ລັບ​ຜູ​້ຄນົ​ທີ​່ມ​ີຄວາມ​ຕ້ອງ​ການ​ທີ​່ເກນີ​ຄວາມ​ສາ​ມາດ​ໃຫ​້ບ​ໍລ​ິການ​ເຂາົ​ເຈົາ້; •​ ຄວາມຕ້ອງການດາ້ນເອກະສານທີ່ຍງັບໍ່ຕອບສະໜອງ​– ແລະວາງແຜນສາໍລັບການເພີມ່​ ໂອກາດຄວາມສາມາດຂອງບກຸຄະລາກອນ​ແລະຜະລິດຕະພັນ. ຄວາມສໍາຄັນຂອງການນໍາສ່ົງໄວສໍາລັບເດັກນ້ອຍ ເດກັນ້ອຍຫາຼຍຄນົຜູ້ຕອ້ງການລົດເຂນັ,​ອາດຍງັຕ້ອງການດາ້ນການຮອງ​ຮບັທາ່ທາງ​ເພ່ີມເຕມີ.​ນີ້​ ໝາຍ​ຄວາມ​ວາ່​ເດກັ​ນ້ອຍຫາຼຍ​ຄນົ​ຕ້ອງ​ການ​ບ​ໍລ​ິການ​ລະ​ດັບ​ປານ​ກາງ.​​ມນັ​ເປນັ​ສິງ່​ຄາໍ​ສນັຫາຼຍ​ສາໍ​ ລັບ​ການ​ນາໍ​ສົງ່​ເດກັ​ນ້ອຍ​ທກຸ​ຄນົ​ຫາ​ການ​ບ​ໍລ​ິການ​ໄວ​ເທົາ່​ທີ​່ເປນັ​ໄປ​ໄດ,້​​ເພ່ືອ​ປອ້ງ​ກນັ​ຫຼ​ືລົດ​ບນັ​ຫາ​ ກັບ​ທາ່​ທາງ​ລງົ. ຄວາມ​ຕ້ອງ​ການ​ສະ​ເພາະຂອງ​ເດກັ​ນ້ອຍ​ແລະ​ຜນົ​ປະ​ໂຫຍດ​ຂອງ​ການ​ນາໍ​ສົງ່​ໄວ​​ແມນ່​ຖກື​ກາ່ວ​ເຖງິ​ ໃນ​ຊວ່ງ​ການ​ຝກຶ​ອບົ​ຮມົ​ກຽ່ວ​ກັບ​ເດກັ​ນ້ອຍ​ໃນການ​ຝກຶ​ອບົຮມົ​WSTP​ລະ​ດັບ​ກາງ.​​ການ​ນາໍ​ສົງ່​ໄວ​ ແມນ່​ເປນັ​ສິງ່​ສາໍ​ຄນັ​ສາໍ​ລັບ​ເດກັ​ນ້ອຍ​ຍ້ອນ​ເຫດ​ຜນົ​ຕໍ​່ໄປ​ນີ:້ 52 53 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ •​ ​ເດກັ​ນ້ອຍ​ຜູ​້ທີ​່ມ​ີຄວາມ​ລາໍ​ບາກ​ໃນ​ການ​ນັງ່​ໃຫ​້ຕ້ັງ​ຊື​່​ສາ​ມາດ​ພັດ​ທະ​ນາ​ບນັ​ຫາ​ດາ້ນ​ທາ່​ທາງ​ໄດ​້ຖາ້​ ວາ່ພວກ​ເຂາົ​ບໍ​່ມີການ​ປະ​ຄອງ​ທີ​່ດ.ີ​​ຖາ້​ເດກັ​ນ້ອຍ​ຖກື​ນາໍ​ສົງ່​ຊກັ​ຊາ້​ບາງ​ບນັ​ຫາ​ດາ້ນ​ທາ່​ທາງ​ອາດ​ ກາຍ​ເປນັ​ບນັຫາ​ຖາວອນ.​​ນີ​້ສາ​ມາດ​ເຮດັ​ໃຫ​້ມນັ​ລາໍ​ບາກ​ສາໍ​ລັບ​ເດກັ​ໃນ​ກາ​ນນັງ່​ຢາ່ງ​ສະ​ດວກ​ສະ​ ບາຍ​ແມ​້ກະ​ທງັ​ວາ່​ມ​ີອປຸະກອນການ​ປະ​ຄອງການ​ຊງົ​ຕວົ. •​ ​ບໍ​່ມ​ີປະ​ສົບ​ການ​ໃນ​ການ​ນັງ່​ແລະ​ເລີມ່​ຕົນ້​ເຄື່ອນ​ທີ,່​​ການ​ພັດ​ທະ​ນາ​ຂອງ​ເດກັ​ອາ​ດ​ຊກັ​ຊາ້. •​ ​ສາໍ​ລັບ​ເດກັ​ນ້ອຍ​ຜູ​້ທີ​່ມ​ີບາງ​ຄວາມ​ສາ​ມາດ​ຍາ່ງ​– ​ການ​ໃຊ​້ລົດ​ເຂນັ​ອາດ​ເຮດັ​ໃຫ​້ຊດິ​ວິດ​ປະ​ຈາໍ​ວນັ​ ຂອງ​ພວກ​ເຂາົ​ງາ່ຍ​ຂືນ້​ແລະ​ຊວ່ຍ​ພວກ​ເຂາົໃຫ​້ເຮດັ​ສິງ່​ຕາ່ງໆ​ໄດ້ຫາຼຍຂືນ້​ໃນ​ມື​້ໜຶງ່. ​ແຕ່​ໜາ້​ເສຍ​ດາຍ,​​ທີ​່ເດກັ​ນ້ອຍ​ບໍ​່ມັກ​ຈະຖກື​ນາໍ​ສົງ່​ໄປ​ຫາ​ການ​ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ໄວ​ເທົາ່​ທີ​່ພວກ​ເຂາົ​ ຄວນ​ຈະ​ຖກື​ນາໍ​ສົງ່.​​ຜູ​້ປກົ​ຄອງ​ອາດ​ຈະ​ຫວງັ​ວາ່​ລກູ​ຂອງ​ພວກ​ເຂາົ​ເຈົາ້​ຈະ​“​ຖກື​ປິນ່​ປວົ​ໃຫ​້ເຊາົ”​​ແລະ​ ຈະ​ກັບ​ມາ​ຍາ່ງ​ໄດ​້ອກີ​ຄັງ້.​​ບາງ​ຜູ​້ປກົ​ຄອງ​ກງັ​ວນົ​ວາ່​ລົດ​ເຂນັ​ຈະ​ມ​ີຄາ່​ໃຊ​້ຈາ່ຍຫາຼຍ,​ຫຼ​ືບ​ໍຮູ​້ກຽ່ວ​ກັບ​ ການ​ບ​ໍລ​ິການ.​​ໃນ​ບາງ​ກ​ໍລະ​ນ,ີ​​ຜູ​້ປກົ​ຄອງ​ອາດ​ຄິດ​ວາ່​ການ​ໃຫ​້ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ຈະ​ເຮດັ​ໃຫ​້ລກູ​ຂອງ​ ພວກ​ເຂາົ​ເຈົາ້​ຢດຸ​ການ​ຍາ່ງ. ມນັເປນັສິງ່ສາໍຄນັທີ່ທມີງານໃຫກ້ານບລໍກິານທງັໝົດອະທິບາຍຈະແຈງ້ກຽ່ວກັບເຫດຜນົວາ່ເປນັ ຫຍງັການນາໍສົງ່ໄວຈິງ່ສາໍຄນັ.​ພະ​ນກັ​ງານ​ຍງັ​ສາ​ມາດ​ສາ້ງ​ຄວາມ​ໝັນ້​ໃຈ​ໃຫ​້ແກ​່ຜູ​້ປກົ​ຄອງ​ແລະ​ແຫຼງ່​ ການ​ນາໍ​ສົງ່​ທີ​່ລົດ​ເຂນັ​ແມນ່​ບໍ​່ໜາ້​ຈະ​ປອ້ງ​ກນັ​ເດກັ​ຈາກ​ການ​ຍາ່ງ​ຖາ້​ວາ່​ນີ​້ແມນ່​ເປນັ​ໄປ​ໄດ​້ສາໍ​ລັບ​ ພວກ​ເຂາົ.​​ປະ​ສົບ​ການ​ຂອງ​ການ​ເຄື່ອນ​ໄຫວ​ຜາ່ນ​ລົດ​ເຂນັ​ໃນ​ຂະ​ນະ​ເດກັ​ກາໍ​ລງັ​ຮຽນ​ຮູ​້ການ​ຍາ່ງ​ຈະ​ ເປນັປະ​ໂຫຍດ​ຕ່ໍ​ການ​ພັດ​ທະ​ນາ​ຂອງ​ພ​ວກ​ເຂາົ​ເຈົາ້​ໃນຫາຼຍ​ຮບູ​ແບບ​ອືນ່ .ໆ ຕົວ ຢ່າງ ຜົນ ສໍາ ເລັດ: ການ ນໍາ ສ່ົງ ໄວ ໂດຍ ຜູ້ ປົກ ຄອງ ໃນ ປະ ເທດ ເມັກ ຊິ ໂກ ນີ້​ແມ່ນ​ຕົວ​ຢ່າງ​ຂອງວິ​ທິ​ສ້າງ​ເຄື່ອ​ຂ່າຍ​ການ​ນໍາ​ສົ່ງ​ໄວ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ຜົນ​ຂອງ​ກຸ່ມ​ສູນ​ຟື້ນ​ຟູສໍາ​ລັບ​ເດັກ​ນ້ອຍ​ ໃນ​ເມັກ​ຊິ​ໂກ. ແນວໃດກໍ່ຕາມ​ບັນດາສູນຟື້ນຟູໂດຍຕົ້ນຕໍແລ້ວເລັງເປົ້າໝາຍໃສ່ທ່ານໝໍດູແລເດັກເກີດໃໝ່​ ແລະແພດເດັກ​ດ້ວຍກິດຈະກໍາສ້າງຄວາມຮັບຮູ້ໃຫ້ເຂົາເຈົ້າ,​ພວກ​ເຂົາ​ຍັງ​ມີ​ການ​ໂຄ​ສະ​ນາ​ການ​ລະ​ດົມ​ ທຶນ​ປະ​ຈໍາ​ປີ​ທີ່​ສໍາ​ຄັນ​ຈຸດ​ປະ​ສົງ​ແມ່ນ​ຊຸມ​ຊົມ​ທົ່ວ​ໄປ​ທີ່​ໃຊ້​​ສື່ນອອກ​ອາ​ກາດ​ຢ່າງກວ້າງ​ຂວາງ​​ລວມ​ເຖິງວິ​ ທະ​ຍຸ​ແລະ​ໂທ​ລະ​ພາບ.​ນີ້​ນໍາ​ໄປສູ່​ການ​ນໍາ​ສົ່ງ​ແບບ​ປາກ​ຕໍ່ປາກຢ່າງ​ຫຼວງຫຼາຍ​​ແລະ​ພ່ໍ​ແມ່ຫຼາຍຄົນ​ໄດ້​ນໍາ​ ສົ່ງ​ລູກຂອງ​ເຂົາ​ເຈົ້າ​ເອົາ​ເອງ. ໃນລະຫວ່າງກິດຈະກໍາຄວາມຮູ້,​ສູນມີຂໍ້ຄວາມທີ່ຈະແຈ້ງ:​ຄວາມສໍາຄັນຂອງການນໍາສ່ົງ​ເດັກນ້ອຍສໍາ ລັບການພື້ນຟູຮ່າງກາຍເມື່ອພວກເຂົາເກີດມາ.​​ພວກ​ເຂົາ​ຍັງ​ນໍາ​ສະ​ເໜີ​ວິ​ໄສ​ທັດ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບ​ຂອງ​ ຄວາມ​ສໍາ​ເລັດ​ກັບ​ຫຼາຍເລື່ອ​ງ​ເລົ່າ​ໃນ​ເຊິງບວກ​ທີ່​ກ່ຽວ​ຂ້ອງ​ກັບ​ການ​ຍ້ອງ​ຍໍ​ແລະ​ການ​ບັນ​ລຸ​ຜົນ​ສໍາ​ເລັດ​ ຂອງ​ເດັກ​ນ້ອຍ​ຜູ້​ທີ່​ເຂົາ​ເຈົ້າ​ເຮັດ​ວຽກ.​​ໃນ​ໄລ​ຍະ​ເວ​ລາ​15​ປີ​ທີ່​ຜ່ານ​ມາ,​ສູນ​ຟື້ນ​ຟູ​ສຸ​ຂະ​ພາບ​ໄດ້​ເຫັນ​ການ​ ປ່ຽນ​ແປງ​ທາງວັດ​ທະ​ນາ​ທໍາ​ເປັນ​ແພດ​ເດັກ​ແລະ​ຄອບ​ຄົວ​ກໍາ​ລັງ​ແຂ່ງ​ຂັນ​ເຮັດ​ການ​ນໍາ​ສົ່ງ​ໄວ. ​ຜົນ​ໄດ້​ຮັບ:​​ໜຶ່​ງສ່ວນ​ສາມ​ຂອງ​ການ​ນໍາ​ສົ່ງ​ທັງ​ໝົດ​ແມ່ນ​ສໍາ​ລັບ​ເດັກ​ນ້ອຍ​ອາ​ຍຸ​3​ປີ​ແລະ​ນ້ອຍກວ່າ. ຜູ້ ຈັດ ການ ສາ ມາດ ສ້າງ ຄວາມ ສໍາ ເລັດ ແນວ ໃດ ໃນ ການ ສ່ົງ ເສີມການ ນໍາ ສ່ົງ ໄວ •​ ຂໍ້​ຄວາມ​ທີ່​ຈະ​ແຈ້ງ​ກ່ຽວ​ກັບ​ຜູ້​ທີ່​ເປັນ​ເປົ້າ​ໝາຍ; •​ ​ເປົ້າ​ໝາຍ​ທີ່​ຈະ​ແຈ້ງ​ຂອງ​ສິ່ງ​ທີ່​ພວກ​ເຂົາ​ຕ້ອງ​ການ​ບັນ​ລຸ; •​ ​ວິທີ​ການ​ທີ່​ແຕກ​ຕ່າງ​ກັນ​ສໍາລັບ​ຜູ້​ຊ່ຽວ​ຊານ​​ແລະ​ພ່ໍ​ແມ່; •​ ​ແບ່ງ​ປັນ​ເລື່ອງ​ເລົ່າ​ຄວາມ​ສໍາ​ເລັດ​ເພ່ືອ​ກະ​ຕຸ້ນ​ສົ່ງ​ເສີມຜູ້​ປົກ​ຄອງ​ແລະ​ຜູ້​ຊ່ຽວ​ຊານ​ໃຫ້​ນໍາ​ສົ່ງ; •​ ​ກິດ​ຈະ​ກໍາ​ການ​ເພ່ີມ​ຄວາມ​ຮັບ​ຮູ້​ທີ່​ຍືນ​ຍົງ​ຕະຫຼອດ​ໄລ​ຍະ​ເວ​ລາ​ປີທີ່​ຜ່ານ​ມາ. 52 53 ການ ດໍາ ເນີນ ການບໍ ລິ ການ ທ່ີ ມີ ປະ ສິດ ທິ ພາບ ແລະ ປະ ສິດ ທິ ຜົນ ການ ວິ ເຄາະປະ ສິດ ທິ ພາບ ແລະ ປະ ສິດ ທິ ຜົນ ຂອງ ການ ບໍ ລິ ການ ​ເມື່ອ​ການ​ບ​ໍລ​ິການ​ກາໍ​ລງັ​ດາໍ​ເນນີ,​​ມນັ​ເປນັ​ປະ​ໂຫຍດ​ທີ​່ສຸດ​ໃນ​ການວ​ິເຄາະ​ຂັນ້​ຕອນ​ການ​ບ​ໍລ​ິການ​ແຕ່​ ລະ​ຂັນ້​ຕອນ​ແລະ​ສງັ​ເກດ​ແຕ​່ລະ​ຂັນ້​ຕອນ​ໃຊ​້ເວ​ລາ​ດນົ​ປານ​ໃດ.​​ການ​ປັບ​ປງຸ​ປະ​ສິດ​ທ​ິພາບ​ຂອງ​ຂັນ້​ ຕອນ​ການ​ບ​ໍລ​ິການ​ຄວນ​ເນັນ້​ໝັກ​ໃສ:່ •​ ການ​ສ່ົງ​ເສີມ​ການ​ເຮດັ​ວຽກ​ເປນັ​ທມີ​ທີ​່ດ;ີ •​ ​ວາງ​ແຜນ​ສິງ່​ທີ​່ສາ​ມາດ​ກະ​ກຽມ​ລວ່ງ​ໜາ້​ສາໍ​ລັບ​ແຕ​່ລະ​ຂັນ້​ຕອນ​ການ​ບ​ໍລ​ິການ. ​ຕາ​ຕະ​ລາງ​ຂາ້ງ​ລຸມ່​ນີ​້ໃຫ​້ບາງ​ຄາໍ​ແນະ​ນາໍ​ສາໍ​ລັບ​ວ​ິທ​ີປັບ​ປງຸ​ປະ​ສິດ​ທ​ິພາບ​ຂອງ​ການ​ບ​ໍລ​ິການ. ວິ ທີ ຕ່າງ ໆ ເພ່ືອ ປັບ ປຸງ ປະ ສິດ ທິ ພາບ ຂອງ ການ ບໍ ລິ ການ – ສໍາ ລັບ ແຕ່ ລະ ຂ້ັ ນ ຕອນ ໃນ ການ ໃຫ້ ບໍ ລິ ການ ລົດ ເຂັນ ການ​ນໍາ​ສົ່ງ​ •​ ​ກໍາ​ນົ​ດ​ເປົ້າ​ໝາຍ​ແລະ​ຄາດ​ໝາຍ​ໃຫ້​ຈະ​ແຈ້ງ​ສໍາ​ລັບ​ລະ​ດັບ​ຂອງ​ຄວາມ​ຕ້ອງ​ການທີ່​ ການ​ບໍ​ລິ​ການ​ຕ້ອງ​ການ​ບັນ​ລຸ​ໄດ້. •​ ຂໍ້​ຄວາມຈະ​ແຈ້ງ​ກ່ຽວ​ກັບວ່າການ​ບໍ​ລິ​ການ​ແມ່ນ​ສໍາ​ລັບ​ໃຜ. •​ ​ລະ​ບຸ​ອົງ​ການ​ນໍາ​ສ່ົງ​ທີ່ຫຼາກຫຼາຍ​ແລະ​​ອາ​ຊີບ​ສໍາ​ລັບ​ການເພ່ີມ​ຄວາມ​ຮັບ​ຮູ້ •​ ​ຕິດ​ຕາມ​ລະ​ດັບ​ຂອງ​ການ​ນໍາ​ສົ່ງ​ຢ່າງ​ໃກ້​ຊິດ. •​ ​ແບງ່​ປນັ​ເລືອ່​ງ​ເລົາ່​ຄວາມ​ສາໍ​ເລດັ​ກບັ​ພະ​ນກັ​ງານ​ໃຫ​້ບ​ໍລ​ິການ​ແລະ​ເຄືອ່​ຂາ່ຍ​ການ​ນາໍ​ ສົ່ງ​ເມື່ອ​ການ​ນໍາ​ສົ່ງ​ເພ່ີມຂຶ້ນ. ​ການ​ປະ​ເມີນ​ ຜົນ •​ ​ວາງ​ແຜນ​ລະ​ດັບ​ຂອງ​ການ​ຝຶກ​ອົບ​ຮົມ​ທີ່​ເໝາະ​ສົມ​ໃຫ້​ແກ່​ພະ​ນັກ​ງານ​ໃຫ້​ບໍ​ລິ​ການ. •​ ສ້າງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ່​ຮ່ວມ​ງານ​ໃນຊຸມ​ຊົມ​ເພ່ືອ​ໃຫ້​ການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ພ້ືນ​ ຖານ​ແລະ​ເບິ່ງ​ການ​ບໍ​ລິ​ການລະ​ດັບ​ປານ​ກາງ. •​ ​ຮັບ​ປະ​ກັນ​ວ່​າ​ມີອຸ​ປະ​ກອນ​ທັງ​ໝົ​ສໍາລັບ​ການດໍາ​ເນີນ​ການ​ປະ​ເມີນ​ຜົນ. ​ການ​ກໍາ​ນົດ​ໃຊ້​ ລົດ​ເຂັນ •​ ​ສ້າງ​ລະ​ບົບ​ຄວບ​ຄຸມ​ຄັງ​ລົດ​ເຂັນທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບ. •​ ​ຖ້າ​ຜະ​ລິດ​ຕະ​ພັນ​ມີ​ຄວາມ​ສາມາດ​ປັບ​ໄດ້​ຈໍາກັດ,​​ຕ້ອງ​ມີ​ການ​ກໍານົດການ​ດັດ​ແປງ​​ ເພື່ອ​ເຮັດ​ໃຫ້​ຜະ​ລິດ​ຕະ​ພັນ​ເໝາະ​ສົມກັບ​ຜູ້​ໃຊ້​ແຕ່​ລະ​ຄົນ. •​ ​ຮັບ​ປະ​ກັນ​ວ່າ​ພະ​ນັກ​ງານ​ໂອ້​ລົມ​ການ​ແກ້​ບັນ​ຫາ​ກ່ຽວ​ການ​ກໍາ​ນົດ​ໃຊ້​ກັບ​ຜູ້​ໃຊ້​ລົດ​ ເຂັນ,​​ແລະ​ຖ້າ​ເປັນ​ໄປ​ໄດ້​ສະ​ແດງ​ໃຫ້​ຜູ້​ໃຊ້​ເຫັນ​ທາງ​ເລືອກ​ຜະ​ລິດ​ຕະ​ພັນ​.​ນີ້​ຈະຫຼີກ​ ລຽງ​ການ​ແກ້​ໄຂ​ບັນ​ຫາ​ໂດຍ​ການ​ປະ​ຕິ​ເສດ​ຜູ້​ໃຊ້. •​ ສ້າງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ່​ຮ່ວມ​ງານ​ໃນຊຸມ​ຊົມ​ເພ່ືອ​ໃຫ້​ການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ພ້ືນ​ ຖານ​ແລະ​ເບິ່ງ​ການ​ບໍ​ລິ​ການລະ​ດັບ​ປານ​ກາງ. ​ການ​ໃຫ້​ທຶນ​ ແລະ​ການ​ສັ່ງ​ຊື້ •​ ບັນທຶກ​ຂໍ້​ມູນ​ເປັນ​ເອ​ກະ​ສານ​ຢ່າງ​ຈະ​ແຈ້ງ​ແລະ​ການ​ເກັບຮັກສາ​ບັນ​ທຶກ​. •​ ​ສ້າງ​ລະ​ບົບ​ຄວບ​ຄຸມ​ຄັງ​ລົດ​ເຂັນທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບ. 54 55 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ວິ ທີ ຕ່າງ ໆ ເພ່ືອ ປັບ ປຸງ ປະ ສິດ ທິ ພາບ ຂອງ ການ ບໍ ລິ ການ – ສໍາ ລັບ ແຕ່ ລະ ຂ້ັ ນ ຕອນ ໃນ ການ ໃຫ້ ບໍ ລິ ການ ລົດ ເຂັນ ​ການ​ກະ​ກຽມ​ຜະ​ ລດິ​ຕະ​ພັນ •​ ຊອກ​ຫາ​ຜະ​ລດິ​ຕະ​ພັນ​ທີມ່​ີຄວາມສາ​ມາດ​ປບັ​ໄດຫ້າຼຍ​ທີ​່ສດຸ​ເທົາ່​ທີ​່ຈະ​ເປນັ​ໄປ​ໄດ.້ •​ ​ຊອກ​ຫາ​ຜະ​ລດິ​ຕະ​ພັນ​ທີ​່ສາ​ມາດ​ດດັ​ແປງ​ໄດ​້ງາ່ຍ. •​ ຜະລດິ​ອ​ຸປະ​ກອນ​ຮອງ​ຮບັ​ທາ່​ທາງ​ທີ​່ກຽມ​ໄວ​້ແລະ/ຫຼ​ືຊອກ​ຫາ​ຜະ​ລດິ​ຕະ​ພັນ​ທີ​່ມອີປຸະກອນ​PSD. •​ ​ຊອກ​ເຄືອ່ງ​ມ​ືທີ​່ເໝາະ​ສມົ​ສາໍ​ລບັ​ການ​ເຮດັ​ການ​ດບັປບັ​ຜະ​ລດິ​ຕະ​ພັນ​ໄດຢ້າ່ງວອ່ງ​ໄວ. •​ ​ຊອກຫາວດັສະດທຸີເ່ໝາະສມົສາໍລບັການເຮດັເບາະນັງ່​ແລະ​ອປຸະກອນ​PSD​ແລະ​ ການດດັແປງຕາ່ງໆ. •​ ​ສາ້ງ​ລະ​ບບົ​ຄວບ​ຄມຸ​ຄງັ​ລດົ​ເຂນັທີ​່ມ​ີປະ​ສດິ​ທ​ິພາບ. •​ ​ກະ​ກຽມ​ຄງັ​ລດົ​ເຂນັ​ຂະໜາດນອ້ຍ​ໃນ​ຂະ​ໜາດ​ທີ​່ແຕກ​ຕາ່ງ​ກນັ. •​ ສາ້ງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ​່ຮວ່ມ​ງານ​ໃນຊມຸ​ຊມົ​ເພືອ່​ໃຫ​້ການ​ບ​ໍລ​ິການ​ລະ​ດບັ​ພ້ືນ​ຖານ​ແລະ​ເບິງ່​ ການ​ບ​ໍລ​ິການລະ​ດບັ​ປານ​ກາງ. ​ການ​ປບັ​ໃຫ້​ ເໝາະ​ສົມ •​ ທມີ​ປິນ່​ປວົ​ແລະ​ທມີ​ເຕກັ​ນກິ​ເຮດັ​ວຽກ​ຮວ່​ມ​ກນັ​ໃນ​ລະ​ຫວາ່ງ​ທີ​່ປບັ​ໃຫ​້ເໝາະ​ສມົ. •​ ​ກະກຽມຕວົ​ເລອືກ​ຕິດ​ຕັງ້​ຜະ​ລດິ​ຕະ​ພັນ​ຕວົ​ຢາ່ງ​ໄວ​້ກອ່ນ. •​ ຊອກ​ຫາ​ຜະ​ລດິ​ຕະ​ພັນ​ທີມ່​ີຄວາມສາ​ມາດ​ປບັ​ໄດຫ້າຼຍ​ທີ​່ສດຸ​ເທົາ່​ທີ​່ຈະ​ເປນັ​ໄປ​ໄດ.້ •​ ​ຊອກ​ເຄືອ່ງ​ມ​ືທີ​່ເໝາະ​ສມົ​ສາໍ​ລບັ​ການ​ເຮດັ​ການ​ດບັປບັ​ຜະ​ລດິ​ຕະ​ພັນ​ໄດຢ້າ່ງວອ່ງ​ໄວ. •​ ​ຊອກ​ຫາ​ຜະ​ລດິ​ຕະ​ພັນ​ທີ​່ສາ​ມາດ​ດດັ​ແປງ​ໄດ​້ງາ່ຍ. •​ ສາ້ງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ​່ຮວ່ມ​ງານ​ໃນຊມຸ​ຊມົ​ເພືອ່​ໃຫ​້ການ​ບ​ໍລ​ິການ​ລະ​ດບັ​ພ້ືນ​ຖານ​ແລະ​ເບິງ່​ ການ​ບ​ໍລ​ິການລະ​ດບັ​ປານ​ກາງ. ​ການ​ຝກຶ​ອບົ​ຮມົ​ຜູ້​ ໃຊ້ •​ ​ມອບ​ໝາຍການ​ຝຶກ​ອບົ​ຮມົ​ຜູ​້ໃຊ​້ໃຫ​້ບ​ຸກ​ຄນົ​ສະ​ເພາະ,​​ຕວົ​ຢາ່ງ​​ຜູ​້ຊວ່ຍ​ຄ​ູຝຶກ. •​ ​ລະ​ບ​ຸສະ​ຖານ​ທີສ່າໍ​ລບັ​ການ​ຝກຶ​ອບົ​ຮມົ​ຜູ​້ໃຊ​້ໃກ​້ກບັ​ພືນ້​ທີ​່ປິນ່​ປວົ​ແລະ​ເຕກັ​ນກິ. •​ ສາ້ງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ​່ຮວ່ມ​ງານ​ໃນຊມຸ​ຊມົ​ເພືອ່​ໃຫ​້ການ​ບ​ໍລ​ິການ​ລະ​ດບັ​ພ້ືນ​ຖານ​ແລະ​ເບິງ່​ ການ​ບ​ໍລ​ິການລະ​ດບັ​ປານ​ກາງ. ​ການ​ຕດິ​ຕາມຜນົ •​ ​ສາ້ງ​ຄວາມ​ອາດສາ​ມາດ​ໃຫ​້ຄູ​່ຮວ່ມ​ງານ​ໃນ​ຊມຸ​ຊມົ​ເພືອ່​ຕິດ​ຕາມ​ລກູ​ຄາ້​ໃນ​ຊມຸ​ຊນົ,​​ການ​ນາໍ​ສົງ່​ກບັ​ ໄປ​ຫາ​ການ​ບ​ໍລ​ິການ​ເມືອ່​ບນັ​ຫາ​ຖກື​ລະ​ບ​ຸວາ່​ບໍ​່ສາ​ມາດ​ແກ​້ໄຂ​ໄດ​້ຢູ​່ໃນ​ລະ​ດບັ​ຊມຸ​ຊມົ.​ ​ໂດຍ​ລວມ •​ ​ຈດັ​ກອງ​ປະ​ຊມຸ​ປະ​ຈາໍ​ທມີ​ເພ່ືອ​ຮວ່ມ​ກນັ​ສາ້ງ​ແຜນ​ວຽກ. •​ ​ຈດັ​ຕາ​ຕະ​ລາງ​ທີ​່ຈະ​ແຈງ້​ສາໍ​ລບັ​ການ​ເຮດັ​ວຽກ​ຮວ່ມ​ກນັ. •​ ບນັທກຶ​ຂໍ​້ມນູ​ເປນັ​ເອ​ກະ​ສານ​ຢາ່ງ​ຈະ​ແຈງ້​ແລະ​ການ​ເກບັຮກັສາ​ບນັ​ທກຶ​ •​ ສາ້ງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ​່ຮວ່ມ​ງານ​ໃນຊມຸ​ຊມົ​ເພືອ່​ໃຫ​້ການ​ບ​ໍລ​ິການ​ລະ​ດບັ​ພ້ືນ​ຖານ​ແລະ​ເບິງ່​ ການ​ບ​ໍລ​ິການລະ​ດບັ​ປານ​ກາງ. ການ ປ່ຽນ ຈາກ ການ ບໍ ລິ ການ ລະ ດັບ ພ້ືນ ຖານ ເທ່ົາ ນ້ັນ ໄປ ເປັນ ການ ບໍ ລິ ການ ລະ ດັບ ພ້ືນ ຖານ ແລະ ລະ ດັບ ປານ ກາງ ​ການ​ບ​ໍລ​ິການລົດ​ເຂນັຫາຼຍ​ຄນົ​ເລີມ່​ຕົນ້​ໂດຍ​ການ​ສະ​ເໜ​ີການ​ໃຫ​້ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ລ​ະ​ດັບ​ພືນ້​ຖານ​ ເທົາ່​ນັນ້.​​ນີ​້ເປນັ​ສະ​ຖານ​ທີ​່ທີ​່ດ​ີເພື່ອ​ເລີມ່​ຕ້ົນ,​​ເປນັ​ການ​ບ​ໍລ​ິການ​ທີ​່ສາ​ມາດ​ເນັນ້​ໝັກ​ໃສ​່ການ​ສາ້ງ​ລະ​ ບົບ​ກຽ່ວ​ຂອ້ງ​ກັບ​ການ​ນາໍ​ສົງ່​ແປດ​ຂັນ້​ຕອນ,​​ແລະ​ບກຸ​ຄະ​ລາ​ກອນ​ສາ​ມາດ​ໄດ​້ຮບັ​ປະ​ສົບ​ການ. 54 55 ​ແນວ​ໃດ​ກໍ​່ຕາມ,​​ຕາມ​ທີ​່ໄດ​້ກາ່ວ​ໄວ​້ຂາ້ງ​ເທງິ,​​ການ​ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ຈາໍ​ນວນຫາຼຍ​ຈະ​ພົບ​ຄວາມ​ຕອ້ງ​ ການ​ສໍາ​ລັບ​ການ​ໃຫ​້ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ລະ​ດັບ​ປານ​ກາງ.​​ນີ​້ບໍ​່ໜາ້​ແປກ​ໃຈ,​​ຕາມ​ທີ​່ມນັ​ຖກື​ປະ​ມານ​ທີ​່35%​ ຂອ​ງ​ຄວາມ​ຕອ້ງ​ການ​ຜູ​້ໃຊ​້ແມນ່​ລະ​ດັບ​ພ້ືນ​ຖານ​ແລະ​65%​ແມນ່ລະ​ດັບ​ປານ​ກາງ​ຫຼ​ືລະ​ດັບ​ສງູ. ​ດັງ່​ນັນ້,​​ເປນັ​ໄປ​ໄດ​້ທີ່ຜູ​້ຈດັ​ການ​ຝາ່ຍບ​ໍລ​ິການ​ຈາໍ​ເປນັ​ຕອ້ງ​ເລີມ່​ຕົນ້​ໃນ​ການ​ວາງ​ແຜນ​ສາໍ​ລັບ​ວ​ິທ​ີໃຫ້​ ພວກ​ເຂາົ​ສາ​ມາດ​ຕອບ​ສະ​ໜອງ​ຄວາມ​ຕ້ອງ​ການ​ທີ​່ຢູ​່ໃນ​ລະ​ດັບ​ປານ​ກາງ​ພາຍ​ໃນ​ການ​ບ​ໍລ​ິການ​ ເຂາົເຈົາ້.​ຕາມ​ທີ​່ໄດ​້ກາ່ວ​ໄວ​້ກ່ອນ​ໜາ້​ນີ,້​​ການ​ບ​ໍລ​ິການ​ລະ​ດັບ​ປານ​ກາງ​ຈາໍ​ເປນັ​ຕ້ອງ​ມ:ີ •​ ​ບກຸ​ຄະ​ລາ​ກອນ​ທີ​່ມ​ີການ​ຝກຶ​ອບົ​ຮມົ​ທີ​່ເໝາະ​ສມົ •​ ​ສິງ່​ອາໍ​ນວຍຄວາມ​ສະ​ດວກ,​ອ​ຸປະ​ກອນ​ແລະ​ວັດ​ສະ​ດ.ຸ ​ບາງບາງ​ຍຸດ​ທະ​ສາດ​ທີ​່ເປນັ​ໄປ​ໄດ​້ສາໍ​ລັບ​ຜູ​້ຈດັ​ການ​ເພ່ືອ​ພິ​ຈາ​ລະ​ນາ​ເມື່ອ​ການ​ຫນັ​ປຽ່ນ​ຈາກ​ການ​ບ​ໍລິ​ ການ​ລະ​ດັບ​ພືນ້​ຖານ​ໄປ​ຍງັ​ບ​ໍລ​ິການ​ລະ​ດັບ​ປານ​ກາງ​ລວມ​ມ:ີ •​ ​ເຮດັ​ວຽກ​ຮວ່ມ​ກັບ​ບກຸ​ຄະ​ລາ​ກອນ​ເພ່ືອ​ລະ​ບ​ຸສາ​ມາດ​ສະ​ເໜ​ີການ​ບ​ໍລ​ິການ​ລະ​ດັບ​ປານ​ກາງ​​ໄດ້​ ແນວ​ໃດ.​ພ​ິຈາ​ລະ​ນາ​ເພ່ີມ​ສິງ່​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ອ​ຸປະ​ກອນ​ທີ​່ຈາໍ​ເປນັ,​​ແລະ​ຮບູ​ແບ​ບ​ ການ​ບ​ໍລ​ິການ​ທີ​່ຈະ​ໃຊ.້ •​ ​ລະ​ບ​ຸວາ່​ບກຸ​ຄະ​ລາ​ກອນ​ທີ​່ໃຫ​້ການ​ບ​ໍລ​ິການ​ລະ​ດັບ​ພ້ືນ​ຖານ​ມ​ີຄວາມ​ສາ​ມາດ​ໃນ​ການ​ໃຫ​້ບ​ໍລ​ິການ​ ລະ​ດັບ​ປານ​ກາງ​ດວ້ຍ​ການ​ຝກຶ​ອບົ​ຮມົ​ເພ່ີມ​ເຕມີ.​​ຖາ້​ແມນ່​– ​ລະ​ບ​ຸແລະ​ຝກຶ​ບກຸ​ຄະ​ລາ​ກອນປຽ່ນ​ ແທນ​ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ​ລະ​ດັບ​ພ້ື​ນ​ຖານ​ກ່ອນ;​​ແລະ​ຈາກ​ນັນ້​ຝກຶ​ບກຸ​ຄະ​ລາ​ກອນ​ລະ​ດັບ​ປານ​ ກາງທີ​່ໄດລ້ະ​ບ​ຸໄວ.້ •​ ​ພ​ິຈາ​ລະ​ນາ​ວາ່​ມນັ​ເປນັ​ໄປ​ໄດ້ຫຼືບໍ່ທີ​່ຈະ​ຮວ່ມ​ມ​ືກັບ​ອງົ​ການ​ອືນ່​-​ຖາ້​ການ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ​ບໍ​່ສ​າ​ ມາດ​ລະ​ກາໍນົດ​ພະນັກງານ​ໄດ​້ຫຼ​ືບໍ​່ມ​ີທນຶ​ວາ່​ຈາ້ງ​ພະນັກງານເພ່ີມ​ອກີ. C.3: ການ ວາງ ແຜນ ການ ຕິ ດ ຕ າມຜົນ ການ​ຕິດ​ຕາມ​ຜນົ​ແມນ່​ຂັນ້​ຕອນ​ທ​ີແປດໃນ​ກາ​ນ​ສະ​ໜອງ​ລົດ​ເຂນັ.​​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ທງັ​ໝົດ​ໄດ​້ຮບັ​ຜນົ​ປະ​ ໂຫຍດ​ຈາກ​ການ​ຖກື​ຕິດ​ຕາມຜນົ.​​ມນັ​ເປນັ​ສິງ່​ສາໍ​ຄນັ​ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ​ທີ​່ຕອ້ງ​ມ​ີແຜນ​ສາໍ​ລັບ​ຈະ​ດາໍ​ ເນນີ​ການ​ຕິດ​ຕາມ​ແນວ​ໃດ.​​ໃນ​ລະ​ຫວາ່ງ​ການ​ຕິດ​ຕາມ,​​ການ​ບ​ໍລ​ິການ​ຍງັ​ໄດ​້ຮບັ​ຜນົ​ປະ​ໂຫຍດ​ຈາກ​ໂອ​ ກາດ​ເພື່ອ​ຮຽນ​ຮູ​້ກຽ່ວ​ກັບ​ຜນົ​ກະ​ທົບ​ຂອງ​ການ​ບ​ໍລ​ິການ​ຕໍ​່ຜູ້​ໃຊ,້​​ສະ​ມາ​ຊກິ​ໃນ​ຄອບ​ຄວົ​ແລະ​ຊມຸ​ຊມົ​ ຂອງ​ເຂາົ​ເຈົາ້ 8.​ການ​ຕິດ​ຕາມ​ ຜົນ,​​ການ​ບໍາ​ລຸງ​ ຮັກ​ສາ​ແລະ​ ການ​ສ້ອມ​ແປງ ການ​ນັດ​ໝາຍ​ເພ່ືອ​ຕິດຕາມ​ຜົນ​ແມ່ນ​ໂອກາດ​ໃນການກວດ​ເບິ່ງ​ ວ່າ​ລົດ​ເຂັນ​ເໝາະ​ສົມ​ດີ​ຫຼືບໍ່​​ແລະ​ໃຫ້ການ​ຝຶກ​ອົບຮົມ​​ແລະ​ການ​ ຊ່ວຍ​ເຫຼືອ​ເພີ່ມ​ເຕີມ.​ກໍານົດ​ເວລາ​ແມ່ນ​ຂຶ້ນ​ກັບ​ຄວາມ​ຕ້ອງການ​ ຂອງ​ຜູ້​ໃຊ້​​ແລະ​ການ​ບໍລິການ​ອື່ນ​ທີ່​ມີ​ໃຫ້​ແກ່​ເຂົາ​ເຈົ້າ.​ນອກ​ນັ້ນ​ ການ​ບໍລິການ​ອາດ​ຈະ​ໃຫ້ການ​ບໍາລຸງ​ຮັກສາ​​ແລະ​ການ​ສ້ອມ​ແປງ​ ສໍາລັບ​ບັນຫາ​ດ້ານ​ເຕັກນິກ​ທີ່​ບໍ່​ສາມາດ​ແກ້​ໄຂ​ໄດ້​ຢ່າງ​ງ່າຍ​ດານ​ ຍຢູ່​ໃນ​ຊຸມ​ຊົນ.​ 56 57 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ຄວາມສໍາຄັນຂອງການຕິດຕາມຜົນ ບາງຕົວຢ່າງກ່ຽວ ກັບ ວ່າ ຍ້ອນ ຫຍັງການຕິດຕາມຜົນ ຈ່ິງສໍາຄັນ Duli: ແມ່ນແມ່ຍິງອາຍຸ 21 ປີ ທ່ີອາໄສຢູ່ກັບຄອບຄົວຂອງລາວ.​ໃນການຕິດຕາມຜົນ,​ທີມງານ ພົບວ່າລາວບໍ່ສາມາດອອກຈາກເຮືອນຂອງລາວໄດ້ເພາະວ່າ​ລົດເຂັນຂອງລາວຢາງຮ່ົວ​ເນື່ອງ​ຈາກ​ມີ​ ແນວ​ແທງ.​ລົດເຂັນຖືກປະຖິ້ມໄວ້ຢູ່ກ້ອງເຮືອນ.​ສ້ອມແປງຢາງລໍ້​ແລະໃຫ້ຄໍາແນະນໍາແກ່ຄອບຄົວ.​ Duli​ສາມາດອອກຈາກເຮືອນຂອງລາວໄດ້ອີກຄັ້ງ.​​ຄອບ​ຄົວ​ບໍ່​ໃຫ້​ຄວາມ​ສໍາ​ຄັນ​ຕໍ່​ການ​ຕິດ​ຕາມ​ຜົນ​ຈົນ​ ກວ່າ​ວ່າ​ພວກ​ເຂົາ​ເຫັນ​ຜົນ​ປະ​ໂຫຍດ.​ທີມ​ງານ​ບໍ​ລິ​ການ​ໄດ້​ຕັດ​ສິນ​ໃຈ​ສ້າງ​ສະ​ຕິກ​ເກີ​ທີ່​ມີ​ເບີ​ໂທ​ຕິດ​ຕໍ່​ການ​ ບໍ​ລິ​ການ​ໃຫ້​ແກ່​ລົດ​ເຂັນ​ທຸ​ກ​ຄັນ​ເພື່ອຫຼຸດ​ຜ່ອນບັນ​ຫາ​ນີ້​ໃນ​ອະ​ນາ​ຄົດ. Maria: ໄດ້ ຮັບລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ 9 ເດືອນຫັຼງ ຈາກ ມີ ອາ ການ ບາດ ເຈັບ ໄຂ ສັນຫັຼງ.​​ໃນ​ການ​ຕິດ​ ຕາມ,​​ລາວຮູ້​ສຶກ​ອືດ​ອັດ​ແລະ​ປະ​ສົບ​ກັບ​ບັນ​ຫາ​ກ້າມ​ຊີນ​ຊັກກະຕຸກ,​​ເຊິ່ງ​ລາວຄິດ​ວ່າ​ອັນ​ເນື່ອງ​ມາ​ຈາກ​ ລົດ​ເຂັນ.​ມີ​ການ​ພົບ​ວ່າ​ແມງ​ໄມ້​ໄດ້​ອາ​ໄສ​ຢູ່​ໃນ​ແນວ​ຫຸ້ມ​ເບາະ​ລົດ​ເຂັນ​​ແລະ​ກັດ​ລາວ.​​ນີ້​ອາດ​ນໍາ​ໄປ​ສູ່​ຜົນ​ ກະ​ທົບ​ດ້ານ​ສຸ​ຂະ​ພາບ​ທີ່​ຮ້າຍ​ແຮງ​ແລະການ​ປະ​ຖິ້ມ​ຜະ​ລິດ​ຕະ​ພັນ.​​ແນວ​ໃດ​ກໍ່​ຕາມ,​​ບັນ​ຫາ​ໄດ້​ຖືກ​ລະ​ບຸ​ ແລະ​ແກ້​ໄຂ​​ແລະ​ຕອນ​ນີ້​Maria​ມີສຸ​ຂະ​ພາບ​ດີ​ແລະ​ມີ​ຄວາມ​ສຸກ​ກັບ​ລົດ​ເຂັນ​ຂອງ​ລາວ. Anton: ​ເປັນ​ທີ່​ຮູ້​ຈັກ​ກັນ​ໃນ​ຊຸມ​ຊົມ​ຂອງ​ລາວ​ສໍາ​ລັບ​ຄວາມ​ສາ​ມາດ​ຂອງ​ລາວ​ໃນ​ຖາ​ນະ​ເປັນ​ນັກ​ກິ​ລາ​ ຣັກ​ບີ້.​​ຈາກ​ນັ້ນ​ລາວ​ ໄດ້ ຮັບ ບາດ ເຈັບ ຈາກ ກິ ລາ ຣັກ ບ້ີ, ເຮັດ ໃຫ້ ເກີດ ອາ ການ ບາດ ເຈັບ ໄຂ ສັນຫັຼງ. ລາວ​ໄດ້​ຮັບລົດ​ເຂັນ​ທີ່​ເໝາະ​ສົມ​ແລະ​ການ​ຝຶກ​ອົບ​ຮົມ​ຜູ້​ໃຊ້​ແຕ່​ໃນ​ການ​ຕິດ​ຕາມ​ຜົນ​ມັນ​ຖືກ​ພົບ​ວ່າ​ລາວ​ບໍ່​ ໄດ້​ອອກ​ຈາກ​ເຮືອນ​ຂອງ​ລາວ.​​ຜູ້​ຊ່ວຍ​ຄູ​ຝຶກ​ເປັນ​ສ່ວນ​ໜຶ່ງ​ຂອງ​ທີມ​ຕິດ​ຕາມ​ຜົນ​​ແລະ​ໃຊ້​ເວ​ລາ​ໂອ້​ລົມ​ກັບ​ Anton​​ແລະ​ໄດ້​ພົບ​ວ່າ​​ລາວ​ໄດ້​ມີ​ການ​ສູນ​ເສຍ​ຄວາມ​ເຊື່ອ​ໝ້ັນ​ແລະ​ບໍ່​ຕ້ອງ​ການ​ພົບໝູ່​ເພ່ືອນ​ຂອງ​ລາວ.​​ ລາວ​ຮູ້​ສຶກ​ໂດດ​ດ່ຽວ,​​ເຫງົາ​ແລະ​ໜ້າ​ອາຍ​ກ່ຽວ​“​ການ​ເປັນ​ຄົນ​ພິ​ການ”.​​ຜູ້​ຊ່ວຍ​ຄູ​ຝຶກ​​ກັບ​ມາ​ໃນ​ວັນ​ຖັດ​ ໄປ​ເພື່ອ​ອອກ​ໄປ​ຂ້າງນອກ​ກັບ​ລາວ​ໃນ​ຄັ້ງ​ທໍາ​ອິດ.​​ຕັ້ງ​ແຕ່​ວັນ​ນັ້ນ,​ຊີ​ວິດ​ຂອງ​Anton​​ໄດ້​ກ້າວ​ໄປ​ໜ້າ. Gihan: ​ແມ່ນ​ເດັກ​ຜູ້​ຊາຍ​ອາ​ຍຸ​3​ປີ​ອາ​ໄສ​ຢູ່​ກັບ​ພ່ໍ​ແມ່​ແລະ​ອ້າຍ​ຂອງ​ລາວ.​​ຕາມ​ທີ່​ຕິດ​ຕາມ​ຜົນ,​​ຄົ້ນ​ພົບ​ ບ່ອນນັ່ງ​ຮອງ​ຮັບ​ຂອງ​ລາວ​ຖືກ​ປົກ​ຄຸມ​ໃນ​ອາ​ຫານ,​​ແລະ​ບໍ່​ໄດ້​ຮັບ​ການ​ບໍາ​ລຸງ​ຮັກ​ສາ.​ ພໍ່ແມ່ຂອງລາວລາຍງານວ່າ​Gihan​ມີຄວາມລໍາບາກໃນການນັ່ງໃຫ້ຊື່​ແລະຮູ້ສຶກອືດອັດໃນລົດ​ເຂັນ.​ ພວກເຂົາສູນເສຍຄວາມ​ເຊື່ອ​ໝັ້ນໃນຜະລິດຕະພັນ​ແລະບໍ່ມັກມັນ.​Gihan​ໄດ້ຖືກຈ່ອງສໍາລັບການປະ ເມີນຜົນຄືນກັບທີມງານຜູ້ທີ່ໄດ້ຮັບການຝຶກອົບຮົບ​ລະດັບປານກາງ.​ການ​ປັບ​ປ່ຽນ​ຖືກ​ເຮັດ​ກັບ​ການ​ຕິດ​ ຕັ້ງ​ລົດ​ເຂັນ​ແລະ​Gihan​​ສາ​ມາດ​ນັ່ງ​ໃຫ້​ຊື່​ແລະ​ເລີ່ມ​ເບິ່ງ​ອ້ອມ​ຮອບ​ແລະ​ສໍາຫຼວດ​ສະ​ພາບ​ແວດ​ລ້ອມ​ ຂອງ​ລາວ.​Gihan​ແລະ​ພ່ໍ​ແມ່​ຂອງ​ລາວ​ມີ​ຄວາມ​ສຸກຫຼາຍ​ແລະ​ເບິ່ງ​ຢ່າງ​ໃກ້ຊິດ​ເມື່ອ​ພວກ​ເຂົາ​ສະ​ແດງວິ​ ທີ​ການ​ດູ​ແລ​ແລະ​ບໍາ​ລຸງ​ຮັກ​ສາ​ລົດ​ເຂັນ​ຂອງ​Gihan. ຜົນ ປະ ໂຫຍດ ຂອງ ການ ຕິດ ຕາມ ຜົນ ສໍາ ລັບ ຜູ້ ໃຊ້ ແລະ ການ ບໍ ລິ ການ •​ ພະນັກງານ​ສາ​ມາດ​ຢືນ​ຢັນ​ໄດ້​ຫຼື​ບໍ​ວ່າ​ລົດ​ເຂັນ​ແມ່ນ​ການ​ຕອບ​ສະ​ໜອງ​ຄວາມ​ຕ້ອງ​ການ​ຂອງ​ຜູ້​ໃຊ້​ໃນ​ ສະ​ພາບ​ແວດ​ລ້ອມ​ຂອງ​ຕົນ​ເອງ. •​ ​ການ​ໄປ​ຢ້ຽມ​ຢາມເຮືອນ​ແລະ​ຊຸມ​ຊົນ​ແມ່ນ​ໂອ​ກາດ​ທີ່​ດີ​ເພື່ອ​ເກັບ​ເອົາ​ເລື່ອ​ງ​ເລົ່າ​ຂອງ​ຜູ້​ໃຊ້​– ​ເຊິ່ງ​ ສາມາດເຮັດເພື່ອ​ໃຫ້​ຄໍາ​ເຫັນ​ຕິ​ຊົມ​ແລະ​ຊ່ວຍໃນເລື່ອງການ​ລະ​ດົມ​ທຶນ. •​ ​ການ​ຕິດ​ຕາມ​ຜົນ​ທີ່​ເອົາ​ສູນ​ເປັນ​ພື້ນ​ຖານ​ແມ່ນ​ຍັງ​ມີ​ໂອ​ກາດ​ເກັບ​ເອົາ​ເລື່ອງ​ເລົ່າ​ຂອງ​ຜູ້​ໃຊ້​ເພ່ືອ​ໃຫ້​ຄໍາ​ ເຫັນ​ຕິ​ຊົມ​ສໍາ​ລັບ​ການ​ບໍ​ລິ​ການ​ແລະ​ຊ່ວຍ​ເຫຼືອ​ດ້ວຍ​ການ​ລະ​ດົມ​ທຶນ. 56 57 ຈຸດ ປະ ສົງ ຂອງ ການ ຕິດ ຕາມ ຜົນ ແລະ ບ່ອນ ທ່ີ ມັນ ຄວນ ເກີດ ຂ້ືນ ​ຈດຸ​ປະ​ສງົ​ຂອງ​ການ​ຕິດ​ຕາມ​ຜນົ​ແມນ່​ເພ່ືອ: •​​​ເກັບ​ເອາົ​ຂໍ​້ມນູ​ຈາກ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ •​​​ກວດ​ເບິງ່ວາ່​ລົດ​ເຂນັ​ຢູ​່ໃນ​ສະພາບໃຊງ້ານໄດ​້ດີ​ •​​​ກວດ​ເບິງ່​ຄວາມ​ເໝາະ​ສມົ​ຂອງ​ລົດ​ເຂນັ. ການ ດໍາ ເນີນ ການ ຕິດ ຕາມ ຜົນ ທ່ົວ ໄປ ​ບາງ​ການ​ດາໍ​ເນນີ​ການ​ທົ່ວ​ໄປ​ທີ່​ເກີດ​ຂືນ້​ຈາກ​ການ​ ໄປ​ຢຽ້ມ​ຢາມ​ການ​ຕິດ​ຕາມ​ຜົນ​ແມນ່: •​ ​ໃຫ້​ຄະ​ແນະ​ນໍາ​ຫຼື​ການ​ຝຶກ​ອົບ​ຮົມ​ເພ່ີມ​ເຕີມ •​ ​ປັບ​ລົດ​ເຂັນ​ຄືນ​ໃໝ່ •​ ​ດໍາ​ເນີນ​ການ​ສ້ອມ​ແປງ​ຂະ​ໜາດ​ນ້ອຍ •​ ​ນໍາ​ສົ່ງຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຫາ​ການ​ບໍ​ລິ​ການ​ອື່ນ​ສໍາ​ລັບ​ການ​ ສະ​ໜັບ​ສະ​ໜູນ​ຫຼື​ຊ່ວຍ​ເຫຼືອ​ຖ້າ​ຈໍາ​ເປັນ. ໃນທກຸບ່ອນທີເ່ປນັ​ໄປ​ໄດ,້​​ການ​ນັດ​ໝາຍ​ເພ່ືອ​ຕ​ິດ​ຕາມ​ຜນົ​ບໍ​່ຄວນປຽ່ນເປນັ​ການ​ປະ​ເມນີ​ຜົນ​ໃໝ່​ຫຼື​ ການ​ຕບົ​ແຕງ່ລົດ​ເຂນັ​ຢາ່ງ​ເຕມັຮບູ​ແບບ.​​ຖາ້​ມີການລະບຸຄວາມຈາໍ​ເປນັ​ຕອ້ງ​ດາໍ​ເນນີ​ການ​ປະ​ເມນີ​ ຜນົ​ຢາ່ງ​ເຕມັ​ຮບູ​ແບບ,​ຫຼ​ືເຮດັ​ວຽກ​ທີ​່ສາໍ​ຄ​ັນ​ກັບ​ລົດ​ເຂນັ​– ​ກໍ່ຄວນເຮດັການ​ນັດ​ໝາຍ​ສໍາລັບສິງ່ນັນ້. ການ ຕິດ ຕາມ ຜົນຄວ ນ ເກີດ ຂ້ືນ ຢູ່ໃສ? ​ການ​ຕິດ​ຕາມ​ຜນົ​ສາ​ມາດ​ເກີດ​ຂືນ້​ຢູ​່ເຮອືນຂອງ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ​ຫຼ​ືຢູ​່ສນູ​ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ຫຼ​ືທກຸ​ສະ​ຖານ​ ທີ​່ອືນ່ໆ​ທີ​່ເໝາະ​ສົມ​ກັບ​ຜູ້​ໃຊ​້ລົດ​ເຂນັ​ແລະ​ພະ​ນັກ​ງານ​ໃຫ​້ບ​ໍລ​ິການ​ລົດ​ເຂນັ. ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມ​ຜນົໃນ​ສະ​ຖານ​ທີ​່ທີ​່ແຕກ​ຕາ່ງ​ກນັ​ແມນ່​ໄດ​້ລະ​ບ​ຸໄວ​້ໃນ​ຕາ​ຕະ​ລາງ​ລຸມ່​ນີ.້ 58 59 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ຜົນ ປະ ໂຫຍດ ຂອງ ການ ຕິດ ຕາມ ຜົນຢູ່ ເຮືອນ ຂອງ ຜູ້ ໃຊ້ ຫືຼ ຊຸມ ຊົມ ທ້ອ ງ ຖ່ິນ ຜົນ ປະ ໂຫຍດ ຂອງ ການ ຕິດ ຕາມ ຜົນ ຢູ່ ສູນ ບໍ ລິ ການ •​ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ເພ່ີມ​ຂື້ນ​ມີ​ຜົນ​ຕໍ່​ຜູ້​ໃຊ້​ແລະ​ຄອບ​ຄົວ​ ຂອງ​ພວກ​ເຂົາ. •​ ພະນັກງານຮຽນຮູ້ເພີ່ມເຕີມກ່ຽວກັບອຸປະສັກຕໍ ່ ກັບການມີສ່ວນຮ່ວມ​ແລະການເຂົ້າຮ່ວມ​ ທີ່ຜູ້ຄົນພະເຊີນຢູ່ໃນເຮືອນ​ ແລະຊຸມຊົມຂອງເຂົາເຈົ້າ. •​ ການເຫັນພະນັກງານດໍາເນີນການ​ ສາມາດເພີ່ມຄວາມຮັບຮູ້ຂອງຊຸມຊົມ​-​ ແລະດັ່ງນັ້ນ​ເພ່ີມການນໍາສ່ົງ. •​ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ແລະ​ເວ​ລາ​ເພີ່ມ​ຂື້ນ​ມີ​ຜົນ​ຕໍ່​ພະ​ນັກ​ ງານ/ການ​ບໍ​ລິ​ການ. •​ ສາມາດດໍາເນີນການສ້ອມແປງຂະໜາດໃຫ່ຍ ດວ້ຍສິງ່ອາໍນວຍຄວາມສະດວກຄບົຖວ້ນຂອງໂຮ ງສ້ອມແປງ. •​ ມີການຕິດຕັ້ງທຸກອຸປະກອນ​ແລະ​ສິ່ງອໍານວຍ ຄວາມສະດວກທັງໝົດໄວ້ແລ້ວ. •​ ພະນັກງານຜູ້ອື່ນ​ແມ່ນມີໃຫ້ສໍາລັບຄວາມຄິດ​ສໍາ​ ຮອງ ການວາງແຜນການຕິດຕາມຜົນ ຜູໃ້ຊລ້ົດເຂນັທງັໝົດໄດຮ້ບັຜນົປະໂຫຍດຈາກການຕິດຕາມຜົນ.​ແນວໃດກໍ່ຕາມ,​ການຕິດຕາມຜນົແ ມນ່ສາໍຄນັທີສຸ່ດສາໍລັບ: •​ ເດັກນ້ອຍທີ່ມີຄວາມພິການ; •​ ຜູ້ໃຊ້ລົດເຂັນທີ່ມີຄວາມສ່ຽງເກີດແຜກົດທັບ; •​ ຜູ້ໃຊ້ລົດເຂັນຜູ້ທີ່ມີສະພາບອາການຮ້າຍແຮງ ຂື້ນ; •​ ຜູ້ໃຊ້ລົດເຂັນຜູ້ທີ່ຕ້ອງການສະໜັບສະໜູນເປັນ ພິເສດໃນລົດເຂັນຂອງ​ເຂົາ​ເຈົ້າ​ (ລະດັບປານກາງ); •​ ຜູ້ໃຊ້ລົດເຂັນຜູ້ທີ່ມີຄວາມລໍາບາກກັບການຝຶກ ອບົຮບົໃນການເຄືອ່ນຍາ້ຍ,​ເຄືອ່ນໄຫວໄປມາ,​​ ດ​ູແລສຸຂະພາບ​ແລະການບາໍລງຸຮກັສາລດົເຂນັ. ການກໍານົດເວລາຂອງການຕິດຕາມຜົນ ບໍ​່ມ​ີກົດ​ລະ​ບຽບ​ກຽ່ວ​ກັບ​ການ​ຕິດ​ຕາມ​ຜນົ​ຄວນ​ເກີດ​ຂືນ້​ເມື່ອ​ໃດ,​ຕາມເວລາທີ່ດີທີສຸ່ດຕ່ໍ​ການຕິດຕາມຜົ ນຈະຂືນ້ຢູກ່ັບຄວາມຕອ້ງການຂອງຜູໃ້ຊລ້ົດເຂນັ. •​ ມນັເປນັປະໂຫຍດຕໍກ່ານທົບທວນ​ຜູໃ້ຊລ້ະດັບປານກາງພາຍໃນ​6​ອາທິດຂອງການ​ ໄດຮ້ບັລົດເຂນັໃໝ​່ເພ່ືອກວດເບິງ່ວາ່ລົດເຂນັຕອບສະໜອງໄດ້ຄວາມຕອ້ງການ​ຂອງເຂາົເຈົາ້ບ.ໍ •​ ສາໍລັບເດກັນ້ອຍ​ແລະຜູ້ທີມ່ີອາການຮາ້ຍແຮງຂືນ້,​ມນັເປນັການດ​ີຖາ້ການຕິດຕານຜນົ​ ແມນ່ຢາ່ງນ້ອຍທກຸໆ​6​ເດືອນ.​ນີເ້ພາະວາ່ຄວາມຕອ້ງການຂອງເດກັນ້ອຍ​ຫຼື​ ຜູ້ທີມ່ີອາການຮາ້ຍແຮງ​ສາມາດ​ປຽ່ນແປງໄດ້ຢາ່ງວອ່ງໄວ. •​ ມນັເປນັການດຖີາ້ມີການໃຫກ້ານຕິດຕາມຜນົແກ່ຜູໃ້ຊຄ້ນົອືນ່ທງັໝົດພາຍໃນ​12​ເດືອນຂອງ​ ການໄດຮ້ບັລົດເຂນັຂອງເຂາົ​ເຈົາ້. 58 59 ຈົງຈ່ືວ່າ:​ຄວນສ້າງການຕິດຕາມຜົນ​ເປັນ​ຕົວຢ່າງ​ການບໍລິການໃນເວລາວາງແຜນການບໍລິການຄັ້ງ ທໍາອິດ.​ການຮ່ວມມື​ໃນຊຸມຊົມແມ່ນຈໍາເປັນ​ເພ່ືອສ້າງຄວາມສາມາດໃນການຕິດຕາມຜົນ. ຜົນກະທົບຂອງການຕິດຕາມຜົນ ຖ້າບ່ໍ ມີ ການ ສ້າງຄູ່ຮ່ວມງາ ນ ໃນຊຸມຊົມ ຈະຮູສຶ້ກໄດ້ຢາ່ງວອ່ງໄວເຖງິຜົນກະທົບຂອງການຕິດຕາມຜນົຕໍກ່ັບຄວາມພ້ອມຂອງການນັດໝາຍ ໃໝ​່​ຖາ້ການບລໍກິານບໍໄ່ດວ້າງແຜນ.​ການບລໍກິານລະດັບປານກາງໂດຍສະເພາະມີຄວາມສຽ່ງເຂົາ້ ໃກກ້ານອີມ່ຕວົພາຍໃນປີທ​ີສາມ. ວທິແີກໄ້ຂທີ່ໜຶງ່ສາໍລັບສິງ່ນີແ້ມນ່ການຮວ່ມມືກັບອງົການຂັນ້ຊມຸຊມົ​– ແລະຝກຶພະນັກງານຂອງ ພວກເຂາົເພືອ່ດາໍເນນີການຕິດຕາມຜນົໃຫຫ້າຼຍເທົາ່ທີຈ່ະເປນັໄປໄດ.້​ພະນກັງານຢູຂ່ັນ້ຊມຸຊນົອາດຈະສ າມາດຄຸມ້ຄອງຫາຼຍໆໜາ້ວຽກການຕິດຕາມຜນົທີງ່່າຍໄດ,້​ໂດຍນາໍສົງ່ຄນືຫາການບລໍກິານລົດເຂນັ ສາໍລັບເຮດັການປະເມນີ​ຜນົໃໝ,່​ການສ້ອມແປງຂະໜາດ,​ຫຼ​ືບນັຫາອືນ່ໆ​ທີ່ພວກເຂາົບໍສ່າມາດ ແກໄ້ຂໄດເ້ທົາ່ນັນ້. ມີຫາຼຍຜນົປະໂຫຍດຂອງບົດບາດນີ​້ທີ​່ຖກືດາໍເນນີໂດຍ​ແບບຢາ່ງ​ທີ​່ດ​ີເຊັນ່ວາ່​ບກຸຄນົທີມ່ີຄວາມພິ ການໃນການເຄື່ອນໄຫວໄປມາ. ​ຜູ້​ໃຊ້​ການຕິດຕາມຜົນ ​ຜູ້​ໃຊ້​ທີ່​ເປັນ​ໄປ​ໄດ້​ໃໝ່ ​ຈໍາ​ນວນ​ລວມ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ ການ ບໍ ລິ ກາ ນ ຂ້ັນ ພ້ືນ ຖານ ​ປີ​ທີ​3 ​ລວມ​ທັງ​ໝົດ ການ ບໍ ລິ ການລະ ດັບ ປານ ກາງ ​ປີ​ທີ​3 ​ລວມ​ທັງ​ໝົດ 60 61 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ການສ້າງຄູ່ຮ່ວມງານ ໃນຊຸມຊົມ ແລະການວາງແຜນຮູບແບບການບໍລິການ C.3.9 Planning follow-up Plan the follow-u p model C.3.9 Planning follow-up Plan the follow-u p model C.3.9 Planning follow-up Plan the follow-u p model ຄູ່ຮ່ວມງານອາດຊ່ວຍເຫຼືອ​​ ເລື່ອງການນໍາສົ່ງ​ແລະການຕິດຕາມ​ ຜົນລວມທັງການບໍາລຸງຮັກສາ​ ແລະການສ້ອມແປງ ຄູ່ຮ່ວມງານຍັງອາດຊ່ວຍເຫຼືອການ ຝຶກອົບຮົບຜູ້ໃຊ້ ຂື້ນຢູ່ກັບຄວາມສາມາດຂອງຄູ່ຮ່ວມ ງານ,​ພວກເຂົາຍັງອາດຊ່ວຍເຫຼືອ ບາງຄວາມຮັບຜິດ​ ຊອບຂອງການບໍລິການທີ່ກ້ວາງຂ້ືນ ການຫຼະດຜ່ອນອຸປະສັກໃນການຕິດຕາມຜົນ ເຖງິ​ແມນ່​ຈະ​ໄດ​້ຮບັ​ຜນົ​ປະ​ໂຫຍດ​ໃຫ​້ກັບ​ຜູ​້ໃຊ​້ການ​ບ​ໍລ​ິການ​ແລະ​ຜູ​້ໃຫ​້ບ​ໍລ​ິການ,​​ຈາໍ​ນວນ​ຄນົ​ທີ​່ໄດ​້ຮບັ​ ການ​ຕິດ​ຕາມ​ຜນົ​ມັກ​ຈະ​ຕໍາ່.​​ມນັ​ສາໍ​ຄນັ​ໃນ​ການ​ຊອກ​ຫາ​ສາ​ເຫດຮາກ​ເຫງົາ້​ວາ່​ເປນັ​ຫຍງັ​ຈາໍ​ນວນ​ຈຶງ່​ ຕໍາ່,​​ເພື່ອ​ແກ​້ໄຂ​ອ​ຸປະ​ສັກ​ແລະ​ປັບ​ປງຸ​ການ​ບ​ໍລ​ິການ. ອຸ ປະ ສັກ ທ່ີ ເປັນ ໄປ ໄດ້ ຕ່ໍ ກັບ ຜູ້ ໃຊ້ ທ່ີ ເຂ້ົາ ຮ່ວມ ການ ບໍ ລິ ການ ການ ຕິດ ຕາມ ຜົນ ຢູ່ນອກ ສູນ ບໍລິການ: •​ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ພະ​ນັກ​ງານ​ສູນ​ການ​ບໍ​ລິ​ການ​ໃນ​ການ​ເດີນ​ທາງ​ໄປ​ຍັງ​ຊຸ​ມ​ຊົມ; •​ ​ເວ​ລາ​ສໍາ​ລັບ​ພະ​ນັກ​ງານ​ສູນ​ການ​ບໍ​ລິ​ການ​ເດີນ​ທາງ​ໄປ​ຍັງ​ຊຸມ​ຊົມ; •​ ​ການ​ຕິດ​ຕາມ​ຜົນ​ບໍ່​ໄດ້​ຖືກ​ຈັດ​ບຸ​ລິ​ມະ​ສິດໂດຍ​ຜູ້​ຈັດ​ການ​ການ​ບໍ​ລິ​ການ; •​ ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ບໍ່​ໃຫ້​ຄວາມ​ສໍາ​ຄັນ​ຕໍ່​ກັບ​ການ​ຕິດ​ຕາມ​ຜົນ​ຈົນ​ກວ່າ​ພວກ​ເຂົາ​ເຫັນ​ຜົນ​ປະ​ໂຫຍດ. ອຸ ປະ ສັກ ທ່ີ ເປັນ ໄປ ໄດ້ ຕ່ໍກັບ ຜູ້ ໃຊ້ ທ່ີ ເຂ້ົາ ຮ່ວມ ການ ບໍ ລິ ການ ການ ຕິດ ຕາມ ຜົນ ຢູ່ ສູນ ບໍລິການ: •​ ​ຄ່າ​ໃຊ້​ໃນ​ການ​ເດີນ​ທາງ​ແລະການ​ເສຍ​ເວລາ​ເຮັດ​ວຽກ​ສໍາ​ລັບ​ສະ​ມາ​ຊິກ​ຄອບ​ຄົວ​ຜູ້​ໜຶ່ງ​ຫຼື​ຫຼາຍຄົນ; •​ ​ຜູ້​ໃຊ້​ແລະ​ສະ​ມາ​ຊິກ​ໃນ​ຄອບ​ຄົວ​ແມ່ນ​ມັກ​ບໍ່​ຮັບ​ຮູ້​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມຜົນ; •​ ​ຄວາມ​ລໍາ​ບ​າກ​ໃນ​ການ​ຊອກ​ຫາ​ການ​ຂົນ​ສົ່ງ​ທີ່​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ້; •​ ​ຄວາມ​ກົດ​ດັນ​ຕໍ່​ກັບ​ການ​ເນັ້ນ​ໜັກ​ໃສ່​ການ​ນັດ​ໝາຍ​ໃໝ່​ຢູ່​ສູນ​ສາ​ມາດ​ເຮັດ​ໃຫ້​ບໍ່​ມີ​ເວລາ​ສໍາ​ລັບ​ການ​ຕິດ​ ຕາມຜົນ; •​ ​ຄວາມ​ລໍາ​ບາກ​ໃນ​ການ​ຈັດ​ຕາ​ຕະ​ລາງ​ການ​ນັດ​ໝາຍ:​​ຜູ້​ໃຊ້​ອາດ​ມາ​ໃນ​ເວ​ລາ​ບໍ່​ມີ​ພະ​ນັກ​ງານ,​ຫຼື​ບໍ່​ມາ​ ໃນ​ເວ​ລາ​ມີ​ພະ​ນັກ​ງານ. 60 61 ຕົວ ຢ່າງວິ ທີ ການ ຕິດ ຕາມ ຜົນ ໃນ ປະ ເທດອິນ ໂດ ເນ ເຊຍ ​ສໍາ​ລັບ​ແຜນ​ງານ​ການ​ສະ​ໜອ​ງ​ລົດ​ເຂັນ​ໃນ​ປະ​ເທດ​ອິນ​ໂດ​ເນ​ເຊຍ;​​ແທນ​ທີ່​ຈະ​ຄິດ​ຄ່າ​ທໍາ​ນຽມ​ໂດຍ​ກົງ​ສໍາ​ ລັບ​ລົດ​ເຂັນ​ຕົວ​ມັນ​ເອງ,​​ພວກ​ເຂົາ​ໄລ່​ເອົາ​ຄ່າ​ທໍາ​ນຽມ​ສະ​ມາ​ຊິກ​ທີ່​ປະ​ກອບ​ສ່ວນ​ໃຫ້​ແກ່ກ​ານ​ບໍ​ລິ​ການ,​​ ການ​ຕິດ​ຕາມ,​​ການ​ບໍາ​ລຸງ​ຮັກ​ສາ,​ແລະ​ຄ່າ​ໃຊ້​ຈ່າຍ​ໃນ​ການ​ບໍ​ລິ​ຫານ.​​ຄ່າ​ທໍາ​ນຽມ​ສະ​ມາ​ຊິກ​ນີ້​ຕັ້ງ​ຊື່​ວ່າ​“​ ສະ​ມາ​ຊິກ”​​ເພື່ອ​ການ​ບໍ​ລິ​ການ​ທີ່​ມີ​ຄຸນ​ນະ​ພາບ​ແລະ​ການ​ສະ​ໜັບ​ສະ​ໜູນ​ຢ່າງ​ຕໍ່​ເນື່ອງ.​ມີ​ລະ​ບົບ​ຄ່າ​ທໍາ​ ນຽມ​“​ທີ່​ເລື່ອນ​ປັບ​ໄດ້”,​​ເຊິ່ງ​ຈໍາ​ນວນ​ເງິນ​ທີ່​ກໍາ​ນົດ​ຈ່າຍ​ແຕ່​ລະ​ຄົນແມ່ນ​ຂື້ນ​ຢູ່​ກັບ​ລາຍ​ໄດ້​ຄົວ​ເຮືອນ​ຂອງ​ ແຕ່​ລະ​ບຸກ​ຄົນ,​​ຕາມ​ທີ່​ລະ​ບຸ​ຜ່ານ​ໃບ​ບິນ​ຄ່າ​ສາທາລະ​ນຸປະ​ໂພ​ກ,​ເອກະສານການຈ້າງງານລັດຖະກອນ,​ ການລາຍງານດ້ວຍຕົວເອງ​ແລະ​ຕົວຊິ້ວັດລາຍຮັບ​ທີ່ສະໜັບສະໜູນອື່ນ.​ ​ແຜນ​ງານ​ສະໜອງ​ລົດເຂັນນີ້ໄດ້ພົບວ່າ​ລະບົບການ​ເປັນສະມາຊິກແມ່ນມີຜົນຕໍ່ຈໍານວນຜູ້​ໃຊ້​ບໍລິການ​ ຂອງ​ແຕ່ລະລະດັບ:​ •​ ​ສະ​ມາ​ຊິກ​ຮູ້​ສຶກ​ໝ້ັນ​ໃຈ​ໃນ​ການຄາດ​ຫວັງ​ການ​ບໍ​ລິ​ການ​ແລະ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ມີ​ຄຸນ​ນະ​ພາບ. •​ ເພາະ​ວ່າ​ສະ​ມາ​ຊິກ​ໄດ້​ຈ່າຍ​ເງິນ​ຢ່າງຫຼວງຫຼາຍທີ່​ກ່ຽວ​ຂ້ອງ​ກັບ​ລະ​ດັບ​ລາຍຮັບ​ຂອງ​ພວກ​ເຂົາ​(​ໂດຍ​ ປົກ​ກະ​ຕິກ​ຢູ່​ໃນ​ລະ​ດັບ​$​2–20,​​ແຕ່​ຢູ່ທຸກ​ບ່ອນ​ແມ່​ນບໍ່​ເກີນ​$​150),​​ພວກ​ເຂົາ​ມີ​ແນວ​ໂນ້ມ​ໃຫ້​ຄວາມ​ ສໍາ​ຄັນ​ຕໍ່ລົດ​ເຂັນ​ຂອງ​ພວກ​ເຂົາ​​ແລະ​ມີ​ຄວາມ​ຮູ້​ສຶກ​ພາກ​ພູມ​ໃຈ​ໃນ​ການ​ເປັນ​ເຈົ້າ​ຂອງ​ມັນ. •​ ເພາະ​ວ່າການ​ເປັນ​ສະ​ມາ​ຊິກ​ເຮັດ​ໃຫ້​ພວກ​ເຂົາ​ມີ​ສິດ​ໄດ້​ຮັບ​ການ​ບໍລິການ​ຕິດຕາມ​ຜົນຟ​ຣີ​ຫຼື​​ຫຼຸດ​ ລາຄາ,​​ເຊິ່ງ​ໝົດ​ອາ​ຍຸ​ພາຍ​ໃນ​2​ປີ,​​ສະ​ມາ​ຊິກ​ແມ່ນ​ມີ​ແນວ​ໂນ້ມ​ໃນ​ກາ​ນ​ຊອກ​ຫາ​ການ​ຕິດ​ຕາມ​ໄວ​ ກວ່າ.​ 62 63 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ການ ດໍາ ເນີ ນ ການ ທ່ີ ເປັນ ໄປ ໄດ້ ເພ່ືອ ແກ້ ໄຂ ອຸ ປະ ສັກ ຕ່ໍ ກັບການ ຕິດ ຕາມ ຜົນ ​ກະ​ຕຸ້ນ,​ສົ່ງ​ເສີມ​ແລະ​ເຮັດ​ໃຫ້​ຜູ້​ໃຊ້​ບໍ​ລິ​ການ​ມີ​ຄວາມ​ມຸ້ງ​ໝ້ັນ​ໃນ​ການ​ໄດ້​ຮັບ​ຜົນ​ປະ​ໂຫຍດ​ຈາກ​ການ​ຕິດ​ ຕາມ​ຜົນ: •​ ​ອະ​ທິ​ບາຍ​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມ​ຜົນ​ໃນ​ລະ​ຫວ່າງ​ການ​ຝຶກ​ອົບ​ຮົມ​ຜູ້​ໃຊ້,​​​ຂັ້ນ​ຕອນ​ທີ​ເຈັດ​ຂອງ​ ການ​ບໍ​ລິ​ການ; •​ ​ແບ່ງ​ປັນ​ເລື່ອ​ງ​ເລົ່າ​ຜົນ​ປະ​ໂຫຍດຂອງ​ການ​ຕິ​ດ​ຕາມ​ຜົນ​ໃນ​ຫ້ອງ​ລໍ້​ຖ້າ,​​ເວັບ​ໄຊ,​​ເທິງ​ກະ​ດານ​ແຈ້ງ​ການ​ ຂອງ​ຊຸມ​ຊົມ; •​ ​ລະ​ບົບ​ສະ​ມາ​ຊິກ​ສໍາ​ລັບ​ຜູ້​ໃຊ້​ການ​ບໍ​ລິ​ການ. ​ກະ​ຕຸ້ນ,​ສົ່ງ​ເສີມ​ແລະ​ເຮັດ​ໃຫ້​ພະນັກງານ​ມຸ້ງ​ໝັ້ນ​ໃນ​ການ​ສະໜອງ​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມ​ຜົນ: •​ ​ທົດ​ລອງ​ແຜນ​ການ​ຕິດ​ຕາມ​ຜົນ​ທີ່ສະໜອງ​ໃຫ້​ໂດຍ​ພະ​ນັກ​ງານ​ຝ່າຍບໍ​ລິ​ການ; •​ ​ເກັບ​ເອົາ​ກໍ​ລະ​ນີ​ສຶກ​ສາ​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມ​ຜົນ. ​ກໍາ​ນົດ​ຜົນ​ທັນ​ທີ​ແລະ​ສາ​ມາ​ດ​ວັດ​ແທກໄດ້​: •​ ຕັ້ງ​ຄາດ​ໝາຍ​ສໍາ​ລັບ​ການ​ທົດ​ລອງ​ແຜນ​ການ​ຕິດ​ຕາມ​ຜົນ; •​ ​ເກັບ​ເອົາ​ແລະ​ແບ່ງ​ປັນ​ເລື່ອ​ງ​ເລົ່າ​ຄວາມ​ສໍາ​ເລັດ. ​ຈັດ​ບຸ​ລິ​ມະ​ສິດ​ການ​ຕິດ​ຕາມ​ຜົນ​ໃນ​ເວ​ລາ​ການ​ຈັດ​ສັນ​ຊັບ​ພະ​ຍາ​ກອນ: •​ ​ໃຊ້​ເລື່ອງ​ເລົ່າ​ຄວາມ​ສໍາ​ເລັດ​ກ່ຽວ​ກັບ​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມ​ເພ່ືອ​ສະ​ໜັບ​ສະ​ໜູນ​ການລະ​ດົມ​ ທຶນ​ສໍາ​ລັບ​ຄ່າ​ໃຊ້​ຈ່າຍ​ສະ​ເພາະ​ທີ່ກ່ຽວ​ຂ້ອງ​ກັບ​ການ​ຕິດ​ຕາມຜົນ; •​ ​ຈັດ​ສັນ​ເວ​ລາ​ເພ່ືອ​ສ້າງ​ການ​ຮ່ວມ​ມື​ໃນ​ຊຸມ​ຊົມ​​ແລະ​ຝຶກ​ແລະ​ພະ​ນັກ​ງານ​ທີ່​ປຶກ​ສາ​ໃນ​ຊຸມ​ຊົມ; •​ ​ຮັບ​ປະ​ກັນ​ວ່າ​ການ​ຂົນ​ສົ່ງ​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ທຸກບ່ອນ. ​ສະ​ໜັບ​ສະ​ໜູນ​ການ​ຮັກ​ສາ​ເພ່ືອ​ການ​ພົບ​ກັບ​ຄວາມ​ທ້າ​ທ້າຍ​ຢ່າງ​ຕໍ່​ເນື່ອງ: •​ ​ຕິດ​ຕາມ​ຂໍ້​ມູນການ​ຕິດ​ຕາມ​ຜົນ​ຢ່າງ​ໃກ້ຊິດ​ແລະ​ລະ​ບຸ​ສາ​ເຫດຮາກ​ເຫງົ້າ​ຂອງ​ບັນ​ຫາ; •​ ​ເຮັດ​ໃຫ້​ການ​ຕິດ​ຕາມ​ຜົນ​ເປັນ​ສ່ວນໜຶ່ງຂອງ​ຮູບ​ແບບ​ການ​ບໍ​ລິ​ການ,​​ລະ​ບົບ​ແລະ​ຂັ້ນ​ຕອນ. ການ ເຂ້ົາ ຮ່ວມ ແລະ ການ ມີ ສ່ວນ ຮ່ວມ ໃນ ຊຸມ ຊົມ ​ການ​ຕິດ​ຕາມ​ຜນົ​ເປນັ​ເວ​ລາ​ປະ​ເມນີ​ຜນົ​ກະ​ທົບ​ຂອງ​ການ​ບ​ໍລ​ິການ​ແລະ​ວາ່​ມນັ​ບນັ​ລ​ຸວ​ິໄສ​ທັດ​ໂດຍ​ ລວມ:​​ຂອງ​ການ​ເພ່ີມ​ຄນຸ​ນະ​ພາ​ບ​ຊ​ີວິດ,​​ການ​ເຂົາ້​ຮວ່ມ​ແລະ​ການ​ມ​ີສວ່ນ​ຮວ່ມ​ໃນ​ຊມຸ​ຊມົ. ​ໜຶງ່​ຂອງ​ບົດ​ບາດ​ທີກ່ວາ້ງ​ຂືນ້​ຂອງ​ການ​ບ​ໍລ​ິການ​ລົດ​ເຂນັ​ແມນ່​ການ​ປັບ​ປງຸ​ຄວາມ​ສາ​ມາດ​ເຂົາ້​ເຖງິ.​​ ນີ​້ສາ​ມາດ​ມ​ີຜນົ​ກະ​ທົບ​ຢາ່ງຫວຼງຫາຼຍ​ກຽ່ວ​ກັບ​ການ​ເຂົາ້​ຮວ່ມ​ແລະ​ການ​ມ​ີສວ່ນ​ຮວ່ມ​ຂອງ​ຜູ​້ໃຊ​້ລົດ​ ເຂນັ​ໃນ​ຊມຸ​ຊມົ. 62 63 ເຮືອນ ຢູ່ ແລະ ສະຖານ ທ່ີ ສາທາລະນະ ທ່ີ ສາມາດ ເຂ້ົາ ເຖິງ ໄດ້ ​ໜຶງ່​ໃນ​ອຸ​ປະ​ສັກຕົນ້ຕໍ​ຕໍ່​ກັບ​ການ​ກັບ​ເຮອືນ​ແມ່​ນການ​ເຂົາ້​ ເຖງິ​ຫ້ອງ​ນໍາ້ ​ຄາໍ​ແນະ​ນາໍ​ກຽ່ວ​ກັບ​ການ​ປຽ່ນ​ແປງ​ທີ່​ງາ່ຍ​ຕໍ່​ກັບ​ເຮອືນ​​ສາ​ ມາດ​ສາ້ງຄວາມ​ແຕກ​ຕາ່ງ​ທີ່ຢາ່ງ​ໃຫຍ່ຫຼວງ​ຕໍ່​ກັບຄນຸ​ນະ​ ພາບ​ຊີ​ວິດ ການ ໂຄ ສະ ນາ ກ່ຽວ ກັບອຸ ປະ ສັກ ດ້ານ ສະ ຖາ ປັດ ຍະ ກໍາ ໃນ ປະ ເທດ ນີ ກາ ຣາ ກົວ ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ໃນ​ປະ​ເທດ​ນີ​ກາ​ຣາ​ກົວ,​​DPO​​ທີ່ເອີ້ນ​ວ່າ​CADISCA​​​ດໍາ​ ເນີນການ​ໂຄ​ສະ​ນາ​ໃນ​ນະ​ຄອນຫຼວງ​ຂອງ​ຕົນເພ່ືອ​ເນັ້ນ​ ໝັກ​ບັນ​ຫາ​ເລື່ອງ​ຂອບ​ຖະ​ໜົນ​ແລະ​ບັນ​ໄດ​ສູງ.​​ສະ​ມາ​ ຊິກ​DPO​(​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ທັງ​ໝົດ)​​ສ້າງ​ທາງ​ເນີນ​​ແລະ​ ຂອບ​ຖະ​ໜົນ​“​ຕ່າງ​ລະ​ດັບ”​200​​ຈຸດ​(​ເຮັດ​ພື້ນ​ທີ່​ນ້ອຍ​ ຂອງ​ລະ​ດັບ​ຂອບ​ຖະ​ໜົບກັບ​ເສັ້ນ​ທາງ)​​ໃນ​ເວ​ລາ​ພຽງ​ ສາມ​ເດືອນ​,​​ເຊິ່ງ​ສ້າງ​ການ​ເຂົ້າ​ເຖິງ​ພື້ນ​ທີ່​ສາ​ທາ​ລະ​ນະ.​ ສາ​ມະ​ຊິກ​ຂອງ​CADISCA​ເຫັນຊຸມຊົນຂອງພວກເຂົາ ກໍາລັງເຮັດບາງຢ່າງທ່ີ​ດີ,​ເຊິ່ງຊ່ວຍ​ເພີ່ມ​ ການສະໜັບສະໜູນ​ແລະສົ່ງຜົນໃຫ້ບໍລິສັດໃນທ້ອງຖິ່ນ​ ສະໜັບສະໜູນ​ການສ້າງຂອບຖະໜົນ​ ແລະທາງເນີນເພ່ີມຂື້ນໃນທົ່ວເມືອງ. ໃນເບື້ອງຕົ້ນ,​CADISCA​ໃຊ້ກິລາບານບ້ວງລົດເຂັນ​ເພື່ອສົ່ງເສີມຄວາມໝັ້ນໃຈ​ຕົນເອງ​ແລະເພີ່ມ ການມສ່ີວນຮວ່ມຂອງສະມາຊກິໃນກດິຈະກາໍຂອງ​DPO.​ການຝຶກອບົຮມົກລິາຍງັໃຫໂ້ອກາດສາໍລບັການ ປະຊຸມປະຈໍາ​DPO​ຢ່າງ​ເປັນ​ປົກກະຕິ​ບ່ອນທີ່ແຜນການ​ສ້າງຄວາມຮັບຮູ້ຖືກ​ຈັດ​ຂຶ້ນ.​ ການຝຶກອົບຮົມເຫຼົ່ານ້ີຖືກຈັດຂື້ນ​ຢູ່ໃນສ່ວນສາທາລະນະ,​​ເຊິ່ງ​ເຮັດ​ໃຫ້​ຊຸມ​ຊົມ​ຮັບ​ຮູ້​ກິດຈະ​ກໍາ​​ແລະ​ກາ​ ນສ້າງ​ຄວາມ​ຮັບ​ຮູ້ຂອງ​DPO.​​ໃນ​ທີ່​ສຸດ,​​ແຜ​ນງານກິ​ລາ​ໄດ້​ຊ່ວຍ​ໃນ​ການ​ສົ່ງ​ຜົນ​ກະ​ທົບ​ຕໍ່​ຄວາມ​ສໍາ​ເລັດ​ ຂອງ​ການ​ໂຄ​ສະ​ນາ​ການ​ເຂົ້າ​ເຖິງ​ຜ່ານ​ການ​ເພ່ີມ​ຄວາມ​ຮູ້​ຂອງ​ປະ​ຊາ​ຊົນ​ແລະ​ສໍາ​ລັບ​ຄົນ​ທີ່​ພິ​ການ.​​ນີ້​ ໃນ​ສຸດ​ທ້າຍ​ຊ່ວຍ​ກົດ​ດັນ​ລັດ​ຖະ​ບານ​ໃຫ້​ທຶນ​ສ້າງຂອບ​ຖະ​ໜົນ​ຕ່າງ​ລະ​ດັບຕະຫຼອດ​ທົ່​ວ​ນະຫຼອງຫຼວງ​ມາ​ ນາ​ກົວ.​​ການ​ຈໍາ​ກັດ​ອຸ​ປະ​ສັກ​ທາງ​ວັດຖຸ​ໄດ້​ເຮັດ​ໃຫ້​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ມີ​ໂອ​ກາດ​ເທົ່າ​ທຽມ​ກັນ​ໃນ​ການ​ເຂົ້າ​ເຖິງ​ ພື້ນ​ທີ່​ສໍາ​ຄັນ​ທາງ​ດ້ານ​ການ​ເງິນ,​​ການ​ສຶກ​ສາ​ແລະ​ສັງ​ຄົມ​ຢູ່ພາຍ​ໃນ​ຕົວ​ເມືອງ. C.3.12 Planning follow-up Removing archit ectural barriers 65 ຄາ່​ໃຊ​້ຈາ່ຍ​ໃນ​ການ​ສາ້ງ​ສະຖານ​ທີ​່ໃຫ​້ເຂົາ້​ເຖງິ​ໄດ​້ໂດຍ​ຄນົ​ພິການ​​ໃນ​ເວ​ລາ​ກໍ​່ສາ້ງ​ແມນ່​ໜ້ອຍ​ທີ​່ສຸດ​ – ​ບາງ​ຄັງ້​ໜ້ອຍກວາ່​​1%​ຂອງ​ຄາ່​ໃຊ​້ຈາ່ຍ​ຂອງ​ການ​ກໍ​່ສ້າງ. ​ການເຂົ້າ​ເຖິງ​ການ​ສຶກ​ສາສາມາດ​ຖືກ​ຂັດຂວາງ​ໂດຍບາງ​ຢ່າງ​ທີ່​ງ່າຍ​ດາຍ​​ ເຊັ່ນ​ວ່າ​ຄວາມ​ກ້​ວາງ​ຂອງ​ເສັ້ນ​ທາງ​ແລະການ​ເຂົ້າ​ເຖິງ​ຫ້ອງ​ນໍ້າ.​​ການ​ສາ​ ມາດ​ໃຫ້​ຊັບ​ພະ​ຍາ​ກອນ​ແລະ​ຂໍ້​ມູນ​ກ່ຽວ​ກັບ​ອາ​ຄານ​​ແລະ​​ເສັ້ນ​ທາງ​ທີ່​ສາມາດ​ ເຂົາ​ເຖິ​ງ​ໄດ້​ໂດຍ​ຜູ້​ພິການ​ສາ​ມາດ​ເຮັດ​ໃຫ້​ໂຮງ​ຮຽນລວມ​ເອົາ​ທຸກ​ຄົນ​ໄດ້.​​ມີ​ຊັບ​ ພະ​ຍາ​ກອນ​ຈໍາ​ນວນຫຼວງຫຼາຍ​ໃນ​ການ​ເຮັດ​ໃຫ້​ອາ​ຄານ​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ້​ ໂດຍ​ຄົນ​ພິການ(1). ​ໂດຍ​ການ​ໃຫ້​ຄໍາ​ແນະ​ນໍາ​ແລະ​ຂໍ້​ມູນ​ກ່ຽວ​ກັບ​ສະ​ພາບ​ແວດ​ລ້ອມ​ທີ່​ສາ​ມາດ​ເຂົ້າ​ ເຖິງ​ໄດ້;​​ການ​ບໍ​ລິ​ການ​ທີ່​ສາ​ມາດ​ອໍາ​ນວຍ​ຄວາມ​ສະ​ດວກ​ການ​ເຂົ້າ​ເຖິງ​ ເຮືອນຢູ່,​​ການ​ຂົນ​ສົ່ງ​ແລະ​ການ​ສຶກ​ສາ;​​ໃນ​ວິ​ທີ​ນີ້,​​ການ​ບໍ​ລິ​ການ​ກໍາລັງ​ເພ່ີມ​ ໂອ​ກາດ​ສູງ​ສຸດສໍາ​ລັບ​ການ​ເຂົ້າ​ຮ່ວມ​ແລະ​ການ​ມີ​ສ່ວນ​ຮ່ວມ​ຂອງ​ຄົນ​ທີ່​ມີ​ ຄວາມ​ພິ​ການ​ດ້ານ​ການ​ເຄື່ອນ​ໄຫ​ວ​ໄປ​ມາ. ການ ຂົນ ສ່ົງ ທ່ີ ສາ ມາດ ເຂ້ົາ ເຖິງ ໄດ້ ​ການ​ຂນົ​ສ່ົງ​ແມນ່​ອ​ຸປະ​ສັກ​ທີ​່ພົບ​ເຫນັ​ເລື້ອຍ​ໆ ສາໍ​ລັບ​ຜູ​້ໃຊ​້ລົດ​ເຂນັ.​​ສິງ່​ທາ້​ທາ້ຍ​ລວມ​ມ:ີ •​ ​ການ​ໃຫ​້ລົດ​ໂດຍສານ​ຢດຸ​ດນົ​ພຽງພໍ​ເພື່ອ​ເຄື່ອນ​ຍາ້ຍ​ແລະ​ເກັບ​ມຽ້ນ​ລົດ​ເຂນັ •​ ​ຖກື​ຄິດ​ຄາ່​ເພ່ີມ​ເຕມີ​ເພ່ືອ​ບນັທກຸ​ລົດ​ເຂນັ​ໄປ​ນາໍ •​ ​ຄວາມ​ສຽ່ງ​ທີ​່ສວ່ນ​ທີ​່ຖອດ​ອອກ​ໄດ​້ຈະ​ສນູ​ເສຍ​ຫຼ​ືຖກື​ລກັ,​ຕວົ​ຢາ່ງ,​ລໍ​້ລົດ​ເຂນັ •​ ​ຄວາມ​ລາໍ​ບ​າກ​ໃນ​ການ​ເຂົາ້​ເຖງິ​ການ​ຂນົ​ສົງ່ສາທາລະນະ​ເນື່ອງ​ຈາກ​ຕນີ​ປະ​ຕ​ູແລະ​ທາງ​ເຂົາ້​ປະ​ ຕລູົດ​ໂດຍສານ. ​ມ​ີການ​ລ​ິເລີມ່​ຂນົ​ສົງ່ສາທາລະນະ​ທີ​່ລວມ​ເອາົ​ທກຸ​ຄນົ​ຢູ​່ໃນຫາຼຍ​ປະ​ເທດ;​​ລວມ​ມ​ີໂຄງການ​Dial-a-Ride​​ໃນ​ ອາ​ຟ​ຣ​ິກາ​ໃຕ​້​ແລະ​ລະ​ບົບ​ລົດ​ເມ​ຂນົ​ສ່ົງ​ດວ່ນ​​ໃນ​ປະ​ເທດ​ໂຄ​ລາໍ​ເບຍ.​​ມ​ີແຫຼງ່ຊບັ​ພະ​ຍາ​ກອນ​ທີ​່ມ​ີປະ​ ໂຫຍດຈາໍນວນຫວຼງຫາຼຍ​ກຽ່ວ​ກັບ​ການ​ຂນົ​ສົງ່​ສາທາລະນະທີ​່ສາ​ມາດ​ເຂົາ້​ເຖງິ​ໄດ​້ໃນ​ທົວ່​ໂລກ.(1) 1​ ​ແຫຼ່ງ​ຊັບ​ພະ​ຍາ​ກອນ​ທີ່​ມີ​ປະ​ໂຫຍດ​ສໍາ​ລັບ​ຂໍ້​ມູ​ນ​ເພີ່ມ​ເຕີມ​ກຽ່ວ​ກັບ​ການ​ຂົນ​ສົ່ງ​ທີ່​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ້​ມ:ີ​​ເວ​ທີການ​ຂົນ​ສ່ົງ​ລະ​ຫວ່າງ​ປະ​ເທດ​ (ITF),​​ການ​ຂົນ​ສົ່ງ​ຫຼາຍ​ຮູບ​ແບບ​ທີ່​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ,້​ອາ​ຟ​ຣິ​ກາ​ໃຕ,້​​ຈົດໝາຍ​ຂ່າວ​ລະຫວ່າງ​ປະ​ເທດກຽ່ວ​ກັບ​ການ​ແລກປຽ່ນ​ຂໍ້​ມູນ​ ເລື່ອງ​ການ​ເຂົ້າ​ເຖິງ,​​ຄູ່​ມື​ແນະ​ນໍາການ​ຂົນ​ສົ່ງ​ສໍາລັບ​ຜູ້​ພິການ​– ​ປື້ມຄູ່​ມື​ແນະນໍາ​ບັນ​ຫາ​ດ້ານການ​ຂົນ​ສົ່ງ. 65 C.4: ການວາງ ແຜນສໍາລັບ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ ແມ່ນ ຫຍັງ? ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ​ສາໍ​ລັບ​ການ​ໃຫ້​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ໝາຍ​ເຖງິ​ການ​ມີ​ເງນິ​ທນຶ​​ແລະແຫຼງ່​ ຊບັ​ພະ​ຍາ​ກອນ​ທີ່​ຈາໍ​ເປັນ​ໃນ​ການ​ດາໍ​ເນນີ​ການ​ແປດ​ຂັນ້​ຕອນ​ຂອງ​ການ​ໃຫ້​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ແລະ​ ຄວາມ​ຮບັ​ຜິດ​ຊອບ​ການ​ບໍ​ລິ​ການ​ທີ່ກວາ້ງ​ຂືນ້​– ​ຢາ່ງ​ຕໍ່​ເນື່ອງ.​​ຜູ້​ຈັດ​ການ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ມີ​ບົດ​ ບາດ​ສາໍ​ຄນັ​ໃນ​ການ​ພັດ​ທະ​ນາ​ແຜນ​ສໍາ​ລັບ​ວິ​ທີ​ເຮດັໃຫ້​ການບໍ​ລິ​ການ​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ມີຄວາມ​ ຍນື​ຍງົ​ທາງ​ດາ້ນ​ການ​ເງນິ. ຕົວ ຢ່າງ ຂອງ ຄໍາ ຖະ ແຫຼງ ຂອງການ ບໍ ລິ ການ ກ່ຽວ ກັບ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ ​ແຜ​ນງານການ​ສະ​ໜອງ​ລົດ​ເຂັນ​ທີ່​ຍືນ​ຍົງ​ແມ່ນ​ໜຶ່ງ​ທີ່​ມີ​ຄວາມ​ສາ​ມາດ​ເພ່ືອ​ສະ​ໜອງ​ລົດ​ເຂັນ​ທີ່​ເໝາະ​ ສົມ​ຜ່ານ​ແປດ​ຂັ້ນ​ຕອນ​ການ​ບໍ​ລິ​ການ​ເພື່ອ​ຄວາມ​ໝັ້ນ​ຄົງ​ຂອງ​ຈໍາ​ນວນ​ຂອງ​ບຸກ​ຄົນ​ໃນ​ໄລ​ຍະ​ເວ​ລາ​ທີ່​ສໍາ​ ຄັນ​ທີ່​ຜ່ານ​ມາ. ​ນີ້​ຮຽກ​ຮ້ອງ​ໃຫ້​ມີ​ການ​ລົງ​ທືນ​ຢ່າງ​ຕໍ່​ເນື່ອງ​ໃນ​ການ​ສະ​ໜອງ​ຜະ​ລິດ​ຕະ​ພັນ,​​ຝຶກ​ອົ​ບ​ຮົມ​ພະ​ນັກ​ງານ,​​ພ້ືນ​ ທີ່,​​ແລະ​ລະບົບການ​ຕິດ​ຕາມ​ແລະ​ການ​ປະ​ເມີນ​ຜົນ.​​ຄວາມ​ຍືນ​ຍົງ​ທາງ​ການ​ເງິນ​ແມ່ນ​ບັນ​ລຸ​ໄດ້​ເມື່ອ​ ການ​ບໍ​ລິ​ການ​ມີ​ຄວາມ​ໝັ້ນຄົງ,​ຫຼື​ສາ​ມາດ​ຮັກ​ສາ​ຄວາມ​ໝັ້ນຄົງ​ໄດ້​ຢ່າງ​ຕໍ່​ເນື່ອງ,​​ເຊິ່ງລວມທັງ​ເງິນ​ທຶນ​ ແລະ​ແຫຼ່ງ​ຊັບ​ພະ​ຍາ​ກອນ​ທີ່​ຈໍາ​ເປັນ​ເພ່ືອ​ເຮັດ​ໃຫ້​ການ​ລົງ​ທຶນ​ນີ້​ຕໍ່​ເນື່ອງ. ການ ວາງ ແຜນ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ ​ນີ້​ລວມ​ມ:ີ •​ ​ລະ​ບ​ຸເງນິ​ທນຶ​ຢາ່ງ​ຊດັ​ເຈນ​ແລະ​ແຫຼງ່​ຊບັ​ພະ​ຍາ​ກອນ​ທີ​່ຈາໍ​ເປນັ​ເພ່ືອ​ການ​ບ​ໍລ​ິການ​ທີ​່ຍນື​ຍງົ (​ເບິງ່​ຮບູ​B.5) •​ ​ລະ​ບ​ຸກາ​ນ​ຊອກ​ແຫຼງ່​ທນຶ​ທີ​່ເປນັ​ໄປ​ໄດ້ •​ ​ລະ​ບ​ຸການ​ສະ​ໜັບ​ສະ​ໜນູ​ທີ​່ບໍ​່ແມນ່​ເງິນ​ທີ​່ເປນັ​ໄປ​ໄດ້ •​ ​ພັດ​ທະ​ນາ​ຍຸດ​ທະ​ສາດ​ສາໍ​ລັບ​ການ​ຮບັ​ປະ​ກນັ​ການ​ໃຫ​້ທນຶ​ແລະ​ການ​ບ​ໍລ​ິຈາກ​ທີເ່ປນັ​ວັດ​ຖຸ ການ ລະ ບຸ ແຫ່ຼງ ທຶນ ທ່ີ ເປັນ ໄປ ໄດ້ ສາ​ມາດ​ໃຫ້​ທນຶ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ໃນຫາຼຍ​ຊອ່ງ​ທາງ​ທີ່​ແຕກ​ຕາ່ງ​ກນັ,​​ຜ່ານ​ປະ​ເພດ​ຂອງ​ ແຫຼງ່ທນຶ​ທີ່​ແຕກ​ຕາ່ງ​ກນັ.​​ບາງ​ການ​ບໍ​ລິ​ການ​ອາດ​ມີ​ແຫຼງ່ທນຶ​ດຽວ​(​ຕົວ​ຢາ່ງ,​​ລັດ​ຖະ​ບານ),​​ແຕ່ກ​ານ​ ບໍ​ລິ​ການ​ສ່ວນ​ໃຫຍ່​ຈະ​ຮບັ​ປະ​ກນັ​ເງນິ​ທນຶ​ແລະ​ແຫຼງ່​ຊບັ​ພະ​ຍາ​ກອນ​ທີ່​ຈາໍ​ເປັນ​ຈາກ​ປະ​ເພດ​ຂອງ​ ແຫຼງ່​ທີ່​ມາ​ທີ່​ແຕກ​ຕາ່ງ​ກນັ.​ແຕ່​ລະ​ແຫຼງ່ທນຶ​ອາດ​ປະ​ກອບ​ສ່ວນ​ເຂົາ້ໃສ່ຂງົເຂດ​ສະ​ເພາະ​ຂອງ​ຄວາມ​ ຕ້ອງ​ການ​ດາ້ນ​ງົບ​ປະ​ມານ​ແລະ​ແຫຼງ່​ຊບັ​ພະ​ຍາ​ກອນ. 66 67 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ແຫ່ຼງທຶນ ຕ່າງໆ ທ່ີ ຜູ້ ຈັດ ການ ອາດ ພິ ຈາ ລະ ນາ ​ລັດ​ຖະ​ບານ ​ລະບົບ​ປະ​ກັນ​ໄພແຫ່ງ​ຊາດ ​ຜູ້​ບໍ​ລິ​ຈາກ​ແລະ​ຜູ້​ອຸ​ປະ​ຖໍາ​ທີ່​ເປັນ​ບຸກ​ຄົນ ​ຜູ້​ບໍ​ລິ​ຈາກ​ແລະ​ຜູ້​ອຸ​ປະ​ຖໍາ​ທີ່​ເປັນ​ບໍ​ລິ​ສັດ​(ທຸ​ລະ​ກິດ) ການ​ປະ​ກອບ​ສ່ວນ​ຂອງ​ຜູ້​ໃຊ້​ຫຼື​ການ​ຊື້​ເຕັມລາຄາ ​ການ​ສ້າງ​ລາຍ​ໄດ້/ວິ​ສະ​ຫະ​ກິດ​ເພ່ືອສັງ​ຄົມ ກຸ່ມຊຸມຊົມ/ສະມາຄົມການກຸສົນ ຄະ​ນະ​ທາງ​ການ​ທູດ ອົງການ​NGO​ລະຫວ່າງປະເທດ​ແລະພາຍ​ ໃນ​ປະ​ເທດ ການລະບຸການສະໜັບສະໜູນທ່ີບ່ໍແມ່ນເງິນທ່ີເປັນໄປໄດ້ ​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ທີ່​ບໍ່​ແມນ່​ເງນິ​ລວມ​ເອາົ​ການ​ບໍ​ລິ​ຈາກ​ເປັນ​ວັດ​ຖຸ​(​ຕົວ​ຢາ່ງ,​​ການ​ບໍ​ລິ​ຈາກ​ອຸ​ປະ​ ກອນ,​​ລົດ​ເຂນັ​ແລະ​ວັດ​ສະ​ດ)ຸ,​​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ເປັນ​ອາ​ສາ​ສະ​ໝັກ,​​ແລະ​ການ​ສະ​ໝອງ​ສິງ່​ອາໍ​ ນວຍ​ຄວາມ​ສະ​ດວກ.​​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ທີ່​ບໍ່​ແມນ່​ເງນິ​ສາ​ມາດຫຼຸດ​ຈາໍ​ນວນ​ເງນິ​ທນຶ​ທີ່​ຈາໍ​ເປັນ​ໃນ​ ການ​ຈັດ​ການ​ການ​ບໍ​ລິ​ການ. ​ບາງ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ອາດ​ໄດ້​ຮບັ​ການ​ບໍ​ລິ​ຈາກ​ລົດ​ເຂນັ​ເປັນ​ປະ​ຈາໍ.​​ນີ້ສາ​ມາດ​ເປັນ​ປະ​ໂຫຍດ​ ທີ່​ສຸດ​ໃນ​ຂະ​ນີ້​– ​ມນັ​ເປັນ​ສິງ່​ສາໍ​ຄນັ​ສະ​ເໝີ​ສາໍ​ລັບ​ການ​ບໍ​ລິ​ການ​ປະ​ເມນີ​ຜົນ​ຄນຸ​ນະ​ພາບ​ແລະ​ ຄວາມ​ເໝາະ​ສມົ​ຂອງ​ລົດ​ເຂນັ​ເຫຼົາ່​ນີ.້​​ບໍ່​ແມນ່​ທງັ​ໝົດ​ທີ່​ໄດ້​ບໍ​ລິ​ຈາກ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ. ການ ລວມ ແຫ່ຼງ ໃຫ້ ທຶນຕ່າງໆ ເຂ້ົາກັນ ເພ່ືອ ເຮັດ ໃຫ້ການ ບໍ ລິ ການ ລົດ ເຂັນ ຍືນ ຍົງ ​ຕາ​ຕະ​ລາງ​ຂາ້ງ​ລຸມ່​ນີ້​ໄດ້​ສະ​ໜອງຕົວ​ຢາ່ງ​ຂອງ​ແຫຼງ່ທນຶ​ຕາ່ງໆ​ທີ່ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ໄດ້​ກາໍ​ນົດ​;​​ ແລະ​ວິ​ທີ​ປະ​ກອບ​ສ່ວນ​ແຫຼງ່ທນຶ​ເຫຼົາ່​ນັນ້​ເຂາົ​ໃສ່​ແຫຼງ່​ທນຶ​ແລະ​ຊບັ​ພະ​ຍາ​ກອນ​ທີ່​ຈາໍ​ເປັນ​ສາໍ​ລັບ​ອງົ​ ການ​ເພື່ອ​ໃຫ້​ມີ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ. 66 67 ແຫ່ຼງທຶນ ສໍາ ລັບການ ບໍລິການ ລົດ ເຂັນ ຕົວ ຢ່າງ ​ແຫຼ່ງທຶນ ​ເງິນ​ທຶນ​ຫຼື​ແຫຼ່ງ​ຊັບ​ພະ​ຍາ​ກອນທີ່​ສະໜອງ​ໃຫ້​ ​ລັດ​ຖະ​ບານ •​ ​ໃຫ້​50%​​ຂອງ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ລົດ​ເຂັນ​ແຕ່​ລະ​ຄັນ​ທີ່​ໄດ້ສະ​ໜອງ​ໃຫ້​ໂດຍ​ ການ​ບໍ​ລິ​ການ; •​ ​ໃຫ້​ທຶນສໍາ​ລັບ​ພະ​ນັກ​ງານ​2​ຄົນ​ທີ່​ເຮັດ​ວຽກ​ໃຫ້​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​(50%​ ຂອງ​ງົບ​ປະ​ມານ​ພະ​ນັກ​ງານ). ​ບໍ​ລິ​ສັດ​(​ທຸ​ລະ​ກິດ) •​ ​ບໍ​ລິ​ສັດ​ໃນ​ທ້ອງ​ຖິ່ນ​ໜຶ່ງ​ໃຫ້​ການ​ບໍ​ລິ​ຈາກ​ປະ​ຈໍາ​ປີ​ໃນ​ແຕ່​ລະ​ປີ​ເພ່ືອ​ເປັນ​ງົບ​ ປະ​ມານຊື້ລົດ​ເຂັນ; •​ ບໍ​ລິ​ສັດ​ອື່ນໃນ​ທ້ອງ​ຖິ່ນ​ໃຫ້​ຄໍາ​ໝັ້ນ​ສັນ​ຍາຈະ​ອຸປະຖໍາ​ເດັກ​ນ້ອຍ​ຈໍາ​ນວນ​10​ ຄົນ​ໃນ​ແຕ່​ລະ​ປີ​– ​ຮັບ​ຜິດ​ຊອບ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ລົດ​ເຂັນ​ແລະ​ຄ່າການ​ໃຫ້​ ການບໍ​ລິ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ.​ ​ບຸກ​ຄົນ •​ ​ໃຫ້​ການ​ບໍ​ລິ​ຈາກ​ແກ່​ການ​ບໍ​ລິ​ການ​(​ບໍ່​ໄດ້​ລະ​ບຸ​ແຖວ​ງົບ​ປະ​ມານ​ສະ​ເພາະ​ໃດ​ ໜຶ່ງ). ​ກິດ​ຈະ​ກໍາ​ຂອງວິ​ສະ​ ຫະ​ກິດ​ເພື່ອ​ສັງ​ຄົມ •​ ການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​ດໍາ​ເນີນ​ກິດ​ຈະ​ກໍາ​ຂອງວິ​ສະ​ຫະ​ກິດ​ເພ່ືອສັງ​ຄົມ​ຈໍາ​ ນວນຫຼວງຫຼາຍ.​ສ່ິງເຫຼົ່ານ້ີລວມມີການກວດສອບການ​ຊ່ວຍເຂົ້າເຖິງ​ (ຂອງອາຄານ)​ແລະການສະໜອງ​ຜະລິດຕະພັນການ​ຄວບ​ຄຸມ​ການ​ຍ່ຽວ.​ ຜົນກໍາໄລທີ່ໄດ້ຈາກການເຮັດວຽກນີ້ແມ່ນໃຊ້ເພ່ືອສະໜັບສະໜູນການບໍລິກ ານລົດເຂັນ,​ແລະໂດຍປົກກະຕິແລ້ວພຽງພໍໃນການໃຫ້ທຶນຢ່າງໜ້ອຍ​50%​ ຂອງງົບປະມານພະນັກ​ງານ. ອົງການ​INGO •​ ການບໍລິການໄດ້ຮັບລາງວັນການໃຫ້ທຶນຊ່ວຍເຫຼືອເພື່ອໃຫ້ລົດເຂັນແກ່ຜູ້ຄົນ ທີ່ອາໄສຢູ່ພື້ນທີ່ສະເພາະໂດຍຜ່ານອົງການ​NGO​ ລະຫວ່າງປະເທດໃນວາລະທີສອງ. ອົງການທາງ​ ສາສະໜາ •​ ໃຫ້ການບໍລິຈາກລົດເຂັນ​200​ຄັນປະຈໍາປີ​ (ລົດເຂັນທີ່ເລືອກໂດຍການບໍລິການ). ການ ພັດ ທະ ນາ ຍຸດ ທະ ສາດ ​ເມື່ອ​ແຫຼງ່ທນຶ​ທີ່​ເປັນ​ໄປ​ໄດ້​ຖືກ​ກາໍ​ນົດ,​​ຜູ້​ຈັດ​ການ​ຝາ່ຍ​ການບໍ​ລິ​ການ​ຈາໍ​ເປັນ​ຕ້ອງ​ພັດ​ທະ​ນາ​ຍຸດ​ທະ​ ສາດ​ສາໍ​ລັບ​ປະ​ເພດ​ຂອງ​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ທີຈ່ະ​ຮອ້ງ​ຂໍ​ຈາກ​ແຫຼງ່ທນຶ​ທີ່​ເປັນ​ໄປ​ໄດ້​ແຫຼງ່​ໃດ,​​ ແລະຫາຼຍ​ປານ​ໃດ.​​ສ່ວນ​ຂອງ​ການ​ພັດ​ທະ​ນາ​ຍຸດ​ທະ​ສາດ​ລວມ​ເອາົ​ການ​ພິ​ຈາ​ລະ​ນາ​​ເປັນ​ໄປ​ໄດ້​ ແນວ​ໃດວາ່​ມນັ​ແມນ່​ແຫຼງ່ທນຶ​ຈະ​ໃຫ້​ເງນິທນຶ​;​​ຫາຼຍ​ປານ​ໃດ​ທີ່​ແຫຼງ່ທນຶ​ອາດສາ​ມາດ​ສະ​ໜອງ​ໃຫ;້​​ ແລະ​​ໃຊ້​ເວ​ລ​າ​ແລະ​ຄວາມ​ພະ​ຍາ​ຍາມຫາຼຍ​ປານ​ໃດ​ທີ່​ຈະຈາໍ​ເປັນ​ເພ່ືອ​ຮບັ​ປະ​ກນັ​ການ​ໃຫ້​ທນຶ​ຄັງ້​ນີ.້ 68 69 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ເພື່ອ​ຊວ່ຍ​ວາງ​ແຜນ​ຍຸດ​ທະ​ສາດ,​​ຜູ້​ຈັດ​ການ​ສາ​ມາດ​ຈັດ​ບຸ​ລິ​ມະ​ສິດ​ແຫຼງ່ທນຶ​ຕາ່ງ ,ໆ​​ແລະ​ວາງ​ແຜນ​ ວາ່​ພວກ​ເຂາົ​ຈະ​ມີ​ວິ​ທີ​ແນວ​ໃດ​ໃນ​ການ​ຮບັ​ປະ​ກນັ​ການ​ໃຫ້​ທນຶ.​ຜຸ້ຈັດການຈາໍເປັນຕ້ອງພິຈາລະນາ: •​ ແຫຼງ່ການໃຫ້ທນຶ:​ຈະ​ເຂົາ້​ຫາຜູ​້ໃດ​? •​ ​ການ​ສະ​ໜັບ​ສະ​ໜນູ:​​ຜູ​້ຈດັ​ການ​ຈະ​ຂ​ໍໃຫ​້ແຫຼງ່​ທນຶ​ນັນ້​ສະໜັບສະໜນູ​ອນັ​ໃດ.​​ນີ​້ອາດ​ເນັນ້​ໝັກ​ໃສ່​ ແຖວ​ງບົ​ປະ​ມານ,​​ເຊັນ່​ວາ່​ຜະ​ລິດ​ຕະ​ພນັ​– ຫຼ​ືຂັນ້​ຕອນ​ການ​ບ​ໍລ​ິການ​ໃດ​ໜຶງ່​(ຫຼ​ືຫາຼຍຂັນ້​ຕອນ​),​​ ທີ​່ມ​ີແຖວ​ງບົ​ປະ​ມານ​ທີ​່ກຽ່ວ​ຂອ້ງຫາຼຍອນັ.​​ພິ​ຈາ​ລະ​ນາ​ແຫຼງ່ທນຶ​ສະ​ເພາະ,​ແລະ​ສິງ່​ທີ​່ເປນັ​ໄປ​ໄດ​້ທີ່​ ສຸດ​ທີ​່ພວກ​ເຂາົ​​ຕອ້ງ​ການ​ການສະ​ໜັບ​ສະ​ໜນູ. •​ ​ການຮອ້ງ​ຂ:ໍ​​ທາ່ນ​ຈະ​ຂ​ໍໃຫ​້ແຫຼງ່ທນຶນັນ້​ສະໜອງ/​ສະ​ໜັບ​ສະ​ໜນູຈາໍນວນ​ຫາຼຍປານ​ໃດ?​​ປັດ​ໃຈ​ທີ່​ ຕອ້ງ​ພ​ິຈາ​ລະ​ນາ​ລວມ​ເອາົ​ຊບັ​ພະ​ຍາ​ກອນ​ຂອງ​ແຫຼງ່ທນຶ​ແລະ​ຂະ​ໜາດ​ຂອງ​ການ​ບ​ໍລ​ິຈາກ​ທີ​່ຜາ່ນ​ ມາ​ເພື່ອ​ການ​ບ​ໍລ​ິການ​ແລະ​ອືນ່ .ໆ​​ແນ​່ໃສ​່ການ​ຮອ້ງ​ເອາົຈາໍ​ນວນ​ເງນິ​ທີ​່ເປນັ​ຈງິ. •​ ​ຄວາມ​ເປນັ​ໄປ​ໄດ:້​​ຄວາມ​ເປນັ​ໄປ​ໄດ​້ທີ​່ແຫຼງ່ທນຶ​ນັນ້ຈະ​ໃຫ​້ທນຶ/ສະ​ໜັບ​ສະ​ໜນູ​ການ​ບ​ໍລ​ິການ.​​ນີ​້ສາ​ ມາດ​ແຍກ​ປະ​ເພດ​ອອກ​ເປນັ​ຕໍາ່,​​ປານກາງ​ແລະ​ສງູ. •​ ​ຄວາມ​ພະ​ຍາ​ຍາມ:​​ສິງ່​ໃດ​ແດ​່ທີ​່ຈະ​ຈາໍ​ເປນັ​ຕໍ​່ການ​ຮບັ​ປະ​ກນັ​ການ​ໃຫ​້ທນຶ,​​ແລະ​ລາຍ​ງານ​ຫຍງັ​ແດ່​ ຫຼ​ືພນັ​ທະ​ອືນ່ໆ​ທີ​່ອາດ​ຈະ​ມ.ີ​​ຈາໍ​ນວນ​ຂອງ​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ຄວນ​ຈະ​ຢູ​່ໃນ​ສັດ​ສວ່ນ​ຈາໍ​ນວນ​ ຂອງ​ການ​ໃຫ​້ທນຶ.​​ພັນ​ທະ​ກ​ໍຄວນ​ຈະ​ສາ​ມາດ​ຊື​້ໄດ/້​ຈດັ​ການ​ໄດ​້ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ. ສອງ​ຕົວ​ຢາ່ງ​ໄດ້​ໃຫ້​ໃນ​ຕາ​ຕະ​ລາງ​ລຸມ່​ນີ້​ແມນ່.​​ໂດຍ​ການ​ພິ​ຈາ​ລະ​ນາ​ປະ​ເພດ​ຂອງ​ການ​ສະ​ໜັບ​ສະ​ ໜນູ,​​ຮອ້ງ​ຂ,ໍ​​ຄວາມ​ເປັນ​ໄປ​ໄດ້​ຂອງ​ຄວາມ​ສາໍ​ເລັດ​ແລະ​ຄວາມ​ພະ​ຍາ​ຍາມ​ທີ່​ຈາໍ​ເປັນ,​​ຜູ້​ຈັດ​ສາ​ ມາດ​ຈັດ​ບຸ​ລິ​ມະ​ສີດ​ໃຫ້​ດີ​ຂືນ້​ເຊິງ່​ໄລ່​ຕາມ​ແຫຼງ່ທນຶ. ແຫ່ຼງທຶນ ປະ ເພດ ການ ສະ ໜັບ ສະ ໜູນ ການ ຮ້ອງ ຂໍ ຄວາມ ເປັນໄປ ໄດ້ ຄວາມ ພະ ຍາ ຍາມ 1.​ ​ບໍ​ລິ​ສັດ​(​ທຸ​ລະ​ ກີດ​ທ້ອງ​ຖ່ິນ) ​ການ​ບ​ໍລ​ິຈາກ​ໃຫ້​ ງບົ​ປະ​ມານ​ກາ​ນ​ ຈດັ​ຊື​້ລດົ​ເຂນັ. 10%​​ຂອງ​ງບົ​ ປະ​ມານ​ລດົ​ ເຂນັ. ​ລະ​ດບັ​ປານ​ກາງ​ (​ເຄຍີ​ໃຫ​້ທນຶ​ທີ​່ຜາ່ນ​ມາ,​​ ແນວ​ໃດ​ກ​ໍຕາມ​ບໍ​່ມກັ​ ໃຫ​້ທນຶ​ແກ​່ອງົ​ການ​ເກົາ່​ ໃນ​ແຕ​່ລະ​ປ)ີ. ​ຢາ່ງ​ໜອ້ຍ​ປະ​ຊມຸ​2​ ຄັງ້​ກບັ​ຜູ​້ຈດັ​ການ​ທຸ​ ລະ​ກດິ;​​ແຜນສະ​ເໜີ​ ແລະ​ງບົປະມານ​2​ ໜາ້​ຈະ​ຖກື​ສົງ່​ແລະ​ ເຊນີ​ຜູ​້ຈດັ​ການ​ໃນ​ວນັ​ ຖດັ​ໄປ. 2.​ ​ລັດ​ຖະ​ບານ​ ທ້ອງ​ຖ່ິນ ​ເປນັ​ໄປ​ໄດ​້ອາດ​ ຈະ​ໃຫ​້ທນຶ​ຄາ່​ໃຊ້​ ຈາ່ຍ​ຂອງ​ການ​ ໃຫ​້ບລໍກິານ​ນອກ​ ສະຖານ​ທີທ່ງັ​ ໝດົ​ໃຫ​້ແກຜູ່​້ໃຊ້​ ລດົ​ເຂນັ​ໃນ​ພ້ືນ​ທີ່​ ເຂາົ​ເຈົາ້. 20%​​ຂອງ​ຄາ່​ ໃຊ​້ຈາ່ຍຂອງ​ ການ​ ບລໍກິານນອກ​ ສະ​ຖານ​ທີ​່ທງັ​ ໝດົ​ແລະ​ 20%​​ຂອງ​ ເງິນ​ເດອືນ​ພະ​ ນກັ​ງານໃຫ​້ບໍ​ ລ​ິການ. ​ລະ​ດບັ​ສງູ​(​ໄດ​້ສນົ​ທະ​ ນາ​ກບັ​ລດັ​ຖະ​ບານ​ ທອ້ງ​ຖິນ່​ນີ​້ເປນັ​ເວລາ​ ໃດ​ໜືງ່​ແລວ້.​​ໄດດ້າໍ​ ເນນີ​ໜຶງ່​ການ​ບລໍກິານ​ ນອກ​ສະຖານ​ທີ​່ໃນ​ພ້ືນ​ ທີ​່ຂອງ​ເຂາົ​ເຈົາ້.​ພວກ​ ເຂາົ​ສດຸ​ທີ​່ສນົ​ໃຈ​ ໃຫກ້ານ​ສະໜບັສະໜນູ​ ສິງ່​ນີ​້​ແລະ​ເບິງ່​ຄ​ືວາ່​ມີ​ ການ​ໃຫ​້ທນຶ). ​ແຜນສະ​ເໜ​ີແລະ​ງບົ​ ປະ​ມານ​ທາງ​ການ​ ຈະ​ຖກື​ສົງ່​.​ຄວາມ​ມຸງ້​ ໝັນ້​ດາ້ນການ​ລາຍ​ ງານ– ​ຮຽກ​ຮອ້ງ​ໃຫ​້ມີ​ ຂໍ​້ມນູ​ທີ​່ຖກື​ຕອ້ງ​ຂອງ​ ໝດົ​ທກຸ​ຄນົ​ເຫນັ​ໄດ້​ ຈາກ​ພ້ືນ​ທີ​່ແລະ​ການ​ ລາຍ​ງານ​ທາງ​ການ​ ເງິນ​ຂອງ​ພວກ​ເຂາົ. 68 69 ວິ ທີການ ໃຫ້ ທຶນ ​ການ​ຮບັ​ປະ​ກນັ​ແຫຼງ່ທນຶ​ທີ່​ຍນື​ຍງົ​ສາໍ​ລັບ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ອາດ​ຈະ​ຢາກ.​​ຕໍ່​ໄປ​ນີ້​ເປັນ​ບາງ​ຕົວ​ ຢາ່ງ​ຂອງ​ວິ​ທີ​ການ​ໃຫ້​ທນຶ​ຕາ່ງໆ​ແລະ​ຄວາມ​ຄິດ​ທີ່​ອາດ​ໄດ້​ຮບັ​ການ​ພິ​ຈາ​ລະ​ນາ.​​ຈື່​ໄວ້ວາ່​ມັກ​ຈະ​ມີ​ ວີ​ທີ​ການ​ທີ່​ແຕ​ກ​ຕາ່ງ​ກນັ​ຂືນ້​ຢູ່​ກັບ​ແຫຼງ່ທນຶ. ວິ ທີ ການ ທາງ ທຸ ລະ ກີດ ທ່ີ ຈະ ຕອບ ສະ ໜອງ ຄວາມ ຕ້ອງ ການ ທາງ ສັງ ຄົມ ແລະ ການ ສ້າງ ລາຍ ໄດ້ ​ອງົ​ການ​NGO​ໃນ​ປະ​ເທດ​ໂຣ​ມາ​ເນຍ​ໃຊ້​ວິ​ສະ​ຫະ​ກິດ​ເພື່ອ​ສງັ​ຄມົ​ເປັນ​ສ່ວນ​ໜຶງ່​ຂອງວິ​ທີ​ການ​ຂອງ​ ມນັ​ເພື່ອ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ.​​ວິ​ທີ​ການ​ມີ​2​ຈຸດ​ປະ​ສງົ​ທີ່​ສາໍ​ຄນັ:​​ຜົນ​ກະ​ທົບ​ທາງ​ສງັ​ຄມົ​ ແລະ​ຜົນ​ກະ​ທົບ​ທາງ​ການ​ເງນິ. ຜູ້​ໃຊ້​ລົດ​ເລນັ​ຖືກ​ຈາ້ງ​ເປັນ​ສ່ວນ​ຂອງ​ທມີ​ສະ​ຫະ​ສາ​ຂາ​ວິ​ຊາ​ຊບີ​ໃນ​ການ​ສະ​ໜອງ​ອຸ​ປະ​ກອນ​ການ​ ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ທີ່​ມີ​ຄນຸ​ນະ​ພາບ​ແລະ​ອຸ​ປະ​ກອນ​ການ​ແພດ​ໃຫ້​ກັບ​ຜູ້​ຄນົ​ທີ່​ມີ​ຄວາມ​ພິ​ການ​​ຄນຸ​ນະ​ ພາບ​ຂອງ​ການ​ບໍ​ລິ​ການ​ແມນ່​ສງູ​ເພາະ​ທມີ​ງານ​ຮູຈ້ກັ​ຄວາມສໍາ​ຄນັ​ຂອງການ​ຈັດ​ວາງ​ຕາໍ​ແໜງ່​ທີ່​ ຖືກ​ຕ້ອງ,​​ແລະ​ປ້ອງ​ກນັ​ອາ​ການ​ແຊກ​ຊອ້ນ​ໃນ​ການ​ດູ​ແລ​ສຸ​ຂະ​ພາບ. ​ກິດ​ຈະ​ກາໍ​ໃຫ້​ການ​ຈາ້ງ​ງານ​ແກ່​ຜູ້​ຄນົ​ທີ່​ມີ​ຄວາມ​ພິ​ການ,​ການ​ສາ້ງ​ຄວາມ​ໝັນ້​ໃຈ​ຂອງ​ຜູ້​ບໍ​ລິ​ໂພກ.​​ ການ​ບໍ​ລິ​ການ​ຍງັ​ສາ້ງ​ລາຍ​ໄດ້​ເພ່ືອ​ສະ​ໜັບ​ສະ​ໜນູ​ແຜ​ນງານອືນ່ໆ​ທີ່​ດາໍ​ເນນີ​ງານ​ໂດຍ​ອງົ​ການ​ NGO. ການຊ້ື ໂດຍ ກົງ ໂດຍ ຜູ້ໃຫ້ ບໍ ລິ ການ ບາງ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ຮຽກ​ຮອ້ງ​ໃຫ້​ມີການປະ​ກອບ​ສ່ວນ​ຕໍາ່​ສຸດ​ຈາກ​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ສໍາ​ລັບ​ການ​ ໄດ້​ຮບັ​ລົດ​ເຂນັ​ແລະ​ການ​ໃຫ້​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ.​ມັກ​ຈະມີ​ລະ​ບົບ​ຄາ່​ທາໍ​ນຽມ​“​ທີ່​ປັບ​ໄດ”້,​​ເຊິງ່​ຈາໍ​ ນວນ​ເງນິ​ທີ່​ກາໍ​ນົດ​ຈາ່ຍ​ແຕ່​ລະ​ຄນົແມນ່​ຂືນ້​ຢູ່​ກັບ​ລາຍ​ໄດ້​ຄົວ​ເຮອືນ​ຂອງ​ແຕ່​ລະ​ບຸກ​ຄນົ,​​ຕາມ​ທີ່​ລະ​ບຸ​ ຜາ່ນ​ໃບ​ບນິ​ຄາ່​ສາທາລະ​ນຸປະ​ໂພ​ກ,​ເອກະສານການຈາ້ງງານລັດຖະກອນ,​ ການລາຍງານດ້ວຍຕົວເອງ​ແລະ​ຕົວຊິວ້ັດລາຍຮບັ​ທີ່ສະໜັບສະໜນູອືນ່.​​ການ​ບໍລິການ​ທີ່​ຮກັສາ​ ບາງທນຶຮອນໃນ​ລັກ​ສະ​ນະ​ນີ້​ຈາໍ​ເປັນ​ຕ້ອງ​ຮບັ​ປະ​ກນັວາ່​ຜູ້​ທີ່​ບໍ່​ສາ​ມາດ​ຈາ່ຍ​ຄາ່​ໃຊ້​ໃດ​ໜຶງ່​ຕໍ່​ກັບ​ລົດ​ ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ບໍ່​ແມນ່ຜູ້​ດ້ອຍ​ໂອກາດ. ຜູ້ ບໍ ລິ ຈາກ ແລະ ຜູ້ ອຸ ປະ ຖໍາ ທ່ີ ເປັນ ບໍ ລິ ສັດ Teletón​ໃນ​ປະ​ເທດ​ເມັກ​ຊິ​ໂກ​ແມນ່​ລາຍການ​ໂທ​ລະ​ພາບ​ແລະ​ວິ​ທະ​ຍຸ​ປະ​ຈາໍ​ປ,ີ​​ຈັດ​ຂືນ້​ເພື່ອ​ຫາ​ ເງນິ​ບໍ​ລິ​ຈາກ​ໃຫ້​ແກ່​ສນູ​ຟືນ້​ຟຸ​ເດັກ​ນ້ອຍ​(​ສນູ​CRIT​).​ມນັ​ຖືກ​ຜະ​ລິດ​ໂດຍ​Televisa​​ແລະ​ຄນົ​ເມັກ​ ຊິ​ໂກຫາຼຍກວາ່​600​ຄນົ​​ແລະ​ສ່ື​ຕາ່ງ​ປະ​ເທດ;​​ແລະ​ບໍ​ລິ​ສັດ​ການ​ຄາ້​20​ບໍ​ລິ​ສັດ​ອຸ​ປະ​ຖາໍ​ລາຍການ​ ນີ.້​​ພວກ​ເຂາົ​ຂາຍ​ວິ​ໄສ​ທັດ​ຄວາມ​ສາໍ​ເລັດ​ຂອງ​ພວກ​ເຂາົ​ດ້ວຍ​ເລື່ອງ​ເລົາ່​ໃນ​ເຊງິບວກ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ ພາບ​ກຽ່ວ​ກັບ​ການ​ເຊືອ່ມ​ໂຍງ​ແລະ​ການ​ບນັ​ລຸ​ຜົນ​ສໍາ​ເລັດ.​​ຕະຫຼອດ​ໄລ​ຍະ​ເວ​ລາ​3​ເດືອນ​ກ່ອນ​ ລາຍການ,​ມີ​ການ​ເປີດ​ເຜີຍກໍ​ລະ​ນີ​ສຶກສາຜ່ານ​ສື່​ມວ​ນ​ຊນົ​ໂດຍ​ເປັນ​ໜຶງ່​ຂອງ​ການ​ສາ້ງ​ລາຍການ.​ມີ​ ການ​ລວມ​ເອາົບຸກ​ຄະ​ລິກ​ໄດ​ດ​ເດັນ່​ໃນ​ການ​ສົງ່​ເສມີ​ໂຄສະນາ​ລາຍການ​ນັນ້. 70 71 ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ ​ໃນ​ປະ​ເທດ​ໂຣ​ມາ​ເນຍ,​​ອງົ​ການ​NGO​ໄດ້​ສາ້ງ​ຄວາມ​ສາໍ​ພັນ​ກັບ​ຜູ້​ອຸ​ປະ​ຖາໍ​ທີ່​ເປັນ​ບໍ​ລິ​ສັດ.​​ເພ່ືອ​ເຮດັ​ ໃຫ້​ຄວາມ​ສາໍ​ພນັ​ນີ້​ເຂັມ້​ແຂງ,​​ງານ​ແຂງ່ຂນັລອຍ​ນໍາ້​ປະ​ຈາໍ​ປີ​ຈະ​ຈັດ​ຂືນ້​ທີ່​ສນູ​ສຸ​ຂະ​ພາບ​ທີ່​ມີ​ຊື່​ສຽງ.​​ ທມີ​ງານ​ທີ່​ຫາຼກຫາຼຍ​ເຊິງ່ລວມມີ​ພະ​ນັກ​ງານ​ບໍ​ລິ​ສັດ,​​ຜູ້​ຊວ່ຍ​ຄູ​ຝຶກ,​​ພະ​ນັກ​ງານ​ອງົ​ການ​NGO​ ແລະ​ຄນົ​ທີ່ພິ​ການ​ດາ້ນ​ການ​ຮຽນ​ຮູ້​ເຂົາ້​ຮວ່ມແຂງ່​ຂນັກນັ​ແລະ​ກນັ.​​ມນັ​ເປັນງານທີ່​ມ່ວນ​ທີ່​ມີ​ຜົນ​ປະ​ ໂຫຍດ​ໃນຫາຼຍ​ລະ​ດັບ.​​ພະ​ນັກ​ງານ​ບໍ​ລິ​ສັດ​ໄດ້​ໃຫ້​ການ​ສະ​ໜັບ​ສະ​ໜນູ​ທາງ​ການ​ເງນິ​ຢາ່ງ​ຕໍ່​ເນື່ອງ​ ຕະຫຼອດ​ປ;ີ​​ບໍ່​ວາ່​ຈະ​ເປັນ​ການ​ປະ​ກອບ​ສ່ວນ​ໂດຍ​ກງົ​ຫຼື​ໂດຍ​ຜາ່ນ​ງານ​ລະ​ດົ​ມ​ທນຶ. ການ ໃຫ້ ທຶນ ຂອງ ລັດ ຖະ ບານ ​ໃນ​ປະ​ເທດ​ເຄນ​ຢາ,​​ກະ​ຊວງ​ການ​ບໍ​ລິ​ການ​ທາງ​ການ​ແພດ​ໄດ້​ຮວ່ມ​ມື​ກັບ​ອງົ​ການ​NGO​ໃນ​ກ​ານ​ບໍ​ ລິ​ການ​ລົດ​ເຂນັ​ແລະ​ການ​ບໍ​ລິ​ການ​ຟືນ້​ຟູ​ອືນ່ໆ​ທີ່​ກຽ່ວ​ຂອ້ງ.​​ອງົ​ການ​NGO​​ໃຫ້​ການ​ສະ​ໜັບ​ສະ​ ໜນູ​ດາ້ນການ​ຂນົ​ສົງ່​ທງັ​ໝົດ​ໄປ​ຫາ​8​ສາ​ຂາ​ທີ່​ຕັງ້​ຢູ່​ໃນ​ໂຮງ​ໝໍ​ຂອງ​ລັດ​ຖະ​ບານ.​​ລັດ​ຖະ​ບານ​ໄດ້​ສະ​ ໜອງ​ບຸກ​ຄະ​ລາ​ກອນ​ໃຫ.້​​ເພື່ອ​ວນັ​ທີ​ທີ່​ກະ​ຊວງ​ໄດ້​ຈັດ​ສນັ​ພ​ະ​ນັກ​ງານ​56​ຄນົ​ໃຫ້​ແກ່ສາ​ຂາ​ຂອງ​ອງົ​ ການ​NGO. ແຜນ ການ ປະ ກັນ ແຫ່ງ ຊ າດ ໃນ ປະ ເທດ ໂຣ ມາ ເນຍ •​ ຂັ້ນ​ຕອນ​ທໍາ​ອິດ​ສໍາ​ລັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ແມ່ນ​ສະໝັກ​ຂໍ​ເອົາໃບ​ຢັ້ງ​ຢືນ​ຄວາມ​ພິ​ການ.​​ຖ້າ​ບໍ່​ມີ​ໃບ​ຢັ້ງ​ຢືນ​ນີ້​ ການສະ​ໝັກ​ຂໍ​ເອົາລົດ​ເຂັນ​ແມ່ນ​ເປັນ​ໄປ​ບໍ່​ໄດ້. •​ ​ຕໍ່​ໄປ​ນີ້​ແມ່ນ​ເຮັດ​ການ​ນັດ​ໝາຍ​ກັບ​ທ່ານ​ໝໍ​ດ້ານການຟື້ນ​ຟູ​ຜູ້​ທີ່​ອອກ​ການ​ກໍາ​ນົດ​ໃຊ້​ລົດ​ເຂັນ. •​ ຈາກນັ້ນຜູ້ໃຊ້ລົດເຂັນ​ຍື່ນ​ໃບສະໝັກຫາໜ່ວຍງານການປະກັນແຫ່ງຊາດ​(NIA). •​ ເມື່ອ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້​ຮັບ​ການ​ອະ​ນຸ​ມັດ/ໃບ​ແລກຊື້​,​​ເຂົາ​ເຈົ້າ​ເລືອກ​ຜູ້​ສະ​ໜອງ,​​ແລະ​ເລືອກ​ລົດ​ ເຂັນອັນໜຶ່ງ​. •​ ຖ້າ​ລາ​ຄາ​ລົດ​ເຂັນ​ແມ່ນ​ນ້ອຍກວ່າ​ເງິນ​ອຸດ​ໜູນ,​​ຈາກ​ນັ້ນ​ຜູ້​ສະ​ໜອງ​ໃຫ້​ລົດ​ເຂັນ​ແກ່​ຜູ້​ໃຊ້​ ໂດຍແລກປ່ຽນກັບໃບແລກຊື້​ເຊິ່ງ​ມັນ​ໃຊ້​ເພ່ືອ​ຮຽກເກັບເງິນນໍາ​NIA. •​ ​ຖ້າ​ລາ​ຄາ​ລົດ​ເຂັນ​ແມ່ນຫຼາຍກວ່າ​ເງິນ​ອຸດ​ໜູນ,​​ຈາກ​ນັ້ນ​ຜູ້​ໃຊ້​ຕ້ອງ​ຈ່າຍສ່ວນຕ່າງ​ຫຼື​ຊອກ​ຫາ​ແຫຼ່ງທຶນ​ ມາ​ເສີມ,​​ຕົວ​ຢ່າງ,​​ຜູ້​ບໍ​ລິ​ຈາກ,​​ນາຍ​ຈ້າງ,​​ແລະ​ບຸກ​ຄົນ.​ ສາໍ​ລັບ​ແຫຼງ່​ຊບັ​ພະ​ຍາ​ກອນ​ເພ່ີມ​ເຕມີ​ເພ່ືອ​ສະ​ໜັບ​ສະ​ໜນູ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ລະ​ດັບ​ພ້ືນ​ຖານ​ ແລະ​ລະ​ດັບ​ປານ​ກາງ,​​ກະ​ລຸ​ນາ​ເບິງ່​ໄຟ​ລ໌​ດິ​ຈິ​ຕອນ​ໃນ​Pen​Drive. 70 71 ເອກະສານ ອ້າງ ອີງ 1.​ Guidelines​on​the​provision​of​manual​wheelchairs​in​less​resourced​settings.​ Geneva:​World​Health​Organization;​2008​(http://www.who.int/disabilities/ publications/technology/wheelchairguidelines/en/). 2.​ Wheelchair​Service​Training​Package​-​Basic​Level.​Geneva:​World​ Health​Organization;​2012​(http://www.who.int/disabilities/technology/ wheelchairpackage/en/). 3.​ Wheelchair​Service​Training​Package​-​Intermediate​Level.​Geneva:​World​ Health​Organization;​2013​(http://www.who.int/disabilities/technology/ wheelchairpackage/wstpintermediate/en/). 4.​ Convention​on​the​Rights​of​Persons​with​Disabilities,​G.A.​Res.​61/106​ (2007)​New​York:​United​Nations;2008​(http://www.un.org/esa/socdev/enable/ rights/convtexte.htm).​​ 5.​ Assistive​devices​provided​through​a​service​have​been​reported​to​reduce​ the​time​and​physical​burden​for​caregivers​(Allen​et​al.,​2006). 6.​ Guidelines​on​the​provision​of​manual​wheelchairs​in​less​resourced​set- tings​2008,​p​113​(http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). 7.​ Guidelines​on​the​provision​of​manual​wheelchairs​in​less​resourced​set- tings​2008,​p​78​(http://www.who.int/disabilities/publications/technology/ wheelchairguidelines/en/). 8.​ Wyndaele​M,​Wyndaele​JJ.​Incidence,​prevalence​and​epidemiology​of​spinal​ cord​injury:​what​learns​a​worldwide​literature​survey?​Spinal​Cord,​2006;44:​ 523–529. 9.​ Razzak​ATMA,​Helal​SU,​Nuri​RP.​Life​expectancy​of​persons​with​spinal​ cord​injury​(SCI)​treated​in​a​rehabilitation​centre​at​Dhaka,​Bangladesh.​Dis- ability,​CBR​and​Inclusive​Development​Journal.​2011;​22(1):​114-123. 10.​ World​Health​Organization,​World​Bank​World​report​on​disability,​page​115.​ Geneva:​World​Health​Organization;​2011​(http://www.who.int/disabilities/ world_report/2011/report/en/). 11.​ Messiou​K.​Encouraging​children​to​think​in​more​inclusive​ways.​British​Jour- nal​of​Special​Needs​Education.​2008;35(1):26–32.

ຊຸດຝຶກອົບຮົມການບໍລິການລົດເຂັນ ສໍາລັບຜູ້ຈັດການ ປ້ືມຝຶກຫັດວຽກ

ສາ ​ລະ ​ບາ ນ 77 ພາກ ທ່ີ ໜ່ຶງ 77​ A. ຄວາມ ຮູ້ ຕ້ົນຕໍ 77​ A.1:​ການ​ນາໍ​ພາ​ການ​ປຽ່ນ​ແປງ 78​ B. ການ ເລ່ີມ ການ ບໍ ລິ ການ ລົດ ເຂັນ 78​ B.1:​​ການ​ເຂົາ້​ເຖງິ​ການ​ບໍ​ລິ​ການ 79​ B.2:​​ສິງ່​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ອຸ​ປະ​ກອນ 79​ B.3:​​ປະ​ເພດ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສົມ 81​ B.4:​​ຈັດ​ວາງ​ບຸກ​ຄະ​ລາ​ກອນ 81​ B.5:​ການ​ບໍລິການ​ລົດ​ເຂນັ​ມີຄາ່​ໃຊ້​ຈາ່ຍ​ແນວ​ໃດ? 82​ C. ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ 82​ C.1:​ທາ່ນ​ຮູ້​ໄດ້​ແນວ​ໃດ​ວາ່ການ​ບໍລິການ​ຂອງ​ທາ່ນ​ກາໍລງັ​ໄດ້ຜົນ​ດ?ີ 84​ C.2:​ການຄຸມ້​ຄອງ​ອຸປ​ະ​ສົງ 84​ C.3:​​ການ​ວາງ​ແຜນ​ການ​ຕິ​ດ​ຕ​າມຜົນ 85​ C.4:​ການວາງ​ແຜນສາໍລັບ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ 86 ພາກ ທີ ສອງ 86​ A. ຄວາມ ຮູ້ ຕ້ົນຕໍ 86​ A.1:​​ການ​ສະ​ໜອງ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ:​​ນະ​ໂຍ​ບາຍ​ລະ​ດັບ​ປະ​ເທດ 88​ A.2:​​ການ​ໃຫ້ການ​ບໍລິການ 89​ B. ການ ເລ່ີມ ການ ບໍ ລິ ການ ລົດ ເຂັນ 89​ B.1:​​ສ່ິງ​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ອຸ​ປະ​ກອນ 93​ B.2:​​ປະ​ເພດ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສົມ 98​ B.3:​​ຈັດ​ວາງ​ບຸກ​ຄະ​ລາ​ກອນ:​​ບົດ​ບາດ​ໜາ້​ທີ່ 98​ B.4:​ການ​ບໍລິການ​ລົດ​ເຂນັ​ມີຄາ່​ໃຊ້​ຈາ່ຍ​ແນວ​ໃດ?​ 100​ C. ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ 100​ C.1:​ການ​ບໍລິການ​ທີ່​ມີ​ປະສິດ​ພາບ​​ແລະ​ປະສິດທິ​ຜົນ 104​ C.2:​​ການ​ພັ​ດ​ທະ​ນາ​ການ​ບໍ​ລິ​ການ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບ 105​ C.3:​ການຄຸມ້​ຄອງ​ອຸປ​ະ​ສົງ 108​ C.4:​​ການ​ວາງ​ແຜນ​ການ​ຕິ​ດ​ຕ​າມຜົນ 109​ C.5:​​ການ​ພັດ​ທະ​ນາ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ 76 77 ການ ດໍາ ເນີນ ການ ສໍາ ລັບ ຜູ້ ຈັດ ການ ເພ່ືອ ສ້າງ ຫືຼ ປັບ ປຸງ ການ ສະ ໜອງ ລົດ ເຂັນ ສະ ໝຸດ ວຽກ ແມ່ນ ແບ່ງ ອອກ ເປັນ ສອງ ພາກ ຄື: ພາກ ທີ ໜ່ຶງ: ສ່ິງ ທ່ີ ຈໍາ ເປັນ ຕ້ອງ ເຮັດ ໃຫ້ ສໍາ ເລັດເພ່ືອ ເລ່ີ ມ ຕ້ົນ ການ ບໍ ລິ ການ ມີ ຫຍັງ ແດ່? ສ່ວນນີເ້ນັນ້ໜັກໃສແ່ປດຂັນ້ຕອນຂອງການສະໜອງລົດເຂນັ,​ສິງ່ອາໍນວຍຄວາມສະ​ດວກ​ ແລະອຸປະກອນ,​ປະເພດຂອງລົດເຂນັທີເ່ໝາະສມົ,​​ຄາ່​ໃຊ້​ຈາ່ຍ​ເບື້ອງ​ຕົນ້​ຂອງ​ການ​ເລີ່​ມ​ການ​ບໍ​ລິ​ ການ​ແລະ​ການ​ຄຸມ້​ຄອງ​ຄວາມ​ຕ້ອງ​ການ. ພາກ ທີ ສອງ: ສ່ິງ ທ່ີ ຈໍາ ເປັນ ຕ້ອງ ເຮັດ ໃຫ້ ສໍາ ເລັດ ເພ່ືອ ເຮັດ ການ ບໍ ລິ ການ ທ່ີ ຍືນ ຍົງ ນອກ ເໜືອ ຈາກ ການ ລົງ ທຶນ ເລ່ີມ ຕ້ົນ ໃນ ເບ້ືອງ ຕ້ົນ ມີ ຫຍັງ ແດ່? ​ສ່ວນນີ້​ເນັນ້​ໜັກ​ໃສ່​ການ​ສະ​ໜອງ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ,​ການດາໍເນນີການບໍລິການ​ແລະການດາໍ ເນນີການເພື່ອປັບປງຸປະສິດທິພາບ,​ປະສິດທິຜົນ,​ແລະ​ຄວາມ​ຮບັ​ຜິດ​ຊອບ​ຂອງ​ການ​ໃຫ້​ບໍ​ລິ​ການ.​ ຍງັ​ມີ​ກາ​ນ​ໂອ້​ລມົ​ເຖງິ​ຄວາມ​ຍນື​ຍງົ​ທາງ​ການ​ເງນິ​​ເຊິງ່ລວມທງັ​ຄວາມ​ສາໍ​ຄນັ​ຂອງ​ການ​ສາ້ງ​ຕັງ້​ ການ​ຮວ່ມງານ​ແລະ​​ກະ​ແສ​ລາຍ​ຮບັ​​ເພ່ືອ​ຈາ່ຍ​ຄາ່​ໃຊ້​ຈາ່ຍ​ຂອງ​ການ​ດາໍ​ເນນີ​ການ​ບໍ​ລິ​ການ​ແລະ​ ການ​ຂະ​ຫຍາຍ​ການ​ບໍ​ລິ​ການ​ຢາ່ງ​ຕໍ່​ເນື່ອງ. ​ທງັ​ສອງ​ພາກ​ແບງ່​ອອກ​ເປັນ​ສາມ​ສ່ວນດັງ່​ນີ:້ A.​​ຄວາມ​ຮູ​້ຫຼກັ B.​​ການ​ເລີ​່ມການ​ບລໍກິານ​ລດົ​ເຂນັ C.​​ການ​ດາໍ​ເນນີ​ການ​ບລໍກິານ​ລດົ​ເຂນັ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 76 77 ພາກ ທີ ໜ່ຶງ A. ຄວາມ ຮູ້ ຫັຼກ A.1: ການ ນໍາ ພາ ການ ປ່ຽນ ແປງ •​ ກວດ​ເບິງ່​ການ​ປຽ່ນ​ແປງ​ທີ​່ຜູ​້ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ໄດ​້ລະ​ບ​ຸໄວ​້ຂາ້ງ​ລຸມ່​.​​ບນັທກຶ​ການ​ດາໍ​ເນນີ​ ການ​ທີ​່ທາ່ນ​ສາມາດເຮດັເພ່ືອ​ແນະ​ນາໍ​ຫຼ​ືປັບ​ປງຸ​ການ​ສະ​ໜອງ​ລົດ​ເຂນັ​ທີ​່ສນູ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ. 1. ສ້າງວິ ໄສ ທັດ ຮ່ວມ ກັນຂອງ ການ ສະ ໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ 2. ສ່ືສານ ແຈ້ງ ບອກ ຄວາມ ສໍາ ຄັນ ຂອງ ການ ສະ ໜອງ ລົ ດ ເຂັນ ທ່ີ ເໝາະ ສົມ ໂດຍ ຄໍານຶງ ເຖິງ ຄວາມ ຮີບ ດ່ວນ 3. ຈັດ ວາງ ພະ ນັກ ງານ ແລະ ແຫ່ຼງ ຊັບ ພະ ຍາ ກອນ 4. ກ ະຕຸ້ນ, ເຂ້ົາ ຮ່ວມ ແລະ ເຮັດ ໃຫ້ ພະນັກງານມີ ຄວາມ ມຸ້ງ ໝ້ັນ: •​ ລວມ​ເອາົພະນັກງານ​ເຂົາ້​ໃນ​ການວາງ​ແຜນ​​ແລະ​ການຈດັ​ຕັງ້​ປະຕບິັດ •​ ເອາົ​ຊະນະ​ອປຸະສັກ​ໄປ​ດວ້ຍ​ກນັ •​ ສາ້ງ​​ແລະ​ຍ້ອງຍ​ໍຄວາມ​ສາໍ​ເລັດ​ໄລ​ຍະ​ສັນ້ •​ ​ເຮດັ​ໃຫ​້ການ​ປຽ່ນ​ແປງ​ຕິດ​ແໜນ້​ໃນ​ລະ​ບົບ​ແລະ​ວັດ​ທະ​ນາ​ທາໍ​ຂອງ​ອງົ​ການ​ຂອງ​ທາ່ນ. 78 79 B. ການ ເລ່ີມ ການ ບໍ ລິ ການ ລົດ ເຂັນ B.1: ການ ເຂ້ົາ ເຖິງ ການ ບໍ ລິ ການ ຄໍາ ຖາມ ຄໍາ ຕອບ ​ຄໍາ​ຖາມ​ທີ​1:​​ການ​ສ້າງ​ເຄືອ​ຂ່າຍ​ການ​ນໍາ​ສົ່ງ ​ໃນ​ຖາ​ນະ​ທີ່​ເປັນ​ຜູ້​ຈັດ​ການ,​ການ​ດໍາ​ເນີນ​ໃດ​ແດ່​ທີ່​ທ່ານ​ ສາ​ມາດ​ເຮັດ​ເພື່ອສ້າງ​ເຄືອ​ຂ່າຍ​ບຸກ​ຄົນ​ແລະ​ອົງ​ການ​ທີ່​ ສາ​ມາດ​ກໍາ​ນົດ​​ແລະ​ນໍາ​ສົ່ງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ຫາ​ການ​ບໍ​ລິ​ການ​ ລົດ​ເຂັນ​ຂອງ​ທ່ານ? ​ຄໍາ​ຖາມ​ທີ​2:​ແບບຟອມການນໍາສົ່ງ ເບິ່ງທີ່​ຕົວ​ຢ່າງ​ແບບ​ຟອມ​ການ​ນໍາ​ສົ່ງ​ໃນ​ປື້​ມຄູ່​ມືແຫຼ່ງ​ຊັບ​ ພະ​ຍາ​ກອນ​ເພີ່ມ​ເຕີມ​ສໍາ​ລັບ​ຜູ້​ຈັດ​ການ​ຢູ່​ໃນ​Pen​Drive. ແບບ​ຟອມ​ການ​ນໍາ​ສົ່ງ​ນີ້​(ຫຼື​​ສະ​ບັບ​ດັບ​ປັບຂອງ​ແບບ​ຟອມ​ ນີ້)​​ຈະ​ເປັນ​ເຄື່ອງ​ມື​ທີ່​ມີ​ປະ​ໂຫຍດ​ສໍາ​ລັບ​ການ​ບໍ​ລິ​ການ​ ຂອງ​ທ່ານ​ບໍ?​ ​ຖ້າ​ບໍ່,​​ຍ້ອນ​ຫຍັງ? ​ຖ້າ​ແມ່ນ​-​​ໃນ​ຖາ​ນະ​ເປັນຜູ້​ຈັດ​ການ​ຂອງ​ການ​ບໍ​ລິ​ການ​ ຂອງ​ທ່ານ​– ​ທ່ານ​ສາ​ມາດ​ເຮັດ​ຫຍັງ​ເພ່ືອ​ແນະ​ ນໍາ​​ແບບ​ຟອມ​ການ​ນໍາ​ສົ່ງ​? (ໝາຍ​ເຫດ​– ​ຖ້າ​ການ​ບໍ​ລິ​ການ​ຂອງ​ທ່ານ/ແມ່ນ​ນໍາໃຊ້​ລະ​ ບົບ​ຢູ່​ແລ້ວ,​​ທ່ານ​ສາ​ມາດ​ອະ​ທິ​ບາຍ​ສ່ິງ​ທີ່​ທ່ານ​ໃນ​ຖານະ​ ເປັນ​ຜູ້​ຈັດ​ການ​ໄດ້​ເຮັດ​ເພ່ືອ​ແນະ​ນໍາ​ຫຼື​ສະ​ໜັບ​ສະ​ໜູນ​ ແບບ​ຟອມ​ການ​ນໍາ​ສົ່ງ).​ 1. ການ ດໍາ ເນີນການ ທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ເພ່ືອ ລະບຸ ແຫ່ຼງການ ນໍາ ສ່ົງ 2. ການ ດໍາ ເນີນ ການທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ເພ່ືອ ສ້າງ ເຄືອ ຂ່າຍການ ນໍາ ສ່ົງ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ເພ່ືອ ຕັດ ສິນ ໃຈ ວ່າ ຈະ ສ່ົງ ເສີມ ແບບ ຟອມ ການ ນໍາ ສ່ົງ ຫືຼບ່ໍ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ເພ່ືອ ເຮັດ ວຽກ ຢ່າງ ຈ່ິງ ຈັງ ໃນ ການ ໃຫ້ບໍ ລິ ການ ລົດ ເຂັນ ຢ່າງ ທ່ົວ ເຖິງ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 78 79 B.2: ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ ແລະ ອຸ ປະ ກອນ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ເພ່ືອ ລະ ບຸ ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ ແລະ ອຸ ປະ ກອນ ທ່ີ ເໝາະ ສົມ ສໍາ ລັບ ຮູບ ແບບ ການ ບໍ ລິ ການ ຂອງ ຂ້ອຍ 2. ການ ດໍາ ເນີນ ການ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ເຊ່ືອມສານແບບ ຟອມ ແລະ ລາຍ ການກວດ ເຂ້ົາ ໃນ ຂ້ັນ ຕອນ ການ ບໍ ລິ ການ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ຈັດວາງ ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ສ້າງ ລະ ບົບ ແລະ ລະບຽບຂ້ັນ ຕອນ ສໍາ ລັບ ແຕ່ ລະ ສະຖານທ່ີ ເຊ່ິງລວມທັງການມອບໝາຍວຽກງານໃນ ບ່ອນ ທ່ີ ເປັນ ໄປ ໄດ້ 80 81 B.3: ປະ ເພດ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ຄວາມ ຕ້ອງ ການ ຂອງ ຜູ້ ໃຊ້ ບໍ ລິ ການ ແລະ ຄຸ ນ ສົມ ບັດ ໃຊ້ ງານ ທ່ີສໍາຄັນທ່ີສຸດຂອງ ຜະ ລິດ ຕະ ພັນ ເພ່ືອ ຕອບ ສະ ໜອງ ຄວາມ ຕ້ອງ ການ ເຫ່ົຼາ ນ້ັນ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ຄວາມ ເໝາະ ສົມ ຂອງ ປະ ເພດ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ, ເບາະ ນ່ັງ ແລະ ອາ ໄຫ່ຼ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ການ ສະ ໜອງວັດ ສະ ດຸ ທ່ີ ເໝາະ ສົມ ເພ່ືອ ການ ເຮັດ ການ ດັດ ແປງ ຜະ ລິ ດ ຕະ ພັນ 4. ການ ດໍາ ເນີ ນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ປຶກ ສາ ກັບ ພາກ ສ່ວນ ກ່ຽວ ຂ້ອງ ຕ່າງໆກ່ຽວກັບ ຄ່າ ໃຊ້ ຈ່າຍ– ຜົນ ປະ ໂຫຍດ ຂອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ແລະ ເບາະ ນ່ັງ ທ່ີ ສະໜອງໃຫ້ ຜ່ານ ການ ບໍ ລິ ການ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 80 81 B.4: ຈັດ ວາງ ບຸກ ຄະ ລາ ກອນ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ພະ ນັກງານ ໃຫ້ ບໍ ລິ ການ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລວມ ເອົາ ພະ ນັກ ງານ ໃຫ້ ບໍ ລິ ການ ເຂ້ົາໃນ ການ ວາງ ແຜນ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ປະ ສານ ງານ ໃນ ການ ເຮັດ ວຽກ ເປັນ ທີມ ແລະ ສ້າງ ແຜນ ການ ເຮັດ ວຽກ ປະ ຈໍາ ອາ ທິດ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ຄວາມ ສາ ມາດ ຂອງ ການ ບໍ ລິ ການ ປະ ຈໍາ ປີ B.5: ການ ບໍລິການ ລົດ ເຂັນ ມີຄ່າ ໃຊ້ ຈ່າຍ ແນວ ໃດ? 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ພິ ຈາ ລະ ນາ ການ ລວມກັນ ຂອງການ ບໍ ລິ ການ ໃນ ເວ ລາ ວາງ ແຜນ ຮູບ ແບບ ການ ບໍ ລິ ການ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ພິ ຈາ ລະ ນາ ການ ຮ່ວມ ງານໃນຊຸມ ຊົມ ໃນ ເວ ລາ ວາງ ແຜນ ຮູບ ແບບ ການ ບໍ ລິ ການ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ກະ ກຽມ ງົ ບ ປະ ມານ ສໍາ ລັບ ຮູບ ແບບ ການ ບໍ ລິ ການ ທ່ີ ວາງ ແຜນ ໄວ້ 82 83 C. ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ C.1: ທ່ານ ຮູ້ ໄດ້ ແນວ ໃດ ວ່າການ ບໍລິການ ຂອງ ທ່ານ ກໍາລັງ ໄດ້ຜົນ ດີ? ພ້ືນ ທ່ີ ແລະ ກິດ ຈະ ກໍາ ການ ບໍ ລິ ການ ຄາດ ໝາຍ ການ ປະ ຕິ ບັດ ງານ ຂອງ ການ ບໍ ລິ ການ ວິ ທີ ການ ເກັບ ຂ້ໍ ມູນ ການ ນໍາ ສ່ົງ ​ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ທີ່​ຖືກນໍາ​ສົ່ງ ການ​ບໍ​ລິ​ການ​ຈະ​ໄດ້​ຮັບ​ການ​ນໍາ​ສ່ົງ​ 30​ຄັ້ງ​ຕໍ່​ເດືອນ ​ບັນທຶກ​ການ​ນໍາ​ສົ່ງ​ທີ່​ໄດ້​ຮັບ ການ ສະ ໜອງ ລົດ ເຂັນ ​ຈໍາ​ນວນ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ໄດ້​ຮັບ​ລົດ​ເຂັນ ​ການ​ບໍ​ລິ​ການ​ຈະ​ກໍາ​ນົດໃຊ້​ແລະ​ ປັບ​ລົດ​ເຂັນ​ໃຫ້​ພໍ​ດີ​ສໍາ​ລັບ​ຜູ້​ໃຊ້​20​ ຄົນ​ຕໍ່​ເດືອນ ​ການ​ກໍາ​ນົດ​ໃຊ້​ລົດ​ເຂັນ​ທີ່​ບັນທຶກ​ໄວ້​ ຢູ່​ໃນ​ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ ປະ ຊາ ກອນ ຜູ້ ໃຊ້ ລົດ ເຂັນ ທ່ີ ໃຫ້ ບໍ ລິ ການ ​ລາຍ​ລະ​ອຽດ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ ນໍາສົ່ງຫາການ​ບໍ​ລິ​ການ,​​ເຊັ່ນ​ ວ່າ​ອາ​ຍຸ,​​ເພດ,​​ຄວາມ​ພິ​ການ,​​ ຄວາມ​ຕ້ອງ​ການ​ດ້ານ​ການ​ຮອງ​ ຮັບ​ທ່າ​ທາງ​ຕ່າງໆ ​ການ​ບໍ​ລິ​ການ​ຈະ​ສົ່ງ​ເສີມ​ການ​ ເຂົ້າ​ເຖິງ​ທີ່​ເທົ່າ​ທຽມ​ກັນ ​ຈໍາ​ນວນ​ການ​ເຂົ້າ​ເຖິງ​ການ​ບໍ​ລິ​ ການຂອງ​ແມ່​ຍິງ,​​ຜູ້​ຊາຍ,​​ເດັກ​ ຍິງ​ແລະ​ເດັກ​ຊາຍ​​ທີ່ໄດ້​ບັນທຶກ​ ໄວ້​ໃນ​​ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ ຄ່າ ໃຊ້ ຈ່າຍ ໃນ ການບໍ ລິ ການ ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ ສະ​ໜອງ​ໃຫ້,​​ລວມ​ເຖິງ​ການ​ດັດ​ ແປງ​ທີ່​ເຮັດ​ພາຍ​ໃນ​ການ​ບໍ​ລິ​ ການ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ສ່ວນ​ບຸກ​ຄົນຂອງ​ລົດ​ ເຂນັ​ແຕ່​ລະ​ຄນັ​ຈະ​ນອ້ຍກວາ່​(​ຈາໍ​ ນວນ​ເງິນ​ທີ່​ລະ​ບຸ​ຕ​າມ​ງົບ​ປະ​ ມານ​ແລະ​ຄ່າ​ໃຊ້​ຈ່າຍ​ທີ່​ເປັນ​ຈິງ​ ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ມີ​ຢູ່) ​ທີ່​ຢູ່​ເຮືອນ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ເຂົ້າ​ເຖິງ​ ການ​ບໍ​ລິ​ການ​ທີ່​ໄດ້​ບັນ​ທຶກ​ໄວ້​ໃນ​ ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 82 83 ໂຄງ ຮ່າງ ແຜນການ ບໍລິການ ລະບຸ ຄວາມ ຕ້ອງການ/ບັນຫາ ທ່ີ ຈະ ຖືກ ຕິດຕາມ ການ ດໍາ ເນີນ ການ/ ຈຸດປະສົງ ໃນ ການ ແກ້ ໄຂ ຄວາມ ຕ້ອງການ/ບັນຫາ ນ້ັນ ຄາດໝາຍ ການ ເກັບ ຂ້ໍ ມູນ 4.​ 5.​ 6.​ 1.​ 2.​ 3.​ 1.​ 2.​ 3.​ 1.​ 2.​ 3.​ ບັນທຶກ ການ ດໍາ ເນີນ ການ ເພ່ືອ ຮູ້ ວ່າ ການ ບໍ ລິ ການ ກໍາລັງໃຫ້ຜົນດີຫືຼບ່ໍ ( ຖ້າ ມີເວລາ) 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ສ້າງ ແຜນ ການ ບໍ ລິ ການ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ການ ຕິດ ຕາມ ພະ ນັກ ງານ ໃນ ການ ເຮັດ ວຽກ ຕ່ໍ ກັບ ແຜນ ການ ບໍ ລິ ການ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ປະ ເມີນ ວ່າການ ບໍ ລິ ການ ກໍາລັງ ບັນລຸ ໄດ້ ເປ້ົາ ໝາຍ ຂອງຕົນ ຢ່າງ ມີ ປະສິດທິພາບ ສ່ໍາ ໃດ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ຍ້ອງ ຍໍ ທີມ ງານ ຫືຼ ຜົນ ສໍາ ເລັດ ຂອງ ແຕ່ ລະ ບຸກ ຄົນ 84 85 C.2: ການຄຸ້ມ ຄອງ ອຸປ ະ ສົງ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສ າມ າດ ໃຊ້ ເພ່ືອ ສ້າງ ລະ ບົບ ເພ່ືອ ຕິດ ຕາມ ການ ນໍາ ສ່ົງ ແລະ ຄຸ້ມ ຄອງລາຍ ຊ່ືລ້ໍ ຖ້າ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ແບ່ງ ປັນ ເລ່ືອງ ເລ່ົາ ຄວາມ ສໍາ ເລັດ ຂອງ ການ ນໍາ ສ່ົງ ໄວ ກັບ ພ່ໍ ແມ່ ແລະ ແຫ່ຼງ ການ ນໍາ ສ່ົງ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ວາງ ແຜນການ ຄຸ້ ມ ຄອງ ການ ນໍາ ສ່ົງ ລູກ ຄ້າ ທ່ີ ມີ ຄວາມ ຕ້ອງ ການ ເກີນ ຄວາມ ສາ ມາດ ຂອງ ການ ບໍ ລິ ການ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ຕິດ ຕາມ ແລະ ປັບ ປຸງ ປະ ສິດ ທິ ພາບ ຂອງ ຂ້ັນ ຕອນ ການ ບໍ ລິ ການ C.3: ການ ວາງ ແຜນ ການ ຕິ ດ ຕ າມຜົນ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ວາງ ແຜນ ການ ຕິດ ຕາມຜົນ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ສ້າງ ແລະ ຝຶກ ອົບ ຮົບ ການ ຮ່ວມ ມື ຂອງ ຊຸມ ຊົມ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 84 85 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ຜູ້ ສະ ໝັກ ທ່ີ ເປັນ ໄປ ດ້ ສໍາ ລັບ ການ ຝຶກ ອົບ ຮົບ ຜູ້ ໃຊ້ ແລະ ການ ຕິ ດ ຕາມ ຜົນ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ເກັບ ເອົາ ແລະ ແບ່ງ ປັນ ເລ່ືອງ ເລ່ົາ ຄວາມ ສໍາ ເລັດ ຂອງ ຜົນ ປະ ໂຫຍດ ຂອງ ການ ຕິດ ຕາມຜົນ C.4: ການວາງ ແຜນສໍາລັບ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ 1. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ສ້າງວິ ໄສ ທັດ ຮ່ວມ ກັນ ກ່ຽວ ກັບ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ 2. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ເງິນ ທຶນ ແລະ ແຫ່ຼງ ຊັບ ພະ ຍາ ກອນ ທ່ີ ຈໍາ ເປັນ 3. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ລະ ບຸ ແຫ່ຼງທຶນ 4. ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາມາດເຮັດເພ່ືອ ຈັດ ບຸ ລິ ມະ ສິດ ແຫ່ຼງທຶນ ແລະ ພັດ ທະ ນາ ຍຸດ ທະ ສາດ ການ ລະ ດົມ ທຶນ 86 87 ພາກ ທີ ສອງ A. ຄວາມ ຮູ້ ຫັຼກ A.1: ການ ສະ ໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ: ນະ ໂຍ ບາຍ ລະ ດັບ ປະ ເທດ •​ ​ອາ່ນ​ສອງ​ຕວົ​ຢາ່ງ​ຂອງ​ນະ​ໂຍ​ບາຍ​ລະ​ດັບ​ປະ​ເທດ​ທີກ່ຽ່ວ​ຂອ້ງ​ກັບ​ການ​ສະ​ໜອງ​ລົດ​ເຂນັ •​ ​ພ​ິຈາ​ລະ​ນາ​ວາ່​ມ​ີນະ​ໂຍ​ບາຍ​ໃດ​ແດ​່ໃນ​ປະ​ເທດ​ຂອງ​ທາ່ນ​ແລວ້. •​ ປກຶ​ສາ​ຫາລ​ືວາ່​ນະ​ໂຍ​ບາຍ​ຂາ້ງ​ລຸມ່​ນີ​້ຈະ​ເປນັ​ໂຫຍດ​ແນວ​ໃດໃນ​ປະ​ເທດ​ຂອງ​ທາ່ນ​​ແລະ​ພິ​ຈາ​ລະ​ ນາ​ບ່ອນ​ທີ​່ພວກ​ມນັ​ຈະ​ເໝາະສມົ​ພາຍ​ໃນ​ໂຄງ​ສາ້ງ​ຂອງ​ລັດ​ຖະ​ບານ​ຂອງ​ທາ່ນ. ຕົວ ຢ່າງ 1: ນະ ໂຍ ບາຍ ໃນ ປະ ເທດ ອັບ ກາ ນິດ ສະ ຖານທ່ີ ກ່ຽວ ຂ້ອງ ກັບ ການ ສະ ໜອງ ລົດ ເຂັນ ​ໃນ​ເດືອນ​ຕຸລາ​2003,​ກະຊວ​ງນັກຮົບ​ເກົ່າ​​ແລະ​ຄົນ​ພິການ​ໃນ​ປະ​ເທດ​ອັບ​ກາ​ນິດ​ສະຖານ​​ໄດ້​ເຜີ​ຍ​ແຜ່​ ນະ​ໂຍບາຍ​ຄົນ​ພິການ​ທົ່ວ​ໄປ.​ນະ​ໂຍບາຍ​ຖືກ​“ພັດທະນາ​ຂຶ້ນ​ໃນ​ແບບ​ທີ່​ຮ່ວມ​ມື​ກັນ​ລະຫວ່າງ​ທຸກ​ພາກ​ ສວ່ນທີ່​ກ່ຽວ​ຂ້ອງ​​ເຊິ່ງລວມມີ​ອົງການ​ຈັດ​ຕັ້ງ​ຄົນ​ພິການ​​ແລະ​ກຸ່ມ​ຊ່ວຍ​ເຫຼືອຕົນ​ເອງ;​ອົງການ​NGO​ ກ່ຽວ​ກັບ​ຄົນ​ພິການ​ທັງ​ລະດັບ​ປະ​ເທດ​​ແລະ​ລະຫວ່າງ​ປະ​ເທດ;​ກະຊວງ​ກ່ຽວຂ້ອງ​ທີ່​ສໍາຄັນ​​ເຊັ່ນ​ວ່າ​ ກະຊວງ​ສຶກສາ,​ກະຊວງ​ສາທາ,​ກະຊວງ​ແຮງ​ງານ​​ແລະ​ສະຫວັດດີກາ​ນສັງຄົມ,​ກະຊວງ​ແມ່ຍິງ,​​ ແລະ​ກະຊວງ​ນັກຮົບ​ເກົ່າ​​ແລະ​ຄນົພິການ​(MMD);​ອົງການ​UN​ທີ່​ກ່ຽວຂ້ອງ;​​ແລະ​ສໍານັກງານ​ ປະທານ​ປະ​ເທດ”​(4).​​ມີ​ການ​ຄາດ​ວ່າ​ນະ​ໂຍ​ບາຍ​ໃນ​ເບື້ອງ​ຕົ້ນ​ຈະ​ນໍາ​ໄປ​ສູ່​ແຜນ​ດໍາ​ເນີນ​ງານ​ທີ່ລະ​ອຽດ​ ແລະ​ມີ​ບຸລິມະສິດ​ສໍາຄັນ​ກວ່າ.​ນະ​ໂຍບາຍ​ຍັງກໍານົດ​ຕື່ມ​ອີກ​ວ່າ: ​ການ​ໃຫ້​ບໍລິການຄົນ​ພິ​ການ​ທາງ​ຮ່າງ​ກາຍ​ຄວນ​ລວມ​ເອົາ​ສູນ​ຟື້ນ​ຟູ​ກ່ຽວ​ກັບກະ​ດູກ;​​ການ​ບໍ​ລິ​ການ​ກາ​ ຍະ​ບໍາ​ບັດ,​​ແລະ​​ອຸ​ປະ​ກອນ​ທຽມ​​ແລະ​ອຸ​ປະກອນຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ.​​ການ​ບໍ​ລິ​ການ​ເຫຼົ່າ​ ນັ້ນ​ຄວນ​ຢູ່​ໃກ້​ກັບ​ໂຮງ​ໝໍ​ລະ​ດັບ​ພາ​ກ​ຫຼື​ໂຮງ​ໝໍ​ແຂວງ​ທີ່​ມີ​ການ​ບໍ​ລິ​ການ​ຜ່າ​ຕັດ​ກະ​ດູກ​ເພ່ືອ​ໃຫ້​ປະ​ຊາ​ ກອນ​ທ້ອງ​ຖິ່ນ​ເຂົ້າ​ເຖິງ​ໄດ້​ງ່າຍ.​ຄົນ​ພິ​ການ​ມີ​ສິດ​ໄດ້​ຮັບ​ອຸ​ປະ​ກອບ.​​ອຸ​ປະ​ກອນ​ຄວນ​ຈະ​ເຮັດ​ມາ​ເປັນ​ ຢ່າງ​ດີ,​​ປະ​ກອບ​ມາ​ເປັນ​ຢ່າງ​ດີ,​​ຂອງວັດ​ສະ​ດຸ​ໃນ​ທ້ອງ​ຖິ່ນ​ເມື່ອ​ໃດ​ກໍ​ຕາມ​ທີ່​ເປັນ​ໄປ​ໄດ້​ແລະ​ສາ​ມາດ​ ສ້ອມ​ແປງ​ໄດ້​ໃນ​ທ້ອງ​ຖິ່ນ.​​ເຕັກ​ໂນ​ໂລ​ຊີ​ທີ່​ເໝາະ​ສົມ​ຄວນ​ເປັນ​ມາດ​ຕະ​ຖານ​ທົ່ວ​ປະ​ເທດ.​​ກົນ​ໄກ​ສໍາ​ລັບ​ ມາດ​ຕະ​ຖານ​ລະ​ດັບ​ປະ​ເທດ​ຄວນ​ຖືກ​ສ້າງ​ຂື້ນ​ດ້ວຍ​ຜູ້​ຊ່ຽວ​ຊານ​ທີ່​ກ່ຽວ​ຂ້ອງ​ໃນ​ການ​ຮ່ວມ​ມື​ກັນ​ກັບ​ກະ​ ຊວງ​MOPH​[​ກະ​ຊວງ​ສາ​ທາ​ລະ​ນະ​ສຸກ]. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 86 87 ຕົວ ຢ່າງ 2: ນະ ໂຍ ບາຍ ໃນ ປະ ເທດ ອາ ຟ ຣິ ກາ ໃຕ້ ກ່ຽວ ຂ້ອງ ກັບ ການ ສະ ໜອງ ລົດ ເຂັນ ​ຂໍ້​ແນະ​ນໍາ​ລະ​ດັບ​ປະ​ເທດ​ໃນ​ປີ​2003​ສໍາ​ລັບ​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະ​ເທດ​ອາ​ຟ​ຣິ​ກາ​ໄດ້​ຖືກ​ພິມ​ເຜີຍ​ແຜ່.​​ ຂໍ້​ແນະ​ນໍາ​ເຫຼົ່າ​ນີ້​ໄດ້​ຖືກ​ພັດ​ທະ​ນາ​ຜ່ານ​ການ​ໃຫ້​ປຶກ​ສາ​ໃນ​ບັນ​ດາ​ທຸກ​ແຂວງ​ໃນ​ປະ​ເທດ​ອາ​ຟ​ຣິ​ກາ​ໃຕ້.​​ ການ​ປະ​ກອບ​ສ່ວນ​ທີ່​ເຮັດ​ໂດຍ​ແຂວງ​Western​Cape​​ແມ່ນ​ອີງ​ໃສ່​ປະ​ສົບ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ​ກ່ຽວ​ກັບ​ ການ​ພັ​ດ​ທະ​ນາ​ຂໍ້​ແນະ​ນໍາ​ຂັ້ນ​ແຂວງ​. ​ການ​ພັ​ດ​ທະ​ນາ​ຂໍ້​ແນະ​ນໍາ​ຂັ້ນ​ແຂວງ​ໄດ້​ເລີ່ມ​ໂດຍ​ກຸ່ມ​ແພດ​ປິ່ນ​ປົວ​ທີ່​ໃຫ້​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ.​​ພວກ​ ເຂົາ​ໄດ້​ປຶກ​ສາ​ກັບ​ຜູ້​ຈັດ​ການ​ແຜ​ນງານຂັ້ນ​ແຂວງ​ແລະ​ການ​ບໍ​ລິ​ການຟື້ນ​ຟູ​ສຸ​ຂະ​ພາບ​ທ້ອງ​ຖິ່ນ​ເພ່ືອ​ພັດ​ ທະ​ນາ​ແຜນ​ເພ່ືອ​ເຮັດ​ໃຫ້​ມາດ​ຕະ​ຖານ​ຂອງ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​ເປ​ັນການ​ບໍລິການ​ມື​ອາຊີບ.​​ແຜນ​ດັ່ງ​ ກ່າວ​ມີ​ສາມ​ຂົງ​ເຂດ​ຈຸດ​ສຸມ​ສໍາ​ຄັນ: 1.​ ​ເຮັດ​ການ​ວິ​ເຄາະ​ສະ​ພາບ​ຂອງການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​ໃນ​ແຂວງ 2.​ ​ດຳ​ເນີນ​ການ​ຝຶກ​ອົບ​ຮົບ​ຂອງ​ຜູ້​ໃຫ້​ບໍ​ລິ​ການ​ລົດ​ເຂັນ 3.​ ​ສ້າງ​ຂໍ້​ແນະ​ນຳ​ສຳ​ລັບ​ຍຸດ​ທະ​ສາດ​ການ​ຄຸ້ມ​ຄອງ​ລົດ​ເຂັນ​ຂັ້ນ​ແຂວງ. ​ຂໍ້​ແນະ​ນໍາ​ຂັ້ນ​ແຂວງ​ໄດ້​ຖືກ​ຮ່າງ​ຂື້ນ​ເຊິ່ງ​ລວມ​ເອົາ​ມາດ​ຕະ​ຖານ​ຂັ້ນ​ຕໍ່າ​ສຸດ​ສໍາ​ລັບ​ຂັ້ນ​ຕອນ​ການ​ບໍ​ລິ​ ການ​ທີ່​ສໍາ​ຄັນ,​​ເຊັ່ນ​ດຽວ​ກັບ​ຂັ້ນ​ຕອນ​ການ​ຄຸ້ມ​ຄອງ​ທີ່​ສໍາ​ຄັນ,​​ເຊັ່ນ​ວ່າ​ການ​ຝຶກ​ອົບ​ຮົບ​ພະ​ນັກ​ງານ,​​ ການ​ຕິດ​ຕັ້ງ​ແລະ​ການ​ຄຸ້ມ​ຄອງ​ລາຍ​ຊື່​ລໍ້​ຖ້າ,​​ງົບ​ປະ​ມານ​ແລະ​ການ​ສະ​ໜອງ​ບໍ​ລິ​ການ​ສ້ອມ​ແປງ​ແລະ​ ບໍາ​ລຸງ​ຮັກ​ສາ. ​ຄະນະ​ຜູ້​ບໍລິຫານ​ຂັ້ນ​ແຂວງ​ໄດ້​ຊ່ວຍ​ກຸ່ມ​ໃຫ້​ກາຍ​ເປັນ​ກຸ່ມ​ທີ່​ປຶກ​ສາ​ທາງ​ການ.​​ຕົວ​ແທນ​ຂອງ​ກຸ່ມ​ນີ້​ມາ​ ພ້ອມ​ກັບ​ຜູ້​ຈັດ​ການ​ຂັ້ນ​ແຂວງ​ເພ່ືອ​ເຂົ້າ​ຮ່ວມ​ກອງ​ປະ​ຊຸມ​ລະ​ດັບ​ປະ​ເທດ​ແລະ​ປະ​ກອບ​ສ່ວນ​ໃນ​ ການສ້າງ​ຂໍ້​ແນະ​ນໍາ​ລະ​ດັບ​ປະ​ເທດ​ສໍາ​ລັບ​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະ​ເທດ​ອາ​ຟ​ຣິ​ກາ​ໃຕ້. 88 89 A.2: ການ ໃຫ້ການ ບໍລິການ ບົດ ບາດ ໜ້າ ທ່ີ ຂອງ ຜູ້ ຈັດ ການທ່ີກວ້າງ ຂ້ືນ ການ ດໍາ ເນີນ ການ ຮ່ວມ ກັນເພ່ືອ ປັບ ປຸງ ການ ສະ ໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ໃນ ປະ ເທດ ການ ດໍາ ເນີນ ການ ທ່ີ ຂ້ອຍ ສາ ມາດ ເຮັດ ໃນ ສາມ ເດືອນ ຕ່ໍ ໄປ ການສ້າງຄວາມຮັບຮູ້ ການປັບປຸງຂອບເຂດຜະ ລິດຕະພັນທ່ີມີໃຫ້ ການສ້າງຄວາມຮັບຮູ້ ການພັດທະນາຄ ວາມຍືນຍົງ ການເພ່ີມໂອກາດກາ ນຝຶກອົບຮົມ ການມີອິດທິພົນຕ່ໍກັບນະ ໂຍບາຍລະດັບປະເທດ ການປັບປຸງຄວາ ມສາມາດເຂ້ົາເຖິງ ນະໂຍບາຍ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 88 89 B. ການ ເລ່ີມ ການ ບໍ ລິ ການ ລົດ ເຂັນ B.1: ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ ແລະ ອຸ ປະ ກອນ B.1.1 ການ ລະ ບຸ ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ ທ່ີ ເໝາະ ສົມ •​ ​ເບິງ່​ທີ​່ລາຍ​ຊື​່ສິງ່​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ຂາ້ງ​ລຸມ່​ນີ.້ •​ ​ຄິດ​ກຽ່ວ​ກັບ​ວ​ິທ​ີແກ​້ໄຂ​ບນັ​ຫາ​ການ​ຝຶກ​ແອບ​ທີ​່ຈະ​ເຮດັ​ວຽກ​ໃນ​ການ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ. ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກຂ້ັນ ພ້ື ນ ຖານ ສ່ິງ ອໍາ ນວຍ ສະ ດວກ ນ້ີ ມີ ຢູ່ ແລ້ວ ບໍ? ນ້ີ ສາມາດ ເປັນ ສ່ິງ ອໍາ ນວຍ ຄວ າມ ສະ ດວກຮ່ວມ ກັນ ກັບການ ບໍ ລິ ການ ທ່ີ ມີ ຢູ່ ແລ້ວໄດ້ ບໍ? ຫ້ອງ ທ່ີ ມີ ຈຸດປະສົງ ອ່ືນ ສາມາດ ຖືກ ປັ ບປ່ຽນ ໄດ້ ບໍ? ສາ ມາດ ຈັດ ສັນ ຫ້ອງ ທ່ີ ມີ ຢູ່ ແລ້ວຄືນ ໃໝ່ ຫືຼ ປັບ ໂຄງ ສ້າງ ຄືນ ໃໝ່ ໄດ້ ບໍ? 1.​​ການ​ລໍ​້ຖາ້​ແລະ​ ການ​ຕອ້ນ​ຮບັ 2.​ພ້ືນ​ທີ​່ງຽບ​ສະ​ ຫງົບ​ສາໍ​ລບັ​ນອນ​ ຫຼິນ້ 3.​ຫອ້ງ​ນໍາ້​ທີ​່ສາ​ ມາດ​ເຂົາ້​ເຖງິ​ໄດ້ 4.​​ພ້ືນ​ທີ​່ຫອ້ງ​ການ​ ສາໍ​ລບັ​ພະ​ນກັ​ງານ 5.​​ສະ​ຖານ​ທີ​່ປິນ່​ ປວົ:​ ​ພືນ້​ທີ​່ສາໍ​ລບັ​ການ​ ປະ​ເມນີ​ຜນົ​ແລະ​ ການ​ປບັ​ລດົ​ເຂນັ​ ໃຫ​້ເໝາະ​ສົມ 6.​​ເຕກັ​ນກິ:​​ພ້ືນ​ ທີ​່ສາໍ​ລບັ​ການ​ກະ​ ກຽ​ມ,​ບາໍ​ລງຸ​ຮກັ​ ສາ​ແລະ​ສອ້ມ​ ແປງ​ລດົ​ເຂນັ​ 90 91 7.​ການ​ເກັບ​ ມ້ຽນ 8.​​ການ​ຝຶກ​ອົບ​ ຮົມ​ຜູ້​ໃຊ້ ສ່ິງ ອໍາ ນວຍ ຄວາມ ສະ ດວກ ລະ ດັບ ປາ ນ ກາງ ເພ່ີມ ເຕີມ ສ່ິງ ອໍາ ນວຍ ສະ ດວກ ນ້ີ ມີ ຢູ່ ແລ້ວ ບໍ? ນ້ີ ສາມາດ ເປັນ ສ່ິງ ອໍາ ນວຍ ຄວ າມ ສະ ດວກຮ່ວມ ກັນ ກັບການ ບໍ ລິ ການ ທ່ີ ມີ ຢູ່ ແລ້ວໄດ້ ບໍ? ຫ້ອງ ທ່ີ ມີ ຈຸດປະສົງ ອ່ືນ ສາມາດ ຖືກ ປັ ບປ່ຽນ ໄດ້ ບໍ? ສາ ມາດ ຈັດ ສັນ ຫ້ອງ ທ່ີ ມີ ຢູ່ ແລ້ວຄືນ ໃໝ່ ຫືຼ ບ ໂຄງ ສ້າງ ຄືນ ໃໝ່ ໄດ້ ບໍ? 9.​​ພ້ືນ​ທີ່ສໍາ​ລັບ​ ປະ​ເມີນ​ຜົນ​ ແລະ​ປັບ​ລົດ​ເຂັນ​ ໃຫ້​ເໝາະ​ສົມ​ ດ້ວຍ​ຕຽງ​ສໍາ​ລັບ​ ປະ​ເມນີ​ຜນົ​ໃນ​ຕໍາ​ ແໜ່ງນອນ 10.​​ພື້ນ​ທີ່​ຫວ່າງ​ ເກັບ​ມ້ຽນ​ເພີ່ມ​ ເຕີມ​ສໍາ​ລັບ​ວັດ​ ສະ​ດຸ​ຕ່າງໆ 11.​​ພື້ນ​ທີ່​ກະ​ ກຽມ​ຜະ​ລິດ​ຕະ​ ພັນ​ເພີ່ມ​ເຕີມ:​​ ການ​ຫຍິບ​ແລະ​ ແນວ​ຫຸ້ມ​ເບາະ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 90 91 B.1.2 ການລະບຸອຸປະກອນ •​ ເບິງ່​ຄູ​່ມ​ືອາ້ງ​ອງີ​ສາໍ​ລັບ​ຂໍ​້ແນະ​ນາໍ​ກຽ່ວ​ກັບ​ອ​ຸປະ​ກອນ​ແລະ​​ເອ​ກະ​ສານ. ອຸປະກອນ •​ ​ລະ​ບຸ​ວ່າອຸ​ປະ​ກອນ​ຫຍັງ​ແດ່​ທີ່​ມີ​ແລະ​ນໍາໃຊ້​ຢູ່​ແລ້ວຢູ່​ໃນສູນ​ການ​ບໍ​ລິ​ການ​ຂອງ​ທ່ານ​ແລະ​ຈົດ​ບັນທຶກ​ ທຸກ​ອຸ​ປະ​ກອນ​ທີ່​ຈະ​ເຮັດ​ຫຼື​ສັ່ງ​ຊື້. ມີຢູ່ແລ້ວ ຈະ ຕ້ອງເຮັດ ຫືຼ ສ່ັງຊ້ື ເອ ກະ ສານ •​ ​ທົບ​ທວນ​ລາຍ​ການ​ຂອງ​ແບບ​ຟອມ​ແລະ​ລາຍ​ການກວດ​ໃນ​ແຫຼ່ງ​ຊັບ​ພະ​ຍາ​ກອນ​ເພ່ີມ​ເຕີມ​ສໍາ​ລັບ​ຜູ້​ຈັດ​ ການ​ຢູ່​ໃນ​Pen​Drive. •​ ​ແບບ​ຟອມ​ແລະ​ລາຍ​ການກວດ​ໃດ​ແດ່ທີ່​ລວມ​ເອົາ​ແລະ​ນໍາ​ໃຊ້​ຢູ່​ແລ້ວ?​​ຈົດ​ບັນທຶກ​ທຸກ​ແບບ​ຟອມ​ ແລະ​ລາຍ​ການກວດ​ທີ່​ຈະ​ຖືກ​ລວມ​ເອົາ​ເຂົ້າ​ໃນ​ການ​ໃຊ້​ປະຈໍາ​ວັນ. ມີຢູ່ແລ້ວ ທ່ີ ຈະ ລວມ ເອົາ ເຂ້ົາ ໃນການ ບໍ ລິ ການ ທ່ີ ມີ ຢູ່ ແລ້ວ B.1.3 ການ ຈັດ ວາງ ພ້ືນ ທ່ີ ເຮັດ ວຽກ •​ ​ເບິງ່​ຄູ​່ມ​ືອາ້ງ​ອງີ​ເພື່ອ​ແນະ​ນາໍ​ກຽ່ວ​ກັບ​ສິງ່​ອາໍ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ອ​ຸປະ​ກອນ. •​ ​ທົບ​ທວນ​ເຄັດ​ລັບ​ກຽ່ວ​ກັບ​ການ​ຈດັ​ວາງ​ພ້ືນ​ທີ​່ເຮດັ​ວຽກ​ທີ​່ດ​ີທີ​່ໄດ​້ລະ​ບ​ຸໄວ​້ຂາ້ງ​ລຸມ່​ນີ:້ 1.​ ​ເອົາສິ່ງ​ຂອງ​ທີ່​ຮົກ​ເຮື້ອ​ອອກ:​ກໍາຈັດ​ເຄື່ອງມື​,​ອາ​ໄຫຼ່,​ອຸປະກອນ​​ແລະ​ເອກ​ະສານ​ເກົ່າ​ທັງ​ໝົດ​ ຖິ້ມ. 2.​ ກໍານົດ​ສິ່ງ​ຂອງ​ທີ່​ໃຊ້​ເປັນ​ປະຈໍາ:​​ເຄື່ອງມື,​ອາ​ໄຫຼ່,​ຄໍາ​ແນະນໍາ​​ແລະ​ເອກະສານ.​​ລາຍ​ການ​ ເຫຼົ່າ​ນີ້​ຄວນ​ຖືກ​ຈັດ​ວາງ​​ເພື່ອ​ໃຫ້​ຊອກ​ຫາ​ພວກ​ມັນ​ໄດ້​ງ່າຍ​ທີ່​ສຸດ​​ແລະ​ໄວ​ທີ່​ສຸດ. 3.​ ລະບົບ​​ແລະ​ຄວາມ​ຮັບຜິດຊອບ:​ມີ​ລະບົບ​ສໍາລັບ​ແຕ່​ລະ​ພື້ນ​ທີ່​ເຮັດ​ວຽກ​​ແລະ​ໃຫ້ບາງ​ຄົນ​ຮັບຜິດ​ ຊອບ​ສໍາລັບ​ການຈັດ​ຕັ້ງ​ລະບົບ​ນັ້ນ. 4.​ ​ຕິດຕາມ:​​ຕິດ​ຕາມລະບົບ​ເພື່ອ​ຮັບປະກັນ​ການປ່ຽນ​ແປງ. 92 93 ພ້ືນ ທ່ີ ເຕັກ ນິກ •​ ​ວິ​ເຄາະ​ຕົວ​ຢ່າງ​ແລະ​ໃຫ້​ຄໍາ​ແນະ​ນໍາ​ສໍາ​ລັບ​ການ​ປັບ​ປຸງ ຂົງ ເຂດ ການໃຫ້ ບໍລິການປ່ິນ ປົວ ແລະ ເຕັກ ນິກນອ ກ ສະ ຖານ ທ່ີ •​ ​ວິ​ເຄາະ​ຕົວ​ຢ່າງ​ແລະ​ໃຫ້​ຄໍາ​ແນະ​ນໍາ​ສໍາ​ລັບ​ການ​ປັບ​ປຸງ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 92 93 B.2: ປະ ເພດ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ B.2.1 ຄວາມ ທົນ ທານ, ຄວາມສາ ມາດ ສ້ອມ ແປງ ໄດ້ •​ ​ເຮດັ​ວຽກ​ຮວ່ມ​ກນັ​ກັບ​ກຸມ່​ຂອງ​ທາ່ນ​ແລະ​ເຮດັ​ສາໍ​ເລັດ​ຊດຸ​ຄາໍ​ຖາມ​ທີມ່ອບ​ໝາຍ​ໃຫ​້ທາ່ນ​– ​ຂືນ້​ຢູ່​ ກັບ​ໝາຍ​ເລກ​ກຸມ່​ຂອງ​ທາ່ນ. •​ ​ໃຊ​້ຄວາມ​ຮູ​້ແລະ​ປະ​ສົບ​ການ​ຂອງ​ຕວົ​ທາ່ນ​ເອງ​ພ້ອມ​ກັບ​ຄູ​່ມ​ືອາ້ງ​ອງີ​ເພ່ືອ​ສາໍ​ເລັດ​ກິດ​ຈະ​ກາໍ. ກຸ່ມ 1 •​ ຄໍາ​ຖາມ​ຫຍັງ​ແດ່​ທີ່​ທ່ານ​ສາ​ມາດ​ຖາມ​ກ່ຽວ​ກັບ​ຄວາມ​ປອດ​ໄພ​ແລະ​ຄວາມ​ທົນ​ທານ​ ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ໄດ້​ສະ​ໜອງ​ໃຫ້? •​ ​ທ່ານ​ຈະ​ສາ​ມາດ​ຊອກ​ຫາ​ໄດ້​ແນວ​ໃດ​ວ່າ​ຜູ້​ສະ​ໜອງ​ຜະ​ລິດ​ຕະ​ພັນ​(​ຜູ້​ບໍ​ລິ​ຈາກ,​​ຜູ້​ຜະ​ ລິດ)​​ຈະ​ສະ​ໜອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ປອດ​ໄພ​ແລະ​ທົນ​ທານ​ສໍາ​ລັບ​ສະ​ພາບ​ການ​ສະ​ ເພາະ​ຂອງ​ທ່ານ? •​ ​ຜູ້​ໃດ​ແດ່​ທີ່​ທ່ານ​ສາ​ມາດ​ໂອ້​ລົມ​ເພ່ືອ​ຊອກ​ຫາ​ກ່ຽວ​ກັບ​ຄວາມ​ປອດ​ໄພ​ແລະ​ຄວາມ​ທົນ​ ທານ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ຖືກ​ນໍາ​ສະ​ເໜີ​ໂດຍ​ຜູ້​ບໍ​ລິ​ຈາກ/ຜູ້​ຜະ​ລິດ/ຜູ້​ສະ​ໜອງ? ​ຄວາມ​ທົນ​ ທານ ກຸ່ມ 2 •​ ​ແມ້​ກະ​ທັງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ທົນ​ທານ​ທີ່​ກໍ່ມີຊິ້ນ​ສ່ວນ​ທີ່​ສາມາດຫຼຸ້ຍ​ຫ້ຽນ​ແລະ​ເພ​ໄດ້.​​ ບາງ​ຊິ້ນ​ສ່ວນທີ່​ເພ​ໄດ້ເຫຼົ່າ​ນີ້​ມີ​ຫຍັງ​ແດ່? ​ຊິ້ນ​ສ່ວນ​ທີ່​ ເພ​ແລະ​ ຫຼຸ້ຍຫ້ຽນ ກຸ່ມ 3 •​ ​ການ​ບໍ​ລິ​ການ​ທີ່​ຕ້ອງ​ການ​ອາ​ໄຫຼ່. •​ ທ່ານ​ສາ​ມາດ​ລະ​ບຸ​ໄດ້​ແນວ​ໃດ​ວ່າຈໍາ​ເປັນ​ຕ້ອງ​ມີອາ​ໄຫຼ່​ໃດ​ແດ່​? •​ ທ່​ານ​ຮູ້​ໄດ້​ແນວ​ໃດ​ວ່າ​ຈໍາ​ເປັນຕ້ອງ​ສັ່ງ​ຊື້ອາ​ໄຫຼ່​ໃດ​ແດ່? ​ອາ​ໄຫຼ່ 94 95 B.2.2 ການ ສະ ໜອງ ລົດ ເຂັນ ທ່ີ ເໝາະ ສົມ ສະ ພາບ ການ 1 •​ ​ອາ່ນ​ສະ​ພາບ​ການ​ທີ​່ຖກືມອບ​ໝາຍ​ຂອງ​ທາ່ນ​ຂາ້ງ​ລຸມ່​ນີ.້​​ຈາກ​ນັນ້​ອາ່ນ​'ຫຼກັ​ການ​ຂອງ​ການ​ສະ​ ໜອງ​ອ​ຸປະ​ກອນຊວ່ຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ທີ​່ເໝາະ​ສມົ​'. •​ ​ກະ​ກຽມ​ສະ​ພາບ​ການ​ໃນ​ການຫຼິນ້​ບົດ​ບາດ​ໃນ​ບນັ​ດາ​ພະ​ນັກ​ງານ​ຂັນ້​ແຂວງ​ແລະ​​ກຸມ່​ພາກ​ສວ່ນ​ ກຽ່ວ​ຂອ້ງ​ໃນ​ການ​ສົງ່​ເສມີ​ສາໍ​ລັບ​ປຽ່ນ​ແປງ​ໃນ​ລະ​ບົບ​ຈດັ​ຊື​້ລົດ​ເຂນັ​(3-5​​ນາ​ທ​ີສາໍ​ລັບຫຼິນ້​ບົດ​ບາດ). ​ໃນ​ເວລາ​ສົນ​ທະ​ນາ​ເລື່ອງ​ການສ​ະ​ແດງ​ລະຄອນ,​​ໃຫ້ຄິດ​ກ່ຽວ​ກັບ: •​ ​ບັນ​ຫາ​ໃນ​ສະ​ພາບ​ການ​ແມ່ນ​ຫຍັງ? •​ ​ການດໍາ​ເນີນ​ການທີ່​ເປັນ​ໄປ​ໄດ້​ເພ່ືອ​ທີ່​ຈະ​ເອົາ​ຊະ​ນະ​ບັນ​ຫາ​ທີ່​ເກີດ​ຂື້ນ. ໂຮງ​ໝໍ​ຂອງ​ລັດ​ຖະ​ບານ​ໃນ​ພາກ​ ພື້ນ​ຂອງ​ທ່ານ​ໄດ້​ຈັດ​ສັນ​ງົບ​ປະ​ ມານ​ສໍາ​ລັບ​ການ​ສະ​ໜອງ​ລົດ​ ເຂັນ.​​ງົບ​ປະ​ມານ​ປະ​ຈໍາ​ປີ​ໄດ້​ຮັບ​ ການ​ທົນ​ທ​ວນ​ຄືນ​ແລະ​ລາຍ​ຊື່ຜະ​ ລິດ​ຕະ​ພັນ​ໄດ້​ຮັບ​ການ​ພິ​ຈາ​ລະ​ນາ​ ຄືນ.​​ເຖິງ​ແມ່ນ​ວ່າ​ແຕ່​ລະ​ປີ​ຈະ​ມີ​ ການ​ຮ້ອງ​ຂໍ​ເພ່ືອ​ປ່ຽນ​ແປງ​ຜະ​ລິດ​ ຕະ​ພັນ​ທີ່​ມີ​ຢູ່​ທີ່​ບໍ່​ເຄີຍ​ມີ​ການ​ປ່ຽນ​ ແປງ​ໃດໆ​ແລະ​ພະ​ແນກ​ຈັດ​ຊື້​ໄດ້​ ສັ່ງ​ຊື້​ຜະ​ລິດ​ຕະ​ພັນ​2​ປະ​ເພດ​ ໂດຍ​ອີງ​ໃສ່​ຄ່າ​ໃຊ້​ຈ່າຍ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 94 95 ຫຼັກ​ການ​ຂອງ​ການ​ສະ​ໜອງ​ອຸ​ປະ​ກອນຊວ່ຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ທີ່​ເໝາະ​ສົມ ເພື່ອ​ໃຫ້​ປະ​ເທດ​ຕອບ​ສະ​ໜອ​ງ​ພັນ​ທະ​ຂອງ​ພວກ​ເຂົາ​ທີ່​ກ່ຽວ​ຂ້ອງ​ກັບ​ເຕັກ​ໂນ​ໂລ​ຊີ​ຊ່ວຍ​ເຫຼືອ​(​ອຸ​ປະ​ກອນ​ ຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ),​​ທີ່​ໄດ້​ກໍາ​ນົດ​ໄວ້​ໃນ​ສົນ​ທິ​ສັນ​ຍາ​ວ່າ​ດ້ວຍ​ສິດ​ທິ​ຂອງ​ຄົນ​ພິ​ການ​ຫຼັການ​ສໍາ​ ຄັນ​ຕໍ່​ໄປ​ນີ້​ຈໍາ​ເປັນ​ຕ້ອງ​ມີ​ການ​ພິ​ຈາ​ລະ​ນາ: •​ ​ຄວາມຍອມຮັບ​– ​ຄົນ​ພິ​ການ​ຈະ​ຕ້ອງ​ມີ​ສ່ວ​ນ​ຮ່ວມ​ໃນ​ທຸກ​ຂັ້ນ​ຕອນ​ຂອງ​ການ​ສະ​ໜອງ​ອຸ​ປະ​ກອນ​ຊ່ວຍ​ ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມ​າ •​ ​ຄວາມ​ສາມາດ​ເຂົ້າ​ເຖິງ​– ​ອຸ​ປະ​ກອນ​ຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ແລະ​ການ​ບໍ​ລິ​ການ​ທີ່​ກ່ຽວ​ຂ້ອງ​ ຈະ​ຕ້ອງ​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ້​ຕໍ່​ກັບທຸກ​ຄົນ​ທີ່​ມີ​ຄວາມ​ຕ້ອງ​ການ​ທີ່​ໄດ້ລະ​ບຸ​ໄວ້ •​ ​ການປັບ​ໄດ້​– ​ອຸ​ປະ​ກອນ​ຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ແລະ​ການ​ບໍ​ລິ​ການ​ທີ່​ກ່ຽວ​ຂ້ອງ​ຈໍາ​ເປັນ​ຕ້ອງ​ ດັບ​ປັບ​ແລະ​ດັດ​ແປງ​ເພ່ືອ​ຮັບ​ປະ​ກັນ​ວ່າ​ພວກ​ເຂົາ​ເໝາະ​ສົມ​ກັບ​ຄວາມ​ຕ້ອງ​ການ​ຂອງ​ແຕ່​ລະ​ຄົນ •​ ​ຄວາມ​ສາ​ມາດ​ຊື້​ໄດ້​– ​ອຸ​ປະ​ກອນ​ຊ່ວຍ​ໃນ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ແລະ​ການ​ບໍ​ລິ​ການ​ທີ່​ກ່ຽວ​ຂ້ອງ​ຕ້ອງ​ ສາ​ມາດ​ຊື້​ໄດ້ •​ ​ການ​ມີ​ໃຫ້​– ​ສິ່ງ​ອໍາ​ນວຍ​ຄວາມ​ສະ​ດວກ,​​ພະ​ນັກ​ງານ​ແລະ​ຜະ​ລິດ​ຕະ​ພັນ​​ຕ້ອງ​ມີ​ພຽງ​ພໍ​ສໍາ​ລັບ​ຄວາມ​ ຕ້ອງ​ການ​ຂອງ​ປະ​ຊາ​ກອນ​ແລະ​ຢູ່​ໃກ້​ເທົ່າ​ທີ່​ເປັນ​ໄປ​ໄດ້​ກັບ​ຊຸມ​ຊົມ​ຂອງ​ບຸກຄົນ​ເຫຼົ່ານ້ັນ •​ ​ຄຸນ​ນະ​ພາບ​– ​ຜະ​ລິດ​ຕະ​ພັນ,​​ສິ່ງ​ອໍາ​ນວຍ​ຄວາມ​ສະ​ດວກ​ແລະ​ການ​ບໍ​ລິ​ການ​ຕ້ອງ​ມີ​ຄຸນ​ນະ​ພາບ​ທີ່​ ເໝາະ​ສົມ. 96 97 ສະ ພາບ ການ 2 •​ ອ່ານ​ກ່ຽວ​ກັບ​ສອງ​ລະ​ບົບ​ການ​ປະ​ມູນ​ຂອງ​ລັດ​ຖະບານ​ຂ້າງ​ລຸ່ມ​ນີ້. •​ ສັງ​ລວມ​ລະ​ບົບ​ປະ​ຈຸ​ບັນ​ໃນ​ປະ​ເທດ​ຂອງ​ທ່ານ​ໃນ​ຂະ​ນະ​ນີ້. •​ ​ເບິ່ງ​‘ບັນດາຫຼັກ​ການ​ກ່ຽວ​ກັບ​ການສະ​ໜອງ​ອຸ​ປະ​ກອນຊ່ວຍ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ທີ່​ເໝາະ​ສົມí. •​ ​ກະ​ກຽມ​ຄໍາ​ແນະ​ນໍາ​ເພ່ືອ​ສ້າງ​ຫຼື​ປັບ​ປຸງ​ລະ​ບົບ​ການ​ປະ​ມູນ​ຂອງ​ລັດ​ຖະ​ບານ​ສໍາ​ລັບ​ການສະ​ໜອງ​ລົດ​ ເຂັນ​ໃນ​ປະ​ເທດ​ຂອງ​ທ່ານ. ອາ ຟ ຣິ ກາ ໃຕ້ ​ການ​ສັ່ງ​ຊື້​ລົດ​ເຂັນ​ໂດຍ​ລັດ​ຖະ​ບານໃນ​ປະ​ເທດ​ອາ​ຟ​ຣິ​ກາ​ໃຕ້​ແມ່ນ​ຖືກ​ຄວບ​ຄຸມ​ໂດຍ​ການ​ປະ​ມູນ​ລະ​ດັບ​ປະ​ ເທດ​.​​ລັດ​ຖະ​ບານ​ເຮັດ​ວຽກ​ກັບ​ຄົນ​ທີ່​ມາ​ຈາກ​ຕ່າງ​ແຂວງ​ຜູ້​ທີ່​ມີ​ຄວາມ​ຊ່ຽວ​ຊານ​ກ່ຽວ​ກັບ​ລົດ​ເຂັນ​ແລະ​ ການ​ບໍ​ລິ​ກາ​ນ​ລົດ​ເຂັນ.​​ພວກ​ເຂົາ​ຍັງ​ປຶກ​ສ​າ​ຫາ​ລື​ກັບ​ຜູ້​ໃຫ້​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​ປະ​ຈຸ​ບັນ. ຫຼັງຈາກການ​ປຶກ​ສາ​ຫາ​ລື​,​ປະ​ເພດ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ແລະ​ລາຍ​ການ​ໃນ​ປະ​ເພດ​ເຫຼົ່າ​ນັ້ນ​ໄດ້​ຖືກ​ກໍານົດ​ ເປັນ​ສຸດ​ທ້າຍ​​ເຊິ່ງລວມ​ມີ​ລາຍ​ລະ​ອຽດ​ສະ​ເພາະຂອງ​ແຕ່​ລະ​ຜະ​ລິດ​ຕະ​ພັນ.​ປະ​ເພດລາຍການລວມ​ມີ​ ປະ​ເພດ​ຕ່າງໆ​ຂອງເບາະ​ນັ່ງ​ທີ່​ສະບາຍ​ຕົວ​​ແລະ​ທີ່ມີ​ຄວາມ​ສ່ຽງ​ສູງ. ​ມີ​ການ​ກໍານົດ​ມາດ​ຕະ​ຖານ​ຄວາມ​ທົນ​ທານ​ຂັ້ນ​ຕໍ່າ​ສຸດ​ສໍາ​ລັບ​ແຕ່​ລະ​ຜະ​ລິດ​ຕະ​ພັນ​. ເມື່ອ​ລາຍ​ລະອຽດ​ສະ​ເພາະ​ຂອງ​ການ​ປະ​ມູນ​ຖືກກໍານົດ​ເປັນ​ສຸດ​ທ້າຍ​ແລະ​ໄດ້​ຮັບອະ​ນຸ​ມັດ​ແລ້ວ,​ຄັງ​ເງິນ​ ແຫ່ງ​ຊາດ​ເປີດ​ການ​ປະ​ມູນ​ສໍາ​ລັບ​ຂະ​ບວນ​ປະມູນ​ລາ​ຄາ.​​ຕົວ​ແທນ​ທີ່​ມີ​ຄວາມ​ຮູ້ກວດ​ກາ​ທຸກຜະ​ລິດ​ຕະ​ ພັນ​ທີ່​ສົ່ງ​ສໍາ​ລັບ​ການ​ປະມູນ​ກ່ອນ​ທີ່​ຈະ​ມອບສັນ​ຍາ​ໃຫ້​ຜູ້​ຊະນະ​ປະມູນ.​ສັນ​ຍາ​ລວມ​ເອົາ​ໄລ​ຍະ​ເວ​ລາ​ສົ່ງ​ ມອບ​ຕໍ່າ​ສຸດ​ແລະ​ບົດ​ລົງ​ໂທດ​ສໍາ​ລັບ​ການ​ລະ​ເມີດ​ເງື່ອນ​ໄຂ​ສັນ​ຍາ. ໂຣ ມາ ເນຍ ​ການ​ໃຫ້​ທຶນ​ຂອງ​ລັດ​ສໍາ​ລັບ​ລົດ​ເຂັນ​ໃນ​ປະ​ເທດ​ໂຣ​ມາ​ເນຍ​ປະ​ຕິ​ບັດ​ຕາມ​ຮູ​ບ​ແບບ​ຂອງ​ການ​ອຸດ​ໜູນ​ສໍາ​ ລັບ​ຢາ​ປົວ​ພະ​ຍາດ.​ຂະ​ບວນ​ການ​ອຸດ​ໜູນ​ສໍາ​ລັບ​ລົດ​ເຂັນ​ເລີ່ມ​ຕົ້ນ​ຂື້ນ​ໃນ​ປີ​2001​ເມື່ອ​ລັດ​ຖະບານ​ຈັດ​ ການ​ປະ​ມູນ​ສໍາ​ລັບ​ຜູ້​ສະ​ໜອງ​ລົດ​ເຂັນ.​​ຕາມ​ຜົນ​ການ​ປະ​ມູນ,​​ໄດ້​ມີ​ການ​ຕົກລົງ​ກັນ​ເລື່ອງລາ​ຄາ​ພ້ືນ​ ຖານ/ລາ​ຄາ​ອ້າງ​ອີງ​​ແຕ່​ບໍ່​ໄດ້​ກໍານົດ​ຫຍັງ​ກ່ຽວ​ກັບ​ຄຸນ​ນະ​ພາບ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ຫຼື​ການ​ໃຫ້​ບໍ​ລິ​ການ.​​ ມີ​ການກໍານົດມູນ​ຄ່າ​ການ​ອຸດ​ໜູນ​ໃໝ່​ໃນ​ແຕ່​ລະ​ປີ.​ ຂັ້ນ​ຕອນ​ທໍາ​ອິດ​ສໍາ​ລັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ແມ່ນ​ສະໝັກ​ຂໍ​ເອົາໃບ​ຢັ້ງ​ຢືນ​ຄວາມ​ພິ​ການ.​ຖ້າ​ບໍ່​ມີ​ໃບ​ຢັ້ງ​ຢືນ​ນີ້​​ ມັນເປັນ​ໄປ​ບໍ່​ໄດ້​ໃນ​ການ​ເຂົ້າ​ເຖິງ​ລົດ​ເຂັນ.​ຖັດ​ໄປ,​ຜູ້​ໃຊ້​ຄວນ​ເຮັດ​ການ​ນັດ​ໝາຍ​ກັບ​ທ່ານ​ໝໍ​ທີ່​ຟື້ນ​ຟູ​ຜູ້​ທີ່​ ຈະ​ຂຽນ​ໃບ​ກໍາ​ນົດ​ໃຊ້​ລົດ​ເຂັນ​ໃຫ້.​ຈາກນັ້ນຜູ້ໃຊ້ລົດເຂັນ​ສົ່ງ​ ໃບສະໝັກຫາໜ່ວຍງານການປະກັນແຫ່ງຊາດ​(NIA).​ເມື່ອ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້​ຮັບ​ການ​ອະ​ນຸ​ມັດ/​ໃບ​ແລກ​ ຊື້​ແລ້ວ,​​ທໍາ​ອິດ​ເຂົາ​ເຈົ້າ​ເລືອກ​ຜູ້​ສະ​ໜອງກ່ອນ,​​ຈາກ​ນັ້ນ​ເລືອກ​ລົດ​ເຂັນ​.​ຖ້າ​ລາ​ຄາ​ລົດ​ເຂັນ​ແມ່ນ​ ໜ້ອຍກວ່າ​ເງິນ​ອຸດ​ໜູນ,​​ຈາກ​ນັ້ນ​ຜູ້​ສະ​ໜອງ​ໃຫ້​ລົດ​ເຂັນ​ແກ່​ຜູ້​ໃຊ້​ໂດຍແລກປ່ຽນກັບໃບແລກຊື້​ເຊິ່ງ​ຖືກ​ໃຊ້​ ເພື່ອ​ຮຽກເກັບເງິນນໍາ​NIA.​​ຖ້າ​ລາ​ຄາ​ລົດ​ເຂັນ​ຫຼາຍກວ່າ​ເງິນ​ອຸດ​ໜູນ,​​ຈາກ​ນັ້ນ​ຜູ້​ໃຊ້​ຕ້ອງ​ຈ່າຍສ່ວນຕ່າງ​ ຫຼື​ຊອກ​ຫາ​ແຫຼ່ງທຶນ​ມາ​ເສີມ,​​ຕົວ​ຢ່າງ,​​ຜູ້​ບໍ​ລິ​ຈາກ,​​ນາຍ​ຈ້າງ,​​ແລະ​ບຸກ​ຄົນ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 96 97 ສະ ພາບ ການ 3 •​ ​ກະ​ກຽ​ມ​ສະ​ພາບ​ບົດ​ສະ​ແດງລະຄອນ​ທີ​່ສະ​ແດງ​ໃຫ​້ເຫນັການ​ພົບ​ປະກັບ​ຜູ​້ບລໍຈິາກ​ບ່ອນ​ທີ​່ທາ່ນ​ ມາ​ພ້ອມ​ກັບ​ແຜນ​ສະ​ໜອງ​ລົດ​ເຂນັ​ທີ​່ເໝາະ​ສມົ​ຜາ່ນ​ລະ​ບົບ​ການ​ໃຫ​້ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ​(ສະ​ແດງ​ ລະຄອນ​3-5​ນາ​ທ)ີ. ໃນ ເວ ລາ ການ ວາງ ແຜນສະ ແດງ ລະຄອນ ຂອງ ທ່ານ: •​ ໂອ້ລົມກ່ຽວກັບວ່າມີການແຈກຢາຍລົດເຂັນທີ່ໄດ້ຮັບບໍລິຈາກມາໃນປະເທດຂອງທ່ານແນວໃດ •​ ເບິ່ງ​‘ຫຼັກ​ການ​ກ່ຽວ​ກັບ​ການ​ສະ​ໜອງ​ອຸ​ປະ​ກອນຊ່ວຍ​ການ​ເຄື່ອນ​ໄຫວ​ໄປ​ມາ​ທີ່​ເໝາະ​ສົມí. 98 99 B.3: ຈັດ ວາງ ບຸກ ຄະ ລາ ກອນ: ບົດ ບາດ ໜ້າ ທ່ີ •​ ເບິງ່ຕາຕະລາງທີ​່ລະບຸບົດບາດ​ໜາ້​ທີ່ຂອງພະນັກງານໃຫ້ບລໍກິານລົດເຂນັ. •​ ຂຽນຊືຂ່ອງຜູ້ທີ່ຮບັຜິດຊອບ​ສາໍລັບແຕ່ບົດບາດໜາ້ທີໃ່ນຕາຕະລາງ. •​ ຖາ້​ທາ່ນ​ຮບັ​ຜິດ​ຊອບ​ສນູ​ບ​ໍລ​ິການຫາຼຍ​ກວາ່​ໜຶງ່​ສນູ​ຈົງ່​ຮບັປະກນັ​ວາ່​ຕອ້ງ​ລະບຸພະ​ນັກ​ງານ​ໃນ​ແຕ່​ ລະ​ສານ​ຖານ​ທີ.່ ຝ່ າຍ ປິ່ ນ ປົ ວ ຝ່ າຍ ເຕັ ກ ນິ ກ ຝ່ າຍ ກ ານ ຝຶ ກ ອົ ບ ຮົ ບ ຜູ້ ໃຊ້ ຝ່ າຍ ບໍ ລິ ຫ ານ ​ສນູ​ບໍ​ລິ​ການ ​ສນູ​ບໍ​ລິ​ການ ​ສນູ​ບໍ​ລິ​ການ B.4: ການ ບໍລິການ ລົດ ເຂັນ ມີຄ່າ ໃຊ້ ຈ່າຍ ແນວ ໃດ? ທົບ ທວນ ຄືນ:​​ແຕ່​ລະ​ແຖວ​ງົບ​ປະ​ມານຂາ້ງ​ລຸມ່​​ແລະ​ພິ​ຈາ​ລະ​ນາວາ່​​ຄາ່​ໃຊ້​ຈາ່ຍ​ໃດ​ສາ​ມາດ​ ຮວ່ມຈາ່ຍ​ຫຼື​ປະຢັດ​ໄດໂ້ດຍ​ການ​ລວມການ​ບໍ​ລິ​ການ​ລົດ​ເຂນັ​ລງົ​ເຂົາ້​ກັບ​ການ​ບໍ​ລິ​ການ​ທີມ່ີ​ຢູ່​ແລ້ວ. ​ໃຊ້​ປາກ​ກາ​ສີ​ດາໍ​ໝາຍ​ວງົ​ມນົ​ຄາ່​ໃຊ້​ຈາ່ຍ​ທງັ​ໝົດ​ທີ່​ສາ​ມາດ​ປະຢັດໄດ.້ ໃຊ້​ປາກ​ກາ​ສີ​ດາໍ​ໝາຍ​ວງົ​ມນົ​ຄາ່​ໃຊ້​ຈາ່ຍ​ທງັ​ໝົດ​ທີ່​ສາ​ມາດຮວ່ມ​ຈາ່ຍ​ໄດ.້ ສະ ພາບ ການ ຕົວ ຢ່າງ ຂອງ ການ ບໍ ລິ ການ ແບບລວມ ກັນ ​ການ​ບໍ​ລິ​ການ​P&O​​ກໍາລັງ​ວາງ​ແຜນ​ລວມ​ເຂົ້​ກັບກນ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​.​​ໄດ້​ມີ​ການ​ກໍານົດ​​ແລະ​ສົ່ງ​ພະ​ ນັກ​ງານ​ສອງ​ຄົນ​ເຂົ້າ​ຮ່ວມ​ຫຼັກ​ສູດ​ຝຶກ​ອົບຮົມພ້ື​ນ​ຖານ​ຂອງ​WSTP. ​ພະ​ນັກ​ງານ​ທັງ​ສອງ​ຈະ​ເຮັດ​ວຽກ​3​ວັນ​ຕໍ່​ອາ​ທິດ​ໃນ​ການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​ແລະ​2​ວັນ​ຕໍ່​ອາ​ທິດ​ໃນ​ການ​ ບໍ​ລິ​ການ​P&O. ​ພື້ນ​ທີ່​ເຮັດ​ວຽກ​ທີ່​ໄດ້​ຖືກ​ຈັດ​ສັນ​ໃນ​ໂຮງ​ສ້ອມ​ແປງ​ສໍາ​ລັບ​ຊ່າງ​ລົດ​ເຂັນ.​​ພະ​ແນກ​ບໍາ​ບັດໄດ້​ລ້າງ​ອຸ​ປະ​ກອນ​ ທີ່​ເພ​ແລະ​ບໍ່​ໄດ້​ໃຊ້​ອອກ​ເພ່ືອ​ສ້າງ​ພ້ືນ​ທີ່​ເຮັດ​ວຽກ​ສໍາ​ລັບ​ໜ້າ​ທີ່​ການ​ປິ່ນ​ປົວ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 98 99 ຄູ່ ມື ແນະ ນໍາ ງົບ ປະ ມານ ຂ້ັນ ຕອນ ການ ບໍ ລິ ການ ກ ານ ບໍ ລິ ກ ານ ແ ລ ະ ກ ານ ນັ ດ ໝ າຍ ກ ານ ປ ະ ເ ມີ ນ ຜົ ນ ກ ານ ກໍ າ ນົ ດ ໃຊ້ ລົ ດ ເຂັ ນ ກ ານ ໃຫ້ ທຶ ນ ແ ລ ະ ກ ານ ສັ່ ງ ຊື້ ກ ານ ກ ະ ກ ຽມ ຜ ະ ລິ ດ ຕ ະ ພັ ນ ກ ານ ປັ ບ ລົ ດ ເຂັ ນ ໃຫ້ ເໝ າະ ສົ ມ ກ ານ ຝຶ ກ ອົ ບ ຮົ ບ - ຜູ້ ໃຊ້ ກ ານ ບໍ າ ລຸ ງ ຮັ ກ ສ າ, ສ້ ອ ມ ແ ປ ງ ແ ລ ະ ກ ານ ຕິ ດ ຕ າມ ຜົ ນ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ເລີ່ມ​ຕົ້ນ ​ການອອກ​ແບບ​ຜະ​ລິດ​ຕະ​ພັນ ​ການ​ຊອກ​ຫາ​ແຫຼ່ງ​ຜະ​ລິດ​ຕະ​ພັນ  ​ເຄື່ອງ​ມື    ອຸປະກອນ   ອາຄານ/ສິ່ງ​ອໍານວຍ​ຄວາມ​ສະດວກ    ​ຄັງ​ວັດ​ສະດຸ  ຄ່າ​ໃຊ້​ຈ່າຍ​ໃນ​ການ​ດໍາ​ເນີນ​ງານ ລົດເຂັນ​​   ​ອາ​ໄຫຼ່  ​ວັດ​ສະ​ດຸ​​    ການ​ຂົນ​ສົ່ງ​(ການ​ຂົນ​ສົ່ງ​ຜະລິດ​ຕະພັນ)   ​ພະ​ນັກ​ງານ ​ການ​ຄຸ້ມ​ຄອງ    ພະນັກງານ​ຝ່າຍ​ປິ່ນປົວ        ​ພະນັກງານ​ຝ່າຍ​ເຕັກນິກ      ຄູ​ຝຶກ/ຜູ້​ຊ່ວຍ​ຄູ​ຝຶກ   ​ຜູ້​ບໍລິຫານ      ​ການ​ຂົນ​ສ່ົງ​ໃນ​ທ້ອງ​ຖິ່ນ ​ການ​ຂົນ​ສ່ົງ​ໃນ​ທ້ອງ​ຖິ່ນ​ສໍາລັບ​ພະນັກງານ     ​ການ​ຂົນ​ສ່ົງ​ໃນ​ທ້ອງ​ຖິ່ນ​ສໍາລັບ​ລູກ​ຄ້າ    ບ່ອນ​ພັກ​ເຊົາ​ສໍາລັບ​ລູກ​ຄ້າ   ວັດ​ສະດຸ​ທີ່​ພິມ​ອອກ      ວັດ​ສ​ະ​ດຸສິ້ນ​ເປືອງ    ການ​ປ່ຽນ​ຖ່າຍ​ເຄື່ອງມື    ຄ່າ​ໃຊ້​ຈ່າຍ​ປະຈໍາ       ​ການ​ຝຶກ​ອົບ​ຮົບ​ພະ​ນັກ​ງານ       ​ການ​ຝຶກ​ອົບຮົມ​ຄູ່​ຮ່ວມ​ງານ/​ເຄືອ​ຂ່າຍ​ການ​ນໍາ​ ສົ່ງ    ການ​ລະດົມ​ທຶນ         ກາ​ນຕິດຕາມ​​ແລະ​ການ​ປະ​ເມີນຜົນ         100 101 C. ການ ດໍາ ເນີນ ການ ບໍລິການ ລົດ ເຂັນ C.1: ການ ບໍລິການ ທ່ີ ມີ ປະສິດ ພາບ ແລະ ປະສິດທິ ຜົນ C.1.1 ການ ຕິດ ຕາມ ສ່ວນທີ 1 •​ ​ໃນ​ກຸມ່​ຂອງ​ທາ່ນ:​​ອາ່ນ​ແລະ​ເຮດັ​ໃຫ​້ສາໍ​ເລັດ​ໃນ​ສວ່ນ​ຕາ​ຕະ​ລາງຂອງ​ທາ່ນ​ຂາ້ງ​ລຸມ່​ນີ.້ •​ ​ບາງຫ້ອງ​ໄດ​້ສາໍ​ເລັດ​ແລວ້​ເພ່ືອ​ຊວ່ຍ​ທາ່ນ​ເລີມ່​ຕົນ້.​​ຄວນ​ປະກອບ​ຂໍ​້ມນູ​ໃສ່ຫ້ອງ​ທີ​່ຍງັ​ເຫຼືອ​. ​ພືນ້​ທີ່​ແລະ​ກິດ​ຈະ​ກາໍ ​ຄາດ​ໝາຍ​ການ​ປະ​ຕິ​ບັດ​ງານ​ຕົວ​ ຢາ່ງ ​ການ​ເກັບ​ຂໍ້​ມນູ ການ ນໍາ ສ່ົງ ​ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ທີ່​ຖືກນໍາ​ສົ່ງ ການ​ບໍ​ລິ​ການ​ຈະ​ໄດ້​ຮັບ​ການ​ນໍາ​ສ່ົງ​ 30​ຄັ້ງ​ຕໍ່​ເດືອນ ​ບັນທຶກ​ການ​ນໍາ​ສົ່ງ​ທີ່​ໄດ້​ຮັບ ເວ​ລາ​ລໍຖ້າໂດຍ​ສະ​ເລ່ຍ​ຈາກ​ ການ​ນໍາ​ສົ່ງ​ໄປ​ຫາ​ການ​ນັດ​ ໝາຍ ​ໃນ​ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້​ບັນທຶກວັນ​ ທີ​ໃນ​ເວ​ລາ​ໄດ້​ຮັບ​ການ​ນໍາ​ສົ່ງ​ ແລະ​ວັນ​ທີ​ປະ​ເມີນ​ຜົນ ການ ສະ ໜອງ ລົດ ເຂັນ ​ຈໍາ​ນວນ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ໄດ້​ຮັບ​ ລົດ​ເຂັນ ​ການ​ບໍ​ລິ​ການ​ຈະ​ກໍາ​ນົດໃຊ້​ແລະ​ປັບ​ ລົດ​ເຂັນ​ໃຫ້​ພໍ​ດີ​ສໍາ​ລັບ​ຜູ້​ໃຊ້​20​ຄົນ​ຕໍ່​ ເດືອນ ​ເວ​ລາ​ລໍຖ້າໂດຍ​ສະ​ເລ່ຍ​ຈາກ​ ການ​ປະ​ເມີນ​ຜົນ​ຫາ​ການ​ປັບ​ ໃຫ້​ເໝາະ​ສົມ ​ຈໍາ​ນວນ​ຂອງການ​ດໍາ​ເນີນ​ ການ​ນັດ​ໝາຍ​ເພ່ືອ​ການ​ຕິດ​ ຕາມ​ຜົນ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 100 101 •​ ບນັທກຶ​ຢູ​່ຂາ້ງ​ລຸມ່​ຍ້ອນ​ຫຍງັ​ມນັ​ຈິງ່​ເປນັ​ປະ​ໂຫຍ​ດ​ໃນ​ກາ​ນຮູ​້ວາ່​ເປົາ້​ໝາຍ​ໄດ​້ຖກື​ບນັລ​ຸໄດ​້ຫຼືບໍ.່ ເປັນ ປະ ໂຫຍ ດ ໃນການ ຮູ້ ວ່າ ໄດ້ ບັນລຸ ໄດ້ເປ້ົາ ໝາຍ ເພາະວ່າ: ເປັນ ປະ ໂຫຍ ດ ໃນ ການ ຮູ້ ວ່າ ບ່ໍ ບັນລຸ ໄດ້ ເປ້ົາ ໝາຍ ເພ າະວ່າ: ​ຈໍາ​ນວນ​ຜູ້​ໃຊ້​ທີ່​ຖືກນໍາ​ສົ່ງ ເວ​ລາ​ລຖໍາ້ໂດຍ​ສະ​ເລຍ່​ຈາກ​ການ​ນາໍ​ ສົ່ງ​ໄປ​ຫາ​ການ​ນັດ​ໝາຍ ​ຈໍາ​ນວນ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ໄດ້​ຮັບ​ລົດ​ເຂັນ ​ເວ​ລາ​ລໍຖ້າໂດຍ​ສະ​ເລ່ຍ​ຈາກ​ການ​ ປະ​ເມີນ​ຜົນ​ຫາ​ການ​ປັບ​ໃຫ້​ເໝາະ​ ສົມ ຈໍາ​ນວນ​ຂອງການ​ດໍາ​ເນີນ​ການ​ນັດ​ ໝາຍ​ເພ່ືອ​ການ​ຕິດ​ຕາມ​ຜົນທີ່​ໄດ້​ດໍາ​ ເນີນ ສ່ວນທີ 2 ​ພື້ນ​ທີ່​ແລະ​ກິດ​ຈະ​ກໍາ ​ຄາດ​ໝາຍ​ການ​ປະ​ຕິ​ບັດ​ງານ​ຕົວ​ ຢ່າງ ​ການ​ເກັບ​ຂໍ້​ມູນ ປະ ຊາ ກອນ ຜູ້ ໃຊ້ ລົດ ເຂັນ ທ່ີ ໃຫ້ ບໍ ລິ ການ ​ລາຍ​ລະ​ອຽດ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ ນໍາສົ່ງຫາການ​ບໍ​ລິ​ການ,​​ເຊັ່ນ​ວ່າ​ ອາ​ຍຸ,​​ເພດ,​​ຄວາມ​ພິ​ການ,​​ຄວາມ​ ຕ້ອງ​ການ​ດ້ານ​ການ​ຮອງ​ຮັບ​ທ່າ​ ທາງ​ຕ່າງໆ ​ການ​ບໍ​ລິ​ການ​ຈະ​ສົ່ງ​ເສີມ​ການ​ເຂົ້າ​ ເຖິງ​ທີ່​ເທົ່າ​ທຽມ​ກັນ ​ການ​ບໍ​ລິ​ການ​ມີ​ຈຸດປະສົງ​ເພ່ືອ​ ຕອບ​ສະ​ໜອງ​ຄວາມ​ຕ້ອງ​ການ​ ຂອງ​ຜູ້​ໃຊ້​ທີ່​ຕ້ອງ​ການ​ລົດ​ເຂັນ​ລະ​ ດັບ​ພ້ື​ນ​ຖານ​ແລະ​ຜູ້​ທີ່​ຈໍາ​ເປັນ​ ຕ້ອງ​ມີການ​ການດັດ​ແປງລົດ​ເຂັນ​ ແລະ​ການ​ຮອງ​ຮັບ​ທ່າ​ທາງຕ່າງໆ ​ຈໍາ​ນວນ​ການ​ເຂົ້າ​ເຖິງ​ການ​ບໍ​ລິ​ ການ​ຂອງ​ແມ່​ຍິງ,​ຜູ້​ຊາຍ,​ເດັກ​ຍິງ​ ແລະ​ເດັກ​ຊາຍ​– ​ທີ່​ໄດ້​ບັນທຶກ​ໄວ້​ ໃນ​ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ ​ປະ​ເພດ​ຂອງ​ຄວາມ​ຕ້ອງ​ການ​ດ້ານ​ ທ່າ​ທາງ​ທີ່​ຖືກ​ນໍາ​ສະ​ເໜີ​ແລະ​ລົດ​ ເຂັນ​ທີ່​ຖືກ​ກໍາ​ນົດ​ໃຊ້​– ​ທີ່​ໄດ້​ບັນທຶກ​ ໄວ້​ໃນ​ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ ​ພື້ນ​ທີ່​ທາງ​ພູ​ມີ​ສາດ​ທີ່​ການ​ບໍ​ລິ​ ການກວມ​ເອົາ ທີ່​ຢູ່​ເຮືອນ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ເຂົ້າ​ເຖິງ​ ການ​ບໍ​ລິ​ການ​– ​ທີ່​ໄດ້​ບັນທຶກ​ໄວ້​ໃນ​ ແຟ້ມ​ຂອງ​ຜູ້​ໃຊ້ 102 103 ຄ່າ ໃຊ້ ຈ່າຍ ໃນ ການບໍ ລິ ການ ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ ສະ​ໜອງ​ໃຫ້,​​ລວມ​ເຖິງ​ການ​ດັດ​ ແປງ​ທີ່​ເຮັດ​ພາຍ​ໃນ​ການ​ບໍ​ລິ​ ການ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ສ່ວນ​ບຸກ​ຄົນຂອງ​ລົດ​ ເຂນັ​ແຕ​່ລະ​ຄນັ​ຈະ​ນອ້ຍກວາ່​(​ຈາໍ​ ນວນ​ເງິນ​ທີ່​ລະ​ບຸ​ຕ​າມ​ງົບ​ປະ​ ມານ​ແລະ​ຄ່າ​ໃຊ້​ຈ່າຍ​ທີ່​ເປັນ​ຈິງ​ ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ມີ​ຢູ່) ​ຈໍາ​ນວນ​ເວ​ລາ​ທີ່​ໃຊ້​ໂດຍ​ພະ​ນັກ​ ງານຕໍ່​ກັບ​ກິດ​ຈະ​ກໍາ​ຂອງ​ການ​ບໍ​ ລິ​ການ​(​ຕົວ​ຢ່າງ​ການ​ປະ​ເມີນ​ ຜົນ,​​ການ​ຕິດ​ຕາມ​ຜົ​ນ,​​ແລະ​ ການ​ຝຶກ​ອົບ​ຮົບ.) •​ ບນັທກຶ​ຢູ​່ຂາ້ງ​ລຸມ່​ຍ້ອນ​ຫຍງັ​ມນັ​ຈິງ່​ເປນັ​ປະ​ໂຫຍ​ດ​ໃນ​ກາ​ນຮູ​້ວາ່​ເປົາ້​ໝາຍ​ໄດ​້ຖກື​ບນັລ​ຸໄດ​້ຫຼືບໍ.່ ເປັນ ປະ ໂຫຍ ດ ໃນການ ຮູ້ ວ່າ ໄດ້ ບັນລຸ ໄດ້ເປ້ົາ ໝາຍ ເພາະວ່າ: ເປັນ ປະ ໂຫຍ ດ ໃນ ການ ຮູ້ ວ່າ ບ່ໍ ບັນລຸ ໄດ້ ເປ້ົາ ໝາຍ ເພ າະວ່າ: ​ລາຍ​ລະ​ອຽດ​ຂອງ​ຜູ້​ໃຊ້​ທີ່​ ນໍາສົ່ງຫາການ​ບໍ​ລິ​ການ,​​ເຊັ່ນ​ ວ່າ​ອາ​ຍຸ,​​ເພດ,​​ຄວາມ​ພິ​ການ,​​ ຄວາມ​ຕ້ອງ​ການ​ດ້ານ​ການ​ຮອງ​ ຮັບ​ທ່າ​ທາງ​ຕ່າງໆ ​ພື້ນ​ທີ່​ທາງ​ພູ​ມີ​ສາດ​ທີ່​ການ​ບໍ​ລິ​ ການກວມ​ເອົາ ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ ສະ​ໜອງ​ໃຫ້,​​ລວມ​ເຖິງ​ການ​ດັດ​ ແປງ​ທີ່​ເຮັດ​ພາຍ​ໃນ​ການ​ບໍ​ລິ​ ການ ​ຈໍາ​ນວນ​ເວ​ລາ​ທີ່​ໃຊ້​ໂດຍ​ພະ​ນັກ​ ງານຕໍ່​ກັບ​ກິດ​ຈະ​ກໍາ​ຂອງ​ການ​ບໍ​ ລິ​ການ​(​ຕົວ​ຢ່າງ​ການ​ປະ​ເມີນ​ ຜົນ,​​ການ​ຕິດ​ຕາມ​ຜົ​ນ,​​ແລະ​ ການ​ຝຶກ​ອົບ​ຮົບ) ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 102 103 C.1.2 ຄໍາ ເຫັນ ຕິ ຊົມ ຂອງ ຜູ້ ໃຊ້ •​ ​ມ​ີບາງຂໍ​້ພ​ິຈາ​ລະ​ນາທີ​່ສາໍ​ຄນັ​ໃນ​ເວ​ລາ​ວາງ​ແຜນ​ເພ່ືອ​ເກັບ​ເອາົ​ຄາໍ​ເຫນັ​ຕ​ິຊມົ​ຈາກ​ຜູ​້ໃຊ​້ການ​ບ​ໍລິ​ ການ​.​​ໃຊ​້ລາຍ​ກາ​ນກວດ​ນີ​້ເພ່ືອ​ຈດົ​ບນັທກຶ​ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ. ການ ວາງ ແຜນ ເກັບ ເອົາຄໍາ ເຫັນ ຕິ ຊົມ ຈາກ ຜູ້ ໃຊ້ ການ ບໍ ລິ ການ ​ຈຸດ​ທີ່​ຈະ​ຕ້ອງ​ພິ​ຈາ​ລະ​ນາ:​​ການ​ຂົນ​ສົ່ງ​​ແລະ​​ເວລາ​ແມ່ນ​ສອງ​ຄ່າ​ໃຊ້​ຈ່າຍ​ທີ່​ສໍາຄັນ​ທີ່​ສຸດ. ມັນ​ຈະ​ເກີດ​ຂື້ນ​ເວລາ​ໃດ? ​ໃຜ​ຈະ​ເຮັດ​ມັນ? ​ຄໍາ​ເຫັນ​ຕິ​ຊົມ​ຫຍັງ​ແດ່​ທີ່​ຄວນ​ຖາມ? ຂ້ໍ ມູນ ພ້ືນ ຖານ (ໃຫ້ ເບ່ິງ ເຄ່ືອງ ມື ທ່ີ ເກັບ ໄວ້ ໃນ ຄູ່ ມື ວ່າ ດ້ວຍ ແຫ່ຼງຊັບ ພະຍາກ ອນ ເພ່ີມ ເຕີມ ສໍາລັບຜູ້ ຈັດການ ຢູ່ ໃນ Pen Drive.) ​ຈຸດ​ທີ່​ຈະ​ຕ້ອງ​ພິ​ຈາ​ລະ​ນາ:​ເພື່ອ​ປະ​ເມີນ​ຜົນ​ກະ​ທົບ​ຂອງ​ການ​ບໍ​ລິ​ການ,​ມັນ​ສໍາ​ຄັນ​ໃນ​ການ​ບັນທຶກ​ສະ​ ພາບ​ການ​ກ່ອນ​ຈະ​ມີ​ການ​ຊ່ວຍ​ເຫຼືອ​ໃດໆ.​​ນັ້ນ​ແມ່ນ,​​ກ່ອນ​ການ​ເລີ່ມ​ການປະ​ເມີນ​ຜົນ. ​ຈະ​ເກັບ​ເອົາຂໍ້​ມູນ​ພ້ືນ​ຖານ​ເວລາ​ໃດ? ​ໃຜ​ຈະ​ເກັບ​ເອົາ​ຂໍ້​ມູນ​ນີ້? ​ຂໍ້​ມູນ​ຈະ​ຖືກ​ເກັບ​ເອົາ​ໃນ​ຊ່ວງ​ເວ​ລາ​ໃດ​ແດ່? 104 105 ກາ ນບັນທຶກ ແລະ ການ ປະມວນ ຜົນຂ້ໍ ມູນ ​ຈຸດ​ທີ່​ຈະ​ຕ້ອງ​ພິ​ຈາ​ລະ​ນາ:​ກາ​ນ​ບັນທຶກ​ຂໍ້​ມູນ​ຢ່າງ​ມີ​ປະສິດທິພາບສາມາດ​ຊ່ວຍ​ປະ​ຢັດ​ເວລາ​​ແລະ​ເງິນ​ໄດ້. ​ທ່ານ​ຈະ​ບັນທຶກ​ຂໍ້​ມູນ​ແນວ​ໃດ? ​ວິ​ທີ​ການ​ໃດ​ແດ່​ທີ່​ທ່ານ​ສາມາດ​ໃຊ້ເພ່ືອ​ເຮັດ​ການ​ບັນທຶກ​ແລະ​ການ​ປະ​ມວນ​ຜົນ​ຂໍ້​ມູນ​ໃຫ້​ມີ​ປະ​ສິດ​ທິ​ພາບ​ ເທົ່າ​ທີ່​ຈະເປັນ​ໄປ​ໄດ້? ​ໃຜ​ຈະ​ບັນທຶກ​ຂໍ້​ມູນ? ​ໃຜ​ຈະ​ປະ​ມວນ​ຜົນ​ຂໍ້​ມູນ? C.2: ການ ພັ ດ ທະ ນາ ການ ບໍ ລິ ການ ທ່ີ ມີ ປະ ສິດ ທິ ພາບ C.2.1 ການ ຕິດ ຕາມ ແຜນ ການ ບໍ ລິ ການ •​ ​ສາ້ງ​ແຜນ​ການ​ບ​ໍລ​ິການ​ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ. •​ ​ເລືອກ​ຄວາມ​ຕ້ອງ​ການ​ຫຼ​ືບນັ​ຫາ​ທີ​່ຈະ​ຖກື​ຕິດ​ຕາມ​ຈາກ​ການ​ບ​ໍລ​ິການ​ຂອງ​ທາ່ນ​ເອງ​ແລະ​ຕືມ່​ຂໍ້​ ມນູ​ໃສ​່ຢູ​່ກ້ອງ​ແຕ​່ລະ​ຫວົ​ຂໍ​້. ໂຄງ ຮ່າງ ແຜນການ ບໍລິການ ລະບຸ ຄວາມ ຕ້ອງການ/ບັນຫາ ທ່ີ ຈະ ຖືກ ຕິດຕາມ ການ ດໍາ ເນີນ ການ/ ຈຸດປະສົງ ໃນ ການ ແກ້ ໄຂ ຄວາມ ຕ້ອງການ/ບັນຫາ ນ້ັນ ຄາດໝາຍ ການ ເກັບ ຂ້ໍ ມູນ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 104 105 C.3: ການຄຸ້ມ ຄອງ ອຸປ ະ ສົງ C.3.1 ການ ສ້າງ ອຸ ປະ ສົງ ແລະ ການ ນໍາ ສ່ົງ ໄວ້ •​ ​ອາ່ນ​ຕົວ​ຢາ່ງ. •​ ​ໂອ​້ລມົ​ແລະ​ຈາກ​ນັນ້​ບອກ​ເຫດ​ຜນົ​ສາໍ​ລັບ​ຄວາມ​ສາໍ​ເລັດ. ຕົວ ຢ່າງ ຜົນ ສໍາ ເລັດ: ການ ນໍາ ສ່ົງ ໄວ ໂດຍ ຜູ້ ປົກ ຄອງ ໃນ ປະ ເທດ ເມັກ ຊິ ໂກ ນີ້​ແມ່ນ​ຕົວ​ຢ່າງ​ຂອງວິ​ທິ​ສ້າງ​ເຄືອ​ຂ່າຍ​ການ​ນໍາ​ສົ່ງ​ໄວ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ຜົນ​ຂອງ​ກຸ່ມ​ສູນ​ຟື້ນ​ຟູສໍາ​ລັບ​ເດັກ​ນ້ອຍ​ ໃນ​ເມັກ​ຊິ​ໂກ. ແນວໃດກໍ່ຕາມ​ບັນດາ​ສູນ​ຟື້ນ​ຟູ​ໂດຍຕົ້ນຕໍແລ້ວເລັງເປົ້າໝາຍໃສ່ທ່ານໝໍດູແລເດັກເກີດໃໝ່​ ແລະແພດເດັກ​ດ້ວຍກິດຈະກໍາສ້າງຄວາມຮັບຮູ້ໃຫ້ເຂົາເຈົ້າ,​ພວກ​ເຂົາ​ຍັງ​ເຮັດ​ການ​ໂຄ​ສະ​ນາ​ລະ​ດົມ​ ທຶນ​ປະ​ຈໍາ​ປີ​ທີ່​ແນ​ເປົ້າ​ໝາຍ​ໃສ່​ຊຸມ​ຊົມ​ທົ່ວ​ໄປ​ທີ່​ໃຊ້​​ສື່ທີ່ອອກ​ອາ​ກາດ​ຢ່າງກວ້າງ​ຂວາງ​​ລວມ​ທັງວິ​ທະ​ຍຸ​ ແລະ​ໂທ​ລະ​ພາບ.​ນີ້​ນໍາ​ໄປສູ່​ການ​ນໍາ​ສົ່ງ​ແບບ​ປາກ​ຕໍ່ປາກຢ່າງ​ຫຼວງຫຼາຍ​​ແລະ​ພ່ໍ​ແມ່ຫຼາຍຄົນ​ໄດ້​ເຮັດ​ ການນໍາ​ສົ່ງ​ລູກຂອງ​ເຂົາ​ເຈົ້າ​ເອົາ​ເອງ. ໃນລະຫວ່າງການ​ສ້າງ​ຄວາມຮັບຮູ້,​ສູນມີຂໍ້ຄວາມທີ່ຈະແຈ້ງ:​ຄວາມສໍາຄັນຂອງການນໍາສ່ົງ​ເດັກນ້ອຍ ສໍາລັບການພື້ນຟູເມື່ອພວກເຂົາເກີດມາ.​ພວກ​ເຂົາ​ຍັງ​ນໍາ​ສະ​ເໜີ​ວິ​ໄສ​ທັດ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບກ່ຽວ​ກັບ​ ຄວາມ​ສໍາ​ເລັດ​ພ້ອມ​ກັບ​ຫຼາຍເລື່ອ​ງ​ເລົ່າ​ໃນ​ເຊິງບວກ​ທີ່​ກ່ຽວ​ຂ້ອງ​ກັບ​ການເຊື່ອມ​ໂຍງ​ແລະ​ຜົນ​ສໍາ​ເລັດ​ ຂອງ​ເດັກ​ນ້ອຍ​ຜູ້​ທີ່​ເຂົາ​ເຈົ້າ​ເຮັດ​ວຽກນໍາ.​​ໃນ​ໄລ​ຍະ​ເວ​ລາ​15​ປີ​ທີ່​ຜ່ານ​ມາ,​ສູນ​ຟື້ນ​ຟູ​ສຸ​ຂະ​ພາບ​ໄດ້​ເຫັນ​ ການ​ປ່ຽນ​ແປງ​ທາງວັດ​ທະ​ນາ​ທໍາ​ເປັນ​ແພດ​ເດັກ​ແລະ​ຄອບ​ຄົວ​ກໍາ​ລັງ​ແຂ່ງ​ຂັນ​ເຮັດ​ການ​ນໍາ​ສົ່ງ​ໄວ. ​ຜົນ​ໄດ້​ຮັບ:​​ໜຶ່​ງສ່ວນ​ສາມ​ຂອງ​ການ​ນໍາ​ສົ່ງ​ທັງ​ໝົດ​ແມ່ນ​ສໍາ​ລັບ​ເດັກ​ນ້ອຍ​ອາ​ຍຸ​3​ປີ​ລົງ​ມາ. ເຫດ ຜົນ ສໍາ ລັບ ຄວາມ ສໍາ ເລັດ 106 107 C.3.2 ການ ວິ ເຄາະ ຂ້ັນ ຕອນ ການ ບໍ ລິ ການ ເວ ລາ ທ່ີມີ ໃຫ້ ສໍາ ລັບ ການ ໃຫ້ ບໍ ລິ ການ ແຕ່ ລະ ມ້ື: _______ ນາ ທີ •​ ​ເຮດັ​ວຽກ​ຮວ່ມ​ກນັ​ເປນັ​ກຸມ່. •​ ​ອາ່ນ​ແຕ​່ລະ​ສິງ່​ທາ້​ທາ້ຍ​ຂອງການ​ບ​ໍລ​ິການ​ໃນ​ຖນັ​ທ​ີ1. •​ ​ອາ່ນ​ຍຸດ​ທະ​ສາດ​ທີ​່ເປນັ​ໄປ​ໄດ​້ສາໍ​ລັບ​ການ​ໃຫ​້ບ​ໍລ​ິການ​ທີ​່ມ​ີປະ​ສິດ​ທ​ິພາບ​ເພີມ່​ຂື​້ນ​ໃນ​ຕາ​ຕະ​ລາງ​ ຂາ້ງ​ລຸມ່​ນີ.້ •​ ​ຈບັ​ຄູ​່ສິງ່​ທາ້​ທາ້ຍ​ຂອງ​ການ​ບ​ໍລ​ິການ​ກັບ​ຍຸດ​ທະ​ສາດ​ເພ່ືອ​ປັບ​ປງຸ​ປະ​ສິດ​ທ​ິພາບ.​​ຂຽນ​ຈາໍ​ນວນ​ຂອງ​ ແຕ່​ລະ​ຍຸດ​ທະ​ສາດ​ລງົ​ໃນ​ຖນັ​ທ​ີ2.​​ສິງ່​ທາ້​ທາ້ຍ​ອາດ​ຮຽກ​ຮອ້ງ​ໃຫ​້ມ​ີຍຸດ​ທະ​ສາດຈາໍນວນ​ໜຶງ່. ຍຸດ ທະ ສາດ ເພ່ືອ ປັບ ປຸງ ປະ ສິດ ທິ ພາບ ຂອງ ການ ບໍ ລິກ ການ 1.​ ​ຊອກ​ຫາ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ມີ​ຄວາມ​ສາມາດ​ປັບ​ໄດ້ຫຼາຍ​ທີ່​ສຸດເທົ່າ​ທີ່​ຈະ​ເປັນ​ໄປ​ໄດ້ 2.​ ຊອກ​ຫາ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ສາ​ມາດ​ດັດ​ແກ້​ໄດ້​ງ່າຍ. 3.​ ຊອກ​ຫາ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ມີອຸ​ປະ​ກອນ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ຕ່າງໆ​(PSDs) 4.​ ​ກະກຽມຕົວ​ເລືອກການ​ຕິດ​ຕັ້ງ​ຜະ​ລິດ​ຕະ​ພັນ​ຕົວ​ຢ່າງ​ໄວ້​ກ່ອນ. 5.​ ​ຜະລິດ​ອຸປະກອນ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ຕ່າງໆ​ໄວ້​ກ່ອນ 6.​ ກຳ​ນົດ​ຕາ​ຕະ​ລາງ​ເວລາ​ທີ່ຈະ​ແຈ້ງເພື່ອ​ອະ​ນຸ​ຍາດ​ສຳ​ລັບ​ການເຮັດ​ວຽກ​ຮ່ວ​ມ​ກັນ 7.​ ຈັດ​ທີມເພື່ອ​ສ້າງ​ແຜນ​ການ​ເຮັດ​ວຽກ​ຮ່ວມ​ກັນ 8.​ ​ທີມ​ປິ່ນ​ປົວ​ແລະ​ທີມ​ເຕັກ​ນິກ​ເຮັດ​ວ​ຽກ​ຮ່ວມ​ກັນໃນ​ລະ​ຫວ່າງ​ການ​ປັບລົດ​ເຂັນ​ໃຫ້​ເໝາະ​ສົມ 9.​ ​ທີມ​ປິ່ນ​ປົວ​ແລະ​ທີມ​ເຕັກ​ນິກ​ໂອ້​ລົມ​ກ່ຽວ​ກັບວິ​ທີ​ແກ້​ໄຂ​​ການ​ກຳ​ນົດ​ໃຊ້​ລົດ​ເຂັນ 10.​ບັນທຶກ​ຂໍ້​ມູນ​ເປັນ​ເອ​ກະ​ສານ​ຢ່າງ​ຈະ​ແຈ້ງ​ແລະ​ການ​ເກັບຮັກສາ​ບັນ​ທຶກ​ 11.ວາງ​ແຜນ​ລະ​ດັບ​ການ​ຝຶກ​ອົບ​ຮົບ​ທີ່​ເໝາະ​ສົມ​ສຳ​ລັບ​ພະ​ນັກ​ງານ​ໃຫ້​ບໍ​ລິ​ການ 12.ຊອກຫາວັດສະດຸທີ່ເໝາະສົມສຳລັບການເຮັດເບາະນັ່ງ​ແລະ​ອຸປະກອນ​PSD​ແລະ​ ການດັດແປງຕ່າງໆ. 13.ຊອກ​ເຄື່ອງ​ມື​ທີ່​ເໝາະ​ສົມ​ສຳ​ລັບ​ການ​ເຮັດ​ການ​ປັບ​ຜະ​ລິດ​ຕະ​ພັນ​ຢ່າງວ່ອງ​ໄວ. 14.ຈັດ​ສັນ​ການ​ຝຶກ​ອົບ​ຮົບ​ຜູ້​ໃຊ້​ໃຫ້​ແກ່​ບຸກ​ຄົນ​ສະ​ເພາະ​ໃດ​ໜຶ່ງ,​​ຕົວ​ຢ່າງ,​​ຜູ້​ຊ່ວຍ​ຄຸ​ຝຶກ 15.​ລະ​ບຸ​ສະ​ຖານ​ທີ່​ສຳ​ລັບ​ການ​ຝຶກ​ອົບ​ຮົມຜູ້​ໃຊ້​ໃຫ້​ຢູ່​ໃກ້​ກັບ​ພື້ນ​ທີ່​ປິນ​ປົວ​ແລະ​ເຕັກ​ນິກ 16.​ສ້າງ​ລະ​ບົບ​ຄວບ​ຄຸມ​ຄັງ​ທີ່​ມີ​ປະ​ສິດ​ທິ​ພາບ. 17.ກະ​ກຽມ​ຄັງ​ລົດ​ເຂັນ​ໃນ​ຂະ​ໜາດ​ທີ່​ແຕກ​ຕ່າງ​ກັນ. 18.​ສ້າງ​ການ​ຮ່ວມ​ມື​ໃນຊຸມ​ຊົມ​ເພື່ອ​ລະ​ບຸ​ຜູ້​ໃຊ້​ບໍ​ລິ​ການ​ແລະ​ໃຫ້​ການ​ຂົນ​ສົ່ງ​ໄປ​ຍັງ​ສູນ​ບໍ​ລິ​ການ​ 19.​ສ້າງ​ຄວາມ​ສາ​ມາດ​ຂອງ​ຄູ່​ຮ່ວມ​ງານ​ໃນ​ຊຸມ​ຊົມ​ເພື່ອ​ໃຫ້​ການ​ບໍ​ລິ​ການລະ​ດັບ​ພື້​ນ​ຖານ​ແລະ​ນຳ​ສົ່ງ​ຜູ້​ໃຊ້​ ການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ປານ​ກາງ 20.ເປີດ​ກວ້າງ​ຕໍ່ແນວ​ຄວາມ​ຄິດ​ໃໝ່​–​​ການ​ສ້າງສັນ​ສິ່ງ​ໃໝ່. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 106 107 ຖັນ 1: ສ່ິງ ທ້າ ທ້າຍ ການ ບໍ ລິ ການ ຖັນ 2: ຍຸດ ທະ ສາດ ການ ບໍ ລິ ການ ການ ປະ ເມີນ ຜົນ: 1. ຖ້າ​ພະ​ນັກ​ງານ​ກໍາ​ລັງ​ເດີນ​ທາງ​ໄປ​ໃຫ້ການ​ບໍ​ລິ​ການ​ຫຼື​ດໍາ​ເນີນ​ການ​ ຢ້ຽມ​ຢາມ​ເຮືອນ,​ເວ​ລາ​ໃນ​ການ​ເດີນ​ທາງ​ອາດ​ຈໍາ​ເປັນ​ຕ້ອງ​ໄດ້​ຮັບ​ ການ​ພິຈາລະນາ​ໃນ​ການ​ປະ​ເມີນ​ຜົນ 2. ​ຖ້າ​ສະ​ມາ​ຊິກ​ໃນ​ທີມ​ບໍ່​ມີ​ປະ​ສົບ​ການ​ການ​ປະ​ເມີນ​ຈະ​ໃຊ້​ເວ​ລາ​ດົນ ການ ກໍາ ນົດ ໃຊ້ ລົດ ເຂັນ: 3. ​ຖ້າ​ຜະ​ລິດ​ຕະ​ພັນ​ມີ​ຄວາມ​ສາ​ມາດ​ປັບ​ໄດ້​ຈໍາ​ກັດ,​​ຕ້ອງ​ກໍານົດ​ ໃຫມີການ​ດັດ​ແປງ​ເພື່ອ​ເຮັດ​ໃຫ້​ຜະ​ລິດ​ຕະ​ພັນ​ເໝາະ​ສົມກັບ​ຜູ້​ໃຊ້​ແຕ່​ ລະ​ຄົນ 4. ​ຖ້າຈໍາ​ເປັນ​ຕ້ອງ​ໄດ້​ສ້າງ​ແນວ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ພິ​ເສດ​,​ກໍ່​ຈໍາ​ເປັນ​ຕ້ອງ​ ໄດ້​ເຮັດ​ການ​ວັດ​ແທກ​​ແລະ​ການ​ແຕ້ມ​ແບບ​ເພີ່ມ​ເຕີມ ການ ກະ ກຽມ ຜະ ລິດ ຕະ ພັນ: 5. ​ເຂົ້າ​ເຖິງ​ປະ​ເພດ​ແລະ​ຂະ​ໜາດ​ຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​ທີ່​ຕ້ອງ​ການ​ໄດ້​ ຢ່າງວ່ອງ​ໄວ 6. ​ຖ້າລົດເຂັນມີຄວາມສາມາດປັບໄດ້ຈໍາກັດ​ກໍ່ອາດຈະຈໍາເປັນຕ້ອງໃຊ້ ເວລາຫຼາຍຂຶ້ນ​ສໍາລັບການກະກຽມລົດເຂັນ 7. ​ຖ້າ​ການ​ດັບ​ແປງ​ສໍາ​ລັບ​ການ​ຮອງ​ຮັບ​ທ່າ​ທາງ​ແມ່ນ​ມີ​ຄວາມ​ຈໍາ​ເປັນ,​ ຈໍາ​ເປັນ​ຕ້ອງ​ໃຊ້​ເວ​ລາ​ຫຼາຍ​ຂື້ນ ການປັບ ໃຫ້ ເໝາະ ສົມ: 8. ​ຖ້າ​ການ​ດັບ​ແປງ​ໄດ້​ຖືກ​ເຮັດ​ແລ້ວ​ຫຼື​​ໄ​ດ້​ເພີ່ມ​ການຮອງ​ຮັບ​ພິ​ເສດ​ໃສ່​ ລົດ​ເຂັນ​ແລ້ວ,​ການ​ປັບ​ໃຫ້​ເໝ​າ​ະ​ສົມ​ຈະ​ໃຊ້​ເວ​ລາ​ດົນກວ່າ 9. ​ຖ້າ​ເຮັດການ​ປ່ຽນ​ແປງ​ໃດ​ໜຶ່ງ​ຕໍ່ກັບ​ການ​ປະ​ກອບ​ລົດ​ເຂັນ​ໃນ​ລະ​ ຫວ່າງ​ການ​ປັບ​ໃຫ້​ເໝາະ​ສົມ;​​ຈໍາ​ເປັນ​ຕ້ອງກວດ​ການ​ປັບ​ໃຫ້​ເໝາະ​ ສົມ​ເພີ່ມ​ເຕີມອີກ ການ ຝຶກ ອົບ ຮົບ ຜູ້ ໃຊ້: 10. ​ຖ້າ​ມັນ​ເປັນ​ຄັ້ງ​ທໍາ​ອີດ​ທີ່​ບຸກ​ຄົ​ນ​ກໍາ​ລັງໄດ້​ຮັບ​ລົດ​ເຂັນ,​ຫຼື​ມີ​ອາການ​ ແຊກ​ຊ້ອນ​ດ້ານ​ສຸ​ຂະ​ພາບ​,​​ອາດ​ຈະ​ຈໍາ​ເປັນ​ຕ້ອງ​ໃຊ້​ເວ​ລາ​ຫຼາຍ​ຂື້ນ​ ເພື່ອ​ກວມ​ເອົາ​ການ​ຝຶກ​ອົບ​ຮົບ​ໃນ​ການ​ດູ​ແລ​ສຸ​ຂະ​ພາບ,​​ການເຄື່ອນ​ ໄຫວ​ໄປ​ມາ,​​ການ​ຈັດ​ການ​ລົດ​ເຂັນ​ເຊັ່ນ​ດຽວ​ກັນ​ກັບ​ການ​ດູ​ແລ​ແລະ​ ການ​ບໍາ​ລຸງ​ຮັກ​ສາ,​​ແລະ​ການ​ນໍາສົ່ງ​ຫາ​ແຫຼ່ງ​ການ​ນໍາ​ສົ່ງ​ອື່ນ 108 109 C.4: ການ ວາງ ແຜນ ການ ຕິ ດ ຕ າມຜົນ C.4.1 ການ ເອົາ ຊະ ນະ ອຸ ປະ ສັກ •​ ​ອາ່ນ​ລາຍ​ຊື​່ຂອງ​ອ​ຸປະ​ສັກ​ທີ​່ເປນັ​ໄປ​ໄດ​້ຕໍ​່ກັບການ​ຕິດ​ຕາມ​ຜນົ​ຂາ້ງ​ລຸມ່​ແລະ​ເພ່ີມ​ອ​ຸປະ​ສັກ​ເພ່ີມ​ ເຕມີ​ຕາ່ງໆທີ​່ກຸມ່​ໄດ​້ຊີ​້ໃຫ​້ເຫນັ. •​ ​ໂອ​້ລມົ​ກຽ່ວ​ກັບ​ການ​ດາໍ​ເນນີ​ການ​ເພ່ືອ​ເອາົ​ຊະ​ນະ​ອ​ຸປະ​ສັກ​ຕໍ​່ກັບການ​ຕິດ​ຕາມ​ຜນົ​ແລະ​ຂຽນ​ພວກ​ ມນັ​ລງົ​ໃນ​ຕະ​ຕາ​ລາງ​ຂາ້ງ​ລຸມ່​. ອຸ ປະ ສັກ ຕ່ໍ ກັບການ ຕິດ ຕາມ ຜົນ ​ອຸ​ປະ​ສັກ​ທີ່​ເປັນ​ໄປ​ໄດ້​ຕໍ່​ການ​ບໍ​ລິ​ການ​ຕິດ​ຕາມ​ຜົນ​ຢູ່ນອກ​ສະ​ຖານ​ທີ່:​ •​ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ພະ​ນັກ​ງານ​ສູນ​ການ​ບໍ​ລິ​ການ​ໃນ​ການ​ເດີນ​ທາງ​ໄປ​ຍັງ​ຊຸ​ມ​ຊົມ; •​ ​ເວ​ລາ​ສໍາ​ລັບ​ພະ​ນັກ​ງານ​ສູນ​ການ​ບໍ​ລິ​ການ​ເດີນ​ທາງ​ໄປ​ຍັງ​ຊຸມ​ຊົມ; •​ ​ການ​ຕິດ​ຕາມ​ຜົນ​ບໍ່​ໄດ້​ຖືກ​ຈັດ​ບຸ​ລິ​ມະ​ສິດໂດຍ​ຜູ້​ຈັດ​ການ​ການ​ບໍ​ລິ​ການ; •​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ບໍ່​ໃຫ້​ຄວາມ​ສໍາ​ຄັນ​ຕໍ່​ກັບ​ການ​ຕິດ​ຕາມ​ຜົນ​ຈົນ​ກວ່າ​ພວກ​ເຂົາ​ເຫັນ​ຜົນ​ປະ​ໂຫຍດ. ​ປະ​ສັກ​ທີ່​ເປັນ​ໄປ​ໄດ້​ຕໍ່ກັບ​ການ​ບໍ​ລິ​ການ​ການ​ຕິດ​ຕາມ​ຜົນ​ຢູ່​ກັບສູນ: •​ ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງ​ການ​ເດີນ​ທາງ​ແລະ​ເວ​ລາ​ບໍ່​ໄດ້​ເຮັດ​ວຽກ​ສໍາ​ລັບ​ສະ​ມາ​ຊິກ​ຄອບ​ຄົນ​ໜຶ່ງ​ຫຼື​ຫຼາຍ​ຄົນ;​ •​ ​ຜູ້​ໃຊ້​ແລະ​ສະ​ມາ​ຊິກ​ໃນ​ຄອບ​ຄົວ​ແມ່ນ​ມັກ​ບໍ່​ຮັບ​ຮູ້​ຜົນ​ປະ​ໂຫຍດ​ຂອງ​ການ​ຕິດ​ຕາມຜົນ;​ •​ ​ຄວາມ​ລໍາ​ບ​າກ​ໃນ​ການ​ຊອກ​ຫາ​ການ​ຂົນ​ສົ່ງ​ທີ່​ສາ​ມາດ​ເຂົ້າ​ເຖິງ​ໄດ້; •​ ​ຄວາມ​ກົດ​ດັນ​ຕໍ່​ກັບ​ການ​ເນັ້ນ​ໜັກ​ໃສ່​ການ​ນັດ​ໝາຍ​ໃໝ່​ຢູ່​ສູນ​ບໍລິການ​ສາ​ມາດ​ເຮັດ​ໃຫ້​ບໍ່​ມີ​ເວລາ​ສໍາ​ລັບ​ ການ​ຕິດ​ຕາມຜົນ; •​ ​ຄວາມ​ລໍາ​ບາກ​ໃນ​ການ​ຈັດ​ຕາ​ຕະ​ລາງ​ການ​ນັດ​ໝາຍ:​​ຜູ້​ໃຊ້​ອາດ​ມາ​ໃນ​ເວ​ລາ​ບໍ່​ມີ​ພະ​ນັກ​ງານ,​ຫຼື​ບໍ່​ມາ​ ໃນ​ເວ​ລາ​ມີ​ພະ​ນັກ​ງານ. ການ ດໍາ ເນີ ນ ການຕ່າງໆ ເພ່ືອ ແກ້ ໄຂ ອຸ ປະ ສັກ ຕ່ໍ ກັບການ ຕິດ ຕາມ ຜົນ ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 108 109 C.5: ການ ພັດ ທະ ນາ ຄວາມ ຍືນ ຍົງ ທາງ ການ ເງິນ C.5.1 ການ ລະ ບຸ ແຫ່ຼງທຶນ •​ ​ອາ່ນ​ຜ່ານ​ລາຍ​ຊື​່ຂອງ​ແຫຼງ່ທນຶ​ທີ​່ເປນັ​ໄປ​ໄດ​້ແລະ​ເບິງ່​ຄູ​່ມ​ືອາ້ງ​ອງີ​ສາໍ​ລັບ​ລາຍ​ລະ​ອຽດ​ເພີມ່​ເຕມີ. •​ ​ເລືອກ​ສາມ​ແຫຼງ່​ໃຫ​້ທນຶ​ທີ​່ທາ່ນ​ເຊືອ່​ວາ່​ມ​ີຄວາມ​ເປນັ​ໄປ​ໄດ​້ທນັ​ທີຫາຼຍ​ທີ​່ສຸດ​ສາໍ​ລັບ​ການ​ບ​ໍລ​ິການ​ ຂອງ​ທາ່ນ​ແລະ​ເຮດັ​ສາໍ​ເລັດ​ຕາ​ຕະ​ລາງ​ຂາ້ງ​ລຸມ່​ສາໍ​ລັບ​ແຫຼງ່ທນຶ​ທີ​່ເລືອກ. ແຫ່ຼງ ໃຫ້ທຶນ ຕ່າງໆ ສໍາລັບ ໃຫ້ ຜູ້ ຈັດ ການ ພິ ຈາ ລະ ນາ 1.​ ​ລັດ​ຖະ​ບານ 2.​ ​ລະບົບ​ປະ​ກັນ​ໄພແຫ່ງ​ຊາດ 3.​ ​ຜູ້​ບໍ​ລິ​ຈາກ​ແລະ​ຜູ້​ອຸ​ປະ​ຖຳ​ທີ່​ເປັນ​ບຸກ​ຄົນ 4.​ ​ຜູ້​ບໍ​ລິ​ຈາກ​ແລະ​ຜູ້​ອຸ​ປະ​ຖຳ​ທີ່​ເປັນ​ບໍ​ລິ​ສັດ​(ທຸ​ລະ​ກິດ) 5.​ ການ​ປະ​ກອບ​ສ່ວນ​ຂອງ​ຜູ້​ໃຊ້​ຫຼື​ການ​ຊື້​ເຕັມລາຄາ 6.​ ການ​ສ້າງ​ລາຍ​ໄດ້/ວິ​ສະ​ຫະ​ກິດ​ເພື່ອສັງ​ຄົມ 7.​ ກຸ່ມຊຸມຊົມ/ສະມາຄົມການກຸສົນ 8.​ ຄະ​ນະ​ທາງ​ການ​ທູດ 9.​ ອົງການ​NGO​ລະຫວ່າງປະເທດ​ແລະພາຍ​ໃນ​ປະ​ເທດ ແຫ່ຼງທຶນ ທ່ີ ເລືອກ ​ຈາໍ​ນວນ​ຄາໍ​ສັງ່​ຊື້​ທີ່​ເປັນ​ບຸ​ລິ​ມະ​ສິດ​ໂດຍ​ພິ​ຈາ​ລະ​ນາ​ເຖງິ: •​ ​ຄວາມ​ພະ​ຍາ​ຍາມ​ທີ​່ຈາໍ​ເປນັ •​ ລາງວນັ​ເປນັ​ເງິນ​ໄລຍະ​ສັນ້​​ຫ​ື​ໄລຍະ​ຍາວ​(ຫຼືທງັ​ສອງ) ບຸ ລິ ມະ ສິດ ແຫ່ຼງທຶນ ການ ລົງ ທຶນ/ ຄວາມ ພະ ຍາ ຍາມ ທ່ີຈໍາ ເປັນ ສູງ/ ກາງ/ ຕ່ໍາ ລາງວັນ ໄລ ຍະ ສ້ັນ ສູງ/ ກາງ / ຕ່ໍາ ລາງວັນ ໄລ ຍະ ຍາວ ສູງ/ ກາງ / ຕ່ໍາ 110 C.5.2 ການ ພັດ ທະ ນາ ຍຸດ ທະ ສາດ •​ ​ອາ່ນ​ຍຸດ​ທະ​ສາດ​ຕວົ​ຢາ່ງ​ຂາ້ງ​ລຸມ່​ນີ.້ •​ ​ຂຽນ​ລາຍ​ຊື​່ແຫຼງ່ທນຶ​3​ແຫຼງ່​ຈາກ​ບົດ​ຝກຶ​ຫັດ​ໃນ​ຕາ​ຕະ​ລາງ​ທີ​່ຜາ່ນ​ມາ. •​ ​ເຮດັ​ສາໍ​ເລັດ​ຖນັ​ໃນ​ຕາ​ຕະ​ລາງ​ສາໍ​ລັບ​ແຫຼງ່ທນຶ​ທີ​່ເລືອກ​ໄວ.້ ແຫ່ຼງທຶນ ປະ ເພດ ການ ສະ ໜັບ ສະ ໜູນ ການ ຮ້ອງ ຂໍ ຄວາມ ເປັນໄປ ໄດ້ ຄວາມ ພະ ຍາ ຍາມ 1.​​ບໍ​ລິ​ສັດ​(​ທຸ​ລະ​ ກີດ​ທ້ອງ​ຖິ່ນ) ​ການ​ບໍ​ລິ​ຈາກ​ໃຫ້​ ງົບ​ປະ​ມານ​ກາ​ນ​ ຈັດ​ຊື້​ລົດ​ເຂັນ. 10%​​ຂອງ​ງົບ​ ປະ​ມານ​ລົດ​ ເຂັນ. ​ລະ​ດັບ​ກາງ​(​ເຄີ​ຍ​ ໃຫ້​ທຶນ​ໃນ​ເມື່ອ​ ກ່ອນ.​ແນວ​ໃດ​ກໍ​ ຕາມ​,​ບໍ່​ມັກ​ໃຫ້​ ທຶນ​ແກ່​ອົງ​ການ​ ເກົ່າ​ໃນ​ແຕ່​ລະ​ປີ). ​ຢ່າງ​ໜ້ອຍ​ປະ​ຊຸມ​2​ ຄັ້ງ​ກັບ​ຜູ້​ຈັດ​ການ​ທຸ​ ລະ​ກິດ;​​ແຜນສະ​ ເໜີ​ແລະ​ ງົບປະມານ​2​ໜ້າ​ ທີ່​ຈະ​ຖືກ​ສົ່ງ​ແລະ​ ເຊີນ​ຜູ້​ຈັດ​ການ​ໃນ​ ວັນ​ຖັດ​ໄປ. 2.​​ລັດ​ຖະ​ບານ​ ທ້ອງ​ຖິ່ນ ​ເປັນ​ໄປ​ໄດ້​ອາດ​ ຈະ​ໃຫ້​ທຶນ​ຄ່າ​ໃຊ້​ ຈ່າຍ​ຂອງ​ການ​ ໃຫ້​ບໍລິການ​ນອກ​ ສະຖານ​ທີ່ທັງ​ ໝົດ​ໃຫ້​ແກ່ຜູ້​ໃຊ້​ ລົດ​ເຂັນ​ໃນ​ພື້ນ​ທີ່​ ເຂົາ​ເຈົ້າ. 20%​​ຂອງ​ຄ່າ​ ໃຊ້​ຈ່າຍຂອງ​ ການ​ ບໍລິການນອກ​ ສະ​ຖານ​ທີ່​ທັງ​ ໝົດ​ແລະ​20%​​ ຂອງ​ເງິນ​ເດືອນ​ ພະ​ນັກ​ງານໃຫ້​ບໍ​ ລິ​ການ. ​ລະ​ດັບ​ສູງ​(​ໄດ້​ ສົນ​ທະ​ນາ​ກັບ​ລັດ​ ຖະ​ບານ​ທ້ອງ​ຖິ່ນ​ ນີ້​ເປັນ​ເວລາ​ໃດ​ ໜື່ງ​ແລ້ວ.​​ໄດ້ດໍາ​ ເນີນ​ໜຶ່ງ​ການ​ ບໍລິການ​ນອກ​ ສະຖານ​ທີ່​ໃນ​ພື້ນ​ ທີ່​ຂອງ​ເຂົາ​ເຈົ້າ.​ ພວກ​ເຂົາ​ສຸດ​ທີ່​ ສົນ​ໃຈ​ໃຫ້ການ​ ສະໜັບສະໜູນ​ ສິ່ງ​ນີ້​​ແລະ​ເບິ່ງ​ຄື​ ວ່າ​ມີ​ການ​ໃຫ້​ ທຶນ). ​ແຜນສະ​ເໜີ​ແລະ​ ງົບ​ປະ​ມານ​ທາງ​ ການ​ຈະ​ຖືກ​ສົ່ງ​.​ ຄວາມ​ມຸ້ງ​ໝັ້ນ​ ດ້ານການ​ລາຍ​ ງານ– ​ຮຽກ​ຮ້ອງ​ໃຫ້​ ມີ​ຂໍ້​ມູນ​ທີ່​ຖືກ​ຕ້ອງ​ ຂອງ​ໝົດ​ທຸກ​ຄົນ​ ເຫັນ​ໄດ້​ຈາກ​ພື້ນ​ທີ່​ ແລະ​ການ​ລາຍ​ງານ​ ທາງ​ການ​ເງິນ​ຂອງ​ ພວກ​ເຂົາ. ລົດ ເຂັນ ຊຸດ ຝຶກ ອົບຮົມ ການ ບໍລິການ ສໍາລັບ​ຜູ້​ຈັດການ 110

WHEELCHAIR SERVICE TRAINING PACKAGE For Managers Reference Manual ສາໍລັບ​ຂໍ້​ມນູ​ເພີ່​ມ​ເຕມີ,​​ໃຫ້​ຕິດ​ຕໍ່​ຫາ: ​World​Health​Organization​(ອງົ​ການ​ອະ​ນາ​ໄມ​ໂລກ) 20,​Avenue​Appia CH-1211​Geneva​27 Switzerland ​ໂທ:​(+​41​22)​791-2715 ​ແຟັກ:​(+​41​22)​791-4874 http://www.who.int/disabilities/en/ ​ອີ​ເມວ:​assistivetechnology@who.int ISBN​978​92​4​154908​0

WHEELCHAIR SERVICE TRAINING PACKAGE Participant’s Workbook ຊຸດຝຶກອົບຮົມການບໍລິການລົດເຂັນ ສໍາລັບຜູ້ຈັດການ ຊັບພະຍາກອນເພ່ີມເຕີມ ຊຸດຝຶກອົບຮົມການບໍລິການລົດເຂັນ ສໍາລັບຜູ້ຈັດການ ຊັບພະຍາກອນເພ່ີມເຕີມ

ສາ ລະ ບາ ນ 1 ຍຸດ​ທະ​ສາດ​ທີ່​ເປັນ​ໄ​ປ​ໄດ້​ສ�າລັບ​ກາ​ນພັດທະນາ​ແຜນ​ງານ​ການ​ ​ ​ ສະໜອງ​ລົດ​ເຂນັ 3​ ​ແບບ​ຟອມ​ການນ�າ​ສົງ່​ຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ​(​ພ້ື​ນ​ຖານ) 4​ ​ແບບ​ຟອມ​ການນ�າ​ສົງ່​ຫາ​ການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ​(​ປານ​ກາງ) 5​ ​ລາຍ​ຊື່​ຂອງ​ແບບ​ຟອມ​ການ​ບ�​ລິ​ການ​ແລະ​ລາຍ​ຊືກ່​ານກວດ​ສອບ 6​ ​ການ​ເຮດັ​ກ່ອງ​ປະ​ເມນີ​ຜົນ 8​ ການ​ເຮດັຕຽງປະ​ເມນີ​ຜົນ 9​ ​ການ​ເຮດັ​ແນວ​ກັນ້​ຕນີ 10​ ຕົວ​ຢາ່ງ​ຂອງ​ເຄື່ອງວັດ​ແທກ 11​ ​ຄູ່​ມື​ແນະນ�າ​ສິງ່​ອ�າ​ນວຍ​ຄວາມ​ສະ​ດວກ​ດາ້ນ​ເຕັກ​ນິກ:​ໂຕະ​ເຮດັ​ວຽກ​ ​ ຂອງ​ຊາ່ງ​ແລະ​ພ້ືນ​ທີ່​ເຮດັ​ວຽກ​ຢູ່​ພືນ້​ດນິ 12​ ​ຄູ່​ມື​ແນະນ�າ​ຊັ​ບ​ພະ​ຍາ​ກອນ​ດາ້ນ​ເຕັກນິກຂອງການ​ບ�​ລິ​ການລະດັບ​ ​ ພ້ືນຖານ 14​ ​ຄູ່​ມື​ແນະນ�າ​ຊບັ​ພະ​ຍາກອ​ນ​ດາ້ນ​ເຕັກນິກຂອງການ​ບ�​ລິ​ການ​ລະ​ດັບ​ ​ ປານ​ກາງ 18​ ​ການ​ກະ​ກຽມ​ໃບ​ເລື່ອ​ຕັດ​ເຫຼັກ​ສ�າລັບ​ການຕັດ​ໂຟມ 19​ ຄູ່​ມື​ແນະນ�າ​ການ​ບ�ລິການ​ລະດັບ​ພ້ືນຖານ​​ແລະ​ປານ​ກາງ​– ວັດ​ສະດຸ 21​ ຄູ່​ມື​ແນະນ�າ​ການ​ຕັງ້​ພ້ືນ​ທີ່​ຝຶກ​ອົບຮມົທັກ​ສະການ​ເຄື່ອນ​ໄຫວ​ໄປມາ 25​ ການ​ປຽບທຽບ​ວິທີ​ການ​ຕາ່ງໆ​ຂອງ​ການ​ຈັດ​ຫາ​ລົດ​ເຂນັ 29​ ​ເຄື່ອ​ງມື​ສ�າລັບ​ການ​ວັດ​ແທກ​ການ​ມີ​ສ່ວນ​ຮວ່ມ​ໃນ​ເວລາ​ປະ​ເມນີ​ຜົ​ ​ ສ�າລັບ​ເຕັກ​ໂນ​ໂລ​ຊີ​ຊວ່ຍ 30​ ເຄື່ອງມື​ສ�າລັບ​ວັດ​ແທກ​ຄວາມ​ພ�​ໃຈ​​ແລະ​ຜົນ​ຮບັ​ໃນ​ເວລາ​ຕິດຕາມ​ຜົນ​ ​ ຂອງ​ເຕັກ​ໂນ​ໂລ​ຊີ​ຊວ່ຍ 35​ ຂ�້​ມນູ​ການ​ຊວ່ຍ​ເຂົາ້​ເຖງິ 1 2 ຍຸດ​ທະ​ສາດ​ທ່ີ​ເປັນ​ໄ​ປ​ໄດ້​ສໍາລັບ​ກາ​ນພັດທະນາ​ ແຜນ​ງານ​ການ​ສະໜອງ​ລົດ​ເຂັນ ຍຸດ​ທະ​ສາດ​ທີ່​ດີ​ສຸດ​ສ�າລັບ​ກາ​ນພັດທະນາ​ແຜນ​ງານ​ສະໜອງ​ລົດ​ເຂນັ​ລະດັບປະ​ເທດ​ຈະ​ຂຶນ້​ກັບ​ ສະພາບ​ການ​ໃນ​ປະຈຸ​ບນັ​ກຽ່ວ​ກັບ​ການ​ບ�ລິການ​ລົດ​ເຂນັ​ໃນ​ປະ​ເທດ​ນັນ້ ,ໆ​ຊບັພະຍາກອນ​ທີ່​ມີ​ໃຫ້​​ ແລະ​ຄວາ​ມຕ້ອງການ​ລົ​ດ​ເຂນັ​ທີ່​ການ​ບ�ລິການ​ຈ�າ​ເປັນ​ຕ້ອງ​ຕອບ​ສະໜອງ.​ມນັ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ ການ​ພຈິາລະນາ​ບນັດາ​ຄ�າ​ຖາມ​​ແລະ​ຍຸດ​ທະ​ສາດ​ຕ�່​ໄປ​ນີ້ທີ່​ອະທິບາຍ​ໄວ້​ຢູ່​ໃນ​ຂ�້​ແນະນ�າ​ລົດ​ເຂນັ ໃນ​ເວລາ​ວາງ​ການ​ສະໜອງ​ລົດ​ເຂນັ. •​ ​ລັກສະນະ​​ແລະ​ຄວາມ​ຕ້ອງການ​ສະ​ເພາະ​ຂອງ​ກຸມ່​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ເປັນ​ແນວ​ໃດ? •​ ມີ​ກຸມ່​ຜູ້​ມີ​ສ່ວນ​ໄດ້​ສ່ວນ​ເສຍ​ບ�,​ຖາ້​ມີ​ຜົນ​ປະ​ໂຫຍ​ດ​​ແລະ​ຄ�າ​ຄິດ​ເຫນັ​ຂອງ​ເຂາົ​ເຈົາ້​ເປັນ​ແນວ​ໃດ? •​ ມີການ​ບ�ລິການ​ລົດ​ເຂນັຢູ່​ແລ້ວ​(ຜາ່ນ​ຮາ້ນ​ສ້ອມ​ແປງ​ໃນ​ທ້ອງ​ຖິນ່,​ການ​ຟືນ້​ຟູ​ທີ່​ອງີ​ໃສ່​ຊມຸ​ຊນົ,​ ອງົການ​ຄນົ​ພິການ,​ໜ່ວຍ​ງານ​ອືນ່​ຂອ​ລັດຖະບານ,​ພາກ​ເອກ​ະຊນົ​ຫຼືລັດຖະບານ)​​ແມນ່​ຫຼືບ�?່ •​ ​ມີ​ການ​ສະໜອງລົດ​ເຂນັ​ໃດໆ​ຢູ່​ນອກ​ໂຄງ​ສ້າງ​ທາງ​ການ​​ເຊັນ່​ວາ່​ການ​ສະໜອງ​ລົດ​ເຂນັ​ທີ່​ນ�າ​ ເຂົາ້​ມາ​ຈ�ານວນ​ຫຼວງຫາຼຍບ�? •​ ສາມາດ​ເຮດັ​ຫຍງັ​ໄດ້​ແດ່​ກັບ​ຊບັພະຍາກອນ​ທີ່​ມີ​ຢູ່​ແລ້ວ? •​ ກນົ​ໄກ​ການ​ໃຫ້​ທນຶ​ປະຈຸ​ບນັ​ເປັນ​ແນວ​ໃດ? 1.​ ລັດຖະບານ​ຕ້ອງການ​ສ້າງ​ຕ້ັງ​ແຜນ​ງານສະ​ໜອງ​ລົດ​ເຂັນ​ລະດັບ​ປະ​ເທດ​ບໍ?​ລັດຖະບານ​ອາດ​ຈະ​ຕິດ​ ຕ�່​ອົງການ​ບ�່​ສັງກັດ​ລັດຖະບານ​​ແລະ​ອົງການຈັດ​ຕັ້ງ​ຄົນ​ພິການທີ່​ສົນ​ໃຈ,​ຜູ້​ໃຊ້​ລົດ​ເຂັນ,​​ແຜນ​ງານ​ການ​ຝຶກ​ ອົບຮົມສ�າລັບ​ຜູ້​ຊ່ຽວຊານ​ດ້ານ​ສຸຂະພາບ,​ອົງການ​ຈັດ​ຕັ້ງ​ສາກົນ​​ເຊັ່ນ​ວ່າ​ອົງການ​ອະນາ​ໄມ​ໂລກ​(WHO),​ ສະມາຄົມກາ​ຍະ​ອຸປະກອນ​ນລະຫວ່າງ​ປະ​ເທດ​(ISPO),​ສະມາຄົມ​ຜູ້​ຊ່ຽວຊານ​ລົດ​ເຂັນ​ລະຫວ່າງ​ປະ​ເທດ​ (ISWP)​​ແລະ​ອົງການ​ບ�່​ສັງກັດ​ລັດ​ລະຫວ່າງ​ປະ​ເທດ​ທີ່​ກ່ຽວຂ້ອງ​ອື່ນ​​ເພ່ືອ​ພັດທະນາ​ແຜນການ​ທີ່​ເໝາະ​ ສົມ​ສ�າລັບ​ການ​ບ�ລິການ​ລົດ​ເຂັນລະດັບ​ປະ​ເທດ.​​ລັດຖະບານ​ອາດ​ຈະ​ກວດ​ເບິ່ງ​ການ​ບ�ລິການກ່ຽວ​ກັບ​ກາ​ ຍະ​ອຸປະກອນ​ຂອງ​ຕົນ​ເອງ​​ແລະ​ໃຊ້​ສິ່ງ​ເຫຼົ່ານ້ີ​ເປັນ​ພ້ືນຖານ​ສ�າລັບ​ກາ​ພັດທະນາ​ການ​ບ�ລິການ​ລົດ​ເຂັນ.​ ລັດຖະບານ​ອາດ​ຈະ​ຕິດ​ຕ�່​ໜ່ວຍ​ງານ​ລັດຖະບານ​ໃນ​ປະ​ເທດ​ອື່ນ​ເພ່ືອ​ຮຽນ​ຮູ້​ຈາກ​ປະສົບ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ​​ ແລະ​ຊອກ​ຄ�າ​ແນະນ�າ. 2.​ ການ​ສະ​ໜອງ​ລົດ​ເຂັນ​ມີ​ຢູ່​ແລ້ວ,​​ແຕ່​ຢູ່​ໃນ​ຂອບ​ເຂດ​ຈໍາກັດ​ຜ່ານ​ອົງການ​ຈັດ​ຕ້ັງ​ເອກະລາດ;​ບ່ໍ​ມີ​ ການ​ຮ່ວມ​ມື​.​ລັດຖະບານ,​ອົງການ​ຈັດ​ຕັ້ງ​ໃນ​ທ້ອງ​ຖິ່ນ​ຫຼືອົງການ​ຈັດ​ຕັ້ງ​ບ�່​ສັງກັດ​ລັດຖະບານ​ສາມາດ​ ປະ​ເມີນ​ຄວາມ​ເປັນ​ໄປ​ໄດ້​ຂອງ​ການ​ຂະຫຍາຍ​ຂອບ​ເຂດການ​ດ�າ​ເນີນ​ງານ​ດັ່ງກ່າວ.​ສາມາດ​ຕັ້ງສູນຊ່ວຍ​ ເຫຼືອ​(resource​centre)​​ເພ່ືອ​ລວມ​ເອົາບຸກຄົນ​ຈາກ​ອົງການ​ຈັດ​ຕັ້ງ​ຕ່າງໆ​ເຂົ້າ​ມາ​ມີ​ສ່ວນ​ຮ່ວມ​ໃນ​ຄວາມ​ ພະຍາຍາມ​ຮ່ວມ​ມື​ກັນ.​ສູນ​ຊ່ວຍ​ເຫຼືອ​ສາມາດພັດທະນາ​ເປັນການ​ຮ່ວມ​ມື​ກັນ​ລະຫວ່າງ​ບັນດາ​ອົງການ​ຈັດ​ ຕັ້ງທ່ີ​ສົນ​ໃຈ​ໃນ​ການ​ບ�ລິການ​ລົດ​ເຂັນ​ຫຼື​ເປັນ​ອົງການ​ບ�່​ສັງກັດ​ລັດອິດສະຫຼ​ະທີ່​ມີ​ສິດ​ອ�ານາດ​ເປັນຂອງ​ຕົນ​ ເອງ. 1 2 3.​ ​ມີ​ບັນດາ​ອົງການ​ຈັດ​ຕ້ັງ​ໃນ​ປະ​ເທດ​​ແຕ່​ບ່ໍ​ມີ​ການ​ໃຫ້​ການ​ບໍລິການ​ລົດ​ເຂັນ.​ອົງການ​ບ�່​ສັງກັດ​ລັດ​ ຫຼືອົງການ​ຄົນ​ພິການສາມາດ​ເຮັດ​ໜ້າ​ທີ່​ເປັນສູນ​ກາງ​ສ�າລັບ​ສູນ​ຊ່ວຍ​ເຫຼືອ.​ອົງ​ການ​ດັ່ງກ່າວ​ຈ�າ​ເປັນ​ຕ້ອງ​ ລະບຸ​ອົງການ​ທີ່​ເໝາະ​ສົມທີ່​ມີ​ປະສົບ​ການ​ດ້ານ​ການ​ສະໜອງ​ລົດ​ເຂັນ​​ເປັນ​ຄູ່​ຮ່ວມ​ງານ​(ຕົວຢ່າງ​ອົງການ​ ຂອງລັດຖະບານ​ຫຼືອົງການ​ບ�່​ສັງກັດ​ລັດ​ໃນ​ປະ​ເທດ​ເພ່ືອນ​ບ້ານ​ຫຼືອົງການ​ບ�່​ສັງກັດ​ລັດ​ສາກົນ)​​ແລະ​ຄວນ​ ຕິດຕາມ​ບັນດາ​ຂັ້ນ​ຕອນ​ລິ​ເລີ່​ມອື່ນ​ໃນ​ສະພາບ​ການ​ທີ​4​ລຸ່ມ​ນີ້.​ນອກ​ນັ້ນ,​ຂະ​ບວນການ​ນີ້​ສາມາດ​ຖືກ​ເລີ່​ມ​ ໂດຍ​ອົງການ​ບ�່​ສັງກັດ​ລັດ​ສາກົນ​ໃດ​ໜຶ່ງ​​ເຊິ່ງຈະ​ຊອກ​ເອົາ​ອົງການ​ບ�່​ສັງກັດ​​ແລະ​ອົງການ​ຄົນ​ພິການ​ໃນ​ທ້ອງ​ ຖິ່ນ​ມາ​ເປັນ​ຄູ່​ຮ່ວມງານ.​ຄວນ​ພະຍາຍາມ​ກ�ານົດ​​ແລະ​ສ້າງ​ເຄືອ​ຂ່າຍກັບປະ​ເທດ​ຫຼືອົງການ​ຈັດ​ຕັ້ງ​ອື່ນ​ທີ່​ ເຄີຍ​ມີ​ປະສົບ​ການ​ຄ້າຍຄື​ກັນ​ໃນ​ການ​ລິ​ເລີ່​ມການ​ບ�ລິການ​ລົດ​ເຂັນ. 4.​ ​​ມີ​ບັນດາ​ອົງການ​ຈັດ​ຕ້ັງ​ໃນ​ປະ​ເທດ​​ແລະ​ບ່ໍ​ມີ​ການ​ໃຫ້​ການ​ບໍລິການ​ລົດ​ເຂັນ.​ອົງການ​ບ�່​ສັງກັດ​ລັດ​ ສາກົນ,​ບ�່​ວ່າ​ຈະ​ດ້ວຍ​ການ​ລິ​ເລີ່​ມຂອງ​ຕົນ​ເອງ​ຫຼືຕາມ​ຄ�າ​ເຊີນ​ຂອງ​ຫຼື​ໂດຍ​ກາ​ນຮ່ວມ​ງານ​ກັບ​ລັດຖະບານ,​ ສາມາດ​ສ້າງ​ຕັ້ງ​ສູນ​ຊ່ວຍ​ເຫຼືອ​ຢູ່​ໃນ​ເມືອງ​ຫຼວງ​ຫຼືຕົວ​ເມືອງ​ສ�າຄັນ​ອື່ນ​ຂອງ​ປະ​ເທດ​ນັ້ນໆ.​ສູນ​ຊ່ວຍ​ ເຫຼືອສາມາດ​ເປັນ​ສ່ວນ​ໜຶ່ງ​ທີ່ສ�າຄັນ​ຂອງ​ສະ​ຖາ​ບັນຟື້ນ​ຟູ​ທີ່​ມີ​ຢູ່​ແລ້ວ.​ສູນ​ຊ່ວຍ​ເຫຼືອ​ຄວນ​ເລີ່​ມດ້ວຍ​ການ​ສະ​ ໜອງ​ຂ�້​ມູນ​ທີ່​ສ�າຄັນ​ໃຫ້​ແກ່​ຜູ້​ໃຊ້ລົດ​ເຂັນ,​ຄອບຄົວ​ຂອງ​ເຂົາ​ເຈົ້າ​ຫຼືຜູ້​ໃຫ້ການ​ດູ​ແລ​​ແລະ​ຜູ້​ຊ່ຽວຊຽນດ້ານ​ ສຸຂະພາບ​ກ່ຽວ​ກັບ​ຄວາມ​ຈ�າ​ເປັນ​ດ້ານ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​​ແລະ​ບັນຫາ​ທີ່​ກວ້າງ​ກວ່າ​ກ່ຽວ​ກັບ​ການ​ເຄື່ອນ​ ໄຫວ​ໄປມາ.​ອົງ​ການ​ບ�່​ສັງ​ກັດ​ລັດສາ​ກົນ​ຄວນ​ພັດ​ທະ​ນາ​ການ​ວິ​ເຄາະ​ພາກສ່ວນ​ກ່ຽວຂ້ອງ​ແລະ​ສ�າຫຼວດ​ຄົນ​ ຜູ້​ທີ່​ໃຊ້​ຫຼື​ຕ້ອງ​ການ​ລົດ​ເຂັນ,​​ເພື່ອ​ລະ​ບຸ​ຊ່ອງວ່າງ​ແລະ​ກ�າ​ນົດ​ຄວາມ​ຕ້ອງ​ການ​ສ�າ​ລັບ​ລົດ​ເຂັນ​ແລະ​ການ​ບ�​ ລິ​ການ.​ການວິໄຈແບບມີສ່ວນຮ່ວມເບື້ອງຕົ້ນຈະ​ໃຫ້ທາງເລືອກສ�າລັບການ​ຕອບ​ສະໜອງຄວາມຕ້ອງການ.​ ຄວນ​ຮັບປະກັນ​ການ​ໃຫ້​ທຶນ​ເພື່ອ​ເລີ່​ມຕົ້ນ​ການ​ສະໜອງ​ລົດ​ເຂັນ.​ຄວນ​ພະ​ຍາ​ຍາມ​ນ​ສ້າງ​ສາຍ​ພົວພັນ​ການ​ ເຮັດ​ວຽກລະ​ຫວ່າງ​ສູນ​ຊ່ວຍ​ເຫຼືອ​ກັບ​ໜ່ວຍ​ງານ​ທີ່​ກ່ຽວຂ້ອງຂອງ​ລັດຖະບານ​ເປັນ​ຂັ້ນ​ຕອນ​ທ�າ​ອິດ​ໃນ​ການ​ ສ້າງ​ຕັ້ງ​​ການ​ບ�​ລິ​ການ​ລົດ​ເຂັນລະດັບ​ປະ​ເທດ. 3 4 ​ແບບ​ຟອມ​ການນໍາສ່ົງຫາການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​​ (​ພ້ືນ​ຖານ) ແບບ​ຟອມ​ການນ�າສົງ່​ຕົວ​ຢາ່ງ:​ແບບ​ຟອມ​ນີ້ສາ​ມາດ​ນ�າ​ໄປ​ປັບ​ໃຊ້​ໂດຍ​ການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ​ ແລະ​ສົງ່ໃຫແ້ຫຼງ່ການນ�າສົງ່​ເພ່ືອ​ຊວ່​ຍ​ພວກ​ເຂາົ​ນ�າສົງ່ຜູໃ້ຊລ້ົດເຂນັຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ. ​ກະ​ລຸ​ນາ​ປະ​ກອບ​ແບບ​ຟອມ​ການນ�າສົງ່ໃຫ້​ສ�າ​ເລັດ​ແລະ​ສົງ່​ຫາ: (​ຊື່​ແລະ​ທີ່​ຢູ່​ການ​ບ�​ລິ​ກາ​ນ​ລົດ​ເຂນັ) ​ຊື່​ຜູ້​ນ�າ​ສົ່ງ: ​ອົງ​ການ​ທີ່​ທ່ານ​ເຮັດ​ວຽກ​ໃຫ້: ​ລາຍ​ລະ​ອຽດ​ການ​ຕິດ​ຕ�່​ຂອງຜູ້​ນ�າ​ສົ່ງ​(​ວິທີ​ທີ່​ດີ​ສຸດ​ໃນ​ການ​ຕິດ​ຕ�່​ຫາ​ທ່ານ): ​ຊື່​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ: ​ວັນ​ເດືອນ​ປີ​ເກີດ: ​ຊື່​ຂອງພ�່​ແມ່/ຜູ້​ດູ​ແລ: ​ທີ່​ຢູ່: ​ຈະສາ​ມາດ​ຕິດ​ຕ�່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້​ແນວ​ໃດ? ​​​​​​​​​​​​​​​​​​​​ໄປ​ສະ​ນີ​ ​ ​​​​​​​​​ໂທ​ລະ​ສັບ​ຕົນ​ເອງ​ ​​​​​​​​​​ໂທ​ລະ​ສັບ​ຂອງ​ເພື່ອນ/​ຂອງເພື່ອນ​ບ້ານ​ ​ຖ້າ​ທາງ​ໂທ​ລະ​ສັບ,​​​ເບີ​ໂທ​ຂອງ​ເຂົາ​ເຈົ້າ​ແມ່ນ​ຫຍັງ: ​ຄວາມ​ພິ​ການ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ,​​ຖ້າ​ຮູ້: ​ເຫດ​ຜົນສ�າລັບ​ການ​ນ�າ​ສົ່ງ: •​ ​ບ�່​ມີ​ລົດ​ເຂັນ •​ ​ລົດ​ເຂັນ​ເພ •​ ​ມີ​ລົດ​ເຂັນ​ທີ່​ບ�່​ຕອບ​ສະ​ໜອງ​ຄວາມ​ຕ້ອງ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ ​ກະ​ລຸ​ນາ​ເພີ່ມ​ຂ�້​ມູນ​ອື່ນໆໃດ​ໜຶ່ງ​ກ່ຽວ​ກັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ທີ່​ທ່ານ​ຄິດ​ວ່າ​ສ�າ​ຄັນ​ຕ�່​ການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​ເພື່ອ​ຮູ້: ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້ຕົກ​ລົງ​ເຫັນ​ດີ​ໃຫ້​ນ�າ​ສົ່ງ​ເຂົາ​ເຈົ້າ​ຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​ບ�? ​ແມ່ນ​ ​ ​ ​ບ�່​ ​ລາຍ​ເຊັນ​ຂອງ​ຜູ້​ນ�າ​ສ່ົງ: ວັນ​ທີ: 3 4 ​ແບບຟອມການນໍາສ່ົງຫາການ​ບໍ​ລິ​ການ​ລົດ​ເຂັນ​​ (​ປານ​ກາງ)​​ ແບບ​ຟອມ​ການນ�າສົງ່​ຕົວ​ຢາ່ງ:​ແບບ​ຟອມ​ນີ້ສາ​ມາດ​ນ�າ​ໄປ​ປັບ​ໃຊ້​ໂດຍ​ການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ​ ແລະ​ສົງ່ໃຫແ້ຫຼງ່ການນ�າສົງ່​ເພ່ືອ​ຊວ່​ຍ​ພວກ​ເຂາົ​ນ�າສົງ່ຜູໃ້ຊລ້ົດເຂນັຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ. ​ກະ​ລຸ​ນາ​ປະ​ກອບ​ແບບ​ຟອມ​ການນ�າສົງ່ໃຫ້​ສ�າ​ເລັດ​ແລະ​ສົງ່​ຫາ: (ຊື່​ແລະ​ທີ່​ຢູ່​ຂອງ​ຜູ້​ໃຫ້​ບ�​ລິ​ການ​ລົດ​ເຂນັ) ​ຊື່​ຜູ້​ນ�າ​ສົ່ງ: ​ອົງ​ການ​ທີ່​ທ່ານ​ເຮັດ​ວຽກ​ໃຫ້: ​ລາຍ​ລະ​ອຽດ​ການ​ຕິດ​ຕ�່​ຂອງຜູ້​ນ�າ​ສົ່ງ​(​ວິທີ​ທີ່​ດີ​ສຸດ​ໃນ​ການ​ຕິດ​ຕ�່​ຫາ​ທ່ານ): ​ຊື່​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ: ​ວັນ​ເດືອນ​ປີ​ເກີດ: ​ຊື່​ຂອງພ�່​ແມ່/ຜູ້​ດູ​ແລ: ​ທີ່​ຢູ່: ​ຈະສາ​ມາດ​ຕິດ​ຕ�່​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້​ແນວ​ໃດ? ​​​​​​​​​​​​​​ໄປ​ສະ​ນີ ​​ ​​​​​​ໂທ​ລະ​ສັບ​ຕົນ​ເອງ​ ​ ​​​​​​​​​​​​ໂທ​ລະ​ສັບ​ຂອງ​ເພື່ອນ/​ຂອງເພື່ອ​ນ​ບ້ານ​ ​ຖ້າ​ທາງ​ໂທ​ລະ​ສັບ,​​​ເບີ​ໂທ​ຂອງ​ເຂົາ​ເຈົ້າ​ແມ່ນ​ຫຍັງ: ​ຄວາມ​ພິ​ການ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ,​​ຖ້າ​ຮູ້: ​ເຫດ​ຜົນສ�າລັບ​ການ​ນ�າ​ສົ່ງ: •​ ​ບ�່​ມີ​ລົດ​ເຂັນ •​ ​ລົດ​ເຂັນ​ເພ •​ ​ມີ​ລົດ​ເຂັນ​ທີ່​ບ�່​ຕອບ​ສະ​ໜອງ​ຄວາມ​ຕ້ອງ​ການ​ຂອງ​ເຂົາ​ເຈົ້າ •​ ​ສ�າ​ລັບ​ເດັກ​ນ້ອຍ: o ​ບ�່​ສາ​ມາດ​ນັ່ງ​ຕັ້ງຊື່​ຫຼື​ບ�່​ສາ​ມາດຢືດຕົວຂຶ້ນ​ຢືນ​ໄດ້​ໂດຍ​ອາ​ຍຸ​1​ປີ; o ​ບ�່​ສາ​ມາດ​ຍ່າງ​ເອງໄດ້ເມື່ອ​ອາ​ຍຸ​2​ປີ. ​ກະ​ລຸ​ນາ​ເພີ່ມ​ຂ�້​ມູນ​ອື່ນໆໃດ​ໜຶ່ງ​ກ່ຽວ​ກັບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ທີ່​ທ່ານ​ຄິດ​ວ່າ​ສ�າ​ຄັນ​ຕ�່​ການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​ເພື່ອ​ຮູ້: ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ໄດ້ຕົກ​ລົງ​ເຫັນ​ດີ​ໃຫ້​ນ�າ​ສົ່ງ​ເຂົາ​ເຈົ້າ​ຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​ ບ�? ​ແມ່ນ​ ​ ​ ​ບ�່​ ​ລາຍ​ເຊັນ​ຂອງ​ຜູ້​ນ�າ​ສ່ົງ: ວັນ​ທີ: 5 6 ​ລາຍ​ຊ່ື​ຂອງ​ແບບ​ຟອມ​ການ​ບໍ​ລິ​ການ​ແລະ​ລາຍ​ ຊ່ືກ​ານກວດ​ສອບ ​ໝາຍ​ເຫດ:​​ແບບ​ຟອມ​ການ​ນ�າ​ສົງ່​ຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂນັ​ແມນ່​ລວມ​ຢູ່​ໃນ​ຄູ່​ມື​ສະ​ບັບ​ນີ້​ແລ້ວ.​ ສາມາດ​ເບິງ່ທຸກ​ແບບ​ຟອມ​ອືນ່​ໃນ​ຊຸດ​ຝຶກ​ອົບຮມົລະດັບ​ພ້ືນຖານ​​ແລະ​ລະ​ດັບ​ປານ​ກາງຂອງ​ WSTP​​ຢູ່​ໃນ​Pen​Drive. ການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ພ້ືນ​ຖານ 1.​​ແບບ​ຟອມ​ການນ�າ​ສົ່ງ​ຫາການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​(​ພື້​ນ​ຖານ) 2.​​ແບບ​ຟອມ​ການ​ປະ​ເມີນ​ຜົນ​ລົດ​ເຂັນລະດັບ​ພ້ືນຖານ 3.​​ແບບ​ຟອມ​ການ​ກ�າ​ນົດ​ໃຊ້​(​ການ​ເລືອກ)​​ລົດ​ເຂັນລະດັບ​ພ້ືນຖານ 4.​ແບບ​ຟອມ​ສັງ​ລວມ​ລົດ​ເຂັນລະດັບ​ພ້ືນຖານ 5.​ລາຍ​ການກວດ​ສ�າລັບ​ການ​ປັບ​ລົດ​ເຂັນ​ໃຫ້​ເໝາະ​ສົມ​ລະດັບ​ພ້ືນຖານ 6.​ລາຍ​ການກວດ​ຄວາມ​ປອດ​ໄພ​ແລະ​ຄວາມ​ພ້ອມຂອງລົດ​ເຂັນ* 7.​​ແບບ​ຟອມ​ການຕິດ​ຕາມຜົນ​ລົດ​ເຂັນ* ​ການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ປານ​ກາງ 8.​​ແບບ​ຟອມ​ການນ�າ​ສົ່ງ​ຫາ​ການ​ບ�​ລິ​ການ​ລົດ​ເຂັນ​(​ປານ​ກາງ) 9.​​ແບບ​ຟອມ​ການ​ປະ​ເມີນ​ຜົນ​ລົດ​ເຂັນ​ລະ​ດັບ​ປານ​ກາງ 10.​ ​ແບບ​ຟອມ​ການ​ກ�າ​ນົດ​ໃຊ້​(ການ​ເລືອກ)​ລົດ​ເຂັນ​ລະ​ດັບ​ປານ​ກາງ 11.​ ​ແບບ​ຟອມ​ສັງ​ລວມ​ລົດ​ເຂັນ​ລະ​ດັບ​ປ​ານ​ກາງ 12.​ ​ລາຍ​ກາ​ນກວ​ດ​ສ�າລັບ​ກາ​ນປັບ​ລົດ​ເຂັນ​ໃຫ້​ເໝາະ​ສົມ​ລະ​ດັບ​ປານ​ກາງ 13.​ ​ລາຍ​ການກວດ​ສ�າລັບການ​ຝຶກ​ອົບ​ຮົບ​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ລະ​ດັບ​ປານ​ກາງ 14.​ ​ຕາ​ຕະ​ລາງ​ອຸ​ປະ​ກອນ​ຮອງ​ຮັບ​ການ​ຊົງ​ຕົວ​(PSD) *​​ແບບ​ຟອມ​ແລະ​ລາຍ​ການກວດ​ແມ່ນ​ເໝາ​ະ​ສົມ​ສ�າ​ລັບ​ທັງ​ການ​ບ�​ລິ​ການ​ລະ​ດັບ​ພ້ື​ນ​ຖານ​ແລະ​ການ​ບ�​ລິ​ການລະ​ດັບ​ປານ​ກາງ 5 6 ​ການ​ເຮັດ​ກ່ອງ​ປະ​ເມີນ​ຜົນ ຄໍາ​ແນະ​ນໍາ​ສໍາ​ລັບການ​ເຮັດ​ກ່ອງ​ປະ​ເມີນ​ຜົນ 1.​ ​ຕັດໄມ້​ອັດ​ທັງ​ໝົດ​ໃຫ້​ສະ​ເໝີ​ທີ່​18​​ມມ.​​ຖ້າ​ບ�່​ມີ​ໃຫ້​ໃຊ້​ 15​​ມມ​ຫຼື​20​ມມ. 2.​​ແນວ​ຮອງ​ຕີນ​ທີ່​ສາມາດ​ປັບ​ຄວາມ​ສູງ​ໄດ້​ຄວນ​ເລື່ອນ​ເຂົ້າ​ ແລະ​ອອກ​ໄດ້​ຢ່າງ​ງ່າຍດາຍ​ລະຫວ່າງ​ລາງ​. 3.​ພື້ນ​ບ່ອນ​ນັ່ງ​​ແລະ​ພ້ືນ​ແນວ​ຮອງ​ຕີນ​ຄວນ​ປົກ​ຫຸ້ມ​ດ້ວຍ​ ໂຟມໜາ​5-10​ມມ​(EVA),​ຫຼື​ເບາະ​ຮອງ​ທີ່​ຈັບ​ແໜ້ນທີ່​ ຄ້າຍຄື​ກັບປະ​ເພດ​ທີ່​ໃຊ້​ຢູ່​ເທິງ​ແນວ​ຮອງ​ຕີນ​ຂອງ​ລົດ​ເຂັນບາງ​ ຊະນິດ. ​ກ່ອງ​ປະ​ເມີນ​ຜົນ​ທີ່​ເຮັດ​ຢູ່​ໃນ​ທ້ອ​ງ​ຖິ່ນ Hardwood rails, glued & screwed to plywood side. 45° cut on inside corner Rounded corners Back Adjustable height footrest should slide easily in and out, and be able to be tted in any of the height positions 5–10 mm EVA foam glued to 18mm plywood 4 pieces 25 mm x 50 mm x 420 mm hardwood glued and screwed to plywood sides ຮາວຈບັທີເ່ປນັໄມເ້ນືອ້ແຂງ,​ຕດິກາວ​ ແລະຫນັນອັດຕດິໃສດ່າ້ນຂາ້ງໄມອ້ດັ.​ຕດັເປນັມມຸ​°45 ຢູແ່ຈດາ້ນໃນ ດາ້ນຫຼງັ ມມຸມນົ ບອ່ນວາງຕີນທີປ່ບັຄວາມສູງໄດຄ້ວ ນເລືອ່ນເຂົາ້​ ແລະອອກໄດຢ້າ່ງງາ່ຍດາຍ,​ແລະ​ ສາມາດປບັໃຫພ້�ດກີບັຄວາມສງູທກຸ ຈດຸໄດ້ ໂຟມ​EVA​10–5​ມມ​ ຕດິກາວໃສກ່ບັໄມອ້ດັ​18​ມມ ໄມເ້ນືອ້ແຂງ​4​ແຜ່ນ​ຂະໜາດ​25​ມມ​x​50 ມມ​x​420​ມມ​ຕດິກາວ​ແລະ​ ຫນັນອັດຕດິໃສດ່າ້ນຂາ້ງໄມອ້ດັ 7 8 ຂະ​ໜາດ​ກ່ອງ​ປະ​ເມີນ​ຜົນ 450​ມມ 18​ມມ 650​ມມ ​ດາ້ນ​ເທງິ 45 0​ ມມ 45 0​ ມມ 36 0​ ມມ 42 0​ ມມ 18 ​ມ ມ 18 ​ມ ມ 10 ​ມ 25​ມມ 450​ມມ 430​ມມ ​ແນວ​ວາ່ງ​ຕີນ​ທີ​່ປບັ​ຄວາມ​ສງູ​ໄດ້ ​ໄມ​້ອດັ​18​ມມ 200​ມມ ​ດາ້ນ​ໜາ້ ໄມ​້ແຂງ​ຍາວ​20​ທອ່ນ 20​ມມ​x​20​ມມ x​430​ມມ 20 ​ມ ມ 20 ​ມ ມ ​ດາ້ນ​ຂາ້ງ 50​ມມ 7 8 ການ​ເຮັດຕຽງປະ​ເມີນ​ຜົນ ຕຽງ​ປະ​ເມນີ​ຜົນ​ຈະ​ຊວ່ຍ​ໃຫ້​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ນັງ່​ສະ​ບາຍ​ໃນ​ຕ�າ​ແໜງ່​ບ່ອນ​ທີ່​ແພດ​ຈະ​ສາ​ມາດ​ເຮດັ​ ການ​ປະ​ເມນີ​ຜົນ​ໄດ້​ດີ​ສ�າ​ລັບ​ການ​ກ�າ​ນົດ​ໃຊ້​ລົດ​ເຂນັ. ຕຽງ​ປະ​ເມນີ​ຜົນ​ຄວນ​ມີ​ຄວາມ​ໝັນ້​ຄງົ,​​ປອດ​ໄພ,​​ແລະ​ມີ​ຄວາມ​ສູງ​ທີ່​ເໝາະ​ສມົ​ສ�າ​ລັບ​ການ​ຍາ້ຍ​ ຈາກ​ລົດ​ເຂນັ. ​ຂະ​ໜາດ ຄວາມ​ຍາວ​ປະ​ມານ​1800​ມມ​x​​ຄວາມ​ກ້​ວາງ​600​ມມ​x​​ຄວາມ​ສູງ500​ມມ​​ສ�າ​ລັບ​ການ​ປະ​ເມີນ​ຜົນ​ທີ່​ກ່ຽວ​ ຂ້ອງ​ກັບ​ລົດ​ເຂັນ​ປົກ​ກະ​ຕິ. ​ວັດ​ສະ​ດຸ​ແລະ​ການ​ກ່ໍ​ສ້າງ •​ ​ໂຄງ​ປະກອບ​ສາ​ມາດ​ເຮັດ​ຈາກ​ໄມ້​ຫຼື​ເຫຼັກ​ •​ ​ເບາະ​ນັ່ງ: o ​ພື້ນ​ໄມ້​ອັດ​13​ມມ o ຄວາມ​ໜາ​ຂອງ​ໂຟມ​ຊິບ​50​ມມ o ​ຊັ້ນ​ເທິງ​ຂອງ​ໂຟມ​ທີ່​ອ່ອນ​ນຸ້ມ​25​ມມ. •​ ​ຄວນ​ຫຸ້ມເບາະ​ນັ່ງ​ດ້ວຍ​ຜ້າ​ທີ່​ອະນາ​ໄມ​ໄດ້​ງ່າຍ​​ເຊັ່ນ​ວ່າ​ໜັງ​ທຽມ​(Rexene)​ຫຼື​ໜັງສັດ.​ຄວນ​ຕັດໜັງທຽມ/​ ໜັງ​ສັດ​ໃຫ້​ເປັນ​ຮູບ​ຮ່າງ,​​ພັບ,​ຕິດ​ກາວ​ແລະ​ຍິ​ບ​ຕິດ​​ຫຼື​ຕິດ​ໃສ່​ໄມ້​ອັດ​ເພ່ືອ​ໃຫ້​ມັນ​ເຂົ້າ​ທີ່. •​ ທາ​ສີ​ຮອງ​ພ້ືນ​ກັນ​ໝ້ຽງ​ໃຫ້​ໂຄງ​ເຫຼັກ​​ແລະ​ສີ​ປົກ​ໜ້າ​ດ້ວຍ​ສີ​ພ່ົນ. 9 10 ​ການ​ເຮັດ​ແນວ​ກ້ັນ​ຕີນ ​ແນວ​ກັນ້​ຕນີ​ຮອງ​ຮບັ​ຕນີ​ຂອງຜູ້​ໃຊ້​ລົດ​ເຂນັ​ຢູ່​ໃນ​ຄວາມ​ສງູ​ທີ່​ເໝາະ​ສມົ​ໃນ​ລະ​ຫວາ່ງ​ການ​ປະ​ເມນີ​ ຜົນ,​​ເພ່ືອ​ໃຫ້​ພວກ​ເຂາົ​ຢູ່​ໃນ​ທາ່​ນັງ່​ທີ່​ດ.ີ ​ເພ່ືອ​ໃຫ້​ຕນີ​ຂອງ​ຜູ້​ໃຊ້​ລົດ​ເຂນັຢູ່​ໃນ​ຕ�າ​ແໜງ່​ທີ່​ຖືກ​ຕ້ອງ,​​ມນັ​ທີ່​ສ�າ​ຄນັ​ວາ່​ຕ້ອງ​ມີ​ແນວ​ກັນ້​ຕນີ​ຈ�ານວນ​ ໜຶງ່​ທີ່​ມີ​ຄວາມ​ສງູ​ແຕກ​ຕາ່ງ​ກນັ,​ຫຼື​ແນວ​ກັນ້​ຕນີ​ນັນ້​ສາ​ມາດ​ປັບ​ໄດ.້ ​ຂະ​ໜາດ ​ບ�​ລິ​ເວນ​ພ້ືນ:​400​ມມ​x​300​ມມ. ​ຄວາມ​ສູງ:​​ແຕກ​ຕ່າງ​ກັນ​ແຕ່​15-150​ມມ. ​ວັດ​ສະ​ດຸ​ແລະ​ການ​ກ່ໍ​ສ້າງ •​ ​ແນວ​ກັ້ນ​ທີ່​ມີ​ຄວາມ​ສູງ​ແຕກ​ຕ່າງ​ກັນ​ສາ​ມາດ​ກອງຊ້ອນ​ກັນ​ໄດ້,​ຫຼື​​ໃຊ້ແນວ​ກັ້ນ​ແບບ​ປັບ​ໄດ້. •​ ​ການສ້າງ​ໄມ້​ອັດ. •​ ສ�າລັບ​ຜູ້​ໃຊ້​ທີ່​ມີ​ສະພາບ​ຮ່າງ​ກາຍ​ທີ່​ສົ່ງຜົນ​ໃຫ້​ມີ​ພື້ນ​ຕີນ​ບ�່​ສະ​ເໝີ​ກັນ​(ບ�່​ວ່າ​ຈະ​ເປັນ​ຍ້ອນ​ຂາ​ຍາວ​ບ�່​ເທົ່າ​ກັນ​ ຫຼືບາງ​ບັນຫາ​ອື່ນ​ກ�່ຕາມ),​ຈ�າ​ເປັນ​ຕ້ອງ​ໃຊ້​ແນວ​ກັ້ນທີ່​ມີ​ຄວາມ​ສູງ​ແຕກ​ຕ່າງ​ກັນ. ​ການ​ກອງຊ້ອນ​ແນວ​ກັ້ນ​ຕີນລະດັບ​ພື້ນຖານ 9 10 ​ຕົວ​ຢ່າງ​ຂອງ​ເຄ່ືອງວັດ​ແທກ ​ເຄ່ືອງ​ວັດ​ເສ້ັນ​ຜ່າ​ສູນ​ກາງ ​ເຄ່ືອງ​ມື​ວັດ​ແທກ​ໄມ້ ​ວັດ​ສະ​ດຸ:​​ໄມ້​ອັດ​3-9​​ມມ. ພື້ນ​ໄມ້​ທີ່​ມີ​ເຄື່ອງ​ໝາຍ​ການ​ວັດ​ແທກ​ແລະ​ແຜ່ນຕິດ​Velcro​​ເພ່ືອ​ຮັກ​ສາ​ດ້ານ​ປັບ​ໄດ້​ໃຫ້​ໝັ້ນຄົງ. ​ດ້ານ​ຂ້າງ​ຂອງ​ໄມ້:​ຂ້າງ​ໜຶ່ງ​ຄົງ​ທີ່​ແລະ​ຂ້າງ​ອື່ນ​ສາ​ມາດ​ປັບໄດ້. ​ເຄ່ືອງ​ມື​ວັດ​ແທກໄວນີ​ນ ​ພື້ນ​ໄວ​ນີນ​ທີ່​ມີ​ເຄື່ອງ​ໝາຍ​ການ​ວັດ​ແທກ. ​ດ້ານ​ຂ້າງ​ຂອງ​ໄມ້:​ຂ້າງ​ໜຶ່ງ​ຄົງ​ທີ່​ແລະ​ຂ້າງ​ອື່ນ​ສາ​ມາດ​ປັບໄດ້. 11 12 ​ຄູ່​ມື​ແນະນໍາ​ສ່ິງ​ອໍາ​ນວຍ​ຄວາມ​ສະ​ດວກ​ດ້ານ​ເຕັກ​ນິກ:​​ ໂຕະ​ເຮັດ​ວຽກ​ຂອງ​ຊ່າງ​ແລະ​ພ້ືນ​ທ່ີ​ເຮັດ​ວຽກ​ຢູ່​ພ້ືນ​ດິນ ​ໂຕະ​ເຮດັ​ວຽກຂອງຊາ່ງ ​ຄວາມ​ເລີກ​ຂອງ​ພື້ນ​ທີ່​ເຮັດ​ວຽກ​ຂອງ​ ຊ່າງ​ແມ່ນ​1500​ມມ ​ຄວາມກວ້າງ​ຂອງ​ໂຕະ​ເຮັດ​ວຽກ​ຂອງຊ່າງ​ແລະ​ພື້ນ​ ທີ່​ການ​ເຮັດ​ວຽກ​ຂອງ​ຊ່າງ​ແມ່ນ​1500​​ມມ ​ຄວາມ​ເລີກ​ຂອງ​ໂຕະ​ ເຮັດ​ວຽກ​ຂອງ​ຊ່າງ​ ​ແມ່ນ​750​ມມ ​ລວມ 2250​ມມ ​ພືນ້​ທີ່​ການ​ເຮດັ​ວຽກ​ ຂອງ​ຊາ່ງ 11 12 ​ຄູ່​ມື​ແນະນໍາ​ຊັ​ບ​ພະ​ຍາ​ກອນ​ດ້ານ​ ເຕັກນິກຂອງການ​ບໍ​ລິ​ການລະດັບ​ພ້ືນຖານ ​ເຄື່ອງ​ມື​ທີ່​ລະ​ບຸຢູ່​ຂາ້ງ​ລຸມ່​ນີ້​ແມນ່​ສ�າ​ລັບ​ການ​ປະ​ກອບ,​​ຕິດ​ຕັງ້,​​ປັບ​ແຕງ່,​​ບ�າ​ລງຸ​ຮກັ​ສາ​​ແລະ​ ການ​ສ້ອມ​ແປງ​ບວກ​ກັບ​ການ​ດັດ​ແປງ​ພ້ືນຖານຂອງ​ຜະ​ລິດ​ຕະ​ພັນ​(​ຕາມ​ທີ່​ເວົາ້​ເຖງິຢູ່​ ໃນຫຼັກ​ສູດ​ການ​ຝຶກ​ອົບ​ຮບົຂັນ້​ພ້ືນຖານ​ຂອງ​WSTP). ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ຊຸດ​ກະ​ແຈ​ເລື່ອນ​ທີ່​ລວມມີ​ເຄື່ອງ​ວັດ​ ແທກ 8​​ມມ​ຫາ​22​ມມ (​ຈະ​ຕ້ອງ​ລວມ​ມີ​ຂະ​ໜາດ​8,​10,​13,​19​ມມ) 2 ຊຸດ​ກະ​ແຈ​ເລື່ອນ​ທີ່​ລວມມີ​ລະບົບ​ວັດ​ ແທກ​ແລະ​ຊັ່ງ​ຕວງ 1 ຊຸດ​ລູກ​ກະ​ແຈ​Allen​ສ�າລັບ​ວັດ​ແທກ ປະ​ເພດ​ກ້ານ​ຍາວ​ດີ​ທີ່​ສຸດ​– ​ໃຫ້​ດີ​ແທ້​ມີ​ດ້າມ​ຈັບ​ເປັນ​ທ່ອນ​ຮູບ​ ໂຕ​T​ 2 ສາຍ​ວັດ​ແທກໂລ​ຫະ ​ຄວາມ​ຍາວ​5​ແມັດ 1 ​ຊຸດ​ໄຂ​ຄວງ​ພິ​ລິບ ​ຂະ​ໜາດ​ໃຫ່​ຍ​ແລະ​ຂະ​ໜາດ​ກາງ 1 ​ຊຸດ​ໄຂ​ຄວງ​ຫົວແປ ​ຂະ​ໜາດ​ໃຫ່​ຍ​ແລະ​ຂະ​ໜາດ​ກາງ 1 ​ໄມ້​ຄ້ອນ​ຢາງ ​ຫົວ​8​ອອນ 1 ຄີມ​ ຫົວ​ສັ້ນ​ປານ​ກາງ 1 ສະ​ຫວ່ານ ປະ​ເພດ​“​ໃບ​ແບ​ນ”​ຂະໜາ​ດນ້ອຍ 1 ຊຸດ​ເຫຼັກ​ສະ​ໄບ​ໂລ​ຫະ​(ເຫຼັກ​ສະ​ໄບ​3​ ອັນ) ​ປະ​ເພດ:​​ເຫຼັກສະ​ໄບຕັດ​ສ�າຮອງ​ຂະໜາດ​ປານ​ກາງ,​​​ເຫຼັກສະ​ ໄບ​ແບບມົນ​ເຄິ່ງໜຶ່ງ,​​ເຫຼັກສະ​ໄບ​ແບບ​ແບນ 1 ​ເຄື່ອງ​ຕັດ​ທ�່​ຂະ​ໜາດ​ນ້ອຍ​ແລະ​ໃບ​ມີ​ ສ�າ​ຮອງ ​ການ​ຕັດ​ທ�່​ຈ​າກ​ຂະ​ໜາດ​12​ມມ​ຫາ​38​ມມ​ 1 ​ເລື່ອຍ​ສ�າ​ລັບ​ເລື່ອຍ​ໄມ້​ແບບ​ໃຊ້​ມື ເລື່ອຍ​“​ຕັດ’’​​ໄມ້​(ບ�່​ແມ່ນ​ເລື່ອຍ​ແຂ້ວ​ໃຫຍ່)​ 1 ​ເລື່ອຍ​ຕັດ​ເຫຼັກ​ຂະ​ໜາດ​12”​ແລະ​ໃບ​ ມີດ ​ສ�າ​ລັບ​ຕັດ​ໂລ​ຫະ​ 1 ​ມີດ​ສ�າ​ລັບ​ຕັດ​ໂຟມ ​ໃບ​ມີດ​ແບບ​ມີ​ແຂ້ວ​ເລັກ​ນ້ອຍ​​ຫຼືມີດ​ປາດ​ເຂົ້າ​ຈີ່​ມາດຕະຖານ 1 ​ມີດ​ຄັດ​ເຕີ​ສ�າ​ລັບ​ຕັດ​ກ່ອງ​ແລະ​ໃບ​ມີດ​ ສ�າ​ຮອງ 1 ​ມີດ​ຕັດ​ໃຫຍ່ 1 ​ຊຸດ​ເຂັມ​ແລະ​ດ້າຍ ​ຊຸດເຂັມຂະໜາດ​ຕ່າງໆ,​ດ້າຍ​ໄນ​ລອນ​ທີ່ໝັ້ນ 1 ​ປ�້າ​ລົມ​ສ�າ​ລັບ​ສູບ​ຢາງ​ ​ສ�າ​ລັບ​ທັງ​ປະ​ເພດ​“Schrader”​​ແລະ​“Presta”​ຂອງ​ ວາວຢາງ​ລົດຖີບ​ 1 ​ຊຸດ​ຈອດ​ຢາງ​ລົດ​ທີ່​ມີ​ຄັນ​ໂຍກ 1 ​ປາກ​ກາ​ໝາຍ​ລະອຽດ 1 ຕົວ​ຂັນ​ຫົວ​ລວດ​(wrench) 1 13 14 ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ​ແວ່ນ​ຕາ​ນິ​ລະ​ໄພ 1 ​ຟອຍ​ທາ​ສີ 1 ​ຊຸດ​ທ�າ​ຄວາມ​ສະ​ອາດ ຄຸ​ແລະ​ຟອຍ​ທາ​ສີ 1 ເຄ່ືອງ​ມື​ໄຟ​ຟ້າ​ທ່ີ​ຕ້ອງການ​ໃຊ້ ​ເຄື່ອງ​ປັບ​ກະ​ແສ​ໄຟຟ້າ​ສ�າລັບ​ເຄື່ອງ​ຈັກ​ ໃນ​ໂຮງ​ສ້ອມ​ແປງ​​ແລະ​​ເຄື່ອງມື​ແບບ​ ໃຊ້​ມື* 1 ​ຈັກ​ຫຍິບ​– ​ແບບໃຊ້​ງານ​ໜັກ 1 ​ຊຸດ​ເຂັມ​ສ�າລັບ​ຈັກ​ຫຍິບ​ແບບ​ໃຊ້​ງານ​ ໜັກ 1 ​ສະ​ຫວ່ານ​ໄຟ​ຟ້າ ຫົວ​ໜີບ​ຂະໜາດ​3-13​ມມ,​ມີ​ຫຼາຍຄວາມ​ໄວ 1 ​ຊຸດດອກ​ສະ​ຫວ່ານ​ສ�າ​ລັບ​ເຈາະ​ໄມ້ 1 ​ຊຸດດອກ​ສະ​ຫວ່ານ​ສ�າ​ລັບ​ເຈາະ​ໂລ​ຫະ 1 ​ເລື່ອຍ​ຈິກ​ຊ�​ໄຟ​ຟ້າ 1 ​ຊຸດ​ໃບ​ມີດ​ຕັດ​ໄມ້​ແລະ​ໂລ​ຫະລະອຽດ 1 ​ເຄື່ອງ​ເຈຍມຸມ​ໄຟ​ຟ້າ 1 ​ຊຸດ​ແຜ່ນ​ເຈຍປານ​ກາງ​​ແລະ​ລະອຽດ 1 ສາຍ​ຕ�່​ໄຟ​ຟ້າ 10​ມ 2 ​ປັກ​ສຽບ​ແບບສາມ​ຮູ 1 ການ​ເກັບ​ມ້ຽນ ​ກ່ອງ​ເຄື່ອງ​ມື 1 ກະ​ແຈ 2 ​ຕູ້​ໂລ​ຫະ​ທີ່​ມີກະ​ແຈ 1 ວັດ​ສ​ະ​ດຸສ້ິນ​ເປືອງ ນ�້າມັນ​ຫຼ�່ລື່ນ ກາວຕິດ​ແໜ້ນ​ແບບສ�າ​ພັດ ​ກາວ​ຕິດ​ໄມ້​PVA​​ມາດ​ຕະ​ຖານ ສີ​ເຄືອບ​ເງົາ​ໄມ້​ພາຍນອກ ​ສີ​ເຄືອບ​ໂລ​ຫະ ​ສີທິນ​ເນີ​ ​ສະ​ບູ່ ​ຟອງ​ນ�້າ ​ເຄື່ອງ​ນຸ່ງ 13 14 ​ຄູ່​ມື​ແນະນໍາ​ຊັບ​ພະ​ຍາກອ​ນ​ດ້ານ​ ເຕັກນິກຂອງການ​ບໍ​ລິ​ການ​ລະ​ດັບ​ປານ​ກາງ ​ລາຍ​ການ​ທງັ​ໝົດ​ທີ່​ລະ​ບຸ​ຢູ່​ໃນ​ລາຍ​ການ​ຊບັ​ພະ​ຍາ​ກອນ​ດາ້ນ​ເຕັກນິກຂອງການ​ບ�​ລິ​ການ​ລະດັບ​ ພືນ້ຖານ​ແມນ່​ຍງັ​ຈ�າ​ເປັນ​ຕ້ອງ​ມີ​ສ�າ​ລັບ​ການ​ບ�​ລິ​ການ​ລະ​ດັບ​ປານ​ກາງ.​ນອກ​ຈາກ​ນີ,້​​ລາຍ​ການ​ທີ່​ ມີ​ເຄື່ອງ​ໝາຍ​*​​ປະກົດ​ມີ​ຢູ່​ໃນ​ລາຍ​ການ​ຊບັ​ພະ​ຍາ​ກອນ​ດາ້ນ​ເຕັກນິກຂອງການ​ບ�​ລິ​ການລະດັບ​ ພືນ້ຖານ​​ແລະ​ໄດ້​ຖືກໝາຍ​ໄວ້​ເພື່ອ​ຢນື​ຢນັ​ວາ່​ຊຸດ​ເພ່ີມ​ເຕມີ​ແມນ່​ຖືກ​ແນະ​ນ�າ​ສ�າ​ລັບ​ການ​ບ�​ລິ​ການ​ ລະ​ດັບ​ປານ​ກາງ. ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ​ລາຍ​ການ​ທ່ີ​ສໍາ​ຄັນ ​ເຄືອ່ງ​ປບັ​ກະ​ແສ​ໄຟຟາ້​ສ�າລບັ​ເຄືອ່ງ​ຈກັ​ໃນ​ ໂຮງ​ສອ້ມ​ແປງ​​ແລະ​​ເຄືອ່ງມ​ືແບບ​ໃຊ​້ມ*ື 1 ​ຈກັ​ຫຍບິ​ເຄືອ່ງ ​ແບບ​ໃຊ​້ງານ​ໜກັ​– ສາມາດ​ຫຍບິຜາ້​ແພໜກັ​ຖາ້​ຈ�າ​ເປນັ 1 ​ລາຍ​ການ​ທ່ີ​ຕ້ອງການ ​ເຄືອ່ງ​ຈອດ​Arc/​ເຄືອ່ງ​ຈອດ​Mig 1 ​ຄູ​່ຖງົ​ມ​ືປອ້ງ​ກນັ​ມ​ືໃນ​ການ​ເຊືອ່ມຈອດ ໜງັ​ໜາ–6” 1 ໜາ້​ກາກ​ປອ້ງ​ກນັ​ຕາ​ສ�າລບັ​ການ​ເຊືອ່ມ​ ຈອດ 2 ​ເຄືອ່ງ​ເຈຍ​ແບບ​ແປນ້​ມາ້ ລ�​້ລດົ​ສ�າລບັ​ພ້ືນ​ຮາບພຽງ​​ແລະ​ພ້ືນ​ບ�​່ລຽບ 1 ເຄືອ່ງ​ຂດັ​ກະ​ດາບ​ຊາຍ​ທີ​່ເປນັ​ແບບ​ສາຍ​ ພານ ທີມ່ສີິງ່​ອ�ານວຍ​ຄວາມ​ສະດວກ​ໃນ​ການ​ດດູ​ຝຸນ່ 1 ​ຊດຸ​ຂອງເຄືອ່ງ​ຂດັ​ກະ​ດາບ​ຊາຍ​ທີ​່ເປນັ​ແບບ​ ສາຍ​ພານ ລະດບັ​ພືນ້​ບ�​່ລຽບ​​ແລະ​ຮາບ​ພຽງ​ດີ 1 ​ເລືອ່ຍ​ແບບ​ສາຍພານ​(Band​saw) ​ຂະ​ໜາດ​ກາງ​ສ�າ​ລບັ​ໄມ,້​​ໄມ​້ອດັ,​​ໂຟມ​PU​​ແລະ​EVA 1 ​ຈກັ​ລມົ 24​ລດິ 1 ຊດຸ​ປນື​ສະ​ເປ​ທີ​່ມ​ີທ�່ 1 ຊດຸ​ເຊືອ່ມ​ດວ້ຍ​ແກສັ ​ເຕົາ້ຈ​ອດທີ​່ມ​ີຫວົ​ຈອດ,​ຕວົ​ປບັ​​ແລະ​ສາຍ​ຈອດ​ຂະໜາດ​ຕາ່ງໆ 1 ​ໜາ້​ກາ​ກປອ້ງ​ກນັ​ຕາ​ສ�າລບັ​ການ​ເຊືອ່ມ​ 1 ສ​ະຫວາ່ນ​ເຈາະ​ແບບ​ມ​ີເສາົ​ຕັງ້​(ຂະໜາດ​ ຫວົເຈາະ​3-13) ຢນື​ເທງິ​ຕັງ່​ຍາວ​ຫຼຢືນື​ເທງິພືນ້ ​ໂດຍ​ມ​ີເຄືອ່ງໜບີ​ສະ​ຫວາ່ນ​(ມ​ີພືນ້​ແບບ​ໝນູ​ຢູ​່ເທງິ​ເຄືອ່ງ​ໜບີ​ສະ​ ຫວາ່​ນຫາຼຍທດິ​ທາງ) 1 ​ເຄ່ືອງ​ມື​ໄຟ​ຟ້າ​ ​ລາຍ​ການ​ທ່ີ​ສໍາ​ຄັນ 15 16 ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ສະຫວາ່ນໄຟຟາ້ທີໃ່ຊມ້ຖືື (ຂະໜາດ​ຫວົ​ເຈາະ​3-13​ມມ) ການຕັງ້ຄາ່ຄວາມໄວທີຫ່າຼກຫາຼຍ​ແລະ​ ແຮງບດິທີຫ່າຼກຫາຼຍແມນ່ເປນັປະໂຫຍດ 1 ເລືອ່ຍຈກິຊ�ໄຟຟາ້ທີໃ່ຊມ້ື 1 ເຄືອ່ງເຈຍມມຸ 1 ຊດຸແຜນ່ເຈຍ ​ແຜ່ນ​ທີ​່ຫຍາບ​​ແລະ​ລະອຽດ​ດີ 1 ຖງົ​ມ​ືປອ້ງ​ກນັ​ມ​ືຈາກ​ເຄືອ່ງ​ເຈຍ 1 ​ສາຍ​ຕ�​່ໄຟຟາ້* 5​ມ​ຫຼ​ື10​ມ 2 ​ລາຍ​ການ​ທ່ີ​ຕ້ອງການ ​ເຫຼກັໄຂຄວງໄຟຟາ້ ແບບບ�ມ່ສີາຍ,​ພ້ອມຊດຸ​ໂຕ​ລະບດິ,​ປກັ​ສຽບ​ໄຟ​​ແລະ​ກະ​ແຈ​Allen​ ຂະໜາດ​ຕ່າງໆ 1 ​ສ​ະຫວາ່ນ​ໄຟຟາ້​ໄຮ​້ສາຍແບບ​ພົກ​ພາ​ (ຂະໜາດ​ຫວົ​ເຈາະ​3-13​ມມ)​18V ການຕັງ້ຄາ່ຄວາມໄວທີຫ່າຼກຫາຼຍ​ແລະ​ ແຮງບດິທີຫ່າຼກຫາຼຍແມນ່ເປນັປະໂຫຍດ 1 ເລືອ່ຍ​ວງົ​ເດອືນ​(​ໃບ​ມດີ​ຕ�າ່​ສດຸ​185​ມມ) 1 ການ​ຈອດ​ເຫຼກັ ປາຍ​ແຫມຼສ�າລບັ​ການ​ເຈາະ​ຮ​ູໃນ​ສາຍຮດັ​​ແລະ​ປາຍພຽງ​ສ�າລບັ​ ການອດັ​ສ້ົນ​ສາຍຮດັ​ທີ​່ຖກື​ຕັດ 1 ເຄ່ືອງ​ມື​ຊ່າງ​ ​ລາຍ​ການ​ທ່ີ​ສໍາ​ຄັນ ​ເລືອ່ຍໆ​ໄມ​້ທີ​່ໃຊ​້ມ​ືເລືອ່ຍ​(​ທົວ່​ໄປ) 22”,​​ແຂວ້​ຕດັລະອຽດ 1 ​ເລືອ່ຍ​ຮບູ​ໂຕ​ຢ​ູ​ແລະ​ຊດຸ​ໃບ​ເລືອ່ຍ ຕດັ​ລະອຽດ​ສ�າລບັ​ໄມ້ 1 ຊດຸ​ເຫຼກັ​ເຈາະ​Spade​bit​ 1 ເ​ຫຼກັ​ເຈາະ​Countersink​bit 1 ມດີຕດັ​(ທີ​່ມ​ີນອັດຈບັ) ​ຕັງ່​ຍາວ​ຕດິ 1 Bench​vice​(ທີ​່ມ​ີນອັດຈບັ)* 6” 2 ຄມີ ​ຫວົ​ຍາວ​– ປານ​ກາງ 1 ​ຄມີ​ລອັກ​(ຄມີ​ຈບັ​ແໜນ້) ​ຫວົ​ນັນ້​– ປານ​ກາງ 2 ​ຄມີ​ລອັກ​(ຄມີ​ຈບັ​ແໜນ້) ​ຫວົ​ຍາວ​– ປານ​ກາງ 2 ​ເຫຼກັໜ​ີໂຕ​C ປອ່ງ​6” 2 ​ເຫຼກັໜ​ີໂຕ​C ປອ່ງ​8” 2 ຊດຸ​ເຄືອ່ງ​ຕອກ​ຕາ​ໄກ​່​ແລະ​ຕາ​ໄກ່ ຫາຼຍ​ຂະ​ໜາດ 1 ປນື​ຍງິ​ເຫຼກັຫຍບິ​(ສ�າລບັ​ໄມ)້ 1 ປນື​Rivet​(pop​riveter) 1 15 16 ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ​ໄມ​້ບນັ​ທດັ​ເຫຼກັ* 1​​ແມດັ​(ວດັ​ແທກ​​ແລະ​ຊັງ່​ຕວງ) 1 ​ໄມ​້ບນັ​ທດັ​ເຫຼກັ 30​​ຊງັ​ຕ​ີແມດັ 2 ​ກ�​້ສາຍ​ວດັ​ແທກ​ທີ​່ເປນັ​ໂລຫະ*​ 5​​ແມດັ 1 ​ເຄືອ່ງ​ວດັ​ໄລຍະ​ຄາ​ລບິ​ເປີ ຄວາມ​ກວາ້ງ​ປາກ​ຄມີ​150​ມມ 1 ​ໄມ​້ໂປຣ​ແທຣກັ​ເຕ​ີໂລ​ຫະ​ 1-180​​ອງົ​ສາ​(​ຄວາມ​ຖກື​ຕອ້ງ1-​ອງົ​ສາ) 1 ​ເຄືອ່ງ​ຈະ​ຮ​ູກາງ 2 ສະ​ໄຄ​ຣ​(Scribe) 2 ​ເຫຼກັຊ​ີນອ້ຍ* ​ມ​ີປະ​ໂຫຍດ​ໃນ​ເວລາເຈາະ​ຫຼ​ື​ເມືອ່​ບ�​່ມ​ີໄຟຟາ້ 1 ​ແຜ່ນ​ສ່ີຫຼຽ່ມສ�າລບັຊາ່ງ​ໄມ້ ​ເຫຼກັ​600​​ມມ​x​400​ມມ 1 ​ກະ​ແຈ​ປາກ​ເລືອ່ນ​ທີ​່ປບັ​ໄດ້​ ປອ່ງ​ກວາ້ງ​ສດຸ​1” 1 ຊດຸ​ປກັ​ສຽບ ວດັ​ແທກ​(ລວມທງັ​ຂະໜາດ​8,​10,​13,​17,​19​ມມ) 1 ​ເຫຼກັງັດ​ລ�​້ລດົ* ​ຊດຸ​4​ອນັ 1 Spoke​key* 1 ​ແວນ່​ຕາ​ນ​ິລະ​ໄພ* ການ​ປກົ​ປອ້ງ​ຕາ​ທົວ່​ໄປ​ຢູໃ່ນ​ໂຮງ​ສ​້ອມ​ແປງ 4 ​ເຄືອ່ງ​ອດັ​ຫູ 2 ​ໜາ້​ກາກ​ປອ້ງ​ກນັ​ຝຸນ່ 4 ​ເຫຼກັ​ສະ​ໄບ​ຖ​ູໄມ​້ຊະ​ນດິ​ແປ​ ​ຂະ​ໜາດ​ກາງ​ 1 ຊດຸເຫຼກັສະໄບຖໄູມ້ 1 ຊດຸເຫຼກັສະໄບແບບມນົເຄິງ່ໜຶງ່​(ສ�າລບັໄມ)້ 1 ​ລາຍ​ການ​ທ່ີ​ຕ້ອງການ ​ຊດຸ​ປກັ​ສຽບ ອມິພີຣຽວ 1 ຊດຸຄມີປາກເລືອ່ນ* ອມິພີຣຽວ​¼–1½ 1 ຊດຸກະແຈ​Allen​(ຮບູໂຕ​L) ອມິພີຣຽວ 1 ຂບົເສາະໄມ້ 1 ເຄືອ່ງວດັແທກ​(Combination​square) 1 ເຄືອ່ງແທກມມູແບບປບັໄດ້ 1 ແຜ່ນສ່ີຫຼຽ່ມນອ້ຍ 10” 1 ສ່ິງຂອງທ່ົວໄປໃນໂຮງສ້ອມແປງ​ ຖງັຂີເ້ຫຍືອ້ 3 ຝອຍປດັພ້ືນ 1 ແນວຊວ້ານຝຸນ່​ແລະຝອຍປດັ 1 17 18 ເຄ່ືອງ​ມື ​ລາຍ​ລະ​ອຽດ ​ຈໍາ​ນວນ ​ການ​ທ�າ​ຄວາມ​ສະ​ອາດ​ເຄືອ່ງ​ນຸງ່ 1 ຄອຸະນາໄມ​ແລະຟອງນ�າ້ສ�າລບັໂຮງສອ້ມ​ ແປງ 2 ​ເຟີ​ນີ​ເຈີ​​ແລະ​ບ່ອນ​ເກັບມ້ຽນ​ທ່ີ​ປອດ​ໄພ​ສໍາລັບ​ໂຮງ​ສ້ອມ​ແປງ​ ​ການ​ລອັກຕູ​້ໂລ​ຫະ​ສ�າ​ລບັ​ເຄືອ່ງ​ມ*ື 2 ​ການ​ລອັກຕູ​້ສ�າ​ລບັ​ວດັ​ສະ​ດຸ 2 ​ຕູ​້ເປດີສ�າ​ລບັ​ໃຊ​້ງານ​ທົວ່​ໄປ 1 ຕູ​້ເປດີສ�າ​ລບັ​ສວ່ນ​ປະ​ກອບ​PSD 1 ​ຕັງ່ 3 ​ໂຕະ​ນັງ່​ເຮດັ​ວຽກ​ຂອງ​ຊາ່ງ* 3 ​ລີນ້​ຊກັ 2 ຮາວ​ຕາກ​ແຫງ້​ ​ສ�າ​ລບັ​ສວ່ນ​ທີ​່ທາ​ສ​ີຫຼ​ືຂດັ​ເງາົ 1 ວັດ​ສ​ະ​ດຸສ້ິນ​ເປືອງ​ ​ສ​ີທາ​ຮອງ​ພ້ືນ ​ສ​ີທາ​ໄມ​້ພາຍນອກ ​ສ​ີທາ​ກນັ​ດາ້ນ​ເທງິ ​ສ​ີທາ​ໄມ​້ພາຍນອກ ສ​ີເຄອືບ​ເງົາ ຊັນ້​ພາຍ​ນອກ ​ເຫຼົາ້ຂາວ* ສ�າລບັ​ການ​ອະນາ​ໄມ​ຝອຍ​ທາສ​ີ​ແລະ​ປນື​ສດີ​ພ່ົນ ສທີາ/ສ​ີເຄອືບ​ເງົາ/ກະປອ໋ງກາວ ກະດາ​ດຊາຍ ​ເບ​ີ40,​80​​ແລະ​150 ສ�​ຂຽນ​ຜາ້ ນ�າ້ມນັກາ​ແລດັ ຊດຸ​ທອ່ນ​ເຊືອ່ມ​ ຫາຼຍ​ຂະ​ໜາດ ຟລກັ​ສ�າລບັ​ເຊືອ່ມ​ ​ໃ​ບມດີ​ຈກິ​ຊ� ຊດຸ​ໃບ​ມ​ີດ​(ການ​ຕດັ​ລະອຽດ)​ສ�າລບັ​ໄມ,້​​ໂລຫະ​​ແລະ​ປລດັ​ ສະຕກິ​ ​ເຫຼກັຫຍບິ​ເຈຍ້ ຄວາມ​ເລກິ​5​ມມ​ຫາ​8​ມມ ​ເຂມັ​ຫຍບິ​ ຫາຼຍ​ຂະ​ໜາດ ​ທອ່ນ​ເຊືອ່ມ​ຈອດ​Arc​ສ�າລບັ​ຈອດ​ໂລຫະ ​ຂະໜາດ:​2​ມມ,​4​ມມ,​6​ມມ ຕາ​ໄກ່ ຫາຼຍ​ຂະ​ໜາດ ໝດຸ​ໂລຫະ​ສ�າລບັ​ຕອ​ກຢດຶ​ ​ເສັນ້​ຜາ່​ສນູ​ກາງ​4​ມມ​​ແລະ​6​ມມ​ ຄວາມ​ຂອງ​ໝຸດຕອກ​ຢດຶ 17 18 ​ການ​ກະ​ກຽມ​ໃບ​ເລ່ືອ​ຕັດ​ເຫັຼກ​ສໍາລັບ​ການຕັດ​ໂຟມ •​ ​ໃຊ້​ໃບ​ເລື່ອຍ​ຕັດ​ເຫຼັກທ�າ​ມະ​ດາ​(ດີ​ແທ້​ອນັ​ເກົາ່​ທີ່​ໃຊ້​ແລ້ວ)​​ແລະ​ຝົນ​ໃສ່​ຂອບແຂວ້​ເລື່ອຍ​ເພື່ອ​ໃຫ້​ ມີດ​ຄມົ​(ສ່ວນ​ຮບູ​ໂຕ​V). •​ ນີ​້ຈະ​ໃຫ​້ທາ່ນ​ມ​ີໃບ​ມີດ​ແຂວ້​ເລື່ອຍ​ທີ​່ຄມົ​ບາ​ງທີ​່ສາມາດ​ຕັດ​ໂຟມ​ໂປ​ລ​ີຢູຣ່​ີເທ​ນ​​ແລະ​ໂຟມຊ​ິບ ຄວາມ​ໜາ​ປານ​ກາງ​​ແລະ​ຕ�າ່​ໄດ້​ຢາ່ງ​ວ່ອງ​ໄວ​​ແລະ​ງາ່ຍ​ດາຍ. •​ ພນັ​ເທັບ​ອ້ອມ​ສົນ້​ໜຶງ່​ຂອງ​ໃບ​ເລື່ອຍ​ເພື່ອ​ເຮດັ​ເປັນ​ດາ້ມ​ຈບັ​​ແລະ​ປົກ​ປ້ອງ​ນີ້ວມື​ຂອງ​ທາ່ນ​ຈາກ​ໃບ​ມີດ. 19 20 ຄູ່​ມື​ແນະນໍາ​ການ​ບໍລິການ​ລະດັບ​ພ້ືນຖານ​​ແລະ​ ປານ​ກາງ​–​ວັດ​ສະດຸ ວັດ​ສ​ະດຸ​ສ�າລັບ​ການ​ດັດ​ແປງ​​ແລະ​ການປັບ​ແຕງ່​ອຸປະກອນ​ຮອງ​ຮບັທາ່​ທາງ​ຕາ່ງໆ​(PSDs)​ ຖືກ​ໃຊ້​ເລື້ອຍໆ​ກວາ່​ໃນ​ການ​ບ�ລິການ​ລະດັບ​ປານ​ກາງ.​​ແນວ​ໃດ​ກ�່ຕາມ,​ການ​ບ�ລິການ​ລະດັບ​ ພືນ້ຖານ​ອາດ​ຈະ​ດ�າ​ເນນີ​ການ​ດັດ​ແປງ​ທີ່​ງາ່ຍດາຍ​​ໂດຍ​ໃຊ້​ວັດ​ສະດຸ​ທີ່​ຄາ້ຍຄື​ກນັ​ກ�່​ໄດ.້​ຈ�ານວນ​ ວັດ​ສະດຸ​ທີ່​ຕ້ອງການ​ຈະ​ຂຶນ້​ກັບ​ຈ�ານວນ​ປັດ​ໃຈ​ຕາ່ງໆ​​ເຊິງ່ລວມມີ​ຈ�ານວນ​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ທີ່​ເຂົາ້​ ມາ​ໃຊ້​ກາ​ນບ�ລິການ,​ປະລມິານ​ການ​ໃຫ້ບ�ລິການ​ລົດ​ເຂນັ​ລະດັບ​ປານ​ກາງ​​ແລະ​ປະ​ເພດ​ລົດ​ ເຂນັ​ທີ່​ສະໜອງ​ໃຫ.້​​ພະນັກ​ງານ​ຝາ່ຍ​ປິ່ນປົວ​​ແລະ​ຝາ່ຍ​ເຕັກນິກ​ຄວນ​ເຂົາ້​ຮວ່ມ​ໃນ​ການ​ຊອກ​ ແຫຼງ່ສະໜອງວັດ​ສະດຸ​ທີ່​ເໝາະ​ສົມ. ​ວັດ​ສະດຸ ຖືກ​ໃຊ້​ສໍາລັບ​: ສ່ິງ​ທ່ີ​ຕ້ອງ​ຊອກ​ຫາ: ​ໂລຫະ/ປລັສຕິກ/​​ ໄມ້ ​ໂລຫະ/ປລັສຕິກ/​ໄມ້​ປະກອບ​ເປັນ​ ໂຄງ​ຮ່າງ​ຂອງ​ອຸປະກອນ​ຮອງ​ຮັບ​ ທ່າ​ທາງການ​ຊົງ​ຕົວ​– ຕົວຢ່າງ​ ບ່ອນ​ນັ່ງ​​ແລະ​​ແນວ​ອີງ​ຫຼັງທີ່​ ແຂງ. ​ໄມ້ອັດ​12​ມມ​​ເປັນ​ປະ​ໂຫຍ​ດຫຼາຍສ�າລັບ​ການ​ເຮັດ​ ບ່ອນ​ນັ່ງ​​ແລະ​ແນວ​ອີງ​ຫຼັງ​ແບບ​ແຂງ.​ມັນ​ແຂງ​​ແຕ່​ ຂ້ອນ​ຂ້າງ​ມີ​ນ�້າໜັກ​ເບົາ.​​ໄມ້ອັດ​ທະ​ເລ​ແມ່ນ​ຕົວ​ເລືອກ​ທີ່​ ທົນ​ທານ​ທີ່​ສຸດ​​ແຕ່​ມັນ​ສາມາດ​ມີ​ລາຄາ​ແພງ​. ອາ​ລູມີ​ນຽມ​3​ມມ​​ແລະ​​ແຜ່ນປລັສຕິກ​acrylic​ຫຼຶ​ ABS​ໜາ​6​ມມ,​ຖ້າ​ມີ,​ສາມາດ​ຖືກ​ໃຊ້​​ເພ່ືອ​ເຮັດ​ແນວ​ ຮອງ​ຫຼັງ​ແບບ​ແຂງ.​ການ​ເພ່ີມ​ແນວ​ພັບ​ໃນ​ແຜ່ນ​ສາມາດ​ ເພີ່ມ​ຄວາມ​ແຂງ​ຂຶ້ນ​ອີກ. ​ໃນ​ເວລາ​ໃຊ້​ວັດ​ສະດຸ​ທີ່​ເປັນ​ແຜ່ນ,​​ໃຫ້​ເອົາ​ໃຈ​ໃສ່​ເພ່ີມ​ເຕີ​ ມ​ເພື່ອ​ເອົາ​ອອກ​​ຫຼືຮອງ​ຂອບ​ທີ່ຄົມ​ເພ່ືອ​ຄວາມ​ປອດ​ໄພ​ ຂອງ​ຜູ້​ໃຊ້. ​ໂຟມ/ການ​ໃສ່​ນວມ​ ຮອງ ​ໂຟມຖືກ​ໃຊ້​ໃນທຸກ​ອຸປະກອນ​ PSD​​ໃນບ�ລິ​ເວນ​ຕ່າງໆ​ທີ່​ສ�າພັດ​ ໂດຍ​ກົງກັບ​ຮ່າງກາຍ​ຂອງ​ຜູ້​ໃຊ້​ ລົດ​ເຂັນ. ​ໂຟມ​ແຂງ,​​ເຊິ່ງມີ​ຮູບ​ຮ່າງ​ຄົງ​ ທີ່​ຖືກ​ໃຊ້​ເພ່ືອ​ຈັດ​ຮູບ​ຮ່າງ​ຂອງ​ PSD​ທີ່​ພວກ​ເຂົາ​ຕ້ອງການ​ເພ່ືອ​ ໃຫ້ການ​ຮອງ​ຮັບ​ທີ່​ຖື​ກຕ້ອງ. ​ໂຟມທີ່​ອ່ອນ​ກວ່າ​ຖືກ​ໃຊ້​ເພ່ືອ​ ເພີ່ມ​ຄວາມ​ສະບາຍຕົວ​​ແລະ​ ຫຼຸດຜ່ອນ​ການ​ກົ​ດທັບ. ຕົວຢ່າງ​ຂອງ​ການ​ໃຊ້​ໂຟມ: •​ ຄວນ​ເພີ່ມ​ໂຟມ​ໃສ່​ສາຍ​ຮັດ​ເພື່ອ​ ຫຼຸດຜ່ອນ​ກາ​ນກົ​ດທັບ​​ແລະ​​ ເພີ່ມ​ຄວາມ​ສະບາຍ​ຕົວ. •​ ສາມາດ​ໃຊ້​ໂຟມ​ແຂງ​ເພ່ືອ​ເຮັດ​ ແຜ່ນ​ຮອງ​ລ�າ​ຕົວ​ດ້ານ​ຂ້າງ​ຫຼື​ ເພີ່ມ​ໃສ່​ເບາະ​ນັ່ງ​​ເພ່ືອ​ເຮັດ​ ແນວ​ຮອງກົກຂາ​ດ້ານ​ຂ້າງ​ຫຼື​ ແນວ​ຮອງ​ກົກຂາ​ດ້ານ​ໃນ. ກວດ​ເບິ່ງ​ຕະຫຼາດທ້ອງ​ຖິ່ນ​​ແລະ​​ໄປ​ເບິ່ງ​ໂຮງງານ​ ຜະລິດ​ໂຟມ,​​ເກີບ,​​ເສ່ືອ​​ແລະ​​ເຄື່ອງ​ເຟີ​ນີ​ເຈີ​​ເພ່ືອ​ຊອກ​ ຫາ​ໂຟມທີ່​ມີ​ໃຫ້​ຢູ່​ພາຍ​ໃນ​ທ້ອງ​ຖິ່ນ. ລອງ​ຊອກ​ຫາ​ຕົວຢ່າງ​ໂຟມ​ໃນ​ທ້ອງ​ຖິ່ນ​ທີ່​ມີ​ຄວາມ​ໜາ​ ແຕກຕ່າງ​ກັນ​(25​ມມ​ຫາ​50​ມມ)​​ແລະ​ຄວາມ​ແຂງ​ ແຕກ​ຕ່າງ​ກັນ. ​ໂຟມ​EVA​​ແມ່ນ​ຕົວຢ່າງ​ຂອງ​ໂຟມທີ່​ແຂງ​ຫຼາຍ​​ເຊິ່ງດີ​ ສ�າລັບ​ການ​ໃຫ້​ການ​ຮອງຮັບ​​ແລະ​ໂຄງ​ສ້າງ​ທີ່​ແຂງ​ ສ�າລັບ​ອຸປະກອນ​PSD.​ບາງ​ຄັ້ງ​ກ�່​ສາມາດ​ພົບ​ໂຟມ​ EVA​​ໄດ້​ຢູ່ໃນ​ບ່ອນ​ຜະລິດ​ເກີບ. ຢາງ​ແຂງທີ່​ໃຊ້​ເພ່ືອ​ເຮັດ​ເກີບ​ແຕະ​ກ�່​ສາມາດ​ຖືກ​ໃຊ້​ແທນ​ ໂຟມ​EVA​​ໄດ້. ​ໂຟມຊິ​ບຄຸນ​ນະພາ​ບດີ​ແມ່ນ​ຕວົຢ່າງ​ຂອງ​ໂຟມທີ່​ມີ​ຄວາມ​ ແຂງ​ປານ​ກາງ.​​ໂຟມຊິ​ບສາມາດ​ຖືກ​ໃຊ້​ເປັນ​ຖານ​ຂອງ​ ເບາະນັ່ງ​ທີ່​ເປັນ​ໂຄງ/​ເປັນ​ຊັ້ນ​​ເພ່ືອ​ເຮັດ​ແຜ່ນ​ຮອງ​ ກະດູກ​ກົກ​ແ​ອວດ້ານ​ຫຼັງ​ຫຼືຖານ​ຮອງ​ກ່ອນ​ນັ່ງ,​ຫຼື​ເພື່ອ​ ເປັນ​ໂຄງສ�າລັບ​ແນວ​ອີງ​ຫຼັງ​ແບບ​ແຂງ. “​ໂຟມ​ເສື່ອ”​ທີ່​ນຸ້ມ​​ແມ່ນ​ຕົວຢ່າງ​ຂອງ​ໂຟມທີ່ອ່ອນ​ ນຸ້ມກວ່າ​ທີ່​ໃຊ້​ສ�າລັບ​ຊັ້ນ​ເພ່ືອ​ຄວາມ​ສະບາຍ​ຕົວ. 19 20 ​ວັດ​ສະດຸ ຖືກ​ໃຊ້​ສໍາລັບ​: ສ່ິງ​ທ່ີ​ຕ້ອງ​ຊອກ​ຫາ: ​ໂຟມ/ການ​ໃສ່​ນວມ​ ຮອງ •​ ​ໂຟມທີ່​ແຂງ​ຫຼາຍ​(ຕົວຢ່າງ​​ ໂຟມ​EVA)​ສາມາດ​ຖືກ​ໃຊ້​ ເພື່ອ​ເຮັດ​ໂຄງ​ຫຼື​ແນວ​ກັ້ນ​ ສ�າລັບ​ແນວ​ຮອງ​ຕີນ​​ແລະ​​ ແຜ່ນ​ຮອງ​ລ�າ​ຕົວດ້ານ​ຂ້າງ​. ​ໂຟມ​“ອ່ອນ​ນຸ້ມທີ່​ສຸດ”​ທີ່​ມີ​ໃຫ້​ທົ່ວ​ໄປ​​ແລະ​ລາຄາ​ບ�່​ແພງ​​ ບ�່​ເໝາະ​ສົມ​ສ�າລັບ​ການ​ເຮັດ​ເບາະບັນ​ເທົາ​ການ​ກົ​ດທັບ​ ໂດຍ​ບ�່​ມີ​ຖານ​ໂຟມທີ່​ແຂງ​ກວ່າ. ກາບ​ໝາກພ້າວ​(​ໃຍ​ກາກ​ໝາກພ້າວ)​ສາມາດ​ຖືກ​ໃຊ້​ ແທນ​ໂຟມທີ່​ແຂງ​ໄດ້. ຜ້າ​ແພ ຜ້າ​ແພ​ຖືກ​ໃຊ້​ເພື່ອ​ປົກ​ອຸປະກອນ​ PSD. ​ໃຫ້​ຊອກ​ຫາ​ຜ້າ​ແພ​ທີ່ທົນ​ທານ​​ແລະ​ອະນາ​ໄມ​ໄດ້​ງ່າຍ​ (ດ້ວຍ​ການ​ເຊັດ​ຫຼື​ເອົາ​ອອກ​ມາ​ຊັກ).​ຜ້າ​ກັນ​ນ�້າ​ແມ່ນ​ດີ​ ສ�າລັບ​ບ່ອນ​ນັ່ງ​​ແລະ​​ແນວ​ອີງ​ຫຼັງ​ຖ້າ​ຜູ້​ໃຊ້​ລົດ​ເຂັນຄວບ​ ຄຸມ​ການ​ຂີ້ກາ​ນຍ່ຽວ​ບ�່​ໄດ້.​ວັດ​ສະດຸ​ປະ​ເພດ​ເສື້ອ​ຍືດທີ່​ ອ່ອນ​ນຸ້ມກວ່າ​(ຜ້າ​ຝ້າຍ​ຫຼື​ຜ້າ​ຝ້າຍ/ລີ​ຄຣາ)​ສາມາດ​ ຖືກ​ໃຊ້​ສ�າລັບ​ແນວ​ອີງ​ຫົວ​​ແລະ​ແນວຮອງ​ລ�າ​ຕົວ​ດ້ານ​ ຂ້າງ.​ຜ້າ​ແພ​ທີ່​ຍືດຂະຫຍາຍ​ໄດ້​ຈະ​ເຂົ້​າ​ກັບ​ຮູບ​ຮ່າງ​ ຂອງ​ອຸປະກອນ​PSD​​ໄດ້​ງ່າຍ​ກວ່າ. ຜ້າສັງ​ເຄາະ​ໂດຍປົກກະຕິ​ແລ້ວ​ຈະ​ເຮັດ​ໃຫ້​ຄົນ​ເຮົາ​ ຮ້ອນ​ກວ່າ​ຜ້າ​ທ�າ​ມະ​ຊາດ. ຖ້າ​ເປັນ​ໄປ​ໄດ້,​​ໃຫ້ພະຍາຍາ​ມີ​ຢ່າງ​ໜ້ອຍສອງ​ສາມ​ສີ​ ແຕກ​ຕ່າງ​ກັນ​​ແລະ​​ໃຫ້​ຜູ້​ໃຊ້​ລົດ​ເຂັນ​ເລືອກ. ຜ້າ​ນີລອນ​​ແລະ​​ ແທັບ​ຢຶດຕິດ​ Velcro​​ຫຼືຫົວ​ ເຂັມຄັດ ຜ້າ​ນີລອນ​​ແລະ​​ແທັບ​ຢຶດຕິດ​ Velcro​​ຫຼືຫົວ​ເຂັມຄັດ​ຖືກ​ໃຊ້​ ເພື່ອ​ເຮັດ​ສາຍຮັດ​​ເຊິ່ງລວມມີ​ ສາຍຮັດ​ກົກ​ແອວ,​ຮາ​ຍຮັດ​ບ່າ​ ໄຫຼ່,​​ສາຍຮັດບີ​ແຄ່ງ​​ແລະ​ຕີນ. ຜ້າ​ນີລອນ​25​ມມ,​35​ມມ​​ແລະ​50​ມມ​​ແມ່ນ​ດີ​ຫຼາຍ.​ ສາຍຮັດ​ຍິ່ງ​ໃຫຍ່​ເທົ່າ​ໃດ,​​ແຮງ​ກົ​ດທັບ​ກ�່​ຈະ​ສະ​ເໝີ​ກັນ​ ເທົ່າ​ນັ້ນ.​ການ​ຈູດ​ສົ້ນ​ສຸດ​ຂອງ​ຜ້າ​ນີລອນ​ຈະ​ເຮັດ​ໃຫ້​ ເສັ້ນ​ໃຍ​ມັນ​ບ�່ຫຼຸດອອກ.​ຜ້າ​ຝ້າຍ​ມີ​ປະສິດທິ​ຜົນ​ໜ້ອຍ​ ກວ່າ​ຫຼາຍ. ຫົວ​ເຂັມຄັດ​(​ເຊັ່ນ​ວ່າ​ອັນ​ທີ່​ໃຊ້​ຢູ່​ໃນຖົງ​ເປ້)​ສາມາດ​ໃຊ້​ ໄດ້​ງ່າຍ​ທີ່​ສຸດ.​​ໃຊ້​ຫົວ​ເຂັມຄັດ​ຄຸນ​ນະພາ​ບດີ,​ຖ້າ​ມີ​ໃຫ້,​​ ເພາະວ່າມັນ​ຈະ​ໃຊ້​ໄດ້​ດົນ​ກວ່າ.​ທົດ​ລອງ​ພວກ​ມັນ​​ໂດຍ​ ການ​ສູບ​ພວກ​ມັນ​ໃສ່​ກັນ​​ແລະ​ພະຍາຍາມ​ດຶງ​ພວກ​ ມັນ​ອອກ.​ພວກ​ມັນ​ຄວນ​ຈັບ​ຕິດ​ກັນ​​ແລະ​ບ�່ຫຼຸດອອກ​ ງ່າຍໆ,​​ແຕ່​ບ�່ຫຼຸດອອກ​ຈາກ​ກັນ​​ເວັ້ນ​ເສຍ​ແຕ່ວ່າ​ມີ​ການ​ ປ່ອຍ​ແລ້ວ. ​ແຖບ​ຕິດ​Velcro​​ແມ່ນ​ແນວ​ຢຶດເກາະ​ທີ່​ດີ,​​ແນວ​ໃດ​ ກ�່ຕາມ​ຈ�າ​ເປັນ​ຕ້ອງ​ຮັກສາ​ໃຫ້​ມັນ​ສະອາດ​ຖ້າ​ບ�່​ດັ່ງ​ນັ້ນ​ ມັນ​ຈະ​ໃຊ້​ບ�່​ໄດ້. ຄວນ​ໃສ່​ແຜ່ນ​ຮອງ​ຢູ່​ກ້ອງ​ສາຍຮັດ​ທຸກ​ອັນ​​ເພ່ືອ​ປົກ​ປ້ອງ​ ຮ່າງກາຍ​ຂອງ​ຜູ້​ໃຊ້. ກາວ ກາວ​ຖືກ​ໃຊ້​ເພ່ືອ​ຕິດ​ໄມ້​​ແລະ​ໂຟມ​ ເຂົ້າກັນ. ​ໃຊ້​ກາ​ວຕິດ​ໄມ້​(​ໂດຍ​ທົ່ວ​ໄປ​ເອີ້ນ​ວ່າ​ກາວ​ຂາວ​ຫຼືກາວ​ PVA)​​ແລະ​ກາວ​ຕິດ​ໂຟມ​(ການ​ຕິດ​ສ�າພັດ,​ກາວຕິດ​ ເກີບ​ຫຼື​ກາວ​ເຫຼືອງ). ຮັບປະກັນ​ວ່າ​ທຸກ​ຄົ​ນທີ່​ໃຊ້​ກາວ​ຮູ້​ວິທີ​ໃຊ້​ພວກ​ມັນ​ຢ່າງ​ ຖືກຕ້ອງ. ​ແນວ​ຢຶດເກາະ ​ແນວຢຶດ​ເກາະ​ຖືກ​ໃຊ້​ເພື່ອ​ຕິດ​ ອຸປະກອນ​PSD​​ໃສ່​ກັບ​ລົດ​ເຂັນ. ​ແນວ​ເກາະ​ທີ່​ເປັນ​ປະ​ໂຫຍ​ດລວມມີ: •​ ກຽວ​ທີ່​ມີ​ນັອດຫັນ​ຈັບ​(ດີ​ແທ້​ແມ່ນ​ນັອດລັອກ)​​ແລະ​ ແຫວນ​ຮອງ •​ ​ນັອດ​ໂຕ​T​(ຕິດ​ກັບ​ໄມ້ອັດ​ແທນ​ນັອດທ�າ​ມະ​ດາ) •​ ​ເຫຼັກຫຍິບ​(ສ�າລັບ​ການ​ຫຍິບຕິດ​ແນວ​ຫຸ້ມ​ເບາະ). ຫຼີກລຽງ​ການ​ໃຊ້​ນັອດ​ກຽວແຫຼມ​​ເພາະວ່າ​ພວກ​ມັນ​ຈະ​ ເປັ​ນອັນຕະລາຍ​ຖ້າ​ອຸປະກອນ​PSD​​ເພ. 21 22 ຄູ່​ມື​ແນະນໍາ​ການ​ຕ້ັງ​ພ້ືນ​ທ່ີ​ຝຶກ​ ອົບຮົມທັກ​ສະການ​ເຄ່ືອນ​ໄຫວ​ໄປມາ ​ພືນ້​ທີ່​ການ​ຝຶກ​ອົບຮມົ​ທັກ​ສະການ​ເຄື່ອນ​ໄຫວ​ໄປມາ​​ແມນ່​ສ�າຄັ​ນຢາ່ງ​ຍິງ່​ສ�າລັບຜູ້​ໃຊ້​ລົດ​ເຂນັ​​ເພ່ືອ​ ຮຽນ​ຮູ້​ການ​ໃຊ້​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ຢາ່ງ​ຖືກຕ້ອງ​​ແລະ​ປອດ​ໄພ. ມັນ​ຄວນ​ປະກອບ​ມີ​ຢ່າງໜ້ອຍ: •​ ພືນ້​ດນິ​ທີ່​ເໝາະສມົ​ໃນ​ທ້ອງຖິນ່​ທີ່​ແຕ​ກຕາ່ງ​ກນັ •​ ​ຄ້ອຍ​ເນນີ •​ ​ຂັນ້​ໄດ ມນັ​ຄວນ​ຕັງ້​ຢູ່​ໃກ້​ກັບ​ເຂດພືນ້​ທີ່​ການ​ປະກອບ​ລົດ​ເຂນັ​​ເພາະວາ່​ນີ້​ແມນ່​ຂັນ້​ຕອນ​ການ​ບ�ລິການ​ຕ�່​ໄປ,​​ ແລະ​ມັກ​ຈະ​ຈ�າ​ເປັນ​ຕ້ອງ​ມີການ​ດັດ​ປັບຕ�່​ກັບ​ລົດ​ເຂນັ​​ເມື່ອ​ຜູ້​ໃຊ້​ໄດ້​ທົດລອງ​ໃຊ້​ລົດ​ເຂນັ​ແລ້ວ.​ສ່ວນ​ ທີ່​ມີ​ການ​ປົກ​ຫຸມ້​ຈະ​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ເງື່ອນ​ໄຂສະພາບ​ອາກາດ​ທີ່​ບ�່​ດ.ີ ​ກາ​ນຈ�າລອງ​ສະພາບ​ພ້ືນ​ດນິ​ພາຍ​ໃນ​ທ້ອງ​ຖິນ່ ​ແນວ​ກີດຂວາງ​​ແລະ​ທາງ​ເນນີ​1:12 21 22 ​ເຂດ​ພ້ືນ​ທ່ີ​ການ​ຝຶກ​ອົບຮົມ​ທັກ​ສະການ​ເຄ່ືອນ​ໄຫວ​ໄປມາ​ຈະ​ປະກອບ​ມີ​ສ່ິງ​ຕ່ໍ​ໄປ​ນ້ີ: ລາຍການ ​ຂະ​ໜາດ ຈຸດປະສົງ:​ສໍາລັບ​ໃຫ້​ ຜູ້​ໃຊ້​ລົດ​ເຂັນ​​ແລະ​ຜູ້​ ຊ່ວຍຂອງ​ເຂົາ​ເຈ້ົາ​ເຮັດ​ ການ​ຝຶກ​ຊ້ອມ: ໜ້າ​ດິນ​ຮາບ​ພຽງ ຍາວ​10​​ມ​x​ກວ້າງ​1​ມ ການ​ເຂັນ​ລົດ​ແບບ​ພ້ືນຖານ ກາ​ນຈ�າລອງ​ສະພາບພ້ືນ​ດິນ​ໃນ​ ທ້ອງ​ຖິ່ນ​(3​ພ້ືນ​ທີ່)​​ເຊັ່ນ​ວ່າ​​ຊາຍ,​ ຫຍ້າ​​ແລະ​ພ້ືນ​ດິນ​ທີ່​ມີ​ຫີນ​ ​ແຕ່​ລະພ້ືນ​ທີ່​ຄວນ​ມີ​ຄວາມ​ຍາວ​ 2000​ມມ​​ແລະ​ກວ້າງ​1000​ມມ​​ເປັນ​ ຢ່າງ​ໜ້ອຍ ​ສະພາບ​ແວດ​ລ້ອມ​ທີ່​ພົບ​ເຫັນ​ ໃນ​ເຂດ​ທ້ອງ​ຖິ່ນ​ຂອງ​ຜູ້​ໃຊ້ ​ແນວ​ກີດຂວາງ​1 1500​ມມ​x​1500​ມມ​x​ຄວາມ​ສູງ​ 25​ມມ ການ​ເຄື່ອນ​ຍ້າຍ​ຢູ່​ເທິງ​ບັນ​ໄດ​ ສະ​ເພາະ ​ແນວ​ກີດຂວາງ​2 1500​ມມ​x​1500​ມມ​x​ຄວາມ​ສູງ​ 100​ມມ ​ແນວ​ກີດຂວາງ​3 1500​ມມ​x​1500​ມມ​x​ຄວາມ​ສູງ​ 200​ມມ ທາງ​ເນີນ​1:12 ​ຍາວປະມານ​3600​ມມ​x​ກວ້າງ​ 1000​ມມ ຄວາມ​ເນີນ:​0​ມມ​(​ເ​ບື້ອງຕ�່າ)​ຫາ​ 300​ມມ​(​ເບື້ອງ​ສູງ) ​ການ​ເຄື່ອນ​ຍ້າຍ​ຢູ່​ເທິງ​ຄ້ອຍ​ ມາດຕະຖານ ທາງ​ເນີນ​1:8 ​ຍາວປະມານ​2400​ມມ​x​ກວ້າງ​ 1000​ມມ ຄວາມ​ເນີນ:​0​ມມ​(​ເ​ບື້ອງຕ�່າ)​ຫາ​ 300​ມມ​(​ເບື້ອງ​ສູງ) ​ການ​ເຄື່ອນ​ຍ້າຍ​ຢູ່​ເທິງ​ຄ້ອຍ​ ສູງ​ຊັນ ຈຸດ​ເລີ່​ມຕົ້ນ​(ຂອບ​ທາງ​​ແລະ​ສ່ິງ​ ກີດຂວາງ)​(​ເບິ່ງ​ຮູບ​1) ສູງ​60ມມ​x​ກວ້າງ​50ມມ​x​ຍາວ​ 1000​ມມ ກາ​ນຜ່ານຜ່າ​ສິ່ງ​ກີດຂວາງ​ໃນ​ ເສັ້ນທາງ​​ແລະປະຕູ ຈຸດ​ເລີ່​ມຕົ້ນ​(ຂອບ​ທາງ​​ແລະ​ສ່ິງ​ ກີດຂວາງ)​2​(​ເບິ່ງ​ຮູບ​2) ສູງ​90​ມມ​x​ກວ້າງ​50​ມມ​x​ຍາວ​ 1000​ມມ ຂັ້ນ​ບັນ​ໄດ​(​ເບິ່ງ​ຮູບ​2) ​ເລິກ​ປະມານ​300​ມມ,​ສູງ​150​ມມ​​ ແລະ​ກວ້າງ​1100​ມມ ການ​ຂຶ້ນ​​ແລະ​ລົງ​ຂັ້ນ​ບັນ​ໄດ​ ຕ່າງໆ ຂະໜາດ​ຕາ່ງໆ​ທີ່​ລະບຸ​ໄວ້​ໃນ​ຕາຕະລາງ​ຂາ້ງ​ເທງິ​ຕ້ອງ​ຖືກ​ດັດ​ປັບ​ສ�າລັບ​ສະພາບ​ການ​ທ້ອງ​ຖິນ່​ ຖາ້​ມີ​ຄວາມ​ແຕກ​ຕາ່ງຫາຼຍຈາກ​ມາດຕະຖານ​ທີ່​ແນະນ�າ​ໄວ.້​ມນັ​ສ�າຄນັ​ວາ່​ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ຕ້ອງ​ຮຽນ​ ຮູ້​ການ​ຜາ່ນ​ຜ່າ​ສະພາບ​ແວດ​ລ້ອມ​ໃນ​ທ້ອງ​ຖິນ່​ຂອງ​ເຂາົ​ເຈົາ້​ຜາ່ນ​ການ​ຝຶກ​ອົບຮມົ​ນີ.້​ຮບັປະກນັ​ວາ່​ ມີ​ການ​ເຂົາ້​ເຖງິ​ສ່ວນ​ໃດ​ໜຶງ່​ສະ​ເພາະ​ຂອງ​ພ້ື​ນທີ່​ການ​ຝຶກ​ອົບຮມົ​ການ​ເຄື່ອນ​ໄຫວ​ໄປມາ. ບາງ​ຄັງ້​ສາມາດ​ລະບຸພ້ືນ​ທີ່​ທີ່​ໃກ້​ກັບ​ພ້ືນ​ທີ່​ການ​ບ�ລິການ​ໄດ້​​ໂດຍ​ການ​ໃຊ້​ພູມສນັຖານ​ທາງ​ທ�າ​ມະ​ ຊາດ​ທີ່​ມີ​ໃຫ.້ 23 24 ຕົວຢ່າງ​ຂອງຈຸດ​ເລ່ີ​ມຕ້ົນ​ທ່ີ​ມີ​ຄວາມ​ສູງ​ແຕກ​ຕ່າງ​ກັນ​ ​ຮູບ​ທີ​1​(​ວັດ​ແທກ​ເປັນ​ມມ)​ 400​ມມ 50​ມມ 50​ມມ 60​ມມ 90​ມມ (2) (2) (1) (1) 1000​ມມ 23 24 ​ຕົ​ວຢ່າງ​ຂອງ​ຕົວ​ຈໍາລອງ​ບັນ​ໄດ 1100 ມມ 950 ມມ 600 ມມ 2150 ມມ 700 ມມ 2000 ມມ 300​mm 300 ມມ 150 ມມ 150 ມມ 150 ມມ 150 ມມ 150 ມມ 300 ມມ ​ຮູບ​ທີ​2​(​ວັດ​ແທກ​ເປັນ​ມມ)​ 25 26 ການ​ປຽບທຽບ​ວິທີ​ການ​ຕ່າງໆ​ຂອງ​ການ​ຈັດ​ຫາ​ລົດ​ເຂັນ ​ວິທີ​ການຈັດ​ຫາ​ລົດ​ເຂນັຕົນ້ຕ�​ທີ່​ຕ້ອງ​ພິຈາລະນາ​ແມນ່​ການ​ຜະລິດ​ລົດ​ເຂນັ​ໃນ​ທ້ອງ​ຖິນ່,​ການ​ນ�າ​ ເຂົາ້​ລົດ​ເຂນັ​ໃໝ່​​ແລະ​ການ​ນ�າ​ເຂົາ້​ລົດ​ເຂນັ​ທີ່​ໃຊ້​ແລ້ວ.​ສາມາດ​ນ�າ​ລົດ​ເຂນັ​ເກົາ່ກັບ​ມາ​ໃຊ້​ໃໝ່​ໄດ້​ຢູ່​ ພາຍ​ໃນ​ກາ​ນບ�ລິການ​ລົດ​ເຂນັ. ​ການ​ຈັດ​ຫາ​ລົດ​ເຂັນ​ທ່ີ​ຫຼາກຫຼາຍທ່ີ​ເຊ່ື​ອຖື​ໄດ້​ໃນ​ໄລຍະ​ຍາວ ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ຕ້ອງການ​ການຈັດ​ຫາ​ໄລຍະ​ຍາວ​ສ�າລັບຜະລິດ​ຕະພນັ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ​ທີ່​ ຫາຼກຫາຼຍ,​ຕາມ​ທີ່​ກ�ານົດ​ໄວ້​ໃນ​ຂ�້​ແນະນ�າ​ກຽ່ວ​ກັບລົດ​ເຂນັ.​​ດ້ວຍຕົວ​ແບບ​ການຈັດ​ຫາ​ໃດໆ​ ກ�່ຕາມ,​ມນັ​ສ�າຄນັ​ໃນ​ການ​ພິຈາລະຈາ​ຄວາມ​ເຊືອ່​ຖື​ໄດ້​ໄລຍະ​ຍາວ​ຂອງ​ການ​ຈັດ​ຫາ​ຜະລິດ​ຕະພັນ.​ ທຸກ​ຕົວ​ແບບ​ການ​ຈັດ​ຫາ​ລ້ວນ​ແຕ່​ມີ​ສ່ິງ​ທາ້​ທາຍ​ໃນ​ດາ້ນ​ຄວາມ​ຍນື​ຍງົ​​ແລະ​ການ​ຄວບ​ຄມຸ​ຄນຸ​ ນະພາ​ບ​​ແລະ​ຈ�າ​ເປັນ​ຕ້ອງ​ພຈິາລະນາ​ເປັນ​ແຕ່​ລະກ�ລະ​ນີ​​ໃນ​ສະພາບ​ການ​ທີ່​ແຕກ​ຕາ່ງ​ກນັ. ຜູ້​ໃຊ້​ລົດ​ເຂນັ​ຄວນ​ເຂົາ້​ຮວ່ມ​ໃນ​ການວາງ​ແຜນ,​ການຈັດ​ຕັງ້​ປະຕິບັດ,​ການ​ຄຸມ້​ຄອງ​​ແລະ​ການ​ປະ​ ເມນີ​ຜົນ​ການ​ສະໜອງ​ລົດ​ເຂນັ1​​ແລະ​ສະ​ນັນ້​ຄວນມີ​ສ່ວນ​ຮວ່ມ​ໃນ​ການ​ຕັດສນິ​ກ�າ​ນົດວິທີ​ແກ້​ໄຂທີ່​ ດີ​ທີ່​ສຸດ​ສ�າລັບ​ສະພາບ​ສະ​ເພາະ​ນັນ້ .ໆ ຖາ້​ມີ​ການ​ບ�ລິການ​ອຸປະກອນ​ທຽມ​ສ�າລັບ​ຮາ່ງກາຍ​(P&O)​ຢູ່​ພາຍ​ໃນ​ທ້ອງ​ຖິາ່ນ,​ການ​ເລືອກ​ການ​ ຜະລິດ​ຢູ່​ໃນ​ທ້ອງ​ຖິນ່​ຫຼືອຸປະກອນ​ທີ່​ນ�າ​ເຂົາ້ຂອງ​ເຂາົ​ເຈົາ້​ສາມາດ​ຊວ່ຍ​ໃນ​ການ​ຕັດສນິ​ໃຈ​ກຽ່ວ​ກັບ​ ວິທີ​ການຈັດ​ຫາ​ລົດ​ເຂນັ​ໃຫ້​ແກ່ການ​ບ�ລິການ​ລົດ​ເຂນັ.​​ນອກ​ນັນ້​ມນັ​ຍງັ​ເປັນປະ​ໂຫຍ​ດ​ໃນ​ການ​ ພຈິາລະນາ​ລາຍການ​ທີ່​ຄາ້ຍຄື​ກນັ​ໃນ​ຕະຫາຼດທ້ອງ​ຖິນ່​​ເຊັນ່​ວາ່​ລົດຖີບ​ຫຼື​ເຄື່ອງ​ເຟີ​ນີ​ເຈີ​ເຫຼັກ,​​ ແລະ​ເຂົາ້​ໃຈ​ເຫດຜົນ​ຍ້ອນ​ຫຍງັ​ທຸລະ​ກິດ​ໃນ​ທ້ອງຖິນ່​ເຫຼົາ່ນີ້​ຈິງ່​ຕັດສນິ​ໃຈ​ຜະລິດ​ເອງ​ຫຼນື�າ ​ເ​ຂົາ້ຜະລິດ​ຕະພັນ​ຂອງ​ເຂາົ​ເຈົາ້.​ການ​ມີ​ຫຼືການ​ບ�່​ມີ​ການ​ຜະລິດ​ອືນ່ຢູ່​ໃນ​ທ້ອງ​ຖິນ່​​ແມນ່​ຕົວ​ຊີ້​ ບອກ​ທີ່​ສ�າຄນັວາ່​ການ​ຜະລິດ​ລົດ​ເຂນັ​ຈະປະສົບ​ຜົນສ�າ​ເລັດ​ຫຼືບ�.່​ການ​ມີ​ຫຼືການ​ບ�່​ມີ​ທຸລະ​ກິດ​ໃນ​ ທ້ອງ​ຖິນ່​ທີ່​ນ�າ​ເຂົາ້​ຜະລິດ​ຕະພັນ​​ແມນ່​ຕົວຊີ້​ບອກ​ທີ່​ດີ​ກຽ່ວ​ກັບ​ຄວາມ​ເປັນ​ໄປ​ໄດ້​ຂອງ​ຕ່ອງ​ໂສ້​ການ​ ສະໜອງ​ທີ່​ເຊືອ່​ຖື​ໄດ້​ສ�າລັບ​ການ​ນ�າ​ເຂົາ້​ສນິຄາ້. ກ່ອນ​ເຮດັ​ການ​ຕັດສນິ​ໃຈ​ກຽ່ວ​ກັບ​ວາ່​ຈະ​ໃຊ້ຕົວ​ແບບ​ການ​ສະໜອງ​ໃດ,​ຂ�​ແນະນ�າ​ໃຫ້​ເຮດັ​ການ​ ສຶກສາວິ​ໄຈ​ຄວາມ​ເປັນ​ໄປ​ໄດ້​ຢາ່ງ​ຄົບ​ຖ້ວນ.​ຈ�າ​ເປັນ​ຕ້ອງ​ມີ​ການ​ຄິດ​ໄລ່​​ແລະ​ປຽບທຽບ​ຄາ່​ໃຊ້​ຈາ່ຍ​ ຕາ່ງ .ໆ​ສາມາດ​ຄາດ​ຄະ​ເນຄາ່​ໃຊ້​ຈາ່ຍ​ເຕມັ​ຈ�ານວນ​ຂອງ​ຜະລິດ​ຕະພັນ​ທີ່​ນ�າ​ເຂົາ້​ໄດ້​ລ່ວງ​ໜາ້​ (ການສະ​ເໜີ​ລາຄາ​ຜະລິດ​ຕະພັນ,​ການ​ຂນົ​ສ່ົງ​​ແລະ​ການ​ນ�າ​ເຂົາ້,​ການ​ເກັບ​ມຽ້ນ),​​ແຕ່​ຈ�າ​ເປັນ​ ຕ້ອງ​ເອາົ​ໃຈ​ໃສ່​ຕ�່​ກັບ​ບນັຫາ​ຕາ່ງໆ​ທີ່​ຈະ​ຢູ່​ນອກ​ການ​ຄວບ​ຄມຸ​ຂອງການ​ບ�ລິກາ​ນລົດ​ເຂນັ​​ເຊັນ່ວາ່​ ການຊກັຊາ້ຂອງການຂນົສົງ່​ຫຼືອັດຕາ​ແລກປຽ່ນ​ທີ່​ບ�່​ຄງົ​ທີ.່​ການ​ກ�ານົດ​ລາຄາ​ຂອງ​ຜະລິດ​ຕະພັນ​ ທີ່​ຜະລິດ​ໃນ​ທ້ອງ​ຖິນ່​ຈ�າ​ເປັນ​ຕ້ອງ​ມີ​ຄວາມ​ຮູ້​ທີ່​ສ�າຄນັ​ກຽ່ວ​ກັບ​ຄາ່​ໃຊ້​ຈາ່ຍ​ໃນ​ການ​ດ�າ​ເນນີ​ໂຮງ​ ສ້ອມ​ແປງ​ພ້ອມ​ກັບ​ຄາ່​ໃຊ້​ຈາ່ຍ​ຕົວ​ຈງິ​ຂອງ​ຜະລິດ​ຕະພັນ​​ແລະ​ສາມາດ​ເປັນ​ເລື່ອງ​ທີ່​ບ�່​ສາມາດ​ ຄາດ​ເດາົ​ໄດ.້​ຈ�າ​ເປັນ​ຕ້ອງຄິດ​ໄລ່ການ​ຂນົ​ສົງ່​ເຊັນ່​ວາ່​ພະນັກງານ​ທີ່​ຈ�າ​ເປັນ,​ບ່ອນ​ເກັບ​ມຽ້ນ​ທີ່​ ຕ້ອງການ​​ແລະການ​ຄຸມ້​ຄອງ​ການ​ນ�າ​ເຂົາ້​ຫຼື​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖິນ່. 1​ ຂ�້​ແນະນ�າ​ກ່ຽວ​ກັບ​ການ​ສະໜອງ​ລົດ​ເຂັນ​ແບບ​ໃຊ້​ແຮງ​ຄົນ​ໃນ​ສະຖານ​ທີ່​ທີ່​ມີ​ຊັບພະຍາກອນຈ�າກັດ​ປີ​2008,​ໜ້າ​34​(http://www. who.int/disabilities/publications/technology/wheelchairguidelines/en/). 25 26 ການ​ປຽບທຽບ​ຜົນ​ປະ​ໂຫຍ​ດຂອງ​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖ່ິນ​ກັບ​ຜະລິດ​ຕະພັນ​ທ່ີ​ ນໍາ​ເຂ້ົາ ບ�່​ວາ່​ຜະລິດ​ຕະພັນ​ຈະ​ຖືກຜະລິດ​ໃນ​ທ້ອ​ງຖິນ່​ຫຼຖືືກ​ນ�າ​ເຂົາ້​ກ�່ຕາມ,​ລົດ​ເຂນັ​ທງັ​ໝົດ​ຄວນ​ເປັນ​ ລົດ​ເຂນັ​ທີ່​ເໝາະສົມ​ຕາມ​ທີ່​ກ�ານົດ​ໄວ້​ໃນ​ຂ�້​ແນະນ�າ​ກຽ່ວ​ກັບ​ລົດ​ເຂນັ2.​​ໃນ​ອະດີດ​ຜາ່ນ​ມາ​ມນັ​ ເປັນ​ໄປ​ບ�່​ໄດ້​ໃນ​ການ​ນ�າ​ເຂົາ້​ລົດ​ເຂນັ​​ເຊິງ່ຖືກ​ອອກ​ແບບ​ມາ​ໂດຍ​ສະ​ເພາະ​ສ�າລັບ​ສະຖານ​ທີ່​ທີ່​ມີ​ ຊບັພະຍາກອນຈ�າກັດ;​ສະ​ນັນ້​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖິນ່​ຈິງ່​ເປັ​ນວິທີ​ດຽວ​ໃນ​ກາ​ນ​ຮບັປະກນັ​ການ​ ສະໜອງ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ.​​ແນວ​ໃດ​ກ�່ຕາມດ​ລົດ​ເຂນັ​ທີ່​ຖືກ​ອອກ​ແບບ​ມາ​ໂດຍ​ສະ​ເພາະ​ສ�າລັບ​ ການ​ໃຊ້​ໃນ​ສະຖານ​ທີ່ທີ່​ມີ​ຊບັພະຍາກອນ​ຈ�າກັດ​​ແມນ່​ນັບ​ມື້​ນັບ​ມີ​ໃຫ້​ນ�າ​ເຂົາ້​ໄດ.້​ດ້ວຍ​ເຫດ​ນີ,້​ມນັ​ ຈິງ່​ເປັນ​ປະ​ໂຫຍ​ດ​ໃນ​ການ​ພິຈາລະນາຜົນ​ປະ​ໂຫຍດຂອງ​ທງັ​ສອງ​ວິທີ​ການ​ນີ.້ ຕາຕະລາງ​ປຽບທຽບ​ເນັນ້​ໃຫ້​ເຫນັ​ຈ�ານວນ​ຂ�້​ພຈິາລະນາ​​ໃນ​ເວລາ​ເລືອກຕົວ​ແບບ​ການ​ຈັດ​ຫາ​ລົດ​ ເຂນັ​​ເພ່ືອ​ຮບັປະກນັ​ວາ່​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສົມ​ທີ່​ຫາຼກຫາຼຍ​ແມນ່​ມີ​ໃຫ້​ສ�າລັບ​ຜູ້​ໃຊ້​ລົ​ດ​ເຂນັ. ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖ່ິນ ​ຂ້ໍ​ດີ ​ຂ້ໍ​ເສຍ •​ ​ຄວາມ​ມຸ້ງ​ໝັ້ນຂອງລັດຖະບານຕ�່​ກັບ​ການ​ຜະລິດ​ ໃນ​ທ້ອງ​ຖິ່ນ​ສາມາດ​ສົ່ງ​ຂ�້ຄວາມ​ໃຫ້​ເຫັນ​ວ່າ​ຄວາມ​ ພິການ​ແມ່ານ​ບັນຫາ​ທີ່​ເປັນ​ຂອງ​ຊຸມ​ຊົນ​​ແລະ​ຈ�າ​ ເປັນ​ຕ້ອງ​ໄດ້​ຮັບ​ການ​ແກ້​ໄຂ​ໃນ​ທຸກ​ດ້ານ​ຂອງ​ມັນ​​ ເຊິ່ງລວມທັງ​ການ​ຜະລິດ​ລົດ​ເຂັນ.​​ •​ ການ​ຜະລິດ​ສາມາດ​ເຮັດ​ໃຫ້​ເປັນ​ສະ​ເພາະ​ຕ�່​ກັບ​ ຄວາມ​ຕ້ອງການ​ໃນທ້ອງ​ຖິ່ນ. •​ ສາມາດ​ສະໜອງຜະລິ​ດຕະພັນ​ໃຫ້​ໄດ້​ງ່າຍດາຍ​ດ້ວຍ​ ອາ​ໄຫຼ່ທີ່​ມີ​ຢູ່​ໃນ​ທ້ອງ​ຖິ່ນ. •​ ສ້າງ​ວຽກ​ເຮັດ​ງານ​ທ�າ​​ແລະ​ທັກ​ສະ​ດ້ານ​ການ​ຜະລິດ​ ໃຫ້​ແກ່​ທ້ອງ​ຖິ່ນ​ທີ່​ສາມາດ​ຮອງ​ຮັບ​ການ​ສ້ອມ​ແປງ​​ ແລະ​ການ​ບ�າລຸງ​ຮັກສາ​ລົດ​ເຂັນ​ໃນ​ທ້ອງ​ຖິ່ນ. •​ ສາມາດ​ແກ້​ໄຂ​ຄວາມ​ຕ້ອງການ​ສ�າລັບ​ລົດ​ເຂັນ​ທີ່​ປັບ​ ໃຫ້​ເໝາ​ະສົມ​ສະ​ເພາະ​ບຸ​ກຄົນ​ຖ້າ​ຜູ້​ຜະລິດ​ໃນ​ທ້ອງ​ ຖິ່ນ​ມີ​ຄວາມ​ສາມາດ. •​ ງ່າຍ​ກວ່າ​ໃນ​ການ​ຮັກສາ​ໃຫ້​ມີ​ລົດ​ເຂັນ​ຢູ່​ໃນ​ຄັງ​ໄວ້​ ຢ່າງ​ສະໝ�່າສະ​ເໝີ​ດ້ວຍ​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖິ່ນ. •​ ສາມາດ​ເກັບ​ມ້ຽນ​ລົດ​ເຂັນ​ໄ​ວ້​ໃນ​ຄັງ​ໄດ້​ໜ້ອຍ​ສຸ​ດກ�່​ໄດ້​​ ເພາະວ່າ​ມີ​ການ​ຜະລິດ​ທີ່​ຕ�່​ເນື່ອງ​​ແລະ​ປັບປ່ຽນ​ໄດ້. •​ ງ່າຍ​ກວ່າ​ໃນ​ການ​ໃຫ້​ຜູ້​ໃຊ້​ໃນ​ທ້ອງ​ຖິ່ນ​ເຂົ້າ​ຮ່ວມ​ໃນ​ ກາ​ພັດທະນາ​ຜະລິດ​ຕະພັນ​​ແລະ​​ຕອບ​ສະໜອງ​ຕ�່​ ກັບ​ຄວາມ​ຕ້ອງການ​​ແລະ​ບັນຫາ​ໄດ້​ໄວ​ກວ່າ. •​ ຍາກ​ໃນ​ການຮັກສາ​ຄຸນ​ນະພາ​ບດ້ວຍ​ການ​ຜະລິດ​ ຂະໜາດ​ທີ່​ບ�່​ໄດ້​ໃຊ້​ກົນ​ຈັກ. •​ ຈ�າ​ເປັນ​ຕ້ອງມີ​ການ​ລົງທຶນ​ໃນ​ເບື້ອງ​ຕົ້ນ​ໃນ​ ດ້ານເຄື່ອງ​ຈັກ,​​ເຄື່ອງມື,​ພ້ືນ​ທີ່​ການ​ຜະລິດ​​ແລະ​ ການ​ຝຶກ​ອົບຮົມ​ພະນັກງານ. •​ ຍາກ​ໃນ​ການ​ຮັກສາ​ພະນັກງານ​ໄວ້​​ເມື່ອຄ�າ​ສັ່ງ​ຊື້​ ພະນັກງານ​ບ�່​ຄຸ້ມ​ຕົ້ນ​ທຶນ​ການ​ດ�າ​ເນີນງານ​ຂອງ​ໂຮງ​ ຜະລິດ. •​ ການ​ຄຸ້ມ​ຄອງ​ໂຮງ​ຜະລິດ​ສາມາດ​ເປັນ​ເລື່ອງ​ສັບສົນ. •​ ອາ​ໄສ​ໃສ່​ການ​ມີ​ຢູ່​ໃນ​ທ້ອງ​ຖິ່ນຂອງ​ວັດ​ສະດຸ​​ແລະ​ ສ່ວນ​ປະກອບ​ຕ່າງໆ. •​ ຈ�ານວນ​ການ​ຜະລິດ​ທີ່​ຈ�າກັດ​ສາມາດ​ເພ່ີມ​ຕົ້ນ​ທຶນ​ ຂອງ​ຜະລິດ​ຕະພັນ. •​ ມີ​ເວລາ​ໜ້ອຍ​ກວ່າ​ໃນ​ການ​ເນັ້ນ​ໜັກ​ໃສ່​ດ້ານ​ການດູ​ ແລ​ປິ່ນປົວ​ຂອງ​ການ​ສະໜອງລົດ​ເຂັນ​​ເນື່ອງ​ຈາກ​ ລັກສະນະ​ທີ່​ລະອຽດ​ທາງ​ດ້ານ​ແຮງ​ງານ​ຂອງ​ການ​ ຜະລິດ​ໃນ​ທ້ອງ​ຖິ່ນ. 2​ ຂ�້​ແນະນ�າ​ກ່ຽວ​ກັບ​ການ​ສະໜອງ​ລົດ​ເຂັນ​ແບບ​ໃຊ້​ແຮງ​ຄົນ​ໃນ​ສະຖານ​ທີ່​ທີ່​ມີ​ຊັບພະຍາກອນຈ�າກັດ​ປີ​2008,​ໜ້າ​71​(http://www. who.int/disabilities/publications/technology/wheelchairguidelines/en/). 27 28 ​ລົດ​ເຂັນ​ທ່ີ​ນໍາ​ເຂ້ົາ ​ຂ້ໍ​ດີ ​ຂ້ໍ​ເສຍ •​ ລົດ​ເຂັນ​ທີ່​ນ�າ​ເຂົ້າ​ສາມາດ​ເປັນ​ສ່ວນ​ເສີມ​ໃຫ້​ແກ່​ລົດ​ເຂັນ​ທີ່​ ມີ​ໃຫ້​ໃນ​ທ້ອງ​ຖິ່ນ​​ເພື່ອ​ຮັບປະກັນ​ວ່າຜະລິດ​ຕະພັນ​​ແລະ​ ສ່ວນ​ປະກອບ​ທີ່​ຫຼາກຫຼາຍ​ແມ່ນ​ມີ​ໃຫ້​ເພື່ອ​ຕອບ​ສະໜອງ​ ຄວາມ​ຕ້ອງການ​ສະ​ເພາະ​ບຸກຄົນ​ຂອງ​ຜູ້​ໃຊ້. •​ ຄຸນ​ນະພາ​ບຜະລິດ​ຕະພັນ​ທີ່​ຄົງ​ທີ່​​ເນື່ອງ​ຈາກ​ຜູ້​ຜະລິດ​ທີ່​ ເຂັ້ມ​ແຂງ​ທີ່​ມີ​ກົນ​ໄກ​ການ​ຄວບ​ຄຸມ​ຄຸນ​ນະພາ​ບທີ່​ດີ. •​ ປະຢັດ​ຕົ້ນ​ທຶນ​ທີ່​ເປັນ​ໄປ​ໄດ້​​ເນື່ອງ​ຈາກ​ການ​ຜະລິດ​ໃນ​ ຈ�ານວນ​ຫຼາຍກວ່າ​ທີ່​ຜະລິດ​ໄດ້ໃນ​ທ້ອງ​ຖິ່ນ.​​ການ​ປະ​ຢັດ​ ຕົ້ນ​ທຶນ​ສາມາດ​ນ�າ​ໄປ​ສູ່​ການ​ມີ​ລົດ​ເຂັນ​ຫຼາຍຂຶ້ນ​ເພື່ອ​ແຈກ​ ຢາຍ. •​ ການ​ບ�ລິການ​ລົດ​ເຂັນ​ຈະ​ມີ​ຄວາມ​ສາມາດ​ເພີ່ມ​ຂຶ້ນ​ໃນ​ ການ​ເນັ້ນ​ໜັກ​ໃສ່​ທັກ​ສະການ​ດູ​ແລ​ປິ່ນປົວ​​ເພາະວ່າ​ໃຊ້​ ເວລາ​ໜ້ອຍ​ກວ່າ​ໃນ​ການ​ຜະລິດ. •​ ສາມາດ​ສ້າງ​ວຽກ​ເຮັດ​ງານ​ທ�າ​ໃນ​ທ້ອງ​ຖິ່ນ​ສ�າລັບ​ການ​ ປະກອບ,​ການ​ດັດ​ປັບ,​ການ​ດັດ​ແປງ​ແນວ​ຮອງ​ຮັບ​ທ່າ​ ທາງ,​ການ​ບ�າລຸງ​ຮັກສາ​​ແລະ​ການ​ສ້ອ​ມ​ແປງ​ລົດ​ເຂັນ. •​ ຕ້ອງການ​ກາ​ນລົງທຶນ​ດ້ານ​ເຄື່ອງ​ຈັກ,​​ເຄື່ອງມື,​ວັດ​ສະດຸ​​ ແລະ​ການ​ຮັກສາ​ຄວາມ​ປອດ​ໄພໜ້ອຍ​ກວ່າ​ການ​ຜະລິດ​ ໃນ​ທ້ອງ​ຖິ່ນ. •​ ຕ້ອງການການ​ຄຸ້ມ​ຄອງ​ໂຮງ​ຜະລິດ/ນາຍ​ຊ່າງ​ທີ່​ສັບສົນ​ ໜ້ອຍ​ກວ່າ​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖິ່ນ. •​ ການ​ຂົນ​ສົ່ງ​​ແລະ​ຄ່າ​ໃຊ້​ຈ່າຍ​ຂອງພາສີ​ນ�າ​ເຂົ້າ. •​ ຄ່າ​ການ​ຂົນ​ສົ່ງ​ສາມາດ​ຕ້ອງການ​ໃຫ້​ມີ​ຄ�າ​ສັ່ງ​ຊື້​ໃນ​ຈ�ານວນ​ ຫຼາຍ​ເພື່ອ​ໃຫ້​ຄຸ້ມ​ຄ່າ.​ •​ ມີ​ຄວາມ​ຢຶດຢຸດ​ໜ້ອຍ​ກວ່າ​ໃນ​ດ້ານ​ປະລິມານ​ຄ�າ​ສັ່ງ​ຊື້​ ໜ້ອຍ​ສຸດ. •​ ​ໄລຍະ​ເວລາ​ລ�ຖ້າ​ດົນ​ກວ່າ​ໃນ​ການ​ຂົນ​ສົ່ງ​​ແລະ​​ເປັນ​ໄປ​ ໄດ້​ວ່າ​ໄລຍະ​ເວລາ​ລ�ຖ້າ​ດົນ​ກວ່າ​ໃນ​ການ​ຜະລິດ​ຖ້າ​ມີ​ຂ�້​ ກ�ານົດ​ດ້ານ​ຈ�ານວນ​ຕ�່າ​ສຸດ​ກ່ອນ​ທີ່​ຈະ​ເ​ລີ່​ມການ​ຜະລິດ​ ໄດ້. •​ ຄ�າ​ສັ່ງ​ຊື້​ໃນ​ຈ�ານວນ​ຫຼາຍກວ່າ​ຈ�າ​ເປັນ​ຕ້ອງ​ມີ​ທຶນ​ຈ�ານວນ​ ຫຼວງຫຼາຍ,​ພື້ນ​ທີ່​ເກັບ​ມ້ຽນ​ທີ່​ໃຫຍ່​ກວ່າ​​ແລະ​ກົນ​ໄກ​ການ​ ຄວບ​ຄຸມ​ລາຍການ​ສິນຄ້າ​ທີ່​ດີກວ່າ. •​ ຍາກ​ໃນ​ການ​ຮັກສາ​ລະດັບ​ສິນຄ້າ​ໃນ​ຄັງ​ໃຫ້​ມີ​ສະໝ�່າສະ​ ເໝີ​​ໂດຍ​ທີ່​ມີ​ການ​ຊື້​ສິນຄ້າ​ຈ�ານວນ​ຫຼາຍໜ້ອຍ​ຄັ້ງ​ກວ່າ. •​ ຜະລິດ​ຕະພັນ​ນ�າ​ເຂົ້າ​ທີ່ມີ​ໃຫ້​ທົ່ວ​ໄປ​ອາດ​ຈະ​ບ�່​ຕອບ​ ສະໜອງ​ໄດ້​ຄວາມ​ຕ້ອງການ​ຂອງ​ທ້ອງ​ຖິ່ນ​ກ •​ ອາດ​ຈະ​ບ�່​ສາມາດ​ສະໜອງຜະລິ​ດຕະພັນ​ທີ່​ມີ​ອາ​ໄຫຼ່ທີ່​ມີ​ ໃຫ້ຢູ່​ໃນ​ທ້ອງ​ຖິ່ນ​ໄດ້.​ •​ ​ບ�່​ສ້າງ​ວຽກ​ເຮັດ​ງານ​ທ�າ​ດ້ານ​ການ​ຜະລິດ​ໃນ​ທ້ອງ​ຖິ່ນ​. •​ ​ເພີ່ມ​ຄວາມ​ຫຍຸ້ງຍາກ​ໃນ​ການ​ເອົາ​ຜູ້​ໃຊ້​ໃນ​ທ້ອງ​ຖິ່ນ​ເຂົ້າ​ ຮ່ວມ​ໃນ​ການພັດທະນາ​ຜະລິດ​ຕະພັນ. ການ​ນໍາ​ເຂ້ົາ​ລົດ​ເຂັນ​ທ່ີ​ໃຊ້​ແລ້ວ ​ໃນ​ຫາຼຍໆ​ສະຖານ​ທີ່​ທີ່​ມີ​ຊບັພະຍາກອນ​ທີ່​ດ,ີ​ການ​ປຽ່ນລົດ​ເຂນັ​ໃໝ່​ເລື້ອຍ​ທ​ຫຼືການ​ໃຊ້​ລົ​ດ​ເຂນັ​ໃນ​ ໄລຍະ​ສັນ້​ກ�່​ໃຫ້​ເກີດ​ຄງັ​ສະ​ສມົລົດ​ເຂນັ​ທີ່​ໃຊ້​ແລ້ວ.​ຜົນ​ຕາມ​ມາ,​ຫາຼຍໆ​ອງົການ​ໄດ້​ເກັບ​ເອາົ,​ກູ້​ຄນື​​ ແລະ​ສົງ່​ອອກ​ລົດ​ເຂນັ​ເຫຼົາ່ນີ້​ສ�າລັບ​ການ​ນ�າ​ໄປ​ໃຊ້​ຄນື​ໃໝ່​ໃນ​ສະຖານ​ທີ່​ທີມ່ີຊບັພະຍາ​ກອນ​ຈ�າກັດ. ​ເມື່ອ​ຕັດສນິ​ໃຈ​ວາ່ການ​ນ�າ​ເຂົາ້​ລົດ​ເຂນັ​ທີ່​ໃຊ້​ແລ້ວ​ແມນ່​ຕົວ​ເລືອກ​ທີ່​ດີ​ສ�າລັບ​ອງົການ​ຂອງ​ທາ່ນ,​​ໃຫ້​ ພຈິາລະນາ​ວາ່​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ​ໝາຍ​ເຖງິ​ຫຍງັ: •​ ຕອບ​ສະໜອງ​ໄດ້ຄວາມ​ຈ�າ​ເປັນ​ຕ້ອງ​ຜູ້​ໃຊ້​​ແລະ​ເງ່ືອນ​ໄຂ​ສະພາບ​ແວດ​ລ້ອມ; •​ ​ໃຫ້​ຄວາມ​ພ�ດີ​ທີ່​ເໝາ​ະສມົ​​ແລະ​ການ​ຮອງ​ຮບັ​ທາ່​ທາງ​ຕາ່ງ ;ໆ •​ ປອດ​ໄພ​​ແລະ​ໃຊ້​ໄດ້​ຍາວ​ນານ; •​ ມີ​ໃຫ້​ຢູ່​ໃນ​ປະ​ເທດ​ນັນ້ :ໆ​​ແລະ •​ ສາມາດ​ມີ​​ແລະ​ໄດ້​ຮບັ​ການ​ບ�າລງຸ​ສ້ອມ​ແປງ​​ແລະ​ການ​ບ�ລິການ​ຍນື​ຍງົ​ໃນ​ປະ​ເທດ​ນັນ້ໆ​ດ້ວຍ​ ລາຄາ​ທີ່​ສາມາດ​ຊື້​ໄດ.້ ​ບາງ​ຂ�້​ພິຈາລະນາ​​ໃນ​ເວລາ​ພິຈາລະນາ​ນ�າ​ເຂົາ້​ລົດ​ເຂນັ​ທີ່​ໃຊ້​ແລ້ວ​ມີ​ດັງ່​ນີ:້ •​ ທາ່ນ​ຮບັປະກນັ​ໄດ້​ແນວ​ໃດວາ່​ລົດ​ເຂນັ​ທີ່​ມີ​ໃຫ້​ແມນ່​ເໝາະ​ສມົ​ສ�າລັບ​ສະຖານ​ທີ່​ທີ່​ມີ​ ຊບັພະຍາກອນ​ຈ�າກັດ? •​ ທາ່ນ​ຕອບ​ສະໜອງ​ແນວ​ໃດ​ຕ�່​ກັບ​ຄວາມ​ຕ້ອງການ​ທີ່​ມີຢູ່​ພາຍ​ໃນ​ປະ​ເທດ​​ເມື່ອ​ລົດ​ເຂນັ​ທີ່​ມີ​ໃຫ້​ ອາດ​ຈະ​ແຕກ​ຕາ່ງ​ຢາ່ງ​ກວາ້ງຂວາງ​ໃນ​ດາ້ນ​ປະ​ເພດ,​ຂະໜາດ​​ແລະ​ຄນຸ​ນະພາ​ບ? •​ ​ທາ່ນ​ຈະ​ໃຫ້ການ​ສະໜອງ​ອາ​ໄຫຼ່ຢາ່ງໝ້ັນຄງົ​ໄດ້​ແນວ​ໃດ? 27 28 •​ ທາ່ນ​ຈະ​ໃຫ້​ເຄື່ອງມື​ທີ່​ເໝາະ​ສມົ​ສ�າລັບ​ການ​ດັດ​ປັບ​​ແລະ​ການ​ປະກອບ​ລົດ​ເຂນັ​ທີ່​ ຫາຼກຫາຼຍຈາກ​ຜູ້​ຜະລິດ​ທີ່​ແຕກ​ຕາ່ງ​ກນັ​ໄດ້​ແນວ​ໃດ? •​ ຜົນ​ກະທົບ​ຕ�່​ກັບ​ຜູ້​ຜະລິດ​​ແລະ​ຜູ້​ໃຫ້​ບ�ລິ​ການ​ໃນ​ທ້ອງ​ຖິນ່​ທີ່​ມີ​ຢູ.່ ການ​ນໍາ​ລົດ​ເຂັນ​ກັບ​ມາ​ໃຊ້​ໃໝ່ຢູ່​ພາຍ​ໃນ​ການ​ໃຫ້ບໍລິການ​ທ່ີ​ມີ​ຢູ່ ​ເມື່ອ​ການ​ບ�ລິການ​ເຕີບ​ໃຫຍ່​ຂະ​ຫຍາຍ​ຕົວ,​​ແນນ່ອນ​ວາ່​ສ່ວນ​ໜຶງ່​ຂອງ​ລູກ​ຄາ້​ຈະ​ໃຫຍ່ຂນຶ​ຈົ​ນຈນົ​ ບ�່ພ�ດີ​ກັບ​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້,​​ໄດ້​ຮບັ​ລົດ​ເຂນັ​ໃໝ່​ຫຼື​ບ�່​ໃຊ້​ລົດ​ເຂນັ​ຂອງ​ເຂາົ​ເຈົາ້​ອີກ​ຕ�່​ໄປ. ຜົນ​ຕາມ​ມາຈາກ​ສິງ່​ນີ,້​ບາງ​ອງົການ​ຈັດ​ຕັງ້​ຈະ​ເລືອກ​ພັດທະນາ​ລະບົບ​ບ່ອນ​ທີ່​ລົດ​ເຂນັ​ຖືກ​ສົງ່​ກັບ​ ຄນື​ຫາ​ການ​ບ�ລິການ​​ແລະ​ນ�າ​ເອາົ​ໄປ​ໃຫ້​ຜູ້​ອືນ່​ໃຊ.້​ນີ້​ສາມາດ​ໃຫ້​ປະ​ໂຫຍ​ດ​ແກ່​ຜູ້​ໃຊ້​ເພ່ີມ​ຂຶນ້,​​ແຕ່​ມີ​ ຫາຼຍຂ�້​ພິຈາລະນາ​ໃຫ້​ຄິດ​ກ່ອນ​ທີ່​ຈະ​ຕັດສິນ​ໃຈ​ວາ່​ນີ້​ແມນ່​ທາ​ງ​ເລືອກ​ທີ່​ດີ​ສ�າລັບ​ການ​ບ�ລິການ​ຂອງ​ ທາ່ນ. ຖາ້​ອງົການ​ໃດ​ໜຶງ່​ເລືອກ​ທີ່​ຈະ​ນ�າ​ຜະລິ​ດຕະພັນ​ເກົາ່​ກັບ​ມາ​ໃຊ້​ໃໝ່​ມນັ​ສ�າຄນັ​ໃນ​ການ​ພິຈາລະນາ​ ວາ່​ລົດ​ເຂນັ​ທີ່​ໃຊ້​ແລ້ວ​ນັນ້​ຄວນ​ເປັນ​ລົດ​ເຂນັ​ທີ່​ເໝາະ​ສມົ​ສ�າລັບ​ຜູ້​ໃຊ້​ນັນ້ .ໆ​ຫາຼຍໆຊິນ້​ສ່ວນ​ອາດ​ ຈະ​ຈ�າ​ເປັນ​ຕ້ອງ​ປຽ່ນ​ໃໝ່​ຫຼືສ້ອມ​ແປງ​​ແລະ​ສ່ວນ​ຕາ່ງໆ​ທີ່​ສາມາດ​ປົນ​ເປື້ອນ​ແບັກ​ທີ​ເຣຍ​(​ໂຟມ,​​ ແ​ນວຫຸມ້​ເບາະ,​ສາຍຮດັ​​ແລະ​ອືນ່ )ໆ​ຄວນ​ຖືກ​ປຽ່ນ​ໃໝ່​ເພ່ືອ​ຄວາມ​ປອດ​ໄພ​​ແລະ​ສຸຂະພາບ​ຂອງ​ຜູ້​ ໃຊ້​ຄນົ​ຕ�່​ໄປ. ບາງ​ປັດ​ໃຈ​ທີ່​ຈະ​ມີ​ຜົນ​ກະທົບ​ຕ�່​ກັບ​ຄວາມ​ສັບສນົ​​ແລະ​ການຢູ່​ລອດ​ຂອງ​ການ​ນ�າ​ລົດ​ເຂນັ​ເກົາ່​ມາ​ ໃຊ້​ໃໝ່​ຢູ່​ພາຍ​ໃນ​ແຜນ​ງານ​ຂອງ​ທາ່ນ​ມີ​ດັງ່​ນີ:້ •​ ການ​ເຂົາ້​ເຖງິ​ອາ​ໄຫຼ່ປຽ່ນ​ຖາ່ຍ •​ ​ຈ�ານວນ​ຂອງ​ລູກຄາ້​ທີ່​ໃຫ້​ບ�ລິການ •​ ກນົ​ໄກ​ການ​ໃຫ້​ທນຶ​ທີ່​ໃຊ້​ກັບ​ລູກ​ຄາ້ •​ ​ອາຍຸ​ຂອງ​ລູກ​ຄາ້ •​ ​ຄນຸ​ນະພາ​ບຂອງ​ຜະລິດ​ຕະພັນ​ທີ່​ສະໜອງ​ໃຫ້ •​ ​ພມູີ​ປະ​ເທດ​​ແລະ​ປັດ​ໃຈ​ດາ້ນສະພາບ​ແວດ​ລ້ອມ​ໃນ​ທ້ອງ​ຖິນ່​(​ເຊິງ່ຈະ​ມີ​ຜົນ​ຕ�່​ກັບ​ອາ​ຍຸ​ໃຊ້​ງານ​ ຂອງ​ລົດ​ເຂນັ) ບາງ​ຂ�້​ພິຈາລະນາ​ເພ່ີມ​ເຕມີ​ລວມມ:ີ •​ ຄວາມຈ�າ​ເປັນ​ໃນ​ການຂນົ​ສົງ່​ລົດ​ເຂນັ​ກັ​ບຄນື​ຫາ​ການ​ບ�ລິການ​ສ�າລັບ​ການ​ນ�າ​ໄປ​ໃຊ້​ໃໝ່ •​ ພືນ້​ທີ່​ເພີມ່​ເຕມີ​ໃນ​ໂຮງ​ສ້ອມ​ແປງ​ສ�າລັບ​ການ​ຕົບ​ແຕງ່ລົດ​ເຂນັ​ •​ ຄວາມ​ຈ�າ​ເປັນ​ສ�າລັບການ​ຝຶກ​ອົບຮມົ​ດາ້ນ​ເຕັກນິກ​​ແລະ​ການ​ຄວບ​ຄມຸ​ຄນຸ​ນະພາ​ບ. 29 30 ​ເຄ່ືອ​ງມື​ສໍາລັບ​ການ​ວັດ​ແທກ​ການ​ມີ​ສ່ວນ​ຮ່ວມ​ໃນ​ເວລາ​ປະ​ເມີນ​ຜົ​ ສໍາລັບ​ເຕັກ​ໂນ​ໂລ​ຊີ​ຊ່ວຍ ​ກ�ານົດ​ຜູ້​ຕອບ: ສະຖານ​ທີ່: ວັນ​ທີ: ຊື່​ຜູ້​ສ�າພາດ: 1.​ ​ທ່ານ​ມີ​ອຸປະກອນ​ຊ່ວຍ​ໃດໆ​ບ�?​ ​ມີ​ ​ບ�່​ມີ​(ຂ້າມ​ໄປ​ຂ�້​5) 2.​ ຖ້າ​ມ,ີ​ທ່ານ​ມີ​ອຸປະກອນ​ຊ່ວຍ​ອັນ​ໃດ?​ 3.​ ຖ້າ​ມ,ີ​​ໃນ​ປະ​ຈຸ​ບັນ​ທ່ານ​ໃຊ້​ອຸປະກອນ​ໃດ​ໜຶ່ງ​ທີ່​ທ່ານ​ມີ​ຢູ່​ບ�?​ ​ມີ​ ​ບ�່​ມີ​(ຂ້າມ​ໄປ​ຂ�້​5) 4.​ ຖ້າ​ມ,ີ​ທ່ານ​ໃຊ້​ອັນ​ໃດ?​​ ​ທັງ​ໝົດ​ ​ບາງ​ສ່ວນ,​ບອກ​ແຈ້ງ:​ ​ຕ�່​ໄປ​ແມ່ນ​ບາງ​ຄ�າ​ຖາມ​ກ່ຽວ​ກັບ​ວ່າ​ທ່ານ​ມີ​ຄວາມ​ຫຍຸ້ງຍາກ​ຫຼາຍປານ​ໃດ​ໃນ​ການ​ເຮັດ​ກິດຈະກ�າ​ປະຈ�າ​ວັນ​ຢູ່​ໃນ​ເຮືອນ​ ຂອງ​ທ່ານ.​ນີ້​ລວມມີ​ການ​ຊ່ວຍ​ເຫຼືອຈາກ​ຄົນ​ອື່ນ​​ແລະ​ການ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ຕ່າງໆ. 5.​ ທ່ານ​ມີ​ບັນຫາ​ໃນ​ຂອບ​ເຂດ​ສ�່າ​ໃດ​ໃນ​ການ​ໃຊ້​ການ​ຂົນ​ສົ່ງ​ສາທາລະນະ​ໂດຍ​ເປັນ​ຜູ້​ໂດຍສານ​​ເພື່ອ​ໄປມາ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 6.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຮັດ​ວຽກ​ເຮືອນ​ເຊັ່ນ​ວ່າ​ຊັກ​ລ້າງ​ຫຼື​ເຮັດອະນາ​ໄມ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 7.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ໄປ​ໂຮງຮຽນ​​ແລະ​ຮຽນ​ໜັງສື? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 8.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ໄດ້​ວຽກ​ເຮັດ​​ແລະ​ຮັກສາ​ວຽກ​ເຮັດ​ໄວ້? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 9.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຂົ້າ​ຮ່ວມ​ໃນ​ກິດຈະກ�າ​ພັກຜ່ອນ​ຢ່ອນ​ໃຈ​​ແລະ​ກິດຈະກ�າ​ຍາມ​ຫວ່າງ​​ເຊັ່ນ​ວ່າ​ກິລາ,​​ເກ​ມ,​ ສິລະ​ປະ​​ແລະ​ຫັດຖະກ�າ,​ການ​ເຕັ້ນ​ລ�າ,​​ເພງ​​ແລະ​​ອື່ນໆ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 10.​ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຂົ້າຮ່ວມ​ຢ່າງ​ຈິງ​ຈັງ​ໃນ​ກິດຈະກ�າ​ທາງ​ສັງຄົມ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ 29 30 ​ເຄ່ືອງມື​ສໍາລັບ​ວັດ​ແທກ​ຄວາມ​ພໍ​ໃຈ​​ແລະ​ຜົນ​ຮັບ​ໃນ​ເວລາ​ ຕິດຕາມ​ຜົນ​ຂອງ​ເຕັກ​ໂນ​ໂລ​ຊີ​ຊ່ວຍ ​ກ�ານົດ​ຜູ້​ຕອບ: ສະຖານ​ທີ່: ວັນ​ທີ: ຊື່​ຜູ້​ສ�າພາດ: 1.​ ທ່ານ​ກ�າລັງ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ອັນ​ໃດ?​ 2.​ ທ່ານ​ໄດ້​ມັນ​ມາ​ເປັນ​ເວລາ​ດົນ​ປານ​ໃດ​ແລ້ວ?​ 3.​ ​ໃນ​ປະຈຸ​ບັນ​ທ່ານ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ບ�?​ ​ ​​ໃຊ້​(ຂ້າມ​ໄປ​ຂ�້​5)​ ​ບ�່ 4.​ ຖ້າ​ບ�່,​ຍ້ອນ​ຫຍັງ​ທ່ານ​ບ�່​ໃຊ້​ມັນ? (ຂ້າມ​ຄ�າ​ຖາມ​ທີ່​ເຫຼືອ​ຖ້າ​ທ່ານ​ຕອບ​ຄ�າ​ຖາມ​4.) ​ຕ�່​ໄປ​ແມ່ນ​ບາງ​ຄ�າ​ຖາມ​ກ່ຽວ​ກັບ​ວ່າ​ໃນ​ປະຈຸ​ບັນທ່ານ​ມີ​ຄວາມ​ຫຍຸ້ງຍາກ​ຫຼາຍປານ​ໃດ​ໃນ​ການ​ເຮັດ​ກິດຈະກ�າ​ຢູ່​ໃນ​ ເຮືອນ​ຂອງ​ທ່ານ.​ນີ້​ລວມ​ເອົາ​ການ​ຊ່ວຍ​ເຫຼືອຈາກ​ຄົນ​ອື່ນ​​ແລະ​ການ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ຕ່າງໆ. 5.​ ທ່ານ​ມີ​ບັນຫາ​ໃນ​ຂອບ​ເຂດ​ສ�່າ​ໃດ​ໃນ​ການ​ໃຊ້​ການ​ຂົນ​ສົ່ງ​ສາທາລະນະ​ໂດຍ​ເປັນ​ຜູ້​ໂດຍສານ​​ເພື່ອ​ໄປມາ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ 6.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຮັດ​ວຽກ​ເຮືອນ​ເຊັ່ນ​ວ່າ​ຊັກ​ລ້າງ​ຫຼື​ເຮັດອະນາ​ໄມ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ 7.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ໄປ​ໂຮງຮຽນ​​ແລະ​ຮຽນ​ໜັງສື? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ 8.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ໄດ້​ວຽກ​ເຮັດ​​ແລະ​ຮັກສາ​ວຽກ​ເຮັດ​ໄວ້? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ 31 32 9.​ ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຂົ້າ​ຮ່ວມ​ໃນ​ກິດຈະກ�າ​ພັກຜ່ອນ​ຢ່ອນ​ໃຈ​​ແລະ​ກິດຈະກ�າ​ຍາມ​ຫວ່າງ​​ເຊັ່ນ​ວ່າ​ກິລາ,​​ ເກ​ມ,​ສິລະ​ປະ​​ແລະ​ຫັດຖະ​ກ�າ,​ການ​ເຕັ້ນ​ລ�າ,​​ແລະ​ເພງ.​ ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ 10.​ທ່ານ​ມີ​ບັນຫາ​ສ�່າ​ໃດ​ໃນ​ການ​ເຂົ້າຮ່ວມ​ຢ່າງ​ຈິງ​ຈັງ​ໃນ​ກິດຈະກ�າ​ທາງ​ສັງຄົມ? ບ�່​ມີ​ບັນຫາ ​ມີ​ບັນຫາ​ເລັກ​ນ້ອຍ ​ມີ​ບັນຫາ​ປານ​ກາງ ​ມີ​ບັນຫາ​ຮ້າຍ​ແຮງ ​ເປັນ​ໄປ​ບ�່​ໄດ້ ບ�່​ກ່ຽວຂ້ອງ ​ຄ�າ​ຄິດເຫັນ​ ຕ�່​ໄປ​ແມ່ນ​ບາງ​ຄ�າ​ຖາມ​ກ່ຽວ​ກັບ​ວ່າ​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ອຸປະກອນ​ຊ່ວຍ​ຂອງ​ທ່ານ. 11.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ຂະໜາດ​ຂອງ​ມັນ?​(ມັນ​ໃຫຍ່​ສ�່າ​ໃດ?) ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 12.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ນ�້າໜັກ​ຂອງ​ມັນ?​(ມັນ​ໜັກ​ແນວ​ໃດ?) ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 13.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃ​ດກ່ຽວ​ກັບ​ມັນ​ງ່າຍ​ສ�່າ​ໃດ​ໃນ​ການ​ເຄື່ອນ​ທີ່​ໄປມາ​ຈາກ​ບ່ອນ​ໜຶ່ງ​ໄປ​ອີກ​ບ່ອນ​ໜຶ່ງ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 31 32 14.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກ່ຽວ​ກັບວ່າ​ມັນ​ເບິ່ງ​ເປັນ​ແນວ​ໃດ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 15.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກ່ຽວ​ກັບວ່າ​ມັນ​ໃຊ້​ງ່າຍ​ສ�່າ​ໃດ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 16.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກ່ຽວ​ກັບ​ເວລາ​ທີ່​ໃຊ້​ໃນ​ການ​ຕິດ​ຕັ້ງ​ມັນ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 17.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບຄວາມ​ເຊື່ອ​ຖື​ໄດ້​ຂອງ​ມັນ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 18.​​ທ່າ​ນພ�​ໃຈ​ສ�່າ​ໃດວ່າ​ມັນ​ຕອບ​ສະໜອງ​ຄວາມ​ຕ້ອງການ​ຂອງ​ທ່ານ?​(ມັນ​ເຮັດ​ທຸກ​ຢ່າງທ່ີ​ທ່ານ​ຕ້ອງການ​ໃຫມັນ​ ເຮັດ,​ພາຍ​ໃນ​ເວລາ​ທີ່​ສົມ​ເຫດ​ສົມ​ຜົນ?) ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 33 34 ຕ�່​ໄປ​ແມ່ນ​ບາງ​ຄ�າ​ຖາມ​ກ່ຽວ​ກັບ​ວ່າ​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ແບບ​ວິທີ​ທີ່​ທ່ານ​ໄດ້​ຮັບ​ອຸປະກອນ​ຊ່ວຍ. 19.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ຄ�າ​ແນະນ�າ​ທີ່​ໄດ້​ຮັບ​ກ່ຽວ​ກັບ​ວ່າ​ເຕັກ​ໂນ​ໂລ​ຊີ​ໃດ​ດີ​ທີ່​ສຸດ​ສ�າລັບ​ທ່ານ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 20.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກ່ຽວ​ກັບ​ເວລາ​ທີ່​ໃຊ້​ເພື່ອ​ໄດ້​ຮັບ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 21.​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ການ​ຊ່ວຍ​ເຫຼືອ​ຖ້າ​ມັນ​ໃຊ້​ບ�່​ໄດ້​ຢ່າງ​ຖືກຕ້ອງ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ 22.​​ທ່ານ​ພ�​ໃຈ​ສ�່າ​ໃດ​ກັບ​ຄວາມ​ຊ່ວຍ​ເຫຼືອ​​ແລະ​ຄ�າ​ແນະນ�າ​ທີ່​ທ່ານ​ໄດ້​ຮັບ​ກ່ຽວ​ກັບ​ວິທີ​ໃຊ້​ມັນ? ບ�່​ດີ​ແທ້ໆ ບ�່​ດີ​ໃຈ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ບ�່ພ�​ໃຈ ​ປະສົມ​ປະສານ​ກັນ ​ສ່ວນ​ໃຫຍ່​ແລ້ວ​ ພ�​ໃຈ ​ດີ​ໃຈ ດີ​ໃຈ​ຫຼາຍ​ ​ຄ�າ​ຄິດເຫັນ​ ຕ�່​ໄປ​ແມ່ນ​ບາງ​ຄ�າ​ຖາມ​ກ່ຽວ​ກັບປະສົບ​ການ​ຂອງ​ທ່ານ​ໃນ​ການ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​. 23.​ຄິດ​ກ່ຽວ​ກັບ​ວ່າ​ທ່ານ​ໄດ້​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະຈຸ​ບັນ​ຂອງທ່ານຫຼາຍປານ​ໃດ​ໃນ​ຕະຫຼອດສອງ​ອາທິດ​ຜ່ານ​ມາ.​​ ໃນ​ມື້​ໂດຍສ​ະ​ເລ່ຍ,​ທ່ານ​ໃຊ້​ມັນ​ຈັກ​ຊົ່ວ​ໂມງ? ບ�່​ໄດ້​ໃຊ້ ໜ້ອຍ​ກວ່າ​1​ຊົ່ວ​ໂມງ​ຕ�່​ມື້ 1​ຫາ​4​ຊົ່ວ​ໂມງ​ຕ�່​ມື້ 4​ຫາ​8​ຊົ່ວ​ໂມງ​ຕ�່​ມື້ ​ຫຼາຍ​ກວ່າ​8​ຊົ່ວ​ໂມງ​ຕ�່​ມື້ ​ຄ�າ​ຄິດເຫັນ​ 33 34 24.​ຄິດ​ກ່ຽວ​ກັບ​ສະພາບ​ການ​ບ່ອນ​ທີ່​ທ່ານ​ຢາກທີ່​ສຸດທີ່​ຈະ​ດ�າ​ເນີນ​ຫຼື​ເຮັດ​ໄດ້​ດີກ​ວ່າ​ກ່ອນ​ທີ່​ທ່ານ​ໄດ້​ຮັບ​ອຸປະກອນ​ ຊ່ວຍ​ໃນປະຈຸ​ບັນ​ຂອງ​ທ່ານ.​ຕະຫຼອດສອງ​ອາທິດ​ຜ່ານ​ມາ,​ອຸປະກອນ​ຊ່ວຍ​ໄດ້​ຊ່ວຍ​ທ່ານ​ໄດ້​ຫຼາຍ​ສ�່າ​ໃດ​ໃນ​ ສະພາບ​ການ​ນັ້ນ? ບ�່​ໄດ້​ຊ່ວຍ​ ​ເລີຍ ​ຊ່ວຍ​ໄດ້​ໜ້ອຍ​ໜຶ່ງ ​ຊ່ວຍ​ໄດ້​ປານ​ກາງ ​ຊ່ວຍ​ໄດ້​ຂ້ອນ​ຂ້າງ​ຫຼາຍ ຊ່ວຍ​ໄດ້​ຫຼາຍທີ່​ສຸດ ​ຄ�າ​ຄິດເຫັນ​ 25.​​ຄິດ​ອີກ​ຄັ້ງ​ກ່ຽວ​ກັບ​ສະພາບ​ການ​ບ່ອນ​ທີ່​ທ່ານ​ຢາກ​ທີ່​ສຸດ​ທີ່​ຈະ​ດ�າ​ເນີນ​ຫຼື​ເຮັດ​ໄດ້​ດີກ​ວ່າ.​​ໃນ​ເວລາ​ທີ່​ທ່ານ​ໃຊ້​ ອຸປະກອນ​ຊ່ວຍ​ໃນປະຈຸ​ບັນ​ຂອງ​ທ່ານ,​ທ່ານ​ຍັງ​ມີຄວາມຫຍຸ້ງຍາກ​ຫຼາຍປານ​ໃດ​ໃນ​ສະພາບ​ການ​ນັ້ນ? ​ເປັນ​ໄປ​ບ�່​ໄດ້ ຂ້ອນ​ຂ້າງ​ຍາກ​ຫຼາຍ ຍາກ​ປານ​ກາງ ​ຍາກ​ໜ້ອຍ​ໜຶ່ງ ​ບ�່​ຍາກ​ເລີຍ ​ຄ�າ​ຄິດເຫັນ​ 26.​​ໂດຍ​ພິຈາລະນາ​ທຸກ​ຢ່າງ,​ທ່ານ​ຄິດ​ວ່າ​ອຸປະກອນ​ຊ່ວຍ​ໃນປະຈຸ​ບັນຂອງ​ທ່ານ​ມີ​ປະ​ໂຫຍ​ດພຽງພ�​ແລ້ວ​ບ�?​(ຜົນ​ ປະ​ໂຫຍ​ດທີ່​ທ່ານ​ໄດ້​ຮັບ​ຈາກ​ການ​ໃຊ້​ອຸປະກອນ​ຊ່ວຍ​ນັ້ນ​ຫຼາຍກວ່າ​ຄວາມ​ຫຍຸ້ງຍາກ​ຕ່າງໆ​ໃນ​ການ​ເກັບ​ມ້ຽນ/ ການ​ຮັກສາ/​ການ​ຂົນ​ສົ່ງ/​ການ​ໃຊ້​ອຸປະກອນ​ນັ້ນ​ບ�?) ບ�່​ຄຸ້ມ​ຄ່າ​ເລີຍ ​ຄຸ້ມ​ຄ່າ​ໜ້ອຍ​ໜຶ່ງ ​ຄຸ້ມ​ຄ່າ​ປານ​ກາງ ​ຄຸ້ມ​ຄ່າ ​ຄຸ້ມ​ຄ່າ​ຫຼາຍ ​ຄ�າ​ຄິດເຫັນ​ 27.​​ພິຈາລະນາ​ເຖິງຄວາມ​ຫຍຸ້ງຍາກ​ທີ່​ເຮັດ​ໃຫ້​ທ່ານ​ໄດ້​ຮັບ​ອຸປະກອນ​ຊ່ວຍ​ໃດ​ໜຶ່ງ.​​ໃນ​ຕະຫຼອດສອງ​ອາທິດ​ຜ່ານ​ ມາ,​ດ້ວຍ​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະ​ຈຸ​ບັນ​ຂອງ​ທ່ານ,​ຄວາມ​ຫຍຸ້ງຍາກ​ທີ່​ທ່ານ​ໄດ້​ຮັບ​ຊ່ວຍ​ໄດ້​ສົ່ງ​ຜົນ​ກະທົບ​ສ�່າ​ໃດ​ ຕ�່ກັບ​ສ່ິງ​ຕ່າງໆ​ທີ່​ທ່ານ​ສາມາດ​ເຮັດ? ​ເປັນ​ໄປ​ບ�່​ໄດ້ ມີ​ຜົນກະທົບຢ່າງ​ໃຫຍ່ຫຼວງ ມີ​ຜົນກະທົບ​ປານ​ກາງ ມີ​ຜົນກະທົບ​ໜ້ອຍ​ໜຶ່ງ ​ບ�່​ມີ​ຜົນກະທົບ​ເລີຍ ​ຄ�າ​ຄິດເຫັນ​ 28.​​ພິຈາລະນາ​ເຖິງຄວາມ​ຫຍຸ້ງຍາກ​ທີ່​ເຮັດ​ໃຫ້​ທ່ານ​ໄດ້​ຮັບ​ອຸປະກອນ​ຊ່ວຍ​ໃດ​ໜຶ່ງ.​​ໃນ​ຕະຫຼອດສອງ​ອາທິດ​ຜ່ານ​ ມາ,​ດ້ວຍ​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະ​ຈຸ​ບັນ​ຂອງ​ທ່ານ,​ທ່ານ​ຄິດ​ວ່າ​ຄົນ​ອື່ນ​ເປັນກັງວົນ​ຫຼາຍສ�່າ​ໃດ​ກ່ຽວ​ກັບ​ຄວາມ​ ຫຍຸ້ງຍາກ​ທີ່​ທ່ານ​ໄດ້​ຮັບ​ອຸ​ປະກອນ​ຊ່ວຍ​ນັ້ນ? ຫຼາຍທີ່​ສຸດ ​ຂ້ອນ​ຂ້າງ​ຫຼາຍ ປານ​ກາງ ​ໜ້ອຍ​ໜຶ່ງ ​ບ�່​ກັ​ງວົນ​ເລີຍ ​ຄ�າ​ຄິດເຫັນ​ 29.​​ໂດຍ​ພິຈາລະນາ​ທຸກ​ຢ່າງ,​ອຸປະກອນ​ຊ່ວຍ​ໃນ​ປະຈຸ​ບັນ​ໄດ້​ປ່ຽນ​ແປງ​ຄວາມ​ມ່ວນ​ຊື່​ ນໃນ​ຊີວິດ​ຂອງ​ທ່ານຫຼາຍປານ​ໃດ?​ ຂີ້ຮ້າຍ​ລົງ ​ບ�່​ປ່ຽນ​ແປງ ​ດີ​ຂຶ້ນ​ໜ້ອຍ​ໜຶ່ງ ​ຂ້ອນ​ຂ້າງ​ຫຼາຍ ຫຼາຍທີ່​ສຸດ ​ຄ�າ​ຄິດເຫັນ​ ​ແຫ່ຼງຂ້ໍມູນ:​ ບັນຊີສາກົນຂອງອົງການ​WHO​​ເພ່ືອ​ຈ�າ​ແນ​ກໜ້າ​ທີ່​ການຂອງ​ຮ່າງກາຍ,​ຄວາມ​ພິການ​​ແລະ​ສຸຂະພາບ​(International​Classification​of​ Functioning,​Disability​and​Health,​ICF). QUEST​2.2.​ດັດ​ແປງ​ຈາກ​QUEST​2.1:​ສະບັບ​ຂອງ​ເດັກນ້ອຍ​ໂດຍ​Sonya​Murchland​2011. IOI-HA.​Cox​RM,​Stephens​D,​Kramer​SE​(2002).​ສະບັບ​ແປ​ຂອງບັນຊີ​ຜົນ​ຮັບ​ສາກົນ​ສ�າລັບ​ເຄື່ອງ​ຊ່ວຍ​ຟັງ​(International​Outcome​ Inventory​for​Hearing​Aids,​IOI-HA).​ວາລະສານ​ສາກົນ​ກ່ຽວ​ກັບ​ການ​ໄດ້​ຍິນ​ສຽງ​(International​Journal​of​Audiology)​41(1):3-26. 35 36 ຂ້ໍ​ມູນ​ການ​ຊ່ວຍ​ເຂ້ົາ​ເຖິງ ​ກາ​ນຮວ່ມ​ງານ​ກັບ​ບນັດາ​ກະຊວງ​ຂອງ​ລັດຖະບານ:​ສາທາ,​ສຶກສາດ​ຄມົ​ມະ​ນາ​ຄມົ​​ແລະ​ບນັດາ​ ອງົການ​ຈັດ​ຕັງ້​ຂັນ້​ຊມຸ​ຊນົ​​ເພ່ືອ​ແນະນ�າ​ກຽ່ວ​ກັບ​ການ​ຊວ່ຍ​ເຂົາ້​ເຖງິ​ສາມາດ​ປັບປງຸ​ການ​ລວມ​ ເອາົ​​ແລະ​ການ​ມີ​ສ່ວ​ນຮວ່ມ​ຂອງ​ຄນົທີ່​ມີ​ຄວາມ​ພິການ​ດາ້ນ​ການ​ເຄື່ອນ​ໄຫວ​ໃນ​ສງັຄມົ​ໄດ້​ຢາ່​ງ​ໃຫຍ່​ ຫຼວງ.​​ການ​ເຮດັ​ໃຫ້​ອາຄານ​ເຂົາ້​ເຖງິ​ໄດ້​ຕັງ້​ແຕ່​ຕົນ້ໃນ​ເວລາ​ກ�່ສ້າງ​ມີຄາ່​ໃຊ້​ຈາ່ຍ​ໜ້ອຍ​ກວາ່​ຫາຼຍ​​ ເມື່ອ​ທຽບ​ກັບ​ການປັບ​ປຽ່ນ​ດັດ​ແປງ​ມນັ​ໃນ​ພາຍ​ຫຼງັ. ​ບາງ​ຂ�້​ມນູ​ງາ່ຍດາຍ​ມີ​ລາຍການ​ຢູ່​ຂາ້ງ​ລຸມ່.​ສາມາດ​ເບິງ່ລາ​ຍລະອຽດ​ເພ່ີມ​ເຕມີ​ໃນ​ແຫຼງ່ຄວາມ​ ຊວ່ຍ​ເຫຼືອທີ່​ລວມມີ​ຢູ່​ໃນ​ຊຸດ​ຝຶກ​ອົບຮມົ​ນີ.້ ການ​ເຮັດ​ໃຫ້​ເຮືອນ​ເຂ້ົາ​ເຖິງ​ໄດ້ •​ ​ຂ�້​ພິຈາລະນາ​ຕົນ້ຕ�​ລວມມີ​ຄວາ​ມສງູ​ຂອງ​ຊັນ້ວາງ​ຂອງ​​ແລະ​ການ​ເຂົາ້​ເຖງິ​ພາຍ​ໃຕ້​ພ້ືນ​ເຮດັ​ວຽກ •​ ທາງ​ເຂົາ້​ປະຕ:ູ​ຄວາມ​ກວາ້ງ,​ທິດ​ທາງ​ປ່ອງປະຕ,ູ​ບ່ອນ​ຈບັ. 35 36 ທາງ​ເຂ້ົາ​ປະຕູ •​ ​ຄວາມ​ກວາ້ງ​ຂອງ​ທາ​ງ​ເຂົາ້​ປະຕ:ູ​900​ມມ •​ ລອງ​ໃສ່​ບານພັບ​ປະຕູ​​ເພ່ືອ​ໃຫ້​ພວກ​ມນັ​ເປີດ​ເຂົາ້​ ໃນ​ຈາກພ້ືນ​ທີ່​ໃຊ້​ງານ​ຫາຼຍກວາ່​ຫາ​ພືນ້​ທີ່​ທີ່​ໃຊ້​ ງານ​ໜ້ອຍ​ກວາ່.​ຕົວຢາ່ງ,​ຈາກ​ຫ້ອງ​ຂບັ​ແຂກ​ ຫາ​ຫ້ອງ​ນອນ. •​ ລອງ​ໃຊ້​ບານພັບ​ທີ່​ອະນຸຍາດ​ໃຫ້​ເປີດ​ໄດ້​ໃກ້​180° ທີ່​ສຸດ​ເທົາ່​ທີ່​ຈະ​ເປັນ​ໄປ​ໄດ.້ •​ ພືນ້​ທີ່​ໝນູ:​ຈ�າ​ເປັນ​ຕ້ອງ​ມີ​ພ້ືນ​ທີ່​ເຂົາ້​ອອກ​ທີ່​ໂລງ່​ ແຈງ້​ຢູ່​ທງັ​ສອງ​ດາ້ນ​ຂອງ​ປະຕ.ູ3 •​ ​ໃນບ່​ອນທີ່​ການ​ເຂົາ້​ອອກຈ�າກັດ:​ສາມາດ​ ພຈິາລະນາ​ໃຊປ້ະຕູ​ເລື່ອນ​(​ເບິງ່​ຮບູ​ອະທິບາຍ:​ ຫ້ອງນ�າ້​ທີ່​ເຂົາ້​ອອກ​ໄດງ້າ່ຍ).​ຕ້ອງ​ຮກັສາ​ຮອຍ​ເ​ລື່ອນ​ເທງິ​ພ້ືນ​ໃຫ້​ດີ​​ເພື່ອ​ໃຫ້​ປະຕູ​ເລື່ອນ​ໄດ້​ດ.ີ ​ຫ້ອງ​ນ້ໍາ •​ ທາງ​ເຂົາ້​ປະຕູທີ່​ເປີດ​ເຂົາ້​ຫ້ອງ​ນ�າ້ຫຼຸດຜ່ອນ​ພ້ືນ​ທີ່ຢູ່​ພາ​ຍ​ໃນ​ຫ້ອງ​ນ�າ້​​ແລະ​ຄວນ​ຫຼີກລຽງ​ຖາ້​ ເປັນ​ໄປ​ໄດ.້​ທາງ​ເລືອກ​ແມນ່​ການ​ໃຊ້​ປະຕູ​ເລື່ອນ. •​ ຮາວ​ຈບັ​ຢູ່​ຂາ້ງ​ຫ້ອງ​ນ�າ້​ແມນ່​ເປັນ​ປະ​ໂຫຍ​ດສ�າລັບ​ການ​ເຄື່ອນ​ຍາ້ຍ​ລົດ​ເຂນັ. 3​ ຂ�້​ພິຈາລະນາ​ດ້ານ​ການ​ອອກ​ແບບ​ສ�າລັບ​ການ​ຊ່ວຍ​ເຂົ້າ​ເຖິງ,​2006,​USAID,​John​Grooms,​Motivation​Charitable​Trust​UK,​ Disability​Organisations​Joint​Front 37 38 ການ​ເຮັດ​ໃຫ້​ຊຸມ​ຊົນ​ເປັນ​ບ່ອນ​ສາມາດ​ໄປມາ​ໄດ້​ງ່າຍ ​ເສ້ັນທາງ •​ ຄວາມ​ກວາ້ງ​ຂອງ​ເສັນ້ທາງ​ຄວນ​ຈະ​ແມນ່​900​ມມ​ທີ່​ ບ�່​ສິງ່​ກີດຂວາງ. •​ ​ເສັນ້ທາງ​ທີ່​ໃຫ້ຫາຼຍຄວນ​ມີ​ຄວາມ​ກວາ້ງ​1500​ມມ​​ ເພື່ອ​ໃຫ້​ລົດ​ເຂນັ​ສອງ​ຄນັ​ສວນ​ທາງ​ກນັ​ໄດ.້ 37 38 ຂອບ​ທາງ •​ ຂອບ​ທາງ​ຕາ່ງ​ລະດັບ​– ຂອບ​ທາງ/ທາງ​ເນນີທີ່​ມີ​ຂອບ​ບ່ອນ​ທີ່​ມີ​ລະດັບ​ແຕກຕາ່​ງກນັ​(​ເບິງ່​ຮບູ​ ສະ​ແດງ​ຂາ້ງ​ລຸມ່). ທາງ​ເນີນ ​ໃນ​ເວລາ​ເຮດັ​ໃຫ້​ອາຄານ​ເຂົາ້​ອອກ​ໄດ້​ງາ່ຍ​– ​ໃຫ້​ພິຈາລະນາ​ເຖງິ​ຄວາມ​ຈ�າ​ເປັນ​ຂອງທຸກ​ຄນົ.​​ ສ�າລັບ​ຜູ້​ໃຫ້​ລົດ​ເຂນັ​​ໃຫ້​ພິຈາລະນາ​ຂ�້​ສະ​ເພາະ​ຕ�່​ໄປ​ນີ:້ •​ ລະດັບ​ຄວາມ​ເນນີ:​ດາ້ນ​ໃນ​1:12,​ດາ້ນ​ນອກ​1:15. •​ ​ພືນ້​ໜາ້:​​ແນວ​ປ້ອງ​ກນັ​ບ�່​ໃຫ້​ມືນ່. •​ ຮາວ​ຈບັ:​ຄວນ​ຍາວ​300​ມມ​ຢູ່​ເດີນ່ລານ​ສ່ວນ​ລຸມ່​​ແລະສ່ວນ​ເທງິ​ກ່ອນ​ຈະ​ສິນ້​ສຸດ. •​ ​ຄວນ​ມເີດີນ່​ລານຢູ່​ສ່ວນ​ລຸມ່​​ແລະ​ສ່ວນ​ເທງິ​ຂອງ​ຄ້ອຍ​​ແລະ​​ເມື່ອ​ມີ​ການ​ປຽ່ນ​ທິດ​ທາງ:​ ຂະໜາດ​1200​ມມ​– 1500​ມມ. •​ ຄວນ​ວັດ​ແທກ​ເດີນ່​ລານ​ສ່ວນ​ເທງິ​ຫາ​ຂອບ​ຂອງ​ວງົ​ເປີດ​ປະຕ.ູ

WHEELCHAIR SERVICE TRAINING PACKAGE Participant’s Workbook ສໍາລັບ​ຂ້ໍ​ມູນ​ເພ່ີ​ມ​ເຕີມ,​​ໃຫ້​ຕິດ​ຕ່ໍ​ຫາ: World​Health​Organization 20​Avenue​Appia CH-1211​Geneva​27 Switzerland http://www.who.int/disabilities/en/ ​ອີ​ເມວ:​assistivetechnology@who.int ISBN​978​92​4​154908​0​

Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes Manual de Referência para Participantes (Inclui o Livro de Exercícios do Participante) Manual de Referência do WSTP para Gerentes – Página 2 Editores: Sarah Frost, Chapal Khasnabis, Kylie Mines e Lourdes de la Peza. Contribuidores: Michael Allen, Johan Borg, Alberto Cairo, Lauren Flaherty, Ricardo Guzman Hefferan, Cristi Ispas, Margaret Lamiell, Henry Lumley, Colin Macfarlane, Peter Mbuguah, Matt McCambridge, Ray Mines, Stephen Muldoon, Isaac Nyathi, Alana Officer, Kiran Patwardhan, Chris Rushman, Elsje Scheffler, Adarsh Shah, Rebecca Jackson Stoeckle, Sruti Mohapatra, Katherine Selengia, Nicky Seymour, Kate Wilson e Eric Wunderlich. Ilustrador: Melissa Puust Fotografias: David Constantine, Chapal Khasnabis e Jesse Moss Vídeos: Chapal Khasnabis, Amanda McBaine e Jesse Moss Apoio financeiro: Agência dos Estados Unidos da América para o Desenvolvimento Internacional Organizações parceiras para projetos pilotos: Cheshire Services Ethiopia (CSE), International Orthodox Christian Charities (IOCC), Management Sciences for Health (MSH), Mobility India, Motivation Africa e United Cerebral Palsy Wheels for Humanity (UCP). Publicado pela Organização Mundial da Saúde em 2015 sob o título Wheelchair Service Training Package for Managers © Organização Mundial de Saúde 2015 A Organização Mundial da Saúde concedeu direitos de tradução e publicação para uma edição em português da Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID), que é o único responsável pela qualidade e fidelidade da versão em português. No caso de qualquer inconsistência entre as versões inglesa e portuguesa, a versão original em inglês deve ser a versão vinculativa e autêntica. Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes © USAID 2017 Manual de Referência do WSTP para Gerentes – Página 3 Terminologia: Os termos usados no pacote de capacitação estão definidos abaixo. Cadeira de rodas adequada Cadeira de rodas que atenda às necessidades e condições ambientais do cadeirante; tenha dimensões e suporte postural adequados, além de ser segura e durável; esteja disponível no país; e possa ser obtida e mantida, com serviços sustentáveis no país ao preço mais econômico e acessível. Cadeira de rodas manual Cadeira de rodas impulsionada pelo próprio cadeirante ou empurrada por outra pessoa. Cadeira de rodas Equipamento que oferece mobilidade sobre rodas e suporte para uma pessoa sentada, que tenha dificuldade para andar ou deslocar-se. Fornecimento de cadeiras de rodas Termo geral que abrange o projeto, a produção e o fornecimento de cadeiras de rodas, assim como o fornecimento de serviços. Serviço de cadeiras de rodas O aspecto do fornecimento de cadeiras de rodas que assegura o fornecimento de uma cadeira de rodas adequada a cada cadeirante. Equipe de serviços de cadeiras Pessoas capacitadas no fornecimento de de rodas uma cadeira de rodas adequada. Cadeirante Pessoa com dificuldade para andar ou locomover-se e que utilize uma cadeira de rodas para mobilidade. Manual de Referência do WSTP para Gerentes – Página 4 Sumário: Manual de Referência do WSTP para Gerentes – Página 5 Sobre o Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes Introdução Após a publicação das Diretrizes para o Fornecimento de Cadeiras de Rodas Manuais em Áreas com Menos Recursos em 2008i, do Pacote de Capacitação para Serviços de Cadeiras de Rodas – Nível Básico (WSTPb) em 2012ii e do Pacote de Capacitação para Serviços de Cadeiras de Rodas – Nível Intermediário (WSTPi) em 2013iii, a Organização Mundial da Saúde (OMS), em parceria com a Agência dos Estados Unidos da América para o Desenvolvimento Internacional (USAID), elaborou este Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes (WSTPm). Esta é a terceira parte do Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas (WSTP), que se concentra mais nos sistemas e procedimentos necessários para que gerentes possam prestar um apoio eficaz ao fornecimento de serviços de cadeiras de rodas adequadas. A cadeira de rodas é um dos dispositivos assistivos mais comuns para viabilizar a mobilidade pessoal. Para pessoas com dificuldade para andar ou locomover-se, a cadeira de rodas é uma ferramenta essencial para a sua mobilidade, emancipação, dignidade e bem-estar geral. A mobilidade abre oportunidades para que os cadeirantes sejam independentes e tenham acesso a saúde, educação, trabalho e emprego, ajudando-os a participar de atividades sociais e culturais. Contudo, a OMS estima que mais de 70 milhões de pessoas precisam de cadeira de rodas e apenas 5% a 15% têm acesso a uma. A importância da mobilidade está refletida na Convenção sobre os Direitos das Pessoas com Deficiência (CDPD)iv, que defende "medidas eficazes para assegurar a mobilidade pessoal das pessoas com deficiência, com a maior independência possível". Para assegurar a sua efetiva mobilidade pessoal, os cadeirantes precisam de uma cadeira de rodas, que esteja corretamente adaptadas ao seu corpo e que atenda às suas necessidades específicas, sobretudo ambientais e de estilo de vida. Isso requer uma abordagem sensível às necessidades individuais. Uma forma eficaz de atender às necessidades individuais dos cadeirantes é com o fornecimento de cadeiras de rodas por meio de um sistema bem organizado de fornecimento de serviços de cadeiras de rodas, que atente às expectativas dos cadeirantes, respeite a sua dignidade e seja prestado por pessoal capacitado. Além disso, são limitadas as oportunidades de capacitação de pessoal para que obtenham os conhecimentos e as capacidades necessárias para fornecer cadeiras de rodas com eficácia. Objetivo O objetivo geral do pacote de capacitação é sensibilizar e desenvolver as capacidades e os conhecimentos de todo o pessoal envolvido no fornecimento de serviços de cadeiras de rodas. A OMS compreende que pessoal capacitado por si só não é suficiente para assegurar o fornecimento de cadeiras de rodas adequadas no país ou cumprir com as responsabilidades descritas nas Diretrizes para Cadeiras de Rodas, a menos que e até que haja um envolvimento de alto nível para estabelecer ou melhorar o fornecimento de cadeiras de rodas no país. Este Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes apresenta uma visão geral da função do gerente de serviço de reabilitação/cadeiras de rodas em engajar pessoas e liderar a implementação das oito etapas de serviço de cadeiras de rodas e das respectivas questões. Entre elas destacam-se os recursos humanos e físicos necessários para fornecer um serviço de cadeiras de rodas, inclusive planejamento, organização, provimento de pessoal, direção, custeio/financiamento, monitoramento e avaliação. Manual de Referência do WSTP para Gerentes – Página 6 O pacote de capacitação pode ser apresentado em 13 ou 14 horas, e esse período pode ser prolongado ou reduzido de acordo com as necessidades específicas e os recursos disponíveis. A apresentação deste pacote de capacitação ajudará os gerentes a: 1. Planejar melhor o fornecimento de serviços de cadeiras de rodas; 2. Aumentar a qualidade do fornecimento de serviços de cadeiras de rodas; 3. Melhorar a retenção de pessoal; 4. Aumentar a quantidade de cadeirantes que recebem cadeiras de rodas que atendem às suas necessidades; e 5. Aumentar a sustentabilidade do fornecimento de serviços de cadeiras de rodas. Público alvo Este pacote de capacitação destina-se a todo o pessoal responsável pela implementação, gestão e avaliação de serviços de reabilitação, inclusive serviços de cadeiras de rodas ou o fornecimento de serviços de cadeiras de rodas. Não é obrigatório ter experiência anterior em gestão de serviços de cadeiras de rodas; contudo, a oficina foi concebida pressupondo-se que os participantes já tenham capacidades gerais de gestão. Abrangência O pacote de capacitação inclui: • Uma visão geral das principais etapas de serviço de cadeiras de rodas descritas nos pacotes de capacitação da OMS para serviços de cadeiras de rodas; • Conhecimentos básicos necessários para o fornecimento de serviços de cadeiras de rodas; • Criação de um serviço de cadeiras de rodas; • Administração de um serviço de cadeiras de rodas; e • Como dar sustentabilidade ao fornecimento de serviços de cadeiras de rodas. Como utilizar o Manual de Referência Este Manual de Referência contém um sumário dos conhecimentos apresentados no Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes. Os participantes podem utilizar o Manual de Referência após o programa de capacitação para relembrar-se dos pontos principais ensinados em cada sessão da capacitação. O manual é dividido em três seções: A: Conhecimentos básicos; B: Criação de um serviço de cadeiras de rodas; e C: Administração de um serviço de cadeiras de rodas. O Manual de Referência também vem com o Livro de Exercícios do Participante. O objetivo do Livro de Exercícios do Participante é desenvolver as capacidades e os conhecimentos do pessoal envolvido no fornecimento de serviços de cadeiras de rodas. O Livro de Exercícios do Participante contém exercícios que ajudam a testar e desenvolver os conhecimentos e as capacidades dos participantes. O Livro de Exercícios do Participante contém material de aulas, apresentações e o Manual de Referência. O objetivo é que os participantes guardem as suas cópias do Manual de Referência juntamente com o livro de exercícios para referência futura, caso necessário. Manual de Referência do WSTP para Gerentes – Página 7 A. Conhecimentos básicos Manual de Referência do WSTP para Gerentes – Página 8 A.1 O que é o fornecimento de cadeiras de rodas adequadas? Fornecimento de cadeiras de rodas é um termo geral referente à concepção, produção, suprimento e fornecimento de serviços de cadeiras de rodas. As cadeiras de rodas são alguns dos dispositivos assistivos mais comuns, oferecendo mobilidade sobre rodas para pessoas com deficiência de mobilidade. A mobilidade é um passo importante no caminho para a inclusão. Quando uma pessoa recebe uma cadeira de rodas adequada por meio de um serviço, abrem-se oportunidades de vida social, trabalho e educação. Além disso, os familiares ficam liberados para participar na comunidade e no emprego.v Não são apenas os indivíduos e as suas famílias que se beneficiam com a maior mobilidade. A economia local e mais ampla é beneficiada com a maior quantidade de membros contribuintes da sociedade. Além disso, as pessoas que têm uma cadeira de rodas adequada apresentam menor tendência de sofrer complicações secundárias de saúde (como, por exemplo, úlceras por pressão) e, portanto, menor tendência de precisar de serviços de saúde. Há uma necessidade urgente de mudanças para podermos ver mais pessoas com acesso ao fornecimento de cadeiras de rodas adequadas. Quantas pessoas precisam de cadeiras de rodas? A OMS estima que 1% de qualquer população precisa de cadeiras de rodas. Isso significa que, em termos globais, estima-se que 70 milhões de pessoas ou mais precisam de uma cadeira de rodas. Essa estatística pode servir como ponto de início para estimar quantas pessoas precisam de uma cadeira de rodas em cada país, distrito ou cidade. Isso significa que gerentes não necessitam esperar por levantamentos detalhados para começar a planejar o fornecimento de serviços de cadeiras de rodas. População 1% Quantidade aproximada de pessoas que precisam de uma cadeira de rodas População mundial 7.000.000.000 1% 70.000.000 Brasil 203.657.000 1% 2.036.570 China 1.401.587.000 1% 14.015.870 Egito 84.706.000 1% 84.760 Índia 1.282.390.000 1% 12.823.900 Nigéria 183.523.000 1% 1.835.230 Rússia 142.098.000 1% 1.420.980 Convenções, estratégias e políticas em apoio ao fornecimento de cadeiras de rodas Muitas pessoas que precisam de cadeiras de rodas ainda não têm uma cadeira de rodas adequada. É necessário empreender uma campanha vigorosa para aumentar o acesso a cadeiras de rodas adequadas. Os gerentes podem utilizar políticas globais, regionais e nacionais para ajudar a defender os direitos à mobilidade das pessoas com deficiência de mobilidade. O quadro abaixo mostra exemplos de convenções, estratégias, políticas e diretrizes que podem ser ferramentas para os gerentes na defesa desses direitos. Política internacional Exemplo regional: a Estratégia de Incheon Políticas e diretrizes nacionais O instrumento de política de mais alto nível é a Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (CDPD). O Artigo 20 da CDPD diz que todas as pessoas têm direito à mobilidade pessoal. Outros artigos da CDPD reforçam a importância e relevância do fornecimento de cadeiras de rodas adequadas. Entre estes: A: 26 – Reabilitação A: 19 – Vida independente e inclusão na comunidade A: 24 – Educação A: 25 – Saúde A: 27 – Trabalho e emprego A: 30 – Participação em atividades culturais, recreativas, esportivas e de lazer. Em 2012, foi adotada a Estratégia de Incheon para "concretizar o direito para pessoas com deficiência na Ásia e no Pacífico. A Estratégia de Incheon tem 10 objetivos. O objetivo número três é o de melhorar o acesso ao ambiente físico, transportes públicos, conhecimentos, informações e comunicação. Durante a elaboração da estratégia, foi apresentado um forte argumento de que esse objetivo não poderia ser alcançado sem acesso a dispositivos assistivos adequados, inclusive cadeiras de rodas. Portanto, o Objetivo 3 inclui uma meta para pela metade a proporção de pessoas com deficiência que precisam, mas não têm dispositivos assistivos ou produtos adequados. Os governos que assinaram a Estratégia de Incheon agora estão empenhados em elaborar planos nacionais para cumprir essa obrigação. O exemplo da Estratégia de Incheon mostra como as políticas internacionais e regionais podem apoiar e incentivar a elaboração de uma política nacional. Planos, políticas e diretrizes nacionais podem ajudar a aumentar a eficácia e sustentabilidade do fornecimento de cadeiras de rodas.vi A elaboração de políticas e diretrizes nacionais requer colaboração entre todas as partes interessadas, inclusive pessoas com deficiência e fornecedores de serviços governamentais e não governamentais. A CDPD e as estratégias regionais pertinentes podem dar apoio à elaboração de planos, políticas e diretrizes nacionais. As diretrizes nacionais podem ajudar a definir como os dispositivos assistivos, inclusive os dispositivos de mobilidade, devem ser fornecidos. Por exemplo, a África do Sul publicou as suas Diretrizes Nacionais para o Fornecimento de Dispositivos Assistivos em 2003, estabelecendo padrões mínimos para as etapas de serviço, a capacitação de pessoal, a criação e gestão de listas de espera, orçamentos e o fornecimento de serviços de reparo e manutenção. A.2 Fornecimento de serviços Os serviços de cadeiras de rodas desempenham uma função importante no fornecimento de cadeiras de rodas. Os serviços de cadeiras de rodas trabalham com os cadeirantes para identificar a cadeira de rodas mais adequada (dentre as disponíveis) para o utilizador. Serviços de cadeiras de rodas de nível básico e intermediário Toda cadeira de rodas bem adaptada ao corpo do cadeirante oferece suporte postural. Encosto, almofada, apoios para os pés e os braços oferecem suporte postural quando ajustados ao tamanho do cadeirante. Contudo, muitas crianças e adultos precisam de suporte postural adicional nas suas cadeiras de rodas. Isso significa que é necessário oferecer diferentes níveis de serviço. Um serviço de cadeiras de rodas de nível básico trabalha com cadeirantes com capacidade de sentar-se eretos sem suporte postural adicional. Um serviço de cadeiras de rodas de nível intermediário trabalha com cadeirantes que precisam de suporte postural adicional para poderem sentar-se eretos com conforto. É importante que os gerentes de um serviço de cadeiras de rodas definam se o seu serviço é de nível "básico" ou "intermediário", pois o serviço intermediário requer pessoal com um nível mais elevado de capacitação, uma variedade maior de cadeiras de rodas, assim como mais materiais e equipamentos. Atendimento adequado às necessidades de mobilidade e suporte postural Clara vive no Timor Leste. Ela trabalha na loja da família, que funciona na parte da frente da sua casa. Clara tem pólio e precisa de uma cadeira de rodas para locomover-se dentro de casa, trabalhar na loja e transitar pela aldeia. Ela consegue sentar-se ereta sem suporte adicional e utiliza uma cadeira de rodas manual, que foi ajustada e adaptada para o seu corpo. Clara é um exemplo de alguém que pode receber uma cadeira de rodas por meio de um serviço de nível básico. Ishade tem oito anos e vive no Sri Lanka. Ela tem paralisia cerebral. Para Ishade, isso significa que ela tem dificuldades para controlar braços, pernas, cabeça e pescoço. Ela não consegue sentar-se ereta sem suporte. Ishade precisa de suporte postural adicional na sua cadeira de rodas. Ishade é um exemplo de alguém que deve receber uma cadeira de rodas por meio de um serviço de nível intermediário. Manual de Referência do WSTP para Gerentes – Página 11 As oito etapas do fornecimento de serviços de cadeiras de rodas; Etapa Resumo 1. Encaminhamen to e consulta A forma de encaminhamento de cadeirantes varia. Os cadeirantes podem encaminhar-se a si mesmos ou ser encaminhados por meio de redes compostas de profissionais governamentais ou não governamentais de saúde e reabilitação que trabalham no nível comunitário, distrital ou regional. Alguns serviços de cadeiras de rodas podem ter de identificar ativamente os potenciais cadeirantes que ainda não recebem serviços sociais ou de saúde nem participam de atividades escolares, profissionais ou comunitárias. 2. Avaliação Cada cadeirante precisa de uma avaliação individual. Isso inclui a recolha de informações sobre o estilo de vida do cadeirante, o seu trabalho, onde vivem e as suas condições físicas. 3. Prescrição (seleção) Com base nas informações obtidas na avaliação, a prescrição de uma cadeira de rodas é definida em conjunto com o cadeirante, familiar ou atendente. A prescrição detalha a seleção de cadeira de rodas em termos de tipo, tamanho, recursos especiais e modificações. Além disso, especifica a capacitação necessária para o cadeirante utilizar e manter a cadeira de rodas corretamente. 4. Financiamento e encomenda Identifica-se uma fonte de financiamento e a cadeira de rodas é obtida do estoque mantido pelo serviço ou encomendada junto ao fornecedor. 5. Preparação dos produtos Funcionários capacitados preparam a cadeira de rodas para a adaptação inicial. Dependendo do produto e das instalações do serviço, esse processo pode incluir a montagem e eventual modificação de produtos fornecidos por fabricantes ou a fabricação de produtos na oficina do serviço. 6. Adaptação O cadeirante experimenta a a cadeira de rodas. São feitos ajustes finais para assegurar a montagem e configuração correta da cadeira de rodas. Quando há necessidade de componentes de suporte postural, pode ser necessário fazer adaptações adicionais. 7. Capacitação do cadeirante O cadeirante e os atendentes aprendem a utilizar e manter a cadeira de rodas com segurança e eficácia. 8. Acompanhame nto, manutenção e reparos Visitas de acompanhamento oferecem a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Modelos de fornecimento de serviços Todos os serviços de cadeiras de rodas devem seguir as oito etapas do fornecimento de serviços de cadeiras de rodas. Contudo, há formas diferentes de fornecer as oito etapas de serviço, como descrito nos modelos de fornecimento de serviços. Uma combinação de diferentes modelos pode fazer parte de um serviço nacional geral. O melhor modelo de fornecimento de serviços depende do contexto e deve ser escolhido em consulta com todas as partes interessadas. O quadro abaixo mostra alguns exemplos dos diferentes modelos de fornecimento de serviços. Serviço baseado em centro Área exclusiva para avaliação Num serviço baseado em centro, os cadeirantes deslocam-se até uma instalação permanente, onde há funcionários capacitados para fornecer serviços. Sendo uma instalação permanente, o serviço pode ter funcionários e áreas exclusivas para o fornecimento de serviços de cadeiras de rodas. O serviço baseado em centro pode ser eficiente para o pessoal. Contudo, para os cadeirantes que moram longe do serviço, o deslocamento pode ser difícil. Área exclusiva para capacitação de mobilidade com cadeiras de rodas Serviço integrado Serviço de cadeiras de rodas integrado a uma clínica comunitária A maioria dos serviços baseados em centro também são "serviços integrados", ou seja, um serviço de cadeiras de rodas é integrado com outro(s) serviço(s). Por exemplo, ele pode ser integrado com um serviço de próteses/órteses, um departamento de fisioterapia ou uma clínica. Nesse contexto, quando o pessoal desempenha outras funções além do fornecimento de serviços de cadeiras de rodas, é importante que tenham tempo suficiente para realizar todas as atividades que lhe sejam designadas. As instalações podem ser partilhadas ou exclusivas. As funções administrativas, financeiras e de gestão podem ser partilhadas. Nesse contexto, uma área da oficina é dedicada à preparação de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 13 Serviço em campo Os locais de fornecimento de serviço em campo podem variar. Exemplos: clínicas comunitárias, prefeituras, locais de reunião, residência do cadeirante Num serviço de cadeiras de rodas em campo, o pessoal de um centro ou serviço integrado desloca-se até as residências dos cadeirantes ou um local centralizado em outro distrito/região – para ver os cadeirantes do distrito/região e fornecer serviços de cadeiras de rodas. Os modelos de serviço em campo em geral baseiam-se numa parceria com uma ou mais organizações do distrito/região. É importante que haja uma boa coordenação com as organizações locais. A oferta de alguma capacitação a funcionários ou voluntários locais pode ajudar a aumentar o sucesso do fornecimento de serviços em campo o nível de apoio da comunidade. A vantagem para os cadeirantes é que a distância de deslocamento é menor. O pessoal em campo deve ser flexível e levar equipamentos essenciais consigo Serviço ambulante Exemplo de um veículo dedicado ao serviço ambulante de cadeiras de rodas Um serviço ambulante é outra forma de fornecer serviços em campo. Contudo, nessa situação, o pessoal tem um veículo especial, que é utilizado para transportar as cadeiras de rodas, assim como as ferramentas e os equipamentos necessários. O pessoal pode atender numa variedade maior de locais e assim alcançar mais cadeirantes. A capacidade de transportar mais ferramentas, equipamentos, materiais e peças sobressalentes aumenta a oportunidade de realizar reparos de cadeiras de rodas no local e o potencial de fornecer alguns serviços de nível intermediário. Com a utilização de um veículo especial, o pessoal pode transportar mais equipamentos e ferramentas Fornecimento colaborativo de serviços Nem todas as oito etapas do fornecimento de serviços de cadeiras de rodas precisam ser realizadas pela mesma organização. A colaboração em uma rede de organizações pode ajudar a aumentar a eficiência, além de ampliar o acesso dos cadeirantes a todas as oito etapas. A etapa um (encaminhamento e consulta) requer colaboração e cooperação com organizações e indivíduos que compõem a rede de encaminhamento do serviço de cadeiras de rodas. As etapas sete (capacitação do cadeirante) e oito (acompanhamento, manutenção e reparo) em geral podem ser fornecidas por um parceiro, como, por exemplo, uma rede de organizações baseadas na comunidade ou organizações de pessoas com deficiência. Esse diagrama mostra como as oito etapas de fornecimento de serviços podem ser oferecidas por meio de uma parceria entre um fornecedor de serviços de cadeiras de rodas e organizações baseadas na comunidade. As etapas 2–7 são realizadas nas instalações do serviço e as etapas 1 e 8, na comunidade. Esse modelo requer que se considere a capacitação de todos os funcionários e voluntários envolvidos. A função do gerente no fornecimento de serviços de cadeiras de rodas O gerente de um serviço de cadeiras de rodas é responsável por apoiar o pessoal que executa as oito etapas do fornecimento de serviços e coordenar a "trajetória" do cadeirante (e seu atendente/familiar) por essas etapas. O gerente também tem funções mais amplas, que são importantes para apoiar o fornecimento de serviços, como: • Realizar campanhas de sensibilização sobre o fornecimento de cadeiras de rodas adequadas; • Melhorar a acessibilidade; • Aumentar as oportunidades de capacitação do pessoal de fornecimento de serviços de cadeiras de rodas; • Desenvolver a sustentabilidade – para a continuidade do fornecimento de serviços de cadeiras de rodas; • Influenciar a política nacional de fornecimento de cadeiras de rodas adequadas; • Aumentar a variedade de cadeiras de rodas disponíveis. Envolvimento ativo dos cadeirantes no fornecimento de serviços O envolvimento ativo de cadeirantes em todos os aspectos do fornecimento de serviços de cadeiras de rodas ajuda a melhorar o resultado para os cadeirantes. Algumas sugestões de estratégias para os gerentes assegurarem o envolvimento de cadeirantes no seu serviço de cadeiras de rodas:vii Manual de Referência do WSTP para Gerentes – Página 15 • Instrua o pessoal a envolver cadeirantes como membros da equipe de fornecimento de serviços em todas as etapas que antecedem o fornecimento da cadeira de rodas. • Crie um sistema no serviço para obter regularmente as opiniões dos cadeirantes sobre o serviço e sugestões para melhorá-lo. • Quando possível, recrute cadeirantes como membros da equipe de fornecimento de serviços. Isso pode ser feito publicando-se anúncios de vagas por meio do setor de deficiência e assegurando-se que todas as áreas do serviço de cadeiras de rodas sejam acessíveis. Cadeirantes na equipe na Romênia Uma ONG que oferece um serviço de cadeiras de rodas na Romênia ativamente recruta cadeirantes para as suas equipes de fornecimento de serviços de cadeiras de rodas. Os recrutas da equipe de fornecimento de serviços em geral passam pela rede de capacitação da organização e pelos programas esportivos para cadeirantes. Os cadeirantes desempenham diferentes funções na equipe, dependendo das suas capacidades. Essa ONG tem observado um impacto enormemente positivo com a inclusão de cadeirantes no pessoal do serviço de cadeiras de rodas. Todos os membros da equipe ficam mais conscientes das necessidades dos cadeirantes com a interação diárias com os colegas; os clientes cadeirantes tendem a sentir-se mais à vontade para compartilhar as suas experiências com o cadeirante membro da equipe, e o cadeirante torna-se um modelo para os outros. A.3 Função de liderança do gerente no processo de mudança A criação ou melhora do fornecimento de serviços de cadeiras de rodas em geral requer mudanças na organização. Contudo, pode ser difícil liderar as mudanças. Parte da função do gerente de um serviço de cadeiras de rodas é liderar mudanças, sendo que algumas atividades essenciais nesse sentido são: • Ajudar a criar uma visão comum para o fornecimento de cadeiras de rodas adequadas; • Comunicar a importância do fornecimento de cadeiras de rodas adequadas a todas as partes interessadas, inclusive autoridades, outros fornecedores de serviços e potenciais doadores; • Alinhar o pessoal e os recursos corretos; • Motivar, engajar e incentivar o pessoal. Criar uma visão comum para o fornecimento de cadeiras de rodas adequadas A criação de uma visão comum de todas as partes interessadas para melhorar o fornecimento de cadeiras de rodas no país pode ajudar a inspirar todas as pessoas que devem trabalhar juntas para concretizar as mudanças. A visão deve descrever o futuro desejado. Por exemplo: "Um mundo onde os cadeirantes são incluídos e participam plenamente de todos os aspectos da vida". É importante partilhar a visão positiva com entusiasmo para que todo o pessoal se sensibilize e se empenhe em melhorar a qualidade devida das pessoas com deficiência. Manual de Referência do WSTP para Gerentes – Página 16 Comunicar a importância do fornecimento de cadeiras de rodas adequadas; Para continuar a inspirar o pessoal e outras partes interessadas, os gerentes devem comunicar constantemente a importância do fornecimento de cadeiras de rodas adequadas. Os gerentes têm de deixar claro que a criação ou melhora do fornecimento de serviços de cadeiras de rodas é uma prioridade e que é urgente. Senso de urgência significa que há uma necessidade que não pode ser evitada ou postergada. As pessoas seguem as prioridades dos seus supervisores; portanto, as ações de um gerente devem criar o senso de urgência. Como comunicar a importância e urgência do fornecimento de cadeiras de rodas adequadas o Fale sobre a necessidade não atendida de cadeiras de rodas adequadas em nível global e nacional, o direito à mobilidade pessoal e os benefícios que os indivíduos, a comunidade e a sociedade derivam com o fornecimento de cadeiras de rodas adequadas. o Discuta o progresso no sentido de criar ou melhorar o fornecimento de serviços de cadeiras de rodas nas reuniões regulares do pessoal. o Conte histórias de sucesso, como, por exemplo, em reuniões do pessoal, e afixe cartazes nas paredes do serviço. Alinhar pessoal e recursos Serviços de cadeiras de rodas precisam de pessoal capacitado, instalações e recursos. Todos os membros da equipe do serviço de cadeiras de rodas devem: • Trabalhar juntos, no mesmo sentido; • Sentir-se apoiados com os recursos necessários para realizar o seu trabalho; • Ser reconhecidos pelas suas contribuições. Como alinhar pessoal e recursos • Identifique as instalações que podem ser usadas no fornecimento de serviços de cadeiras de rodas. • Priorize o fornecimento de serviços de cadeiras de rodas ao designar o tempo do pessoal, as instalações, os equipamentos e os recursos. • Utilize a visão comum e os benefícios do fornecimento de cadeiras de rodas adequadas para relembrar o pessoal do motivo por que o serviço fornece cadeiras de rodas. • Reconheça e recompense o bom trabalho do pessoal de fornecimento de serviços de cadeiras de rodas. • Facilite as condições para os funcionários trabalharem juntos, em equipe. Motivar, engajar e incentivar o pessoal Os gerentes podem ajudar a motivar, engajar e empenhar o pessoal ao: Manual de Referência do WSTP para Gerentes – Página 17 • Incluir o pessoal no planejamento e na implementação – para que possam contribuir as suas experiências e capacidades e para ajudá-los a compreender melhor o que as mudanças significarão e a sua função na implementação. • Superar os obstáculos juntos – para que o pessoal compreenda melhor as causas dos problemas e como resolvê-los. • Definir metas de curto prazo e reconhecer o cumprimento dessas metas – para que o pessoal saiba que os seus esforços têm um impacto e são valorizados. • Integrar as mudanças nos sistemas e na cultura da organização. Por exemplo, crie uma cultura de comemoração do sucesso e incentive as pessoas a falar sobre os sucessos e as histórias positivas durante as reuniões e os intervalos. Além disso, assegure a persistência das mudanças bem- sucedidas ao incluir novas responsabilidades nas descrições das funções de cada indivíduo e atualizar as políticas organizacionais. Manual de Referência do WSTP para Gerentes – Página 18 Seção B: Criação de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 19 B.1 Acesso aos serviços O que significa "serviço equitativo"? Um "serviço equitativo" é um serviço que assegure a mesma oportunidade para cada cadeirante receber uma cadeira de rodas. Isso inclui: • homens, mulheres, meninos e meninas; • jovens, pessoas de meia idade e idosos; • pessoas que vivem próximas e pessoas que vivem em áreas mais distantes – por exemplo, nas zonas rurais; • pessoas de diferentes etnias e condições socioeconômicas. Serviços equitativos reconhecem que todas as pessoas, qualquer que seja a sua deficiência, idade, sexo, religião, riqueza, idioma e grupo étnico, têm o mesmo direito aos serviços. Um serviço equitativo de cadeiras de rodas não é o mesmo que fornecer uma quantidade igual de cadeiras de rodas a pessoas de diferentes grupos (por exemplo, uma quantidade igual de cadeiras de rodas para homens e mulheres), pois as necessidades dos diferentes grupos podem variar. Lembre-se: O acesso a um serviço não significa apenas "chegar ao serviço". Significa saber que o serviço existe, chegar ao serviço ou receber o serviço nas suas casas. Há alguns grupos de pessoas que podem ter dificuldade de acesso aos serviços. Eis alguns exemplos: • mulheres e meninas; • pessoas que vivem distantes dos serviços/pessoas que vivem nas zonas rurais; • pessoas pobres; • crianças; • pessoas de diferentes grupos religiosos ou étnicos; • idosos; • grupos específicos – por exemplo, pessoas com HIV ou lepra podem sofrer discriminação. Os gerentes devem estar cientes dos diferentes grupos abrangidos no seu contexto, que provavelmente têm menos acesso aos serviços. Manual de Referência do WSTP para Gerentes – Página 20 Encaminhamento e consulta Encaminhamento e consulta é a primeira etapa no fornecimento de serviços de cadeiras de rodas. Etapa Resumo 1. Encaminhamen to e consulta A forma de encaminhamento de cadeirantes varia. Os cadeirantes podem encaminhar-se a si mesmos ou ser encaminhados por meio de redes compostas de profissionais governamentais ou não governamentais de saúde e reabilitação que trabalham no nível comunitário, distrital ou regional. Alguns serviços de cadeiras de rodas podem ter de identificar ativamente os potenciais cadeirantes que ainda não recebem serviços sociais ou de saúde nem participam de atividades escolares, profissionais ou comunitárias. O encaminhamento eficaz requer bons vínculos entre um serviço de cadeiras de rodas e a comunidade, pois são as pessoas na comunidade que identificam e encaminham cadeirantes para o seu serviço. Diferentes indivíduos e organizações com maior probabilidade de identificar cadeirantes e encaminhá-los ao seu serviço de cadeiras de rodas: • hospital local; • postos de saúde comunitários; • redes de reabilitação baseada na comunidade; • líderes de aldeia/conselho/igreja; • organizações de pessoas com deficiência; • outros cadeirantes; • médicos/enfermeiras. O que os gerentes podem fazer para desenvolver uma rede de encaminhamento? • Identifique as fontes de encaminhamento (indivíduos e organizações) da sua área. • Discuta com o pessoal do serviço de cadeiras de rodas que informações as fontes de encaminhamento necessitam para poder identificar cadeirantes que precisam de uma cadeira de rodas e como encaminhá-los ao serviço. • Prepare (ou peça ao pessoal que prepare) materiais/panfletos com as informações necessárias para as fontes de encaminhamento. • Visite (ou peça ao pessoal que visite) indivíduos ou organizações que possam fazer encaminhamentos para conversar sobre o serviço de cadeiras de rodas. • Organize um dia de visita no serviço de cadeiras de rodas para cadeirantes e fontes de encaminhamento. • Ofereça a capacitação para redes de encaminhamento às fontes de encaminhamento. • Considere a elaboração de um formulário de encaminhamento para as fontes de encaminhamento preencherem. Os formulários devem ser simples, e o seu serviço deve responder aos encaminhamentos (com a marcação de uma consulta para o cadeirante encaminhado) e enviar um feedback positivo às fontes de encaminhamento que utilizam o formulário. Manual de Referência do WSTP para Gerentes – Página 21 Aumento do acesso equitativo aos serviços Os gerentes desempenham uma função importante, ajudando a aumentar o acesso equitativo aos serviços. O quadro abaixo contém algumas sugestões sobre como aumentar o acesso para diferentes grupos. O que os gerentes podem fazer para aumentar o acesso equitativo aos serviços? Pa ra m ul he re s e m en in as • Assegure a disponibilidade de informações sobre o serviço de várias formas – por exemplo, pelo rádio, panfletos/cartazes com textos simples, imagens visuais. • Certifique-se de que, além dos homens, mulheres também estejam apresentadas nos anúncios do serviço. • Identifique modelos de mulheres cadeirantes que possam falar sobre a importância das cadeiras de rodas para as mulheres em público e na comunidade. • Fale com os líderes da comunidade sobre como as cadeiras de rodas são de igual importância para mulheres, crianças e homens. • Apóie e incentive a participação de mulheres em todos os níveis dos serviços de cadeiras de rodas, inclusive em cargos de gestão e liderança. • Ofereça às OPD informações sobre o serviço de cadeiras de rodas e enfatize que tanto mulheres como homens precisam de cadeiras de rodas para mobilidade. • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para homens, mulheres e crianças – não simplesmente "pessoas". Pa ra c ria nç as • Assegure a disponibilidade de informações sobre o serviço em locais eventualmente frequentados pelos pais de crianças com deficiência – por exemplo, clínicas comunitárias, serviços de reabilitação, mercados, centros comunitários, igrejas, mesquitas, templos. • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para homens, mulheres e crianças – não simplesmente "pessoas". • Ofereça educação e informações sobre o serviço a pessoas que possam tratar crianças com deficiência – por exemplo, médicos, enfermeiras, profissionais de saúde comunitária. • Certifique-se de que, além dos adultos, crianças também estejam apresentadas nos anúncios do serviço. • Explique as vantagens do fornecimento de cadeiras de rodas a crianças em idade precoce sempre que falar sobre o serviço. Além disso, explique as vantagens do fornecimento de cadeiras de rodas a famílias/atendentes de crianças. Pa ra p es so as po br es • Reduza o custo dos serviços o máximo possível. • Identifique formas de oferecer assistência financeira aos cadeirantes sem condições para pagar por transporte até os serviços de cadeiras de rodas ou pelas cadeiras de rodas (quando cobradas). Por exemplo, crie um fundo para cadeiras de rodas. Manual de Referência do WSTP para Gerentes – Página 22 Pa ra id os os • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para todos – inclusive os idosos. • Inclua fotografias de pessoas idosas utilizando cadeiras de rodas nos anúncios sobre o serviço. • Explique as vantagens de uma cadeira de rodas para pessoas idosas, e as suas famílias, ao falar sobre o serviço de cadeiras de rodas. Pa ra p es so as q ue v iv em d is ta nt es d os s er vi ço s/ pe ss oa s qu e vi ve m n as z on as ru ra is • Assegure a disponibilidade de informações sobre o serviço nas zonas rurais – por exemplo, clínicas rurais, mercados, centros comunitários, igrejas, mesquitas, templos. • Ofereça informações sobre o serviço a pessoas que trabalham com pessoas que vivem nas zonas rurais – por exemplo, profissionais de reabilitação baseados na comunidade. • Identifique formas de auxiliar os cadeirantes rurais com transporte caso o serviço não atenda em campo. Por exemplo – assistência financeira para transporte, colaborações com outras organizações que possam ajudar a transportar pessoas até o serviço. • Descubra se é possível oferecer acomodações para cadeirantes de zonas rurais ao visitar o serviço. • Ofereça serviços em campo nas zonas rurais. • Capacite pessoas que já trabalham nas zonas rurais (por exemplo, profissionais de saúde comunitária) para darem apoio aos cadeirantes da comunidade, fazer acompanhamento e ajudar com procedimentos simples de manutenção e reparo de cadeiras de rodas. • Assegure a disponibilidade de cadeiras de rodas que possam ser efetivamente utilizadas em terrenos acidentados nas zonas rurais e ofereça informações sobre como fazer adaptações simples (por exemplo, rampas ou nivelamento de caminhos) para facilitar a utilização de cadeiras de rodas nas zonas rurais. Pa ra d ife re nt es gr up os ét ni co s/ so ci oe co n ôm ic os • Ao falar sobre o serviço de cadeiras de rodas, sempre mencione que o serviço é para todos – qualquer que seja o seu grupo socioeconômico. • Inclua fotografias de pessoas de diferentes grupos étnicos e religiosos da área atendida pelo serviço em todos os anúncios sobre o serviço. • Quando possível, contrate pessoas de diferentes grupos socioeconômicos para trabalhar no serviço. Manual de Referência do WSTP para Gerentes – Página 23 B.2 Instalações e equipamentos O fornecimento de serviços de cadeiras de rodas pode ser realizado em vários locais. Contudo, onde quer que seja, serão necessárias algumas instalações e equipamentos. Os serviços de nível básico precisam de menos espaço e equipamentos do que os serviços de nível intermediário. Instalações e equipamentos para todos os serviços de cadeiras de rodas (básico e intermediário) Área de recepção e espera Qual é o espaço necessário? É necessário ter uma área de registro, onde os cadeirantes e as suas famílias também possam esperar juntos. Caso haja alguma probabilidade de que as pessoas viajem alguma distância para chegar ao serviço, pense sobre onde poderão comprar um lanche. Na ilustração à direita, um comerciante local tem uma barraca do lado de fora da clínica local. Uma área tranquila onde os cadeirantes possam deitar-se enquanto esperam pode ser muito útil. Isso é particularmente importante para: • Pessoas fracas e frágeis, que precisem descansar durante a consulta; • Crianças cansadas; • Qualquer pessoa identificada com uma úlcera por pressão numa área que sustente peso no seu corpo. É necessário ter sanitários acessíveis próximos à área de recepção e espera e à área de avaliação e adaptação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Equipamentos recomendados: • Equipamentos para registro: mesa/escrivaninha, cadeira, telefone e uma local para guardar e arquivar documentos com segurança. • É recomendável ter cartazes, panfletos e vídeos disponíveis na área de espera. Quando um serviço observa uma grande proporção de crianças, é recomendável ter alguns brinquedos simples disponíveis enquanto esperam. Manual de Referência do WSTP para Gerentes – Página 24 Área de escritório para o pessoal Qual é o espaço necessário? O pessoal precisa de um espaço onde possam trabalhar e reunir-se, escrever notas e guardar registros com segurança. Área para avaliação e adaptação Qual é o espaço necessário? É necessário ter um espaço relativamente tranquilo e privado onde os cadeirantes possam ser avaliados pelo pessoal e onde a cadeira de rodas possa ser adaptada. O espaço deve ser acessível para cadeiras de rodas, acomodar familiares e ter iluminação suficiente. É recomendável identificar uma parede acessível e vazia para servir como fundo para a avaliação e fotografias. Num serviço baseado em centro, as dimensões sugeridas para esse espaço são as seguintes (variam muito, dependendo do volume de casos): • Área clínica de nível básico: 3 m x 2,5 m • Área clínica de nível intermediário: 4 m x 3,5 m Às vezes a área clínica fica na residência de alguém. e a ênfase é na flexibilidade e adaptabilidade, sendo necessário levar os equipamentos essenciais consigo. Equipamentos: • Divisórias – caso sejam examinados mais de um cliente de cada vez, devem ser utilizadas cortinas ou divisórias para oferecer privacidade. • Banco ou leito de avaliação – uma estrutura firme e estável com a altura da cadeira de rodas para o cadeirante sentar-se durante a avaliação. A superfície deve ter algum estofamento para proteger a pele, como, por exemplo, EVA ou uma esteira de ginástica ou ioga. Posicione o leito de forma que o avaliador possa trabalhar atrás ou na frente do cadeirante. • Apoios para os pés – um jogo de apoios de diferentes tamanhos para apoiar os pés do cadeirante. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Câmera – é útil ter uma câmera para gravar os pontos principais do processo de avaliação e adaptação (com a autorização assinada do cadeirante). • Fita métrica ou paquímetros. Manual de Referência do WSTP para Gerentes – Página 25 Área para preparação, manutenção e reparo de cadeiras de rodas Qual é o espaço necessário? É necessário ter uma área "técnica" para: • montar, reparar e manter cadeiras de rodas; • fabricar modificações, quando necessário. O espaço deve ser bem iluminado, ventilado e seco, assim como ter uma boa temperatura para trabalhar. A segurança é importante para ferramentas manuais e elétricas. O ideal é ter um armário de metal com fechadura para armazená-las. Num serviço permanente/baseado em centro, a área técnica deve ser dividida da seguinte forma: • Uma área "limpa" para a montagem final dos componentes e o ajuste dos produtos e para realizar as verificações de segurança e prontidão. A área deve ter espaço livre e espaço para bancos. • Uma área de "fabricação" é necessária para fazer modificações e reparos, como cortar e colar espuma, perfurar em geral, lixar, limar e pintar. A área deve ter espaço livre e espaço para bancos. Nem todos os trabalhos técnicos têm de ser realizados na área técnica do próprio serviço. Por exemplo, um serviço de cadeiras de rodas pode terceirizar alguns aspectos técnicos, como a costura de estofamento (a um alfaiate local) e a soldagem (a uma oficina local de metalurgia). Equipamentos: • Armários, prateleiras e quadros de ferramentas suficientes para manter a área organizada e maximizar o espaço livre. • Ferramentas para montagem e ajuste de cadeiras de rodas e fabricação de modificações. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Uma lista de materiais para modificações. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Pelo menos uma bancada para cada técnico. Recomenda-se que pelo menos uma bancada tenha altura ajustável caso haja um cadeirante na equipe. O banco deve ser posicionado com espaço atrás e na frente para que se possa trabalhar no nível do piso. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. (Obs.: as instalações e os equipamentos necessários para uma oficina de fabricação de cadeiras de rodas são bem mais extensos e ultrapassam a abrangência deste manual). Manual de Referência do WSTP para Gerentes – Página 26 Área de armazenamento Qual é o espaço necessário? É necessário ter uma área protegida para armazenar cadeiras de rodas, peças sobressalentes e materiais. A área de armazenamento deve estar próxima à área técnica e ser protegida, seca e livre de animais/pestes. Uma grade de metal na janela oferece segurança adicional. Quando não é possível ter uma sala exclusiva, prepare uma área exclusiva dentro de uma sala. Nesse caso, é necessário considerar as necessidades de segurança. Preparação de uma área de armazenamento: As sugestões abaixo podem ser úteis para a preparação de uma área organizada para armazenamento: • Prateleiras ajudam a maximizar o espaço. • O acesso e a eficiência aumentam deixando-se uma passagem entre prateleiras, caixas e cadeiras de rodas montadas. A passagem deve ficar desimpedida. • Organize os artigos por tipo e tamanho. Para facilitar o controle e a reposição de estoque, recomenda-se agrupar os artigos por tipo. • Artigos pequenos, como parafusos, porcas e arruelas, podem ser guardados em caixas pequenas, uma para cada artigo e tamanho. Marque o nome do artigo na frente da caixa. • Caixas e materiais não devem ser colocados diretamente no chão ou encostados numa parede exterior para não sofrerem danos de umidade. Estrados são úteis para não guardar artigos no chão. • Caso haja uma janela, pode-se acrescentar uma grade para aumentar a segurança. Capacitação do cadeirante Qual é o espaço necessário? É necessário ter uma área de capacitação de cadeirantes para ensinar: • transferências e educação de saúde; • manobra, cuidado e manutenção de cadeiras de rodas; • capacidades de mobilidade. Transferências e educação de saúde podem ser ensinadas numa área clínica, na residência do cliente ou numa instalação em campo. Equipamentos: • Recomenda-se ter os equipamentos básicos, como um leito para praticar transferências. Manual de Referência do WSTP para Gerentes – Página 27 Manobra, cuidado e manutenção de cadeiras de rodas podem ser ensinados na área limpa de uma oficina ou em qualquer outro local apropriado. Equipamentos: • É necessário ter os equipamentos básicos de manutenção de cadeiras de rodas. Capacidades de mobilidade em geral são ensinadas numa área exterior, mas áreas interiores também servem. Uma área exterior construída especificamente para capacitação de mobilidade pode simular as diferentes superfícies que os cadeirantes encontrarão na sua vida diária – como terreno acidentado, terreno mole, drenos, lombadas, guias, degraus, escadas. Num serviço integrado – a área de capacitação de mobilidade pode ser utilizada por pessoas com outras deficiências de mobilidade, como, por exemplo, pessoas que necessitam aprender a utilizar uma prótese de membro ou reaprender a andar após uma lesão. Quando não há espaço para uma área dedicada à capacitação de mobilidade – identifique espaços existentes que possam ser utilizados para capacitação de mobilidade com segurança. Evite áreas onde haja muitos transeuntes e procure um lugar com uma variedade de obstáculos. Os equipamentos portáteis de capacitação de mobilidade podem ser fabricados e instalados no local de fornecimento de serviços de cadeiras de rodas. A ilustração à direita mostra equipamentos portáteis de capacitação de mobilidade instalados sob uma tenda. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Manual de Referência do WSTP para Gerentes – Página 28 Instalações e equipamentos adicionais para serviços de nível intermediário Para fornecer um serviço de cadeiras de rodas de nível intermediário, é necessário ter espaço e alguns equipamentos adicionais. Os requisitos adicionais que os gerentes devem considerar estão descritos abaixo. Área de avaliação e adaptação Um serviço intermediário requer um leito de avaliação para o cadeirante deitar-se durante a avaliação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Uma caixa especializada de avaliação pode ser muito útil para serviços de nível intermediário. Uma caixa de avaliação oferece um apoio ajustável para os pés e um bom acesso para dar apoio durante a simulação das mãos. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. • Blocos de espuma firme para os suportes temporários devem estar disponíveis durante a avaliação e adaptação. • Um espelho de corpo inteiro pode ser muito útil para o cadeirante e o pessoal do serviço observarem a postura e o alinhamento de diferentes ângulos. • Brinquedos e fotografias nas paredes criam um ambiente mais amistoso para as crianças. Armazenamento No nível intermediário, há uma necessidade maior de armazenamento dos materiais necessários para modificações e componentes de suporte postural. Entre os materiais figuram lâminas de espuma, que devem ser armazenadas na posição horizontal e em local seco. Portanto, é necessário ter mais espaço e prateleiras de armazenamento. Área de preparação, manutenção e reparo de cadeiras de rodas O serviço precisa de uma área limpa e uma máquina de costura industrial para estofar componentes e cintas de suporte postural modificados ou fabricados. Sem o espaço e os equipamentos, o serviço terá de terceirizar essa tarefa. Organização do espaço de trabalho Manual de Referência do WSTP para Gerentes – Página 29 Uma vez que as instalações e os equipamentos tenham sido obtidos, o gerente deve atribuir as responsabilidades pela organização de cada instalação, aplicando as quatro etapas abaixo: 1. Elimine a desordem: remova todas as ferramentas, peças, equipamentos, documentos desnecessários. 2. Identifique os artigos utilizados com regularidade: ferramentas, peças, instruções e documentos. Os artigos utilizados com regularidade devem ser organizados para facilitar e agilizar a sua localização. 3. Sistema e responsabilidade: tenha um sistema para cada local de trabalho e alguém responsável pela implementação do sistema. 4. Monitore: o sistema para assegurar a "persistência" da mudança. B.3 Variedade de cadeiras de rodas adequadas O que significa uma cadeira de rodas e almofada adequada? As necessidades dos cadeirantes variam. Mas todos precisam de uma cadeira de rodas e almofada adequada. As diretrizes da OMS para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos oferecem a seguinte definição de cadeira de rodas adequada: • Atende às necessidades e condições ambientais do cadeirante; • Adapta-se bem ao corpo do cadeirante e oferece o suporte postural correto; • É segura e durável; • Está disponível no país; e • Pode ser obtida e mantida, com serviços sustentáveis no país ao custo mais econômico e acessível. Para atender às necessidades dos cadeirantes que utilizam um serviço de cadeiras de rodas, os serviços devem oferecer pelo menos alguns tipos diferentes de cadeiras de rodas e almofadas. O melhor tipo de almofada para o cadeirante depende das suas necessidades. Contudo, todas as pessoas em risco de desenvolver uma úlcera por pressão precisam de uma almofada de alívio de pressão e capacitação sobre como utilizá-la. Custo de não ter os equipamentos corretos em combinação com a capacitação dos cadeirantes A esperança de vida média em países com bons recursos é de aproximadamente 38 anos após a lesão quando esta é sofrida entre os 25 e 34 anos de idade.viii Em contraste, um estudo realizado em Bangladesh constatou que a esperança de vida mediana após uma lesão medular é de 5,36 anos, com 56,4% a falecer dentro de 5 anos após a lesão.ix Das pessoas incluídas no estudo, 80% faleceram em casa e um terço destes apresentavam úlceras por pressão no falecimento. Num hospital de reabilitação no Sri Lanka, foi realizado um levantamento dos custos do hospital na unidade de lesões medulares em 1999. Nessa época, levava-se cerca de 6 semanas para uma úlcera por pressão superficial sarar, a um custo de US$ 286. Uma úlcera por pressão profunda precisava de aproximadamente um ano para sarar, ao custo estimado de US$ 2.483. O mesmo levantamento demonstrou que, com a introdução de uma cadeira de rodas, almofada e colchão corretos, com a devida educação para o paciente, a incidência de úlceras por pressão durante o internamento no hospital poderia ser reduzida em 70% e os gastos com curativos, em quase 60%. Um programa hospitalar em São Paulo, Brasil, criou um serviço voltado à educação para reduzir as complicações secundárias em pessoas com lesões medulares. A incidência de úlceras por pressão foi reduzida em 23%x. Manual de Referência do WSTP para Gerentes – Página 31 Seleção de uma variedade de cadeiras de rodas e almofadas adequadas Adapta-se bem ao corpo do cadeirante e oferece suporte Os cadeirantes precisam de cadeiras de rodas bem adaptadas ao seu tamanho. Quando o tamanho não está certo, a cadeira de rodas pode ser desconfortável, não oferece um bom suporte postural e pode causar lesões ao cadeirante. Isso significa que o serviço de cadeiras de rodas precisa de um estoque de cadeiras de rodas de diferentes tamanhos ou cadeiras de rodas com tamanho ajustável. A maioria dos cadeirantes passa várias horas sentada. Isso significa que a cadeira de rodas não é apenas um recurso de mobilidade. Também lhes dá ajuda a sentar-se eretas com conforto. As pessoas também têm necessidades diferentes de suporte postural e, portanto, precisam de cadeiras de rodas com tipos diferentes de suporte. As pessoas com necessidades de suporte postural de nível básico precisam do suporte de uma cadeira de rodas bem adaptada ao corpo do cadeirante. As pessoas com necessidades de suporte postural de nível intermediário precisam de uma cadeira de rodas bem adaptada ao corpo do cadeirante e suporte adicional. O suporte adicional pode ser criado acrescentando-se suportes posturais adicionais à cadeira de rodas ou instalando-se um assento com suporte especial. O custo de não fornecer o tamanho correto ou o suporte correto O pessoal do Centro de Reabilitação do Western Cape, na África do Sul, documentou as complicações observadas num grupo de crianças em escolas e centros de atendimento, que precisavam de suporte postural. Dentre elas, 21% das crianças desenvolveram outras complicações posturais. O custo dessas complicações para as crianças, as suas famílias e os serviços foi: • Maiores complicações e mais tempo gasto em consultas • Saúde mais frágil • Postura pior e maior desconforto • Menor tolerância na posição sentada (menos tempo sentado com conforto) Manual de Referência do WSTP para Gerentes – Página 32 • Menor participação em programas educacionais • Deterioração da qualidade de vida. Atende às necessidades e condições ambientais do cadeirante Uma cadeira de rodas adequada deve ajudar o cadeirante a fazer o que necessitam fazer. Os cadeirantes precisam subir e descer da cadeira de rodas, empurrá-la, dobrá-la para transporte e armazenamento, assim como realizar as suas atividades diárias. O tipo correto de cadeira de rodas, com os recursos corretos, pode facilitar tudo isso para o cadeirante. Os cadeirantes também precisam de uma cadeira de rodas que funcione bem no seu ambiente. Diferentes cadeiras de rodas são melhores para diferentes ambientes. Por exemplo, algumas cadeiras de rodas são melhores para utilização interna, outras são melhores para ambientes exteriores e terrenos acidentados. Equipamentos abandonados: ter algo é melhor do que não ter nada? Quando não atendem às necessidades do cadeirante, em geral são abandonados. Essa ilustração conta uma história comum. O cadeirante tem três cadeiras de rodas doadas, mas nenhuma atende às necessidades, e não consegue sair de casa. As duas primeiras estão inutilizáveis, pois estão quebradas, sem peças sobressalentes disponíveis. A terceira é nova, mas é de má qualidade, parece bamba e instável quando utilizada fora de casa, fazendo o cadeirante sentir-se inseguro. Segurança e durabilidade Os cadeirantes querem produtos seguros e duráveis, que possam ser reparados a um custo acessível. Os serviços de cadeiras de rodas também são beneficiados quando fornecem cadeiras de rodas seguras, duráveis e com opções de reparo local. Isso pode ajudar a reduzir o custo de reposição das cadeiras de rodas e facilitar a manutenção. Muitos cadeirantes em áreas com menos recursos utilizam as suas cadeiras de rodas sobre terrenos acidentados e expostas à chuva, areia e lama. Essas cadeiras de rodas devem ser fortes e fabricadas para durar nessas condições. As cadeiras de rodas de má qualidade quebram-se com rapidez (por exemplo, em 3 a 6 meses). Em contraste, cadeiras de rodas bem projetadas e bem mantidas podem durar de 3 a 5 anos. Assim obtém-se um valor muito maior pelo preço. Alguns problemas comuns com cadeiras de rodas de má qualidade: • Estofamento de má qualidade no assento e encosto rasga ou afunda; • Roldanas (eixos, pneus, mancais, garfos) quebram-se; • Rodas traseiras (eixo das rodas, aro de impulso, raios, mancais, pneus) quebram-se ou desgastam-se; • Os freios enferrujam e param de funcionar; • Os apoios para os pés quebram-se; • Não têm almofadas ou as almofadas são de má qualidade e perdem a funcionalidade com rapidez; • Peças removíveis se perdem. Manual de Referência do WSTP para Gerentes – Página 33 Função do gerente Os gerentes de serviços de cadeiras de rodas desempenham uma função importante na obtenção e no recebimento de cadeiras de rodas doadas. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. A sua função é a de assegurar: • O serviço tem várias opções de cadeiras de rodas e almofadas – para poder atender (o tanto quanto possível) às diferentes necessidades dos cadeirantes. Isso inclui considerar as diferentes necessidades de variedade de tamanho, suporte postural, meio ambiente e estilo de vida; • As cadeiras de rodas selecionadas são duráveis – sobretudo quando utilizadas em terrenos acidentados e ambientes rigorosos; • As cadeiras de rodas podem ser reparadas localmente. Isso pode incluir a aquisição (ou doação) de peças sobressalentes ou a disponibilidade local de peças sobressalentes para compra. É importante solicitar ativamente feedback dos cadeirantes sobre os produtos fornecidos pelo serviço de cadeiras de rodas. Os gerentes e o pessoal do serviço podem falar com os cadeirantes em visitas em casa, reuniões em grupo ou por meio de Organizações de Pessoas com Deficiência. Ao oferecer um novo tipo de cadeira de rodas ou almofada pela primeira vez, o serviço de cadeiras de rodas pode optar por fazer um teste com um grupo de cadeirantes que experimentem o produto novo durante um período e dêem feedback. O feedback pode ser obtido em entrevistas individuais ou em grupos de discussão. Como os gerentes podem assegurar a durabilidade e a possibilidade de reparo das cadeiras de rodas? Os gerentes podem fazer perguntas aos fornecedores (ou doadores) para obter mais informações sobre as cadeiras de rodas. Por exemplo, os gerentes podem perguntar: • A cadeira de rodas tem alguma certificação (por exemplo: testes de desempenho e testes de garantia de qualidade administrados por um órgão profissional)? Caso sim, quais foram os resultados? • O fornecedor recomenda alguma vida útil específica para a cadeira de rodas? • O fornecedor tem um sistema para comunicação de falhas? • Quem mais compra e utiliza as cadeiras de rodas? O gerente pode entrar em contato com outros serviços que fornecem a cadeira de rodas para obter mais informações sobre o respectivo desempenho? • Quais são as ferramentas necessárias para montar e/ou ajustar a cadeira de rodas? • Há disponibilidade de peças sobressalentes? Essas peças precisam ser compradas no exterior ou algumas das peças sobressalentes necessárias estão prontamente disponíveis no país? • A cadeira de rodas já foi experimentada no país e, caso sim, quais foram os comentários/resultados? • Se a armação quebrar – o reparo pode ser local? • A cadeira de rodas vem com um guia de manutenção? Manual de Referência do WSTP para Gerentes – Página 34 Manutenção e reparo de cadeiras de rodas A etapa oito do fornecimento de serviços de cadeiras de rodas é acompanhamento, manutenção e reparo. 8. Acompanhame nto, manutenção e reparos Visitas de acompanhamento oferecem a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Um aspecto importante dessa etapa é ensinar aos cadeirantes e às famílias como manter a cadeira de rodas. A manutenção regular, quando realizada em casa, pode ajudar a assegurar a durabilidade da cadeiras de rodas e reduzir a necessidade de grandes reparos. Os serviços de cadeiras de rodas também podem capacitar parceiras colaboradoras para fornecer serviços de manutenção e reparo, assim como identificar recursos na comunidade (por exemplo, lojas de conserto de bicicletas) que possam realizar a manutenção e o reparo de cadeiras de rodas. Manual de Referência do WSTP para Gerentes – Página 35 B.4 Alinhamento de pessoal Funções num serviço de cadeiras de rodas Os serviços de cadeiras de rodas com frequência são fornecidos por um grupo de pessoas que trabalham em equipe. Diferentes membros da equipe desempenham diferentes funções – como clínica, técnica, administrativa e gerencial. Diferentes indivíduos podem desempenhar uma ou mais funções. Por exemplo, uma pessoa responsável por uma função clínica também pode participar da gestão do serviço. Em algumas situações, funcionários de diferentes organizações podem trabalhar juntos para desempenhar as diferentes funções. O quadro abaixo mostra como o pessoal responsável por diferentes funções cobrem as diferentes atividades envolvidas no fornecimento de serviços de cadeiras de rodas. Clínica Técnica Capacitaçã o de cadeirantes Administrativ a Gerencial Gestão e desenvolvimento do serviço Promoção do serviço      Obtenção de financiamento  Desenvolvimento da base de encaminhamento     Contato com outras organizações      Avaliação do serviço      Etapas principais do fornecimento de serviços 1. Encaminhamento e consulta     2. Avaliação    3. Prescrição    4. Financiamento e encomenda     5. Montagem e/ou produção  6. Adaptação   7. Capacitação do cadeirante    8. Acompanhamento, manutenção e reparos    Capacitação e desenvolvimento profissional Capacitação do pessoal da rede de encaminhamento    Capacitação do pessoal da rede de acompanhamento    Capacitação do pessoal de fornecimento de serviços    Manual de Referência do WSTP para Gerentes – Página 36 Capacitação As funções do serviço podem ser desempenhadas por pessoas com diferentes históricos educacionais e profissionais, desde que tenham recebido a devida capacitação.1 É importante que o pessoal responsável pelas funções clínicas, técnicas e de capacitação tenha recebido capacitação. • O pessoal clínico e técnico responsável por serviços de nível básico devem ser capacitados nas competências descritas no Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas – Nível Básico. • O pessoal clínico e técnico responsável por serviços de nível intermediário devem ser capacitados nas competências descritas no Pacote de Capacitação da OMS para Serviços de Cadeiras de Rodas – Nível Intermediário. Lembre-se: Ao oferecer capacitação ao pessoal, é recomendável capacitar pelo menos duas pessoas de cada vez. Se houver apenas uma pessoa capacitada, o serviço fica muito vulnerável à possibilidade de essa pessoa sair da organização com todos os seus conhecimentos e experiências. Planejamento da capacidade do serviço Os gerentes devem ter a capacidade de planejar o seu serviço com base em quantos cadeirantes poderão atender a cada mês e ano, o que se pode denominar "capacidade do serviço". A capacidade do serviço abrange: • A quantidade de cadeirantes que receberão uma cadeira de rodas pela primeira vez; • A quantidade de cadeirantes que receberão acompanhamento. A capacidade de serviço está diretamente ligada ao: • Número de funcionários disponíveis para o fornecimento de serviços de cadeiras de rodas; • Tempo do pessoal disponível para o fornecimento de serviços de cadeiras de rodas; • Número de cadeiras de rodas que o serviço consegue obter – o que, por sua vez, com frequência depende está diretamente ligado ao orçamento. Cálculo do tempo do pessoal Para estimar a capacidade do serviço, os gerentes devem calcular o tempo que o pessoal dedicará ao fornecimento de serviços de cadeiras de rodas. Para tanto, os gerentes necessitam saber: • A quantidade de semanas de trabalho disponíveis em cada ano (deduzindo-se os feriados e períodos de férias); • A parcela do tempo que o pessoal dedicará ao fornecimento de serviços de cadeiras de rodas (e não a outras responsabilidades, funções ou atividades). Os gerentes também devem considerar quanto tempo o pessoal gasta nas diferentes etapas do fornecimento de serviços de cadeiras de rodas. Há vários fatores envolvidos. Por exemplo, o grau de experiência do pessoal do serviço; a necessidade de modificar ou não a cadeira de rodas fornecida. Contudo, como referência, uma equipe experiente (clínica e técnica) pode ter a capacidade de fornecer: • uma cadeira de rodas nova a dois clientes de nível básico por dia; ou • uma cadeira de rodas nova a dois clientes de nível intermediário por dia. 1 Diretrizes da OMS: Potenciais candidatos para capacitação para desempenhar essas diferentes funções: Profissionais ou voluntários de RBC, os funcionários atuais do serviço que ainda não receberam capacitação, enfermeiras qualificadas, fisioterapeutas, terapeutas ocupacionais, protesistas, ortesistas, médicos e outros profissionais de reabilitação de saúde, cadeirantes interessados em trabalhar com outros cadeirantes como parte da equipe de serviço. Manual de Referência do WSTP para Gerentes – Página 37 O quadro abaixo contém um exemplo de capacidade de serviço estimada com base numa equipe de duas pessoas que trabalham juntas. Um membro da equipe desempenha uma função clínica, a outra desempenha uma função técnica, e ambos oferecem capacitação para os cadeirantes. A equipe trabalha 5 dias/semana, 42 semanas por ano. Havendo cadeiras de rodas e materiais suficientes, a equipe pode fornecer: • um serviço de cadeiras de rodas de nível básico para uma quantidade estimada de 357 cadeirantes por ano; ou • um serviço de cadeiras de rodas de nível intermediário para uma quantidade estimada de 179 cadeirantes por ano. Serviço básico Serviço intermediário Planejamento da semana de trabalho Número de dias de trabalho por semana 5 5 Número de semanas de trabalho por ano (deduzindo-se os feriados e períodos de férias) 42 42 Estimativa da capacidade de serviço Número de utilizadores do serviço por dia 2 1 Número de utilizadores do serviço por semana 10 5 Número de utilizadores do serviço por ano 420 210 Contingência de 15% (para eventos inesperados) -63 -32 Número estimado de utilizadores por ano 357 179 A função do gerente é a de criar ou desenvolver uma equipe de fornecimento de serviços de cadeiras de rodas • Identifique funcionários atuais ou novos para desempenhar as diferentes funções do serviço de cadeiras de rodas. • Organize uma capacitação para o pessoal que ainda não tem as capacidades necessárias. • Defina o tempo que o pessoal tem disponível para dedicar ao fornecimento de serviços de cadeiras de rodas, com base numa estimativa realista das suas outras responsabilidades, funções ou atividades. • Estime a capacidade anual de serviço – e comunique à equipe. • Dê apoio ao pessoal no desempenho das suas funções de fornecimento de serviços de cadeiras de rodas. Por exemplo: o Envolva o pessoal no planejamento do serviço; o Crie uma ferramenta de planejamento semanal/mensal – com consultas e outras atividades; o Faça reuniões semanais para verificar o progresso, destacar os sucessos e resolver dificuldades. Manual de Referência do WSTP para Gerentes – Página 38 B.5 Custo de um serviço de cadeiras de rodas Uma função importante do gerente é identificar o custo do fornecimento de serviços de cadeiras de rodas. O quadro abaixo mostra algumas das rubricas mais importantes do orçamento associadas à criação e administração de um serviço de cadeiras de rodas. Os custos efetivos variam de acordo com o contexto. Rubrica orçamental Feedback Custos iniciais Concepção dos produtos Compra de uma variedade de produtos Ferramentas Equipamento Prédio/instalações Pode incluir prédio/reforma/modernização. Estoque de materiais Custos operacionais Cadeiras de rodas Estoque de cadeiras de rodas – com base na estimativa de capacidade de serviço e das necessidades previstas para os clientes cadeirantes. Peças sobressalentes É muito recomendável manter um estoque das peças sobressalentes geralmente necessárias. Materiais No nível básico, alguns materiais são necessários para modificações. No nível intermediário, são necessários mais materiais. Frete (transporte de produtos) Transporte e impostos para cadeiras de rodas importadas. Transporte de cadeiras de rodas para centros satélites. Pessoal Administração O guia de orçamentação abrange uma ampla variedade de possíveis funcionários. Não se espera que todos os serviços tenham todos esses funcionários. As marcas (veja a planilha) indicam atividades relacionadas com as etapas de serviço. Um funcionário pode ser responsável pela realização de mais de uma atividade. Pessoal clínico Pessoal técnico Capacitador/capacitador de pares Administrador Transporte local Custos de transporte local de funcionários Por exemplo, acompanhamento, serviços em campo; redes de encaminhamento para capacitação. Transporte local de clientes Deslocamento até o serviço para consultas. Acomodações para clientes custo de acomodações para clientes que precisam passar a noite (caso seja coberto/apoiado pelo serviço). Materiais impressos Formulários, listas de verificação e informações para o cadeirante. Materiais consumíveis Cola, linha, tinta, etc. Reposição de ferramentas Ferramentas desgastam-se – e, portanto, é necessário orçamentar recursos para a reposição. Custos administrativos Considere eletricidade, água, aluguel – para as diferentes áreas do serviço (clínica, técnica, de armazenamento, de capacitação de cadeirantes, de escritórios). Capacitação do pessoal Considere eventuais custos de capacitação do pessoal do serviço Manual de Referência do WSTP para Gerentes – Página 39 Capacitação de parceiros/redes de encaminhamento Considere eventuais atividades de capacitação/sensibilização para parceiros ou organizações encaminhadoras. Angariação de recursos O custo de eventuais atividades de angariação de recursos também deve ser orçamentado. Monitoramento e avaliação Custos associados a monitoramento e avaliação – por exemplo, visitas aos utilizadores do serviço para obter feedback. Os custos podem incluir deslocamentos ou pessoal adicional para realizar o monitoramento e a avaliação. Soluções econômicas Os gerentes que trabalham em áreas com menos recursos devem identificar formas de reduzir os custos. Algumas formas de reduzir os custos: Serviços integrados • Um serviço integrado, que efetivamente partilhe as mesmas instalações, pode oferecer oportunidades significativas de divisão de custos em comparação com a criação de serviços separados. Divisão de custos com outras organizações Um serviço pode formar parcerias com outras organizações para dividir custos. Por exemplo: • Algumas organizações internacionais de doadores/desenvolvimento podem ter interesse em dividir o custo das cadeiras de rodas. A vantagem para o centro de serviço é que os produtos ficam mais acessíveis. A vantagem para a organização internacional é que os seus recursos têm um impacto maior e ajudam o centro de serviço a demonstrar a sua capacidade de alcançar a sustentabilidade financeira. • As organizações comunitárias locais podem estar dispostas a formar uma parceria com o serviço para fornecer mais serviços locais. A parceira comunitária pode ter a capacidade de oferecer instalações e alguns funcionários para realizar algumas das etapas do fornecimento de serviços de cadeiras de rodas (por exemplo, acompanhamento e capacitação de cadeirantes). A vantagem para os cadeirantes é que isso reduziria deslocamentos e custos. A vantagem para o centro de serviço é que os serviços poderiam expandir-se para dentro da comunidade. Potenciais fontes de financiamento Mais informações sobre como obter financiamentos para os custos de criação e administração de um serviço de cadeiras de rodas estão apresentadas em C.4: Planejamento da sustentabilidade financeira. Manual de Referência do WSTP para Gerentes – Página 40 Seção C: Administração de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 41 C.1 Como saber se o seu serviço funciona? Monitoramento e avaliação ajudam o gerente a ver o que está (ou não está) acontecendo como resultado das atividades da sua equipe. Também ajudam o gerente e a sua equipe a aprender o que está e o que não está funcionando, assim como compreender o que os utilizadores do serviço e as partes interessadas acham. O que é monitoramento e avaliação? Monitoramento Avaliação Quando são realizados? • Continuamente • Integrados nas atividades diárias do serviço • Nas fases principais do serviço – por exemplo, durante uma avaliação anual. (embora algumas informações possam ser obtidas continuamente) O que se mede? • Atividades do serviço • Cadeiras de rodas e suportes adicionais utilizados • Quantidade e população de pessoas beneficiadas • Impacto em indivíduos e comunidades • Sustentabilidade Que fontes de informações são utilizadas? • Bancos de dados de utilizadores do serviço • Notas do serviço • Dados do serviço • Feedback dos utilizadores • Relatórios financeiros • Análise do tempo do pessoal • Levantamentos • Questionários • Discussões em grupo • Visitas em casa • Observação do serviço na prática • Análise das contas Serviços eficientes e eficazes Como o monitoramento e a avaliação são úteis para os gerentes e outros indivíduos envolvidos no serviço? • Oferece informações importantes para melhorar a qualidade do fornecimento de serviços • Oferece informações para orientar a compra de produtos • Ajuda a conter os custos, aumentando a eficiência, e a justificar o financiamento atual e proposto • Permite que os serviços demonstrem, com evidências, a eficácia do serviço aos financiadores – inclusive o governo e ONG doadoras • Ajuda a identificar e quantificar as necessidades não atendidas • Ajuda a distribuir recursos corretamente • Aumenta a sensibilização quanto aos benefícios do serviço • Desenvolve parcerias mais sólidas com os beneficiários do serviço. Manual de Referência do WSTP para Gerentes – Página 42 Ao planejar o monitoramento e a avaliação de um serviço, é recomendável criar um modelo com três etapas. Detalhes adicionais encontram-se no quadro 3.5 das Diretrizes para Cadeiras de Rodas. 1. Planejamento da área a ser monitorada 2. Definição de metas de desempenho 3. Identificação de formas de obtenção de informações Ao analisar as informações e os dados recolhidos, que há duas considerações importantes. • Quando uma atividade não está indo bem, trabalhe junto com os utilizadores do serviço, o pessoal do serviço e outras partes interessadas para identificar a raiz do problema. • Quando um atividade está indo bem e as metas são alcançadas, identifique formas de partilhar e comemorar o sucesso para motivar a equipe do serviço e outras partes interessadas. Importância do feedback dos cadeirantes A avaliação permite que o serviço reflita sobre o que funciona e o que necessita mudar. Também permite que o serviço considere se está a cumprir o objetivo geral. O objetivo da avaliação, segundo as Diretrizes para Cadeiras de Rodas, é: • Promover a mobilidade pessoal com a maior independência possível; • Melhorar a qualidade de vida mediante a ampliação do acesso a cadeiras de rodas; • Aumentar a inclusão e a participação. Há vários critérios que podem ser utilizados para avaliar um serviço. Entre estes: Manual de Referência do WSTP para Gerentes – Página 43 • Os cadeirantes atendidos e a intervenção recebida; • Custo do serviço, inclusive o custo dos produtos e do fornecimento de serviços; • Pessoal (quantidade de funcionários e as suas funções e competências); • Instalações e equipamentos disponíveis para o serviço; • A qualidade do fornecimento de serviços (as Diretrizes para Cadeiras de Rodas contêm recomendações de boas práticas na seção 3.3); • O impacto do serviço nos cadeirantes e as suas famílias. É muito importante envolver cadeirantes na avaliação de serviços de cadeiras de rodas. Ao planejar o feedback dos cadeirantes, há algumas considerações importantes. • Transporte e tempo são dois dos custos mais significativos. É possível que os cadeirantes que oferecem feedback precisem de apoio com os respectivos custos de deslocamento ou tempo. • O feedback pode ser obtido rotineiramente de cada utilizador do serviço ou de forma aleatória a cada mês ou ano. • O serviço só tem a beneficiar-se quando os seus utilizadores sentem-se à vontade para oferecer um feedback aberto e franco. Pode ser útil encarregar uma pessoa que não faça parte diretamente do serviço para realizar as entrevistas. Um exemplo dos benefícios da avaliação do serviço na Etiópia: Dois representantes em campo entrevistaram 140 cadeirantes de sete centros de serviço no país. Ambos os representantes tinham uma deficiência de mobilidade, e constatou-se que isso foi muito vantajoso para o seu trabalho. Os próprios representantes em campo ficaram bem informados sobre as dificuldades enfrentadas pelos cadeirantes no seu país. O processo os capacitou como ativistas em prol das necessidades e dos direitos dos cadeirantes. Os utilizadores do serviço tiveram benefícios emocionais e psicológicos ao serem entrevistados por alguém que lhes dava um exemplo positivo. Após as entrevistas de avaliação, formou-se uma rede informal que reforçou o relacionamento entre os fornecedores de serviços e os cadeirantes. Além disso, por meio da avaliação, foram identificados alguns casos de cadeirantes que não tinham recebido uma cadeira de rodas adequada às suas necessidades. Isso ajudou a identificar a necessidade de capacitação no serviço, e o serviço pôde tomar medidas. Importância dos dados iniciais ao avaliar o impacto Para examinar o impacto do serviço nas pessoas que recebem uma cadeira de rodas, é importante registrar a situação de um indivíduo antes de qualquer intervenção, ou seja, antes do início da avaliação. Possíveis oportunidades para a obtenção de dados iniciais: • quando se faz o encaminhamento – pelo pessoal de um centro de encaminhamento ou clínica; • entre o encaminhamento e a avaliação – numa visita em casa ou por telefone; • no momento da avaliação – antes de iniciar a avaliação. Para obter mais informações, consulte a pasta de recursos adicionais no DVD/Pendrive. Ao realizar as entrevistas para obter informações dos utilizadores do serviço, é importante preparar a(s) pessoa(s) que fará(ão) as entrevistas, para que se possa obter uma resposta clara e completa para cada pergunta. Isso é importante para a validade dos dados. Manual de Referência do WSTP para Gerentes – Página 44 Conselhos de técnica de entrevista Preparação • Antes da entrevista, pratique o que dirá. Não diga mais do que o necessário. Técnica • Leia as perguntas exatamente como estão formuladas. • Não sugira respostas ao entrevistado, nem que seja de forma sutil. • Seja neutro caso precise explicar alguma coisa. • Registre as respostas corretamente. Respeite a pessoa • Não continue se a pessoa não concordar em ser entrevistada de livre e espontânea vontade. • Ajude a pessoa a relaxar. • Não demonstre choque, satisfação ou insatisfação com nada que a pessoa diga. • Trate as respostas da pessoa com sigilo. O estabelecimento de um bom sistema de dados iniciais dos utilizadores aumenta a qualidade do fornecimento de serviços de cadeiras de rodas, o que, por sua vez, reflete o impacto do serviço na qualidade de vida do utilizador. Isso pode ser feito: • como parte rotineira do acompanhamento; • como uma atividade distinta. Avaliação do impacto em crianças Quando possível, é importante dar "voz" às crianças e obter o seu feedback sobre o impacto das suas cadeiras de rodas e do serviço. Um exemplo é a utilização do dado de sentimentos.xi Primeiro, categorizam-se os diferentes sentimentos com a criança. Em seguida, pode-se pedir-lhe que complete afirmações como "Sinto-me feliz quando…" ou "Sinto-me triste quando…". Zangado Triste Magoado Envergonhado Animado Feliz Registro e processamento de dados O monitoramento e a avaliação envolvem registro, obtenção, armazenamento e processamento de informações (dados). O registro eficiente de dados pode economizar tempo e dinheiro. O ideal é introduzir os dados diretamente na base de dados, que é criada para processar os resultados e elaborar a maioria dos relatórios do serviço. Os computadores tablets portáteis podem ser muito úteis, pois permitem registrar dados tanto no centro como em visitas em campo. A tecnologia de telefonia móvel avança com rapidez e também pode oferecer um método para introduzir, enviar e receber dados. Elaboração de um plano de serviço Um plano anual de serviço, que é monitorado durante todo o ano, pode ajudar a assegurar um serviço eficiente e eficaz. Não se esqueça de motivar, engajar e incentivar o pessoal do serviço e de envolvê-los na elaboração do plano e das metas. O plano de serviço pode incluir uma avaliação no fim do ano. Um exemplo da estrutura de um plano de serviço encontra-se abaixo. Manual de Referência do WSTP para Gerentes – Página 45 Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Em comparação com os homens, uma quantidade muito menor de mulheres (20% mulheres, 80% homens) utilizou o serviço de cadeiras de rodas no ano passado. Para ampliar a identificação e o encaminhamento de mulheres ao serviço: • Converse com as fontes de encaminhamento, inclusive representantes de aldeias, sobre como identificar mulheres, • Colabore com a OPD nacional para identificar mulheres que possam servir como modelos para incentivar as mulheres a procurar o serviço. Aumente a porcentagem de mulheres com acesso ao serviço de cadeiras de rodas para pelo menos 40%. Continue a atualizar a base de dados de cadeirantes para identificar quantos homens e quantas mulheres utilizam o serviço. C.2 Gestão da demanda Para administrar um serviço, há um equilíbrio importante entre as necessidades dos utilizadores, que geram a demanda, e a capacidade do pessoal do serviço para fornecer um serviço adequado. Geração de demanda A necessidade de serviços pode ser estimada calculando-se 1% da população da área onde o serviço atua. Contudo, quando as pessoas não sabem sobre o serviço e os seus benefícios ou não têm acesso ao serviço, a demanda pode ser baixa a despeito da necessidade. Quando a demanda por serviços é baixa, o custo por utilizador aumenta, o que ameaça a sustentabilidade financeira do serviço. A função do gerente é a de identificar a raiz da baixa quantidade de encaminhamentos. Entre as possibilidades destacam-se: • O serviço não identificou as fontes de encaminhamento mais adequadas. Manual de Referência do WSTP para Gerentes – Página 46 • As pessoas que precisam de uma cadeira de rodas não utilizam as fontes de encaminhamento. • A capacitação da rede de encaminhamento não conseguiu estabelecer os benefícios e a importância de um serviço de cadeiras de rodas. • Os cadeirantes não conseguem utilizar o serviço – por ser longe demais de onde vivem, por não haver transportes disponíveis, etc. Após a identificação da causa da falta de encaminhamentos, o gerente e a sua equipe podem trabalhar para gerar demanda. Gestão da demanda Se a quantidade de pessoas encaminhadas a um serviço ultrapassa a capacidade do pessoal, há três resultados prováveis: • O pessoal dedica menos tempo que o necessário para cada pessoa – e a qualidade do serviço piora; • O tempo que os cadeirantes têm de esperar por uma consulta aumenta; ou • Alguns cadeirantes são rejeitados. Em cada caso, a situação é desmoralizante tanto para os utilizadores do serviço como o pessoal do serviço. Portanto, é muito útil fazer uma gestão cuidadosa da demanda. Os gerentes devem trabalhar inicialmente com menos fontes de encaminhamento, a começar pelas fontes mais próximas. Isso tem a vantagem de facilitar o acompanhamento na fase inicial do serviço. Os meios de comunicação em massa e telefones gratuitos nacionais tendem a gerar demanda em massa de longas distâncias. Sem uma rede de serviço, seria difícil atender e oneroso para os utilizadores do serviço e os fornecedores de serviços. Criação e gestão de listas de espera Quando a demanda por um serviço é alta; crie uma lista de espera. Vale a pena investir tempo na criação de um sistema com uma base de dados para registrar essas informações. Isso permite que o gerente e o pessoal do serviço consultem as informações com eficiência e facilita o processamento de estatísticas do serviço. Após uma pessoa utilizar o serviço, poderão ser acrescentadas informações adicionais, como data da avaliação, data da adaptação, visita de acompanhamento. Triagem de encaminhamentos e listas de espera À medida que aumenta a quantidade de pessoas na lista de espera, algumas organizações fazem uma triagem e priorizam os encaminhamentos. Prioridade deve ser dada aos seguintes grupos de pessoas: • Crianças – em virtude da importância do encaminhamento precoce e do maior risco de desenvolver desvios de postura durante surtos de crescimento; • Cadeirantes em risco de desenvolver uma úlcera por pressão – pois esse é um problema que causa risco de vida; • Cadeirantes com um problema progressivo – em virtude da urgência da sua posição; • Pessoas com dores causadas pela falta de uma cadeira de rodas ou uma cadeira de rodas mal adaptada. Manual de Referência do WSTP para Gerentes – Página 47 Alguns campos essenciais na base de dados a considerar para facilitar a triagem e o planejamento de consultas: • idade; • tipo de deficiência; • motivo do encaminhamento; • localização geográfica. Capacidade de serviço É importante controlar as expectativas do que um serviço pode oferecer – em termos de quantidade de cadeirantes que podem ser atendidos e do nível de fornecimento de serviços. Embora haja necessidade de serviços intermediários e avançados, nem todo serviço tem a capacidade de atender nesses níveis. Contudo, o pessoal do serviço encontrará utilizadores com necessidades além dos seus conhecimentos, capacidades e disponibilidade de produtos. Os gerentes devem ter uma estratégia para lidar com essa situação. Os gerentes podem: • Assegurar a clareza das informações sobre o serviço (o que o serviço pode fazer) nos panfletos/livretos. • Entrar em contato com outros fornecedores de serviços para explorar a possibilidade de encaminhamento ou colaboração nos casos de pessoas com necessidades que ultrapassem a capacidade do seu serviço. • Documentar as necessidades que não podem ser atendidas e planejar a ampliação da capacidade do pessoal e da disponibilidade de produtos. A importância do encaminhamento precoce de crianças Muitas crianças que precisam de cadeiras de rodas também podem precisar de suporte postural adicional. Isso significa que muitas crianças precisam de um serviço de nível intermediário. É muito importante que todas as crianças sejam encaminhadas a serviços o mais cedo possível para prevenir ou retardar os problemas de postura. As necessidades específicas das crianças e os benefícios do encaminhamento precoce são discutidos na sessão sobre Crianças no pacote de capacitação WSTPi. O encaminhamento precoce é importante para crianças pelos seguintes motivos: • Crianças com dificuldade para sentar-se eretas podem desenvolver problemas posturais se não tiverem suporte. Se a criança for encaminhada com atraso, alguns problemas posturais poderão tornar-se permanentes. Isso pode criar dificuldades para a criança sentar-se confortavelmente, até mesmo com suporte. • Sem a experiência de sentar-se e ter mobilidade, o desenvolvimento da criança pode ser retardado • Para crianças com alguma capacidade para andar, a cadeira de rodas pode facilitar a sua vida diária e dar-lhes a oportunidade de fazer mais coisas num dia. Infelizmente, às vezes as crianças não são encaminhadas a um serviço de cadeiras de rodas tão cedo quanto deveriam. Os pais talvez sintam esperança de que a criança fique curada e volte a andar Alguns pais preocupam-se com o custo de uma cadeira de rodas ou não sabem do serviço. Em alguns casos, os pais podem achar que a cadeira de rodas impedirá a criança de andar. É importante que toda a equipe do serviço esteja clara sobre por que o encaminhamento precoce é importante. O pessoal também pode tranquilizar os pais e as fontes de encaminhamento acerca da cadeira de rodas, pois é improvável que impeça a criança de andar quando essa é uma Manual de Referência do WSTP para Gerentes – Página 48 possibilidade. A experiência da mobilidade por meio de uma cadeira de rodas quando a criança está aprendendo a andar beneficiará o seu desenvolvimento de várias formas. Diretrizes para o encaminhamento de crianças Encaminhe crianças que:  tenham dificuldade para sentar-se eretas ou não consigam levantar-se com 1 ano de idade ou que não andem sozinhas com 2 de idade; ou  tenham deficiências físicas significativas ou estejam atrasadas em relação aos marcos de desenvolvimento. Exemplo de sucesso: encaminhamento precoce por pais no México (para atividade em grupo) Este é um exemplo de como um grupo de centros de reabilitação para crianças no México desenvolveu uma rede eficaz de encaminhamento precoce. Embora tivessem médicos neonatais e pediatras como os alvos principais das suas atividades de sensibilização, os centros de reabilitação também realizavam uma grande campanha anual de angariação de recursos na comunidade em geral, utilizando os meios de comunicação em massa, como rádio e televisão. Isso resultou em muitos encaminhamentos por pessoas que ouviram falar do serviço e muitos pais que auto-encaminham os seus filhos. Nessas campanhas de sensibilização, a mensagem era clara: a importância de encaminhar crianças para reabilitação ao nascerem. Também apresentaram uma visão potente de sucesso, com muitas histórias positivas relacionadas com a integração e as realizações das crianças com quem trabalham. Num período de 15 anos, os centros de reabilitação têm observado uma mudança cultural, com pediatras e famílias que agora ativamente fazem encaminhamentos precoces. O resultado: Um terço de todos os encaminhamentos são de crianças com até três anos de idade. Como os gerentes podem incentivar encaminhamentos precoces com sucesso • Mensagem clara sobre os alvos • Objetivo claro para o que se quer realizar • Uma abordagem diferente para profissionais e pais • Partilhar histórias de sucesso para incentivar pais e profissionais a encaminhar • Sensibilização constante durante vários anos. Administração de um serviço eficiente e eficaz Análise da eficiência e eficácia do serviço Após o início das operações do serviço, é recomendável analisar cada etapa de serviço e observar quanto tempo requer. Para aumentar a eficiência das etapas de serviço, é importante: • incentivar um bom trabalho em equipe; • planejar o que se pode preparar com antecedência para cada etapa de serviço. O quadro abaixo oferece algumas sugestões para aumentar a eficiência do serviço. Manual de Referência do WSTP para Gerentes – Página 49 Diferentes formas de aumentar a eficiência do serviço – para cada etapa do fornecimento de serviços de cadeiras de rodas Encaminhamento • Defina metas e objetivos claros para o nível de demanda que o serviço deseja atender. • Mensagem clara sobre quem o serviço atende. • Identifique uma variedade de organizações e profissões de encaminhamento para campanhas de sensibilização. • Monitore atentamente os volumes de encaminhamentos. • Partilhe histórias de sucesso com o pessoal do serviço e a rede de encaminhamento uma vez que os encaminhamentos aumentem. Avaliação • Planeje o nível adequado de capacitação para o pessoal do serviço. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. • Verifique se todos os equipamentos estão instalados para a realização de avaliações. Prescrição • Crie sistemas eficazes de controle de estoques. • Quando os produtos têm ajustabilidade limitada, as modificações devem ser prescritas de forma a adaptar o produto ao corpo do cadeirante. • Oriente o pessoal a discutir soluções de prescrição com o cadeirante e, se possível, mostrar-lhe as opções de produtos. Isso evitará a rejeição de soluções pelo cadeirante. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Financiamento e encomenda • Clareza na documentação de informações e nos registros. • Crie sistemas eficazes de controle de estoques. Preparação dos produtos • Adquira produtos com o máximo possível de ajustabilidade. • Adquira produtos que possam ser facilmente modificados. • Fabrique com antecedência dispositivos de suporte postural e/ou adquira produtos com dispositivos de suporte postural. • Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos. • Adquira os materiais necessários para a fabricação e modificação de almofadas e DSP. • Crie sistemas eficazes de controle de estoques. • Prepare um pequeno estoque de cadeiras de rodas em diferentes tamanhos. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Adaptação • Equipes clínicas e técnicas trabalham juntas durante a adaptação. • Prepare com antecedência amostras de opções de configuração de produtos. • Adquira produtos com o máximo possível de ajustabilidade. • Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos. • Adquira produtos que possam ser facilmente modificados. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Capacitação do cadeirante • Designe uma pessoa específica para a capacitação de cadeirantes, como, por exemplo, um capacitador de pares. • Identifique uma instalação para a capacitação de cadeirantes próximo às Manual de Referência do WSTP para Gerentes – Página 50 áreas clínica e técnica. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Acompanhamento • Desenvolva a capacidade de parceiros comunitários para fazer o acompanhamento de clientes na comunidade, com consultas ao serviço quando há algum problema que não possa ser resolvido no nível comunitário. Geral • Faça reuniões regularmente com a equipe para elaborar planos de trabalho compartilhados. • Agendamento claro de trabalhos conjuntos. • Clareza na documentação de informações e nos registros. • Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário. Transição de um serviço exclusivamente básico para um serviço básico e intermediário Muitos serviços de cadeiras de rodas começam por oferecer apenas o fornecimento de serviços de cadeiras de rodas de nível básico. É um bom começo, pois o serviço pode concentrar-se no desenvolvimento de sistemas associados às oito etapas de fornecimento, e o pessoal pode ganhar experiência. Contudo, como observado acima, muitos serviços de cadeiras de rodas encontram a demanda pelo fornecimento de serviços de cadeiras de rodas de nível intermediário. Isso não é de se surpreender, pois estima-se que 35% das necessidades dos cadeirantes são de nível básico e 65%, de nível intermediário ou avançado. Portanto, o gerente do serviço provavelmente terá de começar a planejar o atendimento às necessidades de nível intermediário no seu serviço. Como mencionado anteriormente, os serviços de nível intermediário requerem: • pessoal com capacitação adequada; • mais instalações, equipamentos e materiais. Algumas possíveis estratégias para a consideração dos gerentes ao fazer a transição de serviços básicos para intermediários: • Trabalhar com o pessoal para identificar como poderiam oferecer serviços intermediários. Considerar as instalações e os equipamentos adicionais necessários e o modelo de serviço a ser utilizado. • Verificar se o pessoal dos serviços de nível básico teria a capacidade para fornecer serviços de nível intermediário com mais capacitação. Caso sim – primeiro identificar e capacitar substitutos para os serviços de nível básico e, em seguida, capacitar o pessoal identificado para o nível intermediário. • Considerar se é possível colaborar com outras organizações – caso o seu serviço não possa identificar funcionários ou não tenha recursos para contratar mais funcionários. Manual de Referência do WSTP para Gerentes – Página 51 C.3 Planejamento do acompanhamento O acompanhamento é a oitava etapa do fornecimento de cadeiras de rodas. Todos os cadeirantes se beneficiam. É importante que o serviço tenha um plano para realizar o acompanhamento. Durante o acompanhamento, os serviços também se beneficiam da oportunidade de aprender sobre o impacto do serviço no cadeirante, nos seus familiares e na comunidade. 8. Acompanhamento, manutenção e reparos O acompanhamento oferece a oportunidade de verificar o ajuste da cadeira de rodas e oferecer mais capacitação e apoio. A frequência depende das necessidades do cadeirante e dos outros serviços disponíveis. O serviço também pode oferecer manutenção e reparos para lidar com problemas técnicos que não possam ser facilmente resolvidos na comunidade. Importância do acompanhamento Alguns exemplos da importância do acompanhamento Duli: é uma mulher de 21 anos que vive com a sua família. Durante o acompanhamento, a equipe descobriu que ela não conseguia sair de casa porque a sua cadeira de rodas estava com os pneus furados. A cadeira de rodas havia sido abandonada debaixo da sua casa. Os furos foram reparados e a família recebeu conselhos. Duli passou a conseguir sair de casa novamente. A família não valorizava o acompanhamento até observar os benefícios. A equipe do serviço decidiu colar adesivos com o telefone de contato do serviço em todas as cadeiras de rodas para reduzir o problema no futuro. Maria: recebeu uma cadeira de rodas adequada nove meses depois de sofrer uma lesão medular. Durante o acompanhamento, ela não se sentia confortável e sofria espasmos, que ela atribuía à cadeira de rodas. Descobriu-se que havia uma infestação de insetos no estofamento da cadeira de rodas, que a estavam picando. Isso poderia ter causado graves complicações de saúde e o abandono do produto. Contudo, o problema foi identificado e resolvido, e Maria agora está saudável e feliz com a sua cadeira de rodas. Anton: era conhecido na sua comunidade pela sua destreza como jogador de rugby, até sofrer um acidente no jogo, que causou uma lesão medular. Ele recebeu uma cadeira de rodas adequada e capacitação, mas descobriu-se, durante o acompanhamento, que ele não saía de casa. Um capacitador fazia parte da equipe de acompanhamento e conversou com Anton, descobrindo que ele havia perdido a confiança e não queria ver os amigos. Ele se sentia totalmente isolado, só e envergonhado por "ser deficiente". O capacitador voltou no dia seguinte para sair com ele pela primeira vez. Desde esse dia, Anton retomou a sua vida. Gihan: é um menino de três anos que vive com os seus pais e irmão. No acompanhamento, constatou-se que o seu assento de suporte estava coberto de comida e não recebia manutenção. Os seus pais disseram que Gihan tinha dificuldades para sentar-se ereto e não se sentia confortável na cadeira. Eles tinham perdido a confiança no produto e não gostavam dele. Foi marcada uma reavaliação para Gihan com uma equipe com capacitação de nível intermediário. Foram feitas modificações na cadeira de rodas, e Gihan passou a sentar-se ereto, a olhar ao seu redor e a explorar o seu ambiente. Gihan e os seus pais ficaram muito felizes e prestaram atenção às instruções sobre como cuidar da cadeira de rodas de Gihan e fazer manutenção. Benefícios do acompanhamento para o cadeirante e o serviço • O pessoal pode confirmar (ou não) se a cadeira de rodas atende às necessidades do cadeirante no seu próprio ambiente. Manual de Referência do WSTP para Gerentes – Página 52 • As visitas em casa e na comunidade são uma boa oportunidade para identificar histórias de cadeirantes que possam ser utilizadas como feedback para o serviço e para ajudar na angariação de recursos. • O acompanhamento baseado no centro também pode ser uma oportunidade para identificar histórias de cadeirantes que possam ser utilizadas como feedback para o serviço e para ajudar na angariação de recursos. Objetivo do acompanhamento e onde deve ocorrer O objetivo do acompanhamento é: • obter informações do cadeirante; • verificar se a cadeira de rodas está em bom estado; • verificar se a cadeira de rodas está bem ajustada. Ações comuns de acompanhamento Algumas das ações comuns que decorrem de uma visita de acompanhamento: • mais conselhos ou capacitação; • reajuste da cadeira de rodas; • realização de pequenos reparos; • encaminhamento do cadeirante para outro serviço para receber apoio ou assistência, se necessário. Sempre que possível, as visitas de acompanhamento não devem transformar-se numa nova avaliação nem no recondicionamento completo da cadeira. Caso seja necessário realizar uma avaliação completa ou trabalhos extensos na cadeira, deve-se marcar uma consulta específica. Onde deve ser realizado o acompanhamento? O acompanhamento pode ser realizado na casa do cadeirante, no centro de serviço de cadeiras de rodas centre ou em qualquer outro local conveniente para o cadeirante e o pessoal do serviço. As vantagens do acompanhamento realizado nos diferentes locais estão relacionadas no quadro abaixo. Vantagens do acompanhamento na casa do cadeirante ou na comunidade local Vantagens do acompanhamento num centro de serviço • Mais econômico para o cadeirante e a sua família. • O pessoal obtém mais informações sobre os obstáculos à participação e inclusão que as pessoas enfrentam nas suas residências e comunidades. • A observação do pessoal em ação pode aumentar a sensibilização da comunidade e, portanto, a quantidade de encaminhamentos. • Menor custo e utilização mais eficiente do tempo do pessoal/serviço. • Com todas as instalações da oficina, é possível realizar reparos mais complexos. • Todos os equipamentos e as instalações já estão preparados. • Outros colegas disponíveis para oferecer outras opiniões. Manual de Referência do WSTP para Gerentes – Página 53 Planejamento do acompanhamento Todos os cadeirantes são beneficiados pelo acompanhamento. Contudo, o acompanhamento é mais importante para: • Crianças com deficiência; • Cadeirantes em risco de desenvolver uma úlcera por pressão; • Cadeirantes com um problema progressivo; • Cadeirantes que precisam de suporte adicional nas suas cadeiras de rodas (nível intermediário) • Cadeirantes que tiveram dificuldades na capacitação de transferência, mobilidade, saúde ou manutenção da cadeira de rodas. Frequência do acompanhamento Não há nenhuma regra para quando o acompanhamento deve ocorrer, pois o melhor momento depende das necessidades do cadeirante: • É recomendável fazer o acompanhamento de cadeirantes intermediários dentro de seis meses após o recebimento de uma nova cadeira de rodas para verificar se atende às suas necessidades. • Para crianças e pessoas com um problema progressivo, o ideal é fazer o acompanhamento pelo menos a cada seis meses, pois as necessidades das crianças ou pessoas com um problema progressivo podem mudar com rapidez. • O ideal é que todos os demais cadeirantes tenham um acompanhamento nos primeiros doze meses após receber as suas cadeiras de rodas. Impacto do acompanhamento quando não há parcerias com a comunidade Acompanhamento dos cadeirantes Novos potenciais cadeirantes Total de cadeirantes Lembre-se: O acompanhamento deve ser integrado ao modelo de serviço durante o planejamento inicial do serviço. As parcerias com a comunidade são essenciais para criar a capacidade de acompanhamento. Manual de Referência do WSTP para Gerentes – Página 54 O impacto do acompanhamento na disponibilidade de novas consultas é logo sentido quando um serviço não planeja. Os serviços intermediários, em particular, correm o risco de aproximar-se da saturação no ano três. Uma solução para isso é colaborar com organizações baseadas na – e capacitar o respectivo pessoal para realizar o acompanhamento o máximo possível. O pessoal baseado na comunidade pode conseguir realizar várias das tarefas de acompanhamento mais simples, encaminhando os cadeirantes de volta ao serviço de cadeiras de rodas apenas para reavaliações, reparos mais complexos ou outros problemas que não consigam resolver. Há várias vantagens quando essa função é desempenhada por alguém que sirva como um exemplo positivo, como, por exemplo, uma pessoa com deficiência de mobilidade. Criar parcerias com a comunidade e planejar o modelo de serviço Um parceiro pode apoiar o encaminhamento e o acompanhamento, assim como manutenção e reparos Um parceiro também pode apoiar a capacitação de cadeirantes De acordo com a sua capacidade, um parceiro também pode apoiar algumas das responsabilidades mais amplas do serviço Redução dos obstáculos ao acompanhamento Não obstante os benefícios para os utilizadores e fornecedores do serviço, a quantidade de pessoas que recebem acompanhamento em geral é baixa. Para superar os obstáculos e melhorar o serviço, é importante identificar o motivo por que a quantidade é baixa. Possíveis obstáculos à participação dos cadeirantes no acompanhamento em campo • Custos de deslocamento do pessoal do centro de serviço até as comunidades; • Tempo de deslocamento do pessoal do centro de serviço até a comunidade; • O acompanhamento não é priorizado pelos gerentes do serviço; • O acompanhamento não é valorizado pelos utilizadores do serviço até observar os benefícios. Possíveis obstáculos à participação dos cadeirantes no acompanhamento baseado no centro • O custo de deslocamento e a ausência de um ou mais familiares no trabalho é um custo financeiro duplo para a família; • Os cadeirantes e familiares com frequência não estão cientes dos benefícios do acompanhamento após receber uma cadeira de rodas; • Dificuldade para encontrar um transporte acessível; • Pode haver pressão para concentrar-se em novas consultas no centro de serviço sem deixar Manual de Referência do WSTP para Gerentes – Página 55 tempo para o acompanhamento; • Dificuldade para marcar consultas: os cadeirantes podem aparecer quando o pessoal não está disponível ou não aparecer quando o pessoal está disponível. Um exemplo de abordagem ao acompanhamento na Indonésia Em vez de cobrar diretamente, um programa de fornecimento de cadeiras de rodas na Indonésia cobra "taxas de associação" que contribuem para o serviço, o acompanhamento, a manutenção e os custos administrativos. Essa taxa de associação dá aos "associados" o direito a um serviço de qualidade e apoio contínuo. Há um sistema de taxas "progressivas", no qual o valor pago por um indivíduo é determinado com base na sua renda familiar, que é calculada com base nas contas de serviços públicos, documentos de contratação do funcionalismo público, auto-declarações e outros indicadores de renda. Esse programa de cadeiras de rodas constatou que o sistema de associação é eficaz em vários níveis: • Os membros sentem-se habilitados para esperar um serviço e produto de qualidade. • Como pagam um valor significativo relativamente ao seu nível de renda (em geral na faixa de US$ 2– 20, podendo chegar a US$ 150), os membros tendem a valorizar as suas cadeiras de rodas e ter orgulho de serem os proprietários. • Como a associação lhes dá o direito a um acompanhamento gratuito ou descontado durante um período de dois anos, aumenta a probabilidade de os associados solicitarem o acompanhamento mais cedo. Possíveis ações para superar os obstáculos ao acompanhamento Motive, engaje e incentive os utilizadores do serviço a descobrir os benefícios do acompanhamento: • Explique os benefícios do acompanhamento durante a capacitação do cadeirante na etapa 7 do serviço; • Partilhe histórias sobre os benefícios do acompanhamento na sala de espera, nos websites, em quadros de avisos na comunidade; • Sistema de associação para os utilizadores do serviço. Motive, engaje e incentive o pessoal do serviço a descobrir os benefícios do acompanhamento: • Implemente um esquema piloto de acompanhamento fornecido pelo pessoal do serviço; • Reúna estudos de casos sobre os benefícios do acompanhamento. Identifique um resultado imediato e mensurável: • Defina metas para um esquema piloto de acompanhamento; • Recolha e partilhe histórias de sucesso. Dê prioridade ao acompanhamento ao distribuir recursos: • Utilize histórias de sucesso sobre os benefícios do acompanhamento para apoiar a angariação de recursos para cobrir custos específicos relacionados com o acompanhamento; • Reserve tempo para desenvolver parcerias com a comunidade, além de capacitar e orientar o pessoal na comunidade; • Tenha acessibilidade a todos os transportes. Mantenha o apoio para enfrentar desafios constantes: • Monitore os dados do acompanhamento com atenção e identifique as raízes dos problemas; • Integre o acompanhamento no modelo de serviço, sistemas e procedimentos. Manual de Referência do WSTP para Gerentes – Página 56 Inclusão e participação na comunidade O acompanhamento é o momento de avaliar o impacto do serviço e verificar se cumpre a visão geral: melhorar a qualidade de vida, inclusão e participação na comunidade. Uma das funções mais amplas de um serviço de cadeiras de rodas é aumentar a acessibilidade. Isso pode ter um impacto significativo na inclusão e participação dos cadeirantes na comunidade. Residências e espaços públicos acessíveis Um dos principais obstáculos ao retorno à casa com frequência é o acesso aos sanitários Orientações sobre medidas simples que podem ser tomadas em casa podem fazer uma enorme diferença na qualidade de vida Uma campanha contra obstáculos arquitetônicos na Nicarágua Na Nicarágua, uma OPD chamada CADISCA realizou uma campanha na capital, Manágua, para destacar o problema da altura de guias e degraus. Os membros da OPD (todos cadeirantes) construíram 200 rampas e guias rebaixadas (nivelando uma pequena extensão da guia com a rua) em apenas três meses, criando acesso a áreas públicas. Os associados da CADISCA foram vistos na sua comunidade, engajados numa atividade positiva, o que aumentou o apoio e instigou empresas locais a patrocinar a construção de mais guias rebaixadas e rampas na cidade. No início, a CADISCA utilizou o basquete em cadeiras de rodas para promover a auto-confiança e aumentar o envolvimento dos associados nas atividades da OPD. As sessões de capacitação esportiva também criaram oportunidades para reuniões regulares da OPD, onde foram elaborados planos para campanhas de sensibilização. Essas sessões de capacitação foram realizadas num parque público, expondo a comunidade às atividades da OPD e aumentado a sensibilização. Em última análise, o programa esportivo ajudou a influenciar o sucesso da campanha de acesso por meio da sensibilização do público e do apoio a pessoas com deficiência. Isso ajudou a exercer pressão sobre o governo para financiar as guias rebaixadas em toda a cidade de Manágua. A remoção de obstáculos físicos tem oferecido igualdade de oportunidades para os cadeirantes no acesso a áreas financeiras, educacionais e sociais importantes da cidade. Manual de Referência do WSTP para Gerentes – Página 57 O custo da inclusão de recursos de acessibilidade no momento da construção é mínimo – às vezes menos de 1% do custo de construção. O acesso à educação pode ser impedido por algo tão simples como a largura de uma passagem e o acesso a sanitários. Ter a capacidade de oferecer recursos e informações sobre prédios e passagens acessíveis pode habilitar as escolas a ser inclusivas. Há vários recursos para dar acessibilidade a prédios.2 Ao oferecer orientações e informações sobre ambientes acessíveis, os serviços podem facilitar o acesso a residências, transportes e educação, assim como maximizar as oportunidades de inclusão e participação das pessoas com deficiência de mobilidade. Transportes acessíveis O transporte é um obstáculo comum para os cadeirantes. Desafios: • convencer os meios de transporte a parar pelo tempo suficiente para transferir e embarcar uma cadeira de rodas • cobrança de uma taxa adicional pelo transporte de uma cadeira de rodas • risco de roubo de peças removíveis, como, por exemplo, as rodas • dificuldade de acesso a transportes por causa de entradas e portas. Há iniciativas de transportes inclusivos em vários países, como a Dial a Ride na África do Sul e o sistema de ônibus expressos na Colômbia. Há vários recursos úteis sobre transportes acessíveis no mundo inteiro.3 2 Consideração de Projeto para Acessibilidade 2006 – Acessibilidade: Instalações de Saúde 2006; Acessibilidade: Escolas 2006. Para obter mais informações sobre acessibilidade, organizações internacionais como a CBM e a Handicap International oferecem recursos detalhados. 3 Recursos úteis com mais informações sobre transportes acessíveis: International Transport Forum (ITF), Accessible Multimodal Transport, África do Sul, Access Exchange International Newsletter, Paratransit Guide – Guidebook to Transport Issues. Manual de Referência do WSTP para Gerentes – Página 58 C.4 Planejamento da sustentabilidade financeira O que é sustentabilidade financeira? Para um serviço de cadeiras de rodas, sustentabilidade financeira significa ter os fundos e recursos necessários para realizar as oito etapas do fornecimento de serviços de cadeiras de rodas e cumprir as responsabilidades mais amplas do serviço – continuamente. Os gerentes de serviços de cadeiras de rodas desempenham uma função essencial na elaboração de um plano para dar sustentabilidade financeira ao serviço de cadeiras de rodas. Exemplo da declaração de sustentabilidade financeira de um serviço Um programa sustentável de fornecimento de cadeiras de rodas é aquele que tem a capacidade de fornecer cadeiras de rodas adequadas por meio das oito etapas de serviço a uma quantidade constante de indivíduos ao longo de um período significativo de tempo. Isso requer investimentos contínuos em produtos, na capacitação do pessoal, em espaço e em sistemas de monitoramento e avaliação. Um serviço alcança a sustentabilidade financeira quando tem a capacidade constante de assegurar os fundos e recursos necessários para viabilizar o investimento contínuo. Planejamento da sustentabilidade financeira O planejamento da sustentabilidade financeira inclui: • identificar claramente os fundos e recursos necessários para sustentar o serviço (veja B.5); • identificar potenciais fontes de financiamento; • identificar potenciais apoios não monetários; • elaborar uma estratégia para assegurar financiamentos e doações em espécie. Identificação de potenciais fontes de financiamento Os serviços de cadeiras de rodas podem ser financiados de várias formas diferentes, por uma série de diferentes fontes de financiamento. Alguns serviços podem ter uma única fonte de financiamento (por exemplo, o governo), mas a maioria dos serviços obtêm os fundos e recursos necessários de uma variedade de fontes. Cada fonte de financiamento pode contribuir para área(s) específica(s) do orçamento ou das necessidades de recursos. Diferentes fontes de financiamento que os gerentes podem considerar Governo Estruturas nacionais de seguro Doadores e patrocinadores individuais Doadores e patrocinadores empresariais Contribuições dos cadeirantes ou preço total Geração de receitas/empreendimento social Grupos comunitários/instituições beneficentes Missões diplomáticas ONG internacionais e nacionais Identificação de potenciais apoios não monetários O apoio não monetário inclui doações em espécie (por exemplo, doações de equipamentos, cadeiras de rodas, materiais), apoio de voluntários, disponibilização de instalações. O apoio não monetário pode reduzir o valor dos fundos necessários para gerir o serviço. Alguns serviços de cadeiras de rodas podem receber regularmente doações de cadeiras de rodas. Embora isso possa ser muito útil, sempre é importante que o serviço avalie se as cadeiras de rodas são adequadas e de boa qualidade. Nem todas as cadeiras de rodas doadas são adequadas. Manual de Referência do WSTP para Gerentes – Página 59 Combinação de diferentes fontes de financiamento para sustentar um serviço de cadeiras de rodas O quadro abaixo apresenta exemplos das diferentes fontes de financiamento que um exemplo de serviço de cadeiras de rodas identificou e como essas fontes de financiamento contribuem para os fundos e recursos necessários para a sustentabilidade financeira da organização. Fontes de financiamento para um exemplo de serviço de cadeiras de rodas Fonte de financiamento Fundos ou recursos fornecidos Governo • Contribui 50% do custo de cada cadeira de rodas fornecida pelo serviço; • Financia dois funcionários que trabalham para o serviço de cadeiras de rodas (50% do orçamento de recursos humanos). Empresas • Uma empresa local faz uma doação anual à rubrica de cadeiras de rodas do orçamento; • Outra empresa local comprometeu-se a patrocinar dez crianças por ano – cobrindo o custo das cadeiras de rodas e do fornecimento dos serviços. Indivíduos • Fazem doações ao serviço (não direcionadas a nenhuma rubrica específica do orçamento). Atividades de empreendimento social: • O serviço de cadeiras de rodas realiza várias atividades de empreendimento social, como a realização de auditorias de acessibilidade (de prédios) e o fornecimento de produtos de controle urinário. Os lucros do trabalho são utilizados para apoiar o serviço de cadeiras de rodas e geralmente são suficientes para financiar pelo menos 50% do orçamento de recursos humanos. ONG internacionais • O serviço recebeu dois financiamentos de ONG internacionais para fornecer cadeiras de rodas a pessoas que vivem em áreas específicas. Organização religiosa: • Faz uma contribuição anual de 200 cadeiras de rodas (selecionadas pelo serviço). Elaboração de uma estratégia Após a identificação de potenciais fontes de financiamento, os gerentes do serviço devem elaborar uma estratégia para o tipo de apoio que solicitarão de cada potencial fonte de financiamento e em que valor. Parte da elaboração de uma estratégia inclui considerar a probabilidade de a fonte de financiamento fazer uma contribuição, o valor que a fonte de financiamento poderia oferecer e quanto tempo e esforço serão necessários para obter o financiamento. Para ajudar a elaborar uma estratégia, os gerentes podem priorizar as diferentes fontes de financiamento e planejar como assegurarão o financiamento. Os gerentes devem considerar: • Fonte de financiamento: quem será contatado? • Apoio: o gerente pedirá o apoio da fonte de financiamento para o quê? Pode concentrar-se numa rubrica do orçamento, como, por exemplo, produtos, ou numa etapa (ou etapas) de serviço com várias rubricas orçamentais associadas. Considere a fonte específica de financiamento e o que tendem a apoiar. • Solicitação: que valor será solicitado da fonte de financiamento? Entre os fatores a considerar destacam-se recursos da fonte de financiamento e o volume de doações anteriores ao serviço ou a outras instituições. Solicite um valor realista. Manual de Referência do WSTP para Gerentes – Página 60 • Probabilidade: qual é a probabilidade de que a fonte de financiamento atenderá/apoiará o serviço? Pode ser categorizada como baixa, média e alta. • Esforço: o que será necessário para assegurar o financiamento, e quais serão os relatórios ou outras obrigações? O nível de esforço para assegurar o financiamento deve ser proporcional ao valor do financiamento. As obrigações também devem ter um custo acessível/viável para o serviço. O quadro abaixo apresenta dois exemplos. Ao considerar o tipo de apoio, a solicitação, a probabilidade de sucesso e o esforço necessário, os gerentes podem priorizar melhor as fontes de financiamento a serem exploradas. Abordagens de financiamento Pode ser difícil obter fontes de financiamento sustentável para um serviço de cadeiras de rodas. Abaixo apresentamos alguns exemplos de diferentes abordagens de financiamento para consideração. Observe que as abordagens com frequência são diferentes, de acordo com a fonte de financiamento. Uma abordagem comercial para atender a uma necessidade social e gerar receitas Fonte de financiamento Tipo de apoio Solicitação Probabilidade Esforço 1. Empresas Doação ao orçamento de compra de cadeiras de rodas 10% do orçamento de cadeiras de rodas Média (ofereceu um financiamento anteriormente, mas nem sempre financia a mesma organização todos os anos) Pelo menos duas reuniões com o gerente comercial; proposta de 2 páginas e apresentação de um orçamento, além de um convite ao gerente para o próximo dia de visita 2. Governo local Potencialmente pode financiar os custos de todas as visitas em campo a cadeirantes da sua área 20% de todos os custos em campo + 20% dos salários do pessoal do serviço Alta (já há discussões com esse governo local há algum tempo. Foi realizado um trabalho em campo na sua área. Estão muito ansiosos para apoiar o trabalho e parece haver recursos disponíveis) Apresentação de proposta formal e orçamento. Relatórios obrigatórios – exigem dados precisos de todas as pessoas visitadas na sua área, além de relatórios financeiros Manual de Referência do WSTP para Gerentes – Página 61 Uma ONG na Romênia utiliza o empreendimento social como parte da sua abordagem à sustentabilidade financeira. A abordagem tem dois objetivos principais: um social e um financeiro. Os cadeirantes são empregados como parte de equipes multidisciplinares que fornecem equipamentos de mobilidade e suprimentos médicos de qualidade a pessoas com deficiência. A qualidade dos serviços é alta, pois as equipes estão bem conscientes da importância do posicionamento correto e da prevenção de problemas de saúde. A atividade oferece empregos para pessoas com deficiência, criando consumidores hábeis. Os serviços também geram receitas para apoiar outros programas administrados pela ONG. Compra direta pelo fornecedor Alguns serviços de cadeiras de rodas exigem uma contribuição mínima do cadeirante para receber uma cadeira de rodas e serviços de cadeiras de rodas. Com frequência há um sistema de taxas "progressivas", no qual o valor pago por um indivíduo é determinado com base na sua renda familiar, que é calculada com base nas contas de serviços públicos, documentos de contratação do funcionalismo público, auto-declarações e outros indicadores de renda. Os serviços que obtêm alguns recursos dessa forma têm de assegurar que as pessoas sem condições de pagar por quaisquer custos da cadeira de rodas não fiquem em desvantagem. Empresas doadoras e patrocinadoras O Teletón, no México, é um evento anual de televisão e rádio organizado para angariar recursos para centros de reabilitação de crianças (centros CRIT). O programa é produzido pela Televisa e mais de 600 meios de comunicação mexicanos e de outros países; e 20 empresas comerciais patrocinam o evento. Eles vendem a sua visão de sucesso com histórias positivas e marcantes sobre a integração e as realizações. Durante um período de três meses antes do evento, são divulgados estudos de casos pelos meios de comunicação, para aumentar o interesse. Personalidades de alto perfil participam na promoção do evento. Na Romênia, uma ONG tem um relacionamento com uma empresa patrocinadora. Para consolidar esse relacionamento, há um evento de gala anual de natação num prestigioso centro de saúde. Equipes integradas com funcionários da empresa, capacitadores, pessoal da ONG e pessoas com deficiência de aprendizagem competem entre si. É um evento divertido com benefícios em vários níveis. Os funcionários da empresa oferecem um apoio contínuo durante todo o ano com contribuições diretas ou eventos de angariação de recursos. Financiamentos do governo No Quênia, o Ministério dos Serviços Médicos entrou em parceria com uma ONG de cadeira de rodas e correspondentes serviços de reabilitação. A ONG oferece todo o apoio logístico a oito filiais alojadas em hospitais públicos. O governo contribui os recursos humanos. Até esta data, o Ministério já designou 56 funcionários às filiais da ONG. Manual de Referência do WSTP para Gerentes – Página 62 Para obter mais recursos de apoio ao fornecimento de serviços de cadeiras de rodas de nível básico e intermediário, consulte o DVD/Pendrive Estrutura nacional de seguro na Romênia • A primeira etapa para o cadeirante é solicitar um certificado de deficiência. Sem esse certificado, não é possível solicitar uma cadeira de rodas. • Em seguida, deve marcar uma consulta com um médico de reabilitação que prescreve uma cadeira de rodas. • O cadeirante apresenta uma solicitação à Agência Nacional de Seguro (NIA, na sigla em inglês) do país. • Ao receber a aprovação/o cupom, o cadeirante escolhe um fornecedor e uma das suas cadeiras de rodas. • Caso o preço da cadeira de rodas seja inferior ao subsídio, a cadeira de rodas é fornecida e paga com o cupom, que o fornecedor utiliza para receber o pagamento da NIA. • Caso o preço da cadeira de rodas seja superior ao subsídio, o cadeirante tem de encontrar fontes complementares de financiamento, como, por exemplo, doadores, empresas e indivíduos. Observe que o livro de exercícios do participante vem em seguida – o livro de exercícios não é separado como no WSTPb/WSTPi. Manual de Referência do WSTP para Gerentes – Página 63 Referências 1. i Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. Genebra: Organização Mundial da Saúde; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 2. ii Wheelchair Service Training Package – Basic Level. Genebra: Organização Mundial da Saúde; 2012 (http://www.who.int/disabilities/technology/wheelchairpackage/en/). 3. iii Wheelchair Service Training Package – Intermediate Level. Genebra: Organização Mundial da Saúde; 2013 (http://www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4. iv Convenção sobre os Direitos das Pessoas com Deficiência, Resol. A.G. 61/106 (2007) Nova York: Organização das Nações Unidas; 2008 (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 5. v Há relatos sobre como os dispositivos assistivos fornecidos por meio de um serviço reduzem o tempo e o esforço físico para os atendentes (Allen et al., 2006). 6. vi Diretrizes para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos. 7. vii Diretrizes da OMS para o fornecimento de cadeiras de rodas manuais em áreas com menos recursos 2008, pág. 78 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 8. viii Wyndaele M, Wyndaele JJ (2006). Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 44: 523–529. 9. ix Razzak ATMA, Helal SU, Nuri RP (2011). Life expectancy of persons with spinal cord injury (SCI) treated in a rehabilitation centre at Dhaka, Bangladesh. Disability, CBR and Inclusive Development Journal; 22(1): 114-123. 10. x Relatório Mundial da Organização Mundial da Saúde e do Banco Mundial sobre Deficiência, página 115. Genebra: Organização Mundial da Saúde; 2011 (http://www.who.int/disabilities/world_report/2011/report/en/). 11. xi Messiou, K. (2008) Encouraging children to think in more inclusive ways, British Journal of Special Needs Education, 35, 1, pág. 26-32. Manual de Referência do WSTP para Gerentes – Página 64 Livro de Exercícios do Participante Ações para gerentes para criar ou melhorar o fornecimento de serviços de cadeiras de rodas A. Conhecimentos básicos B: Criação de um serviço de cadeiras de rodas C: Administração de um serviço de cadeiras de rodas Manual de Referência do WSTP para Gerentes – Página 65 A.3 Liderança de mudanças Examine os facilitadores de mudança relacionados abaixo. Registre as ações que você pode empreender para criar ou melhorar o fornecimento de cadeiras de rodas no seu centro de serviço. 1. Criar uma visão comum para o fornecimento de cadeiras de rodas adequadas 2. Comunicar a importância do fornecimento de cadeiras de rodas adequadas com um senso de urgência 3. Alinhar pessoal e recursos 4. Motivar, engajar e incentivar o pessoal. • Incluir o pessoal no planejamento e na implementação • Superar os obstáculos juntos • Criar e reconhecer as conquistas de curto prazo • Dar persistência à mudança nos sistemas e na cultura da sua organização B.1 Acesso aos serviços 1. Ações que posso empreender para identificar fontes de encaminhamento 2. Ações que posso empreender para desenvolver uma rede de encaminhamento Manual de Referência do WSTP para Gerentes – Página 66 3. Ações que posso empreender para decidir se promovo um formulário de encaminhamento ou não 4. Ações que posso empreender para trabalhar ativamente para assegurar um serviço de cadeiras de rodas equitativo. B.2 Instalações e equipamentos 1. Ações que posso empreender para identificar instalações e equipamentos adequados para o meu modelo de serviço 2. Ações que posso empreender para integrar formulários e listas de verificação nas etapas de serviço 3. Ações que posso empreender para organizar as instalações 4. Ações que posso empreender para criar sistemas e procedimentos para cada instalação, inclusive a delegação de trabalho onde possível B.3 Variedade de cadeiras de rodas adequadas 1. Ações que posso empreender para identificar as necessidades dos utilizadores do serviço e as características mais importantes dos produtos para atender a essas necessidades 2. Ações que posso empreender para identificar a devida variedade de cadeiras de rodas adequadas, almofadas e peças sobressalentes Manual de Referência do WSTP para Gerentes – Página 67 3. Ações que posso empreender para identificar suprimentos adequados de materiais para fazer modificações nos produtos 4. Ações que posso empreender para discutir a relação custo/benefício de cadeiras de rodas e almofadas adequadas fornecidas por meio de um serviço com diferentes partes interessadas B.4 Alinhamento de pessoal 1. Ações que posso empreender para identificar pessoal para o serviço 2. Ações que posso empreender para incluir o pessoal do serviço no planejamento 3. Coordenar o trabalho em equipe e estabelecer um plano de trabalho semanal 4. Ações que posso empreender para identificar a capacidade anual do serviço B.5 Custo de um serviço de cadeiras de rodas 1. Ações que posso empreender para considerar a integração do serviço ao planejar um modelo de serviço 2. Ações que posso empreender para considerar parcerias comunitárias ao planejar um modelo de serviço 3. Ações que posso empreender para elaborar um orçamento para o modelo de serviço planejado Manual de Referência do WSTP para Gerentes – Página 68 C.1 Como sei se o meu serviço funciona? Áreas e atividades do serviço Metas de desempenho do serviço Métodos de recolha de informações Encaminhamento Quantidade de cadeirantes encaminhados O serviço receberá 30 encaminhamentos por mês Registre os encaminhamentos recebidos Fornecimento de cadeiras de rodas Quantidade de cadeirantes que recebem uma cadeira de rodas O serviço prescreverá e adaptará cadeiras de rodas para 20 cadeirantes por mês As prescrições de cadeiras de rodas são registradas nas pastas dos cadeirantes População de cadeirantes atendida Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural O serviço incentivará a igualdade de acesso Quantidade de mulheres, homens, meninas e meninos que utilizam o serviço, de acordo com os dados registrados nas pastas do cadeirantes Custos do serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço O custo individual de cada cadeira de rodas será inferior a (valor especificado de acordo com o orçamento e o custo realista dos produtos disponíveis) Endereço residencial dos cadeirantes que utilizam o serviço – de acordo com os dados registrados nas pastas do cadeirantes Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Manual de Referência do WSTP para Gerentes – Página 69 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3. Registre as ações que você pode empreender para saber se o serviço funciona (caso haja tempo) 1. Ações que posso empreender para criar um plano de serviço 2. Ações que posso empreender para monitorar o pessoal ao elaborar um plano de serviço 3. Ações que posso empreender para avaliar o grau de eficácia do serviço no cumprimento do seu objetivo 4. Ações que posso empreender para reconhecer a equipe ou sucessos individuais C.2 Gestão da demanda 1. Ações que posso empreender para estabelecer um sistema para monitorar encaminhamentos e gerir listas de espera 2. Ações que posso empreender para partilhar as histórias de sucesso de encaminhamentos precoces com pais e fontes de encaminhamento 3. Ações que posso empreender para planejar a gestão de encaminhamentos com necessidades que ultrapassem a capacidade do serviço Manual de Referência do WSTP para Gerentes – Página 70 4. Ações que posso empreender para monitorar e aumentar a eficiência das etapas de serviço. C.3 Planejamento do acompanhamento 1. Ações que posso empreender para planejar o acompanhamento 2. Ações que posso empreender para criar e capacitar parceiros comunitários 3. Ações que posso empreender para identificar potenciais candidatos para capacitação e acompanhamento de cadeirantes 4. Ações que posso empreender para obter e divulgar histórias de sucesso sobre os benefícios do acompanhamento Manual de Referência do WSTP para Gerentes – Página 71 C.4 Planejamento da sustentabilidade financeira 1. Ações que posso empreender para criar uma visão comum da sustentabilidade financeira 2. Ações que posso empreender para identificar os fundos e recursos necessários 3. Ações que posso empreender para identificar fontes de encaminhamento 4. Ações que posso empreender para priorizar as fontes de encaminhamento e elaborar uma estratégia de angariação de recursos Manual de Referência do WSTP para Gerentes – Página 72 Seção A. Atividades relacionadas com os conhecimentos básicos A.1 Apoio ao fornecimento de cadeiras de rodas adequadas: Política nacional • Leia os dois exemplos de política nacional referente ao fornecimento de cadeiras de rodas. • Considere as políticas já adotadas no seu país • Discuta o grau de utilidade que as políticas abaixo teriam no seu país e considere onde se enquadrariam na estrutura do governo Exemplo 1: Política de fornecimento de cadeiras de rodas no Afeganistão Em outubro de 2003, o Ministério dos Mártires e Pessoas com Deficiência do Afeganistão publicou uma Política Nacional Abrangente sobre Deficiência. A política foi “elaborada em colaboração com todas as partes interessadas, inclusive organização de pessoas com deficiência e grupos de auto- ajuda; ONG nacionais e internacionais que trabalham com deficiências; ministérios importantes, como o Ministério da Educação, Ministério da Saúde Pública, Ministério do Trabalho e Questões Sociais, Ministério de Questões da Mulher e Ministério dos Mártires e Pessoas com Deficiência; órgões pertinentes da ONU; e o Gabinete da Presidência” (4). Espera-se que a política inicial resulte num plano de ação mais detalhado e priorizado. A política declara: O apoio oferecido a pessoas com deficiência física deve incluir centros de reabilitação ortopédica; serviços de fisioterapia, assim como dispositivos ortopédicos, assistivos e de mobilidade. Esses serviços devem ser oferecidos próximo a um hospital regional ou provincial com serviços de cirurgia ortopédica para facilitar o acesso da população local. Todos os pacientes têm o direito de receber dispositivos. Os dispositivos devem ser bem fabricados, bem adaptados e com materiais locais sempre que possível, além de poderem ser reparados localmente. A respectiva tecnologia deve ser padronizada em todo o país. Deve-se criar um mecanismo de padronização nacional, com peritos relevantes, em colaboração com o Ministério da Saúde Pública Exemplo 2: Política de fornecimento de cadeiras de rodas na África do Sul Manual de Referência do WSTP para Gerentes – Página 73 Em 2003, a África do Sul publicou diretrizes nacionais para dispositivos assistivos no país. Essas diretrizes foram elaboradas em consulta com todas as províncias da África do Sul. A contribuição feita pela província do Western Cape baseou-se na sua experiência na elaboração de diretrizes provinciais. A elaboração de diretrizes provinciais foi iniciada por um grupo de clínicos que forneciam serviços de cadeiras de rodas. Consultaram um gerente do programa provincial e os serviços locais de reabilitação para elaborar um plano para profissionalizar o padrão de serviços de cadeiras de rodas. O plano tinha três áreas de enfoque principais: 1. Realizar uma análise da situação dos serviços de cadeiras de rodas na província; 2. Implementar a capacitação dos fornecedores de serviços de cadeiras de rodas; e 3. Definir diretrizes para a estratégia provincial para a gestão de cadeira de rodas. Foram elaboradas diretrizes provinciais que incluíram padrões mínimos para as principais etapas de serviço, assim como as principais etapas de gestão, como capacitação do pessoal, criação e gestão de listas de espera, orçamentos e fornecimento de serviços de reparo e manutenção. A gestão provincial ajudou o grupo a tornar-se um grupo assessor formal. Os representantes desse grupo passaram a acompanhar os administradores provinciais em reuniões nacionais e contribuíram para a definição de diretrizes nacionais para dispositivos assistivos na África do Sul. A.2 Fornecimento de serviços Funções mais amplas dos gerentes Manual de Referência do WSTP para Gerentes – Página 74 Ações comuns para melhorar o fornecimento de cadeiras de rodas adequadas no país Ações que posso empreender nos próximos três meses Manual de Referência do WSTP para Gerentes – Página 75 Seção B. Início das atividades de um serviço de cadeiras de rodas B.2.1 Instalações e equipamentos: Identificação de instalações adequadas • Examine a lista de instalações abaixo • Pense sobre soluções práticas que funcionariam no seu serviço. Instalações de nível básico Essas instalações já existem? Essas instalações poderiam ser compartilhadas com um serviço existente? Uma sala com outra finalidade poderia ser convertida? Uma sala já existente poderia ser reorganizada ou reestruturada? 1. Sala de espera e recepção 2. Área tranquila para deitar-se 3. Sanitários acessíveis 4. Área de escritório para o pessoal 5. Área clínica para avaliação e adaptação Manual de Referência do WSTP para Gerentes – Página 76 6. Área técnica para preparação, manutenção e reparo de cadeiras de rodas 7. Armazenamento 8. Capacitação do cadeirante Instalações adicionais de nível intermediário Essas instalações já existem? Essas instalações poderiam ser compartilhadas com um serviço existente? Uma sala com outra finalidade poderia ser convertida? Uma sala já existente poderia ser reorganizada ou reestruturada? 9. Área de avaliação e adaptação com leito para avaliação com a pessoa deitada 10. Espaço adicional para armazenamento de materiais 11. Área adicional de preparação de produtos: costura e estofamento B.2.2 Instalações e equipamentos: identificação dos equipamentos • Consulte as diretrizes para equipamentos e documentação no manual de referência Manual de Referência do WSTP para Gerentes – Página 77 Equipamentos • Consulte o manual de referência • Identifique os equipamentos que já estão disponíveis e em utilização no seu centro de serviço e anote eventuais equipamentos a serem fabricados ou comprados Já disponíveis A serem fabricados ou comprados Documentos Examine a lista de formulários e listas de verificação na pasta recursos adicionais no DVD/Pendrive. • Que formulários e listas de verificação já estão integrados e em utilização? Anote quaisquer formulários ou listas de verificação a serem integrados no dia-a-dia Já disponíveis A serem integrados no serviço existente B.2.3 Instalações e equipamentos: organização do espaço de trabalho • Consulte as diretrizes para instalações e equipamentos no manual de referência. • Consulte as recomendações para a boa organização do espaço de trabalho relacionadas abaixo 1. Elimine a desordem: remova todas as ferramentas, peças, equipamentos e documentos desnecessários 2. Identifique os artigos utilizados com regularidade: ferramentas, peças, instruções e documentos. Esses artigos devem ser organizados para facilitar e agilizar a sua localização 3. Sistema e responsabilidade: tenha um sistema para cada local de trabalho e alguém responsável pela implementação do sistema 4. Monitore: o sistema para assegurar a "persistência" da mudança Manual de Referência do WSTP para Gerentes – Página 78 Área técnica Analise o exemplo e faça recomendações para melhorias Área clínica e técnica em campo Analise o exemplo e faça recomendações para melhorias B.3.1 Variedade de cadeiras de rodas adequadas: durabilidade, possibilidade de reparo • Trabalhe em conjunto com o seu grupo e responda à série de perguntas designada a você – com base no número do seu grupo. • Baseie-se nos seus próprios conhecimentos e experiências, além do manual de referência, para realizar a atividade. Grupo 1 • Que perguntas você pode fazer sobre a segurança e durabilidade dos produtos fornecidos? • Como você pode descobrir se os produtos recebidos do fornecedor (doador, fabricante) são seguros e duráveis no seu contexto específico? • Com quem mais você pode falar para obter informações sobre a segurança e durabilidade dos produtos oferecidos por um doador/fabricante/fornecedor? Manual de Referência do WSTP para Gerentes – Página 79 Durabilidade Grupo 2 • Mesmo os produtos que são duráveis têm peças que normalmente se desgastam e quebram. Quais são algumas dessas peças vulneráveis? Peças que se desgastam e quebram Grupo 3 • Um serviço precisa de peças sobressalentes • Como você pode identificar as peças sobressalentes necessárias? • Como você sabe que peças sobressalentes têm de ser encomendadas? Peças sobressalentes B.3.2 Variedade de cadeiras de rodas adequadas: fornecimento de cadeiras de rodas adequadas Cenário 1 • Leia o cenário designado a você abaixo. Em seguida, leia os "Princípios do fornecimento de dispositivos de mobilidade adequados" • Prepare um cenário de encenação com autoridades provinciais e um grupo de partes interessadas promovendo uma mudança no sistema de compra de cadeiras de rodas (de 3 a 5 minutos de encenação). Ao discutir a encenação, pense sobre • Quais são os problemas identificados no cenário? • Possíveis ações para superar os problemas Manual de Referência do WSTP para Gerentes – Página 80 Um hospital público na sua região adotou um orçamento para o fornecimento de cadeiras de rodas. Todos os anos, o orçamento é reexaminado e a lista de produtos é reconsiderada. Todos os anos há solicitações de mudança de produtos disponíveis, mas nunca ocorre nenhuma mudança e o departamento de compras adquire dois tipos de produtos com base no custo. Princípios do fornecimento de dispositivos de mobilidade adequados Para que os países possam cumprir com as suas obrigações relacionadas com a tecnologia assistiva (dispositivos de mobilidade), definidas na Convenção sobre os Direitos das Pessoas com Deficiência, é necessário considerar os seguintes princípios chave: • Aceitabilidade – pessoas com deficiência devem participar em todas as etapas do fornecimento de dispositivos de mobilidade; • Acessibilidade – dispositivos de mobilidade e serviços afins devem ser acessíveis para todos que tenham uma necessidade identificada; • Adaptabilidade – dispositivos de mobilidade e serviços afins devem ser adaptados e modificados para que sejam adequados às necessidades do indivíduo; • Viabilidade econômica – dispositivos de mobilidade e serviços afins devem ser economicamente viáveis; • Disponibilidade – instalações, pessoal e produtos devem ser suficientes para as necessidades da população e estar localizados o mais próximo possível das comunidades das pessoas; • Qualidade – produtos, instalações e serviços devem ter qualidade adequada. Cenário 2 • Leia sobre os dois sistemas de licitação do governo abaixo • Resuma o sistema atual do seu país. • Consulte os "Princípios do fornecimento de dispositivos de mobilidade adequados" (na página anterior) • Prepare sugestões para criar ou melhorar o sistema de licitação do governo para o fornecimento de cadeiras de rodas no seu país. África do Sul Manual de Referência do WSTP para Gerentes – Página 81 Na África do Sul, a compra de cadeiras de rodas pelo governo é controlada por uma Licitação Nacional. O governo trabalha com pessoas de diferentes províncias com experiência em cadeiras de rodas e serviços de cadeiras de rodas. Também consulta os atuais fornecedores de cadeiras de rodas. Após a consulta, as categorias de produtos e os artigos dessas categorias são finalizados, com uma especificação detalhada de cada produto. As categorias abrangem uma variedade de almofadas para conforto e casos de alto risco. São especificados os padrões mínimos de durabilidade para cada produto. Após a finalização e aprovação das especificações da licitação, o tesouro nacional abre o processo de licitação. Todos os produtos apresentados na licitação são inspecionados por representantes experientes antes da concessão dos contratos. Os contratos incluem prazos mínimos de entrega e as cláusulas de penalidades por descumprimento das condições dos contratos. Romênia O financiamento público de cadeiras de rodas na Romênia é como o subsídio para medicamentos. O processo de subsídio para cadeiras de rodas começou em 2001, quando o Estado organizou uma licitação para fornecedores de cadeiras de rodas. Como resultado da licitação, um preço de base/referência foi definido de comum acordo, mas não houve nenhuma definição de qualidade dos produtos ou do fornecimento de serviços. O valor do subsídio é reestabelecido a cada ano. A primeira etapa para o cadeirante é solicitar um certificado de deficiência. Sem o certificado, é impossível ter acesso a uma cadeira de rodas. Em seguida, o cadeirante deve marcar uma consulta com um médico de reabilitação, que prescreverá uma cadeira de rodas. O cadeirante apresenta uma solicitação à Agência Nacional de Seguro (NIA, na sigla em inglês) do país. Ao receber a aprovação/o cupom, o cadeirante escolhe um fornecedor ee, em seguida, uma cadeira de rodas. Caso o preço da cadeira de rodas seja inferior ao subsídio, a cadeira de rodas é fornecida e paga com o cupom, que o fornecedor utiliza para receber o pagamento da NIA. Caso o preço da cadeira de rodas seja superior ao subsídio, o cadeirante tem de encontrar fontes complementares de financiamento, como, por exemplo, doadores, empresas e indivíduos. Cenário 3 • Prepare um cenário de encenação que demonstre uma reunião com um doador, na qual você apresenta um plano para fornecer cadeiras de rodas adequadas por meio do sistema de fornecimento de serviços (de 3 a 5 min de encenação). Ao planejar a encenação • Discuta como as cadeiras de rodas doadas são distribuídas atualmente no seu país • Leia os "Princípios do fornecimento de dispositivos de mobilidade adequados" Manual de Referência do WSTP para Gerentes – Página 82 B.4 Alinhamento de pessoal: funções • Examine o quadro com as funções do pessoal do serviço de cadeiras de rodas. • Escreva o nome do responsável por cada função do quadro. • Caso seja responsável por mais de um centro de serviço, relacione o pessoal de cada centro de serviço. Clínica Técnica Capacitaçã o de cadeirantes Administrati va Centro de serviço Centro de serviço Centro de serviço Manual de Referência do WSTP para Gerentes – Página 83 B.5.2 Custo de um serviço de cadeiras de rodas: integração de serviços 1. Examine: cada rubrica na ferramenta de orçamentação abaixo e considere os custos que podem ser divididos ou economizados com a integração de um serviço de cadeiras de rodas a um serviço existente. 2. Explique: Marque com um círculo preto todos os custos que podem ser economizados. Marque com um círculo vermelho todos os custos que podem ser divididos. Cenário de exemplo de um serviço integrado Um serviço de próteses e órteses planeja integrar um serviço de cadeiras de rodas. Dois funcionários foram escolhidos e enviados para receber capacitação de WSTP básico. Ambos os funcionários trabalharão três dias por semana no serviço de cadeiras de rodas e dois dias per semana no serviço de próteses e órteses. Foi designado um espaço de trabalho na oficina para um técnico de cadeiras de rodas. O departamento de terapia eliminou todos os equipamentos avariados e não utilizados para criar espaço para uma área de trabalho para a função clínica. Budget Guide Referral & appointment Assessment Perscription Funding & ordering Product preparation Fitting User - training Follow-up, maint. & rep. START-UP COSTS Product design ✓ Sourcing range of products ✓ Tools ✓ ✓ Equipment ✓ ✓ Building/facilities ✓ ✓ ✓ Stock of materials ✓ OPERATIONAL COSTS Wheelchairs ✓ ✓ Spare parts ✓ Materials ✓ ✓ ✓ Freight (product transport) ✓ ✓ Personnel Management ✓ ✓ ✓ Clinical staff ✓ ✓ ✓ ✓ ✓ ✓ ✓ Technical staff ✓ ✓ ✓ ✓ ✓ Peer trainer ✓ ✓ Administrator ✓ ✓ ✓ ✓ ✓ Local transport Local transport for personnel ✓ ✓ ✓ ✓ Local transport for clients ✓ ✓ ✓ Accommodation for clients ✓ ✓ Printed materials ✓ ✓ ✓ ✓ Consumables ✓ ✓ ✓ Tool replacement ✓ ✓ ✓ Overheads ✓ ✓ ✓ ✓ ✓ ✓ Training of personnel ✓ ✓ ✓ ✓ ✓ ✓ Training partners / referral network ✓ ✓ ✓ Fundraising ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Monitoring & evaluation ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ SERVICE STEPS Manual de Referência do WSTP para Gerentes – Página 84 Seção C. Administração de um serviço de cadeiras de rodas C.1.1 Serviços eficientes e eficazes: monitoramento Seção 1 • No seu grupo: leia e preencha a sua seção do quadro abaixo. • Algumas das caixas foram preenchidas para agilizar o início. As caixas restantes devem ser preenchidas. • Registre por que é útil saber se essas metas foram alcançadas. Áreas e atividades Exemplos de metas de desempenho Obtenção de dados Encaminhamento Quantidade de cadeirantes encaminhados O serviço receberá 30 encaminhamentos por mês Registre os encaminhamentos recebidos Tempo médio de espera entre o encaminhamento e a consulta Registre a data de recebimento do encaminhamento e a data da avaliação na pasta do cadeirante Fornecimento de cadeiras de rodas Quantidade de cadeirantes que recebem uma cadeira de rodas O serviço prescreverá e adaptará cadeiras de rodas para 20 cadeirantes por mês Tempo médio de espera entre a avaliação e a adaptação Quantidade de consultas de acompanhamento realizadas Registre por que é útil saber se essas metas foram alcançadas Metas alcançadas Metas não alcançadas Quantidade de cadeirantes encaminhados Tempo médio de espera entre o encaminhamento e a consulta Quantidade de cadeirantes que recebem uma cadeira de rodas Tempo médio de espera entre a avaliação e a adaptação Quantidade de consultas de acompanhamento realizadas Manual de Referência do WSTP para Gerentes – Página 85 Seção 2 Áreas e atividades Exemplos de metas de desempenho Obtenção de dados População de cadeirantes atendida Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural O serviço incentivará a igualdade de acesso O objetivo do serviço será atender às necessidades de cadeirantes que precisem de cadeiras de rodas básicas e os que precisem de modificações e suporte postural Quantidade de mulheres, homens, meninas e meninos que utilizam o serviço, de acordo com os dados registrados nas pastas do cadeirantes Tipos de necessidades posturais apresentadas e cadeiras de rodas prescritas, de acordo com os dados registrados nas pastas do cadeirantes Área geográfica abrangida pelo serviço Endereço residencial dos cadeirantes que utilizam o serviço – de acordo com os dados registrados nas pastas do cadeirantes Custos do serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço O custo individual de cada cadeira de rodas será inferior a (valor especificado de acordo com o orçamento e o custo realista dos produtos disponíveis) Tempo dedicado pelo pessoal nas atividades do serviço (avaliação, acompanhamento, capacitação, etc.) Registre por que é útil saber se essas metas foram alcançadas Possíveis respostas: Metas alcançadas Metas não alcançadas Detalhes dos cadeirantes em relação ao serviço, como idade, sexo, deficiência, necessidades de suporte postural Área geográfica abrangida pelo serviço Custo dos produtos fornecidos, inclusive modificações realizadas no serviço Tempo dedicado pelo pessoal nas atividades do serviço (avaliação, acompanhamento, capacitação, etc.) Manual de Referência do WSTP para Gerentes – Página 86 C.1.2 Serviços eficientes e eficazes: feedback dos utilizadores • Há algumas considerações importantes ao planejar a obtenção de feedback dos utilizadores do serviço. Utilize esta lista de verificação e faça anotações para o seu serviço Planejamento do feedback dos utilizadores do serviço Pontos a considerar (transporte e tempo são dois dos custos mais significativos): Quando será realizado? Quem o realizará? Que perguntas de feedback devem ser feitas? Dados iniciais (consulte as ferramentas armazenadas na pasta recursos adicionais no DVD/Pendrive) Pontos a considerar: Para avaliar o impacto do serviço, é importante registrar a situação antes de qualquer intervenção, ou seja, antes do início da avaliação Quando serão obtidos os dados iniciais? Quem obterá esses dados? Os dados serão obtidos com que frequência? Registro e processamento de dados Pontos a considerar: O registro eficiente de dados economiza tempo e dinheiro Como você registrará os dados? Que métodos você pode utilizar para aumentar a eficiência do registro e processamento de dados o máximo possível? Quem registrará os dados? Quem processará os dados? Manual de Referência do WSTP para Gerentes – Página 87 C.1.3 Desenvolvimento de serviços eficientes: monitoramento de um plano de serviço o Crie um plano de serviço para o seu serviço. o Selecione uma necessidade ou dificuldade a ser monitorada pelo seu próprio serviço e preencha as informações sob cada título Estrutura de plano de serviço Identifique a necessidade/dificuldade a ser monitorada Ação/objetivo para resolver a necessidade/dificuldade Meta Obtenção de dados Manual de Referência do WSTP para Gerentes – Página 88 C.2.1 Gestão da demanda: geração de demanda e encaminhamento precoce • Leia o exemplo • Discuta e, em seguida, relacione os motivos do sucesso Exemplo de sucesso: encaminhamento precoce por pais no México Este é um exemplo de como um grupo de centros de reabilitação para crianças no México desenvolveu uma rede eficaz de encaminhamento precoce. Embora tivessem médicos neonatais e pediatras como os alvos principais das suas atividades de sensibilização, os centros de reabilitação também realizavam uma grande campanha anual de angariação de recursos na comunidade em geral, utilizando os meios de comunicação em massa, como rádio e televisão. Isso resultou em muitos encaminhamentos por pessoas que ouviram falar do serviço e muitos pais que auto-encaminham os seus filhos. Nessas campanhas de sensibilização, a mensagem era clara: a importância de encaminhar crianças para reabilitação ao nascerem. Também apresentaram uma visão potente de sucesso, com muitas histórias positivas relacionadas com a integração e as realizações das crianças com quem trabalham. Num período de 15 anos, os centros de reabilitação têm observado uma mudança cultural, com pediatras e famílias que agora ativamente fazem encaminhamentos precoces. O resultado: Um terço de todos os encaminhamentos são de crianças com até três anos de idade. Fatores de sucesso Manual de Referência do WSTP para Gerentes – Página 89 C.2.3 Gestão da demanda: análise das etapas do serviço Tempo disponível para o fornecimento de serviços a cada dia: _______ minutos o Trabalhem juntos, em grupos o Leia cada desafio no serviço na coluna 2 o Leia as possíveis estratégias para aumentar a eficiência do fornecimento de serviços no quadro abaixo o Corresponda os desafios no serviço com as estratégias para aumentar a eficiência. Anote o número de cada estratégia na coluna 3. Um desafio pode precisar de várias estratégias. Estratégias para aumentar a eficiência do serviço 1. Adquira produtos com o máximo possível de ajustabilidade 2. Adquira produtos que possam ser facilmente modificados 3. Adquira produtos com dispositivos de suporte postural 4. Prepare com antecedência amostras de opções de configuração de produtos 5. Fabrique com antecedência dispositivos de suporte postural 6. Agendamento claro para permitir trabalhos conjuntos 7. Reuniões da equipe para elaborar planos de trabalho compartilhados 8. Equipes clínicas e técnicas trabalham juntas durante a adaptação 9. Equipes clínicas e técnicas discutem soluções de prescrição 10. Clareza na documentação de informações e nos registros. 11. Planeje o nível adequado de capacitação para o pessoal do serviço 12. Adquira os materiais necessários para a fabricação e modificação de almofadas e DSP 13. Adquira as ferramentas necessárias para fazer ajustes rápidos nos produtos 14. Designe uma pessoa específica para a capacitação de cadeirantes, como, por exemplo, um capacitador de pares 15. Identifique uma instalação para a capacitação de cadeirantes próximo às áreas clínica e técnica 16. Crie sistemas eficazes de controle de estoques 17. Prepare um pequeno estoque de cadeiras de rodas em diferentes tamanhos 18. Crie parcerias com a comunidade para identificar utilizadores do serviço e oferecer transporte ao centro de serviço na comunidade 19. Desenvolva a capacidade dos parceiros comunitários para fornecer serviços de nível básico e encaminhar cadeirantes de nível intermediário 20. Esteja aberto a novas ideias – inovação. Coluna 1: desafios do serviço Coluna 2: estratégias do serviço Manual de Referência do WSTP para Gerentes – Página 90 Avaliação: 1. Se o pessoal do serviço viaja até o serviço ou faz visitas em casa, o tempo de deslocamento deve ser incluído na avaliação 2. Quando os membros da equipe são inexperientes, a avaliação leva mais tempo Prescrição: 3. Quando os produtos têm ajustabilidade limitada, as modificações devem ser prescritas de forma a adaptar o produto ao corpo do cadeirante 4. Quando os suportes posturais adicionais têm de ser fabricados, medições e desenhos adicionais são necessários Preparação do produto: 5. Acesso rápido ao tipo e tamanho de produto necessários 6. Quando uma cadeira de rodas tem ajustabilidade limitada, a preparação do produto pode exigir mais tempo 7. Quando é necessário fazer modificações para suporte postural, é necessário mais tempo Adaptação: 8. Caso a cadeira de rodas tenha sofrido modificações ou recebido suportes adicionais, a adaptação levará mais tempo 9. Caso tenham sido feitas modificações na configuração da cadeira de rodas durante a adaptação, será necessário fazer outras verificações de adaptação Capacitação do cadeirante: 10. Caso seja a primeira cadeira de rodas que a pessoa recebe ou haja uma complicação de saúde, será necessário mais tempo para a capacitação do cadeirante em saúde, mobilidade, manobra da cadeira de rodas, cuidado e manutenção, assim como o encaminhamento a outras fontes de encaminhamento Manual de Referência do WSTP para Gerentes – Página 91 C3: Planejamento do acompanhamento: superação dos obstáculos • Leia a lista de possíveis obstáculos ao acompanhamento abaixo e acrescente eventuais obstáculos adicionais que o grupo tenha destacado • Discuta ações para superar os obstáculos ao acompanhamento e relacione no quadro abaixo. Obstáculos ao acompanhamento Obstáculos ao serviço de acompanhamento em campo • Custos de deslocamento do pessoal do centro de serviço até as comunidades • Tempo de deslocamento do pessoal do centro de serviço até a comunidade • O acompanhamento não é priorizado pelos gerentes do serviço • O acompanhamento não é valorizado pelos utilizadores do serviço até observar os benefícios Obstáculos ao serviço de acompanhamento baseado no centro • Custo de deslocamento e ausência de um ou mais familiares no trabalho • Os cadeirantes e familiares com frequência não estão cientes dos benefícios do acompanhamento • Dificuldade para encontrar um transporte acessível • Pode haver pressão para concentrar-se em novas consultas no centro de serviço sem deixar tempo para o acompanhamento • Dificuldade para marcar consultas: os cadeirantes podem aparecer quando o pessoal não está disponível ou não aparecer quando o pessoal está disponível Ações para superar os obstáculos ao acompanhamento Manual de Referência do WSTP para Gerentes – Página 92 C.4.1 Desenvolvimento da sustentabilidade financeira: potenciais fontes de financiamento • Leia a lista de possíveis fontes de encaminhamento e consulte o manual de referência para obter mais detalhes. • Escolha as três fontes que, na sua opinião, têm o maior potencial imediato para o seu serviço e preencha o quadro abaixo com as fontes de financiamento selecionadas. Diferentes fontes de financiamento para a consideração dos gerentes. 1. Governo 2. Estruturas nacionais de seguro 3. Doadores e patrocinadores individuais 4. Doadores e patrocinadores empresariais 5. Contribuições dos cadeirantes ou preço total de compra 6. Geração de receitas/empreendimento social 7. Grupos comunitários/instituições beneficentes 8. Missões diplomáticas 9. ONG internacionais e nacionais Fontes de financiamento selecionadas Número em ordem de prioridade com base em • Esforço necessário • Retorno financeiro a curto ou longo prazo (ou ambos) Priorid ade Fonte de financiamento Investimento/esforço necessário Alto / Médio / Baixo Retorno a curto prazo Alto / Médio / Baixo Retorno a longo prazo Alto / Médio / Baixo Manual de Referência do WSTP para Gerentes – Página 93 C.4.2 Desenvolvimento da sustentabilidade financeira: elaboração de uma estratégia • Leia os dois exemplos de estratégia abaixo • Relacione as três fontes de financiamento do exercício anterior no quadro • Preencha as colunas do quadro com as fontes de financiamento selecionadas Fonte de financiamento Tipo de apoio Solicitação Probabilidade Esforço 1. Empresas Doação ao orçamento de compra de cadeiras de rodas 10% do orçamento de cadeiras de rodas Média (ofereceu um financiamento anteriormente, mas nem sempre financia a mesma organização todos os anos). Pelo menos duas reuniões com o gerente comercial; proposta de 2 páginas e apresentação de um orçamento, além de um convite ao gerente para o próximo dia de visita. 2. Governo local Potencialmente pode financiar os custos de todas as visitas em campo a cadeirantes da sua área. 20% de todos os custos em campo + 20% dos salários do pessoal do serviço. Alta (já há discussões com esse governo local há algum tempo. Foi realizado um trabalho em campo na sua área. Estão muito ansiosos para apoiar o trabalho e parece haver recursos disponíveis). Apresentação de proposta formal e orçamento. Relatórios obrigatórios – exigem dados precisos de todas as pessoas visitadas na sua área, além de relatórios financeiros.

Pacote de Capacitação para Serviços de Cadeiras de Rodas para Gerentes Recursos adicionais de apoio ao fornecimento de serviços de cadeira de rodas Índice Formulário de encaminhamento de cadeiras de rodas – básico............................................... 1 Formulário de encaminhamento de cadeiras de rodas – intermediário .................................... 2 Relação de formulários e listas de verificação do serviço ........................................................ 4 Caixa de avaliação................................................................................................................... 5 Leito de avaliação .................................................................................................................... 7 Apoios para os pés .................................................................................................................. 8 Exemplos de ferramentas de medição ..................................................................................... 9 Guia de instalações técnicas: ................................................................................................ 10 bancada e área de trabalho ................................................................................................... 10 Guia de serviço básico – recursos técnicos ........................................................................... 11 Guia de serviço intermediário – recursos técnicos ................................................................. 13 Preparação de uma lâmina de arco de serra para cortar espuma .......................................... 17 Guia de serviços básicos e intermediários – materiais ........................................................... 18 Guia de preparação de áreas de capacitação de mobilidade ................................................. 21 Comparação entre diferentes métodos de fornecimento de cadeiras de rodas ...................... 25 Ferramentas de medição ....................................................................................................... 30 Ferramenta para medir .......................................................................................................... 31 Informações de acessibilidade ............................................................................................... 36 1 Formulário de encaminhamento de cadeiras de rodas – básico Exemplo de formulário de encaminhamento: Este formulário pode ser adaptado pelos serviços de cadeiras de rodas e distribuído para fontes de encaminhamento para ajudá-las a encaminhar cadeirantes ao serviço de cadeiras de rodas. Preencha o formulário de encaminhamento e envie para: Nome e endereço do serviço de cadeiras de rodas: Nome do encaminhador: Organização para a qual trabalha: Contatos do encaminhador (a melhor forma de contato): Nome do(a) cadeirante: Data de nascimento: Responsável/atendente: Endereço: Forma de contato do(a) cadeirante? Correio Telefone próprio Telefone de amigo/vizinho Se por telefone, qual é o número: Deficiência do(a) cadeirante, se souber: Motivo do encaminhamento: • Não tem cadeira de rodas • Tem uma cadeira de rodas quebrada • Tem uma cadeira de rodas que não atende às necessidades Favor incluir quaisquer informações sobre o(a) cadeirante que considere importante levar à atenção do serviço de cadeiras de rodas: O(A) cadeirante aceitou o encaminhamento para o serviço de cadeiras de rodas? Sim Não Assinatura do(a) encaminhador(a): Data: 2 Formulário de encaminhamento de cadeiras de rodas – intermediário Exemplo de formulário de encaminhamento: Este formulário pode ser adaptado pelos serviços de cadeiras de rodas e distribuído para fontes de encaminhamento para ajudá-las a encaminhar cadeirantes ao serviço de cadeiras de rodas. Preencha o formulário de encaminhamento e envie para: Nome e endereço do serviço de cadeiras de rodas: Nome do encaminhador: Organização para a qual trabalha: Contatos do encaminhador (a melhor forma de contato): Nome do(a) cadeirante: Data de nascimento: Responsável/atendente: Endereço: Forma de contato do(a) cadeirante? Correio Telefone próprio Telefone de amigo/vizinho Se por telefone, qual é o número: Deficiência do(a) cadeirante, se souber: Motivo do encaminhamento: • Não tem cadeira de rodas • Tem uma cadeira de rodas quebrada • Tem uma cadeira de rodas que não atende às necessidades • Para crianças: o incapacidade de sentar-se eretas ou levantar-se com um ano de idade; o incapacidade de andar com dois anos de idade. Favor incluir quaisquer informações sobre o(a) cadeirante que considere importante levar à atenção do serviço de cadeiras de rodas: O(A) cadeirante aceitou o encaminhamento para o serviço de cadeiras de rodas? Sim Não Assinatura do(a) 3 encaminhador(a): Data: 4 Relação de formulários e listas de verificação do serviço Serviços de nível básico 1. Formulário de encaminhamento – nível básico 2. Formulário de avaliação para cadeira de rodas – nível básico 3. Formulário de prescrição (seleção) para cadeira de rodas – nível básico 4. Formulário resumido para cadeira de rodas – nível básico 5. Lista de verificação de adaptação de cadeira de rodas – nível básico 6. Lista de verificação de segurança e prontidão de cadeira de rodas * 7. Formulário de acompanhamento de cadeira de rodas* Formulários e listas de verificação adicionais para serviços de nível intermediário 8. Formulário de encaminhamento – nível intermediário 9. Formulário de avaliação para cadeira de rodas – nível intermediário 10. Formulário de prescrição (seleção) para cadeira de rodas – nível intermediário 11. Formulário resumido para cadeira de rodas – nível intermediário 12. Lista de verificação de adaptação de cadeira de rodas – nível intermediário 13. Lista de verificação de capacitação para cadeirantes – nível intermediário 14. Quadro de suporte postural * formulários e listas de verificação servem tanto para serviços de nível básico como intermediário 5 Caixa de avaliação Instruções para construir uma caixa de avaliação Notas 1. Todos os compensados apresentados são de 18 mm de espessura. Caso não estejam disponíveis, use 15 mm ou 20 mm de espessura. 2. O apoio ajustável para os pés deve deslizar facilmente para dentro e para fora nos trilhos. 3. As superfícies do assento e do apoio para os pés devem ser revestidas com espuma firma (EVA) de 5 a 10 mm de espessura ou esteira antiderrapante, como o tipo usado nos apoios para os pés de algumas cadeiras de rodas. Caixa de avaliação construída localmente 6 Caixa de avaliação – diagramas de dimensões APOIO AJUSTÁVEL PARA OS PÉS 7 Leito de avaliação O leito de avaliação permite que o cadeirante sente-se numa posição confortável, na qual o clínico pode fazer uma boa avaliação para prescrever uma cadeira de rodas. O leito de avaliação deve ser estável, seguro e de altura adequada para a pessoa transferir-se de uma cadeira de rodas. Dimensões Aproximadamente 1800 mm de comp x 600 mm de larg x 500 mm de alt para avaliações normais relacionadas com cadeiras de rodas Materiais e construção • A estrutura pode ser feita de madeira ou aço • Estofamento: Base de compensado de 13 mm Espuma aglomerada densa de 50 mm Espuma macia de 25 mm para a camada superior • O estofamento deve ter uma cobertura de tecido de limpeza fácil, como, por exemplo, couro imitação (Rexene) ou couro. O rexene/couro deve ser recortado na forma adequada, dobrado, colado e afixado no compensado com grampos ou tachinhas. • Pinte as estruturas de aço com uma base anticorrosiva e uma segunda demão de tinta spray 8 Apoios para os pés Os apoios para os pés oferecem suporte para os pés do cadeirante a uma altura adequada para que tenha uma boa posição sentada durante a avaliação. É importante ter disponíveis apoios para os pés com alturas variadas ou um apoio para os pés com altura ajustável para posicionar os pés do cadeirante adequadamente. Dimensões Área da superfície: 400 mm x 300 mm Alturas: variadas, de 15 mm a 150 mm Materiais e construção • Alturas diferentes, que possam ser empilhados, ou um bloco ajustável • Construção com compensado • Para cadeirantes com diiferença de comprimento das pernas ou outra condição que cause desnível das bases dos pés, é preciso utilizar blocos adicionais Apoios empilháveis básicos para os pés 9 Exemplos de ferramentas de medição Ferramenta de medição de madeira Material: compensado de 3 a 9 mm Base de madeira: com marcas de medição e faixas de velcro para fixar a lateral ajustável Laterais de madeira: uma lateral é fixa e a outra é ajustável Ferramenta de medição de vinil Base de vinil com marcas de medição Laterais de madeira: uma lateral é fixa e a outra é ajustável Paquímetros 10 Bancada A profundidade da bancada é de 750 mm A profundidade da área de trabalho do técnico é de 1500mm A largura da bancada e área de trabalho do técnico é de 1500 mm Bancada Área de trabalho do técnico Total 2250mm Guia de instalações técnicas: bancada e área de trabalho 11 Guia de serviço básico – recursos técnicos As ferramentas relacionadas abaixo servem para montagem, configuração, ajuste, manutenção e reparo, assim como modificações básicas dos produtos (descritas no curso de capacitação básica da OMS para serviços de cadeiras de rodas). Ferramentas Detalhes Quantidade Jogo de chaves combinadas – unidades métricas De 8 mm a 22 mm (Deve incluir tamanhos de 8, 10, 13, 19 mm) 2 Jogo de chaves combinadas – unidades imperiais Jogo de chaves Allen – unidades métricas É melhor haste longa, preferencialmente com cabo T deve conter 4 mm, 5 mm, 6 mm 2 Fita métrica metálica 5 m de comp Jogo de chaves Philips Tamanhos grande e médio Jogo de chaves de fenda Tamanhos grande e médio Martelo de borracha Cabeça de 8 oz Alicate Bico curto – médio Bradal Ponta pequena do tipo ‘lâmina plana’ Jogo de limas metálicas Tipo: lima de segundo corte, tamanho médio, meia-cana, redonda, plana Cortador de tubo, pequeno, com lâminas sobressalentes Para corte de tubos de 12 mm a 38 mm Serrote para madeira Um serrote de corte transversal (não longitudinal) Arco de serra de 12 pol. e lâminas Para corte de metal Lâmina para corte de espuma Uma lâmina longa e ligeiramente serrilhada ou uma faca de pão comum Estilete com lâminas sobressalentes Tesoura industrial Jogo de agulhas e linhas Variedade de tamanhos de agulha, linha forte de nylon Bomba pneumática para pneus Para ambos os tipos de válvula de pneu de bicicleta ‘Schrader’ e ‘Presta’ Kit de reparo de furo com espátulas de pneu Caneta marcadora de ponta fina Chave de raio 12 Óculos de segurança Pinceis Kit de limpeza Balde, sabão, esponjas, escovas, panos Óleo lubrificante leve Adesivo de contato Cola comum a base de PVA para madeira Verniz para madeira exterior Tinta de esmalte para metal Diluentes de tinta Ferramentas elétricas desejáveis Máquina de costura industrial Com jogo de agulhas industriais Furadeira elétrica Mandril de 3 a 13 mm, múltiplas velocidades Jogo de brocas para madeira Jogo de brocas para metal Serra tico-tico Lâminas de corte fino para madeira e metal Esmeril angular elétrico Rebolos médios e finos Extensões elétricas 10m Protetor contra surtos elétricos Armazenamento Caixa de ferramentas Cadeados Gabinete de metal com fechadura 13 Guia de serviço intermediário – recursos técnicos Alguns artigos marcados com * aparecem na lista do serviço básico. Eles foram destacados para confirmar a recomendação de um jogo adicional para um serviço intermediário. Maquinário Artigos essenciais Detalhes Quantidade Estabilizador de tensão para máquinas e ferramentas portáteis * Máquina de costura Industrial – capacidade para costurar tecidos pesados quando necessário. 1 Pacote de agulhas de costura Tamanhos variados Maçarico a arco/maçarico mig 1 Hastes de soldagem a arco para aço Tamanho: 2 mm, 4 mm, 6 mm Luvas de proteção para soldagem a arco Couro grosso Abertura de 6 pol. Máscara de proteção ocular para soldagem a arco Artigos desejáveis Esmeril de bancada Rebolos de grãos grossos ou finos 1 Lixadeira de cinta Com mecanismo de extração de pó 1 Cintas de lixa Grãos grossos e finos Serra de fita Tamanho médio para madeira, compensado e espuma de PU e EVA 1 Compressor 24 l 1 Kit de pulverizador com mangueiras 1 Kit de brasagem a gás Maçarico com bicos de tamanhos variados, reguladores e mangueiras 1 Pacote de hastes de brasagem Tamanhos variados Fluxo de brasagem Óculos de proteção para brasagem Furadeira de coluna (mandril de 3 a 13 mm) Fixada em bancada ou no piso Com torno (o ideal é um torno transversal multidirecional com base rotatória) 1 Ferramentas elétricas Artigos essenciais 14 Furadeira elétrica portátil (mandril de 3 a 13 mm) Ajustes para múltiplas velocidades e múltiplos torques são recomendáveis 1 Serra tico-tico portátil 1 Lâminas tico-tico Pacotes de lâminas (de corte fino) para madeira, metal e plástico Esmeril angular 1 Rebolos Rebolos de grãos grossos e finos Luvas de proteção para esmeril angular Extensões elétricas* 5 m ou 10 m 2 Artigos desejáveis Parafusadeira elétrica Sem fio e com um jogo de cabeçotes de tamanhos variados para parafusos, soquetes e Allen 1 Furadeira elétrica portátil sem fio (mandril de 3 a 13 mm) 18V Ajustes para múltiplas velocidades e múltiplos torques são recomendáveis 1 Serra circular (lâmina de tamanho mínimo de 185 mm) Ferro de solda Ponta fina para fazer orifícios em malhas e ponta tipo fenda para selar as extremidades de malhas recortadas Ferramentas manuais Artigos essenciais Serrote para madeira (universal) 22 pol., dentes finos 1 Arco de serra tico-tico 1 Lâminas para arco de serra tico-tico Corte fino para madeira Jogo de brocas planas Broca countersink Guilhotina (com parafusos de fixação) De bancada 1 Torno de bancada (com parafusos de fixação)* 6 pol. 2 Alicate Bico longo – médio 1 Alicate de pressão Bico curto – médio 2 Alicate de pressão Bico longo – médio 2 Braçadeira C Abertura de 6 pol. 2 Braçadeira C Abertura de 8 pol. 2 Jogo de furadores de ilhós Tamanhos variados Pacote de ilhós Tamanhos variados Grampeador (para madeira) 1 15 Pacote de grampos 5 mm de profundidade Pacote de grampos 8mm de profundidade Rebitador manual 1 Pacote de rebites Diâmetro de 4 mm e 6 mm Rebites de comprimentos variados Régua metálica* 1 metro (escalas métrica e imperial) 1 Régua metálica 30 cm 2 Fita métrica metálica* 5 m 1 Paquímetro Vernier Bocal com largura de 150 mm 1 Transferidor metálico De 1 a 180 graus (1 grau de precisão) 1 Punção 2 Riscador 2 Bradal* Útil quando não há uma furadeira ou eletricidade 1 Esquadro de carpinteiro 600 x 400 mm, aço Chave inglesa Abertura máxima de 1 pol. 1 Jogo de soquetes Métricos (inclusive 8, 10, 13, 17, 19 mm) 1 Espátulas de pneu* Jogo de 4 1 Chave de raio* 1 Óculos de segurança* Óculos de proteção geral em oficinas 4 Protetores de ouvidos 2 Máscaras contra poeira 4 Lima plana para madeira Tamanho médio 1 Jogo de limas para madeira 1 Jogo de limas meias-canas (para madeira) 1 Artigos desejáveis Jogo de soquetes Imperial 1 Jogo de chaves combinadas* Imperial, de ¼ a 1½ 1 Jogo de chaves Allen (formato em L) Imperial 1 Plaina spokeshave 1 Esquadro combinado 1 Esquadro ajustável 1 Esquadro pequeno 10 pol. 1 Materiais consumíveis Base para pintura Tinta para madeira exterior Tinta de acabamento Tinta para madeira exterior Verniz Qualidade para exteriores 16 Aguarrás* Para limpar pincéis e pulverizador Tinta / verniz / potes de cola Lixa Grau 40 Lixa Grau 80 Lixa Grau 150 Giz para tecido Graxa Pote médio 1 Artigos gerais de oficina Lixeiras 3 Escova para piso 1 Pá e escova 1 Panos de limpeza Baldes e esponjas de limpeza 2 Móveis de oficina e local seguro de armazenamento Armário de metal com fechadura para ferramentas* 2 Armário com fechadura para materiais 2 Armário sem fechadura para utilização geral 1 Armário sem fechadura para componentes de dispositivos de suporte postural 1 Banco 3 Bancada* 3 Prateleiras 2 Armação para secagem Para peças pintadas ou envernizadas 1 17 Preparação de uma lâmina de arco de serra para cortar espuma Pegue uma lâmina de arco de serra comum (de preferência uma lâmina usada) e esmerilhe a borda dentada até que o fio fique afiado (seção transversal em forma de V), obtendo uma lâmina serrilhada fina e afiada que corte espuma de poliuretano de média e baixa densidade e espuma aglomerada com muita facilidade e rapidez. Enrole um pouco de fita ao redor de uma extremidade da lâmina, criando um punho para proteger os dedos durante o corte da espuma. 18 Guia de serviços básicos e intermediários – materiais Materiais para modificação e fabricação de dispositivos adicionais de suporte postural são usados com mais frequência no nível intermediário; contudo, serviços de nível básico também podem realizar modificações simples usando materiais similares. A quantidade de materiais necessários dependerá de vários fatores, inclusive a quantidade de cadeirantes que utilizam o serviço, o volume do serviço de fornecimento de cadeiras de rodas de nível intermediário e os tipos de cadeiras de rodas fornecidas. O pessoal clínico e técnico deve estar envolvido na aquisição dos devidos materiais. Materiais Utilização: O que procurar Metal/plástico/madeira A estrutura de um dispositivo de suporte postural é composta por metal/plástico/madeira – por exemplo, assentos e encostos rígidos. O compensado de 12 mm é muito recomendável para fabricar assentos e encostos rígidos. É um material resistente, mas relativamente leve. O compensado naval é a opção mais durável, mas pode ser mais caro. Encostos rígidos também podem ser fabricados com chapas de alumínio de 3 mm e chapas de acrílico de 6 mm ou de plástico ABS, quando disponíveis. A rigidez pode ser aumentada dobrando-se a chapa. Ao usar qualquer material em chapa, tome o cuidado adicional de eliminar ou acolchoar as arestas vivas para a segurança do cadeirante. Espuma/estofamento A espuma é usada em todas as áreas de contato direto dos dispositivos de suporte postural com o corpo do cadeirante. A espuma firme, que preserva a sua forma, é usada para dar aos dispositivos de suporte postural a forma necessária para oferecer o devido suporte. A espuma mais macia é usada para aumentar o conforto e reduzir a pressão. Exemplos de uso de espuma: o A espuma deve ser acrescentada às cintas para reduzir a pressão e aumentar o conforto; o A espuma firme pode ser usada para fabricar um suporte lateral para o tronco Verifique os mercados locais e visite fábricas de espuma, calçados, colchões e móveis para identificar a disponibilidade local de espuma. Tente identificar exemplos locais de espuma de diferentes espessuras (25 mm e 50 mm) e diferentes graus de firmeza. O EVA é um exemplo de espuma muito firme, que é adequada para oferecer suporte e uma estrutura firme para um dispositivo de suporte postural. O EVA às vezes pode ser encontrado em locais onde calçados são fabricados. A borracha firme usada para fabricar chinelos pode ser usada para substituir o EVA. A espuma aglomerada de boa qualidade é um exemplo de espuma de firmeza média. A espuma aglomerada pode ser usada como base de uma almofada com forma anatômica ou camadas para fabricar uma almofada elevatória de encosto ou suporte anterior à bacia ou para dar formas mais anatômicas a um encosto rígido. A "espuma de colchão" macia é um exemplo de uma espuma mais macia usada em camadas destinadas a aumentar o conforto. A espuma "muito macia", que é mais barata e de disponibilidade mais ampla, não é adequada para fabricar almofadas de alívio de 19 ou pode ser acrescentada a uma almofada para fabricar um suporte externo ou interno para a coxa. o Uma espuma muito firme (por exemplo, EVA) pode ser usada para acrescentar uma camada ao apoio para os pés ou às almofadas laterais para o tronco. pressão por si só, sem uma base de espuma mais firme. O coquim (fibras de coco) pode ser usado para substituir a espuma firme. 20 Materiais Utilização: O que procurar Tecido O tecido é usado para cobrir dispositivos de suporte postural. Procure um tecido que tenha durabilidade e facilite a limpeza (passando-se um pano ou removendo-se para lavar). Um tecido resistente a água é recomendável para o assento e encosto nos casos de cadeirantes incontinentes. Um material mais macio, como do tipo usado em camisetas (algodão ou algodão/Lycra), pode ser usado nos apoios para a cabeça e nos suportes laterais para o tronco. Tecidos com alguma elasticidade conformam-se com mais facilidade à forma dos dispositivos de suporte postural. Tecidos sintéticos em geral produzem mais calor para a pessoa do que tecidos naturais. Se possível, tente oferecer pelo menos algumas cores diferentes para escolha dos cadeirantes. Malhas de nylon e velcro ou fivelas Malhas de nylon e velcro ou fivelas são usados para fabricar as cintas, inclusive as cintas para o quadril, os ombros, as panturrilhas e os pés. Malhas de nylon de 25 mm, 35 mm e 50 mm são recomendáveis. Quanto mais larga a cinta, mais uniforme é a pressão. Para prevenir o esgarçamento das malhas de nylon, derreta as extremidades recortadas. Malhas de algodão são bem menos eficazes. Fivelas de encaixe (como as utilizadas em mochilas) podem ser muito fáceis de utilizar. Use fivelas de boa qualidade, quando disponíveis, pois a sua durabilidade é maior. Teste-os afivelando e tentando separá-los. Eles devem encaixar-se e desencaixar-se com facilidade, e não se separar sem serem desafivelados. Velcro é um bom material de fixação, mas deve ser mantido limpo ou deixa de funcionar. As cintas de malha devem levar estofamento para proteger o corpo do cadeirante. Adesivos Adesivos são usados para colar a espuma na madeira. Mantenha um estoque de cola para madeira (normalmente conhecida como cola branca ou PVA) e cola para espuma (adesivo de contato, cola de sapateiro ou cola amarela). Certifique-se de que todos os funcionários que trabalhem com adesivos saibam como usá-los corretamente. Prendedores Os prendedores são utilizados para prender os dispositivos de suporte postural às cadeiras de rodas. Entre os prendedores mais úteis destacam-se: o parafusos com porcas (de preferência, contraporcas) e arruelas; o porcas embutidas (fixadas no compensado) em vez de porcas normais o grampos (para prender o estofamento) Evite usar parafusos pontiagudos pois podem tornar- se um perigo em caso de dano ao dispositivo de suporte postural. 21 Guia de preparação de áreas de capacitação de mobilidade A área de capacitação de mobilidade é essencial para os cadeirantes aprenderem a utilizar as suas cadeiras de rodas de forma correta e segura. Deve incluir pelo menos: • Terreno variado e compatível com as condições locais • Declives • Degraus Ela deve estar próxima à área de adaptação, pois esta é a próxima etapa do serviço e a cadeira de rodas com frequência precisa de ajustes após o cadeirante ter tentado movimentar-se nela. É recomendável ter uma seção coberta para períodos de mau tempo. Simulação do terreno local Blocos e rampa 1:12 A área de capacitação de mobilidade deve incluir: Item Dimensões Objetivo para os cadeirantes e os seus atendentes praticarem: Terreno plano 10 m de comp x 1 m de larg Propulsão básica Simulação do terreno local (3 áreas), como areia, grama, pedregulhos, etc. Cada área deve ter um mínimo de 2000 mm de comp e 1000 mm de larg Em ambientes encontrados na localidade Bloco 1 1500 mm x 1500 mm x 25 mm de alt Manobra ao encontrar um único degrau Bloco 2 1500 mm x 1500 mm x 100mm de alt Bloco 3 1500 mm x 1500 mm x 200mm de alt Rampa 1:12 Aproximadamente 3600 mm de comp x 1000 mm de larg Gradiente: De 0 mm (extremidade baixa) a 300 mm (extremidade alta) Manobra num declive normal 22 Rampa 1:8 Aproximadamente 2400mm de comp x 1000 mm de larg Gradiente: De 0 mm (extremidade baixa) a 300 mm (extremidade alta) Manobra num declive acentuado Barreiras (guias e obstáculos) (Veja a Fig. 1) 60 mm de alt x 50 mm de larg x 1000 mm de comp Ultrapassagem de obstáculos no caminho e passagem por portas Barreiras (guias e obstáculos) 2 (Veja a Fig. 1) 90mm de alt x 50 mm de larg x 1000 mm de comp Degraus (Veja a Fig. 2) Aproximadamente 300 mm de profundidade, 150 mm de alt e 1100 mm de larg Subir e descer uma série de degraus As dimensões indicadas no quadro acima devem ser alteradas de acordo com o contexto local quando há diferenças significativas em relação aos padrões sugeridos. É importante que as pessoas aprendam a se locomover nos ambientes locais nessa capacitação. Certifique-se de que haja acesso a qualquer parte específica da área de capacitação de mobilidade. Às vezes é possível identificar uma área próxima à localização do serviço com o terreno natural disponível. 23 Exemplos de barreiras com diferentes alturas Fig. 1 24 Exemplo de simulador de escadas Fig. 2 25 Comparação entre diferentes métodos de fornecimento de cadeiras de rodas Os principais métodos de fornecimento de cadeiras de rodas a serem considerados são a produção local de cadeiras de rodas, a importação de novas cadeiras de rodas e a importação de cadeiras de rodas recicladas. As cadeiras de rodas também podem ser recicladas no âmbito do serviço de cadeiras de rodas. Fornecimento confiável de uma série de produtos a longo prazo Os cadeirantes precisam do fornecimento de uma série de produtos apropriados a longo prazo, como definido nas Diretrizes da OMS para o Fornecimento de Cadeiras de Rodas. Em qualquer modelo de fornecimento, é crucial considerar a confiabilidade do fornecimento de produtos a longo prazo. Todos os modelos de fornecimento apresentam desafios em termos de sustentabilidade e controle de qualidade e devem ser considerados individualmente em diferentes situações. A OMS afirma que cadeirantes devem participar do planejamento, implementação, gestão e avaliação do fornecimento de cadeiras de rodas1 e, portanto, devem ser envolvidos na definição da melhor solução para um determinado contexto. Caso haja serviços locais de próteses e órteses, a escolha destes entre produção local ou importação de dispositivos pode informar a decisão sobre o método de fornecimento de cadeiras de rodas a um serviço. Também é recomendável considerar artigos similares disponíveis no mercado local, como bicicletas ou móveis de aço, e identificar por que essas empresas locais decidiram por produzir ou importar os seus produtos. A presença ou ausência de outras fábricas locais é um indicador muito importante do eventual sucesso de uma fábrica de cadeiras de rodas. A presença ou ausência de empresas locais estabelecidas que importam produtos é um bom sinal de possibilidade de uma cadeia de fornecimento confiável para importar produtos. Antes de tomar uma decisão sobre o modelo de fornecimento a ser adotado, recomenda-se a realização de um estudo de viabilidade completo. Os custos devem ser calculados e comparados. O custo total de um produto importado pode ser estimado com antecedência (cotação de produtos, frete e importação, armazenamento), mas é necessário atentar às questões que estarão fora do controle dos serviços de cadeiras de rodas, como atrasos de entrega. A definição do custo de um produto de fabricação local requer conhecimentos significativos sobre os custos de operação de uma oficina e os custos efetivos dos produtos, que podem ser imprevisíveis. É necessário calcular os aspectos logísticos, como o pessoal necessário, o armazenamento e a gestão da importação ou produção local. Comparação de benefícios da produção local e da importação de produtos Quer sejam de fabricação local quer importadas, todas as cadeiras de rodas devem ser adequadas segundo a definição das Diretrizes da OMS para Cadeiras de Rodas2. No passado, não era possível importar cadeiras de rodas projetadas especificamente para áreas com menos recursos; portanto, a produção local era a única forma de assegurar o fornecimento de produtos adequados. Contudo, cadeiras de rodas projetadas especificamente para utilização em áreas com menos recursos estão ficando mais disponíveis para importação. Com isso em mente, é recomendável considerar os benefícios de ambas as abordagens. O quadro de comparação destaca várias considerações na escolha de um modelo de fornecimento que melhor assegure a disponibilidade de uma gama de cadeiras de rodas adequadas para os cadeirantes. 1 Diretrizes da OMS para o Fornecimento de Cadeiras de Rodas, pág. 34 2 Diretrizes da OMS para Cadeiras de Rodas, pág. 71 26 27 Produção local de cadeiras de rodas Vantagens Desvantagens • O compromisso governamental com a produção local pode destacar que a deficiência é uma questão que pertence à comunidade e deve ser enfrentada em todos os seus aspectos, inclusive a fabricação de cadeiras de rodas. • A produção pode ser adaptada às necessidades locais. • Os produtos podem ser facilmente fornecidos com peças sobressalentes localmente disponíveis. • Cria empregos industriais locais e capacitações que posteriormente poderão servir no reparo e na manutenção local de cadeiras de rodas. • A necessidade de cadeiras de rodas personalizadas pode ser atendida quando a indústria local tem capacidade. • É mais fácil manter níveis constantes de estoque com a produção local. • Armazenamento mínimo para o estoque necessário para produção contínua e flexível. • O envolvimento de cadeirantes locais facilita muito o desenvolvimento de produtos e agiliza a resolução de necessidades e problemas. • Dificuldade de manter a qualidade com a produção não mecanizada em pequena escala. • Investimento inicial necessário em maquinaria, ferramentas, espaço de fabricação e capacitação de pessoal. • Dificuldade para reter o pessoal quando os pedidos de produtos não cobrem os custos operacionais da oficina de produção. • A gestão de uma oficina de produção pode ser complexa. • Dependência de uma disponibilidade local constante de materiais e componentes. • A quantidade limitada de produção pode aumentar o custo dos produtos. • Menos tempo para concentrar-se nos aspectos clínicos do fornecimento de cadeiras de rodas em virtude da natureza intensa da produção local. Cadeiras de rodas importadas Vantagens Desvantagens • Cadeiras de rodas importadas podem complementar os produtos de fabricação local para assegurar a disponibilidade de uma variedade de produtos e componentes diferentes para atender às necessidades individuais dos cadeirantes. • Qualidade uniforme dos produtos em decorrência da existência de fábricas estabelecidas com mecanismos bem estabelecidos de controle de qualidade. • Potenciais economias de custo como resultado do maior volume de produção em comparação com o que seria possível com a fabricação local. As economias de custo podem levar à distribuição de mais cadeiras de rodas. • O serviço de cadeiras de rodas poderá concentrar-se mais em capacitações clínicas se dedicar menos tempo à produção. • Empregos locais podem ser criados para montagem, ajustes, modificações de • Logística e custo de importação aduaneira. • Para que o custo de frete seja viável, pedidos de maior volume talvez sejam precisos. • Menos flexibilidade em termos de quantidades mínimas de pedido. • Maior tempo de transporte e possivelmente maior tempo de produção quando há uma quantidade mínima necessária antes do início da produção. • Pedidos maiores exigem um volume significativo de capital, mais espaço de armazenamento e maiores mecanismos de controle de estoque. • Dificuldade de manter níveis constantes de estoque com compras maiores, mas menos frequentes. • Os produtos importados de maior disponibilidade podem não ser os ideais para as necessidades locais. • Possibilidade de que os produtos não sejam fornecidos com peças 28 suporte postural, manutenção e assistência técnica. • Investimento inicial menor em maquinaria, ferramentas, materiais e segurança em comparação com a produção local. • Gestão menos complicada de oficina/técnicos em comparação com a produção local. • Modelo de serviço em um dia potencialmente factível. sobressalentes localmente disponíveis. • Não cria empregos industriais locais. • Maior dificuldade para envolver cadeirantes locais no desenvolvimento de produtos. 29 Importação de cadeiras de rodas recicladas Em várias áreas com mais recursos, a reposição frequente de cadeiras de rodas ou a sua utilização a curto prazo muitas vezes resulta em acúmulos de cadeiras de rodas usadas. Dessa forma, várias organizações recolhem, restauram e exportam essas cadeiras de rodas para reutilização em áreas com menos recursos. Ao decidir se a importação de cadeiras de rodas recicladas é uma boa opção para a sua organização, tome em consideração o que significa uma cadeira de rodas adequada: • atende às necessidades e condições ambientais do cadeirante; • é mais adequada ao corpo do cadeirante e oferece melhor uporte postural; • é segura e durável; • está disponível no país; e • pode ser obtida e mantida, com serviços sustentáveis no país a um custo acessível. Algumas considerações ao avaliar a opção de importar cadeiras de rodas recicladas: • Como assegurar que os produtos disponíveis sejam adequados para áreas com menos recursos • Como atender às necessidades identificadas num país quando os produtos disponíveis podem apresentar grande variação de tipo e qualidade • Como oferecer um fornecimento constante de peças sobressalentes • Como oferecer as ferramentas certas para ajuste e ajuste e configuração de uma grande variedade de produtos de diferentes fabricantes • O impacto sobre os fabricantes e prestadores de serviços locais Reciclagem de cadeiras de rodas num serviço À medida que os serviços crescem, é inevitável que alguns dos clientes precisem de cadeiras de rodas maiores, recebam novas cadeiras de rodas ou deixem de utilizar as suas cadeiras de rodas. Em resposta a isso, algumas organizações optam por criar um sistema em que as cadeiras de rodas são devolvidas ao serviço e recicladas para outro cadeirante. Assim, mais cadeirantes podem ser beneficiados, mas há várias considerações antes de se decidir se essa é uma boa opção para o seu serviço. Quando uma organização opta por reciclar produtos, é importante ter em mente que a cadeira de rodas reciclada também deve ser adequada para o cadeirante. Será necessário trocar ou reparar várias peças, e qualquer peça que possa alojar bactérias (espuma, estofamento, cintas, etc.) deve ser trocada para a segurança e saúde do próximo cadeirante. Alguns dos fatores que afetarão a complexidade e viabilidade da reciclagem de cadeiras de rodas no seu programa: • Acesso a peças de reposição; • Volume de clientes atendidos; • Mecanismos de financiamento utilizados com clientes; • Idades dos clientes; • Qualidade dos produtos fornecidos; • Terreno local e fatores ambientais (que afetarão a vida útil da cadeira de rodas). Algumas considerações adicionais: • Necessidade de transportar cadeiras de rodas de volta ao serviço para reciclagem • Espaço adicional na oficina para recondicionamento • Necessidade de capacitação avançada em técnicas e controle de qualidade 30 Ferramentas de medição de participação na ocasião da avaliação para tecnologia assistiva Seção de identificação do entrevistado (caso não esteja em outra página). 1. Você tem algum dispositivo assistivo? □ Sim □ Não (Pular para 5) 2. Caso Sim, que dispositivos assistivos você tem? _____________________________________________ 3. Caso Sim, você atualmente utiliza qualquer dos seus dispositivos assistivos? □ Sim □ Não (Pular para 5) 4. Caso Sim, quais você utiliza? □ Todos □ Alguns, especificamente: ________________________________ Agora temos algumas perguntas sobre o seu atual grau de dificuldade para realizar atividades onde você vive. inclusive com a assistência de outras pessoas e utilizando os seus eventuais dispositivos assistivos. 5. Até que ponto você tem problemas para utilizar transportes para a sua locomoção como passageiro? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 6. Até que ponto você tem problemas para realizar tarefas domésticas, como lavar ou limpar? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 7. Até que ponto você tem problemas para ir à escola e estudar? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 8. Até que ponto você tem problemas para obter e manter um emprego? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 9. Até que ponto você tem problemas para participar em atividades recreativas e de lazer, como esportes, jogos, arte e artesanato, dança, música, etc.? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 10. Até que ponto você tem problemas para participar ativamente em atividades religiosas? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica 31 Ferramenta para medir a satisfação e os resultados no acompanhamento da tecnologia assistiva Identificar o entrevistado: Local: Data: Nome do entrevistador: 1. Qual é dispositivo assistivo que está sendo acompanhado? 2. Há quanto tempo você o obteve? 3. Você atualmente utiliza o dispositivo assistivo? □ Sim (Pular para 5) □ Não 4. Caso Não, por que você não o utiliza? (Caso tenha respondido à pergunta 4, pular as próximas perguntas.) Agora temos algumas perguntas sobre o seu atual grau de dificuldade para realizar atividades onde você vive. inclusive com a assistência de outras pessoas e utilizando dispositivos assistivos. 5. Até que ponto você tem problemas para utilizar transportes para a sua locomoção como passageiro? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário 6. Até que ponto você tem problemas para realizar tarefas domésticas, como lavar ou limpar? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário 7. Até que ponto você tem problemas para ir à escola e estudar? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário 8. Até que ponto você tem problemas para obter e manter um emprego? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário 9. Até que ponto você tem problemas para participar em atividades recreativas e de lazer, como esportes, jogos, arte e artesanato, dança, música, etc.? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário 32 10. Até que ponto você tem problemas para participar ativamente em atividades religiosas? □ □ □ □ □ □ Nenhum problema Problemas leves Problemas moderados Problemas graves Problemas totais Não se aplica Comentário Agora temos algumas perguntas sobre o seu grau de satisfação com o dispositivo assistivo. 11. Qual é o seu grau de satisfação com o tamanho? (Qual é o tamanho?) (Não fazer esta pergunta em referência a programas de computador.) □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 12. Qual é o seu grau de satisfação com o peso? (Qual é o peso?) (Não fazer esta pergunta em referência a programas de computador.) □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 13. Qual é o seu grau de satisfação com a facilidade de locomoção de um lugar para outro? (Não fazer esta pergunta em referência a programas de computador.) □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 14. Qual é o seu grau de satisfação com a aparência? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 15. Qual é o seu grau de satisfação com a facilidade de utilização? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 33 16. Qual é o seu grau de satisfação com o tempo necessário para preparar? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 17. Qual é o seu grau de satisfação com a confiabilidade? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 18. Qual é o seu grau de satisfação com a capacidade de atender às suas necessidades? (Faz tudo que você deseja num tempo razoável?) □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário Agora temos algumas perguntas sobre o seu grau de satisfação com a forma como você obteve o dispositivo assistivo. 19. Qual é o seu grau de satisfação com os conselhos recebidos sobre qual tecnologia seria melhor para você? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 20. Qual é o seu grau de satisfação com tempo necessário para obtê-lo? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário 21. Qual é o seu grau de satisfação com a assistência oferecida caso não esteja funcionando adequadamente? □ □ □ □ □ □ □ Terrível Descontente Em geral Indeciso Em geral Contente Encantado 34 insatisfeito satisfeito Comentário 22. Qual é o seu grau de satisfação com a ajuda e os conselhos recebidos sobre como utilizá-lo? □ □ □ □ □ □ □ Terrível Descontente Em geral insatisfeito Indeciso Em geral satisfeito Contente Encantado Comentário Agora temos algumas perguntas sobre a sua experiência na utilização do dispositivo assistivo. 23. Considere o quanto utilizou o seu atual dispositivo assistivo nas últimas duas semanas. Num dia normal, você o utilizou durante quantas horas? □ □ □ □ □ Nenhuma Menos de 1 hora por dia De 1 a 4 horas por dia De 4 a 8 horas por dia Mais de 8 horas por dia Comentário 24. Considere a situação na qual você mais queria ter um desempenho melhor antes de obter o seu atual dispositivo assistivo. Nas últimas duas semanas, até que ponto o dispositivo assistivo o ajudou nessa situação? □ □ □ □ □ Não ajudou nem um pouco Ajudou um pouco Ajudou moderadamente Ajudou bastante Ajudou muito Comentário 25. Considere novamente a situação na qual você mais queria ter um desempenho melhor. Ao utilizar o seu atual dispositivo assistivo, qual é o grau de dificuldade que você AINDA enfrenta nessa situação? □ □ □ □ □ Muita dificuldade Bastante dificuldade Dificuldade moderada Dificuldade ligeira Nenhuma dificuldade Comentário 26. Considerando todos os aspectos, você acha que o seu atual dispositivo assistivo vale a pena? (Os benefícios derivados da utilização do dispositivo assistivo superam eventuais dificuldades de armazenar / manter / transportar / utilizar o dispositivo?) □ □ □ □ □ Não vale nem um pouco a pena Vale a pena um pouco Vale a pena moderadamente Vale a pena bastante Vale a pena muito Comentário 27. Considere as dificuldades que o levaram a obter um dispositivo assistivo. Nas últimas duas semanas, com o seu atual dispositivo assistivo, até que ponto as dificuldades que o levaram a obter o dispositivo assistivo afetaram o que você consegue fazer? □ □ □ □ □ Afetou muito Afetou bastante Afetou moderadamente Afetou ligeiramente Não afetou nem um pouco Comentário 35 28. Considere as dificuldades que o levaram a obter um dispositivo assistivo. Nas últimas duas semanas, com o seu atual dispositivo assistivo, até que ponto, na sua opinião, outras pessoas estavam incomodadas pelas dificuldades que o levaram a obter o dispositivo assistivo? □ □ □ □ □ Muito incomodadas Bastante incomodadas Moderamente incomodadas Ligeiramente incomodadas Nem um pouco incomodadas 29. Considerando todos os aspectos, até que ponto o seu atual dispositivo assistivo mudou o quanto você aproveita a vida? □ □ □ □ □ Pior Não mudou Um pouco melhor Bem melhor Muito melhor Comentário Fontes: Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) da OMS. QUEST 2.2. Modificado com base no QUEST 2.1: Versão para Crianças por Sonya Murchland 2011. IOI-HA. Cox RM, Stephens D, Kramer SE (2002). Traduções do Questionário Internacional – Aparelho de Amplificação Sonora (International Outcome Inventory for Hearing Aids – IOI-HA). International Journal of Audiology 41(1):3-26. 36 Informações de acessibilidade Parcerias com ministérios governamentais (saúde, educação e transportes) e organizações comunitárias para oferecer conselhos sobre acessibilidade podem promover um aumento significativo da inclusão e participação de pessoas com deficiência de mobilidade na sociedade. Está demonstrado que criar acessibilidade em edifícios aumenta os custos de construção em menos de 1%. Abaixo relacionamos algumas informações simples. Detalhes adicionais podem ser encontrados nos recursos incluídos com este pacote • Acessibilidade de escolas • Instalações médicas acessíveis • Considerações de projeto para acessibilidade Inclusão de acessibilidade em residências • Entre as principais considerações destacam-se a altura das prateleiras e o acesso sob as superfícies de trabalho • Portas: largura, sentido de abertura, maçanetas 37 Portas • Largura da porta: 900mm • Tentar instalar as dobradiças de forma que abra para dentro, das áreas mais movimentadas para as áreas mais tranquilas, como, por exemplo, da sala para o quarto. • Tentar utilizar dobradiças que permitam uma abertura o mais próxima possível a 180°. • Espaço de circulação: é necessário ter uma espaço de acesso desobstruído em ambos os lados de uma porta.3 • Onde o acesso é limitado: pode-se considerar uma porta deslizante (consultar o diagrama: acessibilidade aos sanitários). Os trilhos no piso devem estar bem mantidos para que a porta deslize bem. Sanitários • Portas que se abrem para dentro de um banheiro reduzem o espaço interior do banheiro e devem ser evitadas quando possível. Uma alternativa é uma porta deslizante. • Uma barra de apoio ao lado do sanitário é recomendável nas transferência da cadeira de rodas 3 Considerações de projeto para acessibilidade 38 Criando acessibilidade na comunidade 39 Passagens • A largura de uma passagem deve ser de 900 mm de espaço desobstruído. • Nas passagens com grande movimento, a largura melhor é de 1500 mm, para que dois cadeirantes possam passar um ao lado do outro. Guias • Guias rebaixadas onde haja um desnível (ver ilustração abaixo). Rampas 40 Ao tornar edifícios acessíveis – considerar as necessidades de todas as pessoas com deficiência de mobilidade. Para cadeirantes, considerar os seguintes pontos específicos: • Gradientes dos declives: interiores 1:12, exteriores 1:15 • Superfície: não derrapante • Corrimãos: devem estender-se por 300 mm nos patamares inferior e superior • Deve haver patamares no início e fim de declives e quando há uma mudança de direção: dimensões de 1200 mm a 1500 mm • Os patamares superiores devem ser medidos até a borda do raio de abertura da porta

Organização Mundial da Saúde ii

ii Organização Mundial da Saúde

ii Publicado pela Organização Mundial da Saúde em 2015 sob o título Wheelchair Service Training Package for Stakeholders © Organização Mundial da Saúde 2015 A Organização Mundial da Saúde concedeu direitos de tradução e publicação para uma edição em português da Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID), que é o único responsável pela qualidade e fidelidade da versão em português. No caso de qualquer inconsistência entre as versões inglesa e portuguesa, a versão original em inglês deve ser a versão vinculativa e autêntica. Pacote de Treinamento em Serviços de Cadeira de Rodas para Participantes © USAID 2017 Colaboradores: Editores: Sarah Frost, Chapal Khasnabis, Kylie Mines e Lourdes de la Peza Colaboradores: Udaya Adhikari, Sanjay Bantawa, Christine Cornick, Jennifer Howitt Browning, Richard Frost, Francesca Garton, Dhabaleswar Nanda, Lucie Pannell, Adarsh Shah, Natalie Snell, Shudarson Subedi, Purna Bhakta Tandukar e Prakash Wagle Ilustrador: Melissa Puust Créditos das fotos: David Constantine, Chapal Khasnabis e Jesse Moss Créditos dos vídeos: Chapal Khasnabis, Amanda McBaine e Jesse Moss Apoio financeiro: Agência dos Estados Unidos para o Desenvolvimento Internacional Organizações parceiras: BIKASH Nepal, Handicap International, Motivation Charitable Trust, National Federation of the Disabled–Nepal e Spinal Injury Rehabilitation Centre–Nepal iii Terminologia Os seguintes termos utilizados ao longo do pacote de treinamento são definidos abaixo. Cadeira de rodas apropriada Uma cadeira de rodas que atende às necessidades do usuário e as condições ambientais; proporciona ajuste adequado e apoio postural; é segura e durável; está disponível no país; e pode ser obtida e mantida e sustentada por serviços no país a um preço mais econômico e acessível. Cadeira de rodas manual Uma cadeira de rodas impulsionada pelo usuário ou empurrada por outra pessoa. Dispositivo de suporte postural (PSD) Dispositivo físico que fornece suporte postural adicional. Cadeira de rodas Equipamento que proporciona mobilidade sobre rodas e assento de apoio para uma pessoa com dificuldade para andar ou se movimentar. Modificação na cadeira de rodas Uma modificação feita na cadeira de rodas. Fornecimento de cadeira de rodas Termo geral para o projeto, produção, fornecimento e prestação de serviços de cadeira de rodas. Serviço de cadeira de rodas A parte do fornecimento de cadeira de rodas que assegura a provisão de cadeiras de rodas apropriadas aos usuários. Equipe de serviço de cadeira de rodas Pessoas capacitadas no fornecimento de cadeiras de rodas apropriadas. Usuário de cadeira de rodas Pessoa com dificuldade para andar ou se movimentar que requer o uso da cadeira de rodas para sua mobilidade. iii 1 Sobre o Pacote de Treinamento em Serviços de Cadeira de Rodas para Participantes 1 Introdução 2 Público-alvo 3 Objetivo 3 Escopo 3 Instrutores 4 Como começar 5 1. Notas para os instrutores 8 2. Como se preparar para o Workshop para Participantes 16 Planos detalhados da sessão 16 S.1: Introdução 19 S.2: Política para praticar 29 S.3: Gama de cadeiras de rodas adequadas 37 S.4: Trabalhando em conjunto para a mudança 50 Anexos 50 Anexo 1: Resumo para representantes do governo 52 Anexo 2: Resumo para representantes de usuário de cadeira de rodas 54 Anexo 3: Algumas citações e estatísticas comuns 55 Anexo 4: As oito etapas para o fornecimento de cadeira de rodas 57 Anexo 5: O fornecimento de cadeiras de rodas adequadas beneficia a todos 58 Referências iv 1 Sobre o Pacote de Treinamento em Serviços de Cadeira de Rodas para Participantes Introdução Após o lançamento em 2008 das Diretrizes para fornecimento de cadeiras de rodas manuais em locais com poucos recursos(1), foi lançado em 2012 o primeiro pacote dos Pacotes de Treinamento em Serviços de Cadeira de Rodas (WSTP): Pacote de Treinamento em Serviços de Cadeira de Rodas – Nível Básico (WSTPb)(2). Logo após, em 2013, foi lançado o Pacote de Treinamento em Serviços de Cadeira de Rodas – Nível Intermediário (WSTPi)(3). O WSTPb e o WSTPi destinam-se a apoiar a formação de pessoas que trabalham em funções clínicas e técnicas em um serviço de cadeira de rodas, a fim de aumentar o número de pessoal treinado na prestação de serviços de cadeira de rodas no nível básico e intermediário. No entanto, a OMS reconhece que, para que esse treinamento seja eficaz e que as pessoas tenham acesso às instalações, equipamentos e materiais necessários para fornecer cadeiras de rodas apropriadas, é necessário que haja mecanismos eficazes de planejamento, políticas e apoio. Por isso, a Organização Mundial da Saúde (OMS), em parceria com a Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID), desenvolveu a terceira parte do WSTP, composto por dois subpacotes: o Pacote de Treinamento em Serviço de Cadeira de Rodas para Gerentes (WSTPm)e o Pacote de Treinamento em Serviço de Cadeira de Rodas para Participantes (WSTPs). Para estabelecer um bom sistema de fornecimento de cadeiras de rodas em um país, todas as partes relacionadas, incluindo os elaboradores, planejadores e executores de políticas, fabricantes e fornecedores de cadeiras de rodas, prestadores de serviços de cadeira de rodas, organizações de deficientes e usuários de cadeira de rodas precisam estar envolvidos. No entanto, é importante que eles estejam bem informados e entendam a necessidade e o benefício do fornecimento de cadeiras de rodas apropriadas. Este Pacote de Treinamento em Serviço de Cadeira de Rodas para Participantes (WSTPs) destina-se, portanto, a aumentar a conscientização e envolvimento de todos para estabelecer o fornecimento de cadeiras de rodas apropriadas em seu país/região. Este pacote de treinamento tem como base os seguintes documentos-chave: Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (UNCRPD)(4); as Diretrizes para fornecimento de cadeiras de rodas manuais em locais com poucos recursos; e o documento de posição conjunta sobre o fornecimento de equipamentos de mobilidade em locais com poucos recursos(5). 2 A cadeira de rodas é um dos dispositivos assistivos mais comumente utilizados para permitir a mobilidade pessoal. Para as pessoas que tenham dificuldade para andar ou se movimentar, as cadeiras de rodas são ferramentas essenciais para a sua mobilidade, autonomia, dignidade e bem-estar geral. A mobilidade dá a oportunidade para que usuários de cadeira de rodas sejam independentes e tenham acesso a serviços de saúde, educação, trabalho e emprego, além de auxiliá-los na participação de atividades sociais e culturais. No entanto, a OMS estima que mais de 70 milhões de pessoas precisam de uma cadeira de rodas, sendo que apenas de 5% a 15% têm acesso a uma. A importância da mobilidade se reflete na UNCRPD, que defende “medidas eficazes para garantir a mobilidade pessoal com a máxima independência possível para as pessoas com deficiência”. Para garantir a mobilidade pessoal eficaz, os usuários de cadeira de rodas precisam de um equipamento que se encaixe corretamente e atenda às suas necessidades específicas, especialmente estilo de vida e meio ambiente. Isso requer uma abordagem sensível às necessidades individuais. Uma forma eficaz de atender às necessidades individuais dos usuários de cadeira de rodas é fornecer os equipamentos por meio de um sistema de prestação de serviço de cadeira de rodas bem organizado, que atenda às expectativas dos usuários, respeite a sua dignidade e seja prestado por pessoal devidamente capacitado. Os instrutores são incentivados a utilizar este pacote para promover um workshop independente voltado inteiramente para a necessidade e os benefícios do desenvolvimento de um sistema de fornecimento de cadeira de rodas apropriada, ou como um elemento importante de um workshop mais amplo, abordando, por exemplo, a reabilitação nacional ou o desenvolvimento/avaliação de uma política de deficiência. Público-alvo O Workshop para Participantes destina-se a todas as pessoas que possam influenciar o desenvolvimento ou a manutenção do fornecimento de cadeira de rodas apropriada. Os participantes podem ser: • planejadores e executores de políticas (por exemplo, o governo); • líderes influentes/respeitados ou políticos; • organizações de pessoas com deficiência; • usuários, seus familiares e cuidadores; • filantropos/financiadores/doadores; • mídia (digital e impressa); • fabricantes e fornecedores de cadeiras de rodas; • grupos profissionais (como Associação Nacional/Regional de Fisioterapeutas); 3 • organizações não governamentais internacionais e locais; e • quaisquer outros indivíduos ou organizações locais que tenham o potencial de contribuir. Objetivo A OMS entende que as pessoas capacitadas não conseguem garantir por si sós o fornecimento de cadeira de rodas apropriada no país ou assumir suas responsabilidades conforme descrito nas Diretrizes para Cadeira de Rodas,a menos que haja maior nível de envolvimento para estabelecer ou melhorar o fornecimento de cadeira de rodas no país. O objetivo do pacote de treinamento é conscientizar e desenvolver as habilidades e o conhecimento de todo o pessoal envolvido (participantes) no fornecimento de cadeiras de rodas apropriadas em seu país/região. Este pacote fornece uma visão geral do papel dos participantes, informando-os sobre a necessidade e o benefício do fornecimento de cadeiras de rodas apropriadas e obtendo o seu apoio para desenvolver um programa de fornecimento de cadeiras de rodas apropriadas. Escopo O pacote de treinamento pode ser realizado em um mínimo de 3 a 4 horas, embora esse prazo possa ser prorrogado de acordo com as necessidades e recursos específicos disponíveis. A realização deste pacote de treinamento ajudará os participantes a: • melhorar a sua compreensão sobre a necessidade e os benefícios de uma cadeira de rodas apropriada; • estar mais bem informados sobre o seu papel no desenvolvimento do fornecimento de cadeiras de rodas apropriadas; • aumentar a qualidade da prestação de serviço de cadeiras de rodas; • ter melhor compreensão de ambientes livres de barreiras; • se comprometer mais com o compromisso de buscar/fornecer apoio orçamental adequado; e • aumentar a sustentabilidade do fornecimento de cadeira de rodas. Instrutores O Manual do Instrutor WSTPs se destina a qualquer organização ou grupo de organizações que pretendam convocar um Workshop para Participantes WSTP. Para assegurar a continuidade de outros pacotes WSTP, este manual de treinamento foi intitulado Manual do Instrutor, mas considerando a diversidade dos participantes em um workshop WSTPs, os instrutores precisam desempenhar o papel de facilitadores e seguir os princípios básicos da educação de adultos. A boa seleção dos instrutores/facilitadores do workshop é importante para o seu sucesso. Recomenda-se que eles tenham: 4 • experiência em treinamento e orientação de pessoas em um nível adequado; • experiência em gestão de públicos com diversos participantes de diferentes níveis; • uma forte convicção de que a apresentação do fornecimento de cadeiras de rodas apropriadas é benéfica para os usuários de cadeira de rodas; e • capacidade de ouvir e acolher opiniões diferentes e, ao mesmo tempo, garantir que os princípios fundamentais do fornecimento de cadeiras de rodas apropriadas sejam mantidos e o objetivo do workshop seja acolhido. Os instrutores/facilitadores do workshop serão chamados de instrutores em todo o restante deste manual. Recomenda-se que haja um instrutor para cada 8 a 10 participantes. Ter um usuário de cadeira de rodas experiente que conheça bem o assunto e o pacote de treinamento é interessante. Quando mais de um instrutor estiver envolvido, recomenda-se que as sessões sejam divididas entre os instrutores para evitar que uma pessoa conduza muitas sessões consecutivas. Como começar Antes de realizar o programa de treinamento, você deve copiar as seções relevantes do pen drive (dentro da pasta) para o seu disco rígido. A maneira mais simples de realizar o programa de treinamento é: 1. Abrir o Manual do Instrutor da pasta manual e 1.1. Ler as notas das seções Orientação para instrutores e Como se preparar para o Workshop dos Participantes; 1.2. Imprimir e encadernar uma cópia do Manual do Instrutor para cada instrutor, caso você não tenha uma cópia impressa; 1.3. Imprimir um cronograma. 2. Tomar todas as providências necessárias, como sugerido na seção Como se preparar para o Workshop dos Participantes. 3. Dar a cada participante um pôster das etapas do serviço de cadeira de rodas. Se você não tiver esses materiais em estoque, eles podem ser impressos no pen drive. 4. Abra o cronograma e clique nos links de cada sessão, que irão levá-lo para os slides e o local do vídeo exatos. A melhor maneira de realizar o treinamento é abranger as lições em ordem sequencial, seguindo o tempo alocado para cada sessão o máximo possível. 5 1. Notas para os instrutores 1.1 Visão geral do Workshop Sessão Minutos S.1. Introdução incluindo discurso de abertura 30 S.2. Política para praticar 45 S.3. Gama de cadeiras de rodas adequadas 30 Intervalo 30 S.4. Trabalhando em conjunto para a mudança 100 Discurso de encerramento 5 Total 240 1.2 Cronograma e duração do Workshop O Workshop para Participantes é descrito aqui como um workshop de meio dia. Será benéfico alocar mais tempo, se possível, especialmente em uma situação em que os organizadores esperam chegar a um acordo das partes interessadas sobre os planos ou as ações específicas. O Workshop para Participantes pode ser realizado como uma sessão de meio dia em uma conferência/workshop mais amplo, ou imediatamente antes ou após a realização do módulo WSTP Gerentes. Veja abaixo um cronograma-modelo para um workshop de meio dia na parte da manhã: Horário Assunto Apresentador 08h30min – 09h Registro 09h – 09h30min Introdução incluindo discurso de abertura Diretor da organização anfitriã Palestrantes convidados Representante(s) do governo e outros Usuário ou líder da(s) organização(ões) de pessoas com deficiência 09h30min – 10h15min Política para praticar Instrutor 10h15min – 10h45min Intervalo 6 10h45min – 11h15min Gama de cadeiras de rodas adequadas Instrutor 11h15min – 12h55min Trabalhando em conjunto para a mudança Instrutor 12h55min – 13h Discurso de encerramento Instrutor 13h – 14h Almoço Observação: o tempo irá variar de acordo com o número de palestrantes. 1.3 Planos da sessão Para cada uma das sessões existe um plano detalhado da sessão para orientar os instrutores na palestra. No início de cada plano da sessão, há a seguinte informação: • Objetivos: detalha a que se destina cada sessão em especial para os participantes; • Recursos: os recursos que são necessários para a sessão; • Contexto: como a sessão poderá ser adaptada para diferentes contextos (ou situações); • Para preparar: como se preparar para a sessão; • Esboço: um esboço para as principais partes da sessão. O restante do plano da sessão é dividido em tópicos. Para cada tópico, o plano da sessão fornece instruções sobre como apresentar ou facilitar a informação para o tópico em questão. 1.4 Apresentações em PowerPoint Apresentações em PowerPoint (PPT) são fornecidas para as sessões: • Introdução • Política para praticar • Gama de cadeiras de rodas adequadas • Trabalhando em conjunto para a mudança 1.5 Dicas sobre o bom treinamento prático Veja abaixo algumas dicas para que os instrutores tornem o workshop um sucesso: • mantenha as discussões focadas no tema da sessão; • seja um ouvinte ativo, pois você precisará realmente ouvir e entender o que as pessoas dizem, a fim de orientar a discussão de forma eficaz; • ouvir atentamente vai dar um bom exemplo para os participantes; 7 • estimule e modere as discussões; • não permita que uma pessoa ou grupo agressivo e que fala muito domine a discussão; • permaneça neutro e seja cauteloso quanto a expressar seus próprios valores; • use conflitos de opinião de forma produtiva e não permita que os participantes personalizem suas discordâncias. 8 2. Como se preparar para o Workshop para Participantes 2.1 Conheça a situação atual de fornecimento de cadeira de rodas Organizações e instrutores que organizam um Workshop para Participantes WSTP precisam de uma compreensão completa a respeito do fornecimento de cadeiras de rodas no país, região, distrito ou subdistrito. Isso inclui: • identificar claramente as diferentes organizações interessadas e indivíduos-chave; • estar ciente de todas as atividades do fornecimento de cadeiras de rodas ou iniciativas existentes; • compreender as lacunas atuais no fornecimento de cadeiras de rodas; e • conhecimento das leis pertinentes regionais/nacionais, estratégias, políticas e planos de ação. A lista abaixo pode ser usada para resumir a estrutura jurídica nacional, como UNCRPD, estratégias nacionais, planos de ação e leis(6). 9 Estas informações serão usadas para criar um folheto da estrutura jurídica para apoiar a Sessão 2: Política para praticar. Estrutura jurídica Aspecto a ser verificado Lista de verificação UNCRPD A UNCRPD e seu Protocolo Opcional foram assinados?  A UNCRPD e seu Protocolo Opcional foram ratificados?  Estratégias O país tem uma estratégia ou um plano de ação nacional em matéria de redução da pobreza?  O país tem uma estratégia ou plano de ação nacional sobre as questões da deficiência? (Por exemplo, “estratégia para promover e proteger os direitos das pessoas com deficiência”).  Leis, decretos Se existirem, essas estratégias no setor da deficiência são acompanhadas de documentos legislativos específicos (como leis, ordens de execução)?  Estratégias com base no setor O país tem uma estratégia ou plano de ação nacional específicos nos seguintes setores? • serviços sociais • educação • educação inclusiva • emprego • emprego de pessoas com deficiência • saúde • saúde mental • igualdade de gêneros • minorias étnicas • crianças • idosos • bem-estar social em geral • tecnologias assistivas • outro(s) setor(es) significativo(s) para acesso a serviços de qualidade para pessoas com deficiência  Estratégias locais A prática de planejamento comunitário existe no respectivo país? O processo de planejamento (na área da deficiência e dos serviços sociais) é centralizado ou descentralizado? Até que nível de descentralização? Existem planos de ação relacionados à deficiência na comunidade (ou similares)?  10 2.2 Reveja cada plano de sessão e ajuste-o, se necessário Reveja cada plano de sessão e identifique quem irá auxiliar em cada uma. As sessões podem precisar ser ajustadas de acordo com o contexto local. Sugestões para ajustar sessões para diferentes contextos são fornecidas no início de cada plano de sessão, com o título “contexto”. 2.3 Identifique e prepare os palestrantes convidados O objetivo geral do Workshop para Participantes é conscientizar sobre a importância do fornecimento de cadeiras de rodas apropriadas e a diferença que isso pode fazer na vida dos usuários de cadeiras de rodas. As apresentações contundentes de palestrantes importantes são uma parte importante na estratégia para assegurar que esta mensagem seja bem representada, devendo ser o mais relevante possível para o contexto em que o Workshop para Participantes está sendo realizado. Recomenda-se convidar palestrantes que representem setores governamentais e de deficiência (ver Sessão 1). 1. Representantes governamentais: para representar o reconhecimento e apoio do governo ao direito à mobilidade e à importância do fornecimento de cadeiras de rodas. Em alguns países, mais de um ministério tem responsabilidades relativas ao fornecimento de cadeiras de rodas. 2. Representantes do setor de deficiência Representante de usuário de cadeira de rodas: Uma pessoa que tenha experiência no uso de cadeira de rodas e esteja disposta a partilhar a sua experiência pessoal sobre como o fornecimento de cadeiras de rodas apropriadas teve um impacto positivo na sua vida. Essa apresentação destacará a importância da mobilidade pessoal com a máxima independência possível. A importância da assinatura e da ratificação da UNCRPD Assinar a UNCRPD é o primeiro passo para o apoio do governo no fornecimento de cadeiras de rodas apropriadas: assinar a UNCRPD indica intenção moral do governo em se vincular à Convenção; ratificar a UNCRPD indica obrigação moral e legal do governo em implementar a Convenção. 11 Líder respeitado no setor de deficiência: Palestrante principal bem respeitado no campo, com autoridade em seu cargo, experiência e liderança. O seu papel é o de apresentar claramente a mensagem e gerar um senso de urgência e entusiasmo para a mudança entre as partes interessadas. Observação: É possível que uma pessoa seja capaz de desempenhar o papel de duas partes acima. O(s) instrutor(es) precisa(m) identificar e preparar os palestrantes mais adequados com bastante antecedência. Um resumo para os palestrantes está incluído nos anexos. É provável que seja necessária certa consideração entre o instrutor e os palestrantes para refinar a apresentação, a fim de garantir que ela seja adequada ao contexto e à situação atual do fornecimento de cadeiras de rodas e que ela se adapte ao estilo dos palestrantes. Antes do workshop, verifique se os palestrantes desejam usar PPT. Em caso afirmativo, solicite que eles forneçam o PPT o mais tardar no dia anterior. Se isso não for possível, certifique-se de que os palestrantes cheguem antes do início do workshop e tenham alguém disponível para carregar o PPT para o computador do workshop. 2.4 Convide os participantes É importante assegurar que todas as partes interessadas sejam convidadas. Faça uma consulta ampla para que nenhuma organização ou indivíduo-chave sejam esquecidos. Pense cuidadosamente nos participantes cujas vozes precisam ser ouvidas; participantes que têm o potencial de influenciar a mudança; e participantes com a energia e o compromisso de agir para criar a mudança. Enviar os convites com antecedência ajudará a garantir que as pessoas consigam estar presentes. Certifique-se de que os convites indiquem claramente o objetivo do workshop e por que é importante que os participantes estejam presentes. Número de participantes: O número de participantes pode variar, dependendo do número de participantes do país, região, distrito ou subdistrito. Representação de todos os grupos: O instrutor deve avaliar de perto a lista de registro de participantes, a fim de representar todos os grupos e organizações durante a sessão de abertura do workshop. 12 2.5 Planeje o local e o layout da sala Local: O local também deve ser reservado com antecedência. Idealmente, o local deve fornecer uma sala de tamanho adequado para o número de participantes e uma área para o intervalo. O local deve ser adaptado para usuários de cadeira de rodas em toda parte. Isso inclui acesso: ao edifício, à sala em que o workshop será realizado, à área para lanches e aos sanitários. Organização da sala: Os instrutores devem planejar cuidadosamente a forma como a sala será organizada. O Workshop para Participantes inclui sessões plenárias e grupos de trabalho. Portanto, o layout deve possibilitar a transição fácil entre trabalho e plenária em grupo. O layout dependerá do número de participantes. Veja algumas sugestões abaixo: Layout da sala para grupos de até 30 pessoas O melhor layout de sala possui mesas redondas em um semicírculo, ou mesas retangulares, como uma espinha de peixe, como mostrado abaixo. Isso permite que o grupo seja simultaneamente organizado em subgrupos por mesa para discussão e em sessão plenária para ouvir apresentações ou compartilhar em sessões plenárias. Opção 1: Mesas redondas em um semicírculo 13 Opção 2: Mesas retangulares em espinha de peixe Layout da sala para grupos maiores (50 ou mais) 14 Para grupos maiores e salas menores, os participantes podem ficar sentados em fileiras como em um auditório com cadeiras móveis, de forma que as pessoas na primeira fileira possam girar suas cadeiras para fazer um grupo com pessoas na segunda fileira, como mostrado acima. Isso permite que o grupo alterne entre plenária e grupos menores de trabalho rapidamente. 2.6 Prepare recursos e equipamentos Recurso Quantidade  Comentários/instruções Manual do Instrutor 1 por instrutor  Solicite à OMS ou imprima e encaderne Pôster de etapas do serviço 1 por participante  Solicite à OMS ou imprima Recursos suplementares: referências para instrutores. Também decida como compartilhar esses recursos com participantes de acordo com os recursos disponíveis. Por exemplo, em um pen drive USB/pen drive, por meio de um mecanismo de compartilhamento na internet, ou pelo fornecimento de referências a sites. Diretrizes para o fornecimento de cadeiras de rodas manuais em locais com poucos recursos Pelo menos uma cópia para amostra  Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (UNCRPD) Pelo menos uma cópia para amostra  Documento de posição conjunta sobre os dispositivos assistivos em locais com poucos recursos Pelo menos uma cópia para amostra  Livreto Introdução às Diretrizes da CBR e componente de Saúde Pelo menos uma cópia para amostra  Logotipo da WSTP 1 amostra de alta resolução  Para que os participantes usem para mostrar seu compromisso com o fornecimento de cadeiras de rodas apropriadas Formulários: Formulário de registro de participantes 1 por workshop  Amostra disponível no pen drive Etiqueta de nome 1 por participante/ palestrante/instrutor  Produzir localmente e usar o logotipo da WSTP Cronograma 1 por participante  Amostra disponível no pen drive Formulário de consentimento de foto 1 por participante  Adaptar o formulário de amostra no pen drive para a organização anfitriã Certificado de participação 1 por participante  Prepare o certificado de participação ou adapte o modelo fornecido no pen drive 15 Pôsteres – cartazes de sensibilização a serem colocados no local do workshop: WSTP básico: etapas para serviços de cadeiras de rodas, técnicas de mobilidade de cadeiras de rodas, feridas por pressão e como cuidar de uma cadeira de rodas em casa. 4  Solicite à OMS ou traduza (se necessário) e imprima Disponível no pen drive WSTP intermediário: crianças e cadeiras de rodas, diferentes posições, dispositivo de suporte postural (PSD) e lista de verificação para treinamento de usuários de cadeira de rodas intermediários. 4  Vídeos – com legendas em inglês: O que uma cadeira de rodas apropriada significa para mim? S.2.  Disponível no pen drive. Avalie editar as legendas para o idioma local Fornecimento de serviço de cadeira de rodas S.2.  Benefícios de suporte extra – Chaeli S.3.  Benefícios de uma cadeira de rodas apropriada S.3.  Equipamento Item Quantidade Comentários/instruções Projetor de dados 1  Computador 1  Palestrantes 1 conjunto  Para ajudar a ouvir os vídeos Microfones 2 ou mais, dependendo do número de participantes  Um microfone para o instrutor e palestrantes e um microfone “itinerante” para os participantes com perguntas ou para obtenção de comentários de pequenos grupos Quadro branco grande 1  Marcadores para quadro branco 3–4  Suporte para folhas de papel e papel 1 suporte e 1 pacote de folhas de papel  Canetas para o suporte 3-4  Fita adesiva ou similar 1 rolo  Para prender as folhas no suporte e cartazes nas paredes Observação: Para grupos com menos de 20 pessoas, o feedback dos pequenos grupos na sessão plenária pode ser escrito em folhas de flip chart. No entanto, para grupos maiores, o feedback pode ser digitado em um slide de PowerPoint e projetado à medida que pequenos grupos dão o feedback. 16 Planos detalhados da sessão S. 1: Introdução O B JE T IV O S Ao final desta sessão, os participantes poderão:  ter um melhor entendimento da situação atual/política do fornecimento de cadeiras de rodas no país e do caminho a seguir para aprimoramento e sustentabilidade. R E C U R SO S Para a sessão:  PPT: S.1:Boas-vindas e discurso de abertura C O N T E X T O Adapte esta sessão para se adequar ao contexto no qual os participantes vão trabalhar. Pense no seguinte:  se deve ser realizada uma cerimônia de abertura adequada à cultura e ao contexto;  qual é o horário de início apropriado para palestrantes e participantes. P R E P A R A Ç Ã O  Convide os palestrantes convidados com antecedência.  Encontre os palestrantes convidados com bastante antecedência para apoiar a preparação das apresentações (veja o resumo sobre palestrantes nos Anexos).  Insira o nome dos palestrantes do workshop no primeiro slide.  Verifique as apresentações dos palestrantes convidados (se aplicável).  Carregue imagens relevantes no slide de PPT para o representante convidado dos usuários de cadeiras de rodas.  Reveja o registro de participante a fim de reconhecer todos os diferentes grupos de interessados/organizações participantes durante o discurso de boas-vindas.  Reveja o número de palestrantes e o tempo de suas apresentações antes de finalizar o cronograma. D E SC R IÇ Ã O 1. Introdução 2. Palestrantes convidados 3. Discurso de abertura – representante dos usuários de cadeiras de rodas 4. Perguntas e respostas 5 10 10 5 Tempo total da sessão 30 17 1. Introdução (5 minutos) Introduções: Palestrantes convidados e instrutores: O anfitrião dá as boas-vindas a todos os participantes e apresenta os dignitários e instrutores. Participantes: A apresentação dos participantes (nome e organização que representam) irá variar de acordo com o tamanho do grupo e com a cultura e os costumes locais. Para grupos maiores, não é prático que cada participante apresente a si mesmo. No entanto, é útil apresentar os participantes presentes e incentivá-los a conversarem entre si durante os intervalos. 2. Palestrantes convidados (10 minutos) Introduza: Convide o primeiro palestrante convidado e peça que ele/ela descreva o estado atual do fornecimento de cadeiras de rodas no país. Introduza: Convide o segundo palestrante convidado, de preferência um representante do governo, para falar sobre o que o governo está fazendo para atender às necessidades dos usuários de cadeiras de rodas no país. 3. Discurso de abertura – usuário de cadeiras de rodas/representante (10 minutos) Introduza: O palestrante principal deve compartilhar suas experiências como usuário de cadeira de rodas e dizer qual caminho ele/ela acha que deve ser seguido para o fornecimento de cadeiras de rodas no país. A organização anfitriã deve adicionar o 2. Introdução Introdução 18 4. Perguntas e respostas (5 minutos) Explique: • Há cinco minutos disponíveis para que perguntas sejam feitas aos palestrantes convidados. Peça que os ouvintes façam perguntas aos palestrantes. Monitore o tempo rigorosamente. Explique: • Haverá novas oportunidades para perguntas durante o workshop. Os participantes também são incentivados a aproveitar ao máximo os intervalos para a troca de perguntas e informações. 19 S.2: Política para praticar O B JE T IV O S Ao final desta sessão, os participantes poderão:  criar um sentimento de urgência sobre a importância do fornecimento de cadeiras de rodas apropriadas;  destacar as necessidades dos usuários de cadeiras de rodas no país e os benefícios para todos quando esses usuários podem se movimentar e ser o mais independentes possível;  defender as políticas e as normas nacionais e a conscientização sobre os direitos dos deficientes para que os usuários tenham acesso a cadeiras de rodas por meio de um serviço de qualidade. R E C U R SO S Para a sessão:  apostila da estrutura jurídica – uma para cada participante, além de uma cópia adicional por grupo para atividades;  cópia das Diretrizes sobre Cadeira de Rodas; livreto introdutório sobre as Diretrizes CBR e componente de Saúde; documento de posição conjunta sobre os dispositivos assistivos em locais com poucos recursos;  PPT: S.2: Política para praticar;  vídeo: O que uma cadeira de rodas apropriada significa para mim?  vídeo: Fornecimento de serviço de cadeira de rodas. C O N T E X T O Adapte esta sessão para se adequar ao contexto. Pense no seguinte:  os casos de estudo mais relevantes para o contexto;  as principais mensagens que você deseja comunicar. P R E P A R A Ç Ã O  Planeje a formação dos grupos de acordo com o número de participantes – veja as observações em Como se preparar para o workshop para participantes quanto ao planejamento do local e layout da sala.  Pesquise informações necessárias para completar o resumo das políticas oficiais na seção 2.1 e prepare e traduza uma apostila da estrutura jurídica com antecedência. D E SC R IÇ Ã O 1. Introdução 2. Qual são a necessidade e a necessidade não atendida? 3. Importância do fornecimento de cadeira de rodas 4. Importância do apoio do governo 5. Todos têm direitos 6. A política atinge os indivíduos por meio de serviços 7. Torne os direitos reais com um plano nacional 8. Benefícios para todos 9. Resumo dos pontos principais 2 3 3 5 5 5 17 3 2 Tempo total da sessão 45 20 1. Introdução (2 minutos) Inicie com o objetivo do workshop. Destaque: É importante que trabalhemos em conjunto para alcançar uma visão compartilhada para o fornecimento de cadeiras de rodas no nosso país. Uma cadeira de rodas apropriada é um passo essencial para a participação na vida social, trabalho e educação. A mobilidade pessoal é um direito que pode ser conquistado ao se receber uma cadeira de rodas apropriada por meio de um serviço por pessoal capacitado. Serviço de limpeza Peça aos participantes para darem uma olhada em sua cópia do cronograma do workshop. Destaque os horários de início e término e dos intervalos. Explique o serviço de limpeza geral: • local dos banheiros • lanches • com quem falar a respeito de logística de viagem (se necessário) • o que fazer em caso de emergência Explique as expectativas: • desligar os celulares durante as sessões • compartilhar seus pensamentos e opiniões é importante 2. Política para praticar 21 2. Qual são a necessidade e a necessidade não atendida? (3 minutos) Pergunte: Você sabe quantas pessoas em seu país precisam de cadeiras de rodas? Estimule respostas. Explique: • A OMS estima que 1% de qualquer população precisa de cadeiras de rodas. • A população deste país é X (inserir população do censo. Calcule 1% da população recenseada do país)(7). Explique: • A necessidade e a necessidade não atendida. Pergunte: • Qual porcentagem da população necessitada tem acesso a cadeiras de rodas no interior do país? Estimule respostas. 3. Importância do fornecimento de cadeira de rodas (3 minutos) Apresente o vídeo: O que uma cadeira de rodas apropriada significa para mim? Neste vídeo, Faustina, usuária de cadeira de rodas experiente, explica a diferença que fez para sua vida quando ela recebeu uma cadeira de rodas por meio de um serviço. Exiba o vídeo. A OMS estima que mais de 70 milhões de pessoas (1% de qualquer população) necessitam de cadeiras de rodas, mas apenas 5% a 15% têm acesso a uma. (Ficha informativa da OMS sobre deficiência) Há necessidade de ação urgente para melhorar o 2.3 Política para 2.2 Política para População Pessoas que precisam de cadeira de OMS 7.000.000.000 70.000.000 Inserir país Inserir população do país Inserir 1% da população do país O que uma cadeira de rodas apropriada 2.4 Política para 22 Destaque: Uma cadeira de rodas apropriada, fornecida por meio de um serviço, permitiu que Faustina tenha: Dignidade: visto que ela não cai mais de sua cadeira de rodas em vias irregulares. Independência: visto que agora ela é capaz de empurrar a cadeira com segurança e de forma independente em vias irregulares e declives perto de sua casa e do trabalho. Confiança: visto que ela se sente menos deficiente. Mais autoestima: visto que ela se sente melhor quanto a si mesma porque a cadeira de rodas é personalizada para ela. Apresente a história de Shobha, da Índia, que demonstra o impacto que uma cadeira de rodas apropriada tem em sua vida e na comunidade. Explique: Essa história destaca a importância de receber uma cadeira de rodas apropriada por meio de um serviço como um primeiro passo para a inclusão e a participação na sociedade. Shobha vive em uma aldeia em Herepalya, estado de Karnataka, na Índia. Shobha contraiu poliomielite quando tinha menos de um ano e tinha de rastejar em torno de sua casa e aldeia local para se locomover. Essa situação persistiu por muitos anos até Shobha ser avaliada pela equipe rural de serviços de cadeiras de rodas, da Associação de Pessoas com Deficiência (APD), e receber prescrição de uma cadeira de rodas apropriada. Com sua cadeira de rodas, Shobha pode agora se mover em sua casa e na comunidade de forma independente. Além de afetar positivamente a mobilidade de Shobha, sua cadeira de rodas tem aumentado a sua independência econômica. A APD deu a Shobha a oportunidade de participar de um programa de treinamento vocacional adaptado e ela agora tem seu próprio serviço de alfaiataria em casa. Com uma cadeira de rodas apropriada, ela agora pode viajar facilmente e com segurança pela vila e redondezas, a fim de visitar seus clientes e entregar as encomendas. Shobha está empenhada em continuar a expandir a sua própria empresa de alfaiataria e viver de forma independente. 4. Importância do apoio do governo (5 minutos) Explique: Precisamos criar uma mensagem forte e urgente, o que faz com que o governo se sinta motivado a agir. Explique: • Vamos ouvir uma história do Quênia sobre a política governamental quanto à oferta de dispositivos de assistência. 2.5 Política para 23 5. Todos têm direitos (5 minutos) Explique: • Todos têm os mesmo direitos. • A Convenção da ONU sobre os Direitos das Pessoas com Deficiência (UNCRPD) esclarece e qualifica como todas as categorias de direitos se aplicam a pessoas com deficiência e identifica as áreas em que as adaptações têm de ser feitas para que pessoas com deficiência possam efetivamente exercer os seus direitos. Explique: Há uma série de artigos na UNCRPD que reforçam a importância e a relevância da oferta de cadeiras de rodas apropriadas. Pergunte: Alguém sabe qual artigo da UNCRPD refere-se especificamente à mobilidade? Estimule respostas. Leia como o apoio do governo no fornecimento de cadeiras de rodas apropriadas se desenvolveu no Quênia A primeira legislação de apoio às pessoas com deficiência no Quênia foi aprovada depois que o presidente Mwai Kabaki sofreu um acidente rodoviário, após o qual ele teve de usar uma cadeira de rodas por cerca de sete meses. A primeira lei que ele aprovou após voltar a seus deveres como presidente foi a Lei 14 de 2003, para Pessoas Portadoras de Deficiência, que estabeleceu o Conselho Nacional para Pessoas com Deficiência como uma empresa estatal em novembro de 2004. Por que essa primeira Lei foi aprovada? Porque ele percebeu o tanto que era difícil viver sem mobilidade. Naquela época, ele estava em campanha para as próximas eleições e não foi possível continuar sem a cadeira de rodas. Ele sentiu na pele a necessidade de mobilidade pessoal e acessibilidade. Quando ele ganhou a eleição, com base na nova lei, ele começou a tornar os dispositivos de assistência disponíveis e os prédios do governo acessíveis. Desenvolvimento e direitos humanos para todos (http://www.un.org/disabilities/) Convenção da ONU sobre os Direitos das Pessoas com Deficiência (UNCRPD) O foco da UNCRPD é garantir que todos reconheçam que esses direitos se aplicam a todos; incluindo pessoas com deficiência. 24 Cadeiras de rodas apropriadas + Serviços inclusivo s = Fornecime nto efetivo de Cadeiras de rodas apropriadas + Serviços inclusivo s = Fornecime t f ti Cadeira de rodas apropriad a + = Forneci mento eficaz de cadeira de rodas Explique: O artigo 20 da UNCRPD diz: • Todas as pessoas têm direito à mobilidade pessoal. A mobilidade pessoal significa: • A habilidade de se mover de certa maneira e no momento de sua escolha. Explique: • O artigo 26 fala sobre a importância da reabilitação e da habilitação. • A mobilidade pessoal é uma parte essencial da reabilitação. Explique: A mobilidade também é o primeiro passo na criação de acesso a outros direitos: • Artigo 19 – Vida independente e inclusão na comunidade. • Artigo 24 – Educação. • Artigo 25 – Saúde. • Artigo 27 – Trabalho e emprego. • Artigo 30 – Participação na vida cultural, recreação, lazer e esporte. Explique: • Em resumo, a mobilidade é o primeiro passo para a inclusão ou para próximas etapas. • No entanto, é preciso ter uma cadeira de rodas apropriada. Notas para os instrutores: Reabilitação – restaurar habilidades para participar da sociedade; Habilitação – construção de habilidades pela primeira vez. O artigo 20 da UNCRPD diz: ⎯ Todas as pessoas têm direito à mobilidade pessoal. A mobilidade pessoal significa: ⎯ A capacidade de se mover como e quando a pessoa quiser. 2.7 Política para A mobilidade é o primeiro passo para ter acesso a outros direitos: Artigo 19: Vida independente e inclusão na comunidade. Artigo 24: Educação. Artigo 25: Saúde. Artigo 27: Trabalho e emprego. Artigo 30: Participação na vida cultural, recreação, lazer e esporte. 2.9 Política para praticar Artigo 26 Habilitação e Reabilitação: Os Estados Partes promoverão a disponibilidade, o conhecimento e o uso de dispositivos e tecnologias assistivas, projetados para pessoas com deficiência e relacionados com a habilitação e a reabilitação. 2.8 Política para i 2.10 Política para 25 6. A política atinge os indivíduos por meio de serviços (5 minutos) Explique: • É através de um sistema de fornecimento de cadeiras de rodas apropriadas que as necessidades individuais são atendidas. • Importância do treinamento dos fornecedores de serviços e oito etapas do serviço de cadeiras de rodas. Explique: • O treinamento dos usuários de cadeira de rodas é igualmente importante, especialmente para fazer o melhor uso do equipamento em seu próprio ambiente e também quanto à reparação e manutenção. • Um usuário permanente de cadeira de rodas precisa de acesso a serviços por toda a vida. Apresente o vídeo: Fornecimento de serviço de cadeira de rodas Explique: • As Diretrizes sobre Cadeiras de Rodas definem as oito etapas essenciais do serviço. Essas oito etapas são ensinadas em WSTPb e WSTPi. O vídeo descreve uma abordagem para o fornecimento de cadeiras de rodas, que apoia as Diretrizes sobre Cadeiras de Rodas. Exiba o vídeo. Para garantir a perfeita combinação entre os usuários e os produtos, as cadeiras de rodas precisam ser fornecidas por pessoal devidamente capacitado, seguindo oito etapas. 2.11 Política para Essencial para que os indivíduos tenham a maior independência possível. Papel fundamental na adaptação ambiental, reparo e manutenção de suas cadeiras de rodas. Um usuário permanente de cadeira de rodas necessita, ao longo da vida, de acesso a 2.12 Política para Fornecimento de serviço de 2.13 Política para 26 7. Torne os direitos reais com um plano nacional (17 minutos) Explique: Temos usado o termo fornecimento de cadeiras de rodas. Pergunte: O que esse termo realmente significa de acordo com as Diretrizes sobre Cadeiras de Rodas? Permita respostas. Explique: As Diretrizes para o fornecimento de cadeiras de rodas manuais em locais com poucos recursos fazem recomendações sobre: • projeto • produção • fornecimento e • prestação de serviço Os pacotes de treinamento para serviços de cadeiras de rodas (WSTP) proporcionam o conhecimento e as habilidades necessárias para estabelecer o fornecimento de cadeiras de rodas apropriadas. Explique: Para que o fornecimento de cadeiras de rodas seja eficaz e sustentável, é necessário ser apoiado por política e planejamento. As Diretrizes para Cadeira de Rodas são uma ferramenta para o desenvolvimento da política e implementação do CPRD. Introduza a atividade em grupo. Explique: Faremos um trabalho em grupos para avaliar uma apostila de apoio do governo para pessoas com deficiência. Isso resume o apoio do governo: Atividade Grupos: Divida os participantes em quatro grupos. Permita até 10 participantes por grupo e crie grupos adicionais, se necessário. Instruções: Peça aos participantes para darem uma olhada em sua cópia da estrutura jurídica. Solicite que um voluntário por grupo registre qualquer comentário ou correções do grupo. Dê uma apostila adicional para cada líder de grupo. Monitore: Monitore os grupos e ajude se necessário. Seguir as Diretrizes sobre Cadeiras de Rodas. Desenvolver um sistema de fornecimento de serviços e programas de treinamento, conforme descrito nas Diretrizes e no Pacote de Treinamento em Serviços de Cadeira de Rodas. 2.14 Política para 27 Atividade Tempo: Dê 5 minutos para consideração da apostila e 10 minutos para feedback. Dê mais tempo para o feedback se mais de quatro grupos Feedback: Solicite o feedback de um grupo por vez. Anote quaisquer comentários nas folhas de flip chart. Para grupos maiores, pode ser necessário escrever em um slide no PPT para que todos possam ler os comentários. 8. Benefícios para todos (3 minutos) Explique: Quando uma pessoa recebe uma cadeira de rodas apropriada por meio de um serviço, as oportunidades para a vida social, trabalho e educação se abrem. Explique: • Estudos demonstraram que as tecnologias assistivas, quando adequadas para o usuário e seu local, têm um impacto significativo sobre o nível de participação que as pessoas com deficiência podem atingir(8). • Dispositivos assistivos, fornecidos por meio de um serviço, podem reduzir o tempo e o esforço físico dos cuidadores(9). Apresente a história de Saraswathi, da Índia, que demonstra o impacto de uma cadeira de rodas apropriada sobre a pessoa e sua família Saraswathi nasceu em 1985 e quando tinha 4 anos contraiu poliomielite, que lhe paralisou as duas pernas. Incapaz de andar, apesar do uso de órteses e terapia regular, Saraswathi tornou- se completamente dependente de sua família, que vive em uma aldeia muito pequena no estado de Karnataka. Já adulta, Saraswathi entrou em contato com o fornecedor de serviços de cadeira de rodas na região, a Associação para Pessoas com Deficiência (APD). Essa organização avaliou suas necessidades e lhe prescreveu uma cadeira de rodas apropriada. Depois de recebê-la e aprender novas técnicas de mobilidade com a APD, Saraswathi pode estabelecer uma pequena loja de produtos gerais. Esse trabalho lhe garante dinheiro suficiente para que ela possa sustentar sua família de seis pessoas. Com maior independência e mobilidade, ela também tem sido capaz de desenvolver uma vida social muito intensa dentro de sua comunidade. As tecnologias assistivas, quando apropriadas ao usuário e a seu ambiente, têm um impacto significativo sobre o nível de participação que as pessoas com deficiência podem atingir. Dispositivos assistivos, fornecidos por meio de um serviço, podem reduzir o tempo e o esforço físico dos cuidadores. 2.15 Política para 28 9. Resumo dos pontos principais (2 minutos) Resuma: O fornecimento de cadeiras de rodas capacita as pessoas com deficiência a terem mobilidade, se manterem saudáveis e participarem plenamente na vida da comunidade. Leia os pontos principais: • A Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (UNCRPD) diz: Todas as pessoas têm direito à mobilidade pessoal. • A mobilidade pessoal é possível quando as pessoas recebem uma cadeira de rodas apropriada por meio de um serviço que elas possam ter acesso. • Para melhor garantir a implementação do Artigo 20, os participantes podem consultar as Diretrizes para Cadeira de Rodas e o Capítulo 7 do documento de posição conjunta sobre os dispositivos assistivos em locais com poucos recursos. Resuma: Não podemos deixar de apoiar o fornecimento de cadeira de rodas apropriada em nosso país. A Convenção das Nações Unidas sobre os Direitos das Pessoas com Deficiência (UNCRPD) diz: Todas as pessoas têm direito à mobilidade pessoal (Artigo 20). A mobilidade pessoal é possível quando as pessoas recebem uma cadeira de rodas apropriada, por meio de um serviço que elas tenham acesso e que atenda a suas necessidades. 2.16 Política para 29 S.3: Gama de cadeiras de rodas adequadas O B JE T IV O S Ao final desta sessão, os participantes poderão:  Explicar o que é uma cadeira de rodas apropriada e a necessidade de uma variedade de diferentes tipos de cadeiras de rodas. R E C U R SO S Para a sessão:  PPT: S.3: Gama de cadeiras de rodas adequadas;  vídeo: Benefícios de suporte extra – Chaeli;  vídeo: Benefícios de uma cadeira de rodas apropriada. C O N T E X T O Adapte esta sessão para se adequar ao contexto no qual os participantes vão trabalhar. Pense no seguinte:  a variedade de produtos disponíveis no próprio local;  como esses produtos funcionam em diferentes ambientes. P R E P A R A Ç Ã O  Reunir recursos e ler todo o plano de sessão.  Leia os Capítulos 6 e 7 do documento de posição conjunta sobre os dispositivos de mobilidade em locais com poucos recursos. D E SC R IÇ Ã O 1. Introdução 2. Importância de cadeira de rodas e almofada adequadas 3. Proporcionar adequação e suporte postural apropriados 4. Atender às necessidades do usuário e do ambiente 5. Importância de um produto seguro e durável 6. Princípios de fornecimento de cadeiras de rodas apropriadas 7. Resumo dos pontos principais 2 7 5 5 5 4 2 Tempo total da sessão 30 30 1. Introdução (2 minutos) Explique: Nesta sessão veremos a importância de ter acesso a uma gama de cadeiras de rodas apropriadas. 2. O que é cadeira de rodas e almofada apropriadas (7 minutos) Explique: Está definido nas Diretrizes para Cadeira de Rodas o que é uma cadeira de rodas apropriada. Leia a definição de uma cadeira de rodas apropriada. Uma cadeira de rodas apropriada: • atende às necessidades do usuário; • está de acordo com o ambiente do usuário; • é a opção correta para o usuário (tamanho e suporte) sentar-se ereto; • é segura e durável; • pode ter manutenção e consertos no próprio local. Explique: Todo usuário de cadeira de rodas precisa de uma almofada. Explique: • O tipo de almofada mais adequado ao usuário vai depender de suas necessidades. Por esse motivo, os serviços de cadeira de rodas devem ter, no mínimo, uma pequena variedade de almofadas disponíveis. • Todo usuário de cadeira de rodas deve usar uma almofada. • Usuários com risco de desenvolver úlcera por pressão devem usar uma almofada para aliviar a pressão. Explique: Comparativamente, há um custo maior em não ter a almofada correta e não ensinar as pessoas como usá-la. Por exemplo, é mais caro tratar as úlceras por pressão, que podem levar meses ou anos para cicatrizar. Uma cadeira de rodas adequada (adequada para seu objetivo): atende às necessidades do usuário; está de acordo com o ambiente do usuário; é a opção correta para o usuário (tamanho e suporte); é segura e durável; 3.2 Gama de cadeiras de rodas Todo usuário de cadeira de rodas deve usar uma almofada. O tipo de almofada mais adequado ao usuário vai depender de suas necessidades. Usuários com risco de desenvolver úlcera por 3.3 Gama de cadeiras de rodas 31 Explique: • A expectativa (média) de vida nos países com recursos necessários é de aproximadamente 38 anos após a lesão para pessoas que se lesionaram entre 25-34 anos (10). • Por outro lado, um estudo realizado em Bangladesh revelou que a expectativa de vida após a lesão medular é de 5,36 anos, e que 56,4% das pessoas morrem cinco anos após a lesão(11). • Oitenta por cento das pessoas do estudo morreram em casa, e dessas que morreram em casa, um terço tinha úlceras por pressão quando morreram. Explique: • Em 1999, foi realizado um levantamento de custos hospitalares em um hospital de reabilitação no Sri Lanka na unidade de lesão medular. Na época, eram necessárias seis semanas para cicatrizar uma úlcera por pressão superficial a um custo de US$ 286. Uma úlcera por pressão profunda, que leva um ano para cicatrizar, custa cerca de US$ 2.483. • Um ano após introduzir um foco na orientação e almofadas e colchões para alívio de pressão de baixo custo no hospital, a incidência de úlceras por pressão desenvolvidas no hospital reduziu 70% e o gasto com curativos diminuiu em quase 60%. • De acordo com o Relatório Mundial sobre Deficiênciada OMS(12), um programa hospitalar em São Paulo, Brasil, introduziu um serviço com foco em orientação para reduzir as complicações secundárias em pessoas com lesão medular e isso ajudou a diminuir a incidência de úlceras por pressão em 23%. Explique: Ter acesso a uma almofada apropriada e orientação sobre como usá-la é uma parte importante para prevenir complicações de saúde e até mesmo morte prematura. A expectativa média de vida para pessoas lesionadas entre as idades de 25-34 anos, nos países dotados de recursos, é de aproximadamente 38 anos. Dados de um estudo realizado em Bangladesh sugerem que a expectativa de vida média após uma lesão medular é de 5,36 anos. Oitenta por cento das pessoas do estudo morreram em casa, e dessas que morreram em 3.4 Gama de cadeiras de rodas Em 1999, um levantamento de custos hospitalares no Sri Lanka mostrou que: uma úlcera por pressão superficial que leva seis semanas para cicatrizar custa US$ 286 e uma úlcera por pressão profunda que leva um ano para cicatrizar custa US$ 2483. A introdução do equipamento correto e a educação do paciente reduziram a incidência de úlceras por pressão durante a internação em 70% e as despesas com curativos em quase 60%. 32 3. Proporcionar adequação e suporte postural apropriados (5 minutos) Explique: Para proporcionar uma adequação apropriada é necessária uma variedade de tamanhos; incluindo uma opção para crianças. Clique para abrir uma imagem por vez. Pergunte: O que você vê aqui? Sugira: • Criança usando sapatos de adultos. • Tamanho errado, muito grande. • Criança incapaz de correr e fazer o que precisa. Clique na próxima imagem de calçados adequados. Explique: A criança agora tem o tipo de calçado correto, que encaixa corretamente, permitindo a ela correr e brincar. Clique: na imagem da criança na cadeira de rodas. Pergunte: O que você vê aqui? Sugira: • Criança em cadeira de adultos, tamanho errado. • Dificuldade em se mover e brincar. Clique na imagem final. Explique: Com o tipo e tamanho corretos de cadeira de rodas, uma criança tem a oportunidade máxima de fazer o que precisa. Explique: As pessoas têm necessidades de suporte postural diferentes e, portanto, necessitam de cadeiras de rodas com diferentes tipos de suporte. 3.6 Gama de cadeiras de rodas 33 Apresente o vídeo: Benefícios de suporte extra – Chaeli Peça: para os participantes ouvirem a Chaeli descrever como um suporte extra desde cedo a ajudou. Exiba o vídeo. 4. Atender às necessidades do usuário e do ambiente (5 minutos) Apresente o vídeo: Benefícios de uma cadeira de rodas apropriada. Peça: para os participantes observarem como as diferentes cadeiras de rodas ajudam as pessoas no vídeo a realizarem seus trabalhos ou atividades. Exiba o vídeo. Explique: O vídeo destaca que cadeiras de rodas diferentes são adequadas a ambientes diferentes. Quando as pessoas recebem um produto que não funciona bem em seu ambiente – as cadeiras de rodas são frequentemente descartadas. Explique: • Nesta imagem, há três cadeiras de rodas. As duas primeiras foram abandonadas porque precisam de reparo e não há peças de reposição disponíveis. • A terceira foi doada e é nova. No entanto, ela parece frouxa e instável quando utilizada na parte externa e a pessoa que a recebeu se sente insegura. • Essa pessoa tem três cadeiras de rodas, mas nenhuma delas fornece uma solução apropriada para suas necessidades. Benefícios de suporte extra – Campanha 3.7 Gama de cadeiras de rodas Benefícios de uma cadeira de rodas 3.8 Gama de cadeiras de rodas 3.9 Gama de cadeiras de rodas 34 5. A importância de um produto seguro e durável (5 minutos) Explique: Discutimos a importância de um produto correto para a pessoa e o ambiente. Agora vamos considerar os fatores que influenciam a segurança e durabilidade dos produtos. Pergunte: O que acontece quando uma cadeira de rodas não é durável? Explique: • Os produtos que não são duráveis devem ser substituídos mais vezes que os produtos duráveis. • Um produto inadequado pode quebrar após 1-6 meses de uso e exigir substituição. Um produto adequado pode durar de 3–5 anos (6-10 vezes mais) e proporcionar um melhor custo- benefício em longo prazo. Clique nas fotos e Explique: • Esses exemplos de pilhas de cadeiras de rodas descartadas que não podem ser consertadas são encontrados em muitos países em todo o mundo. • Elas ficam em depósitos/ginásios ou junto com outros equipamentos quebrados ou descartados ou resíduos hospitalares. Os produtos que não são duráveis devem ser substituídos mais vezes que os produtos duráveis. Um produto barato e inadequado pode quebrar depois de algumas semanas ou meses e precisar ser trocado, além de poder causar ferimentos ao usuário. Um produto adequado pode durar de 3 a 5 anos e proporcionar um melhor custo-benefício 3.10 Gama de cadeiras de rodas 3.11 Gama de cadeiras de rodas 3.12 Gama de cadeiras de rodas 35 Explique: Ao adquirir ou receber produtos doados, assegure-se que: • a variedade de produtos seja adequada aos ambientes em que será usada; • os produtos sejam duráveis quando utilizados em ambientes ásperos e duros; • os produtos disponíveis possam ser consertados no próprio local. Explique: • A oitava das oito etapas de serviço de cadeira de rodas refere-se à manutenção, reparos e acompanhamento. • Todos os usuários e os membros de suas famílias devem aprender a fazer a manutenção e reparos simples para prolongar a vida do produto. 6. Princípios de fornecimento de cadeiras de rodas apropriadas (4 minutos) Um só produto consegue atender às necessidades de todos os usuários. Portanto, é necessária uma variedade de cadeiras de rodas. Explique: Para os países cumprirem suas obrigações relacionadas a tecnologias assistivas (dispositivos de mobilidade) descritas na UNCRPD, os seguintes princípios fundamentais precisam ser considerados(13). Ao adquirir ou receber produtos doados, assegure-se que: a variedade de produtos seja adequada aos ambientes em que será usada; os produtos sejam duráveis quando utilizados em ambientes ásperos e duros; os produtos disponíveis possam ser d ó i l l 3.13 Gama de cadeiras de rodas 3.14 Gama de cadeiras de rodas 36 Leia a lista devagar. 1. Aceitabilidade – as pessoas com deficiências devem estar envolvidas em todas as etapas de fornecimento do dispositivo de mobilidade. 2. Acessibilidade – os serviços de dispositivos de mobilidade e serviços relacionados devem ser acessíveis a todos que tenham uma necessidade identificada. 3. Adaptabilidade – os serviços de dispositivos de mobilidade e serviços relacionados devem ser adaptados e modificados para garantir que sejam adequados às necessidades do indivíduo. 4. Acessibilidade financeira – os serviços de dispositivos de mobilidade e serviços relacionados devem ter um preço acessível. 5. Disponibilidade – instalações, pessoal e produtos devem ser suficientes para as necessidades da população e disponibilizados o mais próximo possível de suas comunidades. 6. Qualidade – Produtos, instalações e serviços devem ter qualidade adequada. 7. Resumo dos pontos principais (2 minutos) Explique: • Não existe um tipo de cadeira de rodas que irá atender às necessidades de todos os usuários de cadeiras de rodas. • Os usuários de cadeiras de rodas precisam de uma cadeira que atenda às suas necessidades, se adapte a seu ambiente e seja segura e durável. Princípios de desenvolvimento do sistema de fornecimento de cadeiras de rodas adequadas: Aceitabilidade – os usuários devem estar envolvidos em todas as etapas do fornecimento da cadeira de rodas. Acessibilidade – as cadeiras de rodas e os serviços relacionados devem ser acessíveis a todos que tiverem uma necessidade identificada. Adaptabilidade – as cadeiras de rodas e os serviços relacionados precisam ser adaptados e modificados para garantir que sejam adequados às necessidades do indivíduo. Não existe um tipo de cadeira de rodas que irá atender às necessidades de todos os usuários de cadeiras de rodas. Os usuários de cadeiras de rodas precisam de uma cadeira que atenda às suas necessidades, se adapte a seu ambiente e seja segura e Acessibilidade financeira – as cadeiras de rodas e os serviços associados devem ter um preço acessível. Disponibilidade – instalações, pessoal e produtos devem ser suficientes para as necessidades da população e disponibilizados o mais próximo possível de suas comunidades. Qualidade – Produtos, instalações e serviços 3.16 Gama de cadeiras de rodas 37 S.4: Trabalhando em conjunto para a mudança O B JE T IV O S Ao final desta sessão, os participantes poderão:  explicar o papel que os participantes devem desempenhar para facilitar a introdução ou melhoria do fornecimento de cadeira de rodas apropriada;  prorpor estratégias para ajudar a mudar o processo: criar um sentimento de urgência, formar uma parceria forte, comunicar a visão do sucesso, remover obstáculos e fornecer suporte. R E C U R SO S Para a sessão:  Slides de PPT: S.4:Trabalhando em conjunto para a mudança;  vídeo: Leve consigo essa mensagem. Para os instrutores:  “Liderar a mudança para uma saúde melhor” Capítulo 6 Gerentes que Lideram MSH 2005 página 149. C O N T E X T O Adapte esta sessão para se adequar ao contexto no qual os participantes vão trabalhar. Pesquise para fornecer exemplos locais sobre:  estatísticas e histórias de condições de vida de pessoas com deficiências de mobilidade e o acesso delas a serviços de cadeira de rodas adequados para apoiar a necessidade de criar um sentimento de urgência;  esforços e sucessos atuais no fornecimento de cadeira de rodas;  instituições e organizações que podem estar envolvidas e comprometidas a apoiar o fornecimento de cadeira de rodas. P R E P A R A Ç Ã O  Reunir os recursos.  Ler “Liderar a mudança para uma saúde melhor” Capítulo 6 Gerentes que Lideram MSH 2005 página 149.  Rever os slides de PPT e ler todo o plano de sessão. Preparar os slides sobre o número de pessoas que precisam de uma cadeira de rodas no slide no PPT Trabalhando em conjunto para a mudança.  Identificar uma pessoa para gravar os minutos e as ações acordadas.  Preparar quatro folhas de flip chart com os seguintes títulos: Sentimento de urgência; Criar uma equipe principal; Comunicar a visão e a estratégia; Ações imediatas para fornecer apoio. D E SC R IÇ Ã O 1. Introdução 2. Como comunicar um sentimento de urgência 3. Como envolver e comprometer os participantes 4. Como comunicar a visão ou imagem do sucesso 5. Desenvolver uma visão ou imagem positiva do futuro desejado 6. Como fornecer apoio e remover obstáculos 7. Estratégias para ajudar no processo de mudança 6 3 5 3 40 3 40 Tempo total da sessão 100 38 1. Introdução (6 minutos) Associe esta sessão com as sessões anteriores. Nas sessões anteriores, discutimos a grande necessidade não atendida no fornecimento de cadeira de rodas. A mobilidade pessoal permite que muitas pessoas com deficiências tornem-se membros produtivos de suas famílias e comunidades. Para muitas pessoas, uma cadeira de rodas apropriada, bem feita e ajustada pode ser o primeiro passo para a inclusão e participação na sociedade. Apresente os desafios para os participantes ajudarem no processo de mudança. Explique: • A OMS, em parceria com a USAID, desenvolveu os Pacotes de Treinamento em Serviço de Cadeira de Rodas (WSTP) para garantir que as pessoas possam ter acesso a cadeiras de rodas apropriadas. • O objetivo do pacote de treinamento geral é criar consciência e desenvolver as habilidades e o conhecimento de todo o pessoal envolvido no fornecimento de cadeira de rodas. • No entanto, esse pessoal capacitado não pode garantir por si só o fornecimento de cadeira de rodas apropriada no país ou assumir suas responsabilidades conforme descrito nas Diretrizes para Cadeira de Rodas,a menos que haja maior nível de envolvimento para estabelecer ou melhorar o fornecimento de cadeira de rodas no país. Pergunte: Qual você acha que deve ser o papel do participante para garantir o estabelecimento ou a melhoria do fornecimento de cadeira de rodas no país? Estimule respostas e anote no quadro. Respostas mais importantes: criar consciência da necessidade; promover e desenvolver novas políticas; facilitar o acesso aos recursos; criar parcerias e alianças. Alcançar a necessidade não atendida – melhorar o acesso a cadeiras de rodas de alta qualidade a um preço acessível. Implementar as Diretrizes para Cadeira de Rodas da OMS e o Pacote de Treinamento em 4.2 Trabalhando em conjunto Há necessidade de maior envolvimento para estabelecer ou melhorar o fornecimento de cadeiras de rodas no 39 Explique: Introduzir ou melhorar o fornecimento de cadeira de rodas implica em uma mudança organizacional. No entanto, a mudança organizacional pode ser muito difícil. Os participantes podem desempenhar um papel fundamental para facilitar essa mudança como agentes de mudança. Explique: Fatores-chave para o sucesso. • Foram realizados muitos estudos para obter uma maior compreensão das coisas que fazem a mudança organizacional mais propensa a ter sucesso(14). Explique: Durante este workshop, iremos focar em quatro coisas principais que os participantes podem fazer para liderar a mudança. Elas são: 1. As organizações enfrentam muitas prioridades concorrentes. A menos que os participantes criem uma mensagem clara e consistente sobre o sentimento de urgência, o fornecimento de cadeira de rodas apropriada ficará perdido nas prioridades dos gerentes. 2. É necessário formar uma parceria de participantes com energia e comprometimento para promover a mudança. 3. Para envolver e comprometer diferentes participantes, uma visão ou imagem clara e forte deve ser criada e comunicada em todas as oportunidades e locais. 4. Quando a implementação começa, os participantes devem estar lá para fornecer apoio e remover os obstáculos que os gerentes no nível de prestação de serviços não conseguem superar. Criar um sentimento de urgência sobre a necessidade de mudança, a fim de criar um fornecimento de cadeira de rodas apropriada. Montar uma equipe principal de participantes com energia e comprometimento para promover a mudança. Criar uma visão e estratégia compartilhadas fortes e comunicá-las em todas as oportunidades e locais. Fornecer apoio e remover obstáculos que os gerentes não conseguem superar. 40 2. Como comunicar um sentimento de urgência (3 minutos) Pergunte: Como você acha que pode criar um sentimento de urgência? Explique: • Evite a complacência: “Estamos fazendo o possível”. • Mostre aos outros a necessidade de mudança com histórias e estatísticas convincentes. • Mantenha o sentimento de urgência em todas as mensagens e ações em todo o processo de mudança. • Mostre evidências comoventes e válidas que demonstrem que a mudança é necessária. 3. Como envolver e comprometer os participantes (5 minutos) Explique: Pesquisas demonstraram que há poucas pessoas que adotam a mudança facilmente e poucas pessoas muito resistentes à mudança. A maioria das pessoas fica indecisa esperando para ver como um processo de mudança acontece antes de se decidir de qual lado ficar. Se fizer um gráfico e distribuir em colunas o número de pessoas que adotam a mudança facilmente na primeira coluna, as pessoas mais resistentes na última coluna e as indecisas no meio, você terá um gráfico como aquele demonstrado no slide. Destaque: um sentimento de urgência significa que há uma necessidade que não pode ser evitada ou atrasada As ações e decisões dos participantes devem demonstrar que o fornecimento de cadeira de rodas apropriada é uma prioridade. Não subestime os esforços necessários para mudar a situação atual. Se não houver um sentimento de urgência, as pessoas não farão um esforço adicional para realizar a mudança. Evite a complacência: “Estamos fazendo o possível.” Mostre aos outros a necessidade de mudança com histórias e estatísticas convincentes. Mantenha o sentimento de urgência em todas as mensagens e ações em todo o processo de mudança. Mostre evidências comoventes que demonstrem que a mudança é necessária e boa para todos. 41 Explique: Categorização dos usuários: • Inovadores, grupo pequeno de cerca de 2,5%: Ficam felizes em assumir riscos, gostam de fazer coisas novas. • Usuários Iniciais 13,5%: É um grupo muito importante porque geralmente são formadores de opinião, bem conhecidos. As pessoas olham e seguem eles. • Maioria Inicial, 34%: Prestam atenção no que os outros estão fazendo para aprender com eles, principalmente com os Usuários Iniciais. • Maioria Tardia, 34%: Adotam quando a mudança já está acontecendo. Eles precisam ter certeza que algo funcione antes de mudar. • Conservadores ou tradicionais, 16%: É importante conhecer suas preocupações e abordá-las, mas não deve ser dado muito foco para tentar mudá-los. Explique: Se quisermos introduzir uma nova abordagem para o fornecimento de cadeira de rodas, em que devemos focar? Muitas vezes, focamos em argumentar ou tentar convencer os conservadores ou tradicionais. Devemos focar mais em apoiar os Usuários Iniciais e a Maioria Inicial. Estudos mostram que, depois que esses grupos adotam uma mudança, é difícil pará-la. Explique: De acordo com o slide anterior, há uma necessidade de os usuários iniciais comprometidos com a mudança criarem uma equipe principal para mudança. Pergunte: Quais tipos de qualidades os membros da equipe principal devem ter? Explique: • A equipe principal deve ter uma combinação de pessoas com energia suficiente para fazer as coisas acontecerem, além de entusiasmo e compromisso para envolver os demais. Leia a lista de qualidades no slide. Inovadore s Maioria Inicial 34% M i i T di Usuári os Iniciais 13 5% Conservadore s - Tempo de + 4.5 Trabalhando em conjunto A equipe principal deve ter uma combinação de pessoas com energia suficiente para fazer as coisas acontecerem, entusiasmo e compromisso: Poder em seu cargo Experiência Liderança Credibilidade Trabalho em equipe. 4.6 Trabalhando em conjunto para a mudança 42 . Explique: Dependendo das circunstâncias específicas do fornecimento de cadeira de rodas no país, a lista de participantes pode mudar. Leia a lista dos participantes no slide. Explique: Para ter sucesso na formação da equipe principal, é necessário: Leia as características no slide. 4. Como comunicar a visão ou imagem do sucesso (3 minutos) Explique: Para envolver e convencer as pessoas sobre a importância do fornecimento de cadeira de rodas apropriada, você precisa criar uma visão clara e comovente de onde você quer chegar e o que você quer que o serviço ou programa se torne, uma imagem do futuro desejado. Planejadores e executores de políticas (Por exemplo, o governo). Fabricantes e fornecedores. Grupos profissionais (como Fisioterapeutas/Terapeutas Ocupacionais). ONGs internacionais. Organizações de pessoas com deficiências ou grupos de usuários. Pessoas com deficiência, seus familiares e cuidadores. Mostrar entusiasmo e compromisso para envolver outras pessoas Modelar o comportamento necessário: compromisso, confiança e trabalho em equipe. Estruturar reuniões produtivas. Focar nos usuários iniciais. 43 • As pessoas geralmente apoiam o que criam. Tente criar uma visão ou imagem compartilhada, desenvolvida e mantida por aqueles que irão precisar desenvolvê-la. • Liderar com visão o ajudará a lembrar por que está fazendo o que está fazendo e dará inspiração para que a equipe enfrente os obstáculos. • Também é necessário criar uma estratégia para implementar a mudança. Siga as oito etapas do início. Explique: • Mantenha a comunicação simples e cativante. • Leve em consideração as necessidades e preocupações do público ao preparar suas mensagens. • Use todas as oportunidades disponíveis: Por exemplo, reuniões presenciais, conferências, TV/rádio local, páginas da internet, mensagens de telefone celular. • Seja consistente com suas mensagens. Um gesto é melhor que mil palavras. 5. Desenvolver uma visão ou imagem positiva do futuro desejado (40 minutos) Explique: Como vimos nas sessões anteriores, há muitos benefícios no fornecimento de cadeira de rodas apropriada. É muito importante ter uma declaração de visão forte e envolvente para comunicar a todas as pessoas envolvidas. Iremos criar uma visão compartilhada. Esta é a imagem do que queremos alcançar ou criar juntos no futuro. Crie uma visão clara e em movimento do futuro desejado. Envolva aqueles que precisarão desenvolver a visão ao criá-la. A visão irá lembrá-lo por que você está fazendo o que está fazendo e fornecerá inspiração ao enfrentar os obstáculos. Também é necessário criar uma estratégia clara de como o processo será implementado. 4.9 Trabalhando em conjunto para a mudança 4.10 Trabalhando em conjunto 44 Atividade Grupos: Individualmente. Instruções: Explique: Pense no futuro, daqui a três anos. Imagine que conquistamos tudo que é importante para nós no fornecimento de cadeira de rodas. • Qual imagem você vê na sua mente que representa essa conquista? • Qual impacto você vê nos usuários de cadeira de rodas? • Quais mudanças você vê na participação do participante? • Quais mudanças você vê no fornecimento? Peça a cada participante para escrever uma manchete de jornal relatando para o grupo as conquistas daqui a três anos. Isso pode ser por meio de palavras ou imagens. Monitore: Monitore o grupo e ajude se necessário. Tempo: 10 minutos no total. Feedback: Incentive dois ou três participantes a compartilharem seus exemplos e escreva-os no quadro branco. Atividade Grupos: Divida em grupos de 4-6 pessoas (certifique-se de misturar pessoas de diferentes organizações em cada grupo). Instruções: Peça a cada grupo para compartilhar entre os membros sua imagem ou visão individual do futuro de fornecimento de cadeira de rodas apropriada. Peça para criarem uma visão compartilhada combinando os melhores aspectos das visões individuais. Registre a visão deles em um flip chart para compartilhar no plenário. Monitore: Monitore os grupos e ajude se necessário. Tempo: 20 minutos para discutir e 10 minutos para feedback. Respostas mais importantes: pessoas com deficiências agora se tornaram móveis e capazes de participar na vida da comunidade; os participantes estão organizados e cooperam para fornecer acesso a cadeiras de rodas acessíveis, duráveis e apropriadas para usuários que delas necessitam; os prestadores de serviços oferecem serviços integrados, adaptados às necessidades dos clientes, incluindo treinamento para usuários em como manter e usar suas cadeiras de rodas; existem ambientes acessíveis melhores, então as pessoas com deficiências podem usar suas cadeiras de rodas em todos os lugares. 45 Feedback: Peça para cada grupo compartilhar sua visão com o plenário. Comente sobre os elementos comuns das visões e peça para voluntários combinar as visões e compartilhar com o grupo depois. 46 6. Como fornecer apoio e remover obstáculos (3 minutos) Explique: Falamos sobre os três elementos fundamentais para introduzir a mudança organizacional com sucesso: • criar um sentimento de urgência; • formar uma equipe principal de pessoas que levem a iniciativa adiante; e • comunicar a visão ou imagem do sucesso e a estratégia em todas as oportunidades. Explique: • O quarto fator fundamental é um papel importante que os participantes devem desempenhar – fornecer apoio e remover obstáculos que os gerentes não conseguem superar sozinhos. Leia as possíveis áreas de intervenção no slide. Resuma: Existem quatro elementos fundamentais para ajudar no processo de mudança que se tornaram funções importantes para todos os participantes como você. Explique: Agora você sabe o tamanho da necessidade. Leia o número estimado de pessoas que precisam de uma cadeira de rodas no país. Pergunte: 1. Como você irá contribuir para criar um sentimento de urgência sobre a necessidade de mudança no fornecimento de cadeira de rodas em nosso país? Destaque: Os participantes podem usar seu poder e seus relacionamentos para avançar e apoiar o fornecimento de cadeira de rodas. Que tipo de obstáculos não podem ser superados apenas pelos gestores? Política de fornecimento de cadeiras de rodas. Políticas e incentivos dos recursos humanos. Alocação de orçamento. Estabelecimento de padrões nacionais para cadeiras de rodas. Educar e treinar pessoal relevante. 4.12 Trabalhando em conjunto População Pessoas que precisam de cadeira de d OMS 7.000.000.000 70.000.000 Inserir país Inserir população do país Inserir 1% da população do país 47 2. Como você pode contribuir para formar uma equipe principal com energia e comprometimento para promover a mudança? 3. Como você pode compartilhar a visão ou imagem positiva do futuro do fornecimento de cadeira de rodas adequada e apropriada? 4. De que maneira você pode fornecer apoio e ajudar a remover obstáculos para que o fornecimento de cadeira de rodas possa ser melhorado ou implementado? 7. Estratégias para ajudar o processo de mudança (40 minutos) Explique: Para irmos mais além, discutiremos suas ideias para ações que nós, como participantes, podemos tomar para implementar ou melhorar o fornecimento de cadeira de rodas. Atividade Grupos: Divida em grupos de 4-8 pessoas. Decida se grupos mistos (diferentes tipos de organizações ou semelhantes) serão mais úteis para dar seguimento às ações. Instruções: Peça para cada grupo analisar quais ações são necessárias para avançar na implementação ou melhora do fornecimento de cadeira de rodas respondendo às seguintes questões: • Quais ações que nós, participantes, podemos tomar para criar um sentimento de urgência no fornecimento de cadeiras de rodas apropriadas? • O que podemos fazer para montar uma equipe principal de participantes com energia e comprometimento suficientes para levar a iniciativa adiante? • Como podemos comunicar a visão ou imagem do sucesso e a estratégia de fornecimento de cadeira de rodas apropriadas? (oito etapas). • Quais ações imediatas podem ser tomadas para fornecer apoio para o fornecimento de cadeira de rodas? Peça a cada grupo para registrar suas respostas para serem compartilhadas na discussão com o grupo todo. Monitore: Monitore os grupos e ajude se necessário. Tempo: 15 minutos para discutir e 20 minutos para feedback. Criar um senso de urgência sobre a necessidade de fornecimento de cadeiras de rodas adequadas. Montar uma equipe principal de participantes com energia e comprometimento para promover a mudança. Criar uma visão e estratégia compartilhadas fortes e comunicá-las em todas as oportunidades e locais. Fornecer apoio e remover obstáculos que os gerentes não conseguem 48 Registre: Anote as ações propostas em um flip chart. Use uma folha para cada fator marcado com o título: Sentimento de urgência; Montar uma equipe principal; Comunicar a visão e a estratégia e Ações imediatas para fornecer apoio. Exiba: as quatro folhas de flip chart na parede. Pergunte: Registre: Anote as próximas etapas com as pessoas responsáveis e as datas em um flip chart ou diretamente no PPT. Feedback: Peça a um representante de cada equipe para compartilhar as ações propostas para avançar na implementação ou melhora do fornecimento de cadeira de rodas da seguinte maneira: A equipe 1 apresenta as ações propostas para criar um sentimento de urgência. Ao terminar, o restante das equipes pode contribuir com mais ações, caso sejam diferentes. A equipe 2 apresenta as ações para montar uma equipe principal de participantes. O restante das equipes pode contribuir com quaisquer ações complementares. A equipe 3 apresenta ações para comunicar a visão e a estratégia. As equipes podem complementar, se necessário. A equipe 4 apresenta as ações imediatas para fornecer apoio para o fornecimento de cadeira de rodas. As outras equipes podem complementar, se necessário. Quais serão as próximas etapas? Quem será responsável por compilar as visões em uma só? Quando será distribuída a todos? Você vai formar uma força-tarefa para iniciar algumas das ações propostas? Quem levará essas ações adiante? Vocês irão se encontrar novamente? Quando? 49 Discurso de encerramento (5 minutos) Explique: • O logo representa um compromisso de colocar pessoas na estrada – não ficar trancadas dentro de suas casas ou tocas –, aumentando a participação e a inclusão de pessoas com deficiências: por meio do fornecimento de cadeiras de rodas apropriadas entregues por meio de serviços por pessoal capacitado. Incentive os participantes a usarem o logo do WSTP. Apresente o vídeo: Leve consigo essa mensagem. Exiba o vídeo. Agradeça a todos os participantes pela participação e contribuições. Notas para os instrutores: Os instrutores/anfitriões podem escolher como querem apresentar os certificados e encerrar o programa de treinamento. O pôster das etapas do serviço de cadeira de rodas pode ser entregue aqui ou em uma sessão anterior. 4.14 Trabalhando em conjunto Leve consigo essa 4.15 Trabalhando em conjunto 50 Anexos Anexo 1: Resumo para representantes do governo Pontos sugeridos para consideração Tempo sugerido: 5–10 minutos Objetivo da comunicação Destacar a urgência da situação de pessoas com deficiência no país, o que o governo está fazendo para resolver o problema e pedir que outros participantes tomem medidas onde puderem. Introdução • Quem é você e qual departamento você representa? • Qual o papel dele na deficiência? A situação atual • A legislação existe, mas ainda há uma grande necessidade. • Destaque a necessidade por cadeiras de rodas (1% da população do país). • Destaque as outras necessidades de pessoas com deficiências conforme sua percepção: por exemplo, reabilitação, educação, emprego e inclusão na vida da comunidade. Histórico • Quando seu país ratificou a UNCRPD e o Protocolo Opcional? Mencione o Artigo 20, específico sobre o direito à mobilidade pessoal. • Destaque quaisquer leis ou políticas locais relacionadas à deficiência. • Como você monitora e faz cumprir a legislação? • Quais são os desafios com isso? As próximas etapas As Diretrizes para Cadeira de Rodas é uma ferramenta para apoiar a implementação do UNCPRD. 51 Possíveis recomendações que talvez você queira fazer: • Colabore: Juntos conseguimos mais – o governo quer trabalhar com serviços de reabilitação e pessoas com deficiência, ONGs, ONGs internacionais e OPDs para melhorar a situação e cumprir suas obrigações junto à UNCRPD. • Trabalhe em conjunto para desenvolver a política nacional sobre dispositivos assistivos. • Produtos (por exemplo, cadeiras de rodas, triciclos): Melhorar a quantidade, a variedade e a qualidade dos produtos disponíveis para pessoas com deficiência. • Padrões: Adotar padrões de cadeira de rodas específicos, de acordo com as Diretrizes para Cadeira de Rodas. • Serviços: Desenvolver mais serviços, de melhor qualidade. Conclusões e próximas etapas • Todos os participantes nesta sala podem desempenhar uma função para seguir nas próximas etapas. • Precisamos agir rapidamente, já que as pessoas com deficiência estão entre as mais marginalizadas em nosso país. • Precisamos garantir que as conclusões deste workshop continuem e devemos montar uma força-tarefa para fiscalizar que isso seja feito. 52 Anexo 2: Resumo para representantes de usuário de cadeira de rodas Tempo sugerido: 5–10 minutos. Tom: As pessoas serão motivadas por um tom apaixonado, engajado e urgente. Objetivo da comunicação Imaginar como é ser um usuário de cadeira de rodas em seu país para que os participantes do workshop sejam compelidos a agir rapidamente, de forma a trazer mudanças e melhorar a qualidade de vida dos usuários de cadeira de rodas. Introdução Quem é você e qual organização você representa (se for o caso)? Histórico Algumas mensagens importantes • A UNCRPD fornece um quadro de como a vida deve ser para as pessoas com deficiência no seu país. O Artigo 20 sobre mobilidade é muito importante neste workshop, que se compromete a “garantir a mobilidade pessoal com a máxima independência possível para as pessoas com deficiências”, incluindo por meio do acesso a dispositivos de mobilidade de qualidade e treinamento(15). • Por que a mobilidade é tão importante? Porque a inclusão e a participação de pessoas com deficiência podem ser alcançadas se elas puderem se locomover. • Para locomoverem-se, as pessoas com deficiência precisam de cadeiras de rodas apropriadas que sejam adequadas a elas. Situação atual Sua história: As pessoas serão envolvidas pela sua história. Quando você olhar essas questões e pensar na sua experiência como um usuário de cadeira de rodas, pergunte a si mesmo se isso é representativo da maioria dos usuários de cadeira de rodas no seu país. Se não for, inclua informações sobre o que deve ser um típico usuário de cadeira de rodas. Se tiver exemplos da vida real, use-os. Você quer que essa parte destaque vividamente os desafios que as pessoas com deficiência enfrentam. • Quando você se tornou deficiente? 53 • Há quanto tempo você é usuário de cadeira de rodas? • Quais desafios você enfrentou? • Você se esforçou muito para conseguir sua cadeira de rodas? Você escolheu o tipo de cadeira de rodas que recebeu e você teve de pagar por ela? • A sua cadeira de rodas é segura e confiável, e é possível consertá-la se necessário? • É fácil para você realizar suas atividades diárias na cadeira de rodas? Você se sente incluído na sociedade? Conclusões e próximas etapas Mensagem importante • A inclusão e a participação de pessoas com deficiência podem ser alcançadas se elas puderem se locomover. • Precisamos trabalhar em conjunto para garantir que isso seja possível – todos os participantes nesta sala podem desempenhar uma função. Considere terminar abordando esta questão • Quais são suas esperanças para o futuro (para você e todos os usuários de cadeira de rodas)? Método de apresentação Não é necessário ter um PPT para essa apresentação. No entanto, seria útil ter uma imagem para inserir em um PPT enquanto o usuário de cadeira de rodas estiver compartilhando sua história. Se o palestrante preferir preparar um PPT, certifique-se que ele seja carregado antes do workshop, se possível. 54 Anexo 3: Algumas citações e estatísticas comuns • Deficiência e Pobreza(16) Há 1 bilhão de pessoas no mundo com uma deficiência, e 700 milhões dessas pessoas vivem em países economicamente mais pobres. Desses 700 milhões: - apenas 10% das crianças em idade escolar vão à escola - a taxa de alfabetização de adultos é de apenas 3% - o desemprego é cerca de 80% • A pobreza e a exclusão se reforçam mutuamente. As pessoas com deficiências estão desproporcionalmente representadas entre as pessoas mais pobres do mundo. • Em países economicamente mais pobres, 98% das crianças com deficiência não frequentam a escola(17). A educação primária universal exige que o foco recaia especificamente em crianças com deficiências. • Estima-se que 10% da população tenha deficiências e 80% dessas pessoas vivem em países em desenvolvimento(18). • Crianças com menos de 5 anos diagnosticadas com deficiência são menos propensas a receberem o mesmo nível de cuidados de saúde que é dado às crianças sem deficiências. As crianças com deficiência podem ser vistas como encargo, e as famílias que vivem em situação de pobreza podem ser incapazes ou não estão dispostas a gastar recursos escassos em uma criança com deficiência. • As questões de deficiência são inseparáveis das questões de desenvolvimento. Uma verdadeira parceria global não pode ser alcançada enquanto as pessoas com deficiências permanecerem fora da política, planejamento e programação de desenvolvimento (Consulte os artigos 31 e 32 da UNCRPD). • A exclusão das pessoas com deficiências possui um impacto devastador nas economias, tanto em países em desenvolvimento quanto em países desenvolvidos. • Em muitos países de renda baixa e média apenas 5–15% das pessoas que precisam de dispositivos e tecnologias assistivas possuem acesso a eles(19). • “A deficiência não é uma questão especializada: é uma questão de direitos humanos. As prioridades das pessoas com deficiências são comida, abrigo, vida familiar, roupa, renda e plena participação, da mesma forma que qualquer outra pessoa(20)”. • As pessoas pobres com deficiências estão presas em um círculo vicioso de pobreza e deficiência, sendo um causa e consequência do outro(21). 55 Anexo 4: As oito etapas para o fornecimento de cadeira de rodas Etapa Resumo 1. Encaminhamento e agendamento A maneira que os usuários de cadeira de rodas serão encaminhados irá variar. Os usuários podem encaminhar a si mesmo ou ser encaminhados por meio de redes formadas por trabalhadores da saúde e reabilitação governamentais ou não governamentais ou voluntários que trabalham no nível da comunidade, distrito ou regional. Alguns serviços de cadeira de rodas podem precisar identificar ativamente possíveis usuários caso eles ainda não estejam recebendo nenhum serviço de cuidado social ou saúde, ou não estejam participando de escola, trabalho ou atividades da comunidade. 2. Avaliação Cada usuário precisa de uma avaliação individual. Isso inclui reunir informações sobre o estilo de vida dos usuários de cadeira de rodas, o trabalho que fazem, onde vivem e suas condições físicas. 3. Prescrição (seleção) Usando as informações da avaliação, uma prescrição de cadeira de rodas é desenvolvida em conjunto com o usuário, membro familiar ou cuidador. A prescrição detalha o tipo, tamanho, características e modificações especiais da cadeira de rodas selecionada. Também é detalhado o treinamento que o usuário precisa receber para usar e manter a cadeira de rodas de forma adequada. 4. Financiamento e aquisição Uma fonte de financiamento é identificada e a cadeira de rodas é encomendada do estoque mantido pelo serviço ou pelo fornecedor. 5. Preparação do produto Pessoal treinado prepara a cadeira de rodas para a adequação inicial. Dependendo das instalações do produto e do serviço, isso poderá incluir montagem e possível modificação de produtos fornecidos por fabricantes, ou produção de produtos na oficina de serviço. 56 Etapa Resumo 6. Adequação O usuário experimenta a cadeira de rodas. Ajustes finais são realizados para garantir que a cadeira de rodas seja montada e adaptada corretamente. Caso modificações ou suporte postural sejam necessários, adequações adicionais podem ser realizadas. 7. Treinamento de usuários O usuário e o cuidador aprendem como usar e manter correta e efetivamente a cadeira de rodas. 8. Manutenção, reparos e acompanhamento As consultas de acompanhamento são oportunidades de verificar se a cadeira de rodas é adequada e fornecer treinamento e apoio adicionais. O tempo depende das necessidades do usuário e dos outros serviços disponíveis a eles. O serviço pode oferecer também manutenção e reparos de problemas técnicos que não possam ser facilmente resolvidos na comunidade. 57 Anexo 5: O fornecimento de cadeiras de rodas adequadas beneficia a todos 58 Referências 1. Diretrizes para o fornecimento de cadeiras de rodas manuais em locais com poucos recursos. Genebra: Organização Mundial da Saúde; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 2. Pacote de Treinamento em Serviços de Cadeira de Rodas – Nível Básico. 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