The International Classification of Functioning, Disability and Health (ICF) is a classification developed by the World Health Organization (WHO) essential for documenting and understanding functioning and disability, providing a holistic view of a person’s health status. It complements ICD used for documenting mortality and morbidity. ICF provides a standardised language and conceptual framework for describing health and health conditions, facilitating communication between professionals, researchers, policymakers and the general public. In addition, it provides valuable support for the formulation of evidence-based policies and the implementation of effective rehabilitation and social inclusion programs.
Given its importance, a hybrid meeting on ICF collaboration was organised on 24th Feb 2024 at AIMS, Mohali, India. The purpose of the meeting was to bring together global partners to build up an ICF application, encourage research and discuss steps needed to develop uniform data collection in the Health Management Information System (HMIS) that accurately informs disability policy in accordance with human rights.
This meeting built upon the progress achieved during the ICF Education conference held in November-December 2023 at AIMS and GRIID, two premier institutions in North India. A key focus of the discussion was a review of ongoing ICF-based research in pulmonary rehabilitation with a particular reference to groundbreaking publication of four ICF chapters in April 2023 NATCON Chest Compendium. Additionally, Autism and Neurodevelopmental disorders were significant topics of discussion. Both pulmonary rehabilitation and autism are crucial components of the #2030 Rehabilitation Toolkit.
The incorporation of ICF concept in,” SmartStart Hubs – Ontario” [1] and the Kolkata Child Development Model [2] along with the ICF Global update, presentations on ICF application in speech – language rehabilitation, and ICF-Mental health, provided a valuable insights into the diverse applications of ICF.These presentations, delivered by both global and local participants, sparked a strong interest in further research and data collection among online attendees.
Promoting ICF- based research and establishing uniform data collection practices should be integral to planning, extending beyond health to involve multiple sectors.This consensus meeting aims to unite these diverse and valuable efforts onto a single, common platform for universal benefit.
A valuable exchange of ideas took place during the discussions that followed the presentations. Seasoned global ICF scholars engaged in a brainstorming session with local experts in the field of health management, medical education and research with participation from both the public and private sectors. Pioneers in the ICF who are actively involved in advocacy and training emphasised the need for a sustainable model of collaboration.
Within the context of these discussions, the advantages of implementing the ICF as a health indicator were highlighted. These include a broader and more detailed assessment of population health by considering not only medical conditions and illnesses, but also functioning that reflects lived experiences. This approach leads to a more comprehensive understanding of the health and social needs and barriers faced by people with disabilities.
Through the use of ICF, researchers can study the relationship between health conditions, the environment and participation, providing valuable insights into how to improve quality of life and promote human development. The common language provided by ICF facilitates the comparison of data across different countries and regions, thereby promoting international cooperation in health.
Ongoing efforts in the form of conferences, research, education in ICF use and regular meeting involving public sector and private sector institutions is being undertaken North of Delhi to build up ICF through active involvement of GRIID, AIMS and PGI and private Universities of Mullana, Rayat & Bahra and NGOS. Collaboration with Global partners support is being sought to have everyone on the same page.
Models of diverse ICF application across the globe in the Americas, Australia, South Africa, Europe and Southeast Asia need to be replicated in underrepresented areas. [3]
The ICF promotes a bio-psycho-social-spiritual and person-centred approach to health. Recently, the European Union (EU) has adopted the European Health Data space directive. [4] This directive distinguishes between two key uses of health data; primary use in health services and secondary use for statistical, research, policy-making, and other purposes. It is important to note that secondary use of data is not possible without its primary use in health services.
It is worth highlighting that the ICF also supports the monitoring of both the United Nations Convention on the Rights of persons with Disabilities (UNCRPD) and progress towards the Sustainable Development Goals (SDGs) of the 2030 Agenda. In particular, it is relevant to SDG 3, which aims to ensure healthy lives and promote well-being for all, at all ages. With ageing populations and the rise of chronic diseases, the demand for rehabilitation services is growing. The ICF plays a crucial role, providing a framework to assess rehabilitation needs, plan services and monitor outcomes.
Rehabilitation 2030 [5] aims to raise awareness of the need for rehabilitation, promote the inclusion of rehabilitation in health systems and ensure that everyone has access to the rehabilitation services they need. Rehabilitation 2030 requires a system-wide ICF implementation to generate robust data that describe human functioning as the third indicator of health, complementing morbidity and mortality. [6]
This aligns with the historic resolution on strengthening rehabilitation in health systems, passed by the World Health Assembly in 2023. The resolution emphasises enhancing health information systems by capturing rehabilitation-relevant information, including system-level rehabilitation data and functioning-related information.
The ICF is recommended to ensure a comprehensive understanding of functioning and disability while emphasising data disaggregation by sex, age, disability, and other context-relevant factors. Compliance with data protection legislation is also crucial to safeguard privacy and enable robust monitoring of rehabilitation outcomes and coverage. [7]
“The ICF describes functioning as an important supplement to the diagnosis (health condition).The impact of the context is described through environmental factors and personal factors.The integration of various perspectives of functioning follows the biopsychosocial approach.Therefore we can expand the view to include a health information system that also comprises functioning.” [8]
Signatories to consensus statement (by 9 September 2024)
- Alakananda Banerjee
- Anjan Bhattacharya
- Bhavneet Bharti
- Catherine Sykes
- Dharamvir
- Eduardo Santana Cordeiro
- Fernanda Rocha
- Gurpreet Singh Binepal
- Jaana Paltamaa
- Jai Kishan Karahyla
- Liesbeth Siderius
- Lokesh Saini
- Neena Mehta
- Olaf Kraus De Camargo
- Priti Arun
- Sahan Perera
- Stefanus Snyman
- Thomas Maribo
Research participants
- Akash-Department of Pulmonary medicine Mullana
- Tushar- Department of Pulmonary medicine Mullana
- Spandan Biswas Department of Pulmonary medicine Mullana
- Aditi- Department of Pulmonary medicine AIMS
References
- https://www.ontario.ca/page/smartstart-hubs-guidelines
- Bhattacharya A. Relevance of the Universal Practice Model for Early Detection and Early Intervention in Children with Special Needs – The Kolkata Development Model. EC Pedtitr (2014) ECPE-19-RA-241
- Siderius, L., Neubauer, D., Bhattacharya, A., Altorjai, P., Margvelashvili, L., Lamabadusuriya, S., Wierzba, J., Mazur, A., Albrecht, P., and Tasic, V. (2021). Universal Health Coverage “Leave No Child Behind”. Pediatria Polska – Polish Journal of Paediatrics, 96(1), pp.1-6. https://doi.org/10.5114/polp.2021.104822
- https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space_en
- World Health Organization. (2030). Rehabilitation 2030: meeting report (ISBN 978–92–4-008739–2). World Health Organization. https://www.who.int/initiatives/rehabilitation-2030
- Bickenbach, J., Rubinelli, S., Baffone, C., & Stucki, G. (2023). The human functioning revolution: implications for health systems and sciences. Frontiers in Science, 1. https://doi.org/10.3389/fsci.2023.1118512
- Executive Board WHO. Strengthening rehabilitation in health systems. Draft decision proposed by Argentina, Australia, Brazil, China, Colombia, Croatia, Ecuador, Eswatini, Hungary, Ireland, Israel, Japan, Kenya, Morocco, Paraguay, Peru, Romania, Rwanda and Slovakia. WHO (2023). p. 1–5. Available from: Available at: https://apps.who.int/gb/ebwha/pdf_files/EB152/B152_CONF1-en.pdfhttps://docs.google.com/document/d/1ynWWh-xnL6Wl2KKF9uRMBcgmrxjdNDhBCb2H2sun-sY
- https://www.who.int/standards/classifications
Events
- Natcon- April 2022, Mullana Maharishi Markandeshwar University,Haryana,India
- 8th ICF International Symposium 30th Nov-2nd Dec 2022 at GRIID Chandigarh & AIMS Mohali, Punjab India
- ICF progress review meeting Feb 24th, 2024 AIMS Mohali,Punjab India