ISSN 2434-5024
第6巻1号
VOL.6 NO.1

国際リハビリテーション学
Journal of International Rehabilitation

巻頭言「国際リハビリテーション学」のアカデミックスコープ
山口佳小里

特別寄稿
Rehabilitation 2030: The vision and the implementation
Jody-Anne Mills
国立障害者リハビリテーションセンターにおける国際協力
芳賀信彦
国立保健医療科学院の国際協力：政策立案者・担当者を対象とした人材育成

曽根智史

研究論文
【資料】ミャンマーにおける医学的リハビリテーション提供の現状
Phyo Thant Maw, 山口佳小里, 大塚進, 佐々木由理, 平野恭平, 河野眞

第 7 回学術大会（東京）抄録集
知る・気づく・考える リハビリテーション 2030
～中・低所得国におけるリハビリテーション普及への貢献～
大会長：山口佳小里

告知：第 8 回学術大会（宮城）大会テーマ「国際リハビリテーションにおける地域共創～海外と国内の経験を共有しよう～」
大会長：髙橋恵里
国際リハビリテーション研究会
2024 年 2 月

巻頭言「国際リハビリテーション学」のアカデミックスコープ
国立保健医療科学院

医療・福祉サービス研究部
山口佳小里

本誌「国際リハビリテーション学」は、今回で第 6 巻、第 4 巻からは投稿論文の掲載も始まり、海外での調査や実践、国内での国際協力教育等に関する報告が掲載されています。発行元である国際リハビリテーション研究会は、国際リハビ
リテーション学の学問としての確立を目的に定めており、本誌はこのための重要なツールの１つだろうと思います。
さて、国際リハビリテーション研究会は、「国際性という文脈を帯びた場におけるリハビリテーション」の実践と探究を目的とした団体です。そして、リハビ
リテーション、介護、福祉、障害と開発における国際協力や国内の海外ルーツを持つ方を対象とした活動などをスコープに含み、いわゆるリハ専門職だけでな
く、開発学・人類学・社会学・地域研究を専門とする方や、障害をお持ちの方の研究会への関与が期待されています（研究会 web ページより）。「国際性という文脈」と「広義のリハビリテーション」を核とする研究会であり、このような研究会の特徴に対応するものが「国際リハビリテーション学」の範疇と言えるのかもしれません。
今年度の第 7 回国際リハビリテーション研究会学術大会は、WHO のイニシアテ
ィブである「Rehabilitation 2030」をテーマに開催しました。WHO リハビリテーション部門の Mills 氏からご講義いただき、Rehabilitation 2030 がどのようなものであるか理解を深めるとともに、これが主に保健・医療にフォーカスした
リハビリテーション普及の取り組みであることを確認しました。本誌に、第 7 回大会の抄録集ならびに特別寄稿を掲載しておりますので、詳細については是非
そちらをご覧ください。
グローバルな動向にも広くアンテナを張り、キャッチアップしながら研究会の活動が展開され、また、学術誌に関連領域の知見が蓄積され続けることで、国際リハビリテーション学が多彩な色をもった学問として形作られることを期待しています。

国際リハビリテーション学（第 6 巻 1 号）
Journal of International Rehabilitation（Vol.6 No.1）

目 次
巻頭言

………………………………………………………………………………………山口佳小里

特別寄稿
Rehabilitation 2030: The vision and the implementation
Jody-Anne Mills……… 1
国立障害者リハビリテーションセンターにおける国際協力
International Cooperation from the Standpoint of the National Rehabilitation Center for Persons
with Disabilities

芳賀信彦………

13

曽根智史………

19

国立保健医療科学院の国際協力：政策立案者・担当者を対象とした人材育成
International cooperation of National Institute of Public Health

研究論文【資料】ミャンマーにおける医学的リハビリテーション提供の現状

Current Situation of Medical Rehabilitation Services Provision in Myanmar
Phyo Thant Maw, 山口佳小里, 大塚進, 佐々木由理, 平野恭平, 河野眞………
第 7 回学術大会抄録………………………………………………………………………………

27
37【メインシンポジウム 1】Rehabilitation 2030 と国の機関による国際協力【メインシンポジウム 2】社会的課題に対応した国際協力実践【特別セッション 1】PT 協会、OT 協会、ST 協会の国際事業の紹介 ~国際活動の入り口として~【特別セッション 2】国外経験の国内活動への活かし方【ランチタイムセッション】「A/T Bank」【一般演題】
第 7 回学術大会概要および、運営組織概要・協力者一覧…………………………………

60

第 8 回学術大会ポスター………………………………………………………………………

61

投稿規定 …………………………………………………………………………………………

61

投稿用紙 …………………………………………………………………………………………

67………………………………………………………………………

68

編集後記・編集委員一覧

特別寄稿

2023 年 11 月に開催された国際リハビリテーション研究会第 7 回学術大会のオー
プニングシンポジウムの講義について、講義内容を元にした原稿を寄稿いただきました。どうぞご覧ください。

࠙≉ูᐤ✏ࠚ
Rehabilitation 2030: The vision and the implementation
Jody-Anne Mills
WHO Western Pacific Regional Office


Title

nationallevel,

andthenfinally

Good morning, ladies and gentlemen.

introducing you to some of the tools andIt's a privilege to be able to speak to you

approaches that we use for implementing

today about rehabilitation 2030 at the 7th

rehabilitation 2030 in the region.

Conference of the Japanese Society ofInternational

Rehabilitation.

I'ma

The Rehabilitation 2030 journey so far:technical officer at the WHO Western
Pacific

Regional

and

I'm

Rehabilitation 2030 was launched inagendasof2017 and this was the first high-level

rehabilitation and assistive technology as

event dedicated to rehabilitation that thewell as disability and long-term care. I'm

World Health Organization had held. It

fairly new to the region. I only started inwasthe Western Pacific earlier this year. I've

Firstly, it brought together a reallybeen with WHO for approaching 9 years

diverse range of stakeholders, includingnow

multiple

responsible

andOfficeGlobal

for

this

the

has

given

me

the

significant

forseveraldifferent

reasons.

rehabilitation

opportunity to witness and actuallydisciplines together as one rehabilitation

participateofcommunity and this gave us a criticalrehabilitation 2030. From my perspective,

mass or a collective power that we've

rehabilitation 2030 is several things. It's

never had before. Secondly, it signaled aa vision. It's a call for action and it's a set

political will that had previously beenof tools and resources for strengthening

dormant. Rehabilitation 2030 provided arehabilitation in health systems, andplatform for leaders to vocalize thethat's why I've titled this presentation,

importance of rehabilitation to openly

the vision and the implementation. But

acknowledge the level of unmet needs andperhaps the best way to convey both of

to commit to taking action. And finally,

these things is through telling you theandstory of rehabilitation 2030, looking at its

rehabilitation 2030 shifted rehabilitation

impact at the global, regionalfrom being a disability issue and a service

in

the

establishment

and1

perhaps

most

critically,only for persons with disabilities to be anof universal health coverage and as aissue of universal health coverage and theservice relevant to people young and old,

service relevant to the whole population.

with long-term or temporary impairment,

And why was there such a notable shift?

and with any type of health condition,

Well, for one, it gave ministries of healthrehabilitation could become a seriousaintegrateelement of discussions around how werehabilitation into the health system,

manage the crisis of noncommunicable

whereas previously in many countries,

diseases, how we address the challenges

this responsibility had been diffusedof rapidly aging populations and how weacross a number of different ministries, or

respond to those affected by emergencies.

specific

been

mandatecompletelytoabsent,creatingaCall for action

political environment that wasn't really
Another

The main output of the rehab 2030

reason the shift needed to happen is

meeting in 2017 was a call for action1) andbecause it elevated the relevance of

this identified 10 priority areas thatrehabilitation to population health. As aneeded to be addressed if we were reallyservice only for persons with disabilities,

going to advance the agenda. I won't go

rehabilitation could, wrongly as it was, bethrough each of these points in detail, but

dismissed as a service for only a small

it is available online if you'd like to see it.

minority of the population and as such,

But broadly, these actions speak to what

was poorly prioritized, especially in the

we refer to as the building blocks of theface of competing demands for budget andhealth system. This is leadership andfor policy space. But as a core component

governance,

conducivetoadvancement.

2

information

systems,and2030 meeting. This is an international

service delivery. And they also makeadvocacy body for rehabilitation and it

explicit reference to emergencies, which

promoteshas only grown in relevance since this call

workforce, primary healthcare, research,

for action was launched. Participants atand emergencies, and it's filling the need

the meeting made statements of support

forfor this call for action, and they've sincecommunication

convened 2 more Rehabilitation 2030

organizations from around the world canmeetings, one in 2019 and the otherreally participate in.

workforce,

assistive

technologyakey

messagesreallystrong,relatedtoharmonized

platformthatearlier this year in July, and they
continue to push for further action across

The Rehabilitation 2030 journey so far:

all of these different areas.

Regional
Since Rehabilitation 2030 was launchedwithin our Region, 5 low and middle

2017-2020-2023
Since that launch, we've seen several

income countries have launched national

milestones achieved, but there are two

rehabilitation strategic plans, many forrecent ones that I wanted to flag. In May

the first time. These are quite significant

this year, the World Health Assembly

because they bring important visibility toendorsed a resolution on strengthening

rehabilitation within ministries of health,rehabilitation in health systems, and thisand when they're supported by strong

was an official request from Member

implementation mechanisms, they can beStates to WHO and civil society to address

very powerful vehicles for advancement.

unmet needs for rehabilitation through a

In 2019, the Western Pacific Regional

system-strengthening

Framework

approach.

It's

for

Rehabilitation

wasreally important to us WHO that we havepublished, and this was another first forthese resolutions because they give us ourour region. It defines key pillars of action

mandate or our green light to provide

and it defines a pathway or a road map

technical support to countries and tothat governments, civil society and WHO

develop different technical products or

can take to really expand access to

global goods on this topic. And of course,

rehabilitation

the resolution was another very powerful

COVID-19 has been a bit disruptive to thedemonstration of the growing politicalrealization of this framework in recent

support for rehabilitation that we haveyears, it still continues to be our primary

been seeing. The other major milestone I

reference document for how we work withwanted to share was the launch of thecountries. I'm also excited to share that

World Rehabilitation Alliance, which

we have a new area of work emerging infollowed the third Global Rehabilitation

the Pacific where we have been funded by

3

in

the

region.

Whilethe New Zealand Government to explore

activities. These two things: technicala regional supply chain and resource

capacity in the Ministry of Health and an

facility

allocated budget, are to very criticalforeffective

more

cost-efficient

procurement

of

and

enablers

assistivefor

actually

movingrehabilitation forward in the country.

technology. This is just kicking off, but it'sa nice demonstration of a multi-country
cooperative effort to address a challenge

Rehabilitation needs in the Western

at a regional level.

Pacific
I'd like to just briefly turn our focus to

The Rehabilitation 2030 journey so far:what the rehabilitation needs in theCountries

Western Pacific region are. The figures

I've had to select just a few countries to

I'm presenting in this slide and from thedemonstrate some of the progress we'rerehabilitation needs estimator which uses

seeing at a national level. Cambodia is inglobal burden of disease data to give us an

the process of an important shift; The

indication of how many people might

governance of rehabilitation is shifting

benefitfrom the Ministry of Social Affairs to thevarious different health conditions that

Ministry of Health. And this is a reallycontribute towards these needs. They

good

the

show that one in three people could

integration of rehabilitation into healthbenefit from rehabilitation in the region,

services and it also signals the shift inwhich is a huge proportion of thethinkingapopulation and equates to about 610

disability issue to being an issue of

million people. Interestingly, a lot of those

universal health coverage. Mongolia has

people are affected by lower back pain,

created(about 130,000,000) and lower back pain

opportunity

of

a

to

improverehabilitationstrongpolicy

being

space

for

from

rehabilitation

and

the

rehabilitation, and while they're stillalong

facing many challenges related to things

conditions constitute a large portion ofsuch as workforce, information systems

rehabilitation needs. We also see a lot ofand service delivery, the legislative stage

rehabilitationis set with rehabilitation interventions

sensory impairment (vision and hearing

including assistive technology included in

impairments) as well as neurologicalessential packages of care right down todisorders and noncommunicable diseases.

the primary care level. In the Solomon

But what I really wanted to flag throughIslands, rehabilitation has a dedicatedthis graph is not only the diversity of

focal point in the Ministry of Health andrehabilitation needs, but also the strong

they've also allocated a specific budget forcorrelation we see with aging. This is a

the implementation of their rehabilitation

really strong correlation, and it has very

4

with

other

needs

musculoskeletal

stemmingfromsignificant implications for the ministries

canthat are having to respond to rapidly

conceptualization of what rehabilitation

aging populations, such as Japan. We'reis, and all that it can encompass.

reflectquite

anarrowgoing to be seeing a big swell in
rehabilitation demand in the coming

Addressing

years and decades, yet many countries inrehabilitation

unmet

needs

for

our region are still struggling to address

The scale and scope of unmet needs ineven basic rehabilitation needs with their

our region are significant and we have aexisting demographic profiles, which isreally long way to go. But what gives mequite a concern. I also wanted to flag thatsome hope is that we're better positioned

the distribution of needs that we see into address these unmet needs than we

this graph doesn't correlate with theever have been before. We have a deeper

composition of services or with service

understanding of the challenges that we

utilization in countries. Yes, we typicallyface. We have a stronger body ofsee a concentration of rehabilitation

stakeholders that are united under aservices addressing mobility or physicalcommon vision or a shared vision for

impairments, but many needs associatedrehabilitation, and we now have thiswith vision and hearing are going unmet,

growing suite of technical tools andas are those associated with neurologicalguidance to help us conduct health system

conditions, cancers and mental disorders.

strengthening interventions in countries.

The factors is that drive development of

WHO just recently launched many ofsome services more than others actuallythese during the Rehab 2030 meeting thatrarelyepidemiologicalsome of you may have attended in July

profiles in countries, but tend to alignthis year. I'm excited to introduce you tomore with things like funding flows andsome of these. However, I also want tocorrespondto5

emphasize that it takes more than justfrom central to provincial down to thetechnical products and tools to be effective

local

in

particularconcentration of investment or activity at

approach, and it relies on some quite

the central level with inadequate efforts

specific preconditions.

to ensure that these are actually filteringcountries;

it

takes

a

level.

Too

often

we

see

a

all the way down through the different
levels of government, particularly into thePreconditions

community level where we know a lot of

For health systems strengthening to bevery important decisions get made.

effective, there needs to be a certain levelof political awareness and willingness,
which is often underpinned by strong

Laying the foundation for a context-

advocacy. It's important that there's a

specific approachvery

The approach to systems strengthening

challenging to advance the agenda in theactually mirrors the rehabilitation cycle

context of political turmoil or deep

ineconomic crisis, or in the context ofproviders will probably recognize theemergencies. And of course, we can't wait

steps in this cycle. It begins withfor perfect conditions, these never exist,

assessment - really ensuring that we

but we do need to be reflective of whether

understandthe sociopolitical environment is actually

undertaking a process of goal setting or

going to enable meaningful progress.

prioritization of objectives. This is really

level

of

stability.

It

can

be

many

ways.

Any

the

rehabilitation

situation

beforeResources are another precondition forwhere contextualization comes throughsystems strengthening. There needs to be

most strongly, because what's importantaor meaningful in one country or context

commitmentofinvestment

from
to

may not be in another. After action or

progressively expand this moving forward.

more importantly, through the course of

We also need to have human resources or

action, we want to be measuring andtechnical capacity to move the work

evaluating the level of change and theforward and in some contexts… in manyeffectivenessin fact, this is still very nescient, and wereporting on these regularly. Just like theoften have to supplement or bolster thatrehabilitation cycle looks much the same

capacity with some external support.

whether you are a PRM Doctor, agovernments

andawillingnessofphysiotherapist,

And finally, continuity is aligned withinterventions

or

an

and

occupational

our point on stability and many of ourtherapist, this approach to health systems

initiatives will have to penetrate throughstrengthening will look very much the

many

and

same regardless of whether we're wanting

through different levels of the government

to address financing, information systems,

different

political

cycles6

workforce or service delivery. It's reallywetypicallyuse

incountries

andjust a mechanism to ensure that we're

introduce you to some of the WHO

moving forward in a way that is really

products that can support this work.

meaningful to the country.
HealthHealthsystems

strengthening

systems

interventions:interventions

strengthening

GOVERNANCE

AND

governanceandLEADERSHIP

We refer to health system building

Strengthening

blocks and this is quite a useful concept,

leadership for rehabilitation obviously

but the reality is that these building

starts with building political will andblocks are actually not distinct entities.

expanding

They are actually highly interdependent

rehabilitationisand related to each other. While we might

encompasses.

But

focus our efforts on one of them, and wegovernments to lead, they need to havevery often do, we have to be conscious andadequate technical capacity to advanceaware of their relationships to each otherthe rehabilitation objectives. And one of

and what's going on across those different

the ways that we can establish this isbuilding blocks. I could spend a week andthrough building ownership of a national

speaking

systems

strategic plan and having the government

strengthening for any of these areas, butreally lead in its development andconsidering time I'm just going to give you

monitoring, using the Rehabilitation ina few examples of the different healthhealth systems guide for action1). This issystems strengthening interventions thatboth a guide and a methodology for

about

health7

theawareness
and

all

of

what

that

ultimately,

it
for

puts

noncommunicable diseases, and 3) wegovernments at the centre, beginningwant to, in some situations, leveragewith that situation assessment and thendifferent types of insurance to expand

using the findings of this to inform thefinancial protection for rehabilitation.

development of a national strategic plan,This could be using things like accidental

establishingandinjury insurance or return to work

evaluation framework and then building

insurance to increase the pool of revenue

mechanisms

thethat we have to invest in rehabilitation

implementation of the recommendations.

and ensure more people can access it.

strategicplanning

that

and

reallymonitoringtosupportRehabilitation in health financing2) was a
Healthsystems

product

strengthening

it

comes

to

was

launchedattheRehabilitation 2030 meeting earlier thisinterventions: FINANCING
When

that

year. It's a product that brings financing

strengthening

rehabilitation in health financing, theexperts

focus will vary depending on the context.

together onto the same page about how to

But in general, we're trying to achieve 3

move forward with rehab and financing. It

things: 1) We're trying to increase public

addresses revenue collection, pooling andhealthrehabilitation-purchasing and has several case studies

expanding the proportion of public healthfrom different countries, so it's a usefulbudgetresource

revenuethat'sfor

actually

allocated

to

and

for

rehabilitationbuilding

experts

understanding,rehabilitation activities; 2) we want toframing policy dialogues and learning

includefrom different countries experiences.

rehabilitation

andessential

packages of care, such as packages for8

Healthstrengthening

interpreted and used to guide decision

INFORMATION

making. There's also now a rehab module

systems

interventions:that can be integrated in DHIS2 software,

SYSTEMSYou may have heard that saying thatwhich several countries are using forwhat isn't measured doesn't matter, andfacility reporting in our region. And finally,

it's true that one of the biggest barriers wetoface in both advocacy and our technicalrehabilitation included in data collection

health systems strengthening work is a

on patient satisfaction as well as inlack of robust data for rehabilitation. We

surveysneedcommunicate

information on needs, coverage andrehabilitation needs and unmet needs toquality of care. And of course, we

guide decision-making and service design

desperately need more high quality policy

for quality improvement and for forwardandplanning. Unfortunately, rehabilitation isrehabilitation.

this

data

to

emphasize,

andhealthwewantcensuses

systems

to

that

see

collect

researchonrarely included in health information
systems collection and reporting, andHealthsystems

strengthening

when it is, we notice that it occupies a very,

interventions: WORKFORCE

very small amount of real estate. Of

Workforce challenges are holding many

course, health information comes from acountries back from addressing unmet

very wide range of sources and is collected

needs, but often we see these challenges

at different intervals so strengthening

oversimplified or misconstrued as supply

rehabilitation

information

issues. And, of course, inadequate supply

systems actually requires specific efforts

is a challenge in pretty much every

across a range of different sources.

country in our region. But we also see a

Notably,wantlack of jobs for rehabilitation workers inrehabilitation to be included in routine

hospitals at all levels of the health system.

health information systems, and we now

Wehave some nice guidance and tools torecognition of rehabilitation professionals

inthough,healthwesupport this. Anotherreallyone3)

bythat wassee

inadequate

ministries

ofregulation
health.

We

and
see

launched this year, includes a list of

professions without adequate avenues fordifferent indicators that can be considered

progression or specialization and feelingby countries for inclusion in their routine

like they aren't prioritized or valued

facility reporting. What's really nice about

relative to other health occupations. And

this resource is that in addition to this list

all of these have to be addressed if weof indicators, there's a lot of guidance

want to recruit, retain and support aaround how the data that comes fromstrong rehabilitation workforce. The otherthosearea that's important when addressing

indicators

canactually

be9

workforce needs and countries is what werehabilitation

call optimization, and this is basically thefunctioning, and when they're not readilyorganization

theavailable, they can have a very profoundallocation of tasks that enable a healthimpact on people's lives. But expanding

system to make the best use of theaccess to assistive technology is notworkforce that it currently has. So, as well

simply a matter of acquiring more

as efforts to expand and strengthen the

products. It actually requires or involves

workforce, we also want to be helping

building efficient systems of procurement

countries maximize how they can addressandimmediate needs by optimizing theirestablishing regulatory standards andexisting workforce. WHO now have two

specifications for products, and of course,

different technical resources to assist

equipping the workforce to safely provide

countries in workforce development. The

those products to people. WHO is often

first is the Rehabilitation Competency

working with countries to establish

Framework4),

or RCF, and this is apriority lists of products which are thereference document or a starting point tostarting point for having them integrated

help countries, services or universities, for

into

example, develop their own context-

procurements

specificofdisciplines

competency

andframeworks,

and

help

distribution,tooptimize

negotiating

national

costs,

mechanisms

in

the

essential medicines

same

lists6).

of

way

as

We also help

standards or curriculum. And the second

countries work and established theirtool is yet another one that we launchedassistive technology needs through things

earlier this year called the Guide forlike household surveys, and to train their

Rehabilitation Workforce

Evaluation5).

workforce to deliver assistive products.

This uses labor market analysis andcompetency analysis to help countries

Healthtake a deep dive into the situation of theirinterventions: SERVICE DELIVERY

rehabilitation workforce and identify

Insystems

many

ways,

strengthening
improved

servicemore detailed actions that they can take.

delivery occurs through the cumulation of

So far, this has been used in Poland,

efforts to strengthen rehabilitation acrossRwanda, Nepal, Pakistan, and Tajikistan,

all of the building blocks where I alreadyand Laos is planning to implement this intalked about. However, usually explicit

2024.

effortsareneededtoensurethat

rehabilitation is integrated into all levels
Healthsystems

interventions:strengtheningof care and importantly, that it's available

ASSISTIVE

to people with a wide range of different
needs; there's an evident gap in many

TECHNOLOGY

countries

Assistive products are routinely used in

10

for

rehabilitationthataddresses communication, cognition andrehabilitation is, what it encompasses,

self-care needs. And historically, many ofand all of the different products andthe efforts to develop rehabilitation

people that are involved in providing

services have focused on physical or

rehabilitation services.

mobility-related rehabilitation, which has
left gaps for large portions of the

Healthsystems

strengthening

population.

interventions: EMERGENCIES
Emergencies is a hugely relevant topic
at this time, and I don't have time to go

Disease area-specific modules
WHO launched what I think will be a

into it in depth, but I can say that ourvery widely utilized resource7). This is aefforts so far have really focused on

packagedrawingofinterventionsforattention

to thefact

thatrehabilitation, or the PIR, which is a list

rehabilitation needs to be included inof essential evidence-based interventions

emergency preparedness and response

for rehabilitation in the context of 20

from the outset and not, as we sadly often

different health conditions. One of thewitness, something that can be left as an

primary objectives of this tool is to help

afterthought or offloaded onto others

countries integrate rehabilitation into

without some serious implications for how

essential packages of care. But it actually

patient outcomes. WHO has published a

has multiple different applications, many

couple of different technical resources toof which we're still diving into andsupport emergency preparedness andexploring. But one of the nice things about

response, such as the minimum technicalthis product is that it demonstrates whatstandards

11

andrecommendationsforemergency

forlook at all of these. The dedicated pages torehabilitation8) and more. More recently,

each product and you can digest thestrengthening

information a little bit more at your own

rehabilitation and health emergency

pace, but of course please do feel free toresponse9),

reach out to me if you've got any questions

was published, and work is underway toabout these areas of work or specificdevelop a practical toolkit to support the

products, or if you'd like to discuss how

recommendations within that brief.

we're working in countries.

themedicalguidance

on

teams

preparedness, readiness andI wouldn't blame you if at this point
Thank you

you're feeling very overwhelmed. I've

I'd like to thank you again for giving me

spoken about quite a large number ofdifferent

this opportunity and I wish you all thebuilding blocks and emergencies. I'dbest for the remainder of the conference.

encourage you to explore the WHO

Thank you.

different

products

acrossrehabilitation web page to take a closer
Reference: URL of publications
1)

WHO. Health systems-strengthening interventions GOVERNANCE AND LEADERSHIP (2019).
https://www.who.int/publications/i/item/9789241515986

2)

WHO. Rehabilitation in health financing (2024). https://www.who.int/activities/integrating-3)WHO. Guidance on the analysis and use of routine health information systems: Rehabilitation

rehabilitation-into-health-systems/financing
module (2022). https://www.who.int/publications/i/item/9789240050242
4)WHO. Rehabilitation Competency Framework (2021).
https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-andrehabilitation/rehabilitation-competency-framework

5)WHO. Guide for Rehabilitation Workforce Evaluation (2023).
https://www.who.int/publications/i/item/9789240071674

6)WHO. Priority Assistive Products List (2016). https://www.who.int/publications/i/item/priorityassistive-products-list

7)

WHO. Package of interventions for rehabilitation (2023)
https://www.who.int/activities/integrating-rehabilitation-into-health-systems/servicedelivery/package-of-interventions-for-rehabilitation

8)

WHO. Minimum technical standards and recommendations for rehabilitation (2016).
https://www.who.int/publications/i/item/emergency-medical-teams

9)WHO. Strengthening rehabilitation in health emergency preparedness, readiness, response andresilience(2023). https://www.who.int/publications/i/item/9789240073432

ͤᮏཎ✏ࡣࠊࡈㅮ₇ෆᐜࢆ࢔ࣉࣜࢣ࣮ࢩࣙࣥࢆ౑⏝ࡋ࡚᭩ࡁ㉳ࡇࡋࡓࡶࡢ࡟࡞ࡾࡲࡍࠋࡑࡢ
ࡓࡵࠊࢫࣆ࣮ࢳࢆ㐺ษ࡟཯࡛ᫎࡁ࡚࠸࡞࠸⟠ᡤࡀ࠶ࡿྍ⬟ᛶࡀ࠶ࡾࡲࡍⅬࠊࡈ஢ᢎࡃࡔࡉ࠸ࠋ

12࠙≉ูᐤ✏ࠚᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮࡟࠾ࡅࡿᅜ㝿༠ຊ
International Cooperation from the Standpoint of the National Rehabilitation
Center for Persons with Disabilities
ⰾ㈡ಙᙪ Nobuhiko Hagaᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮
National Rehabilitation Center for Persons with Disabilitiesせ᪨ᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮㸦ᅜࣜࣁ㸧ࡣ 1979 ᖺࡢタ❧ᚋ᪩ᮇࡼࡾࠊከᵝ࡞ᅜ㝿༠ຊάືࢆ⾜ࡗ࡚ࡁࡓࠋJICA ࡢࣉࣟࢪ࢙ࢡࢺ࡜ࡋ࡚ࡣ 2015 ᖺࡲ࡛୰ᅜࠊ༡⡿ࠊᮾ༡࢔ࢪ࢔➼ࡢ㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢྥୖ࡟㈉⊩ࡋ࡚ࡁࡓࠋ2011 ᖺ࡟ࡣ୰ᅜࠊ㡑ᅜࡢᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮࡜ࠊ㞀ᐖࡀ࠶ࡿேࠎࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᢏ⾡ྥୖࢆ┠ⓗ࡜ࡋ࡚༠ᐃࢆ⥾⤖ࡋࡓࠋࡲࡓᾏእࡼࡾࡢどᐹ࣭ぢᏛࡸ◊ಟဨࡶᩘከࡃཷࡅධࢀ࡚ࡁࡓࠋ1995ᖺ࡟ᅜࣜࣁࡣࠊWHO ࡼࡾᅜෆ࡛၏୍ࡢࠕ㞀ᐖࡢண㜵࡜ࣜࣁ࡟㛵ࡍࡿ༠ຊࢭࣥࢱ࣮ࠖࡢㄆᐃ
ࢆཷࡅࠊࠕ༠ຊ஦㡯ࠖ࡜ࠕ⾜ືィ⏬ࠖ࡟ᚑ࠸ࠊ㛵㐃ࡍࡿሗ࿌᭩ࡢసᡂࠊᅜ㝿ࢭ࣑ࢼ࣮ࡢ㛤ദࠊ࣐ࢽࣗ࢔ࣝࡢసᡂ࡜බ㛤ࠊ࡞࡝ࢆ⾜ࡗ࡚ࡁࡓࠋ➹⪅ࡢ⚾ぢ࡛ࡣࠊ௒ᚋᅜࣜࣁࡢᅜ㝿㈉⊩ࡣࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢࣜࢯ࣮ࢫ࡟ᜨࡲࢀ࡞࠸ᅜࠎ࡟ࠕ᪥ᮏࡢᙉࡳࠖࢆᥦ౪ࡍࡿࡇ࡜ࢆ㔜どࡍ࡭ࡁ࡜⪃࠼࡚࠸ࡿࠋ
Abstract:
National Rehabilitation Center for Persons with Disabilities (NRCD) has carried out
various activities on international cooperation since its establishment in 1979. NRCD
has contributed to JICA Projects to advance rehabilitation for persons with disabilities
in China, South America, Southeast Asia, etc. until 2015. In 2011, NRCD concluded
agreement of collaboration with the national rehabilitation centers of China and Korea
to improve rehabilitation for persons with disabilities. Also, NRCS has accepted many
visitors and trainees from overseas. In1995, NRCD was designated as WHO
Collaborating Centre for Disability Prevention and Rehabilitation, and has conductedmaking reporting documents, holding international seminars, preparing and publishing
rehabilitation manuals, etc. following Terms of Reference and Work Plan. In my opinion,international cooperation of NRCD should focus on providing nations lacking sufficientrehabilitation resources with Japan’s strengths in future.
࣮࣮࢟࣡ࢻ㸸ᅜ㝿༠ຊࠊJICA ࣉࣟࢪ࢙ࢡࢺࠊ᪥୰㡑 3 ࠿ᅜ㐃ᦠ஦ᴗࠊWHO ༠ຊࢭࣥࢱ࣮
Key words: international cooperation, JICA project, collaboration between Japan, China
and Korea, WHO Collaborating Centre

13ල〇సᢏ⾡◊ಟࡣ 1981 ᖺ࠿ࡽ 2010 ᖺࡢ㛗ࡣࡌࡵ࡟➹⪅ࡣ 1994 ᖺ࠿ࡽ㟼ᒸ┴❧ࡇ࡝ࡶ⑓㝔ᮇ㛫࡟Ώࡾ㞟ᅋ◊ಟ࡜ࡋ࡚⾜ࢃࢀࠊ࢔ࢪ࢔

࡟ᩚᙧእ⛉㈐௵⪅࡜ࡋ࡚ࠊࡑࡢᚋ 2006 ᖺ࠿ኴᖹὒᆅᇦࢆ୰ᚰ࡟ 39 ࢝ᅜ࠿ࡽ 128 ேࡢࡽᮾி኱Ꮫ࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㛛ࡢ㈐⩏⫥⿦ල〇సᢏ⾡⪅ࡀཧຍࡋࡓࠋᅜࣜࣁࡣ

௵⪅࡜ࡋ࡚໅ົࡋࡓࠋࡇࡢ㛫ࠊᾏእࡢᑠඣᩚ

୰ᅜ࡜ࡢ㛵ಀᛶࡶᙉࡃࠊ1985 ᖺ࠿ࡽ୰ᅜࣜ

ᙧእ⛉་ࡸࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㛵ಀ⪅ࡢゼࣁࣅࣜࢸ࣮ࢩࣙࣥ◊✲ࢭࣥࢱ࣮ࡢタ❧࡟㛵ၥࢆཷࡅࡿ࡞࡝ࠊᅜ㝿ⓗ࡞஺ὶࢆ⾜ࡗ࡚ࡁࢃࡗ࡚ࡁࡓࠋྠࢭࣥࢱ࣮ࡣ⌧ᅾ࠿࡞ࡾ኱ࡁ

ࡓࠋ≉࡟ 2008 ᖺ࡟ᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮࡞᪋タ࡟࡞ࡗ࡚࠸ࡿࠋ2008 ᖺ࠿ࡽࡣ୰ᅜ୰

ࢩࣙࣥࢭࣥࢱ࣮㸦௨ୗࠊᅜࣜࣁ㸧ࡢ⤂௓ࢆཷす㒊ᆅᇦࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥேᮦ⫱ᡂࣉ

ࡅ࡚ࠊJICA㸦ᅜ㝿༠ຊᶵᵓ㸧࡟ࡼࡿ࢘ࢬ࣋

ࣟࢪ࢙ࢡࢺࡶ⾜ࡗࡓࠋ༡⡿ࡢࣉࣟࢪ࢙ࢡࢺ

࢟ࢫࢱࣥᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮

ࡶከࡃࠊࢳࣜࠊ࣮࣌ࣝࠊࢥࣟࣥࣅ࢔࡛άືࡋ

ࡢࣉࣟࢪ࢙ࢡࢺ࡟ཧ⏬ࡋࡓࡢࡣ㈗㔜࡞⤒㦂ࡓࠋࢥࣟࣥࣅ࢔࡛ࡣᆅ㞾࡟ࡼࡿୗ⫥ษ᩿ࢆ࡛࠶ࡗࡓࠋྠࢭࣥࢱ࣮ࡢᡭ⾡㒊㛛ࢆྵࡴྛ୰ᚰ࡜ࡋࡓ㞀ᐖ⪅⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ

㒊㛛ࡢ་⒪ᶵჾࡢ᭦᪂࡟ࡘ࠸࡚ᢏ⾡ཧ୚࡜యไࡢᙉ໬ࣉࣟࢪ࢙ࢡࢺ࡟ཧ⏬ࡋࡓࠋᮾ༡

ࡋ࡚㛵ࢃࡗࡓࡶࡢ࡛ࠊ୰ኸ࢔ࢪ࢔࡟࠾ࡅࡿ

࢔ࢪ࢔࡛ࡣࠊࢱ࢖ࠊ࣋ࢺࢼ࣒ࠊ࣑࣐࣮ࣕࣥࡢ

ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢయไ࡜ᅜ㝿༠ຊࡢ⌧άື࡟༠ຊࡋࡓࠋ࣑࣐࣮ࣕࣥ࡟ࡘ࠸࡚ࡣࠊࣜ

ሙࢆయឤࡍࡿࡇ࡜ࡀ࡛ࡁࡓࠋ2021 ᖺ࡟➹⪅ࣁࣅࣜࢸ࣮ࢩࣙࣥホ౯ࡢࣉࣟࢪ࢙ࢡࢺ࡜ࠊ

ࡣᅜࣜࣁ࡟㉱௵ࡋ࡚⌧ᅾ࡟⮳ࡗ࡚࠸ࡿࠋᅜ

⫏⪅ࡢ♫఍ཧຍಁ㐍ࡢࣉࣟࢪ࢙ࢡࢺ࡟ཧ⏬

ࣜࣁ࡟ࡣ⑓㝔ࠊ⮬❧ᨭ᥼ᒁࠊ◊✲ᡤࠊᏛ㝔ࠊࡋࡓࠋ໭࢔ࣇࣜ࢝ࡢࣜࣅ࢔࡟ᑐࡍࡿ⩏⫥ᨭ⟶⌮㒊ࠊ௻⏬࣭᝟ሗ㒊ࡢ 6 㒊㛛ࡀ࠶ࡾࠊ௻

᥼ࣉࣟࢪ࢙ࢡࢺࡣࠊࣜࣅ࢔ᅜෆ᝟ໃࡢᝏ໬

⏬࣭᝟ሗ㒊ࡢ୰࡟࠶ࡿᅜ㝿༠ຊᐊࡀከᵝ࡞

࡟ࡼࡗ࡚㏵୰࡛ᡴࡕษࡾ࡜࡞ࡗࡓࠋ

ᅜ㝿άືࢆᢸᙜࡋ࡚࠸ࡿࠋࡇࡇ࡛ࡣᅜࣜࣁ
࡟࠾ࡅࡿᅜ㝿༠ຊࡢṔྐ࡜⌧≧ࢆ⤂௓ࡍࡿࠋ᪥୰㡑 3 ࠿ᅜ㐃ᦠ஦ᴗ
2011 ᖺ࡟ᅜࣜࣁࡣ୰ᅜࡢࣜࣁࣅࣜࢸ࣮

JICA ࣉࣟࢪ࢙ࢡࢺ࡬ࡢ༠ຊ

ࢩࣙࣥ◊✲ࢭࣥࢱ࣮ࠊ㡑ᅜࡢᅜ❧ࣁࣅࣜࢸᅜࣜࣁࡣタ❧ᚋ᪩࠸᫬ᮇ࠿ࡽ JICA ࡢࣉ࣮ࢩࣙࣥࢭࣥࢱ࣮࡜ࡢ㛫࡟㐃ᦠ༠ᐃࢆ⤖ࢇࣟࢪ࢙ࢡࢺ࡟༠ຊࢆࡋ࡚ࡁࡓ㸦⾲㸯㸧ࠋ⿵⿦ࡔࠋࡇࡢ㐃ᦠࡣ 4 ࡘࡢάືᴫせࢆ┠ⓗ࡜ࡋਦ̏ʁεϱϛζΤϞࢂՅ͹༹ࢢ

14࡚࠾ࡾࠊ◊✲⪅࠾ࡼࡧࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ

໬࣭㧗㱋⪅ၥ㢟኱⮧ࡀᅜࣜࣁࢆゼၥࠊどᐹࡋᑓ㛛⫋ဨࡢᢏ⾡஺ὶࠊඹྠ◊✲ࠊㅮ⩏࣭ㅮࡓࠋྠᅜ࡛ࡶ㧗㱋໬࡜㞀ᐖ⪅࡟ᑐࡍࡿࣜࣁ

₇࣭ࢩ࣏ࣥࢪ࣒࢘➼ࡢᐇ᪋ࠊᏛ⾡᝟ሗࡢ஺᥮

ࣅࣜࢸ࣮ࢩࣙࣥࡀၥ㢟࡟࡞ࡗ࡚࠾ࡾࠊࡉࡲ

ࢆᐇ᪋ࡋ࡚࠸ࡿࠋẖᖺⱝᡭ࠿ࡽ୰ሀࡢࢫࢱ

ࡊࡲ࡞᝟ሗ஺᥮ࢆ⾜ࡗࡓࠋࢵࣇࡀྛ᪋タࢆゼၥࡋ࡚࠸ࡿࡀࠊࡇࡢᩘᖺ
WHO ༠ຊࢭࣥࢱ࣮

ࡣࢥࣟࢼ⚝ࡢࡓࡵ࢜ࣥࣛ࢖࡛ࣥࡢ஺ὶࢆ⾜ࡗ࡚࠸ࡿࠋࡲࡓࢩ࣏ࣥࢪ࣒࢘ࡸࢭ࣑ࢼ࣮ࡢ

ᅜࣜࣁࡣ 1995 ᖺ࡟ᅜෆ࡛၏୍ࡢࠕ㞀ᐖࡢ㛤ദࡶ⾜ࢃࢀ࡚࠾ࡾࠊ2023 ᖺ 9 ᭶࡟㡑ᅜ࡛ண㜵࡜ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㛵ࡍࡿ༠ຊࢭ

⾜ࢃࢀࡓᅜ㝿ࢩ࣏ࣥࢪ࣒࢘࡟ࢃࢀࢃࢀ࡜୰

ࣥࢱ࣮ࠖ࡜ࡋ࡚ୡ⏺ಖ೺ᶵ㛵㸦World Healthᅜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ◊✲ࢭࣥࢱ࣮ࡢࢫࢱ

Organization㸸WHO㸧ࡢㄆᐃࢆཷࡅࡓࠋ

ࢵࣇࡀཧຍࢆࡋࠊ㡑ᅜࡢᅜ❧ࣁࣅࣜࢸ࣮ࢩ

WHO ༠ຊࢭࣥࢱ࣮࡜ࡣࠊWHO ࡢࣉࣟࢢࣛ

ࣙࣥࢭࣥࢱ࣮ࢆぢᏛࡋࡓᚋ࡟ࢩ࣏ࣥࢪ࣒࢘

࣒ࢆᨭ᥼ࡍࡿάືࢆ⾜࠺ࡓࡵ࡟஦ົᒁ㛗࡟࡟ཧຍࡋࡓ㸦ᅗ 1㸧ࠋࡼࡗ࡚ᣦᐃࡉࢀࡓᶵ㛵࡛࠶ࡿࠋ4 ᖺࡈ࡜࡟༠ຊ஦㡯࡟ᑐࡍࡿ⾜ືィ⏬ࢆ❧࡚࡚࠾ࡾࠊ
2020 ᖺ࡟ጞࡲࡗࡓ⌧ᅾࡢ⾜ືィ⏬ࡣࠊ㞀ᐖᾏእ࠿ࡽࡢゼၥ⪅࣭◊ಟ⪅2021 ᖺࡲ࡛࡟࢔ࢪ࢔ࢆ୰ᚰ࡟⣙ 160 ࠿ࡀ࠶ࡿேࠎࡢ೺ᗣቑ㐍࡟㛵ࡍࡿ▱㆑ࡸ㈨※ᅜ࠿ࡽ 11,000 ே௨ୖࡀᅜࣜࣁࢆゼၥࡋࡓࠋࡢ㛤Ⓨࠊ⅏ᐖ᫬ࡢ㞀ᐖࡀ࠶ࡿேࠎࡢ㑊㞴ࡢࡇࢀࡣᖺ㛫ᖹᆒ⣙ 260 ே࡟┦ᙜࡍࡿࠋࡲࡓ

ཷࡅධࢀᡭ㡰࡟㛵ࡍࡿ㛤Ⓨࠊᆅᇦࡢࣜࣁࣅ

ྠࡌᮇ㛫࡟⣙ 60 ࠿ᅜ࠿ࡽ 775 ேࡀᅜࣜࣁ

ࣜࢸ࣮ࢩࣙࣥேᮦ⫱ᡂ࡟㛵ࡍࡿᡭᘬࡁࡢ㛤࡛ᵝࠎ࡞◊ಟࢆཷࡅࡓࠋࡇࡢ୰࡟ࡣᖐᅜᚋࠊ

Ⓨࠊ㞀ᐖࡀ࠶ࡿேࠎࡢ⥲ྜⓗࣜࣁࣅࣜࢸ࣮

࠶ࡿ࠸ࡣࡑࡢᚋࠊᵝࠎ࡞ᙧ࡛ࠊ⌧ᆅ➼࡛ࣜࣁࢩࣙࣥ࡟㛵ࡍࡿ᝟ሗᥦ౪ࠊࣜࣁࣅࣜࢸ࣮ࢩ

ࣅࣜࢸ࣮ࢩࣙࣥࡢάື࡟㛵ࢃࡗ࡚࠸ࡿࢫࢱ

ࣙࣥ㞀ᐖᨭ᥼ᢏ⾡࡟㛵ࡍࡿ WHO ࡢᨻ⟇࣭ࢵࣇࡶ࠸ࡿࠋ౛࠼ࡤ 2021 ᖺ࡟◊ಟࢆ⾜ࡗࡓ᪉㔪ࡢᬑཬࠊࡢ 5 ࡘ࠿ࡽᵓᡂࡉࢀ࡚࠸ࡿࠋ

ࣃࢩࣕ࢖࣭ࣔࣁ࣓ࢵࢻẶࡣࠊ⮬ศ⮬㌟ࡀ⬨㧊᭱㏆ࡢᡂᯝ࡜ࡋ࡚ࠊ
ࠕ᪥ᮏ࡟࠾ࡅࡿᨭ᥼ᶵ

ᦆയࢆཷയࡋࡓࡇ࡜࡟ࡼࡾࠊẕᅜ࢖ࣛࣥࡢ

ჾᨭ⤥ࢩࢫࢸ࣒࡟㛵ࡍࡿሗ࿌᭩ࠖ࡜ࠕ㞀ᐖ࢖㞀ᐖࡀ࠶ࡿேࠎࡢ⏕άྥୖࡢࡓࡵࡢᨭ᥼ࢆ

ࣥࢡ࣮ࣝࢩࣈ㜵⅏࣭᪥ᮏࡢ⤒㦂ࠖࢆ 2020 ᖺ⾜࠺ពᛮࢆᣢࡕࠊᅾఫࡋ࡚࠸ࡿ᪥ᮏ࡛ NPO

࡟Ⓨ⾜ࡋ WHO ࡬ሗ࿌ࡋࡓࠋࡲࡓ WHO ࡟ࢆタ❧ࠊࡑࢀࢆ㏻ࡌ࡚᪥ᮏ࡜࢖ࣛࣥࡢ㞀ᐖ

ࡼࡿ Rehabilitation 2030: a call for action⪅ࢆࡘ࡞ࡄάືࢆ⾜ࡗ࡚࠸ࡿࠋ࢖ࣛࣥࡢ⬨ࡢ meeting report ࢆ᪥ᮏㄒ࡟⩻ヂࡋࠊࠕࣜ㧊ᦆയࡸ௚ࡢ㞀ᐖࡢ࠶ࡿேࠎ࡟㌴࠸ࡍࡸ࣋ࣁࣅࣜࢸ࣮ࢩࣙࣥ 2030 ⾜ືࡢ࿧ࡧ࠿ࡅࠖ

ࢵࢻࢆ㉗ࡗࡓࡾࠊ᪥ᮏࡢࣜࣁࣅࣜࢸ࣮ࢩࣙ

఍㆟ሗ࿌᭩࡜ࡋ࡚ 2021 ᖺ࡟࣮࣒࣮࣍࣌ࢪ

ࣥᑓ㛛ᐙࢆ࢖ࣛࣥ࡟ᣍ⪸ࡋ࡚ࡢ◊ಟ఍ࠊ࢖࡟බ㛤ࡋࡓࠋ

ࣛࣥࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᚑ஦⪅ࡢ᪥ᮏ࡛

ࡲࡓࠊWHO ༠ຊࢭࣥࢱ࣮࡜ࡋ࡚ࢭ࣑ࢼ

ࡢ◊ಟ➼ࢆ⾜ࡗ࡚࠾ࡾࠊ࢖࡛ࣛࣥ NGO ࢆ࣮➼ࢆ㛤ദࡋ࡚࠾ࡾࠊ2007 ᖺ௨㝆ࡣ࡯ࡰẖ❧ࡕୖࡆࠊ⌧ᆅ࡛ࡢάືᒎ㛤ࡶጞࡵ࡚࠸ࡿࠋ

ᖺ⾜ࡗ࡚࠸ࡿ㸦⾲ 2㸧ࠋẖᅇ␗࡞ࡿࢸ࣮࣐ࢆ

᭱㏆࡛ࡣࠊ2023 ᖺ 11 ᭶࡟࢝ࣜࣈᾏࡢᓥタᐃࡋ࡚࠸ࡿࡀࠊ᭱㏆ࡢ 10 ᖺ㛫ࡣ㧗㱋໬ࡸࠊᅜ࡛࠶ࡿࣂࣝࣂࢻࢫࡢࣁࣥࣇ࣮ࣜᅜẸᙉ㞀ᐖ⪅ࡢ೺ᗣቑ㐍ࡀࢸ࣮࣐࡟࡞ࡿࡇ࡜ࡀከ

15

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ึૹ۫੣ࡠٗढ़‫ݜ‬र໪ద͘ΖΓ͑Ͷ‫ݜ‬रΝߨ͏ɼͨ͹಼༲Ν‫ޛࠅؾ‬Ͷఽୣɼ෕‫ͤٶ‬Ζ͞ͳ֋൅౏৏ࠅ

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୯΍͗චགྷ͵ࢩԋٗढ़ʀࢩԋ‫حؽ‬Νཤ༽Ͳ͘ΖΓ͑ͶͤΖͪΌͶ্͍֒͗Ζਕʓ͗݊߃Νң࣍ͤΖͪΌ͹खૌΊ ʷਐର‫׈‬ಊΝ௪࣮ͣͪබ༩๹ͳ݊߃ଁ਒ʷϨύϑϨτʖεϥϱͳ &29,'ϨύϑϨτʖεϥϱͶ͕͜Ζଡ৮झ࿊‫ͳܠ‬ਕࡒү੔߶ྺԿऀճͳϨύϑϨτʖεϥϱ ʷ୯΍͗චགྷ͵ϨύϑϨτʖεϥϱΝण͜ΔΗΖΓ͑ͶͤΖͪΌͶʷ੤ଢฑ༺ஏҮ͹֦ࠅͶ͕͜ΖϨύϑϨτʖεϥϱ͹൅ఴͳ՟ୌ ʷ:+2 ্֒Ͷ‫ͤؖ‬Ζ੊ֆๅࠄॽʷ্֒ं͹ҢಊࢩԋΝߡ͓Ζ ʷਕదࢩԋ౵͹λϓφ໚Ν஦ৼͶʷ߶ྺं͹΍ͯӣಊ‫ؽ‬೵্֒ ʷ߶ྺ‫غ‬Ͷਫ਼ͣΖ্֒ͳ্֒ं͹߶ྺԿʷ্֒ं͹݊߃ଁ਒ͳηϛʖς୉‫و‬ໝࡄ֒ͳ্֒ंࢩԋ্֒ं͹ 42/ ޴৏͹ͪΌ͹ΨʖϓΟϱʀϕϫξέςʷΠζΠͶ͕͜Ζ‫֋ڂݜ‬൅ɼన߻͹‫ݳ‬য়ͳ͞Η͖Δʷ

‫ڠ‬ਫ਼ऀճͳࠅࡏ‫ྙڢ‬Νߡ͓Ζ߶౵‫گ‬үͶ͕͜Ζ্ָ֒ਫ਼ͶଲͤΖਫ਼‫׈‬ʀָसࢩԋ൅ୣ্֒͹ཀྵմͳम࿓ࢩԋ ࣙถ঳ηϘέφϧϞΝ஦ৼͳ͢ͱ

্֒ं‫ݘ‬ཤড়༁ͳ΢ϱέϩʖεϔʀλγΦτΡ͹ࣰ‫ݳ‬߶ౕ৚ๅऀճ‫ڧ؂‬Ծ͹‫ڠ‬ਫ਼ऀճ͹ߑ஛ਐର্֒͹͍Ζਕʓ͹କ൅੓߻ญ঳͹ྡজӺָ

ΠζΠʀ੤ଢฑ༺ஏҮͶ͕͜Ζ্֒༩๹ͳϨύϑϨτʖεϥϱන̐ :+2 ‫ྙڢ‬ιϱνʖͳ͢ͱ͹ιϝψʖ౵֋࠷ࣰ੹

࠸ࠋ2021 ᖺ௨㝆ࡣࢥࣟࢼ⚝ࡶ࠶ࡾࠊ࢜ࣥࣛ
࢖࡛ࣥ㛤ദࡋ࡚࠸ࡿࠋ
ࣜࣁࣅࣜࢸ࣮ࢩ࣐ࣙࣥࢽࣗ࢔ࣝࡢⓎ⾜ᅜ ࣜ ࣁ ࡛ ࡣ ᨻ ᗓ 㛤 Ⓨ ᥼ ຓ 㸦 Official
Development AssistanceࠊODA㸧ࡢ஦ᴗ࡜ࡋ࡚ࣜࣁࣅࣜࢸ࣮ࢩ࣐ࣙࣥࢽࣗ࢔ࣝࢆไ
స࣭Ⓨ⾜ࡋ࡚࠸ࡿࠋ௒ࡲ࡛࡟ 38 ࡢ࣐ࢽࣗ࢔
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Using ICT and Teaching its Effective Use㸦ICT ᶵჾά⏝ࡢᩍ࠼᪉࣭౑࠸᪉࡟㛵ࡍࡿ࣐ࢽࣗ࢔ࣝ㸧ࠖࢆⓎ⾜ࡋࡓࠋ࠾ࢃࡾ࡟᭱ᚋ࡟ࠊ௒ᚋᅜࣜࣁࡀᅜ㝿㈉⊩ࢆ࡝ࡢࡼ࠺࡟㐍ࡵ࡚࠸ࡃ࡭ࡁ࠿ࠊ࡟ࡘ࠸࡚⪃࠼࡚ࡳࡓ࠸ࠋ➹⪅ࡣࠊ඘ศ࡞ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࣜ
ࢯ࣮ࢫࡢ࡞࠸ᅜࠎ࡟ᑐࡋ࡚᪥ᮏࡢᙉࡳࢆᥦ
౪ࡍࡿࡇ࡜ࡀࠊᅜࣜࣁࡢ࣑ࢵࢩ࡛ࣙࣥ࠶ࡿ
࡜⪃࠼࡚࠸ࡿࠋ᪥ᮏࡢᙉࡳ࡜࠸࠺ࡢࡣఱ࠿
࡜࠸࠺࡜ࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋ࡀᑡ࡞ࡃ࡜ࡶேᩘⓗ࡟ࡣ඘ศ࡟‶ࡓࡉࢀ࡚࠸ࡿ
ࡇ࡜ࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་⒪ࡀ་⒪ಖ㝤ࢩࢫࢸ࣒ࡢ୰࡟⤌ࡳ㎸ࡲࢀ࡚࠸ࡿࡇ࡜ࠊ㟈⅏࡜࠿ὠἼ࡜࠸࠺⅏ᐖࡢ⤒㦂ࢆᣢࡗ࡚࠸ࡿ
࡜࠸࠺ࡇ࡜ࠊࡑࡋ࡚᪥ᮏࡀୡ⏺࡟ඛࢇࡌ࡚
㧗㱋໬ࡀ㐍ࢇ࡛࠸ࡿ࡜࠸࠺ࡇ࡜࡛࠶ࡿࠋㄞ
⪅ࡢⓙᵝ࡟ࡣࠊ௒ᚋࡶᅜࣜࣁࡢ࣮࣒࣮࣍࣌
ࢪ➼࡛Ⓨಙࡉࢀࡿᡂᯝ≀ࡸࢭ࣑ࢼ࣮➼࡬ࡢ
ཧຍࢆ㏻ࡌ࡚ࠊᅜࣜࣁࡢᅜ㝿༠ຊάືࢆぢᏲࡗ࡚࠸ࡓࡔࡁࡓ࠸ࠋ
฼┈┦཯㸦COI㸧࡟㛵ࡍࡿグ㍕
ᮏㄽᩥ࡟ࡘ࠸࡚㸪௚⪅࡜ࡢ฼┈┦཯ࡣ࡞࠸ࠋ

18࠙≉ูᐤ✏ࠚࠕRehabilitation 2030 ࡜ᅜࡢᶵ㛵࡟ࡼࡿᅜ㝿༠ຊࠖᅜ❧ಖ೺་⒪⛉Ꮫ㝔ࡢᅜ㝿༠ຊ㸸ᨻ⟇❧᱌⪅࣭ᢸᙜ⪅ࢆᑐ㇟࡜ࡋࡓேᮦ⫱ᡂ᭮᰿ᬛྐ Tomofumi Soneᅜ❧ಖ೺་⒪⛉Ꮫ㝔 National Institute of Public Healthせ᪨ᅜ❧ಖ೺་⒪⛉Ꮫ㝔ࡣࠊཌ⏕ປാ┬┤㎄ࡢヨ㦂◊✲ᶵ㛵࡛࠶ࡾࠊ2002 ᖺ࡟ᇸ⋢┴࿴ගᕷ࡟タ❧ࡉࢀࡓࠋಖ೺་⒪ࠊ⏕ά⾨⏕ࠊ♫఍⚟♴࡟㛵ࡍࡿ㣴ᡂカ⦎࡜ㄪᰝ◊✲ࢆᮏົ࡜ࡋࠊ⣙80 ྡࡢ◊✲⪅ࡀᡤᒓࡋ࡚࠸ࡿࠋ
ᅜ㝿㛵ಀࡢ㣴ᡂカ⦎ࡣࠊJICA㸦ᅜ㝿༠ຊᶵᵓ㸧࡜ᐇ᪋ࡋ࡚࠸ࡿࡶࡢࡀ 3 ௳ࠊWPRO㸦WHOすኴᖹὒᆅᇦ஦ົᒁ㸧࡜ᐇ᪋ࡋ࡚࠸ࡿࡶࡢࡀ 1 ௳࡛࠶ࡿࠋ
JICA ◊ಟ࡟ࡣࠊಖ೺⾨⏕⟶⌮◊ಟࠊUHC㸦ࣘࢽࣂ࣮ࢧ࣭ࣝ࣊ࣝࢫ࣭࢝ࣂࣞࢵࢪ㸧࡟㛵ࡍࡿ◊ಟࠊಖ೺⾨⏕ᨻ⟇ྥୖ◊ಟࡀ࠶ࡿࠋ
WHO/WPRO ࡜ࡣࠊ2005㹼2018 ᖺᗘ࡟࠿ࡅ࡚ࠊ2012 ᖺᗘࢆ㝖ࡃẖᖺᗘࠊᇦෆࡢᨻ⟇ᢸᙜ⪅࡟ᑐࡋ࡚ࠊNCD㸦㠀ឤᰁᛶ⑌ᝈ㸧࡟㛵ࡍࡿ࣮࣡ࢡࢩࣙࢵࣉࢆඹദࡋ࡚ࡁࡓࠋࡲࡓ 2023
ᖺ 9 ᭶࡟ࡣࠊ㧗㱋໬ᨻ⟇࡟㛵ࡍࡿ࣮࣡ࢡࢩࣙࢵࣉࢆඹദࡋࡓࠋࡇࢀࡽ WHO/WPRO ࡜ࡢ࣮࣡ࢡࢩࣙࢵࣉࡣࠊWHO ◊✲༠ຊࢭࣥࢱ࣮࡜ࡋ࡚ࡢάື࡛ࡶ࠶ࡿࠋ
௒ᚋࡶ JICAࠊWHO ➼ࡢᅜ㝿㸦༠ຊ㸧ᶵ㛵࡜࡜ࡶ࡟ࠊ୰పᡤᚓᅜ࡛ NCDࠊUHCࠊ㧗㱋໬➼ࡢᨻ⟇ࢆᢸ࠺ேᮦࡢ⫱ᡂࢆ᥎㐍ࡋ࡚࠸ࡃᡤᏑ࡛࠶ࡿࠋ
Abstract
The National Institute of Public Health (NIPH) is a research institute under the
Ministry of Health, Labour and Welfare, and was established in 2002 in Wako City,
Saitama. Its main mission is to provide training and conduct research related to health,hygiene and social welfare.
NIPH currently conducts three international training programs with the Japan
International Cooperation Agency (JICA) and one with the WHO Western PacificRegional Office (WPRO). Topics of JICA co-organized training programs are healthsystems management, universal health coverage (UHC), and health policy development.
With WHO/WPRO, NIPH has conducted workshops on non-communicable diseases(NCDs) control and prevention for member states in the region every year from FY 20052018, except for FY 2012. In September 2023, NIPH conducted a workshop on aging
policy with WHO/WPRO. These workshops are identified as activities of a designated
WHO Collaborating Center.
NIPH will continue to contribute to human resources development in low- and middleincome countries on NCDs, UHC and ageing with JICA, WHO and other international(cooperative) organizations.

19ᅜ❧ಖ೺་⒪⛉Ꮫ㝔ࡢṔྐ⡆༢࡟ᙜ㝔ࡢṔྐࠊᴫせࢆㄝ᫂ࡉࡏ࡚࠸
ࡓࡔࡁࡓ࠸࡜ᛮ࠸ࡲࡍࠋ2002 ᖺ࡟タ❧ࡉࢀࡓཌ⏕ປാ┬┤㎄ࡢヨ㦂◊✲ᶵ㛵࡛ࡍࠋṔྐⓗ࡟ࡣ 1938 ᖺ࡟タ❧ࡉࢀࡓᅜ❧බ⾗⾨⏕㝔࡜ 1949 ᖺ࡟タ❧ࡉࢀࡓᅜ❧་⒪࣭⑓㝔⟶⌮◊✲ᡤ➼ࡀ⤫ྜࡋࠊᇸ⋢┴࿴ගᕷ࡟⛣㌿ࡋࡓࡶࡢ࡛ࡍࠋ
ᅜ❧බ⾗⾨⏕㝔ࡢⓎ㊊ࡣ᪥ᮏࡢಖ೺ᡤࡢ

㌴ࡢ୧㍯࡜ࡋ࡚࠸ࡲࡍࠋPublic Healthࠊጞࡲࡾ࡜᫬ࢆ࡯ࡰྠࡌࡃࡋ࡚࠸ࡲࡍࠋ1937

Environmental HealthࠊSocial Welfare ࡶᖺ࡟ᮾிࡢ௒ࡢ⪷㊰ຍᅜ㝿኱Ꮫࡢ㏆ࡃ࡟㒔ྵࡵࡓேᮦ⫱ᡂ࡜◊✲ࢆ⾜ࡗ࡚࠸ࡲࡍࠋ㸶ᕷಖ೺㤋ࡀࠊࡉࡽ࡟ᡤἑ࡟㎰ᮧಖ೺㤋࡜࠸ࡘࡢ◊✲㒊࣭ࢭࣥࢱ࣮࡜㸴ேࡢ⤫ᣓ◊✲ᐁ࠺ᙧ࡛ࠊ⌧ᅾࡢ⾜ᨻಖ೺ᡤࡢཎᆺࡀసࡽࢀ

࠿ࡽ࡞ࡾࡲࡍࠋ◊✲⪅ࡣ 80 ྡ࡯࡝࡛ࠊ⣙ 4ࡲࡋࡓࠋࡑࡇࢆࣇ࢕࣮ࣝࢻ࡜ࡋ࡚බ⾗⾨⏕

๭ࡣዪᛶ࡛ࡍࠋ

ᚑ஦⪅ࡢᩍ⫱カ⦎ࢆ⾜࠺ᶵ㛵࡜ࡋ࡚ࠊ1938⤌⧊ᅗ㸦Organization Chart㸧ᖺ࡟ࣟࢵࢡࣇ࢙࣮ࣛ㈈ᅋࡢ㈈ᨻ᥼ຓࢆཷࡅ
࡚⌧ᅾࡢ ༊ⓑ㔠ྎࡢᆅ࡟Ⓨ㊊ࡋࡲࡋࡓࠋ

ᙜ㝔ࡢ⤌⧊ᅗ࡛ࡍࠋ኱఍㛗ࡢᒣཱྀඛ⏕ࡣࠊࡶ࠺㸯ࡘࡢ࣮ࣝࢶࡣᅜ❧་⒪࣭⑓㝔⟶⌮་⒪࣭⚟♴ࢧ࣮ࣅࢫ◊✲㒊࡟ᡤᒓࡋ࡚࠸ࡲ

◊✲ᡤ࡛ࡍࡀࠊࡇࢀࡣᡓᚋࡲࡶ࡞ࡃࠊGHQ

ࡍࠋࡑࡢ௚࡟ࡶ 3 ྡࡢ⌮Ꮫ⒪ἲኈࡢ㈨᱁⪅㸦General Head Quarters㸧ࡢᣦ♧࡟ࡼࡗࡀᙜ㝔࡛ാ࠸࡚࠸ࡲࡍࠋ࡝ࡇ࡛ാ࠸࡚࠸ࡿ

࡚ࠊ᪥ᮏࡢ་⒪ࡢ㏆௦໬ࢆ┠ᣦࡍࡓࡵ࡟⑓

࠿࡜࠸࠸ࡲࡍ࡜ࠊಖ೺་⒪⤒῭ホ౯◊✲ࢭ㝔⟶⌮◊ಟᡤ࡜ࡋ࡚Ⓨ㊊ࡋࡲࡋࡓࠋᅜ❧ಖࣥࢱ࣮࡜࠸࠺་⸆ရ࣭་⒪ᶵჾࡢ㈝⏝ᑐຠ೺་⒪⛉Ꮫ㝔࡟⤫ྜ෌⦅ࡉࢀࡿࡲ࡛࡟ࠊ
3୓ᯝศᯒࢆ⾜ࡗ࡚࠸ࡿ㒊⨫࡟࠸ࡲࡍࠋྠ᫬࡟ࠊ

ே௨ୖࡢ⑓㝔㛗ࠊ஦ົ㒊㛗ࠊ┳ㆤ㒊㛗ࡢ◊ಟᙼࡽࡣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ➼ࡢ㈝⏝ᑐຠᯝࢆᐇ᪋ࡋࡲࡋࡓࠋ

ศᯒࡶ◊✲࡜ࡋ࡚⾜ࡗ࡚࠸ࡲࡍࠋᙜ㝔ࡣࡇࢀ࡟㝈ࡽࡎࠊmultidisciplinary ࡞⤌⧊࡛ࠊᅜ❧ಖ೺་⒪⛉Ꮫ㝔ࡢᴫせᙜ㝔ࡣ᪂ࡋࡃⓎ㊊ࡋ࡚ 20 ᖺవࡾ࡟࡞ࡾ
ࡲࡍࡅࢀ࡝ࡶࠊࢺ࣮ࣞࢽࣥࢢ࡜ࣜࢧ࣮ࢳࢆ

20

ᵝࠎ࡞⫋✀ࡸᑓ㛛ᛶࢆᣢࡗࡓேࡀ࠾஫࠸࡟

ࡾࠊ࠶ࡿ࠸ࡣ㣗ရ⾨⏕ࠊỈ㐨ࠊHIV-AIDSࠊ༠ຊࡋ࡞ࡀࡽ◊ಟࡸ◊✲ࢆ⾜࠺࡜࠸࠺࡜ࡇ

ࡓࡤࡇᑐ⟇ࠊඣ❺⹢ᚅ㜵Ṇࡸ⏕ά⩦័⑓ᑐࢁࡀ≉ᚩ࡛ࡍࠋ

⟇࡟㛵ࡍࡿ◊ಟ࡞࡝ࡶᐇ᪋ࡋ࡚࠸ࡲࡍࠋ

◊ಟࡢᴫせ

ᶵ㛵ㄅ

◊ಟ࡟ࡘ࠸࡚⡆༢࡟⏦ࡋୖࡆࡲࡍ࡜ࠊ㛗

2 ࣨ᭶࡟ 1 ᅇࠊᶵ㛵ㄅࢆⓎ⾜ࡋ࡚࠸ࡲࡍࠋ

࠸ࡶࡢࠊ▷࠸ࡶࡢࠊᅜ㝿࡜ 3 ✀㢮࠶ࡾࠊ≉ࠕಖ೺་⒪⛉Ꮫ: Journal of the National࡟ᅜෆ࡟ࡘ࠸࡚ࡣ᪥ᮏࡢಖ೺ᡤࡸ┴ᗇ➼࡟Institute of Public Health࡛ࠖࠊᖺᗘࡢ᭱ึ

໅ࡵࡿಖ೺་⒪⚟♴ࡢ⾜ᨻᚑ஦⪅ࢆ୺࡞ᑐ࡟ࡣ English Edition ࡜࠸࠺ࡇ࡜࡛ࠊ᪥ᮏ

㇟࡜ࡋ࡚࠸ࡲࡍࠋࢥࣟࢼ๓ࡣᖺ㛫⣙ 2000 ேࡢάືࢆⱥᩥ࡛⤂௓ࡍࡿ≉㞟ྕ࡟ࡋ࡚࠸ࡲ

ࡢ◊ಟ⏕ࡀಟ஢ࡋ࡚࠸ࡲࡋࡓࡀࠊࢥࣟࢼ࡛

ࡍࠋ᪥ᮏࡢไᗘ

୍᫬ῶࡾࡲࡋ࡚ࠊ⌧ᅾࡣᖺ㛫 1500 ྡ⛬ᗘ࡛ࡣࠊ࡞࠿࡞࠿ⱥ

ᅇ᚟ᇶㄪ࡟࠶ࡾࡲࡍࠋ2002 ᖺ࡟Ⓨ㊊ࡋ࡚࠿ㄒ࡛ㄝ᫂ࡋࡓ

ࡽ⣙ 5 ୓ 5000 ேࡢಟ஢⏕ࢆฟࡋ࡚࠸ࡲࡍࠋ

ࡶࡢࡀᑡ࡞࠸

ᅜ㝿࡟ࡘ࠸࡚ࡣᚋ࡯࡝ㄝ᫂ࡋࡲࡍࡀࠊJICA

ࡢ࡛ࠊ⚾࡝ࡶ࡜ࡸ WHO ࡀࢫ࣏ࣥࢧ࣮ࡢࢥ࣮ࢫࢆඹྠ࡛⾜ࡋ࡚ࡣⱥㄒ࡛

ࡗ࡚࠸ࡲࡍࠋ

ࡢⓎಙࡀᚲせᙜ㝔ࡢ㛗࠸ࢥ࣮ࢫ࡛ࡣࠊಖ೺ᡤ㛗ࢆࢺࣞ࡜⪃࠼ࠊᩘᖺ๓

࣮ࢽࣥࢢࡍࡿࢥ࣮ࢫࢆ㛗ᖺࡸࡗ࡚࠸ࡲࡍࠋ

࠿ࡽጞࡵ࡚࠸

⮫ᗋ་࠿ࡽಖ೺ᡤ㛗࡟࡞ࡿ᪉ࡶከ࠸ࡢ࡛ࡍ

ࡲࡍࠋࡀࠊࡑࡢሙྜࡣᙜ㝔ࡢ 3 ࠿᭶ࡢ◊ಟࢆཷࡅᅜ㝿༠ຊ࡚ࠊಖ೺ᡤ㛗ࡢ㈨᱁せ௳ࢆ‶ࡓࡍࡇ࡜࡟࡞

⚾࡝ࡶࡢᅜ㝿༠ຊ࡛ࡍࡀࠊJICA ࡜୍⥴࡟ࡗ࡚࠾ࡾࠊ඲ᅜࡢಖ೺ᡤ࡟ࡣᙜ㝔ࡢಟ஢⏕ࡸࡗ࡚࠸ࡿ◊ಟࡀ 3 ࡘ࠶ࡾࡲࡍࠋHealthࡀᩘከࡃά㌍ࡋ࡚࠸ࡲࡍࠋ
▷ᮇ◊ಟࡣࡑࢀࡒࢀࡢᑓ㛛ᛶࡸࢺࣆࢵࢡ

Systems Management ࢥ࣮ࢫࠋࡇࢀࡣ 3 㐌࡟ᇶ࡙࠸࡚ᐇ᪋ࡋ࡚࠾ࡾࠊ⌧ᅾᖺ㛫 40 ᩘࢥ㛫ࡢࢥ࣮ࢫ࡛ࠊබ⾗⾨⏕㝔᫬௦࠿ࡽࡸࡗ࡚

࣮ࢫࢆ㛤ㅮࡋ࡚࠸ࡲࡍࠋ◊ಟࢸ࣮࣐ࡣࠊබ⾗࠸ ࡲ ࡍ ࠋ ࡑ ࢀ ࠿ ࡽ Universal Health⾨⏕┳ㆤ࡛࠶ࡗࡓࡾࠊ␿Ꮫ࣭⤫ィ࡛࠶ࡗࡓ

Coverageࢥ ࣮ ࢫ ࡜Health Policy

Development ࢥ࣮ࢫࡀࡑࢀࡒࢀ㸰㐌㛫࡛ࡍࠋ
Health Systems Management ࢥ࣮ࢫࡣࠊ
୰పᡤᚓᅜࡢ୰ሀ⾜ᨻᐁࢆᑐ㇟࡟ࡋ࡚࠸ࡲ
ࡍࠋUHC ࢥ࣮ࢫࡣࠊྛᅜࡢ UHC ᢸᙜ⾜ᨻᐁࢆᑐ㇟࡜ࡋ࡚࠸ࡲࡍࠋࡲࡓ Health Policy
Development ࡣ㧗఩ࡢ㒊㛗࣭ᒁ㛗⣭ࡢࠊ࠸ࢃࡺࡿ࣏ࣜࢩ࣮࣓࢖࢟ࣥࢢ࡟㛵ࢃࡿ᪉ࡢࢥ
࣮ࢫ࡜ࡋ࡚ᐇ᪋ࡋ࡚࠸ࡲࡍࠋࣁ࢖ࣛ࢖ࢺ࡛
࠾♧ࡋࡋࡓࢥ࣮ࢫ࡛ࡣࠊࣜࣁࣅࣜࢸ࣮ࢩࣙ

21ࣥ➼࡟ࡘ࠸࡚ࠊ኱఍㛗ࡢᒣཱྀඛ⏕ࡀᥦ౪ࡍࣅ ࣜࢸ ࣮ࢩ ࣙࣥ࡟ 㛵ࡋ࡚ ࡣࠊ Integratedࡿㅮ⩏ࡀྵࡲࢀ࡚࠸ࡲࡍࠋ

People-Centred Service Delivery ࡟ྵࡲࢀࡲࡍࠋࠕࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ 2030ࠖ࡟㛵ࡍᙜ 㝔 ࡶ WHO Collaborating Centreࡿ఍㆟ࡀᮏᖺ 7 ᭶࡟ WHO ࡢࢪࣗࢿ࣮ࣈᮏ

(WHOCC)࡟ㄆᐃࡉࢀ࡚࠸ࡲࡍࠋ3 ௳ㄆᐃࡉ㒊࡛㛤࠿ࢀࡿ࡜࠸࠺࠾▱ࡽࡏࡀ᮶ࡲࡋࡓࡢ

ࢀ࡚࠾ࡾࡲࡋ࡚ࠊ1 ࡘࡣ Integrated People-࡛ࠊᒣཱྀඛ⏕࡟⾜ࡗ࡚࠸ࡓࡔࡁࡲࡋࡓࠋ

Centred Service Delivery ࡛ࠊ࠸ࢃࡺࡿᗈ
࠸ព࿡࡛ࡢᆅᇦಖ೺⚟♴࡛ࡍࠋ⚾ࡀࡑࡢ௦ᑐ㇟⪅୰ᚰࡢ⤫ྜⓗࢧ࣮ࣅࢫᥦ౪࡟㛵ࡍࡿ⾲❆ཱྀࢆົࡵ࡚࠸ࡲࡍࠋࡑࡢ௚࡟Ỉ㐨࡟㛵WHO ࢥ࣮ࣛ࣎ࣞࢸ࢕ࣥࢢࢭࣥࢱ࣮, JPN-ࡍࡿ WHOCCࠊࡑࢀ࠿ࡽᙜ㝔࡛ࡣࢱࣂࢥࡢ

50
Integrated↮ࡢᡂศࢆ୰❧ⓗ࡞❧ሙ࡛ศᯒࡍࡿ㒊⨫ࡀ

People-Centred

Service

Delivery ࡟ࡘ࠸࡚ࡣ࠸ࢃࡺࡿ⊃⩏ࡢබ⾗⾨

࠶ࡾࠊWHOCC ࡟ᣦᐃࡉࢀ࡚࠸ࡲࡍࠋࣜࣁ

⏕ࡔࡅ࡛ࡣ࡞ࡃࠊ་⒪࡜ࡋ࡚ࠊ་⒪Ᏻ඲ࡸ⑓㝔⟶⌮ⓗ࡞せ⣲ࡶྵࡲࢀ࡚࠸ࡲࡋ࡚ࠊࡇࢀ
ࡣᪧᅜ❧་⒪࣭⑓㝔⟶⌮◊✲ᡤࡢὶࢀࢆࡃ
ࡴࡶࡢ࡛ࡍࡀࠊࡑࢀࡽ࡟㛵ࡍࡿேᮦ⫱ᡂࡶ⾜ࡗ࡚࠸ࡲࡋࡓࠋ
WHO/WPRO-⛉Ꮫ㝔 NCDs ࢥࣥࢺ࣮ࣟࣝ
࣮࣡ࢡࢩࣙࢵࣉ
NCD ࡟㛵ࡍࡿ WHO/WPRO ࡢ࣮࣡ࢡࢩ
ࣙࢵࣉࡶ 2005 ᖺ࠿ࡽ࡛ࡍ࠿ࡽࠊ㝶ศ㛗࠸㛫ࡸࡗ࡚࠾ࡾࡲࡋ࡚ࠊ2018 ᖺ୍࡛᪦⤊ࢃࡾࡲࡋࡓࠋ᭱ึࡢ㡭ࡣࠊ࣮࣡ࢡࢩࣙࢵࣉ࡟᮶ࡓ⾜ᨻᐁࡢ᪉࡟ NCD ᑐ⟇ࢆᐇ㝿࡟ಶே࡛య㦂ࡋ࡚ࡶࡽ࠾࠺࡜࠸࠺ࡇ࡜࡛ࠊ㣗஦ࢆグ㘓ࡋࡓࡾࠊẖᮅ㐠ືࡋࡓࡾࠊ೺ᗣデ᩿ࢆཷࡅࡓࡾ
ࡋࡲࡋࡓࠋ⮬ࡽయ㦂ࡋ࡚ࠊ⮬ᅜࡢᨻ⟇࡟⏕࠿22ࡋ࡚ࡶࡽ࠾࠺࡜࠸࠺ࢥࣥࢭࣉࢺ࡛ࡍࠋ2013

ᮏᖺ 9 ᭶ 25 ᪥࠿ࡽ 29 ᪥࡟࠿ࡅ࡚ࠊ
WPROᖺ࠿ࡽࡣࠊ௒ᗘࡣ࣮ࣜࢲ࣮ࢩࢵࣉࡸ࢔ࢻ࣎すኴᖹὒᆅᇦ஦ົᒁ࡜ඹദ࡛㧗㱋⪅࡟㛵ࡍ࢝ࢩ࣮ࢆ୰ᚰ࡜ࡋ࡚ẖᖺࢸ࣮࣐ࢆỴࡵࠊ௻ࡿ࣮࣡ࢡࢩࣙࢵࣉࢆ⾜࡞࠸ࡲࡋࡓࠋ

ᴗࡸ⮬἞య࡞࡝ᵝࠎ࡞ᡤ࡟ぢᏛ࡟⾜ࡁࡲࡋTurning silver to gold, Capacity buildingࡓࠋ

workshop for starting community based
integrated care ࡜࠸࠺ࢱ࢖ࢺ࡛ࣝࡍࠋ᪥ᮏ

2017 ᖺ➨ 5 ᅇ LeAd-NCD ࣮࣡ࢡࢩࣙࢵࣉ

ࡢᆅᇦໟᣓᨭ᥼ࢭࣥࢱ࣮➼ࢆぢᏛࡋ࡚ࠊ᪥

⌧ሙどᐹᮏࡢࢩࢫࢸ࣒ࢆᏛࡧࠊ࠾஫࠸ࡢࢹ࢕ࢫ࢝ࢵ

2017 ᖺ࡟⾜ࡗࡓ 5 ᅇ┠ࡢ LeAd-NCD ࣡ࢩࣙࣥ࡟ࡼࡗ࡚ࠊ⮬ศࡓࡕࡢᅜ࡟ᣢࡕᖐࡿ

࣮ࢡࢩࣙࢵࣉ࡛ࡍࠋࡇࡢ᫬ࡣࠊすᮾிᕷ࡟⾜࠸ࡃࡘ࠿ࡢࣄࣥࢺࢆぢࡘࡅ࡚࠸ࡃ࡜࠸࠺ᵓ

ࡁࠊ㧗㱋⪅ࡢᕷẸࡢ᪉ࠎࡀ⋡ඛࡋ࡚ࢩࣕ࢟

ᡂ࡛ࡋࡓࠋࣈࣝࢿ࢖ࠊ࢝ࣥ࣎ࢪ࢔ࠊ୰ᅜ࡟ຍ

ࢩࣕ࢟య᧯࡜࠸࠺㐠ືࢆᗈࡵ࡚࠸ࡿ࡜࠸࠺

࠼ࠊࢡࢵࢡ࢔࢖ࣛࣥࢻࡸࣃࣛ࢜ࠊࣂࢾ࢔ࢶ࡜

ࡇ࡜࡛ࠊࡑࡢ≧ἣࢆぢࡏ࡚࠸ࡓࡔࡁࡲࡋࡓࠋ

࠸ࡗࡓᓥᕋᅜࠊࡉࡽ࡟࣐࣮ࣞࢩ࢔ࠊࣔࣥࢦ

ᕷẸࡢ᪉࡜୍⥴࡟య᧯ࡋࠊࡑࡢᚋ୍⥴࡟ࢢࣝࠊ࣋ࢺࢼ࣒ࠊࣇ࢕ࣜࣆࣥ➼ࡢᨻ⟇ᢸᙜ⪅ࡀ࣮ࣝࣉ࣮࣡ࢡࢆ⾜࠸ࠊ஺ὶࢆ῝ࡵࡲࡋࡓࠋ

ཧຍࡋࡲࡋࡓࠋ5 ᪥㛫ࡢ࣮࣡ࢡࢩࣙࢵࣉ࡛
ࡋࡓࡀࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟ࡘ࠸࡚ࡶゐࢩࣝࣂ࣮࠿ࡽࢦ࣮ࣝࢻ࡬㸸ᆅᇦໟᣓࢣ࢔ࢆ

ࢀ࡚࠸ࡲࡍጞࡵࡿࡓࡵࡢ⬟ຊ㛤Ⓨ࣮࣡ࢡࢩࣙࢵࣉᐇࡣ JICA ࡢ◊ಟ࡜ࡋ࡚ 10 ᖺࡄࡽ࠸๓࡟

㸦2023.9.25-29 ⛉Ꮫ㝔࡟࠾ࡅࡿ WPRO ࡜㧗㱋໬ᑐ⟇ࢆ 4㹼5 ᖺ⥆ࡅ࡚ࡸࡗࡓࡇ࡜ࡀ

ࡢඹദ࣮࣡ࢡࢩࣙࢵࣉ㸧࠶ࡿࡢ࡛ࡍࡀࠊࡑࡢ᫬ࡣ࠶ࡲࡾⓙࡉࢇࣆࣥ23࡜ࡇ࡞࠿ࡗࡓࡽࡋࡃ࡚ཧຍ⪅ࡀ࠶ࡲࡾ㞟ࡲࡑࢀ࠿ࡽࣉࣟࢢ࣒ࣛෆᐜ࡟㛵ࡍࡿせồࡢࡽࡎࠊཧຍᅜࡶᅛᐃ໬ࡋࡓࡢ࡛ࠊࡑࡢ᫬ࡣ୍

ࣞ࣋ࣝࡀ࡜࡚ࡶୖࡀࡗ࡚ࡁ࡚࠸ࡲࡍࠋࡘࡲ

᪦⤊ࢃࡾ࡟࡞ࡾࡲࡋࡓࠋ௒ᅇࡸࡗ࡚ࡳࡿ࡜ࠊ

ࡾࠕ⥲ㄽࡣࡼࡃࢃ࠿ࡗ࡚࠸ࡿ࠿ࡽࡶ࠺࠸࠸ࠋ

ཧຍࡋࡓ࠸࡜࠸࠺ᅜࡀከࡃ࡞ࡗ࡚࠸࡚ࠊࡸ

⣽࠿࠸ࠊලయⓗ࡞ࡇ࡜ࢆᩍ࠼࡚ḧࡋ࠸ࠖ࡜࠸

ࡣࡾ୰పᡤᚓᅜ࡟࠾࠸࡚ࡶ㧗㱋໬࡟࡝࠺ྲྀ

࠺ࢽ࣮ࢬࡀ࡜࡚ࡶ࠶ࡾࡲࡍࠋ
౛࠼ࡤ UHC ࡢࡾ⤌ࢇࡔࡽ࠸࠸ࡢ࠿ࠊᨻ⟇࡟ᑐࡍࡿࢽ࣮ࢬ

ࢥ࣮ࢫ࡛ࡍ࡜ࠊࣞࢭࣉࢺᑂᰝࡢ⌧ሙࢆぢ࡟ࡀ㧗ࡲࡗ࡚࠸ࡿ࡜ឤࡌࡲࡋࡓࠋ⾜ࡁࡲࡍࠋࠕࡇ࠺࠸࠺ࡩ࠺࡟ᑂᰝࡋ࡚࠸ࡿࡢ
࠿ࠖ࡜ࠋࡶࡕࢁࢇࠊࡑࢀࢆࡑࡢࡲࡲ⮬ศࡢᅜࡇࡇ࠿ࡽࡣࠊ⚾ぢ࡟࡞ࡾࡲࡍࡀࠊࡇࡇ 20࡟ᣢࡗ࡚ᖐࡿࢃࡅ࡛ࡣ࡞࠸ࡢ࡛ࡍࡀࠊࡇ࠺

ᖺ࡯࡝ࡎࡗ࡜ࠊ⚾ಶே࡜ࡋ࡚ࡶ JICA ࡢ௙࠸࠺ࣉࣟࢭࢫࢆ⤒࡚ࠊ᪥ᮏࡣᅜẸⓙಖ㝤ไ஦࡛ࣇ࢕ࣜࣆࣥ࡟⾜ࡗࡓࡾ୰ᅜ࡟⾜ࡗࡓࡾᗘࢆ⥔ᣢࡋ࡚࠸ࡿࡢ࠿࡜࠸࠺ detail ࢆ▱ࡾࡋࡲࡋࡓࡋࠊᅜ㝿◊ಟࡶᐇ㝿࡟❧᱌࣭ᐇ᪋࡟

ࡓ࠸࡜࠸࠺⇕ពࢆឤࡌࡲࡍࠋ

㛵ࢃࡗ࡚ࡁࡲࡋ࡚ࠊ᭱㏆ᑡࡋኚ໬ࡋ࡚࠸ࡿ

ࡲࡓࠊ࠸࠸࡜ࡇࢁࡔࡅ࡛ࡣ࡞ࡃ࡚ࠊၥ㢟Ⅼ࡞࡜࠸࠺ࡇ࡜ࢆ⫙࡛ឤࡌ࡚࠾ࡾࡲࡍࠋࡲࡎ

ࡸ㐣ཤ࡟ኻᩋࡋࡓࡇ࡜ࡶᩍ࠼࡚࡯ࡋ࠸࡜࠸◊ ಟ ཧ ຍ ⪅ ࡀ highly educated & well࠺ࢽ࣮ࢬࡶ࠿࡞ࡾ࠶ࡾࡲࡍࠋ≉࡟ኻᩋࢆᩍ

mannered ࡢ᪉ࡀቑ࠼ࡓ࡜ᛮ࠸ࡲࡍࠋࡉࡽ

࠼࡚ࡃࢀ࡜ゝࢃࢀࡿ࡜ࠊࡇࡕࡽࡶᑡࡋᅔࡗ

࡟࣏ࣜࢩ࣮ࢧ࣏࣮ࢺ࡟ᑐࡍࡿࢽ࣮ࢬࡀ㧗ࡲ࡚ࡋࡲ࠸ࡲࡍࡀࠊ౛࠼ࡤࠊ
ࠕ㧗㱋⪅་⒪ࢆ↓ࡗ࡚࠸ࡿࠊࡘࡲࡾලయⓗ࡞ᨻ⟇ᨭ᥼ࢆࡋ࡚

ᩱ࡟ࡋࡓࡽࡇࢇ࡞ࡇ࡜ࡀ࠶ࡾࡲࡋࡓࠖ࡜࠸

࡯ࡋ࠸࡜࠸࠺ࢽ࣮ࢬࡢ㧗ࡲࡾ࡛ࡍࡡࠋ

࠺ࡇ࡜ࢆఏ࠼ࡓࡾࡋࡲࡍࠋ

24

ࡑࢀ࠿ࡽࠊ᫇ࡢཧຍ⪅ࡣࠕ࠾㔠ࡀ࡞࠸࠿ࡽ

ࡿ᪉ࡀᩘከࡃ࠾ࡽࢀࡲࡍࠋࡑ࠺࠸࠺᪉ࠎࡢ

࠺ࡕࡣ࡛ࡁ࡞࠸ࡼࠖ࡜ゝࢃࢀࡿ᪉ࡀᑡ࡞ࡃ

࡜ࡇࢁ࡟⾜ࡗ࡚ࠊᐇ㝿࡟ࡑࡢ⌧ሙࡢேࠊᆅᇦ

࡞࠿ࡗࡓࡢ࡛ࡍࡀࠊ᭱㏆ࡣ࠾㔠ࡀ࡞࠸࠿ࡽࡢே࡜ゐࢀ࠶ࡗ࡚ヰࢆࡍࡿࡇ࡜࠿ࡽࠊཧຍ

࡛ࡁ࡞࠸࡜ࡣ࠶ࡲࡾゝࢃࢀࡲࡏࢇࠋ࢔ࣇࣜ

⪅ࡣከࡃࢆᏛࡧࡲࡍࠋᐇ㝿ࠊ⚾ࡀᛮ࠸ࡶࡘ࠿

࢝ࡢ࠶ࡿᅜࡢ๪኱⮧ࡀ◊ಟ࡟᮶ࡽࢀࡓࡇ࡜

࡞࠿ࡗࡓࡼ࠺࡞ࡇ࡜ࢆᏛࢇ࡛ᖐࡽࢀ࡚࠸ࡲ

ࡀ࠶ࡿࡢ࡛ࡍࡀࠊࡑࡢ᪉ࡀࠊ
ࠕ࠾㔠ࡀ࡞࠸࠿

ࡍࠋࡲࡓࠊ᪥ᮏࡣ࡞ࡐࡇ࠺࠸࠺ࡇ࡜ࢆᐇ᪋ࡋ

ࡽ࡛ࡁ࡞࠸࡜ゝ࠺ேࡣࠊ࠾㔠ࡀ࠶ࡗ࡚ࡶ࡛

ࡓࡢ࠿ࠊ⌧≧ࡔࡅ࡛ࡣ࡞ࡃ࡚㐣ཤࡢࡇ࡜ࡶ

ࡁ࡞࠸ࡢࡼࠖ࡜࠾ࡗࡋࡷࡗ࡚࠸࡚ࠊ࡞ࡿ࡯࡝

▱ࡾࡓ࠸࡜ࡼࡃゝࢃࢀࡲࡍࠋࡑࡇ࠿ࡽࠊࣄࣥ

࡞ࠊ࡜ᛮ࠸ࡲࡋࡓࠋ㈨㔠ࡀ༑ศ࡛࡞࠸୰࡛ࠊ

ࢺࡸ᪂ࡋ࠸࢔࢖ࢹ࢕࢔ࢆᚓ࡚ࠊ⮬ᅜࡢᨻ⟇࡝࠺ᕤኵࡋ࡚ࡸࡗ࡚࠸ࡃ࠿࡜࠸࠺ࡇ࡜࡟ࠊ

࡟ᑡࡋ࡛ࡶ⏕࠿ࡋ࡚࠸ࡓࡔࡅࢀࡤ࠸࠸ࡢ࡛

௒ࠊ࣏ࣜࢩ࣮࣓࣮࣮࢝ࡢ㛵ᚰࡀ⛣ࡗ࡚࠸ࡿࡣ࡞࠸࠿࡜ᛮ࠸ࡲࡍࠋ

࡜ᛮ࠸ࡲࡍࠋ

◊ಟࢆ࣮࢜࢞ࢼ࢖ࢬࡍࡿࡢࡣ⛉Ꮫ㝔ࡢ◊◊ಟ࡜࠸࠺ᯟ⤌ࡳࡢ୰࡛ࠊ࠸ࢃࡤ୍ࡘ㔩✲⪅࡛ࡍࠋ◊✲⪅ࡀ◊ಟࣉࣟࢢ࣒ࣛࢆ࣮࢜

ࡢ㣤ࢆ㸯㐌㛫ࠊ2 㐌㛫࡜୍⥴࡟㣗࡭ࡿࡇ࡜࢞ࢼ࢖ࢬࡍࡿ฼Ⅼࡀ࠶ࡿ࡜ᛮ࠸ࡲࡍࠋࡶ࡜

࡛ࠊ࠾஫࠸࡟࡜ࡇ࡜ࢇࢹ࢕ࢫ࢝ࢵࢩࣙࣥࡋ

ࡶ࡜⛉Ꮫ㝔࡛ࡣ◊✲࡜◊ಟࡣ㌴ࡢ୧㍯࡛࠶

࡚ࠊྠࡌㄢ㢟ࡸᝎࡳ࡞࡝ࢆඹ᭷ࡍࡿࡇ࡜ࡣ

ࡾࠊ୧᪉ࡁࡕࢇ࡜ࡸࡿࡇ࡜ࢆࣔࢵࢺ࣮࡜ࡋ

࡜࡚ࡶ㈗㔜࡞ᶵ఍࡛ࠊ኱ษ࡞ࡇ࡜ࡔ࡜ឤࡌ

࡚ࡁࡲࡋࡓࠋ◊✲ᡂᯝࢆࡶ࡜࡟◊✲⪅ࡀ◊࡚࠸ࡲࡍࠋࡶࡕࢁࢇ 2㹼3 ᪥ࡢᅜ㝿఍㆟➼࡛ಟࣉࣟࢢ࣒ࣛࢆ❧᱌࣭ᐇ᪋ࡋ࡚Ꮫࡪࠊࡑࢀ࠿

఍ࡗ࡚ࢹ࢕ࢫ࢝ࢵࢩࣙࣥࡍࡿࡇ࡜ࡶ࠸࠸ࡢ

ࡽ◊ಟࢆᐇ᪋ࡍࡿࡇ࡜࡟ࡼࡗ࡚ࠊࡉࡽ࡟ࡑ

࡛ࡍࡀࠊࡑࢀ௨ୖ࡟ࡸࡣࡾ⏕άࢆඹ࡟ࡋ࡞

ࡢ◊✲࡟௜ຍ౯್ࢆࡘࡅࡿ࡜࠸࠺ࡇ࡜ࢆ⚾ࡀࡽ◊ಟࡍࡿࡇ࡜ࡢⰋࡉࡀ࠶ࡿ࡜ᛮ࠸ࡲࡍࠋ

ࡓࡕࡣ┠ᣦࡋ࡚࠸ࡲࡍࠋᙜ㝔ࡣᅜෆ◊ಟࡶᙼࡽࡣᮏᙜ࡟ࡎࡗ࡜ࢹ࢕ࢫ࢝ࢵࢩࣙࣥࡋ࡚

ᩘከࡃᐇ᪋ࡋ࡚࠸ࡲࡍࡀࠊ⚾ࡣࠊᅜෆ◊ಟ࡜࠸ࡲࡍࠋࢥ࣮ࣄ࣮ࣈࣞ࢖ࢡ࡛ࡶࠊ⣚Ⲕࢆ㣧ᅜ㝿◊ಟࡣ➼౯ࡔ࡜ᛮࡗ࡚࠸ࡲࡍࠋ୧᪉኱

ࡳࠊ࠾ⳫᏊࢆࡘࡲࡳ࡞ࡀࡽ⇕ᚰ࡟ࢹ࢕ࢫ࢝

ษ࡛ࡍࠋᅜෆ◊ಟࡢᘏ㛗ୖ࡟ᅜ㝿◊ಟࡀ࠶ࢵࢩࣙࣥࡋ࡚࠸ࡿጼࢆぢ࡚ࠊ᪥ᮏࡀᥦ౪࡛

ࡾࠊᅜ㝿◊ಟࡢᘏ㛗ୖ࡟ᅜෆ◊ಟࡀ࠶ࡿࠋ୧

ࡁࡿࡶࡢࡣ୍యఱࡔࢁ࠺࠿ࠊ࡜⪃࠼ࡿࡇ࡜᪉ࡸࡗ࡚ࡑࢀࡒࢀࢆά࠿ࡋ࡚࠸ࡃࡇ࡜ࡀ኱

ࡶࡋࡤࡋࡤ࡛ࡍࠋ

ษࡔ࡜ᛮࡗ࡚࠸ࡲࡍࠋ
᭱ᚋ࡟࡞ࡾࡲࡍࡀࠊேᮦ⫱ᡂ࡟࠾࠸࡚ࡣࠊ

⚾࡝ࡶᅜ❧ಖ೺་⒪⛉Ꮫ㝔ࡢᅜ㝿༠ຊࡣࠊᖖ࡟ᩗពࢆᣢࡗ࡚◊ಟཧຍ⪅࠿ࡽᏛࡪጼໃ

ࡸࡣࡾ human resources developmentࠊ≉ࢆᣢࡕ⥆ࡅ࡚࠸ࡃࡇ࡜ࡀ኱ษࡔ࡜⪃࠼࡚࠸࡟࣏ࣜࢩ࣮࣓࣮࣮࢝ࡸᨻᗓࡢ⾜ᨻᐁ࡟ᑐࡍ

ࡲࡍࠋࡿࡶࡢ࡛ࠊ࠸ࢃࡺࡿᨻ⟇ேᮦࢆ⫱࡚࡚࠸ࡃ௨ୖ࡛⚾ࡢⓎ⾲ࢆ⤊ࢃࡾࡲࡍࠋࡈΎ⫈࠶ࡢࡀ⛉Ꮫ㝔ࡢᅜ㝿㈉⊩࡛࠶ࡿ࡜ᛮ࠸ࡲࡍࠋ

ࡾࡀ࡜࠺ࡈࡊ࠸ࡲࡋࡓࠋ

ෆᐜࡣᨻ⟇㛤Ⓨ࡛࠶ࡗࡓࡾࠊᐇ᪋࡛࠶ࡗࡓࡾࠊホ౯࡛࠶ࡗࡓࡾᵝࠎ࡛ࡍࠋ⚾࡝ࡶࡀ≉࡟㔜どࡋ࡚࠸ࡿࡢࡀࣇ࢕࣮ࣝࢻࣅࢪࢵࢺ࡛ࡍࠋ
᪥ᮏࡢྛᆅᇦ࡟ࡣࠊᵝࠎ࡞άືࢆࡉࢀ࡚࠸

25◊✲ㄽᩥ

26

࠙㈨ᩱࠚ
࣑࣐࣮ࣕࣥ࡟࠾ࡅࡿ་Ꮫⓗࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᥦ౪ࡢ⌧≧Current Situation of Medical Rehabilitation Services Provision in Myanmar
Phyo Thant Maw 1) #ᒣཱྀెᑠ㔛 2)㸪኱ሯ㐍 3)㸪
బࠎᮌ⏤⌮ 4)㸪ᖹ㔝ᜤᖹ 1)㸪Ἑ㔝┾ 5)
Phyo Thant Maw 1) #Kaori YAMAGUCHI 2)㸪Susumu OTSUKA 3)㸪
Yuri SASAKI 4)㸪Kyohei HIRANO 1)㸪Makoto KONO 5)
せ᪨㏆࠸ᑗ᮶㸪௚ࡢ࢔ࢪ࢔ㅖᅜ࡜ྠᵝ࡟࣑࣐࣮ࣕࣥ࡟࠾࠸࡚ࡶ㧗㱋໬ࡸ⑌⑓ᵓ㐀ࡢኚ໬࡟ࡼࡾ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢽ࣮ࢬࡢቑ኱ࡀぢ㎸ࡲࢀࡿ㸬ࡑࡇ࡛㸪㛵㐃ࡍࡿ᪤Ꮡ㈨ᩱࢆ཰
㞟ࡋ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᥦ౪ࡢ⌧≧࡟ࡘ࠸࡚ᩚ⌮ࡋࡓ㸬࣑࣐࣮࡛ࣕࣥࡣࣘࢽࣂ࣮ࢧࣝ࣊ࣝࢫ࢝ࣂࣞࢵࢪࡣᮍ㐩ᡂ࡛࠶ࡿࡀ㸪බⓗ་⒪᪋タ࡟࠾࠸࡚↓ᩱ࡛ᥦ౪ࡉࢀࡿࢧ࣮ࣅࢫ࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡶྵࡲࢀࡿ㸬ᚑ஦⪅ࡣ⌮Ꮫ⒪ἲኈ
ࡀ᭱ࡶከࡃ㸪ࡑࡢ௚࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་ᖌ㸪⩏⫥⿦ලኈࡀᅜෆ࡛㣴ᡂࡉࢀ࡚࠸ࡿ㸬⑓ᗋᩘ 100 ᗋ௨ୖࡢ⑓㝔࡛ࡣ⑓ᗋᩘ࡟ᛂࡌࡓ⌮Ꮫ⒪ἲኈࡢ㓄⨨ᇶ‽ࡀタࡅࡽࢀ࡚࠸ࡿ㸬㏆ᖺࡢືྥ࡜ࡋ࡚㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢᙉ໬ࡢࡓࡵࡢィ⏬ࡀ 2019 ᖺ࡟Ⓨฟࡉࢀ㸪≉࡟㸪࢔ࢡࢭࢫࡢቑຍ㸪ປാຊࡢᙉ໬㸪ᨭ᥼ᶵჾ࡬ࡢ࢔ࢡࢭࢫࡢᣑ኱࡟㔜Ⅼࡀ⨨࠿ࢀ࡚࠸ࡿ㸬 ♫఍࡟࠾࠸࡚ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ㔜せᛶࡀㄆ㆑ࡉࢀ㸪ᬑཬ࣭ᙉ໬ࡀ┠ᣦࡉࢀ࡚࠸ࡿ㸬௒ᚋࡢ㐍ᤖࢆὀどࡋ࡚࠸ࡃᚲせࡀ࠶ࡿ㸬࣮࣮࢟࣡ࢻ㸸࣑࣐࣮ࣕࣥ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㸪ไᗘ㸪⌮Ꮫ⒪ἲ㸪་⒪ࢧ࣮ࣅࢫ

1) ་⒪ἲே኱㑣 ࡔ࠸࡞ࣜࣁࣅࣜࢡࣜࢽࢵࢡ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊
Daina Medical Corporation, Daina Rehabilitation Clinic, Section of Rehabilitation2) ᅜ❧ಖ೺་⒪⛉Ꮫ㝔 ་⒪࣭⚟♴ࢧ࣮ࣅࢫ◊✲㒊
National Institute of Public Health, Department of Health and Welfare Services3) ≉ᐃ㠀Ⴀ฼άືἲே Rehab-Care for ASIA
Nonprofit Organization, Rehab-Care for ASIA
4) ᅜ❧ಖ೺་⒪⛉Ꮫ㝔 බ⾗⾨⏕ᨻ⟇◊✲㒊
National Institute of Public Health, Department of Public Health Policy5) ᅜ㝿་⒪⚟♴኱Ꮫ ᑠ⏣ཎಖ೺་⒪Ꮫ㒊 సᴗ⒪ἲᏛ⛉International University of Health and Welfare, School of Health Sciences at Odawara,
Department of Occupational Therapy#Email: phyothantmaw@gmail.com ཷ௜᪥ 2023 ᖺ 9 ᭶ 25 ᪥㸭ཷ⌮᪥ 2024 ᖺ 1 ᭶ 29 ᪥

271㸬⥴ゝ

ⓗ࡜ࡍࡿ㸬ࡲࡓᮏሗ࿌ࡀ㸪ᙜヱศ㔝࡟࠾ࡅࡿᅜ㝿༠ຊᨭ᥼ࢆ᳨ウࡍࡿ㝿ࡢ୍ຓ࡜࡞ࡿࡇ

㏆ᖺ㸪㧗㱋໬ࡸឤᰁᛶ⑌ᝈ࠿ࡽ㠀ឤᰁᛶ࡜ࢆᮇᚅࡍࡿ㸬⑌ᝈ࡬ࡢ⑌⑓ᵓ㐀ࡢኚ໬࡟క࠸㸪ᑗ᮶ⓗ࡞ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢽ࣮ࢬቑ኱ࡀୡ⏺ⓗ࡞2㸬᪉ἲㄢ㢟࡜࡞ࡗ࡚࠸ࡿ 1)㸬ࡇࢀ࡟ഛ࠼ࡿࡓࡵ㸪ୡ⏺ಖ೺ᶵ㛵(World Health Organization㸪࣑࣐࣮ࣕࣥ࡟࠾ࡅࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ

௨ୗ㸪WHO )࡛ࡣ≉࡟୰పᡤᚓᅜ࡟࠾ࡅࡿ

ࡢᥦ౪≧ἣ࡟㛵㐃ࡍࡿ㸪᪤Ꮡ㈨ᩱࡢ཰㞟࣭ศࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ₯ᅾⓗ࠶ࡿ࠸ࡣᮍᑐ

ᯒࢆ⾜ࡗࡓ㸬ඛ⾜◊✲ࡸ⾜ᨻ㈨ᩱ➼࡟࠾࠸ᛂࡢࢽ࣮ࢬ࡟ᑐࡍࡿྲྀࡾ⤌ࡳࡢ᥎㐍࡚㸪ᮏࢸ࣮࣐࡟㛵㐃ࡍࡿࡶࡢࢆᑐ㇟࡜ࡋࡓ㸬

Rehabilitation 2030 ࢆ㐍ࡵ࡚࠸ࡿ 2)㸬࡞࠾㸪࣑࣐࣮ࣕࣥㄒ࣭ⱥㄒ࣭᪥ᮏㄒ࡛グ㍕ࡉ ࢔ࢪ࢔ㅖᅜ࡟࠾࠸࡚ࡣ௒ᚋᛴ㏿࡟㧗㱋໬ࢀࡓ㈨ᩱࢆᑐ㇟࡜ࡋࡓ㸬ᚓࡽࢀࡓ㈨ᩱ࠿ࡽ㸪3)㸬࣑࣐ࣕࣥ

࣑࣐࣮ࣕࣥ࡟࠾ࡅࡿ㸪ಖ೺་⒪ไᗘ㸪ࣜࣁࣅ࣮࡛ࡶྠᵝ࡟ᑗ᮶ⓗ࡞㧗㱋໬ࡀぢ㎸ࡲࢀ࡚ࣜࢸ࣮ࢩࣙࣥࢧ࣮ࣅࢫࡢᥦ౪యไ㸪ࣜࣁࣅ࠾ࡾ 4)㸪ࡲࡓ㸪࣑࣐࣮ࣕࣥ࡟࠾ࡅࡿṚஸせᅉࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋ࡢ㣴ᡂ࡟㛵ࡍࡿ᝟ሗࢆ

࡞ࡽࡧ࡟ධ㝔ᝈ⪅࡟༨ࡵࡿᚰ⾑⟶⑌ᝈ㸪៏཰㞟࣭ᩚ⌮ࡋࡓ㸬࡞࠾㸪ᮏㄪᰝࡣ࢖ࣥࢱ࣮ࢿ

ᛶ࿧྾ჾ⑌ᝈ㸪⒴➼ࡢ㠀ឤᰁᛶ⑌ᝈࡢ๭ྜ

ࢵࢺୖ࡟බ㛤ࡉࢀࡓ㈨ᩱࡢࡳࢆᑐ㇟࡜ࡋ࡚

ࡣ㏆ᖺቑຍࡋ࡚࠸ࡿࡇ࡜࠿ࡽ 5)6) 㸪࣑࣐ࣕࣥ࠾ࡾ㸪೔⌮ᑂᰝࡢᑐ㇟࡜ࡣ࡞ࡽ࡞࠸㸬ࡀ㐍⾜ࡍࡿ࡜ண

ࡉࢀ࡚࠸ࡿ࣮࡟࠾࠸࡚௒ᚋࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢽ࣮ࢬ
ࡀቑ኱ࡍࡿࡇ࡜ࡀ⪃࠼ࡽࢀࡿ㸬3㸬⤖ᯝ ࡇࡢࡼ࠺࡞ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢽ࣮ࢬቑ

 ᑐ㇟㈨ᩱࡣ㸪Ꮫ⾡ㄽᩥ㸦7 ௳㸧㸪࣑࣐ࣕࣥ኱࡬ࡢᑐᛂࢆ᳨ウࡍࡿ㝿ࡢᇶ♏᝟ሗ࡜ࡋ࡚㸪࣮ࡢ⾜ᨻ㈨ᩱ㸦4 ௳㸧㸪᪥ᮏࡢ⾜ᨻ㈨ᩱ㸦2ᮏ✏࡛ࡣ࣑࣐࣮ࣕࣥ࡟࠾ࡅࡿࣜࣁࣅࣜࢸ࣮

௳㸧㸪ᅜ㝿ᶵ㛵ࡢ㈨ᩱ㸦12 ௳㸧㸪ࡑࡢ௚ሗ࿌

ࢩࣙࣥᥦ౪ࡢ⌧≧ࢆ᫂ࡽ࠿࡟ࡍࡿࡇ࡜ࢆ┠᭩࡞࡝㸦4 ௳㸧ࡢィ 29 ௳࡛࠶ࡗࡓ㸬௨ୗ㸪

ࢹ࣮ࢱ 11) 㸪 16) 㸪 21) ࢆඖ࡟➹⪅ࡀసᡂ㸬ᅜ㸦㐃㑥㡿㸧㸸 Union Territory 㸪ᕞ࣭ᆅ᪉ᇦ㸸 State ࣭ Region 㸪┴㸸 District㸪㒆㸸 Township㸪⏫㸸 Town 㸪༊㸸 Ward 㸪ᮧ༊㸸 Village Tracts 㸪ᮧ㸸 Village28୺࡜ࡋ࡚࣑࣐࣮ࣕࣥࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ

࡭࡚ࡢேࡀ㸪ᚲせ࡞࡜ࡁ࡟ᨭᡶ࠸ྍ⬟࡞㈝ࢆᢸ࠺⌮Ꮫ⒪ἲ࣭⌮Ꮫ⒪ἲኈ࡟↔Ⅼࢆᙜ࡚⏝࡛㐺ษ࡞་⒪ࢧ࣮ࣅࢫࢆཷࡅࡽࢀࡿ≧ែ࡞ࡀࡽ㸪཰㞟ࡋࡓ᝟ሗࢆࢸ࣮࣐ࡈ࡜࡟ᩚ⌮ࢆᣦࡍUniversal Health Coverage(௨ୗ㸪ࡍࡿ㸬UHC)ࡣᮍ㐩ᡂ࡛㸪2021 ᖺ᫬Ⅼ࡛ UHC ᣦᩘࡣ 52 2019 ᖺ᫬Ⅼ࡛ 60 ࡛࠶ࡿ 10)㸬࡞࠾㸪

3㸬1 ࣑࣐࣮ࣕࣥࡢᴫせ⾜ᨻࡢ༊ศࡣ㸪ᅜ㸦㐃㑥㡿㸧
㸸Union Territory㸪 2014 ᖺ࡟ᐇ᪋ࡉࢀࡓ᭱᪂ࡢᅜໃㄪᰝ࡟

ᕞ࣭ᆅ᪉ᇦ㸸State࣭Region㸪┴㸸 District㸪ࡼࡿ࡜㸪࣑࣐࣮ࣕࣥࡣ㸪⥲ேཱྀ 5,149 ୓ே㸪㒆㸸 Township㸪⏫㸸Town㸪༊㸸Ward㸪ᮧ65 ṓ௨ୖࡢ㧗㱋⪅ேཱྀ 290 ୓ே㸦㧗㱋໬⋡༊㸸Village Tracts㸪ᮧ㸸Village ࠿ࡽᡂࡿ 11)㸬5.8%㸧࡛㸪ᖹᆒᑑ࿨ࡣ 66.8 ṓ㸦⏨ᛶ 63.9

㸦ᅗ 1㸧

ṓ㸪ዪᛶ 69.9 ṓ㸧࡛࠶ࡿ 7)㸬ࡲࡓ㸪᐀ᩍࡈ࡜ࡢேཱྀẚࡣ㸪௖ᩍࡀ 87.9%࡛᭱ࡶከ࠸ 8)㸬

3㸬2 ࣑࣐࣮ࣕࣥࡢಖ೺་⒪ไᗘ⤒῭≧ἣ࡟ࡘ࠸࡚ࡣ㸪2022 ᖺ᫬Ⅼ࡟࠾࠸࡚㸪 1951 ᖺ࡟㸪බ❧ࡢ་⒪᪋タ࡟ᅜẸࡀ⮬ᕫ

GDP:594 ൨ ⡿ ࢻ ࣝ 㸪 ୍ ே ᙜ ࡓ ࡾ㈇ᢸ࡞ࡃデ⒪ࢆ࠺ࡅࡿࡇ࡜ࡀ࡛ࡁࡿࢩࢫࢸ

GDP095.7 ⡿ࢻࣝ㸪ᖺ㛫 GDP ᡂ㛗⋡㸸࣒ࡀᩚഛࡉࢀࡓ 12)13)㸬බ㈝ࢆ㈈※࡜ࡍࡿࡇ

3.0%࡛࠶ࡾ㸪࠸ࡎࢀࡶ 2019 ᖺࡢ್࠿ࡽప

ࡢࢩࢫࢸ࣒ࡣ㸪⌧ᅾࡶ㐺⏝ࡉࢀ࡚࠾ࡾ㸪බ❧ୗࡋ࡚࠸ࡿ 9)㸬ಖ೺་⒪ࡢ≧ἣ࡟㛵ࡋ࡚㸪ࡍࡢ་⒪᪋タࡢデ⒪ࡢ୍㒊ࡀ↓ᩱ࡛ཷࡅࡽࢀ

ࢹ࣮ࢱ 19) 㸪 30) 㸦་ᖌ࣭┳ㆤᖌᩘࡣேཱྀ 1,000 ேࡈ࡜ࡢேᩘ㸪⌮Ꮫ⒪ἲኈᩘࡣேཱྀ 1 ୓ேࡈ࡜ࡢேᩘ㸧ࢆཧ⪃࡟➹⪅ࡀసᡂ㸬⌮Ꮫ⒪ἲኈᩘ࡟ࡘ࠸࡚ࡣ㸪࠸ࡎࢀࡢᅜࡶ 2022 ᖺ᫬Ⅼࡢ್㸪་ᖌᩘ࣭┳ㆤᖌᩘ࡟ࡘ࠸࡚ࡣ㸪࣋ࢺࢼ࣒ 2016 ᖺ㸪᪥ᮏ࣭ࣔࣥࢦࣝ 2018 ᖺ㸪࣑࣐࣮࣭ࣕࣥࣃ࢟ࢫࢱࣥ 2019 ᖺ㸪ࢿࣃ࣮࣭ࣝ࢖ࣥࢻࢿࢩ࢔࣭࢖ࣥࢻ࣭ࢫ࣭ࣜࣛࣥ࢝ࣂࣥࢢ
ࣛࢹࢩࣗ 2020 ᖺࡢ್㸪ࣇ࢕ࣜࣆࣥ࡟ࡘ࠸࡚ࡣ་ᖌᩘ 2020 ᖺ࣭┳ㆤᖌᩘ 2019 ᖺࡢ್㸪࢝ࣥ࣎ࢪ࢔࡟ࡘ࠸࡚ࡣ་ᖌᩘ 2014 ᖺ㸪┳ㆤᖌᩘ 2019 ᖺࡢ್ࢆᘬ⏝ࡋ࡚࠸ࡿ㸬29ࡿ㸬ࡋ࠿ࡋ㸪᳨ᰝ㸪୍㒊ࡢ⸆๣㸪ධ㝔㈝➼ࡣࣥ࡬ࡢ࢔ࢡࢭࢫࡢᣑ኱㸪ᨭ᥼ᶵჾ࡬ࡢ࢔ࢡ

ไᗘࡢ㐺⏝⠊ᅖእ࡛㸪ᝈ⪅㈇ᢸ࡜࡞ࡿࡓࡵ㸪ࢭࢫࡢቑຍ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥປാຊࡢ

≉࡟㎰ᮧ㒊ࡢୡᖏ࡟࠾࠸࡚㸪⏕ά㈝࡟࠾ࡅ

ᙉ໬࡜ᣑ኱㸪࣊ࣝࢫࢧ࣮ࣅࢫ࡬ࡢࣜࣁࣅࣜ

ࡿ་⒪㈝ᨭฟ㈇ᢸࡀ኱ࡁ࠸ࡇ࡜ࡀㄢ㢟࡜࡞ࢸ࣮ࢩࣙࣥࡢ⤫ྜ➼ࢆ┠ᶆ࡟ᐃࡵࡽࢀ࡚࠸

ࡗ࡚࠸ࡿ 14)㸬ࡿ㸬 ࣑࣐࣮ࣕࣥࡢಖ೺་⒪⾜ᨻࡣ㸪ಖ೺┬ᅜ3㸬3㸬2 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᥦ౪᪋タ࣭ᚑࣞ࣋ࣝ㸪ᕞ࣭ᆅ᪉ᇦಖ೺ᒁᕞ࣭ᆅ᪉ᇦࣞ࣋

஦⪅࡜ᥦ౪ෆᐜ

ࣝ㸪┴ಖ೺ᒁ┴࡛ࣞ࣋ࣝ⾜ࢃࢀ࡚࠸ࡿ 15)㸬

 ࣑࣐࣮ࣕࣥ࡟࠾࠸࡚ࡣ㸪సᴗ⒪ἲኈ㸪ゝㄒᅜ❧ᑓ㛛⑓㝔࣭኱Ꮫ⑓㝔࡛ࡣ㸪㧗ḟᑓ㛛་⒪⫈ぬኈࡢ㣴ᡂࡣ⾜ࢃࢀ࡚࠾ࡽࡎ㸪ࣜࣁࣅࣜࡢᥦ౪ࡸ་⒪ᚑ஦⪅ࡢᩍ⫱ࢆᢸࡗ࡚࠸ࡿ㸬ࢸ࣮ࢩࣙࣥ་ᖌ㸪⌮Ꮫ⒪ἲኈ㸪⩏⫥⿦ලኈࡀᕞ࣭ᆅ᪉ᇦࡈ࡜ࡢ୰᰾་⒪ᶵ㛵࡛࠶ࡿ⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟ᚑ஦ࡋ࡚࠸ࡿ 23)㸬࣑⑓㝔㸪་ᖌᩘྡࡀᖖ㥔ࡋ࡚࠸ࡿ㒆⑓㝔㸪་࣐࣮ࣕࣥࡢ⌮Ꮫ⒪ἲኈࡢ᭷㈨᱁⪅ࡣ⣙ᖌ࣭ຓ⏘ᖌ࣭࣊ࣝࢫ࣮࣮࣡࢝➼ࡀ㓄⨨ࡉࢀ࡚

2,000 ே࡜ࡉࢀ࡚࠸ࡿࡀ㸪ᅜእࡸ௚ࡢ⫋✀࡬࠸ࡿᆅᇦಖ೺ࢭࣥࢱ࣮ࡀ࠶ࡿ 17)㸦ᅗ 1㸧㸬ࡢὶኻࡀ࠶ࡿࡓࡵ㸪ᅜෆ࡟࠾ࡅࡿ⌮Ꮫ⒪ἲ

 Ẹ㛫ࡢ་⒪᪋タࡣ඲ᅜ࡛⣙ 6,000 ࠿ᡤ࠶ኈᩘࡣ⣙ 1,000 ே⛬ᗘ࡛࠶ࡿ㸬ࡇࡢ࠺ࡕᅜ

ࡿ㸬ከࡃࡣ་ᖌ 1 ྡࡢデ⒪ᡤ࡛㸪㒔ᕷ㒊࡟❧⑓㝔࡟࠾ࡅࡿ⌧⫋⪅ࡀ⣙ 350 ே㸦2018 ᖺ㞟୰ࡋ࡚࠾ࡾ㸪ᥦ౪ࡉࢀࡿࢧ࣮ࣅࢫࡣබⓗ᫬Ⅼ㸧࡛࠶ࡿ 24)㸬ࡑࡢ࡯࠿㸪Ẹ㛫⑓㝔࣭デ་⒪ಖ㝤ࡀ㐺⏝ࡉࢀ࡞࠸㸬⒪ᡤ㸪⚟♴᪋タࡸ NGO ᪋タ㸦㞀ᐖඣ࣭⪅㸪 ࡑࡢ௚㸪ࣁ࣮ࣈ࡞࡝ࢆ౑ࡗ࡚἞⒪ࢆ⾜࠺㧗㱋⪅᪋タ➼㸧࡟໅ົࡋ࡚࠸ࡿ⪅ࡀ⣙ 500ఏ⤫་⒪⑓㝔ࡸᅜෆእࡢ NGO ࡞࡝ࡀᐇ᪋

ே࠸ࡿ㸬⾜ᨻ༊ࡈ࡜ࡢ⌮Ꮫ⒪ἲኈࡢ㓄⨨ࢆࡍࡿᆅᇦಖ೺άືࡀ࠶ࡿ 18)㸬ᅗ 1 ࡟♧ࡍ㸬་⒪ᚑ஦⪅ᩘ࡟ࡘ࠸࡚㸪ᅗ 2 ࡟♧ࡍ 19)㸬 ࣑࣐࣮ࣕࣥࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་⒪ࡢ⌧ሙ࡛ࡣ㸪᪥ᖖ⏕άືస㸦Activities of Daily

3㸬3 ࣑࣐࣮ࣕࣥࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢧ

Living㸪௨ୗ㸪ADL㸧ࡢホ౯࣭カ⦎ࡣ࠶ࡲ࣮ࣅࢫࡢᥦ౪యไ

ࡾ⾜ࢃࢀ࡚࠾ࡽࡎ㸪⌮Ꮫ⒪ἲኈ࡟ࡼࡿ⑊③

3㸬3㸬1 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㛵ࡍࡿἲ

㍍ῶࡢࡓࡵࡢ≀⌮⒪ἲࡸ㉳❧࣭Ṍ⾜カ⦎࡞ᚊ࣭ไᗘ࡜㏆ᖺࡢືྥ

࡝ᇶ♏ⓗືసカ⦎ࡀ୺࡟⾜ࢃࢀ࡚࠸ࡿ㸬⌮ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡣ࣑࣐࣮ࣕࣥࡢබ❧Ꮫ⒪ἲኈ࠿ࡽᣦᑟࢆཷࡅࡓᝈ⪅ᐙ᪘ࡀࣜࣁ

ࡢ་⒪᪋タ࡟࠾࠸࡚ᥦ౪ࡉࢀࡿࢧ࣮ࣅࢫ࡟

ࣅࣜࢸ࣮ࢩࣙࣥࣉࣟࢢ࣒ࣛࢆ⾜࠺ࡇ࡜ࡶከ

ྵࡲࢀࡿ 20)㸬ࡲࡓ㸪௒ᚋ᝿ᐃࡉࢀࡿ࣑ࣕࣥ࠸ 21)㸬࣐࣮♫఍ࡢ㧗㱋໬ࢆ㋃ࡲ࠼࡚㸪㧗㱋⪅࡟ᑐ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀ༑ศᬑཬࡋ࡚࠸࡞

ࡍࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀ㐍ࡵࡽࢀ࡚࠸ࡿ

࠸ᆅᇦ࡟࠾࠸࡚ࡣ㸪♫఍ಖ㞀┬ࡸಖ೺┬ࡀ20)㸬ᑓ㛛⫋ࡢ㓄⨨ᇶ‽࡟㛵ࡋ࡚ࡣ㸪⑓ᗋᩘ

୺యࡢ Community-Based Rehabilitation

100 ᗋ௨ୖࡢ་⒪ᶵ㛵࡟࠾࠸࡚⌮Ꮫ⒪ἲኈ

㸦CBR㸧ࡢྲྀࡾ⤌ࡳࡀ 1990 ᖺ௦࠿ࡽ⾜ࢃࡢ㓄⨨ᇶ‽ࡀタࡅࡽࢀ࡚࠸ࡿ 21)㸬㸦ᅗ 1㸧㏆ࢀ࡚࠾ࡾ㸪ࡇࡢ୰࡛་Ꮫⓗ࡞ࣜࣁࣅࣜࢸ࣮

ᖺࡢືྥ࡜ࡋ࡚㸪2019 ᖺ 9 ᭶㸪࣑࣐࣮ࣕࣥ

ࢩࣙࣥࡶᥦ౪ࡉࢀ࡚࠸ࡿ 25)㸬CBR ᑓ㛛ࡢ㣴ᨻᗓࡣ WHO ➼ࡢᨭ᥼ࢆཷࡅ㸪ಖ೺࣭ࢫ࣏

ᡂࢥ࣮ࢫࢆಟ஢ࡋࡓ⌮Ꮫ⒪ἲኈ࡜ࣜࣁࣅࣜ

࣮ࢶ┬࡜♫఍⚟♴࣭ᩆ῭᚟⯆┬ࡢྜྠ࡛ࣜ

ࢸ࣮ࢩࣙࣥ་ᖌࢆ୰ᚰ࡜ࡋ࡚㸪ᙜヱᆅᇦࡢࣁࣅࣜࢸ࣮ࢩࣙࣥᅜᐙィ⏬㸦2019-2023㸧ࢆ┳ㆤᖌ࣭࣎ࣛࣥࢸ࢕࢔࣭ᆅᇦఫẸࢆᑐ㇟࡜ࡋ

Ⓨฟࡋࡓ 22)㸬ࡑࡢ୰࡛㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙ

30ࡓㅮ⩦఍㸪ᐙᗞゼၥ㸪㞀ᐖࡢ࠶ࡿ⪅࡞ࡽࡧ࡟

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4 ᖺไ኱Ꮫ࡛ࡢᩍ⫱ࡀ㛤ጞࡉࢀࡓ㸦ࣖࣥࢦ

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Ꮫᖺ 50 ே⛬ᗘ࡛࠶ࡿ㸬ࣖࣥࢦࣥ་⒪ᢏ⾡኱Ꮫࡢ⌮Ꮫ⒪ἲኈ㣴ᡂ࣒࢝ࣜ࢟ࣗࣛࢆ⾲ 1 ࡟⛉┠♧ࡍ 26)㸬࣑࣐࣮ࣕࣥࡢ⌮Ꮫ⒪ἲኈࡣᅜᐙヨ㦂ࢆ⤒࡚ྲྀᚓࡍࡿ㈨᱁࡛ࡣ࡞ࡃ㸪ᐇ㉁ⓗ࡟㣴ᡂᰯ༞ᴗࡀ㈨᱁࡜ࡳ࡞ࡉࢀࡿ㸬࡞࠾㸪࣑࣐࣮ࣕࣥ⌮Ꮫ⒪ἲኈ༠఍ࡀ 2013 ᖺ࡟タ❧ࡉ

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ᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓㝔ࡲࡓࡣ⿦ලᕤ
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ෆ⣙ 5 ࠿ᡤ㸧࡛໅ົࡋ࡚࠸ࡿ㸬ࣜࣁࣅࣜࢸ
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5600᫬㛫㸦147༢఩㸧ᥖ㍕ࢹ࣮ࢱ 26)ࢆཧ⪃࡟➹⪅ࡀసᡂ㸬

4㸬⪃ᐹ࢔࣮࣮࣭࢚ࣜࢡࢫ࣏࣮ࢪ࣮ࣕࡣ᪩ᮇయ㦂Ꮫ⩦ࢆᣦࡍ㸬⤖ᯝ࠿ࡽ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋ࡢ㔞

31ⓗ࡞୙㊊࡜೫ᅾࡢྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿ㸬࣑ࣙࣥࡀ㐍ࡵࡽࢀ࡚࠸ࡿ㸬ࡲࡓ㸪ࣜࣁࣅࣜࢸ࣮

࣐࣮࡛ࣕࣥࡣ௚ࡢᅜ࡜ẚ㍑ࡋ࡚ேཱྀ 10 ୓ࢩࣙࣥᙉ໬ࡢࡓࡵࡢィ⏬ࡀ 2019 ᖺ࡟Ⓨฟே࠶ࡓࡾࡢ⌮Ꮫ⒪ἲኈࡢᩘࡀᑡ࡞࠸㸬ࡲࡓ㸪ࡉࢀ㸪≉࡟㸪࢔ࢡࢭࢫࡢቑຍ㸪ປാຊࡢᙉ໬㸪┴ࡼࡾᑠࡉ࠸ࣞ࣋ࣝࡢ⑓㝔ࡸಖ೺ࢭࣥࢱ࣮

ᨭ᥼ᶵჾ࡬ࡢ࢔ࢡࢭࢫࡢᣑ኱࡟㔜Ⅼࡀ⨨࠿࡟ࡣ⌮Ꮫ⒪ἲኈࡢ㓄⨨ᇶ‽ࡀ࡞ࡃ㸪୙ᅾ࡛ࢀ࡚࠸ࡿ㸬♫఍࡟࠾࠸࡚ࣜࣁࣅࣜࢸ࣮ࢩࣙ

࠶ࡿྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿ㸬CBR ࡢྲྀࡾ⤌ࡳࣥࡢ㔜せᛶࡀㄆ㆑ࡉࢀ㸪ᬑཬ࣭ᙉ໬ࡢࡓࡵࡢ

ࡶ⾜ࢃࢀ࡚࠸ࡿࡀ㸪ᮍࡔࣜࣁࣅࣜࢸ࣮ࢩࣙ

ィ⏬ࡀ㐍ࡵࡽࢀ࡚࠸ࡿ㸬୍᪉㸪ಖ೺་⒪యไ

ࣥࡢᬑཬࡣ༑ศ࡛ࡣ࡞࠸㸬ࡇࢀࡽࡢࡇ࡜࠿

ࡢⓎᒎ࡟ࡣ㸪ᨻ἞࣭⤒῭ࡢᏳᐃࡀ୙ྍḞ࡛࠶ࡽ㸪ᆅᇦ࡟ࡼࡗ࡚ࡣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀ

ࡿ㸬௒ᅇཧ↷ࡋࡓࢹ࣮ࢱࡣᨻኚ๓ࡢࡶࡢࢆ

ᚲせ࡞⪅࡟ᒆ࠸࡚࠸࡞࠸ྍ⬟ᛶࡀ࠶ࡿ㸬ࡇྵࢇ࡛࠾ࡾ㸪ᨻኚ࡟ࡼࡾࢧ࣮ࣅࢫᥦ౪≧ἣࢀ࡟ᑐࡋ࡚㸪௚ࡢಖ೺་⒪ࢧ࣮ࣅࢫ࡜ేࡏ

ࡣኚ໬ࡋ࡚࠸ࡿྍ⬟ᛶࡶ࠶ࡿ 29)㸬௒ᚋ㸪ィ࡚㸪UHC ࢆ㐩ᡂࡍࡿࡓࡵࡢఱࡽ࠿ࡢไᗘᵓ

⏬ࡀ࡝ࡢࡼ࠺࡟㐍ࡴ࠿㸪ᅜෆ᝟ໃ࡜ྜࢃࡏ㸪⠏ࡀ㔜せ࡛࠶ࡿ࡜⪃࠼ࡿ㸬ὀどࡋ࡚࠸ࡃᚲせࡀ࠶ࡿ㸬 ࡲࡓ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀ㉁ⓗ࡟୙㊊ࡋ࡚࠸ࡿྍ⬟ᛶࡶ⪃࠼ࡽࢀࡿ㸬࣑࣐࣮ࣕࣥ

฼┈┦཯ COI ࡟㛵ࡍࡿグ㍕

࡟࠾࠸࡚ࡣ㸪⌧≧࡛ࡣ୺ࡓࡿᑓ㛛⫋ࡣ⌮Ꮫᮏ◊✲࡟㛵ࡋ࡚㸪ሗ࿌ࡍ࡭ࡁ฼┈┦཯ࡣ⒪ἲኈࡢࡳ࡛㸪௚ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ࡞࠸㸬㛛⫋ࡀ㣴ᡂࡉࢀ࡚࠸࡞࠸㸬ࡲࡓ㸪౛࠼ࡤ㣴ᡂ࣒࢝ࣜ࢟ࣗࣛ࡟ ADL ࡀྵࡲࢀ࡚࠾ࡽࡎ㸪ᐇᘬ⏝ᩥ⊩㊶࡟࠾࠸࡚ࡶ ADL ࡢホ౯࣭カ⦎ࡀ⾜ࢃࢀ࡚1) Cieza A, Causey K, Kamenov K,࠸࡞࠸࡞࡝㸪ᥦ౪ࡉࢀ࡚࠸ࡿࢧ࣮ࣅࢫࡢෆ

Hanson SW, Chatterji S Globalᐜ࡟೫ࡾࡀ࠶ࡿྍ⬟ᛶࡀ࠶ࡿ㸬ᮏ㑥ࢆጞࡵ㸪

estimates of the need for㧗㱋໬ඛ㐍ᅜ࡟࠾ࡅࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ

rehabilitation based on the Globalࢽ࣮ࢬ࡜ࡋ࡚㸪㧗㱋⪅ࡢ⮬❧ᨭ᥼ࡀᣲࡆࡽ

Burden of Disease study 2019: aࢀࡿ㸬࣑࣐࣮ࣕࣥ࡟࠾࠸࡚ࡶ௒ᚋ㧗㱋໬♫

systematic analysis for the Global

఍ࢆ㏄࠼ࡿࡇ࡜ࢆ㚷ࡳࡿ࡜㸪ADL ➼ࡢྥୖ

Burden of Disease Study 2019.

࡟㈨ࡍࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢᥦ౪ࡀ㔜せLancet. 2021 Dec

࡜࡞ࡿྍ⬟ᛶࡀ࠶ࡿ㸬

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ࣁࣅࣜࢸ࣮ࢩࣙࣥࡶᥦ౪ࡉࢀ࡚࠸ࡿࡀ㸪ᆅ

https://www.who.int/initiatives/rehabiᇦ࡟ࡼࡗ࡚ࡣ༑ศᥦ౪࡛ࡁ࡚࠸࡞࠸ྍ⬟ᛶ

litation-2030, (accessed 2023-06-26).
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https://www.un.org/development/desaᤣ࠼㸪㧗㱋⪅ࢆᑐ㇟࡜ࡋࡓࣜࣁࣅࣜࢸ࣮ࢩ

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Sci. 2015 Feb;77(1-2):203-12. PMID:

2023-06-11).
21) ⊂❧⾜ᨻἲேᅜ㝿༠ຊᶵᵓே㛫㛤Ⓨ

25797985; PMCID: PMC4361522.
15) ཌ⏕ປാ┬ ➨  ❶ ͉ᮾ༡࢔ࢪ࢔ᆅ

㒊࣑࣐࣮ࣕࣥ㐃㑥ࣜࣁࣅࣜࢸ࣮ࢩࣙ

ᇦ࡟ࡳࡿཌ⏕ປാ᪋⟇ࡢᴫせ࡜᭱㏆ࡢࣥᙉ໬ࣉࣟࢪ࢙ࢡࢺ஦๓ㄪᰝሗ࿌᭩ ືྥ㸦࣑࣐࣮ࣕࣥ㸧͇2015 ᖺ ᾏእ᝟https://openjicareport.jica.go.jp/pdf/11

ໃሗ࿌㸦ᮏᩥ㸧

900404.pdf, (ཧ↷ 2023-07-13).
22) WHO Myanmar Newsletter Special.

https://www.mhlw.go.jp/wp/hakusyo/kaigai/16/dl/t5-06.pdf, (ཧ↷ 2023-06-

Rehabilitation- a core health service.

07).

2019-11-15.

16) Ministry of Health. Department ofhttps://www.who.int/docs/default-

medical Services. 2021 August.

source/searo/myanmar/factsheet-

http://www.doms.gov.mm/wp-

rehabilitation.pdf, (accessed 2023-06-

content/uploads/2022/11/Health-21).
23) Research conducted in collaboration

Facilities_Aug-2021-2.jpg, (accessedwith the University of Public Health,2023-06-10).
17) ཌ⏕ປാ┬➨  ❶ᮾ༡࢔ࢪ࢔ᆅᇦ࡟

Yangon, Myanmar Commissioned byࡳࡿཌ⏕ປാ᪋⟇ࡢᴫせ࡜᭱㏆ࡢືྥ

the International Committee of the㸦࣑࣐࣮ࣕࣥ㸧2017 ᖺᾏእ᝟ໃሗRed Cross. The Impact of physical࿌rehabilitation on the lives of persons

https://www.mhlw.go.jp/wp/hakusyo/kwith physical impairments inaigai/18/, (ཧ↷2023-07-01).

Myanmar: Research Report August
2017. p.2-3.

18) Latt NN, Myat Cho S, Htun NM, Yu
Mon Saw, Myint MN et al.

https://www.lshtm.ac.uk/media/23466

Healthcare in Myanmar. Nagoya J, (accessed 2023-06-25).
24) ➨2ᅇ࢔ࢪ࢔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࣇ

Med Sci. 2016 May;78(2):123-34.
PMID: 27303099; PMCID:

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PMC4885812.

ኚࢃࡿ. p.34.

19) Health at a Glance: Asia/Pacific 2022

https://www.jstage.jst.go.jp/article/rik

measuring progress towards

a/34/Suppl.9/34_S9_1/_pdf, (ཧ↷universal health coverage.

2023-06-30).

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(accessed 2023-07-13).

20) Ministry of Health. The Republic of

26) University of Medical Technology.

the Union of Myanmar. Health in

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34

http://www.umty.gov.mm/Physiothera/rehabilitation-medicine-society/py/content/page/undergraduate-(accessed 2023-07-16).

course, (accessed 2023-07-21).

29) Han SM, Lwin KS, Swe KT, Gilmour27) Thanda Aye, Khin Saw Oo, Myo

S, Nomura S. Military coup during

Thuzar Khin, Tsugumi Kuramoto-

COVID-19 pandemic and healthAhuja, Hitoshi Maruyama. Current

crisis in Myanmar. BMJ Glob Health.

Situation of Myanmar Rehabilitation

2021 Apr;6(4):e005801. doi:

Team and Its Educational

10.1136/bmjgh-2021-005801. PMID:

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Asian Rehabilitation Science, vol.1

30) World Physiotherapy. Membership.

no.1 April 2018 ISSN 2434-07058

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ession-profile, (accessed 2023-07-13).

Medicine.https://www.mmacentral.org/societies

35

Abstract㸸Demand for rehabilitation services will increase in Myanmar due to thedemographic transition towards an aging population and epidemiological transition
from communicable to noncommunicable diseases as well as in other countries. We
describe the current situation of rehabilitation services provision focusing on medical
services based on collected relevant materials. Although Myanmar has not achieved
universal health coverage, there is a national health service delivery system. The
system enables people to receive essential medical treatments including
rehabilitation at public hospitals free of charge. Rehabilitation professionals consistof physiotherapists (PT), which is the largest workforce, rehabilitation doctors, andprosthetists & orthotists (PO). Although those professionals are developed inside
Myanmar, the amount number seems too small to meet needs. Physiotherapist
staffing standards are regulated for provincial and prefectural hospitals with at least
1 physiotherapist for 100 beds. Currently, rehabilitation for older adults has beenpromoted in response to the future aging society of Myanmar. In 2019, the central
government launched a national plan for strengthening rehabilitation focusing on
increasing access to services, strengthening the rehabilitation workforce, andexpanding access to assistive products. Importance of rehabilitation is recognized
and the governmental plan to strengthen and promote rehabilitation is launched.
Progress of the situation should be carefully observed.
Key Words㸸Myanmar, Rehabilitation, Policy and System, Physiotherapy,
Medical Services

36

ᴾ
ᴾ
ᴾ
‫׎‬ᨥἼἡἥἼἘὊἉἹὅᄂᆮ˟ᴾᇹ ᵕ ‫ܖׅ‬ᘐ‫˟ٻ‬ᴾ
৫᥵ᨼᴾᴾჷỦὉൢỀẪὉᎋảỦ޴ἼἡἥἼἘὊἉἹὅ ᵐᵎᵑᵎ޵ᴾ
῍ɶὉ˯৑ࢽ‫׎‬ỆấẬỦἼἡἥἼἘὊἉἹὅ୍ӏồỉᝡྂ῍ᴾ

ᴾ
ᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾᴾ
ᴾ
ᴾ
ᴾ
ᴾ
ᴾ




37

国際リハビリテーション研究会
プログラム
時間

第７回学術大会

第１会場（教室4・2）

開始

終了

尺

9:30

10:00

0:30

10:00

10:05

0:05

第２会場（アクティビティスペース）

開場・受付
開会式
【メインシンポジウム】「Rehabilitation 2030と国の機関による国際協力」
演者

10:05

11:25

1:20

：Jody-Anne Mills（Technical Officer, Rehabilitation Programme,
Department of NCD, WHO）
：芳賀信彦（国立障害者リハビリテーションセンター 総長）：曽根智史（国立保健医療科学院 院長）
座長

11:25

11:35

0:10

：山口佳小里（国立保健医療科学院）

休憩【特別セッション1】【一般演題セッション１】「PT協会、OT協会、ST協会の国際事業の紹介①ペルー障害児スポーツプロジェクト～現地調査を実施して～～国際活動の入り口として～」：松本侑己(独立行政法人

演者：伊藤智典（日本理学療法士協会）

11:35

12:35

1:00

国立病院機構別府医療センター

リハビリテーション科)②ペルー障害児スポーツプロジェクト～本邦研修の報告～：高橋香代子（日本作業療法士協会）：西﨑武文（独立行政法人：立石雅子（日本言語聴覚士協会）

リハビリテーション科）

座長

国立病院機構西別府病院③ペルー障害児スポーツプロジェクト：齋藤崇志（国立障害者リハビリテーションセンター研究所）～アクティブチャイルドプログラムを使用して～：津﨑千佳（独立行政法人

国立病院機構宮崎東病院

リハビリテーション科）④「タイ国自治体ネットワークによるコミュニティベース統合型高齢者ケア事業」認知症カフェ普及

事例報告：鈴木知世（国際教養大学 国際教養学部 4年）
12:35

12:45

0:10

座長：古川雅一（仙台医健・スポーツ専門学校）

休憩【ランチタイムセッション】「A/T Bank」

12:45

13:25

0:40

話題提供者
：中村賢二（生活リハビリサポートいな）
座長：石井清志（国際医療福祉大学）

13:25

13:35

0:10

休憩
【一般演題セッション2】【特別セッション2】①マンパワー不足の改善に向けたCI療法導入の提案「国外経験の国内活動への活かし方」－ドミニカ共和国での実践－：森裕美（株式会社mediVR）

演者②脳卒中片麻痺を呈した特定技能外国人に対して：亀田 佳一氏（医療法人社団北原国際病院グループ）

回復期リハビリテーション病棟で就労支援を実施した事例
13:35

14:35

1:00

：川野晃裕氏（リニエ訪問看護ステーション キッズ世田谷）：道願正歩（東京湾岸リハビリテーション病院）

座長：髙橋恵里（福島県立医科大学 保健科学部）③ネパール地震緊急医療支援におけるリハビリテーション活動：西嶋望（西宮市社会福祉事業団いずみ園）④ミャンマー連邦共和国における作業療法普及の可能性：Phyo Thant Maw（医療法人大那

だいなリハビリクリニック

リハビリテーション部）
14:35

14:45

0:10

座長：車井元樹（国際医療福祉大学成田病院）

休憩【メインシンポジウム２】「社会的課題に対応した国際協力実践」
演者：亀田 佳一（医療法人社団北原国際病院グループ）
14:45

16:15

1:30

：大室和也（AAR Japan 難民を助ける会）：千葉寿夫（株式会社コーエイリサーチ&コンサルティング）：奥井利幸（野毛坂グローカル）座長：勝田茜（姫路獨協大学）

16:15

16:25

0:10

休憩
【クロージングシンポジウム】「Rehabilitation 2030への貢献：私たちの”始めの一歩”を考えよう」（総括）
話題提供者：山口佳小里（国立保健医療科学院）

16:25

17:25

1:00

指定発言者
：河野眞（国際医療福祉大学）：大室和也（AAR Japan難民を助ける会）：三田村徳（東北医科薬科大学病院）
司会：勝田茜（姫路獨協大学）

17:25

17:30

0:05

閉会式

38

࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘ ࠚ
Rehabilitation 2030 ࡜ᅜࡢᶵ㛵࡟ࡼࡿᅜ㝿༠ຊ

Rehabilitation 2030: The vision and the implementation
Jody-Anne Mills(Technical Officer, Rehabilitation Programme, WHO)
Abstract
Rehabilitation 2030 was launched in 2017 with a call to action for governments, development
partners and civil society to meet the profound unmet need for rehabilitation worldwide. Areas
for action concern all elements of the health system, from governance and financing to
information systems, workforce, and service delivery, among others. Rehabilitation 2030
represented a significant shift in how rehabilitation is conceptualized, moving it from being aservice for persons with disabilities, to being a core component of universal health coverage – aservice that should be available for all who need it. The WHO rehabilitation needs estimatorindicates that approximately 2.4 billion, or 1 in 3 people would benefit from rehabilitation. Someof these people rely strongly on rehabilitation to be able to participate in education, work,
recreation and important life roles. Despite this massive need, most countries still lack thecapacity to meet even basic rehabilitation needs within their populations. This presentation will
examine the historical context and barriers that countries have experienced in advancing therehabilitation agenda to date, celebrate the milestones that have been achieved sincerehabilitation 2030 was launched, and present some of the technical tools WHO have recently
developed to better equip countries to expand access to quality rehabilitation services, where andwhen they are needed.



















39

࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘ ࠚ
Rehabilitation 2030 ࡜ᅜࡢᶵ㛵࡟ࡼࡿᅜ㝿༠ຊᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮࡟࠾ࡅࡿᅜ㝿༠ຊ
International Cooperation from the Standpoint of National Rehabilitation Center
for Persons with Disabilities
ⰾ㈡ಙᙪ
ᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮ ⥲㛗
₇⪅ࡣ 2021 ᖺ࡟ᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮㸦ᅜࣜࣁ㸧࡟␗ືࡍࡿࡲ࡛㸪ᑠඣᑓ㛛⑓㝔࡜኱Ꮫ⑓㝔࡟ࡑࢀࡒࢀ 15 ᖺ⛬ᗘ໅ົࡋ࡚࠸ࡓ㸬ࡇࡢ㛫㸪ᾏእࡢᑠඣᩚᙧእ⛉་㸪ࣜࣁࣅࣜࢸ࣮ࢩ
ࣙࣥ⛉་ࡸࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋࡜ᵝࠎ࡞ᙧ࡛஺ὶࡋ࡚ࡁࡓ㸬2008 ᖺ࡟ࡣ JICA ࡢ࢘ࢬ࣋࢟ࢫ
ࢱࣥᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮ᨭ᥼ࣉࣟࢪ࢙ࢡࢺ࡟ᢏ⾡ཧ୚࡜ࡋ࡚༠ຊࡋࡓ㸬ᅜࣜࣁࡣ 6 ࡘࡢ㒊㛛࡛ᵓᡂࡉࢀ㸪௻⏬࣭᝟ሗ㒊ࡢ୰࡟࠶ࡿᅜ㝿༠ຊᐊࡀᅜ㝿༠ຊ࡟㛵ࢃࡿᴗົࢆᢸ
ࡗ࡚࠸ࡿ㸬ᅜࣜࣁࡣ 1979 ᖺࡢタ❧ᚋ᪩ᮇࡼࡾ JICA ࡢࣉࣟࢪ࢙ࢡࢺ࡟㛵ࢃࡾ㸪2015 ᖺ㡭ࡲ࡛୰ᅜ㸪ࢥࣟࣥࣅ࢔㸪ࢳࣜ㸪࣑࣐࣮ࣕࣥ࡞࡝ࡢ㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢྥୖ࡟㈉⊩ࡋ࡚ࡁࡓ㸬2011 ᖺ࡟ࡣ୰ᅜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ◊✲ࢭࣥࢱ࣮㸪㡑ᅜᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮࡜㸪㞀ᐖࡀ࠶ࡿேࠎ
ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᢏ⾡ࢆྥୖࡉࡏࡿࡇ࡜ࢆ┠ⓗ࡜ࡋ࡚㸪༠ຊཬࡧ஺ὶ࡟㛵ࡍࡿ༠ᐃࢆ⥾⤖ࡋࡓ㸬ࡲࡓᾏእࡼࡾࡢどᐹ࣭ぢᏛࡸ◊ಟဨࢆ✚ᴟⓗ࡟ཷࡅධࢀ㸪2021 ᖺࡲ࡛ࡢྜィ࡛㸪どᐹ࣭ぢᏛ⪅ࡣ⣙160 ࣨᅜࡼࡾ 11,000 ே௨ୖ㸪◊ಟဨࡣ⣙ 60 ࣨᅜࡼࡾ⣙ 800 ே࡜࡞ࡗࡓ㸬◊ಟဨࡢ୰࡟ࡣ㸪◊ಟᚋ࡟ẕᅜࡢ㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㈉⊩ࡋ࡚࠸ࡿ⪅ࡶከ࠸㸬
1995 ᖺ࡟ᅜࣜࣁࡣ㸪ᅜෆ࡛၏୍ࡢࠕ㞀ᐖࡢண㜵࡜ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㛵ࡍࡿᣦᐃ◊✲༠ຊࢭࣥࢱ࣮ࠖ࡜ࡋ࡚ WHO ᣦᐃ◊✲༠ຊࢭࣥࢱ࣮ࡢᣦᐃࢆཷࡅ㸪4 ᖺẖ࡟᭦᪂ࡉࢀࡿࠕ༠ຊ஦㡯ࠖ࡜ࠕ⾜ືィ⏬ࠖ࡟ᚑ࠸㸪ᵝࠎ࡞άືࢆ⾜ࡗ࡚ࡁ࡚࠸ࡿ㸬㛵㐃ࡍࡿሗ࿌᭩ࡢసᡂ㸪ᅜ㝿ࢭ࣑ࢼ࣮ࡢ㛤ദ㸪ࣜࣁࣅࣜࢸ࣮ࢩ࣐ࣙࣥࢽࣗ࢔ࣝࡢసᡂ࡜බ㛤㸪࡞࡝࡛࠶ࡿ㸬ᅜ㝿ࢭ࣑ࢼ࣮ࡣẖᖺ⾜ࢃࢀ㸪㏆ᖺࡢ࣮࣮࢟࣡
ࢻ࡜ࡋ࡚ࡣ㞀ᐖ⪅ࡢ೺ᗣቑ㐍㸪㧗㱋໬࡜ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㸪ࡀᣲࡆࡽࢀࡿ㸬ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ
࣐ࢽࣗ࢔ࣝࡣ⌧ᅾࡲ࡛࡟ 38 㡯┠࡟ࡘ࠸࡚Ⓨ⾜ࡋ㸪࢔ࢪ࢔ኴᖹὒᆅ༊ࡢྛᅜ࡟㏦௜ࡋ࡚࠸ࡿ㸬ࡇࡢ௚࡟ WHO 㛵㐃㈨ᩱ࡜ࡋ࡚ࠗࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ 2030 ⾜ືࡢ࿧ࡧ࠿ࡅ࠘఍㆟ሗ࿌᭩ࢆ࿴ヂࡋ࡚බ㛤ࡋ࡚࠸ࡿ㸬
ᅜࣜࣁ࡟࠾ࡅࡿᅜ㝿㈉⊩ࡣ௒ᚋࡶ⥅⥆ࡍࡿࡀ㸪௒ᚋࡢࣉࣛࣥ࡜ࡋ࡚₇⪅ࡣಶேⓗ࡟㸪ࣜࣁࣅࣜࢸ࣮
ࢩࣙࣥࣜࢯ࣮ࢫ࡟ᜨࡲࢀ࡞࠸ᅜࠎ࡟ࠕ᪥ᮏࡢᙉࡳࠖࢆᥦ౪ࡍࡿࡇ࡜ࢆ㔜どࡍ࡭ࡁ࡜⪃࠼࡚࠸ࡿ㸬ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㛵ࡍࡿࠕ᪥ᮏࡢᙉࡳࠖ࡜ࡋ࡚ࡣ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㛵㐃ᑓ㛛⫋ࡀከ࠸ࡇ࡜㸪་⒪ಖ㝤ไᗘ࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་⒪ࡀྵࡲࢀ࡚࠸ࡿࡇ࡜㸪ᆅ㟈ࡸὠἼ࡞࡝ࡢ⅏ᐖࡢ⤒㦂ࡀ࠶ࡿࡇ࡜㸪ୡ⏺࡟ඛࢇࡌ࡚ேཱྀࡢ㧗㱋໬ࡀ㐍ࢇ࡛࠸ࡿࡇ࡜㸪࡞࡝ࡀ⪃࠼ࡽࢀࡿ㸬40࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘ ࠚ
Rehabilitation 2030 ࡜ᅜࡢᶵ㛵࡟ࡼࡿᅜ㝿༠ຊᅜ❧ಖ೺་⒪⛉Ꮫ㝔࡟࠾ࡅࡿᅜ㝿༠ຊ࡟ࡘ࠸࡚
㸫ᨻ⟇❧᱌⪅⾜ᨻᐁࡢேᮦ⫱ᡂࢆ୰ᚰ࡜ࡋ࡚㸫᭮᰿ᬛྐ
ᅜ❧ಖ೺་⒪⛉Ꮫ㝔㝔㛗 ᅜ❧ಖ೺་⒪⛉Ꮫ㝔㸦௨ୗ㸪⛉Ꮫ㝔㸧ࡣ㸪ཌ⏕ປാ┬┤㎄ࡢヨ㦂◊✲ᶵ㛵࡛࠶ࡾ㸪2002 ᖺ࡟ᅜ❧බ
⾗⾨⏕㝔㸪ᅜ❧་⒪࣭⑓㝔⟶⌮◊✲ᡤ㸪ᅜ❧ឤᰁ⑕◊✲ᡤࡢཱྀ⭍⛉Ꮫ㒊ࡀ⤫ྜࡉࢀ㸪ᇸ⋢┴࿴ගᕷ࡟タ⨨ࡉࢀࡓ㸬⌧ᅾ㸪6 ⤫ᣓ◊✲ᐁ㸪6 ◊✲㒊࣭2 ࢭࣥࢱ࣮㸪⥲ົ㒊ࡢయไ࡛㸪◊✲⫋ࡢᐃဨࡣ⣙ 80 ྡ࡛࠶ࡿ㸬ಖ೺་⒪㸪⏕ά⾨⏕㸪♫఍⚟♴࡟㛵ࡍࡿ㣴ᡂカ⦎࡜ㄪᰝ◊✲ࢆᮏົ࡜ࡋ࡚࠾ࡾ㸪◊ಟ࡜◊✲ࢆ࠸ࢃࡤ㌴ࡢ୧㍯࡜ࡋ࡚ᐇ᪋ࡋ࡚࠸ࡿ࡜ࡇࢁࡀ≉ᚩ࡛࠶ࡿ㸬ᅜෆࡢ◊ಟࡣ㸪୺࡜ࡋ࡚㸪බ⾗⾨⏕࡟ᦠࢃࡿᆅ᪉⮬἞యࡢ⫋ဨࢆᑐ㇟࡜ࡋ࡚࠸ࡿ㸬㛗ᮇࡢ◊ಟ࡜▷ᮇ◊ಟࢆྜࢃࡏࡿ࡜㸪ᖺ㛫 1500 ྡ௨ୖࡢཷㅮ⏕ࢆཷࡅධࢀ࡚࠸ࡿ㸬ᅜ㝿㛵ಀࡢ◊ಟࡣ㸪JICA㸦ᅜ㝿༠ຊᶵᵓ㸧࡜ᐇ᪋ࡋ࡚࠸ࡿࡶࡢࡀ 3 ◊ಟ㸪WPRO㸦WHO すኴᖹὒᆅᇦ஦ົᒁ㸧࡜ᐇ᪋ࡋ࡚࠸ࡿ࣮࣡ࢡࢩࣙࢵࣉࡀ 1 ௳࡛࠶ࡿ㸬
JICA ◊ಟࡣ㸪ᅜࣞ࣋ࣝࡢᢸᙜ⪅ࢆᑐ㇟࡜ࡋࡓ UHC㸦ࣘࢽࣂ࣮ࢧ࣭ࣝ࣊ࣝࢫ࣭࢝ࣂࣞࢵࢪ㸧࡟㛵ࡍࡿ◊ಟ㸪୰ሀ⾜ᨻᐁࢆᑐ㇟࡜ࡋࡓಖ೺⾨⏕⟶⌮◊ಟ㸪㒊㛗࣭ᒁ㛗⣭ࡢ⾜ᨻᐁࢆᑐ㇟࡜ࡋࡓಖ೺⾨⏕ᨻ⟇ྥୖ◊ಟࡀ࠶ࡿ㸬
WPRO ࡜ࡣ㸪2005㹼2018 ᖺᗘ࡟࠿ࡅ࡚㸦2012 ᖺᗘࢆ㝖ࡃ㸧ẖᖺ㸪ᇦෆࡢᨻ⟇ᢸᙜ⪅࡟ᑐࡋ࡚㸪
NCD㸦㠀ឤᰁᛶ⑌ᝈ㸧㸪࠸ࢃࡺࡿ⏕ά⩦័⑓ᨻ⟇࡟㛵ࡍࡿ࣮࣡ࢡࢩࣙࢵࣉࢆඹྠ࡛ᐇ᪋ࡋࡓ㸬⛉Ꮫ㝔ࡣ㸪୺࡟఍ሙ࣭ཷධࢀࡢ‽ഛ㸪ㅮ⩏ࡢ୍㒊࣭ᐇᆅぢᏛࢆᢸᙜࡋࡓ㸬≉࡟ 2013 ᖺᗘ௨㝆ࡢ 6 ᅇࡣ㸪࣮ࣜࢲ࣮ࢩࢵࣉ࡜࢔ࢻ࣎࢝ࢩ࣮࡟ὀ┠ࡋ㸪ྛᅇࢸ࣮࣐ࢆỴࡵ࡚㸪ᨻ⟇ࡢᐇ㊶࡟ᙺ❧ࡘෆᐜ࡜ࡋࡓ㸬
2023 ᖺ 9 ᭶࡟ࡣ㸪WPRO ࡜ࡢඹദ࡛㸪㧗㱋໬ᨻ⟇࡟㛵ࡍࡿ࣮࣡ࢡࢩࣙࢵࣉ㸦TURNING SILVER
INTO GOLD: Capacity building workshop for starting Community-Based Integrated Care㸧ࢆ㛤ദࡋࡓ㸬ᮏ࣮࣡ࢡࢩࣙࢵࣉ࡛ࡣ㸪ᇸ⋢┴ෆࡢᆅᇦໟᣓࢣ࢔ࢭࣥࢱ࣮ࡸᅾᏯ་⒪ᣐⅬ➼ࡢࢃࡀᅜࡢ⌧ሙ࡛ࡢྲྀ⤌ࡳ࡟㛵ࡍࡿᐇᆅぢᏛࢆ⾜ࡗࡓ㸬ࡇࢀࡽࡢ WPRO ࡜ࡢඹྠ࣮࣡ࢡࢩࣙࢵࣉࡣ㸪⛉Ꮫ㝔࡟ 3 ࡘ࠶ࡿ WHO ◊✲༠ຊࢭࣥࢱ࣮ࡢ࠺ࡕࠕWHO Collaborating Centre for Integrated People-Centred Service Deliveryࠖ࡜ࡋ࡚ࡢάື࡛ࡶ
࠶ࡾ㸪ᇦෆࡢ㧗㱋໬ᨻ⟇࡟㛵୚ࡍࡿேᮦࡢ⫱ᡂࡸᨻ⟇ࡢ᥎㐍࡟㈉⊩ࡍࡿࡶࡢ࡜⪃࠼ࡽࢀࡿ㸬௒ᚋࡶ JICA㸪WHOWPRO ➼ࡢᅜ㝿㸦༠ຊ㸧ᶵ㛵࡜࡜ࡶ࡟㸪NCD㸪UHC㸪㧗㱋໬➼࡟㛵ࡍࡿᨻ⟇ࢆᢸ࠺㸪ప୰㛤Ⓨᅜࡢᨻ⟇❧᱌⪅࣭⾜ᨻᐁࡢேᮦ⫱ᡂࢆ᥎㐍ࡋ࡚࠸ࡁࡓ࠸㸬
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41

࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘㸰ࠚ♫఍ⓗㄢ㢟࡟ᑐᛂࡋࡓᅜ㝿༠ຊᐇ㊶ᣢ⥆ྍ⬟࡞་⒪ࢆୡ⏺࡟໭ཎࢢ࣮ࣝࣉࡢ┠ᣦࡍ་⒪ࡢᾏእᒎ㛤ட⏣ ె୍㸦໭ཎᅜ㝿⑓㝔㸧⚾ࡀᡤᒓࡍࡿ໭ཎࢢ࣮ࣝࣉࡣᮾி㒔࡛⬻࡜ᚰ⮚ࡢ⑌ᝈ࡟ண㜵㸪ᩆᛴ་⒪࠿ࡽࣜࣁࣅࣜ㸪ᅾᏯࣇ࢛ࣟ
࣮ࡲ୍࡛㈏ࡋࡓ་⒪ࢆᥦ౪ࡋ㸪ᮾி㒔࡛ୖ఩ 3 ఩࡟ධࡿ⬻༞୰ᝈ⪅࡬ࡢ἞⒪ᐇ⦼ࢆᣢࡘ⑓㝔࡛࠶ࡾ࡞ࡀࡽ㸪⑓㝔ࡢᯟࢆ㉺࠼࡚ᣮᡓࢆ⥆ࡅࡿ⑓㝔࡛㸪ᵝࠎ࡞஦ᴗ࡟ྲྀࡾ⤌ࢇ࡛࠸ࡲࡍ㸬ࡇࡇ࡟ධ⫋ࡋࡓࡇ࡜࡛㸪⚾ࡣᾏእ஦ᴗࡸ᪂つ஦ᴗ❧ࡕୖࡆ࡞࡝㸪ᵝࠎ࡞஦ᴗ࡟ᦠࢃࡾ㸪௚⑓㝔࡛ࡣ࡛ࡁ࡞࠸㈗㔜ࡢ⤒㦂ࢆࡋ࡚ࡁࡲࡋࡓ㸬ࡑࡢ 1 ࡘࡀᮏㅮ₇ࢱ࢖ࢺࣝ࡟ࡶ࠶ࡿ་⒪ࡢᾏእᒎ㛤࡛ࡍ㸬ᙜࢢ࣮ࣝࣉࡀ་⒪ࡢᾏእᒎ㛤࡛┠ᣦࡋ࡚࠸ࡿࡢࡣᣢ⥆ྍ⬟࡞་⒪ࢆ㏵ୖᅜ࡟ᵓ⠏ࡍࡿࡇ࡜࡛ࡍ㸬ࡑࡢࡓࡵ࡟⌧ᆅࡢ᪉ࠎࡀ⮬❧ࡋ࡚་⒪ࢆᥦ౪࡛ࡁࡿ⬟ຊࢆ㌟࡟ࡘࡅࡿࡇ࡜㸪↓⌮࡞ࡃᣢ⥆࡛ࡁࡿࡼ࠺
ࣅࢪࢿࢫ࡜ࡋ࡚ᡂ❧ࡉࡏࡿࡇ࡜࡟ὀຊࡋ࡚࠸ࡲࡍ㸬2016 ᖺ࡟㛤タࡋࡓ࢝ࣥ࣎ࢪ࢔ࡢ Sunrise Japan
Hospital ࡛ࡣ㸪㛤㝔๓ࡢ 1 ᖺ㛫㸪᪥ᮏ࡛࢝ࣥ࣎ࢪ࢔ே་⒪⪅࡟ᩍ⫱ࢆ⾜࠸㸪㛤㝔ᚋࡶ᪥ᮏேࡀ⌧ᆅ࡛⥅⥆ࡋ࡚ᩍ⫱ࢆ⥆ࡅ࡚࠸ࡲࡍ㸬ࡲࡓ㸪⑓㝔ࡣ⮫ᗋ⬟ຊࡔࡅ࡛ࡣ㐠Ⴀ࡛ࡁ࡞࠸ࡓࡵ㸪⮫ᗋ௨እ࡟᪋タ⟶⌮ࡸ஦ົ㸪⤒Ⴀ࡟ࡘ࠸࡚ᩍ⫱ࢆ⾜ࡗ࡚࠸ࡲࡍ㸬௒࡛ࡣ㸪࢝ࣥ࣎ࢪ࢔ேࢫࢱࢵࣇࡀᡂ㛗ࡋࡓࡓࡵ㸪⌧ᆅࡢ᪥ᮏேࡢᩘࡣ༙ᩘ࡟࡞ࡾ㸪⌧ᆅࡢ᪉ࢆᑐ㇟࡜ࡋࡓእ㈨⣔⑓㝔࡛࠶ࡾ࡞ࡀࡽ⤒Ⴀ㠃࡛㯮Ꮠ㌿᥮ࡋ࡚࠾ࡾ㸪᪥ᮏ་⒪㍺ฟࡢᡂຌࣔࢹࣝ࡜ࡋ࡚᪥ᮏᨻᗓ࠿ࡽࡶᅜෆእ࡟⤂௓ࡉࢀࡿࡼ࠺࡟࡞ࡗ࡚࠸ࡲ
ࡍ㸬࢝ࣥ࣎ࢪ࢔㐍ฟ᫬࡟ࡣᮾ࢔ࢪ࢔࣭࢔ࢭ࢔ࣥ⤒῭◊✲ࢭࣥࢱ࣮㸪⤒῭⏘ᴗ┬ࡢᨭ᥼ࢆཷࡅࡲࡋࡓ㸬ࡑࡢᚋ㸪࣋ࢺࢼ࣒㸪ࢱ࢖࡬ࡢ㐍ฟ᫬࡟ࡶ⤒῭⏘ᴗ┬ࡢᨭ᥼ࢆཷࡅࡲࡋࡓ㸬㈨㔠ⓗ࡞ᨭ᥼ࡔࡅ࡛࡞ࡃ㸪ᨻᗓࡢᨭ᥼ࢆཷࡅࡿࡇ࡜࡛㸪㐍ฟඛࡢᅜ࡛ಙ㢗࡛ࡁࡿࣃ࣮ࢺࢼ࣮ࢆᚓࡿࡇ࡜࡟ࡶᨭ᥼࠸ࡓࡔ࠸࡚࠸ࡲ
ࡍ㸬⚾ࡀࡇࡇ 10 ᖺ࡯࡝ᾏእ஦ᴗ࡟㛵ࢃࡗ࡚ឤࡌࡿࡢࡣ᪥ᮏࡢᛴ㏿࡞ἐⴠ࡛ࡍ㸬⤒῭ࡀ 30 ᖺ㛫೵⁫ࡋ࡚࠸ࡿ᪥ᮏࡣ㸪་⒪࡟࠾࠸࡚ࡶඃ఩ᛶࢆኻ࠸࠿ࡅ࡚࠸ࡲࡍ㸬௒ᚋࡣୡ⏺ࡢ୰࡛ࡢ᪥ᮏࡢ❧ࡕ఩⨨ࢆᐈほどࡋ㸪᪥ᮏࡀୡ⏺࡟ྥࡅ࡚ᥦ౪࡛ࡁࡿ౯್ࢆぢࡘࡵ┤ࡍᚲせࡀ࠶ࡾࡲࡍ㸬ࡑࡋ࡚⌧≧㸪᪥ᮏࡢ࢔ࢻࣂࣥࢸ࣮ࢪ࡜ゝ࠼ࡿࡢࡣୡ⏺୍ࡢ㧗㱋ᅜᐙ࡛࠶ࡿࡇ࡜࡜㸪⬻⚄⤒እ⛉ࡢ࢞ࣛࣃࢦࢫⓗ㐍໬ࡔ࡜⪃࠼࡚࠸ࡲࡍ㸬⌧ᅾ㸪ᮾ༡࢔ࢪ࢔ࡣᛴ㏿࡞⤒῭ᡂ㛗୰࡛㸪㏆࠸ᑗ᮶㸪௒ࡢ᪥ᮏ࡜ྠ➼ࡢ⤒῭ຊࢆᣢࡘࡼ࠺࡟࡞ࡿ཯㠃㸪㧗㱋໬ࡀ㐍ࡳ᪥ᮏ࡜ྠᵝࡢㄢ㢟࡟┤㠃ࡍࡿ࡜ゝࢃࢀ࡚࠸ࡲࡍ㸬᪤࡟┤㠃ࡋ࡚࠸ࡿ㧗㱋໬ၥ㢟ࡢゎỴ᪉ἲࢆ⏕ࡳฟࡋ㸪ࡑࢀࢆୡ⏺࡟㍺ฟࡍࡿࡇ࡜ࡇࡑ᪥ᮏࡀୡ⏺࡟㈉⊩ࡍ࡭ࡁࡇ࡜࡛
ࡣ࡞࠸࡛ࡋࡻ࠺࠿㸬ᮏㅮ₇࡛ࡣ㸪⚾ࡓࡕࡢᾏእ஦ᴗ࡜ࡑࢀࡽࡢ஦ᴗࢆ⤒㦂ࡍࡿࡇ࡜࡛ᚓࡓ⚾ࡢ⚾ぢ࡟ࡘ࠸࡚࠾ヰࡉࡏ࡚࠸ࡓࡔࡁࡲࡍ㸬ᾏእ࡛་⒪ࢆࡋࡓ࠸࡜⪃࠼࡚࠸ࡿࢭࣛࣆࢫࢺࡢⓙᵝࡀࠕࡇࢀ࠿
ࡽࡢ᪥ᮏ་⒪ࡢᾏእᒎ㛤ࠖ࡟ࡘ࠸࡚⪃࠼ࡿࡁࡗ࠿ࡅࡢ 1 ࡘ࡟࡞ࢀࡤᖾ࠸࡛ࡍ㸬42࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘㸰ࠚ♫఍ⓗㄢ㢟࡟ᑐᛂࡋࡓᅜ㝿༠ຊᐇ㊶

1*2 ࡟ࡼࡿᅜ㝿༠ຊࡢᐇ㊶኱ᐊ࿴ஓAAR Japan㞴Ẹࢆຓࡅࡿ఍
NGO ࡟ࡼࡿᅜ㝿༠ຊࡢᐇ㊶࡟ࡘ࠸࡚㸪⚾ࡀᡤᒓࡍࡿ AAR Japan ࡢ౛ࢆ୰ᚰ࡟⤂௓ࡍࡿ㸬NGO ࡜ࡣ㸪㠀ᨻᗓ⤌⧊㸦Non-Governmental Organization㸧ࡢ␎⛠࡛࠶ࡾ㸪ᅜ㝿ᨭ᥼ࡢୡ⏺࡟࠾࠸࡚ࡣ㸪ᅜᐙᶵ㛵ࡸᅜ㐃ᶵ㛵࡜␗࡞ࡾ㸪Ẹ㛫ࡀ⤌⧊ࡍࡿᨭ᥼ᅋయࡢࡇ࡜ࢆ NGO ࡜࿧ࡪ㸬NGO ࡢ≉ᚩࡣ㸪㛗ᮇⓗ࡞άືࢆᰂ㌾࡟ᐇ᪋ࡍࡿࡇ࡜ࡸ㸪άືࡢ㈈※ࡀᐤ௜࡛࠶ࡿࡇ࡜࡞࡝࡜ゝ࠼ࡿ㸬AAR Japan ࡣ㸪1979 ᖺ࡟࢖ࣥࢻࢩࢼ㞴Ẹࢆᨭ᥼ࡍࡿ┠ⓗ࡛᪥ᮏ࡟࡚タ❧ࡉࢀ㸪௨᮶ 44 ᖺ㛫࡛㸪60 ࢆ㉸࠼ࡿᅜࡸᆅᇦࡢேࠎࢆᨭ᥼ࡋ࡚ࡁࡓ㸬⌧ᅾࡣ㸪㞴Ẹࡸ㞀ࡀ࠸⪅ࡀ┤㠃ࡍࡿㄢ㢟࡬ࡢᑐᛂ㸪⅏ᐖࡢ⿕⅏⪅࡬ࡢ⥭ᛴᨭ᥼࡞࡝ࢆ 17 ࣧᅜ࡛ᒎ㛤ࡋ࡚࠸ࡿ㸬≉࡟㸪㞀ࡀ࠸⪅ࡢㄢ㢟ゎỴࡸ⏕άࡢ㉁ྥୖࢆ┠ᣦࡍάື࡜ࡋ࡚㸪࢝ࣥ࣎ࢪ࢔ࡸ࣑࣐࣮ࣕࣥ㸪ࣃ࢟ࢫࢱࣥ࡞࡝࡛ࡢ࢖ࣥࢡ࣮ࣝࢩࣈᩍ⫱஦ᴗ㸪ࣛ࢜ࢫ࡛ࡢ⏕ィྥୖ஦ᴗ㸪࢘ࢡࣛ࢖ࢼ࡛ࡢே㐨ᨭ᥼㸪࢘࢞ࣥࢲ࡛ࡢᆅ㞾⿕ᐖ⪅ᨭ᥼࡞࡝ࢆᐇ᪋ࡋ࡚࠸ࡿ㸬ከ᪉㠃࡬ࡢ࢔ࢡࢭࢩࣅࣜࢸ࢕ࡀ☜ಖࡉࢀ࡚࠸࡞࠸㞀ࡀ࠸⪅ࢆᨭ᥼ᑐ㇟࡜ࡍࡿ஦ᴗ࡛ࡣ㸪ᙜேࡸ㛵ಀ⪅ࡢ⬟ຊᙉ໬㸦ேᮦ⫱ᡂ㸧㸪࿘ᅖࡢேࠎ࡬ࡢၨⓎ㸪≀⌮ⓗ࢔ࢡࢭࢩࣅࣜࢸ࢕ࡢ☜ಖ㸪♫఍ไᗘ࡬ࡢ࢔ࣉ࣮ࣟࢳ࡞࡝ࡀ㔜せ࡞ᵓᡂせ⣲࡜࡞ࡿ㸬ࡇࡇ࡛㸪ேᮦ⫱ᡂ࡜♫఍ไᗘ࡬ࡢ࢔ࣉ࣮ࣟࢳ࡟ࡘ࠸࡚㸪࢝ࣥ࣎ࢪ࢔ࡢ౛ࢆ⤂௓ࡍࡿ㸬࢝ࣥ࣎ࢪ࢔࡛
ࡣ㸪㞀ࡀ࠸ࡢ࠶ࡿඣ❺ࡀ㸪ᆅඖࡢ㏻ᖖᏛᰯ࡛㐺ษ࡟Ꮫ࡭ࡿ⎔ቃࢆᩚഛࡍࡿ஦ᴗ㸦࢖ࣥࢡ࣮ࣝࢩࣈᩍ
⫱஦ᴗ㸧ࢆᐇ᪋ࡋ࡚࠸ࡿ㸬ࡑࡇ࡛ேᮦ⫱ᡂࡢᑐ㇟࡜ࡍࡿࡢࡣ㸪Ꮫᰯ⟶⌮⫋ࡸᩍဨ㸪ᩍ⫱⾜ᨻ⫋ဨ㸪ᆅᇦ⾜ᨻࡢ㛵ಀ⪅࡛࠶ࡿ㸬ࡑࢀࡒࢀࡢㄢ㢟࡟ྜࢃࡏࡓ◊ಟࢆᐇ᪋ࡍࡿ࡜࡜ࡶ࡟㸪ཷㅮ⏕ࡀᚋ࡟ㅮᖌ࡜
࡞ࡗ࡚◊ಟࢆᐇ᪋ࡍࡿࡇ࡜ࢆ┠ᶆ࡟ࡋࡓㅮᖌ㣴ᡂ◊ಟࡶ⾜࠺㸬ཷㅮ⏕ࡀ▱㆑ࡸᢏ⬟ࢆ㌟࡟௜ࡅࡿࡇ
࡜ࡔࡅ࡛ࡣ࡞ࡃ㸪ᣢ⥆ⓗ࡞◊ಟ㐠Ⴀࡸ㸪ᐇ㊶ࡲ࡛ࡢࣇ࢛࣮ࣟ࢔ࢵࣉࡢほⅬ࡛ࡶάືࢆ⤌ࡳ❧࡚ࡿᚲせࡀ࠶ࡿ㸬࡞࠾⌧ᆅࢫࢱࢵࣇࡢ⫱ᡂࡶ኱ኚ㔜せ࡛࠶ࡿ㸬ࡲࡓ㸪ྠ஦ᴗ࡟࠾ࡅࡿไᗘ㠃࡬ࡢ࢔ࣉ࣮ࣟࢳࡢᡂᯝ࡜ࡋ࡚ࡣ㸪࢖ࣥࢡ࣮ࣝࢩࣈᩍ⫱࡟㛵ࡍࡿᅜᐙᡓ
␎ࡢసᡂ㐣⛬࡟ཧຍࡋ㸪AAR ࡀᢕᥱࡋ࡚࠸ࡿ⌧ሙࡢㄢ㢟ࢆ⾜ᨻᩥ᭩࡟ṧࡋࡓࡇ࡜㸪AAR ࡀసᡂࡋࡓ
࢖ࣥࢡ࣮ࣝࢩࣈᩍ⫱ࢳ࢙ࢵࢡࣜࢫࢺ࡟ࡘ࠸࡚ᨻᗓᢎㄆࢆᚓࡓࡇ࡜࡞࡝ࡀ࠶ࡿ㸬⾜ᨻ࡬ࡢ୎ᑀ࡞ሗ࿌
ࡸ┦ㄯ࡟ᇶ࡙࠸ࡓಙ㢗㛵ಀࡢᵓ⠏࡜⾜ᨻ⫋ဨࡢᕳࡁ㎸ࡳࢆ⾜ࡗࡓࡇ࡜ࡀ୍ࡘࡢせᅉ࡛࠶ࡿ㸬஦ᴗࢆᐇ᪋ࡍࡿᅜࡸᆅᇦ࡟ࡼࡾ㸪஦ᴗᐇ᪋᫬ࡢ㓄៖ࡍ࡭ࡁ࣏࢖ࣥࢺࡣ␗࡞ࡿ㸬ࡑࡢࡓࡵ㸪ࡑࡇ࡟ఫࡴேࠎ
ࡢㄢ㢟ព㆑ࡸពぢࢆ࣮࣋ࢫ࡟㸪ඹ࡟஦ᴗࢆᙧᡂࡋᐇ⾜ࡍࡿጼໃࡸయไࡀᴟࡵ࡚㔜せ࡛࠶ࡿ㸬43࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘㸰ࠚ♫఍ⓗㄢ㢟࡟ᑐᛂࡋࡓᅜ㝿༠ຊᐇ㊶ࣔࣥࢦࣝ࡟࠾ࡅࡿ㞀ᐖ⪅ᶒ฼᮲⣙ࡢᐇ⌧࡜ JICA ᢏ⾡༠ຊࣉࣟࢪ࢙ࢡࢺࡢᙺ๭
༓ⴥᑑኵ
ᰴᘧ఍♫ࢥ࣮࢚࢖ࣜࢧ࣮ࢳ㸤ࢥࣥࢧࣝࢸ࢕ࣥࢢ ࣔࣥࢦ࡛ࣝࡣ㸪JICA ᢏ⾡༠ຊࣉࣟࢪ࢙ࢡࢺࠕ࢘ࣛࣥࣂ࣮ࢺࣝᕷ࡟࠾ࡅࡿ㞀ᐖ⪅ࡢ♫఍ཧຍಁ㐍ࣉࣟࢪ࢙ࢡࢺ㸦2016 ᖺࠥ2020 ᖺ㸪௨ୗ DPUB1㸧ࠖ㸪ࠕ㞀ᐖ⪅ᑵປᨭ᥼ไᗘᵓ⠏ࣉࣟࢪ࢙ࢡࢺ㸦2021 ᖺ
ࠥ2025 ᖺ㸪௨ୗ DPUB2㸧ࠖࡀᐇ᪋ࡉࢀ࡚࠸ࡿ㸬DPUB1 ࡣᖜᗈࡃάືࢆᐇ᪋ࡋ㞀ᐖ⪅ࡢ♫఍ཧຍ඲⯡ࢆ᥎ࡋ㐍ࡵࡿࡶࡢ࡛㸪DPUB2 ࡣ㞀ᐖ⪅ࡢᑵປ࡟≉໬ࡋࡓྲྀࡾ⤌ࡳ࡛࠶ࡿ㸬➹⪅ࡣ㸪୧ࣉࣟࢪ࢙ࢡ
ࢺ࡟ᴗົ୺௵࡜ࡋ࡚ཧຍࡋ㸪ࣉࣟࢪ࢙ࢡࢺ㐠Ⴀ࠿ࡽάືᐇ᪋࣭⟶⌮࡞࡝ࢆᢸᙜࡋࡓ㸬
DPUB1 ࡣ㸪ேᮦ⫱ᡂ࡜ࡋ࡚㞀ᐖ⪅ᅋయ࡜⾜ᨻᶵ㛵ࡢ⬟ຊᙉ໬ࡀᅗࡽࢀ㸪άື࡜ࡋ࡚㞀ᐖ⪅ⓑ᭩ࡢసᡂ㸪≀⌮࣭᝟ሗ࢔ࢡࢭࢫࣅࣜࢸ࢕ᑐ⟇㸪㞀ᐖ⌮ゎࡢಁ㐍࡞࡝ࡀᐇ᪋ࡉࢀࡓ㸬DPUB2 ࡛ࡣ㸪ேᮦ⫱ᡂ࡜ࡋ࡚ࢪࣙࣈࢥ࣮ࢳ࡜௻ᴗၨⓎேᮦࡢ⫱ᡂࡀᅗࡽࢀ㸪άື࡜ࡋ࡚㞀ᐖ⪅࡟ᑐࡍࡿᑵປᨭ᥼ࢧ࣮ࣅ
ࢫࡢᥦ౪㸪௻ᴗ࡟ᑐࡍࡿ㞀ᐖ⪅㞠⏝ၨⓎࡀᐇ᪋ࡉࢀࡓ㸬➹⪅ࡀᢸᙜࡋࡓ JICA ᢏ⾡༠ຊࣉࣟࢪ࢙ࢡࢺ࡛ࡣ㸪ேᮦ⫱ᡂ࡜」ᩘࡢάືࡀࢭࢵࢺ࡛ᐇ᪋ࡉࢀ࡚࠸
ࡿ㸬⫱ᡂࡉࢀࡓேᮦࡀ㸪άືࢆᐇ᪋ࡋ㸪⥅⥆ࡍࡿࡇ࡜ࡀ⌮᝿࡜⪃࠼࡚࠸ࡿ㸬ࡲࡓ⥅⥆ࡍࡿࡓࡵ࡟ࠕไ
ᗘࡢᵓ⠏ࠖࡀồࡵࡽࢀ࡚࠸ࡿ㸬DPUB1 ࡛ࡶ DPUB2 ࡛ࡶ㸪ࡇࡢไᗘᵓ⠏ࢆぢᤣ࠼ࡓேᮦ⫱ᡂ࡜άືࡀ㔜せ࡛࠶ࡗࡓ㸬≀⌮࢔ࢡࢭࢫࣅࣜࢸ࢕ࢆ஦౛࡟ྲྀࡿ࡜㸪ࣉࣟࢪ࢙ࢡࢺ㛤ጞᙜ᫬㸪ᵝࠎ࡞ㄢ㢟ࡀᣦ᦬ࡉࢀ࡚࠸ࡓ㸬ࡋ࠿ࡋ DPUB ࡛ㄪᰝࡋ㸪ၥ㢟ࢆᩚ⌮ࡋ࡚ࡳࡿ࡜ࠕᘓ⠏⟶⌮ไᗘࠖ࡟ၥ㢟ࡀ㞟⣙ࡉࢀ࡚࠸ࡿࡇ࡜ࡀࢃ࠿
ࡗࡓ㸬ࡑࡇ࡛㸪ᘓ⠏⟶⌮ไᗘ࡜⟶⌮᪉ἲ㸪ࡲࡓἲไᗘࡸᘓ⠏ᇶ‽ࡢぢ┤ࡋࢆ⾜࠸㸪≀⌮࢔ࢡࢭࢫࣅࣜ
ࢸ࢕ࡢྥୖ࡟㈉⊩ࡍࡿࡇ࡜ࡀ࡛ࡁࡓ㸬
DPUB2 ࡛ࡶྠᵝ࡛࠶ࡿ㸬ࡲࡎㄢ㢟ࡢᢕᥱ࡜ᩚ⌮ࢆ⾜࠸㸪࡝ࡢㄢ㢟ࢆ࡝ࡢࡼ࠺࡟ゎỴࡍࡿ࠿㸪㛵ಀ⪅඲ဨ࡛ᩚ⌮ࡍࡿ㸬௒ᅇࡣ㸪⫋ᴗ⤂௓㸪௻ᴗၨⓎ㸪⾜ᨻᨭ᥼ࣉࣟࢢ࣒ࣛ㸪㞀ᐖ⪅ࡢ⬟ຊᙉ໬ࡢ 4 ࡘ࡟ᩚ⌮ࡋ㸪ࡑࢀࡒࢀᑐ⟇ࢆㅮࡌࡓ㸬ࡍ࡭࡚ࡢㄢ㢟ࢆࣉࣟࢪ࢙ࢡࢺ࡛ゎỴࡍࡿࡢ࡛ࡣ࡞ࡃ㸪⫋ᴗ⤂௓ᡤ㸪⫋ᴗカ⦎ᶵ㛵㸪ᆅ᪉⮬἞య㸪NGO ࡞࡝࡜㐃ᦠࡋ㸪ゎỴ࡟ᙜࡓࡿ㸬⤖ᯝ࡜ࡋ࡚㸪ࢪࣙࣈࢥ࣮ࢳᑵ
ປᨭ᥼ไᗘࢆᵓ⠏ࡋ㸪௻ᴗၨⓎάືࢆᙉ໬ࡍࡿࡇ࡜ࡀ࡛ࡁ㸪⌧ᅾ㸪㞀ᐖ⪅ࡢᑵປࡀᚎࠎ࡟࡛ࡣ࠶ࡿ
ࡀಁ㐍ࡉࢀ࡚࠸ࡿ㸬
ࡇࡢ 2 ࡘࡢࣉࣟࢪ࢙ࢡࢺ⤒㦂࠿ࡽ㸪ᢏ⾡༠ຊࣉࣟࢪ࢙ࢡࢺ࡛ᡂᯝࢆฟࡋ㸪ᣢ⥆ᛶࢆ☜ಖࡍࡿࡓࡵ࡟
ࡣ㸪ேᮦ㸪▱㆑㸪ไᗘ㸪ண⟬ࡢ 4 ࡘࡀ㔜せ࡜⪃࠼࡚࠸ࡿ㸬≉࡟ண⟬ࡣ㔜せ࡛࠶ࡾ㸪ண⟬つᶍ㸪☜ಖ㸪౑⏝࡟⮳ࡿࡲ࡛㸪⾜ᨻᶵ㛵࡜⥥ᐦ࡟༠㆟ࡋண⟬☜ಖ࡟ດࡵࡿ㸬ࡲࡓண⟬ࡀ㊊ࡾ࡞࠸ሙྜࡢᑐ⟇ࡶ᳨ウࡍࡿ㸬ࡉࡽ࡟௻ᴗࡸ NGO ࡜ࡶ㐃ᦠࡋ㸪ᙼࡽ࡟࣓ࣜࢵࢺࡀ⏕ࡌࡿࡼ࠺࡞ᨭ᥼⟇ࡸไᗘࢆ‽ഛࡋ㸪ඹྠࡋ࡚ㄢ㢟ゎỴ࡟ᙜࡓࡾ㸪㔠㖹ⓗ㈇ᢸࡀ฼┈࡟࡞ࡿࡼ࠺࡟ດࡵ࡚࠸ࡿ㸬ࡍ࡭࡚ࡀୖᡭࡃ⾜ࡃヂ࡛ࡣ↓࠸ࡀ㸪ࡇࡢࡼ࠺࡞ᑐ⟇࡟ࡼࡾࣔࣥࢦ࡛ࣝࡣ୍ᐃࡢᡂᯝࡀฟ࡚࠸ࡿࡶࡢ࡜ಙࡌ࡚࠸ࡿ㸬ᮏ஦౛ࡀఱ
࠿ࡢཧ⪃࡟࡞ࢀࡤᖾ࠸࡛࠶ࡿ㸬

44࣓࠙࢖ࣥࢩ࣏ࣥࢪ࣒࢘㸰ࠚ♫఍ⓗㄢ㢟࡟ᑐᛂࡋࡓᅜ㝿༠ຊᐇ㊶

ࢱ࢖ࡢ㧗㱋ศ㔝ࡢᅜ㝿༠ຊᐇ㊶࡟ࡘ࠸࡚
ዟ஭฼ᖾ
㔝ẟᆏࢢ࣮ࣟ࢝ࣝ ୡ⏺ⓗ࡟㧗㱋໬ࡀࡍࡍࡴ࡞࠿㸪ࢱ࢖ࡣ≉࡟ࡑࡢ㏿ᗘࡀ㏿࠸㸬ᖹᆒᑑ࿨ࡢఙࡧࡶ࠶ࡾ㸪௒ᚋࡉࡽ࡟せ௓ㆤ㧗㱋⪅ࡀቑ࠼ࡿࡇ࡜ࡀぢ㎸ࡲࢀࡿ㸬୍᪉࡛㸪⏕άಖㆤ㸪ᖺ㔠㸪௓ㆤಖ㝤࡞࡝ࡢබⓗไᗘࡀ୙༑ศ
࡞࡞࠿㸪ᅜࡢᨻ⟇࡜ࡋ࡚㸪ಖ೺࣎ࣛࣥࢸ࢕࢔㸪㧗㱋⪅ࢣ࢔࣎ࣛࣥࢸ࢕࢔㸪ࢣ࢔ࢠࣂ࣮࡞࡝ࠕ◊ಟࢆཷࡅࡓࠖ࣎ࣛࣥࢸ࢕࢔࡞࡝ᆅᇦࢥ࣑ࣗࢽࢸ࢕࡟ࡼࡿ㧗㱋⪅௓ㆤࡀ㔜せ࡜ࡋ࡚࠸ࡿ㸬᪥ᮏᆺࡢ♫఍ⓗಖ㞀ࢩࢫࢸ࣒࡜ࡣ␗࡞ࡿࠕࢱ࢖ᆺᆅᇦໟᣓࢣ࢔ไᗘࠖࡢ☜❧ࢆ┠ᣦࡋ࡚ྛᆅᇦ࡛ࡣᵝࠎ࡞ྲྀࡾ⤌ࡳࢆᶍ⣴ࡋ࡚࠸ࡿ㸬ࢱ࢖࡟࠾ࡅࡿ㧗㱋⪅ࢣ࢔ไᗘࢆࡲ࡜ࡵ㸪ࡑࡢ࠺࠼࡛㸪⚄ዉᕝ┴‫‮‬Ἑཎ⏫㸪NGO 㔝ẟᆏࢢ࣮ࣟ࢝ࣝࡀࢱ࢖࡛ᐇ᪋ࡍࡿࠕࢱ࢖ᅜࡢࠕ⮬἞యࢿࢵࢺ࣮࣡ࢡࠖ࡟ࡼࡿࢥ࣑ࣗࢽࢸ࢕࣮࣋ࢫ⤫ྜᆺ㧗㱋⪅ࢣ࢔ࡢᬑཬࣔࢹࣝᵓ⠏࡜ேᮦᚠ⎔ࣉࣟࢪ࢙ࢡࢺ㸦␎⛠㸸ࢫ࣐࣮ࢺ㸤ࢫࢺࣟࣥࢢࣉࣟࢪ࢙ࢡ
ࢺ㸧ࠖࢆ஦౛࡜ࡋ࡚ሗ࿌ࡍࡿ㸬ࢱ࢖࡟࠾ࡅࡿ㧗㱋⪅ࢣ࢔ไᗘࡣ㸪1㸧ඖẼ࡞㧗㱋⪅ࢆᑐ㇟ 2㸧ఱࡽ࠿ࡢᨭ᥼ࡀᚲせ࡞㧗㱋⪅ࢆᑐ㇟
3㸧௓ㆤࡀᚲせ࡞㧗㱋⪅ࢆᑐ㇟ ࡜ศ㢮ࡉࢀྲྀࡾ⤌ࡳࡀ࡞ࡉࢀ࡚࠸ࡿ㸬ࡑࢀࡒࢀࡢάືࡢᢸ࠸ᡭࡣ࣎
ࣛࣥࢸ࢕࢔ࡀ୰ᚰ࡛࠶ࡾ㸪1㸧ࡣ㧗㱋⪅ࢡࣛࣈ㸪2㸧ࡣಖ೺࣎ࣛࣥࢸ࢕࢔ࡸ㧗㱋⪅ࢣ࢔࣎ࣛࣥࢸ࢕࢔㸪
3㸧ࡣࢣ࢔ࢠࣂ࣮ࡀ࠶ࡓࡿ㸬≉࡟㸪3㸧࡟㛵ࡋ࡚ࡣ᪥ᮏࡢ௓ㆤಖ㝤࡟ఝࡓไᗘ࡛࠶ࡿࠕࢥ࣑ࣗࢽࢸ࢕
࣮࣋ࢫ㧗㱋⪅ࢣ࢔ࢩࢫࢸ࣒ࠖ࡟๎ࡗ࡚࠸ࡿ㸬ࡇࢀࡣ㸪ࢣ࢔࣐ࢿ࣮ࢪ࣮ࣕࡀసᡂࡋࡓࢣ࢔ࣉࣛࣥ࡟ᇶ
࡙ࡁ㸪᭷ൾ࣎ࣛࣥࢸ࢕࢔࡛࠶ࡿࢣ࢔ࢠࣂ࣮ࡀ௓ㆤࢧ࣮ࣅࢫࢆᥦ౪ࡍࡿබⓗࢩࢫࢸ࣒࡛࠶ࡿ㸬ࢣ࢔ࢠ
ࣂ࣮ࡣ 70 ᫬㛫ࡢ◊ಟࢆཷㅮࡍࡿࡇ࡜ࡀᚲ㡲࡛࠶ࡾ㸪420 ᫬㛫ࡢ௓ㆤኈ◊ಟࢆ࠺ࡅࡓࡶࡢࡶᑡ࡞ࡃࡣ
࡞࠸㸬ࢫ࣐࣮ࢺ㸤ࢫࢺࣟࣥࢢࣉࣟࢪ࢙ࢡࢺ࡛ࡣ㸪ࢱ࢖ࡢ⮬἞యࢆࢿࢵࢺ࣮࣡ࢡ໬ࡋ㸪ྛྲྀࡾ⤌ࡳࢆ┦஫࡟Ꮫࡪࡇ࡜ࢆ┠ⓗ࡜ࡋࡓࣉࣟࢪ࢙ࢡࢺ࡛࠶ࡿ㸬ᚑ᮶ࡢ㛤Ⓨ༠ຊࣉࣟࢪ࢙ࢡࢺ࡛ࡣ㸪஦๓࡟┠ⓗ࡜ࢱ࣮ࢤࢵࢺࢆタᐃࡋ࡚㸪ࣔࢹࣝ஦ᴗࢆᐇ᪋ࡋ㸪ࡑࡢᡂᯝࢆ௚ᆅᇦ࡟ᬑཬࡍࡿ࢔ࣉ࣮ࣟࢳࡀ࡜ࡽࢀࡿࡇ
࡜ࡀከ࠿ࡗࡓ㸬㐩ᡂࡍ࡭ࡁ஦㡯ࡀ᫂☜࡛࠶ࡿ཯㠃㸪ᆅᇦࡢ๰ពᕤኵࡢవᆅࡀᑡ࡞ࡃ㸪࣮࢜ࢼࢩࢵࣉ
ࡢ㔊ᡂࡸ㸪ண⟬ⓗ㸪ேⓗᣢ⥆ྍ⬟ᛶ࡟ㄢ㢟ࡀ࠶ࡿࡇ࡜ࡶ࠶ࡿ㸬ྠࣉࣟࢪ࢙ࢡࢺ࡛ࡣ㸪㐩ᡂࡍ࡭ࡁ┠ⓗࢆタᐃࡏࡎ࡟㸪ࡲࡓࣄࢺ㸪ࣔࣀ㸪࢝ࢿࡶᢞධࡋ࡞࠸ࣘࢽ࣮ࢡ࡞࣐ࢿࢪ࣓ࣥࢺࢆ⾜ࡗ࡚࠸ࡿ㸬ྠࣉࣟࢪ࢙ࢡࢺࡣ㸪ཧຍ⮬἞యࡀ㸪ࣉࣟࢪ࢙ࢡࢺ㛤ጞ᫬ࡢ 9 ⮬἞య࠿ࡽ 26 ⮬἞య࡟ᣑ኱ࡋ࡚࠸ࡿ㸬ᆅᇦࡢ๰ពᕤኵ㸪୺యᛶ㸪ᬑཬࡢᐜ᫆ࡉ࡞࡝ከࡃࡢ฼Ⅼࡀ࠶ࡾ㸪ࢹ࢖ࢣ࢔ࢭࣥࢱ࣮ࡢタ❧㸪ㄆ▱⑕࢝ࣇ࢙ࡢᐇ᪋࡞࡝ᡂᯝࡀⓎ⌧ࡋ࡚࠸ࡿ㸬୍᪉࡛㸪ᙜヱ࢔ࣉ࣮ࣟࢳࡣࢿࢵࢺ࣮࣡ࢡྛ⮬἞యࡀ࠶ࡿ⛬ᗘࡢ⬟ຊ࡜ண⟬ࢆᣢࡘ㝿࡟ࡢࡳ᭷ຠ࡜ᛮࢃࢀࡿ㸬
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45

࠙≉ูࢭࢵࢩࣙࣥ 1ࠚ
PT ༠఍㸪OT ༠఍㸪ST ༠఍ࡢᅜ㝿஦ᴗࡢ⤂௓ 㹼ᅜ㝿άືࡢධࡾཱྀ࡜ࡋ࡚㹼⌮Ꮫ⒪ἲ࡜ᅜ㝿஦ᴗఀ⸨ᬛ඾
㸦බ┈♫ᅋἲே ᪥ᮏ⌮Ꮫ⒪ἲኈ༠఍㸧ࢢ࣮ࣟࣂࣜࢮ࣮ࢩࣙࣥࡀ㐍ࢇ࡛࠸ࡿ㸬ே㸪≀㸪㔠㸪᝟ሗ࡞࡝ࡀᅜቃࢆࡇ࠼࡚⛣ືࡋ㸪ᆅ⌫つᶍ࡛ᙳ㡪ࡀⓎ⏕ࡋ࡚࠸ࡿ㸬ᾏእࡢ኱௻ᴗࡀ᪥ᮏ࡟㐍ฟࡋ࡚࠸ࡿࡇ࡜㸪ࢫ࣐࣮ࢺࣇ࢛ࣥࡢ⇿Ⓨⓗ࡞ᾏእᒎ㛤㸪᪥ᮏ௻ᴗࡢ௚ᅜ࡛ࡢᕤሙࡢタ⨨㸪ᾏእᫎ⏬ࡢど⫈ࡸ᪥ᮏࡢ࢔ࢽ࣓࣮ࢩࣙࣥࡢᾏእ࡬ࡢᒎ㛤㸪Ⅽ࣮᭰ࣞࢺࡸ TPP ࡛㍺ฟධࡢ㆟ㄽ࡞࡝㸪ᵝࠎ࡞ࡶࡢࡀ࠶ࡿ㸬࣊ࣝࢫࢣ࢔㡿ᇦ࡛ࡣឤᰁ⑕㸪࣡ࢡࢳࣥࡸ⸆๣㸪་⒪ჾᮦ㸪㣗ᩥ໬㸪ࡉࡽ࡟ࡣ࣊ࣝࢫࢸࢵࢡ࡟㛵㐃ࡍࡿࢹࣂ࢖ࢫࡸࢩࢫࢸ࣒㸪࢔ࣉࣜ࡞࡝೺ᗣ࡟ᙳ㡪ࡍࡿࡶࡢࡶᅜቃࢆ㉺࠼࡚࠸ࡿ⌧≧ࡀ࠶ࡿ㸬ᆅ⌫つᶍㄢ㢟࡟ྲྀࡾ⤌ࡴࡓࡵᅜ㐃⥲఍࡛ᐃࡵࡽࢀࡓ SDGs ࡟ࡣ 17 ࡢࢦ࣮ࣝࡀ࠶ࡿࡀ㸪ࡑࡢ࠺ࡕࢦ
࣮ࣝ 3 ࡣࠕEnsure healthy lives and promote well-being for all at all ages࡛ࠖ࠶ࡿ㸬ࡇࡢࢦ࣮ࣝࢆ
㐩ᡂࡍࡿࡓࡵ㸪ࢱ࣮ࢤࢵࢺ࡜ᣦᶆࡀ♧ࡉࢀ࡚࠾ࡾ㸪ࣘࢽࣂ࣮ࢧࣝ࣊ࣝࢫ࢝ࣂࣞࢵࢪࡢ㐩ᡂࡀྵࡲࢀ
࡚࠸ࡿ㸬ࡲࡓ㸪ࣘࢽࣂ࣮ࢧࣝ࣊ࣝࢫ࢝ࣂࣞࢵࢪࡣ㸪ࠕIt covers the full continuum of essential healthservices, from health promotion to prevention, treatment, rehabilitation and palliative care.࡛ࠖ㸪ࡇࡇ࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀྵࡲࢀ࡚࠸ࡿ㸬ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡣᶓ᩿ⓗ࡞ㄢ㢟࡛࠶ࡿࡇ࡜࠿ࡽ㸪
SDGs ࡟࠾࠸࡚ࡣࡇࡢࢦ࣮ࣝ 3 ࡢࡳ࡞ࡽࡎ㸪ከࡃࡢࢦ࣮ࣝ࡟ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀ㛵㐃ࡋ࡚࠸ࡿ㸬ࡑࢀࡽㄢ㢟࡟ᑐᛂࡍࡿࡓࡵ࡟ࡣ㸪ࣃ࣮ࢺࢼ࣮ࢩࢵࣉ࣮࣡ࢡࡀᚲ㡲࡛࠶ࡿࡇ࡜࠿ࡽ㸪ࢦ࣮ࣝ 17 ࡟ࡑࡢ
㔜せᛶࡀ࠺ࡓࢃࢀ࡚࠸ࡿ㸬࢖ࣥࢻ㸪࢔ࣇࣜ࢝ࡢ⇿Ⓨⓗ࡞ேཱྀቑ࡜࠸࠺ࢢ࣮ࣟࣂࣝࢺࣞࣥࢻࡀ࠶ࡿ୍᪉㸪᪥ᮏ࡟┠ࢆྥࡅࡿ࡜ᑡ
Ꮚ㧗㱋♫఍࡛㸪⏕⏘ປാேཱྀࡢῶᑡࡀࡍࡍࢇ࡛࠸ࡿ㸬᪥ᮏᨻᗓ࡛ࡣ㸪ᑡᏊ㧗㱋♫఍࡟క࠺㸪⤒῭ᡂ㛗ࡢపୗࢆ㜵ࡄࡓࡵ࡟ᵝࠎ࡞ྲྀࡾ⤌ࡳࡀ࡞ࡉࢀ࡚࠸ࡿࡀ㸪2040 ᖺ᫬Ⅼ࡛ᘓタ࣭ᅵᮌࡸ௓ㆤ࡞࡝ 7 ⫋✀࡛ᢸ࠸ᡭࡀ୙㊊ࡍࡿࡇ࡜ࡀண ࡉࢀ࡚࠸ࡿࡀ㸬௒ᖺࡢ 6 ᭶࡟㛤ദࡉࢀࡓእᅜேᮦࡢཷࡅධࢀ࣭ඹ⏕࡟㛵ࡍࡿ㛵ಀ㛶൉఍㆟࡟࠾࠸࡚ࡣᵝࠎ࡞ពぢ஺᥮ࡀ࡞ࡉࢀࡓ㸬ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋㸪⌮Ꮫ⒪ἲኈࡀᅜෆእ࡛ά㌍࡛ࡁࡿ♫఍ࡣ࡝ࡢࡼ࠺࡞ࡶࡢ࠿㸬
ᮏㅮ₇࡛ࡣࢢ࣮ࣟࣂࣜࢮ࣮ࢩࣙࣥࡸࣃ࣮ࢺࢼ࣮ࢩࢵࣉ࣮࣡ࢡ㸪SDGs ࡟ࡶゐࢀ࡞ࡀࡽ㸪⌮Ꮫ⒪ἲኈ
ࡀ࡝ࡢࡼ࠺࡞ሙᡤ࡛ά㌍ࡍࡿ࠿㸪ࡲࡓࡇࢀࡽࡢ⌧≧ࢆࡩࡲ࠼࡚࡝ࡢࡼ࠺࡞ᅜ㝿஦ᴗ㸪άືࡀ࠶ࡿ࠿
࡟ࡘ࠸࡚ሗ࿌ࡋࡓ࠸࡜⪃࠼ࡿ㸬

46࠙≉ูࢭࢵࢩࣙࣥ 1ࠚ
PT ༠఍㸪OT ༠఍㸪ST ༠఍ࡢᅜ㝿஦ᴗࡢ⤂௓ 㹼ᅜ㝿άືࡢධࡾཱྀ࡜ࡋ࡚㹼᪥ᮏసᴗ⒪ἲኈ༠఍ᅜ㝿㒊࡟ࡼࡿᅜ㝿໬஦ᴗ࡟ࡘ࠸࡚
㧗ᶫ㤶௦Ꮚ
㸦୍⯡♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠఍㸧᪥ᮏసᴗ⒪ἲኈ༠఍ᅜ㝿㒊ࡣ㸪ࠕᅜ㝿ⓗసᴗ⒪ἲኈࠖࡢ⫱ᡂ࡟ὀຊࡋ࡚࠸ࡲࡍ㸬ᅜ㝿ⓗసᴗ⒪ἲኈࡣ㸪ᅜ㝿♫఍ཬࡧᆅᇦࡢከᵝᛶ࡜ከᩥ໬ࢆㄆ㆑࣭ᑛ㔜ࡋ㸪ࡑࡋ࡚సᴗ⒪ἲ࡟㛵ࡍࡿᅜ㝿ⓗㄢ㢟ゎỴࡢࡓࡵࡢ᝟ሗຊ࡜Ⓨಙຊࢆᣢࡘேᮦ࡛࠶ࡿ࡜⪃࠼࡚࠸ࡲࡍ㸬ᮏ᪥ࡣ㸪ᅜ㝿㒊ࡀ఍ဨ࡟ᥦ౪ࡍࡿ◊ಟ఍㸪ຓᡂ㔠ไᗘ㸪ᅜ㝿஺ὶ஦ᴗ࡟ࡘ࠸࡚ࡈ⤂௓ࡋࡲࡍ㸬ᅜ㝿㒊࡛ࡣᖺ࡟2ᅇ㸪࢜ࣥࣛ࢖ࣥ◊ಟ఍ࠕⱥㄒ࡛Ⓨ⾲ࢭ࣑ࢼ࣮㸦2023/10/22㸧ࠖ࡜ࠕࢢ࣮ࣟࣂࣝேᮦ
⫱ᡂࢭ࣑ࢼ࣮㸦2023/12/17㸧ࠖࢆ㛤ദࡋ࡚࠸ࡲࡍ㸬
ࠕⱥㄒ࡛Ⓨ⾲ࢭ࣑ࢼ࣮ࠖࡣ㸪ᅜ㝿Ꮫ఍ࡸᾏእࡢ᪋タ࡬ࡇࢀ࠿ࡽ⾜ࡗ࡚ࡳࡼ࠺㸪₇㢟Ⓩ㘓࡟ྥࡅࡓᢒ㘓సᡂࢆࡋࡓ࠸➼㸪ᾏእ࡬ࡢ㊊᥃࠿ࡾ࡜ࡋ࡚‽ഛࢆ㐍ࡵࡓ࠸࡜࠸࠺᪉ࡢཧຍࢆ᥎ዡࡋ࡚࠸ࡲࡍ㸬ࠕࢢ࣮ࣟࣂࣝேᮦ⫱ᡂࢭ࣑ࢼ࣮ࠖࡣ㸪ᾏእ࡛ᑵປࡋࡓࡾ㸪ࢢ࣮ࣟࣂࣝ࡟άືࡋ࡚࠸ࡿసᴗ⒪ἲኈ࣭-,&$ᾏእ༠ຊ㝲⤒㦂⪅࡟ࡈㅮ₇ࢆ࠸ࡓࡔࡃ࡞࡝㸪సᴗ⒪ἲ
ኈࡢᅜ㝿ⓗ࡞άື᪉ἲ࡟ࡘ࠸࡚᝟ሗᥦ౪ࡋ࡚࠸ࡲࡍ㸬ࡑࡋ࡚㸪఍ဨࡢᅜ㝿Ꮫ఍ཧຍࡸᅜ㝿஺ὶࡢᨭ᥼ࢆ᥎㐍ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࡓࠕᾏእ◊ಟຓᡂไᗘࠖ
࡛ࡣ㸪ᾏእ࡛㛤ദࡉࢀࡿᏛ఍࡟࠾ࡅࡿసᴗ⒪ἲ࡟㛵㐃ࡍࡿ◊✲Ⓨ⾲ࡸᾏእࡢసᴗ⒪ἲ࡟㛵㐃ࡍࡿ⮫ᗋ㸦ᩍ⫱㸧᪋タ࡬ࡢゼၥᕼᮃ⪅ࢆເ㞟ࡋ㸪Ỵᐃࡍࢀࡤ㈝⏝ࡢ୍㒊ࢆ⿵ຓࡋ࡚࠸ࡲࡍ㸬๰タ௨㝆㸪6ྡࡢᅜ㝿Ꮫ఍Ⓨ⾲࡜5ྡࡢ᪋タゼၥࢆᨭ᥼ࡋࡲࡋࡓ㸬᭱ᚋ࡟㸪ᅜ㝿஺ὶࡢ୺せ஦ᴗ࡜ࡋ࡚㸪ࠕ࢔ࢪ࢔సᴗ⒪ἲ༠఍஺ὶ఍ࠖ࡜ࠕ᪥ᮏ㸫ྎ‴సᴗ⒪ἲࢪࣙ࢖ࣥࢺࢩ࣏ࣥࢪ࣒࢘ࠖࡀ࠶ࡾࡲࡍ㸬ࠕ࢔ࢪ࢔సᴗ⒪ἲ༠఍஺ὶ఍ࠖࡣ㸪㝸ᖺ࡛㛤ദࡋ࡚࠸ࡿᅜ㝿஺ὶ࣭᝟ሗ஺᥮࢖࣋ࣥࢺ࡛ࡍ㸬㤶 㸪㡑ᅜ㸪ࣇ࢕ࣜࣆࣥ㸪ࢩ࣏࣮ࣥ࢞ࣝ㸪ྎ‴㸪᪥ᮏࡢ6༠఍ࡀཧຍࡋࡲࡍ㸬ẖᅇࢸ࣮࣐ࢆỴࡵ࡚㸪ྛᅜ࣭ᆅᇦࡀᢪ࠼ࡿㄢ㢟࣭⌧≧࡟ࡘ࠸࡚Ⓨ⾲ࢆࡋ࡚࠸ࡲࡍ㸬㐣ཤ࡟ࡣྛᅜ࣭ᆅᇦࡢసᴗ⒪ἲ஦᝟㸪㣴ᡂᩍ⫱࣭༞ᚋᩍ⫱㸪Ꮫ⾡άື㸪⢭⚄㞀ᐖ㸪ዪᛶసᴗ⒪ἲኈ࡬ࡢᨭ᥼㸪ࢥࣟࢼ⚝࡟࠾ࡅࡿྲྀ⤌ࡳ࡞࡝ࡢⓎ⾲ࡀ࠶ࡾࡲࡋࡓ㸬ࡲࡓ㸪ྎ‴సᴗ⒪ἲ༠఍࡜༠ຊࡋ㸪2017ᖺ࠿ࡽ2ᖺࡈ࡜࡟஫࠸ࡢᅜ࡛ࠕ᪥ᮏ㸫ྎ‴సᴗ⒪ἲࢪࣙ࢖ࣥࢺࢩ࣏ࣥࢪ࣒࢘ࠖࢆ㛤ദࡋ࡚࠸ࡲࡍ㸬COVID-19ࡢᙳ㡪࡟ࡼࡾᘏᮇࡉࢀࡓࡇ࡜ࡶ࠶ࡾࡲࡋࡓࡀ㸪ࡇ
ࢀࡲ࡛࡟4ᅇ㸦2017ᖺ᱈ᅬᕷ㸪2019ᖺ⚟ᒸᕷ㸪2022ᖺྎ໭ᕷ㸪2023ᖺᐅ㔝‴ᕷ㸧㛤ദࡋ࡚ࡁࡲࡋࡓ㸬୧༠఍࠿ࡽከࡃࡢసᴗ⒪ἲኈࡀཧຍࡋ࡚஺ὶࢆ῝ࡵ࡚࠸ࡲࡍ㸬2022ᖺ12᭶࡟ࡣྎ‴సᴗ⒪ἲ༠఍࡜Ꮫ⾡஺ὶ༠ᐃࡢ⥾⤖ࡀᐇ⌧ࡋ㸪఍ဨ㛫ࡢ஺ὶࢆࡉࡽ࡟ಁ㐍ࡋ࡚࠸ࡃࡓࡵࡢ᳨ウࢆ㐍ࡵ࡚࠸ࡲࡍ㸬ࠕᾏእࡢసᴗ⒪ἲኈ࡜஺ὶࡋࡓ࠸ࠖ
ࠕᾏእ࡛సᴗ⒪ἲࢆᒎ㛤ࡋ࡚ࡳࡓ࠸ࠖ
ࠕ㏵ୖᅜ࡛ᅜ㝿༠ຊ࡟ཧຍ
ࡋࡓ࠸ࠖ࡞࡝ࡢ⯆࿡࣭㛵ᚰࡀ࠶ࡿ཯㠃㸪ࠕㄒᏛࡀ㞴ࡋ࠸ࡢ࡛⚾࡟ࡣ↓⌮ࠖࠕᅜ㝿༠ຊ࣭ᅜ㝿஺ὶ࡬ࡢཧ
ຍ࡬ࡢ᪉ἲࡀࢃ࠿ࡽ࡞࠸ࠖ࡜୙Ᏻ࡟ᛮࡗ࡚࠸ࡿ᪉ࡶከ࠸࡜ᛮ࠸ࡲࡍ㸬ࡐࡦ㸪ᮏ఍ᅜ㝿㒊ࡀ௻⏬࣭㐠Ⴀࡍࡿ஦ᴗ࡟ཧຍࡋ࡚ࡳ࡚ࡃࡔࡉ࠸㸬୍Ṍࢆ㋃ࡳฟࡍ㸪᪂ࡋ࠸Ⓨぢࡀ࠶ࡿ࠿ࡶࡋࢀࡲࡏࢇ㸬

47

࠙≉ูࢭࢵࢩࣙࣥ 1ࠚ
PT ༠఍㸪OT ༠఍㸪ST ༠఍ࡢᅜ㝿஦ᴗࡢ⤂௓ 㹼ᅜ㝿άືࡢධࡾཱྀ࡜ࡋ࡚㹼ゝㄒ⫈ぬኈ༠఍ࡢ⌧≧࡜᪉ྥᛶ࡟ࡘ࠸࡚
❧▼㞞Ꮚ
㸦୍⯡♫ᅋἲே᪥ᮏゝㄒ⫈ぬኈ༠఍㸧ᅜ㝿ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ◊✲఍࠿ࡽ༠఍ࡢᅜ㝿஦ᴗࡢ⤂௓ࢆࡋ࡚࡯ࡋ࠸࡜࠸࠺ࡈ౫㢗ࡀ࠶ࡾࡲࡋࡓ㸬⌮Ꮫ⒪ἲኈ㸪సᴗ⒪ἲኈ࡜୪ࢇ࡛ࡢࡈ౫㢗࡛ࡋࡓࡢ࡛༠఍ࡀ࠾ᘬࡁཷࡅࡍࡿࡇ࡜࡟࡞ࡾࡲࡋࡓ㸬ࡋ࠿ࡋᮏ༠఍࡟ࡣᅜ㝿஦ᴗ࡜࿧࡭ࡿࡶࡢࡀ࡞࠸࡜࠸࠺ၥ㢟ࡀ࠶ࡾࡲࡍ㸬ࡇࡢࡇ࡜ࢆṇ┤࡟࠾ఏ࠼ࡋࡓୖ࡛㸪ᢡゅࡢᶵ఍࡛ࡍࡢ࡛㸪ゝㄒ⫈ぬኈ࡜ᅜ㝿㛵ಀࡢάືࢆࡵࡄࡿ⌧≧ࢆᩚ⌮ࡋ࡚࠾ヰࡋࡉࡏ࡚࠸ࡓࡔࡁࡓ࠸࡜ᛮ࠸ࡲࡍ㸬⌮Ꮫ⒪ἲኈࡸసᴗ⒪ἲኈ࡟㐜ࢀࡿࡇ࡜ 32 ᖺ㸪1997 ᖺ࡟ゝㄒ⫈ぬኈࡢᅜᐙ㈨᱁ࡣไᐃࡉࢀࡲࡋࡓ㸬ࡑࡋ࡚ゝㄒ⫈ぬኈ༠఍ࡀάືࢆጞࡵࡓࡢࡣ 2000 ᖺࡢࡇ࡜࡛ࡍ㸬2009 ᖺ࡟ࡣ୍⯡♫ᅋἲே࡜࡞ࡾࡲࡋࡓ㸬タ❧࠿ࡽ 20 ᖺ௨ୖ⤒㐣ࡋ࡚࠸ࡿࡶࡢࡢ㸪ࡑࡢ㛫㸪༠఍ࡢᙺဨࡢ┠ࡣ࡯ࡰෆ㒊ࡢ⤌⧊࡙ࡃࡾ࡟
ྥࡅࡽࢀ࡚࠸ࡓ࡜࠸ࡗ࡚ࡶ㐣ゝ࡛ࡣ࠶ࡾࡲࡏࢇ㸬ࡉ࡚㸪༠఍࡛ࡣ㛵ಀ┬ᗇ࡟ゝㄒ⫈ぬኈࢆእᅜேࡢᅾ␃㈨᱁ࠕ་⒪ࠖࡢᇶ‽࡟ධࢀ࡚࠸ࡓࡔࡃࡼ࠺ാ
ࡁ࠿ࡅࢆጞࡵࡲࡋࡓ㸬␃Ꮫࡋ࡚᪥ᮏ࡛ゝㄒ⫈ぬኈࡢ㈨᱁ࢆྲྀᚓࡋࡓᾏእࡢேࡣ㸪᪥ᮏ࡛ࡑࡢࡲࡲゝㄒ⫈ぬኈ࡜ࡋ࡚ാࡃࡇ࡜ࡣ࡛ࡁ࡞࠸ࡢ࡛ࡍ㸬᭱㏆ࡲ࡛ᮏ༠఍࡛ࡣࡑࡢ஦ᐇࢆ▱ࡾࡲࡏࢇ࡛ࡋࡓ㸬ࡇࢀࡶ༠఍ࡢάືࡀෆྥࡁ࡛࠶ࡗࡓࡇ࡜ࢆ♧ࡍ୍౛࡛ࡋࡻ࠺㸬⌧ᅾ㸪༠఍࡛ࡣ఍ဨᩘࡢከ࠸ᅋయࡢ୍ࡘ࡜ࡋ࡚ IALP㸨ࡢ఍㆟࡟ฟᖍࡍࡿ㸪APSSLH㸨࡞࡝࢔ࢪ࢔
ࡢ⤌⧊࡜ࡢ㛵ಀᛶࢆᵓ⠏ࡍࡿ㸪࡞࡝ᑐእⓗ࡞άືࢆᚎࠎ࡟ቑࡸࡑ࠺࡜ࡋ࡚࠸ࡲࡍ㸬⤌⧊࡜ࡋ࡚ࡢάືࡀࡑࡢࡼ࠺࡞≧ἣ࡛ࡍ࠿ࡽ㸪ᾏእ࡜ࡢ㛵ಀᛶࢆసࡿ࡜࠸࠺Ⅼࡣ࠿࡞ࡾࡢ㒊ศ㸪ಶே࡟௵ࡉࢀ࡚ࡁࡲࡋࡓ㸬1960 ᖺ௦㸪ࡲࡔᅜෆ࡛ࡢᩍ⫱ࡀጞࡲࡗ࡚࠸࡞࠸᫬ᮇ࡟ᾏእ࡛ゝㄒ⫈ぬ⒪ἲ
ࡢᏛၥࢆಟࡵࡓேࠎࡣඛ㥑⪅࡜ࡋ࡚ࡇࡢ㡿ᇦࢆᨭ࠼࡚ࡁࡲࡋࡓ㸬⮬㌟ࡀᅜ㝿ⓗ࡞Ꮫ༠఍࡛㔜せ࡞ᙺ๭ࢆᯝࡓࡍࡔࡅ࡛࡞ࡃ㸪ᅜ㝿Ꮫ఍࡛ࡢⱥㄒ࡟ࡼࡿⓎ⾲ࡸㄽᩥసᡂࡢᣦᑟࢆ㏻ࡋ࡚ⱝ࠸᪉ࠎࢆ⃭ບࡋ⫱࡚ࡿࡇ࡜ࡶ✚ᴟⓗ࡟⾜ࡗ࡚࠸ࡲࡍ㸬ࡲࡓᅜ㝿༠ຊᶵᵓ㸦JICA㸧ࢆ㏻ࡋ࡚ᾏእ࡟ฟࡿேࡶ࠸ࡲࡍ㸬ὴ㐵ඛ࡟ࡣゝㄒ⫈ぬኈ࡜࠸࠺⫋✀ࡀ᫂☜࡟☜❧ࡉࢀ࡚࠸࡞࠸ᅜࡶ࠶ࡾࡲࡍ㸬␗࡞ࡿᩥ໬ࡸ⪃࠼᪉ࢆ༑ศ⌮ゎࡋ㸪⮫ᗋࢆ㏻ࡋ࡚ゝㄒ⫈ぬ⒪ἲࡢ▱㆑ࡸᢏ⬟ࢆఏ࠼ࡿࡇ࡜ࡣᐜ࡛᫆ࡣ࠶ࡾࡲࡏࢇࡀᣮᡓࢆ⥆ࡅ࡚࠸ࡲࡍ㸬௒ᅇ㸪ᅜ㝿ⓗ࡞㛵ಀᛶࢆసࡗࡓࡉࡲࡊࡲ࡞ே࡟ఛࡗࡓヰࢆࡲ࡜ࡵ㸪༠఍ࡀ఍ဨࢆᨭ᥼ࡍࡿࡓࡵ࡟ఱ
ࡀ࡛ࡁࡿ࠿㸪ࡑࡢ᪉ྥᛶ࡟ࡘ࠸࡚ࡶ࠾ヰࡉࡏ࡚࠸ࡓࡔࡁࡓ࠸࡜ᛮ࠸ࡲࡍ㸬
㸨IALP㸸International Association of Communication Sciences and Disorders
㸨APSSLH㸸Asia Pacific Society of Speech, Language and Hearing48

࠙≉ูࢭࢵࢩࣙࣥ 2ࠚࠕᅜእ⤒㦂ࡢᅜෆάື࡬ࡢά࠿ࡋ᪉ࠖ

ୡ⏺࡟࠾ࡅࡿ㉸㧗㱋♫఍ࡢ᭱ඛ➃ ࠸ࢁ࡝ࡾࡢୣ㸸ேཱྀῶᑡ♫఍࡟࠾ࡅࡿᣢ⥆ྍ⬟࡞♫఍ࡢᐇ⌧ࢆ┠ᣦࡋ࡚ ட⏣ ె୍
㸦໭ཎᅜ㝿⑓㝔㸧་⒪ࡢᾏእᒎ㛤࡜ᆅᇦ་⒪࡟ࡣ㸪⌧ᅾࡢ་⒪㈨※㸪ேᮦ㸪ᑗ᮶ண ࡉࢀࡿ♫఍ⓗኚ໬࡞࡝ከࡃࡢ㐪࠸ࡀ࠶ࡾࡲࡍ㸬་⒪ࡢᾏእᒎ㛤ࡣᇶᮏⓗ࡟㸪᪥ᮏ࡟᪤࡟Ꮡᅾࡋ࡚࠸ࡿ་⒪ࢆ㸪ࡑࢀࢆᣢࡓ࡞࠸ᅜ࡟
ᣢࡕࡇࢇ࡛ᗈࡵࡿ࡜࠸࠺ྲྀࡾ⤌ࡳࡀከ࠸ࡼ࠺࡟ᛮ࠸ࡲࡍ㸬⚾ࡀᡤᒓࡍࡿ໭ཎࢢ࣮ࣝࣉࡢᾏእ஦ᴗࡶ
ࡑ࠺࡛ࡋࡓ㸬ᮾ༡࢔ࢪ࢔࡞࡝⤒῭ⓗ࡟ᡂ㛗ࡋ࡚࠸ࡃᅜ࡟㸪⌧ᆅ࡟ࡣ࡞࠸ᚲせ࡞ࣔࣀࢆᣢࡕࡇࡵࡤ㸪ࢽ࣮ࢬࢆᥗࡳࡸࡍࡃࣅࢪࢿࢫ࡜ࡋ࡚ᡂࡾ❧ࡘྍ⬟ᛶࡶ㧗࠸࡜ᛮ࠸ࡲࡍ㸬୍᪉㸪᪥ᮏࡢᆅ᪉ࡣሙᡤ࡟
ࡶࡼࡾࡲࡍࡀ㸪㏵ୖᅜ࡜ẚ㍑ࡍࢀࡤ༑ศ࡜ࡣ࠸࠼࡞࠸ࡲ࡛ࡶ⎔ቃࡀᩚࡗ࡚࠸ࡿ࡜ࡇࢁࡀ࡯࡜ࢇ࡝࡛
ࡍ㸬ࡋ࠿ࡋ㸪⤒῭ⓗ࡞ᡂ㛗ࡀᮃࡵࡎ㸪ࡉࡽ࡟㐍ࡴ㧗㱋໬ࡸேཱྀῶᑡࢆ⪃៖ࡍࡿ࡜㸪㊊ࡾ࡞࠸ࡶࡢࢆᣢ
ࡕࡇࢇ࡛ࡶᣢ⥆ࡉࡏࡿࡇ࡜ࡣ㞴ࡋࡃ㸪ࡇࢀࡲ࡛࡟࡞࠸᪂ࡓ࡞ゎỴ⟇ࢆ⪃࠼࡞ࡅࢀࡤ࡞ࡾࡲࡏࢇ㸬࡝ࡢᅜࡶ⤒㦂ࡋࡓࡇ࡜ࡢ࡞࠸ୡ⏺୍ࡢ㧗㱋ᅜᐙ࡜࡞ࡗࡓ᪥ᮏࡣ⊂⮬࡟ゎỴ᪉ἲࢆ⏕ࡳฟࡉ࡞ࡅࢀࡤ࡞
ࡽ࡞࠸ࡢ࡛ࡍ㸬࡛ࡣ㸪࡝࠺ࡸࡗ࡚⏕ࡳฟࡍ࠿㸬ᾏእ࡛་⒪ࡸᩥ໬㸪♫఍ࢆ⤒㦂ࡋ࡚ࡁࡓⓙࡉࢇࡢ⤒㦂ࡸ▱㆑ࡀࡑࡢ㘽࡟࡞ࡿ࠿ࡶࡋࢀࡲࡏࢇ㸬౛࠼ࡤ㸪࢖ࢱࣜ࢔ࡢࢧࣝࢹ࢕࣮ࢽࣕᓥ㸪ࢥࢫࢱࣜ࢝࡞࡝ 100 ṓ௨ୖ࡟࡞ࡗ࡚ࡶ⮬❧ࡋ࡚⏕άࡋ࡚࠸ࡿ㧗㱋⪅ࡀ㠀ᖖ࡟ከ࠸ᆅᇦࡣࣈ࣮ࣝࢰ࣮ࣥ࡜࿧ࡤࢀ࡚࠸ࡲࡍࡀ㸪ࡇࡇ࡟ࡣ㧗ᗘ་⒪ࢆᥦ౪࡛ࡁࡿ⑓
㝔ࡣ࠶ࡾࡲࡏࢇ㸬ඹ㏻ࡋ࡚ぢࡽࢀࡿࡢࡣ㸪⮬↛㇏࠿࡞⎔ቃࡢ୰࡛㸪ࣂࣛࣥࢫࡢࡼ࠸㣗஦ࢆ࡜ࡾ㸪᪥ࠎᙺ๭ࢆᣢࡗ࡚ປാࡋ㸪♫఍ⓗ࡞ࡘ࡞ࡀࡾࡀᙉ࠸ᑠࡉ࡞ࢥ࣑ࣗࢽࢸ࢕ࡢ୰࡛⏕άࢆࡋ࡚࠸ࡿ࡜࠸࠺ࡇ
࡜࡛ࡍ㸬ࣈ࣮ࣝࢰ࣮ࣥࡢఫẸࡀ࡞ࡐ೺ᗣ㛗ᑑ࡛࠸ࡽࢀࡿࡢ࠿⛉Ꮫⓗ࡟ド᫂ࡉࢀ࡚࠸ࡲࡏࢇࡀ㸪ࡇࡢヰࢆ⪺ࡃ࡜೺ᗣ㛗ᑑ࡟་⒪ࡣᚲせ࡞ࡢ࠿␲ၥ࡟ᛮࡗ࡚ࡋࡲ࠸ࡲࡍ㸬⚾ࡓࡕࡣ㸪ࡇࡢࡼ࠺࡞᪥ᮏ࡛ࡣ
࠶ࡲࡾ▱ࡽࢀ࡚࠸࡞࠸᝟ሗࡸ▱㆑ࢆᣢࡕᐤࡿࡇ࡜࡛ୡ⏺୍ࡢ㧗㱋♫఍ࡀ┤㠃ࡍࡿㄢ㢟ࡢゎỴ⟇ࢆ๰ࡾฟࡍࡇ࡜ࡀ࡛ࡁࡿ࠿ࡶࡋࢀ࡞࠸࡜⪃࠼࡚࠸ࡲࡍ㸬⚾ࡀᡤᒓࡍࡿ໭ཎࢢ࣮ࣝࣉࡣᮾ᪥ᮏ኱㟈⅏࡛ὠἼࡢ⿕ᐖ࡟࠶ࡗࡓᐑᇛ┴ᮾᯇᓥᕷ࡟㸪ேཱྀῶᑡ♫఍࡟࠾࠸࡚ࡶᣢ⥆ྍ⬟࡞♫఍ࡢᐇ⌧ࢆ┠ᣦࡋ࡚」ྜ᪋タࠕ࠸ࢁ࡝ࡾࡢୣࠖࢆ㛤タࡋࡲࡋࡓ㸬࠸ࢁ࡝ࡾࡢୣࡣ࢝ࣇ࢙㸪࠾㢼࿅㸪ᒾ┙ᾎ㸪࣍ࢸࣝ㸪ከ┠ⓗ࣮࣒ࣝ㸪ࢡࣜࢽࢵࢡࡸ௓ㆤ᪋タࡀ୍య࡜࡞ࡗࡓ᪋タ࡛ࡍ㸬ࡇࡇࢆᣐⅬ࡟ࢥ࣑ࣗࢽࢸ࢕ࢆసࡾேᕤⓗ࡟ࣈ࣮ࣝࢰ࣮ࣥࢆసࢀ࡞࠸࠿࡜ྲྀࡾ⤌ࢇ࡛࠸ࡲࡍ㸬ᾏእ࡛་⒪ᨭ᥼ࡍࡿ᪉ࠎࡣ㸪௨๓ࡢ⚾ࡶྵࡵ㸪᪥ᮏࡢ་⒪ࡢ᪉ࡀඃࢀ࡚࠸ࡿ࡜࠸࠺ᛮ࠸㎸ࡳࡀ࠶ࡿ࠿ࡶࡋࢀࡲࡏࢇࡀ㸪ࡶࡋ࠿ࡋࡓࡽ་⒪㏵ୖᅜ࡛᪥ᮏࡢㄢ㢟ࢆゎỴࡍࡿ㘽ࡀぢࡘ࠿ࡿ࠿ࡶࡋࢀࡲࡏࢇ㸬49࠙≉ูࢭࢵࢩࣙࣥ 2ࠚࠕᅜእ⤒㦂ࡢᅜෆάື࡬ࡢά࠿ࡋ᪉ࠖ

ᅜෆ࡛ࡢ࣐ࢿࢪ࣓ࣥࢺᴗົ࡟ά࠿ࡉࢀࡿ㟷ᖺᾏእ༠ຊ㝲࡛ࡢ⤒㦂ᕝ㔝 ᫭⿱㸦ࣜࢽ࢚ゼၥ┳ㆤࢫࢸ࣮ࢩࣙࣥ࢟ࢵࢬୡ⏣㇂㸧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⫋ࡀᅜ㝿༠ຊ࡟ᦠࢃࡿ஦ᴗ࣭ᴗົᙧែࡣ࠸ࡃࡘ࠿Ꮡᅾࡍࡿࡀ㸪ࡑࡢ୰࡛ࡶ
㟷ᖺᾏእ༠ຊ㝲㸦⌧ JICA ᾏእ༠ຊ㝲㸧ࡣ㸪㛗ᖺ୺࡞ὴ㐵ᡭẁࡢ୍ࡘ࡟࡞ࡗ࡚࠾ࡾ㸪➹⪅ࡶඖ㝲ဨࡢ
1 ே࡛࠶ࡿ㸬➹⪅ࡣ኱Ꮫ༞ᴗᚋ㸪ᅜෆ࡛ 5 ᖺ㛫⌮Ꮫ⒪ἲኈ࡜ࡋ࡚㸪୺࡟ᑠඣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥศ㔝࡟ᦠࢃࡗࡓ㸬ࡑࡢᚋ㸪2018 ᖺ 10 ᭶࠿ࡽ࢘ࢬ࣋࢟ࢫࢱࣥඹ࿴ᅜࡢᅜ❧ᑠඣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮࡟ὴ㐵ࡉࢀࡓ㸬࢘ࢬ࣋࢟ࢫࢱࣥࡣ World Physiotherapy 㠀ຍ┕ᅜ࡛㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟㛵ࡍࡿ▱㆑࣭ᢏ⾡࡜ࡶ࡟࡜࡚ࡶ୙㊊ࡋ࡚࠸ࡿ㸬㉱௵ඛ࡛ࡢ୺࡞άື࡜ࡋ࡚㸪ᅜෆ඲ᇦ࠿ࡽධ㝔ࡋ࡚ࡃࡿᏊ࡝ࡶࡓࡕ
ࢆᑐ㇟࡟㸪┳ㆤᖌ࡜࡜ࡶ࡟㐠ື⒪ἲ࡟㛵ࢃࡗࡓ㸬άືࡢ᭱୰㸪2020 ᖺ 3 ᭶࡟ COVID-19 ࡟ࡼࡾ㸪JICA ึ࡜࡞ࡿ඲㝲ဨ᧔㏥(ᖐᅜ)ࢆ⤒㦂ࡋࡓ㸬ᮏ᮶ 2 ᖺ㛫ࡢ௵ᅜ࡛ࡢάືࡣ㸪1 ᖺ༙࡛ᖐᅜ࡜࡞ࡾ㸪άື⮬యࡣ୰㏵༙➃࡞ᙧ࡛⤊஢ࡋࡓ㸬ࡑࡢᚋࡣ㸪⌧ᅾᡤᒓࡍࡿゼၥ┳ㆤࢫࢸ࣮ࢩࣙࣥ࡟࡚໅ົࡋ࡚࠸ࡿ㸬ᙜ஦ᴗᡤ࡛ࡣ㸪ฟ⏕ᚋ NICU ࡞࡝ࢆ⤒࡚⮬Ꮿ࡟㏥㝔ࡍࡿ་⒪ⓗࢣ࢔ඣ㸪ᨭ᥼Ꮫ⣭࡟ᅾ⡠ࡋᏛᰯࡢᤵᴗࡸᑐே㛵ಀ࡟ᅔ㞴ࡉࢆᢪ࠼ࡿ
⚄⤒Ⓨ㐩⑕ඣ࡞࡝ከᒱ࡟ࢃࡓࡾゼၥࢆ⾜ࡗ࡚࠸ࡿ㸬ᅜෆ࡛ࡶ⑓㝔࣭㏻ᡤ᪋タ࡬ࡢ࢔ࢡࢭࢫࡀ㞴ࡋ࠸ᐙᗞ㸪⌧⾜ࡢไᗘ࡛ࡣ༑ศ࡞ᨭ᥼ࡢᑐ㇟࡜࡞ࡽࡎ⫱ඣ㈇ᢸࡀ኱ࡁ࠸࡜ឤࡌ࡚࠸ࡿᐙᗞ࡞࡝ࡀᏑᅾࡋ㸪ࡑࡢࡼ࠺࡞ᐙᗞࢆᨭ᥼ࡍࡿࡇ࡜ࡣᅜ㝿ࣜࣁ࡟࠾ࡅࡿ CBR ࡟ࡶ㢮ఝࡋ࡚࠸ࡿ㸬ᙜ஦ᴗᡤ࡛ࡶ CBR ࡢࡼ࠺࡟ᐙ᪘㛫ࡢࢥ࣑ࣗࢽࢸ࢕సࡾࡸ௚᪋タ࡜ࡢ㐃ᦠ᪉ἲ࡞࡝ࢆ⌧ᅾ㐍ࡵ࡚࠸ࡿ㸬ࡲࡓ㸪᫖ᖺ 4 ᭶࠿ࡽ⟶⌮⫋࡜࡞ࡾ㸪஦ᴗᡤࡢ⤒Ⴀ࣭ᴗົᩚഛ࣭ேᮦ⫱ᡂ࡞࡝࡟ᦠࢃࡗ࡚࠸ࡿࡀ㸪㝲ဨ࡛ࡢ⤒㦂ࡣ኱ࡁ࠸㸬ከࡃࡢ㝲ဨࡣάືඛ࡟࡚ᴗົᩚഛࡸேᮦ⫱ᡂ࡞࡝ࡢ࣐ࢿࢪ࣓ࣥࢺࢆ⾜࠺㸬➹⪅ࡣάືᙜึ㸪⌧ᆅࢫࢱࢵࣇ࡬୍᪉ⓗ࡟⮬ศࡢ⪃࠼ࢆᢲࡋࡘࡅ㸪άືࡀ࠺ࡲࡃ㐍ࡲ࡞࠿ࡗࡓ㸬ࡉࡲࡊࡲ࡞ே✀ࡸゝㄒ㸪ಙ௮᐀ᩍࡀ஺ࢃࡿ␗ᅜࡢᆅ࡛⏕ά࣭άືࢆࡍࡿ୰࡛㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟࠾
࠸࡚ࡶ౯್ほࡸ೔⌮ほ㸪Ṛ⏕ほࡢ㐪࠸ࡀ኱ࡁࡃᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࢆᐇឤࡋࡓ㸬άືࢆ㐍ࡵࡿ୰࡛ࡶ
ࠕ┦ᡭࢆ⌮ゎࡍࡿࠖࠕ≀஦ࢆಠ▔ࡋከゅⓗ࡟ᤊ࠼ࡿࠖࡇ࡜ࢆព㆑ࡋࡓࡇ࡜࡛㸪⌧ᆅࢫࢱࢵࣇ࠿ࡽᑡࡋ
ࡎࡘཷࡅධࢀ࡚ࡶࡽ࠼ࡿࡇ࡜ࡀቑ࠼ࡓ㸬ࡑࢀࡲ࡛࣐ࢿࢪ࣓ࣥࢺ⤒㦂ࡢ࡞࠿ࡗࡓ➹⪅ࡀᚓࡓᏛࡧࡣ㸪⌧ᅾࡢᙺ⫋࡟࠾࠸࡚ࡶ኱ษ࡟ࡋ࡚࠸ࡿ㸬ࡲࡓ㸪ᐙ᪘ࡸࣉࣛ࢖࣮࣋ࢺࢆ኱ษ࡟ࡋ㸪⏨ᛶ࣭ዪᛶࡢᙺ๭ࡀ᫂☜࡟ศ࠿ࢀࡿ௵ᅜࡢ౯್ほ࡟ࡩࢀࡿ୰࡛㸪㏆ᖺ᪥ᮏ࡛ࡶ㆟ㄽࡉࢀ࡚࠸ࡿࠕ࣮࣡ࢡࣛ࢖ࣇࣂࣛࣥࢫࠖ
ࠕ⏨ᛶࡢ⫱ඣࠖࡶ⪃࠼ࡿᶵ఍ࡀከࡃ࠶
ࡾ㸪ࡇࡕࡽࡶ⌧ᅾࡢ࣐ࢿࢪ࣓ࣥࢺ࡟ά࠿ࡉࢀ࡚࠸ࡿ㸬ࡇࡢࡼ࠺࡟⚾ࡢ⌧ᅾࡢάື࡜ᅜ㝿༠ຊ࣭ᅜ㝿ࣜࣁࡢ⤒㦂ࡀ࡝ࡢࡼ࠺࡟⤖ࡧࡘ࠸࡚࠸ࡿ࠿㸪࡞ࡐ⪃࠼᪉ࡀኚ໬ࡋࡓ࠿ࢆࢩ࣏ࣥࢪ࣒࢘࡟࡚⤂௓ࡋ㸪ࡳ࡞ࡉࢇ࡜ពぢ஺᥮࡛ࡁࡓࡽᎰࡋ࠸㸬50࠙ࣛࣥࢳࢱ࢖࣒ࢭࢵࢩࣙࣥࠚ

㹼ࡦࡁࡔࡋ࡜ࡘ࡞ࡀࡾ A/T bank㹼
୰ᮧ㈼஧
㸦⏕άࣜࣁࣅࣜࢧ࣏࣮ࢺ࠸࡞㸧ᅜෆእࢆၥࢃࡎ㸪ẖ᪥ࡢάື⌧ሙࡢ࢔ࣉ࣮ࣟࢳ࡛㏞࠺ࡇ࡜ࡣከ࠸ࡢ࡛ࡣ࡞࠸࡛ࡋࡻ࠺࠿㸬ࠕ⮬ศࡢ㛵ࢃࡾࡣ㸪ࡑࡢሙࡢ⎔ቃࡸ࡜ࡾࡲࡃே㛫㛵ಀ㸪Ṕྐࡸᩥ໬㸪┦ᡭࡢ⤒῭ᛶࡸᩍ⫱⫼ᬒ࡟㐺ࡋࡓࡶࡢࡔࡗࡓࡢࡔࢁ࠺࠿㸽ࡑࡋ࡚ே࡜ேࡢࡘ࡞ࡀࡾࡸᗈࡀࡾ࡟⮬ศࡣ㛵ࢃࢀ࡚࠸ࡓࡢࡔࢁ࠺࠿㸽ࠖ࡜⮬ၥ⮬⟅ࡋࡓ⤒㦂ࡣከࡃࡢ᪉࡟࠾࠶ࡾࡔ࡜ᛮ࠸ࡲࡍ㸬⣲ᮔ࡟ࡑࢇ࡞᝿࠸࡟ᐤࡾῧ࠸ࡓ࠸࡜㐺ṇᢏ⾡ࣂࣥࢡ㸦Appropriate Technology:௨ୗ ATbank㸧ࢆጞࡵᩘᖺࡀ⤒ࡕࡲࡋࡓ㸬㐺ṇ࡜࠸࠺࡜ᩜᒃࡀ㧗ࡃ࡞ࡗ࡚ࡋࡲ࠺࠿ࡶࡋࢀࡲࡏࢇࡀ㸪ᩥ໬ࡸ♫఍⫼ᬒ㸪⎔ቃࡸ⤒῭≧ἣࡀከ✀ከᵝ࡞ᅜ㝿༠ຊࡢ⌧ሙ࡛ࡣ㸪ⓙࡉࢇࡢ࡝ࢇ࡞య㦂ࡶࡁࡗ࡜࡝ࡇ࠿ࡢ࣭ࡔࢀ࠿
ࡢཧ⪃࡟࡞ࡿࡣࡎ࡜⪃࠼࡚࠾ࡾࡲࡍ㸬኱ษ࡞ࡢࡣሙ㠃࣭ሙ㠃࡛㑅ࡪࡇ࡜ࡀ࡛ࡁࡿᘬࡁฟࡋࡸࡘ࡞ࡀ
ࡾࡢከᵝࡉ࡛ࡣ࡞࠸࠿࡜㸬ከᵝ࡞♫఍࣭ከᵝ࡞ᩥ໬⎔ቃࡢ୰࡛άືࡍࡿᅜ㝿ࣜࣁሙ㠃࡛ࡣ≉࡟㸪࠶ࡿ᫬⮬ศ࡜ࡋ࡚ࡣኻᩋࡋࡓ㸪௒ࡦ࡜ࡘࡔࡗࡓ࡜ᛮ࠺య㦂ࡶ㸪ᐇࡣ࡝ࡇ࠿ࡢㄡ࠿ࡢ࠸ࡘ࠿࡟ࡣ㸪㐺ṇ࡛ᚲせ࡞᝟ሗ࡟࡞ࡿ࠿ࡶࡋࢀࡲࡏࢇ㸬኱ษ࡞ࡢࡣ⤒㦂ࡢඹ᭷࡜⪃࠼ࡲࡍ㸬
ࡲࡓ㏻ಙ≧ἣࡢኚ໬ࡢ୰࡛ᵝࠎ࡞ ICT ࡸ㸪㐀ᙧ࡟㛵ࢃࡿᢏ⾡ࡀᏳ౯࡟ኚ໬ࡋࡘࡘ࠶ࡿ 3D ࣉࣜࣥࢱ࣮࡞࡝㸪࢔ࢼࣟࢢ୍㎶ಽࡔࡗࡓ௨๓ࡢᅜ㝿ࣜࣁࡶሙ㠃࡟ࡼࡗ࡚ኚ໬ࡋ࡚࠸ࡲࡍ㸬ࡇ࠺ࡋࡓయ㦂ඹ᭷ࡸࢳࣕࣞࣥࢪ㸪࠺ࡲࡃ⾜࠿࡞࠿ࡗࡓࡇ࡜࡞࡝ࡶྵࡵᵝࠎ࡞࢔ࣉ࣮ࣟࢳࢆ⵳✚ࡍࡿᚲせࡀ࠶ࡾࡲࡍ㸬௒ᅇ㸪௒ࡲ࡛ࡢࢶ࣮ࣝࢆࡼࡾ౑࠸ࡸࡍࡃኚ᭦ࡋ㸪ࡲࡓ SNS ࡛ࡢࡸࡾྲྀࡾࢆቑࡸࡍࡇ࡜࡛㸪ⓙࡉࢇࡢẖ᪥ࡢከᵝᛶࢆࡼࡾඹ᭷ࡋࡸࡍࡃࡋࡲࡋࡓ㸬ᐇ㝿ࡢඹ᭷ࢶ࣮ࣝ࡟ゐࢀ࡞ࡀࡽ㸪Ẽ㍍࡟ཧຍࡋ࡚࠸
ࡓࡔࡁ㸪௒ᚋࡢከࡃࡢேࡢ࠸ࢁ࠸ࢁ࡞Ẽ࡙ࡁࡸ⧅ࡀࡾࡀ⏕ࡲࢀࡿࢫࢱ࣮ࢺ࡜࡞ࡿࡇ࡜ࢆᮇᚅࡋ࡚࠾
ࡾࡲࡍ㸬AT ࢔࢖ࢹ࢔ඹ᭷ࡸࢳࣕࣞࣥࢪࡢࢫࢱ࣮ࢺࡢ᫬㛫࡟ࡋࡲࡋࡻ࠺㸬ࡇࢀ࠿ࡽᅜ㝿༠ຊ࡟㛵ࢃࡿேࡓࡕ㸪ࡑࡋ࡚ᡃࠎ⮬㌟ࡢ㌟㏆࡞ࢶ࣮ࣝ࡜ࡋ࡚඘ᐇࡋ࡚࠸ࡃ࡜Ⰻ࠸࡛ࡍ
ࡡ㸬ࡈ༠ຊࡼࢁࡋࡃ࠾㢪⮴ࡋࡲࡍ㸬
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51

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ㸯ࠚ࣮࣌ࣝ㞀ᐖඣࢫ࣏࣮ࢶࣉࣟࢪ࢙ࢡࢺ 㹼⌧ᆅㄪᰝࢆᐇ᪋ࡋ࡚㹼ᶈᯇᮏ ౡᕫ 1)2)㸪 ὠ㷂 ༓ె 2)3)㸪 す㷂 Ṋᩥ 2)4)㸪 ᗈ⏣ ⨾Ụ 1)2)
1) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ูᗓ་⒪ࢭࣥࢱ࣮ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉2) බ┈♫ᅋἲே ኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ ᅜ㝿άື᥎㐍ጤဨ఍3) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ᐑᓮᮾ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉4) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ すูᗓ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ ࠙ࡣࡌࡵ࡟ࠚ
኱ศ┴⌮Ꮫ⒪ἲኈ༠఍࡛ࡣ㸪ᅜ㝿༠ຊᶵᵓ㸦௨ୗ㸸JICA㸧ⲡࡢ᰿ᢏ⾡༠ຊ஦ᴗ࡜ࡋ࡚㸪࣮࣌ࣝ࡟࠾
ࡅࡿ㞀ᐖඣࢫ࣏࣮ࢶᣦᑟຊᙉ໬࠾ࡼࡧᬑཬಁ㐍ࣉࣟࢪ࢙ࢡࢺࢆᐇ᪋ࡋ࡚࠸ࡿ㸬௒ᅇ㸪᪥ᮏ࣭࣮࣌ࣝ
཭ዲᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮㸦௨ୗ㸸INR㸧࡛⌧ᆅㄪᰝࢆᐇ᪋ࡋࡓࡢ࡛ሗ࿌ࡍࡿ㸬࠙⫼ᬒࠚ
2013 ᖺࡼࡾࢩࢽ࢔ᾏእ࣎ࣛࣥࢸ࢕࢔࠾ࡼࡧ▷ᮇ㟷ᖺᾏእ༠ຊ㝲࡟ࡼࡗ࡚⥅⥆ࡉࢀࡓࠕ࣮࣌ࣝ㞀ᐖ⪅ࢫ࣏࣮ࢶ஦ᴗࠖࡣ㸪௒᪥ࡲ࡛ཷࡅ⥅ࡀࢀ࡚࠸ࡿ㸬INR ࡟࠾ࡅࡿ㞀ᐖඣࢫ࣏࣮ࢶࡢ⌧≧ࡸㄢ㢟ࢆ☜ㄆࡋࡓୖ࡛㸪᪥ᮏ࡜࣮࣌ࣝࡢ༠ຊయไࡢලయⓗෆᐜཬࡧ␃ពⅬࢆ᫂☜࡟ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࡓ⌧ᆅㄪᰝࢆᐇ᪋ࡋࡓ㸬࠙᪉ἲࠚ⌧ᆅㄪᰝࡣ㸪኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ࡢ⌮Ꮫ⒪ἲኈ 4 ྡ࡜⌧ᆅ㏻ヂ 1 ྡ࡟࡚ᐇ᪋ࡋࡓ㸬ㄪᰝᮇ㛫ࡣ㸪
2023 ᖺ 2 ᭶ 6 ᪥ࠥ2023 ᖺ 2 ᭶ 9 ᪥㸬ሙᡤ㸸INR㸦࣐ࣜᕷࢳ࣮ࣙࣜࢪࣙࢫᆅ༊㸧㸬ᑐ㇟㸸INR ࡢ་ᖌ
2 ྡ࡜⌮Ꮫ⒪ἲኈ 4 ྡ㸬ᑐ㇟㒊㛛㸸⢭⚄㐠ືⓎ㐩㞀ᐖ㒊㸪▱ⓗ㞀ᐖ࣭♫఍㐺ᛂ㞀ᐖ㒊㸪⬨㧊ᦆയ㒊㸬ᐇ᪋ෆᐜ㸸࢙࣒࢘ࣝ࢝ࢭࣞࣔࢽ࣮㸪᪋タぢᏛ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥぢᏛ㸪㞀ᐖඣࢫ࣏࣮ࢶぢᏛ㸪་ᖌ㸪⌮Ꮫ⒪ἲኈ㸪ᝈ⪅࠾ࡼࡧᐙ᪘ࢆᑐ㇟࡜ࡋࡓ࢖ࣥࢱࣅ࣮ࣗࢆ⾜ࡗࡓ㸬࠙⤖ᯝࠚ⌧ᅾࡣ 3 㒊㛛୰㸪⢭⚄㐠ືⓎ㐩㞀ᐖ㒊㸪▱ⓗ㞀ᐖ࣭♫఍㐺ᛂ㞀ᐖ㒊ࡢ 2 㒊㛛࡛ࢫ࣏࣮ࢶࢆᐇ᪋ࡋ࡚
࠸ࡓ㸬⢭⚄㐠ືⓎ㐩㞀ᐖ㒊࡟࠾࠸࡚㸪᭱ࡶከ࠿ࡗࡓ⑌ᝈࡣ⮬㛢⑕࡛࠶ࡾ㸪ᖺ㱋㸸3㹼10 ṓ㸪ᖺ㛫ᑐ㇟⪅㸸320 ྡ㸪1 ࢢ࣮ࣝࣉ㸸12 ྡ㸪ᐇ᪋᫬㛫㸸2 ᫬㛫㸪㐌㸸1 ᅇ㸪1 ࢭࢵࢩࣙࣥ㸸6 ᅇ㸪㏣ຍࢭࢵࢩࣙ
ࣥࡣ 4 ࣨ᭶ᚅࡕࡢ≧ែ࡛࠶ࡗࡓ㸬▱ⓗ㞀ᐖ࣭♫఍㐺ᛂ㞀ᐖ㒊࡛㸪᭱ࡶከ࠿ࡗࡓ⑌ᝈࡣ⢭⚄Ⓨ㐩㐜⁫㸪ᖺ㱋㸸10㹼37 ṓ㸪ᖺ㛫ᑐ㇟⪅㸸300 ྡ㸪1 ࢢ࣮ࣝࣉ㸸6 ྡ㸪ᐇ᪋᫬㛫㸸2 ᫬㛫㸪㐌㸸3 ᅇ㸪1 ࢭࢵࢩࣙࣥ㸸20 ᅇ㸪㏣ຍࢭࢵࢩࣙࣥࡣᚅᶵࡢ≧ែ࡛࠶ࡗࡓ㸬ࡲࡓ㸪ᆅඖ࡛࠶ࡿࢳ࣮ࣙࣜࢪࣙࢫᆅ༊࠿ࡽࡢ
㏻㝔ࡀከ࠿ࡗࡓ㸬ᐙ᪘࡬ࡢ࢖ࣥࢱࣅ࣮࡛ࣗࡣ㸪ඣࡢᑵ⫋࡟ࡘ࠸࡚୙Ᏻࡀ࠶ࡿ࡜ࡢኌࡶ⪺࠿ࢀࡓ㸬ࢫ࣏࣮ࢶෆᐜࡣ㸪ࣂࢫࢣࢵࢺࡸࢧࢵ࣮࢝ࡢࢻࣜࣈࣝ㸪ࢫࢸࢵࣉ⦎⩦࡛㸪ࢤ࣮࣒ࡣ⾜ࢃࢀ࡚࠸࡞࠿ࡗࡓ㸬⌮Ꮫ⒪ἲࡣ㸪6㹼8 ࢭࢵࢩࣙࣥࢆ୍ࡘࡢ἞⒪࡜ࡋ࡚࠸ࡓ㸬࠙⤖ㄽࠚࢫ࣏࣮ࢶࡢ㒊ศⓗ࡞ಶேືస⦎⩦ࡣ⾜ࢃࢀ࡚࠸ࡓࡀ㸪㞟ᅋ࡛⾜࠺ࢺ࣮ࣞࢽࣥࢢࡸ⦎⩦ヨྜࡣ㸪⾜ࢃࢀ࡚࠸࡞࠿ࡗࡓ㸬௒ᚋࡣ㸪௒ᅇࡢ⌧ᆅㄪᰝࢆᇶ࡟㸪㞀ᐖඣࢫ࣏࣮ࢶࡢ㐠Ⴀ࣭ᣦᑟ⬟ຊྥୖࢆ┠ᶆ࡟㸪
2023 ᖺ 5 ᭶ 14 ᪥࠿ࡽ኱ศ┴ࢆᣐⅬ࡜ࡋࡓゼ᪥◊ಟࢆᐇ᪋ࡍࡿணᐃ࡛࠶ࡿ㸬52

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 1ࠚ࣮࣌ࣝ㞀ᐖඣࢫ࣏࣮ࢶࣉࣟࢪ࢙ࢡࢺ 㹼࢔ࢡࢸ࢕ࣈࢳࣕ࢖ࣝࢻࣉࣟࢢ࣒ࣛࢆ౑⏝ࡋ࡚㹼‫۔‬ὠ㷂༓ె   㸪ᯇᮏౡᕫ   㸪す㷂Ṋᩥ   㸪ᗈ⏣⨾Ụ   1) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ᐑᓮᮾ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉2) බ┈♫ᅋἲே ኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ ᅜ㝿άື᥎㐍ጤဨ఍3) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ูᗓ་⒪ࢭࣥࢱ࣮ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉4) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ すูᗓ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉࠙COI 㛤♧ࠚ
₇㢟Ⓨ⾲࡟㛵㐃ࡋ㸪Ⓨ⾲⪅ࡽ࡟㛤♧ࡍ࡭ࡁ COI 㛵ಀ࡟࠶ࡿ௻ᴗ➼ࡣ࠶ࡾࡲࡏࢇ㸬࠙ࡣࡌࡵ࡟ࠚ
ᡃࠎࡣ኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ࢆᥦ᱌ᅋయ࡜ࡋ࡚㸪2022 ᖺ࠿ࡽ᪥ᮏ࣭࣮࣌ࣝ཭ዲᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮㸦௨ୗ㸪INR㸧ࢆᑐ㇟࡟㸪ᅜ㝿༠ຊᶵᵓ㸦JICA㸧ⲡࡢ᰿ᢏ⾡༠ຊ஦ᴗࠕ࣌ࣝ
࣮㞀ᐖඣࢫ࣏࣮ࢶࣉࣟࢪ࢙ࢡࢺࠖࢆᐇ᪋ࡋ࡚࠸ࡿ㸬INR ࡟࠾ࡅࡿ⌧≧ࡢㄢ㢟ࢆ᫂ࡽ࠿࡟ࡍࡿࡓࡵ㸪⮬ᕫ࠾ࡼࡧ௚⪅᥇Ⅼ᪉ᘧ࡟ࡼࡿᣦᑟᢏ⾡ホ౯ࢩ࣮ࢺ㸦௨ୗ㸪ホ౯ࢩ࣮ࢺ㸧ࢆసᡂࡋ࡞ࡅࢀࡤ࡞ࡽ࡞
࠿ࡗࡓ㸬ࡋ࠿ࡋ㸪COVID-19 ࣃࣥࢹ࣑ࢵࢡ࡟ࡼࡾ⌧ᆅࡢ≧ἣࡀ೵⁫ࡍࡿ୰㸪ึࡵ࡚ࡢᅜ㝿άື࡛ホ౯ࢩ࣮ࢺࢆసᡂࡍࡿࡇ࡜ࡣᐜ࡛᫆ࡣ࡞࠿ࡗࡓ㸬௒ᅇ㸪බ┈㈈ᅋἲே᪥ᮏࢫ࣏࣮ࢶ༠఍ࡀ㛤Ⓨࡋࡓ࢔ࢡࢸ࢕ࣈࢳࣕ࢖ࣝࢻࣉࣟࢢ࣒ࣛ㸦௨ୗ㸪ACP㸧ࢆᇶ࡟ホ౯ࢩ࣮ࢺࢆసᡂࡍࡿࡇ࡜࡛㸪INR ࡟࠾ࡅࡿ㞀ᐖඣࢫ࣏࣮ࢶࡢᏳ඲⟶⌮ࡸᣦᑟ⪅ࡢホ౯ࡀྍ⬟࡜࡞ࡗࡓ㸬ࡇࡢྲྀࡾ⤌ࡳࢆ㏻ࡋ࡚㸪ACP ࡣ೺ᖖࡢᏊ౪ࡓࡕࡔࡅ࡛࡞ࡃ㞀ᐖඣࡸ㛤Ⓨ㏵ୖᅜ࡛ࡢ㐠ືᣦᑟ࡟ࡶᐇ⏝ⓗ࡛࠶ࡾ㸪௒ᚋࡢάື࡟ࡶ༑ศᛂ⏝࡛ࡁࡿࡶࡢ࡛࠶ࡿࡓࡵ㸪సᡂ࡟⮳ࡿࡲ࡛ࡢࣉࣟࢭࢫ࡜ホ౯ࢩ࣮ࢺ࠾ࡼࡧ ACP ࡢෆᐜࢆࡇࡇ࡟⤂௓ࡍࡿ㸬࠙᪉ἲࠚ
2022 ᖺ 9 ᭶㹼11 ᭶ࡢ㛫㸪᪥ᮏഃ⌮Ꮫ⒪ἲኈ 2 ྡࢆ୰ᚰ࡟࣮࣌ࣝഃ་ᖌ 1 ྡ࠾ࡼࡧ⌮Ꮫ⒪ἲኈ 1 ྡ࡜༠ാࡋ࡚ホ౯ࢩ࣮ࢺࢆసᡂࡋࡓ㸬ෆᐜࡣ㸪኱㡯┠࡟ࠕᏳ඲⟶⌮ࠖ࡜ࠕ⌮Ꮫ⒪ἲࠖࡢ 2 ࡘࢆタᐃࡋ㸪ࡑࢀࡒࢀ ACP ᣦᑟ⪅ྥࡅࡢࠕᏳ඲⟶⌮ࢳ࢙ࢵࢡࣜࢫࢺࠖ࡜ࠕᣦᑟ⪅࡜ಖㆤ⪅ࡢࡓࡵࡢࢳ࢙ࢵࢡࣜࢫ
ࢺࠖࢆཧ⪃࡟సᡂࡋࡓ㸬࠙⤖ᯝ࠾ࡼࡧ⪃ᐹࠚ
ACP ࡣᏊ࡝ࡶࡀⓎ㐩ẁ㝵࡟ᛂࡌ࡚㌟࡟ࡘࡅ࡚࠸ࡃືࡁࡢࣉࣟࢢ࣒ࣛ࡜ࡋ࡚㸪᪥ᮏࡢ་⒪ᶵ㛵࣭ᩍ⫱⌧ሙ࠿ࡽࢫ࣏࣮ࢶᑡᖺᅋ㸪ࣉࣟࢫ࣏࣮ࢶࢳ࣮࣒ࡲ࡛ᐇ㝿ࡢᣦᑟ⌧ሙ࡛✚ᴟⓗ࡟ά⏝ࡉࢀ࡚࠸ࡿ㸬ෆᐜࡣᣦᑟ⪅ྥࡅ࡜ᐙᗞྥࡅ࡟ศ࠿ࢀ࡚࠾ࡾ㸪๓⪅ࡣືࡁࡢほᐹホ౯㸪Ⓨ㐩ẁ㝵ࡢ≉ᚩࡸᣦᑟࡢࣀ࢘
ࣁ࢘➼㸪ᚋ⪅ࡣぶᏊ࡛࡛ࡁࡿ㐠ື㐟ࡧࢆ୰ᚰ࡜ࡋ࡚࠸ࡿ㸬௒ᅇ㸪ᣦᑟ⪅ྥࡅࡢྛࢳ࢙ࢵࢡࣜࢫࢺࢆ
ཧ⪃࡟ࡋࡓࡇ࡜࡛ホ౯ࢩ࣮ࢺసᡂࡢࣄࣥࢺࡀᚓࡽࢀ㸪≉࡟Ᏻ඲⟶⌮ࡸࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥᢏ⾡ࡢ㡯┠࡛ࡣホ౯ࡍ࡭ࡁどⅬࢆᢚ࠼ࡿࡇ࡜ࡀ࡛ࡁࡓ㸬ࡋ࠿ࡋ㸪ACP ࡣ࠶ࡃࡲ࡛ࡶ㐠ືࣉࣟࢢ࣒ࣛࡢ୍⎔࡛࠶ࡿࡓࡵ㸪་Ꮫⓗホ౯ࡸࢫ࣏࣮ࢶᢏ⾡ホ౯ࡢ㡯┠࡟ࡘ࠸࡚ࡣᕤኵࡍࡿᚲせࡀ࠶ࡗࡓ㸬࠙ࡲ࡜ࡵࠚ
ACP ࡣ㐠ືࣉࣟࢢ࣒ࣛࡔࡅ࡛࡞ࡃホ౯ࢩ࣮ࢺసᡂ࡟ࡶᛂ⏝ࡀຠࡃࡶࡢ࡛࠶ࡾ㸪㛤Ⓨ㏵ୖᅜࡢᏊ࡝
ࡶࡸ㞀ᐖඣࡢ㐠ືࢆ⾜࠺㝿࡟ࡣ㠀ᖖ࡟ᙺ❧ࡘࢶ࣮࡛ࣝ࠶ࡿ㸬53

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 1ࠚ࣮࣌ࣝ㞀ᐖඣࢫ࣏࣮ࢶࣉࣟࢪ࢙ࢡࢺ㹼ᮏ㑥◊ಟࡢሗ࿌㹼‫۔‬す㷂Ṋᩥ   㸪ὠ㷂༓ె   㸪ᯇᮏౡᕫ   㸪ᗈ⏣⨾Ụ   1) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ すูᗓ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉2) බ┈♫ᅋἲே ኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ ᅜ㝿άື᥎㐍ጤဨ఍3) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ᐑᓮᮾ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉4) ⊂❧⾜ᨻἲே ᅜ❧⑓㝔ᶵᵓ ูᗓ་⒪ࢭࣥࢱ࣮ ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉࠙⫼ᬒࠚ᪥ᮏ࣭࣮࣌ࣝ཭ዲᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮(௨ୗ:INR)ࢆ࢝࢘ࣥࢱ࣮ࣃ࣮ࢺ࡜ࡋࡓ
ࠕ࣮࣌ࣝ㞀ᐖ⪅ࢫ࣏࣮ࢶ஦ᴗࠖࡣ㸪2013 ᖺࡼࡾࢩࢽ࢔ᾏእ࣎ࣛࣥࢸ࢕࢔࠾ࡼࡧ▷ᮇ㟷ᖺᾏእ༠ຊ㝲࡟࡚௒᪥ࡲ࡛༠ຊయไࡀ⥅⥆ࡉࢀ࡚ࡁࡓ㸬2022 ᖺ࠿ࡽࡣබ┈♫ᅋἲே኱ศ┴⌮Ꮫ⒪ἲኈ༠఍ࡀཷࡅ
ධࢀᅋయ࡜࡞ࡾࠕ࣮࣌ࣝ࡟࠾ࡅࡿ㞀ᐖඣࢫ࣏࣮ࢶᣦᑟຊᙉ໬࠾ࡼࡧᬑཬಁ㐍ࣉࣟࢪ࢙ࢡࢺࠖࢆ⾜ࡗ࡚࠸ࡿ㸬COVID-19 ࣃࣥࢹ࣑ࢵࢡࡢᙳ㡪࡛ᮏ㑥◊ಟࡢᐇ᪋ࡀ༴ࡪࡲࢀࡓࡀ㸪᫬ᮇࡢኚ᭦ࢆ⤒࡚࡞ࢇ࡜࠿ᐇ᪋ࡍࡿࡇ࡜ࡀ࡛ࡁࡓ㸬௒ᅇࡣ◊ಟෆᐜ࡜◊ಟࢆཷࡅࡓ INR ࢫࢱࢵࣇࡀ❧᱌ࡋࡓ࢔ࢡࢩࣙࣥࣉ
ࣛࣥ㸪࢔ࣥࢣ࣮ࢺ⤖ᯝࢆ୰ᚰ࡟ሗ࿌ࡍࡿ㸬࠙┠ⓗࠚᮏ㑥◊ಟࡢᆅ࡛࠶ࡿ኱ศ┴࡟ࡣ㸪ࠕኴ㝧ࡢᐙࠖࢆࡣࡌࡵ࡜ࡋ࡚㸪㞀ᐖඣ࣭⪅ࡢࢫ࣏࣮ࢶ࡟㛵ࢃࡿ᪋タࡸᅋయࡀ࠶ࡿ㸬ᮏ㑥◊ಟࡢ┠ⓗࡣ㸪◊ಟࢆ㏻ࡋ࡚㞀ᐖඣࢫ࣏࣮ࢶࡢᐇ᪋᪉ἲࡸၨⵚάືࡢ᪉ἲࢆᏛ
ࡧ㸪INR ࡢ་ᖌ࣭⌮Ꮫ⒪ἲኈࡢ㞀ᐖඣࢫ࣏࣮ࢶࡢ㐠Ⴀ⬟ຊ࡜ᣦᑟ⬟ຊࡀྥୖࡍࡿࡇ࡜࡛࠶ࡗࡓ㸬ࡲࡓ㸪᭱⤊ⓗ࡟ࡣ࣮࣌ࣝᅜෆ࡛ࡢάືࡢᣦ㔪࡜࡞ࡿ࢔ࢡࢩࣙࣥࣉࣛࣥࢆ❧᱌ࡍࡿࡇ࡜࡛࠶ࡗࡓ㸬࠙άືࡢෆᐜࠚ
INR ࡢ་ᖌ 2 ྡ㸪⌮Ꮫ⒪ἲኈ 4 ྡࡀ᮶᪥ࡋ㸪኱ศ┴ูᗓᕷ࠾ࡼࡧ኱ศᕷෆ࡛ 2023 ᖺ 5 ᭶ 14 ᪥࠿ࡽ 30 ᪥ࡲ࡛ࡢ 17 ᪥㛫ࡢ◊ಟࢆ⾜ࡗࡓ㸬◊ಟࡢෆᐜࡣᛴᛶᮇ⑓㝔㸪ᅇ᚟ᮇ⑓㝔࡛ࡢ᪥ᮏࡢ་⒪◊ಟ㸪ኴ㝧ࡢᐙࢆࡣࡌࡵ࡜ࡋࡓ㞀ᐖ⪅࡟㛵㐃ࡍࡿ᪋タ࡛ࡢ㞀ᐖඣ࣭⪅ࢫ࣏࣮ࢶ◊ಟ㸪㞀ᐖ⪅ࢫ࣏࣮ࢶ኱఍
ࡢぢᏛ㸪ࢩ࣏ࣥࢪ࣒࢘㸪᪥ᮏࡢᩥ໬࡟㛵ࡍࡿ◊ಟ࡛࠶ࡗࡓ㸬యㄪ୙Ⰻ࡞࡝኱ࡁ࡞ၥ㢟ࡶ࡞ࡃ㸪ணᐃࡋ
࡚࠸ࡓ 17 ᪥㛫ࡢ◊ಟࢆᐇ᪋ࡍࡿࡇ࡜ࡀ࡛ࡁࡓ㸬◊ಟࡢ᭱ᚋ࡟ࡣ INR ࢫࢱࢵࣇࡀ࢔ࢡࢩࣙࣥࣉࣛࣥ
ࢆసᡂࡋ㸪ᮏ㑥◊ಟ࡛Ꮫࢇࡔࢫ࣏࣮ࢶࡢᐇ᪋࡟ྥࡅࡓࢫࢣࢪ࣮ࣗࣝࡸᐇ᪋ෆᐜࡢⓎ⾲ࢆ⾜ࡗࡓ㸬◊ಟᚋࡢ࢔ࣥࢣ࣮ࢺ࡛ࡣ◊ಟෆᐜࡸ᪥⛬㸪᫬㛫㓄ศ࡞࡝࡟ᑐࡋ࡚Ⰻዲ࡞ᅇ⟅ࡀᚓࡽࢀࡓ཯㠃㸪COVID19 ࣃࣥࢹ࣑ࢵࢡࡢᙳ㡪ࡢࡓࡵ࡜⌮ゎࡣ࡛ࡁࡓࡀ㸪᪋タࡸᏛᰯ࡛ࡢ㞀ᐖඣࢫ࣏࣮ࢶࡢぢᏛࡀฟ᮶࡞࠿
ࡗࡓࡇ࡜ࡀṧᛕ࡛࠶ࡗࡓ࡜ࡢពぢࡶᣲࡀࡗࡓ㸬࠙௒ᚋࡢྲྀࡾ⤌ࡳࠚ௒ᚋࡣື⏬ࢆ⏝࠸ࡓᢏ⾡ᣦᑟ㸪࣮ࣝࣝࣈࢵࢡసᡂ࡞࡝ࡢᨭ᥼ࢆ⾜࠸ INR ࢫࢱࢵࣇࡢ⌧ᆅ࡛ࡢྲྀࡾ
⤌ࡳࢆάᛶ໬ࡋ㸪᭦࡞ࡿᣦᑟຊᙉ໬ࢆ┠ᣦࡍணᐃ࡛࠶ࡿ㸬࠙೔⌮ⓗ㓄៖ࠚ
Ⓨ⾲࡟࠶ࡓࡾ㛵ಀ᪋タࡢᢎㅙࢆᚓࡓ㸬ࡲࡓ㸪ᝈ⪅࠾ࡼࡧ᪋タ฼⏝⪅࡟ᑐࡋ㸪ಶேࡀ≉ᐃࡉࢀ࡞࠸ࡼ
࠺㓄៖ࢆ⾜ࡗࡓ㸬54

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 1ࠚࠕࢱ࢖ᅜ⮬἞యࢿࢵࢺ࣮࣡ࢡ࡟ࡼࡿࢥ࣑ࣗࢽࢸ࢕࣮࣋ࢫ⤫ྜᆺ㧗㱋⪅ࢣ࢔஦ᴗࠖ
ㄆ▱⑕࢝ࣇ࢙ᬑཬ㸸஦౛ሗ࿌‫۔‬㕥ᮌ▱ୡ  㸪ᒣཱྀెᑠ㔛  㸪Ἀᾆᩥᙪ  1) ᅜ㝿ᩍ㣴኱Ꮫ ᅜ㝿ᩍ㣴Ꮫ㒊 4 ᖺ2) ᅜ❧ಖ೺་⒪⛉Ꮫ㝔3) ᮾி㒔ᕷ኱Ꮫ࠙⫼ᬒࠚ㏆ᖺᛴ㏿࡞㧗㱋໬ࡀ㐍ࡴࢱ࢖࡛ࡣ㸪 ྛᆅᇦࡢ≉ᚩࡸ㈨※࡟༶ࡋࡓ㧗㱋⪅ࢣ࢔ࡢయไᵓ⠏ࡀồࡵࡽࢀࡿ㸬 ㄆ▱⑕ࢣ࢔ࡣ≉࡟ᆅᇦࡄࡿࡳࡢ⌮ゎ࡜ᨭ࠼ྜ࠸ࡀ㔜せ࡛࠶ࡿ㸬 JICA ⲡࡢ᰿ᢏ⾡༠ຊ஦ᴗࠕࢱ࢖ᅜࡢ⮬἞యࢿࢵࢺ࣮࣡ࢡ࡟ࡼࡿࢥ࣑ࣗࢽࢸ࢕࣮࣋ࢫ⤫ྜᆺ㧗㱋⪅ࢣ࢔ᬑཬࣉࣟࢪ࢙ࢡࢺ࡛ࠖࡣ㸪 ᪥ᮏࡢ⮬἞య࡜ࢱ࢖ࡢ」ᩘ⮬἞యࢆࢿࢵࢺ࣮࣡ࢡ໬ࡋ㸪 ྛᆅࡢྲྀࡾ⤌ࡳࢆ┦஫࡟Ꮫࡧྜ࠺ࡇ
࡜࡟ࡼࡾ㸪ࠕࢥ࣑ࣗࢽࢸ࢕࣮࣋ࢫ⤫ྜᆺ㧗㱋⪅ࢣ࢔ࠖࡢඃⰋ஦౛ࢆྛᆅ࡟㐺ྜࡋࡓᙧ࡛ᬑཬࡍࡿάື
ࢆᐇ᪋ࡍࡿ㸬 ࡑࡢ஦౛࡜ࡋ࡚㸪 ࢱ࢖࡛ࡢㄆ▱⑕࢝ࣇ࢙ᬑཬ࡟ྲྀࡾ⤌ࡴ㸬࠙┠ⓗࠚྠ஦ᴗ࡟࠾࠸࡚ලయⓗ࡟ᬑཬࡀ㐍ࢇ࡛࠸ࡿάື஦౛ࠕㄆ▱⑕࢝ࣇ࢙ࠖࡢᬑཬ⤒⦋ࢆ᫂ࡽ࠿࡟ࡍࡿ㸬࠙᪉ἲࠚ஦ᴗィ⏬࣭ሗ࿌᭩ࡢㄪᰝࢆ⾜࠸㸪 ㄆ▱⑕࢝ࣇ࢙ᬑཬࡢ⤒⦋ࢆᩚ⌮ࡋࡓ㸬࠙೔⌮ⓗ㓄៖ࠚ
ᙜⓎ⾲ࡣ஦ᴗィ⏬࣭ሗ࿌᭩ࢆᇶ࡟ㄪᰝࡍࡿ஦౛ᩚ⌮࡛࠶ࡾ㸪೔⌮ⓗ㓄៖ࡀồࡵࡽࢀࡿᑐ㇟ࡀᏑᅾࡋ
࡞࠸ࡓࡵ㸪ヱᙜࡋ࡞࠸㸬࠙⤖ᯝࠚྠ஦ᴗ࡛ࡣ㸪 ࢱ࢖ྛᆅࡢ⮬἞యࢆࢿࢵࢺ࣮࣡ࢡࡍࡿࡇ࡜࡛㸪 ┦஫ࡢᏛࡧ࠶࠸࡟ࡼࡿάືࡢᬑཬࢆ
ᐇ᪋ࡋ࡚࠸ࡿ㸬 ㄆ▱⑕࢝ࣇ࢙࡟࠾࠸࡚ࡣ㸪 ࡲࡎ⮬἞య A ࡟ᑐࡋ࡚᪥ᮏࡢ⌧ᆅどᐹ࣭◊ಟࢆᐇ᪋ࡋ㸪ㄆ▱⑕࢝ࣇ࢙ࡸㄆ▱⑕ࢧ࣏࣮ࢱ࣮㣴ᡂㅮᗙ࡞࡝ࡢ஦౛ࢆᏛࡪᶵ఍ࡀಁࡉࢀࡓ㸬 ࡑࡢ▱ぢࢆࡶ࡜࡟㸪⮬἞య A ࡛ࡣ㸪 ㄆ▱⑕࢝ࣇ࢙ࢆィ 9 ᅇᐇ᪋㸪 ࡲࡓᨵၿࡋ࡚ࡁࡓ㸬 ࡑࡢ⤒㦂ࡀࢿࢵࢺ࣮࣡ࢡࡢᯟ⤌ࡳ࡟ࡼࡾ㸪 ┦஫ࡢゼၥ㸪 ࢜ࣥࣛ࢖ࣥ఍㆟㸪 ຓゝ࡞࡝ࢆ㏻ࡌ࡚⮬἞య B࣭C ࡜ࡢᏛࡧ࠶࠸ࡢᶵ఍࡜࡞ࡾ㸪 ⮬἞య B࣭C ࡶࡑࢀࡒࢀ⊂⮬࡟ㄆ▱⑕࢝ࣇ࢙ࢆᐇ᪋ࡋࡓ㸬 ࡲࡓ㸪 ྠ஦ᴗࡢࢿࢵࢺ࣮࣡ࢡ࡟
ຍ┕ࡍࡿ⮬἞యᩘࡣ 26 ࠿ᡤ࡟ᣑ኱ࡋ࡚࠾ࡾ㸪 ࡇࢀ࡟క࠸ㄆ▱⑕࢝ࣇ࢙ࡢྲྀࡾ⤌ࡳࡶ௚ࡢ⮬἞య࡟ᗈࡀࡾࡘࡘ࠶ࡿ㸬࠙⪃ᐹࠚ⮬἞యࡢࢿࢵࢺ࣮࣡ࢡࡢ࣓࢝ࢽࢬ࣒ࡣ㸪 ㄆ▱⑕࢝ࣇ࢙ࡢᬑཬ࡟᭷ຠ࡛࠶ࡗࡓ࡜⪃࠼ࡽࢀࡿ㸬 ࡑࡢ⌮⏤࡜ࡋ࡚㸪 1) ᥼ຓᶵ㛵ࡣࢿࢵࢺ࣮࣡ࢡࢆᵓ⠏ࡍࡿᨭ᥼ࡸࡑࢀ࡟ࡼࡿᏛࡧྜ࠸ࢆಁ㐍ࡍࡿάືࡀ
୺࡛࠶ࡗࡓ㸪 2) ᚲせண⟬ࡣྛ⮬἞యࡀᡭᙜࢆ⾜࡞ࡗࡓ㸪 3) ୰ኸᨻᗓ୺య࡛ࡣ࡞࠿ࡗࡓ㸪 4)ከࡃࡢ㛵ಀᶵ㛵ࡢࢿࢵࢺ࣮࣡ࢡ࡟ࡼࡾ┦஫ゼၥࡸ◊ಟཧຍᶵ఍ࡀከࡃసࢀࡓ㸪 ࡇ࡜࡟ࡼࡿ㧗࠸࣮࢜ࢼ࣮
ࢩࢵࣉࡢ㔊ᡂ࡜ࡑࢀ࡟ࡼࡿ୺యⓗ࡞๰ពᕤኵࡀ࡛ࡁࡓࡓࡵ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿ㸬55

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 2ࠚ࣐ࣥࣃ࣮࣡୙㊊ࡢᨵၿ࡟ྥࡅࡓ CI ⒪ἲᑟධࡢᥦ᱌
ïࢻ࣑ࢽ࢝ඹ࿴ᅜ࡛ࡢᐇ㊶ïᶈ᳃ ⿱⨾ 1)2)㸪୰ᑿ Ꮫே 3)4)
1) ᰴᘧ఍♫ mediVR2) ⊂❧⾜ᨻἲே ᅜ㝿༠ຊᶵᵓ JICA ᾏእ༠ຊ㝲3) ᮐᖠ་⛉኱Ꮫ኱Ꮫ㝔 ಖ೺་⒪Ꮫ◊✲⛉4) ᮐᖠ་Ꮫᢏ⾡⚟♴ṑ⛉ᑓ㛛Ꮫᰯ ⌮Ꮫ⒪ἲኈ⛉࠙⫼ᬒ࣭┠ⓗࠚ⊂❧⾜ᨻἲேᅜ㝿༠ຊᶵᵓ㟷ᖺᾏእ༠ຊ㝲࡜ࡋ࡚㸪ࢻ࣑ࢽ࢝ඹ࿴ᅜࡢࣜࣁࣅࣜࢭࣥࢱ࣮࡛άືࡋ
ࡓ㸬ᙜࣜࣁࣅࣜࢭࣥࢱ࣮ࡣ᪂ᆺࢥࣟࢼ࢘࢖ࣝࢫࡢᙳ㡪ࢆཷࡅ࡚∦㯞⑷ࢆጞࡵ࡜ࡋࡓᑐ㇟⪅ࡀᛴቑࡋ㸪1 ேࡢసᴗ⒪ἲኈ(OT)ࡀከᩘࡢᑐ㇟⪅ࢆྠ᫬࡟ᑐᛂࡋ࡚࠸ࡿ≧ἣ࡛࠶ࡿ㸬✚ᴟⓗ࡞἞⒪௓ධࡀ
ᚲせ࡛࠶ࡿ୍᪉࡛㸪༑ศ࡞἞⒪ࡀ࡛ࡁ࡚࠾ࡽࡎ࣐ࣥࣃ࣮࣡୙㊊ࡀㄢ㢟࡜࡞ࡗ࡚࠸ࡿ㸬࣐ࣥࣃ࣮࣡୙
㊊ࡢ⿵᏶ࡀ࡛ࡁࡿ἞⒪ἲࡢ୍ࡘ࡜ࡋ࡚ CI ⒪ἲ(Constraint-induced movement therapy ௨ୗ㸪CI⒪ἲ)ࡀ࠶ࡿ㸬ࡇࡢᡭἲࡢ࠺ࡕ㸪⮬ᕫ⟶⌮ᆺ CI ⒪ἲࡣ㸪OT ࡀ㐺ษ࡞㞴᫆ᗘㄪ⠇ࢆ᪋ࡋࡓ࠺࠼࡛カ⦎ࢆᑟධࡍࡿࡇ࡜࡛㸪ෆⓗືᶵ௜ࡅࡢᙉ໬ࡸࢭࣝࣇࣔࢽࢱࣜࣥࢢ⢭ᗘࡢྥୖຠᯝࡀㄆࡵࡽࢀ㸪㯞⑷ᡭࡢ౑⏝㢖ᗘ࡟ዲᙳ㡪ࢆ୚࠼ࡿྍ⬟ᛶࡀ࠶ࡿ࡜ࡉࢀ࡚࠸ࡿ㸬ࡲࡓ㸪ᑐ㇟⪅ࡀ⮬❧ࡋ࡚⎔ቃタᐃࢆ⾜࠺ࡓࡵ㸪࣐ࣥࣃ࣮࣡ࡢ⿵᏶ࡀᮇᚅ࡛ࡁࡿ࡜ࡉࢀ㸪ᛴᛶᮇ࠿ࡽ៏ᛶᮇࡲ࡛ࡢᑐ㇟⪅࡟ᑐࡋ୍࡚ᐃࡢ
ᡂᯝࡀᚓࡽࢀࡿ࡜ࡍࡿሗ࿌ࡀከᩘ࠶ࡿ㸬ࡑࡇ࡛㸪ᮏ◊✲ࡢ┠ⓗࡣ㸪CI ⒪ἲࢆ㏻ࡌࡓ୍ᑐ」ᩘ࡟ࡼ
ࡿ௓ධࢩࢫࢸ࣒ࡢᵓ⠏ࢆᅗࡿࡓࡵ࡟㸪ᑐ㇟⪅ࢆ୍ே࡟㝈ᐃࡋ㸪CI ⒪ἲ࡟ࡼࡿ἞⒪ຠᯝࡢ᳨ドࢆᐇ᪋ࡍࡿࡇ࡜࡜ࡋࡓ㸬ᮏ◊✲ࡣ೔⌮ⓗᣦ㔪࡟ᚑ࠸㸪◊✲ཧຍ⪅ࡢᶒ฼࡜ࣉࣛ࢖ࣂࢩ࣮ࢆᑛ㔜ࡋࡓ㸬࠙᪉ἲࠚ୰➼ᗘ⬻༞୰∦㯞⑷⪅ 1 ྡ࡟ᑐࡋ Daly ࡽ 1)ࡢሗ࿌࡟ೌ࠸㸪Fugl-Meyer Assessment(FMA)ࡢ
ୖ⫥㡯┠࡟࠾࠸࡚ 30ࠥ49 Ⅼࡢᑐ㇟⪅ࢆ୰➼ᗘ⬻༞୰ࡢໟྵᇶ‽࡜ࡋ࡚タࡅࡓ㸬CI ⒪ἲࡢ㐺ᛂᇶ‽ࡣ㸪ࠕᡭ㛵⠇ࡀ 20 ᗘ௨ୖ㝶ពⓗ࡟ఙᒎ࡛ࡁࡿࠖ㸪ࠕẕᣦࢆྵࡴ 3 ᮏᣦࡢ୰ᡭᣦ⠇㛫㛵⠇࡜㏆఩ᣦ⠇㛫㛵⠇ࡀ 10 ᗘ௨ୖఙᒎ࡛ࡁࡿࠖ࡜ࡍࡿ㸬ෆᐜࡣ Takebayashi ࡽ 2)ࡢᡭἲࢆཧ⪃࡟ࡋ㸪CI ⒪ἲ࡟‽ࡌࡓㄢ㢟ᣦྥᆺ࢔ࣉ࣮ࣟࢳ࡜ Transfer package ࢆᐇ᪋ࡋ㸪 1 ᪥ 300 ᅇ࠿ࡽ 600 ᅇࢆ┠Ᏻ࡟ᐇ᪋ࡋࡓ 3)㸬௓ධ๓ᚋࡢ㯞⑷ഃୖ⫥ࡢᶵ⬟࡜᪥ᖖ⏕άෆࡢ౑⏝㢖ᗘࢆほᐹࡍࡿࡓࡵ㸪FMA ࡟ຍ࠼㸪Motor Activity Log (MAL)ࡢ㯞⑷ഃ౑⏝㢖ᗘ (AOU) ࠾ࡼࡧືసࡢ㉁(QOM)ࢆ⏝࠸ࡓ㸬௓ධᮇ㛫ࡣ 2 㐌㛫࡜ࡋࡓ㸬࠙⤖ᯝࠚ௓ධ๓ᚋ࡛ୖ⫥ FMA ࡀ 35(୰➼ᗘ)࠿ࡽ 50(㍍ᗘ)࡬㸪MAL ࡀ AOU0 ࠿ࡽ 3㸪QOM0 ࠿ࡽ 3࡬ᨵၿࡋ㸪㯞⑷ᡭࢆ౑⏝ࡋࡓ㣗஦ࡸὙ㢦ࡀྍ⬟࡜࡞ࡗࡓ㸬࠙⪃ᐹࠚ⮬ᕫ⟶⌮ᆺ CI ⒪ἲࡢ௓ධ๓ᚋ࡛㸪FMA ࡸ AOU㸪QOM ࡟ᨵၿࡀㄆࡵࡽࢀࡓ㸬ࡇࡢࡇ࡜࠿ࡽ㸪CI ⒪ἲࡣ㸪࣐ࣥࣃ࣮࣡୙㊊ࡀㄢ㢟࡜࡞ࡗ࡚࠸ࡿᙜࣜࣁࣅࣜࢭࣥࢱ࣮࡟࠾࠸࡚㸪ᑐ㇟⪅ࡢ⮬❧ᗘࢆྥୖࡉࡏࡿ᭷⏝࡞ᡭἲࡢ୍ࡘ࡟࡞ࡾ࠺ࡿྍ⬟ᛶࡀ࠶ࡿ㸬56

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 2ࠚ⬻༞୰∦㯞⑷ࢆ࿊ࡋࡓ≉ᐃᢏ⬟እᅜே࡟ᑐࡋ࡚
ᅇ᚟ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓Ჷ࡛ᑵປᨭ᥼ࢆᐇ᪋ࡋࡓ஦౛
‫۔‬㐨㢪ṇṌ   㸪ᒣᮏ┿⏕   㸪ዟᒣ⯟ᖹ   㸪ᆏ⏣⚈Ꮚ  㸪ᒣ⏣೺  1) ᮾி‴ᓊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊2) ᮾி㒔❧኱Ꮫ኱Ꮫ㝔 ே㛫೺ᗣ⛉Ꮫ◊✲⛉ సᴗ⒪ἲ⛉Ꮫᇦ3) ⚄ዉᕝ┴❧ಖ೺⚟♴኱Ꮫ኱Ꮫ㝔 ಖ೺⚟♴Ꮫ◊✲⛉4)៞᠕⩏ሿ኱Ꮫ་Ꮫ㒊 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་Ꮫᩍᐊ
࠙ࡣࡌࡵ࡟ࠚ
ᖺࠎቑຍࡋ࡚࠸ࡿ⌧≧࡛࠶ࡿ㸦ἲົ┬㸪2023㸧㸬
᪥ᮏᅾ␃እᅜேࡣ௧࿴ 4 ᖺᮎ᫬Ⅼ࡛ 307 ୓ே࡛࠶ࡾ㸪ࡑࢀ࡟క࠸㸪᪥ᮏࡢ་⒪ࢧ࣮ࣅࢫࢆཷࡅࡿእᅜேࡶቑ࠼࡚࠾ࡾ㸪⮫ᗋ⌧ሙ࡟࠾࠸࡚ᵝࠎ࡞ᩥ໬࣭⩦័ࢆ⪃៖ࡋࡓᨭ᥼ࡀồࡵࡽࢀࡿ㸬௒ᅇ㸪⬻༞୰∦㯞⑷ࢆ࿊ࡋࡓ≉ᐃᢏ⬟ࣅࢨ࡛ᅾ᪥୰ࡢࢿࣃ࣮ࣝே
࡟ᑐࡍࡿᑵປᨭ᥼ࡢ⤒㦂ࢆሗ࿌ࡍࡿ㸬⑕౛࡟ཱྀ㢌࡜᭩㠃࡛ㄝ᫂ࢆ⾜࠸㸪ྠពࢆᚓ࡚࠸ࡿ㸬࠙⑕౛⤂௓ࠚ
⑕౛ࡣ㸪ྑ⿕Ẇฟ⾑ࢆⓎ⑕ࡋࡓ 40 ௦ᚋ༙ࡢࢿࣃ࣮ࣝே⏨ᛶ࡛࠶ࡿ㸬ᅇ᚟ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓
Ჷධ㝔᫬㸦Ⓨ⑕ᚋ 41 ⑓᪥㸧㸪ᕥୖୗ⫥ࡢ㔜ᗘ㐠ື㯞⑷࣭ὀពᶵ⬟㞀ᐖࢆ࿊ࡋ࡚࠸ࡓ㸬ゝㄒ⌮ゎࡀࢿࣃ࣮ࣝㄒ࡛ࡣၥ㢟࡞࠸ࡀ㸪᪥ᮏㄒ࡛ࡣ 1 ๭⛬ᗘ࡛࠶ࡗࡓ㸬ADL ࡣ୰➼ᗘ௓ຓࢆせࡋ㸪⛣ືᡭẁࡣ㌴᳔Ꮚ࡛࠶ࡗࡓ㸬⑓๓ࡣ㸪࣮࢝ࣞᒇ࡛ㄪ⌮ᴗົ࡟ᚑ஦ࡋ㸪᪥ᮏㄒࢆ౑⏝ࡋ࡚᪥ᖖ⏕άࢆ㏦ࡗ࡚࠸ࡓ㸬ࡲࡓ㸪 ࣄࣥࢻ࣮ࢗᩍࢆಙ௮ࡋ࡚࠾ࡾ㸪ࢺ࢖ࣞືసࢆᕥᡭ࡛⾜࠺࡞࡝ࡢ⏕άつ⠊ࡀ࠶ࡗࡓ㸬Canadian
occupational performance measure (COPM) ࡟࡚ࠕ௙஦ࠖࡢ㔜せᛶࡣ 10/10 㸪㐙⾜ᗘ࣭‶㊊ᗘࡣ࡜ࡶ࡟ 1/10 ࡛࠶ࡗࡓ㸬≉ᐃᢏ⬟ࣅࢨ࡛ᅾ᪥ࡋ࡚࠾ࡾ㸪᚟⫋ྍ⬟࡞ᴗົࡣ࣮࢝ࣞᒇࡢㄪ⌮ᴗົࡢࡳ࡛࠶
ࡗࡓ㸬ࡼࡗ࡚㸪᚟⫋ࡢᚲせᛶࡀ㧗࠸࡜⪃࠼ࡽࢀ㸪࣮࢝ࣞᒇࡢㄪ⌮ᴗົ࡟ᚑ஦ࡍࡿࡇ࡜ࢆసᴗ⒪ἲ┠ᶆ࡜ࡋࡓ㸬ึᮇ࡛ࡣ㸪ゝㄒไ㝈ࡸಙ௮ࢆ⪃៖ࡋࡓୖ࡛┠ᶆタᐃࢆ⾜࠸㸪ADL カ⦎ࢆ୰ᚰ࡟⾜ࡗࡓ㸬ゝㄒไ㝈࡟ᑐࡋ࡚ࡣ㸪⩻ヂ࢔ࣉࣜࡸࢿࣃ࣮ࣝㄒ⾲グࡢᥖ♧≀ࢆ౑⏝ࡋ㸪సᴗ⒪ἲࡢᐇ᪋࠾ࡼࡧືస
ࡢᐃ╔ࢆᅗࡗࡓ㸬Ṍ⾜࡟ࡼࡿ⛣ື࡛ ADL ࡀಟṇ⮬❧࡜࡞ࡗࡓࡓࡵ㸪సᴗ⒪ἲ࡛ࡣᑵປ࡟㔜Ⅼࢆ⨨ࡁ௓ධࢆᐇ᪋ࡋࡓ㸬ᑵປ࡟࠾࠸࡚ᚲせᛶ࠿ࡘᐇ⌧ྍ⬟ᛶࡢ㧗࠸సᴗࢆࢳ࣮࣒࡛ᢳฟࡋ㸪సᴗࡢホ౯࣭カ⦎ࢆᐇ᪋ࡋࡓ㸬࠙⤖ᯝࠚ
㏥㝔᫬㸪ᐇ⏝ⓗ࡞ᒇእṌ⾜ࡀྍ⬟࡜࡞ࡗࡓ㸬ࠕᤲ㝖ࠖ㸪ࠕㄪ⌮ࠖࡀᐇ᪋ྍ⬟࡜࡞ࡾ㸪COPM ࡛ࡣ㐙⾜ᗘ࣭‶㊊ᗘ࡜ࡶ࡟ 10/10 ࡜࡞ࡗࡓ㸬ࡲࡓ㸪እ᮶ࣜࣁࣅࣜ࡟ࡼࡿᑵປᨭ᥼࡟ຍ࠼㸪ࠕㄪ⌮ࠖ㸪ࠕ㟁㌴฼⏝ࠖ
࡟ࡘ࠸࡚ࡢ♫఍㐺ᛂࣉࣟࢢ࣒ࣛࢆసᡂࡋ㸪ᐙ᪘࡜࡜ࡶ࡟カ⦎ࢆ⥅⥆ࡍࡿ㐠ࡧ࡜࡞ࡗࡓ㸬࠙⪃ᐹࠚ⑕౛࡟ᑐࡋ࡚㸪ᩥ໬ⓗ⫼ᬒ࡞࡝ࡢᝈ⪅≉ᛶࢆ⪃៖ࡋࡓసᴗ⒪ἲ㸪ከ⫋✀࠾ࡼࡧᐙ᪘ࢆྵࡵࡓࢳ࣮࣒
࢔ࣉ࣮ࣟࢳ࡟ࡼࡿᑵປᨭ᥼ࡀ᭷ຠ࡛࠶ࡗࡓ࡜⪃࠼ࡽࢀࡿ㸬⮫ᗋ⌧ሙ࡟࠾ࡅࡿ≉ᐃᢏ⬟እᅜே࡬ࡢᨭ
᥼᪉ἲ࡟ࡘ࠸࡚㸪௒ᚋࡉࡽ࡞ࡿ᳨ウࡀᚲせ࡜⪃࠼ࡿ㸬

57

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 2ࠚࢿࣃ࣮ࣝᆅ㟈⥭ᛴ་⒪ᨭ᥼࡟࠾ࡅࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥάືᶈすᔱ ᮃ 1)1)すᐑᕷ♫఍⚟♴஦ᴗᅋ ࠸ࡎࡳᅬ࠙ࡣࡌࡵ࡟ࠚ
2015 ᖺⓎ⏕ࡋࡓࢿࣃ࣮ࣝᆅ㟈࡛ࡣᅜෆእ࠿ࡽከࡃࡢ⌮Ꮫ⒪ἲኈࡀ⥭ᛴ་⒪ᨭ᥼࡛άືࡋࡓ㸬⌮Ꮫ⒪ἲኈ࡜ࡋ࡚άືࡋࡓ⥭ᛴ་⒪ᨭ᥼࡟ࡘ࠸࡚ሗ࿌ࡍࡿ㸬࠙⅏ᐖ≧ἣࠚ
2015 ᖺ 4 ᭶ 25 ᪥ 11 ᫬ 56 ศ㤳㒔࢝ࢺ࣐ࣥࢬࡢ໭す 77km ௜㏆ࢆ㟈※࡜ࡍࡿᆅ㟈㸦M7㸬8㸧ࡀⓎ⏕ࡋࡓ㸬᭦࡟ࡣ 5 ᭶ 12 ᪥ 12 ᫬ 51 ศ࢝ࢺ࣐ࣥࢬ໭ᮾ 76km ௜㏆࡛వ㟈㸦M7㸬3㸧ࡀ㉳ࡇࡗࡓ㸬ᘓ≀ࡢಽቯ㸪ᅵ◁⅏ᐖ㸪ᒣᓅᆅᇦࡢ㞷ᔂ➼࡟ࡼࡾṚ⪅⣙ 9㸪000 ྡ㸪㈇യ⪅⣙ 23㸪000 ྡ࡟⿕ᐖࡀཬࢇࡔ㸬㟈⅏┤ᚋ࠿ࡽ⌧ᆅࢿࣃ࣮ࣝࢆࡣࡌࡵྛᅜࡢ⌮Ꮫ⒪ἲኈࡀከᩘάື࡟ཧຍࡋࡓ㸬₇⪅ࡣᙜ᫬࢝ࢺ࣐ࣥࢬ࡟⁫ᅾ୰࡟⿕⅏ࡋࡓ㸬JICA ࣎ࣛࣥࢸ࢕࢔ᙜ᫬࡟ᵓ⠏ࡋ࡚࠸ࡓࢿࢵࢺ࣮࣡ࢡࢆ㥑౑ࡋ࡚⿕⅏≧ἣࢆㄪᰝࡋ᪥ᮏ࡟᝟ሗࢆⓎಙࡋࡓ㸬࢝ࢺ࣐ࣥࢬࡢࢺࣜࣈࣦ࢓ࣥ኱Ꮫࢸ࢕࣮ࢳࣥࢢ࣍ࢫࣆࢱࣝ㸦௨ୗ TUTH ࡜ࡍࡿ㸧ࡣᘓ≀ࡢ୍㒊ࡀ᪥ᮏࡢᨭ᥼࡛ᘓ࡚ࡽࢀࡓ⑓㝔࡛࠶ࡿ㸬㟈⅏┤ᚋ TUTH ࡣࢲ࣓࣮ࢪࡀᑠࡉ࠿ࡗࡓࡓࡵ⑓㝔ᶵ⬟ࡀ⥔ᣢ࡛ࡁከࡃࡢࡅࡀேࡀᦙ㏦㸪἞⒪ࡀ⾜ࢃࢀࡓ㸬TUTH ࡛ࡣ㟈⅏Ⓨ⏕ 1 㐌㛫ᚋࡢ᫬Ⅼ࡛ᡭ⾡ࢆཷࡅ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆᚲせ࡜ࡍࡿᝈ⪅ࡀ 350 ྡᚅᶵࡋ࡚࠸ࡿ≧ែ࡜࡞ࡗࡓ㸬≉ᐃ㠀Ⴀ฼άືἲே࢔࣒ࢲ(௨ୗ AMDA ࡜ࡍࡿ)ࡣࡇࡢࡼ࠺࡞≧ἣ࠿ࡽ⌮Ꮫ⒪ἲኈࡢὴ㐵ࢆỴᐃࡋࡓ㸬࠙άືࠚ
₇⪅ࡣ 5 ᭶ 10 ᪥ࡼࡾ TUTH ࡟ὴ㐵㸪άືࢆ㛤ጞࡋࡓ㸬ୖୗ⫥㦵ᢡࡸୗ⫥ษ᩿ᝈ⪅ࡢࣜࣁࣅࣜࢸ࣮
ࢩࣙࣥ࡟ຍ࠼࡚㟈⅏๓࠿ࡽࡢእ᮶㏻㝔⪅ࡀᑐ㇟ࡔࡗࡓ㸬TUTH ࡢ⌮Ꮫ⒪ἲኈ㸪࠾ࡼࡧ࣋ࣝࢠ࣮ࡢ⌮Ꮫ⒪ἲኈ࡜⌮Ꮫ⒪ἲᴗົࢆ⾜࠸࡞ࡀࡽ㸪࡝ࡇ࡟࡝ࡢࡼ࠺࡞ධ㝔ᝈ⪅ࡀ࠸ࡿࡢ࠿ᢕᥱࡍࡿࡇ࡜࠿ࡽ㛤ጞࡋࡓ㸬᪥ࡈ࡜࡟⿕⅏ᝈ⪅ࡢᑐ㇟⑌ᝈࡣ⬨㧊ᦆയࡀቑຍ㸬Ṍ⾜⿵ຓල࣭㌴࠸ࡍ࡞࡝ྛᝈ⪅ࡢ⛣ື᪉ἲࡢ⋓ᚓࡀ࡛ࡁࢀࡤ㏥㝔࣭㌿㝔ࡀ㐍ࡵࡽࢀࡓ㸬௚ࡢᅜ㝿 NGO ࡢ⌮Ꮫ⒪ἲኈ࡜ࡶྛᝈ⪅ࡢ᝟ሗ཰㞟࡜ඹ᭷ࢆ⾜࠸㸪ᚋ᪥ࣇ࢛࣮ࣟ࢔ࢵࣉ࡬࡜⧅ࡆࡿࡇ࡜ࡀ࡛ࡁࡓ㸬㏆㞄ࡢ⑓㝔ࡸࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭ
ࣥࢱ࣮➼࡟ࡶከࡃࡢᝈ⪅ࡀ㌿㏦ࡉࢀࡓࡀ㸪⑓ᗋᩘࢆ㉸࠼ࡿ་⒪ᶵ㛵ࡀከ࠿ࡗࡓ㸬⌧ᆅࡢ⌮Ꮫ⒪ἲኈ
࡟ຍ࠼㸪ྛᅜࡢ⌮Ꮫ⒪ἲኈࡀ㐃ᦠࡋ࡚ᨭ᥼ࡀ⾜ࢃࢀࡓ㸬࠙⪃ᐹࠚࢿࣃ࣮ࣝᆅ㟈࡛ࡣᝈ⪅࡜་⒪ᶵ㛵࡟࡜ࡗ࡚⑓㝔ᶵ⬟ࢆ⥔ᣢ࣭⥅⥆ࡍࡿࡓࡵ㸪ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡣ㔜せ࡞ᙺ๭ࢆᯝࡓࡋࡓ㸬࠙೔⌮ⓗ㓄៖ࠚ
ᮏሗ࿌࡛ࡣಶேࡀ≉ᐃࡉࢀࡿ᝟ሗࡣྵࡲ࡞࠸㸬෗┿ࡢ౑⏝࡟ࡘ࠸࡚Ꮫ⾡◊✲ࡢࡓࡵ࡟౑⏝ࡍࡿࡇ࡜ࢆ᧜ᙳ᫬࡟ᑐ㇟⪅࡟ཱྀ㢌࡛ㄝ᫂ࡋྠពࢆᚓࡓ㸬ࡲࡓᮏሗ࿌࡟࠶ࡓࡾ AMDA ࡢチྍࢆᚓ࡚࠸ࡿ㸬58

୍࠙⯡₇㢟ࢭࢵࢩࣙࣥ 2ࠚ࣑࣐࣮ࣕࣥ㐃㑥ඹ࿴ᅜ࡟࠾ࡅࡿసᴗ⒪ἲᬑཬࡢྍ⬟ᛶ
ᶈPhyo Thant Maw 1)㸪኱ሯ 㐍 2)㸪Ⳣཎ ὒᏊ 3)1) ་⒪ἲே኱㑣 ࡔ࠸࡞ࣜࣁࣅࣜࢡࣜࢽࢵࢡࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊2) NPO ἲே ReCA
3) ࣇ࣮ࣜࣛࣥࢫ
࠙ࡣࡌࡵ࡟ࠚ
WHO ࡣ୰࣭పᡤᚓᅜࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㸦௨ୗࣜࣁ㸧㐍ᒎࡢࡓࡵ Rehabilitation2030 ࡟ྲྀࡾ⤌ࢇ࡛࠸ࡿࡀ㸪ࣜࣁᑓ㛛⫋㸦࡜ࡃ࡟సᴗ⒪ἲኈ㸧ࡢ୙㊊࣭୙Ꮡᅾࡢㄢ㢟ࡀ࠶ࡿ㸬࠙┠ⓗࠚ୰࣭పᡤᚓᅜࡢ୍ࡘ࡛࠶ࡿ࣑࣐࣮ࣕࣥ㐃㑥ඹ࿴ᅜ㸦௨ୗ࣑࣐࣮ࣕࣥ㸧࡟࠾ࡅࡿసᴗ⒪ἲ㛵㐃ࡢṔྐ࡜⌧≧ࢆ⥲ᣓࡋࡑࡢᬑཬࡢྍ⬟ᛶࢆ᥈ࡿ㸬࠙᪉ἲࠚㅖ㈨ᩱ࣭ᩥ⊩➼࠾ࡼࡧࣜࣁ㛵ಀ⪅࠿ࡽࡢ⪺ࡁྲྀࡾ᝟ሗ➼ࢆ㞟⣙࣭ᩚ⌮࣭⪃ᐹࡋࡓ㸬 ೔⌮ⓗ㓄៖ࢆせࡍࡿ᝟ሗࡣ౑⏝ࡋ࡚࠸࡞࠸㸬࠙⤖ᯝࠚ࣑࣐࣮࡛ࣕࣥࡣ㸪1959 ᖺ࡟ࡣᅜ❧ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓㝔ࡀ㛤㝔㸬 1964 ᖺ࡟ࡣ⌮Ꮫ⒪ἲኈࡢ㣴ᡂࡀጞࡲࡗࡓ㸬సᴗ⒪ἲࡶᑟධࡉࢀ㸪▷ᮇࡢㅮ⩦ࡀ⾜ࢃࢀࡓࡀసᴗ⒪ἲኈ㣴ᡂ࡟ࡣ⮳ࡽ࡞࠿ࡗࡓ㸬ࡋ࠿ࡋ㸪1956 ᖺ࢖ࣥࢻ࡬༙ᖺࡢ◊ಟ࡬ 2 ྡࢆὴ㐵㸪ᅜ❧ࣜࣁ⑓㝔ෆ࡟ࡣసᴗ⒪ἲᐊࡀ㛤タࡉࢀ┳ㆤᖌࢆᅜእࡢసᴗ⒪ἲ◊ಟ࡬ὴ㐵ࡍࡿ➼㸪ᑟධ࣭㣴ᡂ㛤ጞ࡬ࡢᶵ㐠ࡣ࠶ࡾ 1975 ᖺ࡟ࡣ⌮Ꮫ⒪ἲኈࡀⱥᅜࡢ኱Ꮫసᴗ⒪ἲᏛ⛉࡟␃Ꮫࡋసᴗ⒪ἲኈ㣴ᡂࡀጞࡲࡿணᐃࡔࡗࡓࡀᐇ⌧ࡋ࡚࠸࡞࠸㸬ࡇࡢ᫬ᮇ࣑
࣐࣮ࣕࣥࡣࣅ࣐ࣝ♫఍୺⩏ィ⏬ඪᨻᶒ࡟ࡼࡿ⤫ไ⤒῭ࡸ㙐ᅜⓗᨻ⟇࡟ࡼࡾᵝࠎ࡞㠃࡛೵⁫ࡋ࡚࠾ࡾ⤒῭ⓗ࡞ไ⣙ࡀ኱ࡁ࠿ࡗࡓ࡜ᛮࢃࢀࡿ㸬
1990 ᖺ௦௨㝆ࡣ⌮Ꮫ⒪ἲኈࡢᩍ⫱Ỉ‽➼ࡢྥୖࡀぢࡽࢀ㸪᪥ᮏ࠿ࡽࡢᨭ᥼ࡶጞࡲࡾ 2008㹼13 ᖺࡢ
JICA ࡟ࡼࡿࣜࣁᙉ໬ࣉࣟࢪ࢙ࢡࢺ࡟ࡣసᴗ⒪ἲኈࡢ㛗࣭▷ᮇᑓ㛛ᐙࡀ」ᩘὴ㐵ࡉࢀ㸪ࡑࡢᚋࡉࡽ࡟
సᴗ⒪ἲኈࡢ㛗࣭▷ᮇ࣎ࣛࣥࢸ࢕࢔ࡀ 3 ྡὴ㐵ࡉࢀࡓ㸬2014࣭15 ᖺ࡟ࡣ᪥ᮏࡢ኱Ꮫ㝔సᴗ⒪ἲศ㔝ಟኈㄢ⛬࡬⌮Ꮫ⒪ἲኈ 2 ྡࡀ␃Ꮫࡋ 2 ᖺᚋಟ஢࣭ᖐᅜࡋࡓ㸬ࡲࡓ㸪ࢱ࢖ᅜ࡬ࡶ⌮Ꮫ⒪ἲኈࢆసᴗ⒪ἲࡸゝㄒ⒪ἲࡢ◊ಟ࡟ὴ㐵㸬ࡉࡽ࡟㸪2017࣭18 ᖺ⌮Ꮫ⒪ἲኈ 2 ྡࡀ᪥ᮏࡢ኱Ꮫ(సᴗ⒪ἲᏛ⛉)࡟ධᏛ㸬᪤࡟᪥ᮏࡢసᴗ⒪ἲኈ㈨᱁ࢆྲྀᚓࡋ࡚࠸ࡿ㸬ⱥᅜࡢ༠ຊࡶ࠶ࡾ 2022 ᖺ㡭࡟ࡣ኱Ꮫ࡛ࡢసᴗ⒪ἲᏛ⛉ࡀタ❧ணᐃ࡛࠶ࡗࡓࡀࢥࣟࢼ⚝ࡸ㌷ࡢࢡ࣮ࢹࢱ࣮࡟ࡼࡿ♫఍ࡢΰ஘࡟ࡼࡾᐇ⌧ࡋ࡚࠸࡞࠸㸬స
ᴗ⒪ἲࡣ⢭⚄㞀ᐖ㡿ᇦࡶ㔜せ࡛࠶ࡿ㸬࣑࣐࣮ࣕࣥࡢ⢭⚄་⒪ࡣ⥲ྜⓗ࡞⢭⚄⑓㝔ࡀ 2 ࠿ᡤ㸪⢭⚄⛉ᑓ㛛་ᖌࡶ⣙ 200 ྡ࡜⬤ᙅ࡛࠶ࡿࡀ㸪⑓㝔ෆసᴗࡀᐇ᪋ࡉࢀ࡚࠾ࡾᑓ㛛⫋࡬ࡢᮇᚅࡣ㧗࠸㸬࠙⪃ᐹࠚ୰࣭పᡤᚓᅜ࡟࠾ࡅࡿసᴗ⒪ἲᬑཬࡢ㜼ᐖせᅉ࡜ࡋ࡚⌮ゎ୙㊊࣭㈈ᨻไ⣙➼ࡀ࠶ࡿࡀ࣑࣐࣮ࣕࣥ࡟
࠾࠸࡚ࡣ㛵ಀ⪅ࡢ⌮ゎ࣭ពḧࡣ㯪᫂ᮇ࠿ࡽ࠶ࡗࡓ࡜᥎ᐹࡉࢀ㸪♫఍࣭⤒῭ࡀᏳᐃࡋ㣴ᡂࡀጞࡲࢀࡤ
ᬑཬࡀ㐍ࡴ࡜ᛮࢃࢀࡿ㸬

59➨  ᅇᏛ⾡኱఍Ꮫ⾡኱఍ᴫせ࠾ࡼࡧࠊ㐠Ⴀ⤌⧊Ꮫ⾡኱఍ᴫせ኱఍ྡ ᅜ㝿ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ◊✲఍ ➨ 7 ᅇᏛ⾡኱఍ࢸ࣮࣐ ࠕ▱ࡿ࣭Ẽ࡙ࡃ࣭⪃࠼ࡿ޴ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ 2030޵ࠖ 㹼୰࣭పᡤᚓᅜ࡟࠾ࡅࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᬑཬ࡬ࡢ㈉⊩㹼኱఍㛗 ᒣཱྀ ెᑠ㔛㸦ᅜ❧ಖ೺་⒪⛉Ꮫ㝔㸧఍ ᮇ 2023 ᖺ 11 ᭶ 19 ᪥㸦᪥㸧10:00㹼17:30
఍ ሙ ⪷ᚰዪᏊ኱Ꮫ 4 ྕ㤋 ⪷ᚰࢢ࣮ࣟࣂࣝࣉࣛࢨ
㸦ᮾி㒔῰㇂༊ᗈᑿ 4-2-24㸧Ꮫ⾡኱఍Ꮫ఍㐠Ⴀ⤌⧊ᐇ⾜ጤဨ㛗㧘ᶫ ᜨ㔛   ⚟ᓥ┴❧་⛉኱Ꮫᐇ⾜ጤဨ▼஭ Ύᚿ   ᅜ㝿་⒪⚟♴኱Ꮫ኱すᾏᩯᰴᘧ఍♫ࢥ࣮࢚࢖ࣜࢧ࣮ࢳ㸤ࢥࣥࢧࣝࢸ࢕ࣥࢢ
຾⏣ ⲁ    ጲ㊰⋊༠኱Ꮫᕝ㔝 ᫭⿱ࣜࢽ࢚ゼၥ┳ㆤࢫࢸ࣮ࢩࣙࣥ࢟ࢵࢬୡ⏣㇂㌴஭ඖᶞ   ᅜ㝿་⒪⚟♴኱Ꮫᡂ⏣⑓㝔Ἑ㔝 ┾    ᅜ㝿་⒪⚟♴኱Ꮫ㰻⸨ ᓫᚿᅜ❧㞀ᐖ⪅ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮◊✲ᡤᗉྖ ๛ோ   ▼ᕳ೺⫱఍⑓㝔㐨㢪 ṇṌ   ᮾி‴ᓊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓㝔ྂᕝ 㞞୍   ௝ྎ་೺࣭ࢫ࣏࣮ࢶᑓ㛛Ꮫᰯ୕⏣ᮧ ᚨ   ᮾ໭་⛉⸆⛉኱Ꮫ⑓㝔



60



国際リハビリテーション研究会 第8回学術大会

国際リハビリテーションにおける地域共創～海外と国内の経験を共有しよう～
2024年11月17日(日)開催場所：いろどりの丘 宮城県東松島市野蒜ケ丘2丁目25番2
本学術大会は、国際リハビリテーション研究会学術大会として初めて対面で地方開催される大会です。
日本国内の地方では、私たち国際リハビリテーション研究会が活動の対象としてきた中低所
得国と類似する課題を抱えていることがあります。
都市部と地方の格差、東日本大震災などの災害からの復興、資源が十分ではない環境での地域づくりなど、さまざまな挑戦をしている現場で、その活動の様子を肌で感じながら、これまでの経験を国内から海外へ、海外から国内へと相互に活かす方法を一緒に考えましょう。

JSIR home page https://int-rehabil.jp/
JSIR Facebook https://www.facebook.com/pages/category/Nonpro
61

国際リハビリテーション学 投稿規定
1．本誌の目的
本誌は、国際リハビリテーション研究会の学術誌として国際リハビリテーション学およびその関連領域における研究と実践を公表し、国際リハビリテーション学を発展させることを目的とする。
2．投稿資格筆頭著者は、国際リハビリテーション研究会会員に限る。
3．研究の倫理性研究に当たって、ヒトを対象とした研究では、世界医師会によるヘルシンキ宣言や厚生労働省による医学研究に関する指針など当該研究の該当する倫理指針を遵守し、著者の所属機関などの研究倫理委員会（またはそれに相当する倫理審査にかわる組織）による承認を得た上で研究を行うものとする。当該研
究が倫理的配慮を必要とする場合は、論文内に倫理審査委員会名および承認番号（または承認年月日）を必ず記載し、さらに必要に応じて、研究を実施した国の倫理基準に従い、本人あるいは保証人から同意を得た旨を記載する。
4．使用言語
投稿原稿は日本語または、英語で作成すること。
5．原稿の種類種類

内容

総説

国際リハビリテーションに関する研究・調査論文の文献考察

Review Article
原著
Original Article

を行い、著者自身の考察を加えて論評しているもの。
国際リハビリテーションに関する独創的な研究論文。

報告

原著には該当しないが、国際リハビリテーションにおいて価Report

値のある研究および実践的な活動をまとめたもの。

資料

上記のいずれにも当てはまらないが、国際リハビリテーショ

Information

ンにおいて有用な情報や資料となりうると判断されるもの。

本文の文字数
12,000 字以内

12,000 字以内

12,000 字以内

12,000 字以内※本文の文字数には引用文献、図、表、写真を含む。

62

6．原稿の構成
内容頁

詳細① 全ての著者名と所属機関の名称（日本語と英語の両方を記載）
1頁

著者等の情報所属が教育機関の場合、大学名、学部名、学科名まで記載する。それ以外の場合は所属施設の名称、所属部署名まで記載する。

② 投稿責任者の連絡先（メールアドレスと電話番号）② 原稿の種類②論文タイトル（日本語）③論文タイトル（英語）2頁

表紙④日本語要旨（400 字以内）
⑤英語要旨（300 語以内）
⑥日本語キーワード：5 語以内⑦英語キーワード：5 語以内

3 頁以降

本文

※「7．執筆要領」を参照の上、規定に沿って執筆すること※1 頁目の著者情報は査読時には削除し匿名化した上で査読を行う。

7．執筆要領
1）原稿レイアウトは A4 サイズ・横書き・縦 40 行×横 40 字とする。和文のフォントは MS 明朝、英文及び数字のフォントは半角・Century とし、いずれもサイズは 10.5 ポイントとする。日本語の句点は全角のピリオド（．）読点は全角のカンマ（，）とする。英語の句点は半角のピリオドと半角の空白（. ）読点は半角のカンマと半角の空白（, ）とする．
2）原稿には査読の便宜のために、各頁の左余白に行番号を付ける。頁番号は各頁の下中央に入れる。
3）原稿は著者情報、表紙、本文の順に作成する。（詳細は「6．原稿の構成」参照）
4）本文は原則として下表に示す構成とし、それぞれに見出しを設けて記述する。
項目
1. 緒言

その他の項目例

研究や活動の背景と目的を明確に記載

はじめに

する。

（Introduction）
2. 方法

内容

研究方法、方法と対象（Method）

研究や活動の方法を記載する。研究倫理面については、配慮の必要性の有無を含
め、本項目に記載する。

3. 結果

研究結果、活動結果（Results）

研究や活動の結果を記載する。客観的事実としての結果を本項目に記載し、著者らの分析や意見は考察に記載する。

4. 考察

結果についての考察や評価を記載する。

63

（Discussion）

研究の限界や活動の特殊性は本項目に記載する。

5. 結語（※省略しても良い）

おわりに、結論

本研究・活動から明らかになったことを（Conclusion）

簡潔に記載する。

利益相反（COI）について

COI について、その有無も含めて明記する。

謝辞（※省略しても良い）

助成のある場合は明示する。

引用文献

本執筆要領の 10）11）及び記載例に倣って記載する。

5）本文の「章」に相当する見出しは「1.」「2.」・・、「節」に相当する見出しは「1.1」
「1.2」
・・、
「項」
に相当する見出しは「1.1.1」「1.1.2」・・のように記載する。さらに小さい見出しが必要な場合は順に「(1)」「（2)」のように記載する。章・節・項・目の見出しおよび本文中の数字は半角のアラビア数字とする．
6）英文要旨は、英語に関して充分な知識をもつ専門家にチェックを受けることが望ましく、英語として不十分な場合、査読において再チェックを求めることがある。
7）年号は原則として西暦を使用し、外国語・外国人名・地名は原語もしくはカタカナ（最初は原綴りを併記）で書く。略語は本文中の最初に出たところでフルネームを入れる。
8）数字は半角のアラビア数字として、度量衡単位は CGS 単位とする。
9）図表写真について
・本文とは別に全ての図表写真データを記載した「図表写真ファイル」を Word 等のドキュメント形式
で作成する。
・図表ファイルは 1 頁に 1 点の記載とし一連番号をつける。各データのタイトルや説明は、図と写真の場合はその下部中央、表の場合は上部中央に記載する。
・図表写真のタイトルで使用するフォントは MS 明朝とし、英文及び数字のフォントは半角・Centuryとする。フォントサイズは 10.5 ポイントとする。
・図表中で使用するフォントは MS 明朝とし、英文及び数字のフォントは半角・Century とする。掲
載時の原稿は 2 段組になることを考慮し、文字サイズと線幅を設定する。
・挿入希望位置は本文中に朱筆する。
・Word 等のドキュメント形式で「図表ファイル」を作成する際に画像化し貼付したデータ（jpg、gif、
png、xlsx、pptx、pdf 等の拡張子を有するファイル）がある場合には、投稿時に画像化前のデータを提出する。
・色は白黒かつ、十分な解像度が得られているものとし、十分な解像度が得られていない場合には、データの再提出を依頼する場合がある。
・図表写真は 1 点につき 400 字相当とみなす。
・いずれの原稿の種類においても、挿入可能な図表写真は 6 点以内とする。
10）文献リストは引用文献のみとする。文献著者は 5 名までを記載し、6 名以上は「他」として記載する。
11）本文中の該当箇所に、引用順に[1][2]…の通し番号をつけ、文末に番号順に掲載する。

64

＜雑誌の場合＞
著者名.論文名.誌名.出版年,巻数,号数,はじめのページ-おわりのページ.
1)川住隆一,佐藤彩子,岡澤慎一.応答的環境下における超重症児の不随意的微小運動と心拍数の変化について.特殊教育学研究.2008,vol.46,no.2,p.81-92.
2)Galya Frank. Life histories in occupational therapy clinical practice. American Journal
Occupational Therapy.1996,vol.50,no.4,p.251-264.
＜図書の場合＞
著者名.“章の見出し”.書名.編者名.版表示,出版社,出版年,はじめのページ-おわりのページ.
3)菅原和孝.“コミュニケーションとしての身体”.身体と文化.菅原和孝・野村雅一編.第 2 版,大修館書店,1996,p.22-28.
4)Joshua S. Goldstein. “International relations and everyday life”. Occupational Science –the evolving
discipline-. Ruth Zemke, Florence Clark, ed. Second edition, F. A. Davis. 1996. p.13-21.
＜ウェブサイトの場合＞
著者名.“ウェブページの題名”.ウェブサイトの名称.更新日付.入手先,(入手日付).
5)坂本和夫編.“パルスレーザーアブレーションにおけるドロップレットフリー薄膜の作製技術”. JSTORE.2005-11-01. http://jstore.jst.go.jp/cgi-bin/techeye/detail.cgi?techeye_id=32, (参照 2006-06-23).
6)“Grants.gov Application Guide SF424 (R&R)”. U.S. Department of Health and Human Services.
http://grants1.nih.gov/grants/funding/424/SF424_RR_Guide_General.pdf ,（accessed 2006-07-01）.
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学術誌「国際リハビリテーション学」編集委員会
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11．校正について
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掲載料は無料とする。
――――――――――――――――――――――――――――――――――――――――――――――
この規定は 2021 年 8 月 6 日より発効する。
【附則】
1．

2022 年 6 月 1 日に一部改正、同年 7 月 25 日より実施する。

2．

2023 年 6 月 6 日に一部改正実施する。

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学術誌「国際リハビリテーション学」投稿用紙
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御中

下記の論文を「国際リハビリテーション学」に投稿いたします。なお、本論文は、他誌に掲載済み、あるいは掲載予定でないことを誓約します。投稿するにあたり、共著者も投稿することに同意し、その内容に責任をもつことを承諾します。
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67

編集委員
有田久仁子

東京都立大学大学院

石井清志

薬ゼミ情報教育センター

伊藤智典

日本理学療法士協会

大西海斗

コーエイ・リサーチ＆コンサルティング

勝田

姫路獨協大学茜

車井元樹

国際医療福祉大学成田病院

河野眞

国際医療福祉大学

髙橋恵里

福島県立医科大学

寺村

大阪保健医療大学晃

古川雅一

仙台医健・スポーツ専門学校

村瀬順二

名古屋市療養サービス事業団

山口佳小里

国立保健医療科学院

山本啓太

AAR Japan［難民を助ける会］
（敬称略）

編集協力者
岩下夏岐

総合研究大学院大学

大澤 諭樹彦

浴風会

老健くぬぎ

（敬称略）

編集後記
学術誌第 6 巻 1 号をお読みいただき， 誠にありがとうございます． 2023 年は，新型
コロナウイルスが感染症法上 5 類に移行され，あらためて日常生活のありがたさと, その日常生活を支援するリハビリテーションの意義を再確認する年となりました．今回の投稿論文は, ミャンマーにおけるリハビリテーションの動向とこれからの展望について，貴重なご報告を頂きました．また，第７回学術大会でご登壇いただいた先生方からの寄稿頂
き，新しいセクションが加わりました．学術大会抄録のセクションでは，演題一つ一つか
らの気づきが多く, 示唆に富む内容となっております． 論文の執筆者の皆様および学術大会にご参加の皆様に深く感謝申し上げます．私のように残念ながら学会に参加できな
かったという方も，本号から益々活発になる国際リハビリテーションの息吹を感じていただけたのではないでしょうか．今後も会員の方人一人の現場からの生き生きとした情報を共有し，研究論文の掲載を通じて分野の発展をけん引する学術誌を目指してまいります．皆様からの率直なご意見や投稿を心よりお待ちしております！
（有田68

久仁子/東京都立大学大学院）

国際リハビリテーション学

第6巻1号

Journal of International Rehabilitation, VOL.6 NO.1
（ISSN 2434-5024）
2024 年 2 月

発行

発行者：国際リハビリテーション研究会
Website: https://int-rehabil.jp
E-mail: jsir.office@int-rehabil.jp