Miracle for 10 thousand: Hope-Building Hospital for Children with Disabilities
Mapo district of Seoul metropolitan government

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
● The Hidden Face of the Republic of Korea and the Miracle on the Han River: a Steady Increase in Children with Disabilities The 'Miracle on the Han River' is the result of Korea's rapid industrialization and economic development. Although it has achieved remarkable development in the fields of economy, culture and society under the iconic motto of "Let's Live Well," Korea has also suffered from accompanying side effects such as postponed maternity due to the incorporation of an increasing number of women into the labor force combined with environmental pollution. As a result, the incidence of fetal birth defects has been steadily increasing in Korea. For example, according to the data released by the National Health Insurance Service (NGIS), the number of children aged 0-1 years with congenital disabilities increased from 13,786 in 2005 to 32,601 in 2011, representing an increase of 136.5% over a period of seven years. In addition, the incidence of autism in Korea is the highest in the world, and is twice that of the United States and Europe. Furthermore, it is estimated that there are more than 300,000 children with disabilities in Korea, including children with unregistered disabilities. ● '0' Hospital and Rehabilitation Center for '300,000' children in Korea Despite the fact that the number of children with disabilities continues to increase, there is no integrated rehabilitation hospital in Korea. The fundamental reason is that medical insurance premiums are so low for child rehabilitation treatment that long-term treatment aggravates the deficit of medical institutions in Korea. In line this economic logic, large hospitals are reducing or even closing their child rehabilitation facilities, while institutional support remains inadequate. This is in marked contrast to the concerted efforts of advanced countries to reduce potential social costs by actively establishing children rehabilitation hospitals and helping disabled children to receive early treatment. The United States, Germany and Japan, for instance, have 40, 140 and 202 child rehabilitation centers, respectively. ● Emergence of 'Rehabilitation Refugees' Waiting up Two Years for Treatment Early intensive treatment of children with disabilities is not only effective but also minimizes their disability, which greatly affects the quality of life. However, the lack of information, heavy financial burden, and lack of treatment facilities cause many children with disabilities to miss the “golden time” for treatment. Families with disabled children are left unprotected in the country's welfare blind spot. In fact, they are often referred to as 'rehabilitation refugees' because they are forced to wander from hospital to hospital in search of an available bed in the pediatric ward of a general pediatric or adult-centered hospital, where beds are notoriously limited. Even if children are treated after a long period of waiting, their families suffer from economic difficulties due to the high cost of rehabilitation treatment, which is not covered by the national health insurance scheme. This leads to a vicious circle of "family disintegration due to economic difficulties → unemployment for single child care → deprivation and social marginalization."

B. Strategic Approach

 2. What was the solution?
(1) Presentation of Korea's first model of child rehabilitation: Realization of private sector centered public healthcare for 'medical + education + self-reliance' services. (2) Establishment of a culture of voluntary donation by over 10,000 citizens and 500 companies: Securing funds for stable hospital operation. (3) Setting the social agenda based on the consensus that "Everyone is happy when children with disabilities are happy."

 3. How did the initiative solve the problem and improve people’s lives?
● Presentation of the Country's New Paradigm of Public Healthcare Facilities: Realization of "Welfare Mapo" According to a social survey conducted by the Mapo-gu district in 2015, the most desired welfare service for people with disabilities was 'medical / rehabilitation support’ (51.2%), indicating that the need for medical rehabilitation services for the disabled is the most urgent concern among residents. Thus, Mapo-gu decided to build the Integrated Children Rehabilitation Hospital in order to improve the physical, mental and social functions of children with disabilities for the purposes of improving the quality of life of residents and helping children with disabilities to return to society and achieve self-reliance without difficulties. The most important things to consider when setting up the hospital was to identify what was most necessary for children with disabilities, what they wanted, and which treatments would be most effective for them. However, there was not a single disabled children rehabilitation hospital in Korea at that time. Thus, in November 2011, we conducted benchmarking in order to observe the status of disabled facilities in advanced countries such as Germany, Austria and Switzerland and to reflect their best practices in our facility. Our delegates visited the Hochried Rehabilitation Hospital, the Munich Children’s Rehabilitation Center, the Caritas Disability Workshop, and the Spital Children Rehabilitation Hospital, and consulted them on the establishment of the first children’s rehabilitation hospital in Korea. We then established a full-fledged partnership with the related organizations and secured funds needed for the construction of the hospital. For instance, we established a long-term plan for building the hospital under an agreement with the Purme Foundation, a private organization, in 2011. In the course of this process, we won project approval from the Seoul Metropolitan Government (SMG) on condition that we secure a certain proportion of private fund-raising, whereupon we received 5 billion won in construction costs and 3.5 billion won in medical equipment purchase costs from the SMG. In addition, we secured 1.5 billion won in medical equipment purchase costs from the central government. Above all, we sought voluntary participation by citizens and corporations in resolving social issues through donations and contributions, and secured sufficient financial resources to expedite the completion of the hospital ahead of schedule. The goal of the Children's Rehabilitation Hospital in Mapo-gu is to establish a professional rehabilitation system tailored to children with disabilities by providing medical care from birth to growth. The hospital provides integrated rehabilitation services specialized for each stage in the life cycle of children, i.e. every 4 years, starting from childbirth. As a result, the Children’s Rehabilitation Hospital was designated as a social safety net hospital of Seoul in recognition of its excellence in the domain of public service, and signed an MOU with the SMG. Having already launched pediatric care customized to meet the specific needs of local residents, the hospital has recently expanded its dental care to cover the general public as well as children with disabilities, and now plans to continue expanding such medical services.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
● Realization of the Public-Private Partnership at the Local Level, a First in the Nation: Building an Integrated Rehabilitation Hospital for Disabled Children that Provides 'Medical + Education + Self-Reliance' Services This project is significant in that it is Korea's first co-governance model to involve the central government, local government, civil society and businesses, as well as being the country's largest integrated rehabilitation hospital. As an integral aspect of national healthcare, the field of medical rehabilitation is one of the core responsibilities of the central government. However, the Korean government failed to address this field due to the heavy burden it imposed on the health budget. However, Mapo-gu made successful promotion of the initiative its top priority and selected the Purme Foundation as a counterpart for negotiations. In January 2014, the two parties signed a concession agreement composed of 60 articles and 175 clause. We established 'co-governance' to coordinate the multiple stakeholders' opinions and conflicts of interests. The construction of the hospital is innovative in that it is Korea's first disabled children’s rehabilitation hospital completed under the initiative of a local government, thus setting an example to follow in the realm of public medical services.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
● The Major Player: Mapo-gu District Office Mapo-gu, with its population of 380,000, is a major district in the mega city of Seoul. It promotes residents' welfare as one of its top priorities under the slogan of "Welfare Mapo Where All Residents Live Well Together" under the leadership of the major of the fifth popularly elected municipal government. In order to improve the quality of life for children with disabilities, Mapo-gu has materialized private sector-centered public healthcare offering 'medical + education + self-reliance' services, while showcasing the Korean model of child rehabilitation centers for the first time in Korea. Consequently, Mapo-gu has eliminated the blind spot in its rehabilitation welfare services for children with disabilities, improved the overall welfare of local residents in the district through other cultural, leisure and sports facilities, and provided unique medical services to disabled children with urgent rehabilitation needs across the nation. ● Size of Affected Population: 300,000 Children with Disabilities Nationwide According to the Ministry of Health and Welfare, the registered number of children with disabilities nationwide is about 90,000, but the number of children who are not registered with the Ministry due to prejudice or a lack of information on disabilities is estimated to be about 300,000. Most notably, a large number of children with congenital disabilities or having acquired disabilities at a later stage of their development experience multiple disorders, and thus require integrated rehabilitation. In this regard, the new hospital provides an opportunity for approximately 300,000 children with disabilities across the country to be treated in a timely manner and become self-reliant in their daily life.
 6. How was the strategy implemented and what resources were mobilized?
● Promotion of the Initiative The construction of the Mapo-gu Children’s Rehabilitation Hospital was promoted in September 2011 following the execution of an MOU between Mapo-gu District Office and the Purme Foundation. After receiving a conditional approval for promotion at the investment/loan evaluation session of the SMG and the Ministry of the Interior, respectively, the district office completed the basic design of the hospital in August 2013. We held four town hall meetings between 2011 and 2014 to actively reflect the residents' opinions. The groundbreaking ceremony was held in March 2014 and the hospital was completed the following year. A core feature of this initiative is Mapo-gu’s encouragement of local residents and communities to participate in the construction process of the hospital, rather than relying on the traditional business model whereby a project is driven by government offices from start to finish. As a result of our efforts to reflect local residents' input, we successfully established the Disabled Children's Rehabilitation Hospital, which can be used by local residents and children with disabilities alike. ● Securing Stable Operating Funds through a Win-Win Public-Private Partnership Model between the Central and Local Governments, Civil Society and Businesses Everyone agrees on the necessity of building hospitals to cure sick children. However, there are several reasons why local governments in Korea shied away from undertaking such an initiative. The construction of such a hospital requires a sizeable plot of land and entails considerable costs. Securing the budget for the construction costs was the most important factor in determining the success of the initiative. To overcome the limitations of public financial resources, Mapo-gu proposed a new co-governance model for the hospital between the central government, the municipality, civil society and businesses. Mapo-gu District Office offered 3,212.9㎡ of land, which it had purchased from SH Corporation for ₩9.2 billion, free of charge for the construction of the hospital. In September 2011, it signed an MOU with the Purme Foundation after selecting it as a preferential counterpart for negotiations. In January 2014, the two parties signed a contract of "the Rehabilitation Hospital for (Disabled) Children and a Social Welfare Facility." In addition, Mapo-gu actively engaged in discussions with the central government and related organizations in order to resolve the burden of operating expenses. For example, the district office received ₩1.5 billion from the central government to purchase medical equipment for the special children's hospital after passing the government's rigorous funding evaluation. It secured a budget of ₩8.5 billion from the SMG for the construction work and purchase of equipment. In January 2015, the SMG and the Purme Foundation signed an MOU and, as a result, the district office receives an additional ₩900 million in operating expenses each year. Members of the hospital’s medical staff have also participated in the realization of a win-win public-private partnership in the welfare sector. They offer high-quality rehabilitation services at 30% lower prices than those of large hospitals. Administrators have also joined forces by accepting salaries equivalent to only 80% of those of general hospitals. In addition, the hospital is working hard to help reduce income inequality by supporting ₩170 million in medical expenses (as of December 2016) to be paid by the poorest and most vulnerable groups, and providing assistive devices for use by the children. Despite starting from scratch without public funding or assistance of any form, the district’s passion and commitment to children with disabilities was eventually able to overcome the severe financial limitations thanks to the continuing interest of the central government, local government, civil society and businesses, steering the initiative at the district level to great success.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
●1) Mapo-gu District Mapo-gu decided that the problem of rehabilitation and care for children with disabilities should be resolved jointly by not only the families but also by the local community and the government. The district provided the site for the hospital and led the promotion of the initiative by offering administrative support. ●2) The Purme Foundation The Purme Foundation is a nonprofit public benefit corporation established in 2005 with the aim of rehabilitating children with disabilities and establishing hospitals to that end. Since signing an MOU with Mapo-gu for the construction of a rehabilitation hospital for children in September 2011, the foundation has raised funds to build the hospital from citizens and businesses, and is in charge of managing and operating the initiative processes. ●3) Other Public Organizations Other public institutions have promoted financial support for disabled children. The Ministry of Health and Welfare has offered subsidies for equipment purchase, while the SMG has provided financial assistance for the construction and operation of the hospital. ●4) Citizens and Businesses A total of 9,695 citizens and 486 companies have participated in fund raising activities, raising a total of ₩32.8 billion for the hospital. Individual donators include writers who donated their royalty payments, entertainers who took the lead in making donations through participation in triathlon competitions for seven years, athletes, schoolchildren, housewives and kindergarten children. The amount corresponds to about 70% of the total project cost of ₩46.5 billion. ●5) Academia and Experts A counseling group composed of experts on welfare for the disabled conducted 'a study on the establishment and operation of a rehabilitation hospital for children' and laid the groundwork for the establishment of an effective hospital capable of offering 'One-Stop-Service' from treatment to vocational rehabilitation from a life cycle point of view.

 8. What were the most successful outputs and why was the initiative effective?
● Establishment of Appropriate Social Security Systems for the Poorest and Most Vulnerable (SDG 1-3) Most households with children with disabilities belong to the middle and lower classes. Notably, the burden of expenditure on medical expenses is enormous. In order to alleviate their financial burden, Mapo-gu has expanded coverage of the lower income group by 200% and provides medical care for disabled family members who do not meet the eligibility criteria of the government’s guidelines. It also provides special programs designed for the siblings and other family members of disabled children. ● Contribution to Reducing Premature Birth Rate due to Illness (SDG 3-4) Preterm infants are children who are born with insufficient physical and mental development, concentrating on the care of the acute phase directly linked to their lives while receiving treatment in the incubator. The Purme Children’s Rehabilitation Hospital is cooperating with the NICU wards of fourteen large hospitals in Seoul, Gyeonggi, and Incheon to monitor the occurrence of disabilities in premature infants and to prevent premature death and disability among infants. ● Contribution to Enhancing Gender Equality and Family Confidence(SDG 5-4) When a child suffering from mental retardation is born, the mom runs around the country looking for treatment while the dad gets worn out at work. Therefore, the Children’s Rehabilitation Hospital has held a total of 1,000 sessions of special care programs for such families, including psychological counseling for the family and parent education focused on promoting the human rights of the mother, who usually shoulders the burden of taking care of a child with disabilities in the family. As a result, a mother who cares for a child with a disability is able to recover her own life by standing back from her child to some extent in order to concentrate on her social activities. ● Improving the Employment Rate of the Poorest and Most Vulnerable (SDG 8-5) The Purme hospital’s vocational rehabilitation center is dedicated to developing the vocational ability of severely disabled persons with difficulties in employment and linking them to the job market. In cooperation with the Korea Employment Agency for the Disabled, it contributes to the creation of jobs for people with disabilities in order to attract subsidiary-type standard workplaces for the disabled.

 9. What were the main obstacles encountered and how were they overcome?
● Differences in Viewpoints between the Public (Mapo-gu) and Private (the Purme Foundation) Sectors Although the vision pursued by Mapo-gu and the Purme Foundation was one and the same, namely, "the provision of integrated services for medical, vocational and social rehabilitation," the differences between public and private organizations became evident in the course of promoting the initiative. For example, opinions differed with regard to the contents of role sharing to be contained in the agreement, the allocation of facilities in the construction stage and so on. However, they have found solutions through the constant exchange of opinions and coordination, while also sharing the vision of building a hospital that develops hand in hand with the local community. ● Overcoming Local Residents' Aversion through Transparent Public Administration There were some local residents who were opposed to the construction of the hospital due to vague prejudices. In order to reach a consensus with local residents, Mapo-gu discussed ways to improve the happiness index of local residents while conferring with people from all walks of life, including business people, citizens, and municipal councilors. Mapo-gu held four briefing sessions on the initiative, with the first in 2011, in a bid to highlight the need for the establishment of a children’s rehabilitation hospital, and shared all the details of the initiative with local residents in a transparent way. After carefully reviewing the 74 suggestions made by residents at the briefing sessions, Mapo-gu decided to install additional facilities for use by local residents, such as restaurants, rooftop gardens, children's libraries, cafes, and swimming pools within the hospital premises. In the process, the district office gained the residents' trust, drew consensus from some local residents who were initially opposed to the hospital due to social prejudice, and boosted the driving force behind the initiative.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
● Korea's First Model of Child Rehabilitation in Korea: Realization of Private Sector-Centered Public Medical Services through Integrated 'Medical + Education + Self-reliance' Services Mapo-gu’s integrated rehabilitation hospital initiative is extremely meaningful in that it is the country's first model of cooperation between the central government, local government, civil society and businesses for a good cause, and because it is the country's largest integrated rehabilitation hospital designed for treating both disabled and non-disabled children in Korea. For the professional treatment of children, the Children's Rehabilitation Hospital runs four medical departments including the Rehabilitation Department, Child and Adolescent Department, Mental Health Department, and Dental Department. It is equipped with 91 hospital beds, 10 day wards, and various rehabilitation treatment rooms as well as vocational rehabilitation centers designed to help people with disabilities, who have been treated, to find employment. As a result of 6 months of intensive treatment, a child with an autistic disorder showed a more than twofold increase in his developmental age profile in each PEP (Psycho Educational Profile) category. Another child with disabilities occasioned by cerebral palsy has surpassed the developmental status of non-disabled children by more than five times in the cognitive, physical, receptive, and expressive language fields after just two months of ABA intensive rehabilitation therapy. What has enabled the hospital to deliver such excellent outcomes is its one-stop solution to healthcare, education, and self-reliance, which it realizes through its professional rehabilitation treatment programs. ● Improving Awareness of People with Disabilities and Promoting Social Integration Local residents who opposed the construction of the hospital are now making use of its convenience facilities together with children with disabilities, as well as helping create a community culture that advocates harmony at the local level through such diverse events as cultural performances, field classes for elementary school students. Meanwhile, children who visit the hospital learn naturally from their childhood that disabilities are not 'something to discriminate against' but merely 'slight differences to be reckoned with.' In other words, a children’s rehabilitation hospital is not merely a medical institution that treats children but also a venue for social integration that spreads the perception that all human beings, whether able-bodied or disabled, have a sense of dignity and are fully equal. ● Reducing Social Costs and Making Long-term Investments for Future Generations The project was based on the straightforward belief that it is a sound investment aimed at reducing the social costs for which Mapo-gu is responsible for the sake of the local residents it serves. Early intensive care in childhood not only minimizes disability but also has a high cure rate, which has a significant impact on the quality of life of children with disabilities. Mapo-gu Children's Rehabilitation Hospital has been providing various services tailored to each individual's level of disability, including ABA Early Intensive Care and body area treatment with the purpose of preventing the degree of disability from worsening and thereby dramatically reducing future social welfare costs.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
● A Hospital Built by Citizens: Improved Trust in Public Service through Real-Time Communication and Feedback Before building the children’s hospital, opinions were exchanged between Mapo-gu office and the local residents at meetings and briefing sessions about how to use the site prior to the decision on the construction of the hospital there. At these gatherings, the majority of residents sympathized with the need to build a social welfare facility for the poorest and most vulnerable people and expressed their hopes that a community network could be formed where local residents could join them through the facility. Until then, there was no rehabilitation hospital for 'disabled children' among the 328 hospitals and medical institutions in the Seoul metropolitan area. The situation was no different in areas outside Seoul where welfare realities were even worse than in the capital city. Under the philosophy that children with disabilities should be treated and respected without discrimination, Mapo-gu recognized its social responsibility as a public institution and completed the construction of the nation's first rehabilitation hospital for disabled children in order to realize its residents' demands for proper welfare for disabled children. Mapo-gu believed that it had to maintain its policy of persuading and embracing even those people who had the opposite opinion, even when the initiative in question was involved with the creation of an absolutely necessary welfare facility for the community. Indeed it thought such an approach was one of its roles as a public institution charged with promoting the wellbeing of all its residents. Therefore, instead of pursuing a one-sided project by ignoring the opinions of a very small number of residents who had a sense of rejection, the district office strived to actively communicate with them by accepting and respecting their objections. The district office held four public hearings between 2011 and 2014 at which it explained the necessity of establishing a rehabilitation hospital for children and disclosed all the details of the initiative in a transparent manner. In this process, it helped to raise the credibility of public administration by collecting and reflecting the requests made by residents to build children's libraries and sports centers, for instance, within the hospital premises. As a result, Mapo-gu was ranked second in the nation in the 2016 integrity evaluation of 243 local organizations around the country conducted by the Anti-Corruption & Civil Right Commission.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
● Loving Your Family is a Key Virtue: Introduction of 'Residential Type Hospital Rooms' for the Families of Disabled Children as an Advanced Health Service Mechanism. Mapo-gu has introduced 'Residential Type Hospital Rooms' in the admission ward and the day ward located on the 5th and 6th floors of the Children's Rehabilitation Hospital. The rooms are installed in the same environment as the actual residential structure. It is a new type of rehabilitation model that integrates hospitalization and outpatient treatment in the form of intensive rehabilitation. Through this program, the burden of care of parents of children with disabilities can be reduced in the social adjustment period after discharge. On the other hand, Mapo-gu has offered the special caregiver program, which consists of amily psychological counseling and parent education, over 1,000 times so far to protect the 'human rights' of women and mothers, the main protectors of children with disabilities, helping to boost their quality of life. In addition, Mapo-gu provides ₩2 million to each disabled child under 18 years of age who cannot access medical treatment due to financial constraints and ₩1.2 million to each of their non-disabled siblings to cover special education and psychological treatment.

Contact Information

Institution Name:   Mapo district of Seoul metropolitan government
Institution Type:   Local Government  
Contact Person:   Seulki Park
Title:   planning  
Telephone/ Fax:   +82-2-3153-8505/+82-2-3153-8549
Institution's / Project's Website:  
E-mail:   bambi@mapo.go.kr  
Address:   212, Worldcup-ro
Postal Code:   03937
City:   Mapo-gu
State/Province:   Seoul

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