WHO. World Health Organization. Rehabilitation in health systems. Geneva. 2017
Globally, but especially in low- and middle-income countries, rehabilitation in health systems requires strengthening so that high-quality, affordable services are available to all who need them (1,6). Such strengthening will not only ensure respect for human rights but also improve health and provide social and economic benefits. Furthermore, as universal health coverage is firmly identified as the target of Sustainable Development Goal 3 (health), countries are encouraged to ensure equitable access to high-quality, affordable health services, including rehabilitation (19). Progress towards universal health coverage, and universal rehabilitation coverage in particular, varies widely around the world. Historically, rehabilitation has been a low priority for many governments, especially those with limited health investment, which has resulted in underdeveloped, poorly coordinated services (6). For example, while there is a notable scarcity of robust data on the availability of rehabilitation services, several studies conducted in southern Africa indicate a substantial gap between the requirement for rehabilitation and its reception (20–23). It is urgent to support countries in preparing to address the growth in demand for rehabilitation services that is anticipated with ageing populations, the rising prevalence of noncommunicable diseases and the increasing numbers of people living with the consequences of injury (1–4).
Rehabilitation services benefit health and society, for individuals, communities and national economies (6,24–29). Investment in rehabilitation increases human capacity by allowing people with a health condition to achieve and maintain optimal functioning, by improving their health and by increasing their participation in life, such as in education and work, thus increasing their economic productivity (30). For children in particular, rehabilitation optimizes development, with far-reaching implications for participation in education, community activities and in later years, work (31–33). Rehabilitation can also expedite hospital discharge, prevent readmission (34,35) and allow people to remain longer in their homes (15,36,37). While the economic benefits associated with these outcomes are generally recognized only in longer-term analysis, their impact can be profound (27,38–42).
Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Health condition refers to disease (acute or chronic), disorder, injury or trauma. A health condition may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition (6). Rehabilitation thus maximizes people’s ability to live, work and learn to their best potential. Evidence also suggests that rehabilitation can reduce the functional difficulties associated with ageing and improve quality of life (2,37,43).
These recommendations respond to strong calls in the World report on disability for Member States to “develop, implement, and monitor polices, regulatory mechanisms, and standards for rehabilitation services, as well as promoting access to those services” (6, p. 122). The recommendations are also intended to support countries in implementing objective 2 of the WHO global disability action plan 2014–2021, “to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation” (30, p. 3). The United Nations Convention on the Rights of Persons with Disabilities (44)calls on Member States to take appropriate measures to organize, strengthen and extend rehabilitation services and programmes (Article 26). To date, limited information has been available to countries on strengthening rehabilitation in the health system to respond to the growing population demand for services. The aims of these recommendations are to address this information gap and to provide system-level recommendations for improving rehabilitation service delivery.
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