Framing rehabilitation through health policy and systems research: priorities for strengthening rehabilitation

Alarcos Cieza, Sensory Functions, Disability and Rehabilitation Unit, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland. ciezaa@who.int.
Aku Kwamie, Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
Qhayiya Magaqa, Sensory Functions, Disability and Rehabilitation Unit, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
Nino Paichadze, Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington DC, 20052, United States of America.
Carla Sabariego, Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, 6002, Lucerne, Switzerland.
Karl Blanchet, Geneva Centre of Humanitarian Studies, Université de Genève, The Graduate Institute (IHEID), 28, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland.
Nukhba Zia, International Health, Health Systems Division, International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America.
Abdulgafoor M. Bachani, International Health, Health Systems Division, International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America.
Abdul Ghaffar, Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
Bente Mikkelsen, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.

Document Type

Journal Article

Publication Date

9-20-2022

Journal

Health research policy and systems

Volume

20

Issue

1

DOI

10.1186/s12961-022-00903-5

Keywords

Health policy; Health systems strengthening; Rehabilitation; Systems thinking

Abstract

BACKGROUND: Recent estimates report that 2.4 billion people with health conditions globally could benefit from rehabilitation. While the benefits of rehabilitation for individuals and society have been described in the literature, many individuals, especially in low- and middle-income countries do not have access to quality rehabilitation. As the need for rehabilitation continues to increase, it is crucial that health systems are adequately prepared to meet this need. Practice- and policy-relevant evidence plays an important role in health systems strengthening efforts. The aim of this paper is to report on the outcome of a global consultative process to advance the development of a research framework to stimulate health policy and systems research (HPSR) for rehabilitation, in order to generate evidence needed by key stakeholders. METHODS: A multi-stakeholder participatory technical consultation was convened by WHO to develop a research framework. This meeting included participants from selected Member States, rehabilitation experts, HPSR experts, public health researchers, civil society and other stakeholders from around the world. The meeting focused on introducing systems approaches to stakeholders and deliberating on priority rehabilitation issues in health systems. Participants were allocated to one of four multi-stakeholder groups with a facilitator to guide the structured technical consultations. Qualitative data in the form of written responses to guiding questions were collected during the structured technical consultations. A technical working group was then established to analyse the data and extract its emerging themes. This informed the development of the HPSR framework for rehabilitation and a selection of preliminary research questions that exemplify how the framework might be used. RESULTS: A total of 123 individuals participated in the multi-stakeholder technical consultations. The elaborated framework is informed by an ecological model and puts forth elements of the six WHO traditional building blocks of the health system, while emphasizing additional components pertinent to rehabilitation, such as political priority, engagement and participatory approaches, and considerations regarding demand and access. Importantly, the framework highlights the multilevel interactions needed across health systems in order to strengthen rehabilitation. Additionally, an initial set of research questions was proposed as a primer for how the framework might be used. CONCLUSIONS: Strengthening health systems to meet the increasing need for rehabilitation will require undertaking more HPSR to inform the integration of rehabilitation into health systems globally. We anticipate that the proposed framework and the emerging research questions will support countries in their quest to increase access to rehabilitation for their populations.

Department

Global Health

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