Why is rehabilitation so important?
Our next activity introduces improved access to rehabilitation for people with disabilities. Here Jody-Anne Mills and Dr. Alarcos Cieza from the World Health Organization’s Disability and Rehabilitation Team provide an overview of why rehabilitation is important in global health.
Rehabilitation can be defined as a set of interventions designed to optimise 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.1 Rehabilitation thus maximises 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.
Just like promotion, prevention, treatment and palliation, rehabilitation is a health strategy that needs to be available for the whole population; it is likely that everyone at some stage in their life will need rehabilitation services.1
Rehabilitation in the global health context
For a long time, preventing and managing communicable diseases dominated global health priorities. Today, communicable diseases pose less of a threat to populations in many parts of the world, while the prevalence of non-communicable diseases is increasing dramatically, and populations are ageing at a startling rate.2 Consequently, people are living longer and with more chronic conditions. This can have major health, social and economic implications for individuals and governments, and it’s imperative that health systems deliver services that not only help prevent and treat chronic conditions, but support the people who live with them.1,3 Rehabilitation is a key part of this; helping people remain independent and productive, and participating in the activities that are important to them.
Rehabilitation is not only important for people with chronic conditions, however. Injuries continue to constitute a significant burden to health systems, and can be associated with considerable demand for rehabilitation.4 Many of those that survive motor vehicle accidents and war, for example, benefit from acute and long-term rehabilitation to achieve the best outcomes possible.
The role of rehabilitation in maximising the impact of other medical and surgical interventions can also not be ignored. Many people who access care will require rehabilitation in the hospital and community to facilitate their recovery and prevent complications. Several studies show that rehabilitation can help reduce length of stay and avoid re-admissions to hospital, for example.1
The current state of rehabilitation availability
Despite the fact that the demand for rehabilitation is increasing, many countries, especially low- and middle-income countries, do not have the capacity to address existing needs. As well as being poorly represented in national health policies, strategic plans and budgets, rehabilitation lacks the workforce needed to deliver safe and effective interventions across the levels of the health system. Data from the Eastern Mediterranean, South East Asia and Africa regions suggests that the available workforce for rehabilitation is less than a tenth of what is needed.5 This can leave substantial gaps in service availability across different levels of care.
For example, a recent survey from the Western Pacific region found that even in tertiary facilities (e.g. a specialist hospital, usually including training), service users are unlikely to be able to access occupational therapy, speech pathology, rehabilitation medicine or audiology services. The situation is worse at the primary health care level and in the community.6
Improving the status of rehabilitation in countries involves more than improving the availability of providers, however. Financial, geographical, transportation and sociocultural barriers can restrict access to and utilisation of services, while poor training, development, supervision and accountability of providers can compromise quality of care.7 All these issues need to be addressed in order for people to be able to receive the rehabilitation they require.
Acknowledging the magnitude of existing and emerging needs for rehabilitation, the Rehabilitation 2030 Initiative was launched by the World Health Organization in February 2017. This initiative includes a Call for Action that highlights ten priority actions requiring coordinated and concerted efforts by the rehabilitation community and Ministries of Health.8
The Rehabilitation 2030 Call for Action emphasises the need to strengthen the health system to prove effective and sustainable rehabilitation interventions for all who need them. It seeks to embed rehabilitation into integrated people-centred health services, which are designed around the needs of people, rather than conditions and institutions.9
Research institutions, development partners, professional associations and policy makers, amongst other stakeholder groups, all have a role to play in raising awareness of the role and benefits of rehabilitation, strengthening its evidence base, and raising its profile in national policies, plans and budgets.10
© The London School of Hygiene & Tropical Medicine