Learning, acting and building for rehabilitation in health systems

By ReLAB-HS Consortium (Johns Hopkins Bloomberg School of Public Health’s International Injury Research Unit (JH-IIRU), Nossal Institute for Global Health at the University of Melbourne, Humanity and Inclusion, MiracleFeet, PhysioPedia, and UCP Wheels for Humanity)

We live in a time of rapid demographic and epidemiological change. Improvements in health care mean people live longer -the proportion of the population over 60 years of age will double in the next 30 years and they will live with the concurrent illnesses and disability that are part of the ageing process. Additionally, approximately 150 million children and adolescents experience disabilities. And COVID-19 – a disease that appears to manifest as long-term chronic ill-health in many – has demonstrated that we now live in a world where both communicable and non-communicable disease must be tackled simultaneously.

Rapid urbanization and concurrent increases in car ownership and use leave people vulnerable to injuries. In addition, we live in a world that faces political, economic and environmental flux and shock. Conflict and environmental disasters are common.

Already stretched health systems in low- and middle-income countries (LMICs) face challenges including poor infrastructure, insufficient specialized care-providers and trained professionals, and inadequate financial resources.

Rehabilitation and assistive technology

Rehabilitation is integral to overall health and wellbeing. According to recent estimates, one in three people across the globe will require rehabilitation at some point in their lives.

Yet many people do not have access to much needed assistive technology (AT) or rehabilitation services, which exacerbates their condition and may lead to further complications and lifelong consequences. Lack of access to rehabilitation and AT impacts not only on people’s functioning, quality-of-life, and well-being, but has implications for their family and community. Lack of rehabilitative support can trap people in a whirlpool of poverty due to lack of educational and work opportunities, as well as social isolation due to stigma and discrimination.

Building better health systems

  • In many LMICs, rehabilitation and AT are often offered as stand-alone services. However, there is need to rethink organization of rehabilitation services as an integral part of health systems to achieve better health and well-being of the population.
  • Solutions need to be contextualized, demand-driven, and be informed by principles of systems and implementation science; there’s unlikely to be a one-size-fits-all solution. This calls for a better understanding of local needs, how rehabilitation services and health systems are currently organized and operate, and barriers to integration that need to be addressed.
  • Potential patients need to understand the services that they require and where they can get them from. People are the center of the health system.
  • Engagement with non-governmental organizations, civil society organizations, and the private sector is key to ensure successful implementation and uptake of interventions.

Building such health systems will require collaboration across the primary, secondary and tertiary levels and between different sectors within and outside government. The road ahead is not easy, but it is necessary if we are to meet the needs of citizens and communities facing acute and long-term challenges.