Supporting evidence-informed policy making in rehabilitation: A logic framework for continuous improvement of rehabilitation programs

Improving Access to and Coverage of Rehabilitation Services through the Implementation of Rehabilitation in Primary Health Care: A Case Study from Chile

The demand for rehabilitation services (RS) is increasing worldwide, particularly in low-and middle-income countries (LMICs), where up to 50% of people currently don't have access to the RS they need. This case report describes how Chile integrated rehabilitation into primary health care (PHC) to improve access, coverage, and equity. The report draws on the first-hand experiences of two Ministry of Health (MoH) officials involved in transitioning from specialized to PHC-centered rehabilitation. The cornerstone of Chile's strategy is the Comprehensive Rehabilitation in PHC Program (RehabPHC), launched in 2007. It has three main service delivery strategies: Community Rehabilitation Rooms (CRRs), Integrative Rehabilitation Rooms (IRRs) linked to Family Health Centers (CESFAM), and Rural Rehabilitation Teams (RRTs) that provide mobile rehabilitation in remote areas. RehabPHC revolutionized the delivery, organization, and financing of rehabilitation. Rehabilitation coverage increased from 12 CRRs in 2007 to 307 in 2022, available in 52.6% of CESFAMs. Key to this progress was strong leadership and financial commitment from the MoH to ensure a sustainable, PHC-centered national rehabilitation system. Essential to planning was collecting and continuously monitoring data on rehabilitation needs and RehabPHC service indicators, which promoted evidence-based resource allocation. A dedicated policy was also critical, defining development pathways and coordination mechanisms for rehabilitation financing, advocacy, data collection, and monitoring. Chile's experience underscores the importance of strong governance, financial commitment, and evidence-based planning in integrating rehabilitation into PHC. As such, it provides a valuable blueprint for countries facing similar challenges.

The Learning Rehabilitation System: Strengthening an intersectoral strategy to improve functioning of an ageing population

Rehabilitation uses a person-centred approach that relies on dynamic case management and works across sectors, including social protection, labour, and education to improve individual functioning. Global population ageing means that more people will live with impairment in functioning. Responding to this growth in impairment will require countries to strengthen rehabilitation at all levels of their health systems as highlighted by the 2023 WHO Resolution on Rehabilitation. Efforts to strengthen rehabilitation can benefit from the concept of the Learning Health System, which implies a cyclical process of identifying issues, developing and implementing responses, monitoring the consequences of systems' change, and revising the response. However, we argue that it is not enough to simply adopt the notion of the Learning Health System for strengthening rehabilitation. We should rather think of a Learning Rehabilitation System. This is because rehabilitation is an intrinsically inter-sectoral strategy given its focus on people's functioning in their daily lives. Therefore, we believe that introducing the notion of the Learning Rehabilitation System is more than a terminological change; it is a fundamental programmatic shift that can contribute towards the goal of strengthening rehabilitation as an intersectoral strategy to improve functioning of an ageing population.