LETTER TO THE EDITOR
Justine GOSLING1,2 and Satish MISHRA2
From the 1Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland and 2World Health Organization Regional Office for Europe, Copenhagen, Denmark. E-mail: goslingj@who.int
Citation: J Rehabil Med 2023; 55: jrm18456. DOI: https://doi.org/10.2340/jrm.v55.18456.
Copyright: © Published by Medical Journals Sweden, on behalf of the Foundation for Rehabilitation Information. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/)
Accepted: Sep 7, 2023; Published: Sep 25, 2023
Competing interests and funding: The authors have no conflicts of interest to declare.
Developing the rehabilitation health workforce is foundational for effective service delivery; however, in many countries in the World Heath Organization (WHO) European Region, there are not enough rehabilitation professions to meet service demands. The WHO considers rehabilitation an essential health service and a key component of universal health coverage. Rehabilitation addresses a person’s limitations in everyday physical, mental and social functioning due to ageing or a health condition, including chronic diseases or disorders, injuries, or trauma, and supports independence and participation in education, community life and employment (1).
The rehabilitation workforce includes professions such as audiologists, occupational therapists, optometrists, physiotherapists, prosthetists and orthotists, and speech and language therapists, among others. The WHO European Region is below the global mean for the number of health professionals delivering rehabilitation services per 1 million population, which significantly limits development of, and access to, rehabilitation services (2). While there is a shortage of rehabilitation professionals across the WHO European Region, the shortage is particularly acute in the 21 middle-income countries, where, in 2016, there were 12 times fewer physiotherapists, 141 times fewer occupational therapists, 6 times fewer prosthetics and orthotics professionals, and 3 times fewer physical and rehabilitation medicine practitioners than in the 32 high-income countries of the Region (3).
Demand for rehabilitation services is already high and growing. Evidence based on the Global Burden of Diseases study, presented publicly in raw data form in the WHO European Health Information Gateway, showed that, in 2019, 2 in 5 inhabitants of the WHO European Region have diseases or impairments amenable to rehabilitation, whilst, in some countries, the need is as high as 1 in 2 (4). Improved healthcare, population ageing, and the increase in non-communicable diseases are the main drivers of the increased need for rehabilitation (1). Recognizing the increasing need for rehabilitation services and the shortages in the workforce, the rehabilitation 2030 “Call to action” initiative (5), and sustainable development goal 3c, called for a substantial increase in health financing, recruitment, development, training and retention of the health workforce. Such is the increasing need, and the attention rehabilitation is finally beginning to receive, that in May 2023 the first ever resolution on rehabilitation was passed at the World Health Assembly, WHO’s global decision-making body attended by delegations from all WHO Member States. This momentous event solidified the importance of rehabilitation within health systems as an essential health service worldwide and will be a catalyst for actions.
To initiate actions, in the summer of 2022 the WHO Regional Office for Europe convened a hybrid meeting with the aim of initiating a high-level discussion among decision-makers and rehabilitation stakeholders to support the development of competency-based rehabilitation education in central Asian and eastern European countries (6). Participants worked towards producing a roadmap for developing rehabilitation education in the 9 attending countries: Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.
The meetings report documented that most countries in central Asia and eastern Europe are yet to fully develop the roles and importance of rehabilitation professionals in the healthcare system, or to define and integrate these professions into the country’s health professional classifications (6). In most countries, entry-level education programmes for occupational therapy, physiotherapy, prosthetics and orthotics, and speech and language therapy are non-existent. Moreover, where they do exist, they are not consistent with competency-based or contemporary international professional standards. In many of the ex-Soviet countries, rehabilitation doctors are the main subspecialty in the rehabilitation field and electrotherapy techniques are considered the key rehabilitation intervention for any condition.
In addition, it was reported that workforce data is not routinely collected at any level of the health system, meaning that the overall picture of the situation remains very unclear. There is no regulation of scope of practice for individuals providing physiotherapy or occupational therapy services within health systems in the central Asia region, and no educational institutions nor corresponding ministries of education have instituted examinations or licensing requirements to practice.
Common challenges identified for the 9 participating countries in developing the rehabilitation workforce included:
It is clear that workforce strengthening is required in these countries to increase rehabilitation services as part of committing to achieving universal health coverage and optimizing individuals’ function in order to support inclusivity, economic prosperity and independence among individuals, communities and society as a whole. With this, the following broad recommendations were made to start to remedy these shortfalls and make progress on developing the rehabilitation workforce:
The vital need, key challenges and opportunities for developing the rehabilitation workforce for the central Asian and eastern European region have been identified. High-level engagement is essential to initiate actions and was achieved, paving the way for real future development. Engagement with rehabilitation professionals to expand the depth of engagement and work towards removing some of the barriers to developing the rehabilitation workforce would accelerate actions.
The authors would like to acknowledge the significant contribution of the WHO national professional officers and global professional organizations to this meeting.