1- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ,takian@tums.ac.ir
2- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ,
Abstract: (16 Views)
Background: Rehabilitation is a fundamental component of Universal Health Coverage (UHC) and plays a critical role in optimizing functioning and improving health outcomes across populations. In line with the World Health Organization's Rehabilitation 2030: A Call for Action, strengthening rehabilitation within primary health care (PHC) is considered essential for achieving equitable and people-centered health systems. This scoping review aimed to examine global policies, experiences, and barriers related to the integration of rehabilitation services into PHC from a health policy perspective.
Methods: A scoping review was conducted following the Arksey and O'Malley methodological framework. A comprehensive literature search was performed in PubMed, Scopus, and Web of Science. Studies addressing policies, programs, implementation experiences, and factors influencing the integration of rehabilitation services into PHC were included. After duplicate removal, titles, abstracts, and full texts were independently screened by two reviewers. Data were extracted using a researcher-developed data extraction form and analyzed according to Walt and Gilson's Health Policy Triangle framework, encompassing four dimensions: content, context, actors, and process.
Results: Of the 3,053 records identified, 63 studies met the eligibility criteria. The findings revealed that the integration of rehabilitation services into PHC remains fragmented and insufficiently coordinated across health systems. Most included studies were conducted in high-income countries, while evidence from low- and middle-income countries remained limited. Identified integration models included family- and community-based approaches, home-based rehabilitation, telerehabilitation, direct access to rehabilitation services, outpatient rehabilitation, and geriatric care models. Major barriers of integration included inadequate financing, shortages of trained rehabilitation professionals, weak governance, and insufficient interprofessional collaboration.
Conclusions: Despite emerging innovations and promising integration models, substantial structural and policy-related barriers continue to hinder the effective integration of rehabilitation services into PHC. Achieving equitable, sustainable, and effective integration requires stronger political commitment, sustainable financing mechanisms, workforce capacity development, and enhanced intersectoral and interprofessional collaboration, particularly in low- and middle-income countries.
Methods: A scoping review was conducted following the Arksey and O'Malley methodological framework. A comprehensive literature search was performed in PubMed, Scopus, and Web of Science. Studies addressing policies, programs, implementation experiences, and factors influencing the integration of rehabilitation services into PHC were included. After duplicate removal, titles, abstracts, and full texts were independently screened by two reviewers. Data were extracted using a researcher-developed data extraction form and analyzed according to Walt and Gilson's Health Policy Triangle framework, encompassing four dimensions: content, context, actors, and process.
Results: Of the 3,053 records identified, 63 studies met the eligibility criteria. The findings revealed that the integration of rehabilitation services into PHC remains fragmented and insufficiently coordinated across health systems. Most included studies were conducted in high-income countries, while evidence from low- and middle-income countries remained limited. Identified integration models included family- and community-based approaches, home-based rehabilitation, telerehabilitation, direct access to rehabilitation services, outpatient rehabilitation, and geriatric care models. Major barriers of integration included inadequate financing, shortages of trained rehabilitation professionals, weak governance, and insufficient interprofessional collaboration.
Conclusions: Despite emerging innovations and promising integration models, substantial structural and policy-related barriers continue to hinder the effective integration of rehabilitation services into PHC. Achieving equitable, sustainable, and effective integration requires stronger political commitment, sustainable financing mechanisms, workforce capacity development, and enhanced intersectoral and interprofessional collaboration, particularly in low- and middle-income countries.
Type of Study: Systematic Review |
Subject:
Rehabilitation Management
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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 (CC-By-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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