Introduction
The World Health Organization (WHO) recognizes disability as a global and public health issue, a human rights issue, and a priority in growth and development [1]. Many people with disabilities have a lower-level status in terms of health compared to other people in their society. The poor health status they experience is not necessarily a direct result of their disabilities but is related to their access to services and treatment programs [2]. In most countries, the Ministry of Health is in charge of community health. So, rehabilitation services are run by the government, the private sector, or non-government [3]. Rehabilitation includes specific goals to reduce the impact of disability, empowering a disabled person to achieve independence and be present in the community, manage himself, and obtain a higher quality of life [4]. In many developing countries, there are not enough resources to diagnose and prevent disability, provide rehabilitation and treatment needs, and plan special services for people with disabilities [5]. There are serious challenges in the functioning of the system. The health system is seen as an injustice in the access of all people to treatment and rehabilitation services, dissatisfaction with the quality of services provided, high costs, and the inability to pay treatment and rehabilitation costs for the general public [6, 7].
In Iran, the health system pays more attention to the treatment concept and less to rehabilitation. One of the reasons for this neglect could be the lack of a specific place for rehabilitation in Iran’s health system and the provision of services by several organizations such as the Ministry of Health, the Welfare Organization, the Exceptional Education Organization, and the Martyr and Red Crescent Foundations [8, 9]. Few studies have been conducted on the rehabilitation system in Iran’s health care system, and there is no written and specific policy for providing rehabilitation services. The main question is how to keep up with current developments and eliminate the country’s rehabilitation structure deficiencies. Considering the general purpose of this study, which is to compare the planning and components of the rehabilitation structure in the health care system of several countries, the researchers have tried to examine the components of the systems to meet the needs of the health system by conducting a comparative study. In this study, the countries of Germany, Japan, Canada, Turkey, and South Africa, which are the leading countries in terms of rehabilitation systems in their continents, were selected to identify the structure of rehabilitation in the health system of these countries and compare them with Iran and make practical suggestions to improve Iran’s rehabilitation system.
This study aimed to compare the rehabilitation structure of Iran with these selected countries, and the findings can be used as a guide for legislation by the government to provide the infrastructure of the rehabilitation system.
Materials and Methods 
This applied research has been done with a descriptive-comparative method. The information required was obtained through existing databases, including the review of books, scientific journals, documents, publications, library documents, research reports, official documents published by the investigated countries and the WHO, and a search in the global Internet network. 
To collect data related to the countries under study, the keywords of “rehabilitation organization,” “health system,” “health management,” “financial components,” “legal components,” “social components,” and “policy components” were searched along with the names of the countries under study. Next, the research related to the health and rehabilitation system was collected, translated, and analyzed in domestic and foreign search databases such as Irandoc, SID, and Magiran and foreign databases such as Google Scholar, Scopus, ScienceDirect, PubMed, and Elsevier between the 2000 and January 2022. While conducting and analyzing the research, in the first stage, 150 research articles and reports were collected from the countries under study. Then, 100 articles were excluded from the study due to their irrelevance based on their abstract, text, or unavailability. Finally, 50 articles and reports were analyzed and compared as approved articles. To compare the countries’ rehabilitation structure, organizational dimensions, health management, and financial, legal, social, and policymaking components in the rehabilitation system of these countries were examined and compared with each other.
The Bereday model was used in this study [8, 10]. This method consists of 4 stages: Description, interpretation, proximity, and comparison. In the description stage, the research phenomena were prepared based on evidence, information, and note-taking, and by preparing sufficient findings for examination in the next stage. The data collected and described in the first stage was checked and analyzed in the interpretation stage. In the proximity stage, the information obtained from the previous stages was classified and put together to create a framework for comparing similarities and differences. Finally, in the comparison stage, the details of the similarities and differences in criteria and sub-criteria were discussed, and the research questions were answered.
In this research, sampling was done purposefully. The statistical population included the structure of rehabilitation in the health system of the countries of the world, and the research sample included the countries of Iran, Germany, Japan, Canada, Turkey, and South Africa, each based on the geographical region and representatives of the continents of America, Europe, Asia, and Africa. The information related to the rehabilitation system’s health management and financial, legal, social, and policy components were collected. Then, the desired information and content were searched according to the research objectives, and the collected data were arranged in tables for each component of the rehabilitation system. In this way, by organizing the data, similarities, and differences between the designated countries and suggestions and solutions to improve each component of the rehabilitation system in Iran were presented.
Results 
In Iran, the Ministry of Health and Medical Education is responsible for health management and achieving the highest level of health services for all members of society. However, in rehabilitation management, in addition to the Ministry of Health, the Welfare Organization, the Red Crescent, the Martyr Foundation, and the Affairs of Veterans and Exceptional Education, each has a separate role. In Turkey, as in Iran, this responsibility rests with the Ministry of Health. South Africa’s health system consists of a large public and private sector. The government funds the country’s public health, with the Ministry of Health responsible for overall health care. In Germany, the responsibility lies with the Federal Joint Committee, the Ministry of Health and Social Security, and the Federal Social Committee, consisting of 4 bodies: The Emergency Care Committee, Dental Care Committee, Hospital Care Committee, and Physician Affairs Committee. In Japan, health management is managed by the Ministry of Health, Labor, and Welfare and is covered by the public insurance system. In Canada, responsibilities are divided between the federal government, the Accreditation Department, and private bodies.
Comparing the financial components of the health and rehabilitation system in Iran, half of the health costs are paid directly from the families’ own pockets, which puts them in the abyss of back-breaking expenses caused by the occurrence of disease [8, 5]. Credits of the organizational structure of service insurance in Iran are related to the Ministry of Welfare and Social Security. The Welfare Organization provides part of the rehabilitation budget; insurance does not cover many rehabilitation services, including occupational therapy. In South Africa, the government offers a major part of health expenses at the national and state levels [11]. The Ministry of Finance and the Social Security Institute finance and allocate resources in Turkey. Insurance companies play a small role in providing health services [12]. In Germany, health insurance is the most important source of healthcare financing [13]. In Japan, one-third of health care costs are covered by general taxes [14]. In Canada, about 70% of health costs are financed by public taxes, and the federal government provides part of the costs and implements public health coverage [15].
Comparing the legal components, in Iran, based on Article 84 of the Fourth Development Plan Law, the government is obliged to take measures in the field of food and nutrition security in the country, providing a suitable food basket and reducing diseases caused by malnutrition and expanding public health in the country. In South Africa, the public healthcare system provides health services with all its weaknesses, poor quality, and poor infrastructure [11]. In Turkey, the Ministry of Health is responsible for implementing care policies, and its supervisory authority is the Social Security Institute [12]. In Germany, health care is provided by a wide range of non-private organizations, and the federal government is responsible for legislating and planning the tasks of these organizations, schools for children with special needs, nursing homes, and youth organizations [13]. In Japan, local governments are important in passing laws and providing social services and urban healthcare. Public health centers also offer services at the provincial level and urban health centers [14]. In Canada, most activities in daily public health and supporting infrastructure are the responsibility of state and regional governments [15].
Comparing the social components, Iran has a population of 82 million people with diverse cultures accepting many immigrants. The population growth rate is high, and the population is aging. In South Africa, racial and geographical differences in access to healthcare services can be seen. There is a lack of access to health systems in poor and marginalized areas, and unfair gender treatment occurs [11]. In Turkey, life expectancy has increased, and the difference in the quality of care and health in the eastern and western regions has decreased compared to the past [12]. In Germany, from a social point of view, the number of nuclear families and the population of elderly people have increased, and the working forces in society have decreased [13]. In Japan, there has been an increase in the number of nuclear families and the elderly population. Following the increase in the elderly population, the existence of geriatric hospitals with limited amenities and the lack of rehabilitation services are some of the social problems in the country [14]. Canada is the second largest country in the world, with a low population density, which is culturally influenced by the United States of America. It has a population with high cultural diversity due to high immigration rates, the unique rights of indigenous peoples, and a significant increase in life expectancy [15].
Comparing the components of policymaking, in Iran, setting the national health policy requires review and, if necessary, changes in the existing health system policies [8], which has led to the approval of the fourth development plan law [16]. In South Africa, in recent years, there have been concerns about the lack of policies and guidelines in the field of rehabilitation. This lack of policy has often caused services in this country to be absent or underdeveloped [11]. In Turkey, the provincial managers of the Ministry of Health implement health policies at the operational level. The Grand National Assembly of Turkey is the highest policymaking body for all sectors, including health [12]. In Germany, policies and decisions are the responsibility of the federal government and the Ministry of Health and Social Security [13]. In Japan, policies in the field of health and rehabilitation are the responsibility of the Ministry of Health and the Ministry of Welfare [14]. The healthcare policies and programs in Canada are strongly influenced by non-governmental organizations such as health service associations and professional organizations such as regulatory organizations, protective associations, trade :union:s, and patient and disease defense associations [15].
Discussion
Comparing the rehabilitation structure in Iran’s health system with other countries regarding organizational components and health management in most countries, including Turkey, South Africa, Germany, and Japan, the Ministry of Health is responsible for health management and health care. In Iran, the Ministry of Health is responsible for health management and health achievement by all members of society. In addition to the Ministry of Health, the Welfare Organization, the Red Crescent, the Martyr and Veterans Foundation, and the Exceptional Education Organization, each has a separate role in rehabilitation management. According to the WHO, developing countries lack a favorable situation in terms of organization and management in the health and rehabilitation system [8, 1]. The case in Iran is the same. More attention is paid to formulating laws and regulations and little attention to how these policies are implemented and the stakeholders in policymaking [8, 17].
In terms of financial components, the findings indicated that the studied countries, through health insurance, public tax, public health insurance coverage, and social security institution, try to provide healthcare costs for society members, especially services for people with disabilities. However, in Iran, a large part of health care and rehabilitation costs are paid directly from the families’ pockets, and financial barriers are one of the significant obstacles to the access of people with disabilities to medical and rehabilitation services. Previous research in Iran also confirmed that financial obstacles could put families in the abyss of back-breaking expenses caused by the occurrence of disease [18, 19, 20]. Currently, the inadequacies of our country’s health system in providing services and financing should be considered. Especially the use of rehabilitation services in the private sector, the high costs of rehabilitation services, and the lack of insurance coverage force people with disabilities to leave the treatment process [8].
The findings confirm that in a country like Germany, financial obstacles and the lack of integration in the referral system can affect vulnerable and low-income groups [14]. For this reason, health services are one of the most important concerns of governments in all low-income or high-income countries [8, 21]. Also, rehabilitation costs can be an obstacle for people with disabilities in high-income and low-income countries, and restrictions on access to health and rehabilitation services lead to restrictions on the participation of these people in society and activities [19].
Regarding legal components, in most countries under review, specific laws and regulations exist for providing services to people with disabilities. Studies have shown that in Iran, very limited measures have been taken to control the quality of health services and the data of the Iranian system, and the implementation of the established laws is not done well. However, several measures in this field have been taken in some countries under investigation [22]. Also, the findings indicated that in Iran, various institutions play a role in the formulation of rehabilitation laws, and also various factors lead to the formation of the rehabilitation system.
Regarding the social component, the findings indicate that most social and cultural factors affecting health in the country are ignored [8, 18]. Abdi et al. listed the social barriers affecting health and rehabilitation, negative social attitudes towards people with disabilities, and ignoring cultural factors among the social obstacles to providing rehabilitation services to people with disabilities in the health system [18]. Kleinitz et al. pointed to social and cultural barriers such as the lack of information on consumers of health and rehabilitation services and negative sociocultural attitudes and beliefs towards people with disabilities [23]. Fisher’s findings showed that providing some training and social resources for the implementation of social policies can affect the level of access of families to the health and rehabilitation services they need [24]. Therefore, preparing preventive measures, education, and social and cultural policies in the country can improve people’s access to health and rehabilitation services.
In terms of policy components, as mentioned, the provision of rehabilitation services in Iran and policies in this field is carried out by several organizations, including the Ministry of Health, the Welfare Organization, and the Red Crescent. The unknown nature of rehabilitation in the country can be caused by the lack of public awareness and service providers and policymakers, which has affected inter-sectoral cooperation and the correct implementation of policies [18]. The results of studies in Germany have shown that correct policymaking and cooperation in the rehabilitation process will improve the condition of people with disabilities [25]. Bailey stated that the existence of deficiencies in local policies towards disability, negative attitudes, and limited understanding of the rights of people with disabilities, not only among families and community members but also among policymakers and local officials, are among the obstacles that must be overcome to facilitate people’s access to appropriate rehabilitation services [26].
Therefore, making changes and improving the rehabilitation structure in the health system is often focused on political decision-making by the executive and legislative branches of the government, and health system reforms usually face difficult political challenges. These reforms and policies do not end only with adopting a plan; whether these reforms are implemented compassionately and correctly or not plays an important role.

Ethical Considerations
Compliance with ethical guidelines
This study followed all the ethical principles of research, including the confidentiality of the information and high-hand documents. It should be noted that this research did not have human participants.

Funding
This article is taken from the PhD thesis of Mozhgan Farhabod in managing healthcare services at the Islamic Azad University of Research and Science Branch.

Authors' contributions
Planning and conceptualization: Mozhgan Farhabod and Irvan Masoudi Asl; Methodology: Mozhgan Farhabod, Irvan Masoudi Asl and Mohammad Kamali; Data collection, validation, analysis, research, draft writing, reviewing, editing, and finalizing the article: All authors.

Conflict of interest
All authors declared no conflict of interest.


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