Joint Statement “What about rehabilitation? Indispensable in the pursuit of universal health coverage!”

On the occasion of the International Day for Universal Health Coverage (UHC), on 12th December, the The Global Rehabilitation Alliance (GRA) and its affiliated PRM organizations have called for the attention of health stakeholders around this important principle.

The advocacy narrative makes strong linkages between rehabilitation and UHC: we call for rehabilitation to be affordable, accessible, available, and quality; for this, rehabilitation needs to be integrated into health systems and included in financially-covered packages of care.

ISPRM has contributed to the Joint Statement “What about rehabilitation? Indispensable in the pursuit of universal health coverage!”:

Rehabilitation is the core health strategy that optimizes the individual’s functioning. Everyone needs rehabilitation services or assistive technologies at some point in their life, due to congenital disorders at very young age, chronic diseases, injuries or trauma, or due to health conditions related to ageing – that can limit the capacity to function in everyday life. Recently, rehabilitation has also proved to be a crucial health measure for COVID-19 patients in the acute, sub-acute and long-term phases, shortening the duration of hospitalization, relieving pressure on acute care and facilitating recovery.

Today 2.4 billion people of all ages are in need of rehabilitation services, encompassing assistive technologies and a wide range of interventions (exercises, training, education, support and counselling, and adaptation of the environment) offered by rehabilitation professionals in diverse rehabilitation settings like homes, communities, hospitals, and rehabilitation centers. Yet, there is a significant unmet need for rehabilitation across all world regions. In low and middle-income countries more than 50% of people who require rehabilitation services do not receive them.

An ageing population, increasing prevalence of non-communicable diseases, and injuries have generated and will continue generating higher demand for rehabilitation services and assistive technologies. Current health trends show that we live longer, but with more limitations in functioning. According to the recent paper published in the Lancet “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019”, the number of persons who would benefit from rehabilitation had increased by 63% from 1990 to 2019. Although rehabilitation is crucial to respond to the health challenges of the 21st century, health systems worldwide are still focused on reducing mortality and morbidity; functioning often remains a neglected aspect of health care.

Rehabilitation, together with promotion, prevention, treatment, and palliative care, is an essential part of Universal Health Coverage – as set in the Declaration of Astana on Primary Health Care (2018) and in the UN Political Declaration on UHC (2019). Therefore, all individuals, in all communities, should be able to receive rehabilitation care, without suffering financial hardship.

However, this is far from being reality: in particular in low-income countries, rehabilitation services are often low-quality, under-resourced, and undeveloped. Their financial coverage is highly variable, absent or often provided by non-governmental organisations. Access to rehabilitation is in general limited because it is unavailable and, if available, it’s unaffordable for the most marginalized populations. Persons with disabilities needing rehabilitation services and assistive technologies face additional and significant barriers to access them, because of stigma and discrimination, inaccessible information and infrastructures, and because they are more likely to live in poverty. These barriers hinder the realization of Art. 26 of the Convention on the Rights of Persons with Disabilities.

Being ten years away from the deadline of Sustainable Development Goals target 3.8 – which sets to achieve Universal Health Coverage by 2030 – and as the world struggles to respond and recovery from the COVID-19 pandemic, we urge governments to:
● Re-orient health decision-making in order to respond not only to the imperative of reducing mortality and morbidity, but also to the increasing population’s needs in terms of daily functioning, participation, well-being and quality of life.
● Include rehabilitation services and technologies in financial risk protection mechanisms, with the objective of achieving universal health coverage. Recognising that many countries are operating in a limited fiscal space, the coverage of rehabilitation services and assistive technologies should start from high-priority interventions, expand to an essential package, and grow over time as resources become available.
● Integrate rehabilitation at all levels of the health system, from community to primary health care, to hospitals and specialized care, and from neonatology to geriatrics. This requires allocating adequate resources for the provision of rehabilitation services and establishing production lines for a comprehensive range of essential assistive technologies for all ages, types and levels of disorders and disabilities.
● Recognize, strengthen and train rehabilitation workforce, and prepare other health professionals to detect and refer persons in need of rehabilitation.
● Provide financial and technical support, through international cooperation and multilateral initiatives, with a view to strengthen the provision and improve access to rehabilitation services and assistive technologies, in particular in low and middle income countries.
● Champion or support a World Health Assembly’s Resolution on Rehabilitation for All, which would provide the political framework for stronger commitments and wider health coverage, catalyse resources for this sector, and give additional impetus to the WHO’s Rehabilitation 2030 initiative.

We remain ready and committed to collaborate with governments, health providers, the World Health Organization, technical and financial partners to improve access to quality rehabilitation services and devices for everyone in need, everywhere, but in particular in low- and middle-income countries.

The Global Rehabilitation Alliance
With the contribution and endorsement of its members, in particular: Humanity & Inclusion, Liliane Foundation, Light for the World, World Federation of Occupational Therapists, World Physiotherapy, and the International Society of Physical and Rehabilitation Medicine.

Read full statement HERE: http://www.isprm.org/wp-content/uploads/2021/04/Joint-Position-Statement-UHC-GRA.pdf