Responding to the growing need for rehabilitation around the world, particularly in countries torn apart by conflict, is not without its challenges. However, there are also considerable opportunities. These include developing innovative, cost-effective service delivery models at the primary care level; exploring the potential of new information technology; and investing in local infrastructure. Through this approach, ReLAB-HS will expand access to quality rehabilitation services in the community and home setting – improving health, restoring people’s independence and enhancing quality of life.
Our holistic program combines a number of complementary initiatives at various levels, within different sectors. We will continuously evaluate, refine and adapt solutions, and scale up successful interventions.
Capacity building is the cornerstone of ReLAB-HS. Given the urgent need for rehabilitation professionals, we will develop health workers’ skills so that they can provide quality rehabilitation and assistive technology (AT) services across the lifespan. In addition, ReLAB-HS will foster political commitment to rehabilitation, building the capacity of decision-makers and strengthening governance. This will help ensure that rehabilitation is prioritized, sufficient resources are allocated, and services are integrated into the health system. We will also inspire local leadership to promote ownership and sustainability.
Generating evidence and sharing learning are at the heart of ReLAB-HS. We will increase access to rehabilitation knowledge and boost research capacity.
Rehabilitation services are often established after conflicts to help address the needs of survivors. In some countries, this leaves a legacy of quality services but there are limitations in how those benefits can be integrated into health systems as they develop. ReLAB-HS will explore how conflict legacies has influenced the emergence of rehabilitation and how that affects access to comprehensive services for all.
Our approach is person-centered and participatory. ReLAB-HS will engage users, healthcare providers and decision-makers in the program. To address marginalization and discrimination it is vital to consider the overlapping factors that fuel vulnerability, such as gender, caste/ethnicity, race, wealth, disability, age and education. That’s why gender equality and social inclusion (GESI) is a cross-cutting theme in our work. We will involve vulnerable groups, including women and girls, in program design, delivery and monitoring. Through this inclusive approach, Re-LAB-HS seeks to redress unequal power relations and promote equal rights, opportunities and respect for all.
The time is right to examine how to deliver emerging commitments and address the gap between current need and current availability. Our approach includes the right mix of actions to help learn the most effective solutions to address the gaps and explore the most effective solutions to better integrate rehabilitation into health systems. This builds on decades of effort among the global community that has created the conditions for our work.
Our approach emphasizes continuous learning. The fifth workstream focuses on applied research, which will be used to refine proposed activities and evaluate outcomes and impact. Knowledge management is a cross-cutting theme in the entire program.
Many activities will be supported through innovative digital platforms that will share information, evidence and research findings; improve rehabilitation service delivery; and develop the health workforce. These platforms comprise telerehabilitation, the eLearning portal, knowledge hub, communities of practice, mentoring and a single ‘store’ for resources. We aim to increase diversity, equity and inclusion by involving contributors from diverse settings in developing the portals.
This phase of the program encompasses the first four workstreams:
ReLAB-HS will develop clinical guidance, including digital tools, resources and online training modules, to increase the capacity, skills and knowledge of doctors, nurses and community health workers to deliver rehabilitation in primary care settings. To ensure that the resources respond to local needs, stakeholders will be consulted, such as rehabilitation clinicians and researchers, end-users, caregivers for people with disabilities, decision-makers and program planners.
We will harness promising technology and service delivery models, refining and adapting existing telerehabilitation and mHealth innovations to suit local contexts. Our approach is aimed at bringing rehabilitation services to where people live, rather than waiting for them to come to specialized health centers.
ReLAB-HS will also streamline the procurement and distribution of Assistive Technology (AT) services, especially wheelchairs, at the primary care level. This may entail contracting NGOs and private AT providers.
Historically, rehabilitation has been a low priority for many governments in resource-limited countries. Knowledge and data are essential to help policymakers reach informed decisions about resource allocation, based on current demand, and formulate effective policy. ReLAB-HS will therefore develop accessible tools, including a new policy simulation tool.
We will carry out costing studies, which will be used to monitor return on investments and ensure resource mobilization for rehabilitation. Analyzing financing mechanisms for rehabilitation is important to foster sustainability and scale-up of rehabilitation services and AT. Monitoring the performance of rehabilitation and AT will not only inform planning, but also promote accountability of authorities and healthcare providers to the people who use the services. This should lead to improved quality and greater ownership.
ReLAB-HS will also strengthen the health information system, generating data to shape decisions about resource allocation.
To drive far-reaching change, the conditions must be created to strengthen and integrate rehabilitation into the health system. ReLAB-HS will identify key factors for success to inform decisions about scale-up, resource allocation and sustainability.
Strong leadership is essential. Accordingly, ReLAB-HS will launch a Leadership Academy to increase knowledge and nurture champions within the government, health workforce and user groups – inspiring a new generation of rehabilitation leaders. The academy will link leaders with frontline health workers, boost leadership skills and create mentoring opportunities for providers at the community and primary care level.
ReLAB-HS will enhance the capacity of users and user groups to engage in rehabilitation and AT service planning, delivery and monitoring. This will shape health systems that truly respond to people’s needs for rehabilitation and AT.
We will also build formal and informal networks of rehabilitation stakeholders, including organizations working with people with disabilities and professional associations. Networks with shared interests and agendas will be supported to work together in advocating for evidence to be translated into practice.
To support national and local workforce development initiatives, equitable open access to education and learning will be facilitated through a toolkit hosted on a sustainable online platform that provides quality, evidence-based resources. Key elements include:
The last phase of the program will focus on building outputs and outcomes to create lasting impact. This entails reinforcing the conditions needed for strong health systems that integrate rehabilitation and AT across all levels of care, enabling vulnerable people in low-income countries to reach their full potential. Key outputs include increased availability of rehabilitation services, greater demand from healthcare providers and users, and strengthened capacity (technical, policy and research). Informed, empowered leaders and users; better access to evidence, knowledge, tools and guidance; combined with active networks are all essential to bring about far-reaching change.
Successful elements of ReLAB-HS interventions will be scaled up to other countries and supported by Accelerator Grants. These seed grants will focus on strengthening and integrating service models, technology prototypes, clinical guidance and resources for policy and planning across various contexts in which consortium partners have established relationships.
The aim of the Accelerator Grants is to develop local capacity, provide mentorship to local stakeholders and leaders in the field, and pilot activities for regional and global exchange and scale-up. Award criteria will be developed to balance various considerations, including need, readiness and a diverse range of recipients. Details around process and eligibility will be determined during the inception phase of the program.