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SEVENTY-SIXTH WORLD HEALTH ASSEMBLY WHA76.6 Agenda item 13.4 30 May 2023

Strengthening rehabilitation in health systems

The Seventy-sixth World Health Assembly,

Having considered the consolidated report by the Director-General;1

Considering that the need for rehabilitation is increasing due to the epidemiological shift from

communicable to noncommunicable diseases, while taking note of the fact that there are also new

rehabilitation needs emerging from infectious diseases like coronavirus disease (COVID-19);

Considering further that the need for rehabilitation is increasing due to the global demographic

shift towards rapid population ageing accompanied by a rise in physical and mental health challenges,

injuries, in particular road traffic accidents, and comorbidities;

Expressing deep concern that rehabilitation needs are largely unmet globally and that in many

countries more than 50% of people do not receive the rehabilitation services they require;

Recognizing that rehabilitation requires more attention by policy-makers and domestic and

international actors when setting health priorities and allocating resources, including with regard to

research, cooperation and technology transfer on voluntary and mutually agreed terms and in line with

their international obligations;

Deeply concerned that most countries, especially developing countries, are not sufficiently

equipped to respond to the sudden increase in rehabilitation needs created by health emergencies;

Emphasizing that rehabilitation services are key to the achievement of Sustainable Development

Goal 3 (ensure healthy lives and promote well-being for all at all ages), as well as an essential part of

achieving target 3.8 (achieve universal health coverage, including financial risk protection, access to

quality essential health-care services and access to safe, effective, quality and affordable essential

medicines and vaccines for all);

Reaffirming that rehabilitation services contribute to the enjoyment of human rights, such as the

right to the enjoyment of the highest attainable standard of physical and mental health, including sexual

and reproductive health, the right to work and the right to education, among others, and that Member

States’ obligations and commitments in this regard are consistent with the United Nations Convention

on the Rights of Persons with Disabilities;

Noting the Declaration of Astana, which emphasizes that rehabilitation is an essential element of

universal health coverage and an essential health service for primary health care;

1 Document A76/7 Rev.1

WHA76.6

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Recalling resolution WHA54.21 (2001) and the International Classification of Functioning,

Disability and Health, which provides a standard language and a conceptual basis for the definition and

measurement of health, functioning and disability;

Recalling also the role of rehabilitation for effective implementation of: resolution

WHA66.10 (2013), in which the Health Assembly endorsed the global action plan for the prevention

and control of noncommunicable disease 2013–2020; resolution WHA69.3 (2016) on the global strategy

and action plan on ageing and health 2016–2020; resolution WHA71.8 (2018) on improving access to

assistive technology; decision WHA73(33) (2020) on the road map for neglected tropical diseases

2021–2030; resolution WHA74.7 (2021) on strengthening WHO preparedness for and response to health

emergencies; and resolution WHA74.8 (2021) on the highest attainable standard of health for persons

with disabilities;

Recalling further the political declaration of the high-level meeting on universal health

coverage (2019), including the commitment therein to increase access to health services for all persons

with disabilities, remove physical, attitudinal, social, structural, and financial barriers, provide quality

standard of care and scale up efforts for their empowerment and inclusion;

Noting that persons in marginalized or vulnerable situations often lack access to affordable,

quality and appropriate rehabilitation services and to assistive technology, accessible products, services

and environments, which impacts their health, well-being, educational achievement, economic

independence and social participation;

Concerned about the affordability of accessing rehabilitation services, related health products and

assistive technology, and inequitable access to such products within and among Member States, as well

as the financial hardships associated with high prices, which impede progress towards achieving

universal health coverage;

Reaffirming that universal health coverage implies that all people have access, without

discrimination, to nationally determined sets of needed treatment, promotive, preventive, rehabilitative

and palliative essential health services, while recognizing that, for most people, rehabilitation services

and access to rehabilitation-related assistive technology are often an out-of-pocket expense, and

ensuring that users’ access to these services is not restricted by financial hardship or other barriers;

Noting with concern that, in most countries, the current rehabilitation-related workforce is

insufficient in number and quality to serve the needs of the population, and that the shortage of

rehabilitation professionals is higher in low- and middle-income countries and in rural, remote and

hard-to-reach areas;

Stressing that disability-sensitive, quality, basic and continued education and training of health

professionals, including effective communication skills, are crucial to ensure that they have the adequate

professional skills and competencies in their respective roles and functions to provide safe, quality,

accessible and inclusive health services;

Noting that rehabilitation is a set of interventions designed to optimize functioning in individuals

with health conditions or impairments in interaction with their environment and, as such, is an essential

health strategy for achieving universal health coverage, increasing health and well-being, improving

quality of life, delaying the need for long-term care and empowering persons to achieve their full

potential and participate in society;

WHA76.6

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Noting as well that the benefits of improving access to affordable assistive technology, accessible

products, services and infrastructures and rehabilitation include improved health outcomes following a

range of interventions, as well as facilitated participation in education, employment and other social

activities, and significantly reduced health care costs and burden of care providers, and that

telerehabilitation can contribute to the process of rehabilitation;

Further noting that rehabilitation requires a human-centred, goal-oriented and holistic approach,

guiding coordinated cross-governmental mechanisms that integrate measures linked to public health,

education, employment, social services and community development and to work in collaboration with

civil society organizations, representative organizations and other relevant stakeholders;

Recognizing that the provision of timely care for the acutely ill and injured will prevent millions

of deaths and long-term disabilities and contribute to universal health coverage;

Concerned that lack of access to rehabilitation may expose persons with rehabilitation needs to

higher risks of marginalization in society, poverty, vulnerability, complications and comorbidities, and

impact on function, participation and inclusion in society;

Noting with concern that the fragmentation of rehabilitation governance in many countries and

the lack of integration of rehabilitation into health systems and services and along the continuum of care

result in inefficiencies and failure to respond to individual and populations’ needs;

Also noting with concern that the lack of awareness among health care providers of the relevance

of rehabilitation across the life course and for a wide range of health conditions leads to preventable

complications, comorbidities and long-term loss of functioning;

Appreciating the efforts made by Member States, the WHO Secretariat and international partners

in recent years to strengthen rehabilitation in health systems, but mindful of the need for further action;

Deeply concerned that, without concerted action, including through international cooperation, for

strengthening rehabilitation in health systems, rehabilitation needs will continue to go unmet with long-

term consequences for persons and their families, societies and economies;

Noting the Rehabilitation 2030 Initiative, which acknowledges the profound unmet need of

rehabilitation, emphasizes the need for equitable access to quality rehabilitation and identifies priority

actions to strengthen rehabilitation in health systems,

1. URGES Member States:1

(1) to raise awareness of and build national commitment for rehabilitation, including for

assistive technology, and strengthen planning for rehabilitation, including its integration into

national health plans and policies, as appropriate, while promoting interministerial and

intersectoral work and meaningful participation of rehabilitation users, particularly persons with

disabilities, older persons, persons in need of long-term care, community members, and

community-based and civil society organizations at all stages of planning and delivery;

1 And, where applicable, regional economic integration organizations.

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(2) to incorporate appropriate ways to strengthen financing mechanisms for rehabilitation

services and the provision of technical assistance, including by incorporating rehabilitation into

packages of essential care where necessary;

(3) to expand rehabilitation to all levels of health, from primary to tertiary, and to ensure the

availability and affordability of quality and timely rehabilitation services, accessible and usable

for persons with disabilities, and to develop community-based rehabilitation strategies, which will

allow rehabilitation to reach underserved rural, remote and hard-to-reach areas, while

implementing person centred strategies and participatory, specialized and differentiated intensive

rehabilitation services to meet the requirements of persons with complex rehabilitation needs;

(4) to ensure the integrated and coordinated provision of high-quality, affordable, accessible,

gender-sensitive, appropriate and evidence-based interventions for rehabilitation along the

continuum of care, including strengthening referral systems and the adaptation, provision and

servicing of assistive technology related to rehabilitation, including after rehabilitation, and

promoting inclusive, barrier-free environments;

(5) to develop strong multidisciplinary rehabilitation skills suitable to the country context,

including in all relevant health workers; to strengthen capacity for analysis and prognosis of

workforce shortages as well as to promote the development of initial and continuous training for

professionals and staff working in rehabilitation services; and to recognize and respond to

different types of rehabilitation needs, such as needs related to physical, mental, social and

vocational functioning, including the integration of rehabilitation in early training of health

professionals, so that rehabilitation needs can be identified at all levels of care;

(6) to enhance health information systems to collect information relevant to rehabilitation,

including system-level rehabilitation data, and information on functioning, utilizing the

International Classification of Functioning, Disability and Health, ensuring data disaggregation

by sex, age, disability and any other context-relevant factor, and compliance with data protection

legislation, for a robust monitoring of rehabilitation outcomes and coverage;

(7) to promote high-quality rehabilitation research, including health policy and systems

research;

(8) to ensure timely integration of rehabilitation into emergency preparedness and response,

including emergency medical teams;

(9) to urge public and private stakeholders to stimulate investment in the development of

available, affordable and usable assistive technology and support for implementation research and

innovation for efficient delivery and equitable access with a view to maximizing impact and cost

effectiveness;

2. INVITES international organizations and other relevant stakeholders, including

intergovernmental and nongovernmental organizations and organizations of persons with disabilities,

private sector companies and academia:

(1) to support Member States,1 as appropriate, in their national efforts to implement the actions

in the Rehabilitation 2030 Initiative and to strengthen advocacy for rehabilitation, as well as

1 And, where applicable, regional economic integration organizations.

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support and contribute to the WHO-hosted World Rehabilitation Alliance, a multistakeholder

initiative to advocate for health system strengthening for rehabilitation;

(2) to harness and invest in research and innovation in relation to rehabilitation, inclusive of

available, affordable and usable assistive technology, including the development of new

technologies, and support Member States, as appropriate, in collecting health policy and system

research to ensure future evidence-based rehabilitation policies and practices;

3. REQUESTS the Director-General:

(1) to develop, with input from Member States and in collaboration with relevant international

organizations and other stakeholders, and to publish, before the end of 2026, a WHO baseline

report with information on the capacity of Member States to respond to existing and foreseeable

rehabilitation needs;

(2) to develop feasible global health system rehabilitation targets and indicators for effective

coverage of rehabilitation services for 2030, focusing on tracer health conditions, for

consideration by the Seventy-ninth World Health Assembly, through the 158th session of the

Executive Board;

(3) to develop and continuously support the implementation of technical guidance and

resources to provide support to Member States in their national efforts to implement the actions

of the Rehabilitation 2030 Initiative, building on their national situations in access to physical,

mental, social and vocational rehabilitation;

(4) to ensure that there are appropriate resources as regards the institutional capacity of WHO,

at headquarters and at regional and local levels, to support Member States in strengthening and

increasing the variety of available rehabilitation services and access to available, affordable and

usable assistive technology, and to facilitate international collaboration in this regard;

(5) to support Member States to systematically integrate rehabilitation and assistive technology

into their emergency preparedness and response as part of their investment in strengthening their

own emergency medical teams, including by addressing the long-term rehabilitation needs of

those affected by health emergencies, including COVID-19;

(6) to report on progress in the implementation of this resolution to the Health Assembly in

2026, 2028 and 2030.

Ninth plenary meeting, 30 May 2023

A76/VR/9

= = =

Saatja: EURO DAR <[email protected]>

Saadetud: 06.09.2024 15:51

Adressaat: <=?iso-8859-1?Q?Helen_S=F5ber?=>

Koopia: <"Triin Uusberg">; <[email protected]>; <[email protected]>; Kaisa Mitt-

Alvarez <[email protected]>; <[email protected]>; KÖHLER,

Kristina <[email protected]>

Teema: Invite to nominate focal person / WHO consultation for the

selection of rehabilitation indicators for global reporting

Dear National Counterpart,

Please find attached nomination letter for your kind attention, noting

that the deadline for nomination is 30 September 2024.

Thank you and best regards,

Health Workforce and Service Delivery Programme

WHO Regional Office for Europe

Copenhagen, Denmark

Web:

Follow WHO on | | |

UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Denmark

Fax: +45 45 33 70 01 Website: https://www.who.int/europe

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ

Date: 5 September 2024

Ms Helen Sõber

Adviser

European Union Affairs and International Co-operation

Department

Ministry of Social Affairs

Suur-Ameerika 1

10122 Tallinn

Estonia

REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L’EUROPE

REGIONALBÜRO FÜR EUROPA ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО

Head office:

UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01

Email: [email protected] Website: https://www.who.int/europe

Our reference: Notre référence: Unser Zeichen: См. наш номер:

Your reference: Votre référence: Ihr Zeichen: На Ваш номер:

Dear Ms Sõber,

Request for nominating a rehabilitation focal person to participate in a WHO consultation for the

selection of rehabilitation indicators for global reporting

We would like to make reference to the document “Rehabilitation 2030: a call for action” launched by WHO in

2017 to improve governance and investment in rehabilitation, expand high-quality rehabilitation services, and

to enhance data collection in Member States. As stakeholders of rehabilitation move forward with

implementing Rehabilitation 2030 at the country level, the World Health Assembly unanimously endorsed the

Resolution WHA 76.6 ‘Strengthening Rehabilitation in Health Systems’. The resolution requests the Director-

General of WHO ‘to develop, with input from Member States, before the end of 2026, a baseline report with

information on the capacity of Member States to respond to existing and foreseeable rehabilitation needs, and

to report on progress on the implementation of the Resolution to the World Health Assembly in 2026, 2028,

and 2030’.

Following this request, we are pleased to inform you that the Department for NCD, Rehabilitation and

Disability at WHO Headquarters will organize an online global consultation with Member States in November-

December 2024, for the selection of rehabilitation indicators for global reporting. An effort will be made to

align with existing regional frameworks and indicators for rehabilitation. Following this consultation, Member

States will be requested to report on the indicators. A concept note for this activity can be found enclosed.

To participate, we would appreciate if you could kindly nominate a focal person with knowledge in rehabilitation

and who is in a position to collaborate with those responsible at the monitoring and evaluation department of the

Ministry. We look forward to receiving the nomination, giving the name, job title, organization, department and

email addresses, at your earliest convenience and no later than September 30th 2024.

Shirin Kiani, Technical Officer, Rehabilitation, Assistive Technology & Disability Inclusion, is responsible for

this activity and it would be appreciated if you would address your reply to her at [email protected] with

[email protected] in copy.

Sincerely yours,

Dr Natasha Azzopardi Muscat

Director, Division of Country Health Policies and Systems

– 2 –

Encls:

Concept Note

WHA 76

Copy for information to:

Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of

Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia

H.E. Ms Riia Salsa-Audiffren, Ambassador Representative of the Republic of Estonia, Permanent Mission of

the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin

du Petit-Saconnex 28A, CH-1209 Genève, Switzerland

H.E. Mr Andre Pung, Ambassador Extraordinary and Plenipotentiary (agréé), Embassy of the Republic of

Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark

Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia

Global Rehabilitation Indicators

WHO Member States consultation

November-December 2024

Concept note

Background

In 2019, an estimated 2.45 billion individuals were living with a health condition that would benefit

from rehabilitation, contributing to 310 million years of healthy life lost due to disability (YLD). This

number has increased by 63% from 1990 to 20191. At least 1 billion people need assistive products

(AP) and this is expected to increase to 2 billion by 20502. Many people, however, have limited

access to the required rehabilitation services, in particular in low- and middle-income countries3.

In 2017, WHO launched Rehabilitation2030, a call for concerted action to address the profound

unmet need for rehabilitation services. This initiative sets in stone 10 priority domains of action to

strengthen health systems for rehabilitation. It was followed by the endorsement of the World

Health Assembly (WHA) Resolution 76.6 “Strengthening rehabilitation in health systems” in May

2023, which urges countries “to expand rehabilitation to all levels of care, from primary to tertiary,

and to ensure the availability and affordability of quality and timely rehabilitation services”4. The

resolution also requests the Director-General of WHO to develop, with input from Member States,

before the end of 2026, a baseline report with information on the capacity of Member States to

respond to existing and foreseeable rehabilitation needs, to report on progress on the

implementation of the Resolution to the World Health Assembly in 2026, 2028, and 2030. The

resolution also requests the development of a feasible global health system rehabilitation target and

indicator for effective coverage of rehabilitation services for consideration by the 79th World Health

Assembly in 2026.

WHO Global Rehabilitation Indicators

The WHO Rehabilitation Programme, including the 3 levels of the organization, is conducting a

Member State consultation for the development of a list of rehabilitation indicators for global

reporting on rehabilitation, including for assistive products provision. In an effort to maximize

international comparability, this set of rehabilitation indicators will focus on the reporting for core

aspects of health system building blocks.

1 Cieza A, Causey K, Kamenov K, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021: 396(10267):2006-17, doi: http://dx.doi.org/10.1016/S0140 -6736(20)32340-0. 2 https://www.who.int/news-room/fact-sheets/detail/assistive-technology 3 Kamenov K, Mills JA, Chatterji S, et al. Needs and unmet needs for rehabilitation services: a scoping review. Disabil Rehabil. 2019;41(10):1227-37. 4 https://www.who.int/news/item/27-05-2023-landmark-resolution-on-strengthening-rehabilitation-in-health- systems

It is envisioned to use the indicators as a basis for developing the WHO global baseline report

requested by WHA Resolution 76.6 and for reporting on the implementation of the Resolution.

Methodology

Member States, through their corresponding WHO regional and country offices, are invited to

participate in a virtual consultation (see below). Ministries of Health are recommended to nominate

a focal person with knowledge in rehabilitation and who is in a position to collaborate with those

responsible at the monitoring and evaluation department of the Ministry.

For the indicators selection process, a document presenting a draft list of indicators for

consideration by Member States will be shared well in advance to the consultation. It will be used to

select the final set of rehabilitation indicators for global reporting that is shared and agreed upon by

Member States across WHO regions.

The consultation will consist of 3 steps with the following objectives respectively:

1/ online meeting to present and discuss the process of selecting Global Rehabilitation Indicators

and reporting mechanism: presentations by WHO outlining the proposed indicators, data sources

and reporting, including timelines, and selection process.

2/ online survey to develop a preliminary list of Global Rehabilitation Indicators that is shared across

WHO regions.

3/ online meeting to consolidate the list of Global Rehabilitation Indicators: presentations by WHO

outlining the survey results and a proposed final indicator list, followed by a plenary discussion.

Objectives

1. To obtain feedback on the proposed rehabilitation indicators for regional/global reporting

2. To select and consolidate a set of Global Rehabilitation Indicators

3. To explain and learn about country requirements for data collection and reporting

Dates and consultation format

Representatives of Ministries of Health for rehabilitation, including assistive product provision, will

be asked to attend 2 virtual meetings (each of approximately 2 hours duration) and complete 1

online survey in between. It is expected that these meetings will be held in November-December

2024.

Working language

The document containing a draft list of indicators will be translated in all UN languages. Meetings will

be in English. However, interpreters will be available for translation in the other UN languages.