Rehabilitation workforce 2, cont’d.

Background and objective
The need for rehabilitation is growing due to health and demographic trends, especially the rise of non-communicable diseases and the rapid ageing of the global population. However, the extent to which rehabilitation is integrated into health systems is mostly unclear. Our objective is to describe and compare the nature and extent of integration of rehabilitation within health systems across nine middle-income countries using available Systematic Assessment of Rehabilitation Situation (STARS) reports.
Methods
Cross-country comparative study with variable-oriented design using available rehabilitation health system assessment reports from nine middle income countries.
Findings
The integration of rehabilitation into health systems is limited across countries. Governance and financing for rehabilitation are mostly established within health ministries but weakly so, while health information systems are characterized by no available data or data that is insufficient or not routinely generated. The overall numbers of rehabilitation workforce per capita are low, with frequent reports of workforce challenges. In most countries the availability of longer-stay, high-intensity rehabilitation is extremely low, the availability of rehabilitation in tertiary hospitals is modest and in government supported primary care its almost non-existent. Multiple concerns about rehabilitation quality arose but the lack of empirical data hinders formal appraisal.
Conclusion
The study sheds light on the limited integration of rehabilitation in health systems and common areas of difficulty and challenge across nine middle income countries. All countries were found to have a basis on which to strengthen rehabilitation and there were often multiple areas within each health system building block that required action in order to improve the situation. Findings can inform governments, regional and global agencies to support future efforts to strengthen rehabilitation. Additionally, our study demonstrates the value of STARS reports for health policy and systems research and can serve as a model for further comparative studies.

研究背景与研究目的
随着健康与人口结构变迁，尤其是非传染性疾病负担的上升以及全球人口的快速老龄化，康复医疗的需求日益增长。然而，康复医疗融入卫生系统的程度在很大程度上尚不明确。本研究旨在利用已发布的《康复状况系统评估报告》（Systematic Assessment of Rehabilitation Situation, STARS），描述并对比9个中等收入国家的卫生系统中康复医疗的融入性质与程度。

研究方法
本研究采用变量导向设计的跨国比较研究，使用来自9个中等收入国家的现有康复医疗卫生系统评估报告开展分析。

研究结果
各国康复医疗融入卫生系统的程度普遍有限。康复医疗的治理与筹资工作大多依托卫生部门开展，但落实力度薄弱；卫生信息系统普遍缺乏可用数据，或数据不足、未实现常规化采集。人均康复医疗从业人员总量偏低，且频繁出现从业人员相关的各类难题。在多数国家，长期住院、高强度康复服务的可及性极低，三级医院的康复医疗服务可及性尚可，但在政府支持的基层医疗卫生机构中，康复服务几乎空白。研究发现了诸多康复医疗质量相关的问题，但由于缺乏实证数据，无法开展正式的评估。

研究结论
本研究阐明了9个中等收入国家的卫生系统中康复医疗融入程度有限的现状，以及各国普遍存在的困难与挑战。所有受访国家均具备强化康复医疗体系的基础条件，且每个卫生系统板块中往往存在多个亟需改进的领域。本研究结果可为各国政府、区域及全球机构提供决策参考，助力未来强化康复医疗体系的相关工作。此外，本研究验证了STARS报告在卫生政策与系统研究中的应用价值，可为后续同类跨国比较研究提供参考范式。