Powering Universal Health Coverage by Integrating Rehabilitation into Primary Care

Universal Health Coverage (UHC) seeks to ensure that all people can access essential health services without financial hardship, yet rehabilitation remains insufficiently funded and integrated within many health systems. This gap persists despite strong global policy commitments, such as SDG Target 3.8, the Declaration of Astana on Primary Health Care, the Rehabilitation 2030 Initiative, and World Health Assembly Resolution 76.6, all of which affirm rehabilitation as an essential component of people-centered health systems. Rehabilitation is critical for enabling individuals to maintain self-care and independence, participate in society, and achieve meaningful health outcomes across the life course. As populations age and the burden of chronic conditions, injuries, and non-communicable diseases increases, demand for rehabilitation to optimize functioning continues to grow. However, in many settings, rehabilitation services are concentrated in specialized or tertiary facilities, limiting access. Primary care, as the first point of contact and foundation of people-centered health systems, offers a strategic opportunity to address these gaps. Integrating rehabilitation into primary care can support early identification of functional limitations and the optimization of functioning, improve continuity of care, facilitate access to appropriate services, assistive products, and coordinated service delivery close to communities. Strengthening this integration is essential to advancing an inclusive, equitable, and responsive UHC agenda.

Despite rehabilitation being recognized and increasingly recognized as an essential health service, it remains inadequately integrated into primary care, particularly in low- and middle-income countries (LMICs). Often perceived as specialized or optional, rehabilitation is absent from national and sub-national service packages, underfunded, and disconnected from primary care delivery. This results in fragmented care, delayed interventions, preventable declines in functioning, and worsened health and economic outcomes, especially for people living in rural areas, or those with chronic conditions, disabilities, or age-related functional decline. To address these challenges, rehabilitation must be systematically embedded in primary care systems. Integrating rehabilitation into primary care can be achieved by developing national and sub-national strategic plans and policies that explicitly include rehabilitation in UHC benefit packages, strengthening multidisciplinary primary care teams with rehabilitative expertise, integrating rehabilitation into curricula of the health workforce, and expanding training in rehabilitation principles for frontline community health workers. Additionally, implementing strategies for screening for rehabilitation needs, referral pathways, and coordinated rehabilitation care models can strengthen service availability and enhance continuity of care. Health policy and systems research (HPSR) including studies on governance, financing, delivery models, and implementation, is needed to generate evidence and guide the integration of rehabilitation into primary care and for advancing equitable, inclusive, and accessible, people-centered UHC, while also developing and evaluating patient self-care and education tools, decision-support tools for primary care providers, and context-appropriate clinical guidelines and continuing professional development strategies to ensure quality and sustainability at the primary care level.

This Research Topic focuses on advancing UHC by strengthening the integration of rehabilitation into primary care across diverse health system contexts. Contributions are invited that address themes such as policy and practices for embedding rehabilitation within UHC benefit packages; current gaps and challenges regarding primary care rehabilitation services, models of integrated, people-centered rehabilitation in primary and community care; workforce development, task-sharing, education for primary care–based rehabilitation; financing mechanisms; use of digital health and innovation to support service delivery currently and in the future; and strategies to improve equity, access, and quality of rehabilitation services. Submissions exploring implementation challenges and learnings, health system reforms, and outcomes related to functional health and participation are particularly encouraged. We welcome a range of manuscript types, including original research, implementation and health systems studies, policy analyses, systematic and scoping reviews, methods papers, perspectives, case studies and brief reports. Interdisciplinary and context-specific contributions from low-, middle-, and high-income settings are especially encouraged to inform scalable and sustainable approaches to integrating rehabilitation into primary care.