Introduction to WHO’s Basic package of interventions for rehabilitation: A toolkit for primary care professionals
The World Health Organization (WHO) is developing a Basic package of interventions for rehabilitation: A toolkit for primary care professionals that supports existing health workers (those not trained as rehabilitation specialists) to safely and effectively deliver basic rehabilitation care that helps to address critical unmet rehabilitation needs. The toolkit supports doctors and nurses in identifying people with rehabilitation needs, providing basic care, and referring to rehabilitation specialists (rehabilitation-trained therapists and doctors) when necessary and feasible.
Importance of enhancing rehabilitation delivery in China
In China, the demand for rehabilitation services has been steadily increasing due to the country’s ageing population (402 million people projected to be over 60 by 2040) and the prevalence of noncommunicable diseases. However, the availability and accessibility of these services remain limited, especially in rural and underserved areas. Primary care settings, including aged-care facilities, which are expanding across the country, hold immense potential as a service delivery platform for rehabilitation, a need that is currently unmet. Integrating rehabilitation into primary care settings and strengthening referral pathways that connect them with rehabilitation service providers will ensure more people receive the care on time and through a cost-effective approach.
Pilot test of WHO’s Basic package of interventions for rehabilitation: A toolkit for primary care professionals in China
In a significant collaborative effort in May this year, WHO together with Hong Kong Society for Rehabilitation (WHO Collaborating Center), Sun-Yat Sen University (WHO Collaborating Center), Seventh Affiliated Hospital, Tongji Hospital, and Tongji Medical College of Huazhhong University of Science and Technology jointly conducted a 5-day pilot test of the resource among primary care workers with support from rehabilitation specialists in Shenzhen, China. This pilot aimed to evaluate the acceptability, appropriateness, and feasibility of the resource within the primary care services.
Each day of the workshop covered various primary care and rehabilitation topics. From hands-on training sessions to interactive discussions, the participants were actively engaged. The palpable synergy between the primary care workers and rehabilitation specialists set a positive tone for the workshop, reflecting their enthusiasm and commitment. To gather qualitative feedback on the training’s effectiveness, a post-test and structured interviews with participants were undertaken to measure knowledge gains.
A group of participants and trainer performing a demonstration of a rehabilitation intervention, China.
Photo credit: Hong Kong Society for Rehabilitation
Participant engagement and outcomes
The workshop included 18 primary care workers (doctors, nurses, and junior rehabilitation therapists) supported by 10 experienced rehabilitation specialists (occupational and physical therapists and physical rehabilitation medicine doctors). One of the workshop’s highlights was establishing a mentorship programme. Primary care workers were linked to mentors (rehabilitation specialists) based on their local areas, fostering a sense of community and continuous learning.
The feedback from participants was overwhelmingly positive. An impressive 94% of primary care workers and 90% of rehabilitation service providers agreed that the Basic package of interventions for rehabilitation: A toolkit for primary care professionals was acceptable, feasible, and effective. This endorsement underscores the workshop’s success and potential to transform primary care services.
As a result of the workshop, basic rehabilitation care is now being delivered by primary care workers in their respective facilities, with local rehabilitation trained mentors and the WHO rehabilitation team providing remote support via a WeChat platform.
Despite the positive outcomes, participants highlighted the need for policy changes and additional support to sustain the momentum, noting that addressing these challenges is necessary for long-term success.
Participants of the workshop in a classroom, China.
Photo credit: Hong Kong Society for Rehabilitation
The first signs of impact
Uncle Feng
Uncle Feng, 87, a retired auto engineer, lives in Yee Hong Heights (YHH), an older people home. After a COVID-19 hospitalization and a transient ischemic attack, his health declined, causing hand numbness with difficulty making a fist and holding a cane. On discharge from the hospital, Uncle Feng returned to YHH and began rehabilitation.
Jenny, a YHH junior therapist prescribed exercises after the recent training in May: elastic finger exercises and ball pinching. Uncle Feng diligently performs these for 30 minutes daily. He appreciates the simplicity and flexibility of the routine.
After 2 weeks, his finger weakness improved significantly, dropping from 5 to 3 out of 10 on a self-rated assessment. He can now make fists and use this hand more. Uncle Feng finds the exercises accessible to master and follows Jenny’s advice not to overdo them.
Patient doing a rehabilitation exercise, China.
Photo credit: Hong Kong Society for Rehabilitation
The older adults who ate at the same table with him noticed that Uncle Feng’s condition had improved and said it would be great if they also received further rehabilitation. Uncle Feng’s younger brother also had similar problems, so Uncle Feng introduced his younger brother to the rehabilitation exercises. Uncle Feng is very grateful to get rehabilitation.
Bojin and Ling
Bojin, a stroke survivor in Conghua, China, experienced significant improvements in his mobility and independence through the Basic package of interventions for rehabilitation: A toolkit for primary care professionals.
After suffering a stroke 12 years ago that left him with limited mobility on his left side, Bojin relied heavily on his wife Ling for daily tasks. However, BRP trainee Jianting introduced door-to-door rehabilitation services, improving Bojin’s condition. Through daily hand and shoulder exercises and gait training, Bojin saw remarkable progress: his shoulder mobility increased, stiffness decreased, and his walking time to the market reduced from 30 to 20 minutes. This rehabilitation enhanced Bojin’s physical capabilities and rekindled hope for the couple, inspiring dreams of future activities and demonstrating the profound impact of targeted rehabilitation efforts on quality of life.
Patient doing a rehabilitation exercise with the health worker, China.
Photo credit: Hong Kong Society for Rehabilitation
Follow-up actions and conclusion
Mentors will provide continuous support, share valuable resources, and answer questions through the digital platform WeChat, ensuring the trained primary care workers can access rehabilitation specialist advice and guidance whenever needed. In addition, over 3 months, mentors will visit health facilities, assess the needs of primary care workers, and provide practical support. These visits are crucial for identifying specific challenges and offering tailored solutions that improve health care delivery.
Three months after the initial visits, the WHO Rehabilitation team and the Hong Kong Society for Rehabilitation will follow up on the activities of the primary care workers. This follow-up is essential to reviewing progress, addressing ongoing issues, and ensuring that the training and mentoring have a lasting impact.
Patient in a wheelchair doing a rehabilitation exercise with two health workers, China.
Photo credit: Hong Kong Society for Rehabilitation
This initiative’s impact goes beyond one region. Trained primary care workers from other areas are already putting their skills to use, bringing rehabilitation to primary care. Digital mentoring, on-site support, and close follow-up empower these primary care workers for better rehabilitation delivery.
Please visit the webpage to learn more about the Basic package of interventions for rehabilitation: A toolkit for primary care professionals.
link