Table 3 The reviewed rehabilitation workforce literature integrated into SWOT analysis framework

Strengths

• Unmet needs for rehabilitation workers are broadly identified: e.g. more in low-income countries and in rural regions elsewhere.

• Already existing initiatives report promoting culturally competent rehabilitation, such as for aboriginal communities in Oceana and rural communities in sub-Saharan Africa.

• Existence of long-distance education and international clinical education/service placements, inclusively from higher to lower income countries.

• Existing knowledge of initiatives and factors that influence/improve the recruitment and retention of rehabilitation health workers in rural or remote areas of some high-income countries.

Weaknesses

• No agreed strategy to determine rehabilitation supply requirements.

• Under-development of information systems for monitoring supply.

• Absence of professional registration/licensing/regulation for rehabilitation workers in many countries.

• Lack of a uniform classification for different rehabilitation competencies, practices and credentials.

• Lack of training programs for educating qualified rehabilitation workers in low-income countries.

• International migration seems to aggravate global inequalities, but it has been scarcely studied.

• Lack of physically accessible sites, inadequate equipment, lack of transportation and lack of capacity of people with disabilities to afford rehabilitation services impede access.

• Existing barriers (e.g. legal, lack of funding or stakeholders’ awareness) that prevent access to rehabilitation care.

• Coverage gaps typically affect more the socially vulnerable people with disabilities (under/uninsured, resource-poorest, belonging to disadvantaged race/ethnic groups, living in rural or remote areas).

• Rehabilitation services delivered outside hospitals are typically less funded, less attractive to rehabilitation workers and thereby less accessible to people with disabilities.

Opportunities

• Possibilities for a global scaling-up of some initiatives that aim to supply underserved areas with needed rehabilitation workers.

• Locally tailored policy solutions and innovative service delivery models are increasingly used and tested to enhance access to rehabilitation in underserved areas.

• Possible solutions to undersupply and inadequate skill-mix (e.g. shifting and sharing of competencies across rehabilitation workers and other health providers).

• The study and development of the rehabilitation workforce can benefit from, and be integrated within, the recent advances in the field of Human Resources for Health toward universal health coverage.

Threats

• Complexity and heterogeneity on the composition of the rehabilitation workforce.

• Variability of competencies and scope of practice within the same professional label across countries and some within the same country.

• Oversimplification: e.g. studying, monitoring and developing specific professions, nationally and internationally, instead of a whole rehabilitation workforce—including how this is distributed by regions, sectors, service-levels, etc.

• Low priority in the health agenda.