Table 2 Rehabilitation workforce recommendations and their article evidence and Delphi consensus

 Within the delivery of rehabilitation services, there should be the designation of a specific rehabilitation coordinator/focal person who oversees the process.

[83]; [61]; [79]; [62]; [60]

 Multidisciplinary supervision should be available to support the implementation of rehabilitation practices at all levels.

[71, 75]; [60]; [80]; [65]; [66]

 All cadres of rehabilitation workers should receive specific training on advocacy and empowerment and be able to undertake endeavours that promote these within their communities to complement the work of disabled people's organisations (DPOs).

[56, 67, 69, 81, 87]; [57]; [61]; [78]; [74]; [79]; [64]; [62]

 Experience and educational requirements for rehabilitation workers will be set depending on context and cadre; however, all workers, especially those at the community level, should have: strong social skills, sensitivity to others’ views and a commitment to working with persons with disabilities.

[87]; [81]

 Rehabilitation services (including the additional training and supervision specific to rehabilitation), should be incorporated into all generic community health workers’ current service provision role.

[75]

 Community-based rehabilitation workers should be multi-skilled and supported to take a holistic problem-based approach, with appropriate referral mechanisms to other more specialised service providers.

[78]; [56]; [62]; [72]

 In some situations, a community rehabilitation cadre should be trained with a broad range of generic rehabilitation skills (rehabilitation skills that are applicable to a large number of service users) and comprehensive knowledge on disability.

[56, 67, 69]; [63]

 In some situations, a community rehabilitation cadre should be trained with specialised context specific rehabilitation skills.

[77]

 In some situations, a community rehabilitation cadre should be trained with generic rehabilitation skills (rehabilitation skills that are applicable to a large number of service users) as well as one specialised area of rehabilitation.

[87]

 Persons with disabilities (including different types of disabilities) should be encouraged and supported to train as rehabilitation workers so that the service reflects the communities they serve.

[69]; [85]

 Different workforce mixes are going to be required in different contexts, and service providers should be open to a combination of: specialists, generic community rehabilitation cadres, and a cadre combining some specialist and some generic skills.

[87]; [57]

 While generic community health workers should be aware of the rehabilitation needs of persons with disabilities and be able to make appropriate referrals, it is not realistic to expect them to provide these services in addition to their current service provision role.

 Community-based rehabilitation workers are an effective means of identifying and targeting persons with disabilities.

[67, 77]; [72]; [78]; [60]; [87]; [76]; [74]

 With appropriate training and availability of referral supports, community-based rehabilitation workers can provide services to persons with both physical and mental disabilities.

[75, 77]; [69]; [72]; [64]

 Clear job descriptions and expectations for all rehabilitation cadres should be developed collaboratively with the workforce, managers/implementers and government bodies.

[62]; [67]; [87]

 Training of the rehabilitation workforce should involve persons with disabilities (including different types of disabilities), in the planning and delivery of the training courses.

[69]; [72]; [70]

 Training of rehabilitation workers should use a context sensitive, rights-based approach and encourage problem-based learning and discussions.

[62]; [56]; [87]; [82]

 Supervision of the rehabilitation workforce should be supportive and involve frequent practice observation and meetings that adopt collaborative problem-solving approaches.

[71, 75, 83]; [60]; [65]

 The self-efficacy of rehabilitation workers, specifically those in lower level cadres, is important for job commitment, satisfaction and subsequently retention and motivation of workers.

[75, 83]; [60]; [59]; [80]; [58]; [66]

 Community rehabilitation workers require respect and recognition as professionals, which includes certification and acknowledgement of their decision-making abilities, opportunities for further training and career advancement and where feasible, should be financially compensated for their work.

[83]; [80]; [58]

 The area of rehabilitation is a delicate and stressful area and requires self-awareness on the part of the health worker and requires the provision of time and spaces for consistent reflection and supportive debriefing for healthcare workers.

[85]

 The rehabilitation workforce should be structured through an integrated tiered system, from community work to facility-based services with appropriate supervision at each level.

[75]; [80]; [61]; [72]; [79]; [85]; [86]; [64]

 Community rehabilitation services can be effectively provided by shifting some rehabilitation tasks from conventionally trained rehabilitation professionals to cadres with a shorter length of training.

[68, 69, 79]; [72]; [77]; [87]; [60, 64]; [66]

 Transport, compensation, and material resources should be targeted in order to provide a working environment that will be able to retain rehabilitation workers.

[62]; [60]; [81, 83]; [66]

 Persons with disabilities should be involved in the selection of community-based rehabilitation workers.

[69]; [72]

 Where a generic community health workforce exists, they should be trained in disability identification and awareness, rehabilitation referral, and basic service provision for persons with disabilities.

[75]; [76];

[73]; [78]; [74]; [70]; [64]

 Community based workers should have a minimum generalist skill-set with specialised services being offered at the facility-based level.

[68]; [61]

 All rehabilitation workers should be trained on case management, social protection, the CBR Matrix, monitoring and record-keeping.

[81]; [78, 82]; [62]; [79]; [86, 88]

 All rehabilitation health workers should be trained on the CBR Matrix and the contextual challenges and practical opportunities for applying it in their area.

[56, 69]; [68]; [84]; [66]; [73]

 As rehabilitation workers often emotionally support persons with disabilities and their families, they should have basic counselling skills and an understanding of appropriate referral pathways and of their limits and when to refer.

[68]; [72]; [85]

 Supervisors should be equally competent in the process skills of supervision and the technical skills of rehabilitation interventions.

[87]; [71]; [59]

 The rehabilitation workforce configuration should be guided by community needs assessments targeting the characteristics of the workforce that will make it more acceptable and accessible to persons with disabilities and their families.

[56, 67, 69, 71, 77]; [75]; [82]; [79]

 Community-based rehabilitation services should be accountable to the communities in which they work and these communities should have mechanisms to contribute feedback regarding the services they receive.

[56, 71]; [58]; [72]; [65]; [88]