Strengthening primary care with the world health organization's basic package of interventions for rehabilitation: developing a list of interventions and a clinical resource.

Abstract

Background: Access to rehabilitation, a critical component of universal health coverage (UHC) remains limited, particularly in primary care (PC) and low-resource settings. To address this gap, the WHO Rehabilitation Programme developed the Basic Package of Interventions for Rehabilitation (Basic PIR). This toolkit is designed to empower PC non-rehabilitation workers to deliver a prioritised set of easy, safe and effective rehabilitation interventions through task-sharing. This article describes the participatory process used to develop the WHO's Basic PIR, specifically its list of interventions and guiding clinical resource.

Methods: The development of the Basic PIR utilized a three-phase participatory methodology. In Phase 1, interventions were extracted from the WHO's Package of Interventions for Rehabilitation (PIR) using feasibility criteria and prioritised via a two-stage modified Delphi process with an international Technical Working Group. Phase 2 structured these interventions into clinical targets by adapting existing WHO task-sharing frameworks and clinical practice guidelines. In Phase 3, the prototype resource was field-tested during 5-day training sessions with PC workers in Ghana and Fiji, using qualitative group discussions to evaluate usability and guide final structural revisions. This participatory process was coordinated by a five-member WHO Rehabilitation Programme internal review panel to optimize the tool for PC and low-resource settings.

Results: In Phase 1, thirteen functioning domains related to health conditions were identified, leading to the preselection of 188 out of 297 interventions for rehabilitation from the WHO's Package of Interventions for Rehabilitation, with 71 interventions ultimately included in the Basic PIR. In Phase 2, a prototype clinical resource with eight functioning domains and corresponding intervention targets was created. The preliminary field tests in Phase 3 resulted in specific modifications, including the revision of rehabilitation steps and the development of new patient handouts to improve usability and clarity.

Conclusion: By promoting a functioning-based approach, the Basic PIR aims to improve access to rehabilitation services in primary care and low-resource settings, which has the potential to contribute to the achievement of UHC. Future pilot studies will evaluate its feasibility and acceptability, guiding its broader implementation.