Learning, Acting and Building for Rehabilitation in Health Systems - ReLAB-HS
The need for accessible rehabilitation, including assistive technology (AT), services is urgent and growing. The proportion of the population over 60 will double in the next 30 years, the majority of whom will live with chronic disease. 150 million children and adolescents experience disabilities, increasing with population growth. Injuries are more frequent due to conflict, rapid urbanization and motorization. The enormous unmet rehabilitation needs are concentrated amongst the poorest and most vulnerable populations in low-and middle-income countries (LMICs) and conflict affected settings.
Learning, Acting and Building for Rehabilitation in Health Systems (ReLAB-HS) aims to support development of health systems that are responsive to this escalating challenge by co-designing, and implementing innovative, comprehensive, cost-effective interventions that strengthen health systems for provision of rehabilitation including AT. The program will work across all health system building blocks and levels of care, focusing on a set of priority conditions and how they can be integrated into primary health care (PHC)3 and coordinated with other levels of care.
The ReLAB-HS interventions are comprised of six synergistic work streams:
- Service delivery and workforce: Strengthening rehabilitation in health systems requires building workforce competencies at all levels of care and harnessing benefits of new technologies and service delivery models that allow efficient provision of appropriate rehabilitation, while simultaneously building clinical capacity and planning tools. ReLAB-HS will introduce promising technologies and service delivery models appropriate for LMICs that circumvent persistent barriers to rehabilitation.
- Policy and prioritization: Building and integrating rehabilitation services demands policy and program decision-makers to be equipped with the knowledge, data and tools to drive prioritization and resource allocation based on rehabilitation demand. ReLAB-HS will design policy simulation tools, analyze rehabilitation costing and financing models, and adapt health information systems that facilitate integration of AT-inclusive rehabilitation into all levels of care within health systems.
- Drivers for change to integrate rehabilitation: Strengthening rehabilitation also needs to adapt the drivers of health system change identified in other areas of health, these include leadership development, network building and user (demand side) engagement. Intervention success factors and their impact will be identified to inform decisions about their value in scale up, resource allocation, and sustainability.
- Education for rehabilitation: Learning for rehabilitation will be enabled through a sustainable online platform with quality, evidence-based learning resources. The platform will also provide focus for ReLAB-HS, curate and disseminate information, and host ReLAB-HS's communities of practice (COPs), mentoring and knowledge management and translation.
- Cross-cutting systems research, evaluations & knowledge management: Rigorous evaluation using participatory methods will provide evidence and recommendation to support local decision-making, and build capacity for and applied research, catalyzing engagement with evidence generation, dissemination and uptake.
6.Scale-up and sustainability through accelerator grants: Leadership, evidence generation, capacity building and evaluations will work towards supporting rehabilitation leaders across various rehabilitation service delivery sectors to develop and apply for seed grants, and then to support and learn from their contextually relevant implementation. This will catalyze further scale-up and impact of the approaches developed, refined and implemented in ReLAB-HS.
ReLAB-HS will initially focus efforts in four countries where service delivery models, technology prototypes, clinical guidance, and resources for policy and planning will be implemented and evaluated. All countries will be determined in consultation with USAID. Successful elements of ReLAB-HS interventions will be scaled up to other countries and supported by an Accelerator Grants program. Award criteria will be developed to balance considerations including need, readiness and a diverse mix of recipients.
Our approach is characterised by inclusion of end users, people with rehabilitation needs including persons with disabilities and civilian victims of conflict, as well as stakeholders at all levels of the health system. Founded on principles of implementation and systems science with a person-centered health systems lens, our approach will guide transformation of health systems to embed AT-inclusive rehabilitation, adapt to new challenges, and support scale-up. It will inspire a new generation of rehabilitation leaders through a Leadership Academy and inclusive processes.
Prof Barbara McPake
Dr Sumit Kane
Professor Ajay Mahal
Dr Manjula Marella
Dr Wesley Pryor
Dr Matt Reeve
Dr Alex Robinson
The ReLAB-HS consortium comprises partners with expertise in health systems, implementation science and delivery innovations in rehabilitation in over 70 countries.
Johns Hopkins Bloomberg School of Public Health (JHU)
Humanity and Inclusion
United Cerebral Palsy/Wheels for Humanity (UCPW)
This is a new USAID award of $39.5m over five years, financed through the Leahy War Victims Fund (LWVF).
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