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Hum Resour Health. 2017 Sep 22;15(1):70. doi: 10.1186/s12960-017-0240-1.

A study of human resource competencies required to implement community rehabilitation in less resourced settings.

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Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
Department of Psychology, Maynooth University, John Hume Building, Maynooth University North Campus, Co. Kildare, Ireland.
Faculty of Medicine and Health Sciences, Centre for Rehabilitation Studies, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
Olomouc University Social Health Institute, PalackĂ˝ University, UniverzitnĂ­ 22, 771 11, Olomouc, Czech Republic.
Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
School of Psychology, Massey University, Private Bag 102-904, North Shore, Auckland, 0745, New Zealand.
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England.
School of Nursing, Midwifery, and Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
Department of Health Research, SINTEF Technology and Society, P.O. Box 124 Blindern, NO-0314, Oslo, Norway.
Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
Department of Sociology, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.



It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings.


This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings.


Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning.


This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.


Community-based rehabilitation; Delphi study; Human resources; Low resource settings; Realist synthesis; Rehabilitation

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