Skip to main content
Download PDF

Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review

BMC Public Health volume 24, Article number: 806 (2024) Cite this article

Abstract

Introduction

Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events.

Aims

The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature.

Methodology

A scoping review was conducted using the Arksey and O’Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010–2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks.

Results

The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response plans.

Conclusion

Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of available evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

Peer Review reports

Background

The outcome of conflict and other disasters such as earthquakes or landslides frequently result in traumatic injuries such as fractures, burns, amputations, spinal cord and crush injuries, among others, creating surges in rehabilitation and assistive technology needs [1]. This surge need can quickly overwhelm the health system’s ability to provide rehabilitation, delaying urgent interventions or making accessing services difficult or impossible. [2,3,4]. There can be significant and life changing consequences for those whose rehabilitation needs are unmet or delayed, leaving a legacy of disability for years to come [5,6,7,8].

The World Health Organization (WHO) defines rehabilitation as “A set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment" [9] and considers rehabilitation as a key element of universal health coverage [10] as well as an essential component of emergency response [1, 6]. Further cementing its status as an essential health service, the 2023 landmark World Health Assembly rehabilitation resolution EB152/10 calls for the timely integration of rehabilitation into emergency preparedness and response plans.

The vital role and benefits of rehabilitation are well recognized in global rehabilitation disaster and emergency response guidelines from the highest authorities in health [11,12,13,14]. Early rehabilitation in disaster contexts has been shown to reduce disability and improve quality of life [7, 15, 16]. Longer term, rehabilitation is a wise societal investment, supporting individuals to participate in family life, education, and employment [9].

Conflict and other disasters frequently occur in low- and middle-income countries (LMICs) where existing rehabilitation services may be underdeveloped [3, 17], due to a lack of resources and understanding of rehabilitation and its benefits. Without existing infrastructure and integrated services, these health systems are unlikely to have rehabilitation disaster preparedness frameworks, and therefore are not well positioned to respond to increased rehabilitation demand caused by surge events [18]. In such circumstance, those in need of rehabilitation services often do not receive them, or accessing services is delayed and only available at a time and place that is inadequate to meet the need [19].

The timeliness of delivery, quality and effectiveness of rehabilitation interventions are greatly enhanced when preparedness plans are in place prior to any disaster, to provide a framework for initiating necessary considerations and actions [20, 21]. The United Nations state that “preparedness refers to the knowledge and capacities developed by governments, professional response and recovery organisations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current hazard events or conditions” [22].

Countries such as Iran and Nepal have had disaster rehabilitation frameworks in place before a disaster occurred [8, 23]. However, evidence to evaluate LMICs health system rehabilitation disaster preparedness plans and frameworks to effectively respond to the impact of disasters with rehabilitation is scattered. An overview of the evidence is therefore essential to understand the current situation, learn from experiences, and develop consolidated recommendations that can inform the development of national disaster rehabilitation frameworks. This scoping review attempts to answer the research question of “What can we learn on rehabilitation preparedness and response in health systems in low- and middle-income countries in the context of conflict and disasters?” The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim is to summarize recommendations about rehabilitation and assistive technology service provision in disasters and conflict identified in the gathered literature.

For the purpose of this study, only disasters that may result in trauma were included. Such disasters include earthquakes, tropical storms, tsunamis, volcanic eruptions, fires, explosions, building collapse, floods, conflict, terrorism, and mass casualty incidents. In this study, LMICs are defined according to the World Bank 2022 classification [24].

Methods

A protocol was developed by the research team guiding the literature search, publication selection, information extraction and descriptive synthesis of results. The Arksey and O’Malley framework [25] guided the methodological development. To ensure methodological quality and transparency, the results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist [26]. See Additional file 1: Appendix 1 for details.

Search strategy

For each concept relevant to the research question, a list of search terms was developed (Table 1). The Medical Subject Headings (MeSH) database was utilized to ensure all appropriate search terms were included and, to narrow the search and to improve specificity. Field terms were used when key terms were not included under the MeSH headings. Four bibliographic databases were used as they are among the largest and most authoritative medical journals relevant to rehabilitation: CINHAL, Cochrane, Pubmed and Scopus. See Additional file 2: Appendix 2 for details. A hand search of the reference lists of all eligible studies was completed to identify relevant publications not identified by the database searches.

Table 1 Key concepts and their search terms
Full size table

To consider grey literature such as reports or guidance documents from key stakeholders that have not been published in scientific journals or indeed their websites, 18 rehabilitation lead or focal persons working at key international organisations were contacted by email requesting relevant publications. This was considered an important step by the authors as these organizations are working in the field on the research topic and may provide eligible documents not publicly available. The organisations were: the Christian blind mission, European Physiotherapy Association, Humanity & Inclusion, the International Committee of the Red Cross, Interburns, International Society for Prosthetists and Orthotists, the International Society of Physical and Rehabilitation Medicine, Médecins Sans Frontières, World Physiotherapy, World Federation of Occupational Therapy, and WHO. Rehabilitation lead or focal persons were asked to respond within two weeks, and one reminder email was sent. Additionally, their organisations’ websites were searched for relevant publications.

Eligibility criteria

Eligible articles should fulfil the following inclusion criteria:

  • mention to propose, implement or evaluate the delivery of rehabilitation and/or assistive technology services in disaster or conflict situations.

  • have a health systems perspective.

  • focus on LMICs, as defined by the World Bank [24].

  • be a primary research study, government or organisation policy paper or report.

  • have been published between 2010 and 2022 (2010 was chosen as first year for the eligible period this is when the Haiti earthquake occurred).

  • have been published in English and the full text was available.

Articles were excluded if they:

  • were publications on pandemics, such as COVID-19 and Ebola, as these result in different short and long term rehabilitation needs on a much greater scale and are outside the scope of this review.

  • were publications focusing on international emergency medical teams, military or short-term non-governmental organisations projects as these are not a part of a country’s government financed health system.

  • reported refugee interventions in high-income countries.

  • were publications in non-disaster or non-conflict situations.

  • were a scoping or systematic review, commentary or opinion articles from foreign teams or book chapters and conference presentations.

  • reported only about psychological rehabilitation, as this is specializing on a single in-depth topic beyond our searches scope.

  • emergency preparedness for persons with disabilities, such as preparing for evacuations and medications.

Additionally, methodologically poor studies describing conclusions that cannot be considered reliable, or only mentioning rehabilitation but not giving details, were excluded. Studies reporting prevalence information for health systems, such as prevalence of people requiring rehabilitation following a disaster, were only included if information was collected through a health system relevant survey, such as those conducted by an official body of the health system such as the ministry of health.

Eligibility assessment

The four authors working in the field of policy and research on topic of rehabilitation in health systems were involved in the screening process (JG, RM, ALL, CS). Studies obtained from the database searches were uploaded to EndNote, a reference manager tool, and duplicates were removed. The remaining studies were then uploaded to Rayyan, a literature review platform, [27], for eligibility assessment. JG reviewed the titles and abstracts of all articles against the inclusion criteria twice. A fifth reviewer, blinded to the first author’s decisions, reviewed 20% of the publications which were randomly selected from each year within the search period. A reconciliation meeting was held to discuss disagreements and agree upon the status of those studies with RM as moderator. The full text of the resultant 217 studies was read and assessed for eligibility by JG, and the final 27 included studies agreed upon by all authors.

Data extraction and synthesis of results

The extracted data included study characteristics such as year of publication, disaster event, country, aims, type of study, participants, findings regarding their intervention, activities or observations on rehabilitation and/or assistive technology in disaster preparedness or response, as well as any recommendations the authors made. JG categorized included articles into one of the six WHO rehabilitation health system building blocks [28] based on the studies’ main focus to clearly present the evidence to answer the research question. The six building blocks are: service delivery, health workforce, health information systems, medical products such as assistive products, financing and leadership and governance. ALL reviewed the final categorization decisions, and disagreements were resolved in a reconciliation meeting. It is recognized that the building blocks are interlinked into health systems, and that eligible studies may touch on more than one block [29].

Results

The database searches resulted in 27 studies for anlaysis (Fig. 1). The grey literature search and the contacting of key organisations focal persons yielded zero additional publications. Of the 18 individuals contacted, 7 replied by either sending their organisation’s global guidelines, or by apologizing that their reports were unpublished and for internal use only. Three national Systematic Assessment of Rehabilitation Situation (STARS) reports were identified from the website searches, but these were excluded as they did not provide information on rehabilitation services in conflict or disaster situations.

Fig. 1
figure 1

PRISMA 2018 flow diagram [26]

Full size image

Overview of included studies

The included studies were based on events in 11 countries: 9 from China, 4 from the Philippines, 2 each from Bangladesh, Haiti, India, Iran, and Nepal, and 1 each from Brazil, Nigeria, Pakistan and Turkey. Seventeen of the 27 studies described activities related to earthquakes, 6 were not focused on a specific disaster event, 2 were each related to landslides and typhoons. The majority of the 27 studies were observational studies or case reports, and many collected data years after the event.

When classified according to the six building blocks of health systems, 14 studies focused on service delivery, followed by 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block (Table 2, 3, 4 and 5). No study primary focused on the financing and assistive technology building blocks, however, these topics were mentioned in some of the studies that were categorized in other building blocks.

Table 2 Summary of the service delivery results
Full size table
Table 3 Summary of the workforce results
Full size table
Table 4 Summary of the health information systems results
Full size table
Table 5 Summary of the leadership and governance results
Full size table

Service delivery

Most studies (n = 15) focused on rehabilitation service delivery (Table 2). This is an expected finding, considering that an individual’s rehabilitation need can only be met with direct service provision, and disaster and conflict situations create demand. Of these, 11 studies were based on earthquakes, with 6 of these from earthquake prone China. Nine studies evaluated service delivery and 6 reported the implementation of services. Most studies made recommendations to develop and integrate rehabilitation into emergency preparedness and response.

Mousavi et al. (2019) [53] iterated what other studies included in this scoping review also emphasized, that the delivery of rehabilitation services during disasters is highly dependent on the existing system, and that, in the absence of strong and integrated rehabilitation services within the existing health system, service delivery during disasters will be inadequate. Disasters also add to the existing unmet need for rehabilitation, with studies in the review reporting a large proportion of individuals with pre-disaster need accessing rehabilitation services set up for disaster victims [3, 31].

Taking Iran as an example, Mousavi et al. (2019) [53] reported that a lack of policy guidance, limited decision makers’ limited knowledge of rehabilitation, a lack of an effective responsible rehabilitation body; weak disaster-related competencies; and under-prioritization of rehabilitation by government were the greatest barriers towards developing rehabilitation services.

Describing reasons for a lack of rehabilitation services in disasters, Carvalho et al. (2019) [30] posed that low demand for services can occur, not because the need does not exist, but because they are not accessible and because rehabilitation need can be repressed by competing personal needs, financial constraints to pay for services and transport, and lack of access and knowledge of the rehabilitation services available.

Uddin et al. (2021) [37] suggested that a lack of rehabilitation professionals and disaster specific training were the main barriers to providing rehabilitation services for those with injuries sustained in the 2017 Bangladesh landslide. The authors recommended increasing rehabilitation capacity through task sharing and integrating rehabilitation technical training into the emergency response structure. Supporting this suggestion, Hotz et al. (2012) [35] recommended a train-the-trainer model to expand workforce capacity and capabilities, based on experiences in Haiti after the 2010 earthquake.

Ali et al. (2010) [33], Keshkar et al. (2014) [34], Li et al. (2019) [32], and Mousavi et al. (2019) [39] evidenced the long-term need for assistive technology provision for those injured in earthquakes, and emphasized that AT provision, as part of rehabilitation interventions, are associated with outcomes such as better functioning and greater quality of life. The case report from the Philippines by Ganchoon et al. (2018) [3] demonstrated that rehabilitation services can be effectively delivered within other relief and medical aid missions. Table 6 summarizes the recommendations from studies focusing on service delivery, with the top four most referenced recommendations being: 1) Early multi-professional rehabilitation [3, 32,33,34, 38, 40, 42]; 2) Assistive technology provision [3, 32,33,34, 39]; 3) Community-based rehabilitation provision [3, 38, 40], and; 4) Psychological support [33, 34, 42].

Table 6 Summary of recommendations from the service delivery studies
Full size table

Workforce

Six studies focused on rehabilitation workforce (Table 3) from 6 countries, 1 responding to an earthquake and the others not based on a specific disaster. The included studies demonstrate that the rehabilitation workforce has little experience in disaster preparedness and response. This was reported to be due to a lack of training and awareness of professionals in their role in disaster responders.

Habib et al. (2014) [45] found only three occupational therapists in Bangladesh who had disaster response experience, and these were from national or international non-governmental organizations. From the national occupational therapy professional organizations register, Ching et al. (2019) [43] found only 24 occupational therapists with disaster response experience in the Philippines, who mostly only had experience in providing mental health support to the pediatric population in disasters. These findings by Ching et al. (2019) [43] contradict an earlier policy study by Duque et al. (2013) [52], classified in this review under the leadership and governance category, describing the process and challenges faced to produce the national Philippines disaster preparedness and response plan for occupational therapists. In the aforementioned plan, key recommendations to support workforce development in disaster preparedness and response were made, which, 5 years on, appeared to have been minimally implemented.

The included articles link the lack of rehabilitation workers’ experience in disasters to them having little understanding of the role they can play. In a Nigerian survey, Ojukwu et al. (2019) [7] found that only 68.7% of physiotherapists acknowledged their potential role in disaster management. Conversely, in the only eligible study involving rehabilitation nurses, Kalanlar et al. (2021) [44] surveyed nurses in a single hospital in Turkey and found that most felt they had a role to play in disaster response. However, 72% of the nurses had no experience of disaster work, and 94% felt that they need training in disaster rehabilitation.

He et al. (2011) [46] described the implementation of a program to teach basic rehabilitation skills to rapidly increase rehabilitation capacity for earthquake victims, and advocated for its use in future emergencies. However, the programs outcomes, costs, implementation challenges, and sustainability were not described. Table 7 summarizes recommendations of studies focusing on workforce with the top 3 most referenced recommendations listed foremost: 1) entry level and post graduate practical training to develop disaster management knowledge and skills [7, 43, 44, 46]; 2) professionals and their organisations should be involved in shaping disaster policy and advocacy [7, 45, 47], and 3) creating an awareness of the role of rehabilitation disaster among the public and other healthcare professionals [7, 43, 47].

Table 7 Summary of recommendations from the workforce studies
Full size table

Health information systems

Three studies from 2 countries fulfilled the criteria for the health information systems category (Table 4), all of them relating to earthquakes. The studies provided data demonstrating that disasters can result in significant disability [48], long term need for rehabilitation and assistive technology, and community modifications due to environmental barriers or earthquake damage [49, 50].

However, the quality of the eligable studies design and sampling was poor and as a result, likely underrepresents true prevalence. For example, a poorly described and sampled study by Bimali et al. (2018) [48] excluded people who have difficulties with understanding and communicating, co-morbidities, or preexisting disability. The study by Zhang et al. (2014) [49] collecting data following an earthquake acknowledges that many patients received treatment outside the province, and therefore their data could not be included. Table 8 summarizes the recommendations of studies focusing on health information systems, with the most referenced recommendation being that provision of early and appropriate rehabilitation, which includes psychological support and assistive technology, is essential.

Table 8 Summary of recommendations from the included health information systems studies
Full size table

Leadership and governance

Three policy studies from Iran, Nepal and the Philippines were categorized under leadership and governance (Table 5), all documenting professional organization’s attempts to develop national rehabilitation disaster preparedness plans. These studies suggest that disaster preparedness and response activities are driven from the ‘bottom up’ of a health system in the absence of policy, and indicate a possible lack of awareness of rehabilitation in disasters at national coordination levels.

Ardalan et al. (2016) [51] described the process of developing a comprehensive disaster preparedness plan for rehabilitation in Iran. The authors identified that information sharing, advocacy in the media, workforce education, and availability of funding were the best methods for improving stakeholders’ participation and collaboration in formulating a rehabilitation disaster plan. Inadequate basic services provided by unqualified staff had the greatest negative impact on formulating a rehabilitation disaster response plan. Reflecting on the 2015 earthquake, the Nepal physiotherapy association [8] made recommendations for future disaster response planning. They reflected that the immediate activation of the pre-established rehabilitation subcluster played a key role in coordinating the earthquake response, and also in implementing a long-term rehabilitation strategy that included community services for those in remote locations or who had lost their homes. They emphasized that coordination and strong leadership are essential for effective response, and that professional associations should be consulted. Table 9 summarizes recommendations of studies focusing on leadership and governance with the most referenced recommendations listed being: 1) Advocacy on the role of rehabilitation professionals [8, 51, 52] and 2) rehabilitation professionals and community health workers should be involved in drafting of disaster response plans [8, 51, 52].

Table 9 Summary of recommendations from the leadership and governance results
Full size table

Discussion

This scoping review synthesised the evidence on the preparedness of health systems in LMICs to respond with rehabilitation services and assistive technology to the demand associated with conflict and disasters situations. Additionally, we collated the recommendations identified in the gathered literature. The body of published literature was found to be small with just 27 eligible studies, and their findings demonstrate that integration of rehabilitation in disaster response and preparedness in LMICs is limited across all health systems building blocks. Studies focusing on service delivery were the most cited for all the building blocks, perhaps a result of requests for evaluation and achievement reporting.

Importantly, the results are not indicative of a lack of the need for rehabilitation and assistive technology in disasters, but rather the lack of published literature in English on the topic, or a lack of access to it. It has been suggested that the scarcity of literature highlights the gap between service delivery and evaluation of interventions, and that further research is needed on measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings [54]. The paucity of evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response.

The substantial number of studies (n = 17) published on earthquakes could be due to the large media and political attention earthquakes receive, possibly making them more attractive for researchers and easier to gain funding and support for. Most studies addressed service delivery, what is expected considering that rehabilitation need requests service provision, and disaster and conflict situations create demand. Additionally, our searches indicate that there is a lack of published data collected on the need for rehabilitation in disasters, and consequently, there is a lack of evidence to support investing resources and initiating actions to develop rehabilitation response plans. The four most prominent recommendations were: the provision of early and multi-professional rehabilitation, including assistive technology, psychological support, and integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters, and; the integration of rehabilitation into disaster preparedness and response.

Service delivery

The literature categorised under service delivery stressed the vital role of early rehabilitation and long-term rehabilitation and assistive technology needs for victims, while underlining that emergency provision can only be successfully provided if developed and integrated rehabilitation services already exist in the health system. Furthermore, access to psychological support and community rehabilitation services were recommended areas for development in emergency response. The literature highlighted that underdeveloped rehabilitation services limit effective emergency response, and suggested that the existing unmet rehabilitation need, coupled with the new disaster need and subsequent media and political attention received, could provide a catalyst for the development of sustainable rehabilitation services, if advocacy efforts strong [6].

Workforce

Developing the rehabilitation workforce is fundamental to any disaster response [55]. A significant barrier to providing rehabilitation services in disasters is the lack of rehabilitation professions [7, 56]. This review’s findings agree with the wider body of literature demonstrating poor awareness by professionals of the role they can play in disasters, and a lack of disaster specific training [54]. Rehabilitation 2030 [28] and the Sustainable development goal 3C [57] call for a substantial increase in health financing, recruitment, development, training and retention of the health workforce. More specifically, WHO calls for the expansion of rehabilitation workforce production and the strengthening of regulations and quality assurance mechanisms to upscale accessibility to quality rehabilitation services [58].

Health information systems

The very limited evidence categorised under the health information systems building block is a symptom of the magnitude of challenges faced when attempting to collect quality data in disaster situations, when the focus is on saving lives in chaotic, austere situations [59]. Poor medical record keeping, the lack of assessment tools [54] and evidence on best practice in disaster contexts presents another barrier [60]. The challenge in conducting rigorous trials and collect data in complex and surprise disaster settings cannot be underestimated, and support and resources are needed to facilitate such projects. This may explain why there were no studies found on conflict, where the rehabilitation need is high and safety uncertain [61].

Assistive technology

Our searches found no studies solely focused on assistive technology in disaster contexts, but 7 of the 27 included studies recommended the provision of assistive technology. The absence of focused literature is surprising given the high and growing levels of unmet need for assistive technology during crises [60]. This finding may be due to assistive technology sometimes being an afterthought of rehabilitation and lacking quality and appropriate prescription [62]. Provision of assistive technology in disaster contexts is limited by the lack of guidance on how to identify assistive technology needs in environments with little or no existing systems for provision [60]. However, it is encouraging that evidence of the need and provision of assistive technology in disaster contexts is emerging, and is supported by the United Nations Convention on the Rights of Persons with Disabilities formalizing the legal requirement to provide assistive technology to those who need it [63].

Financing

It was unsurprising that this review found no studies that even mentioned the financing of rehabilitation or assistive technology in disaster contexts. Poor awareness of rehabilitation and assistive technology means that the development of services are rarely a government priority. Too often no coordination mechanisms or responsible officer exist, and consequently financing is limited or absent [64, 65].

Leadership

Finally, the literature presents efforts in Iran, Nepal and the Philippines to create rehabilitation disaster response frameworks. However, the success, acceptability, and viability of progress with implementing these frameworks is yet to be evaluated in subsequent literature.

The secondary aim of the review was to summarize recommendations identified in the gathered literature. Early, multi-professional rehabilitation with assistive technology provision, that expanded into community services and included psychological support for patients were frequently recommended as priority areas for service delivery. Training for rehabilitation professionals to prepare them for disaster work was also highlighted often as a priority need. Strong advocacy efforts to create awareness of the need, the importance of rehabilitation in disasters, and the need of including rehabilitation in health strategy disaster preparedness and response, were consistently recommend across all studies.

In summary, the results from this scoping review suggest initiating actions to develop the following 4 priority areas; the provision of early and multi-professional rehabilitation, including assistive technology, psychological support, and integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters, and; the integration of rehabilitation into disaster preparedness and response. There are several resources [11,12,13,14, 28, 58, 66] and communities such as the WHO World Rehabilitation Alliance available to assist with implementing these recommendations.

Limitations of this review

Relevant studies may have been missed from this review as only studies available in English could be considered, and not all reports are publicly available. In some instances, resources may not be available to publish details on activities. It would have been relevant to include country disaster management plans, but their identification would have been difficult as they would likely not be publicly available or, are published in languages other than English. Where rehabilitation services are yet to be developed within health system, rehabilitation is unlikely to feature in disaster management plans in any case. Another limitation is the exclusion of studies focused only on psychological rehabilitation, an important component of rehabilitation, as this is a highly specialized topic beyond our searches scope. The authors acknowledge that analysis according to categorization under one of the six WHO health system building blocks is imperfect as there will always been some overlap, such is the plexus of health system components. The methodology was chosen as a widely recognized and standardized method for health system analysis. Furthermore, categorizing the eligible studies and their recommendations together eases the readers understanding and aids clarity.

Conclusion

The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs, largely due to low awareness of rehabilitation, undeveloped existing rehabilitation health systems, as well as a lack of rehabilitation professionals, and disaster specific training for them. The lack of evidence demonstrating the rehabilitation and assistive technology need, and effective responses in disasters, is limiting advocacy efforts and the development of services in disasters. Reporting on the need and evaluation of responses to disasters from the field is essential for preparing feasible and meaningful preparedness plans.

Disasters can be an opportunity, even the catalyst, to develop rehabilitation within national health systems, and to integrate rehabilitation into disaster preparedness and emergency response plans. The main recommendations collected in this review suggest priority areas of actions to develop rehabilitation services in disasters.

Availability of data and materials

The datasets used and/or analysed during the current study available in the appendix supplementary file.

References

  1. Mills J-A, Gosney J, Stephenson F, Skelton P, Norton I, Scherrer V, et al. Development and implementation of the World Health Organization emergency medical teams: minimum technical standards and recommendations for rehabilitation. PLOS Currents Disasters. 2018. https://doi.org/10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce.

  2. Khan F, Amatya B, Gosney J, Rathore FA, Burkle FM. Medical Rehabilitation in Natural Disasters: A Review. Arch Phys Med Rehabil. 2015;96(9):1709–27.

    Article  PubMed  Google Scholar 

  3. Ganchoon F, Bugho R, Calina L, Dy R, Gosney J. Philippine academy of rehabilitation medicine emergency basic relief and medical aid mission project (November 2013-february 2014): The role of physiatrists in super typhoon haiyan. Disabil Rehabil. 2018;40(18):2217–25.

    Article  PubMed  Google Scholar 

  4. Awais S, Saeed A. Study of the severity of musculoskeletal injuries and triage during the 2005 Pakistan earthquake. Int Orthop. 2013;37(8):1443–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. WHO. Summary: World report on disability 2011. World Health Organization; 2011. Report No.: 6099570705.

  6. Zhang X, Reinhardt JD, Gosney JE, Li J. The NHV Rehabilitation Services Program Improves Long-Term Physical Functioning in Survivors of the 2008 Sichuan Earthquake: A Longitudinal Quasi Experiment. PLoS ONE. 2013;8(1). https://doi.org/10.1371/journal.pone.0053995.

  7. Ojukwu CP, Eze OG, Uduonu EM, Okemuo AJ, Umunnah JO, Ede SS, et al. Knowledge, practices and perceived barriers of physiotherapists involved in disaster management: A cross-sectional survey of Nigeria-based and trained physiotherapists. Int Health. 2021;13(6):497–503.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Reed D, Shakya NR, Pokhrel S, Sharma S. The Role of Physical Therapists in the Medical Response Team Following a Natural Disaster: Our Experience in Nepal. J Orthop Sports Phys Ther. 2015;45(9):644–6.

    Article  Google Scholar 

  9. WHO. Rehabilitation in health systems. 2017.

    Google Scholar 

  10. WHO. The world health report: health systems financing: the path to universal coverage. 2010.

    Google Scholar 

  11. WHO. Emergency medical teams: minimum technical standards and recommendations for rehabilitation. 2016.

    Google Scholar 

  12. Humanity and Inclusion. Early rehabilitation in conflict and disasters. 2020.

    Google Scholar 

  13. World Physical Therapy. The role of physical therapists in disaster management. 2016.

    Google Scholar 

  14. World Federation of Occupational Therapists. WFOT Disaster Preparedness and Risk Reduction Manual. 2022.

    Google Scholar 

  15. Khan F, Amatya B, Rathore F, Galea M. Medical rehabilitation in natural disasters in the Asia-Pacific region: the way forward. Int J Natural Disaster Health Secur. 2015;2(2):6–12.

    Google Scholar 

  16. Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, Delisa JA. Medical rehabilitation after natural disasters: Why, when, and how? Arch Phys Med Rehabil. 2012;93(10):1875–81.

    Article  PubMed  Google Scholar 

  17. Trivedi NS, Rathod PV. Physiotherapy in disaster management: physiotherapist view. Natl J Integr Res Med. 2017;8(4):32–4.

    Google Scholar 

  18. Gosney JE Jr. Physical medicine and rehabilitation: critical role in disaster response. Disaster Med Public Health Prep. 2010;4:110–2 United States.

    Article  PubMed  Google Scholar 

  19. Gosney J, Reinhardt JD, Haig AJ, Li J. Developing post-disaster physical rehabilitation: role of the World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine. J Rehabil Med. 2011;43(11):965–8.

    Article  PubMed  Google Scholar 

  20. FEM Agency. National disaster recovery framework: strengthening disaster recovery for the nation. Author Washington, DC; 2011.

  21. United Nations Office for Disaster Risk Reduction. The human cost of weather related disasters, 1995–2015. 2015.

  22. United Nations Office for Disaster Risk Reduction. Terminology on Disaster Risk Reduction. 2009.

    Google Scholar 

  23. Ardalan A, Sohrabizadeh S, Latifi MF, Rajaei MH, Asadi A, Mirbeigi S, et al. Responding to physical and psychological health impacts of disasters: case study of the Iranian disaster rehabilitation plan. East Mediterr Health J. 2016;22(3):212–8.

    Article  CAS  PubMed  Google Scholar 

  24. World Bank. Country classification. 2022.

    Google Scholar 

  25. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

    Article  Google Scholar 

  26. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

    Article  PubMed  Google Scholar 

  27. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.

    Article  PubMed  PubMed Central  Google Scholar 

  28. WHO. Rehabilitation in health systems: A guide for action. 2019.

    Google Scholar 

  29. WHO. Systems thinking for health systems strengthening. 2019.

    Google Scholar 

  30. Carvalho ML, Freitas CM, Miranda ES. Physical rehabilitation in the context of a landslide that occurred in Brazil. BMC Public Health. 2019;19(1):1615.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chung EYH. The Outcomes and Impact of a Post-Earthquake Rehabilitation Program in China: A Qualitative Study. Qual Health Res. 2017;27(2):170–81.

    Article  PubMed  Google Scholar 

  32. Li WS, Chan SY, Chau WW, Law SW, Chan KM. Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake. Prosthet Orthot Int. 2019;43(1):104–11.

    Article  PubMed  Google Scholar 

  33. Ali I, Mir Aa Fau - Jabeen R, Jabeen R Fau - Ahmad M, Ahmad M Fau - Fazili A, Fazili A Fau - Kaul R-UR, Kaul Ru Fau - Kumar R, et al. Morbidity pattern and impact of rehabilitative services in Earth quake victims of kashmir, India. 1658.

  34. Keshkar S, Kumar R, Bharti BB. Epidemiology and impact of early rehabilitation of spinal trauma after the 2005 earthquake in Kashmir. India Int Orthop. 2014;38(10):2143–7.

    Article  PubMed  Google Scholar 

  35. Hotz GA, Moyenda ZB, Bitar J, Bitar M, Ford HR, Green BA, et al. Developing a trauma critical care and rehab hospital in Haiti: a year after the earthquake. Am J Disaster Med. 2012;7(4):273–9.

    Article  PubMed  Google Scholar 

  36. Awais SM, Dar UZ, Saeed A. Amputations of limbs during the 2005 earthquake in Pakistan: A firsthand experience of the author. Int Orthop. 2012;36(11):2323–6.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Uddin T, Islam MT, Gosney JE. 2017 Bangladesh landslides: physical rehabilitation perspective. Disabil Rehabil. 2021;43(5):718–25.

    Article  PubMed  Google Scholar 

  38. Zhang X, Hu XR, Reinhardt JD, Zhu HJ, Gosney JE, Liu SG, et al. Functional outcomes and health-related quality of life in fracture victims 27 months after the Sichuan earthquake. J Rehabil Med. 2012;44(3):206–9.

    Article  PubMed  Google Scholar 

  39. Mousavi G, Khorasani-Zavareh D, Ardalan A, Khankeh H, Ostadtaghizadeh A, Kamali M, et al. Continuous post-disaster physical rehabilitation: a qualitative study on barriers and opportunities in Iran. J Injury Viol Res. 2019;11(1):35–44.

    Google Scholar 

  40. Li Y, Reinhardt JD, Gosney JE, Zhang X, Hu X, Chen S, et al. Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake. J Rehabil Med. 2012;44(7):534–40.

    Article  PubMed  Google Scholar 

  41. Benigno MR, Kleinitz P, Calina L, Alcido MR, Gohy B, Hall JL. Responding to the health and rehabilitation needs of people with disabilities post-Haiyan. Western Pac Surveill Response J. 2015;6 Suppl 1(Suppl 1):53–9.

    Article  PubMed  Google Scholar 

  42. Xiao M, Li J, Zhang X, Zhao Ze. Factors affecting functional outcome of Sichuan-earthquake survivors with tibial shaft fractures: a follow-up study. J Rehabil Med (Stiftelsen Rehabiliteringsinformation). 2011;43(6):515–20.

    Article  Google Scholar 

  43. Ching PE, Lazaro RT. Preparation, roles, and responsibilities of Filipino occupational therapists in disaster preparedness, response, and recovery. Disabil Rehabil. 2021;43(9):1333–40.

    Article  PubMed  Google Scholar 

  44. Kalanlar B, Akcay D, Aslan SG. Rehabilitation Nurses’ Opinions on Disaster Rehabilitation Services, Their Training Needs and Perceptions of Preparedness for Disasters. Int J Caring Sci. 2021;14(2):1052–61.

    Google Scholar 

  45. Habib M, Uddin J, Rahman SU, Jahan N, Akter S. Occupational therapy role in disaster management in Bangladesh. WFOT Bulletin. 2013;68(1):33–7.

    Google Scholar 

  46. He HC, Chen P, Liu SX, Lei ZJ, Yang YH, He CQ. The urgent rehabilitation technique education program for Wenchuan earthquake victims. Hong Kong J Emerg Med. 2011;18(5):324–7.

    Article  Google Scholar 

  47. Bessette J, Lapointe AM, Gendron M, Camden C. Physiotherapy in Haiti: A qualitative study exploring local clinicians’ perspectives. Physiother Res Int. 2021;26(2):1–9.

    Article  Google Scholar 

  48. Bimali I, Adhikari SP, Baidya S, Shakya NR. Impairment and functional status of people with disabilities following Nepal earthquake 2015. Kathmandu Univ Med J. 2018;16(64):285–9.

    Google Scholar 

  49. Zhang L, Zhao M, Fu W, Gao X, Shen J, Zhang Z, et al. Epidemiological analysis of trauma patients following the Lushan earthquake. PLoS ONE. 2014;9(5).

  50. Li-Tsang CW, He CQ, Lo AG, Ding SJ, Deng X, Yang YH, et al. Rehabilitation needs of the survivors of the 2013 Ya’an earthquake in China. J Rehabil Med. 2015;47(7):586–92.

    Article  PubMed  Google Scholar 

  51. Ardalan A, Sohrabizadeh S, Latifi MF, Rajaei MH, Asadi A, Mirbeigi S, et al. Responding to physical and psychological health impacts of disasters: case study of the Iranian disaster rehabilitation plan. East Mediterr Health J. 2016;22(3):212–8.

    Article  CAS  PubMed  Google Scholar 

  52. Duque RL, Grecia A, Ching PE. Development of a national occupational therapy disaster preparedness and response plan: the Philippine experience. WFOT Bulletin. 2013;68(1):26–30.

    Google Scholar 

  53. Mousavi G, Ardalan A, Khankeh H, Kamali M, Ostadtaghizadeh A. Physical rehabilitation services in disasters and emergencies: A systematic review. Iran J Public Health. 2019;48(5):808–15.

    PubMed  PubMed Central  Google Scholar 

  54. Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, Marx M, et al. Disability and health-related rehabilitation in international disaster relief. Glob Health Action. 2011;4:7191.

    Article  PubMed  Google Scholar 

  55. Conradie T, Berner K, Louw Q. Rehabilitation workforce descriptors: a scoping review. BMC Health Serv Res. 2022;22(1):1169.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Khan F, Amatya B, Mannan H, Burkle FM Jr, Galea MP. Rehabilitation in Madagascar: Challenges in implementing the World Health Organization Disability Action Plan. J Rehabil Med. 2015;47(8):688–96.

    Article  PubMed  Google Scholar 

  57. WHO. Resolution adopted by the General Assembly on 25 September 2015 [without reference to a Main Committee (A/70/L.1)] 70/1. Transforming our world: the 2030 Agenda for Sustainable Development. 2015.

    Google Scholar 

  58. WHO. Rehabilitation Competency Framework. 2021.

    Google Scholar 

  59. Reinhardt J, Li J, Gosney J, Rathore F, Haig A, Marx M. International society of physical and rehabilitation medicine's sub-committee on rehabilitation disaster relief,disability and health-related reha-bilitation in international disaster relief. Glob Health Action. 2011;4.

  60. Whittaker G, Wood GA, Oggero G, Kett M, Lange K. Meeting AT needs in humanitarian crises: The current state of provision. Assist Technol. 2021;33(sup1):3–16.

    Article  PubMed  Google Scholar 

  61. Gosling J, Golyk V, Mishra S, Skelton P. We must not neglect rehabilitation in Ukraine. EClinicalMedicine. 2022;50.

  62. Maximo T, Clift L. Assessing service delivery systems for assistive technology in Brazil using HEART study quality indicators. Technol Disabil. 2015;27(4):161–70.

    Article  Google Scholar 

  63. UN, Assembly G. Convention on the Rights of Persons with Disabilities, 13 December 2006, A/RES/61/106, Annex I. 2006

  64. Van Niekerk K, Dada S, Tönsing K. Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals. Disabil Rehabil. 2019;41(8):912–25.

    Article  PubMed  Google Scholar 

  65. Nigeria Ministry of Health. The Nigerian health care system: need for integrating adequate medical intelligence and surveillance systems. J Pharm Bio Allied Sci. 2011:470–8. https://doi.org/10.4103/0975-7406.90100.

  66. World Health Organization. Strengthening rehabilitation in health emergency preparedness, readiness, response and resilience: policy brief. 2023.

    Google Scholar 

Download references

Acknowledgements

The authors thank Clara McNaughton for support with eligibility checks and data extraction.

Funding

None from any author.

Author information

Authors and Affiliations

  1. Center for Rehabilitation in Gobal Health Systems, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Justine Gosling, Roxanne Maritz & Carla Sabariego

  2. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden

    Ariane Laplante-Lévesque

  3. Swiss Paraplegic Research, Nottwil, Switzerland

    Carla Sabariego

  4. Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Carla Sabariego

Authors
  1. Justine Gosling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roxanne Maritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ariane Laplante-Lévesque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carla Sabariego
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JG, RM and CS designed the scoping review. JG, RM, ALL and CS wrote and reviewed the manuscript. JG and RM planned the search strategy, eligibility checks, data extraction and data synthesis. ALL reviewed the analysis. JG conducted the search, eligibility checks, data extraction and data synthesis.

Corresponding author

Correspondence to Justine Gosling.

Ethics declarations

Ethics approval and consent to participate

Not Applicable.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1.

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

Additional file 2: Appendix 2.

Bibliographic databases searches.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gosling, J., Maritz, R., Laplante-Lévesque, A. et al. Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review. BMC Public Health 24, 806 (2024). https://doi.org/10.1186/s12889-024-17992-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-17992-2

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us