Prioritizing rehabilitation in Pakistan’s health system: a qualitative policy analysis

Rehabilitation, is a neglected domain in Pakistan’s health system. There are insufficient financial and human resources to address the unmet needs. Despite the increasing demand for rehabilitation and assistive technology (AT) and implications for improving health inequities, it receives little political attention. This analysis identifies the factors that shape the prioritization of rehabilitation in Pakistan’s national health system. We conducted 29 key informant interviews with actors concerned with rehabilitation policy and practice in Pakistan, complemented by a purposeful review of peer-reviewed and grey literature to achieve thematic saturation. The data was triangulated and thematically analyzed using a policy framework on national prioritization of rehabilitation services. Based on the framework, we identified three key elements that shape the inadequate prioritization of rehabilitation in Pakistan. First, rehabilitation lacks a consistent problem definition; there is a lack of consensus among key actors regarding the importance and need for rehabilitation and AT in the health system. Second, governance arrangements are fragmented across multiple ministries, with rehabilitation services often being associated with disability and included under the Social Welfare Department, rather than the Ministry of National Health Services, Regulations, and Coordination (MoNHSRC). Third, with respect to structural factors, scarcity of resources in the existing health system, societal stigmas and social inequalities have negatively shaped the abilities of both rehabilitation service seekers and providers. Identifying the key components impeding prioritization for rehabilitation in Pakistan’s health system is a crucial first step in advancing the issue within sub-national and national policy agendas and improving equity in access to rehabilitation services. Rehabilitation professionals and other actors responsible for rehabilitation policy and practice should systematically work together to prioritize and integrate rehabilitation services within the current health system structures to advance health equity, enabling all individuals to lead fulfilling lives, regardless of their background or circumstances.