Development of an entry-level physiotherapy program in a low-resource setting: an innovative model in Tajikistan

Tajikistan, a low-resource country in Central Asia, has only recently begun developing formal physiotherapy services and education programs. In response to a 2018 gap analysis conducted by World Physiotherapy, the Strengthening Rehabilitation Services in Health Systems (SRSHS) project was launched in 2019 to establish an entry level physiotherapy program (PT-ELP). This study analyzed the implementation of the SRSHS project (2019–2024) by mapping its activities to the World Health Organization (WHO) Stepwise Guide: Using a Contextualized Competency Framework to Develop Rehabilitation Programmes and Their Curricula (2020). The objectives were to (1) assess the alignment between project activities and the WHO Stepwise Guide, and (2) identify gaps and lessons learned to inform future rehabilitation education initiatives in low-resource settings. A qualitative document analysis was conducted using 178 project documents produced between 2019 and 2024. These were systematically mapped to the WHO Stepwise Guide’s five curriculum development phases. Triangulation with project stakeholders was used to validate findings and ensure credibility. Project activities demonstrated substantial alignment with the WHO framework. Planning (Steps 1–3) and construction/sequencing (Steps 4–8) were largely completed through stakeholder engagement, curriculum development workshops, and the creation of syllabi for eight physiotherapy courses. Steps 9–10 (assessment design and progression criteria) were partially achieved, with limited integration of assessment methods into learning objectives. Steps 11–12 (implementation and evaluation) progressed through bridge trainings and consultancy support, although a formal curriculum evaluation cycle was only initiated during the 2023–2024 extension phase. The Tajikistan PT-ELP illustrates how international frameworks can be effectively adapted to low-resource contexts through staged consultancy and locally tailored teaching resources. The experience highlights the importance of embedding assessment strategies and evaluation mechanisms from the outset, alongside sustained educator development to ensure successful implementation and long-term sustainability.