The World Health Organization has assembled a carefully filtered list of 71 rehabilitation interventions that doctors and nurses without rehabilitation training could deliver in primary care, and it has packaged them into a clinical resource shaped by field tests in Ghana and Fiji. The work, published in BMC Primary Care, describes how a WHO Rehabilitation Programme team distilled 297 interventions from the WHO’s Package of Interventions for Rehabilitation down to a compact set judged safe, easy to learn, and feasible for non-specialist health workers, then organized them into eight functioning domains with a decision-tree structure for everyday use.

The need the toolkit addresses is large. Current estimates cited in the paper suggest roughly 2.6 billion people could benefit from rehabilitation for diverse health conditions at some point in their lives, a figure driven upward by aging populations, more injuries, the high prevalence of noncommunicable diseases such as heart disease, diabetes, cancer and musculoskeletal conditions, and the long-term consequences of communicable diseases like HIV and COVID-19. Advances in curative care have also produced more survivors of illness and injury, many of whom need rehabilitation to optimize their functioning. Yet rehabilitation services are often poorly integrated into primary care, particularly in low- and middle-income countries, where fewer than 10 skilled rehabilitation practitioners serve per million people.

The resulting product, the Basic Package of Interventions for Rehabilitation, or Basic PIR, has three components: a list of interventions, a clinical resource, and an implementation guide. It is designed to empower primary care non-rehabilitation workers, defined as clinicians not trained in rehabilitation, such as doctors and nurses, to deliver a prioritized set of easy, safe and effective interventions through task sharing. Task sharing, the authors stress, expands service delivery to lay and mid-level health professionals rather than taking tasks away from higher-level providers, and it mirrors the logic of two existing WHO tools: the Mental Health Gap Action Programme, mhGAP, and the Integrated Care for Older People initiative, ICOPE. Clinical decision-making in the new resource follows a user-friendly decision-tree structure similar to those programs.

Development proceeded in three phases under a five-member internal review panel drawn from the WHO Rehabilitation Programme, which included one consultant from the WHO Regional Office for Africa, one technical advisor from the Western Pacific office, and two consultants plus one technical advisor from the European office. The panel brought specialized expertise in health financing, workforce development, service provision and standards, and health information systems. In the first phase, the panel screened the 20 health conditions covered by the parent PIR against epidemiological criteria: high prevalence in primary care settings, coverage of different disease areas such as musculoskeletal, cardiovascular and neurological conditions, higher global burden measured in years lived with disability, higher global prevalence where disability weights were comparable, and links to many affected aspects of functioning. Ten health conditions survived this structured review, and the panel mapped 13 functioning domains from the PIR that broadly corresponded to them.

Those domains were then organized using the WHO International Classification of Functioning, Disability, and Health as a reference framework into eight overarching areas: mental functions; hearing, speech and communication; vision; swallowing; respiratory and cardiovascular; motor functions and mobility; pain; and self-care and participation. A preliminary list of interventions was extracted against predetermined criteria. A suitable intervention had to be deliverable safely and effectively by primary care non-rehabilitation workers based on a protocol and after short online training, address a functioning problem easy to identify by those workers, have a duration feasible alongside their usual clinical role, and require only low-cost or locally available equipment or consumables. Interventions for which at least three of the five panel members voted yes made the preliminary list of 59.

External validation came from a 26-member Technical Working Group assembled by purposive sampling through international professional networks, global rehabilitation organizations and primary care societies. Candidates needed at least five years of clinical, academic or policy experience in primary healthcare or rehabilitation, demonstrated expertise in one of the eight functioning domains, and balanced representation across professions and regions. The final group comprised 17 rehabilitation specialists, including occupational, physical and speech therapists, orthotists and prosthetists, and rehabilitation physicians, plus 9 non-rehabilitation primary care professionals, including general practitioners, family physicians, audiologists, ophthalmologists, optometrists and nurses, spanning all six official WHO regions. In a two-stage modified Delphi process, members gave binary yes-or-no judgments on intervention suitability via online surveys, with consensus defined as at least 70 percent voting yes to retain an intervention. Open-ended feedback led the panel to integrate 10 additional interventions absent from the initial list but highly suitable for task sharing, such as advice on safe swallowing for dysphagia.

Ranking and prioritization followed. The working group scored interventions from 0, the lowest, to 5, the highest, on four criteria: the benefit achieved in primary care, defined as the effect on everyday functioning or reduced risk of complications; the need in the primary care population; the resource requirements, including worker time and equipment; and the ease with which non-rehabilitation workers could deliver the intervention safely. Members also each selected the 10 interventions they believed would have the greatest impact on the health and functioning of their populations. The final selection used a multi-stage consensus analysis: interventions needed an average ranking score of 3.0 or higher and prioritization votes from five or more members. Modifications included adding compression garments and urinary catheters, excluding group conversation and soft tissue techniques for feasibility reasons, and combining modified sports with recreation activities. Although standalone clinical trial evidence for thermotherapy is mixed, basic thermotherapy was retained because it came directly from the validated clinical practice guidelines of the parent PIR and was explicitly prioritized by the working group as a safe, low-cost self-management modality. After the inclusion of 11 assistive product interventions and 21 assessments and pharmacological agents, the final list contained 71 interventions.

The second phase turned the list into a prototype clinical resource structured around functioning domains and functioning targets, each carrying three clinical components: assessment recommendations aligned with ICOPE and mhGAP for health system compatibility; evidence-based red flags acting as strict referral criteria and contraindications, drafted by the lead author and independently cross-verified by the panel; and exercise, education and patient advice modules populated by mapping the verified clinical practice guidelines and Cochrane systematic reviews used to build the parent PIR. The components feed a four-step decision-tree model of Assess, Plan, Deliver Care and Monitor. The panel evaluated the draft through an online survey and a web conference, then the 26 working group experts, divided into sub-panels by domain expertise, provided text feedback on clarity and errors before a joint web conference secured consensus.

The third phase tested the prototype in the field, focusing on two of the eight domains, motor functions and mobility, and self-care and participation. Field tests were carried out in Ghana in 2021 and Fiji in 2022, involving 19 health workers in Ghana and 17 in Fiji from primary care settings nationwide. After five days of face-to-face lectures, practical sessions and role-playing, participants joined group discussions on their confidence in providing rehabilitation and the support they would need. Their feedback drove concrete revisions. Ghanaian workers found it hard to distinguish the Plan and Deliver Care steps, so the process was simplified from four steps to three, with Plan merged into Deliver Care, and an assessment form was developed to guide the Assess stage. Fijian workers wanted to grade functioning difficulty to track progress, prompting a 0-to-10 grading system for each functioning domain and illustrated patient handouts with simple instructions that patients could photograph, photocopy or print for use at home. The working group also added red flags, including sudden onset hearing loss accompanied by vertigo, red eye for vision, and choking and coughing for swallowing, and modified the sequence of swallowing interventions to begin with neck strengthening exercises and end with advice on appropriate food texture.

The authors are candid about limits. Developer bias is possible because the five panel members were central to the preliminary review, the selection of Delphi participants and the tool’s development, and the panel leaned geographically toward the European region. The evidence base relied heavily on existing WHO tools and documents rather than a comprehensive literature review, and no formal scoping review was conducted, which may have left some relevant functioning domains out. The field tests covered only two of the eight functioning domains, involved a small number of health workers from just two countries, and collected feedback immediately after training with no application of strategies in a clinical setting, so client outcomes and satisfaction were not assessed. The team also cautions that the toolkit addresses only low-complexity interventions, should be viewed as a preliminary resource rather than a blueprint for workforce planning or resource allocation, and must not define or limit national essential health benefit packages, since doing so could narrow services while neglecting complex acute, secondary and tertiary care needs. Because individuals with conditions requiring specialized care could otherwise remain in primary care, the resource includes clear referral pathways and a red flags section, and the authors emphasize that rehabilitation specialists should remain involved as mentors to prevent clinical stagnation and ensure complex cases are safely escalated. Future pilot studies across multiple countries will use implementation research to evaluate the Basic PIR’s operational feasibility, acceptability and appropriateness, gather primary care workers’ views on the task-sharing model, and explore collaboration with rehabilitation specialists, with the aim of helping bridge the rehabilitation gap in ways that could contribute to universal health coverage.

Subject of Research: Development of the WHO Basic Package of Interventions for Rehabilitation, a task-sharing toolkit of 71 interventions and a clinical resource for primary care workers

Article Title: Strengthening primary care with the world health organization’s basic package of interventions for rehabilitation: developing a list of interventions and a clinical resource

Article References: Tannor, A., Touhami, D., Duttine, A., Rauch, A., Kleinitz, P., Marks, E., Cieza, A., & Sabariego, C. (2026). Strengthening primary care with the world health organization’s basic package of interventions for rehabilitation: developing a list of interventions and a clinical resource. BMC Primary Care, 27(1), Article 373. https://doi.org/10.1186/s12875-026-03479-z

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03479-z

Keywords: rehabilitation, primary care, task sharing, World Health Organization, universal health coverage, Delphi process, functioning domains, Ghana, Fiji, noncommunicable diseases, clinical resource, low-resource settings