Methodology for Assessing the Need for Physiotherapists in Low and Middle Income Countries: From Theory to Practice

This project aimed to develop a methodology that is easy to apply and that helps decision-makers estimate workforce development needs, based on countries presenting similar characteristics. The final goal being to encourage investment in training workforce.

In collaboration with health economists, a calculation method was defined, combining rehabilitation professional density with another indicator reflecting the country’s position in relation to other similar countries. Several parameters were taken into consideration: HDI, country income, YLD, out of pocket expenditures and health expenditures. They were analyzed both in terms of feasibility and pertinence. With the selected indicators, the methodology was applied to two countries with different scenarios of workforce development. Results were shared with local actors to confirm the appropriateness of the proposed methodology. 

A new approach was developed based on two primary indicators: the density of physiotherapists per 10,000 inhabitants and public health expenditure per capita. These indicators reflect both a country's income level and the priority given to the healthcare sector. By categorizing countries into homogeneous groups or quintiles, based on the density of the two indicators mentioned above, standards can be established that are specific to each country yet consistent among those with similar economic and health profiles. Two scenario were defined: the first scenario set a standard at the maximum of the first quintile; the second scenario at the maximum of the second quintile.  For each scenario, a strategy of workforce development based on coverage needs over a 20-years period was proposed.  

This methodology can be applied to a variety of countries and can support workforce development strategies. The project underscores the importance of proposing methods and tools for defining rehabilitation workforce development needs that are both flexible and comparable across countries with similar characteristics. The resulting scenarios demonstrate the adaptability of the approach. Each country can use this method as a decision-making and advocacy tool, tailoring it with data relevant to their context.

Estimating the need for rehabilitation professionals is essential to promote rehabilitation within the health system, in line with the Rehabilitation 2030 Agenda. This method and tool can be used as a stand-alone approach or be integrated into the WHO GROWE assessment, enabling authorities to define workforce development strategies and better meet the rehabilitation needs of their populations.