Availability of Physical Rehabilitation Facilities for People with Disabilities in Iran: A Comparative Study on Universal Health Coverage.

Background: Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels.

Methods: This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016.

Results: On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher.

Conclusion: According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.