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Rehabilitation workforce

ENLACE REHABILITATION NEED WORKFORCE COUNTRY PROFILE TECHNICAL NOTES ABOUT

 

The rehabilitation workforce plays a crucial role in providing the rehabilitation services needed by persons experiencing limitations in everyday physical, mental, and social functioning to reduce disability. Rehabilitation worker shortages, inequitable distribution, and issues of quality and relevance pose a major barrier to people accessing the care they need, when and where they need it. The rehabilitation personnel density at the population level informs the capacity of the health system to deliver rehabilitation to the population, allowing program planners to conduct rehabilitation need assessment, and allocate and prioritize resources for rehabilitation. 

This visualization presents data on rehabilitation personnel of six of the core rehabilitation professions: physiotherapists, occupational therapists, speech and language therapists, rehabilitation doctors (also known as physiatrists), psychologists, and prosthetic and orthotic professionals. The visualization presented includes the profession density (overall and by profession) and the ratio of rehabilitation personnel per population in need of rehabilitation in countries of the Americas. These are by no means the only rehabilitation professions and future data collection will aim to expand to a wider range of professions including chiropractors, rehabilitation nurses and mid-level rehabilitation workers.
 

Two indicators are featured:

  1. Rehabilitation workforce density per 10,000 population. This indicator informs on the capacity of the health system to deliver rehabilitation to the population. It is presented as the overall rehabilitation workforce and by profession.
  2. Rehabilitation workforce per population in need of rehabilitation (per 10,000 population). This is a more sensitive and specific type of rehabilitation workforce density indicator as it accounts for the capacity of the health system to deliver rehabilitation care to those who need it.

Rehabilitation workforce density per 10,000 population

Regionwide, the median number of rehabilitation professionals per 10,000 population is 2.87 (mean = 8.6).

There is a substantial variation in the rehabilitation workforce density across countries of the Americas, from a low of 0.27 professionals per 10,000 population in Haiti to 43.49 professionals per 10,000 population in Argentina.

The English, French, and Dutch-speaking Caribbean, specifically the group of PAHO/WHO Member States countries, has the lowest level of rehabilitation personnel density in the range of 0.27 to 5.0 rehabilitation professionals per 10,000 population.

The most common available profession is Physiotherapy, followed by Psychology. It should be noted, however, that not all psychologists work in rehabilitation settings or on conditions presented in the rehabilitation need data. Therefore, caution should be exercised when including psychologist numbers in the rehabilitation workforce.   

Rehabilitation workforce per population in need of rehabilitation

When considering the number of rehabilitation professionals for rehabilitation need, the median is 9.2 rehabilitation professionals per 10,000 people with conditions amenable to rehabilitation services. 

The English, French, and Dutch-speaking Caribbean, and Central America, Mexico, and Spanish-speaking Caribbean with 4.1 and 5.3 rehabilitation professionals per 10,000 people in need of rehabilitation respectively, are the subregion with the lowest level of rehabilitation professionals per population in need of rehabilitation. 

Canada and the United States, is the region with the highest number of rehabilitation professionals per population in need of rehabilitation (48.1 professionals per 100,000 population) 

There is a substantial variation in the number of rehabilitation professionals per population in need of rehabilitation, from a low of 0.0 professionals per 10,000 population in Dominica to 124.8 professionals per 10,000 population in Argentina. 

The countries with the lowest number of rehabilitation professionals per population in need of rehabilitation (≤ 4.0 professionals per 10,000 population) are Dominica, Grenada, Haiti, Siant Vincent and the Grenadines, Belize, Guatemala, Nicaragua, Honduras, Guyana, Dominican Republic, and Trinidad and Tobago.

Workforce data and information for this topic were collected by the PAHO Regional Rehabilitation program via desk research, examination of country site visit reports, direct engagement with rehabilitation professionals in specific countries, and discussions with the ministry of health representatives through PAHO country offices.

Publicly available data on the numbers of physical and rehabilitation medicine doctors (physiatrists), physiotherapists, occupational therapists, speech and language therapists, prosthetists and orthotists, and psychologists per country were collected. Publicly available information from international professional associations such as World Physiotherapy (formerly World Confederation of Physical Therapy) and the World Federation of Occupational Therapy (WFOT)​ was used as primary data as these organizations are in close contact with leaders from the national professional associations. Data from some countries were also provided by the International Society of Physical and Rehabilitation Medicine (ISPRM), the International Society of Prosthetics and Orthotics (ISPO), or local professional associations. Data on the number of psychologists in each country were obtained from the World Mental Health Atlas which, in some countries, also contained information for occupational therapists and speech and language therapists. For countries that had undertaken a recent national rehabilitation assessment (Bolivia, El Salvador, Guyana, and Haiti) data were used from this source. The WHO Global Health Observatory was also used as a source for physiotherapists. Finally, when available, public or non-public data from Statistical Departments of Ministries of Health, or Ministries of Labor were used, especially in countries and territories without professional associations. 

Where significant discrepancies in data occurred from different sources, follow-up was made to verify the information with the Ministry of Health. If not possible to verify, a decision was taken on which source to use by the PAHO advisor on disability and rehabilitation. A master database was created detailing sources of data, which will be maintained and updated by PAHO as new data emerges. 

Workforce indicators
In this topic, two main indicators are featured:

  1. Rehabilitation workforce density per 10,000 population. This indicator informs on the capacity of the health system to deliver rehabilitation to the population. It is presented as the overall rehabilitation workforce and by profession.
  2. Rehabilitation workforce per population in need of rehabilitation (per 10,000 population). This is a more sensitive and specific type of rehabilitation workforce density indicator as it accounts for the capacity of the health system to deliver rehabilitation care to those who need it.   

The summary table is included with data per country. Major gaps in data exist and as new data emerges, this topic and visualization will be updated.

Data and information for these indicators were presented at the national level, and the countries and territories were clustered into four subregions:  

  • Canada and the United States. 
  • Central America, Mexico, and the Spanish-speaking Caribbean.  
  • English, French, and Dutch Speaking Caribbean.  
    • English, French, and Dutch Speaking Caribbean (PAHO/WHO Member States only).
    • English, French, and Dutch Speaking Caribbean (Territories only).
  • South America.  

Suggested citation

Rehabilitation workforce in the Region of the Americas. ENLACE data portal. Pan American Health Organization (PAHO/WHO), 2022. [Internet] https://www.paho.org/en/enlace/rehabilitation-workforce