Readiness assessment for the integration of rehabilitation services into primary healthcare in a resource-limited setting: protocol for a parallel convergent mixed-method study in Karnali Province, Nepal.

Authors

Brish Bahadur Shahi, Nistha Shrestha, Sunil Pokharel, Thaneshor Paneru, Rita Adhikari, Prakash Upadhayay, Kanchan Thapa

Published in

BMJ open. Volume 16. Issue 7. Pages e110082. Jul 16, 2026. Epub Jul 16, 2026.

Abstract

Globally, 8 million people experience conditions for which rehabilitation services can be beneficial. These services are considered an essential health service for the attainment of Universal Health Coverage. According to the Nepal Demographic and Health Survey 2022 report, 23% of the population has some type of functional disability, among whom 6% have total functional disability. This study aims to assess the readiness of rehabilitation services, knowledge of health workers, experience of service recipients and policy framework.
A mixed-methods study design will be conducted to assess the readiness for rehabilitation services over a period of 2 years, from July 2024 to 2026. This study protocol will examine the status of rehabilitation services, knowledge and skill gap of health workers, experiences of elderly and persons with disabilities for rehabilitation service utilisation. Similarly, the perception and experience of stakeholders working in the service sector will be assessed through key informant interviews. The participants of the current study will be 23 health facilities, more than 300 health workers in primary healthcare centre in Karnali and a convenience sample of elderly and disabled population. Furthermore, the study will explore (1) facility readiness index by domain; (2) health worker knowledge/practice score; (3) user-reported barriers; and (4) qualitative themes around governance/financing/workforce/WHO health system building blocks. The study team has designed a study protocol and conducted pre-testing in a similar setting.
The present study was approved by Nepal Health Research Council (Ref #49, 21 July 2024). Prior to ethical approval, the study team obtained approval from the Ministry of Social Development, Karnali Province. Informed consent was obtained from all the participants involved in the study. All collected data will be used solely for study purposes. The findings of the study will be published as a report from the Publication of the Ministry of Social Development, and major findings will be published in the Journal.

PMID:
42463474
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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