Rehabilitation is a core component of the continuum of healthcare, alongside health promotion, prevention, curative and palliative care (World Health Organization [WHO] 2023). Rehabilitation has been demonstrated as an essential service needed by considerable numbers of any population. One in three (2.6 billion) people globally, 240 million people in the African region and 7.5 million people in Uganda, was reported in 2021 to have experienced health conditions that could benefit from rehabilitation (Institute for Health Metrics and Evaluation [IHME] 2024). The growing need for rehabilitation is linked to demographic trends characterised by ageing populations, rising prevalence of noncommunicable diseases, ongoing consequences of conflicts and injuries and improved access to healthcare interventions (Kamenov et al. 2019). Rehabilitation is critical for all people throughout the lifespan to improve their functioning and participation in society.

The need for rehabilitation in the African region is largely unmet, with at least 63% of people in need of rehabilitation services not receiving the required care in African countries (WHO African Region 2024). In Uganda, the focus of this reflection, rehabilitation services are mainly provided by physiotherapists, occupational therapists, orthopaedic technologists and speech and language therapists working at tertiary and secondary health facilities, that is public national referral hospital, regional referral hospitals and a few general hospitals, as well as private hospitals and clinics located in urban and peri-urban settings. Rehabilitation services are generally lacking at the primary healthcare level and rural settings, where the majority of the Ugandan population lives and accesses health services including rehabilitation. Rehabilitation services in rural areas are supplemented by a small number of faith-based organisations providing primary healthcare (Ministry of Health 2023). As a result, rehabilitation services in Uganda are sub-optimal, under prioritised and inadequately coordinated, relying heavily on inconsistent donor support. Moreover, rehabilitation data are not reflected in decision-making and national reporting (Ministry of Health 2023).

In 2021, the Learning, Acting and Building for Rehabilitation in Health Systems (ReLAB-HS) Activity was set up in Uganda with financial assistance from United States (US) Agency for International Development (USAID). Learning, Acting and Building for Rehabilitation in Health Systems aimed to support the Ugandan Ministry of Health in strengthening health systems to respond to growing needs for rehabilitation across the lifespan. Specifically, the initiative aimed to improve the delivery and demand for quality rehabilitation services at the community level; develop the capacity of health system leaders, rehabilitation managers and providers and support the development and implementation of rehabilitation plans and policies.

To improve the delivery and demand for quality rehabilitation services at the community level, ReLAB-HS co-designed an improved rehabilitation and assistive technology service delivery model for primary healthcare facilities. To implement the model, 60 existing primary healthcare providers and 200 community health workers were trained to provide basic rehabilitation and assistive products. This initiative of integrating rehabilitation into primary healthcare brought rehabilitation and assistive products closer to the community. Additionally, ReLAB-HS built the capacity of health system leaders including rehabilitation professionals. It supported upgrading training curricula for physiotherapists from degree to master’s and occupational therapists and orthopaedic technologists from diploma to degree. Importantly, ReLAB-HS supported the development of the first national rehabilitation and assistive technology strategic plan. The project undertook rapid assistive technology assessment to inform the development of the national assistive products priority list (APL). Furthermore, the project supported the development of social behaviour change communication materials for health leaders, providers and users. Lastly, ReLAB-HS worked with WHO and stakeholders to integrate rehabilitation standard indicators into the national health management information systems.

However, in January 2025, the United States Government issued a blanket executive stop-work order in Uganda with immediate effect. The executive order froze the implementation of ReLAB-HS Activity, without an opportunity to transition the activities to the Ugandan Government for sustainability. This immediately affected the provision of basic rehabilitation and assistive technology services at 10 primary healthcare facilities, impacting approximately 99 000 people in need of rehabilitation services. The executive order affected the integration of rehabilitation data into the national health management information system (HMIS). It also affected the operationalisation of the national rehabilitation and assistive technology strategic plan. Furthermore, the order affected the finalisation of the national APL and the social behaviour change communication material.

Consequently, the executive order has affected the majority of adults and children with functioning limitations who were accessing and utilising rehabilitation and assistive technology services at primary healthcare facilities closer to their homes. This implies that they need to resume travelling long and costly distances in search of rehabilitation services. This in a long run will affect access to and utilisation of rehabilitation services in terms of dosage and intensity as well as continuity, leading to poor quality of life at the population level.

Efforts to streamline the rehabilitation and assistive technology services by operationalising the strategic plan, national assistive product priority list, standard rehabilitation indicators as well as opportunities to create awareness at national, regional, district and community levels have been shuttered. This has affected national motivation to strengthen rehabilitative services in the health system. Previously enthusiastic rehabilitation professionals are demotivated and frustrated as they have no partner to support them to advocate for improved rehabilitation services and build their capacity to provide quality rehabilitation services. The immediate stoppage of US financial assistance has had negative consequences at individual and health system levels, including reduced access to rehabilitation services among individuals, increased out-of-pocket expenditure at individual level and poor health outcomes.

As many other developed countries have commenced withdrawing development funds, there is an opportunity for African governments to re-think their health investment strategies and adopt integration of health services, as opposed to implementing standalone health programmes as a means to reduce wasteful health expenditure. Integrated health programmes have the potential to increase access to rehabilitation and assistive technology services at all levels of the health system, especially at primary healthcare level. This editorial calls on African governments to better understand and recognise that rehabilitation and assistive technology as a critical health services for the attainment of Universal Health Coverage (UHC) and Sustainable Development Goal-3 (SDG-3).

To improve access to rehabilitation services, African governments need to revitalise the community-based rehabilitation approach; embrace technological advances to promote remote and/or digital rehabilitation initiatives; increase workforce for rehabilitation at secondary and tertiary level and lastly, improve capacity of existing workforce (primary care providers and community health workers) to provide basic rehabilitation services.