Challenges and solutions to effective stewardship of rehabilitation services: a scoping review

Strong and effective stewardship is a fundamental function of health systems. However, rehabilitation services often receive insufficient attention due to the limited priority assigned to them by governments and health systems. In many countries—particularly low- and middle-income nations—this neglect has resulted in fragmented and poorly coordinated rehabilitation services across various sectors, with inconsistent service delivery influenced by the internal policies of individual institutions. This study investigates the broader barriers to rehabilitation services, analyzes their implications for stewardship, and proposes solutions to improve governance and system coordination. In this scoping review of studies conducted in Iran and globally, we identified factors and strategies for effective stewardship of rehabilitation services using Arksey and O'Malley's framework. Searches were performed in English databases (PubMed, Web of Science, and Scopus) and Persian databases (SID and Magiran), as well as the Google Scholar search engine, utilizing relevant English keywords and their Persian equivalents. Data were analyzed through a qualitative methodology employing directed content analysis. Additionally, Veillard et al.'s Health System Stewardship Framework was utilized to identify and analyze the challenges and solutions implemented in other countries. From a total of 38 published articles on rehabilitation services, six themes, eight sub-themes, 81 challenges, and 74 solutions were identified. The challenges included the ineffectiveness of the fragmented rehabilitation structure and stewardship, the absence of a comprehensive plan, and inadequate coordination and communication. Proposed solutions from these studies included establishing a central regulatory and governance body; developing rehabilitation services that recognize rehabilitation as a population-based strategy for health and well-being across a wide range of health conditions throughout the continuum of care and throughout life; and creating databases to track individuals with disabilities and the rehabilitation services provided to them. Effective stewardship of integrated rehabilitation services necessitates service continuity, coordinated policymaking, and active stakeholder engagement. A cohesive governance structure, bolstered by a robust information system, is crucial for evidence-based decision-making. Aligning policies with operational plans fosters collaboration and improves service efficiency.