WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of Proposals: 31 January 2013
The Disability and Rehabilitation team is pleased to announce a call for research proposals to support
the development of the World Health Organization Guidelines on health-related rehabilitation.
The guidelines will support the implementation of the rehabilitation aspects of the Convention on the
Rights of Persons with Disabilities (UN 2006). They will provide guidance to governments and other
relevant actors on how to develop, expand and improve the quality of rehabilitation services in less
resourced settings in line with the recommendations in the World report on disability (WHO/World Bank
2011), notably the integration and decentralization of rehabilitation services within the health system.
The guidelines will position rehabilitation within the context of the WHO "Framework for Action" for
strengthening health systems, which consists of six clearly defined building blocks: leadership and
governance; service delivery; human resources; medical products and technologies; financing; and
information systems.
Seven distinct, but linked, packages of work (each containing a number of specific research questions)
reflecting each of these “building blocks” have been developed (please see below). Interested applicants
are invited to submit proposals on one or more of the work packages. The resultant rehabilitation
guidelines must be based on the best available evidence. It is recognized that rehabilitation is a complex
and long term process and therefore it is anticipated that a variety of approaches such as primary
research; literature reviews; existing systematic reviews, evidence-based guidelines and standards;
expert opinion processes (users and professionals); and case studies will be needed to answer the
research questions.
There are four questions for which systematic reviews have been deemed applicable. They are listed
separately under the relevant work package. See Package 3 Service Delivery (2 PICO questions) and
Package 6 Financing (2 PICO questions). For these questions applicants are required to develop PICO
questions using the template provided as well as outline protocols for systematic reviews. Final details
of systematic reviews will be negotiated between successful applicants and WHO secretariat.
The final number of systematic and literature reviews will be dependent on available funding. It is
expected that research will be completed within 6 to 8 months of commencement.
Background and Supporting Documentation
The WHO/World Bank 2011 World report on disability is a primary reference for this work. The attached
documentation provides additional essential background information and guidance on language,
concepts and definitions to ensure that there is conceptual consistency across proposals. Applicants are
requested to ensure that proposals reflect the language, concepts and definitions contained herein.

Concept Paper: WHO Guidelines on health-related rehabilitation

Matrix on dimensions of rehabilitation and related lexicon

Declaration of conflict of interest form
1
Submission Process
The deadline for submission of proposals is 31 January 2013. Proposals received after the deadline will
not be considered. Full proposals must be submitted via email to Rachel Mcleod-Mackenzie at
mackenzier@who.int. All proposals must be written in English and address all components contained in
the proposal guideline below.
Applicants are welcome to provide proposals on more than one work package. In addition applicants
may consider systematic reviews independently of the main group of research questions in each work
package.
WHO will respond to questions regarding proposals after 7 January 2013. Enquiries should be directed in
writing via email to Kristen Pratt at prattk@who.int.
Selection and Award Process
All proposals will be reviewed on a competitive basis by a committee of experts and will be evaluated
according to merit based on the following criteria:

Appropriateness and robustness of proposed methodological approach 30%

Capacity of research team to implement proposal 30%

Reasonable costs and value for money 25%

Feasibility of approaches to achieve results within given time frame and precision and clarity of
proposal 15%
Eligibility Criteria and Requirements
The following types of organizations are encouraged to apply: research organizations, including
independent groups and those based within universities, think-tank organizations, NGOs and civil
society organizations, government organizations with a mandate to conduct research or use research in
policy formulation or decision-making.
Disabled Peoples Organizations and individuals from organizations in low and middle income countries
(LMIC) that are engaged in research are strongly encouraged to apply. Collaborations between LMIC
organizations and individuals and organizations in high-income countries are also encouraged.
Proposed Timeline for Call
Event
Call for proposals
Deadline for submission of proposals
Assessment of proposals
Advice to successful applicants and finalize terms of reference
Research commences
Dates
13 December 2012
31 January 2013
February 2013
March/April 2013
April 2013
2
Content of proposals
Title page
Focus area of the research: the number and title of the work package and/or
PICO question(s) for systematic review.
Name and contact details of organization, principal researcher and alternate
contact (administrative contact).
Study design
For each work package on which you are submitting a proposal please
describe the research design e.g. systematic review, literature review etc.
For all questions specified as requiring a systematic review PICO questions
should be elaborated in the format provided.
Research methods
Search strategy – detailed overview of the research strategy(s) and related
rationale for the questions in each package should include: types and sources
of information; proposed search terms and inclusion/exclusion criteria. The
strategy should also include languages to be searched, time periods for
evidence collection, and any limitations to the strategy.
Data analysis – details of how the data collected will be analyzed i.e. what
techniques will be used, what tools will be used if any; and how the
approaches selected will ensure the best result in answering the research
questions. Details should also be provided of how the data and results will be
presented. The GRADE approach should be used for all PICO questions and
results should be presented in Summary of Findings Tables and GRADE
Evidence Profiles. http://www.gradeworkinggroup.org/index.htm
Ethical considerations
All research funded by WHO must conform to ethical standards as outlined by
the WHO Ethics Review Committee (ERC). Ethics review and clearance should
be obtained for any research involving human subjects.
Timeline and
deliverables
Outline of key activities, milestones and outputs with related timeframes.
Present in a tabular format.
Budget & justification
for costs
Details of resources and expenditure needed for each key activity.
Amounts should be in USD.
Research team
Names , positions, qualifications and contact details for all principal
investigators and investigators. CVs for key team members to be included in
the appendices and should include recent relevant publications and referee
contact details.
For all team members responsible for systematic reviews please provide
details of GRADE experience.
Reference list
References should be cited in the text using author/date. Reference lists at the
end of the document should be formatted according to the WHO style guide.
Appendices
Include relevant appendices e.g. CVs, Declaration of conflict of interest form.
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WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 1: Background
Background to commissioning brief:
The number of people who would benefit from rehabilitation is expected to increase. The WHO/World
Bank World report on disability (2011) cited prevalence data indicating that approximately 1 billion
people or 15% of the world's population has a disability, of which 110-190 million adults experienced
very significant disability. This number is expected to increase due to global population ageing and
increased incidence of chronic diseases together with other environmental factors such as injuries from
road traffic crashes, climate change, natural disasters and conflict (WHO, 2011).
Rehabilitation can improve functioning and lead to increased independence and participation in
activities such as education, employment and community activities. Indirect benefits of rehabilitation
include reduced care responsibilities for other family members and reduced pressure on health systems.
Global data on the coverage and quality of rehabilitation services are lacking. However, national-level
data reveals large gaps in access to rehabilitation services in many low and middle-income countries,
and the quality of rehabilitation services that are provided are often inadequate.
Rehabilitation is not prioritized adequately within the different levels of health planning. Lack of capacity
of health systems in less resourced settings to deliver adequate rehabilitation services drives Member
States needs for knowledge and guidance on strengthening health systems to improve access to and the
quality of rehabilitation services for people who experience loss of functioning due to a health condition.
Research Questions:
1.1
What is the effectiveness of rehabilitation in achieving rehabilitation objectives1?
1.2
What are the economic and social benefits (including impact on health systems) of rehabilitation,
and the risks of not providing access to rehabilitation?
1.3
What is the prevalence of health conditions associated with disability disaggregated by sex, age,
countries, and regions?
1.4
What difficulties in functioning (i.e. impairments, activity limitations and participation
restrictions) are associated with these health conditions/a selection of these health conditions?
1.5
1.6
What is the level of need and unmet need in relation to rehabilitation?
Based on prevalence, difficulties in functioning, and need what are the priorities for
rehabilitation2?
1
Rehabilitation objectives include: preventing the loss of functioning; slowing the rate of loss of function;
improvement or restoration of function; compensation for lost function; maintenance of current function.
2
Consideration could be given to priority health conditions, regions and countries
4
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 2: Leadership and Governance
Background to commissioning brief:
The World report on disability highlighted that many countries lack legislation and policies related to
rehabilitation and subsequent strategies and plans for the provision of rehabilitation services. Creating
or amending national legislation/policies and strategies/plans on rehabilitation and establishing
infrastructure and capacity to implement these are critical to improving access to rehabilitation services.
Research Questions:
2.1
What works in including people with disabilities in decision making regarding the development,
implementation and monitoring/evaluation of policies and plans?
2.2
What are the features3 of national legislation/policies that work4 to support the development
and provision of rehabilitation services?
2.3
Do any of the listed features of national legislation/policieshave a greater risk of adverse effect
on particular groups of people5 and types of services?
2.4
What are the features of a rehabilitation strategy/plan that work to achieve rehabilitation
objectives?
2.5
What are the key steps to developing national legislation/policies and related strategies/plans
for rehabilitation?
2.6
What factors facilitate or impede the implementation of national legislation/policies and related
strategies/plans for rehabilitation?
2.7
What works in monitoring and evaluating rehabilitation legislation/policies and strategies/plans?
3
Features may encompass for example: inclusion/exclusion criteria such as impairment type, level of impairment,
age etc; links to CRPD; cross sectoral linkages; stakeholder involvement.
4
What works could refer to for example: increased funding; addressed unmet needs; increased accountability;
raised awareness; increased political will; qualitative evidence that it made a difference.
5
Should consider for example: people with disabilities, carers/family members, health professionals.
5
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 3: Service Delivery
Background to commissioning brief:
Unmet needs for rehabilitation services can result in poor outcomes for people with disabilities including
deterioration in general health status, activity limitations, participation restrictions and reduced quality
of life. These negative outcomes can have broad social and financial implications for individuals, families
and communities. The World report on disability highlighted that while some people with disabilities
have complex rehabilitation needs that require management in specialized settings, the majority of
people require fairly low-cost, modest rehabilitation services that can be delivered in mainstream health
settings. Priorities for service delivery include strategies for the integration of rehabilitation services into
mainstream health care settings, decentralization of rehabilitation services, and the provision of
coordinated and multidisciplinary rehabilitation services to ensure continuity of care.
Research Questions:
3.1
What are the components of appropriate service standards6for the delivery of rehabilitation
services?
3.2
What rehabilitation measures should be available at each level of the health care system?
3.3
What resources7are required for the delivery of rehabilitation services at each level of the health
care system?
3.4
What factors reduce8 and/or increase barriers to access to rehabilitation services?
3.5
What works to ensure people with disabilities receive a continuum of rehabilitation services
across different phases of care, different levels of the health system and across important
transitional9 periods?
6
Service standards are essentially a quality assurance mechanism to ensure appropriate systems are in place to
meet minimum standards of safety and quality. Standards may be based around for example: access to services;
individual needs; decision making & choice; respect for rights; consumer focused service management, complaints
& disputes etc.
7
Resources include infrastructure, equipment, supplies, human resources, assistive technologies.
8
For example, increasing awareness about services, and increasing awareness about the types and availability of
assistive devices.
6
3.6
What10needs to be in place to ensure that the rehabilitation process is effective and efficient11?
3.7
What monitoring and evaluation systems are required to ensure useful information is available
to improve care, and appropriate rehabilitation processes are followed within health care
systems?
PICO Questions for Systematic Review
Question:
What service provision models work for different health conditions/resource settings/phases to ensure
the provision of rehabilitation services?
Population:
Intervention:
Comparison:
Outcome:
Timing (if relevant):
Setting (if relevant):
Question:
What types of assessment tools can be used to ensure individual's rehabilitation needs are adequately
identified?
Population:
Intervention:
Comparison:
Outcome:
Timing (if relevant):
Setting (if relevant):
9
Transitional periods relate to developmental periods such as early childhood, primary school, secondary school
etc.
10
For example screening, assessment, referral, treatment, prescription, follow-up, care coordination etc.
11
Involves the identification of a person’s problems and needs; relating the problems to relevant factors of the
person and the environment; defining rehabilitation goals; planning and implementing measures; and assessing
the effects.
7
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 4: Rehabilitation Workforce
Background to commissioning brief:
The World report on disability revealed that many countries, including both low-income and highincome countries, report shortages of rehabilitation personnel and an unequal geographical distribution
of the existing workforce. In addition there are concerns about the quality and productivity of the
rehabilitation workforce particularly in low-income countries. Improving the availability, accessibility,
acceptability and quality of rehabilitation services is largely dependent on ensuring the rehabilitation
workforce is adequately prepared and mobilized. Further evidence is needed about the best ways to
improve the competence of the rehabilitation workforce, and the strategies that help to address the
deficiencies in the supply and distribution of rehabilitation personnel.
Research Questions:
4.1
What are the competencies needed to deliver and manage quality rehabilitation services?
4.2
Who12 should be trained to develop the competencies required for the delivery and
management of rehabilitation services at each level of the health care system?
4.3
What are the strategies which work to enable rehabilitation personnel to develop and maintain
the competencies required for the delivery of rehabilitation services?
4.4
What are the strategies which work to increase the supply and improve the distribution of
rehabilitation personnel required for the delivery of rehabilitation services?
4.5
What are the minimum requirements13 (i.e. ratio and competencies) of rehabilitation personnel
needed for the delivery of rehabilitation services?
4.6
What characteristics14 of the rehabilitation workforce facilitate equitable access to rehabilitation
services?
12
Both general and specialized personnel should be considered including people with disabilities and carers/family
members.
13
A denominator should be identified i.e. by population, health conditions prevalence, urban/rural location,
LMIC/MIC and level of service delivery.
14
Characteristics include gender, ethnicity etc.
8
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 5: Assistive Technology
Background to commissioning brief:
Assistive technology is “any item, piece of equipment, or product, whether it is acquired commercially,
modified, or customized, that is used to increase, maintain, or improve the functional capabilities of
individuals with disabilities”. Assistive technologies, when appropriate to the user and the user’s
environment, have been shown to be powerful tools to increase independence and improve
participation. Many studies cited in the World report on disability showed that unmet need for assistive
technologies is considerable in both low/middle and high income countries. Whilst assistive technology
should be considered across all other health systems strengthening areas such as service delivery and
financing, this work package focuses on establishing what evidence is available in the area of design,
production/procurement, and supply/distribution in order to improve access to assistive technology for
people with disabilities.
Research Questions:
5.1
What types of assistive technology are required at each level of the health system?
5.2
What policies, guidelines and regulations are required to ensure the appropriate 15design,
production /procurement, and supply/distribution of assistive technology?
5.3
What systems work to ensure the appropriate design, production/procurement, and
supply/distribution of assistive technology?
5.4
What quality assurance systems are required to ensure the appropriate design,
production/procurement, and supply /distribution of assistive technology?
15
Appropriate includes: safe, effective, equitable and sustainable
9
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of proposals: 31 January 2013
Work Package No 6: Financing
Background to commissioning brief:
The cost of rehabilitation can be a barrier for people with disabilities in high-income as well as lowincome countries. Even where funding from governments, insurers, or NGOs is available, it may not
cover enough of the costs to make rehabilitation affordable. Spending on rehabilitation is difficult to
determine because it is generally not disaggregated from other health care expenditure. Health care
funding often provides selective coverage for rehabilitation services – for example by restricting the
number and type of assistive devices, the number of therapy visits over a specific time, or the maximum
costs – in order to control costs. While cost controls are needed, they should be balanced with the need
to provide services to those who can benefit. Financing strategies can improve the provision, access, and
coverage of rehabilitation services, particularly in low-income and middle-income countries.
Research Questions:
6.1
What are the barriers in financing rehabilitation?
6.2
What examples are there of cost effective rehabilitation measures that are best buys for LMIC?
6.3
What is the evidence for cost effectiveness of rehabilitation with a focus on both “low cost high
volume”16 services and “high cost and low volume”17 services?
6.4
What are the factors18 that affect the cost of rehabilitation services in different contexts?
6.5
What financing models19 are used around the world?
6.6
What is the impact of user fees on utilization of and access to rehabilitation services?
6.7
What financing models work to maximize the efficiency and effectiveness of resources, and to
ensure equitable access to rehabilitation services?
5.8
What strategies can be used to maintain discreet funding for rehabilitation within health
systems funding?
16
Need provide evidence across all settings, however there is likely to be a particular focus on low income settings.
Data most likely to come from middle to high income countries.
18
Considerations include: type of service model; workforce constitution; cost of living and other related infrastructure.
19
Models may include: directly financed by users; insurance based financing schemes; state financing; private-public; NGO.
17
10
PICO Questions for Systematic Review:
Question:
What is the evidence for cost effectiveness of rehabilitation with a focus on both “low cost high
volume”20 services and “high cost and low volume”21 services?
Population:
Intervention:
Comparison:
Outcome:
Timing (if relevant):
Setting (if relevant):
Question:
What would be the cost benefits of different rehabilitation outcomes for the individual, family and
society?
Population:
Intervention:
Comparison:
Outcome:
Timing (if relevant):
Setting (if relevant):
20
21
Need to provide evidence across all settings, however there is likely to be a particular focus on low income settings.
Data most likely to come from middle to high income countries.
11
WORLD HEALTH ORGANIZATION
CALL FOR RESEARCH PROPOSALS
GUIDELINES ON HEALTH-RELATED REHABILITATION
Deadline for submission of Proposals: 31 January 2013
Work Package No 7: Information Systems
Background to commissioning brief:
One of the main recommendations of the World report on disability is to improve the collection and
analysis of data relating to disability. This is particularly important in the area of rehabilitation where
global data is currently very limited. For example, there is limited data on the need for rehabilitation,
the type and quality of interventions provided, and estimates of unmet needs. Data on rehabilitation
services are often incomplete and fragmented, and when available comparability is hampered by
differences in definitions, classifications of measures and personnel, populations under study,
measurement methods, indicators and data sources. Better information systems that enable the
collection and processing of rehabilitation data from various sources, and the use of this information for
policy making and management of rehabilitation services is essential.
Research Questions:
7.1
What information systems are used for rehabilitation policy and planning?
7.2
Which systems work to deliver effective relevant and accessible information?
7.3
What data should information systems capture across different levels of the health system and
for what purpose?
7.4
What are the sources for this data?
Which information should they not capture?
What are the criteria needed to determine burden vs. use?
What data has been used to demonstrate changes in the quality and efficiency of rehabilitation?
7.5
What works to ensure data is used effectively for improving policy and planning?
7.6
What works to effectively engage clinicians/managers in collecting and using data to improve
the quality of service delivery and outcomes for service users?
7.7
What research is a necessary component to information systems?
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