Improving Access to and Coverage of Rehabilitation Services through the Implementation of Rehabilitation in Primary Health Care: A Case Study from Chile.

The demand for rehabilitation services (RS) is increasing worldwide, particularly in low-and middle-income countries (LMICs), where up to 50% of people currently don't have access to the RS they need. This case report describes how Chile integrated rehabilitation into primary health care (PHC) to improve access, coverage, and equity. The report draws on the first-hand experiences of two Ministry of Health (MoH) officials involved in transitioning from specialized to PHC-centered rehabilitation. The cornerstone of Chile's strategy is the Comprehensive Rehabilitation in PHC Program (RehabPHC), launched in 2007. It has three main service delivery strategies: Community Rehabilitation Rooms (CRRs), Integrative Rehabilitation Rooms (IRRs) linked to Family Health Centers (CESFAM), and Rural Rehabilitation Teams (RRTs) that provide mobile rehabilitation in remote areas. RehabPHC revolutionized the delivery, organization, and financing of rehabilitation. Rehabilitation coverage increased from 12 CRRs in 2007 to 307 in 2022, available in 52.6% of CESFAMs. Key to this progress was strong leadership and financial commitment from the MoH to ensure a sustainable, PHC-centered national rehabilitation system. Essential to planning was collecting and continuously monitoring data on rehabilitation needs and RehabPHC service indicators, which promoted evidence-based resource allocation. A dedicated policy was also critical, defining development pathways and coordination mechanisms for rehabilitation financing, advocacy, data collection, and monitoring. Chile's experience underscores the importance of strong governance, financial commitment, and evidence-based planning in integrating rehabilitation into PHC. As such, it provides a valuable blueprint for countries facing similar challenges.

Estimation of the demand for palliative care in non-oncologic patients in Chile.

BACKGROUND: Access to palliative care is an emerging global public health challenge. In Chile, a palliative care law was recently enacted to extend palliative care coverage to the non-oncologic population. Thus, a reliable and legitimate estimate of the demand for palliative care is needed for proper health policy planning. OBJECTIVE: To estimate the demand for Palliative Care in Chile. METHODOLOGY: Diseases likely to require palliative care were identified according to literature and expert judgement. Annual deaths of diseases identified were estimated for the periods 2018-2020. Demand estimation corresponds to the identification of the proportion of deceased patients requiring palliative care based on the burden of severe health-related suffering. Finally, patient-years were estimated based on the expected survival adjustment. RESULTS: The estimated demand for palliative care varies between 25,650 and 21,679 patients depending on the approximation used. In terms of annual demand, this varies between 1,442 and 10,964 patient-years. The estimated need has a minor variation between 2018 and 2019 of 0.85% on average, while 2020 shows a slightly higher decrease (7.26%). CONCLUSION: This is a replicable method for estimating the demand of palliative care in other jurisdictions. Future studies could approach the demand based on the decedent population and living one for a more precise estimation and better-informed health planning. It is hoped that our methodological approach will serve as an input for implementing the palliative care law in Chile, and as an example of estimating the demand for palliative care in other jurisdictions.