From policy to practice: why the WHO’s Africa rehabilitation strategy 2025–2035 risks failure without educational reform
Résumé
Background: In July 2025, the WHO African Regional Committee adopted an ambitious strategy to address the 63% rehabilitation access gap through a comprehensive five-pillar framework. However, systematic educational exclusion of rehabilitation in African medical curricula may undermine implementation across all strategic pillars. Methods: Analysis of the WHO AFRO 2025-2035 strategy implementation framework, complemented by systematic curriculum assessment across Central African medical schools and ethnographic observations from Cameroon documenting current access barriers and workforce knowledge gaps. Results: Medical schools across Central Africa systematically exclude rehabilitation from curricula, with the University of Dschang representing a rare exception (4 h annually). This educational vacuum generates cascading failures: policymakers cannot prioritize services they don't understand (Pillar 1: Governance), physicians cannot refer to specialists they've never encountered (Pillar 2: Workforce), evidence-based interventions are dismissed in favor of pharmaceuticals (Pillar 3: Service Delivery), rehabilitation needs remain invisible in data systems (Pillar 4: Information), and financing mechanisms struggle to support undervalued services (Pillar 5: Resources). Field evidence reveals patients traveling over 1,000 km for rare rehabilitation expertise, reflecting profound system-level educational failures. Conclusion: Without urgent educational reform, the WHO strategy risks replicating historical implementation failures despite comprehensive policy architecture. Educational exclusion represents not a peripheral concern but a foundational threat to strategy success. Medical curriculum integration offers a cost-effective, scalable intervention that amplifies all five strategic pillars. African health leaders must prioritize educational reform as essential infrastructure, not optional enhancement.
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