{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:03:16Z","timestamp":1784260996458,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Social Development, Karnali Province, Nepal","award":["Annual Grant FY 2081\/82"],"award-info":[{"award-number":["Annual Grant FY 2081\/82"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, 8\u2009million people experience conditions for which rehabilitation services can be beneficial. These services are considered an essential health service for the attainment of Universal Health Coverage. According to the Nepal Demographic and Health Survey 2022 report, 23% of the population has some type of functional disability, among whom 6% have total functional disability. This study aims to assess the readiness of rehabilitation services, knowledge of health workers, experience of service recipients and policy framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods study design will be conducted to assess the readiness for rehabilitation services over a period of 2 years, from July 2024 to 2026. This study protocol will examine the status of rehabilitation services, knowledge and skill gap of health workers, experiences of elderly and persons with disabilities for rehabilitation service utilisation. Similarly, the perception and experience of stakeholders working in the service sector will be assessed through key informant interviews. The participants of the current study will be 23 health facilities, more than 300 health workers in primary healthcare centre in Karnali and a convenience sample of elderly and disabled population. Furthermore, the study will explore (1) facility readiness index by domain; (2) health worker knowledge\/practice score; (3) user-reported barriers; and (4) qualitative themes around governance\/financing\/workforce\/WHO health system building blocks. The study team has designed a study protocol and conducted pre-testing in a similar setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The present study was approved by Nepal Health Research Council (Ref #49, 21 July 2024). Prior to ethical approval, the study team obtained approval from the Ministry of Social Development, Karnali Province. Informed consent was obtained from all the participants involved in the study. All collected data will be used solely for study purposes. The findings of the study will be published as a report from the Publication of the Ministry of Social Development, and major findings will be published in the Journal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110082","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:05:12Z","timestamp":1784257512000},"page":"e110082","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Readiness assessment for the integration of rehabilitation services into primary healthcare in a resource-limited setting: protocol for a parallel convergent mixed-method study in Karnali Province, Nepal"],"prefix":"10.1136","volume":"16","author":[{"given":"Brish Bahadur","family":"Shahi","sequence":"first","affiliation":[{"name":"Ministry of Social Development, Surkhet, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nistha","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Ministry of Health and Population Department of Health Services, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Pokharel","sequence":"additional","affiliation":[{"name":"Independent Researcher, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaneshor","family":"Paneru","sequence":"additional","affiliation":[{"name":"Ministry of Social Development, Surkhet, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Noble Shivapuri Research Institute, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Upadhayay","sequence":"additional","affiliation":[{"name":"Handicap International, Surkhet, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2698-3506","authenticated-orcid":false,"given":"Kanchan","family":"Thapa","sequence":"additional","affiliation":[{"name":"Noble Shivapuri Research Institute, Kathmandu, Nepal"},{"name":"Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"2026071620050574000_16.7.e110082.1","unstructured":"IHME . WHO Rehabiliation Need Estimator, 2024. Available: https:\/\/vizhub.healthdata.org\/rehabilitation\/"},{"key":"2026071620050574000_16.7.e110082.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32340-0"},{"key":"2026071620050574000_16.7.e110082.3","unstructured":"UNICEF . UNICEF 2021 Disabilities Report - Executive Summary, Available: https:\/\/data.unicef.org\/wp-content\/uploads\/2022\/05\/Disabilities-Report-executive-summary_EN.pdf"},{"key":"2026071620050574000_16.7.e110082.4","unstructured":"WHO . Rehabilitation. Key Facts, 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/rehabilitation"},{"key":"2026071620050574000_16.7.e110082.5","unstructured":"Ministry of Health and Population (Nepal), New ERA, ICF . Nepal Demographic and Health Survey 2022. Kathmandu, Nepal: Ministry of Health and Population [Nepal], 2023. Available: https:\/\/www.DHSprogram.com"},{"key":"2026071620050574000_16.7.e110082.6","unstructured":"Government of Nepal NHRC and M of H and P . Measuring access to assistive technology in Nepal Nepal Health Research Council."},{"key":"2026071620050574000_16.7.e110082.7","first-page":"951","article-title":"National Population and Housing Census 2021","volume":"6","year":"2021","journal-title":"Angewandte Chemie International Edition"},{"key":"2026071620050574000_16.7.e110082.8","unstructured":"Eide A , Neupane S . Living conditions among people with disability in Nepal, 2016. Available: www.sintef.no"},{"key":"2026071620050574000_16.7.e110082.9","unstructured":"The World Health Organization, Nepal Ministry of Health and Population . Situation assessment of rehabilitation in nepal government of Nepal ministry of health and population department of health services epidemiology and diseases control division leprosy control and disability management section Teku, Kathmandu. 2022."},{"key":"2026071620050574000_16.7.e110082.10","unstructured":"World Health Organization . Guidance on the Analysis and Use of Routine Health Information Systems : Rehabilitation Module. Geneva: World Health Organization; Licence: CC BY- NC-SA 3.0 IGO. 2022."},{"key":"2026071620050574000_16.7.e110082.11","unstructured":"Nepal Law Commission . The Public Health Service Act, 2075 (2018). Vol 2075, 2019. Available: https:\/\/www.lawcommission.gov.np\/en\/wp-content\/uploads\/2019\/07\/The-Public-Health-Service-Act-2075-2018.pdf"},{"key":"2026071620050574000_16.7.e110082.12","unstructured":"Ministry of Health and Population . National health Policy of Nepal, 2076, 2019. Available: https:\/\/drive.google.com\/file\/d\/1jZ6KrLmjJNjMvbemJ6dSox-30PJndfAT\/view"},{"key":"2026071620050574000_16.7.e110082.13","unstructured":"Ministry of Social Development . Karnali province health policy. 2019."},{"key":"2026071620050574000_16.7.e110082.14","unstructured":"Ministry of Social Development, Karnali Province N . Health sector strategic actionplan (2080-2087). 2080."},{"key":"2026071620050574000_16.7.e110082.15","unstructured":"Karnali Province Government, MInistry of Social Development HSD . Province annual heatlh report annual health report."},{"key":"2026071620050574000_16.7.e110082.16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3126\/jsdpj.v2i1.63265","article-title":"Opportunities and Challenges of Nepal\u2019s Health Systems: A Critical Study in Federal Context","volume":"2","author":"Dahal","year":"2024","journal-title":"Journey Sust Dev Peace J"},{"key":"2026071620050574000_16.7.e110082.17","unstructured":"Karnali Province Government, MInistry of Social Development HSD . Permed activities and status of health service in Karnali. Surkhet, Karnali, Nepal. 2021."},{"key":"2026071620050574000_16.7.e110082.18","unstructured":"World Health Organization . Service Availability and Readiness Assessment (SARA) An annual monitoring system for service delivery Reference Manual, 2014. Available: http:\/\/www.who.int\/healthinfo\/systems\/sara_reference_manual\/en\/"},{"key":"2026071620050574000_16.7.e110082.19","unstructured":"Kathmandu N . Nepal health facility survey 2015 preliminary report. 2016."},{"key":"2026071620050574000_16.7.e110082.20","unstructured":"Nepal Health Research Council . National ethical guidelines for health research in Nepal and standard operating procedures. 2022."},{"key":"2026071620050574000_16.7.e110082.21","unstructured":"World Medical Association . 64th WMA General Assembly Fortaleza Brazil. 2013."},{"key":"2026071620050574000_16.7.e110082.22","unstructured":"C for IO of medical S . Guidelines for Health-related Reseaarch Involving humans. Dictionary of Pharmaceutical Medicine 2016;42."},{"key":"2026071620050574000_16.7.e110082.23","unstructured":"World Health Organization . Policy on use and sharing of data collected in Member States by the World Health Organization (WHO) outside the context of public health emergencies (Provisional), 2017. Available: www.who.int\/ihr\/procedures\/SPG_data_sharing.pdf"},{"key":"2026071620050574000_16.7.e110082.24","unstructured":"Province Government of Karnali M of SD . Rehabliation strategic plan 2080-2087. 2023."},{"key":"2026071620050574000_16.7.e110082.25","doi-asserted-by":"publisher","DOI":"10.1590\/S0042-96862000000600004"},{"key":"2026071620050574000_16.7.e110082.26","unstructured":"WHO . Quality assurance of pharmaceuticals: meeting a major public health challenge: The WHO Expert Committee on Specifications for Pharmaceutical Preparations, 2007. Available: www.who.int\/about\/licensing\/copyright_form\/en\/index.html"},{"key":"2026071620050574000_16.7.e110082.27","doi-asserted-by":"crossref","first-page":"100289","DOI":"10.1016\/j.lansea.2023.100289","article-title":"Stroke systems of care in South-East Asia Region (SEAR): commonalities and diversities","volume":"17","author":"Sebastian","year":"2023","journal-title":"The Lancet Regional Health - Southeast Asia"},{"key":"2026071620050574000_16.7.e110082.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001298","article-title":"Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015","volume":"2","author":"Khatri","year":"2015","journal-title":"PLOS Glob Public Health"},{"key":"2026071620050574000_16.7.e110082.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-06681-0","article-title":"Health system gaps in cardiovascular disease prevention and management in Nepal","volume":"21","author":"Shrestha","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2026071620050574000_16.7.e110082.30","unstructured":"Karnali Province Planning Comission G of KP . Sustainable development goals baseline report of karnali province. sustainable development goals. 2022."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:05:23Z","timestamp":1784257523000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2025-110082"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110082","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}