In the 21st century, African countries are challenged with a triple disease burden, namely, non-communicable diseases (NCDs) and injuries, as well as communicable diseases 1. To address these conditions in their recovery phases, rehabilitation services need to be a priority to assist people regain function as quickly as possible and to reduce long-term disability 2. With globalisation, the risk of non-communicable diseases and of work-related injuries is increasing rapidly 1, in turn, an urgent need for rehabilitation services in African countries. This need reflects demographic transitions, epidemiological shifts, and persistent health system inequities. This triple burden of disease includes the sequelae of chronic infection, including conditions such as HIV and COVID-19; the NCDs, including cardiovascular disease, stroke, diabetes, and obesity; and injuries leading to musculoskeletal conditions such as low back pain; traumatic injuries, including road traffic accidents, occupational hazards, and consequences of violence, war and armed conflicts; and congenital conditions 1. These conditions frequently occur at younger ages than in high-income settings, resulting in substantial long-term physical challenges and disability and loss of functional independence. Despite this rising burden, access to high-quality, evidence-based rehabilitation services remains limited and unevenly distributed, with pronounced disparities between public and private sectors, urban and rural, and in conflict-affected settings 1. Clinical practice guidelines (CPGs) across health care specialities are systematically developed recommendations designed to optimise patient care by identifying resources and integrating evidence on the benefits and harms of alternative interventions 3. Within rehabilitation, CPGs have the potential to standardise care, improve its quality, enhance its cost-effectiveness, and support workforce training and accountability across levels of care. In African countries, awareness, development, and routine use of rehabilitation CPGs have the potential to support non-specialist providers and expand equitable access to effective interventions in a seamless and timely manner. Despite the recognised benefits of CPGs, most rehabilitation professionals in African countries rely on CPGs developed for an international audience or in high-income countries. Access to these guidelines is often limited, and translating their recommendations into routine practice within African healthcare settings remains challenging. Furthermore, CPGs developed in other contexts frequently lack contextual and cultural relevance to the unique settings of the 54 sovereign countries in Africa, thereby limiting their applicability and undermining effective knowledge translation. This editorial aims to raise awareness of the critical role of contextualised rehabilitation CPGs in strengthening clinical practice and professional capacity. It highlights key factors influencing the development, adaptation, and implementation of CPGs and proposes priority actions to enhance their impact across diverse African settings, in alignment with the WHO Rehabilitation 2030 agenda 2. In the African context, several factors influence the use of CPGs and evidence-based interventions. These extend beyond awareness to include constrained research capacity, limited funding, weak policy mandates, shortages of skilled personnel, and the absence of coordination structures such as a continental CPG clearinghouse. Consequently, many African countries rely on guidelines produced by the World Health Organisation or international bodies, which often prioritise biomedical interventions and provide limited rehabilitation-specific guidance without specific considerations for the African context. Importantly, rehabilitation CPGs developed in high-income countries frequently require systematic adaptation to African contexts, considering differences in resources, workforce composition, specialist availability, cultural norms, and service delivery platforms. This favours guideline adaptation and contextualisation, rather than direct adoption to ensure relevance and feasibility 4. Increasing evidence shows that most CPGs developed in African countries and other low- and middle-income countries are of poor methodological quality and are often not rolled out for large-scale implementation. This can be enhanced by strengthened capacity across four interrelated professional pillars, including clinical practice, education and training, leadership, and research. This enables effective guideline use with improved patient outcomes with efficient use of resources. Weaknesses at any point within these pillars limit the effectiveness of CPGs and perpetuate inequities in rehabilitation access and outcomes in practice. Reliance of African countries on community-based rehabilitation and primary health care platforms highlights the need for CPGs that explicitly support task-shifting and the involvement of non-specialist health workers. Well-designed guidelines can provide simplified, evidence-informed protocols that enable community health workers and caregivers to deliver safe and effective rehabilitation interventions, particularly in settings with severe shortages of rehabilitation professionals 5. From an implementation science perspective, the effectiveness of CPGs depends on dissemination strategies, stakeholder engagement, training, monitoring, and feedback mechanisms 3. Yet, systematic evaluation of rehabilitation guideline implementation remains limited in many African contexts. Integrating implementation and evaluation components into CPG initiatives is essential to ensure fidelity, identify contextual barriers, and inform continuous improvement. Research capacity underpins the entire evidence ecosystem. The quality and relevance of rehabilitation CPGs reflect the strength of primary and secondary research conducted within local contexts 3, 5. While countries such as South Africa, Nigeria, Kenya, and Malawi have made notable progress in research training and guideline capacity building, substantial variation exists across the continent 4. In African settings, postgraduate training opportunities for rehabilitation professionals remain scarce, with limited access to master's and doctoral-level education. This limits the development of clinical academics, weakens evidence-informed decision-making in leadership, and contributes to the marginalisation of rehabilitation within national health policies. Recognising Africa's heterogeneity, capacity-strengthening strategies must be tailored to country income levels, workforce maturity, and health system resilience rather than assuming a one-size-fits-all approach. Regional initiatives demonstrate that progress is possible. The South African Guidelines Excellence (SAGE) project illustrates that adapting global evidence-based guidelines can be cost-effective and feasible in resource-limited settings 4. Expanding such models across regions, alongside initiatives like the Core Outcome Measures in Effectiveness Trials (COMET), could enhance standardisation, comparability, and translation of rehabilitation evidence. Digital health innovations, including tele-rehabilitation and mobile health platforms, offer additional opportunities to disseminate guidelines, support supervision, and monitor implementation, particularly in underserved areas. However, digital guidance must be accompanied by investments in infrastructure, digital literacy, and regulatory frameworks. Clarify and institutionalise rehabilitation CPG processes, emphasising contextualisation, implementation, and evaluation rather than guideline production alone. Strengthen professional capacity across practice, training, leadership, and research, with context-sensitive approaches reflecting Africa's diversity. Embed rehabilitation CPGs within primary health care and community-based models, supporting structured task-shifting and equity. Invest in implementation science and digital platforms to enhance uptake, monitoring, and learning. Integrate rehabilitation firmly into national health policies and Universal Health Coverage frameworks, ensuring accountability and sustainability. The development of CPGs in the speciality of physical medicine and rehabilitation in African countries is at a critical crossroad. While awareness, regional strategies, and interprofessional collaboration are increasing, persistent gaps in capacity, implementation, and evaluation limit their impact. With coordinated investment and context-responsive strategies, rehabilitation can shift from a neglected service to a central pillar of equitable, resilient health systems across African countries, in turn addressing several of the United Nations Sustainable Development Goals 1. Etienne Ngeh Ngeh: conceptualisation, supervision, writing – review and editing, writing – original draft, methodology. Ritchie Barber: methodology, writing – review and editing. Christopher Kuaban: methodology, writing – review and editing, formal analysis, supervision. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article, as no new data were created or analysed in this study.
Ngeh et al. (Wed,) studied this question.
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