Institutional mechanisms excluding rehabilitation from medical education in Central Africa: A mixed-methods case...

Access to rehabilitation services in sub-Saharan Africa is severely limited, with the WHO reporting that more than 63 % of people in the region do not receive needed rehabilitation services. This study analyzes how the exclusion of rehabilitation from medical curricula in Cameroon affects care access and evaluates implications for implementing the WHO Regional Strategy to Strengthen Rehabilitation in Health Systems 2025-2035.

We employed a sequential mixed-methods design comprising: (1) qualitative interviews with medical education leaders (n = 12) from 7 medical schools, analyzed using reflexive thematic analysis; and (2) clinical observation of 847 consecutive rehabilitation consultations over 24 months at Bafoussam Regional Hospital, evaluating referral patterns, prescription quality, and geographic patient distribution. We implemeted and assessed a 4 h rehabilitation education module for 2 promotions (year five) medical students.

Interviews revealed three mechanisms maintaining rehabilitation's exclusion from medical education: coercive (all 12 interviewees noted absence from accreditation requirements), normative (10/12 cited professional hierarchies that devalue rehabilitation), and mimetic (8/12 described uncritical curriculum replication from other schools). Analysis of 847 rehabilitation consultations showed that only 4.8 % of prescriptions included adequate clinical context; nearly half of patients (47 %) traveled over 100 km to access care. Physician specialty (OR = 3.7, 95 % CI: 2.1-6.4), recent graduation (OR = 1.9, 95 % CI: 1.1-3.2), and personal rehabilitation experience (OR = 4.3, 95 % CI: 2.5-7.6) predicted higher-quality referrals. The 4-h educational intervention at University of Dschang improved students' rehabilitation knowledge from 41.3 % to 78.7 % (p < 0.001) and referral confidence from 23 % to 87 % (p < 0.001).

The exclusion of rehabilitation from medical curricula in Cameroon is associated with widespread "Single Practitioner Syndrome"-a phenomenon where care becomes centralized around rare practitioners, creating systemic inefficiencies and access barriers. Even minimal educational interventions show potential for significant improvement in knowledge and referral practices. Implementation of the WHO Regional Strategy will require addressing these foundational educational barriers while acknowledging resource constraints in Central African health systems.