World Health Organization · 1st edition, 2025 · 47 pages
A practical case study documenting Georgia's stepwise integration of evidence-based rehabilitation into universal health coverage for stroke, traumatic brain injury, and spinal cord injury.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Health policy-makers, rehabilitation service planners, health financing specialists, rehabilitation professionals (physicians, physiotherapists, occupational therapists, speech therapists, psychologists), WHO country offices, and ministries of health in low- and middle-income countries seeking to integrate rehabilitation into universal health coverage.
- Evidence
- Expert consensus and technical working group methodology; prioritization based on YLD data from Global Burden of Disease 2019 and multi-criteria scoring; intervention selection mapped from WHO's evidence-based Package of Interventions for Rehabilitation; costing and implementation informed by national stakeholder consultations and nine-month evaluation.
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO publication documents Georgia’s pioneering use of the Package of Interventions for Rehabilitation (PIR) to develop and implement the country’s first state-funded rehabilitation service package within its Universal Health Care Programme. Starting in 2023, Georgia prioritized five neurological and musculoskeletal conditions—stroke, traumatic brain injury, spinal cord injury, fractures, and amputation—based on burden of disease and feasibility, initially implementing outpatient multidisciplinary rehabilitation for three neurological conditions at six authorized centres.
The document details the four-step development process: prioritizing health conditions using years lived with disability (YLD) data and a scoring system; mapping PIR interventions to ten Georgian rehabilitation service types (multidisciplinary assessment, individual physiotherapy, aqua therapy, lymphatic therapy, occupational therapy, speech therapy, psychotherapy, assistive product provision, patient education, and medical consultation); costing based on session numbers and workforce time; and budgeting considering regional capacity. The total needs-based cost was estimated at 38.7 million Georgian lari annually, with a capacity-based implementation budget of 30 million lari.
After nine months of implementation, evaluation revealed both successes—improved patient outcomes and high satisfaction—and challenges including delayed rehabilitation onset leading to preventable complications, insufficient public awareness requiring targeted campaigns, lack of clinical guidelines (now being developed), and additional out-of-pocket costs for transport, accommodation, and medications. The report emphasizes that while the PIR proved invaluable for evidence-based prioritization and service definition, successful implementation requires concurrent development of referral pathways, workforce standards, quality standards, clinical guidelines, and comprehensive awareness-raising among both health workers and the public.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Georgia established eligibility for rehabilitation within 24 months of diagnosis for stroke, traumatic brain injury, spinal cord injury, fractures, and amputation, with funding covering up to 90 days of rehabilitation per cycle
- Ten rehabilitation service types defined with specific costs per session: multidisciplinary assessment 227 GEL (60 min), individual physiotherapy 39 GEL (30 min), occupational therapy 45 GEL (30 min), speech therapy 50 GEL (45 min), psychotherapy 76 GEL (45 min)
- Inpatient rehabilitation calculated at 213 GEL per bed-day, with 14 days for stroke/traumatic brain injury/spinal cord injury and 7 days for amputation/fractures
- Funding proportion varies by beneficiary category: 100% for socially vulnerable persons (rating score ≤70 000), internally displaced persons, and state care residents; 90% for teachers, veterans, pensioners, and students; 80% for general population
- Service providers must have permits for inpatient/rehabilitation facilities, offer all ten service types, and employ at least one certified rehabilitation physician to become authorized
- Continuation of rehabilitation beyond 90 days requires Functional Independence Measure (FIM) improvement >10% from baseline to demonstrate effectiveness
- Six rehabilitation centres authorized across four of eleven Georgian regions (three in Tbilisi, one each in Imereti, Kvemo Kartli, and Adjara) by 2024
- Commission at Ministry of Health reviews all applications to determine beneficiary eligibility and initially prescribed rehabilitation cycles, with plans to shift full cycle design to providers after first year
Rehabilitation service types, specialists, session duration and costs in Georgia
Table extracted from the guideline
| Service type | Specialist | Time per session (min) | Price per session (GEL) |
|---|---|---|---|
| Multidisciplinary team assessment (incl. individual rehabilitation plan) | Doctor, physiotherapist, occupational therapist, other professions as needed | 60 | 227 |
| Individual physiotherapy | Physiotherapist | 30 | 39 |
| Individual physiotherapy: Aqua therapy | Physiotherapist | 30 | 40 |
| Lymphatic therapy | Doctor, nurse | 60 | 78 |
| Occupational therapy | Occupational therapist | 30 | 45 |
| Speech and language therapy | Speech and language therapist | 45 | 50 |
| Psychotherapy | Psychologist | 45 | 76 |
| Provision and training in assistive products | Physiotherapist, occupational therapist, prosthetist/orthotist | 45 | 56 |
| Education of patients, families and caregivers | Doctor, nurse, other professions | 60 | 72 |
| Rehabilitation doctor consultation/supervision | Doctor | — | 54 |
Source: World Health Organization, Using the Package of Interventions for Rehabilitation in Georgia. Reproduced in summary form.
From the guideline
Verbatim
“In 2020, there was no mention of rehabilitation in the national health plans or reporting; it was addressed only in the disability legislation and policy frameworks.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
Georgia's integration of rehabilitation into UHC represents a significant advance for our region, where rehabilitation has historically been siloed within disability and social protection systems rather than health. As someone who has worked extensively with WHO on health system strengthening in the Caucasus, I find the stepwise approach—starting with three high-burden neurological conditions at outpatient level before expanding to five conditions and inpatient services—to be pragmatic and replicable. The most critical recommendation for Georgian clinicians is to establish immediate referral pathways from acute stroke units and trauma centres to authorized rehabilitation providers; the documented delays of 4–18 months post-injury that result in contractures and spasticity waste scarce rehabilitation resources treating preventable complications. However, we must acknowledge the implementation reality: with only six authorized centres concentrated in Tbilisi, Batumi, and three other cities, equitable geographic access remains a major barrier, compounded by additional out-of-pocket costs for transport, accommodation, and medications that the state package does not cover—costs that disproportionately burden rural and socially vulnerable populations despite the tiered funding structure. The concurrent development of national clinical guidelines for these five conditions, based on the PIR interventions, is essential and overdue; clinicians need standardized protocols to ensure evidence-based, consistent care quality across providers.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
This document is directly relevant to Georgia as it documents the country’s own rehabilitation integration process; it serves as a practical template for other South Caucasus and Eastern European countries pursuing UHC and rehabilitation strengthening. The stepwise approach—starting with three conditions at outpatient level before expanding—offers a realistic model for resource-constrained settings. Countries in the region will need to adapt the prioritization criteria to their own epidemiological profiles, conduct workforce assessments (Georgia estimated 500 physiotherapists, 300 PRM physicians, 30 speech therapists, 25 occupational therapists, and only 3 prosthetist-orthotists nationally in 2020), and address similar challenges around delayed acute-phase rehabilitation, fragmented financing across health and social sectors, awareness gaps among referrers and patients, and the need for national clinical guidelines and service standards to accompany benefit package implementation.
Questions this guideline answers
Quick answers
Which health conditions are covered by Georgia's rehabilitation service package?
Initially, outpatient rehabilitation for stroke, traumatic brain injury, and spinal cord injury. The plan is to expand to include fractures and amputation, then add inpatient acute and subacute rehabilitation for all five conditions as budget allows. Cerebral palsy, vision impairment, hearing loss, intellectual development disorders, and autism already had existing state-funded packages and were therefore excluded.
How did Georgia use the WHO Package of Interventions for Rehabilitation (PIR)?
The PIR served three key functions: (1) its list of 20 high-burden conditions informed prioritization using YLD data and a multi-criteria scoring system (cut-off >20); (2) evidence-based interventions for each condition were mapped to Georgian rehabilitation service types to define the package content; and (3) intervention descriptions informed costing by estimating session numbers needed per service type, phase, and severity level.
Who is eligible for state-funded rehabilitation in Georgia and what proportion of costs are covered?
Patients with stroke, traumatic brain injury, or spinal cord injury diagnosed within 24 months, medically stable, able to participate actively and follow one-step instructions. Socially vulnerable persons (rating ≤70 000), internally displaced persons, and state care residents receive 100% funding; teachers, veterans, pensioners, and students receive 90%; others receive 80%. Rehabilitation is funded for up to 90 days per cycle; subsequent cycles require >10% improvement on the Functional Independence Measure.
What were the main challenges identified after nine months of implementation?
Delayed initiation of rehabilitation (sometimes 4–18 months post-injury) led to preventable complications (contractures, spasticity) consuming rehabilitation time; low uptake due to insufficient awareness among health workers and patients required national awareness campaigns; additional out-of-pocket costs for co-payments, transport, accommodation, and medications created financial barriers; and lack of standardized referral pathways, clinical guidelines, and service quality standards at programme launch complicated implementation.
Related on GMJ
Interconnected resources
Dictionary of Public Health
Conditions A–Z
GMJ News coverage
- Heat Exhaustion and Heat Stroke on Safari: Clinical Recognition and PreventionOct 2026
- Post-stroke heart failure triples risk of poor outcome in large vessel occlusion patients treated with endovascular therapySep 2026
- Setmelanotide shows promise in treating acquired hypothalamic obesity, new trial demonstratesSep 2026
- Lab-grown brain circuits challenge 'irreversible' spinal cord injury paradigmJul 2026
ASF accreditation standards
Other guidelines on this topic
- Falls: assessment and prevention in older people and in people 50 and over at higher risk
- Health Technology Assessment of Medical Devices, 2nd edition
- Framework for the Response of Integrated Health Service Delivery Networks to COVID-19
- Checklist for the Management of Human Resources for Health in Response to COVID-19
- Promoting health equity, gender and ethnic equality, and human rights in COVID-19 responses: Key considerations
- Issuer
- World Health Organization
- Type
- Publication
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-01-27
- Languages
- English
- Scope
- Country case study documenting the development and implementation of a state-funded rehabilitation benefit package using the WHO Package of Interventions for Rehabilitation (PIR) in Georgia's Universal Health Care Programme, covering five priority health conditions (stroke, traumatic brain injury, spinal cord injury, fractures, amputation) with initial implementation for three neurological conditions at outpatient level.
- Audience
- Health policy-makers, rehabilitation service planners, health financing specialists, rehabilitation professionals (physicians, physiotherapists, occupational therapists, speech therapists, psychologists), WHO country offices, and ministries of health in low- and middle-income countries seeking to integrate rehabilitation into universal health coverage.
- Pages
- 47
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978–92–4-010510–2
- Evidence
- Expert consensus and technical working group methodology; prioritization based on YLD data from Global Burden of Disease 2019 and multi-criteria scoring; intervention selection mapped from WHO's evidence-based Package of Interventions for Rehabilitation; costing and implementation informed by national stakeholder consultations and nine-month evaluation.
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
Using the Package of interventions for rehabilitation in Georgia. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
