Institutional mechanisms excluding rehabilitation from medical education in Central Africa: A mixed-methods case study from Cameroon with implications for WHO regional strategy implementation
Bibliographic record
Abstract
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. Additionally, we implemented and assessed a 4-h rehabilitation education module for final-year medical students ( n = 87) at the University of Dschang. 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. • Medical curricula in Central Africa systematically exclude rehabilitation training. • Educational gaps create physicians unable to recognize rehabilitation indications. • 847 clinical observations document consequences: inappropriate referrals, therapeutic migration. • Minimal exposure (4 h) at University of Dschang generated significant student interest. • Curriculum integration represents cost-effective pathway for WHO Strategy implementation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".