In many contexts, especially but not limited to some low- and middle-income countries, the occupational therapy workforce is scant or inexistent, with scale up or expansion efforts often impeded by a lack of local capacity for occupational therapy education. National or international investment and technical support is needed for expanding education; developing local capacity to absorb, deploy, and manage a workforce expansion; and estimating and measuring both the cost and benefit of expansion efforts.

Problem and opportunity

Occupational therapy is underdeveloped as a profession in many countries worldwide. When available, occupational therapy is often concentrated in a few services and areas, thereby accessible to only a fraction of the population.

Identified weaknesses ^{9 16 17 23}

The occupational therapy workforce is scarce and often absent in many LMIC contexts, hence unable to meet even basic health, rehabilitation, and occupational needs of the population.
In many LIMICs, occupational therapy education programmes are also absent or underdeveloped, limiting capacity for development and scale up of the profession.
Many HICs are also not self-sufficient in education capacity for needed occupational therapy services and thereby rely on international recruitment, causing a ‘brain drain’ from LMICs that critically need occupational therapists.
Low recognition of the value of function and participation for health and wellbeing, with the result that the focus of occupational therapy on improved occupational engagement and functioning rather than survival or other medical outcomes often lowers priority of the occupational therapy profession in the health agenda, particularly in low-resource countries with multiple unmet health needs.
Few economic analyses are conducted for occupational therapy (e.g., return on investment studies) to assist in developing a case for investment in the scale up of the occupational therapy workforce.

Opportunities for advancement of occupational therapy

There are now numerous WHO-developed and other cross-stakeholder global initiatives for strengthening rehabilitation services and scaling up the respective human resources. Global tools or frameworks are available as result of these endeavours (e.g., WHO Rehabilitation Competency Framework; Guide for Rehabilitation Workforce Evaluation).^{19 24 31 32}

Outcomes related to improved independence and increased societal participation can justify the investments needed for the scale-up of the occupational therapy workforce, if studied.⁹
Although far from meeting population needs, data collected by WFOT indicates an approximate 137% rise in the number of occupational therapists globally since 2006.¹
Resources available from WFOT such as the Minimum Standards for the Education of Occupational Therapists³³ have supported the development of the profession and the 83% rise in the number of occupational therapy education programmes across the world during the same time frame.³⁴
WFOT actively supports and guides nations that are developing the first education programme in a country or region, often meeting with governments, educational institutions and local leaders to advocate for the need for occupational therapy education that meets the Minimum Standards for the Education of Occupational Therapists.³³

Objectives

Long-Term Goals (three cycles of four years)

The occupational therapy workforce is scaled up in underserved contexts as a result of planned, sustained investments focused on increasing the local or national capacity to educate and employ occupational therapists to substantively reduce supply shortages.

Short-Terms Goals (one cycle of four years)

Economic analyses are conducted to support the scale up of the occupational therapy workforce in underserved contexts, with international technical support as necessary.
Capacity-building initiatives are deployed to increase occupational therapy education, with international technical support as necessary.

Specific actions and tasks

The actions focus on three main action levels: first, quantifying scale-up investment needs, costs, and benefits; second, advocating for and translating quantified investment needs into scale-up and policy action; and third, building education and deployment capacity, with international support as needed.

Quantify investment needs for the expansion of the occupational therapy workforce, identifying costs and potential benefits.

a. Determine the full-time equivalents needed for the scale up of occupational therapists in the context of service delivery models, scopes of practice, and health system and population needs.

b. Quantify the initial and ongoing investment costs for increasing occupational therapy workforce education and employment to meet scale-up needs.

c. Perform economic analysis of benefits of the investment beyond their cost, considering broader societal impacts for investing in scaling up the occupational therapy workforce.

d. Determine regional or nationwide scale-up and investment needs and benefits for the occupational therapy workforce, extending from any local or sector-level analysis.

Advocate and translate expansion needs into occupational therapy workforce investment programmes and policy decisions.

a. Identify the interests, values, objectives, and incentives for stakeholders who can influence an expansion policy decision and its implementation.

b. Use data to justify investments in the scale up of occupational therapy or related service areas.

c. Translate knowledge on the economic, health system, and population benefits of expanding the occupational therapy workforce for decision-makers.

d. Contribute to the development, implementation and monitoring of nationwide or regional expansion plans for the occupational therapy workforce or broader health workforces.

Build occupational therapy education and deployment capacity.

a. Establish regional, cross-national coalitions to build capacity, knowledge, and resources for the scale up of occupational therapy education, governance, regulation and continuous development.

b. Provide international assistance to fund and support local education of occupational therapy graduates in nations with scale-up needs, particularly where severely underdeveloped.

c. Build international partnerships, including across regions, to create scale for funding, and to technically support, develop, and share knowledge about local initiatives to develop the occupational therapy workforce.

d. Build and/or use existing tools to support capacity building (e.g., WFOT Minimum Standards for the Education of Occupational Therapists, WHO Rehabilitation Competency Framework).

e. Assess and develop programmes to reduce professional and student attrition rates and optimise the deployment of occupational therapists and its graduates.