Even within nations, inequities exist in the distribution of occupational therapists and population access to occupational therapy services. Inequities in access are commonly defined by factors such as geographic region, urban /rural / remote location, and sector, service, or practice area. With strengthened workforce data and supply shortage determinations, these inequitable distributions within nations can be identified and addressed. Actions may include enhancing recruitment or retention packages, building professional development programmes for those working in underserved areas, or using innovative service delivery models or workforce strengthening approaches that extend the outreach of the occupational therapy workforce to vulnerable populations.

Problem and opportunity

The occupational therapy workforce needs to be accessible across geographic areas (e.g., in rural versus urban locations), service levels or practice areas (e.g., in mental health or school-based practices) or sectors (e.g., public versus private), according to population needs, scope of practice, and service requirements. However, disparities in the occupational therapy workforce distribution are common and result in inequitably served populations.

Identified weaknesses^{9 16 17 23}

Rural populations are typically underserved by the health workforce due to difficulties in recruiting and retaining qualified professionals. In the occupational therapy literature, rural areas have often been identified as underserved in both HICs and LMICs.^{32 35}
Difficulties to fill occupational therapy vacancies have been found for some practice areas, including in mental health occupational therapy, although research indicates such recruitment problems are context-sensitive and do not apply equally to all countries.³²
Inequitable distribution of occupational therapists per sectors and country regions also affects population access. As an example, in South Africa the scarce supply of occupational therapists is concentrated in the private sector of the wealthier regions and thereby the service is inaccessible to the majority of the country’s population.^{11 36}

Opportunities for advancement of occupational therapy

Innovative service delivery models (e.g., tele-rehabilitation, community-based or outreach programmes, integration into primary care) are possible means toward extending access to qualified occupational therapists to underserved areas, especially rural or remote regions.^{26 37 38}
Other workforce strengthening activities include prioritising more advanced^39-41 and supervisory tasks for occupational therapists, for example using tele-monitoring or videoconferencing to guide and support rural-based, lower level or community-level workers or practitioners.^{42 43}
Novel areas of practice (e.g., in primary care^{37 41 44 45}) can enhance the outreach of occupational therapy practice to local communities and populations, yet job opportunities and the workforce supply to fill existing positions remain limited.⁴⁶

Objectives

Long-Term Goals (three cycles of four years)

Systematic reduction of disparities in access to occupational therapists as a result of better workforce distribution (e.g., by geographic and practice areas) and of equity-oriented workforce strengthening programmes (e.g., recruitment, retention, and professional development of the rural workforce).

Short-Terms Goals (one cycle of four years)

Determination of inequities in distribution of occupational therapists and population access to occupational therapy defined by factors such as region, rural and remote areas, or by sector, service, or practice area.
Development / implementation of workforce strengthening measures (e.g., recruitment or retention packages, workforce deployment programmes, or professional development programmes) for improving equitable access to occupational therapy.
Study and implementation of innovative service delivery models that extend the outreach of the occupational therapy workforce to underserved populations.

Specific actions and tasks

The actions focus on the identification of inequitable distribution and population access to occupational therapists, as well as on an examination of factors and workforce strengthening solutions for effective workforce deployment. Finally, there is a focus on innovative service delivery models that extend the outreach of occupational therapists.

Monitor the distribution of occupational therapists to address inequities in population access to occupational therapy services.

a. Develop mechanisms for monitoring equitable population access to the occupational therapy workforce.

b. Identify disparities in population access and use of occupational therapy services, and in the supply of occupational therapists by geographic areas, sector, or service/practice areas.

c. Identify populations experiencing the greatest disparities in access to occupational therapy services.

d. Develop and use workforce datasets, regularly updated, that are inclusive of where occupational therapists work.

Identify contributing factors and intervention programmes to address inequities in access to occupational therapy.

a. Determine barriers and facilitators to the deployment of occupational therapists in underserved locations, sectors, or practice areas.

b. Test evidence-based employment solutions to reduce population inequities in access to occupational therapists (e.g., recruitment and retention packages for underserviced areas).

c. Test evidence-based educational solutions to reduce population inequalities in access to occupational therapists (e.g., rural-based student recruitment and fieldwork opportunities).

d. Deploy and evaluate equity-based incentives for occupational therapists in underserviced areas (e.g., rural add-on payments, service awards, outreach incentives, housing and child support services, loan repayment programmes, specialisation, credentialing, professional development opportunities).

e. Evaluate evidence-based self-employment programmes or incentives to reduce population inequalities in access to occupational therapists in underserviced areas (e.g., reduce administrative barriers, fees, or financial disadvantages of operating in less-resourced, remote or less densely populated contexts).

f. Involve interested groups (e.g., policy-makers, health system planners, public health authorities, professional representatives) in addressing inequities in the access to occupational therapy services.

Develop and implement innovative service delivery models and workforce strengthening measures that extend access to the occupational therapy workforce.

a. Study and implement innovative service delivery models that extend access of underserviced populations to occupational therapy providers and services.

b. Reduce barriers for occupational therapists to remotely deliver services.

c. Develop continuing education and practice tools for competent and effective use of technology-driven interventions (e.g. tele-rehabilitation, mobile rehabilitation, or tele-monitoring solutions) to bridge gaps in accessibility of occupational therapy services.

d. Optimize the use of skilled occupational therapy human resources within their core competencies and scope of practice (e.g., supervision and training of formal and informal caregivers, developing and implementing community-based and outreach programmes).