Strengthening the occupational therapy workforce in low-resource contexts: guidance, tools, and examples derived from the World Federation of Occupational Therapists Global Strategy

Occupational therapists promote occupational performance and engagement in activities that give value and meaning to life for individuals and communities experiencing, or at risk of experiencing physical, mental, and other impairments and disabilities (World Federation of Occupational Therapists, 2019). About 2.4 billion people are currently estimated to have health conditions or disabilities that would benefit from rehabilitation (Cieza et al, 2021). While the population need for rehabilitation and occupational therapy services has risen worldwide (Jesus et al., 2019), it has increased the most in low- and middle-income countries (LMICs) (Jesus et al., 2019, 2022a). Given increased life expectancy, global ageing of the population, and rising rates of chronic and non-communicable conditions, the growing population need for occupational therapists is likely to continue to increase over time, particularly in LMICs (Jesus et al., 2019, 2022a) where the occupational therapy workforce is often underrepresented or absent (Jesus et al., 2023a).

Data from the World Federation of Occupational Therapists (WFOT) for 2024 show that 47% of member organizations had <1 occupational therapist per 10,000 population, including many LMIC nations with <0.001; this finding contrasts with some high-income countries (HICs) which can have up to 24 occupational therapists per 10,000 population (World Federation of Occupational Therapists, 2024a). Furthermore, many LMICs do not have occupational therapy education programmes, professional regulation, or continuing competency requirements, which hampers the expansion and continuous development of the profession (Jesus et al., 2022b, 2023a; Agho & John, 2017). Inequitable distribution of the workforce also occurs within many countries, including in LMICs. For example, in South Africa, many occupational therapists are deployed in densely populated provinces, whereas 74.8% of the occupational therapists work in the private sector serving merely 16% of the country’s population (Ned et al., 2020). Finally, a scoping review of occupational therapy workforce research found that LMICs accounted for a total of 11% of the occupational therapy workforce research publications (Jesus et al., 2023b), despite these countries collectively accounting for over 75% of the global population need for rehabilitation services (Jesus et al., 2019).

WFOT launched the Global Strategy for the Occupational Therapy Workforce in late 2024 for strengthening access to occupational therapy. While applicable to nations of all income levels, the Strategy is particularly relevant as a guiding framework in LMICs and low-resourced contexts. WFOT also developed tools to collate, host, and disseminate practical information for implementation of the Global Strategy. This commentary aims to describe these recent developments, with a focus on LMICs and other contexts with low occupational therapy workforce resources. In the view of public interest, this commentary is published simultaneously in the Brazilian Journal of Occupational Therapy, South Africa OT`ASA, WORK: A Journal of Prevention, Assessment & Rehabilitation, and Philippines eFocalPoint to reach a wider audience.

WFOT Global Strategy for the Occupational Therapy Workforce

The WFOT Global Strategy was developed by a team with experience of working across HICs and LMICs. The guiding framework was the result of a multi-year, 10-step development process that included scoping reviews, situational analyses, expert consultation, surveys and focus groups with national WFOT delegates from across the world (Jesus et al., 2021, 2022b, 2023a, 2024; Bhattacharjya et al., 2024).

The Strategy contains seven strategic directions (see Figure 1), ranging from developing occupational therapy workforce data, to building workforce leadership and planning capacity. A rationale is provided for each strategic direction, as well as a description of long- and short-term goals, specific guidance for action, and examples of operationalisation tasks.

Figure 1
Global Strategy for the Occupational Therapy Workforce.

The Global Strategy is expected to be used by professional organisations, educators, regulators, researchers, governments and nongovernment organisations, including WFOT. The Global Strategy aims to be a guiding framework with key domains for action, but is not itself an action plan. It is intended that each country, region or area establish its own, context-sensitive priorities and actions for workforce strengthening. We invite readers to consult the full document, including its executive summary, on the website of the World Federation of Occupational Therapists (2024b).

WFOT Workforce Hub

To provide access to tools and examples of actual practices in strengthening the occupational therapy workforce, the WFOT recently launched the Global Occupational Therapy Workforce Hub on the website of the World Federation of Occupational Therapists (2024a). This open access, online repository provides a central location to share or consult resources on specific topics and activities related to the Global Strategy. Guides/toolkits, best practices, policy or position statements, research papers, datasets, case studies, interactive contents/websites, and other resources are available on the Workforce Hub. Resources can be searched within the scope of each of the seven strategic directions of the WFOT Strategy (Figure 1), or by keyword, language or resource type.

A recently developed WFOT resource, available as part of the Hub, is a new portal with interactive workforce data derived from the WFOT Human Resources Project. This initiative on the website of the World Federation of Occupational Therapists (2024a) describes occupational therapy workforce supply and distribution, education programmes and other national-level occupational therapy workforce data from over 100 WFOT member organisations. The data has been collected by WFOT every two years since 2006, providing valuable insights regarding the development of the profession over the past two decades.

All organisations and individuals are encouraged to contribute relevant resources to the Workforce Hub. With a crowdsourcing approach, we invite you to share resources to allow others to learn from your work and experiences. As an example, the “OT ECHO” project, an International Interprofessional Mentorship Program is a crowdsourced resource recently uploaded to the Hub relevant to LMIC. The resource provides no-cost, remote continuing professional development opportunities for occupational therapists around the world through a tele-mentorship group (Castillo & McKinnon, 2025). The tele-mentorship program has enabled participants to form relationships, gain knowledge from qualified experts in specialty practice areas, and increase confidence in their clinical skill sets (Castillo & McKinnon, 2025; Barlow & Sullivan, 2022).

Webinar Series and Examples of Action from LMICs

Since October 2024, WFOT has hosted a series of webinars on topics related to implementation of the Global Strategy. Each webinar has provided practical examples of initiatives implemented at a regional or national level in contexts facing an undersupply of occupational therapists.

The first WFOT webinar in late 2024 introduced the Global Strategy, including its development, structure, guidance and associated tools. The plans of the Bermuda Occupational Therapy Association to develop the profession to meet the Bermuda Health Strategy illustrated key elements of the WFOT Global Strategy. The presentation highlighted the relevancy of the WFOT Strategy for a context with only a small supply of approximately 35 occupational therapists.

The second webinar, focused on leadership, advocacy and policy for workforce planning, included a presentation from the Occupational Therapy Association of South Africa. The presentation outlined the reflective journey associated with advocating for occupational therapy during recent health policy reforms in South Africa.

The Colombian College of Occupational Therapists demonstrated the valuable use of social media in the collection of workforce data in the third webinar that focused on data and research for building occupational therapy human resources. The presentation illustrated how high engagement with digital tools promoted the feasibility of using online surveys for workforce data collection in Colombia.

During 2025, additional webinars are planned on the topics of workforce management and retention, and occupational therapy education and scholarship. Registration in these webinars, as well as access to recordings of past sessions are available at World Federation of Occupational Therapists (2025). Access to all upcoming and past sessions is cost free.

WFOT’s Ongoing Developments

The WFOT is one among other agents of change facilitating the strengthening of the occupational therapy workforce worldwide. For example, WFOT is working with the World Health Organization (WHO) on a pilot study for the National Health Workforce Accounts. This pilot project involves the collection of detailed workforce data from 25 WFOT member organisations to demonstrate the future viability of including occupational therapy data in the WHO National Health Workforce Accounts. Success of this pilot study has significance for the future availability of important data for workforce planning at the international, national and local level. Success may also demonstrate the importance of re-categorisation of occupational therapists in the International Standard Classification of Occupations (ISCO) published by the International Labour Organization, a cause that has been the subject of a long-standing WFOT lobby. Unfortunately, occupational therapists are currently found in the ISCO under ‘Health Professionals Not Elsewhere Classified’, a nonspecific category that hampers data collection and workforce development for the profession.

Other examples of WFOT collaboration with WHO relate to Rehabilitation 2030, a broad ranging initiative geared towards the inclusion of occupational therapy and other rehabilitation professions in services covered by Universal Health Coverage. Examples of WFOT activities include nominating expert occupational therapists to committees tasked with defining priority rehabilitation interventions, as well as providing expert consultation for the development of instruction modules for the provision of assistive technology.

Findings from the WFOT Human Resources Project highlight mental health is a specific practice area with shortages of occupational therapists for funded positions in 31% of member organisations. A global survey was conducted by WFOT to identify barriers and facilitators for occupational therapy practice in mental health. From the 1102 responses obtained from 67 countries or territories, factors such as waiting times, service funding, intervention costs, and therapist availability were identified as barriers to occupational therapy practice. A statistically significant higher reporting of safety concerns was found in LMICs (Jesus et al, 2025). These findings, in addition to consultations planned with member organisations will be used by WFOT to inform specific guidance to develop practice in mental health, in alignment with the Global Strategy for the Occupational Therapy Workforce.

Conclusion

To meet the growing population needs for occupational therapy, the occupational therapy workforce must be systematically strengthened worldwide, particularly in low-resource contexts. The WFOT Global Strategy for the Occupational Therapy Workforce provides strategic guidance for the strengthening of the profession. To operationalise the Strategy, WFOT has developed cost-free tools and resources that enable regional, national, and local agents of change to strengthen the profession within their own context. As a key crowdsourcing approach, the WFOT invites the sharing of resources through the newly created Workforce Hub.

The Global Strategy serves as a call for action for all individuals and organisations to work together to improve access to occupational therapy. Each country, region or area needs to establish its own, context-sensitive priorities and actions for workforce strengthening. It takes a ‘village’ to strengthen the profession worldwide. The WFOT and its resources are just one part of this global village.

• How to cite:
  Jesus, T. S., von Zweck, C., Ledgerd, R., & World Federation of Occupational Therapists. (2025). Strengthening the occupational therapy workforce in low-resource contexts: guidance, tools, and examples derived from the World Federation of Occupational Therapists Global Strategy. Cadernos Brasileiros de Terapia Ocupacional, 33, e2501. https://doi.org/10.1590/2526-8910.ctoED332025012

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Publication Dates

• Publication in this collection
  07 July 2025
• Date of issue
  2025