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Dear Editor
Rehabilitation is increasingly recognized as a core component of well-functioning health systems, essential for improving health, functioning, and a key pillar of universal health coverage (UHC) [1]. According to the Global Burden of Disease Study 2019, approximately 2.4 billion people globally could benefit from rehabilitation services [2]. However, in many low- and middle-income countries (LMICs), including Iran, access remains inadequate, particularly due to fragmented service delivery, limited workforce capacity, and weak governance structures [3]. In Iran, access to rehabilitation services is marred by regional inequalities, lack of comprehensive financing, and insufficient data systems [4]. Globally, rehabilitation remains underdeveloped in resource-constrained settings, making it a pressing health system priority [5]. Recent global momentum, including the World Health Organization (WHO) rehabilitation 2030 initiative and the World Health Assembly resolution on strengthening rehabilitation, has underscored the centrality of rehabilitation within UHC [6]. However, translating these commitments into effective national action requires robust governance mechanisms, which remain insufficiently developed in many LMICs, including Iran. 
In this context, we recently conducted a study to validate a Rehabilitation System Governance Evaluation Questionnaire for Iran, designed to assess key domains, including policymaking, strategic planning, organization, stewardship, and control, building on existing governance frameworks [7]. The findings of this study highlight critical governance gaps that help explain the persistent fragmentation of rehabilitation services in the country. In particular, the results point to weak inter-sectoral coordination, a lack of a unified national strategy, and insufficient monitoring and accountability mechanisms. These deficiencies are compounded by limited integration of rehabilitation into health financing structures and information systems, ultimately constraining equitable access to services [4]. 
While a comprehensive report of the validation study’s methodology and detailed results is presented in a full research article (currently in preparation), this Letter to the Editor aims to rapidly translate the key governance findings into policy recommendations for strengthening rehabilitation within Iran’s UHC framework.
These findings reinforce that rehabilitation challenges in Iran are not merely technical or resource-related, but fundamentally governance-related. Without coherent leadership, clear institutional arrangements, and accountability frameworks, efforts to expand rehabilitation services risk remaining fragmented and inefficient [8]. Comparative studies have emphasized that countries that integrated rehabilitation within their broader health governance structures achieved better service coverage and system efficiency [9].
Addressing these gaps requires a shift toward more integrated and participatory governance. Rehabilitation must be explicitly embedded within national health policies and UHC strategies, supported by clear regulatory frameworks and sustainable financing mechanisms [6]. Strengthening institutional structures, such as dedicated units within the Ministry of Health, can enhance coordination among sectors and stakeholders. 
Improving system integration is also essential. Incorporating rehabilitation into primary healthcare, insurance benefit packages, and national health information systems can reduce fragmentation and financial barriers while enabling better monitoring of service delivery and outcomes [2]. In addition, investing in capacity-building among policymakers and managers and developing comprehensive data systems are critical for evidence-informed decision-making.
Governance reform must be accompanied by stronger accountability and stakeholder engagement. Establishing transparent oversight mechanisms and regular national reporting can improve system performance, while actively involving civil society, non-governmental organizations, and people with disabilities can enhance responsiveness and public trust [3].
Rehabilitation governance should be recognized not as a peripheral concern but as a foundational element of health system performance. Given that many people worldwide can benefit from rehabilitation services, strengthening governance structures is essential for achieving equitable and efficient rehabilitation systems. Aligning these reforms with global UHC commitments offers a timely opportunity to ensure that rehabilitation is fully integrated into the health system and responsive to population needs. Iran has an opportunity to reform its rehabilitation system by embedding governance at the center of service delivery. We urge policymakers, health leaders, and researchers to prioritize governance reforms to ensure that rehabilitation is no longer sidelined but recognized as a vital element of health system performance and social equity.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research. 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors contributed to the concept, drafting, and final approval of the comment.

Conflict of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors thank the experts and stakeholders who contributed to developing the governance evaluation questionnaire.