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Rehabilitation is a vital component of health systems, essential for enhancing functioning, independence, and quality of life. Globally, the 2019 Global Burden of Disease study estimates that 2.4 billion people require rehabilitation services. In low- and middle-income countries like Iran, access remains limited due to fragmented delivery, workforce shortages, regional disparities, inadequate financing, and weak governance structures.

Despite international momentum from the WHO Rehabilitation 2030 initiative and the 2023 World Health Assembly resolution urging integration of rehabilitation into health systems, governance in Iran's rehabilitation sector remains underdeveloped and under-researched. To address this, we validated the Iranian Rehabilitation System Governance Evaluation Questionnaire, adapted from prior frameworks, to assess key domains: policymaking, strategic planning, organization, stewardship, and control. This tool enables evidence-informed evaluation in the Iranian context.

Robust governance underpins efficient, equitable rehabilitation systems. The World Health Organization emphasizes that without strong leadership, coordinated policies, and accountability mechanisms, expansion efforts risk inefficiency and fragmentation. Comparative analyses show that countries integrating rehabilitation into broader health governance achieve superior coverage and performance.