Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study
Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.
Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.
Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator
Background: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital.Methods: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data.Results: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills.Conclusions: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.Keywords: Post Graduate Training, Family Medicine, Procedural Skills, Rural, District hospitals
Leadership and the functioning of maternal health services in two rural district hospitals in South Africa
Using caregivers’ perceptions of rehabilitation services for children with Cerebral Palsy at public sector hospitals to identify the components of an appropriate service
Despite a growing body of evidence favouring a family-centred approach to rehabilitation services for children with cerebral palsy (cp), the essential components for a quality service for children with disabilities and their families living in poorly-resourced South African (SA) settings remains unknown. The study aimed to identify key components of an appropriate rehabilitation service which would meet the needs of children with CP and their caregivers at SA public sector hospitals. This cross-sectional descriptive study used the modified Measure of processes of care (Mpoc-20) questionnaire together with two open-endedquestions with a convenience sample of caregivers attending therapy at CP Clinics in gauteng and limpopo hospitals. A total of 263 caregivers attending cerebral palsy clinics at 31 public sector hospitals in gauteng and limpopo were interviewed. Kind and caring attitudes, exercises or “training” for the child, and practical assistance (handling ideas and suggestions, assistive devices, food supplements, nappies, advice) were components of care most valued. The most frustration was caused by long queues waiting for files or at the pharmacy and being treated disrespectfully whilst providing caregivers with information and explanations regarding treatment choice were services that could be improved. Key components for an appropriate therapy service include caring and respectful attitudes, hands-on therapy, handling suggestions and practical assistance. Logistical and administrative procedures together with disrespectul and unhelpful attitudes negatively impact rehabilitation service delivery.
Staffing rural hospitals through Umthombo Youth Development Foundation (UYDF) in South Africa: Challenges and Opportunities
Abstract Despite the governments ‘healthcare for all’ focus since the country’s first democratic election in 1994, many rural district hospitals in South Africa have struggled to find and retain adequate staffing levels in order to be able to deliver on the District hospital package of services. Many of these hospitals have relied on non-profit organisations and other privately owned institutions to assist them in improving their staffing levels and service delivery. Umthombo Youth Development Foundation (UYDF), a NPO’s started in 1999 at one rural hospital in the Province KwaZulu-Natal, provides funding to youth from rural areas to study a health science degrees with the understanding that they will return to serve at their rural-based hospitals. This review describes the role that UYDF has played in assisting rural-based hospitals with recruiting and retaining staff, the relationship between UYDF and hospitals, the ‘UYDF’ model, as well as the challenges and opportunities presented through the partnership between UYDF and rural district hospitals. It aims to inform and contribute to health policy initiatives that can help rural-based hospitals to recruit, attract and retain staff. Using a case study research design, existing data was used to present a detailed descriptive analysis of the UYDF health education and employment model. The results from this research paper suggest that the model provides a solution which can address the problem of hospital staffing, and that if challenges are managed, other rural-based hospitals in the country could benefit from the model.
Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape
Background: Understanding caregivers’ views on rehabilitation services is important as it may assist in informing healthcare services and patient management.Objectives: The aim of this study was to explore caregivers’ perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field.Method: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts.Results: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery.Conclusion: Based on the participants’ feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.
Contributing Factors to Implementation Gaps in Rehabilitation Services in South Africa: Perspectives from health facility-level Rehabilitation Clinician-Managers
Abstract Previous studies have examined health policy implementation globally. However, few studies have examined policy implementation as it relates to rehabilitation services. This study aimed to report on the factors which may be contributing to policy implementation gaps in rehabilitation services in a rural district of South Africa. Qualitative semi-structured interviews were conducted with rehabilitation providers who have both clinical and managerial duties in health facilities. The framework method was used to guide analysis. Findings suggest that gaps between rehabilitation policy and the available services may be attributable to a lack of systems hardware and the presence of maladaptive systems software. Additionally, the limited ability of rehabilitation managers to exercise their power to plan and organise rehabilitation services constrained policy implementation. The implications of this work point to the need to better include rehabilitation managers in priority setting and resource allocation processes at the level of the health facility.