A description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centere

Liebenberg, Handri (2014-04)

Thesis (M Human RehabSt)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Rehabilitation services, mainly rendered by therapists employed by the Department of Health, forms a critical part of the Primary Health Care (PHC) package of care. Different policies, within the Department of Health (DOH), provide guidance on rehabilitation service delivery. However, implementation of these policies remains a challenge. The current study aimed to describe and analyse the organisational capacity of rehabilitation services at the study site and to assess how congruent the rehabilitation service at the study site was with existing rehabilitation policy. A descriptive methodology was applied making use of both quantitative and qualitative methods in analyzing the organisational capacity of this study site and the alignment of rehabilitation services offered, with the National Rehabilitation Policy (NRP). The study used the Kaplan framework, the objectives of the NRP and specific selected articles of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to develop indicators to be used for the description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centre. Questionnaires based on seven objectives from the NRP were developed to collect quantitative data from five service providers, the facility manager of TC Newman CDC and the managers of two Non- Governmental Organisations (NGO) working in the drainage site. Face to face, audio recorded, semi- structured interviews were used to collect qualitative data from the five service providers. A folder audit and document review was used to enhance quantitative findings. After analysis of the data, I still felt the need for additional information and thus developed an open ended questionnaire for participants to complete. Barriers (e.g. defaulting of clients, a lack of standard documentation, poor monitoring and evaluation) and facilitators (e.g. outreach and support, competent staff and multi-disciplinary team) were identified in implementing the NRP. Participants highlighted the importance of accessing rehabilitation services with a focus on the outreach to peripheral clinics and funded NGO’s. Intersectoral collaboration is evident, but mainly with funded NGO’s. A lack of standardised documentation, inadequate monitoring and evaluation systems and uniformed documentation were some of the challenges identified by participants. The absence of participation by persons with disabilities was noted by all participants. With reference to the organisational capacity, the participants had a good understanding of rehabilitation within the PHC context. Participants felt confident in delivering rehabilitation services and were able to identify shortcomings in service delivery. It is concluded that rehabilitation services are not delivered exactly in accordance with the objectives of the NRP. However the organisation demonstrated capacity to deliver rehabilitation services at PHC level, but there is still a need to enhance service delivery on community based level. The results of this study gave me as a manager and implementer of health policy in the District Health System the opportunity to gain deeper insight as to how rehabilitation services are currently rendered. Results from the study highlighted how coherent rehabilitation service delivery is with current policy in health and the capacity of the organisation to deliver rehabilitation services. This gave me the opportunity to adjust and review current rehabilitation service delivery and implement changes, as the study progressed.

AFRIKAANSE OPSOMMING: Rehabilitasie word hoofsaaklik deur terapeute in die departement van gesondheid gelewer binne fasiliteite en vorm ‘n belangrike deel van die Primêre Gesondheid Sorg dienste (PGS). Daar is verskillende beleid binne die Departement van Gesondheid beskikbaar, wat rehabilitasie definieer. Ten spyte van beleid, bly die implimentering van hierdie beleide ‘n uitdaging. Hierdie studie het ontstaan om the kapasiteit van die organisasie te beskryf, om rehabilitasie dienste te implimenteer en ook te bepaal hoe hierdie dienste ooreenstem met die Nasionale Rehabilitasie Beleid (NRB). ‘n Beskrywende metodologie was gebruik, wat uit ‘n kwantitatiewe en kwalitatiewe deel bestaan het. ‘n Vraelys is ontwikkel op grond van die 7 doelwitte beskryf binne die NRB. Dit is gebruik vir die versameling van kwantitatiewe data, by vyf diensversakffers, `n gesondheidsbestuurder en die bestuurders van twee nieregerings organisasies. Kwalitatiewe data is verkry deur onderhoude met die vyf diensverskaffers. ‘n Oudit van pasiënt lêers en die evaluering van dokumente het kwantitatiewe data versterk. Na die analisering van data en die behoefte vir addisionele inligting, is ‘n oop-end vraelys ontwikkel en versprei na deelnemers om te voltooi. Die studie het die organisatoriese kapasiteit van die organisasie ontleed deur gebruik te maak van Kaplan se raamwerk vir organisasie kapasiteit en die doelwitte van die NRB, asook sekere geselekteerde artikels uit die “United Nations Convention of the Rights of Persons with Disabilities” UNCRPD. Deelnemers het belangrikheid van toegang tot rehabilitasie dienste bevestig, met ‘n fokus op uitreik na perifêre klinieke in die sub distrik en befondse Nie-Regerings Organisasies (NRO). Intersektorale skakeling was beskryf, maar beperk tot befondse NRO’s. Verskillende uitdagings soos bv. gestandardiseerde dokumentasie, onvoldoende monitering en evalueringssisteme en die dokumentering van inligting was geïdentifiseer. Die afwesigheid van persone met gestremdhede en hulle deelname by terapie was genoem deur deelnemers. Verskillende uitdagings asook fasiliteerders was geïdentifiseer deur deelnemers t.o.v die implementering van bestaande beleid.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86671
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