A description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centere
Date
2014-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
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.
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.
Description
Thesis (M Human RehabSt)--Stellenbosch University, 2014.
Keywords
Dissertations -- Rehabilitation, Theses -- Rehabilitation, People with disabilities -- Rehabilitation -- Government policy -- South Africa, People with disabilities -- Rehabilitation -- South Africa -- Evaluation, UCTD