Towards strengthening of rehabilitation at primary care : exploring the needs and perspectives regarding rehabilitation services in two South African and Zimbabwean settings
Date
2024-03
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Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Introduction: There is an escalating demand for rehabilitation as a health strategy globally. The growing burden of health-related disability, particularly pronounced in low-and-middle-income countries (such as South Africa and Zimbabwe) will strain the already-compromised health systems. This juxtaposition of growing functioning problems and reportedly poor rehabilitation, notably at primary care, signifies an important gap towards strengthening of rehabilitation services. Detailed contextual information regarding the patients’ rehabilitation needs is required to inform the development of targeted strategies.
Aim: The overall aim of the study was to explore the type and impact of functioning problems in adults, the associated rehabilitation service needs, and strategies to strengthen primary care rehabilitation in low-resource contexts.
Research setting: The research was conducted across10 systematically selected primary health care facilities in two districts of the Eastern Cape, South Africa (Amathole and Buffalo City), and two districts in Manicaland, Zimbabwe (Mutare Urban and Makoni).
Methodology: The research encompassed three interrelated studies:
Study 1: A scoping review synthesized the status of peer-reviewed literature on functioning problems linked to health conditions contributing significantly to adult disability in South Africa and Zimbabwe. The problems were mapped to the International Classification of Functioning, Disability and Health framework. A web-based application, Rehab4all, was developed to facilitate this review.
Study 2: A qualitative, descriptive study obtained diverse perspectives from 43 purposefully selected adult patients regarding the perceived impact of their functioning problems on their life roles and suggestions on how rehabilitation services can be improved.
Study 3: A qualitative, descriptive study gained insights from 37 primary care providers on current rehabilitation service delivery and innovative ways of enhancing primary care rehabilitation.
Results: A 130 distinct functioning problems were identified from 282 studies. There was a huge lack of evidence on health-related functioning problems among Zimbabwean adult populations. In South Africa, the top 20 functioning problems, with prevalence ranging from 15 – 70.6%, were predominantly related to mobility, pain, and mental health. The South African and Zimbabwean primary health care facilities were ill-equipped to address the wide array of prevalent functioning problems, as rehabilitation services are inadequate, inappropriate, or absent. A complex network of intertwined factors resulted in sub-optimal provision, access to, and utilization of rehabilitation. These factors included patients’ and providers’ lack of interest, awareness, knowledge, and skills regarding rehabilitation, compounded by lack of resources and high levels of undesirable social determinants of health. To improve the current situation, patients and providers recommended multifactorial strategies including education, skills training, community engagement and financial investment to ensure adequate supplies, infrastructure, and human resource capacity.
Conclusion: Patients attending primary health care in South Africa and Zimbabwe have a high but under-recognised need for rehabilitation. The primary health care system falls short in its ability to identify, manage, and support the rehabilitation needs of people with functioning problems. Individuals’ participation in society is further hampered by the lack of development and integration of other government sectors. Achieving transformation in primary care rehabilitation within these countries will require an all- sector and society approach. This involves collaboration and coordination across various sectors and engaging the broader community in rehabilitation service development.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (PhD)--Stellenbosch University, 2024.