Doctor Scientiae / Following the introduction of the Health Act of 1995, the Primary Healthcare Package
for South Africa, a set of norms and standards was developed in 2000, to ensure
good quality of care and to act as a guide to provide good service at this level of
care. Related to this, and bringing health services to the people, was the aspect of
rehabilitation. It was highlighted that rehabilitation services should be restructured
and strengthened in order to improve access to these services for those who did not
have them before. This led to the development of the National Rehabilitation Policy
in 2000, which focused on improving accessibility to all rehabilitation services, in
order to facilitate the realisation of every citizen’s constitutional right to have access
to healthcare services, but this policy was not implemented. During 2002, the
Department of Health produced a strategic plan for the reshaping of public health
services in the Western Cape. This initiative, Healthcare 2010, the Future for Health
in the Western Cape 2020, mapped the way forward to improve substantially the
quality of care provided by the health service. This plan was based on the primary
healthcare approach and aimed to shift patients to more appropriate levels of care. It
became evident that in order to move forward with the 2020 vision, there needed to
be a greater understanding of the current situation.
This study focused primarily on the aspect of rehabilitation, with a specific focus on
systematic review and three dimensions of the process of care, namely patient
information; service provider information; and realised access. These dimensions
assisted in evaluating the rehabilitation service in order to understand what was
happening in the delivery of rehabilitation services, focusing on the experiences of
patients with physical disabilities, as well as service providers and caregivers, and
realised access that included satisfaction of all participants in the rehabilitation
centres. Hence the aim of this study was to evaluate the process of care at three
selected rehabilitation centres in the Western Cape Province within the contextual
framework of the National Rehabilitation Policy (NRP) and the United Nations
Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in
achieving this aim, objectives were developed as follows: to determine the reported
barriers and facilitators to rehabilitation services through a systematic review; to
determine the profile of patients with disabilities accessing rehabilitation services at
three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending
rehabilitation centres in the Western Cape Province; to explore clients’ perceptions
of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions
of and satisfaction with the rehabilitation services; to explore the experiences of
service providers with the rehabilitation services; and to map the links between the
experiences and perceptions of the key stakeholders.
This was an evaluation study, which was primarily descriptive, with the focus on
process evaluation. Process evaluation provides an indication of what happened,
and why. The study was conducted at three rehabilitation centres in the Western
Cape Province. Voluntary participation of patients, service providers and caregivers
was gained by signing a consent form. Both qualitative and quantitative methods of
data collection were used in this study. Questionnaires were used for quantitative
data collection and SPSS version 17 and 21 was used to analyse the data. Focus
group discussions and in-depth interviews, which were based on interview guides
and tape recorded, were used to gather information on experiences and perceptions
of all the participants. Quantitative data capturing was checked for errors by using
excel spread sheets, where data was entered twice in two different spread sheets
and checked for differences, as responses were coded by using numbers.
Qualitative data was checked for errors by following the trustworthiness process
where data was transcribed verbatim, and where necessary translated by two
different translators to ensure accuracy. The researcher consulted with the
supervisors during data analysis to enhance quality in the coding process and
identification of themes and relevant quotations.
Results showed that barriers to rehabilitation outnumbered facilitators of the
rehabilitation process. There was a gap identified in the profile of the patients with
regards to their rehabilitation needs. Records of the patients had missing information
posing a challenge to data collection and possible presenting a distorted picture of
service provision. However, records showed that not all rehabilitation professionals
were not consulted during the rehabilitation process of care. Ninety-five percent
(95%) of the clients consulted with physiotherapists, whereas only 4% consulted
social workers. Rehabilitation service providers did not reflect a rehabilitation team.
There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals.
Service providers were negligent with some of the processes to be followed when
consulting clients, such as getting consent to treat the patient and educating patients
regarding their ailments, which then affected satisfaction of the patients. However,
there were also positive aspects like treating patients with respect and allowing
patients to ask questions during consultation. Caregivers on the other hand were
satisfied with the rehabilitation process, as they found the centre easily accessible
for their family members and were involved in the rehabilitation of the patients.
In conclusion, the rehabilitation process was satisfying to the participants of this
study. The main challenge that patients and caregivers experienced was financial
constraints. Staffing remains a problem in rehabilitation centres in the Western Cape
Province, as there were not enough staff for rehabilitation service delivery at these
selected rehabilitation centres. Other staff members were not utilised during the
rehabilitation process. These findings raise issues for the Western Cape Department
of Health to consider regarding rehabilitation, as people with disabilities are not
receiving optimal care. The study makes recommendations to the Department of
Health in the Western Cape Province regarding the improvement of the rehabilitation
process of care.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uwc/oai:etd.uwc.ac.za:11394/4078 |
| Date | January 2013 |
| Creators | Mlenzana, Nondwe Bongokazi |
| Contributors | Frantz, J. |
| Publisher | University of the Western Cape |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Rights | University of the Western Cape |
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