Substance abuse and rural realities : experiences and perceptions of service providers in northern KwaZulu-Natal, South Africa.

Master of Occupational Therapy. University of KwaZulu-Natal, Westville 2014.Substance abuse is recognized as a worldwide problem and in South Africa contributes to significant morbidity and mortality. However, there appears to be concerns in the service delivery especially in rural areas. This is partly due to the minimal South African research that has overlooked the impact of indigenous substances which have affected many, notably those in rural areas and disadvantaged communities. Therefore a qualitative phenomenological study with substance abuse service providers in UMkhanyakude Rural District of KwaZulu Natal, South Africa was conducted. Methods: Focus groups and interviews were conducted with various stakeholders, namely Mental Health Care Teams within hospitals, managers at a District Health Level, social workers and managers from Department of Social Development and fieldworkers and manager of the NGO-Ophondweni Youth Development Initiative in UMkhanyakude District. Results: The findings of the study suggests that service providers experience challenges in service delivery in rural areas of South Africa. These include, culture (amarula festival and ancestral worship) that exacerbates the use of substances, high rate of unemployment and poverty such that people resort to home brewed substances for sustainable living, lack of resources within the respective work places (NGOs and governmental departments) of service providers (staff shortage and equipment/vehicles). The lack of resources is also exacerbated by the geographical isolation of rural areas, consequently, the treatment or rehabilitation is weak and disjointed among stakeholders. Furthermore poor monitoring and evaluation of services coupled with lack of research in rural areas was noted. Strengths included prevention programmes, good inter-sectoral collaboration including strong support from civil societies. Conclusion: The collective perceptions and experiences of rural substance abuse service providers were challenging in rendering the service in rural areas. However, there were strengths or enablers noted. Evidently, the South African acts and policies has overlooked rural areas and a lack of resources exacerbates the situation. It is recommended that protocol and service standard for Substance Abuse Occupational Therapy services for after care and community based rehabilitation should be developed for easier monitoring and evaluation for quality improvement rehabilitation service