Assessment of the availability and accessibility of rehabilitation services in a rural district of South Africa

This research examines the availability and accessibility of rehabilitation services in South Africa from a health policy and systems perspective and uses the Capability Approach as the theoretical framework for the whole study. The key components of this research are: 1) rehabilitation policies 2) rehabilitation service capacity and 3) perspectives from people with disabilities as users of the service. My study employs both quantitative and qualitative designs to address the research questions. The policy component qualitatively examines the extent to which South Africa's policies facilitate access to rehabilitation services in the public sector through a review of policies for the period 1994-2019. The rehabilitation service capacity complements the policy review by establishing the readiness of district hospitals in a rural district of South Africa to provide these services using an adapted health facility assessment tool. The health facility assessment includes a quantitative descriptive assessment of the infrastructural accessibility of the health facility, and the availability of assistive devices, equipment, and the rehabilitation workforce. The combined findings from the policy review and the service capacity then inform a qualitative description of the implementation gap. In order to understand the contributing factors to this implementation gap, interviews with health facility rehabilitation managers were conducted to explore these further. Finally, interviews with people with physical disabilities uncover the barriers and facilitators to accessing the rehabilitation services in the included district hospitals. The findings point to important gaps in rehabilitation services in the district across all components of the services. Further, these supply-side gaps reinforce each other and interact with prevailing demand-side barriers to constrain access to rehabilitation services for people with physical disabilities. My study makes a theoretical contribution by expanding the Capability Framework, and then concludes with key recommendations