INTRODUCTION: In some areas of South Africa, people with impaired mobility are known to have difficulty accessing wheelchairs. This study aimed to critically appraise public healthcare policies addressing service delivery in terms of assistive devices in general, and more specifically wheelchairs within primary health care METHOD: South African public healthcare policies that address assistive device service delivery were identified and thematically analysed using retrospective deductive document analysis. The themes used correspond to the WHO guidelines for the provision of wheelchairs within the context of the guiding principles of primary health care i.e., accessibly, affordability, acceptability, appropriateness, and availability. An analysis was undertaken on how the provision of assistive devices under these principles was addressed RESULTS: Three policies were identified addressing assistive device service delivery i.e. The National Rehabilitation Policy, The Policy Framework and Strategy for Disability and Rehabilitation Services in South Africa 2015 - 2020, and the National Health Insurance Policy. The National Rehabilitation Policy addressed the majority of the WHO guiding principles on wheelchair provision. Guidelines for non-discriminatory and evidence-based service delivery and the availability of assistive devices were identified in all the documents. Scant attention was paid to service delivery of assistive devices for people residing in urban or peri-urban areas. There was a paucity of guidance on service delivery to people with impaired mobility who were unable to access health services, those unaware of the services available and those who were not aware of the benefits of an assistive device CONCLUSION: The policies, viewed together, addressed all the WHO guiding principles, although some gaps were observed in each policy. A proposal emanating from this review was that an update of the National Rehabilitation Policy would address these deficiencies Keywords: assistive devices, health policy, impaired mobility, disability, rehabilitation
Background: Hand osteoarthritis (HOA) is common in older women who seem to cope with the associated limitations in hand function. The importance of identifying coping mechanisms within a local context might have implications for intervention, especially with the introduction of National Health Insurance. Method: A three-phase sequential exploratory mixed methods design was used. The sample consisted of 71 women aged 60 years and over with self-reported osteoarthritis living in Wentworth, Durban. A screening questionnaire, the Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF), as well as semi-structured interviews, were used to explore participants' functional limitations and coping mechanisms. Results: The majority of participants were aged 74 years or younger. Seventy-two per cent accessed health care at the primary healthcare clinic at a seniors' service centre. Eighty-seven per cent reported hand symptoms, 10% had self-reported, doctordiagnosed HOA, although 47% met or partially met the American College of Rheumatology criteria for HOA. The AIMS2-SF identified only one common problem caused with respect to functional limitation and coping mechanisms associated with HOA, i.e. managing vigorous activities. Coping mechanisms by the participants included adapting their lifestyle and activities, having a positive attitude and accepting assistance, including spiritual help.
Conclusion:There is a gap in the screening and diagnosis of HOA, and a lack of appreciation of its bio-psycho-social effect on women's general well-being. Holistic healthcare management was not accessible to the participants, nor directed towards improving their quality of life. Participants accessed support that compensated for therapeutic care through spiritual and other means.
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