Policy implementation in wheelchair service delivery in a rural South African setting

Abstract

BackgroundWheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa.ObjectivesThe aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings.MethodQualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery.ResultsStudy findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost.ConclusionThe gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

Barriers to the Implementation of the Health and Rehabilitation Articles of the United Nations Convention on the Rights of Persons with Disabilities in South Africa

“…For example, research on wheelchair provision in South Africa found that lack of knowledge among provincial managers about the practical challenges was a leading cause of the lack of implementation of the assistive device mandates of the CRPD as well as the South African Department of Health Guidelines. 23 …”

Locally manufactured wheelchairs in Tanzania – are users satisfied?

“…Appreciating the commitment of the government to the rights of people with disabilities in provision of services 2 , the primary objective of this preliminary study was todetermine the extent of satisfaction among users of locally manufactured wheelchairs, as part of the process of monitoring social accountability Overall, the wheelchair users' satisfaction was relatively high. As with other developing countries [9][10][11][12] , participants were satisfied with wheelchair related aspects such as effectiveness of use, safety, and participation in activities, though a small proportion expressed satisfaction with service related aspects. This suggests that the locally manufactured wheelchairs were perceived to be appropriate in meeting the needs of the users.…”

“…The authors however selected to focus attention on the aspects for which wheelchair users have expressed different levels of dissatisfaction. Understanding the reasons for disparities in the level of satisfaction in wheelchair users may not be easy because of the complex and multifaceted process of wheelchair service delivery 11 . Relating to satisfaction with respect to functional needs, the proportion of users who have expressed some degree of dissatisfaction in the use of personal or public transportation (41.3%) cannot be ignored.…”

“…Like other developing countries with limited resources, there is little information about the level of satisfaction among users of various assistive devices [9][10][11][12] . Therefore this preliminary study set out to determine the extent to which locally manufactured wheelchairs met the activity and participation needs of users, and the users' satisfaction with the features and services associated with the provision, repair and maintenance of the wheelchairs.…”

Inequities in health outcomes and access to health care in South Africa: a comparison between persons with and without disabilities

“…For example, many deaf people require sign-language interpreters to reduce communication difficulties between deaf service users and hearing practitioners (Kritzinger et al 2013). In addition, wheelchair users require wheelchairs which are correctly prescribed in accordance with international and national policy guidelines (Visagie, Scheffler, and Schneider 2013).…”