Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

Abstract

BackgroundThe large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building.MethodsA qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge.ResultsCapacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated.ConclusionSouth African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.

Provider core competencies for improved Mental health care of the nation

“…It emphasises a recovery model of mental health care, while also reflecting the activities of health promotion and prevention prioritised in PHC-R. 105 The proposed PHC-focused mid-level rehabilitation worker (MLRW) will be specifically trained in these areas and will work under the supervision of rehabilitation therapists. 105,106 Whether they are going to be called mid-level workers or whether they will be recognised by the HPCSA and employed by the State with an NQF laddered career path towards a health professional qualification is unclear at this point. It is envisaged that selected psychosocial interventions identified for delivery by trained non-specialist health care workers could also be included in their training, (see Chapter 1) with appropriate supervision from other mental health care practitioners (for example, nurses and therapists) in accordance with guidelines for task shifting provided by the WHO (2008).…”

A chasm: Consequences of poor collaboration between health and education in paediatric cerebral palsy care in Johannesburg

“…Nearly 20 years since the development of the NRP and WP6, strides have been made in both the health and education sectors to implement policy in order to improve accessibility to all rehabilitation services and thereby improve the quality of life of children with disabilities (Department of Basic Education, 2015 ). Yet, anecdotal evidence as well as research conducted by the National Department of Health ( 2016 ), Louw et al ( 2018 ) and Ned et al ( 2017 ) suggests that limited collaboration exists between these sectors, resulting in continued fragmented and uncoordinated service delivery.…”

“…Furthermore, the framework states that appropriate referral pathways create access to suitable care and these must be aligned with departmental policy. Louw et al (2018) stated that access to effective rehabilitation is a basic human right and that rehabilitation has the ability to economically optimise health outcomes and the overall quality of life. However, the 20 rehabilitation professionals (physiotherapists, occupational therapists, SLTs, podiatrists, rehabilitation managers or directors) who participated in Louw et al's (2018) study stated that, despite the South African government's efforts to re-engineer public healthcare, rehabilitation services at primary healthcare level have not improved (Louw et al, 2018).…”

Tailored training for physiotherapists on the use of clinical practice guidelines: A mixed methods study

“…Nilsen (2015) noted the international challenge of contextualising tailored knowledge translation strategies to translate best‐evidence approaches into local practice (Nilsen, 2015). The South African Guidelines Excellence (SAGE) project described CPG‐use in South African primary healthcare (Kredo, Machingaidze, Louw, Young, & Grimmer, 2015), highlighting knowledge translation challenges in South Africa that are not experienced in many developed countries (Dizon, Grimmer, Machingaidze, Louw, & Parker, 2018; Dizon, Grimmer‐Somers, & Kumar, 2011; Louw et al, 2018). This particularly relates to complex contextual barriers that may hinder effective local South African uptake of best evidence (Eisenberg, 2002; Ridde, 2016).…”