Describing the Rehabilitation Workforce Capacity in the Public Sector of Three Rural Provinces in South Africa: A Cross-Sectional Study

Abstract

The World Health Organisation emphasises the importance of addressing gaps in health systems where rehabilitation services are poorly integrated. In South Africa, regions with the largest disability rates are usually the areas where rehabilitation is least accessible, due to inadequate workforce capacity. The first step towards addressing workforce capacity is to determine current capacity. This paper presents a cross-sectional study to describe rehabilitation workforce data in the public sector of three rural South African provinces. A web-based therapist survey and a telephonic facility survey was conducted. Data were collected regarding total number of therapists per province, age, years employed, qualifications, salary level, profession type, level of care, and rural/urban distribution. Descriptive statistics were conducted, while Chi-squared tests compared professions regarding highest qualification and salary level. Population-adjusted ratios were calculated using national uninsured population statistics. The web-based survey had 639 responses while the telephonic survey reported on 1166 therapists. Results indicated that the mean age of therapists across the respective provinces was 28, 35 and 31 years of age, and the mean employment years in the respective provinces were three, eight and five years. Most of the workforce (n = 574) had a bachelor’s degree as their highest qualification. A total of 27% of the workforce were community service therapists and 61% of therapists earned a production-level salary. Occupational therapy was best (40%) and speech and audiology therapy least (7%) represented. Three percent of therapists worked at primary level, versus eighty percent at secondary level. Forty percent of therapists worked in rural areas. Workforce density per province ranged from 0.71–0.98 per 10,000 population. Overall, results show that the rehabilitation workforce density is low, and that the distribution of therapists between rural and urban settings, and levels of care, is inequitable. Considering the rise in rehabilitation need, prioritisation and strengthening of the rehabilitation workforce capacity is vital to ensure integration across all levels of care and service.

Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review

“…This provides a sobering picture of the reality of the complexity and immensity of rehabilitation needs resulting from the high prevalence and wide range of functioning problems in the adult populations presenting to primary care. Yet, only 6–20% of PHC facilities provide rehabilitation services in South Africa [ 16 ]. The NHI seeks to provide adequate and relevantly skilled health workers especially at primary care [ 18 ].…”

“…The limited public sector resources has to fund many competing health needs considering the high burden of disease. Furthermore, one in five adult South Africans present with multimorbidity [ 15 ] and associated functioning problems are notable but rarely addressed, especially at primary care level where only 6% of the total rehabilitation workforce work [ 16 ]. Thus, integrating rehabilitation services will require strong advocacy supported by relevant data on functioning needs to inform service planning.…”

Rehabilitation Capacity in South Africa—A Situational Analysis

“…We focused our assessment on the public health sector since the majority (about 84%) of the South African population utilises the public sector of health care [ 29 ], and thus excluded questions on non-state rehabilitation services. Additional data collected on human resources were reported on in another published manuscript [ 30 ].…”

“…To collect human resource data, the rehabilitation managers in four of the five provinces networked with lead clinicians or managers at each rehabilitation facility to obtain information on the total number of each type of therapist, and the total number of therapists by province. We previously published detailed procedures for collecting and validating information on rehabilitation workforce personnel and human resources [ 30 ]. The fifth province required permission from each health facility, which was not logistically possible within the study timeframe, as this province has more than 800 facilities.…”

Bridging the chasm between patients’ needs and current rehabilitation care: perceptions of adults presenting for primary care in the Eastern Cape

“…Rehabilitation forms one of the five pillars of primary care [ 13 ] and must be integrated into PHC to effectively meet the needs of the population. Currently there is a shortage of rehabilitation professionals at primary care, especially in rural areas [ 14 ]. Access to rehabilitation services in PHC is often contingent on initial consultation and referral by primary care providers (PCPs) at Community Healthcare Centers or Clinics, who are often nurses or doctors.…”