Occupational therapy graduates' reflections on their ability to cope with primary healthcare and rural practice during community service

Abstract

Health reform in post-apartheid South Africa (SA) has been geared to improve health outcomes and rectify historical inequalities 1,2. The majority of the SA population (70%) generally access the public health system while only 18,4%, with medical insurance, access the much better resourced-private healthcare system 3. The district health system facilitates the delivery of services in the public sector through geographically-zoned districts where services are offered at quaternary, tertiary, secondary, district and primary levels 4. Factors such as the burden of disease, trauma and violence led to the implementation of the National Health Insurance (NHI) by the Department of Health (DoH) to ensure greater access to health 5-6. The primary healthcare (PHC) plan acknowledges "health care as a universal right, encompassing the promotion of healthy living, early disease detection, prevention and treatment, community-based disease management and rehabilitation" 6:1. The re-engineered PHC plan is key to the success of the NHI 7. Occupational therapists form part of the multidisciplinary teams that provide rehabilitative, preventative and promotive programmes in hospital and community settings. Despite the positive intent of the health policies, implementation at grassroots level remains a problem. A key challenge for occupational therapy relates to an expectation that they offer services at community-and primary health care (PHC) clinics, in addition to those already being rendered at the district hospital level 8 .

The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa

“…In South Africa, most therapists with less than 2 years of experience will be doing community service in rural or underserved areas where working conditions are relatively challenging (Naidoo et al 2017;Singh et al 2015). Hence, newly qualified therapists will be more attracted to CPD activities that offer them opportunities to learn through practical and interprofessional approaches (Naidoo et al 2017), and this was confirmed in this study.…”

Changing demographic trends among South African occupational therapists: 2002 to 2018

“…There are very few plans aimed at recruitment and retention of occupational therapists beyond community service to the public sector. The lack of posts in the public sector is one of the primary reasons for poor retention of community service therapists [30]. Other push factors include restricted resources, poor supervision, cultural incompetence, feelings of unpreparedness for the skill set required [7,9,22,31] negative exposure to rural and urban experiences during training, favouring urban over rural placements, proximity to home, family contact, relationships and dependents [32].…”

The role of Occupational Therapy in Africa: A scoping review

“…Witchger-Hansen and Blaskowitz 75 demonstrate a successful occupational therapy community-based vocational training program for Tanzanians with physical disabilities, finding improvements in occupational performance ratings specifically in regards to involvement in income-generating activities. Understandably, this requires African occupational therapy educational programs to incorporate CBR skill development, including skills in program development, evaluation and management, particularly through practice placements in local community settings, to ensure therapists are knowledgeable and competent in CBR practice approaches [75][76][77][78] .…”