Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990–2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates

Abstract

Background Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)‘s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability. Methods This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012–2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018–2022). Results Trends for YLDs counts per condition year (1990–2017) and forecasted values (2018–2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions. Conclusion Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.

Rehabilitation and primary care treatment guidelines, South Africa

“…South Africa has a unique epidemiological profile and the need for rehabilitation services is substantial. 24 Although life expectancy increased between 1990 and 2017, the country is experiencing colliding epidemics of communicable and noncommunicable diseases, which have changed disease profiles and trends. In addition, people are living with increased morbidity and a poorer quality of life, both of which can be ameliorated by rehabilitation.…”

“…A 2021 analysis found that almost 60% of all years lived with disability in South Africa were due to conditions amenable to rehabilitation, including ( Fig. 1 ): 24 (i) human immunodeficiency virus infection and acquired immunodeficiency syndrome (with resultant tuberculosis); (ii) chronic respiratory disease; (iii) type 2 diabetes mellitus; (iv) low back pain and other musculoskeletal disorders; (v) age-related and other hearing loss; (vi) neonatal disorders; (vii) congenital birth defects; (viii) lower limb, upper limb, spinal and multiple fractures and dislocations; (ix) cardiovascular disease and stroke; and (x) burns.…”

“…Note: The figures in parentheses represent the number of years lived with disability per 100 000 population based on 2019 Global Burden of Disease data for South Africa. 24 …”

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

“…YLDs are increasing at a higher rate in low- and middle- income countries (LMICs), compared to high- income countries (HICs) [ 7 ]. In South Africa (SA), YLDs due to health conditions that contribute to most disability increased by about 270% from 1990–2017, with a further 6% predicted increase from 2017–2022 [ 8 ]. Thus, health systems in LMICs need to adapt in response to the epidemiological transitioning reflective of high levels of morbidity and functioning problems [ 9 ].…”

“…This was done by describing the most prevalence types of functioning problems (impairments, activity limitations and participation restrictions). These functioning problems were associated with the top 10 conditions contributing most to years lived with disability in South Africa and for which evidence-based rehabilitation interventions to address associated disability exist [ 8 ]. The most prevalent functioning problems were mapped to the ICF framework.…”