RURAL REHAB SOUTH AFRICA (RuReSA): SUBMISSION ON THE NHI
2011-11-04
1. RE-ENGINEERING PRIMARY HEALTH CARE (PHC)
1. Holistic health. Health is a state of physical, mental and social well-being. Mental Health Care (MHC) and rehabilitation
services (in terms of primary, secondary and tertiary prevention) form an integral part of PHC and health promotion,
prevention1, early identification and early intervention services should be provided for in all three PHC streams at district,
community, household and school level.
2. A broad approach to improving access to services. Efforts to improve access to health care services for children and adults
with disabilities should be inter- and multi-sectoral (including all government and civil society stakeholders) and aimed at
removing barriers to access in the overall physical environment (e.g. financial, transport, roads) and not only in terms of access
to facilities (health and school).
3. Mental Health Care (MHC) and rehabilitation services. The availability of MHC and rehabilitation services for children
and adults at all levels of care, including household and community, will improve access to care for those unable to attend
clinics due to financial, transport and physical barriers. (It should be noted that barriers to accessing ID documents and
obtaining official refugee status might seriously hamper access to health. No person may be refused health care, regardless of
his or her inability to pay for it. This requires urgent and serious consideration.)
4. Human resources for rural PHC services. Creative solutions and additional funding will be required to provide universal
coverage of rural MHC and Rehabilitation needs. Of concern is the lack of attention given to the provision of human resources
for MHC and rehabilitation services in the Re-engineering PHC document.
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It is estimated that 50% of disabilities are preventable and directly linked to poverty (Department of International Development (2000) Disability, Poverty and
Development. DFID
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5. District, clinic and community posts for health therapists and mid level workers (MLWs). The additional number of
health therapists2 and MLWs (including Occupational Therapy Technicians) as well as appropriate transport vehicles will be
needed in order to reach the population at risk for impairment and disability.
6. Assistive devices and specialist practitioners. If the government is serious about improving access to health care for children
and adults with disabilities, then a wider range of quality assistive devices3, appropriate for rural use, need to be made
available on state tender. This will of necessity include the availability of health therapists at district level, as well as
specialized practitioners for Orientation and Mobility (O&M) for people with visual impairment, Augmentative and
Alternative Communication (AAC) for children and adults with little or no functional speech (LNFS) 4. A substantial increase
in budgeting for assistive devices for children and adults will be required.
2. NATIONAL HEALTH INSURANCE (NHI)
1. Representation and consultation: Rural Rehab South Africa (RuReSA) urges the government to include rural and urban
allied health therapists (including Psychologists) in the consultation process when addressing the staffing, services and
equipment norms and standards at various levels of care in the NHI. Rural-based health therapist experts should be
represented on the NHI and allied health experts should be included on the Technical Advisory Committee of the NHI, when
setting norms and standards at different levels of care, and developing accreditation and assessment criteria for the NHI.
Treatment protocols for children and adults should be developed in conjunction with rural health therapists, who should be
included in diagnosis related groups (DRGs) and consequent performance management, that are not limited to medical
interventions.
2. Management and staffing levels. Greater emphasis should be placed on improving management and staffing levels for
improved health outcomes for children and adults (especially in rural areas). The understanding that rural areas have different
needs in terms of human resources (HR), financial requirements and autonomy should be implicit and there should be a clear
understanding that rural approaches are required in order to respond to rural community health needs.
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Health therapists are Occupational Therapists, Physiotherapists, Speech and Language Therapists and Audiologists
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Assistive devices for persons with visual impairment and communication difficulties
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Little or no functional speech (LNFS) is defined as less than 12 words
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3. Rehabilitation services are required at all levels of care (primary, secondary and tertiary), from district to centralized and
specialist hospitals. Methods of service delivery and acuteness of care differ across the spectrum due to specific circumstances
in rural areas, namely the historical lack of specialist and financial resources, technology and transport.
4. Rehabilitation midlevel workers (MLWs). The concept of rehabilitation MLWs is still a highly contentious issue among
health therapists. A representative consultative forum should be held regarding the role and scope of rehabilitation MLW and
their training and registration that are envisioned within the NHI. Community Care Givers (CCGs) will require to be sensitized
to child and adult disability issues, to be trained to screen children and adults at risk for impairment and disability and refer
appropriately, but will not be competent to provide basic rehabilitation interventions, or measure, order and issue assistive
devices.
5. Human resources for Rehabilitation and MHC services. The emphasis on providing access to appropriate care (especially
at household level) within the re-engineering PHC system will demand an increase in health therapists, psychologists and
rehabilitation MLWs at community level (with the required additional resources of transport and accommodation). This
increased need of appropriately trained allied health workers i.e. health therapists and MLWs will need to be reviewed at
tertiary level in terms of curriculum as well as numbers trained.
6. Monitoring and Evaluation (M&E) - Rehabilitation indicators. Currently district rehabilitation indicators describe outputs
and not outcomes and these should be revisited as a matter of urgency. At the national level the only rehabilitation indicator in
the National Indicator Data set (NIDS) gives data on new assistive devices issued annually (wheelchairs, walking aids and
hearing aids).
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