Disability & rural health: - PowerPoint Presentation

Slide1

Disability & rural health:proofing what for whom?

Kate SherryRHAP Rural-Proofing Program Stakeholders’ Forum 26th November 2013Slide2

Rural Rehab South Africa

Founded September 2011Physio, Occupational Therapy, Speech Therapy, Audiology2-fold purpose: - Policy

input (NDOH, NDOE)

- Promoting rural careers for therapists, including: - Training institution input - Rural therapists’ support network - Development of best practice Slide3

So what is “rehab”?Slide4

Disability in contextSlide5

Disability as a development issue

Links with poverty: Disabled people = 20% of poorest people (World Bank in Yeo 2003)Links with rurality: 80% of chronically poor households = rural (Aliber 2001)Links with MDG’s: Cannot eradicate poverty unless PWD’s are included in development efforts (Lee 1999)

Population estimates: 4-10%, depending on source and definitionsSlide6

Population at risk of/affected by disability

Quadruple burden of disease: - HIV/AIDS & TB –> neurological, developmental, and other impairments

- NCD’s –>

stroke, amputation, loss of eyesight, loss of vital capacity, MENTAL HEALTH

- Maternal & child care –> birth trauma leading to neurological and developmental impairments, birth defects, intrauterine impairment (e.g. FAS) - Trauma & violence -> SCI, TBI, orthopaedic, mental health

sequelae

MAJORITY

of health-care users are at risk (NB prevention)

Most households

will have a disabled member at some pointSlide7

Role of environment in determining level of participation restrictionSlide8

So what do therapists do

?Slide9

Ways of thinking about disability

“Medical model”: - Individual, problem-centred focus Intervention response: “Fix what is broken” Services: technical, institution-centred, individual-focused

Blind spot: impairments that cannot be “fixed”Slide10

Ways of thinking about disability (2)

“Welfare model” - Individual (sometimes family), basic needs & maintenance focus Intervention response: “care” Services: traditionally institution-based

Blind spots: long-term sustainability, isolationSlide11

Ways of thinking about disability (3)

“Social model” - Focus on barriers in society, aim at full participation Intervention response: create environments that aim at inclusion- “community-based rehabilitation” (CBR) Services: integrated, community-based,

multisectoral

Blind spot: value of technical rehabilitationSlide12

So what?

Each model dictates different service emphasis, different service delivery platformCurrent international thinking most strongly influenced by International Classification of Functioning (ICF) (WHO,2001)

System of describing functioning of person with a health condition (replacing “disability and handicap”)

Attempts

balance between need for individual/technical rehab and community-level interventionsGlobal “best practice WHO Guidelines on Community-Based Rehabilitation (2010)Slide13
Slide14

CBR: what does it mean?

Rehab belongs to every sector, not just health “Rehabilitation” used in 2 senses – the whole picture

, AND the

technical service

offered under health clusterShares principles with PHC: accessibility, affordability, sustainability, community participation, etc Slide15

In South Africa:

Strong disability movement during 1980’s and 1990’s – relatively progressive policy put in place by post-1994 administrationIntegrated National Disability Strategy (1997)Policies

based on CBR exist in

Health

(National Rehab Policy, 2009), Education (White Paper 6 on Inclusive Education, 2001) and Social Development (DSD Policy on Disability, 2010), amongst othersHealth has been the most proactive sector, employs the majority of rehab therapistsNonetheless, implementation of the NRP has not really been realised Slide16

Key policies for rehab in South Africa

Constitution of South Africa (1996)Integrated National Disability Strategy (1997)Norms & Standards for a Comprehensive PHC Package (2000 & 2010) National Rehabilitation Policy (2000)

Community Service for Rehab Professionals (2003)

Assistive Devices Policy (2003)

Uniform Patient Fees System (annual)Free Health Care for PWD’s (2003)UN Convention on the Rights of PWD’s (2006, ratified by SA 2007)Slide17

A picture of the sector

Split between disability movement and (mainstream) professionalsFragmentation within disability movementProfessional territorialism and lack of unityTertiary, institution-focused, and private sector weightingMid-level worker debateLack of national and provincial leadership in public sectorSlide18

Recent progress

Public sector professional forums move for joint meetingProfessional organisations desire to increase public sector membershipTraining institutions: increased PHC focusRural community service placements SA ratifies UNCRPD

National Rehabilitation Task Team

Role of

RuReSASlide19

Rehab in health sector context

Competition of priorities: underrated by managers and officials Rehab/disability is a stigmatised and overlooked

issue

Impact on

institutional placement and power Impact on HR: recruitment and retentionPolicy as PROCESS (Walt & Gilson 1994):

e.g. research in

Umzimvubu

subdistrict

, Sherry & Watson

2010Slide20

Rehab as a “silo” is ineffective

Disability needs to be integrated in every program, at every level – if it is to be addressed at all

A major attitude shift is neededSlide21

Health policies need to be disability

-proofed, as well as rural-proofedSlide22

3 aspects to rural rehab policy work

Getting basic disability/rehab policies in placeMaking sure these are rural-friendlyMaking sure all

health policies are disability-friendlySlide23

Getting basic rehab policies in place

Historical lack of clear service level agreements – provincially dependent, no benchmarksE.g. NHI Rehab Task Team

– service delivery platform & basic service package, staffing allocations Slide24

Rural issues in rehab

ACCESS ACCESS ACCESSTerrain and infrastructureEconomic implications

HR challenges

Sustained engagement with service

Service model: home & clinic based- OUTREACH broad scope mid-level worker cadre continuity of care, record-keeping & tracing

time allocations Slide25

Ensuring rehab policies are rural-friendly

Examples:Mid-level worker debate: generic vs profession-specificStaffing structure e.g. KZN 2013Slide26

Ensuring health policies are rehab-friendly

Examples:CCG level 1 training (2012): presence of a disabled person signifies a vulnerable householdAll standard treatment guidelines: need to include referral to rehab – audit implications

Access to services (DPW, other)

: include sign-language interpreters, large-print/braille text, multiple media, strategies for reaching a hard-to-reach population, physical access, signage, security/assistanceSlide27

Backing other rural-rehab-friendly policies

E.g. PHC re-engineering:Shift to household-levelStrengthen CHW networks

Prevention and health promotion

We

add:Outreach budgeted and planned forDistrict hospital as hubMid-level rehab workers at clinic level

Role of therapists in schools addressedSlide28

Where to from here?

Need for baseline dataRural-friendly basic rehab package Commitment to HR and budget

Translation at

provincial

levelIntegration across programs within healthUnite disability sector for stronger voiceTackle other sectors…Slide29

Thank you!Questions?