Analysis of the disability framework and strategy in South Africa: access to healthcare for persons with disability
Date
2020
Authors
Hussein El Kout, Naeema Ahmad Ramadan
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Abstract
Background: The prevalence of disability is increasing across the globe and disability rights are not upheld. Currently in South Africa, there is no disability policy except for the framework and strategy for disability and rehabilitation which seeks to address inequalities in health care access for people with disabilities and promote rehabilitation across the continuum of health. The framework and strategy for disability and rehabilitation has been developed for 2015-2020 and it aims to improve access to health care. Analysis of policy has been recommended to expose gaps in the processes, and recommendations for future policy. To date the analysis for framework and strategy for disability and rehabilitation has not been conducted.
Aim: To review the framework and strategy for disability and rehabilitation in South Africa, related to access to health care for persons with disabilities.
Method: A qualitative single case study design comprising of a document review and key informant interviews with twelve key informants was employed. A framework approach was used to analyse data obtained from both the document and the key informant interviews. In accordance with the framework approach, inductive and deductive thematic analysis was done, utilising the predetermined dimensions of the Walt and Gilson triangle framework for health policy analysis, and Penchansky and Thomas framework of access to health care.
Results: Findings indicated that, there was a broad range of role players in development of the framework and strategy for disability and rehabilitation, with the exclusion of health economists. The context of the FSDR included global legislation, situational and structural factors. There was a lack of alignment of the content to access to health care, resulting in a minimal distributional impact of the document. Development and implementation followed a top down approach with no formal monitoring and evaluation of the FSDR. Barriers to the processes of the FSDR include a lack of leadership and resources, and poor staff attitudes. Facilitators of the FSDR processes were a broad range of actors, mentorship and a case study.
Recommendations: The development of a comprehensive framework for monitoring and evaluation of disability policy is recommended. These study findings suggest a need for disability training and conscientisation amongst rehabilitation staff and the general public to ensure improved awareness of
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disability and rehabilitation. Furthermore, the barriers to the policy processes need to be addressed to ensure adequate policy implementation and monitoring.
Conclusion: The framework and strategy for disability and rehabilitation lacked alignment to access to health care specific to Penchancky and Tomas (1981) theory of access, and despite facilitators to the processes, multiple barriers to the processes resulted in poor outcomes of the FSDR. Further research of the analysis of the FSDR at national level is needed, prior to the formation of a disability policy for SA.
Description
A research dissertation submitted in fulfilment of the requirements for the degree of Master of Science in Physiotherapy to the University of The Witwatersrand, Johannesburg, 2020