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The Experiences of Community Service Rehabilitation Professionals Who Managed 

Their Own Department in South Africa 

 

A dissertation presented to 

The Department of Speech Pathology and Audiology 

School of Human and Community Development 

Faculty of Humanities 

University of the Witwatersrand 

In partial fulfilment of the requirements 

 for the degree Master of Speech Pathology 

 

BY 

Julia Allsop 

1612003 

UNDER THE SUPERVISION OF 

Dr K. Masuku 

 

March 2024 

 

 

 

 

 

 

 



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Abstract: 

Background: 

A compulsory community service year for all healthcare professionals, including rehabilitation 

healthcare professionals was introduced to address the challenges of access to healthcare 

especially in rural South African communities as a result of inequalities brought about by 

apartheid. Even though the focus of the community service year was for healthcare 

professionals to render clinical services under the supervision of a more experienced healthcare 

professional, this has changed over the years. Due to the lack of resources and funding and 

subsequently the shortage of healthcare professionals, community service rehabilitation 

professionals often find themselves placed in healthcare facilities without the supervision of  a 

senior member of staff. Community service rehabilitation professionals therefore end up taking 

up the role of head of department without prior preparation or training. 

Aim: 

The aim of this study is to explore the experiences of rehabilitation community service 

healthcare professionals who have managed their own department during their community 

service year. 

Methodology: 

Semi-structured interviews were conducted with 15 rehabilitation healthcare professionals. A 

purposive  sampling strategy was used to recruit participants. Interviews were conducted online 

via Zoom. All interviews were transcribed verbatim and analysed using a framework analysis 

approach employing Faloy’s five elements of management. 

Findings: 

The following 16 themes demerged from data analysed from the semi structured interviews 

with participants: (i). Undergraduate training does not prepare students for managing a 

rehabilitation department; (ii). Insufficient handover from the previous community service 

therapist and not enough orientation at the beginning of the year; (iii). Create new documents 

that outline plans for their community service year; (iv). Duties expected of a community 

service rehabilitation professional, (iv- a) Clinical duties expected of a community service 

rehabilitation healthcare professional heading a department; (iv -b). Administrative duties 

expected of a community service rehabilitation professional heading a department; (v). Not 

having enough time for clinical and administrative duties; (vi). Co-ordinating with staff 



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members within the healthcare facility; (vii). Discovering outside resources to collaborate with 

to assist with managerial and clinical duties; (viii). Staff negative attitudes towards community 

service rehabilitation professional; (ix). Staff’s lack of knowledge of rehabilitation healthcare 

professions; (x). Meetings with other managers; (xi). Little to no feedback or verification 

structures in place, (xii). Creating a handover for the next community service therapist, (xiii) 

Ethical considerations, (xiii -a) Language barriers, (xiii-b) performing duties outside of scope 

of practice, (xiii -c) Lack of carryover of treatment due to lack of personnel (xiv) Safety, and (xv) 

Emotional toll on community service rehabilitation professionals  

Conclusion: 

Findings from the study suggest the need for different kinds of informal and formal support 

structures that are needed for rehabilitation community service practitioners who have no 

access to a supervisor during their community service year. This includes creating a better 

support network of professionals in the same district who can assist each other as well as better 

support from the healthcare professionals at the healthcare facility. Furthermore, the findings 

highlighted the need for continued professional development (CPD) courses that could be 

capacitate community service rehabilitation professionals who are heading a department by 

focus on providing both practical support and assistance with managerial duties. These 

implications will allow community service rehabilitation professionals to feel more supported 

and have greater confidence in their abilities as a clinician and a manager leading to better 

service given to patients.  

Key Words: 

Community service, rehabilitation healthcare, supervision, rehabilitation professionals 

 

 

 

 

 

 

 



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Table of Contents: 

 

Abstract: ..................................................................................................................................... 2 

List of Tables: ............................................................................................................................ 6 

Declaration: ................................................................................................................................ 7 

Acknowledgements: ................................................................................................................... 8 

Glossary of Terms: ..................................................................................................................... 9 

Chapter 1: Background and Rationale ..................................................................................... 10 

Outline of different chapters included in this dissertation: .................................................. 15 

Chapter Summary:................................................................................................................ 16 

Chapter 2: Literature Review ................................................................................................... 17 

Community Service in The South African Context: ............................................................ 17 

Policy Reforms Pertaining To Rehabilitation: ..................................................................... 19 

Rehabilitation Professions in South Africa: ......................................................................... 21 

Community Service Readiness: ........................................................................................... 23 

Conceptualising Management Using Faloy’s Five Elements of Management: ................... 25 

Chapter Summary:................................................................................................................ 26 

Chapter 3: Methodology: ......................................................................................................... 28 

Research Question ................................................................................................................ 28 

Main Aim ............................................................................................................................. 28 

Sub-Aims:............................................................................................................................. 28 

Positionality:......................................................................................................................... 28 

Research Design: .................................................................................................................. 29 

Study Participants:................................................................................................................ 31 

Table 2: Table of participant demographics ........................................................................ 34 

Study Site: ............................................................................................................................ 36 

Data Collection:.................................................................................................................... 36 

Data Collection Materials: ................................................................................................... 37 

Table 3:Outline of Questions to be included in the interview guide and a theoretical 

justification for each question. ............................................................................................. 37 

Trustworthiness: ................................................................................................................... 40 

Table 4: Table Depicting Trustworthiness Strategies .......................................................... 40 

Ethical Considerations: ........................................................................................................ 43 

Chapter Summary:................................................................................................................ 44 

Chapter 4: Findings .................................................................................................................. 46 



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Table 5: Table depicting the themes mapped onto Faloy’s 5 functions of management. .... 47 

Element 1: Planning ............................................................................................................. 48 

Element 2: Organisation: ...................................................................................................... 53 

Element 3: Co-ordination: .................................................................................................... 56 

Element 4: Command: .......................................................................................................... 59 

Element 5: Control: .............................................................................................................. 62 

Themes That Did Not Align With The Framework of Faloy’s 5 Elements of Management:

 .............................................................................................................................................. 65 

Chapter Summary:................................................................................................................ 70 

Chapter 5: Discussion .............................................................................................................. 71 

Element 1: Planning ............................................................................................................. 71 

Element 2: Organisation ....................................................................................................... 73 

Element 3: Co-ordination ..................................................................................................... 75 

Element 4: Command ........................................................................................................... 77 

Element 5: Control ............................................................................................................... 79 

Themes That Did Not Fit Into The Framework of Faloy’s Five Elements of Management:

 .............................................................................................................................................. 80 

Chapter Summary:................................................................................................................ 82 

Chapter 6: Conclusion and Implications of The Study: ........................................................... 84 

Strengths of The Study: ........................................................................................................ 85 

Limitations of The Study: .................................................................................................... 86 

Implications of The Study: ................................................................................................... 87 

Further Research Topics: ..................................................................................................... 89 

References: ............................................................................................................................... 92 

Appendices:.............................................................................................................................. 98 

 

 

 

 

 

 

 

 



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List of Tables: 

 

 

Table 1: Glossary of Terms: ...................................................................................................... 9 

Table 2: Table of participant demographics ............................................................................ 34 

Table 3:Outline of Questions to be included in the interview guide and a theoretical 

justification for each question. ................................................................................................. 37 

Table 4: Table Depicting Trustworthiness Strategies .............................................................. 40 

Table 5: Table depicting the themes mapped onto Faloy’s 5 functions of management. ........ 47 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Declaration: 

 

I, Julia Allsop, hereby declare that this research project and report are my own work and that 

all due credit has been given to authors whose work was consulted. This work is being 

submitted in partial fulfilment of the degree: Masters of Speech Pathology at the University of 

the Witwatersrand. It has not been previously submitted at this university or any other 

institution. 

 

Signed: __ ___________________________ 

Date: ___14 March 2024___________________________ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Acknowledgements: 

To my research supervisor Dr Khetsiwe Masuku. Thank you for your support and guidance 

throughout this process. I have enjoyed my time working with you and appreciate your valuable 

input and assistance with this research project. 

To the participants of this study who willingly gave of their time and shared their experiences 

with me. Without you this study would not be possible and I am very appreciative of your 

participation. 

To my family for encouraging me to further my studies and supporting me during this 

endeavour. I could not have done it without you. Also, I hope you like your present of my 

completed thesis for your birthday father! 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Glossary of Terms: 

Table 1: Table describing the glossary of terms. 

Term: Definition: 

Community Service A compulsory year in which a newly 

graduated rehabilitation professional has to 

work in a government healthcare facility in 

order to qualify for independent practice 

(Department of Health, 2006). 

Rehabilitation Professional A person who has completed a four-year 

professional degree that provides 

rehabilitation services focusing on 

limitations of function (Campbell et al., 

2016). 

Healthcare Facility A location where healthcare is provided 

either at a clinic, a district hospital or a 

tertiary hospital (Lederer & Wetzel, 2014). 

Supervision To observe and give feedback on the 

completion of a task (Hess, 2014). 

District A district within the healthcare system is 

defined as a self-contained part of the 

healthcare system that services the outlined 

administrative and geographical area (Pillay 

et al., 2001). 

 

 

 

 

 

 

 



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Chapter 1: Background and Rationale 

 

This chapter provides a background to the study. It particularly addresses  what is known about 

community service in South Africa, with specific reference to the history of community service, 

why it was implemented, how the purpose and outcomes of community service have changed 

over time and how these changes have affected access to healthcare and particularly 

rehabilitation healthcare services and professionals as this is the main focus of the study. The 

chapter also argues for the relevance of the study in South Africa through outlining what is 

known about the subject in terms of the available literature and current literature gaps that 

necessitates the study. This chapter furthermore outlines the different chapters that form part 

of the dissertation and a brief description of the contents of each chapter. 

Prior to 1994, access to healthcare services was demarcated across socio-economic, racial and 

geographical lines (Maphumulo & Bhengu, 2019). As a result, there were inequalities in the 

provision of healthcare services in South Africa. To redress the inequalities of the past, the 

government of the new dispensation implemented a 12-month compulsory community service 

year, wherein healthcare professionals are placed in a government healthcare facility to provide 

healthcare services to communities, with a special focus on rural government healthcare 

facilities (Department of Health, 2006). Compulsory community service was initially 

implemented only for medical doctors in 1998, however, by the year 2003 a total of 17 

healthcare professional disciplines were legislated to complete a year of community service 

before being able to practice independently. These healthcare professional disciplines include 

audiologists, clinical psychologists, dentists, diagnostic radiographers, diagnostic 

sonographers, dietician, environmental health practitioners, medical practitioners, nuclear 

medicine, radiographers, occupational therapists, pharmacists, physiotherapists, professional 

nurses, radiotherapy, speech and audiology therapists and speech language therapists 

(Department of Health, 2006). The aim of the community service year was and still is to provide 

necessary access to healthcare in underserviced communities as well as to provide young 

professionals with the opportunity to grow their clinical skills and knowledge under 

supervision (Reid et al., 2018), while increasing the number of doctors and other healthcare 

professionals working in rural South African areas (Hatcher et al., 2014). 

 

 



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Problem Statement and Significance:  

Approximately 50 percent of the population of South Africa lives in rural areas, with 

insufficient access to healthcare (Dubois et al., 2017). Poor access to healthcare services is 

compounded for people living in rural areas. This is due to  amongst other factors, the fact that 

70 percent of doctors in South Africa prefer to work in the private sector, leaving only 

approximately 11000 doctors in the public sector to service the 85 percent of the population 

who do not afford a private medical aid scheme (Dubois et al., 2017). In South Africa, people 

who live in rural areas also struggle to access rehabilitation services as a result of the factors 

outlined by Sherry, (2014) which include no access to transport to travel to healthcare facilities, 

long waiting times, and lack of knowledge of other healthcare workers to refer to rehabilitation 

professionals. Rehabilitation professionals, namely speech language therapists, audiologists, 

occupational therapists, dieticians, and physiotherapists (previously known as allied health 

professionals), are an integral part of healthcare. These professions make up a group of tertiary 

educated healthcare workers who are not doctors or nurses, but specialists in specific diagnosis, 

management and intervention of acute and chronic therapeutic conditions and specifically 

focus on impairments, functional limitations and assist in participation in life (Campbell et al., 

2016). 

Rehabilitation healthcare professionals often face significant challenges in state run hospitals 

in South Africa due to the lack of funding and resources (Sherry, 2014). With a growing patient 

load seeking rehabilitation services, in South Africa, due to the increasing number of patients 

living with chronic non-communicable diseases that require therapeutic services to assist with 

everyday functioning and quality of life (Dizon et al., 2017). Non-communicable diseases form 

part of the quadruple burden of disease prevalent in South Africa. The quadruple burden of 

disease is made up of child and maternal health, non-communicable, injury due to violence and 

crime and HIV and TB. The high percentage of patients with these diseases puts strain on an 

under resourced healthcare system in South Africa (Haskins et al., 2016). With a lack of 

healthcare professionals but an increase in disease, this can lead to further challenges such as 

long wait times and insufficient supplies within the healthcare system (Haskins et al., 2016).  

Non-communicable diseases are diseases such as cancer, cardiovascular diseases, diabetes and 

respiratory diseases (Nojilana et al.,2016). There has been an increase in the prevalence of 

noncommunicable disease in South Africa due to lifestyle choices such as unhealthy diets, lack 

of physical activity and tobacco use (Nojilana et al., 2016). Due to colonialism and 



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globalisation, food markets have altered to produce ultra processed foods in order to bring 

down the cost of food, the amount of time needed to cook and, to be most affordable to lower 

income families hence people living in poverty do not have access to healthy, fresh food 

(Manderson & Jewett, 2023). Furthermore, persons who work in low-income sedentary jobs 

may have less time to exercise. These points suggest that in lower income communities the 

personal power to consume healthy food and live an active lifestyle is taken away leading to a 

higher risk of these diseases (Manderson & Jewett, 2023). Therefore, due to the rise of non-

communicable diseases due to the lifestyle choices made, rehabilitation professions require 

more budget in order to be able to adequately assist their patients with non-communicable 

diseases (Hanass-Hancock et al., 2013). 

Adding to the difficulties faced by rehabilitation professionals practicing in state hospitals, is 

the low number of staff employed within the state healthcare system. It has been reported that 

the vacancy rate for rehabilitation professionals is 22 percent nationally (Ned et al., 2020). The 

provinces with the highest vacancy rate of rehabilitation healthcare professionals are Eastern 

Cape and Mpumalanga (Department of Health, 2013). Eastern Cape and Mpumalanga are two 

of the most under resourced provinces in South Africa and they also happen to have a larger 

percentage of their areas being classified as rural (Vergunst et al., 2017). This shows that the 

provinces with the poorest communities have the lowest number of rehabilitation healthcare 

professionals (Department of Health, 2013). There is also evidence that community service 

rehabilitation professionals prefer placements in tertiary institutions and being situated in more 

affluent areas which also has an impact on the number of rehabilitation professionals servicing 

under resourced communities (Maseko et al., 2014). The most notable reasons for rehabilitation 

professionals leaving the government sector have been fiscal austerity, immigration, moving 

to the private sector and the freezing of posts (Sherry, 2014). Many healthcare professionals 

are choosing to move to the private sector or to immigrate due to long working hours, poor 

renumeration, work related stress due to high patient loads, lack of resources and higher 

incidents of occupational hazards (Mumbauer et al., 2021). The freezing of healthcare worker’s 

posts is a significant factor in the vacancy of personnel at state-run hospitals. This is caused by 

budget constraints and competing priorities that require more of the budget as determined by 

the Human Resource for Health Plan for South Africa (Ned et al., 2020). 

The impact of the factors mentioned above, in particular the high vacancy rate in state run 

healthcare facilities is that community service rehabilitation professionals end up being placed  

in healthcare facilities where there is no supervising therapist within their profession and 



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therefore being placed in a position of having to manage a department with limited experience 

and resources in their year of community service (Shipalana, 2018). An example of this is in 

the Limpopo province, where there are no advertised vacancies for chief therapists or assistant 

director posts for rehabilitation professions, but community service rehabilitation professionals 

are placed at those facilities with no support and either not being supervised at all or being 

supervised by managers practicing a different profession to theirs (Shipalana, 2018). 

Management is defined as the process of organising, planning, directing, and controlling an 

organisation’s members and resources to ensure that particular goals are reached (DuBrin, 

2009). As of 6 March 2024, no advertisements for chief therapists or assistant director posts 

were found on the government website. 

The lack of supervision at community service placement healthcare facilities can have a 

negative impact on the community service rehabilitation professionals placed at those 

healthcare facilities, as well as the patients that they serve. For example, for community service 

rehabilitation healthcare professionals, the first years of practice sets the foundation for future 

actions (Paterson et al., 2007). This may lead to bad habits, poor attitudes and lack of work 

ethic which can be difficult to change in future working environments (Paterson et al., 2007). 

Community service rehabilitation professionals who have had little supervision have rated 

themselves as competent after a year of practice (Paterson et al., 2007). Benner created a five-

stage model of clinical competencies that need to be achieved during the learning process. 

Benner’s stage model determined that it is expected that a nurse should take at least three years 

of practice under supervision before reaching a competent stage (Mohamed & Abouzaied, 

2021). This suggest that a lack of a supervisor to guide a community service rehabilitation 

professional into ensuring they learn best practice, can lead to overconfidence in practical skills 

of a community service rehabilitation professional (Paterson et al., 2007). Overconfidence in 

clinical ability can impact the service provided to patients as the community service 

rehabilitation professional may not be aware they are not working in a way that is best practice 

without having a supervisor to correct them.  

Studies that have been conducted on community service in South Africa have focused mostly 

on the medical professions experience of community service (Hatcher et al., 2014; Reid et al., 

2018). Studies where the focus has been on rehabilitation healthcare professionals have 

highlighted the experiences of only one profession, for example studies have only highlighted 

the experiences of occupational therapists or speech language therapists, but not a sample made 

up of multiple professions representative of the rehabilitation team (Penn et al., 2009; van 



14 
 

Stormbroek & Buchanan, 2016). Where studies have been conducted with one rehabilitation 

healthcare professional discipline, the studies have only been conducted within one province 

of South Africa (Shipalana, 2018; Khan et al., 2009; Paterson et al., 2007) . Studies on specific 

rehabilitation professions have also tended to document their general experiences of 

community service without zooming in on specifics such as management of a department. This 

study will include participants representative of various types of rehabilitation professionals 

and will be conducted nationwide to gather as much data on this phenomenon as possible and 

be representative of different contexts. It is important to conduct this research in order to 

determine how to support and better prepare community service rehabilitation professionals 

for their community service to ensure that they provide the best care possible to their patients 

and are able to manage the managerial, emotional, and practical aspects of their role, especially 

in light of the current financial difficulties in the department of health that impact on filling of 

vacancies. By having a community service rehabilitation professional who is adequately 

trained to manage a department this will also benefit their patients as being able to adequately 

manage the administrative aspects of a department will allow the department to run more 

effectively and a community service rehabilitation professional who feels confident in their 

abilities will also make patients feel comfortable in the standard of care they are being provided. 

Community service rehabilitation professionals who have a positive experience during their 

community service may consider working in state run healthcare facilities. If more community 

service rehabilitation professionals are prepared to work in state run healthcare facilities post 

community service, this could increase the amount of rehabilitation professionals in the state 

healthcare system. This in turn, will allow more access to rehabilitation services for patients by 

having more rehabilitation staff available.  

The main aim of the study is to determine the experiences of community service rehabilitation 

healthcare professional managing their own respective rehabilitation departments in South 

Africa during their community service year. 

The sub-aims of the study are as follows: 

• To determine how and by whom community service rehabilitation healthcare 

professionals were prepared to manage a department. 

• To explore the challenges experienced by community service rehabilitation healthcare 

when managing their own department. 



15 
 

• To describe the facilitators and support systems community service rehabilitation 

healthcare professionals had access to when managing their own department 

Outline of different chapters included in this dissertation: 

 

Chapter 1: This chapter argues for the relevance of the study. This is done by the chapter 

providing a background on community service and the state of the healthcare system in South 

Africa as well as introduces the concept of rehabilitation professionals. It then outlines the 

factors which led to community service rehabilitation professionals managing their own 

departments. This chapter then also outlines the different chapters to come. 

Chapter 2: This chapter describes, discusses and critiques literature relevant to the key 

constructs of the study. Literature covers, international and local policies around rehabilitation 

and what rehabilitation is in the South African context. Furthermore, it gives a background into 

community service in South Africa as well as introduces the theoretical framework 

underpinning this study. 

Chapter 3: The methodology section begins by describing the aims and sub aims of this study. 

It then highlights the positionality of the researcher as well as explain the research design used. 

It goes on to describe the participants through explaining the participant selection criteria as 

well as giving a breakdown of the demographics of the participants. This chapter then goes into 

further details about data collection and the process of analysing the data through using a 

framework analysis approach which gave rise to the themes generated in this study. Finally, 

the ethical considerations are outlined and the trustworthiness strategies used are described. 

Chapter 4: This chapter outlines and describes the findings of the study. The themes of the 

study are then mapped onto Faloy’s five elements of management and described in further 

detail using quotes from participants to demonstrate the themes spoken about. 

Chapter 5: This chapter discusses the findings of the study in relation to published literature 

and argues whether the findings agree, correlate with, or refute already published studies. 

Chapter 6: This chapter highlights the conclusions from this study through determining if the 

aims of the study are met. The strengths and limitations of the study are highlighted along with 

the implications of the study in terms of bettering rehabilitation policies, how the findings of 

the study can be used to improve current practice and what further research can be done. 



16 
 

Chapter Summary: 

This chapter gives an introduction into the implementation of community service and 

highlights the healthcare professions who are required to complete a community service year. 

It also informs about the aims of the community service year. It then goes on to explain the 

different rehabilitation professions and their importance in assisting persons with non-

communicable diseases. The challenges faced within the state run healthcare facilities are also 

highlighted and it is explained that due to these challenges many healthcare professionals are 

leaving the state run healthcare facilities and choosing to work in private healthcare. The lack 

of staff in state run healthcare facilities both due to healthcare professionals choosing to work 

in private healthcare as well as the freezing of government posts leads to community service 

rehabilitation professionals being placed at healthcare facilities with no senior personnel of the 

same profession. This leads to the phenomenon of community service rehabilitation 

professionals managing their own department. The lack of supervision in the formative years 

of professional development and the consequences thereof are also explored in this chapter. 

This chapter then highlights other studies conducted on community service and explains why 

this study is important and the impact it can have on professional development. Finally, an 

outline of the chapters in this dissertation is provided. 

 

 

 

 

 

 

 

 

 

 

 



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Chapter 2: Literature Review 

 

This chapter will outline the different literature pertaining to the topic of community service 

rehabilitation professionals who have managed their own department. It gives background into 

the different policies around rehabilitation professions both internationally and within South 

Africa as well as outlining what rehabilitation professions and community service are, 

highlights community service readiness, and finally outlines the theoretical framework Faloy’s 

five elements of management which underpins this study. Google scholar was used to access 

the articles cited. The keywords used were community service, rehabilitation professionals, 

South Africa, allied professionals, healthcare and management. The time period given was 

1994 – 2024 to give access to more articles due to the scarcity of research on this topic.  

Community Service in The South African Context: 

Prior to 1994, inequality in South Africa’s health care system was historically caused by five 

main factors. The first factor was the lack of a central, binding health care policy which led to 

ineffective management systems and poor policy measures which allowed the healthcare 

system to become divided by socioeconomic, racial and geographical factors (Van Rensberg 

& Fourie, 1994). The second factor is racial segregation and white dominance which created a 

foundation of inequality where discriminatory measures and practices of inequality were used 

to serve the healthcare needs of population groups unequally (McLaren et al., 2014). Thirdly, 

due to free markets (laws of supply and demand govern the economic system without 

government interference), market justice (healthcare should be based on an individual’s ability 

to pay through their own efforts) and profit-taking (selling an asset when it has risen in price) 

in the South African health care system, this gave rise to unequal distribution of resources and 

healthcare personnel, where disadvantaged race groups such as persons of colour were given 

insufficient resources to serve their populations (Van Rensberg & Fourie, 1994). The fourth 

factor is the white dominance of healthcare professionals who determined how to run 

healthcare facilities based on their own personal interests and occupational gain without taking 

into account the healthcare most needed by the whole population leading to disparities in 

healthcare between the different racial groups (Van Rensberg & Fourie, 1994). The final factor 

is that South Africa has a large population made up of a multitude of cultures which each have 

their own traditions and belief systems. This in turn determines what a person defines as an 

illness and whom they will consult for medical assistance based on their beliefs. A culture of 

traditional healers is prevalent in South Africa which also influences the population’s use of 



18 
 

healthcare especially when traditional healthcare is not readily available (McLaren et al., 2014). 

Medical pluralism is defined as differing medical traditions and practices based on different 

principles and cultural beliefs but can coexist within a society (Amzat & Razum, 2014). 

Medical pluralism is common within South Africa through the use of both modern medicine 

as well as traditional healers. In African and Asian countries, traditional medicine is widely 

sought after especially in rural areas where access to healthcare is scarce. The impact of medical 

pluralism is that a patient may consult multiple healthcare providers (both medical and 

traditional) who give conflicting options which leads to confusion and mistrust in healthcare 

systems. In turn, due to the mistrust in healthcare systems, essential care and procedures may 

be delayed which effects treatment outcomes (Moshabela et al., 2012). 

Post-apartheid, three different levels of healthcare were introduced, namely a primary, 

secondary, and tertiary level of healthcare. A primary healthcare facility consists of local clinics 

and community health centres where preventative, promotional, curative and rehabilitation 

services are offered and are only open for eight hours a day (Cullinan, 2006). These facilities 

are mainly run by nurses, but a doctor may visit and provide regular visits to the clinic 

(Cullinan, 2006). A person who has an ailment must first visit a primary healthcare facility 

before they are referred to a secondary facility for further management. A secondary healthcare 

facility consists of district and regional hospitals. A district hospital provides both inpatient 

and outpatient services where patients receive care from a general medical practitioner and 

have access to other rehabilitation services (Cullinan, 2006). This hospital does not employ any 

specialised medical doctors and only has access to basic diagnostic equipment such as x-rays 

and laboratories (Cullinan, 2006). A regional hospital employs at least five of the following 

specialised doctors: surgery, medicine, orthopaedics, paediatrics, obstetrics and gynaecology, 

psychiatry, diagnostic radiology, and anaesthetics as well as general medical practitioners and 

other rehabilitation services (Cullinan, 2006). Tertiary hospitals are academic hospitals where 

multiple specialists and services are available and complex operations take place. In order to 

gain access to a tertiary level hospital a patient must be referred from a level two hospital first 

(Cullinan, 2006). 

A scoping review conducted by Maphumulo and Bhengu (2019) which aimed to determine the 

challenges to improve the quality of healthcare services in South Africa found that the most 

significant factor found that hindered the quality of healthcare in the government healthcare 

system was shortage of human resources due to not enough staff being employed in state-run 

healthcare facilities. The shortage of human resources due to fiscal austerity, immigration, 



19 
 

freezing of posts and healthcare professionals moving to the private sector has an impact on 

service delivery as prolonged waiting times occur, which means that patients are not being 

treated as quickly as they should be and this can have an effect on their prognosis (Maphumulo 

& Bhengu, 2019). Multiple adverse events such as complications and sometimes death occur 

due to patients being turned away or not helped at state healthcare facilities because of lack of 

human and medical resources (Maphumulo & Bengu, 2019). 

Community service was therefore implemented in South Africa to attempt to increase the 

number of healthcare workers in government hospitals in order to address the shortage of 

human resources and provide access to adequate healthcare to more patients at all levels of 

healthcare facilities in the country (Reid et al., 2018). The aims of community service for 

healthcare professionals, as stated in the background, is to provide healthcare to rural areas in 

South Africa as well as allow young healthcare professionals the opportunity to develop their 

clinical skills under supervision (Reid et al., 2018). Both these aims should be regarded with 

equal importance, however, as it is deemed as ‘service’ community service placements are 

made according to healthcare needs deemed by the Department of Health and not necessarily 

where sufficient supervision will be given to the community service healthcare worker (Reid 

et al., 2018). Community service in South Africa can be described as a compulsory service 

completed within a year post qualification which allows for education and employment. This 

can be used at a strategy to place additional healthcare workers in rural areas where healthcare 

services are limited and therefore may not have additional personnel to act as supervisors to 

community service healthcare professionals (Reid at el., 2018). 

Policy Reforms Pertaining To Rehabilitation: 

The Sustainable Development Goals (SDGs) for 2030 is an initiative that was created by the 

United Nations in 2015. This is a collection of 17 goals each targeting a different humanitarian 

and environmental challenge in order to improve the overall wellbeing of the global population 

(United Nations, 2015). Sustainable goal number three mandates states to ensure good health 

and wellbeing for all citizens at all ages. It further states that within Sub-Saharan Africa the 

shortage of healthcare professionals is a potential threat for the realisation of this goal (United 

Nations, 2015). The goal specifically states that there are ten nurses and midwives for every 

10000 people in sub-Saharan Africa (UN, 2015). Before the Covid-19 pandemic, progress had 

been made towards the achievement of this goal in the form of increasing life expectancy, 

decreasing the number of infections of non-communicable diseases and reducing maternal and 

child mortality (Khetrapal & Bhatia, 2020). 



20 
 

The Rehabilitation 2030 framework on the other hand is a call for action, which is a framework 

initiated and coordinated by the World Health Organisation (WHO) aimed at increasing the 

availability for rehabilitation services globally (World Health Organisation, 2017). This 

initiative was created in February 2017 in order to assist in fulfilling goal three of the SDGs 

through rehabilitation services as well as primary healthcare by aiming to optimise functioning 

and support persons with health conditions to become as independent as possible in order to 

participate in society (WHO, 2017). The overall goals of the Rehabilitation 2030 initiatives are 

for rehabilitation policies to be implemented from a leadership and governance level, planning 

and implementation of a standardised toolkit to make rehabilitation services more readily 

available and initiate research and find evidence on rehabilitation services and health policies 

in low- and middle-income countries (Negrini & Gimigliano, 2017). This framework highlights 

that rehabilitation services are deemed as necessary in a global context. The aims of the 

framework in theory would assist in increasing access to rehabilitation worldwide. However, 

it is at the behest of local governance to initiate the aims outlined in this policy and as such, so 

far South Africa has made policies to improve access to rehabilitation service but a standardised 

toolkit is not in existence yet. 

Specific policies relating to the implementation of rehabilitation services in South Africa 

include the National Rehabilitation Policy which was adopted in 2000. This policy has a total 

of seven aims listed as to improve access to rehabilitation services, to improve intersectoral 

collaboration in order to create a comprehensive rehabilitation program, to facilitate 

appropriate distribution of resources and ensure they are used appropriately, to improve human 

resource development to ensure the needs of the consumer and service providers are met, to 

ensure persons with disabilities are included during planning, monitoring and implementing 

rehabilitation services, and to encourage research into rehabilitation initiatives (Mji et al., 

2017). The intention behind this policy is to improve access to rehabilitation services as well 

as improve the ability of rehabilitation professionals to work more effectively through more 

human resources and ensuring all persons accessing rehabilitation services needs are met. 

However, there is little evidence to show that these aims have been put in place as rehabilitation 

departments are still under resourced leading to long wait times and the inability to provide 

sufficient care to their patients (Haskins et al., 2016).  

Another policy outlining the importance of rehabilitation services in South Africa is The 

Framework and Strategy for Disability and Rehabilitation Services in South Africa 2015-2020. 

This policy framework aimed to facilitate the provision of appropriate, affordable, accessible 



21 
 

and quality rehabilitation services to persons with disabilities throughout their life span in 

South Africa through appropriate and effective resource allocation and intersectional 

collaboration (Department of Health, 2015). This was aimed to be done through seven 

strategies outlined by the Department of Health (DoH) (2015) as follows: (i) ensure 

rehabilitation services are available at every level of healthcare; (ii) developing an effective 

referral system between the different rehabilitation units at every level of healthcare; (iii) foster 

collaboration between different department; (iv) create standards for accessibility by improving 

signage, infrastructure and means of communication (v) increase healthcare worker’s 

knowledge and awareness of persons with disabilities and the attitudes toward them; (vi) 

improve monitoring of rehabilitation services, (vii) improve the human resources available for 

disability and rehabilitation services (viii) improve access to appropriate assistive devices and 

technologies. The implementation of this policy has been hindered by actor dynamics, 

insufficient resources, rushed processed, poor record keeping, inappropriate leadership, 

negative staff attitudes, and insufficient monitoring (Hussein et al., 2022).  

These international, regional, and national healthcare and rehabilitation healthcare policies 

outline how important rehabilitation services are in the medical field as they provide integral 

services needed by patients to assist in improving quality of life. When looking at these policies 

however, it is obvious that there is a gap in policy on community service. There are no 

community service guidelines that explicitly state the role and duties of the community service 

healthcare professionals and how much supervision they should be receiving. It is important to 

note that whilst South Africa has instated policies to improve rehabilitation healthcare, there 

has been little actual progress in improving rehabilitation departments such as being short 

staffed and not having sufficient resources (Hussein et al., 2022). A great barrier to accessing 

rehabilitation services is the lack of rehabilitation professionals (Sherry, 2014). This has a 

direct impact on incoming community service rehabilitation professionals and it creates the 

phenomenon where there are no senior rehabilitation professionals available for supervision 

and a community service therapist is expected to become a manager of the department. This 

can have further implications post their community service year where it may deter community 

service rehabilitation professionals from wanting to work in state healthcare facilities creating 

a further shortage of personnel. 

Rehabilitation Professions in South Africa: 

Rehabilitation professions are a four-year professional degree which entails becoming a 

healthcare working specialising in identifying, treating and providing aids for chronic 



22 
 

conditions (Campbell et al., 2019). Rehabilitation professionals focus on the everyday 

functioning of persons with health difficulties. Each profession specialises in a certain type of 

body function and how to address difficulties within that aspect of the body (Campbell et al., 

2019). Speech language therapists specialise in speech and language and a person’s ability to 

communicate and feed effectively (South African Speech and Hearing Association, 2022). 

Audiologists focus on hearing and balance disorders (South African Association for 

Audiologists, 2022). Physiotherapists concentrate on mobility and gross motor movements 

(South African Society of Physiotherapy, 2022). Occupational therapists focus on activities of 

daily living and fine motor movements (Occupational Therapy Association of South Africa, 

2022). A dietician works with nutrition and assisting patients with their diet and lifestyle 

choices (Association for Dieticians in South Africa (2022). 

Ned et al (2020), conducted a study looking into the changing demographic trends of South 

African occupational therapists between 2002 and 2018. This study concluded that 65 percent 

of working occupational therapists identified as white, 16 percent as black, 9 percent as 

coloured and 8 percent as Indian. However, the growth of incoming black and coloured 

occupational therapists was noted at 61.8 percent and 60.5 percent respectively whereas the 

population of incoming white occupational therapists has declined to 31.5 percent. Ned et al 

(2020), explain that although segregated policies have been abolished in universities and that 

universities have instated quotas to improve the number of black, coloured and Indian students, 

the rehabilitation professions are not as well-known as other careers such as medicine or 

engineering especially in rural areas. It is also noted that the rehabilitation professions do not 

tend towards as high a renumeration despite requiring high levels of academic ability. 

Therefore, there is a likelihood that matriculants may choose careers that afford them a higher 

renumeration rate and status than a rehabilitation profession. 

In South Africa there is a shortage of rehabilitation professionals especially in the public sector. 

According to the Framework and Strategy for Disability Services in South Africa 

approximately 22-27 percent of posts for rehabilitation professionals in the state healthcare 

facilities are vacant (Morris et al., 2019). In 2015 there were 1213 occupational therapists, 1256 

physiotherapists and 596 speech language therapists and audiologists employed in state posts. 

The data on specific patient to rehabilitation professional ratios is currently unreliable. 

However, according to the 2011 census there were approximately 2.8 million people living 

with a disability in South Africa and 84 percent of these people rely on government provided 

healthcare services. This equates to each rehabilitation healthcare professional servicing 1051 



23 
 

persons living with disabilities in South Africa assuming that they all require rehabilitation 

services (Morris et al., 2019). These statistics only take into account persons classified as living 

with disabilities and not persons living with disabilities due to chronic illness which is also a 

significant portion of a rehabilitation professionals’ case load and would increase the number 

of patients seen per professional if included (Morris et al., 2019). 

The quadruple burden of disease encompasses child and maternal health, HIV and TB, non-

communicable diseases, and injuries due to violence and crime. These are statistically the most 

common cause of death within South Africa. Due to the increased number of patients with such 

diseases but not enough rehabilitation professionals within the government sector, this creates 

more strain on an already under resourced and understaffed healthcare system (Haskins et al., 

2016). The rehabilitation professions provide a number of services to persons diagnosed under 

the burden of disease. Firstly, rehabilitation professionals provide a holistic well-being 

approach to treatment as opposed to management of an impairment. They focus on improving 

physical, mental, and communicative abilities (Ebrahim et al., 2020). Multidisciplinary 

interventions are also a key aspect of rehabilitation service as working with other professionals 

allows for integrated treatment plans that target all areas of need. Rehabilitation professions 

primarily focus on function and ensuring the patient is able to function to the best of their 

abilities to be able to have quality of life and as much independence as possible (Ebrahim at 

al., 2020). Therefore, understaffing of rehabilitation professionals has a great impact on 

patients with such diseases. Understaffing is especially prevalent in rural areas where over 46 

percent of the population reside and who have the highest risk for being effected by non-

communicable diseases and are also the most dependent on government healthcare services 

which are serviced by only 19 percent of health professionals who work in remote and rural 

areas (Haskins et al., 2016). 

Community Service Readiness: 

A study conducted by Wranz (2011), explored the perceived readiness for community service 

from the experiences of speech language therapists that had graduated from Stellenbosch 

University and completed their community service in different contexts in 2009. The results 

from this study indicated that the community service speech language therapists who 

participated in the study felt that their clinical and theoretical training had been adequate to 

allow them to practice in their community service year. However, many participants reported 

that additional knowledge should be given on aspects of working within a hospital and multi-

disciplinary team. Participants in the study recommended lecture series on administrative and 



24 
 

managerial skills that may be needed during the community service year as well as being given 

the opportunity to work within a multi-disciplinary team during their undergraduate training 

(Wranz, 2011). The results from this study indicate that community service speech language 

therapists that participated in this study feel as if they have adequate training in the clinical 

aspects of their profession but need more exposure to managerial aspects (ordering stock and 

monthly reports) of their profession during their undergraduate studies. 

Naidoo et al (2017), conducted a study to determine occupational therapy graduates’ readiness 

to work in primary healthcare and rural practice once graduating from The University of Kwa-

Zulu Natal. This study found that graduates were well prepared to work in urban and peri-urban 

settings where their clinical training had been conducted, but struggled to practice in rural 

settings which they had less exposure to during their undergraduate studies. A main concern in 

this study was the linguistic and cultural barriers they had faced in a rural setting which they 

felt had not been adequately addressed while studying. Furthermore, this study once again 

highlighted the need for multi-disciplinary training during undergraduate training as due to the 

rural setting a multi-disciplinary approach is often used and allows the rehabilitation 

professions to better understand each other’s professions. The lack of knowledge of 

administrative and managerial tasks was also mentioned and highlighted in this study. The 

participants further recommended that being aware of the managerial systems within the 

Department of Health and hospitals as well as being aware of how to go about securing 

resources to ensure adequate service delivery should be included in the undergraduate 

curriculum (Naidoo et al., 2017). 

A study looking at community service physiotherapist’s suggestions on how to improve the 

curricula to better prepare students for community-based therapy suggested  that including 

exposure to different stakeholders such as organisations that advocate for persons with 

disabilities would be beneficial during their undergraduate studies (Mostert-Wentzel et al., 

2013). This would allow students to be more knowledgeable about a variety of conditions they 

may be exposed to and to understand the condition on a personal level in order to treat patients 

respectfully and culturally appropriately (Mostert-Wentzel et al., 2013). 

This information is important to note as it highlights that community service rehabilitation 

professionals who have access to supervision and are not managing their own departments still 

report wanting to have been given more information during their undergraduate studies about 

managerial and procedural systems within a government hospital as well as other factors such 



25 
 

as experience working in more rural settings. For community service rehabilitation 

professionals who are managing their own departments, the need for this type of information 

is even greater and being provided such information before their community service year could 

mitigate some of the challenges experiences during community service as they would already 

have some idea on how to manage a department and managerial procedures and duties that are 

required of them. 

Conceptualising Management Using Faloy’s Five Elements of Management: 

Management is defined as the process of organising, planning, directing, and controlling an 

organisation’s members and resources to ensure that particular goals are reached (DuBrin, 

2009).  Faloy (1916), describes management as encompassing five elements namely, planning, 

organising, co-ordination, command and control (Fells, 2000). Planning encompasses 

predicting the future and creating an action plan to prepare for it. This must take into account 

the available resources and future projects which may arise. Organising is outlined by Fayol 

(1916) as the duties undertaken by the different personnel and how to ensure that these duties 

are being fulfilled to the highest standard by all personnel. Commanding is described by Fayol 

(1916) as ensuring each manager within the personnel fulfils their responsibilities to their 

subordinates and to ensure the interests of the business are met. Co-ordinating is ensuring that 

each individual department is able to harmoniously work with other departments to reach a 

shared goal. Lastly, control is having verification and measures when implementing a plan in 

order to identify weaknesses and problems before they arise and address them (Fells, 2000). 

This theory of management has previously been used in a rehabilitation study, one conducted 

by Du Toit et al (2010), which explored creating a competency-based curriculum for eye care 

managers in Sub-Saharan Africa. In the study by Du Toit et al., (2010) which used this 

framework, many stakeholders were approached to give feedback on what they deemed should 

be included in the curriculum of training eye care managers. The results from participant 

responses were then analysed and tabulated according to Faloy’s five elements of management. 

This approach allowed the researchers to organise the data in a concise and precise manner in 

order to present it in a way which allowed the reader to understand the data easily. This study 

also highlights how this theoretical framework can be used when analysing managerial 

practices of rehabilitation professionals. It allowed the researcher to identify gaps within the 

managerial system that community service rehabilitation professionals managing their own 

department experience and the researcher can suggest ways in which these gaps can be 



26 
 

mitigated to assist future community service rehabilitation professionals who have to manage 

their own department. 

Igbokwe et al (2020), also used this theory of management but in a more practical manner.  

Igbokwe et al (2020)’s, study investigated how to prepare schools in Nigeria for students to 

return after lockdown during the Covid-19 pandemic. The authors outlined the different 

stakeholders within a school and using Faloy’s five elements practically outlined how each 

stakeholder (such as principals and teachers) could prepare their environment and implement 

policies to ensure the safety of personnel and students. This study illustrates how this theory of 

management can be used not just for managers of a team or the heads of an institution but also 

can be adapted to include different types of managers, stakeholders and different styles of 

management. This is important for this study as community service rehabilitation professionals 

who manage their own department do not manage a team of people but are responsible for 

managerial duties that ensure their department is able to run efficiently. Therefore, this 

framework allows for considering that in this situation there is a lone manager without 

employees to manage. It also shows how a manager interacts with different departments to be 

able to run an institution efficiently which is important to a community service rehabilitation 

professional who may rely on senior staff in different departments for assistance. 

Chapter Summary: 

This chapter has highlighted how community service came about post-apartheid and the factors 

that led to the creation of community service mainly to improve access to healthcare in rural 

communities as well as give newly graduated medical professionals an opportunity to learn and 

improve their clinical skills. The international and local rehabilitation policies are also outlined 

to highlight how important rehabilitation services are deemed to be but there is a lack of specific 

policies relating to community service for rehabilitation professionals. Furthermore, it is 

important to note that even though South Africa has ratified these policies access to 

rehabilitation healthcare is still limited due to lack of rehabilitation professionals. This leads 

into rehabilitation within the South African context where there is a lack of rehabilitation 

professionals for the population. This is due to lack of access and awareness of the 

rehabilitation professions in rural communities which means people of colour were not given 

equal access to study the rehabilitation professions. The quadruple burden of disease has led to 

an increase in patients seeking rehabilitation professionals which puts strain on an already 

under resourced system. Freshly graduated community service rehabilitation professionals 

enter this system without having the appropriate knowledge of administrative and managerial 



27 
 

tasks expected of them which causes an emotional toll on them. Finally, Faloy’s five elements 

of management are explained in detail and it is shown how this framework can be used in 

different contexts. It is highlighted that this framework was chosen for this study as it allows 

for management for a department without any other personnel as well as how a manager 

interacts with different departments to run their department effectively. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



28 
 

Chapter 3: Methodology: 

 

This chapter will outline the aims and sub-aims of this study. It will describe the positionality 

of the researcher. It also goes on to detail the research design, the recruitment of participants 

and demographics of the participants as well as the materials used during data collection. The 

data collection process is also outlined. This chapter then explains how the data was analysed 

using the framework analysis method as well as details the trustworthiness methods used during 

the study to ensure rigour and the ethical considerations of the study. 

Research Question: What are the experiences of community service rehabilitation healthcare 

professionals who have managed their own respective rehabilitation departments in South 

Africa during their community service year? 

Main Aim: To determine the experiences of community service rehabilitation healthcare 

professional managing their own respective rehabilitation departments in South Africa during 

their community service year. 

Sub-Aims: 

• To determine how and by whom community service rehabilitation healthcare 

professionals were prepared to manage a department. 

• To explore the challenges experienced by community service rehabilitation healthcare 

when managing their own department. 

• To describe the facilitators and support systems community service rehabilitation 

healthcare professionals had access to when managing their own department. 

Positionality: 

This research is especially important to the me based on my own experiences during my 

community service year. During my community service year, I was placed in a level 1 district 

hospital in rural Thabazimbi, Limpopo where I was the only speech language therapist and 

audiologist to service the hospital. I was also expected to service the community within the 

surrounding municipality. I was therefore, “appointed” head of the speech and audiology 

department of the hospital and was given additional managerial duties I had not been prepared 

for. This was also the first time I had practiced without supervision and had to trust in myself 

to provide the best service delivery to my patients without consulting a more experienced 

professional. The challenges I faced during my experience included feeling very isolated with 



29 
 

a lack of support. I did not feel confident in my abilities as I was used to having other peers 

and senior professionals around to assist me or to bounce ideas off. Where I was placed,  no 

one in the rehabilitation department really understood my profession and could not assist me. 

The nearest speech language therapists and audiologists were all over an hours drive away. I 

met the head of speech and audiology in my district once and could phone their department if 

I was in need of assistance but this was not the same as having onsite supervision to see the 

daily therapy sessions and to give guidance on whether or not I was doing due justice to my 

patients. Therefore, this research is very important to me as I have been through this situation 

and would like to explore ways in which future community service rehabilitation professionals 

can be better assisted if put in a managerial position with no experience. 

Research Design: 

This study employed a qualitative research design. A qualitative research method is described 

as a scientific method of gathering non-numerical data (Babbie, 2017). It aims to determine 

why certain phenomena occur and focuses on the meanings, concepts, definitions, 

characteristics, metaphors, symbols and descriptions of the subject of the research (Babbie, 

2017). This approach was deemed ideal for this study because the study aimed to describe the 

experiences of community service rehabilitation professionals in terms of managing their own 

department which entailed non-numerical data collection but rather data in the form of 

participant testimony which gave insight into the phenomena from their perceptions and 

experiences. 

An exploratory research approach was employed. Exploratory research is used when the 

problem being investigated in the study is not extensively researched and documented 

(Creswell et al., 2007). This type of research is beneficial as it allows the researcher to 

determine different themes and ideas from the results which can be used in future studies to 

gather more information on the topic. Therefore, exploratory research was selected for this 

study as it allowed the researcher to analyse the data from the interviews that took place to 

determine different themes and trends and to better describe the experiences of community 

service rehabilitation professionals when heading their own department. This information can 

then be used to discuss how these experiences can help improve the way in which community 

service rehabilitation professionals are prepared for community service and heading their own 

department. There is also paucity of research in this area and therefore by conducting this study, 

more research is done on this phenomenon which has the ability to give rise to further research. 



30 
 

This research was conducted using semi-structured interviews which are defined as an open 

style of interviews, in which the interviewer has a framework of open-ended questions to ask 

but can ask additional questions based on what the interviewee says and can further probe for 

more information (Edwards & Holland, 2013). The main theme or topic of the interview is 

thought out in advance by the interviewer and is usually written up into an interview schedule 

for guidance during the interview (Edwards & Holland, 2013). 

Adams (2015) highlights the advantages and disadvantages of semi-structured interviews. 

They state that advantages of semi-structured interviews include allowing the interviewer to 

determine the individual thoughts and opinions of the participants about the research subject 

as well as probing participants on topics they may not feel comfortable talking about in a group 

setting. The disadvantages stated include that  interviews can be  time-consuming due to having 

to arrange interview times with participants and the time of actually conducting the interview. 

Semi-structured interviews are also labour-intensive as transcribing and analysing the data can 

be a laborious process. (Adams, 2015). These disadvantages were addressed by using a Google 

form where prospective participants inputted their contact details and preferred method of 

communication (Whatsapp, email or phone call) in order to arrange a suitable time for the 

interview. The researcher had an interview guide with questions to ask during the interview 

which assisted in ensuring the interview ran smoothly and all information that was needed was 

gathered. The participant was informed ahead of time approximately how long the interview 

will take in order to plan their schedule around the interview. 

The semi-structured interviews were synchronous online interviews. Synchronous interviews 

were conducted online via Zoom where both the interviewer and the interviewee were online 

at the same time to conduct the interview (Janghorban, 2014). Some advantages of synchronous 

online interviews include the ability to interview people in a different location which is not 

accessible to the interviewer physically due to distance, which in turn opens up the study to 

more participants. As there is a small population of rehabilitation professionals who have 

managed their own departments, which had the potential to limit the number of participants to 

be interviewed for the study, synchronous online interviews allowed the researcher access to 

more potential participants. This also allowed the researcher to gather more data from many 

different participants from different parts of the country to allow for representation of 

participants and contexts.(McDermott & Roen, 2012). 



31 
 

The disadvantage of synchronous online interviews is that the interviewer may have less 

opportunity to create a welcoming interview ambiance which may lead to the interviewee 

feeling uncomfortable and less willing to open up to the interviewer. To mitigate this, the 

participants were asked to have the camera option on, so that the researcher and the participant 

were able to see each other, as being able to see the other person when talking creates a more 

natural conversation environment and assisted the participant in feeling more relaxed by being 

able to see the researcher. Ensuring the participant also has access to the correct software and 

had a stable internet connection may also be a difficulty with synchronous online interviews as 

not everyone has these services readily available to them. This was addressed in the participant 

information sheet where the participants were made aware of what was to be expected of them 

to be able to participate in this study and what applications they needed to participate in the 

interviews. The final disadvantage of synchronous online interviews is ensuring the correct 

identity of the participant as the researcher may not have had contact with the participant before 

and therefore would not be able to verify who they are due to technological advancements such 

as artificial intelligence which makes it easier to conceal one’s identity online. Online video 

call applications also have audio only options and the interviewee may choose this option 

which makes ensuring the participant is who they say they are more challenging (Deakin & 

Wakefield, 2014). This was mitigated through only conducting video call interviews in order 

to ensure that the person being interviewed was who they said they were. The was one instance 

where a participant’s video camera was broken and an audio only interview was conducted but 

the participant verified that they had read the participant information sheet and consented to 

the interview and therefore it was determined that their identity was correct and the interview 

went ahead. 

Study Participants: 

Sampling Strategy: 

Purposive sampling was used first to recruit participants, as qualitative research relies on the 

experiences of individuals (Merriam, 2019). This method of sampling entails gaining access to 

participants who have experienced the phenomena being studied and can provide the most 

relevant and rich information on it (Merriam, 2019). Purposive sampling was selected for this 

study as community service rehabilitation professionals have lived through the experience of 

heading their own department and were therefore in a better position explain their own personal 

experience as opposed to others explaining their experience for them. The researcher recruited 

participants through contacting the professional boards of the different professions namely, 



32 
 

South African Speech Language and Hearing Association (SASLHA), Occupational Therapy 

Association of South Africa (OTASA), South African Association of Audiologists (SAAA), 

South African Society of Physiotherapy (SASP) and, Association for Dieticians in South Africa 

(ASDA). The researcher asked to advertise the study through these organisations to their 

members. After the organisations gave their permission to advertise the study, the researcher 

sent the organisation a research advert with a google forms link. The potential participants were 

asked to show their interest in participating in the study through leaving their name and contact 

details as well as preferred method of being contacted on the google form. The researcher then 

contacted the participants who had indicated their interest to participate in the study through 

the google form via their preferred method of communication and requested that they complete  

the consent form before arranging an interview. Once the completed consent form was received 

via email, the researcher organised an online interview through Zoom at a time that was most 

convenient for the participant. 

Selection Criteria: 

A selection criterion is made up of an inclusion and exclusion criteria. An inclusion criterion 

is made up of characteristics a participant must have that the researcher will need to explore in 

order to answer their research question (Patino & Ferreira, 2018). In contrast, an exclusion 

criterion is when a participant may have all the characteristics the researcher needs to answer 

the research question but they may have additional characteristics that will impact the results 

they provide and not provide the researcher with the desired outcome (Patino & Ferreira, 2018). 

It is important to have these criteria in order to ensure that the participants that are selected will 

be able to provide the correct type of information to answer the research question and in turn 

reliable results will be obtained (Patino & Ferreira, 2018). 

The following  selection criteria was used to select participants for the study: 

1) The participants had to have managed  their own department when they were in their 

community service year. 

2) Participants had to have a degree in a rehabilitation healthcare profession, namely, 

speech language therapy, audiology, physiotherapy, occupational therapy, and 

dietetics. 

3) Participants had to have been  registered with the Healthcare Professions Counsil of 

South Africa (HPCSA) as a rehabilitation professional. 



33 
 

4) The participants had to be employed and practicing within the South African context. 

5) Participants had to have a device that connects to the internet and be willing to make 

use of their own data to participate in the online interviews. 

Sample Size: 

Due to this study using a qualitative research approach, the sample size was small. According 

to Vishnevsky and Beanlands (2004), an exploratory research approach consists of a sample 

size of ten or less individuals as this is an adequate number of participants to collect enough 

data to be able to obtain adequate detail for analysis. On the other hand, Crouch and McKenzie 

(2006), state that to conduct research using semi-structured interviews a sample size of less 

than 20 participants is sufficient due to the nature of the topic being researched. Because the 

topics that utilise semi-structured interviews as the method of data collection mostly deal with 

personal experiences and opinions of the participants, less participants are required due to the 

nature of such interviews and the data collected from the interviews should provide enough 

information to analyse in order to complete the study (Crouch & McKenzie, 2006). Data 

saturation must also be considered when determining sample size (Ness, 2015). Data saturation 

is a term used to describe when sufficient data has been collected and as such, the themes and 

results are the same across participants and therefore no new themes are being highlighted 

during data collection. In fact, Ness, (2015) reports that ten participants would suffice data 

saturation when conducting qualitative interviews. Furthermore, Braun and Clarke (2013), 

state that for studies that explore the experiences of a population of people, a small sample size 

is sufficient and using interactive data collection methods such as interviews, a sample size of 

between 10-20 participants is sufficient for a medium size study. Ultimately the final sample 

size of this study was 15 participants as determined by data saturation and the study being 

medium sized as. Table 2 below outlines the participants of the study and their demographics. 

 

 

 

 

 

 

 



34 
 

Table 2: Table of participant demographics 

 

Year 

Community 

Service Was 

Completed 

In 

Current 

Age 

Gender Profession Province 

Community 

Service Was 

Completed 

In 

Type of 

Healthcare 

Facility 

Where 

Community 

Service Was 

Completed 

2019 26 Female Occupational 

Therapist 

KwaZulu 

Natal 

Level 1 

hospital 

2022 23 Female Speech 

Language 

Therapist 

KwaZulu 

Natal 

Clinic 

2020 26 Female Occupational 

Therapist 

Eastern Cape District 

hospital 

2022 24 Female Audiologist Gauteng Tertiary and 

provincial 

hospital 

2020 26 Female Dietician Gauteng Community 

healthcare 

centre 

2021 25 Female Occupational 

Therapist 

KwaZulu 

Natal 

Community 

healthcare 

centre 

2022 22 Female Audiology KwaZulu Community 

healthcare 

centre 



35 
 

Year 

Community 

Service Was 

Completed 

In 

Current 

Age 

Gender Profession Province 

Community 

Service Was 

Completed 

In 

Type of 

Healthcare 

Facility 

Where 

Community 

Service Was 

Completed 

2023 24 Female Occupational 

Therapist 

Free State Primary 

healthcare 

2023 26 Female Occupational 

Therapist 

Free State District 

hospital 

2017 29 Female Physiotherapist Western 

Cape 

Regional 

hospital 

2007 38 Female Physiotherapist Gauteng Primary 

healthcare 

2008 38 Female Occupational 

Therapist 

KwaZulu District 

hospital 

2010 36 Female Physiotherapist Gauteng District 

hospital 

2016 29 Female Audiologist KwaZulu TB hospital 

2006 38 Female Speech 

Language 

Therapist 

KwaZulu Tertiary 

hospital 

 

As seen in Table 2, a total of 15 rehabilitation healthcare professionals participated in the study. 

The sample size was made up of six occupational therapists, three physiotherapists, three 

audiologists, two speech language therapists and one dietician. Participants were between the 

ages of 22 and 38 years old with a mean age of 28.6 years. All participants were female. Seven 

participants completed their community service in KwaZulu Natal, two participants completed 



36 
 

their community service in the Free State, three in Gauteng, one in the Eastern Cape and in the 

Western Cape respectively. Four participants completed their community service in district 

hospitals, six participants at primary healthcare level, two at a tertiary hospital, one at a regional 

hospital and one at a tuberculosis hospital. 

Study Site: 

All interviews were conducted online via Zoom. The researcher is based in Johannesburg and 

conducted the interviews from her home. The participants were based throughout South Africa 

as stipulated in the Table 2 above and their location during the interview was not recorded. 

Data Collection: 

1. Ethical clearance was obtained from the University of Witwatersrand Non-Medical 

Human Research Ethics Committee . Protocol Number: H22/09/01 

2. Organisations representing different rehabilitation healthcare professionals (SASHLA, 

OTASA, SAAA, SASP and ASDA) were contacted. The researcher asked the 

organisations to advertise the study and if members of these organisations are willing 

to be participants in the study, then they were asked to contact the researcher. They 

were also be given a link to a Google form for the participant to fill out with their name 

and contact details if they were interested in participating in the study. 

3. A pilot study was then conducted, and the results thereof determined that no changes 

needed to be made to the study’s data collection tool (interview schedule) and the 

process. 

Pilot Study: 

A pilot study acts as a trial of the main study which can be used to assess either the 

feasibility of a study or testing a research instrument before the actual study is 

conducted (Malmqvist et al., 2019). The pilot study in this research was used to assess 

the interview guide in order to determine if the questions asked provided the researcher 

with rich data to analyse and result in substantial results. The pilot study also assessed 

the process of the study, namely if the data collection process that was planned would 

be appropriate. The pilot study was conducted with one participant known to the 

researcher that fits the selection criteria. This was done through an online interview 

where the researcher used the interview guide to ask questions and gather data from the 

participant. This data was analysed using the data analysis method of framework 



37 
 

analysis and it was determined that the questions asked were appropriate in gaining the 

data needed for the study. 

4. Once a participant had agreed to the study, then a consent form and participant 

information sheet was sent to them via email. They had to complete the consent form 

before participating in the study. 

5. The researcher then conducted semi-structured interviews with the participants via 

video call on Zoom online at a time specified by the participants. Video call was chosen 

as being able to see the researcher’s face allowed the participants to feel more 

comfortable. 

6. The online interviews were also recorded with consent from the participant to record 

the data for analysis and reporting. 

All interviews were conducted in English. Data collection took place between 21 February 

2023 and 26 May 2023. Fifteen interviews were conducted including the pilot study; however, 

one interview was unusable as the participant did not meet the selection criteria. Therefore, 

sixteen interviews were conducted but only fifteen were analysed. The average duration of the 

interviews was 28 minutes. 

Data Collection Materials: 

The data collection materials  used for this study included a self-developed interview schedule. 

Table 3 gives an outline of the interview guide with questions and the theoretical justifications 

of these questions.  The researcher probed further if needed. A computer with Zoom was used 

to conduct the interviews and video recorded the interview to record the data for later on 

analysis and reporting. ` 

Table 3:Outline of Questions to be included in the interview guide and a theoretical 

justification for each question. 

Question: Theoretical Justification: 

Section A: Demographic Questions 

Age One reason demographic questions are asked 

is to increase repeatability of the study as the 

more detailed the information about the 

participants are, the easier it is to replicate 

Gender 

Your Profession 



38 
 

Province where Community Service was 

completed 

similar participants. (Hughes, Camden & 

Yangchen, 2016). 

Type of healthcare facility where community 

service was completed 

Section B: Questions on Readiness for Community Service When Managing a 

Department. 

What aspects of managing a department 

where you exposed to during your 

undergraduate studies? 

Questions on readiness are important to ask 

in order to assess how the participants 

perceived their readiness when entering 

community service in order to determine 

how undergraduate programmes can better 

prepare them for community service when 

heading a department alone. It is also 

important to determine how the participants 

perceive their readiness for independent 

practice to determine whether the community 

service year can be altered to ensure 

competent and confident clinicians are 

created (Wranz, 2011). 

What do you wish you had more exposure to 

during your undergraduate studies before 

community service? 

Section C: Questions on Management as a Community Service Rehabilitation 

Professional 

What structures were in place to assist in 

planning for future needs that may arise 

throughout the year? 

Questions relating to management are 

important to ask as it gives insight into the 

workings of the department and what was 

expected of the community service 

rehabilitation professional. These questions 

also allow the participant to explain how they 

were able to manage a department and if they 

were able to collaborate with others (Naidoo 

et al., 2017). 

What duties were you expected to complete 

as a department head? 

What forms of collaboration with other 

managers were available? 

In what way would the different departments 

interact with each other to assist with 

management duties? 



39 
 

What measures were in place to reflect on 

tasks done and allow to better prepare for the 

future? 

Section D: Questions on Challenges Experienced when Managing a Department as a 

Community Service Rehabilitation Professional. 

In terms of being prepared to manage a 

department, what do you wish you had been 

exposed to during your undergraduate 

studies? 

Questions on challenges are asked to 

determine any barriers that are faced by a 

population of people. This is important 

information to find out as it helps to 

determine how the experience can be 

improved for the population being studied 

(Bissell, May & Noyce, 2004). 

Describe any additional challenges you had 

during your community service year. 

Do you have any suggestions on how to 

improve these challenges? 

Section E: Questions on Support Structures Offered When Managing a Department 

What support structures were offered to you 

whilst heading a department during your 

community service year? 

Determining the support structures present 

within a system is important as it can 

highlight either the need for more support 

structures or how to improve the current 

support structures offered. If sufficient 

support structures are present then this can 

assist in being an example on how to improve 

other organisations support structures 

(Baxter & Glendinning, 2010). 

How did you find the support structures 

available to you to be beneficial? 

What other additional support structures do 

you wish had been made available to you? 

 

Data Analysis: 

The data was analysed manually by the researcher whilst imploring the framework analysis 

approach outlined by Gale (2013). The data was obtained from the online semi structured 

interviews. In accordance with the framework approach to data analysis, both a deductive and 

an inductive thematic analysis of data approach was employed. With regards to the inductive 

thematic analysis, the researcher first transcribed the data verbatim from the audio recordings 

of the semi-structured interviews. Secondly, the researcher familiarised themselves with the 



40 
 

interviews and transcribed data through reading and re reading the data. Thirdly, the data was 

coded using collaborative coding between the student researcher and their supervisor. 

Collaborative coding involved simultaneously going through and reading the transcripts and 

highlighting any important information that was mentioned within and across the different 

interviews and categorising these into codes as agreed upon by the researcher and the 

supervisor. Where discrepancies arose in the process of collaborative coding, discussions 

occurred between the researcher and the supervisor until consensus was reached and a code 

was agreed upon. The end result of this process was the  creation  and reviewing of a codebook 

(Richards & Hemphill, 2017). It was important to use this method to code data to ensure 

trustworthiness of the study (Richards & Hemphill, 2017). The researcher then independently 

collapsed the codes into more defined themes, which were checked by the supervisor as a mean 

of inter coder reliability (O Connor & Joffe, 2020). Once the researcher and the supervisor 

agreed on the themes, then the second level of analysis, the inductive step was employed. In 

this step of data analysis, the researcher inductively mapped the themes that emerged from the 

analysed data into the tenets of Faloy’s framework. The themes mapped on Faloy’s framework 

were also sent to the supervisor for checking before the next step of interpreting the data and 

reporting the data as key findings occurred. 

Trustworthiness: 

Table 4 below outlines the different trustworthiness strategies, their definitions, and how they 

were implemented within this study. 

Table 4: Table Depicting Trustworthiness Strategies 

Trustworthiness Strategy: Definition according to 

Shenton (2004): 

How it will be ensured in the 

study: 

Credibility Credibility aims to ensure 

the research measures what 

it is supposed to measure. 

This was done through 

iterative questioning which 

involved probing of answers 

to ensure truthful responses. 

This was done through data 

analysis ensuring the data is 

relevant to the research aims 



41 
 

Trustworthiness Strategy: Definition according to 

Shenton (2004): 

How it will be ensured in the 

study: 

and answers the research 

question. 

Member checking, peer 

debriefing and peer scrutiny 

were also used to ensure 

credibility. 

Transferability Transferability seeks to 

determine if the study’s 

findings are applicable to 

other situations. 

This was done by including 

detail such as research 

methods, participant selection 

criteria and the time period 

over which the data was 

collected in the final research 

report. 

Dependability Dependability is defined as 

whether the research study is 

repeatable, and the same 

results will be obtained if 

repeated. 

This was done by including 

detail such as research 

methods, participant selection 

criteria and the time period 

over which the data was 

collected in the final research 

report. 

Thick description was also 

used to ensure the concepts 

and methods used in the study 

are accurately described and 

can be repeated. 

Conformability Confirmability is ensuring 

the data is as a result of the 

participants testimony and 

This was achieved by 

justifying within the research 

report why certain techniques 

and methodologies were used 



42 
 

Trustworthiness Strategy: Definition according to 

Shenton (2004): 

How it will be ensured in the 

study: 

not influenced by the biases 

of the researcher. 

as well as outlining any 

limitations of the study. 

This was also done by using 

opened ended questions 

within the interviews to 

ensure the participants answer 

the questions using their own 

experiences and are not led by 

the researcher. 

Another technique that was 

used was supervisor 

debriefings to ensure the 

researcher has another person 

to check the work and 

determine if bias was present. 

Recording the interviews also 

assisted with this as the 

researcher could refer back to 

exactly what the participant 

said to ensure it is accurately 

portrayed in the study. 

 

 

 

 

 

 



43 
 

 

Ethical Considerations: 

Ethical Principles: 

This study was submitted to the Wits HREC (Non-Medical) for ethical clearance before 

commencement. Protocol Number: H22/09/01 

1.Confidentiality, anonymity, and safekeeping of information: 

The participants were assured that the interviews conducted will be kept confidential and only 

the researcher and her supervisor have access to the recordings and transcripts. The data 

collected from the interviews was adapted to ensure the participants remain anonymous as all 

identifiable information about the participant was removed. The information gathered during 

this study will be stored on a password protected computer and password protected word 

documents to ensure only the researcher and their supervisor has access to the interviews and 

transcripts. 

2. Autonomy: 

Participation in this study was voluntary. The participants were allowed to withdraw from the 

study at any moment in time if they so wished and were able to refuse to answer any questions 

they did not wish to answer. 

3. Consent: 

Participants had to give informed consent before participating in the study. They were provided 

with an information sheet which outlined what the study was about, what their participation 

entailed and how their confidentiality was ensured during the study. They were given an 

opportunity to ask the researcher any questions they had before consenting to participation if 

they so wished. They were then given a consent form to sign to show their consensual 

willingness to participate. 

4. Beneficence and non-maleficence: 

This study did not appear to pose any direct risk to the participants, and they did not stand to 

gain from this study. Participants were informed as such. 

5. Justice: 



44 
 

As the study was low risk there was little to no chance of potential harm to the participants. 

The researcher was aware that the participants were giving of their time and knowledge to 

assist in gaining data for the study and therefore treated the participants with the respect due to 

them. All participants were given equal opportunity to describe their experiences and be treated 

in a fair manner. 

6.Debriefing and results for participants: 

The participants were given the opportunity to discuss any concerns they may have had about 

the study with the researcher before, during and after their participation. A copy of the research 

report will be made available to them at their request. 

Distress Protocol: 

The ethical implications of semi-structured interviews as a method of data collection must be 

considered. The subject matter of the interviews may be sensitive and may cause emotional 

reactions during the interview. This was considered during the interview and if there were any 

signs of emotional distress the interview could be terminated as well as access to counselling 

provided at the willingness of the participant. A distress protocol was also in place for if such 

an event occurred then appropriate action could be taken. The interview process may also be 

strenuous and take a long time therefore, the option to take breaks during the interview was 

provided if needed (National Disability Authority, 2009). 

Another aspect of the research study that needed to be considered under ethical considerations 

was online interviews. As video calling applications have the option to conceal one’s face there 

was a possibility that the participant may not be who they say they are. As the researcher was 

also not having face to face contact with the participant, it may be more difficult to determine 

the reliability of participant (Rodham & Galvin, 2006). This was addressed by only conducting 

video interviews where the face can be seen. 

Chapter Summary: 

This chapter has outlined how this study was conducted by first stating the aims and 

positionality of the study. The research design of this study was a qualitative exploratory 

research approach due to this study highlighting the experiences of community service 

rehabilitation professionals who managed their own departments. Semi-structured online 

interviews were used to conduct data collection as this allowed the researcher to further probe 

the participants as well as have more access to participants nationally through online 



45 
 

interviews. The participants were made up of rehabilitation professionals who has completed 

their community service having to manage a department. The data from these interviews was 

then analysed using the framework analysis method where the themes were mapped onto 

Fayol’s five elements of management. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



46 
 

Chapter 4: Findings 

 

This chapter outlines and details the findings of the study in the forms of themes and subthemes. 

The themes and subthemes that emerged from the data are mapped onto Faloy’s five elements 

of management, namely, planning, organisation, co-ordination, command, and control. These 

themes are presented accompanied by further detail with quotations from the participants. 

Addi