Rehabilitation service in the northern KwaZulu-Natal, uThungulu and service providers’ knowledge and attitudes towards public private partnerships.

Abstract

Rehabilitation assists persons with disabilities attain physical independence and self-determination. In South Africa, the distribution of rehabilitation services is largely poor. Rehabilitation services in uThungulu District, KwaZulu-Natal are covered by the public sector. The uThungulu public health sector provides limited rehabilitation services, with physiotherapists working in multidisciplinary teams. Consequently, achieving rehabilitation goals of functional independence is affected. Public and private rehabilitation service providers working together can help to combat this problem. Furthermore, rehabilitation services are unevenly distributed in rural uThungulu. This study explores current rehabilitation service provision practices in uThungulu and the possibility of Public Private Partnerships (PPPs). A sample of 50(37 public and 13 private) rehabilitation service providers were interviewed; using a mixed methods exploratory case study. Through the use of focus groups, individual interviews and questionnaires, participants were requested information on their perception of the availability, accessibility and equitability of rehabilitation services in uThungulu district. The knowledge and attitude service providers had towards PPPs were also explored. Rehabilitation practitioners reported poor rehabilitation service provision in uThungulu due to the poor socio-economic circumstance of uThungulu, limited multidisciplinary rehabilitation service providers and poor delivery of rehabilitation services. Sixty-four percent of the participants reported that their rehabilitation was not sufficient. Ninety-two percent of the participants reported working in a multidisciplinary team however human resource shortages were also reported resulting in institutions being constantly short-staffed. Sixty-nine percent of the participants reported the non-availability of designated rehabilitation units in their institutions. Professionals working at institutions with designated rehabilitation units evaluated the effectiveness of the rehabilitation programme significantly more positively than those working at institutions without such designated units (U= 98.5, p=0.01). Participants stated that they receive an average of 5.37±4.79 rehabilitation referrals per day. Forty percent of the participants stated that rehabilitation sessions occur daily, with 38% of respondents reporting rehabilitation sessions lasting between 30 to 45 minutes. A moderate, positive correlation was found between participants’ perceptions of managerial support and perceived rehabilitation programme effectiveness (rs= 0.45, p=0.01). A weak, positive and statistically significant correlation between perceived effectiveness of rehabilitation programme and ease of administrative process was found (rs= 0.29, p= 0.04). Two thirds (66%) of the participants did not know about PPP and only a third (34%) knew about it. Rehabilitation service in uThungulu is provided predominantly in hospital departments and less so at community-based centres such as clinics. UThungulu’s rehabilitation services are multidisciplinary, but often with an incomplete quota of rehabilitation practitioners. Rehabilitation services were perceivednegatively by providers in the uThungulu District. These negative perceptions were due to a lack of equipment, the absence of designated rehabilitation units, human resource shortages, a lack of managerial support and cumbersome administrative processes. Furthermore, rehabilitation service providers perceived rehabilitation as insufficient and ineffective. Rehabilitation service providers in uThungulu were not aware of PPPs. The possible utilisation of PPPs as tools for adequate rehabilitation service provision thus could not be ascertained sufficiently. The few providers who were aware of PPPs reported a positive potential for PPPs as vehicles of rehabilitation service provision.