Situational and Gap Analysis of Human Need and Capacity in ...

Situational and Gap Analysis of Human Need and Capacity in ...

Situational and Gap Analysis of Human Need and Capacity in South Africa What the commissioned research has established thus far Cape Peninsula University of Technology, 11 August 2011 On behalf of the SACOHSD BACKDROP Re-engineering in the DoH of PHC & DHS Debates on the role and place of a rehabilitation team in the new DHS model. WHO Report makes the case that rehabilitation plays role in health care delivery

Rehabilitation workforce is not appreciated, is under-valued and under-resourced. SOUTH AFRICAN HEALTH CONTEXT 1. MTSF in alignment with the MDG 2. 10 PP DoH 3. Negotiated Service Delivery Agreement (NDSA) 4. NHI 5. DHS & PHC MTSF

Improved quality of basic education A long and healthy life for all South Africans

All people in South Africa are and feel safe Decent employment through inclusive economic growth A skilled and capable workforce to support an inclusive growth path An efficient, competitive and responsive economic infrastructure network Vibrant, equitable and sustainable rural communities with food security for all Sustainable human settlements and improved quality of household life A responsive, accountable, effective and efficient local government system Environmental assets and natural resources that are well protected and continually enhanced Create a better South Africa and contribute to a better and safer Africa and World An efficient, effective and development oriented public service and an empowered, fair and inclusive citizenship

NSDA Output 1: Increasing Life Expectancy Output 2: Decreasing Maternal and Child mortality Output 3: Combating HIV and AIDS and burden of disease from TB decreasing the Output 4: Strengthening Health System Effectiveness

HR the heart of the matter At the core of this challenge is HR development, management, allocation, and retention. The supply, allocation, and distribution of health care workers, at all levels of the health system, lies at the heart of thinking underpinning the planned re-engineering of the District Health System (DHS). Role of SACOHSD As a response to many of the challenges SACOHSD commissioned a review to investigate the current status quo with respect

to a specific category of health professionals, a group referred to by many as allied health professionals and workers, who operate in a complex and, relatively poorly understood, field of rehabilitation therapy in South Africa. SACoHSD concern The SACoHSD were concerned that the critical role rehabilitation health therapists play in the wider health and social framework of the DHS and PHC was not well understood and, becoming undervalued. Linked to this was a perception that not enough public posts were being created or filled, in

sufficient numbers to absorb the numbers of qualified students being trained at HEI in RSA OBJECTIVES of the REVIEW to unpack and understand the basis of the current status quo & the emerging picture in relation to unmet needs, public sector demand and supply, as well as educational supply, to identify the gap between current and projected need, supply, and demand and, create evidence for supporting or, developing potential solutions to what appears to be a mismatch between public and educational need, demand, and supply.

This report places some broad questions on the agenda how disability and rehabilitation are currently understood globally and in South Africa; the scale and scope of the rehabilitation (and disability) challenge and population at risk relative to the national burden of disease; the scale of human resource supply in the public sector and that being developed by education and training institutions; and how the concept and practice of disability and rehabilitation could be more integrated into the proposed re-engineering of the PHC in South Africa. Key findings- Conceptual I Globally disability and rehabilitation as health

science concepts is not well understood. Concepts of disability are contested in terms of its size, nature, levels and types of interventions required and diversity There are different perspectives on disability spans human rights, development, political, social medical and traditional spectrum Key findings- Conceptual II There is a need to address disability (functioning, activity, social participation) as a cross-cutting human rights and developmental issue enshrined as part of the MDGs since 2010 Increasing evidence that poverty increases the risk of

disability Naming and categorizing the rehabilitation workforce under the term allied health workers, in the public sector, reflects an unstated lesser status and value, reflected in current job grading and levels of remuneration in the public sector. Key findings Measurement and Cost How one defines disability, determines what gets measured when ascertaining the size of the population at risk. In the SA context, (about to change with the 2011 census) what has been measured (and how) has not revealed an accurate size of disability and, the

nature and scale of the rehabilitation challenge. While crucial, it remains difficult (but not impossible) to begin to quantify the direct and indirect cost of disability Some Key findings- Health Conditions I Linked to the conceptual and statistical debate is the lack of detail on morbidity, co-morbidity and linkages between SA BoD or, epidemiological profile with respect to interventions needed from a range of rehabilitation workers in the private and public sectors. The case studies demonstrate a clear and emerging link between rehabilitation, disability, and morbidity, as well as ways to prevent and minimize disability, in all of the key areas of South Africas BoD. The link between HIV/AIDS and issues like motor development delay

and other functional and participation impairments is well documented . This has huge significance and, exponentially widens the size and scale of the potential population at risk and rehabilitation services. Key findings- Health Conditions II A growing body of research material is being produced that links rehabilitation and the epidemiological profile of the SA population, with HIV/AIDS, chronic disease, and injuries as a consequence of violence and road traffic accidents The critical role rehabilitation plays in relation to screening and early intervention with respect

to early childhood development is also evident Key Findings Rehabilitation Services I Despite a place in the DHS & PHC plans, rehabilitation services are not well resourced nor, visible at the level of communitybased services, thus opportunities to offer a continuum of treatment is not present Service delivery is often limited or, non-existent at community-level, especially in rural areas or, resource-poor communities, resulting in a service delivery gap which the educational institutions have had to fill since 1994 through service learning sites in all fields of rehabilitation, Key Findings Rehabilitation Services I I Service delivery tends to be facility rather than communitybased and is not viewed as either systematic or thorough

enough to address the scale of need Expansion of service delivery platforms by development of mid-level and community-based rehabilitation workers in SA are not well developed. Models and evidence does exist on good practice and lessons learnt The Rehabilitation workforce I While incomplete, data to date highlights certain trends: Rehabilitation workforce is 31,000 people, with 1/3 in the public sector; unlike some middle income countries, SA has a solid core of rehabilitation workers, especially at the specialist level. SA has a strong foundation of specialist and technical skills; the global finding is that the less resourced a country is,

especially in rural areas, the more the need for high level specialist skills such as diagnosis, pathology, problem-solving, clinical decision-making, and communication and, critical role specialists can play in the area of advice, support, or intervention for mid-level and CBR workers; The Rehabilitation workforce II retention of health therapists given the low salary band and opportunities on offer in the private sector and overseas is a challenge; there are some mid-level workers but not enough trained community-based rehabilitation workers, despite some experience at this level of operation;

The Rehabilitation workforce III While incomplete, data to date highlights certain trends: HR distribution is uneven across provinces, with the majority of posts allocated and filled in the public sector belonging to PT and OT, with a much smaller number in the field of audiology and speech and language therapy; there is a substantial number of vacant, yet active, posts not filled, particularly

in provinces like Limpopo and the Eastern Cape; while the data from the educational institutions is not as yet complete the finding is that institutional capacity exists to develop a good training and learning platform. Matching skills to current need remains a challenge; South Africa has some good experience in developing a cadre of CBR workers. This area could be strengthened, along with the development of rehabilitation mid-level workers

Some critical challenges I to re-conceptualize and/or articulate a comprehensive position and role for rehabilitation at all levels in the health system (and other inter-linked sectors), especially in relation to the concept of CBR to track and synthesize an emerging body of evidence to underpin arguments for a more central role and place of rehabilitation in SA with respect to prevention, health promotion, access, and treatment to more deeply understand the nature, scale, and composition of the population at risk in SA with respect to levels of functional and social participation in relation to the national BoD

Some critical challenges II to unpack and discern potential reasons that lie behind the number of posts within the public sector not currently filled (but active) in relation to the rehabilitation workforce to unpack and deepen the concept, practice and role of CBR and position it within the new re-engineered PHC model and District Management Team, including the identification and development of relevant skills sets required from professionals, mid-level workers and, CBR workers to develop a teaching platform and educational curricula that closely corresponds with the SA social reality and, new

trajectories in the health system Some critical challenges III Address the inequity in relation Disability and Rehabilitation To harness the comparative advantage SA has to other developing countries of a large pool of rehabilitation professionals that could contribute to an expansion of quality and well-supervised rehabilitation interventions to improving the well being of citizens to quantify the potential social and economic cost of the national BoD for the country in the absence of various levels of rehabilitation intervention facility-based and community-based to lobby and engage the DoH and Ministerial Review Team on the critical importance of including CBR at the centre of the PHC model, given the BoD, supported by an expanded core of specialist

rehabilitation practitioners Conclusion Conceptual Measurement and cost Health Conditions Rehabilitation services

Rehabilitation workforce Critical challenges Review Report This review is written against the backdrop of a rethinking and re-engineering process taking place in the DOH with respect to how PHC goes forward in SA. The role and place of a rehabilitation team within the new model is in the mix but unspecified or, defined at all levels of the DHS. The review, placed alongside the WHO Report, highlights the important role rehabilitation plays and, can play, with respect to early detection, prevention, access, and levels of treatment to improve the well being of a population at risk and, that the

capacity of the rehabilitation workforce we have or, could unleash, is not fully appreciated and, as a consequence, under-valued and under-resourced. Some key challenges arising are: Critical challenges The report concludes with a set of critical challenges for the public sector and HEI in SA to deliver an effective, accessible, and improved quality of care to citizens experiencing a range of functional impairments and participatory limitations. The report is by no means definitive, limited by gaps in the content and status of available empirical evidence and data in the field of rehabilitation and

human resource capacity and, time available to capture and process emerging findings. Rehab Service Model Worcester GSA Multi-Disciplinary Team Worcester Hospital - Assessment Treatment Training Referral to next Level

Multi-Disciplinary Team District Hospital - Assessment - Treatment - Training CHC - OUTREACH TO PHC Outreach Team PHC Clinics

- Screening Home Programs Training CBS Focus: Training - HBC - Sub-Acute Wards - ECD

CBS on Farms Multi Disciplinary Team 1. 2. 3. 4. 5. 6. 7. Physiotherapist Occupational Therapist Speech/Audiology

Dietician Social Worker @ Level2/District Hospital Clinical Psychologist Orthopaedic Aftercare Nursing Service GAPS 1. Research evidence based outcomes 2. In-patient Rehab Unit / Rehab beds per sub-district Principles 1. PHC philosophy - accessibility 2. CBR Partnership with Community, NGO, DPOs

3. Training 4. Support 5. Appropriate Referral 6. Focus for prevention programmes: Women, Children, HAST, Chronic Diseases Acknowledgement and thanks

SACoHSD Participating HEI provided data Task Team (GP, RM, DG, HK, JC, TM) CPUT UCT & US LD, TF, SB CRS ES. GM, MG

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