Access to Public Healthcare Rehabilitation Services by Persons with Disabilities in South Africa: a Scoping Review
Purpose: The South African National Health System, funded by National Health Insurance, aims to ensure universal access to quality healthcare for all South Africans. The aim of this scoping review was to explore barriers and facilitators experienced by persons with disabilities when accessing rehabilitation services in public healthcare facilities in South Africa. For this scoping review, disability was seen as defined in the International Classification of Functioning, Disability and Health (ICF), and access was understood to include availability, accessibility, acceptability, and affordability of rehabilitation.
Method: Sources were included if they were published between 2012 and 2021, in English, and contained primary research undertaken in South Africa pertaining to accessibility to public healthcare facilities for rehabilitation by persons with disabilities. Following Joanna Briggs Institute guidelines, the search included CINAHL, EBSCOhost, Scopus, Web of Science, PubMed, Science Direct, SciELO, and Google Scholar. Rayyan was used to screen sources for eligibility. Ineligible sources were removed, based on titles and abstracts, and the eligibility of remaining sources was confirmed in the full texts review. Although 70 sources were identified and screened, only 19 were found to be eligible for inclusion. Data was extracted on Microsoft Excel and Word templates. Analysis and synthesis were done using Microsoft Excel and Taguette.
Results: The findings showed that the most prominent barrier restricting the access of persons with disability to rehabilitation was affordability. Other barriers were availability and acceptability of services. Physical access to rehabilitation was affected by inaccessible transport and community mobility, social and community barriers. The facilitators that were most prevalent were personal attitudes, family and friends - societal and community - and governmental support.
Conclusion and Implications: This scoping review confirmed that access to rehabilitation services in public healthcare facilities in South Africa is a multifaceted issue, which requires a multisectoral approach to achieve sustainable and effective solutions. Intersectoral and interprofessional approaches by public healthcare rehabilitation service providers and stakeholders are necessary to improve access to services.
Better reliance on facilitators that are already in place should improve access to rehabilitation services. This includes improved collaboration with community leaders, family members and users of disability services.