Rehabilitation services in a district health system: managers’ perceptions

Abstract

The growth of rehabilitation services in a specific district in the Eastern Cape has been of concern to the majority of the therapists working in that setting between 2012 and 2015. With the importance of primary health care as the driver of South Africa’s National Health Insurance scheme, and the need for rehabilitation services increasing, the investigation of the perceptions of managers who oversee rehabilitation services is pertinent. The objectives of the study were to explore and describe the perceptions of managers regarding rehabilitation services in a district health system and to make recommendations to the Provincial Department of Health regarding the management of rehabilitation services at a district level based on the managers’ perceptions. A qualitative, exploratory, descriptive, contextual research design was used as minimal information relating to the topic was found. The complexity of perceptions, their influence on behaviour and the environment, are wellexplored using these design approaches. Purposive sampling and semi-structured interviews were used to elicit meaningful responses from managers familiar, and tasked, with the oversight of the rehabilitation service. Data analysis was performed utilising Tesch’s model of thematic synthesis. To ensure rigour within the research Lincoln and Guba’s model of trustworthiness was followed. The ethical principles of respect for persons, beneficence and justice were upheld in the study. A thick description was utilised when reporting the findings and a literature control was done to place the findings in the present literature on the topic. The study has provided insights and perceptions of an important layer within the district health system. These perceptions are meaningful, as they influence the manner in which policy and plans are interpreted and implemented, and decisions are made within the environment of rehabilitation services. Three major themes arose from the data analysis process, namely: The managers’ reported positive factors regarding rehabilitation services, they identified challenges affecting the implementation of rehabilitation services in the District Health System, and they provided suggestions for the improvement of rehabilitation services in the District Health System. The positive views held by those in management positions indicate that there are strong foundations on which to build the rehabilitation service, and features of the system that need to be acknowledged, continued and strengthened. The challenges experienced by this layer of management point to aspects that need to be addressed in order to improve and optimise the impact of the inclusion of rehabilitation services in Primary Health Care. The findings in this study clarify these challenges, and if these are not addressed, the goals of the progressive health care system which South Africa is trying to implement cannot be fully achieved. Furthermore, the discrepancies and gaps that exist between urban and rural, and better and poorer resourced districts are likely to widen. The limitations of the study were identified and recommendations were made for practice (management), education and research