the role of the department of health in giving effect to u n convention on the rights of persons...
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THE ROLE OF THE DEPARTMENT OF
HEALTH IN GIVING EFFECT TO U N
CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES
Portfolio and Select Committee on Women, Children and People with Disabilities21 August 2012
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Outline
Within a Framework of giving effect to the U N Convention, the following matters will be addressed:
The status on rehabilitation personnel including retention and recruitment
Creating access to rehabilitation services at all levels of care with a focus on Primary Health Care
Extending Rehabilitation beyond “Health” Providing assistive devices
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No of qualified practitioners on the HPCSA register as at March 2012
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Category Number
Occupational therapists 3816
Occupational therapy assistants 344
Occupational therapy technicians 354
Physiotherapists 6162
Physiotherapy assistants 270
Audiologists 256
Speech therapists 572
Speech therapists and audiologists
1439
Community speech and hearing workers
22
Medical orthotists and prosthetists
419
Orthopaedic footwear technicians 57
Note on HPCSA numbers
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HPCSA numbers contain total of all practitioners registered
Contain both in public and private sectors
Also contain retired and non practicing practitioners
On average only a quarter are in the public health system
Psychologists
PROVINCE TOTAL NO OF PSYCHOLOGISTS
IN HOSPITALS IN DISTRICTS/COMMUNITY
GAUTENG 93 48 45
LIMPOPO 50 50 -
NORTH WEST 10 6 4
NORTHERN CAPE 8 4 4
MPUMALANGA 18 18 -
FREE STATE 25 19 6
EASTERN CAPE 42 31 11
WESTERN CAPE 75 69 6
KZN 48 45 3
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No of Rehabilitation Personnel in the public health service
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Province Occ Ther Physio Ther
MED OP Speech Ther
GP 175 239 19 143
FS 85 86 13 20
WC 32 37 4 12
NW 34 44 2 10
NC 36 48 3 22
MP 69 61 7 30
LP 138 155 4 56
KZN 121 236 8 75
EC 104 134 22 35
TOTAL 794 1040 82 403
No of health professionals per 100000 in GP & NWOT PT MOP STA
2 2.5 0.2 1.5
0.9 1.1 0.02 0.3
Work is underway to develop staffing norms for different levels of rehabilitation services
Most regional, tertiary and specialized hospitals have a full compliment of professionalsSpecialised hospitals are limitedOccupational therapists and physiotherapists also available at district level attached to clinics & CHCsSpeech Language and hearing services are the least available at primary level
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Example of Vacancy rate in Gauteng
Category No of posts
Posts filled Posts vacant
Vacancy rate
OT 191 175 16 8.3%
PT 250 239 13 5.2%
MOP 19 19 0 0%
Sp Therapist 43 43 0 0%
Audiologist 10 10 0 0%
STA 96 90 6 6.2%
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Retention and expansion of training of personnel As a retention strategy, therapists receive
Occupational Specific Dispensation (OSD). Human Resource for Health Plan
Inform Planning of required posts and cadres Expanded training opportunities
Medical orthotists and prosthetists programme at Walter Sisulu University
New training programmes for speech therapy and audiology at Fort Hare and Walter Sisulu considered
Training of Orientation & Mobility Instructors requires follow-up
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Increasing access through NHIExamples of Rehab therapists per population (SA as a whole)
Rehab therapists in private sector per population
Rehab therapists in public sector per population
1 OT per 14 500 pop 1 Physio per 9 000 pop
1 OT per 2 800 population1 Physio per 1 600 population
1 OT per 53 000 population1 Physio per 50 000 population
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Creation of additional post to meet priority service needs
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The inclusion of rehabilitation in the Primary Health Care Package and integration in the re-engineering of PHC process creates urgent demand for posts and improving the conditions of service of rehabilitation personnel and enhanced health services for persons with disabilities Screening for visual & hearing impairment &
development is part of the school health policy & protocols have been developed.
Rehabilitation competencies are recommended for inclusion in the CHW Training
Rehabilitation personnel are to be included in developing the HR norms for PHC re-engineering
Integration with priority programmes
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Rehabilitation was considered a vertical programme in the past. Integration with programmes @ policy planning and implementation levels is necessary for comprehensive care
Mandatory audiological evaluation for TB patients who are at risk for ototoxic hearing loss
The Road to Health Chart is an effective tool for early identification of impairment and disability. However optimal impact of the tool requires improved utilization and the availability of referral paths.
Integration with chronic diseases
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Non-Communicable Rehabilitation is part of comprehensive
service delivery to patients with secondary complications of NCDs including Stroke.
This role was re-affirmed in the Declaration of the S A Summit on NCDs ( September 2012)
HIV & AIDS Rehabilitation personnel are responsive to the
needs of children and adults with HIV & AIDS There is an increasing knowledge base on the
rehabilitation needs of this target group.
Further enhancing assess to services Creating physical access at facilities
A 2010 report on accessibility showed status at hospitals, District hospitals were least accessible
Environmental accessibility of hospitals included @ NHI pilot sites
Health Facilities Planning developing norms and standards for rehabilitation inclusive of accessibility requirements
enhancing quality of service delivery through a survey to be lead by the NCD Cluster.
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The Department acknowledges that
Rehabilitation extends beyond the health domain
and adopts an intersectoral approach to
comprehensive management
Government departments we collaborate with on disability
Name of department Issues for collaboration
Social Development Social security , assessment instruments
Services for persons with disabilities
Children with disabilities
DWCPD UN Convention
Disability Machinery
Disability research
Basic Education Implementing White paper 6
School health
Assistive devices provision
Government departments we collaborate with on disability
Name of department Issues for collaboration
National Treasury National contracts for wheelchairs and hearing aids
Higher Education Training of professionals
Training of midlevel workers
StatsSA Disability in Census
Implementing WHO classifications; ICD10& ICF
SABS Standards for wheelchairs and fastening devices
Accessibility to buildings
Standards for accessible transport
Collaboration with civil society and professional associations
Name of organization Issues for collaboration
SA Disability Alliance Access to health services
Assistive devices provision
Orientation and mobility services
SA Society for Physiotherapists Training of midlevel workers
General rehab services
Occupational Therapy Association of SA
Training of midlevel workers
Staffing norms
General rehab services
SA Speech, Hearing Language Association
Early hearing detection and intervention
Assistive devices provision
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Wheelchairs, hearing aids and artificial limbs are prescribed and fitted by appropriately trained professionals
Recipients are trained to use and care for the device properly
It is important that a recipient receives the correct device
More therapists are specializing in seating to give optimum service based on scientific evidence
Assistive devices provision
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With new technology audiologists have migrated from analogue hearing aids to issuing digital hearing aids
New wheelchair contract contains motorized wheelchairs to cater for quadriplegics who need them
About 16 cochlear implants are also performed per annum
More than R50million was spent on wheelchairs in 2010/11
However we are aware of failure to receive assistive devices due mainly to
financial limitations
Conclusion
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The DOH acknowledges that persons with disabilities & the families/caregivers experience barriers accessing health & rehabilitation services.
Present policy development & planning creates significant opportunities for an increase in the number of posts and the enhancement of quality rehabilitation and health services provided to persons with disabilities
Enhanced priority is expected to increase funding allocation for assistive devices.