Occupational therapy services and perception of integration of these at primary healthcare level in South Africa

Abstract

Background: Literature indicates that access to rehabilitation services in South Africa is limited. Recent policy documents by the
National Department of Health related to disability and rehabilitation propose the integration of occupational therapy services in primary
healthcare (PHC). However, the implementation strategies concerning integration are not clear as there is inadequate evidence locally
on the occupational therapy service provision in PHC even though there is growing evidence internationally.
Purpose: This study sought to determine the services provided by occupational therapists in PHC and to explore the perceptions of
the occupational therapists on the integration of occupational therapy services within the PHC reengineering streams of the National
Health Insurance (NHI).
Method: A two-phase explanatory sequential mixed method strategy was utilised in this study. A quantitative survey was sent to
members of the occupational therapy professional association and an organisation of professionals providing rehabilitation services in
rural communities. Qualitative data were then collected using semi-structured interviews with five therapists who completed the survey.
Findings: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the communitybased
rehabilitation (CBR), the Social Model, the International Classification of Functioning, Disability and Health (ICF), and the
Medical Model using client self-management and case-management intervention approaches. The majority of occupational therapists
are currently based in district hospitals (42%), community health centres (16%), community organisations (8%), and clinics (8%).
Those working in the community indicated they work in a multidisciplinary team (MDT). They also use PHC service delivery models
to manage people with disabilities (PWDs). Occupational therapists in PHC have a strong perception of their relevance in the PHC
reengineering streams, despite the numerous barriers and few facilitators to the integration of occupational therapy services in the
PHC reengineering streams of the NHI.
Conclusion: The perception of the study participants is that occupational therapy service integration in the PHC reengineering
streams will lead to improved healthcare. However, they are also of the opinion that integration will not happen without advocacy from
occupational therapists or occupational therapy being adequately supported in PHC.

Key words: Occupational therapy, primary health care re-engineering, integration, National Health Insurance, universal health coverage.