The Health Systems Trust, together with Inclusive Practices Africa, a research group of the Faculty of Health and Rehabilitation Sciences affiliated to the University of Cape Town, are due to release the findings of its latest South African Health Review the week of 7 December, timed to overlap with the International Day for Persons with Disabilities, under the theme of 2020, "not all disabilities are visible."
The 23rd edition of the South African Health Review recognises the gains made in disability- inclusive health care, but also acknowledges that progress has been slow in the public health system. Authors note that disability-awareness programmes advocate for the inclusion and full participation of persons with disabilities, and stress the necessity for developing a participatory approach to disability-awareness activities which are respectful of linguistic and cultural diversity, traditions and preferences, but tend to be driven by people who are not disabled. They argue that the implementation of self-advocacy programmes will contribute to dispelling stereotypes of persons with disabilities as passive recipients of welfare and charity programmes.
Other resounding messages that have emerged from this collection include the following:
COVID-19 has deepened the multiple layers of vulnerability and challenges for persons with disabilities and has amplified the barriers to service access and discontinuities in the health system. Persons with disabilities are at heightened risk of contracting the virus, not only because of underlying conditions, but also due to contextual barriers. Many persons with disabilities have ongoing health needs which require access to medication, medical supplies, therapy and assistive devices. While some people benefitted from online services and delivery, this was not accessible to all, especially for those relying on public transport and public sector health services. Gaps were noted in financial assistance, food parcels, clean water, and domestic help. Worries that everyday activities, such as buying groceries, coupled with dependence on caregivers, guardians, friends and relatives can contribute to increased psychological distress to increasing mental health needs for persons with disabilities with the strain of increased psychological distress burdening the already inadequate health system.
There is strong motivation for strengthening community-based rehabilitation services and extending the idea of rehabilitation beyond individual interventions. There is a need for a paradigm shift from an overwhelmingly medicalised and individualised approach to disability which focuses on fixing impairments, to a rehabilitation service delivery model which acknowledges the critical role of mid-level community rehabilitation workers and community-based peer supporters for persons with disabilities which has greater impact at community level.
There are systemic barriers that lead to inadequate health, development and academic outcomes for children with disabilities. Intersectoral collaboration in the health and education sectors is affected by poor co-ordination and integration at various levels of the system and while the South African National Departments of Health and Basic Education have both individual as well as co-ordinated policies to facilitate the participation of children and youth with disability, there is a disjuncture to how these policies are implemented. More effort and political will are required to make it easier for children and youth with disabilities to transition much more seamlessly between these sectors.
The unemployment rates for persons with disabilities in the formal sector are still considerably higher than those of non-disabled persons in South Africa. The vast majority of South Africans with disabilities, and particularly those who are historically disadvantaged, face significant challenges in accessing employment or opportunities for livelihood development. Disabling environments such as lack of reasonable accommodation and programmes focusing on integration and retention of employees with disabilities are inadequate and rehabilitation must extend beyond vocational assessment to a more comprehensive approach to workplace inclusion.
This publication was made possible, through data shared with the Health Systems Trust by the South African National Department of Health (NDoH)
This publication was funded by the Health Systems Trust with partial support from the National Department of Health.
The SAHR can be access on www.hst.org.za:
About the South African Health Review
The South African Health Review (SAHR) is an accredited peer reviewed publication. Now in its 23rd edition, the aims of the Review are to advance the sharing of knowledge, to feature critical commentary on policy implementation, and to offer empirical understandings for improving South Africa's health system.
The SAHR is recognised as one of the most authoritative sources of commentary on the South African health system. It is widely used in teaching public health at undergraduate and postgraduate level in South Africa and by scholars, donors and development organisations, journalists, policy makers and policy implementers at various levels of the health system.
Chapters for the Review comprise a mix of specifically commissioned work reflecting upon core health systems issues as well as issues of particular importance, with findings from topical research. Authors comprise subject specialists assisted wherever feasible by less experienced researchers as a means of capacity development. Contributors include those working in the formal public health sector, parastatal organisations, scientific councils, non-governmental organisations, academia, and bilateral and multilateral support agencies.
About the Health Systems Trust
The Health Systems Trust (HST) is a leading role-player in the South African public health arena, focusing on health systems strengthening, research, and strategic support in the implementation of priority health programmes. Established in April 1992, on the brink of democracy in South Africa, HST has played a significant role in the evolution of the national health system. Today our strength lies in the knowledge, insight and experience we harness through synergising our research and implementation outputs towards a healthy life for all.
Antoinette Stafford Cloete, E:
Lunga Memela E:
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