Abstract
BackgroundWheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa.ObjectivesThe aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings.MethodQualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery.ResultsStudy findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost.ConclusionThe gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.
Highlights
The provision of assistive devices to compensate for loss of function is an essential part of rehabilitation (United Nations [UN] 2006a)
The results are presented with reference to the framework of the eight service steps of a comprehensive wheelchair service as stipulated by the WHO (WHO 2008)
According to the WHO Guidelines (WHO 2008), a clear referral network allows community sources and healthcare service providers to identify and refer persons who may benefit from wheelchairs
Summary
The provision of assistive devices to compensate for loss of function is an essential part of rehabilitation (United Nations [UN] 2006a). A wheelchair, defined as ‘a device providing wheeled mobility and seating support for a person with difficulty in walking or moving around’, is one such assistive device (World Health Organization [WHO] 2008:11). Wheelchair provision in rural areas must, take into account the uneven terrain, lack of paved roads and sidewalks, eroded paths, small houses and narrow doors often found in these settings (Eldar 2001). Transport services are often limited in low-resourced settings and wheelchairs become the primary mode of mobility (Schoenberg & Coward 1998; WHO 2008). South African and international documents guide rehabilitation service delivery and the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa
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