Disability and rehabilitation : essential considerations for equitable, accessible and poverty-reducing health care in South Africa

Abstract

The right to health for people with disabilities in South Africa is supported by both the South African Constitution and the country's ratification of the UN Convention on the Rights of Persons with Disabilities. However, to date, health service planning and provision have tended to overlook rehabilitation as a component of primary health care. Evidence suggests that people with disabilities and their families experience greater health risks, but systematically worse access to care than their non-disabled peers, especially with regard to South Africa's quadruple burden of disease. Access barriers include environmental, transport and cost challenges, but also serious system limitations, including programme design, lack of health worker knowledge and skills in working with disability, and the widespread absence of planning and resourcing for rehabilitation.As the experience of disability intersects with priority health conditions such as HIV and AIDS, and non-communicable diseases, there is reason to believe that the effectiveness of other programmes may be curtailed, unless disability is considered in health system design. Disability is also strongly related to other vulnerabilities, including gender, race, age and rural location. Disability and poverty tend to be mutually reinforcing, both because poor people are at greater risk of becoming disabled, and because people with disabilities are more likely to become or remain poor.Primary health care re-engineering offers a vehicle for making health care more accessible to people with disabilities, preventing disability through early intervention, and making rehabilitation services available and accessible to all. Health systems strengthening should now look to the universal design of facilities and activities, the incorporation of disability considerations into all health programmes, and the resourcing of rehabilitation services, particularly at primary health care level, as a matter of urgency.