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 Disabilities 21 August /08/2012 1

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 21/08/2012 2

No of qualified practitioners on the HPCSA register as at March /08/ CategoryNumber Occupational therapists3816 Occupational therapy assistants344 Occupational therapy technicians354 Physiotherapists6162 Physiotherapy assistants270 Audiologists256 Speech therapists572 Speech therapists and audiologists1439 Community speech and hearing workers22 Medical orthotists and prosthetists419 Orthopaedic footwear technicians57

Note on HPCSA numbers 21/08/  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 LIMPOPO50 - NORTH WEST1064 NORTHERN CAPE844 MPUMALANGA18 - FREE STATE25196 EASTERN CAPE WESTERN CAPE75696 KZN /08/2012 5

No of Rehabilitation Personnel in the public health service 21/08/ ProvinceOcc TherPhysio TherMED OPSpeech Ther GP FS WC NW NC MP LP KZN EC TOTAL

No of health professionals per in GP & NW OTPTMOPSTA Work is underway to develop staffing norms for different levels of rehabilitation services  Most regional, tertiary and specialized hospitals have a full compliment of professionals  Specialised hospitals are limited  Occupational therapists and physiotherapists also available at district level attached to clinics & CHCs  Speech Language and hearing services are the least available at primary level 21/08/2012 7

Example of Vacancy rate in Gauteng CategoryNo of postsPosts filledPosts vacantVacancy rate OT % PT % MOP19 00% Sp Therapist43 00% Audiologist10 00% STA % 21/08/2012 8

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 21/08/2012 9

Increasing access through NHI Examples 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 pop 1 Physio per pop 1 OT per population 1 Physio per population 1 OT per population 1 Physio per population 21/08/

Creation of additional post to meet priority service needs 21/08/ 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 21/08/ Rehabilitation was considered a vertical programme in the past. Integration with 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 21/08/  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 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. 21/08/

21/08/ 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 departmentIssues for collaboration Social DevelopmentSocial security, assessment instruments Services for persons with disabilities Children with disabilities DWCPDUN Convention Disability Machinery Disability research Basic EducationImplementing White paper 6 School health Assistive devices provision

Government departments we collaborate with on disability Name of departmentIssues for collaboration National TreasuryNational contracts for wheelchairs and hearing aids Higher EducationTraining of professionals Training of midlevel workers StatsSADisability in Census Implementing WHO classifications; ICD10& ICF SABSStandards for wheelchairs and fastening devices Accessibility to buildings Standards for accessible transport

Collaboration with civil society and professional associations Name of organizationIssues for collaboration SA Disability AllianceAccess to health services Assistive devices provision Orientation and mobility services SA Society for PhysiotherapistsTraining of midlevel workers General rehab services Occupational Therapy Association of SATraining of midlevel workers Staffing norms General rehab services SA Speech, Hearing Language AssociationEarly hearing detection and intervention

Assistive devices provision 21/08/  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 21/08/  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 21/08/  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.