Disability inclusion in African health systems' responses during COVID-19: A scoping review.

Background: People with disabilities often experience poorer access to healthcare because of multiple barriers even in non-crisis times, especially more so in low- and middle-income countries. The coronavirus disease 2019 (COVID-19) pandemic significantly constrained health systems, thus exacerbating access barriers. African health system responses to, and considerations made for people with disabilities during the pandemic have not been adequately examined to inform future inclusive practices during emergent and non-emergent periods. Objectives: This review aimed to explore disability considerations and accommodations included by African governments in their health systems' responses during the COVID-19 pandemic. Method: A scoping review was carried out of peer-reviewed published articles on the Web of Science, Academic Search Premier, MEDLINE, Africa-Wide Info, and CINAHL databases. A desktop search of African government websites for COVID-19 country plans and reports was also conducted. Deductive thematic analysis of included texts was performed to identify disability inclusiveness in the health responses. Results: Ten peer-reviewed articles and three COVID-19 country plans or reports were included in the review. Data reflected a general finding that included countries that failed to effectively consider and include the healthcare needs of persons with disabilities during the pandemic. Conclusion: Poor inclusion of persons with disabilities was effected in healthcare systems' responses during COVID-19 in Africa. Contribution: This article contributed insights about gaps in healthcare systems' responses and highlighted development foci that could improve systems towards greater inclusivity of persons with disabilities' health needs in low- and middle-income countries.

Exploring national human resource profile and trends of Prosthetists/Orthotists in South Africa from 2002 to 2018.

BACKGROUND: The World Health Organization (WHO) in 2017 estimated that around 35-40 million people require prosthetic or orthotic services. The Framework and Strategy for Disability and Rehabilitation 2015-2030 for South Africa highlights a shortage of human resources for disability and rehabilitation services to manage the various risks and types of impairments faced by the population. OBJECTIVE: To describe the demographic trends of Prosthetists/Orthotists (P/O) registered with the Health Professions Council of South Africa (HPCSA) from 2002 to 2018. METHODS: The study was a retrospective record-based review of the Health Professions Council of South Africa (HPCSA) database from 2002 until 2018. The database of registered Prosthetists/Orthotists was obtained from the HPCSA. RESULTS: Data were analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). In 2018, there were 544 P/Os registered with the HPCSA with a ratio of 0.09 P/Os per 10,000 population. There has been an average annual increase of 6% from 2002 to 2018. The majority (71.9%) of P/Os are located in the more densely populated and urbanized provinces, namely Gauteng, KwaZulu-Natal and Western Cape. The majority of registered P/Os identified as white (61%) followed by Black (22%), Indian (7%) and Coloured (2%). Most of registered P/Os are under the age of 40 years (54.2%) and males make up 73% of the registered P/Os. CONCLUSION: This study highlights the unequal spatial distribution trends of P/Os which could be accounted for by South Africa's apartheid history and the subsequent slow pace of transformation. Addressing the existing shortages is necessary to expand access to P/Os services and to ensure the motivation, planning and provision of adequate infrastructure to provide these services. The study presents a compelling case for the prioritization and strengthening of this workforce for the achievement of effective universal health coverage for persons with disabilities.

Suitability of 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for the Eastern Cape, South Africa: A qualitative study.

BACKGROUND: Major lower limb amputation has a severe impact on functional mobility. Mobility can be salvaged with a prosthesis, but this is not always the best option. It is often difficult to decide whether to refer someone for a prosthesis or not. A prosthetic screening tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' was developed and is used for prosthetic prescription in parts of the Western Cape province of South Africa. OBJECTIVES: This study aimed to explore the suitability of the tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for use in the Eastern Cape province of South Africa. METHOD: A qualitative study was conducted with conveniently sampled occupational therapists (OTs) (n = 10), physiotherapists (PTs) (n = 12) and prosthetists (n = 6) in government employment in the Buffalo City Metro Municipality. Participants were trained in the use of the tool and used it for four weeks with patients. Their experiences of the tool were assessed through three focus group discussions with emergent themes being identified during inductive data analysis. FINDINGS: Participants indicated that the tool could assist with prosthetic prescription, goal setting, communication and teamwork. They thought that the tool was multidisciplinary in nature, comprehensive and practical. Findings showed a lack of teamwork in this study setting. Resistance to change and a lack of time might also hamper implementation of the tool. CONCLUSION: The tool can assist with managing the backlog for prostheses and to guide prosthetic prescription in the Eastern Cape province. CLINICAL IMPLICATIONS: A prosthesis can help to salvage functional mobility after lower limb amputation. However, not all people who had above knee amputation manage to walk with a prosthesis. The tool reported on in this article provides information that can guide prosthetic prescription and rehabilitation goals.