Access to wheelchairs by persons with mobility impairment in a remote rural district of KwaZulu–Natal, South Africa: therapists’ perspectives

Introduction: The WHO estimated that 1% of the world’s population need a wheelchair,  but few had access. Access to wheelchairs for most of the  South African poor population is through accessing rehabilitation services at public health facilities. This study explored access to wheelchair services from the perspective of rehabilitation therapists, within the uMkhanyakude district of  KwaZulu-Natal. Therapists’ perceptions  on access, and its impact on service delivery is  under explored in the literature.
Methods: Semi-structured interviews with eleven rehabilitation therapists in the uMkhanyakude district  directly involved with wheelchair services were conducted.  Levesque et al’s conceptual framework of access to health care was used to analyse the data. Themes consistent with these dimensions i.e. approachability, acceptability, availability and accommodation, affordability and appropriateness were identified from the data.
Results: Access to wheelchairs was perceived to be facilitated by the establishment of meaningful relationships with wheelchairs users, the ability to eventually provide an appropriate wheelchair for all users, the provision of services close to where people lived, the training of caregivers and the use of local peer trainers. Perceived barriers were limited outreach by the rehabilitation staff, poor screening of those with mobility impairment by other categories of staff, and limited space and time to provide services. Further barriers linked to the therapists included their uncertainty about their level of competency in the context and lack of peer support for the rehabilitation staff, especially those working alone. Barriers associated with clients were the limited understanding of  wheelchairs, what was perceived to be a lack of responsibility to look after the wheelchairs which led to poor maintenance.
Conclusions: The aspects of the five dimensions of access of Levesque et al’s framework were  identified as both facilitators and barriers.The therapists working in this remote rural area have a a strong sense of responsibility about the wheelchair service delivery process and offered clients the best they could with limited human and financial resources. They have a good understanding of the wheelchair users and the environment they function in, which enabled constant adaptation of the services to meet the needs of that specific community.