Practical insights for enhancing primary care rehabilitation services in low-resource contexts.

Abstract

Background:  Rehabilitation services are crucial for addressing the growing burden of functioning problems related to chronic conditions in low and middle-income countries. These services, however, remain limited in South Africa and Zimbabwe's primary health care (PHC) settings.

Aim:  To identify recommendations for enhancing the accessibility and quality of rehabilitation services in PHC in South Africa and Zimbabwe from the perspectives of primary care providers (PCPs) and patients.

Setting:  Ten PHC facilities in the Eastern Cape, South Africa and in Manicaland, Zimbabwe.

Methods:  A qualitative descriptive study was conducted. Semi-structured interviews were conducted with 37 PCPs and 40 patients. Thematic analysis of transcribed and translated data was done in ATLAS.ti version 22.2.4.

Results:  Five key recommendations emerged: (1) provide rehabilitation services closer to home through facility-based services, outreach, home visits and telerehabilitation; (2) improve patient awareness of rehabilitation through patient education, community engagement and patients actively seeking information; (3) enhance PCPs' knowledge and basic skills in rehabilitation through training and guideline development; (4) improve communication among PHC stakeholders; and (5) advocate for rehabilitation inclusion in leadership, resource allocation and multi-disciplinary teams.

Conclusion:  Implementing the identified recommendations could significantly improve the accessibility and quality of rehabilitation services in PHC, aligning with global initiatives to scale up rehabilitation in health systems. Future research should focus on evaluating the implementation and impact of these recommendations.Contribution: The study emphasises the inclusion of PCPs' and end-users' voices in providing practical, context-specific strategies for establishing or strengthening rehabilitation services in low-resource PHC settings.