'Services were completely shut down': access to rehabilitation in the rural Eastern Cape Province of South Africa during COVID-19.

Introduction: Persons with disabilities living in rural areas were disproportionately affected during the COVID-19 pandemic. This population, with a higher propensity for poor health and higher need for health services, bore the brunt of adverse effects of emergency regulations that cancelled or restricted access to rehabilitation. South African legislative and policy frameworks support the availability and promotion of disability and rehabilitation services as priority healthcare programs for all. Rehabilitation services in the country were, however, underresourced prior to the pandemic, and halted during lockdowns because of their non-essential status in the healthcare system. Within this context, this study explored the experiences of rehabilitation practitioners in the Eastern Cape Province of South Africa during the COVID-19 pandemic.

Methods: Forming part of a mixed study on inclusiveness of pandemic responses to people with disabilities, we reviewed government responses across different African countries, analysed the South African government responses to the pandemic and conducted interviews with rehabilitation practitioners in the rural Eastern Cape Province of South Africa. This article reports on the qualitative interviews, while the reviews and survey findings were published elsewhere. Rehabilitation practitioners were recruited from a provincial rehabilitation forum for practitioners who work in the public health facilities in the province. A combination of online and telephone individual interviews were conducted with participants, as well as three asynchronous interviews using Google Forms and WhatsApp. Transcriptions of interviews were analysed inductively and thematically through coding and categorisation.

Results: Eight practitioners participated in the study (a response rate of 8.4%). This included six physiotherapists and two occupational therapists. Three themes developed from data reported by the participants: reconfiguring rehabilitation services, experienced impact on rehabilitation service delivery and exacerbation of pre-pandemic rehabilitation shortfalls.

Discussion: The low priority of rehabilitation services as part of health services exacerbated pre-pandemic barriers for persons with disabilities. The cessation of such services rendered rehabilitation wholly inaccessible to persons with disabilities in the province, with detrimental effects on their function, health and wellbeing. Practitioners suggested that integrated collaborative health and rehabilitation service delivery enabled the continuation of some service aspects to some persons with disabilities. Initiatives and adaptations to services were driven by practitioners, although often in the absence of clear directives from the Department of Health. Some alternative methods of delivery (eg telerehabilitation) that were deployed elsewhere, were not as accessible and viable for use in the rural Eastern Cape Province, which has poor technological infrastructure and connectivity.

Conclusion: The pandemic challenged rehabilitation services as it remained deprioritised. However, rehabilitation also adapted, with practitioners strategising on ways of reconfiguring these rehabilitation services. Health systems responses to emergent health events should include and capacitate rehabilitation services to support preventive and promotive approaches.