{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:24:14Z","timestamp":1785432254862,"version":"3.56.0"},"reference-count":52,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0There is a recognised need for rehabilitation services at primary health care (PHC) level. In addition, there are clear policies (international and national) and guidelines for use by healthcare planners in South Africa to implement rehabilitation services. Although rehabilitation services are provided on the primary platform, its operationalisation has not been in an integrated manner. Clarity on the level of integration within existing PHC rehabilitation service delivery is required for its inclusion in a reengineered PHC.\n\nAim:\u00a0The study explored the extent to which rehabilitation services are integrated into PHC service delivery based on the expressed reality of rehabilitation professionals.\n\nSetting:\u00a0The Johannesburg Metropolitan District of Gauteng, South Africa.\n\nMethods:\u00a0In-depth interviews with 12 PHC rehabilitation professionals were completed to elicit their experiences with PHC rehabilitation services.\n\nResults:\u00a0The theme\u00a0the current state of rehabilitation services \u2013 \u2018this is the reality; you need to do what you need to do\u2019\u00a0along with its two subcategories, was generated from this study. The theme describes the expressed reality of suboptimal, underdeveloped and poorly integrated rehabilitation services within the Johannesburg Metropolitan District. Rehabilitation service providers have adapted service delivery by including isolated components of rehabilitation integration models, but this has not yielded an integrated service.\n\nConclusion:\u00a0Rehabilitation services although recognised as a crucial service in PHC must be critically analysed and adapted to develop integrated service delivery models. There should be a shift from selected coping mechanisms to targeted, integrated services.\n\nContribution:\u00a0The study describes PHC rehabilitation services and explores best practice models for integrated service planning and delivery.<\/jats:p>","DOI":"10.4102\/phcfm.v16i1.4069","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T19:29:21Z","timestamp":1706556561000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Perceptions of integrated rehabilitation service delivery in a metropolitan district"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-5104","authenticated-orcid":false,"given":"Lebogang J.","family":"Maseko","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6742-3727","authenticated-orcid":false,"given":"Fasloen","family":"Adams","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4562-6413","authenticated-orcid":false,"given":"Hellen","family":"Myezwa","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,1,29]]},"reference":[{"key":"ref0","unstructured":"United Nations. Transforming our world: The 2030 agenda for sustainable development. New York, NY: UN General Assembly; 2015."},{"key":"ref1","unstructured":"Mckenzie A, Schneider H, Schaay N, Scott V, Sanders DD. Primary health care systems (PRIMASYS): Case study from South Africa. Geneva: World Health Organization; 2017."},{"key":"ref2","unstructured":"World Health Organization. Rehabilitation in health systems. Geneva: World Health Organization; 2017."},{"key":"ref3","unstructured":"WHO-Unicef. Alma-Ata 1978 primary health care. International Conference Primary Health Care [homepage on the Internet]. 1978 [cited 2018 Aug 11]; p. 63. Available from: https:\/\/www.unicef.org\/media\/85611\/file\/Alma-Ata-conference-1978-report.pdf"},{"key":"ref4","unstructured":"Naledi T, Barron P, Schneider H. Primary health care in South Africa since 1994 and implications of the new vision for PHC re-engineering. In: Padarath A, English R, editors. South African Health Review. Durban: Health Systems Trust; 2011, p. 17\u201318."},{"key":"ref5","unstructured":"National Department of Health. White paper on the NHI: Towards universal health coverage. Pretoria: Department of Health, Republic of South Africa."},{"key":"ref6","unstructured":"National Department of Health. Framework and strategy for disability and rehabilitation services in South Africa 2015\u20132020. Pretoria: Department of Health, Republic of South Africa; 2015; p. 3\u201325."},{"key":"ref7","unstructured":"World Health Organization. Rehabilitation in health systems: Guide for action information sheet. Geneva: World Health Organization; 2019, p. 1\u20132."},{"key":"ref8","unstructured":"WHO. WHO global disability action plan 2014\u20132021. Better health for all people with disability. Geneva: World Health Organization; 2015, p. 1\u201332."},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Dookie S, Singh S. Primary health services at district level in South Africa: A critique of the primary health care approach. BMC Fam Pract. 2012;13(1):67. https:\/\/doi.org\/10.1186\/1471-2296-13-67","DOI":"10.1186\/1471-2296-13-67"},{"key":"ref10","unstructured":"Gaede B, Versteeg M. The state of the right to health in rural South Africa. S Afr Health Rev [serial online]. 2011;2011;99\u2013106. Available from: http:\/\/www.hst.org.za"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: A comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13(JANUARY-MARCH 2):e010. https:\/\/doi.org\/10.5334\/ijic.886","DOI":"10.5334\/ijic.886"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Maphumulo WT, Bhengu BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019;42(1):1901. https:\/\/doi.org\/10.4102\/curationis.v42i1.1901","DOI":"10.4102\/curationis.v42i1.1901"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Vergunst R, Swartz L, Hem K, et al. The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa. Disabil Rehabil. 2018;41(22):1\u20137. https:\/\/doi.org\/10.1080\/09638288.2018.1478001","DOI":"10.1080\/09638288.2018.1478001"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Scheffler E, Mash R. Surviving a stroke in South Africa: Outcomes of home-based care in a low-resource rural setting. Top Stroke Rehabil. 2019;26(6):423\u2013434. https:\/\/doi.org\/10.1080\/10749357.2019.1623473","DOI":"10.1080\/10749357.2019.1623473"},{"key":"ref15","unstructured":"Naidoo D, Van Wyk J, Nat RJ. Are final year occupational therapy students adequately prepared for clinical practice? A case study in KwaZulu-Natal. S Afr J Occup Ther. 2014;44(3):24\u201328."},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Govender P, Naidoo D, Bricknell K, Ayob Z, Message H, Njoko S. \u2018No one prepared me to go home\u2019: Cerebrovascular accident survivors\u2019 experiences of community reintegration in a peri-urban context. Afr J Prim Health Care Fam Med. 2019;11(1):1\u20138. https:\/\/doi.org\/10.4102\/phcfm.v11i1.1806","DOI":"10.4102\/phcfm.v11i1.1806"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Hanass-Hancock J, McKenzie TC. People with disabilities and income-related social protection measures in South Africa: Where is the gap? Afr J Disabil. 2017;6:1\u201311. https:\/\/doi.org\/10.4102\/ajod.v6i0.300","DOI":"10.4102\/ajod.v6i0.300"},{"key":"ref18","unstructured":"Harsha D. Provision of rehabilitation services within the District Health System \u2013 The experience of rehabilitation managers in facilitating this right for people with disabilities. S Afr J Occup Ther [serial online]. 2010 [cited 2018 Mar 18];40(1):22\u201326. Available from: http:\/\/www.scielo.org.za\/pdf\/sajot\/v40n1\/06.pdf"},{"key":"ref19","unstructured":"Davis S. Rehabilitation: The use of theories and models in practice. London: Elsevier; 2006."},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Glendinning C. Breaking down barriers: Integrating health and care services for older people in England. Health Policy (New York). 2003;65(2):139\u2013151. https:\/\/doi.org\/10.1016\/S0168-8510(02)00205-1","DOI":"10.1016\/S0168-8510(02)00205-1"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"McColl MA, Shortt S, Godwin M, et al. Models for integrating rehabilitation and primary care: A scoping study. Arch Phys Med Rehabil. 2009;90(9):1523\u20131531. https:\/\/doi.org\/10.1016\/j.apmr.2009.03.017","DOI":"10.1016\/j.apmr.2009.03.017"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Huljev D, Pandak T. Holistic and team approach in health care. Signa Vitae. 2016;11(Suppl 2):66\u201369. https:\/\/doi.org\/10.22514\/SV112.062016.14","DOI":"10.22514\/SV112.062016.14"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Van Rensburg ZJ. Levels of health literacy and English comprehension in patients presenting to South African primary healthcare facilities. Afr J Prim Health Care Fam Med. 2020;12(1):1\u20136. https:\/\/doi.org\/10.4102\/phcfm.v12i1.2047","DOI":"10.4102\/phcfm.v12i1.2047"},{"key":"ref24","unstructured":"World Health Organization. CBR guidelines: Health component. Geneva: World Health Organization; 2010, p. 1\u201372."},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Hultberg EL, L\u00f6nnroth K, Allebeck P. Co-financing as a means to improve collaboration between primary health care, social insurance and social service in Sweden. A qualitative study of collaboration experiences among rehabilitation partners. Health Policy (New York). 2003;64(2):143\u2013152. https:\/\/doi.org\/10.1016\/S0168-8510(02)00145-8","DOI":"10.1016\/S0168-8510(02)00145-8"},{"key":"ref26","unstructured":"National Department of Health. Policy framework and strategy for ward-based primary healthcare outreach teams. Pretoria: Department of Health, Republic of South Africa, 2018; p. 22."},{"key":"ref27","unstructured":"National Department of Health. Strengthening the South African health system: Towards an integrated and unified health system. Presidential Health Summit 2018. 2018; p. 1\u201335."},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Louw Q, Grimmer K, Dizon JM, Machingaidze S, Parker H, Ernstzen D. Building capacity in primary care rehabilitation clinical practice guidelines: A South African initiative. Health Res Policy Syst. 2018;16(96):2\u201311. https:\/\/doi.org\/10.1186\/s12961-018-0368-z","DOI":"10.1186\/s12961-018-0368-z"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Reynolds HW, Sutherland EG. A systematic approach to the planning, implementation, monitoring, and evaluation of integrated health services. BMC Health Serv Res. 2013;13:168. https:\/\/doi.org\/10.1186\/1472-6963-13-168","DOI":"10.1186\/1472-6963-13-168"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Taylor SJ, Bogdan R, DeVault ML. Introduction to qualitative research methods: A guidebook and resource. Hoboken, NJ: John Wiley & Sons, Inc.; 2016.","DOI":"10.1002\/9781394260485"},{"key":"ref31","unstructured":"Department of Cooperative Governance and Tradition Affairs. Profile and analysis: City of Johannesburg Metro [homepage on the Internet]. 2020 [2022 Apr]. Available from: https:\/\/www.cogta.gov.za\/ddm\/wp-content\/uploads\/2020\/08\/Take2_DistrictProfile_JHB1606-2-2.pdf"},{"key":"ref32","unstructured":"Jhb Metro Rehab. Audiology, occupational therapy, physiotherapy, podiatry, speech-language therapy [homepage on the Internet]. 2023 [cited 2022 Apr]. Available from: https:\/\/jhbmetrorehab.co.za"},{"key":"ref33","unstructured":"KwaZulu-Natal Department of Health. KwaZulu-Natal Province Department of Health [homepage on the Internet]. Definitions of Health Facilities. 2001 [cited 2022 Apr]. Available from: http:\/\/www.kznhealth.gov.za\/definitions.htm"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Ngubane M, Chetty V. Caregiver satisfaction with a multidisciplinary community-based rehabilitation programme for children with cerebral palsy in south africa. S Afr Fam Pract. 2017;59(1):35\u201340. https:\/\/doi.org\/10.1080\/20786190.2016.1254929","DOI":"10.1080\/20786190.2016.1254929"},{"key":"ref35","unstructured":"Elo S, Kaariainen M, Kanste O, Polkki T, Utriainen K, Kyng\u00e4s H. Qualitative content analysis: A focus on trustwortiness Health [homepage on the Internet]. [cited 2019 Mar 09]. Available from: https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2158244014522633"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80\u201392. https:\/\/doi.org\/10.1177\/160940690600500107","DOI":"10.1177\/160940690600500107"},{"key":"ref37","unstructured":"Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. Newbury Park, CA: Sage; 2017."},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Flick U, editor. Mapping the field. In: The SAGE handbook of qualitative data analysis. London: Sage; 2014, p. 1\u201318.","DOI":"10.4135\/9781446282243.n1"},{"key":"ref39","unstructured":"World Health Organization. A vision for primary health care in the 21st century. Geneva: World Health Organization; 2018, p. 1\u201364."},{"key":"ref40","unstructured":"Republic of South Africa. National Health Insurance Bill. Pretoria: Department of Health. Republic of South Africa; 2019, p. 1\u201360."},{"key":"ref41","unstructured":"Department of Social Development. White paper on the rights of persons with disabilities. Government Gazette [serial online]. 2016 [cited 2022 Jun];(39792):4\u2013197. Available from: http:\/\/www.gov.za\/sites\/www.gov.za\/files\/39792_gon230.pdf"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Wakida EK, Talib ZM, Akena D, et al. Barriers and facilitators to the integration of mental health services into primary health care: A systematic review. Syst Rev. 2018;7(1):1\u201313. https:\/\/doi.org\/10.1186\/s13643-018-0882-7","DOI":"10.1186\/s13643-018-0882-7"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Ned L, Cloete L, Mji G. The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system. Afr J Disabil. 2017;6(1):a311. https:\/\/doi.org\/10.4102\/ajod.v6i0.311","DOI":"10.4102\/ajod.v6i0.311"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Chetty V, Hanass-Hancock J. A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa. AIDS Care. 2016;28(sup1):132\u2013139. https:\/\/doi.org\/10.1080\/09540121.2016.1146204","DOI":"10.1080\/09540121.2016.1146204"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Chatterjee S, Naik S, John S, et al. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): A randomised controlled trial. Lancet. 2015;383(March):1385\u20131394. https:\/\/doi.org\/10.1016\/S0140-6736(13)62629-X","DOI":"10.1016\/S0140-6736(13)62629-X"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Gilson L, Barasa E, Nxumalo N, et al. Everyday resilience in district health systems: Emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health. 2017;2(2):e000224. https:\/\/doi.org\/10.1136\/bmjgh-2016-000224","DOI":"10.1136\/bmjgh-2016-000224"},{"key":"ref47","unstructured":"World Health Organization. Introductory booklet: CBR guidelines. Geneva: World Health Organization; 2010, p. 1\u201370."},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: A review of facilitators and barriers perceived by involved actors. J Public Health (United Kingdom). 2014;37(4):716\u2013727. https:\/\/doi.org\/10.1093\/pubmed\/fdu102","DOI":"10.1093\/pubmed\/fdu102"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Kloppers M, Pretorius B, Vlok ED. Clients\u2019 subjective experience of their participation in rehabilitation at an out-patient community rehabilitation center. S Afr J Occup Ther. 2016;46(1):59\u201363. https:\/\/doi.org\/10.17159\/2310-3833\/2016\/v46n1a12","DOI":"10.17159\/2310-3833\/2016\/v46n1a12"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Nielsen BB. The role of trust in collaborative relationships: A multi-dimensional approach. Management. 2004;7(3):239\u2013256. https:\/\/doi.org\/10.3917\/mana.073.0239","DOI":"10.3917\/mana.073.0239"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Louw Q, Conradie T, Xuma-Soyizwapi N, et al. Rehabilitation capacity in South Africa \u2013 A situational analysis. Int J Environ Res Public Health. 2023;20(4):3579. https:\/\/doi.org\/10.3390\/ijerph20043579","DOI":"10.3390\/ijerph20043579"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"link":[{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4069\/6759","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4069\/6760","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4069\/6761","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4069\/6762","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/4069\/6762","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T08:04:26Z","timestamp":1776067466000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/4069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,29]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12,21]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v16i1.4069","relation":{},"ISSN":["2071-2928","2071-2936"],"issn-type":[{"value":"2071-2928","type":"print"},{"value":"2071-2936","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,29]]},"article-number":"a4069"}}