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Factors that influence doctors in the assessment of applicants for disability grant

TUMBO, JM
2014

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Background: A disability grant is the financial assistance given by the government to South African citizens and bona fide refugees who have debility that results in inability to work. Doctors in state hospitals and clinics are tasked with the duty of assessing applicants for this grant. Ideally, the assessment is done by an institutional committee consisting of a doctor, physiotherapist, social worker, occupational therapist and specialised nurses. However, this is not always the case because of a shortage of personnel, particularly in rural areas. A lack of clear guidelines for the assessment process has led to confusion and differences in the outcomes. This poses major problems for the doctors, as well as the applicants, who often are dependent on the grant for survival. The aim of this study was to explore the factors that influence doctors in the assessment of applicants for a disability grant.

 

Methods: A qualitative study using free attitude interviews was conducted amongst doctors involved in the assessment process in Limpopo province. Content analysis was used to identify themes from the interviews.

 

Results: The assessment process was not entirely objective and was influenced by subjective factors. These included the mood of the doctors, emotions such as anger and sympathy, and feelings of desperation. Perceptions by the doctors regarding abuse of the system, abuse of the grant, the inappropriateness of the task, lack of clear guidelines and the usefulness of the committees were important in decision making. The doctors’ personal life experiences were a major determinant of the outcome of the application.

 

Conclusion: The assessment of applicants for a disability grant is a subjective and emotional task. There is need for policy makers to appreciate the difficulties inherent in the current medicalised process. Demedicalisation of certain aspects of disability assessment and other social needs that doctors do not view as a purely clinical functions is necessary. In addition, there is a need for clear, uniform policy on and guidelines for the management of the grant, the role of the doctor has to be defined, healthcare practitioners must be trained in disability assessment, institutional committees should be established and intersectoral initiatives should be encouraged to address issues of poverty and dependence.

Features of integrated professional training for physically disabled people in a community-based rehabilitation programme in the rural and urban areas of Congo

LUTALA, MP
MASIKA, VP
KASEREKA, MC
KASAGILA, EK
2014

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Background: The rehabilitation of physically disabled people has been explored from the perspectives of patients, health professionals, rehabilitation agencies, etc. However, no study has linked disability types, training programmes and career prospects. In this study, we therefore evaluated the professional integration of trained disabled people.

 

Methods: This retrospective survey included all physically disabled people admitted to two rehabilitation centres in Congo between 1996 and 2005. Data collection used registers from two units, the medical unit and the rehabilitation unit, to obtain information on age, sex, disability type, follow-up training, present living activity and field of training. We defined ‘professional integration’ as being when the current profession matched the training received at the rehabilitation centre.

 

Results: The percentage of participants with integrated training was 96.8% (95% CI; 92.1–98.7%). In the urban setting, 6.7% (95% CI; 2.6–16.1%) of the trainees were not integrated, while all were integrated in the rural setting. Trainees aged between 16 and 25 years and those 51+ years represented 12.5% (95% CI; 4.9–28%) and 50% (95% CI; 25.3–74.6%) of the non-integrated cases respectively. Paralysis from poliomyelitis was the most common [62.9% (95% CI; 54.3–70.8%)] disability, and the non-integrated participants included people with poliomyelitis [1.2% (95% CI; 0.2–6.7%)], general paralysis [10.5% (95% CI; 2.9–31.3%)] and sight disorders [50% (95% CI; 9.4–90.5%)]. Tailoring was the main field of training [57.4% (95% CI; 48.7–65.7%)], and high numbers of participants with non-integrated training worked in tailoring, shoe making, welding and computer repair.

 

Conclusions: Despite a high rate of integration in Congo, professional training and subsequent integration would still benefit from a comprehensive approach that considers the type of disability, training and socio-demographic features. Further studies targeting alumni from the training programmes and their ongoing assessment are warranted.

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