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. 2025 Feb 25;20(2):e0315778.
doi: 10.1371/journal.pone.0315778. eCollection 2025.

Document review of the paper-based implementation of the Framework and strategy for disability and rehabilitation in Gauteng, South Africa

Naeema Ahmad Ramadan Hussein El Kout  1 , Natalie Benjamin-Damons  1 , Sonti Imogene Pilusa  1
Affiliations

Document review of the paper-based implementation of the Framework and strategy for disability and rehabilitation in Gauteng, South Africa

Naeema Ahmad Ramadan Hussein El Kout et al. PLoS One. .

Abstract

Background: The prevalence of disability is on the rise globally and in South Africa, with a high number of unmet needs and poor actualisation of the health rights of persons with disabilities. A tool to realise these rights is health policy, such as the framework and strategy for disability and rehabilitation (2015-2022)(FSDR). There are limited data on the implementation outcomes of the FSDR.

Objective: To review the implementation of the FSDR according to the paper-based provincial reports.

Methods: The study conducted a document review and utilised a concurrent mixed-method design, combining qualitative and quantitative data extracted from paper-based evaluation templates developed by the South African National Department of Health (NDoH). The qualitative analysis involved thematic coding using the RE-AIM framework to examine the FSDR's implementation across eight provinces, while quantitative data, such as frequencies and percentages, provided supplementary insights.

Results: The quantitative results revealed that 87% of the reports from provinces reported physical accessibility to the FSDR, and 62% of provinces received training on the implementation of the FSDR. Only two out of eight provinces have conducted monitoring and evaluation since implementing the FSDR in 2015. Qualitative findings revealed poor reach and adoption of the FSDR owing to a lack of implementation training for end users. The lack of indicators resulted in poor maintenance of the FSDR, as well as the lack of human resources and equipment which resulted in the reduced efficacy of the FSDR.

Conclusion: The FSDR has not achieved its full level of implementation due to numerous barriers, such as lack of resources, human capacity, and training on implementation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Percentage of provincial facilities with physical access to Functional Screening and Disability Rehabilitation (FSDR) services across eight provinces.
Fig 2
Fig 2. Provincial training status on FSDR implementation across eight provinces, indicating whether training was conducted or not.
Fig 3
Fig 3. Number of rehabilitation professionals trained on FSDR implementation in three provinces that provided data.
Fig 4
Fig 4. Monitoring and evaluation (M&E) reporting status for FSDR implementation across eight provinces.
Fig 5
Fig 5. Availability of rehabilitation professionals to support FSDR implementation across eight provinces.
Fig 6
Fig 6. Proportional distribution of rehabilitation staff at Primary Health Care (PHC) levels relative to all available rehabilitation professionals.
See this image and copyright information in PMC

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