1. ENABLING PERSON-CENTRED CARE:
USING THE ICF TO FACILITATE WELLNESS
The Second International Symposium: ICF Education
New Somerset Hospital
30 June 2017
Tracey Naledi
Chief Director: Health Programmes

2. © Western Cape Government 2012 |
Presentation Outline
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1. The Western Cape at a glance: Our contextual realities
2. The Policy context:
• International
• National
• Provincial
3. The Road to Wellness: Our collective goal
4. Case illustration and progress on implementation
5. Conclusion

3. The Burden of Disability in the Western Cape

4. © Western Cape Government 2012 |
Burden of Disability
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SOURCE: StatsSA. Census 2011 Profile of persons living with disability
• Poor sight, physical disabilities and hearing disabilities
are the top three disabilities
• Coloured and African Communities mostly affected

5. © Western Cape Government 2012 |
The prevalence of Intellectual Disability (ID)
Based on Census 2011 statistics:
• The prevalence of ID in South Africa (SA) remains unclear (McKenzie, et.al, 2013)
• Estimates ranging from 0.27 % to 3.6% of the South African population having ID
(Adnams, 2010)
• This figure can be compared with that of 1.2% for the USA and 1.29% for Australia

6. © Western Cape Government 2012 |
The burden is likely to increase
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INJURIES
• substance
abuse
• Mental illness
Chronic
diseases
(Diabetes,
HPT, IHD)
• Increasing burden
• Incresed co-
morbidities and
complexity
• Poor clinical
control
• Increased
complications

7. Challenges to rehabilitation service
provision

8. © Western Cape Government 2012 |
Challenges
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• Mal-alignment between policy and implementation
• Provincial Health Plan 1996
• Healthcare 2010
• All underpinned by PHC Approach
• Poor access to rehab services
• Largely in the Metro and in Specialized Services
• Poor development of community based services (CBS)
• Not comprehensive and integrated
• Poor service continuum across the health service platforms
• Little research in disability and rehab
• A paucity of appropriate rehabilitation indicators

9. What are we doing about this?

10. Strategic Policy Directives

11. © Western Cape Government 2012 |
The International Policy Context
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• UN Convention on the Rights of People with Disabilities
• Imperative on government towards the progressive realization of services for the
disabled
• Move away from the concept of disability as a purely medical problem - a
defect of the body
• Understanding of disability as a consequence of more complex systems of social
restriction.
• World Health Organisation International Classification of Functioning, Disability
and Health

12. © Western Cape Government 2012 |
The National Policy Context
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• The Bill of Rights in the South African Constitution
• Everybody is equal before the law and has equal protection and benefit of the law,
• Prohibiting discrimination on a number of grounds, including disability
• Integrated National Disability Strategy (INDS)
• Disability-related services includes introducing measures to change attitudes and practices that stigmatise
and marginalise people with disabilities.
• Government to remove the barriers that currently prevent the realisation of the rights of adults and children
with disabilities in all sectors.
• Helping people with disabilities to become fully participating members of society, with access to all the
benefits and opportunities of that society
• The Policy Framework and Strategy for Disability and Rehabilitation services in South Africa (2015)
• Outlines comprehensive and integrated disability and rehabilitation services within the broader health
and developmental context to facilitate improved access at all levels of health care.
• The White Paper on the Rights of Persons with Disabilities (WPRPD) (2016)
• Outlines 9 strategic pillars that guide state departments in development and implementation of
targeted interventions that remove barriers and apply the principles of universal design for persons
with disability in South Africa.
• Other instruments:
• The National Health Act (61 of 2003)
• Mental Health Care Act 17 of 2002)
• Primary Health Care Re-engineering
• Mental Health Care Act
• The National Mental Health Policy Framework and Strategic Plan (2013–2020)

13. © Western Cape Government 2012 |
PSP 2014-2019:
Provincial Strategic Goals
STRATEGIC GOAL 1:
Create
opportunities for
growth and jobs
STRATEGIC GOAL 2:
Improve education
outcomes and
opportunities for
youth development
STRATEGIC GOAL 3:
Increase wellness,
safety and tackle
social ills
STRATEGIC GOAL 4:
Enable a resilient,
sustainable, quality
and inclusive living
environment
STRATEGIC GOAL 5: Embed good governance and integrated service
delivery through partnerships and spatial alignment

14. © Western Cape Government 2012 |
PSG3: Strategic Focus Areas
Inclusive Safe
and Healthy
Communities
Resilient and
Healthy Families
Engaged and
Healthy Youth
Safe and Healthy
Children
•Alcohol Harm
reduction
•Road Safety
Communication
and Awareness
•People with
Disabilities
•WoW
•Families at Risk
•Young Women &
Girls
•The First 1000
Days Initiative
• Interdepartmental
collaborations strengthening
at provincial level (PSG3)
• Starting to cascade to
district and sub district level
• Drankenstein ISDM
• Saldanha
• Khayelitsha
• GUNYA
• YW&G and First 1000
days key interventions for
prevention

15. © Western Cape Government 2012 |
Healthcare 2030: The Road to Wellness
Healthcare 2030: The Road to Wellness
The 2030 objective is to:
A quality experience in a world class, public health service.
Motivate the population to take responsibility for their health
Shift focus from illness to wellness
Achieve amongst the best health outcomes in the world
Four Pillars of service transformation:
15
2030
Vision :
“Access
to person
-
centred,
quality
care”

16. © Western Cape Government 2012 |
Our Goal
16Healthcare 2030: The Road to Wellness
• To reduce the impact of disablement (activity limitations and participation
restrictions) and facilitating full participation in society.
• To provide goal-orientated processes aimed at enabling impaired persons to
reach an optimum mental, physical, sensory and/or social functional level
• To adopt the WHO recommended International Classification of Functioning,
Disability and Health (ICF) – person centered services that focus on reaching the
most optimal outcome levels

17. © Western Cape Government 2012 |
Rehabilitation Services
To deliver a Comprehensive package of services to people in the Province
Rehabilitation services integrated
into services provided at all the
levels of care in particular strengthen
DHS:
• HCBC services
• proactive & reactive
• Intermediate Care
• Rehab Care Workers
• PHC and D Hospitals
• Reduce symptoms, activity
limitations and participation restriction
• Acute Hospitals
• Homeostasis
• Specialised Hospital (WCRC)
Presentation Right to Food 4 december 2013
Core Functions and Responsibility and Summary of Services
Community Based
Services
Facility Based
Services
District Hospital
(L1)
Regional
Hospitals (L2)
Tertiary &
Central
Hospitals (L3)
SpecialisedServices
(EMS&FPS)
SpecialisedHospitals
TB,Psychiatry,Rehabilitation,Dental

18. Implementation progress & case illustrations

19. © Western Cape Government 2012 |
What we have done so far
Presentation Right to Food 4 december 2013
1. Policy position on Rehab Services adopted
2. Technical Working Groups at provincial and local levels (metro and rural) established
3. Prioritized:
• Comprehensive situational analysis on rehabilitation services (service norms, HR norms for Rehab teams & support
teams, governance, quality etc.)
• Policy development
• Assistive Devices and technologies
• Monitoring and Evaluation
• Inter-sectoral action (DSD, Education, Civil Society)
4. Significant increase in Allied Health Professionals in the DHS particularly in rural areas moving towards having a team in
each sub district
5. Rehab Care Worker pilot
6. Pilot of Child Speech and Hearing programme in Mitchell’s Plain
7. Additional post for Prov Coordinator in Speech and Hearing, additional resources for Assistive devices, cochlear
implants etc.
8. Cabinet Decision to move ID to DSD with other depts (Health, Education etc) providing additional specialised services

20. © Western Cape Government 2012 |
Outcome Levels on Admission
(As a % of all Admissions)
April 2016 – March 2017
nQ1=187, nQ2=181, nQ3=174, nQ4=166
0 1 2 3 4 5
Apr - Jun 5 67 16 5 5 2
Jul - Sept 6 68 17 4 4 1
Oct - Dec 6 76 13 4 1 0
Jan - Mar '17 8 69 14 4 5 0
0
10
20
30
40
50
60
70
80
PercentageofallAdmissions
Outcome Level on Admission
Apr - Jun
Jul - Sept
Oct - Dec
Jan - Mar '17

21. © Western Cape Government 2012 |
Outcome Level on Discharge
(As a % of all Discharges)
April 2016 – March 2017
nQ1=187, nQ2=181, nQ3=174, nQ4=166
0 1 2 3 4 5
Apr - Jun 5 1 4 22 55 13
Jul - Sept 3 1 6 22 54 14
Oct - Dec 3 1 11 25 51 10
Jan Mar '17 4 2 10 26 43 15
0
10
20
30
40
50
60
PercentageofallDischarges
Outcome Level on Discharge
Apr - Jun
Jul - Sept
Oct - Dec
Jan Mar '17

22. © Western Cape Government 2012 |
Tygerberg Hospital
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• Tertiary, academic hospital:
• Largest hospital in the Western Cape and the second largest hospital in South
Africa
• Services a drainage area in the Western Cape with a population over 3.4 million
people
• Bed capacity: 1 384 active beds (1 899 beds)
• Department of Occupational Therapy:
• The ICF is used as a framework to design services
• Assessment tools mapped for alignment with ICF constructs
• Focus on tracking patient outcomes:
Outcomes Monitored Achieved (n = 17875)
Return to work/school 8.5% (n = 1534)
Referred to next level of care 60% (n = 10725)

23. © Western Cape Government 2012 |
Uniform Rehabilitation Assessment and Referral Form
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• Piloting of the Uniform Rehabilitation Assessment and Referral Form:
• Developed by Rural Rehabilitation Forum – Ms Felix will expand
• A standardised/uniform rehabilitation assessment and referral form based on the
ICF to ensure the rehabilitation patient information is understood universally
across all health disciplines
• Used to improve communication by establishing a common language to
describe health and health-related conditions
• Completed by all health professionals (allied health professionals and other
clinicians) who evaluate clients for rehabilitation purposes.
• Used as:
• An assessment of patients who require rehabilitation treatment.
• A referral form for rehabilitation patients who are being referred to other health
practitioner/clinicians.
• As a discharge plan for patients who have completed their rehabilitation
treatment as deemed necessary.

24. © Western Cape Government 2012 |
Conclusion
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• The Burden of disability in the Western Cape is lowest in the country but the burden
is expected to increase over time
• Rehab services in the Western Cape have historically been weak and were based
on a biomedical model
• New policy position in line with international, national and provincial imperatives
• Huge mind shift:
• Wellness
• Life course approach, person centeredness, integrated health services with good
continuum
• Maximal participation into home, community and work life: Inter-sectorality

25. Thank youThank you