Bezuidenhout M.1
1Manguzi Hospital, KwaNgwanase, South Africa

Background: The WHO has developed comprehensive guidelines on wheelchair services in low resource settings. Despite this, disability and rehabilitation services remain under resourced, underdeveloped and fragmented across rural South Africa and there is little evidence of a working model of service delivery within the rural public health sector. Tracing and following up clients within a deep rural setting has significant challenges. Coupled with minimal rehabilitation within the acute care setting, early discharges home and often insurmountable barriers in accessing further care, this can lead to poor program outcomes and community integration.

Purpose: To describe socioeconomic challenges faces by end users and the impactbthis has on service design and delivery
To describe systems and resources (including human resource and development) which need to be in place before further service delivery development can occur.
To describe the integration of this service at PHC and community level
To emphasize the need for a CBR approach through peer supporters rather than a biomedical approach to seating services
To explore outcomes according to routine data collected.

Methods: Manguzi hospital has developed an effective outreach seating amdmpeer support service over the last few years. Comprehensive data is routinely collected- quantitative and qualitative. An active surveillance system is employed in tracking follow up appointments. Peer supporters, wheelchair repairers and community health workers are involved at all levels of the program!. The service has effectively shifted from a therapist-run, clinically focused service to a peer-supporter run, CBR focused service with the therapist as a technical support resource.

Results: 25% total defaulter rate for reseating appointments (based on a once a year minimum reseating follow up) Average of 11 reseating appointments per month honoured Average of 4 new clients per month seated New functional wheelchair skills gained by clients at each outreach clinicn(in addition to health information, screening, reseating and repairs) 39 wheelchairs repaired on average per month Psychosocial problems readily identified and followed up by peer supporters.

Conclusion(s): Integrating peer support and decentralizing your wheelchair seating services within a rural South African setting has huge benefits for the clients, their families and the health care system itself. Services must be designed according to end user needs and preferences, and should be integrated with other services and systems. Although appropriate systems and resources need to be in place, the service could be duplicated in other settings.

Implications: This model of service delivery could be replicated in other rural settings.

Funding acknowledgements: None

Topic: Primary health care

Ethics approval: Not needed- describing a current service

All authors, affiliations and abstracts have been published as submitted.

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