Assistive Devices: A Basic Human Right
"Assistive devices for persons with disabilities and access to these are a precondition for achieving equal opportunities, enjoying human rights and living in dignity." - United Nations
The World Health Organisation (WHO) defines assistive devices as: "any piece of equipment, or product that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities." These include mobility devices that are designed to assist or improve a user's personal mobility - to change and maintain body position and walk or move from one place to another. The devices most commonly provided by the organisations we researched are wheelchairs (powered and manual), prosthetics and orthotics.
The WHO's understanding of the situation in South Africa is that "the provision of mobility devices forms an integral part of healthcare and that these are provided by the Ministry of Health through the national health care system." We conducted research to find out exactly what the Department of Health offers and what the alternatives are for people in need of assistive devices.
Department of Health
The starting point of our research was with the Department of Health but their lack of assistance left us with only the information on their website (www.doh.gov.za). The statement that "the waiting period for the assistive device; depending on the type of device and how far the person is from the city where the device is made; is four weeks" is in strident contrast with the findings of the Mobility Assistive Devices Advisory Committee (MADAC). They reported that the average waiting period for a wheelchair or assistive device is three years.
In 2010 the Public Protector revealed that there is a backlog in the provision of wheelchairs and assistive devices that has been perpetuated for years, and that the backlog then stood at R4.081 million. They also found that budget allocations for wheelchairs and assistive devices are not protected. As budget pressures increase for pharmaceuticals, drugs, blood, laboratory tests etc., funds are diverted away from mobility devices allocations.
We could not ascertain from the Department what the limit per person per device is or what the range of device per category is. The website provides guidance to patients, referring them back to the hospital at which they were treated - where the rehabilitation professional will assess, prescribe and fit the assistive device.
What are the alternatives? Ari Seirlis, the CEO of QASA is adamant on the role of NPOs in the delivery of assistive devices: "Any non-profit organisation, professing to be serving a constituency of people with disabilities, would surely prioritise to be able to source and find the most elementary and appropriate assistive devices to that constituency. We should be careful sometimes to pass on the responsibility to someone else, from someone else's pocket, as we could be left with a membership with no assistive devices, looking to us for the most basic requirements. Let it be the foremost responsibility of an NGO serving people with disabilities, to identify the most basic needs of our constituency, and make sure that we mobilise resources to ensure maximum mobility or opportunity before being too creative about other services."
We researched a few Non Profit Organisations (NPO) that are trying to assist persons with disabilities as best they can within the confines of their limited funding and resources.
The Rachel Swart Fund in Cape Town has been assisting people with disabilities for the past 52 years. Their website is very clear, informative and transparent, setting out information such as who their major donors are, who they are affiliated with, and which schools, hospitals and suppliers they support. They are the only NPO we approached who openly consented to our request for sight of their financial statements.
Joy Taylor, the manager, advised us that a detailed Occupational Therapist (OT) report and quotation for the device being applied for must accompany the application. Their committees meet three times a year to assess applications and available funds.
Desiree van der Vyver, OT at the George Provincial Hospital, spoke highly of the Fund. "I found the Rachel Swart Fund a very positive organisation that always clearly communicated the progress of the application." One of her patients recently received a motorised wheelchair to the value of approximately R24,000 from the Fund. Desiree and her colleagues have approached the Rachel Swart Fund before and found that their applications have always been successful.
The QuadPara Association of South Africa (QASA) constantly lobbies the relevant government departments to make assistive devices more readily available.
QASA provide assistive devices to enable and empower people with disabilities through various project initiatives, which include:
The FL Smidth Rustenberg Assistive Devices Project focuses on the needs of people in the Rustenburg area. Potential recipients are identified by disability agencies in the area. An implementation plan has been put in place by QASA, the funder and other stakeholders to ensure fair and equitable distribution of these assistive devices.
The Wheelchair and Assistive Devices Project focuses on quadriplegics and paraplegics who are most disadvantaged. This project tries not to do the work of the state nor the Road Accident Fund nor the Workmen's Compensation Commission, but often intervenes and provides wheelchairs.
Project Tshedza is an initiative launched in 2011. The Development Bank of Southern Africa (DBSA) is providing an amount of R100,000 per year for the next four years to support this project. Hilda Hecker, received a wheelchair hoist for her vehicle valued at R17,543.80 through Project Tshedza in April this year: "I received a wheelchair hoist for my car - this gives me priceless independence. I was only expected to pay 10% of the total value of the assistive device. Throughout I found QASA extremely helpful and supportive."
The National Council for Persons with Physical Disabilities in South Africa (NCPPDSA) is an initiative to advance the independence and integration of persons with disabilities within the South African community. Danie Botha-Marais, their Children's Programme Officer, advised that they assist applicants with advice regarding appropriate devices and by applying to various donors (principally Vodacom and Game) for funding on their behalf.
They provide about 350 wheelchairs per year based on a selection criteria specified by their donors. The NCPPDSA states that they "respond to referrals as rapidly as possible, seeing clients in the order of clinical priority and keeping in mind the social background, financial situation and the disability."
Unfortunately we could not establish contact with any of their recipients as we were advised that: "In most cases the clients that we assist do not want to be exposed and then of course there is confidentiality." Rolling Inspiration has however reported previously on the handing over of wheelchairs provided by the project, for example: on page 65 of the November / December 2010 issue.
The focus of the South African Disability Development Trust (SADDT) is "the provision of assistive devices to employed disabled people to enable them to secure and sustain employment."
Moira Short, their Project Manager, explained that their selection criteria is strictly conducted according to their in-house "policy guideline." Whereas QASA pays the supplier directly, the SADDT encourages the applicant to source their own assistive device and to state in their application which quotation they prefer. Each applicant is limited to R20,000.
We interviewed a number of SADDT's recipients, all of whom spoke highly of this organisation. Lionel Prinsloo received a Magnifier to the value of +- R12,000, Gavin Maggott received a laptop computer and Jacques Lloyd received a motorised wheelchair. As motorised wheelchairs cost more than R20,000 Jacques had to pay in the difference but was still extremely impressed by Moira’s care and support. Recipient comments ranged from; "I don't know what I would have done without their help", to "I now feel part of the economic system in South Africa."
The WHO and UN appear to be under the impression that the basic human right of South Africans in respect of mobility device requirements is being upheld by the Department of Health. Our research, based on the findings of respected organisations such as the office of the Public Protector and MADAC, reveal that this is not so. The lack of management of budget allocations is leaving millions of people with disabilities in the lurch. Those few who do receive any assistance are reliant on non-governmental organisations that do their best, despite severe funding constraints.
Assistive devices are a necessity, not a luxury. They enable people to live with dignity - why is our government failing persons with disabilities?