3   WITS SPECIAL EDITION JOurNAL 2013 

Research

Article

NATIONAL HEALTH INSURANCE – 
IMPLICATIONS FOR REHABILITATION 

PROFESSIONALS AND SERVICE DELIVERY

Correspondence Author:
Dr Hellen Myezwa
Department of Physiotherapy,
Faculty of Health Sciences,
University of the Witwatersrand
Johannesburg, South Africa
Email: hellen.myezwa@wits.ac.za
 Van.niekerk@wits.ac.za

ABSTRACT:  This paper reviews the National Health Insurance (NHI) in 
view of what is proposed and authors  suggest how it may impact on the 
rehabilitation sector namely occupational therapy, physiotherapy, speech 
and language therapy and audiology. A review of the basic description 
of the NHI and the different elements is presented. Particular attention 
is paid to how much interface and mention is made of rehabilitation. 
The current status of rehabilitation service provision and its response to 
the needs of the population, in particular the burden of disease and the 
related finance models are discussed. Suggestions are presented for the 
way forward to ensure rehabilitation professionals and services rendered 
are not caught flat footed.

KEY WORDS: NATIONAL HEALTH INSURANCE, REHABILITATION, IMPLICATIONS, OCCUPATIONAL  
THERAPY, PHYSIOTHERAPY.

Myezwa H, PhD1;
Van Niekerk M, PhD2

 1 University of the Witwatersrand, Faculty of 
  Health Sciences, School of Therapeutic Sciences, 
  Department of Physiotherapy.
 2 University of the Witwatersrand, Faculty of 
  Health Sciences, School of Therapeutic Sciences, 
  Department of Occupational Therapy.

INTRODUCTION
The motivation for National Health In­
surance (NHI) is driven by the inequali­
ties that exist in the provision of health 
in South Africa (Department of Health 
2011a). The NHI is in its early phase 
of development and rehabilitation pro­
fessionals need to engage and respond  
proactively. An important starting point 
is to examine the full intent of the NHI.

Our objectives have several dimen­
sions: 1) To examine and assess the Na­
tional Health Insurance (NHI) and the 
points at which it addresses rehabilita­
tion issues. 2) Identify gaps in the NHI 
pertinent to rehabilitation. 3) Analyze 
our current situation in terms of staffing 
service delivery and response to cur­
rent needs. 4) Provide recommendations 
for inclusion of rehabilitation services 

shows that SA exceeds the WHO 
recommended level of expenditure 
(Department of Health 2011a). In spite 
of this, expenditure for health in South 
Africa is still inverted with 16% of the 
population having 4.1% of the GDP 
spent on their health needs while an 
almost equal percentage of GDP is spent 
on 84% of the country’s population, as 
illustrated by Figure 1.

An interesting historical perspective 
found in the NHI Green Paper is that the 
proposals to reform the model to finance 

within the NHI. Epidemiological data 
to inform rehabilitation service is in its 
infancy (Jelsma et al 2002) and therefore 
we acknowledge the lack of cohesive 
data for rehabilitation.

REVIEW OF THE NHI
The green paper on the NHI outlines 
the allocation of resources to heath care 
delivery and how it is at odds with the 
quality of care provided. A comparison 
of the percentage of Gross Domestic 
Product (GDP) spent on health care 

Figure 1: Resources versus population distribution



4   WITS SPECIAL EDITION JOurNAL 2013

and efficiency. As such, the NHI has 
undertaken to review and strengthen the 
PHC system i.e. Primary Health Care 
re­engineering which includes systems 
strengthening. 

The systems for service delivery 
that have been targeted are the district, 
school based PHC services and the 
municipal ward based service. Delivery 
of services within these streams 
involves distinct proposed approaches 
such as strengthening administrative 
systems, cost effective interventions 
with adequate professional staff, ethical 
service delivery, adhering to set quality 
standards and adherence to clinical 
guidelines.

Public and private partnership link­
ages are proposed to enhance service 
delivery. Provision of service by 
contracted private practitioners and 
models to provide services may be 
through defining a selected number of 
services at primary and hospital care. 
Rehabilitation is mentioned in the 
provision of services only under the 
district hospital. It is seemingly not 
embedded in the description of services 
anywhere else but mentioned under 
the definition of health benefits, the 
discussion on underfunding, the use of 
pooled resources and in the definition 
of universal coverage. However, includ­
ing rehabilitation at the appropriate 
service­delivery levels (e.g. PHC level 
and hospital settings) is important, 
as reference to this document for 
implementation by policy makers will 

health systems is not a new phenomena 
and has its roots as early as 1928 with 
a commission on old age pension and 
national insurance. Subsequent efforts 
included a committee of enquiry into 
National Health Insurance (1935), the 
Gluckman commission 1942­1944. 
Two committees in 1994 and 1995 
respectively investigated reforms in 
healthcare funding, which were fol­
lowed by various inquiries into social 
health insurance between 1997 and 2002 
(DOH 2011a). Finally, a Ministerial 
advisory committee on national health 
insurance was established, which made 
recommendations regarding reforms 
to the healthcare system, effectively 
implementing Resolution 53 made at 
the ANC’s 2007 Polokwane Conference 
(ANC 2010). This was the first time that 
the work of a commission or committee 
resulted in implementation of a plan 
to address the inequities in health care 
service delivery. The NHI’s main aim 
is to improve access to health. It further 
aims to subsidise people, across the 
different population groups, who cannot 
afford health care and links contribu­
tions to the scheme to people’s ability to 
pay. It also aims to procure services on 
behalf of the populace and to improve 
and rehabilitate the public health system. 

Prioritising health interventions and 
staffing is based on the country’s health 
needs, as expressed by the burden of 
disease. The NHI green paper empha­
sises that the public health sector 
services the bulk of the population, and 
carries the greatest burden of disease 
(Department of Health 2011a). Burden of 
disease relates to information about the 
mortality, morbidity, injuries, disabilities 
and related risk factors (Econex 2009) 
and provides important information 
for health planning to address any 
persistent gaps to ensure better health 
for the population (Bradshaw et al 
2003). The NHI aims to achieve this by 
establishing a committed, accountable 
and skilled force of health care workers, 
ensuring sustainable and equitable 
access to health care for all in South 
Africa (emphasising community­based 
promotion and prevention services), 
and ensuring responsible leadership 
(Kleinert & Horton 2009:760; Matsotso 
et al 2013:1).

Figure 2: Estimated DALYs per Category for South Africa, 2000, from Econex 
2009:2

Burden of disease information is 
based on three figures: years of life 
lost due to premature death (YLLs) 
and years of life lived with disability 
(­ies) (YLDs).  When combined, these 
figures form the disability­adjusted life 
year (DALY) (Bradshaw et al 2003:682; 
Econex 2009:1) which is indicative 
of non­lethal health outcomes and 
premature death (Jelsma et al 2002).  
Globally, the burden of disease is 
presented in terms of three categories 
of conditions: 1) pre­transitional causes 
of death, including communicable 
diseases, maternal conditions, prenatal 
condition and nutritional deficits, 2) 
non­communicable conditions (e.g. 
diseases of lifestyle such as hypertension 
and diabetes) and 3) injuries.  In global 
analyses, HIV/AIDS and tuberculosis 
form part of the first group, as they 
are communicable diseases. In South 
Africa, however, their contribution to 
the burden of disease is so significant 
that the data are kept separate, giving 
South Africa a quadruple burden of 
disease (Bradshaw et al 2003).  The most 
recent figures on the quadruple burden 
of disease, published by the Medical 
Research Council’s ( MRC)  Burden of 
Disease Research Unit published 2006, 
as interpreted by Econex 2009, can be 
seen in Figure 2.

Many of the guiding principles of  
NHI are similar to those of Primary 
Health Care (PHC) and include the right 
to access, social solidarity, effectiveness, 
appropriateness, equity, affordability 



5   WITS SPECIAL EDITION JOurNAL 2013 

of disease in terms of disability­adjusted 
life years as expressed in Table 2.

Figures based on DALYs are important 
to therapists as these figures are indi­
cative of the need for rehabilitation in a 
country’s population.

CURRENT RESPONSE TO REHABILI-
TATION NEEDS
Two methods have been used to assess 
the current rehabilitation response to 

health needs, namely: an assessment of 
published papers in the local journals 
and an analysis of the common con­
ditions seen by therapists.  The pattern 
of publications represents by proxy the 
current focus of demand, service deli­
very and research within the professions, 
while conditions that are captured 
in statistics will reflect professional 
activity.  Arksey and O’Malley (2005:21­
22) indicated that rapid review of the 

result in deliberate inclusion. Many of 
the heath system concerns covered in the 
NHI policy documents can be applied to 
rehabilitation service delivery issues. 
Importantly, figures obtained from  
the National Department of Health 
(NDoH)(Department of Health 2010) 
indicate a low percentage of therapists 
employed by the NDoH, as illustrated  
in Table 1.

Figures reported in the Human 
Resource plan for Health show a steady 
increase in the employment of members 
of all three professions in the NDoH from 
2003 to 2010 (Department of Health 
October 2011).  While the employment 
of physiotherapists and speech therapists 
and audiologists continued to increase 
from 2010 to 2012, there is a decline 
in the employment of occupational 
therapists, dropping from 837 in 2010 to 
794 in 2012.  Despite the decline in the 
employment of occupational therapists 
between 2010 and 2012, overall there 
is still an increase in employment 
between 2003 and 2012 – from 531 in 
2003 to 794 in 2012.  Employment of 
physiotherapists in the NDoH increased 
significantly from 617 in 2003 to 1040 
in 2012. The ratio of health workers 
across the board to 100000 population 
is not optimal with physiotherapists at 
a ratio of 12 and occupational therapists 
7 (HST 2013).  The same could be said 
of the ratio of doctors and nurses to 
patients, which although better stands 
at 55 doctors and 361 nurses to 100000 
(DoH 2011). Across all professions 
discrepancies exist across public and 
private, urban and rural and across types 
of service (George et al 2012). It has 
been pointed out that the debate around 
human resources should not be reduced 
to one of numerical shortage but should 
extend to appropriate use of the existing 
personnel (George 2012).

In order for the rehabilitation 
professions to remain relevant, they 
need to address the burden of disease, 
which reflects the demands for health 
care (Econex 2009).  In order to ensure 
effective service delivery, staffing and 
the supply of health care services should 
relate with the need as expressed by the 
DALYs (Econex 2009).

The MRC­study highlighted the top 
20 contributors to South Africa’s burden 

Table 1: Employment figures of selected rehabilitation professions in NDoH as at 
March 2012

Occupational 
therapy- 

OT

Physiotherapy-
PT

Speech language 
and hearing 
SLT (includes 

single registered 
practitioners)

Registered with 
HPCSA

3861 6162 2267

Employed by NDoH 794 1040 403

Percentage 
employed in NDoH

20.56% 16.88% 17.78%

Table 2: Revised estimates of DALYs for South Africa, 2000, adapted from Norman 
et al 2006:22 (Norman et al 2006)

Rank Cause Percentage

1 HIV/AIDS 30.9

2 Interpersonal violence 6.5

3 Tuberculosis 3.7

4 Road traffic accidents 3.0

5 Diarrhoeal diseases 2.9

6 Lower respiratory infections 2.8

7 Low birth weight 2.6

8 Asthma 2.2

9 Stroke 2.2

10 Unipolar depressive disorders 2.0

11 Ischaemic heart disease 1.8

12 Protein­energy malnutrition 1.3

13 Birth asphyxia and birth trauma 1.2

14 Diabetes mellitus 1.1

15 Alcohol dependence 1.0

16 Hearing loss, adult onset 1.0

17 Cataracts 0.9

18 Hypertensive heart disease 0.9

19 Fires 0.9

20 Falls 0.9



6   WITS SPECIAL EDITION JOurNAL 2013

literature is important as it provides 
information at a glance to amongst 
others, policy makers.

Three studies assessing publications 
to show the focus for research in 
physiotherapy have been published 
(Mothabeng 2003; Mothabeng 2006; 
Frantz et al 2011). Two of these studies 
assessed the relevancy of the papers to  
the country’s needs. The authors con­
cluded that there is some relevancy to 
the country’s needs. Mothabeng (2003, 
2006) iden tified gaps such as HIV, 
health promotion and human resources 
which in the later review (Frantz et al 
2011) reflected progress. Though the 
bulk of the research was in clinical 
practice areas, 60% in 2002 and 45% 
in the period 1989­2003 the author did  
not give detail on the type of conditions 

covered. Between 2002­2010 the most 
published clinical areas were muscu­
loskeletal (47), education (17), chronic 
lifestyle diseases (15), neurology (15), 
cardiopulmonary (13) followed by com­
municable disease (11) (117 of 170 
69%) (Frantz et al 2011). Similarly, an 
overview of papers published between 
2003 and 2012 in the South African 
Journal of Occupational Therapy shows 
that development­related interventions 
in childhood is the topic of most papers 
(17 of 136 papers) with mental health­
related conditions second (12 of 136 
articles). There were two papers on  
HIV/AIDS during this period.

Tables 3 and 4 outline the conditions 
seen in Gauteng within all the physio­
therapy departments. No national figures 
are available and similar figures are 

not available for the other professions.
While it is not possible to accurately 

link the information obtained from 
the journal articles or the NDoH 
to the country’s burden of disease 
because these sources do not relate 
the information to the cause of the 
conditions, it can be extrapolated that 
physiotherapists already address some 
conditions that relate to the burden of 
disease. Some conditions treated by 
physiotherapists, such as head injuries 
can easily be assumed to fall within 
the category of injuries. With the 
current data collection methods, other 
conditions are not as easily classified.  
For example, ICU conditions, which 
could be the result of injury, HIV/AIDS­
related complications, communicable, 
and non­communicable diseases. 

Table 3: Conditions seen in Gauteng hospitals2005-2011 by physiotherapists.

 

2005

 

2006

 

2007

 

2008

 

2009

 

2010

 

2011

 

n(%) n(%) n(%) n(%) n(%) n(%) n(%)

ICU conditions 1699 (3.68) 2376 (3.79) 3289(4.60) 3708(4.55) 3624(4.56) 5791(4.25) 5730(5.49)

Hands 1883(4.08) 2980(4.76) 2881(4.03) 2490(3.06) 3236(4.07) n/d n/d

COPD/chronic 
lungs 1994(4.32) 2792(4.46)

 

 n/d 3376(4.15) 3852(4.85)

n/d n/d

Amputations : 
Vascular 2099(4.54) 2912(4.65) 2908(4.07) 2645(3.25) 2641(3.32)

n/d n/d

Head Injuries 2306(4.99) 2855(4.56) 3121(4.37) 3061(3.76) 2993(3.77) n/d n/d

Laringectomy 2661(5.76) 3929(6.27)

 

 n/d

 

 n/d

 

 n/d

n/d n/d

Neck 
(Discogenic 
Lesions) 3260(7.06) 3794(6.06) 4311(6.03) 4518(5.55) 4284(5.39) 5467(4.01)

 

 

Cerebral Palsy 3469(7.51) 3850(6.14) 4446(6.22) 4705(5.78) 4940(6.22) 4971(3.65) 3524(3.38)

Soft Tissue 
Injuries 3881(8.40) 4384(7.00) 5298(7.41) 6001(7.37) 5557(6.99) 7969(5.84) 5679(5.45)

Cerebral 
Vascular 
Incidents 4199(9.09) 6022(9.61) 8312(11.63) 7562(9.29) 7478(9.41) 9424(6.91) 6429(6.16)

Soft Tissue 
Reconstructive 
Surgery 4636(10.03) 7193(11.48) 6385(8.93) 5489(6.74) 5136(6.46)

n/d n/d

Brachial Plexus 
injuries 4694(10.16) 6596(10.53) 7558(10.57) 7482(9.19) 7155(9.00)

n/d n/d

Transplants 6323(13.68) 8181(13.06) 5276(7.38) 4054(4.98) 3452(4.34) n/d n/d



7   WITS SPECIAL EDITION JOurNAL 2013 

The overview of the publications 
in the South African Journal of 
Occupational Therapy (SAJOT) shows 
that occupational therapists address 
some conditions related to the burden 
of disease. However, in the absence 
of data related to the actual numbers 
of occupational therapists working 
in the different fields of practice of 
the profession, it is not possible to 
evaluate whether these publications are 
reflective of the profession. It appears 
that the statistics kept by hospital 
departments and other institutions, 
such as the Health Professions Council 
of South Africa HPCSA, do not enable 
researchers to relate such statistics to the 
country’s burden of disease. The way 
in which statistical data is kept requires 
reorganisation to determine realistic 
evaluation of service delivery in the  
NHI and private contexts.

WHAT IS THE CURRENT RESPONSE 
TO THE NHI AND WHAT DOES IT 
MEAN FOR REHABILITATION? 
Two major factors are evident from 
the analysis done using key elements 
identified in the PHC reengineering 
efforts, namely discrepancies in reha­
bilitation service delivery and a 
poorly structured information system 
(which appears worse in OT than PT).  
Despite the dearth of similar statistical 
information for all three professions, 
the gaps have been assessed using the 
response to burden of disease, personnel 
needs, approaches to service delivery at 
both a broad level (how the service is 
structured e.g. CBR vs. institution) and 
more specifically how patients receive 
service at the point of contact with 
health professionals. The type of service 
will be distinguished based on whether 
the patient gets his service in one place 

(supermarket approach) or his has to 
move from professional to professional 
(service in silos). Therapists are seeing a 
wide range of conditions that represent 
the quadruple burden of disease. 
Based on the statistics assessed in 
Gauteng DoH the type of rehabilitation 
information collected is currently mal­
aligned with burden of disease data and 
could be improved.

The availability of therapists remains 
a challenge to service delivery. In 
relation to systems and improvement 
of management as outlined in the NHI 
document, Bateman (2012) interviewed 
therapists working in rural areas. Some  
of the practical difficulties for reha­
bilitation included: in­patients referred  
to hospitals and not receiving atten­
tion, no allocation of transport to 
rehabilitation, premature discharge with ­
out therapy leading to complica tions  

Table 4: Conditions seen by Physiotherapists by  category 2005-2011 (Source of data: NdoH – statistics project 2013)

Year and annual figures and percentages

Conditions

 

2005 
n 
(%)

2006 
n 
(%)

2007 
n 
(%)

2008 
n 
(%)

2009 
n 
(%)

2010 
n 
(%)

2011 
n 
(%)

Ortho 24196

(52.36)

32443

(51.78)

36609

(51.22)

38224

(46.93)

36297

(45.67)

50463

(37.01)

39845

(38.21)

Respiratory 16285

(35.240

21896

(34.95)

26176

(36.62)

33702

(41.38)

33818

(42.55)

20985

(15.39)

16499

(38.2)1

Neuro 14832

(32.10)

18744

(29.92)

24829

(34.74)

25331

(31.10)

25512

(32.10)

31519

(23.11)

23290

(22.33)

Women’s health  

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

5566

(4.08)

2891

(2.77)

Other ( ICU, burns general 
weakness)

5727

(12.39)

8317

(13.27)

8688

(12.16)

9517

(11.69)

9369

(11.79)

27715

(20.32)

21315

(20.44

Others : Specify  

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

2010

(1.47)

2011

(1.93)

Others : Specify  

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

 

(0.00)

2010

(1.47)

2011

(1.93)

Grand total 46208

(100.00)

62656

(100.00)

71473

(100.00)

81443

(100.00)

79484

(100)

136366

(100.00)

104285

(100.00)



8   WITS SPECIAL EDITION JOurNAL 2013

and readmissions. An important obser­
vation is the focus of the health system 
on curative and mortality issues, whereas 
a rehabilitation­orientated health system 
would focus on morbidity and quality of 
life data (Bateman 2012). 

EXPENDITURE AND FINANCING OF 
REHABILITATION SERVICES
Very little information could be found 
in the literature on actual expenditure 
distribution of related costs. Within 
the medical aid schemes R7 billion of 
R97 billion approximately 10­15% per 
annum is spent on allied health services 
(Occupational therapy, Physiotherapy, 
Biokinetics, Speech) and related needs 
(Medical Aid­press release 2012). In 
the public sector, no information on 
expenditure could be found in published 
literature. Thus proxy indicators such 
as staff and infrastructural support can 
only be used to give a sense of where 
the expenditure is spent. Seventeen 
percent (1040) of physiotherapists on 
the HPCSA register work in the public 
sector (NDoH 2013 and  21% (794) of 
OTs. With Gauteng having the highest 
figures of personnel in public service 
followed by KwaZulu Natal and the 
lowest being in the Western Cape (HST 
2013, DoH 2011).

An audit of the national health 
care facilities (Health Systems Trust 
2013) reveals that only 6­20% of PHC 
facilities offer rehabilitation services. 
Occupational and physiotherapy services 
were 20 and 19% respectively. In 
hospitals, the onsite services are offered 
by 32­77% of facilities respectively 
(HST 2013). Furthermore, the current 
medical aid coverage in the country 
reveals that expenditure on health is 
disproportionate in the private and public 
sector with per person expenditure  
being four times higher in the private 
sector (R11150 vs. R2766) (Department 
of Health 2011a). It is important to align 
the distribution and the type of services 
to the burden of disease which would 
improve the country’s health delivery 
and rehabilitation efforts.

RECOMMENDATIONS
Quadruple burden of disease
With regard to the rehabilitation 
professions response to the burden of 

disease, further studies and appropriate 
training should be done into the areas 
and fields of practice of all members 
of the professions. The shortage of 
therapists at appropriate levels needs to 
be addressed and engagement with fresh 
strategic approaches to this problem 
should be examined.

Service delivery
There is need for the re­examination of 
service delivery models from the level 
of district hospital to community health 
centre. A “one size fits all” is not the 
answer and the perennial shortages of 
therapists at all levels, calls for radical 
approaches to service delivery models. 
The delivery of service at these levels 
should perhaps respond to the call by 
the PHC reengineering to provide a 
service that is not discipline or specific 
programme based to one that is more 
holistic. Figure 3 gives a pictorial 
representation of the two models.  

The provision of service in silos of 
physiotherapy, occupational therapy and 
speech therapy should be re­examined 
and shift towards the WHOs supermarket 
approach where the patient will obtain 
all rehabilitation services in a trans­
disciplinary manner (WHO 2012).  This 
calls for a more concerted acceptance 
of a multidisciplinary health personnel 
(Davis 2006). Attrition of rehabilitation 
staff has not been fully studied. George 
et al (2012) reported a 15% HIV/AIDS 
prevalence among professional staff and 
migration to be responsible for attrition 
(George et al 2012). Urban migration 
and emigration have been cited as 
reasons for therapist attrition but no 

national study could be found to support 
this. Training of rehabilitation personnel 
with appropriate skills for a tailor made 
system is important. The rehabilitation 
personnel at district level will require 
good generalist skills and specific skills 
for the community setting (Maleka and 
Franzsen 2008).

The NHI aims to promote innovative 
models of providing specialist care 
and a parallel to integrated working 
practices between GPs and hospital 
based specialists (Department of Health 
2011a). Therapists could develop and test 
models of private­public partnerships 
that could be funded to produce the 
necessary evidence for larger roll 
out where the context lends itself to 
this model. Coupled with the need to 
examine service delivery models is the 
need to assess and improve the quality 
of management within the delivery of 
rehabilitation services. This includes 
interventions to improve waiting time, 
consistency of treatment, quality of 
treatment; meeting treatment needs 
and patient satisfaction are some of the 
issues that need to be examined.

RESEARCH
The time has come for rehabilitation 
professionals to examine their approach 
to research. As Mothabeng (2003) 
points out the need for increased 
clinical research and alignment with 
national needs is imperative. However, 
larger population based studies that 
can contribute to policy and clinical 
practice is urgently needed. The NDoH 
2011 Research Summit Report outlined 
some important strengths, weaknesses 

Figure 3: Models of service delivery – patient – therapist



9   WITS SPECIAL EDITION JOurNAL 2013 

and opportunities with the current 
research agenda which rehabilitation 
professions should strive to build on 
where appropriate. Some strengths 
include existing research infrastructure 
robust surveillance systems and good 
internationally recognised literature in 
the areas of chronic disease and injury 
prevention and violence (Department of 
Health 2011b). Rehabilitation fraternity 
could possibly draw data collection 
systems that will add the dimension of 
morbidity and rehabilitation specific 
strengths in improving patient function 
and quality of life. Existing surveillance 
systems could include rehabilitation data 
that contribute to policy changes. Our 
current research agendas will contribute 
to appropriate measures and variables 
but as rehabilitation professionals 
it is important to engage and map a 
clear way forward. This could include 
enhancing the weaknesses that exist in 
the larger research agenda such as aging 
and inadequate numbers of researchers, 
limited funding, lack of national sur­
veillance systems for morbidity data  
(e.g. cancer registers, quality of care and 
poor systems to translate data into policy 
and practice) (Department of Health 
2011b). Opportunities such as the global 
focus on chronic non­communicable 
diseases and social determinants of 
health, and the WHO call to reduce 
deaths from non­communicable diseases 
by 2% per year should be examined.

CONCLUSION
The NHI calls for an examination of 
equitable service delivery. To do this, 
every profession including rehabilitation 
professions needs to examine their 
research, service delivery and its distri­
bution financially and in terms of 
personnel, response to burden of disease 
and the quality of service provided.

REFERENCES

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Bateman C 2012 One size fits all’ health policies 
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Bradshaw D, Groenewald P, Laubscher R, 
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Davis S 2006 Rehabilitation:the use of theories 
and models in Practice Elsevier, Toronto  

Department of Health 2010. Rehabilitation statis­
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Rehabilitation services

Department of Health 2011a. National Health 
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Department of Health 2011b. Strengthening 
research for health, innovation and development  
in South Africa

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