Barriers, facilitators, and the future of integrated rehabilitation services in primary health care in a South African metropolitan area: an exploratory qualitative study

Background/Aims The World Health Organization's Rehabilitation 2030 initiative emphasises the need for integrated rehabilitation services within primary health care, particularly in low- and middle-income countries, to address persistent inequities in access. This study explored the expectations and lived realities of rehabilitation personnel regarding the integration of rehabilitation services in primary health care within a South African metropolitan district, with a focus on identifying key barriers and facilitators. Methods An exploratory qualitative design was used. In-depth interviews were conducted with 12 rehabilitation professionals purposively selected from nine primary health care facilities in the Johannesburg Metropolitan District. Thematic analysis was used to identify themes and sub-themes. Results Two overarching themes were identified: barriers to integration, which encompassed systemic issues such as ineffective referral pathways, staffing shortages, inadequate infrastructure, and gaps between policy and practice; and facilitators and future directions, which included promoting interprofessional collaboration, community and private sector partnerships, discipline-specific mid-level workers and improved student training for community-based service delivery. Participants highlighted both current enablers and aspirational strategies for future integration. Conclusions Despite persistent structural challenges, multiple opportunities exist to strengthen rehabilitation services within primary health care. Addressing referral inefficiencies, aligning policy with practice, fostering collaboration, and investing in workforce development are essential for realising the vision for integrated, accessible and equitable rehabilitation at the community level to achieve universal health coverage. Implications for practice For rehabilitation professionals, these findings highlight the need to move beyond treating individual impairments and review their service delivery models to actively facilitate a more integrated and equitable primary healthcare system. This move includes strengthening referral and feedback pathways so that service users experience continuity of care across hospitals, district-level services, primary health care and the community level. Included in this is advocacy for fairer staffing and an appropriate skill mix, including the purposeful use and supervision of mid-level rehabilitation workers and community health workers. In addition, rehabilitation professionals should work with managers to secure adequate space, equipment and timely access to assistive devices. Rehabilitation professionals should also be intentional in building their literacy of key rehabilitation and primary healthcare policies and ensure that rehabilitation is represented in planning and decision-making structures through active citizenry in professional associations. Finally, rehabilitation professionals are called to invest in establishing interprofessional teamwork and partnerships with non-governmental organisations, community structures and private providers, while engaging in ongoing learning and mentorship so that they can function not only as clinicians, but also as advocates, leaders and system-builders within an integrated people-centred primary healthcare service.