Optimising resource use in audiology and speech therapy practice in South Africa: sectoral challenges, adaptive strategies and system-level implications

PURPOSE: Efficient and contextually responsive resource utilisation is central to sustainable healthcare delivery, particularly in resource-constrained settings. Within South Africa's dual healthcare system, characterised by structural inequities, there is limited evidence on how practitioners operationalise resource use in practice. This study explored challenges associated with productive resource utilisation among audiology and speech therapy practitioners and identified strategies to enhance efficiency and sustainability across sectors. DESIGN/METHODOLOGY/APPROACH: A qualitative design was employed using semi-structured interviews with 92 practitioners across public and private sectors and urban, peri-urban, and rural contexts in four South African provinces (Gauteng, KwaZulu-Natal, Western Cape, and Limpopo). Data were analysed thematically using Braun and Clarke's framework, with exploratory inferential analyses examining sectoral differences. Qualitative codes were quantified at participant level to allow descriptive and exploratory statistical comparison across sectors. FINDINGS: Four themes emerged. First, public sector resource constraints included equipment shortages (80%), staffing limitations (75%) and budgetary constraints (85%), particularly in rural areas (χ2 = 17.89, p < 0.01). Second, private sector optimisation strategies emphasised efficiency through technology (70%) and staff training (60%), with higher digital tool use (t = 3.45, p < 0.01). Third, resource allocation priorities differed, with public practitioners prioritising equitable access and private practitioners personalised care (χ2 = 22.45, p < 0.001). Fourth, innovations included community partnerships, task-sharing and hybrid funding approaches. ORIGINALITY/VALUE: This study provides novel insight into how resource optimisation is enacted within a dual healthcare system in an LMIC. It demonstrates how systemic inequities shape decision-making and service delivery, offering contextually grounded strategies to inform health system strengthening, including implications for public-private integration and South Africa's National Health Insurance. By integrating thematic analysis with exploratory quantitative comparisons, the study extends existing literature beyond descriptive accounts of resource scarcity to illustrate how practitioners adapt operationally within structurally unequal healthcare environments.