Brain injury, whether traumatic or acquired, is a life-altering event with profound and lasting consequences for individuals and their families. The literature describes brain injury as a catastrophic occurrence that disrupts nearly every aspect of a person’s life. It is also recognised as an exceptionally prolonged and pervasive stressor, leading to multifaceted changes over time (Mahar & Fraser, 2011).
According to the Global Burden of Disease Study (GBD) 2021, South Africa recorded 160,607 cases of head injuries, with an incidence rate of 282 per 100,000 people. The prevalence rate for the same year stood at 473 per 100,000 (HIME, 2021). However, methodological challenges in epidemiological studies, such as incomplete hospital records, insufficient research funding, and overcrowded healthcare facilities, have been noted by Brown et al. (1991). More than two decades later, Naidoo (2013) suggested that these issues still hinder the accuracy of current epidemiological studies in South Africa. Given these limitations, it is widely assumed that the actual incidence of traumatic brain injury (TBI) in the country is likely higher than reported figures.
To assess the service landscape for individuals with acquired brain injury (ABI), Headway Gauteng conducted a brief survey in recognition of International Head Injury Awareness Day. The survey garnered eighty responses, representing fifteen different professionals involved in ABI care across eighty-eight different sites in South Africa.
Service landscape and rehabilitation gaps
Among the survey respondents, 82.5% work in the private sector, 12.5% in the public sector, 11.3% in the NPO sector, and 5.2% in academia. Responses represent six Nepos operating across eight sites, seven in Gauteng and one in the Western Cape. An academic institution accounted for three responses, all from speech therapists. Ten responses came from clinicians in the public sector, spanning seven healthcare institutions, clinics, or departments—five in Gauteng, one in the Free State, and one in the Western Cape. The majority of responses (66) were from clinicians providing a service in the private sector, representing fifty-four different private practices.
According to a STATS SA media release on May 23, 2024, only 15.7% of South Africans were enrolled in a medical aid scheme in 2023, with the highest coverage in the Western Cape (25.7%), followed by Gauteng (22.4%). Therapists working in public hospitals report that TBI patients often receive minimal rehabilitation, sometimes as little as one week, with limited specialised outpatient services available post-discharge. In contrast, private-sector patients typically have access to longer rehabilitation programs, though coverage varies significantly based on medical aid plans. Some funders provide for intensive, long-term outpatient therapy, while others do not clearly define coverage for Prescribed Minimum Benefits (PMBs) or offer only limited therapy options.
The role of NPOs in bridging the gap
In this challenging landscape, NPOs like Headway Gauteng play a vital role in supporting individuals affected by traumatic or non-traumatic brain injuries. Their services extend across both the public and private sectors, offering post-acute interventions as well as long-term support. They assist families suddenly thrust into turmoil by a life-changing event and those on a decades-long journey grappling with the long-term effects of acquired brain injury.
While many clinicians across various sectors are passionate about expanding rehabilitation access for ABI patients, there remains little comprehensive understanding of the full disease burden in South Africa.
This service mapping exercise was a small but important step in our endeavour to understand the Brain Injury Landscape in South Africa and to foster cross-sector collaboration to improve services for individuals living with ABI.
By Sharize Schaerer, Rehabilitation ManagerRITA HENN and Partners