Developing implementation strategies for the framework and strategy for disability and rehabilitation in South Africa: An approach using the Expert Recommendations for Implementing Change framework

Abstract

Background: The expiry of South Africa’s Framework and Strategy for Disability and Rehabilitation (FSDR) created an opportunity to critically assess its effectiveness, strengths and limitations to inform the development of a new disability and rehabilitation policy. Objectives: As the primary gap in the FSDR related to weak implementation rather than policy intent, this study aimed to develop evidence-informed implementation strategies. Findings from a document review, semi-structured interviews and focus group discussions were triangulated and guided by the Expert Recommendations for Implementing Change (ERIC) framework. Method: A descriptive qualitative design was used. Four focus group discussions were conducted with stakeholders involved in FSDR implementation to reach consensus on practical strategies to strengthen implementation. Data were analysed using combined inductive and deductive thematic approaches, and identified strategies were mapped to the ERIC framework. Results: Seven themes were identified as key determinants of implementation success or failure: limited awareness and training; resource constraints; poor interdepartmental collaboration; weak governance and policy buy-in; inadequate monitoring and evaluation systems; the need for context-specific approaches; and ongoing professional development. Stakeholders actively contributed to refining strategies within each thematic area. Conclusion: The findings highlight critical implementation gaps in training, governance, resources and collaboration. Addressing these through targeted, contextually appropriate strategies can strengthen future disability and rehabilitation policy implementation and improve service delivery in South Africa. Contribution: This study offers a roadmap for improving disability and rehabilitation policy implementation and can inform both future policy planning and clinical service delivery.