Public health system strengthening : The transition of adolescents with severe bilateral cerebral palsy from paediatric to adult care in the Western Cape, South Africa
1
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
2
Department of Health and Wellness, Westerncape Government, Cape Town, South Africa
3
Neuroscience Institute, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1755
ABSTRACT
BACKGROUND:
With advances in neonatal and paediatric care in majority world settings, more children reach adulthood with severe physical disabilities, necessitating quality long-term care. The transition from paediatrics to adult based services demands interdisciplinary, multi-level system coordination, which is poorly managed in LMIC settings. 1,2
METHODS:
To evaluate our health service, a retrospective descriptive audit was conducted on patient records in a Cerebral Palsy Clinic at Red Cross War Memorial Children’s Hospital, a tertiary paediatric hospital in Cape Town, South Africa. Led by the developmental paediatrician, a clinical governance framework and the UNICEF Health System Strengthening approach was adapted to create an audit tool. A quantitative analysis was conducted to identify facilitators and address barriers in the system, thus improving outcomes.
RESULTS:
Between 2023 and 2025, 100 children (13 -18 years) dependant on caregivers, living with bilateral cerebral palsy from early brain injury, were transitioned into primary adult healthcare services. The majority of families were anxious with a single event transition mandating 3 sessions over 2 years. Priority interventions included introducing transition to caregivers, planning acute and chronic care and knowledge sharing between services. Barriers identified were long waiting times for appointments in clinics, inadequate medication stock, reduced therapy and unclear medical interventions.
CONCLUSIONS:
Despite perceived systemic barriers to transitions from a paediatric to adult health services for young adults with physical and intellectual disabilities in resource limited setting, a gradual, coordinated discharge can be achieved with effective responsive planning and a cohesive team. Although parents eventually celebrated their child approaching adulthood on discharge, more advocacy is needed for adults living with childhood disabling conditions. A deeper situational analysis with key stakeholders is needed. The WHO Global Goals for Health Equity for persons with disabilities can consolidate local strategies placing families at the center of public health systems.3
With advances in neonatal and paediatric care in majority world settings, more children reach adulthood with severe physical disabilities, necessitating quality long-term care. The transition from paediatrics to adult based services demands interdisciplinary, multi-level system coordination, which is poorly managed in LMIC settings. 1,2
METHODS:
To evaluate our health service, a retrospective descriptive audit was conducted on patient records in a Cerebral Palsy Clinic at Red Cross War Memorial Children’s Hospital, a tertiary paediatric hospital in Cape Town, South Africa. Led by the developmental paediatrician, a clinical governance framework and the UNICEF Health System Strengthening approach was adapted to create an audit tool. A quantitative analysis was conducted to identify facilitators and address barriers in the system, thus improving outcomes.
RESULTS:
Between 2023 and 2025, 100 children (13 -18 years) dependant on caregivers, living with bilateral cerebral palsy from early brain injury, were transitioned into primary adult healthcare services. The majority of families were anxious with a single event transition mandating 3 sessions over 2 years. Priority interventions included introducing transition to caregivers, planning acute and chronic care and knowledge sharing between services. Barriers identified were long waiting times for appointments in clinics, inadequate medication stock, reduced therapy and unclear medical interventions.
CONCLUSIONS:
Despite perceived systemic barriers to transitions from a paediatric to adult health services for young adults with physical and intellectual disabilities in resource limited setting, a gradual, coordinated discharge can be achieved with effective responsive planning and a cohesive team. Although parents eventually celebrated their child approaching adulthood on discharge, more advocacy is needed for adults living with childhood disabling conditions. A deeper situational analysis with key stakeholders is needed. The WHO Global Goals for Health Equity for persons with disabilities can consolidate local strategies placing families at the center of public health systems.3
| eISSN: | 2654-1459 |
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