000			03119 am a22002173u 4500
042			_adc
100	1	0	_aTrafford, Zara _eauthor _92967
700	1	0	_aSwartz, Leslie _eauthor _92968
245	0	0	_a'Five minutes earlier, you were giving hope': Reflections from interviews with doctors conducting assessments for South Africa's childhood disability Care Dependency Grant
260			_bF1000 Research Limited, _c2022-11-25.
500			_a/pmc/articles/PMC7614167/
500			_a/pubmed/36777883
520			_aBackground: In South Africa, medical doctors functionally decide whether a primary caregiver can access state-funded social assistance cash transfers ('social grants') for the care of their disabled child. In this paper, we unpack the subjective experiences of one group of doctors in the country's Western Cape province who are involved in conducting assessments for the care dependency grant, designed to support the cost of disabled children's specific needs. Methods: Individual in-depth interviews were conducted with five paediatric doctors who practice at three Cape Town public sector hospitals and regularly conduct assessments for the care dependency grant. Analysis was thematic and used deductive coding. Results: The doctors we interviewed were aware that care dependency grants were probably shared among household members but felt this was acceptable, as it contributed to the child's wellbeing. Doctors seemed to be applying nuanced, individualised assessments but often felt the need to simplify the documentation of these assessments, sometimes even bending the rules, to ensure access. Doctors' primary allegiance in these processes appeared to be to their patients. They identified more with their care responsibilities than their bureaucratic gate-keeping role but nonetheless felt the weight of their responsibility for decision-making, in the context of extremely strained public resources and a lack of guidance from the government's social assistance implementation agency. Conclusions: The hyperlocal practices and approaches that doctors described allows for perception of the messier - but also more accurate - details of the system that is actually in place. Doctors' narratives also reflect long-standing inattention to the 'trickle down' of guidelines to frontline implementers of disability-related grants. This cadre is a valuable but under-utilised source of evidence and information about the real-world functioning of disability-related grants administration and they should be actively included in implementation planning.
540			_aCopyright: © 2022 Trafford Z and Swartz L
540			_ahttps://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
546			_aen
690			_aResearch Article _91689
655	7		_aText _2local
786	0		_nWellcome Open Res
856	4	1	_uhttp://dx.doi.org/10.12688/wellcomeopenres.18424.2 _zConnect to this object online.
999			_c489 _d489