Cerebral palsy in South Africa: A call for comprehensive care and support

CELEBRATED on November 20 each year, World Children's Day raises awareness about the rights and welfare of children while also highlighting the enormous challenges they face. One of these challenges is cerebral palsy (CP).

Cerebral palsy refers to a group of permanent movement and posture disorders caused by injury to or abnormal development of the brain early in life, leading to difficulties with movement and coordination. Although the brain injury does not progress, its impact on movement and function may worsen over time without sustained and coordinated treatment and care. 

Globally, the prevalence of CP remains relatively constant in high-income countries but is considerably higher in low-and middle-income countries where perinatal complications (complications during late pregnancy to the first week or month after birth), limited access to skilled obstetric care, and deep social and economic inequalities persist. 

In South Africa, CP is a major cause of disability in children and reflects the enduring consequences of injury to the foetus or newborn brain. Managing CP in this context requires attention to the medical, social, and structural factors that influence both the onset of the condition and how it affects children throughout their lives.

The increased prevalence of CP in South Africa is closely linked to newborns experiencing a lack of oxygen, early births, neonatal infections, and delayed recognition of high-risk pregnancies. Underlying factors during pregnancy could potentially be a further contributory factor, but needs further study Socioeconomic inequities exacerbate these risks: poverty, malnutrition, and poor maternal health contribute to complications that affect a baby at or near birth, while unemployment and poor living conditions compound the long-term impact of disability. 

Families of children with CP often experience significant financial strain arising from the costs of transport, therapy, and assistive devices. The cumulative social and economic burden extends beyond the child, reinforcing cycles of disadvantage that widen the disparities between urban and rural communities and between those with and without access to specialist care.

Structural limitations within the public health system further hamper the delivery of comprehensive CP care. Specialised multidisciplinary clinics are concentrated at universities, leaving district and rural facilities under-resourced and with limited neurodevelopmental expertise.

Fragmented referral systems delay diagnosis, rehabilitation, and the procurement of supportive devices that can help children with CP move more easily and maintain better posture. Early detection is also inconsistent because the monitoring of children’s development isn’t implemented regularly in primary care and providers often lack the training to identify subtle early abnormalities in movement. 

Consequently, many children are referred late — often after preventable complications such as contractures (tightening or shortening of muscles, tendons, or joints) or hip displacement have developed.

Strengthening early identification through provider training, standardised screening tools, and community-based follow-ups could enable timely intervention and improve the brain’s ability to rewire itself in response to learning and experience during critical developmental windows. 

Rehabilitation remains the cornerstone of management, yet therapy sessions are infrequent due to overwhelming caseloads and shortages of physiotherapists, occupational therapists, and speech therapists. Logistical challenges, transport costs, and caregiver fatigue further limit attendance, resulting in fragmented care and less-than-ideal functional outcomes.

Children with CP also face profound challenges within the education system. Although inclusive education is supported by national policy, the implementation of these principles remains limited. Many mainstream schools lack the infrastructure, adaptive materials, and trained educators required to accommodate learners with mobility or communication impairments. Special schools are oversubscribed and unevenly distributed, leaving many children excluded from formal education. 

Coordination between the Departments of Health and Education can be improved to support children transitioning from early intervention to schooling. Parental advocacy is often hampered by limited knowledge of rights and resources, and caregivers carry the emotional and financial strain of full-time care, frequently at the expense of employment. These cumulative pressures underscore the need for stronger intersectoral collaboration to align early detection, rehabilitation, and educational inclusion.

While South Africa possesses progressive frameworks such as the Integrated National Disability Strategy, this needs to be translated into practice. Rehabilitation and disability services remain underfunded and are often perceived as peripheral to mainstream health priorities. 

Data to guide planning and resource allocation are scarce: there is no national CP registry (though efforts underway to address this) and most local studies are small, hospital-based, and descriptive. 

This evidence gap hinders the evaluation of service coverage and outcomes. Establishing a national surveillance system and promoting research on cost-effective community-based rehabilitation, caregiver training, and digital health interventions could improve how services are designed and policies respond to the needs of children and their families.

Despite these challenges, several opportunities exist. Expanding community-based rehabilitation programmes, partnerships between universities, non-governmental organisations and provincial health departments, and the use of tele-rehabilitation and mobile health technologies can potentially extend specialist expertise to underserved areas.

Family-centred models that equip caregivers to implement home-based therapy have shown promise in improving participation and functional outcomes. These innovations illustrate the potential of scalable, context-appropriate approaches that bridge the gap between tertiary expertise and community implementation. 

Ultimately, CP remains one of the most significant yet preventable causes of childhood disability in South Africa. Its management demands an ecosystem approach that integrates early detection, equitable access to rehabilitation, inclusive education, caregiver empowerment, and sustained policy support. 

Coordinated intersectoral investment in training, research, and service delivery can help improve functional outcomes and enhance the quality of life for children living with CP and their families.

*Professor Solomons is the Executive Head of the Department of Paediatrics and Child Health at Stellenbosch University.

Cape Times