Background: Audiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa. Methods: The data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002–2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service–target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply–need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: ‘best guess’ (no intervention), ‘optimistic’ (feasible intervention), and ‘aspirational’ (significant intervention) scenarios up to 2030. Results: Most (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply–need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals. Conclusions: It is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.

Background: Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care. Main body: Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions. Conclusion: There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.

In the context of the World Report on Disability, <!--RIDCIT0034--> 34. Wylie, K., McAllister, L., Davidson, B., & Marshall, J. (2013). Changing practice: Implications of the world report on disability for responding to communication disability in underserved populations. International Journal of Speech-Language Pathology, 15, 1–13. [Taylor & Francis Online], [Web of Science ®] View all references question how speech-language pathologists (SLPs) change practices to benefit under-served people with communication disability. This commentary provides a South African response premised on Political Consciousness. In South Africa, a grossly unequal society, the under-served population is not only those with communication disability but also include those who are at a communication disadvantage due to disabling conditions. As a consequence of the combined effects of a severe shortage of SLPs as well as maldistribution in service provision, the under-served are mainly poor Black South Africans who are the majority population. Political Consciousness allows one to examine how selected forces at the macro-level, meso-level, and micro-level may enable or limit services to the under-served majority. At a macro-level, this study appraises policies and actions advancing and impeding service delivery. At the meso-level it is argued that hegemonic professional knowledge is limiting and an equity-driven population-based approach is advocated. At a micro-level, the Relationship of Labouring Affinities is offered as a conceptual tool for critical engagement. In conclusion, it is suggested that the speech-language pathology profession must collectively become political actors at all levels to effect change.

The professions of speech–language pathology and audiology provide valuable services for persons with communication, hearing, and feeding/swallowing disabilities. However, from a global perspective, mainstream practice discourses represent values from colonial perspectives (called Northern here). As such, they remain largely inaccessible to most people in the world. We argue, from a South African perspective, for a postcolonial or Southern discourse in alignment with other Africans, Latin Americans, and Asians who historically have had limited opportunities to shape professional practices. We use ideology critique (a disruptive tool) to reflect and make visible hegemonic Northern practices. Critical science and decoloniality are offered as pivotal axes for transformation. Decoloniality is discussed in relation to (i) Equitable (ii) Population-based (iii) Innovations for (iv) Communication (EPIC) using illustrative examples of emerging South African practices. We argue for redefining communication disorder professions' cultural borderlands to engage Northern with Southern ideologies critically to strengthen professional practice transformation.

Teachers and learners must be able to shift flexibly along the continuum of monologic and dialogic interactional repertoires to advance learning. This paper describes how teachers and learners interacted during whole-class instruction along the continuum between monologic and dialogic interaction in primary school classrooms in Western Cape, South Africa. Method: A video-observation method was used to analyse TLIs across 15 lessons in intermediate phase classrooms. TLIs were analysed in relation to indicators viz. authority, questions, feedback, explanation, meta-level connection and collaboration. The transcriptions of TLIs were described using quantitative and qualitative techniques. Results: The study found that teachers sustained dominant monologic interactions by asserting their authority, asking mainly closed-ended questions, and providing confirming/correcting feedback which constrained the interaction. Learners had limited opportunities for explanations or collaboration. Across most lessons there were episodic shifts from monologic TLIs to transitional TLIs. These transitions were achieved by using mainly open-ended questions and feedback to expand the interaction. Dialogic TLIs were not evident. Conclusion: Monologic TLIs were dominant, closing down opportunities for communication. While transitional TLIs were evident, they were episodic and showed the potential for opening interaction opportunities. The absence of dialogic TLIs suggested that collaborative engagement opportunities were unavailable. The opportunity for intervention to increase dialogic TLIs is discussed.

This paper posits that for occupational therapy and occupational science to be able to address complex social issues, a radical reconfiguration of the dominant historical rationalities that govern their theorising and practices is required. This position is informed by the rationale for and the philosophical and theoretical foundations of a doctoral study currently being undertaken by the first author, entitled: 'Humanity affirmations and enactments in post-apartheid South Africa: A phronetic case study of human occupation and health'. The paper commences with the description of the problem - a historicised dual occupational diagnosis. The first diagnosis considers post-apartheid South Africa (1994-2014) as embodying and embedded in a vicious cycle; 'divided-wounded-violent', and held hostage by an enduring history of dehumanisation. The second diagnosis considers occupational therapy and occupational science, which the paper argues are not yet adequately positioned and prepared, both theoretically and practically, to serve as enabling resources for society to interrupt vicious cycles of dehumanisation. In order to address the problem we need practical knowledge to possibly enable our society to humanise and heal itself. This paper proposes an alternative two pronged philosophical foundation - Phronesis and Ubuntu - to advance such knowledge. The synergistic use of critical contemporary interpretations of Aristotle's intellectual virtue Phronesis (practical knowledge) to guide theorising about knowledge production; along with the African philosophy of critical humanism called Ubuntu to guide theorising about the core concepts of human occupation and health as well as their interrelationship. Key words: Critical, Phronesis, Ubuntu, human occupation, health, humanity