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Disability and global health: Special issue of International Journal of Environmental Research and Public Health

KUPER, Hannah
POLAK, Sarah
Eds
2019

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Papers included in this special issue are:

 

Missing millions: How older people with disabilities are excluded from humanitarian response

SHEPPARD, Phillip
POLACK, Sarah
McGIVERN, Madeleine
July 2018

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The aim of this study was to explore the experiences of older people with disabilities across a range of humanitarian settings, considering:

  • whether older people with disabilities have additional needs and challenges accessing humanitarian assistance and protection
  • what factors facilitate or limit access by older people with disabilities to humanitarian assistance and protection
  • to what extent is humanitarian response inclusive of older people with disabilities

A systematic literature review of published studies was conducted. Key online humanitarian guidelines were explored to review how far they explicitly address older people with disabilities. Data from six population-based disability surveys comparing the living situation of older people with and without disabilities were analysed. These included databases from two crises-affected populations in Haiti (post-earthquake) and Palestine. Data from four non-humanitarian settings was also reviewed to explore more broadly the situation for older people with disabilities – India, Guatemala, Cameroon and Nepal. Interviews were held with older people with disabilities, members of their families and local key informants in two conflict-affected populations in Ndutu and Mtendeli refugee camps in Western Tanzania, and Donetsk and Luhansk regions of Eastern Ukraine to find out about their experiences. Staff of five international agencies working in humanitarian response were also interviewed. 

 

Findings highlight particular issues facing older people with disabilities in humanitarian crises: more risk escaping from danger;  barriers to accessing social protection and work; barriers to accessing health and rehabilitation services; barriers to accessing food and other essentials; unsuitable housing and poor living conditions;  insecurity and discrimination; threats to dignity and independence; social isolation and loneliness; risks to mental health; and missing from humanitarian response.

 

A table brings together the findings from the different components of the research to show the needs, risks, barriers and enablers for older people with disabilities identified in the research. Recommendations are provided to humanitarian donors, policy makers and practitioners

Disability, CBR & Inclusive Development, Volume 29, No.2, 2018 (Summer 2018)

July 2018

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Research articles are:

  • Lived Experience of Psychosocial Disability and Social Inclusion: A Participatory Photovoice Study in Rural India and Nepal
  • Barriers and Facilitators for Wheelchair Users in Bangladesh: A Participatory Action Research Project
  • A Cross-sectional Survey of Rehabilitation Service Provision for Children with Brain Injury in Selangor, Malaysia
  • Effect of Abacus Training on Numerical Ability of Students with Hearing Loss
  • Cross-Cultural Adaptation and Evaluation of Psychometric Properties of Persian Version of Supports Intensity Scale among Adults with Intellectual and Developmental Disabilities

Review:

  • Developmental Social Work for Promoting the Socioeconomic Participation of Persons with Disabilities: An Application of the Capability Approach
     

Brief reports:

  • Zero Rejection Policy in Admission of Children with Special Needs - Myth or Reality
  • Ujamaa and Universal Design: Developing Sustainable Tactile Curricular Materials in Rural Tanzania

Monitoring employment rights of people with disabilities in Kathmandu, Nepal, Holistic report 2018

PRASAI, Sagar
PANT, Aashish
June 2018

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This report presents the results of a monitoring project on the employment situation of persons with disabilities in Nepal. The report is one step toward a comprehensive evaluation of Nepal’s constitutional, legal and policy framework. Findings scrutinise the country’s implementation of laws and policies based on the daily life experiences of persons with disabilities. These experiences are used to assess the level of rights violations, the reasons behind those violations, and possible solutions. This holistic report offers an in-depth analysis of the life circumstances for persons with disabilities, with a specific focus on employment. The analysis has been conducted in relation to fundamental human rights principles of dignity, autonomy, participation, inclusion and accessibility, non-discrimination and equality and respect for difference. The report highlights the degree of implementation of the constitution, laws, policies and programs, enacted to protect and advance the human rights, and specifically the employment rights, of persons with disabilities. The report also highlights the experiences of persons with disabilities with reflection of societal attitudes. 

This study is part of a larger initiative called the DRPI AWARE (Asian Workplace Approach that Respects Equality) project. In each of the three monitoring sites (Hyderabad, Dhaka, Kathmandu), monitors used an interview and focus group guide to capture a specialized data set and analyze violations of the right to work and employment.

Disability-inclusive social protection research in Nepal: A national overview with a case study from Tanahun district

BANKS, Lena M
et al
2018

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Social protection programmes are increasingly being adopted in low- and middle-income countries as a set of strategies for poverty reduction, improving livelihoods and decreasing inequality. Due to high levels of poverty and social exclusion, people with disabilities – who comprise upwards of 15% of the global population – have been identified as a key target group for inclusion in social protection, in both international guidelines and in national strategies. However, there is currently a lack of evidence on whether these programmes are adequately reaching and meeting the needs of people with disabilities.

The aim of this research was to assess the extent to which social protection systems in Nepal and Vietnam address the needs of people with disabilities. This research uses a mixed methods approach, combining a national policy analysis with district-level qualitative and quantitative studies in each country

Everybody Matters: Good practices for inclusion of people with disabilities in sexual and reproductive health and rights programmes

Van SLOBBE, Caroline
November 2017

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This publication provides introductory chapters from two activists who work to create better opportunities for people with disabilities in Nigeria and India. Subsequently, the challenges that organisations worldwide have encountered whilst improving the access to and knowledge of sexual and reproductive health and rights for people with disabilities are presented. Ways in which they managed to find solutions and the results achieved are reviewed. Some cases show the importance of a more personal approach whilst others emphasise the advantage of changing systems and policies. Different regions, types of disabilities and various SRHR-topics are reflected in these stories. All cases provide lessons learnt that contribute to a set of recommendations for improved responses. The closing chapter highlights the challenges, solutions, and ambitions that are presented and lead up to a concise overview of recommendations.  

Good practice examples include:

A shift in SRH programming (Nepal)

Breaking Barriers with performance art (Kenya)

Her Body, Her Rights (Ethiopia)

People with disabilities leading the way (Israel Family Planning Association)

Best Wishes for safe motherhood (Nepal)

It’s my body! (Bangladesh)

Calling a spade a spade (Netherlands)

Four joining forces (Colombia)

Change agents with a disability (Zimbabwe)

Tito’s privacy and rights (Argentina)

Sign language for service providers (Kenya)

Towards Inclusion - A guide for organisations and practitioners

VAN EK, Vera
SCHOT, Sander
2017

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This guide is the result of collaboration between Light for the World (LFTW), Mission East (ME), and ICCO Cooperation.

Based on decades of experience of working with the most marginalized and excluded communities, the three organizations cooperated to record their experiences in a publication which can be used in a variety of relief and development contexts. ‘Towards Inclusion’ is designed to be an easy to use reference for organizational and program/project development with a focus on gender responsiveness and disability inclusion.

The guide is made up of three parts:
• the first part guides users through the process of organizational self-assessment to determine readiness to change and identify key steps towards becoming a more inclusive organization.
• the second part introduces the ACAP framework, as a means of improving inclusion in programming via Access, Communication, Attitude and Participation. A range of tools for measuring and improving inclusion at all stages of the project cycle are provided.
• the third part provides guidelines for the people or ‘change facilitators’ who will guide organizations through the process of change towards becoming more inclusive.

The publication can be found at “Towards Inclusion Guide” and the accessible version of the publication can be downloaded. Both are free of charge.

Possibilities for organisation trainings and/or webinars on the practical application of the guide are under consideration. Contact ACAP@gmail.com.

Water justice, gender and disability : South Asian Water Studies (SAWAS), special issues, vol.5, no.4, June 2017

CLEMENT, Florian
NICOL, Alan
CORDIER, Sylvie
Eds
June 2017

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The papers in this volume on gender, persons with disabilities and WASH in South Asia help to provide important pointers on ways forward. A common thread throughout the four articles is that a constellation of challenges still exists, from 'exclusion' through prejudice at different levels, to institutional realities that render policy and other instruments ineffective in practice. In some cases, even, there remains a complete absence of key legal and policy instruments.  

Titles of the articles in this issue are: 

  • Planning for inclusion: exploring access to WASH for women and men with disabilities in Jaffna District, Sri Lanka
  • Breaking down Barriers: Gender and Disability in Access to Agricultural Water Management in Nepal
  • The Gender Gap between Water Management and Water Users: Evidence from Southwest Bangladesh​
  • Are policies enough to mainstream Gender in water and sanitation programs? Experiences from community managed drinking water supply schemes in India

Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal

DEVKOTA, Hridaya Raj
KETT, Maria
GROCE, Nora
MURRAY, Emily
June 2017

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BACKGROUND:
Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth.

METHOD:
The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes.

Reproductive Health, 2017

WHO launches rehabilitation standards for Emergency Medical Teams

WORLD HEALTH ORGANISATION (WHO)
May 2017

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WHO together with health partners such as CBM, Handicap International, and the International Committee of the Red Cross, have released the ‘Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation’ which provides important guidance on how emergency medical teams (EMTs) can incorporate rehabilitation in their response to emergencies. Using the experiences from the 2015 Nepal earthquake, this video shows the impact it had on the lives of those injured years later and highlights the reasons why rehabilitation needs to be a core component of any emergency medical response. Integrating rehabilitation into the EMT response resulted in greater clinical care by producing important, cost-effective, and positive long term outcomes at the individual, family, and community levels

Cardiovascular diseases (CVD) and rehabilitation. Factsheet

HANDICAP INTERNATIONAL
March 2017

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Cardiovascular disease (CVD) refers to conditions that affect the heart and blood vessels. Most commonly this includes coronary heart disease (heart attacks), cerebrovascular disease (stroke) or raised blood pressure (hypertension). A stroke occurs when a blood clot (ischaemia) or a bleed (haemorrhage) disrupts the blood supply to part of the brain, starving that area of oxygen. Stroke is a leading cause of serious long-term disability. Common impairments and activity limitations from cardiovascular diseases are hemiplegia, word forming difficulties and slurring of speech, cognitive function, depression, sensory loss and shortness of breath. Different examples of rehabilitation in the care continuum are given. A case study of stroke in Nepal is provided. 

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

DFID data disaggregation action plan - Better data for better lives

UK DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID)
UK AID
January 2017

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This action plan sets out the steps that the UK Department for International Development (DFID) will take to promote, provide and make use of their own development and humanitarian programme data which can be disaggregated on the basis of sex, age, disability status and geography (in the short term). It also has the objective to build the culture within DFID on disaggregated data, and to work with others to change the international development system on disaggregated data. A review is scheduled for 2020. Working with partners, influencing, capacity building and management information, research, analysis and reporting are outlined. Trailblazer country programmes with Bangladesh, Nepal, Zimbabwe and Rwanda are reported.

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

BIBHAV Acharya
et al
January 2017

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Abstract

Background

Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.

Partnerships network

We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.

Conclusions

We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

ACHARYA, Bibhav
MARU, Duncan
SCHWARZ, Ryan
et al
January 2017

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"Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation."

The wellbeing of children with developmental delay in Bangladesh, Bhutan, Laos, Nepal, Pakistan and Vietnam: An analysis of data from UNICEF’s Multiple Indicator Cluster Surveys

EMERSON, Eric
SAVAGE, Amber
LLEWELLYN, Gwynnyth
December 2016

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This report, produced by the University of Sydney’s Centre for Disability Research and Policy (CDRP),
uses data collected in rounds four and five of UNICEF’s Multiple Indicator Cluster Surveys programme (MICS) to describe the wellbeing of young children with and without developmental delay in six Asian countries. The United Nations Sustainable Development Goals (SDG) were used as a framework for identifying indicators of child wellbeing.

The report, authored by CDRP Disability and Inequity Stream Leader Professor Eric Emerson with Dr Amber Savage of the Family and Disability Studies Initiative, University of Alberta, Canada and CDRP Director Professor Gwynnyth Llewellyn, found that children with Developmental Delay in Bangladesh, Bhutan, Laos, Nepal, Pakistan and Vietnam are more likely than their peers to:
• Be living in poverty (SDG1). In five out the six countries children with developmental delay were more likely to be living in poverty than their peers
• Experience hunger (SDG2). In all six countries children with developmental delay were more likely to have experienced persistent severe hunger than their peers
• Suffer poor health (SDG3). On three indicators (poor peer relationships, diarrhoea and fever) children with developmental delay were more likely to have poor health than their peers. On three indicators (obesity, aggression and acute respiratory infections) there was no systematic difference between children with and without developmental delay.
• Experience barriers to quality education (SDG4). On all four indicators (attendance at early childhood education centre, family support for learning, access to learning materials in the home, maternal level of education) children with developmental delay were more disadvantaged than their peers.
• Experience barriers to clean water and sanitation (SDG6). On two indicators (improved sanitation, place to wash hands) children with developmental delay were more disadvantaged than their peers. On one indicator (improved drinking water) there was no systematic difference between children with and without developmental delay.

The authors noted that “Since the development of the United Nations Convention on the Rights of the Child (UNCRC) in 1998, increased attention has been paid to monitoring the well-being of children. The UN Convention on the Rights of Persons with Disabilities (UNCRPD) and UNCRC both contain explicit provisions regarding the rights of children with disabilities. These impose obligations on governments to act to ensure that children with disabilities enjoy the same rights and opportunities as other children. In order to promote the visibility of children with disabilities, enable better policy, and monitor progress, disaggregation of data related to children’s well-being on the basis of disability is needed."

Together towards an inclusive world (series of videos to celebrate CRPD's 10th anniversary)

Australian Disability and Development Consortium
December 2016

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ADDC and ten of its members have produced a series of short videos featuring persons with disability who are, or were, engaged in a disability-inclusive development (DID) project or initiative (in Australia or overseas). In these videos they share their personal stories and how disability inclusive development projects changed their lives, benefitted their communities and contributed to a more inclusive society.

The video series was officially launched during a parliamentary event in Canberra on 30 November 2016 in the presence of some of the persons featuring in the videos and of senior politicians from different Australian political parties.

The event was opened by an address by Senator Concetta Fierravanti-Wells, Minister for International Development and the Pacific. In her speech, she confirmed both the Australian government’s and her personal strong commitment to ensuring that all Australian development programs are disability-inclusive and to championing DID internationally. You will find a transcript of the Minister’s speech here attached.​

Challenges to principled humanitarian action: Perspectives from four countries.

NORWEGIAN REFUGEE COUNCIL
Handicap International
July 2016

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The purpose of this paper is to contribute to an increased understanding of the perceived and actual challenges humanitarians face in operational contexts as they apply the principles of humanity, impartiality, neutrality and independence. A snapshot is provided of four case studies; Colombia, Nepal, northern Syria and South Sudan. Through a combination of field research, headquarters interviews, desk research, and a webinar, views and observations are presented from the humanitarian community. These observations provide a glimpse into the challenges faced by principled humanitarians. As a result the paper puts forward seven recommendations intended to assist humanitarians and states to sharpen tools and strengthen approaches when implementing principled humanitarian protection and assistance. An addendum to this study provides perspectives from selected members of the donor community. This research was conducted through interviews with state representatives in Geneva, aiming to understand how donors perceive their responsibilities in upholding the humanitarian principles and the Good Humanitarian Donorship Principles. This final chapter highlights challenges faced by states while supporting principled humanitarian action, particularly in conflict zones. On the basis of this research, additional recommendations for both states and humanitarians are proposed to strengthen the adherence to the humanitarian principles

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