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Accessing community health services: challenges faced by poor people with disabilities in a rural community in South Africa

GRUT, Lisbet
MJI, Gubela
BRAATHEN, Stine H
INGSTAD, Benedicte
2012

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Poor people with disabilities who live in poor rural societies experience unique problems in accessing health services. Their situation is influenced by multiple factors which unfold and interplay throughout the person’s life course. The difficulties do not only affect the person with a disability and his or her family, but also impact on the relevant care unit. The barriers are rooted in a life in poverty, upheld and maintained by poverty-reinforcing social forces of the past and the present, and reinforced by the lack of the person’s perspective of the health services. This article explores how difficulties may interact and influence access to and utilisation of health services, and how this may render health services out of reach even when they are available. The study reveals that non-compliance is not necessarily about neglect but could as well be a matter of lived poverty. The study was based on in-depth interviews with people with disabilities and family members, and semi-structured interviews with health personnel. The data analysis is contextual and interpretive. When offering health services to people with disabilities living in resource-poor settings, services should take into consideration the person’s history, the needs, and the resources and abilities of the family group. Rethinking access to health services should transcend a narrow medical institutionalization of health professional’s training, and include a patient’s perspective and a social vision in understanding and practice. Such rethinking requires health service models that integrate the skills of health professionals with the skills of disabled people and their family members. Such skills lie dormant at community level, and need to be recognized and utilized.

Journey through the Trials and Triumphs of Disability

LAAS, Helen L
2012

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One Woman’s journey through the Trials and Triumphs of Disability, Disabled Peoples International 8th World Assembly 2011 Durban, South Africa, October 10–13, 2011. When embarking on my career as a teacher at a special school in South Africa, I never thought that a motor vehicle accident would place me in the position where my learners with disabilities suddenly saw me as an ally. Little did I realise the chasm that exists between able-bodied people and people with disabilities, or the remarkable role I would find myself in whilst actively addressing disability and Inclusive Education issues. My experiences with disability in South Africa drew encouraging attention from delegates at the Disabled People’s International 8th World Assembly when I shared my story. The resounding positive response affirmed that my experiences are not unique to nationality, gender, race or age, and are typical of the time and country in which I live, where people with disabilities are considered to have little potential, and woman with disabilities are further marginalised. In the infancy of our democracy, we are still in the early days of attending to equity amongst all South Africans. This story comprises both a narrative and a graphic presentation which run parallel, although not always telling an identical story; they complement one another and should be experienced simultaneously. Ultimately, it relates the success that can be achieved by pro-active people with disabilities as members of the South African society within their own spheres of knowledge and skill to change attitudes and practices of people without disabilities in education and local communities.

Assistive Technologies in a Workplace Environment: Barriers for the Employment of People with Disabilities

JAKOVLJEVIC, M
BUCKLEY, S
2011

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Purpose: The employment equity policies and implementation of technology- specific guidelines within the South African ‘Code of Good Practice on the Employment of People with Disabilities’, was created to encourage employment equity for employees with disabilities, by companies in Johannesburg.

 

This study reports on the results of the investigation in assistive technologies in a workplace environment, and barriers for the employment of persons with disabilities in the South African environment.

 

Method: Qualitative data, collected from two retail and service companies in the form of semi-structured individual and focus group interviews, was analysed using a constant comparative method, identifying major themes and sub-themes.

 

Results: A surprisingly small number of persons with disabilities were found to be employed by participating companies, which tended not to focus on these people when formulating their policies and plans. In addition, technological aspects of the Code were largely unacknowledged, with little effort being made to accommodate the needs of persons with disabilities. An even lower incidence of assistive technology usage was found, along with a large number of conceptual and perceived barriers that hinder the employment of persons with disabilities and the implementation of appropriate technology.

Documenting good practices at partner level

MUTUVI, Kavutha
MAINA, Gacheru
LACKEY, Douglas
2011

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This report documents the good practices of HelpAge and its partners while implementing a regional advocacy programme to mitigate the impact of HIV and AIDS among older people in six sub-Saharan African countries. It presents information about what is working and not working in different situations and contexts by highlighting and documenting the lessons learned and the process of what works, how and why. This resource is useful for anyone interested in the impact of HIV and AIDS among older people in Africa

Job ability

SUHINDRA, C.N
2011

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"This database provides various sources of information related to livelihoods opportunities for persons with disabilities in Bangladesh, India, Pakistan and Sri Lanka. Users can complete a registration form online to access information, guidance, support and learning opportunities, as well as search and apply for jobs. This resource is useful for people with disabilities interested in livelihoods opportunities"

Family-based HIV prevention and intervention services for youth living in poverty-affected contexts : the CHAMP model of collaborative, evidence-informed programme development

BHANA, Arvin
et al
June 2010

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The Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) is a family-focused, evidence-based intervention that has been tested in low-income contexts in the US, Caribbean and South Africa. This paper gives a description of the theoretical and empirical bases of the development and implementation of CHAMP in the US and South Africa

Rethinking HIV/AIDS in South Africa : has response been overmedicalized?

KELLEY, Laura M
EBERSTADT, Nicholas
April 2010

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This paper examines the potential impact of HIV and AIDS on different levels of South African society (individual, household, and national) over time. Using differences in demographic projections to guide the analysis, the prospective implications of HIV and AIDS on households, society, economy and nation are discussed and issues that could influence or mitigate those possible impacts are examined. The challenges that South Africa is likely face due to the effects of its AIDS-related excess mortality are outlined and the conclusion is drawn that programmes delivering a broader variety of services than are currently offered are needed

National response to disability and HIV in Eastern and Southern Africa

HANASS-HANCOCK, Jill
GRANT, Kitty
February 2010

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Although people with disabilities are often at increased risk of exposure to HIV, this policy brief outlines that less than half of the national strategic plans in Eastern and Southern Africa recognise disability as an issue of concern. Recommendations are provided to governments and civil society on how to address the issue effectively. This policy brief would be useful to people interested in HIV policies in Africa

CBR stories from Africa : what can they teach us?

COLERIDGE, Angela
HARTLEY, Sally
Eds
2010

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"Community Based Rehabilitation (CBR) is an evolving concept. Its effectiveness depends on continuous reflection, debate and learning. This book aims to facilitate this process through the stories of five CBR programmes in Africa, told by those involved with the programmes and reflected on with honesty...Each of the five programmes has been invited to document their work, describing how its programme started and assessing the effectiveness of the approach it has chosen. They were asked to identify their successes and challenges, and to reflect on how difficulties are being overcome. Life stories illustrate the impact each approach can have on individual lives. The book offers itself as a reflective tool, to be used by practitioners. Each chapter asks specific questions of its readers, inviting them to draw comparisons with their own programme. The concluding section of the book outlines ideas for evaluating and developing their CBR programmes"

Stepping into the unknown

HEARD
2010

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"Stepping into the Unknown tells the stories of four people with disabilities who gather for a life-affirming event at Oribi Gorge in South Africa. The film covers the links between being disabled and HIV positive and participants' experiences in accessing HIV services, rehabilitation and information on HIV. This life-changing event links closely to how these people stepped into the unknown when they faced their fears about their disabilities and being exposed to HIV"

HIV/AIDS and Disability Organizations in South Africa

Poul Rohleder
Leslie Swartz
Arne Henning Eide
Nora Groce
Marguerite Schneider
January 2010

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Despite the seriousness of the HIV epidemic globally, and in South Africa in particular, little is known about how HIV/AIDS affects disabled people. One important and little explored area is the role that organisations that represent disabled people or that work on behalf of disabled people, are playing in addressing the HIV/AIDS epidemic among the disabled people they represent or serve. This paper presents the findings of a nationwide survey of disability organisations in South Africa. The purpose of this study was to explore the role of disability organisations in addressing the HIV epidemic among disabled people in South Africa. The findings suggest that while organisations recognise the importance of providing HIV education, and many have taken steps to do so, disabled people are largely excluded from general HIV prevention messages. Disabled people also have significant difficulties in accessing general health care, relevant for HIV testing and treatment. In a country trying to manage serious social problems with limited resources, this paper highlights the need for increased cooperation and collaboration between relevant parties in order to facilitate the changes necessary for disabled people to access needed health information and care.

Disability in national strategic plans on HIV and AIDS : a review on the national response to the interrelations of disability and HIV in eastern and southern Africa|Final report

GRANT, Kitty
STRODE, Ann
HANNASS-HANCOCK, Jill
December 2009

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This report examines national AIDS and HIV strategic plans (NSPs) in eastern and southern Africa and includes findings, discussions and best practice examples on the integration of disability throughout the countries. "Generally, the findings of the report show that less than 50% of the countries in Eastern and Southern Africa recognise disability as an issue of concern, or specifically recognise the vulnerability of people with disabilities to HIV and AIDS within their NSPs. Furthermore, it found that even where countries have recognised disability as an issue, there is limited specific guidance within the NSP on HIV-related service provision to meet the needs of people with disabilities. Only one country, South Africa, showed extensive integration of disability into the various focus areas of its NSP." The report concludes with recommendations and provides detailed appendices of national reports for each country surveyed

Capacity building in network organisations : experiences from and practical guidelines for HIV and other networks

SLUIJS-DOYLE, José
November 2009

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This report assesses seven capacities of organisations of people living with HIV and other HIV network organisations to see what makes a well-functioning network. These capacities are: involvement and accountability; partnership alliances; leadership; knowledge and skills; internal communication; impact, outputs and external communication; and management and finance. The report looks at four network organisations in Eastern and Southern Africa, with secondary research drawn from networks in Bangladesh, Nepal and India. The findings and recommendations cannot be applied universally to capacity strengthening in all network organisations, but need to be adapted to the context of each particular group

Integrating multiple gender strategies to improve HIV and AIDS interventions : a compendium of programs in Africa

INTERNATIONAL CENTER FOR RESEARCH ON WOMEN
May 2009

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This report looks at how four specific gender strategies are being used in HIV and AIDS intervention programmes, how they are working, and how people are learning from and sharing their experiences toward strengthening programmes and expanding successes. A number of programmes in 11 African countries, as well as multi-country programmes are examined. The four gender strategies are: - Reducing gender-based violence; - Increasing women‘s legal protection; - Addressing male norms and behaviours, and - Strategies to increase women‘s income and productive resources.

Community-based surveillance of antimicrobial use and resistance in resource-constrained settings|Report on five pilot projects

HOLLOWAY, Kathleen A
2009

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This document describes five pilot surveillance projects that were set up in India (three sites) and South Africa (two sites) with the aim of developing a model for undertaking integrated community-based surveillance in resource-constrained settings and generating baseline data. The methodology used in each area aimed to collect antimicrobial resistance (AMR) and use data from the same geographical area over time, but was modified to suit the particular characteristics of each site

The price of exclusion : the economic consequences of excluding people with disabilities from the world of work

BUCKUP, Sebastian
2009

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People with disabilities can work and contribute to the economy, just like people without disabilities. This report highlights the macro-economic cost of excluding people with disabilities from the labour market. The study quantifies the economic losses of ten countries in Asia and Africa and presents the outcomes. It would be useful to people interested economic and employment issues for people with disabilities

A custom distorted : beliefs about sexual abuse involving teenagers with intellectual disability at a rural setting in South Africa

PHASHA, N
MYAKA, Lucy
2009

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This paper is based upon the findings of a study that took place in a rural setting in KwaZulu-Natal, South Africa. It describes the social problem of sexual abuse of teenagers with intellectual disabilities by analyzing the roots of common misconceptions of intellectual disability, which render these teenagers vulnerable to sexual abuse. This paper is useful for anyone interested in learning more about disability and misconceptions of disability in Africa

South African national HIV prevalence, incidence, behavior and communication survey 2008 : turning a tide among teenagers ?

SHISANA, O
et al
2009

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"South Africa has the largest burden of HIV/AIDS and is currently implementing the largest antiretroviral treatment (ART) programme in the world. It is therefore fitting that South Africa is the first in the world to conduct three repeated national HIV population-based surveys to help monitor our response as a nation to the HIV/AIDS epidemic. This report is the third in a time series of population-based HIV seroprevalence surveys which started in 2002 and were repeated in 2005 and again in 2008"

Hearing community voices : grassroots perceptions of an intervention to support health volunteers in South Africa

CAMPBELL, Catherine
et al
December 2008

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"This paper reports on community perceptions of a three-year project which sought to train and support volunteer health workers in a rural community in South Africa. "With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV and AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS - as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement"

Best practices in the socio-economic rehabilitation of persons affected by leprosy and other marginalised people in their communities: findings from nine evaluations in Bangladesh, India and Africa

VELEEMA, Johan P
2008

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This paper presents an overview of findings from the formal evaluation of 9 socio-economic rehabilitation programmes (SER), in 4 countries in Africa, in Bangladesh and in India from 2002-2005. Bringing together the recommendations resulted in a description of best practices in the implementation of socio-economic rehabilitation programmes, derived from actual experiences in different contexts.

All the 9 programmes focused on supporting individual leprosy-affected beneficiaries or their families. Four projects also supported other marginalised clients. The usual interventions were micro-credit, housing and sponsoring of education for the children.

The recommendations touched upon each of the five steps in individual rehabilitation: Selection of clients, needs assessment, choosing an intervention, monitoring / follow--up of clients during rehabilitation, and separation at the end of the rehabilitation process. The evaluators also suggested ways in which participation of the client in their own rehabilitation might be boosted, made recommendations for the organisational structure of programmes, on maximising community involvement and emphasised the importance of information systems and of investing in the programme staff. A number of recommendations were specific to the types of interventions implemented i.e, housing, education or micro-credit.

Evidence of the impact of SER on the quality of life of clients is limited, but suggests increased self-esteem and increased respect/status in the family and community.

 

Asia Pacific Disability Rehabilitation Journal, vol.19, no.1, 2008

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