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How CBM Australia supports engagement with government for disability inclusion and prevention

CBM AUSTRALIA
March 2016

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CBM Australia engages both directly and indirectly with governments. Indirectly, CBM Australia supports other organisations, for instance disabled people’s organisations or civil society organisations to engage with governments. This report looks at the different ways that CBM partners seek influence government and promote sustainability. It considers the different roles and relevance of activism, advocacy, service delivery and advisory approaches.

 

The cases in this report were identified and gathered through semi-structured interviews with CBM’s Program Officers, Technical Advisors, regional/country office and project staff in-country, as well as drawing on reports and evaluations. The report starts with a section explaining the four different approaches to working with government, followed by a brief introduction to each approach, highlighting what CBM are doing and the key lessons learned. Each section is followed by case studies giving more detailed insight into how CBM are engaging, key achievements, challenges and the lessons learned. Fifteen case studies covering key projects from CBM Australia’s International Programs and the Inclusive Development Team are described in this report.

Enabling education review, issue 4

ENABLING EDUCATION NETWORK
December 2015

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This newsletter contains a variety of articles about inclusive education in several countries around the world. The topics focus mostly on funding, managing and sustaining inclusive education; engaging and empowering beneficiaries in finding solutions; facilitating parental and child involvement and early childhood education

Enabling Education Review, issue 4

Is any wheelchair better than no wheelchair? A Zimbabwean perspective

VISAGIE, Surona
MLAMBO, Tecla
VAN DER VEEN, Judith
NHUNZVI, Clement
TIGERE, Deborah
SCHEFFLER, Elsje
2015

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Background: Within a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation.

 

Objectives: This paper aimed to describe a group of Zimbabwean wheelchair users’ satisfaction with wheelchairs, wheelchair services and wheelchair function.

 

Method: A mixed method, descriptive study was done. Quantitative data was collected from 94 consecutively sampled wheelchair users, who accessed wheelchair services at 16 clinics in five Zimbabwean provinces between October 2013 and February 2014, using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase.

 

Results: More than 60% of participants were dissatisfied with the following wheelchair features: durability (78.6%), weight (75.6%), ease of adjustment (69.1%), effectiveness (69.0%), safety (66.7%), reliability (66.7%), and meeting user needs (60.6%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69.0%), follow-up (67.0%), and service delivery (68.3%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53.2%) and outdoor (52.7%) mobility.

 

Conclusion: Findings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that policy and minimum service standards which incorporate evidence and good practice guidelines for wheelchair services and management of wheelchair donations are developed for Zimbabwe.

Caring for a child with Cerebral Palsy: The experience of Zimbabwean mothers

DAMBI, Jermaine M
JELSMA, Jennifer
MLAMBO, Tecla
2015

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Background: The needs of caregivers of children with disability may not be recognized despite evidence to suggest that they experience increased strain because of their care-giving role. This strain may be exacerbated if they live in under-resourced areas.

 

Objectives: We set out to establish the well-being of caregivers of children with Cerebral Palsy (CP) living in high-density areas of Harare, Zimbabwe. In addition, we wished to identify factors that might be predictive of caregivers’ well-being. Finally, we examined the psychometric properties of the Caregiver Strain Index (CSI) within the context of the study.

 

Method: Caregivers of 46 children with CP were assessed twice, at baseline, and after three months, for perceived burden of care and health-related quality of life (HRQoL) using CSI and EQ-5D respectively. The psychometric properties of the CSI were assessed post hoc.

 

Results: The caregivers reported considerable caregiver burden with half of the caregivers reporting CSI scores in the ‘clinical distress’ range. Many of the caregivers experienced some form of pain, depression and expressed that they were overwhelmed by the care-giving role. No variable was found to be associated with clinical distress. The CSI demonstrated good overall internal consistency (Cronbach’s Alpha = 0.8), stability over time (Z = 0.87, p = 0.381) and was significantly and negatively correlated with the EQ-5D VAS (Spearman’s rho = −0.33, p = 0.027), demonstrating concurrent validity.

 

Conclusion: Caregivers must be monitored routinely for their level of distress and there is an urgent need to provide them with support. The CSI is likely to be a valid measure of distress in this population.

Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Equal basis 2014 : access and rights in 33 countries

BURKE, Megan
PERSI VICENTIC, Loren
December 2014

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This report presents research about efforts to meet the needs and uphold the rights of persons with disabilities in four thematic areas: health care, rehabilitation, work and employment, and accessibility and enabling environments. Research findings are drawn from the experiences of landmine and cluster munition survivors and other persons with similar needs in 33 countries experiencing armed conflict or emerging from armed conflict or political or economic transition. Findings are placed within the context of relevant articles of the Convention on the Rights of Persons with Disabilities and the World Report on Disability

Including children with disabilities in primary school : the case of Mashonaland, Zimbabwe

DELUCA, Marcella
TRAMONTANO, Carlo
KETT, Maria
October 2014

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This paper summarises education information disaggregated by age, gender and impairment gathered on children with disabilities in 268 schools in four districts in Mashonaland West Province (MWP), Zimbabwe, and outlines results from a survey given to parents, caregivers and teachers on knowledge, attitudes and practices. Findings highlighted a lack of training in inclusive education and the major barriers identified were a lack of assistive devices; distance to school and lack of transportation; cost; and human resource allocation. This research forms part of a three-year project led by Leonard Cheshire Disability Zimbabwe Trust to promote the provision of inclusive primary education for children with disabilities in that province and these findings provide the programme team with the possibility of adapting interventions and measuring changes over the duration of the project

Working Paper 26

The African report on violence against children

THE AFRICAN CHILD POLICY FORUM (ACPF)
September 2014

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This report reveals that Africa’s children are still subjected to levels of physical and emotional violence despite more than a decade of efforts by governments. The report “constitutes the most comprehensive study to date of the phenomenon in Africa and lays down the priorities for action at various levels that will be required to achieve better protection of children.  The report’s findings are principally informed by large scale surveys undertaken in Ethiopia, Kenya, Malawi, Mali, Morocco, Uganda, Zambia and Zimbabwe, and a review of more than 75 studies and reports. It reveals that a distinctive range of social, cultural and economic factors can combine to increase the risk of African children facing increased levels of physical and emotional violence in domestic settings, at schools, in institutions and in the workplace. These risks may be exacerbated in times of political upheaval and conflict, and girls are particularly vulnerable”

Surviving spinal cord injury in low income countries

ODEROD, Tone
August 2014

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Life expectancy and the situation of persons living with Spinal Cord Injury (SCI) in low income settings was explored. Mortality rates from injuries and challenges in daily lives of people with injuries from poorer economic backgrounds are were investigated and are compared with those with higher incomes. Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals.

There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges.

Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.

Surviving spinal cord injury in low income countries

ØDERUD, Tone
2014

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Background: Mortality rates from injuries are higher for people from poorer economic backgrounds than those with higher incomes (according to the World Health Organization [WHO]), and health care professionals and organisations dealing with people with disabilities experience that individuals with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives.

 

Objectives: The aims of this study were to explore life expectancy (life expectancy is the average remaining years of life of an individual) and the situation of persons living with SCI in low income settings.

 

Method: Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals.

 

Results: There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges.

 

Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.

Increasing access into higher education: Insights from the 2011 African Network on Evidence-to-Action on Disability Symposium – Education Commission

LYNER-CLEOPHAS, Marcia
SWART, Estelle
CHATAIKA, Tsitsi
BELL, Diane
2014

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This article provides some insights into the challenges regarding inclusion in higher education of students with disabilities. It does this by elucidating aspects of the proceedings of the Education Commission at the African Network on Evidence-to-Action on Disability (AfriNEAD) Symposium, which took place in Zimbabwe in November 2011. The presentations specifically focused on the education of people with disabilities from early childhood through to higher education. This article, however, is informed by presentations focusing on increasing access to higher education. The article is focused on the implementation of evidence in practice, research and policies stemming from rigorous debate and scientific foundations, whilst taking into account the dynamic realities of the higher education context. Themes such as the systemic approach needed for inclusion to be successful, increasing access and the dynamic role of students with disabilities are highlighted.

HIV-related disability in HIV hyper-endemic countries : a scoping review

HANASS-HANCOCK, Jill
et al
September 2013

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This article presents the results of the first scoping review to examine the extent, nature and range of disability among people living with HIV in HIV hyper-endemic countries. The studies indicate that people living with HIV experience a variety of disabilities. Impairments in body structure/function comprise the majority of data, with particular focus on mental function. Data on activity limitations and participation restriction were limited, however, they were recorded. They indicate severe impact on people’s life and possible adherence. The review argues that the time has come to elevate the focus holistically on health and life-related consequences of living with HIV and to integrate disability into the discussions and approaches to HIV care

World Journal of Aids, Vol 3, No 3

Zimbabwe sexual and reproductive health sign language dictionary

THE HIV AND AIDS MANAGEMENT AND SUPPORT ORGANIZATION (THAMASO-ZIMBABWE)
DISABILITY AND HIV AND AIDS TRUST(DHAT)
2012

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"The Dictionary includes an illustrated guide to signing and signing for individual letters, along with illustrations and descriptions for common words and for those new HIV/SRHR signs that have been developed, making it an invaluable reference for both those with hearing impairments and those without hearing challenges. The dictionary is suitable for use in educational institutions (schools, colleges and universities) as well as in health institutions such as hospitals, clinics and VCT centres. Counsellors and all staff working directly and indirectly in the HIV and SRHR sectors will find the dictionary most useful"

Disability and poverty in developing countries : a snapshot from the World Health Survey

MITRA, Sophie
POSARAC, Aleksandra
VICK, Brandon
April 2011

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This paper outlines the economic and poverty situation of working-age persons with disabilities and their households in 15 developing countries. Using data from the World Health Survey, the study presents estimates of disability prevalence, individual-level economic well-being, household-level economic well-being, and multidimensional poverty measure. Detailed appendices are provided to support the results of the study. This paper is useful for people interested in the social and economic conditions of people with disabilities in developing countries
Social Protection Discussion Paper No 1109

Strategic funding : strengthening partnernship for real development

HEALTHLINK WORLDWIDE
June 2010

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'This learning paper considers how strategic funding allows community based and non-governmental organisations the flexibility to develop their responses to HIV and AIDS; it creates the space for organisational development to enable those changes and for organisations to learn from, and share with, each other'

HIV decline in Zimbabwe due to reductions in risky sex?|Evidence from a comprehensive epidemiological review

GREGSON, Simon
et al
April 2010

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This article presents research which assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence in Zimbabwe. It comprised of a comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour in the period 1985 - 2007. The findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country, nevertheless, in 2007 one in seven adults in Zimbabwe was still infected by a life-threatening virus and mortality rates remained at crisis point

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

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

The loss of the middle ground : the impact of crises and HIV and AIDS on ‘skipped-generation’ households

SAMUELS, Fiona
WELLS, Jo
November 2009

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This project briefing presents key findings and policy recommendations from a study conducted in the East and Southern African region that aimed to improve understanding on how these households cope during emergencies. A literature review was followed by country case studies in Northern Uganda and Zimbabwe in which members of self-help group households, both older people and children, and organisations involved in the emergency response were interviewed. Recommendations are provided on how emergency preparedness and response can better meet the needs of such households in the region
Project briefing, No 33

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