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How do we support women and girls with disabilities to overcome stigma against them? - Evidence brief

MACTAGGART, Islay
FELIX, Lambert
May 2021

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Stigma refers to the labelling of an individual or group of people in a way that ultimately denies them full social acceptance and equality of opportunity, and is often the root cause of discrimination and exclusion experienced by people with disabilities. The negative implications of stigma are far-reaching and profound, including limiting opportunities for accessing health care, education or livelihoods; affecting quality of life  and wellbeing, and increasing the risk of violence and abuse. Stigma is intersectional, meaning that women and girls with disabilities often experience several layers of discrimination, on account of both their disability and their gender. Reducing stigma experienced by women and girls with disabilities is therefore critical to supporting their full inclusion in society on an equal basis as others.

 

Evidence was reviewed and recomendations are provided.

How can we overcome barriers to accessing rehabilitation for persons with disabilities in LMIC? - Evidence brief

MACTAGGART, Islay
April 2021

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Rehabilitation is described as a set of measures to optimise the functioning of individuals, and is important for wellbeing, participation and quality of life. Rehabilitation includes diagnosis, treatments, surgeries, assistive devices and therapies. Not all people who need rehabilitation are people with disabilities, and not all people with disabilities need rehabilitation. The World Health Organisation (WHO) recently estimated that 1 in 3 people globally (2.41 billion people) would benefit from rehabilitation: this number has increased nearly two thirds since 1990, due to population growth and increase in Non-Communicable Diseases (NCDs). In contrast, there are estimated to be less than 10 skilled rehabilitation practitioners per million population in Low and Middle Income Countries (LMICs), and only 5 – 15% of people in need of assistive devices are thought to have received them.

 

Evidence is reviewed and recommendations provided

What evidence is there for the benefits of inclusive education for children without disabilities? - Evidence brief

STEFFEN, Liändrie
March 2021

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Inclusive education offers a variety of potential academic and social benefits for all students; with as well as without disabilities. However, a common concern among the non-disabled population is the potential negative impacts the inclusion of students with disabilities might have on their non-disabled classmates.  These negative beliefs and attitudes by parents and teachers can translate into a lack of implementation of inclusive education. There is substantial evidence for the benefits of inclusion for students with disabilities, however, there is very little evidence on the impact it has on non-disabled students, particularly in LMICs compared to HICs. This evidence brief explores evidence-based recommendations on the benefits of inclusive education for children without disabilities and how this issue shapes inclusive education implementation in LMICs.

What are the most effective strategies for strengthening health systems for disability inclusive development? - Evidence brief

MACTAGGART, Islay
February 2021

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Health system strengthening refers to initiatives that improve one or more functions of health systems, leading to better health. There is a large body of evidence on what works to strengthen health systems in low- and middle-income countries (LMICs), much of which is aligned to the World Health Organization (WHO) health system building blocks (service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership/governance). Despite the fact that some people with disabilities have additional health needs, and many face additional barriers to accessing healthcare, inclusion of people with disabilities is largely missing from this evidence base. Separately, a smaller evidence base exists on increasing the effectiveness of specific health-related services targeting people with disabilities, such as health-related Community Based Rehabilitation (CBR), rehabilitation services more broadly, and mental health services. This second evidence base is less closely aligned to the building blocks. Reviewing these outputs in parallel goes some way towards identifying effective strategies for strengthening health systems for disability inclusive development.

How can we ensure the safety and wellbeing of children with disabilities during humanitarian crises? - Evidence brief

QURESHI, Onaiza
September 2020

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This brief reviewed evidence-based recommendations on how to ensure the safety and wellbeing of children with disabilities in humanitarian settings. The right to safety for all is enshrined in Article 11 of the CRPD, yet this population has been consistently neglected in the global literature around children affected by disaster and crises, and as such the recommendations made are limited to specific humanitarian settings (e.g., natural disasters, war and conflict) and towards children with physical and mobility challenges. There is a need to further explore their diverse needs and experiences by recognising them as independent actors who can meaningfully participate in and contribute to the development of services and policies targeted towards them

How can we measure disability in research related to the COVID-19 response?

MACTAGGART, Islay
KUPER, Hannah
August 2020

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There is growing evidence that COVID-19 is disproportionally impacting the lives of people with disabilities. This includes evidence of the increased risk of severe outcomes of contracting COVID-19 amongst people with existing health conditions, including many people with disabilities. It also includes a wide range of other potential impacts such as: reductions or disruptions in non-COVID-19 health or rehabilitation services, the effects of shielding on isolation and mental health, the implications of social distancing on people who require carer support, and the impact on poverty, participation and wellbeing due to disrupted disability-inclusive development programmes.

 

Measurement of disability in research has historically been contested and a number of different tools exist. Clear guidance is needed on how to determine which tool to use to understand the situation of people with disabilities in different settings, and plan responsive and inclusive COVID-19 programmes and policies to support their needs. Good quality, comparable data on disability is essential for tracking the impact of the COVID-19 pandemic, as well as prevention and mitigation interventions, amongst people with disabilities. Such evidence is also imperative for tracking progress towards the Sustainable Development Goals, and UNCRPD compliance.

 

This evidence brief synthesises findings from a scoping review of ICF-compatible tools to measure disability in population-based surveys with a focus on LMICs (2018), protocols and research outputs from seven population-based surveys of disability across Asia, Africa and the Pacific, secondary analyses of the South African Census, US National Health Interview Survey and three Demographic and Health Surveys, reflections from global stakeholders in disability measurement (including the UN Flagship Report on Disability), and evidence compiled for the upcoming Global Disability Research Massive Open Online Course at the London School of Hygiene & Tropical Medicine

What do we know about how to support mental health and wellbeing during the COVID-19 pandemic from past infectious disease epidemics?

QURESH, Onaiza
SCHERER, Nathaniel
July 2020

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The question and the problem:

Symptoms of mental ill-health are common during widespread outbreak of an infectious disease, with high rates of depression, anxiety and post-traumatic stress disorder (PTSD) reported during recent epidemics, such as the recent Ebola crises and SARS-CoV-1. Elevated symptoms of mental ill-health are not limited to patients only, and are seen in healthcare workers, family members and indeed more widely across the general population. Early evidence coming from the COVID-19 pandemic demonstrates high rates of mental ill-health and mental health service provision is needed. This evidence brief summarises evidence on mental health support during COVID-19 and other recent pandemics, informing policy and practice during this crisis.

How can social protection responses to COVID-19 be made disability inclusive?

BANKS, Lena Morgon
HUNT, Xanthe
June 2020

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Question & problem

The COVID-19 pandemic and strategies essential for its containment are resulting in severe strains on economies, particularly in low- and middle-income countries (LMICs). These impacts will be felt most by groups already in or at risk of poverty, including the estimated 1 billion people with disabilities globally. Interventions to address the short- and long-term economic effects of the pandemic are urgently needed. Some countries have begun implementing or announced plans for interventions addressing the economic impacts of COVID-19, such as food assistance, emergency cash transfers, unemployment assistance or expansions to existing social protection programmes. As these programmes are developed, it is important to consider the extent to which their design and delivery is inclusive of people with disabilities. Failure to adequately include people with disabilities in this process will lead to widening inequalities.

How can the health of people with disabilities in humanitarian camps be supported during the COVID-19 pandemic? - Evidence brief

HUNT, Xanthe
2020

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More than 10% of the world’s 35 million displaced people are people with disabilities. People with disabilities and their families are at significant risk of discrimination, stigma, violence, and marginalisation, and get little access to adequate services in humanitarian camps. Disabled people are frequently sidelined during health sector planning in humanitarian camps, and healthcare access is a particular challenge. The COVID-19 pandemic, and measures necessary for its containment, pose a particular threat and challenge in humanitarian settings. Containment measures such as mass ‘stay-at-home' orders, social distancing, self-isolation and quarantine are often unsuitable for, or difficult to implement in, camp settings. People in humanitarian camps, then, need special consideration within the COVID-19 response. However, among people in humanitarian camps, people with disabilities are particularly vulnerable to being left behind or overlooked in COVID-19 planning and programming. Their double vulnerability as refugees and disabled people warrants special consideration.

 

Evidence in considered and recommendations provided.

How can we promote the inclusion of people with disabilities in programme design? - Evidence brief

QURESHI, Onaiza
2020

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In order to fully encapsulate the principles of ‘Nothing About Us without Us’ within development efforts, a strong knowledge base from programmes worldwide is needed to identify effective ways to promote the meaningful inclusion of people with disabilities in the design and delivery of programmes.

Development programmes need to move beyond passive consultations and seek meaningful engagement from people with disabilities from the early stages of programming right till the end so that the solutions and lessons learned are inclusive and representative for people with disabilities worldwide.

How do we improve access to healthcare for people with disabilities?

HUNT, Xanthe
August 2019

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Gaining access to healthcare is often a challenge for people with disabilities in low- and middle-income countries. Part of this has to do with a general dearth of healthcare services in low-resource settings. But part of this difficulty has to do with structural, attitudinal, economic and social barriers to participation and healthcare which affect people with disabilities more than people without disabilities. This lack of access to healthcare is a problem because, in general, people with disabilities may need to access healthcare more frequently than people without disabilities. Full and equitable access to quality healthcare is a human right, and an important imperative of the global agenda. This evidence brief summarises what we know about how to improve access to healthcare for people with disabilities in low-resource settings.

What interventions are effective to support home-based carers?

HUNT, Xanthe
August 2019

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Question & problem

Many people with disabilities require the assistance of other people in order to go about their daily lives. In high-income countries, home-based carers are professional or para-professional workers who provide assistance to people with disabilities, in their homes. They are often well-trained, and remunerated for their services. However, individuals with disabilities in many low- and middle-income countries (LMIC) predominantly live with their family, and receive home-based care from family members. There are some stresses associated with giving care to others, and these include burnout, compassion fatigue, and an array of emotional and social consequences related to the caring role. The carers, too, need care. This evidence brief summarises what we know about how to support home-based carers, taking into consideration that these people, in LMIC, are often untrained, unpaid family members of the person for whom they are caring.

How do we ensure that children with disabilities are not bullied in school?

HUNT, Xanthe
August 2019

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Question & problem

Students with disabilities are bullied more often than their typically developing peers. Students in schools for children with disabilities may be victimized more often than students with disabilities in inclusive settings. Being bullied, which can take forms which are physical, verbal, indirect (relational, emotional, or social), and/or sexual, is associated with negative academic, social, and psychological outcomes for the victim. This evidence brief summarises what we know about how to prevent bullying of children with disabilities.

What works to improve educational outcomes of children with disabilities in school?

HUNT, Xanthe
August 2019

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Question & problem

For people with disabilities, a major determinant of social and economic outcomes in adulthood, is access to, and the adequacy of, education in childhood and adolescence. Yet, children with disabilities are less likely to be enrolled in, or complete, school. Further, there are substantial gaps in the evidence regarding what works to improve educational outcomes of children with disabilities in school. Educational outcomes, here include academic achievement, pass rates, and grade completion. Many studies measure child behaviour and proxy or distal outcomes in response to various interventions, but not actually how children with disabilities do in these domains. This is particularly the case in LMIC, where there is a dearth data about the effects of educational policies and practices on child educational outcomes.

How do we ensure that social protection assistance initiatives work for people with disabilities?

HUNT, Xanthe
August 2019

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Question & problem

Social protection systems and other financial assistance, including cash transfers and integrated benefits packages, may be important ways to facilitate the inclusion of people with disabilities in services and society. There is limited information, however, with regards to their impact in low- and middle-income settings. To understand how these programs work, it is important to recognise that there are disability-targeted entitlements, but people with disabilities may also be eligible for mainstream programmes aimed at other targeted groups, such as people of a certain socio-economic status. This evidence note summarises what is known about challenges faced by both of these types of initiatives, as well as evidence-based recommendations to strengthen them.

How do we provide mental health support to children with psychosocial disabilities in school?

QURESH, Onaiza
August 2019

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Question & problem

It is estimated that approximately 10-20% of children, adolescents and young people (under the age of 18) worldwide have a disabling mental health condition. Approximately two-thirds of the global youth population goes to school for a significant proportion of the day. The idea of delivering mental health support in the setting has gained prominence as a way to increase the coverage and accessibility of mental health support for children. While there is a wealth of evidence around school mental health approaches in HIC, there is limited information with regards to their impact in low- and middle-income settings. This evidence brief explores what has worked for the delivery of school mental health initiatives in diverse settings, as well as evidence-based recommendations to strengthen them.

What are the key considerations for including people with disabilities in COVID-19 hygiene promotion programmes?

WILBUR, Jane
HUNT, Xanthe
August 2019

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Question & problem

People with disabilities may be more likely to acquire COVID-19, and if infected may be more likely to experience serious symptoms, or die. Aside from those consequences of the pandemic related to morbidity and mortality, people with disabilities are often reliant on carers to aid with common daily tasks, and so social distancing measures may be unfeasible. Furthermore, safe water, sanitation and hygiene (WASH) services and facilities may be inaccessible to people with disabilities, and, in many settings, efforts to deliver services in a socially-distanced world have resulted in the roll out of digital or remote healthcare approaches which are sometimes not accessible or inclusive. One of the key interventions in response to the COVID-19 pandemic has been international attention, and improved funding, programming and media messaging in support of WASH. People with disabilities – who are most at risk of negative consequences of COVID-19 – most need access to such interventions. Yet, WASH access is considered to be one of the biggest challenges of daily life for many people with disabilities.

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