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CRPD jurisprudence on Assistive Technologies through Concluding Observations: An analysis from Global South perspectives

INTERNATIONAL DISABILITY ALLIANCE (IDA)
GLOBAL DISABILITY INNOVATION HUB (GDI)
October 2023

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States parties have several obligations with regard to assistive technologies under the CRPD under Article 4, including undertaking and promotion of research and development of or new technologies, incorporating information and communications technologies, mobility aids, devices and assistive technologies that are suitable for persons with disabilities. It also prioritizes technologies at an affordable cost. States are also to provide accessible information to persons with disabilities about mobility aids, devices, and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities. This obligation is further elaborated in other Articles of the Convention, which may explain why the CRPD Committee has not focused observations around assistive technology related to this Article

Strengthening rehabilitation in health emergency preparedness, readiness, response and resilience: policy brief

Pete Skelton
et al
July 2023

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Strengthening rehabilitation in health emergency preparedness, response, and resilience: policy brief outlines the evidence for rehabilitation in emergencies and the need for greater preparedness of rehabilitation services. It shows how existing guidelines support the integration of rehabilitation in emergencies and sets out the steps that decision-makers can take to better integrate rehabilitation into health emergency preparedness and response.

Case studies are provided from Japan, Nepal, Phillipines, Australian and Sweden

Repair strategies for assistive technology in low resource settings

OLDFREY, Ben
HOLLOWAY, Cathy
WALKER, Julian
McCORMACK, STEVEN
DEERE, Bernadette
KENNEY, Laurence
SSEKITOLEKO, Robert
ACKERS, Helen
MIODOWNIK, Mark
July 2023

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Purpose: To  investigate the  practices of  repair that  exist for  users of  mobility assistive products in  low resource settings, as  well  as  the  psychosocial impact that  the  repair, or  non-repair, of  these devices has on users’ lives.

Materials and Methods: This article collates data on repair practices and the responses from participants on  the  topic of  repair from studies conducted by  the  authors across four  different low  resource settings in  Kenya, Uganda, Sierra Leone, and  Indonesia. This  data was  then analyzed to  identify the  common themes found across geographies

 

DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY

https://doi.org/10.1080/17483107.2023.2236142 

Cost analysis of 3D printing services implementation into public services to produce orthoses: An Ugandan case-study

NIZET, Alicia
BRUS, Aude
December 2022

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3D printing is a new technology and there is a need for producing evidence to justify and demonstrate its associated costs and benefits. Humanity and Inclusion has been implementing an innovative 3D printing project in Uganda, in the Omugo Refugee Settlement, to address the unmet rehabilitation needs of people with disabilities (PETRA Project) since November 2018. This project is implemented in collaboration with the public hospital of the Arua District (Arua Regional Referral Hospital). 

 

This study aims to calculate implementation and running costs of 3D printing services to produce orthoses in a public service (here ARRH), in addition to traditional services, in a developing context.

Specific objectives:

To define and detail all phases of the patient pathway for the 3D printed orthosis provision(from patients’ identification to orthoses delivery);

To evaluate costs of the 3D printed orthosis procurement (from patients’ identification to orthoses delivery) based on lifetime of digital material;

To give a better understanding on how to implement such a digital service in a public health structure.

 

The results of this study will allow HI, other organisations, States or potential donor to enrich their decisions on the implementation of 3D-printed orthoses production in their context of intervention - embedded in addition to traditional services or in remote areas where there is no traditional services.

 

Hypotheses, choices and data are based on the information collected through multiple sources and methodologies (desk review, semi-structured interviews, surveys, workshop, and literature review) and are specific to the context of Arua, Uganda. To calculate all the costs related to the service that produces and delivers 3D-printed orthoses, a matrix has been created.

SDG-CRPD Resource Package

OFFICE OF THE HIGH COMMISSIONER FOR REFUGEES (OHCHR)
December 2020

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OHCHR developed a package of resources to support realizing the Sustainable Development Goals for persons with disabilities. These include resources on policymaking (Policy Guidelines for Inclusive SDGs; Training Materials and Videos) and resources on monitoring (Human Rights Indicators on the Convention on the Rights of Persons with Disabilities and a Data Sources Guidance).

 

SDGs:

The Policy Guidelines on inclusive Sustainable Development Goals set out the main actions that should be used to develop policies to achieve the goals for persons with disabilities. Training Materials complementing the guidelines include tools to develop in-person and online trainings. The videos mirror the guidelines and can be used for training and awareness-raising activities.

 

There are Policy Guidelines, Training Materials and Videos for SDG goals 10, 16, 17, 1, 3, 4, 5, 8 and 11. There are thematic briefs for SDG goals 2, 6, 13, 8, 11, 9 and 17.

 

CRPD:

Presented article by article, the indicators are key to facilitating understanding and implementation of the Convention’s provisions. They provide guidance on actions to measure implementation of the CRPD and to track progress over time. Data sources guidance mirrors the human rights indicators and provides examples of different sources of data to inform the outcome indicators.

 

There are indicators and data sources guidance for articles: 1-4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 17, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33.

Pre-Primary and Primary Inclusive Education for Tanzania (PPPIET) – Foundation phase : Desk Review presented by the Task Team February 2020

JUDGE, Emma
August 2020

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The Disability Inclusive Development (DID) consortium is working together on the Pre-Primary and Primary Inclusive Education in Tanzania (PPPIET) programme whose ultimate goal is to foster quality sustainable inclusive education for all children with disabilities (CWD) at scale across Tanzania in mainstream pre-primary and primary government schools.  To achieve this, it aims to support collective, coordinated systems change by establishing an agreed common model of basic inclusive pre-primary and primary education in mainstream government schools, and galvanising significant progress in spreading its systematic implementation for all CWD across Tanzania over six years.

 

This task requires the cooperation of government, civil society and DPOs to achieve real change.  No single organisation or government department can achieve inclusive education on its own.  Cooperation between all government ministries, including education, health, finance and social welfare are key to providing individual support to learners with disabilities.  Pooling the skills and resources, and exchanging learnings to achieve quality inclusive education of children can help all involved.  Working together will build collective commitment and action, not just amongst DID consortium members but also across government, donors, education actors and the private sector. 

 

The first part in this process was for the Task Team to conduct a desk review to establish an overview of the current educational context with regards to children with disabilities, including legislative, policies and practice, inclusive education strategies, disability contexts, cultural perspective, interventions, existing assessment and quality assurance processes, and opportunities and challenges. 

Practicing in a person-centred environment – self-help groups in psycho-social rehabilitation

LANDSTAND, Bodil J
HEDLUNDl, Marianne
KENDALL, Elizabeth
2020

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Aim: The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabil- ities. In this study, we explore person-centred support in which participants in self-help groups are under- going rehabilitation to develop their knowledge, skills and confidence necessary to handle life’s challenges.

 

Method: The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilita- tion clients aged between 20 and 60 years; eight were men and twenty-six were women.

 

Results: Three main categories emerged as being important self-help processes that were likely to pro- mote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives.

 

Conclusion: Peer support delivered through the structured self-help environment can facilitate the devel- opment of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.

Access to basic needs and health care for Malawian prosthetic and orthotic users with lower limb physical disabilities: a cross-sectional study

MAGNUSSON, Lina
FINYE, Clifford
ENSTEDT, Catrin
May 2020

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Purpose: To investigate access to basic human rights such as health, a standard of living adequate for health, education, work, marrying and establishing a family, and voting for prosthetic and orthotic users with lower limb disabilities in Malawi.

 

Materials and methods: A cross-sectional design and a questionnaire were used to collect data from 83 participants.

 

Results: Most participants reported their overall physical and mental health as good (60 [72%] and 50 [60%], respectively) and said they could access medical care (69 [83%]). Fifty (60%) participants had access to food, 72 (87%) had access to basic water, and 55 (66%) lived in housing adequate for their health. Most participants had studied in school (74 [89%]) but only 27 (33%) of the participants were working. Forty-three (52%) were married and 53 (64%) had children. Seventy-six (92%) participants could vote if they wished.

 

Conclusions: Rurality and high costs of transport and medication increase the barriers to accessing several basic human rights for people with lower limb physical disabilities. Interventions to target these barriers and increase access to secondary school, employment, and income could improve health equity for people with physical disabilities in Malawi and similar contexts.

Experiences accessing and using rehabilitation services for people with physical disabilities in Sierra Leone

AENISHANSLIN, Justine
AMARA, Abu
MAGNUSSON, Lina
April 2020

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In order to explore the experiences of persons with physical disabilities accessing and using rehabilitation services in Sierra Leone, interviews with 38 individuals with differing physical disabilities were carried out in three locations across Sierra Leone (Freetown, Bo and Makeni).

The analysis resulted in six themes:  The initial and ongoing need for rehabilitation throughout life; Challenges with the cost of rehabilitation and transportation to reach rehabilitation services; Varied experiences with rehabilitation staff; Coming to terms with disability and facing stigma; The struggles without and opportunities with rehabilitation services; Limited knowledge and availability of rehabilitation services.

Addressing barriers to affordability, access, and availability of rehabilitation and addressing knowledge gaps, attitudinal barriers and stigma towards rehabilitation and persons with disability are discussed.

 

Disability and Rehabilitation, April 2020

DOI: 10.1080/09638288.2020.1755375

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

SKEMPES, Dimitrios
et al
October 2018

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The process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities is described.  A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants.

 

Globalization and Health (2018) 14:96
https://doi.org/10.1186/s12992-018-0410-5

Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape

MLENZANA, Nondwe B.
EIDE, Arne H.
FRANTZ, Jose M.
2018

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Background: Understanding caregivers’ views on rehabilitation services is important as it may assist in informing healthcare services and patient management.

 

Objectives: The aim of this study was to explore caregivers’ perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field.

 

Method: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts.

 

Results: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery.

 

Conclusion: Based on the participants’ feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.

Assistive technology policy: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit

MACLACHLAN, Malcolm
BANES, David
BELL, Diane
BORG, Johan
DONNELLY, Brian
FEMBEK, Michael
GHOSH, Ritu
GOWRAN, Rosemary Joan
HANNAY, Emma
HISCOCK, Diana
HOOGERWERF, Evert-Jan
HOWE, Tracey
KOHLER, Friedbert
LAYTON, Natasha
LONG, Siobhán
MANNAN, Hasheem
MJI, Gubela
ONGOLO, Thomas Odera
PERRY, Katherine
PETTERSSON, Cecilia
POWER, Jessica
RAMOS, Vinicius Delgado
SLEPIČKOVÁ, Lenka
SMITH, Emma M
TAY-TEO, Kiu
GEISER, Priscille
HOOKS, Hilary
2018

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Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization’s Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable.

The impact of physical rehabilitation on the lives of persons with physical impairments in Myanmar: Research Report

LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE
August 2017

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The aim of this study was to assess the impact of physical rehabilitation on the physical functioning, economic status and quality of life of people with physical impairments in Myanmar. This project took place between January 2015 – December 2016 and investigated the impact of physical rehabilitation (specifically with prosthesis or orthosis) on the lives of about 100 persons with physical impairments attending 2 rehabilitation centres in Myanmar. Assessment was made of physical functioning, socio-economic status and quality of life before and after receipt of physical rehabilitation services. Quantitative and qualitative data were collected, and a review of Quality of Life tools was undertaken as part of this research, which is reported separately

SDGs, Inclusive Health and the path to Universal Health Coverage

HASHEMI, Goli
KUPER, Hannah
WICKENDEN, Mary
2017

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The Sustainable Development Goals (SDGs) are a set of goals designed to improve the social, economic and well-being of all, while maintaining global and environmental sustainability. Health is one of the 17 goals, and focuses not only on addressing morbidity and mortality, but also on improving access to healthcare services for all through Universal Health Coverage (UHC). While disability is not specifically mentioned in this goal, a focus on people with disabilities is important given the inclusive nature of the SDGs and the fact that people with disabilities make up the largest minority group in the world. This paper aims to critically consider what the health goal could mean for people with disabilities and advocates for inclusive health. It discusses the complex relationship between disability and health, and why people with disabilities are more vulnerable to poor health are discussed, and then considers factors that impact access to quality healthcare for people with disabilities and how these impact on the achievement of the targets in SDG Health Goal and the main principles of UHC. The paper argues that developing an inclusive approach to healthcare will not only improve achieving good health for all, but is also important since experiencing poor health may reduce quality of life and participation (e.g. in education, employment or community activities). Poor quality of life and participation can exacerbate disability, poverty and exclusion in addition to increasing suffering, morbidity and early mortality. The paper concludes that an inclusive UHC will not only fulfil the fundamental rights of people with disabilities to health and rehabilitation, as emphasized within the UN Convention on the Rights of Persons with Disabilities, but also contribute to the achievement of the SDGs.

 

Disability & the Global South (DGS), 2017, Vol. 4 No. 1

Users’ satisfaction with prosthetic and orthotic assistive devices in the Lao People’s Democratic Republic: A cross-sectional study

DURHAM, Jo
SYCHAREUN, Vanphanom
SANTISOUK, Phonevilay
CHALEUNVONG, Kongmany
2016

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Purpose: User satisfaction with assistive devices is a predictor of use and an important outcome measure. This study evaluated client satisfaction with prosthetic and orthotic assistive devices and services in three provinces in the Lao People’s Democratic Republic.

 

Method: A cross-sectional study was done, using the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The sample was drawn from the client register of three of the five Rehabilitation Centres in the country which are under the Ministry of Health’s Centre for Medical Rehabilitation. Clients were eligible if they had received their device in the 12 months prior to the study. Based on the number of registered clients, the sample size was calculated as 274 with a 95% confidence interval, with the final sample N = 266. Qualitative semi-structured interviews were also conducted (N = 34).

 

Results: Most of the assistive devices were in use at the time of the survey and were reported to be in good condition (n = 177, 66.5%). The total mean score for satisfaction (services and device combined) was 3.80 (SD 0.55). Statistically significant differences were observed in satisfaction between gender and location of residence. Effectiveness and comfort were rated as the two most important factors when using a device; at the same time, these were the most common reasons for dissatisfaction and sub-optimal use.

 

Conclusion and Implications: Clients were quite satisfied with the assistive device and services provided, yet many reported barriers to optimal device use and difficulties in accessing follow-up services. There is a need to examine how prosthetic and orthotic devices can be improved further for better comfort and ambulation on uneven ground in low-resource contexts and to address access barriers.

Identifying Rehabilitation Workforce Strengths, Concerns and Needs: A Case Study from the Pacific Islands

GARGETT, Alexandra Lewis
LLEWELLYN, Gwynnyth
SHORT, Stephanie
KLEINITZ, Pauline
2016

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Purpose: This exploratory case study was undertaken to inform capacity development of the rehabilitation workforce in member nations of the Pacific Islands Forum (PIF).

 

Method: Participants at the 1st Pacific CBR Forum in June 2012 were key informants for this study. They comprised the disability focal points from government departments in each of the 14 countries, representatives of DPOs and disability service providers. The study was conducted in 3 phases:  a template to gather data on rehabilitation workers; key informant interviews; and, stakeholder workshops to identify strengths and needs of the rehabilitation workforce in the Pacific.

 

Results: The detailed case study findings suggest two critical drivers for rehabilitation health workforce development in the Pacific context. The first is leadership and commitment from government to serve rehabilitation needs in the community. The second is the urgent need to find alternative ways to service the demand for rehabilitation services as it is highly unlikely that the supply of specialist personnel will be adequate.

 

Conclusions: A multi-sectoral view of health and social service systems is a key element for the development of a rehabilitation health workforce. The endorsement of the WHO Global Disability Action Plan by the World Health Assembly in 2014 further enhances the opportunity to work collaboratively across sectors in Pacific countries. Specialist personnel are and will remain in short supply. There is opportunity for the region to lead the development of alternate workforce mechanisms through the training and supply of skilled community-based rehabilitation personnel.

Graduates’ perceptions of prosthetic and orthotic education and clinical practice in Tanzania and Malawi

MAGNUSSON, Lina
SHANGALI, Harold G
AHLSTRÖM, Gerd
2016

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Background: Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries.

 

Objectives: To describe how Tanzanian and Malawian graduates’ of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates.

 

Methods: Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data.

 

Results: Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment.

 

Conclusions: Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.

Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries

O’Dowd, Jessica
MacLachlan, Malcolm
Khasnabis, Chapal
Geiser, Priscille
2015

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Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers.

 

Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting.

 

Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families.

 

Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms.

Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.

Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities : a study protocol

SKEMPES, Dimitrios
BICKENBACH, Jerome
September 2015

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This paper seeks to develop a study protocol that can assess and improve the provision of rehabilitation services for people with disabilities across the world. The research targets a knowledge gap that exists whereby there are no indicators to reliable identify the performance of rehabilitation systems and monitoring technologies. The paper provides a detailed analysis of the issue before outlining and justifying a choice of methods for data collection and analysis, and the likely impact and use of the study results

BMC International Health and Human Rights, 15:25

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

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