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

KUPER, Hannah
POLAK, Sarah
Eds
2019

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Papers included in this special issue are:

 

Unmet needs and use of assistive products in two districts of Bangladesh: Findings from a household survey

PRYOR, Wesley
NGUYEN, Liem
ISLAM, Qumrun Naher
JALAL, Faruk, Ahmed
MANJULA, Marella
December 2018

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Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice.

Int. J. Environ. Res. Public Health 2018, 15(12), 2901;
doi:10.3390/ijerph15122901

DFID’s strategy for disability inclusive development 2018-23

December 2018

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The UK Department for International Development (DFID)'s vision is a world where all people with disabilities, women, men, girls and boys, in all stages of their lives, are engaged, empowered and able to exercise and enjoy their rights on an equal basis with others, contributing to poverty reduction, peace and stability. A world where no-one is left behind.

Over the next five years DFID will prioritise four strategic pillars for action: (i) inclusive education, (ii) social protection, (iii) economic empowerment, and (iv) humanitarian action. To complement this focus DFID are adopting three cross-cutting areas, vital to disability inclusion, which will be consistently and systematically addressed in all of their work: (v) tackling stigma and discrimination; (vi) empowering girls and women with disabilities; and (vii) access to appropriate assistive technology.

DFID have introduced a new set of standards for all DFID business units to meet. The standards require all country offices and departments to; review their leadership and culture, engage with people with disabilities, influence others, adapt programming and improve data and evidence.

Access to assistive products in Kurigram and Narsingdi, Bangladesh. Policy brief 2.

HUMANITY & INCLUSION BANGLADESH
et al
August 2018

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This ‘policy brief’ outlines findings on Assistive technology and Products (AP) needs, unmet needs and access patterns arising the Rapid Assessment of Disability (RAD) study conducted in 2016 and 2017, in partnership between the Bangladesh Bureau of Statistics (BBS) and Humanity & Inclusion (HI) Bangladesh, with technical oversight from the Nossal Institute for Global Health, University of Melbourne, Australia. The study was part of the HI project: Towards Global Health: Strengthening the Rehabilitation Sector through Civil Society funded by the European Union. Findings from the 4254 adults surveyed in the two districts are reported here.

 

The purpose of this component of the RAD study was to learn about the usage of AP, characteristics of AP users, barriers to use of AP, unmet and met needs of AP, and to highlight major policy implications for AP service provision, in two target areas of Kurigram and Narsingdi. The survey includes an adapted version of Washington Group (WG) ‘short set’ of Disability Questions. A modified version of the WHO’s draft Assistive Technology Assessment Tool (needs module) – or the ‘ATA-needs’, was also implemented. Findings from this study also helped modify and improve the draft ATA-needs tool

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

DESMOND, Deirdre
et al
May 2018

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"Assistive technology (AT) is a powerful enabler of participation. The World Health Organization’s Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a “state of the science” view of AT users, conceptualized as “People” within the set of GATE strategic “P”s. 

Disability and Rehabilitation: Assistive Technology 
Volume 13, 2018 - Issue 5: Position Papers from the First Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit

This issue has 7 papers from the GREAT summit

https://doi.org/10.1080/17483107.2018.1471169

Assistive technology

WORLD HEALTH ORGANISATION (WHO)
May 2018

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A brief introduction to facts behind the global unmet need for assistive technology and the WHO response in coordination the Global Cooperation on Assistive Technology (GATE).

Assistive technologies in developing countries

ROHWERDER, Brigitte
March 2018

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This rapid review looks at examples of existing literature on the availability of assistive technologies and efforts to make these technologies more affordable and accessible in developing countries. Needs and access to assistive technologies are overviewed. The discussion of market characteristics of assistive technologies covers availability, affordability, quality, appropriate design, and awareness and demand.  Efforts to increase the affordability and accessibility of assistive technology are discussed covering: The Global Cooperation on Assistive Technology (GATE); the WHO Priority Assistive Products List; and EYElliance and eye health initiatives. Market shaping and community based approaches are discussed in this context.

 

This is a K4D helpdesk report. This report was commissioned by the UK Department for International Development (DFID)

Assistive products for children with disabilities guide

UNICEF
March 2018

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UNICEF has issued an Assistive Products guide which addresses needs in four impairment groups: mobility, vision, hearing, and communication.  It provides details of some assistive products currently available on the market and information on when and how they are to be used. It covers a range of devices, from low-tech (e.g., walking sticks, pencil grips) to more complex (e.g., specialized computer software/hardware or motorised wheelchairs). This publication provides practical information to guide UNICEF, partner agencies and Governments in procurement planning and provisioning of assistive products. The information is designed to help with decision-making on the most appropriate assistive products to meet programme objectives and realise the rights of children with disabilities. The selection of assistive products in this overview is based on the World Health Organization’s (WHO’s) 2016 Assistive Products Priority List (APL). References to particular brands and models are only illustrative examples available at the time of publication and do not constitute an endorsement of the manufacturer by UNICEF. Indicative prices listed are in US dollars.

Addressing the rising prevalence of hearing loss

WORLD HEALTH ORGANISATION (WHO)
February 2018

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Hearing loss is the fourth highest cause of disability globally, with an estimated annual cost of over 750 billion dollars. These facts are well known and have contributed to growing global consciousness on the need for accessible hearing care in all regions of the world. Looking forward however, the demand for hearing care is likely to grow significantly in coming decades. This report highlights the potential escalation of hearing loss to the middle of the century, and focusses on the factors responsible for hearing loss and the means to address them. 

WHO estimates in 2008 found that 360 million people worldwide live with disabling hearing loss, including 32 million children and 180 million older adults. The most recent estimations place this figure at over 466 million people with disabling hearing loss in 2018. The main areas of the world affected by disabling hearing loss are the South Asian, Asia Pacific and Sub-Saharan African regions, with a prevalence rate almost four times that of the high income regions.

 

Measures to address these concerns deal with: prevention of infections in mothers and babies; chronic ear infections; noise exposure; and ototoxic hearing loss.

 

Public health aspects are highlighted. 

African Journal of Disability Vol 7 (2018) - Special collection: Disability and inclusion in Africa - The role of assistive technology

2018

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This journal provides

  • Nine original research articles on a variety of topics including the cost of raising a child with autism, experiences of care givers to stroke survivors, dyslexic's learning experiences, communication rehabilitation, disability and food security, hearing children of deaf parents and rehabilitation of stroke survivors. 
  • Three review articles: Intellectual disability rights and inclusive citizenship in South Africa: What can a scoping review tell us?; The benefits of hydrotherapy to patients with spinal cord injuries; Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities.
  • There is an opinion paper entitled - Deafening silence on a vital issue: The World Health Organization has ignored the sexuality of persons with disabilities
  •  There is a case study - Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa

Learning from experience: Guidelines for locally sourced and cost-effective strategies to modify existing household toilets and water access

WORLD VISION
CBM Australia
2018

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This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.

To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.

HOME MODIFICATIONS FOR WASH ACCESS
This document is one of two developed in the Jaffna District and describes the strategies which were used to assist people with disabilities to access toilet and water facilities at their own home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka. Houses and toilet structures in the region were made of brick and concrete. No new toilets were built and modifications involved only minor work to existing household structures, water points and toilets.

NOTE:
The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.

Central African Republic: People with disabilities at high risk - 4 years into conflict, more support, protection needed

HUMAN RIGHTS WATCH
June 2017

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People with disabilities in the Central African Republic have faced violent attacks, forced displacement, and ongoing neglect in the humanitarian response, Human Rights Watch said today. A peace accord signed on June 19, 2017, offers a chance to help this abused and marginalized group.

People with disabilities face high risk from violent attacks and forced displacement and are being neglected by aid groups as conflict in the Central African Republic intensifies.

New Human Rights Watch research in the country shows that people with a range of disabilities are often unable to flee violence, are especially vulnerable to attack while trying to flee, and face unsafe and unhealthy conditions in displacement camps.

This video and blog page report on the problems faced by people with disabilities as conflict in the Central African Republic intensifies. People with a range of disabilities are often unable to flee violence, are especially vulnerable to attack while trying to flee, and face unsafe and unhealthy conditions in displacement camps.

The Rehabilitation Management System: Evaluating and planning physical rehabilitation services

PRYOR, Wesley
SMITH, Fleur
April 2017

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Ensuring quality and affordable rehabilitation services to anyone in need is at the heart of Handicap International mandate and strategy. The organisation is implementing physical rehabilitation projects in 40 countries,  The Rehabilitation Management System was initially developed to allow for more effective and reliable analysis of the quality of rehabilitation services in low resource countries. It draws on international standards, consensus and evidence and it is made of a set of scorecards that are used to monitor key components of management and support service planning. The initial instrument went through several participatory revisions and has been now implemented by Handicap International partners for about 6 years. While it covers domains that are specific to rehabilitation services, it is aligned to the broader health system strengthening framework. It is currently used in around 14 physical rehabilitation centers in 8 countries where settings and governance systems considerably vary, reflecting the different stages of development of physical rehabilitation services worldwide.

The “Rehabilitation Management System: Evaluating and planning Physical Rehabilitation services” guide follows the revision of the RMS scorecards, as a response to the demand from partner organisations, programmes and the Handicap International’s Rehabilitation Technical Unit for a greater adaptability of the system. It is hoped that this guide will further assist partners and programmes in implementing the RMS in effective and strategic management of their services in order to provide the highest quality care in the most sustainable manner.

Leaving no-one behind: using assistive technology to enhance community living for people with intellectual disability

OWUOR, John
LARKIN, Fiona
MacLACHLAN, Malcolm
April 2017

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The transformation of community care for people with intellectual disabilities (ID) through enhanced access to assistive technology (AT) is discussed. The problems associated with lack of access to AT and the extent to which these occur are reported. Issues in lack of AT provision, including lack of global standards, are discussed. A call to action is made with reference to the appropriate parts of CRPD.   

 

 

Disability and Rehabilitation: Assistive Technology, 12:5, 426-428

DOI: 10.1080/17483107.2017.1312572 

Right to health: Reality of persons with spina bifida and hydrocephalus

MCPHERSON. Amy
January 2017

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"This report maps the situation of persons with SBH in relation to healthcare access and is a follow up of the CRPD Concluding Observations Art.25. Through a comprehensive survey, IF collected valuable data on the experiences, satisfaction, and perceptions of healthcare coverage of individuals with SBH across Europe. Based on its findings, the financial coverage of treatment and assistive products for patients with SBH is grossly insufficient across the EU. Europe as a whole lacks multidisciplinary care and specialised SBH teams, which translates into long waiting times and insufficient knowledge of the SBH specificities. 

Considering these findings, IF urges the EU Member States to adequately support the healthcare needs of persons with SBH, and to invest more substantially into creating multidisciplinary clinics that can help avoid preventable complications 11 and may reduce the overall burden 12 on the patient and the system. In addition, the Member States should actively support creation of the European Reference Networks as a way of improving care for persons with SBH. IF also calls on the European institutions for support in training medical professionals on rights of persons with disabilities."

School and classroom disabilities inclusion guide for low- and middle-income countries

BULAT, Jennae
HAYES, Anne
et al
January 2017

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This guide provides strategies and recommendations for developing inclusive classrooms and schools. We specifically address the needs of Sub-Saharan African countries, which lack the resources for implementing inclusive education. However, our strategies and recommendations can be equally useful in other contexts where inclusive education practices have not yet been adopted. Strategies for enhancing existing school and classroom environment and instruction include: modify the physical environment; modify classroom managment strategies; ensure social inclusion; adopt best instructional practices; apply strategies for students with sensory disabilities; and use assistive technologies. Strategies for adopting response to intervention include: tier by tier implementation; individualised education plans; and planning for school wide adoption of inclusive practices and a multilevel system of support.

 

 

Pilot testing of 3D printing technology for transtibial prosthesis in complex contexts (Togo, Madagascar and Syria)

CONICAVE, Jerome
TAN, Daniele
2017

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In January-October 2016, Handicap International carried out a pilot testing of 3D printing technology for transtibial prosthesis in Togo, Madagascar and Syria. The aim of the study was to explore and test how physical rehabilitation services can be more accessible to people living in complex contexts via innovative technologies (such as 3D printing, treatment processes that use Internet technology and tools) and decentralised services by bringing them closer to the patients. This scientific summary provides the context, the objectives, the methodology, the results of the study, and perspectives for the future.

A number of technical appendices are available

RS/05

Standards for prosthetics and orthotics

WORLD HEALTH ORGANISATION (WHO)
2017

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This document provides a set of standards and a manual for implementation to support countries in developing or improving high-quality, affordable prosthetics and orthotics services. Its aim is to ensure that prosthetics and orthotics services are people-centred and responsive to every individual’s personal and environmental needs. Implementation of these standards will support Member States in fulfilling their obligations under the CRPD and in meeting the SDGs, in particular Goal 3. With these standards, any government can develop national policies, plans and programmes for prosthetics and orthotics services of the highest standard. This document has two parts: the standards and an implementation manual. Both parts cover four areas of the health system:

• policy (governance, financing and information);

• products (prostheses and orthoses);

• personnel (workforce);

• provision of services

Thriving in a trade school with a disability

GREENBERG, David
2017

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This USA based guide highlights the benefits of vocational education, potential careers, and laws that protect both students and employees with disabilities. Employers can also find simple steps for promoting diversity and inclusion in the workplace. Vocational career ideas and adaptive tools for students with physical disabilites, learning and cognitive disabilities, visual impairments and hearing impairments are listed. Vocational rehabilitation resources and resources for veterans with disabilites are covered. Other topics are transitioning from high school to work and workplace diversity and inclusion.

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