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The missing billion - Access to health services for 1 billion people with disabilities

KUPER, Hannah
HEYDT, Phyllis
July 2019

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One billion people around the world live with disabilities. This report makes the case that they are being “left behind” in the global community’s work on health. This lack of access not only violates the rights of people with disabilities under international law, but UHC (Universal Health Care) and SDG 3 cannot be attained without better health services for the one billion people with disabilities. 

Health and healthcare are critical issues for people with disabilities. People with disabilities often need specialized medical care related to the underlying health condition or impairment (e.g., physiotherapy, hearing aids). They also need general healthcare services like anyone else (e.g., vaccinations, antenatal care). On average, those with disabilities are more vulnerable to poor health, because of their higher levels of poverty and exclusion, and through secondary conditions and co-morbidities. People with disabilities therefore may require higher levels of prevention, diagnosis, and treatment services. However, health services are often lower quality, not affordable, and inaccessible for people with disabilities. In many situations these barriers are even more significant for women with disabilities, compared to men with disabilities.

Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal

DEVKOTA, Hridaya Raj
KETT, Maria
GROCE, Nora
MURRAY, Emily
June 2017

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BACKGROUND:
Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth.

METHOD:
The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes.

Reproductive Health, 2017

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

Advances in Autism, vol.3, no.3, 2017 Special issue: Improving access to healthcare

2017

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Special issue: Improving access to healthcare. The aim of this special issue is to stimulate discussion and new research on the health and health care of people with autism spectrum disorder. In a co-productive approach, we give people on the autism spectrum, their families and health care providers a voice to open an exchange between professionals and people with lived experience. The guest editorial is freely accessible. There are six papers:

 

  • Autism and healthcare
  • Quality of health and health services in people with fragile X syndrome: perspective of their parents
  • Transition tools and access to adult primary care
  • Systemic-attachment formulation for families of children with autism
  • An online ASD learning module for pediatric health care professionals
  • Pain in Rett syndrome: peculiarities in pain processing and expression, liability to pain causing disorders and diseases, and specific aspects of pain assessment

Integration of childhood tuberculosis into maternal and child health, HIV and nutrition services: A case study from Uganda

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Uganda case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The methodology for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and iCCM benchmarks"

Integration of childhood TB into maternal and child health, HIV and nutrition services. A case study from Malawi.

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi in order to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Malawi case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The method for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and benchmarks for integrated community case management (iCCM)"

Global strategy on human resources for health: Workforce 2030. DRAFT for the 69th World Health Assembly

World Health Organisation (WHO)
May 2016

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This report was presented to Member States at the World Health Assembly in May 2016 and is to be read in conjunction with A69/38: Draft global strategy on human resources for health: Workforce 2030. Report by the Secretariat. The vision of this work and report is to "Accelerate progress towards universal health coverage and the UN Sustainable Development Goals by ensuring equitable access to health workers within strengthened health systems". Objectives are "To optimise performance, quality and impact of the health workforce through evidence-informed policies on human resources for health, contributing to healthy lives and well-being, effective universal health coverage, resilience and strengthened health systems at all levels",  "To align investment in human resources for health with the current and future needs of the population and of health systems, taking account of labour market dynamics and education policies; to address shortages and improve distribution of health workers, so as to enable maximum improvements in health outcomes, social welfare, employment creation and economic growth", "To build the capacity of institutions at sub-national, national, regional and global levels for effective public policy stewardship, leadership and governance of actions on human resources for health" and "to strengthen data on human resources for health, for monitoring and ensuring accountability for the implementation of national and regional strategies, and the global strategy".  Global milestones by 2020 and 2030, policy options of Member States, responsibilities of the WHO Secretariat and recommendations to other stakeholders and international partners are discussed for each objective.

 

Health financing country diagnostic: a foundation for national strategy development

MCINTYRE, Diane
KUTZIN, Joseph
2016

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Health systems’ analysis is not an exact science in the sense that it is not a case of calculating an indicator and comparing that to a target that is set in stone. Instead, the analysis rests on describing elements of the existing system and critically assessing this on the basis of a clear understanding of health financing policy, the objectives associated with UHC, and relevant comparisons with and lessons from other countries. The paper attempts to provide guidance on how this can be done by highlighting the key issues that should be considered and some of the specific questions that should be addressed. It is not intended to provide a strict chapter-bychapter outline for a system assessment, but instead to foster and guide a systematic approach to the analysis of the health financing system. The health financing country diagnostic is written for Ministries of Health, advisors and others actors responsible for developing and implementing health financing policies, and provides step-by-step guidance on how to undertake a situation analysis of a country’s health financing system. Topics considered include: key contextual factors that influence health financing policy and attainment of policy goals; overview of health expenditure patterns; review of health financing arrangements; analysis UHC goals and intermediate objectives; and overall assessment - priorities for health financing reform.

Online resource for parents and carers of children with autism

SIVARAMAKRISHNAN, Shobha
March 2015

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An information resource for the parents, carers and any other health professionals involved in the welfare of children on the autism spectrum. Within this document, it is outlined what is meant by the term 'autism', possible signs to look for in assessing and diagnosing a condition on the spectrum, associated physical or mental impairments which can be associated with a condition on the spectrum, and finally how a healthcare or other relevant professional (eg. education) may be best able to manage the condition in a variety of conditions

Note: The user has given permission for the uploaded document to be reproduced and made publicly available on the Source website

A human right to health : what about persons with disabilities?

HANDICAP INTERNATIONAL
2015

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This advocacy briefing paper presents key information about including people with disabilities in health systems. It highlights key health facts, related legal frameworks and explores issues such as lack of access to equitable healthcare and the benefits of equitable healthcare. It provides recommendations for stakeholders and suggests ways to measure progress

Advocacy briefing paper

Why should rehabilitation be integrated into health systems?

HANDICAP INTERNATIONAL
2015

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This advocacy briefing paper presents information about the importance of rehabilitation being integrated into health systems. It highlights a brief overview and definition of rehabilitation, and related key health facts and issues such as lack of access to rehabilitation, the value of rehabilitation and legal frameworks. It provides recommendations for stakeholders and suggests ways to measure progress

Advocacy briefing paper

Health-related rehabilitation and human rights : analyzing States' obligations under the United Nations convention on the rights of persons with disabilities

SKEMPES, Dimitrios
STUCKI, Gerold
BICKENBACH, Jerome
August 2014

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This article analyses States' obligations with respect to rehabilitation of health under the Convention on the Rights of Persons with Disabilities. Based on internationally accepted standards of human rights law interpretation and drawing extensively on current literature from the field of global health policy, the authors identify the range of governments legal obligations regarding health related rehabilitation across several key human right commitment areas, such as equality and nondiscrimination; progressive realization; international cooperation; participation in policymaking processes; the accessibility, availability, acceptability, and quality of rehabilitation services; privacy and confidentiality; and informed decision making and accountability.To support effective implementation of the Convention, governments need to focus their efforts on all these areas and devise appropriate measures to monitor compliance with human rights principles and standards in rehabilitation policy, service delivery, and organization. This study lays the foundations for a rights-based approach to rehabilitation offering a framework that may assist in the evaluation of national rehabilitation strategies, the development of appropriate indicators and the identification of gaps in the implementation of the Convention

Archives of Physical Medicine and Rehabilitation, Volume 96, Issue 1

Universal health coverage for inclusive and sustainable development. A synthesis of 11 country case studies.

MAEDA, Akiko
ARAUJO, Edson
CASHIN, Cheryl
HARRIS, Joseph
IKEGAMI, Naoki
REICH, Michael R.
et al
2014

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Universal health coverage (UHC) for inclusive and sustainable development synthesises the experiences from 11 countries—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The UHC policies for each country are examined around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The path to UHC is specific to each country, but countries can benefit from experiences of others and avoid potential risks

An evidence review of research on health interventions in humanitarian crises

BLANCHET, Karl
et al
November 2013

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This report presents a review of the evidence base of public health interventions in humanitarian crises by assessing the quantity and quality of intervention studies, rather than measuring the actual effectiveness of the intervention itself.  It notes an increase in quality and volume of evidence on health interventions in humanitarian crises and recognises that evidence remains too limited, particularly for gender-based violence (GBV) and water, sanitation and hygiene (WASH). This report identifies a number of common needs across all areas, namely more evidence for the effectiveness of systems and delivery, better developed research methods, and more evidence on dispersed, urban and rural populations, on ensuring continuity of care and measuring and addressing health care needs in middle-income settings (particularly NCDs)

Note: Use links on the left hand side of the webpage to access either the full report, the executive summary, or the individual chapters arranged by health topic

Improving health at home and abroad : how overseas volunteering from the nhs benefits the uk and the world

ALL PARTY PARLIAMENTARY GROUP ON GLOBAL HEALTH
July 2013

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"This report describes how British health volunteers help to make big improvements in health in other countries whilst at the same time benefiting the UK. It argues that even more could be achieved with better organisation and support and that more people can be involved through virtual communication as well as by actually travelling abroad"

Improving health at home and abroad : how overseas volunteering from the NHS benefits the UK and the world|Executive summary

ALL PARTY PARLIAMENTARY GROUP ON GLOBAL HEALTH
July 2013

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This executive summary presents a summary of the main report which describes how British health volunteers help to make big improvements in health in other countries whilst at the same time benefiting the UK. It argues that even more could be achieved with better organisation and support and that more people can be involved through virtual communication as well as by actually travelling abroad

Evolution of victim assistance within Handicap International

HANDICAP INTERNATIONAL
April 2013

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"This Viewpoints piece describes the development and elaboration of victim assistance within HI. It highlights, in particular, the interplay between programming, research, and policy development. Drawing on examples from South Sudan and Libya, the reflection also describes how HI has integrated its approach by incorporating survivors of gun violence into existing victim assistance and disability projects, and increasingly focuses on injury prevention"
Viewpoint Series, No 2

Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

Lagomarsion G.
Garabrant A.
Adyas A.
Otoo N.
Muga R.
et al
September 2012

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The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.

Giving with one hand...evaluation of post-earthquake physical rehabilitation response in Haiti, 2010 : a systems analysis

TATARYN, Myroslava
BLANCHET, Karl
2012

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This report presents the evaluation of the post-emergency rehabilitation response in Haiti in order to assess what had been achieved, to learn from good and not-so-good practice, and to promote the development of an effective rehabilitation sector in the future.This evaluation provides evidence, to inform humanitarian organisations, about what must be done in a post-disaster situation so that people with disabilities have access to relief and protection on an equal basis with others, and what is required in the long-term to develop a good rehabilitation service

Improved and standardized method for assessing years lived with disability after injury

HAAGSMA, JA
et al
2012

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"This article presents the results of study that aimed to develop a standardized method for calculating years lived with disability (YLD) after injury. The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury"
Bull World Health Organ, 90

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