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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.

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.

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.

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

World Health Statistics 2012

WORLD HEALTH ORGANISATION (WHO)
2012

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"World Health Statistics 2012 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage"
Note: The summary brochure, full report, report in English by section, the indicator compendium and printed copy order forms are available from the link above

Global status report on noncommunicable diseases 2010

WORLD HEALTH ORGANIZATION (WHO)
2011

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"This report sets out the statistics, evidence and experiences needed to launch a more forceful response to the growing threat posed by noncommunicable diseases. While advice and recommendations are universally relevant, the report gives particular attention to conditions in low- and middle-income countries, which now bear nearly 80% of the burden from diseases like cardiovascular disease, diabetes, cancer and chronic respiratory diseases. The health consequences of the worldwide epidemic of obesity are also addressed"

Access to services for persons with disabilities in challenging environments : supplement to the seminar held in Amman (Jordan) in December 2009

DIXON, Catherine
BLANCHET, Karl
Eds
July 2010

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This is a collection of articles on research, policy initiatives and case studies on the theme of access to services based upon exchanges during a seminar on access to services in Amman in December 2009. It was written by Handicap International staff, field partners and international experts. There are three sections: key concepts and references on access to services; challenging environments; and innovation to improve access. This resource would be useful for practitioners and policy makers interested in access to services for people with disabilities.

IDF diabetes atlas

UNWIN, Nigel
et al
2010

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This report presents evidence that diabetes is a global epidemic. It contains comprehensive information in the following sections: What is diabetes?; The Global Burden; Regional Overviews; Diabetes and Development; Linking Local to Global; Resources and Solutions; References; Additional Resources. This report is useful for health professionals, scientists, economists, policy-makers, and national and international agencies

What really matters : a guide to person-centered excellence|Application for services for people with mental illness

THE COUNCIL ON QUALITY AND LEADERSHIP (CQL)
2010

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"This guide promotes quality improvement in behavioral health services and supports. These best practices and the resulting quality improvement initiatives can be applied across the range of supports and services for people with mental illness...This manual has eight main sections and each section contains a key factor with its success indicators. We use the term ‘factor’ to refer to the main area: for example, Person-centered Planning. Likewise, each factor has a number of ‘success indicators’ that describe critical aspects of the factor. For each success indicator there are three parts: a statement of the indicator; a brief explanation of the meaning behind this indicator; a description of how organizations apply this indicator in practice"

Evidence for the effectiveness of rehabilitation-in-the-community programmes

VELEMA, Johan P
EBENSO, Bassey
FUZIKAWA, Priscila L
March 2008

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"The present literature review identified 29 reports from 22 countries in Asia, Africa and Central America reporting on the outcomes of rehabilitation-in-the-community programmes in low and middle income countries published between 1987 and 2007. Interventions included home visits by trained community workers who taught disabled persons skills to carry out activities of daily living, encouraged disabled children to go to school, helped find employment or an income generating activity, often involving vocational training and/or micro-credit. Many programmes had a component of influencing community attitudes towards disabled persons. The information collected shows that such programmes were effective in that they increased independence, mobility and communication skills of disabled persons, helped parents of disabled children to cope better and increased the number of disabled children attending schools. Economic interventions effectively increased the income of disabled persons although they rarely made them financially independent. CBR activities result in social processes that change the way community members view persons with disabilities, increase their level of acceptance and social inclusion and mobilise resources to meet their needs"
Leprosy Review, Vol 79, Issue 1

Universal coverage of health services: tailoring its implementation

CARRIN, Guy
MATHAUER, Inke
XU, Ke
EVANS, David
2008

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In 2005, the Member States of WHO adopted a resolution encouraging countries to develop health financing systems capable of achieving and/or maintaining universal coverage of health services – where all people have access to needed health services without the risk of severe financial consequences. In doing this, a major challenge for many countries will be to move away from out-of-pocket payments, which are often used as an important source of fund collection. Prepayment methods will need to be developed or expanded but, in addition to questions of revenue collection, specific attention will also have to be paid to pooling funds to spread risks and to enable their efficient and equitable use. Developing prepayment mechanisms may take time, depending on countries’ economic, social and political contexts. Specific rules for health financing policy will need to be developed and implementing organizations will need to be tailored to the level that countries can support and sustain. In this paper we propose a comprehensive framework focusing on health financing rules and organizations that can be used to support countries in developing their health financing systems in the search for universal coverage.

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