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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.

Reimagining the workplace: disability and inclusive employment

LEONARD CHESHIRE
February 2019

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This UK based report examines the challenges and barriers facing disabled people throughout their working journey, as well as considering solutions to some of the key issues. Through our own research survey and interviews we look at the impact on disabled people where they cannot access adequate support as well as what works in improving their employment prospects

 

Topics discussed include: conditions of employment; preparing for work; falling out of work; and the performance of government based programmes.

 

ComRes interviewed in 2018 online 1,647 disabled adults in the UK, aged between 18 and 65, and in 2017 they interviewed 1,609 disabled adults. ComRes interviewed 503 UK line managers responsible for or involved in the recruitment process in 2018 and in 2017.  Between 1 December 2018 – 20 January 2019, Leonard Cheshire conducted in-depth telephone interviews with seven disabled people of working age about their experiences of employment. 

 

Recommendations are made throughout.

Provision of wheelchairs in Tajikistan: Economic assessment of alternative options

WORLD HEALTH ORGANISATION (WHO). REGIONAL OFFICE FOR EUROPE
2019

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"This publication presents the results of a study on the economic aspects of various models for the provision of wheelchairs in Tajikistan. The study was conducted under the leadership of the Ministry of Health and Social Protection, Republic of Tajikistan and with technical support from the WHO Country Office, Tajikistan. The study was finalized in consultation with Tajik users of wheelchairs, the Ministry of Health and Social Protection and international experts on wheelchair production and provision, and made use of national and international evidence on the provision of wheelchairs to inform the analysis and develop evidence-based policy options. While the study focuses on the Tajik context and its aspirations to expand in-country production of wheelchairs, its approach and findings will also be of interest to other countries in a similar situation and to other interested stakeholders"

 

 

Scaling up inclusive approaches for marginalised and vulnerable people. K4D emerging issues report

CARTER, Becky
JOSHI, Anu
REMME, Michelle
July 2018

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This rapid review summarises the evidence on how to scale up inclusive approaches to complex social change. It looks at how to design scalable inclusive change interventions, as well as how to plan and manage the scale-up process. Focusing on interventions with the aim of reaching the most marginalised and transform social norms, it covers programmes aiming to deliver inclusive outcomes for women and girls (with a particular focus on preventing violence against women and girls) and persons with disabilities. To date, many interventions seeking to change harmful gender and disability norms have been implemented as small-scale projects. There are limited experiences of scale-up and fewer evaluations of these experiences. However, there are some documented case studies as well as emerging analysis that draw out lessons learned. From this evidence base, this rapid desk review identifies eight critical issues commonly highlighted as important considerations when scaling up inclusive change interventions:

1. Opportunities for systemic approach, including integrating political and community-level scale-up, and coordinating across multiple sectors and stakeholders

2. Political support for scale-up

3. Strategic choices: balancing reach, speed, cost, quality, equity, and sustainability

4. Catalysing change: tipping points, diffusion effects, and local champions

5. Locally grounded, participatory, and adaptive approaches

6. Long-term approaches with funding models to match

7. Cost-effective and financially feasible scale-up strategies

8. Measuring impact and sustainability.

 

Scale-up pathways are discussed including: horizontal, vertical, functional and organisational.

A number of case studies are given.

Disability in humanitarian context: A case study from Iraq

HUMANITY & INCLUSION (HI)
June 2018

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This brief presents and addresses some of the challenges that prevent internally displaced persons with disabilities and other vulnerable population groups (elderly, injured persons, pregnant women, etc.) in camp settings from accessing humanitarian services in Iraq and impede on the development of an inclusive humanitarian response. Examples drawn from Handicap International’s experience working in Iraq with persons with disabilities and vulnerable population groups further illustrate those challenges. The recommendations to the humanitarian community provided in this brief aim at improving the protection of persons with disabilities and their inclusion in the humanitarian response

Deafness and hearing loss

WORLD HEALTH ORGANIZATION (WHO)
March 2018

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A short factsheet about deafness and hearing loss covering key facts, causes (congenital and acquired), impact (functional, social and economic), prevention, identification and management and WHO response. 

Wheelchair Service Provision Course

LOWE, Rachel
RAU, Barbara
2018

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This MOOC (Massive Open Online Course) aims to provide a basic theoretical understanding of wheelchair mobility and to develop an understanding of the theoretical principles, skills and knowledge underlying the management skills and knowledge in the management of wheelchair service delivery.  Starting on 3 September 2018 and lasting for 4 weeks, it will involve around 4-6 hours of work each week (depending on your learning style)

This course is aimed at Physiotherapy and Physical Therapy professionals, clinicians, students and assistants. It will introduce the role of the wheelchair in mobility, explore assessment and the roles of the multidisciplinary team in wheelchair service delivery, as well as provide a theoretical understanding of management techniques and related clinical considerations. It will not teach practical skills or lead to any clinical qualification. 

 

Resource book on Disability Inclusion

LIGHT FOR THE WORLD
2017

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This is a resource book on disability inclusive practices. Within this book a variety of resources has been brought together that are relevant for disability inclusion. This is of particular interest for persons working in (development) organisations who would like to ensure that their projects and programmes are inclusive of persons with disabilities.

This book consists of four parts:

Core concepts
How To Pages
Resource Listing
Trainer-facilitator’s Guide

The book relies heavily on the experiences and practices of inclusion developed by different organisations to which the authors are indebted, and they have tried to make reference to the sources wherever possible. In addition, they have drawn on their experiences as programme managers and disability inclusion advisors.

These materials may be used for non-commercial purposes, with proper references to all authors and sources involved. Should you use this resource book in your training or other work, please let us know via lab@light-for-the-world.org.

Guide for business on the rights of persons with disabilities

WYNHOVEN, Ursula
et al
August 2017

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A guide to help improve business’ understanding of the rights of people with disabilities, including how to respect, support and give them an opportunity to improve their competitiveness and sustainability in alignment with relevant United Nations (UN) conventions and frameworks.

 

This guide is the result of an international collaborative effort spanning over 12 months. Its findings and recommendations are based on the following: desk research, a review of publically available information, literature and case studies, ongoing consultations with an international multistakeholder expert group constituted specifically to advise on and shape the development of this guide, good practice examples submitted by companies across the world to the partner organizations, and an extensive global consultation with interested businesses and other stakeholders. 

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.

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.

Humanitarian Hands on Tool (HHoT)

CBM
2017

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The CBM smartphone app 'Humanitarian Hands-on Tool' (HHoT) provides step-by-step guidance on how to implement an inclusive emergency response. With disability-inclusive humanitarian action broken down into individual task cards, which explain the basic 'how-to' details in simple language and images, this web-based tool and downloadable mobile app aims to become the ‘go-to’ field resource for all agencies planning humanitarian work that leaves no-one behind

The 2015 Nepal earthquake(s): Lessons learned from the disability and rehabilitation sector's preparation for, and response to, natural disasters

LANDRY, Michel
SHEPHARD, Phillip
LEUNG, Kit
RETIS, Chiara
SALVADOR, Edwin
RAMAN, Sudha
November 2016

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This article outlines lessons learned from 2015 Nepal earthquake that can be applied to future disasters to reduce overall disability-related outcomes and more fully integrate rehabilitation in preparation and planning. Information is presented on disasters in general, and then specficially on the earthquake(s) in Nepal. Field experience in Nepal before, during, and after the earthquake is described, and actions that can and should be adopted prior to disasters as part of disability preparedness planning are examined. Emerging roles of rehabilitation providers such as physical therapists during the immediate and postdisaster recovery phases are discussed. Finally, approaches are suggested that can be adopted to “build back better” for, and with, people with disabilities in postdisaster settings such as Nepal.

 

Physical Therapy, Volume 96, Issue 11, 1 November 2016, Pages 1714–1723

https://doi.org/10.2522/ptj.20150677

 

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis

MCVEIGH, Joanne
MACLACHLAN, Malcolm
GILMORE Brynne
MACLEAN Chiedza
EIDE, Arne H.
MANNAN Hasheem
GEISER Priscille
DUTTINE Anthony
MJI Gubela
MACAULIFFE Eilish
SPRUNT Beth
AMIN Mutamad
NORMAND Charles
et al
August 2016

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General principles requiring contextual adaptation regarding optimal policy related governance of health related rehabilitation in less resourced settings were developed from a literature review and realistic synthesis. A systematic review of literature published since 2003 was carried out. Multiple reviewers selected articles for inclusion in the realistic synthesis.  A Delphi survey of expert stakeholders refined and triangulated findings from the realist synthesis. Context mechanism outcome pattern configurations (CMOCs) were identified from the literature and then developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes; collection of disaggregated disability statistics; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users; robust inter-sectoral coordination; and ‘institutionalising’ programmes.

 

 

Challenges to principled humanitarian action: Perspectives from four countries.

NORWEGIAN REFUGEE COUNCIL
Handicap International
July 2016

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The purpose of this paper is to contribute to an increased understanding of the perceived and actual challenges humanitarians face in operational contexts as they apply the principles of humanity, impartiality, neutrality and independence. A snapshot is provided of four case studies; Colombia, Nepal, northern Syria and South Sudan. Through a combination of field research, headquarters interviews, desk research, and a webinar, views and observations are presented from the humanitarian community. These observations provide a glimpse into the challenges faced by principled humanitarians. As a result the paper puts forward seven recommendations intended to assist humanitarians and states to sharpen tools and strengthen approaches when implementing principled humanitarian protection and assistance. An addendum to this study provides perspectives from selected members of the donor community. This research was conducted through interviews with state representatives in Geneva, aiming to understand how donors perceive their responsibilities in upholding the humanitarian principles and the Good Humanitarian Donorship Principles. This final chapter highlights challenges faced by states while supporting principled humanitarian action, particularly in conflict zones. On the basis of this research, additional recommendations for both states and humanitarians are proposed to strengthen the adherence to the humanitarian principles

Making microfinance accessible to persons with disabilities: awareness and attitudes among Indian microfinance institutions

GUPTA, Vin
May 2014

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This research focuses on three stakeholders: Microfinance Institutions (MFIs), Persons with Disabilities (PWD), and non-disabled clients. It attempts to highlight the following:

  • Understanding of MFIs about disability, their perceptions of persons with disabilities, and their preparedness to include them as potential clients
  • Concerns and apprehensions of PWD to becoming potential MFI clients
  • Views of non-disabled clients on including PWD in their groups

The study investigates the knowledge and the perceptions about disability among each stakeholder group and attempts to elucidate how that impacts the ability of PWD to access microfinance services. Four microfinance institutions of different geographic areas were studied. The survey inolved 1,000 people of whom 57 were disabled. 

Empowering communities through knowledge transfer : training guide for community based rehabilitation

FERRANTE, Marco
2014

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This manual, along with the attached annex, presents useful information about community based rehabilitation (CBR) in Sudan. It is to be used as a practical tool for both existing CBR schemes and other communities that are looking forward to establishing CBR schemes. This document is divided into the following eight practical units:

 

1: Community Based Rehabilitation: Concepts and practical strategies

2: Community Based Rehabilitation and Social change

3: CBR & Education

4: CBR & Health

5: CBR & Livelihood

6: CBR & Employment

7: CBR & Management strategies

8: Training of trainers guide

 

The annex provides additional advice on the practical application of CBR theories and strategies in the context of Sudan

 

Note: OVCI gave copyright permission for this document to be uploaded and made publicly available on the Source website

Guidance note on disability and emergency risk management for health

WORLD HEALTH ORGANIZATION (WHO)
et al
2012

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"The Guidance note on disability and emergency risk management for health is a short, practical guide that covers actions across emergency risk management, such as risk assessment, prevention, preparedness, response, recovery and reconstruction. Developed primarily for health actors working in emergency and disaster risk management at the local, national or international level, and in governmental or nongovernmental agencies, the guidance note points out the health-related actions that are required to ensure that both mainstream and specific support are available and accessible to people with disabilities in emergencies"

Field based training for mental health workers, community workers, psychosocial workers and counselors : a participant-oriented approach

VAN DER VEER, Guus
FRANCIS, Felician Thayalara
July 2011

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"This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work. It sums up the characteristics required of the workers, their learning needs, the messages that the training needs to convey, and the characteristics and potential contents of a tailor made, participants-oriented programme"
Intervention, Vol 9, Issue 2

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