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Disability Inclusion Helpdesk Report : What works in mental health services and community interventions to support people with mental health conditions and psychosocial disabilities: a rapid evidence review

MILLS, China
AHLENBÄCK, Veronica
HAEGEMAN, Emma
September 2019

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Summaries on the findings from the following queries:

What works to develop quality services and community interventions to support people with mental health conditions and psychosocial disabilities and wellbeing for all, across the lifecycle?

What are examples of effective interventions in this area?

African Journal of Disability, Vol 8, 2019

2019

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This journal volume includes:

  • 33 research articles
  • 2 review articles
  • an opinion paper
  • a case study
  • two book reviews

Additionally there is a special collection of 3 papers concerned with the Role of Assistive Technology.

“Even the fowl has feelings”: access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia

SCHENK, Katie D
TUN, Walter
SHEEHY, Meredith
OKAL, Jerry
KUFFOUR, Emmanuel
MOONO, Grimond
MUTALE, Felix
KYEREMAA, Rita
NGIREABAKUNZI, Edson
AMANYEIWE, Ugochukwu
LECLERC-MADLALA, Suzanne
October 2018

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Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities.

 

Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors.

 

Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities.

 

Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response.

 

Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability.

Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Applied research on disability in Africa : general mapping

INTERNATIONAL FOUNDATION OF APPLIED DISABILITY RESEARCH (FIRAH)
2014

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“The goal of this literary review is to report on existing knowledge about applied research on the African continent, regarding the living conditions of people with disabilities, poverty, violence and sexual abuse especially regarding children and women with disabilities, community-based rehabilitation and employment”

Situation analysis of programs to meet the HIV prevention, care, and treatment needs of persons with disabilities in Ghana, Uganda, and Zambia

TUN, Waimar
et al
December 2013

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With growing recognition that persons with sensory (blindness and deafness), physical, and intellectual disabilities are at risk for HIV, it is crucial to understand the HIV programming needs of persons with disabilities and challenges to accessing HIV-related services. The HIVCore project, funded by the U. S. Agency for International Development, conducted a situation analysis in Ghana, Uganda, and Zambia with persons with disabilities and service providers to describe existing HIV services for persons with disabilities, identify factors affecting access to and use of HIV services, and identify opportunities and gaps for addressing HIV service needs of persons with disabilities. By identifying the needs and challenges in HIV programming for persons with disabilities and by identifying existing programs, the findings from this assessment can be used to guide the implementation of disability-inclusive programming.

Stakeholder consultations on community-based rehabilitation guidelines in Ghana and Uganda

WICKENDEN, Mary
MULLIGAN, Diane
FEFOAME, Gertrude O
KATENDE, Phoebe
2012

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Background: The focus of this paper is the new broadened conceptualisation of community-based rehabilitation (CBR), which promotes the empowerment and inclusion of people with disabilities (PWDs) in diverse ways within their communities. New guidelines for CBR were launched in October 2010 by WHO/ILO/UNESCO/IDDC, and this paper describes part of the process by which these were produced using participatory approaches involving International Non-Government Organisations (INGOs) and local partners. The paper reviews the evolution of CBR and describes how grassroots consultation by INGOs working with key stakeholders in the disability arena can influence policy on disability issues, and reciprocally how policy change can inform organisations’ practice and research activities. This ongoing bidirectional influence is illustrated with data from the participatory consultation process about the new CBR guidelines carried out by Sightsavers in Uganda and Ghana

 

Objectives: To consult with key stakeholders in the disability arena in Uganda and Ghana, in order to gain their opinions and suggestions for improvements to the then draft CBR guidelines, as part of a wider global participatory process of consultation on the document.

 

Methods: The INGO Sightsavers gathered qualitative data through focus group discussions and questionnaires in both countries.

 

Results: The participants’ critiques of the draft guidelines carried out in multiagency participatory processes were analysed thematically and fed back to the CBR guidelines editorial team.

 

Conclusion: The paper concludes that stakeholders in diverse communities can actively contribute to shaping policy and practice through participatory consultations. Local and national government and non-government organisations and other key informants can inform the development of national and international guidelines and policies. This participatory approach can be successfully facilitated by INGOs. In turn, these processes have prompted organisations to adapt their own policies and programmes in order to be more responsive to the local needs and concerns of PWDs.

Quest for quality : interventions to improve human resources for health among faith-based organisations

ADJEI, George A
et al
February 2009

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"Traditionally, faith-based health organisations have been important health care providers in many remote and other under-serviced areas. Currently, these facilities bear the brunt of the competition for scarce human resources. It is important for faith-based organisations to learn from recent experiences and from the creative ways in which colleagues seek to retain their health workers and improve quality of human resource management. [As part of a]"...linking and learning programme, some faith-based umbrella organisations in Tanzania, Ghana, Uganda, and Malawi have joined forces to share their experiences in confronting the human resources crisis: by developing retention schemes, offering in-service training, task shifting, developing the planning and management skills of their staff, better coordination of salary and incentive structures with the public systems, and the development of lobbying instruments for national and international use"

Antimalarial drug quality in the most severely malarious parts of Africa - a six country study

BATE, Roger
COTICELLI, Philip
TREN, Richard
ATTARAN, Amir
May 2008

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This article describes research conducted on a range of antimalarial drugs, procured from private pharmacies in urban and peri-urban areas in the major cities of six African countries which were subjected to semi-quantitative thin-layer chromatography (TLC) and dissolution testing to measure active pharmaceutical ingredient content against internationally acceptable standards

Improving nutrition as a development priority : addressing undernutrition in national policy processes in sub-Saharan Africa

BENSON, Todd
2008

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This report examines the findings of a qualitative institutional study on nutrition in four countries in Ghana, Mozambique, Nigeria, and Uganda. The focus is twofold: first, to seek a general understanding as to why it is difficult for undernutrition to be targeted as a national development priority; and secondly to examine in more detail the four interrelated elements of the policy processes that are relevant to addressing undernutrition in each country. These are: policy making structures, political actors, the narrative of undernutrition that informs the policy choice and the timing of policy change

Programming experiences in early childhood development

UNITED NATIONS CHILDREN'S FUND (UNICEF)
November 2006

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This document presents examples and case studies from 21 countries. They demonstrate the benefit of cross-sectoral programming to support early childhood development, some building on early child care or education programme

CSO capacity for policy engagement : lessons learned from the CSPP consultations in Africa, Asia and Latin America

CHOWDHURY, Naved
FINLAY-NOTMAN, Chelsie
HOVLAND, Ignie
August 2006

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This paper explore the views of Southern civil society organisations (CSOs) on the issues of evidence-based policy engagement and came out of the Civil Society Partnerships Programme (CSPP). "During its first phase the CSPP conducted a series of consultative seminars and workshops in Africa, Asia and Latin America. The aim was to provide a forum for representatives from policy research institutions and non-governmental organisations (NGOs), as well as other stakeholders, to come together. Participants discussed the opportunities and challenges for CSOs when using evidence to inform policy, presented lessons and best practice in this area, shared experiences about ongoing activities and identified opportunities for collaborative work"

Medicine prices surveys and proposed interventions to improve sustainable access to affordable medicines in 6 sub-Saharan African countries|Etudes des prix des medicaments et interventions proposeees pur ameliorer durablement l'acces aux medicaments dan

WORLD HEALTH ORGANIZATION (WHO)
2006

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This document brings together the outcomes of six surveys into medicine prices - for Ghana, Kenya, Mali, Tanzania, Chad and Uganda - and one for the East African Community (Kenya, Uganda and Tanzania) . The reports for Mali and Chad are written in French and the others in English

USAID project profiles : children affected by HIV/AIDS

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
January 2005

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This document presents profiles of 114 projects (90 country-specific, 12 regional, and 12 global) funded by USAID. It includes a section on USAID projects that support access to education in Africa. The project profiles include the names of implementing organisations, funding periods and amounts, objectives, strategies, key accomplishments, priority activities for the year ahead, and materials and tools available to other projects that can help meet the needs of children and youth affected by HIV and AIDS. The diversity of these projects demonstrates the US government's efforts to meet the wide variety of needs of children and youth affected by HIV and AIDS. Approaches vary in both strategy and scale. The vast majority of projects work with communities to identify opportunities that strengthen existing resources without undermining local ownership. In many places, communities are already mobilised and have systems in place to identify, protect, and provide basic necessities to the most vulnerable children. USAID supports the strengthening and monitoring of these existing activities

Mapping malaria risk in Africa

MAPPING MALARIA RISK IN AFRICA / ATLAS DU RISKE DE LA MALARIA EN AFRIQUE (MARA/ARMA)
December 2004

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This site presents maps of malaria risk and endemicity (the presence of malaria) in Africa, drawing on published and unpublished data, and through spatial modelling of malaria distribution, seasonality and endemicity. Many factors, especially endemicity, affect the choice of control methods. In the absence of such data it is impossible to rationalize the allocation of limited resources for malaria control. This site presents an opportunity to rethink endemicity and how we may map malaria risk in order to better support planning and programming of malaria control

The use of information and communication technologies (ICTs) in African public library services

ROSENBURG, Diana
July 2004

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This article concerns the use of computers in public libraries in developing countries. To investigate the current level of use of ICTs and plans for the future within the public library environment, a survey was undertaken of 22 public library services in ten English-speaking African countries. The results indicate great disparities in the level of access to computers between the countries, and within country, and indicate a need for more funding and appropriate training

Low cost access and connectivity : local solutions

UN ICT TASK FORCE
2004

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This publication, a UN ICT Task Force Working Group Paper, brings together case studies of local initiatives which highlight innovation in meeting the information and communication needs in developing countries. Seven papers explore connectivity and access issues in different countries. Papers on Benin and Cameroon are in French

RBM communications assessment : challenges and opportunities in Ghana, Mali, Senegal, Tanzania and Uganda

SHUFFELL, Sara
2004

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This report is from an assessment carried out between October 2002 and April 2003 in Ghana, Mali, Senegal, Tanzania and Uganda. It was part of a Roll Back Malaria Communications Assessment as an initial stage in the process to develop effective and inclusive national malaria communication strategies in RBM participating countries across Africa. It notes the challenges that are raised in the context of development communications in Africa: the absence of basic malaria communications strategies, poor visibility of National Malaria Control Programmes, and lack of regional coordination and information sharing to name a few. There are, however, many opportunities to develop better malaria communications listed in the report

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