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MAANASI - A sustained, innovative, integrated mental healthcare model in South India

JAYARAM, Geetha
GOUD, Ramakrishna
CHANDRAN, Souhas
PRADEEP, Johnson
2019

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Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.

A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term.   Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. 

As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930.  Empowerment of treated clients is the final outcome, assisting them in self-employment. 

Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

 

Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 104-113, Oct. 2019

 

 

Epilepsy: a public health imperative

WORLD HEALTH ORGANISATION (WHO)
2019

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This report is the first global report on epilepsy summarising the available evidence on the burden of epilepsy and the public health response required at global, regional and national levels.

This report is a call for sustained and coordinated action to ensure that every person with epilepsy has access to the care and treatment they need, and the opportunity to live free from stigma and discrimination in all parts of the world. It is time to highlight epilepsy as a public health imperative, to strongly encourage investment in reducing its burden, and to advocate for actions to address gaps in epilepsy knowledge, care and research.

Minimum standards for protection, gender and inclusion in emergencies

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC)
November 2018

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The International Federation of Red Cross and Red Crescent Societies (IFRC) Minimum standards for protection, gender and inclusion in emergencies (2018) is in its second edition. The first pilot version of the IFRC Minimum standard commitments to gender and diversity in emergency programming was published in 2015. The pilot version has been tested globally by Red Cross and Red Crescent staff, volunteers and management in low-, medium- and high-scale disasters and humanitarian crises. This edition is the result of three years of testing, revision and feedback from protection, gender and inclusion (PGI) and sectoral specialists. New chapters, such as cash-based interventions, have been added as well as a stronger focus on sexual and gender-based violence and disability inclusion to align with the commitments of the IFRC and its member National Societies. This edition is accompanied by the IFRC Protection, gender and inclusion in emergencies toolkit (2018–2019).

This guidance presents Red Cross and Red Crescent staff, members and volunteers with a set of minimum standards for protection, gender and inclusion (PGI) in emergencies. It aims to ensure that the emergency programming of the International Federation of Red Cross and Red Crescent Societies (IFRC) and National Societies provides dignity, access, participation and safety for all people affected by disasters and crises.

It provides practical guidance on how to mainstream these four principles in all sectors, based on a consideration of gender, age, disability and other diversity factors. This includes limiting people’s exposure to the risks of violence and abuse and ensuring that emergency programmes “do no harm”.

The standards address protection, gender and inclusion concerns by providing practical ways to engage with all members of the community, respond to their differing needs and draw on their capacities in the most non-discriminatory and effective way. This helps to ensure that local perspectives guide assistance delivery. The standards also support incorporation of the seven Fundamental Principles of the International Red Cross and Red Crescent Movement.

3rd World Disability & Rehabilitation Conference (WDRC 2018) - Book of abstracts

O'CONNOR, Loren
Ed
November 2018

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The 3rd World Disability & Rehabilitation Conference 2018 was held from 12th and 13th November 2018 in Kuala Lumpur, Malaysia. People with disabilities and researchers, practitioners, policy makers, industry experts, university faculty and organizations along with advocates and volunteers working with people with disabilities participated and presented their original and unpublished results of conceptual, constructive, empirical, experimental, experiential or theoretical work through abstract and poster presentation. Total 33 participants presented their abstract and poster throughout this conference. The theme of WDRC 2018 was “Global advocacy and rights of people with disabilities”

Women and young persons with disabilities: Guidelines for providing rights-based and gender-responsive services to address gender-based violence and sexual and reproductive health and rights

HOLOBOFF RADFORD, Anastasia
et al
November 2018

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This publications aims to provide practical and concrete guidelines for making Gender-Based Violence (GBV) and Sexual and Reproductive Health and Rights (SRHR) services more inclusive of and accessible to women and young persons with disabilities and for targeting interventions to meet their disability-specific needs.
 
Critical services for all victims and survivors of GBV include health services (e.g. first-line support, sexual assault examination and care, mental health assessment and care), justice and policing services (e.g. assessment and investigation, perpetrator accountability and reparations, safety and protection, justice sector coordination), social services (e.g. crisis counselling; help lines; legal and rights information, advice, and representation; psychosocial support and counselling), and coordination at both the national and local level.

 

Fundamental SRHR services for women and young persons—with and without disabilities— include comprehensive sexuality education; information, goods, and services for the full range of modern contraceptive methods, including emergency contraception; maternal/newborn healthcare (including antenatal care, skilled attendance at delivery, emergency obstetric care, post-partum care, and newborn care); prevention, diagnosis, and treatment for sexual and reproductive health issues (e.g. sexually transmitted infections, including HIV, syphilis, and HPV, cancers of the reproductive system and breast cancer, and infertility); safe and accessible abortion, where it is not against the law; and post-abortion care to treat complications from unsafe abortion.

 

While the primary audience of these Guidelines is GBV and SRHR service providers and support staff, these Guidelines are also intended as a valuable resource for all stakeholders—including those in government, international organizations, and non-governmental organizations—involved in designing, developing, implementing, or advocating for GBV or SRHR services for women and young persons with disabilities. 

Shaping health systems to include people with disabilities. K4D emerging issues report

DEAN, Laura
et al
November 2018

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People with disabilities are at a heightened risk of communicable and non-communicable diseases and these diseases can cause debility and disability. Health needs of these people often extend beyond requiring continual longterm medical support to addressing broader social inequities. Key areas that are likely to be critical in re-orientating health systems from a biomedical approach towards inclusive health systems that are more responsive to the needs of people with debility and disability in low and middle-income countries (LMICs) are offered in this report and cover the following:

 

  • 1. Nothing about us without us: prioritising person-centred health systems
  • 2. Responding to issues of access in mainstreaming disability within health systems
  • 3. Ensuring the provision of specialised services
  • 4. Community based rehabilitation 
  • 5. Improving the collection and use of disability related data against modified legal and policy frameworks
  • 6. Partnerships are paramount
  • 7. Financing and social protection 

Case studies are provided from Sudan, India, Liberia, Uganda and Nigeria

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

SKEMPES, Dimitrios
et al
October 2018

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The process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities is described.  A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants.

 

Globalization and Health (2018) 14:96
https://doi.org/10.1186/s12992-018-0410-5

Primary health care seeking behaviour of people with physical disabilities in Bangladesh: a cross-sectional study

TALUKDAR, Jhalok Ronjan
MAHMUD, Ilias
RASHID, Sabina
September 2018

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People with disabilities constitute about 10% of the total population of Bangladesh. They are more likely to experience poor health than those without disabilities. However, there is a lack of evidence on their primary health care (PHC) seeking behaviour for their general illness. The aim of this study was to understand the PHC seeking behaviour of people with physical disabilities (PWPDs), and to investigate the determinants of such behaviours. 282 PWPDs, aged ≥18 years, were studied using a structured questionnaire. Participants were recruited from the out-patient department of a rehabilitation centre in Dhaka between November and December 2014.

 

Archives of Public Health (2018) 76:43 

https://doi.org/10.1186/s13690-018-0293-1

 

Lost in digitalization? Municipality employment of welfare technologies

FRENNERT, Susanne
2018

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Introduction:

Swedish municipalities face a number of daunting challenges; an aging population, the public’s increased demands and expectations on municipality services, and a strained economy to mention some. Welfare technology, a Scandinavian concept launched to promote digitalization, is seen as one solution to meet these challenges.

 

Objective: 

Despite these promises, few welfare technology applications are offered by local Swedish municipalities and care organizations. Numerous studies have shown that Swedish municipalities have a great interest in welfare technologies.

 

Methods: 

In this article, we draw on empirical research in one Swedish municipality. Through two case studies it is illustrated how technological change and municipality employment of welfare technologies are employed.

 

Results: 

These case studies show how core values of care are being lost in the quest for digitalization due to the lack of organizational skills and knowledge in transforming the relationship of caregiving and care-receiving through the use of digital technology.

 

Conclusions: 

Digitalization and welfare technologies deployed ought to represent and support the core values of caregiving and to receive care. Thus, digital transformation most likely will transform conditions for care receivers and working conditions for care workers. New work processes will evolve, which in turn produce new meanings of home help service work and caregiving.

Improving social inclusion and empowerment for people with disabilities in low- and middle-income countries: why does it matter and what works?

WHITE, Howard
SARAN, Ashrita
POLLOCK, Sarah
KUPER, Hannah
July 2018

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The aim of the Rapid Evidence Assessment (REA) is to provide an assessment of the effectiveness of interventions to improve social inclusion and empowerment for people with disabilities in low- and middle-income countries (LMICs). The studies included in this REA are taken from the Disability EGM prepared by the Campbell Collaboration for DFID under the auspices of the Centre for Excellence for Development Impact and Learning (CEDIL). Eligible studies included systematic reviews and impact evaluations published in English from 2000 onwards that assessed the effectiveness of interventions for people with disabilities in LMICs. The REA focused on studies identified by the EGM process that included ‘social inclusion’ or ‘empowerment’ as study outcomes and used the World Health Organization CBR matrix as a framework to categorise the different interventions and outcomes considered by the studies available. Evidence limitations and gaps were identified. 

There were 16 eligible primary studies, including studies conducted in 12 countries: Bangladesh (two studies), Brazil, Chile, China (two studies), Ethiopia, India (three studies), Kenya (two studies), Malaysia, Thailand, Turkey, Uganda, and Vietnam (two studies). Five of the studies concern interventions for people with physical or sensory impairments, nine for people with mental health or neurological conditions, and two for all disability types.

Challenges and priorities for global mental health in the Sustainable Development Goals (SDG) era

ACADEMY OF MEDICAL SCIENCES
June 2018

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Published in 2011, the Grand Challenges in Global Mental Health initiative provided a framework to guide the research needed to improve treatment and prevention of mental health disorders and expand access to mental health services. At the Academy’s workshop on global mental health participants reflected on progress since 2011, focusing on specific life-course stages, and identified priorities for research in treatment and prevention, as well as enduring challenges and emerging opportunities

Learning From Experience: Guidelines for locally sourced and cost-effective strategies for hygiene at home for people with high support needs.

World Vision/CBM Australia
May 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.

HYGIENE AT HOME FOR PEOPLE WITH HIGH SUPPORT NEEDS
This document is one of two developed in the Jaffna District and describes strategies that used to assist households and individuals in hygiene tasks at 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.

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

Psychosocial disabilities in the Middle East. K4D Helpdesk Report.

BOLTON, Laura
May 2018

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This desk based review reports on the then current best estimates of psychosocial disability in the following countries in the Middle East and North Africa: Lebanon, Jordan, Occupied Palestinian Territories (OPTs), Iraq, Syria and Yemen. Factors influencing prevalence of psychosocial disability in each of these countries, and whether conflict was an important factor were considered. Prevalent forms of psychosocial disability and how might they differ by country were reviewed. How prevalence and form of psychosocial disability differ across the following demographic characteristics: gender, age, religion, ethnic group was addressed. The state of provision, both state and non-state, for those with psychosocial disabilities in these countries, and variation of eligibility and access to provision/services across demographics (e.g. age, gender, religion or ethnic group) were also considered.

Where there is no psychiatrist A mental health care manual

PATEL, Vikram
HANLON, Charlotte
March 2018

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This is a practical manual about mental health care, aimed at community health workers, primary care nurses, social workers and primary care doctors, particularly in low resource settings. It describes more than 30 clinical problems associated with mental illness, using a problem-solving approach to guide the reader through their assessment and management. It addresses the lack of understanding of mental health among many health workers. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for symptoms.

 

This product is an update of the first edition 2003. It is also available as Open Access.

Barriers to Healthcare Services for People with Disabilities in Developing Countries: A Literature Review

BAART, Judith
TAAKA, Florence
2018

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Purpose: This literature review aimed to identify the main barriers in access to mainstream healthcare services for people with disabilities.

 

Method: Online databases were searched for relevant articles published after 2006.  Preference was given to articles pertaining to developing countries. On the basis of pre-determined inclusion and exclusion criteria, 16 articles were selected for the review. Barriers noted in the articles were grouped thematically.

 

Results: There appeared to be 7 main barriers - 4 related to the demand side i.e., pertaining to the individual seeking healthcare services, and 3 barriers on the supply side i.e., pertaining to healthcare provision. These are: 1) Lack of information; 2) Additional costs of healthcare; 3) Limited mobility; and, on the demand side, 4) Stigmatisation; while on the supply side, 5) Staff attitude; 6) Communication barriers; and, 7) Inaccessible facilities.

 

Conclusion: To ensure that people with disabilities can successfully access the necessary health services, the barriers on the demand side (the individuals requiring healthcare) as well as the barriers that are part of the healthcare system, should be attended to.

Millennium development goals (MDGs)

WORLD HEALTH ORGANIZATION (WHO)
February 2018

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This factsheet presents a  progress report on the UN’s Millennium Development Goals relating directly to health, highlighting key statistics, progress and areas for further improvement

Fact sheet N° 290

Disability and vocational rehabilitation in rural settings

HARLEY, Debra
et al
2018

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A graduate student textbook offered in 39 chapters, each with different authors and subjects. Abstracts, test questions and citations are freely available on-line. Full text is charged for. The book surveys rehabilitation and vocational programs aiding persons with disabilities in remote and developing areas in the U.S. and abroad. Contributors discuss longstanding challenges to these communities, most notably economic and environmental obstacles and ongoing barriers to service delivery, as well as their resilience and strengths. Considerations are largely of the US but there is a chapter on each of Asia and Pacific region, Australasia, Canada, Mexico, India, Turkey, Colombia and the UK. 

 

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

TIWARI, Ajun
et al
January 2018

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The primary objective of this study is to estimate the expenditure in primary (outpatient) care incurred by leprosy patients in two different health system settings in India. The secondary objective is to compare the effect of the health systems on consumer behaviour and practices. 

The study followed a cross-sectional design, where a cohort from the Union Territory of DNH (an administrative division ruled directly by the federal government) was compared with a cohort from Umbergaon block of Valsad district, Gujarat, India. A block is the smallest administrative unit under a district. The cohorts were leprosy cases detected between April 2015 and March, 2016. A sample of 120 participants from each group was selected randomly. In the financial year of 2015–16, DNH reported 425 and Umbergaon reported 287 cases. 

A household survey was conducted between June and October, 2016 by means of a structured questionnaire collecting data on patient demographics, HH socioeconomic status, accessibility of health services, treatment seeking history and OPD expenditure. Respondents were asked to report on the last three OPD visits, either in a public or private facility, in the last 6 months. 

The costs were categorized as direct and indirect expenditure. The direct part included the expenditure on consultation, investigations and medicines & supplies. The indirect part constituted expenditure on transport, food, and days lost during illness of the patient and attendant

PLOS Neglected Tropical Diseases, January 4, 2018

https://doi.org/10.1371/journal.pntd.0006181

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