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How Inclusive Design and Programming Advances UHC
- 1. 11 HOW INCLUSIVE DESIGNAND PROGRAMMING ADVANCES UNIVERSAL HEALTH COVERAGE LMG Project Technical Learning Session Photo:MSHStaff
- 2. 2 Seminar Objectives • Raiseawareness of inclusive development and its connection to universal health coverage • Discuss how to design inclusive programs, and how adapt existing programs to be more inclusive • Provide recommendations for practical actions and resources that MSH can use with governments, service providers, civil society, and development partners to ensure inclusion of persons with disabilities
- 3. LMG Project Experiencein Inclusion 3
- 4. 4 Seminar Outline 1. Settingthe stage: UHC as an anchor of MSH’s work 2. State of health for persons with disabilities 3. Designing inclusive health programs – example using inclusive health checklist 4. Questions and discussion
- 5. • Consensus goalin Global Health • Key principle: people should receive the healthcare they need without having to suffer financial hardship 5 Universal Health Coverage
- 6. 6 What does disabilityinclusion have to do with UHC?
- 7. 7 Disability is aGlobal Health Issue • More than 1 billion people with disabilities globally = about 15% of world’s population or 1 in 7 people • 93 million children – or 1 in 20 of those under 15 years of age – live with a moderate or severe disability • Disproportionately affects women, older people, poor people, LGBTQ, and minorities
- 8. State of Healthfor Persons with Disabilities • Greater unmet needs around health and rehabilitation than general population • Seldom targeted by health promotion and prevention activities • Women with disabilities receive less breast and cervical cancer screenings • People with intellectual disabilities are less likely to have their weight checked • Adolescents and adults with disabilities more likely to be excluded from SRH programs 8
- 9. 9 • Lack ofawareness, knowledge, and understanding • Prejudice and stigma • Inadequate policies and standards • Physical, financial, and attitudinal barriers to services • Inadequately trained providers • Exclusion of persons with disabilities from decision-making • Lack of data and evidence Why Health Systems Fail Persons with Disabilities:
- 10. 10 Left Behind? Afghanistan Case Widelyheld up as a HSS success story, yet… • Afghans with disabilities report health care coverage and positive experiences did not improve between 2005 and 2013 • Services less available to address their needs despite decade of international investment • Persons with disabilities commonly not included in design of health system reconstruction, mainstream health workers were not trained, and NGOs did not deliberately plan for inclusion Source: Trani J-F, Kumar P, Chandola T. Assessment of the progress toward universal health coverage for disabled people in Afghanistan: a multi-level analysis. Lancet Global Health 2017;5:e828-38
- 11. What is Neededto Move Inclusive Health Forward? Purposefully seek out persons with disabilities – apparent and non-apparent – and obtain their input for program design Establish partnerships with disabled people’s organizations (DPOs) Ensure persons with disabilities are aware of their rights and the mechanisms for complaints Budget for inclusion Address misconceptions, stigma, and lack of knowledge of disability among health providers and community M&E to inform policy and guide future programming efforts Ensure representation in decision-making/governance bodies 11
- 12. 12 A Checklist forInclusive Programming LMG Project adapted tool: Inclusive Health Checklist
- 13. 13 Inclusive Programming Throughthe Project Cycle SITUATIONAL ANALYSIS PLANNING AND DESIGN HUMAN RIGHTS PRINCIPLES MONITORING AND EVALUATION IMPLEMENTATION Reproduced from: UNFPA, Harvard School of Public Health Program of International Health and Human Rights (2010) A human rights-based approach to programming. United Nations Population Fund, New York; Page 377 Inclusive Health Checklist • Human rights-based approach • Spark thinking about inclusion throughout the phases of the project cycle • Identify rights-holders and duty-bearers • Consider empowerment and accountability capacities
- 14. 14 Using the Checklistto Design & Deliver More Inclusive Programs (Example) Imagine that MSH recently won a $10 million award to support UHC reform in Kenya. The main objectives are to: 1. Improve service timeliness and quality through scale up of basic package of health services 2. Pilot and adapt decentralized financing mechanisms 3. Enhance institutional capacity of national health insurance agency and district level health management teams What are some steps we can take to ensure the project is inclusive of persons with disabilities?
- 15. 15 Step 1: SituationalAnalysis (Example) Who are the key rights-holders and duty-bearers? Right holders: Persons with disabilities (all types), Kenyan National Council for Persons with Disabilities, Association for the Physically Disabled of Kenya, United Disabled Persons Duty bearers: Health providers, MOPHS, National Health Insurance Fund of Kenya, Ministry of East African Community Labor and Social Protection (MEACLSP) What are the capacity gaps of persons with disabilities and gaps of duty-bearers? What are the relevant power relationships, discriminatory practices, stigma, inequities? Is the right to health for persons with disabilities protected in domestic laws/policies? Has the UNCRPD has been ratified? Ratified CRPD in May 2008, but not Optional Protocol. Disability rights added to constitution in 2010. There are disparities between health laws/reforms and practice, many legal provisions lack enforcement modalities. Financing remains a challenge. There is no law that expressly provides for free and informed consent to treatment, it is implied. Persons with disabilities are often shunned away in society, and lack opportunities to work or go to school. They do not have access to mainstream health services, particularly in rural areas. Stigma is especially high for mental health related disabilities. Persons with disabilities are not empowered to speak up against HS injustices. Many providers are not trained on disability. Weak MOPHS and MEACLSP coordination, especially at district level.
- 16. Step 2: Designand Planning (Example) Have you identified interventions to close gaps in empowerment capacities of persons with disabilities? Have you involved persons with disabilities in the planning of project activities? And established partnerships with DPOs? Stakeholder meetings are planned with GoK representatives, DPO representatives, health workers, and community members (with and without disabilities) to receive input on project design. Project staff pursue partnership with district level groups of United Disabled People of Kenya. Possible interventions: strengthening leadership of DPOs, developing advocacy skills, building networks and alliances, raising awareness of health rights and services available for persons with disabilities. Have you identified interventions to close gaps in accountability capacities of the duty-bearers? Possible interventions: training of health workers on rights and needs of persons with disabilities, addressing barriers to accessibility of services, establishing cross-ministry oversight to ensure health-related policies are inclusive and enforced, building HMIS capacity to collect disability data. 16 Have we ensured that project information, materials, and curricula will be available in accessible formats? Materials are made in large print, sign language interpreters are provided during meetings, reasonable accommodations will be factored into district budgets for service delivery, transportation costs are taken care of for people with mobility needs.
- 17. 17 Step 3: Implementation(Example) Are persons with particular types of disabilities not utilizing the project’s services? Have measures been taken to investigate these situations and target potentially excluded groups? Have you established routine ways for persons with disabilities to be engaged in activity implementation and in the review of progress/results? Have you established mechanisms and reviewed procedures to ensure that persons with disabilities are in fact benefiting from project implementation? Review of service statistics in 3 districts indicated that all service users with disabilities in the first quarter had physical disabilities. The project then established relationships with Kenya National Association of the Deaf and the Kenya Society for the Blind to identify possible barriers to accessing existing services. DPO partners participate in quarterly project review and planning meetings. Persons with disabilities are represented on district level UHC governance committees. Partners from United Disabled People of Kenya participate in monthly audits of services and conduct annual surveys of users and potential clients.
- 18. 18 Step 4: Monitoring& Evaluation (Example) Have persons with disabilities been involved in defining success for the project and establishing the M&E plan? DPOs have participated in the initial stakeholder meeting to establish the vision of the overall project as well as launch meetings in each target district where M&E plans were finalized. Did persons with disabilities and duty-bearers participate in deciding how the results will be disseminated? Is data routinely disaggregated by disability? Data is disaggregated by type of disability in accordance with Kenyan law by visual, hearing, learning or physical incapability. DPOs and GoK, along with other stakeholders, were consulted to design project results meetings within each district, resulting in the addition of sessions for dialogue between all parties to plan rollout of effective practices from insurance pilots to new regions.
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- 20. 20 THANK YOU! For moreinformation please contact: Kate Wilson – kwilson@msh.org Maggie Lamiell – mlamiell@msh.org Meredith Schlussel – mschlussel@msg.org
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- 22. Suggested Resources • WorldReport on Disability by World Health Organization & World Bank,(2011) • First ever world report on disability with comprehensive coverage of health issues. http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf • Promoting sexual and reproductive health for persons with disabilities by WHO & UNFPA • This guidance note addresses issues of sexual and reproductive health (SRH) programming for persons with disabilities. http://whqlibdoc.who.int/publications/2009/9789241598682_eng.pdf • A Health Handbook for Women with Disabilities by Hesperian Health Guides Developed with the participation of women with disabilities in 42 countries, this guide helps women with disabilities to overcome the barriers of social stigma and inadequate care to improve their general health, self-esteem, and independence. http://hesperian.org/books-and-resources/ • WHO Action Plan 2014-2021 “Better Health for Persons with Disabilities” • The Disability Action Plan outlines measures to assist Member States to align their national health and rehabilitation policies and plans with the CRPD. http://www.who.int/disabilities/policies/actionplan/disability_action_plan_en.pdf • QualityRights Tool Kit by World Health Organization • Provides countries with practical information and tools for assessing and improving quality and human rights standards in mental health and social care facilities. The Toolkit is based on the United Nations Convention on the Rights of Persons with Disabilities. http://www.who.int/mental_health/publications/QualityRights_toolkit/en/ • Make a Change!: A Call to Action from Women Leaders with Disabilities by MIUSA This video calls attention to the need for a new strategy for working toward disability inclusion in development and humanitarian programs. We are calling it the practice of "infiltration", in which people with disabilities are proactively participating in the services and programs which, as members of their communities, are rightfully theirs. http://www.youtube.com/watch?v=ojx2-IcA6oo 22
- 23. Connecting with DisabledPeople’s Organizations The LMG Project has started a list of contact info for DPOs: https://docs.google.com/a/msh.org/document/d/1FgQTMVPClA Y5Cg0un-a3Ha5MimTi0-m5bitFYJdUS1M/edit?usp=sharing 23
- 24. Text from UNConvention on the Rights of Persons with Disabilities, Article 25 – Right to Health States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. In particular, States Parties shall: a) Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes; b) Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons; c) Provide these health services as close as possible to people's own communities, including in rural areas; d) Require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical standards for public and private health care; e) Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance where such insurance is permitted by national law, which shall be provided in a fair and reasonable manner; 24
- 25. AAAQ Framework •Availability: Healthfacilities, goods, and services must be available in adequate numbers through a State, including adequate numbers of health care providers trained to provide disability-specific support and mental health-related services. •Accessibility: Includes four overlapping dimensions: • Non-discrimination • Physical accessibility • Economic accessibility • Information accessibility •Acceptability: Health care facilities, goods, and services provided to persons with disabilities must be culturally acceptable and respectful of medical ethics. •Quality: Health care facilities, goods, and services provided to persons with disabilities must be of good quality, as well as scientifically and medically appropriate. 25
- 26. SNAPSHOTS OF THELMG PROJECT’s INCLUSION PROGRAMS 26
- 27. 27 • Teams ofsenior decision makers from civil society and government • Work on sector-level challenge throughout program • Training includes: – Disability rights and UNCRPD – Good governance practices – Leading in teams – Strategic problem solving • 3 regional programs involving 15 countries and 103 participants SENIOR LEADERSHIP PROGRAM on Physical Rehabilitation and Disability Rights
- 28. PROGRAMS • East Africa:23 participants from Sudan, Ethiopia, Tanzania, Zambia • Southeast Asia: 38 participants from Cambodia, Laos PDR, Myanmar, Philippines, Vietnam • Francophone Africa: 42 participants from Togo, DRC, Burundi, Chad, Madagascar, Niger SAMPLE ACHIEVEMENTS: 28 EXAMPLES OF TEAM PROBLEMS: • Lack of materials and supplies for services • Under-utilized services at facilities • Insufficient human resources • Poor quality of services or low client satisfaction • Lack of services in particular regions • Lack of data on needs LMG/ICRC REGIONAL SENIOR LEADERSHIP PROGRAMS SAMPLE ACHIEVEMENTS: • Developed & piloted national data collection tool • Established national advisory groups • Increase national budget for PR • Held stakeholder meetings • Advocated for inclusion in health insurance • Drafted policy
- 29. 29 • Part ofWHO Wheelchair Service Training Package • Helps stakeholders: – understand need for and benefit of an appropriate wheelchair – understand their role in developing appropriate wheelchair provision and barrier-free environments; – increase quality of service delivery – gain more commitment to seek/provide appropriate budgetary support • 20 meetings in 18 countries WHEELCHAIR SERVICE STAKEHOLDER MEETINGS
- 30. 30 • LMG supportedMobility International USA (MIUSA) to scale up their WILD program –Action-planning so women identify how to use what they learn in the program –M&E and follow up coaching –Facilitator Guide so alumni can replicate WILD • Alumni return to their communities to lead change and advocate for their rights • Women from over 50 countries attended WILD in Eugene, Oregon –20 trained as WILD trainers WOMEN’S INSTITUTE ON LEADERSHIP AND DISABILITY (WILD)
- 31. RECOMMENDATIONS FOR ACTIONS TOOVERCOME PERSISTING BARRIERS AND REALIZE INCLUSIVE HEALTH (resulting from the roundtable discussions at the PMAC conference 2017) 31
- 32. 32 RECOMMENDATIONS FOR ACTION 1.“Nothing about us without us.” Support persons with disabilities to “infiltrate” the health system and become advocates, policy makers, and program implementers WITHIN the health system themselves. – Many persons with disabilities have been systematically excluded from education and isolated from society. They need education, capacity building, peer support and coaching to be prepared to advocate for their rights and engage in policy. Investments should be made to build this capacity at the community level. – Advocating is like advertising, you don’t know something is on sale until you see the ad. So for someone with a disability to be an effective advocate, they must be aware of their rights and understand the policy process.
- 33. 33 RECOMMENDATIONS FOR ACTION(continued) 2. Civil society advocates and technical experts should: – Strategically consider their audience and target messaging and approach accordingly – Identify key champions to influence change, looking for catalysts with influence who can get the ball rolling – Start where they can and demonstrate benefits to advocate for expansion – Aim to influence multiple levels of the system; consider what the Philippines calls a “bibingka approach”—working at both national level through high-level champions and grassroots level with community action. – National level action can be slow, but at lower levels local authorities may have resources at their immediate disposal. – Provide input to government on what data to collect and help make sure that the data collection process is accessible to all individuals , regardless of their type of disability. (e.g., including sign-language interpreters for house-hold surveys).
- 34. 34 RECOMMENDATIONS FOR ACTION(continued) 3. Government (ministry of health and health officials) should: • Establish some form of permanent counsel for persons with disabilities to support program and reform continuity, despite turnover of elected officials. This counsel should have the authority to work across government agencies and coordinate action. • Foster more partnerships for joint action with civil society. • Make sure the following are in place in the health system to ensure persons with disabilities are included in all health programs: supportive legislation, implementing regulations and responsible body within government with appropriate authority; standards and guidelines; measures and indicators for collecting data on inclusion. • Reach out to other ministries and agencies that affect health and health programming ,such as the planning and finance ministries.
- 35. 35 RECOMMENDATIONS FOR ACTION(continued) 4. Development partners should: • Support the development of tools which can help determine costs and budgetary requirements to ensure all health programs are inclusive of persons with disabilities • Support evidence-generation on the needs and the benefits of inclusive health • Support organizational capacity building for Disabled People’s Organizations (DPOs) • Advise governments and service providers on how to monitor and improve the quality of the implementation of inclusive health programs
Editor's Notes
- #2 How Inclusive Design and Programming Advances UHC Please join us for the LMG Project's second Technical Learning Seminar. The topic of this session is inclusive programming. Have you ever wondered if you were leaving people out in the design and implementation of programs? Or wished you had more tools to reach those who are hardest to reach so our programs truly support health for all? With 15 percent of the world's population living with some form of disability, we will discuss how MSH's Universal Health Coverage (UHC) priorities cannot be realized without inclusion and specifically how the LMG Project has engaged in this space. This seminar will explore the need for inclusive development, discuss how to consider inclusion throughout the project cycle, and provide some practical resources for you to use in your current work, regardless of the health area or building block you focus on. Learning objectives: - To raise awareness about inclusive development and its connection to UHC - To understand what an inclusive program model looks like, how to incorporate inclusion in the design of new programs, and how to identify opportunities to make our existing programs more inclusive - To provide actionable resources for inclusive programming Please come ready to learn what this means for our work at MSH and identify steps you can take with your teams to ensure our efforts toward universal coverage are truly universal.
- #4 LMG’s work is done in collaboration with existing USAID partners. Generally, these partners have existing projects with USAID and we are applying LMG is working with partner organizations (including International Committee for the Red Cross, Centers for Victims of Torture, Ponseti International Association, and Mobility International USA) LMG primarily focuses on strengthening the leadership capacity, strategic planning, management systems, governing boards, and organizational sustainability of partner organizations that provide services and protection for vulnerable groups. Additionally, LMG is working with partners to identify, test, and document the essential elements needed to successfully introduce, scale up, sustain, and ensure the quality of evidence-based intervention packages at the country-level. Throughout these activities, LMG is applying its gender approach to support the full and equal participation and inclusion of women and vulnerable persons in decision making, and opening the doors for these groups to take on and thrive in leadership positions at all levels.
- #6 This is our anchor, of which the other two focuses are key elements. In helping countries to achieve Universal Health Coverage (UHC), which has emerged in recent years as the consensus overall goal in global health, we will increasingly codify and leverage select signature tools and approaches that MSH has developed and proven through our field experience, particularly in the essential areas of leadership, management, and governance; health finance; and pharmaceutical/ commodities management – each of which is critical to building health systems that are able to sustainably provide universal access to equitable, high-quality care. We will ensure that these select tools and approaches are configurable and adaptable to context, that we clearly identify the specific elements that are essential to their efficacy, and that we collect and use evidence on how they contribute to achievement of UHC. Universal Health Coverage (UHC) has been defined as providing access to needed health services without incurring financial hardships for the whole population [1], and is receiving renewed attention at both global and national levels. In 2005 the Member States of the World Health Organization (WHO) adopted a resolution encouraging countries to develop health financing systems aimed at achieving UHC [2]. Recently, the quest for countries to achieve UHC has received significant support from key global players, with the WHO, World Bank and United Nations General Assembly all making commitments to the UHC agenda [3],[4]. The fact that millions of people still lack access to basic health care services motivates this attention [5]. Similarly, the costs associated with utilising health services place an immense financial burden on many households. Global estimates indicate that every year, nearly 150 million people experience catastrophic health expenditure where household out-of-pocket payments for health care consume such a proportion of their income that it forces them to forego other goods and services [6], while 100 million are pushed into poverty [1]. UHC is increasingly embraced at a global level as a priority in the post-2015 development agenda [3],[7]. Health is acknowledged as essential for human welfare and sustained economic and social development [1]. When people have poor health, with lack of health service being a one of the contributing factors, they often are vulnerable to poverty. At the same time, people seeking health services may incur impoverishing health costs [1]. This paradox provides an affirmation of the critical link between health, sustainable development and economic growth [8]. Ill health affects productivity and diverts households’ income to seeking health services, thus negatively impacting on economic and social development [5],[9]. Achieving UHC is primarily an issue of equity, ensuring that people can access the health services they need to keep them healthy and productive, while at the same time, safeguarding them from being pushed into poverty due to out-of-pocket health expenditures [3]. UHC strategy will contribute to improving health as well as reducing the vulnerability to poverty; thus contributing to the post-2015 agenda on sustainable development.
- #8 Disability is a global public health issue because people with disability, throughout the life course, face widespread barriers in accessing health and related services, such as rehabilitation, and have worse health outcomes than people without disability. There are more than 1000 million people with disability globally, that is about 15% of the world’s population or one in seven people. Of this number, between 110 million and 190 million adults experience significant difficulties in functioning. It is estimated that some 93 million children – or one in 20 of those under 15 years of age – live with a moderate or severe disability. The number of people who experience disability will continue to increase as populations age, with the global increase in chronic health conditions. National patterns of disability are influenced by trends in health conditions and environmental and other factors, such as road traffic crashes, falls, violence, humanitarian emergencies including natural disasters and conflict, unhealthy diet and substance abuse. 7. Disability disproportionately affects women, older people, and poor people. Children from poorer households, indigenous populations and those in ethnic minority groups are also at significantly higher risk of experiencing disability. Women and girls with disability are likely to experience “double discrimination”, which includes gender-based violence, abuse and marginalization. As a result, women with disability often face additional disadvantages when compared with men with disability and women without disability. Indigenous persons, internally displaced or stateless persons, refugees, migrants and prisoners with disability also face particular challenges in accessing services. The prevalence of disability is greater in lower-income countries than higher-income countries. In its outcome document of the high-level meeting on disability and development in 2013, the United Nations General Assembly noted that an estimated 80% of people with disability live in developing countries and stressed the need to ensure that persons with disabilities are included in all aspects of development, including the post-2015 development agenda. People with disability face widespread barriers in accessing services, such as those for health care (including medical care, therapy and assistive technologies), education, employment, and social services, including housing and transport. The origin of these barriers lies in, for example, inadequate legislation, policies and strategies; the lack of service provision; problems with the delivery of services; a lack of awareness and understanding about disability; negative attitudes and discrimination; lack of accessibility; inadequate funding; and lack of participation in decisions that directly affect their lives. Specific barriers also exist in relation to persons with disabilities being able to express their opinions and seek, receive and impart information and ideas on an equal basis with others and through their chosen means of communication. These barriers contribute to the disadvantages experienced by people with disability. Particularly in developing countries, people with disability experience poorer health than people without disability, as well as higher rates of poverty, lower rates of educational achievement and employment, reduced independence and restricted participation. Many of the barriers they face are avoidable and the disadvantage associated with disability can be overcome. The World report on disability synthesizes the best available evidence on how to overcome the barriers that persons with disability face in accessing health, rehabilitation, support and assistance services, their environments (such as buildings and transport), education and employment.
- #9 People with disabilities have the same general health care needs as everyone else, and therefore need access to mainstream health care services. Many of the barriers experienced by persons with disabilities are avoidable and the disadvantage associated with disability can be overcome. Households in poor countries with disabled members spend a third more of their income on health care compared with other households Persons with disabilities are commonly excluded from these health decision-making processes, which can hide or even reinforce health inequities Persons with disabilities experience greater unmet needs for services are more likely to be denied care have poorer health outcomes
- #10 All efforts to include fully persons with disabilities, their needs, and their concerns in health policy and programmes must confront multiple challenges. People’s impairments are not the source of these challenges. Instead, these are the challenges that the world imposes on persons with disabilities: Lack of awareness, knowledge, and understanding. Although one person in every 10 has a disability, persons with disabilities are often “invisible”. Policy-makers and providers often greatly underestimate the number of persons with disabilities. If they think there are few persons with disabilities, they may assign them low priority among groups needing attention. Also, they may assume incorrectly that persons with disabilities are not sexually active and so do not need SRH services. Prejudice and stigma. Public attitudes differ from place to place and among different types of disability. The great majority of persons with disabilities face prejudice and stigma in their daily lives. This prejudice underlies the deprivation of a wide range of human rights, from freedom of movement and association to health and education and pursuit of a livelihood. Physical and attitudinal barriers to health services. Physical barriers to access may reflect simple lack of awareness and forethought or else the assumption that “it costs too much” to remove these barriers. Changing misperceptions and prejudiced attitudes, however, may be more difficult to address than removing physical barriers. Exclusion of persons with disabilities from decision-making. Too often even programmes with the best intentions have treated persons with disabilities as a “target” – passive recipients of services. In fact, persons with disabilities constitute a significant stakeholder group that should have a place at the table whenever health programmes are planned and decisions are made. Their involvement is the best assurance that programmes will meet needs effectively.
- #11 Similar results in Chile’s review of their UHC program Some argue that disability should be a bellweather for international development. If people with disabilities are not being reached by development programs, then these efforts are not full effective. World Bank’s review of its own projects found that out of 2,576 active projects, only 52 (2%) were ultimately found to be inclusive of persons with disabilities, based on available documentation. --- apparent contradiction between public commitments and action “Leaving no one behind” as we work toward SDGs will require deliberate efforts to ensure the inclusion of persons with disabilities in health Health disparities will be reduced by making existing health care systems more inclusive at all levels and making public health programs accessible to persons with disabilities throughout the life course. Article 32 – inclusive development
- #12 Include disability questions/sections in existing sample surveys Effective multi-sectoral engagement to account for social determinants of health and address societal knowledge and attitudes for persons with all disabilities Explicit inclusion of persons with disabilities in all health programs rather than just offering specific disability services in a silo. Ensure that inclusions of persons with disabilities is seen not only as a development priority, but also one that comes with funding. Establish avenues for civil society advocates and persons with disabilities to access decision-makers and the legislative process (and build their capacity to be well-prepared to advocate and participate). Build a critical mass of disability advocates to increase the visibility and influence of inclusive movements.
- #13 approach (HRBA) is applied throughout the program cycle, as depicted in Figure A.[i] Figure A. Diagram of A Human Rights-Based Approach[ii A HRBA] seeks to analyze inequalities which lie at the heart of development problems and redress discriminatory practices and unjust distributions of power that impede development progress. - UNHCR Key benefits to a Human Rights Based Approach: 1. Promotes realization of human rights and helps government partners to uphold their commitments. 2. Increases and strengthens the participation of the local community. 3. Improves transparency. 4. Promotes results. 5. Increases accountability. 6. Reduces vulnerabilities by focusing on the most marginalized and excluded in society. 7. More likely to lead to sustained change as human rights-based programs have greater impact on norms and values, structures, policy and practice.
- #14 approach (HRBA) is applied throughout the program cycle, as depicted in Figure A.[i] Figure A. Diagram of A Human Rights-Based Approach[ii A HRBA] seeks to analyze inequalities which lie at the heart of development problems and redress discriminatory practices and unjust distributions of power that impede development progress. - UNHCR Key benefits to a Human Rights Based Approach: 1. Promotes realization of human rights and helps government partners to uphold their commitments. 2. Increases and strengthens the participation of the local community. 3. Improves transparency. 4. Promotes results. 5. Increases accountability. 6. Reduces vulnerabilities by focusing on the most marginalized and excluded in society. 7. More likely to lead to sustained change as human rights-based programs have greater impact on norms and values, structures, policy and practice.
- #15 As we proceed with project startup, design and implementation, what are some steps we can take to ensure the project is inclusive of persons with disabilities?
- #16 1. Have you identified key right-holders (persons with disabilities) and duty-bearers (those who govern – policymakers, health officials, health providers, etc.) that have a stake in your activity? 2. Have you identified power relationships, discriminatory practices, stigma, inequities faced by persons with disabilities in the project’s context? 3. Have you reviewed the extent to which the health rights of persons with disabilities are protected and promoted in [insert country name]’s constitution, domestic laws/policies? Has the UNCRPD been ratified? Have you explored the extent to which any applicable laws are implemented and enforced in practice? 4. Have you identified the empowerment capacity gaps of persons with disabilities that constrain them from claiming their right to health? And the accountability capacity gaps of duty-bearers to meet their obligations?
- #17 5. Have you involved persons with disabilities in the planning of project activities? 6. Have you established partnerships with disabled people’s organizations (DPOs) that can assist in accessing persons with disabilities and designing activities in a relevant way? 7. Have you considered the benefits and risks from potential project policies and activities for persons with disabilities in selecting implementation strategies? 8. Have you aligned the implementation strategy to ensure services/programs will be available, accessible, acceptable, and of high quality for persons with disabilities? And reviewed standards and policies to ensure participation, non-discrimination, and accountability? 9. Have you identified what interventions are required to close the most important gaps in empowerment capacities of persons with disabilities? 10. Have you identified what interventions are required to close the most important gaps in accountability capacities of the key duty-bearers? 11. Have you ensured that project information, materials, and curricula will be available in accessible formats? 12. Have you designed an orientation process for project staff and partners on disability inclusion?
- #18 13. Have you established routine ways for persons with disabilities to continue to be engaged in activity implementation and in the review of progress/results? 14. Have you established mechanisms and review procedures to ensure that persons with disabilities are in fact benefiting from project implementation? 15. Is project implementation contributing as intended to the empowerment capacities of persons with disabilities? And to the accountability capacities of duty-bearers? 16. Are persons with particular types of disabilities not utilizing the project’s services? Have measures been taken to investigate these situations and target potentially excluded groups? 17. Have unintentional discriminatory practices been identified during implementation? And if so, have they been rectified?
- #19 18. Have persons with disabilities been involved in defining success for the project and establishing the M&E plan? 19. Is data routinely disaggregated by disability? 20. Does the M&E plan include targets to measure progress in relation to availability, accessibility, acceptability, and quality of services? 21. Does the M&E plan measure the ways in which the project ensures human rights principles, including participation, inclusion, and transparency related to persons with disabilities? (Process Indicator) 22. Does the M&E plan measure goods, services and deliverables produced to develop the capacity of persons with disabilities and duty-bearers? (Output Indicator) 23. Does the M&E plan measure the legal, policy, institutional and behavioral changes leading to better performance of persons with disabilities in realizing their right to health and duty-bearers to meet their obligations? (Outcome Indicator) 24. Does the M&E plan measure sustained, positive changes in the life, dignity and wellbeing of persons with disabilities? (Impact Indicator) 25. Did persons with disabilities and duty-bearers participate in deciding how the results will be disseminated?
- #20 What is the current situation related to the right of health for persons with disabilities in our current programming? What actions can we to take to keep moving toward inclusive health? How can we explicitly include persons with disabilities in new programming when it is often not a donor requirement? Principle of Change: Start where you can and start now. What now? What stood out to you? Is anything surprising? What actions can we take to keep moving toward inclusive health? What is the current situation related to the right to health for persons with disabilities in your communities?
- #25 The right to health is indivisible, interdependent, and interrelated with other human rights
- #26 The right to health is not to be understood as a right to be healthy. The right to health contains both freedoms and entitlements. The freedoms include the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free from torture, non-consensual medical treatment, and experimentation. By contrast, the entitlements include the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable level of health. An important analytical framework used to deepen understanding of the content of the right to health is that health services, goods, and facilities, including the underlying determinants of health, shall be available, accessible, acceptable, and of good quality. This framework applies to mental and physical health care and related support services provided to persons with disabilities. · Non-discrimination: Mental and physical health care services must be available without discrimination on the basis of disability or any other prohibited ground. States must take positive measures to ensure equality of access to persons with disabilities. States must also ensure that persons with disabilities get the same level of medical care within the same systems as others. ·Physical accessibility: Health facilities, goods, and services must be within safe physical reach for persons with disabilities and other vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, and persons with HIV/AIDS. Accessibility also implies that medical services and underlying determinants of health, such as safe and potable water and adequate sanitation facilities, are accessible, within safe physical reach, including in rural areas. Accessibility further includes adequate access to buildings for persons with disabilities. · Economic accessibility: Health facilities, goods, and services, including medicines and assistive devices, must be economically accessible (affordable) to consumers with disabilities. · Information accessibility: Accessibility includes the right to seek, receive, and impart information and ideas concerning health issues. Information relating to health and other matters, including diagnosis and treatment, must be accessible to persons with disabilities. This entitlement is often denied to persons with disabilities because they are wrongly judged to lack the capacity to make or participate in decisions about their treatment and care. However, accessibility of information should not impair the right to have personal health data treated with confidentiality. Quality: Among other things, this quality requirement mandates skilled medical and other personnel who are provided with disability training, evidence-based interventions, scientifically approved and unexpired drugs, appropriate hospital equipment, safe and potable water, and adequate sanitation.
- #28 Overlapping themes from all 3 evaluations: The SLP fostered new relationships and professional networks. The participants better understood the UNCRPD and how to incorporate what they learned into their work. The field project allowed participants to practice their new leadership, management and governance skills, and improve their team building skills. The participants incorporated what they learned about leadership, management, and governance into their jobs.
- #29 3 programs, 6 languages, 9 workshops, 15 countries, 85 interviews, 103 participants
- #30 WHO realizes that trained personnel alone cannot ensure appropriate wheelchair provision in the country or carry out their responsibilities as outlined in the Wheelchair Guidelines, unless and until there is a higher level of involvement to establish or improve wheelchair provision within the country. The purpose of the training package is to create awareness and develop the skills and knowledge of all personnel required to be involved (stakeholders) in establishing appropriate wheelchair provision in their country/region. This package provides an overview of the stakeholder’s role, informing them about the need for and benefit of appropriate wheelchair provision and getting their support to develop an appropriate wheelchair provision programme. The training package can be delivered in a minimum of 3–4 hours, although this period may be extended according to the specific needs and resources available. Delivery of this training package will help stakeholders to: • improve their understanding about the need for and benefit of an appropriate wheelchair; • be better informed about their role in developing appropriate wheelchair provision; • increase the quality of wheelchair service delivery; • attain better understanding of barrier-free environments; • gain more commitment to seek/provide appropriate budgetary support; and • increase the sustainability of the wheelchair provision.