THE Zimbabwe National Disability Policy estimates 15% of the population to have a disability, about two billion people. This is a significant figure which is likely to increase considering demographic and epidemiological changes.
The causes of disability are many and include disease, accident/injury, old age and disasters. People with disabilities are at higher risk of developing secondary health conditions, such as infections, mental health and pressure sores. However, they are still being left behind in accessing health services leading to poorer health, undiagnosed and untreated conditions, limited ability to participate in every activity and early deaths.
They experience systemic barriers that include physical, communication, financial, attitudinal, and technological and policy barriers that prevent them from accessing quality healthcare.
Health inequities experienced by people with disabilities have been exacerbated by health emergencies such as the Cocid-19 pandemic. According to the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (2001), disability results from the interaction between health conditions or impairments and the environment.
The framework considers not just the medical condition but the functional impact of the condition, emphasising the broader spectrum of physical, mental and social well-being. Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) emphasises that people with disabilities have the right to the highest attainable standard of health without discrimination.
Hence people with disabilities should have access to health services that are gender-sensitive and inclusive of health-related rehabilitation.
The same range of standard and affordable healthcare provided to other people should be provided to people with disabilities and this should encompass the area of sexual and reproductive health. In addition, disability specific services that promote early identification should be designed and provided to minimise and prevent further disabilities.
Such services should be provided within communities and hardest to reach areas. Reducing health disparities can decrease healthcare costs associated with complications, hospitalisations and emergency care and enable people with disabilities to contribute fully to society and the economy.
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Health equity promotes social inclusion, enabling people with disabilities to participate fully in all aspects of life, enhancing their quality of life and overall well-being.
In line with article 26 of the CRPD, the provision of comprehensive habilitation and rehabilitation services and programmes in health will improve the functional abilities and assist people with disabilities to regain their skills, promoting greater independence and self- sufficiency.
Further, the intersecting identities of disability such as gender, age, religion and economic status should not be overlooked. For example, two people with the same health condition or impairment will experience disability differently. People with disabilities living in rural or hard to reach areas will experience greater challenges accessing health services.
Limited health literacy and the lack of accessible health information can prevent individuals with disabilities from understanding and managing their health conditions effectively.
The WHO Global Report on Health and Equity for Persons with Disabilities (2022) affirms that a wide-range of differences in health outcomes exist between people with disabilities and those without disabilities.
This is because people with disabilities die at a younger age as they are at higher risk of mortality than the general population.
People with disabilities have a higher rate of acquiring new health conditions, increasing morbidity. The differences in everyday functioning have been attributed to unfair conditions such as barriers to accessibility, restricted participation in society and discrimination on the grounds ofdisability.
While effort is being made to realise the right to the highest attainable standard of health for people with disabilities, inclusive actions are often not practiced, reducing access to healthcare including rehabilitation services.
Recommendations Addressing factors such as stigma and discrimination, poverty, education and employment opportunities will promote access to affordable healthcare and assistive technologies by people with disabilities.
Further, physical, communication and attitudinal barriers should be addressed in healthcare facilities. Healthcare professionals should be trained on disability inclusion and specific health needs of people with disabilities.
Health information should be provided in accessible formats such as braille, large print and easy to read.
In addition, people with disabilities should be educated about their health rights and available services. The provision of health services should consider measures that promote fair provision of services without hardship including health promotion and prevention strategies.
To achieve universal health coverage financial barriers should be addressed to reduce patient out of pocket payments and service delivery models should not restrict access and be more inclusive and accessible.
Health insurance coverage must include essential services for people with disabilities such as rehabilitation, assistive technologies and long-term care.
Where possible, subsidies and financial assistance programmes should cover medical care, assistive technologies and patient out of pocket payments.
Most assistive technologies and medication for long-term care are beyond the reach of many people with disabilities, therefore promoting and regulating healthcare pricing and preventing excessive pricing is essential.
The strengthening of community-based services is essential to support independent living and community participation.
The role of caregivers should not be overlooked; hence support should be provided to caregivers and families of people with disabilities.
Disability specific services require long term planning and strategies that are inclusive to facilitate progressive realisation, prioritising the most disadvantaged and providing cost effective, relevant interventions.
To achieve this goal, conducting research on health disparitiesaffecting people with disabilities will inform policy and practice.
Alternatively, mainstream health services such as screening, assessments and sexual reproductive health services must be inclusive of people with disabilities.
Strengthening the primary health system will entail building the capacity of health professionals to adopt inclusive approaches in providing essential care and empowering people with disabilities and their families to increase social participation and enhance self-care and self-reliance in health. A person-centred care approach to healthcare should be adopted to address unique experiences and needs of individuals with disabilities.
Understanding the diverse needs of people with disabilities will guide the equitable allocation of resources.
For a more sustainable solution, adopting policies that support employment of people with disabilities will provide them with a stable income and other health benefits.
Providing inclusive healthcare services requires collaboration among governments, healthcare providers, disability advocacy groups and the community. It is a moral and ethical obligation that promotes a fair and inclusive society.
- Tigere is a development practitioner and writes in her personal capacity. These weekly New Horizon articles, published in the Zimbabwe Independent, are coordinated by Lovemore Kadenge, an independent consultant, managing consultant of Zawale Consultants (Pvt) Ltd, past president of the Zimbabwe Economics Society and past president of the Chartered Governance & Accountancy Institute in Zimbabwe. — kadenge.zes@gmail.com or +263 772 382 852.
