Good Practice: WASH

TIMOR-LESTE

The Multi-stakeholder Partnership for Inclusive Water, Sanitation and Hygiene (2011)[1]

The overall objective of this seven-week inclusive WASH project was to ensure the successful mainstreaming    of   persons    with   disabilities'    needs   into   WASH   initiatives    through multistakeholder partnerships between NGOs and the government.    The Leprosy Mission implemented the project in collaboration with WaterAid, Plan International, DWASH, Bee Saneamentu no Igene iha Komunidade (BESIK), and Ra'es Hadomi Timor Oan (RHTO).

Partners worked with The Leprosy Mission to propose projects to all WASH agencies in Timor- Leste, gathered data on challenges facing persons with disabilities, developed sustainable solutions and training workshops for stakeholders, implemented training for stakeholders, and developed prototypes for technical solutions.

Partners also developed a report on recommendations for stakeholders to continue with WASH projects and followed up on the commitment of other stakeholders to continue working towards inclusive WASH in Timor-Leste.

The project achieved the following:

• Policy: implementation of guidelines on inclusive standards for water points and public toilets was launched in February 2011, and were integrated into the guidelines for the National Sanitation Policy. All new water points are built in accordance with the accessibility standard developed as part of the project.
• Capacity Building: the local DPO now provides training workshops on disability inclusive development for other stakeholders.
• Advocacy and Awareness: a member of the local DPO participated in a speaking tour of several Australian cities (Brisbane, Canberra, Melbourne, Townsville) promoting awareness of the challenges faced by persons with disabilities in rural Timor-Leste. The project was promoted through local Timorese radio stations and the international head offices of all agencies involved.
• Accessibility: educational brochures of inclusive WASH were produced in local dialects. The venue for the workshop and transportation were accessible to persons with disabilities.
• Participation: village engagement was the primary focus and local people were encouraged to share their WASH experiences and challenges during the sessions in the villages.Gender Issues: Gender experts were actively involved in the project, and the role of women as carers and helpers of persons with disabilities when using WASH facilities was emphasize.

Health and Persons with Psycho-social Disabilities

In some countries, people who are perceived as having a psychosocial disability or a mental health condition often face particular challenges in accessing health care and, worse, often face severe abuses in the context of care or treatment. These can include arbitrary detention in prisons or involuntary commitment to institutions, where residents may experience forced treatments and medication, verbal and physical abuse, poor conditions and overcrowding, and are often chained up for long periods of time[2].

Abuses have also been documented at community level where, due to false perceptions about persons with psychosocial disabilities, local health care providers - including traditional healers - sometimes also engage in abusive practices, often including shackling, even of children[3]. Families and relatives are often the main support mechanisms available to individual patients with various psychosocial disabilities, but frequently struggle to provide effective support, given the lack of community-based support facilities such as outpatient medical and rehabilitation services and counselling based on free and informed consent.

Mental and psychosocial disability is a universal disease with universal challenges. No continent, region, nor country is safe. However, remedial responses vary on the basis of culture, traditions, resources, policies and social and community consciousness. The adoption of the 2030 Agenda for Sustainable Development and the recognition therein of mental health as an important part of human health is a measure of much promise in the international mobilization in favour of mental health and well-being[4].

Resulting from the complex nature of mental health conditions, successful treatment requires regular access to health care professionals and a variety of support services. Unfortunately, mental health care services are often not available or are under-utilized, particularly in developing countries. The WHO has estimated that, in developed countries, the treatment gap (the percentage of persons who need mental health care but do not receive treatment) ranges from 44 per cent to 70 per cent; in developing countries, the treatment gap can be as high as 90  per cent. Common mental health conditions such as depression can be extremely disabling, yet many people with those conditions do not receive treatment[5].

Among the challenges to mental health care access are limited availability and affordability of mental health care services, insufficient mental health care policies, lack of education about mental illness, and stigma. In many countries, the cost of mental health services is a significant barrier to accessing care for persons with mental health conditions. Although many countries have introduced public mental health care, private mental health care, health insurance, and mixtures of these systems, persons with severe mental illness have a high level of economic and social disadvantage. Mental disorders are not covered by insurance policies in many countries, making mental health care unaffordable for many people. The WHO also reports that 25 per cent of all countries do not provide disability benefits to patients with mental disorders, and one-third of the world’s population lives in countries that allocate less than 1 per cent of their health budget to mental health. In addition, 31 per cent of countries do not have a specific public budget for mental health illness. This means that cost is, and remains, a significant barrier to accessing mental health services[6].

Another challenge to accessing mental health care is the availability of essential medicines and pharmaceuticals. This is a particularly challenge in many developing countries, and severely restricts access to treatment for mental disorders. The same WHO report highlights that almost 20 per cent of countries do not have at least one common antidepressant, one antipsychotic, and one antiepileptic medication available in primary care settings.

The WHO recommends the integration of specialized mental health services into primary healthcare. This helps to improve access to health care and reduces stigma for people with mental health disorders and their families. Stigma is reduced significantly because primary healthcare services are not associated with any specific health conditions, such as mental health disorders.

Raising awareness among healthcare professionals, social service providers, government officials, security authorities, caregivers, traditional and spiritual healers, and the public on the needs of persons with mental and psychosocial disabilities is very important in addressing and resolving harmful beliefs, negative attitudes, and prejudices. Awareness raising is essential in the building of organizational and individual capacity to deliver the range of health and social services that will enable persons with mental and psychosocial disabilities and their family members to live fully inclusive lives in their communities[7].