Measures to Ensure the Right of Persons with Disabilities to Health Services

The present section explores approaches to ensuring the right to health services for persons with disabilities. As with the implementation of other rights enshrined in the CRPD, there are a range of measures that can be taken by countries and other stakeholders to ensure the right to health services for persons with disabilities.

Legislative and Policy Frameworks

Countries have specific obligations under international law to respect, protect and ensure the right to health for persons with disabilities. States, in cooperation with persons with disabilities and their representative organizations, should conduct a review or scoping of all relevant legislation and policy that touches on the right of persons with disabilities to health care. Through this process, State parties can identify areas in need of reform or development, which can provide a foundation for establishing a comprehensive legislative and policy framework for the right to health for persons with disabilities. In developing new legislation and policy frameworks, it is essential that an implementation plan be established and that monitoring and evaluation processes are included. (See Module on National Action Plans).

In evaluating legislative and policy frameworks the following areas, among others, should be considered.

The Role of Doctors, Nurses, and Administrators

As members of the caring professions, health professionals have a particularly important role. Awareness among health service professionals of the needs of persons with disabilities in health care settings is, therefore, of paramount importance. Beyond understanding the rights and concerns of persons with disabilities, organizations representing persons with disabilities have reiterated the continuing attitudinal barriers in health care, including patronizing and ignorant front-line staff. Negative attitudes and harmful beliefs create significant barriers to the provision of health services for persons with disabilities. Measures to achieve genuinely inclusive health services must address attitudinal barriers including the education of health care professionals on the rights of persons with disabilities. Attitudinal barriers can have a devastating impact on the quality of health care particularly for people with learning and mental health disabilities who have a long history of misunderstanding, fear and stigma.

In the area of health services it is of utmost importance to involve frontline healthcare providers in daily contact with persons with disabilities in awareness-raising. Awareness- raising is essential to the building of organizational and individual capacity to deliver the range of health services that will enable persons with disabilities to live fully inclusive lives in their communities.

Physical Accessibility

Persons with disabilities with health problems cannot visit hospitals or health clinics if buildings are physically inaccessible to them. To ensure enjoyment of the right of persons with disabilities to health services, accessibility must therefore be addressed broadly, for example in relation to entrances to buildings and healthcare facilities, appropriate equipment, restroom facilities, and to transportation to the health care facility. Accessibility should be focused mainly on the difficulties of orientation to the health care setting, including completion of registration forms, location of a seat in the waiting area, and realization of when to enter the examination room.

Informational Barriers

Health service information is rarely available in formats that are accessible to persons with disabilities. This limits people's understanding of what services are available and how to access them , raising questions about:

1. whether the uptake of disability, mental health and general services by persons with disabilities is an accurate reflection of real need; and
2. the quality of informed consent to treatment that is being secured.

Health outreach and health promotion efforts also often fail to reach persons with disabilities.

Economic Barriers

Economic and financial factors are real barriers in relation to health service for persons with disabilities. While financial barriers within the health care system can affect members of the general population in accessing health care, persons with disabilities may experience additional disadvantages in their health and well-being. Low-income persons with disabilities are more likely to experience financial barriers to care. There are significant differences in the availability of services between those who are able to pay for services and those who do not have the resources to do so. In many countries, only those who can afford to pay for supportive devices such as crutches, hearing aids and reading glasses are able to receive them.

Ensuring DPOs' Participation

Health and social services support should be provided, organised and designed around what is important to service users from their own perspectives. User involvement and participation remains limited in the health sector, although there is now a greater awareness of the importance of developing effective forms of participation. This is consistent with the CRPD, which provides that persons with disabilities and their representative organizations should be consulted in law, policy and programming decisions (Art. 4(3).

In order to ensure a fully inclusive health sector, it is essential for government officials to consult with and ensure the participation - at all stages of health-related policy development, implementation, monitoring and evaluation - of persons with disabilities across the full range of disability, along with their representative organizations. It is recognized in relation to health services that there is no ‘one size fits all’, and that the services and situations in each community and country are unique and different.

DPOs may have valuable contributions to make in areas including the following:

• training of doctors, nurses and health professionals;
• design of accessible health services;
• advice on accessibility to the created environment;
• advice on communication access;
• identification of strategies for inclusion; and
• provision of support to families of persons and patients with disabilities.

A disability access focal point could be designated within each hospital or health clinic to serve as a resource and to interface with the disability community, with the families of patients with disabilities, and with others. DPOs should be included in all outreach to civil society organizations in relation to health service utilization.