Good Practice: Supporting and Ensuring DPOs Participation

BANGLADESH

WISH2ACTION: Organisation for Persons with Disabilities (OPDs) Championing on Disability Inclusive Sexual and Reproductive Health and Rights (SRHR) Services[1]

From September 2018 to August 2021, HI implemented its WISH2ACTION project in Bangladesh to include persons with disabilities in SRHR services through community engagement and national policy changes. Instead of establishing new networks, WISH2ACTION leveraged ODPs existing structures at the national and community level to implement project activities, including:

 

  • disseminating SRHR information on services to persons with disabilities;
  • lobbying to create community outreaches so that the services are accessible in the communities;
  • advocating for and facilitating training of disability-inclusive SRHR services.
  • advocating at the health facility level to make the health facility infrastructure and services disability inclusive; and
  • offering representation of persons with disabilities in community structures (e.g., CMCs) to share the challenges faced by persons with disabilities in accessing SRHR services, and support in identifying possible solutions.

Through working with ODPs, WISH2ACTION increased the number of persons with disabilities receiving SRHR services. Additionally, ODPs enhanced their ability to advocate actively for SRHR services for persons with disabilities, resulting in behavioral changes within communities and empowering women with disabilities to confidently, "speak up on SRHR issues and their rights." In training ODP members on SRHR, WISH2ACTION also addressed common resource restraints, such as limited access to funding and training that helped groups expand the scope of their work and support to persons with disabilities.

Institutional Structures to Support Access to Health Services

Persons with disabilities should be able to access health services within the general health system. Institutional structures at national level must work to ensure the adequate provision of health services for persons with disabilities. In many cases disability issues are addressed primarily by a focal ministry, often a ministry for social affairs. The Health Ministry in many countries has responsibility for mainstreaming disability across all relevant parts of the health services and for rolling out the latest medical and surgical advances to help persons with disabilities lead fuller and more active lives.

Mainstreaming in the context of health promotes inclusion and addresses the barriers that exclude persons with disabilities from accessing health services open to the general population. Mainstreaming is about making appropriate adjustments to healthcare services, policies, practice, facilities and delivery so that persons with disabilities can achieve full inclusion and active, barrier-free participation in health care and enjoy the benefits of advances in medical science and technology. Moreover, as disability is present throughout the entire life cycle, so health services must be available and accessible to persons with disabilities at all stages of life.

The CRPD calls for the establishment of (i) a national framework for its implementation and monitoring (Art. 33), consisting of one or more ‘focal points’ within government, (ii) the possible establishment of a ‘coordination mechanism’ to promote, protect and monitor implementation, and (iii) the designation or establishment of an independent monitoring mechanism. This framework, which must also include the participation of persons with disabilities and their representative organizations, should be harnessed to advance implementation of health rights, and to ensure that efforts in this regard are harmonized across the government.

Budgeting

The non-affordability of health services and transport accounts for two of the main reasons why persons with disabilities do not receive needed health care in low-income countries. Many governments around the world have difficulty providing adequate resources for the health services. There is often very severe competing pressure within health budgets for limited resources, and services such as those provided by general hospitals do not cover the needs of persons with disabilities. In many countries current budgetary allocations are not enough to make significant impacts in the field of services for persons with disabilities. Nonetheless, governments can improve health outcomes for persons with disabilities by making health services affordable, within the best use of the available resources.

In many countries in both the developed and developing worlds, there has been a significant increase in the range and diversity of health and personal social services provided by private health care providers. Where private health insurance dominates private health markets and care financing, governments should ensure that persons with disabilities are covered and consider measures to make health premiums affordable. Governments should use financial incentives to encourage health care providers to make services accessible and provide comprehensive assessments, treatment, and follow-up. Governments should also consider options for reducing or removing out-of-pocket payments for people with disabilities who do not have other means of financing their need for health care services.

Collecting Data on the Provision of Health Care Services for Persons with Disabilities

Data on the rate at which persons with disabilities use health services is often not readily available in many countries. The uptake of health services by persons with disabilities is rarely measured in several countries. General surveys do not fully or consistently disaggregate data on disability in such a way that a distinct analysis of the social, economic and demographic factors relating to disability in health services can be made. The CRPD requires States to collect appropriate information, including statistical and research data, to enable them to formulate and implement policies to give effect to inclusive health services and other rights guaranteed in the treaty.

According to WHO, there are “insufficient rigorous and comparable data and research related to disability and health care systems nationally and globally. Data are collected on mortality, but policy-relevant data on functioning and disability are lacking. National data collection systems, which may include censuses, population surveys and administrative data registries, do not often collect data on disability. People with disability are often excluded from trials that seek scientific evidence for the outcomes of a health intervention. The lack of evidence is a significant barrier for decision-making and in turn impacts on access to mainstream health care and specialized services for people with disability.[2]”

Per WHO, Data needed to strengthen health care systems include: number of people and health status of people with disability; social and environmental barriers, including discrimination; responsiveness of health care systems to persons with disabilities; use of health care services by people with disability; rehabilitation and habilitation needs and the extent of the need, both met and unmet, for care. Disaggregating these data further by sex, age, income or occupation is important for uncovering patterns, trends and other information about “subgroups” of people with disability[3].

[1]  Excerpted from: Faruk Ahmed Jalal et al., Step Towards Disability Inclusive Sexual Reproductive Health: Learnings from WISH2ACTION Project (Bangledesh), August 2021). © Handicap International – Humanity & Inclusion, Bangladesh

[2] See WHO: Objective 3: To strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services.

[3] WHO: Disability and Rehabilitation Team: www.who.int/disabilities.