Global Good Practices: Access to Health

Bangladesh

WISH2ACTION: Improving Accessibility of Health Centres through Universal Design and Reasonable Accommodation[1]

In accordance with Bangladesh’s “Rights and Protection of Persons with Disabilities Act, 2013”, health services providers are required to make changes or ‘reasonable adjustments’ to their practices to improve delivery of services for persons with disabilities and protect them from discrimination or disadvantage. As such, the Government of Bangladesh established Union Health and Family Planning centres at the rural community level under the Director- General of Family Planning (DGFP), Ministry of Health and Family Welfare. However, given that universal accessibility design was not considered during their development, the centres initially remained inaccessible for persons with disabilities and vulnerable patients

Handicap International's (HI) FCDO-funded WISH2ACTION project, implemented in the Sitakund Upazila region, aims for a barrier-free environment for persons with disabilities to improve their participation in community facilities, including sexual reproductive and health (SRH) services. Through the WISH2ACTION project, HI partnered with the Government of Bangladesh, local NGOs, and organizations for persons with disabilities (OPDs) to make structural changes to select centres for family planning and SRH services accessible. WISH2ACTION's two-pronged approach comprised disseminating information on accessible SRH services to persons with disabilities, including providing door-to-door counseling on family planning, neonatal services, and adolescent healthcare. Then, WISH2ACTION staff and ODP members encouraged persons with disabilities to visit their local health centres for services once centres were accessible for their assistive devices.

Finland

A Disability Card to Support Equal Access[2]

In 2016, the European Union (EU) piloted the "EU Disability Card" in eight countries, including Finland, for persons with disabilities to communicate their needs and access support across the EU Member States. The Finnish Service Foundation for People with an Intellectual Disability (KVPS) coordinated the implementation of the national trial from 2018 to 2020 in collaboration with other NGO partners, the Finnish Disability Forum, and the Social Insurance Institution of Finland to promote the card.

Between June and October 2018, over 4,000 persons with disabilities in Finland requested the card. The Finnish disability card, which includes a photo and braille text, allows people to choose symbols to put on the back of the card, indicating the type of assistance they require. Individuals can also include a QR code linking to information on their condition or the "What Matters to Me" app, developed by the Finnish organization Bester in partnership with persons with disabilities. The app allows people to store information about their support needs to share as necessary.

USA

The Rehabilitation Act of 1973 and Americans with Disabilities Act (ADA) of 1990[3]

Section 504 of the US Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by any program or activity receiving federal financial assistance. It requires compliance with specific standards for design and construction of new facilities and ensures the accessibility of programs as a whole. Furthermore, the Americans with Disabilities Act (ADA) of 1990, Title II (ADA) extends protection against discrimination to the full range of state and local government services, programmes, and activities. It requires covered public entities to provide equal access to programs, services, and activities for persons with disabilities. The Title II regulations and ADA Standards for Accessible Design include specific requirements regarding new construction and alterations to buildings and facilities, including health care facilities, as well as requirements for service animals, communications, and telecommunications. For existing facilities that are not accessible, program access requirements under Title II allow public entities the option to relocate programmes or to provide accessible services at other locations.

Water, Sanitation, and Hygiene (WASH)

Access to water, sanitation and hygiene (WASH) facilities is a precondition of good health for all persons. Article 28 of the Convention ensures ‘equal access by persons with disabilities to clean water services, and to ensure access to appropriate and affordable services, devices and other assistance for disability-related needs’. For many years, the sanitation and hygiene needs of persons with disabilities have been treated as of low priority. Many persons with a disability live without access to basic sanitary services, which can exacerbate impairments and poverty.

Disabled persons are likely to experience increased health risks because of a lack of access to sanitation and hygiene services. The lack of inclusive facilities means that persons with disabilities sometimes must engage in unhygienic and dangerous practices. Access to safe and clean water and sanitation facilities is a basic right of all persons, including persons with disabilities, denial of which can have serious implications for their well- being. For example, inaccessible toilet and water facilities are major contributory factors to school dropouts among children with disabilities, especially girls.

Sanitation and hygiene programmes have to mainstream the needs of persons with disabilities. Further, sanitation projects need to go beyond technical solutions and address attitudinal and institutional barriers to accessible sanitation. Better facilities reduce exposure to disease and illness, thereby increasing opportunities and life chances for disabled persons. To apply successful policies and practices more widely, the participation of persons with disabilities in inclusive sanitation and hygiene programme design is crucial, including sharing successful examples. The benefits far outweigh the cost of improved access for all.

[1]Exerpted from: STEP TOWARDS DISABILITY INCLUSIVE SEXUAL REPRODUCTIVE HEALTH: LEARNINGS FROM WISH2ACTION PROJECT

[2]Zero project: Innovative Policy 2019 on Independent Living and Political Participation

[3]Americanswith Disabilities Act of 1990. https://www.ada.gov/pubs/adastatute08.pdf. Title II of the ADA is enforced by the U.S. Department of Justice, Civil Rights Division, Disability Rights Section, and the HHS Office for Civil Rights. The Title II regulations are set forth at 28 C.F.R. Part 35.