Leading the way for inclusion: Disability and rehabilitation post-COVID-19
16 December 2021
In this blog Linda L. Thumba from ReLAB-HS, provides a recap on our recent webinar Leading the way for inclusion: Disability and rehabilitation post-COVID-19.
In the last two years society has been impacted by COVID-19 in more ways than we could have ever imagined. Persons with disabilities have disproportionately been affected by the pandemic, further amplifying their vulnerability and limited access to crucial health care services, and policies and society have yet to fully address these issues. Given the evolution of COVID-19, highlighted by various waves, and now with the discovery of the Omicron variant, it is increasingly important to learn from our past in dealing with the virus and truly take a person-centered approach to provide scalable health and rehabilitation services for persons with disabilities.
To mark International Day of Persons with Disabilities on December 3, 2021, a panel was assembled by Learning, Acting and Building for Rehabilitation in Health Systems Consortium (ReLAB-HS) to discuss this matter. Hosted by Rosemary Morgan, ReLAB-HS Gender Equality and Social Inclusion (GESI) Coordinator, the webinar was intended to draw attention to the needs of persons with disabilities particularly in light of the COVID-19 pandemic. The panel consisted of professionals working towards greater inclusion of persons with disabilities, including Lillian Asiimwe from ReLAB-HS Uganda, Diana Shcherninina from ReLAB-HS Ukraine, and Muhammad Iqbal from ReLAB-HS Pakistan, and ReLAB-HS Program Director, Abdulgafoor M Bachani from Johns Hopkins International Injury Research Unit. Below you can watch the full video of the webinar:
Rehabilitation and assistive technology (AT) services remain hard to reach
With around 1 billion people globally having at least one disability, and approximately 2.4 billion individuals who could benefit from rehabilitation and assistive technology services, COVID-19 has magnified the existing barriers to quality health services.
Geographic limitations persist in many countries with rehabilitation facilities primarily in urban areas. Muhammad Iqbal indicated that in Pakistan this may be linked to inadequate census data collection which inaccurately captures information about the degree of complexity of disabilities and the needs of the population. In Uganda, community-based rehabilitation services are no longer functional.
We heard from the panelists about attitudinal and communication barriers, for example, the lack of social acceptance of users of AT in Pakistan, and limited training among the health workforce to communicate with and provide services that meet the rehabilitation and AT needs in Uganda.
Infrastructure was also identified as a barrier, with aging health and rehabilitation facilities in Uganda having physical barriers that limit persons with disabilities from accessing these buildings, and patient beds that are ill-suited for their needs. In Ukraine, the requirement of an official disability status, and the associated long waiting times to acquire this status, renders many helpless, having to go without rehabilitation for months.
Impact of COVID-19
Throughout the pandemic we have all had to adapt to a narrowly defined way of interacting, with social distancing, increased frequency of hand washing, wearing masks, and virtual interactions. This has profoundly impacted engagement and inclusion of persons with disabilities who depend on reading lips for communication, or maybe unaware of physical proximity due to blindness.
Panelist Muhammad Iqbal discussed that in a country like Pakistan, a large proportion of important messaging around COVID-19 has not been available in the necessary formats, such as braille, sign language etc, for persons with disabilities. And with the increased burden on health systems managing COVID-19 patients, when a person with disabilities falls ill, the staff may not have the necessary sensitivity and skills to attend to their needs. Lillian Asiimwe discussed how in Uganda, limitations in health workforce skills to communicate or provide services for persons with disabilities, may have an impact on their experience of services. Diana Shcherbinina discussed how in Ukraine those who do not fall ill but still require rehabilitation services have been left to figure it out by independently locating, and in some cases, financing their own services outside of the main health centers.
Some countries have policies, others don’t, but still no action
Lillian pointed out that there appears to be commendable political will in Uganda. Although they have considerable depth of legislation in response to the Convention on the Rights of Persons with Disabilities, with policies promising access to free health care for all, various forms of rehabilitation services have been excluded. According to the Uganda Functional Difficulties Survey, Lillian pointed out, that of those who need assistive technology, close to two thirds of persons with disabilities still do not have access. The implementation of such policies falls short by excluding essential services like rehabilitation. In Ukraine, while there may be some policies in existence, the population has limited awareness of the rights afforded to them. In Pakistan there appears to be greater grassroots action with local level advocacy efforts, however, at the national level there is a lack of leadership to amplify those voices.
Leading the way
Program Director Abdulgafoor M Bachani summed up the webinar by highlighting the importance of accurate and comprehensive measurements and data collection, and recognizing that facilities or programs can only address what is known empirically and diagnostically. Echoing the fact that a person-centered, GESI approach is key, Abdul emphasized the need to strengthen various aspects of the health system to better address the specific needs of persons with disabilities, which in turn, would benefit the entire population. This discussion illuminated a few of the health system realities in the three countries, but will certainly apply to many more settings across the globe. While COVID-19 has shown us that we still have many uphill battles, the resolve of persons with disabilities remains, and it is our job as a society to see, hear, and count persons with disabilities and all individuals with rehabilitation needs to build more inclusive communities.