Policy Development: An Analysis of Disability Inclusion in a Selection of African Union Policies Inclusive

Contemporary debates in international development discourse are concerned with the non-tokenistic inclusion and participation of marginalised groups in the policy-making process in developing countries. This is directly relevant to disabled people in Africa, which is the focus on this article. The United Nations Convention on the Rights of Persons with Disabilities delineates the principles of inclusion in society. Furthermore, the African Union (AU) plays a key role in advising its Member States and with regard to disability issues, whose advice should be reflected in disability-inclusive policies. This paper analyses nine policy or strategy documents produced by the AU, covering the policy domains of education, health, employment and social protection that are crucial to the development of disabled people. These were analysed according to seven discrete elements (rights, accessibility, inclusivity, implementation plans, budgetary allocations, enforcement and disaggregated management information systems) using a rating scale of one to four with four being the highest level of inclusion. The process (for example, level of consultation), the context (for example, the Millennium Development Goals and the Sustainable Development Goals) and actors involved in the policy development were reviewed as far as was possible from the documents. None of the policies reached even 50% of the total possible score, indicating poor levels genuine of inclusion. Rights scored a highest rating but this is still at a low level. This suggests that there is recognition of the rights of disabled people to inclusion, but this is not generally integrated within inclusive implementation plans, budgetary allocations, enforcement mechanisms and disaggregated management information systems for monitoring. The limited socio-economic inclusion of disability within AU policies is indeed a lost opportunity that should be reviewed and rectified. The findings have broader ramifications for the non-tokenistic and genuine involvement of poor and marginalised groups in the international policy-making arena

Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

Background: Disability and caste are two different forms of oppression; however, people of the Dalit caste in Nepal and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15–49 years. Maternal healthcare service utilization was assessed by antenatal care (ANC), health facility (HF) delivery, and postnatal care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by inclusion of a disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery, and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30–0.84) and PNC (OR 0.47, CI 0.25–0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste, and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05–0.74). Conclusions: Disabled women—whether Dalit or non-Dalit—had lower rates of utilizing all maternal healthcare services than non-disabled women. Interestingly, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention be re-examined and more nuanced interventions considered to ensure improved access and outcomes among all vulnerable groups

Протеом липопротеинов высокой плотности

БЕЛКИЛИПОПРОТЕИНЫ, ЛВППРОТЕО

Mental illness, poverty and stigma in India: a case-control study

Objective: To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mentalillness(PSMI) in Delhi, India, controlling for gender, age and caste. Design: Matching case(hospital)–control(population) study. Setting:University Hospital (cases) and National Capital Region (controls),India. Participants: A case–control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophreniaor affective disorders were recruited and 647 individuals of same age,sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded. Main outcome measures: Higher risk of poverty due to stigma among PSMI. Results :38.5% of PSMI compared with 22.2%of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma(OR 2.60,95%CI 1.27 to 5.31) ,scheduled castes/scheduled tribes/other backward castes(2.39,1.39 to 4.08),mental illness (2.07,1.25 to 3.41)and female gender(1.87,1.36 to 2.58).A significant interaction between stigma,mental illness and gender or caste indicates female PSMI or PSMI from ‘lower castes’ were more likely to be poor due to stigma than male controls(p\u3c0.001)or controls from other castes(p\u3c0.001). Conclusions: Public stigma and multidimensional poverty linked to SMI are pervasive and intertwined.In particular for low caste and women,it is a strong predictor of poverty.Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty,increasing the burden for the family. Mental health professionals need to be aware of and address these issues

Malnutrition and disability: unexplored opportunities for collaboration

There is increasing international interest in the links between malnutrition and disability: both are major global public health problems, both are key human rights concerns, and both are currently prominent within the global health agenda. In this review, interactions between the two fields are explored and it is argued that strengthening links would lead to important mutual benefits and synergies. At numerous points throughout the life-cycle, malnutrition can cause or contribute to an individual's physical, sensory, intellectual or mental health disability. By working more closely together, these problems can be transformed into opportunities: nutrition services and programmes for children and adults can act as entry points to address and, in some cases, avoid or mitigate disability; disability programmes can improve nutrition for the children and adults they serve. For this to happen, however, political commitment and resources are needed, as are better data

Malnutrition and disability: unexplored opportunities for collaboration.

There is increasing international interest in the links between malnutrition and disability: both are major global public health problems, both are key human rights concerns, and both are currently prominent within the global health agenda. In this review, interactions between the two fields are explored and it is argued that strengthening links would lead to important mutual benefits and synergies. At numerous points throughout the life-cycle, malnutrition can cause or contribute to an individual's physical, sensory, intellectual or mental health disability. By working more closely together, these problems can be transformed into opportunities: nutrition services and programmes for children and adults can act as entry points to address and, in some cases, avoid or mitigate disability; disability programmes can improve nutrition for the children and adults they serve. For this to happen, however, political commitment and resources are needed, as are better data