Access to health care of persons with disabilities as an indicator of equity in health systems

Health systems are often evaluated using indicators such as maternal mortality, which reflect the health status of the population and the effectiveness of health services. Addressing the right to health of persons with disabilities is a significant challenge for health systems because health services for this subgroup are interdependent on other sectors in society, such as education, employment and transportation. By considering health care access of persons with disabilities, it is possible to evaluate the overall effectiveness of the health system in terms of equity, accessibility and right to health

Accessible Home Environments for People with Functional Limitations: A Systematic Review

The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home

Predictors of Utilisation of Skilled Maternal Healthcare in Lilongwe District, Malawi

Background: Despite numerous efforts to improve maternal and child health in Malawi, maternal and newborn mortality rates remain very high, with the country having one of the highest maternal mortality ratios globally. The aim of this study was to identify which individual factors best predict utilisation of skilled maternal healthcare in a sample of women residing in Lilongwe district of Malawi. Identifying which of these factors play a significant role in determining utilisation of skilled maternal healthcare is required to inform policies and programming in the interest of achieving increased utilisation of skilled maternal healthcare in Malawi.Methods: This study used secondary data from the Woman’s Questionnaire of the 2010 Malawi Demographic and Health Survey (MDHS). Data was analysed from 1126 women aged between 15 and 49 living in Lilongwe. Multivariate logistic regression was conducted to determine significant predictors of maternal healthcare utilisation. Results: Women’s residence (P = .006), education (P = .004), and wealth (P = .018) were significant predictors of utilisation of maternal healthcare provided by a skilled attendant. Urban women were less likely (odds ratio [OR] = 0.47, P = .006, 95% CI = 0.28–0.81) to utilise a continuum of maternal healthcare from a skilled health attendant compared to rural women. Similarly, women with less education (OR = 0.32, P = .001, 95% CI = 0.16–0.64), and poor women (OR = 0.50, P = .04, 95% CI = 0.26–0.97) were less likely to use a continuum of maternal healthcare from a skilled health attendant.Conclusion: Policies and programmes should aim to increase utilisation of skilled maternal healthcare for women with less education and low-income status. Specifically, emphasis should be placed on promoting education and economic empowerment initiatives, and creating awareness about use of maternal healthcare services among girls, women and their respective communities

HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: differential access to HIV/AIDS information and services

Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41–0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18–1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda’s AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities

Policies and Processes for Social Inclusion: Using EquiFrame and EquIPP for Policy Dialogue Comment on “Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development”

The application of EquiFrame in the analysis of sexual and reproductive health policies by Ivanova et al to a new thematic area, their selection of only some of the Core Concepts of human rights in health service provision and the addition of new vulnerable groups relevant to the purpose of their analysis, are all very welcome developments. We also applaud their application of EquiFrame to policies in countries where it has not previously been used, along with their use of interviews with policy-makers to produce a deeper understanding of policy processes. We argue that clear justification for the inclusion of additional, or replacement of some exiting vulnerable groups within EquiFrame should be accompanied by clear definitions of such groups, along with the evidence-base that justifies their classification as a vulnerable or marginalised group. To illustrate the versatility of EquiFrame, we summarise a range of ways in which it has been used across a number of regions; including a brief Case Study of its use to develop the National Health Policy of Malawi. While EquiFrame focuses on policy content, we preview a new policy analysis tool – Equity and Inclusion in Policy Processes (EquIPP) – which assesses the extent of equity and inclusion in broader policy processes. Together, EquiFrame and EquIPP can be used to help governments and civil society ensure that policies are addressing the much stronger emphasis on social inclusion, now apparent in the Sustainable Development Goals (SDGs). Keywords: Policy Analysis, EquiFrame, Equity an

Assistive technology for older persons – analyses of data from WHO's rapid assistive technology assessment

With a growing population of older persons globally, the need for mainstream assistive technology (AT) as well as assistive technology specifically intended for older persons is on the increase. The association between age and functional limitations strongly indicates a growing demand due the current demographic development. There was however until recently limited data that can describe the situation, monitor development and compare between countries and populations. Quality data is essential for developing regional, national and international responses to current and future need for AT globally. The Global Report on Assistive Technology (GReAT) was launched on 16th May 2022 and highlights both substantial gaps in provision of AT and AT related services globally and in particular in low- and middle-income countries. As part of the process leading up to the GReAT, World Health Organization and partners developed the "rapid Assistive Technology Assessment" (rATA) survey to enable data collection that for the first time can provide estimates of AT use and need in a global perspective. The purpose of this presentation is to present key indicators from rATA among older persons in the countries that participated in the global data collection.publishedVersio

Global report on assistive technology

There is a large, unmet need for assistive technology worldwide. The Global report on assistive technology was developed in response to the World Health Assembly resolution (WHA71.8) on improving access to assistive technology adopted in May 2018. The Global report is expected to play an instrumental role in setting the global roadmap for improving access to assistive technology for everyone, everywhere. The Global report on assistive technology presents a comprehensive dataset and analysis of current assistive technology access, drawing the attention of governments and civil society to the need for, and benefit of, assistive technology, including its return on investment. The Global report sets out ten recommendations for improving access to assistive technology, which in turn support the achievement of the Sustainable Development Goals, inclusive Universal Health Coverage, and alignment with the Convention on the Rights of Persons with Disabilities. Guided by an Expert Advisory Group, the WHO and UNICEF have jointly developed this report in the context of an integrated approach, based on the best available scientific evidence and international experience, in collaboration with stakeholders from diverse settings, multiple countries, and all regions. It is primarily directed at policy-makers, providers of assistive technology, donors and funding agencies, and industry leaders. It is also aimed at broader stakeholders including users and potential users of assistive technology and their families or caregivers.publishedVersio

Moving from family care to residential and supported accommodation: a national, longitudinal study of people with intellectual disabilities

A cohort of nearly 11,000 persons was traced over 8 years to determine those who had moved from family care and those who had remained. The majority (85%) continued to live with families, and, for two thirds (67%), no future move was deemed necessary. The 2 main predictors of moving were as follows: A need had been previously recorded and the family had used out-of-home respite services during the 8 years. However, just one quarter of those identified as needing to move had done so in the 8 years. Conversely, no prior indication of need had been recorded for two thirds of people who had moved in this period. The complexities of assessing need and equitably meeting demands are discussed

Human resources for health: focusing on people with disabilities

The abstract is included in the text