Disability inclusive healthcare planning and policy in Zimbabwe

ACCORDING to the World Health Organisation (WHO) 2011 Global report on disability, 15 percent of the World population has some form of disability and this makes People With Disability (PWD) the world largest minority group (World Health Organisation & The World bank, 2011).

By Enoch Msungwini

About 80 percent of PWD live in the developing world including Zimbabwe with one in every 5 individuals having some form of disability(Fisher, 2005).

According to the International Classification of Functioning, Disability and Health (ICF)framework(World Health Organization, 2010) a person’s level of functioning is a dynamic interaction between her or his health conditions, environmental factors, and personal factors.

One of the main challenges in Zimbabwe and other developing countries approach to disability is use and over reliance on the medical model which views disability as a ‘problem’ that belongs to the disabled individual and not concerning anyone else other than the disabled individual.

An example is a case of a disabled student on a wheelchair supposed to attend school but couldn’t because of steps and in this scenario the medical model would suggest that this is because of the wheelchair rather than the failure in the planning of the building to be disability inclusive at planning and policy level.

On the other, it is ideal to adopt the social model of disability which draws on the idea that it is society that disables people because of the planning and designing that is based on everything that meet the needs of the majority of people who are not disabled. There is a recognition within the social model that there is a great deal that society can do to reduce, and ultimately remove, some of these disabling barriers, and that this task is the responsibility of society, rather than the disabled person.

The social model is more inclusive in approach and pro-active planning about how disabled people can participate in activities  or access health services on an equal footing with non-disabled people.

It is imperative at planning and design stage that certain adjustments are made to ensure that to ensure that disabled people are not excluded. Notable disabled people were supported by inclusive disability policy, planning and support environment which enabled them to flourish and become powerful people notably Joshua Malinga a Presidential Advisor on Disability in Zimbabwe, Stephen Hawking a renowned Physicist and Scientist and John Nash an American Mathematician.

Despite the World leaders ratifying the United Nations Convention on the Rights of People with Disabilities (UNCRPD) in and Article 25 of the CRPD specifies Access to Health as an explicit right for people with disabilities but access to health services is still a challenge compounded by a compendium of factors.

The factors include poor policies, poverty, cost of services and structural challenges at health facilities. The challenges are exacerbated by lack of appropriate training for frontline health workers to effectively attend to PWD as well as attitudes of some health service providers towards PWD(Ahumuza et al., 2014; Sida, 2015).

In addition, there other challenges affecting access to health services for PWD include lack of Assistive Technologies (AD)(WHO, 2016) which can help in promoting and enhancing communication by PWD as they try to seek service especially those with hearing impairments (Smith et al., 2004; World Health Organization. and United Nations Population Fund., 2009).

Research has shown a link between poverty and disability particularly in LMICs as a result of restricted economic participation of PWD in full time employment, business and reduced mobility and this will in turn reduces their ability to access health services and inaccessible transport(Groce et al., 2009).

The private health sector in Zimbabwe have made some strides in promoting disability inclusive infrastructure particularly for the physically disabled to accommodate wheelchairs in the health facilities, disability friendly toilets and having a ramp for hospitals with upstairs.

This is contained in the Association of Healthcare Funders of Zimbabwe (AHFoZ)-Private Hospitals Association of Zimbabwe (PHAZ) joint Accreditation document for private hospitals. Although the accreditation document is not a statutory document based on an Act of Parliament but it has gone a long way in promoting this noble development. Such efforts are greatly appreciated because they go a long way in promoting inclusivity and reducing the environmental barriers for PWD. “My disability exists not because I use a wheelchair, but because the broader environment isn’t accessible.” Stella Young, an Australian comedian, journalist and disability rights activist.

It is my opinion that collectively there is a lot that the Ministry of Health and Child Care can do together with key stakeholders, partners, other relevant Ministries and funding agencies to enhance access to health services for PWD. The initiatives can include close collaboration with Disabled People Organisations, Outreach services to rural communities and training initiatives to capacitate frontline health workers like doctors and nurses and scaling up rehabilitation services in the community.

The Disability course for Health Professionals in LMICs organised by International Centre for Evidence in Disability at London School of Hygiene and Tropical Medicine is one of such courses that can capacitate frontline health workers in LMICs to increase screening and management skills.

Enock Musungwini is an MSc Public Health scholar at London School of Hygiene and Tropical Medicine in London, UK and a 2018-19 Chevening Scholar. He is a Health Policy and Advocate for Universal Health Coverage and undertook a Special course on Global Disability and Health. He holds a Masters in Business Administration (Graduate School of Business Leadership, MSU), BSc Hons Psychology (Zimbabwe Open University), Diploma in General Nursing (Parirenyatwa School of Nursing) and Certificate in Health Leadership and Management (Graduate Business School, University of Capetown, South Africa). He is also a Member of the Regional Africa Evidence Network Reference Group at University of Johannesburg, Zimbabwe Embassy UK Health Cluster Committee and Volunteer with African Diaspora Global Health Café. He can be reached on twitter @Enomark1979 emusungwini@yahoo.co.uk

The views expressed in this article are mine.

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