AS we approach the International Universal Health Coverage Day (UHC Day) on 12 December 2019, it is critical to rally African governments including Zimbabwe to reflect on the milestones in achieving UHC. Universal Health Coverage (UHC) is a key part of the concept of primary healthcare launched in 1978 known as the Alma Ata (1978) declaration and reinforced in 2018 under the Astana declaration (2018). UHC aims to mobilize diverse stakeholders to call for stronger, more equitable health systems to achieve universal health coverage, leaving no one behind. IS IT POSSIBLE?
By: Enock Musungwini – MPH, MBA, BSc (Hons) & RGN
It is critical for Low to Middle Income countries to adopt and or promote Disability Inclusive Development model to ensure achievement of Universal Health coverage. According to World Health Organisation (WHO), Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, being of sufficient quality and ensuring that the use of these services does not expose the user to financial hardship.
The achievement of Universal Health Coverage (UHC) is a key aim of the global health agenda, and an important target of the the 2030. Agenda for Sustainable Development, adopted by all United Nations Member States in 2015. The UN SDGs provides a shared blueprint for peace and prosperity for people and the planet, now and into the future and particularly SDG 3 on ensuring healthy lives and promote well-being for all at all ages.
The UN have recognized that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth as well as tackling climate change. All the above affect persons with disability more than any other members of the community who now constitute 155 of the global population (missing billion link). Most LMICs are signatories to the 2006 Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol and this provides a framework to change attitudes and approaches to persons with disabilities CRPD link.
The Convention adopts a broad categorization of persons with disabilities and reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms.
According to Professor Hannah Kuper, Director of International Centre for Evidence in Disability, people with disabilities are more likely to experience poor health and they will therefore have greater need for general healthcare services, as well as rehabilitation and specialist services, related to their underlying impairment link. Another research by Vergunst et al done in rural South Africa found that persons with disabilities face barriers when accessing health care services especially those in rural areas are worse off. Rural contexts in LMICs present greater barriers than urban contexts. It concluded that there is “triple vulnerability” – poverty, disability and rurality.
Kuper and Hanefield posited that it is difficult to achieve UHC without a focus on people with disabilities and that changes should be made to improve coverage for people with disabilities and this will also likely to benefit a wider group, including older people, ethnic minorities, and people with short-term functional difficulties. In line with the principles of “Leave no one behind” and “reaching the furthest first”, it is imperative to address the critical needs of vulnerable groups, indigenous peoples, the elderly and people with disabilities as the best way of ensuring that no one is left behind by the 2030 Agenda for Sustainable Development and UHC.
Research has shown a link between disability and poverty and that Disability is both a cause and a consequent of poverty. It is critical to break that chain and cycle of poverty potentiated by disability. Disability limits access to education and employment, and leads to economic and social exclusion. Poor people with disabilities are caught in a vicious cycle of poverty and disability, each being both a cause and a consequence of the other.
An International Labour Organization study in 2009 of 10 LMICs found that excluding people with disabilities from the workforce resulted in gross domestic product losses of between 3 and 7 percent. This was not only due to a failure to tap the talent of people with disabilities but often also their families and caregivers who will not participate in economic activities.
Disability Inclusive Development is an important concept valued by UNDP and other international development partners. UNDP support countries to develop and strengthen disability law and policy frameworks, improve accessibility of services, social protection, livelihood opportunities, and promote the participation of PWDs in political and public life. In support, the UK Government through the DFID have done a lot to ensure Disability Inclusive Development.
The DFID first ever Disability Inclusion Strategy sets out how the UK will deliver the ambition to put people with disabilities at the heart of everything it does. DFID pledged and committed to eradicate poverty, deliver the Sustainable Development Goals (SDGs) and implement the UN Convention on the Rights of Persons with Disabilities (UN CRPD).
In support, the World Bank has reiterated the need to promote social inclusion and building inclusive communities by stating that including persons with disabilities and expanding equitable opportunities is at the core of World Bank Group’s work. Disability Inclusive Development is aligned with the World Bank Group’s goals to end extreme poverty and promote shared prosperity. It is my considered view that that embedding disability in every stage of program planning, design, infrastructure development, town planning and empowering people with disabilities to guide that process will create community development that is truly inclusive.
Organisations such as CBM UK working with partners in LMICs have done a lot in promoting Disability Inclusive Development by working with Disabled Persons’ Organisations and reaching out to persons with disability in far to reach areas. It therefore requires continued support and close collaboration between national governments, UN agencies, civil society and Disabled Persons Organisation movements. Funding and capacity building are critical aspects to support DPOs and their member networks to fully demand and claim their positions in society and community.
Enock Musungwini is a Public Health and Policy Specialist, Management Consultant and Development practitioner with over 16 years experience in health covering Disability, SRH, Health Financing, Health Insurance, HIV/AIDS, Health regulation, gender, youths and advocacy. Enock holds a Master of Public Health (LSHTM, UK) MBA (MSU, Zim), BSc Hons Psychology (ZOU, Zim).
** THE VIEWS EXPRESSED IN THIS ARTICLE ARE MINE **