‘Leaving no one behind’: Strengthening access to eye ... · • David Lewis, CBM...
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‘Leaving no one behind’: Strengthening access to eye-health programmes for people with disabilities in six low- and middle-income countries Manfred Mörchen 1 , Asahel Bush 2 , Petra Kiel 3 , David Lewis 2 , Babar Qureshi 4 1 CBM, Manila, Philippines; 2 CBM, Melbourne, Australia; 3 CBM, Bensheim, Germany; 4 CBM, Cambridge, United Kingdom PURPOSE The “World Report on Disability 2011” highlighted that people with disabilities face significant barriers to accessing health services. 1 In recent years efforts have been made to mitigate some of these barriers by embedding disability-inclusive development principles into health, including eye-health programs. 2,3 We report salient results of a desk-based synthesis evaluation to capture current practices and lessons learnt from CBM supported inclusive eye health programs from six low-and middle-income countries (Cambodia, Egypt, Ethiopia, Indonesia, Pakistan, Vietnam). METHODS Ten purposively selected midterm and final evaluations were synthesized based on an assessment framework of synthesis evaluation. 4 Narrative analysis was informed by a practical framework for improvement of inclusive practices in eye- health programmes. 5 RESULTS Accessibility: Across all programs physical accessibility of medical facilities was improved (figure 1). However there was evidence that some of the adjustments (for instance ramps) were underutilized (figure 2). Accessibility was often confined to physical aspects with the need for accessible communication (such as information about cataract surgery for patients with intellectual impairments) being neglected. “Messaging inclusion”: Training about inclusion resulted in increased awareness and more positive attitudes of eye-health staff towards persons with disabilities. However, an overly narrow approach on making eye-health services disability- inclusive particularly at the primary eye- health level resulted in limited consideration of the inclusion of other marginalized populations. At the primary level disability generally exacerbates multiple other context-specific barriers such as poverty, ethnicity, gender, cultural norms etc. It is this combination of barriers which can reduce access to eye and other health services. Collaboration with Disabled People Organizations (DPOs): DPOs were often actively involved in for example accessibility audits for eye hospitals or screening activities in communities (figure 3). It is however unclear in how far community approaches led by DPOs resulted in more eye patients (particularly with disabilities) accessing eye health services. Monitoring: Results of the integration of the “Washington Group Short Set of Questions on Disability” 6 for self-reported functional difficulties in the Health Information System of one project suggest that for instance eye patients reporting additional hearing difficulties constitute a significant proportion of the out-patient department population (Chart 1). Overall, collection of disability-disaggregated data posed significant challenges, making it difficult to assess how eye patients with other additional difficulties benefitted from inclusive practices (figure 4). CONTACT AUTHORS • Manfred Mörchen, CBM [email protected] • David Lewis, CBM [email protected] CONCLUSIONS Embedding long-term inclusive development approaches in prevention of blindness programs addressing immediate eye- health needs requires detailed contextual analysis in the design phase. Synthesis results suggest that access barriers can be mitigated, but improved monitoring is urgently needed to inform WHO’s goal of universal eye health and to abide by Article 25 of the United Nations Convention on the Rights of Persons with Disabilities: “Persons with Disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability”. 7 REFERENCES 1 WHO. The World Report on Disability. WHO 2011. Available at http://www.who.int/disabilities/world_report/2011/report.pdf 2 Mörchen M, Ormsby G, Bonn TS, Lewis D. Addressing disability in the health system at CARITAS Takeo Eye Hospital. Community Eye Health 2013;26:8-9. Available at https://www. cehjournal.org/wp-content/uploads/addressing-disability-in-the- health-system-at-caritas-takeo-eye-hospital.pdf 3 Eisenberg Y, Rimmer JH, Mehta T, Fox MH. Development of a community health inclusion index: an evaluation tool for improving inclusion of people with disabilities in community health initiatives. BMC Public Health 2015;15:1050. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603756/ pdf/12889_2015_Article_2381.pdf 4 Olsen, O’Reilly. Evaluation methodologies. International Organisation Development 2011. Available at http://www. iodparc.com/resource/evaluation_methodologies.html 5 CBM. Inclusion made easy in eye health programmes. Available at http://www.cbm.org/article/downloads/54741/ Inclusion_in_Eye_Health_Guide.pdf 6 Washington Group on Disability Statistics. 2017, Available at http://www.washingtongroup-disability.com/wp-content/ uploads/2016/01/The-Washington-Group-Short-Set-of- Questions-on-Disability.pdf 7 United Nations Convention on the Rights of Persons with Disabilities, 2006. Available at http://www.un.org/disabilities/ documents/convention/convoptprot-e.pdf Figure 1: Improving horizontal accessibility for patients with visual impairment in a tertiary eye hospital Figure 2: Ramp obstructed with motorbikes and benches in a primary health center Figure 3: Employment of people with disabilities in screening activities at World Sight Day, Takeo Eye Hospital, Cambodia Figure 4: ©Julie Smith Chart 1: Number of eye patients with additional difficulties 2011-2016 (average annual number of out-patients 30,388 at Takeo Eye Hospital, Cambodia understanding mobility hearing 2011 0 200 400 600 800 1000 2012 2013 2014 2015 2016
Transcript of ‘Leaving no one behind’: Strengthening access to eye ... · • David Lewis, CBM...
‘Leaving no one behind’: Strengthening access to eye-health programmes for people with disabilities in six low- and middle-income countriesManfred Mörchen1, Asahel Bush2, Petra Kiel3, David Lewis2, Babar Qureshi41CBM, Manila, Philippines; 2CBM, Melbourne, Australia; 3CBM, Bensheim, Germany; 4CBM, Cambridge, United Kingdom
PURPOSEThe “World Report on Disability 2011” highlighted that people with disabilities face significant barriers to accessing health services.1 In recent years efforts have been made to mitigate some of these barriers by embedding disability-inclusive development principles into health, including eye-health programs.2,3 We report salient results of a desk-based synthesis evaluation to capture current practices and lessons learnt from CBM supported inclusive eye health programs from six low-and middle-income countries (Cambodia, Egypt, Ethiopia, Indonesia, Pakistan, Vietnam).
METHODSTen purposively selected midterm and final evaluations were synthesized based on an assessment framework of synthesis evaluation.4 Narrative analysis was informed by a practical framework for improvement of inclusive practices in eye-health programmes.5
RESULTSAccessibility: Across all programs physical accessibility of medical facilities was improved (figure 1). However there was evidence that some of the adjustments (for instance ramps) were underutilized (figure 2). Accessibility was often confined to physical aspects with the need for accessible communication (such as information about cataract surgery for patients with intellectual impairments) being neglected.
“Messaging inclusion”: Training about inclusion resulted in increased awareness and more positive attitudes of eye-health staff towards persons with disabilities. However, an overly narrow approach on making eye-health services disability-inclusive particularly at the primary eye-health level resulted in limited consideration of the inclusion of other marginalized populations. At the primary level disability generally exacerbates multiple other context-specific barriers such as poverty, ethnicity, gender, cultural norms etc. It is this combination of barriers which can reduce access to eye and other health services.
Collaboration with Disabled People Organizations (DPOs): DPOs were often actively involved in for example accessibility audits for eye hospitals or screening activities in communities (figure 3). It is however unclear in how far community approaches led by DPOs resulted in more eye patients (particularly with disabilities) accessing eye health services.
Monitoring: Results of the integration of the “Washington Group Short Set of Questions on Disability”6 for self-reported functional difficulties in the Health Information System of one project suggest that for instance eye patients reporting additional hearing difficulties constitute a significant proportion of the out-patient department population (Chart 1). Overall, collection of disability-disaggregated data posed significant challenges, making it difficult to assess how eye patients with other additional difficulties benefitted from inclusive practices (figure 4).
CONTACT AUTHORS• Manfred Mörchen, CBM
[email protected]• David Lewis, CBM
CONCLUSIONSEmbedding long-term inclusive development approaches in prevention of blindness programs addressing immediate eye-health needs requires detailed contextual analysis in the design phase. Synthesis results suggest that access barriers can be mitigated, but improved monitoring is urgently needed to inform WHO’s goal of universal eye health and to abide by Article 25 of the United Nations Convention on the Rights of Persons with Disabilities: “Persons with Disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability”.7
REFERENCES1 WHO. The World Report on Disability. WHO 2011. Available at http://www.who.int/disabilities/world_report/2011/report.pdf
2 Mörchen M, Ormsby G, Bonn TS, Lewis D. Addressing disability in the health system at CARITAS Takeo Eye Hospital. Community Eye Health 2013;26:8-9. Available at https://www.cehjournal.org/wp-content/uploads/addressing-disability-in-the-health-system-at-caritas-takeo-eye-hospital.pdf
3 Eisenberg Y, Rimmer JH, Mehta T, Fox MH. Development of a community health inclusion index: an evaluation tool for improving inclusion of people with disabilities in community health initiatives. BMC Public Health 2015;15:1050. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603756/pdf/12889_2015_Article_2381.pdf
4 Olsen, O’Reilly. Evaluation methodologies. International Organisation Development 2011. Available at http://www.iodparc.com/resource/evaluation_methodologies.html
5 CBM. Inclusion made easy in eye health programmes. Available at http://www.cbm.org/article/downloads/54741/Inclusion_in_Eye_Health_Guide.pdf
6 Washington Group on Disability Statistics. 2017, Available at http://www.washingtongroup-disability.com/wp-content/uploads/2016/01/The-Washington-Group-Short-Set-of-Questions-on-Disability.pdf
7 United Nations Convention on the Rights of Persons with Disabilities, 2006. Available at http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf
Figure 1: Improving horizontal accessibility for patients with visual impairment in a tertiary eye hospital
Figure 2: Ramp obstructed with motorbikes and benches in a primary health center
Figure 3: Employment of people with disabilities in screening activities at World Sight Day, Takeo Eye Hospital, Cambodia
Figure 4: ©Julie Smith
Chart 1: Number of eye patients with additional difficulties 2011-2016 (average annual number of out-patients 30,388 at Takeo Eye Hospital, Cambodia
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Figure 1 is a photograph of an eye examination room with a broad yellow line leading to the examination table to be used by people with visual impairment.
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Figure 2 is photograph showing the entrance area to a hospital (medical service station?). although there is a ramp for accessibility this has been obstructed by parked motorbikes and by benches.
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Figure 3 is a photograph showing an eye screening event at which a male staff with an amputated arm is using the ...board to check people's visual ....(acuity?).
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Chart 1 shows in columns the number of eye patients with additional difficulties such as hearing, mobility and understanding difficulties per year from 2011 to 2016 at Takeo Eye Hospital Cambodia. Within an average out-patient number of 30,388 between 400 and almost 1000 persons had additional hearing difficulties, between 50 and 100 had additional mobility difficulties, and between 10 and 100 had additional difficulties in understanding.
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Figure 4 is a cartoon drawing that shows a clinic on top of a small hill that is reachable by a staircase only and a person in a wheelchair at the bottom of those stairs. Two staff of the clinic say: "Disabled people? No, we have none on our records." Beneath the drawing it says: The team concluded that few disabled people needed health care.
