Training of Trainers Workshop ARASA Training of Trainers Workshop Human Rights and Programming for Persons with Disabilities: Special focus on Access to Health care services   10 – 14 November 2014 Johannesburg, South Africa   Presented By: Phillimon Simwaba  

KEY MESSAGES ABOUT PEOPLE WITH DISABILITIES AND THE RIGHT TO HEALTH CARE Disability is everyone’s business People with disabilities are not necessarily sick People with disabilities are not asexual Access means more than ramps People with disabilities want the same things in life that everyone wants For people with disabilities, prejudice can be the biggest barrier

KEY MESSAGES ABOUT PEOPLE WITH DISABILITIES AND THE RIGHT TO HEALTH CARE Everywhere and always, people with disabilities are entitled to self-determination, privacy, respect and dignity It is best and usually easy to mainstream health services that accommodate people with disabilities People with disabilities are a crucial constituency in all programmes Programmes best suit people with disabilities when people with disabilities help to design them: “Nothing about us without us” is a key principle

DEFINITION OF HEALTH: UNCRPD Health can be defined as “a state of physical, mental, and social well being and not merely the absence of disease or infirmity”. Good health is a prerequisite for participation in a wide range of activities including education and employment Article 25 of the United Nations Convention on the Rights of Persons with Disabilities(CRPD) reinforces the right of persons with disabilities to attain the highest standard of health care, without discrimination

DISABILITY AND HEALTH People with disabilities face many barriers to good health; Studies show that individuals with disabilities are more likely than people without disabilities to report: Having poorer overall health Having less access to adequate health care Engaging in risky health behaviors, including smoking and physical inactivity People with disabilities often are more susceptible to preventable health problems that decrease their overall health and quality of life. Secondary conditions such as pain, fatigue, obesity, and depression can occur as a result of having a disabling condition

KEY FACTS Stereotypes about disability on the part of healthcare providers; Health care provider misinformation, and lack of appropriately trained staff; Limited health care facility accessibility and lack of examination equipment that can be used by people with varying disabilities; Lack of sign language interpreters; and Lack of materials in formats that are accessible to people who are blind or have low vision

BARRIERS TO HEALTH CARE People with disabilities encounter a range of barriers when they attempt to access health care including the following Prohibitive costs: Affordability of health services and transportation are two main reasons why people with disabilities do not receive needed health care in low-income countries - 32-33% of non-disabled people are unable to afford health care compared to 51-53% of people with disabilities Limited availability of services: The lack of appropriate services for people with disabilities is a significant barrier to health care

BARRIERS TO HEALTH CARE Physical barriers: Uneven access to buildings (hospitals, health centres), inaccessible medical equipment, poor signage, narrow doorways, internal steps and inadequate bathroom facilities create barriers to health care facilities For example: women with mobility difficulties are often unable to access breast and cervical cancer screening because examination tables are not height-adjustable Inadequate skills and knowledge of health workers: People with disabilities are more than twice as likely to report finding health care provider skills inadequate to meet their needs

ADDRESSING BARRIERS TO HEALTH CARE Governments can improve health outcomes for people with disabilities by improving access to quality, affordable health care services, which make the best use of available resources Policy and legislation Assess existing policies and services, identify priorities to reduce health inequalities and plan improvements for access and inclusion. Make changes to comply with the CRPD. Establish health care standards related to care of persons with disabilities with enforcement mechanisms

ADDRESSING BARRIERS TO HEALTH CARE Service delivery Provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate access to health care services. For example: changing the physical layout of clinics to provide access for people with mobility difficulties or communicating health information in accessible formats such as Braille, large print and pictorial Promote community-based rehabilitation (CBR) to facilitate access for PWDs to existing services Human resources Integrate disability education and continuing education for all health-care professionals.

HOW TO INCLUDE PERSONS WITH DISABILITIES Blind since birth, Mr. X has experienced first-hand the effects of ignorance about disability within the health system. He recalls his blood being drawn as a child without anyone mentioning the needle prick would hurt. “The nurse went through my fingers, saying how beautiful they were, then without warning she pushed the needle into my small finger," he says. "Of course it hurt, and my first reaction was to bite her hand. My point is the health workers should be taught how to properly deal with patients who have visual impairment. I believe that our rights as patients are equal to those of persons without disabilities.”

WHAT HEALTH CARE PROVIDERS CAN DO Give persons with disabilities the information needed to live a long and healthy life Listen and respond to their health concerns. Give PWDs the information needed to prevent or treat a health concern even if the person with disability does not ask for it. Health expert should offer information Communication must be clear and direct with the patient in a language they understand. If PWDs don’t understand questions or instructions, repeat; use other words, or find another way to provide the information

WHAT HEALTH CARE PROVIDERS CAN DO source alternative communication options including large print, Braille, pictorial, audio and sign language based on individual requirements. These may be arranged through local disable peoples organizations and community based rehabilitation. Take the time needed to meet the PWDs health care needs

THANK YOU