1 Haiti: Toolkit for Long-Term Reconstruction for All Recovery A collaboration between GPDD WG on Haiti and IDB Chapter 5 Health

2 Impact of the earthquake Why do we build back better? How do we build back better? How do we ensure access to the healthcare system for all? Take Action! Further resources Outline Haiti Hospital Appeal Photo A collaboration between GPDD WG on Haiti and IDB

3 It was estimated in 1998 that 7% of the 9,035,536 of Haitian population (around 600,000) had some form of disability, half of them occurring in children under 15 years of age. Blindness was the most frequent disability (1% of the population). Source: PAHO, 2010 Pre-Earthquake Facts A collaboration between GPDD WG on Haiti and IDB

4 Before the earthquake, Haiti had 594 primary health care centers (with or without beds); 30 reference communal hospitals (30-60 beds each); six centers for integrated diagnostics, 10 department hospitals (with 150 beds each); and three university hospitals (1,500 beds in total). (PAHO, 2010) Pre-Earthquake Facts UN Photo / Marco Dormino A collaboration between GPDD WG on Haiti and IDB

5 Suffered structural damage that has rendered them unusable (PAHO, 2010) Now, there are more than 314 health partners that work together under the United Nations Health Cluster in Haiti. (PAHO, 2010) Impact of the Earthquake A collaboration between GPDD WG on Haiti and IDB on Health UN Photo / Marco Dormino

6 Disproportionate impact on people with disabilities due to inequities in rescue and response > 300,000 people injured; resulting physical disabilities through amputations, spinal cord injuries, head trauma, multiple fractures, among other injuries Post-traumatic stress, psychosocial disabilities, and lack of adequate care The United Nations has estimated that for every death, another three are seriously injured - and through delays in treatment, this could lead to 450,000 newly disabled people in Haiti. Source: CBM UK ( disabled.html ) disabled.html A collaboration between GPDD WG on Haiti and IDB Impact of the Earthquake on Health

7 Why do we build back “Thanks to a recent extraordinary rise in public and private giving, today more money is being directed toward the world's poor and sick than ever before. But unless these efforts start tackling public health in general instead of narrow, disease-specific problems(…) poor countries could be pushed even further into trouble, in yet another tale of well-intended foreign meddling gone awry.” Laurie Garrett, Senior Fellow for Global Health Council on Foreign Relations, Foreign Affairs, January/February 2007 A collaboration between GPDD WG on Haiti and IDB BETTER?

8 Article 25: Health States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. See to read Article 25 in its entiretyhttp:// Health and the CRPD A collaboration between GPDD WG on Haiti and IDB

9 Article 26: Habilitation and Rehabilitation States Parties shall take effective and appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. To that end, States Parties shall organize, strengthen and extend comprehensive habilitation and rehabilitation services and programmes, particularly in the areas of health, employment, education and social services…. See to read Article 26 in its entiretyhttp:// A collaboration between GPDD WG on Haiti and IDB Health and the CRPD

10 Long-term recovery aftermath is an opportunity to make progress in access to health in Haiti The ultimate goal is for people with disabilities and other vulnerable populations to gain the same health services as provided to others and receive specific health services required because of their disabilities strengthening health systems in Haiti Implementing health services and A collaboration between GPDD WG on Haiti and IDB

11 It also implies : Access to assistive devices and assistive devices maintenance WHO Community Based Rehabilitation (CBR) guidelines recently updated include community health considerations and are an invaluable tool WHO Community Based Rehabilitation A collaboration between GPDD WG on Haiti and IDB strengthening health systems in Haiti Implementing health services and UN Photo Marco Dormino

12 How do we ensure the right to Access Ensure that all facilities are physically accessible for people with disabilities. (See Chapter 1 of this toolkit for more information related to physical accessibility) Offer training and sensitization on disability issues and communication methods (i.e. Braille/sign language) to doctors and health staff Provide public health information in accessible formats for people with disabilities Ensure that persons with disabilities have access to the medications they require (such as anti-epileptic, anti-depressant, and other psychiatric drugs) A collaboration between GPDD WG on Haiti and IDB health for all?

13 UN Photo Marco Dormino A collaboration between GPDD WG on Haiti and IDB “ “ensure access of people with disabilities to health care by providing transportation to clinics or offering home visits” Source: Women’s Refugee Commission (2008) UN Photo Marco Dormino

14 Prevent water and sanitation-related diseases. To ensure equal access to water and sanitation facilities, additional measures may be required. For example, tube wells, hand pumps and water carrying containers should be designed or adapted for access to water quickly and easily and temporary toilets in camps and shelters need to be accessible to all. (Source: Handicap International, 2005) A collaboration between GPDD WG on Haiti and IDB How do we ensure the right to health for all?

15 Prevent water and sanitation-related diseases. If PWDs are denied equal access to water sources or latrines due to discrimination, it may be necessary to monitor access or form separate queues. It may also be necessary for someone to be available to assist those persons whose disability severely restricts them from accessing water sources or sanitation facilities, even with modifications. PWDs can also be involved in design, building and maintenance of these temporary facilities. (Source: Handicap International, 2005) A collaboration between GPDD WG on Haiti and IDB How do we ensure the right to health for all?

 Health and Rehabilitation Services Long-term recovery is an opportunity to make progress in Access to Health in Haiti and ensure: Same health services as provided to other persons Same health services Access to rehabilitation and health services needed because of their disabilitiesrehabilitation and health services needed because of their disabilities Access to appropriate assistive devices and assistive devices maintenanceappropriate assistive devices Development of enabling inclusive policies which ensure equality, accessibility and quality of health and rehabilitationenabling inclusive policies 16 A collaboration between GPDD WG on Haiti and IDB How do we ensure the right to health for all?

17 Ensure that rehabilitation programs and assistive technologies fit the specific demands of Haiti's culture and rugged natural physical environments. Use Universal Design for health and rehabilitation facilities. Make public health information available in many different accessible communication formats. Offer inclusive community development and services close to home. (CBR strategies may be helpful for rehabilitation in rural settings.) Take Action! A collaboration between GPDD WG on Haiti and IDB

18 Open Community level disability registers to know the persons and needs. This is very useful and can be maintained AT EMERGENCY HEALTH CENTRES OR rehab camps Start single window rehab support ONE FOR 1000 POPULATION Parent support services(Camp based/home based support for children below 6 years -Portage parent support materials are useful) and training workshops for families on basic rehab support and care. Take Action! A collaboration between GPDD WG on Haiti and IDB

19 Multi disciplinary medical camps for screening and assessment Devices Bank-Borrow and use devices (wheel chairs, chairs for use in toilets, foldable ramps/walkers/parallel bars/multi sensory materials ) Build local self help mutual groups for sustainability of services Take Action! A collaboration between GPDD WG on Haiti and IDB Take Action!

20 Take Action! A collaboration between GPDD WG on Haiti and IDB For information in regard to Potential Prosthetics and Orthotics Service Providers and Centers/Hospitals undertaking Spinal Injury Care in Haiti: Haiti Mission Report, Sue Eitel DCHA/DG/SPANS (page 13, 14, 15) Take Action!