1. The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa Tryphine Zulu MPH, MSc, BPharm Marion Heap PhD Edina Sinanovic PhD

2.  Deafness affects about 15-26% of the world’s population with an estimated prevalence of 3.7% in South Africa  Deaf people experience challenges in accessing health care in all three dimensions of access-affordability, accessibility & acceptability  Consequently they have poorer health outcomes than the hearing population  Sign language Interpreters mitigate some of these challenges  No legal provision for Sign Language Interpreters in health care in many countries incl. South Africa  To advocate for funding of such initiatives, reliable cost estimates are essential, however such data is scarce Introduction

3.  DeafSA estimates South African Sign language users to be between 600 000 and 1.5million  Qualified South African Sign Language interpreters are very few  In 2011, there were only 84 registered SASLI of which only 41 of these are qualified SASLI  Charge fees of about R350+ per hour Deaf population in South Africa

4.  Project run by UCT Human Rights and Health Program provides SASLI to SASL users free of charge  The pilot project provides sign language interpreters for Deaf clients accessing health services within the Cape Metro district as well as training medical sign language interpreters.  Deaf clinic assistants are also provided in some clinics to assist Deaf clients at no extra charge. The pilot Project

5.  1. To describe the socio-demographic and the socio- economic characteristics of the Deaf people who use this service  2. To calculate the average number of SASLI assisted- visits per person per year between 2008-2013  3. To calculate the economic costs of providing the service from a pilot project persepctive  4. To estimate the costs of upscaling to the Cape Metropole District Health Services Objectives

6.  Secondary data analysis of the Pilot Project’s database  Ingredients method for the costing analysis Methods

7.  There were a total of 1000 requests between 2008 and 2013, and there were 292 individual clients during this period  Socio-demographic and socio-economic data was available for 136 Deaf respondents who were potential users or had utilised the services of the pilot project between 2008 and 2013.  The average age of the respondents was 40.5 ± 11.3 years with an age range of 20 to 70 years.  62% of the respondents were female Results

8. Results: Socio-demographics

9. Results: Socio-Economics

10. Results: Utilisation of the SASLI service

11.  Capital costs- office space, computers, cellphones, training of Interpreters  Operating costs: Personnel, transport, water and lights, telecommunications, stationery, PC consumables Costs from the Project’s perspective

12.  Avge cost per visit =total costs per annum ÷ number asssisted visits per year  =R676 386.12 ÷ 326   =R 2 074.80 per visit Costs from the Project’s perspective (2)

13. SASLI Project unit-cost components per interpreter- assisted visit Costs from the Project’s perspective (3)

14.  Costs= No of visits per person X Unit cost per visit X Population in need  Unit cost= R 2 074.80 per visit  Average number of visits per year  Minimum =1.68  Median= 2  Maximum=3.58  Population in need calculated from DeafSA stats of SASL users in South Africa  Nationally minimum 600 000, max 1.5million  By proportion based on StatsSA census data  Cape Metropole min-43 321, max-108 302 Results: Costs of Scaling up to the Cape Metropole District

15. Cost of providing SASLI in the Cape Metropole

16. Cost of providing SASLI services as a proportion of the WC DHS Budget

17.  In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population.  However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.  Despite the costs, provision of SASLI should be seen from both a Human rights perspective and as a risk mitigation strategy Conclusion

18.  Deaf Federation of South Africa, (2009). Policy on the Provision and Regulation of South African Sign Language Interpreters.  Deaf Federation of South Africa. (2013). South African Language Interpreter Tariffs. Accessed from www.deafsa.co.za on 25/03/2013 www.deafsa.co.za  Harmer, L. (1999). Health care delivery and deaf people: Practice, problems and recommendations for change. Journal of Deaf Studies and Deaf Education, 4(2): 73-110. Bibliography

19.  Thank you