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Challenges of inclusion: a qualitative study exploring barriers and pathways to inclusion of persons with mental disabilities in technical and vocational education and training programmes in East Africa

EBUENYI, Ikenna D
ROTTENBURG, Esther S
BUNDERS-AELEN, Joske F G
REGEER, Barbara J
November 2018

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Purpose: To explore barriers and pathways to the inclusion of persons with mental and intellectual disabilities in technical and vocational education and training programmes in four East African countries, in order to pave the way to greater inclusion.

 

Materials and methods: An explorative, qualitative study including 10 in-depth interviews and a group discussion was conducted with coordinators of different programmes in four East African countries. Two independent researchers coded the interviews inductively using Atlas.ti. The underlying framework used is the culture, structure, and practice model.

 

Results: Barriers and pathways to inclusion were found in the three interrelated components of the model. They are mutually reinforcing and are thus not independent of one another. Barriers regarding culture include negative attitudes towards persons with mental illnesses, structural barriers relate to exclusion from primary school, rigid curricula and untrained teachers and unclear policies. Culture and structure hence severely hinder a practice of including persons with mental disabilities in technical and vocational education and training programmes. Pathways suggested are aiming for a clearer policy, more flexible curricula, improved teacher training and more inclusive attitudes.

 

Conclusions: In order to overcome the identified complex barriers, systemic changes are necessary. Suggested pathways for programme coordinators serve as a starting point.

Adolescents with disabilities: Enhancing resilience and delivering inclusive development

JONES, Nicola
PRESLER-MARSHALL, Elizabeth
STAVROPOLULOU, Maria
July 2018

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This report takes stock of evidence from LMICs, drawing on findings from a thematic evidence review combined with emerging findings from the Gender and Adolescence: Global Evidence (GAGE) survey and qualitative research baseline studies in Bangladesh, Ethiopia, Jordan and Palestine. These interviews involved more than 6,000 adolescents and their caregivers – including approximately 600 girls and boys with physical, visual, hearing or intellectual impairments, alongside service providers and policy actors. The report draws attention to the multiple and intersecting capabilities that need to be supported in order for adolescents with disabilities in LMICs to reach their full potential. It goes beyond a focus on their access to education and health services, and also considers their rights to psychosocial wellbeing, protection from violence, mobility and opportunities to participate within their communities, as well the skills, assets and support they need to become economically independent once they transition into adulthood. 

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Inclusion through community based rehabilitation : lessons learned in Burkina Faso, Ethiopia & Mozambique 2009 - 2011

LIGHT FOR THE WORLD
2012

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"The LIGHT FOR THE WORLD Community Based Rehabilitation (CBR) Framework brought together 14 CBR projects in Ethiopia, Burkina Faso and Mozambique between 2009 and 2011 to share experiences and learning. This report reflects the experiences of the projects during this period and the lessons learned that can provide invaluable learning for other CBR projects. It also provides a useful record of the projects’ activities and outcomes, and enables future planning"

Inspiring futures : learning from memory work in Africa

DUNN, Alison
HAMMOND WARD, Sarah
2009

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This learning paper looks at the experiences of applying memory work as part of broader strategies to mitigate the impact of HIV and AIDS in five African countries. It explores how six NGOs in sub-Saharan Africa established memory work as a key component of their community-based HIV programmes and draws on the experience of people living with HIV and AIDS, children and young people who participated in the initiative, partner organisations' own learning and analysis and the end of project evaluation report

More than words? action for orphans and vulnerable children in Africa : Monitoring progress towards the UN Declaration of Commitment on HIV/AIDS

YOUNG, Helen
Ed
2005

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This qualitative research looks at how far the rights and needs of orphans and vulnerable children are being met in four of the worst-affected countries in sub-Saharan Africa. Based on surveys and focus group discussions with children, parents, caregivers and officials in Ethiopia, Mozambique, Uganda and Zambia, this report offers an insight into how far commitments are being met and provides practical recommendations for action at both a national and an international level

Resilience and success of persons with disabilities in Ethiopia

TEFERRA, Tirussew
2005

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"This is an empirical cross-disability study among successful persons with hearing, visual and motor impairments. It tries to explore the threads of resilience which may be attributed to personal as well as environmental factors within the Ethiopian context. As it is the first attempt in the country, it is presumed to bring a fresh insight in the field and serve as a basis future intervention and research endeavour"
Chapter 5 from the book "Disability in Ethiopia: Issues, Insights and Implications" by Tirussew Teferra

Applied research on disability in Africa : the East Africa report

WADDELL, Mary Ann

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“This literature review concerns the achievements of a project which started in 2014 and will last three years. The aim of this project is the dissemination and promotion of applied research results and disability to researchers and field stakeholders of the African continent (particularly to Disabled People Organizations), in order to increase knowledge on the situation of people with disabilities and the recommendations made to improve their social participation… The goal of this literary review is to report on existing knowledge about applied research on East Africa, regarding physical disability, mental health and less on learning disabilities, the concerns of people with disabilities and their carers’, adults and children, medical aspects of disability, identification of disability, experiences of disability, policy and policy implementation”

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