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Health economic evaluation in orthotics and prosthetics: a systematic review protocol

CLARKE, Leigh
DILLON, Michael
SHIEL, Alan
June 2019

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The aim of this systematic review is to critically appraise the existing orthotic/prosthetic health economic evaluation literature and therefore determine evidence gaps, critical method design issues and the extent to which the literature informs orthotic/prosthetic policy and investment decisions

 

Systematic Reviews volume 8, Article number: 152 (2019)

doi:10.1186/s13643-019-1066-9

 

 

Access to social protection among people with disabilities: Evidence from Viet Nam

BANKS, Lena
et al
January 2019

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This study uses mixed methods to explore participation in disability‐targeted and non‐targeted social protection programmes in Viet Nam, particularly in the district of Cam Le. Following an overview of social protection in Viet Nam, and in addition to presenting quantitative measures of access, this article identifies challenges and facilitators to participation in social protection.

A mixed‐methods approach was used to evaluate the extent to which people with disabilities are accessing existing social protection programmes, including an evaluation of the effects of barriers and facilitators to access. First, a national policy analysis was conducted to provide an overview of available social protection entitlements, and how their design and implementation may affect access for people with disabilities. Second, qualitative and quantitative research was conducted in one district of Viet Nam to measure coverage and uptake of specific entitlements and to explore factors influencing access in greater depth.

 

International Social Security Review,Vol. 72, 1/2019
https://doi.org/10.1111/issr.12195

Unmet needs and use of assistive products in two districts of Bangladesh: Findings from a household survey

PRYOR, Wesley
NGUYEN, Liem
ISLAM, Qumrun Naher
JALAL, Faruk, Ahmed
MANJULA, Marella
December 2018

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Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice.

Int. J. Environ. Res. Public Health 2018, 15(12), 2901;
doi:10.3390/ijerph15122901

Access to assistive products in Kurigram and Narsingdi, Bangladesh. Policy brief 2.

HUMANITY & INCLUSION BANGLADESH
et al
August 2018

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This ‘policy brief’ outlines findings on Assistive technology and Products (AP) needs, unmet needs and access patterns arising the Rapid Assessment of Disability (RAD) study conducted in 2016 and 2017, in partnership between the Bangladesh Bureau of Statistics (BBS) and Humanity & Inclusion (HI) Bangladesh, with technical oversight from the Nossal Institute for Global Health, University of Melbourne, Australia. The study was part of the HI project: Towards Global Health: Strengthening the Rehabilitation Sector through Civil Society funded by the European Union. Findings from the 4254 adults surveyed in the two districts are reported here.

 

The purpose of this component of the RAD study was to learn about the usage of AP, characteristics of AP users, barriers to use of AP, unmet and met needs of AP, and to highlight major policy implications for AP service provision, in two target areas of Kurigram and Narsingdi. The survey includes an adapted version of Washington Group (WG) ‘short set’ of Disability Questions. A modified version of the WHO’s draft Assistive Technology Assessment Tool (needs module) – or the ‘ATA-needs’, was also implemented. Findings from this study also helped modify and improve the draft ATA-needs tool

Inclusive service delivery for persons with disabilities in Mongolia

MAMUTKULOV, Raushenbek
ASIAN DEVELOPMENT BANK (ADB)
2018

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The Ensuring Inclusiveness and Service Delivery for Persons with Disabilities (PWDs) project in Mongolia aims to ensure access to improved services, employment opportunities, and more support through social welfare reform for PWDs.

Estimates of disability prevalence in Mongolia tend to be underreported, especially among older people, girls, and women, thus leaving a substantial number of persons with disabilities (PWDs) without the necessary services and protection. Early identification of disability is inadequate and current disability assessments follow an outdated, narrow medical approach. Many people perceive PWDs to be incapable of living independently and a burden to society.

A brief overview is given of a project aiming to ensure access to services and employment for PWDs to increase their autonomy and contribution to the economy and society in general.

(ADB Brief, Social Protection Brief, No.91)

Disability and inclusive education - A stocktake of education sector plans and GPE-funded grants

BANHAM, Louise
PAPAKOSTI, Elena
et al
March 2018

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This report was commissioned by the Global Partnership for Education’s Secretariat to take stock of how disability and inclusive education are included in education sector plans in 51 countries, including GPE-funded programs, such as education sector program implementation grants, program documents, implementation progress reports education sector analysis, if applicable, and other relevant GPE program documents.

This report documents progress and highlights the need to step up support to GPE partner countries on disability and inclusive education, to improve consideration of issues around disability and inclusion in education sector analysis and sector planning processes to better promote the achievement of GPE 2020 strategic goal 2, and to fulfill the transformative vision of Agenda 2030

Disability and vocational rehabilitation in rural settings

HARLEY, Debra
et al
2018

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A graduate student textbook offered in 39 chapters, each with different authors and subjects. Abstracts, test questions and citations are freely available on-line. Full text is charged for. The book surveys rehabilitation and vocational programs aiding persons with disabilities in remote and developing areas in the U.S. and abroad. Contributors discuss longstanding challenges to these communities, most notably economic and environmental obstacles and ongoing barriers to service delivery, as well as their resilience and strengths. Considerations are largely of the US but there is a chapter on each of Asia and Pacific region, Australasia, Canada, Mexico, India, Turkey, Colombia and the UK. 

 

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

TIWARI, Ajun
et al
January 2018

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The primary objective of this study is to estimate the expenditure in primary (outpatient) care incurred by leprosy patients in two different health system settings in India. The secondary objective is to compare the effect of the health systems on consumer behaviour and practices. 

The study followed a cross-sectional design, where a cohort from the Union Territory of DNH (an administrative division ruled directly by the federal government) was compared with a cohort from Umbergaon block of Valsad district, Gujarat, India. A block is the smallest administrative unit under a district. The cohorts were leprosy cases detected between April 2015 and March, 2016. A sample of 120 participants from each group was selected randomly. In the financial year of 2015–16, DNH reported 425 and Umbergaon reported 287 cases. 

A household survey was conducted between June and October, 2016 by means of a structured questionnaire collecting data on patient demographics, HH socioeconomic status, accessibility of health services, treatment seeking history and OPD expenditure. Respondents were asked to report on the last three OPD visits, either in a public or private facility, in the last 6 months. 

The costs were categorized as direct and indirect expenditure. The direct part included the expenditure on consultation, investigations and medicines & supplies. The indirect part constituted expenditure on transport, food, and days lost during illness of the patient and attendant

PLOS Neglected Tropical Diseases, January 4, 2018

https://doi.org/10.1371/journal.pntd.0006181

Disabling bodies of/and land: Reframing disability justice in conversation with indigenous theory and activism

JAFFEE, Laura
JOHN, Kelsey
2018

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A central claim of this paper is that the destruction of Earth through practices of settler colonialism is inextricable from the disablement of Indigenous ontology, peoples, and communities. The disablement of land/body as a tactic of settler colonialism has persisted for centuries and takes multifarious forms. By highlighting Indigenous struggles to protect Mother Earth and her sacred resources, we suggest that Indigenous ontology, specifically relationships to land (Deloria, 1972), challenges Eurocentric/settler disability theory at the epistemological level by rejecting the taken-for-granted dualism between the environment and (disabled) humans within (settler) disability studies. Indigenous ontology, and Indigenous peoples’ experiences of settler colonialism, belie a clear bifurcation of humans and the environment, or bodies and space. Land appropriation, resource extraction, linguistic genocide, forced removal, erasure, and devastation by settlers invariably wreaks havoc on the land, spirit, livestock, and bodies of Indigenous peoples. Rejecting logics of elimination and imagining alternative futures- in opposition to the capitalist state’s projection of futures devoid of disability and Indigeneity- is essential for realizing national and bodily self-determination for non-Indigenous disabled and Indigenous peoples in the present and into the future.

 

Disability and the Global South, 2018, Vol.5, No. 2, 1407-1429

Caregivers' views on stigmatisation and discrimination of people affected by leprosy in Ghana

ASAMPONG, Emmanuel
DAKO-GYEKE, Mavis
ODURO, Razak
January 2018

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In Ghana, the social interpretation of leprosy regardless of the language, culture and tradition engenders stigmatisation and discrimination that leads to social rejection and exclusion of persons who have been cured of the disease. Often, these persons are cared for by relatives who happen to live with them in a confined place. From the views of these caregivers, this paper identifies areas of stigmatising and discriminatory tendencies against people affected by leprosy who reside in a Leprosarium in Accra. A qualitative interview with semi-structured interviews were conducted for twenty caregivers.

Poverty and disability in low- and middle-income countries: A systematic review

BANKS, Lena Morgon
KUPER, Hannah
POLACK, Sarah
December 2017

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Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs).

Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics.

 

https://doi.org/10.1371/journal.pone.0204881

Extra costs of living with a disability: A review and agenda for research

MITRA, Sophie
PALMER, Michael
KIM, Hoolda
MONT, Daniel
GROCE, Nora
April 2017

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Background
There has been a growing interest in disability and poverty on the international research and policy stages. Poverty assessments for persons with disabilities may be affected by the experience of extra costs associated with a disability.

Objective
This article provides a systematized review of the global literature on the direct costs associated with living with a disability at the individual or household level.

Methods
We searched three databases for peer-reviewed journal articles that estimated extra costs associated with disability: Econlit, SocIndex and PubMed.

Results
We found 20 such studies conducted in 10 countries. These studies were predominantly from high-income countries. Although studies were heterogeneous (e.g., in terms of disability measures and cost methodologies), estimated costs were sizeable and some patterns were consistent across studies. Costs varied according to the severity of disability, life cycle and household composition. Highest costs were observed among persons with severe disabilities, and among persons with disabilities living alone or in small sized households.

Disability and Health Journal
Volume 10, Issue 4, October 2017, Pages 475-484
https://doi.org/10.1016/j.dhjo.2017.04.007

Inclusive teaching and learning in higher education as a route to excellence

DISABLED STUDENTS SECTOR LEADERSHIP GROUP
LAYER, Geoff
January 2017

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The report encourages UK higher education providers (HEPs) to look at how they can support and offer the best environment for disabled students. It considers the requirement to provide ‘reasonable adjustments’ under the UK Equality Act 2010, and suggests actions to mitigate risks associated with that. It has been produced by the Disabled Student Sector Leadership Group, a sector-led group. 

DFE-00044-2017

African Disability Rights Yearbook volume 5 2017

NGWENA, Charles
et al
2017

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This volume of the African Disability Rights Yearbook is divided into four sections presenting articles, country reports, commentaries on regional developments and a book review. The first section A of the journal presents a number of articles on issues affecting people with disabilities in Africa, ranging from education and rights of children with disabilities to albinism. Section B presents country reports on Djibouti and Madagascar. Section C presents two articles: one on mental health and the other on disability rights developments in the East African Community post-2012. Finally a review of E. Barnes’s 2016 book "The minority body: A theory of disability" is given.

 

Chap. 2: Intervention Cost-Effectiveness: Overview of Main Messages

DT, Jamison
JG, Breman
AR, Measham
et al
September 2016

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"Although efficient spending on health has always been a desirable goal, it is particularly critical in the face of recent threats, such as HIV/AIDS and drug-resistant bacteria, as well as the problems presented by increasing prevalence of chronic diseases, such as diabetes and cardiovascular disease (CVD), that threaten to roll back the significant health gains achieved in the past two decades. This book is an opportunity to assess anew the costs associated with and the health gains attainable from specific interventions and thereby better inform the allocation of new health funding." 

The political economy of financial inclusion: tailoring donor policy to fit

DEVELOPMENTAL POLICY REVIEW
September 2016

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"Financial inclusion has recently become a globally acclaimed policy objective. This provokes the need to review policy in this sector, particularly in light of the tensions that arise between donor approaches founded on market modernism and governments with more activist leanings. This is done here in the context of efforts to move donor development policy beyond ‘best practice’ institutional blue-prints to those which are ‘good enough’, which seek to understand underlying political economy dynamics in order to find space to engage with governments. In doing so, it is argued that there is scope for ‘working with the grain’ and harnessing the political economy of government policy in order to produce financial inclusion outcomes." 

Impact area overview: the right to inclusive quality education

PLAN INTERNATIONAL
July 2016

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A review by Plan International of their work in the area of inclusive education is presented. Rights associated with inclusive education, education targets in SDGs and global education intitatives and trends are outlined. Issues associated with inclusive education implementation and what needs to be done are discussed. The experience, standards, priorities and strategies and advocacy of Plan International are reported.

Strengthening community and primary health systems for tuberculosis. A consultation on childhood TB integration

UNICEF
2016

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An estimated one million children between the age of 0-14 fall ill with tuberculosis (TB) every year, over 67 million children are infected and might develop active disease at any time. In 2013, the WHO with key partners launched the Roadmap for Childhood TB, outlining ten key actions to improve outcomes for children affected by TB, including improved data, development of child-friendly tools for diagnosis and treatment, engagement of key stakeholders at all levels of the system, and the development of integrated family- and community-centred strategies to provide comprehensive and effective services at the community level. A consultation on childhood TB integration took place in New York on June 1 and 2, 2016 to stimulate further the dialogue. The meeting addressed 7 topics: perspectives on childhood TB; country discussions on integration; integrating childhood TB interventions into service delivery; an opportunity for TB risk assessment at the community level: TB/HIV adapted integrated community case management (iCCM); childhood TB integration at the national, district, and community level; and financing childhood TB integration 

Methods for the economic evaluation of health care programmes. 4th edition. Chapter 1 to 3)

DRUMMOND. Michael
et al
September 2015

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The analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly are discussed. A critical appraisal framework is employed, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy.

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