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The community-based actions that removed barriers to inclusive education in Kenya

ELDER, Brent C
PAYNE, Mbuh
OSWAGO, Benson
2021

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This article represents a culmination of inclusive education projects implemented in western Kenya since 2010. In this article, we discuss the 2018 iteration of this on-going community-based participatory research (CBPR)-informed project in which we utilised multiple theoretical frameworks to inform our methods in this project, including decolonising methodologies and Critical Disability Studies (CDS). We conducted qualitative interviews as a way to learn about the ways in which inclusion committees facilitated the partial removal of barriers to the development of an inclusive education system in the region over the last decade. In this article, we provide an overview of the barriers to inclusive education in the global South and sub-Saharan Africa, with a particular focus on western Kenya. We present findings that highlight the various inclusion committee actions that contributed to the partial removal of barriers which included: sensitising communities about inclusive education; promoting access to inclusive education; and implementing inclusive strategies like income generating activities (IGAs) and co-teaching. We conclude the article by suggesting potential ways forward for inclusive education in Kenya including: a multi-sector approach for family supports; providing government incentives to inclusive schools; and promoting IGAs and co-teaching practices in teacher education programs and in schools.

An overview of assistive technology products and services provided in Malawi

SMITH, Emma M
EBUENYI, Ikenna D
KAFUMBA, Juba
JAMALI-PHIRI, Monica
MACLACHLAN, Malcolm
MUNTHALI, Alister
2020

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Background

Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi.

 

Objective

To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi.

 

Study Design

Online survey of representatives from key stakeholder organisations.

 

Methods

We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions.

 

Results

A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them.

 

Conclusion

A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population.

Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia

HOUNSOME, Natalia
KINFE, Mersha
SEMRAU, Maya
ALI, Oumer
TESFAYE, Abraham
MENGISTE, Asrat
BREMNER, Stephen
AHMED, Abdulkadir
FEKADU, Abebaw
DAVEY, Gail
December 2020

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We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meeting. 

 

Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 114, Issue 12, December 2020, Pages 1021–1034

https://doi.org/10.1093/trstmh/traa111
 

An AT Innovator case study: Amparo

WILLIAMS, Rhys
OLDFREY, Ben
HOLLOWAY, Catherine
December 2020

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An interview is reported with Lucas Paes de Melo, the CEO of Amparo, to discuss the journey so far of prosthetics company, Amparo. Rather than focus on the product, this insights paper provides an honest reflection of the journey to establishing an assistive technology company and delves into transferable insights. In doing so, they aim to provide insights to help current and future AT entrepreneurs to see behind the curtain of working in this space.

WHO launches assistive technology capacity assessment (ATA-C)

WORLD HEALTH ORGANISATION (WHO)
November 2020

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WHO has developed the assistive technology capacity assessment (ATA-C) tool, a system-level tool to evaluate a country’s capacity to finance, regulate, procure and provide assistive technology. The ATA-C tool enables countries to better understand the current status and identify key actions to improve access to assistive technology: it can be used for awareness raising, policy and programme design and ongoing monitoring and evaluation.

The ATA-C is part of the WHO Assistive Technology Assessment (ATA) Toolkit, helping countries to collect effective and relevant data on assistive technology

The case for investing in assistive technology

ATscale
November 2020

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In this new report, ATscale describes the enormous gains that access to assistive technology (AT) can have in health, for the community and the economy. The figures are dramatic: investment in the provision of four assistive products - hearing aids, prostheses, eyeglasses, and wheelchairs - will result in a return on investment of 9:1.

Having access to AT can make the difference between failure or success in school, between a job or unemployment, between a life of opportunity or a life of dependency. An example: for a child in a low- or middle-income country, access to AT can make a difference of $100,000 in lifetime income.

Altogether, providing AT to all who need it would yield more than USD 10 trillion in economic benefits over the next 55 years.

Investing in AT both has a transformative impact on people’s wellbeing and makes sound economic sense for funders and governments. 

Product Narrative: Digital Assistive Technology. A market landscape and strategic approach to increasing access to digital assistive technology in low- and middle- income countries

SAVAGE, Margaret
LIAO, Cynthia
CHAUDRON, Matilde
BOYER, Jeffrey
BHATNAGAR, Tigmanshu
LAURENTIUS, Dennis
TORRENS, George
PERRY, Katherine
MORJARIA, Priya
BARAJAS, Felipe Ramos
GOEDDE, Barbara
November 2020

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This document is the final in a series of in-depth analyses that identify key barriers and promising market interventions. The previous four documents focused on wheelchairs, hearings aids, prostheses, and eyeglasses.

The report provides market landscapes of 3 areas of digital AT: mobile phones; screen readers; and augmentative and alternative communication (AAC) devices.

A common set of recommendations focused on improving access emerged from the individual product landscapes:

  • Develop and adopt policies, including legislation, regulations, minimum product standards, and guidelines to support accessibility and uptake of digital AT at the global and country levels.
  • Support governments of low- and middle-income countries (LMICs) to increase awareness of digital AT by including digital assistive products such as smartphones and augmentative and alternative communication (AAC) devices on national assistive product lists.
  • Support innovative financing schemes or negotiate pricing agreements to reduce the cost of digital AT to end users.
  • Increase availability of training programmes for users, suppliers, and service providers on the availability of digital AT and digital literacy skills.

Product Narratives: the challenges of supply and demand-side barriers for priority AT

HOLLOWAY, Cathy
OLDFREY, Ben
END FINEBURG, Alison
SEGHERS, Frederic
SOENDERGAARD, Dennis
September 2020

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This Disability Innovation Live session, looked at the Assistive Technology (AT) Product Narratives (PNs). The Product Narratives were developed by the Clinton Health Access Initiative (CHAI) under the FCDO funded AT2030 programme, led by GDI Hub, in support of the ATscale Strategy.

These PNs set out what we know about the state of the global market for each AT product, and identify global recommendations for how to address some of the barriers to access currently experienced in low and middle-income countries. In this session, we hear from the experts about what the PNs are, how they will inform global policy, and how we hope they will help us reach more people with life-changing AT

Product Narrative: Eyeglasses. A market landscape and strategic approach to increasing access to eyeglasses in Low- and Middle-Income Countries

CHAUDRON, Mathilde
SAVAGE, Margaret
et al
July 2020

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Increasing access to eyeglasses to eliminate the burden of uncorrected refractive errors in LMICs will require a multisectoral approach that brings together the public and the private sector, multilateral organisations, and donors. This will require an approach that increases demand for eyeglasses, raises the number of access points for screening and provision, and accelerates the availability of affordable products. To achieve this, we propose five strategic objectives that can strengthen the market in both the short and longer term.

Product Narrative: Prostheses. A market landscape and strategic approach to increasing access to prosthetic devices and related services in Low- and Middle-Income Countries

LIAO, Cynthia
SEGHERS, Frederick
SAVAGE, Margaret
FINEBERG, Alison
AUSTIN, Vicki
HOLLOWAY, Catherine
OLDFREY, Ben
April 2020

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While about 1.5 million people undergo amputations every year, WHO estimates that only 5-15% of amputees who need prosthetic devices in LMICs have access to them. High prices of prosthetic services in lower- and middle-income countries (LMICs), combined with high indirect costs for users (for example to travel to service points), make prosthetic services unaffordable to many of the people who need them. 

Prosthetic services can be made more affordable by: 1) increasing the number of service units (in particular, by leveraging decentralised service models and the innovative technologies that enable them); 2) establishing reimbursement schemes that encapsulate all costs to the user; and 3) leveraging alternative forms of financing for both capacity-building and user financing.

An opportunity exists to transform access to prosthetic services and products in LMICs, but this will require a coordinated effort between: 1) governments to expand service capacity; 2) global stakeholders to provide guidance on products and technologies; 3) suppliers to expand market presence and offerings; and 4) donors to support these activities. 

Five strategic objectives are proposed to accelerate access to prosthetic services in LMIC

Policy brief: Access to assistive technology

WORLD HEALTH ORGANISATION (WHO)
2020

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This brief is for policy-makers in any ministry involved in designing assistive technology policies and programmes (such as ministries of health, finance and social welfare), especially those involved in designing universal health coverage programmes. It is also relevant for all stakeholders working in these areas. The brief highlights key challenges in ensuring equitable access to high-quality, affordable assistive technology and suggests actions to improve access within universal health coverage or any other national health/welfare programme.

Accessing rehabilitation services: A challenge to overcome. Removing financial barriers towards universal health coverage

HUMANITY & INCLUSION (HI)
November 2019

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Building on the main findings emerging from comparative studies - iFAR (improve Financial Access to Rehabilitation services) studies carried out by Humanity & Inclusion - on the financial accessibility of rehabilitation services in 9 low and middle income countries, this factsheet contains recommendations to guide effective actions that can improve access to rehabilitation for everyone

Bridging the mobile disability gap in refugee settings

DOWNER, Matthew
September 2019

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This case study highlights refugees with disabilities’ access to mobile services and the benefits and challenges associated with using these services in three different humanitarian contexts. The analysis is based on a representative survey of refugees in three contexts: Bidi Bidi refugee settlement (Uganda), Kiziba refugee camp (Rwanda) and with urban refugees in Jordan. It also includes qualitative data drawn from two focus groups conducted with refugees with disabilities in Bidi Bidi and Kiziba. The survey used the Washington Group Questions (WGQs) to assess prevalence of disability amongst the refugee population

Good practices on the implementation of the UNCRPD in Timor Leste (2015-2017)

HANDICAP INTERNATIONAL
DOS SANTOS, Domingos T.M.
et al
August 2019

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The 2015-2017 Advocating for Change Project (AfC), a project funded by the German Federal Ministry for Economic Cooperation and Development (BMZ), aimed at promoting and advocating for rights of people with disabilities through the push for the ratification of the UNCRPD at the national level, improving quality decentralization process at the local level and promoting quality livelihood action for people with disabilities through improved and inclusive vocational training center (CNEFP) in Tibar.

One particular activity in this project is the collection and dissemination of best practices with the "Making it Work" methodology. This methodology aims to document and promote already existing best practices that adhere to the principles of UNCRPD. Making it Work utilizes a multi stakeholder approach and encourages members of DPOs and other organizations to identify best practices and effective action in and surrounding their localities. These best practices are then collected with the ultimate goal to serve as examples of embodiment of the UNCRPD for replication by organizations or institutions elsewhere.

Cluster Munition Monitor 2019

INTERNATIONAL CAMPAIGN TO BAN LANDMINES – CLUSTER MUNITION COALITION (ICBL-CMC)
August 2019

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Cluster Munition Monitor covers cluster munition ban policy, use, production, transfers, and stockpiling in every country in the world, and also contains information on cluster munition contamination and clearance activities, as well as casualties and victim assistance. Its principal frame of reference is the Convention on Cluster Munitions, although other relevant international law is reviewed, including the Convention on the Rights of Persons with Disabilities. The report focuses on calendar year 2018, with information included into August 2019 where possible. Sections are: cluster munition ban policy; contamination and clearance; casualties; victim assistance; and status of the convention

Every learner matters: Unpacking the learning crisis for children with disabilities

McCLAIN-NHLAPO, Charlotte
et al
June 2019

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This paper was developed by the World Bank in partnership with Leonard Cheshire and Inclusion International. It is an attempt to add knowledge to the current understanding of the importance of learning achievements, with a focus on children with disabilities. While the premise is that inclusive education refers to the inclusion of all children, the focus of this paper is on children with disabilities.

The aim of the paper is to:

  • Provide an evidence-based review of educational participation of children with disabilities.
  • Establish a case for focusing on learning achievements for students with disabilities.
  • Take stock of current mechanisms of measurement of learning outcomes and review their inclusivity.
  • Explore evidence of practice and systems which promote disability-inclusive learning for all. 

Four case studies are provided - from Pakistan, South Africa, Canada and UK.

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

 

 

Coordination between health and rehabilitation services in Bangladesh: Findings from 3 related studies

PRYOR, Wesley
MARELLA, Manjula
NGUYEN, Liem
SMITH, Fleur
JALAL, Faruk Ahmed
CHAKRABORTY, Ripon
HAQUE, Mazedul
MOSTOFA, Golam
HASAN, Rajib
April 2019

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The unmet need for rehabilitation is profound and is likely to worsen as population health shifts towards longer lives lived with more ill-health and disability. The WHO Global Action Plan on Disability and the Rehabilitation 2030 framework [1] call for quality evidence to inform targeted responses.
The intent of this work is to examine six IDSCs (Integrated Disability Service Centres) in detail but to use the results to inform new activities through the network of more than 100 Integrated Disability Service Centres, with potential to influence practice in other services. As such, results of this work have the potential to directly inform policy decisions concerning future investments in rehabilitation services in Bangladesh and bring awareness to key stakeholders on current challenges and potential solutions.

Research was conducted during March-October 2018 in Kurigram, Tangail, Manikgonj, Dhaka and Narsingdi districts of Bangladesh to map out the current trends and determinants of good coordination
between health and rehabilitation, emphasising quantitative measures of: timeliness, continuity, acceptability, availability and integration

The micro-politics of caring: tinkering with person-centered rehabilitation

GIBSON, BARBARA
TERRY, Gareth
SETCHELL, Jenny
BRIGHT, Felicity A S
CUMMINS, Christine
KAYES, Nicola M
April 2019

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Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care’s core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question.

 

Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of “diffractive” analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members’ diverse experiences, traditions, and epistemological commitments, we engaged with data from nine “care events” generated in previous research to interrogate the multiple forces that co-produce care practices.

 

Results: We map our analyses under three categories: scripts mediate practice, securing compliance through “benevolent manipulations”, and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one’s expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care.

Leaving no-one behind: Building inclusive social protection systems for persons with disabilities

KIDD, Stephen
et al
February 2019

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How to make social protection systems and schemes more inclusive of persons with disabilities is examined. Social protection can play a key role in empowering persons with disabilities by addressing the additional costs they face, yet the majority of persons with disabilities are currently excluded from schemes.

The report identifies a wide range of barriers persons with disabilities experience in accessing social protection to be overcome. It calls for better data on disability, disability-specific and old age pension schemes and expanded coverage; adapting communications about social protection schemes; and improving disability assessment mechanisms. The research underpinning the report comprised involved a review of the literature, an analysis of household survey datasets, and consultations with key stakeholders and persons with disabilities in seven low- and middle-income countries: Brazil, India, Kenya, Mauritius, Rwanda, South Africa and Zambia.

Topics covered include:

  • Types of social protection schemes for persons with disabilities
  • Levels of investment in social protection for persons with disabilities
  • Coverage of persons with disabilities by social protection
  • Impacts of social protection on persons with disabilities
  • Barriers to accessing social protection and measures to address them
  • Links between social protection schemes and other public services

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