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What are the most effective strategies for strengthening health systems for disability inclusive development? - Evidence brief

MACTAGGART, Islay
February 2021

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Health system strengthening refers to initiatives that improve one or more functions of health systems, leading to better health. There is a large body of evidence on what works to strengthen health systems in low- and middle-income countries (LMICs), much of which is aligned to the World Health Organization (WHO) health system building blocks (service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership/governance). Despite the fact that some people with disabilities have additional health needs, and many face additional barriers to accessing healthcare, inclusion of people with disabilities is largely missing from this evidence base. Separately, a smaller evidence base exists on increasing the effectiveness of specific health-related services targeting people with disabilities, such as health-related Community Based Rehabilitation (CBR), rehabilitation services more broadly, and mental health services. This second evidence base is less closely aligned to the building blocks. Reviewing these outputs in parallel goes some way towards identifying effective strategies for strengthening health systems for disability inclusive development.

The role of rehabilitation care workers in South African healthcare: A Q-methodological study

GAMIET, Shamila
ROWE, Michael
October 2019

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Background: The South African Department of Health identified the need to train a new cadre of community health worker (CHW) in the field of rehabilitation as part of their 2030 Health Plan that aims to improve primary healthcare (PHC) and community-based rehabilitation (CBR). Community health workers can be effectively utilised in CBR if their role is understood and their potential is not limited by professional protectionism and scepticism. A clear understanding of the scope of practice of a new cadre will minimise resistance by health professionals.

 

Objectives: The aim of this study was to explore rehabilitation health professionals’ perception of the role of the new cadre, called rehabilitation care workers (RCWs), in South African healthcare.

 

Methods: Q-methodology was used to gather and interpret the data. A convenient sample of 16 health professionals participated in the study. Participants ranked statements about the role of the RCWs from strongly agree to strongly disagree. Data were entered into PQMethod software program for statistical and factor analysis.

 

Results: Two factors emerged. Participants loading onto Factors 1 and 2 were of the opinion that RCWs’ role would be to strengthen PHC and CBR and to promote participation of people with disabilities (PWD) in intermediate care and community.

 

Conclusion: Rehabilitation health professionals’ positive perception of the new cadre is encouraging so that it could ensure their effective utilisation in CBR. Rehabilitation care workers were perceived as capable of enhancing the lives of PWD by ensuring inclusive development.

 

 

African Journal of Disability, Vol 8, 2019

WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights

WORLD HEALTH ORGANISATION (WHO)
2019

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SELF-CARE is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider. 

The purpose of this guidance is to develop a peoplecentred, evidence-based normative guideline that will support individuals, communities and countries with quality health services and self-care interventions, based on PHC (Primary Health Care) strategies, comprehensive essential service packages and people-centredness. The specific objectives of this guideline are to provide:

• evidence-based recommendations on key public health self-care interventions, including for advancing sexual and reproductive health and rights (SRHR), with a focus on vulnerable populations and settings with limited capacity and resources in the health system

• good practice statements on key programmatic, operational and service-delivery issues that need to be addressed to promote and increase safe and equitable access, uptake and use of self-care interventions, including for advancing SRHR.

Abandoned by the state : violence, neglect, and isolation for children with disabilities in Russian orphanages

MAZZARINO, Andrea
September 2014

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This report presents the situation of violence, neglect, and isolation for children with disabilities in Russian orphanages.  The report is based on visits by Human Rights Watch researchers to 10 orphanages in 6 regions of Russia, as well as on more than 200 interviews with parents, children, and young people currently and formerly living in institutions in these regions in addition to 2 other regions of Russia. It finds that many children and young people with disabilities who have lived in state orphanages suffered serious abuse and neglect on the part of institution staff that impedes their development. The report presents the background of the current situation and its detailed findings. and makes recommendations to key Russian stakeholders to ensure protection of the rights of children with disabilities in Russia and to comply with its international human rights obligations

Note: Easy read version is available from the web link

Operational guide for implementation of IICCHAA project

INDIAN INITIATIVE OF CHILD CENTRED HIV & AIDS APPROACH (IICCHAA)
2008

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This operational guide provides a broad direction for implementing memory work in India in the field, based on a communication needs assessment carried out as part of the Indian Initiative for Child Centred Approaches to HIV & AIDS (IICCHAA). The guide is divided into two sections: how to roll out the training effectively at field level and some basic information about HIV and AIDS

Community mental health policy

RADTKE, B
et al
2008

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This resource presents CBM’s community mental health (CMH) policy which "is human rights based, seeks to empower service users and facilitate their active participation in service provision, is culture, poverty and gender sensitive and based upon collaboration and networking with other organizations and the public sector." There are two main delivery models: integration of CMH into existing community-based rehabilitation (CBR) programmes, and implementation of CMH services into primary health care services provided by the government with sharing of resources or the implementation of stand-alone CMH services. This resource is useful for people interested in community mental health policy

Empowered to differ : stakeholders' influences in community-based rehabilitation

FINKENFLÜGEL, Harry
2004

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'Empowered to differ' equally addresses researchers and CBR professionals. The book gives an overview about the developments in the field of community-based rehabilitation since 1978, using the examples of CBR projects in Southern Africa. Finkenflügel asks for the knowledge and the evidence for CBR and to what extent the roles, interests and powers of stakeholders can contribute to this knowledge and evidence

Beyond de-institutionalisation : the unsteady transition towards an enabling system in South East Europe

AXELSSON, Charlotte
GRANIER, Pascal
ADAMS, Lisa
2004

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This report from the Disability Monitor Initiative for South East Europe addresses the unsteady transition within the Balkan countries toward a system that enables and empowers disabled people at all levels. For this region this transition means moving forward with the process of de-institutionalisation and promoting community based services and independent living facilities.
Only through the sharing of information and a mutual learning process between all stakeholders and countries, can the goal of an inclusive society be achieved. This report gives an overview about all the affected fields and gives stakeholders as well as NGOs from other countries a good insight into how these processes can work

Equal opportunities for all : promoting community-based rehabilitation (CBR) among urban poor populations. Initiating and sustaining CBR in urban slums and low-income groups

ASSOCIATION AMICI DI RAOUL FOLLEREAU (AIFO)
October 2001

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Most CBR experience has come from rural areas in developing countries. However, even in large cities specific population groups - such as people living in slums or low-income areas in the urban peripheries - may face difficulties in accessing rehabilitation services. To address this, the World Health Organization set up a number of pilot consultations and projects in seven countries (Indonesia, India, the Philippines, Brazil, Bolivia, Egypt and Kenya) in 1995. This document gives a report of a final meeting of representatives of these pilot projects.

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