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.
This manual aims to facilitate mental health and psychosocial support (MHPSS) experts and managers in designing, implementing and evaluating community-based MHPSS (CB MHPSS) programmes, projects and activities for emergency-affected and displaced populations in humanitarian settings. It is specifically designed to support managers and experts hired by the International Organization for Migration (IOM). However, it can also be used, in its entirety or in some of its components, by MHPSS experts and managers working for IOM’s partners, including international and national governmental organizations, non-governmental organizations (NGOs), countries, donors and civil society groups.
The first chapter introduces concepts, models and principles of CB MHPSS work; the other chapters are operational and programmatic. These chapters are of two types: •
Those that have to do with the process of a CB MHPSS programme:
Engaging with communities; - Assessing and mapping; - Psychosocial mobile teams; - Technical supervision and training; - Monitoring and evaluation; - Plus two annexes on coordination and ethical considerations. •
Those that introduce specific CB MHPSS activities: - Sociorelational and cultural activities; - Creative and art-based activities; - Rituals and celebrations; - Sport and play; - Non-formal education and informal learning; - Integration of mental health and psychosocial support in conflict transformation and mediation; - Integrated mental health and psychosocial support, and livelihood support; - Strengthening mental health and psychosocial support in the framework of protection; - Counselling; - Community-based support for people with severe mental disorders.
There is great variation across countries regarding the rehabilitation needs of the population, characteristics of the health system and the challenges that face rehabilitation. For this reason, it is important for each country to identify their own priorities and develop a rehabilitation strategic plan. A rehabilitation strategic plan should seek to increase the accessibility, quality and outcomes of rehabilitation.
To assist countries to develop a comprehensive, coherent and beneficial strategic plan, WHO has developed Rehabilitation in health systems: guide for action. This resource leads governments through a four-phase process of (1) situation assessment; (2) strategic planning; (3) development of monitoring, evaluation and review processes; and (4) implementation of the strategic plan. This process utilizes health system strengthening practices with a focus on rehabilitation.
The Rehabilitation in health systems: guide for action provides practical help that directs governments through the four phases and twelve steps. The process can take place at national or subnational level. Typically phases 1 to 3 occur over a 12-month period, while phase 4 occurs over the period of the strategic plan, around 5 years. The four phases and accompanying guidance are outlined below
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.
This report makes the case that integrated people-centred eye care is the care model of choice and can help meet the challenges faced. Chapter 1 highlights the critical importance of vision; describes eye conditions that can cause vision impairment and those that typically do not; reviews the main risk factors for eye conditions; defines vision impairment and disability; and explores the impact of vision impairment. Chapter 2 provides an overview of the global magnitude of eye conditions and vision impairment and their distribution. Chapter 3 presents effective promotive preventive, treatment, and rehabilitative strategies to address eye care needs across the life course. Chapter 4 starts by taking stock of global advocacy efforts to date, the progress made in addressing specific eye conditions and vision impairment, and recent scientific and technological advances; it then identifies the remaining challenges facing the field. Chapter 5 describes how making eye care an integral part of universal health care (including developing a package of eye care interventions) can help address some of the challenges faced by countries. Chapter 6 presents IPEC and explains the need for engaging and empowering people and communities, reorienting the model of care based on a strong primary care and the need for coordinating services within and across sectors; and creating an enabling environment. The report ends with five recommendations for action that can be implemented by all countries to improve eye care.
This is a practical manual about mental health care, aimed at community health workers, primary care nurses, social workers and primary care doctors, particularly in low resource settings. It describes more than 30 clinical problems associated with mental illness, using a problem-solving approach to guide the reader through their assessment and management. It addresses the lack of understanding of mental health among many health workers. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for symptoms.
This product is an update of the first edition 2003. It is also available as Open Access.
"This reports looks at the main barriers to the realisation of disabled people’s right to live independently and be included in the community, which is set out in Article 19 of the UN Convention on the Rights of Persons with Disabilities (CRPD). They are grouped in seven broad areas: (1) misunderstanding and misuse of key terms, (2) negative attitudes and stigma, (3) lack of support for families, (4) prevalence of institutional services, (5) barriers related to community support services, (6) barriers in mainstream services and facilities, and (7) barriers, concerning other CRPD provisions, with effect on Article 19. A set of recommendations is also provided, outlining measures required to address these barriers"
With this manual, the World Health Organization (WHO) is responding to requests from colleagues around the world who seek guidance on psychological interventions for people exposed to adversity.
The manual describes a scalable psychological intervention called Problem Management Plus (PM+) for adults impaired by distress in communities who are exposed to adversity. Aspects of Cognitive Behavioural Therapy (CBT) have been changed to make them feasible in communities that do not have many specialists. To ensure maximum use, the intervention is developed in such a way that it can help people with depression, anxiety and stress, whether or not exposure to adversity has caused these problems. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe people’s problems are.
Purpose: The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this framework constitutes a supplementary source to inform disability-related decision making in integrated Primary Care.
Method: The implementation process of the ICF in a Latin American Primary Care and Community-Based Rehabilitation setting is described and the ICF diagram is applied to a life story as an example of its current use. Participant observation, in-depth study of reports of team meetings and the review of clinical files are the main data collection methods. Data analysis is enabled by the combination of single-case study with theory testing, which facilitates the generation of hypotheses in this exploratory study.
Results: A valuable time component of the ICF may support continuity in Primary Care and the universal application of the ICF framework can promote comprehensiveness by integrating individual rehabilitation and collective disability prevention. A way to mitigate the perceived dominance of biomedical disease and deficiency thinking is proposed in order to encourage the biopsychosocial focus of Primary Care. Finally, the implementation of the International Classification of Diseases (ICD-10) in the health condition domain of the ICF highlights the importance of social responsibility towards disability.
Conclusion: This study suggests that a creative implementation of the ICF during life course to everyone who uses universally accessible healthcare may strengthen the integrative functions of Primary Care, and may be at the heart of the information system of this essential part of the healthcare system. Further research on the complementary use of ICF and ICD-10 is suggested in order to support community-based multisectoral intervention which may be coordinated by Primary Care.
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
This manual presents indicators that "capture the difference (Community-Based Rehabilitation) CBR makes in the lives of people with disabilities in the communities where it is implemented. This manual presents these (base and supplementary) indicators and provides simple guidance on collecting the data needed to inform them. The indicators have been developed to show the difference between people living with a disability and their families and those without disabilities in relation to the information reported in the indicators. This comparability provides valuable information to CBR managers, donors and government agencies alike, which can be used to guide decision-making, support advocacy and improve accountability. Further, the ability of the indicators to provide a comparison of the populations of persons with disability to persons without disability aligns with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which states that persons with disability have equal rights to those without disabilities...this manual serves to standardize the monitoring of differences made by in the lives of people with disabilities and their families, making it possible to compare the difference CBR makes across areas and countries. This manual aligns with the WHO Global Disability Action Plan 2014–2021, and may also be used to monitor other development plans in an easy and efficient way”
Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania. Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods. In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.
This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming. Based on a literature review, discussion and field observations, the authors identify continuing challenges posed by polio and argue that the attention, funding and commitment now being directed towards eradication be shifted to provide for the rehabilitative, medical, educational and social needs of those for whom the disabling sequelae of polio will remain a daily challenge for decades to come
Social Science & Medicine, Vol 107
This report presents a summary of the main issues and conclusions from a CBR and persons with intellectual disabilities workshop. The workshop’s four sessions included "a session on health care needs led by Alaa Sebeh; a session on inclusive education led by Katharina Pfortner; a session on livelihoods and economic independence led by Philipa Bragman; and lastly, a session on social participation and empowerment led by Kathy Al Ju’beh." At the end of the workshop the participants agreed to establish an electronic group/network on CBR and intellectual disabilities. All presentations can be accessed from the website in pdf format
"CBR and Persons with Intellectual Disabilities"
24-25 November 2012
This manual aims to increase knowledge and skills in caring for a child with cerebral palsy. Research highlighted the significant needs of the caregivers, and how they can gain a huge amount of support from meeting with each other in an understanding environment. The manual is divided into 11 modules and promotes a participatory learning approach with an emphasis on the empowerment of parents and caregivers. It provides an opportunity for parents to organise themselves and to consider strategies at the community level to address some of the issues which affect them and their child
Note: An online community that aims to support practitioners share their learning and experiences around the parent training manual is available from the weblink. Members can share questions and perspectives, news items and resources with eachother via email or through a community website
"The guidelines aim to raise awareness of violence against women among health-care providers and policy-makers, so that they better understand the need for an appropriate health-sector response. They provide standards that can form the basis for national guidelines, and for integrating these issues into health-care provider education...The guidelines are based on systematic reviews of the evidence, and cover: identification and clinical care for intimate partner violence; clinical care for sexual assault; training relating to intimate partner violence and sexual assault against women; policy and programmatic approaches to delivering services; mandatory reporting of intimate partner violence"
"This document summarizes ‘Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines’, the World Health Organization (WHO), 2013 publication, developed by an international group of experts following a thorough review of evidence. It contains evidence-based recommendations for the introduction of policies into health services and programmes to improve responses within the health sector to violence against women. Each recommendation is classified as either "strong" or "conditional", on the basis of the generalizability of benefit across different communities and cultures, the needs and preferences of women to access services, as well as taking into consideration the level of human and other resources that would be required"
This report assembles and summarizes information on spinal cord injury, in particular the epidemiology, services, interventions and policies that are relevant, together with the lived experience of people with spinal cord injury. It also provides recommendations for actions based on this evidence that are consistent with the aspirations for people with disabilities as expressed in the Convention on the Rights of Persons with Disabilities
"These standards are intended for use by those working on child protection or related areas of humanitarian action...The Minimum Standards for Child Protection in Humanitarian Action follow the structure of the Sphere standards. Each standard is accompanied by key actions, measurements (including indicators and targets), and guidance notes. Child protection in emergencies includes specific activities by child protection actors, whether national or community-based, and/or by humanitarian staff supporting local capacities. It also includes activities in other humanitarian sectors. The Minimum Standards therefore contain 26 standards: (a) 6 general standards to address child protection needs (b) 8 standards to ensure a quality child protection response (c) 4 standards to develop adequate child protection strategies and (d) 8 standards to ensure mainstreaming of child protection in other sectors"
"This article is an application of the Guidelines for Psychological Practice with Girls and Women to psychological issues faced by Women with Disabilities. It includes culture-specific issues faced by Women with Disabilities, the multiple roles of Women with Disabilities, the importance of informal support systems, and the intersection between feminism and disability...Perspectives of health professionals, disability advocates, and family members are provided to identify issues that need to be included in a comprehensive psychology of Women with Disabilities"
Psychology of Women Quarterly, Vol 34, No 4
Source e-bulletin on Disability and Inclusion