Giving priority to comprehensive health care for persons with disabilities

usually ID As “those who suffer from long-term physical, mental, intellectual or sensory impairments which, when interacting with various barriers, may impede their full and effective participation in society on an equal basis with others”, people with disabilities are often failed by health systems, leading to In worse health outcomes.

Statistics South Africa estimated this Persons with disabilities constitute 7.7% of the country’s populationalthough this excludes children under five years of age, people living in institutions, and people with mental illness, making this a much lower estimate of the actual prevalence. This number will continue to increase as the population grows and ages.

Fundamentally, disability arises from the interaction between disability and environmental, societal, or personal barriers. People with disabilities reported barriers to accessing health care such as inaccessible health facilities and negative attitudes of service providers. They are also excluded from many health care services, with disability-related health services (such as rehabilitation and assistive technology) often reported as inadequate or poor.

All of this drives the need to improve the health system to ensure that all people have access to the full range of quality health services they need to live healthy lives. This is something we should also take into consideration when we celebrate Casual day on Saturday, September 6, to create awareness for people with disabilities.

It is possible to make health systems disability-inclusive. However, South Africa does not currently have a comprehensive tool to assess the inclusion of people with disabilities in its healthcare system. Our project aims to contribute to filling this gap.

We are part of Special Olympics International (SOI) Rosemary Collaborative Initiative Titled “Leveraging Research and Advocacy to Make Health Systems More Inclusive for People with Intellectual Disabilities.” SOI is partnered with The Missing Billion Initiative To adapt the current MBI system level range Which describes the components required to create a disability-inclusive health system. The original framework aims to make health systems inclusive of all persons with disabilities.

It was the result of this partnership Specific unit for intellectual and developmental disabilities (IDD).. This tool, which focuses on direct international communication, is being piloted in eight countries and three states in the United States. The results of these assessments will appear in a global report on the health of people with intellectual and developmental disabilities (PWIDD) that Special Olympics plans to launch in 2025.

Working as consultants for South Africa, we are using the tool to evaluate the inclusion of people with direct contact disorder in the country’s healthcare system. The importance of the Missing Billion Framework is its ability to clarify how systemic factors influence service delivery and produce outcomes and outcomes relevant to people with disabilities. The tool consists of four system-level components and five service delivery components (two on the demand side, three on the supply side) (Figure 1). It is assumed that improving performance with respect to inclusion of disability in these nine components will improve the outcomes of this system, i.e. effective service coverage and thus lead to improved health outcomes (health status) for persons with disabilities.

Figure 1: Health system framework for the missing billion

Preliminary findings of our desk review and policy analysis against the MBI framework system indicators show:

In terms of governance, South Africa has been praised for its policies that are consistent with international laws and the Constitution. For example, South Africa signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2007. However, the last CRPD country progress report was published in 2014. South Africa has legislation that protects the right to health for people with disabilities In general, without any specific reference to PWIDD. There is no independent law of their own. They are referred to as a priority group in National Mental Health Policy Framework and Strategic Plan 2023-2030 (Ministry of Health, 2023). There is no independent policy on international direct communication in the country.

In health policy plans, National Policy and Strategic Framework on Palliative Care 2017-2022 Takes into account that health care facilities and services must prioritize PWIDD and ensure reasonable accommodations are provided. Many NDPs talk about making services accessible to people with disabilities, without specifically mentioning IDD, but do not explain how to implement this inclusion.

It remains unclear how PWIDD will be represented under the leadership of the Ministry of Health. There are no dedicated health sector structures for IDD and IDD needs are often bundled within mental health action plans. We found no evidence of formal representation of PWIDD or their carers on national task forces.

Health in South Africa is financed through a two-tiered health system divided along social and economic lines, leading to unequal access to healthcare (Department of Health, 2019). Health services are mostly provided by the tax-funded public sector, which serves about 84% of the population, while the private sector serves about 16% of the population through medical aid schemes. But there is no budget allocated for the inclusion of persons with disabilities.

the White Paper Evaluation Report on the Rights of Persons with Disabilities 2023 It highlights that the budget allocated to the disability sector is currently fragmented with different departments funding specific projects relevant to them. There are some best practices though. For example, basic primary health care services are free in clinics for all public health care users and are charged on a sliding scale that is means-tested at higher levels of care. People who receive disability grants are also entitled to free health care in hospitals (Department of Social Development, 2016). The South African Revenue Service allows declaration of disability allowing tax refunds on disability related purchases.

In terms of data and evidence, in South Africa there are a number of data sources that collect national data which include WHO Disability Assessment Tablethe Washington Collection of Disability Statistics (WGSS) disability data, SA census statisticsthe National Health and Nutrition Examination Surveyand Demographic and health survey. While our preliminary findings show that some representativeness of disability data is taken into account at the national level (as is the case in all of the datasets mentioned above) and that data collection methods use validated and internationally recognized tools (such as the WGSS), they do not measure Effectively disabling disability.

The WGSS questions used ask about a range of performance domains and do not collect specific information about the disorder, and are therefore unable to specifically identify PWIDD, thus prohibiting disaggregation of data by IDD status. For this reason, we conclude that there is a paucity of data regarding information related to international communication disruption in the country. We were unable to identify national data for outcome indicators related to service coverage and health status outcomes due to the lack of disaggregation by ICD in national datasets.

We call on the Government of National Unity to cooperate and partner with us in this endeavor because this assessment can help prioritize activities by policy makers, including the Ministry of Health as well as the Department of Women, Youth and Persons with Disabilities. The study will also provide many opportunities to develop disability inclusion in the country within structures, programs, monitoring and evaluation, and to make health care inclusive for people with disabilities. There are opportunities to link with existing efforts to implement the program pillars White Paper on the Rights of Persons with Disabilities As well as coordinating disability reporting.

Professor Leketeseng Ned, Dr Nomvo Dwadwa-Hinda and Dr Babalwa Tiabashi-Phom are affiliated with the Department of Disability and Rehabilitation Studies at Stellenbosch University.