Meeting Needs - Wiman

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26692 Meeting the Needs of People with Disabilities— New Approaches in the Health Sector A technical note by Ronald Wiman, Einar Helander, and Joan Westland June 2002 The views expressed in this report are those of the authors and do not necessarily reflect the official position of the World Bank. Table of Contents 1. Introduction.........................................................................................................................1 2. Policy Context.........................
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    Meeting the Needs of People with Disabilities—New Approaches in the Health Sector  A technical notebyRonald Wiman, Einar Helander, and Joan WestlandJune 2002   The views expressed in this report are those of the authors and do not necessarily reflect theofficial position of the World Bank. 26692    Table of Contents 1. Introduction.........................................................................................................................12. Policy Context.....................................................................................................................22.1 World Bank Health Sector Objectives...............................................................................22.2. Health for All....................................................................................................................32.3 The Legacy of Institutionalization.....................................................................................43. Community-Based Services................................................................................................53.2 Supply of Health Services to People with Disabilities.......................................................63.2.1 Prevention....................................................................................................................73.2.2 Rehabilitation...............................................................................................................83.2.3 Technical Aids and Assistive Devices.........................................................................93.2.4 Accessibility..............................................................................................................104. Sources of Supply.............................................................................................................105. Costs and Financing..........................................................................................................116. Strategic Choices...............................................................................................................136.1 The Widening Service Gap.............................................................................................136.2 Mainstreaming or Targeted Interventions.......................................................................146.3 Community-Based Services.............................................................................................158. Conclusion........................................................................................................................178.1 Addressing Immediate Needs...........................................................................................178.2 Introducing a Community-Based Strategy.......................................................................188.3 Changing the System......................................................................................................20Annexes.................................................................................................................................21Annex 1. Current Concepts and Prevalence...........................................................................21Current Concepts................................................................................................................21Prevalence of Disablement.................................................................................................22Gender and Disability.........................................................................................................22Types of Disability.............................................................................................................23Future Trends......................................................................................................................24ANNEX 2. Summarizing Demand Characteristics and Required Service Responses...........26Bibliography..........................................................................................................................28   1   1. Introduction Economic and social development measures are key factors in improving health, lengtheninglife, and improving the quality of life. While development tends to decrease the overall risks of ill health and disablement, people with disabilities are an increasing subgroup as populationsage and child survival rates increase.People with disabilities tend to be disempowered and deprived of economic and socialopportunities and security because of social and physical barriers in society. They tend to bepoor by all poverty standards—material deprivation, low human development, lack of voiceand influence, and acute vulnerability to economic, social, and health risks. Furthermore, theyare also underserved by most public and private institutions and services. 1 As a result, peoplewith disabilities tend to be the poorest of the poor. Women with disabilities in particular arevulnerable to poverty because they often have few economic means and may resort to beggingfor survival.The many faces of poverty—such as inadequate nutrition, unsanitary water andfacilities, unsafe living and working conditions, limited access to reproductive health servicesand safe motherhood, lack of information and economic resources, and unavailability of healthand social welfare services and protection—are major risk factors for preventable illnesses andresulting disabilities. At the same time the direct cost of illnesses and temporary or permanentdisability increase the risk of falling into poverty. Poverty, poor health conditions and theirdisabling effects, high health care costs, and diminished earning capacity are linked. Indeed,disability is a main cause of poverty in countries that have limited or nonexistent socialprotection systems. 2 In Tanzania, for instance, households that had a member with a disabilityhad a consumption level of less than 60 percent of the average. 3   1 For more on the status of people with disabilities, see Einar Helander, Prejudice and Dignity—An Introductionto Community-Based Rehabilitation , 2 nd edition (New York: United Nations Development Programme, 1999)Available online at:http://dag.virtualave.net/p_d.htm.See also Ann Elwan, Poverty and Disability—A Survey of  Literature , Social Protection Discussion Paper No. 9932 (Washington, D.C.: World Bank, 2000). Available onlineat:http://www.worlbank.org/sp/ .  2 Even in countries with long history of social protection the total incomes of people with disabilities are only afraction of the non-disabled population. For instance, in 1997 the median income of people with disabilities in theUnited States was about one-fifth of the income of employed, nondisabled people. The employment rate of peoplewith disabilities people was 50 percent, whereas the employment rate of the nondisabled working population was78 percent. See:http://www.census.gov/hhes/www/disable/emperndistbl.pdf .  3 Howard White, “Africa Poverty Status Report,” 3 rd draft, In “Ability, Poverty and Development—An IssuesPaper,” Department for International Development, United Kindom (2000). Available online at:http://www.dfid.gov.uk/Pubs/files/disability.pdf .    2 The role of the health sector in the prevention of disabling conditions, in addressingdisabling diseases and limiting their effects, as well as in rehabilitation is central. Therefore,health sector interventions should address the disability dimension to best facilitate povertyreduction.Approaches to analyzing health risks, service supply and demand, and the performanceof the health care sector from a disabled people’s perspective will require a framework thatgoes beyond the health sector and the traditional medical approach to disabilities. Community-based approaches that are integrated into primary health care (PHC) strategies and “Educationfor All” programs are often cost-effective alternatives to disability-targeted projectsspecifically. 4 However, such cross-sector approaches require a medium- or long-terminvestment not only in policy development and management structures and capacity, but incommunity participation and empowerment of people with disabilities.The number of people with disabilities is growing fast. The service gaps are wide andgrowing. Disability-specific interventions can only reach and benefit a minority of disabledpeople who are in need of curative and rehabilitative services. This note aims to introduceperspectives, concepts, and guidelines that may facilitate the effective inclusion of a disabilitydimension in health sector development plans and operations. 2. Policy Context Disability issues are linked to poverty and social development and therefore should be anintegral part of the human development agenda. Although the number of people withdisabilities is increasing worldwide, adequate disability policies and their implementation andenforcement remain elusive. This section provides an overview of outdated policies andconcepts of disability and proposes more viable alternatives that have been successful at theproject level. 2.1 World Bank Health Sector Objectives The World Bank is the world’s largest development investor in the health, nutrition, andpopulation field. The Bank’s objectives in this sector are to help client countries: ã Improve the health, nutrition, and population outcomes of the poor and protect thepopulation from the impoverishing effects of disease and high fertility. ã Enhance the performance of health care systems by promoting equitable access topreventive and curative health, nutrition, and population services that are affordable,effective, well-managed, of good quality, and responsive to clients’ needs.
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