Ensuring Equal Access to Quality Health for Persons with Disabilities: Current Situation and Future Vision

1. MINISTRY OF MEDICAL SERVICES

2. PRESENTATION BY THE PERMANENT SECRETARY NGARI M.W (MS), CBS During the national conference on disability and accessibility rights towards implementing PWDS ACT 2003 at KICC ON 27th June 2012.

3. TOPIC “Ensuring equal access to quality health, information treatment and device for persons with disabilities. Current situation and vision for the future.”

4. CONFERENCE THEME “Towards a barrier free society for all.”

5. VISION AND MISSION VISION • An efficient and cost-effective medical care system for a health nation. MISSION • To promote and participate in the provision of integrated and high quality curative and rehabilitation medical services to all Kenyans.

6. MANDATE • To offer stewardship and co-ordination of delivery of medical services in a manner that supports attainment of the NHSSPII objectives.

7. NHSSPII • Outline strategic objectives in overall health sector medium term plan. • Outlines programmes and specific system strategic plans and more information on strategic objectives for a given area/need. • ANNUAL OPERATION PLANS(AOPS) and respective medium term expenditure framework for the health sector outlines the key outputs the sector will focus on during a defined year, to enable the sector to attain the priorities outlined by respective ministries strategic plans. • PERFORMANCE CONTRACTING has made the sector to achieve set targets at different levels of service deliver during the given year.

8. GUIDLING PRINCIPLES STRATEGIC THRUSTS –focuses on Strategic thrusts defined primary areas of focus where the ministry will priotize to implement its mandate.inorder to address • Efficiency-best output from available resources. • Equity and human rights –fairness in the distribution and use of resources. • Quality-highly feasible standards of care. • Effectiveness-interventions give clients the best possible health outcomes • Partnership and collaboration-working with others.

9. DEFINATION OF DISABILITY • “Disability” means a physical ,sensory,mental,or other impatient ,including any visual ,hearing, leaning or physical incapatibility,which impacts adversely on social, economic or environment participation.

10. ACCESSIBILTY Definition • Ability to reach, understand or approach something, someone. • What is required for compliance. Environments – Physical,Social, and Attitudinal All can either disable people with impairment or foster their participation and inclusion. • There is interconnection in access to different domains of the environment including buildings,roads,transpotation,information and communication. These domains are interconnected. • Access to environment –has benefit for a border range of people e.g. ramps(curbs cuts assist parents pushing baby strollers. • Information helps those with less education or speakers of a language or marginalized.

11. BARRIERS TO ACCESSIBILITY INADEQUENTE POLICY AND STANDARDS • Policy designs do not always take to accounts the needs of people with disability or existing policies and standards are not enforced. NEGATIVE ATTITUDES • Beliefs and prejudice constitute barriers especially when a healthcare worker cannot see past disability, teachers do not see the value of teaching CWD, employers discriminate against PWDS while family members have low expectations e.g. relatives with disabilities. LACK OF PROVISION OF SERVICES • PWDS are vulnerable to deficiency in services like health care, rehabilitation, support and assistance. PROBLEMS IN-SERVICE DELIVERY • Staffing in competencies and training affects the quality and adequacy of service to PWDS.

12. INADEQUATE FUNDING • Resources allocated to implementing policies and plans are often inadequate, LACK OF ACCESSIBILITY Built environments, transport system and information are often inaccessible. This leads to preventing PWDS from seeking for services including health. Information is essentially unavailable in accessible formats. LACK OF CONSULTATION AND INVOLVEMENT • In decision making LACK OF DATA AND EVIDENCE • Lack of comparable and evidence on programme that work successfully.

13. PROGRESS IN MAINSTREAMING DISABILITYCURRENT SITUATION • Activities being carried out by Ministry of Medical Services on Disability Mainstreaming Indicator Disability Mainstreaming 1. Formulation of TOR for both disability Mainstreaming Teams and Disability Medical Assessment Committees 2. Formulation of Disability Mainstreaming Teams at the following levels of health service delivery • National Level hospitals • Provincial Director of Medical Service’s Offices • Facility level (Hospitals) 3. Formulation of Disability Medical Assessment Committee at the • National Hospitals • Level 5 Hospitals • Level 4 Hospitals 4. Development and Implementation of Disability Medical Assessment and Guide tool.

14. 5. Assessment, Categorization and certification of PWDs for the purpose of registration by the NCPWD in all level 4, 5, and 6 Hospitals and for other services. 6. Sensitization of Health Workers on Disability Act 2003 and UN Convention on the rights of PWDS. 7. Disability mainstreaming 8. Implementation of Article 20 of the Disability Act 2003 • Training of Health Workers on sign language • Accessibility to Information and Health Services to PWDS captured on the service charters

15. NB Disability Mainstreaming in health is on going • The Ministry of Medical Services through the Inter-ministerial Committee on the report on the UN Convention on the rights of PWDs participated in drafting the country report in 2011. • The Ministry of Medical Services with other stakeholders in disability participated in Disability Day of the year 2011. • Ministry involved in organizing for the conference on Accessibility rights • Developed community strategy

16. MEASURES TAKEN IN IMPLEMENTING THE RELEVANT PROVISIONS FOR ACCESS SPECIFIC ARTICLES IN DISABILITY ACT 2003 ARTICLE: 21 ACCESSIBILITY AND MOBILITY • Browser environment and disability friendly to access buildings, roads, and other social amenities and assistive devices and other equipment to promote mobility. RESPONSE • Sensitization of health workers on barrier free environment for PWDS, sign language, provision of I.E.C materials on disability e.g. 500 HWS have been sensitized on sign language. • Availability of at least a wheelchair in outpatient and other service delivery sites.

17. Provision of assistive and supportive device. • Community strategy guidelines have been developed and employment of community health extension workers (CHEWS) to carry out comprehensive community health (primary care) services. • Specialized service is in level 3 to level 6 of health facilities. • Development of instruction Braille-equipment to produce Braille materials and screen headers have however not been availed in hospitals for person who are blind to access information in about hospitals e.g. service charter message. • Speech reading assistive listening and acoustics in indoor settings for hearing impaired persons have not been put in place. • Deaf, blind require sign language interpreters or tactile or hands on interpreters- training of health workers at Diploma level on sign language has started in University of Nairobi. • Clear and simple language approach is being encouraged to health workers to communicate with people with intellectual impairments. • Speech generating devices and yet to be acquired to address communication barrier persons or individuals who are none speaking.

18. ARTICLE 22 PUBLIC BUILINGS A number of health facilities were constructed before the enactment of Disability Act 2003 and before ratification of UN Convention on the rights of PWDS. This is due to lack of disability awareness by component in the training uncouple of planner, architects and construction engineers arriving other reasons. • However appropriate measures are being taken to modify gradually these structures to be accessible. • A number of health facilities have no ramps in place, accessible paths of travels to all places within the facility for accessibility etc. Disability

19. RESPONSE TO THE REALIZATION OF ADJUSTMENT ORDER AND TAX EXEMPTION • Due to an expected paradigm in policy implementation and the fact that disability concept has to be mainstreamed in all Government Ministries, the Ministry of Health like any other Ministry as faced challenges in implementing adjustment orders specially infrastructure. • However facilitation of persons with disabilities for registration and other services have received a very positive response. • The impact on tax exemption has been realized across the board even though guidelines on scoring for the possible beneficiaries has still being worked out. Consequently challenges medical rehabilitation, therapy and devices have also been experienced.

20. TREATMENT AND DEVICES REHABILITATION • A set of measures that assist individuals who experience or are likely to experience disability, to achieve and maintain optimal functioning in interaction with their environment. • Assistive services are designed, made or adapted to help a person perform a particular task: products may specifically produced or generally available for people with a disability.

21. ARTICLE 26(UN CONVERNTION FOR THE RIGTHS OF PWDS) • HABILITATION &REHABILITATION. Calls for appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability and full inclusion and participation in all aspects of life.

22. REHABILITATION MEDICINE • Improving functioning through Diagnosis and treatment of Health conditions, reduction of impairments, prevention and treatment of implications. • Rehabilitation doctors (Psychiatrists, Pediatricians, Ophthalmologist, neurosurgeons and athropaedic surgeons etc) are involved in Rehabilitation Medicine. • Improving joint and limb function • Pain management, wound and psychosocial well-being mostly in level 5 & 6 Hospitals and some level 4 Hospital.

23. Therapy • Restoring & compensating for the loss of functioning & preventing or slowing deterioration in functioning in every area of life. • Occupational therapist, orthotics, physiotherapists, prosthetics, psychologists, rehabilitation and technical assistant social workers & speech and language therapists. • Mostly in level 4-6 Hospitals.

24. Assistive Devices Items, pieces of equipment or product acquired commercially; modified or customized used to increase maintain or improve the functional capabilities of individuals PWDS. • Crutches • Prostheses • Orthoses • Wheelchairs • Tricycle • Hearing aids and cochlear implants • White cares, magnifies, ocular devices talking book & software for screens magnification & reading. • Communication boards & speech synthesizer Tools for use to increase independence and accessibility and improve participation. Mostly in level 4-6.

25. GAPS AND CHALLENGES IN IMPLEMENTATION OF THE ACT • Lack of guiding policies on Universal design especially on accessibility. • Lack of linkage between professional curricula developers, implementers and policy makers. • Inadequate funding • Failure by policy makers to prioritize disability mainstreaming • Staff shortage and capacity development • Poor attitude

26. ACCESS NEEDS FOR THE ELDERLY, WOMEN AND CHILDREN • Kenya Essential Package for Health (KEPH) outlined strategies and objectives of care in service delivery in all levels of the health system. All cohorts needs are taken care of including the elderly women and children.

27. KEPH LEVELS OF CARE 6 – Tertiary Hospitals 5 – Secondary Hospitals 4 – Primary Hospitals 3 – Health Centers, Maternities, Nursing Homes 2 – Dispensaries/clinics- (Interface between Community) & formal Health Systems Community:Village/Households/Families/Individuals

28. MONITORING PROGRESS • PS Performance Contract on disability indicator • Development and Supervisory of monitoring tools • AOP (Annual Operation Plan) • Quarterly reports

29. STRATEGIES FOR ENHANCING IMPLEMENTATION OF THE ACT VISION FOR THE FUTURE • Identify accessibility to physical spaces as key areas for mainstreaming the rights of PWDS, build awareness on accessibility, increase the capacity for action and build strategic partnerships’ • To Conduct Audit Of Hospital environment • Holding workshops on accessibility and policy on disability to health workers • Stage and organize community and public events highlighting what has been done, is required to be done to improve access (for ”access benefits all”) • Develop and increase the capacity of rehabilitation professionals. • Designate and provide accessible parking spaces, ramps and lifts (available signs) and indicators • Install and build accessible toilets and bathrooms • Adjust counter heights in all health service delivery sites. • Provide tactile maps and improve signage.

30. Internet channel for conveying information about health services to ease any potential physical barrier (especially those with hearing, visual or autistic spectrum conditions by redesigning our website). • Redesigning ICT devices and systems to ensure the device can connect with wide range of use interface devices (done with stakeholders) • Procurement-Ensure rehabilitation equipment specifications are reviewed and compatible with disability accessibility principles and policies • Collaborate with organizations to ensure essential telephones and telephones manufactured in or imported into the country are to be hearing aid compatible (provide inductive and acoustic connection allowing individuals with hearing aid and cochlear implants to communicate by telephone • Challenge ignorance and prejudice in disability to health workers by training HWS to treat PWDS as customers and clients on equal basis and with respect. • Monitor and evaluate the implementation of accessibility rules, policies and standards. • Impress on health professional bodies and institutions to introduce accessibility as a component in training curricula design.

31. Improve the supervisory and monitoring tool and data collection measures, progress in improving accessibility. • Introduce case management reform systems and electronic record- keeping to co-ordinate and integrate service provision. • Ensure PWDS are informed of their rights and mechanisms of complaints. • Strengthen community based rehabilitation for PWDS under community strategy. • Train Community Health Extension Workers (CHEWS) and Community Based Rehabilitation Health Workers (CBRHWS) on accessibility concepts. • Adopt a national disability strategy and plan of action, consolidate a comprehensive team with vision for improving the well being of PWDS • PWDS play a key role in service delivery and should be consulted and involved in all stages of program implementation. • Improve human resource capacity • Provide adequate funding • Increase public awareness and understanding of disability • Improve disability data collection • Strengthen and support research on disability

32. CONCLUSIONS • For proper accessibility to be attained, PWDS, stakeholders and governments must participate equally and show strong commitment at all levels and across the sectors. • Adopting universal design and implementing reasonable accommodating are two important strategies. Effective planning adequate human resource and financial investment are key. • Investing in specific programmes and service for PWDS like Rehabilitation, Support services, Training in Rehabilitation including assistive technologies is important e.g. wheelchairs, hearing aids, white canes END THANK YOU