Wednesday, June 15, 2011

In Rwanda disability is not solely viewed as health issue; it is also viewed as an issue of development and human rights

Last week, in New York, I participated in the launch of the first ever World Report on disability alongside the World Health Organization and the World Bank. This launch marks a critical step toward expanding our reach as global health activists.

According to the Report, 15.3% of Africans have disabilities. This equates to approximately 151 million African men, women, girls and boys or about 15 times the population of my own country, Rwanda. In Rwanda, the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) and the Optional Protocol occurred in 2008. We are committed to ensuring that all Rwandan citizens are supported and included in our society.

Disability is not just a health issue; it is also an issue of development and human rights as people with disabilities face particular barriers to health, education and social services. Many are poor or become poorer due to their disability, and find great challenge in accessing appropriate transport and communication devices. From the perspective of a health minister, policy must address barriers faced by people with disabilities. These barriers should be removed or minimized for the health of the individual and also for the health of society.

The World Report on disability recommends better education and training of health workers so that they can better understand the need to include people with disabilities in mainstream services. I fully endorse this principle. However, this is not enough. We also must invest in the training and provision of skilled staff to rehabilitate persons with disabilities, a service that is vital for those who are born with disability, and for those who become disabled as a result of disease, injury or conflict. This concerns physicians who specialize in rehabilitation, in addition to psycho-social therapists, and engineers.

Human resource capacity for health care is a serious problem in Africa. We do, however, know that rehabilitation delivered at the community level (as opposed to transfers to central hospitals) can ensure the timely delivery of care, and ensure that disabled persons continue to be integrated into their community in positive ways. In the community based approach, children can be empowered to go to school, and adults enabled to engage in productive work. Without rehabilitation, and without appropriate devices, people with disabilities remain dependent and excluded from mainstream society. We must do something about this problem in the months and years ahead, and make sure we permit everyone to access the services they require to maximize their functioning. Rwanda is committed to this effort, in line with our responsibility to implement Article 26 of the CRPD.

And yet we must also remain vigilant, for impressive treaties and comprehensive reports will not have their desired impact, unless we are willing and able to make a difference at the grassroots level - in the clinics, in our schools and in workplaces.

Much needs to be done in this regard, and we can start by learning from best practices in Africa that address the barriers encountered by people with disabilities.

There is also a need to ensure that people with disabilities and their families are supported and informed so that they can take control of their own health. People with disabilities often face extra costs as they must pay for a taxi given that the bus is not accessible. They may require special diets, or other types of extra support. We must tackle these barriers and added costs. In low income countries, lack of funding prevents us from providing the entire package of healthcare services needed. Given this limitation, as the Report emphasizes, people with disabilities are 50% more likely to suffer catastrophic health expenditure than non-disabled people. Thus, it is important to reduce out-of-pocket health costs wherever we can.

If we do not remove or minimize the barriers, and if we do not meet these specific needs, then we are not including and supporting people with disabilities to the best of our ability. This report has  two chief recommendations that we must strive to achieve with efficiency, appropriately and effectively. (1) Remove barriers to our mainstream services, and (2) ensure the provision of specialist services. Each country will have to find the strategic plan that works the best in that setting, and and will need improved policies, changed attitudes, more research, more involvement of people with disabilities in policy development, and more coordinated action.

There is also a need to focus on removal of specific barriers created by individual disabilities, giving people with different ailments the same chance to access promotional, preventive, and curative health services. This approach will reduce marginalisation and stigma, and provide access to services adapted to the specificity of different handicaps. Such programs would be integrated across the health system. We need specific tools and specific counselling approaches, adapted to each disability. All such programs would respect confidentiality, be of good quality and protect human rights. This is how Rwanda aims to provide health services for its sick and disabled..

Currently in Rwanda we have over 30 specialized centers across the country receiving and taking care of persons with handicaps. We have promoted the creation of more than 15 associations concerned with the Rights of Persons with disabilities. Many of the associations operate at the national level. People living with disabilities have a representative in Parliament; and we have an umbrella of associations of people living with disabilties that promote HIV/AIDS awareness and other health issues. This umbrella association is fully supported by the government and elected among the associations of  people with disabilities, by the associations themselves, to represent them. This umbrella serves as their voice in all matters concerning health. People living with disabiltiies are included in planning and follow up of programmatic and financial impelementation of activities in the health sector. In order to improve planning and advocacy we decided two years ago to conduct a census of people leaving with disabiltiies. In 2010 we called on each of the 3 community health workers in each village to visiting all houses in their communities to do the census of people with disabilities – including age, gender, and type of disabilty. Out of a total population of 11 million, approximately 522,850 people were found living with disabilites. Now we are designing a project for clinical evaluation of all the disabilities in order to budget the care and treatment needed to rehabilitating these persons. As written in the Rwandan constitution: health is a human right for all. In that context, Rwanda will make every effort to advance this agenda for the rights and inclusion of persons with disabilities. This is the duty of each and every person in the health sector. This report should inspire our friends and neighbors in Africa and around the world.