Building back better: Disability-inclusive health as a legacy of the COVID-19 pandemic in Zimbabwe
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Infectious and Tropical Diseases
Abstract
A leading scientist said that in Zimbabwe "The health system is on its knees" as it tries to cope with the COVID-19 epidemic. As a result, the delivery of health programmes is greatly challenged. Certain groups will be particularly vulnerable to these healthcare service gaps, and this includes the approximately 10%-15% of Zimbabweans who are living with disabilities.
Inequity in healthcare access is common with respect to disability. People with disabilities, on average, have poorer health and consequently higher general healthcare and specialist service needs (e.g. rehabilitation). Yet, they face many barriers when accessing healthcare, such poverty, service inaccessibility, and lack of disability-knowledge and skills of healthcare providers. Consequently, people with disabilities often have unmet healthcare needs, which is a violation of their rights. This vulnerability has been highlighted within the COVID-19 pandemic, with data from the UK showing that 59% of COVID-19 deaths are among people with disabilities. The vulnerability of the health of people with disabilities during the COVID-19 is three-fold. First, they are more likely to contract the disease, because they have greater difficulties socially isolating and may live in care homes. Second, they experience more severe morbidity with COVID-19 as they are on average older with more pre-existing conditions. Third, people with disabilities will often need routine health services, such as a supply of medication and physiotherapy. Disruption of continuation of this healthcare will lead to worsening of health and functioning for this group.
We therefore urgently need to understand and mitigate the vulnerability of people with disabilities to COVID specifically, and poor health and healthcare access more generally. The aim of this project is to use participatory approaches to understand the challenges that people with disabilities face in accessing healthcare in Zimbabwe, and identify areas for improvement to build back a disability-inclusive healthcare system during and after the COVID-19 pandemic.
The research has three stages:
First, we will undertake co-produced and participatory qualitative fieldwork in Zimbabwe to build the evidence base on impacts of the coronavirus pandemic among people with disabilities. We will focus on challenges experienced in accessing healthcare during COVID-19 pandemic, as well as pre-pandemic. A workshop will be held with 5-8 people with disabilities, to agree and identify key research priorities and approaches. We will undertake qualitative interviews with approximately 20 adults with disabilities, including men and women, and people with a range of impairment types, and 10 other key informants (e.g. healthcare professionals). Interviews will ideally be led by researchers with disabilities. Thematic analysis will be undertaken, with verification of results by the original workshop attendees.
Concurrently, we will complete a situational analysis of the healthcare delivery system in Zimbabwe and how far it is inclusive of people with disabilities. This 30-item tool has been developed by the Missing Billion initiative and covers key health system domains (e.g. governance, human resources). It will allow identification of challenges and facilitators of healthcare access from a health system perspective.
Finally, we will co-produce key strategies for disability inclusive recovery of the healthcare system from the pandemic (e.g. healthcare worker training, strengthening the role of Organizations for Disabled People in advocating for health) to build back better to a more disability inclusive world. This will be done through holding participatory workshop with people with disabilities, Disabled Peoples Organizations, UNPRPD partners and healthcare workers. We will share preliminary findings and invite their feedback.
We are committed the meaningful participation with people with disabilities throughout each of these activities.
Inequity in healthcare access is common with respect to disability. People with disabilities, on average, have poorer health and consequently higher general healthcare and specialist service needs (e.g. rehabilitation). Yet, they face many barriers when accessing healthcare, such poverty, service inaccessibility, and lack of disability-knowledge and skills of healthcare providers. Consequently, people with disabilities often have unmet healthcare needs, which is a violation of their rights. This vulnerability has been highlighted within the COVID-19 pandemic, with data from the UK showing that 59% of COVID-19 deaths are among people with disabilities. The vulnerability of the health of people with disabilities during the COVID-19 is three-fold. First, they are more likely to contract the disease, because they have greater difficulties socially isolating and may live in care homes. Second, they experience more severe morbidity with COVID-19 as they are on average older with more pre-existing conditions. Third, people with disabilities will often need routine health services, such as a supply of medication and physiotherapy. Disruption of continuation of this healthcare will lead to worsening of health and functioning for this group.
We therefore urgently need to understand and mitigate the vulnerability of people with disabilities to COVID specifically, and poor health and healthcare access more generally. The aim of this project is to use participatory approaches to understand the challenges that people with disabilities face in accessing healthcare in Zimbabwe, and identify areas for improvement to build back a disability-inclusive healthcare system during and after the COVID-19 pandemic.
The research has three stages:
First, we will undertake co-produced and participatory qualitative fieldwork in Zimbabwe to build the evidence base on impacts of the coronavirus pandemic among people with disabilities. We will focus on challenges experienced in accessing healthcare during COVID-19 pandemic, as well as pre-pandemic. A workshop will be held with 5-8 people with disabilities, to agree and identify key research priorities and approaches. We will undertake qualitative interviews with approximately 20 adults with disabilities, including men and women, and people with a range of impairment types, and 10 other key informants (e.g. healthcare professionals). Interviews will ideally be led by researchers with disabilities. Thematic analysis will be undertaken, with verification of results by the original workshop attendees.
Concurrently, we will complete a situational analysis of the healthcare delivery system in Zimbabwe and how far it is inclusive of people with disabilities. This 30-item tool has been developed by the Missing Billion initiative and covers key health system domains (e.g. governance, human resources). It will allow identification of challenges and facilitators of healthcare access from a health system perspective.
Finally, we will co-produce key strategies for disability inclusive recovery of the healthcare system from the pandemic (e.g. healthcare worker training, strengthening the role of Organizations for Disabled People in advocating for health) to build back better to a more disability inclusive world. This will be done through holding participatory workshop with people with disabilities, Disabled Peoples Organizations, UNPRPD partners and healthcare workers. We will share preliminary findings and invite their feedback.
We are committed the meaningful participation with people with disabilities throughout each of these activities.
Publications
Kuper H
(2022)
Should disability-inclusive health be a priority in low-income countries? A case-study from Zimbabwe.
in Global health action
Smythe T
(2022)
A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare.
in African journal of disability
Smythe T
(2022)
A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19.
in African journal of disability
Description | The research that we conducted showed that people with disabilities are being left behind by the health system in Zimbabwe, and that this inequality was further exacerbated by the COVID-19 pandemic. This evidence makes an important contribution to knowledge as it is the first large-scale qualitative study conducted on access to healthcare for people with disabilities in Zimbabwe, and the only one to date that has recorded their experiences during the pandemic. Furthermore, we undertook a comp |
Exploitation Route | This information has been shared with key stakeholders in Zimbabwe who are considering how to use it to influence the Disability Policy and implementation and the new Health Sector Strategy. Moreover, the pilot-testing of the diagnostic health system toolkit has allowed this tool to be finalised. It will now be available for use in other settings in order to undertake a situational analysis of the health system to identify areas for strengthening to promote disability inclusion. |
Sectors | Healthcare |
Description | There are two key non-academic impacts of this grant. First, the findings were disseminated to key stakeholders in Zimbabwe (from health sector, disability sector) who are using them to inform programmes and policies related to disability-inclusive health. Second, the grant allowed the finalisation of a diagnostic toolkit for assessing disability inclusion in the health system. Separate funding has been obtained to develop a manual and support structure for the toolkit. It will then be widely disseminated to help health systems assess their level of disability inclusion and areas for further strengthening. It is already being used in Brazil for this purpose. |
First Year Of Impact | 2022 |
Sector | Healthcare |
Impact Types | Societal,Policy & public services |
Description | Guidance on creating disability inclusive health systems |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Contribution to new or improved professional practice |
URL | https://policycommons.net/artifacts/3181972/disability-inclusive-health-care-systems/3980539/ |
Description | Diagnostic toolkit |
Amount | $35,000 (USD) |
Organisation | University of Oxford |
Department | Structural Genomics Consortium (SGC) |
Sector | Public |
Country | United Kingdom |
Start | 02/2022 |
End | 07/2022 |
Title | Diagnostic toolkit for assessing disability inclusion in the health system |
Description | The Missing Billion diagnostic tool for assessing disability inclusion in the health system was developed prior to this study. It was pilot tested within the Zimbabwe project, which allowed important information to be obtained but also for the tool to be finalised. We have now received additional funding to finish the tool and develop a manual to support its widespread dissemination and use. |
Type Of Material | Physiological assessment or outcome measure |
Year Produced | 2022 |
Provided To Others? | No |
Impact | The diagnostic toolkit is now being finished and will be available for use from end 2022. |
Description | Conference key note address |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | - Keynote speaker at the Wave Summit in Helsinki (September, 2022). |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.ashoka.org/sv-nrd/program/waves-summit-2022 |
Description | Dissemination workshops |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | - Presented at a side-event to the World Health Summit in Berlin (October, 2022) to launch the new Missing Billion report. Other panel members were the Chief Scientific Officer at WHO and the former Prime Minister of New Zealand. |
Year(s) Of Engagement Activity | 2022 |
Description | Dissemination workshops |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | A dissemination workshop was held in Zimbabwe to share the key findings. It was attended by representatives from the government, health sector, academia, organization of people with disabilities and NGOs. |
Year(s) Of Engagement Activity | 2022 |
Description | Webinar events |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Presented at UNPRPD UNDP event - evidence based programmes for disability inclusion |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.undp.org/speeches/evidence-based-programmes-disability-inclusion-support-participatory-s... |
Description | Webinar events |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | Three webinar events were held to disseminate the findings from the research, all hosted from within the UK. Overall attendance was >200 people. Colleagues from Zimbabwe and LSHTM presented the findings together. |
Year(s) Of Engagement Activity | 2022 |
Description | Webinar events |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | - Chaired a side event on disability and health at the Global Disability Summit "Global health: strengthening disability inclusion in mainstream health services." (February, 2022). |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.youtube.com/watch?v=OZDPdz9aNbo |
Description | Webinar events |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | - Panel member of COSP15 Side event: Research and data for advancing the rights of children with disabilities |
Year(s) Of Engagement Activity | 2022 |
URL | https://bettercarenetwork.org/sites/default/files/2022-06/cosp15_side_event_-_research_and_data_for_... |