Evidence briefs

22 results

How can we overcome barriers to accessing rehabilitation for persons with disabilities in LMIC?

Rehabilitation is described as a set of measures to optimise the functioning of individuals, and is important for wellbeing, participation and quality of life. Rehabilitation includes diagnosis, treatments, surgeries, assistive devices and therapies. Not all people who need rehabilitation are people with disabilities, and not all people with disabilities need rehabilitation. The World Health Organisation (WHO) recently estimated that 1 in 3 people globally (2.41 billion people) would benefit from rehabilitation: this number has increased nearly two thirds since 1990, due to population growth and increase in Non-Communicable Diseases (NCDs). In contrast, there are estimated to be less than 10 skilled rehabilitation practitioners per million population in Low and Middle Income Countries (LMICs), and only 5 – 15% of people in need of assistive devices are thought to have received them.

  • Livelihood & Social Protection
  • Health
SignificanceFeasibilityApplicabilityEquity
Recommendations
  • Use updated WHO guidance to strengthen and better integrate rehabilitation services into health systems
  • Build the capacity of an indigenous rehabilitation workforce to better meet population rehabilitation needs
  • Identify context-relevant approaches to tackle key barriers to accessing rehabilitation among people with disabilities in LMICs
  • Collect, strengthen and share evidence on what works to improve access to rehabilitation for people with disabilities

What are the core principles that should be considered in the development of policies and programmes related to persons with disabilities in LMICs?

Globally, over a billion people live with a disability. Nearly 80% live in low- and middle-income countries (LMICs). Disability is associated with lower educational attainment, lower employment rates, and limited access to health services. The United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD) is a landmark global treaty, that came into force in May 2008, to realise the rights of persons with disabilities. The UNCRPD brought a paradigm shift in recognising the need to address barriers affecting persons with disabilities across all spheres of life. The purpose of the Convention, as stated in Article 1, is “to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.” However, despite development in some areas, persons with disabilities continue to experience numerous barriers to their full inclusion and participation, especially in LMICs. In this brief, we reflect on literature reviewed across the Disability Evidence Portal to summarise the core principles that need to be considered in the formulation and implementation of policies and programmes that promote inclusion of persons with disabilities in LMICs.

  • Cross-cutting
  • Health
  • Livelihood & Social Protection
SignificanceFeasibilityApplicabilityEquity
Recommendations
  • Enhance disability inclusion by reducing or eliminating the barriers and/or providing additional required measures to facilitate participation and inclusion.
  • Align national policies and programmes on disability with the UNCRPD framework.
  • Take a collaborative approach to realising the rights of persons with disabilities, and invest in capacity development to achieve the Sustainable Development Agenda of ‘Leave no one behind.’
  • Recognise the influence of intersectionality, and adopt a twin-track approach to promoting disability-inclusive development in all areas including education, health, employment, and social activities.
  • Improve and harmonise data collection to inform appropriate programme design and implementation as well as evaluate the impact of policies and programmes, using standardised approaches that allow disaggregated data by disability status.
  • Further develop the evidence base to inform and guide policy making.

What works to improve mental health for parents of children with disabilities?

Parents play a pivotal role in facilitating childhood development and healthcare access for children with disabilities. However, these carers need support to achieve maximum social inclusion and functioning in their communities. In addition to the usual parenting demands, parents of children with disabilities often take on complex care tasks while having to balance other aspects of family life and work commitments. As a result, they may experience additional stresses that may impact on their well-being. However, these effects may be resolved if caregivers are provided with appropriate psychological interventions.

  • Health
SignificanceFeasibilityApplicabilityEquity
Recommendations
  • Focus on increasing access to training interventions to alleviate psychological stress in carers.
  • Provide better access to respite care to reduce the burden on family members as well as acute services as the only source of meaningful support.
  • Develop contextually-appropriate and culturally-sensitive interventions that take account of the carers’ socio-economic settings.
  • Train local community workers and other parents with children with disabilities using community resources to provide parent training and support interventions.
  • Focus on developing a good quality evidence base from LMICs to determine what works to improve the mental health outcomes of carers of children with disabilities.

How can access to mental health services be improved for people with disabilities?

Evidence shows that people with physical, sensory and/or intellectual disabilities (herein referred to as ‘people with disabilities’) are at higher risk of mental health conditions. This may be due to a range of personal, social and economic factors, for example, difficulties in activities and functioning and barriers to social and economic participation experienced by people with disabilities. People with disabilities are also more likely to experience violence, abuse and discrimination, major risk factors for mental health conditions. There is some evidence, mainly from high income countries (HICs), of effective mental health interventions for people with disabilities; including accessible mainstream mental health services and interventions developed/adapted for specific impairment types. However, people with disabilities can face a range of barriers accessing mental health interventions, especially in low- and middle-income countries (LMICs) where mental health services and personnel are sparse. There is increasing evidence around the effectiveness of mental health intervention models in LMICs, including stepped-care and task-shifting programmes, however there is limited information about how to make them disability-inclusive. 

This evidence brief explores what we know about how to improve access to mental health care for people with disabilities in low-resource settings.

  • Health
SignificanceFeasibilityApplicabilityEquity
Recommendations
  • Integrate disability inclusion into mental health care systems and interventions
  • Provide reasonable accommodations so that mental health services and interventions are accessible to people with disabilities
  • Train mental health care workers to deliver services for people with disabilities.
  • Improve the identification of mental health difficulties among people with disabilities
  • Engage people with disabilities in the design and implementation of mental health policies and services.
  • Conduct research on ‘what works’ to promote access to mental health services

How can health and social care services promote the safety and well-being of people with intellectual disabilities during the COVID-19 pandemic in LMICs?

Globally, there are 108 million people living with intellectual and development disabilities (IDD). Evidence repeatedly shows that people with IDD are more likely to experience co-morbidities, yet tend to face several barriers to access health care services. This has resulted in a widespread health inequality, with evidence from high-income countries indicating that people with IDD live on average 20 years less compared to those without intellectual disabilities. It is clear that people with IDD are also at substantially higher mortality risk from COVID-19, particularly people with Down Syndrome. The global COVID-19 pandemic has also contributed to further challenges to the physical and mental well-being among people with IDD as well as people with disabilities in general. In this brief, we have summarised the current evidence on strategies that would facilitate the safety and well-being of people with IDD.

  • Health
  • Livelihood & Social Protection
  • COVID-19
SignificanceFeasibilityApplicabilityEquity
Recommendations
  • People with IDD should be prioritised for COVID-19 vaccination, in particular people with Down Syndrome.
  • Vaccine promotion campaigns for people with IDD should be inclusive, person-centred, and focussed
  • Reasonable adjustments should be made to clinical policies and practices to ensure equity of access and provision for people with IDD
  • Robust behaviour support response plan should be put in place for people with IDD, particularly those with behaviours of concern
  • Strengthen data collection to assess the impact of COVID-19 on people with IDD as well as their caregivers
  • Take a collaborative approach including people with IDD and civil society organisations to inform all policies and programmes that facilitate their safety and well-being during the COVID-19 pandemic

Remaining questions

There are no remaining questions related to this theme