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Lovemore Rambiyawo Disability Issues
The erroneous assumption that people with disabilities (PWDs) are not sexually active has had the most devastating impact.
PWDs in general and women with disabilities in particular have been denied sexual and reproductive health rights.
Resultantly, the health of persons with disabilities is severely compromised. Good health is an antecedent to the enjoyment of all social, economic, political and cultural rights.
PWDs constitute 15 percent of the global population, access to health is thus a veritable hurdle for the world’s largest minority.
The World Report on Disability (2011) notes that half of persons with disabilities cannot afford healthcare, compared to one third of their non-disabled peers.
The report further notes that across the world, PWDs have poorer health outcomes, lower education achievements, less economic participation and higher rates of poverty than people without disabilities.
This all-encompassing lack of basic human basic needs is attributed to PWDs experiencing barriers in accessing services that the generality of society takes for granted.
These difficulties assume greater proportions in disadvantaged communities in the Global South, including Zimbabwe.
Zimbabwe, with a population of over 17 million (UN figures), has an estimated population of 2,6 million PWDs, an extremely marginalised population, which in common with PWDs worldwide, suffers from a documented lack of access to fundamental freedoms and rights across the entire political, economic, social and cultural spectrum that other people in society take for granted.
In the arena of sexual and reproductive health and rights (SRHR), where PWDs have been excluded from mainstream SRH interventions on the erroneous assumption that they are not sexually active, social exclusion of PWDs reaches its lowest point.
A Family Planning Association Policy Statement from the US Department of Health ( January 2011), following extensive research, made a crucial finding that PWDs across the globe are assumed to be sexually inactive.
This perception by medical personnel, care givers and the generality of society and resultant stereotyping, ignoring of their sexuality, results in PWDs being subjected to attitudinal, physical, economic and informational barriers to accessing sexual healthcare.
To further compound the vulnerability of women with disabilities in the SRH arena, the World Report on Disability further notes that PWDs are at greater risk of violence with multiple and intersecting forms of discrimination that women with disabilities often experience, compounding their vulnerability to different forms of violence, including gender-based violence. The risk of gender-based violence is further aggravated as women and girls with disabilities, due to their physical, visual and hearing impairments, are perceived to be easy targets by men. Fighting back and reporting of issues of sexual violations against women and girls with disabilities by the victims becomes a major constraint and as a result, most of the cases go unreported.
Inadequate policies and/or lack of application of national laws and policies serve to compound the disability problem. Zimbabwe’s health policy is guided by the National Health Strategy (NHS) 2016-2020 — Equity and Quality of Health: Leaving No One Behind, which sets out the strategic direction for the health sector over five years to attain the vision to have “the highest possible level of health quality of life for its citizens”.
The NHS is, however, fundamentally flawed as it leaves PWDs behind. While it identifies quality, equity, gender and community participation as cross-cutting issues integrated across all the strategy areas, disability is conceptualised erroneously as a non-communicable disease.
It is not integrated into the priority programme of communicable diseases; non-communicable diseases; reproductive, maternal, newborn, child health and adolescents; public health surveillance and disaster preparedness.
It is also not integrated into goal 2 of improving service delivery platforms and goal 3 of creation of an enabling environment for service delivery.
This is in stark contrast to the United Nations Convention on the Rights of Persons with Disabilities (CRPD) , which does not locate disability in the individual, but in society.
The convention recognises that disability is an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others.
Article 25(a) of the CRPD, of which Zimbabwe is a signatory, binds member states to provide PWDs with the same range, quality and standard of free or affordable healthcare and programmes as provided to other persons, including in the area of sexual and reproductive health (SRH) and population-based public health programmes. By acknowledging that disability is a socially-created problem, the CRPD brings into sharp focus the realisation that the problem of disability demands a political and social response.
The convention facilitates more concrete actions and measures to further remove barriers, create accessible and enabling environments and conditions and to secure equal opportunities for participation by all PWDs.
Regrettably, despite ratification in September 2013, Zimbabwe has not yet domesticated the CRPD.
It is not all doom and gloom, however. Following an innovative project in which the umbrella disability body trained 1 700 PWDs in HIV and AIDS prevention, treatment, care and support in 30 districts in all 10 provinces of Zimbabwe, Population Services Zimbabwe (PSZ), the leading provider of SRH services in the country, upped the ante by scaling the innovation functionally into SRH and training and supplying PWDs in the 30 targeted districts with short-term contraception.
In the one-year project which ran from October 2016 to September 2017, PSZ, in conjunction with the umbrella body, was also able to conduct a survey to address discrimination and stigma in their quest for FP and SRH services to enhance PWDs access and utilisation of family planning services.
This enabled the project to address, to some extent, the first three of the 12 actions identified in the Unfinished Agenda to meet FP2020 Goals.
These are : Conduct research that identifies the needs of the most vulnerable or under-served individuals; Evaluate interventions to reduce inequities and vulnerability; and understand dynamics of contraceptive decision-making and use.
Sexual and reproductive issues for women and girls with disabilities have also acquired a high profile dimension through the United Nations Partnership on the Rights of Persons with Disabilities (UNPRPD) which is implementing a two-year project titled: “Advancing the Rights of Women and Girls with Disabilities in Zimbabwe”.
The project, running in 20 districts, is being implemented by the United Nations Cultural and Scientific Organisation (UNESCO) Regional Office for Southern Africa, United Nations Development Fund (UNDP) and United Nations Population Fund (UNFPA) Zimbabwe and runs up to December 2020. It is heartening that the project has a heavy component on sexual and reproductive health and is also grounded on research that enables implementing partners to address issues impinging on full and effective participation of PWDs, especially women and girls with disabilities in various spheres of life.
Operating in 38 countries, the UNPRPD is, indeed, a very ambitious project. The UN has a very large target on its back.
The UN country teams have to demonstrate, beyond any shadow of doubt, how innovative its disability inclusion projects are, how the projects meet the criteria of cost effectiveness and causal impact, and proof of concept viability test.
They will also have to demonstrate how effectively its activities are target group-specific, corresponding directly to needs and gaps identified, allow targeting of resources where they are most needed and are most effective, thereby achieving maximum impact and value for money worth of UN cooperation.
Proof of concept viability might well prove to be the acid test for the project as it has to meet the “CORRECT” proof of concept viability test:
Is it CREDIBLE— grounded on sound need for inclusion evidence; OBSERVABLE — its incremental nature enables all users to see the results in practice; RELEVANT— addresses the sharply felt problem of disability exclusion in the critical arena of health; RELATIVE ADVANTAGE over existing practices; EASY to install and understand; COMPATIBILITY — it is in sync with the potential users’ established values, norms and facilities of inclusion; TESTABLE — it has been successfully tested on a small scale prior to adoption on a larger scale. Cognisant that the CRPD recognises disability mainstreaming as an integral part of sustainable development strategies, the UNPRPD will need to be assessed on its disability mainstreaming success considering that civil society organisations have not been trained in disability mainstreaming; there is no disability mainstreaming policy to guide the implementation of the CRPD and there is no practical coordination of disability mainstreaming in Zimbabwe.
Ensuring disability inclusion is no mean feat and requires that all conceivable stakeholders act collaboratively, collectively and inclusively to ensure full and effective participation of people with disabilities in the critical arena of health.
For more information visit: www.nascoh.org.zw
Lovemore Rambiyawo, who is physically-impaired, is acting executive director of National Association of Societies for the Care of the Handicapped (NASCOH); an umbrella body to 70 disability organisations in Zimbabwe. He can be reached at: [email protected]
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