Building back better: Disability-inclusive health as a legacy of the COVID-19 pandemic in Zimbabwe

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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.