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

重建得更好：津巴布韦 COVID-19 大流行留下的残疾包容性健康

• 批准号: AH/V01353X/1
• 负责人: Hannah Kuper
• 金额: $ 11.5万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=AH%2FV01353X%2F1
• 关键词: Building; back; better; Disability; inclusive

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.

一位著名科学家说，在津巴布韦，“卫生系统正处于瘫痪状态”，因为它试图科普COVID-19疫情。因此，保健方案的实施受到很大挑战。某些群体将特别容易受到这些医疗服务差距的影响，其中包括约10%-15%的津巴布韦残疾人。残疾人在获得医疗保健方面的不平等现象十分普遍。一般而言，残疾人的健康状况较差，因此对一般保健和专科服务（如康复）的需求较高。然而，他们在获得医疗保健时面临许多障碍，如贫困、无法获得服务以及医疗保健提供者缺乏残疾知识和技能。因此，残疾人的医疗保健需求往往得不到满足，这侵犯了他们的权利。这种脆弱性在COVID-19大流行中凸显出来，来自英国的数据显示，59%的COVID-19死亡病例是残疾人。在COVID-19期间，残疾人的健康脆弱性有三个方面。首先，他们更有可能感染这种疾病，因为他们在社会隔离方面有更大的困难，并且可能住在养老院。其次，他们因COVID-19而经历更严重的发病率，因为他们平均年龄更大，先前存在的疾病更多。第三，残疾人往往需要常规保健服务，如药品供应和理疗。因此，我们迫切需要了解和减轻残疾人对COVID的脆弱性，以及更普遍的健康和医疗保健服务差的情况。该项目旨在采用参与式方法了解津巴布韦残疾人在获得医疗保健方面面临的挑战，并确定需要改进的领域，以在COVID-19大流行期间和之后重建包容残疾人的医疗保健系统。该研究分为三个阶段：首先，我们将在津巴布韦开展共同制作和参与性的定性实地调查，以建立冠状病毒大流行对残疾人影响的证据基础。我们将专注于COVID-19疫情期间及疫情前在获取医疗服务方面所遇到的挑战。将与5-8名残疾人举行一次研讨会，以商定和确定关键的研究优先事项和方法。我们将对大约20名成年残疾人（包括男性和女性）和各种类型的残疾人以及其他10名关键知情人（例如医疗保健专业人员）进行定性访谈。访谈最好由残疾研究人员主持。将进行专题分析，并由最初的讲习班与会者核实结果。同时，我们将完成对津巴布韦医疗保健提供系统的情况分析，以及它在多大程度上包容残疾人。这款包含30项内容的工具由“失踪的十亿人”倡议开发，涵盖关键的卫生系统领域（例如治理、人力资源）。最后，我们将共同制定关键战略，使医疗系统从大流行病中恢复到残疾包容性（例如，医疗工作者培训，加强残疾人组织在倡导健康方面的作用），以更好地重建一个更加包容残疾的世界。为此，将与残疾人、残疾人组织、《减贫战略》伙伴和保健工作者举行参与性讲习班。我们会分享初步的研究结果，并邀请他们提供意见。我们致力让残疾人士有意义地参与每一项活动。

项目成果

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19.

• DOI: 10.4102/ajod.v11i0.991
• 发表时间: 2022
• 期刊: African journal of disability
• 影响因子: 1.7
• 作者: Smythe T;Mabhena T;Murahwi S;Kujinga T;Kuper H;Rusakaniko S
• 通讯作者: Rusakaniko S

A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare.

• DOI: 10.4102/ajod.v11i0.990
• 发表时间: 2022
• 期刊: AFRICAN JOURNAL OF DISABILITY
• 影响因子: 1.7
• 作者: Smythe, Tracey;Mabhena, Thubelihle;Murahwi, Shepherd;Kujinga, Tapiwanashe;Kuper, Hannah;Rusakaniko, Simbarashe
• 通讯作者: Rusakaniko, Simbarashe

Should disability-inclusive health be a priority in low-income countries? A case-study from Zimbabwe.

• DOI: 10.1080/16549716.2022.2032929
• 发表时间: 2022-12-31
• 期刊: Global health action
• 影响因子: 2.6
• 作者: Kuper H;Smythe T;Kujinga T;Chivandire G;Rusakaniko S
• 通讯作者: Rusakaniko S