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

一位著名科学家表示，在津巴布韦，“卫生系统处于瘫痪状态”，因为它试图应对COVID-19疫情。因此，保健方案的执行受到极大的挑战。某些群体将特别容易受到这些医疗保健服务缺口的影响，其中包括大约10%-15%的津巴布韦残疾人。在获得医疗保健方面的不平等现象在残疾方面很常见。平均而言，残疾人的健康状况较差，因此对一般保健和专业服务（例如康复）的需求较高。然而，他们在获得医疗保健服务时面临许多障碍，例如贫困、服务无障碍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，这是对他们权利的侵犯。在2019冠状病毒病大流行期间，这一脆弱性得到了强调，英国的数据显示，59%的COVID-19死亡病例是残疾人。在2019冠状病毒病期间，残疾人的健康脆弱性体现在三个方面。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，而且可能住在养老院。其次，他们的COVID-19发病率更严重，因为他们的平均年龄更大，既往疾病更多。第三，残疾人往往需要常规保健服务，如药物和物理治疗。这种医疗保健的中断将导致这一群体的健康和功能恶化。因此，我们迫切需要了解和减轻残疾人对COVID的脆弱性，以及更普遍的健康状况不佳和医疗保健可及性。该项目的目的是通过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，以便在2019冠状病毒病大流行期间和之后重建包容残疾人的医疗保健体系。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质的实地调查，以建立关于冠状病毒大流行对残疾人影响的证据基础。我们将重点关注2019冠状病毒病大流行期间以及大流行前在获得医疗保健方面遇到的挑战。将举办一个有5-8名残疾人参加的研讨会，以商定和确定主要的研究重点和方法。我们将对大约20名成年残疾人（包括男性和女性）、各种残疾类型的人以及10名其他关键信息提供者（例如保健专业人员）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，并由原讲习班与会者对结果进行核实。同时，我们将完成津巴布韦医疗保健服务系统的情景分析，以及它在多大程度上包容了残疾人。这一包含30个项目的工具由“失踪十亿人”行动开发，涵盖卫生系统的关键领域（如治理、人力资源）。它将从卫生系统的角度确定卫生保健获取的挑战和促进因素。最后，我们将共同制定关键战略，使卫生保健系统从大流行中恢复到包容残疾人的阶段（例如，卫生工作者培训，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包容残疾人的世界。为此，将与残疾人、残疾人组织、人口和发展方案合作伙伴和保健工作者举行参与性讲习班。我们将分享初步调查结果并征求他们的反馈意见。我们致力于让残疾人有意义地参与每一项活动。

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.