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MINISTRY OF MEDICAL SERVICES

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NGARI M.W (MS), CBS

During the national conference on disability and accessibility rights towards implementing PWDS ACT 2003 at KICC ON 27th June 2012.

PRESENTATION BY THE PERMANENT SECRETARY

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“Ensuring equal access to quality health, information treatment and device for persons with disabilities. Current situation and vision for the future.”

TOPIC

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“Towards a barrier free society for all.”

CONFERENCE THEME

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VISION An efficient and cost-effective medical care system for a

health nation. MISSION To promote and participate in the provision of integrated

and high quality curative and rehabilitation medical services to all Kenyans.

VISION AND MISSION

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To offer stewardship and co-ordination of delivery of medical services in a manner that supports attainment of the NHSSPII objectives.

MANDATE

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Outline strategic objectives in overall health sector medium term plan.

Outlines programmes and specific system strategic plans and more information on strategic objectives for a given area/need.

ANNUAL OPERATION PLANS(AOPS) and respective medium term expenditure framework for the health sector outlines the key outputs the sector will focus on during a defined year, to enable the sector to attain the priorities outlined by respective ministries strategic plans.

PERFORMANCE CONTRACTING has made the sector to achieve set targets at different levels of service deliver during the given year.

NHSSPII

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STRATEGIC THRUSTS –focuses on Strategic thrusts defined primary areas of focus where the

ministry will priotize to implement its mandate.inorder to address

Efficiency-best output from available resources. Equity and human rights –fairness in the

distribution and use of resources. Quality-highly feasible standards of care. Effectiveness-interventions give clients the best

possible health outcomes Partnership and collaboration-working with

others.

GUIDLING PRINCIPLES

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“Disability” means a physical ,sensory,mental,or other impatient ,including any visual ,hearing, leaning or physical incapatibility,which impacts adversely on social, economic or environment participation.

DEFINATION OF DISABILITY

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Definition Ability to reach, understand or approach something, someone. What is required for compliance. Environments – Physical, Social, and AttitudinalAll can either disable people with impairment or foster their

participation and inclusion. There is interconnection in access to different domains of the

environment including buildings,roads,transpotation,information and communication. These domains are interconnected.

Access to environment –has benefit for a border range of people e.g. ramps(curbs cuts assist parents pushing baby strollers.

Information helps those with less education or speakers of a language or marginalized.

ACCESSIBILTY

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INADEQUENTE POLICY AND STANDARDS Policy designs do not always take to accounts the needs of people

with disability or existing policies and standards are not enforced. NEGATIVE ATTITUDES Beliefs and prejudice constitute barriers especially when a healthcare

worker cannot see past disability, teachers do not see the value of teaching CWD, employers discriminate against PWDS while family members have low expectations e.g. relatives with disabilities.

LACK OF PROVISION OF SERVICES PWDS are vulnerable to deficiency in services like health care,

rehabilitation, support and assistance.

PROBLEMS IN-SERVICE DELIVERY Staffing in competencies and training affects the quality and

adequacy of service to PWDS.

BARRIERS TO ACCESSIBILITY

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INADEQUATE FUNDING• Resources allocated to implementing policies and plans are

often inadequate,

LACK OF ACCESSIBILITYBuilt environments, transport system and information are often

inaccessible. This leads to preventing PWDS from seeking for services including health. Information is essentially unavailable in accessible formats.

LACK OF CONSULTATION AND INVOLVEMENT In decision making

LACK OF DATA AND EVIDENCE Lack of comparable and evidence on programme that work

successfully.

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Activities being carried out by Ministry of Medical Services on Disability Mainstreaming Indicator

Disability Mainstreaming1. Formulation of TOR for both disability Mainstreaming Teams and

Disability Medical Assessment Committees2. Formulation of Disability Mainstreaming Teams at the following levels of

health service delivery National Level hospitals Provincial Director of Medical Service’s Offices Facility level (Hospitals)3. Formulation of Disability Medical Assessment Committee at the National Hospitals Level 5 Hospitals Level 4 Hospitals4. Development and Implementation of Disability Medical Assessment and

Guide tool.

PROGRESS IN MAINSTREAMING DISABILITYCURRENT SITUATION

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5. Assessment, Categorization and certification of PWDs for the purpose of registration by the NCPWD in all level 4, 5, and 6 Hospitals and for other services.

6. Sensitization of Health Workers on Disability Act 2003 and UN Convention on the rights of PWDS.

7. Disability mainstreaming8. Implementation of Article 20 of the Disability Act 2003 Training of Health Workers on sign language Accessibility to Information and Health Services to PWDS

captured on the service charters

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NB

Disability Mainstreaming in health is on going• The Ministry of Medical Services through the Inter-

ministerial Committee on the report on the UN Convention on the rights of PWDs participated in drafting the country report in 2011.

• The Ministry of Medical Services with other stakeholders in disability participated in Disability Day of the year 2011.

• Ministry involved in organizing for the conference on Accessibility rights

• Developed community strategy

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SPECIFIC ARTICLES IN DISABILITY ACT 2003

ARTICLE: 21 ACCESSIBILITY AND MOBILITY

1. Browser environment and disability friendly to access buildings, roads, and other social amenities and assistive devices and other equipment to promote mobility.

RESPONSE Sensitization of health workers on barrier free environment for

PWDS, sign language, provision of I.E.C materials on disability e.g. 500 HWS have been sensitized on sign language.

Availability of at least a wheelchair in outpatient and other service delivery sites.

MEASURES TAKEN IN IMPLEMENTING THE RELEVANT PROVISIONS FOR ACCESS

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Provision of assistive and supportive device. Community strategy guidelines have been developed and

employment of community health extension workers (CHEWS) to carry out comprehensive community health (primary care) services.

Specialized service is in level 3 to level 6 of health facilities. Development of instruction Braille-equipment to produce Braille

materials and screen headers have however not been availed in hospitals for person who are blind to access information in about hospitals e.g. service charter message.

Speech reading assistive listening and acoustics in indoor settings for hearing impaired persons have not been put in place.

Deaf, blind require sign language interpreters or tactile or hands on interpreters- training of health workers at Diploma level on sign language has started in University of Nairobi.

Clear and simple language approach is being encouraged to health workers to communicate with people with intellectual impairments. 

Speech generating devices and yet to be acquired to address communication barrier persons or individuals who are none speaking.

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A number of health facilities were constructed before the enactment of Disability Act 2003 and before ratification of UN Convention on the rights of PWDS. This is due to lack of disability awareness by component in the training uncouple of planner, architects and construction engineers arriving other reasons.

However appropriate measures are being taken to modify gradually these structures to be accessible.

A number of health facilities have no ramps in place, accessible paths of travels to all places within the facility for accessibility etc. Disability

 

ARTICLE 22 PUBLIC BUILINGS

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Due to an expected paradigm in policy implementation and the fact that disability concept has to be mainstreamed in all Government Ministries, the Ministry of Health like any other Ministry as faced challenges in implementing adjustment orders specially infrastructure.

However facilitation of persons with disabilities for registration and other services have received a very positive response.

The impact on tax exemption has been realized across the board even though guidelines on scoring for the possible beneficiaries has still being worked out. Consequently challenges medical rehabilitation, therapy and devices have also been experienced.

RESPONSE TO THE REALIZATION OF ADJUSTMENT ORDER AND TAX EXEMPTION

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REHABILITATION A set of measures that assist individuals who

experience or are likely to experience disability, to achieve and maintain optimal functioning in interaction with their environment.

Assistive services are designed, made or adapted to help a person perform a particular task: products may specifically produced or generally available for people with a disability.

TREATMENT AND DEVICES

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HABILITATION &REHABILITATION. Calls for appropriate measures, including through

peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability and full inclusion and participation in all aspects of life.

ARTICLE 26(UN CONVERNTION FOR THE RIGTHS OF PWDS)

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Improving functioning through Diagnosis and treatment of Health conditions, reduction of impairments, prevention and treatment of implications.

Rehabilitation doctors (Psychiatrists, Pediatricians, Ophthalmologist, neurosurgeons and athropaedic surgeons etc) are involved in Rehabilitation Medicine.

Improving joint and limb function Pain management, wound and psychosocial well-

being mostly in level 5 & 6 Hospitals and some level 4 Hospital.

REHABILITATION MEDICINE

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• Restoring & compensating for the loss of functioning & preventing or slowing deterioration in functioning in every area of life.

• Occupational therapist, orthotics, physiotherapists, prosthetics, psychologists, rehabilitation and technical assistant social workers & speech and language therapists.

• Mostly in level 4-6 Hospitals.

Therapy

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Items, pieces of equipment or product acquired commercially; modified or customized used to increase maintain or improve the functional capabilities of individuals PWDS.

Crutches Prostheses Orthoses Wheelchairs Tricycle Hearing aids and cochlear implants White cares, magnifies, ocular devices talking book & software for

screens magnification & reading. Communication boards & speech synthesizerTools for use to increase independence and accessibility and

improve participation. Mostly in level 4-6.

Assistive Devices

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Lack of guiding policies on Universal design especially on accessibility.

Lack of linkage between professional curricula developers, implementers and policy makers.

Inadequate funding Failure by policy makers to prioritize

disability mainstreaming Staff shortage and capacity development Poor attitude

GAPS AND CHALLENGES IN IMPLEMENTATION OF THE ACT

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Kenya Essential Package for Health (KEPH) outlined strategies and objectives of care in service delivery in all levels of the health system. All cohorts needs are taken care of including the elderly women and children.

ACCESS NEEDS FOR THE ELDERLY, WOMEN AND CHILDREN

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6 – Tertiary Hospitals 5 – Secondary Hospitals 4 – Primary Hospitals  3 – Health Centers, Maternities, Nursing Homes  2 – Dispensaries/clinics- (Interface between Community) & formal Health Systems  Community:Village/Households/Families/Individuals 

KEPH LEVELS OF CARE

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PS Performance Contract on disability indicator Development and Supervisory of monitoring tools AOP (Annual Operation Plan) Quarterly reports

MONITORING PROGRESS

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Identify accessibility to physical spaces as key areas for mainstreaming the rights of PWDS, build awareness on accessibility, increase the capacity for action and build strategic partnerships’

To Conduct Audit Of Hospital environment Holding workshops on accessibility and policy on disability to health

workers Stage and organize community and public events highlighting what

has been done, is required to be done to improve access (for ”access benefits all”)

Develop and increase the capacity of rehabilitation professionals. Designate and provide accessible parking spaces, ramps and lifts

(available signs) and indicators Install and build accessible toilets and bathrooms Adjust counter heights in all health service delivery sites. Provide tactile maps and improve signage.

STRATEGIES FOR ENHANCING IMPLEMENTATION OF THE ACT  VISION FOR THE FUTURE

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Internet channel for conveying information about health services to ease any potential physical barrier (especially those with hearing, visual or autistic spectrum conditions by redesigning our website).

Redesigning ICT devices and systems to ensure the device can connect with wide range of use interface devices (done with stakeholders)

Procurement-Ensure rehabilitation equipment specifications are reviewed and compatible with disability accessibility principles and policies

Collaborate with organizations to ensure essential telephones and telephones manufactured in or imported into the country are to be hearing aid compatible (provide inductive and acoustic connection allowing individuals with hearing aid and cochlear implants to communicate by telephone

Challenge ignorance and prejudice in disability to health workers by training HWS to treat PWDS as customers and clients on equal basis and with respect.

Monitor and evaluate the implementation of accessibility rules, policies and standards.

Impress on health professional bodies and institutions to introduce accessibility as a component in training curricula design.

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Improve the supervisory and monitoring tool and data collection measures, progress in improving accessibility.

Introduce case management reform systems and electronic record- keeping to co-ordinate and integrate service provision.

Ensure PWDS are informed of their rights and mechanisms of complaints.

Strengthen community based rehabilitation for PWDS under community strategy.

Train Community Health Extension Workers (CHEWS) and Community Based Rehabilitation Health Workers (CBRHWS) on accessibility concepts.

Adopt a national disability strategy and plan of action, consolidate a comprehensive team with vision for improving the well being of PWDS

PWDS play a key role in service delivery and should be consulted and involved in all stages of program implementation.

Improve human resource capacity Provide adequate funding Increase public awareness and understanding of disability Improve disability data collection Strengthen and support research on disability

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For proper accessibility to be attained, PWDS, stakeholders and governments must participate equally and show strong commitment at all levels and across the sectors. 

Adopting universal design and implementing reasonable accommodating are two important strategies. Effective planning adequate human resource and financial investment are key.

Investing in specific programmes and service for PWDS like Rehabilitation, Support services, Training in Rehabilitation including assistive technologies is important e.g. wheelchairs, hearing aids, white canes

  END  THANK YOU

CONCLUSIONS