Persons With Disabilities Must be Prioritised in Universal Health Coverage (UHC)
By Mildred Omino
Growing up, I grappled with the fact that I was paralysed as a result of polio infection. My mother was a nurse and my father was a Clinical Officer. How could a daughter of health workers contract polio? My mother worked at Ojolla Health Centre in Kisumu West and, from her explanation, it is likely that I received an expired vaccine because the facility lacked electricity which compromised vaccine preservation. This explanation laid bare the adverse effects of inequality and pushed me to advocate for an equitable world. Had the health facility had electricity, I would not have contracted polio.
When I finished high school I made a deliberate effort to attend forums where disability issues were discussed. In one such forum I met older women with disabilities who shared their experiences and sensitised us on HIV/AIDs and reproductive health among young people. This forum revealed to me various health disparities experienced by women with disabilities. These included inaccessible health facilities and equipment, stigma and negative attitudes of health workers towards the reproductive health rights of women with disabilities.
In 2020, I was awarded a year-long George Washington University Health Equity Fellowship, one of the seven global programs of the Atlantic Institute, housed at the Rhodes Trust (Oxford, UK). This allowed me to pursue my commitment to advance sexual and reproductive health rights (SRHR) for girls and women with disabilities. In June, 2020 I saw an Advocacy Accelerator call for applications for a sponsored short course on Universal Health Coverage (UHC) for Health Leaders and Managers, jointly offered by AMREF International University (AMIU) and Strategic Purchasing Africa Resource Centre (SPARC). This course could not have come at a better time, as the COVID-19 restrictions have exacerbated the inequalities experienced by women with disabilities. I applied and was successful. This gave me the opportunity to learn more about UHC and how to use the UHC framework to advocate for health equity. I am greatly humbled to be among the few applicants who were sponsored by Advocacy Accelerator.
Disparities in access to healthcare
More than one billion people in the world have some form of disability. Eighty per cent of these people live in developing countries and are poor. Disability is an umbrella term for impairments, activity limitations and participation restrictions. It is the interaction between individuals with a health condition and personal and environmental factors. Disabled persons achieve less academically, participate less economically and have poorer health outcomes compared to able-bodied people. These disparities are caused by various barriers to access, and socioeconomic factors. For instance, women with disability receive less screening for breast and cervical cancer than women without disability. Adolescents and adults with disabilities are more likely to be excluded from sexuality education. Barriers to health include high cost of healthcare, especially since disabled people are some of the poorest, difficulty in accessing health facilities or medical equipment, lack of public health information in accessible formats and negative attitudes from healthcare workers, especially on sexual health and reproductive healthcare service delivery.
The lack of access to sexual and reproductive health services disproportionately affects those with disabilities. Low utilisation of services by women with disabilities is worse in remote and rural areas. Underdeveloped infrastructure and lack of social amenities compound the adverse situation of girls and women with disabilities.
Health equity in implementation of UHC
Kenya has made numerous global and regional commitments to promoting health, including launching the pilot phase of its UHC programme in December 2018. The phased pilot was implemented across four counties with the objective to ensure that all people access health services without the risk of financial ruin. The UHC framework reflects three dimensions of coverage – population coverage, service coverage, and financial coverage/ protection and, reflects eight principles – Equitable Access, Efficiency, Quality, Inclusiveness, Availability, Adaptability, Choice, and Innovation. It is geared towards affordable healthcare for all including vulnerable populations like persons with disabilities. The pilot phase has since ended and a refashioned version of the scheme is due to begin sometime in 2021.
While the UHC framework provides a comprehensive approach to affordable healthcare for all, girls and women with disabilities remain disadvantaged from enjoying the benefits of UHC, especially reproductive health. Young girls and women with disabilities have poor health seeking behaviour owing to inability/difficulty in accessing health facilities, lack of reproductive health information in accessible formats, lack of sexuality education, low self-esteem owing to historical discrimination, exclusive policies which lack disability specific indicators and most importantly, misconceptions and myths around disability and sexuality. The situation is compounded by attitudinal barriers from the community and health workers. Vulnerable populations are frequently viewed from the perspective of income levels, thereby ignoring the vulnerabilities that come with disability. For persons with disabilities this is a twofold setback.
The training on Universal Health Coverage was an eye-opener and quite impactful in so many ways. I have shared the knowledge with my peers whom we work with in mentoring young girls with disabilities to be self-advocates for health equity and disability justice. We have explored the principles and dimensions of UHC and enhanced our learning materials in order to improve our health equity advocacy. In my disability mainstreaming work at the University of Nairobi, I will endeavour to share the knowledge gained to advance health equity and shedding light on the need for quality healthcare for Persons with disabilities. The training also provided me an opportunity to expand my networks for health rights advocacy by tapping into a rich training cohort. With our improved reproductive health education materials capturing the knowledge I gained on advocacy and health equity through the UHC platform during the training, our work has been enriched and we look forward to having greater impact in terms of sharing knowledge & information. I am very grateful to the Advocacy Accelerator for its support.
Meet the author
Mildred Adhiambo Omino, MPA, B.Com is a disability and Gender Activist with a focus/interest on sexual and Reproductive Health Equity for girls & women with disability. She is an alumnus of Political Leadership and Governance Programme (PLGP) by Freidrich Herbert Stiftung (FES) Kenya, Disability and Sexuality Rights Online Institute & Feminist Leadership, Movement Building and Rights Institute both facilitated by Creating Resources for Empowerment and Action(CREA).
She is also an alumni of Reproductive Rights as Human Rights by Center for Reproductive Rights. She is an Atlantic Fellow for Health Equity program based in Milken Institute School of Public Health in George Washington University. Her Fellowship focus is on Sexual Reproductive Health Equity for girls and women with disabilities.