Part 2: Disability Inclusiveness in Eye Health Services
Barriers and Solutions for Accessible Health Services
In order to develop eye health services for people with disabilities, particularly people with low vision and blindness, it is important to understand the commonly experienced barriers.
These barriers and possible solutions can apply to all health services.
Common barriers to health services for PWD’s.
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Possible solutions
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Affordability, or availability, of transport to assess service
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Provision of ‘transport options’ to support people with disabilities to reach appropriate health services.
Encourage PWD to use local health services.
Establish a network of volunteers
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Physical access of building prevents good access to service
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Review physical access to health services, ensure ramps, wide doorways, accessible toilet spaces with rails, clear signage, and clear markings on the floor.
Ask a person from a Blind Association, DPO to do an audit of the accessibility of the building.
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Poor quality services that do not meet the needs of people with disabilities
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Undertake internal review of a particular service to ensure the needs of people with disabilities are being met when they access the health service.
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Affordability of the service
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Reduced service fees for people with disabilities and their families and household.
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Inadequate information in the community about the possible benefits of the health service.
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Negative attitudes, low expectations and discrimination from health care staff
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Work with people with disabilities or a DPO and undertake staff training to achieve positive, friendly and caring
attitudes towards people with disabilities.
Employ a person(s) with disabilities.
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Fear of what may happen when they attend a health service
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Increase community information regarding health services. When patients are identified, provide extensive information to allay fears, for example information regarding what to expect in terms of time, money, procedures etc.
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Low expectations in the community or family of what a person with disability can achieve may lead to inadequate support for them to attend health services
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Always promote positive messages regarding people with disabilities and what they can do when their community supports them.
For example, education, a job, and caring for a family.
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2- Where can Change be Implemented?
Successful disability inclusion in eye health services means that the needs of people with disabilities have been met and that they benefit fully from the service. Multiple changes with multiple groups are required.
Who is required to change?
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Examples of changes to be made
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Persons with disabilities
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Be aware of their own right
Be active in taking care of their health
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Disabled People Organisations (Blind Association, Association, Club, Self-help groups of PWD)
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Establish relationships with eye health services, share information that can be passed on to patients regarding DPO membership, contact details, services etc.
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Eye Health Organisations (Ophthalmology Hospital, Unit, CHS, Health Center and other clinics) - Managers and Leaders
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Commit time and resources to their own learning, and also for their staff.
Provide time and resources for key service processes to be reviewed and made more disability inclusive.
Work with person(s) with disabilities or DPO when undertaking staff training
Employ person(s) with disabilities.
Develop a Disability Policy or a Disability Action Plan for the organisation
Ensure premises are accessible for all people with disabilities.
Ensure all staff are trained in the appropriate ways to assist and guide people with visual impairments.
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Eye Health Organisations (Ophthalmology Hospital, Unit, CHS, Health Center and other clinics) – Staff
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Develop greater understanding and respect for people with disabilities.
Participate in reviews of service processes and familiarise themselves with changes.
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Village Health Workers
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Establish strong relationships with eye health services and communicate information to PWD.
Refer to appropriate eye health service, rehabilitation, vocational training and education services for people with visual impairments or other types of disabilities.
Ensure that accompanying the referral is
adequate information, such as costs, time & expectations, in order to facilitate the attendance.
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CBR Field Workers (if exist)
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Establish strong working relationships with eye health service.
Reliable follow up once patient referred from an eye health service to the CBR service.
Refer clients to eye health services when appropriate, assist for follow up appointments.
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Local People
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Knowledge amongst community members of the rights and potential of people with disabilities.
Knowledge of the benefits of health services.
Provision and support of people with disabilities to health services.
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Ministry of Health and PBL Staff
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Provide disability inclusive guidelines to health services.
Greater knowledge and support regarding disability inclusion in health services.
Support for disability inclusion through training across primary health care system and with other relevant ministries.
Develop community based eye care center and door-to-door service; mainstreaming eye care service with other outreach services.
Ensure equal opportunities so that people with disabilities are employed within health system.
Play supervisory roles to ensure good monitoring and application of the guidelines.
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Relevant ministries: Construction, Transportation and Labor Invalids and Social Affairs
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Provide legal documents and guidelines supporting disability inclusive in health services.
Promote accessibility standards and building codes.
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Mass organization: Women Union, Red Cross, Association for support PWD and orphans, Association for support CWD, Fatherland Front and mass media, etc.
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Update and disseminate relevant information to PWD, agencies, mass organizations, and people in communities.
Contribute and impact on health services at all level.
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3- How can Eye Health Services be made more Disability Inclusive?
Eye Health Services may vary within government health systems and the culture in which they operate.
These recommendations help organizations develop relevant and appropriate processes for disability inclusive within eye health services making it easier for all people – men and women, boys and girls as well as people with disabilities to access services. These recommendations help to identify ‘entry points’ for disability inclusion, so that it becomes an integrated approach in the program - promotion, prevention, treatment and rehabilitation.
Disability inclusion at the Health Care Unit:
Screening and initial identification processes
Patient transport and transfer processes
Clinical diagnosis of low vision and blindness and counseling process
Effective referral to disability service organizations
Reliable follow up process
Eye health promotion activities
Health Information Systems
Accessible Building Upgrade
Step One: Screening and Initial Identification Processes
Promote screening activities to communities in a way that people with disabilities are able to learn about, understand and access eye health services.
Work with local organisations to raise awareness and assist with identification of people with disabilities.
For example: schools and educational systems, village health/ maternal child health workers, religious organisations, disabled people’s organisations, community rehabilitation workers, and other community based organisations such as Red Cross, Women Union.
Step 2: Patient Transport and Transfer Processes
Once a person with a disability has been identified with an eye condition requiring further eye services, always check how the individual will reach the eye clinic/hospital.
People with disabilities and their family often experience greater levels of poverty and social isolation, as well complexities when travelling – therefore they will need encouragement and assistance to utilise the services.
Identify with the family the transport means and costs to the referral hospital/clinic.
Step 3: Clinical Diagnosis of Low Vision and Blindness and Appropriate Counselling Process
Develop a protocol for staff to use in the process of diagnosis of blindness or low vision.
Conduct refresher training to ensure all relevant staff understand the protocol process to provide a consistent level of care.
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