Better data is needed to understand the causes and impacts of disability and the specific disadvantages of people with disabilities

Cape Town, South Africa| Global and national data shows that people with disabilities have increased healthcare needs compared to others. However, people with disabilities experience a range of barriers to healthcare and are often left behind.

Firstly, these barriers include inaccessibility of services and transport. For example, a disability audit of primary health care (PHC) clinics in KwaZulu-Natal showed that only half of the facilities had essential features such as ramps, doors and toilets that provide wheelchair access, and almost none provided information in Braille or offered sign language interpretation. Secondly barrier identified include the unaffordability of services; people with disabilities bear additional costs related to disability, e.g. specialist transport costs and additional care and support; yet they are on average poorer. Disability grants may contribute towards these costs but are insufficient to counteract the extra cost of addressing disability needs. Thirdly, it was found that there are widespread gaps in the availability of disability-specific care. South Africa has 7 937 registered physiotherapists, or 137 per million population, which is less than half the number in countries like the USA and Australia. Other generalist rehabilitation services are also not widely available in South Africa, such as speech and language therapy, occupational therapy, ear and hearing services, ophthalmology and psychiatry. These services are scarce, particularly outside the private sector, and are also inequitably distributed, with rural areas being the most deprived.

Universal Health Coverage (UHC) means that people can obtain all the health services they need, without incurring financial hardship. However, in South Africa people with disabilities on average have a 20-year life expectancy gap compared to their peers without disabilities. The inequities in access to health care among people with disabilities, who make up 16.1% of the South African population, need to be addressed to achieve UHC. The importance of focusing on disability in relation to UHC is increasingly important. To accomplish UHC better data is needed to understand the causes and impact of disability, specific vulnerabilities of people with disabilities. Such information will enable tangible solutions that will address the health care needs of people with disabilities and ensure that UHC is leaving no one behind.

In recent years, the SAMRC has continued with the transformation of the institution into a disability-inclusive environment and to contribute towards knowledge generation aimed at the improvement of health care access for people with disabilities. Although much remains to be done, the Gender and Health Research Unit (GHRU) has made some important strides to increase our knowledge about disability. The unit leads the Sub-Saharan Africa Team of the Disability Data Initiative (DDI). The DDI identifies and analyses data sets that include disability questions to help advance the rights of people with disabilities, to try and move toward sustainable human development. It also provides robust methods for using disability questions in these data sets, as well as specific country briefs. The South African analysis includes so far data sets such as the Census, General Household Survey and the Demographic Household Survey.

Findings

The DDI 2023 report reveals that, compared to their peers without disabilities, people with disabilities are more likely to experience multiple  deprivations (income, education, living standards and health).. It also revealed that multidimensional poverty varies by gender and geographical location. For instance, the South African reports show that multidimensional poverty is particularly experienced by people with disabilities living outside the provinces of Gauteng and Western Cape. The DDI team has also looked at the South African Burden of disease study assessing the increase in Years Lived with Disability - YLD . The analysis revealed that HIV, mental health, musculoskeletal, neurological and sense organ disorders are the five main contributors to YLD in South Africa. The increase in YLD and the vulnerability of people with disabilities calls for disability-accessible health care services and better inclusion of disability and rehabilitation services in primary health care services.

Although people with disabilities report barriers to access health care, little data are available on the accessibility of public health care facilities. Hence, the unit has developed and tested an action orientated tool to assess the level of disability accessibility and inclusion in primary health care clinics – currently called the Disability Awareness Checklist (DAC). This tool was launched at the Stellenbosch Disability Research Hub conference in 2023. A group of experts was formed which now further developed this tool into a toolkit that also provides a tangible intervention menu for South Africa. The toolkit can also be adapted to other countries.

Increasing the level of disability inclusion and accessibility in our healthcare facilities through ensuring better data on disability will lay a foundational cornerstone for achieving Universal Health Coverage (UHC).

Further reading:

1. Assembly, U.G., Political declaration of the high-level meeting in universal health coverage. 2019, UN: New York. Pg 6
2. Web links: https://www.samrc.ac.za/intramural-research-units/ddi-ssa AND https://www.samrc.ac.za/intramural-research-units/testing-gbv-quality-assurance-tool 

For more enquiries/interviews:

1. Prof Jill Hanass-Hancock
   Senior Specialist Scientist: Gender and Health Research Unit
   Email: Jill.HanassHancock@mrc.ac.za
    
2. Ms Yolanda Phakela
   Public Relations Manager
   Email: Yolanda.Phakela@mrc.ac.za
   Mobile: 073 801 3691