What will it take to bridge the health gap for people with disabilities and provide access to assistive technology for all those who need it?

Sixteen percent of the world’s population – 1.3 billion people – live with a serious disability. Nujeen Mustafa, a disability and refugee rights advocate and high-profile supporter of UNHCR, is one of them. 

In her opening remarks at a session which she co-moderated at the 2023 World Health Summit in Berlin, she described her early life in Aleppo, Syria. She did not have a wheelchair and had only sporadic access to the physiotherapy she needs to improve the condition of her legs, which are affected by cerebral palsy. ‘Growing up I had no conception of equity, inclusion, or accessibility,’ she said. ‘Accessibility for me meant having someone strong carry me down the stairs and put me into the back of a taxi to get me to the hospital when I got sick’.

This is the reality that many people with disabilities live through due to lack of inclusion of disability in the vision for healthcare systems. I’m here today because I’d like to see that change.

Nujeen Mustafa, Disability and Refugee Rights Advocate, UNHCR

Seven partners join forces to highlight the urgent need for inclusive health systems  

In the first-ever disability- and assistive technology-focused session at the World Health Summit, participants asked: Why is health equity for persons with disabilities and access to assistive technology a key driver for the achievement of Universal Health Coverage? And what are concrete actions which can make health systems more inclusive? These were some of the questions explored during a far-ranging, interactive session sponsored by the German Federal Ministry for Economic Cooperation and Development (BMZ) and organised by partners actively involved in the topic of disability-inclusive health systems – ATscale, the Global Partnership for Assistive Technology; Christian Blind Mission; Clinton Health Access Initiative; the Missing Billion Initiative; and Special Olympics – with support from Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH. Pascal Bijleveld, the CEO of ATscale, co-chaired the session together with Nujeen Mustafa.

Political declarations are important. Now we have to turn words into action.

The first speaker, Ariane Hildebrandt, Director General at BMZ, welcomed the renewed commitment to global action on an often-neglected issue.

We need to base our health systems on the essential needs of people living with a disability, otherwise we will not be able to ever reach Universal Health Coverage.

Ariane Hildebrandt, BMZ

The recent political declaration on Universal Health Coverage adopted by UN member states includes strong and clear language on health inequalities for persons with disabilities – ‘a reality we cannot accept,’ in the words of Ariane Hildebrandt – and emphasises the role of primary health care systems in making inclusive health services both accessible and affordable. 

‘It is now our shared responsibility to turn words into action,’ she said. Germany, for its part, will be intensifying its commitment to strengthening resilient and inclusive health systems in partner countries through the global health programming supported by BMZ. In 2025, Germany and Jordan will co-host the Global Disability Summit in Berlin – an event which will create strong momentum on disability-inclusive development and humanitarian action.

What kind of changes are needed to make health systems more inclusive?

The session featured a variety of different perspectives on this question, with the voices of persons with disabilities and users of assistive technology at the center.

For Barbara Njovo, a Special Olympics athlete leader from Zimbabwe, a top priority is to train healthcare workers to better serve people with disabilities, and especially people with intellectual disabilities. She described how confused she was after she visited a health clinic and came to realise that she had been given contraceptive pills which she hadn’t asked for. Experiences like these have also made her appreciate the importance of self-advocacy:

Self-advocacy enables people with disabilities to be empowered to ask questions and be included in conversations about our health.

Barbara Njovo, Special Olympics

Fredrick Msigallah, an advocacy officer with Comprehensive Community Based Rehabilitation Tanzania, wants to see improvements in the ‘3As’ – affordability, accessibility, and acceptability – and believes that community-based approaches are a key strategy for achieving this. Comprehensive services, including access to assistive technology, need to be available for free or at low cost at the primary health care level. Health facilities need to be accessible for persons with disabilities, but health information and educational materials do, too, for persons with vision or hearing impairments. Finally, interventions to provide healthcare to persons with disabilities must be culturally acceptable and therefore demand-driven:

Whatever programmes we are planning, persons with disabilities should be involved, because they are the ones who know much better the challenges they are facing.

Fredrick Msigallah, Comprehensive Community Based Rehabilitation Tanzania

Alarcos Cieza, Head of the Integrated Service Delivery Unit and the Sensory Functions, Disability and Rehabilitation Unit, WHO Department of Noncommunicable Diseases, would like to see actors at all levels move beyond a ‘box ticking’ mentality which wrongly assumes that all persons with disabilities need is access to rehabilitation and assistive technology – and that rehabilitation and assistive technology are only needed by persons with disabilities. ‘Both assumptions are wrong and are counterproductive,’ she said. Persons with disabilities need access to comprehensive services – from preventive care and cancer screenings to sexual and reproductive health services and palliative care – while everyone at some point in their lives will require rehabilitation and assistive technology.

Health equity from the perspective of disability is an entry point to equity for all.

Alarcos Cieza, World Health Organization

What steps are countries taking to make health systems inclusive?

The second half of the session looked at some promising examples.

Kenya recently launched a holistic Rehabilitation Services and Assistive Technology Strategy, the first of its kind for the country. According to Patrick Amoth, the Director General at the Ministry of Health, the strategy aims to improve access to care for the estimated 3 million persons with disabilities and 12 million who require a form of assistive technology through investments in health infrastructure, human resource capacity and rehabilitation equipment. Other important measures include the development of disability medical assessment and categorisation guidelines, and the payment of social health insurance premiums for more than 13,000 persons with disabilities to guard against catastrophic health expenditure.

In Cambodia the focus has been on improving the inclusion of persons with disabilities in the health and social protection systems. Vanny Peng, a senior health advisor with GIZ, described how improvements to IDPoor, Cambodia’s national poverty identification programme, has resulted in more persons with disabilities receiving so-called ‘equity cards’ which entitle them to free health services and transportation to health facilities, as well as other forms of social assistance. A disability app has also improved available evidence about the barriers experienced by persons with disabilities.

Needs vary by country, but the building blocks are the same

Even when countries are committed to addressing barriers to inclusion, it can be difficult to know where to start. This is why the Missing Billion Initiative has broken down a complex issue into specific ‘building blocks’ which provide a structure for moving forward. 

 ‘Countries have different needs and are at different points on their journey to inclusive health systems,’ said Hannah Kuper, the co-founder of the Initiative. ‘This is not just an issue in low-income countries. High-income countries must also do more.’

Using a health system assessment framework, countries can assess where they are in key areas – including governance, policies, leadership, financing, data and evidence – and then identify priorities for action. The Missing Billion Initiative and its partners will initially support the introduction of this approach in 10 countries.

Inclusive systems work better for everybody

The clear message which emerged from this session is that the inclusion of persons with disabilities and access to assistive technology affect everyone – and need to be everyone’s concern.

If we build inclusive systems, they will work better for everybody.

Hannah Kuper, Missing Billion Initiative

While the signs of momentum are encouraging, there is a lot of work to do to hold countries accountable to the commitments they have made. As Nujeen Mustafa put it in her closing comments, ‘No single country in the world can say that they have Universal Health Coverage until they include disability. Until that becomes a reality, the mission is still underway.’

October 2023