Health Sector Disability Mainstreaming Manual PDF 2017

Health Sector Disability Mainstreaming Manual Federal Democratic Republic of Ethiopia Ministry of Health January 2017 1 It’s hard to create a healthier community without full and effective...

Health Sector Disability Mainstreaming Manual Federal Democratic Republic of Ethiopia Ministry of Health January 2017 1 It’s hard to create a healthier community without full and effective participation of persons with disabilities! Message from the director Currently, the issue of persons with disability is recognized and endorsed on a global level, and it is essential to full fill the interests of persons with disabili- ty, especially in the pursuit to meet the sustainable development goals. Feder- al Ministry Health, Women and Youth Affairs Directorate (WYAD) has been working on various issues to mainstream disability at the grassroots level within health sector in collaboration with health sector women and youth structures. Especially, Federal ministry of health women’s and youth affaire directorate examines and inspect services accessibility of health facilities starting from the design, providing comprehensive awareness raising trainings on understanding of disability and disability mainstreaming as well as sign language training for health professionals, the directorate creates access to health and health related information for persons with hearing impairment/deaf through sign language interpretation to health related programs and spots and for persons with visu- al impairment/blind through Braille, this are among the many works that are currently being done by the directorate. In order to insure full and effective inclusion of persons with disability in to health sector, it is essential to produce a manual or guideline to implement different activities in systematic manner. For this reason, federal ministry of health womens and youth affairs directorate developed Health Sector Disability Mainstreaming Manual (HSDMM) to ad- dress the issue of disability in a systematic approach as well as to it plays a great role in support and realization of health sector transformation agendas. Health sector disability mainstreaming manual intended to address and ensure acces- sible health services/health facilities for persons with different impairment, en- hance the awareness of health service providers on disability mainstreaming and inclusive health service, it sets out detailed standards and guidelines for ensuring quality and equitable access to health services for persons with dis- ability just like none disabled persons. This manual developed in support of, national and international law, guidelines, decrees, proclamation and regula- tions. Additionally, Health Sector Disability Mainstreaming Manual (HSDMM) will facilitate to achieve compassionate respectful and caring health profession- als and health services, the manual will have a significant role to play in the development of the information revolution, ensuring quality and equity health services for all and it facilitate to achieve Woreda transformation agendas. Therefore, I believe health sector disability mainstreaming manual will facilitate to take advantage of the country’s resources towards health sector for all citizens without any discrimination, and I strongly recommend and advise health sector officials, senior managerial level staffs, middle level managers and officers, as well as for the staffs at various levels should be keen to take this mandate and put into practice on the work they have doing in the planning, implementation, moni- toring and evaluation. Finally, I extend my gratitude to all governmental and non- governmental organizations and professionals involved in producing this manual. Mrs. Yamrot Andualem Federal Ministry of Health Women and Youth Affairs Directorate Director I  Acknowledgment Federal Ministry of Health has a great appreciation for the professionals listed below for the precious time and knowledge they devoted to prepar- ing health sector disability mainstreaming manual. 1.From Federal Ministry of Health Mr. Zewdu Guluma 2.From Ministry of Labor and Social Affairs Mr. Ahmed Jemal 3.Federation of National Association of Persons with Disabilities in Ethi- opia Mr. Bereket Huseman 4.From Handicap International Ethiopia Mr. Abraham Sileshi 5.From Ethiopian Center for Disability and Development Mrs. Liya Solomon We also thank all those organizations who have provided a positive re- sponse to the above mentioned professionals who have made the manual preparation process successful. F.D.R.E Ministry of Health II Table of content Message from the director Acknowledgment Table of content ----------------------------------------------------------------- l Introduction --------------------------------------------------------------------- 1 International and national conventions and Legal Frameworks on Dis- ability -----------------------------------------------------------------------------3 Objectives of the manual-------------------------------------------------------4 Section One 1.1. Understanding disability ------------------------------------------------- 6 1.2. Disability and Impairment ----------------------------------------------- 6 1.3. Causes of impairment and Disability------------------------------------8 1.3.1. Causes of impairment ----------------------------------------- 8 1.3.2. Causes of disability---------------------------------------------8 1.4. Types of Impairment ------------------------------------------------------8 1.5. Ways to relating with persons with disabilities-----------------------11 1.6. Barriers of participation for persons with disabilities----------------12 1.7. Measures should be taken to include persons with disabilities-----12 Section Two 2. Accessibility, awareness and advocacy --------------------------------- 14 2.1. Creating awareness for health service providers on disability ---- 14 2.2. Accessibility --------------------------------------------------------------16 2.3. Physical accessibility of health facilities ----------------------------- 17 2.3.1. Outside gates and interior doors as well as Windows --- 18 2.3.2. Local lanes/path ways, corridors and Lifts/elevators ----19 2.3.3. Service provision rooms and Equipment ------------------22 2.4. Communication and transferring important information------------24 III  2.4.1. For visual impaired/blind and partially blind persons --25 2.4.2. Fully and partially hearing impaired persons ------------25 Section Three 3. Monitoring and Evaluation ---------------------------------------------- 27 Section Four 4. Conclusion and focus areas and way forward ----------------------------28 4.1. Conclusion ---------------------------------------------------------------28 4.2. Focus areas and way forward ----------------------------------------- 28 4.2.1. Federal Ministry of Health --------------------------------- 28 4.2.2. Regional Health Bureau, Zonal and Woreda Health Department Offices------------------------------------------ 30 4.2.3. Health Service Providers ----------------------------------- 30 4.2.4. Health Professionals and Administrative staffs ----------31 4.2.5. Role of stakeholders -----------------------------------------31 Annex 1: A tool to assess health service accessibility -------------------33 Annex 2: Words We Must Use to Communicate With persons with Disabilities ------------------------------------------------------- 36 Annex 3: Federation and National associations of persons with disability address -------------------------------------------------38 Annex 4: Disability Inclusion Survey questionnaire --------------------40 Annex 5: Duties and Responsibilities of Focal person ----------------- 46 Annex 6: Information about six-service providers Filled form --------48 Reference IV Introduction Currently, the number of persons with disability estimated to be more than one billion globally, according to the joint report of World health organization and World Bank 2011 for most countries it is estimated that more than 15.3 % of the total number of their people are persons with disability, and the number of persons with disability reaches an average of 15-20 % in developing countries. According to the Ethiopian Popula- tion and Housing Census data 2007, Ethiopia has a total of 1.09 % per- sons with disability. However, according to World Health Organization and World Bank report on 2011, there are 17.6% of persons with differ- ent impairment live in Ethiopia. United Nation Convention on the Rights of Persons with Disability (UN- CRPD) is one of the agreements that Ethiopia has ratified and promoted to accelerate its growth and transformation plan. Under this convention Article 25 stated that, “States Parties recognize the persons with disabil- ity have the right to access to the highest healthcare without any dis- crimination based on their types of impairment.” In this section Article A there is a further suggestion that “to provide persons with disabilities a limited, quality, accessible, and affordable healthcare program to oth- er people, including sex and reproductive health and public health pro- grams that are based on public health”. Federal Ministry of Health is conducting and implementing a number of activities aimed at promote and scale up equity, quality and accessible health services for persons with disability, for instance, before the actual construction of health facilities the issue of persons with different im- pairment take in to consideration on design stage. In particular, Women and Youth Affairs Directorate (WYAD) is working hard create acces- sible health services by mainstream persons with different impairment in health different services starting from its annual plan. Beside, rising the awareness of health professionals to create accessible health services for persons with different impairment, the directorate is working hard in collaboration with Public Relation and Communication Directorate (PRCD) including sign language translation to health and health related spots and information and TV program of the sector intended to reach the deaf audience. 1 Ministry of Health is doing the above stated and other different activi- ties to ensure healthier society, but it is not as such progresses are made towards creating accessible health facilities for persons with disability. Therefore, there are still works to be done to create equity and quality health services for persons with disability beneficiaries just like none dis- abled persons. The development of this manual will create accessible health services an equal basis for persons with disability without any barrier and this manu- al will also contribute for the success of health sector transformation plan. 2  I. National and International Conventions and Legal Frameworks on Disability United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was launched in December 2006 and was ready for sign- ing in March 2001. As of June 26, 2012, 172 countries have ratified the Convention, and 162 countries have signed the agreement. It also 92 countries approved the operational protocol. Ethiopia has signed the convention on March 2007 and ratified the dec- laration of the Rights of persons with disabilities on July 2010. Ethiopia has proclaims the convention inform of proclamation number 676/2002 on the approval. This convention is a law that is adopted from the con- vention on the rights of persons with disabilities in all corners of the world. Moreover, if the countries that have signed the Protocol have been violated any of these provisions, the case has been established for the international court. In 2006, the United Nations a Convention on the Rights of Persons with Disabilities (UNCRPD) Article 25 states that “States Parties need to rec- ognize persons with disability have the right to access to the highest healthcare without any discrimination based on their types of impair- ment.” This convention is a document based on right based model, and it is anchored or based on eight (8) Basic Principles. These are, 1.Respect for inherent dignity, individual autonomy, including the freedom to make one’s own choices, and independence of persons 2.Non-discrimination 3.Full and effective participation and inclusion in society 4.Respect for difference and acceptance of persons with disability as part of human diversity and humanity 5.Equality of opportunity 6.Accessibility 7.Equality between men and women 8.Respect for the evident capacities of children with disability and respect for the right of children with disability to preserve their identities 3 In addition to the international convention on the Rights of Persons with Disabilities, it is important to note that other international agreements, conventions and other legal frameworks impose disabilities. Ethiopia’s Commitments to Disability at the National Level 1. FDRE Constitution (1995) states, “The State shall, within available means, allocate resources to provide rehabilitation and assistance to the physically and mentally disabled, the aged, and to children who are left without parents or guardian.” 2. A proclamation of FDRE (Proclamation No. 916/2015) to determine the power, duties, responsibilities and decision-making orders; Re- garding person with disability, Article 10/4 says, “All public sectors need to institutionalized and empowered the issue of persons with disability to act and as equal opportunity and to create full and effec- tive participation” 3. Proclamation No. 624/2009 (Ethiopian Building Proclamation) on Article 36 Sub Article 1 and sub article 2 it clearly states “Facilities for persons with disability”. It specifies charter to implement of proc- lamation 5-2003 in Article 33, 4. National Plan of Action for Inclusion of Persons with Disabilities 2010-2020, 5. Proclamation of rights to employment of persons with disability 568/2000 and its implementation guideline, 6. National Programme of Action of Rehabilitation of persons with dis- ability 2011, 7. Developmental Social Welfare Policy, November 2007, is the main focus area of the policy is person with disability, 4 II.Objectives of the manual ★★Main objective: mainstream and create accessible health service provision for persons with disability as a citizen of the country with- in the ministry at all directorates and at a national level as well as to assist to meet the intended agendas of Ministry of Health ★★Specific Objective: →→To enable health professionals to have an overall understanding of disability and to enable them to be and provide compassionate, re- spectful and caring health services. →→To provide accessible health services for persons with different types of impairment according to their need and interest. →→Creating a system approaches to guarantee equity, quality and acces- sible health service provision for persons with disability; →→Provide health and health related information accessible to persons with disabilities in accordance with their needs, interest and disabil- ity type; 5  Section One 1.1. Understanding disability The way we understand disability and impairment is critical in un- derstanding the basic need and special needs of persons with dis- ability in response of their human rights and to respond to their service demand. This means that our understanding these concepts is based on a negative or positive attitude on disability. Currently, the perception of disability and its deep impact doesn’t only trans- late or alter the concept but also changes the meaning of these key terms. It is important to recognize that the societies have a different ways of understand persons with disability in terms of their culture, with- in specific values and trends they are live in. Thus, while the con- cept of disability is a growing issue or concept, our understand- ing of the subject should be progressive when we understand the meaning and concept of these key words in terms of our level of thinking. 1.1. Impairment and disability  Impairment Impairment is a limited or total loss of functioning in parts of the body or organ of the body, this means loss of long or short term physical, mental, vision, hearing and other physical and sensory impairment. Thus, when the body faces physical and emotional im- pairment and mental illness, the effect will be activity limitation, which signifies a person’s physical condition, vision or hearing loss, mental illness and physical limitations.  Disability Disability is a long-term or a short term physical, mental, intellec- tual or sensory (vision & hearing) Impairment which in interaction with environmental, social, attitudinal, institutional and various barriers may hinder full and effective participation in society on an equal basis with others (UNCRPD, 2006). 6 It is common to use the terminology disability and impairment in- terchangeably as it described the above. Disability is defined as the result of interactions between persons with different impairment in dealings with environmental, social, institutional and other barriers that hinders and face in a full and effective way in the community just like none disabled persons. In most parts of our community believe that impairment is the direct result of disability. However, based on the concept, there is a linkage between impairment and disability, it is important to realize that disability is the result of negative attitudes and lack of access. On the other hand, the umbrella terminology is defined by World Health Organization (WHO) 2001 as, which includes physical functioning, operational limitations, and participation limitations. According to proclamation number 568/2000, persons with disabil- ity is a person who is disadvantaged due to physical, mental, or sen- sory impairment to economical, social or cultural disparity which result unequal opportunity to employment. Due to short and long term physical, mental, psychological and sen- sory impairment may hinder full and effective participation of per- sons with disabilities in the community like none disabled persons (UNCRPDs Dec 6/2006). According to the World Health Organization (WHO), disability is an umbrella terminology that refers to participation limitation, activity limitation, and physical limitation. Disability is a limited function and challenge for the individual to make or to do, and the limitation of participation is the challenges that defy the individual to participate in daily life. Accordingly, disability is a complicat- ed experience associated with the individual and the community. While the concept of disability often has no uniform implications, there are several points to consider when interpreting. These points may differ in the meaning, for example, for employment issues, support cases, court case, education, etc. However, it is possible to understand the word in terms of four major models. These models are the lenses that we see and perceive disability. 7 Additionally, the models use and provide the legal frame work to the community and the structure as a reference. These models are; Charity Model Medical Model Social Model Rights Based Perspective Particularly, Ministry of Health believes that it is essential to support the right based model/perspective to make health ser- vices accessible to persons with disability and, in some ways accept a social model. 1.3. Causes of impairment and disability 1.3.1. Causes of impairment Impairment can occur during prenatal, during birth and post- natal periods, in natural or manmade accidents or ways. 1.3.2. Causes of Disability Causes of disability are factors that contribute to the incident of disability, which is physical, environmental, attitudinal, in- stitutional, communication barriers and other challenges. 1.4. Types of Impairment There are different types of impairment, look at these types of im- pairment with their appropriate word in the table below: No Types of impairment Title 1 Visual impairment (partially vi- A person with visual im- sual impaired and blind) pairment 2 Hearing impairment (partially A person with hearing hearing impaired and Deaf) impairment or Deaf 3 Physical Impairment (leprosy, A person with disability wheelchair users, a person with short stature, a person with spi- nal cord and other related impair- ment, quadriplegia, paraplegia, hemiplegia, Amputation of upper and lower limbs etc. 8 4 Intellectual Impairment A person with intellectual (down syndrome, autism, impairment etc) 5 Mental illness (schizophre- A person with mental ill- nia, bipolar mood disorders, ness etc.) 6 Deaf and Blind A person with Deaf and Blind 7 Multiple impairment (more A person with multiple than one types of impair- impairment ment ) 9 Learning and specific learn- ing impairment 10 Speech impairment (stutter- ing, stammering, etc.) ★★Visual Impairment Visual impairment mean, the absence of the eye function as it expect to do partially or totally. It is divided into two parts, the first one is total blindness and the second is partial blind- ness. Total blindness is when the eye does not function com- pletely, and partial blindness is reduced of the sight of the eye until it assisted by eye glass. ★★Hearing impairment It is types of impairment when people lose or reduce their sense of hearing in natural or manmade catastrophes. Depend on the degree of their hearing loss persons with hearing im- pairment can be classified in to two parte this are partial deaf/ partial hearing loss and deaf. Deafness varies from person to person based on the age of their hearing loss, we can classify them before and after they developed/ acquired spoken lan- guage. 9 spoken language, the deaf can often speak and also can read lips, but those who lose their hearing ability before they de- veloped spoken language are more prefer to use sign lan- guage than lip read and also they can’t talk. ★★Physical Impairment Physical impairment refers to any short and long term injures or impairment on physical or which hinders mobility. Includ- ing neurologic, musculoskeletal disorders (leprosy, polio), both of the paraplegia, of all knee muscle fibers (quadriple- gia), cerebral palsy, (Ostogenesis imperfect) (multiple scle- rosis), prostate hemiplegia, amputation of limbs, short stat- ure, and other similar types of injuries. ★★Intellectual Impairment Intellectual impairments – Refer to below average intellec- tual function that results in the person requiring supervision during with related that daily activities in life with daily life activities. It begins early in life during the developmental pe- riod (before age 18). Intellectual impairment will occur due to alcohol consumption during pregnancy, iodine deficiency in pregnancy, injury to the brain at birth or later in the devel- opmental period, genetic and metabolic disorders and other related causes. Persons with intellectual impairment have be- low average mental ability or intelligence quotient (IQ). ★★Multiple impairments While more than one types of impairment happen at a per- son, we call it multiple impairments. These are, deaf-blind, mental illness and speech, intellectual and mental impair- ments, physical and speech impairments, intellectual impair- ment and physical impairment, etc. when a person impaired by more than one impairment and an individual will need extensive support for the long-term involvement in one of the major functions. 10 1.5. Ways to effectively communicate with persons with disabilities There are a number of ways to use to communicate with per- sons with disabilities and a few of these are: ※※When you engaged in a long conversation with a person on a wheelchair try to position yourself at the same eye level by sitting or stooping down, if your conversation is more than a minute. This/your action will be more positive to the individuals and they will not get their head up. ※※Greetings by handshaking, if the individuals have limited ability to use his or her hand, touch/tap their shoulder with a smile. If you want to get help, ask properly and listen to their needs carefully before you are rendering assistance. Explain directions to the person about where assistive de- vices are. ※※When persons with low vision or total blind is moving place to place in the compound, do not leave half open or half close the doors, you should close or open the doors or windows completely. ※※When it is appropriate, ask for help to read Inc informa- tion for blind persons. ※※If you are assisting blind persons, allow them to hold your arm on top of the elbow, move one step forward rather than thrust or push forward. Explain for them that it is “this is the stair” or “ now we are ascending the stair” ※※Even if you have previously been contacted with the per- son with visual impairment, do not assume that the person is aware of your voice. Introduce yourself by name, keep the volume of your voice normal, and talk to the person directly: ※※Always be sure of your method of communication while communicating with the deaf or hard of hearing. Make sure you talk to them face to face without covering your mouth or looking towards other directions. If necessary, communicate in writing; 11 ※※Where there is a sign language interpreter, it is better to talk looking directly to the deaf than the interpreter..Avoid asking the interpreter as “Please... tell him/her that…’. ※※It is important to recognize the different levels of Intellec- tual disability. It can be either mild or sever. If individuals with intellectual disabilities speechless or have difficulty to speak, we should be patient and listen to them. If you want to make sure that a person with intellectual disabil- ity understood what you have said, you should politely ask him/her ‘Did you hear me? Do you want me to repeat what I have said? Do you understand what I have said? They also understand it better if it is a good idea to reit- erate what you said in a simple, slow language or using pictures. 1.6. Barriers for participation for persons with disabilities Persons with disability have the right to participate in various social, economic, and political issues, like any other persons without disabilities, but they are not actively participating due to various challenges/ barriers. Among these barriers the followings are the major ones, ＞＞Attitudinal Barrier ＞＞Communication barrier ＞＞Institutional barrier ＞＞Environmental and Physical barriers 1.7. Measures that should be taken to include persons with disabilities ※※Assign a representative or a focal person who can handle and follow the issues of disability at health facilities; ※※There should be a systematic approach and strategy to guaran- tee the issue of disability addressed, mainstreamed and given emphasis on planning, implementation, monitoring and evalu- ation; 12 ※※Budget should be allocated to accomplish various activities, such as awareness raising training for staff; ※※Information and communications and other related issues should be accessible for persons with different impairment; ※※Make appropriate improvements to health facility / at the workplace or the process / service delivery. ※※Make sure reasonable accommodation is in place for persons with different impairment to ensure that they are using ser- vices or employed. 13  Section Two 2. Awareness Creation and Advocacy on Accessibility Awareness creation programs are the key tool to change the atti- tudes of the general community especially for health professional, administrative bodies, and for those engineers working in health sector and members of bid making committees to eradicate tradi- tional beliefs and myth about disability and persons with disability, and it is a tool that to eradicate inaccessible health service provi- sion. Especially, it is very much important and must to raise the aware- ness of health service providers, administrative staffs, higher offi- cials and health professionals so as to enable persons with disabil- ity have an exclusive health services provision according to their impairment type. As we know, health service providers are a key factor or actor to bring a dynamic change that our country wishes to meet the ex- pected goals, from this health service providers, health extension workers are key actors for the success of Ethiopian health sector strategic plan. It is important and essential to cascade and establish a system or a structure to capacitating health extension workers on the awareness and inclusive health services for persons with disability, this will bring a lot change on the sector, because health extension workers are working in close proximity to the commu- nity and need to develop their awareness, skills and knowledge on inclusive health service for persons with disabilities. 2.1. Creating Awareness on disability for health service providers It is essential to create a wide range of capacity building and aware- ness rising programs for health service providers so as to enable them to provide accessible, inclusive, equity and quality health ser- vices for persons with different impairments as well as for none dis- abled persons. Because of this reason it is important to provide the following major topics on standard training package. These are:- 14 1. Understanding disability 1.1. Impairment and disability 1.2. Causes of impairment 1.3. Types of impairment 1.4. Disability terminology 1.5. Discriminatory actions or activities 1.6. Models of disability 1.7. Barriers of disability 1.8. Disability in Ethiopia 1.9. Collaboration of national Association of persons with disability with health sector 2. Inclusive health services for persons with disability 2.1. What is disability inclusive health service mean 2.2. Issues to be considered in disability inclusive health service delivery - Inclusive health service policy and packages -Other national and related policies 2.3. Enabling environment on health service delivery 2.4. Reasonable accommodation to health service provision 2.5. Accessible health service in twin track approach 3. Reproductive health and other related health service provision 4. Gender and disability in health sector As it mentioned in the above, it is important to provide a standardized training of trainer of training for selected health service providers, after training they will going to give an awareness rising training at least for two consecutive days for health bureaus staffs, for engineers/constructors of the health sector, for health service providers/professionals, for administrative staffs, for higher officials, for member of bid making members, and for other individuals who are work- ing in health sector. 15 Alongside this, it is essential to provide basic Ethiopian sign lan- guage training for health service providers (starting from gate keep- ers up to higher officials with health service). A trainee has to take Ethiopian sign language training for not less than 27 consecutive days for 4 hour per a day. For this reason the training should focus on:- - Basic courses of Ethiopian Sign Language for communication training - Essential, permanent courses of Ethiopian Sign Language training - Health and health related sign language training courses - Drama and role play methods of Sign Language training To implement effective training for intended period of time on basic training of Ethiopian sign language and disability mainstreaming awareness raising training, the following stages has to be imple- mented/practiced:- - Adult training - Group discussion and presentation - Role play and demonstration - Experience shearing - Case Study - Filed visit.... etc. 2.2. Accessibility Persons with disabilities have equal right As any citizins (human being) to participate and take part in different aspects of economical, social, and political issues. It is essential for a person to have and establishing a family, to participate in social and political activities, to participate on religious issue, accessing public utility/facilities, to move around from place to place, and also it is essential to arrange and prepare standardized full range of conditions so that persons with disability can find the whole way of life. Access to health service means that the Health service accessibility mean, without any obstacle or discrimination factor bridge the gap to create disability friendly and accessible health service provision/delivery as well as accessible health services through health extension workers for persons with different types of impairment. Moreover, accessibility indicates, providing equity and quality health service for all members of the society. 16 Still accessibility is a major issue or problem for devel- oping countries like Ethiopia. The society at large be- lieves and understood that accessibility is all about rump and having an elevator which is incorrect. But, there are different forms, types and features of accessibility. Accessibility can be categorized in to three major parts, these are, 1. Environmental and physical accessibility, 2. Access to means of information and communication, 3. Institutional and policy accessibility. 2.3. Environmental and physical accessibility of health services Environmental accessibility means creating a facilitator condition to physical accessibility for a person with different types of impair- ment to maneuver in health services facilities without any barrier. Health service deliveries should have to have or be ready to ac- commodate the needs and interests of everyone who seeks access to services. This means, patients shod have to receive any services without any barriers. Physical inaccessibility of health services is prohibiting everyone especially persons with disability to no to ac- cess services according to their impairment type. It is the result of a physical barrier that services are not accessible for a wheelchair and a crunch user as well as for visual impaired and low vision person. Because of this reason, persons with visual and a person with physical impairment are not accessing health services just like none disabled persons. To reduce this problem, health service de- liveries have to be accessible and accommodate for everyone. Persons with disabilities are facing different form of barriers when they come to health service starting from their home, so health ser- vice providers and the compound itself has to be ready to provide exclusive health services for persons with different types of im- pairment. Therefore, health service has to be accessible for persons with different types of impairment without any obstacle/barrier starting from outside gate to every service delivery room. 17 2.3.1. Internal doors, entrance gates and windows ☆☆Every accessibility issues begins from the entrance gates because of that ev- ery entrance gates has to be free from any obstacles and barriers has to be re- moved for persons with disability, ☆☆Service delivery room doors and en- trance gates has to be user friendly for any persons who seek to access health services without any difficulty, ☆☆Whether or not the gateway has al- ways been a double entry, the width must be above 90 cm. Above 1.80 cm width will allow trans- porting two wheelchairs side by side ☆☆ Therefore, any service provision ar- eas/ room’s interior doors should be 90 cm by 2.10 cm. ☆☆ For persons with physical impair- ment, the width of the door must have to be 90 cm, and the door handle should not have to be above 90 cm tall. ☆☆ Doors must be easy to open and it should be au- tomatic (25 seconds), door handles must be long and easy to hold for opening which should be accessible to a a wheel- chair users. ☆☆There must have been enough space for wheelchair users to open and close the doors. 18 ☆☆If the door is made of glass, a partial glass should be painted to prevent damage to the person with low vision. ☆☆Windows should be well lit. This is ideal for treating patients with limited vision and interpreting sign language or lip read- ing. ☆☆Do not have the thresholds. If there is a must to have, it should be as close to 2 cm as possible. It should not be overstated, ☆☆Doors of glass must be tinted or marked in color or shade in between 85-100 and 1.40- 160 cm height. At the bot- tom of the door, kicking plate should be created up to 30 cm height. ☆☆Door ring or alarm sounds and other audio record- ings on the door must have a light signal. 2.3.2. Pathways, corridors and lifts/elevator ☆☆ Inland lane must be connected from entry point to any service area and to the bathroom or toilet, and the width should be more than 1.50 cm. 1.80 cm of path width can be trans- port two wheelchair at a time. ☆☆ Pathways must have a free space that can rotate wheelchair freely. The free space size should be 1.50 cm di- ameter. it should not be reduced, 19  ☆☆Corridors that are located in health facilities should be arranged fairly for those persons with different types of im- pairment, and there should not be any obstacles/barrier that restricts any move- ment in these corridors. ☆☆Each corridors and pathways must have a minimum width of 1.80 cm, which can serve two service seekers at the same time (deaf and his interpreters, visual im- paired persons and their assistants or two wheelchair users at a time). ☆☆Every corridor (passageway) and inner lane will be made attractive and indexed on the floor, allowing visual impaired/blind cus- tomers/patients to easily refer to white cane. ☆☆Internal roads must be free of stum- bling blocks. If there are holes and open sewerage, they should be sealed. ☆☆Direction need to be hanging up at a height of more than two meters. ☆☆If there is various steps/stairs on the ways of service delivery rooms an if there is no elevator/lift, ramp is required to be in place for wheelchair users. If the slopes of the ramps should be between 5% and 8% it will be easy to use and safe for wheel- chair users. If the length of the ramp is longer than 600 cm (6 m) or if the ramp changes it di- rection, it has to have a 1.50 cm free space for rest. 20 ☆☆A hand rail is needed to be installed on ei- ther side of the ramp to lean on it for persons with physical impairment on the height be- tween 70 cm and 90 cm. ☆☆At both edge of the ramp, the stand must be 5 cm long and paint must be rubbed to facil- itate for a wheelchair user person not to fall and to indicate for person with low vision. ☆☆The width of the steps of stairs should be equal. The width should not exceed 30 cm and the height should not exceed 16 cm. ☆☆The floor of the stairs should not be sleeper; it must be build by rough substances/materials. ☆☆The surfaces at the beginning and at the end of the steps of stairs should be colored, and the layers of the edges (the forefront) should be marked with different colors. ☆☆ f the health facility has a building, it must have functional elevators or lift. ☆☆ The width of the elevator shutter/ door should not be below 90 cm. the entrance/door of the elevator height should not be less than 2.10 cm. ☆☆ An interior liner width of the lift/ elevator must be not less than 1.10 cm and the bottom depth or length should not be less than 1.40 cm. if the diameter area is between 1.40 cm and 1.60 cm it allows wheelchairs users to maneuver their wheelchairs easily. ☆☆Elevator Button must be placed at 90 cm up to 1.10 cm height and the buttons must have Braille text and sound for persons with visual impairment/blind. 21 ☆☆After the doors of the elevator opened, there should be a free space with the size of 1.50 cm x 1.50 cm diameter, ☆☆A hand rail should be provided with an elbow on all three walls and the support should be above 80 cm up to 85 cm above the floor. 2.3.3. Medical Equipment and Service Provision Rooms ☆☆ There should be a display on the top of the door or on the side of the door which shows about the services that is provided in service rooms. If the displays are in written format, it should be in color and in Braille texture which makes it easy for persons with disability. ☆☆ Health services provision rooms should be accessible for persons with disability and the rooms need to have free space for wheelchair users to maneuver their wheelchair. ☆☆ Health service delivery rooms that are directly providing dif- ferent service for persons with disability should be no less than 12 square meters (4 m x 3 m), and it has to have at least 90 cm width free space in the corner. As it mentioned in the above, it is important to install the door handle at 90 cm tall and verify the door width at 90 cm. there should be adequate/sufficient light in the room. ☆☆ The items on the floor should not restrict movement of persons with visual impairment/ blind around service delivery rooms and entire compound. ☆☆ Half opened doors and windows into the service area should be completely closed or fully open, as they may expose additional injury to persons with visual impair- ment/ the blind. ☆☆If service delivery rooms and com- pounds have stairs, a mobile ramp (made of wood or metal), has to be prepared or a standardized ramp has to be constructed. This creates accessible for persons with physical impairment. 22 ☆☆For ramps that have already been built or new, it must have handrail on both sides. This is because any patient that uses a wheelchair, crunch, or person with visual impairment can access and lean on. ☆☆Surgical tables, examination tables, de- livery tables and hospital beds should be flexible and automatic or manual; this will create easy and comfortable service provision for patients with different impairment. ☆☆ Receptions, information desks, card rooms, pharmacies, laboratories and other relater service provision room windows located in health care facility are usually not standardized for clients/ patients with different types of impair- ment. Therefore, these kinds of service areas especially windows should be de- signed up to 50 cm height to entertain the interest of persons with short stat- ure, for wheelchair users, for persons with different kinds of physical impairment. ☆☆An accessible bathroom/toilets needs to be constructed in a nearby reachable ar- eas. Men and women must have different toilets. The toilet room has to have 1.50 cm x 1.50 cm square/diameter. Door width must be no less than 90 cm and it hast to be opened to out- side with simple lock. ☆☆The toilet door handles has to lie at a height of 90 cm above the ground, it has to be long, easy to grab and open and close it. Moreover, adequate space should be available for wheelchair us- ers. 23 ☆☆Accessible toilet should have seat type rather than squat types and it should in- clude armrest connected to the wall in three directions, over 80 cm above the floor. The width between the two paral- lel supports should be 60 cm. ☆☆The toilet seat has to be on the opposite side of the door and the height should be 50 cm from the floor. As well as, the room has to contain enough light. ☆☆Toilets need to be designed for wheelchair users with the 1.50 cm diameter to maneuver freely and free space must be allocated to park their wheelchair when the use the toilet. ☆ ☆International sign should be placed on the top of the toilet wall or on the side of the wall. The toilet door should be light and bright colors. ☆☆Hand washing facilities that are used in bath- room for any patients or clients should not ex- ceed 50-70 cm height. 2.4. Transferring important information and communication Information is a key for everyone. When we transfer information or messages, the information must be correctly accessed and has to reach the intended recipient. A person who is going to transfer the information or message should be able to access and understand exactly how to transfer information as it is for the others. Persons with disabilities are able to communicate with health ser- vice providers while going to access health services. During this time, they will face various forms of communication barriers. It is the fact that persons with visual impairment and persons with hear- ing impairment are facing different forms of communication barri- er. Therefore, it is important to understand how service providers can and should be able to provide information to the blind / visual impaired persons and the clients who are deaf and hard of hearing. 24  2.4.1. For blind and partially blind/visual impaired clients ☆☆Direction indicator poles and other information provision meth- ods found in health facility should be prepared with large fonts for persons with low vision ☆☆Every elevators/lifts found in health service facilities must be provided with sound and brail information. ☆☆Information about services and other related issues about the rooms, professionals and services must be on posted at diagno- sis rooms and other related service provision areas (pharmacies, laboratories, toilet or bathroom, cafe or lounges, etc.), on the top of the door in Braille format and large fonts to let blind and par- tially blind people to access every information freely and fairly. ☆☆It is important to consider the issue of partially blind persons when there is a preparation of health and health related infor- mation through flyer, pamphlets, newsletters, and etc. As well as, health and health related information’s and communications must be transcribed to Braille format to reach visual impaired persons. ☆☆One of the health services that isn’t accessible to persons with visual impairment is different medicine that are given by phar- macists doesn’t have Braille on it. Therefore, pharmacies under health service provisions should consult with a person or an or- ganization that supply Braille medicaments. 2.4.2. For hard of hearing and deaf persons ☆☆It is important to note that information and communications are the main challenge that persons with hearing impairment cur- rently faced when they access health services. Because of this reason, there should be an enormous activities have to be im- plemented to scale up the attitudes of health service providers. ☆☆Health service providers at health facilities have to know that, there are different ways (sign language, text/writing, lip read- ing, by sign language interpreter and other different ways) of communication when they face deaf and hard of hearing clients. ☆☆It is essential to provide sign langue training for health service providers to enable information and communication accessibili- ty to deaf and hard of hearing clients. If this isn’t possible, they can communicate with the various methods mentioned above. 25 ☆☆When we provide health service and related information’s through sign language interpreter to deaf and hard of hearing persons, we must consider that we are transferring the patient information to third party. However, when we communicate with our client or patient we must turn our face to the patient not to the interpreter. If our client can read and write, we can communicate freely through writing without any challenge. ☆☆We can communicate through lip reading with persons who lost their hearing after they acquired language. At this time, it is im- portant to make sure that we have adequate lighting around and speaking normally (we do not need to be too slow or too fast); ☆☆We have to raise our voice during informal conversations with customers who are hard of hearing. It is important to make sure that the area is not noisy and that our voice is not gulp down by the outside noise during communication. 26  Section Three 3. Monitoring and Evaluation For successful implementation of this manual, regular monitoring and evaluation activity will be conducted continuously through fed- eral ministry of health in collaboration with regional health bureau, zonal health departments, Woreda health offices, Kebele and with health institutions. Information’s and findings in the monitoring and evaluation process will help to identify those challenges and barriers to provide both feedback and technical support to address these issues. Ministry of health, women and youth affair directorate in collaboration with policy plan directorate follows the implemen- tation of this manual and monitors every activity towards main- streaming disability in health sector. Standardized checklists and report formats will be developed in consultation with concerned stakeholders and used for monitoring and evaluation activities. In the ministry of health, those reports prepared at different levels of directorate should mainstream the issue of disabilities in reporting systems of the health sector. In addition, those issues included in this manual will be given an emphasis and should be raised as an agenda in different levels of health sector review meetings. More- over, the effectiveness on the implementation of issues included in this manual will be evaluated on annual review meetings of health sectors by involving National associations of persons with disabil- ity, different health service providers and stakeholders and those organizations work on disability. Federal Ministry of Health will monitor the performance of Zonal, Woreda and Kebele health offices on the activities carried out starts from their plan to the quarterly, biannual, and annual, reports on the activities they have done to mainstream persons with different types of impairment in to health service Provisions and give appro- priate feedbacks. 27  Section Four 4. Conclusion, focus areas and way forward 4.1. conclusion Creating a healthy society is priority task of Federal Ministry of Health to achieve health sector transformation plan, and to acceler- ate the country’s renaissance journey. Thus, health sector should be strengthened to ensure equity and quality health services for persons with disabilities. It’s not only geographical or physical accessibility that ensure inclusive health services for persons with disability but also there should be different forms of health service accessibility at all levels. Therefore, it is not only the government responsibility or health sector to mainstream the issue of persons with disability but also it requires the struggle and the involvement of all citizens, particularly by health sector officials, health professionals and dif- ferent support staffs of the sector should be able to contribute to the realization of the strategic plan of the sector. Federal Ministry of Health, Regional Health Bureaus, Zonal health offices, Woreda Health Offices, health service providers and health professionals have to realize that there are a number of persons with disability in the country and should be committed to provide health services based on knowledge and skills. Every health sector disability mainstreaming services should be provided in to consid- eration of four strategic agendas, which is information revolution, Woreda Transformation, equity and quality health services and compassionate, respectful and caring health services and health professionals. Thus, Health Sector Disability Mainstreaming Manual (HSDMM) is intended to achieve the above mentioned transformation agendas especially to create and provide equity and quality health services for persons with disabilities. 4.2. Focus Areas and Way Forward 4.2.1. Federal Ministry of Health 1. Federal Ministry of Health (FMoH) has to mainstream or in- clude the issue of persons with disability in to health sector pol- icies, manuals and strategies to make sure equity and quality 28  health services addressed for all. It is necessary to establish a team of professionals as a committee to evaluate the dissemi- nated policy, strategies, and manuals to assess the implementa- tion process and to fill the gaps. It is important to assign focal persons at ministry of health as well as to the regional health bureau, Zonal and Woreda health office. 2. It is to be noted that indicators must be set in Health Manage- ment Information system (HMIS) database to register persons with different impairment service users. 3. It is well known that previously built health service facilities are not accessible for persons with different impairment. So, federal ministry of health has to take this issue into consideration by creating reasonable and accessibility modification. 4. Health and Health related television messages, information, spots and programs that are produced by different directorates in the ministry or by other stakeholders/partners must include a sign language interpretation, as well as health and health relat- ed information’s should be prepared in radio, audio and Braille format to reach persons with visual impairment and deaf audi- ences. 5. Various directorates at the Ministry of Health need to ensure that they are taking in to consideration and mainstream the issue of persons with disability in to their plans, with the commitment to monitor and evaluate the planning performance. 6. Designs that are presented by Health Infrastructure Directorate should be consulted and evaluated by relevant internal director- ates and with concerned stakeholders regarding the accessibility to persons with disability before the actual construction. 7. Health Extension Directorate of the Ministry need to plan and work on awareness rising activities to health extension workers and mainstream the issue of disability on a different actions and packages to be trickledown to grassroots level. 8. Regarding medicines fund and supplies, Ministry of Health should make sure that Braille text are included in packages of the medicament that are imported from abroad or produced lo- cally. 9. Ministry of Health, in collaboration with stakeholders, will es- tablish disability audit task forces and the task force will prepare a questionnaire and will conduct disability audit. Based on the audit result the taskforce will provide a feedback. 29 4.2.2. Regional Health Bureau, Zonal and Woreda Health offices 1. Regional health bureaus, Zonal and Woreda health offices should ob- tain Health Sector Disability Mainstreaming Manual (HSDMM) and implementation strategies prepared by Federal Ministry of Health. They should also translate the Manual in to their regional language, and they should trickle down the implementation of the manual to hospitals, health centers, health post and health professionals. 2. Regional health bureaus, Zonal and Woreda health offices should have to include the issue of persons with disability in their annual plan, follow the implementation process and provide feedback. 3. Health and Health related television messages, informations, spots and programs that are prepared by regional health bureau, zonal and woreda health office must include sign language interpretation, as well as health and health related informations should be prepared in radio, audio and Braille format to reach persons with visual impair- ment/Blind audiences. 4. Regional Health Bureaus, Zonal and Woreda Health Offices should work in partnership with national associations of persons with dis- abilities and with Disabled people Organizations (DPOs). 5. To provide accessible health service for persons with disability and to ensure the implementation of these manual, focal persons should be assigned in different strictures of the region. 4.2.3. Health Service Providers 1. Governmental, non-governmental and private health service provid- ers should identify their gaps in relation to accessible health service provision for persons with disability and discuss with relevant bodies to set a possible solution. 2. Health service providers should have to assign a focal person who will follow a provision of equity and quality health services for per- sons with disability as well as the implementation of health sector disability mainstreaming manual. 3. Health service providers will need to include the issue of persons with disability in to their annual plan and follow their performance with potential feedback. 4. Health and Health related television messages, informations, spots and programs that are prepared by themselves or by regional health bureau, zonal and woreda health office must ncluded sign language interpretation, as well as health and health related informations should be prepared in radio, audio and Braille format to reach persons with visual impairment and deaf audiences. 30 5. If previously built health service facilities are not accessible for persons with different impairment, service providers has to take this issue into consideration by creating reasonable and accessi- bility modification for persons with different impairment. 6. Various written manuals and instructions intended to main- stream disability in health sector should have to be kept in a place where every staffs can access them. 7. Health service providers should have to prepare and provide awareness rising training on disability mainstreaming and basic sign language training for the staffs. 8. Awareness raising platform should be arranged for the patients and to general community at health service facility waiting ar- eas by inviting and involving organizations that are working on disability. 4.2.4. Health professionals and Administrative staffs 1. Health professionals and Administrative staffs should have to know that, the service they are providing is not given as s gift, but they should be aware it is the rights of persons with disability based on the laws of the country and when they face different challenges in relation to disability mainstreaming health service provision, they have to seek alternate solutions to address the issues. 4.2.5. Role of Stakeholder 1. Disable people organizations and disable national associations that are around health facilities should provide technical and personnel support to health service providers so as to main- stream the issue of persons with disability. 2. Disable people national associations and disable people orga- nization should invite health professionals to their programs to provide health information, education, and services to their member’s. In addition, the organizations and national associa- tions of persons with disability should encourage its members to use nerby health facility that is accessible for those persons with different impairment. 31 Annex 32  Annex 1: A tool to assess health service accessibility Ministry of Health has prepared a tool, to assess and provide enhanced health service comprehensive packages. This ques- tionnaire is intended to ensure and to take action the service that is provided to persons with disability. Name of the health care institution / office _______________ ____________________________ Region_____________ Sub City / Zone Woreda ___________ Questionnaire completed on day / month / year. __________ The name of the expert who collected the data ____________ ______________________ No Questions Yes partial No Concerning the entrance gates 1 The gate is friendly for crunch or a wheel- chair user patient/clients 2 Accessible to visual impaired/blind Concerning health facilities compound 3 There are an opening holes that are not sealed 4 The advertisements or other billboards are hanging at a maximum height. 5 The compound is user friendly or acces- sible for wheelchair and crunch users 6 Are there any obstacles that are placed at sidewalk which prohibits mobility Health service provisions rooms 7 The rooms are accessible for a wheel- chair/crunch users clients 33 8 Descriptions about the room is written and post- ed at the top of the door or at the side of the wall 9 Descriptions about the room is written by Braile and posted at the top of the door or at the side of the wall 10 The windows are bright enough 11 Utility Equipment (such as beds, chairs, tables, etc.) are accessible for wheelchair user patients/ clients 12 The height of information desks were made short/ 13 The height of the window minimized for the services that are provided through window, 14 If glass windows are used at the facilities, is it painted to reduce the risk Elevators/lifts, stairs, and corridors 15 The lifts/elevators are accessible for wheelchair users without any challenge. 16 Lifts/elevators have adequate information (such as Audio and Braille) for persons with visual impairment service seekers 17 The lifts/elevator has providing information through light for persons with hearing impair- ment/deaf. 18 There are ramps which replace stairs/there are ramps side by side the stair 19 The slop of the ramps are accessible and user friendly for persons who uses a wheelchair and crunch. 20 The size and the width of the corridors in health facilities are conducive for a person who uses a wheelchair and crunch. 21 The stairs has painted with different colors Toilets/ bathrooms 34 22 Toilets doors are accessible for a person who uses a wheelchair and crunch without any challenge. 23 The toilet door is opening to outside 24 The toilet seat is accessible/user friendly for wheelchair and crunch users patients/ clients. 25 The toilet has enough space to maneuver a wheelchair without any problem. 26 Different toilet rooms assigned for women and men 27 The toilet has enough light for users 28 Universal sign of toile is posted at door of every washing/toilet rooms 35  Annex 2: Words We Must Use to Communicate with persons with Disabilities ＊＊ Do not use negative words when you communicate with persons with disabilities, ＊＊ Confirm if the words are appropriate before you use (consult Concerned bodies), ＊＊ If you have any doubts, do not use the words, ＊＊ Use words to break traditional beliefs, attitudes and myths, ＊＊ Do not prioritized the disability before the person (not visual impaired women, but a person with visual impair- ment), ＊＊ Identify the person, not the disability, ＊＊ Disability is not a disease, don’t say (sick, victim, suf- ferer, etc.), ＊＊ Talk to persons with disability or their national associa- tions otherwise professionals about the words you have to use. For instance Inappropriate word (don’t use) Appropriate words (you can use) Handicap/invalid/disabled/ suf- A person with disability fers from/victim Paralyzed, lame, weak, impaired,/ A person with physical disability injured, Idiot/retard/imbecile/mentally A person with intellectual impair- retarded/slow ment/learning disability (or impair- ment) insanity, Mad/lunatic /crazy A person with mental illness / psy- chiatric/ psychosocial disability/ impairment deaf, speechless, and dumb A person who is deaf/with hearing impairment The blind/visually impaired A person who is blind/with low vision/with vision impairment Wheelchair-bound/confined to a A wheelchair user wheelchair 36  Leprosy A person affected by leprosy Her body has cerebral palsy A person with cerebral palsy Epilepsy A person who has seizure Born with disability /deformed Disabled before born Disabled during and after born Walk by crunch A person who use a crunch/assis- tive device Disabled community disability community Dwarf/midget A person of small/short stature Disabled seating/disabled toilets Accessible toilets, accessible bath- bathrooms rooms, accessible parking etc. Has a down syndrome A person with down syndrome The right person / normal person,/ not disabled person, able bodied Cripple/lame Attack/fit/spell A person with physical impair- ment/muscular dysfunction Source: From Federations of Ethiopian National Associations for Persons with Disability (FNAPD) Manual 37  No Name of Association Address Telephone P.O. Email Address Number Box 1 Federation of National Woreda 04, 0 1 1 1 1 1 2 9 3 6 18430 [email protected] Associations of Persons with Gulele Sub city, 0 1 1 1 5 8 0 8 0 2 AA [email protected] Disabilities (FNAPD) A.A 0111553003 www.fenapd.org 0111565158 2 Ethiopian National As- Woreda 06, Ara- 0 1 1 1 1 1 1 0 2 1 [email protected] sociation of the blind da Sub City, A.A 0111119293 (ENAB) 3 Ethiopian National Associa- Woreda 03, 0111222517 21359 enadet1972@gmail. tion of the Deaf (ENAD) Gulele Sub city, AA com A.A [email protected] 4 Ethiopian National Associ- Woreda 01, 0113211503 70811 [email protected] ation Peoples Affected by Kolfe Keranyo 0113211259 AA www.enapal.org Leprosy Leprosy Families Sub-City, Addis 0113211287 (ENAPAL) Ababa 0118300057 5 Ethiopian National Associa- Woreda 04, Bole 0 1 1 6 6 3 1 8 6 6 14457 [email protected] tion of Intellectual Disability Sub city, Addis 0116622723 [email protected] (ENAID) Ababa, Ethiopia 6 Ethiopian National Asso- Woreda 06, 0 1 1 1 5 5 7 8 9 7 32041 [email protected] ciation of Deaf and Blind Arada Sub City, 0911108984 (ENADB) Addis Ababa, Ethiopia 38 associations of persons with disability address Annex 3: Addresses of Federation and National  No Name of Association Address Telephone P.O. Email Address Number Box 7 Ethiopian National Asso- Woreda 01, Ara- 0111266748 [email protected] ciation for Persons with da Sub City, Ad- 0922584727 Physical Impairment for dis Ababa, development 8 Ethiopian Women with Woreda 08, Yeka 0118120500 43128 [email protected] Disability National Asso- Sub City, A.A AA www.ewdna.org ciation 39 Annex 4: Disability Inclusion Survey questionnaire Ministry of Health has prepared a tool, to assess and provide enhanced health service comprehensive packages. This questionnaire is intended to ensure and to take action the service that is provided to persons with dis- ability. ★★General Information 1. Name of the health service facilities: _________________________ ________________ 2. Name and responsibilities of the focal person : __________________ _______________________________________________ 3. The Addresses of The health Facilities: _______________ ______________________________________________ Phone number: ________________________ Email Address: ____________________ 4. Number of staffs; Male ___________ Female____________ 5. Number of Persons with disability staffs; Male _____Female ______ 6. Types of service that are provided by health facility _______________ ________________________________________________ __________________________________________________________ __________________________________________________ 7. Do you have a persons with disability clients ____________________ 8. If your answer is Yes; A. A person with physical Impairment: Male: ____ Female: ___Total: ___ B. A person with hearing Impairment: Male: ___ Female: ___ Total: ____ C. A person with visual Impairment: Male: ____ Female: _____ Total: __ D. A person with Intellectual impairment: Male: ___ Female: ___ Total: _ E. A person who are Deaf and Blind: Male ____ Female ____ Total ____ F. Other ______________________: Male ____ Female ____ Total ____ 9. The age range of persons with disability who accessed health services A. 1-4 B. 5-8 C. 9-12 D. 13-18 E. 19-30 F. 31-40 G. 41-60 H. More than 60 40 A. Identifying the obstacles of participation 1. What do you consider to be the least obstacle for persons with dis- abilities to access health facility? □□They do not want to benefit from their health services provided by the health facility; □□The physical conditions of the health facility are not accessible to persons with disability □□Other/none disabled clients/patients do not want to be with people with disabilities □□Reasonable accommodation is not budgeted for persons with disabil- ity □□None disabled health service providers do not want to be close to persons with disabilities □□health service providers don’t have the awareness on how to workers closely with persons with disabilities □□different programs of the health facility are not suitable as well as accessible for persons with disability; □□The policy of health sector does not encourage Persons with disabil- ity to have a role in the organization □□other: _________________________________________________ 2. What do you think is the barrier to working in partnership with the National Associations and organizations of persons with disability? □□Organizations and National Associations of persons with disabilities are not happy with your programs and agendas, □□The awareness of the organizations and national Associations of per- sons with disabilities about development program is very low, □□The physical and environmental conditions of the health facility are not accessible to persons with disability, □□Health sector programs did not include/ mainstream the issue of per- sons with disability, □□Reasonable accommodation is not budgeted for persons with disabil- ity □□We have a low awareness of disability associations and their pro- grams □□No national associations of persons with disability come to our facil- ities for work with us, □□Our policy is not encouraging to work in partnership with the persons with disability, □□other: _________________________________________________ 41 B. Awareness, knowledge and understanding of health service providers about persons with disability; 1. As a manager, what kind of understanding that do you think employ- ees have about persons with disability? □□It is assumed that, creating inclusion of persons with disabilities is not a responsibility of the health facilities, □□Persons with disabilities need to be included in our programs and need to be supported/assisted, □□Service providers fell like persons with disabilities are not effective in their work and participation, □□They think that inaccessibility of the facility minimized the partner- ship, accessing the service and participation of persons with disabil- ity. □□Some employees think that it is unnecessary to create a connection to work with people with disabilities, □□They think that reasonable accommodation is to costy to mainstream persons with disability, □□They think that, health facilities doesn’t know how to include people with disabilities, □□They think, they do not know about disability □□Other: __________________________________________ C. Creating Accessible environment and services for persons with disability What are the programs and activities that the health service should do to accommodate persons with disabilities? 1. Enhance the capacity of health service providers on disability main- streaming by creating awareness rising and inclusive development? □□Provide staff with a explanation of disability policies, awareness on how mainstream and how to incorporate the issue of persons with disability into their programs, □□Provide training for health service providers on inclusive health ser- vice, □□providing useful materials or assistive devices for persons with dis- ability to access the service or on their job, □□Share information on counseling, training, reasonable accommoda- tion and accessibility measures that should be taken into consider- ation by inviting organization and national associations of persons with disability, □□ other: ________________________________________________ 42 2. What to do to crate disability inclusive service, programs and activities, □□Give emphasis to disability inclusion in all institutional programs and policies, □□Develop a detailed planning and implementation strategy on the issue of disability □□Representing or assign a focal person who will monitor the planned activity implementation □□Register children’s with disability, youngster and adult as well as men and women’s with disability beneficiary of health service provision □□To create equity and quality health services regarding on gender and disability, it is important to focus on women’s with disability, □□Integrating the issue of disability into the program monitoring and evaluation (performance level, accomplished activities, number of persons with disability who participated and beneficiated for the ser- vice, etc ), □□Create a partnership with national associations and by employee a concerned specialist provide a training for the staffs, follow the ac- complishment of the program activities as well as implement other activates concerning persons with disability, □□other: _________________________________________ 3. Create a collaboration with Organizations and National associations of persons with disability □□Invite influential members of the association to visit field activities, □□Visit the associations and joining their meetings □□Visit the activities that are accomplished or implemented by the as- sociations, □□Involve the association as a public wing at the conference meetings the health service conducted by health sector □□Provide a training to the staffs using managers of the association and persons with disability individual, □□Invite member of the association and organization as a representa- tives in to planning and monitoring committee, □□ Other:_______________________________________ 4. Create accessible health facilities and accessible offices □□Invite concerned stakeholders to conduct disability audit and figure out a possible solution to mainstream disability in the health sectors and down to the other service providers, 43 □□Meetings and other related activities that is financed by health sector, need to be conducted in accessible meeting hall and during the meeting, training or other related activities, infor- mation accessibility need to be implemented through Braille, large fonts and sign language interpretation, □□Ensure and provide health and health related information printing are accessible to persons with disability and provide alternative options, □□Other: __________________________________________ 5. The commitment of the institution/facility to inclusive development □□Demonstrating the successful implementation of the sector/ facilities towards inclusion of persons with disability in dif- ferent ways (through report, flyer, etc.), □□Distribute various information to national associations of persons with disability and nongovernmental organization to disseminate the information by their information dissemina- tion method, □□Provide media / multimedia platforms specifically for people with disabilities □□The issue of persons with disabilities should be included in effective lesson learned, best practices, discussions, and re- ports, □□Establish a promotion method about the institution’s com- mitment and its effort on the activities that are implemented regarding inclusion of persons with disability, □□Other: __________________________________________ ★★Action plan 1. What is required for the health service facility to include per- sons with disabilities into the program (you can mark in all an- swers that you believe it is right) □□A policy or commitment to be derived from the relevant body □□Donors commitment □□Commitments of the management □□Provide a training for the staffs 44 □□Get the insights of the community □□Creating accessible services targeting persons with disabili- ties in the community □□Review program plans □□Develop a reasonable accommodation in health services and health facilities □□Receive technical assistance from organizations and national associations of persons with disabilities □□Exceptional financial support □□I do not know □□Other: ___________________________________________ ________________________________________________ _______________________________________________ 2. What should the health facility do to provide equity and quality health services for persons with disability? □□General information on disability and related issues □□Information on how the disability inclusive development ap- plies □□Information on how to mainstream persons with different im- pairment □□Assistance to develop disability related policy □□Developing a comprehensive health policy for all □□Provide awareness rising training for service providers □□Invite the eligible candidates with disabilities to share their experiences □□Getting people with disabilities out of the community □□all of them □□I do not know □□Other: ___________________________________________ ________________________________________________ ________________________________________________ _______________________________________________ 45  Annex 5: Duties and responsibilities of the focal person Even though, it is the responsibility of all health sector staff to enhance the participation and to benefit persons with disabilities in the health ser- vice provision, but it is also important to consider and assign a focal person who will follow-up and monitor every health related activities that will take place in the area. The focal person may possibly select from Women and Youth Affairs Directorate, or any other relevant office in the sector and the focal person will handle the following and other related tasks: ☼☼ To mainstream disability in to health sector, the focal person will de- velop action plan and implementation strategy to cascade jointly with concerned office in health sector, ☼☼ The focal persons will follow and monitor each health sector offices and departments mainstreamed the issue of disability in to their an- nual plan, ☼☼ The focal person will considers the participation and benefit of per- sons with disabilities in health sector during planning, monitoring, and supportive supervision as well as evaluation period, ☼☼ The focal person will produce a report on the area of accessing health services activities and other related issues, and the focal person will send the report to concerned body, ☼☼ The focal person will conduct follow up and support the implementa- tion of health sector disability mainstreaming manual, ☼☼ The focal person will follow up and make sure focal persons are as- signed to the lowest level of health sector structure, ☼☼ The focal person will endeavor to provide a possible solutions on the challenges that persons with disability faces day to day in health sec- tor or he/she call for a solution to concerned body/office, ☼☼ The focal person will establish a joint force to assess the accessibility of health facilities for persons with disabilities found under his su- pervision and at all level. he/she will produce and submit the findings of the assessment to concerned office as well as the focal person will figure out possible intervention and solution on the findings observed during assessment, ☼☼ In collaboration with human resource department, the focal person will work on the employment of persons with disability in the sector, 46 ☼☼ The focal person should map and identify organizations and national associations of persons with disability and need to work collabora- tion with them to increase access to health and related services for persons with disability, ☼☼ After the focal person received a training of trainers on health sector disability mainstreaming strategies, he/she will facilitate a training or provide a training to health professionals and health sector different staff, ☼☼ The focal person will put into action the above mentioned activities as well as he/she will perform other different related activities assigned by women’s and youth affairs director or concerned department. 47 Annex Six: Health service registration form Sample 48  References 1. Central Statistical Agency of Ethiopia (2007), Population and Housing Census Information. 2. Federal Democratic Republic of Ethiopia (1995 EC), Constitu- tion 3. Federal Democratic Republic of Ethiopia (916/2015), A Procla- mation to Obtain the Power and Duties of the Executive Orders, 4. Ministry of Labor and Social Affairs (2012-2021), National Ac- tion Plan for Persons with Disabilities. 5. Ministry of Labor and Social Affairs (2000 EC), Employment of Persons with Disabilities Act 568/2000 EC, 6. Ministry of Labor and Social Affairs (2014), National Social Protection Policy, 7. Ministry of Works and Urban Development (2009), Construc- tion of Ethiopian Building Proclamation No.624 / 2009, 8. Ministry of Works and Urban Development (2010), Construc- tion of Ethiopian Building Proclamation implimentation strate- gy No. 5-2003. 9. The Conceptual Framework for the National Plan of Action for the Physical Rehabilitation in Ethiopia (2005) 10. The United Nations, International Convention on the Rights of Persons with Disabilities (2006) 11. World Health Organization and World Bank (2011), Joint Glob- al Report on the Disability i ii iii