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Disability Inclusion Helpdesk Report : What works in mental health services and community interventions to support people with mental health conditions and psychosocial disabilities: a rapid evidence review

MILLS, China
AHLENBÄCK, Veronica
HAEGEMAN, Emma
September 2019

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Summaries on the findings from the following queries:

What works to develop quality services and community interventions to support people with mental health conditions and psychosocial disabilities and wellbeing for all, across the lifecycle?

What are examples of effective interventions in this area?

Attitudes of health service providers: the perspective of Persons with Disabilities in the Kumasi Metropolis of Ghana

BADU, Eric
OPOKU, Maxwell P
APPIAH, Seth C Y
2016

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Introduction: Awareness of disability issues has gained considerable interest by advocacy groups in recent years. However, it is uncertain whether attitudes and perceptions of all service providers and society have adjusted accordingly towards the health care of people with disabilities. This study sought to examine the attitudes of health providers from the perspective of people with disabilities in the Kumasi Metropolis.


Methods: A cross-sectional study using semi-structured questionnaires was conducted with people with disabilities (with physical, hearing and visual impairments,) in the Kumasi Metropolis. The study used a multi-stage sampling involving cluster and simple random sampling to select 255 respondents split amongst the following five clusters of communities; Oforikrom, Subin, Asewase, Tafo and Asokwa. Data were analysed using STATA 14 and presented in descriptive and inferential statistics.


Results: The study found that 71% of the respondents faced some form of discrimination including the use of derogatory remarks, frustration and unavailable required services on the basis of their disability, the type of services they need and the location. Women were 3.89 times more likely to face discrimination; Adjusted odds ratio (AOR) = 3.89 (95% confidence interval [CI]; 1.41, 10.76), and visually impaired was more likely to be discriminated at the facility compared with physical disability; AOR = 5.05 (95% CI; 1.44, 17.65). However, respondents with some educational qualification and those who stayed with their family members were less likely to face discrimination; AOR = 0.08 (95% CI; 0.01, 0.39).


Conclusion: The study recommends the provision of in-service training for service providers to update their knowledge on disability issues and improve access to services for people with disabilities.
 

Assessment of Rehabilitation Capacity in Ghana

Christian, Asare
et al
2016

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Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana.

 

Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author.

 

Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence- based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities.

 

Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts.

 

Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.

Financial Access to Healthcare among Persons with Disabilities in the Kumasi Metropolis, Ghana

Badu, Eric
Opoku, Maxwell Peprah
Appiah, Seth Christopher Yaw
Agyei-Okyere, Elvis
2015

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Purpose: According to the World Health Organisation, 10% to 15% of the population of every developing country lives with disability. This amounts to about 2.4 - 3.6 million Ghanaians with disability. Since their contribution is important for the development of the country, this study aimed to assess the financial access to healthcare among persons with disabilities in the Kumasi Metropolis of Ghana.

 

Methods: A cross-sectional study, involving administration of a semi- structured questionnaire, was conducted among persons with all kinds of disabilities (physically challenged, hearing and visually impaired) in the Kumasi Metropolis. Multi-stage sampling was used to randomly select 255 persons with disabilities from 5 clusters of communities - Oforikrom, Subin, Asewase, Tafo and Asokwa. Data analysis involved descriptive and analytical statistics at 95% CI using SPSS software version 20.

 

Results: There were more male than female participants, nearly one-third of them had no formal education and 28.6% were unemployed. The average monthly expenditure on healthcare was GHC 21.46 (USD 6.0) which constituted 9.8% of the respondents’ income. Factors such as age, gender, disability type, education, employment, and whether or not they stayed with family members had significant bearing on the average monthly expenses on healthcare (p<0.05).Transportation cost, the travel distance to facilities, and the regular sources of payment for healthcare, had significant relationship with access to healthcare (p<0.05). Although about 63.5% of the respondents used the National Health Insurance Scheme as the regular source of payment for healthcare, 94.1% reported that sources of payment did not cover all their expenses and equipment.

 

Conclusion: Financial access to healthcare remains a major challenge for persons with disabilities. Measures to finance all healthcare expenses of persons with disabilities are urgently needed to improve their access to healthcare.

Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Universal health coverage for inclusive and sustainable development. A synthesis of 11 country case studies.

MAEDA, Akiko
ARAUJO, Edson
CASHIN, Cheryl
HARRIS, Joseph
IKEGAMI, Naoki
REICH, Michael R.
et al
2014

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Universal health coverage (UHC) for inclusive and sustainable development synthesises the experiences from 11 countries—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The UHC policies for each country are examined around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The path to UHC is specific to each country, but countries can benefit from experiences of others and avoid potential risks

Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

LAGOMARSION, G
GARABRANT, A
ADYAS, A
OTOO, N
MUGA, R
September 2012

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The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.

HIV & AIDS "train the trainers" manual

AFRICA UNION OF THE BLIND (AFUB)
2010

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"This manual is for use by Trainers of Trainers. i.e. trainers of visually impaired Peer Educators. It has been developed to provide awareness and training on HIV&AIDS prevention, treatment, care and support and to equip blind and partially sighted participants with Peer Educations skills. It is hoped that blind and partially sighted participants will become effective Peer Educators in training other visually impaired persons in their communities"
The user has given permission for the uploaded document to be reproduced and made publicly available on the Source website

Obstetric care in poor settings

MILLS, Samuel
et al
2007

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This report explores why maternal mortality continues to be so high in developing countries, and why emergency obstetric services are little utilized, through research carried out in poor areas in Ghana (Kassena-Nankana district), India (Uttar Pradesh state), and Kenya (Nairobi slums)

Delivering antiretroviral therapy in resource-constrained settings : lessons from Ghana, Kenya and Rwanda

RITZENTHALER, Robert
July 2005

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This publication is aimed at governments, development partners, and public and private health facilities seeking to provide ART as part of comprehensive care and support for people living with HIV and AIDS. It describes valuable lessons learned from several ART learning sites throughout Ghana, Kenya and Rwanda. By the end of April 2005, more than 5,800 new patients had initiated ART through this treatment and care initiative. Strategies, challenges and key recommendations are presented and comments by national and community leaders, providers and patients appear throughout the text to give readers a sense of the programs as they progressed. The lessons may not have direct relevance to all health facilities providing or planning to provide ART; it should be used or adapted depending on the epidemiological, political, social, cultural and economic context of each setting

USAID project profiles : children affected by HIV/AIDS

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
January 2005

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This document presents profiles of 114 projects (90 country-specific, 12 regional, and 12 global) funded by USAID. It includes a section on USAID projects that support access to education in Africa. The project profiles include the names of implementing organisations, funding periods and amounts, objectives, strategies, key accomplishments, priority activities for the year ahead, and materials and tools available to other projects that can help meet the needs of children and youth affected by HIV and AIDS. The diversity of these projects demonstrates the US government's efforts to meet the wide variety of needs of children and youth affected by HIV and AIDS. Approaches vary in both strategy and scale. The vast majority of projects work with communities to identify opportunities that strengthen existing resources without undermining local ownership. In many places, communities are already mobilised and have systems in place to identify, protect, and provide basic necessities to the most vulnerable children. USAID supports the strengthening and monitoring of these existing activities

Women's stories, women's lives : experiences with cervical cancer screening and treatment

BOYD, Anne R
BURNS, Michele
Eds
2004

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This publication is a collection of stories based on interviews with women in developing countries who participated in ACCP programmes. These women's stories illustrate the unnecessary suffering cervical cancer can cause women and their families and how prevention programs can save women's lives. ACCP projects have focused on regions in which cervical cancer incidence and mortality are highest: sub-Saharan Africa, Latin America and South Asia, and have also focused on reaching women in their 30s and 40s

Liverpool school of tropical medicine : Malaria knowledge programme. Annual report 2003-2004 : reduction in the suffering by improving the management of malaria through better intervention and control of malaria.’

LIVERPOOL SCHOOL OF TROPICAL MEDICINE (LSTM)
2004

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The report shows the overall activities of the Malaria Knowledge Programme during 2003-2004. It initially outlines the research activities and the new knowledge outputs. Using a framework developed by Liverpool School of Tropical Medicine's Vulnerability and Health Alliance the report contains an evaluation of the implications and effects of the research findings on those most vulnerable to the effects of malaria

HIV/AIDS and the public sector workforce : an action guide for managers

RAU, Bill
2004

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The guide is designed for human resource managers, employee welfare managers, medical officers and labor representatives in government ministries and agencies. It will assist in designing and developing prevention, care, and support programmes, and in mitigating the effect of staff losses due to AIDS in the public workplace. It includes information on the effects of HIV on the public sector, the components of prevention, care and support programmes and policies in the public sector, methods to gain the support of senior management and employees for HIV/AIDS workplace programmes and policies, background information on the disease, and country experiences

New products into old systems : The Global Alliance for Vaccines and Immunization (GAVI) from a country perspective

STARLING, Mary
BRUGHA, Ruairi
WALT, Gill
January 2002

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Based on research in four countries - Mozambique, Ghana, Lesotho and Tanzania - this report examines the impact of GAVI on national health priorities and public health systems. It focuses on country experiences of applying for support, the capacity of systems to incorporate and utilise new vaccines effectively, and sustainably. The report finds that, while most countries are glad of the political interest immunisation systems are gaining through GAVI, they have concerns about a number of issues: the pressure to make rapid decisions on vaccine selection; the usefulness of reward and evaluation criteria; delays in vaccine availability; and problems related to needle disposal

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