By Kate Wilson, Technical Advisor, LMG Project
People with disabilities often lack access to essential health and social services
Although there have been significant investments in health and development in several African countries, people with disabilities often still lack access to essential health and social services. They also lack access to proven and frequently relatively low-cost interventions that could support them in living independent, productive and healthy lives. These inequities and barriers are especially associated with disability (See the World Health Organization’s informative page on Disability and Health). People with disabilities have poorer health, lower educational achievements, less economic and political participation, and higher rates of poverty than people without disabilities.[1] Furthermore, entrenched stereotypes and attitudes (which in many cases have become institutionalized into health and social systems) often keep people with disabilities at the margins of society, preventing their full participation.
Global efforts such as the United Nations Convention on the Rights of Persons with Disabilities and the national policies that follow the convention are important steps toward ensuring that people with disabilities are able to live independent, fulfilling and meaningful lives. Access to physical rehabilitation services[2] is crucial for the full socio-economic integration demanded by the convention. However, despite the presence of promising policies in many countries, there is still much work to be done to implement those policies, and ensure that national systems have the capacity and resources to fulfill their obligations.
Strengthening senior leadership around physical rehabilitation and disability rights
In August 2013, the USAID-funded Leadership, Management and Governance Project (LMG), in partnership with the International Committee of the Red Cross (ICRC), launched the first Regional Senior Leadership Program (SLP) focusing on physical rehabilitation and disability rights in Dar es Salaam, Tanzania. The SLP is a team-based leadership development program that equips senior decision-makers with the skills to address key challenges, and work together to achieve results that are important to the health of their community, region, and nation.
Teams of high-level decision-makers (23 participants in total) came from Ethiopia, Sudan, Tanzania, and Zambia for the first of three sessions of the SLP. These participants represented diverse sectors and voices in their home countries and included representatives from ministries of health and labor, executive directors of national disabled people’s organizations, national disability focal points, directors of hospitals and physical rehabilitation centers, university faculty, and persons with disabilities. The SLP is implemented over a nine-month timeframe through a series of three workshop sessions, along with field application between sessions.
LMG is funded by USAID to work with these in-country partners of ICRC to strengthen the capacity of their physical rehabilitation centers, and to improve the enabling environment for physical rehabilitation services in select countries. In this role, LMG staff provide technical assistance alongside colleagues at ICRC so that these national leaders can strengthen the quality of the physical rehabilitation centers they help oversee across Africa and elsewhere.
In addition to collaborating on the SLP, ICRC is developing guidelines and procedures for its physical rehabilitation centers on physical rehabilitation services as well as the production of mobility devices and other related technologies. To complement this work, LMG is working with ICRC to develop standardized procedures for essential management systems and leadership development training modules for center staff.
The SLP program promotes ownership at all levels
The SLP process was collaboratively designed by two LMG Project consortium partners, the Yale Global Health Leadership Institute and Management Sciences for Health. To promote ownership of the program, Yale instructors are leading delivery of the program in partnership with representatives from the International Committee of the Red Cross (ICRC)’s Physical Rehabilitation Programme and Special Fund for the Disabled. Each ICRC representative serves as a facilitator for one of the country teams, coaching the teams during the three workshops, and helping each team sustain their momentum and complete assignments when they return to their own countries. An intended additional outcome of the SLP is to strengthen the capacity of these ICRC facilitators to lead multi-disciplinary teams through a systematic problem-solving process that achieves results. The teams then incorporate this approach into their routine work after the program ends.
The LMG Project knows that it is critically important to have the right people in the right decision-making positions involved in the SLP to truly introduce and sustain change in their country’s health and social systems. LMG and ICRC are working together to leverage ICRC’s convening power and long commitment to the service of the participating countries to ensure that the right decision-makers have a voice at the table. In this regard, ICRC staff played a key role in identifying the especially strong group of delegates who participated in this SLP. Over the next nine months, the leadership teams will work together to address systems challenges related to disability and physical rehabilitation (i.e., supply chain development, the availability of reliable data for policymaking, wait times for orthopedic devices, etc.) in their respective countries, with ICRC staff serving as the focal point providing ongoing support and coaching.
SLP sessions are demand-driven, and solve problems in order to meet people’s health needs
During the first SLP workshop, participants reported that physical rehabilitation services are available to some extent in all four countries, but accessing them at the right time—if at all—is a major challenge for those who need them. This is especially true for people living in rural and remote areas, and for women and children. In addition, the service centers that do exist are not led or managed efficiently and are therefore unable to provide the consistent, high-quality and comprehensive services needed to ensure effective physical rehabilitation.
Participants also acknowledged that many technical solutions related to physical rehabilitation for people with disabilities exist, but that there is a gap between knowledge and action, and between policy and implementation. Focusing on strengthening service delivery and the skills of providers alone is not enough. The health professionals and policymakers in the room expressed the need to strengthen their leadership, management, and governance skills in order to solve these pressing and complex challenges.
SLP sessions are demand-driven, and solve problems in order to meet people’s health needs
During the first SLP workshop, participants reported that physical rehabilitation services are available to some extent in all four countries, but accessing them at the right time—if at all—is a major challenge for those who need them. This is especially true for people living in rural and remote areas, and for women and children. In addition, the service centers that do exist are not led or managed efficiently and are therefore unable to provide the consistent, high-quality and comprehensive services needed to ensure effective physical rehabilitation.
Participants also acknowledged that many technical solutions related to physical rehabilitation for people with disabilities exist, but that there is a gap between knowledge and action, and between policy and implementation. Focusing on strengthening service delivery and the skills of providers alone is not enough. The health professionals and policymakers in the room expressed the need to strengthen their leadership, management, and governance skills in order to solve these pressing and complex challenges.
Participants are now prepared to put knowledge into action back home
The SLP teams have now defined their priority problem, created a shared vision of success, and set measurable objectives. They also began a root cause analysis for their problem areas. Participants left the first workshop eager to apply their learning—with an understanding that the real power of the SLP comes from the actions they take once they are back home to introduce and institute effective change. Participants are now in their home countries where they are convening stakeholders, surveying clients, and conducting further examination to complete their root cause analyses, and to arrive at a consensus on possible strategies to achieve their objectives. They will return to Dar es Salaam at the end of November 2013 to present their root cause analyses, finalize their strategies, and develop 6-month implementation plans. The final round of workshop sessions will occur in late spring when the teams will reconvene to present their results, identify lessons learned, celebrate their successes, and build on and sustain the progress they’ve made.
Check the LMG blog for more news in the coming months on this dynamic Senior Leadership Program.
Related Links:
Dynamic Training Brings Senior Leaders Together
LMG page on Improving Services for Vulnerable Populations