malcolm.maclachlantcd.ie Centre for Global Health

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malcolm.maclachlan_at_tcd.ieCentre for Global
Health School of Psychology
Inclusive Global Health Research in Trinity
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We specialise in multi-country comparative
interdisciplinary research seeking to
strengthen health systems ensure equal and
equitable access for all.http//www.medicine.tcd
.ie/global_health/
CENTRE FOR GLOBAL HEALTH
Strengthening Research for Health, Development
and Equity, BAMAKO 2008
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Inclusive means what?

• Trying to ensure that those groups often
  marginalized by and excluded from mainstream
  society get equal and equitable benefits from
  their citizenship

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Inclusive means what?

• Social Exclusion arise because of
• Poverty, Disability, Ethnicity, Gender,
  Sexuality, Age, Locality, Etc
• Inclusion that is what development is all
  about to bring into society people that have
  never been a part of it. James Wolfensohn, World
  Bank

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Inclusive Global Health Research StreamCurrent
Projects

• EquitAble how can we enabling more equitable
  access to healthcare in Africa?
• Sudan, Namibia, Malawi, South Africa EU FP7
• A-PODD how can research evidence best influence
  inclusive policy making?
• Malawi, Ethiopia, Uganda, Sierre Leone HRB
• Include how is disability included in national
  development plans?
• Tanzania, Zambia, Mauritania - World Bank
• Indigo Inclusive Global Health Stream Irish
  Aid/HEA
• AfriNEAD African Network on Evidence to Action
  In Disability - Irish Aid Others

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• EquitAble how can we enabling more equitable
  access to healthcare in Africa?
• Sudan, Namibia, Malawi, South Africa EU FP7
• Full title Enabling universal and equitable
  access to healthcare for vulnerable people in
  resource poor settings in Africa
• Project manager Hasheem Mannan
• Co-Investigator Eilish McAuliffe

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EquitAble

• 1. Public Health cannot hope to be EQUITABLE
  unless it is equally ACCESSIBLE to ALL.

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EquitAble

• 1. Health services cannot hope to be EQUITABLE
  unless they are equally ACCESSIBLE to ALL.
• 2. Assessing the health service experience of
  persons with disability, may be a good way of
  PROBING the effectiveness of the overall public
  health system.

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• We adopt the ICF definition of disability
• functional impairment
• activity limitation
• participation restrictions
• Disability as a continuum a universal
  experience.

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The EquitAble Access Model
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EquitAble Partners

• Afhad University for Women, Sudan
• University of Stellenbosch Department of
  Psychology and the Centre for Rehabilitation
  Studies, South Africa
• University of Malawi Centre for Social Research,
  Malawi
• University of Namibia Multidisciplinary Research
  and Consultancy Centre, Namibia
• Human Sciences Research Council, South Africa
• Secretariat of the African Decade for Persons
  with Disabilities
• National Institute for Intellectual Disability,
  Trinity College Dublin
• SINTEF Health Research, Norway

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EquitAble Country Rationale

• Sudan Large proportion of the population has
  been displaced

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EquitAble Country Rationale

• Sudan Large proportion of the population has
  been displaced

• Namibia Population is highly dispersed

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EquitAble Country Rationale

• Sudan Large proportion of the population has
  been displaced

• Malawi Chronic poverty and high disease burden
  compete for meagre resources
• Namibia Population is highly dispersed

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EquitAble Country Rationale

• Sudan Large proportion of the population has
  been displaced
• South Africa Despite relative wealth universal
  and equitable access to health care yet to be
  attained

• Malawi Chronic poverty and high disease burden
  compete for meagre resources
• Namibia Population is highly dispersed

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Focus of Research

• Work Package 2
• Evidence of best practice
• in policy and practice in each county,
• regionally and internationally.

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Focus of Research

• Work Package 3
• Intensive qualitative
• exploration of experiences of service users,
• non-users and providers in different contexts.
• Ethnographic Framework in depth interviews
  observations facility reviews

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Focus of Research

• Work Package 4
• Extensive quantitative
• exploration of epidemiology, living conditions,
  contextual and systems factors for persons with
  disabilities via household survey.
• 4 sites in each country (urban, rural, ethnicity,
  place)
• 500 people per site
• 8,000 people in total.

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Focus of Research

• Work Package 5 Getting Evidence into Action
• High level engagement
• E.g. Global Ministerial Forum on Research for
  Health, Bamako, 2008.
• Joint launch of the project by Ministers for
  Health and Education, Sudanese Government.
• AfriNEAD African Network for Evidence to Action
  on Disability.
• others

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Characteristics of a good health systems probe

• A systems probe assesses a particular aspect of
  a system, those aspects being more systems
  dependent than many other health outcomes.
• Such probes are likely to be most informative if
  they incorporate a broad sweep of health services
  related activities
• .

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Disability as a Public Health Services Probe

• The incidence of disability is related to a
  number of systems issues
• Maternal Child Care
• Nutritional Status
• Immunization coverage
• Communicable Diseases (e.g. HIV/AIDS)
• As is the quality of the outcomes

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Additional systems aspects of Disability as a
Health Services Probe

• Service Utilisation The use which persons with
  disabilities make of health services is an
  indicator of the services overall accessibility
• Chronic Disease Burden Disabled people live with
  many chronic conditions that require on-going
  health professional input
• Rehabilitation and Enabling Technologies Some
  disabled people are in on-going contact with
  rehabilitation services that provide and maintain
  enabling technologies that enhance their quality
  of life
• Interacting Vulnerability Factors Disability
  interacts with other factors, such as ethnicity
  and gender, that may marginalise people and
  affect access to healthcare
• Inter-sector Communication The quality of life
  of persons with disability cannot be maximised by
  health services alone but require efficient
  inter-sector communication and planning

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Conclusions

• EquitAble will
• Provide policy, qualitative and quantitative
  evidence of health service provision, and
  barriers to it, for persons with disability and
  other marginalised groups in four countries,
  across different regions, groups and contexts.
• Interface with ongoing research on how to get
  evidence-into-action in policy and practice.
• Detail how the provision of services to persons
  with disabilities can be used as a probe to
  evaluate broader health system performance.