“The health care system in Pakistan is not responsive at all when it comes to the needs of persons with disabilities.” That’s the stark message from Atif Sheikh, Executive Director of STEP, one of Pakistan’s biggest disabled people’s organisations (DPOs).
“It’s not accessible in terms of infrastructure,” Atif explains. “It’s not accessible in terms of reach. People in rural areas have never seen a doctor in their lives if they are disabled.”
He goes on to tell us how people living with disabilities in Pakistan experience profound and multiple challenges in every aspect of life, from reduced income and negative attitudes, to struggling to access basic services like health and education.
We meet Atif and his colleagues at STEP in their office on the outskirts of Islamabad. Their organisation has been championing the rights of people with disabilities since 1997. By maintaining links and networks with small local DPOs working all over the country, they have a deep insight into the reality facing people with disabilities and a clear sense of how services can better meet their needs.
The importance of healthcare in giving people the support the need to participate in everyday life is clear, according to Atif. “People with disabilities are not able to get rehabilitation when they need it, so they remain out of the mainstream for all of their lives,” he says. “[But] once they have access to basic health and rehabilitation services, they can move to education services.”
Tackling the exclusion of people with disabilities is a daunting challenge. But a new UK aid funded programme, the Right to Health, aims to break down the barriers to accessing health care services.
Sightsavers has been working in partnership with STEP since 2005. The DPO’s expert guidance, technical advice and access to other local DPOs has been essential in both the design and implementation of the new programme.
One of the first initiatives of the programme was to introduce more effective systems and practices about how to collect accurate data on disability across health services, in order to understand the scale of the challenge.
“Data is quite a serious issue because in Pakistan, people with disabilities have never been counted,” Atif says. He explains that in most of the previous national population censuses, questions about disabilities were not even included. Data is important for policymaking, decision-making and budget allocations for the services. As Atif puts it: “If you don’t have numbers you can’t take any decisions.”
STEP was able to translate and adapt a short questionnaire called the Washington Group questions (which enables accurate data collection on how disability affects people’s lives) for use in health care settings. The DPO then trained healthcare workers across partner hospitals to use the Washington Group questions in their day-to-day work.
STEP has also been instrumental in the design of disability inclusion training aimed at hospital workers and healthcare workers. By training staff in the hospitals on disability, gender equality and sign language, their attitudes, and their ability and confidence to better support patients with disabilities, are improved.
Members of STEP have also conducted accessibility audits of the programme’s four partner hospitals to understand where they may inadvertently be excluding people with disabilities. The audits, conducted by people with disabilities, are designed to identify the challenges people face accessing the hospital and its services that could prevent them from receiving the care they need.
This can include anything from physical barriers like buildings without ramps, to language and communication barriers, including a lack of sign language. Clear recommendations about how facilities could be improved will be given to the hospital administration teams after the audits.