Health

Under Article 25 of the CRPD, the state has an obligation to establish PWDs’ right to have access to the highest attainable standard of health without discrimination. Its duties also include taking appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation.

Laws and Policies Promoting Disability Rights

The Disability Rights Act establishes the right of PWDs to live in a healthy environment. It states that depending on the type of disability, quality medical services and health care facilities must be provided to PWDs [1]. It prohibits discrimination against PWDs; and also empowers them to make complaints to the District Committee against any discrimination faced while availing health care services and to claim compensation [2].

The Act addresses aspects of food security and nutrition for disabled children and adults. It requires the state to take preventive measures to lower the risk of factors responsible for causing disabilities among children and women and to reduce their medical expenses [3].

It also calls for use of accessible modes of communication in all hospitals and medical institutions including sign language interpretation or employment of speech language therapists where deemed necessary [4].

AUnder the Act ll aspects of accessibility and mobility is to be ensured for PWDs in medical and health care institutions [5].

Lastly, Schedule 11(kha) of the Act specifies that the State should encourage insurance companies to set up separate insurance for disabled PWDs to increase their social security.

Under the National Health Policy 2011, the State is committed to providing unrestricted access to health care services and other medical services without discrimination [6] and to raise widespread awareness on nutrition, health hazards, and available health care services to ensure a healthy and balanced lifestyle for PWDs. It also provides that free healthcare and services shall be provided for the poor and the disadvantaged members of the society, which especially benefits financially disadvantaged PWDs [7].

The Sixth Five Year Plan FY 2011 – FY 2015 requiresthat relevant authorities shall make early detection of symptoms of disability, primary medical rehabilitation, undertake a nutrition programme for pregnant women, appoint trainee doctors, nurses and other caregivers to deal with disability issues and introduce support services for use of assistive devices and equipment at health centers [8].

The National Food Policy 2006 expressly refers to achieving food security for all including PWDs (Strategy 2.3.1).

The National ICT Policy 2009 refers to ensuring quality healthcare to all citizens by innovative application of ICT (Clause D. 7) and improving management of healthcare delivery system using telemedicine and modern technologies benefitting PWDs in the long run. It also refers to the goals of improved community awareness, access to health care facilities, and quality assurance of health care services and enhancement of the capacity of the National Health Service delivery system (Clause E.7.1 – E7.4).

Gaps and Limitations in the Law

There are no monitoring mechanisms to oversee compliance with health standards and guidelines for public health care services and facilities for PWDs. There is no provision in the various Plans for raising public awareness about the plan provisions; PWDs are largely therefore unaware of their various health entitlements [9].

There is no separate budget allocated for PWDs relating to health [10]. The Sixth Five Year Plan is silent on the need to develop a physical rehabilitation system, [11] although the Disability Rights Act provides for adoption of family and community based rehabilitation through private initiatives, establishment of institutions to enable rehabilitation especially for the intellectually disabled and setting minimum standards of care depending on the type and nature of disability [12].

Situation Analysis/ Survey Findings

The services provided at the many Government Health Centers across the country are neither easily accessible nor affordable for most PWDs. There is only one doctor available for every 35,000 people; the current doctor patient ratio is 1:0.48, in contrast to the international ratio of 1:3 [13].

Sanitation: 94% of PWDs surveyed said that their family homes did not have a disabled friendly washroom/toilet. Only 6% of the PWDs had access to a disabled friendly washroom/toilet in their family homes. 86% of the PWDs said that they do not enjoy the same sanitation services as non-disabled people.

Inaccessibility of Public Health Centers: Public health centers, such as Upazila Health Complexes and district general hospitals, generally lack the expertise required for early identification of disability, fitting of artificial limbs, handling aids and appliances and knowledge on educational or therapeutic services or vocational rehabilitation. Most doctors, nurses and health workers lack knowledge regardingprevention of secondary disability, early intervention, or rehabilitation [14].

Persons with psycho-social disabilities: There are currently fourteen State run centers for persons with psycho-social disabilities in medical colleges. There are also two other exclusive/specialized facilities for such persons [15].

Medical Rehabilitation: PWDs still largely depend on traditional healers. About 70% of the disabled population have special needs for medical rehabilitation and social integration, but cannot access these from existing health care service delivery system. Medical rehabilitation is available only through selected NGOs, and only in urban areas [16].

Fig1_HealthFig 1: Do you know of any PWD being rehabilitated through the existing health services/benefits provided to PWDs?

Disabled pregnant women and injured patients: Medical professionals generally lack knowledge on how to provide services to to women with disabilities when they become pregnant, including pre-natal, natal and post-natal care. There is also inadequate treatment for certain injuries (especially a spinal cord injury) and reports of disability resulting from medical negligence (namely lack of knowledge of orthopedic surgeons in dealing with post-polio cases if they fracture an affected limb due to any injury and/or accident) [17]. There are no patient-counseling facilities and limited facilities for children with disabilities.

Fig2_HealthFig 2: What steps, if taken, shall ensure that PWDs get the same health benefits and receive the same health services as non-disabled people?

Inability to communicate as a barrier to Health Services: Government hospitals do not have environments adapted to the needs of PWDs. Doctors and nurses on duty lack specialist expertise to take care of people with disabilities. There are generally no sign language interpreters in hospitals for those with hearing and speech difficulties.

Cost of Health Services: Government hospitals do not provide medicine or other treatments for free for people with disabilities despite Ministry guidelines stating that this should be the case Private medical care is hugely expensive and inaccessible for most. While Government hospitals provide devices such as hearing aids, crutches to disabled patients for free these are often given out without proper assessment of their working condition. Disabled patients have to buy their own devices as government provided ones do not last.

Fig3_HealthFig 3: Do PWDs receive health benefits/services free of cost?

Lack of reserved hospital beds and health service counters: Most hospitals lack an adapted ward or separate counter for PWDs. Faridpur Town Hospital is the only known hospital that has a separate counter and five beds reserved for people with disabilities

Lack of awareness of available health services: Every district has at least one health center but most PWDs remain unaware of their services, given inadequate publicity.

Fig4_HealthFig 4: Are PWDs informed about the preventive steps/measures that can be taken to protect themselves from HIV/AIDS and malaria? Are the awareness materials made accessible through the dissemination of such materials in Braille for example?

Recommendations

  • Proper Implementation of the law: The Ministry of Health and Family Welfare should ensure strict compliance of the law and develop monitoring systems to maintain a quality standard with respect to health services for PWDs.
  • Accessibility: Comply with the National Building Code 2008 and Schedule 3 of the Disability Rights Act to ensure all hospitals, maternity and diagnostic centers, and medical institutions are made accessible for patients with disabilities. Put up signs showing the directions to separate disabled facilities, arrange separate wheelchair access at every building entrance and on each floor, ensure lifts in multi-storied buildings, install automatic doors, employ assistants to help disabled patients and separate counters for disabled patients to avoid their being made to stand in long queues.
  • Communication: Engage audio and use of Braille in hospitals and where necessary engage a sign language therapist.
  • Free Medical Services: Ministry of Health and Family Welfare to monitor access of poor patients with disabilities to free healthcare.
  • Training: Give specialized training to doctors, hospital employees, ward boys, employees and nurses on treating people with disabilities. Training Curriculum and Syllabus, for example the MBBS for medical practitioners to include disability issues. Train more sign language experts to communicate with people with hearing and speech difficulties. Train all concerned persons on their legal obligations to treat people with disabilities, and to build empathetic behaviour and positive attitudes.
  • Extra care to be taken to prevent disability at birth and in the event of an accident: Ensure skills among medical professionals to provide services to pregnant women with disabilities and to treat patients with certain injuries (especially a spinal cord injury) with extra care and precaution to prevent the occurrence of disability.
  • Awareness building: Undertake extensive awareness programmes about the existence of district health centers and entitlements of PWDs under national policies [there are currently eighty One Stop Services in operation under the Jatiyo Protibondhi Unnayan Foundation (JPUF) across the country [18] and disseminate information about such services and programmes to enable disabled patients to make informed decisions regarding the kind of treatment they want to receive.

Dissemination of information

    of nutrition, health risks, diseases and preventive behaviors among disabled people and of their right to access health care services.

 

[1] Section 16, Rights and Protection of Persons with Disabilities Act, 2013.
[2] Section 36, Rights and Protection of Persons with Disabilities Act, 2013.
[3] Schedule 3, Rights and Protection of Persons with Disabilities Act, 2013
[4] Schedule 4, Rights and Protection of Persons with Disabilities Act, 2013.
[5] Schedule 11, Rights and Protection of Persons with Disabilities Act 2013.
[6] Clause 1 of the Main Policy section, Ministry of Health and Family Welfare, Health Policy 2011 : file:///C:/Users/ASUS/Downloads/Health%20Policy%202011%20(1).pdf
[7] Clause 20, Methodology Section, Ministry of Health and Family Welfare, Health Policy 2011 : file:///C:/Users/ASUS/Downloads/Health%20Policy%202011%20(1).pdf
[8] Ministry of Planning Commission. Website: http://www.plancomm.gov.bd/wp-content/uploads/2013/09/SFYP_Part-2.pdf
[9] Handicap International. Bangladesh Report on mapping of the physical rehabilitation sector 2014. Page 10 (on file).
[10] NGDO, NCDW and BLAST, FGD Findings Sharing Meeting, 9 October 2013, Dhaka (on file).
[11] Handicap International. Bangladesh Report on mapping of the physical rehabilitation sector 2014(on file).
[12] Schedule 8, Rights and Protection of Persons with Disabilities Act, 2013.
[13] Page 12, Consolidated Report 7 FGDs, 1 October 2013.
[14] Handicap International. Bangladesh Report on mapping of the physical rehabilitation sector 2014. (on file).
[15] ‘Report on The Situation of Persons with Disabilities in Bangladesh: Universal Periodic Review Of Bangladesh UPR 16Th Session, 22 April – 3 May 2013’. N.p., 2012. Web: dpi.org/documents/UPR%20Bangladesh.docx
[16] Country Profile on Disability, People’s Republic of Bangladesh: http://siteresources.worldbank.org/DISABILITY/Resources/Regions/South%20Asia/JICA_Bangladesh.pdf
[17] Participant at a discussion meeting with Steve Estey, 10 December 2014, Centre for the Rehabilitation of the Paralyzed, Savar.
[18] http://www.nfddp.gov.bd/
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