16.05.2019 Making eye health programmes inclusive in Zimbabwe
A team from CBM International including the Advisor for Inclusive Development for Country Planning, the Africa East Advisor for Inclusive Development, the Focal Point for Inclusion in Eye Health and Environmental Sustainability, and CBM Zimbabwe’s country office staff co-facilitated an Inclusive Eye Health (IEH) workshop with representatives from Zimbabwe’s national umbrella body of Disabled People’s Organisations (DPOs), the Federation of Organisations of Disabled People in Zimbabwe. This team of diverse and enthusiastic facilitators would in three days take a group of people with varying capacities in inclusive eye health practices and leave them confident enough to make commitments to start practicing inclusion in their work.
The workshop participants were made up of a mixture of clinicians, mainly ophthalmologists and ophthalmic nurses, eye unit coordinators and programme managers from CBM’s in-country implementing partners, Council for the Blind and the Reformed Church in Zimbabwe. Also present were representatives from the Ministry of Health and Child Care as well as DPO representatives to ensure for varied perspectives and lived experiences. Having persons with disabilities taking part in the workshop enriched participant’s experiences as they challenged especially service providers to look critically at themselves and question the degree to which their programmes were inclusive.
Zimbabwe was selected in 2017 as one of five priority strategic countries to roll out CBM’s Inclusive Eye Health Initiative (2017 – 2021). This initiative was brought about because many marginalised people are not accessing eye health services and some services do not enable meaningful, lifelong change. CBM’s inclusive eye health initiative prioritises a stronger focus on inclusive and comprehensive eye care programmes, integrated into national systems.
The first day of the training introduced participants to the United Nations Convention on the Rights of Persons with Disabilities as a human rights instrument guaranteeing the rights of persons with disabilities. Facilitators challenged participants to use this instrument to frame the right to access to health as people with disabilities want to access their programmes. The ‘Game of Life’ was done as an exercise for participants to understand different levels of equality experienced by people determined by factors such as where they are born, the opportunities they are afforded, their economic status and access to education. It was highlighted in this ‘game’ that people with different impairments have diverse lived experiences. The ‘game’ revealed that although everyone is born equal (formal equality) what is more important is to ensure equality of outcomes that no matter the situation one is able to still access health care (and other) services without barriers. Participants were then tasked to measure their work against five access standards namely accessibility, affordability, acceptability, availability and quality, to identify their strengths and areas of improvement. Although some efforts are being made to ensure equal access to services, it became apparent that these are often not coordinated and in some cases not even known by the communities they are targeting.
The second day explored strengthening IEH through a strong gender, data and accessibility lens. The intersectionality between gender and disability was discussed as women with a disability often face greater barriers to accessing services when compared to men with disabilities. Partners were tasked to analyse whether they take gender into account when planning projects and it became apparent that there is still a gap in making this important consideration. The session on data also sparked much debate around appropriate ways to capture data on disability. The Washington Group Questions were tabled as a suggestion when wanting to collate more comprehensive data over a fixed time frame but admittedly not convenient in day to day running of programmes. Participants were tasked with the help of DPOs to create innovative ways to disaggregate data by disability as often times if people are not counted, they do not count! CBM’s accessibility policy and namely its seven accessibility commitments were shared with participants and they were encouraged to keep CBM accountable to these commitments and to use the CBM policy to model their own.
The final day of the workshop enabled participants to have a practical feel of the concepts they had learnt through a visit to Sekuru Kaguvi Hospital’s (SKH) eye units. They were able to gather data on the level of access to services experienced by the patients there by administering surveys which they had designed. Workshop participants additionally had the opportunity to interview health care personnel and administrative staff to get a comprehensive picture of service provision at SKH. CBM is co-funding a project at the hospital and this exercise provided the opportunity for critical reflection into work being done and what needs to be done differently. Having mastered basic concepts and with practical experience in hand, the participants developed action plans aimed at taking what they had learnt about inclusion back to their programmes and work places. What came out clearly from the action plans was the need for support from disabled persons organisations in ensuring accountability and adherence to the principles of the Convention on the Rights of Persons with Disabilities. Partners expressed interest in developing accessibility policies modelled on the work of CBM. Several participants saw the importance of having accessibility audits done in their workplaces and on being more cognisant of persons with disabilities when collecting data on populations reached by their services.
Although CBM’s partners are well versed in the work which they do in eye care provision, it was apparent from the first day of the inclusive eye health workshop that they required some support in understanding how to make their programmes inclusive. By the end of the workshop the outlook was a positive one as partners were prepared to share what they had learnt in order to ensure their programmes are inclusive of all persons.