The emerging pattern of disability in Rwanda

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Background

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone’s performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).

Objectives

This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation.

Method

Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organisations or faith-based organisations.

Results

Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities’ catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier.

Conclusion

Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families.

Contribution

Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda.

Prevalence, Pattern, and Factors Associated With Self-reported Disability Among the Bhutanese Population: A Secondary Data Analysis of Population and Housing Census

We analyzed the Population and Health Census of Bhutan (PHCB) 2017 to assess the prevalence and pattern of self-reported disability among people aged ≥15 years and the associated factors. The PHCB 2017 used the Washington Group Short Set on Functioning questionnaire to assess the disability ("lot of difficulty" or "cannot do at all") in seeing, hearing, mobility, cognition, self-care, and communication. Of the 536 443 persons included in the analysis, 384 101(71.6%) were aged <45 years, 283 453(52.8%) were men, and 206 103(38.4%) were from the rural area. The prevalence of any self-reported disability was 2.8%, among whom 34.2% reported multiple disabilities. The disability prevalence (any) was significantly higher among people aged ≥65 years, illiterate, economically inactive, permanent residents, residing in a rural area, and from central and eastern regions of the country compared with their respective counterparts. Further research on access to rehabilitation and linking with social protection schemes for the disabled is required in this country.

Challenges in Accessing Health Care for People with Disability in the South Asian Context: A Review

South Asia is a unique geopolitical region covering 3.4% of the world’s surface area and supporting 25% of the world’s population (1.75 billion). Available evidence from South Asia shows variable estimates of the magnitude of disability. The projected magnitude depends on whether an impairment focus is highlighted (approximately 1.6–2.1%) or functionality is given precedence (3.6–15.6%). People with disability (PWD) face significant challenges to accessing health care in the region. Studies show that adults with disability reported a four times higher incidence of a serious health problem in a year’s recall period. Evidence shows a significantly higher rate (17.8%) of hospitalization among PWD compared to others (5%). Chronic conditions like diabetes were also significantly higher. Women with disability had significantly more concerns on reproductive health issues. Studies from the South Asia region reveal that not only did PWD have a higher load of adverse health outcomes but they also faced significantly more barriers in accessing health services.

Realization of the rights of persons with disabilities in Rwanda

This scoping study assessed the realization of the rights for persons with disabilities in Rwanda since the signing of the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) in 2008. Underpinned by the five-stage framework of Arksey and O'Malley, the scoping study examined peer-reviewed literature published between 2008 and 2017. Nine electronic databases were searched using keywords specific to disability in Rwanda. Data were charted by three reviewers according to pre-determined and emergent categories. Descriptive statistics were used to describe the data sources. A total of 60 scholarly articles met the inclusion criteria. Within the research, studies pertaining to the UN CRPD Articles of health, awareness raising, accessibility, and children with disabilities were the most published. The literature identified a movement towards the realization of the rights for persons with disabilities in Rwanda since the country signed the UN CRPD. Despite efforts to meet these rights, discrimination against persons with disabilities still exists and greater investment in the disability sector is needed, particularly for justice, social protection, and mental health services. Given the state of the evidence, concerning research gaps also exist in regards to deinstitutionalization and protection issues (i.e., violence and abuse). This consolidation of evidence may help to inform the decision-making priorities for government and civil society organizations in policy and programming and also direct future research.