Have we forgotten our obligation to train health workers on disability? A policy analysis in sub-Saharan Africa

Abstract

AbstractPeople with disabilities generally have worse health outcomes than people without disabilities, leading to a 10–20-year difference in life expectancy. Research on the barriers to accessing health care frequently points to the role of health workers’ attitudes and lack of training to provide high quality health care to people with disabilities. Current training initiatives are unsystematic and limited to specific cadres or institutions. Yet, many countries that have adopted the UN Convention on the Rights of Persons with Disabilities likely have legal obligations to train health workers on disability in these laws. The purpose of this paper was to systematically explore the laws and policies in sub-Saharan Africa to understand how countries should be training their health workers. We searched WHO MiNDBANK and UN websites for disability laws and policies. We systemically extracted information across 11 domains: 1) requirements, 2) training objectives, 3) training cost, 4) training duration, 5) competencies covered, 6) educational stage, 7) training methods, 8) impairment-specific, 9) cadres, 10) benefits for attendance, and 11) monitoring and evaluation plans. 53 documents in English, French, and Portuguese from 32 countries were eligible for inclusion, while 16 countries had no disability laws or policies. Of the documents included, 24 (45%) did not have any mention of health worker training, while 17 (32%) recommended and 10 (19%) required health worker training. Most laws had no further specifications to describe training, though more robust laws and policies had information on the budget allocation, competencies, educational stage, and cadres included. Several countries in sub-Saharan Africa do have disability laws that require health worker training, and more countries should be including health worker training in their curricula to comply with their national laws.Key messages (2-4)Out of the 48 countries included, 16 had no disability laws, policies, or strategies in eligible databases. While most countries adopted disability policies following the implementation of the UN CRPD in 2006, there remains a notable absence of current and comprehensive disability legislation in many areas, affecting the scope and effectiveness of disability training for health workers.Nearly half of the documents reviewed across 48 countries did not mention disability training for health workers within their national disability laws or policies. Where training was mentioned, it varied significantly, with some countries recommending or mandating training, but often limiting it to specific health worker groups, which might not comprehensively cover all healthcare providers who encounter disabled patients.Malawi, Lesotho, and Rwanda are notable for their detailed training objectives and evaluation plans within their disability policies. These countries provide examples of more proactive approaches, focusing on specific training needs such as sign language and the inclusion of budgeting for training implementation.Despite the presence of laws and policies, there is often a lack of detailed implementation and monitoring plans, which limits the effectiveness of these policies. The study highlights the need for laws and policies to be accompanied by specific, actionable, and funded plans to ensure that disability training for health workers is not only mandated but also effectively implemented.Reflexivity statementThe authors of this paper include 3 women who are experts on disability and health, two of whom are from low- and middle-income countries. One author is disabled and another is from sub-Saharan Africa.