A global system in which poor countries are unable to develop and produce their own vaccines to match their demand is not sustainable; particularly when faced by potential future pandemics. Credit: PAHO/Karen González.

By Jonatan Konfino and Shubha Nagesh
Jul 20 2021 (IPS)

“Vaccine equity is the challenge of our time,” Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), told the gathering in opening remarks.  “And we are failing”at a special ministerial meeting of the Economic and Social Council.

Earlier, G7 leaders wrote a letter of support declaring that wealthier countries should pay the cost to vaccinate low and middle income countries.

Globally, indiscriminate inequity exists in the procurement and distribution of vaccines, which has hit the countries in Asia and Africa the most. According to the World Health Organization, among the 832 million vaccine doses that have been administered, 82% have gone to high- or upper-middle-income countries, while only 0.2% have been shipped to low-income countries

The United States announced that it would donate 500 million doses of the Pfizer vaccine to COVAX to supply COVID vaccine doses to countries in need. In addition, several countries pledged support to a waiver to intellectual property restrictions, which could allow countries to produce the vaccine generically to amplify production and supply.

While these are essential steps in the right direction, a global system in which poor countries are unable to develop and produce their own vaccines to match their demand is not sustainable; particularly when faced by potential future pandemics.

Stringent measures, with global solidarity and commitment to build global vaccine equity and ensure the last person gets the vaccine in rich and poor countries alike before the next global health crisis hits is the need of the hour. This is a time when internationalism wins over nationalism, and globalism works better than local.

Globally, indiscriminate inequity exists in the procurement and distribution of vaccines, which has hit the countries in Asia and Africa the most. According to the World Health Organization, among the 832 million vaccine doses that have been administered, 82% have gone to high- or upper-middle-income countries, while only 0.2% have been shipped to low-income countries.

According to a United Nations report, in high-income countries alone, 1 in 4 people have been vaccinated, a ratio that drops precipitously to 1 in 500 in low-income countries.

This inequitable vaccine access is rooted in the power, influence and the control of few rich countries who have determined vaccine allocation. Early on, despite COVAX’s commitment to vaccinate the world’s population, Western countries developed vaccines separately, in bulk, more than what was necessary, hoarded and vaccinated all, including their young people, who are considered less at risk.

Citizens of low income countries faced shortage, even those who were at risk for COVID-19. As a result, many countries have been left behind.

In the Global South, countries have welcomed and celebrated the ‘noble’ decision of rich countries to donate overstocked vaccines. However, we must take a step back to understand why countries need donations in the first place.

Our struggle to access vaccines is not a consequence of our present shortcomings but of our long histories––many of which are burdened with the legacy of violent colonialism. If poor countries need to rely on donated vaccines, it’s a sign that the global health system is not working. Global Health has failed in this Pandemic.

It’s not just about purchasing doses. A painful history of unequal power relations has shifted resources out of low- and middle-income countries to their high-income counterparts.

We are working against a persistent lack of support for the infrastructure that allows countries in the Global South to independently drive scientific development. Moreover, our material resources and human capital have supported northern economies for decades.

This is exacerbated by the problem of brain drain, in which talent is pulled from low- and middle-income countries to their high-income counterparts, perpetuating dependence and inequities. For example, it is estimated that researchers working internationally from low-income countries produce 10 times more patents than their compatriots at home.

Scientific and health sovereignty are strategic drivers of equitable access to health.
Rich countries are often lauded for aid and donations- progress can be made when we move from charity to rights-based models.

To sustain development efforts, international cooperation and collaboration that allows what countries need is international cooperation that enhances local capacity and expertise, enables country infrastructure and retains the talent to generate innovation at home is crucial. It’s about Human Rights, Social Justice and Equity.

In the short term, developing countries need to be able to produce vaccines and access them equitably. This includes relaxing the World Trade Organization’s Trade Related Access to International Property Rights to enable countries to produce vaccines on site.

In the long term, international collaboration across nations is urgent. For example, the Sputnik-V vaccine program in Argentina involves cooperation between the Gamaleya Institute, the Russian Investment Fund and a national pharmaceutical, Richmond Lab, to develop and produce vaccines for Argentina and the southern cone. This type of cooperation is strategic to expand vaccine production and enhance technology investment in developing countries.

Regional cooperation will strengthen the health and technology sectors in developing countries. During the last few months, AstraZeneca vaccines have been produced between Argentina, which produces the active substance of the product and Mexico, which subsequently completes and bottles doses.

COVID is a global threat today. There will be more, severe threats in future. As we move forward, let the lesson from the crisis not go in vain. Together, in solidarity, we can each do our bit to advance our shared vision of an equitable world. It has taken extraordinary drive to develop the vaccine. Reimagining Global Health should be  about the deliberate intention to get this vaccine to the last person.

Jonatan Konfino MD, MSc, PhD is a Senior Atlantic Fellow for Health Equity and Professor of Public Health at Universidad Nacional Arturo Jauretche and George Washington University. Secretary of Health in the Municipality of Quilmes, Buenos Aires, Argentina. 

Shubha Nagesh is a medical doctor by training and a Global Health Consultant. She presently works for The Latika Roy Foundation, Dehradun, India. She is a Senior Atlantic Fellow in Global Health Equity.

A local cemetery working running on the ground collecting logs for funeral pyres, to perform the last rites for patients who died of Covid, on 29 April at the Ghazipur cremation ground in New Delhi. (Ghazipur Cremation Ground/File-Amit Sharma)

By Shubha Nagesh and Ifeanyi Nsofor
DEHRADUN, India/ABUJA, May 12 2021 (IPS)

The media is awash with the devastating news of deaths and sufferings due to COVID-19 coming out of India. What most media outlets overlook is the way Indian communities are rallying to save lives, reduce sufferings and stop the current wave of the pandemic.

As of May 11, 2021, India’s COVID-19 case total is about 23 million – with above 19 million recoveries, while total deaths are 250,025, according to the health ministry. All levels of hospitals and health facilities are full, after optimising their beds and staff, oxygen is almost not available, medicines are being bought in the black market and crematoriums have been inundated, forcing them to use nearby open spaces and parking lots to deal with the surge. Despite being the world’s largest producer of vaccines, India does not have enough for its own people.

Communities have to be acknowledged as the true heroes in this second wave of COVID-19 outbreak in India. Without support however, even they cannot flatten the COVID-19 curve

Shubha lives in Dehradun, in North India- with a population of one million, Dehradun is no different from anywhere else in India, but for the lack of much media attention. The Kumbh Mela, (a major pilgrimage and festival in Hinduism) did bring some focus to the state of Uttarakhand as a super-spreader event in the last month.

The past week has been consumed with calls all day around beds, medicines, oxygen and plasma. It all got really intense when someone in her own family got really serious and her condition scared the family tremendously. That was when the reality actually hit home – the scarcity, the fear, and the unrelenting nature of the virus.

While institutional care has taken priority in the conversation around COVID, from what is evident on the ground, it is the people who are enabling each other to seek appropriate care. Communities are coming together to maximise the resources they have, to promote preventive care and support post-hospital care. Mahatma Gandhi captured this sense of community aptly;

“a nation’s culture resides in the heart and in the soul of the people”.

This quote by Gandhi describes an important truth – one that still inspires us to believe the tremendous strength and courage that the people of India show in coming to the aid of sick people.

The current situation in India is clearly demonstrating the inequity in access to care, utilisation of care and showcases how institutions are catering to the privileged while the less-privileged suffer. As India attempts to rebuild, one good starting point is strengthening community supports and networks between the community and healthcare facilities.

Communities are the heart and soul of India. They have the potential to make or break the health of its people and impacts the determinants that drive health. It is important for us to understand its might and do all to meet the potential, now.

We give five examples of communities taking leadership to stem this second wave of COVID-19 in India:

First, religion unites. Religious communities have come forward to do their bit for patients and their families. The Sikh community in India and abroad has come forward to support families by distributing food, creating helplines, distributing oxygen, converting gurudwara premises into makeshift health facilities, and so much more.

Second, the power of celebrity. In India’s Covid-19 response, while most of the celebrities chose to stay quiet, one celebrity has been helping all along, including transportation for the migrant workers to return home, arrangement for hospital beds and oxygen cylinders, etc- Sonu Sood has been phenomenal in his relief efforts, and as he admits, “This was sheer teamwork and the will to help our fellow countrymen”.

Third, the Indian community knows no boundaries. Within the country and the Indian diaspora communities, the people are providing support. Nothing is too small to give. It all eventually adds up. For instance, the India COVID SOS is less than two weeks old.

However, it now has more than 500 members donating funds, equipment and expertise to stem the outbreak. In Dehradun, the number of people who have connected to share information about beds, oxygen, medicines and tests is unbelievable. It will take all of us, each of us, to get through this difficult time.

Fourth, heroic efforts of good samaritans, men, women and many others have ensured food for families through the pandemic. Pushkar Sinha of South Delhi collected details of all the elderly living in his building, collaborated with a nearby hospital and registered them for getting Covid-19 vaccination through the government’s Co-WIN app.

When some of the people said they were unable to get to the hospital, he arranged cars to ferry them. Deshna Krupa and her mom Ahalya from Chennai have been cooking free meals for Covid-19 patients who are quarantined at home.

Two sisters from Patna, Bihar, Anupama Singh and Neelima Singh along with their mother, Kundan Devi prepare and deliver food to homes.

Within days, groups all over India emerged to help support those in need.

Finally, the power of youths. Young people becoming volunteers to create resources for those in need of services. When Arushi Chaddha asked for help on Instagram, Suhail Shetty came forward to arrange for an oxygen concentrator. Nupur and Rahul Agarwal started “Mission Oxygen” to track oxygen concentrators and supplies, when they found a shortage of 3000.

With the help of social media, youth developed digital covid helplines to support affected families with testing, treatment, hospitalisation, oxygen support facilities, mental health, counselling and food services. Youth volunteers have created mobile apps to track bed situations in hospitals across the country.

India is really struggling with Covid-19 and needs global support. Importantly, communities have to be acknowledged as the true heroes in this second wave of COVID-19 outbreak in India. Without support however, even they cannot flatten the COVID-19 curve. The government must show responsibility to ensure that these community efforts are amplified.

COVID-19 has amplified the omission of disabled people. Credit: Bigstock

By Sara Rotenberg and Shubha Nagesh
DEHRADUN, India/OXFORD, UK, Mar 24 2021 (IPS)

2020 will be remembered as the year that changed the world, as COVID-19 spared no country, no community, and no person. As the pandemic continues in 2021, there is recognition that some groups are impacted more than others, not just by the virus itself, but also by the socio-economic and access inequities exacerbated by global shutdowns. Globally, countries, and organisations are seeking to build back better and address inequities.

António Guterres, Secretary-General of the UN, highlighted that we have ignored inequality for too long, putting the poor at greater risk during the pandemic.

UK-based studies corroborate this: people in affluent areas are 50x less likely to die from COVID-19, while people of black ethnicity and disabled people are 4 and 3 times more likely to die from COVID 19, respectively.

Only 0.5% of international development funding goes towards disability-inclusive programs.  despite the fact that people with disabilities make up 15% of the world’s population

A third of 18-24 year olds have lost their job–twice the rate of working age adults. The disproportionate impacts on women include reduced reproductive health rights; increased unpaid care responsibilities; more domestic violence; and a record decrease in women leaving the workforce. Together, these trends threaten global gains on equity and inclusion.

India exemplifies the challenges and inequities so many in low- and middle-income countries faced during the pandemic. India’s poor have been hit the hardest in everything from the disease itself to the economic and social impacts of national lockdowns.

Scores of migrants walked hundreds of kilometres to their villages, exemplifying how people in the informal sector lost their jobs, livelihood, and homes. Public and private healthcare facilities tried to support COVID-19 patients, but reports question the accessibility and equity of the services for the poor. Economically, experts expect that millions of people in India will become impoverished due to the pandemic.

For global health more broadly, the pandemic has threatened to drive back progress made in recent decades and highlighted how we neglected calls for health systems strengthening in recent years. Yet, we see opportunities and calls to ‘build back better’, the global health community must first ask itself “What is wrong with Global Health?” so we avoid these systemic issues and build a more inclusive world.

The reality is that many things went wrong within global health prior to 2020. To date, we have seen certain groups forgotten in the global health space. For instance, only 0.5% of international development funding goes towards disability-inclusive programs.  Even less of this goes directly to global health, despite the fact that people with disabilities make up 15% of the world’s population. COVID-19 has amplified the omission of disabled people.

For example, India’s COVID-19 tracker, Aarogya Setu App, public health guidance, and testing sites have remained inaccessible for disabled people. In lockdowns, disabled people also had difficulties accessing essential food, information, medicines, and supplies.

We suggest three ways to address access inequalities in Global Health:

1. Underrepresented and marginalized groups need better, authentic representation. Global health organizations must continually ask themselves who is not represented or reached in their programs, and actively take steps to fix it. Involving advocates and activists from the very beginning will include the needs of at-risk populations and enhancing acceptance, inclusion and belonging.

2. Global health needs better, timely, factual, and accessible communication. Creating accessible and acceptable communication strategies and messages that are deployed to reach even the most remote areas is key to ensuring global health connects everyone.

3. Act in solidarity. Governments, civil society, and international organisations need to come together to distribute resources proportionately to need. Distributive justice can ensure greater security for all–whether that is for health, income, employment–which ultimately impacts our collective ability to weather catastrophes, like pandemics.

COVID-19 has been a pivotal moment and offers a unique opportunity to build back a better, more equitable, healthier world. However, without an explicit focus on inequity, we risk leaving out those who global health has forgotten, despite our moral obligation and duty to protect.

In 2020, we showed that anything is possible with political will, dedicated funding, and global action. In 2021, we need a paradigm shift in our approach to global health so that it captures those who most need it. We must apply what we have learned from collective action for COVID-19 to the greatest challenges facing our society: inequity. By addressing this, we ensure that global health is truly accessible to all.

All views expressed are personal reflections

Shubha Nagesh is a medical doctor and a global health consultant based in Dehradun, India. She strives to make Childhood Disability a global health priority.

Sara Rotenberg is a Rhodes Scholar and DPhil Student in the Nuffield Department of Primary Care Health Sciences at the University of Oxford.

Credit: Unsplash /Melanie Wasser.

By Ifeanyi Nsofor and Shubha Nagesh
ABUJA, Jan 22 2021 (IPS)

Dealing with COVID-19-related city lockdowns has been exceptionally stressful, particularly for those parents who have had to balance work, personal life, children and elderly, providing home schooling or facilitating virtual learning, managing infection control within the home, and more, all while being disconnected from support services.

Beyond all this, other mediators and moderators play a key role in outcomes for parents and children, including their function and adaptation – sociodemographic, exposure, negative events, personality traits, and the experience of death among close family and friends.

It is therefore unsurprising the results of C.S. Mott Children’s Hospital National Poll on Children’s Health 2020 survey of child health concerns.

Clear links exist between mental health indicators and child-parent conflict and closeness, with anxious parents being particularly vigilant to responding to cues of children’s distress by encouraging them to express their opinions and providing support and acceptance of their decisions
The poll is a national sample of parents to rate the top health concerns for U.S. children and teens aged 0-18 years. A breakdown of the results shows the top ten concerns as follows: overuse of social media/screen time (72%); bullying/cyberbullying (62%); Internet safety (62%); unhealthy eating (59%); depression/suicide (54%); lack of physical activity (54%); stress/anxiety (54%); smoking/vaping (52%); drinking or using drugs (50%); and COVID-19 (48%).

The findings also show that parents’ biggest concerns for young people are associated with changes in lifestyle and mental health consequences of the pandemic.

There are fewer similar studies from the Global South; one study from China showed that the quarantine’s impact on children’s emotion and behaviour is mediated by the parents’ individual and group stress, with a stronger effect from the latter.

Parents who reported more difficulties in dealing with quarantine showed more stress, which in turn, increased the children’s problems. A study from Singapore explored work-family balance and social support and their links with parental stress. It revealed that lockdowns can be detrimental to parenting and marital harmony, especially for parents with poor work family balance and weak social support.

Clear links exist between mental health indicators and child-parent conflict and closeness, with anxious parents being particularly vigilant to responding to cues of children’s distress by encouraging them to express their opinions and providing support and acceptance of their decisions.

Previous studies have revealed that family structures who hold on their own in difficult times will best thrive and get past pandemic and other similar situations.

India’s lockdown declared without advance notice, saw many nuclear families from cities shift back to their ancestral towns for economic reasons. The lack of jobs, particularly in the informal sector, lack of resources to enroll children in online schooling and being cut off from health services and public transport made families shift back into joint family structures to support one another in times of uncertainties.

In Nigeria, the most severe impact of the pandemic on parenting is the loss of livelihoods among low-income families who earn daily within the informal economy – 65% of economic activities are within the informal sector. Most of them do not own bank accounts and may not have savings. The lockdown impacted these informal sector workers the most and consequently their ability to parent effectively.

Thus, the impact of pandemics on the mental health outcomes of children and their families must be explored as a distinct phenomenon. We suggest three ways to enable this:

Improve access to psycho-social support for families, parents and children during lockdowns in pandemic situations. Globally, there is second wave of the pandemic. In the United Kingdom, the country is in total lockdown. This implies that families continue to deal with the challenges identified by the C.S. Mott Children’s Hospital National Poll.

Governments, civil society organisations, public health administrators must begin to assign social workers to visit families and help them deal with the mental health consequences of lockdowns. Conduct outreaches to provide emotional and mental health support for children and families in low-income communities with poor internet access.

An example from India is the The Mental Health Action Trust (MHAT) in Northern Kerala, that developed a unique mental health initiative that has a strong focus on empowering local communities and implementing mental health services through more than a thousand volunteers who run the community service.

Use technology to provide remote to support to parents and children. When families are informed on how lockdowns could affect them, they are better prepared to deal with such challenges. Nigeria’s leading non-profit organization providing mental health support, Mentally Aware Nigeria Initiative, has been reaching out to individuals through social media to help them deal with mental health consequences of the pandemic.

They do this via the Project COVID-19. Services provided include mental health assessment and linkage to counsellors, monthly virtual conversation café using WhatsApp to discuss coping skills and providing support to keep isolation journals. Such organisations are few in the global south and should be supported by government, international donors and the private sector to take their services to scale.

Finally, COVID-19 has changed the workplace and it is no longer business as usual. A significant amount of stress is attributed to juggling work life and home, employers should better support their employees to ease some of the pressure.

Companies should promote frequent check-ins and flexibility, more relaxed patterns of work schedules, incorporate breaks between intense work meetings, encourage recreational online family gatherings, time offs and financial incentives etc. Company health plans should include mental health care. Connecting families to mental health services is another great way to support parents, and therefore families.

COVID-19 is a reminder that countries must invest in epidemic preparedness. These investments should be family-centred to ensure that parents and caregivers are equipped to provide the best parenting possible.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University. Ifeanyi is the Director Policy and Advocacy at Nigeria Health Watch.

Dr Shubha Nagesh works for the Latika Roy Foundation in Dehradun, India. She is a senior Atlantic Fellow for Health Equity at George Washington University. Shubha strives to make childhood disabilities a global health priority.

Credit: United Nations

By Shubha Nagesh
DEHRADUN, India, Aug 17 2020 (IPS)

According to the World Health Organization (WHO) at-least 15% of the population globally has some form or other of a disability- considered the world’s largest minority population and one that any of us can join at any point in our lives. It therefore makes so much sense for each one of us to invest towards inclusion, so everyone has the right to live their life to their full potential and contribute meaningfully to society. This article seeks to highlight the updates from the disability world in the past four months, particularly the last month, both globally and in India.

As we continue to learn to cope with a global emergency of unprecedented scale, the Americans with Disabilities Act (ADA) celebrated its 30th anniversary, since it was signed into law on July 26 1990. Considered to be the most important civil rights act since 1960, the ADA is essentially the law that prohibits discrimination against disabled people.  The act hoped to give people with disabilities equal opportunity, full participation, independent living and economic sufficiency.

The ADA generation comprises of young people who ‘came of age’ under the ADA- young people who are willing to relate with, acknowledge and not just accept the disability, but in fact take pride in it.

Their spark to make their own lives better is warming others to do the same, thereby creating a whole generation of people who now approach life with a rights-based perspective- a much needed magnification of the spectrum of disability justice.

Somehow this flicker has to warm up beyond America, particularly in middle and low income countries, which in fact is home to the majority of people with disabilities.

The right attitude also allows for the health care provider to view the person first and the disability later, enabling the person’s right to assessment, intervention, treatment, rehabilitation, or inclusion

The inequities faced by them has been made more than evident in the face of the pandemic, as they seem to be dying more than ever, are denied treatment rightfully theirs, and continue to be discriminated against by not just health systems, but others too, all of which influence their chances at life and death.

In India, two events took place in recent times that impacted people with disabilities- in July, the government of India proposed amendments to the Rights of Persons with Disability Act (RPDA) 2016, to decriminalise minor offences, in as many as 19 legislations.

This proposal to negate and water down the Act was met with huge resistance from disability advocates and activists across the country, who insisted that doing the same would adversely affect people with disabilities in India. The solidarity and the strength with which the community came together to resist these lame changes in the name of “easing business” by the Government, succeeded in cancellation of the amendments.

Also in July, the Supreme Court delivered a significant decision that people with disabilities are socially backward and therefore qualify for the same benefits and relaxations as candidates from Scheduled Castes and Scheduled Tribes, both in education and employment.

The Delhi High Court has reiterated that as per Census 2011, illiteracy rate among people with disabilities was almost 51% in India and despite the quota for disabled rising from 3-5%, employment rates and retention rates continue to be abysmally low. Hopefully with this new decision when put to full effect could elevate people with disabilities, particularly their education and employment potential.

As someone who has worked with children with developmental disabilities for almost ten years now, based on what we have seen and what we hear from parents, families and the older children, while there are an array of barriers that prevent inclusion into society, perhaps the most difficult one to overcome is the attitudinal barrier or the mindset of the larger society that chooses discrimination over diversity and its acceptance.

This challenge is large, escalates other barriers, has multiple origins like hate, ignorance, fear, lack of understanding etc, needs to be addressed from multiple levels and dimensions, and will take years to come through.

As a medical doctor, the one aspect I would like to focus on is training for medical professionals on disability; for all cadres of health workers and early on in the curriculum, for its impact on the individual, their family and society at large is significant.

This education, if provided the right way, could be life changing in understanding disability and impairment, provide equitable and timely intervention and address people with disabilities with dignity and respect.

If young doctors, particularly those in rural and peri-urban contexts understood disability and referred children for early intervention as soon as they picked up red flags in development, it could improve quality of life for children significantly and save the families and the health systems considerable investments in rehabilitation.

It could support families to access healthcare more often and thereby have positive health outcomes, leading to overall improvement in the health of the population.

Further, the right attitudes could also facilitate reduction of other barriers, including physical barriers like infrastructure, health communication could become more accessible and inter sectoral coordination between different departments could facilitate more one stop solutions for people with disabilities.

The right attitude also allows for the health care provider to view the person first and the disability later, enabling the person’s right to assessment, intervention, treatment, rehabilitation, or inclusion. But above all this, people with disabilities could be  treated with equal opportunities for access, treatment, medical benefits and therefore improve opportunities for education and/or employment, all of which would eventually contribute to the progress of society.

If this isn’t worth fighting for, what is?
It’s time to rethink disability, embrace it and handle it with love.
Love recognises no barriers. It jumps hurdles, leaps fences, penetrates walls to arrive at its destination full of hope- Maya Angelou

Excerpt:

Unless diversity is accepted and inclusion becomes everyone’s business, it will be impossible to achieve the goal of universal health coverage because 15% of the global population who have some form of disability will be left behind. Credit: Bigstock.

By Shubha Nagesh and Ifeanyi Nsofor
Jul 30 2020 (IPS)

Over the next seven years, Google will invest a whopping $10 billion in India to improve technology, health and education, according to CEO Sundar Pichai. This is unprecedented and could be a game changer that could improve health, education and economic empowerment. 

While Google should be commended for such foresight, it is also pertinent to note that there was no mention of how this investment would benefit India’s 26 million persons living with disabilities. Without a doubt, investments in the Indian economy must be all-inclusive. This means including persons living with disabilities, particularly women and children.

For long, disability has been neglected to the detriment of millions of Indians who live with various forms of it. The plight of persons living with disabilities in India is not unique. In the global south, efforts to improve the health and wellbeing of persons with disabilities are usually led by individuals with disabilities, civil society and disabled persons organisations.

In the global south, efforts to improve the health and wellbeing of persons with disabilities are usually led by individuals with disabilities, civil society and disabled persons organisations

Unless diversity is accepted and inclusion becomes everyone’s business, it will be impossible to achieve the goal of universal health coverage because 15% of the global population who have some form of disability will be left behind.

Indeed,  inequities faced by persons living with disabilities have been magnified at this time of COVID-19. These challenges include unprecedented number of deaths, lack of access to finances, people-centered healthcare, home–based caregivers etc. Furthermore, closure of intervention centres and special schools, have postponed assessments and therapy sessions for children with developmental disabilities.

Education is also a major challenge as most schools turned online, without working on accessibility and barriers to inclusion, and so left out thousands of children.

There are many non-profits and government organisations in India that provide services to persons with disabilities, and most have been closed since April 2020, but staff are working overtime to provide the best services through online mediums thereby avoiding disruption of services and ensuring continued developmental progress in children.

So far, feedback from families are varied: from increased involvement of parents to no progress because such parents do not have access to digital technology.

This is the time to build a new era with accessibility as its key feature in India. However, to realise this, the private sector must play a key role as a funder and incubator of ideas.

These are five ways Google could ensure that its $10 billion investment in India is inclusive of persons living with disabilities.

First, involve persons living with disabilities in any plans to discuss the investment. This involvement must be from the beginning when plans are developed to when impact is evaluated. New initiatives must actively seek inputs from persons living with disabilities with different kinds of impairment. If this diverse representation is pursued, the inputs would be inclusive and could mitigate some challenges that may arise.

Second, ensure at least 20% of all roles are reserved for persons living with disabilities, to be well distributed along gender and age groups. Women are needed in leadership positions as the impact they make are phenomenal, with valuable indices like empathy, wellbeing and happiness. Also, children living with disabilities should not be left out.

Third, improve healthcare delivery by training health workers on providing care that is respectful and meets the needs of persons living with disabilities. Health facilities must be obligated to provide services without discrimination.

To achieve this, the investment should include partnerships with schools where health workers are trained to make the curriculum disability-friendly. Health workers already in service should also be trained and retrained on disability-centered care. Disability competencies for health professionals adopted by medical schools in India, should be used to train students, as well as train and retrain health professionals.

Fourth, ensure provision of social determinants of health such access to education, economic empowerment, access to clean water and sanitation for persons living with disabilities. For instance, access to clean water and sanitation helps reduce the incidence of infectious diseases.

Indeed, one of the most important public health interventions to reduce the spread of COVID-19 is frequent hand washing with soap under running water. Moreover, the more educated people are, the better their health-seeking behaviours.

Also, providing economic empowerment interventions would empower persons living with disabilities to pay for their healthcare themselves when the need arises.

Lastly, such a huge investment requires regular monitoring and evaluation. Persons living with disabilities should be included in monitoring teams. No one better than persons living with disabilities can evaluate the impact and the influence of programs that create change and transformation to improve the quality of life of members of the community. Also, lessons learnt can help others know how to cater for the needs of persons living with disabilities.

To be sure, Google is a private business and is entitled to deploy its corporate social responsibility however it deems fit. However, as one of its biggest markets, India is deserving of this investment.

It would amount to perpetuating gross inequities in India if persons living with disabilities are left behind again.

Dr Shubha Nagesh is a medical doctor and works with the Latika Roy Foundation, Dehradun India

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

High school student in eastern India, studies a leaflet on menstrual hygiene. Credit: Stella Paul/IPS

By Shubha Nagesh and Monalisa Padhee
DEHRADUN, India, Jul 10 2020 (IPS)

The Coronavirus pandemic and the resulting lockdown has intensified most inequities in society- specifically those that affect vulnerable communities, including persons with disabilities, particularly young girls. As an aftermath of recent media attention, many government organizations, nonprofits and philanthropies have come together to ensure girls and women in remote communities have access to menstrual care products.

Despite these efforts, a large number of girls with disabilities who face the double burden of discrimination — stigma of disability and taboos associated with menstruation — have been left behind.

Girls and women comprise more than half of the total number of persons with disabilities. The majority of them live in low and middle income countries. A number of them are denied basic human rights because society is not set up to meet their unique needs. For instance, a large number do not attend schools, are not employed meaningfully, and are subject to neglect, abuse, violence, sexual harassment and much else.

The menstrual health needs of vulnerable populations need to be prioritized. Each girl deserves to have a safe and dignified menstrual experience irrespective of her disabilities

Families and parents grapple with additional worries that include safety and hygiene around menarche (onset of periods) and menstruation. These concerns magnify for families whose daughters have cognitive and intellectual impairments and behavioural challenges as part of their disability. Knowledge and awareness around effective menstruation management becomes a challenge with heavy reliance on parents and or caregivers.

The pandemic has further worsened access and support due to restricted access, closure of establishments, traffic restrictions, and financial constraints. There are many families who are unable to afford disposable sanitary products for their daughters and rely on cloth which puts an additional burden of washing. These are re washed and reused- oftentimes, dried in closed spaces and corners that receive no sunlight, risking infection upon re use. Stigma continues around access, utilisation and safe disposal of menstrual products, particularly in urban poor and rural contexts.

Even outside pandemics and crises, the menstrual health needs of vulnerable populations need to be prioritized. Each girl deserves to have a safe and dignified menstrual experience irrespective of her disabilities. Policies and practices are best if inclusive and accommodate unique provisions and needs for girls and women with disabilities.

We propose the following four recommendations to ensure uninterrupted menstrual health services, particularly the supply of products during a pandemic or other emergency crisis situation.

First, it’s important to have an inclusive crisis management policy, one that prioritises the sexual and reproductive health needs of the girls and women with disabilities with deliberation. Developing systems prior to pandemics so these services persist as essential and vital at all times, will support uninterrupted services.

Second, provision of supplies in adequate quantities is essential- on an average if a girl or woman uses 15-20 sanitary pads per month, providing at least three month supplies of 20 pads a month to each girl with a disability will be reasonable. Girls with intellectual impairment, more often than not, are unable to keep track of their menstrual dates or identify symptoms that develop prior to a menstrual period. Having an adequate stock of pads beforehand to safeguard against situations like this pandemic will prevent girls from resorting to unhygienic practices.

Third, having adequate training of community health workers to identify the number of girls with disabilities in the community and their future needs, well in advance, and communicate with the agencies monitoring supplies to ensure regular and ample supplies.

Fourth, agencies who link the disabled community to organisations and donors must have robust systems in place to match needs, when it is required and where it is required. The processes must be seamless with needs outlined in advance, donations matched well with needs, priority measures to determine disabled communities who need supplies the most and accountability in distribution.

If all donors and philanthropies could come together to enable creation of centralised nodal agencies to channelise procurement, distribution, monitoring and evaluation, the system becomes transparent, accountable and effective. Including disability organisations in the dialogue and the actual effort that follows will ensure establishment of supply chains that deliver on time to those that need it the most such as remote villages, urban poor settlements, migrant communities, hard to reach slums.

Some of the above are already in place in India and need integration and scale to reach vulnerable populations, like those with disabilities. UNICEF recommends through recent guidelines processes that could be implemented to ensure menstrual products reach girls during a pandemic; these could be adapted by including the voices of girls with disabilities in formulating strategies to meet their needs.

After all, periods don’t pause for a pandemic and any other crisis and we need to ensure that the needs and challenges of the vulnerable population are adequately addressed.

Dr Shubha Nagesh is an Atlantic Fellow in Global Health Equity and works with the Latika Roy Foundation, Dehradun India

Monalisa Padhee, PhD, is the head of Women Wellness Initiative at the Barefoot College working with women and girls in rural India. She is a senior Aspen New Voices fellow and Atlantic Fellow for Global Health Equity.

An eight-month-old boy is examined by a doctor in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Ifeanyi Nsofor and Shubha Nagesh
ABUJA, Dec 16 2019 (IPS)

Recently, Madhukar Pai, the Director of McGill University Global Health Program wrote about the inequity in global health research. He observed that researches are skewed in favor of the global north. We agree that this inequity exists. However, we also have found that global fellowships such as the Atlantic Fellowship, of which we are both Senior Fellows, are platforms to reverse this inequity, foster international partnerships and amplify voices of development practitioners from the global south. 

Shubha Nagesh is a medical doctor by training and thereafter specialised in Global Health from Karolinska Instituet, Sweden as an Erasmus Mundus Fellow. She presently works with children with developmental disabilities in the foothills of the Indian Himalayas.

Ifeanyi Nsofor is a Nigerian medical doctor and a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and 2006 Ford Foundation International Fellow. Ifeanyi is a leading advocate for universal health coverage in Nigeria.

The world must realise that fostering a global village requires that different geographical locations do not attempt to solve problems alone. There must be a sense of community in all efforts to improve health

The Atlantic fellowship is funded by the Atlantic Institute and connects the seven Atlantic fellows programmes spread across six countries. The goal of the Atlantic Institute is to advance fairer, healthier societies. Fellows have diverse backgrounds and are united by their commitment to a more inclusive world.

As Senior Fellows of the Atlantic Fellowship for Health Equity at George Washington University, both authors have benefitted from an enriching fellowship year. This experience has led to convenings in the U.S., Rwanda and other locations and have been great learning opportunities to understand the local health systems and the benefits of international collaborations.

The mid-year convening at the University of Global Health Equity in Rwanda, allowed both authors to witness firsthand the partnership between the government of Rwanda and Partners in Health, which has led to significant improvements in mental health through the Mario Pagenel Fellowship in Global Mental Health Delivery. In previous opinion pieces, Shubha wrote about her Rwanda experience and Ifeanyi did the same.

From our combined experiences of benefiting Erasmus Mundus Fellowship, Ford Foundation International Fellowship, Aspen New Voices Fellowship and Atlantic Fellowship, there are four lessons that the global health community can learn to gradually reverse the inequity in global health workforce.

First, talent is universal, but opportunities are not. Opportunities for development experts from the global south are limited, especially those that demand leadership positions. Fellowships help create platforms for development experts from different countries to interact, get to know each other and learn about the capacities that everyone brings to the table.

For instance, the 2019 Atlantic Fellows for Health Equity at George Washington University comprises of 18 Fellows from 7 countries – Ghana, Malawi, Nigeria, US, Philippines, India and Iraq. Over a period of one year, the Fellows exchanged ideas and supported each in pushing for health equity in their different countries.

Second, prioritise women in global health workforce appointments because women face more inequities than men. Out of the 18 Fellows mentioned above, 15 are females. This was intentional on the part of the organizers in order to ensure that the gap between men and women will gradually be reduced. While women form the bulk of the health workforce, . key decision makers in the health sector are usually men. The recent appointment of Winnie Byanyima as the Executive Director of UNAIDS, after serving a successful 6-year tenure as the Executive Director of Oxfam, should be replicated across more global health agencies.

Third, Fellowships can amplify global south voices on the global stage. This is the core aim of the Aspen Institute’s New Voices Fellowship. It has trained more than 100 senior fellows from many countries from the global south.

These fellows have written more than 1,000 opinion pieces published on different platforms and have been interviewed on radio, TV and other platforms sharing their ideas. Ifeanyi is a Senior New Voices Fellow and has within the past 2 years written and published 33 opinion pieces on platforms such as Devex, The Hill, Scientific American, Biomed Central, All Africa, Inter Press News Service etc.

Therefore, this opinion piece is another case of amplifying voices of Indian and Nigerian development experts on the global stage.

Fourth, collaborations are for life and reduce inequities. The agenda of most fellowships is to nurture collaboration and not competition. Collaboration beats competition, every single time. Mentorships created within the boundaries of Fellowships can be transformed to collaborations that could prove beneficial for a long time.

The world must realise that fostering a global village requires that different geographical locations do not attempt to solve problems alone. There must be a sense of community in all efforts to improve health. This African proverb captures our thoughts succinctly; “If you want to go quickly, go alone. If you want to go far, go together.”

To be sure, Fellowships will not stamp out the global health workforce inequity overnight. However, fellowship should be used as platforms to systematically work to reverse the inequities articulated by Madhui Pai.

As Senior Fellows for health equity at the Atlantic Institute, we will collaboratively continue to advance fairer, healthier and more inclusive societies.