Barriers to the Implementation of the Health and Rehabilitation Articles of the United Nations Convention on the Rights of Persons with Disabilities in South Africa

Document Type : Original Article

Authors

1 Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland

2 School of Psychology, Trinity College Dublin, Dublin 2, Ireland

3 Centre for Rehabilitation Studies, Department of Interdisciplinary Health Sciences, School of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract

Background
The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) is a milestone in the recognition of the human rights of persons with disabilities, including the right to health and rehabilitation. South Africa has signed and ratified the CRPD but still has a long way to go in reforming policies and systems in order to be in compliance with the convention. This paper seeks to fill a gap in the literature by exploring what the barriers to the implementation of the health and rehabilitation articles of the CRPD are, as identified by representatives of the disability community.
 
Methods
This investigation used a qualitative, exploratory methodology. 10 semi-structured interviews of a purposive sample of representatives of disabled persons organizations (DPOs), non-governmental organizations (NGOs), and service providers in South Africa were conducted. Participants were drawn from urban, peri-urban, and rural settings in order to reflect diverse perspectives within South Africa. Data was analysed using a multi-stage coding process to establish the main categories and relationships between them.
 
Results
Six main categories of barriers to the implementation of the health and rehabilitation articles of the CRPD were identified. Attitude barriers including stigma and negative assumptions about persons with disabilities were seen as an underlying cause and influence on all of the other categories; which included political, financial, health systems, physical, and communication barriers.
 
Conclusion
The findings of this study have important implications for strategies and actions to implement the CRPD. Given the centrality of attitudinal barriers, greater sensitization around the area of disability is needed. Furthermore, disability should be better integrated and mainstreamed into more general initiatives to develop the health system and improve the lives of persons living in poverty in South Africa.

Highlights

 

 

Watch the Video Summary here. 

 

Keywords

Main Subjects

Full Text

 

 

References

  1.  

    1. World Health Organization (WHO). World report on disability. Geneva, Switzerland: World Health Organization; 2011.
    2. Disability Division for Social Policy and Development. Convention on the Rights of Persons with Disabilities [A/RES/61/106]. 2007; https://www.un.org/development/desa/disabilities/resources/general-assembly/convention-on-the-rights-of-persons-with-disabilities-ares61106.html. Published 2007.
    3. Schulze M. Understanding the UN Convention on the Rights of Persons with Disabilities. Handicap International;2009.
    4. Convention on the Rights of Persons with Disabilities. New York: United Nations; 2016.
    5. Africa UCTS. Accelerating the implementation of the UNCRPD in South Africa. http://www.za.undp.org/content/south_africa/en/home/operations/projects/poverty_reduction/accelerating-the-implementation-of-the-uncrpd-in-south-africa.html. Published 2013.
    6. Statistics South Africa. General Household Survey. Pretoria; 2010.
    7. Graham L, Moodley J, Ismail Z, Munsaka E, Ross E, Schneider M. Poverty and disability in South Africa: Research report. https://www.uj.ac.za/faculties/humanities/csda/Documents/Poverty_Disability%20Report%20FINAL%20July%202014%20Web.pdf. Published 2014.
    8. UNICEF. Children with Disabilities in South Africa: A Situation Analysis: 2001-2011. http://www.unicef.org/southafrica/SAF_resources_sitandisability.pdf. Published 2012.
    9. Department for International Development. Better global disability data needed to ensure no one is left behind. https://www.gov.uk/government/news/better-global-disability-data-needed-to-ensure-no-one-is-left-behind--2. Published October 23,  2014
    10. McKenzie J, Mji G, Gcaza S. With or without us? An audit of disability research in the southern African region. African Journal of Disability. 2014;3(2):1-6. doi:10.4102/ajod.v3i2.76
    11. Chalklen S, Seutloadi K, Sadek S. Literature Review. Bulamoyo: South African Federation for the Disabled; 2009.
    12. DiCicco‐Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006;40(4):314-321. doi:10.1111/j.1365-2929.2006.02418.x
    13. Whiting LS. Semi-structured interviews: guidance for novice researchers. Nurs Stand. 2008;22(23):35-40. doi:10.7748/ns2008.02.22.23.35.c6420
    14. Strauss A, Corbin JM. Basics of qualitative research: Grounded theory procedures and techniques. Sage Publications Inc; 1990.
    15. Corbin JM, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13(1):3-21. doi:10.1007/bf00988593
    16. Charmaz K. Reconstructing grounded theory. In: The SAGE Handbook of Social Research Methods. Los Angeles: Sage. 2008:461-478.
    17. Tomlinson M, Swartz L, Officer A, Chan KY, Rudan I, Saxena S. Research priorities for health of people with disabilities: an expert opinion exercise. Lancet. 2009;374(9704):1857-1862. doi:10.1016/s0140-6736(09)61910-3
    18. SAHR Commission. Towards a Barrier-free Society: A Report on Accessibility and Built Environments. South African Human Rights Commission; 2002.
    19. Mall S, Swartz L. Sexuality, disability and human rights: strengthening healthcare for disabled people. S Afr Med J. 2012;102(10):792-793.
    20. Hoefmans A, De Beco G. The UN Convention on the Rights of Persons with Disabilities: an Integral and Integrated Approach to the Implementation of Disability Rights. http://repositoriocdpd.net:8080/bitstream/handle/123456789/701/Inf_HoefmansA_UNConventionDisabilities_2010.pdf?sequence=1. Published 2014.
    21. Groce NE, Rohleder P, Eide AH, MacLachlan M, Mall S, Swartz L. HIV issues and people with disabilities: a review and agenda for research. Soc Sci  Med. 2013;77:31-40. doi:10.1016/j.socscimed.2012.10.024
    22. Lang R, Kett M, Groce N, Trani JF. Implementing the United Nations Convention on the rights of persons with disabilities: principles, implications, practice and limitations. ALTER - European Journal of Disability Research / Revue Européenne de Recherche sur le Handicap. 2011;5(3):206-220. doi:10.1016/j.alter.2011.02.004
    23. Visagie S, Scheffler E, Schneider M. Policy implementation in wheelchair service delivery in a rural South African setting. African Journal of Disability. 2013;2(1):1-9. doi:10.4102/ajod.v2i1.63
    24. Schneider M, Eide AH, Amin M, MacLachlan M, Mannan H. Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa. African Journal of Disability. 2013;2(1):1-9. doi:10.4102/ajod.v2i1.40
    25. Banks LM, Polack S. The Economic Costs of Exclusion and Gains of Inclusion of People with Disabilities. Cambridge, UK: CBM/International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine; 2014.
    26. Yeo R. Chronic poverty and disability. Working Paper No. 4. Manchester: Chronic Poverty Research Centre; 2001.
    27. Beresford P. Poverty and disabled people: Challenging dominant debates and policies. Disabil Soc. 1996;11(4):553-568.  doi:10.1080/09687599627598
    28. Braithwaite J, Mont D. Disability and poverty: a survey of World Bank poverty assessments and implications. ALTER-European Journal of Disability Research/Revue Européenne de Recherche sur le Handicap. 2009;3(3):219-232.
    29. Trani JF, Loeb M. Poverty and disability: a vicious circle? Evidence from Afghanistan and Zambia. J Int Dev. 2012;24(S1):S19-S52. doi:10.1002/jid.1709
    30. Yeo R, Moore K. Including disabled people in poverty reduction work: “Nothing about us, without us.” World Dev. 2003;31(3):571-590.
    31. Farmer P. Pathologies of power: rethinking health and human rights. Am J Public Health. 1999;89(10):1486-1496.
    32. Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ. 2002;80(2):97-105.
    33. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104.
    34. Wilkinson RG, Pickett KE. Income inequality and population health: a review and explanation of the evidence. Soc Sci Med. 2006;62(7):1768-1784.
    35. Lehohla P. Poverty Trends in South Africa: An examination of absolute poverty between 2006 and 2011. Statistics South Africa. 2014.
    36. Braathen SH, Vergunst R, Mji G, Mannan H, Swartz L. Understanding the local context for the application of global mental health: a rural South African experience. Int Health. 2013;5(1):38-42. doi:10.1093/inthealth/ihs016
    37. Grut L, Mji G, Braathen SH, Ingstad B. Accessing community health services: challenges faced by poor people with disabilities in a rural community in South Africa. African Journal of Disability. 2012;1(1):1-7.
    38. East CJ. An investigation of the lived reality of the disjuncture between policy and practice in the implementation of South Africa's disability grant. https://open.uct.ac.za/handle/11427/10442. Published 2012.
    39. Louw DJ. The African concept of Ubuntu. In: Sullivan D, Tifft L, eds. Handbook of restorative justice: a global perspective. London: Routledge; 2006:161-174.
    40. Mji G, Gcaza S, Swartz L, MacLachlan M, Hutton B. An African way of networking around disability. Disabil Soc. 2011;26(3):365-368.
    41. Ingstad B. Community Based Rehabilitation in Botswana. The Myth of the Hidden Children. Queenston: The Edwin Mellen Press; 1997.
    42. Ashton B. Promoting the Rights of Disabled Children Globally–Disabled Children Become Adults: Some Implications. Somerset: Action on Disability & Development; 1999:397-534.
    43. Loeb M, Eide AH, Jelsma J, Toni Mk, Maart S. Poverty and disability in eastern and western cape provinces, South Africa. Disabil Soc. 2008;23(4):311-321. doi:10.1080/09687590802038803
    44. Graham L, Moodley J, Selipsky L. The disability–poverty nexus and the case for a capabilities approach: evidence from Johannesburg, South Africa. Disabil Soc. 2013;28(3):324-337. doi:10.1080/09687599.2012.710011
    45. Ataguba JE, McIntyre D. Paying for and receiving benefits from health services in South Africa: is the health system equitable? Health Policy Plann. 2012;27(suppl 1):i35-i45. doi:10.1093/heapol/czs005
    46. Ataguba JE, Day C, McIntyre D. Monitoring and evaluating progress towards universal health coverage in South Africa. PLoS Med. 2014;11(9):e1001686. doi:10.1371/journal.pmed.1001686
    47. World Health Organization (WHO). CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and, Social Inclusion of People With Disabilities. Geneva: WHO; 2004.
    48. Dolan C, Concha M, Nyathi E. Community rehabilitation workers: do they offer hope to disabled people in South Africa's rural areas? Int J Rehabil Res. 1995;18(3):187-200.
    49. Rule S, Lorenzo T, Wolmarans M, et al. Community-based rehabilitation: new challenges. In: Watermeyer B, Swartz L, Lorenzo T, eds. Disability and social change: A South African agenda. Cape Town: HSRC press;2006:273-290.
    50. Brinkmann G. Unpaid CBR work force: between incentives and exploitation. Asia Pacific Disability Rehabilitation Journal. 2004;15(1):90-94.
    51. Law FB. Developing a policy analysis framework to establish level of access and equity embedded in South African health policies for people with disabilities. Stellenbosch: Stellenbosch University; 2008.
    52. Maart S, Jelsma J. Disability and access to health care–a community based descriptive study. Disabil Rehabil. 2014;36(18):1489-1493.
    53. Saloojee G, Phohole M, Saloojee H, Ijsselmuiden C. Unmet health, welfare and educational needs of disabled children in an impoverished South African peri‐urban township. Child Care Health Dev. 2007;33(3):230-235.
    54. Kritzinger J, Schneider M, Swartz L, Braathen SH. “I just answer ‘yes’ to everything they say”: Access to health care for deaf people in Worcester, South Africa and the politics of exclusion. Patient Educ Couns. 2014;94(3):379-383. doi:10.1016/j.pec.2013.12.006
    55. Haricharan HJ, Heap M, Coomans F, London L. Can we talk about the right to healthcare without language? A critique of key international human rights law, drawing on the experiences of a Deaf woman in Cape Town, South Africa. Disabil Soc. 2013;28(1):54-66.
    56. MacLachlan M. Culture & Health: A Critical Perspective Towards Global Health. Chichester: Wiley; 2006.
    57. Kachaje R, Dube K, MacLachlan M, Mji G. The African Network for Evidence-to-Action on Disability: A role player in the realisation of the UNCRPD in Africa. African Journal of Disability. 2014;3(2):1-5.
    58. Mji G, Chappell P, Statham S, et al. Understanding the current discourse of rehabilitation: With reference to disability models and rehabilitation policies for evaluation research in the South African Setting. South African Journal of Physiotherapy. 2013;69(2):4-9.
    59. MacLachlan M, Mji G, Chataika T, et al. Facilitating disability inclusion in poverty reduction processes: group consensus perspectives from disability stakeholders in Uganda, Malawi, Ethiopia, and Sierra Leone. Disability & the Global South. 2014;1(1):107-127.
    60. 60.   MacLachlan M, Mannan H, Huss T, Munthali A, Amin M. Policies and processes for social inclusion: using equiframe and equipp for policy dialogue: Comment on" Are sexual and reproductive health policies designed for all? Vulnerable groups in policy documents of four European countries and their involvement in policy development." Int J Health olicy Manag. 2015 16;5(3):193-196. doi:10.15171/ijhpm.2015.200
    61. Iacono T, Murray V. Issues of informed consent in conducting medical research involving people with intellectual disability. J Appl Res Intellect Disabil. 2003;16(1):41-51. doi:10.1046/j.1468-3148.2003.00141.x

Files

History

  • Receive Date: 04 December 2015
  • Revise Date: 13 August 2016
  • Accept Date: 15 August 2016
  • First Publish Date: 01 April 2017

Share

How to cite

Statistics