Equity in Focus: Prayatna Nepal's Lalitpur Health Workers Orientation on Disability and Sexuality

Author: Jalasa Sapkota
Published: 2023/08/23 - Updated: 2024/09/30
Publication Type: Informative
Topic: Disability Sexuality - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Paper by Jalasa Sapkota underscores how an inclusive and compassionate approach from healthcare practitioners can lead to improved healthcare outcomes and overall well-being for individuals with disabilities. Drawing insights from the event Disability and Sexual Orientation for Health Workers of Lalitpur Metropolitan City, organized by Prayatna Nepal, this piece underscores the significance of fostering understanding and sensitivity among healthcare providers towards the unique healthcare challenges faced by those with disabilities.

Introduction

The Need for Equitable Healthcare for Individuals with Disabilities:

In today's evolving landscape, the critical importance of providing healthcare services that are both equitable and considerate of individuals with disabilities has never been more pronounced. Despite global efforts to champion inclusivity and uphold the fundamental right to healthcare, a concerning disparity endures in the availability of accessible and dignified healthcare services for individuals with disabilities. Challenges such as physical barriers, entrenched biases, and communication obstacles continue to hinder the seamless delivery of medical care. This is compounded by the dearth of understanding among healthcare professionals regarding the intricacies of this population's needs, often resulting in suboptimal care and outcomes.

Main Item

Amidst these challenges, organizations such as Prayatna Nepal have taken proactive steps to address the existing gaps in healthcare services for people with disabilities. These efforts are rooted in the principles of empowerment and inclusiveness. Since its establishment, Prayatna Nepal has accomplished significant milestones, particularly in uplifting visually-impaired girls and women. Through a diverse range of initiatives, the organization aligns itself with the broader global and national disability rights movement, embracing the social and rights-based model of disability. At the core of Prayatna Nepal's ethos lies the resounding principle of "Nothing about us without us," which stands as a testament to its commitment to ensuring the active participation and agency of individuals with disabilities.

Drawing insights from the event Disability and Sexual Orientation for Health Workers of Lalitpur Metropolitan City, organized by Prayatna Nepal, this piece underscores the significance of fostering understanding and sensitivity among healthcare providers towards the unique healthcare challenges faced by those with disabilities.

Area of Discussions:

The orientation covered a diverse range of disability-related topics. It began by tracing the Evolution of the Concept of Disability, ensuring Conceptual Clarity around universal design and reasonable accommodation. The exploration extended to encompass the multi-dimensional nature of Disability and the diverse interpretations of it, including the establishment of identification criteria and an array of disability categories. Additionally, the orientation delved into nuanced Concepts and Domains of Sexual and Reproductive Health. It addressed formidable Healthcare Challenges faced by individuals with disabilities and emphasized the importance of a coherent perspective on the Sexual and Reproductive Health of Women with Disabilities, even sparking stimulating debates.

The orientation further enhanced insight into Sexual and Reproductive Health Rights through engaging Case Story Workshops, disability Inclusive Development strategies were explored to ensure accessible and responsive services. The discussion also underlined the significance of aligning Policy Provisions with the needs of Persons with Disabilities. The sessions were predominantly facilitated by Sarita Lamichhane, Founder-President of Prayatna Nepal. Additionally, a few sessions were led by Sarita Maharjan, who holds the role of Health Section Chief at Lalitpur Metropolitan City.

Exploring Reproductive Health Rights Components:

Delving into the components of Reproductive Health Rights (RHR) underscores their essential role in establishing inclusive healthcare provisions, particularly for individuals with disabilities. Through the analysis of the various dimensions of RHR, a robust framework emerges, underscoring its significance in promoting holistic well-being.

One crucial facet of this framework revolves around facilitating comprehensive access to education, information, and counseling pertaining to sexual and reproductive health, encompassing topics such as motherhood, safe abortion, and family planning. Similarly, the right to accessible family planning information and choice stands as a fundamental tenet within the realm of reproductive health rights. Furthermore, recognizing the unique needs of pregnant women and those grappling with reproductive health concerns, ensuring proper nutrition and adequate rest becomes an imperative consideration.

In the pursuit of an all-encompassing approach to reproductive health rights, it is paramount to extend respectful health services to individuals with disabilities. This necessitates the transformation of health facilities offering reproductive services into spaces that are genuinely disability-inclusive, fostering an environment of equitable care. Within this framework, coercion finds no place when it comes to decisions regarding abortion or contraception for pregnant women. Similarly, the principle of non-discrimination based on disability must be upheld, ensuring that all individuals are granted access to reproductive services without prejudice.

Debating Disabilities, Health, and Well-being:

To dismantle misconceptions and ignite meaningful discourse around health and well-being, a debate took center stage. Participants converged to engage in insightful dialogues, addressing key statements:

1. Deliberation ignited around the idea of surgically removing the uterus of individuals with multiple disabilities due to challenges in managing menstrual health.

2. A contentious topic emerged regarding the potential use of permanent birth control or injections for family planning among individuals with multiple disabilities, a group vulnerable to heinous acts.

3. The spotlight turned to the notion of exclusively pairing individuals with disabilities in marriage.

4. A pivotal question challenged the conventional perspective of viewing individuals with disabilities as uniquely abled rather than solely disabled.

5. The discourse also probed the belief that individuals with disabilities lack sexual desires.

The debate concluded with a resounding rejection of the presented statements by the majority of participants. These propositions were deemed stark violations of the fundamental human rights of those with disabilities. The consensus firmly asserted that birth control should not be used to curb violence, and marriage remains a personal choice, unaffected by disability. Lastly, the intricacies of sexual desires among individuals with disabilities surfaced as a perplexing subject. Despite the debate's earnest efforts, a definitive resolution on this matter remained elusive. Evidently, further exploration and understanding are imperative within this intricate domain.

Disability-Inclusive Approach in Sexual and Reproductive Health Services:

The session delved extensively into the crucial importance of establishing healthcare environments that are inclusive of individuals with disabilities, particularly focusing on enhancing the accessibility and quality of sexual and reproductive health services for women with disabilities.

One of the fundamental aspects discussed during the session was the need to ensure that healthcare facilities are designed in a manner that is accommodating to individuals with disabilities. This entails incorporating essential features such as ramps, elevators, spacious doorways, and accessible restrooms, which collectively work to facilitate seamless mobility for people with disabilities.

Communication emerged as another pivotal dimension of disability-inclusive services in the context of sexual and reproductive health. The session emphasized the importance of providing robust communication support mechanisms to cater to the diverse needs of patients. This includes ensuring the availability of sign language interpreters to assist those with hearing impairments, developing user-friendly informational materials that are easily comprehensible for various cognitive abilities, and designing websites that are optimized for effortless navigation by individuals with disabilities.

Recognizing the role of healthcare professionals in delivering effective and compassionate care, the session highlighted the significance of staff empowerment. It was underscored that healthcare providers need to be equipped with comprehensive sensitivity training, disability awareness, and proficient communication skills.

Assessing Healthcare Center Performance:

During the orientation phase, an evaluation of disability-inclusive development was carried out, using a 0 to 1 scale. The healthcare center's performance was evaluated through concise questions, such as facilitating wheelchair access, effective disability accommodation, regular feedback solicitation, health worker training, accessible services for vision and hearing impairment, direct consent from individuals with multiple disabilities, external referrals for expertise, extending services to homes, and auditing progress.

Voting results unveil health institutions' priorities for disability-inclusive development. Notably, Statement 1, addressing wheelchair access, received the highest votes, emphasizing physical accessibility. Statement 6, providing services for hearing impairment, also garnered significant support. Although Statement 8, referring cases to specialized organizations, received fewer votes, it remains of notable interest. These outcomes signify a focus on immediate, tangible accessibility measures, supplemented by external expertise for intricate cases. Other statements garnered fewer votes, implying their comparatively lower assessment priority.

Legal Frameworks and Healthcare Commitments for persons with Disabilities:

The Rights of Persons with Disabilities Act, 2074, notably Article 19, emphasizes the rights of women with disabilities, reflecting Nepal's commitment to safeguarding their health and reproductive rights. This provision acknowledges the distinct challenges faced by these women and underscores the necessity for targeted strategies to address their unique circumstances.

In Nepal's Constitution, Article 35 ensures the entitlement of every citizen to essential healthcare services from the state, devoid of financial burdens. It guarantees non-discriminatory access to emergency medical care and underscores the importance of informed healthcare decision-making. Furthermore, Article 38 strengthens women's rights in Nepal, specifically Subsection 2, which guarantees women's access to safe maternal and reproductive health.

As outlined in Article 25 of the Convention on the Rights of Persons with Disabilities, Nepal commits to providing persons with disabilities equitable access to healthcare services. This includes ensuring that individuals with disabilities receive comparable quality and standard of health care, encompassing sexual and reproductive health, as provided to others. Additionally, the Convention highlights the imperative for health professionals to uphold equal care standards for persons with disabilities through awareness-raising, training, and adherence to ethical healthcare standards.

Gaps in Disability-Friendly Healthcare Services:

The existence of gaps in the current approach to disability-friendly healthcare highlights several critical issues. One pressing concern is the lack of adherence to conventions and legal provisions, leading to work being carried out without proper adherence to established standards. Additionally, the realization of disability-friendly health services remains a significant challenge, raising questions about the accessibility and inclusivity of healthcare systems.

Moreover, a noteworthy gap lies in the awareness among healthcare personnel and employees regarding the reproductive rights of individuals with disabilities, particularly focusing on women. Similarly, a limited perspective on what constitutes 'disability-friendly' often revolves around physical infrastructure, neglecting the broader spectrum of this concept.

Within this context, a distinct shortfall is evident in the awareness of reproductive health rights among women with disabilities, perpetuating their vulnerability and exclusion from crucial healthcare conversations. Furthermore, the absence of adequate familial and guardian support contributes to the compromised well-being of women with disabilities, underscoring the need for a comprehensive support system.

Despite the complex and unique healthcare needs of women with disabilities, the establishment of supplemental facilities and provisions to address these needs has been notably lacking. Additionally, the dehumanizing treatment of disabled women as devoid of sexuality continues to persist, emphasizing the urgent necessity for a more inclusive and respectful approach.

A pervasive challenge that remains unaddressed is the persistence of barriers across various domains - institutional, physical, attitudinal, and communicative. These barriers hinder the progress towards a truly inclusive healthcare environment and limit the potential for women with disabilities to lead fulfilling and empowered lives. Addressing these gaps requires a concerted effort to promote awareness, transform attitudes, and implement comprehensive policies that encompass the holistic needs of disabled individuals, particularly women, within the realm of healthcare.

Analysis of Participants' Commitments and Action Plans:

The review of the "Orientation on Disability and Sexuality for health workers" outcomes highlights key observations in participants' action plans. Participants acknowledged the need to enhance attitudes and infrastructure to create a more disability-friendly environment. They recognized the value of such orientations in sensitizing health providers to disability rights and sexual/reproductive health issues within disabilities' context.

Significant insight arose around sign language training for healthcare providers, especially for communication with deaf or hard-of-hearing patients. To implement envisioned changes, participants stressed regular stakeholder meetings, involving ward officials, health chiefs, and providers, to address identified gaps. Many emphasized the roles of entities like Lalitpur Metropolitan City, ward offices, and health providers in driving change. Collaborative efforts were seen as essential for actionable plan implementation. Participants' individual action plans collectively displayed strong dedication to accessible and inclusive health services, including for those with disabilities. Some even suggested extending disability awareness programs through Prayatna Nepal and Lalitpur Metropolitan City to wider health networks, believing it would strengthen support for disability-sensitive health services.

Conclusion:

In conclusion, the Disability and Sexuality Orientation program for Health Workers in Lalitpur Metropolitan City has provided an enlightening opportunity, equipping participants with historical insights into disability, profound understanding of sexual and reproductive health rights, and comprehensive knowledge of relevant policies. These accomplishments lay the foundation for an empathetic healthcare environment attuned to the unique needs of individuals with disabilities. Aligned with Sustainable Development Goal 17, which aims to strengthen implementation mechanisms and global partnerships for sustainable development, this initiative marks a beginning rather than an end. Sustained progress and genuine transformation necessitate the continued support of such initiatives. Essential funding from entities like the UN and relevant agencies must be directed towards fostering inclusive and accessible healthcare for all, including individuals with disabilities. These ambitions must translate into action through investments in disability-representing organizations, uniquely positioned to comprehend the challenges and aspirations at hand. Through collective efforts, we can pave the way for a healthcare landscape that not only acknowledges but also celebrates the diversity inherent in the human experience. Together, we can forge a future where healthcare is a universal entitlement, seamlessly available to all, while honoring and supporting each individual's distinct needs.

Author Credentials: Jalasa Sapkota is a visually impaired writer, researcher, and advocate for disability inclusion. With a background as a former Research Assistant at Diverse Patterns Limited and now as a Resource Person for the International Council for Education of People with Visual Impairment's (ICEVI) Gender Equality and Women's Rights Task Group, she has dedicated her career to advancing the rights and opportunities of persons with disabilities. Visit Jalasa's biography for comprehensive insights into her background, expertise, and accomplishments.