Meeting the health needs of persons with disabilities during COVID-19 (coronavirus)

People across the globe are experiencing unprecedented challenges from COVID-19 (coronavirus), as the pandemic poses serious impacts on our health and well-being. While the virus can affect anyone, we know from past global health emergencies that crises hit the poor and most vulnerable the hardest, including persons with disabilities. 

Persons with disabilities often have underlying health needs that can increase the severity of symptoms if they contract COVID-19. They are also at increased risk of catching the virus because of a lack of information about the spread of the disease and its symptoms. These basic facts often do not come in the accessible formats they may need, such as Braille, large print, sign language, captions, audio provision, and graphics.

Social distancing may also jeopardize the delivery of essential home-based care. Meanwhile, persons with disabilities in care home settings face greater risk of contracting the virus from other residents or staff.

COVID-19 is merely another example of the longstanding health inequities that persons with disabilities face.  Although we don’t know the full impact yet, we have a good understanding of where we were before the pandemic.

The missing billion

A recent report from the London School of Hygiene & Tropical Medicine, The Missing Billion: Access to Health Services for 1 Billion People with Disabilities, shows how health systems are failing this marginalized group. It found that global health goals such as universal health coverage are unattainable unless access their to healthcare is dramatically improved.

The report outlines the three-fold health needs of persons with disabilities: standard health needs, needs stemming from higher vulnerability to poor health, and needs for specialized medical treatment or rehabilitation services.

Persons with disabilities face significant barriers even in accessing standard services, and as a result they have poorer health outcomes than those without disabilities.  For example, the report reveals that persons with disabilities are twice as likely to have HIV/AIDS, three times as likely to have diabetes, and 50% more likely to experience catastrophic health expenditures. In addition, 40% of persons with disabilities have lower life expectancy because of restricted access to healthcare.

Inaccessible facilities, financial barriers, lack of accessible transport, and previous negative experiences with the healthcare system are just some of the ways that persons with disabilities struggle to access the care they need. Even when able to access it, they often contend with stigma, a lack of assistive technologies, or inadequate health worker training, reducing their quality of care.

The path to inclusion

Creating disability-inclusive health systems is a critical part of ensuring quality health care for all.  At the World Bank, we understand that inclusion of persons with disabilities is vital to achieving the Sustainable Development Goals (SDGs)and our twin goals of ending extreme poverty and boosting shared prosperity.

To achieve SDG 3, health systems need to address the needs of vulnerable and marginalized groups including persons with disabilities. We recognize disability inclusion as an important part of building human capital, and we've made it a mainstream part of our work. We've incorporated it into our IDA19 commitments to projects in the poorest countries as well as the Environmental and Social Framework that we are applying to all our new project financing.

The World Bank’s Disability Inclusion and Accountability Framework suggests the following steps to make health systems more accessible and inclusive:

1. Collect disability-disaggregated data to track the achievement of universal health coverage.
2. Apply universal access and design approaches in health infrastructure projects, including transport services, accounting for the views of users with disabilities. 
3. Promote disability-inclusive universal health coverage by improving the availability of disability-specific services and ensuring that persons with disabilities can access sexual and reproductive health services.
4. Develop training programs for healthcare professionals on the specific care needs and rights of persons with disabilities. Programs should also address stigma, including against people with mental health problems and psychosocial disabilities.
5. Develop community-based approaches in mental healthcare that integrate prevention, treatment, and care services. Promote deinstitutionalization and alternatives to coercive care practices in the mental health system.

In recent decades, the World Bank has helped governments improve health outcomes for persons with disabilities.  For example, in the Kyrgyz Republic, the Bank supported the creation of community-based health clinics and schools with a focus on accessibility for persons with disabilities.

In Burundi and Rwanda, the Emergency Demobilization and Transitional Reintegration Project and the Emergency Demobilization and Reintegration Project provided targeted support for vulnerable groups, including housing for ex-combatants with severe disabilities and training activities to support their health and autonomy.

COVID-19 has demonstrated widespread gaps in access to care for persons with disabilities, underscoring the need for effective health systems.  As countries work to curb the spread, they can draw from numerous practices, lessons, and recommendations that address the specific health needs of persons with disabilities. Investing in these areas demonstrates commitment to helping all people to have healthy and vibrant lives, including the most vulnerable. Offering quality care to people with disabilities will make health systems better for everyone. 

Charlotte McClain-Nhlapo is the Global Disability Advisor at the World Bank. 

Phyllis Heydt is a Director at the Office of the WHO Ambassador for Global Strategy.

Professor Hannah Kuper is the Director of the International Centre for Evidence in Disability at LSHTM (London School of Hygiene and Tropical Medicine).