At some point in our lives, most of us will become disabled.
Congenital impairment, accidents, chronic and terminal illnesses, or ageing makes it highly likely each person will become part of the 16% of the global population that is currently disabled. People with disabilities often have greater health needs than people without disabilities, and face a range of health inequities, including higher prevalence of HIV, diarrhoeal disease, diabetes, and obesity. These inequities lead to higher mortality, resulting in a staggering 10-20 year difference in life expectancy globally.
While health care providers frequently treat with people with disabilities, there are several studies that show health workers feel unprepared and unsupported to provide care for people with disabilities adequately. Therefore, one of the key questions to improve these health inequities for this population is: how can we better train health workers about disability to reduce health inequities for people with disabilities?
To answer this question, and with the generous support of the Murray Speight Research Grant and Wallace Watson Career Scholarship, I travelled to Ghana—a country that has been leading on disability training for health workers. Most health workers in Ghana have received some form of training, ranging from a one-off workshop about disability and health to several years of sign language training in their health worker training. Since most countries do not have this level of integration, it is critical to learn how trained health workers use their training and what others can learn from this example to improve and implement their own efforts to train health workers.
In Ghana, I was fortunate to speak to a range of health workers who had been through training, as well as individuals who had led the training. These individuals spoke at length about the significant impact the training had on them individually and professionally. Two stories stick out as demonstrating the catalytic impact of this training.
First, one health worker told me she used to hiss at the people with disabilities who would sit outside the sexual and reproductive health clinic, since she believed that they did not need or deserve sexual and reproductive health care. Since the training, she welcomes them into the clinic, gives them her phone number for any emergencies, and understands how to support them in accessing their right to health.
Second, a trainer told me about the impact the training had on one of the community health workers. Because of the training, she ensured she saw the children with disabilities in each household she visited. At one home, she recognised the children with disabilities were not only kept inside and hidden from the community, but also did not attend school. She used her training to lead a dialogue with the family about the rights of children with disabilities, which encouraged them to send their children to school.
These two examples demonstrate just two of the stories that showcase the transformative impact of this training and how this simple, cost-effective intervention can have such drastic impact on the health and lives of people with disabilities. While this highlights the effect of training, several challenges to full implementation remain, including sourcing sustainable funding for training programs, having formal recognition in the health worker curriculum, and having sufficient by-in from health workers.
This research shows that training on disability can be an important tool to challenge negative attitudes that health workers may have about disabled people. However, the unsystematic nature of training currently leaves healthcare workers with different competencies dependent on their geography, educational background, and level of seniority. Instead, health educational institutions and licensing boards should work towards standardizing requirements for health worker training on disability, such as listing it as a licensing requirement to ensure everyone has some form of training as part of the health workforce. This approach, rather than legal solutions, provides a tangible and enforceable way to integrate disability training into health worker curricula.
As health systems continue to recover and be re-imagined in the post-pandemic era, there is renewed focus on how to upskill, task-shift, and retain health workers who are leaving the field in ever-increasing numbers. Empowering them with the appropriate tools to deliver high-quality care to people with disabilities—who have higher rates of health utilisation, worse health outcomes, and higher mortality rates—is an important component of building disability-inclusive health systems. Therefore, disability training for health workers is an essential to empower health workers treat all patients and should be rapidly scaled to meet people with disabilities’ right to health.
I am extremely grateful to the Murray Speight Research Fund, the Rhodes Trust, and the Wallace Watson Career Scholarship for their support of this fieldwork and my research.