UncategorizedDeborah TigereNo Comments

Retinoblastoma in Zim and the need to expand access to eyecare

THE month of October is Cancer Awareness Month, and it is important to raise awareness about retinoblastoma, a rare type of eye cancer that is common in children, often under the age of five years. 

It affects the retina, which is at the back of the eye. The retina sends signals to the brain to help you see. The World Health Organisation (WHO) recognises retinoblastoma as a significant cause of childhood cancer affecting one in every 15 000 live births leading to 8 000 new cases of retinoblastoma diagnosed globally each year. 

The National Eye Health Strategy for Zimbabwe (2021 – 2025) highlights retinoblastoma as one of the eye conditions that causes childhood blindness. Many parents including health care professionals might not be aware of the symptoms and retinoblastoma goes undiagnosed until it is too late.

Symptoms include a white reflection in the pupil known as cat’s eye.  It can be noticeable in photos taken with a flash or dim lighting.

One or both eyes may appear to be misaligned, which can sometimes be mistaken for lazy eye (amblyopia).  In some cases, there can be persistent redness or swelling of the eye without any apparent cause which might not improve with usual treatments.

Young children may have trouble seeing, squinting or following objects with their eyes. The affected pupil may not respond normally to light and the affected eye might look different in size and appearance compared to the other eye. 

Advanced retinoblastoma may cause pain due to increased pressure in the eye. If the cancer affects one eye in its early stages, the symptoms may be too subtle to detect during routine checks and the other eye may compensate for vision loss.

Young children may find it difficult to express or communicate vision problems, the discomfort or pain, making it difficult for parents to identify that something is wrong with their children’s eyesight.  

In some cases, retinoblastoma may be inherited but some parents may not be aware of the family history on the condition, and they may not be alert to the need for early specialised screening.  Parents of children with retinoblastoma experience a range of intense emotions. The initial diagnosis of retinoblastoma is devastating, and parents are overwhelmed with the fear of the cancer, which can lead to vision loss or death of the child.

Watching the child go through treatment options, such as surgeries and chemotherapy, leads to feelings of helplessness and anxiety.  The treatment options require travel to specialised centres and the medical bills can impose a significant financial strain on parents. 

More often, the emotional and financial stress can strain relationships between parents and other family members.

Early treatment will preserve the vision in one or both eyes. Delayed treatment can lead to vision loss or removal of the eye. 

Retinoblastoma can be life-threatening if left untreated, it progresses to advanced stages. The cancer starts in the retina and can grow aggressively spreading to other parts of the body, such as the brain, bones and bone marrow, making it difficult to treat and significantly increasing the risk of death. 

Recommendations

Retinoblastoma is highly treatable when caught early, hence increased awareness helps the parents, caregivers and healthcare professionals to recognise the symptoms. 

Regular eye examinations, especially for children with a family history of retinoblastoma, are crucial.  Multidisciplinary care involving specialists such as ophthalmologists, oncologists and radiation therapists is essential in providing personalised treatment and care depending on the severity. 

Cancer diagnosis and treatment can be emotionally difficult for children and their families.

Connecting with other parents who have children with retinoblastoma helps reduce the feelings of isolation.  Regular follow-up is essential for monitoring recurrence, managing any side effects and ensuring that the survivors receive rehabilitation services including visual aids or prosthetic eyes to adjust changes in vision or appearance. 

In addition, children with hereditary forms of retinoblastoma have an increased risk of developing other cancers which may include brain tumours, further emphasising the importance of regular follow-up.

Careful management and care are necessary because while treatment like chemotherapy and radiation can be lifesaving, the treatments carry risks of side effects such as growth delays or secondary cancers. 

Treatments like surgery or radiation may leave scars or cause facial changes hence prosthetic eyes should be made available for cosmetic reasons as the changes may affect the confidence and social interaction in children. Children with retinoblastoma vision loss may experience developmental delays particularly in tasks that rely on motor skills or reading. Retinoblastoma should be incorporated into the broader Cancer Awareness Month campaigns to ensure that the rare condition gets attention, helping to save lives.

It is important to increase access to eyecare services for children to enable early diagnosis, therefore, strengthening the primary health system through training specialists and improving the infrastructure to provide the critical cancer care will improve the survival rates and quality of life for children particularly in underserved communities. 

Training of health professionals to recognise early signs can lead to timely diagnosis, which will significantly improve the outcomes.  Financial assistance programmes for treatments such as chemotherapy, surgery or prosthetics will ensure that families are not financially devastated.

Such assistance programmes can include subsidies or low-cost treatment that can ensure access to services and on-going care.  Resources should be allocated for funding research aligned towards therapies or potential cures. While the effects of retinoblastoma vary widely, early detection and timely treatment are crucial to save both the child’s vision and life.

UncategorizedDeborah TigereNo Comments

Business, disability network a link for inclusive employment

THE Ministry of Public Service, Labour and Social Welfare launched the Zimbabwe National Business and Disability Network (NBDN) on September 25. 

Zimbabwe became the 14th country in Africa and 80th in world to launch the NBDN. This initiative was led by the Employers Confederation of Zimbabwe (Emcoz) in collaboration with Sightsavers, International Labour Organisation (ILO) and other partners. 

The NBDN will be steered by a committee whose responsibility is to engage more businesses to be part of the network and facilitate the necessary support.

The NBDNs are affiliated to ILO, Global Business Disability Network (GBDN), which acts as a network of networks to facilitate the peer to peer sharing and adoption of good practices in managing NBDNs.  

The role of the NBDN is to facilitate learning among businesses and sharing of policies and practices on disability issues.

This includes leveraging on existing policies, strategies and guidelines such as the National Disability Policy, Guidelines on The Employment of Persons with Disabilities in the Public Service and the National Assistive Technology Strategy, among others, providing a clear path for businesses to follow.

The network will adopt different strategies and mechanisms to facilitate learning by companies. Further, the NBDN will provide technical guidance to their members on how to address barriers and challenges that they can face in recruiting and retaining employees with disabilities. 

Other tools that can be used by the network include the ILO GBDN assessment tool that provides companies with a comprehensive framework to evaluate and improve their practices related to disability inclusion in the workplace. 

The assessment tool considers aspects of recruitment, retention, workplace accommodations and inclusive policies enabling companies to benchmark their level of disability inclusion efforts against global practices. 

The NBDN will serve as a single voice of businesses in promoting disability inclusive employment in Zimbabwe.

Many employers are unaware of the full potential of people with disabilities or may hold misconceptions about their abilities. Unconscious bias and stereotypes about disability often influence recruitment processes. 

For example, some employers assume that hiring someone with a disability will be more difficult and costly. Online job opportunities and application systems are sometimes not accessible to people with disabilities creating barriers.

Employers might not be familiar with the types of accommodations needed for different disabilities and may fear the cost and complexities of providing them.

In addition, companies may lack internal resources or expertise to effectively recruit and support employees with disabilities.  Many employers fail to actively engage the organisations and networks that support individuals with disabilities limiting their access to a diverse workforce.

A non-inclusive workplace culture can make it harder to attract and retain employees with disabilities.  Therefore, addressing such challenges requires companies to recognise and be part of the NBDN regardless of the sector, size or geographical location. 

Private or public sector companies can be a member of the NBDN and commit towards improving their disability inclusion policies and practices.

However, some companies have fears or concerns joining NBDN because they assume it will expose them to scrutiny regarding compliance to disability inclusion and disability laws.  Some employers are concerned about the resistance from existing workforce and leadership as it may reveal gaps in their current culture. 

Some businesses that have very little experience and unfamiliar with disability inclusion might feel unprepared to adopt certain practices. Some employers might be concerned that joining the NBDN will require significant time and resources, straining their human resources and diversity efforts.  In some cases, employers fear the complexity of making organisational changes, such as facilitating accessibility and adapting workspaces. 

While the above fears are a reality, the NBDN is designed to address most of these concerns by offering support, resources and best practices.

The NBDN enables the companies to promote inclusive environments and demonstrate their commitment to diversity and accessibility.  The network will provide resources and share best practice in the recruitment, retention and support for employees with disabilities.

In addition, companies stay informed of the disability laws and standards for accommodating workers with disabilities. Companies that engage with the NBDN will enhance their reputation as an inclusive employer and tap into the diverse experiences and skills of employees with disabilities.

Inclusive workplaces have higher levels of productivity and retention, creating supportive environments that increase satisfaction. Employees with disabilities often provide creative solutions for inclusion; therefore, companies that embrace these innovations can improve customer service and product development which benefits all consumers or clients. 

Disability inclusion is a journey that requires continuous guidance therefore, collaborating with the National Business and Disability Network will enable support and strengthen companies’ workforce, enhance diversity and contribute to a more equitable society.

The efforts of the National Business Disability Network resonate closely the Sustainable Development Goals (SDGs) – decent work and economic growth (SDG 8), reduced inequalities (SDG 10), no poverty (SDG 1) and partnership for goals (SDG17). 

This aligns with the government priorities around inclusion, employment and economic growth.  The NBDN will promote the inclusion of people with disabilities in the work force ensuring that they have access to decent work and equal opportunities. 

Promoting inclusive recruitment, retention and career development for people with disabilities will reduce inequalities in the workplace.  Enabling people with disabilities to secure meaningful employment will break the poverty and disability cycle and reduce their economic vulnerability. 

Therefore, fostering partnerships between businesses, government, agencies and disability organisations will promote a shared goal around disability inclusion. 

The National Disability Policy emphasises the importance of achieving economic empowerment and self-reliance by people with disabilities, therefore, all forms of discrimination based on disability on matters concerning employment is considered an offence.

Businesses are encouraged to employ persons with disabilities based on skills, qualifications, knowledge and abilities.  Workplace adjustments, training and professional development, accessible workplaces must be provided among other accommodations to ensure that employees with disabilities perform their roles on an equal basis as others. 

People with disabilities are integral in achieving the broader economic and social objectives, while supporting companies in building sustainable, inclusive and equitable work environments.

UncategorizedDeborah TigereNo Comments

Cataract Surgery a life-changing intervention.

Vision plays a critical role in every facet of life. It contributes towards daily living. Cataracts are a leading cause of avoidable blindness.

According to the World Report on Vision (WHO 2019), globally one billion people have a vision impairment that can be prevented or yet to be addressed.

Of the one billion people, 65,2 million people have cataracts. Cataract is an eye condition that is age related, mainly affecting individuals aged 50 years and above.

The symptoms include cloudiness in the lens of the eye leading to increasingly blurred vision.

If left untreated, the condition worsens over time, leading to severe visual impairment or blindness.

This often results in significant limitations in performing daily tasks.

Multiple factors cause cataracts over a person’s life, which lead to aging of the lens.

These factors include smoking, poor nutrition, ultraviolet exposure, diabetes, some medical conditions or medication, severe dehydration, injuries or previous eye surgeries.  In children, congenital cataracts can occur within the first year of life, usually from birth and often caused by a faulty gene passed from the parent to the child.

If congenital cataract goes undetected in an infant, it can lead to permanent visual loss. Some people develop cataract in both eyes.

This is known as bilateral cataract, while the development of cataract in one eye is called unilateral cataract.

Causes of unilateral cataract include trauma, radiation exposure, diseases such as diabetes.

The burden of cataract is not borne equally due to inadequate services and uneven distribution.

The Rapid Assessment of Avoidable Blindness conducted in Manicaland (2016), Masvingo and Matabeleland South Provinces (2019) revealed an estimated average of 65% of people aged 50 years and above suffer from untreated cataract, hence cataract is a major contributor to avoidable blindness in the country.

The studies revealed that most people did not access cataract surgery because of fear, high cost of services including patient out of pocket payments and distance to health facilities among other barriers.Vision impairment caused by cataracts can be corrected through surgical interventions by removing the cloudy lens.

The procedure is performed by an Ophthalmologist.In most cases the manual small incision cataract surgery is done.

There has been advances in surgical techniques, such as phacoemulsification surgery.Removing the lens entails that the eye is not able to focus, and the correction is done by replacing the lens with an artificial one, known as an intraocular lens. Cataract surgery is a relatively simple procedure that can be performed within 15 to 20 minutes.However, it can take longer due to other underlying conditions. Therefore, a pre-operative cataract assessment is necessary to inform the procedure.

For those with bilateral cataract, the procedure for each eye is done six to 12 weeks apart to allow for recovery on one eye before the next procedure.   It is a day case procedure.

However, in most cases, depending on the context and hospital facilities, a patient is kept overnight to enable monitoring and measuring of day one post operative visual acuity.

Some people leave hospital soon after surgery with instructions and return the following day for the post operative assessment. Patients will be provided with eye drops to use for four weeks after surgery. For most people, surgery restores vision with no complications.

However, some people may experience complications such as continued vision loss, ongoing eye pain and infections among others.

An ophthalmologist can successfully treat most complications. Good outcome thresholds are defined to promote improved quality in cataract surgery. 

Usually, people are set up for clear distance vision after surgery and may need to wear a pair of spectacles for reading or close up work.

This also depends on the type of intraocular lens that would have been inserted.

A pair of spectacles will protect the eyes from harmful ultra-violet rays.

Recommendations

Vision loss due to cataracts requires a comprehensive approach that includes promotional, preventative treatment and rehabilitative interventions.

Cataract surgery is considered a cost-effective intervention in health care.Therefore, resources should be provided to avoid unnecessary vision impairment or blindness.

The provision of resources should include eye health professionals training, financing, strengthening health information systems and advocacy to increase quality and equity.

Providing cataract surgery on outreach will address inequities experienced in accessing eye care services and increase access to cataract surgery.

Eye care services should be integrated in the primary health services to strengthen the early detection and referral of people who require cataract surgery.

To enhance the efficiency and quality of cataract surgery, eye health professionals should be trained in addition to creating an enabling environment to provide services.   Effective cataract service delivery requires a patient centred approach that ensures services are affordable, especially in less resourced settings by offering subsidised services. Patient education is of importance considering that several people are afraid of going through cataract surgery.

Therefore, highlighting the benefits of surgery and demystifying myths and misconceptions is essential.Pre and post operative guidance and counselling will provide clear information about the procedure, recovery and risks to patients.

The quality of cataract surgery done by an ophthalmologist improves with the increase in the number of operations.

But that should not be the only determining factor for good outcomes.It is important to invest in modern cataract surgery technology such as phacoemulsification, which is less invasive and allows for quicker recovery.

Regular training should be provided to eye health surgeons and staff to maintain high standards of care.The regular monitoring of surgical outcomes and complications will improve surgical quality and safety.

Periodic follow-up of patients after surgery will enable health professionals to check for complications and ensure healing.

This is because several people do not return for hospital reviews due to the high costs of patient out of pocket payments.Addressing specific needs of vulnerable populations, such as the elderly or women, will ensure that they are not left behind in accessing cataract surgery.

Service delivery should be culturally sensitive to the norms and languages of the populations being served.Adopting cost effective models that include high volume surgical centres will make the services more accessible without compromising on the quality of surgery.

UncategorizedDeborah TigereNo Comments

Crucial role of eye health in children’s development

ACCORDING to the World Report on Vision (2019), globally 312 million people below the age of 19 years have a vision impairment.

However, the lack of population-based surveys remains a gap in planning eye care services for children.

Among children, the leading causes of blindness and moderate or severe visual impairment are cataract, uncorrected refractive error, retinopathy of prematurity, congenital ocular anomalies, corneal scarring and cerebral visual impairment.

The Zimbabwe National Eye Health Strategy (2021-2025) estimates 8 000 children below the age of 16 years to have childhood blindness due to congenital cataracts, glaucoma, eye injuries, measles and retinoblastoma.

This figure could be an underestimation given the lack of population-based surveys on child eye health.

Eye conditions such as glaucoma and retinoblastoma, if not treated can lead to permanent vision loss.

In addition, other eye conditions, such as dry eyes, allergic conjunctivitis require care due to irritation or painful symptoms.

Poor nutrition, for example vitamin A deficiency and the lack of immunisation for the prevention of measles infection, significantly contributes to poor vision in children with Africa at higher risk.

The number of children with uncorrected refractive error in particular myopia is expected to increase substantially due to reduced outdoor activities, inadequate eye protection and increase in excessive screen time.

The burden of eye conditions and vision impairment is not borne equally, in addition several children fail to access eye care services due to the high cost of services, distance to health facilities and overwhelmed health facilities that do not consider the long hours of waiting.

Poor vision among children affects their physical, cognitive and social development, leading to lifelong consequences.

Children experiencing poor vision will struggle to achieve their developmental milestones, which at times can be misinterpreted as intellectual disabilities.

Uncorrected vision problems interfere with learning and performing daily activities leading to poor education outcomes, low self-esteem further affecting the quality of life.

Within education settings, children with poor vision will experience challenges reading, writing, walking to school, identifying objects or interacting with friends.

More often children experiencing visual impairment are called ‘names’ and experience stigma because of their poor performance in school.

Visual functioning is an important element for academic performance in school-aged children which may also affect their well-being and hinders productivity and opportunities throughout their adult life.

Hence the vision loss in children is not just a health issue but presents economic costs.

Children experiencing severe visual impairment will require assistance from family members or carers.

Further assistive technologies and rehabilitation services are required to support daily living activities and education, further straining the family income.

While effort is made to provide spectacles in addressing refractive error in school aged children, stigma associated with spectacle wear has restricted participation and led to low-self-esteem.

Children adapt to eye conditions until the situation worsens leading to delayed interventions and poor quality of life. In most cases children and parents are not aware of the reduced visual functioning; therefore, routine eye screening and eye examinations are important for detecting and addressing the eye conditions before the quality of life is compromised.

Recommendations

Considering the increase in the number of children and adolescents with un- corrected refractive error and other eye conditions,  population-based planning for eye care services

Such programmes should take into consideration school-based programmes that catalyse the effective delivery of eyecare services for children.

School-based programmes are recommended as a low-cost intervention for facilitating refraction services and providing spectacles considering the number of school aged children with uncorrected refractive error.

Eye health programmes should include promotion and health education to promote access, enforce good health practices and increase the demand for services.

Education and awareness will address any misconceptions around eye care services and spectacle wear for children. Visual rehabilitation is essential for children with poor visual outcomes who require further assistance to strengthen their visual function.

Eye care services for children should be comprehensive by providing for refractive correction and vision screening including assistive technology such as spectacles or low vision devices to achieve a good outcome.

The integration of primary eye care into primary health care will strengthen the identification of children, who require eye care services, and this will also entail that eyecare services will be provided within communities to enhance access.

Referral pathways should take into consideration the scheduling of appointments and follow-up reminders to enable effective coordination of services.

Primary health professionals should be capacitated to support the early identification and referral of children who require further management.

Parents have a role to play in managing screen time for their children to reduce eye strain and potential eye problems. Parents should not only be involved in educating their children on the importance of eye health but should also contribute to the design and implementation of eye care programmes for children.

Promoting a parent/ child centred approach in the provision of eyecare services will increase the uptake of services and demystify misconceptions.

The integration of technology such as Peek acuity (mobile phone technology) will enhance the effectiveness of vision screening among school children, improve follow-up and data management, establishing a mechanism for continuity of care.

The cost of services should not be a barrier for accessing this essential service, therefore, health financing should be considered to make eyecare services for children accessible and affordable.

Considering the inequities experienced in accessing eyecare services the provision of subsidised services should be prioritised in partnership with other key stakeholders.

Despite some of the challenges presented in accessing eyecare services for children, emphasis should be placed on engaging different players to address the gaps and this includes coordinating across the sectors of health, education and the private sector to support service delivery.

The coordination between the Ministry of Health and Child Care and the Ministry of Primary and Secondary Education remains essential in the provision of eye care services for children particularly in facilitating school-based programmes.

The provision of quality eyecare services for children remains a priority for the achievement of the sustainable development goals and universal health coverage.

InsightsDeborah TigereNo Comments

Disaster preparedness is everyone’s responsibility

A DISASTER is a sudden catastrophe that causes disruption to a community exceeding the ability of the community to cope often leading to suffering or loss of life and livelihoods. 

Disasters are caused by natural or man-made induced hazards and their frequency and impact is likely to increase in the coming years due to increased vulnerability and natural hazards. 

Disaster preparedness is defined as a set of measures undertaken in advance by governments, organisations, communities and individuals to better respond and cope with immediate aftermath of a disaster with the aim of reducing loss of life and livelihoods.   

It is an important element of disaster risk management which compliments prevention and recovery. Disaster preparedness weakens the impact of a hazard, enhances effective response, timeliness, quality of operations and reduces the extent of needs in the event of a disaster. 

With the increase in disasters due to climate change and environmental degradation among other factors, a number of populations are more prone to disasters. 

The world is experiencing a number of natural disasters such as earthquakes, cyclones which have been intertwining with conflict and fragile situations, further worsening the situation in a heavily contested world. 

While the world was battling with other disasters it was affected by the Covid 19 pandemic crisis which made governments to promptly take the initiative to prepare for a crisis, making it difficult to extend their support to other countries while they are dealing with their own issues.

In in the past decade Zimbabwe mainly experienced slow on set disasters such as drought, however there has been an increase in rapid disasters such as cyclones and floods. The humanitarian landscape has changed and disasters have become more protracted and complex. The recurrence of disasters in disaster prone areas makes the communities more vulnerable. 

Organisations providing support towards humanitarian action are overwhelmed due to the number of disasters across the world with donors overstretched.  The SENDAI Framework for Disaster Risk Reduction (2015 -2030) is a major development agreement for member states to provide actions that protect development from the risk of disasters. 

The framework emphasises the importance of preparedness, anticipatory risk management and the need to involve stakeholders in reducing disaster risk. There is need to protect people from risk and impact of disasters, and ensuring that marginalised groups are not left behind and participate in disaster preparedness.

Priority 4 of the framework stipulates the need to enhance disaster preparedness for effective response and to build back better in recovery, rehabilitation and reconstruction.

The Sendai Framework aligns to the 2030 agenda agreements including the Sustainable Development Goal (SDG) 3 on climate change which promotes the need for disaster preparedness.

In Zimbabwe the national policy for civil protection highlights the need for every Zimbabwean to assist in averting the effects of disasters. 

In line with the Civil Protection Act of 1989 and its amendments 1992/2001, it is the responsibility of the government to initiate disaster preparedness measures through the various structures within the local administration.  The department of Civil Protection under the Ministry of Local Government, Public Works and National Housing has the mandate to coordinate disaster management in collaboration with stakeholders from national level to local level.

In addition, the department of Civil Protection in Zimbabwe manages  a disaster fund  which is financed by the Central Government, however more often the fund is not adequate given the frequency and magnitude of emerging disasters.  Efforts are being made to review the current legislation in order to align to best practice, build national and community resilience, strengthen funding and response mechanisms.

The following actions complement disaster preparedness:

For humanitarian action to be effective, a people centred approach is recommended as it builds the resilience of communities.  Simple initiatives go a long way in building the resilience of communities to respond and cope in the aftermath of a disaster. 

This requires the participation of the affected people and communities because the affected people and the first responders have the capacity to manage risk.

An early warning system is an integrated system that monitors a hazard or threat and takes into account forecasting, risk assessments that inform the message to be communicated to individuals and at risk communities.

Early warning systems enable timely action to mitigate the hazard or disaster risk. Such systems should integrate the effort of communities and national systems. 

It is therefore important to understand the composition and dissemination of information to enhance action and preparedness for response.

Anticipatory action also known as early action is taken when a disaster is imminent, either before a crisis or before a significant development in the crisis.

Usually anticipatory action is guided by agreed triggers of action or pre-determined activities based on historical analysis and risk analysis.

Interventions are provided as soon as the pre-agreed thresholds are reached thereby reducing the vulnerability of a community. 

Anticipatory action is often informed by an established early warning system and humanitarian actors should collaborate to avoid duplication of efforts.

The risk informed approach addresses the needs and risks that a community may face thereby risk proofing humanitarian response interventions. 

An evidence based periodic risk assessment and analysis should be conducted to enable potential and existing risks to be identified and analysed before a disaster. The risk informed approach forecasts on potential risks and the probability of the occurrence.

Communities should be involved in the risk assessment, ensuring that marginalised groups are not left behind.

The approach should not be generalised but should be context specific in order to inform decision making. Humanitarian interventions should be designed on the understanding of risks and implemented to reduce the risk.

The crisis modifier provides for early action which is timely, flexible and immediate lifesaving.  The crisis modifier is triggered in a protracted crisis or when a crisis deteriorates. 

The crisis modifier is an internal funding mechanism that takes the following models:  modifying existing budgets, accessing the central emergency response fund and ring-fencing contingency budgets.

The different actions are not a panacea for all emergencies, however it is important to understand the scope, frequency and occurrence, risks and vulnerabilities of disasters which impact communities in order to plan and respond effectively.

Zimbabwe should evaluate the hazards and characteristics of disasters to inform disaster management.

While planning for emergencies is done at different levels, society needs to be informed about the risks. Localisation of humanitarian capacity is sustainable and will build the resilience of communities. 

There is need to strengthen preparedness as a strategy for effective response in humanitarian action and the government should provide resources to strengthen capacity in disaster preparedness. 

This will enable the humanitarian teams to effectively and efficiently respond to build the resilience of communities and reduce the impact of disasters. 

The participation of Zimbabwe in global platforms will promote best practice and enhance cooperation in disaster management.

InsightsDeborah TigereNo Comments

Perspectives: Enhancing digital inclusion for women with disabilities

Gender has influenced the social norms of men and women and disability influences how people make their choices in society.

Disability defines how a person with an impairment interacts with social attitudes, structures and the environment.

Disability is heterogeneous and has diverse personal characteristics, which need to be considered in digital technology.

Women with disabilities have been denied the opportunity to participate on an equal basis as others.

Article 9 on the Convention of the Rights of Persons with Disabilities (CRPD) recognises that women and girls with disabilities face multiple discrimination because of their disability and gender, they are more vulnerable to poverty and abuse.

There is need to take measures to ensure the equal and full participation of women with disabilities in society.

According to the World Report on Disability (2011), generally people with disabilities experience inequality and are denied access to health care, political participation, education and employment opportunities.

Global estimates show that one in every five women is likely to have a disability compared to one in every eight men.

Research shows that the gender gap is further amplified at the intersection with disability.

The experiences of women with disabilities in social exclusion make them feel disempowered physically, emotionally and financially.

In order to achieve Sustainable Development Goal 5 and combating inequalities, women with disabilities need to be empowered in order to realise their full potential.

The concerns and rights of women with disabilities need to be addressed through mainstreaming disability in efforts of gender equality and women’s empowerment.

Some of the challenges faced by women with disabilities include a higher rate of unemployment compared to their male counterparts or women without disabilities.

Women with disabilities are more likely to be abused and are often exposed to discriminatory practices such as forced sterilisation, violence, denial of sexual reproductive health care and neglect.

This year’s theme for the International Women’s Day is “DigitALL Innovation and Technology for Gender Equality”.

Including everyone in innovation and technology addresses inequalities and promotes the achievement of Sustainable Development Goals (SDGs).

The digital divide faced by women with disabilities has been overlooked and the intersectional challenges faced by women with disabilities has further exacerbated the situation.

Women with disabilities face barriers in adopting technology, which affects their participation in society.

Technology abuse is becoming increasingly common and its negative effects are more severe on women with disabilities.

Limitations in accessing technology and digital literacy by women with disabilities increases their exposure to digital harm such as online harassment and sexual exploitation.

Digital devices and services are often not accessible and easy to use by people with disabilities as some of the software and content is not relevant to their needs.

Affordability is a major barrier, which impedes the procurement of a digital device or access to digital services by women with disabilities.

The active engagement of women with disabilities in technology can help level inequalities and promote their participation.

It is also clear that what was impossible decades ago is now possible due to digital technology and we have to ensure that women with disabilities are not left behind.

In order to achieve digital inclusion, the first step is to understand the nature of digital discrimination hindering access and use.

In addition, it’s important to capture the opinions of women with disabilities on the use of technology and how it influences their lives.

There is need to assess gender differences in the choice and use of assistive technology.

Understanding the context including barriers to access and use will enable the development of strategies that address the gap in digital divide.

The lack of understanding often leads to the discrimination of women with disabilities on the other hand women with disabilities miss out on important information which can improve their quality of life.

It is important to note that technology has the potential to break down the barriers that hinder participation by women with disabilities.

Technology is the gateway to information and further promotes financial inclusion, a safe environment and provides employment opportunities.

Women with disabilities need to be supported to develop their digital skills, by capacitating them on accessibility features to promote use and to be made aware of opportunities associated with the use of technology.

Consulting women with disabilities is an opportunity to understand their lived experiences through defining their digital challenges and needs.

Diversity within disability should be represented and investing in digital skills education for women with disabilities should be prioritised.

Assistive technology refers to the assistive products including related systems and services. Assistive technology promotes independence and self-sufficiency in education, health care and employment for people with disabilities.

According to the World Health Organisation (WHO) estimates, only one in every 10 people in need have access to assistive technology despite the importance.

Accessibility features in technology are important for the inclusion of women with disabilities in society.

Products with an accessible design will take into account some of the following accessibility features; easy to read text, good colour contrast, user customisation and compatibility features such as screen readers.

Such technology can aid tasks such as reading, writing, searching for information and communication.

Other technologies include mobility aids such as wheelchairs, prosthetic devices and hearing aids which enhance the day to day functionality of a person with a disability.

Involving women with disabilities is research and innovation will align the development of assistive technology to the needs and relevance, drawing from a full range of human diversity.

Inclusive designs should align to the principles of universal design to enable use by all people at the greatest extent possible.

A holistic approach in the provision of assistive technology should be considered and this entails; availing resources or subsidies for procurement, fitting and customisation, repair and replacement.

The lack of gender and disability disaggregated data remains a gap and influences policy and business decisions on the use of technology by women with disabilities.

While a user led approach is effective in defining the needs of users and promoting inclusive designs, women with disabilities face challenges to pursue a career in assistive technology due to misconceptions and inaccessible facilities.

There has been emphasis on encouraging women to pursue careers in science and technology; women with disabilities must be part of such initiatives.

Society needs to shape a future that adopts inclusive policies and provides an accessible environment to accommodate diverse potential. Beyond equity, there is need to define the needs of women with disabilities to achieve their potential.

InsightsDeborah TigereNo Comments

New Horizon: Attitude a major barrier for achieving disability inclusion

THE United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) (2006) defines people with disability as those who have long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society and on an equal basis with others.

Therefore, disability is defined as negative interactions that occur when a person with an impairment interacts with the attitudinal and environmental barriers.

Subsequently disability leads to loss of opportunities, hinders effective and full participation on an equal basis with others in society. Disability is an evolving concept and the fact that disability is heterogeneous makes it a complex phenomenon.

The different models of disability, which include medical, charity and social model, are still evident, but the Convention on the Rights of Persons with Disabilities (CRPD) promotes the human rights model, which is anchored on the understanding that people with disabilities are human rights bearers, who should have equal obligations as everyone else in society.

The World Report on Disability (WHO, 2011) estimates, 15% of the world’s population to have a disability and 80% of people with disabilities to be in low-income countries, and more than half to be women. The situation has further exacerbated the poverty disability cycle and the intersectional barriers experienced by women and girls with disabilities. Disability is a cause and consequence of poverty.

Milestones achievements

The Disabled Persons Act (Chapter 17:01) though it has its weaknesses was a major law addressing the needs of people with disabilities since its enactment in 1992.

Zimbabwe ratified the UNCRPD and its optional protocols on September 23, 2013 and this was regarded as a major commitment by the government to align to international protocol and promote the rights of people with disabilities in Zimbabwe.

The Constitution for Zimbabwe Amendment (No. 20) Act, 2013 provides for disability and clearly recognises the rights of people with disabilities. Section 3 of the constitution provides for values and principles that include the recognition of people with disabilities among other founding values.

Further, section 22 of the Constitution mandates the state and institutions to recognise the rights of people with disabilities, and to consider specific requirements that enhance communication and promote their participation in development.

Hence, discrimination against a person with a disability is unconstitutional. Sign language has been adopted as one of the official languages in Zimbabwe. In June 2021, Zimbabwe adopted the National Disability Policy, which was a major milestone and commitment by the government to fulfil, promote, protect and respect the rights of people with disabilities.

The National Disability Policy is aligned to the provisions of the CRPD and aims to strengthen institutional and legal frameworks. According to the National Disability Policy (NDP) 2021, Zimbabwe estimates 15% of the population (about 15 million) to have a disability which is 2 250 000 people with disabilities.

Since then, Zimbabwe is in the process of adopting new legislation on disability, the Persons with Disabilities Bill, which is a commendable development towards the international obligation in promoting the rights of people with disabilities.

Challenges faced

People with disabilities are often marginalised and continue to face exclusion from mainstream development and that includes, access to education, health, employment, housing, political participation and disaster risk management to mention a few.

People with disabilities do not live in isolation, therefore, programmes and interventions need to be inclusive. However, society does not understand how disability affects the lives of people with disabilities.

There are cultural beliefs that have been imbedded in society; this includes stereotypes that devalue people with disabilities.

According to article 5 of the CRPD, non-discrimination is an immediate obligation and a pre-condition for addressing the rights of people with disabilities.

Attitudinal barriers are behaviours, perceptions and assumptions that discriminate against people with disabilities and are a source of other barriers that people with disabilities face.

Attitudinal barriers often emerge from ignorance, lack of understanding, being judgmental and misconceptions about people with disabilities.

People with disabilities are treated as inferior, objects of pity and are patronised instead of being empowered. In most cases, society assumes people with disabilities are incapable without giving them a chance to demonstrate their skills and they are denied access to opportunities.

Stigma attached to disability can lead to over-protection, neglect and mistreatment. For example, some families are still hiding their children with disabilities because they fear condemnation, as disability is viewed as a punishment for wrongdoing.

Some impairments are misunderstood, as a result people isolate to avoid offending the person with a disability because they are not sure about how to engage or interact.

Silent disabilities, such as the deaf or autism are not given attention. Organisation’s view employing a person with a disability as expensive because of reasonable accommodation and they silently decline people with disabilities employment opportunities.

Changing the negative perceptions

Disability should not be viewed as deficit or shortcoming but as a responsibility where people can be supported to live independently. With a positive attitude, it becomes easier to address barriers that people with disabilities face by showing respect, focusing on their capacities and abilities rather than the disability.

Recognising the person first before the impairment and allowing the voice, choice and autonomy of people with disabilities enhances inclusion. It therefore, becomes imperative to avoid making assumptions and to learn about disability inclusion.

Organisations should systematically address attitudinal barriers through awareness, policies and procedures in order to enhance full participation by people with disabilities.

A multi-sectoral approach is necessary for achieving disability inclusion and disability should be adopted as a cross cutting issue across the various thematic areas in development.

In developing programmes, adopting a twin-track approach that addresses the specific needs of people with disabilities and at the same time promoting mainstream development will minimise the discriminatory attitude.

People with disabilities need to be empowered as disability exclusion makes them think that they are less of a person at same time the barriers faced are societal and there is need to raise awareness, provide knowledge and capacitate society to change the way they view disability.

Society needs to be made aware of their negative attitudes and beliefs that underpin their behaviour so that they can unlearn the stereotypes.

In light of the National Disability Policy and other related protocols, including the National Development Strategy (NDS1), people with disabilities should not be left behind.

The government is committed to achieve an inclusive society where people with disabilities realise their full potential; however, society needs to change their attitude and promote disability inclusion.

InsightsDeborah TigereNo Comments

Prevention of hearing loss a priority for universal health

March 3 is World Hearing Day (WHD) and Zimbabwe joins the rest of the world in commemorating the day under the theme “Ear and Hearing Care for All”.

A person, who is unable to hear as well as someone that has partial ability to hear sound, is said to have hearing loss. The hearing loss can be mild, moderate, severe or profound, which can affect one or both ears.

Hearing impairment is a silent disability and more often ignored by policy-makers and communities. Unlike physical or visual disabilities, hearing impairment has silent symptoms that affect all ages and their functionality. Hearing loss affects communication, quality of education, interaction, mental health and well-being further leading to economic loss.

Children, who experience hearing loss, need to be supported in order to learn and achieve their full potential. The world has become virtual and relies more on the ability to hear. The World Health Organisation (WHO), World Report on Hearing (2021) estimates 1,5 billion people to have hearing loss, which is likely to increase to 2,5 billion by 2050.

Over 400 million people, including 34 million children live with disabling hearing loss. More than 1,1 billion young people are at risk of permanent hearing loss due to loud music or sound. This requires behaviour change to protect their ears through monitoring and limiting noisy activities or loud sounds.

It is also known that many causes of hearing loss can be prevented and these include; ear diseases and infections, ototoxic medicines, nutritional deficiencies and smoking.

The World Report on Hearing recommends cost effective public health measures to address hearing loss guided by the acronym “H.E.A.R.I.N.G”.

Hearing screening and intervention is imperative for addressing hearing loss for those at risk. Infants and children are at risk of hearing loss mainly due to disease and infections. While adults are mainly at risk due to recreational and occupational noise.

Therefore, there is need to facilitate hearing screening programmes targeting new born babies, infants, children and adults taking into account at risk categories.

Ear disease prevention and management requires ear diseases and infection to be treated at the earliest stage to avoid complications, hearing loss or deafness. Diseases, such as otitis media are common among adolescents and adults, they can be treated and the impact mitigated through timely measures.

Administering immunisation is one way of preventing ear diseases and infection. Ear and hearing care services should be made available  at all levels of care (primary, secondary, tertiary) in order to supportthe identification, treatment of diseases and surgery.

In addition, ear and hearing care services should be integrated into the primary health system. The training of health personnel is a necessity for providing quality ear and hearing care services.

Access to technologies and maintenance is one of the biggest challenges. Access to quality, affordable hearing aids and other assistive technology will enhance the quality of ear and hearing services. Adequate technology, rehabilitation and health care services enable people with hearing loss to participate on an equal basis as others.

Although there has been significant progress in the development of high-end technology in the past decade, the availability of affordable assistive technology in low and middle-income countries is limited, making assistive devices a luxury and not a necessity.

Rehabilitation services enable people experiencing hearing loss to access services in the form of counselling or speech and auditory therapy to enable the reduction of hearing loss induced deficits, such as participation and quality of life.

Health facilities should be equipped with audiology equipment and where possible, audiology booths can be decentralised in schools and supported with the relevant personnel to increase access.

 Improved communication is key in addressing the challenges experienced by people with hearing loss. Many children with hearing loss are born to parents, who can hear thus the need to improve parental awareness, as these parents need to learn how to communicate with their children.

Zimbabwe adopted sign language as one of its official languages, however, like any language, effort should be made and training provided to make use of the language. Sign language learning and interpretation services should be made available in education and health centres including other public facilities.

Captioning services during trainings or professional settings will enhance access to information by those with hearing loss. Such services should be widely accessible. People with hearing loss need to receive the necessary attention in times of humanitarian crisis.

Their involvement in disaster preparedness initiatives is a necessity and will ensure they are not left behind when disaster strikes.

Noise reduction in the form of occupational, recreational or environmental sound is a major risk and contributor towards hearing loss. It is important to adopt global standards for safe listening devices and regulate safe listening around the environment. It also entails promoting programmes to influence behaviour and adoption of safe listening practice.

Greater community engagement is a catalyst for influencing change. In order to change the behaviour and attitude towards hearing  loss and the causes, communities need to be engaged in raising awareness and promoting positive ear and hearing health care practices. Working with organisations of people with disabilities in particular organisations representing people, who are hard of hearing or deaf will strengthen the advocacy efforts in addressing the stigma associated with the hearing loss.

Hearing loss should not be ignored; ear and hearing care should be prioritised and made accessible. Integrated people centred ear and hearing care will enable the participation of communities in defining the health policies and services.

Experience shows that many children and adults suffer from ear conditions without seeking medical attention. While some individuals assume the child will outgrow the ear infection it leads to hearing loss or complications.

The use of home remedies and traditional medicine to treat ear infections is still common. Through integrated people, centred ear and hearing care, individuals and communities will be empowered to understand ear conditions and made aware of hearing care needs in order to promote acceptance of services. The ultimate goal is to strengthen the primary health care system and access ear and hearing care services closer to home.

Research and evidence will enhance the planning of ear and hearing care interventions and strengthen the primary health system. It is important to promote and develop products that can be adapted and used. Special attention should be given to research and innovation in  the development of affordable assistive technology that matches the country needs.

Health financing models should also consider access to health technology and services to ease the burden. The challenges presented with inadequate ear and hearing care services require public health attention and financing to enable the achievement of universal health coverage.

InsightsDeborah TigereNo Comments

Inclusive social protection: Leaving no one behind

SOCIAL protection is defined as policies or actions that seek to enhance the capacity and well-being of vulnerable and poor people, while addressing equitable economic growth.

Social protection systems will vary from country to country taking into account a number of factors that include the policies and social context of a country.

Over the past decade there has been a commitment by governments to build and strengthen social protection systems in relation to the “leaving no one behind” mantra and attainment of Sustainable Development Goals (SDGs).

The objective of social protection programmes is to address gaps that affect social and economic development by reducing poverty, inequalities and social exclusion.

Income insecurity, affects households and negatively impacts on access to health and education. When economies experience down turn and spending is strained, increased social protection spending is necessary in order to revive the economy.

The emphasis should not just be on poverty reduction but holistically looking at the society at large. The dynamic and unpredictable environment has been worsened by climate change induced disasters, social exclusion and unemployment, further deepening  poverty.

In countries that are performing well, poverty exists, especially among vulnerable groups such as the disabled, elderly, migrants, child-headed households hence, some social protection systems are required. 

Most social protection programmes focus on improving livelihoods and welfare that enhance access to affordable health and social assistance.

Social protection programmes will enable society to balance between addressing immediate needs and progressing towards investment, wealth accumulation and managing risk. 

This is specifically important for Zimbabwe as we focus on achieving an upper-middle income economy by 2030.  The government of Zimbabwe through its strategy to achieve an upper-middle income economy by 2030 has emphasised the need to safeguard and ring-fence resources targeting vulnerable groups in society and will work with development partners to complement its efforts.

Social protection programmes

Section 30 of the Constitution of Zimbabwe provides for the need to ensure practical social protection measures are implemented with the available resources to all citizens in need.  

Other statutory provisions complementing the constitution include, Social Welfare Assistance Act (Chapter 17:06) 1990, Older Persons Act, Disabled Persons Act (1992), Children’s Act among others.

The Ministry of Public Service, Labour and Social Welfareis responsible for implementing most of the social protection programmes with support from other ministries.

According to the World Bank and Zimstat (2019) poverty is widespread in Zimbabwe, and those in extreme poverty increased  by 30% in 2017 to 38% in 2019, with 0,4% of the GDP spent on social protection which is far less than other regional comparators.

While there was an increase of the social protection spending from 16% to 37% in the same period, the coverage still remained low. The government of Zimbabwe through the respective ministries is making effort to implement social protection programmes. The Ministry of Primary and Secondary Education, supports school feeding programmes and works with the Ministry of Public Service to provide tuition grants under the Basic Education Assistance Module (Beam) targeting vulnerable children who are unable to pay school fees and supporting them to attain education in their respective schools.

The Beam programme was launched in 2001 with financing coming from the Government of Zimbabwe and donors.

The Assisted Medical Treatment Order (AMTO) under the health assistance programme pays health fees for poor households through the health referral system.

Beneficiaries are provided with medical treatment vouchers to access health services in government hospitals.  However, the challenges experienced in government hospitals, such as drug shortages, has affected the effectiveness of the programme, hence the need to prioritise financing of public health institutions.

The Harmonised Cash Transfers were introduced in 2011, with the aim of strengthening the purchasing power of vulnerable households.

Cash transfers will improve house hold food consumption and nutrition, reduce risky coping mechanisms such as child marriages, improve health and education outcomes.

Research shows that although cash transfers influence the attainment of developmental goals, temporary cash transfers alone are insufficient in reducing poverty. 

In the past years, the food security situation has worsened in Zimbabwe due to persistent droughts, flooding and cyclones. One of the biggest challenges faced by the country is balancing chronic and transient vulnerability in light of the limited resources.

Communities permanently living at the edge of a crisis are more at risk and yet the country is faced with an increase in transient vulnerability.  Loan facilities are being unveiled to support vulnerable groups to establish a source of livelihoods and support is being provided to child protection programmes, including the elderly and people with disabilities.

Way forward

Social protection policies are key to improving human well-being, and there is need to ensure that the population is made aware and the majority are able to access social protection services.

Therefore, social protection programmes should be designed to include vulnerable groups. This includes the need to understand the context, gaps, capacities and barriers. 

Due to challenges associated with limited resources, countries should at least aim to provide some social protection floors that give the minimum access to health and basic income security with the aim of expanding.

According to the International Labour Organisation (ILO) strategy and the 2012 Social Protection Floors Recommendation, (No 202) social protection floors should at least consist of the following:

  •  Access to essential health and maternity care;
  •  Basic income for children providing nutrition and education;
  • and Basic income security for those who are unable to earn sufficient income, older persons, unemployed and persons with disabilities. 

Efforts made by the government of Zimbabwe indicate we are moving in the right trajectory.

In line with the 2030 Agenda for Sustainable Development and the National Development Strategy (NDS1), the government of Zimbabwe aims to ensure that people are at the centre of development and will support the establishment of social protectionprogrammesand financing.

The 2023 budget presented by the Minister of Finance and Economic Development shows a  commitment by the government to increase the financing of social protection programmes; ZW$23 billion towards Beam, ZW$12,1 billion towards drought mitigation, ZW$9,28 billion for harmonised cash transfers including other dedicated budgets towards people with disabilities, health assistance, Covid-19 response and sustainable livelihoods.

With such commitment, the assessment of social protection programmes is necessary in order to determine whether people who have been provided with support have graduated to another level or remain in poverty.

According to the Organisation for Economic Cooperation and Development (OECD) a comprehensive social protection system should include a policy and legislative framework, a budget to support the framework, together with specific programmes and their corresponding implementation systems.

Such a comprehensive system will addresspoverty and vulnerability in addition to promoting inclusive social development and equitable economic growth.