Category Archives: Economy
It has now over a year since the Ebola outbreak started in Guinea. CBM supported partners in Guinea and Sierra Leone – 2 of the 3 most affected countries – were forced to scale down their routine activities like community eye care, cataract operations, and community mental health care. The loss of local staff either from Ebola or due to difficulties in travel, and the reduction in clients coming for services has led to a risk of insolvency of institutions, among other negative effects. By extension, tens of thousands of people who depended on them for health, and other social services are no longer getting the services they require resulting in greater disability and deeper poverty.
CBM is working with a grass-roots organisation in Sierra Leone to reduce the vulnerability of people with disabilities and their families to Ebola through awareness raising strategies.
Dr Julian Eaton, Psychiatrist and CBM Mental Health Advisor for West Africa, tells us more about the mental health programme and its role in responding to psychosocial needs of the population in Sierra Leone.
Our activities in Sierra Leone since the Ebola outbreak started
When the Ebola crisis began in March 2014, our programmes in Sierra Leone were affected. Due to the rapid spread of this disease, there were significant travel bans imposed, bans on public gatherings, closure of schools, reduction in the use of hospitals by people etc. Routine cataracts and surgeries came to a standstill and routine programmes started collapsing.
We needed to continue supporting our existing partners as there was no income flowing in due to lack of day-to-day expenses of operations and surgeries etc. Business services started collapsing due to the lack of finances and there was a massive gap between what was existing and what was needed by the people.
CBM’s first response to the outbreak was to redirect our efforts as much as we could, within the framework of our programme, to support the mental health and psychosocial response to the outbreak.
CBM projects in Sierra Leone
The ‘Enabling Access to Mental Health’ Programme (EAMH) supported by CBM has been active for the past four years in Sierra Leone. Addressing the consequences of mental health is an important part of standard Ebola response. Today, this programme focuses more on the specific mental needs of people affected by this disease. It provides mental health facilities to families of Ebola victims, children who are now orphans, health workers who are under a huge amount of stress and survivors who are marginalised by their families and communities.
The programme has dedicated three blocks to:
- Block 1, Capacity Building: support the 21 mental health nurses trained by the EAMH programme in the districts, so they can provide services for those who are suffering the consequences of the outbreak. Other efforts, like the provision of trainers and specialists to prepare teams of other organisations (such as child protection) are also being made.
- Block 2, Advocacy: The EAMH has also established the Mental Health Coalition that brings together stakeholders to advocate for the inclusion of mental health in the government’s agenda. The Mental Health Coalition has been engaging from the beginning of the outbreak with the response pillars of both, the Ministry of Health and the Ministry of Social Welfare, to ensure that the mental health component of the outbreak is not neglected and that local actors are taken into consideration. The Coalition, being one of the main actors in this area, works in close collaboration with WHO, UNICEF, and the other NGOs.
- Block 3, Awareness: Radio programmes and support to the other blocks are being provided, to raise awareness about the psychosocial consequences of the outbreak, and to fight stigma and discrimination.
To address the massive increase in needs CBM has also added more resources to scale up support for psychosocial disability. We have collaborated closely with the WHO to write a standard manual for psychosocial first aid (both in English and in French). This manual is currently being used by national governments, WHO and other international and local NGOs in Sierra Leone, Nigeria, Mali, Guinea, Togo and Liberia.
In Sierra Leone the Mental Health programme has been the strongest programme supporting services outside psychiatric hospitals. It has deployed nurses who are the main referral for people doing counselling.
Building Resilience for persons with disabilities during the Ebola Crisis
Another project has begun to ensure the resilience of people with disabilities to the outbreak. CBM has liaised with our local partners in Sierra Leone to adapt all official messages from the WHO, UNICEF and the government, to ensure they are accessible for people with disabilities.
We are adopting a participatory approach in this project – our partners are conducting training sessions for Organisations for Persons with Disabilities (DPOs), who in turn train communities in the villages. We have involved key organisations in this project – specialist schools for hearing impairment, amputee groups etc. so that people with disabilities can have a say in how they want messages to be transmitted to them. Right now our collaborating local partner organisations are identifying other DPOs and organising workshops.
Disaster Risk Reduction and preparedness in Nigeria and Togo
We are strengthening capacities of Mental Health workers to provide mental health support in crisis situations. All these projects are strongly focused in working through our local partners, capacitating them, working in collaboration and therefore, assuring sustainability and continuation after the Ebola crisis period.
Beyond the realm of mental health, CBM is supporting existing partners involved in eye health in Sierra Leone, to sustain their programmes and to reduce the vulnerability of their target group to Ebola. The partners have had to scale down their eye health activities in their catchment areas thereby depriving communities of much needed eye health service. A person who is blind is doubly vulnerable compared to able-bodied members of society due to the fact that they require support in their daily living as a result of an inaccessible environment. A key strategy Ebola health workers are promoting is the “don’t touch rule” to reduce the spread of infection. Such a rule, to a person who is blind completely immobilises them and elevates their risk of infection to Ebola.
In this context, CBM eye health partners aim to: increase the knowledge of their staff and traditional leaders regarding Ebola to enable them to effectively sensitize communities in the catchment area; and to work with DPOs to reach out to persons with disabilities especially persons who are blind.
The current Ebola epidemic has overloaded and stressed health infrastructure in the affected countries; the number of health care workers – already insufficient before the outbreak – has gone down even further as many health workers became infected and lost the fight. Social stigma towards survivors of Ebola and their families has increased thus worsening distress and isolation. Family and social ties have been severed; cultural practices have been over-turned; and livelihoods have been severely strained.
In future, the affected countries, and the international community will have to engage at a much wider scale to re-establish the socio-cultural, economic, and political systems, which Ebola has severely shaken. This will be a critical and indispensable step if the affected countries are to overcome future public health challenges like the current one.
In the coming months, CBM will participate, with other development agencies and the governments of the three affected countries, in a major conference looking at lessons learnt in mental health and psychosocial support from the outbreak, and how we can work together to rebuild mental health services.
A research report from the International Centre on Evidence in Disability (ICED) formed the basis of a discussion today with the UN Committee of Experts on the Convention on the Rights of Persons with Disabilities.
It was a pleasure for me to facilitate a dialogue between the Committee and Dr Hannah Kuper, co-director of the ICED at the London School of Hygiene and Tropical Medicine on their recent research report ’The costs of exclusion and the gains of inclusion of persons with disabilities‘.
The first part of the research provides the evidence of the link between poverty and disability, described by Dr Kuper as ‘strong as the evidence between lung cancer and smoking’.
The second part of the research looks at three sectors, namely; health, education and employment, providing evidence from low and middle income countries on the costs of exclusion and the gains of inclusion of persons with disabilities…
Did you know that In Bangladesh, reductions in wage earnings attributed to lower levels of education among people with disabilities and their child caregivers were estimated to cost the economy US$54 million per year?
Or that the inclusion of people with sensory or physical impairments in schools in Nepal was estimated to generate wage returns of 20%?
Read more of this wonderful research, and disseminate it to the people who listen to economic arguments, but always ask for the evidence!
On Sunday 21 September, more than 300,000 marchers flooded the streets of New York City making it the largest climate change march in history and putting this important issue on the top of the global agenda. In addition, in conjunction to the opening of the 69th UN General Assembly, Secretary-General Ban Ki-moon hosted the UN Climate Summit on Tuesday, 23 September. It was lovely timing since it was also the Fall Equinox (Spring Equinox for my friends in the Southern Hemisphere – !Hola Uruguay!)
Due to this high-level event, climate change has been a pervasive topic at the UN and in NYC and this theme will continue to be important as the post-2015 development agenda progresses. One example is that the newly appointed President of General Assembly, Sam Kutesa, will hold a High-level Event on Combating Climate Change in June 2015.
With this increased emphasis on climate change and related disaster risk reduction (DRR) – in the post-2015 process, it is crucial that persons with disabilities are included in these conversations, debates and initiatives. Why is this important?
It is important because weather-related disasters are increasing in number and severity and the number of people affected by them has risen. Disasters and their aftermath have a huge impact on persons with disabilities who are among the most vulnerable in an emergency, sustaining disproportionately higher rates of morbidity and mortality, and at the same time being among those least able to access emergency support. For example, research indicates that the mortality rate among persons with disabilities was twice that of the rest of the population during the 2011 Japan earthquake and tsunami (UN, 2013). Moreover, for every person that dies during a disaster, it is estimated that three people sustain an injury, many causing long-term disabilities, such as the case in Haiti after the 2010 earthquake in which approximately 200,000 people are expected to live with long-term disabilities as a result of injuries (UN Enable, 2013).
Persons with disabilities are often forgotten, and most likely to be abandoned during disasters (DiDRRN, 2013)as well as more likely to be invisible and overlooked in emergency relief operations (Choy, 2009). When the emergency hits they may have difficulty reaching safe areas, become separated from family and friends which is a key to survival and coping, have trouble accessing vital emergency information, or lose assistive devices such as wheelchairs, crutches, prostheses, white canes or hearing aids. In addition, moving and transferring persons with disabilities requires handling techniques to avoid injury or further injury. Yet, the first-ever UN global survey of persons living with disabilities and how they cope with disasters indicates that the percentage of those with disabilities who could evacuate with no difficulty almost doubles if they were given sufficient time. This underlines the importance of early warning systems and ensuring that warnings reach all members of the community regardless of any mobility or communication barriers (UNISDR, 2013).
For the few who are evacuated, shelters are not accessible and consequently survivors with disabilities are also excluded from the emergency responses: including food, basic needs and health support. In addition, in the aftermath of a disaster, the damage to infrastructure caused by extreme weather events can reduce or completely remove access and safe mobility. Inclusive practice in all relief operations is needed to ensure that response and service delivery is not fragmented but mindful of all sources of vulnerability (Kett & Scherrer, 2009).
- Strong advocacy by and with persons with disabilities is needed to ensure disability inclusion is a key criterion in all emergency relief operations
- The evidence base concerning the vulnerability of persons with disabilities in weather-related emergencies, and key factors, which create resilience, need to be greatly strengthened, with key messages disseminated.
- Evaluations of both emergency and development programmes, in areas affected by a changing climate, need to clearly include disability in their terms of reference.
- Early warning systems need to ensure that warnings reach all members of the community, including persons with disabilities regardless of mobility or communication barriers.
- In the reconstruction phase following severe weather and other emergencies, it is essential that universal accessibility standards are applied in all public buildings and spaces, water and sanitation points and for the homes where people with mobility disabilities live.
Choy, R. (2009). Disasters are always inclusive: Vulnerability in humanitarian crises, Development Bulletin, Special Issue No. 73, April 2009, Development Studies Network, ANU, Canberra.
DiDRRN. (2013) Inclusion of Persons with Disabilities in Simulation Exercise. From: www. didrrn.net/home/
Kett, M and Scherrer, V. (2009). The Impact of Climate Change on People with Disabilities. Report of e-discussion hosted by The Global Partnership for Disability & Development (GPDD) and The World Bank (Human Development Network – Social Protection/Disability & Development Team).
UN. (2013). Panel Discussion on Disaster resilience and disability: ensuring equality and inclusion. United Nations Headquarters on October 10, 2013.
UN Enable. (2013). Disability, natural disasters and emergency situations: A need to include persons with disabilities. From: www.un.org/disabilities/default.asp?id=1546
UNISDR. (2013, October 10). UN Global Survey Explains Why So Many People Living with Disabilities Die in Disasters. [Press release 2013/29].
For years, CBM has needed hard evidence on the economic impact of restoring vision, and now we have it.
A recently completed study in Kenya, Bangladesh and the Philippines showed that following a sight-restoring cataract operation, the average economic gain per family per year is £250. Not much by UK standards, but an awful lot of money for a Bangladeshi family.
It costs CBM about £20 to do one cataract surgery, so the return on investment is 1,500%!
In 2010, CBM and its local partners restored eyesight to 644,000 cataract blind people who would otherwise have remained blind, due to poverty. So a bit of maths shows that the global economic impact of CBM’s cataract surgical work comes in at about £160 million. Not bad at all!
Now, we have to get the message across to governments that restoring vision benefits their economies!