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Consideration of what accessibility means

In this video Dorothy Boggs describes ways to overcome barriers to accessibility presenting solutions for accessibility for all.
DOROTHY BOGGS: In this step, we are going to consider what accessibility to health care means. Accessibility is a general term that describes the degree to which a product, device, service, or environment is available to be used by all intended audiences. It is a human right to have accessible infrastructure and services and accessibility is well supported in the United Nations Convention on the Rights of Persons with Disabilities, the UNCRPD.
The UNCRPD specifies that people with disabilities should have equal access to transport, physical environment, information and communication, and other facilities and services that are open and provided to the public. Accessibility is fundamental to the practical implementation of many parts of the UNCRPD, including the right to employment, education, and health care. Last week, in step 2.11, Accessing Health Services, we examined various access barriers. We will now revisit these barriers to accessibility and explore ways to overcome these barriers with the aim to ensure accessible disability-inclusive health and rehabilitation services and systems.
This requires input from people with disabilities, as they are most familiar with and most affected by barriers to health care access and have the best ideas for how to overcome these barriers.
The overall aim is to achieve a broader concept called universal design, which means that buildings, products, services, and environments are accessible and usable by all, including older people, people without disabilities and people with disabilities. First, let’s look at how we can overcome attitudinal barriers in health settings. Reducing stigma and misconceptions, and increasing knowledge and awareness are key to overcome this barrier so that health care providers provide respectful, knowledgeable and supportive responses to people with disabilities.
Some examples of how this can be ensured include: completing disability trainings for health care staff to sensitise staff to the needs of people with disabilities; also, including the health needs of people with disabilities within the curriculum of undergraduate and graduate education programmes for health care workers; and using user satisfaction surveys so people with disabilities’ opinions are valued and listened to.
Next, how can we overcome physical barriers to accessibility in health settings? This means ensuring the buildings and outdoor spaces are accessible to people with disabilities. Some examples of how this can be ensured include completing accessibility audits of health clinics to identify access barriers and take the necessary steps to improve accessibility. Accessibility audits could lead to recommendations
for: changing signage so signs are clear with better contrast alongside other forms such as pictures, so it especially benefits people with sensory and intellectual impairments; and changing outdoor and indoor grounds so they are smoother and free from obstacles, with pathways that are clear, both indoors and outdoors; and also ensuring accessible entrances and infrastructure, so doorways are wider and ramps and accessible bathrooms are provided; and finally, ensuring accessible transport, so people with mobility impairments are able to reach health and rehabilitation centres.
How can we ensure accessible information for people with disabilities? This relates to ensuring both the giving and receiving of information is accessible.
Some examples of how this can be ensured
include: providing guidance to health care professionals on who to offer information to, such as for sexual and reproductive health services; ensuring multiple alternative formats for information, including Braille and easy-read formats with plain language and use of symbols, and ensuring captions are included when producing videos.
How can we ensure accessible communication for people with disabilities? It is important to use different, varied ways to communicate that are appropriate for an individual and his or her needs.
Some examples of how this can be ensured
include: offering health professionals training in alternative methods of communication for people with different impairments; ensuring there are options for sign language interpreters for health care and rehabilitation sessions; and using simple clear language with accompanying pictorial formats when explaining health and rehabilitation information to a person with an intellectual impairment.
Finally, how can we ensure financial access for people with disabilities? This involves making sure that the costs to access health or rehabilitation services are accessible for people with disabilities, including user fees and additional charges for medicine and equipment.
Some examples of how this can be ensured include: advocating for and strengthening existing social assistance or protection programmes, working closely with disabled people’s organisations so health care and rehabilitation costs can be partially or fully funded for people with disabilities, including accessible transport, medicines, and equipment; and exploring livelihoods training options, such as income-generating activities or micro-finance mechanisms, so people with disabilities’ financial options and income can increase.
We will now revisit the health clinic diagram that we introduced last week in Step 2.11, Accessing health services. We previously identified the access barriers, so we’ll now identify ways that these barriers can be overcome so the health clinic is more accessible. Take a few moments to review the barriers we identified and to think about what you have learned in this step about ways to overcome barriers to accessibility by identifying solutions. Remember to make sure you think about a range of environmental factors and a range of disabilities, such as physical or sensory impairments, intellectual disabilities or mental health conditions.
Let’s start together by exploring the journey that a person with a disability might experience at the health clinic if the access barriers were to be overcome. The signage is now more accessible. It is clearer, has better contrast, is unobstructed and uses additional directional diagrams to reinforce the entrances. The staff are more welcoming, now readily available for the caregiver and child with disability and more understanding of their needs following a disability awareness training. The outside environment is more accessible, where obstacles and uneven ground were removed, and ramps are provided at both entrances. Accessible transportation is now provided, which is more affordable with a reduced fare for people with disabilities.
The cost of both the clinic appointment and associated costs, including medicine and equipment, have been reduced. The inside environment is now more accessible, with a lower reception desk and wider doorways for wheelchair users. And finally, the communication barrier has also been addressed, by providing a sign language interpreter for this appointment with a person who has a hearing impairment. We have now discussed the importance and human rights of accessibility. We explored a variety ways to overcome various barriers to accessibility with the aim to ensure accessible, disability-inclusive health and rehabilitation services and systems. Lorraine Wapling will now provide an example of how communication barriers can be overcome with deaf people through British Sign Language.
Following this demonstration, we will explore an eye health case study from Pakistan that provides an example of how this service was made more inclusive and accessible to people with disabilities in the next step.
LORRAINE WAPLING: Direct communication with Deaf people is very important, but around the world there are many different sign languages. However, if you can just say, “hello, I’m happy to meet you”, most Deaf people will understand and appreciate it.

Our second activity this week introduces improved access to health care for people with disabilities. In this step, Dorothy Boggs (LSHTM) explores ways to overcome different types of access barriers for people with disabilities presenting possible solutions for accessibility for all.

In Step 2.11 Accessing health services, Dorothy presented different types of access barriers and identified these in a health clinic setting diagram.

In this video, she discusses the human right and importance of accessibility for all, especially people with disabilities, as supported by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). She presents the concept of universal design and then discusses ways to overcome different types of access barriers for people with disabilities. We review the health clinic setting diagram and identify solutions to overcome the various access barriers that were identified.

The presentation concludes with a proposed example of overcoming a communication barrier. Lorraine Wapling, who presented Step 2.9 Sexual and reproductive health case study, emphasises the importance of communication with Deaf people and introduces a British sign language greeting.

In the ‘See Also’ section below, see additional examples of accessibility resources, including an EasyRead version of the UNCRPD, a website for learning international sign language, an example of an accessibility audit guide and a collection of accessibility guides as strategies for inclusive development.

What are your thoughts and experiences about overcoming access barriers? Have you ever conducted an accessibility audit? What are your proposed solutions for accessibility? Share your thoughts in the comments area below.

© The London School of Hygiene & Tropical Medicine

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Global Health and Disability

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