United Nations International Children’s Emergency Fund‘s (UNICEF) latest data on persons with disabilities in Ethiopia shows that nearly 9.3 percent of Ethiopia’s total population has some form of disability. Ranging from inaccessible sidewalks and street crossings to inadequate health services, persons with disabilities in Ethiopia face several challenges in order to go about their daily business and lead a quality life. For example, children with disabilities in Ethiopia find it hard to access education when compared to their able-bodied peers. Persons with disabilities are also less likely to get jobs because of their condition. In addition, mainly because of infrastructural and medical equipment barriers, persons with disabilities, including children, lack access to health services. However, human rights instruments, including the Convention on the Rights of Persons with Disabilities (hereafter CRPD), to which Ethiopia is a party dictate that persons with disabilities are entitled to equal opportunities and quality of life as others. More specifically, persons with disabilities have the right to health which allows them to access health facilities, goods, and services within safe physical reach. This article analyzes Ethiopia’s obligation under the right to health to address the challenges faced by persons with disabilities in the health sector. It does so by describing the difficulties faced by persons with disabilities in accessing health services in Ethiopia.
Access to health services in Ethiopia and persons with disabilities.
A study which assessed access of health services by persons with disabilities in Hawassa discovered that out of the 326 study participants, 244 faced a minimum of one barrier (physical, medical equipment and/or communication related) to access health services. According to the study, visually impaired people and people who use crutches faced difficulty in accessing health centers because of poor road network and absence of disability friendly transport. On the other hand, persons with hearing impairment faced communication problems while others reported inconvenient patient admission beds, stretchers, and chairs. Another study which was conducted on 15 persons with disabilities revealed that the visually impaired and persons with other physical disabilities struggled to access public owned pharmacies because of the pharmacies’ inconvenient layout and design for persons with disabilities. For example, the participants could not access stairs that lead to the pharmacies. Individuals with hearing impairment were also unable to communicate with pharmacists.
In addition to encountering problems when accessing health centers and medicines, persons with disabilities usually do not receive quality health information – which forms part of a health service– and are vulnerable to diseases as a result. For example, a study conducted in Addis Ababa on 426 young persons with disabilities shows that even though most of the study participants had knowledge about sexually transmitted diseases, they lack comprehensive knowledge “regarding sexual and reproductive health related issues such as awareness of the full range of family planning methods, types of sexually transmitted infections and means of HIV prevention”. The study also discovered that because of lack of adequate information, the study participants were reluctant to utilize services on sexual and reproductive health. As described in this article, persons with disabilities in Ethiopia including children face a number of problems in accessing health services. However, Ethiopia is a party to international human rights treaties such as the International Covenant on Economic and Social Rights (hereafter ICESCR) and CRPD which protect the right to health of persons with disabilities. The obligation of Ethiopia to realize the right to health of persons with disabilities is discussed below.
The right to health and access to health services for persons with disabilities.
The right to health of persons with disabilities is protected under articles 12 (1) of the ICECSR and 25 of the CRPD which state that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. And States, by virtue of article 25 (a) of the CRPD, have to “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programs as provided to other persons”. In other words, based on the explanation given by the UN Committee on Economic, Social and Cultural Rights (hereafter CESCR) under its fifth general comment on the rights of persons with disabilities, “the right to physical and mental health also implies the right to have access to, and to benefit from, those medical and social services – including orthopedic devices – which enable persons with disabilities to become independent, prevent further disabilities and support their social integration”. In addition, the CESCR has stated that accessibility of health services is one of the four essential elements of right to health which are availability, accessibility, acceptability, and quality. Accordingly accessibility entails that health facilities, goods, and services have to be accessible to everyone without discrimination for all sections of the population including persons with disabilities. Accessibility also includes the “right to seek, receive and impart information and ideas concerning health issues”.
Therefore, it can clearly be seen from these two articles that persons with disabilities have the right to enjoy health services, including the right to receive health information, equally with others and States have the obligation to implement this right. But what constitute the obligation of States to implement the right to health of persons with disabilities? The CESCR has provided an authoritative explanation on the obligation of states to implement the right to health of individuals under its fourteenth general comment on health. Accordingly, “the right to health, like all human rights, imposes three types or levels of obligations on States parties: the obligations to respect, protect and fulfil”. The obligation to respect requires states to refrain from denying equal access to health services for everyone including persons with disabilities. Under the obligation to protect, States are obliged to prevent third parties from interfering in the right to health of persons with disabilities. Finally, the obligation to fulfill obliges states to take positive measures such as adopting appropriate legislative, administrative, budgetary, judicial, and promotional measures that enable and assist persons with disabilities to enjoy the right to health. However, it should be noted that since the right to health is a social and economic right, these obligations are going to be achieved progressively based on the level of development of States and available resources. Nevertheless, even though the right to health of persons with disabilities is going to be achieved progressively, States have obligations which are of immediate effect. One of these obligations of immediate effect is the obligation of States to take steps towards fulfilling the right to health of persons with disabilities.
As explained in this article, persons with disabilities face several challenges in accessing health services in Ethiopia. But as a State party to the ICECSR and CRPD, Ethiopia is required to implement its obligation to respect, protect, and fulfill the right to health and make health services accessible for persons with disabilities. However, given the level of development of the country, it is not possible to improve the health sector for everyone at once. As a result, Ethiopia should take steps towards addressing the challenges in delivering health services – including disseminating health information – to progressively realize the right to health of persons with disabilities. For example, Ethiopia could implement strategies to utilize its health budget sufficiently in order to make hospitals, health centers, and pharmacies friendly to persons with disabilities. Ethiopia could also collaborate with national and international organizations to gain resources and increase the budget it allocates to persons with disabilities. Moreover, the State and other stakeholders have to create awareness among the relevant government authorities such as the Ministry of Health and health bureaus of Regional States on how to incorporate the interests of persons with disabilities when constructing health centers. Civil societies should also help the Government to better the health services that are provided to persons with disabilities by providing material resources and relevant skills.
By – Michael Mengistu.