Key Elements toward the Implantation of the WHO Disability Action Plan in Madagascar

Introduction: With a relatively young population of approximately 23,000,000 inhabitants, Madagascar might have 3,450,000 people with disabilities. Around 80% live in rural areas. More than 90% of the inhabitants live with less than 2$ daily.

People with disabilities face major obstacles accessing health care and services, including rehabilitation.

This article purposes to emphasise the main strategic elements and key interventions with regard to the objectives established by the WHO's global action plan on disability as well as our current challenges.

Overview of the Situation of Disability and Rehabilitation:

For the Malagasy people, a disability can be conceived as a fatality or as a punishment due to the transgression of cultural prohibitions («Tsiny»).

There are several risk factors leading to physical disability: insufficient monitoring performed on pregnancies, low delivery rate in medical structures [1], undernourishment, infections, traumas mainly through traffic accidents and fall, high prevalence of high blood pressure (35.8%).

The low awareness of the population, late prognosis, priority use of traditional “practitioners”, the concentration of rehabilitation services in the cities explain the late referrals and the seriousness of the conditions observed.

The physical rehabilitation services in Madagascar are managed by the public, private and non governmental sectors. Specialised staff is lacking.

It is hard to access rehabilitation services due to the direct and indirect costs facing the persons with disability and/or their families.

Important Aspects from the Action Plan for Madagascar:

Breaking the vicious circle linking handicap to poverty is crucial for the country's development. The WHO global action plan is a reference framework for our National Disability Mainstreaming Plan (NDMP) [2]. It suggests a broader vision for example by building the link with emerging problems such as non communicable diseases.

Activities towards the Implementation of the Action Plan:

• to remove barriers and improve access to health services and programmes
  The persistent lobbying done by the Platform of the Federation of PWDs in Madagascar resulted in the issue of a law on the rights of people with disabilities, the ratification of the UNCRPD in 2014. This involvement has led to the designing of the NDMP this year through a participative process.

• to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation
  A major step was the conception of a national development plan of physical rehabilitation services, supported by WHO. It is of prime importance that the lead comes from someone within the country sharing a clear vision with the MOH and all stakeholders such as the higher education. The creation of a core team of professionals in rehabilitation, through a mid-level education program supported by Leeds Teaching Hospitals and Overseas Partnering and Training Initiative, and the identification of key partners adhering to the initiative such as the Special Funds for the Disabled, CBM, Growing The Nations Therapy Programmes have been success factors.
  The initial education program in occupational therapy was started this year.

• to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services
  The integration of data on conditions and disabilities in the health national information system is just starting. Nevertheless, the rehabilitation doctors now have a national data base.

Outlook:

Our outlooks take into consideration the following:

• a multi-sector approach;

• the consolidation of level results;

• a better access to the services as a continuum to health care;

• continuing capacity building;

• set standards for a better quality of health care, the creation of professional networks;

• continuing to improve and ensure accessibility of rehabilitation infrastructures and equipments;

• the development of CBR;

• the improvement of the data base on disability;

• the intensification of research activities.

References:

[1] Demographic and health survey in Madagascar 2008 – 2009, National Statistics Institute, 2010

[2] National Disability Mainstreaming Plan Madagascar 2015 – 2019. Ministry of Population, March 2015.