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COMMENTS & OPINIONS  

President Koroma, We Need Free Healthcare for People with Disabilities
By Ajan Fofanah, London, UK
Jun 29, 2011, 17:00
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In a previous publication, I pleaded to our President Dr. Ernest Bai Koroma, for a policy change that will lead to the provision of free access to healthcare for people with disabilities.

 

Consequently, I have been contacted by many Sierra Leoneans, at home and in the Diaspora, and other relevant entities, wanting to follow-up on the outcome of that publication and plea free healthcare for people with disabilities.

 

It is not surprising that people, who care about the predicaments of people with disabilities, within our population, have started demonstrating some unflinching interest in the well-being of this socially excluded and marginalised group. People with disabilities are a faction of our population, which is not only vulnerable; but also worse-off, as a result of their diagnosis. Therefore, this client group would need to be kindly supported by all of us, and especially the government.

 

At the 2000 UN Summit, world leaders representing citizens from both poor and rich countries committed themselves, at the highest political level, to achieve particular time-bound targets that will contribute to ending extreme poverty worldwide, which now includes: improving the standard of living for people with disabilities. This urgent convergence resulted to signing onto a Millennium Declaration to free our fellow men, women and children from the abject and dehumanising conditions of extreme poverty, to which more than a billion of people are currently subjected.

 

The Sierra Leone Government has an obligation to uphold the dictates of the Millennium Development Goals, including mainstreaming disability issues. In order to ameliorate and terminate certain demeaning and deplorable experiences of life, wealthy countries had pledged to provide resources to the realisation of particular goals; whilst poorer countries, including Sierra Leone, did pledge to improve policies and governance, and increase accountability to their own citizens.

 

The recent move by the Sierra Leone Government to domesticate the Convention on the Rights of Persons with Disabilities would have encouraged the president to explicitly delegate health and social care actors to initiate a platform to discussing the issue of free healthcare for people with disabilities. This is expected because the purpose of the convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.

 

Since the commitment to achieve the goals comes from the highest political echelon, our government should not only sign up to the declaration; but should also be seen to be exercising such commitment towards achieving its goals. Subscribing to a declaration without effecting policies that will improve peoples lives could be regarded as a gross neglect for human right and dignity.

 

It is in this regard that, civil society organisations would arguably be also interested in what the president is planning to do to bring about a policy change for people with disabilities. Both the Convention on the Rights of Persons with Disabilities and the recently revised Millennium Developments Goals, have not only succeeded in bringing the issue of disability to the forefront of our political agenda; but also highlighted the important role of civil societies; who are mandated to creating their own structures, systems and processes to ensure that governments are held to the highest possible standards of performance. 


The issue of disability should be examined in a multi-faceted dimension, considering both its economic and ethical significance. People with disabilities are not at all handicapped; they are only suffering from a disability. Thus, they could surely be empowered to contribute to nation-building, if they are provided with the required necessities to enjoy life, freedom and their inherent dignity. Who ever imagined that an amputee would win an International Marathon competition? Well, this is not news anymore an amputee had won a world marathon, which is an event that requires the best use of ones legs. Will this accomplishment not contribute to the economic development of his country? 


Morally, I do not believe that anyone would be so callous to an extent of not supporting the government in improving the living standard of people with disabilities. A disability is a fact of life! There are notable individual differences in man, which are mediated either by our genetic make-up or the environment that we find ourselves. Although some disabilities are of congenital origin, evidence suggests that civil wars, especially in developing countries, have led to their surge. In the case of Sierra Leone, we still live to painfully remember how the previous civil war has hampered the lives of our people.  Moreover, even some disabilities that people suffer from are sometimes worsened by their material conditions to life; which also adversely interact with other determinants of health. Hence, is it ethically right to deny people with disabilities the access to free healthcare?

 

The issue of disability is very delicate and requires a collaborative working relationship; as it is a discipline in which no particular government or expert can claim monopoly of all the knowledge that is required to respond to all disability needs. This makes it imperative for all stakeholders, including the affected, Sierra Leoneans at home and abroad, civil societies and our president and government, in particular, to work together to make life better for people with disabilities. 

 

While some critics bicker that it is taking too long for the president to respond to the plea for a policy change; others are also concerned that President Koroma is yet to pronounce his determination to tackle disability issues in Sierra Leone.  These mixed feelings have honestly resulted to some key stakeholders now wanting to know what President Koroma is really planning, to offset the plight of people with disabilities.


For the president to respond to this clarion call, it would be prudent for him to at least make a statement of intent about providing free healthcare for persons with disabilities. A statement of intent does not impose on a government to do anything without careful consideration; but it will be a clear manifestation that our president does care about this client group.

 

As mentioned earlier, disability issues can be very elusive. Our first approach therefore, is to have a clear definition of disability, both from the conventional and in our own cultural context. The fact that there are different types of disabilities means that, we need to clearly understand and acknowledge what should be regarded as a disability.

 

Once this has been determined, we will then be able to collect vital statistics to inform the incidence and prevalence of disabilities, in the country as a whole. These figures would motivate us to put ideas together, in view to having policies that will enable people with disabilities to enjoy the highest attainable standard of health.

 

Many organisations would like to extend their philanthropic gesture to help us tackle some disability-related issues, but they may find it difficult to do so, without having some vital statistics on disability. This information is very important, as it does not only help in designing projects that will contribute to improving the lives of people with disabilities, but also to achieving other Millennium Development Goals. Whether our data is meant for the purpose of national, local or international support, such statistical disability information will also serve as a baseline when evaluating the outcome of any proposed interventions.


In tackling disability issues, we need to consider where the resources to gather and collate our disability figures will come from, as this undoubtedly represents a conundrum, in the midst of limited financial resources, and competing priorities. However, it is a challenge that could be easily accomplished through the newly created Primary Health Care Commission. The commission consists of Peripheral Health Units, which could collaborate to raise awareness about disability issues, throughout society and even at a family level. At the same time, these individual catchment agencies can be charged with the responsibility to register and collect details of people that suffer from disabilities, within their respective localities.

 

Depending on the reliability and validity of such an exercise, it will enlighten us about how many disability cases exist. Such figures would encourage all potential stakeholders to create or adopt a framework for assessing the health and social care needs of people with disabilities. Most importantly, the assessment of health and social care needs should not only be based on a normative or comparative perspective, but that which also reflects the felt and expressed needs of people with disabilities. This is our best way forward! Because, it is the most appropriate means of knowing which services/projects are to be designed, to respond to the burden of disability that is affecting our beloved nation.

 

The pronouncement of our Honourable Minister of Lands Cpt. Allieu Pat Sowe, that the government had allocated acres of land, at Yams Farm, to inhabit people with disabilities is a laudable indication that the president and his government have a critical role to play in supporting people with disabilities. However, the government should also ensure that its effort to alleviate the sufferings of people with disabilities, by trying to meet their housing need, is not seen as being counter-productive. To avert this kind of situation, the government needs to be putting some mitigating strategies in place, which will discourage recipients from mismanaging their lands. It is advisable that, any land given by the government to these beneficiaries be exclusively inhabited by people with disabilities and their families; and not by any other private individual; as this may create a foundation for people with disabilities to lose their land.


Through this land allocation, the Ministry of Lands has created a foundation and a good lead for people with disabilities. Understandably, the president cannot do everything at the same time; as there are other strategic national issues to address. But collectively, other government departments should also devise programmes, in support of disability. 

 

The issue of disability is a remit for our social welfare and health sectors; as paying for healthcare acts as a major barrier to people with disabilities. Therefore, both the Ministries of Social Welfare and Health could collaborate or act individually to table a parliamentary motion for free access to healthcare for people with disabilities.


In retrospect, however, I would respectfully urge President Ernest Bai Koroma to express his statement of intent about free healthcare for people with disabilities. Apart from mobilising government sectors, a statement of intent, could also attract many other benefits, including support from the private sector, as well as many other donor agencies that are empathic to the needs of this vulnerable group. There could also be a scope, for the government to benefit from training on disability issues, provided by the Commonwealth Secretariat, in support of countries, on capacity building and institutional framework to address the plights of persons with disabilities in the commonwealth.

 

If we are all serious about disability issues, we should all endeavour to start from somewhere. In my opinion, we need to have a clear understanding of the issue; know its incidence and prevalence rate, with a view to designing a care programme that will promote and safeguard the interest and well being of people with disabilities.


Mr. President, people with disabilities have waited, for far too long, for an improvement to their quality of lives. Sierra Leoneans at home and abroad; civil societies and the international community are all waiting for a response to the plea for free access to healthcare for people with disabilities. 


His Excellency, we could make a huge difference by creating what never existed as you have already done for pregnant women, lactating mothers and children under five. So, introducing a free healthcare programme for people with disabilities, as your bequest, would not only encourage other actors to contribute to tackling disability issues, but will also clearly demonstrate that you truly care about the plight of people with disabilities in Sierra Leone.

 

Author:

Ajan Fofanah is based in London, and works for the British National Health Service. He specialises in Public Health & Programme and Project Management, and is currently a scholar of Medical Law & Ethics (LLM). Ajan is also a patron of the Messeh Partnership Trust (MPT) in Sierra Leone.


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