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People with disabilities face stigma because of their impairments. They are often marginalised, more so if they have psycho-social disabilities. This makes it difficult for them to access basic services such as healthcare.
But community based workers have specialised skills and experience working at a household and community level. They are able to identify, screen and support vulnerable individuals and families. These workers are part of an essential service in health systems across Africa. They include community health workers, home based carers, community rehabilitation workers and community development workers.
We conducted a study in three rural communities in Botswana, South Africa and Malawi. We found that community rehabilitation workers, community development workers and community health workers bridged the gaps between people with disabilities, their families and services at district level. They worked in communities and were able to help authorities identify families with a person with a disability.
Community based workers are able to build trusting relationships with people with disabilities and their families. This support helps reduce their anxiety and allows them to participate in community campaigns and events. In doing so, their dignity and sense of belonging in their families and communities is restored.
South Africa’s disaster management plan for COVID-19 targets the most vulnerable. But it needs to respond in a more deliberate way when it comes to people with disabilities. To do this, it needs to harness the critical mass of community based workers as key links to help reduce community transmission of the virus.
Community based workers
A national study on young people with and without disabilities in South Africa showed that community rehabilitation workers are able to reduce inequalities in access to health and social services. They can do this through health literacy and activism, and mobilising community resources through co-ordinated action with the different government departments.
This is why this cadre of worker is well placed during the COVID-19 crisis. They can help ensure that people with disabilities are not left behind in screening, testing and referral to health services. This is particularly important given that many are more vulnerable to ill-health and dying.
Community rehabilitation workers are able to ensure that people with intellectual disability get easy-to-read information about the virus. This includes mitigation strategies and hygiene rules.
Community rehabilitation workers can also raise these matters with community radio station and journalists. This would ensure that it reached vision impaired and blind people.
They are also able to provide emotional and spiritual support to people with disabilities and their families. This is particularly important for mothers or caregivers of children with disabilities.
Many people with disabilities are self employed or in informal employment. This means that they have to be included in government and non-government initiatives around income protection. Community based workers are able to access the necessary information that will help people with disabilities to submit forms to the relevant authorities.
In addition, community based workers have links with networks and organisations. This can help them to access relevant information about government’s stimulus packages and interventions for small and medium enterprises. They provide a conduit for information about these resources. They are also able to do early identification (screening, tracing), deal with food security (they know which families are most in need and at risk). They can also ensure continuity of referrals not only for rehabilitation and medical needs, but for creating links to economic resources through government’s assistance to small and medium enterprises.
Community based workers act as critical catalysts in improving the access to health, social and economic development as well as education resources. In turn, this facilitates integration into existing services.
Their skills, abilities and competencies are integral to the human resources for health workforce. These need to be harnessed in flattening the curve of the COVID-19 pandemic.
At the same time, the mental health and wellbeing of these community based workers and caregivers also needs to be prioritised. They also need personal protective equipment such as gloves, masks, sanitisers and aprons.
Kashifa Abrahams, a researcher in the South African parliament, contributed to this article.
Theresa Lorenzo, Professor and PhD programme convenor, Division of Disability Studies, and co-lead of Inclusive Practices Africa, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town; Anthea Hansen, Lecturer, University of Cape Town; Harsha Dayal, Research Associate, Africa Centre for Evidence, University of Johannesburg, and Sumaya Gabriels, Lecturer, University of Cape Town