The coronavirus disease 2019 (COVID-19) pandemic continues to cause a trail of destruction globally. In the full wake of the pandemic in Kenya, a disproportionate effect is most likely to be among the vulnerable groups, such as the 918,270 people living with disabilities (PLWD) in the country. According to Kenya National Bureau of Statistics (2019) Census report, women with disability in the country are 523,883 while 394,330 are men. Majority are living in the rural areas, with only 179,492 living in urban areas – mainly in dense, poor and unserviced informal settlements – rendering them more vulnerable to the COVID-19 pandemic.
1. Unique PLWD needs in the COVID-19 era
PLWD are more vulnerable due to the nature of their disabilities. Lack of mobility is the leading disability in the country, followed by those visually impaired and cognition. Others are mental, intellectual, or sensory disabilities. COVID-19 pandemic puts all these categories of PLWD at risk of increased morbidity and mortality. In the current crisis, they are less likely to access health services, and more likely to experience greater health needs, worse outcomes, and discriminatory laws and stigma than other demographic groups in the country. With the limited Government capacity to respond to COVID-19, historical evidence points to the likelihood of PLWD being the least likely to be targeted with the interventions.
The country must therefore ensure that the unique needs of PLWD are considered in the ongoing COVID-19 containment and response planning. Interventions against the pandemic should be available and accessible to the PLWD in high quality and acceptable manner.
Public health messaging ought to also target PLWD and other vulnerable groups and should be disseminated in simple language across all the accessible formats. Strategies for vital inperson communication should be safe and accessible for persons with disability – in braille, sign language and large print. Although it is commendable that daily ministerial and periodic presidential addresses use sign language interpreters, wearing of transparent masks by communicators and health-care providers is encouraged to allow lip reading.
Physical distancing or self-isolation mechanisms – including the mandatory quarantine, the night curfew and movement cessation into and out of Nairobi and parts of the coastal strip – are already disrupting service provision for PLWD in those areas, who often rely on assistance for delivery of food, medication, and personal care. It is feared that escalation of these measures into full national lockdown would adversely affect majority of PLWD who reside in rural areas.
The Government of Kenya and all duty bearers should therefore design the mitigation mechanisms not to lead to the segregation or institutionalisation of PLWD. Community level protective measures should be prioritized in the alternative, allowing care givers to continue to safely support PLWD, enabling them to meet their daily living, health care, and transport needs, and maintain their employment and educational commitments.
2. Important public health measures
The main public health measures that should propagated to curb the spread of COVID 19 are as follows:
- Improved accessibility to hand washing areas with running water and soap so that PLWDs are able to use the facilities without assistance.
- PLWDs should embrace having hand sanitizers with them at all times. They should sanitise their assistive appliances like wheel chairs and crutches to ensure that they are not carriers of the virus.
- Use of gloves should be encouraged and the same be frequently sanitized. The assistive devices should be washed with water and soap once they reach home. Caution should be exercised if gloves are used. PLWD should ensure they do not touch their face with the gloves.
- Handwashing should be encouraged for personal assistants, parents, guardians of persons with disability who assist them frequently.
- Persons with visual impairments who have to use touch to tell their environment should be encouraged to use gloves and if possible, to avoid touch of people and surfaces all together to prevent COVID 19 transmission.
- Use of masks throughout by PLWD depending on their disability, preferably one with an elastic to the ears to avoid frequently having to put it in place. Some may need assistance to put on again, so once assisted it should remain in place. Depending on the type of disability, some persons with disabilities have personal assistants, who also have to put on a mask, so that they do not infect the persons with disability and vice versa.
- Social distance; currently it is recommended to be 1 metre away, and lately some say 1.5 metre away from each other. This may be difficult especially for persons with disability who require someone to constantly be around them for assistance. This being the case depending on the disability, both the aide and the person with disability should be in a mask. They should have a sanitizer to constantly sanitize their hands. Staying home, remains the best option for all including PLWD.
PLWD in Kenya are indeed at increased risk of severe acute respiratory syndrome coronavirus infection or severe disease because of existing comorbidities, and are additionally facing traditional barriers to health care during the current pandemic. Health-care staff ought to be provided with rapid awareness training on the rights and diverse needs of this group to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision. The Government should ensure that COVID-19 mitigation mechanisms are inclusive of PLWD to ensure they maintain respect for dignity, human rights and fundamental freedoms, and avoid widening existing disparities.
Of necessity, this includes accelerating efforts to include these groups in COVID-19 containment and response planning. It will require diligence, creativity, and innovative thinking, to preserve Kenya’s commitment to UHC, and ensure PLWD are not forgotten.
Disclaimer: All views expressed here are that of the author and do not necessarily represent views/opinions of any entity or agency.
a Public Health and Disability Inclusion Expert