In 2014, Madagascar partnered with the World Health Organization (WHO) to implement the Disability Action Plan. While there are no specifics on the number of disabled persons in Madagascar, an article in the Journal of Rehabilitation Methods estimates that about 2.8 million persons with disabilities exist in the country. The goals of the Action Plan are to increase access for persons with disabilities to health care services and programs, extend support services and rehabilitation and strengthen data collection on disability so it can be compared internationally. Organizations such as Humanity and Inclusion have also been working to improve the correlation between disability and poverty in Madagascar.

Access to Rehabilitation

The regions around Madagascar have about 1.6 physicians for every 10,000 people, whereas Madagascar has about 1. Eight rehabilitation specialists received training through “A Rehabilitation Training Partnership in Madagascar” in 2015, contributing to the now 10 total specialists in the country. This means limited access to medical professionals trained in rehabilitation for persons with disabilities.

Rehabilitation for people with disabilities can span from fitting them with orthopedic limbs and hearing aids to providing people with mental disabilities education on how their disability affects them as well as how to work with it in their daily lives. Sufficient rehabilitation for persons with disabilities was low in 2011, with The World Health Organization reporting that about 3% of people received it globally. People often view disability and poverty in Madagascar, and globally, as a cycle. A 2017 study called “Poverty and disability in low- and middle-income countries: A systematic review” reported that poverty and disability appear to exist in a cycle in lower and middle-income areas, where poverty can lead to disability and disability can lead to poverty.

How Disability Impacts Poverty

According to “A Survey of World Bank poverty Assessments” by Jeanine Braithwaite and Daniel Mont, when receiving the same income as persons without disabilities, persons with disabilities will have a lower standard of living. This is due to the different needs of persons with disabilities. Braithwaite and Mont’s studies into disability in developing countries revealed that households with persons with disabilities were slightly more likely to be in poverty.

How Poverty Impacts Disability

Poverty has limited access to health care in Madagascar. About 75% of Madagascar’s population lives below the international poverty line, according to The World Bank. The cost of health care, and transportation to health care centers, can be barriers for people in poverty to accessing treatment. USAID reported that less than 40% of Madagascar’s population lives within an hour’s walk, or 5 kilometers, from a health care center, meaning many people face additional transportation costs when they need to access health care.

A study about the barriers to implementing the Disability Action Plan in Madagascar stated that of “disability-adjusted life” in 2004, non-communicable diseases caused 29%. The report concluded that the data correlates with limited access to treatment, revealing a link between disability and poverty in Madagascar through the way that poverty impacts health care access.

Solutions

Madagascar has previously passed the Law on Disability, which promoted the freedoms and equal rights of persons with disabilities. The National Decade of Disabled Persons, a time frame in which the government would work to improve conditions for those with disabilities, was ratified in Madagascar in 2002 and ran from 2003 to 2013. Since passing those pieces of legislation, Madagascar has been working to implement The World Health Organization’s global Disability Action Plan since 2014. Expectations have determined that it will wrap up in 2021.

The country has already made some strides toward completing the program and impacting disability and poverty in Madagascar. In 2015, Madagascar ran a workshop and training program in partnership with Leeds Teaching Hospitals NHS Trust, which the Rehabilitation Medicine in Madagascar and a counterpart in the United Kingdom then delivered. This workshop trained and licensed eight new doctors. The doctors have now created the Association of Physical and Rehabilitation Medicine of Madagascar (AMPRMada), which has created a database for Madagascar rehabilitation centers to use. Today, according to an AMPRMada report, its database greatly helps rehabilitation planning nationally because it provides a single place to access all the rehabilitation centers’ data.

Humanity and Inclusion have also been working to improve the lives of persons with disabilities in Madagascar. The organization has been in Madagascar for 30 years. One of its ongoing projects focuses on ensuring persons with disabilities have access to adequate rehabilitation by:

• Examining barriers to accessing rehabilitation services
• Assessing the related economic areas
• Setting up and improving rehabilitation services and “orthopedic fitting,” which means ensuring things like prosthetic limbs and metal braces fit patients correctly
• Looking into increasing “education, training, and networking” in order to increase the number of rehabilitation workers
• Improving funding for rehabilitation services
• Keeping track of how the “National Rehabilitation Plan” progresses
• Raising awareness

A report that details the progress of ongoing Humanity and Inclusion projects estimated that, when it is completed, its rehabilitation project will benefit 5,000 people, 47% of whom are children with disabilities.

Looking Ahead

It can sometimes be hard to calculate the effects of disability in Madagascar due to a lack of data. Research studies have, however, been able to estimate the number of disabled persons and the link between disability and poverty in Madagascar. Through the country’s legislation and partnerships with outside organizations, such as the World Health Organization, Madagascar is continuing to address and attempt to improve access to health care and rehabilitation for persons with disabilities. Organizations like Humanity and Inclusion have been contributing to those changes with ongoing projects that address access to rehabilitation services for persons with disabilities.

– Melody Kazel
Photo: Flickr