The problem.

Kenya, with a population of approximately 56 million, faces a notable challenge in addressing the needs of individuals living with disabilities, constituting over 2.2% of the total population with 1.9% of men and 2.5% of women grappling with some form of disability. Further analysis of prevalence rates indicates disparities between urban and rural populations, with 2.6% of individuals in rural areas reporting disabilities, compared to 1.4% in urban areas.

Examining disabilities by domain sheds light on the specific challenges faced by this population. Mobility is the most reported difficulty, representing 29% of the overall disabled population. Additionally, other domains such as sight, hearing, cognition, and communication contribute to the diverse landscape of disabilities, affecting individuals at rates ranging from 25% to 8%. Notably, albinism, a condition experienced by 0.02% of Kenya's population, adds a unique dimension to the spectrum of disabilities.

The distribution of disability by county highlights significant disparities in the demand for rehabilitation services, with notable spikes observed in specific regions. Counties such as Embu, Homabay, Makueni, and Siaya stand out, indicating an elevated need for disability-related support and services.

Why?

The concentrated disability prevalence in specific counties, such as Embu, Homabay, Makueni, and Siaya, highlights a pressing need for interventions. The uneven distribution of disabilities emphasizes the urgency for targeted efforts and resource allocation to address the unique challenges faced by individuals in these areas. Without interventions, these disparities may perpetuate unequal access to services, potentially impeding the overall well-being and inclusivity of affected populations.

Below is the unmet assistive devices gap by domain.

The convoluted pathway to accessing Assistive Technology (AT), marked by challenges in service delivery, supply chain, and financing, underscores the critical need for a comprehensive intervention. Service delivery hurdles, including limited availability of services in public health facilities and skill gaps in healthcare personnel, create barriers to accessing necessary care. Additionally, the supply chain faces challenges due to policy gaps and inadequate availability of quality AT products. Financing remains a major obstacle, with AT and rehabilitative services lacking priority in national financing schemes and county development plans, leaving individuals to finance these services out of pocket.

In response to these challenges, the AT program aims at streamlining access to AT and rehabilitative services. By addressing service delivery limitations, integrating AT into the national supply chain, and advocating for increased financial prioritization, the program seeks to alleviate the burden of consequential health conditions and empower persons with disabilities. This comprehensive approach not only addresses immediate accessibility challenges but also contributes to fostering a more inclusive and supportive environment for the overall well-being of individuals with disabilities throughout the country.

TRANFORMATIONAL IMPACT

CHAI is actively partnering with the Ministry of Health (MOH), the State Department of Social Protection, various counties, and key state agencies such as KEMSA and NCPWD to drive transformative changes in the disability landscape. The main objective of this initiative is to enhance accessibility and inclusivity for individuals with disabilities.

The Program has set ambitious goals for the next three years, aiming to increase access to over 300,000 units of AT and enable more people with disability access to rehabilitative services. The program's strategic focus lies in scaling up of AT and rehabilitative services across four domains: Physical/Mobility, Vision, Hearing, and Communication. This expansion will be achieved by increasing access to specific AT devices, including wheelchairs, prostheses, spectacles, low vision devices, braille, orbit readers, note takers, hearing aids, communication boards, and smart eye-gazes.

Key Action Points-2023

1.The expansion of access to 60,000 units of Assistive Technology (AT) is currently underway across various domains.

a. Visual Domain: High plus spectacles (50 pairs), Filters (100 pairs), Readers (3000 pieces), Low Vision assessment tool kits for referral facilities in 37 counties, Low vision telescopes (90 pieces), Magnifiers (100 pieces), training on the International online library for individuals with print disabilities, Braille kits (400), Lego Braille bricks (90 pieces), White canes (1000 pieces), 100 units of Braille Machines for primary and high school education, Adapted Laptops installed with JAWS, Digitization of textbooks (500 titles), Portable screening and diagnosis tool kits for referral facilities in 37 counties. These resources aim to extend user identification beyond facilities into communities and schools.

b. Mobility/Physical: The procurement initiative for 1000 wheelchairs is currently underway, with a 60/40 allocation for basic and intermediary wheelchairs. The distribution of these wheelchairs will prioritize counties with the highest identified needs based on available data. Additionally, the procurement of prosthetic materials and accessories is in progress.

c. Hearing: We are currently identifying suppliers for Berra machines, hearing aids, screening audiometers, and diagnostic audiometers. These devices will be strategically placed in five counties to address the needs of individuals with hearing impairments.

Other devices for various domains are under consideration for procurement in the first quarter, demonstrating our commitment to enhancing assistive technology accessibility.

2.Advancing the Scope of Rehabilitation Services Nationwide.

Status: The past year marked a foundational phase, where our primary focus was on establishing structures conducive to the coordination and implementation of rehabilitation efforts. Emphasis was placed on strengthening the governance, coordination, and human resource aspects of the program. Fundamental policy structures essential for executing supply chain interventions, such as the Assistive Technology (AT) priority listing, was developed. Additionally, efforts were directed towards comprehending the existing models of care and services at the national referral hospital. The groundwork included the preparation and execution of a baseline survey to support the selection of beneficiary facilities and identify key areas under the three main modules of the project.

Furthermore, the three sub-committees have reviewed the workplan, aligning activities to be executed by the Ministry of Health (MOH) and stakeholders. Domain-specific costed annual work plans have been formulated, consolidating into a comprehensive national annual work plan with sequenced activities that will guide the entire program. Drafts for Monitoring and Evaluation, facility reporting tools, including both daily activity registers and summaries, as well as domain-specific guidelines and protocols, have been developed.

3.Capacity Building for Healthcare Workers (HCWs): Training Initiatives Across Multiple Domains.

Progressing towards our goal of upskilling healthcare workers (HCWs), we have initiated training for 20 individuals in long-term courses spanning various domains. Specifically, 10 individuals are undergoing training in physical health, 2 in audiology, and 8 are being trained in visual.

a) Audiology and Hearing Aid Technology: 2 students

b) Ophthalmology and Cataract Surgery: 6 students

c) Ophthalmology, Refraction, and Low Vision: 2 students

d) Orthopaedic Technologist: 10 students

Our target is to train a total of 118 students over the course of three years. This ambitious plan is structured as follows:

4.Integration of Play Therapy at 10 Service Points by the End of the Year.

Our current emphasis has been on formulating a comprehensive implementation plan to guide the entire process of integrating play therapy at designated service points as well as special needs schools. The development of this plan considers the entire patient continuum, with a specific focus on the identified cohort. This includes mapping out the pathway for early identification, screening, and implementing targeted interventions. The goal is to seamlessly incorporate play therapy into the existing framework at more than 10 service points by the end of the year.

Below is the pathway.

5.Seeking Additional Partnerships to Expand Wheelchair access.

The project is proactively seeking collaborations with new partners to augment the scaling efforts and surpass the distribution of wheelchair units beyond the initial target of 1,000. The vision is to foster alliances with diverse stakeholders who can align their efforts with ATscale to collectively achieve the project's goals. One pivotal focal point of collaboration centres around Assistive Technology Devices.

A strategic component of this vision involves leveraging donations of wheelchairs and eyeglasses from organizations such as the Latter Days Saints Charity and the Vision Catalyst Fund (VCF). This collaborative approach aims to bolster the accessibility of vital assistive devices for individuals with diverse needs.

Service Delivery:

• Expand rehab services nationwide, outlining services at different care levels and all domains.
• Introduce play therapy for children that allows for the development of physical, creative, emotional, social, and cognitive skills.
• Continue building healthcare workers' capacity for rehab services and AT.
• Advocating for Investment in early identification and diagnostics
• Complete the development of guidelines and protocols and disseminate to facilities.

Supply Chain:

• Launch of the Essential AT list to be used for KEMSA for procurements.
• Integrate AT into the national supply chain, support county forecasting.
• Introduce AT products, ensuring accessibility.

Data and Data Use:

• Work on Establish the reporting framework for rehab services. (Reporting tools etc)
• Develop a national Rehabilitation dashboard for partner mapping and policy makers.

Building A world of Play.

Background:

In the context of positive childhood development, play is acknowledged as fundamental. However, challenges persist, especially for children with diverse abilities in Kenya. The "Building a World of Play” seeks inclusivity for children aged 0-13, addressing barriers to enriching play experiences.

Problem Statement:

limited and unequal access to inclusive play affect children aged 0-13 with diverse abilities. Barriers include lack of guidelines, delayed disability identification, lack of assistive technology, scarce resources, and insufficient infrastructure. These issues impact mental, physical, and social development, exacerbating inequalities.

Transformational Impact:

The transformational impact of the "World of Play" project is multi-faceted, addressing key areas of childhood development and societal inclusivity.

1.Holistic Child Development:

• Service Delivery: The establishment of nationwide rehabilitative services, introduction of play therapy, and capacity-building for healthcare workers will contribute to holistic child development. Access to quality early childhood development services positively influences cognitive, social, and emotional well-being.

2.Inclusive Play Spaces:

• Accessible environments and assistive technologies are essential for the inclusion of individuals with disabilities.

3.Data-Driven Decision-Making:

• Data and Data Use: Establishing a reporting framework for rehabilitative services and advocating for AT.

4.Equal Opportunities and Social Inclusion:

• Developing a national strategic plan, creating sustainable systems, and establishing policies for inclusive play, align with global efforts to promote equal opportunities.

5.Environmental Sustainability:

• Integrating environmental sustainability into play space design aligns with global calls for eco-friendly practices highlighting the importance of sustainable development, including considerations for energy efficiency, waste management, and biodiversity preservation.

6.Early Identification and Intervention:

• Early identification and intervention significantly impact long-term outcomes for children with developmental challenges.

7.Community Engagement and Ownership:

• Emphasize on the importance of community involvement in health initiatives for lasting impact.

Project Goals:

1.Develop an Inclusive 3-Year National Strategic Plan for Building a World of Play:

• Conduct a nationwide needs assessment.
• Collaborate with stakeholders for diverse perspectives.
• Integrate international best practices into the plan.
• Establish clear metrics for progress.

2.Create Sustainable Education, Health, and Community Systems Incorporating Play through Assistive Technology:

• Embed play-based learning in school curricula.
• Collaborate with healthcare providers for integrated services.
• Engage communities in designing play spaces.
• Implement training programs for stakeholders

3.Development of National Policies, Guidelines, Standards, and Protocols for Building a World of Play:

• Collaborate with government bodies for inclusive play policies.
• Develop guidelines for accessible play spaces.
• Set standards for AT inclusion in play and education.
• Create protocols for monitoring and evaluation.

4.Develop Skills-Based Training Modules Across Project's Thematic Areas and Context:

• Identify core thematic areas.
• Design modular training programs.
• Deliver training through partnerships.
• Establish mechanisms for continuous development.

5.Develop National Strategies for Sustainable Green Play Spaces Across the Continuum:

• Promote eco-friendly design for play spaces.
• Collaborate for responsible waste management.
• Implement strategies for energy efficiency.
• Advocate for green play spaces in urban planning.

6.Design and Develop a National Pathway for Early Identification of Children Abled Differently for Inclusive Play:

• Collaborate with healthcare professionals for early identification.
• Conduct awareness campaigns.
• Establish referral pathways.
• Implement a data-driven system for tracking progress.