Zimbabwe Day 2: Prosthetics and Policy

My second day in Zimbabwe was spent seemingly entirely in taxis as I was ferried from one place to another in search of my appointments.  In the morning, I visited an NGO service provider, Jairos Jiri, and in the afternoon an advocate for persons with disability, the Disabled Women’s Support Organization.

The Jairos Jiri Orthopedic Workshop is one of the facilities in Zimbabwe that produces prosthetic devices for amputees.

Products of Jairos Jiri's Orthopedic Workshop

Products of Jairos Jiri’s Orthopedic Workshop

The workshop had a staff of eight on the day I visited, five technicians, a cleaner, an accountant and the director.  The technicians and the accountant are persons with disability and while the Workshop wasn’t intended as a sheltered program, that’s how it has developed.  Some of the technicians have been with Jairos Jiri for more than twenty years and produce high quality items with less than ideal resources.  For wheelchairs, they accept donated chairs and then re-furbish them, customized to the client.  For prosthetics, they conduct an initial assessment, measure, fabricate and then fit below-knee and above-knee prostheses.

Gilbert, Director of the Orthopedic Workshop, holds up a new prosthetic leg.

Gilbert, Director of the Orthopedic Workshop, holds up a new prosthetic leg.

The technicians are also able to produce orthopedic shoes and assist with adjustment of crutches.

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Unfortunately, Jairos Jiri is not able to provide these items free of charge.  Because the raw materials for prosthetics need to be imported, there is some cost to the client; wheelchairs, even though they are made from donated parts may still cost US $100 (compared to $250 – 300 for new).  For some clients, medical aid is available reducing the cost, but there is still an out-of-pocket expense for clients.  Gilbert, the Director of the Workshop, estimates 10 people come to the workshop every day for consultation or assessment, but only a handful of those are able to purchase the products, even at the reduced rates offered by Jairos Jiri.

On top of the costs, the facility itself is a fair distance from the center of Harare and far from public transportation options.  When I visited at the Workshop, I saw the technician who makes the shoes arriving in a hand-cranked wheelchair. The Workshop is about 300 meters from the main road, up a fairly steep slope which is potholed and broken.  And this, for residents of Harare, is the most affordable options for prosthetics and mobility devices.

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Rejoice Timire, Disabled Women’s Support Organization

In the afternoon, I met with Rejoice Timire, the head of the Disabled Women’s Support Organization (DWSO).  Our meeting took place in an internet cafe which Rejoice uses as a base of operations to keep overhead costs to a minimum.  With over 5,000 members, DWSO is an active advocacy organization for women’s rights and disability rights in Zimbabwe, working with both communities to amplify its voice. DWSO was one of the disabled people’s organizations in Zimbabwe that successfully pushed for Zimbabwe’s accession to the Convention on the Rights of Persons with Disabilities (CRPD).  Now, the DPOs must push for localization and implementation of the CRPD by the Department of Social Welfare, the focal point for the CRPD.

In the past, Rejoice and DWSO members participated in a peer support outreach program at the local hospitals.  The program focused on persons who suffered from spinal injuries and other traumatic injuries and sought to help them understand and accept their condition, to “welcome them to our world,” as Rejoice described it.  Due to funding, this worthy program has been discontinued.

Disabled Women’s Support Organization conducts awareness raising activities, one of the largest will be next month’s Disability Explore which is attended by members of Parliament and organized with assistance from the Disability Desk in the President’s office.


Persons with disability might be losing out in the SDG Framework

The Sustainable Development Goals (SDGs) will be formalized later this year and serve as the guiding framework for development through 2030.  United Nations Secretary General Ban Ki Moon has made the SDGs a cornerstone of his legacy and a tremendous amount of effort has gone into the drafting and design of the Goals.  At present, there are 17 proposed Goals and some 169 indicators and Ban’s recent Synthesis report of the SDG process has re-affirmed the proposed goals and indicators (although Ban did try to simplify the presentation of the Goals by aligning them under six themes).  The next major milestones in the SDG process are the High level thematic debate on implementation next month and the financing meeting in the Ethiopia capital, Addis Ababa, in July.  After the Addis meeting, the Goals will likely be finalized and approved in September at the meeting of the United Nations General Assembly.

I have written previously about the opportunity that the Sustainable Development Goals posed for mine action and specifically landmine survivor assistance.  With the stated aim of leaving no one behind, the Goals and indicators offer a framework for ensuring that everyone benefits from development.  However, because the Goals are so broad, I fear that leaving some behind will be very possible.  At this point in the negotiations, the Goals and indicators are relatively final, but the means to achieve the Goals are still to be decided; the Addis financing meeting should resolve much of the uncertainty.

One of the major criticisms of the Millennium Development Goals (MDGs, which are the predecessor of the SDGs) was the absence of any mention of disability.  Since 2000 when the MDGs went into effect, the international community negotiated the Convention on the Rights of Persons with Disabilities and the participants in the creation of the SDGs recognized the importance of specifically including disability and persons with disabilities in the SDG framework.  Disability is mentioned in all three major documents released in the SDG process, the report of the High Level Panel of Eminent Persons (May 2013), the Open Working Group’s proposed Goals and indicators (August 2014), and the Secretary General’s Synthesis report (December 2014). A special session of the United Nations General Assembly also discussed the inclusion of persons with disability in development and made recommendations to the SDG process.

However, in reading and re-reading these three key documents, I felt that the importance of disability inclusive development was being lost.  A content analysis of the documents suggests the same.  I reviewed all three documents for mentions of major groups that had been highlighted for inclusion in the SDGs: Women & Gender, Youth and Children, Persons with Disability, and other Vulnerable persons.  In the report of the High Level Panel of Eminent Persons, disability was mentioned once for every six mentions of women or gender.  This ratio improved in the Open Working Group’s proposal where disability was mentioned once for every three mentions of women or gender.  However, in the Synthesis report, disability is mentioned only once for nine mentions of women or gender.  A similar pattern is seen when comparing disability to youth and children: disability receives one mention for every 7.5 mentions of youth and children in the High Level Panel’s report; one mention for every three mentions in the Open Working Group’s proposal; and only one mention for every eight in the Synthesis report.  Persons in vulnerable situations consistently received a similar number of mentions as persons with disabilities.

Figure 1 shows the relative percentage of mentions of the four categories selected for content analysis in the three documents:

Disability in the SDGs Chart

The chart shows that while the Open Working Group’s proposed Goals and indicators recognized the needs of persons with disabilities and persons in vulnerable situations, the High Level Panel focused more attention on youth and children and the Secretary General has focused more attention on women and gender.

The diminishing focus on disability is not just a measure of the number of mentions, but also the content of those mentions.  The High Level Panel of Eminent Persons’ report, while featuring few mentions of disability, recognized the importance of disability in the proposed development framework and the Panel sought input from persons with disability, reporting:

People with disabilities also asked for an end to discrimination and for equal opportunity. They are looking for guarantees of minimum basic living standards.

The High Level Panel put persons with disability on the same level as gender and ethnicity when speaking about the importance of leaving no one behind:

The next development agenda must ensure that in the future neither income nor gender, nor ethnicity, nor disability, nor geography, will determine whether people live or die, whether a mother can give birth safely, or whether her child has a fair chance in life.

In contrast, Ban Ki Moon’s Synthesis report declared, “This is the century of women: we will not realize our full potential if half of humanity continues to be held back.”  Ban’s report then added a series of other groups whose full potential has not been met: “We also need to include the poor, children, adolescents, youth, and the aged, as well as the unemployed, rural populations, slum dwellers, persons with disabilities, indigenous peoples, migrants, refugees and displaced persons, vulnerable groups and minorities.”

Ban tasks the development framework to “remove obstacles to full participation by persons with disabilities” and states that:

[The] strength of an economy must be measured by the degree to which it meets the needs of people, and on how sustainably and equitably it does so. We need inclusive growth, built on decent jobs, livelihoods and rising real incomes for all and measured in ways that go beyond GDP and account for human well-being, sustainability and equity. Ensuring that all people, including women, persons with disabilities, youth, aged, and migrants have decent employment, social protection, and access to financial services, will be a hallmark of our economic success.

The High Level Panel gave agency to persons with disabilities, and called for the inclusion of disabled peoples organizations in civil society discussions.  The High Level Panel did not declare a “century of women.” Ban’s report focuses on women over other sectors of society, including persons with disability and talks about the role of the international community and the development framework for “removing obstacles” and “ensuring access” but did not discuss how to do so, especially in light of the discrimination persons with disability described to the High Level Panel.

The international community will meet in February and July to discuss the implementation and financing of the Sustainable Development Goals. However, with the Secretary General’s Synthesis report as the most recent overview document, the diminishing focus on disability worries me. There is a movement to create a Global Financing Facility for maternal and child health that will support the SDGs related to women’s and children’s health (World Bank) and the Addis financing meeting will presumably offer other financing mechanisms to achieve the Goals.  Advocacy and activism is important to ensure that implementation measures and financing schemes proposed in the next few months are inclusive of persons with disability. I fear that efforts on behalf of women and children will take precedence over those for persons with disability (and as the Secretary General’s Synthesis report shows, women have a very strong champion).  The disability community applauded the Open Working Group’s recommended goals and indicators for their inclusiveness, and now the community must mobilize to ensure that the financing and implementation measures agreed in Addis are similarly inclusive.

Michael P. Moore

January 5, 2015

moe (at) landminesinafrica (dot) org