According to the united nations (un), the world population reached 7 billion in 2011, with the vast majority (5.8 billion) living in less-developed regions.1 In that same year, the World Health Organization (WHO), in partnership with the World Bank, published the first-ever World Report on Disability (WRD), identifying that about 15% of the world's population lives with some form of a disability. This fact suggests that the prevalence of disability is rising; possible causes include an aging population, chronic disease spread, and improved methodologies to measure disability.2 This translates to over 1 billion people living with a disability, 80% of whom live in the developing world.3 Lower-income countries have been found to have a higher prevalence of disability than high-income countries.3 It is well recognized that persons with disabilities experience poverty more intensely, have poorer health outcomes, and face barriers to access education, employment, and health services. In many low-income countries, where even basic health care needs are often unmet, rehabilitation is not a consideration of national governments and rarely is prioritized. Even within the health care systems and professional schools, rehabilitation is poorly understood, underresourced, and lacking in training curricula.4 However, with the grass-roots movement of the disability community that led to the UN Convention of the Rights of Persons with Disability in 2006 (Fig. 101–1),5 there has been an attitudinal shift globally in the recognition of the value of persons with disabilities, as well as the importance of sustainable rehabilitation training, services, and care in all sectors. This chapter will introduce the role of rehabilitation in developing countries, describe the unique needs, challenges, and successes connected with it, and provide an overview of initiatives and resources addressing advocacy, assistive devices, education, research, and humanitarian efforts.
Source: Article 26 of the UN Convention on the Rights of Persons with Disabilities.
STATE OF HEALTH CARE FOR PERSONS WITH DISABILITY IN THE DEVELOPING WORLD
While globally, there has been encouraging progress in health, with people living longer and fewer living in extreme poverty, vulnerable groups continue to fall further behind. In most societies, people with disabilities are among the most marginalized, facing discrimination, stigma, and inaccessible environments.6 In response to the WRD, and in consideration of the UN Convention on the Rights of Persons with Disabilities (Fig. 101–1), the WHO prepared a global action plan for disability for 2014 to 2021 (Fig. 101–2). In this document, the WHO states that “disability is a development priority,” with higher disability prevalence in lower-income countries and the perpetual cycle of disability and poverty reinforcing each other. Affordability is the primary reason for lack of access to health care among persons with disabilities in low-income countries.2 Poverty heightens the risk of impairments through poor health care, nutrition, ...