Twin-track approach to inclusive eye health in Pakistan

13 August, 2014 - CBM Australia

According to the new World Health Organisation (WHO) action plan, adopted in May by the World Health Assembly, people with disabilities should have access to all health services offered to the general population.

Last year, CBM updated and launched a ‘how-to’ guide on inclusive eye health, providing comprehensive guidance to eye care service providers to ensure that all people with disabilities can access adequate eye care services. We speak here with Dr Babar Quereshi, a medical adviser for CBM’s Eastern Mediterranean Region, about how CBM is working on inclusive eye health with partners in Pakistan.

A CBM inclusive eye health program in Pakistan.


CBM is working hard in Pakistan to spearhead inclusive access to eye health care. How have you been doing this? 

“We’ve been working with CBM partners and discussing inclusive eye health. We held partner workshops where our manual, Inclusion made easy in eye health programs, was discussed to ensure that our partners begin to implement inclusive practices in their projects and programmes. Implementation is going to be in phases and every year our partners will report their progress.”


How long will it be until changes are seen in practice?

“Since the first version of the manual was launched one or two partners have started to implement it. We’ve seen changes in physical access made to buildings and healthcare workers being trained in sign language. But it is too early to see big changes. We’ll probably see results coming over the next five years. Though of course some partners will implement things faster than others, it’s not a fast-track process.”


What about where CBM hasn’t got partners?

“We’ve been addressing inclusive eye health from two perspectives and the second part of our strategy has been to go to Pakistan’s national eye care programme. With our partners, we can only have limited reach. With the national programme we can implement in every single district of Pakistan. Government works slowly, but the infrastructure and reach is much bigger and so the impact will also be much greater and sustainable.”


How did you set about such an ambitious task?

“We went to a lot of advocacy meetings and made a lot of presentations with policy makers and the national committee on eye health – the Ministry of Health’s top policy body on eye care. Pakistan’s national eye care programme has been in operation for more than 20 years and every district of that country now has a state-of-the-art eye care programme. We said, ‘The essentials of the eye care programme are there, but what you need to do next is to make it inclusive for people with disabilities.’ ”


How open were policy makers to what you had to say?

“There was resistance but this wasn’t because people wanted to resist becoming inclusive, but because people weren’t clear what inclusion meant. They thought, ‘Are we now going to be looking after people with physical disabilities? Are we going to be doing hearing care?’ We had to explain that that wasn’t the idea. We had to say, ‘You are still involved with eye care, but we want people with disabilities to be able to access your services too.’

“Then it was like a curtain lifting off their eyes – ‘Oh that’s what’s meant by inclusion of other people with disabilities in eye care.’ It was about breaking what we want to see down into simpler, understandable pieces.

“The national committee has now appointed a task force to recommend to government the steps that need to be taken at all districts in Pakistan to make eye health inclusive, as well as to consider the cost.”


So what are the next steps in Pakistan?

“The next important challenge is considering who is going to actually put the recommendations in the manual into practice. For the partners it’s easier. They can look at their workplace and think of what they need to do and how they’re going to do it. For the national eye plan it’s about how they’re going to operationalise the whole programme.

I’ve been asked to work with the task force to break it down into small, achievable steps so implementation doesn’t become a monumental task. CBM can play an instrumental role in providing successful models of inclusive eye health in one or two districts.”


Are there any successful models you can point to at the moment in Pakistan?

“When the primary healthcare initiatives (PHIs) to reconstruct the flood-hit areas in the Union Councils of Charsadda,  Abazai, Bakook, Hassan Zai and Shack No 6. were launched after the severe flooding in the summer of 2010, we set about trying to make the PHIs inclusive. That was a good experience and people were very engaged, very motivated. We’ve since seen a massive influx of patients, and access to eye health by people with disabilities has improved by 200%-250%.”


What are the main challenges in implementing inclusive eye health programmes?

“Changing the mindsets of people about disability is the biggest difficulty – at a project, programme, national and policy levels. That’s what takes a lot of time and it shouldn’t be underestimated.

Just by having a workshop or sending people a manual doesn’t mean things will change. There has to be continuous reinforcement of the ideas so they begin to register people with disabilities as individuals, they need to consider when planning and implementing. There needs to be continuous advocacy, continuous mentoring.”


What’s next after Pakistan?

“We’ll be slowly taking the inclusive eye health programme out to other countries. Later this year we’ll carry out a similar exercise for the Middle East region. The whole region is aware of inclusive eye health care and the manual has already had good exposure there. It’s just a matter of closer follow-up in the implementation and facilitating understanding where it’s needed.”


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The right to a full life of faith

15 July, 2014 - Steph Gaut

I’m not sure why I was so taken aback – after all, the conference was labelled ‘Honest Conversations.’ But as I sat and listened, I realised I still have so much to learn about the value of inclusion…

CBM’s Luke14 Honest Conversations conference took place in Melbourne on July 10 and 11. Over two days, more than 100 delegates were propelled into a world of challenging truths and sometimes-confronting situations that encouraged people to share intimate thoughts and feelings about the current state of disability inclusion in Australia’s church communities.

In his opening address, guest speaker Jeff McNair highlighted the ways in which Christian communities often overlooked people with disabilities as valuable and valued participants.

Integration, Jeff championed, was “absolutely critical” to any kind of disability ministry or program – and you “better have a doggone good reason as to why you’re not fully including people if you’re not!”

Jeff McNair speaks passionately about disability and the church at Luke14′s Honest Conversations conference.


I could feel people shifting uncomfortably in their seats – I know I was. Our church absolutely includes people with disabilities! I was feeling silently indignant. We have programs for people with disabilities don’t we? And I’m sure other people here have special programs too that cater specially for people with disabilities.

It was almost as if Jeff had read my mind. Because he continued: “Many ministries are designed, to a lesser or greater degree, to be segregated. These ministries range from churches for people with a disability where those without a disability work within the ‘disabled church’ to serve to segregated ministries, and to programs experiencing varying degrees of separation. But for the church to be the Church, we must acknowledge that segregated ministries send the wrong message.”


Dr Shane Clifton guest spoke at the Honest Conversations conference about his life-changing experiences with acquired disability, and the importance of emotional and spiritual wellbeing.


It was a powerful message: that true inclusion occurs only when people with disabilities receive the same opportunities and experiences as people without disabilities.

The conversations flowed freely over the two-day conference; people were sharing their deepest and most intimate thoughts, sharing experiences of exclusion and how it made them personally feel, and bonding and learning through some incredible panel discussions and workshops designed to enhance your understanding of disability experience in the church.


Conference delegates learnt about different types of disabilities and the importance of an all-accessible church community.


Among new-found friends and some fabulous food, I realised that inclusion was about more than just ‘ticking the boxes’. People with disabilities have rights to worship, study the Word and serve others in whichever faith community they choose to do so with full access to and support from their wider community.

Here’s looking to more Honest Conversations next year!

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The Silent Barrier: sexual abuse and violence against women and girls with disability

27 June, 2014 - Rachel Wallbridge


Women like Oumou (left) and Bissara face the triple of being female, living with a disability and being amongst the poorest of the poor.

Women like Oumou (left) and Bissara face the triple of being female, living with a disability and being amongst the poorest of the poor.


Rachel Wallbridge is an Advocacy and Policy Officer at CBM Australia and has a particular interest in gender issues.

Preventing and addressing violence against women and girls as well as their empowerment and participation is a topic that has always been very dear to my heart, and last year it took me to work with a Pan-African NGO in Ghana, West Africa. While I was somewhat prepared for facing gender challenges, what I saw with women and girls with disability was something I was not prepared for.

Globally, violence against women is an epidemic and ending it will require all the will, drive and savvy political manoeuvring leaders and local activists can muster. Yet violence against women and girls with disability remains a brutal and silent barrier to the fulfilment of human rights. The impact of sexual abuse and violence against women and girls with disability remains to be adequately acknowledged and discussed in many mainstream gender discussions, at both a local and international level. For example, most of the highly publicised and hashtagged Global Summit to End Sexual Violence in Conflict in London failed to meaningfully acknowledge the unique threats facing women and girls with disability.


The problem

Women and girls with disability are often at greater risk of violence, injury, abuse, neglect, maltreatment or exploitation.[1] Violence against women and girls with disability not only causes physical, psychological and social pain, but it’s also a significant barrier to a woman or girl with a disability meaningfully contributing to and participating in family and community life.

The facts are sobering. Women with a disability are two to three times more likely to be physically or sexually abused than women without a disability.[2] Women with disability are also most vulnerable to abuse in their own homes,[3] and women with an intellectual disability are particularly at risk and are also less likely to seek refuge or access redress than women with physical impairments.[4]

Although women with disabilities experience many of the same forms of violence all women experience, the intersection of gender and disability means that violence takes on unique forms, has unique causes, and results in unique consequences.[5] For example, people with disabilities can experience abuse such as withholding essential care and medications.[6] Other abuses include physical, physiological, sexual or financial violence, neglect, social isolation, entrapment, degradation, detention, denial of health care, and forced sterilization and psychiatric treatment.[7]

Women with disability face additional barriers to justice that can magnify the effects of abuse and violence. Firstly, it can be more difficult for women with disability to leave a violent or abusive situation. This could be due to being care-dependent on the abuser, not being able to take children with her, inaccessible support services and transportation to leave, being physically unable to implement an escape plan or the inability of a shelter or support service to adequately provide for her daily needs.[8] Secondly, discrimination through the justice system means that women with disability may not be considered as reliable reporters or witnesses of crimes. In addition, prevailing social stereotypes may mean that women with disability can be dehumanised or excluded from the services.

It is important to also understand how violence and sexual abuse against women, including girls, can also be a cause of disability. For example, in the Kup region of Papua New Guinea, it has been reported that rape against young girls has caused serious injury and disability.[9]

An important related issue magnifying the impact of sexual violence and abuse against women and girls with disability is the inaccessibility of sexual and reproductive health care. Ignorance and attitudes from both the community and individuals (including health care professionals) represent one of the main barriers for women accessing this type of health care.[10] Society prejudices often assume women with disabilities are ‘asexual’ and are unable to manage their own sexuality and fertility.[11] This stigma and discrimination then affects the access, level and availability of sexual and reproductive health services.


Current protections and solutions

A rights-based approach uses human rights principles and conventions as guiding frameworks, and views people with disabilities as rights-holders as opposed to passive beneficiaries.[12] Like all people with disability, women and girls are protected under the United Nations Convention on the Rights of Persons with Disability (UNCRPD). The UNCPRD in Article 6 acknowledges the intersection of gender and disability, saying “state parties recognize that women and girls with disabilities are subject to multiple discrimination, and in this regard shall take measures to ensure the full and equal enjoyment by them of all human rights and fundamental freedoms.”[13] The convention also includes a specific prevision on the elimination of all forms of exploitation, violence and abuse, including their “gender-based aspects.”[14]

While the human rights of women with disability are protected under the UNCRPD, implementation remains a significant barrier. Attitudes and social stigmas present the largest barrier yet to the fulfilment and enjoyment of all human rights for people with disability. Women and girls with a disability face a triple threat: being female, having a disability and being amongst the poorest of the poor.[15]

A human rights approach to this issue will ensure that services including education and health are disability inclusive. This is done through a twin-track approach where disability is both mainstreamed throughout regular services as well as creating disability specific interventions that aim to increase the empowerment and participation of people with disabilities. A focus on disability inclusive development positively impacts those with disability as it helps work towards lowering the stigma and discrimination faced by people, including women.

The development of entire communities is dependent on the recognition and fulfilment of human rights of its entire people. Individuals and communities who perpetrate violence against women and girls with disability not only directly risk the health and lives of the women and girls within them, but also prevent the community from reaching its full potential.


[1] United Nations (2006) Convention on Rights of Persons with Disability, Preamble, Retrieved from

[2] United Kingdom Department for International Development (2000) Disability, Poverty and Development at

[3] Stephanie Ortoleva and Hope Lewis (August 2012) “Forgotten Sisters – A Report on Violence Against Women with Disabilities: An Overview of its Nature, Scope, Causes and Consequences,Northeastern University School of Law Research Paper No. 104-2012, 16.

[4] United Nations Population Fund (2013) A Deeper Silence and Pacific Sisters with Disabilities, 18.

[5] Ortoleva and Lewis (2012) “Forgotten Sisters,” 14.

[6] United Nations Population Fund (2013) A Deeper Silence, 19.

[7] Carolyn Frohmader and Stephanie Ortoleva, “The Sexual and Reproductive Rights of Women with Disabilities”, ICPD International Conference on Population and Development Beyond 2014, July 2012 see

[8] Pacific Sisters, 19.

[9] Pacific Sisters Report, 17.

[10] World Health Organisation and United Nations Population Fund Guidance Note, “Promoting Sexual and Reproductive Health for Persons with Disabilities” 2009, 1.

[11] Spratt, A Deeper Silence, 18.

[12] Key conventions include the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights, International Covenant on Economic, Social and Cultural Rights, UN Convention on the Elimination of All Forms of Discrimination Against Women, UN Convention on the Rights of the Child.

[13] UNCRPD, 2006, Article 6(1).

[14] CRPD, 2006, Article 16: Freedom from exploitation, violence and abuse.

[15] United Nations Population Fund, 2005, Promoting Gender Equality,

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World Environment Day: adapting to climate change

5 June, 2014 - David Lewis



It’s nearly 25 years, since I went with my family to work with CBM in Sierra Leone and then Niger in West Africa. I recall the courage of poor, rural people as they grew food for their families under very harsh and uncertain environmental conditions. The people with disabilities, their families and communities in our CBM program knew that their year’s food supply depended on good fertile soils, timely rains and gentle sunshine to ripen their crops.

Today is ‘World Environment Day’. It is a day when I reflect on creation and the beautiful environment we have been given. However it is also a day when I consider that the environmental situation for most of the world’s poorest people, including those I knew with disabilities in West Africa, is becoming increasingly harsh and uncertain.

The current situation:

In recent times, CBM has been consulting on environmental issues with Self-Help Groups of people with disabilities and their families, together with other development organisations. In both Cambodia and India, the poor, rural people who generously gave us their time all described similar issues.

There are more extreme weather conditions, with longer periods of drought and very hot days. When the rains do come, they often come with very intense storms causing flooding, washing away crops, livestock and good farming soil, and destroying homes and infrastructure.

Clean water for drinking and washing is becoming scarce, with water tables dropping to very low levels, not seen in the lifetimes of the old people.

Many community members are being forced to move to ‘low income settlements’ in the cities, because their land is no longer productive.

Unfortunately the issues described by these Self-Help Groups of people with disabilities are similar to those occurring in many parts of the world. These changing weather patterns and extremes are consistent with observed climate change.

The Self-Help Groups also described many other environmental issues. People with disabilities and their communities lack toilet facilities, and this creates hardship and poor security especially for women and girls going out for toileting in the bush at night.  They also lack firewood and other fuels for cooking, and at night many families don’t have any form of lighting, meaning that children can’t do their homework and advance at school.


IMG_1624_forWebCBM’s response:

Through Community Based Rehabilitation (CBR) programs we are working with people with disabilities and their communities so they can access innovative farming and gardening programs, helping them adapt to climate change and improving their food security and incomes.

We are part of programs and advocacy aimed at improving access to clean water and safe toilet facilities, with hygiene activities. These activities also help in preventing diseases which lead to disability.

CBM’s Emergency Response Unit is providing relief and recovery following severe weather events like Typhoon Haiyan in the Philippines,  and also ensuring people with disabilities are included in ‘disaster risk reduction’ activities, so that communities are better prepared for severe weather events.

At a global level we are working to ensure that people with disabilities are fully included in international programs seeking environmentally sustainable development. Within CBM itself, we are seeking to be good stewards of the world’s resources. We have joined worldwide efforts aimed at tackling climate change, and protecting and enhancing the beautiful environment we have been given.

Earlier this year, I felt very honoured to receive an Order of Australia Medal. However with this honour, I feel a very big responsibility to continue working with the world’s poorest people with disabilities, that they may live in safe, healthy environments which meet their needs for food, water, energy and other resources, and a happy family life.

This ‘World Environment Day’, please join us in this quest. Thankyou!

Check out how Oumou Moussa is helping to feed her community with the produce from a garden that she started with the help of CBM:




David Lewis is CBM Australia’s Strategic Programmes Director, and a recent recipient of the Medal of the Order of Australia for his work with the world’s poorest people with disabilities. In this post on World Environment Day, David explains how climate change is impacting the most vulnerable people, and what we’re doing to help them adapt and thrive in changing environments.

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People with Mental Illness are starting to be heard

30 May, 2014 - Braedan Hogan

In light of the World Health Assembly’s recent adoption of the WHO Global Disability Action Plan 2014 – 2021, we wanted to showcase the work CBM and our partners do to improve the health of people with disability around the world.


Firstly, we meet CBM’s Julian Eaton as he considers how the health demands of persons with psychosocial disabilities are finally starting to be heard and met in West Africa.

Julian (pictured) is currently the Mental Health Advisor for the CBM West Africa region, living in Togo with his family. Julian trained as a doctor in London before specialising as a psychiatrist. Prior to moving to Togo, Julian and his family lived in Nigeria for eight years. Here’s what Julian has to say below:

A voice from the most marginalised

It is well recognised that persons with psychosocial disabilities are among the most marginalised people in many countries. This is both in terms of social exclusion (and often grave human rights abuse) and in terms of investment in appropriate services and care. However, also in both these areas, things are gradually changing as the nascent service-user and self-advocacy community develops and finds its voice.

CBM is working mainly in the poorest communities around the world and it is very clear that one of the main areas that organisations of persons with psychosocial disabilities are campaigning on is access to health care. While this is only one area where this group is marginalised and unable to access services, it is a crucial one for many people.

Myths surrounding mental health

There are many myths and prejudices that have perpetuated this situation, including the idea that there is nothing that can be done, or such services are a bad investment. However, people with psychosocial disabilities are often vulnerable to poor physical health. In addition, the majority of the most severe and disabling mental conditions can respond well to treatment. At a service level, the costs associated with mental health care compare favourably to the relative costs of treating other conditions.

In terms of physical health services, even though people with psychosocial disabilities have an increased risk of poor physical health, their access to health services is much lower. People with a diagnosis of schizophrenia, for example, die on average 15 to 20 years younger than the rest of the population, even in higher-income countries.

Development opportunities neglected

There are many barriers to accessing care, including the stigma attached to many conditions, and a dismissive attitude and poor understanding among professionals. In parallel to poor access to health services, persons with psychosocial disability are often not given the opportunity to benefit from development initiatives such as microfinance or other poverty alleviation strategies.

Access to quality, affordable and humane mental health services is, if anything, even more difficult. Even in higher-income settings, only around 50% to 65% of people who need it access care routinely, and in lower-income countries this figure is typically 15% or lower.

This is largely because services just do not exist outside of capital or major cities. However, it is also because the mental health services in many countries remain dominated by large, specialist psychiatric hospitals, which provide poor care and are stigmatising. In sub-Saharan Africa, the typical percentage of the national health budget devoted to mental health is less than 1%, all of which is used in these hospital-based services. 31% of countries in Africa have no dedicated mental health budget at all. This is despite the huge proportion of total measured disability that is attributable to mental ill health.

Access to medical (and mental health) care is not only a human right but often makes the difference between a lifetime of disability, or one of good health, social inclusion and active participation in the economy. The choice of good-quality, local care is all too rare in many countries, but is the focus of campaigns by many relevant stakeholders, including persons with psychosocial disabilities. For example, the Movement for Global Mental Health has produced a position paper on the post-2015 development agenda, where this is a key ask.

Thankfully, (potential) service users are now campaigning vociferously about the services they want, the worst examples of old institutions are being closed and the science of understanding how to deliver care in an effective, appropriate way has moved forward enormously in recent years. This, coupled with global pressure from organisations such as the World Health Organization (WHO), who have a new Comprehensive Global Mental Health Action Plan, and increased prioritisation of mental health by civil society and non-governmental organisations mean we should be able to look forward to a significant improvement in the current state of affairs.

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