Understanding and improving disability training for health workers in sub-Saharan Africa

The World Health Organization estimates that 16% of the world’s population is disabled. Health worker training in many countries has been described as limited, ineffective, and unsystematic with regard to disability. This insufficiency is likely to be detrimental to the quality of health care that disabled people receive across health systems globally and understanding the training and other mechanisms that help health workers to improve their care for disabled patients could improve health outcomes. To date, there has been limited research on disability training to health workers in sub-Saharan Africa. Pilot programmes in countries like Ghana have shown promise, but there remain substantial gaps in the literature. This aim of this thesis is to understand how to improve health worker training in sub-Saharan Africa by exploring the current state of health worker training on disability in sub-Saharan Africa and makes recommendations to improve it. The thesis explores these topics through i) a systematic literature review to characterise existing health worker training on disability globally; ii) a document analysis of disability laws and policies in selected countries in sub-Saharan Africa; iii) secondary analysis of regional data to understand how disabled people use health services; and iv) qualitative interviews to explore health workers’ perspectives of training on disability in Ghana. The systematic review found that there are numerous individual interventions to train health workers about disability, but these are usually one-off trainings, with limited evaluation, follow-up, or consistency across settings. Similarly, the document analysis showed some laws and policies required training, but did not provide further details (i.e., curriculum, budget, timing, etc.) necessary for implementation. Furthermore, secondary analysis showed that there were no substantial differences in where disabled people seek care, which emphasized the importance of training every health worker. Finally, the qualitative data demonstrated that training interventions were acceptable and effective in changing the attitudes and behaviour of health workers. However, these interviews, together with the other results of the thesis, show that health worker training must be more robust in its frequency, formality, and follow-up to ensure health workers are all trained to improve health equity for disabled people.