Involving people with disability is everyone’s responsibility and requires action by households and communities, by governments and health care workers and by organisations involved in the response. Generally inclusion of people with disabilities in programmes requires a twin track approach of mainstreaming and targeting. This is further explained in the diagram below:

Source: DFID

The World Health Organisation (WHO), UNICEF and SDDirect have all developed guidance on how to involve people with disabilities in COVID-19 response programs. Below we summarise these ideas and explain how they can be applied within hygiene programmes specifically.

  1. Think about disability-inclusion when designing your COVID-19 response programmes and fully resource it. Ensure budgets include resourcing for staff capacity development on disability inclusion, and for all disability related programme and policy activities.
  2. Conduct a rapid review of the WASH related barriers and challenges experienced by people with disabilities and their carers during COVID-19. WaterAid has developed step by step guidance on how to do this. Apply Wash’Em’s handwashing demonstration tool to quickly explore current handwashing behaviours and barriers to practicing these behaviours among people with disabilities. WEDC’s accessibility audit can be used to engage people with disabilities in the design of inclusive infrastructure.
  3. Identify ways of engaging people with all types of disabilities at all stages of COVID-19 programmes, from planning to evaluation. Work with community leaders and service providers to identify households that include a person with a disability. Effectively engaging people with disability requires implementing organisations to remember that not all disabilities can be seen and some people with disabilities may be hard to identify because they spend most of their time at home. Programmes must actively seek to include people with different impairments, ages, genders, and their carers, and the needs of these individuals will not be homogenous. It is important to continue to engage people with disabilities throughout the planning, rapid review, design, implementation, monitoring and evaluation stages of your programme. This is important because even when programmes are designed with inclusivity in mind they can still encounter challenges during delivery.
  4. Consult and partner with Disabled Persons Organisations and Disability Service Providers during COVID-19. In most countries there are existing Disabled Persons Organisations (DPO) and Disability Service Providers working with these organisations can help inform each stage of your programme to ensure it is inclusive. Key individuals from these organisations may be able to continue to work with and engage people in communities when larger organisations are unable to do this. However bear in mind that DPOs may be over burdened with requests to support and advise on COVID-19 responses. DPOs often have limited resources and capacities, so it is vital to support their core costs, including overheads, organisational and capacity development efforts, as well as funding any joint activities. Make sure to consider who DPOs represent and ensure all impairment groups and genders are represented. For instance, some DPOs are umbrella organisations, some focus on specific impairment groups.
  5. Provide assistance to people with disabilities and carers to enable them to carry out COVID-19 protective measures. This may include providing households with a person with a disability additional hygiene products (e.g. more soap or cleaning products) or specific hygiene items to address their needs (e.g. incontinence products and menstrual hygiene materials). Make sure that these items also reach people in residential settings and care facilities. Additionally these households with a person with a disability may require greater access to water than other households in order to maintain hygiene, and may be in less of a position to afford or collect this. Households with disabilities may also need targeted shelter assistance to enable them to practice physical distancing. This can be carried in collaboration with DPOs or by referral to disability service providers. There are also guidance and resources to help people with intellectual and cognitive impairments to understand COVID and how to prevent infection, and for carers to support this.
  6. Provide advice on how to keep support structures and assistive devices clean. People with disabilities may need to hold on to support structures to use WASH and other facilities (e.g. handrails). Within households, people may have built support structures out of wood as it is cheaper than metal, but it is harder to clean. Encourage people to paint or varnish wood so that it is easier to clean and therefore more hygienic. People with disabilities may also use assistive devices such as walking sticks, wheelchairs, crutches, and communication aids. These surfaces can easily become contaminated and must be cleaned regularly with soap and water to stop the virus spreading. Further guidance for wheelchair users is available here. After cleaning, hands must be washed with soap. Assistive devices should be cleaned at the following times: when entering or leaving the household, after coming into physical contact with anyone outside your household, after touching surfaces when outside the home (e.g. door knobs, railing, money etc) and after visiting public spaces. People with disabilities and carers must be made aware of this. For WASH facilities in public locations funding for operation and maintenance needs must be included in programmes and need to consider establishing processes for regularly cleaning of surfaces and handrails. See our guidance on cleaning and disinfection for more information.

Source: Tennessee Health Department

7. Make all WASH facilities and services, including handwashing stations accessible. If people with disabilities want to wash your hands, but are unable to reach or turn the lever on the handwashing facility they may have to go to a lot of effort to get somewhere that has soap and water (contaminating surfaces along the way) or they may just be forced to not wash their hands together. There are several resources documenting how to make handwashing facilities more inclusive. These include Compendium of accessible WASH technologies and the IDS compendium of handwashing technologies for low resource settings. Do accessibility and safety audits of existing and new WASH facilities, to make sure all people can use them. Make sure you ensure that people with different impairments, ages, genders, and their carers can take part. Accessibility and safety audits are available for water points, latrines, school latrines, menstrual hygiene management facilities and healthcare facilities.

8. During the COVID-19 crisis people are encouraged to wash clothes and bodies more regularly, so accessible bathing facilities are needed. The Compendium of Accessible WASH Technologies includes designs for accessible bathing facilities. Also support people with disabilities to access assistive devices, including lifting devices, through disability service providers where these exist. Lifting devices that can be made locally and at a low cost are included in CBM’s guidelines on supporting hygiene at home for people with disabilities.

9. Apply a gender lens to disability inclusive WASH COVID-19 responses. It is vital that all disability inclusion efforts are gender aware because WASH is a gendered issue. They also have specific WASH needs, such as maternal or menstrual health. Women and girls within the family often support people with disabilities. For more information on considering gender in COVID-19 response programmes see our resource on this.

10. Make sure COVID-19 communication and programme delivery processes reach people with disabilities and are accessible. It is vital that messaging does not inadvertently increase disability stigma and marginalisation. Sometimes hygiene approaches like handwashing with soap and water can focus on an individual changing behaviours. If people don’t or can’t change their behaviours, this can lead to blame and anger, which can be heightened during an outbreak. As well as ensuring that everyone can access WASH facilities, all hygiene behaviour change messaging must be about supporting each other. WaterAid’s Guidance for creating empowering and inclusive WASH and COVID-19 responses includes do’s and don’ts on how to integrate principles of equality and non-discrimination in messaging. Below we draw on this guidance and add some additional points for disability inclusion:

DO: Frame communication messages in a way that builds community spirit and collective action: use terms like ‘we’, ‘together’.

DON’T: Do not focus only on individualistic messages, which reinforce individualistic responses and actions as this may disadvantage people with disabilities. Do not use emotional triggers like shame or guilt or fear – we have a responsibility to avoid promoting further hysteria or blame. Avoid negative language.

DO: In graphics or videos portray a diverse group of people including women, men, girls and boys with different impairments. In graphics or videos portray people with disabilities supporting or interacting with others. Depict a range of handwashing facilities that reflect local circumstances but are adapted for a range of needs.

DON’T: Try not to just include visuals of people with physical disabilities. Do not leave out people with disabilities from graphics or videos.

DO: Acknowledge and respond to the diverse needs of people with different impairments and their carers. Tailor messages for carers of people with disabilities on the importance of supporting another person to maintain hand and personal hygiene. This includes menstrual hygiene management and the cleaning of any assistive devices used. Use or promote existing guidance and resources for carers supporting people with learning disabilities and autism during COVID-19. Promote social support networks for carers (where they exist), or support DPOs to develop these.

DON’T: Avoid blanket approaches that suggest that everyone can change behaviours without any specific adaptations. Do not forget that carers are an important target group who need support and information on how to support another person to maintain personal hygiene as independently as possible, whilst also ensuring they are adequately protected.

DO: Make communication materials more accessible. Make materials visual, text-light and use simple local language. Use large font, high contrast images and text (that are appropriate for people with colour vision deficiencies), print materials on non-glare paper. Use sign language, Easy Read, audio, Braille, captioned media, augmentative and alternative communication modes. Keep information simple and repeat it. Use give-away materials to reinforce messages for people with intellectual or cognitive disabilities. Ensure everyone involved in the COVID-19 response, carers and community healthcare workers are trained on communicating effectively with people with disabilities.

DON’T: Do not solely rely on high tech solutions to communicate messages. Not everyone will have the internet or a phone, and technologies may not be accessible to everyone.

DO: As part of a ‘do no harm’ approach do a risk assessment before and during your programme. Involve people with disabilities in all material design. Monitor backlash to your materials (e.g. on social media) such as derogatory comments about people with disabilities. Delete and respond to negative comments and then advocate for the rights and needs of people with disabilities. Check that your communication materials do not amplify or put blame on one group (or if the audience is interpreting it as such).

DON’T: Do not ostracise or promote ‘calling out’ of people or parts of the population. This may encourage vigilant tactics or backlash. Avoid terms such as “victim”; “infecting” or “spreading to others”.

CBM’s Humanitarian Hands on Tool (HHoT) app is a step by step guide on inclusive humanitarian fieldwork. Cards relevant to COVID-19 include communication, handwashing and hygiene. This short film gives an overview. UNICEF also provides guidance and tips on communicating in an accessible way.

11. If conducting in person activities in communities make sure programmes actively involve people with disabilities. In many contexts in-person activities are being minimised. However if you have assessed the risk in your context and have decided that it is still safe to go ahead then there are a range of simple ways that programming can be made inclusive. To start with, don’t assume that if people with disabilities are not attending or participating in hygiene promotion that it's because they are not interested. There may be a range of barriers preventing their participation and these are important to understand. When starting work in a community, work with local leaders and DPOs to inform them about your proposed programme and get them to help you identify people with disabilities in their community. If small, physically distanced group events are being held then these need to be close to the households of people with disability. At these gatherings people with disabilities and older people can be encouraged to sit at the front. If people need to travel to access programme services (e.g. at health centres or public distribution points) then special transport may be arranged for people with disabilities. If setting up WASH committees, actively encourage people with disabilities to take part and then support them to be able to do this effectively and safely. Conduct additional follow up visits to households with disabilities as people may not always feel comfortable expressing their questions or talking about their WASH needs in front of others. If hygiene promoters are doing household visits make sure they ask this simple question: ‘Can everyone in the family use this handwashing facility?’. Use this question to spark a discussion and encourage people to adapt facilities to make them more inclusive.

12. Promote disability inclusion within healthcare services. This includes raising staff awareness about disability, the imperative to provide healthcare services without discrimination, how to communicate effectively to people with a range of impairments, and ensuring WASH facilities are accessible within health care facilities.

13. Advocate to governments and other organisations that disability inclusion measures should be built into hygiene policies, implementation plans and strategies. When doing advocacy and policy work try to meaningfully include people with disabilities in the process.

14. Be evidence driven. Learn from other epidemics and document your own organisational experiences of doing inclusive programming as part of the COVID-19 response. What isn’t counted doesn’t count - so collect data on disability. This could be gathering qualitative and / or quantitative data. Embedding the Washington Group Short Set of questions to routine data collection is advised by DFAT, DFID and other donors in order to disaggregate data on disability.

Source: Humanity Inclusion

Want to know more about considering disability in COVID-19 hygiene programmes:

Editor notes:

Written by: Jane Wilbur

Reviewed by: Hannah Kuper, Islay Mactaggart, Sian White, Chelsea Huggett

Last updated: 25.5.2020

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