International Development Committee inquiry

Humanitarian crises monitoring: coronavirus in developing countries: secondary impacts

Written evidence submitted by CBM UK

October 2020

CBM (Christian Blind Mission) works with partners across the world to bring change at an individual level, challenge systemic discrimination and support the voice and power of people with disabilities and mental health conditions as agents of change, in development and humanitarian settings.

1. The Covid19 pandemic highlights the challenges that marginalised and at-risk groups already face. It reinforces the importance of maintaining a strong commitment to inclusive development and humanitarian response. Humanitarian crises also exacerbate existing gender inequalities and increase the barriers faced by people with disabilities and older people. Covid has created additional health, food security, income and GBV risks which do not affect all groups equally. Women, children, Dalits and people with disabilities are already marginalised and the pandemic has intensified this.

2. CBM UK responded immediately to the Covid pandemic, working with country offices and partners to adapt programming so that people with disabilities remained supported and included. We are also working to adapt our work to meet the longer term needs of persons with disabilities as a result of Covid19 and have applied for ODA funding to achieve this. This submission highlights our findings in Ghana, Nepal and Zimbabwe and the programmatic adaptations needed to mitigate the secondary impacts of Covid, some of which are awaiting approval for UK ODA funding.

Ghana

3. Ghana was one of the earlier African countries to be affected by the pandemic.[1] Although rates of infection and death are lower than the global average, the secondary impacts are of significant concern, in particular for persons with disabilities and mental health conditions.

4. CBM partner BasicNeeds Ghana worked with five partner CSOs to conduct a rapid phone survey of community mental health volunteers and members of Self-Help Groups (SHGs) of persons living with mental health conditions and their caregivers. The survey identified that the Government of Ghana’s Coronavirus Alleviation Programme (CAP) has been concentrated in Greater Accra and Kumasi but neglected other parts of the country.

5. Information on safety and hygiene protocols to prevent the spread of Covid, and mitigation of the social and economic impact of the disease on the poorest and marginalised populations, has been inadequate and unreliable, with northern Ghana and rural hard-to-reach locations most poorly served. The hygiene and safety awareness raising efforts have been predominantly English language and urban-focused.

6. There has been inadequate clarity on application of electricity rebates, and discontinuation of the community free water supply and feeding programme in Accra and Kumasi after just two weeks, with infrequent and poorly targeted food distribution at local level.

7. There has also been insufficient attention to the mental health and psychosocial support (MHPSS) needs of the general population, especially persons already living with mental illness and/or using mental health care services. Efforts of Ghana Psychological Association to offer MHPSS have been limited due to funding and logistical challenges. Inadequate availability of PPE and hygiene equipment, distributed inequitably, has left many individuals living with mental health conditions and their families without. There has been little attempt to alleviate income losses of the most vulnerable households who have had to stay home and/or in isolation.

Programme adaptation

8. Using an example of a CBM project proposal, we recommend that programming to improve resilience to the secondary impacts of Covid among persons with mental health conditions seeks to improve the safety, health and wellbeing of vulnerable women, men, and adolescents living with pre-existing or emerging mental health conditions; through direct support to improve psychological resilience and through advocacy to improve access to basic needs. Mental health service users should be at the centre of delivering MHPSS to their peers, and advocating to policy-makers for the inclusion of people with mental health conditions in service provision and response. Programmes should also be inclusive of people with other disabilities, such as physical, sensory or communication impairments, who face additional and multiple discrimination, stigma and marginalisation.

Nepal

9. Whilst Nepal has experienced lower than global average rates of infection and death[2], lockdown measures have created abrupt and widespread economic, social and health challenges. This is having a significant impact on persons with disabilities, who are already excluded from the formal and informal economies and social protection mechanisms.

10.       Along with other marginalised groups, people with disabilities tend to have lower accumulated savings, leaving them highly vulnerable to economic shocks. A Rapid Needs Assessment (RNA) conducted by CBM and consortium partner World Vision found that in Karnali and Province 5:

• 89% of households have seen a two-thirds drop in their income since the pandemic
• 73.5% of suppliers have raised the cost of essential goods by an average of 13.5%
• 85% of households are experiencing food insecurity
• 40% of households have reduced their spending on education
• 78% of people with disabilities were not receiving government or NGO relief packages due to lack of access, information on where and how to receive support, or prioritisation by support providers
• The majority of family members are also adopting coping mechanisms such as reducing food intake, borrowing money and selling assets.

11.       The RNA also found that 17% of surveyed households in Province 2 and Province 5[3] include persons with disabilities, in contrast to the most recent census data issued by the government (2011) which reported a 1.94% rate of persons with disability. The government’s methodology for identifying and registering persons with disabilities is limited: as of 2018, only 40% have been issued identity cards linking them to government services[4], the rest remain outside the government’s social protection reach.

Programme adaptation

12.       Adaptation in disaster preparedness and response programmes must be inclusive to ensure that people with disabilities are also supported, including during the Covid pandemic. Using an example of a CBM project proposal to improve lives and support people with disabilities affected by disasters during Covid, to establish sustainable resilient livelihoods in Nepal, we recommend that programmes:

• Run inclusive vocational and business planning and community based training and mentoring
• Sensitise families, communities and employers via infotainment, street drama etc.
• Provide transportation and assistive devices and work with training centres and employers to make policies and infrastructure accessible
• Establish self-help groups and training, mentorship and linkages with likeminded local networks and organisations
• Provide start-up funds
• Support access to social protection, health and business insurance, and train beneficiaries on DRR
• Conduct advocacy with local governments on disability inclusive livelihoods and social protection policies and practices resulting in a longer-term culture shift.

Zimbabwe

13.       The pandemic hit Zimbabwe later than other African countries and followed a number of other crises, such as Cyclone Idai, droughts and floods leading to a food crisis, and cholera outbreaks, which have already weakened systems and resilience.

14.       Before Covid, 7.7 million Zimbabweans already urgently needed aid due to drought and a protracted economic crisis. Lockdown has decimated people’s incomes further. During the pandemic, diaspora remittances have declined, prices of goods have risen and there has been a shortages of basic goods and low demand for Zimbabwean tourism and exports. Lockdown closure of the informal sector, the country’s largest source of work, has diminished the livelihoods of low-income families and is having social impacts as networks and support structures are disrupted.

15.       Covid restrictions have had an impact on eye health where resources have been redirected to Covid control. Outpatient care, outreach and elective surgeries have been paused, creating a backlog of patients needing sight-saving surgery, and there has been a delay in imports of medical supplies. The redirection of limited healthcare resources to Covid also increases risks for people reliant on medication for mental health conditions.

Programme adaptation             

16.       CBM has proposed a UK Aid Direct project Improving vision for communities in Zimbabwe’s Mashonaland Central Province. The project will help clear the backlog of eye surgery; subsidise eye health services through a fee structure; dispense glasses free of charge; and provide transport for poor rural patients needing treatment at Bindura Provincial Hospital. The project will ensure adherence to MoHCC Infection Prevention and Control strategies to ensure triage, early recognition, and source control of Covid patients, including standard precautions for all patients and diligent hand hygiene. Trainings will take social distancing, hygiene and safety measures.

CBM UK, Munro House, 20 Mercers Row, Cambridge, CB5 8HY

Contact Rachel Aston, Policy Manager at rachela@cbmuk.org.uk