Slow and Steady Progress

Accessibility

The accessibility in African countries vary greatly due to differences in economics. But overall, the accessibility for the continent is fairly below standards compared to countries like the United States and the United Kingdom. There have been significant amounts of changes made in the South African government regarding advocacy for people with disabilities. However, there is still room for improvement. In opposition to South Africa, many other countries are struggling to support themselves in general without having to invest money in disability related components. These countries are struggling to supply normal health care and job opportunities for individuals without disabilities. So it is safe to say that they are focused on handling those issues before moving on to others. 

The best approach for struggling countries would be to select a few disability components that would improve accessibility the greatest but also cost the least. According to the Independent Living Institute, this would include things adding ramps, changing toilet cubicles, size of elevators and doorways, and removing hazards to blind people. Restructuring buildings entirely would be fairly expensive, so adding small components like wooden ramps would be the best option. 

From Youth Village Kenya

A man from Japan with a spinal cord injury that requires him to use a wheelchair, Hideto Kijima, made a website that reviews a multitude of countries for: hotels, accessibility, barber shops, and coca-cola. Some of his trips were fairly recent so his reports haven't changed much. He found that the most accessible places for someone in a wheelchair were the tourist areas like hotels and airports. Most of them had proper bathrooms, ramps, and even sometimes transportation for those who are immobile. However, he found that Malawi, Cameroon, Mozambique, Eritrea, Guinea, Liberia, Sudan and Mauritania had almost no accessibility. He saw one, maybe two, wide bathrooms, struggled to travel around on the dirt roads and sometimes couldn't enter buildings because of the lack in ramps. Although, in all of his logs of each country, he explained that no matter the accessibility or lack there of, people were very kind to him and always offered help. Especially in Senegal where he said there was a lot of others in wheelchairs so they understood his struggles. 

From Voice of America Blogs

Universal Design & Assistive Technology

Universal design is meant to make all amenities of infrastructure accessible for everyone, people with physical or mental disabilities, mothers with strollers, and children. This idea is being widely implemented throughout the United States, but only because we have the luxury of doing so. As I mentioned before, South Africa is the most developed country in the continent of Africa. They have implemented programs to advocate for those with disabilities. A organization, Universal Design Africa has completed projects in South Africa at universities and other institutions, in addition to reforming some modes of transportation. There isn't any type of universal design being implemented in any other countries because most are still trying to make accessible bathrooms and doorways. 

Assistive technologies consist of hearing aids, wheelchairs, prosthetics, eyeglasses etc. UNICEF reports that, "Studies in Malawi and Namibia indicate that more than 80% of those who need assistive technology do not have it." Similar to universal design, the majority of assertive technologies are in South Africa. According to IT News Africa, in 2016, Google awarded a little over $700,000 to the South African Federation of the Disabled (SAFOD) to help people of sub-saharan Africa that are disabled. Their primary goal was to map areas were there were significant amounts of accessibly and assistive technologies vs areas with little to none. This would allow SAFOD to focus on areas that needed the most changes. 

There is one program, The SWING Project, that is aiming to increase access to education centers and universities by increasing the prevalence of assistive technologies in Northern Africa. This project previously existed in Eastern Europe, Central Asia, the Western Balkans and the Mediterranean region. Their primary focus is on one institution in Egypt and two in Morocco. One drawback of this project is that they are skipping to the top of the education chain and starting with college. Where in many other African countries, children are struggling to make it to elementary level classes. 

From Pinterest

Healthcare

General healthcare is still in the works for many African countries, let alone mental health care. The Rand Corporation found that in African countries, "75 percent of people who suffer from mental illness do not have easy access to the mental health care they need." However, the World Health Organization (WHO) has a Comprehensive Mental Health Action Plan. Their plan includes updating current mental health policies and laws, then slowly integrating better systems into the communities. Britain and the WHO are partnering up with African governments from Uganda, Ethiopia, Nepal and South Africa to set up pilot programs in order to gage the possible outcomes of these programs.

They also are actively implementing programs to attempt to erase the stigma behind mental illnesses. In low income countries, people with known mental illnesses have their legs chained together, to a tree or to beds in their homes. The WHO has created the Chain-Free Initiative which works against these actions in homes, hospitals and the environment as a whole. No progress can be made if members of these counties don't believe in the change.

From The New York Times

Works Cited

Accessibility in South Africa. (n.d.). Retrieved from https://www.independentliving.org/cib/cibharare5.html

Borg, J., Berman-Bieler, R., Khasnabis, C., Mitra, G., Myhill, W. N., & Raja, D. S. (n.d.). A Discusion Paper. Assistive Technology for Children with Disabilities: Creating Opportunities for Education, Inclusion and Participation,6-29. Retrieved from https://www.unicef.org/disabilities/files/Assistive-Tech-Web.pdf.

Eastern Mediterranean Region. (n.d.). Retrieved from http://www.emro.who.int/mental-health/chain-free-initiative/

Google awards R10 Million grant to African organisation. (2016, April 19). Retrieved from http://www.itnewsafrica.com/2016/04/google-awards-r10m-grant-to-african-organisation/

Kijima, H. (n.d.). Travel for All. Retrieved from http://www.kijikiji.com/english/access/africa.htm

W., & A., M. (2015, March 10). Mental Health Care in Sub-Saharan Africa: Challenges and Opportunities. Retrieved from https://www.rand.org/blog/2015/03/mental-healthcare-in-sub-saharan-africa-challenges.html

The role of assistive technology in renegotiating the inclusion of students with disabilities in higher education in North Africa. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.1080/03075079.2018.1437721?journalCode=cshe20

Universal Design Africa - Accessible by Design. (n.d.). Retrieved from http://udafrica.com/

What is Africa Doing About it?

Laws and Policies - UNCRPD

Mental health in African countries is a relatively underdeveloped issue. There isn't a sufficient amount of laws and policies protecting people with disabilities mental or physical. So the impact of the lack of policies is greater than the actual, almost nonexistent policies themselves. World organizations like the United Nations is actively working to implement programs within more developed countries in Africa like Ghana, Uganda, South Africa and Zambia.

From Social Connectedness

The Convention on the Rights for Person's with Disabilities (CRPD) is one of the first steps taken towards recognizing and advocating for PWDs. According to the, United Nations, the CRPD was first signed by the United Nation's general assembly in 2006 as a worldwide system. Their main goal was to "promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity." Essentially, this was very similar to advocating for overall human rights, for example economic, social and cultural rights, just for people with disabilities. This bill really worked towards implementing anti-discrimination laws which ensures equality between them and others. There were 19 different articles established in the CRPD. But in relation to Africa the only concrete legislative action taken was in South Africa - constitution of South Africa, Chapter 2, Bill of Rights, Section 9: Equality - which included things like freedom, respect, equality, anti-discrimination, protection for PWDS. These primary laws were extremely necessary to begin the fight for rights in the PWDs community which slowly started to lead to more focused concepts. South Africa has signed and approved the CRPD but still had a lot of work to make their systems compliant with the convention's standards. On a happier note, in 2013 they submitted their first country's report to the United Nations and was it approved!

Another project implemented for poor countries for the Mental Health and Poverty Project (MHaPP), by the WHO; with the goal of strengthening mental health systems in low income countries in Africa. There were multiple steps identified that would bring Africa where it needs to be. The plan begins with the government recognizing and committing to the program, next would be analyzing what specific policies and programs would actually make it. The next step involves formulating the specific programs, acknowledging them on an international level to make sure they comply with those standards and finally it ends with writing the policies in to make them legalized.

From Robin Hammond

However, one country stands above all with implementation of mental health policies, the Republic of South Africa. They have formulated a National Mental Health Policy Framework and Strategic Plan covering the years 2013 through 2020. They did this by gathering data of the highest documented and diagnosed mental illnesses under the correct definition. They discussed causes of mental illnesses giving them the ability to pin-point where the prevalence will be the highest. This plan also evaluated necessary budgets, policy mandates, organization, prevent, advocacy/human rights, medication and governmental standards. So in essence, South Africa is taking the right steps towards mental health recognition, treatment etc. However, there are still handfuls of other African countries that need this but due to their lack in resources in other areas like employment and economics, mental health has been put on the back burner being deemed not necessary.

Education

Education in Africa for people without disabilities is already an issue in itself. So the fact that there are even some programs advocating for people with disabilities is extraordinary. One of these programs include the African Education Trust. They work with government schools to help determine which students need more help in the classroom while educating the teachers on how they can provide that assistance. The AET works on problems regarding physical accessibility into buildings, adjusting the curriculum for those who are struggling, and for students who can't attain public schools, blind or deaf, receive recommendations of other schools that can accommodate them the best. 

From IRIN

A lot of other programs focus on inclusive learning. This type of learning is extremely important and necessary because even if students with disabilities are allowed in schools, they are subjectified by stigmas regarding their physical appearances or mental capabilities. These inclusive learning programs would separate children from their peers in order to make learning more personalized and effective. However, it is still important that these students are kept in non-inclusive environments exposing them to all kinds of children differing from them. 

It is found that around only 2% of disabled children across African countries are attending schools, meaning that 1 in four disabled children are being educated (African Report on Children with Disabilities). The WHO found that 40% of Africa's schools populations have students with disabilities that would require some kind of special services. There are no found statistics on high school graduation rates, and especially college, because Africa is set so far behind other countries regarding education in general, and even more for children with disabilities. 

From Philadelphia Tribune

Employment

A study in Northern Ghana was conducted to find the rates of employment in relation to disability and gender. Men and women with and without disabilities were sent into a face-to-face interview with an employer. The data was collected from the employer about which participants were hired and which were declined. Their results found that the majority of people unemployed were person's with disabilities, in particular women (NCBI). Women are largely unemployed in African countries disabled or not because of the gender gap. So women commonly struggle to surpass the poverty line if they suffer from some kind of noticeable disability. This mostly steams from the stigma following disabilities in Africa. Many employers believe that people with disabilities are incapable of completing any task, mental and physical. 

The United Nation's, Division for Social Policy and Development Disability, reports that globally in developing countries, 80-90% of people with disabilities are unemployed whereas in industrialized countries 50-70% are unemployed. The Congo has the highest unemployment rate for general population being 46.10 but Benin has the lowest being 1.00. So the rates vary greatly between countries making it difficult to gage the national unemployment rate. In the United States, according to the Bureau of Labor Statistics, the unemployment rate for person's with disabilities is a little over 10%. So we can imagine that this number would be a lot higher for Africa. 

From ProFellow

Africa is one of the poorest developing continents on the planet, struggling with many things we tend to take for granite like employment and education. People without disabilities in Africa tend to struggle more than people with disabilities in the United States; so it very difficult for us to fathom the amount of difficulty that PWDs face in very undeveloped, struggling countries across Africa.

Works Cited

Abosi, O. (2007). Educating Children with Learning Disabilities in Africa. Learning Disabilities Research & Practice,22(3), 196-201. doi:10.1111/j.1540-5826.2007.00242.x

Developing Effective Mental Health Policies and Plans in Africa. (2011). Mental Health and Poverty Project,90-96. doi:10.1002/9781119979203.ch5

Disability and Employment Enable. (n.d.). Retrieved from https://www.un.org/development/desa/disabilities/resources/factsheet-on-persons-with-disabilities/disability-and-employment.html

Disability Inclusion - Africa Educational Trust. (n.d.). Retrieved from https://africaeducationaltrust.org/disability-inclusion/

Naami, A. (2015, June 3). Disability, gender, and employment relationships in Africa: The case of Ghana. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433490/

National Institute of Mental Health Five-Year Strategic Plan for Reducing Health Disparities. (2013). PsycEXTRA Dataset. doi:10.1037/e608152007-001

Nunn, M., Borrel, A., & DeFranco, A. (2014). THE AFRICAN REPORT ON CHILDREN WITH DISABILITIES: PROMISING STARTS AND PERSISTING. The African Report on Children with Disabilities. Retrieved from ACPF.

The United Nations Convention on the Rights of Persons with Disabilities. (2017). Disability for Africa. doi:10.1007/978-3-319-43790-3

Unemployment rate of people with a disability 10.5 percent in 2016. (2017, June 26). Retrieved from https://www.bls.gov/opub/ted/2017/unemployment-rate-of-people-with-a-disability-10-point-5-percent-in-2016.htm?view_full

A Common "Curse" in Africa

African Demographics

According to the World Atlas, the continent of Africa is located in the eastern hemisphere. It is the second largest and most populated continent in the world. The World Population Review says that Africa is split into 54 different countries, 9 territories and 2 de facto independent states. Despite African being the second most populated country, it has a very low population density, 65 people per square mile. Africa is a rapidly growing country with almost half of its population under the age of 15. However, the life expectancy is very low to due HIV/AIDS epidemic that considerably affects the population. The highest populated countries in Africa include: Nigeria, Ethiopia, Egypt, Democratic Republic of the Congo, and South Africa. The least populated countries include: Saint Helena (United Kingdom non-soveriegn country), Seychelles, Sao Tome and Principe, Mayotte (French country), and Cape Verde. 

From UNEP

From the Economist

Africa's Growing Countries

Nigeria is Africa's largest country and it is continuously growing. Its population is expected to surpass China's by the year 2100, estimating around one billion people. This is very interesting considering the size of Nigeria is comparable to the state of Texas. In addition to Nigeria, another large population boom subsides in the Sub-Sahara. The country of Tanzania grew over a million in just 13 years. However, this is concerning for many people due to the fact that Tanzania is the one of the world's poorest countries. It is expected that most of Africa's countries will at least triple in size due to high fertility rates and low quality family planning. 

Disability Statistics

The United Nations report that there are around eight million disabled people in Africa; meaning that between physical, mental and sensory disabilities at least 10% of the population is disabled. They found that it is more common for women to be disabled as well as disabilities being more common in rural areas compared to urban. African Renewal states that in the country of Kenya alone, population being 44 million, a fourth of the whole populations suffers from some sort of mental disability. In South African countries, population estimating 53 million, it is found that a third of people suffer from a mental disability as well. In the country of Nigeria at least 40 to 50 million people suffer. And in Ghana 2.8 out of the 25.9 have a mental illness. In the country of Sierra Leone, a total of 525,000 people suffer from depression and schizophrenia. 

From Rand Corporation

Africa's Healthcare System

The healthcare system differs from country to country so I'll be discussing Africa's most developed countries due to the fact that the undeveloped countries can't afford time or money to be focused around healthcare. Word Psychiatry explains that a majority of African countries have no health policies or plans set in place. So the World Health Organization (WHO) formulated a two step plan in addition to claiming that each state needed to adopt some sort of health plan for their citizens. Two years later they found that these plans had not worked and evidence showed that most of the health concerns that pertain to mental disabilities. The World Psychiatry Association (WPA) and the WHO worked together to promote the betterment of mental health in mainly Sub-Saharan Africa countries. Their goals included: reversing the negative views on mental disorders, change current or add new legislation and to try and make programs affordable for those in need. The WPA organized meetings with their own representatives and with the leaders of numerous African countries to educate them on mental health and ways to promote it. 

Absence of Mental Health Professionals / Institutionalization

The average number of psychiatrists for the African region is 0.05/100,000. Most of the time psychiatric nurses are the professionals who treat patients and prescribe medicine. Out of the 44 million people in Kenya, 80 are psychiatrists, 30 are clinical psychologists, and out of the 500 psychiatric nurses only 250 work in mental health. There is clearly a concerning gap for the amount of people who need help and the amount of people can give it. In Nigeria (population 174 million) there are only 130 psychiatrists meaning that only 10% of Nigerians have access to mental support. In a country of 25.9 million people, Ghana, there are only three psychiatric hospitals and 20 psychiatrists. And unfortunately Sierra Leone has one single psychiatric hospital in a country of over seven million people. 

From World Press Photo

Etiology and Treatment of Mental Disabilities - Moral Model

Mental illness in Africa isn't a topic that isn't commonly discussed or accepted. A Kenyan humor writer, Ted Malanda, explained that mental illness and depression is such a disregarded issue in Africa that the African language doesn't even have a word for it, it has never been an identified disease. They generally ignore the issue because they don't believe it is actually real. And in the cases where they do have to acknowledge a mental illness, they contribute it to a religious reason. For extreme mental illnesses, like dissociative identity disorder or schizophrenia, they usually attribute it to possession of the devil or religious punishment. For these reasons people with mental disabilities aren't treated well. They are usually disregarded and some of the time shunned from their families; similar to how people with physical disabilities were treated in Emmanuel's Gift. 

Perception of PWD

As I explained above there is a lot of discrimination against people with disabilities in general as well a people with mental disabilities/illnesses. A lot of the time people don't know how to treat someone, or they won't, and even if they wanted to there are not a lot of resources available. The WPA and the WHO are actively working for acceptance and further education if African communities across the continent. If people are start to become informed there is a better chance that they will understand and furthermore accept the problems that exist in their societies. 

From Newswire

Works Cited:
Ababa, A. (2016, March). United Nations Economic Commission for Africa. Retrieved February, 2018, from https://www.uneca.org/sites/default/files/PublicationFiles/demographic_profile_rev_april_25.pdf
Cassimally, K. A. (2013, March 4). Tackling Mental Illness In Africa. Retrieved February, 2018, from https://www.nature.com/scitable/blog/labcoat-life/tackling_mental_illness_in_africa
Njenga, F. (2007, October). The concept of mental disorder: an African perspective. Retrieved February, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174593/
OKASHA, A. (2002). Mental health in Africa: the role of the WPA. Retrieved 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489826/