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Special report

Challenges and barriers for implementation of the World Health Organization Global Disability Action Plan in low- and middle- income countries

Fary Khan, Mayowa Ojo Owolabi, Bhasker Amatya, Talhatu Kolapo Hamzat, Adesola Ogunniyi, Helen Oshinowo, Alaeldin Elmalik, Mary P. Galea
Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia. E-mail:

DOI: 10.2340/16501977-2276


Objective: To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries.
Methods: A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conducted intensive workshops at medical/academic institutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabilitation facilities. A modified Delphi method identified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia.
Results: Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (governmental/policymakers) and micro levels (community/social/individual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabilitation workforce, guidelines and accreditation standards; coordination amongst healthcare sectors; social issues; data and research; legislation and political commitment. Common potential facilitators included: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research.
Conclusion: Disability care is an emerging priority in low- and middle-income countries to address the needs of people with disability. The challenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services.

Lay Abstract

Disability and rehabilitation is an emerging global priority to address the rights and needs of persons with disability (PwD). Despite differences in the healthcare systems and practices in many developing countries, there are also many similarities in challenges faced by both health care professionals and PwD. The WHO ‘Global Disability Action Plan’ provides specific actions to strengthen and support rehabilitation services. This article identifies potential barriers and facilitators for the implementation of GDAP from the Nigerian perspective compared with those reported in Madagascar, Pakistan and Mongolia.

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