Efforts to eradicate polio by 2018 will fail unless people with disabilities are included in elimination strategies, says Sue Coe.
Eliminating polio from the world would be a wonderful achievement. Around 400 scientists from 80 countries have declared that this could be achieved by 2018 if a new strategic plan by the Global Polio Eradication Initiative is implemented. They say that the main challenge is vaccinating children in all at-risk communities against the disease.
Fifteen per cent of the world's population have an impairment.  Yet most disabled people are denied adequate healthcare for reasons including inadequate access to health facilities and staff's perceptions that they cannot be assisted.
Just two per cent of disabled people are estimated to access primary healthcare services. This includes even the non-disabled children of disabled mothers. Therefore, without proactive strategies to target their inclusion in polio elimination work, the 2018 goal could be missed.
Article 25 of the UN Convention on the Rights of Persons with Disabilities — which came into force in 2008 — obliges states to "provide persons with disabilities with the same range, quality and standard of free or affordable healthcare as provided to other persons, including … population-based public health programmes".  Articles 6 and 7 define obligations to women and children with disabilities in accessing services, acknowledging the discriminations they face.
To ensure disabled children and mothers are included in healthcare outreach work, various measures are needed. Healthcare facilities should be physically accessible, for example, with step-free access with a handrail and access to a toilet suitable for those with limited physical mobility. Information needs to be delivered in easy-to-understand ways, and in ways that people with hearing and visual impairments can also follow.
Most significantly, healthcare workers need training to address misconceptions about dealing with disabled people. Stigma runs deep against disabled people in many of the world's communities. Nurses, with simple disability awareness training, could easily include children with different impairments in vaccination programmes.
These measures need not be expensive — planning ahead is the key. For example, designing buildings for universal access adds approximately 0.5 per cent to the total cost at the construction stage, but it can add up to 30 per cent of the cost if done later as an adaptation.
One area of practice to draw on is community-based rehabilitation (CBR). Originally an approach started in the late 1970s to improve access to rehabilitation services for disabled people, it has evolved into a multisectoral strategy addressing their broader needs in communities. In recent years there is a strong and growing body of success stories of CBR bringing disabled people into the heart of their communities.
Health remains a key component of these programmes. The WHO produced a set of comprehensive guidelines, published in 2010, including practical guidance on health inclusion in communities.  These provide guidance on how to develop and strengthen CBR programmes and encourage the empowerment of disabled people and their families.
By making primary healthcare services, including polio vaccination programmes, accessible to all in communities, the desired goal of polio eradication in five years has a stronger chance of being met.
Sue Coe has worked in international development for 25 years across Africa, Asia, Europe and the Middle East. Now a development and disability inclusion consultant, she previously worked for World Vision, Practical Action (formerly ITDG), VSO and Action on Hearing Loss (formerly RNID). Coe can be contacted at [email protected].
 WHO/World Bank World Report On Disability [kB] (WHO, 2011)
 UN UN Convention on the Rights of Persons with Disabilities (UN, 2006)
 WHO CBR Guidelines (WHO, 2010)