Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study Acknowledgments Accelovate-a Partnership in Accelerated Global Health Innovation Accelovate is a global program dedicated to increasing the availability and use of lifesaving innovations for low-resource settings. Led by Jhpiego, the Accelovate program began in 2011 as a five-year, United States Agency for International Development (USAID)-funded program under the Technologies for Health (T4H) grant. Also available from Accelovate: Postpartum Rehabilitative Pre-eclampsia Male Hemorrhage Medicine & Eclampsia Circumcision Design Challenges promote the development of innovative solutions where appropriate technology is lacking Solution Landscapes assess what solutions exist Value Propositions assess the benefits and drawbacks of an array of solutions for our context Business Cases assess manufacturability and commercial potential Market Readiness Assessments evaluate a selected technology/solution for market-level readiness factors Briefs describe technology access and utilization challenges in a topical area and outline Accelovate’s approach Excel Tools present raw data that implementers may develop for programming and advocacy purposes Literature Reviews review secondary data, usually to understand a bottleneck This report is made possible by the generous support of the American people through USAID, under the terms of the Technologies for Health award AID-OAA-A-11-00050. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. Jhpiego is an international, nonprofit health organization affiliated with Johns Hopkins University. For more than 40 years, Jhpiego has empowered frontline health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By putting evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations. Suggested Citation: Aceelovate. 2015. Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study. Accelovate Final Report. Baltimore, MD: Jhpiego. Accessed at: www.jhpiego.org/accelovate. Published by: Jhpiego Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231-3492, USA www.jhpiego.org © Jhpiego Corporation, 2015. All rights reserved. Cover photo courtesy of Cheryl Ann Xavier Table of Contents Abbreviations v Acknowledgments vi Glossary x Executive Summary xii Introduction 1 Methods 6 Findings 22 Kenya 22 Philippines 34 Cross-Context Quantitative Findings 42 Qualitative Findings–Kenya and Philippines 47 Discussion 57 Limitations and Strengths 72 Recommendations 74 References 86 Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study—page iii Appendices Appendix A. Philippines Baragay Supporters 88 Appendix B. Survey Instrument Development 93 Appendix C. Wheelchair Survey Tool 100 Appendix D. Data Collector Training Agenda, Kenya 120 Appendix E. Data Collector Training Agenda, Philippines 124 Appendix F. In-Depth Interview Guide 129 Appendix G. Description of Variables Used in Wheelchair Analysis 132 Appendix H: Kenya Research Consultation Agenda and Participants 135 Appendix I. Philippines Research Consultation Agenda and Participants 138 Appendix J. Data Tables: Kenya 144 Appendix K. Data Tables: The Philippines 158 page iv—Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study Abbreviations ADL Activities of daily living CI Confidence interval DPO Disabled people’s organization FBO Faith-based organization IHPDS Institute of Health Policy and Development Studies IRB Institutional review board ISPO International Society for Prosthetics and Orthotics JHSPH Johns Hopkins University School of Public Health LGU Local government unit M-PESA Mobile electronic money transfer NGO Nongovernmental organization ODK Open Data Kit OR Odds ratio PWDs Persons with disabilities USAID United States Agency for International Development WHO World Health Organization Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study—page v Acknowledgments Accelovate wishes to acknowledge the contributions of Jhpiego’s United States-based study team, including Dr. Eva Bazant, Principal Investigator; Elizabeth Hurwitz, Accelovate Program Officer and Wheelchair Portfolio Lead; Emma Williams, Monitoring, Evaluation, and Research Advisor; Jamie Noon, Senior Technical Advisor; Shannon Egan, Accelovate Program Officer; Deepti Tanuku, Director of the Accelovate Program; and Sam Dowding, Accelovate Deputy Director and Program Administrator. Thanks also to Hibest Assefa, Senior IRB Specialist; Diwakar Mohan, Analytic Advisor; and Gayane Yenokyan, Biostatistician. We appreciate the partnership of Dr. Lee Kirby of Dalhousie University and Dr. Jon Pearlman, Director of the International Society of Wheelchair Professionals, as well as that of our colleagues at MSH’s Leadership, Management and Governance project, Maggie Lamiell and Sylvia Vriesendorp. Accelovate is grateful for the support of USAID colleagues in the Bureau for Global Health, including Neal Brandes, Sara Sulzbach, Stefanie Evans, and UnJa Hayes; and in the Center of Excellence on Democracy, Human Rights and Governance, including Rob Horvath, Sue Eitel, Sandy Jenkins, and Cathy Savino. The research team would also like to express our gratitude to the more than 800 wheelchair users who were respondents in this study, as well as the caregivers who supported their participation. Thank you for sharing your experiences and insights. In Kenya, Accelovate would like to express appreciation to: nn The Jhpiego/Kenya MER team, including: Anthony Gichangi, Local Lead Investigator; Tom Marwa, government and sector liaison; Charles Waka, Information Technology Specialist; Naomi Maina, MER Assistant; and Jonesmus Wambua, Data Analyst nn Other key Jhpiego/Kenya staff: Brenda Onguti, Accelovate Field Technical Advisor and Study Coordinator; Levis Onsase, Field Team Supervisor nn Jhpiego Country Director Dr. Mildred Mudany and former Jhpiego Country Director Isaac Malonza page vi—Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study nn Field Team Supervisors: Jane Ayub and Immaculate Obaga nn Data collectors: Rosemary W. Kamau, Rachel Hongo, Patrick K. Kande, Doreen Manene, Richard B. Okola, Nelly Saiti Erick Waga and Christine Titi nn The wheelchair sector experts who guided this work, including: Charles Kanyi, James Keitany, Norah Keitany, Peter Mbuguah, Gideon Muga, Abdullah Munish (Tanzania), David Munyendo, and Hubert Seifert nn The USAID Kenya Mission, including Lilian Mutea and Sheila Macharia. nn The organizations providing access to lists of potential study respondents, including: Action Network for the Disabled; AIC Child Care Kajiado; AIC Cure Kijabe; Association of Persons with Disability: Busia, Eldoret, Kisii, Kisumu, Machakos, Mombasa, Nakuru, Nairobi, and Nairobi Mobile Clinic; Athi River for the Physically Handicapped Self Help Group; Bethany Kids; Disability Resource and Information Center; Henry Wanyoike Foundation; Kenya Paraplegic Organization; Disabled Persons Organizations in the counties of Kiambu, Nakuru, Mombasa, and Kajiado; LDSCharities Kenya; Litein Hospital; Machakos Central Group for the Disabled, Mombasa Secondary School for the Disabled; Motivation International; National Fund for the Disabled; Nyabondo Rehabilitation Center; and Port Reitz School Mombasa nn The county governments that allowed us to conduct the study in their jurisdictions and permitted the use of their health facilities as data collection sites In the Philippines, Accelovate wishes to acknowledge the contributions of: nn The Philippines-based Jhpiego Research team and other Jhpiego staff, including: Dr. Bernabe Marinduque, Local Lead Investigator; Lorena Rolando, Research Assistant; Cheryl Ann Xavier, Senior Technical Advisor; Local Government Unit Advisors Ann Lustresano and Ismael Penado; Jhpiego Country Director Dr. Dolores Castillo; and Jhpiego Program Manager Averdin Bucad nn Institute for Health Policy and Development Studies, Wheelchair Use and Services in Kenya and Philippines: A Cross-Sectional Study—page vii University of Philippines Manila and key staff: Dr. Hilton Lam, Dr. Grace Marie Ku; Dr. Ferdiliza Dandah Garcia; Mr. Tyrone Reden Sy; Dr. Adovich Rivera; and Dr. Braylien Siy nn Field Team Supervisors: Amelyn Asence; Jesebell de Jesus; Kent Jason Cheng; Mylene Mae Lamayra; and Paul Lester Chua nn Data Collectors: Anabelle Abella; Roy Luister Acos; Sarah May Atentar; Arianne May Balaoing; Renalyn Bustamante; John Benedict Constantino; Jamila Carreon; Judith Dado; Jean de los Reyes; Adelaine Espiritu; Gilana Gonzales; Jennifer Ildefonzo; Paola Mercaida; Jhoanna Quesada; and Cleford Trocino nn The USAID Philippines Mission, including Nancy Ebuenga nn Representatives of the various Philippine Government Agencies that approved and endorsed the research and data collection from wheelchair users within their area of jurisdiction, including Carmen Reyes-Zubiaga, Director of the National Council of Disability Affairs, and Frances Priscilla Cuevas of the Department of Health nn Mayors of the Local Government Units (LGUs) selected for the study, including Hon. Vergel Aguilar of Las Piñas City; Hon. Jejomar Erwin Binay, Jr. of Makati City; Hon. Benjamin Abalos of Mandaluyong City; Hon. Herbert Bautista of Quezon City; and Hon. Maria