The COVID-19 pandemic has made things worse for persons with disabilities, and this situation demands immediate intervention. However, the epidemic worsened these issues, particularly regarding employment and information access. African countries must act quickly to undertake interventions to address the problems faced by individuals with disabilities.

In 2017, a car accident caused Anna Nzioka's right leg to sustain two fractures. She has gradually learned to walk again after several procedures and physical therapy sessions, although with the use of a crutch.

Even while moving at a quick speed, Nzioka needs to stop frequently and cannot walk long distances.

The 40-year-old single woman was severely impacted by the COVID-19 pandemic because it became difficult for her to access healthcare services for her condition. She runs a small tailoring shop in Viwandani, one of the many informal settlements in Nairobi, the capital of Kenya, where there is extreme poverty due to the lack of employment opportunities.

According to Kenya's 2019 national census, 385,417 (nearly 42%) of the 918,270 people who lived with a handicap and were at least five years old had a mobility impairment.

"The hospital is far [about 16.8 kilometers away]," you say. I would have to go through the town center first, then I would board a matatu (public transportation) that goes to Westlands and drops me off at the Association for the Physically Disabled of Kenya (APDK), which is where the hospital, according to Nzioka, who spoke to SciDev.Net.

It is difficult, and getting there would cost me around 350 [Kenyan] shillings, or roughly $2.50.

Disability effects of COVID-19

The government enacted a slew of regulations in 2020 to stop the COVID-19 virus's spread. Curfews and temporary restrictions on entering and leaving Nairobi County were two of them.

As the government tried to stabilize already overstretched resources, several specialized clinics and lower-level healthcare facilities were shut down or transformed into COVID-19 treatment centers. Access to medical services and other essential utilities were directly impacted by this.

The quality and accessibility of healthcare was a major theme in many political parties' manifestos in Kenya before the general elections in 2022.

53 percent of Kenya's 50 million residents, as determined by the World Bank's poverty index, live on less than US$1.90 per day, making every day a battle more difficult than the one before it.

As of 2022, up to four out of every ten Nigerians lived in poverty. There are currently 223 million people residing in the country overall, 25 million of whom are disabled.

Numerous mitigation strategies were put in place after the first COVID-19 cases in both nations were confirmed. Late in March 2020, Nigeria progressively began enforcing a lockdown, first in the states of Lagos, Ogun, and the Federal Capital Territory before expanding it to the remaining 36 states. The lockdown in Kenya was gradual and originally applied to hotspot locations.

These extensive restrictions on transportation drove many businesses out of existence. Due to social stigma, educational restrictions, and environmental constraints, trading is the primary source of income for many people with disabilities in many African nations. Therefore, the pandemic meant that their means of subsistence were diminished or eliminated.

Tom Okwiri, a resident of Nairobi's Korogocho slum in Kenya, is all too aware of this. The father of four was born with cerebral palsy, severely limiting his mobility and impairing his right side. His family was unable to support his desire for higher education when he finished his secondary schooling in 2001, so he got employment as an unskilled teacher at a nearby low-cost private school, where he worked until he was fired in April 2020.

"I was among the first to lose my work when the pandemic hit and schools were shuttered. Additionally, I got the infection twice, as if that weren't enough. I'm not sure where I would be right now if it weren't for the kindness of my friends, neighbors, and a nearby chemist, he told SciDev.Net.

Mercy Wanjiru gave birth to a bouncing baby boy five years ago. He experienced his first seizure three months later, which served as a precursor to the diagnosis of severe cerebral palsy two years later.

Wanjiru, a casual worker and lone mother of two, was forced to stop going to a Nairobi waste dump every day to search for sellable stuff when the pandemic hit. This meant that she was unable to pay for her son's necessary daily anti-seizure medication. As part of pandemic response plans and later owing to her inability to cover the bill, his weekly physiotherapy sessions were also placed on hold indefinitely.

"During the pandemic, many health facilities became inaccessible, and those that were still operational served greater numbers of people," Wanjiru said. This resulted in frequently long lines of people, which made it challenging for those who required medical attention to get it, particularly those who had mobility issues or those who provided care.

According to the UN Office of the High Commissioner for Human Rights, people with disabilities have a lower employment rate than the general population and are more likely to work in the unorganized sector. Additionally, COVID-19 regulations may have had an indirect negative impact on people with disabilities by restricting breadwinners from working, which had a detrimental effect on household incomes.

"When COVID-19 arrived, Lagos was placed on lockdown. I used to be able to generate money at the nearby night market, but I was unable to do so after that. My children and I found life to be challenging, and we frequently had to rely on begging for food from our neighbors. They weren't making enough money, therefore it wasn't simple, according to Lagos-based food vendor Rafiat Adebajo.

Her firm was also impacted by the city's limited access to transportation and food supplies. She returned to her native village as soon as the lockdowns were lifted since she found life as a widow and mother of four in a less wealthy area of the city to be intolerable.

The pandemic control efforts were destined to further marginalize slum dwellers—a community that is already frequently left out—and at a crucial moment.

Building a case for interventions

In two of Nairobi's slums, a three-week series of telephone interviews with residents, local healthcare practitioners, religious leaders, and important decision-makers was done as part of the African Population and Health Research Center's (APHRC) study on improving health in slums.

This was a portion of a bigger study that ran from 2017 to 2021 and included 1,000 homes in Bangladesh, Kenya, Nigeria, Pakistan, and Kenya. In seven informal settlements spread across the four study countries, the study's primary objective was to examine the general procedures and effects of COVID-19 mitigation measures on the lives of the urban poor.

Because of the decreased accessibility and availability of healthcare services and the rise in medicine prices, the mitigation actions against COVID-19 were perceived by all the localities studied to have had a significant negative impact on inhabitants.

"The study was motivated by the requirement to produce data on healthcare utilization and provision in urban slums. According to Peter Kibe, a researcher at the APHRC and a member of the study team, the goal of the study was to make it possible to develop a more inclusive health system that takes into account the particular characteristics of populations in slum situations.

Understanding how the pandemic influenced the need for healthcare among disabled persons residing in these places was one goal of the study. Due to institutional, environmental, and attitude barriers, access to healthcare is frequently uneven for people with disabilities. These difficulties were made even more difficult by the epidemic and the accompanying response strategies.

Communication Issues

People with impairments, especially those who cannot communicate through conventional methods, are often given little thought in many of the continent's nations. This took on greater significance during the epidemic as many people were unable to get an official word about the mitigation efforts that the various governments were implementing.

Ndifreke Andrew-Essien, the founder of the FAECARE Foundation with headquarters in Nigeria, claims that lack of information was one of the greatest problems some of their beneficiaries faced.

Since most government statements were published in print or on video, they were sometimes inaccessible to the people we deal with. This meant that some information was always out of reach for people who had hearing or vision impairments, the speaker explained. As a group, we had to further modify the messaging to make it approachable and relevant for those with these types of disabilities.

A summons to action

Governments are being urged to be more inclusive in light of some of the issues raised and to use the epidemic as a teaching tool for health system reform.

Being the sole adult in the house made it challenging to care for the kids, especially my son. It's far from the hospital he goes to, but I can't afford it. We [in the slums] need these [healthcare] facilities closer to us, so the government ought to attempt to do that," Wanjiru remarked.

Increasing the ability of community health workers to give vital support services, such as home visits, health promotion messages, and joint disease treatment, is another idea.

To avoid additional marginalization, Andrew-Essien asks for the equitable execution of relief initiatives, including those in remote and rural areas.

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