The Learning Post: insights from UK Aid Match

Improving disability inclusion in Rwanda: an interview with CBM UK

Episode Summary

In our latest podcast episode, we speak to Dorota Kachniarz, Programme Manager at CBM UK, part of CBM Global Disability Inclusion, to learn how they improved and supported disability inclusion through their eye health programme in rural Rwanda.

Episode Transcription

Emma 00:09:

Welcome to The Learning Post, a podcast dedicated to sharing insights and learnings from UK Aid Match. 

My name is Emma Hayward and I'm a Performance and Risk Manager for UK Aid Match as well as your host for this episode. 

In this episode, we speak to Dorota, programme manager at CBM UK, part of CBM Global Disability Inclusion, who have recently completed a three-year project in rural Rwanda aimed at improving access to quality, inclusive and comprehensive eye health services. 

Good morning, Dorota, and thank you for joining me.

Dorota 00:45:

Good morning and thank you for giving us the opportunity to talk about our project.

Emma 00:50:

No problem. To start us off, could you tell our listeners a bit about your project in Rwanda, and outline how the project design and implementation supported disability inclusion?

Dorota 01:00:

Sure. So, CBM and Kabgayi Eye Unit, who is our partner in this project, have a longstanding relationship with the aim to support equal access to eye health for people in Rwanda. So over the years, CBM has been supporting Kabgayi to develop its infrastructure, human resources, also equipment, and that helped Kabgayi in becoming what they are now, which is the most productive eye health centre in Rwanda.

This project took a very similar approach, strengthening public hospitals using experienced Kabgayi Eye Unit staff to provide training and mentorship to staff at ophthalmology departments.


So, CBM as a disability inclusion organization, always works to remove barriers that people with disabilities might face, including improving their access to healthcare. So, this project also had a specific objective, which was to contribute to services at ophthalmology departments being more accessible and inclusive. We've done it through collaboration with organizations of persons with disabilities, by conducting with them accessibility assessments of the facilities at the start of the project. So, this was looking at accessibility in different areas, infrastructure, communication, policies etc. And this followed by specific adaptations made based on recommendations from this assessment. 


Another part of supporting disability inclusion were activities aimed at developing the hospital staff skills to help them in identification and provision of the support to patients with disabilities. And this, through training in disability inclusion, training in inclusive eye health, which were also organized with the support of organizations of persons with disabilities like National Union of Disability Organizations of Rwanda, NUDOR. We also organized sign language training for staff at hospitals to try to remove the barriers that patients with hearing impairments might face. And that's in collaboration with Rwanda National Union of the Deaf. 


And the main strategy for reaching people with disabilities, with services, was done through strengthening of the collaboration between hospitals and primary health centres in their catchment areas, in the areas where they work, as well as community health workers. And of course, again, organizations of persons with disabilities present in the area. So, that led to identification of persons with disabilities living in the communities and we were able to reach them with the information of what services were available for them. 

Emma 04:00:

Wonderful. It sounds like partnerships with organizations of people with disabilities are particularly important in successful implementation of inclusion of people with disabilities. 

We know that for many grant holders collecting relevant data for people with disabilities is a major challenge in supporting disability inclusion. Could you tell us about how CBM approached disability data collection and management in the Rwanda project? And particularly how you involved those external partners and stakeholders in this?

Dorota 4:30:

Luckily for us, the Ministry of Health in Rwanda has been thinking about the introduction of Washington Group Questions, which are internationally recognized surveys that collect data on disability. This among others thanks to advocacy by CBM and other organizations. The public hospitals we were working with were responding positively to the idea of training and introduction of the short set of Washington Group Questions in their system. And Kabgayi Eye Unit has been trained in the methodology by CBM previously, so they knew how to do it. 

Washington Group questions, even though they are internationally recognized as the best existing system for collecting data on disability that is internationally comparable, there are some very specific challenges when introducing it into the health system. It's not easy to use Washington Group questions by health professionals because they perceive disability as a medical condition rather than focusing on the barriers that people are facing. 

And also, it is very difficult to see the authority and allow the patient to assess themselves, to assess the difficulties they are experiencing when doing everyday activities. And based on their assessment, categorize a person as having or not having disability as per methodology of Washington Group Questions. 


So even though we did first the training in disability inclusion, staff needed to understand why it was important to desegregate data. Basically without knowing how many people with disabilities they were reaching, it was impossible to know who was not being reached and how to change it. And also this training in disability inclusion was aimed to provide them with understanding of other models of disability, social or rights-based model, which perceive disability very differently than the medical models. But still, it's a very long process to shift the perception that disability is created by the barriers that exist in the society rather than a medical condition.

And in addition, a common challenge that was related to data collection in general. So, the digital system used by the hospitals to record statistics have not yet had disability related category. So it was more work for hospital staff to complete the relevant data in the additional register provided by the project. 

Introducing the collection of data desegregated by disability into the systems took a long time. So the data started to be collected in the second year of the project. Then there was a need for reviewing how the process has been going, and we decided to go with the refresher training as well. 

Emma 07:35:

Yeah Brilliant. Thank you. Even more impressive within that three-year timeframe is one of the major successes of the project, and that one of the district hospitals that you were working with had actually introduced disability data collection into their systems. Is that correct?

Dorota 07:52:

Yes. I think that all participating hospitals started thinking or started introducing disability data desegregation also in other departments beyond ophthalmology. And so, that means there is a clear buying into the idea that there is a need for disability desegregated data. And they were telling us that one of the reasons they think they might use this data is to have argument for budget allocation for further improvements in accessibility because, again, we focused our efforts on improving accessibility within the ophthalmology departments. 

So, now the hospitals are planning to do the same things that has been done in ophthalmology departments elsewhere. And the data will help them to get the resources if they will be able to show how many people with disabilities actually are attending the hospital, then that would be easier for them to secure the budget for further improvements.

Emma 08:53:

Yeah, wonderful. I think that's a huge achievement and a really good example of the added value that the project has created. 

Finally, Dorota, what would be your top three recommendations for other grant holders in supporting and improving disability inclusion within their projects?

Dorota 09:09:

So definitely invest in training in desegregation of data by disability. As we all know, in the absence of data, persons with disabilities will remain invisible, but also it is necessary to train before, as I mentioned, in disability inclusion in general. And then if you can involve in your projects, staff with disabilities, and there is really no better way to raise awareness and promote disability inclusion than this. But in general, there must be in some way participation of persons with disabilities in the project, and if not through staff this can be done through collaboration with organizations of persons with disabilities. In our case, they participated in accessibility assessment, in trainings, in monitoring and raising awareness.


In general, the accessibility assessments are a great way to start as well because it will give you the baseline of the situation and you will know what to do, basically, to improve inclusion. And then finally, the budget, because you need to budget for those trainings. You need to budget for participation of organizations of persons with disabilities. You need to have a budget for assessment and then for improvements. If possible, it's good to have flexible budget line for reasonable accommodation, meaning any modifications that you will need to do to make sure that people with different disabilities can participate and access activities and benefits. 

Emma 10:49:

Wonderful. Some very clear and practical recommendations there.

Thanks for sharing your experiences with us today, Dorota. And congratulations to CBM and partners on the progress made towards disability inclusion in Rwanda.

Dorota 11:04:

Thank you for inviting us to talk about this.

Emma 11:07:

Listen out for our next podcast episode in this short disability inclusion series, which will focus on our organizational approaches to disability inclusion at MannionDaniels.

To find out more about UK Aid Match projects, head over to the grant section of the UK Aid Match website at And don't forget to subscribe to The Learning Post so you don't miss any future episodes. Thanks for listening.