Ghana disability data disaggregation pilot project: Results of integrating disability into routine data collection systems 2016 - 2018.

The pilot phase of the Ghana disability data disaggregation (DDD) project was carried out in two districts of the Brong Ahafo region: Kintampo North District and Tano South District. The target population of this project comprised the MDA project implementers from national, regional, district and community level (health workers, disease control officers at district levels, and Communities Drug Distributors (CDD)) and household members of these communities.

Methods
A quasi-experimental design combining qualitative and quantitative methods was used to explore the different experiences of project implementation at various stages from national, regional, district and community level.

The project was designed to be embedded within the MDA programme with the aim of ensuring efficiency and sustainability. A qualitative approach including both in-depth interviews (IDIs) and focus group discussions (FGDs) was used to document stakeholders’ views at all levels concerning the implementation process.

A quality audit process using a quantitative approach was also carried out in six communities of the two project districts.

Existing data collection tools were adapted to include space for disability data; these were the community registers used by CDDs and forms used at sub-district and district levels. At the level of the MDA project implementer, data was collected using various qualitative data collection approaches including in-depth interviews, focus group discussions and workshop discussions. A short questionnaire was developed in order to collect data during the audit process.

Results
In Tano South, data was collected from 22,572 people in 39 communities in the first round of data collection (Round 1) and from 21,982 people in 37 communities in the second round of data collection (Round 2). In Kintampo North, data was collected from 61,774 people in 73 communities in Round 1 and from 63,762 people in 76 communities in Round 2.

The prevalence of disability (using the WGSS – ‘a lot of difficulty’ or ‘cannot do at all’) varied considerably between villages as well as between rounds. In Tano South, 0.8% of those registered reported having a disability in Round 1, raising to 3.2% in Round 2. The range between the villages remained similar, from a minimum of 0% in both rounds, to a maximum of 16.5% in Round 1 and 15.1% in Round 2. In Kintampo North, there was a similar increase between Rounds 1 and 2: the prevalence in Round 1 was 1.7% and in Round 2 was 3.4%. The range between the villages decreased significantly in Round 2. The minimum prevalence among the villages was 0% in both rounds; however, the maximum in Round 1 was 63.4% and in Round 2 was 31.4%.

Among those people identified as having a disability in Tano South in Round 1, 100% received MDA treatment compared to 83.8% overall. In Round 2, the proportion of people with disabilities taking the treatment in this district was slightly lower (91.5%) and so was among the total population (80.7%). In Kintampo North in Round 1, 91.3% of those identified as having a disability received treatment compared to 81.4% overall. In Round 2, the proportion of those taking drugs among people with disabilities was higher (99.8%); the proportion in the total population increased slightly to 82.5%.

From the audit data, the results show that during Round 2, 3.7% of community members enumerated reported disability (‘a lot of difficulty’ or ‘cannot do at all’) in seeing, 1.7% in hearing, 4.0% in walking or climbing and 2.3% in remembering or concentrating. The proportion was similar in both rounds.

Conclusion
The pilot showed that collecting data on disability through MDA programmes is feasible and has a number of programmatic benefits. The main positive outcome was the change in health provider attitudes and perceptions towards disability. Following receiving the training in the WGSS, health providers and CDDs were better able to understand the needs of people with disabilities and the importance of equitable access to health services. The project also improved communication between health workers, CDDs and people with disabilities. This pilot showed that planning and monitoring are a critical element to put in place in order to collect quality data on disability, and time should be allocated to training and sensitisation.