Small changes, big difference: accessibility audits in action

The audit team at one of the facilities to be assessed.

I recently led a team to conduct an accessibility audit on two hospitals, both of which have mental health units, in Ghana between 5-8 July 2021.

The accessibility audit was undertaken as part of the Ghana Somubi Dwumadie disability inclusion programme that focuses on mental health.

The aim of the audits was to assess whether the hospitals, including their mental health units, were meeting Ghana’s accessibility standards, and identify areas for improvement. The team members selected to take part in the audit were from the Upper East Region of Ghana where the facilities were assessed. The team included a wheelchair user, a person with albinism, members who are blind or deaf, a mental health coordinator and an engineer from Ghana Health Service, as well as representatives from the facilities.

This was the first exercise of its kind for the Ghana Somubi Dwumadie project, funded by UK aid from the UK government. Sightsavers is a partner of the project, led by Options and working in collaboration with the Ghana Federation of Disability Organisations. The exercise revealed how inaccessible some parts of the facilities were to people with disabilities, including people with mental health conditions.

Our team had prepared for the audit by taking part in nine hours of training on the accessibility tool and its checklist developed by Ghana Somubi Dwumadie. The accessibility audit for the two facilities was led by Sightsavers for the project. Before going to the field, I had also practised at home to make sure I knew what I was doing.

On 5 July, the team travelled by minivan (this was the most COVID-19 secure way for us to travel) to the Upper East Region and paid a courtesy visit to the office of the regional director of the Ghana Health Service, to pass on our thanks for granting the team permission to conduct the audits.

We then headed to the Presbyterian Hospital in Bawku. At first, the hospital representative accompanying us was nervous about protecting the image of the facility. But after further explanation of the purpose of our assignment, the representative joined fully in the audit process, which consisted of:

• Taking specific measurements to ensure toilets met accessibility standards and were accessible to people with disabilities

• Verifying whether the doors of the facilities met accessibility standards

• Measuring doors, ramps, pathways, steps and other elements to ensure they met accessibility standards and making sure all rooms, circulation paths, and other areas were accessed during the audit

On completion of the audit checklist at the first facility, the team assessed it using the scoring method in the Ghana Somubi Dwumadie accessibility manual. We then had another meeting with the management team to share the summary of the audit and give recommendations on how they could take action to address some basic measures without requiring any funds (for example, lowering signposts and rearranging beds to allow wheelchair users to move around freely).

Once this was complete, we moved on to the second hospital, in Bongo, and repeated the process.

After the audits were finished, the team urged the management of both facilities to take measures to ensure their service provision is accessible and non-discriminatory to all people with disabilities, including people with mental health conditions who are a particular focus of Ghana Somubi Dwumadie’s work. We wrote up a report and action plan for each facility to recommend other improvements that the management teams could make, including widening doorways, adding ramps and simplifying signs.

The team also impressed upon the management the need to ensure that current and future budgets for the hospitals would accommodate accessibility features, particularly when new blocks are built, and ensure that Ghana’s accessibility standards for built environments were met.

It was very encouraging to take part in the collaborative process of conducting the audits, and we assured the management teams at both hospitals that we’d continue to work with them to help them meet accessibility standards.

The next step for us is to continue conducting these audits in other primary health care settings. By doing this vital work, we’ll gradually make sure that as many public facilities as possible are accessible to people with disabilities.

The accessibility audits in these facilities will serve as a blueprint that all primary health care settings can use to improve access.

To find out more about accessibility audits, see here