Meerman, Jan (1,2); Jongeneel, Joris (2); van der Klink, Jac (1) (2017). 'Measuring essential capabilities of blind people in Sierra Leone; a valuable addition to assessing health outcomes.' Paper presented at the annual conference of the HDCA, Cape Town 2017.
This study aims to show that the capability approach may be of great benefit to target inequalities in capabilities like health, in low-middle income countries (LMIC’s). Besides in the domain of poverty and human development (i.e. in the elaboration of de human development-index (HDI) of the United Nations), the capability approach proved valuable in many research areas such as education, health and disability. Sierra Leone is one of the bottom countries on the HDI index; moreover the prevalence of blindness in Sierra Leone (SL) is among the highest of all LMIC’s. The burden of disease is particularly high in vulnerable groups, such as females, children, disabled people and chronically ill. This study aims to explore the capability sets of the Sierra Leonean blind with a focus on essential personal, social and environmental conversion factors of their little resources. National health policies tend to be based on utilitarian instruments like DALYs, in addition capabilities can help improve the implementation of curative and preventive programs.
Participants consisted of blind (n= 15), normal sighted (n=13), visually impaired (n=14) and visually restored after cataract surgery (n=11). A qualitative interview was conducted to identify the capabilities of all participants. The questions of the ICECAP-A which measures health and wellbeing, served as a basis to identify basic capabilities like ‘feeling safe and secure’, ‘love, friendship and support’, ‘being independent’, ‘achievement and progress’ and ‘enjoyment and pleasure’. Next, other capabilities were explored. Thematic analysis was performed to identify themes around the impact of vision loss on the realization of capabilities in daily life, including the identification of the most important conversion factors. In the interviews special attention was given to the capability ‘access to (eye) care’ as this was discussed in previous literature. All interviews took place at the Baptist eye clinic or at a suitable place near the homes of the blind. The interviews were executed with the help of a local interpreter.
Thematic analysis indicated six themes: ‘health’, ‘education and occupation’, ‘social decline’, ‘mental state, religion and fear’ and ‘making a living and autonomy’. Within these themes conversion factors related to the capabilities of the blind were explored.
Most blind people in SL are not abled to achieve the most essential capabilities such as social support, safety and security, nourishment and access to (eye) care. Almost all blind mentioned social exclusion and lack of resources as main limiting conversion factors. Five of the blind participants even reported social exclusion by friends and family members. Normally sighted people were not able to achieve their capabilities either, especially the values to achieve and progress and enjoyment and pleasure were not realizable. The capability set of cataract patients expanded remarkably after operation.
This qualitative analysis has explored the applicability of the capability approach in blind people in LMIC’s. It shows several influential conversion factors preventing the achievement of capabilities of the blind. The identification of limiting social conversion factors could lead to specific health interventions that support people with a level of wellbeing that is below dignity. Health in LMIC’s can be seen as a meta-capability, enabling the realization of other capabilities. Further discussion of essential capabilities in vulnerable groups should target social and cultural factors such as stigma leading to social exclusion of people who need help the most. Further research could be aimed at the validation of a questionnaire of health capabilities in a low resource setting of sub-Saharan Africa. The strength of the capability approach in reducing inequalities lies in the increased awareness of the detrimental lack of essential capabilities of vulnerable groups.