On Wednesday 3rd June, 2020, The Action Foundation and Kenya Institute of Special Education (KISE) convened an online dialogue on Therapy Support for children with disabilities in Informal Settlements Amidst COVID-19. The webinar was
moderated by Lydia Chege, the Research, Assessment & Partnerships Manager at KISE. There were five panelists who included:
1. Wilfrida Otieno, Chief Physiotherapist, Ministry of Health
2. Grace Barbara, Director, Graced Junior School
3. Emmanuel Kasaine, Inclusive Education Champion
4. Lilly Oyare, Founder & Director, Little Rock IECD Centre
5. Elvis C.Kale , M&E Officer, APDK
The participants in the webinar included Rehabilitation Services Professionals, Parents/Caregivers to Children with Disabilities, NGO leaders, Disabled Persons Organizations (DPOs), Special Needs Education Practitioners among other categories.

This webinar was the second in a series by TAF and KISE on ‘COVID-19 and
Therapy Support for Children with Disabilities’


The webinar sought to:
1) Identify how COVID-19 pandemic has affected the provision of and access to
therapy services
2) Establish the specific challenges to provision of therapy services to Children
with Disabilities in Informal Settlements
3) Identify what measures various organizations and the government have put in
place to ensure continued provision of therapy services amidst COVID-19 at
community level
4) Explore practical alternatives to direct therapy during this period for
organizations and rehabilitation professionals; brainstorm on required
5) Chart a way forward on stakeholders’ actions to ensure provision and access
to therapy services for Children with Disabilities

Background: State of Therapy Support Services Provision
Access to therapy services for children with disability in this COVID-19 pandemic era has been major challenge; the prevailing situation has served to exacerbate existing day-to-day challenges that rehabilitation professionals, parents and caregivers to children with disabilities face in their bid to provide and access therapy services. Children with disabilities in low-income settings and informal settlements have particularly been hard-hit. These children are from families that in the past have had to bear the blunt of an economy on its’ feet; whereby ensuring access to basic needs (food, shelter, clothing) override every other need such as medical attention and therapy services.

The convening of this webinar on COVID-19 and Therapy for Children with Disabilities in Informal Settlements was necessitated by the need to get a picture of the real situation on the ground. This webinar was a build-up from the concerns that were raised in the previous discussion. The issues highlighted in the previous webinar included concerns of regressions, lost milestones and anxiety experienced by the principal care-giver.

The Discussion; Therapy Services Situation in Informal Settlements
The organizations that the panelist represented have been offering therapy services in informal settlements pre-COVID. Also, in the panel was the Chief Physiotherapist at the Ministry of Health to offer insights on what steps, if any, the government has taken to address the issues of therapy provision. The panelists were requested to paint a picture of what changes have been made in response to the COVID-19 pandemic within their organizations. One stated that they used to provide physiotherapy and occupational therapy twice or thrice a week depending on the needs of a child. This has been disrupted by the current situation. She went ahead to say that they have had to factor in provision of food aid to families in their programs since the main outcry has been on lack of food. She also stated that there is a growing concern and general anxiety over lost milestones for the children. They do make occasional phone calls to check in on the wellbeing of the children. Another issue that came out is that children are not responding well due to change in routine and thus the issue of lost milestones.

The inclusive education champion and school head teacher stated how pre-COVID, bringing together parents of the children with disabilities in his school was easy and effective. Post-COVID, he has experienced great hesitation and reluctance from the caregivers to be engaged due to fears of COVID-related news. Providing therapy services in the informal settlements is quite a challenge during this period and echoed the concerns raised that families are in need of food aid. He asserted the need for sensitization since there is general lack of awareness on COVID-19 within theinformal settlements.It has been slow but steady learning for the part of the caregivers on how to handle their children and tele-therapy can be utilized during this period by sharing with parents/caregivers therapy videos. The children are more responsive since they can see a familiar face on the video and have the therapy done by their caregiver/parent. The participants unanimously asserted on the need for  therapy services to be acknowledged as an ESSENTIAL SERVICE by the Ministry of Health. This will ensure children that are in dire need of therapy services can access the services.

Following up on experiences shared in the previous webinar where parents expressed need for support in attending to their children at home, a representative from Sense International shared about their video demonstrations for home-based therapy that were available on YouTube. She asserted that in spite of ensuring thatthe videos are in the public domain, they wouldn’t want a situation where a child is harmed unintentionally in the process. She thus cautioned caregivers to employ utmost caution in the process. She recommends that the videos be used alongside guidelines from their primary therapy service providers & always ensure that they seek their guidance.

One of the key challenges highlighted in the previous webinar was the issue of access to internet-supported smart phones & internet for sharing videos on how parents can provide therapy for their children. Conducting therapy on a child for a parent/caregiver following guidelines provided on videos in reality is not inclusive as most parents don’t have smart phones let alone internet. A suggestion on peer-parent support groups to enable access to the therapy videos through Bluetooth sharing and dialogues on caregiving was proposed as a means to surmount the challenge.

Conclusion and Way Forward
Wilfrida Otieno, Chief Physiotherapist, Ministry of Health, highlighted the ongoing discussions within the ministry on putting in place measures that will ensure provision and access to therapy services. She invited representatives from DPOs, Therapy practitioners and NGOs in the forum to take part in further discussions on guidelines for resumption of therapy services in the time of COVID-19. It was recommended that parents employ great patience and understanding of their children during this period. Ensuring a calm atmosphere at home while being careful on what is discussed within the household so as to not instill fear and anxiety in the children is recommended.

This 2nd Webinar was quite resourceful based on a survey filled by the participants.It was said to be informative and a thoughtful approach to addressing the issue of provision and access to therapy services during this period. It is our hope that this effort towards ensuring access to therapy services for children with disabilities will serve to provide a platform for meaningful engagement and action on the matter.On 17th of June, the discussions at The Ministry of Health were held where wepresented our collective memoranda on guidelines for resumption of occupational, physio and speech therapy services in Kenya in the context of COVID-19.We look forward to working together with other Rehabilitation Professionals, Persons with disability, Parents of Children with Disability and Organizations working with/for People with Disabilities to advocate for occupational, physio & speech + language therapy to be recognized as essential services.