Lack of Access to Other Disability-Related Services
Interviews also revealed how many persons with disabilities face barriers in accessing essential services such as physiotherapy, speech therapy, occupational therapy, and psychotherapy.[56] Neither private nor public insurance schemes in Iran cover these services.[57] Although the National Health Transformation Plan, established in 2013, has expanded the number of people having access to the national health insurance scheme and reduced health care expenses, the plan does not specifically reference persons with disabilities or disability-related healthcare services. [58] As Alihemmat Mahmoodnejad, head of the Association for Defending Rights of Disabled Persons, noted, “Unfortunately, disabled persons have no place in the National Health Transformation Plan and even have to purchase wheelchairs at a very high price. They face many problems in accessing rehabilitation equipment, but the government has not supported these needs so far.”[59]
Mohammad Ali Mohseni Bandpay, supreme consultant of the SWO, said the government would pay particular attention to rehabilitation services for persons with disabilities in further development of the National Plan.[60] However, in 2017, the vice president of the parliamentary health and treatment commission stated that although 350 additional medical services have been included in the national health insurance plan as part of the National Health Transformation Plan, rehabilitation services and other disability-related health services are still not covered.[61]
People we interviewed said that the lack of access to rehabilitation and other services harmed their development, health, and well-being or that of their family members. For example, Bahar, a 7-year-old girl with physical disabilities, was forced to stop occupational therapy sessions for six months because her parents could not afford the approximately 1.5 million IRI ($39.89) monthly fee. Her mother, Farideh, explained that this interruption in occupational therapy has caused a serious deterioration in Bahar’s condition:
Her feet have become more rigid. She loses her balance while seated and can’t even lie down easily. Lack of sufficient exercise had even weakened her writing and drawing because she can’t hold the pencil tight in her hands.[62]
Najmeh, mother of a girl with physical disabilities said, “I had to cut back on food for my family to continue taking Shabnam to hydrotherapy. This is very important for her. She also had physiotherapy before but had to stop because we couldn’t afford it anymore.”[63] Arash, a 24-year-old man with muscular dystrophy said, “Hydrotherapy and exercise in the swimming pool is crucial to slow my condition’s progression. But I can’t go to public pools because they are not accessible. I wish the SWO had at least dedicated one exercise and pool facility for us in the whole city.”[64]
Fariba, a teacher working at a special school for children with disabilities in Tehran, spoke about a boy with autism in the school, who is the only child in a family with a good income. Fariba explained,
His mother says that they still can’t afford all the services he needs and must compromise on many household expenses for their son’s sake. So, you can imagine the situation for other children with autism who are not that fortunate.[65]
Limited free or subsidized rehabilitation services are provided in some centers subcontracted by the SWO in major cities of Iran. But persons with disabilities who used them said that the services are often of poor quality and that sufficient time is not allocated for each person, so they stopped using them.[66] Some said they could not use such services due to long distances from their homes and lack of accessible transportation.[67]
For example, Fatemeh, a woman with physical disabilities, said,
Our local SWO office once arranged with a rehabilitation center to offer occupational therapy sessions to us for 20 percent of the market price. But there were too many clients and very few specialists. Most of the therapists were university students who were still training. So I realized that it was not worth the transportation costs and difficulties, so I withdrew.[68]
Psychotherapy and psychological consultation is not covered by any public or private insurance, nor through any SWO support programs.[69] As a result, persons with psychosocial disabilities are limited to medical treatment and hospitalization as their only available options. In the Persian year 1396 (March 2017 to March 2018), the official fee for one session of psychological consultation varied between 430,000 to 1.5 million IrI ($39.89) depending on the location and level of expertise
Five persons with psychosocial disabilities we interviewed said that they would like to have regular psychological consultations but cannot afford it.[70] One man with a psychosocial disability said,
I wish I could see … someone who wouldn’t make fun of me, but just listened to me. I went to such a doctor three years ago and felt very good. But it was very expensive, and the insurance agency said they don’t pay that cost back, so my brother who is my guardian said that I should not go anymore because we are not that rich.[71]
The new Law to Protect the Rights of Disabled Persons, which came into force in May 2018, mandates the Ministry of Health to ensure that health insurance provided to persons with disabilities registered with SWO covers the physical and mental rehabilitation services they need.[72]
