NIHR GRP: Using participatory approaches to improve access to healthcare for disabled people in Uganda The NIHR Global Research Professorship scheme is open to all professions and Higher Education Institutions in England and the Devolved Administrations, to nominate health researchers and methodologists with an outstanding clinical and applied health research record and its effective translation for improved health. Global Research Professors are required to have existing strong links with partners in institutions in countries on the OECD DAC list and the award should plan to support training and capacity development in these partners. 
There are one billion disabled people globally. Disabled people, on average, have higher healthcare needs than others, yet they face barriers in accessing it. As a result, they have worse health outcomes, including 2-3 times higher mortality rates across all ages. Policies and laws supporting the right to healthcare for disabled people are often not put into practice.
Evidence is growing that interventions to improve healthcare led by communities are particularly effective. They are low-cost, scalable and address locally relevant concerns. One example is the Participatory Learning and Action (PLA) approach developed to prevent maternal and newborn deaths. In PLA, women’s community groups are established and meet monthly to: 1) identify problems, 2) identify solutions, 3) plan and implement solutions, and 4) evaluate their efforts. PLA significantly reduces maternal and newborn deaths, usually by at least 20%, and is endorsed by WHO.
The aim of this study is to assess whether the PLA for Disability (PLA-D) approach can reduce mortality and improve health of disabled people in Uganda. 
Research will be undertaken by a consortium of UK and Uganda based partners. We will identify the problems facing disabled people in accessing healthcare in Uganda, through: 1) In-depth interviews with key informants (e.g. disabled people, health workers), 2) Analysis of existing numerical data, 3) Updating reviews on access to healthcare for disabled people.
We will then collaborate with disabled people and health professionals to use this information to adapt the PLA approach for disabled people. We will decide who should facilitate the groups, where they should meet, and how to adapt PLA delivery and materials. Five PLA-D groups will be established, each including about 20 disabled people. We will assess whether they are feasible to run or need further adaptations.
We will then undertake a trial to assess whether PLA-D is effective. We will identify 128 clusters (villages or city blocks) in Luuka district, and randomly assign them to be in the intervention or control group. In the control group, we will help to strengthen the health system, by undertaking an accessibility audit of health facilities and providing training on disability to healthcare workers.  In the intervention group we will establish one PLA-D group per cluster, as well as the health system strengthening activities. We will interview all disabled people in the study about health and healthcare access at baseline and follow-up (1 year and 2 years), and record if any participants had died. The intervention and control groups will be compared to assess whether mortality rates were lower and health/healthcare access better in the intervention groups than among controls, and what the cost was for the outcomes achieved.
Community engagement is at the heart of PLA as well as the Disability Movement with its ethos “Nothing about us, without us”. We will include disabled people as advisors at every stage, and as researchers wherever possible.
We will hold community meetings and with disabled people’s organisations. We will engage with policy and programme implementers, both in Uganda and internationally, by producing short documents of key findings and holding meetings. We will reach academics through publishing articles in journals and presenting at meetings and conferences. Objectives:
To use an evidenced-based approach to co-create PLA-D.
To assess the feasibility of PLA-D implementation.
To undertake a cluster-based Randomised Controlled Trial (RCT) to assess the effectiveness/cost-effectiveness of PLA-D in reducing mortality.
To undertake a process evaluation of PLA-D to understand mechanisms for impact and scale-up.
To strengthen capacity for informing disability policy and practice through the conduct of high-quality research.