Co-designing the disability awareness toolkit for disability-inclusive and accessible health and post-GBV clinical services in South Africa.

backgroundPeople with disabilities face profound health disparities and systemic barriers to healthcare access, especially in low- and middle-income countries. These barriers range from inaccessible infrastructure and communication formats to negative attitudes and limited training among healthcare workers. This paper focuses on the co-design of the Disability Awareness Toolkit (DAT), a practical, contextually grounded toolkit to promote inclusion and accessibility in health and post-GBV clinical services in South Africa.

methodThe development of the DAT followed the co-design framework established by Birds et al., structured around two design cycles. The first cycle focused on creating the Disability Awareness Checklist (DAC) and its accompanying automated reporting system. The second cycle involved the development of the DAC's implementation support tools, including an intervention menu and a training component. Each cycle incorporated (a) pre-design activities such as literature and document reviews and key interest holder mappings, (b) co-design activities such as workshops with a diverse group of interest holders-including persons with disabilities-alongside DAC facilitator training, and pilot testing in healthcare settings, and (c) post-design adaptation. Feedback was collected using accessible, structured formats to ensure clarity and inclusivity. Any conflicting feedback was resolved through follow-up discussions and consensus-building, reinforcing the participatory and inclusive nature of the process.

resultsThe iterative co-design process was informed by the lived experiences of healthcare users and providers, revealing the importance of local relevance, flexibility, and power-sensitive collaboration. The final DAT consists of a comprehensive toolkit: the DAC with 53 core elements, automated reporting tools, a practical intervention menu tailored to local contexts, and an integrated training approach. The consultative process led to formally adopting appreciative inquiry as a key facilitation technique, helping participants better identify actionable, locally feasible solutions. The combination of the tool design and appreciative inquiry showed promise to create awareness and initiate change.

conclusionThe DAT's evolution highlights the power of co-design in addressing healthcare inequalities. It demonstrates how inclusive, locally grounded, and flexible design processes can produce meaningful quality assurance tools that reflect the diverse realities of service users and providers in unequal contexts.