**5. Challenges of service providers and recipients**

Individuals with various forms of disabilities require a range of services to address their diverse needs. Services provided to PWDs must be continuous, effectively and efficiently coordinated and transition from one stage to the other. They should range from early intervention to educational services, healthcare and rehabilitation, vocational training and access to employment, housing, support services, leisure, and mobilityrelated services [15, 20, 40–44]. Although the 1992 Constitution of the Republic of Ghana, Persons with Disability Act, 2006, National Disability Policy, 2000, and other frameworks lay foundation for services provision to address the needs of PWDs, the experiences of service-providers and service-users is characterised by challenges. There is no coordinated and systematic service provision for PWDs in Ghana to holistically address the numerous challenges that they encounter daily in a sustainable manner.

We will use the framework of the 5 A's of access to service proposed by Blanchet [20] to discuss these challenges. The 5 A's are Availability, Accessibility, Affordability, Acceptability and Accountability [42, 45, 46].

Regarding the Availability of services, as discussed previously, fewer interventions exist to address the needs of PWDs. Most of the available services are mainstream interventions which lump PWDs with other vulnerable populations, therefore,

#### *Perspective Chapter: Disability-Inclusive Sustainable Services – The Role of Social Workers DOI: http://dx.doi.org/10.5772/intechopen.106283*

making it difficult to include eligible PWDs and/or inadequately address their needs. For example, unemployed PWDs are not included in the eligibility lead criteria. How then do they provide for themselves, given that the support that they also receive from family and friends is minimal? [11]. Regarding education, there are not many schools to cater for the number of children with disabilities in Ghana. For example, one secondary school for persons with hearing impairment that admits 250 students yearly is inadequate to cater for the needs of children with hearing impairment across the country [37]. Similarly, two secondary schools for persons with visual impairment across the country is agreeably inadequate to ensure inclusion for vulnerable children with visual impairment. These schools are still relevant given the challenges facing inclusive education in Ghana.

Secondly, it is also evident that PWDs have difficulty accessing existing services due to attitudinal and environmental barriers [47–50]. Altitudinal barriers which hinder efforts for the inclusion of PWDs are rooted in Ghanaian socio-cultural beliefs, traditions, and practices, which marginalize PWDs [11, 51, 52]. Environmental barriers including, physical, transportation, information and inaccessible healthcare also persist and impede the inclusion and full-effective participation of PWDs in mainstream activities [4, 53]. Another form of accessibility challenge relates to excessive bureaucratic process, including lengthy paperwork, which most times require physical presence to determine eligibility. This situation, coupled with environmental barriers, could compound the situation of PWDs.

Thirdly, we discuss affordability. There is virtually no government programme/ incentive to address the assistive devices needs of PWDs in Ghana. These devices are costly [54, 55], as well as disability-related services, such as the cost of personal assistants and accessible transportation [30]. Further, due to the challenges in government inclusive educational institutions, parents of children with disabilities enroll their children in private schools, which could be more expensive. However, currently, there is no government incentive/scholarships targeting the education of PWDs

Monitoring and evaluation of social services in Ghana is slow, and that could impact accountability. A study of the DCAF for PWDs by Ephraim et al. reported calls by the beneficiaries to increase monitoring to prevent misuse of the fund.

Service providers also encounter challenges while delivering services. Professional social work practice in Ghana is still a developing field of practice [18] and hence faces several challenges [56, 57]. Baffoe and Dako-Gyeke [18] argue that social work practice is mostly characterised with western welfare regimes [58], contrary to the Ghanaian traditional way of solving problems, which is mostly through family support and networks. Thus, social work values, principles and methods are not fully understood, and integrated into Ghanaian values and the role of social workers left vaguely to the discretion of institutions [57].

Further, government service providers, who are mostly social workers, face several challenges in the line of duty. Ghanaian social workers have several responsibilities but have inadequate resources and logistics to effectively perform their duties. Inadequate logistics could be a challenge to the provision of adequate and quality services to PWDs. Also, the lack of incentives/motivation, including opportunities for career progression could also impact service provision [59].

Despite the challenges of advancing disability rights including inadequate professional social workers at the department of social welfare agencies and financial difficulties [19] social workers continually strive to harmonize efforts and interventions aimed at providing assistance to persons with disabilities that goes beyond the capacity of families and communities [18].
