Developing an implementation model for the inclusion of children with developmental disabilities in mainstream primary schools in Ethiopia

Children with developmental disabilities (DD) in Addis Ababa, Ethiopia, are often excluded from education. Progression towards inclusion in mainstream schools is encouraged by policies, but these have infrequenty been translated into implementation on the ground. Through 39 semi-structured interviews, we aimed to build an implementation model to promote the inclusion of children with DD in Addis Ababa, based on stakeholders’ perspectives and recommendations. Stakeholders interviewed included caregivers of children with DD, school teachers and principals/managers, non-governmental organization representatives, government officials, clinicians and academics/consultants. Themes were developed deductively using template analysis and based on Implementation domains of the Context and Implementation of Complex Interventions framework Pfadenhauer et al., 2017. From an implementation Theory perspective, the most endorsed conceptualisation of inclusion was enrolment of children with DD with moderate to high support needs in special education units in mainstream schools; mainstream classes were considered an appropriate education approach for children with DD with milder needs. When discussing the implementation Process, stakeholders noted that commitment of all stakeholders and systematic changes are needed for sustainable progress. Recommended Implementation Strategies to address expectations and challenges of key implementation Agents (children, caregivers, and teachers) were raising awareness in the community, training and supporting teachers, and supporting children’s development through healthcare and family interventions. The implementation model developed aims to offer children with DD opportunities to progress academically in special and inclusive classes, through systematic change, commitment of all stakeholders and specific implementation strategies. The latter should be targeted at supporting teachers, children and caregivers and raising awareness in the community.