LONDON — While 15 percent of the world’s population lives with a disability, prevalence is even higher in low- and middle-income countries. Here, people with disabilities face the same challenges as everyone else — access to education and health care, or living free from poverty and violence — but such challenges are often exacerbated by mobility constraints, stigma, and social isolation.
“Solutions need to be locally led, because people with disabilities are the experts of their conditions, they know what the barriers are, and they are constantly coming up with innovative solutions.”— Alexandra Kay, disability inclusion adviser, Scope Global
Too often, the needs and rights of people with disabilities have been overlooked in development programs or addressed separately, as bolt-on projects. However, development practitioners now have an opportunity and an obligation to change that.
Development Enabled explores the daily challenges of people with disabilities while looking at solutions on how to support a disability-inclusive world.
Only by embedding disability in every stage of program planning, and empowering people with disabilities to guide that process, can the community create development that is truly inclusive.
Education and work: Breaking the poverty trap
One area where development organizations and their partners could weaken a stubborn link between disability and poverty is through improving inclusivity in schools and at work. An International Labour Organization study in 2009 of 10 LMICs found that excluding people with disabilities from the workforce resulted in gross domestic product losses of between 3 and 7 percent. This was not only due to a failure to tap the talent of people with disabilities but often also their families and caregivers.
Development programs focused on education must take an inclusive approach from the outset, and infrastructure is a good place to start, said Mary Keogh, director of CBM International’s Disability Inclusive Development Initiative. For example, building ramps at building entrances, improving road surfaces, or offering accessible transport contribute to an inclusive approach.
Access to the right assistive technology can also help children with disabilities participate alongside peers on an equal basis, Keogh said. And at a time when technology is revolutionizing the learning materials students use, there is a window of opportunity to ensure they are designed to be accessible for all.
Assistive solutions do not need to be expensive. For example, according to a Boston Consulting Group estimate, of the 2.5 billion people globally who live with uncorrected poor vision, 90 percent live in LMICs. A $5 pair of spectacles could open up their “ability to learn, to work, to lead safe, independent lives, and to realize their full potential,” said Jayanth Bhuvaraghan, chief mission officer at Essilor. Some 80 percent of all learning, he said, occurs through vision and uncorrected poor vision costs the global economy $272 billion every year in lost productivity.
Teachers’ and employers’ low expectations around the capability of children and adults with disabilities is another barrier that limits their ability to thrive educationally and economically, noted Hannah Loryman, social inclusion policy advisor at Sightsavers.
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If teachers think children are incapable of learning, they become more isolated in the classroom, perform worse and are at risk of dropping out, she added. Providing training to teachers on inclusive classroom practices can make a big difference here and finding ways to facilitate this in LMICs where teachers face large classroom sizes and limited resources is an important challenge.
Schools can also be a good place to begin dismantling the stigma and social isolation that people with disabilities often cite as their biggest barrier.
While some forms of stigma are entrenched around beliefs and social norms, others are due to lack of knowledge or exposure to people with disabilities, noted Loryman. Sightsavers’ programs have shown that when children with disabilities are supported to attend a mainstream school, they make friends and participate in the classroom with their peers, she said. “That’s a really important way of breaking down stigma, because if children are living together and learning together, then they grow with that positive impression of people with disabilities.”
Work by the development community around attitudes toward HIV/AIDS or gender equality could also provide valuable lessons for practitioners to weave into programs and scale up efforts to tackle stigma against disability, Loryman added.
Hiring more disabled people as development workers in the field would be a huge step toward creating positive perceptions about people with disabilities, as well as programs that meet their needs, said Alexandra Kay, disability inclusion adviser at Scope Global.
The employment by Scope in the Pacific of a disability inclusion consultant who is blind, for example, has created some “amazing outcomes” in terms of changing perceptions around what people with disabilities can achieve, she noted.
Equal access to health care
The relationship between disability and poverty runs in both directions, with insufficient health care provision or unsafe work environments in LMICs putting people more at risk of accidents or preventable disease resulting in a disability, Kay said. At the same time, however, a lack of affordable rehabilitation services can mean people with disabilities do not get the support required to live fuller lives.
There are some positive examples at government level — most recently in Sierra Leone — where health care has been offered free to people with disabilities to overcome financial barriers. In such cases, the development community can work with governments to help raise awareness about new policies so that health care providers and people with disabilities are aware of their existence, Loryman said.
But while expanding the provision of rehabilitation is clearly an area where the development community and governments can contribute, the sector also needs to help ensure people with disabilities gain better access overall to mainstream health care services and are not inadvertently excluded from health-related development projects, Keogh added.
A common misconception, for example, that women with disabilities are asexual can mean their sexual and reproductive health and rights are neglected, or they are not offered the same screening that women without disabilities receive, she noted. It can also be difficult for people with disabilities to physically access health centers, especially in rural regions, meaning mobile outreach can be a good solution.
Partnering with governments can also help ensure people get the screening they need to avoid becoming disabled, said Bhuvaraghan. Essilor’s 2.5 New Vision Generation division and the Indian state of Telangana this year co-launched a free eye screening program that aims to reach 37 million people within six months and provide spectacles to those who need them.
Safety and security
Development practitioners also have a role to play addressing the high rates of violence — including sexual and gender-based — that people with disabilities experience. Being heavily reliant on carers or living in institutions can put people with disabilities at even higher risk of neglect, violence and sexual predation, noted Loryman.
Research conducted by Sightsavers in Tanzania and Bangladesh revealed that victims of violence can feel unable to tell their families. Barriers ranged from communication difficulties such as family members not speaking sign language, to fear, or an ingrained sense of worthlessness.
The issues that affect women in general are often compounded for women with disabilities, Keogh noted. For example, women with visual impairment or intellectual disabilities are even less likely to be believed or viewed as a credible witness if they report an assault. More education is needed for people with disabilities around potential dangers, their rights, and which services are available to them, she said, while service providers and judicial systems must also become more inclusive.
‘Nothing about us without us’
For the development community to effect meaningful change, it must first ensure people with disability have both a voice and agency throughout the planning and implementation of programs.
Working closely with disabled people’s organizations — and making their ”nothing about us without us” slogan a guiding principle for any disability-related intervention — is a good place to start, Kay advised.
“Solutions need to be locally led, because people with disabilities are the experts of their conditions, they know what the barriers are, and they are constantly coming up with innovative solutions,” she said, adding that Scope Global tries to ensure people with disabilities are approached to be on its program committees, especially those related to program development and planning.
One small step that development practitioners can take, Loryman said, is to make communication more inclusive. Examples could include translating materials into braille, employing sign-language interpreters, and making assistive devices available.
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Development actors are, however, getting better at embedding inclusion within their work, Loryman acknowledged. For example, in 2014, the U.K. Department for International Development developed a disability framework and on Dec. 3 published its new Disability Strategy.
Since the introduction a decade ago of the U.N. Convention on the Rights of Persons with Disabilities, a great deal of progress has been made internationally in terms of policies and laws related to disability, Loryman added. People with disabilities need however to be involved in the creation of any new legislative framework, which also needs to be implemented and properly resourced to become effective, she added. Uganda, for example, has introduced disability planning guidelines.
It is also important that people with disabilities are placed in positions of power related to issues extending beyond disability, Loryman argued. For example, the election this year of a woman with a disability, Ana Peláez Narváez, onto a U.N. committee related to women’s rights is an important step toward ensuring that the voice of people with disabilities “shapes the broader development, national and international agendas.”
For more coverage on creating a disability-inclusive world, visit the Development Enabled series here.