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Qualitative Study Exploring access to learning opportunities for children with disabilities during school closures of COVID-19 in Bangladesh

Mrittika Barua, Sayema Akter, Shamsul Kabir, Faria Binte Arif, Abdul Mannan, Protyasha Ghosh, Jannatul Hridhi, Sumata Chakma, Kamrul Hasan
April 2022

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Background: The COVID-19 pandemic caused significant challenges to education globally, as schools were closed, and alternative means had to be sought to enable students to continue with their studies. In the resource-constrained setting of Bangladesh, the pandemic impacted on the education of 37 million children (UNICEF 2021), of whom children with disabilities have been amongst the most severely affected. Already disadvantaged compared to children without disabilities in terms of access to education, the pandemic and the challenges of accessing remote learning have deepened inequalities between children with disabilities and their able-bodied peers. This study was undertaken as part of DID Task Order 13 Bangladesh, the goal of which is for girls and boys with disabilities to have equal access to quality education and support. Interventions are based in the two districts of Narsingdi and Siranjganj and the subdistricts of Narsingdi Sadar, Tarash and Sirajganj Sadar. The aim of this research was to explore the experiences of children with disabilities, their parents and teachers in respect of access to learning opportunities during school closures and beyond. Its findings inform the interventions of the project, specifically the support required for individual learners with disabilities and their families as well as for the schools where they are enrolled. Method: This qualitative study was carried out in the three sub-districts of Bangladesh mentioned above and based in schools denoted for project intervention. Children with disabilities were purposively selected from school records to represent a range of ages, grades, type of disability and different sexes. Screening was conducted using the UNICEF Child Functioning Module (CFM). Data was collected between October 2021 and February 2022 and included in-depth interviews with 22 children with disabilities, 23 caregivers and six teachers, as well as through household and school observations. Findings: Based on the CFM, 91% of the children interviewed have difficulties in more
than one functional domain, with the most common being difficulties in controlling behaviour, learning and communication. The study found the CFM to be more sensitive to identification of functional difficulties than the teachers’ assessments. Through the interviews, a range of challenges were raised regarding continuation of learning during the pandemic. Almost all the children mentioned that they missed their schools, and particularly their friends. Caregivers expressed concern about their children being out of touch with their studies, acknowledging that schools provide an environment that helps students learn. When movements were restricted, and children could not go to
coaching classes or be with their friends, some children displayed regressive behaviour such as increased agitation because of the social isolation. One of the most common supports that facilitated learning during school closures was the appointment of private tutors. In addition, family members helped their children study at home. Where teachers were able to visit children and provide structure and support for home learning (in the form of assignments), this significantly contributed to children’s motivation to continue with their education. While the caregivers tried to support their children as far as possible, several factors impacted negatively on learning viz. lack of motivation of children to continue with their studies, inadequate support from teachers and financial constraints undermining the ability of families to cover the costs of education. Especially challenging was the lack of access to technological support and limited time and skills of parents to support their children with disabilities, in addition to their household responsibilities and other children to look after. Although caregivers talked about the lack of support from teachers, the teachers, on the other hand, mentioned that they were not fully equipped with knowledge and skills to appropriately support learners with disabilities. In some instances, children with disabilities were kept behind a grade for not passing their class assessments or were allowed to progress to the next grade without achieving the required competencies. Observations of homes revealed that almost all of the children with disabilities interviewed were living in low-income households, with overcrowding, outside washrooms, minimal furniture and no conducive study areas. Some houses had mud flooring and tin rooves, posing multiple safety and physical barriers for children with disabilities. School visits enabled identification of inaccessible infrastructure, including access roads, entrances and washrooms. Although all of the schools visited had ramps, none of these were fully usable and none had rails. As schools reopen, interviewees identified various strategies that would contribute to encouraging learners with disabilities to return to school and participate effectively in learning. These include specific focus on learners with disabilities by teachers in order to
provide targeted support; ending discrimination against those who do not perform well academically; and differentiation of the curriculum and assessments for learners with intellectual disabilities. These interventions, together with ensuring accessible school infrastructure, will contribute to creating a more enabling environment for learners with disabilities.
Recommendations: The COVID-19 pandemic has further deepened vulnerability of low income families and exclusion of children with disabilities from education. In order to address the potential widening gap that could be created by a surge of dropouts following school closures, various interventions need to be prioritized. These include building on the strategies of resilience already developed by families to support learning of their children; and enhancing parents’ confidence in providing support themselves. In addition,linkages between home and school need to be strengthened and appropriate learning resources made available to children at home, taking cognizance of the inaccessibility of
technology and remote programmes for children with disabilities (both in terms of devices and connectivity). It is essential that teachers’ role in supporting learning at home for children with disabilities be strengthened; and that teachers are equipped with skills to cater for disability and diversity among learners. This needs to be accompanied by removal of barriers in the built environments of schools and their surrounds.

Using radio drama to tackle disability discrimination in Nigeria

BBC Media Action
Inclusive Futures
February 2022

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As part of the Inclusive Futures programme, BBC Media Action produced a radio drama, Story Story, and accompanying social media content, to tackle stigma and discrimination around disability in Nigeria. This content was broadcast from November 2020 to November 2021 through local radio partners in six states – Enugu, Federal Capital Territory (FCT), Kano, Kaduna, Kogi and Lagos.

This briefing draws on a literature review and key insights from BBC Media Action’s mixed-methods evaluation of the drama conducted in June and July 2021.

Accessible Sanitation in the Workplace – Important Considerations for Disability-Inclusive Employment in Nigeria and Bangladesh

Stephen Thompson
Rasak Adekoya
Utpal Mallick
Omojo Adaji
Abdur Rakib
Mark Carew
January 2022

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This paper explores the relationship between accessible sanitation and disability-inclusive employment in Bangladesh and Nigeria. Both countries have sanitation and hygiene challenges as well as disability-inclusive employment challenges, but the existing evidence on the intersection of these issues that is focused on Nigeria and Bangladesh is extremely limited. Building on the literature where this complex issue is addressed, this paper presents the findings of a qualitative pilot study undertaken in Nigeria and Bangladesh. It focuses on the need for toilets at work that are easy for people with disabilities to use in poor countries. These are sometimes called accessible toilets. Accessible sanitation is not regarded as a challenge that must be addressed by people with disabilities themselves, but as a challenge that must be addressed by many people working together – including governments, employers, and the community.

Information and Communication Technologies (ICTs) and Inclusive Education

Humanity & Inclusion
2021

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  • Children with disabilities are among the most excluded learners in the education system. The exponential development of ICTs(Information and Communication Technologies) throughout the world is a real opportunity to improve the educational inclusion of these children.
  • The aim of the study was to: i) identify existing ICTs that can support the educational inclusion of children with disabilities; ii) identify the challenges to the implementation of these ICTs in the classroom in some of Handicap International’s French-speaking countries of intervention, namely Benin, Burkina Faso, Madagascar, Mali, Morocco, Niger, Senegal and Togo. The study consists of two separate documents: this report outlining the methodology of the study, the process for the development of the ICT Directory, and the main lessons learned, on the one hand, and a document listing the ICTs identified during the research, on the other hand.
  • The study was based on secondary research, interviews with experts and with potential users of the ICTs in the intervention countries, namely teachers, parents and students with disabilities in Benin, Niger and Senegal. 

Digital fabrication of lower limb prosthetic sockets

OLDFREY, Ben
BARBARESCHI, Giulia
WILLIAMS, Rhys
HOLLOWAY, Catherine
December 2020

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This innovation insight discusses current approaches to digital fabrication of lower limb prosthetics (LLP) sockets aimed at low resourced settings. Digital fabrication of LLPs sockets has been researched for a number of decades, yet these technologies are not widely adopted, and most of the activities within this domain reside in high-income settings. However, the majority of amputees are in LMICs where there is a severe lack of access to services. It is in LMICs then, that the advantages that digital technologies offer could be of particular benefit however little to no progress in digital workflow adoption has been made to date.

What do we know about how to support mental health and wellbeing during the COVID-19 pandemic from past infectious disease epidemics?

QURESH, Onaiza
SCHERER, Nathaniel
July 2020

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The question and the problem:

Symptoms of mental ill-health are common during widespread outbreak of an infectious disease, with high rates of depression, anxiety and post-traumatic stress disorder (PTSD) reported during recent epidemics, such as the recent Ebola crises and SARS-CoV-1. Elevated symptoms of mental ill-health are not limited to patients only, and are seen in healthcare workers, family members and indeed more widely across the general population. Early evidence coming from the COVID-19 pandemic demonstrates high rates of mental ill-health and mental health service provision is needed. This evidence brief summarises evidence on mental health support during COVID-19 and other recent pandemics, informing policy and practice during this crisis.

How can social protection responses to COVID-19 be made disability inclusive?

BANKS, Lena Morgon
HUNT, Xanthe
June 2020

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Question & problem

The COVID-19 pandemic and strategies essential for its containment are resulting in severe strains on economies, particularly in low- and middle-income countries (LMICs). These impacts will be felt most by groups already in or at risk of poverty, including the estimated 1 billion people with disabilities globally. Interventions to address the short- and long-term economic effects of the pandemic are urgently needed. Some countries have begun implementing or announced plans for interventions addressing the economic impacts of COVID-19, such as food assistance, emergency cash transfers, unemployment assistance or expansions to existing social protection programmes. As these programmes are developed, it is important to consider the extent to which their design and delivery is inclusive of people with disabilities. Failure to adequately include people with disabilities in this process will lead to widening inequalities.

Learning Paper – Inclusive Sports for Development Project

NEUPANE, Sudarshan
JALAL, Faruk Ahmed
CHAKRABORTY, Ripon
Md. ISLAM, Shafiqul
PAUL, Ashok Kumar
Md. MUHIT, Mubdiul
April 2020

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Children with disabilities in Bangladesh have equal access to play, recreation and leisure, and sporting activities, including in the school system (contributing to enjoyment of article 30 5.d of UNCRPD).

Accelerating Disability Inclusive Formal Employment in Bangladesh, Kenya, Nigeria, and Uganda: What are the Vital Ingredients?

WICKENDEN, Mary
THOMPSON, Stephen
MADER, Philip
BROWN, Simon
ROHWERDER, Brigitte
March 2020

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This Working Paper provides an overview of disability as a concept and relevant global treaties and statistics, including evidence of trends and complexities in promoting disability inclusive employment broadly and with some focus on formal employment specifically. We describe the current situation in each of the four focus countries, demonstrating the similarities and differences between them. We then discuss some promising interventions that have been tried, usually on a small scale, in diverse settings, and which may be applicable in our four focus countries (Bangladesh, Kenya, Nigeria, and Uganda). Finally, we present the potential interventions that will be trialled in the Inclusion Works programme, using an innovation-driven, adaptive management approach.

 

The Inclusion Works programme (2018–2022), funded by the UK Department for International Development, aims to improve employment rates for people with disabilities in Bangladesh, Kenya, Nigeria, and Uganda. 

 

The opinions expressed are those of the authors and do not necessarily reflect the views or policies of the UK government or members of the Inclusion Works consortium.

Aid out of reach: A review of the access to humanitarian aid for women and men, girls and boys with disabilities affected by Cyclone Idai, Mozambique

BAART, Judith
WESTER, Mirian
2019

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The objective of this study is to generate empirical evidence on the barriers to accessing aid for women and men, girls and boys with disabilities in a post-Cyclone Idai context. By doing so, it also seeks to contribute to policy development for an inclusive humanitarian response in Mozambique

The research followed a qualitative design, using interviews and focus group discussions followed by inductive analysis to reveal dominant themes and stories. Data was collected in 30 in-depth interviews with women and men, girls and boys with disabilities and/or caregivers in communities (Beira), as well as in resettlement sites (Dondo).

Disability stigma in the Disability Inclusive Development (DID) programme countries: an overview of the evidence

ROHWERDER, Brigitte
September 2019

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This literature review outlines factors contributing to disability stigma in low- and middle-income countries. Overviews of disability stigma in the six Disability Inclusive Development (DID) programme countries – Bangladesh, Jordan, Kenya, Nepal, Nigeria, and Tanzania – are presented next. The review then looks at the literature on interventions to reduce disability stigma. Interventions aimed at addressing disability stigma in developing countries have been aimed at the intrapersonal and familial level; the interpersonal level; and the structural level.

How do we improve access to healthcare for people with disabilities?

HUNT, Xanthe
August 2019

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Gaining access to healthcare is often a challenge for people with disabilities in low- and middle-income countries. Part of this has to do with a general dearth of healthcare services in low-resource settings. But part of this difficulty has to do with structural, attitudinal, economic and social barriers to participation and healthcare which affect people with disabilities more than people without disabilities. This lack of access to healthcare is a problem because, in general, people with disabilities may need to access healthcare more frequently than people without disabilities. Full and equitable access to quality healthcare is a human right, and an important imperative of the global agenda. This evidence brief summarises what we know about how to improve access to healthcare for people with disabilities in low-resource settings.

What interventions are effective to support home-based carers?

HUNT, Xanthe
August 2019

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Question & problem

Many people with disabilities require the assistance of other people in order to go about their daily lives. In high-income countries, home-based carers are professional or para-professional workers who provide assistance to people with disabilities, in their homes. They are often well-trained, and remunerated for their services. However, individuals with disabilities in many low- and middle-income countries (LMIC) predominantly live with their family, and receive home-based care from family members. There are some stresses associated with giving care to others, and these include burnout, compassion fatigue, and an array of emotional and social consequences related to the caring role. The carers, too, need care. This evidence brief summarises what we know about how to support home-based carers, taking into consideration that these people, in LMIC, are often untrained, unpaid family members of the person for whom they are caring.

How do we ensure that children with disabilities are not bullied in school?

HUNT, Xanthe
August 2019

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Question & problem

Students with disabilities are bullied more often than their typically developing peers. Students in schools for children with disabilities may be victimized more often than students with disabilities in inclusive settings. Being bullied, which can take forms which are physical, verbal, indirect (relational, emotional, or social), and/or sexual, is associated with negative academic, social, and psychological outcomes for the victim. This evidence brief summarises what we know about how to prevent bullying of children with disabilities.

What works to improve educational outcomes of children with disabilities in school?

HUNT, Xanthe
August 2019

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Question & problem

For people with disabilities, a major determinant of social and economic outcomes in adulthood, is access to, and the adequacy of, education in childhood and adolescence. Yet, children with disabilities are less likely to be enrolled in, or complete, school. Further, there are substantial gaps in the evidence regarding what works to improve educational outcomes of children with disabilities in school. Educational outcomes, here include academic achievement, pass rates, and grade completion. Many studies measure child behaviour and proxy or distal outcomes in response to various interventions, but not actually how children with disabilities do in these domains. This is particularly the case in LMIC, where there is a dearth data about the effects of educational policies and practices on child educational outcomes.

How do we ensure that social protection assistance initiatives work for people with disabilities?

HUNT, Xanthe
August 2019

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Question & problem

Social protection systems and other financial assistance, including cash transfers and integrated benefits packages, may be important ways to facilitate the inclusion of people with disabilities in services and society. There is limited information, however, with regards to their impact in low- and middle-income settings. To understand how these programs work, it is important to recognise that there are disability-targeted entitlements, but people with disabilities may also be eligible for mainstream programmes aimed at other targeted groups, such as people of a certain socio-economic status. This evidence note summarises what is known about challenges faced by both of these types of initiatives, as well as evidence-based recommendations to strengthen them.

How do we provide mental health support to children with psychosocial disabilities in school?

QURESH, Onaiza
August 2019

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Question & problem

It is estimated that approximately 10-20% of children, adolescents and young people (under the age of 18) worldwide have a disabling mental health condition. Approximately two-thirds of the global youth population goes to school for a significant proportion of the day. The idea of delivering mental health support in the setting has gained prominence as a way to increase the coverage and accessibility of mental health support for children. While there is a wealth of evidence around school mental health approaches in HIC, there is limited information with regards to their impact in low- and middle-income settings. This evidence brief explores what has worked for the delivery of school mental health initiatives in diverse settings, as well as evidence-based recommendations to strengthen them.

What are the key considerations for including people with disabilities in COVID-19 hygiene promotion programmes?

WILBUR, Jane
HUNT, Xanthe
August 2019

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Question & problem

People with disabilities may be more likely to acquire COVID-19, and if infected may be more likely to experience serious symptoms, or die. Aside from those consequences of the pandemic related to morbidity and mortality, people with disabilities are often reliant on carers to aid with common daily tasks, and so social distancing measures may be unfeasible. Furthermore, safe water, sanitation and hygiene (WASH) services and facilities may be inaccessible to people with disabilities, and, in many settings, efforts to deliver services in a socially-distanced world have resulted in the roll out of digital or remote healthcare approaches which are sometimes not accessible or inclusive. One of the key interventions in response to the COVID-19 pandemic has been international attention, and improved funding, programming and media messaging in support of WASH. People with disabilities – who are most at risk of negative consequences of COVID-19 – most need access to such interventions. Yet, WASH access is considered to be one of the biggest challenges of daily life for many people with disabilities.

Uzbekistan: Case for inclusion

NAM, Galina
2019

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The inclusion of children with disabilities in mainstream education has become an important agenda for many developing countries. The Uzbekistan government has also attempted to provide equal educational opportunities to this previously excluded group of children. Despite these efforts, however, many children with disabilities remain segregated. The total number of children with disabilities under 16 years old in the country is 97,000 (Uzbek Society of Disabled People, 2014). The majority of them either study at specialised educational institutions, or receive home-based education. Those who are placed at specialised institutions are often deprived of resources and services necessary to receive adequate education (UNICEF, 2013). While limited by the lack of reliable empirical data and research, this article aims to present the current situation in the development of inclusive education in Uzbekistan. It outlines the major legislative documents intended to support inclusive education and identifies some of the current obstacles to inclusive education practices.

 

Disability, CBR and Inclusive Development, Vol 30, No 1 (2019)

Physical therapy for diabetic peripheral neuropathy: A narrative review

NIZAR, Abdul Majeed Kutty
JABBAR, Mohammed Abdul Razzaq
SREENIVASULU, Sura
2019

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Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus in both developed and developing countries. It is found in about 10% of diabetic clients at diagnosis, and in the majority of clients 25 years down the line. Clients with pre-diabetes may also develop neuropathies that are similar to diabetic neuropathies. Long-term hyperglycemia can cause peripheral nerve damage, resulting in distal-predominant nerve fibre degeneration. Loss of feeling in the lower limbs is a high risk for limb amputation. Despite efforts to make an early diagnosis and to halt the progression of diabetic neuropathy, currently there is no effective treatment available at a global level, except for strict control of blood glucose.

Physical therapy can improve the overall quality of life of diabetes mellitus clients with peripheral neuropathy and can alleviate the symptoms of neuropathy. This paper assesses the effectiveness of interventions used by physical therapists to minimise dysfunctions in people with DPN. It reviews the different treatment strategies and presents evidence and conditions for its applications.
 

 

Disability, CBR and Inclusive Development, Vol 30, No 1 (2019)

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