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Can cities be inclusive?

PATRICK, Michaela
ARRUBLA PALACIO, Maria Clara
VASUDEVAN, D
JAMIL, Fuad
CHOUDHARY, Utsav
NARANGEREL, Tamirkhuu
September 2023

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5 short talks covering disability inclusivity in cities with speakers from Colombia, Indian, Indonsia and Mongolia. Part of the Disability Innovation Summit: Inclusive Interactions summit of 13 Sep 2023 held by the Global Disability Hub.

Persons with disabilities and climate change in Nepal: Humanitarian impacts and pathways for inclusive climate action

Jennifer M'Vouama, Humanity & Inclusion (HI)
Mosharraf Hossain, Team Leader, Global Inclusion Consulting Ltd
Sukharanjan Sutter, IRG Development Services Limited
Mahesh Ghimire, local consultant, Nepal
August 2023

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Climate change is affecting every region on Earth and already causing irreversible impacts. While it is a global phenomenon, its negative impacts are felt more intensely by poorer countries and poor communities heavily reliant on natural resources and lacking coping and adaptive capacities to deal with a changing climate. Within those poor communities and countries, persons with disabilities are often amongst the most marginalized people. They experience attitudinal, physical and communication barriers that undermine their access to services and opportunities supporting their well-being and resilience. For this reason, they tend to be disproportionately vulnerable to climate impacts, including more frequent and intense disasters, as those exacerbate pre-existing vulnerabilities. Yet, while it is acknowledged that climate change will exacerbate inequity should we fail to ensure inclusive and participatory decision-making processes in climate governance, disability inclusion in climate action largely remains marginally addressed. Persons with disabilities have been historically left out of climate responses at various levels, from local and national country plans to global negotiations occurring at the UN Conferences of the Parties1 (COP).


Nepal is experiencing an increasing number of climate-related disasters, with a global study ranking it as the fourth worst hit country in the world by weather-related loss events in 20172. Urban floods, landslides, extreme heat, storms, drought, and wildfires are very common climate disasters affecting communities across the country, especially rural populations and their natural resource-dependent livelihoods. Nepal’s vulnerability to climate change lies in its varied topography marked by steep terrain and remoteness, its diverse geo-climatic system and social vulnerability, exacerbated by challenges to deliver effective and comprehensive disaster risk reduction and management strategies. To address this serious threat to economic development and prosperity, Nepal has put in place a rich overarching climate change policy framework early on, encompassing dedicated policies and plans, as well as sectoral planning processes integrating climate resilience. Nepal has also established various leadership, coordination, and stakeholder engagement mechanisms to guide climate change policymaking, articulate implementation across the government’s three-tier federal structure, and ensure dialogue with key stakeholders including civil society actors.

Endorsed in 2011, Nepal’s Framework on Local Adaptation Plans for Action (LAPA) is a particularly praised initiative, promoting a bottom-up, inclusive, and flexible approach for integrating climate adaptation and resilience aspects into local planning. This pioneering, community driven process, places the adaptation needs and opportunities of most vulnerable and highly vulnerable groups at the heart of the approach. Gender considerations factoring intersecting factors of marginalization such as age and ethnicity have been given priority in these processes, to address women’s increasing economic insecurity and workload due to climate change. But inclusion of women with disabilities, or persons with disabilities in general in local adaptation planning has not been strongly evidenced to date.


According to Nepal Census 2022, 2.2% of the Nepali Population have some form of disability, mainly a physical disability. However, other sources estimate this figure to be much higher. Nepal ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2008 and passed the Disability Rights Act in 2017, establishing constitutional directives to support persons with disabilities and making it illegal to discriminate based on disability. Yet, perception of persons with disability in Nepal remains generally negative, due to persistent and deep-rooted Hindu religious beliefs associating disability with sinning in a previous life. Women and girls with disability face greater marginalization and discrimination and tend to be hidden away by families. Nepal’s caste system also plays a role in shaping the vulnerability of persons with disabilities. Thus, widespread stigma compounded by the intersectionality of certain factors, combined with structural inaccessibility, create significant barriers to have equal access to resources and participate in decision-making. This tends to translate into poor socio-economic status, poor health outcomes, and no or low education levels, especially among women and girls. Persons with disabilities in Nepal can register under social welfare to access several disability-targeted benefit packages, including a Disability Grant. However, the process tends to be paved with barriers, leading to high exclusion rates.
It is in this context that HI sought to better understand the unique challenges and opportunities for persons with disabilities in the face of climate change in Nepal. This report is intended to inform how persons with disabilities understand and perceive climate change, what is their experience of dealing with climate extremes, what is the impact on their health, livelihoods and support system, and their actual level of inclusion in climate adaptation planning. To capture those perspectives, HI surveyed 388 persons with disabilities across Nepal’s 7 provinces, consulted 20 key informants from the disability movement, government institutions, and the aid sector, and conducted 8 targeted focus group discussions to hear from women, youth, and persons representing diverse disability types. This report is a contribution to the growing evidence base documenting the disproportionate impacts of climate change on persons with disabilities and calling for disability-inclusive climate action at all levels of governance.

Repair strategies for assistive technology in low resource settings

OLDFREY, Ben
HOLLOWAY, Cathy
WALKER, Julian
McCORMACK, STEVEN
DEERE, Bernadette
KENNEY, Laurence
SSEKITOLEKO, Robert
ACKERS, Helen
MIODOWNIK, Mark
July 2023

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Purpose: To  investigate the  practices of  repair that  exist for  users of  mobility assistive products in  low resource settings, as  well  as  the  psychosocial impact that  the  repair, or  non-repair, of  these devices has on users’ lives.

Materials and Methods: This article collates data on repair practices and the responses from participants on  the  topic of  repair from studies conducted by  the  authors across four  different low  resource settings in  Kenya, Uganda, Sierra Leone, and  Indonesia. This  data was  then analyzed to  identify the  common themes found across geographies

 

DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY

https://doi.org/10.1080/17483107.2023.2236142 

Assistive technology in Korea: Findings from the 2017 National Disability Survey

DANEMAYER, Jamie
LIN, Myung-Joon
July 2023

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Explicitly monitoring the need, use and satisfaction of assistive product (AP) provision is essential to support population health and healthy longevity in ageing/aged countries, like Korea. We present findings from the 2017 Korea National Disability Survey (NDS) on AP access and compare them to international averages, introducing Korea’s data into the wider coherence of global AP research.

 

Disability and Rehabilitation: Assistive Technology

https://doi.org/10.1080/17483107.2023.2225565 

 

Who is disabled? On whether the functional definition of disability targets the same individuals as the subjective definition

Judith Baart
Willem Elbers
Alice Schippers
May 2023

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With the increased attention to disability as a vulnerability criterion in the Sustainable Development Goals, international organizations and NGOs within the international development sector have started to pay explicit attention to persons with disabilities, including the collection of data on persons with disabilities. The Washington Group Short Set of Questions, which focuses on functional limitations, has been gaining popularity as an assessment tool for disability. This set of questions reflects a categorization of disability that does not necessarily correspond with subjective disability assessments, such as the yes/no question (“do you have a disability?”) which many development actors have used in their assessment tools when they collect disability data This study compares the subjective and the functional limitations assessment tools for disability to answer the question: do they identify the same individuals as persons with disabilities? Based on a survey carried out amongst persons with disabilities in Cambodia, we included both the Washington Group Short Set and a subjective question asking respondents to self-identify their disability type. We find that, although all respondents self-identified as disabled, not all respondents would be considered disabled according to the Washington Group Short Set of questions. In addition, there is little overlap between specific disability types according to a subjective classification method and the domains of functioning measured through the Washington Group methodology. Our findings affirm that categorization as abled or disabled depends on the tool used. This is important, as the assessment approach chosen by those collecting disability data can shape the design choices of policies and programs, and determine who benefits.

Assistive technology: The current perspective in India

SENJAM, Suraj S
MANNAM, Hasheem
May 2023

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Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

 

Indian J Ophthalmol. 2023 May; 71(5): 1804–1809.

doi: 10.4103/IJO.IJO_2652_22

Beyond visibility: A learning Brief on Vulnerability Focal Point Approach

Humanity and Inclusion
January 2023

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This fact sheet presents the main lessons learned and the factors that helped and hindered the use of the intervention called the Vulnerability Focal Point (VFP) approach to improve access to and use of SRH services by people with disabilities.

The lessons learned from the VFP approach provide a reflection on what has worked and what has not. In addition, this note recommends ways to further improve the approach based on the experience and reflections of key stakeholders, including project beneficiaries (people with disabilities in the selected sites), VFPs, respective local government representatives, Humanity & Inclusion (HI) and its partners, and donors. The lessons learned will be crucial for making informed decisions about the continuation, scaling up, replication and sustainability of the VFP approach in the future.

Inclusive Futures: Using social behaviour change to promote disability inclusion in development programmes

Inclusive Futures
Sightsavers
August 2022

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This brief focuses on the use of social behaviour change (SBC) in the Inclusive Futures programme. It includes an introduction to social behaviour change, followed by three examples of how it is being used in our Inclusive Futures work. These examples reflect emerging findings and our approaches as we go forward. The brief is designed to:
•Explain what SBC is and what it can be useful for – particularly when addressing disability stigma and discrimination
•Present examples of how SBC can be used in different ways to support disability inclusion in development programmes

Mainstreaming disability inclusive employment in international development

Mary Wickenden
Philip Mader
Stephen Thompson
Jackie Shaw
July 2022

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People with disabilities are under-represented in the global workforce, and this problem is often particularly acute inthe‘global south’. This is an editorial to a special issue that seeks to provide new perspectives on why this is the case. We deliberately wanted to place this collection in the Journal of International Development as a core development publication, rather than in a disability specific one, because we think it is important to ‘mainstream’ disability within development so that the international community can develop an increased understanding and awareness of disability dilemmas. The challenges faced by disabled people need to be tackled as part of all development thinking and programming.

Capability-sensitive principles for assistive technology to support young graduates with disabilities in Bangladesh and Kenya into employment

MORRIS, Lisa-Dione
ALGHAIB, Ola Abu
NORTHRIDGE, James
July 2022

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Owing to increased inclusion of young people with disabilities into the private sector in Bangladesh and Kenya, there is an urgent need to find alternative ways to support young graduates with a disability in the workplace with assistive technology solutions. The aim of the paper is to identify barriers for private workplace sectors to use assistive technology to support young graduates seeking, maintaining and retaining employment. This qualitative study adopted the research onion design of Saunders et al. Data were collected usinginterviews and focus group discussions and analysed using thematic analysis. The findings reveal that barriers are linked to seven key person-centred capability themes: the dream, external factors, internal factors, assistive technology vision,strategic design priorities and gaps and assistive actions.

 

Journal of International Development, Volume 34, No. 5

Assistive Technology in two humanitarian contexts: Bangladesh and Jordan

KETT, Maria
June 2022

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Despite increased focus on the need for assistive technology (AT), along with estimates of need and gaps in provision in humanitarian contexts, very little is actually known about how people who need AT are managing in these contexts. To address this need, this study explored four main questions: 

What do we currently know about the need for AT in humanitarian contexts?
How is this need currently met?
What gaps are there in the evidence about these needs?
What mechanisms are needed to ensure provision of AT in humanitarian contexts? 

It explored these questions through individual interviews with AT users and their families, as well as people working in the sector, in two humanitarian response contexts: Bangladesh and Jordan. In Bangladesh, we partnered with CBM Global and their local partner, the Centre for Disability in Development, and in Jordan, all those interviewed were beneficiaries of HelpAge International.

The questions focused on the areas identified as gaps in the initial literature review, and used qualitative methodologies to probe and gain further insight into gaps across the entire AT ecosystem.

"We bear it and accept our fate” Perceptions of healthcare access from people with disabilities in Cox’s Bazar

PANELLA, Amanda
June 2022

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In November and December 2021, Ground Truth Solutions (GTS) and the International Organisation for Migration’s (IOM) Needs and Population Monitoring unit (NPM) conducted qualitative interviews with persons with mobility and vision impairments from Rohingya refugee and host community populations with the aim of better informing and supporting agencies in developing disability-inclusive programmes and engagement activities. These interviews focused on access to health services, aiming to gain insight into how people with disabilities experience engaging with healthcare services – as well as perceived barriers to access. It also looked at health information needs so that the humanitarian community will be better equipped to identify gaps in programming, deliver more equitable services, and build trust with this marginalised group. To weave tangible experiences into the narrative and bring findings to life, this research took a ‘user journey’ approach to create a set of ‘personas’ derived from key informant interviews with Rohingya and Host Community people with disabilities in Cox’s Bazar, resulting in this highly illustrative report.

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.

Are persons with disabilities included in the effort to leave no-one behind? Mapping disability data in development in Asia and the Pacific

CBM GLOBAL’S INCLUSION ADVISORY GROUP
February 2022

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In the Asia Pacific region, UNFPA and partners work together to implement the Incheon Strategy to “Make the Right Real” for Persons with Disabilities. The Incheon Strategy is the region’s first set of disability-specific development goals to track progress towards the fulfilment of rights of persons with disabilities.

In the region, it is estimated that there are over 650 million persons with disabilities. However, without accurate, timely and disaggregated data, countries are unable to develop effective policies and programmes, monitor the wellbeing of persons with disabilities and evaluate the equity and impact of development efforts. This endangers country commitments to ‘leave no one behind’ and undermines their obligations to the Convention on the Rights of Persons with Disabilities.

This groundbreaking report demonstrates the importance of ensuring data is inclusive and provides recommendations for immediate action in order to improve the collection, analysis and reporting of disability data

Barriers and facilitators to providing assistive technologies to children with disabilities in Afghanistan

WHITAKKER, Golnaz
WOOD, Gavin
February 2022

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Due to the impacts of the ongoing conflict, Afghanistan’s child population is at high risk of being born with or acquiring a primary or secondary disability. According to a recent estimate, up to 17 per cent of Afghanistan’s children live with some form of disability. Assistive technologies (AT) – the systems, services and products that enhance the functioning of people with impairments – are likely to be required by a large proportion of children with disabilities in Afghanistan. Afghanistan has signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which includes a commitment to provide AT equitably to all who need it. However, little action has been taken to meet this commitment, and there continues to be a vast gap between the need for AT and its provision. This work presents the landscape of AT provision, the barriers and facilitators to provision, and provides recommendations to begin to close the gap. 

Semi-structured interviews were conducted to build on the evidence in the literature, and to understand the factors affecting AT provision in Afghanistan

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.

Assistive Technology in urban low-income communities in Sierra Leone & Indonesia: Rapid Assistive Technology Assessment (rATA) survey results

CAREW, Mark
WALKER, Julian
OSSUL-VERMEHREN, Ignacia
BARTLETT DEVELOPMENT PLANNING
January 2022

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It is estimated by the World Health Organisation (WHO) that 15% of the world's population has a disability and one billion people need one or more Assistive Products (AP) but as little as one in ten have access to the device they need. There is however very little data to define this need for AP in low-resource settings. 

To contribute to the knowledge gap, the findings from the surveys presented in this report give a unique insight into disability prevalence and access to AT in five urban low-income communities in Sierra Leone and Indonesia, where a total of 4,256 individuals were surveyed using the rATA tool.

The rATA tool is designed for the rapid evaluation of the need, use, supply and impact of AT, Rapid Assistive Technology Assessment (rATA) is a new survey from WHO. A version modified by the Development Planning Unit-University College London (DPUUCL) was conducted in September 2019 for the research project “AT2030 community led solutions”, as part of the AT2030 programme led by Global Disability Innovation Hub.

Inclusive design and accessibility of the built environment in Varanasi, India: AT2030 Inclusive Infrastructure Case Studies

PATRICK, Michaela
MCKINNON, Iain
MISHRA, Satish
GUPTA, Shivani
ROY, Prabha
CHOUDHURY, Utsav
MURUGHAR, Kavita
RAHEJA, Gaurav
October 2021

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This is the second of six case studies analysing the state of accessibility and inclusive design in low-resource contexts around the world. The six independent case studies will be analysed to develop a comparison report and finally a global action report that will offer evidence and recommendations that support making infrastructure, the built environment and urban development in low-resource settings more accessible and inclusive.

This purpose of this case study is to explore the state of inclusive and accessible environments for persons with disabilities in Varanasi, India, through engagement with policy, industry and community stakeholders (policy, practice and people). Through this engagement, the case study is developing evidence on the challenges and opportunities for implementing inclusive and accessible design in Varanasi and makes recommendations on local actions towards becoming a more inclusive city.

Lives turned upside down in COVID-19 times: exploring disabled people's experiences in 5 low-and-middle income countries using narrative interviews

WICKENDEN, Mary
SHAW, Jackie
THOMPSON, Stephen
ROHWERDER, Brigitte
2021

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This article explores COVID-19 related experiences of disabled people in Bangladesh, Kenya, Nigeria, Nepal and Uganda. Narrative interviews generated storied responses, focussing on respondents' priorities, which enabled us to hear what was most significant for them and their families. 143 interviews were conducted online or by phone by 7 local researchers (3 disabled), with appropriate inclusive support. Nearly everyone was interviewed twice to capture the progression of impacts over time. The data was analysed thematically through a virtual participatory approach. An overarching 'subjective' theme of feelings experienced by the participants was labelled 'destabilisation, disorientation and uncertainty'. We also identified 'concrete' or material impacts. People experienced various dilemmas such as choosing between securing food and keeping safe, and tensions between receiving support and feeling increased vulnerability or dependence, with interplay between the emotions of fear, loss and hope. We found both the concept of liminality and grief models productive in understanding the progression of participants' experiences. Disabled people reported the same feelings, difficulties and impacts as others, reported in other literature, but often their pre-existing disadvantages have been exacerbated by the pandemic, including poverty, gender and impairment related stresses and discrimination, inaccessible services or relief, and exclusion from government initiatives.

A disability inclusive response to COVID-19 - four lessons learned about including people with disabilities in humanitarian aid

MORRIS, Lisa
ELLIOTT, Chris
PIERI, Susan
September 2021

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Inclusive Futures played a crucial role in supporting some of the most marginalised people with disabilities in Bangladesh, Kenya, Nepal, Nigeria, and Tanzania during the COVID-19 pandemic. This paper summarises what we learned and it can be used to include people with disabilities in future programming, particularly in contexts at risk of crisis.

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