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Combatting the costs of exclusion for children with disabilities and their families

MONT, Daniel
UNICEF
March 2021

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Compared with other children, children with disabilities are less likely to receive an education, less likely to be employed as adults, more likely to be victims of violence, less likely to start their own families and participate in community events, and more likely to live in poverty. 

The exclusion of children with disabilities affects not only them, but imposes costs on the whole community. If these children lack the opportunity to be productive, society loses out on what they could have produced.  The barriers faced by people with disabilities can also create more responsibilities for their family members, which can limit their opportunities to work or get an education.

Moreover, the impact of exclusion extends beyond the economic cost. If people with disabilities are absent from public discourse, the community cannot benefit from their ideas. If they are excluded from political participation, the government cannot truly represent the interests of all citizens. 

A growing body of research suggests that the costs of exclusion are high. Fortunately, evidence also demonstrates that there are effective ways to ameliorate these costs. A strong case can be made for the social and economic benefits of inclusion. This paper is an effort to begin making that case.

 

Traffic crash injuries and disabilities : The burden on Indian society

WORLD BANK
February 2021

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Road crashes endanger the lives and livelihoods of millions of road users globally and in India.  The risk of a road crash in low-income countries is three times higher than compared to that in high-income countries. Not only does it lead to untold and unaccounted for suffering and loss for victims and their families, but also, it drains the GDP of countries by claiming millions of economically productive young lives6. While it is recognized that RTIs affect the developed and developing world in different ways, it also impacts poor households and disadvantaged sections of the population within developing countries differently. World Bank commissioned a survey-based assessment study in association with the Save LIFE Foundation (SLF) to determine such differential impacts more objectively in India. This study aims to capture the socioeconomic realities and nuances of road crashes at the sub-national level in India. It seeks to document inter-linkages between poverty, inequalities, road users, and road crash outcomes by analyzing data from four States in India, i.e., Uttar Pradesh, Bihar ,Tamil Nadu and Maharashtra. The four states have been selected on the basis of several criteria including demographic and geographical representation, magnitude of fatality burden and socio-economic parameters such as economic growth, poverty rate and social welfare. 

Let’s break silos now! Achieving disability-inclusive education in a post-COVID world

HUMANITY & INCLUSION (HI)
November 2020

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Children with disabilities face multiple obstacles to access and thrive in education. In low- and middle-income countries, 50% of children with disabilities are out of school.  More than 40% of countries in the regions of Asia, Latin America and the Caribbean still lean towards segregated education systems. Obstacles for the education of children with disabilities exist both within and outside the education system. The COVID-19 pandemic has further exacerbated inequalities in education. In times of crisis, coordinated multi-sectoral approaches are even more important to address the complexity and interdependency of children’s care, safety, wellbeing and education. 

The extensive experience of Humanity & Inclusion and its partners across the 27 countries where they implement Inclusive education projects was crucial to develop this report and to nourish it with first-hand expertise and evidence. The Report contains arguments, testimonies, case-studies, and a list of actionable recommendations for governments in low and middle income countries, aid donors, and multilateral agencies

WHO launches assistive technology capacity assessment (ATA-C)

WORLD HEALTH ORGANISATION (WHO)
November 2020

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WHO has developed the assistive technology capacity assessment (ATA-C) tool, a system-level tool to evaluate a country’s capacity to finance, regulate, procure and provide assistive technology. The ATA-C tool enables countries to better understand the current status and identify key actions to improve access to assistive technology: it can be used for awareness raising, policy and programme design and ongoing monitoring and evaluation.

The ATA-C is part of the WHO Assistive Technology Assessment (ATA) Toolkit, helping countries to collect effective and relevant data on assistive technology

Ensuring the right to quality inclusive education for persons with disabilities: From commitment to action

UNESCO
November 2020

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The international symposium "Ensuring the right to quality inclusive education for persons with disabilities: From commitment to action", co-organized by UNESCO, the Leonard Cheshire, and the Ministry of Education of Portugal brought together a wide range of stakeholders across the globe to discuss progress, successes achieved and challenges to ensure full participation and access to quality learning opportunities for all learners.

The symposium aims were to:

  • review persisting, as well as new challenges, due to the COVID-19 pandemic that are hindering the fulfilment of the right to inclusive education for learners with disabilities.
  • facilitate the exchange of experiences on factors influencing successful inclusive policies and practices for learners with disabilities and strengthen dialogue and cooperation amongst stakeholders at policy and practice levels.
  • explore how the inclusion of learners with disabilities in inclusive settings can be more effectively addressed by governments with regards to the commitments of Article 24 of the Convention on the Rights of Persons with Disabilities (CRPD), the CRPD General Comment 4 on article 24, and Sustainable Development 4 SDG 4, to ‘ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

The programme included:

Opening session - Accelerating efforts towards inclusive education for learners with disabilities. (Video recording: English - French - Spanish)

Session 1 - From legislation to inclusive practices: Re-designing policy frameworks, funding and monitoring arrangements across sectors for inclusive education for learners with disabilities. (Video recording: English - French - Spanish)

Session 2 - Revisiting the teaching and learning process to ensure access and participation of learners with disabilities.

Session 3 - Moving towards inclusive and safe learning environments, including by addressing violence and bullying against learners with disabilities.
 

Closing session - Rebuilding a Stronger Global Disability Inclusive Education System post COVID-19. (Video recording: English - French - Spanish)

The case for investing in assistive technology

ATscale
November 2020

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In this new report, ATscale describes the enormous gains that access to assistive technology (AT) can have in health, for the community and the economy. The figures are dramatic: investment in the provision of four assistive products - hearing aids, prostheses, eyeglasses, and wheelchairs - will result in a return on investment of 9:1.

Having access to AT can make the difference between failure or success in school, between a job or unemployment, between a life of opportunity or a life of dependency. An example: for a child in a low- or middle-income country, access to AT can make a difference of $100,000 in lifetime income.

Altogether, providing AT to all who need it would yield more than USD 10 trillion in economic benefits over the next 55 years.

Investing in AT both has a transformative impact on people’s wellbeing and makes sound economic sense for funders and governments. 

Product Narrative: Digital Assistive Technology. A market landscape and strategic approach to increasing access to digital assistive technology in low- and middle- income countries

SAVAGE, Margaret
LIAO, Cynthia
CHAUDRON, Matilde
BOYER, Jeffrey
BHATNAGAR, Tigmanshu
LAURENTIUS, Dennis
TORRENS, George
PERRY, Katherine
MORJARIA, Priya
BARAJAS, Felipe Ramos
GOEDDE, Barbara
November 2020

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This document is the final in a series of in-depth analyses that identify key barriers and promising market interventions. The previous four documents focused on wheelchairs, hearings aids, prostheses, and eyeglasses.

The report provides market landscapes of 3 areas of digital AT: mobile phones; screen readers; and augmentative and alternative communication (AAC) devices.

A common set of recommendations focused on improving access emerged from the individual product landscapes:

  • Develop and adopt policies, including legislation, regulations, minimum product standards, and guidelines to support accessibility and uptake of digital AT at the global and country levels.
  • Support governments of low- and middle-income countries (LMICs) to increase awareness of digital AT by including digital assistive products such as smartphones and augmentative and alternative communication (AAC) devices on national assistive product lists.
  • Support innovative financing schemes or negotiate pricing agreements to reduce the cost of digital AT to end users.
  • Increase availability of training programmes for users, suppliers, and service providers on the availability of digital AT and digital literacy skills.

Addressing disability-related costs through social protection systems

COTE, Alexandre
CARRARO, Ludovico
SIJAPATI BASSNET, Bimbika
NASIIR, Mercoledi
SRISOM, Sawang
WAKANIYASI, Josh
O'BRIEN, Felicity
October 2020

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Understanding disability-related costs is critical to building social protection systems that truly support inclusion, participation, and sustainable escape from poverty of persons with disabilities across the life cycle. It challenges some usual approaches with regards to targeting, mutually exclusive benefits, and focus on incapacity to work rather than support to inclusion. 

Supporting the dissemination of a background paper, the webinar presented the diversity of disability-related costs and the role of different methods used to assess them. It also presented some practices of accounting for disability costs in the design of mainstream social protection schemes as well as how low and middle-income countries can progressively build the combination of cash transfers, concessions, and services needed to address them.

 

Speakers topics were:

Understanding disability-related costs for better social protection systems.

Accounting for disablity related costs in design of mainstream family assistance schemes, the case of Moldova and Mongolia.

Supporting a survey to estimate the good and services required for basic participation in Indonesia.

How social protection systems can progressively address disability-related costs: the case of Thailand. 

Not either or Disability allowance and economic empowerment in Fiji.

Looking under the veil: Challenges faced by people with disabilities in cross-border entrepreneurship

MATSAURE, Keresencia
CHINDIMBA, Agness
ZIMANO, Felistas R
RUFFIN, Fayth
September 2020

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Background: Cross-border entrepreneurship is one source of livelihood that is transforming people’s lives, especially those with limited resources and educational qualifications and those in need of supplementary earnings to complement meagre formal earnings. However, despite strides made to make this avenue worthwhile, this Zimbabwean study shows that hidden hindrances still persist from procedural and structural barriers from road entry point management systems. To people with disabilities (PWDs), the impact of these hidden barriers is severe to the extent of obstructing their optimum progression into cross-border entrepreneurship.

 

Objectives: This article sought to interrogate some veiled challenges in border management systems affecting PWDs’ quest to venture into cross-border entrepreneurship. This angle has, to this end, been timidly addressed as most organisations and legislation have concentrated on making things work for the majority of the populace.

 

Method: Qualitative phenomenological method in which researchers’ lived experiences, review of literature, ideas and opinions is complemented by secondary survey data from a road entry point management system study in the Zimbabwean setting.

 

Results: Cross-border entrepreneurship has potential to transform people’s lives: 1) road and border management systems’ procedural and structural complications present hidden challenges impeding PWDs’ entry and optimum participation in cross border entrepreneurship, 2) people with disabilities are not automatically dependents; in fact, most have dependents looking up to the, 30 social construction of disability persists and must be curbed and 4) there is a need to institute a ‘stakeholders triad approach’.

 

Conclusion: The existing road entry points’ management systems are not informed by considerations from PWDs, hence the existence of hidden challenges. Cross-border entrepreneurship can open significant livelihood avenues to PWDs. A stakeholders ‘triad-approach’, proposed herein, can solve some of the policy discrepancies as it recommends utilising inputs from PWDs, research and policy-makers.

 

African Journal of Disability, Vol 9, 2020 

Product Narratives: the challenges of supply and demand-side barriers for priority AT

HOLLOWAY, Cathy
OLDFREY, Ben
END FINEBURG, Alison
SEGHERS, Frederic
SOENDERGAARD, Dennis
September 2020

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This Disability Innovation Live session, looked at the Assistive Technology (AT) Product Narratives (PNs). The Product Narratives were developed by the Clinton Health Access Initiative (CHAI) under the FCDO funded AT2030 programme, led by GDI Hub, in support of the ATscale Strategy.

These PNs set out what we know about the state of the global market for each AT product, and identify global recommendations for how to address some of the barriers to access currently experienced in low and middle-income countries. In this session, we hear from the experts about what the PNs are, how they will inform global policy, and how we hope they will help us reach more people with life-changing AT

Uganda's disability data landscape and the economic inclusion of persons with disabilities

Development Initiatives
September 2020

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This report looks at the landscape of data on disability in Uganda – summarising what data on persons with disabilities is available, who produces and uses it, and how – as well as what this means for the economic inclusion of persons with disabilities.

 

For persons with disabilities to benefit from and contribute to society and the economy there needs to be effective policies, programmes and services that support their inclusion, particularly in employment. Reliable information and data on persons with disabilities, known as ‘disability data’, is essential to planning and for decision-making. When it is of high quality, accessible and used effectively, disability data can help organisations of persons with disabilities (OPDs), civil society, government and businesses better understand and prioritise interventions that are vital for supporting persons with disabilities and ensuring their inclusion.

 

OPDs, civil society and the government have an important role to play in strengthening the landscape of disability data. Developed as part of Development Initiatives’ work on data to support disability inclusion, in consultation with Uganda’s disability rights movement, this report presents an analysis of Uganda’s landscape of disability data. It highlights important data sources, challenges and recommendations, providing a valuable evidence base to inform efforts aimed at strengthening the enabling environment for disability inclusion.

Product Narrative: Eyeglasses. A market landscape and strategic approach to increasing access to eyeglasses in Low- and Middle-Income Countries

CHAUDRON, Mathilde
SAVAGE, Margaret
et al
July 2020

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Increasing access to eyeglasses to eliminate the burden of uncorrected refractive errors in LMICs will require a multisectoral approach that brings together the public and the private sector, multilateral organisations, and donors. This will require an approach that increases demand for eyeglasses, raises the number of access points for screening and provision, and accelerates the availability of affordable products. To achieve this, we propose five strategic objectives that can strengthen the market in both the short and longer term.

A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries

BARBOSA, Euridxe
et al
June 2020

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This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings. Five databases were searched for articles related to the cost-effectiveness of emergency care interventions to treat acute stroke in LMICs.

 

https://doi.org/10.1016/j.afjem.2020.05.009

 

African Journal of Emergency Medicine

Available online 11 June 2020
 

Considering the disability related extra costs in social protection

MONT, Daniel
COTE, Alexandre
et al
June 2020

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This paper tackles several critical elements required for social protection systems and programs to adequately consider disability related extra costs. In the first part, it will explain the diversity of disability related costs. The second part will present current methods to assess and measure disability related costs and the issues they raise. The last part will present how social protection systems can take into account and tackle those different disability related costs.

 

This background paper is a part of a series produced in the frame of a project led by ILO and UNICEF in close collaboration with the International Disability Alliance (IDA) and supported by the UN Partnership on the Rights of Persons with Disabilities. It has been co-financed by Leonard Cheshire in the frame of the DFID funded I2I project. The UNPRPD project aims at developing practical guidance for countries, development agencies and DPOs for reforms towards inclusive social protection systems fostering empowerment of persons with disabilities across the life cycle. The papers summarize key issues and present policy recommendations and proposal to build inclusive social protection systems supporting empowerment and participation of persons with disabilities across the life cycle

Product Narrative: Prostheses. A market landscape and strategic approach to increasing access to prosthetic devices and related services in Low- and Middle-Income Countries

LIAO, Cynthia
SEGHERS, Frederick
SAVAGE, Margaret
FINEBERG, Alison
AUSTIN, Vicki
HOLLOWAY, Catherine
OLDFREY, Ben
April 2020

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While about 1.5 million people undergo amputations every year, WHO estimates that only 5-15% of amputees who need prosthetic devices in LMICs have access to them. High prices of prosthetic services in lower- and middle-income countries (LMICs), combined with high indirect costs for users (for example to travel to service points), make prosthetic services unaffordable to many of the people who need them. 

Prosthetic services can be made more affordable by: 1) increasing the number of service units (in particular, by leveraging decentralised service models and the innovative technologies that enable them); 2) establishing reimbursement schemes that encapsulate all costs to the user; and 3) leveraging alternative forms of financing for both capacity-building and user financing.

An opportunity exists to transform access to prosthetic services and products in LMICs, but this will require a coordinated effort between: 1) governments to expand service capacity; 2) global stakeholders to provide guidance on products and technologies; 3) suppliers to expand market presence and offerings; and 4) donors to support these activities. 

Five strategic objectives are proposed to accelerate access to prosthetic services in LMIC

Participation in Practice: Examples of inclusive action for a “Participation Revolution”

March 2020

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Humanitarian organizations and donors have committed to change the way humanitarian action is carried out and create a “Participation Revolution.” In this webinar issues addressed included:

  • inclusion of the people and communities affected by humanitarian crises in practice;
  • how organizations are ensuring that the voices of the most vulnerable groups considering gender, age, ethnicity, language, and special needs are heard and acted upon;
  • how program activities and budgets are designed to support the changes that affected people demand


In this webinar, organized on 26 March 2020 by PHAP and the Steering Committee for Humanitarian Response, we took stock of the progress to date on workstream six of the Grand Bargain and heard success stories from the field that can help agencies achieve a sustained change in how they design and deliver their programs.

 

A full transcript is available. Webinar registrants were asked to provide what they thought, in their context, was the most important factor enabling participation in practice and what they thought was the most important factor preventing participation in practice. Answers are provided in an Annex.

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