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Improving social inclusion and empowerment for people with disabilities in low- and middle-income countries: why does it matter and what works?

WHITE, Howard
SARAN, Ashrita
POLLOCK, Sarah
KUPER, Hannah
July 2018

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The aim of the Rapid Evidence Assessment (REA) is to provide an assessment of the effectiveness of interventions to improve social inclusion and empowerment for people with disabilities in low- and middle-income countries (LMICs). The studies included in this REA are taken from the Disability EGM prepared by the Campbell Collaboration for DFID under the auspices of the Centre for Excellence for Development Impact and Learning (CEDIL). Eligible studies included systematic reviews and impact evaluations published in English from 2000 onwards that assessed the effectiveness of interventions for people with disabilities in LMICs. The REA focused on studies identified by the EGM process that included ‘social inclusion’ or ‘empowerment’ as study outcomes and used the World Health Organization CBR matrix as a framework to categorise the different interventions and outcomes considered by the studies available. Evidence limitations and gaps were identified. 

There were 16 eligible primary studies, including studies conducted in 12 countries: Bangladesh (two studies), Brazil, Chile, China (two studies), Ethiopia, India (three studies), Kenya (two studies), Malaysia, Thailand, Turkey, Uganda, and Vietnam (two studies). Five of the studies concern interventions for people with physical or sensory impairments, nine for people with mental health or neurological conditions, and two for all disability types.

Improving educational outcomes for people with disabilities in low and middle-income countries: why does it matter and what works?

KUPER, Hannah
SARAN, Ashrita
WHITE, Howard
July 2018

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The studies included in this Rapid Evidence Assessment (REA) are taken from the Disability Evidence and Gap Map (EGM) prepared by the Campbell Collaboration for the UK Department for International Development (DFID) under the auspices of the Centre for Excellence for Development Impact and Learning (CEDIL). Eligible studies included systematic reviews and impact evaluations published in English from 2000 onwards that assessed the effectiveness of interventions for people with disabilities in LMICs. Qualitative studies, process evaluations, and non-impact evaluations (e.g. crosssectional surveys) were not eligible for inclusion. Quality grading was applied to the literature, so that assessment could be made of where there was strong evidence and where evidence was limited or missing. The studies were grouped by education sub-outcomes related to different stages in education across the life course; that is: early intervention, primary education, secondary education, non-formal education, and lifelong learning. 

 

There were 24 eligible individual studies, including studies conducted in the Middle East (10), Asia (7), and Africa (5), one from Latin America, as well as one multicountry study

Missing millions: How older people with disabilities are excluded from humanitarian response

SHEPPARD, Phillip
POLACK, Sarah
McGIVERN, Madeleine
July 2018

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The aim of this study was to explore the experiences of older people with disabilities across a range of humanitarian settings, considering:

  • whether older people with disabilities have additional needs and challenges accessing humanitarian assistance and protection
  • what factors facilitate or limit access by older people with disabilities to humanitarian assistance and protection
  • to what extent is humanitarian response inclusive of older people with disabilities

A systematic literature review of published studies was conducted. Key online humanitarian guidelines were explored to review how far they explicitly address older people with disabilities. Data from six population-based disability surveys comparing the living situation of older people with and without disabilities were analysed. These included databases from two crises-affected populations in Haiti (post-earthquake) and Palestine. Data from four non-humanitarian settings was also reviewed to explore more broadly the situation for older people with disabilities – India, Guatemala, Cameroon and Nepal. Interviews were held with older people with disabilities, members of their families and local key informants in two conflict-affected populations in Ndutu and Mtendeli refugee camps in Western Tanzania, and Donetsk and Luhansk regions of Eastern Ukraine to find out about their experiences. Staff of five international agencies working in humanitarian response were also interviewed. 

 

Findings highlight particular issues facing older people with disabilities in humanitarian crises: more risk escaping from danger;  barriers to accessing social protection and work; barriers to accessing health and rehabilitation services; barriers to accessing food and other essentials; unsuitable housing and poor living conditions;  insecurity and discrimination; threats to dignity and independence; social isolation and loneliness; risks to mental health; and missing from humanitarian response.

 

A table brings together the findings from the different components of the research to show the needs, risks, barriers and enablers for older people with disabilities identified in the research. Recommendations are provided to humanitarian donors, policy makers and practitioners

The disability data portal

July 2018

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The Disability Data Portal provides a snapshot of the data globally available on people with disabilities in 40 countries. The portal also identifies where there are gaps in the current body of data. 

The portal was designed for the Global Disability Summit, held on 24 July 2018, and focusses on data relating to four thematic areas: inclusive education, stigma and discrimination, technology and innovation, and economic empowerment. 

The portal presents key development indicators relevant to the Summit themes, mostly drawn from the Sustainable Development Goals (SDGs), along with others relevant to the UN Convention on the Rights of Persons with Disabilities (CRPD)

Disability, CBR & Inclusive Development, Volume 29, No.2, 2018 (Summer 2018)

July 2018

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Research articles are:

  • Lived Experience of Psychosocial Disability and Social Inclusion: A Participatory Photovoice Study in Rural India and Nepal
  • Barriers and Facilitators for Wheelchair Users in Bangladesh: A Participatory Action Research Project
  • A Cross-sectional Survey of Rehabilitation Service Provision for Children with Brain Injury in Selangor, Malaysia
  • Effect of Abacus Training on Numerical Ability of Students with Hearing Loss
  • Cross-Cultural Adaptation and Evaluation of Psychometric Properties of Persian Version of Supports Intensity Scale among Adults with Intellectual and Developmental Disabilities

Review:

  • Developmental Social Work for Promoting the Socioeconomic Participation of Persons with Disabilities: An Application of the Capability Approach
     

Brief reports:

  • Zero Rejection Policy in Admission of Children with Special Needs - Myth or Reality
  • Ujamaa and Universal Design: Developing Sustainable Tactile Curricular Materials in Rural Tanzania

Young persons with disabilities: Global study on ending gender-based violence, and realising sexual and reproductive health and rights

McCLOSKEY, Megan
MEYERS, Stephen
July 2018

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This study provides an analysis on the situation of young persons with disabilities concerning discrimination and gender-based violence, including the impact on their sexual and reproductive health and rights. It also provides an assessment of legal, policy and programming developments and specific good practices in service delivery as well as best-standard prevention and protection measures. Finally, policy and programming recommendations are provided to assist in greater promotion of the rights of young persons with disabilities, with a particular emphasis on preventing and responding to gender-based violence, and realizing sexual and reproductive health and rights.

Disability in humanitarian context: A case study from Iraq

HUMANITY & INCLUSION (HI)
June 2018

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This brief presents and addresses some of the challenges that prevent internally displaced persons with disabilities and other vulnerable population groups (elderly, injured persons, pregnant women, etc.) in camp settings from accessing humanitarian services in Iraq and impede on the development of an inclusive humanitarian response. Examples drawn from Handicap International’s experience working in Iraq with persons with disabilities and vulnerable population groups further illustrate those challenges. The recommendations to the humanitarian community provided in this brief aim at improving the protection of persons with disabilities and their inclusion in the humanitarian response

Bridging the Gap: Examining disability and development in four African countries. The case for equitable education

GROCE, Nora
et al
June 2018

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Over the course of a three-year project the Leonard Cheshire Research Centre worked with research teams in four countries: Kenya, Sierra Leone, Uganda and Zambia to better understand the relationship between disability and development in each country across four domains: education, health, labour markets and social protection. This mixed methods research used a range of interrelated components, including policy and secondary data analysis, a household survey of 4,839 households (13,597 adults and 10,756 children), 55 focus group discussions and 112 key informant interviews across the four countries. 

 

This report explores key findings in relation to education. Key findings discussed include school attendance, cost of education, inability to learn and gap in educational attainment.

Disability inclusion and accountability framework

McCLAIN-NHLAPO, Charlotte
et al
June 2018

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The main objective of the Disability Inclusion and Accountability Framework is to support the mainstreaming of disability in World Bank activities. It lays out a road map for (a) including disability in the Bank's policies, operations and analytical work, and (b) building internal capacity for supporting clients in implementing disability-inclusive development programs. The primary target audience of the Framework is Bank staff but it is also relevant to the Bank's client countries, development partners and persons with disabilities. The framework provides four main principles for guiding the World Bank’s engagement with persons with disabilities: nondiscrimination and equality, accessibility, inclusion and participation, and partnership and collaboration. 

 

The appendices to this framework highlight key areas in which the Bank can have a significant impact on the inclusion, empowerment, and full participation of persons with disabilities. These areas include transport, urban development, disaster risk management, education, social protection, jobs and employment, information and communication technology, water sector operations, and health care. 


Report No. 126977
 

Exploring the links between water, sanitation and hygiene and disability; Results from a case-control study in Guatemala

KUPER, Hannah
et al
June 2018

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A case-control study was conducted, nested within a national survey. The study included 707 people with disabilities, and 465 age- and sex-matched controls without disabilities. Participants reported on WASH access at the household and individual level. A sub-set of 121 cases and 104 controls completed a newly designed, in-depth WASH questionnaire.

Challenges and priorities for global mental health in the Sustainable Development Goals (SDG) era

ACADEMY OF MEDICAL SCIENCES
June 2018

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Published in 2011, the Grand Challenges in Global Mental Health initiative provided a framework to guide the research needed to improve treatment and prevention of mental health disorders and expand access to mental health services. At the Academy’s workshop on global mental health participants reflected on progress since 2011, focusing on specific life-course stages, and identified priorities for research in treatment and prevention, as well as enduring challenges and emerging opportunities

Assistive technology

WORLD HEALTH ORGANISATION (WHO)
May 2018

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A brief introduction to facts behind the global unmet need for assistive technology and the WHO response in coordination the Global Cooperation on Assistive Technology (GATE).

Psychosocial disability in the Middle East

BOLTON. Laura
May 2018

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A K4 helpdesk report, commissioned by DFID (UK), provides a rapid review of literature to provide best estimates of psychosocial disability in specific countries in the Middle East.

Topics discussed include:

Prevalence and different forms of mental health conditions and psychosocial disability

Factors influencing prevalence

Differences across demographics

Provision for those with psychosocial disabilities

Disability stigma in developing countries

ROHWERDER, Brigitte
May 2018

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This K4D helpdesk report, commissioned by UK DFID, answers the question "What are the core drivers behind stereotypes, prejudice (including pity/shame etc), and harmful practices against persons with disabilities in developing countries and what promising strategies/pathways for addressing these drivers have been identified?" using desk research.

 

Across the world stereotypes, prejudice, and stigma contribute to the discrimination and exclusion experienced by people with disabilities and their families in all aspects of their lives. This rapid review looks at available evidence on the drivers of disability stigma in developing countries, and promising strategies for addressing these. Most of the available evidence uncovered by this rapid review comes from Sub-Saharan Africa, and is from a mix of academic and grey literature. Evidence gaps remain. The available literature has focused more on studying the victims of stigmatisation than the stigmatisers. 

Assistive technology and people: a position paper from the first global research, innovation and education on assistive technology (GREAT) summit

DESMOND, Deirdre
et al
May 2018

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"Assistive technology (AT) is a powerful enabler of participation. The World Health Organization’s Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a “state of the science” view of AT users, conceptualized as “People” within the set of GATE strategic “P”s. 

Disability and Rehabilitation: Assistive Technology 
Volume 13, 2018 - Issue 5: Position Papers from the First Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit

This issue has 7 papers from the GREAT summit

https://doi.org/10.1080/17483107.2018.1471169

Inclusive service delivery for persons with disabilities in Mongolia

MAMUTKULOV, Raushenbek
ASIAN DEVELOPMENT BANK (ADB)
2018

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The Ensuring Inclusiveness and Service Delivery for Persons with Disabilities (PWDs) project in Mongolia aims to ensure access to improved services, employment opportunities, and more support through social welfare reform for PWDs.

Estimates of disability prevalence in Mongolia tend to be underreported, especially among older people, girls, and women, thus leaving a substantial number of persons with disabilities (PWDs) without the necessary services and protection. Early identification of disability is inadequate and current disability assessments follow an outdated, narrow medical approach. Many people perceive PWDs to be incapable of living independently and a burden to society.

A brief overview is given of a project aiming to ensure access to services and employment for PWDs to increase their autonomy and contribution to the economy and society in general.

(ADB Brief, Social Protection Brief, No.91)

“They Stay until They Die” A lifetime of isolation and neglect in institutions for people with disabilities in Brazil

RIOS-ESPINOSA, Carlos
et al
May 2018

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This report documents a range of abuses against children and adults with disabilities in residential institutions in Brazil. The research is based on direct observations during visits to 19 institutions (known in Brazil as shelters and care homes), including 8 for children, as well as 5 inclusive residences for people with disabilities. In addition, Human Rights Watch researchers interviewed 171 people, including children with disabilities and their families, adults with disabilities in institutions, disability rights advocates, representatives of non–governmental organizations, including disabled persons organizations, staff in institutions, and government officials.

 

Research was carried out between November 2016 and March 2018 in the states of São Paulo (including São Paulo and Campinas), Rio de Janeiro (including Rio de Janeiro, Duque de Caxias, Niteroi and Nova Friburgo), Bahia (Salvador) and Distrito Federal (including Brasilia and Ceilândia).

Learning From Experience: Guidelines for locally sourced and cost-effective strategies for hygiene at home for people with high support needs.

World Vision/CBM Australia
May 2018

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This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.

To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.

HYGIENE AT HOME FOR PEOPLE WITH HIGH SUPPORT NEEDS
This document is one of two developed in the Jaffna District and describes strategies that used to assist households and individuals in hygiene tasks at home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka.

NOTE: The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.

Digital Accessibility Toolkit

CBM
May 2018

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The purpose of this toolkit is to share a selection of tools and recommendations pertaining to the accessibility of Information and Communication Technologies (ICT). Based on international standards and a scan of available technologies, these tools and recommendations are intended to contribute to the social and economic inclusion of persons with disabilities by ensuring that information is equitably accessible.

The goals of this toolkit are:

  • To outline the key international frameworks around digital accessibility and why it is critical for inclusion of persons with disabilities.
  • To link people with tools, practice examples, free online training, and other resources so that their practice is digitally accessible.
  • To ensure that digital accessibility is an inherent aspect of daily practice.
  • To align the practices of those working with and for CBM. 

This toolkit is intended to be used as a guide and practice resource by people working with and for CBM so that we produce accessible digital content and communications, and place accessibility at the centre of our ICT procurement processes. We hope that the toolkit will be a resource for the wider community of persons with disabilities, Disabled People’s Organisations (DPOs), and nongovernmental organisations (NGOs).

Livelihood opportunities amongst adults with and without disabilities in Cameroon and India: A case control study

McTAGGART, Islay
et al
April 2018

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There is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian setting. A population-based case–control study of adults (18+) with and without disabilities was undertaken in North-West Cameroon and in Telangana State, India. It was found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others

 

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