UN Convention on the Rights of Persons with Disabilities: a call to action on poverty, discrimination and lack of access

Menu:

Click on the image to download the PDF Version

Cover page of Conference Report (Click here to download the PDF Version) 

3. Poverty is a human rights issue


“Now we must take concrete steps to transform the vision of the Convention into real victories on the ground. We must deliver development that is truly for all.”
Ban Ki-moon, Secretary-General of the United Nations

“Addressing disability is a significant part of reducing poverty. Bringing disabled people out of the corners and back alleys of society, and empowering them to thrive in the bustling center of national life, will do much to improve the lives of many from among the poorest of the poor around the world.”
James Wolfensohn, former World Bank President, 2002

Poverty reduction is the world’s first priority. So say the Millennium Development Goals, which were agreed by every country in the world, and made halving the number of people living in extreme poverty by 2015 their first objective.

Examining how best to do this for disabled people was the complicated task of this conference. We know from the World Bank’s latest poverty statistics5 (August 2008) that the world is likely to meet this goal. But what do these broad measures really tell us about the relationship between poverty and disability and about the millions left living below the poverty line? Even the definition of poverty needs examination, contends panel speaker Charlotte McClain-Nhlapo of the World Bank. “Poverty is unique,” she said, “in being both an economic and human rights issue.”

Inclusive development means an increase in participation, access and representation by disabled people, as well as an increase in income. But it is important, she believes, for all disability stakeholders to recognize that to gain the full range of rights for people with disabilities, we must promote the economic rationale for poverty reduction. Without supporting a change in disabled people’s economic status, the necessary social change will not take place. Two distinct approaches to how this might be done came up repeatedly in panel speeches and workshops:

  1. Include people with disabilities in mainstream poverty reduction and social programs

  2. Create other programs specifically designed for and targeted towards disabled people.

In every country in the world, people with disabilities have a higher unemployment rate than non-disabled people. © Leonard Cheshire Disability.Many maintain that both have a role in poverty reduction and that a synthesis of the two, known as the “twin-track approach,” is the best way forward. Mainstreaming and targeting need not work separately in any area of poverty reduction, argues panel speaker Sophie Mitra, who spoke in the context of including persons with disabilities in social safety nets. The same is true for job creation, according to Mark Palmer-Edgecumbe from Barclays Bank, who described a bank program that trains disabled people to work in mainstream job environments.

Again and again, poverty workshop speakers and participants emphasized that general poverty reduction programs may not meet disabled people’s specific needs. Classifying people with disabilities as a “vulnerable group,” for instance along with women or minority language speakers, can also create initiatives and policies that are too general to be useful.

The twin-track approach allows programs to be specifically designed for poverty reduction among people with disabilities. They can take particular needs, such as access, into account, which will then allow people to join mainstream initiatives. Its other component is targeting employers and governments to address issues within their reach, such as transport, equal opportunities policies and provision of disability equality training.

The workshops also emphasized important links between poverty and disability that can be different in different countries. Workshop speaker Dermot Foley explained how in Bangladesh, for example, poverty might be more closely associated with people who become disabled later in life, rather than those born with a disability. In several countries including Afghanistan, Zambia and Botswana, age rather than poverty was the strongest determinant of disability prevalence. Lack of education was also strongly associated with poverty among people with disabilities in many countries, illustrating the link between poverty of opportunity and economic deprivation, although not confirming which caused the other.

Treating all disabilities as equal in terms of their impact on poverty is also not the most effective means of bringing about change. For instance, in Bangladesh, research has found that people with ambulatory disabilities are three times more likely to remain economically active after becoming disabled than those with visual impairments. In other countries, visual impairment is associated with staying single, which can put people at greater risk of poverty in countries where marriage is nearly universal.

3.1 Panel presentations

Broadly considering the best ways to reduce poverty among disabled people, the four panel speakers on poverty covered initiatives by multilateral organizations, governments and the private sector:

3.1.1 Writing an “economic constitution”: inclusion of people with disabilities in national poverty reduction strategies
Charlotte McClain-Nhlapo, Senior Operations Officer, World Bank

The IMF and World Bank introduced Poverty Reduction Strategy Papers (PRSPs) in developing countries in 1999. PRSPs can be viewed as a country’s “economic constitution,” setting basic development values, objectives, strategies and operational rules that are framed and supported by social consensus.

Poverty is unique in being both an economic and a human rights issue, with compelling evidence showing that conditions of poverty directly influence the incidence of disability. People with disabilities are often among the poorest and have little representation in the wider society. Legally, frameworks such as the Universal Declaration of Human Rights include full rights for people with disabilities because they address all citizens.

In practice, some of these rights need to be reinforced by the new impetus of the UNCRPD, which calls for shared responsibility among all stakeholders to address the negative impact of poverty on persons with disabilities. It also mandates adequate social protection and specifically refers to poverty reduction plans such as PRSPs.

PRSPs will be instrumental in meeting the MDGs, which cannot be met without the inclusion of disabled people. They can form operational frameworks for achieving the MDGs at a country level, and are becoming increasingly important policy instruments for development. As both a process through which civil society (including disabled people’s organizations) can participate in policy development and an instrument to align donor activities, PRSPs can be a tool to enforce and measure accountability. Keeping the creation and implementation of PRSPs participatory will be vital to their success.

To truly include people with disabilities, the people behind PRSPs will need to do things differently. This means including people with disabilities in all stages of design and implementation, as was done in Tanzania, for example. In 2005, the country published its second PRSP and involved disabled people’s organizations during the review and formulation process, creating awareness of the PRSP process in the disability sector. Inclusion has also increased in other countries: in 2000 there were only three mentions of disability in PRSPs, but by 2003 there were 17. At this point, Tanzania’s final PRSP and those of other countries that have incorporated disability may be considered an improvement, but more work on inclusion is still needed.

To help make PRSPs more effective in addressing disability, Ms. McClain-Nhlapo called everyone concerned to take on the following principles:

  1. Mainstreaming disability into PRSPs is not sufficient – words must be followed by actions

  2. DPOs need to have staying power

  3. All stakeholders need to create the demand for true inclusion

  4. Those concerned must get involved and understand the process

  5. Identify champions in government and work with them

  6. Develop strategic alliances with other stakeholders for inclusion, such as those focused on women’s and children’s issues

  7. Add the missing elements to the PRSPs

Ms. McClain-Nhlapo believes that the application of the UNCRPD to the development process is likely both to reduce poverty and to promote wider social change. Without advancing the economic rationale for inclusive development, however, it runs the risk of being a paper tiger. Being committed to expanding the principles of inclusion throughout its work, the World Bank can promote the economic arguments behind them. The momentum for this that the UNCRPD creates will be crucial.

3.1.2 Social protection and the role of social safety nets in low income countries
Sophie Mitra, Assistant Professor of Economics, Fordham University, USA

Social safety nets can play a dual role in disability according to panel speaker Sophie Mitra: through mitigating the poverty associated with disability and, through improved services, limiting disability caused by accidents and other preventable causes. To reach the highest level of impact, Dr. Mitra argues, social programs need to adopt the twin-track approach and employ both targeted and mainstream initiatives. Social safety nets include social insurance programs, social assistance programs and in-kind transfers such as assistive devices – canes or crutches, for instance. While a country works towards a fully mainstreamed social system, targeting can fill in the gaps and speed up the process.

The advantages of this approach begin when targeted programs take the needs of both people with disabilities and their caregivers into account. Social benefits may not only improve their welfare, but may also increase their status and bargaining power within the household. The negative impact of this approach may show itself in higher administrative costs and increased bureaucracy, which could be beyond the capacity of some developing countries. Coverage may then become limited to only certain segments of the disabled population, for instance those who become disabled on the job, which can leave other disabled people in a more vulnerable position.

People who receive benefits may also be less likely to seek paid work, which can lead to greater segregation and will not necessarily benefit the larger economy. This approach can also reinforce stereotypes of disability and not lead to the overall economic empowerment of people with disabilities.

Mainstreaming may offset these disadvantages, which can affect a large number of people with disabilities, promotes inclusiveness and can cost less than benefits. Effective mainstreaming takes time, however, and targeted programs can fill in the gaps until all services become fully inclusive. In this instance, poverty reduction is closely related to improving access in four areas:

1. Physical accessibility

  1. The built environment, including government facilities and transport systems

  2. The ability of social workers to visit persons with disabilities

  3. The ability of family representatives to apply for, enroll and receive benefits on behalf of a person with disability

  4. Removal of geographical differences in program coverage (by region or d. urban vs. rural)

2. Social accessibility

To ensure that a program is socially accessible, one would need to address the following points:

  1. Is the program information available in different formats (such as Braille)?

  2. Is the program information delivered through different channels besides the government (media, community)?

  3. Do the attitudes of social safety net staff prevent or discourage access to benefits for persons with disabilities?

  4. Do some of the social safety net staff have disabilities?

3. Inclusive program design

Social safety nets may be designed in ways that exclude persons with disabilities. To find out if this is the case, one needs to ask questions such as:

Would people with disabilities have difficulty meeting some of the eligibility conditions?

When health, education and other services are not inclusive, how can conditional cash transfers (benefit payments), based for instance on fulfilling school and clinic attendance, be modified so that they can reach persons with disabilities?

4. Inclusive program evaluation

Program evaluations need to address the following questions:

  1. What proportion of people with disabilities who are eligible to participate in the program, actually take part?

  2. What are the profiles of participants with disabilities compared to people with disabilities who do not participate?

  3. What poverty alleviation and reduction impact does the program have on persons with disabilities?

Overall, to be most effective in poverty reduction among persons with disabilities, social protection must follow a twin-track approach of providing targeted and mainstream programs. It is also important to dedicate efforts to the collection of disability data, so that program evaluations can be inclusive.

3.1.3 Poverty elimination through recruitment: a Barclays case study
Mark Palmer-Edgecumbe, Global Head of Diversity, Barclays, UK

“If I asked you to list ten things that Barclays is famous for, I am pretty sure that eliminating poverty would not feature on that list.” So began Mark Palmer-Edgecumbe of Barclays Bank, and he even wondered himself, he said, why he had been asked to speak at this conference on poverty elimination. But as he considered Barclays’ work around the world, he realized that he had a lot to say about how to recruit, train and employ people with disabilities in a way that makes economic sense for them and their employers.

Focusing on “Recruitment that Works,” one of the bank’s recruitment initiatives in the UK, Mr. Palmer-Edgecumbe explained that it was designed in collaboration with the Employers Forum on Disability in the UK, to bring long-term unemployed people with disabilities back into employment. Two brothers, Paul and John, form an interesting case study of how the project works.

In 2006 Paul and John, both of whom had been injured in active service following long military careers, were living on disability payments after leaving the army. They saw an advertisement for “Recruitment that Works” inviting people with disabilities to apply for work with Barclays at one of their UK call centers. The ad stated that they would be assessed for the job on their ability, rather than their disability, and so they applied to be customer service advisors.

Barclays then assessed them to see if they had the basic competence to do the job, which they had. At 48 and 58 years old, the brothers had not worked for five and 15 years, respectively. This had not been through choice, however – despite applying for many jobs, they never got past the first interview.

The program then spent the next six weeks coaching them in preparation for their interviews with Barclays – a process they call “work preparation.” Their interviews were successful, showing that the preparation had worked, and they then had two weeks of on-the-job work experience. After that they had a final assessment and they were both successful in this as well.

Paul and John were two of 18 disabled people who started the program, and 13 who made it to the final interview stage. All 13 were offered jobs, beating Barclays’ own target of recruiting five long-term unemployed people with disabilities.

Barclays then wanted to maintain the level of support the trainees had received once they started employment with the bank. They trained every single member of staff at the call centre – some 300 people − in disability confidence, including the security guards and catering staff who were not even their own employees. When Paul and John started their jobs, they were also allowed to work part time until they were confident in their new roles.

All of this sounds very positive, and it is, believes Mr. Palmer-Edgecumbe, but Barclays believes that “Recruitment that Works” will only be successful over time if it is part of a holistic disability strategy. In Barclays’ case, this starts with leadership from the very top of the company, the Chief Executive, John Varley, who is their disability champion and, coincidentally, is also the President of the Employers Forum on Disability.

The bank’s strategy is to understand that reasonable adjustments are key. A centralized and centrally funded reasonable adjustments scheme ensures that it is as easy for line managers to recruit and develop a disabled individual, as it is a non-disabled person. They also maintain a disability helpline as the first port of call for help, support and advice for disabled employees and their line managers. In addition, all Barclays’ policies, practices and sources of help and advice are available from their Disability One Stop Shop – an intranet portal that tailors the information according to whether you are a disabled worker, line manager or co-worker of a disabled individual.

There is also mandatory training in disability confidence for all line managers and everyone who works in recruitment. To tackle issues and learn from people’s day-to- day experiences, the Chief Executive hosts two “Disability Listening Groups” a year, in which he checks in with disabled staff, ensures that the strategy is working and takes any necessary actions to adjust it.

From the bank’s point of view, this amounts to getting the basics right, which helps ensure that disabled employees contribute fully to the organization. Equally important is that they also have the possibility to realize their own potential, and Barclays has established a global disability mentoring scheme through which every disabled employee who would like one, has access to a trained mentor.

So, from the point of view of Paul and John and Barclays’ other disabled employees, they have been lifted out of poverty by the “Recruitment that Works” program. From Barclays’ point of view, as a commercial company, why should it spend so much time and effort to recruit disabled people, when it could just recruit young people finishing schools and universities?

The answer is that, in addition to doing something positive for people with disabilities, there is a genuine business benefit to focusing on ability. Barclays started “Recruitment that Works” seven years ago at a different call centre, where they recruited 11 disabled people. Today, all of those individuals are still employed at that call centre and they are all top performers, highly motivated and also great ambassadors for Barclays.

Their high performance, low turnover and low absenteeism is something unheard or even undreamed of in the high turnover world of call centers. “Recruitment that Works” has become a project that makes good economic sense for Barclays, and for the disabled employees.

Since Barclays has done this and knows it works, the next challenge is for everyone at the conference to do something similar. Taking forward the spirit of this project, it is obvious that eliminating poverty is not just about giving someone money. It is also about providing a real job in mainstream society that can help provide dignity and self respect, and counteract feelings of worthlessness. And about Barclays’ role in this process, Mr. Palmer-Edgecumbe is very proud.

3.1.4 Strategies for reaching the poorest of the poor: the role of the African Decade
A.K. Dube, Head of Secretariat, African Decade, South Africa

Poverty remains a central concern of the African Decade of Persons with Disabilities, which was proclaimed by the African Union for the period 1999 – 2009, and extended to run for another decade in 2008. Managed by a Secretariat based in South Africa, its activities empower governments, NGOs, DPOs and development organizations, to include disability and persons with disabilities into policies and programs in all sectors of African society. Capacity building, advocacy, lobbying, coordination, monitoring and reporting are all part of the Decade’s agenda. Like the other speakers on poverty, Mr. Dube highlighted the fact that poverty for people with disabilities may include high levels of unemployment, poor health and lack of access to services, education, infrastructure and rehabilitation support. All of this leads to restricted prospects for individuals, a negative impact on whole economies and entrenched negative attitudes towards disability.

Because so many stakeholders are involved in the African Decade, the Secretariat works as a facilitator rather than an implementer. One of their main roles is to work with governments to develop models of work, advocacy and implementation that can be replicated in different countries. These models can then lead to country- level mainstreaming strategies and the development of indicators in all government sectors.

The other side of this approach involves strengthening the capacity of non-governmental organizations in planning programs and running their programs efficiently. Within this, the Decade particularly mobilizes under-represented disability groups, such as women with disabilities and disabled youth.

Supporting the ratification and implementation of the UNCRPD is another focus, and the Decade’s strategy is to facilitate the participation of people with disabilities in country- level PRSPs and Country Action Strategies (CAS). This will feed into programs that help shape the policy and legislation environments within African countries, and facilitate mainstreaming of disability in all sectors, particularly HIV/AIDS. To help non-professionals understand the UNCRPD, the Secretariat is currently simplifying its language to make it more accessible to both persons with disabilities and others. A forthcoming law conference and a summer school on the new convention will also spread its message to a wide audience.

Touching on subjects covered by the other panel speakers, Mr. Dube explained how the Secretariat also called for people with disabilities to undertake accurate research into disability prevalence and social protection. This, he believes, will help unlock resources from governments and development organizations and create replicable models.

Working within the African Union and its constituent organizations, the Secretariat has a wide remit and opportunity to influence both policy and practice. It also attracts wide donor support, including from current funding partners Sida (the government of Sweden), DPOD Denmark, the Southern Africa Trust, DFID (the UK government) and CBM. Irish Aid and the EU are soon likely to support research.

The Secretariat also established decade steering committees (DSCs) in 20 countries. Each DSC should reflect the multi-disciplinary nature of disability and should be composed of representatives from government, DPOs, NGOs, the national AIDS council, media representatives, employers and trade unions. Working within the broad framework, the African Decade activities can reach as many people and organizations as possible, to decrease the poverty of people with disabilities.

3.2 Workshops

3.2.1 Disability must never again stand alone – Workshop 1: Mainstreaming disability to reduce poverty
Speakers: Teresa Mwendwa, Friends of the Disabled Federation, Kenya Elisabet Eklund, UNDP, Kenya

“Unless disabled people are brought into the development mainstream, it will be impossible to cut poverty in half by 2015 or to give every girl and boy the chance to achieve a primary education, by the same date-goals agreed to by more than 180 world leaders at the United Nations Millennium Summit, in September 2000.” James Wolfensohn, Former President, World Bank

Many contend that poverty is both a cause and a result of disability. Social stigma and lack of access to health, education and employment opportunities can lead to a vicious circle of reduced income and increased disability.

The basic needs of people with disabilities are the same as those for all people. In many countries, however, governments have set up structures to provide services for disabled people that run parallel to other government ministries or programs. Existing outside of the mainstream, these structures may never quite reach the majority of people with disabilities. In the main government ministries or departments, staff may not be sensitized to disability, or have the technical expertise and financial resources, to provide the necessary programs for people with disabilities.

The first workshop speaker, Teresa Mwendwa, proposed that the best way to overcome these problems is to mainstream disability into all sectors and in all development programs. This would include the full participation of people with disabilities, and supporting better research and data collection on disability and development. The UNCRPD provides a comprehensive framework on how to do this and enshrines disability issues in all programs: it can never again be thought of as standing alone.

The IMF and World Bank introduced PRSPs in 1999 in Africa, Asia, Eastern Europe and Latin America to form comprehensive country-based strategies for poverty reduction. Supporting the MDGs and addressing all aspects of development, they could be catalysts for involving people with disabilities in all socioeconomic development activities. They could also address the needs and participation of certain subgroups, such as women and children with disabilities.

Unfortunately, until recently few country PRSPs had a disability dimension, although the number is now increasing. Outcomes from proposed activities still vary, however, and PRSPs sometimes lump people with disabilities together with other “vulnerable groups.”

Experience has shown that when the specific causes of exclusion and the exact needs of people with disabilities are not explicitly identified, the resulting strategies and programs designed to address the “vulnerable groups” are likely to miss the differences in poverty determinants.

As the MDGs cannot be achieved without the participation of people with disabilities, disabled people’s contribution to PRSPs will be vital. One means of participation is through DPOs, which will need to involve themselves in all elements of the PRSP/development process, rather than waiting to be asked. Each PRSP addresses several issues that are particularly relevant to people with disabilities and in which they can make a large contribution: health and rehabilitation, education, infrastructure (which is particularly relevant to disability in terms of access issues) and employment.

Having emphasized that disabled people’s organizations must push for involvement, Ms. Mwendwa also pointed out that those preparing the PRSPs need to take disabled people’s needs into account. These could include presenting materials in alternative formats, considering physical access to meeting spaces and inviting people in advance so that they can make appropriate travel arrangements.

Turning specifically to Kenya, the second speaker, Elisabet Eklund, shared that Kenya won the UN’s Public Service Award for implementing the Performance Contracting Process, which is part of the Results Based Management (RBM) introduced by the Public Sector Reform Programme. The Award was won for “Improved transparency, accountability and responsiveness in the Public Service” in 2007.

Introduced in 2004, the Public Service Reform and Development Secretariat coordinates all public service reforms and should improve the quality of government interventions. They have also written a new national strategic plan, which includes “Vision 2030,” a goal based on three pillars: economic, social and political. Persons with disabilities are covered under the social pillar, through special provisions for vulnerable groups.

In the same year, Kenyan public services also introduced RBM, which calls for a cultural and attitudinal change among all levels of civil servants. RBM contributes to the creation of a shared culture of values, a common understanding of competency development and building networks of colleagues throughout the entire public service. It also incorporates various management tools such as strategic plans and annual performance plans, which different organizations can use to analyze public policy through a disability lens.

A World Bank study estimates the annual loss of global GDP caused by high rates of unemployment among people with disabilities at between US$1.37 trillion and US$1.94 trillion. This is the perspective through which the issue of a comprehensive poverty reduction strategy for persons with disabilities should be considered in PRSPs.

All of this has also been embodied in Kenya’s Disability Act 2003, and reflects well in advance the issues from the UN Convention on the Rights of Persons with Disabilities, which Kenya ratified in June 2008. The Disability Act establishes a National Council for Persons with Disabilities (NCPWD), which consists of a maximum of 27 council members and a secretariat lead by a director.

The Public Service Reform and RBM offer several other areas for further studies in mainstreaming disabilities. The different tools used for RBM, such as strategic plans and annual performance plans from different organizations, could be analyzed through a disability lens. Also, service charters could be evaluated by relevant disability organizations.

In Kenya, these first steps towards mainstreaming are already paying dividends. A recent study found that only 8% of people with disabilities faced discriminatory attitudes from public authorities, which is much lower than anecdotal reports from other countries. The Disability Act also requires a 5% quote for employment of people with disabilities, which again is higher than similar figures in other countries.

To help promote mainstreaming in government, donor and multilateral programs in all countries, workshop participants called for:

  1. Wide stakeholder consultations in all development and government activities

  2. Training for government ministers in disability issues

  3. The UNCRPD could be used as a tool to mobilize resources for mainstreaming and the training and sensitization that will lead to it

3.2.2 First steps towards preparing for work – Workshop 2: Microfinance is not the tool to reach the poorest of the poor
Speakers: Enzo Martinelli, International Disability and Development Consortium Livelihoods Task Group Leader, UK Marinke van Riet, Executive Secretary and Director, International Forum for Rural Transport and Development, UK

Microfinance provides small loans and other small-scale financial services that allow poor people to start or improve small businesses. Typical microfinance programs provide access to capital for those who may be excluded from the formal banking sector, including some people with disabilities. This kind of program may not include other financial products, such as savings groups or financial training.

Such programs have been effective for people who have the skills, experience and personality traits to make their businesses viable, and the financial acumen to manage their loans. Most likely, they already have some training and experience in their field and in money management.

In Sierra Leone, young people with disabilities have formed their own tool making business. © Jenny Matthews/ Leonard Cheshire Disability.For the poorest people with disabilities however, using microfinance as the only tool to reach financial independence may be too big a first step. This is the conclusion of Enzo Martinelli, who believes that more collaborative support programs from a range of service providers such as DPOs, NGOs and civil society groups can best meet this group’s needs. 7 This is especially true for people who may also need help with practical issues such as access, transport and training. Skills development, increasing access to social protection, support for waged employment and savings groups are all appropriate interventions to consider for people with disabilities, who are just starting a transition into work.

Some specific activities that integrated projects can take to support people about to start small economic activity are:

  1. Identify market-driven opportunities for small businesses that provide competitive advantages to people with disabilities

  2. Research vocational training linked to marketable skills and marketable products among both services for disabled people and in mainstream training and business institutions

  3. Adapt the vocational training curriculum to take into account disabled people’s access and other needs

  4. Build self-confidence and provide career guidance for self-employment options

  5. Facilitate peer support by successful entrepreneurs for people with disabilities

Marinke van Riet also agrees that the small loans given by microfinance institutions may not work for the most vulnerable people. Instead, she advocates grants rather than small loans, which can help people with disabilities establish small businesses. In explaining how this is done through an NGO called Trickle Up, she pointed out that this approach also includes many of the services Mr. Martinelli mentioned – support for group savings, business training and help with building equity. Once the process of sensitizing disabled people to self-employment has begun, programs can foster an understanding of money management through gradual exposure to financial services with higher complexity. One effective way to do this is through group saving and lending, with support from disabled people’s organizations to reduce the credit risk. A possible next step is to find microfinance institutions interested in including people with disabilities to expand their customer base. The new entrepreneurs can also be helped to develop their products and their penetration in local markets. Finally, commercial banks can be involved once businesses progress to an appropriate size.

To make such efforts sustainable, partnerships with disabled people’s organizations can help promote microfinance schemes, enhance their performance, monitoring and follow up, and consolidate lessons learned. Creating structures to replicate and scale up success is also important and this might involve partnerships between the various stakeholders. Above all, inclusion should be a goal of the program, both in terms of including people with disabilities in the economy and in their participation in mainstream financial institutions.

The Trickle Up program is one example of how inclusion can change organizational cultures to reach more people with disabilities. Since 1979 it has targeted the most vulnerable people who cannot access mainstream microfinance institutions or qualify for loans. By 2007, 7% of their clients were people with disabilities. The target for 2015 is 15% and they have worked with DPOs to help achieve this. They have also taken steps to become inclusive themselves, including changing the language they use (for example, using the phrase “differently abled”) and providing disability training to all of their staff.

In the workshop discussions, participants made the point that the people who may seem to be the poorest, such as newspaper vendors and beggars, may not be – the poorest people with disabilities may be invisible to outsiders and doing very little. Akin to this are the problems faced by everyone in the world’s poorest countries, such as poor transport infrastructure, which can be even more acute for people with disabilities.

They also pointed out that there are many ways to use groups for savings, including self- help and campaigning groups, groups for people with one type of disability, groups of people with different impairments and mixed groups of disabled and non-disabled people. Further investigation is needed to test which model is most effective.

Microfinance institutions’ attitudes sometimes cause problems, such as denying access to financial services to displaced people, which makes it harder for them to resume financial independence. As many such institutions have now turned into banks, they could adopt the kinds of diversity policies now in place in many of the banks. The workshop called for a range of action points, to increase disabled people’s participation in the wide range of activities that could support them in entering the workforce:

  1. Inclusion and mainstreaming, including training on how to become inclusive, are vital for all microfinance stakeholders working to enable people with disabilities to access financial services

  2. Lobby governments to provide more inclusive policies for microfinance institutions to include and become accessible to people with disabilities. Anti-discrimination legislation should be enacted

  3. Address the lack of knowledge among banks and microfinance institutions about disability, as well as their fears that people with disabilities represent bigger business risks than other groups

  4. All stakeholders should make a commitment to considering potential market research opportunities. This is especially important within the disability sector as it can break stereotypes about jobs that people with disabilities can do

  5. Involve DPOs in developing the policies of microfinance institutions.

Stakeholders in the disability movement can campaign to make banks and micro finance institutions inclusive for people with disabilities in the same way that people successfully campaigned to end Barclays’ participation in apartheid.

3.2.3 Making social protection a hand up – Workshop 3: the role of state safety nets in low income countries
Speakers: Kate Gooding, Sightsavers International, UK, and Thomas Ongolo, Secretariat of the African Decade, Kenya
Pradeep Kumar, former Disability Commissioner, Government of Karnataka, India

        “In Europe, 14% of the OECD’s GDP is spent on social protection schemes,
        but less than 2% of Africa’s GDP is spent on social protection.”
        Alessandro Conticini, Senior Chief of Adolescent Development, Protection and HIV/AIDS

Social protection as innovation and a tool to promote inclusion was an important theme for this workshop. There is increasing interest in social protection, in the form of service provision or financial support, for people in many different situations, and the question is how to make it most effective for people with disabilities.

When considering cash grants, speakers and participants called for them to be seen as a “hand up” rather than a “hand out.” Several studies of social protection have found that it can improve nutrition, health and access to education for recipients and their households. Also, contrary to assumptions that social assistance promotes dependence and discourages work, research has also found that cash transfers promote economic activity through investments in microenterprises and the maintenance of productive assets.

How to make social protection truly inclusive is at the heart of the issue, and there are good reasons to consider disabled people as a target group. For instance, there may be extra costs associated with living with disability, and state social transfers can compensate for these. There is also the acknowledged high level of poverty faced by many disabled people, which would automatically qualify them for social protection in some countries. The question of access is always critical however, as institutional, social and environmental barriers may stop people from learning of suitable programs or prevent them from taking the necessary steps, such as travelling to government offices, to participate in them.

There is also debate about whether social protection transfers should be in cash or in kind, such as providing assistive devices. In-kind transfers sometimes have the benefit of bringing a specific support, for instance mobility aids, which allows people to participate more widely in their communities. Some devices may also be too expensive for people to afford without help, or unavailable locally, so in-kind support can help disabled people access the technology that is most appropriate for their particular needs.

The next question is about eligibility. Social protection programs in some countries extend to all people with disabilities, while others apply only to those in financial need. Even defining disability becomes an issue: is someone temporarily disabled eligible? Should the relative severity of impairment be considered? Should it apply only to those who cannot work and if so, how is this determined? DPOs can help clarify these issues with governments and monitor how well the programs are actually reaching the intended participants.

Another alternative is to link cash payments to school or health clinic attendance. While this can promote fuller participation, it can also exclude people with disabilities from benefit schemes if the schools or health services are not accessible. Alternatively, it could put pressure on services to become inclusive.

Overall, the workshop speakers and participants believed that it is important for cash transfers to be part of wider action to support inclusion and greater rights. Once again the question is how these measures are handled, and the participation of people with disabilities and disabled people’s organizations in their design and implementation, is very important. Issues to consider in assessing people’s support needs include their assets, income, costs, skills and other factors affecting employment – not just their impairments. Is there a role for programs that provide both services and cash, depending on need?

Many of these principles have already been put in place in South Africa, where South Africa Disabled People, a national disabled people’s organization, advocates for grants to be seen as part of the inclusion process and contributing to overall poverty reduction. People with disabilities were involved in developing South Africa’s cash transfer program, which pays Rand 940 to over 1.4 million people a month.

The grants are typically used to cover extra costs related to disability, such as use of more expensive transport (private or adapted) where public transport is inaccessible, attendant care services, assistive technology, rehabilitative equipment or devices, transportation services, housing and workplace modifications, interpreter or reader services, and periodic medical or hospital visits.

Social Protection can enhance participation in the family and in society. © Leonard Cheshire Disability.

The funds may also be used to pay for education or health services, buy goods and food for the household and cover other living costs. While the size of the grant may not allow people with disabilities to live independently, it can allow recipients to contribute to household expenses and their families’ wellbeing in ways that were impossible before. This may both increase their status within the family and community, and enhance their participation in society.

The Indian state of Karnataka can tell a similar positive story. In 1995, the People with Disabilities Act provided for a quota of 3% of funds used in all poverty alleviation programs to be targeted towards people with disabilities. There is a strong civil society sector in Karnataka, and from the beginning, disabled people’s organizations and NGOs were involved in participatory governance of the program and associated services. Some of their joint achievements include:

  1. The Office of the Commissioner for Disabilities built a strong coalition

  2. Nodal NGOs were identified in all districts to focus on promoting disability rights, legislation, government schemes and poverty alleviation programs

  3. Getting support in the media.

There was a District Disability Management Review, a tool for practicing participatory governance in disability, which they saw as having four phases:

  1. Capacity building of the key stakeholders

  2. Advisory role

  3. Monitoring and evaluation

  4. Grievance redress.

It was also felt to be necessary to educate stakeholders about the different quotas. To do this, the district nodal NGO organized awareness-raising workshops and provided information about programs, schemes and government targets to people with disabilities in various formats. Involving disabled people in planning to this degree led to a “results based management program.” Monitoring and evaluation of how the quotas were implemented was undertaken by the district nodal NGO and other stakeholders, and held in the presence of four different authorities:

  1. District-in-charge Minister

  2. District in-charge Principal Secretary

  3. Commissioner for Disabilities

  4. Monthly meetings of the District Deputy Commissioner.

This process includes information on the benefits transferred to people with disabilities in the district, and any shortfalls had to be explained.

The Office of the State Commissioner for Disabilities was a great help to this process, as an independent and autonomous office with quasi-judicial powers. It was the first state office to function as a “civil court,” and this model was recommended to other states and praised by DFID in its 2005 Country Report.

Karnataka’s dynamic process of implementing quotas for participation in social programs can teach several important lessons, believes Pradeep Kumar. It takes more than political aspirations to make quotas work: you need an administrative system that is sensitive to disability and a proactive civil society. Above all, this kind of participatory governance must be based on the principle “nothing about us, without us.”

To make the various forms of social protection work best for people with disabilities, workshop participants called on governments and civil society to:

  1. Evaluate what social protection is needed

  2. Involve disabled people in program design

  3. Develop participatory governance

  4. Include more support for children, including daycare and parenting, and family support services

  5. Evaluations are needed to both advocate for programs and to make them more effective.

3.2.4 Poverty and disability programs must be integrated – Workshop 4: Poverty reduction strategies for the poorest of the poor
Speakers: Philippa Thomas, UK Government Department for International Development, Zimbabwe Professor Nora Groce, Chair, Leonard Cheshire Disability and Inclusive Development Centre, UK

Programs to address poverty and disability are caught in a vicious circle, contends Philippa Thomas. First, there is growing international consensus about the aims and modalities for delivering poverty reduction. Disability is also an increasing concern among those working for poverty reduction and the promotion of human rights. Yet disability largely remains off the poverty reduction agenda. Why? The reasons behind this problem encompass many fields:

  1. Disability stigma and ignorance

  2. Different understandings and interpretations of the social model of disability

  3. Insufficient appreciation of the relationship between poverty and disability.

All of these can result in mistrust between people involved in disability and poverty reduction, and render disability a special interest topic that may be difficult for those not directly involved in it to understand. A number of differences in approach can contribute to this mutual unintelligibility:

Data and statistics: Globally, existing statistics are insufficient and may not meet the different needs of mainstream development actors and people in the disability movement. People with disabilities may be unable to access data for a range of reasons, and the two sets of stakeholders may use mutually exclusive terminology and jargon. Beyond this, disabled people may be “invisible” to development organizations, and people with disabilities may not know of development activities.

Donor priorities: Donors now often focus on harmonized approaches to development, such as Poverty Reduction Budget Support (PRBS), when a donor provides funds directly to a partner government’s central exchequer, to support their programs in poverty reduction. Another increasingly used mechanism is a Sector Wide Approach (SWAp) process, in which donors give significant funding to a government’s comprehensive sector policy and expenditure program (for example on health or education), consistent with a sound macro-economic framework. There is a shift away from direct project support among donors, and less emphasis on support to civil society. Funding tends to be large in scale and many donors have limited expertise in disability.

Civil society organizations may be small scale: Organizations by and for disabled people, on the other hand, often focus on small-scale projects. They may have limited mainstream development expertise, and a small capacity to adapt to the new donor approach. Unfortunately, there may also be questions on how representative and accountable some of the civil society organizations really are. In an ideal world, states, service providers and DPOs would work together. The state would define rights and entitlements through legislative and policy framework, set standards and monitor implementation. It would also provide resources and ensure that mainstream services, particularly health and education, are accessible to disabled people.

Disability service providers would help reduce the impact of impairments through access to assistive devices and rehabilitation, and enable disabled people to access their rights. The DPOs would advocate and lobby for disability rights, and ensure that the state and service providers remain responsive and accountable to the needs and rights of disabled people.

The DFID experience in Zimbabwe shows that this kind of cooperation is beginning to be possible, even in our far from ideal world. The situation for people with disabilities in Zimbabwe is a result of many contradictions. The country is experiencing a protracted humanitarian crisis: the causes may be contested but the effects are clear – hyperinflation, economic decline, rising food insecurity and deteriorating basic services. Disabled people are among the poorest and most marginalized in the country, and suffer disproportionately from Zimbabwe’s deterioration. They are more likely to need health care than non-disabled people, and are less able to collect water from alternative sources or spend hours in queues for basic goods. Disability support services have collapsed. A focus on short-term humanitarian assistance has further marginalized disability issues.

More positive developments include most NGOs and UN agencies’ use of disability as a targeting criterion to identify the poorest and most vulnerable households. A disability rights act was also passed in 1990, there is a disability advisor in the Office of the President and there are disability benefits and grants, although these have lost all value because of hyperinflation.

DFID now supplies humanitarian assistance to the Zimbabwean people, with a focus on saving lives and livelihoods and promoting universal access to HIV/AIDS prevention, treatment and care. Recently DFID commissioned a disability scoping study and selected disabled people as consultants. The study process was an empowering and transformative experience, challenging attitudes. Mainstreaming disability in its flagship livelihoods program, The Protracted Relief Programme (PRP), is DFID’s priority:

  1. All concept notes and proposals for PRP must address disability
  2. NGOs will be encouraged to partner with disabled people’s organizations
  3. Local disability advisers will be appointed.

Disabled people’s organizations (DPOs) are being supported to participate in program meetings.

DFID has also worked closely with the Foreign Office who supported a capacity building needs assessment of DPOs and a dialogue workshop, which ended with the two national umbrella DPOs signing a memorandum of understanding, to guide future cooperation.

DFID has also raised awareness of disability among other donors and this has led to UNICEF and the European Commission identifying disability as a priority issue. From their experiences, DFID has learned several lessons for further disability work in Zimbabwe and other countries, including the need to gather and disseminate evidence and analysis, to build coalitions of development and disability organizations, and to manage expectations. It is also important to accept that this process has no quick or easy answers, but offers the opportunity for everyone involved to embrace and promote change.

Professor Nora Groce then turned the workshop’s attention to the people with disabilities who may not be being included in current poverty reduction programs. Often, she contends, global poverty is discussed within a very narrow point of view, even within the disability realm. Much of the ongoing dialog is framed in terms of employment, while the majority of the developing world is self-employed, and many people combine a variety of income generating activities to support themselves and their families. To be really effective, we therefore need to conceive and design programs that allow individuals with disabilities the autonomy to decide how and when they work, and whether they would prefer to work for themselves or for others. At the moment, poverty reduction programs often concentrate on teaching just one skill or a limited skill set to disabled persons, which puts them at the mercy of a single employer.

With this comes the need to support people with disabilities while they learn the skills to manage their own financial affairs. Too often, when disabled people get a job, their wages are not directly under their control: even if they are working, their ability to decide for themselves how and when to spend their money is significantly limited. This is particularly true for many disabled women in developing countries. (Certainly this is a wider concern for many women, but being a disabled woman will compound this issue.)

Even when people with disabilities are allowed to keep the money they earn, they often have little experience in understanding how best to budget and save this income. Often, parents and teachers spend little time teaching an understanding of finances and money to their disabled children, while the same subject is considered an important part of coming of age for non-disabled children in the same households or classrooms. Additionally, job training and skill building is often framed as an adult concern, with education for children with disabilities focusing on school-based education that provides basic skills such as reading and math. Excluded from this scenario are the millions of children who do not get to school in the first place, or those who leave school early.

These children still need some sort of non-formal educational outreach to provide them with skills that will allow them to earn a living in later life. Obviously, the more education a disabled child can get, the better – however, practical consideration should be given to ensuring that children who cannot complete a basic education are not also unable to support themselves in future years.

Of even greater concern are the vast majority of disabled adolescents whose education has ended, but who are not being given the skills and job training to enter the adult world of work at the same pace, and at the same age, as their non-disabled peers. This leaves many disabled adolescents facing an enormous time gap, during which they wait at home and are bypassed by their non-disabled peers who begin to enter the workforce. Instead of being included in the workforce in an age-appropriate way within their cultures, their entrance to the workforce is delayed, and thus their experiences become markedly different from those of their non-disabled peers. Disabled adolescents are also often put at a significant disadvantage from the outset, because even if they are fortunate enough to get an education through the schools, they are often left out of internships, apprenticeships and part-time after school jobs that help young people build skills they will need for the workforce. Additionally, even when a disabled adolescent is able to get an internship or first job, there is little room for failure. Should they not perform well in the first job opportunity they have, family and community members are often quick to decide that these young people should not be in the workforce or are unemployable.

In fact, many adolescents – in both developed and developing countries – do not thrive in their first job (as many readers will recall from their own experiences as adolescents with their first jobs), and poverty reduction programs must make sure that disabled young people have the same right to try, fail and try something else, as all other young people.

The Leonard Cheshire Disability and Inclusive Development Center will be investigating issues of self-employment in developing world economies in a series of research projects over the next few years.

Workshop participants then went on to call for three action points to tackle the interconnected fields of disability and poverty reduction:

  1. Identify methods and approaches that reach and engage persons with disabilities who are currently not involved (poorest of the poor)
  2. Develop strategies to ensure that awareness of persons with disabilities who are the poorest of the poor is raised
  3. Identify where we can leverage opportunities to build capacity in multiple stakeholders.

3.2.5 Inclusion is an economic necessity – Workshop 5: Mainstreaming disability in employment
Speakers: Imtiaz Mohammed, Senior Programme Manager for Asia, Leonard Cheshire Disability, UK
Mr. Chi Junchang, International Department, China Disabled People’s Federation, People’s Republic of China

Is mainstreaming what we need and want? Imtiaz Mohammed opened this workshop by asking participants to consider what is really most effective in supporting people with disabilities into work. While we may celebrate the fact that many NGOs, including Save the Children and World Vision, and bilateral donors including DFID and USAID, have integrated disability into their programs, we also recognize that sometimes disability needs to be addressed as a specific issue.

This is referred to as a twin-track approach and might include, for example in the health sector, first promoting general health care services and ensuring that they are accessible to people with disabilities. The other part of the process is to provide disability equality training for service providers, adapt facilities and provide health information in accessible formats. It could also extend towards sensitizing providers to any special health care needs that people might have because of their disabilities. When the twin-track approach is applied to employment, it is important to ensure that government legislation and policies target all vulnerable groups, including people with disabilities, and that a distinct business case is made for disabled people’s economic empowerment. For instance, if the up to 10% of the population now excluded from work because of their disability could be employed, this would have a significant impact on the overall economy. In order for this to happen, some adaptations to employment conditions may be necessary. This could include making allowances for increased travel time or increasing access to workplaces.

The corporate sector can be cynical, but it can be useful for people with disabilities simply to be exposed to the world of work. Disabled people in workplaces will be advocates for disability among others with whom they work. One approach to increasing the participation of people with disabilities in work is to have a champion at work, maybe one person on every floor or department who advocates with disabled colleagues for their needs to be addressed.

Many work initiatives for people with disabilities focus on small-scale employment, yet it is debatable whether this kind of work truly lifts people out of poverty. Entrepreneurs may be born, not made, and while building their skills is important, some people will be more comfortable and productive in other kinds of work. Social protection programs must also address people’s particular needs and be structured to help people overcome barriers, rather than enforcing them. Some specific actions to promote employment include:

  1. Advocacy/campaigning on the “disability business case”
  2. Provision of appropriate training and support
  3. Flexible forms of employment
  4. Apprenticeships/placements
  5. Assistance at work and personalized support
  6. Adaptation of premises and equipment
  7. Promotion of entrepreneurship programs
  8. Meeting the complex needs of people with severe and multiple disabilities.

 Mr. Chi Junchang of the China Disabled People’s Federation echoed Mr. Mohammed’s emphasis on the inclusion of people with disabilities as an economic necessity. In China, 40 to 60% of disabled people are not employed, and those who do work earn less than half the amount of non-disabled people.

Although a law in China mandates that 1.5% of employees in every business must be people with disabilities, many employers would rather pay a fine than hire disabled staff. Because of lower levels of education, disabled people may also lack some of the skills needed for employment. The CDPF has explored three ways to overcome these problems:

  1. Collectively assigned employment
  2. Employment in normal workplaces
  3. Entrepreneurship, a new area for people with disabilities because of previous programs that trained disabled people only in specific skill areas.

 Entrepreneurship is often the best way for people with disabilities to get to the highest level of employment that they can attain. To support this process, the CDPF advocates strengthening government policies, raising people’s educational levels, business management training, funding, and technical support for the young businesses. Using successful ideas from other countries, the CDPF started a program in Wuhan, a province of 8.5 million people. Using a course originally created by the government for people who had been laid off their jobs, “Start or Improve Your Own Business,” the CDPF targeted people with disabilities with new training methods. These included increasing students’ confidence and enthusiasm about starting their own businesses and simulating businesses in classrooms. Out of 105 participants, 21 started their own businesses, which range from computer repair to massage. Nine students who needed seed capital to get started were given loans of up to $1,500. Most of the businesses have been successful and some new entrepreneurs now employ other people, thereby contributing even more to the economy as a whole.

Workshop participants also shared their experiences of employment promotion. Javid Abidi from India pointed out that access is fundamental to mainstreaming. For instance, in India, some employers are willing to hire people with disabilities, but their buildings are not accessible. Access also extends beyond buildings, other participants added. For instance, UNECA employed a deaf staff member in their Department of Statistics, but did not provide an interpreter, which made the job significantly more difficult. Beyond this, access to computers might mean that disabled people could work from home and cut down on travel difficulties.

It is also important to consider how social protection and rights interact. For example in Uganda, a disabled man got a job in a computer department, but was fired after a week because the employer said that he could not lift the computers. Is this really a requisite skill or is it an excuse?

Some participants were also concerned that creating entrepreneurs might not meet market needs and that it might not be mainstreaming. Mr. Chi believed that in China, however, the entrepreneurs did meet market needs, because they based their businesses on what they believed would make a profit. Other people added that in smaller or less developed economies, entrepreneurship might be more important as a way into work.

 

When the UNCRPD is ratified and implemented, mainstreaming will not be a matter of choice. To help with this process, participants thought that employers should be given incentives to include people with disabilities, and labor laws must change. Training is essential, but participants echoed the representative from Barclays Bank, who believed that training should only be given if there is a good chance that it will lead to a job. The Convention implies sharing of responsibility – employers will not be motivated to employ people with disabilities unless there is something in it for them. To elaborate on this, participants added that some people with disabilities have been living so far outside the world of work that they do not work well, and need training to understand the mindset and requirements of being employed.

Together, the workshop participants called on employers, people with disabilities and governments to recognize:

  1. Making a business case for the inclusion of people with disabilities in the workforce should include focusing on what disabled people can offer
  2. Financial incentives are a good idea in the area of access, and the costs can be offset against taxes
  3. Use new technology and new ways of working to make it easier for people with disabilities to take part in paid employment
  4. Entrepreneurship and paid employment are appropriate in different areas, situations and countries. People must take the overall economic situation into account when deciding which method of training or work promotion is appropriate.

3.2.6 The great equalizer – Workshop 6: Particular challenges of poverty in post-conflict countries
Speakers: Jean-Francois Trani, Research Fellow, Leonard Cheshire Disability and Inclusive Development Centre, UK
Teddy Kaberuka, National Federation of Persons with Disabilities, Rwanda

Poverty and disability are linked, claims Jean-Francois Trani, but it is poverty of opportunity and not necessarily a lack of money or assets that is the important factor. Two independent studies of the relationship between poverty and disability in two very different countries – Afghanistan and Zambia – provide the evidence for this possibly contentious statement.

The research in Afghanistan, a country that has been in conflict for over two decades, surveyed 5,130 households in 34 provinces comprising 38,320 individuals, and identified 1,038 people with disabilities. In Zambia, which is not a post-conflict country, the survey included 5,751 households with a total of 28,189 people from nine provinces, and 3,090 people with disabilities were found.

Using the International Classification of Functioning (ICF) developed by the World Health Organization, questionnaires in both surveys covered health, education, income, activity, debt, livelihoods, self-perception, awareness, marriage and social participation. All the participants were from 14 to 65 years old and the disabilities surveyed included mobility and sensory, intellectual and learning, behavioral and psychological, communication and social functioning limitations and fits, seizures and epilepsy. The results in both countries were similar: age, as opposed to poverty, was the strongest determinant of disability prevalence. The second strongest association was a not having an education, and people who had gone to primary, secondary or tertiary education had a lower rate of disability. Perhaps not surprisingly, a higher proportion of unemployed people are at risk of disability than employed people. This might show a link between economic poverty and disability, but does not indicate which came first.

In Afghanistan, use of public health facilities was associated with a higher rate of disability, but, conversely, perception of availability of public health facilities was associated with lower risk of disability. Overall, the gap between rich and poor, as measured by their own statements of their assets, was not a significant factor in disability prevalence.

Certain other patterns and differences between the two countries were evident, however. In Afghanistan, women are more at risk of cognitive, mental or multiple types of disability, including epilepsy, but this is not the case in Zambia. An increasing risk of sensory impairment is associated with single or engaged respondents compared with married respondents in both countries. This is also true in Zambia for mobility and cognitive, mental or multiple impairments. In Afghanistan, respondents belonging to the middle wealth group are relatively more at risk of mental impairment, but not any other type of disability. This is not the case in Zambia, where a higher rate of sensory impairment is associated with being among the wealthiest group. Living in an urban area is correlated to a high rate of sensory impairment in Afghanistan, but not in Zambia.

It is widely believed that discrimination, lack of access and exclusion – all-important themes at the conference – make people less able to reach existing resources and more at risk of multidimensional poverty. It is this multidimensional poverty that is linked to disability, this research suggests. Poverty is a great leveler or equalizer, and affects families with non-disabled family members to the same degree as it does families with a disabled family member. Yet these results show that poverty measured by level of assets is neither systematically associated with disability measured by types of activity limitation, nor can it be considered as a determinant factor of disability.

Perhaps the word deprivation is a more appropriate description of the set of socioeconomic factors that have an impact on poverty prevalence. For instance, disabled people are less likely to be educated, employed and have adequate access to health care in both Afghanistan and Zambia. Therefore the presenters call for an integrated approach to tackle the needs of disabled people and incorporate them into the mainstream of multidimensional poverty reduction strategies.

It is also important to acknowledge that disability is not a permanent state that remains unchanged throughout life once acquired. It is a matter of definition, of perception and of various environmental, social and political factors that are different in different contexts. In the future, as our understanding, awareness and knowledge of disability increases, the prevalence of disability will increase – to include those with mild or moderate impairments and those who have lesser yet genuine needs. At the same time, an opposing process will result from better access to health services, nutrition and hygiene in low income countries such as Afghanistan and Zambia, meaning that fewer people will face the consequences of preventable illnesses that are the cause of several disabling conditions. So, as disability itself changes, our understanding of its causes and affects will need to change along with it.

One means that people with disabilities have found to challenge multidimensional poverty was discussed by Teddy Kaberuka from the National Federation of Persons with Disabilities in Rwanda. During Rwanda’s emergency period, defined in this context as lasting from 1994 to 2000, there was little data available on disability and no programs to address it. Since then, disabled people’s organizations and disability activists have been reshaping their link with government structures, and have formed the umbrella organization that Mr. Kaberuka represents.

After 2005, the disability movement in the country strengthened itself through improved communication. Government welfare provision has improved, but people with sensory impairments remain excluded from many interventions. Because of the seriousness of the conflict in Rwanda, people might have expected that tensions would still exist between the different ethnic groups, but this has not been a problem within the disability movement, Mr. Kaberuka reported. World Bank funding has supported programs for demobilized former combatants, but these groups have managed to work within the national organization.

The long period of conflict and other causes of poverty within Rwanda have presented other constraints, however. The topography of the country can make travel difficult and there is a lack of infrastructure in many areas. There is also insufficient data and information for use in lobbying, and people with disabilities can still be stigmatized within the wider society. A national census to identify disability prevalence would be very helpful.

Disabled people’s organizations also often struggle financially and Mr. Kaberuka calls for international NGOs and multilateral organizations such as the UN, to strengthen and empower them. The process, known as LLRD – Linking Relief, Rehabilitation and Development – would also help ensure that disability is integrated into the development process.

Following these thought-provoking presentations and a lively discussion, the workshop participants came up with the following calls for action:

  1. Include disability data in national censuses
  2. People with all “types” of disabilities, including those wounded by war and others, should be represented
  3. Strengthen disabled people’s organizations in conflict-affected countries and raise awareness of UN structures
  4. Distribute resources more effectively
  5. More detailed analysis of multidimensional aspects of poverty – especially the link between poverty and disability – should examine specific factors that impact on disability. These might include marriage, access to health care, decision-making processes, etc.

Our results show that poverty measured by level of assets is neither systematically associated with disability measured by types of activity limitation, nor can it be considered as a determinant factor of disability. − Jean- Francois Trani.

3.2.7 Collective power empowers individuals – Workshop 7: Self-help groups and empowerment
Speakers: Peter Coleridge, Consultant, UK
Laurence Hee, National Council of Cheshire Homes, Malaysia

“But mainstream free-market theory suffers from a ‘conceptualization failure’, a failure to capture the essence of what it is to be human . . . . [This view], to quote Oscar Wilde, knows the price of everything and the value of nothing.”
Muhammed Yunus, Founder, Grameen Bank

Self-help groups have the capacity to empower people to overcome not just economic poverty, but also the poverty of opportunity caused by lack of access and limited participation in society. Poverty, contends Peter Coleridge, is not simply a scarcity of resources; it is a denial of the fundamental freedom and opportunity to develop as a human being.

In helping to create a society in which all citizens have equal opportunities to develop their full potential, self-help groups have a role in facilitating people with disabilities to gain increased confidence and self-esteem. They can also create economic opportunities and foster efforts to achieve full human rights.

In India most groups started as issue-based and 90% of members were women. Most have now become mainly savings and credit groups that act as an alternative to moneylenders and offer the opportunity for people to save together. The savings form a pool of capital, from which loans are given to members to start or improve their small businesses, or for other reasons. This approach is in contrast to some other microfinance programs, such as the Grameen Bank, which uses outside money for loans and does not require prior savings.

Seeing the success of the more than seven million self-help groups in India, which now reach approximately 140 million people, large institutions such as the World Bank and the government now support them as tools for poverty reduction. While this is a positive development overall, it runs the risk of seeing self-help groups as focused mainly on material gain, and could ignore the human process of group interaction. It might also make the groups open to political manipulation.

Using self-help groups specifically for people with disabilities began in the mid-1980s. Originally based around disability as an issue, they have now followed most of the other groups into savings and credit. Forming federations has given groups a voice at district level that encourages politicians to view the disabled members as an organized constituency.

Some of the key principles involved in starting a group are that they require skilled and thoughtful facilitation and that no two groups are the same. The first meetings aim to build confidence, not solve problems: listening to other members and discussing is- sues need practice, particularly considering the diversity of disabilities, education and economic background of some participants.

Every voice deserves to be heard. © Leonard Cheshire Disability.

Successful groups will usually develop a mission and initially focus on something easily achievable, such as statutory rights. Some common features mark them: clear goals, consistent membership, active participation by all and a focus on their own issues, ideas and feelings. As such groups develop, they often share responsibilities, resolve conflicts constructively and agree and keep to procedures. They can then join other groups and other movements working towards the reduction of poverty and deprivation.

Issues for groups to consider include who owns them – do they belong to NGOs or are they independent? Lobbying for entitlements will only work if those entitlements exist, so wider campaigning may be necessary. The fact that members have disabilities themselves does not mean that they have complete knowledge of rehabilitation, and other services in their areas and people with communication impairments may be excluded, or find it difficult to contribute.

The workshop went on to discuss whether mixed groups of disabled and non-disabled people would be effective. People generally thought that they could work, but if people with disabilities became a minority, it might be difficult to discuss issues that relate specifically to their needs. The same is true for women entering men’s groups or mixed groups that have a gender imbalance – some people could feel outnumbered.

Including people with learning disabilities is also a challenge, as is working most effectively with facilitators. While using a facilitator is an essential part of the process, people need to be aware of potential problems – for example, workshop participants shared how sometimes facilitators take too much ownership of groups and do not leave at an appropriate time. Another issue is illiteracy, which can prevent people from accessing services or participating as fully as other members.

Laurence Hee then discussed how disability work in Malaysia is shifting from a charity perspective to a rights-based approach that is about empowerment. Malaysia benefits from a government that is committed to supporting people with disabilities and has  introduced several programs since 1990 to strengthen employment opportunities. Through these schemes 7,013 disabled people have been successfully placed into jobs, and a new program introduced in 2007 has already supported 64 people to establish their own businesses, including mobile phone repair shops, photocopying outlets and cyber cafés.

Lower paid workers with disabilities can also receive grants from the government to cover the difference between the wage they earn and the amount they need to attain a basic minimum standard of living. The government and the National Council of Cheshire Homes Malaysia both also offer training in independent living and appropriate support to meet individual needs, with an emphasis on building independent decision making skills. For people whose disabilities might make it difficult for them to compete on the open market, the government also supports sheltered workshops that include a training component. The goal is for the training to help people get to the point when they have enough skills to work in the mainstream economy.

A number of NGOs in Malaysia focus on disability, among them the Cheshire Homes, which have recently shifted from a focus purely on residential care to an empowerment model that includes inclusive education, livelihood support and advocacy and campaigning. In the Selangor Cheshire Home, a skills training program prepares people with disabilities for waged employment and starting their own businesses. They have focused particularly on people with learning disabilities, who have taken courses in baking, office work, hospitality, and information technology. When they finish the courses, people are helped into work through additional training in business management and assistance in obtaining small loans for seed capital.

Among disabled people’s organizations in Malaysia, the Beautiful Gate Foundation program in economic empowerment stands out for being fully managed by and for people with disabilities. They have set up four centers in different locations, covering people with different needs in rehabilitation and employment skills. Their diverse programs include peer counseling, transport, job referral services and support for financial needs, self-employment and assistive devices. Training extends to courses in leadership skills, bookkeeping and advanced computer use, promoting the idea that the widest possible range of careers is open to people with disabilities, including senior management roles.

Workshop participants then called for a number of specific steps to promote empowerment:

  1. Advocate for multifaceted economic empowerment programs to address different abilities and move away from the traditional model
  2. Share more experiences to facilitate this process
  3. Mainstream disability in poverty reduction strategies
  4. Take an integrated approach to sheltered workshops to make them more holistic, identify useful markets/outlets and then share this information. Sheltered employment may eventually convert to open employment to ensure integration.

3.2.8 Fighting marginalization through engagement –Workshop 8: Community development
Speakers: Tingyu Wang, Regional Programme Manager for East Asia, Leonard Cheshire Disability, Thailand Maurice Kilduff, Executive Director, Cheshire Homes South Africa

“Despite recent achievements, people with disabilities remain the single largest sector of the least-served and most discriminated against in almost all societies in the Asia Pacific region.” United Nations Economic and Social Commission for Asia and the Pacific, 2003

Reducing poverty and achieving full human rights: without one, you can’t have the other. So concluded the participants in this workshop, who believe that for people with disabilities, marginalization is at the heart of both of these issues. Community development in this context should be a rights-based and inclusive process. Since previous UN treaties and conventions already gave rights to disabled people (as they did to all people), the purpose of the UNCRPD should be to realize these rights, believes Tingyu Wang. To be successful, programs need to address a holistic range of issues, including economic empowerment, livelihood development, inclusive education, and advocacy and campaigning. They also need to facilitate change among a number of different stakeholders, including employers, families, government agencies, community groups, NGOs and international donors. Self-help groups can play an important role in interacting with all of these other types of organization.

Cheshire services in East Asia and South Africa have both taken this approach. For instance, in China, the first year of an economic empowerment program has had remarkable results, by building on a partnership among the China Disabled Peoples Federation, the Ministry of Labor and Social Security, and the International Labour Organization. Before taking this integrated approach, the small business training and development course had produced 17 disabled entrepreneurs in nine years. Yet after the partnership was established, it produced 12 new entrepreneurs in one year.

The project is successful because it addresses all the issues an entrepreneur will face, and works with partners to provide a range of services that include:

  1. Small loans and training to start and run small businesses
  2. Vocational training and apprenticeships
  3. Work with employers to make workplaces more accessible
  4. Promoting the employment rights of people with disabilities
  5. Improving social safety nets
  6. Helping people access their government’s support programs.

 Taking steps in just one of these areas, such as training, would not encourage the kind of institutional change needed. A similar process has taken place in Malaysia, where a livelihoods program works with both the public and private sectors to support employment opportunities for people. Taking on the wider human rights agenda, it also promotes acceptance of disability within workplaces. To date, 58 people have taken part in the program, which has focused on capacity building, social security and sustainable livelihood programs. Similar projects will soon be established in other East Asian countries. In South Africa, where food has recently become very expensive, impoverished communities surround all 16 Cheshire services. To extend their work with people with disabilities, the Cheshire services have also started supporting disabled people’s families and neighbors in the wider community. Specifically, their objectives are to enhance:

  1. Education of children
  2. Skills transfer to the community
  3. Economic empowerment of parents/guardians
  4. Re-unification of the family.

As a first step, Cheshire Homes South Africa has established eight vegetable gardens adjoining Cheshire residential facilities. Being community based, they provide viable support to local people, and employment for Cheshire service users. There are also six hydroponics tunnels that grow a wider range of vegetables, and a commercial vegetable project that generates income for 38 families from a very poor area. These are small beginnings for community development, but may offer a useful model, since vegetable gardening is not expensive and brings immediate, tangible benefits. It is also widely supported by donors, governments, volunteers and even some retail shops. Working in the context of sustainable development, over time Cheshire Homes will become less involved in the management of community programs, which will become self-governing. In the short term, an international organization with Leonard Cheshire Disability’s reputation and resources can act as a catalyst to engage poor people with disabilities and those around them to access government funding and other social service and development programs.

Leonard Cheshire Disability and the Cheshire Homes can also play a role in convincing parents and guardians that education is of value. When unemployment is as high as 80% in some communities, this is a major task. For generations, the people around them, whether disabled or not, have experienced marginalization, with lack of access to employment even if they have managed to access education.

Under these circumstances, the delivery of immediate economic benefit to the community is the most convincing incentive. Without meaningful change in living standards, free education is not a great benefit. Schoolbooks, stationery, transport, clothing and nutrition remain insurmountable barriers. Community-based development from a rights-based perspective is probably as difficult a task as any individual or organization can choose to address, said Maurice Kilduff. To make it work, it must be multifaceted, and partnership is of the utmost importance.

To make this community development approach work best for people with disabilities, workshop participants reinforced the following points:

  1. There is a need to develop and implement programs addressing the needs of marginalized people with disabilities, such as deaf blind people, people with intellectual disabilities, etc.
  2. Institutions should be empowered to be in a position to build a database of parents and guardians of people with disabilities, who are staying or receiving services from Cheshire Homes, and make sure that service users do not lose contact with them
  3. Lobby government to develop early intervention programs in disability, and mainstream early childhood programs for children with disabilities
  4. Leonard Cheshire Disability should make sure that people with disabilities are consulted and included in any decision-making process within the organization that would lead to any change (positive or negative), and further make sure that representation is at all levels.

3.2.9 Reform in one sector does not create employment – Workshop 9: Reducing poverty through preparation in the labor market
Speakers: David Rojas, Organization of American States, USA Flavio Coutoe Silva de Oliveira, Government of State of Minas Gerais, Brazil

Regional and continental initiatives need to understand local behavior through local partners. These elements become key to helping people with disabilities enter the labor market, sharing outside solutions, but adapting them to local needs and capabilities. Workshop speaker David Rojas based this conclusion on the experience of POETA – Partnership in Opportunities for Employment through Technology in the Americas, which provides employment training for people with disabilities. Created by the Trust for the Americas, an independent non-profit organization affiliated to the Organization of American States, POETA provides on-site training and support in the use of information technology at 69 sites in 18 countries, each training an average of 100 people with disabilities per year. Key project partners include the private sector, governments and civil society, which work together to create long-term, lasting employment opportunities for people with disabilities, and their communities.

The POETA program deals with both of what they call the “supply” and “demand” sides of employment. To meet the “demand” side, people with disabilities start learning to use computer hardware and software through project partners, including universities, schools and NGOs. In this way, project participants gain skills that are in demand by local employers.

POETA increases the “supply” of jobs that employers can make available to the trainees, by helping to create job placement opportunities, and by raising private companies’ awareness of disabilities and the benefit of having an inclusive corporate environment. They then follow this up by working with the media and fighting for disability rights using international legal instruments.

Realizing that teaching IT skills alone is not enough, POETA trains students to be prepared for the full range of experiences they will meet in the workplace. These additional disciplines include: social interaction; customer relations; conflict resolution; leadership; teamwork; self-esteem; time management; how to keep a job; and entrepreneurial skills for people interested in self-employment or running their own businesses.

Facilitating cooperation between the private sector and governments is another important feature of the POETA program. They have a strategic alliance with Microsoft and have reached out to work with the International Labour Organization to help include disability in international efforts to promote inclusion.

The workshop’s second speaker, Dr Flavio Oliveira, added to Mr. Rojas’s contribution with comments about employment of people with disabilities from the point of view of the government of the state of Minas Gerais, in Brazil. Dr Oliveira runs CAADE, an acronym for “Special Coordination of Support and Assistance to Persons with Disabilities,” which is part of Minas Gerais’s State Bureau of Social Development (SEDESE). CAADE supports, mentors and evaluates public policies for disabled people in Minas Gerais, and one of its programs is to provide a home to the only agency within Brazil’s national employment system dedicated to persons with disabilities.

State employment and income policies for persons with disabilities in Brazil are implemented mostly through the National System of Employment – SINE. In Minas Gerais there are 100 SINE service agencies that address employment needs for the population in general, including persons with disabilities.

In Brazil, people with disabilities have historically had a low level of education and professional qualifications. Access remains a problem, and both people with disabilities and employers tend to lack knowledge about disability and inclusion. According to data from the João Pinheiro Foundation, the population of the state of Minas Gerais will be 20.5 million by 2010. Disabled people represent 14.9% of the population, or up to 2,667,709 people, of whom 1,635,344 are between 15 and 59 years old and of working age.  

On the positive side, companies in Brazil with 100 or more employees are required to employ people with disabilities as a minimum of 2% of their workforce. This figure rises to 5% for companies of 1,000 employees or more, and companies that do not comply are fined. To help companies meet the quota, the Brazilian government and the government of the state of Minas Gerais support training of disabled people, and run programs that raise awareness of diversity in the workplace.

CAADE’s goal is improvement of employment opportunities for people with disabilities. To make this happen, CAADE has partnered with the country’s biggest professional education agencies and universities to offer support and counseling to job hunters with disabilities. They also work jointly to promote cooperation among the social security and labor inspection bodies that enforce the employment quota system.

Workshop participants then discussed whether it is better to focus on the formal or informal sector to promote employment for people with disabilities. Their conclusion is that interested parties need to focus on both, but use different strategies for each. Government support and training programs can tailor their advice to disabled people, depending on which sector they hope to enter. In Brazil, this response may be tempered by the fact that the official policy is to improve inclusion of people with disabilities in workplaces, thereby increasing the social responsibility of employers in the formal sector. The Brazilian government also hopes to create a model of affirmative action that can be followed by other countries.

Inclusion may be seen as a horizontal process, meaning that it is necessary to work with schools and other teaching institutions, transport bodies and other sectors to promote true access to work. Laws alone cannot make it possible: rather, it is increased awareness that makes people embrace the principles behind the laws.  

Although there are nine million people with disabilities in Brazil old enough to work, only 1.5 million are actually working. Of these, only 350,000 are formally employed and protected by labor laws.

From this, workshop participants came up with six calls for action and guiding principles:

  1. People with disabilities getting jobs is not enough; a comprehensive program of awareness raising, training and advice is necessary
  2. A human resources plan is needed
  3. Governments should be lobbied to create a board for employment of people with disabilities
  4. The public sector must place people with disabilities in ministries responsible for social security and welfare
  5. Recognize the importance of mentoring, supporting and counseling services for people with disabilities
  6. A public board should be created to enforce labor laws and policies on 6. employment of people with disabilities.

3.2.10 Must becoming disabled mean becoming improvised? Workshop 10: Household income and debt
Speaker: Dermot Foley, Doctoral Student, Columbia University, USA

In rural Bangladesh, becoming disabled later in life leads directly to poverty, according to recent research carried out in the Chuadanga region by Dermot Foley and Jahan Chowdhury. Located in the Khulna Division of the country, Chuadanga district is 300km southwest of the capital city Dhaka and had a population of 1,007,130 people in 2006.

A baseline study by the Bangladeshi organization Impact Foundation Bangladesh found a disability prevalence rate of 5.7%. Of the 256 households they found with one or more members labeled as having a disability, 61% had less than 0.2 hectares of land, compared to over 60% of their peers who had more than one hectare.

Overall, Chuadanga is characterized by low income, a lack of fiscal resources and a general lack of support from non-governmental organizations and government agencies. It also has the lowest female employment rate in Bangladesh, and agriculture is the largest employment sector by far at 64%, with business a distant second at 14%. While Bangladesh as a whole experienced an increase in per capita income and living standards in the 1990s, the income gap between the highest and lowest earners in the country increased during the same period, and this is evident in Chuadanga.

The study selected 40 households that included people who had become disabled since 1997 and lived in chronic poverty. Four types of disability were included in equal amounts: blindness, orthopedic impairments, hearing impairments and mental disorders. To provide for a comparative analysis of the current socioeconomic structure, 32 households without a disabled member were also selected.

Their findings were striking: 87% of the participants who are labeled as having a disability left full-time employment within the first year after diagnosis. For participants labeled as having a disability for five years or longer, the employment rate fell from 13% in year one to 2% in year seven.

Participants who had not worked as laborers fared far better in terms of staying employed after onset of disability. For instance, 78% of the shop owners remained employed, compared to none of the people in manual or unskilled jobs, such as rickshaw drivers.

The wives of men who became disabled also ended up working fewer hours. Of the 90% of wives who noted an increase in the time required to care for their husbands after the onset of disability, 26% gave up 15 hours of work and 28% did 26 hours less of paid work per week than before the onset. Gender issues are also evident in the fact that treatment expenditure for women with disabilities consistently decline after women reach the age of 44, irrespective of household status. Medical expenditure is highest for males aged 35–44, but the difference between average expenditure of the remaining age groups is not statistically significant. The result of these factors on household income is devastating; beyond the psychological issues, they can lead to the loss of two incomes and an increase in expenses.

In terms of income, study participants with ambulatory disabilities were three times more likely to remain economically active than those with visual impairments. Among households without disabled members, the studies noted that 80% gradually moved up the social and economic ladder because of the uninterrupted employment spans (of both male and female earners) and relatively lower medical expenditure. Some of the problems experienced by the households that include disabled people may result from the lack of state social services in Bangladesh, which leads people to seek help through social networks. These networks provide crucial emotional and practical support, and facilitate access to those formal services that do exist. The absence or decline of social connections that can result from the onset of disability makes it far more difficult to break away from poverty and ill health.

In addition to this, the outcome of the onset of disability is rapid depletion of assets, increased financial and social burdens on the family, isolation from the community, increased debt, and impoverishment. In the study, the direct cost of treatment and equipment among affected families varied from five days to one year’s worth of normal income, with the average being four months’ worth.

Microfinance has become a significant stimulator of employment in Bangladesh, with more than 1,000 microfinance organizations opening since 1990, offering interest rates from 10% to 30%.

The microcredit programs in Chuadanga offered by organizations such as Bangladesh Rural Advancement Committee and Grameen Bank, stress their preference for women borrowers to foster their empowerment and self-sufficiency. Working on a peer-group basis, defaulting on loans by any member is the responsibility of the entire group.

Sadly, disability seems to have presented barriers to inclusion in such microfinance programs. Of the study participants, 8% of women with disabilities are members of credit-providing non-governmental organizations, as compared with 90% of non- disabled women. Even the mothers and wives of people with disabilities often find themselves excluded from such lending groups, as they are perceived as “high risk payers,” implying that there is a higher probability of non-repayment among those labeled as being associated with disability. This is consistent with the findings of Lewis and Sygall (1997) in their study in Tanzania and Malawi.

These findings lead to the conclusion that economic opportunities in Bangladesh are increasing, but access to them is now limited to people without disabilities and, in some cases, without family members with disabilities. Their predicament is greater than their perceived disabilities, because it also involves stigma and ignorance manifested in discrimination. One step towards overcoming this lies in changing the practice of microfinance organizations to ensure that they genuinely include people with disabilities.

For people both with and without disabilities, the move from the farm to non-farm sectors of employment is impossible unless they learn the skills needed to participate in new forms of work, and take advantage of new economic opportunities. There may be many ways to facilitate this, but all, Mr. Foley concluded, have to consider how the context of discrimination against people with disabilities and their families negates broad-based poverty reduction programs.

To complement this assertion, workshop participants brought up the twin-track approach: broad-based development programs integrate disability into their work, and disability is also addressed as a specific issue. Government inclusion policies are also relevant because they could go some way towards fighting overt discrimination. Mainstream poverty alleviation programs could also include elements focused specifically on women and girls that would also address the needs of disabled participants or people with disabled family members.

In addition to the deterioration of relationships and social interaction faced by people with disabilities in Chuadanga, social programs rarely confront discriminatory beliefs. Gestures like donations, relief and legal facilities earmarked for people with disabilities never reach them, making their lives ever more claustrophobic and marginalized.

To help bring these suggestions to life, workshop participants called on people involved in this field to:

  1. Consider promoting revolving loans that focus on small units (families with members that have disabilities), mentorship opportunities and financial training to combat social isolation and increase ownership
  2. Integrate protection of the family members of disabled children to access funds and training (which pertains to Article 27 of the UNCRPD)
  3. Skills provided to disabled people and their families should be specific to their own communities and relevant based on local knowledge and input. This includes training for trades identified as locally feasible and viable.

3.2.11 Older disabled people: a distinct social group – Workshop 11: Disability and aging Speakers: Lizzie Nkosi, Country Programme Director, Help Age International, Ethiopia Hassan Musa Yousif, Ph.D., UNECA African Centre for Gender and Social Development, Human and Social Development Section, Ethiopia

The percentage of older people among Africa’s population is growing quickly. While there were 31.6 million older people in Africa in 1990, this will more than double to 64.5 million in 2015, the year for achieving the Millennium Development Goals.

The aging of the African population will have a significant impact on the number of disabled people on the continent. For instance, the 2001 population and housing census in Botswana indicates very clearly that disability rates increase with age, particularly among people aged 60 or over. The rate continues to rise as people get older: while people between 60 and 70 have a 10% disability rate, people over 75 have a 31% disability rate. Disability prevalence is also higher among older women, because they tend to live longer than men.

Poverty impacts on the rate of disability as well. For example, a person may have an impairment such as deteriorating vision, but if the right eyeglasses are available, the person will not be disabled. When people live in very poor or remote circumstances, however, a condition that could be easily treated elsewhere can lead to severe disability. Older people in Africa are more likely to have such conditions than other people, which is part of the reason that disability prevalence rises with age. Since the incidence of disability goes up as people get older for many reasons including illness, the impact of chronic poverty and injuries, addressing the needs of disabled older people is becoming urgent. This is particularly true for people in countries experiencing conflict or in refugee situations, since it may be difficult or impossible to access appropriate treatment or support.

Since older people in developing countries often remain economically active throughout their lives because there are no social security programs to support them, they are particularly affected by a loss of income brought on by the onset of disability. When older people act as care givers for a disabled person, such as a spouse or child, their earning power is also curtailed. In both cases, lower income can also result in poorer health, as people cannot afford appropriate health care.

Older disabled people may also face a double burden of discrimination: for instance, a young deaf person may be able to learn sign language but an older deaf person may be denied the opportunity to learn it “at their age.” Some might argue that even official statistics ignore this group, as very few studies of older people with disabilities  have been conducted at all, and those that have been carried out have been done in more developed countries.

So, while many people at the conference believe that disability is a development issue, Dr Yousif put forward the idea that age and disability together also create specific circumstances that must be addressed in development programs. In industrial countries, economic modernization has brought profound changes to the structure of families and communities. It is reasonable to expect that similar changes will occur in developing countries, including falling birth rates, nuclear families becoming relatively more important while extended families have less influence, and population movements from rural to urban areas. All of these factors will have a direct impact on older people’s lives. Taking this into account, the disability movement could work more closely with development organizations, to promote the inclusion of disabled older people in Taking this into account, the disability movement could work more closely with
development organizations, to promote the inclusion of disabled older people in a wide range of social programs and initiatives. Self-help organizations for older disabled people could be founded and supported, with a remit to address a range of issues from economic support to lobbying for changes in the law. For organizations or institutional bodies providing emergency relief, it is also important to build the needs of older people with disabilities into service assessment, delivery and monitoring.

Disability in old age is a dynamic process: as age and the burden of disease increase, so does the risk of disability. Also, it is cumulative, as the aging process does not stop once people have become disabled.

To help bring about these positive developments, workshop participants made a number of recommendations:

  1. Improve the evidence on hard-to-reach marginalized groups, such as by collecting disability and age-disaggregated data
  2. Donors should relate funding and policy decisions to human rights obligations towards older disabled people
  3. Prevent disability through appropriate services and poverty reduction programs, and appropriately manage the disabilities that people already have
  4. Older women with disabilities must be included in all social and development programs and in government policies
  5. Study the impact of conflict on disability, and incorporate disability concerns in peace and post-conflict development initiatives.

3.2.12 Bringing disability into poverty reduction agenda – Workshop 12: Creating inclusive poverty reduction strategies, national action plans and budgets
Speakers: Richard Arcenio, former Anti-Poverty Commissioner, Department of Social Welfare, Philippines Dorothea Rischewski, Social Protection Section, GTZ, Germany Kassahuhn Yilbetal, CBM, Ethiopia

Poverty reduction is central to the Philippine government’s programs, asserts Richard Arcenio, and disability has also become a central component in anti-poverty programs. Mr. Arcenio was a Sectoral Representative for the Persons With Disability Sector for the National Anti-Poverty Commission (NAPC) Office of the President from 2002–2005. Being chaired by the country’s president gives the NAPC the strength to mainstream disability with the Philippine government, and contribute to poverty reduction strategies. Although the situation for people with disabilities in the Philippines still needs to be improved, this is a step in the right direction, Mr. Arcenio believes.

The Social Reform and Poverty Alleviation Act created the NAPC in 1998 to enhance programs, approaches and strategies that strengthen the partnership between government and the basic sectors. Specifically, it also looks at NGO participation in social reform and strengthens microfinance through the government’s own microfinance initiative and private organizations. People with disabilities are represented through the Disability Sectoral Council, which forms a Sectoral Agenda on each of the NAPC’s six core poverty reduction strategies:

  1. Asset reform 
  2. Human development
  3. Livelihood and employment
  4. Social security
  5. Peace and order
  6. Participation in governance.

The agenda then serves as a roadmap for engagement with various stakeholders for the following three-year period. Mr. Arcenio was also active with PhilCOCHED, the Philippine Council of Cheshire Homes for the Disabled from 2005–2007. Composed of representative officials from 35 Cheshire Homes around the country and other community-based partners, PhilCOCHED supports people with disabilities to develop their skills and knowledge to enhance their participation within mainstream society. Its work in the Philippines started in the early 1960s with a residential home for paraplegics. Today, it runs programs and services to provide:

  1. Educational, food and accommodation support to young students with disabilities
  2. Medical and vocational rehabilitation and livelihood opportunities to the poorest of the poor people with disabilities.

PhilCOCHED works closely with Leonard Cheshire Disability, an international non- government organization based in London, supporting more than 250 projects for people with disabilities with local partners, in 54 countries worldwide.

Taken together, the programs of the NAPC and PhilCOCHED represent a two-pronged approach to including disability in development programs. With the government ensuring that disability is included in the development agenda, the groups carrying out inclusive development programs dovetail with government inclusion efforts. This could serve as a model for other countries in which the respective roles of government and civil society in the implementation of inclusive PRSPs have not yet been clearly defined.

Picking up on this issue, the next speaker, Dorothea Rischewski, considered that PRSPs are the most important policy documents in more than 60 low-income countries. The theory is that PRSPs are specific to each country’s needs and have broad stakeholder participation. In reality there may be problems, for example exclusion of democratically elected bodies such as parliamentarians and lack of meaningful participation by community groups. Marginalized groups such as poor people and people with disabilities may also be excluded from the implementation of some programs.

For people with disabilities to participate most effectively, contends Ms Rischewski, disabled people’s organizations must be empowered and all partners – multi- and bilateral development partners, NGOS and community organizations – need to work together. A successful example of cooperation between an NGO and a community organization includes the joint GTZ program with CBM (Christian Blind Mission), Handicap International and local disabled people’s organizations in Cambodia, Tanzania and Vietnam.

Some signs that such a partnership is working include an increase in the strength of DPOs, inclusion of people with disabilities in mainstream organizations and mainstream society, and requests from community groups reaching national policy discussions. In the past, organizations have taken a number of steps to help bring about such change:

  1. Awareness training for all stakeholders – through, among other means, the handbook “Making PRSP inclusive”
  2. Involvement of government representatives on national and regional/ provincial/local level
  3. Institutional, technical and political capacity development of community organizations including:
    1. Small equipment 
    2. Specific training for the target group (such as sign language training)
    3. Micro grants 
  4. Inclusive monitoring and evaluation
  5. Publications that cover examples of best practice.

In the three phases of development of PRSPs – drafting, implementation, and monitoring and evaluation – input from disability stakeholders is essential. Experience has shown that development actors have often participated in the first phase, but not the last two: to make PRSPs more effective, this needs to change.

One reason for a decline in participation may be an evidence gap between the second and third phases, because of poor monitoring and poor participation by vulnerable groups. Involving local stakeholders at every stage is one way to tackle this. Another way is to involve international NGOs that can bring financial resources, their good reputation with project participants and political campaigning networks, to the whole PRSP process. If bilateral organizations also join in implementation, they can put pressure on national governments for transparency and accountability. The danger is that they do not always focus on vulnerable groups, so some disabled people’s particular needs may be inadvertently dropped from their programs.

The best way forward, Ms. Rischewski believes, is to clearly identify all development actors and their specific roles. Efforts for meaningful participation should then be guided by four standards:

  1. Rights – implement fundamental rights. The UNCRPD mandates enforcement and institutionalization of participatory rules for inclusive growth strategies (Arts. 3, 32)
  2. Structures – establish functioning structures. Stakeholders can help build up and maintain national networks of community organizations in cooperation with international NGOs
  3. Legitimacy – secure legitimacy of community service organizations. International NGOs can play a role in assisting in the process of improving democratic representation and capacity among community organizations
  4. Capacity – develop existing capacity of community service organizations.

The third speaker, Kassahuhn Yilbetal, expanded on these ideas through a case study of PRSPs in Ethiopia. On the positive side, people with disabilities and their organizations participated in the process and raised issues at public forums. DPOs made some efforts to lobby for inclusion, and the National Federation organized workshops for MPs, experts and officials. Unfortunately, however, the issue of disability did not sufficiently feature in the final document. The reasons for this are diverse, including lack of follow-up by DPOs, cost implications, promises not being kept and lack of knowledge on how to include effective measures for people with disabilities.

In the face of this, disability stakeholders have decided to try to do their best out of the strategy as it stands, look for ways to address the issue during strategy reviews, and ensure monitoring mechanisms to address disability. Several organizations are working to bring disability into development programs, for instance CBM and the Poverty Action Network of Civil Society organizations in Ethiopia have started an inclusive project. UN agencies have also formed an interest group to consider possible actions and strategies to promote inclusion of disability in the national PRSP.

To empower workshop participants to bring disability into the PRSP agenda, the speakers suggested using some specific tools:

  1. Regular media programs on PRSPs and disability
  2. Training for experts and policy makers on inclusive PRSPs
  3. Developing manuals on how to include disability in PRSP processes (see, for example: “Making PRSP inclusive“ by CBM, HI, GTZ)
  4. Capacity development for people implementing development programs.

The workshop participants then suggested three specific calls for action to make PRSPs more inclusive:

  1. Stakeholders should lobby the UNECA to facilitate the process to make country PRSPs disability-friendly
  2. Stakeholders should form effective partnerships with development partners
  3. The capacity of all stakeholders, including civil society, governments and development partners, should be enhanced in inclusive development.

3.2.13 Disability: a public concern, a development issue and a challenge for society – Workshop 13: Mainstreaming disability within the UN
Speakers: Bob Ransom, Ethiopian Center for Disability and Development, Ethiopia Alessandro Conticini, Senior Chief of Adolescent Development, Protection and HIV/AIDS

Although the Millennium Development Goals (MDGs) make no reference to disability, workshop speaker Bob Ransom believes that international development policy has evolved over the last decade. It now reflects an emerging awareness that disability, and persons with disabilities, must be mainstreamed in development. The former President of the World Bank has even stated that the MDGs cannot be met unless persons with disabilities are included in development and poverty reduction efforts. 19 UN agencies engaged in development work, such as UNDP and UNESCO, have clear policies on disability and inclusive development. The UNCRPD now mandates that the work of all UN agencies should be inclusive. Starting from this base, what is the best way to make this happen within the UN and allied development organizations? Mr. Ransom suggests four strategies to make development truly inclusive:

  1. Create national partnerships for disability and development

    In many countries, DPOs are now taking the lead in raising awareness and demanding respect for the rights of people with disabilities, including access to health services, education and work opportunities.

    For such change to occur in the foreseeable future, a larger number of stakeholders must join them and take rigorous action. National partnerships for disability and development, bringing together disability stakeholders – DPOs, disability NGOs, development NGOs, government and concerned individuals – could mobilize a critical mass of concerned individuals and organizations to force change in government and NGO policies and practices.
     
  2. Strengthen the advocacy role of disabled people’s organizations in inclusive development

    In developing countries, DPOs may not be fully aware of the concept of mainstreaming disability in development. In many countries, individual leaders with disabilities are strong advocates for rights and inclusion, but national poverty reduction programs fail to include persons with disabilities. Where specific efforts have been made, DPOs often find it difficult to sustain inclusive development awareness-raising and advocacy activities. DPOs may spend much of their effort on management and finance, and lack staff experienced in development.

    Mr. Ransom further proposes that the slogan “Nothing about us without us” has been misunderstood and misused. Although it is clear that people with disabilities and their organizations must be involved in all decisions affecting them, sometimes DPOs claim exclusive leadership, “ownership,” and control over anything related to disability, excluding others in the process. The slogan does not mean that DPOs have to fight exclusion and advocate for their rights alone. Disability rights, equality of opportunity and inclusive development do not “belong to,” or exist as the exclusive domain or responsibility of, people with disabilities and their organizations. Disability is a public concern, a development issue for government and a challenge for society as a whole. People with disabilities and their organizations need allies – politicians, government officials, economists, lawyers, teachers and development specialists – to achieve inclusion. “Nothing about us without us” is a call for inclusion and collaboration, not exclusion and competition.

    The organizational capacity of national and local DPOs must be strengthened, to enable them to advocate more effectively for inclusive development through awareness- raising activities, civil society consultations on development and poverty reduction plans and programs, and monitoring implementation of such plans and programs at national and local levels. Donors interested in supporting inclusive development should do more to meet the costs of strengthening DPOs and developing trained, paid professional staff to manage them. Inclusive development, as a process and result, will not be achieved unless the capacity of DPOs is increased to play the comprehensive awareness-raising and advocacy role required.
     
  3. Establish inclusive development technical assistance organizations

    Although DPOs and disability NGOs often have little knowledge of economic and social development theory and practice, they are expected to influence national development policy and programs. The reverse is true for development agencies and NGOs when it comes to disability – they have little knowledge about disability and persons with disabilities. Inclusive development requires development practitioners to learn about disability, and DPOs and disability specialists to learn about development.

    In response, Mr. Ransome proposes a new kind of organization that combines disability and development expertise. It would provide specialist services to help government and NGOs plan and implement inclusive development strategies and practices. Such a technical organization would employ, as disability and development experts, persons with disabilities trained in fields such as development economics, enterprise development, law, community development, water and sanitation, community-based rehabilitation, and other development-related disciplines. Its services would include technical guidance and consultancy services on practical ways, for example, to mainstream children with disabilities in child sponsorship and other programs targeting children, to mainstream women with disabilities in women’s empowerment programs, and to mainstream youth and adults with disabilities in skills training and enterprise development programs.

    Such an organization is similar to the Centers for Independent Living (CILs) found in America and Europe that provide services to individuals with disabilities, and lobby government and other community organizations to improve access to their services by persons with disabilities and their families. The proposed organization is also similar to the private consulting firms in some countries, run by persons with disabilities, which conduct disability audits of companies and organizations, making recommendations on how to increase disabled people’s access to the organization’s goods and services. The provision of technical expertise and training services is on a fee basis, thus contributing to the financial sustainability of the organization.
     
  4. Hold international development cooperation agencies accountable

    Some of the major international development cooperation agencies are not translating their policies into action. There is also little pressure from national governments in developing countries on development cooperation agencies to include a disability dimension in the programs they support.

    UN agencies, DPOs, NGOs and governments must hold donor agencies accountable for the practical application and implementation of their inclusive development policies and strategies. This can be done through the proposed national partnerships for disability and development, as well as by individual DPOs and NGOs.

    DPOs and NGOs might undertake “inclusive development audits” of the development cooperation programs of donor agencies and UN organizations in a country, examining the extent to which disability and persons with disabilities are included. National poverty reduction programs (PRSPs) might be particularly examined, as they are often supported by a number of donor agencies, many of which have inclusive development policies. The purpose of such audits is to demonstrate the disparity between stated policies of international development cooperation and UN agencies and the reality on the ground – and to demand greater accountability.

    The next speaker, Alessandro Conticini of UNICEF, began by suggesting that previous UN failures of the kind described by Mr. Ransom mean that caution is now needed. In Ethiopia, the disability policy framework is good, but it is difficult to legislate against negative attitudes.

    The UN technical working group on disability in Ethiopia in 2005–6 stated the importance of raising awareness and advocacy within UN programs. There must be visible mainstreaming, they stressed, and Mr. Conticini raised the example of gender, which has became so mainstreamed that it now sometimes seems to be invisible as an issue.

    In Ethiopia, the UN gives grants to organizations working in disability and is considering developing an outreach program for service delivery. Again, Mr. Conticini sounded a note of caution at this positive news: changing attitudes, he said, is more difficult than raising funds.

    Social protection remains an important issue. In post-war Europe, social protection programs gave people enough support to move out of poverty and the same kind of thing should happen in Africa. From the donor point of view, the World Bank has US$2 billion available for social protection, but this is not enough to make a significant difference. Wealthier countries and regional bodies, such as the African Union, have a responsibility to help build social protection schemes, including partnerships across countries.

    One important way forward is capacity building. Who should do it and how it should be done are the important questions here. NGOs need to put more resources into developing DPOs, Mr. Conticini believes, with real commitment to the process.

    The UNCRPD can be a useful tool to help with this. Africa has other national or regional conventions and charters on disability, and those seeking to use a convention to enforce rights should choose the one with the strongest language. Usually this will be the UNCRPD and so it should be used to interpret other human rights instruments.

    The issue of whether the UN should create a special agency dedicated to disability received a great deal of attention at the workshop. Mr. Conticini believed it would not be a good idea, as it would be too narrow and interfere with mainstreaming. Other participants thought that it is important to remember that disability is a human rights issue, and supported the need for a UN specialist agency to reinforce the importance of the UNCRPD.

    Some participants also commented that the term “vulnerable people” does not follow this human rights approach, and the phrase “disabled people” should be used instead. Also, without involving disabled people in the UN structure to address disability, the correct changes will not be made, they asserted. The same is true for NGOs and other groups, which must mainstream disability within their own organizations before than can advise others on the subject.

    The World Bank Disability and Development Team spearheaded the establishment of a Global Partner- ship on Disability and Development (GPDD), bringing together DPOs, NGOs, donor agencies, UN organizations, international financial institutions, universities, research institutions and interested individuals, to promote inclusive development. The GPDD now has a Secretariat in Washington with a full-time Executive Director, Ms. Maria Verónica Reina, and implements activities in the areas of education, poverty reduction and disability, and conflicts, crises, and disasters. (www.world- bank.org/disability/gpdd)

    Mr. Conticini responded that, unfortunately, development plans talk about vulnerable groups and so the UN has to use this language. He believes that despite the terminology, the UN knows what it needs to do – put disability on the development agenda. Including a strong DPO element within planning and operations, as well as taking on board the human rights message, will allow this to happen.

    The workshop’s Chair, Vittoria Beria from the UN Department of Economic and Social Affairs, complimented Ethiopia on its progress on disability, saying that it had acted more quickly than the UN as a whole. Representatives from DPOs added that for these changes to truly take hold, people with disabilities must be empowered to steer and take full advantage of all progress in this area.

    Recognizing that driving change was the goal of everyone in the room, workshop participants then called for several action points:
     
    1. Create unilateral leadership for disability and development
    2. Strengthen the advocacy role and capacity of DPOs
    3. Establish inclusive development technical assistance organizations
    4. Hold international agencies to account
    5. There should be more support for disability equality training in the UN and more disabled staff employed

                                                                                                                                Top