Environmental Audit CommitteeWritten evidence submitted by Sightsavers

Introduction

Two of our staff members attended the Rio+20 UN Sustainable Development Conference, and their experiences are reflected in the submission that follows. We were also involved in some joint civil society activities prior to the conference and engaged with the BOND Rio+20 group, chaired by Stakeholder Forum. Our engagement with the Rio+20 conference was mainly focussed around neglected tropical diseases, and in particular the links between Neglected Tropical Diseases (NTDs) and water and sanitation, and the need to include disabled people in sustainable development.

The Declaration

Disability in the declaration

1. One in five of the world’s poorest people are disabled.1 At least 80% of the world’s disabled population live in developing countries. Living in poverty can make people more vulnerable to disabling conditions; at the same time environmental, societal or attitudinal barriers can combine to limit the opportunities open to disabled people, meaning that they stay poor.

2. In developing countries, disabled people experience disproportionately high rates of poverty, and face exclusion from mainstream social, economic and political life. Disability affects all eight of the Millennium Development Goals (MDGs), and the exclusion of disabled people seriously undermines efforts to achieve them. The UN Convention on the Rights of Persons with Disabilities (CRPD), which is ratified by the UK, states that international development programmes and cooperation should be inclusive of and accessible to disabled people, including those who are blind and visually impaired. There is, however, no reference to people with disabilities in either the MDGs themselves or the accompanying policies and guidelines, and they have been insufficiently included in other development programmes and processes.

3. We welcome the inclusion of disabled people in statements on green economy, education, and sustainable cities; the commitment to engage disabled people as a key stakeholder in sustainable development; and the mention of the need for “meaningful involvement” of people with disabilities as part of civil society (point 43). However, overall there was limited focus on the needs of disabled people, especially on key areas such as employment, technology transfer, disaster risk reduction and food security, with only five mentions of disabled people in the outcome document. This could and should have been much higher.

4. The emphasis on human rights within the document is welcome but needs to be put into practice. The list of previous conventions to which the Rio+20 signatories re-committed themselves did not include the UN CRPD, which is a serious omission in any document committed to ensuring human rights for the world’s most vulnerable people.

5. The re-commitment to the Millennium Development Goals is welcome in its avoidance of duplication or competition. However, the MDGs are only a partial statement of the actions needed to ensure development for all. Overall, none of the commitments repeated in the start of the outcome document relate to the needs and rights of people with disabilities; given that they are 15% of the world’s population and disproportionately likely to suffer the effects of ill health and poverty, this is a serious flaw.

6. Point 104 refers to the use of gender-sensitive indicators. It is widely accepted that the measurement of appropriate data on different target groups is an important way of catalysing progress and holding development actors accountable for their promises. At the moment there is no systematic collection of data on the impact of development, including the MDGs, on disabled people. This is something we hope will be included both in whatever replaces the MDGs and in any final Sustainable Development Goals (SDGs) or other framework emerging from Rio. However, based on this document, this does not seem likely, meaning that this group will miss out once again.

7. Sightsavers agrees with point 107 of the document that reducing inequality and social exclusion are essential to eradicate poverty. Social protection that helps to achieve this would be a positive step, particularly if it is designed to take account of the needs of those disabled people who could benefit from it and targeted appropriately. However, social protection on its own is not sufficient. Disabled people, as the rest of their communities, need to be able to access a full range of services such as health and education, and to be able to lift themselves and their families out of poverty and dependence.

Recommendations

Disabled people, including those who are blind and visually impaired, must be included in the operationalisation of all commitments in the document, especially those on employment, food security, disaster risk reduction, water and sanitation, social protection, health, and education.

Future international negotiations on development must take account of the UN Convention of the Rights of Persons with Disabilities (UN CRPD), in particular article 11, which relates to situations of risk and humanitarian emergencies, compelling signatories to take “all necessary measures to ensure the protection and safety of persons with disabilities” in such situations; and article 32, which states that signatories must ensure that all international development programmes are “inclusive of and accessible to persons with disabilities”.

All targets, monitoring and indicators used to measure the progress of sustainable development efforts must specifically measure the impact on disabled people.

Food security

8. People with disabilities are among the most vulnerable groups in times of food insecurity. They experience the same challenges as non-disabled members of the population but are also vulnerable to additional risks, such as neglect or abandonment, especially in mobile, hungry populations. Blind people may struggle to find out where food is being distributed; if they manage to find a distribution centre they are likely to be at the back of the queue. A lack of proper nutrition has serious effects for children, and can lead to stunting and blindness.

9. Disabled people should be central to food security and sustainable development, and be supported to identify and address their needs. This includes working with Blind People’s Organisations (BPOs) and Disabled People’s Organisations (DPOs) to ensure that food security programmes are inclusive of disabled people—for example, making sure that community grain stores are made wheelchair accessible, and that blind people are included in community food committees.

Case study: Food Security in Mali

In Mali Sightsavers has supported disabled people to run their village grain bank, thereby ensuring that they contribute to community food security and are also able to meet their own food needs. The cooperative nature of the programme ensures that disabled people are central to the provision of affordable grain to their community.

Project Rehabilitation Kati, in partnership with the Mali Union of the Blind (UMAV) has been running since 1995, and it spans 46 villages in Mali. Its remit is to teach blind and visually impaired people mobility skills, and provide training in things to enable them to earn a living: such as gardening, agriculture, animal farming, fishing and craft techniques. The project also creates support committees for blind people, to make sure they are listened to and involved in the development of their communities.

In 2008, among the activities that came about as the result of these support committees were three cereal banks in the villages of Farabana, Sanankoroba, and Tangala. Last year over 10 tonnes of cereal was sent to the banks.

Mamoutou Traore lives in Farabana, and lost his sight ten years ago. “It was a few years ago that I first heard about the concept of grain banks,” he says. “I met a friend from the village past the river who told me all the happiness his people know, especially during the lean period, because of the installation of the bank. Thus, during a meeting with UMAV and Sightsavers and the support community, we suggested a cereal bank for the blind. The bank allows us to trade in grain, giving our community a rate cheaper than the general market. It means grain is always available. This bank has changed our lives, and it means that blind people no longer have to worry about feeding our families, we have fixed the problem ourselves!”

10. It is regrettable, therefore, that in the outcome document there are no specific actions to address the needs of marginalised or vulnerable groups such as disabled people. Without specific actions to target assistance to the most marginalised, these efforts are likely to only be partially successful. We would hope, therefore, that as these commitments are actualised their impact on different population groups is monitored and those managing them held to account.

Recommendations

Work to develop food security programmes should involve blind people’s organisations and disabled people’s organisations to ensure that their needs are identified and addressed.

The potential of disabled people (including those who are blind and visually impaired) to contribute to the food security needs of their community should be recognised and made use of.

Water

11. Access to clean water and sanitation is a key determinant of health. As well as impacting on water-borne diseases such as dysentery and cholera, clean water and sanitation play a key role in preventing the spread of neglected tropical diseases (NTDs), which affect one billion people worldwide. The issue of accessibility is also vital; sanitation and water facilities need to be accessible to all population groups, including disabled people.

12. Over one billion people are infected with one or more of the 17 diseases defined by the World Health Organization (WHO) as neglected tropical diseases (NTDs). NTDs can cause pain and chronic disability. They can impair childhood growth and mental development and hinder economic growth. Parasite-infected water and poor sanitation encourages the development and transmission of nine NTDs. Good water, sanitation and hygiene (WASH) practices are critical to NTD elimination and control strategies, including the elimination of trachoma. The integration of WASH efforts into NTD control programmes is vital to breaking transmission cycles and achieving sustainable control and elimination.

13. In order to be effective WASH services must be accessible to the entire community they serve, including disabled people. Accessibility often requires only very minor alterations such as the installation of handrails in facilities, elevated wells, or wider doorways to latrines. Inclusive WASH services benefit all community members including children, pregnant women and older people. If included from the design and engineering stages, these adaptations can be very low cost.

14. Communication around good hygiene and sanitation behaviour must also be inclusive of all community members, including disabled people. For example, materials should be made available in Braille, large-print or audio versions so that blind and visually-impaired people can access them.

Case study: Inclusive sanitation in Tienfala

Over the years, more than 5,000 people left the village of Tienfala in Mali to escape the blinding effects of trachoma and river blindness. Even government representatives were unwilling to be posted there because of these diseases.

Sightsavers worked in partnership with WaterAid, the Malian Ministries of Health and Social Welfare and different disability, development and sanitation organisations. The existing well, which kept drying up making irrigation difficult, was replaced with a new one adapted for people with disabilities such as blindness, and accessible latrines have been installed. This was the result of blind people’s input as to what was needed for the town’s development.

The whole community has supported accessible water and sanitation services for disabled people. They have ensured that the wells used by disabled community members have higher walls—so that blind community members can locate them easily using a white cane; they have made the path to the well flat and accessible to wheelchair users, it also has stones laid out on either side that crunch under-foot as you approach—signalling to visually impaired people that you are nearing the well. The latrines for disabled community members are accessible too, meaning that the access point is wide enough to fit a wheelchair, and the latrines themselves are raised off the ground to make them easier to locate and use.

This new well has played a pivotal role in the transformation of community life in Tienfala. As well as supporting gardening activities (which can now run all year long), it also serves the general population with regard to washing, cooking and drinking, and perhaps most importantly of all, the E (environmental hygiene) element of the SAFE strategy, to prevent trachoma.

Since 1995, Sightsavers has supported the distribution of Mectizan® to prevent river blindness in Mali, and today the disease is fully controlled in Tienfala. Trachoma has also virtually been eliminated. Blind people not only have a valuable means of income by way of the garden, but are also actively involved in the community’s sanitation issues. This once deserted village is now full of life as a result of this collaborative project.

15. Sightsavers welcomes the inclusion of water and sanitation as a unified right in the Rio+20 discussions. The recognition of the importance of water and sanitation “for human health” in the outcome document is also very welcome; however, there is no mention of the critical role water and sanitation plays in the transmission of neglected tropical diseases, as outlined above. Point 138, in the section on health, refers to “the social and environmental determinants of health”; improved sanitation and hygiene behaviour change play an important role in the control and elimination of NTDs, particularly diseases such as trachoma and schistosomiasis.

16. The document mentions the importance of investment in infrastructure for water and sanitation. It is vital that this infrastructure is made inclusive and accessible. Modifying facilities to be accessible is feasible but it is more cost effective if accessibility is included in the initial design stage.

17. The Sustainable Cities section of the document has positive language regarding the importance of “all people” having “access to basic services, housing and mobility” and “a safe and healthy living environment for all, particularly children, youth, women and the elderly and disabled” (points 134–135). This “safe and healthy living environment” must of course include safe water and proper sanitation facilities; facilities which take account of the ways in which disease is spread and help to minimise transmission and which are designed to be accessible to all members of their communities.

Recommendations

Efforts to improve access to sanitation and clean water should be particularly targeted at communities where trachoma, onchocerciasis and schistosomiasis are endemic.

Sanitation work should be integrated with initiatives on trachoma, onchocerciasis and other water-related NTDS to ensure greater impact and value for money.

For access to water and sanitation to be effective, steps should be taken to ensure they are provided to entire populations, including disabled people.

Disabled people, including those who are blind and visually impaired, should be included in the design of facilities for their communities.

Health and population

18. The high profile of health in the outcome document is welcome; the role played by the World Health Organisation in this regard was very effective and could be replicated in future international negotiations.

19. There are some welcome statements in this section; in addition to upholding people’s right to health, it also recognises that health is a contributor to the achievement of sustainability goals. Health is one of the positive effects of sustainable development—this is seen in the critical role of water in addressing blinding diseases such as trachoma, and in the impact of the environment on people’s health, for example through malnutrition and water-borne diseases. This section of the document also makes specific reference to neglected tropical diseases as a major health problem, which is a step forward; it would have been better still to see an understanding that treatment of NTDs, as well as for other major diseases such as HIV, TB and malaria must go hand in hand with work to build strong health systems.

20. The outcome document also recognises that health is “an outcome and indicator of all three dimensions of sustainable development”. Improvements in the health of a population—including measures such as rates of treatable or avoidable blindness and incidence of neglected tropical diseases alongside the more commonly measured infant mortality and life expectancy—are an important indicator of the economic, environmental and social progress created by government policies.

21. The commitment to take action on the social determinants of health (SDH) and to strengthen health systems is very welcome. Health inequities arise from the social conditions in which people are born, are educated, live and work. Despite its commitment to addressing the SDH, Sightsavers would have welcomed specific actions to address the health inequities between and within countries, and efforts to support the most marginalised groups. Effective health systems are critical in reducing health inequities and contributing to sustainable development—by promoting, maintaining and protecting people’s health today and that of future generations. The document could also have benefited from greater attention to the role of communities in decision-making on health. Inclusive participation in health decision making is critical if we are to address continuing inequalities in health.

22. While we recognise that this document is a broad statement of intention and cannot cover every issue in detail, it is important to remember when discussing health issues the huge unmet need for eye care services in developing countries. Globally, 285 million people are visually impaired and 39 million blind. 90% of visually impaired people live in developing countries, and 80% of all visual impairment can be avoided or cured; yet there is a desperate shortage of trained health workers at all levels to provide this treatment. Vision impairment is both a cause and a consequence of poverty, and people with poor sight or disabilities are less likely to access treatment for other illnesses, to be educated, to earn a living, and even to be properly nourished.

Recommendations

In order to achieve national and international goals in health, there must be greater and more effective support to health systems.

A well performing health workforce is essential if people are to access good health services and live healthy lives. All countries, developed and developing, must work together to overcome the shortage of health workers that prevents further progress in health indicators.

NTDs are a major public health problem—particularly for people living in poverty, including disabled people. Greater efforts are needed to control and eliminate them where possible.

Eye care services must be included in the package of health services available to people living in developing countries.

Green jobs and social inclusion

23. Unemployment among disabled people is as high as 80% in some countries. This not only makes it more difficult for disabled people to pull themselves and their families out of poverty, but also denies them the opportunity to develop their skills, and means their societies cannot benefit from their talents and efforts. Given the high numbers of blind and disabled people living in developing countries, this wasted potential is a national missed opportunity as well as a personal misfortune. Technical and vocational training support needs to be available to disabled people to enable them to fulfil their potential and contribute to their countries’ development.

24. In order to be able to access employment, populations must have long-term sustainable access to quality health and education services. If education services are not of sufficient quality, or are not accessible to all, then efforts to provide employment opportunities will only benefit some and may further marginalise others. Being disabled more than doubles the chance of never enrolling in school in some countries.2 A good quality, inclusive education needs to be made available to all disabled children to provide them with the opportunities to take up further education or vocational training to gain employment.

25. The same applies to healthcare; people must be healthy and well enough to work in order for such efforts to be effective. This applies to the general population, who among other health benefits must have access to treatments for the neglected tropical diseases that affect 1 billion people, and eye care services to protect and improve their vision; to children, who must as part of regular check-ups have access where necessary to Vitamin A supplementation to protect them from increased risk of mortality, repeated infections and unnecessary blindness; and to disabled people of all ages, to whom health services must be fully accessible both physically, financially and otherwise.

Case Study: Ghana Careers Fair

Sightsavers has worked with Standard Chartered to hold a careers fair for people with disabilities. Attendees were given the opportunity to showcase their skills and be interviewed by some of the 27 companies present, including Vodaphone and Barclays Bank.

Inspirational presentations were given by disabled people who are currently in employment, such as Mawuse Yakor, who is partially sighted due to albinism. Mawuse is a qualified accountant, and works as an audit officer.

“Some people do not want to associate with you, and even discourage others from doing so,” she says, as many people view albinos negatively, and are often afraid of this condition that affects skin and sight. “The colour of our skin should not, and must not, be an indictment on our professional abilities.”

Company representatives who already employ people with disabilities also made comments during the presentations, which helped to allay the fears of some employers.

Mawuse’s employer has had to make some small adjustments, such as changing the brightness of her computer screen. There are also some very low cost accessible technology devices employers can install to make the workplace more suitable for people with disabilities—such as such as screen readers that allow blind people to use computers.

The event highlighted the opportunities available to the private sector to harness its contacts and experience, to support work to further the rights of people with disabilities in the countries where they work.

26. The outcome document contains multiple mentions of employment for young people, but none for disabled people, who also suffer disproportionately from a lack of such opportunities. Statements regarding “decent work for all”, “especially men and women living in poverty” are welcome but to be effective in fighting poverty efforts must be made to ensure that people with disabilities are supported to find livelihoods that enable them to lift themselves, their families and communities out of poverty.

Recommendations

Any new international commitments on social inclusion and employment should explicitly include disabled people as well as women and young people.

Efforts to provide employment must also ensure that the target populations have good standards of health and education, and that these services are accessible to all community members including disabled people.

Disaster Risk Reduction

27. Disasters and climate related shocks can exacerbate both poverty and disability: people with disabilities are disproportionately affected by disasters, and disasters can result in increased numbers of people with disabilities. People with disabilities are at increased risk in emergency and disaster situations; they are often excluded and marginalised from both immediate emergency interventions and longer term recovery or rehabilitation programmes. Disabled children are also very vulnerable in emergency contexts; they can face neglect, be exposed to abuse and risk separation in emergencies.

28. Article 11 of the UN Convention on the Rights of Persons with Disabilities (UN CRPD) states that protection and safety must be provided for people with disabilities during situations of risk. Inclusive disaster preparedness and climate resilient reconstruction is crucial to make sure that the needs of persons with disabilities are met.

29. Disabled people have a right to inclusion in emergency relief operations with their specific needs taken into account and must therefore be key stakeholders in any efforts to integrate disaster risk reduction into sustainable development policy, planning and implementation. This means that both the planning process and the implementation systems are accessible and inclusive. Adaptations to existing early warning signals or shelters may be required to make them accessible, and reconstruction support and post-disaster social safety nets must be inclusive of disabled people and relevant to their needs. Ways this can be achieved include making leaflets available in Braille, and including sign language in early warning systems.

Case study: Inclusive Disaster Preparedness in Bangladesh

With climate change affecting water levels all over the world, Bangladesh is especially stricken by severe flooding, as 75% of its land is only ten metres above sea level. Communities and livelihoods are regularly threatened by these environmental disasters, but community members who are disabled find themselves even more vulnerable, reliant on disaster relief just to get by.

A successful application to 2011’s Sightsavers Innovation Fund has led to a project examining the effects of climate change on the lives of people with disabilities, and how to ensure that disaster preparedness activities are responsive to their particular needs. It will also investigate alternative livelihoods for areas prone to the effects of climate change. A collaboration between Disabled Rehabilitation and Research Association (DRRA) and Sightsavers, it is taking place in the districts of Khulna and Satkhira.

The project has been working, in conjunction with a number of community volunteers, with 278 disabled adults in the two regions with a target of helping them become self-reliant. It has also been working with local government in order to help make development and disaster relief plans sensitive to the needs of people with disabilities. We hope that the methods developed and subsequent lessons from this project will aid future disaster relief operations worldwide.

30. The outcome document recommends “comprehensive hazard and risk assessments”. If these assessments are truly comprehensive then they will specifically address the particular vulnerabilities and needs of disabled community members, including those who are blind and visually impaired. It is also important to make full use of the capabilities of disabled people to contribute to the safety and resilience of their community.

Recommendations

DRR planning should be examined at both local and national level to ensure that it is inclusive of disabled people in assessment of risks and strategies for warning, response and recovery.

Disabled people should be supported and encouraged to participate in work to help their community prepare for, react to and recovery from disasters.

The provision of international humanitarian relief should be fully compliant with article 11 of the UN CRPD.

Education

31. International conventions state that primary education should be free and compulsory for all children without discrimination. This underpins commitment to MDG 2: Universal Primary Education, where there has been good progress. Yet disabled children have been left behind; being disabled more than doubles the chance of never enrolling in school in some countries.3 Education systems need to provide specific support for disabled children, allowing them to gain independence and escape poverty. Development partners should put inclusion at the heart of their education support.

32. Point 229 of the Rio outcome document refers to “ensuring equal access to education for persons with disabilities”. While this specific mention is welcome, and recognises that disabled children are among those least likely to be able to take advantage of increased educational provision, access alone is not enough unless accompanied by strategies to ensure disabled children are not just attending school but receiving a quality education. Schools, teacher training and equipment must all be designed to ensure that blind and disabled children are able to learn alongside their non-disabled peers and achieve the kind of learning outcomes that will enable them to participate fully in their societies.

Recommendations

Education plans must tackle the causes of marginalisation and promote accessible and inclusive learning environments.

Alongside efforts to increase access to education, quality of education and learning outcomes must be monitored and improved.

Teacher training, school design and the provision of equipment and textbooks must all take account of the requirements of blind and visually impaired children.

Sustainable Development Goals

33. Sightsavers is a member of both the international and UK chapters of the “Beyond 2015” campaign, (www.beyond2015.org) and supports their positions on this issue.org.

34. Sightsavers is currently involved in efforts to ensure that an effective set of global development goals is created to replace the MDGs when they expire in 2015. We are particularly concerned that this new framework is developed in an inclusive and transparent manner, and that it ensures development and human rights for marginalised groups, including disabled people.

35. Point 79 in the Rio outcome document says that an “effective institutional framework for sustainable development… should… promote synergies and coherence; seek to avoid duplication and avoid unnecessary overlaps”. In order for the goals of sustainable development and poverty eradication to be achieved, it is important to avoid competition. For this reason we would like to see the Sustainable Development Goals developed using the same process and framework that is already in place to decide what will replace the Millennium Development Goals, to ensure coordination and maximise international commitment to the end result.

36. Point 248 mentions “inclusive and transparent intergovernmental process”. This is very welcome. The current set of Millennium Development Goals do not make any reference to disability; other marginalised groups have also lost out. In order to rectify this, it is important that the opinions of people living in poverty are sought and listened to. The current post-2015 process is already much more participatory than the one that went before; any work to develop a set of SDGs should build on the work that is already underway and ensure that it is grounded in real life experiences of the people to whom it will matter the most.4

Recommendations

The process of developing Sustainable Development Goals should build on existing processes and structures to replace the Millennium Development Goals.

The voices of people living in poverty, especially marginalised groups, should be actively sought and taken into account in any such process.

A global development framework encompassing both poverty eradication and sustainable development must do more to reach marginalised groups, such as those living in extreme poverty, with disabilities, or suffering from mental health problems.

Conclusions

37. As can be seen from the series of recommendations outlined in previous sections, there are a number of weaknesses in the outcome document. Efforts to improve development outcomes for people living in poverty are of course welcome, and there are some positive aspects of the agreement—such as the confirmation of the right to water and sanitation. However, in total, the document—like most development commitments, including the Millennium Declaration—does not sufficiently address the needs of marginalised groups, in particular disabled people. In addition, planning on different areas (such as water and sanitation, and health) should be integrated to ensure cost efficiency and improved outcomes.

38. There are wider implications of the lack of success of the UN Sustainable Development Conference. The difficulty that was encountered in trying to agree an ambitious, practical and inclusive international agreement on development has been well documented. As the deadline to achieve the Millennium Development Goals approaches, and the process to replace the existing framework gets under way, this lack of consensus is very concerning.

28 August 2012