Disability and development - International Development Committee Contents

2  Why DFID needs a strong commitment to disability

Leaving no-one behind

7. Disabled people are among the poorest of the poor. One witness observed: "If one goes into the poorest urban slum or the most marginalized rural village and asks "who is the poorest person in your community"? one will almost invariably be directed to the household of a person with a disability."[14] Disabled people experience disadvantage on many fronts—from a lack of access to lifesaving services, to violence and abuse (Table 1). DFID's Permanent Secretary, Mark Lowcock, has described this as a "key threat to reaching the Millennium Development Goals".[15]As one of our witnesses pointed out, if any country with one billion people had such low employment, education and health outcomes as the world's disabled population, it would probably be at the top of international development priorities.[16]

8. The Prime Minister has said hewants to ensure "no-one is left behind" in future global development work.[17] The Minister says this is already becoming an important guiding principle for DFID.[18]Table 1 illustrates thatdisabled people have been left behind in progress towards the Millennium Development Goals: if DFID is serious that no-one should be left behind in future work, a strong commitment to disability will be essential.

9. DFID's approach to disability is important not only because of its direct impact on the ground, but also because of the signal it sends to other donors. The US, Australia, and Germany have all done some work on disability,[19] but their work only covers some countries and sectors, and is not on its own enough to mitigate the substantial disadvantages that disabled people face.[20] Galvanising support from other bilateral and multilateral donors will be key.[21] Witnesses to the inquiry firmly praised the UK's statements on leaving no-one behind,[22] and said DFID should now lead by example, "moving that commitment into practice".[23] Such a step could have a large multiplier effect:

    That focus on disability could be enormously influential, not just for those [...] people who you are investing in, but for showing the others who have done nothing on disability the impact that that can have. [...] You could then get more from your money than you were anticipating.[24]
Table 1: Key facts on disabled people's progress towards the Millennium Development Goals
Goal/target Available evidence on disabled people in developing countries
1.B Achieve full and productive

employment and decent work for all, including women

and young people

-  The unemployment rate is often 80%

-  Any work is oftenlow paid, outside the formal labour market .

2. Ensure that, by 2015,

children everywhere, boys and girls alike, will be able to

complete a full course

of primary schooling

-  One third of all out of school children have a disability[25]

-  Over 90 per cent of children with disabilities are out of schoolin Africa.[26]

3.2 Share of women in wage

employment in the

non?agricultural sector

-  Women with disabilities are almost half as likely to have jobs as men.
4. Reduce by two thirds, between 1990 and 2015, the under-five mortality rate -Babies and children with disabilitiesmay not get adequate nutrition, may not be immunised, or may not be considered valuable enough for healthcare[27]
5.B Achieve, by 2015,

universal access to reproductive health

-  Inadequate access tosexual and reproductive health services

-  Higher risk offorced sterilization, forced abortion and forced marriage

6.A Have halted by 2015 and begun to reverse the spread


-  Many disabled people experience sexual assault or abuse during their lifetime.

-  Healthcare services may beinaccessible, disabled people may be turned away from HIV education, or denied equal access to services that could prolong their lives.

7.C Halve by 2015 the proportion of people without sustainable access to safe drinking water and basic


-  Disabled people face technical and social barriersto accessing clean water
Target 8.E.

In cooperation with pharmaceutical companies, provide access to affordable

essential drugs in

developing countries

-  Disabled people are twice as likely to find health care providers' skills and facilities inadequate, thrice as likely to be denied health care, and four times more likely to be treated badly in the healthcare system.[28]

Source: Simplified version of table from Professor N Groce, Disability and the Millennium Development Goals, UN, New York, 2011, pp 17-26

Getting value for money from UK aid

10. The Coalition Government has made value for money a priority for DFID. DFID aims to "target [UK aid] at people and places who will benefit most from our money".[29] We therefore sought evidence on whetherinvesting in disability was good value for money.

11. Experts told us that the cost of excluding disabled people from development work is much greater than the cost of including them.[30] If disabled people are unable to participate in education and employment, the impact on their communities and economies is severe. A pilot study by the International Labour Organisation found that countries could lose up to 5% of their GDP if disabled people did not have equal access to employment—and this is before taking into account indirect losses such as social security payments, or caregivers' lost wages.[31] One witness described how an employment project for disabled people work in Malawi had helped the whole community:

    One community leader, completely spontaneously, said to me, "It has made a huge difference. Now that disabled people are benefiting our community, the whole community has come out of poverty. [...] Before, they were dependent; they were drawing our resources. Now they are productive, it means the whole community has a better potential." That, for me, represents what we mean by value for money.[32]

12. Not only does investing in disability offer economic benefits, it also ensures these benefits reach some of the world's poorest people. A strong commitment to disability would ensure DFID's aid does indeed "target people who will benefit most". Bob McMullan, who helped introduce a 'disability-inclusive' aid programme during his time as a minister in the Australian Government, told us:

    The poorest of the poor are people with disabilities in developing countries, and if our development programmes are not targeting them, we are missing the point. [...] In terms of improving the lives of the poorest people, this is the value for money number one.[33]

Delivering human rights objectives

13. The UK ratified the UN Convention on the Rights of Persons with Disabilities (CRPD)—a legally binding convention summarising disabled people's rights—in 2009.[34] States that have ratified the Convention are required to "ensure that international cooperation, including internationaldevelopment programmes, is inclusive of and accessible to persons withdisabilities". They must also"take all necessary measures to ensure the protection and safety of persons with disabilities" in humanitarian emergencies.[35] UK performance against the Convention is due for review in late 2014, and we plan to submit our report as evidence to inform this review.[36] A strong commitment to disability, put into action, would help demonstrate how the UK is meeting its objectives under the Convention.

14   Professor N Groce, Disability and the Millennium Development Goals, United Nations, New York, 2011, p1 Back

15   Mark Lowcock, speaking in 2007 when he was Director General for Policy and International Finance, quoted in DFID, How to Note - Working on Disability in Country Programmes,2007, p1 Back

16   Bob McMullan, Tales from an Imaginary Country, Leonard Cheshire Disability and Inclusive Development Centre, University College London, Working Paper Series: No.22, 2013 Back

17   United Nations, A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development: the Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, New York, 2013, p7 Back

18   Q135 Back

19   USAID (DIS0088), Australian Government Department of Foreign Affairs and Trade (DIS0063), Q4 [Mr Chandrasekar] Back

20   Q92 [Prof Groce], USAID (DIS0088) para 11. For country/sector coverage please refer to: USAID 'Where we work' and DIS0088 para 9; Australia Department of Foreign Affairs and Trade 'Where we give aid' and Development for All: Towards a Disability-Inclusive Australian Aid Program 2009-2014; German Federal Ministry for Economic Cooperation and Development, Action Plan for the Inclusion of Persons with Disabilities (2013-2015), 2013, pp14-15. Back

21   Development Initiatives, Investments to End Poverty, 2013, pp 68-69, illustrates the diversity of bilateral donors and the important role played by multilateral agencies. Back

22   For example, Vision Alliance (DIS0013) para 13, RESULTS UK (DIS0021) para 8.1, AbleChild Africa (DIS0026) para 2.8.1 Back

23   Q127. See also the Joint National Association of Persons with Disabilities (DIS0083) para 4. Back

24   Q32 [Ms Wapling] Back

25   Based on 2005 data. 57 million children are still out of school, so disabled children probably still disproportionately affected, and some estimates suggest the proportion has even increased (source, World Vision, DIS0023, para 9 and 'Of all the world's children deprived of education, two fifths are disabled', The Guardian, 18 March 2014) Back

26   Based on 2005 data. Back

27   Dr Tom Shakespeare (DIS0002) para 3.1 Back

28   World Health Organisation, quoted in Dr Tom Shakespeare (DIS0002) para 3.2 Back

29   DFID, 'Increasing the Effectiveness of UK Aid', accessed 22 March 2014 Back

30   Q65. See also USAID (DIS0088) para 11 Back

31   International Labour Organisation, The Price of Exclusion: the Economic Consequences of Excluding People with Disabilities from the World of Work, Geneva, 2009, Table 65 and p.4. Table 65 shows the result for South Africa was as high as 7% - although this result involved a large number of assumptions, so we have excluded this result for caution. Back

32   Q30 [Ms Wapling] Back

33   Q22 and Q30 [Mr McMullan] Back

34   United Nations Enable, Convention and Optional Protocol Ratifications and Signatories, accessed 22 March 2014 Back

35   United Nations Convention on the Rights of Persons with Disabilities, New York, 2006, Articles 32 and 11. Back

36   United Nations Committee on the Rights of Persons with Disabilities, 'Sessions for Convention on Rights of Persons with Disabilities', accessed 22 March 2014 Back

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Prepared 10 April 2014