House of Commons - Disability and development - International Development Committee

Disability and development - International Development Committee Contents

5 What a strong commitment to disability means for DFID's sector programmes

A realistic schedule for change

51. DFID has to strike a balance between many different priorities. In the long-term, we would expect all its programmes to be accessible to disabled people: but we recognise it is not realistic to do this immediately—a phased approach will be necessary.[137] Australia's experience provides a useful model of how to set ambitious targets without trying to do everything at once. Bob McMullan, the minister responsible for introducing Australia's strategy on disability and development, explained that the strategy focussed on just two sectors, and also on four countries.[138] This approach meant the agency's developing disability expertise was not spread too thinly, whilst still aiming for results on an ambitious scale.[139]

52. DFID has taken an important symbolic step with its new commitment to make all directly-funded school buildings accessible to disabled children. We understand this announcement has already had a positive knock-on effect on other donors, with the World Bank now looking to make its new school buildings accessible too.[140]However, while this commitment is welcome, it is well-known that accessible buildings are a relatively simple, low-cost, response to disability.[141] If disabled people are to enjoy full access to programmes, donors also need to tackle more stubborn barriers such as information and stigma.[142]We would now expect DFID to show more ambition. We recommend DFIDchoose one or two substantial sectors (e.g. health or education), and a small number of countries, to focus on. Within these chosen areas, it should thenpledge to give disabled people full access to all its programmes.

53. Over the course of the inquiry, we have heard compelling evidence of disabled people's needs across a wide range of sectors, so it will not be easy to choose where to start (Box 3). Our witnesses suggested two ways to handle this difficult decision: first, they emphasised that DFID should ask disabled people themselves which sectors to focuson.[143] Second, they proposed thatDFID should also focus on sectors where it is already performing strongly, and countries where it already has good relations with the government: this provides a strong foundation to build on, and makes it easier to demonstratewhat is possible.[144]We recommendthat disabled people take the lead in deciding which the sector(s) DFID should to focus on initially. We further recommend that DFID play to its strengths, and select sectors and countries in which it has a strong track record. Although we recommend that DFID take a focussed approach to begin with, we also urge itto set out a long-term timetable showing how it will expand its commitments to more sectors and countries in due course.
Box 3:Testimony on some of the challenges that disabled people face across the spectrum of DFID's work

Health

"I will never forget the testimony of one disabled woman in West Africa, who reported that, when she presented at a hospital in the early stages of labour, health workers laughed at her and asked how on earth she could have managed to get pregnant."—witness to the inquiry speaking of his time at the WHO[145]

Education

"She was no longer in school. She had hoped to pass junior secondary school three, and was determined to make it as far as the disability would allow. Then, she got pregnant. She told her interviewer, "Yes I have been mistreated sexually and physically and also insulted by my teachers and colleagues in school. When I decided to leave school it was because I was impregnated by some guys I didn't know. Because of my poor eyesight I can't remember them, so they denied responsibility." After she became pregnant the school refused to let her continue."
—the case of a girl with albinism and a visual impairment in Sierra Leone.[146]

Employment and Social Protection

"Persons with disability are always the last to be hired and the first to be discharged"[147]
—evidence from a disabled person in Afghanistan..

"I was lucky to find support and to be able to continue my education and then get a job, as it is sadly not the case for all persons with disabilities, including [landmine] survivors, who remain the poorest amongst the poor because they often do not have access to such services and opportunities".[148]—evidence from a disabled person in Laos.

"I am living by borrowing from other people and relatives here and there. I am just surviving."[149]
—recent research into stipends in Bangladesh.
Violence against Women and Girls

"At the age of 16 this girl went to a jute field to fetch wood. There, the son of a powerful chairman of the village raped her. She went back to her home, bloodied and in a lot of pain, and after she reached home she collapsed. Her brother's wife asked her what had happened and the girl told her, using sign language. Later, she died. The girl's elder brother wanted to file a case against the chairman's son, but the chairman's people threatened him. He did file the case, but the police didn't take it on because the chairman was powerful. The police said that [the girl's death] was suicide. They threatened the girl's elder brother and made him sign that it was suicide…. Still, today, there has been no justice."[150]
—The story of a deaf girl in Bangladesh.

54. While much of our evidence suggested DFID should focus on particular sectors and countries to start with, this was not universal. For example, USAID has chosen not to focus on particular sectors, as it wanted to signal that disability was relevant to every sector, and it wanted the flexibility to take new opportunities in different sectors, and to exploit cross-sector links.[151] We see the reasoning behind this approach, but on balance judge that a sector-specific focus, like Australia's, will make it easier for DFID to set ambitious and time-bound goals. We think DFID can put in place other checks and balances to ensure it does not suffer from a lack of breadth. A carefully worded disability strategy would signal that disability is relevant to all sectors. And even if DFID only focussed on one or two sectors, we would expect it to be alert to key linkages: for example witnesses highlighted how, if DFID focussed on education, a small, targeted interventionin nutrition, health or accessible transport may have a large multiplier effect on disabled children's learning.[152] The evidence also suggests there would be some relatively "quick wins" across a diverse range of sectors (Box 4): it would be a mistake for DFID to focus slavishly on one or two sectors to the extent that it missed these opportunities.

55. We accept that once DFID has chosen to focus on one or two priority sectors, extensive work outside these focal areas could leave itoverstretched. Nonetheless,to maximise the impact of its work, DFID should remain alert to importantlinks between sectors, as USAID has done. It should also look outfor "quick wins" across its whole portfolio, where a small interventioncould have a large multiplier effect on disabled people's ability to participate.

Box 4Examples of "quicker wins" that could improve disabled people's access to services

Physical access:
-  Small cash transfers to cover the costs of transport to and from school, work or clinics[153]
-  Extend DFID's guidance on school infrastructure to other sectors such as health[154]
-  Support DPOs to carry out accessibility audits of key facilities[155]

Access to information:
-  Train DPOs to disseminate health information—for example on HIV/AIDS, and on vaccinations[156]
-  Provide EasyRead information on issues such as sexual and reproductive health. Such information has already been produced in the UK, and could be translated for other country contexts at relatively little cost.[157]

Access to professional advice:
-  Provide basic disability sensitisation training for professionals such as teachers, health workers and members of the judiciary.[158] This should include training on recognising and responding to abuse.[159] Where possible, such training should be delivered by people with disabilities.[160]
-  If people's disabilities affect their communication, allow them longer appointments[161]

Overcoming cost barriers:
-  Small cash transfers to cover user fees[162]

Overcoming stigma and social norms:
-  Ensure newly produced help sheets, publicity campaigns and textbooks include images of people with disabilities[163]
-  Ensure people with disabilities are among those trained to provide basic services such as HIV/AIDS counselling[164]
-  Ensure UK-sponsored media outputs include positive coverage of disabled people (working in collaboration with the BBC World Service)[165]
-  Provide technical support on the design of complaints procedures, to help disabled people report discrimination or abuse[166]

CHARACTERISTICS OF A GOOD SECTOR-WIDE RESPONSE TO DISABILITY

56. The precise nature of DFID's response will of course depend on the sector(s) that it chooses to focus on. Our written evidence provides excellent examples of effective programmes from specific sectors, and it would be useful for DFID to refer to this as it develops its disability strategy. The evidence also contains some overarching messages with relevance to any sector.

Considering multiple levels of exclusion

57. A recurrent theme in the evidence we received is the importance of targeting exclusion at all levels—including information barriers; cost barriers; and discriminatory attitudes from service providers, community members and governments.[167] DFID's existing disability programming shows it is already addressing these barriers on a small scale:[168] the challenge will be to apply this approach sector-wide.

58. In particular, submissions emphasise that, if disabled people are to get full access to programmes in any sector, it is vital to tackle stigma.[169] They propose a variety of responses:

· At the family level, they recommend providing more support in caring for disabled children.[170]

· At the community level, they recommend bringing disabled people and community members together, through for example community-based rehabilitation programmes;[171] education; livelihoods programmes; sport; and disability training delivered by disabled people.[172]

· At the national level, they recommend supporting national governments to run publicity campaigns; include disability as topic on the school curriculum; and foster disabled role models, including disabled parliamentarians.[173]

59. Several submissions emphasised that tackling stigma takes time.They therefore said it was important that DFID provide long-term support. A DPO in Nigeria told us:

174

We recommend that, once DFID has decided which sectors and countries to focus on, it should consider in detail the steps needed to combat stigma in these chosen areas. This will allow it to tackle the root cause, as well as the symptoms, of disabled people's exclusion. We also note that overcoming stigma takes time. Echoing our findings on Violence Against Women and Girls, we recommend that programmes designed to tackle stigma last at least five years, with opportunities for further follow-up.

Tailoring the approach to the context

60. Many submissions also said that programmes need to be tailored to local circumstances.[175] This appears to be particularly true for education. Many of our submissions recommended that disabled children be educated in the same classes as those without disabilities (inclusive education);[176] but some said this was not always a suitable approach for those with more complex conditions.[177] During the inquiry we met, via video conference, a young man with intellectual disabilities from India: he told us how he had learnt much more after he moved to a special school.[178] Two of our witnesses were education specialists, and—while broadly supportive of inclusive education—they saidthat the answer was "not black and white": the best approach mightdepend on the nature of children's disabilities, local attitudes, resources, and existing facilities.[179]The Ministertold us she agreed a flexible approach was best— and indeed, in 2007 DFID produced a Guidance Note with a similar view.[180]However DFID's most recent guidance on school buildings states that "a growing body of evidence is [...] showing that inclusive schools are more cost-effective, and academically and socially effective, than special schools".[181]We note that the education of disabled children is a complex area, and that the best approach is not "one size fits all": DFID's recent guidance on school buildings does not capture these complexities, but we trust its forthcoming guidance on inclusive education will take a more nuanced approach.

AVOIDING PERVERSE INCENTIVES

61. DFID is making increasing use of payment by results, in sectors including education, to encourage programmes to increase their reach and effectiveness.[182] We understand the reasons for this approach. However, there is a danger that it will, unintentionally, discourage staff from including disabled people, and instead prioritise the 'low-hanging fruit'.[183] Some of DFID's payment by results programmes include additional checks and balances to ensure disabled people are not left out (for example, the Girls' Education Challenge), but this is not universal.[184]We note that disaggregated reporting is particularlyimportant in programmes that use payment by results, or else these may create perverse incentives not to include disabled people.

Ensuring help reaches disabled people in emergencies

62. Disabled people (and, similarly, older people) face particular risks in emergencies. Recent research suggests only 20% of disabled people could evacuate without difficulty in the event of a disaster.[185] Even if disabled people manage to evacuate, they may be denied asylum in neighbouring countries on the grounds of their disability,[186] or may be unable to access shelters and refugee camps.[187]

63. DFID works with a number of specialist NGOs to help target assistance to disabled people in emergencies. For example, it provided Handicap International with around £300,000 for work with 'vulnerable' groups—including disabled people—following Typhoon Haiyan in the Philippines.[188] During our recent visit to the Middle East, we saw first-hand an impressive rehabilitation programme for disabled people in the Zaatari refugee camp,[189] run by Handicap International with DFID support.

64. Witnesses praised DFID's work with specialist disability NGOs in emergency settings [190]—but said these agencies could notmeet the needs of disabled people on their own.[191] For example in the region of Syria,available evidence suggests the international response to disabled refugees has been inconsistent.[192] The accessibility of camps varies ; and there have also been difficulties in identifying disabled people's needs outside of camps.[193] Aleema Shivji, UK Director of Handicap International, told us that many of the most crucial steps to reach disabled people did not require detailed specialist expertise, and could readily be carried out by 'mainstream' agencies with suitable training.[194] Such steps include:

· ensuring that disabled people participate in disaster preparedness work;[195]

· gathering data on the locations of disabled people, and their needs;[196]

· making simple modifications to refugee camp design;[197]

· reaching out to disabled refugees who are not living in camps;[198]

· working in partnership with local DPOs.[199]

65. DFID has supported Handicap International to carry out some limited training of non-specialist agencies,[200] and Ms Shivji said there would be scope to do this more widely, but "because there is no accountability around it, people do it if they have the sense that they want to, but there is not really a systematic coverage of it".[201] As a major donor, DFID is in a strong position to push for more systematic coverage.[202] It has been working with the UN Office for the Coordination of Humanitarian Affairs (OCHA) to improve data on emergencies, and could build on this by requiring all its partner agencies to report data on the proportion of disabled people reached.[203] Submissions also said there were opportunities to reach more disabled people by creating central pools of expertise within the UN system;[204] and by further strengthening the available guidance.[205]

66. We welcomeDFID's support forspecialist agencies to help disabled people in recent emergencies. However, if DFID is to reach disabled people in need throughout its humanitarian work, it must also use its influence on UN agencies and large humanitarian NGOs. We recommend that, as a condition of funding, DFID should require all its humanitarian partners to say how they will reach disabled people, and to report the number of disabled people they have helped. To enable partners to reach more disabled people, DFID should increase its support for specialist organisations to provide training for non-specialists. We also recommend that DFID urge the UN to create a central pool of disability experts, similar to the current pool for gender; provide funds for the pool; and encourage other donors to do the same. In addition, we recommend DFID press the UN to endorse cross-sectorguidelines on best practice for reaching disabled people in emergencies.

137 For example, Q79 [Mr Wainwright], Bond Disability and Development Group (DIS0011) para 8.2, Norwegian Association of Disabled (DIS0024) para 3 Back

138 Q 23 [Mr McMullan]. The sectors were education and infrastructure: AusAID worked to make these sectors accessible for disabled people throughout its work worldwide. The countries were Samoa, Cambodia, Papua New Guinea and East Timor: AusAID worked to ensure programmes in these countries were accessible, across multiple sectors. The strategy covered a five year period, after which the priorities would be reviewed. Source AusAID, Development for All: Towards a Disability Inclusive Australian Aid Program, 2009-2014,pp 14-22. Back

139 Q23 [Mr McMullan] Back

140 Q133 Back

141 Lorraine Wapling (DIS0062) para 1.4, WaterAid (DIS0018) para 3.1 Back

142 For example, World Vision (DIS0023) para 10, Dr Rebecca Dingo (DIS0044) para 6, Vision Alliance (DIS0013) paras 3,6,9, Nepal National Association of Service Providers in Physical Rehabilitation (DIS0016) para 2 Back

143 Q92 [Dr Shakespeare] Back

144 Q23 [Ms Wapling], Q80 [Ms Frost], Q92 Back

145 Dr Tom Shakespeare (DIS0002) para 3.3 Back

146 Plan UK (DIS0042) para 5.5 Back

147 Accessibility Organisation of Afghan Disabled (DIS0069) Back

148 Quality of Life Association (DIS0049) para 3.3 Back