Government response |
The UK Government welcomes the IDC's report on disability,
and agrees that disability is a significant development challenge
and important to DFID's mandate of reducing extreme poverty.
We appreciate the committee's acknowledgement of the good work
on disability that DFID is already undertaking and the increased
focus on disability over the last 15 months. The UK Government
is committed to ensuring that disabled people, and all other excluded
social groups, are systematically and consistently included in
DFID's policy, programming and international work and will embed
the recommendations from the IDC as far as possible. The
UK supports the ambition of the High Level Panel Report on the
post 2015 development agenda to eradicate extreme poverty and
leave no one behind.
The UK government's vision for development is to
reduce poverty and transform economies by helping poorer countries
achieve a secure, self-financed, timely exit from poverty. As
global poverty rates decrease, extreme poverty is increasingly
concentrated in fragile states and within marginal population
groups that face specific barriers. People with disabilities are
especially vulnerable and are over-represented amongst the persistently
poor, particularly disabled girls and women and those with other
characteristics that contribute to exclusion such as race, age
DFID supports a comprehensive social inclusion approach
to 'leaving no one behind'. All DFID's investments are based
on anextensive poverty analysis at the country level which includes
an assessment of the level of access, opportunity and influence
of different geographic and social groups. It also outlines how
investments will contribute to reducing extreme and persistent
poverty and promote the needs and rights of vulnerable and excluded
people. Creating parallel and separate analyses and reporting
processes for different groups does not allow for an understanding
of overlapping inequalities, and may risk further exclusion of
people not included in a strategy. Within the social inclusion
approach, however, we agree that people with disabilities have
specific needs and that it is important that decision makers have
a nuanced understanding of these.
In order to support a strengthened response on disability,
- Publish a disability framework by November 2014.
This will set out our clear commitment, approach and actions
to strengthening disability in our policy, programme and international
work. It will also include an explanation of how we will strengthen
departmental capability on disability, how we will influence our
partners to do more and a timeframe for taking forward the activities
outlined in our response to the IDC recommendations. We will
develop the framework in discussion with Disabled people's Organisations
and Non-Government Organisations working on disability.
- Continue to advocate for 'no one left behind',
as a key principle of the post 2015 development framework, and
for goals to be underpinned by disaggregated data by different
social group to ensure that they are met by everyone;
- Include people with disabilities systematically
in our humanitarian response work;
- Announce further sectoral commitments on disability
by October 2014;
- Strive to make DFID a more disability inclusive
- Develop, progress and deepen our work on improving
global evidence and data on disability.
In order to strengthen DFID's capability we will:
- Provide clear and simple guidance for all staff
on the principles for disability inclusion (including effective
consultation and 'nothing about us without us'), and detailed
sectoral guidance for advisors and specialists;
- Identify a senior level (managerial) champion
in DFID on disability to work alongside the Ministerial champion;
- Include Disabled Peoples' Organisations (DPOs)
in the PUSS' disability group;
- Increase the central staffing team working on
- Appoint a group of experts on disability within
DFID to provide stronger technical capability and advice across
the department. We will explore how external expertise from DPOs,
NGOs and academics can contribute to this network;
- Include disability as a focal area in the next
social development advisers' conference (Autumn 2014).
The UK Government is grateful to the Committee for
highlighting the urgent need to do more for the millions of disabled
people living in poverty and dealing with stigma and discrimination
on a daily basis.
Recommendation 2 - Disability strategy, country
operational plans, BAR.
· We recommend
that DFID introduce a disability strategy. Disability should be
a priority for DFID. Its current approach to social impact appraisal,
which considers the risk of exclusion across a wide range of marginalised
groups, is valuablebut not enough. There remains a danger
that disabled people's interests will be lost among those of groups
who are more visible - all the more after the current Minister
moves roles. By publishing clear objectives, and timetables, as
it has done for gender, the Department can signal its commitment
to disability, and help ensure this commitment endures even as
key individuals move on.
· We also
recommend that the disability strategy be supported by clear references
to disability in all Country Operational Plans, and in the next
Bilateral Aid Review. (Paragraph 25)
Disagree. DFID takes a
social inclusion approach to development programming. People
can be excluded from development for a number of reasons including,
but not limited to disability,ethnicity, gender, geography, age,
race or any combination of these. Introducing single issue strategies
does not allow for an understanding of the multi-layered and interlocking
causes of poverty, and poses the risk of further excluding people
who are not included in a strategy. It also risks creating silos,
and encouraging single issue projects rather than supporting their
inclusion in mainstream programmes.
By the end of November 2014, DFID will develop a
disability framework. This will set out our clear commitment,
approach and actions to strengthening disability in our policy,
programme and international work. It will also include an explanation
of how we will strengthen departmental capability on disability,
how we will influence our partners to do more, and a timeframe
for taking forward the activities outlined in our response to
the IDC recommendations. We will develop the framework in discussion
with Disabled People's Organisations and Non-Government Organisations
working on disability.
In order to really embed disability inclusion in
DFID's work, our focus is on strengthening the principles of disability
inclusion in all of our programme management functions, which
will apply to all DFID investments. However, we will also include
specific reference to considering disability and other vulnerabilities
in guidance for future country level operational plans.
Recommendation3 - Evidence base for large-scale
programmes and CSOs
We welcome DFID's research into disability, and support
its commitment to evidence-based programming. However, as we found
in our report on Violence against Women and Girls, DFID should
strike a balance between building an evidence base on disability,
and implementing programmes. The scale and urgency of the challenge
are such that DFID cannot wait for perfect data before embarking
on large-scale disability programmes. Rather, DFID should take
an ambitious but flexible approach:
· We recommend
that DFID set challenging milestones for implementing more large-scale
programmes. It should begin these programmes by piloting, as it
has done in Rwanda, so that it can stop any projects that are
not working, and rapidly scale up those that are.
we recommend DFID take a pragmatic approach to funding applications
from disability-focussed civil society organisations, and should
not let imperfect data prevent it funding promising projects with
a clear potentialalbeit unprovenbenefit. We recommend
that DFID continue to undertake research on disability, and monitor
closely whether the research is put into practice by DFID and
its partners. (Paragraph 29)
Agree. DFID will continue
to invest in evidence on disability, and is keen to support new
evidence that moves beyond a focus on barriers to inclusion.
DFID has recently (May 2014) awarded (subject to contract) a
new £2m disability research grant in collaboration with the
Economic and Social Research Council, which will look at 'what
works' in disability inclusion in health, livelihoods, education
and social protection.
We agree that there is enough evidence to scale up
in some areas on disability, and as such are beginning to invest
in more large scale programming on disability. A recent example
of this is in Pakistan, whereDFID is funding a £104m programme
in Punjab and Khyber Pakhtunkhwa to support the rehabilitation
and upgrading of existing education infrastructure. DFID Pakistan
is conducting a feasibility study to ensure that this programme
addresses the needs of children with disabilities. Through strengthened
systems as well as ministerial and managerial championing, we
will look to strengthen disability inclusion within more large-scale
We agree that large scale programmes, including those
on disability, should have clear milestones and pilot phases where
necessary to enable flexible programming.
DFID already takes a pragmatic approach to funding
civil society organisations' (CSOs') work on disability. For example,
DFID was the first bilateral donor to support the Disability Rights
Fund (and is still a key sponsor of the fund), pledging support
soon after the adoption of the UN Convention of the Rights of
Persons with Disabilities in order to increase UK support to southern
Through DFID's key central civil society funding
mechanism, the Global Poverty Action Fund (GPAF), we currently
support 18 CSOs working on disability, and two of the 41 CSOs
DFID has central Programme Partnership Arrangements with are disability
focussed (Sightsavers and ADD). In addition we fund a large number
of disability projects through country level civil society programmes,
as well as a number of mainstream civil society organisations
with a strong track record in disability, for example Plan and
DFID has also provided research funding to CSOs to
drive innovation on disability. For example, we funded UK designers
to develop and implement an innovative package to ensure the rapid
and appropriate provision of emergency wheelchairs to injured
and disabled people in humanitarian crises (through Motivation
UK). DFID also supported Vision For A Nation to pilot 'adjustable
lense' glasses, which can be adjusted by a nurse or recipient
in the field, removing the need for costly prescription lenses.
Recommendation4 - Intellectual and psychosocial
· We recommend
that DFID's disability strategy state specifically how DFID will
reach people with intellectual and psychosocial disabilities through
· We further
recommend that DFID cover ageing in the same strategy as disability,
given the strong overlaps between the two issues. It should, though,
recognise that not all disabled people are older people, to ensure
the focus on older people does not eclipse the priorities of disabled
children or younger adults. (Paragraph 32)
Agree. DFID will look
for opportunities to reach people with intellectual and psychosocial
disabilities, for example through our work to strengthen health
systems and through our support to CSOs working in this area.
We agree that there is often an overlap between disability
and ageing and also that not all disabled people are older people.
Through implementing a social inclusion approach
rather than introducing a separate disability strategy, we seek
to understand and consider the needs of all excluded groups, including
those who face multiple exclusion.
Recommendation 5 - Data disaggregation, programme
documents and results framework
· We welcome
the Prime Minister's commitment to reporting disaggregated data
on the number of disabled people who benefit from development
programmes. We also commend the steps DFID is taking to make better
data available. We recommend that DFID report results disaggregated
by disability in all Annual Reviews, Project Completion Reviews
· We also
recommend that it disaggregate targets in its Results Framework
by disability, as it does for gender. We recognise that collecting
data on disability is not straightforward, and teams have many
other demands on their time, so recommend a pragmatic approach
in the short termfor example, using the Washington Group
questions. In the medium term, we recommend DFID develop more
precise data disaggregated by type of disability. Wherever possible,
we recommend that DFID report results disaggregated to show people
who belong to several marginalised groups at once (e.g. disabled
women), to help tackle the 'double discrimination' that such people
face. (Paragraph 35)
Agree. DFID is committed
to improving data on disability, and to the principle outlined
in the high level panel report that no target for the post 2015
framework will be met, unless it is underpinned by disaggregated
data which shows that it has been met for all relevant income
and social groups.
To support this, DFID is planning a joint technical
conference with the UN and with Leonard Cheshire Disability research
unit (UCL) to look at global practice and policy on strengthening
data on disability in preparation for the post 2015 framework.
DFID's priority in this area is to strengthen national
governments' ability to collect, analyse anduse data in the countries
in which we work at a national, regional and local level, and
in different sectors. This information will be used to inform
national level results frameworks and reporting against future
international development goals. To do this, DFID made a new
commitment in September 2013 to advocate the use of the Washington
Group questions on disability wherever possible in DFID supportednational
censuses and household surveys, and to champion their use with
As the IDC recognises, collecting disaggregated data
at the programme level is difficult. DFID will make disaggregated
data onage and disability part of our requirements for funding
humanitarian proposals. DFID's broader approach is to identify
programmes with a specific focus on disability at the design phase,
and to monitor this inclusion throughout the programme management
Recommendation7 - Including disabled people in
planning, monitoring and research - programme management review
- We warmly welcome the steps DFID has taken to
give disabled people greater say in aspects of its work, in particular
the fact that it modified some WASH and social protection programmes
in response to disabled people's feedback. The challenge is to
do this more consistently across DFID's whole portfolio.
- DFID is currently reviewing its programme management,
and we recommend it take this opportunity to give disabled people
more influence - from programme design through to evaluation and
research. DFID should ensure people with all types of disability
participate, and should adjust its communications to make sure
they are reached. It should consult family and community members
as well as disabled people themselves. More specifically, DFID
- Ensure that disabled people play a prominent
role in drawing up DFID's disability strategy, and help shape
its Country Operational Plans.
- Seek to give more disabled people visible and
senior roles in programme delivery -as already happens at the
Kabul Orthopaedic Centre, which DFID helps fund.
- Invite DPOs from developing countries to join
its disability advisory group, even if only in writing or by telephone.
Agree. DFID upholds the
fundamental right of disabled people to have influence in the
programmes and decisions which affect them.
DFID will consult disabled people in the preparation
of the upcoming disability framework outlining our approach to
including disability in programmes and policy making.
The PUSS' disability advisory group currently consists
of UK-based partner organisations working on disability in developing
countries, however we will expand this group to include the Disability
Rights Fund, who is an important DFID partner (based in the US)
working directly with DPOs in developing countries. We are also
working with the Office of Disability Issues to identify UK DPOs
with significant experience in developing countries to join this
At DFID's country office level, stakeholder engagement
and participation is a fundamental part of all strategic decision
making and programme management.
Recommendation 8 - DPO funding from country offices
· We strongly
welcome DFID's support for DPOs. However, we are concerned that
it is hard for disabled people's organisations to access funding
directly from DFID. We recommend that DFID make its funding more
accessible to DPOs. We do not wish to prescribe how DFID does
this, but do recommend that it address the main barriers such
as information that is not accessible, and complex grant conditions.
We are also concerned that, if DPOs can only access
DFID funding through intermediaries, DFID is missing a valuable
opportunity to train its staff in local disability issues. While
we recognise country offices have many calls on their time, we
recommend that DFID seek to establish more direct contact with
DPOs, which could be an efficient way to tap into local knowledge
and networks. (Paragraph 43)
Agree. We agree that supporting
and strengthening Disabled People's Organisations (DPOs) is vital
for participation, voice and consequently for improved development
outcomes for people with disabilities.
DFID is currently redesigning our central civil society
funding mechanism, the Global Poverty Action Fund, which is being
specifically designed to ensure that it is open to a wide range
of organisations. We would welcome more applications from DPOs.
DFID's deliberate model, however, is to route much
of our support to DPOs, many of whom are small organisations which
require significant organisational development support, through
intermediary organisations. These include the Disability Rights
Fund, ADD International and Sightsavers as well as through large
in-country civil society strengthening programmes such as the
human rights and governance fund in Bangladesh. These organisations
are significantly better placed than DFID to provide technical
and mentoring support to DPOs as well as funding and small grant
All DFID funding opportunities are advertised on
Gov.uk.This platform has enabled DFID to comply with the Web Content
Accessibility Guidelines (WCAG), which have been designed to be
compatible with assistive technologies to ensure that all information
is accessible for users with disabilities.
We agree that it is important for DFID country offices
to have dialogue and a relationship with DPOs and other stakeholders.
Many already do, and we will ensure that this principle is reinforced
across the department.
Recommendation9 -Influencing mainstream NGOs to
· We welcome
DFID's current work to build DPO capacity and to reach out to
marginalised groups, and encourage it to ensure this is standard
practice in all its work with DPOs. We also recommend that, whenever
DFID provides grants to 'mainstream' civil society organisations
(for example, women's organisations), it monitor whether they
are including disabled people (Paragraph 44)
Agree. DFID agrees with
the need to influence UK mainstream NGOs to do more on disability.
We have already held an initial meeting (February 2014) with mainstream
NGO partners to discuss ways in which they can better mainstream
disability, encouraging them to do more, and we will continue
this dialogue. We will also ask the civil society organisations
we fund through central mechanisms to report on their work on
disability and inclusion in future annual reviews.
DFID has a central civil society learning forum -
the PPA Learning Partnership - which we have set up to drive improvements
across the CSO sector and to support a more coherent policy dialogue
with DFID. This forum has been praised in recent ICAI reports
on PPAs and on learning. We will encourage the PPA partners leading
on disability - ADD and Sightsavers - to do more to raise the
profile of disability within the Learning Partnership and to use
this opportunity to influence others and share joint learning
Recommendation10 - UK DPOs
We encourage DFID to renew its links with UK DPOs,
and to consider where their expertise might usefully complement
that of NGOs. (Paragraph 45)
Agree.DFID has made arrangements
with the Department for Work and Pensions' Office of Disability
issues (the HMG lead on disability) to jointly discuss with UK
DPOs, and will also involve UK DPOs in the PUSS' disability advisory
Recommendation 11 - Disability staffing within
We commend the dedication of DFID's current disability
team, but are concerned that DFID has no full-time disability
specialists. To ensure its commitments to disability are sustainable,
we recommend DFID develop a larger team, with more capacity, including:
a senior sponsor; a complement of Social Development Advisors
specialising in disability; and a wider network of people to champion
disability in each country office. We further recommend DFID ensure
all staff are trained in basic principles of disability rights
and access to development programmes. It should consider making
disability the theme for the next Social Development Advisor team
conference. It should also ensure disability specialists are represented
in its humanitarian division, as well as in its development work.
Agree. DFID will increase
staff working on disability in the central policy team to two
full time staff. This team plays a key role in providing support,
tools and guidance and sharing best practice with the rest of
DFID, including a basic disability awareness module which will
be rolled out to all staff
DFID will also appoint a knowledge group of disability
experts across the department. These will be individuals with
expertise in disability in specific sectors who will act as an
advisory and knowledge sharing group for department. We will explore
how external expertise can contribute to this network.
The DFID staff member currently seconded (until July
2015) to the disability section in the Australian development
agency DFAT will continue to provide regular inputs and advice
on DFID's growing disability work, based on her experience of
what is working on disability within the Australian development
DFID will continue to work to ensure that the highly
skilled 80 strong cadre of Social Development Advisers (who are
central in ensuring that DFID programming reaches the most excluded)
have the knowledge and skills needed on disability. Disability
will be a focal area at the next Social Development Advisers'
professional conference in autumn 2014.
DFID will appoint a senior level managerial disability
champion (to work alongside the Ministerial champion) by September
Recommendation12 - Staff with disabilities within
We are concerned that DFID only employs 45 staff
with a declared disabilityand that no locally appointed
staff in its overseas offices have declared they are disabled.
A visible disabled workforce could be a powerful way to challenge
stigma and discrimination, and to get a deeper understanding of
the barriers that disabled people face. DFID should investigate
why it has not attracted more disabled staff, and should consider
whether targets would help it redress the balance in some of its
offices. (Paragraph 50)
Agree. A low number of
declarations of disability on DFID's HR system is not the same
as a low number of people with disabilities being employed. DFID's
new HR system - Passport - implemented in 2013, will enable us
to have a much richer understanding of the diversity of our staff.
DFID is running a diversity monitoring campaign during 2014 to
encourage staff to complete this part of their online profile.
As of May 2014, 26% of staff had completed this, and 90 people
have now declared a disability. The PUSS will personally focus
on this issue to drive up declaration rates. We know from other
government departments that declaration increases gradually and
it takes time to achieve full coverage.
To further support disabled people joining the department
DFID has joined the guaranteed interview scheme: anyone with a
disability whose application meets the minimum criteria for an
advertised post is therefore guaranteed an interview. 'Minimum
criteria' means that a candidate must provide evidence in their
application form that they meet the level of competencies (according
to the civil service competency framework), qualifications, skills
or experience defined as essential for the position.
DFID is accredited to the Job Centre Plus Two Ticks
logo. This year we will review the efficacy of the operation of
the two ticks logo in order to identify potential improvements
which we can make.
DFID's signed the 'Time to Change' pledge in 2013,
following which we commissioned an audit of how DFID accommodates
employees experiencing mental health problems. This found that
we had made a significant effort to publicise support for employees
with mental health problems but we have a way to go until employees
can talk openly about mental health problems. The findings will
inform an action plan for improvement in this area.
DFID continues to be actively involved in the design
of a cross Civil service training solution on mental health and
will roll it out to staff upon completion.
Recommendation13 - Focus on disability in specific
sectors / countries, plus 14 disabled people's role in choosing
(13) DFID has taken an important symbolic step
with its new commitment to make all directly-funded school buildings
accessible to disabled children. However, while this commitment
is welcome, it is well-known that accessible buildings are a relatively
simple, low-cost, response to disability. If disabled people are
to enjoy full access to programmes, donors also need to tackle
more stubborn barriers such as information and stigma. We would
now expect DFID to show more ambition. We recommend DFID choose
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 then pledge to give disabled people full access
to all its programmes. (Paragraph 52)
(14) We recommend that 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 it to set out a long-term timetable showing how it
will expand its commitments to more sectors and countries in due
course. (Paragraph 53)
Partially agree.DFID is
focussing on including disability more systematically across the
breadth of our policy, programming and through influencing our
development partners. DFID will make further specific sectoral
commitments in 2014 as we did in 2013 when we committed to making
all directly-funded school buildings accessible to disabled children.
We also see the bigger goal in strengthening the critical foundations
that allow us to systematically include disability more effectively
across the breadth of our policy and programming.
In terms of disabled people's role within programming
design and decision making, country offices are strongly encouraged
to consult with disabled people in policy making and programme
design. We will continue to use the PUSS' disability advisory
group and the new disability knowledge group in DFID to discuss
DFID's planned approach, sectoral commitments and guidance on
disability with disabled people and NGOs working on disability.
Recommendation15 - Quick wins
We accept that once DFID has chosen to focus on
one or two priority sectors, extensive work outside these focal
areas could leave it overstretched. Nonetheless, to maximise the
impact of its work, DFID should remain alert to important links
between sectors, as USAID has done. It should also look out for
"quick wins" across its whole portfolio, where a small
intervention could have a large multiplier effect on disabled
people's ability to participate (Paragraph 55)
Agree. DFID's social inclusion
approach allows us to consider opportunities to reach excluded
groups in all our programmes. We will continue to remain alert
Recommendation 16 - Combatting stigma
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.
Agree. DFID agrees that
tackling stigma and social norms is a critical area for disabled
people. We are already addressing this in a number of ways and
will look for more opportunities. For example, many disabled
beneficiaries from DFID's human rights and governance programme
in Bangladesh, implemented through the Manusher Jonno Foundation,
now have jobs and livelihoods as a result of the programme. During
feedback on the programme, they reported that their livelihoods
have led to a reduction in stigma in their families and communities
as they were seen as contributors rather than as a burden.
We will encourage DFID programme teams and civil
society partners to do more analysis and share best practice in
terms of what works in reducing stigma and discrimination.
Recommendation17 - new education tool - nuanced
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.
Agree. DFID agrees that
in education a 'one size fits all' approach is not the best approach,
and we have been conscious of this in how we support children
with disabilities in education. The upcoming Topic Guide on Inclusive
Education and Learning will look specifically at the evidence
about 'what works' in terms of a nuanced understanding of the
different needs of educating children with disabilities.
Recommendation18 - PBR and perverse incentives
We note that disaggregated reporting is particularly
important in programmes that use payment by results, or else these
may create perverse incentives not to include disabled people.
Agree.Payment by Results
has the potential to be a useful tool to promote the inclusion
of disabled people in developing countries. For example, it may
be possible to design a Results Based Aid programme which paid
a partner government for every additional child attending school,
with an extra premium for disabled children.
DFID agrees with the importance of designing Payment
by Results programmes carefully and is actively supporting this.
In order to avoid perverse incentives which might otherwise disadvantage
disabled people, particular attention must be given to the precise
nature of the results being rewarded.
Recommendation 19 - Humanitarian response
We welcome DFID's support for specialist 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
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-sector guidelines on best practice for reaching
disabled people in emergencies. (Paragraph 66)
Agree. DFID agrees that
there is scope for us to do more to include people with disabilities
systematically in our humanitarian response work. We will:
Include disaggregated data on age and disability
as part of our requirements for funding humanitarian proposals;
Develop an internal guidance note for humanitarian
advisers so they know how they should be assessing proposals and
what the issues for older people and disabled people are (Handicap
and HelpAge will assist);
Prepare a technical guidance note for DFID staff
on supporting mental health in humanitarian crises;
Encourage the 2016 World Humanitarian Summit to
highlight disability and older people in humanitarian assistance;
Look at where we can influence others to do more
- e.g. through our support to UN Common Humanitarian Funds and
through funding to the Start Network and Rapid Response Facility;
Encourage partners, particularly civil society
partners who deliver the majority of humanitarian assistance,
to build their expertise, and to develop viable proposals that
we can fund at scale which include older and disabled people,
providing disaggregated data to us as standard.
Recommendation20-23 - Health spend (prevention
and treatment) and guidance note
DFID is already taking some welcome steps to help treat or prevent
the conditions that cause disability. DFID stands out as one of
the only international donors to work on mental health (Paragraph
(21) These programmes are valuablebut they
represent a very small share of DFID's overall health budget (Paragraph
(22). We are pleased that, in choosing how to spend
its health budget, DFID takes into account a range of important
factors, particularly international guidelines on cost-effectiveness.
However, we are concerned that DFID's approach to health spending
may under-state the importance of treating and preventing the
conditions that lead to disability. (Paragraph 79)
(23). We recommend DFID issue a guidance note to
clarify that, in making difficult decisions on health spending,
it is important to look beyond narrow measures of cost-effectiveness.
The value of programmes that treat and prevent disabling conditions
lies not only in their medical impact, but also in their ability
to increase people's opportunities and potentially lift them out
of poverty. We recommend DFID thoroughly appraise the case for
spending more in the following areas. If DFID decides not to increase
its spending, it should explain its reasons to the Committee.
Mental health care
Rehabilitation and basic care, e.g. for people
with spinal cord injuries
Provision of assistive devices, potentially joining
forces with USAID or other major donors to buy in bulk
Neglected Tropical Diseases
We also recommend DFID gather detailed data on the
cost and impact of all its treatment and prevention work, so as
to improve the international evidence base on cost-effectiveness.
Agree. DFID's existing
guidance on financing is already clear about the inclusion of
the wider benefits of interventions beyond a narrow definition
of cost effectiveness (https://www.gov.uk/government/publications/dfids-approach-to-value-for-money-vfm).
DFID guidance on business cases for new programmes is also clear
that costs and benefits for each of the feasible options should
include direct and indirect benefits including expected economic,
poverty and social impacts.
On health interventions specifically, DFID issued
a guidance note specifying that cost-effectiveness is only one
factor in decision making on health spending. A range of other
factors are also considered, such as the disease burden amongst
the poor, what other partners are doing and where the gaps are.
DFID is currently appraising all funding commitments
for the next four years. Final funding decisions will take a
broad range of areas into consideration.
DFID's work on health service strengthening will
enable health services in different countries to make better informed
choices about their overall levels of investment in health, both
in specific conditions (including those listed) and about overall
levels of investment.
Through DFID's civil society department we support
programmes on rehabilitation such as support to the International
Committee of the Red Cross who have large physical rehabilitation
programmes and support to Motivation UK to provide assistive devices
in developing countries. Bulk purchase of assistive devices alone
could be problematic as they need to be suitable for the terrain,
appropriate for each individual, and must be able to be repaired
Mental health makes up almost 7% of the health burden
of disease in developing countries. Given the large unmet need,
DFID's focus is on ensuring that this is included in our work
on health systems strengthening. As well as this, we are currently
preparing a guidance note for DFID advisers on supporting mental
health work in emergency situations.
At the London Declaration on Neglected Tropical Diseases
(NTDs) in January 2012, the UK committed to substantially increase
our NTD programming. This included additional spend on guinea
worm, lymphatic filariasis, schistosomiasis and onchocerciasis
as well as new programmes on trachoma and visceral leishmaniasis,
integrated NTD programmes in two countries, research and capacity
strengthening. Some of these programmes start in 2014; we will
evaluate the results and impact of these programmes to inform
future investment decisions. The USA and the UK are the two largest
donors on NTD implementation programmes.
DFID supports work on non-communicable diseases (NCDs),
through improving the provision of basic health services for the
poorest, which will strengthen health services to address all
health problems including NCDs. The UK also supports some focussed
work including hepatitis B immunisation to prevent liver cancer,
through support for the Global Alliance for Vaccines and Immunisations
DFID has committed to save an additional 250,000
newborn lives by 2015 (and an additional £2.1bn on women's
and newborn health between 2010 and 2015). The investments in
saving lives will also help to prevent disability as a result
of newborn complications, particularly around prematurity, low
birthweight, delayed breathing and infection.
Since January 2011, DFID has been increasing our
own focus on evidence building, this has led to a significant
expansion in the number and range of evaluations, which are helping
to bring greater clarity to areas of health where there are evidence
gaps or where evidence is contested. The results of these evaluations,
along with all annual reviews of projects and all project completion
reports, are made public through DFID's website.
Recommendation24 - Dementia
Dementia is a growing cause of disability in developing
countries, and the Prime Minister has called for it to be "at
the heart of the development agenda": we urge DFID and the
Department of Health to update the Committee on their plans to
accomplish this. (Paragraph 81)
Agree.The Prime Minister
held a Dementia Summit in 2013 and DFID is a member of the cross
government Dementia Steering Group taking this forward. There
are many causes of dementia, and DFID has programmes on some of
these including HIV and AIDS and Human African Trypanosomiasis
(sleeping sickness). At present dementia is a smaller proportion
of the health burden of the poor in DFID priority countries than
other conditions such as TB, Malaria, HIV and maternal and child
health which people suffer from a younger age.
The UK focus for health in developing countries is
on improving the provision of basic health services for the poor
by supporting health system strengthening, health worker capacity
and access to essential medicines. This focus will strengthen
health services to address all health problems including dementia.
It will also ensure that countries' health systems can adapt to
changing health burdens as their populations age, which will increase
as low- and middle-income countries progress through demographic
transition and adults begin to live longer lives.
Recommendation 25 - Road Safety
We welcome DFID's response to the recommendations
on road safety in our 2011 report on DFID's Role in Building Infrastructure
in Developing Countries. We also welcome the news that the World
Bank will only approve loans to programmes that address road safety.
DFID should keep up the pressure on the World Bank to meet its
road safety commitments, requiring that all new programmes are
supported by a full life-cycle risk analysis, and by monitoring
mechanisms to ensure risks are successfully mitigated. We also
recommend that it require other multilateral development partnersincluding
development banks and the European Union to introduce similar
road safety policies, as a condition of future UK funding. (Paragraph
Agree. In addition to
DFID's current support to the Global Road Safety Facility (GRSF),
we are already engaging with multilateral development partners
on transport policy and research, including issues of road safety.
As a Board member of GRSF, the UK has supported the mainstreaming
of road safety across all World Bank transport programmes and
has encouraged increased engagement with other multilateral development
partners. The Multilateral Development Banks' (MDBs') Road Safety
Working Group is currently reviewing the needs and opportunities
for a Global Road Safety Incentive Fund, as well as developing
MDB Road Safety Indicators, which will describe a common approach
to road safety requirements for all MDB road transport projects.
In addition to working with multilateral development
partners, DFID works directly to improve road safety in some partner
countries. For example, in Nepal, DFID is improving safety conditions
of highly vulnerable mountain roads, and strengthening the capacity
of government for implementation of road safety measures. Through
the African Community Access Programme, DFID is undertaking applied
research on measures to improve road safety.
Recommendation26 - Armed violence
Given the links between armed violence and disability,
we welcome DFID's research programme on urban violence in developing
countriesthe Safe and Inclusive Cities programme. We recommend
DFID develop further programmes to tackle armed violence, and
target all groups at risk of violence, including young men and
older people. (Paragraph 85)
Agree. People with disabilities
suffer a disproportionate amount in conflict situations, and conflict
is a cause of additional disability. DFID has committed 30% of
its budget to fragile and conflicted affected states, to support
peace and security as a basis for peaceful, sustainable development.
DFID supports governments to provide rule of law, security and
justice and basic services in order to help prevent conflict and
to meet the needs of those populations.
Recommendation27 - Influencing multilaterals
DFID spends more than half of its budget through
multilateral agencies. It should exert its substantial influence
to ensure this budget is accessible to disabled people. We recommend
that DFID require its multilateral partners to demonstrate that
they are reaching disabled people, by reporting disaggregated
data: the current policy review at the World Bank provides one
good opportunity to do this. When DFID conducts its 2015 Multilateral
Aid Review, we recommend it include criteria on disability. DFID
should also require its partners to show how disabled peopleincluding
DPOs and disabled parliamentariansare participating in
programming, from design through to evaluation. (Paragraph 88)
Agree. DFID takes the
efficacy of our expenditure through multilateral agencies very
seriously, which is why we commissioned the first Multilateral
Aid Review (MAR) in 2011. This looked at whether expenditure
through different agencies represented value for money against
a number of criteria, which included their focus on equity and
inclusion. Many of the multilateral organisations we fund have
policies to mainstream disability in their work, for example UNICEF
and theWorld Health Organisation.
Disability and development is one of seven emerging
topics that are being addressed by the World Bank on-going review
of safeguard policies and procedures. The first draft of the
revised safeguard policies is expected in June and at that point
the UK will review the document to ensure that the policy is inclusive
of disabled people.
The Multilateral Aid Review (MAR) framework already
includes some assessment of whether an organisation promotes the
participation of people with disabilities. In preparation for
MAR in 2015 we will look at how this is working to see whether
any changes are needed. As we continue to work with multilaterals
to ensure they provide value for money, we are also pushing for
reforms to strengthen the efficiency of these organisations to
deliver aid in an inclusive manner.
Recommendation 28 - WB influencing bilateral governments
We recognise that the PRSP process is led by
country governments. However, we would expect the World Bank to
discuss with governments how they plan, through their PRSP, to
meet their obligations under the UN Convention for the Rights
of Persons with Disabilities. DFID should press the World Bank
to do so.
DPOs participate in PRSP process, and we recommend
DFID help them to do this, for example by providing economics
training, by sharing relevant research on disability and poverty,
or by advising on effective monitoring techniques to ensure that
any PRSP commitments on disability are duly translated into practice.
Agree. We agree that the
World Bank has an important role in influencing partner governments.
The World Bank, with the World Health Organisation, are currently
developing a Model Disability Survey (MDS). The MDS will support
other interventions such as the UN's Washington Group questions
on disability to address the lack of accurate and comparable data
on disability both at national and international levels, identified
by their World Report on Disability as one of the major impediments
to better understanding of disability and to the development and
implementation of disability inclusion policies.
A key objective of DFID's support to DPOs and disability
movements is to build their capacity to hold their Governments
to account, particularly for the ratification and implementation
of the UN Convention on the Rights of Persons with Disabilities.
Recommendation 29 - HIV and affordable antiretrovirals
- influencing the EU
HIV/AIDS is closely associated with conditions
that cause disability. This makes the provision of affordable
Anti-Retroviral Therapy (ART) all the more urgent. We recommend
that, in any forthcoming trade negotiations, the UK press the
EU to retain existing flexibilities that facilitate the production
of affordable generic ART. (Paragraph 91)
Agree. The UK government
is committed to scaling up access to treatment for HIV and making
markets for anti-retrovirals work better to reduce prices, increase
the number of quality suppliers and enhance access for poor people.
DFID's partnership with the Clinton Health Access Initiative (CHAI)
has already contributed to secure price reductions of almost 50%
on both first- and second-line therapies for HIV. This has saved
African Governments over £500 million, sufficient to put
an extra 500,000 people on AIDS treatment for three years.
The UK supports countries making use of the flexibilities
available under the Trade Related Aspects of Intellectual Property
Rights (TRIPS) agreement. We support a case-by-case and evidence-based
approach to the inclusion of intellectual property (IP) provisions
in free trade agreements. While the protection of IP is only one
of a number of factors that determine the cost of medicines, we
seek to ensure that provisions on IP rights in EU free trade agreements
do not have negative impacts on the ability of citizens of the
poorest countries to access affordable essential medicines.
Recommendation 30 - Ministerial messages on disability
Many DFID partner countries have been slow to implement
the UN Convention on the Rights of Persons with Disabilities.
We agree with the Minister that it might be counter-productive
to make aid conditional on implementing the Convention. However,
we recommend the UK take other steps to press for disabled people's
rightsfor example, by supporting civil service capacity
building, and by sending key messages with Foreign Office travelling
DFID should also consider supporting the UN
Partnership to Promote the Rights of Persons with Disabilities.
If it decides not to support the Partnership, it should use the
funds for other work to promote disabled people's rights, and
should report back to the Committee on its plans. (Paragraph 96)
Agree. We agree that there
can be a gap between Governments ratifying and implementing the
UN Convention on the Rights of Persons with Disabilities (UNCRPD).
Through support to the Disability Rights Fund for example, we
are specifically supporting DPOs to lobby for both the ratification
and the implementation of the UNCRPD, including through the production
of alternative CRPD reports.
We will look for opportunities to remind governments
of their obligations under the UNCRPD at a Ministerial and officials
level and will encourage multilateral partners to do the same.
We will consider supporting the UN Partnership to
Promote the Rights of Persons with Disabilities.
Recommendation31-34 - Engagement with the Private
(31) DFID's engagement with the private sector
creates exciting possibilities for its work on disability. We
recommend that DFID require its private sector partners to report
on the number of disabled people they employ, and - for services
such as creditthe number of disabled people they serve.
Reporting requirements should be proportionatewe accept
DFID would not want to impose a heavy burden on very small companies.
However it should, as a minimum, require such reporting from larger
companies supported through CDC Group, the Private Infrastructure
Development Group, and the High Level Prosperity Partnerships.
(32) We recommend DFID require all partner
companies to produce action plans stating how they will work towards
international health and safety standards. If DFID is working
with very small businesses, it should provide financial support
for any necessary adjustments to meet these recommendations. (Paragraph
(33) Wherever private sector organisations
are responsible for delivery of key public services, we recommend
that DFID work with partner governments to ensure appropriate
regulations are in place for disabled people's access. (Paragraph
(34) We recommend DFID investigate the feasibility
of a Kite Mark standard to recognise disability-inclusive employers.
It should report back its findings in its response to this report.
Partially agree. We know
that livelihoods and jobs are what matter most to poor people,
and inclusive growth is an important objective for DFID going
DFID's focus in our private sector work is often
on influencing how supply chain relationships work, for example,
integrating small-scale producers in markets and global trade.
Where there are drivers for sector-wide change, for example,
in the Bangladesh garment sector following the Rana Plaza building
collapse, DFID made wider efforts involving business, national
governments and the International Labour Organisation. We supported
specific measures to support the women and men disabled as a result
of the disaster for example.
CDC investment policy states that non-discrimination
(including disability) is a requirement for all investee companies.
Their Toolkit provides guidance on the implementation of the Investment
Policy and includes checks on whether non-discrimination policies
are in place in investee companies.
Recommendation 33 is context-specific and needs to
be assessed on a case-by-case basis by the relevant Country Office.
Through stronger internal guidance, we will be supporting and
encouraging all DFID staff to apply principles of inclusion to
all DFID programming.
In our experience, a new standard or kitemark for
compliance is likely to have limited take up from companies (there
are many similar initiatives), and is ultimately unlikely to drive
The private sector has a huge role in driving innovation.
DFID's is setting up Global Development Innovation Ventures
(GDIV) a new independent body that will provide funding for any
innovation that delivers development outcomes more effectively
or at lower cost than standard practice. The fund recognises that
good innovations could come from anywhere and will be open on
an ongoing basis for ideas from anywhere and any sector. DFID
encourages academics, NGOs, entrepreneurs and other companies
to apply to G-DIV with any products or services that address a
development need, including in addressing disabled people's specific
DFID is also running a programme called Amplify,
which is collaboration between DFID and design firm IDEO.org.
The programme aims to bring in new actors to define a development
challenge, generate and test. The next two challenges are focused
on early child development (likely to focus on cognitive development)
and education (learning and vocation training) for communities
displaced by protracted crises. Both present a significant opportunity
for organisations working on disability to engage in the challenge
and to submit ideas that address their issues within these broader
challenges. We will consider whether a future challenge should
be on disability.
Recommendation 35 - Conditions on non-DFID ODA
It is important that all UK Official Development
Assistance (ODA) is accessible to disabled people, no matter which
department is responsible. We recommend all departments that spend
ODA put in place measures to monitor the number of disabled people
who benefit from their development programmes. This is particularly
important for the Foreign and Commonwealth Office, which spends
most UK ODA outside DFID, and is the lead department on human
rights issues. (Paragraph 101)
departments have to make sure that ODA spend is within the OECD
DAC ODA guidelines - which have the promotion of economic development
and welfare as its main objective (as defined by the OECD DAC)
and deliver value for money.
Recommendation 36 - 37 - Post 2015 development
(36) The post-2015 development framework is currently
being deliberated upon by UN General Assembly members. It is vital
that this framework secure better outcomes for disabled people
than the Millennium Development Goals. (Paragraph 102)
(37) We strongly endorse the High-Level Panel's
emphasis on leaving no-one behind in the next global development
framework. We also welcome the proposal to disaggregate data by
disability, and consider no goal met unless it is also met for
disabled people. The Prime Minister has shown impressive leadership
in bringing disability into the post-2015 development process,
and we now urge the UK to use all diplomatic channels to ensure
this momentum is sustained until the goals are finally agreed.
Agree. The UK is pushing
for the principle of 'Leave no one behind' and a 'data revolution'
to be included in the MDG's successor development framework. This
was a central element of the report prepared for the UN Secretary
General by the High Level Panel, co-chaired by the Prime Minister.
The next framework should ensure that no person is denied universal
human rights and basic opportunities, regardless of disability,
ethnicity, gender, geography, age, race or other status. All goals
should be underpinned by disaggregated data, to monitor progress
across different social and economic groups.
Recommendation 38 - Disaster Risk Reduction framework
We recommend that DFID press for the next framework
on disaster risk reduction to include explicit references to disabled
people, rather than simply vulnerable groups (Paragraph 106)
We are at an early stage of the process for negotiating
the next Disaster Risk Reduction framework. While an extensive
consultation process has been underway since 2012, publication
of the first draft framework by the UN is still pending completion
of that process. Once issued, the UK will continue to push for
agreement on the need to prioritise those who are most vulnerable
and will include a strong focus on people with disabilities.