46.DFID is adopting a twin-track approach to achieving disability-inclusive development. This involves funding projects that are disability-specific, as well as mainstreaming disability across DFID’s programmes. This is a similar approach to other cross-cutting thematic policy areas we have scrutinised, most recently DFID’s work on climate change. This is a comprehensive approach that could achieve the aims of DFID’s Strategy if implemented in an integrated and systematic way. Programmes, business units, and teams across DFID need to be clear about what mainstreaming involves, and how it could be effectively implemented. Sightsavers suggested that:
DFID should provide clear guidance for staff on how they are expected to ‘consistently and systematically’ address the three cross-cutting areas in all of their work and on how to mainstream disability more broadly.
One way of providing clarity, as the Institute for Development Studies (IDS) recommended, would be:
to highlight how activities under different pillars and cross-cutting themes are connecting and aggregating to meet the overarching outcomes. This will ensure that the Strategy better reflects the complex and interrelated challenges people with disabilities face and that it is underpinned by an integrated rather than siloed approach.
47.ADD International wrote that:
It will be crucial to build synergy between different DFID departments directly responsible for the delivery of the Strategy, such as the Inclusive Societies Team, and other business units whose work should contribute to achieving the minimum standards by July 2019.
This will reduce the potential for efforts in one programme to inadvertently hamper progress in other programmes. It is likely also to encourage a more effective use of resources. Similarly, the Strategy and its delivery plan could provide more clarity internally to DFID staff and externally to implementers and other actors, by being more specific about outcomes, deliverables and resources for mainstreaming.
48.We received several pieces of evidence expressing concern about the vagueness of the Strategy and the delivery plan, which adds to the problem of a lack of clarity about what is expected of staff to implement mainstreaming. Humanity and Inclusion (HI) stated that:
Disability Strategy’s Delivery Plan does provide a framework for actions, with lead departments, and as such is a vital and welcome tool for outlining DFID’s work on inclusion. But in many cases actions are too vague and lack specific outcomes. For example, in Deliverable 2 of the Economic Empowerment strategic pillar DFID say they would “support people to develop skills for decent work”. The plan doesn’t specify what skills they would support people to develop. Are they job-finding or vocational skills? There is also no mention of how DFID will benchmark this. Given that DFID country offices have struggled to prioritise specific outcomes having specific outcomes would help country offices shape their programmes so that they can measure and identify where impact is being made.
This poses a risk that implementation will be inconsistent and difficult to measure across DFID programmes. Both HI and Sightsavers, among others, suggested that DFID republishes the delivery plan “with clear outcomes from the actions and allocate sufficient resources for their implementation”, also “including specific actions from individual country offices”.
49.DFID committed to republish the Strategy’s delivery plan by the end of 2019 to take these concerns into account. The Minister, Baroness Sugg, told us:
The original Strategy, the first ever one, was ambitious and comprehensive. It has that high ambition that has led to a lot of positive work being done. But we have also heard that feedback from DPOs and NGOs during this inquiry; so we are planning on publishing a revised version of the delivery plan itself by the end of the year.
We look forward to receiving more detail about the planned changes to the delivery plan for DFID’s Disability Inclusion Strategy—in advance of these being finalised—as part of the Government’s reply to this Report.
50.To mainstream disability, DFID requires its business units to consider disability inclusion in all business cases. This is a positive step. However, Sightsavers noted that:
this initial commitment does not always continue to the logframe or annual review, which highlights that DFID need to ensure that increased ambition on paper is realised in practice.
51.In addition to business case development, DFID has developed a set of both “minimum” and “high achievement” standards (see table below), with a requirement that all “business units”—which include country offices—meet the minimum standards by the end of 2019, and at least four country programmes meet the high achievement standards by the same deadline. Baroness Sugg told us that:
there is real enthusiasm and drive in the Department and country offices. We have disability champions now in every business unit, who are responsible for making sure that this is not just a box-ticking exercise. You mention the minimum standards and the aim is for every country office to reach them by the end of the year. We are on track for that. It may not be that we get a full 100% on that, but we are, through the delivery board and through the disability champions, making sure that we are progressing towards that for the end of the year and learning from where we are.
Gerard Howe, DFID’s Head of Inclusive Societies, added that:
Also within our delivery plan, we have committed that four DFID country offices will meet the higher end of those minimum standards. I wrote to eight country offices around six weeks ago now inviting them to take part in these higher standards.
52.It is also important that DFID’s commitments to disability inclusion are an integral part of country programmes. Mosharraf Hussein from ADD International told us:
I firmly believe that, if these commitments are translated at the country level, it will engage more disabled people in each country. First, DFID needs to make sure the four pillars and the deliverables are included in the country-level strategies because, if the documents of the country programmes are not disability inclusive, this issue will be forgotten. That is the starting point. […] Secondly, resources are very important.
53.In reply to this Report, we expect DFID to provide us with an interim report on progress by all its business units and country offices towards the target of meeting the minimum standards on disability inclusion by the end of this year, 2019. In addition, we request an equivalent update on the eight country offices invited to work towards the high achievement standards.
54.Several organisations working on disability inclusion expressed concern that the Strategy is not backed up by appropriate financial and human resources. Motivation explained:
Disability has been an overlooked area for years and there is therefore a lot of work that needs to be done to ensure programmes are being delivered to standards set out in the strategy. Funding needs to be allocated to focused disability programmes, rather than just pushing to have it mainstreamed across other programmes.
55.Chemonics International pointed out that “Without this financial support, policies can remain as rhetoric and fail to translate into tangible improvements”. Chemonics also wrote that:
The current strategy, unfortunately, does not include details related to improving internal capacity on disability-inclusive development. Future or support documents should consider incorporating improved measurement to promote accountability, as well as articulate how DFID will ensure that there is enough internal capacity to deliver on its goals.
56.IDS pointed out that:
what is lacking in the Strategy and deliverables is an articulation of an overall target in terms of increasing disability-focused programming and spending over the next five years and in comparison to programming and spending now.
57.ADD international suggested that there needs to be bigger investment internally to enable staff to implement the Strategy effectively:
Strengthening the capacity of DFID teams at all levels to develop disability-inclusive approaches will be essential in delivering the Strategy. This will only be possible if significant spending is allocated to achieve this.
58.ICAI said that there are gaps in implementing the Strategy because “there are issues about staffing people with expertise, and resourcing in general”. And that there is “uncertainty about how to implement, particularly in country offices”. They added:
One of the lessons we have learned from other Departments around the world trying to implement work on disability is that it is difficult, and expertise is required.
59.DFID should also increase the number of people with disabilities among its staff and in country offices. The Disability Rights Advocacy Fund (DRAF) explained that:
The more persons with disabilities work and volunteer within donor agencies, the greater the likelihood that the donor will be successful in achieving disability inclusion. Donors that create disability-friendly environments encourage the inclusion of more persons with disabilities as staff and program participants. Raising awareness amongst staff on the social model of disability, adapting communication and information systems and making offices, workshops and conferences accessible all help to create an inclusive atmosphere.
CBM UK backs this suggestion, through direct experience at GDS18:
DFID needs stronger in-house expertise. We noted that a number of basic accessibility checks had not been made in relation to the Disability Summit, for instance provision of hoists in toilets and screen reader friendly documentation online. Strengthened capacity would need to be in the form of permanent rather than temporary or seconded staff, to engender consistency, with a sufficient level of expertise and seniority.
60.We note the new Secretary of State, Rt Hon. Rory Stewart MP, had a strong focus on boosting DFID’s expertise in focused areas. He told us:
My instinct is always that we have to specialise, that the world is too big, and the problems too large, for us to pretend we can do everything equally well. The problem DFID has is that every Secretary of State who comes in suddenly has a new priority. To take an example, traditionally we did not do work on disabilities. A new Secretary of State will come in, and suddenly we have to stand up a new centrally managed programme on disabilities […].
If we genuinely do not have expertise in an area, we have to think very, very seriously before we go into that area.
61.Our evidence indicated that consideration should be given to extending resources to external partners. HI suggested that DFID:
Ensure that implementing partners receive adequate support to implement change in their programming. For example, the provision of capacity building on including collection analysis and use of reliable data on disability for programming as well as reporting.
DFID should also be clear with implementers on what is expected of them. Chemonics provided an example on how USAID was able to do this:
For example, in 2018 USAID released its Education Policy that provided overall goals and commitment to education. This document was supplemented by both the Education Policy Program Cycle Implementation and Operational Guidance as well as a How-To Note for implementers on how to effectively include persons with disabilities in USAID supported education programs. Together these documents articulate goals and provide implementers with clear targets and programmatic and technical guidance. Similar guides and technical notes that support the different strategic pillars, as well as guidance on how to operationalise the inclusion of the cross-cutting themes would be helpful and may aid DFID in realising the goals set forth in the strategy.
62.The dominant view in the evidence we received is that there are research and data gaps on disability inclusion that need to be addressed soon, to enable effective programming and implementation. One prevalent view is that the Washington Group Questions (WGQs)—a tool to gather data on prevalence of disabilities to aid planning and programming—though useful, it is not sufficient on its own. Professor Tom Shakespeare told us:
We are worried by the dominant focus on the Washington Group’s six questions. The International Disability Alliance, DFID and many other multilaterals and bilaterals seem to be saying that this solves the problem. Our thinking is that the questions are not comprehensive. You will hear later about mental health, but they are particularly poor on mental health. There are ambiguities, for example the question on understanding: is that you understanding things or you being understood? Those are very different things and, in many languages, those are quite confused concepts. Cognition and empathy blur. The thresholds for disability are wrong. Either you have “some difficulty”, which is too low a threshold for disability and suddenly 25% of the population is disabled, with the effect that the differences between disabled and non-disabled people begin to disappear because there are too many people in the disability group; or you have to have “a lot of difficulty”, which is too high a threshold and you have a prevalence of about 3%.
Dr. Ola Abu Alghaib added that:
We assume that, if Governments, development or humanitarian actors use the Washington Group questions, we are ticking the box of inclusion. That is a misunderstanding that leads to a lot of ignorance about how to understand other sources of data, which are equally important. For example, Governments’ administrative data is important in humanitarian and development actions.
The ODI suggested that, to get a more comprehensive set of data, there is a:
need to combine official statistics with unofficial data and link data sources and recommended promoting household-survey based measurement and the reestablishment of a disability-related repository; combining evidence from civil society organisations to public transport records; and pursuing creative ways to capitalise on existing data.
63.IDS highlighted a potentially overly narrow focus on quantitative data and that “the Strategy could have gone further, committing to ensuring evidence is produced with persons with disabilities, not just on them”, a view shared widely across the evidence.
64.To be able to use data collection tools like the WGQs, BOND Disability and Development Group (BOND DDG) highlighted that:
Organisations using the questions require training at all levels for them to be effective. DFID staff and partners need to understand why they should use them, and how to connect data with decision-making processes based on evidence and available guidance. We recommend that DFID builds the capacity of actors to collect, analyse and use data on disability and allocate specific resources to support DFID staff and delivery partners to use Washington Group Questions.
This view is also supported by The Leprosy Mission England and Wales (TLMEW), who told us that one way of addressing the problem would be to require:
that programmes that require collection of such data are accompanied by a commitment to the capacity building of local partners and disabled people’s organisations.
VSO suggested that:
If efforts are going to be made to gather universally coherent disaggregated data, then there needs to be further investment in very practical guidelines and definitions based on real-world examples.
65.An important gap in data collection is groups that are “left behind” in the current data collection methods (by being “left out”). For example, BOND DDG mentioned:
children and adults with disabilities living on the streets, in orphanages and other institutions and transient populations, as well as those with impairments which may not be well captured by existing tools. We recommend that in addition to collecting disaggregated data, DFID looks to collect a range of qualitative and quantitative data on disability.
The Bond group also pointed to the unintended consequences of misunderstood safeguarding provisions in the agreements framing some research projects. BOND DDG said:
sometimes clauses on protecting vulnerable populations in research can lead to researchers not including people with disabilities, particularly people with intellectual, communication or psychosocial disabilities, in their research. DFID should ensure that efforts to protect people do not lead to discrimination. Ensuring research partners build their understanding on disability and engage with disabled people’s organisations will be key to this.
Other groups at risk of being left out of data collection processes are: “those with less commonly recognised disabilities such as dyslexia, and those on the lower autism spectrum”, and those with intellectual disabilities.
66.In terms of collecting data on disability inclusion in their own programmes, DFID is using the OECD DAC disability inclusion and empowerment policy marker. However, reporting is varied as HI suggested:
not all the partners report disability disaggregated data to DFID and when they do, the quality of the data is questionable. One of the main reasons for this, partners we work with tell us, is the time needed to adapt their data collection tools as well as guidance and technical support they need from DFID.
67.The importance of involving people with disabilities and their organisations at all aspects of implementing and planning DFID’s Strategy was highlighted starkly throughout our evidence. DFID should continue to reach out to a diverse and expanding population of DPOs to ensure that the department captures a broad range of perspectives as well as not overburdening the relatively small number of DIFD’s ‘usual suspects’ in the UK and other countries. The British Council stated that DFID should “ensure disabled people are actively involved in identifying and addressing barriers” to their inclusion.
68.Palladium suggested that for DFID to achieve an organisational culture change it is important to do two things:
First, to shape organisational culture, it will be important to raise awareness of unconscious bias and of appropriate measures to mitigate the effects of such bias. Secondly, while increasing the number of persons with disabilities as staff within DFID is important, it is vital to also ensure individuals with a disability are distributed across different functions and not stuck in stereotypical silos. This focus on distribution as well as representation will enable greater cultural change.
69.DFID’s Strategy stated that the department is:
introducing a new DFID-wide Disability Inclusion Delivery Board to hold senior responsibility for the implementation of this strategy within DFID. This Board will include senior officials from all relevant DFID Departments with lead responsibility for actions included in the accompanying delivery plan.
There is a concern among organisations working on disability inclusion that the Delivery Board does not include people with the appropriate technical expertise to oversee the delivery plan, and continue to improve it based on early learning. The issues we have highlighted in this Report around the lack of specific and measurable deliverables in the delivery plan, inevitably indicate that the ability of DFID to monitor progress accurately will be compromised.
70.Tracing expenditure on mainstreamed and cross-cutting issues poses a challenge. In response to our request for expenditure data on mental health, the then Minister, Lord Bates, wrote:
There are no specific codes for psychosocial disabilities/mental health, or stigma and discrimination. We are therefore not able to provide estimates for these themes at this time.
In response to this information, Julian Eaton from CBM and LSHTM said:
It is not tenable not to track something. If you value it, you need to track it. We know the amount of attention and focus on a topic tends to follow the degree to which people are judged around their success on it.
The inability to track spending in some areas of DFID’s work on disability poses questions over DFID’s ability to evaluate progress on it. This also has implications for DFID’s ability to make informed decision on future funding allocations.
71.We also heard that the accountability mechanisms set up internally by DFID were somewhat confusing to outside organisation. IDS suggested that:
It would also be useful to have more detail on how the accountability mechanism of the DFID-wide Disability Inclusion Delivery Board will interact with the Key Stakeholder Group and Partnership Forum, and whether the Group and Forum have a role in reviewing and setting new targets and standards based on their understanding of the needs of people with disabilities.
72.Overall, regular reporting on progress in this early period of delivering the Strategy is likely to prove crucial for shaping and steering a successful launch and sustainable trajectory for delivery. Naomi Collet, a Middle East economics’ analyst told us that “Transparency on expenditure should also be improved, with the sums dedicated to disability-specific programmes being made publicly available”. Motivation suggested that “DFID should publish a report one year on, to ensure that it continues to push forward and build on momentum gained through the Global Disability Summit and the publishing of the new disability strategy”. In their written evidence DFID committed to publish a year-on report on GDS18, but there is no mention of a similar report on the Strategy.
73.To effectively mainstream disability, DFID suppliers need to be compelled to consider disability inclusion in all their activities. Suppliers which are led by non-disabled people should also partner with DPOs or with individuals with disabilities to ensure their activities are inclusive. Chemonics International suggested that:
Stronger action needs to be taken within existing solicitations for funding to mandate the inclusion of persons with disabilities for the twin-track approach to be realized. For example, solicitations for general development and humanitarian programmes could provide weighted evaluation criteria related to disability inclusion, include specific targets or milestones on disability as well as require consultations with local disabled persons organizations (DPOs). Without these efforts, disability inclusion risks being continually marginalized within the development community. Expanding portfolio-wide funding and contracting requirements to ensure that all programs are inclusive would serve as a model of good practice for other bilateral and multilateral donors to follow.
Other evidence supports this idea, and further suggests making “disability equality a legal requirement in development projects, as has been done for gender equality in 2014 through the International Development (Gender Equality) Act”.
74.Palladium made the practical suggestion that:
Encouraging diversity in the supply chain by engagement of companies owned or led by people with disabilities and by encouraging programme implementers to do the same will increase economic empowerment and bring diversity of thought to DFID programming. Placing requirements on implementers to deliver on disability related targets, including promoting disability inclusion in their workforce and supply chains, has the potential to have a positive impact on disability inclusion both in the UK and overseas.
75.We received evidence that DFID should fully to align its disability inclusion efforts with the UK’s implementation of the SDGs. Dr. Abu Alghaib told us that:
We are still missing the opportunity to monitor the Convention on the Rights of Persons with Disabilities. We are almost 10 years away from 2030. The sustainable development goals were very successful in indicating disability allocations, but many countries are failing. We are still failing to provide countries with an understanding of how to monitor these two interlinked frameworks. When I talk about development and disability, what do I need to do beyond the Washington Group questions to ensure I am targeting people with disabilities in social protection, WASH programmes, and education and employment, across all sectors? That is key.
76.CBM also highlights the missed opportunity of aligning DFID’s Strategy with international frameworks:
Coherence with international frameworks is also unclear in the Strategy, in particular how it complies with the UNCRPD and achieves SDG targets, which we believe is a missed opportunity for strong monitoring and accountability.
77.The ODI draws attention to the fact that “disability is ‘among the most glaring data gaps in SDG monitoring’ with negative effects on designing and implementing effective programmes”.
78.The committee notes three main areas that should have received specific commitments in DFID’s Strategy: health, ageing, and inclusion of people with intellectual disabilities.
79.Professor Shakespeare told us that “it almost felt as if health had been diminished in importance” in DFID’s Strategy. Juliet Milgate from Sightsavers noted that:
DFID talks about it [universal health coverage] in the context of the Strategy, but unfortunately does not have any concrete actions attached to it. The purpose or goal of universal health coverage is to ensure that everyone has access to the health services they need and that in accessing these health services they are not pushed into further poverty.
80.In terms of mainstreaming disability, she highlights for example that the Strategy and delivery plan “do not compel health advisers at DFID to take account of the needs of people with disabilities”. The ODI also stressed that:
Appropriate and quality health care is critical as PWDs tend to have greater unmet health care needs and poorer levels of health than the general population, largely because they face greater difficulty—attitudinal, physical and systemic barriers—in accessing even primary health care.
81.TLMEW highlighted in their written evidence that:
DFID’s new Disability Inclusion Strategy seems to ignore the causal link between Neglected Tropical Diseases (NTDs) and disability and does not give sufficient priority to funding programmes which support case-management of those NTDs which are not susceptible to mass drug administration (MDA) and which can cause life-long complications and disabilities.
Juliette Millgate told us that:
we see neglected tropical diseases as a litmus test for universal health coverage and promoting equity. Neglected tropical diseases, as you know, are diseases of poverty that affect more than 1.5 billion people globally. They affect people living in impoverished conditions with poor access to water and sanitation, and can lead to chronic impairments, which are long term and often irreversible. They also link to stigma and social exclusion.
82.The link between ageing and disability should be made clearer in DFID’s work on disability inclusion. Age International (AI) highlighted that
‘More than 250 million older people globally experience moderate to severe disability’. The prevalence of impairments that can lead to disability increases with age, however it is not inevitable. Access to healthcare, support services and an enabling environment are important contributing factors.
Additionally, AI wrote that:
Disability can compound the difficulties faced by older people in developing countries in relation to maintaining an income through work. If an older person has care needs other family members may be forced to give up their own employment to provide informal care. For example, in 2010 the estimated worldwide cost of dementia was $604 billion, and in developing countries most of the care provided was by family members.
Older people who develop age-related disabilities need to be taken into consideration in the provision of help to gain access to assistive technology, employment, social protection, and healthcare among other areas of development interventions.
83.Adopting a twin track approach of funding disability-specific projects and mainstreaming disability across DFID’s work is the right approach to take. However, DFID should ensure that it scales up its spending on disability-specific projects over time, as well as provide support for effective and imaginative mainstreaming with specific funding. DFID should also ensure that disability is a key consideration in broader strategic and budgetary decisions, such as the long-awaited Comprehensive Spending Review, as well as internal allocations to DFID’s programmes. It could be helpful to set an overall target for increasing disability-focused programming and spending over the next five years. DFID should also ensure that the initial commitment to disability inclusion in business cases is followed on in projects’ log frames and other planning and reporting documents.
84.Mainstreaming disability requires a systematic sharing of information and coordination at all stages between country programmes, business units, country offices, and suppliers. DFID should ensure specialist experts are appointed to different areas of the Strategy, and that staff across DFID receive specific technical training on using relevant tools like the extended set of the Washington Group Questions. DFID should also increase the numbers of people with disabilities amongst its cadres at all levels, and make sure disabled people are consulted more widely on disability inclusion planning and delivery. DFID should also consider building disability inclusion into the competencies of its advisers, along the same lines of gender mainstreaming. Country offices should develop their own contextual theories of change and action plans that guide their delivery of disability-inclusive development depending on each country’s situation, and enable direct assessment and adaptation. To lead by example, DFID should make all its offices - in the UK and its operating countries - physically accessible to people with disabilities.
85.DFID committed to republish its delivery plan to make it more specific and measurable by the end of 2019. As we recommend above, we request a consultative update on progress with this revision in the Government’s reply to this Report. The re-published delivery plan should include a clear allocation of resources attached to deliverables, and a clear evaluation mechanism with a clear timeline. DFID should also update its Strategy to include neglected issues like the link between universal health coverage and the needs of disabled people, and the linkages between ageing populations and disabilities related to old age. We also urge DFID to publish its global health position paper as soon as possible, and address these issues within it.
50 Bond Disability and Development Group (), p. 3
51 Institute of Development Studies (), p. 1
52 ADD International (), p. 3
54 Humanity & Inclusion (), p. 2
55 Including: CBM UK ()
56 Humanity & Inclusion (), p. 2
57 Sightsavers (), p. 3
59 Sightsavers (), p. 4
63 Committee staff-led roundtables with international organisations, 15th and 18th February 2019
64 Motivation Charitable Trust (), p. 3
65 Chemonics International (), p. 3
66 Ibid., p. 2
67 Institute of Development Studies (), p. 3
68 ADD International (), p. 4
72 Disability Rights Advocacy Fund, Inc. (), p. 2, (quote in evidence from Wapling, Lorraine and Bruce Downie, p. 33)
73 CBM UK (), p.3
75 Humanity & Inclusion (), p. 1
76 Chemonics International (), p. 2
80 Overseas Development Institute (), p. 5
81 Institute of Development Studies (), p. 4
82 Bond Disability and Development Group (), p. 5
83 The Leprosy Mission England and Wales (), p. 4
84 VSO (), p. 2
85 Bond Disability and Development Group (), p. 6
88 VSO (), p. 2
89 The Organisation for Economic Cooperation (OECD)’s Development Assistant Committee (DAC) develops a set of policy markers that describe Official Development Assistance (ODA) measures in relation to their realisation of OECD development policy objectives.
90 Humanity & Inclusion (), p. 3
91 British Council (), p. 8
92 Palladium (), p. 2
93 DFID’s , p. 26
94 Committee staff-led roundtables with international organisations, 15th and 18th February 2019
95 Department for International Development Annex A (), p. 2
97 Committee staff-led roundtables with international organisations, 15th and 18th February 2019
98 Institute of Development Studies (), p. 3
99 Naomi Collett (), p. 3
100 Motivation Charitable Trust (), p. 5
101 Department for International Development (), p. 1
102 Chemonics International (), p. 4
103 Naomi Collett (), p. 2
104 Palladium (), p. 2
106 CBM UK (), p. 2
107 Overseas Development Institute (), p. 5
111 Overseas Development Institute (), p. 2.
112 The Leprosy Mission England and Wales (), p. 1
114 The , 2011
115 Age International (), p. 2
116 Ibid., p. 3
Published: 30 July 2019