DFID’s work on disability–inclusive development Contents

DFID’s Strategy—cross-cutting themes

129.DFID’s Strategy acknowledges that:

People with disabilities face intersecting and compounding forms of discrimination on the grounds of gender, sexuality, impairment type, age, race, ethnicity, religion or belief, and location which all contribute to disability-related exclusion. Women and girls, children and youth, older people, and indigenous people with disabilities all experience a range of complex, structural and institutional barriers and face multiple exclusions. Women and girls, in particular, are disproportionately affected by disability. It is estimated that 19 per cent of women across the world have a disability, compared to 12 per cent of men. Evidence across many indicators (health, sexual and reproductive health and rights, water and sanitation, and gender-based violence) demonstrates that women and girls with disabilities are marginalised and discriminated for their gender as well as for their disability.177

Tackling Stigma and Discrimination

130.In its Strategy DFID committed to:178

support the full participation and leadership of people with disabilities in all aspects of decision-making and amplify their work in leading the charge against stigma and discrimination. We will continue to provide leadership on inclusive governance processes and inclusive elections, so that people with disabilities can influence decision makers on the allocation of resources and hold them to account;
transform harmful stereotypes, attitudes and behaviours;
challenge and change unequal power relations between men and women, and negative attitudes and discriminatory practices that hold women and girls with disabilities back;
influence and support others—including national governments - to ensure there are the policies, structures and resources needed to counter discrimination, monitor change and hold decision-makers to account from the global to the local level;
lead innovation to test and scale up best practices in eradicating stigma and discrimination. For example, our flagship Disability Inclusive Development programme will lead investment into new innovations to tackle stigma and discrimination, reaching millions of people through targeted interventions.

131.The UN’s Report on Disability and Development concluded that:

The main barriers to inclusion entail discrimination and stigma on the ground of disability, lack of accessibility to physical and virtual environments, lack of access to assistive technology, essential services, rehabilitation and support for independent living that are critical for the full and equal participation of persons with disabilities as agents of change and beneficiaries of development.179

132.In a PWD youth survey conducted by Include Me TOO, 31% of respondents said that what mattered most to them is “the removal of stigma and discrimination”, only second to education.180 The importance of tackling stigma and discrimination through all DFID’s development projects is highlighted throughout the evidence we received. Evidence also stresses the importance of DFID’s continued leadership globally in this area. The committee was told though that DFID should show how it will do so in practical terms. IDS wrote:

DFID should maximise and reflect in the Strategy and Delivery Plan the opportunities the DID programme offers for learning between DFID, the DID consortium partners, national governments, persons with disabilities and organisations that represent them. There is potential for DFID to deepen the understanding of entrenched stigma and discrimination, becoming a world leader in reducing its impact across sectors and removing it as a barrier to achieving inclusive societies.181

133.TLMEW added:

While we appreciate DFID’s acknowledgement of the importance of stigma and exclusion, TLMEW would like to see how DFID intends to incorporate this cross-cutting theme into the deliverables and action points of the delivery plan.182

134.As stigma is often contextual, DFID should work closely with national governments to address it in each given context. IDD-Birmingham wrote:

The country offices should seek to work more closely with national governments and media outlets to encourage them to take effective measures to tackle deep-rooted stigma and prejudices within society.183

135.An important issue here is to address how stigma adversely affects data collection, and prevents certain groups from benefiting from disability inclusion efforts, and in particular efforts to remove stigma and discrimination. For example, TLMI-UK pointed out that:

Taking note of the existing stigma and discrimination against persons affected by leprosy and their families, the UN Human Rights Council formulated Principles and Guidelines for elimination of the discrimination against persons affected by leprosy which have been adopted by the General Assembly and the Human Rights Council. These principles and guidelines clearly emphasizes the responsibility of the national governments in eliminating discrimination against persons affected by leprosy and their families.184

136.Caroline Bradbury from the University of Birmingham highlighted in her written evidence that stigma for people with leprosy includes violence as a result of cultural misconceptions:

In regions of Africa those with albinism may be assaulted and sometimes killed for their body parts for use in witchcraft-related rites or to make ‘lucky’ charms. Women and girls are at risk and are frequently raped and defiled with the belief that sex with a woman with albinism is a cure for diseases such as AIDS.185

Addressing stigma in these situations is particularly crucial, as it has the potential of save lives.

137.DFID should work with national governments on addressing stigma and discrimination across all policy areas, legislation, and in the justice system. Country offices should work closely with national governments and media outlets to tackle deep-rooted stigma in society. Disabled people and DPOs should be involved in working with DFID programmes on changing the image of people with disabilities as victims in need of help, to one of active agents in society. DFID should also consult widely on how to address alleviating discrimination against people who do not identify as disabled out of fear of stigma, like people with leprosy-related disabilities.

Empowering girls and women with disabilities

138.DFID stated the following in its Strategy:

We will go further than our obligations under the UK’s Gender Equality Act (2014), which considers gender equality at the outset of all our development and humanitarian assistance. We will promote the leadership of women and girls with disabilities, amplify their voices, and ensure their effective and meaningful participation in all spheres of life at all levels. We will tackle the taboos and denial of their rights to information, advice and autonomy around their own sexual and reproductive health, including menstrual health, particularly those with psychosocial and intellectual disabilities.186

139.DFID’s commitment to work with women and girls with disabilities is welcomed throughout the evidence. There were however a few areas where the Strategy and DFID’s work in this area could be strengthened.

140.CBM noted that at GDS18 “commitments from national governments on women and girls with disabilities tended to be fewer and amongst the more vague commitments”.187 As part of its global leadership on GDS18 commitments, DFID should encourage national governments to make specific pledges to deliver in this area. DFID should also make sure that its own activities to empower women and girls are made clear when republishing the Strategy’s delivery plan.

141.Looking at the intersecting aspects of discrimination affecting women throughout their life cycle as children, adolescent girls and older women is also key to capturing the various areas that DFID should address to eliminate discrimination against women and girls. Plan International said:

It is essential that an intersectional life-course approach to programming and participation is undertaken. That the categories of ‘women’ and ‘girls’ should not be conflated so that the specific needs of girls, based on the intersection of their age, gender and disability (and any additional characteristics) can be identified and met through development programming.188

The ODI supports this point and added:

a truly comprehensive approach requires attention to gender and life-cycle dimensions of disability, as well as to the intersectional synergies of socioeconomic status, location (e.g. urban and rural) ethnicity, context (e.g. natural disaster, displacement or protracted crisis) and type and severity of impairment.189

142.In terms of sexual and reproductive health, Professor Shakespeare told us:

DFID’s record on sexual and reproductive health and rights is very good. In a world where, I am afraid, the United States is not positive in this regard, Europe and Britain have an important part to play. I hope that, as a result of your report but also in its internal thinking, DfID realises that, every time it talks about sexual and reproductive health and rights, disability is part of it, and disabled women and girls, boys and men, are vulnerable and excluded.190

143.AI draws attention to discrimination against older women:

Recent research shows that one in seven women aged 65+ in low and middle income countries are in the labour force. In poorer countries, older women are increasingly taking up paid work in order to support themselves and their households, adding significantly to their load and making any form of retirement impossible. Older women in low and middle-income countries are also propping up economies by making substantial contributions in unpaid care and domestic work to their families and communities. Older women provide on average 4.3 hours of unpaid care and domestic work per day. Although carrying out work in later life has many positive benefits, the accumulation of a lifetime of intersecting inequalities means that many older women carry out their work and care responsibilities living with disabilities and poor health. Evidence shows that older women’s lives may be made worse-off from their efforts to help others. DFID has been active in reducing gender inequality through the launch of their Strategic Vision for Gender Equality: Her Potential, Our Future. However there is no mention of older women.191

144.We suggest throughout this report that PWD’s and their organisations should be at the heart of DFID’s work on disability inclusion. IDD-Birmingham drew our attention to the scarcity of women working in DPOs:

A report by the World bank (2007), entitled ‘Social Analysis and Disability: A Guidance Note’,192 points out that DPOs are often dominated by men, who often fail to prioritise the concerns of women and children. I would recommend incorporating a commitment to working closely with DPOs to raise awareness of gender equality and encourage them to provide opportunities for women to move into leadership positions. I would also consider a particular focus on supporting DPOs that are led by women. The DPO network AKASA, for example, has achieved impressive results in terms of empowering rural women living in conflict-affected areas of Sri Lanka.193

145.We welcome DFID’s focus on women and girls with disabilities, and the fact that there are specific policy markers and spending codes in this area. DFID should pay more attention in their programming on accessibility of information on women’s rights and available support in cases of discrimination. DFID should ensure its adoption of a life-cycle approach is comprehensive and includes older women. DFID should also differentiate between the specific needs and forms of discrimination against adolescent girls. DFID should ensure it specifically works with DPOs led by women on this area, to inform their planning across programmes. DFID needs to ensure their activities focusing on women and girls are clear when republishing the delivery plan at the end of 2019 and use their leadership to encourage other national governments to take specific actions to eliminate intersecting discrimination against women and girls. DFID should ensure its programmes on sexual and reproductive health should pay specific attention to how these issues affect disabled people.

Assistive technology

146.DFID committed to the following in the 2018 Strategy:194

As part of the new global partnership ATscale, which 19 governments and organisations committed to join at GDS18, our ambition is that by 2030 over 500 million people will be being reached by essential AT.
We are also committed to bridging the disability divide through digital technologies through DFIDs Digital Strategy. Technological innovations and the expansion of mobile phones and internet access can link excluded people to jobs, finance and markets, and improve access to services previously out of reach. They also create opportunities for marginalised voices to be heard, contributing to greater accountability.
Our forthcoming Health Systems Strengthening Position Paper will include our approach to Leaving No One Behind as part of our support to health systems, including people with disabilities.

147.We welcome DFID’s commitment to assistive technology as a way of removing some of the barriers to inclusion for PWDs. The focus on assistive technology at GDS18 was also welcome, as evidence we received shows. There is however, disappointment at other national governments’ commitments in this area:

we were disappointed by the lack of specific commitments on assistive technology made by National Governments, multilaterals, bi-laterals, private sector and other civil society organisations. We believe that DFID has a role to play in pushing this up that agenda and should use every opportunity to advocate for greater sector engagement.195

148.DFID should use its bilateral and multilateral funding mechanisms to push for greater commitments to assistive technology. David Constantine from Motivation told us:

Four years ago, the WHO created the Global Cooperation on Assistive Technology, the GATE movement, which created a list of 50 essential devices that Governments should be providing. They can pay lip service to that but, if DFID stepped up beyond ATscale and said, “Okay, every bit of funding we give bilaterally to Governments has a commitment to it that you will start to look at the correct provision of AT and the right products within that list of 50, and the right way of providing them,” that would be a good start. You can provide them very badly or with no service or assessment of any kind, and you will do harm.196

It is important to pay particular attention to the potential harm that could be caused by using unsuitable assistive devices.

149.Assistive technology is an area that needs more spending to meet the growing demand. Bringing national governments and donors on board is therefore essential. Baroness Sugg told this committee in relation to working with the private sector: “assistive technology for example. We are really scaling up our funding for that’.197 Motivation raised the question about the sustainability of funding for assistive technology:

What happens after ATscale? Is it going to just stop? Will it have reinvestment? I know more money has gone in recently, but it is a long-term game. You either start using an assistive device early on in life or, as you said, you come to it later in life, but it is a long-term need. In 2030, we are all going to be 11 years older. Do you think our need for assistive technology will be any less? No, it will not. The WHO estimated, and I am sure you heard, that a billion people in the world need some form of AT now. By 2050, that will double to 2 billion.198

150.One way of mainstreaming the use of assistive technology effectively is to link it to each of the four pillars of the Strategy:

An example of this is the story of sisters Jashmine and Farhanaj, who were born in India with under-developed legs and hands. […] When they were young children, their parents used to carry them to school on their backs or push them on bicycles. It was a long journey on rough roads which was exhausting and took the girls’ parents away from earning an income. Although both of the girls are bright and creative, their parents started to give up on their education; it was just too difficult to get them to school every day. The girls were assessed and fitted with Motivation tricycles which changed their lives forever. Both girls were able to travel to school on their own, became more independent, and could even help with the business by going to market to pick up stock.199

151.Reiterating the need for assistive technology across DFID’s disability inclusion mainstreaming efforts, CBM UK noted that:

Whilst there has been a boost to disability mainstreaming there has not been a noticeable corresponding investment in disability specific interventions. The essential goods and services these provide, such as assistive devices, and teaching of braille or sign language, may not otherwise be provided through mainstream programmes.200

The ODI pointed out that assistive technology is also key to accessing a wider range of services:

PWDs in LMICs often face significant restrictions to their voice and agency, due to inappropriate infrastructure and transportation, unaffordable assistive devices and persistent discriminatory attitudes, which hamper their opportunities for participation and enjoyment of a full and productive life.201

VSO added:

In particular, investment in state infrastructure, specialist personnel and assistive technologies is greatly needed in many developing contexts to ensure access to mainstream and specialist public services. Greater emphasis could be made in the strategy about investment in professional capacity within public services to produce the human resources needed to ensure people with disabilities receive much needed services.202

152.Dr. Jaime Lindsey from the University of Essex pointed out the lack of emphasis on accessible information in the Strategy, as a form of basic assistive tool:

Accessible information should be central to the Strategy so that disabled people are less reliant on gatekeepers and, instead, can make decisions based on information they themselves understand. In turn, this can facilitate disabled people to access the various domains of health, housing, employment and other opportunities.203

153.We welcome DFID’s recognition of the need to identify clearly the risks to delivery of its strategic aims of failure to secure sufficient levels of assistive technology. DFID should use its leadership role to encourage bigger commitments from national governments, international organisations, and the private sector to the provision of assistive technology.

154.DFID should work closely with national governments on training and building capacity to provide specialist public services for people with disabilities, including accessible buildings and information, and trained staff. DFID should also ensure accessibility of information is considered across all its programmes to enable greater access to the services provided by DFID projects.

155.DFID should also have measures in place ensure that the ‘Do No Harm’ principle is not breached by (a) the lack of suitable assistive devices provided via its projects; and (b) the provision of unsuitable devices.

Mental health and psychosocial disabilities

156.In the Strategy DFID stated the following:204

Mental health is a fundamental part of being human, covering a full spectrum from everyday well-being through to mental health conditions and long-term psychosocial disabilities. Yet globally, mental health conditions. are on the rise and one of the leading causes of disability. Experiences of being separated from communities or hidden away, entrenched discrimination, negative attitudes and human rights violations—in some cases being tortured and abused—remain an all too common reality. Despite the profound need, progress has been painfully slow and woefully neglected by the international community. The majority of people with mental health conditions and psychosocial disabilities will not access essential services and support in their lifetime, and for the slim minority that do, the quality of services is all too often poor and, at times, violates their basic rights and dignity.
We commit to develop a more comprehensive approach and a theory of change to step up on mental health for all.
We will also step up as a global leader to provide inclusive and accessible mental health and psychosocial support (MHPSS) in conflict and emergencies.

157.A major area of concern for cross-cutting issues of the Strategy as stated earlier in this report is the inability to track spending on them, which in turn affects ability to evaluate progress in delivering results. Julian Eaton told us that:

There is no question that the only way to do mental health well is to recognise its cross-cutting nature. […] At the same time, that does not mean you cannot measure it or you should not have a clear focus and agenda that is evidenced-based and has a clear budget allocation, for example.205

DFID told us that:

On mental health in particular, we are looking at publishing a position paper by the end of the year on how we better integrate mental health within all our projects, but at the moment we do not think it would be a good idea to allocate a specific marker for that.206

158.An additional problem in planning and making informed decisions on mental health and psychosocial support, is the paucity of data. We highlighted the inadequacy of the WGQs earlier in this report. This is particularly pertinent to mental health and psychosocial disabilities. Julian Eaton told us that:

The Washington Group is only trying to do one thing. First of all, even if it was perfect on mental health, it would not be able to achieve a lot of the other things we are trying to measure. The main thing about it is that it has a desire to do something very, very briefly and very quickly. It attempts to pick up the functional impacts of physical and sensory impairments, which cannot be done so easily for the much more diffuse social impacts of certain mental health problems.207

159.It is important to provide support to people with mental health and psychosocial disabilities to access the justice system and their legal rights. TLMI-UK wrote that:

There are mental health legislations that need an immediate review to ensure that they conform to human rights standards. DFID may please focus on supporting the Ministries of Health in countries to review such mental health legislations to seek compatibility with the CRPD.208

160.Recent data from the WHO suggests that:

One in five people in war zones have mental health conditions […]. 22% of people living in conflict areas have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. Women are more likely to be affected than men and the burden rises with age. In about 9% of the population, the mental disorder is moderate to severe. In 13%, it is mild.209

We received good feedback on DFID’s record in paying attention to mental health and psychosocial support in emergency and conflict responses. Julian Eaton said:

to DFID’s credit, it is leading on this […]. It has been a bit easier to track spend on this area than on some other cross-cutting issues in DFID. […]. The area of mental health and psychosocial support in emergency settings has a longer track record than mental health in long-term development. […] We have some really good learning on that.210

161.An area which needs attention in humanitarian and emergency response is climate change related events. Evidence from the Glasgow Caledonian University Centre for Climate Justice makes the link between environmental stressors and mental health:

In recent years, research on acute and chronic and indirect impacts on mental health stemming from environmental stressors has broadened to consider the influence of climate change. [For example] acute climate-related events in the form of extreme and sudden weather events can cause severe psychological trauma as a result of injury, death/injury of loved ones, loss of property and shock.211

In May 2018, we published our report into ‘UK aid for combatting climate change’. Across the evidence we received for that inquiry, there was a broad agreement that “it will be the least developed countries and the most vulnerable people who will be hit the first and the hardest”212 by the impacts of climate change.

162.Intellectual disability in the Strategy and most of the evidence is grouped with mental health and psychosocial issues, which are broader and different issues, and as a consequence subsumes the needs of, and therefore services for people with intellectual disabilities.213 DFID should scale up efforts to include data measurement for this group, and identify the differences between these three categories of disability.

163.As with other areas of DFID’s Strategy, there is a particular role for DPOs to play here. BOND’s Mental Health and Psychosocial Disabilities Group suggested that DFID should:

Deepen its commitment to strengthening civil society and Disabled People’s Organisations (DPOs) to ensure that people with a psychosocial disability or mental health condition are represented and not excluded from access to the opportunities available to others. This is needed to address the significant power imbalance that exists both for people with disabilities and for people with a psychosocial disability within the disability sector, particularly women.214

164.The committee welcomes DFID’s commitment to publishing a position paper on mental health across DFID’s programmes by the end of 2019. The mental health position paper should explain how DFID intends to fill data gaps in this area. DFID should also develop a specific policy marker and spending codes for work on including people with mental health and psychosocial disabilities. DFID should work closely with national governments to give high priority to mental health, and on protecting the rights of people with mental health and psychosocial disabilities in areas like employment, health, and the legal system. DPOs have an important role to play in this area. DFID must ensure that support is available to families of people with Mental health and psychosocial disabilities. DFID should also recognise the specific needs of people with intellectual disabilities, and target them accordingly in their programming. In their work on climate change, DFID should include considerations on the link between environmental stressors and mental health.