The WHO estimates that around 15 per cent of the world’s population, or more than 1 billion people, have a disability. Disability-inclusive social protection can play a key role in empowering persons with disabilities by providing a minimum income as well as financial support to address the additional costs they face as a result of their disability.
Moreover, access to social protection for all persons is recognised as a basic human right across a range of human rights conventions, and Article 28 of the Convention on the Rights of People with Disabilities also recognises the ‘right of persons with disabilities to social protection’.
However, the vast majority of persons with disabilities in low- and middle-income countries do not have access to social protection and there has so far been limited research into how to improve the situation.
With a new report, we hope to make a contribution to the understanding of the barriers to accessing social protection facing people with disabilities and how to overcome them.
Lack of information
One of the barriers is lack of data on persons with disabilities accessing social protection. For example, absence of disaggregated data means that it is not possible to evaluate the extent of access to mainstream schemes.
Most social protection schemes and systems do not have monitoring mechanisms which can capture the challenges experienced by people with disabilities in accessing support. Very few social protection management information systems include indicators on disability.
While social protection programmes in general have been extensively evaluated, there have been few evaluations of disability-specific schemes and minimal attention has been given to disability in the evaluation of mainstream programmes.
An easy way to start remedying this would be to ensure that all evaluations and household surveys incorporate the Washington Group Short Set of Questions in order to enable the identification of people with disabilities and produce disaggregated data.
Lack of investment in relevant programmes
In order to improve access to social protection for people with disabilities, there is a need to make mainstream programmes more inclusive and increase investment in disability-specific programmes.
Our research shows that, in order to fulfil the right to social protection for people with disabilities, it is essential that governments invest in disability-specific programmes. Unfortunately, investment in disability-specific programmes in low- and middle-income countries is generally very low: as figure 1 shows, only a handful of countries invest more than 0.3 per cent of GDP, and most spend a lot less.
A range of different schemes are necessary in order to provide adequate support for people with disabilities. Figure 2 below shows relevant schemes across the life cycle, based on what is provided by most high-income countries.
Common schemes in high-income countries include child disability benefits and disability school stipends for children. For working age people, income replacement benefits are available for those with reduced capacity to work, while personal independence payments compensate for the cost of disability regardless of labour market status. In addition, some social protection programmes are provided to groups who have a high likelihood of experiencing disability, such as old age and veteran’s pensions. We propose categorising these programmes as ‘disability-relevant’, since a large proportion of their beneficiaries have disabilities.
In fact, in low- and middle-income countries old age pensions are probably the social protection programmes with the largest coverage among people with disabilities. There are 67 tax-financed old age pensions across low- and middle-income countries, of which 35 offer universal coverage either through a universal or pension-tested social pension.
A significant number of low- and middle-income countries also offer disability benefits for persons of working age: 32 countries have a disability benefit in place, although coverage varies widely.
On the contrary, only a few low- and middle-income countries provide specific or personal independence benefits to compensate people with disabilities for the additional cost they face as a result of their disability. Often disability is conflated with lack of ability to work and a disability benefit is, therefore, provided based on the assumption that persons with disabilities are unable to work. This ignores the fact that most people with disabilities can and want to work but need support to overcome the various barriers to participating in the labour market.
The vast majority of low- and middle-income countries, therefore, need to establish or significantly expand disability-specific social protection schemes and old age pensions, in order to progressively reach all people with disabilities who require support.
Barriers to disability-inclusive schemes related to the wider environment
Social protection systems and schemes are more likely to be disability-inclusive if there is a broader national disability-sensitive environment.
In many low- and middle-income countries, limited understanding of disability, discrimination and weak institutions contribute to limiting access to social protection for people with disabilities.
Those interested in improving access to social protection, therefore, also need to address issues within the broader environment.
In many low- and middle-income countries, disability issues are handled by poorly resourced institutions within relatively weak social affairs ministries or agencies. These institutions are often tasked with policy, coordination as well as delivery of services to people with disabilities, but are often not provided with the necessary resources.
A more effective strategy is to have a high-level institution with responsibility for mainstreaming disability inclusion across sectors. This institution should not be tasked with service delivery, but with ensuring the inclusion of people with disabilities across all service delivery ministries and enforcing national policies for the inclusion of persons with disabilities.
Our research also found that the level of awareness of disability rights among policy makers and their advisors is often low, with disability often approached from a medical or charity perspective. There is, therefore, a need to further advance and improve awareness of disability rights across all sectors.
Disabled Persons Organisations (DPOs) have an important role to play in awareness raising and in building the demand for disability-inclusive social protection. Unfortunately, some DPOs are hesitant to advocate for social protection as it is seen by some as perpetuating an image of people with disabilities as passive recipients of support.
Barriers related to programme design and implementation
Finally, designers of social protection schemes need to be aware of some of the potential barriers that can arise from programme design and implementation.
For disability-specific schemes, the disability assessment mechanism is critical. Unfortunately, most low- and middle-income countries still use highly problematic medical assessments that do not assess how the person functions in his or her environment and are likely to exclude many eligible people, in particular persons with invisible disabilities. In addition, people often have to travel long distances to access the assessment, and assessors are not always properly trained.
There is no single best practice when it comes to disability assessment mechanisms, and few examples of good practices from low- and middle-income countries. Compromises are inevitable in contexts with limited access to the necessary professionals to carry out assessments, but the chances of a good solution being developed is higher if governments invest sufficiently in implementing a good quality mechanism that works in the specific context.
For mainstream schemes, the use of conditionalities in Conditional Cash Transfer (CCTs) and work requirements in public works programmes can create barriers for people with disabilities. In the case of CCTs that require compliances in terms of attending school, children with disabilities are more at risk of exclusion, since they are less likely to be able to attend school. In response to this, some CCT programmes exempt children with disabilities from the conditionalities.
In general, there is a need for more attention to ensuring the inclusion of people with disabilities in these types of mainstream programmes.
The vast majority of people with disabilities in low- and middle-income countries do not have access to the social protection support they need. There is an urgent need for governments to increase investment in disability-inclusive schemes – both disability-specific schemes and old age pensions, since mainstream schemes are unlikely to provide sufficient coverage or high enough transfers. At the same time, more attention is needed to ensure that people with disabilities have equal access to mainstream social protection schemes.
More generally, improving access to social protection for people with disabilities also requires improving availability of disaggregated data, and making institutions more inclusive across sectors.