DRAFT Mainstreaming People with Disabilities in UPPR:
Context and Strategies
Table of Contents
Mainstreaming People with Disabilities in UPPR:.................................................................................... 1
Context and Strategies.............................................................................................................................. 1
Table of Contents........................................................................................................................... 1
1. Introduction................................................................................................................................... 2
2. Principles and Actions for
Mainstreaming People with Disabilities in Development Work.......... 3
2.1. Introduction to
Disability...................................................................................................... 3
Impairment and Disability............................................................................................................. 3
Talking about people with disabilities............................................................................................ 3
Attitudes towards people with disabilities in Bangladesh............................................................ 3
2.2. Disability as a
development issue.......................................................................................... 4
Prevalence and vulnerability.......................................................................................................... 4
People with disabilities in development........................................................................................ 4
Direct and indirect exclusions from development work................................................................ 5
Mainstreaming disability as an opportunity to improve development........................................... 5
2.3. Principles of
Mainstreaming.................................................................................................. 5
Twin-Track Approach..................................................................................................................... 6
Participation of people with disabilities......................................................................................... 6
2.4. Actions for Mainstreaming.................................................................................................... 6
Measuring Prevalence.................................................................................................................... 6
Changing Attitudes........................................................................................................................ 7
Institutionalizing participation of Disabled People’s Organizations.............................................. 7
Revising Employment Practices.................................................................................................... 7
3. Urban context and the
Disability Sector in Bangladesh................................................................ 8
3.1. The questions of
disability and urban poverty....................................................................... 8
3.2. The Disability Sector in
Bangladesh: NGO interventions..................................................... 8
3.3. Disabled People's
Organizations: successes and limitations.................................................. 9
Suggestions for building productive relationships with DPOs.................................................... 10
Networks of Disabled People’s Organizations............................................................................ 10
3.4. Government action on
disability.......................................................................................... 10
3.5. The Key Challenge:
Exclusion from the mainstream........................................................... 11
4. Strategy on Mainstreaming
People With Disabilities in UPPR................................................... 12
4.1. Introduction......................................................................................................................... 12
4.2. Output 1: Mobilization........................................................................................................ 12
Recommendations....................................................................................................................... 13
4.3. Output 2: SIF....................................................................................................................... 13
Recommendations....................................................................................................................... 13
4.4. Output 3: SEF...................................................................................................................... 14
Recommendations....................................................................................................................... 14
4.5. Output 4: Partnerships
and Linkages................................................................................... 14
Recommendations....................................................................................................................... 14
4.6. Output 5: Project
Management............................................................................................ 15
Recommendations....................................................................................................................... 15
4.7. Summary.............................................................................................................................. 15
Recommendations....................................................................................................................... 15
1. Introduction
This is a document about people with disabilities and a
discussion of challenges and methods to include them in development work,
specifically in the urban poverty reduction work being carried out by Urban
Partnerships for Poverty Reduction (UPPR). Its three sections consider first general
principles and actions for mainstreaming people with disabilities; secondly the
context within Bangladesh of disability, the disability sector and especially
disability in urban areas; and thirdly a strategy to mainstream people with
disabilities within UPPR.
“Disability” is understood as distinct from “impairment”:
“impairment” is the physical or intellectual condition of the individual and
“disability” is the interaction between the “impairment” and factors in
attitudes and the built environment. Working under this framework allows us to
make reference to international consensus and work on disability, and specify
the link between these categories, conditions in Bangladesh and the relevance
of this for development work.
With this idea of disability, international statistics present
a prevalence rate of 15-20% of the world’s population; the best statistics on
disability in Bangladesh present a prevalence rate of 9.1%. This is a
significant part of the population that is especially vulnerable and yet often
excluded explicitly or implicitly from development programs.
We consider a twin-track model of work to include people
with disabilities. This is combination of specific programs for people with
disabilities as well as enhancing inclusion in all areas of work. Actions for
mainstreaming people with disabilities include proper measures of prevalence,
changing attitudes towards disability, institutionalizing participation of
people with disabilities and revising employment practices.
In Bangladesh there have been diverse interventions in the
disability sector from government and non-governmental actors, and importantly,
the formation of Disabled People’s Organizations. These interventions and
organizations involved have rich practical knowledge of qualitative issues regarding
working with people with disabilities. But there is less systematic collection
of evidence to put the issues in proper context or to quantify the extent of exclusions
we know take place.
After a review of UPPR program, these general claims of
exclusion were to some extent substantiated. While UPPR had been working with
disability, it had been doing it unsystematically, and the emphasis had been on
special interventions such as assistive devices and education support. It was
found that, in general, people with disabilities were being excluded,
especially from community mobilization and from socio-economic grants. UPPR’s
mission is to target the “most vulnerable”, but it, paradoxically, ended up excluding
people for being too vulnerable to support.
In order to address these issues, actions have been
proposed at each level of UPPR’s work, applicable for each of its five outputs.
One of the preconditions for UPPR to be able to work successfully in this area
is changing attitudes towards people with disabilities. Fortunately, however,
it has been shown that initiating work – surveys, participation of people with
disabilities, or other interventions – leads naturally to change in community
attitudes and the mobilization of their support.
The goals of these recommendations are both to improve the
work done with this part of the population, and also to better achieve UPPR's
mission of reaching the most vulnerable. We aim to transfer work done with
people with disabilities from assistencialism into work that fosters
participation and leads to empowerment. In terms of UPPR’s poverty reduction
efforts, integrating people with disabilities creates an inclusive model of
urban poverty reduction that encompasses the most marginalized groups among the
poor.
2. Principles and Actions for Mainstreaming People with Disabilities in Development Work
2.1. Introduction to Disability
Impairment and Disability
Disability is a difficult term because the way that it is
used in everyday life is different from what is now international consensus.[1] Development
professionals and laypeople alike often use the word disabled to refer to impairment.
An individual can have an impairment, which could be
physical, mental, sensory, or more than one of these. He/she might have a
physical impairment such as paralysis in the legs; a mental impairment that
makes concentrating difficult; or a sensory impairment such as partial or total
loss in hearing and sight.
Impairment, however, is just one of the factors in disability:
Disability results from the interaction between persons with
impairments and attitudinal and environmental barriers that hinders their full
and effective participation in society on an equal basis with others.[2]
Someone who uses a wheelchair is disabled when there are
steps without ramps, when there is not enough room for his/her wheelchair to
enter into a toilet, or when someone refuses to consider them for a job.
Someone who is blind is disabled when books are not available in Braille, when
there are no tactile signs marking entrances or routes, or if they are insulted
for their blindness.
Talking about people with disabilities
Currently, the preferred language is “people with
disabilities”, because it focuses on the disability and not the impairment.
“Physically-challenged” or “differently-abled” both emphasize the difference in
the individual – the impairment – rather than the role that attitudes or environments
have in jointly creating the disability. In formal contexts, slang terms should
be avoided as they are often derogatory and part of the discrimination that
people with disabilities face.
When conducting field work, however, using the word “disabled”
(in Bangla, protibondhi) without
explanation will probably result in miscommunication. It is often more helpful
to give examples of a range of different impairments and sparingly make
reference to slang terms. “Disabled” is sometimes understood to be only
physically disabled, or restricted to very severe conditions.
2.2. Disability as a development issue
Prevalence and vulnerability
A commonly used estimate is that people with disabilities
are 10% of any population. The recent World
Report on Disability updated this with estimates that global prevalence
rates of disability are 15-20% of the adult
population.[3]
Most results from Bangladesh are, however, considerably lower than these
estimates.[4] But this
difference could simply be because of differences in methodology.[5]
As in the rest of the world, people with disabilities in
Bangladesh do not have equal access to health, employment, education or
services related to their disabilities. They are a vulnerable population in
themselves, and over-represented in other vulnerable populations: women, the
poor and the old all have higher results of disability.[6] The
relationship between other vulnerabilities and disability goes both ways: poverty is both a cause and a consequence
of disability.[7]
People with disabilities in development
Much of this document is concerned with how to “mainstream”
people with disabilities in development work. But that does not mean
development work does not already affect people with disabilities. People with
disabilities are being affected both positively and negatively by existing
programs and services.
On the one hand, there are programs directly targeting
people with disabilities, and programs with a diversified target population
that also benefit people with disabilities. In Bangladesh there are a range of
NGOs and government services that are targeting people with disabilities in a
variety of ways, from empowerment to service provision and social security.
Development in general can also benefit people with disabilities directly or,
through families and communities, indirectly.
On the other hand, however, when development organizations
implement programs without considering people with disabilities then they may
well be furthering or creating new exclusion. One of the arguments for
mainstreaming is that development work might be reinforcing or creating
exclusion and inequality.
Direct and indirect exclusions from development work
Infrastructure, policies and practices can directly or
indirectly result in the exclusion of people with disabilities. Services
designed for vulnerable groups sometimes directly discriminate against people
with disabilities by not seeing them as suitable beneficiaries. Reportedly,
some micro-credit programs refuse to give credit to people with disabilities.
Likewise, some forms of community mobilization limit the participation of
people with disabilities. Sometimes this exclusion is a paradoxical exclusion:
services for the “most vulnerable” are excluding people because they are “too
vulnerable”.
In other cases, design of infrastructure makes access
difficult or impossible for people with disabilities. And because of lack of
capacity and awareness, they might not receive adequate services if they were
able to access them.
Aside from their beneficiaries, development organizations
are often themselves not following best practices as employers. In Bangladesh,
a majority of GOs, NGOs and UN agencies are working in buildings without basic
accessibility. In many of these organizations there are very few staff with
disabilities. A notable exception to this is some of the NGOs that are directly
working on disability, and their example proves that there are people with
disabilities with capacity at every level.
Mainstreaming disability as an opportunity to improve development
Including people with disabilities as beneficiaries of
development programs is essential for those programs to meet their objectives.
The Millennium Development Goals, for example, cannot be met without direct
attention to people with disabilities.[8]
Measures taken to improve accessibility for people with
disabilities create a more general inclusiveness. Ramps, hand-railings and
physically secure environments benefit all, and especially so the old, pregnant
women or people temporarily disabled; likewise, alternate sources of
information for people with visual disabilities will benefit people who have
difficulties reading.
As well as inclusive designs, including people with
disabilities requires the possibility for services to be tailored for different
individuals. Adaptations based on a specific person’s capabilities and needs
can make the difference between someone being able to access a service or not.[9]
The message of disability is that different people access
services in different ways. Seeing through the lens of disability allows
organizations to develop a more inclusive, people-centric vision.
2.3. Principles of Mainstreaming
The goal of mainstreaming is to contribute to a sustained
empowerment of people with disabilities. Inclusion is one of the means to this
end. Mainstreaming people with disabilities in a project’s work is not a
one-off event, but rather a process as long as the project itself.
Twin-Track Approach
The twin track approach is to implement mainstreaming
through strengthening programs that specifically target people with
disabilities as well as strengthening inclusion and equality in all areas of
work.[10] This
methodology is inclusive and avoids the segregation of one set of services for
people with disabilities and another for people without disabilities.
This dual approach ensures that mainstream programs address
the direct and indirect exclusion of people with disabilities and promote
equality of rights and access. Mainstream programs have to address the needs of
people with disabilities rather than waiting for or depending on specialized
programs to do so.
Programs specifically targeting people with disabilities
often provide services that tackle general needs as well as those that are
specifically disability-related. The twin-track approach means that while they
do this they should also emphasize the strengthening of programs for the more
general population and the participation of people with disabilities in them.
Participation of people with disabilities
One of the key goals of mainstreaming is the fostering and
development of people with disabilities’ participation at each level of a
project’s work: as both beneficiaries and implementers. A mainstreaming
strategy should be designed and implemented with the participation of people
with disabilities, and the strategy should aim to development this into a
long-term participation in the project.
Developing the participation of people with disabilities is
necessary to create a lasting mainstreaming. If a project institutionalizes
links with people with disabilities it can establish feedback processes inform
about needs to be met and gaps in service provision.
2.4. Actions for Mainstreaming
Measuring Prevalence
To ensure the participation of people with disabilities in
development programs, individual and aggregate data is needed about people with
disabilities and the type of disabilities they have. The alternative -- having
poor or no information on disability -- can often make exclusion worse.
Of different methods of measuring disability, asking “do you
have a disability?” will generate low rates of disability – between 1 and 3%.[11]
International standards for censuses measuring prevalence of disability focus
on basic activities (e.g. “Do you have difficulty walking or climbing steps?”)
and in the responses measure different levels of difficulties.[12]
The data to be gathered should be designed so that it is
specific enough to inform the process of mainstreaming and/or specific
services. Based on the context, different aspects of the features of disability
– impairment, functionality, participation, exclusion – will need to be
measured.
Changing Attitudes
Interventions that exclusively or partially target people
with disabilities need to take into account attitudinal factors that could lead
to exclusion (including self-exclusion) of people with disabilities.
Awareness-raising is required among both beneficiaries and service-providers
for interventions to be able to reach their intended target.
Responses from people with disabilities and their families
might well be along the lines of “How can a sick child go to school?”, “I can’t
work because I can’t see”, “He/she can’t do anything”. Changing attitudes
involves sharing examples of other people with disabilities who are going to
school, doing work even though they can’t see and doing things that might not
be easily imaginable by these respondents.
Sharing these experiences of people with disabilities is
necessary at each level of work. It will give material and inspiration for
organizations and beneficiaries to think through diverse modalities of
inclusion.
Work in this area has the potential to gather momentum in a
snow-ball effect: increasing participation and measuring prevalence of people
with disabilities will contribute to changing of attitudes. Programs working
towards inclusion can start a process that has positive effects beyond their
direct work.
Institutionalizing participation of Disabled People’s Organizations
Disabled People’s Organizations (DPOs) are organizations by and for people with disabilities. Some organizations work for people with disabilities but are not
DPOs because they are not managed or administered by people with disabilities.
DPOs are the ideal representatives of people with
disabilities. As well as being vital stakeholders, they are experts in the
lived experiences of people with disabilities. Programs looking to
mainstreaming disability should look to access, include and develop the
expertise of DPOs.
Relationships with DPOs can be made formally and informally.
They should be consulted in design processes and their formal inclusion should
be sought in decision-making processes. DPOs can deliver trainings on
disability issues, and they should be involved in and trainings related to
mainstreaming people with disabilities.
Establishing connections with DPOs will create an important
feedback mechanism. The needs and capabilities of people with disabilities are
diverse, and change through time. DPOs are also in an excellent position to
advise on their members who may have had trouble accessing a particular
service, or experienced discrimination.
Revising Employment Practices
Organizations should review their hiring practices and
working environments to analyze the way they may be excluding people with disabilities.
Reviews may be best carried out with external help from Disabled People’s
Organizations.
3. Urban context and the Disability Sector in Bangladesh
3.1. The questions of disability and urban poverty
Various programs and interventions by government and non-government
organizations work with people with disabilities in urban areas. Interventions
vary from social safety-nets, assistive device support, treatment,
rehabilitation, education and/or employment generation to formation of
self-help groups and DPOs. These interventions have considered specific types
of disability and especially vulnerable groups, such as street children with
disabilities. Knowledge in this sector is embedded in practices of these
institutions and disabled people's organizations.
There are a range of references for prevalence of
disability within urban areas in Bangladesh. The best national measure is that
of the Household and Income Expenditure Survey 2010, which had a module on
disability. Using a methodology that reflects international standards, it
reports disability prevalence of 7.49% in urban areas as opposed to 9.63% in
rural areas.[13]
This is significantly more than a national disability-specific survey by
NFOWD/Handicap, which gave rates of 4.2% in urban areas and 6% in rural areas.[14] On
the other hand, it is significantly less than international figures. WHO cites
a prevalence in low income countries of 16.5% in urban areas as opposed to
18.5% in rural areas.[15]
All of these three prevalences report higher rates of
disability in rural areas rather than urban areas. One possible reason for a
lower rate in urban areas is better access to services. But at the moment this
is just guess work: currently we do not have satisfactory evidence in
Bangladesh to determine one way or the other. While urban contexts do see a
higher concentration of government and non-government services, one of the
questions for the poor in general and people with disabilities is how much
access they have to them.
In access to services, one of the main factors is
transport. Transport is a relevant issue that is cross-cutting through nearly
all areas of experience of people with disabilities in the urban context, and
one that is a vital consideration in any intervention on disability. By
transport we understand the holistic path from entering/exiting accommodation,
moving to the place where a vehicle (rickshaw / bus / cng / etc.) will be
availed, entering the vehicle, being seated, exiting, moving to and then
entering one's destination.
Each step in this process is routinely problematic in the
Bangladeshi urban context where smooth and safe footpaths are a rarity, and
public and private transport and buildings have inadequate accessibility
features. Added to routine difficulties are temporary hazards which can include
traffic and water-logging. On the other hand, however, ad-hoc interpersonal
solutions are regularly adopted such as transport by rickshaw supported by the
driver, or assisted access to buildings.
Attitudes towards people with disabilities in Bangladesh
Attitudes towards people with disabilities in Bangladesh
vary from community to community, family to family and person to person. At the
same time as there are examples of strong discrimination by family, community,
organizations and government there are
also heartening examples of inclusion and transformation.
The forms of stigma that exist lead to direct
discrimination. Some families hide people with disabilities from view, and/or
do not give equal food, clothes or opportunities. In some communities people
with disabilities are not called by their name but rather by insulting words
based on their impairment. In social and economic terms discrimination can
directly exclude people with disabilities from schools, hospitals, employment,
marriage and other areas.[16]
Poverty is certainly related to these forms of
discrimination, but the relation is not clear. On the one hand, poor people
with disabilities might not be given attention or support while in public; on
the other hand, some suggest that better off families might be more isolating
for people with disabilities.
Experience of disability programs in Bangladesh shows that
while these forms of stigma cannot be eliminated, many of them can be
transformed positively and good-will can be unlocked.
3.2. The Disability Sector in Bangladesh: NGO interventions
Interventions by NGOs in the area of disability have been
made both in terms of specific programs for people with disabilities, and work
to mainstream people with disabilities.[17] The
National Forum of Organizations Working with the Disabled (NFOWD) has over
three hundred member organizations working in fifty-nine districts: this
indicates the range of work being done with people with disabilities.
The disability sector traditionally makes a distinction
between the “medical model” of work and the “social model”, but in practice
NGOs in Bangladesh are mixing different styles of work. Handicap International,
for instance, gives emphasis on assistive devices, but has also recently
conducted a program building the capacity of Disabled People's Organizations,
and includes work with people with and without disabilities. Likewise, the
Center for Rehabilitation of the Paralyzed (CRP), takes a broad approach to
rehabilitation. Beyond physical rehabilitation and the production of assistive
devices, CRP also works with social and economic rehabilitation, including
training courses and gradual adaptation to prepare for the home environment.
Actors in the disability sector in Bangladesh are
increasingly moving towards consensus in using language of rights of people
with disabilities and their empowerment. But precisely because different types
of work are often mixed together – some more medically oriented, some more
rights-based – it is important to consider for each program the extent to which
they are empowering people with disabilities and how much the work is
assistencialism dressed up in rights-based language.
As well as specific interventions, the concern of
mainstreaming people with disabilities has been directly addressed by various
NGOs. Perhaps the most important of these is work done by the Center for
Disability in Development (CDD). They have developed Community Approaches to
Handicap in Development (CAHD), a framework for mainstreaming people with
disabilities in development work, and accompany this with an institutional
capacity to deliver training to development organizations.[18] The
framework suggests activities in areas it labels as Rehabilitation, Management,
Social Communication and Inclusion and Rights; with interventions from local to
international levels.
These areas cover the necessary ingredients to adapt
organizations to mainstream people with disabilities: two of these of crucial
importance are changing attitudes towards disability and of institutionalizing
the participation of people with disabilities in decision-making processes.
3.3. Disabled People's Organizations: successes and limitations
In Bangladesh, the two principal NGOs that have dedicated
resources to developing disabled people's organizations are Action on
Disability and Development (ADD) and Bangladesh Protibondhi Kallyan Somity
(BPKS). Disabled People's Organizations (DPOs) are organizations run by people
with disabilities for people with disabilities. Successes of DPOs
include transformations of the lives of their members, with profound attitude
changes in communities, engaging local and national stakeholders.
Even though they have been making great achievements, the
goal of Disabled People's Organizations is not always clear. DPOs successes are
often in a gray area that is neither rights-based work, nor the provision of
services. The mechanisms through which DPOs have transformative affects on
people's lives are through sharing of experiences and motivation. These
mechanisms, however, are largely unmonitored, and even though DPOs value these
successes (not directly related to rights-based work) they often still describe
what they are doing as “rights-based”.
For development actors, DPOs can potentially be the
representatives of people with disabilities and through that partners in
development. While there are success stories of this happening in practice, it
is often not explicitly the part of the DPO's mission to take this role.
Furthermore, representing the diverse situations of people with disabilities is
a never-ending task. There are particular groups that are often poorly
represented: people with intellectual disabilities, for instance, and women
with disabilities. Similarly, some experiences with DPOs have shown that they
may not be including poor and extreme poor people with disabilities.
Suggestions for building productive relationships with DPOs
Development organizations wanting to work with DPOs have to
keep in mind that DPOs are often grassroots organizations and will need support
in converting their ideas and experiences into priority areas and program
design. DPOs often have more experience in community mobilization and
rights-based work than in developing proposals or implementation of complex
projects. Establishing relationships with them can often be a chance to enhance
DPOs capacity.
At their best, DPOs can represent people with diverse
impairments and in diverse conditions. Different disabilities are experienced
differently, and disability is also different for women, children and elderly.
Organizations working with DPOs should encourage the representation of these
different groups.
Working with DPOs is like working with other NGOs, and it
should be kept in mind that each DPO has different levels of capacity and
integrity.
Networks of Disabled People’s Organizations
In Bangladesh there are three important national networks of
DPOs: NADPO, NCDW and NGDO.[19] As of July
2011:
NADPO: National Alliance of Disabled People’s
Organizations is a network of 94 DPOs in 42 districts. A good portion of these
DPOs were formed with support from BPKS[20].
NGDO: National Grassroots Disability Organization is
a network of 106 DPOs in 23 districts. Nearly all of these DPOs were formed by
ADD[21]. Its
sister network NCDW (National Council for Disabled Women) is a network
of 92 women’s only DPOs in 23 districts.
DPOs that are members of NADPO are in the majority not
members of NGDO, and vice-versa. NGDO and NCDW have a strong fraternal
relationship, as do many of their member organizations.
A list of DPOs is being compiled by Handicap International
and will hopefully facilitate the navigation of this complex landscape.
3.4. Government action on disability
Government work on disability follows is based on the
Persons With Disability Welfare Act (2001).[22] While this
law does not reflect the subsequent United Nations Convention on Rights of
People with Disabilities or provide mechanisms for redress of discrimination of
people with disabilities, it does have various mechanisms that can be accessed,
including the establishment of district committees for the welfare of people
with disabilities, and government identification cards for people with
disabilities.
Further to this legal framework, it is the Ministry of
Social Welfare that has responsibility for people with disabilities. This is an
unfortunate relegation of disability to an issue of welfare rather than a
cross-cutting issue relevant across all ministries.
The Department of Social Services provides monthly grants
for people with severe disabilities and education stipends to students with
disabilities, although the coverage of these grants is limited. Between the
Department of Social Services and the National Foundation for Development of
Disabled People, the government provides special schools for children with
disabilities, rehabilitation centers and Disability Service Centers.
3.5. The Key Challenge: Exclusion from the mainstream
While there is poor quantitative data on this issue in
Bangladesh, experiences from organizations working with people with disabilities,
and disabled people organizations themselves highlight systematic exclusion
from mainstream society. Exclusion operates in a number of sectors, including
health, education and employment. As well as acting sector-wise, exclusion also
operates on the level of family, community and society: at each of these levels
people with disabilities are discriminated against, either implicitly or
explicitly, and sometimes with violence.
These reports of exclusion make it vitally important that
service providers and others consider the way that people with disabilities are
included – or excluded – from services that are available for disabled and
non-disabled population. A first need is for better information detailing the
extent and the nature of this exclusion; information will ensure that service
providers and others directly tackle the problem and its size. Secondly, the
concern for organizations, especially those working in development, is whether
they are creating new exclusions of people with disabilities, even as
they work for the advancement of populations that include people with and
without disabilities. Thirdly, programs directly targeting people with
disabilities must consider whether their work is creating new segregations and
the way it relates with mainstream services and society.
4. Strategy on Mainstreaming People With Disabilities in UPPR
4.1. Introduction
The following strategy
is a product of a consulting with national stakeholders, a desk-review of UPPR
work, field-trips to seven towns, and a series of questionnaires sent to town
teams; it is based on information from 23 UPPR towns
UPPR’s Extreme Poverty strategy notes that “viewing the extreme poor as a homogenous group,
rather than as a collection of vulnerable groups, results in some groups being excluded
from poverty reduction interventions”.[23] In order for urban poverty reduction to be
successful, the specific vulnerabilities of different groups need to be
addressed.
One of the vulnerable
groups within the extreme poor are people with disabilities. It is a group
already receiving substantial attention from communities and towns in UPPR’s
work. Disability is one of the four
categories of social vulnerability identified in PIP (or participatory
identification of the poor, a process in which community leaders catorgize
households into one of three poverty groups based on agreed criteria) , it is
an issue regularly raised by communities in the communitation action plan
(CAP), and has been addressed by specific community contracts in many towns.
This work has not,
however, been systematic or focussed across the project. People with
disabilities are usually not represented among leadership of CDCs or Clusters,
and people with disabilities are not often targetted by SEF grants. Despite
inclusion in some places, the more general pattern is one of exclusion.
This section presents
findings and recommendations on mainstreaming people with disabilities for each
of the five outputs of UPPR project. Mainstreaming people with disabilities
within UPPR work requires a scaling-up of best practices and a renewed focus on
this vulnerable group.
4.2. Output 1: Mobilization
Mobilization has included limited numbers of people with
disabilities as PG members or PG/CDC/Cluster leaders: People with
disabilities either exclude themselves or are excluded from processes of
mobilization. Mobilization often changes the attitudes of women, who previously
thought they could not work outside the home, but it has not made corresponding
changes in the attitudes of people with disabilities.
PIP underestimates numbers of HH with disabled family
members: Communities do not always understand the what is meant by the word
“disability” in the PIP process, and implementation is not always accurate.
Concepts of disability are not consistent.
Eight towns have conducted extra surveys on people with
disabilities (PWD) to design and implement contracts: in order to
facilitate contract design and implementation, several towns have done surveys
of their own design.
Disability is frequently raised in CAP but uninformed and
not connected with solutions: communities regularly raise disability in CAP
as an issue to be addressed by UPPR. Popular solutions are those of treatment
or of financial support, but there are only weak mechanisms to converting these
CAP results into solutions. Both communities and town-teams are lacking in
context for the work that can be done for and with people with disabilities.
People with disabilities are excluded through
discrimination from family, community and self-discrimination.
Recommendations
Mobilization has to
be redesigned in order to ensure the inclusion of people with disabilities.
Raise awareness on disability: without efforts to
change attitudes of people with disabilities, their families and communities,
inclusion and empowerment will not happen.
Pilot action groups for people with disabilities at CDC
and Cluster levels: people with disabilities and guardians of people with
disabilities can form a special group to discuss their issues which then can be
fed into the CAP. Alternatively, they
can create their own CAP. As well as a
member of their family belonging to a PG, an action group of PWDs will ensure
their direct engagement.
Design, conduct and repeat a standardised survey of
people with disabilities: specific information on types of disabilities,
needs and capabilities is needed to inform contract design and implementation
These steps will lead to a sustained participation, and
information that guides contract design and implementation.
4.3. Output 2: SIF
There are some, but limited, accessibility features in
SIF infrastructure. So far 15 towns have made minor accessibility
modifications (especially for latrines). Footpaths in general are particularly
beneficial to PWDs, and can be made more PWD-friendly. But most infrastructure does not have
accessibility features.
Towns state that HQ guidance and PMID designs mean they
will create more accessible infrastructure in future.
Recommendations
Make all UPPR infrastructure more PWD-friendly and
accessible: Designs of infrastructure should be made more accessible, with
modifications made available.
Provide tailored solutions to meet the water and
sanitation needs of PWDs: meet individuals’ needs on a case-by-case basis,
through adaptations to UPPR infrastructure and adaptations done to their houses
and surrounding areas.
Orient and sensitize UPPR staff, pourashova and
communities on possible designs. Without knowledge sharing, community
members and UPPR staff will not be aware of what can be done for inclusive
infrastructure and HH-level interventions.
Provide guidelines and support to build UPPR staff
capacity. UPPR staff need an illustrated manual to convey ideas; visits to
other projects would also be useful. (There is a good example in Kollanpur,
Dhaka of PWD-friendly latrines.
4.4. Output 3: SEF
Twelve towns have made specific contracts for people with
disabilities in 2010 and 2011. Contracts were made on assistive devices and
or education/training.
People with disabilities are excluded from apprenticeships,
startup-business grants, and education grants by communities and towns.
Towns and communities sometimes see PWD’s needs as different and to be
addressed by contracts that exclusively deal with disability. Towns mention
difficulties in getting employers’ agreement to take apprentices with
disabilities, and complications of transport.
Recommendations
Develop guidelines for towns on best practices for SEF
interventions on PWD: provide guidance to town on contracts, such as those
delivering assistive devices or education.
Pilot new interventions on unmet needs (e.g. forms of
community-based rehabilitation): Examples could include providing tuition
for home learning to those unable to go to school and/or providing daycare to
relieve pressure on family.
Use SEF grants to target people with disabilities and not
just their families. Education Support and Apprenticeship grants especially
need to be reviewed.
4.5. Output 4: Partnerships and Linkages
Six towns have partnerships with NGOs, four have linkages.
Specific interventions have sought registration for government ID cards.
Narayangonj has an excellent partnership with a disabled
people’s organisation. A pre-primary school has given opportunities to
previously excluded children, which has led to participation in mainstream
education, changed community attitudes and facilitated access to government
services.
There have been positive responses from communities in
places where disability contracts were implemented. Communities’ attitudes
can change significantly in response to work initiated in preliminary work
(such as surveys) and implementation of contracts.
Recommendations
Facilitate access to government ID cards for people with
disabilities across UPPR. The government ID card is difficult to obtain;
most people do not know where and when to get it. Obtaining it gives access to
monthly support as well as allowances for students.
Develop linkages and partnerships at community, town and
HQ levels with effective Disabled People’s Organisations (DPOs). DPOs are
ideal representatives of people with disabilities: they are organizations run for and by people with disabilities.
Make DPOs partners in development. Most DPOs are
grassroots organizations, and working with them requires UPPR to adapt to
organizations whose capacity might be limited. For sustainability, UPPR should
build the capacity of these organizations.
Towns can use information as base for work outside of
UPPR. With good information on disability (from surveys), towns can share
information and create linkages and partnerships with GOs and NGOs, and raise
disability issues at TLCC.
4.6. Output 5: Project Management
There is little information at town-level on
participation of PWD. There is no systematic information gathering on
numbers of beneficiaries or participation in community mobilization.
Nearly all towns express need for guidelines and
orientation on disability
Offices (in towns and HQ) are lacking basic accessibility
features
Recommendations
Introduce disability indicators into reporting and
monitoring. Surveys of people with disabilities at community level will
allow UPPR to collate numbers of beneficiaries of different grants with
disabilities.
Support towns through guidelines and training.
Guidelines and training should cover mainstreaming disability in general, as
well as specific types of contracts (e.g. for assistive devices).
Establish focal points on disability at HQ and town-level.
Liaise with municipalities, LGED and Public Works
Departments on accessibility of public and private buildings. Where
possible, make modifications to UPPR offices.
Create internships for people with disabilities (HQ,
Towns). Including people with disabilities in our work spaces is a path for
our sensitization, positive discrimination, and potentially building stronger
relationships with DPOs.
Recruit COs with experience in mobilizing people with
disabilities.
4.7. Summary
UPPR has addressed people with disabilities in its work,
but without a uniform approach.
Some interventions have been excellent. Both
communities and Towns are interested to work in this area.
Some interventions and approaches did not tackle
inequality and discrimination. There is a danger that treating disability
as a vulnerability of a household encourages viewing people with disabilities
as a burden, rather than seeing their potential empowerment.
Recommendations
The recommendations for each output suggest changes at
each level of UPPR’s work, from community to HQ. As well as scaling up best
practices, these recommendations will introduce a comprehensive
disability-focus to UPPR work
National-level consultations should be pursued. The
work proposed is based upon existing ideas in poverty reduction and the
disability sector, but at the same time it is innovative, and aiming to target
a population previously overlooked by poverty reduction efforts as well as
disability-specific work.
[1] Please see the WHO and World Bank World Report on Disability (2011), ch.
1, for a more thorough treatment of international consensus.
[2] United
Nations Convention on the Rights of Persons with Disabilities (2006),
Preamble. Available online at
http://www.un.org/disabilities/default.asp?navid=14&pid=150.
[3] World
Report on Disability, p. 29. The figures are 15.6 and 19.4% respectively
from the World Health Survey and the Global Burden of Disease.
[4] The
Household Income and Expenditure Survey 2010 included a disability module gave
prevalence of 9.1%, using the Washington Group questions. Other measures have
given lower figures: the 2001 census gave less than 1% of the population as
disabled. The largest other survey was that done by Handicap International and
NFOWD in 2005 which found a prevalence of 5.6%. See Disability in Bangladesh: A study in Prevalence (2005). An in-depth
survey was recently completed by ICDDRB in conjunction
with Melbourne University, but as of July 2011 results are awaiting
publication.
[5] Capturing the complex and varied nature of
disability in a single number is impossible. For a general review of
methodology see Mont, Daniel “Measuring Disability Prevalence” (World Bank,
2007).
[6] World
Report on Disability, p. 27.
[7] See Thomas, Philippa “Disability, Poverty
and the Millennium Development Goals: Relevance, Challenges and Opportunities
for DFID” (2005). GLADNET Collection, Paper 256, p. 5.
[8] (Ibid, pp. 7-9)
[9] For a concrete example of how inclusiveness
and individual designs might work in one sector, please see Jones, Hazel and
Reed, Bob Water Sanitation for Disabled
People and Other Vulnerable Groups (2005). WEDC, Loughborough University,
2005. This manual stresses the need for “an inclusive design approach” combined
with “an individual approach” addressing modifications that can be made based
on specific beneficiaries’ capabilities and needs.
[10] See DFID’s Disability, Poverty and Development (2000), p. 11.
[11] “Measuring Disability Prevalence”, p. 7.
[12] See the “Short Set” of questions and their
rationale from the Washington Group on Disability Statistics. Online at:
http://www.cdc.gov/nchs/washington_group/wg_questions.htm
[13] Preliminary Report on Household Income and
Expenditure Survey 2010, p. 77.
[14] Disability in Bangladesh: A Study in
Prevalence, p. 12.
[15] World Report on Disability, p. 28.
[16] See Unnayan Shamannay’s report prepared for
ADD Bangladesh, “In Quest of Disability Sensitive PRSP” (2004) for issues
raised in grassroots consultations. More detailed examples of indirect and
direct discrimination and failure to provide reasonable accommodation can be
found in Smith, Hezzy “Establishing a New Disability Law Based on Grassroots
Expectations” (2010).
[17] For a fuller summary of the disability sector
in Bangladesh, see State of the Rights of Persons with Disabilities in
Bangladesh 2009, Disability Rights Watch Group Bangladesh, pp. 19-35.
[18] See Disability in Development: Experiences
in Inclusive Practices, 2006 for a description of CAHD.
[19] The National Forum of Organizations Working
with the Disabled (NFOWD) is an important stakeholder and resource but most of
its members are not DPOs. Young Power for Social Action (YPSA) works in
Chittagong, where it has formed 33 DPOs.
[20] A national NGO: Bangladesh Protibondhi
Kallayan Somity, http://www.bpksbd.org/.
[21] An international NGO: Action on Disability
and Development, http://www.add.org.uk/
[22] NFOWD in consultations with other stakeholders
have submitted a developed a draft of a new Disability Rights Law.
[23]
Singh, Kishore “Strengthening the Extreme Poverty Focus in UPPR Implementation,
Institutional Practices and Policies” (2009), p. 15.
1 comment:
This document definitely clarifies and gives a better understanding
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