Question & problem
Disability inclusion entails integrating individuals with disabilities into day-to-day activities and promoting equal opportunities to those without disabilities. To this end, several disability inclusive programs have been implemented with the aim of giving people with and without disabilities equal opportunities to participate in all facets of life to the best of their abilities and aspirations. This brief summarises current evidence about how to effectively scale up disability-inclusive programs.
Quote
Recommendations
Key recommendation
Action
Combine attempts to modify policy and/or law with actions to influence local social norms. Understand what needs to be adapted and raise awareness at the institutional and societal levels. Promote inclusive infrastructural development and attitudinal change to create a setting that supports and embraces people with disabilities. Efforts to create a supportive environment for persons with disability should comply with the guidelines from the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
Key recommendation
Action
Planning and needs assessment processes must take into consideration the perspectives of individuals with disabilities from the conceptualization stage to the implementation of the policies and intervention at all levels. Also reach out to marginalised disability groups such as women, girls, children, youths, and the elderly, as well as persons with psychosocial, intellectual, and communication impairments through sensitization programmes
Key recommendation
Action
As interventions are scaled up, monitor their effectiveness and sustainability beyond the project life cycle; evaluate any programme modifications; and monitor changes in social norms. Evaluations of programmes should consider data from control groups or before-and-after groups. To be able to create and execute policies, as well as to recognise and resolve the obstacles that people with disabilities face in exercising their rights, it is necessary to gather information, including statistical and research data that has been appropriately disaggregated with targets connected to disabilities, clearly indicated.
Key recommendation
Action
Set realistic budgets that are clearly described, with adequate provision of human resources and program activities, including evaluation and monitoring activities.
Key recommendation
Action
Anti-discrimination laws and regulations that make it easier for people with disabilities in all their diversity to be included should be put into action and enforced. Disability differences must be considered when developing and implementing programs. The use of the CBR matrix could also help implement programmes and policies that cover a wide range of elements that are crucial to attaining an all-inclusive society.
Challenges
Challenge #1: Environmental, attitudinal and organisational barriers prevent persons with disabilities in realising their rights and meaningful participation on an equal basis with others.
- Careful planning is required to ensure a supportive environment where people with disabilities can participate on an equal basis with others.
- Disability inclusive programs need to better understand the specific accessibility needs of people with disabilities, address the concerns of service providers and employers, and recognise the programmatic, political and legislative setting.
Challenge #2: Lack of engagement with people with disability and marginalised disability groups in decision-making
- Persons with disabilities, their families, and the public should be made aware of policies that promote the rights of persons with disability and how to access them, and there should be systems in place to do so.
- Make sure that people with disabilities have a platform to express their complaints and can provide relevant policy ideas based on their own experiences.
- Integrate people with disabilities into activities by connecting them with potential implementers and opportunities.
Challenge #3: Absence of high-quality evaluations of disability-inclusive programs.
- Projects are usually evaluated by the same organisations that implement them. To make these programs more evidence-based, they should be evaluated by an independent organisation.
- Future research should provide high-quality evidence that is trustworthy, generalisable, valid, consistent, and unbiased. Furthermore, more experimental, qualitative, and participatory research is needed to develop and identify effective interventions.
- In light of preliminary findings, more research on interventions and their outcomes should be conducted to assist implementers and policymakers in continuing to improve disability-inclusive programs.
Challenge #4: Lack of resources and funding for environmental adaptation, human resource development, training, activity implementation, and monitoring and evaluation.
- To secure significant long-term funding, sufficient evidence that interventions are cost-effective and financially feasible is required.
- Studies call for more funding and resources to deliver the necessary materials and human resources for programmes that integrate people with disabilities.
Challenge #5: Despite the existence of progressive policies and laws, there are still gaps in implementation exacerbated by the complexities of disability and inclusion.
- To avoid focusing on a few areas such as inclusive health and education, it is necessary to consider all elements of inclusion in the implementation of national programs, activities, and policies guided by the community-based rehabilitation (CBR) matrix.
- Recognise the diversity among people with disabilities, and promote and preserve their human rights, including those who need more intensive support.
Finding the answers
A review of reviews was conducted to examine the evidence on the implementation of disability-inclusive programs in low and middle-income countries from the systematic, narrative, scoping, and literature reviews. The highlighted challenges and recommendations are based on the findings of fifteen reviews from low- and middle-income countries (LMICs). Four studies focused on inclusive education, seven on inclusive health, one on inclusive livelihood and social protection, one on inclusive political involvement, and one nonspecific. In terms of age range, five studies focused on children and adolescents, four encompassed all age groups, four focused on young adults and adults, and two were not age-specific. The databases that were searched were Research Gate, PubMed, Science Direct, and Google Scholar.
Recommendations & actions
Key recommendation
Action
Combine attempts to modify policy and/or law with actions to influence local social norms. Understand what needs to be adapted and raise awareness at the institutional and societal levels. Promote inclusive infrastructural development and attitudinal change to create a setting that supports and embraces people with disabilities. Efforts to create a supportive environment for persons with disability should comply with the guidelines from the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
Key recommendation
Action
Planning and needs assessment processes must take into consideration the perspectives of individuals with disabilities from the conceptualization stage to the implementation of the policies and intervention at all levels. Also reach out to marginalised disability groups such as women, girls, children, youths, and the elderly, as well as persons with psychosocial, intellectual, and communication impairments through sensitization programmes
Key recommendation
Action
As interventions are scaled up, monitor their effectiveness and sustainability beyond the project life cycle; evaluate any programme modifications; and monitor changes in social norms. Evaluations of programmes should consider data from control groups or before-and-after groups. To be able to create and execute policies, as well as to recognise and resolve the obstacles that people with disabilities face in exercising their rights, it is necessary to gather information, including statistical and research data that has been appropriately disaggregated with targets connected to disabilities, clearly indicated.
Key recommendation
Action
Set realistic budgets that are clearly described, with adequate provision of human resources and program activities, including evaluation and monitoring activities.
Key recommendation
Action
Anti-discrimination laws and regulations that make it easier for people with disabilities in all their diversity to be included should be put into action and enforced. Disability differences must be considered when developing and implementing programs. The use of the CBR matrix could also help implement programmes and policies that cover a wide range of elements that are crucial to attaining an all-inclusive society.
Policy priorities
Non-governmental organisations and other stakeholders are leading disability inclusive programs in low- and middle-income countries (LMICs), but for these initiatives to be sustained, political will and legislative changes are necessary. To address the current environmental and attitudinal barriers, national governments and other stakeholders, including disabled people’s organisations (DPOs), must collaborate to enact and enforce laws and regulations that are consistent with the UNCRPD. In LMICs, there are significant gaps in the effective engagement of persons with disabilities in policy, programs, and decision-making processes. In order to accommodate the perspective of people with disabilities, governments and stakeholders must work together to develop policies that will empower, support, and facilitate meaningful interaction with DPOs. At the Global Disability Summit, numerous stakeholders pledged their support for disability inclusion around a number of key themes, including inclusive livelihood and social protection, education, and health. They also committed to meaningfully engage with DPOs. It is therefore critical that these commitments be translated into tangible actions that are aligned to the UNCRPD and Sustainable Development Goals (SDGs).
Conclusion
The review identifies some of the key challenges to disability inclusion and recommends solutions for overcoming them. Effective scaling up of disability inclusive programs requires meaningful interaction with DPOs at all phases of policy development and program design given that they are key to implementing all of the review's recommendations. DPOs' play important roles including giving the disability community its own voice, determining the needs of those with disabilities, expressing opinions on priorities, assessing services, advocating for change, and raising public awareness. Decision makers and implementors must also consider the diversity of persons with disabilities when developing and implementing disability inclusive programs in order to include everyone, even those who require more intense support. Mainstreaming disability issues at a national level is critical to successful sustainable development efforts. Hence, governments must work in collaboration with civil society organizations, DPOs and other stakeholders to fulfil the various SDGs on inclusion, particularly in areas related to education, growth and employment, inequality, and the accessibility of human settlements. Successful implementation, close monitoring, and evaluation of policies and intervention is important. Furthermore, high-quality disaggregated data must be collected for monitoring and evaluation, as well as for statistics and research reasons, so that policies may be developed and implemented.
Gaps & research needs
There are many disability-inclusive programs in operation, however the majority of literature evaluations focus on inclusive education. On other programs that are inclusive of people with disabilities, there is little research. Although there are a lot of review studies on children and adolescents in this review most of them are on inclusive education. However, there is not much research on children and adolescents in other areas, such health and social protection. Evidence on how to effectively scale up and sustain disability inclusive programs is still limited. More studies focusing on interventions and their outcomes is needed. Depending on the type and severity of their disability, people with disabilities may encounter different barriers that hinder them from fully and effectively participating in society on an equal level with others. People with severe disabilities, for instance, will require more intensive support than those with minor disabilities to overcome these barriers. As a result, additional research is required to determine which interventions are the most effective disaggregated by age group, sex, and type and severity of disability.
Acknowledgements
Peer Review: This brief was peer reviewed by Diana Hiscock, Global Disability Advisor, HelpAge International, and Sarah Marks, Research Fellow at the International Centre for Evidence on Disability, LSHTM.
Publication details: © London School of Hygiene & Tropical Medicine, February 2023.
Suggested citation: Lupenga Joseph. Evidence Brief: How can we effectively scale up disability-inclusive programs? Disability Evidence Portal, 2023.