Question & problem
Social protection systems and other financial assistance, including cash transfers and integrated benefits packages, may be important ways to facilitate the inclusion of people with disabilities in services and society. There is limited information, however, with regards to their impact in low- and middle-income settings. To understand how these programs work, it is important to recognise that there are disability-targeted entitlements, but people with disabilities may also be eligible for mainstream programmes aimed at other targeted groups, such as people of a certain socio-economic status. This evidence note summarises what is known about challenges faced by both of these types of initiatives, as well as evidence-based recommendations to strengthen them.
Recommendations
Key recommendation
Action
People with disabilities need to be actively encouraged to participate in mainstream social protection efforts where no targeted ones exist, and this participation needs to be made simple.
Key recommendation
Action
The aims of social protection include promoting the development of stronger livelihoods, ensuring access to healthcare and other services, fostering economic and social development, and reducing poverty and inequalities. Financial assistance alone may not be enough to facilitate this level of participation, and so integrated packages, which are responsive to users’ needs, are required.
Key recommendation
Action
Benefits must match the identified needs of people with disabilities, and service users can help to keep programming accountable. Service users involved in programming can also help to raise awareness and improve perceptions of the utility of benefits amongst others.
Key recommendation
Action
Policy is needed to reduce any geographic and financial barriers to access, and ensure that – at point of use – there are no attitudinal or institutional barriers to high quality service delivery.
Key recommendation
Action
De-centralised services can go some way to making social protection more accessible to people with disabilities, for instance, where application processes and benefit receipt can occur in the community. Where benefits are targeted to people with disabilities, processes for assessing eligibility need to be inexpensive and easy to navigate.
Challenges
Challenge #1: Without disability-targeting, mainstream social protection schemes may not adequately support people with disabilities, who face additional costs, exclusion and barriers to participation.
- People with disabilities are more vulnerable to poverty and exclusion from key services than non-disabled people and so require social protection more than others. Yet, they may have difficulties accessing these programmes.
- Making mainstream social protection schemes inclusive of people with disabilities will be an important step towards addressing poverty alleviation goals, including Sustainable Development Goal 1, target 3).
Challenge #2: Financial assistance along may not be sufficient to facilitate participation and improve access to key services for people with disabilities.
- Review evidence suggests that access to social protection falls below what is needed, and that benefits from participation in such programs are mostly limited to maintaining minimum standard of living.
- Cash transfer type programming, or financial grants, can be embedded within a wider framework of action to support participation, including providing access to transport and housing, tackle discrimination and empower people with disabilities.
Challenge #3: People with disabilities are excluded from planning, decision-making and evaluation of programs designed to benefit them.
- Where social protection and other forms of financial assistance are targeted at people with disabilities, experts with lived experience need to be included in determining benefits and delivery mechanisms, and in providing feedback about programme effectiveness.
Challenge #4: Policy-makers and providers may not be held accountable for delivering on provisions.
- Discriminatory attitudes among administrators and inefficient processing of the claims of people with disabilities can put off potential beneficiaries from accessing benefits and reduce the chance of success for those who do.
- Benefits and linked services need to be of high quality and delivered in accordance with political and legal provisions for doing so, if they are to make a meaningful impact on the lives and livelihoods of people with disabilities.
Challenge #5: Processes for accessing social protection or other benefits may be inaccessible or present unintended barriers to utilisation for people with disabilities.
- Some studies have found that disability-targeted grants processes are more centralised than mainstream benefits, and are thus harder to access. Decentralising processes for applying for, and accessing, benefits could go some way to improving coverage.
- Further, acquiring an official determination of disability can be costly and administratively onerous, and so fair, accessible and simple ways of assessing eligibility need to be developed and employed.
Finding the answers
We conducted a scoping of the literature, examining systematic, narrative, and other types of review evidence as well as individual study papers concerning social protection, cash transfers and grants for people with disabilities in low- and middle-income countries. All recommendations are based on literature from low- and middle-income countries. This evidence note is based on the findings of 19 studies from low- and middle-income countries and 2 reviews of the evidence from low- and middle-income countries.
Recommendations & actions
Key recommendation
Action
People with disabilities need to be actively encouraged to participate in mainstream social protection efforts where no targeted ones exist, and this participation needs to be made simple.
Key recommendation
Action
The aims of social protection include promoting the development of stronger livelihoods, ensuring access to healthcare and other services, fostering economic and social development, and reducing poverty and inequalities. Financial assistance alone may not be enough to facilitate this level of participation, and so integrated packages, which are responsive to users’ needs, are required.
Key recommendation
Action
Benefits must match the identified needs of people with disabilities, and service users can help to keep programming accountable. Service users involved in programming can also help to raise awareness and improve perceptions of the utility of benefits amongst others.
Key recommendation
Action
Policy is needed to reduce any geographic and financial barriers to access, and ensure that – at point of use – there are no attitudinal or institutional barriers to high quality service delivery.
Key recommendation
Action
De-centralised services can go some way to making social protection more accessible to people with disabilities, for instance, where application processes and benefit receipt can occur in the community. Where benefits are targeted to people with disabilities, processes for assessing eligibility need to be inexpensive and easy to navigate.
Policy priorities
Service users need to be included in policy and programming processes for the design, implementation, and evaluation of social protection actions at a national and sub-national level. Strong policy can ensure that geographic, attitudinal, practical and financial barriers to access are minimal, and that there is accountability among point-of-use providers to deliver benefits. Finally, if policy makes provision for integrated, disability-targeted packages of benefits and services, as well as strong monitoring mechanisms, then the full vision of social protection for people with disabilities – participation, reduction of inequality, and access to services – is more likely to be achieved, than where minimum standards of living are preserved with financial assistance alone.
Conclusion
There is some evidence that social protection, cash transfer, grant and other forms of financial assistance promote participation, facilitate inclusion, improve service access and reduce inequalities for people with disabilities. However, these programs need to be a) embedded within an integrated package providing a variety of supports, including practical supports like transport and housing; b) accessible to people with disabilities; and c) administered well so that de jure provisions result in de facto benefits.
Gaps & research needs
In general, there is a need for more evidence regarding the impact of different types of social protection, cash transfer, and grants programs on the lives and livelihoods of people with disabilities in low- and middle-income countries. More research including comparison groups drawn from the general population is needed to determine equity in access to social protection and impact of programming. Finally, it would be useful to research to explore how gender, age and impairment type influences access to programs of this type, as such knowledge would be useful for designing inclusive programs.
Acknowledgements
Publication details: © Disability Evidence Portal, London School of Hygiene & Tropical Medicine, August 2019.
Suggested citation: Xanthe Hunt. Evidence Brief: How do we ensure that social protection assistance initiatives work for people with disabilities? Disability Evidence Portal, 2019.
Disclaimer: The views expressed in this publication are those of the authors and should not be attributed to the Disability Evidence Portal or its funders.