What are the core principles that should be considered in the development of policies and programmes related to persons with disabilities in LMICs?

Challenge #1: Persons with disabilities are limited in participation due to barriers resulting from physical and virtual inaccessibility.

• Accessibility is a precondition for an inclusive society for all, and for persons with disabilities to fully enjoy all human rights and fundamental freedoms. However, persons with disabilities continue to experience both environmental and attitudinal barriers. Research from the UN Department of Economic and Social Affairs indicate that about a quarter of persons with disabilities in Sub-Saharan Africa, Latin America, and Asia, have experienced environmental barriers to access health-care facilities, schools, workplace, and toilet facilities at home. 
• Provision of accessibility needs incurs additional costs, e.g. the operational cost to construct inclusive buildings and WASH facilities can range between 0.5 per cent and 1 per cent of the total budget. All disability inclusive policies should recognise the additional cost of accessibility and have a dedicated funding stream. This will encourage programmes to consider disability inclusion in budgeting.

Challenge #2: Persons with disabilities frequently experience inequality and discrimination.

• Widespread assumptions and misunderstanding about abilities of persons with disabilities are still prevalent in many settings. For example, prevailing stereotypes about capability to efficiently undertake employment, or whether persons with disabilities are sexually active. As a result, the rights of persons with disabilities are often overlooked and there is lack of political will to allocate adequate resources to overcoming this.
• The heterogeneous nature of disability and barriers placed on people with different types of disabilities by society is often overlooked, leading to discordance between domestic laws and the UNCRPD framework. Meeting the requirements of persons with disabilities may also be influenced by the type and severity of impairment they experience, the assistive devices they find supportive, and the context in which they live. One review noted that often laws in East Africa do not explicitly recognise certain types of disability such as mental illness, making people who experience mental illness vulnerable to discrimination due to inadequate legal protection.
• Furthermore, persons with disabilities face multiple disadvantages resulting from the interaction of different social attributes including gender, culture, race, age, education level, religion, geographical location, and legal status. They are further influenced by national and regional structures of power such as policies, laws, families, social norms, and religious beliefs. For e.g., employment related policies and programmes for women with disabilities need to take into account the implications of both gender and disability.
• Although the majority of all nations have ratified the UNCRPD, there are still major gaps in the effective implementation of its principles into practice. Even when new, inclusive policies are developed, these are often not implemented in practice. A recent study reviewed reports from 19 countries on CRPD compliance and found that the reporting on psychosocial disabilities was of lower quality in low-income countries.

Challenge #3: Insufficient capacity to efficiently implement inclusive policies and programmes.

• Capacity refers to both the structural and functional ability of an organisation (including government departments and civil society actors) to achieve its objectives, and is dependent on both tangible resources (e.g., human and financial) and intangible resources (e.g., leadership, political will). Capacity development is essential for both the policy process as well as at the level of specific programmes.
• The UN disability and development report highlighted the lack of capacity among multiple stakeholders such as policy makers, persons with disabilities, organisations of persons with disabilities (OPDs), teachers, and employers. Capacity building is essential as it provides an opportunity for the relevant stakeholder to increase their understanding of the needs and then identify and implement appropriate strategies to enhance disability-inclusive policies and programmes.
• UNCRPD Article 4.3 emphasises consulting and actively involving persons with disabilities, through their representative organisations, in all decision-making processes related to the development and implementation of policies and programmes for persons with disabilities. However, in practice persons with disabilities are seldom consulted (e.g. employment, hygiene, social protection), meaning their perspectives are ignored, which leads to policies and programmes that are not inclusive, need-based, and do not adequately address all the barriers experienced by persons with disabilities.
• Even when persons with disabilities are consulted, for e.g. to support writing the UNCRPD country reports, the final decision to incorporate their inputs rests with the government departments. Another survey conducted by the International Disability Alliance (IDA) found that stakeholders are involved mostly in the implementation phase rather than seeking their input at all stages including development and evaluation of policies and programmes.
• Lack of financial capacity can have an impact on the implementation of policies as well as the sustainability and feasibility of effective programmes such as mental health provision.

Challenge #4: Lack of consistent and good quality disability data.

• Good quality disability data is essential to assess the needs of people with disabilities, and accordingly plan and implement specific policies and programmes. Disability can be measured and classified at a population level in a standardised way, to allow comparison of data both within and across nations. There is, however, lack of consistent and good quality disability data in accessible forms, and when data is collected, it is not consistently collated, disaggregated, and disseminated. A recent review of household surveys and censuses in LMICs found that only 31% included disability questions. Of these, half included functional difficulties questions such as the Washington Group Short Set (WGSS).

Challenge #5: The evidence base on what works for persons with disabilities in LMICs is sparse.

• The evidence base around the effectiveness of disability-inclusive development programmes in LMICs is very low e.g., the existing body of evidence about the impact of labour market supports for people with disabilities in LMICs is inconclusive. In most cases, available evidence comes from a small number of studies implemented in a few settings, at a small scale, over a relatively short period of time, and from evaluations that used weak methodology.
• In particular, there exists a significant gap in understanding how disability leads to extra costs of living and poverty in LMICs, which has direct relevance to informing the design of disability inclusive programmes.