How can social protection responses to COVID-19 be made disability inclusive?

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Question & problem

The COVID-19 pandemic and strategies essential for its containment are resulting in severe strains on economies, particularly in low- and middle-income countries (LMICs). These impacts will be felt most by groups already in or at risk of poverty, including the estimated 1 billion people with disabilities globally. Interventions to address the short- and long-term economic effects of the pandemic are urgently needed. Some countries have begun implementing or announced plans for interventions addressing the economic impacts of COVID-19, such as food assistance, emergency cash transfers, unemployment assistance or expansions to existing social protection programmes. As these programmes are developed, it is important to consider the extent to which their design and delivery is inclusive of people with disabilities. Failure to adequately include people with disabilities in this process will lead to widening inequalities.

Quote

“Given the emphasis placed on social protection as an important development tool for spurring and equalizing social and economic growth… there is a pressing need to determine whether these programmes are adequately reaching persons with disabilities and whether participation is producing the desired impacts among this group.”
Banks LM et al 2017

Recommendations

Eligibility criteria should be reviewed to avoid the widespread exclusion of people with disabilities in need of support during COVID-19.

Key recommendation

Programmes must consider whether their eligibility criteria are disability-inclusive.

Action

Eligibility criteria based on poverty must take into account disability-related extra costs (e.g. raising poverty line for applicants with disabilities, offering separate programmes to cover these costs). Eligibility criteria based on disability should ensure the definitions and assessment procedures are in line with the UN Convention on the Rights of Persons with Disabilities (e.g. based on functioning rather than impairments). Assessments should use trained community informants rather than medical personnel, where possible.

Application procedures and facilities for social protection and relief interventions must be accessible to people with all types of disabilities.

Key recommendation

Application procedures for social protection and relief interventions need to be designed with accessibility to people with disabilities in mind.

Action

All components of the application process must be accessible and inclusive for people with disabilities e.g. ensuring that physically accessible facilities; application materials and information is available in accessible formats such as screen-reader compatible, simplified texts and recordings. It is important that staff are also trained on disability and provided with additional support for for effective consultations.

Mechanisms for delivering social protection and other must be accessible and support the agency of people with disabilities

Key recommendation

The mechanisms of delivering benefits, and information on how to use them need to be accessible to and support the agency of people with disabilities.

Action

Ensure in-person and electronic delivery points and procedures are accessible. Transfer benefits directly to the recipient except in clearly defined circumstances e.g. children, people with severe intellectual/cognitive impairments, or where requested by the recipient.

The content of COVID-19 economic responses must be relevant to people with disabilities and adequate to meet their needs.

Key recommendation

The content of COVID-19 economic responses must be relevant to people with disabilities.

Action

Programmes should consider the needs and situation of people with disabilities when designing benefit packages and offer relevant adaptations e.g. through temporary employment schemes with alternatives to manual labor, unemployment insurance covering the informal sector and adjusted benefit levels to offset extra costs of disability. Meaningful consultations with people with disabilities during programme development and a rapid review of the economic challenges experienced by people with disabilities during the COVID-19 pandemic could help inform the development of disability-relevant social protection and economic relief interventions. Further, monitoring of programmes should track access and impact by disability status.

Social protection should be coordinated with other sectors and actors to develop complementary interventions

Key recommendation

Programmes should coordinate social protection and relief interventions with other sectors and actors so as to address environmental and social barriers that make it difficult for people with disabilities to meet their basic needs and improve their livelihoods.

Action

Programmes must consider both the financial and non-financial barriers people with disabilities face in meeting their basic needs and improving their livelihood. Some of these barriers may be addressed through social protection. Other barriers such as negative attitudes and inaccessible environments however, may require coordination with other sectors/actors to develop complementary or adapted interventions e.g. through food delivery where purchasing food is challenging, training of healthcare and other essential workers on disability-inclusion.

Challenges

Challenge #1: People with disabilities are disproportionately affected by economic downturns, and households affected by disability are less resilient to shocks.

  • The COVID-19 pandemic has led to economic pressures for many households, such as the loss of income from disruptions to work and increased spending.
  • Prior to the pandemic, people with disabilities were more likely to be living in poverty and have lower incomes and higher expenses than people without disabilities – circumstances which the crisis have exacerbated.

Challenge #2: Eligibility criteria for social protection and other interventions may exclude people with disabilities in need of support

  • Many programmes are targeted to people living in poverty. However, common strategies for determining who is poor underestimate poverty amongst people with disabilities. Importantly, eligibility criteria for poverty doesn’t take into account disability-related extra costs. This means that the income which people with disabilities do have does not go as far as for a person without disability who doesn’t have to pay for these goods and services.
  • Some programmes include having a disability as an eligibility criteria. However, the definition of disability and assessment procedures can exclude many people with disabilities. Additionally, assessment procedures often require documentation of a clinical impairment, which is not in line with widely accepted definitions of disability and are difficult to obtain when, particularly during COVID-19, health services are limited.

Challenge #3: Enrolment procedures for social protection and relief interventions can affect access to programmes for people with disabilities.

  • Previous studies have found many people with disabilities are not enrolled in schemes they are eligible for.
  • Frequent challenges include to participation in social protection schemes for people with disabilities include: poor awareness of available programmes, lack of information and communication in accessible formats, misconceptions and stigma of disability amongst programme staff, urban-based and physically inaccessible application points, and financial and administrative difficulties gathering necessary documentation, particularly for medical assessments of disability.

Challenge #4: People with disabilities can face challenges receiving social protection benefits once enrolled in programmes.

  • Reasons include difficulties such as travel to delivery points or unpredictable delivery schedules.
  • Electronic delivery (e.g. cash transfers sent using mobile money) are being trialled in some countries. Little evidence is available on if these platforms are accessible for people with disabilities.
  • Benefits are often controlled by other family members, rather than by the recipient with a disability.

Challenge #5: The content of many social protection and economic relief programmes is often not relevant or inadequate to meet the needs of many people with disabilities

  • Some programmes may not be relevant to many people with disabilities. For example, temporary employment schemes often focus on unskilled manual labour, which would not be suitable for most people with physical impairments. Similarly, people with disabilities are overrepresented in the informal sector, and so many would not benefit from unemployment insurance focused on formal sector workers only.
  • Relief packages may be insufficient to meet the needs of people with disabilities. For example, they often do not consider disability-specific needs (e.g. access to disability-related health and social services, coverage of disability-related costs, overcoming barriers such an inaccessible environments and discrimination).

Finding the answers

This evidence brief builds off of a 2017 systematic review on access to and impact of social protection amongst people with disabilities in LMICs, which reviewed 15 peer-reviewed articles. It is also informed by a 2019 PhD on disability and social protection in LMICs and recent in-depth research on disability, poverty and social protection programmes conducted in multiple LMIC settings (Maldives, Tanzania, Nepal, Vietnam, Peru, Lesotho, Bangladesh, Kenya).

Recommendations & actions

Eligibility criteria should be reviewed to avoid the widespread exclusion of people with disabilities in need of support during COVID-19.

Key recommendation

Programmes must consider whether their eligibility criteria are disability-inclusive.

Action

Eligibility criteria based on poverty must take into account disability-related extra costs (e.g. raising poverty line for applicants with disabilities, offering separate programmes to cover these costs). Eligibility criteria based on disability should ensure the definitions and assessment procedures are in line with the UN Convention on the Rights of Persons with Disabilities (e.g. based on functioning rather than impairments). Assessments should use trained community informants rather than medical personnel, where possible.

Application procedures and facilities for social protection and relief interventions must be accessible to people with all types of disabilities.

Key recommendation

Application procedures for social protection and relief interventions need to be designed with accessibility to people with disabilities in mind.

Action

All components of the application process must be accessible and inclusive for people with disabilities e.g. ensuring that physically accessible facilities; application materials and information is available in accessible formats such as screen-reader compatible, simplified texts and recordings. It is important that staff are also trained on disability and provided with additional support for for effective consultations.

Mechanisms for delivering social protection and other must be accessible and support the agency of people with disabilities

Key recommendation

The mechanisms of delivering benefits, and information on how to use them need to be accessible to and support the agency of people with disabilities.

Action

Ensure in-person and electronic delivery points and procedures are accessible. Transfer benefits directly to the recipient except in clearly defined circumstances e.g. children, people with severe intellectual/cognitive impairments, or where requested by the recipient.

The content of COVID-19 economic responses must be relevant to people with disabilities and adequate to meet their needs.

Key recommendation

The content of COVID-19 economic responses must be relevant to people with disabilities.

Action

Programmes should consider the needs and situation of people with disabilities when designing benefit packages and offer relevant adaptations e.g. through temporary employment schemes with alternatives to manual labor, unemployment insurance covering the informal sector and adjusted benefit levels to offset extra costs of disability. Meaningful consultations with people with disabilities during programme development and a rapid review of the economic challenges experienced by people with disabilities during the COVID-19 pandemic could help inform the development of disability-relevant social protection and economic relief interventions. Further, monitoring of programmes should track access and impact by disability status.

Social protection should be coordinated with other sectors and actors to develop complementary interventions

Key recommendation

Programmes should coordinate social protection and relief interventions with other sectors and actors so as to address environmental and social barriers that make it difficult for people with disabilities to meet their basic needs and improve their livelihoods.

Action

Programmes must consider both the financial and non-financial barriers people with disabilities face in meeting their basic needs and improving their livelihood. Some of these barriers may be addressed through social protection. Other barriers such as negative attitudes and inaccessible environments however, may require coordination with other sectors/actors to develop complementary or adapted interventions e.g. through food delivery where purchasing food is challenging, training of healthcare and other essential workers on disability-inclusion.

Policy priorities

Meaningful consultations with people with disabilities and disabled people’s organisations, and the inclusion of people with disabilities in positions of leadership at the policy level, is imperative if the needs and priorities of people with disabilities are to be represented. Fiscal policy responses, as well as service-oriented ones during the COVID-19 pandemic, must have a disability lens applied to them prior to finalisation and implementation. Countries implementing policy in response to COVID-19 must do so with a view to ensuring that mainstream policy provisions are inclusive of people with disabilities, and specific policy provisions are made which reflect the needs and priorities of people with disabilities.

Conclusion

People with disabilities will be disproportionately affected by the economic implications of the ongoing COVID-19 pandemic unless responses are disability-inclusive in their design and implementation. This may include meaningful consultations with people with disabilities, leadership at the programme and policy level, appropriate budgeting and monitoring of progress through routine collection of data on disability.

Gaps & research needs

Rapid research is urgently needed to understand the social, economic and health-related impacts of the current COVID-19 pandemic on people with disabilities, including in LMICs. Additionally, research is needed to explore the extent to which people with disabilities are accessing social protection and other relief interventions designed to mitigate the impact of COVID-19, including barriers and enablers to enrolment. Further, evidence is needed on the impact of these interventions amongst people with disabilities, to assess whether they are adequate to meet the needs of recipients with disabilities and any areas for improvement.

Acknowledgements

The evidence synthesis and recommendations presented here previously appeared in Banks, L.M., Davey, C., Shakespeare, T., & Kuper, H. Disability-inclusive responses to COVID-19:  Lessons learnt from research on social protection in low- and middle-income countries. World Development. under review.

Publication details: © London School of Hygiene & Tropical Medicine, June 2020.

Suggested citation: Lena Morgon Banks & Xanthe Hunt. How can social protection responses to COVID-19 be made disability inclusive?  Disability Evidence Portal, 2020.

Disclaimer: The views expressed in this publication are those of the author/s and should not be attributed to the Disability Evidence Portal and/or its funders”