Question & problem
Globally, there are approximately 1 billion older adults (aged 60 years and above) and this number is expected to rise to 1.4 billion by 2030 and 2.1 billion by 2050. Over 38% of older adults have some form of disability. Older adults with disability (OAWD) constitute a heterogeneous group of people with multiple vulnerabilities. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the Sustainable Development Goals (SDGs) of the 2030 Agenda set the pace for the protection and inclusion of OPWD in mainstream development to promote their welfare and overall wellbeing. Social protection is an essential condition for the socio-economic development of all persons, especially marginalized groups such as OAWD. Social protection programmes constitute measures that provide benefits to guarantee income security and access to essential services. There is a paucity of evidence on the inclusion of OAWD into social protection programs, especially in low- and middle-income countries. This brief synthesizes evidence on strategies that work to include OAWD in social protection programmes.
Quote
Recommendations
Key recommendation
Action
Develop services that are client-centred, nuanced, and responsive, by involving OAWD and their families to ensure well-planned client-centred decisions are made in the planning, implementation, and evaluation of the program. Decentralize approaches to social security protection using a bottom-top approach to involve OAWD considering the diversity of the population.
Key recommendation
Action
Develop robust comprehensive eligibility and assessment criteria for social protection to make the program accessible and inclusive of all OAWD. Steps can include a needs assessment, stakeholder engagement (with OAWDs, advocacy groups and policy makers), review and comparison with international standards, clarity on relevant indicators and assessments that are non-discriminatory and capacity-building for those involved in assessing OAWD for eligibility.
Key recommendation
Action
Expand universal pension systems including additional benefits for OAWD to ensure adequacy (by covering disability-related costs) and reach. Train social care staff to facilitate nuanced and proactive approaches to support OAWD as they grow older.
Key recommendation
Action
OAWD should be informed about services available to them through their organizations. Services linked to social protection programmes should be mapped onto the self-identified needs of OAWD and be made accessible and usable to them.
Key recommendation
Action
Delink eligibility for disability benefits from capacity to work. Employ interventions that support or promote employability. Provide incentives to employers to hire OAWD and support their transition into the labour market.
Key recommendation
Action
Provide a legal basis for social services via legislation to ensure that the services are grounded statutorily. Ensure that policy development occurs in consultation with key stakeholders and public participation from OAWD, follows multiple rounds of review and refinement from legal advocates with experience working in livelihood development rights and accompanies an action plan for follow up on implementation and enforcement.
Challenges
Challenge #1: Poor coverage of disability-related needs of OAWD and centralization of the programme
- Most social security programmes especially in low and middle-income countries (LMICs) are mainstream programmes and rarely consider disability-related issues. For instance, social security programmes such as pension systems do not address the full range of costs experienced by OAWD like disability-related expenditure on assistive technology, support, and or assistance.
- Moreover, there is a problem in terms of affordability and appropriateness of healthcare support, especially in LMICs, where little to no healthcare insurance exists and services tend to focus on short-term illnesses and communicable diseases.
- Top-bottom approach to social protection that centralizes programmes available to OAWD, hence the services may not be reflective of the needs of OAWD.
Challenge #2: Limited access to social protection services
- Stringent or vague eligibility criteria for social protection restrict access to social protection services, specifically older and more vulnerable groups.
- Medicalization of assessment for disability benefits systematically excludes other OAWD such as individuals with non-visible disabilities.
Challenge #3: Inadequate resources and human resources for social protections
- In most LMICs, there are limited social protection resources and inadequate services that are unable to provide for the needs of OAWD due to the unavailability of funding allocations, prevalent inequality and discrimination and adapted support systems.
- Inadequate social workforce to support the transition of OAWD as they grow older due to limited opportunities for training that focuses on geriatric care, disability management and age-related issues.
Challenge #4: Insufficient information about social support services available to OAWD
- There is insufficient information about social protection services available to OAWD. If vulnerable groups are unaware of the full range of benefits available to them, it hinders the uptake of the program uptake and its ability to meaningfully impact their social participation and wellbeing.
Challenge #5: Declining income security and employability
- A decline in the ability to work, access, or maintain employment in formal and informal sectors leads to poor livelihood outcomes and further marginalization. One contributor to this challenge is that OAWD are denied access to continual training and skills development opportunities in comparison with their younger peers. This discrimination further exacerbates the cycle of poor livelihood outcomes.
- OAWD also suffer from the lack of workplace accommodations or inclusive practices e.g. physical accessibility tools, and assistive technologies that can help them to fully participate in the workplace.
Challenge #6: Lack of statutory legal framework for social services
- Social protection schemes especially in LMICs lack a legal basis to certify the programmes as statutory. A recent review showed that only 46% and 75% of social protection schemes in the Asia Pacific and Africa respectively were established on a statutory basis. The lack of legislature adds to uncertainty around provisions and a lack of accountability from program administration around the distribution of resources.
Finding the answers
We conducted a review of reviews to analyse evidence from systematic, scoping, and desk reviews on approaches that work to ensure OPWD are equally included in social protection programmes. A literature search was performed in six databases, Web of Science, Embase, CINAHL, APA PsycInfo, Google Scholar, and EBM Reviews from inception to 31st March 2023, using indexed mesh terms. The search identified 887 articles, of which 30 qualified for full-text screening. Subsequently, we included seven studies that met the eligibility criteria. Of the seven studies, four articles provided information from high-income settings, while the remaining three provided data from low- and middle-income settings. The studies reported on various social protection programmes including pensions, cash transfers, in-kind support, fee waivers, subsidies, job protection, and other welfare-based interventions. All recommendations and actions were derived from the included studies and additional references consulted.
Recommendations & actions
Key recommendation
Action
Develop services that are client-centred, nuanced, and responsive, by involving OAWD and their families to ensure well-planned client-centred decisions are made in the planning, implementation, and evaluation of the program. Decentralize approaches to social security protection using a bottom-top approach to involve OAWD considering the diversity of the population.
Key recommendation
Action
Develop robust comprehensive eligibility and assessment criteria for social protection to make the program accessible and inclusive of all OAWD. Steps can include a needs assessment, stakeholder engagement (with OAWDs, advocacy groups and policy makers), review and comparison with international standards, clarity on relevant indicators and assessments that are non-discriminatory and capacity-building for those involved in assessing OAWD for eligibility.
Key recommendation
Action
Expand universal pension systems including additional benefits for OAWD to ensure adequacy (by covering disability-related costs) and reach. Train social care staff to facilitate nuanced and proactive approaches to support OAWD as they grow older.
Key recommendation
Action
OAWD should be informed about services available to them through their organizations. Services linked to social protection programmes should be mapped onto the self-identified needs of OAWD and be made accessible and usable to them.
Key recommendation
Action
Delink eligibility for disability benefits from capacity to work. Employ interventions that support or promote employability. Provide incentives to employers to hire OAWD and support their transition into the labour market.
Key recommendation
Action
Provide a legal basis for social services via legislation to ensure that the services are grounded statutorily. Ensure that policy development occurs in consultation with key stakeholders and public participation from OAWD, follows multiple rounds of review and refinement from legal advocates with experience working in livelihood development rights and accompanies an action plan for follow up on implementation and enforcement.
Policy priorities
To promote the adequacy and reach of social protection services for OAWD, policies are needed to expand pension coverage using a combination of both contributory and tax-financed old-age pensions. Further, disability-related expenditure needs to be covered to ensure adequacy. Moreover, a robust legal framework is required to provide a legal basis for social protection schemes via legislation to ensure that services have statutory certification. Thus, policymakers from the ministries of labour and social welfare, as well as legislators should provide clear leadership and coordinate activities toward improving the adequacy and promoting coverage of social protection schemes for OAWD.
Conclusion
The inclusion of OAWD into social protection schemes has been problematic due to primarily limited access and poor coverage of disability-related needs. Hence, the provision of comprehensive eligibility criteria and client-centred services is paramount to ensuring universal access to effective social protection schemes.
Gaps & research needs
This evidence brief has some limitations as follows. Firstly, the majority of the evidence came from studies conducted in high-income countries. Secondly, there was high heterogeneity in most of the included reviews. Thirdly, some of the included studies in the reviews were not specific to OAWD. Hence, our recommendations are not exhaustive and might not be generalizable to OAWD. Currently, there is limited information about the inclusion of OAWD in social protection schemes, especially in low and middle-income countries. Hence, further studies are required to provide robust information from Africa and Asia.
Acknowledgements
Peer Review: This brief has been reviewed by Ebenezer Dassah, Kwame Nkrumah University of Science and Technology and Onaiza Qureshi, Knowledge Exchange Officer, ICED, LSHTM.
Publication details: © International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, December 2023.
Suggested citation: Sulaiman, S.K. Evidence Brief: What works to ensure older men and women with disabilities are equally included in social protection programmes, Disability Evidence Portal, 2023.