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Presented at the Disability Innovation Summit: Inclusive Interactions conference organised by the GDI hub on 13 Sept 2023.

Challenges in the development and bringing to market of functional, affordable, high quality AT devices are outlined. The development of the manual standing wheelchair and the lessons learnt in taking it from prototype to market (using the GRID model) are introduced. The challenges of affordability and of awareness of AT including by professionals is highlighted. The work of the National Centre for Assistive Health Technologies (NCAHT at AIIMS, New Delhi) including experience zones of architectural barriers where people can try wheelchars on different surfaces and realise that disability is imposed by the environment is briefly described. Wheelchair skills training and community outings are part of the centre. Other topics mentioned include: the need to normalise disability; the need for collaborations; funders; scalability; fragmented markets and the need to access global markets 

Presented at the Disability Innovation Summit: Inclusive Interactions conference organised by the GDI hub on 13 Sept 2023

ATscale has a goal of reaching 500 million more people, mostly in low and middle income countries, with AT by 2030.

This short talk focusses on major fundamential issues found in the first 2 years of operations:

• Awareness - lack of awareness of AT even amongst health professionals
• Fragmentation - AT is not a sector and is fragmented in types of AT (vision, hearing, mobility etc), in ministries involved (social welfare, health, education etc), in civil society and in the private sector
• Expertise - implementation is a challenge. AT needs to be built as a discipline

Climate change is affecting every region on Earth and already causing irreversible impacts. While it is a global phenomenon, its negative impacts are felt more intensely by poorer countries and poor communities heavily reliant on natural resources and lacking coping and adaptive capacities to deal with a changing climate. Within those poor communities and countries, persons with disabilities are often amongst the most marginalized people. They experience attitudinal, physical and communication barriers that undermine their access to services and opportunities supporting their well-being and resilience. For this reason, they tend to be disproportionately vulnerable to climate impacts, including more frequent and intense disasters, as those exacerbate pre-existing vulnerabilities. Yet, while it is acknowledged that climate change will exacerbate inequity should we fail to ensure inclusive and participatory decision-making processes in climate governance, disability inclusion in climate action largely remains marginally addressed. Persons with disabilities have been historically left out of climate responses at various levels, from local and national country plans to global negotiations occurring at the UN Conferences of the Parties1 (COP).

Nepal is experiencing an increasing number of climate-related disasters, with a global study ranking it as the fourth worst hit country in the world by weather-related loss events in 20172. Urban floods, landslides, extreme heat, storms, drought, and wildfires are very common climate disasters affecting communities across the country, especially rural populations and their natural resource-dependent livelihoods. Nepal’s vulnerability to climate change lies in its varied topography marked by steep terrain and remoteness, its diverse geo-climatic system and social vulnerability, exacerbated by challenges to deliver effective and comprehensive disaster risk reduction and management strategies. To address this serious threat to economic development and prosperity, Nepal has put in place a rich overarching climate change policy framework early on, encompassing dedicated policies and plans, as well as sectoral planning processes integrating climate resilience. Nepal has also established various leadership, coordination, and stakeholder engagement mechanisms to guide climate change policymaking, articulate implementation across the government’s three-tier federal structure, and ensure dialogue with key stakeholders including civil society actors.

Endorsed in 2011, Nepal’s Framework on Local Adaptation Plans for Action (LAPA) is a particularly praised initiative, promoting a bottom-up, inclusive, and flexible approach for integrating climate adaptation and resilience aspects into local planning. This pioneering, community driven process, places the adaptation needs and opportunities of most vulnerable and highly vulnerable groups at the heart of the approach. Gender considerations factoring intersecting factors of marginalization such as age and ethnicity have been given priority in these processes, to address women’s increasing economic insecurity and workload due to climate change. But inclusion of women with disabilities, or persons with disabilities in general in local adaptation planning has not been strongly evidenced to date.

According to Nepal Census 2022, 2.2% of the Nepali Population have some form of disability, mainly a physical disability. However, other sources estimate this figure to be much higher. Nepal ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2008 and passed the Disability Rights Act in 2017, establishing constitutional directives to support persons with disabilities and making it illegal to discriminate based on disability. Yet, perception of persons with disability in Nepal remains generally negative, due to persistent and deep-rooted Hindu religious beliefs associating disability with sinning in a previous life. Women and girls with disability face greater marginalization and discrimination and tend to be hidden away by families. Nepal’s caste system also plays a role in shaping the vulnerability of persons with disabilities. Thus, widespread stigma compounded by the intersectionality of certain factors, combined with structural inaccessibility, create significant barriers to have equal access to resources and participate in decision-making. This tends to translate into poor socio-economic status, poor health outcomes, and no or low education levels, especially among women and girls. Persons with disabilities in Nepal can register under social welfare to access several disability-targeted benefit packages, including a Disability Grant. However, the process tends to be paved with barriers, leading to high exclusion rates.
It is in this context that HI sought to better understand the unique challenges and opportunities for persons with disabilities in the face of climate change in Nepal. This report is intended to inform how persons with disabilities understand and perceive climate change, what is their experience of dealing with climate extremes, what is the impact on their health, livelihoods and support system, and their actual level of inclusion in climate adaptation planning. To capture those perspectives, HI surveyed 388 persons with disabilities across Nepal’s 7 provinces, consulted 20 key informants from the disability movement, government institutions, and the aid sector, and conducted 8 targeted focus group discussions to hear from women, youth, and persons representing diverse disability types. This report is a contribution to the growing evidence base documenting the disproportionate impacts of climate change on persons with disabilities and calling for disability-inclusive climate action at all levels of governance.

Explicitly monitoring the need, use and satisfaction of assistive product (AP) provision is essential to support population health and healthy longevity in ageing/aged countries, like Korea. We present findings from the 2017 Korea National Disability Survey (NDS) on AP access and compare them to international averages, introducing Korea’s data into the wider coherence of global AP research.

Disability and Rehabilitation: Assistive Technology

https://doi.org/10.1080/17483107.2023.2225565 

Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

Indian J Ophthalmol. 2023 May; 71(5): 1804–1809.

doi: 10.4103/IJO.IJO_2652_22

This brief focuses on the use of social behaviour change (SBC) in the Inclusive Futures programme. It includes an introduction to social behaviour change, followed by three examples of how it is being used in our Inclusive Futures work. These examples reflect emerging findings and our approaches as we go forward. The brief is designed to:
•Explain what SBC is and what it can be useful for – particularly when addressing disability stigma and discrimination
•Present examples of how SBC can be used in different ways to support disability inclusion in development programmes

Owing to increased inclusion of young people with disabilities into the private sector in Bangladesh and Kenya, there is an urgent need to find alternative ways to support young graduates with a disability in the workplace with assistive technology solutions. The aim of the paper is to identify barriers for private workplace sectors to use assistive technology to support young graduates seeking, maintaining and retaining employment. This qualitative study adopted the research onion design of Saunders et al. Data were collected usinginterviews and focus group discussions and analysed using thematic analysis. The findings reveal that barriers are linked to seven key person-centred capability themes: the dream, external factors, internal factors, assistive technology vision,strategic design priorities and gaps and assistive actions.

Journal of International Development, Volume 34, No. 5

In November and December 2021, Ground Truth Solutions (GTS) and the International Organisation for Migration’s (IOM) Needs and Population Monitoring unit (NPM) conducted qualitative interviews with persons with mobility and vision impairments from Rohingya refugee and host community populations with the aim of better informing and supporting agencies in developing disability-inclusive programmes and engagement activities. These interviews focused on access to health services, aiming to gain insight into how people with disabilities experience engaging with healthcare services – as well as perceived barriers to access. It also looked at health information needs so that the humanitarian community will be better equipped to identify gaps in programming, deliver more equitable services, and build trust with this marginalised group. To weave tangible experiences into the narrative and bring findings to life, this research took a ‘user journey’ approach to create a set of ‘personas’ derived from key informant interviews with Rohingya and Host Community people with disabilities in Cox’s Bazar, resulting in this highly illustrative report.

Background: The COVID-19 pandemic caused significant challenges to education globally, as schools were closed, and alternative means had to be sought to enable students to continue with their studies. In the resource-constrained setting of Bangladesh, the pandemic impacted on the education of 37 million children (UNICEF 2021), of whom children with disabilities have been amongst the most severely affected. Already disadvantaged compared to children without disabilities in terms of access to education, the pandemic and the challenges of accessing remote learning have deepened inequalities between children with disabilities and their able-bodied peers. This study was undertaken as part of DID Task Order 13 Bangladesh, the goal of which is for girls and boys with disabilities to have equal access to quality education and support. Interventions are based in the two districts of Narsingdi and Siranjganj and the subdistricts of Narsingdi Sadar, Tarash and Sirajganj Sadar. The aim of this research was to explore the experiences of children with disabilities, their parents and teachers in respect of access to learning opportunities during school closures and beyond. Its findings inform the interventions of the project, specifically the support required for individual learners with disabilities and their families as well as for the schools where they are enrolled. Method: This qualitative study was carried out in the three sub-districts of Bangladesh mentioned above and based in schools denoted for project intervention. Children with disabilities were purposively selected from school records to represent a range of ages, grades, type of disability and different sexes. Screening was conducted using the UNICEF Child Functioning Module (CFM). Data was collected between October 2021 and February 2022 and included in-depth interviews with 22 children with disabilities, 23 caregivers and six teachers, as well as through household and school observations. Findings: Based on the CFM, 91% of the children interviewed have difficulties in more
than one functional domain, with the most common being difficulties in controlling behaviour, learning and communication. The study found the CFM to be more sensitive to identification of functional difficulties than the teachers’ assessments. Through the interviews, a range of challenges were raised regarding continuation of learning during the pandemic. Almost all the children mentioned that they missed their schools, and particularly their friends. Caregivers expressed concern about their children being out of touch with their studies, acknowledging that schools provide an environment that helps students learn. When movements were restricted, and children could not go to
coaching classes or be with their friends, some children displayed regressive behaviour such as increased agitation because of the social isolation. One of the most common supports that facilitated learning during school closures was the appointment of private tutors. In addition, family members helped their children study at home. Where teachers were able to visit children and provide structure and support for home learning (in the form of assignments), this significantly contributed to children’s motivation to continue with their education. While the caregivers tried to support their children as far as possible, several factors impacted negatively on learning viz. lack of motivation of children to continue with their studies, inadequate support from teachers and financial constraints undermining the ability of families to cover the costs of education. Especially challenging was the lack of access to technological support and limited time and skills of parents to support their children with disabilities, in addition to their household responsibilities and other children to look after. Although caregivers talked about the lack of support from teachers, the teachers, on the other hand, mentioned that they were not fully equipped with knowledge and skills to appropriately support learners with disabilities. In some instances, children with disabilities were kept behind a grade for not passing their class assessments or were allowed to progress to the next grade without achieving the required competencies. Observations of homes revealed that almost all of the children with disabilities interviewed were living in low-income households, with overcrowding, outside washrooms, minimal furniture and no conducive study areas. Some houses had mud flooring and tin rooves, posing multiple safety and physical barriers for children with disabilities. School visits enabled identification of inaccessible infrastructure, including access roads, entrances and washrooms. Although all of the schools visited had ramps, none of these were fully usable and none had rails. As schools reopen, interviewees identified various strategies that would contribute to encouraging learners with disabilities to return to school and participate effectively in learning. These include specific focus on learners with disabilities by teachers in order to
provide targeted support; ending discrimination against those who do not perform well academically; and differentiation of the curriculum and assessments for learners with intellectual disabilities. These interventions, together with ensuring accessible school infrastructure, will contribute to creating a more enabling environment for learners with disabilities.
Recommendations: The COVID-19 pandemic has further deepened vulnerability of low income families and exclusion of children with disabilities from education. In order to address the potential widening gap that could be created by a surge of dropouts following school closures, various interventions need to be prioritized. These include building on the strategies of resilience already developed by families to support learning of their children; and enhancing parents’ confidence in providing support themselves. In addition,linkages between home and school need to be strengthened and appropriate learning resources made available to children at home, taking cognizance of the inaccessibility of
technology and remote programmes for children with disabilities (both in terms of devices and connectivity). It is essential that teachers’ role in supporting learning at home for children with disabilities be strengthened; and that teachers are equipped with skills to cater for disability and diversity among learners. This needs to be accompanied by removal of barriers in the built environments of schools and their surrounds.