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Poverty and disability in low- and middle-income countries: A systematic review

BANKS, Lena Morgon
KUPER, Hannah
POLACK, Sarah
December 2017

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Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs).

Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics.

 

https://doi.org/10.1371/journal.pone.0204881

Disability, health and human development

MITRA, Sophie
October 2017

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This book presents new research on disability, health, and wellbeing in four countries (Ethiopia, Malawi, Tanzania and Uganda) . The primary focus is empirical. It also makes a conceptual contribution as it presents a new model of disability based on the human development and capability approach. It addresses four questions: 

  • How should disability be defined to analyse and inform policies related to wellbeing?
  • What is the prevalence of functional difficulties?
  • What inequalities are associated with functional difficulties?
  • What are the economic consequences of functional difficulties? 

Detailed data analysis using large-scale household survey datasets is combined with an interactional model of disability based on Amartya Sen’s capability approach.

 

DOI 10.1057/978-1-137-53638-9

 

First of book series: the Palgrave Studies in Disability and International Development

People with disabilities and income-related social protection measures in South Africa: Where is the gap?

HANASS-HANCOCK, Jill
MCKENZIE, Tamlyn C.
2017

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Background: People with disabilities are at increased risk of poverty, particularly in low-and middle-income countries. However, recent evidence suggests that this association is more nuanced than previously anticipated and that we need better data to understand the opportunity and out-of-pocket costs that diverse groups of people with disabilities may experience.


Objective: This paper discusses if disability is associated with opportunity cost and loss of income both on the individual and household level in South Africa, and if these costs differ depending on disability type and severity.


Methods: For this purpose, the paper analyses General Household Survey 2011 data (people between 15 and 59) using descriptive statistics disaggregated via disability type and severity. The paper also assesses if social grants counteract these costs and reduce economic vulnerability.


Results: The analysis of the data reveals that people with disabilities are affected by issues relating to multidimensional poverty such as lower educational attainment and fewer employment opportunities. In addition, households of people with disabilities (with the exception of milder visual problems) earn significantly less than households without people with disabilities, and this particularly applies to households with people with severe disabilities. This vulnerability also varies by disability type. The country’s social protection mechanisms, in terms of social grants, counteract economic vulnerability to some extent but do not consider the nuanced economic impact of diverse conditions nor the increased out-of-pocket costs related to disability.


Conclusions: This calls for more equitable social protection mechanisms that include accessible services, livelihood programmes and disability benefits.

Teachers’ Perceptions of Disabilities on the Island of Roatán, Honduras

SCHNEIDER, Cornelia
2017

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Purpose: Roatán, a small island in Honduras, is home to six ethnic groups. Due to financial constraints, many children have limited access to schooling. This article is a study on teachers’ perceptions of disabilities and students with disabilities and inclusive education on the island.

 

Method: Twenty seven teachers working in public and private schools, and schools funded by the World Bank, were interviewed in March-April of 2014 in order to explore cultural and social representations of disabilities on the island.

 

Results: The findings show that many of the teachers’ representations can be analysed under the lens of different models of disability - the medical model, the social model, and a religious-moral model. Inclusive education is perceived less as a means of including children with disabilities in the regular classroom, and more as a method of creating institutions to take care of their needs.

 

Conclusion: There is a strong intersection of poverty, post-colonialism and disability which makes working under an inclusive lens very difficult for teachers. The cultural norms influence ideas of normalcy and disabilities, and the blame is on parents for having children with disabilities.

Smarter, greener, more inclusive? Indicators to support the Europe 2020 strategy. 2017 edition

EUROSTAT
July 2017

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The focus of this publication is on showing progress of the EU and its Member States towards the goals and targets defined in the Europe 2020 strategy. The analysis of long-term trends, as described by the strategy’s headline indicators, is accompanied by additional contextual information, which improves understanding of the driving forces behind the developments that these indicators show. The current edition builds upon and updates the previous releases. The publication provides analyses based on the most recent statistics in the five thematic areas of employment, R&D and innovation, climate change and energy, education, and poverty and social exclusion. Each area is analysed in a dedicated chapter. An executive summary outlines the main statistical trends observed in the indicators. Additional country profiles describe the progress of each Member State towards its national Europe 2020 targets

DOI: 10.2785/760192

Making the SDGs count for women and girls with disabilities

UN WOMEN
July 2017

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"In line with several critical areas under thematic review at the High-level Political Forum on Sustainable Development in 2017, this brief underlines the need to mainstream disability into all efforts to achieve gender equality and women’s empowerment (SDG 5); highlights key issues for ending poverty (SDG 1) and ensuring healthy lives (SDG 3) for women and girls with disabilities; and calls for closing data gaps on gender and disability"

Exploring the links between poverty and disability in rural Bangladesh

DAVIS, Peter
May 2017

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This paper explores the links between poverty and disability drawing from 60 qualitative life-history interviews conducted in rural Bangladesh, in 48 households, in three districts, in March 2016. The paper provides insights into the relationship between poverty and disability with the aim of informing policy and practice concerned with both reducing poverty and improving the life chances of people with disabilities. All of the households had a person with a disability as a member, and in three households, two household members had a disability. Mechanisms by which poverty caused or exacerbated disabilities, and also how people with disabilities fell into poverty, were prevented from escaping poverty, and, in some cases, succeeded in escaping poverty are explored. 
 

‘These are not luxuries, it is essential for access to life’: Disability related out-of-pocket costs as a driver of economic vulnerability in South Africa

HANASS-HANCOCK, Jill
NENE, Siphumelele
DEGHAYE, Nicola
PILLAY, Simmi
2017

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Background: With the dawn of the new sustainable development goals, we face not only a world that has seen great successes in alleviating poverty but also a world that has left some groups, such as persons with disabilities, behind. Middle-income countries (MICs) are home to a growing number of persons with disabilities. As these countries strive to achieve the new goals, we have ample opportunity to include persons with disabilities in the emerging poverty alleviation strategies. However, a lack of data and research on the linkages between economic vulnerability and disability in MICs hampers our understanding of the factors increasing economic vulnerability in people with disabilities.


Methods: This article aims to present data related to elements of this vulnerability in one MIC, South Africa. Focusing on out-of-pocket costs, it uses focus group discussions with 73 persons with disabilities and conventional content analysis to describe these costs.


Results: A complex and nuanced picture of disability-driven costs evolved on three different areas: care and support for survival and safety, accessibility of services and participation in community. Costs varied depending on care and support needs, accessibility (physical and financial), availability, and knowledge of services and assistive devices.


Conclusions: The development of poverty alleviation and social protection mechanisms in MICs like South Africa needs to better consider diverse disability-related care and support needs not only to improve access to services such as education and health (National Health Insurance schemes, accessible clinics) but also to increase the effect of disability-specific benefits and employment equity policies.

Being disabled in Britain: a journey less equal

EQUALITY AND HUMAN RIGHTS COMMISSION
April 2017

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"Being disabled in Britain is a review into disability inequality in Great Britain. It builds on the Equality and Human Rights Commission’s statutory five-yearly report on equality and human rights progress in England, Scotland and Wales, Is Britain Fairer?.

We want this report to be used by UK and devolved governments to make improvements to law and policies, by local government to ensure services meet the needs of disabled people, and by disability groups to strengthen their case for change.

The report includes chapters on six areas of life, including education, work, health, justice and participation in politics, looking at where there has been progress and where there are still serious issues to be tackled. It also looks the experiences of those with different impairments and how these impact on people’s life chances"

Guatemala National Disability Study ENDIS 2016 Report

DONICIO Carlos
GRECH Shaun
Islay MACTAGGART
Jonathan NABER
Dr Ana Rafaela SALAZAR DE BARRIOS
Gonna ROTA,
Sarah POLLACK
April 2017

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The Guatemala National Disability Study (ENDIS 2016) was undertaken to address a need for up to date reliable data on disability in Guatemala.

Through a population based survey:

* To estimate the national disability prevalence among adults and children in Guatemala, and to provide regional estimates for 5 broad regions

* To disaggregate the prevalence of disability in Guatemala by age, sex, type of functional limitation and socio-economic status

* To explore the impact of disability on: poverty, quality of life, participation, health and opportunities to go to school and to work amongst children and adults respectively

Through a qualitative study:

* To explore cultural, ideological, and social interpretations and responses to disability; provide insight into the disability and poverty relationship; and examine social, political, and economic dimensions operating within this relationship.

Disability and Climate Resilience: A Literature Review

SMITH, Fred
SIMARD, Mathieu
TWIGG, John
KETT, Maria
COLE, Ellie
April 2017

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"This literature review covers a comprehensive body of literature targeting data from 2007 onwards in low and middle-income countries. It presents evidence from a literature review that retrieved and screened 1,011 articles and 546 grey literature sources. A total of 107 relevant sources were selected from the published and grey literature in accordance with the study design, of which 53 were included in the final review. The paper explains the literature review methodology, discusses concepts and definitions of resilience and introduces key global frameworks relating to climate change, disaster risk reduction and development"

Extra costs of living with a disability: A review and agenda for research

MITRA, Sophie
PALMER, Michael
KIM, Hoolda
MONT, Daniel
GROCE, Nora
April 2017

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Background
There has been a growing interest in disability and poverty on the international research and policy stages. Poverty assessments for persons with disabilities may be affected by the experience of extra costs associated with a disability.

Objective
This article provides a systematized review of the global literature on the direct costs associated with living with a disability at the individual or household level.

Methods
We searched three databases for peer-reviewed journal articles that estimated extra costs associated with disability: Econlit, SocIndex and PubMed.

Results
We found 20 such studies conducted in 10 countries. These studies were predominantly from high-income countries. Although studies were heterogeneous (e.g., in terms of disability measures and cost methodologies), estimated costs were sizeable and some patterns were consistent across studies. Costs varied according to the severity of disability, life cycle and household composition. Highest costs were observed among persons with severe disabilities, and among persons with disabilities living alone or in small sized households.

Disability and Health Journal
Volume 10, Issue 4, October 2017, Pages 475-484
https://doi.org/10.1016/j.dhjo.2017.04.007

Exploring structural violence in the context of disability and poverty in Zimbabwe

MUDEREDZI, Jennifer T.
EIDE, Arne H.
BRAATHEN, Stine H.
STRAY-PEDERSEN, Babill
2017

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Background: While it is widely assumed that disability, poverty and health are closely linked, research falls short of fully understanding the link. One approach to analysing the links between disability and poverty is through the concept of structural violence, referring to social structures that contribute to the impoverishment of individuals or communities. These structures can be political, ecological, legal and economic, among others.


Objective: To explore structural violence and how it affects families of children with cerebral palsy among the Tonga ethnic group living in poor rural communities of Binga in Zimbabwe.


Method: This is a longitudinal, qualitative and ethnographic study. Data were collected over a period of eight years from 2005 to 2013. Data collection techniques were in-depth interviews, participant observation and focus group discussions. Purposive sampling was used to recruit 53 informants.


Results: Structural violence was noted through four themes: internal displacement and development, food and politics, water and sanitation, and social services. Poverty was noted in the form of unemployment, lack of education, healthcare, food and shelter. The concept of structural violence inflicted social suffering on the informants. Politics played a major role in activities such as food withdrawal, lack of water, development and allocation of local resources to ‘the people of the city’, leaving the informants struggling with care.

 

Conclusion: Political and economic forces have structured risks and created a situation of extreme human suffering. The capabilities approach brings out the challenges associated with cerebral palsy in the context of development challenges.

Evaluating the impact of a community–based parent training programme for children with cerebral palsy in Ghana

ZUURMOND, Maria
et al
January 2017

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"Cerebral palsy is the most common cause of physical disability in children worldwide, and yet in most low resource settings there are few services available to support children with cerebral palsy or their families. Research is required to understand the effectiveness of community and/or home based programmes to address this gap. This 2-year study aimed to evaluate a participatory caregiver training programme called ‘Getting to know cerebral palsy’ in Ghana. The training programme consisted of a monthly half-day support group with training, and a home visit, delivered across eight sites in Ghana over 10 months. A total of 76 families and children were included at baseline and 64 families followed up one year later at endline. Children were aged between 18months and 12 years with a mean of 3.8 years and a range of severity of cerebral palsy. Nearly all (97%) the caregivers were female and the father was absent in 51% of families. The study was a pre-post intervention design using mixed methods to evaluate the impact. A baseline and endline quantitative survey was conducted to assess caregiver quality of life (QoL) and knowledge about cerebral palsy and child feeding, health, and nutrition outcomes. Qualitative data was collected to explore the impact and experiences of the training programme in more depth".

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

ACHARYA, Bibhav
MARU, Duncan
SCHWARZ, Ryan
et al
January 2017

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"Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation."

High-Level Political Forum 2017

INTERNATIONAL DISABILITY ALLIANCE (IDA)
2017

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The theme for HLPF 2017 (High-Level Political Forum on sustainable development), 10-19 July 2017, is "Eradicating poverty and promoting prosperity in a changing world". The set of goals to be reviewed in depth will be goals 1, 2, 3, 5, 9, 14 and 17.

Key documents for HLPF 2017

Policy Briefs: HLPF 2017  
Global Report on the participation of organisations of persons with disabilities (DPOs) in VNR Processes 
Accessible Information Communication Technology and Assistive Technologies and Persons with Disabilities 
HLPF 2017: Submission Paper by the Stakeholder Group of Persons with Disabilitie

Issue brief: Making the SDGs count for women and girls with disabilities

UN WOMEN
2017

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The 2030 Agenda for Sustainable Development provides global opportunity and obligation to work towards achieving the Sustainable Development Goals (SDGs) for all women and girls, and address the rights and demands of women with disabilities as a matter of priority. This brief underlines the need to mainstream disability into all efforts to achieve gender equality and women’s empowerment (SDG 5); highlights key issues for ending poverty (SDG 1) and ensuring healthy lives (SDG 3) for women and girls with disabilities; and calls for closing data gaps on gender and disability.

The brief provides the following at a glance facts about women and girls with disabilities:

  • One in five women live with a disability globally
  • An estimated one in four households has a person with disabilities
  • Women are more likely than men to become disabled throughout the course of their lives
  • Women comprise up to three-quarters of persons with disabilities in low and middle-income countries
  • Prevalence of disability is higher among marginalised populations and people in rural areas.

Inclusive disaster risk reduction

LAFRENIERE, Annie
WALBAUM, Veronique
2017

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This policy paper defines the themes of inclusive disaster risk reduction and explains how these activities fit into the HI mandate. It also identifies the target population and defines modalities of intervention–standard expected outcomes, standard activities–as well as monitoring and evaluation indicators.

Pilot testing of 3D printing technology for transtibial prosthesis in complex contexts (Togo, Madagascar and Syria)

CONICAVE, Jerome
TAN, Daniele
2017

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In January-October 2016, Handicap International carried out a pilot testing of 3D printing technology for transtibial prosthesis in Togo, Madagascar and Syria. The aim of the study was to explore and test how physical rehabilitation services can be more accessible to people living in complex contexts via innovative technologies (such as 3D printing, treatment processes that use Internet technology and tools) and decentralised services by bringing them closer to the patients. This scientific summary provides the context, the objectives, the methodology, the results of the study, and perspectives for the future.

A number of technical appendices are available

RS/05

Global report on the participation of organisations of persons with disabilities (DPOs) in VNR (voluntary national review) processes

INTERNATIONAL DISABILITY ALLIANCE (IDA)
STAKEHOLDER GROUP OF PERSONS WITH DISABILITIES
2017

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"This global report raises awareness for DPOs and how to engage with their governments in the national consultation processes on SDG implementation. This case study features the volunteering countries of Argentina, Bangladesh, Denmark, El Salvador, Ethiopia, India, Indonesia, Italy, Kenya, Nigeria, Peru, Sweden and Togo.

The information summarised in the country chapters was derived from DPOs and partners working at the national level on SDG implementation and information may be subjective. The country chapters are structured to include; status of persons with disabilities, engagement in the voluntary national review process, thematic issues--poverty alleviation, healthcare, women with disabilities and accessibility—and analysis of the submitted VNR report

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