Disability Inclusive Development for achieving SDGs in Nepal

Introduction

The Sustainable Development Goals 2030 aim to leave no one behind. They acknowledge persons with disability should be included in all aspects of development. People with disability are mentioned in several places of the document including the preamble. It emphasizes vulnerable groups, including people with disability, should be empowered to be able to participate in the development process, not just as recipients but as active contributors. Paragraph 23 of the document states, People who are vulnerable must be empowered. Those whose needs are reflected in the Agenda include all children, youth, persons with disabilities (of whom more than 80 percent live in poverty)”. Though there are only a few references to people with disability, it is obvious that all 17 goals are related to people with disability and without their involvement in all goals the SDGs cannot be achieved.

 Disability-inclusive development means all stages of the development process must be inclusive of and accessible to persons with disabilities. It requires all persons to be afforded equal access to education, health care services, work and employment, social protection, among others[1].

An inclusive approach seeks to identify and address barriers that prevent any person, including people with disabilities, from participating in and benefiting from development. The explicit inclusion of people with disabilities as active participants in the development processes leads to broader benefits for families and communities. It reduces the impact of poverty and positively contributes to a country’s economic growth.

Components of Inclusive Development

Inclusive education:  requires that children with disabilities be included in education, including early childhood learning. Participants need teachers who are trained and capable of delivering age-appropriate learning. Educational infrastructure needs to be accessible and the provision of suitable accommodation is ensured.

Inclusive health services:  require accessible buildings and equipment, appropriately trained health care providers and accessible information. In the case of children with disabilities, comprehensive early assessments should be provided, and identification and referral systems should be in place.

Inclusive livelihood:  persons with disabilities require access to vocational training, skills development and employment support programs. Work opportunities in the communities where people live to ensure people with disability can engage in employment, including rural and remote areas. Such opportunities also improve social networks and support mechanisms for a whole of community approach.  

Empowerment and Participation: People with disabilities are required accessible training and support to participate in family, social and political life. Accessible legal services are necessary for effective participation in family and community life and must be monitored effectively.

The importance of disability-inclusive development

Development efforts should benefit everyone. Emphasis must be placed on the participation and engagement of most vulnerable groups, such as persons with disability, to ensure Sustainable Development Goals (SDGs) are achieved. People with disabilities are the largest and most disadvantaged minority in the world. They make up 15 percent of the global population (about one billion people)[2], with most extended families caring for someone with a disability.[3] This has particular implications for women and girls who are typically the primary carers for family members with disabilities. Having a family member with a disability can heighten gender inequality within the household and limit women’s and girls’ opportunities for education and employment. This in turn undermines their ability to contribute to poverty reduction and household economic growth.

The link between disability and poverty is clear, with 80 percent of people with disabilities living in developing countries[4], and one in five of the world’s poorest have a disability.[5] Furthermore, people with disabilities and their families are more likely to be poor and remain poor as a result of higher living costs, barriers to participation in education, health and employment, and unpaid caring responsibilities.

Economic opportunities for people with disabilities are often limited by inaccessible education, resulting in lower educational attainment, poorer health, and lower employment rates. This has an impact at individual, household and national levels, with national economies losing an estimated five percent of the gross domestic product when people with disabilities do not have equal access to employment (this cost is greater when indirect costs, such as caregivers’ lost wages, are taken into account).[6]

The above factors highlight the importance of enabling people with disabilities and their families to lift themselves from poverty through accessible and appropriate health services, and education and employment opportunities. This requires concerted efforts to overcome stigma and discrimination in order to recognize the value and capacity of people with disabilities. Disability-inclusive development enables people with disabilities to participate on an equal and equitable basis to realize their full potential. This enables countries to harness the potential contribution of all citizens, maximizing opportunities for poverty reduction and sustainable economic growth. People with disability have so many barriers to attaining equal participation, that the concept of equity is required to ensure equal participation.

Twin-track approach

Disability Inclusive Development (DID) involves a twin-track approach, being:

1.  Mainstream approach—actively including people with disabilities as participants and beneficiaries of development efforts across all sectors.  Actively including people with disabilities in mainstream development efforts to ensure broader systems, policies and services include and benefit people with disabilities.

2. Disability-specific approach—targeting issues specific to disability to develop initiatives designed specifically for the benefit of people with disabilities.

The targeted effort is required to address barriers and exclusion experienced by people with disabilities and to accelerate efforts towards disability inclusion. Targeted efforts include providing disability-specific support and services, such as:

•   rehabilitation services including assistive devices to support mobility and independent daily living

•   assistive technology to enhance communication

·            transport services to facilitate access to health, education, livelihood and social participation.

•   life skills, leadership and vocational skill development training programs for people with disabilities to build their capacity to participate more fully in home and community life..

Inclusive development requires accessible accommodation, including trained support workers, and modifications and/or adjustments that align with universal design recommendations. Sign language interpreters, accessible transport, accessible formats for documents, to name a few examples of inclusive development practice. As can be seen, a disability-specific approach enables persons with disabilities to enjoy and exercise all human rights and fundamental freedoms on an equal basis to others, as outlined in CRPD.[7]

Way forward

Data Collection: The first step towards DID is reliable data and information. Reliable information is necessary to formulate an inclusive plan that does not leave people behind.  Data must also be inclusive of the most vulnerable, to ensure future planning considers essential services for all. Gathered data needs to be disaggregated by gender, geography, disability, and other categories, to ensure no group is left behind. It adds that such disaggregation should be part of all targets. Since 2001, a worldwide effort has been made to collect internationally comparable disability data through the UN's Washington City Group on Disability Statistics. Some countries are yet to act on this, including Nepal. UNCRPD and SDG both highlighted the importance of data collection.

Preparing human resources: As of now, Nepal does not have an accredited training programme for CBR/disability workers. The availability of trained professionals such as Physiotherapists is limited and mostly confined to the cities. Small training programs facilitated by local government and NGOs have no clear coordinated or standardized practice to support a systematic approach to disability identification, early detection and prevention. This results in ambiguous data being collected by health posts and minimally trained/qualified workers. These concerns extend to the education system, where teachers receive very little or no training in inclusive education, and are provided with few resources to create a classroom inclusive of children with a disability. 

A program is needed to build the capacity of national and local government, in collaboration with NGOs for the development of an accredited training program for Multi-Purpose Rehabilitation Workers (MPRWs) to be employed across local health, education and livelihood services.

 Therefore, government, in consultation with active NGOs working in this field, should initiate a training programme to produce enough Multi-Purpose Rehabilitation Workers (MPRWs).

Increasing physical access and access to information/communication: In recent years the Nepali government has taken initiative to make physical infrastructure accessible to people with disability. However, this has been limited to installing a ramp at the entrance to buildings. Many of these ramps have not been constructed to a recommended universal standard. Many roads and paths leading to essential services are inaccessible for people with disability, elderly people, pregnant women, people with small children.  Engineers, architects and construction workers require training on universal design.

Access to WASH, meeting and training venue and access to information and communication is frequently ignored. Students do not receive braille books and audio materials and there are few sign language interpreters. Government should pay attention to developing materials and human resources.

Increasing access/availability and quality of assistive devices: Assistive devices available in Nepal are mostly donated or sponsored through international aid. Such support does not allow for individual needs or customized options that meet the needs of the individual person. In many cases children with disabilities are provided with adult size wheelchairs, often resulting in poor posture and long-term irreparable damage to the individual. The supply of vision and hearing devices is limited and the quality of hearing aids varies. Many brands are expensive beyond the purchasing capacity of the people who need them.

Government should, under the ministry of health, identify a focal point to make an appropriate assessment of the need of such devices and supplies as per the prescription by the relevant doctors.  In each province, an orthopedic appliances workshop should be established in attachment with the government hospitals.

Increasing opportunities for vocational skill development and employment: Disability is a cause and consequence of poverty. In developing countries, it is hard for people with disability to get decent work due to their low level of education and lack of vocational skills. Government should invest in developing the appropriate vocational skill for people with disability. Existing trade schools, under CTEVT should make sure that their training programme is accessible for people with disability. The reservation quota should be closely monitored to ensure people with disability are able to access the opportunities they are entitled to. The provision of soft loans through local co-operative would be good for self-employment.

Conclusion:

The SDGs cannot be achieved if people with disability are left behind. Governments need to take proactive action to ensure people with disabilities are included in their plans from the federal to local level. Accessibility is a pre-condition to inclusion for people with disability and many other people i.e. senior citizens, people with chronic health conditions, children and pregnant women. People with disabilities, provided opportunity, can contribute in the development of the national workforce and contribute to the capacity development of the community at large. Addressing disability needs multi-sectoral collaboration and engagement of all stakeholders (government, NGOs and private sector) to ensure no one is left behind.

[1] World bank

[2]      World Bank and World Health Organization, World Report on Disability, 2011, p. 261.

[3]      ibid., p. 3.

[4]      United Nations Enable, Factsheet on Persons with Disabilities, viewed 23 January 2015, <http://www.un.org/disabilities/default.asp?id=18>.

[5]      World Bank and World Health Organization, World Report on Disability, 2011.

[6]      International Labour Organization, The Price of Exclusion: the Economic Consequences of Excluding People with Disabilities from the World of Work, Geneva, 2009, Table 65, p. 4.

[7]      CRPD, Article 2, viewed 23 January 2015, <www.un.org/disabilities/convention/conventionfull.shtml>