Including People with Disabilities in Development

NANCY ROLLINSON defines disability and examines the issue in relation to poverty and development in Bangladesh.

HANDICAP INTERNATIONAL

People with disabilities are a diverse and heterogeneous group. Defining disability by referring to impairment reflects a medical model within which disability is seen as an individualised concept, a medical condition that a person has and that can be addressed through medical management. This model fails to demonstrate respect for difference and acceptance of persons with disabilities as part of human diversity and humanity (UNCRPD Article 1).1

However, understanding the diverse functional challenges people experience can help in our understanding of how to address barriers to create an environment that enables participation. It is important to ensure that specific needs of a person are met in order to facilitate participation in society. This may be through assistive devices: wheelchair, hearing aid, communication board etc, rehabilitation services, and advocacy and empowerment initiatives challenging contextual barriers to participation: environmental, social, cultural and institutional. This can lead to communities within which people with disabilities are included in society on equal basis with others.

Disability defined
The United Nations Convention on the Rights of People with Disabilities (UNCRPD), ratified by the Government of Bangladesh (GoB) in 2007, provides a reference for persons with disabilities to include: Those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

Key points of the reference:

-Long-term nature of impairment.

-Physical impairment includes reduced muscle strength, deformities, loss of limbs, which often lead to difficulty moving from one position to another and/or one place to another.

-Mental impairment, affecting reasoning and mood, often affects development of relationships with others.

-Intellectual impairment may affect ability to understand and act on information.

-Sensory impairment affecting vision or hearing which may impact on communication: reading, listening to conversations, joining in communications.

Key element of the reference is:

-Interaction of impairment with barriers affects opportunity for equal participation

1. Environmental barriers: the built and physical environment within which we live.

RECU concept: the physical environment may be inaccessible if people are not able to R: reach; E: enter; C: circulate; U: use services in their communities.

* R = reach the services from home. This may be the school, the workplace, the market, the training centre, the flood shelter. Barriers include steep, muddy, narrow pathways and slopes, potholes; overcrowded buses accessed by high steps, lack of seats or resting places; rickshaws that do not want to carry a wheelchair as well as person who uses a wheelchair or who are not able to give extra time for a person with a disability to get on or off the rickshaw; signs giving information, direction, advice, awareness that people are not able to understand.

Reaching services: Steps with 150mm height and 300mm depth and handrails at 850-900mm and 700mm (for children) make moving around the community safe and dignified.

* E = enter the building or service area you wish to use. Barriers include steps, steep ramps, lack of handrails, high concrete platforms protecting against flood or cyclone, narrow doorways, door handles which are difficult to grip, raised threshold at entrance, lack of tactile floor marker to indicate entrance for a person with a visual impairment.

Entering services: a ramp with a maximum gradient of 1:12 should be provided as well as a set of steps at the entrance of all public service centres. Ramps and steps should have handrails at 850-900mm and 700mm (for children) from ground level.

* C = circulate and move about inside the building or area. Barriers include narrow corridors, raised thresholds at entrance to rooms, narrow door widths, lack of resting places, obstacles including furniture or work equipment, signs that people are not able to understand.

* U = use the services and facilities. Barriers include dimensions and design of internal furniture, equipment and communication, eg lack of hand rails in toilets, no seating platforms at tube wells, workbenches that a person is not able to sit on when using a wheelchair because they are too high or do not leave space underneath for legs, a sewing machine that can only be operated by foot rather than hand, instructions and communication not available in a variety of mediums, e.g., written, pictorial, audio, visual for access by people with different communication requirements.

Using services: workbenches 650-800 mm high with a depth of 300mm enable a person who uses a wheelchair to work.

An accessible physical environment makes movement and use easier for all members of the community when following principles of 'universal design'. "Universal design" means the design of products, environments, programmes and services to be usable by all people, to the greatest extent possible, without the need for adaptation or specialised design (UNCRPD). People with disabilities, people who are elderly, women who are pregnant, people who carry heavy loads, children: all benefit from implementation of the principles of universal design.

2. Social and cultural barriers:

a. Negative behaviour from family members, the community, local authorities including prejudice, pity, over protection, and stigma (which may be experienced by persons with disability and their family) leading to exclusion, discrimination and lack of opportunity to realise potential.

b. Social exclusion is often the hardest barrier to overcome and is usually associated with feelings of shame, fear and rejection.

3. Institutional barriers:

a. Policies and acts that do not address the rights of everyone in the community or discriminate against groups, including people with disabilities

b. Poor implementation of international and national legislation promoting the rights of people with disabilities

c. Disability seen as welfare or "specialist" issue

d. Lack of consultation with people with disabilities and their representative groups.2

International facts and figures
The United Nations (UN) estimates 10-12 percent of the world's population, an estimated 600 million people, are living with disability. The figure is more prominent among the poorest in the world, 15-20 percent.3 Approximately 500 million (82 percent) of people with disabilities throughout the world are living in developing countries,4 and 70 to 80 percent of adults with disabilities are without employment and live in great poverty.5 Only 1 to 2 percent of children with disabilities go to school in developing countries (UNESCO); only 1 percent of girls with disabilities are taught reading and writing (UNICEF).

National facts and figures
A disability prevalence survey conducted by Handicap International (HI) and National Forum of Organizations Working with the Disabled (NFOWD) in 2005 found 5.6 percent of the population is living with disability in Bangladesh, 7.9 million individuals in a population of 141.9 million.6 This figure may be lower than UN estimates due to issues including the hidden nature of disability in Bangladesh and subsequent difficulty in identifying individuals. Having a family member with a disability increases the vulnerability of their family; the Asian Development Bank estimates 25 percent of the population in the Asia Pacific region is affected by disability.7

-The actual number of employed persons with disabilities in Bangladesh may be less than 1 percent.8 This represents a significant loss in economic revenue as well as a huge sector of the community that is excluded from contributing to their family, community and country.

-89 percent of children with disabilities in Bangladesh do not receive education.9

The relationship between disability and poverty
People with disabilities are highly over represented among the poor with 82 percent below the poverty line. Poverty is a cause and a consequence of disability: people who are poor often lack resources to prevent malnutrition which may lead to disability, work in hazardous conditions that place them at risk of injury and disability, are at risk during times of disaster and have poor access to health services that may prevent disability. Poverty is a consequence of disability as people with disabilities often lack access to education, health services and income generating activities; they are often denied human, social and economic rights. The relationship between poverty and disability and barriers to participation include lack of empowerment, participation and inclusion within activities to promote social and economic progress.

The disability creation process12
The disability creation proces13 illustrates how risk factors, personal factors, environmental factors and life habits interact with one another. When a person's life habits, including education, livelihood activities, family and community life reflect exclusion and reduced participation they may be considered to be living in a disabling life situation as they are not enabled to contribute to their own self development and that of their families and communities. On the other hand, if enabled to participate and develop life habits, their potential to contribute will be realised.

People with disabilities in situations of disasters
Living in poverty further increases the vulnerability of people with disabilities, and capacity to deal with disasters. Fundamental human rights of persons with disabilities are commonly neglected and unseen in emergencies as well as in development context.

In situations of disasters, the needs of persons with disabilities tend to be overlooked, which can lead to their exclusion from participating in any community response. This makes them highly vulnerable to disasters.

-HI Bangladesh experience in the flood of 2004 showed that 60 percent of people with disability were overlooked during disaster.

-Another survey on coastal areas in Bangladesh shows that many people with disabilities were widely excluded on the grounds of inaccessible shelters and food distribution mechanisms.

-The 2008 cyclone Nargis in Burma disrupted physical, social, economic and environmental networks and support systems and disproportionately affected people with disabilities.14

-In the 2004 Sri Lankan Tsunami only 41 out of 102 people with disability in one community survived, those who died were unable to leave their homes or failed to comprehend in time the need to escape.

People with disabilities are most affected in disaster. Disasters also lead to disability:

After the Asian Tsunami, it was estimated that there was a 20 percent increase in the number of people with disabilities in the affected areas (CBM International 2005). The 2010 earthquake in Haiti has led to 300,000 people with injuries including an estimated 2-4000 amputees.

When a disaster occurs, the immediate emotional effects: shock, numbness, anger, distress are also evident along with physical effects. As the days and weeks go by, the physical effects of the disaster may fade, but the emotional wounds: the wounds to the heart, the wounds to the soul may last. The long term effects of coping and adapting with disaster and/or living in a disaster prone area on mental health are little studied but believed to be significant.

The policy and legislative framework in Bangladesh
In accordance with all national and international commitments/obligations, and under the purview of the National Constitutional provisions, the Government of Bangladesh developed a National Policy on Disability in 1995. This was the first official recognition by the government to the issue of disability as a development agenda. In 14 sections, the policy document described in details what the GOB would like to take up for the development of people with disabilities in this country. The sections are:

The Policy was given a legislative back up by enacting the Disability Welfare Act, which was adopted in the National Parliament in 2001. This was the first time that a national definition and classification of disability was provided. The law outlined the constitution of (a) the National Coordination Committee, chaired by the Minister, Ministry of Social Welfare (MOSW), (b) the National Executive Committee, chaired by the Secretary of MOSW, and (c) a District Committee at each of the 64 administrative districts, chaired by respective Deputy Commissioners.

The law emphasised the necessity to identify all persons with disabilities and provide them with identity cards by the District Committees, which would help them in accessing public and private amenities/utilities, which the GOB stressed in a set of 10 schedules. These are as follows:

Bangladesh was the 91st UN Member State to sign the UNCRPD on May 9, 2007, and the 8th UN Member State to ratify it on November 30, 2007. The UNCRPD is a human rights instrument with an explicit, social development dimension reaffirming that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms. It clarifies how all categories of rights apply to persons with disabilities and identifies areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and where protection of rights must be reinforced.The next year, on May 12, Bangladesh was the 16th UN Member State to accede (ratify without signing) to the Optional Protocol of the UNCRPD. By following this step, Bangladesh expressed its commitment and allegiance to the International Committee on the Rights of Persons with Disabilities as the optional protocol addresses the ability of the Committee on the Rights of Persons with Disabilities to receive and respond to complaints from individuals and groups about violations of the Convention.

According to Article 4-1 (a) and (b) of the UNCRPD, Bangladesh now should amend, update and/or modify its national laws and policies (including its disability related legislation and policies) in the spirit of its content. To this end, a Bangladesh Parliamentarians caucus has been formed with the remit of moving forward the National Forum of Organizations Working with the Disabled (NFOWD) supported review and revision of the Disability Welfare Act 2001, to reflect a rights-based approach and the values and principles outlined in the UNCRPD. To supplement the GoB initiatives for establishing the rights of people with disabilities, many national and international organisations are working to achieve the objectives of the UNCRPD in Bangladesh. Failing to include people with disabilities into development reduces the socio-economic status of many households, increases dependency on social safety nets which are not widely available, perpetuates misconceptions and stigmatisation that people with disabilities are not able to work and contribute to their families and communities, and will hamper Bangladesh in its pursuit of the Millennium Development Goals (MDGs). GoB, donors, NGOs and INGOs are required to ensure that their actions and practices are disability inclusive: "Ensuring international cooperation, including international development programmes, are inclusive of and accessible to persons with disabilities" (UNCRPD Article 27).

1. http://www.un.org/disabilities/documents/ convention/convoptprot-e.pdf

2. http://www.make-development-inclusive.org/

3. World Bank 2004. Disability in Bangladesh: a situational analysis. http://siter esources. worldbank.org/DISABILITY/Resources/Regions/Southpercent20Asia/DisabilityinBangladesh.pdf 4. http://www.cbm.org/en/general/downloads / 19456/Make_Development_Inclusive_Concepts_and_Guiding_Principles.pdf

4. http://www.handicap-international.fr/kit-pedagogique/documents/en/ppt/1basicPWD.ppt

5. UNDP Human Development Report 2009 http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_BGD.html

6. www.ausaid.gov.au/keyaid/disability.cfm

7. http://siteresources.worldbank.org/ DISABILITY/ Resources/Regions/Southpercent20Asia/ JICA_Bangladesh.pdf

8. Centre for Services and Information on Disability. Documentation of Good Practices on Inclusive Education In Bangladesh For UNICEF Regional Office of South Asia www.csidnetwork.org

9. www.dfid.gov.uk/Pubs/files/disability.pdf

10. www.cbm.org/eng/general/downloads/19456 /Make_ Development_Inclusive_Concepts_and_ Guiding_Principles.pdf

11. http://www.ripph.qc.ca/?rub2=2&rub=6&lang =en

12. http://www.ripph.qc.ca/?rub2=2&rub=6&lang =en 13. 2009 GPDD & WB http://gpdd-online.org/news/docs/Impact_of_Climate_Change_on_Disability-Report-Final_012010.doc

13. http://www.ripph.qc.ca/?rub2=2&rub =6&lang=en

14. 2009 GPDD & WB http://gpdd-online.org/ news/docs/Impact_of_Climate_Change_on_Disability-Report-Final_ 012010.doc

Nancy Rollinson, a physiotherapist, is the Disability Technical Advisor for Handicap International Bangladesh. She may be contacted at communication@ handicap-internationalbgd.org.