Best practice approaches to ensuring that international development/humanitarian programmes are inclusive of and accessible to people with disabilities need not be costly or complicated. They can be applied across all international development sectors. They include the following.
Mainstreaming disability in development and humanitarian response is broadly defined as the inclusion of people with disabilities in all aspects of development and humanitarian efforts (DESA, 2011, p. 5). It means that disability should be considered in all programming (although disability-specific actions and programming may also be required) (DESA, 2011, p. 5).
Mainstreaming is simultaneously a method, a policy and a tool for achieving social inclusion, which involves the practical pursuit of non-discrimination and equality of opportunity (DESA, 2011, p. 5). Mainstreaming disability is about ‘recognizing persons with disabilities as rights-holding, equal members of society who must be actively engaged in the development process irrespective of their impairment or other status, such as race; colour; sex; sexual orientation; language; religion; political or other opinion; national, ethnic, indigenous or social origin; property; birth or age’ (DESA, 2011, p. 5).
People with disabilities share most basic needs with other people in society, so mainstreaming has been recognised as the most cost-effective and efficient way to achieve equality for persons with disabilities (DESA, 2011, p. 5; Coe & Wapling, 2010, pp. 884-885; Bruijn et al., 2012, p. 25). Experience suggests that an estimated 80 per cent of people with disabilities can be included without any specific additional intervention, or with low-cost and simple community-based interventions that do not require specific expertise (Bruijn et al., 2012, pp. 26, 73).
It is important that efforts to mainstream disability begin with analysis of barriers and careful planning (Coe & Wapling, 2010, p. 884). An evaluation of Norwegian efforts to mainstream disability, for example, found that such efforts were poorly designed and insufficient (NCG, 2012, pp. 76-77). There is a risk that mainstreaming can lead to ‘token involvement of disabled people and the neglect of their self-determination and equality’ if not carried out well (Meekosha & Soldatic, 2011, p. 1394).
The ‘twin track approach’ combines mainstreaming with disability-specific projects needed to achieve the full inclusion and participation of people with disabilities (DFID, 2000, p. 11; DESA, 2011, p. 5; CBM, 2012, p. 15). It is the ‘most commonly referenced approach by UN agencies, bilateral development agencies and NGOs for including people with disabilities in development’ and humanitarian response (Al Ju’beh, 2015, p. 55).
Successful outcomes require emphasis on both tracks, as they complement each other (Al Ju’beh, 2015, p. 55). Often the balance is tipped towards disability specific services in international development, rather than mainstreaming (Al Ju’beh, 2015, pp. 55-56).
Raising awareness and changing attitudes/behaviours
Evaluations of disability inclusion in mainstream development NGOs’ programmes found that ‘challenging staff and community attitudes is the key first step to seeing positive change towards the inclusion of disabled people in development work’ (Coe & Wapling, 2010, p. 881-882; Coe, 2012, p. 404-405; UNICEF, 2013, p. 12; Bruijn et al., 2012, p. 90). Interacting with people with disabilities can result in a positive change in the attitudes and behaviour of those implementing programmes and enable them to better tailor their services to meet the needs of people with disabilities (WRC, 2015, p. 2). Evaluations of disability inclusion efforts by a mainstream development NGO found that positive attitudinal change towards children and adults with disabilities is possible in a relatively short period (Coe, 2012, p. 404).
Bringing disability into the political and social discourse can create awareness and understanding of it at organisational, community and institutional levels, which can promote positive attitudes towards it (DESA, 2011, p. 8; Al Ju’beh, 2015, p. 50; UNICEF, 2013, p. 12; CBM, 2012, p. 15). Greater awareness encourages identification of incidence, type and impact of disability (CBM, 2012, p. 15). This awareness should encompass recognition of the diverse experiences of people with disabilities, and an understanding of the social model and the different barriers people with disabilities face (Al Ju’beh, 2015, p. 50; Coe, 2012, p. 403). It is important to reinforce inclusion messages regularly with all stakeholders (Coe, 2012, p. 405).
Comprehensive accessibility ‘ensures that physical, communication, policy and attitudinal barriers are both identified and addressed’ (CBM, 2012, p. 17). Providing comprehensive accessibility is thought to be ‘an enabler of an improved, participative economic and social environment for all members of society’ (DESA, 2013, p. i, 6; CBM, 2012, p. 15).
See also information on accessibility and universal design.
Reasonable accommodation is defined by the UNCRPD as necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms’ (UNCRPD, 2006, p. 4). It is an important strategy in mainstreaming (WHO & World Bank, 2011, p. 264). It can include:
- structural modifications to facilities;
- use of equipment with universal design features;
- communication in appropriate formats;
- modification of working times or arrangements; and
- alternative models of service delivery (WHO & World Bank, 2011, p. 74).
Requirements for reasonable accommodation can be voluntary or mandatory (WHO & World Bank, 2011, p. 241). In some circumstances, for example where employers bear the cost of providing reasonable accommodations, they may be less likely to hire people with disabilities, although various finical incentives can be offered to counter these obstacles (WHO & World Bank, 2011, p. 242). While accessibility can be realised progressively, reasonable accommodation has potential to be realised more immediately (Schulze, 2010, pp. 55, 62).
Best practices for disability inclusion in development and humanitarian work are ‘participatory, actively and meaningfully involving people with disability in all matters concerning them in the process of forming policies and programmes’ (DESA, 2011, p. 7; see also: Al Ju’beh, 2015, p. 51; Coe & Wapling, 2010, p. 883; Bruijn et al., 2012, p. 38-40; CBM, 2012, p. 15; Smith et al., 2012, p. 11; NCG, 2012, p. 76).
Include all impairment groups
Participation needs to involve all impairment groups and also consider intersectionalities with gender, age, ethnicity and other factors that can contribute to discrimination or exclusion (Al Ju’beh, 2015, p. 51; Coe & Wapling, 2010, p. 883; DESA, 2011, p. 7). It is ‘especially important to ensure the inclusion of the most marginalized groups of persons with disabilities, such as persons with psychosocial disabilities and persons with intellectual disabilities’ (DESA, 2011, p. 7). Not doing so can result in programmes’ impact being substantially reduced as a result of too much emphasis being placed on ‘small selection of the most articulate and least isolated disabled people’ (Coe & Wapling, 2010, p. 883; Bruijn et al., 2012, p. 38). For example, Norwegian aid was found to focus primarily on people with physical/mobility disabilities, with less relevance for other disability groups (NCG, 2012, p. 76).
The mantra of the disability movement, ‘nothing about us, without us’, highlights that organisations should provide services with people with disabilities, rather than for them (Al Ju’beh, 2015, p. 52; Kett & Twigg, 2007, p. 103). DPOs can play an important role in this process: donors should consider helping to address DPOs’ capacity gaps, which are sometimes large (DESA, 2011, p. 7; Wapling & Downie, 2012, pp. 39-47; Kett & Twigg, 2007, p. 104; Bruijn et al., 2012, p. 57; NCG, 2012, p. xviii). For example, an evaluation of Norway’s work on disability inclusion in development found that the most relevant and effective interventions were those supporting advocacy and capacity building of DPOs (NCG, 2012, p. 76). It is also important to be accountable to people with disabilities (DESA, 2011, p. 7).
The involvement and leadership of people with disabilities in community institutions and activities can lead to better attention to their concerns in organisations and programmes, and greater appreciation by other community members of their skills and capacities (WRC, 2015, p. 2; CBM, 2012, p. 15).
People with disabilities can help collect and analyse data. An example of participatory research carried out with people with disabilities is the ‘Voices of the Marginalised’ project, piloted in Bangladesh, which identifies the issues people with disabilities feel are most critical (Burns et al., 2014). The research modelled the process of empowerment itself (Burns et al., 2014, p. 68). However, there is a ‘lack of knowledge of the use of this approach in disability research in non-Western countries’ (Katsui & Koistinen, 2008, p. 747). A review of the literature on the monitoring and evaluation of CBR programmes also found no standard approach to the inclusion of people with disabilities in M&E (Lukersmith et al., 2013).
Best practices for disability inclusion adopt a rights-based approach (DESA, 2011, p. 7; Wapling & Downie, 2012, p. 27; Al Ju’beh, 2015, pp. 86-97; NCG, 2012, p. 77). This means that ‘each mainstreaming initiative should contribute systematically to the implementation of the UNCRPD, which aims to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity’ (DESA, 2011, p. 7; Al Ju’beh, 2015, p. 93). A rights-based approach promotes barrier removal and inclusion in all sectors, including health, rehabilitation, assistance and support, environments, education and employment (DESA, 2011, p. 7). Evaluations of disability mainstreaming in World Vision programmes found that the UNCRPD offered opportunities for good progress because of governments’ adoption of it (Coe, 2012, p. 407).
Legislation plays an important role in enforcing rights, creating minimum standards in accessibility, and ensuring participation (WHO & World Bank, 2011). Technical assistance can build governments’ capacity to put in place or strengthen such legislation (WHO & World Bank, 2011, p.269).
Community-based rehabilitation (CBR) has evolved to become a strategy for rehabilitation, equalisation of opportunities, poverty reduction, and the social inclusion of people with disabilities (WHO & World Bank, 2011, p. 13; UNICEF, 2013, p. 17; CBM, 2012, p. 15). It is increasingly being implemented through the combined efforts of people with disabilities, their families, organisations, and communities, and government and non-governmental services (WHO & World Bank, 2011, p. 13).
There is limited but growing evidence that CBR can improve wellbeing for persons with disabilities and their families (Mauro et al., 2014; Biggeri et al., 2014). Evaluation of CBR programmes supported by Norwegian aid found that local ownership and buy-in made them effective and sustainable (NCG, 2012, pp. 79-80). While CBR is said to have great potential, ‘WHO estimates that CBR still only reaches a small number of all persons with disability’ (Groce & Bakhshi, 2011, p. 1159).
Experience from a number of development NGOs shows that successful disability inclusion requires organisational change (Bruijn et al., 2012, p. 8, 64). It is important that donors emphasise the issue’s importance and NGOs recognise it as an organisational priority to ensure that the appropriate resources are provided (DESA, 2011, p. 8; Coe & Wapling, 2010, p. 884).
Evaluations of attempts to mainstream disability inclusion in a development NGOs’ programming found that ‘early effective training on social model principles is crucial’ (Coe, 2012, p. 403; Bruijn et al., 2012, p. 32). Training carried out by people with disabilities themselves was found to be particularly helpful (Bruijn et al., 2012, p. 34). Wapling and Downie’s report looking at donors and disability inclusion finds that ‘experience shows the most substantial gains are made when donors and development agencies change the way disability is internally defined and understood, when they commit to approaching disability from a human rights-based perspective rather than an impairment-based one, and when the empowerment and support of disabled people’s organizations is central to their strategy’ (2012, p. 13). It is important to secure commitments from senior staff; set concrete organisational targets for disability inclusion; design inclusive budgets; and to collaborate with others (Wapling & Downie, 2012, pp. 27-29; Coe, 2012, pp. 406-407). Inclusion messages need to be regularly reinforced, as there can be a ‘tendency to drift from socially inclusive principles back towards medical/charity model approaches when implementation starts’ (Coe, 2012, p. 403).
Mainstreaming disability takes time, commitment and resources. Donors can benefit from:
- appointing disability champions;
- involving people with disabilities in decision making as advisors;
- including disability in baseline surveys and situational analyses;
- disaggregating data to include numbers of people with disabilities; and
- supporting research linked to disability
(Wapling & Downie, 2012, pp. 29-31; Coe, 2012, p. 400; Bruijn et al., 2012, pp. 68, 91).
Adapting existing programming tools to be disability inclusive has been found to be more effective than providing generic checklists (Coe, 2012, pp. 405-406).
Evaluations of attempts to mainstream disability inclusion in a development NGO’s programming found creating a disability inclusive environment in the organisation itself was essential (Coe & Wapling, 2010, p. 883; Bruijn et al., 2012, p. 69). A more disability-friendly organisation can be created by:
- conducting regular disability awareness training sessions and including it in staff induction programmes;
- hiring more staff, volunteers or consultants with disabilities;
- adapting communication and information systems;
- making offices, workshops and conferences accessible; and
- creating a sense of shared commitment by using access as a starting point for wider discussions (Wapling & Downie, 2012, pp. 33-35; Al Ju’beh, 2015, pp. 63-68).
Case studies of successful disability inclusion
Intentional efforts can quickly achieve a ten-fold increase in the disabled people being included in a mainstream NGO’s programmes: this was one of the findings if a synthesis of the externally evaluated lessons from World Vision’s disability inclusion work (Coe, 2012, p. 404).
Case study resources
The World Report on Disability identifies different strategies for inclusion in various sectors.
A UN Department of Economic and Social Affairs (DESA) report outlines case studies that illustrate best practices at international, regional, sub-regional and national levels for including persons with disabilities in all aspects of development efforts.
An ILO-Irish Aid report outlines case studies of organisations working toward the inclusion of people with disabilities in all spheres of life.
The Zero Project‘s reports collect and profile innovative practises in disability inclusion from around the world. They include information on impact and effectiveness, as well as transferability, scalability, and cost-efficiency (e.g. Balmas et al., 2015; Fembek et al., 2014; Fembek et al., 2013).
The CBM guide to ‘Inclusion made easy’, provides case studies and lessons learned in various sectors.
- Al Ju’beh, K. (2015). Disability inclusive development toolkit. Bensheim: CBM. See document online
- Biggeri, M., Mauro, V., Deepak, S., Trani, J-F., Kumar, J., & Ramasamy. P. (2014). Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya district, in India. Disability & Rehabilitation, 36(18), 1508-1517. See document online
- Bruijn, P., Regeer, B., Cornielje, H., Wolting, R., van Veen, S., & Maharaj, N. (2012). Count me in: Include people with disabilities in development projects – A practical guide for organisations in North and South. Veenendaal: LIGHT FOR THE WORLD. See document online
- Burns, D., Oswald, K., & the ‘we can also make change’ team. (2014). ‘We can also make change’: Piloting participatory research with persons with disabilities and older people in Bangladesh. Sightsavers, HelpAge International, ADD International, Alzheimer’s Disease International, & Institute of Development Studies. See document online
- CBM. (2012). Inclusion made easy: A quick program guide to disability in development. Bensheim: CBM. See document online
- Coe, S. (2012). More practical lessons from five projects on disability-inclusive development. Development in Practice, 22(3), 400-408. See document online
- Coe, S., & Wapling, L. (2010). Practical lessons from four projects on disability-inclusive development programming. Development in Practice, 20(7), 879-886. See document online
- DFID. (2000). Disability, poverty and development. London: DFID. See document online
- DESA. (2013). Accessibility and Development: Mainstreaming disability in the post-2015 development agenda. New York: UN. See document online
- DESA. (2011). Best practices for including persons with disabilities in all aspects of development efforts. New York: UN. See document online
- Groce, N. E., & Bakhshi, P. (2011). Illiteracy among adults with disabilities in the developing world: a review of the literature and a call for action. International Journal of Inclusive Education, 15(10), 1153-1168. See document online
- Katsui, H., & Koistinen, M. (2008). The participatory research approach in non‐Western countries: Practical experiences from Central Asia and Zambia. Disability & Society, 23(7), 747-757. See document online
- Kett, M., & Twigg, J. (2007). Disability and disasters: Towards an inclusive approach. In World disasters report – Focus on discrimination. Geneva: IFRC. See document online
- Lukersmith, S., Hartley, S., Kuipers, P., Madden, R., Llewellyn, G., & Dune, T. (2013). Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disability and Rehabilitation, 35(23), 1941-1953. See document online
- Mauro, V., Biggeri, M., Deepak, S., & Trani, J-F. (2014). The effectiveness of community based rehabilitation programs: An impact evaluation of a quasi-randomised trial. Journal of Epidemiology & Community Health, 68, 1102-1108. See document online
- Meekosha, H., & Soldatic, K. (2011). Human rights and the global South: The case of disability. Third World Quarterly, 32(8), 1383-1397. See document online
- Nordic Consulting Group. (2012). Mainstreaming disability in the new development paradigm: Evaluation of Norwegian support to promote the rights of persons with disabilities. Oslo: NORAD. See document online
- Schulze, M. (2010). Understanding the UN convention on the rights of persons with disabilities. Handicap International. See document online
- Smith, F., Jolley, E,. & Schmidt, E. (2012). Disability and disasters: The importance of an inclusive approach to vulnerability and social capital. The World We Want. See document online
- UNCRPD. (2006). Convention on the rights of persons with disabilities and optional protocol. New York: UN. See document online
- UNICEF. (2013). The state of the world’s children 2013: Children with disabilities. New York: UNICEF. See document online
- Wapling, L., & Downie, B. (2012). Beyond charity: a donor’s guide to inclusion – Disability funding in the era of the UN Convention on the Rights of Persons with Disabilities. Boston: Disability Rights Fund. See document online
- WHO & the World Bank. (2011). World report on disability. Geneva: WHO. See document online
- WRC. (2015). ‘I see that it is possible’: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. New York: WRC. See document online