Disability and Development

We were surprised that the Minister ruled out the possibility of a disability strategy in her evidence to us.

We recommend that DFID introduce a disability strategy. Disability should be a priority for DFID. Its current approach to social impact appraisal, which considers the risk of exclusion across a wide range of marginalised groups, is valuable—but not enough. There remains a danger that disabled people’s interests will be lost among those of groups who are more visible – all the more after the current Minister moves roles. By publishing clear objectives, and timetables, as it has done for gender, the Department can signal its commitment to disability, and help ensure this commitment endures even as key individuals move on. We also recommend that the disability strategy be supported by clear references to disability in all Country Operational Plans, and in the next Bilateral Aid Review.

We welcome DFID’s research into disability, and support its commitment to evidence-based programming. However, as we found in our report on Violence against Women and Girls, DFID should strike a balance between building an evidence base on disability, and implementing programmes. The scale and urgency of the challenge are such that DFID cannot wait for perfect data before embarking on large-scale disability programmes. Rather, DFID should take an ambitious but flexible approach. We recommend that DFID set challenging milestones for implementing more large-scale programmes. It should begin these programmes by piloting, as it has done in Rwanda, so that it can stop any projects that are not working, and rapidly scale up those that are. Similarly, we recommend DFID take a pragmatic approach to funding applications from disability-focussed civil society organisations, and should not let imperfect data prevent it funding promising projects with a clear potential—albeit unproven—benefit. We recommend that DFID continue to undertake research on disability, and monitor closely whether the research is put into practice by DFID and its partners.

We recommend that DFID’s disability strategy state specifically how DFID will reach people with intellectual and psychosocial disabilities through its programmes. We further recommend that DFID cover ageing in the same strategy as disability, given the strong overlaps between the two issues. It should, though, recognise that not all disabled people are older people, to ensure the focus on older people does not eclipse the priorities of disabled children or younger adults.

We welcome the Prime Minister’s commitment to reporting disaggregated data on the number of disabled people who benefit from development programmes. We also commend the steps DFID is taking to make better data available. We recommend that DFID report results disaggregated by disability in all Annual Reviews, Project Completion Reviews and logframes. We also recommend that it disaggregate targets in its Results Framework by disability, as it does for gender. We recognise that collecting data on disability is not straightforward, and teams have many other 60 Disability and development demands on their time, so recommend a pragmatic approach in the short term—for example, using the Washington Group questions. In the medium term, we recommend DFID develop more precise data disaggregated by type of disability. Wherever possible, we recommend that DFID report results disaggregated to show people who belong to several marginalised groups at once (e.g. disabled women), to help tackle the ‘double discrimination’ that such people face.

We welcome the news that DFID plans to introduce further programmes aimed at disabled people. We trust DFID will take our recommendations into account as it develops these plans, and we look forward to hearing an update in the Government’s response to this report.

We warmly welcome the steps DFID has taken to give disabled people greater say in aspects of its work, in particular the fact that it modified some WASH and social protection programmes in response to disabled people’s feedback. The challenge is to do this more consistently across DFID’s whole portfolio. DFID is currently reviewing its programme management, and we recommend it take this opportunity to give disabled people more influence – from programme design through to evaluation and research. DFID should ensure people with all types of disability participate, and should adjust its communications to make sure they are reached. It should consult family and community members as well as disabled people themselves. More specifically, DFID should: • Ensure that disabled people play a prominent role in drawing up DFID’s disability strategy, and help shape its Country Operational Plans. • Seek to give more disabled people visible and senior roles in programme delivery - as already happens at the Kabul Orthopaedic Centre, which DFID helps fund. • Invite DPOs from developing countries to join its disability advisory group, even if only in writing or by telephone.

We strongly welcome DFID’s support for DPOs. However, we are concerned that it is hard for disabled people’s organisations to access funding directly from DFID. We recommend that DFID make its funding more accessible to DPOs. We do not wish to prescribe how DFID does this, but do recommend that it address the main barriers such as information that is not accessible, and complex grant conditions. We are also concerned that, if DPOs can only access DFID funding through intermediaries, DFID is missing a valuable opportunity to train its staff in local disability issues. While we recognise country offices have many calls on their time, we recommend that DFID seek to establish more direct contact with DPOs, which could be an efficient way to tap into local knowledge and networks.

We welcome DFID’s current work to build DPO capacity and to reach out to marginalised groups, and encourage it to ensure this is standard practice in all its work with DPOs. We also recommend that, whenever DFID provides grants to ‘mainstream’ civil society organisations (for example, women’s organisations), it monitor whether they are including disabled people

We encourage DFID to renew its links with UK DPOs, and to consider where their expertise might usefully complement that of NGOs.

We commend the dedication of DFID’s current disability team, but are concerned that DFID has no full-time disability specialists. To ensure its commitments to disability are sustainable, we recommend DFID develop a larger team, with more capacity, including: a senior sponsor; a complement of Social Development Advisors specialising in disability; and a wider network of people to champion disability in each country office. We further recommend DFID ensure all staff are trained in basic principles of disability rights and access to development programmes. It should consider making disability the theme for the next Social Development Advisor team conference. It should also ensure disability specialists are represented in its humanitarian division, as well as in its development work.

We are concerned that DFID only employs 45 staff with a declared disability—and that no locally appointed staff in its overseas offices have declared they are disabled. A visible disabled workforce could be a powerful way to challenge stigma and discrimination, and to get a deeper understanding of the barriers that disabled people face. DFID should investigate why it has not attracted more disabled staff, and should consider whether targets would help it redress the balance in some of its offices.

DFID has taken an important symbolic step with its new commitment to make all directly-funded school buildings accessible to disabled children. However, while this commitment is welcome, it is well-known that accessible buildings are a relatively simple, low-cost, response to disability. If disabled people are to enjoy full access to programmes, donors also need to tackle more stubborn barriers such as information and stigma. We would now expect DFID to show more ambition. We recommend DFID choose one or two substantial sectors (e.g. health or education), and a small number of countries, to focus on. Within these chosen areas, it should then pledge to give disabled people full access to all its programmes.

We recommend that disabled people take the lead in deciding which the sector(s) DFID should to focus on initially. We further recommend that DFID play to its strengths, and select sectors and countries in which it has a strong track record. Although we recommend that DFID take a focussed approach to begin with, we also urge it to set out a long-term timetable showing how it will expand its commitments to more sectors and countries in due course.

We accept that once DFID has chosen to focus on one or two priority sectors, extensive work outside these focal areas could leave it overstretched. Nonetheless, to maximise the impact of its work, DFID should remain alert to important links between sectors, as USAID has done. It should also look out for “quick wins” across its whole portfolio, where a small intervention could have a large multiplier effect on disabled people’s ability to participate

We recommend that, once DFID has decided which sectors and countries to focus on, it should consider in detail the steps needed to combat stigma in these chosen areas. This will allow it to tackle the root cause, as well as the symptoms, of disabled 62 Disability and development people’s exclusion. We also note that overcoming stigma takes time. Echoing our findings on Violence Against Women and Girls, we recommend that programmes designed to tackle stigma last at least five years, with opportunities for further follow- up.

We note that the education of disabled children is a complex area, and that the best approach is not “one size fits all”: DFID’s recent guidance on school buildings does not capture these complexities, but we trust its forthcoming guidance on inclusive education will take a more nuanced approach.

We note that disaggregated reporting is particularly important in programmes that use payment by results, or else these may create perverse incentives not to include disabled people.

We welcome DFID’s support for specialist agencies to help disabled people in recent emergencies. However, if DFID is to reach disabled people in need throughout its humanitarian work, it must also use its influence on UN agencies and large humanitarian NGOs. We recommend that, as a condition of funding, DFID should require all its humanitarian partners to say how they will reach disabled people, and to report the number of disabled people they have helped. To enable partners to reach more disabled people, DFID should increase its support for specialist organisations to provide training for non-specialists. We also recommend that DFID urge the UN to create a central pool of disability experts, similar to the current pool for gender; provide funds for the pool; and encourage other donors to do the same. In addition, we recommend DFID press the UN to endorse cross-sector guidelines on best practice for reaching disabled people in emergencies.

DFID is already taking some welcome steps to help treat or prevent the conditions that cause disability. DFID stands out as one of the only international donors to work on mental health

These programmes are valuable—but they represent a very small share of DFID’s overall health budget

We are pleased that, in choosing how to spend its health budget, DFID takes into account a range of important factors, particularly international guidelines on cost- effectiveness. However, we are concerned that DFID’s approach to health spending may under-state the importance of treating and preventing the conditions that lead to disability.

We recommend DFID issue a guidance note to clarify that, in making difficult decisions on health spending, it is important to look beyond narrow measures of cost-effectiveness. The value of programmes that treat and prevent disabling conditions lies not only in their medical impact, but also in their ability to increase people’s opportunities and potentially lift them out of poverty. We recommend DFID thoroughly appraise the case for spending more in the following areas. If DFID decides not to increase its spending, it should explain its reasons to the Committee. • Mental health care Disability and development 63 • Rehabilitation and basic care, e.g. for people with spinal cord injuries • Provision of assistive devices, potentially joining forces with USAID or other major donors to buy in bulk • Neglected Tropical Diseases • Non-Communicable Diseases • Newborn Health We also recommend DFID gather detailed data on the cost and impact of all its treatment and prevention work, so as to improve the international evidence base on cost-effectiveness.

Dementia is a growing cause of disability in developing countries, and the Prime Minister has called for it to be “at the heart of the development agenda”: we urge DFID and the Department of Health to update the Committee on their plans to accomplish this.

We welcome DFID’s response to the recommendations on road safety in our 2011 report on DFID’s Role in Building Infrastructure in Developing Countries. We also welcome the news that the World Bank will only approve loans to programmes that address road safety. DFID should keep up the pressure on the World Bank to meet its road safety commitments, requiring that all new programmes are supported by a full life-cycle risk analysis, and by monitoring mechanisms to ensure risks are successfully mitigated. We also recommend that it require other multilateral development partners—including development banks and the European Union— to introduce similar road safety policies, as a condition of future UK funding.

Given the links between armed violence and disability, we welcome DFID’s research programme on urban violence in developing countries—the Safe and Inclusive Cities programme.We recommend DFID develop further programmes to tackle armed violence, and target all groups at risk of violence, including young men and older people.

DFID spends more than half of its budget through multilateral agencies. It should exert its substantial influence to ensure this budget is accessible to disabled people. We recommend that DFID require its multilateral partners to demonstrate that they are reaching disabled people, by reporting disaggregated data: the current policy review at the World Bank provides one good opportunity to do this. When DFID conducts its 2015 Multilateral Aid Review, we recommend it include criteria on disability. DFID should also require its partners to show how disabled people— including DPOs and disabled parliamentarians—are participating in programming, from design through to evaluation.

We recognise that the PRSP process is led by country governments. However, we would expect the World Bank to discuss with governments how they plan, through their PRSP, to meet their obligations under the UN Convention for the Rights of Persons with Disabilities. DFID should press the World Bank to do so. DPOs 64 Disability and development participate in PRSP process, and we recommend DFID help them to do this, for example by providing economics training, by sharing relevant research on disability and poverty, or by advising on effective monitoring techniques to ensure that any PRSP commitments on disability are duly translated into practice.

HIV/AIDS is closely associated with conditions that cause disability.This makes the provision of affordable Anti-Retroviral Therapy (ART) all the more urgent. We recommend that, in any forthcoming trade negotiations, the UK press the EU to retain existing flexibilities that facilitate the production of affordable generic ART.

Many DFID partner countries have been slow to implement the UN Convention on the Rights of Persons with Disabilities. We agree with the Minister that it might be counter-productive to make aid conditional on implementing the Convention. However, we recommend the UK take other steps to press for disabled people’s rights—for example, by supporting civil service capacity building, and by sending key messages with Foreign Office travelling ministers. DFID should also consider supporting the UN Partnership to Promote the Rights of Persons with Disabilities. If it decides not to support the Partnership, it should use the funds for other work to promote disabled people’s rights, and should report back to the Committee on its plans.

DFID’s engagement with the private sector creates exciting possibilities for its work on disability.We recommend that DFID require its private sector partners to report on the number of disabled people they employ, and – for services such as credit—the number of disabled people they serve. Reporting requirements should be proportionate—we accept DFID would not want to impose a heavy burden on very small companies. However it should, as a minimum, require such reporting from larger companies supported through CDC Group, the Private Infrastructure Development Group, and the High Level Prosperity Partnerships.

We recommend DFID require all partner companies to produce action plans stating how they will work towards international health and safety standards. If DFID is working with very small businesses, it should provide financial support for any necessary adjustments to meet these recommendations.

Wherever private sector organisations are responsible for delivery of key public services, we recommend that DFID work with partner governments to ensure appropriate regulations are in place for disabled people’s access.

We recommend DFID investigate the feasibility of a Kite Mark standard to recognise disability-inclusive employers. It should report back its findings in its response to this report.

It is important that all UK Official Development Assistance (ODA) is accessible to disabled people, no matter which department is responsible. We recommend all departments that spend ODA put in place measures to monitor the number of disabled people who benefit from their development programmes. This is particularly important for the Foreign and Commonwealth Office, which spends Disability and development 65 most UK ODA outside DFID, and is the lead department on human rights issues.

The post-2015 development framework is currently being deliberated upon by UN General Assembly members. It is vital that this framework secure better outcomes for disabled people than the Millennium Development Goals.

We strongly endorse the High-Level Panel’s emphasis on leaving no-one behind in the next global development framework. We also welcome the proposal to disaggregate data by disability, and consider no goal met unless it is also met for disabled people. The Prime Minister has shown impressive leadership in bringing disability into the post-2015 development process, and we now urge the UK to use all diplomatic channels to ensure this momentum is sustained until the goals are finally agreed.

We recommend that DFID press for the next framework on disaster risk reduction to include explicit references to disabled people, rather than simply vulnerable groups