Is disability really on the development agenda?

Bill Albert and Michael Turner conducted a review of the official disability policies of major governmental and international development agencies for the Disability KaR Programme. Below are the main findings.

The adoption by the United Nations in 1993 of the Standard Rules on the Equalization of Opportunities for Persons with Disabilities was an important official international recognition of the need to address the social and economic exclusion of disabled people. Rule 21 specifically refers to international cooperation and obliges States to ensure that measures to achieve the equalisation of opportunities of disabled people are fully integrated into general development programmes.

However, disability is not specifically mentioned in the Millennium Development Goals (MDGs). Perversely, this omission may have served as a catalyst for many people and organisations to affirm or reaffirm the links between disability and poverty.

Of course, such concerns, together with the argument that disability is essentially a human rights issue, have been around for some time and these form the principles of the international disability movement, whose lobbying has helped move disability up the development agenda.

In recent years, a number of development agencies have produced statements and policy documents about disability and development, the World Bank, the EU, UK and Italy among them. It is important to consider if these pronouncements, or indeed the basic tenets of the Standard Rules, are reflected in the official policies adopted by the leading development agencies.

Approaching the research

Finding out about existing official policies was not an easy task. Websites were consulted, followed up with emails, letters and/or telephone calls, with mixed success. While some organisations had disability policies, many had either never been implemented or had never made it to project level. Another difficulty was that many agencies have produced documents on disability and development, the status of which was unclear. The existence of documents is not necessarily evidence of official policies, let alone action.

Conversely, not having an official policy does not mean that an agency is necessarily ignoring disability issues entirely. The UK Department for International Development (DFID) is an example of this. Its 2000 Issues Paper Disability, poverty and development, which seems to have become better known outside than inside DFID, is not a policy statement. However, DFID funds a variety of disability activities.

The research sought answers to the following:

• How is disability defined?
• What is the approach employed to tackle disability once it is defined?
• How is disability seen with respect to the MDGs?
• How is disability seen in terms of the process of multilateral development i.e. Poverty Reduction Strategy Processes (PRSPs) and Sector Wide-Approaches (SWAPs)?
• Is disability mainstreamed?
• . What is the view of the role of disabled people's organisations (DPOs) in terms of policy formation and/or project development?

Unfortunately, due to gaps in the information available, it was not possible to tabulate findings in a comparative manner across the entire range of issues.

How is disability defined?

A clear definition of disability would seem to be central to designing a disability policy or strategy. If disability is seen essentially as a health issue the solutions will be quite different from an understanding of disability that highlights human rights, discrimination and exclusion. It was, therefore, surprising to find so little serious attention paid to this question. Attempts at a definition mostly consisted of a compromise between the different, quite opposed, social and medical models of disability.

The new International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization (WHO) seems set to become the gold standard for defining disability. It is referred to by the World Bank, and the Asian Development Bank also appears to be taking it on board.

However, the ICF is not unproblematic; even though disability ('disablement' is the word used in the ICF) is viewed as arising from the negative impact of the environment in its broadest sense, the minute classifications of health and functioning remain central. Many critics have argued that the ICF represents medical model thinking clothed in watered-down social model language. It is doubtful whether it will overturn deeply-held medical assumptions about the nature of disability. Because such assumptions tend to inform action, there is the strong possibility that in practice international development agencies will default to a health-centred understanding of disability. The only way this will be avoided is by retaining an ongoing, critical awareness of the contradictions inherent in the ICF together with a vigorous commitment to human rights supported by clear practical guidance for implementation.

Approach to disability issues

The majority of agencies that have policy statements advocate a human rights approach. The increasing focus on this agenda follows decades of lobbying by disabled people, the lead given by the UN, particularly since the Standard Rules of 1993, and the more recent negotiations on an International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities. The commitment to a human rights approach is also prominent in the policy statements of Scandinavian countries.

Scandinavian DPOs and their countries have played a leading role in putting human rights at the heart of disability and development. In 2000 in Copenhagen, the Nordic ministers for development cooperation declared to: 'Recognise and promote the UN Standard Rules [#133;] and to assure that special measures are taken to create accessibility and participation in development society for persons with disabilities in order to strengthen their possibilities to exercise their human rights.'

However, there has been criticism that, with the exception of Norway, there has been a failure overall to establish national strategies for inclusion of the disability dimension in the development cooperation. Denmark decided not to make mainstreaming disability a priority.

Outside Scandinavia, a number of European countries have indicated that they are considering disability and development policies, but only Italy has produced one. The Italian guidelines are comprehensive, if at times eclectic. They begin with strong statements on the centrality of human rights and then detail how disability needs to be twin-tracked - both mainstreamed into overall policy and supported through disability-specific projects.

In the United States, USAID's policy is set in the traditional anti-discrimination mode which characterises the Americans with Disabilities Act and other civil rights legislation in the country. The definition of disability is, however, strictly medical.

Policies into practice

Effective implementation is required if good disability policies are to become more than empty rhetoric and a substitute for action. At the moment, with a few notable exceptions, the latter appears to be the reality.

One of the clearest examples is that of USAID, which since 1996 has been trying to develop a more inclusive approach to disability issues. However, a series of reports highlight the limited impact its policy has had on the operation of its missions, which continue broadly to support specific disability projects in traditional social welfare areas rather than through mainstreaming.

A 2003 report by the Finnish Ministry of Foreign Affairs also highlighted that in Finland most of the assistance was given via NGOs in disability-specific projects and that disability had not been mainstreamed. In particular there had not been enough attention to adjusting policy in line with the shift to a human rights approach and the overall policy had to be overhauled to take into account the new international aid instruments (PRSPs and SWAPS).

The World Bank website reveals that in almost all PRSPs there is no mention of disability; if it is mentioned, the reference is to 'the disabled' within a list of vulnerable groups and/or either social welfare or health. According to the International Labour Organisation (2002): 'An examination of all 29 currently available African Interim PRSPs shows that - with [notable exceptions] - [disabled people] have again been either "forgotten" or treated in a way that does not correspond to their aspirations to socio-economic integration.'

A 2002 baseline assessment of the Bank's activities relating to disability concluded that few of its current activities 'include disability in any meaningful way.' Perhaps this should not come as a surprise when gender, a much more prominent cross-cutting issue than disability, has also not been well served by PRSPs.

However, the Bank's efforts were given new impetus in 2002 by the appointment of Judith Heumann as its first Advisor on Disability and Development. The Bank is also seeking to develop a Global Partnership on Disability and Development.

Conclusion

Is disability really on the official development agenda? Well, some of the main players are talking about the issues in some way. However, if we are concerned about real changes being put in motion, the most optimistic answer would be "not yet".

Of course, there have been many disability-focused development projects, many of which have delivered positive results for disabled people, but to a large extent they remain locked within a traditional social welfare paradigm with limited value for mainstreaming disability in development and delivering a wider human-rights agenda.

What is called for from international aid agencies, besides a far stronger, clearer commitment, is a genuine understanding that disability is a social issue that cannot be addressed without bringing DPOs, Southern and Northern, into the heart of the process (see Box 1). Disability needs to be mainstreamed and promoted explicitly and officially as a cross-cutting issue, as gender has been. Above all, we must not let good intentions or declarations about human rights be a substitute for action that addresses the social exclusion, grinding poverty and human rights abuses that continue to blight the lives of disabled people worldwide.

Dr. Bill Albert is a member of the International Committee of the British Council of Disabled People (BCODP), and a researcher on disability and development. Michael Turner is a writer and researcher on disability issues.

For references, please see the resources page.