What about the 1 in 7? Important progress in getting DFID (and other donors) to get serious on disability

Mosharraf Hossain - ADD International

Disability campaigners Mosharraf Hossain and Julia Modern on a new report on disability and developmentJulia

Back in 1988, I was denied a job in the Bangladesh civil service. This wasn’t because I didn’t have the skills to do the job – I had a Masters in Economics from the University of Dhaka – but because I am disabled. I contracted polio at the age of three, and was left with a mobility impairment, which according to the rules then in place meant I was excluded from being a civil servant.

You might think this sounds outrageous, but this kind of discrimination is still all too common around the world. Over the last few months, the UK Parliament’s Select Committee on International Development has been holding an inquiry looking at disability and development, and it has heard countless stories like mine, and worse: like the disabled woman in West Africa who reported that when she presented at a hospital in the early stages of labour, health workers laughed at her and asked how on earth she could have managed to get pregnant. The Select Committee, which is a parliamentary body set up to monitor the activities of the UK’s Department for International Development (DFID), decided to hold this inquiry because they had been told again and again by organisations like ours that the aid system was not delivering for disabled people. They found that this is true.

An inaccessible well built under the NUSAF II project in Uganda, supported by the World Bank. Image copyright Edson Ngirabakunzi and Joseph Malinga
An inaccessible well built under the NUSAF II project in Uganda, supported by the World Bank. Image copyright Edson Ngirabakunzi and Joseph Malinga

The report that the Committee has released today tells a compelling story. DFID has a reputation for being one the most progressive donors on disability (although it’s been overtaken by Australia in recent years), but the Select Committee’s evidence shows that even at DFID only 5% of bilateral aid spending is on programmes that are designed to benefit disabled people. With 15% of the world’s population being disabled, this clearly isn’t enough.

Worse still, many development programmes are – inadvertently or not – designed in ways that exclude disabled people, such as the World Bank-funded project in Uganda that installed boreholes with steps, which people who use wheelchairs can’t access.

This kind of exclusion is a major cause of poverty, and in some cases is leading to the world’s one billion disabled people falling even further behind the rest of their communities. As Bob McMullan, one of the witnesses at the inquiry pointed out, if any country with one billion people had such low employment, education and health outcomes as the world’s disabled population, it would probably be at the top of international development priorities. However, we know how to change the situation.

In Bangladesh, disabled people came together in Disabled People’s Organisations (DPOs) and we defeated the discriminatory policy that excluded disabled people from the civil service. I could have that job if I applied now. There are also some great examples of donors working well with disabled people, including at DFID – for example the changes that were made to a social protection programme in Zimbabwe based on consultation with DPOs, which led to a dramatic increase in the number of disabled people that the programme reached.

Over the last year or so, we have been very encouraged by the actions of Lynne Featherstone MP, one of the Ministers at DFID, who has consistently championed the rights of disabled people. The Minister recently announced a commitment that from now on all new school buildings that DFID supports will be designed to accessible standards that include disabled people.

But we share the Select Committee’s concern that the current support for inclusion at DFID is carried by a few key individuals who will in all likelihood move on, and we want to see the Department being more ambitious about what they can achieve. The Committee’s report recommends that DFID put in place several key mechanisms to make sure disability gets mainstreamed across the organisation, rather than staying a niche issue that individuals work on if they have a personal interest, including the following:

  • a disability strategy with clear targets and timescales;
  • a larger team of staff working on disability, including ‘champions’ within each country team and a senior sponsor; and
  • strong reporting processes to ensure accountability.

The report also contains a welcome emphasis on the central role of disabled people in this process, calling for DFID to actively encourage and

Mosharraf Hossain with UK Minister Lynne Featherstone MP, as she signs a declaration committing the UK to including disabled people in the post-2015 negotiations
Mosharraf Hossain with UK Minister Lynne Featherstone MP, as she signs a declaration committing the UK to including disabled people in the post-2015 negotiations

support disabled people’s leadership, and to seek their guidance on how to design, implement and monitor programmes. Our experience working with DPOs in Africa and Asia over the last 30 years demonstrates how important this element is: disabled people are the best experts on their own development, and truly empowering them to get involved in the development process is vital. With the publication of this report, a very important step has been taken towards making aid more inclusive.

Because this is an official select committee report, DFID must provide a government response setting out how it will meet the recommendations made. We look forward with much excitement to this response, and to seeing DFID take immediate action to increase education of disabled children, employment of disabled youth and investment for the health of disabled people in low and middle-income countries.

Making DFID’s aid more inclusive of disabled people will be transformative, not only for disabled people themselves, but for whole communities. In her evidence to the inquiry Lorraine Wapling described how an employment project for disabled people in Malawi has helped the whole community:

‘One community leader, completely spontaneously, said to me, “It has made a huge difference. Now that disabled people are benefiting our community, the whole community has come out of poverty. […] Before, they were dependent; they were drawing our resources. Now they are productive, it means the whole community has a better potential.” That, for me, represents what we mean by value for money’.

Mosharraf Hossain is Director of Policy and Influencing and Julia Modern, Parliamentary Liaison Manager at UK based ADD International. which works with disability movements in 8 countries in Africa and Asia, challenging the barriers and discrimination faced by disabled people. 

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11 Responses to “What about the 1 in 7? Important progress in getting DFID (and other donors) to get serious on disability”
  1. Ken Smith

    Hi , I just couldn’t believe the statistic that 15% of the world’s population is disabled. I guess it has come from this WHO report here http://www.who.int/disabilities/world_report/2011/report/en/ .
    I’ve not read the whole report but the first few lines of the summary are
    About 15% of the world’s population lives with some form of disability, of whom 2-4% experience significant difficulties in functioning. On that basis I guess DFID’s 5% looks more reasonable.

  2. Kate

    On the % spend – and without making any effort to read the IDSC report – I guess judgement on this partly depends on whether disabled people are included in other programmes. If the 5% is projects specifically targeting disabled people, what proportion of the 95% consider disability in the same way they might look at eg barriers related to gender?

    Sounds as though DFID has made progress though – memories of repeatedly asking DFID to include disabled people and being told they wouldn’t because the Nordic donors had that covered.

  3. Julia Modern

    Hi Ken,

    Yes you’re right, the 15% figure is from the WHO report. If you read the report you’ll see that the 2-4% figure refers to people with ‘very significant difficulties’ with functioning – defined as analogous to something like quadriplegia (paralysis), total blindness, or severe depression. A significant proportion of the not-so-severely impaired population included in the 15% will also have trouble using services as they are currently provided as well, particularly because of the huge impact of attitudinal barriers, such as that faced by the woman featured in the blog who was trying to access maternity services.

    An argument can be made that since disabled people are significantly more likely to be among the very poor (DFID’s target group), they should be over-represented in terms of the amount of money that is spent, so the figure should be higher than 15%.

    Even if you don’t accept this argument, it’s significant that the 5% figure is actually made up both of programmes that entirely and only benefit disabled people (a total of £27.7 million, or only 0.66% of bilateral spend) and ‘mainstream inclusive’ programmes where disabled people are one specified group of beneficiaries, ranging from 3% to 17% of beneficiaries where the percentages are given. So within that 5% you’ve got a lot of money that isn’t being spent on disabled people.

    It’s impossible to calculate an accurate figure for how much of the money spent on mainstream programmes directly benefits disabled people because it’s just not recorded that way – which I assume is why the IDSC report used the figures that they did – but if we are generous and assume that 15% of beneficiaries are disabled people, adding that figure (£25 million) to the amount spent on disability-focused programmes makes £52.7 million, or 1.3% of bilateral spend. Not very impressive, really.

    If you want to take a look at the figures yourself they’re given in DFID’s Annex B to the inquiry: http://data.parliament.uk/writtenevidence/WrittenEvidence.svc/EvidenceHtml/5515

    The more important point though is the point Kate is making – how many non-inclusive projects are excluding disabled people? Disabled people are everywhere – we don’t all live together in one place – and we need access to the same services as everyone else. If my local borehole is inaccessible then it wouldn’t really make much difference to me if 15% of boreholes in the country were accessible. We can’t just do targeted projects and expect that to be ok. Really, 100% of DFID projects should be ‘designed to benefit disabled people’ because it should be expected that there will normally be disabled people among a beneficiary group. Targeted projects are needed too, because disabled people are so deeply excluded, but running projects without considering the needs of such a significant proportion of any local population seems strange. That’s why in the report the IDSC recommended that all DFID staff get training on disability inclusion, which I agree is vital.

    I hope this helps clarify things. Let me know if you have any questions.



  4. Ken Smith

    I think it depends on cost whether 100% of DFID projects , should be designed to benefit disabled people. If it costs 15% more to build an accessible borehole that will benefit 15% more people that’s a good idea. If it costs 150% more and benefits 2% more people and means you build no borehole at all in the next village I’m not so sure. There are hard choices to make about where the money DFID spends will get the most benefit to the most people but I agree they should make those choices with eyes wide open looking at the needs of everyone in the community including groups who traditionally have been excluded and marginalised.

  5. Julia Modern

    Hi Ken,

    You’re right, there are always difficult decisions to make when you’re dealing with limited funding. However, this doesn’t to me legitimise discriminating against a section of the population – think about how you would react if the same argument was used about women, for example. Would you be ok with the idea that we should build schools without proper separate toilet facilities for women because it’s cheaper that way and we can build more schools to serve more people (boys only, of course) overall? Why would disabled people be different?

    Value for money is a very important discussion, but it’s far more complex than often presented, and the problem with the way that things currently work is that usually inclusive design is not even considered. To really assess the value for money of making particular interventions inclusive, you have to look at the differential costs of inclusive and non-inclusive designs. The data on this isn’t great, because this area has been so thoroughly neglected, but the consensus is the costs are far, far below what you seem to be assuming. The World Bank says that the additional cost of building a school to universal design standards is less than 1% of the total,* while there are examples of redesigned waterpoints that cost no more than the design previously used as standard (along with some more expensive examples, ranging from 6% more to 28% more – though the 28% more design is under investigation to find out why the costs are so much higher, suggesting it’s not the norm*). These of course are the simplest things to change – working to break down attitudinal and informational barriers is just as important as infrastructural barriers and may take more substantive change – but it’s clear that the additional costs are unlikely to be as high as often assumed.

    Secondly, you can’t consider cost effectiveness without looking also at the cost of exclusion, a point that was made repeatedly throughout the parliamentary inquiry including in the oral evidence sessions. The IDSC report says: ‘A pilot study by the International Labour Organisation found that countries could lose up to 5% of their GDP if disabled people did not have equal access to employment — and this is before taking into account indirect losses such as social security payments, or caregivers’ lost wages.’ The quote from Lorraine Wapling in the blog above says it very eloquently: thoroughly including disabled people is a benefit to the community, and could actually save money rather than consuming it.

    Value for money considerations should be based on a careful consideration of all these factors, including the equity of interventions*. If we do take this holistic approach, it’s clear that there’s a good economic argument for the inclusion of disabled people, as well as a good moral argument.

    * http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2007/03/01/000310607_20070301144941/Rendered/PDF/388640EdNotes1August2005CostOfAccess12.pdf

    * http://www.wateraid.org/~/media/Publications/Mainstreaming-disability-and-ageing-in-water-sanitation-and-hygiene-programmes.pdf

    * This is the approach used by the UK’s Independent Commission on Aid Impact (ICAI), incidentally, which is based on four dimensions: Economy, Efficiency, Effectiveness and Equity: http://www.bond.org.uk/data/files/ICAIs-Approach-to-Effectiveness-and-VFM.pdf

  6. Ken Smith

    Hiya , I just picked those figures for increased costs at random, I didn’t mean to suggest that is what they would be. It was more a reaction to the view that 100% of DFID projects should be designed to benefit disabled people , which seemed to leave no room for any value for money considerations at all.

    • Mosharraf Hossain

      Are 5% of UKAID beneficiaries disabled? At least not in Bangladesh!

      I would be happy if 5% of DFID bilateral aid would reach to 2 to 4% of the world population. The 5% figure includes both disability specific and mainstream programs aiming to benefit disabled people. I agree with Julia that it is difficult to calculate how much of the money spent for mainstream programs benefits disabled people. I can give an example of Bangladesh.

      DFID spent 60 m in 2010 -2014 to support Third Primary Education Development Program (PEDP3) of the Government of Bangladesh for mainstream education with a specific focus to reach children with special needs. The project is in the half way, DPOs reports they can find ramps in schools but hardly see any disabled students!

      Bangladesh has been successful to achieve MDG 2 enrolling 18,432,499 school going children which is 98.7% of the target. But only 118,575 students with disabilities are enrolled in primary school through out the county in 2011. Disabled children are 1 in 156 children who are going to primary school. They are are not even 1% of the beneficiaries who are supported by DFID bilateral aid. Bangladesh reached the target so value for money is justified but at the cost of keeping 90% children with disabilities out of the schools.

      On International Disability Day 2006, Kofi Anan urged the world community to redouble the development efforts for disabled people as they are marginalised and lag behind in the race for development. Will DFID set an ambitious target of spending 20% of its annual expenditure for 800 million disabled people, who are living in the developing countries of the world?

  7. Julia Modern

    Hi Ken,

    Sure, I understand what you were getting at – and I’m sorry if I implied you were unclear that you were just suggesting random costs to illustrate the point, because you weren’t!

    The point I was trying to make is that I don’t think it’s appropriate for any programme to not consider the needs of disabled people. While value for money has a valid place in deciding the details of a programme, in order to make an assessment of the value for money of inclusion you have to consider the needs of disabled people in the first place. Projects that don’t think about this at all frankly shouldn’t exist.

    Unfortunately, it’s very common for people working in development, even when they mean very well, to make assumptions about the costs of including disabled people. The point I was trying to make by contrasting actual figures with the random ones you suggested was that the unresearched assumptions people make are as a rule much higher than the actual costs. Inclusive development is often considered too difficult and too expensive for people to deal with, when it’s excluding disabled people from society and from productive opportunities that costs us.


  8. Michelle Lewis Sandall

    Hi. I’m doing some study on DFID and disability at a country programme level and have a question on one of your statements. You say that:

    5% figure is actually made up both of programmes that entirely and only benefit disabled people (a total of £27.7 million, or only 0.66% of bilateral spend) and ‘mainstream inclusive’ programmes where disabled people are one specified group of beneficiaries, ranging from 3% to 17% of beneficiaries where the percentages are given.

    However, looking at the document you linked to (http://data.parliament.uk/writtenevidence/WrittenEvidence.svc/EvidenceHtml/5515), they say that £52,043,466 is being spent on disability focused programmes, and the much larger amount (215,299,972) was spent on mainstream/inclusive programmes (where I would argue having seen some of these in person, that less than 3-17% of beneficiaries are disabled).

    So where does the 27.7 million figure come from? I’m not arguing it’s wrong, just asking where the material comes from, mainly as I would like to reference it properly and can’t from the DFID submission/Annex!


  9. Polly Meeks

    Hi Michelle

    Thanks for your message. I work at ADD, and have been following this up on behalf of Mosharraf and Julia.

    It’s a good question! As you say, the IDSC website shows not £27.7 million, but £52 million.

    The reason is that the £27.7m figure is from 2012-13, whereas the £52 million is from 2013-14.

    When this blog was published, it was too early to do any meaningful analysis on 2013-14. We knew DFID’s 2013-14 expenditure was rising sharply across the board – not just on disability, but the full details weren’t available until much later in the year, so we couldn’t do a like-for-like comparison. That’s why all the calculations use 2012-13 figures.

    But unfortunately it appears the data on the IDSC website has been abridged, and the 2012-13 figures that we used for our calculations aren’t shown separately anymore. (The website isn’t really designed to handle large spreadsheets – I know this one caused it some problems).

    So I’m sorry this isn’t more help in getting you the reference that you need. I’d suggest contacting both the IDSC, and the DFID public enquiry point (ask for the parliamentary liaison team), for fuller information on 2012-13.

    Hope that helps a little – please get back to me if there’s anything you’d like to follow up. All the best for the rest of your study.


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