Authors: Lynch, Paul; Jolley, Emma
Affiliated organization: University of Birmingham (UB)
Type of publication: Research document
Date of publication: July 2017
The World Health Organization estimates that 15% of the world’s population, i.e., over one billion people, live with some form of disability. Women, older people and people in low income settings are disproportionately affected by disability due to increased health risks and limited access to services. The United Nations Convention on the Rights of Persons with Disabilities is a global treaty that affirms the rights and fundamental freedoms of people with disabilities and describes how adaptations must be made for people with disabilities to participate fully in society. Although 166 countries signed the United Nations Convention on the Rights of Persons with Disabilities, its implementation varies and remains a challenge in many settings.
The World Report on Disability published by the World Health Organization in 2011 suggests that the prevalence of severe and moderate disabilities is higher in Africa than in many other regions of the world, especially in younger (<60 years) population groups. Infectious diseases and injuries are likely to be responsible for much of this burden although the evidence on causes is limited. Poverty and disability are closely linked, and in low income settings such as sub-Saharan Africa, the relationship between the two is extremely strong. The limited resources available in these settings coupled with the lack of knowledge on disability have limited governments’ capacity to invest in social inclusion, leaving this group increasingly marginalized and vulnerable.
African settings have traditionally fallen on faith-based organizations and charities that have provided education, livelihood and healthcare services through a range of targeted but often small scale programs. While these parallel services have undoubtedly been beneficial for many, their separate provision has compounded the idea of “segregation” and even unintentionally exempted governments from investing in services accessible to all citizens.
Although 166 countries signed the United Nations Convention on the Rights of Persons with Disabilities, its implementation varies and remains a challenge in many settings
With the adoption of the Sustainable Development Goals and the “Leave no one behind” agenda, there is a global momentum to ensure that marginalized groups, not least people with disabilities, are included, and accounted for, in the mainstream development efforts.
The literature review presented here was conducted as an integral part of a social inclusion program supported by the international non-governmental organization Sightsavers in West Africa. The review focused specifically on five West African countries: Cameroon, Mali, Liberia, Senegal and Sierra Leone.
Legislation and policy
All five countries are signatories to and have ratified the United Nations Convention on the Rights of the Child. Although all the countries are signatories to the United Nations Convention United Nations Convention on the Rights of Persons with Disabilities and the optional protocol, to date (February 2017) only Mali had ratified both (in 2008). Senegal, Sierra Leone and Liberia had ratified the Convention (in 2010, 2010 and 2012, respectively) but not the protocol, while Cameroon is yet to ratify both the documents.
In education, in 2011, the government of Liberia passed a revised Education Act, which declares basic compulsory education for all children and requires children with disabilities to attend mainstream schools. Similarly, in Senegal, Law 91/22 (1991) declares schooling compulsory by law for all children aged 6 to 16 years irrespective of their background or characteristics. Mali and Senegal also developed policies on early childhood development and education of all preschool children including children with disabilities.
We also found that some policy provisions limited to specific groups of people with disabilities had led to increased inequalities within the disability group. For example, an inter-ministerial action between the Ministries of Social Affairs and Secondary Education in Cameroon targets students with disabilities and aims at the exoneration of registration fees and Parent Teacher Association levies. This action, however, has been limited only to students with physical disabilities and children of disabled parents in public schools.
Impact of disability
A large number of studies explored the effect of disability on health, education, social participation and livelihoods of people with disabilities. The evidence of the relationship between disability and marginalization has been reported in all five settings. Adults with disabilities were more likely to experience serious health problems and report limited access to healthcare and rehabilitation services. A few studies examined specifically the relationship between disability and sexual health.
People with disabilities were reported to be a vulnerable group for HIV and other sexually transmitted infections due to high levels of poverty, low literacy, and low likelihood of marriage, risky sexual behaviors and sexual violence in this population group. In many settings both adults and children with disabilities reported significant limitations and environmental barriers in their domestic life, interpersonal relationships and self-care.
In Cameroon women with disabilities reported facing triple discrimination resulting from their gender, perceived inabilities and low socio-economic status. A study conducted in Liberia among people with mental health issues reported limited access to education, employment and positive social relationships. Another study in Liberia identified extreme poverty as the main challenge for people with disabilities, particularly in rural areas, where social protection services and access to justice were not available and opportunities for engagement in remunerative jobs barely existed.
Enablers and barriers for disability inclusion
Many studies focused specifically on education settings. Thus, a study from Liberia focused on the role of educational centers in Monrovia and found that the centers had a significant positive impact on the quality of life of children with disabilities and their families; the study identified a need for further inclusion of children with disabilities in decision-making and planning. Stigma towards people with disabilities was reported to limit access to education, and the lack of governments’ political will was reported to impact social attitudes and stigma.
The inclusion of disability-related issues in general policies such as health, education and social welfare is undoubtedly an important step to keeping disability on the political agenda
A multicomponent research in Sierra Leone also found that both the school environment and the attitudes of students and staff impacted on the education experiences and outcomes; and the quality of education was often undermined by the lack of skills and unpreparedness of teachers. Similar findings were reported by two studies from Cameroon. A study in secondary schools reported that the teachers lacked appropriate skills, educational resources and support from the Principal, which resulted in the high levels of anxiety and stress among the teachers. Another study showed that the teaching curriculum and attitudes had a significant impact on inclusion within the classroom, and that the negative attitudes towards children with disabilities could be avoided by the provision of high quality teacher training on disability and inclusive practices.
We found that not all countries had ratified the UNCRPD (Cameroon) or the protocol (Cameroon, Liberia, Senegal and Sierra Leone), a move they should undertake with support from local players. We found that although all studied countries had put in place progressive policies and legislation to support access of people with disabilities to public services, the implementation of the pledges made lags behind due to insufficient financial resources and multiple competing priorities faced by governments. The inclusion of disability-related issues in general policies such as health, education and social welfare is undoubtedly an important step to keeping disability on the political agenda. It is also worth noting that the policies and programs for people with disabilities are rapidly evolving.
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