Discussion Papers - Disability

Disability and Poverty in Developing Countries: A Snapshot from the World Health Survey (3mb pdf)
Social Protection Discussion Paper No. 1109; Publication Date: 04/11
by Sophie Mitra, Aleksandra Posarac and Brandon Vick

This study aims to contribute to the empirical research on social and economic conditions of people with disabilities in developing countries.  Using comparable data and methods across countries, this study present a snapshot of economic and poverty situation of working ago person with disabilities and their households in 15 developing counties.  The study uses data from the World Heath Survey (WHS) conducted by the World Health Organization. The countries for this study are: Burkina Faso, Ghana, Kenya, Malawi, Mauritius, Zambia, and Zimbabwe in Africa; Bangladesh, Lao People’s Democratic Republic (Lao PDR), Pakistan, and the Philippines in Asia; and Brazil, Dominican Republic, Mexico, and Paraguay in Latin America and the Caribbean.  The selection of countries was driven by the data quality.

Disability and International Cooperation and Development: A Review of Policies and Practices (675kb pdf)
Social Protection Discussion Paper No. 1003; Publication Date: 05/10
by Janet Lord, Aleksandra Posarac, Marco Nicoli, Karen Peffley, Charlotte McClain-Nhlapo and Mary Keogh 

This review examines recent policies of major multilateral and bilateral agencies, which they have employed to include disability in development aid. It also provides, whenever possible, examples of their programs. This review does not assess the merits or impact of those policies or practices; it only provides their mapping. The content of the summaries of individual organizations and agencies updates and extends previous compilation efforts by Inclusion International (2005 a, b), Disability Awareness in Action (1995), Handicap International/ Christoffel-Blindenmission (2006), and United Nations (2009). The review indicates the following five emerging trends: (i) disability has become a part of international cooperation and development aid; (ii) international cooperation policies often link disability to Millennium Development Goals (MDGs); (iii) the agencies often combine several approaches to frame the inclusion of disability in development, including human rights, participation, inclusion and development; (iv) disability is included both through specific / targeted and mainstreaming/ inclusion / integration programs; and (v) approaches, policies and programs are dynamic and have changed over time.

Beyond DALYs: Developing Indicators to Assess the Impact of Public Health Interventions on the Lives of People with Disabilities (368kb pdf)
Social Protection Discussion Paper No. 0815; Publication Date: 05/08
by Daniel Mont and Mitchell Loeb

Two indicators – the Activity Limitation Score (ALS) and the Participation Restriction Score (PRS) – are presented in this paper for use in assessing the impact of public health interventions on the lives of disabled people.  They address a gap in the Disability-Adjusted Life Years (DALY) approach which is not sensitive to changes in people’s functional status resulting from interventions that do not change an underlying medical diagnosis.  Household data from Zambia are used to explore the potential usefulness of these measures.

Disability & Development in the World Bank: FY2000-2007 (176kb pdf)
Social Protection Discussion Paper No. 0808; Publication Date: 05/08
by Jeanine Braithwaite, Richard Carroll, Daniel Mont and Karen Peffley

The objectives of this paper are: 1) to present the record of World Bank’s involvement in disability as part of its overall development strategy; 2) to share with development partners some of the good practices the World Bank has discovered; and 3) to stimulate new ways to address the problems of people with disabilities through partnerships, better practices and the further mainstreaming of disability into the work of the World Bank.

Disability and Poverty: A Survey of World Bank Poverty Assessments and Implications (250kb pdf)
Social Protection Discussion Paper No. 0805; Publication Date: 02/08
by Jeanine Braithwaite and Daniel Mont

In this paper the authors survey the World Bank poverty assessment literature to date on the relationship between disability and poverty.  The authors find that using standard assumptions about the distribution of household consumption among household members and the typical way that poverty lines are set in World Bank poverty assessments, this relationship may not appear to be as quantitatively significant as common sense and anecdotal evidence would suggest.  The author's assessment is limited by the fact that household surveys which are used by the Bank to determine consumption and consumption-based poverty typically do not include any questions about the disability status of household members.  Only in one region of the Bank’s work, Europe and Central Asia, do the authors find poverty assessments with numeric poverty rates for households with disabled member(s).  Other poverty assessments done in other regions of the Bank, in some cases, do provide data on disabled people in regard to employment, health, social assistance, or a related subject, but do not provide poverty rates per se.  This literature is assessed in this work, and directions for further research the authors will undertake are indicated.

Disability in Kazakhstan: An Evaluation of Official Data (626kb pdf)
Social Protection Discussion Paper No. 0802; Publication Date: 02/08
by Ai-Gul S. Seitenova and Charles M. Becker

The authors attempt first to create an historical picture of disability in Kazakhstan by analyzing government population statistics and studying the evolution of disability determination procedure in the former Soviet Union and independent Kazakhstan. Doing so is not a trivial task, as there has been almost no systematic research, either in Russian or English.   However, the effort is useful, as it enables us to cast light on the set of problems concerning disability in Kazakhstan, including those that remain hidden in the official reports. The authors conclude that the optimistic official picture of disability patterns in Kazakhstan is almost certainly inaccurate. As the paper details, the quality of official disability data is high, and much can be learned from the patterns. However, changing definitions and strictness of enforcement make time series comparisons problematic, and the improvements in adult disability recorded are inconsistent both with trends for children, and with mortality trends. Rather, we note that barriers for applying disability benefits have increased and incentives to report disabilities have decreased markedly in the past 15 years, so that it is virtually certain that there is substantial hidden disability.

Disability Insurance with Pre-funding and Private Participation: The Chilean Model (436kb pdf)
Social Protection Discussion Paper No. 0719; Publication Date: 11/07
by Estelle James, Augusto Iglesias and Alejandra Cox Edwards

The disability insurance system in Chile is much less well-known than the pension part, but it is equally innovative. It differs from traditional public disability insurance in two important ways: 1) it is largely pre-funded - through the accumulation in the retirement account and later through an additional payment made when the person becomes permanently disabled, sufficient to cover a lifetime defined benefit annuity; and 2) the disability assessment procedure includes participation by private pension funds (AFPs) and insurance companies, who finance the benefit and have a direct pecuniary interest in controlling costs. Survivors’ insurance is handled in the same way, through a combined D&S fee. the authors argue that pre-funding will raise disability fees in the early years of a new system as funds are built up but reduce them in the long run as benefits are covered out of accumulated funds. the authors further hypothesize that the participation of private pension funds in the assessment procedure will keep system costs low, by cutting the incidence of successful disability claims. Finally, the authors expect that these incentives will also lead to cost-shifting - to other AFP’s by selection and to the public treasury via the minimum pension guarantee (MPG). Using simulations based on a special data set that was provided to us by the Association of AFPs and applying the Cox proportional hazard model to a retrospective sample of new and old system affiliates (ESP 2002), the authors conclude that these hypotheses are broadly consistent with observed behavior.

Convention on the Rights of Persons with Disabilities: Its Implementation and Relevance for the World Bank (276kb pdf)
Social Protection Discussion Paper No. 0712; Publication Date: 06/07
by Katherine Guernsey, Marco Nicoli and Alberto Ninio

This review and commentary is intended to provide World Bank staff with informational resources to understand the relevance of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) for the World Bank, and to support them in implementation activities.  Given that it is estimated that fewer than 50 countries currently have disability non-discrimination legislation, and that many countries will have to engage in legislative reform in order to ensure compliance with the CRPD, it is anticipated that client countries will increasingly call upon the Bank to assist them in CRPD-related legislative and other associated reform initiatives.  In addition, Bank staff engaged in operations addressing issues covered by the CRPD will need to be aware of legal obligations for client countries arising under the CRPD, as well as benchmark principles set at international level, so that they can ensure that on-going initiatives will not inadvertently compromise client country compliance with the treaty.

Measuring Disability Prevalence (282kb pdf)
Social Protection Discussion Paper No. 0706; Publication Date: 03/07
by Daniel Mont

Disability and poverty are intricately interlinked.  Unfortunately, high quality, internationally comparable data on disability that is important for the planning, implementation, monitoring, and evaluation of inclusive policies is often not available.  This paper reviews what is meant by disability and puts forth a way of measuring disability suitable for internationally comparable prevalence rates. It clarifies good standards in collecting data on disability and makes recommendations for prevalence measures of disability suitable for censuses. Since a single disability prevalence rate can be highly problematic, a better practice would be to report at least two prevalence rates - one representing a moderate threshold for functional limitations and one with a more severe threshold.

Disability, Poverty and Schooling in Developing Countries: Results from 11 Household Surveys (154kb pdf)
Social Protection Discussion Paper No. 0539; Publication Date: 11/05
by Deon Filmer

This paper analyzes the relationship between whether a young person has a disability, the poverty status of their household, and their school participation using 11 household surveys from nine developing countries.  Between 1-2% of the population is identified as having a disability. Youth with disabilities sometimes live in poorer households, but the extent of this concentration is typically neither large nor statistically significant.  However, youth with disabilities are almost always substantially less likely to start school, and in some countries have lower transition rates resulting in lower schooling attainment.  The order of magnitude of the school participation disability deficit is often larger than those associated with other characteristics such as gender, rural residence, or economic status differentials.

Disability and Social Safety Nets in Developing Countries (195KB PDF)
Social Protection Discussion Paper No. 0509; Publication Date: 05/05
by Sophie Mitra

This paper deals with how social safety nets may reach the poor with disabilities in developing countries. It presents a framework for analyzing the inclusion of disability in social safety nets. The paper first reviews evidence on the relation between disability and poverty, and discusses the roles that safety nets may play with regard to disability. Safety nets can reach persons with disabilities through inclusive mainstream programs as well as disability targeted programs. The advantages and challenges of disability targeting are then discussed. The paper proceeds to analyze different ways that can be used to include disability considerations in the implementation of mainstream safety nets through the reduction of physical, communication and social barriers surrounding such programs and through the careful design and evaluation of safety nets. The use of disability targeting versus or in combination with disability mainstreaming is then discussed.

Disability Employment Policy (114kb pdf)
Social Protection Discussion Paper No. 0413; Publication Date: 07/04
by Daniel Mont

This paper is the first in a series aimed at analyzing disability employment policy and developing recommendations for policy reform in middle income countries. As the first paper in this series, this study provides a general overview of the relationship between disability and employment, focusing primarily on disability employment policies in OECD countries. It discusses how well these policies address the dual functions of integration and income security, and reports on recent trends. A variety of policy tools are examined: full and partial disability cash benefits, vocational rehabilitation and training, supported work, sheltered and public sector employment, hiring quotas, tax incentives for employers, and anti-discrimination laws. A general set of recommendations are offered on designing disability employment policies in emerging economies.

Disability Pensions and Social Security Reform: Analysis of the Latin American Experience (157kb pdf)
Social Protection Discussion Paper No. 0325; Publication Date: 12/03
by Carlos O. Grushka and Gustavo Demarco

This paper describes the disability pension arrangements prevailing in ten Latin American countries that reformed their pension systems. The analysis is limited to the topic of disability pensions, without attempting to evaluate other critical aspects such as the available infrastructure: handicapped access generally (ramps, blind cues), medical and nursing support, home care, and so on. The relative significance of disability pensions is highly dependant on these factors and, however, they are really limited in most countries of Latin America.

Disability and Work in Poland (547kb pdf)
Also available in Polish (776kb pdf)
Social Protection Discussion Paper No. 0101; Publication Date: 01/01
by Tom Hoopengardner

Disability is more prevalent in Poland than in any other country in the world, and the cost of the disability pension system and programs to encourage the employment of people with disabilities is among the highest in the world - over four percent of GDP. Too-generous benefits and lax enforcement encourage abuse of the disability pension system. The quota-levy system interacts with the system of Supported Work Establishments to benefit entrepreneurs rather more than people with disabilities. Poland's policies for people with disabilities need fundamental redesign in order to help those who truly need help, to increase labor force participation among people with disabilities, to discourage abuse of the system, and to reduce the wage tax that supports disability benefits and programs.

Including the Most Vulnerable: Social Funds and People with Disabilities (360kb pdf)
Social Protection Discussion Paper No. 0023; Publication Date: 09/00
by Pamela Dudzik and Dinah McLeod

People with disabilities face many of the challenges that other vulnerable groups face, such as lack of adequate support services in their communities, lack of resources and economic opportunities, and physical and attitudinal barriers to their participating fully in society. One of the best-established World Bank instruments for targeting poor and vulnerable groups is social funds. The authors review the extent of current disability activities within World Bank-financed social funds and provide recommendations and resources for increasing support for persons with disabilities in social fund subprojects. Among other initiatives, social funds can provide infrastructure and services that people with disabilities can use, support organizations that help persons with disabilities formulate and demand projects, and promote greater public understanding of disability issues.

Survey of Disability Projects.The Experience of SHIA, Swedish International Aid for Solidarity and Humanity (152kb pdf)
Social Protection Discussion Paper No. 0013; Publication Date: 6/00
by Kaj Nordquist

This paper reviews the work of SHIA, an umbrella association of Swedish organizations of people with disabilities, and derives lessons and good practices on disability-related activities. SHIA emphasizes supporting human rights while supporting better lives through investments. It accomplishes this in part by working closely with local organizations of people with disabilities; SHIA's strategy is to empower such organizations and thereby to empower people with disabilities. The paper demonstrates that effective partnerships are possible, the challenges of such partnerships, and the need to focus on technical assistance. Recommendations for the World Bank provide possible directions for Bank involvement in disability work.

Disability Issues, Trends and Recommendations for the World Bank (223kb pdf)
Social Protection Discussion Paper No. 0007; Publication Date: 02/00
by Robert L. Metts

This paper is intended to provide the World Bank with the information and insights necessary for policy formulation and strategic planning in the area of disability. After describing the two major contemporary disability definitions and comparing their suitability for disability policy and planning, the paper presents a descriptive analysis of the evolution and current status of disability policy and practice. Based on this information, a political and economic case is made in favor of investing public and private resources, including World Bank resources, in policies and strategies designed to increase access for people with disabilities to social and economic opportunities. The essential elements of such policies and strategies are then described and incorporated into a strategic framework for possible use by the World Bank in its ongoing effort to develop appropriate and cost-effective approaches to disability.

Poverty and Disability: A Survey of the Literature (156kb pdf)
Social Protection Discussion Paper No. 9932; Publication Date: 12/99
by Ann Elwan

This review summarizes the literature on disability and its relationship to poverty, including education, employment, income, and access to basic social services. Despite the dearth of formal analysis, it is clear that in developing countries, as in more developed areas, disabled people (and their families) are more likely than the rest of the population to live in poverty. It is a two-way relationship – disability adds to the risk of poverty, and conditions of poverty increase the risk of disability. Disability in developing countries stems largely from preventable impairments associated with communicable, maternal and perinatal disease and injuries, and prevention has to remain a primary focus. An increasing emphasis on community based participatory rehabilitation reflects growing recognition of the inadequacy of past official programs, particularly involving specialized and exclusionary institutions.

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