SOCIAL ASSISTANCE AND DISABILITY - Sightsavers 社會(huì)救助和傷殘Sightsavers

1、SOCIAL ASSISTANCE AND DISABILITY IN DEVELOPING COUNTRIESAnna Marriott with Kate GoodingJuly 2007Supported by DFID and Sightsavers International Disclaimer: The views expressed in this document are the responsibility of the authors, and do not necessarily reflect the views of Sightsavers Internationa

2、l.For further information please contact HYPERLINK mailto:pals pals or PALS Sightsavers InternationalGrosvenor HallHaywards Heath West Sussex RH16 4BXContents TOC o 1-3 h z u HYPERLINK l _Toc172602441 Acronyms PAGEREF _Toc172602441 h 3 HYPERLINK l _Toc172602442 Executive summary PAGEREF _Toc17260244

3、2 h 4 HYPERLINK l _Toc172602443 Section 1:Introduction PAGEREF _Toc172602443 h 7 HYPERLINK l _Toc172602444 1.1 Social assistance in developing countries PAGEREF _Toc172602444 h 8 HYPERLINK l _Toc172602445 1.2 Disability, poverty and social assistance PAGEREF _Toc172602445 h 8 HYPERLINK l _Toc1726024

4、46 1.3 This study PAGEREF _Toc172602446 h 10 HYPERLINK l _Toc172602447 1.4 Structure of the report PAGEREF _Toc172602447 h 10 HYPERLINK l _Toc172602448 1.5 Methodology PAGEREF _Toc172602448 h 11 HYPERLINK l _Toc172602449 Section 2:Stakeholder engagement PAGEREF _Toc172602449 h 12 HYPERLINK l _Toc172

5、602450 2.1 Disability movement PAGEREF _Toc172602450 h 12 HYPERLINK l _Toc172602451 2.1.1The social model of disability PAGEREF _Toc172602451 h 13 HYPERLINK l _Toc172602452 2.1.2Support for social assistance PAGEREF _Toc172602452 h 14 HYPERLINK l _Toc172602453 2.1.3Social assistance as an empowering

6、 investment meeting extra costs PAGEREF _Toc172602453 h 15 HYPERLINK l _Toc172602454 2.1.4Social assistance as income support PAGEREF _Toc172602454 h 16 HYPERLINK l _Toc172602455 2.1.5Avoiding dependence PAGEREF _Toc172602455 h 17 HYPERLINK l _Toc172602456 2.1.6Only part of the solution PAGEREF _Toc

7、172602456 h 18 HYPERLINK l _Toc172602457 2.1.7Social assistance as a right and entitlement PAGEREF _Toc172602457 h 18 HYPERLINK l _Toc172602458 2.1.8Engagement by disability organisations PAGEREF _Toc172602458 h 19 HYPERLINK l _Toc172602459 2.2 Governments PAGEREF _Toc172602459 h 22 HYPERLINK l _Toc

8、172602460 2.3 International development donors, agencies and consultants PAGEREF _Toc172602460 h 25 HYPERLINK l _Toc172602461 SECTION 3:Do disabled people access mainstream social assistance programmes? PAGEREF _Toc172602461 h 29 HYPERLINK l _Toc172602462 3.1 Unconditional social assistance PAGEREF

9、_Toc172602462 h 29 HYPERLINK l _Toc172602463 3.2 Conditional social assistance PAGEREF _Toc172602463 h 32 HYPERLINK l _Toc172602464 3.2.1Conditional cash transfers PAGEREF _Toc172602464 h 32 HYPERLINK l _Toc172602465 3.2.2Cash or food for work PAGEREF _Toc172602465 h 34 HYPERLINK l _Toc172602466 SEC

10、TION 4:Targeted social assistance for disabled people PAGEREF _Toc172602466 h 37 HYPERLINK l _Toc172602467 4.1Extent and scope of targeted schemes PAGEREF _Toc172602467 h 37 HYPERLINK l _Toc172602468 4.2Coverage and accessibility PAGEREF _Toc172602468 h 41 HYPERLINK l _Toc172602469 4.3Assessment of

11、eligibility PAGEREF _Toc172602469 h 45 HYPERLINK l _Toc172602470 4.4Cost PAGEREF _Toc172602470 h 51 HYPERLINK l _Toc172602471 Section 5:Impact of social assistance PAGEREF _Toc172602471 h 53 HYPERLINK l _Toc172602472 5.1Social empowerment PAGEREF _Toc172602472 h 54 HYPERLINK l _Toc172602473 5.2Acces

12、s to services PAGEREF _Toc172602473 h 56 HYPERLINK l _Toc172602474 5.3Economic security and empowerment PAGEREF _Toc172602474 h 57 HYPERLINK l _Toc172602475 SECTION 6:Linking social assistance for disabled people with other support strategies PAGEREF _Toc172602475 h 65 HYPERLINK l _Toc172602476 6.1L

13、inking social assistance with other measures PAGEREF _Toc172602476 h 65 HYPERLINK l _Toc172602477 6.1.1Integrating disability-specific social assistance with other measures PAGEREF _Toc172602477 h 66 HYPERLINK l _Toc172602478 6.1.2Social assistance, employment opportunities or both? PAGEREF _Toc1726

14、02478 h 68 HYPERLINK l _Toc172602479 6.1.3Integration within a mainstream scheme: Zambia PAGEREF _Toc172602479 h 69 HYPERLINK l _Toc172602480 6.1.4Challenges and opportunities for integration PAGEREF _Toc172602480 h 70 HYPERLINK l _Toc172602481 6.2Fragmentation within social assistance PAGEREF _Toc1

15、72602481 h 72 HYPERLINK l _Toc172602482 SECTION 7:Discussion and conclusions PAGEREF _Toc172602482 h 75 HYPERLINK l _Toc172602483 7.1Summary PAGEREF _Toc172602483 h 75 HYPERLINK l _Toc172602484 7.2Recommendations PAGEREF _Toc172602484 h 76 HYPERLINK l _Toc172602485 7.3Gaps and questions PAGEREF _Toc

16、172602485 h 81 HYPERLINK l _Toc172602486 7.3.1Type of assistance PAGEREF _Toc172602486 h 81 HYPERLINK l _Toc172602487 7.3.2Scheme design PAGEREF _Toc172602487 h 83 HYPERLINK l _Toc172602488 7.3.3What is the impact of social assistance for the diversity of disabled people? PAGEREF _Toc172602488 h 85

17、HYPERLINK l _Toc172602489 7.4 Concluding remarks PAGEREF _Toc172602489 h 86 HYPERLINK l _Toc172602490 ANNEX 1:Methodology PAGEREF _Toc172602490 h 87 HYPERLINK l _Toc172602491 ANNEX 2:UN Guidance on social assistance and disability PAGEREF _Toc172602491 h 89 HYPERLINK l _Toc172602492 Bibliography PAG

18、EREF _Toc172602492 h 91Acronyms ADB: Asian Development BankAP: Assessment Panel CASE:Community Agency for Social Enquiry (South Africa)CCT: Conditional Cash TransfersCDG:Care Dependency Grant (South Africa)C-SAFE:Consortium for Southern Africa Food Emergency DFID:Department for International Develop

19、ment (UK)DG:Disability grant (South Africa)DPO:Disabled Peoples OrganisationDRC:Disability Rights Commission (UK)EC:European CommunityFNDP: Fifth National Development Plan (Zambia)GTZ:Deutsche Gesellschaft fr Technische ZusammenarbeitIDC International Disability Caucus ILO International Labour Organ

20、izationIMF: International Monetary FundINGO:International Non-Governmental OrganisationLEAP:Livelihood Empowerment for Alleviation of Poverty (Ghana)MO: Medical OfficerNorad:Norwegian Agency for Development Co-operationNREGS:National Rural Employment Guarantee Scheme (India)NSPS:National Social Prot

21、ection Strategy (Zambia)OECD: Organisation for Economic Co-operation and Development.PATH Program of Advancement though Health and Education (Jamaica)PMO: Pension Medical OfficerPWD: People with disability SAFCD: South African Federal Council on DisabilitySida: Swedish International Development Coop

22、eration AgencyUNCRD:United Nations Convention on the Rights of Persons with DisabilitiesVELUGU:Rural Poverty Elimination Program, Andhra Pradesh, IndiaWB: World BankZAPD:Zambian Agency for People with DisabilitiesExecutive summarySocial protection is increasingly recognised by government and develop

23、ment agencies as an important component of poverty reduction and development. Social assistance, in the form of cash and in-kind transfers, has received particular attention. Disabled people are often identified as one of a number of groups who could potentially benefit from this form of support. Ho

24、wever, very little information is available about the use and impact of social assistance for poor, disabled people and their households in developing countries.This study draws on the existing literature and discussion with a limited number of stakeholders to investigate social assistance for disab

25、led people in developing countries. It explores the perspectives of key stakeholders and, using the information available on both mainstream and targeted social assistance programmes, examines their characteristics and ability to reach and benefit disabled people. The study focuses on developing cou

26、ntries, particularly in Africa, but also draws on information from higher income countries. It is intended as an initial review rather than a definitive analysis.The discussion with disabled people and their organisations for this study was limited and far from representative, but it raised a number

27、 of important issues. There is concern within the disability movement that social assistance could promote a return to the medical model and a welfare attitude to disability, but many organisations see a positive role for social assistance. This may be in meeting the extra costs of disability, or as

28、 a buffer against poverty.Disability organisations stress that social assistance must aim to empower and support peoples capacity for independence. For this, it must be seen as a right, underpinned by legislation, be part of a wider programme of measures to promote rights, and be developed with the

29、participation of disabled people. In general, there has been very limited involvement of disabled people in the recent discussion of social assistance and development of national social protection strategies. However, some organisations have been involved in advocacy, and there have been growing cal

30、ls for engagement.Efforts by donors and governments to promote social assistance are gaining momentum, yet it seems they are doing little to ensure the appropriate inclusion of disabled people in the process. Challenges facing governments include an absence of information on appropriate approaches a

31、nd limited data. Donors are paying more attention to the rights of disabled people, but there is little analysis of the links between this work and social assistance. The World Bank and ILO seem to be most active in this area. Several mainstream schemes (aimed at, for example, vulnerable children or

32、 poor households) include disability in their targeting criteria. However, given that monitoring and evaluation systems are generally weak or non-existent, there is very little disaggregated data from these schemes to show the actual inclusion of disabled people. The study found little evidence to s

33、uggest that more than a handful of mainstream schemes are actively seeking to appropriately include disabled people. There are several barriers to access, including limited public information, physical inaccessibility, and bureaucracy, and means tests may unfairly exclude disabled people who face hi

34、gh costs associated with disability. Conditions attached to transfers, such as school or health clinic attendance, raise additional programmatic needs and may exclude disabled people if these services are not accessible. Public works schemes are likely to exclude disabled people unless special provi

35、sions are made. The debate on what measures work to ensure fair and equal access to the benefits of such programmes is still at the very early stages. Several countries have social assistance schemes specifically targeting disabled people. However, most are small in scale and value. Coverage is ofte

36、n limited and uneven, constrained by inadequate funding, complex administrative requirements, limited awareness, poor physical access and corruption. The majority of schemes target adults of working age who are severely disabled or unable to work. However, assessment of this is complex. Challenges i

37、nclude finding a way to equalise assessment through uniform criteria while considering social contexts, and the appropriate combination of individualised medical examinations and more social approaches. Means testing also faces difficulties, not least in relation to taking into account the extra cos

38、ts associated with disability. Little reliable evidence exists to estimate the real costs involved in administering and delivering targeted social assistance for disabled people.Evidence on the impact of social assistance for disabled people is extremely limited. Guided by suggestions from disabilit

39、y organisations and disabled people, as well as the limited anecdotal and research evidence that does exist, the study considers social and economic impacts. There are indications that social assistance may have a positive impact on self-esteem by enabling a contribution to the household budget and

40、encouraging mobilisation of disabled people. However, there are also reports that disabled people often lack control over spending of the grant. There is evidence that social assistance can improve access to health services, but the picture on education is more mixed, with access depending on provis

41、ion of adequate services. Social assistance seems to improve household health and economic status. However, evidence on the economic status of the disabled individual is less clear, particularly regarding employment. This last point leads to the long-standing concern around balancing social assistan

42、ce with support for employment. Experience in high income countries suggests that support during the transition to work is critical.Disabled people consulted for this study stressed that social assistance must be part of a bigger programme of support. The study looks at draft strategies for Ghana an

43、d Zambia as well as literature on South Africa to examine the integration of social assistance with other measures. There are indications that governments do see social assistance as one option within a wider framework of support for education, employment and other rights, but there seems to be litt

44、le integration between social assistance and these other measures. Instead there is a tendency to divide disabled people into two categories: those in need of social assistance, and those deemed capable of productive activity and handled through disability mainstreaming in training or employment; po

45、ssible links between the two are not explored. In balancing social assistance with other measures, policy makers need to consider appropriate sequence of measures and the role of social assistance in compensating for the extra costs associated with disability. Possible strategies to improve integrat

46、ion include a more comprehensive assessment for disabled individuals that considers a range of needs, and clearer understanding of social assistance as a means rather than an end.There are indications of fragmentation within social assistance strategies. Grants for disabled people need to be conside

47、red within this wider context, as other social protection mechanisms (or their absence) have a significant impact on the effectiveness and manageability of social assistance for disabled people. If disability grants are the only assistance available to working age adults, they are likely to be used

48、for purposes other than those originally intended and may lead to perverse incentives to risk health. The limited information available on social assistance and disability leaves many questions unanswered, and these are indicated in the concluding section for further discussion. However, three key p

49、rinciples for effective social assistance are clear from the research: There must be strong legal foundations to make social assistance a right and entitlement.Disabled people must be involved in design, implementation and evaluation of social assistance schemes. Social assistance must be developed

50、as part of a wider system, hand in hand with the development of inclusive services, support for employment, anti-discrimination legislation and the full range of services. Disability issues cannot be dealt with through social assistance alone. In addition, there is a pressing need for more informati

51、on. Improved data on disability are essential for the effective design, delivery and monitoring of both targeted and mainstream schemes. Dedicated resources are required to redress the current inadequacy of such data. Priority areas for research include:barriers to access the role of conditionsasses

52、sment of the costs associated with disabilityparticipatory research with disabled people to understand the impact of existing social assistance schemesidentification and documentation of good practiceinvestigation of how social assistance programmes can effectively interact and reinforce other servi

53、ces and programmes.There are several potentially valuable sources of further information, including analysis and monitoring of the various national social protection strategies currently under development, including in Ghana and Zambia, and evaluation of recently introduced schemes, as in Bangladesh

54、. Section 1:IntroductionThe role of social protection in reducing poverty and promoting development in low-income countries is gaining increasing attention from international organisations, donors and governments. A growing body of evidence suggests that social protection not only helps to reduce po

55、verty but has a wider transformative role in tackling power imbalances, enabling and promoting human capital investments and productivity, and contributing to economic growth. This growing discussion on social protection frequently identifies disabled people as one of a number of vulnerable groups,

56、including women, older people and children, who could potentially benefit from social protection initiatives. However, in contrast to these other groups, little is known about the impact of current approaches on disabled people or their households. This study aims to begin to close this gap. Althoug

57、h recognising the critical importance of a broad social protection agenda, including legislation and action to tackle discrimination, this study focuses on social assistance, and particularly cash transfers, as the component of social protection attracting particular attention from donors and also r

58、aising concern among some parts of the disability movement. There appears to be a lack of information, understanding and agreement on the appropriateness and effectiveness of social assistance programmes in tackling the challenges faced by disabled people in developing countries. Before turning to a

59、ssess the information that is available on current social assistance programmes, this introduction continues with some definitions and brief background information on social assistance, disability and poverty. Definitions Social protection: Support to individuals or households to reduce vulnerabilit

60、y and guarantee an acceptable standard of living. It includes:Social assistance: non-contributory cash and in-kind transfers to the poor (e.g. fee waivers, disability allowance).Social insurance: individuals or households spread risk by paying contributions so that if they experience a shock or nega