About Sightsavers

Sightsavers is an international development organisation which works with partners to eliminate avoidable blindness and promote equality of opportunity for people with disabilities in over thirty developing countries. Our programmes also include working to ensure quality inclusive education, strengthen health systems and eliminate neglected tropical diseases (NTDs).

We welcome the opportunity to contribute to the International Development Committee’s inquiry on the impact of coronavirus on developing countries and the UK government’s response.

Introduction

Amid the COVID-19 outbreak, Sightsavers is monitoring the situation closely, and doing everything we can to protect our staff, partners and the communities in all the countries where we work, as well as support the global response.

Our key priority is to support the immediate response to COVID-19. Sightsavers is offering resources and expertise to the countries where we work, as we did during the Ebola crisis in West Africa [1] and working closely with national partners at all levels. Through our network across 30 countries in Africa and Asia, we are well placed to provide technical and practical support to the global response.

We are working with DFID and our funders to explore how we can adapt our programmes to support the response in the countries where we work.

We are working with the International Disability and Development Consortium (IDDC) and the International Disability Alliance (IDA) to raise awareness of COVID-19 among its network of over 1,100 organisations, as well as to run a policy campaign [2] which shares people with disabilities experience of this pandemic and asks that international and health responses are equitable and accessible for all.

Through our membership of the IDDC – in partnership with IDA – and the Bond Disability and Development Group, we have made earlier submissions to the IDC’s inquiry on the need for a disability inclusive response to the crisis.

We have also produced guidance for development partners on how to include people with disabilities in responses to the COVID-19 pandemic [3]. We bring specific expertise on the development of accessible communication materials to people with a wide range of disabilities and adaptation of health facilities and other services to ensure people with disabilities can access their right to health care. We are an associate member of the Hygiene and Behaviour Change Coalition for COVID-19, led by DFID and Unilever [4], to help ensure that disability inclusion is central to its response.

The urgent need for a disability inclusive response

It is widely recognised, including by the UN Secretary General [5] and the Director General of the WHO [6], that people with disabilities are being disproportionately impacted by COVID-19. Many people with disabilities live in poverty due to high levels of discrimination; inequality; barriers accessing education, health care and employment; vulnerable livelihoods and inadequate social protection. These circumstances are exacerbated by disasters, including the COVID-19 pandemic [7].

This disproportionate impact is being shaped by various factors, including the existing barriers that prevent many people with disabilities accessing adequate health care. Inaccessible health facilities, transport networks and high costs can all make accessing adequate health care extremely challenging. People with disabilities who already have health conditions, or who are older, are particularly at risk.

People with disabilities are also experiencing greater risk of COVID-19 as many of the preventative measures required to keep the Coronavirus at bay are often inaccessible, including handbasins, sinks and communal water pumps. Physical distancing and self-isolation are impossible for many people with disabilities who rely on daily access to care, assistance or rehabilitation, and people with complex needs who require ongoing support.

The discriminatory context and barriers people with disabilities are experiencing during the pandemic can be addressed if development stakeholders take appropriate and inclusive action [8]. As the International Development Committee has noted previously, disability is a critical development issue [9]. It is therefore vital that the current inquiry explores and highlights the impact of coronavirus on people with disabilities in developing countries.

Prior to the COVID-19 outbreak, DFID was increasingly including disability in its policies and strategies [10], and had become a prominent global voice on disability inclusion, including on key issues such as data, as well as playing an important role in promoting disability inclusion amongst partners. DFID should use this learning and expertise not only to apply a disability inclusive lens to the UK’s response but also to influence others to do the same.

There are particular actions that DFID and the UK Government as a whole can take now to ensure its response to the COVID-19 pandemic is fully inclusive and applies the leave no on behind principle.

The UK Government should apply an intersectional approach in all overseas development assistance (ODA), taking steps to identify and include the most marginalised people, including people with complex needs and psychosocial disabilities, and accounting for how different factors intersect to shape vulnerability.

The interplay of factors such as age, disability, gender, ethnicity, religion, language, location and other factors need to be considered in the short term and long-term response to the crisis. For example, crises such as COVID-19 affect women and men differently. Gender norms and inequities mean that women often have less decision-making power, unequal access to health care and are less involved in responses [11]. For women and girls these inequities are often amplified. Women and girls with disabilities experience higher rates of violence than their non-disabled peers [12]. During crises there is often an increase in gender-based violence [13] and so there is a significant risk that girls and women with disabilities are currently experiencing high rates of violence. Given the UK’s leadership on both gender and disability, the Government is in a good place to ensure that responses are both gender and disability inclusive and recognise the intersections.

It is vital that children with disabilities are able to access their right to education during and after the pandemic. Sightsavers works closely with Ministries of Education, supporting the development of policies and teachers’ capacity to deliver education to children with disabilities. During the COVID-19 outbreak when schools are closed, we are supporting the design and delivery of distance teaching programmes so that they are accessible to children with disabilities. DFID should ensure that any of their support to distance learning, including through the EdTech hub, considers the need for mechanisms to be inclusive and accessible to children with different learning needs.
However, there are serious long-term implications for children with disabilities. Prior to the pandemic 50% of children in low and middle-income countries were out of school [14]. Children with disabilities are more likely to drop out of school than their peers and there is a real risk that many children with disabilities currently out of school due to the pandemic will not return [15].

DFID must ensure that people with disabilities and their representative organisations are included in responses to the COVID-19 pandemic. Disabled peoples’ organisations (DPOs) working at grassroots level are currently playing a vital role through keeping their members informed, providing accessible communications and essential services. In many countries DPOs are mobilising to advocate with their governments for the inclusion of people with disabilities in the COVID-19 response. It is important to work with people with disabilities and representative organisations to identify immediate concerns and build a clear advocacy plan to influence the response of governments to the COVID-19 crisis.

The limited data that exists on disability is impacting the ability of governments and development actors to determine the impact, and identify appropriate responses, for people with disabilities [16]. The lack of evidence on the inclusion of people with disabilities in responses to previous disease outbreaks means that the evidence base to build effective responses from is limited [17] - in keeping with a general lack of data on disability in developing countries.

The tools to collected better data on disability – such as the Model Disability Survey [18] and Washington Group Question Sets [19] – do exist, but are currently under-used, leaving large gaps in available data on which to act on before, during and after crises.

Recommendations:

DFID should ensure that all long-term development planning effectively mainstreams disability-inclusion and identifies targeted disability measures where appropriate, in line with DFID’s Strategy for Disability Inclusive Development [20]. In line with an effective twin-track approach, the UK Government should ensure all emergency, pandemic response, and re-allocated funds, mainstream disability-inclusion and identify targeted disability measures.
DFID should ensure any funding that is re-purposed in response to the pandemic is not at the expense of existing disability commitments.
In its response, DFID should ensure effective consultation and engagement with Disabled People’s Organisations.
DFID should provide funding for and partner with Disabled People’s Organisations and disability-focused organisations to build capacity on disability inclusion.
DFID should make inclusive education a priority of its response by ensuring that all children can access all learning resources and that children most at risk of inclusion, such as children with disabilities, are prioritised when schools re-open.
DFID should include explicit mechanisms to reach women and girls with disabilities in programmes to tackle violence against women and girls, by ensuring gender-based violence (GBV) prevention and response services are accessible to and prioritise children and adults with disabilities. DFID should ensure disability is embedded into its efforts to eliminate violence against women and girls.
DFID should ensure that data collection and evidence collected during responses to COVID-19 includes disability data, and where possible is disaggregated by sex, age and disability, to track disability inclusion and provide a better evidence base for future responses and promote the use of Washington Group Question Sets [21] and the Model Disability Survey [22] as appropriate tools for data collection.
The UK Government should influence the development of partner government’s national development plans to ensure they are disability-inclusive and protect the rights of people with disabilities in emergency response planning and recovery in future.
The UK Government should use its influence as a global leader on disability to ensure an inclusive response to crisis in the short and longer term.

Strengthening health systems

In times of crisis, the first responsibility of the health sector is to save lives and provide health care where it is most needed. The need to develop stronger, more resilient health systems across the world is being exposed by the COVID-19 pandemic. In many countries health systems are particularly weak and the persistent lack of access to reliable quality health care increases people’s vulnerability over time.

Sightsavers works extensively with Ministries of Health in all the countries where we work; strengthening human resources, infrastructure, and planning and management capacity to ensure that scarce domestic resources are effectively used.

We are continuing to engage with ministries at this time to ensure maintenance of essential health services where possible and explore flexing our support in relation to COVID-19 priorities. This may include supporting planning and management, advising on supply chains for essential services, integrating COVID-19 messaging into health communications activities, and ensuring all services are accessible to those in danger of being left behind.

Investing in health workers worldwide, as well as providing adequate protective equipment and other essential medicines helps prepare low and middle-income countries to deal with the immediate threat of Covid-19 and avoid thousands of preventable deaths. But these investments are also critical if we are to emerge from this crisis with health systems that can effectively beat future outbreaks.

Recommendations:

Ensure the principle of leaving no one behind is effectively embedded into DFID’s policy on a global health strategy.
All development actors must learn the lessons from this pandemic, and take this opportunity to strengthen health systems to deliver Universal Health Coverage and remove barriers experienced by people with disabilities in accessing affordable, quality health care, water, sanitation and public health information during and after the pandemic.
It is vital that all development actors – including DFID and its partners– play a leading role in ensuring they are taking steps to strengthen health systems and ensure their immediate and long-term responses to the pandemic are disability inclusive.

Using the Sustainable Development Goals as a framework for recovery

We welcome DFID’s approach to supporting programmes at this time and working collaboratively to enable the flexing of programmes where possible. As a result of guidance issued by the World Health Organization (WHO) on neglected tropical diseases (NTD) programmes [23], some NTD treatment activities have been put on hold, while others, such as the treatment and care of patients, can continue.

We are working with DFID to look at how we can adapt our flagship NTD programme, Ascend West and Central Africa. This is a programme that Sightsavers leads in a consortium with the SCI Foundation, the Liverpool School of Tropical Medicine (LSTM), and Mott MacDonald, that treats five different NTDs in 13 African countries and is UK Aid’s flagship NTD programme.

Our NTD programmes already have a strong focus on communications around hand washing. We bring expertise in design of social behaviour change communications messages and campaigns, and practical experience in their delivery across multiple countries. We are adapting NTD communication materials and mass media campaigns to integrate coronavirus messaging and pivoting the use of NTD community volunteers to also support the COVID-19 response.

While we recognise the need to support the COVID-19 response by flexing programmes in the short term, it is important for DFID to consider the long-term consequences on the delivery of these programmes as the crisis develops. Additionally, we cannot assume that health services in the countries we support will be the same following COVID-19 and what the economic and political implications will be on resuming programmes.

While it is impossible to say what the long-term impact on all our programmes will be, particularly as the virus continues to spread, we are committed to working closely with communities, government and civil society partners, the corporate sector and donors around the world to assess and respond appropriately to the ever-changing situation.

As the Secretary of State for International Development has said, developing countries are “simultaneously facing a health crisis, a humanitarian crisis and the risk of a protracted economic crisis leading to much greater hardship for years to come”[24] and that the pandemic could “threaten to undo 30 years of international development work”[25]. It is important that the response to the short-term emergency and longer-term does not set back years of progress. In order to mitigate the impact of the crisis, the response and recovery to COVID-19 should be used as an opportunity to rebuild fairer, more inclusive societies, in line with the ambition set out in the 2030 Agenda.

The pandemic has demonstrated the urgent need for the prioritisation of Sustainable Development Goal (SDG) implementation in general – it has shown the lack of policy coherence, weaknesses in health systems, failures in education, governance, environmental protection and employment – and has seriously undermined the 2030 Agenda. People with disabilities and other excluded groups are being disproportionately impacted and discriminated against in multiple contexts [26]. In the response to the COVID-19 pandemic, governments have consistently failed to apply the Leave No One Behind principle.

Recommendations:

The UK Government needs to ensure that work on a long-term recovery is centred around the SDGs as the appropriate development framework – especially the need for policy coherence, partnerships and leaving no one behind – the central principle of the 2030 Agenda.
The commitment to Leave No One Behind must be realised in practice, in order to ensure genuine development progress for the people who need it most; to build fairer more inclusive societies and work to end all forms of discrimination.
The UK Government should influence the international community to take the opportunity to learn from this pandemic and work together to remove barriers to health care, emergency response and end all forms of discrimination so that people with disabilities never again experience the human rights violations that are occurring on a daily basis throughout this pandemic.

For further information about this submission or any aspect of Sightsavers’ work, please contact Sightsavers’ Parliamentary Adviser, Alex Voce at avoce@sightsavers.org

7 | Submission to the IDC’s inquiry on the impact of coronavirus