Written evidence submitted by World Vision UK
 

World Vision is the world's largest international children's charity. We are a child focused Christian relief, development and advocacy organisation dedicated to working with children, their families and communities to overcome poverty and injustice. We work in 100 countries to improve the lives of 100 million people worldwide. 

We welcome the opportunity to provide evidence to the Committee on World Vision’s approach to disability-inclusive programming.

Summary

1.       Approximately 15% of the global population live with some form of impairment[1]. People with disabilities, and children in particular, face an array of challenges. They are disproportionally likely to live in poverty and experience higher rates of violence and abuse. Often stigmatised by their communities, they are denied access to vital services such as an education and healthcare.

2.       By neglecting to include children with impairments in the development process, their risk of vulnerability increases. Therefore, to lift individuals and communities out of poverty, it is essential to include adults and children with disabilities in development interventions. Attention must be targeted towards breaking down the social barriers experienced by individuals and equip them with tools to be able to actively participate in their own development.

3.       The UK Department for International Development had once made disability-inclusive programming a key priority. However, it has slipped down the agenda. For instance, lack of disaggregated data on DFID programmes makes it hard to see if the department is truly having an impact on the lives of those with disabilities, or are even including them in projects.

4.       We welcome the recent highlighting of disability issues by DFID, and Lynne Featherstone MP in particular. This must turn into practical action, including funding being made available to enable DFID and its partners the resource to mainstream disability across all their programmes and to better measure disability-inclusive impact.

5.       UNICEF estimates for every 1 child that is killed as a consequence of armed violence, 3 children are left with permanent, life-long injuries or disabilities[2]. Therefore, in fragile contexts efforts must be made to ensure children and adults with disabilities are not ‘forgotten victims’[3] in the event of natural disasters or conflicts but instead are considered and included in all preparedness and recovery plans.  

A need for UK Government to focus on disability

6.       At World Vision we seek the sustained well-being of children within their families and communities, especially the most vulnerable. Children and adults with disabilities are often among the most vulnerable people in the communities in which we work. In World Vision’s latest research on Most Vulnerable Children programming, both child and adult respondents identified children with disabilities (CWDs) among groups of most vulnerable children[4]. There are a range of causes of vulnerability including: poverty, lack of opportunities, deprivation of rights, serious stigma and discrimination, inaccessibility to facilities and services such as education and healthcare, lack of self-confidence.

7.       Children with disabilities are also more vulnerable to abusive relationships. For example in Kenya it was estimated that 15-20% of CWDs experience grave levels of physical and sexual violence[5]. Natural disasters and conflicts can also increase the vulnerability where, for example, physical impairments may cause individuals to be less mobile. The UN committee on the Rights of Persons with Disabilities has described individuals with disabilities currently living and fleeing Syria were the ‘forgotten victims’ of the conflict[6]. They have become extremely vulnerable and face grave violations of their rights as they struggle to access essential services. Emergency response programmes aren’t always well catered for people with disabilities (PWDs) either.

8.       Approximately 15% of the global population live with some form of impairment[7], with people with disabilities, children in particular, disproportionately more likely to live in poverty[8]. The inter-linkages between poverty and disability have been widely acknowledged and also feature in the UK government’s disability strategies, most noticeably the Department for International Development (DFID) Disability, poverty and development[9]. However, it is also recognised that these groups are often excluded from development processes[10].The statistics accompanying children with disabilities remain shocking; 80% of the 200 million children with disabilities living in developing countries[11] and over 90% of children with disabilities still not receiving education[12]. Furthermore, in countries that have been praised for reducing under-five mortality rates to less than 20 percent, experts believe the figure for children with disabilities could actually be as high as 80 percent mortality[13]. There needs to be a renewed push from the international community to ensure disability-inclusive programming remains central to the global development discourse.

9.       One of the major criticisms of the Millennium Development Goals (MDGs) set out by the United Nations remains to be the absence of a focus on disability. It could be argued that the lack of inclusion of CWDs in development programming caused one of the prominent barriers to achieving the MDGs. For example, in the 2007 UNESCO Education for All Global Monitoring Report, it was estimated that one third of the 77 million children missing out on education were disabled and in Africa, fewer than 10% of disabled children attended school[14]. It has become clear that if we were to achieve MDG2 - universal primary education - there would have to be a deliberate focus on making education accessible to all, and ensuring the inclusion of disabled children would be an integral part of that. With 57 million children still out of school in 2013[15] achieving MDG2 seems unlikely.

10.   As we approach the 2015 deadline, conversations have now begun around disability in the post-MDG agenda. World Vision particularly commends Permanent Undersecretary of State for International Development, Lynne Featherstone and DFID in leading in these global discussions. World Vision agrees that in order to tackle poverty, we must address the needs of the people with disability[16] and welcomes the Minister’s commitment to make disability rights a key development priority[17]. We believe that to truly bring communities out of poverty we must eliminate the social stigma and discrimination CWDs experience and ensure that disability inclusion should be mainstreamed in all development interventions. A particular focus on challenging the social norms and stigmatisation towards CWDs needs to be embedded in all interventions and DFID should make funding available to make this achievable. As the post-2015 framework is beginning to take shape, we should not see disability-inclusion as a stand-alone goal, but rather a cross-cutting theme relevant to all development issues.

Changing attitudes and behaviours towards disabilities is vital

11.   According to the UN Convention on the Rights of the Child, children with disabilities have the right to a full and decent life, to equally and meaningfully participate in and benefit from humanitarian assistance and development processes in their communities[18]. However, the rights of these children may be violated by attitudinal, institutional or environmental barriers that exist in any given society. Every community or society has barriers that prevent some of its members (especially those with physical, sensory or intellectual impairments) from participating in activities that other members of society enjoy.

12.   World Vision works according to the social model of disability. Our approach to disability inclusion focuses on the social, programming and rights issues. World Vision seeks to raise awareness of disability to ensure that disabled people’s human rights are respected, to reduce social stigma, break down barriers and to ensure that disabled people are included in and not excluded from their community’s development.  World Vision partners with disabled peoples organisations (DPOs) and other organisations to achieve this aim. We recognise that not all with disabilities will be categorised as ‘most vulnerable’. However World Vision works on the basis that only when inclusion with equal access to development opportunities is achieved, will most individuals with disabilities become less vulnerable.

World Vision’s approach to disability-mainstreaming: our programmes and projects

13.   World Vision promotes ‘disability mainstreaming’ ensuring that the rights of disabled people are met and as equally represented. Disability is recognised as relevant for World Vision programmes and projects across all sectors and is deliberately considered at all stages throughout their assessment, design, implementation, monitoring and evaluation. The goal is to enable equal access and opportunities for people with disabilities as programme participants and beneficiaries.

14.   Given that disabled children are often hidden within populations, World Vision proactively seeks to understand the ratio in the population and to ensure that the number of individuals with disabilities participating in World Vision programmes and projects will at least reflect it. In World Vision’s long-term area development programmes, we seek to reflect this ratio with the number of CWDs included as sponsored children. Although our approach is to include disability issues in all our development programmes, we also realise that more targeted (including at CWDs) projects are needed. Inclusive programming alone will not be sufficient to support those who are most vulnerable in the community. In this light, we support DFID’s ‘twin-track’[19] approach to disability; to promote the deliberate inclusion and active participation of CWDs in all areas of development whilst not neglecting to also address the particular needs of those individuals. 

15.   In 2006 World Vision UK was awarded a five year grant from DFID as a part of their Programme Partnership Agreement (PPA). From 2008, the PPA grant amounted to approximately £2.5million per year, part of which was earmarked to mainstream disability into World Vision’s programming. Our strategic objective to ‘strengthen the engagement of disabled people in poverty reduction’ took a learning approach to mainstream disability across particular WV partners. Priority was given to developing training on disability issues for WV staff (by 2011 it had reached over 2,500 staff); piloting projects in selected DFID priority countries and learning in areas of service delivery such as in education; development of external partnerships with national disabled peoples organisations (DPOs); and evaluation[20]. We considered all of these elements essential to successfully mainstreaming disability. These are now central components of our development programming..

16.   In 2010 World Vision UK produced a training handbook “Travelling Together – how to include disabled people on the main road of development”[21], which as well as highlighting the inequality that disabled people face, provides practical tools to promote inclusion in community development.  This handbook is widely used, raising awareness and promoting the inclusion of disabled people in development internationally. In designing a disability-inclusive strategy, DFID must take into account that persons with disabilities are diverse and belong to different gender, age, culture, race and ethnicity, socio-economic background, religion, educational background, and family background. Research by the International Institute for Child Rights and Development (IICRD) and World Vision on Most Vulnerable Children has also demonstrated that CWD who are included in development programmes, supported and cared for by family, peers and community and have access to education and social opportunities are far less vulnerable and able to play an active role in their own development[22]. Thus we recommend that DFID funds and supports programming solutions that promote the full inclusion of CWD, by removing barriers to access to education, health, protection and other vital services. Children with disabilities also have different types and degrees of impairment, and these should be taken into account for mainstreaming disability into DFID’s programming.

17.   A major factor that contributed to the positive progress made in mainstreaming disability throughout the 2006-2011 PPA programme was training World Vision and its partners’ development workers themselves in acknowledging the rights of disabled people to be included in development programmes. This allowed our staff to then educate the community and focus on programmes and projects of inclusiveness and accessibility, not on individuals’ condition or impairments. World Vision’s development programming approach deliberately takes a positive, rights-based approach to disability. We focus on the positive ‘assets’ or ‘capabilities’ of individuals, families and communities and seek to build on these, rather than starting with a negative deficits approach. We recommend that DFID provides disability equality orientation and refresher training to key stakeholders including DFID staff and leadership. This promotes attitudinal and behavioural changes, accessibility and inclusive programming, in order to eliminate discrimination against persons with disabilities in DFID’s programmes. Wherever possible, disability training should be provided by, or in cooperation with, community-based or national disabled people’s organisations.

18.   In 2011, World Vision UK was awarded a second PPA grant, with a new focus on child protection. Our goal to ensure ‘children and communities, especially the most vulnerable and those in the poorest and/or most fragile contexts, are cared and protected’ has mainstreamed disability into its programmes. Baseline and monitoring data for this PPA outcome is disaggregated by disability, to ensure levels of inclusion are measured and reflected upon. Mainstreaming disability into child protection programming has also contributed to a change in social norms around the inclusion of certain groups in development processes and has led to decreased levels of prejudice in the community. What is currently missing from DFID reporting is the lack of clear disaggregated data on the numbers of PWDs and specifically CWDs in targeted areas, being reached and impacted. We call on DFID to demand clear, disaggregated data from projects they fund. If this proves logistically challenging, DFID should provide enough funds to ensure this standard of data is still provided.

19.   Progress has also been made on both an international and national level in raising awareness of the rights of disabled people and World Vision has seen a rise in opportunities to influence decision-makers on this issue. For example, through the collaborative efforts of World Vision India and WV International’s Global Advocacy Team, Nisha Das, a 15-year-old girl, represented the voices of children and youth at the thematic debate on Inequality at the United Nations (UN) Headquarters in New York on July 8, 2013.  The event, titled “The role of the United Nations in promoting a new global human order,” was convened by the President of the UN General Assembly, H.E. Mr. Vuk Jeremić.  Nisha was invited to be the sole representative of the youth and gave a statement during the interactive debate on “Reducing Inequality: Perspectives from Civil Society.”  She is part of World Vision India’s North Kolkata Area Development Program and a leader of the National Forum of Children with Disability in India. World Vision believes that PWDs must be central to any discussions concerning disability and development. Opportunities should be made for those who can best represent the rights and views of citizens with disabilities ranging from the global level, at the UN to state governments and in parliament, and at the local level, in the community.  

Targeting disability in fragile states

20.   World Vision UK focuses on reaching the most vulnerable people living in the world’s toughest places. We deliberately choose to work in fragile contexts where communities are often recovering from conflict and in areas where the national government is not fulfilling its responsibilities[23] to its citizens. Research suggests that children with disabilities experience violence at a greater rate of 1.7 annually than able-bodied youths[24]. UNICEF estimates for every 1 child that is killed as a consequence of armed violence, 3 children are left with permanent, life-long injuries or disabilities. Between 1990 and 2001, 6 million more had been left disabled[25]. In natural disasters and conflicts, the needs of CWDs are often neglected and these individuals become ‘forgotten victims’[26] of the emergency. In these areas, we are aware that impairments may not only affect an individual at birth but it may also be the consequence of living in these conditions and our programmes reflect this.

21.   World Vision’s child friendly spaces (CFS) – a child protection and non formal education intervention used to support communities in emergencies – allow staff to identify the most vulnerable children, including those with disabilities. CFS programmes aim to mainstream the needs of disabled children, (both as a predetermined condition or as a result of the crisis), which provide the necessary provisions for those groups as well as maintaining activities essential to a child’s development such as access to education and healthcare.

22.   A 3 year research programme by Columbia University is currently assessing the impact of CFS run by World Vision, Save the Children and UNICEF. Its initial findings have found that the effectiveness of child friendly spaces in a camp for Congolese refugees in western Uganda suggest that children who regularly attend CFS were able to sustain their psychological well-being, where as those who didn’t attend had a marked deterioration. Almost 50% of children categorised as ‘most vulnerable’ who had scored ‘at risk’ levels of psychological difficulties at the time the baseline was conducted were regular attendees of CFS. All children showed a reduction in difficulties to normative levels at a follow up assessment[27].

23.   We recommend that DFID reviews its humanitarian response strategies to ensure its assistance is reaching the most vulnerable groups, including but not exclusively, those with disabilities. When working in these challenging contexts, DFID must be prepared to provide both physical and psychological rehabilitation to all victims of armed violence. In its recovery programming, DFID must be flexible and consider the potential need to adapt beneficiaries’ livelihoods to better suit their new circumstances.  

Conclusion

24.   In 2000, DFID highlighted the critical need to address disability issues in response to tackling poverty. However in the years since, we have seen discussions around disability-inclusive programming often neglected and replaced by other DFID priorities. We applaud Lynne Featherstone in driving efforts to return DFID’s attention towards this issue however more action is required by DFID to ensure assistance is targeted and inclusive of people, particularly children, with disabilities. DFID should not view disability as a separate agenda for its development programmes but instead, commit to achieving inclusion of disabled individuals, those who are excluded or marginalised in the communities DFID and its partners work in.

25.   DFID must demand more from its implementing partners in terms of disaggregating available data by disability, age and gender; enabling full transparency in measuring the inclusion of disabled individuals in the programmes and projects it funds. Funding must be made available by DFID to ensure disaggregation of data can happen effectively.

26.   In DFID programmes there needs to be a strong focus on tackling the discrimination experienced by people with disabilities in communities. Interventions should celebrate an individual’s capabilities, not their impairments and promote active participation in the community. The more positive attention paid to how an individual can contribute to their own development will aid efforts to breakdown social and physical barriers in society. Particular attention should be paid to children with disabilities, ensuring they have access to education, healthcare and other basic services that will contribute towards the creation of supportive networks for the child. In these instances, they will be less vulnerable to abuse and exploitation often experienced by children with disabilities. DFID must recognise that the needs of adults with disabilities and the needs of children with disabilities can greatly differ.

27.   In fragile contexts, DFID must make every effort to reach the most vulnerable children. In designing disaster risk reduction strategies, the needs of children with impairments must be considered. In emergency response and medical care must be fully accessible to and inclusive of people with disabilities. The Rights of disabled people and that of children must be upheld during and in the aftermath of emergencies, in areas such as refugee and internally displaced persons camps.

28.  Globally, the space to advocate on the inclusion of different development issues in a post-2015 framework is very crowded and it will prove challenging to keep the pressure on disability to be included as a cross-cutting theme. If DFID is truly committed to bringing disability-inclusion to the forefront of development, it needs to ensure this topic remains central to the development discourse. The voices of disabled adults and children should be heard and considered at all levels of decision-making. Opportunities should be opened up to bring representatives of these groups into the centre of the post-2015 development debate.

December 2013