- This topic has 6 replies, 1 voice, and was last updated 2 months ago by Dorothy Nakato Mubezi.
September 1, 2021 at 1:53 am #5668
Persons with disabilities face disability related costs to achieve daily living activities and participation in community. Those costs are related to good and services that they may require in relation to health condition, functional difficulties, and the barriers in their environment. They can be direct costs such as assistive devices, using taxi because public transport is not available or accessible, sign language interpreters, rehabilitation… They can also be linked to loss of opportunity to earn income for their family members who may have to stop working to provide them support.
The more persons with disabilities seek participation (going to school, working, taking part in community and public life…) the more costs they face (more transport, diverse assistive devices, greater need for interpretation and human assistance). Today in many low and middle income, most those costs are unaffordable for persons with disabilities and their families which contribute greatly to restriction of participation, isolation and poverty.
Addressing disability related costs is therefore a pre-condition to significantly reduce inequalities and poverty as well as support access of persons with disabilities to health, education and employment by 2030.
Removing barriers in the environment, for instance by making infrastructures, transport and services more accessible or ensuring that services and workplace provide reasonable accommodation would go a long way decrease disability extra costs faced by persons with disabilities and their families. While critical, such policies have impact in the long term and may be also challenging in contexts with higher informal economy where state regulations can have limited impact.
Social protection has a key role to play in addressing those disability costs by providing support to individuals in different ways: cash transfer such as disability allowances, concessions such fee waivers, high subsidies on transportation, as well as provision of support services (see related question of the month). Together with Universal Health Coverage policies, it can address direct health care costs, including rehabilitation and assistive devices. However, while more countries are considering such support, in 2017 less than 20% of persons with significant disabilities were accessing disability benefits in low- and middle-income countries.
September 2, 2021 at 7:04 am #5676
September 10, 2021 at 3:42 am #5716Chansamone chasuakao::
It’s still a long way to go, example in my country – Laos. the persons with disabilities still not included in the formal system support – means discriminations – they still not been covered in the social security fund as others. What about the consideration for adding extra cost for disability – it needs to go step by step – breaking the wall to create opportunity first then go to the equal support as others then specific additional supports –
September 13, 2021 at 12:10 pm #5763Daniel Mont
Yes, Chansamone, discrimination is a problem, so also can be the unintended consequences of social protection policies that don’t take an inclusive approach. For example, defining disability as the “inability to work” creates an incentive to not work, and to strengthen the attitude that people with disabilities can’t work. Instead of thinking of disability benefits as “income replacement” they should be structured to support participation by covering the extra costs of disability. Determining those costs can be tricky. Here is a link to a paper of ours that talks about the methodology:
September 17, 2021 at 3:00 pm #5787Sophie MitraUp::1
There is evidence of higher costs for families with disabilities including higher health-related expenditures, assistance with daily care costs, and transportation costs. Universal health coverage policies, making public transportation more accessible and subsidizing care and transportation costs may be effective at reducing extra costs.
September 28, 2021 at 10:10 pm #5818Bagival Pradeep::
Having worked within the government, this question used to repeatedly surface before State Coordination Committee headed by the Minister in -charge of disability affairs in India. In some of the L/MICs , public transport services have been subsidized or provided free of charges. But persons with physical disabilities often find these services inaccessible due to barriers they face.
Given the fact that many LMICs are unable to allocate adequate resources to social protection for persons with disabilities on account of competing priorities, there has to be exemption /waiver of the cost of public services for certain ‘benchmark’ disabilities. Majority of persons affected by rare diseases experience disability resulting in limitations in Activities of Daily Living (ADL) and irrespective of their income level, struggle to meet medical expenses related to their treatment. For instance, some of the progressive provincial governments in India have created an exclusive health fund for persons with disabilities from low income group to access medicines and other health related services that are expensive in nature and associated with rare diseases.
While legislations in many low/middle income countries ( S.E. Asia) have subsidized education/health services for persons with disabilities , the provisions of the law often remain unimplemented and therefore there is a need for anti-discrimination commissions to be established and should function proactively to ensure social protection measures are disability-inclusive. I have meet families of persons with disabilities in S.E. Asia who were constrained to go to neighboring countries for rehabilitation services as the services were not available in their country and this ‘out of pocket expenditure’ had resulted in families falling back in poverty. The national govts need to take ownership of strengthening their health and rehabilitation services so that families of persons with disabilities do not have to incur out of pocket expenditure for health related services.
Tax exemptions such as Income tax/Profession tax for persons with disabilities and their families has been a significant step in some countries that has enabled families to meet disability related costs. Many countries have made provision for ‘Disability Fund’ and through public-private partnership to garner resources so that families of persons with disabilities with low income could be supported to meet additional expenses.
Social protection programmes result in enhancement of productivity and employability of persons with disabilities and thereby resulting in economic empowerment. National social protection policies should be fully disability- compliant with express provisions to support persons with disabilities and their families. Most importantly, through political will and leadership of the executive office in charge of disability affairs, governments in LMICs should ensure social protection policies and practices are able to address day-to-day challenges faced by persons with disabilities and their families.
September 30, 2021 at 12:43 am #5819Dorothy Nakato Mubezi::
The best and most practical steps that low and middle income countries can take to support persons with disabilities to cover the diversity of their disability related costs by 2030.
Example of disability related costs:
Specific disability expenditures
- Assistive Devices and Personal Assistance
- Rehabilitation/Habilitation/Vocational Rehabilitation
- Housing Modifications, Special vehicles
Sign language interpretation, Braille books
Extra expenditures on general items
- Health care
- Extra transportation (e.g. taxis)
Housing premiums (location, accessibility
Less employment opportunities
Less education opportunities
Lower earnings of
people with disabilities
Loss of earning or education opportunities for family members who are care givers.
Given the fact that many LMICs are unable to allocate adequate resources to social protection for persons with disabilities on account of competing priorities and the scarce resources, it is still challenging for Governments to cover disability related costs. However, they should take the following steps:
- Disability specific support;This gives high level of support to persons with disabilities and it covers a small population which I believe LMICs can manage.
This calls for combined the support to overcome barriers (can decrease with more inclusive environment) as well as support inherent to the personal functional limitation (permanent)
- Assistive devices, rehabilitation (benefit persons with disabilities but also people with injury, older persons …). Is required now and and will always be necessary
- LMICs should provide accessible and inclusive basic services for all: inclusive education, health, justice, infrastructure and information, transports, basic income security …This has a low level of support but covers greater population of persons with disabilities and will ultimately have a big impact but will take a lot of time.
- LMICs should explore both in cash and in-kind support to persons with disabilities to be able to cover the diversity of their disability related costs.
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