disability inclusive responses to covid 19 lessons learnt from research on social CORD-Papers-2022-06-02 (Version 1)

Title: Disability-inclusive responses to COVID-19: Lessons learnt from research on social protection in low- and middle-income countries
Abstract: The one billion people living with disabilities globally already face a heightened risk of poverty which will likely be exacerbated by the COVID-19 pandemic unless interventions to address its economic impacts are disability-inclusive. This paper draws on the literature on disability poverty and social protection in low- and middle-income countries to explore the pathways through which the current pandemic may increase the risk of poverty amongst people with disabilities such as loss of income from disruptions to work particularly in the informal sector and higher future spending and productivity losses from disruptions to healthcare and other key services (e.g. rehabilitation assistive devices). It also explores how social protection and other initiatives to mitigate the economic impacts of the pandemic should consider the needs of people with disabilities with recommendations for disability-inclusive actions in the design and implementation of eligibility criteria and application procedures as well as the delivery and content of benefits. Across recommendations meaningful consultations with people with disabilities leadership at the program and policy level appropriate budgeting and monitoring of progress through routine collection of data on disability are key for improving access to and impact of economic responses for people with disabilities.
Published: 2020-08-28
Journal: World Dev
DOI: 10.1016/j.worlddev.2020.105178
DOI_URL: http://doi.org/10.1016/j.worlddev.2020.105178
Author Name: Morgon Banks Lena
Author link: https://covid19-data.nist.gov/pid/rest/local/author/morgon_banks_lena
Author Name: Davey Calum
Author link: https://covid19-data.nist.gov/pid/rest/local/author/davey_calum
Author Name: Shakespeare Tom
Author link: https://covid19-data.nist.gov/pid/rest/local/author/shakespeare_tom
Author Name: Kuper Hannah
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kuper_hannah
sha: 145e3f9d2b32ea7855b4458d2b1d11b30e564978
license: no-cc
license_url: [no creative commons license associated]
source_x: Elsevier; Medline; PMC
source_x_url: https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32904300
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32904300
pmcid: PMC7455235
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455235
url: https://www.ncbi.nlm.nih.gov/pubmed/32904300/ https://doi.org/10.1016/j.worlddev.2020.105178 https://api.elsevier.com/content/article/pii/S0305750X20303053 https://www.sciencedirect.com/science/article/pii/S0305750X20303053?v=s5
has_full_text: TRUE
Keywords Extracted from Text Content:  recipients Honduras LMICs Bangladesh found un-or Banks, 2019 adult recipients Organizations Functioning-based IMF ): UNCRPD women Mauritius Brazil, COVID-19 Neupane people line 2020a Banks People São Tomé Cabo Verde COVID-19 people
Extracted Text Content in Record: First 5000 Characters:amongst people with disabilities, and suggests how social protection and other economic responses should consider the needs of people with disabilities. The COVID-19 pandemic has led to economic pressures for many households, which may disproportionately affect people with disabilities and their households. Notably, the pandemic has resulted in massive disruptions to the labor market. A rapid survey of over 5,000 households in Bangladesh found 63% of people had been rendered economically inactive and weekly income had dropped by almost 80% amongst poor households since the start of the pandemic (Rahman & Matin, 2020) . Households with members with disabilities tend to have fewer working members to offset income losses if one or more members lose work, as people with disabilities are more likely to be un-or underemployed and other household members may forgo work to provide caregiving support (WHO & World Bank, 2011) . For example, a survey of people with physical impairments in Jordan found that 58% lived in a household with a single income earner pre-pandemic, of which 78% had lost their jobs due to COVID-19 restrictions (Humanity & Inclusion, 2020) . Further, people with disabilities -particularly women with disabilities -are more likely work in the informal sector (Mizunoya & Mitra, 2013) , which lacks job security and financial protections such as unemployment insurance or paid sick and carer leave. People with disabilities may also take longer to re-enter the workforce after restrictions are eased, as factors such as stigma of disability, inaccessible environments and poor access to education and training limit job opportunities (WHO & World Bank, 2011) . Additionally, many of the health and social services that people with disabilities require (e.g. rehabilitation, assistive devices, care for chronic conditions, psychiatry, medications, personal assistance) have been disrupted due to COVID-19. For example, there is concern that restrictions in China led to poor access to mental healthcare, particularly for older adults and people unable to access telehealth services (Yang et al., 2020) . Disruptions to needed services can results in deteriorating health, which may lead to higher future healthcare spending and immediate and long-term losses to functioning and productivity (Shakespeare et al., 2018) . Finally, people with disabilities and their households often have fewer coping mechanisms for managing economic stressors, as many are already living in poverty. Numerous studies conducted pre-pandemic found people with disabilities have lower incomes and savings, weaker social networks, fewer assets and a heightened risk of food insecurity compared to people without disabilities (Banks et al., 2017; WHO & World Bank, 2011) . People with disabilities also incur disability-related extra costs -such as for assistive devices, health services, accessible transportation and personal assistance -that lower their disposable income (Mitra et al., 2017) . Some countries have begun implementing interventions addressing the economic impacts of COVID-19, such as food assistance, emergency cash transfers, unemployment assistance or expansions to existing social protection programs (IMF, 2020a). As these programs are developed, it is important to ensure their design and delivery is inclusive of people with disabilities. Programs must consider whether their targeting strategies are disability-inclusive. For example, many interventions target people living in poverty using means-testing (income thresholds to determine poverty) or proxy-means-testing (household or individual characteristics to predict poverty). However, means-testing often underestimates poverty among people with disabilities by not accounting for extra costs of disability Gooding & Marriot, 2009 ): incorporating even conservative estimates of disabilityrelated extra costs increased the proportion of people with disabilities who were considered poor by 3.7 percentage points (pp) in Vietnam (Braithwaite & Mont, 2009), 9.7 pp in Bosnia and Herzegovina (Braithwaite & Mont, 2009) , and 18.4 pp in Cambodia . Similarly, proxy means-testing often has exclusion errors that are particularly biased against people with disabilities and older adults (Kidd, 2017) . Some programs explicitly target people with disabilities. For example, Georgia, Mexico, Mongolia, Lesotho, Tunisia and São Tomé and Principe plan to implement new or expand existing disability-targeted social assistance schemes in their COVID-19 response (IMF, 2020a). However, determining who is disabled is methodologically and logistically challenging Mont et al., 2019) . Many disability assessments require clinical documentation of impairments, which is not in line with the conceptualization of disability espoused by the UNCRPD (Mont et al., 2019; Walsham et al., 2019) and, particularly during COVID-19, may be difficult to conduct when health services are limited. Further, some schemes only include people
Keywords Extracted from PMC Text: screen-reader LMICs Neupane Mauritius adult recipients " Mactaggart 2020a people Banks, 2019 São Tomé recipients People line Cabo Verde Brazil, IMF Honduras Banks Functioning-based UNCRPD COVID-19
Extracted PMC Text Content in Record: First 5000 Characters:Programs must consider whether their targeting strategies are disability-inclusive. For example, many interventions target people living in poverty using means-testing (income thresholds to determine poverty) or proxy-means-testing (household or individual characteristics to predict poverty). However, means-testing often underestimates poverty among people with disabilities by not accounting for extra costs of disability (Banks et al., 2016, Gooding and Marriot, 2009): incorporating even conservative estimates of disability-related extra costs increased the proportion of people with disabilities who were considered poor by 3.7 percentage points (pp) in Vietnam (Braithwaite & Mont, 2009), 9.7 pp in Bosnia and Herzegovina (Braithwaite & Mont, 2009), and 18.4 pp in Cambodia (Palmer et al., 2019). Similarly, proxy means-testing often has exclusion errors that are particularly biased against people with disabilities and older adults (Kidd, 2017). Some programs explicitly target people with disabilities. For example, Georgia, Mexico, Mongolia, Lesotho, Tunisia and São Tomé and Principe plan to implement new or expand existing disability-targeted social assistance schemes in their COVID-19 response (IMF, 2020a). However, determining who is disabled is methodologically and logistically challenging (Mactaggart et al., 2016, Mont et al., 2019). Many disability assessments require clinical documentation of impairments, which is not in line with the conceptualization of disability espoused by the UNCRPD (Mont et al., 2019, Walsham et al., 2019) and, particularly during COVID-19, may be difficult to conduct when health services are limited. Further, some schemes only include people with very severe disabilities, such as people requiring full-time caregiving or deemed unable to work - excluding the much larger group of people with more moderate disabilities, who often have a high need for social protection (Banks et al., 2016, Gooding and Marriot, 2009). Functioning-based assessments of disability, involving trained community informants, may be an effective and rapid method for identifying people with disabilities for social protection and other assistance, particularly during the COVID-19 pandemic. Finally, COVID-19 programs that are not coordinated with other social protection schemes risk the exclusion of people with disabilities. For example, some countries do not allow the receipt of multiple forms of social protection (Banks, 2019), which could limit access for recipients of other schemes (e.g. disability-targeted cash transfers or Old Age Pensions) who require additional support to cope with the economic effects of COVID-19. Previous studies have found many people with disabilities are not enrolled in schemes they are eligible for. For example, coverage of disability-targeted programs was 40% in Cam Le, Vietnam (Banks, Walsham, Minh, et al., 2019), 25% in the Maldives (Hameed et al., 2020), and 13% in Tanahun, Nepal (Banks, Walsham, Neupane, et al., 2019). Similarly, studies of non-disability targeted program in Peru and Tanzania found low levels of enrolment amongst eligible people with disabilities despite high levels of poverty (Bernabe-Ortiz et al., 2016, Kuper et al., 2016). Common barriers to enrolling in social protection schemes should be considered when developing COVID-19 interventions. Frequent challenges include: poor awareness of available program, lack of accessible information and communication (e.g. Braille, screen-reader compatible, sign language), misconceptions and stigma of disability amongst staff, urban-based and physically inaccessible application points, and financial and administrative difficulties gathering necessary documentation, particularly for medical assessments of disability (Banks et al., 2016; Banks, Walsham, Minh, et al., 2019; Banks, Walsham, Neupane, et al., 2019; Mitra, 2005). Adaptations to enrolment procedures may help support the inclusion of people with disabilities. For example, in some districts of Nepal, Disabled Peoples' Organizations were credited with improving enrolment in disability-targeted programs, as they provided their members with accessible information about available schemes, helped with applications, and worked with assessment panels to improve their understanding of disability (Banks, Walsham, Neupane, et al., 2019). Further, decentralization and streamlining of application processes was credited with increasing enrolment in disability-targeted programs in Vietnam (Banks, Walsham, Minh, et al., 2019). Previous studies highlight that people with disabilities can face challenges receiving social protection benefits once enrolled, due to difficulties reaching delivery points or unpredictable delivery schedules (Gooding & Marriot, 2009). COVID-19 is altering delivery mechanisms in some countries, such as in the Gambia, Morocco and Togo, where cash transfers are being distributed through mobile applications (IMF, 2020a). These strategies may improve access to
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