Interregional Consultative Expert Meeting
on disability-sensitive policy design and evaluation
for sustainable livelihoods for all in the twenty-first century

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Background to the Meeting

2. Overview of policy options related to sustainable livelihoods, safety nets and participation

The data suggest that social and economic isolation of persons with disabilities comes at a very high cost - both to persons with disabilities and to society as a whole.

Worldwide, the socioeconomic dynamics of disability have tended to be similar among countries for a long period of time. People often tend to lose some or all of their rights to social and economic inclusion as a result of incurring a disability, which typically results in some degree of social and economic isolation and marginalization. This, in turn, tends to perpetuate negative societal perceptions of people with disabilities, which can result in low levels of self-esteem among those who experience disabling conditions. To varying degrees persons with disabilities have been prevented - or restricted - from making social and economic contributions, which means that their families, communities and societies often are denied the value of their contributions; this also can result in added costs associated with specialized care and services.

The question of achieving sustainable livelihoods for persons with disabilities can be regarded as a continuum of interrelated issues from full, unassisted participation in open labour markets, through assisted labour market participation, such as sheltered workshops, specialized investments in human resources development, such as vocational training, education and social services, to legal requirements on level of rehabilitation services to further social integration.

Employment statistics related to persons with disabilities in high-income countries often are of limited reliability due to poor quality data, incompatible disability definitions and statistical biases; they also may employ different definitions on employment. For instance, in the United States of America 14.3 million of an estimated 48.9 million persons with disabilities were reported to be employed in 1991to 1992; for the European Union, the European Commission estimated, in 1996, that people with disabilities are 2 or 3 times more likely to be unemployed and for longer periods than the rest of the population. Employment statistics for people with disabilities generally are limited or non-existent in developing countries. Nevertheless, there is evidence that unemployment rates for persons with disabilities are high in all countries.

The first employment policies for people with disabilities began to emerge in the 1920s and 1930s. In Europe these strategies took the form of quota and quota levy systems; in Canada, Denmark, Finland, Sweden and the United States they took the form of vocational rehabilitation and training strategies while in the former Soviet Union they took the form of reserved employment and support for state-authorized enterprises run by persons with disabilities.

On the economic side, traditional segregated care and custodial care systems have proven to be expensive and counterproductive due to the high operational costs of the institutions on which they are based and the observed tendency of these institutions to prevent people with disabilities to gain social and economic access to realize self-reliance. Policies and strategies to bring persons with disabilities into the social and economic mainstream increasingly are recognized as superior from both an economic and a social perspective because of the focus on strengthening capacities of persons with disabilities to make economic contributions, which furthers their social integration while reducing expenditures on custodial care and specialized services.

In keeping with the principles embodied in the World Programme of Action and the Standard Rules, most contemporary national employment strategies and policies concerning persons with disabilities encompass more than traditional hiring quotas, reserved employment schemes and rehabilitation strategies as means to address the root causes of unequal access to employment and livelihoods. A recent comparative study on employment policies for persons with disabilities in eighteen countries found that "exclusion from work is increasingly conceived as a matter for economic policy rather than for welfare policy". [12]

Increasingly, specialized public agencies to provide employment services for disabled persons are being replaced in industrialized countries by strategies that seek to include persons with disabilities in mainstream labour market programmes; often persons with disabilities are identified as a priority group. Mainstream provisions are augmented where necessary with special services for groups that have particular needs, which may present special employment difficulties.

The data suggest two principal contemporary approaches to providing workplace accommodation for persons with disabilities:

• An approach used generally in North America requires employers to accommodate known limitations of employees with disabilities. These may include alterations in the physical layout of workspaces, equipment modifications or use of assistive devices, job restructuring, modification of work schedules and training and provision of technical aids or personal assistance.
• An approach used generally in Europe requires employers to make their entire workplaces accessible. The Federal Republic of Germany, for example, requires employers to install and maintain workrooms, plant facilities, machines and tools, and arrange the work so that the greatest number of severely disabled people can find permanent employment.

An observed trend is an increasing use of financial incentives to facilitate the employment of persons with disabilities, which may include grants, relief from social security contributions, tax credits and wage subsidies. Grants typically are provided for removal of architectural barriers. Grants are available in Denmark, the Netherlands and Portugal to cover the costs of personal assistance in the workplace. Direct assistance for special tools and equipment is provided in the Federal Republic of Germany; the Netherlands provides grants for educational material. Social security measures may be structured to encourage beneficiaries with disabilities to become gainfully employed. The United States of America, for example, provides extended medical coverage for persons with disabilities when they first become employed.

Sheltered work has a history of constraining people who could often find employment in the open market. Therefore, in many countries sheltered work is being augmented or replaced with supported employment strategies designed to offer employment options to severely disabled persons in mainstream enterprises, for instance continuous on-the-job support in competitive employer paid work. The United Nations Voluntary Fund on Disability has co-financed a number of innovative projects in this area, which has included support for computer training of blind girls and young women in Western Asia to training persons with disabilities to fabricate and maintain wheelchairs in Africa, where the emphasis is on women with disabilities, and in Latin America. [13] There is, however, no consensus on the shape of future disability-sensitive employment strategies for people with severe disabilities. Sheltered employment remains the primary employment strategy for the severely disabled in most countries of the European Union.

There is evidence of a complementary trend towards privatization and increased competition in the provision of social services with the emphasis on achieving access for persons with disabilities to the full range of social services. This has opened up the market for disability-related services provision, which has provided opportunities for persons with disabilities and disabled people's organizations to become service providers that take advantage of their detailed knowledge and understanding of disability issues to improve services offered. For instance, the report of the United Nations "Workshop on Ensuring Access to Social Services of Under-served Populations", held at the National Institute of Development Administration of Thailand, in Bangkok in 1998, noted in this regard:

"Many social services fail to respond adequately to the needs of the users, because providers often do not adopt a client focused approach. The result may be a situation whereby social services provision misses its target groups altogether or fails to provide the quality needed. Incorporating the clients' point of view in the planning and delivery of social services will contribute significantly to the accessibility, quality and effectiveness of those services (paragraph 22).

"The adequacy and effectiveness of social services is highly dependent on innovation and advocacy activities by the non -governmental organizations (paragraph 34)" and the importance of "partnerships in planning and coordination of services delivery. [14]

Access to appropriate education of persons with disabilities assumes vital importance in efforts to promote viable employment and sustainable livelihoods by, for and with persons with disabilities. Over the past 10 years there have been a number of international declarations and proclamations recognizing the rights of persons with disabilities to equal education opportunities in mainstream educational settings, wherever possible, such as the "Salamanca Statement and Framework for Action on Special Needs Education" [15] and the "Copenhagen Declaration" and "Programme of Action of the World Summit for Social Development". [16]

A technical study prepared for the World Bank found that "there are personal, social and economic dividends to educating primary-aged children with special educational needs wherever possible in mainstream schools. To achieve inclusive primary education, major changes will be needed in the way in which primary schooling is planned and implemented. Preparation for teaching in inclusive primary schools requires reforms of much current induction and in-service teacher education." [17] Research conducted as far back as the 1980s on analyzing the cost effectiveness and educational merits of mainstreaming and integration strategies confirmed the desirability of mainstreaming approaches. Consequently, present policy in most industrialized countries focuses on integration of children with disabilities into mainstream educational systems, wherever possible. For instance, the "Americans with Disabilities Act" of the United States requires that education be as inclusive as possible. The data available suggest that inclusive educational offerings outside of Europe and North America remain limited.

The United Nations has been concerned with the question of rehabilitation of persons with disabilities virtually since its inception. In the 1960s the (then) United Nations Department of Economic Affairs, in response to requests from Governments, produced a series of monographs on technical aspects of rehabilitation. A 1967 report prepared by the United Nations Secretariat states that the goal of rehabilitation is: "The social adjustment of a disabled individual within the framework of the community to which he is to be restored as an active and self-sufficient participant, is in the broadest sense of the term the ultimate goal of rehabilitation" [18]. The data suggest that to be fully effective the rehabilitation process must be carried out with close coordination of a variety of services - medical, educational, social, psychological and vocational. The social worker as a member of the rehabilitation team has a key role in motivating the client and promoting services with a two-fold purpose: to help the disabled individual overcome the physical and emotional effects of his disability, and to help society as a whole eliminate social and economic obstacles that impede the integration of persons with a disability into the mainstream of the community.

In many developing countries disability service systems historically have tended to consist of small-scale rehabilitation services, education, training and sheltered employment programmes and projects imported from industrialized countries by churches, non-governmental organizations as well as private voluntary service organizations. However, such efforts rarely have reached a significant portion of their target populations due to high operational costs and limited operational resources. Such programmes increasingly are being replaced by community-based programmes, including community-based rehabilitation (CBR) that aim to empower, educate and provide employment opportunities for people with disabilities. CBR first emerged in the industrialized countries of Europe and North America in the 1960s and early 1970s as a reaction to segregated institutional care. The CBR concept was formalized as a "strategy" for developing countries by the World Health Organization - among other members of the United Nations system - during the 1970s. The data suggest that CBR has contributed to development of cost effective, responsive community based approaches to empower and support disabled persons and their families:

"CBR includes village based CBR workers; the identification, assessment and referral where appropriate of disabled children and adults, the design of aids and appliances by local craftsmen; and the teaching of simple rehabilitation techniques to family members for use with their disabled children. Awareness raising, public education, counseling, multi-sectoral collaboration, community development and promotion of integrated education also are key ingredients of CBR programmes". [19]

A recent evaluation of community based rehabilitation for the disabled in the Republic of Indonesia, implemented with the financial support of the United Nations Voluntary Fund on Disability (Project INS/99/D26), stressed the importance of a bottom-up, community based strategic approach as opposed to top-down predominantly governmental institution-based approaches. Special empowerment measures have to be undertaken especially at group, community and locality levels. Training and development of indigenous, paraprofessional facilitators are important to the success of a project as is the need for greater emphasis on developing entrepreneurial skills and placement of workers with disabilities in the community. [20]

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Notes:

12 Patricia Thorton and Neil Lunt, Employment policies for disabled people in eighteen countries: a review (University of York, Social Policy Research Unit, 1997).

13 General Assembly document A/54/388/Add.1.

14 United Nations Commission for Social Development document E/CN.5/1999/6.

15 UNESCO, "Report on the World Conference on Special Needs Education" (Salamanca, 7-10 June 1994).

16 Report of the World Summit for Social Development, Copenhagen, 6-12 March 1995 (United Nations publication, Sales no. E.96.IV.13), chap. I, resolution I.

17 James Lynch, Primary Education for All Including Children with Special Needs (Regional Study) World Bank Human Resources and Social Development Division, Asia Technical Department (Washington, DC, World Bank, July 1993).

18 Social Work in rehabilitation programmes for the Disabled. United Nations Department for Economic Affairs, 1967

19  Susan Miles, "Engaging with the Disability Rights Movement: the experience of community based rehabilitation in Southern Africa", Disability and Society, 11: 1996.

20  Cited in United Nations Commission for Social Development document E/CN.5/2001/7

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