Leaving No-one Behind: Building Inclusive Social Protection Systems for Persons with Disabilities Stephen Kidd, Lorraine Wapling, Rasmus Schjoedt, Bjorn Gelders, Diloá Bailey-Athias, Anh Tran and Heiner Salomon Working Paper: February 2019 Development Pathways Limited 5 Kingfisher House Crayfields Business Park New Mill Road Orpington BR5 3QG United Kingdom Tel. +44 (0) 1689 874764 Email: [email protected] http://www.developmentpathways.co.uk Twitter: @DevPathways This material has been funded by UK aid from the UK government; however the views expressed do not necessarily reflect the UK government’s official policies. i In memory of our dear colleague Krystle Kabare ii Executive Summary Executive summary A Introduction Worldwide, it is estimated that more than one billion people live with a disability. Persons with disabilities – and their households – are more likely to live in poverty and have lower standards of living than persons without disabilities. Many experience higher costs in their daily living expenses as a result of their disability. The challenges faced by persons with disabilities vary across the lifecycle as well as between cultures, societies, genders and economic classes. Access to social protection can play a key role in enhancing the wellbeing of persons with disabilities. This report examines how to make social protection systems and schemes more inclusive of persons with disabilities. The research underpinning the report comprised a review of relevant literature, an analysis of household survey datasets and consultations with key stakeholders and persons with disabilities in seven low- and middle-income countries: Brazil, India, Kenya, Mauritius, Rwanda, South Africa and Zambia. B Types of social protection schemes for persons with disabilities From the perspective of disability, social protection schemes can be classified into four types: disability-specific schemes, for which only persons with disabilities are eligible; disability-relevant schemes, which are largely accessed by persons with disabilities (old age and veterans’ pensions); targeted mainstream schemes, for which ‘capacity to work’ is a key criterion; and, mainstream schemes for which persons with disabilities are usually eligible on an equal basis to others. Disability-specific and disability-relevant schemes are offered across the lifecycle and are funded by general government revenues (tax-financed) and contributions. Key schemes funded by general taxation include: disability benefits for children that help families address the additional costs they face and compensate for any loss of income resulting from increased care responsibilities; disability benefits for people of working age and old age pensions, which offer income replacement to those who cannot or should not work; personal independence benefits which compensate people with disabilities for the additional costs they face; and, financial support for carers who have experienced a loss of income. Although only a few low- and middle-income countries provide specific child disability benefits, at least 32 low- and middle-income countries have disability benefit schemes for persons of working age. There are 67 tax-financed old age pensions across iii Executive Summary low- and middle-income countries, of which 35 offer universal coverage either through a universal or pension-tested social pension. There are few examples of carers’ benefits in low- and middle-income countries. C Levels of investment in social protection for persons with disabilities There is no comprehensive information available on the overall level of investment by countries in social protection for persons with disability. While over 80 per cent of high- income countries invest at least 1 per cent of GDP in disability-specific benefits for persons of working age, only six low- or middle-income countries – Brazil, Georgia, Kyrgyz Republic, Mauritius, Namibia and South Africa – invest more than 0.3 per cent of GDP. However, in some countries, when social insurance disability benefits are included, the level of investment is higher: for example, the proportion of GDP invested in disability benefits for both children and adults of working age is 1.5 per cent in Brazil and 1.4 per cent in Uzbekistan. Across low- and middle-income countries, old age pensions – which, to large extent, benefit persons with disabilities – comprise the largest social protection schemes: 24 countries invest more than 0.5 per cent of GDP in tax-financed old age pensions, reaching 4.8 per cent of GDP in Georgia. It is not possible to determine the level of investment within mainstream schemes in persons with disabilities because there is little disaggregated data on recipient household members, but it is likely to be minimal given that the majority of investment in mainstream programmes benefits those without disabilities. D Coverage of persons with disabilities by social protection In most low- and middle-income countries, coverage of both persons with and without disabilities by social protection is low, and there is little evidence on the extent to which persons with disabilities specifically access schemes. Nonetheless, there is some evidence that the type and severity of functional limitation can influence access to national social protection schemes and systems, although it varies by country. For example, in South Africa, access to tax-financed schemes is lower for those with seeing and hearing difficulties while, for most types of disability, coverage is slightly less among those with the most profound functional limitations when compared to those with less severe – but still significant – limitations. In India, the pattern is different, with more of a balance in coverage across people with different types of functional limitations. There is also some evidence that coverage of persons with disabilities varies across and within different types of schemes. The coverage of people of working age by disability benefits is above 3 per cent in Mauritius, Georgia and South Africa while, among other iv Executive Summary low- and middle-income countries with disability-specific benefits, it is less than 2 per cent, and negligible in many. Universal old age pensions and disability benefits offer much higher coverage of persons with disabilities than those targeted at the poorest members of society. Yet, as Nepal demonstrates – where the universal Disability Allowance only reaches 0.4 per cent of the working age population – not even universal benefits guarantee access to everyone who is eligible due to implementation barriers. The evidence on the coverage of persons with disabilities by mainstream schemes is limited and results are variable. For example, in South Africa, 67 per cent of children aged 5-17 years with a severe functional limitation access the Child Support Grant compared to 63 per cent of children without a disability. In contrast, in Indonesia’s Program Keluarga Harapan (PKH) conditional cash transfer programme, the coverage of households including a person aged 15 years and over with a severe functional limitation is 2.2 per cent, which is lower than the coverage of those without a person with a disability (2.5 per cent). There is minimal information available on the access of persons with disabilities to public works schemes. However, in India’s MGNREGA, only 8 per cent of people with a severe functional limitation living in rural areas are employed in the programme, compared to 12.5 per cent of persons without a disability. E Values of transfers offered to persons with disabilities The relative value of social protection transfers varies across countries, which partly determines their impacts. However, there is a positive relationship between the value of transfers and the coverage of the population across disability benefits and old age pensions: at higher coverage levels there is a tendency for transfer values to be higher. F Impacts of social protection on persons with disabilities There have been few studies examining the impacts of social protection schemes on persons with disabilities. A small number of disability-specific benefits have been evaluated, with most studies from South Africa. They offer some evidence on incomes and consumption, education, health, livelihoods and psychosocial impacts. For example, in Cam Le district in Vietnam, the Disability Allowance has had a positive impact on the ability of recipient households to meet basic food needs, with the allowance primarily used for food, clothing, household expenses and to access general health services. In a survey in Tanahun, Nepal, half of households with a Disability Allowance recipient as a member reported that it helped them meet basic food requirements. In South Africa, the Care Dependency Grant was reported to have improved the general health of 98 per cent of beneficiary households surveyed. However, there is very little information on the v Executive Summary impacts of mainstream schemes and old age pensions on persons with disabilities, due to an absence of disaggregated data. The research also undertook a simulation that demonstrated that South Africa’s tax- financed social protection benefits were responsible for an overall reduction in the food poverty rate for persons with severe functional limitations of 46.8 per cent. Simulated impacts are much lower in India. The difference between the two countries is due, to a large extent, to the lower relative transfer values and coverage in India compared to South Africa. G Barriers to accessing