Building social protection floors and comprehensive social security systems
Flagship Thematic Area: Disability
Disability-inclusive social protection systems
1 billion people around the world, or 15 per cent of the global population are considered to have a physical impairment. Most of them are of working age. An estimated 2-3 per cent of the population are considered to live with severe disabilities.
The latest ILO estimates of effective coverage show that only 33.5 per cent of people with severe disabilities worldwide receive a disability benefit.
In low and middle income countries and low income countries, coverage are as low as 11.3% and 8.6% respectively.
As a result of this low coverage, people with disabilities have greater difficulties in accessing needed goods and services while at the same time experiencing greater needs.
Although persons with disabilities were significantly affected by COVID-19, in 2020, fewer than half of the 181 countries that adopted COVID 19 social protection responses referred to people with disabilities. Measures specifically directed at this group accounted for a mere 8.5 per cent of all measures announced. (ILO COVID-19 Social Protection Monitor)
The ILO approach to building disability-inclusive social protection systems is grounded in the UN Convention on the Rights of Persons with Disabilities and the joint statement entitled “Towards inclusive social protection systems supporting the full and effective participation of persons with disabilities”. Among other things, this approach emphasizes the importance of moving away from an “incapacity to work” perspective and institutionalized care, beyond a one-size-fits-all eligibility threshold.
Instead, the approach focuses on:
Guarantee income security that enables access to necessary goods and services;
Cover disability-related costs and facilitate access to the required support, including services and assistive devices;
Provide effective access to health care, including disability-related medical care and rehabilitation, as well as HIV prevention and care;
Ensure access to services across the life cycle, such as child care, education and vocational training; long term care
Provide support with employment, including return-to-work programmes and support for living in the community;
Take into account the diversity of this population group, both in terms of type of disability, the environment and other factors such as age, gender and ethnicity.
To achieve this, a twin-track approach is needed: (a) all social protection programmes are designed, implemented and monitored in a way that ensures the inclusion of persons with disabilities, with particular emphasis on removing barriers and avoiding adverse effects; and (b) adequate disability-specific programmes deliver the support and benefits required by persons with disabilities that are not provided by mainstream programmes.
The ILO provides technical support to countries also on the following aspects of designing and implementing social protection systems that work for the inclusion of people with disabilities:
The design of benefits and eligibility determination mechanisms should take into account the higher living costs of people with disabilities in comparison to people without disabilities due to higher health or transport costs and additional expenses for necessary support services or assistive devices, personal assistance, sign language and interpretation, and indirect opportunity costs, such as time spent on support activities by family members. Women are more affected than men due to attitudinal barriers and since they shoulder a disproportionate share of unpaid care work for family members with disabilities.
Disability allowances that are addressing disability-related costs should be compatible with mainstream social protection schemes . Disability related costs also need to be factored in when determining benefit levels or income thresholds for means tested schemes. The ILO supports countries to factor disability-related costs into the design of schemes, both for the benefits and services provided as well as for the eligibility thresholds.
While disability cash benefits are important to secure income security and to cover disability-related extra costs, cash alone is not sufficient. It is equally important to ensure access to health care, rehabilitation, assistive devices, personal assistance, as well as access to other services that are not part of social protection but where social protection systems play a key role in facilitating access to them, such as early childhood development, education and active labour market programmes. These services should be accessible for people with disabilities and they should be designed to support inclusion. The design should also ensure responsiveness to the specific needs of and equal access for women and girls with disabilities to benefits and health, care, rehabilitation or other services who often face additional discrimination and barriers.
For the economic inclusion of working-age people living with disabilities, it is important to design benefits in ways that are compatible with employment. For people with disabilities it can be very difficult to find employment and when they find employment, they often face additional costs, for example to travel to the workplace. However, the vast majority of schemes still requires proof of at least partial incapacity to work as a precondition for a person with disabilities to qualify for a benefit. If those are the only disability benefits available, it compels people to have to choose between either receiving the disability support benefit while being locked out of employment or taking the risk of entering the labour market and having to assume all the costs themselves. This risk is even greater for women with disabilities, who are likely to face intersectional discrimination in the labour market, in particular access to formal employment but also regarding wages and career opportunities.
It is difficult to produce reliable coverage estimates since data on the prevalence and severity of disabilities and existing disability benefits and services are scarce. It is therefore crucially important to include disability questions in the collection of administrative data or household surveys and to disaggregate data by disability status, as well as by age, sex and other relevant parameters.
Since the adoption of the Convention on the Rights of Persons with Disabilities, the “Washington Group Short Set” (WGSS) of questions has become the standard tool for determining the prevalence of disability (for example in household surveys). In addition to the WGSS, disability specific modules (ILO Model Labour Force Resources) and surveys (WHO Model Disability Survey), as well as surveys conducted by the Foundation for Scientific and Industrial Research (SINTEF), are needed to provide more detailed information on the situations of people with disabilities and the barriers they face.
If a disability is determined, disability assessments should be carried out to analyze individual disability-related support needs and availability of related service offers. Assessment mechanisms should be easily available nationwide, affordable and focus not only on functional impairment or medical assessment but also on the diverse barriers that people with disabilities face and their support requirements. In this process, it is important to disaggregate data by sex to grasp the situation of women and girls with disabilities. Gender-specific barriers to access disability determination and assessment processes also need to be takin into consideration.
Direct engagement with people with disabilities through their representative bodies (organizations of people with disabilities) along the full policy cycle of planning, implementing, monitoring and reforming social protection policies and programmes is a requirement under Article 4.3 of the Convention on the Rights of Persons with Disabilities and Paragraph 3(r) of Recommendation No. 202. Consultation of Organisations of People with Disabilities should be the starting point for meaningful participation throughout the full implementation cycle. Such engagement is necessary to ensure that policies are designed to reflect beneficiaries’ needs and are effective. This also includes careful consideration of ensuring adequate representation of women with disability.
Women and girls are disproportionately impacted by disability. Due to the intersectionality between disability and gender, they are less likely than men with disabilities to be in employment, more likely to be out of school, more likely to be institutionalized and poverty is disproportionately higher among women and girls with disabilities. Women are also more affected by the nature of care and support arrangements for persons with disabilities. Where families take on the primary responsibility for care and support, it is mainly women and girls that fulfil this role, with the vast majority of unpaid carers worldwide being women. This contributes to reduced economic opportunities for women, which poses an issue for women themselves, wider households and the economy as a whole.
The ILO offers the trainings and courses to strengthen constituents’ capacities regarding disability-and social protection in a range of countries. For example, the certified short course on “Social Protection and Inclusion of Persons with Disabilities” delivered in collaboration with Bonn-Rhein-Sieg University of Applied Science. 4 cohorts have already been trained in 2020 and 2021. It has been co funded by the UNPRDP and the UNICEF NORWAY disability partnership. In addition, tailor made trainings to the government as requested are also provided. Under UNPRPD project, these include;
Jordan: eligibility of thresholds for cash transfers
Philippines: trainings in the context of the pilot disability assessment and disability data management systems
Senegal: equal opportunity card
Mexico: assessments of rights perspective and communication in key SP programmes
Kenya: trainings in the context of the national support needs survey
Capacity strengthening of OPDs for advocacy and input to regional report (South Asia)
The Results Monitoring Tool will keep track of the actions implemented through this thematic approach and will monitor the following indicators:
Number of countries that have improved their data systems on disability prevalence and information on the situation of persons with disabilities and the barriers they face
Number of countries that have increased coverage of persons with disability in mainstream and/or disability-specific schemes.
Number of countries that have improved their social protection schemes and programmes on disability-inclusive design and implementation and on designing schemes to promote inclusion, through measures such as improved disability assessment mechanisms, inclusive delivery mechanisms, improved adequacy of benefits, making schemes compatible with work or other social protection benefits and consideration of the additional costs of disability;
Number of countries that have improved the gender-responsiveness of their mainstream or disability-specific disability social protection schemes and programmes
Number of countries that have institutionalized effective participation structures for representatives of organizations of persons with disabilities along the implementation cycle;
Number of countries and number of OPDs that have increased technical capacities to design and implement gender-responsive and disability-inclusive social protection systems that work towards the inclusion of women and men with disabilities
Through its Results Monitoring Tool, the Flagship Programme will also assess to what extent the results have been achieved while applying international social security standards and principles for social protection.