published in: august 2010 - handicap international€¦ · · 2013-03-12published in: august 2010...

Published in: August 2010

Published by: Handicap International Bangladesh Plot: CESD (4), Road 125, Gulshan 1. Dhaka 1212 Tele/fax: +88 02 885 97 94/881 91 28 Email: [email protected] Website: www.handicap-international.org

This Guide Book was developed by Handicap International Bangladesh with support from the United States Department of State, Bureau of Population, Refugees and Migration, within the proj-ect ’Practical better life opportunities for people with disabilities at Rohingya Refugees camps and surrounding communities, Cox’s Bazar district’ 2009-2010. The opinions, findings and conclusions stated herein are those of Handicap International and do not necessarily reflect those of the United States Department of State.

Table of Contents

Introduction ..................................................................................................................... 03

Section One: Setting the scene How Can we Define Disability? .................................................... ....... 04 Livelihood overview .............................................................................. 10 What are Inclusive Livelihoods? ........................................................... 12

Section Two: Why Inclusive Livelihoods? International facts and figures on disability ................................... ....... 14 National facts and figures on disability .......................................... ....... 14 What is the relationship between disability and poverty? .................... 15 National, regional and international polices .................................. ....... 18

Section Three: Recommendations for implementing inclusive livelihoods Strategies in inclusive livelihoods .......................................................... 22 Twin track approach ............................................................................. 22 Handicap International operational framework for mainstreaming ....................................................................................... 23

Section Four: Case studies and good practices .......................................................... 28

Annex One: United Nations Convention on the Rights of Persons with Disabilities Article 27: Work and employment ....................................................... 39 Article 28: Adequate standard of living and social protection ............................................................................. ....... 40 Article 32: International cooperation .................................................... 41

Annex Two: Individual assessment form ................................................................ 42

Annex Three: Action plan form. ................................................................................ 46

Bibliography ..................................................................................................................... 47

Inclusive Livelihoods GuidelineHandicap International Bangladesh

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Poverty, stereo typing, discrimination, poor access to education and work, lack of self confidence: people with disabilities often face exclusion, increased vulnerability and barriers in accessing their fundamental human rights to contribute to the livelihoods of their families, communities and country.

Livelihood activities bring different returns:

• Economic and financial: people contribute to provision for themselves and their families

• Social: recognition by the community for contribution to goods and services

• Psychological: increased sense of self worth, satisfaction and self esteem.

The guideline is intended for the use of local authorities, international and national non government organisations, community based organisations and Disabled People’s Organisations to facilitate inclusion of people with disabilities into livelihood activities.

The guideline includes an overview of disability, livelihoods and barriers people with disabilities face in securing access to livelihood opportunities. It contains practical tools including Handicap International operational framework for mainstreaming and including people with disabilities into livelihood activities, and examples of assessment forms and action planning forms. Case studies provide real life examples of inclusive livelihoods from the field.

The goal of the guideline is to increase involvement of people with disabilities in livelihood activities so that they are able to contribute to the economic wellbeing of their families and communities.

Introduction


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How Can we Define Disability?

The United Nations Convention on the Rights of People with Disabilities1 (UNCRPD), ratified by the Government of Bangladesh in 2007 and enforced as international law in 2008 defines persons with disabilities as including:

Those who have long-term physical, mental, intellectual or sensory impairments which; in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others.

Key points of the definition:

• Long-term

• Physical impairment includes reduced muscle strength, loss of limbs and may lead to difficulty moving from one place to another, performing strenuous tasks and using tools and equipment.

• Mental impairment affecting reasoning, mood, may affect developing relationships with others and working in a team environment.

• Intellectual impairment may affect ability to understand and act on information and development of knowledge by the use of reasoning, intuition, or perception and performing complex tasks.

• Sensory impairment affecting vision or hearing which may impact on communication: reading, listening to conversations, understanding instructions, using information technology and orientation in the workplace.

1http://www.un.org/disabilities/default.asp?id=150

SectionOne Setting the scene


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INTERACTION OF IMPAIRMENT WITH BARRIERS AFFECTS OPPORTUNITY FOR EQUAL PARTICIPATION; THIS LEADS TO A

DISABLING LIFE SITUATION – A DISABILITY.

• Environmental barriers: the built and physical environment within which we live.

RECU concept: the physical environment may be inaccessible if people are not able to

R: reach; E: enter; C: circulate; U: use services in their communities

u R = reach the services from home. This may be the school, the workplace, the market, the training centre, the flood shelter. Barriers include steep, muddy narrow pathways and slopes, potholes; overcrowded buses accessed by high steps, lack of seats or resting places; rickshaws that do not want to carry a wheelchair as well as person who uses a wheelchair or who are not able to give extra time for a person with a disability to get on or off the rickshaw; signs giving information, direction, advice, awareness that people are not able to understand.

Reaching services: Steps with 150mm height and 300mm depth and handrails at 850-900mm and 700mm (for children) make moving around the community safe and dignified.

u E = enter the building or service area you wish to use. Barriers include steps, steep ramps, lack of handrails, high concrete platforms protecting against flood or cyclone, narrow doorways, door handles which are difficult to grip, raised threshold at entrance, lack of tactile floor marker to indicate entrance for a person with a visual impairment.


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Entering services: a ramp with a maximum gradient of 1:12 should be provided as well as a set of steps at the entrance of all public service centres. Ramps and steps should have handrails at 850-900mm and 700mm (for children) from ground level.

u C = circulate and move about inside the building or area. Barriers include narrow corridors, raised thresholds at entrance to rooms, narrow door widths, lack of resting places, obstacles including furniture or work equipment, signs that people are not able to understand.

u U = use the services and facilities. Barriers include dimensions and design of internal furniture, equipment and communication eg lack of hand rails in toilets, no seating platforms at tube wells, workbenches that a person is not able to sit at when using a wheelchair because they are too high or do not leave space underneath for legs, a sewing machine that can only be operated by foot rather than hand, instructions and communication not available in a variety of mediums eg written, pictorial, audio, visual for access by people with different communication requirements.

Using services: workbenches 650-800 mm high with a depth of 300mm enable a person who uses a wheelchair to work.

An accessible physical environment makes movement and use easier for all members of the community when following principles of: ‘universal design’.² People with disabilities, people who are elderly, women who are pregnant, people who carry heavy loads, children will all benefit.

Access to Leda Mosque.

2 “Universal design” means the design of products, environments, programs and services to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. (UNCRPD)


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• Social and cultural barriers.

Social exclusion is often the hardest barrier to overcome and is usually associated with feelings of shame, fear and rejection.

Negative behaviour from family members, the community, and local authorities includes prejudice, pity, over protection, and stigma (which may be experienced by the person with disability and their family) leading to exclusion, discrimination and lack of opportunity to realise potential.

• Institutional barriers:

u Policies, practices and legislation that do not address the rights of everyone in the community or discriminate against groups including people with disabilities.

u Poor implementation of international and national legislation promoting the rights of people with disabilities.

u Disability seen as welfare or ‘specialist’ issue and as such mainstream service providers and development organizations do not feel they can address the needs of people with disabilities and exclude them.

u Lack of consultation with people with disabilities and their representative groups including Disabled People’s Organisations to identify needs and capacities.


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Addressing barriers:The responses to barriers presented are not a definitive or prescriptive list; they are intended as an illustration of practical means to address barriers people with disabilities may face.

• Physical impairment includes reduced muscle strength, loss of limbs and may lead to difficulty moving from one place to another, performing strenuous tasks and using tools and equipment.

• Help the person to move around more easily: referral support from a stakeholder who works with rehabilitation and assistive devices: crutches, wheelchair etc.

• Ensure access to the physical environment: seek advice from stakeholder who is experienced in working with people with disabilities and/or Disabled People’s Organisation for advice on access guidelines, dimensions and standards.

• Identify tasks that are appropriate and safe.

• Modify tools and equipment as required on an individual basis to make them easier to use.

• Adopt and apply a code of reasonable accommodation³ and non discrimination in organisational livelihood policies and practices.

• Mental impairment affecting reasoning, mood, may affect developing relationships with others and working in a team environment.

• Identify appropriate tasks and provide training/work based support as required on an individual basis.

• Allocate a work peer to provide social and task based support.

• Sensitise work colleagues through awareness sessions delivered by an experienced in working with people with disabilities and/or Disabled People’s Organisation to challenge stigma.

• Adopt and apply a code of reasonable accommodation and non discrimination in organisational livelihood policies and practices.

• Intellectual impairment may affect ability to understand and act on information and development of knowledge by the use of reasoning, intuition, or perception and performing complex tasks.

3“Reasonable accommodation” means necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms. UNCRPD


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• Identify appropriate tasks as required on an individual basis.

• Provide training/work based support and break tasks into small achievable sections that are easier to accomplish.

• Allocate a work peer to provide social and task based support.

• Sensitise work colleagues through awareness sessions delivered by an organisation experienced in working with people with disabilities and/or Disabled People’s Organisation to challenge stigma.


• Sensory impairment affecting vision or hearing which may impact on communication: reading, listening to conversations, understanding instructions, using information technology and orientation in the workplace.

• Identify any requirements for accessing and using information and technology on an individual basis.

• Provide orientation to workplace and work based support.

• Allocate a work peer to provide social and task based support

• Sensitise work colleagues through awareness sessions delivered by an organisation experienced in working with people with disabilities and/or Disabled People’s Organisation to challenge stigma.



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Livelihood overview: Livelihoods can be defined as the sum of ways and means by which individuals, households or com-munities make and sustain a living. It is a broader concept than income-generating activities. It is a term often used to describe self-employment, and encompasses the economic activities that people develop as well as their social, institutional and organisational environment illustrated in figure one. A livelihood approach analyses the broad spectrum of strategies that people develop to sustain their liv-ing including economic activities such as farming and non-farming activities, seasonal migration, and economic and social relationships with traders and landowners.4

Figure One: Livelihood approach components.4

Savings are an important strategy within the livelihood approach as they are a reserve during emergen-cies to cover the emergency and assist with start up after the emergency; cover irregular income flow over the year and address need for occasional high expenses.4

4 Handicap International 2006. Good Practices for the Economic Inclusion of People with Disabilities in Developing Countries. www.handicap-international.org


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Livelihood strategies develop in a cyclical manner in order to achieve livelihood outcomes: ways and means of sustaining a living. The Department for International Development (DFID) sustainable livelihood framework illustrates how access to livelihood assets influence needs and opportunities and needs and opportunities influence assets as a response to, or imposed by, the impact of the vulnerability context individuals, groups and communities live within.

Figure Two: Sustainable livelihoods framework.5

While gaining a livelihood people have to respond to the vulnerability context they live within. This context includes the urban and rural environment; life as a refugee or as a slum dweller; in ecologically fragile areas such as the hoar and char areas; natural disasters; erratic rainfall, diminishing resources, pressure on the land; changing life cycles and kinship networks; changing and challenging gender roles; health conditions such as typhoid, diarrhoea, dysentery; chaotic markets, increasing food prices, inflation, and national and international competition. The vulnerability context includes marginalisation and discrimination people with disabilities face due to physical, social and institutional barriers.

Capacity to utilise needs and opportunities is determined by livelihood assets determining the choices people make in the development of their livelihood strategies. Realisation of the needs of people with disabilities and their access to opportunities are impacted upon by the physical, social and institutional barriers they face which in turn may limit or promote opportunities to develop livelihood assets.

5 Department for International Development (DFID) 1999. Sustainable Livelihoods Guidance Sheets. [email protected]


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Livelihood assets include:

Assets cannot be disconnected from issues and challenges of access to needs and opportunities arising from changing circumstances in the political, economic, socio-cultural and physical environment people live within. Livelihood outcomes through affecting livelihood assets influence needs, vulnerability and in turn outcome in a cyclical manner.

What are Inclusive Livelihoods? Inclusion is a concept that promotes equality and the widest possible participation from all members of a community. People with disabilities are amongst the poorest, most marginalized, voiceless and disadvantaged in society. Rights, needs and potential of people with disabilities can be effectively addressed through the framework of inclusion. Within this guideline inclusion refers to inclusion of people with disabilities and inclusive livelihoods seeks to ensure people with disabilities are actively included within the mainstream livelihood approach illustrated in figure one. Inclusion of people with disabilities supports the socio economic development of the country, communities, families and individuals themselves. People with disabilities are women, men, girls, boys of all ages; they have diverse experiences and life contexts. They are a heterogeneous group and one single means to address the barriers they face for inclusion within livelihood opportunities will not be effective eg we cannot recommend all people with visual impairment learn to make mats. People with disabilities are subject to other types of marginalization due to gender, caste, status as a refugee etc which are cross cutting themes in many development contexts. Inclusion involves taking the perspective of people with disabilities into each stage of socio economic development activities:

Inclusive Development: Ensuring that all phases of the development cycle (design, implementation, monitoring and evaluation) include a disability dimension and that persons with disabilities are meaningfully participating in development processes and policies6 . According to DFID, Inclusive Development respects the full human rights of every person, acknowledging diversity, eradicating

6 International Disability and Development Consortium. Inclusive Development and the Convention on the Rights of Persons with Disabilities. 2005


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poverty and ensuring that all people are fully included and can actively participate in development process and activities, regardless of age, gender, disability, state of health, ethnic origin or any other characteristic.

It is based on the following key concepts: 7

• Inclusion: persons with disabilities accepted as equal partners in development and included as full participants in all development activities.

• Equity: persons with disabilities enjoy equitable access to the benefits resulting from development activities; development activities promote non discrimination and equal opportunities for people with disabilities to participate in every facet of life: civil, political, economic, social and cultural.

• Access: persons with disabilities enjoy access to the built environment, transportation, information and communications infrastructure so that they can participate in all aspects of life and enjoy full range of human rights.

7 World Bank cited by http://www.inclusive-development.org/cbmtools/


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SectionTwo

Why Inclusive Livelihoods?

International facts and figures on disability: The United Nations (UN) estimates 10-12% of the world’s population, an estimated 600 million people, are living with disability.8 The figure is more prominent among the poorest in the world at 15-20%.8 Approximately 500 million (82%) of people with disabilities throughout the world are living in developing countries,9 and 70 to 80% of adults with disabilities are without employment and live in great poverty.10

National facts and figures on disability: A disability prevalence survey conducted by Handicap International (HI) and National Forum of Organizations Working with the Disabled (NFOWD) in 2005 found 5.6% of the population is living with disability in Bangladesh, 7.9 million individuals in a population of 141.9million.11 This figure may be lower than UN estimates due to issues including the hidden nature of disability in Bangladesh and subsequent difficulty in identifying individuals. Having a family member with a disability increases the vulnerability of their family; the Asian Development Bank estimates 25% of the population in the Asia Pacific region is affected by disability.12

The actual number of employed persons with disabilities in Bangladesh may be less than 1%.13 This represents a significant loss in economic revenue as well as a huge sector of the community that is excluded from contributing to their family, community and country.

Failing to include people with disabilities into livelihood activities reduces the economic status of many households, increases dependency on social safety nets which are not widely available, perpetuates misconceptions and stigmatisation that people with disabilities are not able to work and contribute to

8 World Bank 2004. Disability in Bangladesh: a situational analysis. http://siteresources.worldbank.org/DISABILITY/Resources/Regions/South%20Asia/DisabilityinBangladesh.pdf 9 http://www.cbm.org/en/general/downloads/19456/Make_Development_Inclusive_Concepts_and_Guiding_Principles.pdf10 http://www.handicap-international.fr/kit-pedagogique/documents/en/ppt/1basicPWD.ppt 11 UNDP Human Development Report 2009 http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_BGD.html12 www.ausaid.gov.au/keyaid/disability.cfm 13 http://siteresources.worldbank.org/DISABILITY/Resources/Regions/South%20Asia/JICA_Bangladesh.pdf


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their families and communities and means that Bangladesh will not be able to achieve the Millennium Development Goals (MDGs).

What is the relationship between disability and poverty?People with disabilities are highly over represented among the poor with 82% below the poverty line.8

Poverty is a cause and a consequence of disability: people who are poor often lack resources to prevent malnutrition, work in hazardous conditions that place them at risk of injury and disability, and do not have access to health services that may prevent disability. Poverty is a consequence of disability as people with disabilities often lack access to education, health services and income generating activities; they are often denied human, social and economic rights.9 The relationship between poverty and disability and barriers to participation include lack of empowerment, participation and inclusion within activities to promote social and economic progress, illustrated in figure three.

Figure three: A circle with poverty leading to disability, and disability leading to and deepening poverty 14,15

• Deficits in economic, social and cultural rights• Lack of access to o Information and preventative maternal healthcare o Food security, safe water and sanitation• Increased exposure to disease and lack of access to quality curative

and rehabilitation services• Increased occupational risks/dangerous employment• Higher vulnerability in conflict situations and natural disasters/

increased risk of injury/disability

• Denial of opportunities for economic, social and human development• Reduced participation in decision making and denial of civil and political

rights• Social and cultural exclusion and stigma• Discrimination in all aspects of life• Lack of access to education and training• Exclusion from the job market• Higher vulnerability in conflict situations and natural disasters• Difficulties for accessing food, water and sanitation• Lack of access to rehabilitation to achieve independent living• Lack of voice/influence/choices

DISABILITY

POVERTY

14 www.dfid.gov.uk/Pubs/files/disability.pdf15 www.cbm.org/eng/general/downloads/19456/Make Development Inclusive Concepts and Guiding Principles.pdf


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Disability creation process

The disability creation process16 illustrates how risk factors, personal factors, environmental factors and life habits interact with one another, figure four. When a person’s life habits, including livelihood activities, reflect exclusion and reduced participation they are living in a disabling life situation as they are not enabled to contribute to their own self development and that of their families and communities. On the other hand if enabled to participate and develop life habits their potential to contribute will be realised.

16 http://www.ripph.qc.ca/?rub2=2&rub=6&lang=en


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The poverty – disability – poverty cycle illustrated in figure three and the disability creation process figure four illustrate poverty as a factor that causes a disabling life situation. People who are poor have a higher possibility of facing malnutrition and other risk factors. Malnutrition, for instance, has a direct impact of the integrity of the organic systems eg the nervous system, the skeletal system; the muscular system. If the organic systems are impaired capability to move around, to see, to hear may be affected. For example lack of vitamin A due to malnutrition is the leading cause of preventable blindness in children and night blindness of women who are pregnant. Reduced ability to see in interaction with social, institutional and physical obstacles or barriers may exclude children from going to school and/or participating in livelihood activities; through this exclusion the child may be considered as living in a disabling life situation as they are not able to realise their potential for self development and to contribute to their families and communities. People who are poor are more likely to engage in hazardous work including child labour.

Hazardous work places people at risk of injury eg:

• Carrying heavy loads can injure the back and neck.

• Climbing up scaffolding places people at risk of falling.

• Working with chemicals can damage skin and lungs.

• Working with fire and furnaces places people at risk of sustaining burn injuries.

Figure three illustrates that people who are living in poverty are less likely to be able to access medical treatment and/or rehabilitation to prevent their injury becoming a disability and impact on their life habits.

Child labour represents reduced opportunity to go to school and receive an education, developing intellectual capabilities and life skills. The disability creation process illustrates that reduced abilities in interaction with environmental factors and life habits may lead to a disabling life situation as potential for development is limited. A child will not grow to have choices in life habits including their type of employment, their role in community life and their access to nutrition and well being. As such the poverty – disability – poverty cycle continues.

Figure four illustrates that social behaviour and norms, faced by people with disabilities as stigma and marginalisation, in interaction with other social, institutional and physical environmental barriers present a challenge for people with disabilities, their families and communities to support an environment where life habits do not support a disabling life situation.

Thus, increasing the participation of persons with disabilities in society in a sustainable manners should involve both i) supporting the person to increase their functional capacities, their skills and abilities, and ii) working with the society at large and the environment, to remove social, institutional and physical barriers.

17 http://www.who.int/nutrition/topics/vad/en/


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National, regional and international polices Disability inclusive development is guided and endorsed by national, regional and international polices.

Millennium Development Goals (MDGs) and Biwako Millennium Framework for Action (BMF)

The United Nations set the eight MDGs to address poverty and consequences of poverty, of particular significance within the context of inclusive livelihoods:

MDG 1: Eradicate extreme poverty and hunger

MDG 3: Promote gender equality and empower women

MDG 7: Ensure environmental sustainability

The BMF is a political framework for Asia and the Pacific spanning 2003-2012 within which states agreed to work towards an inclusive, barrier free and rights based society for people with disabilities. Priority areas identified for action are:

(a) Self-help organizations of persons with disabilities and related family and parent associations

(b) Women with disabilities

(c) Early detection, early intervention and education

(d) Training and employment, including self-employment

(e) Access to built environments and public transport

(f) Access to information and communications, including information, communications and assistive technologies

(g) Poverty alleviation through capacity-building, social security and sustainable livelihood programs.

The MDGs are not disability inclusive but cannot be reached without addressing disability issues; the BMF is a framework for including disability issues within programs to achieve the MDGs.

Government of Bangladesh Poverty Reduction Strategy Paper (PRSP) 2005 19

developed to reduce poverty. Actions related to disability include :

18 http://www.unescap.org/esid/psis/disability/bmf/summary.html


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1. Data collection pertaining to disability under thematic of MDGs.

2. Policy formation to address the needs and rights of people with disabilities to income generating activities.

3. Access to education for children with disabilities.

4. Improving health services including disability prevention, early detection and availability of rehabilitation and assistive technology.

5. Creating opportunities for people with disabilities to generate income.

6. Ensuring access to public services for people with disabilities.

7. Including people with disabilities in national and community level decision making committees, social and cultural functions and democratic procedures including voting.

Government of Bangladesh Disability Welfare Act 2001:

Legislation developed specifically to enforce the rights of people with disabilities.

Part – F: Rehabilitation and Employment of the Persons with Disability:

1. Appropriate schemes including Credit-Support programs for rehabilitation of persons with disabilities.

2. Establishment and maintenance of rehabilitation centres at Government and Non-Government level.

3. Design, develop and implement a training manual for vocational training of people with disabilities.

4. Identification of appropriate job/employment areas for people with disabilities and arrange employment opportunities thereto.

5. Ensure equal employment opportunities while recruiting employees in the Government Departments, Statutory Bodies and Local Authorities for suitably qualified persons with disabilities.

6. Subject to formulation of Government Policy, relax the prescribed minimum age limit for recruitment of people with disabilities in the Government Departments, Statutory Bodies and Local Authorities.

19 http://planipolis.iiep.unesco.org/upload/Bangladesh/PRSP/Bangladesh%20PRSP%202005%20Unlocking%20the%20potential.pdf


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7. Ensure reserve quota in the recruitment of posts to the Government Departments, Statutory Bodies and Local Authorities: 10% class three and four, 1% class one positions

8. Disseminate information on job-opportunities to people with disabilities.

United Nations Convention on the Rights of Persons with Disabilities (Ratified by the Government of Bangladesh November 2007, enforced as international law 2008)

Key points of key articles (see annex one for full article)

Article 27: Work and employment

1. States Parties recognize the right of persons with disabilities to work, on an equal basis with others:

(a) Prohibit discrimination on the basis of disability;

(b) Protect the rights of persons with disabilities, on an equal basis with others, to just and favourable conditions of work, including equal opportunities and equal remuneration for work of equal value, safe and healthy working conditions, including protection from harassment, and the redress of grievances;

2. States Parties shall ensure that persons with disabilities are not held in slavery or in servitude, and are protected, on an equal basis with others, from forced or compulsory labour.

Article 28: Adequate standard of living and social protection

1. States Parties recognize the right of persons with disabilities to an adequate standard of living for themselves and their families, including adequate food, clothing and housing, and to the continuous improvement of living conditions, and shall take appropriate steps to safeguard and promote the realization of this right without discrimination on the basis of disability.

2. States Parties recognize the right of persons with disabilities to social protection and to the enjoyment of that right without discrimination on the basis of disability, and shall take appropriate steps to safeguard and promote the realization of this right.

Article 32: International cooperation

1. (a) Ensuring that international cooperation, including international development programs, is inclusive of and accessible to persons with disabilities;


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(b) Facilitating and supporting capacity-building, including the exchange and sharing of information, experiences, training programs and best practices.

Full texts of UNCRPD articles 27, 28 and 32 can be accessed in annex one. The UNCRPD does not identify a separate or different group of human rights for people with disabilities than those of the 1948 International Declaration of Human Rights but provides a response to address barriers people with disabilities face in realizing their rights. The articles of the UNCRPD are a practical framework and tool for planning, monitoring and evaluating actions to ensure rights of people with disabilities.

Challenges

Despite identification of barriers to inclusion, development of strategies to challenge marginalization and exclusion of people with disabilities and endorsable legislation it is estimated that less than 1% of the 7.9 million (based on HI and NFOWD disability prevalence rate of 5.6%) people with disabilities in Bangladesh are working. Many challenges remain to improve the lives of people with disability. Ensuring access to education, health services, the right to earn a living and participate in decision making alongside others in the community requires a coordinated approach within which stereotypes, stigma and discrimination are challenged, organisations and individuals respect and apply endorsed legislation and policies.


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SectionThree

Recommendations for implementing

inclusive livelihoods

Strategies in inclusive livelihoods Disability and disabling life situations are the result of interaction between risks, impairments, capabilities and socio cultural, environmental and/or institutional barriers, which prevent people accessing services and opportunities and being included in the communities they live within. Challenging these barriers and risk factors can promote and enable participation, inclusion and equality. Providing access to services and opportunities that enable people with disability to achieve their desired levels of autonomy is necessary and important. This may include early identification and intervention; provision of rehabilitation services and assistive devices; alongside access to education, work and social safety nets. These activities need to take place within a socio cultural environment that does not stigmatise and discriminate; a physical environment that enables people to reach, enter, circulate within and use services and facilities; and an institutional environment that implements and monitors endorsable legislation.

The twin track approachMany people with disabilities do not need special facilities; their needs can be met by mainstream services with increased awareness, change in attitudes and minor practical adjustments. One of the most successful approaches may be to apply a strategy that parallels the ‘twin-track’ approach developed by DFID20 to work towards facilitating the inclusion of people with disabilities in mainstream livelihood and socio economic development programs by empowering people with disabilities through specific initiatives illustrated in figure four. These may include social work and self-confidence building, or specific structures such as self-help groups or Disabled Peoples Organisations.

The most successful strategy is to work towards an inclusive society where people with disabilities have access to the same services as the rest of the population, while organizations of/for people with disabilities focus on supporting people with disabilities through their core activities.4

20 Department for International Development (DFID) 2000. Disability, Poverty and Development. www.dfid.gov.uk/pubs/files/disability.pdf


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Figure four: Twin Track Approach

Twin Track Approach…

Equal opportunities and full participation of people with disabilities

Inclusive system of services

Facilitate inclusion of disability issues in all services, development programs and initiatives:

• Basic needs: food, shelter, water and sanitation

• Health (including rehabilitation and assistive devices)

• Education

• Social participation

• Work, employment, livelihoods opportunities

• Political participation and social justice

Through a barrier free environment, positive community attitudes, inclusion of people with disabilities in planning and decision making and a rights-based approach.

Specific initiatives

Further develop specific initiatives to enhance the personal and collective empowerment of people with disabilities via:

• Capacity Building

• Building self confidence

• Peer support

• Visibility and exemplarity

• Awareness raising

In particular through self help groups and Disabled Peoples Organisations

Handicap International operational framework for mainstreaming and inclusive developmentHandicap International has a tried and tested operational methodology for inclusion of people with disabilities into mainstream livelihood programs illustrated in figure five. Please note that other organisations may have mainstreaming methodologies or approaches towards livelihoods. Handicap International operational framework is presented as a case study and an option to adopt by organisations as appropriate.


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• Step one: identification of people with disabilities.

Mainstream organizations select a focal person for facilitating inclusion of people with disabilities; the focal person should have their capacity built, by linking with an organization who works with disability or a Disabled People’s Organisation. The goal of capacity building is that the focal person is able to identify persons with disability, and have an understanding of the rights of persons with disabilities and barriers they face in accessing rights. The focal person will ensure that community workers and livelihood facilitators are able to identify people with disabilities and facilitate their inclusion into livelihood activities.

1. Identification should be part of the organisational standard participatory rural analysis, house to house baseline surveying activities etc.

2. Sensitise the community to disability as a preparatory activity prior to surveying. This will facilitate confidence in families to disclose information about members with a disability addressing the hidden nature of disability.

3. Include community members with disabilities within survey teams and ensure that survey tools capture information about people with disabilities within households and the community.

4. Capture disaggregated data on community members with disabilities.

5. Neglecting these steps may mean that you do not capture information about all community members with a disability; as a result planning, budgeting and program design may not address the needs of people with disabilities.

Key points:

• Nominate a focal person in your organisation to have their capacity built on disability

• Build capacity of the focal person so that they are able to support community field workers in inclusion of people with disabilities

• Do not conduct a separate survey to identify people with disabilities in the community (twice the work) but make your initial survey disability inclusive. Add a question to you regular information collection form to find out if there are any persons with disabilities living in the house, their sex, age and current occupation.

• Be careful how you phrase the question: families may be ashamed of their member with a disability, they may be over protective of them, or they may neglect them and forget to include them in a survey. Use respectful people first language: person with a disability; do not use slang or negative vocabulary such as cripple, crazy person or dumb.


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Appropriate terminology

What is not appropriate• Case, problem, victim

• Patient

• Disabled people, people with special needs

• The disabled, PWD

• Retarded, mentally defective

• Cripple, lame, deformed

• Wheelchair bound or ‘Confined’ to a wheelchair

• Spastic, CP victim

• The blind

• Deaf and Dumb’, dumb

• Crazy, nuts

What is appropriate• Person, individual

• Client, person

• People/persons with impairment/disabilities

• Person with impairment/disability

• Person with intellectual disability

• Person with physical impairment

• Person who uses a wheelchair

• Person who has cerebral palsy

• Person with visual impairment

• People with hearing impairment

• People with mental disability

• Step two: the community worker conducts an individual assessment of people with disabilities identified during community appraisal.

1. The goal is to identify demographic and disability related information, information about specialised and mainstream services used and/or required by the person alongside experience, skills, assets and motivation possessed. Please see annex two for a sample assessment format.

2. The community worker, livelihood facilitator, person with disability and family members use information collected to make a plan of action for inclusion into a livelihood activity if appropriate. Please see annex three for sample action plan form.


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Figure five: Operational framework for mainstreaming and including people with disabilities into livelihood activities.

• Step three: referral.

Referral activities can be conducted through support from a stakeholder who is experienced in working with people with disabilities, local authorities and/or Disabled People’s Organisation. The community worker will find specialised rehabilitation worker support as appropriate through this stakeholder.

1. Specialised services including assistive device, rehabilitation, surgery, eye check.

2. Mainstream services including promoting environmental and socio cultural accessibility, soft skill development, vocational training, asset transfer, apprentice-ship etc.

• Step four: creating an enabling environment for inclusive livelihood activities


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The livelihood facilitator supports creation of an enabling environment within which all members of the community are able to access services.

1. Socio cultural access at community level can be enhanced through activities to raise awareness, demystify and de stigmatise disability. Link with a local Disabled People’s Organisation for advice and support, include disability issues in any livelihood based community events: ask Disabled People’s Organisation and/or community members with disabilities for advice on scripts in dramas, themes for art competitions, courtyard sessions etc.

2. Prepare the person for the livelihood activity through soft skill development. Many people with disabilities have never been to school, never had a job, never had responsibility for making decisions about themselves, and/or never had the opportunity to be responsible for assets. Spend time or link with Disabled People’s Organisation to build self awareness and confidence, to explain time keeping, to explain commitment and responsibility. Understand concerns and provide support to address them.

3. Prepare the workplace

a) Colleagues and employers may discriminate against their new member with a disability: provide or link with Disabled People’s Organisation to provide disability sensitisation and orientation sessions so that the person is not working in a hostile environment where they feel stigmatised; assign a supervisor or fellow worker to be responsible for monitoring the workplace to ensure it remains friendly

b) Address any barriers to physical accessibility; apply principles of ‘universal design’21 to any infrastructure development. Seek help from Disabled People’s Organisation or an organisation who specialise in disability issues for advice.

c) Assess tools and equipment to identify any modifications that may be required. Seek help from the Disabled People’s Organisation or an organisation who specialise in disability issues for advice.

d) Provide ongoing personalised support through accompaniment and follow up to help the person with disability to succeed. Help them solve problems, discuss challenges and look for new opportunities as they acquire skills and confidence.

21 “Universal design” means the design of products, environments, programs and services to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.


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SectionFour

Case studies and good practices

Apprenticeship: a wider scope in rural economyIn Bangladesh 79% of the people live in rural areas22 where there are limited vocational and skill development training institutes. In these cases people generally learn technical knowledge through apprenticeships: a person learns on the job by joining an industry, artisan or business owner. Negative attitudes of business owners (tailoring shop, electrical mechanic shop etc.), lack of awareness on the potential of people with disabilities (by business owners and people with disabilities themselves), low self esteem and confidence of people with disabilities are all factors that can limit opportunities for apprenticeship. These can be tackled by individualized support to persons with disabilities, awareness raising, linking persons with disabilities with potential trainers, and developing the capacities of potential trainers to work with persons with disabilities.

Md. Hossain dreams of being an electrician

Md Hossain is a 21 year old man born to a poor family in Musani village 13 km. north of Teknaf Upazilla in Cox’s Bazar district in the south east of Bangladesh. His father Md. Latif is a farmer and his mother is a housewife. He is the third of eleven brothers and sisters. Md Hossain’s parents were very unhappy that Md. Hossain was born with both legs deformed. Two years ago, Md. Hossain could not stand alone. His legs were so weak that they could not hold his body weight. From 2007-2008 Handicap International (HI) conducted a project: ‘Enhancing the participation of people with disability in community development at Rohingya refugee camps and surrounding communities in Bangladesh’.

22 http://www.discoverybangladesh.com/meetbangladesh/population_character.html


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The project was supported by the US Department of State Bureau of Population, Refugees and Migration. During this project HI provided Md Hossain with primary rehabilitation therapy with the goal of strengthening his legs through exercises and provided him with an elbow crutch to help him walk. After working hard with his exercises Md Hossain was able to stand and move around the homestead with his elbow crutch. With a new phase of the project from 2009 to 2010 the HI team visited Md Hossain to learn how he was managing and what his life was like. He told them:

“I feel very sad staying at home all the time. But what can I do? I have no friends and nothing to do”

Md. Hossain was very frustrated with his life. Sometimes he went shopping to the nearby market when his family asked him to but most of the time he stayed at home alone as he had no friends in the community. He was not recognized as an active member in decision making of his family. Neither his family nor he knows what he can do to live a more meaningful and happy life.

After having some support from the HI inclusive livelihood officer to explore his ideas, barriers and opportunities Md Hossain became more confident and positive of the potential for his life. He was interested in learning to be an electrician. In the mean time he also participated in HI organized ‘How to Manage Money’ and ‘Working within Community” training sessions and different HI programs including disability awareness sessions and inclusive sport and leisure activities.

Md. Hossain is enjoying inclusive sport


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The HI livelihood officer found a training opportunity for Md Hossain through apprenticeship in a local electrical shop situated at Leda village.

Now Md Hossain is passing most of his time learning through doing different tasks in the shop. But Leda market is 2 km away from his house and it is very difficult for him to go such a distance with an elbow crutch. HI plan to provide him with a tricycle. They will help him and his family make the narrow pathway from his home to the road to Leda accessible so that he is able to cross it with his tricycle; this will widen his movement and help him enjoy his new freedom.

‘Handicap International has opened my mind and I have found the meaning of my life. I want to establish an electronic mechanic shop’ said by Md. Hossain. He has set his aim in life and HI is assisting him to remove all the barriers to reach the aim.

Md. Hossain receiving orientation on how to use money


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The HI team continued their support to Md Hossain, by early 2010 he had successfully completed his apprenticeship training at the electrical shop. Subsequently Md Hossain expressed his interest in starting his own business to the HI livelihood officer; however a few obstacles lay in his path: finding start up capital, finding a shop premises to rent and equipment. Even though Bangladesh has a rich culture of micro credit it is particularly complicated for person with disabilities to access these schemes due to pre conditions, high interest rates and no grace period for payback etc. The HI livelihood officer had several discussions with the shop owner who provided the initial training for Md Hossain and he agreed to provide Md Hossain with start up capital and initial tools. The second obstacle was finding an appropriate location for the shop. Md Hossain didn’t look forward to travel for a long distance daily for his work; roads are dangerous as they are busy with traffic and difficult to travel along by tricycle as they are muddy and potholed. The HI livelihood officer and Md Hossain had several discussions with land owners near the main road at the village centre close to Md Hossain’s house , finally one person agreed to construct a small shop for Md Hossain next to the main road and to rent it out to him at a reasonable rate. At present the shop is being constructed and is nearing completion. Md Hossain is energetic and optimistic since one of his dreams is about to come true.

“I never thought that I will be able to start my own business but with the help of everyone, looks like my dream is becoming a reality”

Electrician training for Md. Hossain


Modification in livelihood tools or workplace helps persons with disability in inclusion in livelihood activities or to restore previous occupation.

Modification of tools or workplace may be required to establish or re-establish a lost livelihood activity. Standard tools used in livelihood activities can often be modified. Yeasmin Akter is not able to operate a sewing machine by foot peddle; however when operating with her hands she is able to participate in Technical Assistance Incorporate (TAI)

sewing sessions alongside her friends and neighbours. Many people with a disability do not seek livelihood opportunities and many who acquire a disability do not return to their previous occupation due to lack of awareness of the potential of modified livelihood tools.

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Yeasmin Akter, Kutupalong camp


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Awareness raising:

Attitudes towards people with disabilities can be one of the biggest barriers in inclusion. Therefore, promoting the rights and capacities of persons with disabilities and sharing examples of successful persons with disabilities is an important step towards inclusion.

From a social outcast to a teacher for tomorrow: the story of Abdul Amin

Mr. Abdul Amin is an 18 year old man living in Nayapara refugee camp in Southern Bangladesh. From childhood, he was affected by severe spinal deformities. His spine is curved and as a result his body is twisted, his joints are stiff and he has muscle wasting and weakness in both legs.

In 2008, HI team met Mr Abdul, he was confined to his room. At first the team assessed him to identify barriers which restricted him from participating in family and community activities. He was depressed regarding the attitude of the community, the negative attitude of the community had more impact on Abdul’s wellbeing than his own physical impairment. He was interested in continuing his education however discrimination from school teachers who did not support him in following his studies and stigma from his classmates were a major barrier. The teachers weren’t corporative towards him and his classmates frequently insulted him and sometimes beat him up. Further his neighbours and community members insulted and mocked him in various ways when he came out of his home. Due to the pressures of society he frequently confined himself to his house and room avoiding, school and social interaction.

HI team and Mr Abdul developed a rehabilitation plan to increase the strength in his arms and to reduce the stiffness he felt in his legs. The HI Disability officer provided some therapeutic interventions such as strengthening exercises and deep breathing exercises and together Mr Abdul and the disability officer worked to build functional skills for activities of daily living: self care skills including bathing and dressing. The disability officer also supported Mr. Abdul and his family members by explaining to

Challenging attitudes and perception people with disabilities as advocates in their communities


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them his about his impairment, prognosis and its management.

Beside this, the HI team organized different types of awareness raising programs such as film projections, courtyard sessions and workshops with community members to raise awareness about disability issues with the goal of reducing stigma and discrimination. Mr. Abdul was also included in the HI inclusive sports practice and competitions where he could interact with other children, youth and adults in sports and leisure activities. These activities are run by volunteers in the community and participants include boys and girls, children, youth and adults with and without disabilities. They are an opportunity for building friendships, for increasing physical, mental and social well being as well as challenging stereotypes surrounding disability.

Simultaneously, HI inclusive education officer organized meetings with school teachers and Mr Abdul’s parents about his schooling. He organized formation of a peer group. A peer group includes a child or youth with a disability and a child or youth without a disability. The peer without a disability provides social support and helps with travel between home and school and between classrooms which ensures that their peer is able to be included in education. The HI inclusive education officer helped Mr Abdul and his peer to identify what kind of assistance and information they both needed to make the relationship successful. Today Mr Abdul has successfully completed class five non formal primary education.

In 2010 the HI team assisted Mr Abdul to be admitted in to a computer training program facilitated by Technical Assistance Incorporate (TAI) in Nayapara Camp. He is following his computer course

Mr. Abdul attends class with peer partner.


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with great enthusiasm.

“I have a great dream to be a school teacher. So if I can successfully complete the computer training, I can teach what I have learnt to other students.”

HI also provided Mr Abdul with a wheelchair to enable him to travel long distances. The HI accessibility expert is planning to construct some modifications to the access road to his shelter, and the toilet and the bathing cubicle near his home this year to ensure that physical barriers are minimized in his living environment

“Community member’s attitudes have changed significantly towards me. Now I can travel anywhere in the community with full freedom, no body teases me or beasts me anymore.”

Microfinance: the initial capital to start

Like any other entrepreneur, people with disabilities find lack of financial capital to invest as one of their major barriers in starting a livelihood activity.

Microfinance in Bangladesh can be accessed on an individual basis with credit granting decisions based on assessment of individual assets including financial security, land, livestock etc. For individuals who do not have assets accessing microfinance is challenging. Many microfinance organisations have established innovative approaches to increase access to services including the formation of village groups. The group proves it stability and capacity to manage money through running a group saving scheme for three to six months. After this time a microfinance organisation will extend credit to a limited number of group members, the group rather than the individual remain responsible for ensuring return on credit ie if the individual is unable to return the group will do it for them. Incrementally the microfinance organisation extends credit to other members of the group providing the group remains viable. People with disabilities who do not have access to microfinance on an individual basis face challenges in accessing microfinance through a group approach.

Barriers include:

• Group members not willing to include a member with a disability due to factors such as: stigma, prejudice, lack of awareness of the potential of people with disabilities, not wanting to take on a member who may ‘jeopardise’ the group due to low productivity, being cursed, and inability to return credit…

• A person with a disability may not put themselves forward to join a group due to: fear of stigma and marginalisation from the rest of the community, lack of “soft” skills – communication, leadership, interpersonal skills, lack of access due to physical environment and lack of appropriate assistive


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devices, poor realisation of their own potential, lack of awareness of microfinance as they are not involved in community discussions, information and communication material from microfinance organisation is not accessible…

These barriers can be tackled in various ways, including: developing the capacities of persons with disabilities and their representative organizations to understand microfinance, its potential and constraints; raising awareness and training mainstream microfinance providers to include persons with disabilities in their services, including by implementing reasonable accommodations and making adjustments to their methodologies and products; and supporting the creation/strengthening of linkages, referral services and ongoing monitoring and support between persons with disabilities and microfinance providers.


Mr Ali and his market stall

Mr. Ali, a 20 year old man lives in Leda village in Cox’s bazaar district in the south east of Bangladesh. During an accident at work a heavy land mass fell on him. He lost his sense of feeling and the ability to move his legs; he also lost his job.

The community worker from Handicap International (HI) found Mr Ali lying on his bed alone in his home during a household disability survey in 2008. He had to depend on family members to perform most of his daily living activities i.e. toileting, bathing, dressing and transferring from one place to another. Mr Ali was newly married; he and his wife lived with his extended family. As Mr Ali was no longer able to support himself or his wife or contribute economically to the household he felt he was a burden to the family. His family members were not supportive, they did not extend their care to him and they excluded his wife from family activities and decision making.

HI provided home based rehabilitation to help Mr Ali perform his daily living activities independently, Mr Ali worked hard and progressed quickly. HI also provided him with a wheelchair to increase his mobility around his homestead and community.

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The HI community worker discovered during conversation that Mr. Ali was interested to set up a small stall to sell food and household items. He was unable to start this business as he did not have enough start up capital. Besides, he was worried about the attitude of his neighbours and community. Many people consider disability as a result of sin and Mr Ali though people may not visit him to buy goods.

The HI community worker arranged several court yard session addressing different issues including causes of disability, prevention, potentiality of people with disability and rights in Mr Ali’s neighbourhood. This started the process of challenging misconceptions about disability and people helping people to understand that disability is neither a communicable disease nor a sin.

The community people had a microfinance savings group and they agreed to include Mr Ali. Mr Ali proceeded to receive a microfinance loan which he used to help him to start a small shop in nearby village market. HI worked with the market community and Mr Ali on access issues, they identified a toilet which HI and the market committee worked together to make accessible for Mr Ali to use. Now people come and buy things from his shop, Mr Ali is happy as he contributes economically to the family and he no longer spends his days at home alone.


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Annex One: United Nations Convention on the Rights of Persons with Disabilities (Ratified by the Government of Bangladesh November 2007, enforced as international law 2008)

Key articles

Article 27

Work and employment

1. States Parties recognize the right of persons with disabilities to work, on an equal basis with others; this includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities. States Parties shall safeguard and promote the realization of the right to work, including for those who acquire a disability during the course of employment, by taking appropriate steps, including through legislation, to, inter alia:

(a) Prohibit discrimination on the basis of disability with regard to all matters concerning all forms of employment, including conditions of recruitment, hiring and employment, continuance of employment, career advancement and safe and healthy working conditions;

(b) Protect the rights of persons with disabilities, on an equal basis with others, to just and favourable conditions of work, including equal opportunities and equal remuneration for work of equal value, safe and healthy working conditions, including protection from harassment, and the redress of grievances;

(c) Ensure that persons with disabilities are able to exercise their labour and trade union rights on an equal basis with others;

(d) Enable persons with disabilities to have effective access to general technical and vocational guidance programs, placement services and vocational and continuing training;

(e) Promote employment opportunities and career advancement for persons with disabilities in the labour market, as well as assistance in finding, obtaining, maintaining and returning to employment;

(f) Promote opportunities for self-employment, entrepreneurship, the development of cooperatives and starting one’s own business;

(g) Employ persons with disabilities in the public sector;


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(h) Promote the employment of persons with disabilities in the private sector through appropriate policies and measures, which may include affirmative action programs, incentives and other measures;

(i) Ensure that reasonable accommodation is provided to persons with disabilities in the workplace;

(j) Promote the acquisition by persons with disabilities of work experience in the open labour market;

(k) Promote vocational and professional rehabilitation, job retention and return-to-work programs for persons with disabilities.

2. States Parties shall ensure that persons with disabilities are not held in slavery or in servitude, and are protected, on an equal basis with others, from forced or compulsory labour.

Article 28

Adequate standard of living and social protection

1. States Parties recognize the right of persons with disabilities to an adequate standard of living for themselves and their families, including adequate food, clothing and housing, and to the continuous improvement of living conditions, and shall take appropriate steps to safeguard and promote the realization of this right without discrimination on the basis of disability.

2. States Parties recognize the right of persons with disabilities to social protection and to the enjoyment of that right without discrimination on the basis of disability, and shall take appropriate steps to safeguard and promote the realization of this right, including measures:

(a) To ensure equal access by persons with disabilities to clean water services, and to ensure access to appropriate and affordable services, devices and other assistance for disability-related needs;

(b) To ensure access by persons with disabilities, in particular women and girls with disabilities and older persons with disabilities, to social protection programs and poverty reduction programs;

(c) To ensure access by persons with disabilities and their families living in situations of poverty to assistance from the State with disability related expenses, including adequate training, counselling, financial assistance and respite care;

(d) To ensure access by persons with disabilities to public housing programs;

(e) To ensure equal access by persons with disabilities to retirement benefits and programs.


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Article 32

International cooperation

1. States Parties recognize the importance of international cooperation and its promotion, in support of national efforts for the realization of the purpose and objectives of the present Convention, and will undertake appropriate and effective measures in this regard, between and among States and, as appropriate, in partnership with relevant international and regional organizations and civil society, in particular organizations of persons with disabilities. Such measures could include, inter alia:

(a) Ensuring that international cooperation, including international development programs, is inclusive of and accessible to persons with disabilities;

(b) Facilitating and supporting capacity-building, including through the exchange and sharing of information, experiences, training programs and best practices;

(c) Facilitating cooperation in research and access to scientific and technical knowledge;

(d) Providing, as appropriate, technical and economic assistance, including by facilitating access to and sharing of accessible and assistive technologies, and through the transfer of technologies.

2. The provisions of this article are without prejudice to the obligations of each State Party to fulfil its obligations under the present Convention.


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